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Backup Documents 09/24/2019 Item #16E 9 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP 7 TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT E C E C THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIG A 1 ' Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the Cqutib, AcJtojnt 'n Office at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the Coup tt664} y Office no later than Monday preceding the Board meeting. **NEW** ROUTING SLIP Risk Management Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the exception of the Chairman's signature,draw a line through routing lines#I through#2,complete the checklist,and forward to the County Attomey Office. Route to Addressee(s) (List in routing order) Office Initials Date 1. Risk Risk Management 1/0/4 2. County Attorney Office County Attorney Office 0 ' s/ \o\ tvq 4. BCC Office Board of County Commissioners /S/ \0\ k'Qk 4. Minutes and Records Clerk of Court's Office 1 ?J r Ay. 5. Procurement Services Procurement Services PRIMARY CONTACT INFORMATION Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the addressees above,may need to contact staff for additional or missing information. Name of Primary Staff Ana Reynoso/PURCHASING Contact Information 239-252-8950 Contact/ Department Agenda Date Item was SEPTEMBER 24,2019 ✓ Agenda Item Number 16.E.9. Approved by the BCC Type of Document CONTRACT Number of Original 2 Attached Documents Attached PO number or account N/A 16-6593 Bound Tree t/ number if document is Bound Tree Medical, LLC to be recorded Medical, LLC INSTRUCTIONS & CHECKLIST Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not appropriate. (Initial) Applicable) 1. Does the document require the chairman's original signature STAMP OK N/A 2. Does the document need to be sent to another agency for additional signatures? If yes, N/A provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet. 3. Original document has been signed/initialed for legal sufficiency. (All documents to be AR signed by the Chairman,with the exception of most letters,must be reviewed and signed by the Office of the County Attorney. 4. All handwritten strike-through and revisions have been initialed by the County Attorney's N/A Office and all other parties except the BCC Chairman and the Clerk to the Board 5. The Chairman's signature line date has been entered as the date of BCC approval of the AR document or the final negotiated contract date whichever is applicable. 6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's AR signature and initials are required. 7. In most cases(some contracts are an exception),the original document and this routing slip N/A should be provided to the County Attorney Office at the time the item is input into SIRE. Some documents are time sensitive and require forwarding to Tallahassee within a certain time frame or the BCC's actions are nullified. Be aware of your deadlines! 8. The document was approved by the BCC on 09/24/2019 and all changes made during /A,Mt the meeting have been incorporated in the attached document. The County an op cin for Attorney's Office has reviewed the changes,if applicable. this line. 9. Initials of attorney verifying that the attached document is the version approved by the N/A is not BCC,all changes directed by the BCC have been made,and the document is ready for th• an option for Chairman's signature. this line. 16E9 MEMORANDUM Date: October 3, 2019 To: Ana Reynoso, Procurement Services From: Martha Vergara, Sr. Deputy Clerk Minutes & Records Department Re: Contract #16-6593 "Assumption Agreement" Contractor: Bond Tree Medical, LLC Attached for your records is an original of the referenced document above, (Item #16E9) adopted by the Board of County Commissioners on Tuesday, September 24, 2019. The Board's Minutes & Records Department has kept an original as part of the Board's Official Records. If you have any questions, please feel free to contact me at 252-7240. Thank you. Attachment E BoundTree medical AFFIDAVIT OF SIGNATURE AUTHORITY I, Mark Dougherty, Treasurer and Secretary of Bound Tree Medical,LLC,organized and existing under the laws of Ohio and having its principal place of business at 5000 Tuttle Crossing Boulevard, Dublin, Ohio 43016, hereby authorize Rhiannon Greene,VP of Pricing and Information Systems,to sign contracts and bid agreements for the benefit of Bound Tree Medical, LLC that do not exceed$1,000,000 in value. I certify that as Secretary and Treasurer of Bound Tree Medical, LLC, I have the power to grant signing authority to take the action called for by the foregoing statement. Wie46, Mark D gherty, Sary and T asurer Date Bound Tree Medical,LLC State of Ohio,County of Franklin The foregoing instrument was acknowledged before me this day of I1/O/'1 ,2016. Darrell Hughes,Notary Public My Commission Never Expires - DARRELL A.HUGHES Notary Public,State data NO EXPIRATION DATE �OFO. 16E 9 ASSUMPTION AGREEMENT This Assumption Agreement is made and entered into on thisc 4 of crt , 2019 by and between Bound Tree Medical, LLC ("Vendor") and Collier County, a political subdivision of the State of Florida("County"). WHEREAS, on July 11, 2017 (Agenda Item 16.E.7), the County awarded Invitation to Bid (ITB) #16-6593 "EMS Expendables"to Midwest Medical Supply Company,LLC. d/b/a MMS-A Medical Supply Company, a subsidiary of Concordance Healthcare Solutions, LLC. The award of ITB #16- 6593 is hereinafter referred to as "Agreement" and attached hereto as Exhibit A, together with all addendums and Vendor's proposal; and WHEREAS, Bound Tree Medical, LLC hereby represents and warrants to the County that through an Asset Purchase Agreement entered into with Concordance Healthcare Solutions,LLC, it is the successor in interest in relation to the Agreement; and WHEREAS, the parties wish to formalize Bound Tree Medical, LLC assumption of rights and obligations under the Agreement effective as of the date first above written. NOW THEREFORE, IN CONSIDERATION of the mutual promises in this Assumption Agreement, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged by the parties, it is agreed as follows: 1. Vendor accepts and assumes all rights, duties, benefits, and obligations of the Consultant under the Agreement, including all existing and future obligations to pay and perform under the Agreement. 2. Vendor will promptly deliver to County evidence of insurance consistent with the Agreement. 3. Further supplements to, or modifications of, the Agreement shall be approved in writing by both parties. 4. Notice required under the Agreement to be sent to Vendor shall be directed to: VENDOR: Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd Dublin, OH 43016 Main Phone: (800) 533-0523 Attention: Chris Fyffe Email: Submitbids@boundtree.com 5. The County hereby consents to Bound Tree Medical,LLC assumption of the Agreement in order to continue the services provided under ITB# 16-6593. No waivers of performance or extensions of time to perform are granted or authorized. The County will treat Bound Tree Medical, LLC as the [19-PRC-04030/1492864/1] Page 1 of 2 16E 9 Vendor for all purposes under the Agreement. Except as provided herein, all other terms and conditions of the Agreement remain in full force and effect. IN WITNESS WHEREOF, the undersigned have executed and delivered this Assumption Agreement effective as of the date first above written. Witnesses: Bound Tree Medical,LLC z Witness Signature By: / / / Signature Darrell Hughes Print/Type witness name Rhiannon Greene 1i Print/Type Name Witness Signature Senior Vice President,Pricing Title Christopher Fyffe Print/Type witness name ATTEST: BOARD OF COUNTY Crystal K. Ki e Clerk of Courts COMMISSIONERS & Com- , r...;' or COLLIER C• ��" RIDA .,,.1...A , ., .,. -.,7,. !... ...:. ..,e).. , ill.- AO° MP By: .<<. k 1I■1�►' By: -�� .r. Attest a t9 Chairin '.I ,� C - i ' W,'Liam L. McDaniel Jr., Cha rman signature donly� ••. .,,3 Approve.I:s i1 and legality: I it It 4 MIA 111 A Jeffrey A. '1;tzk County Atto. ey [19-PRC-04030/1492864/1] Page 2 of 2 CA( EXHIBIT A 16E 9 Cater County Administrative Services Department Procurement Services Division INVITATION TO BID Date: 11/30/2016 From: Adam Northrup, Procurement Strategist (239) 252-6098 (Telephone) (239) 252-6302 (FAX) adamnorthrup@colliergov.net (Email) To: Prospective Vendors Subject: Solicitation: 16-6593 — EMS Expendables As requested by the Division of Emergency Medical Services, the Collier County Board of County Commissioners Procurement Services Division has issued this ITB for the purpose of obtaining fair and competitive responses. Please refer to the Public Notice included in this document for the opening date and time and any applicable pre-ITB conference. All questions regarding this ITB must be submitted online on the Collier County Procurement Services Division Online Bidding System website: www.colliergov.net/bid. All responses to questions will be posted on the website with electronic notification to all prospective vendors. We look forward to your participation in Collier County's competitive procurement process. cc: Tony Camps (7) F1i.sim rrrent Serrcr Dotson•3327 Tarrson Trail East•r4aples.Florida 34112-4901•2 .-252$407•uvrw.o llien3ov.netlprocurementsernces #16-6593—EMS Expendables 1 ITB Template_06132016 16E 9 Invitation to Bid Index Public Notice 3 Exhibit I: Scope of Work, Specifications and Response Format 4 Exhibit II: General Bid Instructions 7 Exhibit III: Standard Purchase Order Terms and Conditions 13 Exhibit IV: Additional ITB Terms and Conditions 16 Attachment 1: Vendor Submittal - Vendor's Non-Response Statement 23 Attachment 2: Vendor's Check List 24 Attachment 3: Vendor Submittal - Bid Response Form 25 Attachment 4: Vendor Submittal — Local Vendor Preference Affidavit 27 Attachment 5: Vendor Submittal — Immigration Affidavit 28 Attachment 6: Vendor Substitute W—9 29 Attachment 7: Vendor Submittal - Insurance and Bonding Requirements 30 #16-6593—EMS Expendables 2 ITB Template_06132016 16E 9 Collier County Administrative Services Department Procurement Services Div cion Public Notice Sealed bid responses for Solicitation 16-6593 -EMS Expendables, will be received electronically only at the Collier County Government, Purchasing Department, 3327 Tamiami Trail E, Naples, FL 34112 until 3:00 PM, Collier County local time on January 4th, 2017. Solicitation responses received after the stated time and date will not be accepted. Solicitation 16-6593 - EMS Expendables All questions regarding this ITB must be submitted online on the Collier County Procurement Services Division Online Bidding System website: www.colliergov.net/bid. All responses to questions will be posted on the website with electronic notification to all prospective vendors. All solicitation responses must be made on the official ITB response form included and only available for download from the Collier County Procurement Services Division Online Bidding System website noted herein. ITB Documents obtained from sources other than Collier County Procurement Services Division may not be accurate or current. Collier County encourages vendors to utilize recycled paper on all manual bid response submittals. Collier County does not discriminate based on age, race, color, sex, religion, national origin, disability or marital status. BOARD OF COUNTY COMMISSIONERS COLLIER COUNTY, FLORIDA BY: /s/ Edward F. Coyman Jr. Director, Procurement Services Division Publicly posted on the Collier County Procurement Services Division website: www.colliergov.net/purchasinq and in the lobby of the Procurement Services Division Building on 11/30/2016. #16-6593-EMS Expendables 3 ITB Template_06132016 16E 9 Exhibit I: Scope of Work, Specifications and Response Format As requested by the Collier County Division of Emergency Medical Services, (hereinafter, the "Division or Department"), the Collier County Board of County Commissioners Procurement Services Division (hereinafter, "County") has issued this Invitation to Bid (hereinafter, "ITB") with the intent of obtaining bids from interested and qualified firms in accordance with the terms, conditions and specifications stated or attached. The Vendor, at a minimum, must achieve the requirements of the Scope of Work and specifications stated. The results of this solicitation may be used by other County departments once awarded according to the Board of County Commissioners Procurement Ordinance. Brief Description of Purchase Collier County Government is interested is seeking responses from qualified emergency medical supply companies to purchase expendable medical supplies. The County's Emergency Medical Services (EMS) department is attempting to streamline its order and payment process, reduce expenses, and deliver its products in an efficient manner. Historically, County departments have spent approximately $325,000 annually. Background Collier County Emergency Medical Services (EMS) is committed to bringing compassionate and timely life-saving emergency medical care to the streets, homes, and workplaces, making Collier County a safer and healthier place to live and visit. EMS strives to continuously improve the EMS System with the changing needs of our community in pursuit of pre-hospital emergency medical care excellence. Detailed Scope of Work Interested companies must provide a turnkey order, payment and delivery process for purchases over the Internet and include: 1. Provide and deliver expendable medical supplies. 2. Provide an Internet website with the ability to order products and equipment in a secured and password protected environment. 3. Provide a search engine to find items within the vendor's item catalog. 4. Provide a "shopping cart" feature to capture items that have been selected by EMS personnel (prior to final checkout and payment). 5. Provide detailed order acknowledgement and confirmation including items and quantities ordered, agreed to net pricing per item, extended prices, total order amount. 6. Provide a printable detailed final order confirmation. 7. Provide a secured payment acceptance using a Collier County purchasing card. 8. Provide order email confirmations. 9. If applicable, remove State of Florida sales tax associated with the order. 10. Provide a report with order history of all purchased items available to be downloaded into Microsoft Excel. 11. Provide a clearly identified return policy, including time limits, product restrictions, restocking charges if applicable, length of time for credit to appear, and who pays return shipping 12. Provide a warrranty period for products and proof of conformance to recognized standards #16-6593—EMS Expendables 4 ITB Template_06132016 16E 9 13. Add additional products to the County's Core Item's list at the request of the County's EMS Department. 14. Provide prices on the Excel work sheet labeled Attachment 8: Bid Schedule. Award Criteria ITB award criteria is as follows: • All questions on the Bid document shall be answered as to price(s), time requirements, and required document submissions. • Award shall be based upon the responses to all questions on the Bid Response Page(s). • Further consideration may include but not be limited to, references, completeness of bid response and past performances on other County bids/projects. • Prices will be read in public exactly as input on the electronic bid response form or written on the manually submitted Bid Response Page(s) at the time of the bid opening; however, should an error in calculations occur whenever unit pricing and price extensions are requested, the unit price shall prevail. Mathematical miscalculations may be corrected by the County to reflect the proper response. • The County's Procurement Services Division reserves the right to clarify a vendor's proposal prior to the award of the solicitation. • It is the intent of Collier County to award to the lowest, qualified and responsive vendor(s). • Attachment 8: Bid Schedule shall serve as a representative sample of the type of items the County may purchase, and the quantities listed therein shall be used for the award purpose only. Once an award is made, the County may request to add additional products to the core products list at any time. • For the purposes of determining the bidder with the lowest price for award purposes only the following methodology will be used: The interested bidder will input the requested information into lines 1-235 (Section A). The discounted price provided will be multiplied by the quantity listed to yield a Representative Total for each line. Additionally, provide a percentage discount for the product categories listed in lines 237-261 (Section B). The responsive, responsible bidder with the total for each line shall be awarded. • Collier County reserves the right to select one, or more than one supplier; however, it is the intent to select a primary and secondary for each line item. • The County reserves the right to remove line items from the evaluation of the bid schedule if multiple qualified responsive bidders cannot provide a product. • The County reserves the right to issue a formal contract or standard County Purchase Order for the award of this solicitation. Term of Contract The contract term, if an award(s) is/are made is intended to be for one (3) year(s) with three (2) Two year renewal options. Requests for consideration of a price adjustment shall be made in writing to the Procurement Director. Price adjustments are dependent upon proof of manufacturer increase in supply cost, the consumer price index (CPI) over the past twelve (12) months, budget availability and/or program manager approval. #16-6593—EMS Expendables 5 ITB Template 06132016 16E9 Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. No delivery fees shall be accepted, any such fees should be built into the item price. Projected Timetable Event Date Issue Solicitation Notice 11/30/2016 Last Date for Receipt of Written Questions _ 12/23/2016; 3:00PM Solicitation Deadline Date and Time 1/04/2017; 3:00PM Anticipated Evaluation of Submittals January 2017 Anticipated Board of County Commissioner's Contract February 2017 Approval Date Vendor Required Documents • Attachment 2: Vendor's Check List • Attachment 3: Vendor Bid Response Form • Attachment 4: Local Vendor Preference • Attachment 5: Immigration Law Affidavit • Attachment 6: Vendor Substitute W-9 • Attachment 7: Insurance and Bonding Requirement #16-6593—EMS Expendables 6 ITB Template_06132016 16E9 Exhibit II: General Bid Instructions 1. Purpose/Objective As requested by the Collier County departments or divisions identified in Exhibit 1, the Collier County Board of County Commissioners Procurement Services Division (hereinafter, the County) has issued this Invitation to Bid (hereinafter, the "ITB", or"Bid") with the sole purpose and intent of obtaining bid responses from interested and qualified firms in accordance with the terms, conditions, and specifications stated and/or attached herein/hereto. The successful vendor will hereinafter be referred to as the "Vendor" All bids must be submitted on the Bid form furnished by the County noted in Attachments 2, 3, 4, 5, 6, and 7 of this ITB. No bid will be considered unless the Bid form is properly signed. Vendor is responsible to read and follow the instructions very carefully, as any misinterpretation or failure to comply with these instructions could lead to the bid submitted as being rejected as non-responsive. 2. Pricing Vendors must provide unit prices using the unit of measured specified by the County. All prices will remain firm for a period of one hundred and eighty (180) calendar days from date of bid opening. After award by the Board of County Commissioners, prices may only be adjusted as outlined in Exhibit I: Term of Contract. 3. Alternate Bid Pricing In the event that alternate pricing is requested, it is an expressed requirement of the bid to provide pricing for all alternates as listed. The omission of a response or a no-bid or lack of a submitted price will be the basis for the rejection of the submitted bid response. All bids responses received without pricing for all alternates as listed will be considered technically non-responsive and will not be considered for award. 4. Equal Product Manufacturer's name, brand name and/or model number are used in these specifications for the purpose of establishing minimum requirements of level of quality, standards of performance and/or design required, and is in no way intended to prohibit the bidding of other manufacturer's items of equal or similar material. An equal or similar product may be bid, provided that the product is found to be equal or similar in quality, standard of performance, design, etc. to the item specified. Where an equal or similar is bid, the Bid must be accompanied with two (2) complete sets of factory information sheets (specifications, brochures, etc.) and test results, if applicable, of unit bid as equal or similar. Equal product samples, if required for evaluation, and at no cost to the County, must be submitted with Bid. Unless otherwise directed in the solicitation, the bid will not be considered unless samples are delivered to specified address by bid due date. The County shall be sole judge of equality or similarity, and its decision shall be final in the best interest. #16-6593—EMS Expendables 7 ITB Template_06132016 16E9 5. Discounts Any discounts or terms must be shown on the Bid form. Such discounts, if any, may be considered in the award of tie bids. In no instance should payment terms less than fifteen (15) calendar days be offered. 6. Exceptions Vendors taking exception to any part or section of these specifications shall indicate such exceptions on a separate sheet entitled "EXCEPTIONS TO SPECIFICATIONS." Failure to indicate any exceptions to the specifications shall be interpreted as the Vendors intent to fully comply with the specifications as written. The County, at its sole discretion, shall determine if the exceptions are material in nature, and if the Vendor's exceptions may be declared grounds for rejection of bid proposal. 7. Addenda The County reserves the right to formally amend and/or clarify the requirements of the bid specifications where it deems necessary. Any such addendum/clarification shall be in writing and shall be distributed electronically to all parties who received the original bid specifications prior to the deadline for submission of Bids. All changes to this ITB will be conveyed electronically through a notice of addendum or questions and answers to all vendors registered under the applicable commodity code(s) at the time when the original ITB was released, as well as those vendors who downloaded the ITB document. Additionally, all addendums are posted on the Collier County Procurement Services Division Online Bidding System website: www.colliergov.net/bid. Before submitting a bid response, please make sure that you have read all, understood clearly and complied completely with any changes stated in the addenda as failure to do so may result in the rejection of your submittal. 8. Bid Submission All electronic bids shall be submitted online via the Collier County Procurement Services Division Online Bidding System: www.colliergov.net/bid. All paper bids shall be submitted to the County Procurement Director, Collier County Government, Procurement Services Division, 3327 Tamiami Trail E, Naples, FL 34112, by the date and time as stated in the Legal Notice. The County assumes no responsibility for bid responses received after the due date and time, or at any office or location other than that specified herein, whether due to mail delays, courier mistakes, mishandling, inclement weather or any other reason. Late bid responses shall be returned unopened, and shall not be considered for award. Vendors must submit one (1) paper copy clearly labeled "Master," and two (2) compact disks (CD's) with one copy of the proposal on each CD in Word, Excel or PDF. List the Solicitation Number and Title on the outside of the box or envelope. All bids sent by courier service must have the bid number and title on the outside of the courier packet. Vendors who wish to receive copies of bids after the bid opening may view and download same from the Collier County Procurement Services Division Internet bid site. 9. Questions If the vendor should be of the opinion that the meaning of any part of the Bid Document is doubtful, obscure or contains errors or omissions it should report such opinion to the Procurement Strategist before the bid opening date. Direct questions related to this ITB only to the Collier #16-6593—EMS Expendables 8 ITB Template_06132016 16E 9 County Procurement Services Division Internet website: www.colliergov.net/bid. Questions will not be answered after the date noted on the ITB. Vendors must clearly understand that the only official answer or position of the County will be the one stated on the Collier County Procurement Services Division Online Bidding System website. For general questions, please call the referenced Procurement Strategist identified in the Public Notice. 10. Protests Any prospective vendor/ proposer who desires to protest any aspect(s) or provision(s) of the solicitation (including the form of the solicitation documents or procedures) shall file their protest with the Procurement Director prior to the time of the bid opening strictly in accordance with the County's then current Procurement Ordinance and policies. 11. Rejection and Waiver The County reserves the right to reject any and all bids, to waive defects in the form of bid, also to select the bid that best meets the requirements of the County. Vendors whose bids, past performance or current status do not reflect the capability, integrity or reliability to fully and in good faith perform the requirements denoted may be rejected as non- responsive. Bids that do not meet all necessary requirements of this solicitation or fail to provide all required information, documents or materials may be rejected as non-responsive. 12. Local Vendor Preference (LVP) The County is using the Competitive Sealed Quotation methodology of source selection for this procurement, as authorized by Ordinance Number 2013-69 establishing and adopting the Collier County Procurement Ordinance. Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector for at least one year prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor's staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year. Under this solicitation, bidders desiring to receive local preference will be invited and required to affirmatively state and provide documentation as set forth in the solicitation in support of their status as a local business. Any bidder who fails to submit sufficient documentation with their bid offer shall not be granted local preference consideration for the purposes of that specific contract award. Except where federal or state law, or any other funding source, mandates to the #16-6593—EMS Expendables 9 ITB Template_06132016 16E9 contrary, Collier County and its agencies and instrumentalities, will give preference to local businesses in the following manner. Competitive bid (local price match option). Each formal competitive bid solicitation shall clearly identify how the price order of the bids received will be evaluated and determined. When a qualified and responsive, non-local business submits the lowest price bid, and the bid submitted by one or more qualified and responsive local businesses is within ten percent of the price submitted by the non-local business, then the local business with the apparent lowest bid offer (i.e., the lowest local bidder) shall have the opportunity to submit an offer to match the price(s), less one (1) dollar, offered by the overall lowest, qualified and responsive bidder. In such instances, staff shall first verify if the lowest non-local bidder and the lowest local bidder are in fact qualified and responsive bidders. Next, the Procurement Services Division shall determine if the lowest local bidder meets the requirements of Fla. Stat. Sec.287.087 (Preferences to businesses with drug-free workplace programs). If the lowest local bidder meets the requirements of Fla. Stat. Sec. 287.087, the Procurement Services Division shall invite the lowest local bidder to submit a matching offer, less one (1) dollar, within five (5) business days thereafter. If the lowest local bidder submits an offer that fully matches the lowest bid, less one (1) dollar, from the lowest non-local bidder tendered previously, then award shall be made to the local bidder. If the lowest local bidder declines or is unable to match the lowest non-local bid price(s), then award will be made to the lowest overall qualified and responsive bidder. If the lowest local bidder does not meet the requirement of Fla. Stat. Sec 287.087, and the lowest non-local bidder does, award will be made to the bidder that meets the requirements of the reference state law. Bidder must complete and submit with their bid response the Affidavit for Claiming Status as a Local Business which is included as part of this solicitation. Failure on the part of a Bidder to submit this Affidavit with their bid response will preclude said Bidder from being considered for local preference on this solicitation. A Bidder who misrepresents the Local Preference status of its firm in a bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one (1) year. The County may, as it deems necessary, conduct discussions with responsible bidders determined to be in contention for being selected for award for the purpose of clarification to assure full understanding of, and responsiveness to solicitation requirements. 13. Immigration Affidavit Certification Statutes and executive orders require employers to abide by the immigration laws of the United States and to employ only individuals who are eligible to work in the United States. The Employment Eligibility Verification System (E-Verify) operated by the Department of Homeland Security (DHS) in partnership with the Social Security Administration (SSA), provides an Internet-based means of verifying employment eligibility of workers in the United States; it is not a substitute for any other employment eligibility verification requirements. The program will be used for Collier County formal Invitations to Bid (ITB) and Request for Proposals (RFP) including professional services and construction services. Exceptions to the program: • Commodity based procurement where no services are provided. • Where the requirement for the affidavit is waived by the Board of County Commissioners #16-6593—EMS Expendables 10 ITB Template_06132016 16E 9 Vendors/ Bidders are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the vendor's/bidder's proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Vendors are also required to provide the Collier County Procurement Services Division an executed affidavit certifying they shall comply with the E-Verify Program. The affidavit is attached to the solicitation documents. If the Bidder/Vendor does not comply with providing both the acceptable E- Verify evidence and the executed affidavit the bidder's /vendor's proposal may be deemed non-responsive. Additionally, vendors shall require all subcontracted vendors to use the E-Verify system for all purchases not covered under the "Exceptions to the program" clause above. For additional information regarding the Employment Eligibility Verification System (E-Verify) program visit the following website: http://www.dhs.gov/E-Verify. It shall be the vendor's responsibility to familiarize themselves with all rules and regulations governing this program. Vendor acknowledges, and without exception or stipulation, any firm(s) receiving an award shall be fully responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 as located at 8 U.S.C. 1324, et seq. and regulations relating thereto, as either may be amended and with the provisions contained within this affidavit. Failure by the awarded firm(s) to comply with the laws referenced herein or the provisions of this affidavit shall constitute a breach of the award agreement and the County shall have the discretion to unilaterally terminate said agreement immediately. 14. Lobbying All firms are hereby placed on NOTICE that the County Commission does not wish to be lobbied either individually or collectively about a project for which a firm has submitted a bid. Firms and their agents are not to contact members of the County Commission for such purposes as meetings of introduction, luncheons, dinners, etc. During the bidding process, from bid opening to final Board approval, no firm or its agent shall contact any other employee of Collier County with the exception of the Procurement Services Division. 15. Certificate of Authority to Conduct Business in the State of Florida (Florida Statute 607.1501) In order to be considered for award, firms must be registered with the Florida Department of State Divisions of Corporations in accordance with the requirements of Florida Statute 607.1501 and provide a certificate of authority (www.sunbiz.orq/search.html) prior to execution of a contract. A copy of the document may be submitted with the solicitation response and the document number shall be identified. Firms who do not provide the certificate of authority at the time of response shall be required to provide same within five (5) days upon notification of selection for award. If the firm cannot provide the document within the referenced timeframe, the County reserves the right to award to another firm. 16. General Information When it is deemed by the County that a bid cannot be awarded as originally intended, the County reserves the right to award this bid through an approach which is the best interest of the County. #16-6593—EMS Expendables 11 ITB Template_06132016 16F9 Alternate bids will not be considered unless authorized by the ITB. In case of identical bids tying as low bid, the County shall ask vendors to submit certification that they have a drug-free workplace in accordance with Section 287.087 Florida Statutes. Should all vendors provide said certification; the County will give local vendor preference. 17. Bid Award Process Award of contract will be made by the Board of County Commissioners in public session. Award shall be made in a manner consistent with the County's Procurement Ordinance. Award recommendations will be posted outside the offices of the Procurement Services Division as well as on the Collier County Procurement Services Division website on Wednesdays and Thursdays prior to the County Commission meetings. Any actual or prospective respondent who desires to formally protest the recommended contract award must file a notice of intent to protest with the Procurement Director within two (2) calendar days (excluding weekends and County holidays) of the date that the recommended award is posted. Upon filing of said notice, the protesting party will have five (5) days to file a formal protest and will be given instructions as to the form and content requirements of the formal protest. A copy of the "Protest Policy" is available at the office of the Procurement Director. #16-6593—EMS Expendables 12 ITB Template_06132016 16E9 Exhibit III: Standard Purchase Order Terms and Conditions 1. Offer delivery; provided that risk of loss prior to This offer is subject to cancellation by the actual receipt of the goods by the COUNTY COUNTY without notice if not accepted by nonetheless remain with VENDOR. VENDOR within fourteen (14) days of issuance. b) No charges will be paid by the COUNTY for packing, crating or cartage unless otherwise 2. Acceptance and Confirmation specifically stated in this Purchase Order. This Purchase Order (including all documents Unless otherwise provided in Purchase attached to or referenced therein) constitutes Order, no invoices shall be issued nor the entire agreement between the parties, unless payments made prior to delivery. Unless otherwise specifically noted by the COUNTY on freight and other charges are itemized, any the face of this Purchase Order. Each delivery of discount will be taken on the full amount of goods and/or services received by the COUNTY invoice. from VENDOR shall be deemed to be upon the c) All shipments of goods scheduled on the terms and conditions contained in this Purchase same day via the same route must be Order. consolidated. Each shipping container must be consecutively numbered and marked to No additional terms may be added and Purchase show this Purchase Order number. The Order may not be changed except by written container and Purchase Order numbers must instrument executed by the COUNTY. VENDOR be indicated on bill of lading. Packing slips is deemed to be on notice that the COUNTY must show Purchase Order number and objects to any additional or different terms and must be included on each package of less conditions contained in any acknowledgment, than container load (LCL) shipments and/or invoice or other communication from VENDOR, with each car load of equipment. The notwithstanding the COUNTY'S acceptance or COUNTY reserves the right to refuse or payment for any delivery of goods and/or return any shipment or equipment at services, or any similar act by VENDOR. VENDOR'S expense that is not marked with Purchase Order numbers. VENDOR agrees 3. Inspection to declare to the carrier the value of any All goods and/or services delivered hereunder shipment made under this Purchase Order shall be received subject to the COUNTY'S and the full invoice value of such shipment. inspection and approval and payment therefore d) All invoices must contain the Purchase Order shall not constitute acceptance. All payments are number and any other specific information as subject to adjustment for shortage or rejection. identified on the Purchase Order. Discounts All defective or nonconforming goods will be of prompt payment will be computed from the returned pursuant to VENDOR'S instruction at date of receipt of goods or from date of VENDOR'S expense. receipt of invoices, whichever is later. Payment will be made upon receipt of a To the extent that a purchase order requires a proper invoice and in compliance with series of performances by VENDOR, the Chapter 218, Fla. Stats., otherwise known as COUNTY prospectively reserves the right to the "Local Government Prompt Payment cancel the entire remainder of the Purchase Act," and, pursuant to the Board of County Order if goods and/or services provided early in Commissioners Purchasing Policy. the term of the Purchase Order are non-conforming or otherwise rejected by the 5. Time Is Of the Essence COUNTY. Time for delivery of goods or performance of services under this Purchase Order is of the 4. Shipping and Invoices essence. Failure of VENDOR to meet delivery a) All goods are FOB destination and must be schedules or deliver within a reasonable time, as suitably packed and prepared to secure the interpreted by the COUNTY in its sole judgment, lowest transportation rates and to comply shall entitle the COUNTY to seek all remedies with all carrier regulations. Risk of loss of available to it at law or in equity. VENDOR any goods sold hereunder shall transfer to agrees to reimburse the COUNTY for any the COUNTY at the time and place of expenses incurred in enforcing its rights. #16-6593—EMS Expendables 13 ITB Template_06132016 16E9 VENDOR further agrees that undiscovered VENDOR shall indemnify and hold harmless the delivery of nonconforming goods and/or services COUNTY from any and all claims, including is not a waiver of the COUNTY'S right to insist claims of negligence, costs and expenses, upon further compliance with all specifications. including but not limited to attorneys'fees, arising from, caused by or related to the injury or death 6. Changes of any person (including but not limited to The COUNTY may at any time and by written employees and agents of VENDOR in the notice make changes to drawings and performance of their duties or otherwise), or specifications, shipping instructions, quantities damage to property (including property of the and delivery schedules within the general scope COUNTY or other persons), which arise out of or of this Purchase Order. Should any such change are incident to the goods and/or services to be increase or decrease the cost of, or the time provided hereunder. required for performance of the Purchase Order, an equitable adjustment in the price and/or 11. Warranty of Non-Infringement delivery schedule will be negotiated by the VENDOR represents and warrants that all goods COUNTY and VENDOR. Notwithstanding the sold or services performed under this Purchase foregoing, VENDOR has an affirmative obligation Order are: a) in compliance with applicable laws; to give notice if the changes will decrease costs. b) do not infringe any patent, trademark, Any claims for adjustment by VENDOR must be copyright or trade secret; and c) do not constitute made within thirty (30) days from the date the unfair competition. change is ordered or within such additional period of time as may be agreed upon by the VENDOR shall indemnify and hold harmless the parties. COUNTY from and against any and all claims, including claims of negligence, costs and 7. Warranties expense, including but not limited to attorneys' VENDOR expressly warrants that the goods fees, which arise from any claim, suit or and/or services covered by this Purchase Order proceeding alleging that the COUNTY'S use of will conform to the specifications, drawings, the goods and/or services provided under this samples or other descriptions furnished or Purchase Order are inconsistent with VENDOR'S specified by the COUNTY, and will be of representations and warranties in section 11 (a). satisfactory material and quality production, free from defects and sufficient for the purpose If any claim which arises from VENDOR'S breach intended. Goods shall be delivered free from any of section 11 (a) has occurred, or is likely to security interest or other lien, encumbrance or occur, VENDOR may, at the COUNTY'S option, claim of any third party. These warranties shall procure for the COUNTY the right to continue survive inspection, acceptance, passage of title using the goods or services, or replace or modify and payment by the COUNTY. the goods or services so that they become non-infringing, (without any material degradation 8. Statutory Conformity in performance, quality, functionality or additional Goods and services provided pursuant to this cost to the COUNTY). Purchase Order, and their production and transportation shall conform to all applicable 12. Insurance Requirements laws, including but not limited to the Occupational The VENDOR, at its sole expense, shall provide Health and Safety Act, the Federal commercial insurance of such type and with such Transportation Act and the Fair Labor Standards terms and limits as may be reasonably Act, as well as any law or regulation noted on the associated with the Purchase Order. Providing face of the Purchase Order. and maintaining adequate insurance coverage is a material obligation of the VENDOR. All 9. Advertising insurance policies shall be executed through No VENDOR providing goods and services to the insurers authorized or eligible to write policies in COUNTY shall advertise the fact that it has the State of Florida. contracted with the COUNTY for goods and/or services, or appropriate or make use of the 13. Compliance with Laws COUNTY'S name or other identifying marks or In fulfilling the terms of this Purchase Order, property without the prior written consent of the VENDOR agrees that it will comply with all COUNTY'S Purchasing Department. federal, state, and local laws, rules, codes, and ordinances that are applicable to the conduct of its business. By way of non-exhaustive example, 10. Indemnification this shall include the American with Disabilities Act and all prohibitions against discrimination on #16-6593—EMS Expendables 14 ITB Template 06132016 16E 9 the basis of race, religion, sex creed, national conditions of this Purchase Order, provided that origin, handicap, marital status, or veterans' COUNTY has provided VENDOR with notice of status. Further, VENDOR acknowledges and such breach and VENDOR has failed to cure without exception or stipulation shall be fully within 10 days of receipt of such notice. responsible for complying with the provisions of the Immigration Reform and Control Act of 1986 19. General as located at 8 U.S.C. 1324, et seq. and a) This Purchase Order shall be governed by regulations relating thereto, as either may be the laws of the State of Florida. The venue amended. Failure by the awarded firm(s) to for any action brought to specifically enforce comply with the laws referenced herein shall any of the terms and conditions of this constitute a breach of the award agreement and Purchase Order shall be the Twentieth the County shall have the discretion to Judicial Circuit in and for Collier County, unilaterally terminate said agreement Florida immediately. Any breach of this provision may b) Failure of the COUNTY to act immediately in be regarded by the COUNTY as a material and response to a breach of this Purchase Order substantial breach of the contract arising from by VENDOR shall not constitute a waiver of this Purchase Order. breach. Waiver of the COUNTY by any default by VENDOR hereunder shall not be 14. Force Majeure deemed a waiver of any subsequent default Neither the COUNTY nor VENDOR shall be by VENDOR. responsible for any delay or failure in c) All notices under this Purchase Order shall performance resulting from any cause beyond be sent to the respective addresses on the their control, including, but without limitation to face page by certified mail, return receipt war, strikes, civil disturbances and acts of nature. requested, by overnight courier service, or by When VENDOR has knowledge of any actual or personal delivery and will be deemed potential force majeure or other conditions which effective upon receipt. Postage, delivery and will delay or threatens to delay timely other charges shall be paid by the sender. A performance of this Purchase Order, VENDOR party may change its address for notice by shall immediately give notice thereof, including all written notice complying with the relevant information with respects to what steps requirements of this section. VENDOR is taking to complete delivery of the d) The Vendor agrees to reimbursement of any goods and/or services to the COUNTY. travel expenses that may be associated with this Purchase Order in accordance with 15. Assignment Florida Statute Chapter 112.061, Per Diem VENDOR may not assign this Purchase Order, and Travel Expenses for Public Officers, nor any money due or to become due without the employees and authorized persons. prior written consent of the COUNTY. Any e) In the event of any conflict between or assignment made without such consent shall be among the terms of any Contract Documents deemed void, related to this Purchase Order, the terms of the Contract Documents shall take 16. Taxes precedence over the terms of the Purchase Goods and services procured subject to this Order. To the extent any terms and /or Purchase Order are exempt from Florida sales conditions of this Purchase Order duplicate and use tax on real property, transient rental or overlap the Terms and Conditions of the property rented, tangible personal purchased or Contract Documents, the provisions of the rented, or services purchased (Florida Statutes, Terms and/or Conditions that are most Chapter 212), and from federal excise tax. favorable to the County and/or provide the greatest protection to the County shall 17. Annual Appropriations govern. The COUNTY'S performance and obligation to pay under this Purchase Order shall be contingent upon an annual appropriation of funds. 18. Termination This Purchase Order may be terminated at any time by the COUNTY upon 30 days prior written notice to the VENDOR. This Purchase Order may be terminated immediately by the COUNTY for breach by VENDOR of the terms and #16-6593—EMS Expendables 15 ITB Template__06132016 16E9 Exhibit IV: Additional ITB Terms and Conditions 1. Additional Items and/or Services During the contract term, Collier County reserves the right to add related items and/or services upon negotiation of a satisfactory price by the Project Manager and Vendor. 2. Conflict of Interest Vendor shall provide a list of any businesses and/or organizations to which the firm has any affiliation or obligations within the past five (5) years; whether paid or donated, which could be construed by the County as a conflict of interest. Disclosure of any potential or actual conflict of interest is subject to County staff review and does not in and of itself disqualify a firm from consideration. These disclosures are intended to identify and or preclude conflict of interest situations during contract selection and execution. 3. Vendor Performance Evaluation Collier County has implemented a Vendor Performance Evaluation System for all contracts awarded in excess of$25,000. To this end, vendors will be evaluated on their performance upon completion/termination of agreement. 4. Deductions for Non-Performance The County reserves the right to deduct a portion of any invoice for goods not delivered, or services not performed in accordance with requirements, including required timeframe. The County may also deduct, or chargeback the Vendor the costs necessary to correct the deficiencies directly related to the Vendor's non-performance. 5. Termination Should the Contractor be found to have failed to perform services in a manner satisfactory to the County, the County may terminate this Agreement immediately for cause; further the County may terminate this Agreement for convenience with a thirty (30) day written notice. The County shall be sole judge of non-performance. In the event that the award of this solicitation is made by the Procurement Services Director, the award and any resultant purchase orders may be terminated at any time by the County upon thirty (30) days written notice to the awarded vendor(s) pursuant to the Board's Procurement Ordinance. 6. Offer Extended to Other Governmental Entities Collier County encourages and agrees to the successful vendor extending the pricing, terms and conditions of this solicitation or resultant contract to other governmental entities at the discretion of the successful vendor. 7. Environmental Health and Safety All Vendors and Sub vendors performing service for Collier County are required and shall comply with all Occupational Safety and Health Administration (OSHA), State and County Safety and Occupational Health Standards and any other applicable rules and regulations. Vendors and Sub vendors shall be responsible for the safety of their employees and any unsafe acts or conditions that may cause injury or damage to any persons or property within and around the work site. All firewall penetrations must be protected in order to meet Fire Codes. #16-6593—EMS Expendables 16 ITB Template_06132016 16E 9 Collier County Government has authorized OSHA representatives to enter any Collier County facility, property and/or right-of-way for the purpose of inspection of any Vendor's work operations. This provision is non-negotiable by any department and/or Vendor. All new electrical installations shall incorporate NFPA 70E Short Circuit Protective Device Coordination and Arc Flash Studies where relevant as determined by the engineer. All electrical installations shall be labeled with appropriate NFPA 70E arch flash boundary and PPE Protective labels. 8. Florida Wood Products The Vendor/Contractor agrees to comply with Florida Statute 255.20 to provide lumber, timber and other forest products produced and manufactured in the State of Florida as long as the price, fitness and quality are equal. 9. Public Records Compliance Florida Public Records Law Chapter 119, including specifically those contractual requirements in 119.0701(2)(a)-(b) as follows: IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF PUBLIC RECORDS AT: Communication and Customer Relations Division 3299 Tamiami Trail East, Suite 102 Naples, FL 34112-5746 Telephone: (239) 252-8383 The Contractor must specifically comply with the Florida Public Records Law to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the Contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the Contractor or keep and maintain public records required by the public agency to perform the service. If the Contractor transfers all public records to the public agency upon completion of the contract, the Contractor shall destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the Contractor keeps and maintains public records upon completion of the contract, the Contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. 10. Standards of Conduct The Vendor shall employ people to work on County projects who are neat, clean, well-groomed and courteous. Subject to the American with Disabilities Act, Vendor shall supply competent employees who are physically capable of performing their employment duties. The County may require the Vendor to remove an employee it deems careless, incompetent, insubordinate or #16-6593—EMS Expendables 17 ITB Template_06132016 16E9 otherwise objectionable and whose continued employment on Collier County projects is not in the best interest of the County. '11. Licenses The Vendor is required to possess the correct professional and other licenses, and any other authorizations necessary to perform the required work pursuant to all applicable Federal, State and Local Law, Statute, Ordinances, and rules and regulations of any kind. Additionally, copies of all the required licenses must be submitted with the bid response indicating that the entity bidding, as well as the team assigned to the County account, is properly licensed to perform the activities or work included in the ITB documents. Failure on the part of any vendor to supply this documentation with their bid response may be grounds for deeming vendor non-responsive. A Vendor with an office within Collier County is required to have an occupational license. All State Certified contractors who may need to pull Collier County permits or call in inspections must complete a Collier County Contractor License registration form and submit the required fee. After registering the license/registration will need to be renewed thereafter to remain "active" in Collier County. Questions regarding professional licenses should be directed to Contractor Licensing, Community Development and Environmental Services at (239) 252-2431, 252-2432 or 252-2909. Questions regarding required Business Tax Receipt (formerly known as Occupational Licenses) should be directed to the Tax Collector's Office at (239) 252-2477. 12. Protection of Property The Vendor shall ensure that the service is performed in such manner as to not damage any property. In the event damage occurs to any property as a direct result of the Vendor or their Sub vendor in the performance of the required service, the Vendor shall repair/replace, to the County's satisfaction, damaged property at no additional cost to the County. If the damage caused by the Vendor or their Sub vendor has to be repaired/replaced by the County, the cost of such work will be deducted from the monies due the Vendor. The County's project manager, shall coordinate with the Vendor/ Contractor the return of any surplus assets, including materials, supplies, and equipment associated with the scope or work. 13. Prohibition of Gifts to County Employees No organization or individual shall offer or give, either directly or indirectly, any favor, gift, loan, fee, service or other item of value to any County employee, as set forth in Chapter 112, Part III, Florida Statutes, the current Collier County Ethics Ordinance and County Administrative Procedure 5311. Violation of this provision may result in one or more of the following consequences: a. Prohibition by the individual, firm, and/or any employee of the firm from contact with County staff for a specified period of time; b. Prohibition by the individual and/or firm from doing business with the County for a specified period of time, including but not limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of any contract held by the individual and/or firm for cause. 14. Invoice and Payments The County's project manager reserves the right to establish any one, or a combination of, these industry practices for contracts or purchase orders: Lump Sum (Fixed Price): a firm fixed total price offering for a project; the risks are transferred from the County to the contractor; and, as a business practice there are no hourly or material #16-6593—EMS Expendables 18 ITB Template_06132016 16E 9 invoices presented, rather, the contractor must perform to the satisfaction of the County's project manager before payment for the fixed price contract is authorized. Time and Materials: the County agrees to pay the contractor for the amount of labor time spent by the contractor's employees and subcontractors to perform the work (number of hours times hourly rate), and for materials and equipment used in the project (cost of materials plus the contractor's mark up). This methodology is generally used in projects in which it is not possible to accurately estimate the size of the project, or when it is expected that the project requirements would most likely change. As a general business practice, these contracts include back-up documentation of costs; invoices would include number of hours worked and billing rate by position (and not company (or subcontractor) timekeeping or payroll records), material or equipment invoices, and other reimbursable documentation for the project. Unit Price: the County agrees to pay a firm total fixed price (inclusive of all costs, including labor, materials, equipment, overhead, etc.) for a repetitive product or service delivered (i.e. installation price per ton, delivery price per package or carton, etc.). The invoice must identify the unit price and the number of units received (no contractor inventory or cost verification required). Payments are made in accordance with the Local Government Prompt Payment Act, Chapter 218, Florida Statutes. Vendor's invoices must include: • Purchase Order Number • Description and quantities of the goods or services provided per instructions on the County's purchase order or contract. Invoices shall be sent to: Board of County Commissioners Clerk's Finance Department ATTN: Accounts Payable 3299 Tamiami Trail E Ste 700 Naples FL 34112 Or emailed to: bccapclerkcollierclerk.com. Collier County, in its sole discretion, will determine the method of payment for goods and/or services as part of this agreement. Payment methods include: • Traditional — payment by check, wire transfer or other cash equivalent. • Standard — payment by purchasing card. Collier County's Purchasing Card Program is supported by standard bank credit suppliers (i.e. VISA and MasterCard), and as such, is cognizant of the Rules for VISA Merchants and MasterCard Merchant Rules. The County may not accept any additional surcharges (credit card transaction fees) as a result of using the County's credit card for transactions relating to this solicitation. The County will entertain bids clearly stating pricing for standard payment methods. An additional separate discounted price for traditional payments may be provided at the initial bid submittal if it is clearly marked as an "Additional Cash Discount." Upon execution of the Contract and completion of each month's work, payment requests may be submitted to the Project Manager on a monthly basis by the Contractor for services rendered for that prior month. Services beyond sixty (60) days from current monthly invoice will not be considered for payment without prior approval from the Project manager. All invoices should be submitted within the fiscal year the work was performed. (County's fiscal year is October 1 - #16-6593—EMS Expendables 19 ITB Template_06132016 16E 9 September 30.) Invoices submitted after the close of the fiscal year will not be accepted (or processed for payment) unless specifically authorized by the Project Manager. Payments will be made for articles and/or services furnished, delivered, and accepted, upon receipt and approval of invoices submitted on the date of services or within six (6) months after completion of contract. Any untimely submission of invoices beyond the specified deadline period is subject to non-payment under the legal doctrine of"laches" as untimely submitted. Time shall be deemed of the essence with respect to the timely submission of invoices under this agreement. In instances where the successful contractor may owe debts (including, but not limited to taxes or other fees) to Collier County and the contractor has not satisfied nor made arrangement to satisfy these debts, the County reserves the right to off-set the amount owed to the County by applying the amount owed to the vendor or contractor for services performed of for materials delivered in association with a contract. Invoices shall not reflect sales tax. After review and approval, the invoice will be transmitted to the Finance Division for payment. Payment will be made upon receipt of proper invoice and in compliance with Chapter 218 Florida Statutes, otherwise known as the "Local Government Prompt Payment Act." Collier County reserves the right to withhold and/or reduce an appropriate amount of any payment for work not performed or for unsatisfactory performance of Contractual requirements. 15. Survivability Bids (ITBs/RFPs): The Consultant/Contractor/Vendor agrees that any Work Order/Purchase Order that extends beyond the expiration date of Solicitation 16-6593 resultant of this solicitation will survive and remain subject to the terms and conditions of that Agreement until the completion or termination of any Work Order/Purchase Order. 16. Insurance Requirements The Vendor shall at its own expense, carry and maintain insurance coverage from responsible companies duly authorized to do business in the State of Florida as set forth in Insurance and Bonding Requirements Attachment of this solicitation. The Vendor shall procure and maintain property insurance upon the entire project, if required, to the full insurable value of the scope of work. The County and the Vendor waive against each other and the County's separate Vendors, Contractors, Design Consultant, Subcontractors agents and employees of each and all of them, all damages covered by property insurance provided herein, except such rights as they may have to the proceeds of such insurance. The Vendor and County shall, where appropriate, require similar waivers of subrogation from the County's separate Vendors, Design Consultants and Subcontractors and shall require each of them to include similar waivers in their contracts. Collier County shall be responsible for purchasing and maintaining, its own liability insurance. Certificates issued as a result of the award of this solicitation must identify "For any and all work performed on behalf of Collier County." The General Liability Policy provided by Vendor to meet the requirements of this solicitation shall name Collier County, Florida, as an additional insured as to the operations of Vendor under this solicitation and shall contain a severability of interests provisions. Collier County Board of County Commissioners shall be named as the Certificate Holder. The "Certificate Holder" should read as follows: #16-6593—EMS Expendables 20 ITB Template_06132016 16E9 Collier County Board of County Commissioners Naples, Florida The amounts and types of insurance coverage shall conform to the minimum requirements set forth in the Insurance and Bonding Requirements Attachment, with the use of Insurance Services Office (ISO)forms and endorsements or their equivalents. If Vendor has any self-insured retentions or deductibles under any of the below listed minimum required coverage, Vendor must identify on the Certificate of Insurance the nature and amount of such self- insured retentions or deductibles and provide satisfactory evidence of financial responsibility for such obligations. All self-insured retentions or deductibles will be Vendor's sole responsibility. Coverage(s) shall be maintained without interruption from the date of commencement of the Work until the date of completion and acceptance of the scope of work by the County or as specified in this solicitation, whichever is longer. The Vendor and/or its insurance carrier shall provide 30 days written notice to the County of policy cancellation or non-renewal on the part of the insurance carrier or the Vendor. The Vendor shall also notify the County, in a like manner, within twenty-four (24) hours after receipt, of any notices of expiration, cancellation, non-renewal or material change in coverage or limits received by Vendor from its insurer and nothing contained herein shall relieve Vendor of this requirement to provide notice. In the event of a reduction in the aggregate limit of any policy to be provided by Vendor hereunder, Vendor shall immediately take steps to have the aggregate limit reinstated to the full extent permitted under such policy. Should at any time the Vendor not maintain the insurance coverage(s) required herein, the County may terminate the Agreement or at its sole discretion shall be authorized to purchase such coverage(s) and charge the Vendor for such coverage(s) purchased. If Vendor fails to reimburse the County for such costs within thirty (30) days after demand, the County has the right to offset these costs from any amount due Vendor under this Agreement or any other agreement between the County and Vendor. The County shall be under no obligation to purchase such insurance, nor shall it be responsible for the coverage(s) purchased or the insurance company or companies used. The decision of the County to purchase such insurance coverage(s) shall in no way be construed to be a waiver of any of its rights under the Contract Documents. If the initial or any subsequently issued Certificate of Insurance expires prior to the completion of the scope of work, the Vendor shall furnish to the County renewal or replacement Certificate(s) of Insurance not later than ten (10) calendar days after the expiration date on the certificate. Failure of the Vendor to provide the County with such renewal certificate(s) shall be considered justification for the County to terminate any and all contracts. 15. Debris Vendor shall be responsible for the removal and disposal of all debris from the site and the cleaning of the affected areas. Vendor shall keep the premises free of debris and unusable materials resulting from their work and as work progresses; or upon the request of the County's representative, shall remove and dispose such debris and materials from the property. The Vendor shall leave all affected areas as they were prior to beginning work. 16. Direct Material Purchase The County reserves the right to require Vendor to assign some or all of its agreements with material suppliers directly to the County. Any such goods and/or materials purchased by the County pursuant to such an assignment of a material supply agreement shall be referred to as #16-6593—EMS Expendables 21 ITB Template_06132016 16E 9 "County Furnished Materials" and the responsibilities of both the County and the Vendor relating to said materials shall be governed by the terms and conditions of this solicitation. Additionally, the County at its sole option may choose to purchase some or all of the goods and/or materials from other suppliers. In either instance the County may require the following information from the Vendor: • Required quantities of material. • Specifications relating to goods and/or materials required for job including brand and/or model number or type if applicable • Pricing and availability of goods and/or materials provided under Vendor's agreements with material suppliers 17. Grant Compliance The purchase of any goods and/or services that are funded through Federal Grant Appropriations, the State of Florida, or any other public or private foundations shall be subject to the compliance and reporting requirements of the granting agency. 18. Equipment Vendor shall have available and in good working condition, the necessary equipment to perform the required service. If required by the County, the Vendor shall supply a list of equipment and an hourly rate for each. Hourly rates will commence once equipment arrives at the service site, unless otherwise agreed in writing by the Project Manager. In the event that additional specialized and/or heavy equipment (backhoe, crane, mudhog, etc.) is needed, the Project Manager must be notified in advance for approval. The reimbursement of additional equipment expense shall be at cost and will commence once equipment arrives at the service site, unless otherwise agreed in writing by the Project Manager. The County reserves the right to request and obtain documentation of the Vendor's cost for time and material projects, and to withhold payments until documentation is provided. All County-purchased equipment must be new and of current manufacture in production at the time of bid opening, and carry industry standard warranties. At the time of delivery, at least two (2) complete shop repair manuals and parts lists must be furnished with each type of equipment. Vendor must service all equipment prior to delivery and/or acceptance by the County. The scope of these specifications is to ensure the delivery of a complete unit ready for operation. Omission of any essential detail from these specifications does not relieve the Vendor from furnishing a complete unit. 19. Reserved Rights Collier County reserves its right in any solicitation to accept or reject any or all bids, proposals or offers; to waive minor irregularities and technicalities; or to request resubmission. Also Collier County reserves the right to accept all or any part of any bid, proposal, or offer, and to increase or decrease quantities to meet the additional or reduced requirements of Collier County. Collier County reserves its right to cancel, extend or modify any or all bids, proposals or offers; to award to one or more vendors; to award all or part of a solicitation; and to award by individual line items when it is deemed to be in the best interest of the County. Collier County reserves its right to reject any sole response. #16-6593—EMS Expendables 22 ITB Template_06132016 16E9 Co/tier County Administrative Services Department Procurement Services Division Attachment 1: Vendor Submittal -Vendor's Non-Response Statement The sole intent of the Collier County Procurement Services Division is to issue solicitations that are clear, concise and openly competitive. Therefore, we are interested in ascertaining reasons why prospective Vendors did not wish to respond to this ITB. If your firm is not responding to this ITB, please indicate the reason(s) by checking any appropriate item(s) listed below and return this form via email or fax to the Procurement Strategist listed on the first page or mail to: Collier County Procurement Services Division, 3327 Tamiami Trail East, Naples, Florida 34112. We are not responding to this ITB for the following reason(s): Solicitation: 16-6593 — EMS Expendables Services requested not available through our company. ❑ Our firm could not meet specifications/scope of work. • Specifications/scope of work not clearly understood (too vague, rigid, etc.) ❑ Project is too small. ❑ Insufficient time allowed for preparation of response. U Incorrect address used. Please correct mailing address: Other reason(s): Firm's Complete Legal Name Address City, State, Zip Telephone Number FAX Number Signature/Title Type Name of Signature Date: #16-6593—EMS Expendables 23 ITB Template_06132016 16E9 Co ier County Administrative Services Department Procurement Services Division Attachment 2: Vendor's Check List IMPORTANT: THIS SHEET MUST BE SIGNED BY VENDOR. Please read carefully, sign in the spaces indicated and return with bid. Vendor should check off each of the following items as the necessary action is completed: 1. The Bid has been signed. 2. The Bid prices offered have been reviewed. 3. The price extensions and totals have been checked. 4. The payment terms have been indicated. 5. Provide a snapshot of your website and documentation showing the presence of an internal search engine, shopping cart, printable order acknowledgement/confirmation, and acceptance of Collier County Purchasing Card. 6. Provide documentation of return policy 7. Provide example of usage reports that can be requested by the County. 8. Any delivery information required is included. 9. Addendum have been signed and included, if applicable. 10. Affidavit for Claiming Status as a Local Business, if applicable. 11. Immigration Affidavit and company's E-Verify profile page or memorandum of understanding. 12. Copies of licenses, equipment lists, subcontractors or any other information as noted in this ITB. 13. The mailing envelope must be addressed to: Procurement Director Collier County Government Procurement Services Division 3327 Tamiami Trail E Naples FL 34112 The mailing envelope must be sealed and marked with: • Solicitation: 16-6593— EMS Expendables • Opening Date: 1/04/2016; 3:00PM 14. The bid will be mailed or delivered in time to be received no later than the specified opening date and time. (Otherwise bid cannot be considered.) 15. If submitting a manual bid, include any addenda (initialed and dated noting understanding and receipt). If submitting bid electronically, bidder will need to download all related documents on www.colliergov.net/bid. The system will date and time stamp when the addendum files were downloaded ALL COURIER DELIVERED BIDS MUST HAVE THE BID NUMBER AND TITLE ON THE OUTSIDE OF THE COURIER PACKET. Company Name Signature & Title Date #16-6593—EMS Expendables 24 ITB Template_06132016 1 E 9 Caner County Administrative Services Department Procurement Senmces Division Attachment 3: Vendor Submittal - Bid Response Form FROM: Board of County Commissioners Collier County Government Center Naples, Florida 34112 RE: Solicitation: 16-6593 — EMS Expendables Dear Commissioners: The undersigned, as Vendor, hereby declares that the specifications have been fully examined and the Vendor is fully informed in regard to all conditions pertaining to the work to be performed for as per the scope of work. The Vendor further declares that the only persons, company or parties interested in this Bid or the Contract to be entered into as principals are named herein; that this Bid is made without connection with any other person, company or companies submitting a Bid; and it is all respects fair and in good faith, without collusion or fraud. The Vendor proposes and agrees if this bid is accepted, to comply with the requirements in full and in accordance with the terms, conditions and specifications denoted herein. The Vendor agrees to provide the following: Item # Description Total 236 BID TOTAL $ Any discounts or terms must be shown on the Bid Response Form. Such discounts, if any, will be considered and computed in the tabulation of the bids. In no instance should terms for less than fifteen (15) days payment be offered. Prompt Payment Terms: % Days; Net_ Days ❑ Bid Response Form is electronic. Please input your prices online. ❑ Bid Response is as follows: Note: If you choose to bid manually, please submit an ORIGINAL and ONE COPY of your bid response pages. The undersigned do agree that should this Bid be accepted, to execute a formal contract, if required, and present the formal contract to the County Procurement Director for approval within fifteen (15) days after being notified of an award. #16-6593—EMS Expendables 25 ITB Template_06132016 16 E 9 IN WITNESS WHEREOF, WE have hereunto subscribed our names on this day of , 20 in the County of , in the State of Firm's Complete Legal Name Address City, State, Zip Florida Certificate of Authority Document Number Federal Tax Identification Number CCR# or CAGE Code Telephone Number FAX Number Signature/Title Type Name of Signature Date Additional Contact Information Send Payments To: (REQUIRED ONLY if different from above) Firm's Complete Legal Name Address City, State, Zip Contact Name Telephone Number FAX Number Email Address #16-6593—EMS Expendables 26 ITB Template_06132016 1 E 9 Co ler Coutity Administrative Services Department Procurement Services Division Attachment 4: Vendor Submittal — Local Vendor Preference Affidavit Solicitation: 16-6593—EMS Expendables (Check Appropriate Boxes Below) State of Florida(Select County if Vendor is described as a Local Business ❑ Collier County ❑ Lee County Vendor affirms that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section XI of the Collier County Procurement Ordinance: Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector for at least one year prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor's staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this section. Vendor must complete the following information: Year Business Established in Collier County or❑ Lee County: Number of Employees (Including Owner(s) or Corporate Officers): Number of Employees Living in ❑ Collier County or❑ Lee (Including Owner(s)or Corporate Officers): If requested by the County, vendor will be required to provide documentation substantiating the information given in this affidavit. Failure to do so will result in vendor's submission being deemed not applicable. Vendor Name: Date: Address in Collier or Lee County: Signature: Title: STATE OF FLORIDA ❑ COLLIER COUNTY ❑ LEE COUNTY Sworn to and Subscribed Before Me, a Notary Public, for the above State and County, on this Day of , 20 Notary Public My Commission Expires: (AFFIX OFFICIAL SEAL) #16-6593—EMS Expendables 27 ITB Template_06132016 16E 9 Coter County Administrative Services Depattment Procurement Services Division Attachment 5: Vendor Submittal—Immigration Affidavit Solicitation: 16-6593— EMS Expendables This Affidavit is required and should be signed, notarized by an authorized principal of the firm and submitted with formal Invitations to Bid (ITB's)and Request for Proposals (RFP) submittals. Further, Vendors / Bidders are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the vendor's/bidder's proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Failure to include this Affidavit and acceptable evidence of enrollment in the E-Verify program, may deem the Vendor I Bidder's proposal as non-responsive. Collier County will not intentionally award County contracts to any vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e) Section 274A(e) of the Immigration and Nationality Act ("INA"). Collier County may consider the employment by any vendor of unauthorized aliens a violation of Section 274A(e)of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A(e) of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s)) and agrees to comply with the provisions of the Memorandum of Understanding with E- Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor's/Bidder's proposal. Company Name Print Name Title Signature Date State of County of The foregoing instrument was signed and acknowledged before me this day of ,20 , by who has produced as identification. (Print or Type Name) (Type of Identification and Number) Notary Public Signature Printed Name of Notary Public Notary Commission Number/Expiration The signee of this Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this affidavit to interrogatories hereinafter made. #16-6593—EMS Expendables 28 ITB Template_06132016 16E 9 Cater County Administrative Services Department Procure 1sent Sevices Diveien Attachment 6: Vendor Substitute W—9 Request for Taxpayer Identification Number and Certification In accordance with the Internal Revenue Service regulations, Collier County is required to collect the following information for tax reporting purposes from individuals and companies who do business with the County (including social security numbers if used by the individual or company for tax reporting purposes). Florida Statute 119.071(5) require that the county notify you in writing of the reason for collecting this information, which will be used for no other purpose than herein stated. Please complete all information that applies to your business and return with your quote or proposal. 1. General Information (provide all information) Taxpayer Name (as shown on income tax return) Business Name (if different from taxpayer name) Address City State Zip Telephone FAX Email Order Information Remit I Payment Information Address Address City State Zip City State Zip FAX FAX Email Email 2. Company Status (check only one) Individual/Sole Proprietor Corporation Partnership Tax Exempt(Federal income tax-exempt entity Limited Liability Company under Internal Revenue Service guidelines IRC 501 (c)3) Enter the tax classification • (D=Disregarded Entity, C=Corporation, P=Partnership) 3. Taxpayer Identification Number(for tax reporting purposes only) Federal Tax Identification Number(TIN) (Vendors who do not have a TIN,will be required to provide a social security number prior to an award of the contract.) 4. Sign and Date Form Certification: Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge. Signature Date Title Phone Number #16-6593—EMS Expendables 29 ITB Template_06132016 16E9 Cofer County Administrative Services Department Procurement Services Division Attachment 7: Vendor Submittal - Insurance and Bonding Requirements Insurance I Bond Type Required Limits 1. ® Worker's Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Compensation Statutory Limits and Requirements 2. ® Employer's Liability $500,000 single limit per occurrence 3. ® Commercial General Bodily Injury and Property Damage Liability(Occurrence Form) patterned after the current $1,000,000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury ISO form Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. ® Indemnification To the maximum extent permitted by Florida law, the Contractor/Vendor/Consultant shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys'fees and paralegals'fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the Contractor/Vendor/Consultant or anyone employed or utilized by the Contractor/Vendor/Consultant in the performance of this Agreement. 4. ® Automobile Liability $ 1,000,000 Each Occurrence; Bodily Injury& Property Damage, Owned/Non-owned/Hired; Automobile Included 5. ❑ Other insurance as ❑ Watercraft $ Per Occurrence noted: ❑ United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Maritime Coverage (Jones Act) shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. $ Per Occurrence ❑ Pollution $ Per Occurrence ❑ Professional Liability $ per claim and in the aggregate • $1,000,000 per claim and in the aggregate • $2,000,000 per claim and in the aggregate ❑ Project Professional Liability $ Per Occurrence ❑ Valuable Papers Insurance $ Per Occurrence #16-6593—EMS Expendables 30 ITB Template_06132016 16E 9 ❑ Employee Dishonesty/Crime $ Per Occurrence Including Employee Theft, Funds Transfer Fraud, Include a Joint Loss Payee endorsement naming Collier County. 6. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers' check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5% of the cost proposal. All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance Corporation. 7. ❑ Performance and For projects in excess of$200,000, bonds shall be submitted with the Payment Bonds executed contract by Proposers receiving award, and written for 100% of the Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-"or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5% of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. 8. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 9. ® Collier County must be named as "ADDITIONAL INSURED"on the Insurance Certificate for Commercial General Liability where required. 10. ® The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. 11. ® Thirty (30) Days Cancellation Notice required. 11/2/2016 RLC Vendor's Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five (5) days of the award of this solicitation. Name of Firm Date Vendor Signature Print Name Insurance Agency Agent Name Telephone Number #16-6593—EMS Expendables 31 ITB Template_06132016 16E9 Colmer Comity Email: adamnorthrup©colliergov.net Administrative Services Division Telephone: (239) 252 6098 tvac lr FAX (239) 252-6302 ADDENDUM 1 Memorandum Date: November 30, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 1: 16-6593 — EMS Expendables The following is issued as an addendum identifying the following change(s) for the referenced solicitation and completely replaces the section entitled ''Term of Contract": Term of Contract The contract term, if an award(s) is/are made is intended to be for ane-(-3-)years-)--Mth4three -2-) Two y or renewal options three (3) years with two (2) one (1) year renewals. Requests for consideration of a price adjustment shall be made in writing to the Procurement Director. Price adjustments are dependent upon proof of manufacturer increase in supply cost, the consumer price index (CPI) over the past twelve (12) months, budget availability and/or program manager approval. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. No delivery fees shall be accepted, any such fees should be built into the item price. xxx Note: Language deleted has been struck thretigh. New language has been underlined. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. (Signature) Date (Name of Firm) Addendum 1 16E9 Co, , f �.7- County Email: adamnorthrup@colliergov.net Telephone: (239) 252-6098 Administrative Sevices Dvision FAX; (239) 252-6302 PrracJr_'+n).rit Servic& ADDENDUM 2 Memorandum Date: December 5, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 2: 16-6593— EMS Expendables The following is issued as an addendum identifying the following change(s) for the referenced solicitation. Note: Language deleted has been strtisi4-through. New language has been underlined: Excerpts of the following section have been changed. Award Criteria For the purposes of determining the bidder with the lowest price for award purposes only the following methodology will be used: The interested bidder will input the requested information into lines 1-235 328 (Section A). The discounted price provided will be multiplied by the quantity listed to yield a Representative Total for each line. Additionally, provide a percentage discount for the product categories listed in lines 330 —354 237 261 (Section B). The responsive, responsible bidder with the lowest total for each line shall be awarded. Attachment 8: Bid Schedule has been replaced in full by the following file. (Items highlighted in yellow indicate a change has been made from the original bid schedule.): 16-6593—Attachment 8— Bid Schedule (AD 2). Attachment 3: Vendor Submittal—Bid Response Form, Page 25, has been fully replaced by the following file: 16-6593— Page 25 (AD 2) As a result of these changes, the due date for this solicitation will be extended until 3:00PM on Friday January 6m, 2017. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. (Signature) Date (Name of Firm) Addendum 2 1 E come, ca -n,ty Email: adamnorthrup@colliergov.net Telephone: (239)252-6098 AdmnistraGveSe*esDiision FAX: (239) 252-6302 P oc,a;ement Sewic .: ADDENDUM 3 Memorandum Date: December 28, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 3: 16-6593— EMS Expendables The following is issued as an addendum identifying the following change(s) for the referenced solicitation. • Attachment 8: Bid Schedule has been replaced in full with the attached file. The only change made was a formula correction starting on line Q247. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. 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Vendor should check off each of the following items as the necessary action is completed: 1. The Bid has been signed. /2. The Bid prices offered have been reviewed. r`3. The price extensions and totals have been checked. f 4. The payment terms have been indicated. 1 5. Provide a snapshot of your website and documentation showing the presence of an internal search engine, shopping cart, printable order acknowledgement/confirmation, and acceptance of Collier County Purchasing Card. -I6. Provide documentation of return policy 7. Provide example of usage reports that can be requested by the County. 8. Any delivery information required is included. / 9. Addendum have been signed and included, if applicable. 10. Affidavit for Claiming Status as a Local Business, if applicable. 4 11. Immigration Affidavit and company's E-Verify profile page or memorandum of understanding. J 12. Copies of licenses, equipment lists, subcontractors or any other information as noted in this ITB. 13. The mailing envelope must be addressed to: Procurement Director Collier County Government Procurement Services Division 3327 Tamiami Trail E Naples FL 34112 The mailing envelope must be sealed and marked with: • Solicitation: 16-6593—EMS Expendables • Opening Date: 1/04/2016; 3:00PM 14.The bid will be mailed or delivered in time to be received no later than the specified opening date and time. (Otherwise bid cannot be considered.) 15. If submitting a manual bid, include any addenda (initialed and dated noting understanding and receipt). If submitting bid electronically, bidder will need to download all related documents on www.colliergov.net/bid. The system will date and time stamp when the addendum files were downloaded ALL COURIER DELIVERED BIDS MUST HAVE THE BID NUMBER AND TITLE ON THE OUTSIDE OF THE COURIER PACKET. niJW(S tt PC1i(A ( L 6 A SGC Co p ny Name) Sin lure ` Title I L4 1 l r.7) Date #16-6593—EMS Expendables 24 ITB Template_06132016 16E9 Cater County Email: adamnorthrup@colliergov.net Administrative Services E".kviskx� Telephone: (239) 252-6098 Procurement Services FAX: (239) 252-6302 ADDENDUM 1 Memorandum Date: November 30, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 1: 16-6593— EMS Expendables The following is issued as an addendum identifying the following change(s)for the referenced solicitation and completely replaces the section entitled "Term of Contract": Term of Contract The contract term, if an award(s) is/are made is intended to be for :-- _ _. _ - _ three (3)years with two (2) one (1)year renewals. Requests for consideration of a price adjustment shall be made in writing to the Procurement Director. Price adjustments are dependent upon proof of manufacturer increase in supply cost, the consumer price index(CPI) over the past twelve (12) months, budget availability and/or program manager approval. Surcharges will not be accepted in conjunction with this contract, and such charges should be incorporated into the pricing structure. No delivery fees shall be accepted, any such fees should be built into the item price. Note: Language deleted has been struck-through. New language has been underlined. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. • C . �. i /Li ) 1K7 (Signre) Date tiuWef ; ' caSu,101 OILC. (Name of Firm) U Addendum 1 1 16E 9 Cofer County Email: adamnorthrup@colliergov.net Telephone: (239)252-6098 Administrative Servioes I vision FAX: (239)252-6302 F}rOC Jr#?mPnt Sr.n.res ADDENDUM 2 Memorandum Date: December 5, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 2: 16-6593—EMS Expendables The following is issued as an addendum identifying the following change(s)for the referenced solicitation. Note: Language deleted has been s#r-uck-throug i. New language has been underlined: Excerpts of the following section have been changed. Award Criteria • For the purposes of determining the bidder with the lowest price for award purposes only the following methodology will be used: The interested bidder will input the requested information into lines 1 235 328(Section A). The discounted price provided will be multiplied by the quantity listed to yield a Representative Total for each line. Additionally, provide a percentage discount for the product categories listed in lines 330—354 237 261 (Section B). The responsive, responsible bidder with the lowest total for each line shall be awarded. Attachment 8:Bid Schedule has been replaced in full by the following file. (Items highlighted in yellow indicate a change has been made from the original bid schedule.): 16-6593—Attachment 8—Bid Schedule(AD 2). Attachment 3: Vendor Submittal—Bid Response Form, Page 25, has been fully replaced by the following file: 16-6593— Page 25(AD 2) As a result of these changes, the due date for this solicitation will be extended until 3:00PM on Friday January 6th, 2017. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. ))(4 (Sig .tre) Date tdwec.+ t i(�(�\f t trA tLi66/1i6t/�om. LLl(Name of Firm) Addendum 2 1 16E9 Colter aunty Email: adamnorthrup@colliergov.net Telephone:(239)252-6098 Adrninistidlive Services Division FAX:(239)252-6302 PE ocurerrent Senoim ADDENDUM 3 Memorandum Date: December 28, 2016 From: Adam Northrup, Procurement Strategist To: Interested Bidders Subject: Addendum 3: 16-6593—EMS Expendables The following is issued as an addendum identifying the following change(s)for the referenced solicitation. * Attachment 8: Bid Schedule has been replaced in full with the attached file. The only change made was a formula correction starting on line Q247. Please sign below and return a copy of this Addendum with your submittal for the above referenced solicitation. C\7 ) Q-(--\Gt.d) kit Jr) (Signa u ) {l1 C,e) Date M.( l) �5lt %GJ J{�� LL (Name of Firm) Lee Addendum 2 1 16E9 co r Comity ;bts Su'fi:;3(:'.i`:'3S;aa.`"a`Department ' f(:y)/q„s,(1 erg S&iFvi;.C*,s DlviSion Attachment 3: Vendor Submittal - Bid Response Form FROM: HIItok e Q4 `. , : it/ 14. tr41- Board of County Commissioners Collier County Government Center Naples, Florida 34112 RE: Solicitation: 16-6593—EMS Expendables Dear Commissioners: The undersigned, as Vendor, hereby declares that the specifications have been fully examined and the Vendor is fully informed in regard to all conditions pertaining to the work to be performed for as per the scope of work. The Vendor further declares that the only persons, company or parties interested in this Bid or the Contract to be entered into as principals are named herein; that this Bid is made without connection with any other person, company or companies submitting a Bid; and it is all respects fair and in good faith, without collusion or fraud. The Vendor proposes and agrees if this bid is accepted, to comply with the requirements in full and in accordance with the terms, conditions and specifications denoted herein. The Vendor agrees to provide the following: Item # Description Total 236 329 BID TOTAL ...... . .. $ d 6.Yr ' .. Any discounts or terms must be shown on the Bid Response Form. Such discounts, if any, will be considered and computed in the tabulation of the bids. In no instance should terms for less than fifteen (15)days payment be offered. Prompt Payment Terms: , .,�% Days; Net° `} Days Note: If you choose to bid manually, please submit an ORIGINAL and ONE COPY of your bid response pages. The undersigned do agree that should this Bid be accepted, to execute a formal contract, if required, and present the formal contract to the County Procurement Director for approval within fifteen (15) days after being notified of an award. #16-6593—EMS Expendables ITB Template_06132016 25 16E9 IN WITNESS WHEREOF, WE have hereunto subscribed our names on this l( day of uk r3 , 20 �" in the County of h1 , in the State of io:i . Firm's Complete Legal Name �c�t L F,S C�i rA .Sc.,{�p IL Lb LL c- Address 1 00 fro A + City, State, Zip E&y -44N. C 47 f + n 0 ( `3 C) Li Florida Certificate of Authority nilI/-4oe Z f ci (o C . ` ( o Document Number Federal Tax Identification 141'5 ' 171-11 ‘ C% Number CCR #or CAGE Code C Telephone Number 3%t..v-as D... ~-q l (a 0 FAX Number J giO ,-f- ci Signature/Title a ,. y 1 / '7C,S7P(~2 < Type Name of Signature .+ Date 1 C.f ) i -1 Additional Contact Information Send Payments To: (REQUIRED ONLY if different from above) Firm's Complete Legal Name W ecl1 Cil( rrQ C LL Address �� ( ..)c ! 1,4-41oc 1._tri�r' -e City, State, Zip 410 IL 6104112- ,Q006p Contact Name n 1 ft Telephone Number g ' (MC° " c� 1 l S FAX Number 311-1 - c2p( CC- , Email Address C .��(YVYtS,(Y\ cod • e_..,0 #16-6593—EMS Expendables 26 ITB Template_06132016 16E9 Co ier County (F\ !administrative asrvicvs Department Pro jrorn mt 5c%rviuss Division Attachment 4: Vendor Submittal- Local Vendor Preference Affidavit Solicitation: 16-6593-EMS Expendables(Check Appropriate Boxes Below) State of Florida(Select County if Vendor is described as a Local Business ❑ Collier County ❑ Lee County Vendor affirms that it is a local business as defined by the Procurement Ordinance of the Collier County Board of County Commissioners and the Regulations Thereto. As defined in Section XI of the Collier County Procurement Ordinance: Local business means the vendor has a current Business Tax Receipt issued by the Collier County Tax Collector for at least one year prior to bid or proposal submission to do business within Collier County, and that identifies the business with a permanent physical business address located within the limits of Collier County from which the vendor's staff operates and performs business in an area zoned for the conduct of such business. A Post Office Box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used for the purpose of establishing said physical address. In addition to the foregoing, a vendor shall not be considered a "local business"unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business"under this section.A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year under this section. Vendor must complete the following information: Year Business Established in ❑Collier County or ❑ Lee County: Number of Employees(Including Owner(s)or Corporate Officers): Number of Employees Living in ❑ Collier County or❑ Lee(Including Owner(s)or Corporate Officers): If requested by the County, vendor will be required to provide documentation substantiating the information given in this affidavit. Failure to do so will result in vendor's submission being deemed not applicable. Vendor Name:_.,.... Date: Address in Collier or Lee County: Signature: Title: STATE OF FLORIDA ❑ COLLIER COUNTY ❑ LEE COUNTY Sworn to and Subscribed Before Me, a Notary Public, for the above State and County, on this Day of_.._.. , 20 Notary Public My Commission Expires: (AFFIX OFFICIAL SEAL) #16-6593—EMS Expendables 27 ITB Template_06132016 ,� 16E9 ,,s,„„,i)lt.,,,,: ` k,„..,< ,,.:' Attachment 5: Vendor Submittal—Immigration Affidavit Solicitation: 16-6593—EMS Expendables This Affidavit is required and should be signed, notarized by an authorized principal of the firm and submitted with formal Invitations to Bid (ITB's)and Request for Proposals(RFP)submittals. Further, Vendors/ Bidders are required to enroll in the E-Verify program, and provide acceptable evidence of their enrollment, at the time of the submission of the vendor's/bidder's proposal. Acceptable evidence consists of a copy of the properly completed E-Verify Company Profile page or a copy of the fully executed E-Verify Memorandum of Understanding for the company. Failure to include this Affidavit and acceptable evidence of enrollment in the E-Verify program, may deem the Vendor Bidder's proposal as non-responsive. Collier County will not intentionally award County contracts to any vendor who knowingly employs unauthorized alien workers, constituting a violation of the employment provision contained in 8 U.S.C. Section 1324 a(e)Section 274A(e)of the Immigration and Nationality Act("INA"). Collier County may consider the employment by any vendor of unauthorized aliens a violation of Section 274A(e)of the INA. Such Violation by the recipient of the Employment Provisions contained in Section 274A(e)of the INA shall be grounds for unilateral termination of the contract by Collier County. Vendor attests that they are fully compliant with all applicable immigration laws (specifically to the 1986 Immigration Act and subsequent Amendment(s))and agrees to comply with the provisions of the Memorandum of Understanding with E- Verify and to provide proof of enrollment in The Employment Eligibility Verification System (E-Verify), operated by the Department of Homeland Security in partnership with the Social Security Administration at the time of submission of the Vendor's/ Bidder's proposal. Company Name CYlci4tkQ,s mPct t`c 0.f.V�'tA., ( LL C Print Name 0 t t{� t`n. .- ek r Title 66/c G;,..d . C.a 1 t-4— Signature ( 2yOTN-,.r. .;e•--s•-. 11Date 1 1 L4 i 1 -7 State of Vet a� County of 1/et tt.5 t ek Thee ?.-4.),,,I,foregoing instrument was signed and acknowledged before me this t 1 day of,370.C§'.h.. .t- ,201,by no AA +� who has produced l5eetS{JCt1L. kNOW 'as identification. (Print or Type Name) (Type of IdentificAtion and Number) Notary lic Signature +,,;x" JULIA P.ONESTO 4 Printed Name of NotaryPublic a te_ Commission#EE9 Ql1i7 � _ Expires February TwaTmyFaroyn p•gq 454018 Notary Commission Number/Expiration The signee of this Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this affidavit to interrogatories hereinafter made. #16-6593—EMS Expendables 28 ITB Tem plate_06132016 16 E 9 EmployerWizard Page 1 of 1 E-vet.„.„ Mrplcome User 10 aSI awn Employment Eligibility Verification Regina Frey RFREMS8 02 01 PM 05n30/20i2 Lou Out Click any g)for help Home Company Information New Case View Cases Company Name: Midwest Medical Supply Co LLD View/Edit searen Cases Company ID Number: 199641 Orly Profile Doing Business As(DBA) MMS-A Medical Supply Company Edit Prow° Name: DUNS Number: Change Password Gnome Security Otosetione Physical Location: Mailing Address: M y Ci;r1OW,y Address 1: 13400 Lakefront Olive Address 1: Edil Company Profile Address 2: Address 2: Add New User City: Eaqn Day City: State: MO State: View Eksang Users Zip Code: 63045 Zip Code: Close Company Amount County: SAiNi LOUIS View atepens Additional Information: Employer Identification Number:43174119 View Essential Resources Total Number of Employees: 100 tu 499 Take Tetanal Parent Organization: View User Manual Administrator: Midwest Medical Supply Co LLC Organization Designation: Contact Us Employer Category: None of these categories apply NAICS Code: 423 MERCHANT WHOLESALERS DURABLE GOODS View!Edit Total Hiring Sites: 11 NNW Etht Total Points of Contact. 1 I View/Edit S Npartfpeni c.ii0111eiam SwIrrRy.wev,ohs do v S CRaenshp and immigration Services sew IASCIS gOv 00N1 https://e-verify.useis.gov/emp/EmployerWizard.aspx 8/9/2012 E 9 Cray c;oun.zy Administrative Services Department t?mc iter.ient$:rvic Division Attachment 6: Vendor Substitute W—9 Request for Taxpayer Identification Number and Certification In accordance with the Internal Revenue Service regulations, Collier County is required to collect the following information for tax reporting purposes from individuals and companies who do business with the County(including social security numbers if used by the individual or company for tax reporting purposes). Florida Statute 119.071(5) require that the county notify you in writing of the reason for collecting this information, which will be used for no other purpose than herein stated. Please complete all information that applies to your business and return with your quote or proposal. 1. General Information (provide all information) (� + t Taxpayer Name { i a w f�k rn PDQ t r,ok t .3U. �3 C ,l-SQ a h LL.. (as shown on income tax r•tur_n) Business Name 111 (f1 (if different from taxpayer nem h ' 4.1; Address ! 400 Lr. .e'STOr1.4" FJ&. City e- r` C 11 y State m a _ Zip (03oIt Telephone 3111--a.9)I'act°0 FAX Email Order Information Remit I Payment Information ,, -t Address �� V.-•-•3-2/0- ? 3�. Address cG275 5n141.r 0+''1 C-e, +e City State Zip - City(1 ki C:C.Dti„o State I t--^ Zip&de T7. � ---� FAX ( " �3'.J OCY-e FAX 3 I�-`�- �,� �(S- S c7� ' , V Email afftGacc.AofS Email 1R0r ,4vn.5rned C.ai e ccrfr%. (AA,co rdlar C.e R-67( oim 2. Company Status (check only one) Individual I Sole Proprietor _Corporation _Partnership __Tax Exempt(Federal Income tax-exempt entity >< Limited Liability Company under Internal Revenue Service guidelines IRC 501 (c)3) Enter the tax classification (D=Disregarded Entity C=Corporation, P=Partnership) 3. Taxpayer Identification Number(for tax reporting purposes only) Federal Tax Identification Number(TIN) '`>F . / 74fi 4(p (Vendors who do not have a TIN,will be required to provide a social security number prior to an award of the contract.) 4. Sign and Date Form Certification:Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge. Signature.. Date_=:kdr)'- ._... t Title Er'f 1 . <> e ' . Phone Number 3gt'-r,.,-rasa- 4460 #16-6593-EMS Expendables 49 ITS Template_06132016 16E9 Cu ,e.County ..,ii"ir1`:i 'r°ilfk'?CreNict,,s Department ' ' Owision Attachment 7: Vendor Submittal - Insurance and Bonding Requirements Insurance/Bond Type Required Limits 1. ®Worker's Statutory Limits of Florida Statutes, Chapter 440 and all Federal Government Compensation Statutory Limits and Requirements 2. ® Employer's Liability $500,000 single limit per occurrence 3. Z Commercial General Bodily Injury and Property Damage Liability(Occurrence Form) patterned after the current $1,000,000 single limit per occurrence, $2,000,000 aggregate for Bodily Injury ISO form Liability and Property Damage Liability. This shall include Premises and Operations; Independent Contractors; Products and Completed Operations and Contractual Liability. 4. ►.1 Indemnification To the maximum extent permitted by Florida law, the ContractorNendor/Consultant shall indemnify and hold harmless Collier County, its officers and employees from any and all liabilities, damages, losses and costs, including, but not limited to, reasonable attorneys'fees and paralegals'fees, to the extent caused by the negligence, recklessness, or intentionally wrongful conduct of the ContractorNendor/Consultant or anyone employed or utilized by the ContractorNendor/Consultant in the performance of this Agreement. 4. ® Automobile Liability $ 1,000.000 Each Occurrence; Bodily Injury& Property Damage, Owned/Non-owned/Hired; Automobile Included 5. ❑ Other insurance as ❑Watercraft $ Per Occurrence noted: ❑ United States Longshoreman's and Harborworker's Act coverage shall be maintained where applicable to the completion of the work. -._ .__......__.._...... .Per Occurrence ❑ Maritime Coverage(Jones Act)shall be maintained where applicable to the completion of the work. $ Per Occurrence ❑ Aircraft Liability coverage shall be carried in limits of not less than $5,000,000 each occurrence if applicable to the completion of the Services under this Agreement. Per Occurrence ❑ Pollution $ Per Occurrence ❑ Professional Liability $ per claim and in the aggregate • $1,000,000 per claim and in the aggregate • $2,000,000 per claim and in the aggregate ❑ Project Professional Liability $ Per Occurrence ❑ Valuable Papers Insurance $ Per Occurrence #16-6593—EMS Expendables 30 ITB Template_06132016 16E9 ❑ Employee Dishonesty/Crime $ Per Occurrence Including Employee Theft, Funds Transfer Fraud, Include a Joint Loss Payee endorsement naming Collier County. 6. ❑ Bid bond Shall be submitted with proposal response in the form of certified funds, cashiers'check or an irrevocable letter of credit, a cash bond posted with the County Clerk, or proposal bond in a sum equal to 5%of the cost proposal.All checks shall be made payable to the Collier County Board of County Commissioners on a bank or trust company located in the State of Florida and insured by the Federal Deposit Insurance Corporation. 7 ❑ Performance and For projects in excess of$200,000, bonds shall be submitted with the Payment Bonds executed contract by Proposers receiving award, and written for 100% of the Contract award amount, the cost borne by the Proposer receiving an award. The Performance and Payment Bonds shall be underwritten by a surety authorized to do business in the State of Florida and otherwise acceptable to Owner; provided, however, the surety shall be rated as "A-a or better as to general policy holders rating and Class V or higher rating as to financial size category and the amount required shall not exceed 5%of the reported policy holders' surplus, all as reported in the most current Best Key Rating Guide, published by A.M. Best Company, Inc. of 75 Fulton Street, New York, New York 10038. 8. ® Vendor shall ensure that all subcontractors comply with the same insurance requirements that he is required to meet. The same Vendor shall provide County with certificates of insurance meeting the required insurance provisions. 9. El Collier County must be named as "ADDITIONAL INSURED"on the Insurance Certificate for Commercial General Liability where required. 10. ® The Certificate Holder shall be named as Collier County Board of County Commissioners, OR, Board of County Commissioners in Collier County, OR Collier County Government, OR Collier County. The Certificates of Insurance must state the Contract Number, or Project Number, or specific Project description, or must read: For any and all work performed on behalf of Collier County. 11. ® Thirty(30) Days Cancellation Notice required. 11/2/2016 RLC Vendor's Insurance Statement We understand the insurance requirements of these specifications and that the evidence of insurability may be required within five(5)days ofohne award of this solicitation. )1-1 Name of Firm ►` tiuktA3Qs,+mfct CA — 4. 4 C (- Date i ) 1 fir. .. , D Vendor Signature Print Name * --i- 2-0--€X 1 Insurance Agency !�n . b t f' Agent Name ! -c.. Telephone Number LIN -0,44,1) #16-6593--EMS Expendables 31 ITS Template_06132016 16E9 xz6. ..,... 4. k '4-7: rit ; il_ FLORIDA DEPARTMENT OF STATE Division of Corporations October 27, 2014 CSC COURTNEY WILLIAMS Qualification documents for MIDWEST MEDICAL SUPPLY CO., L.L.C. were filed on October 24, 2014, and assigned document number M14000007749. Please refer to this number whenever corresponding with this office. Your limited liability company is authorized to transact business in Florida as of the file date. To maintain "active" status with the Division of Corporations, an annual report must be filed yearly between January 1st and May 1st beginning in the year following the file date or effective date indicated above. If the annual report is not filed by May 1st, a $400 late fee will be added. A Federal Employer Identification Number (FEI/EIN) will be required when this report is filed. Apply today with the IRS online at: https://sa.www4.irs.gov/modiei n/individuaVindex.jsp. Please notify this office if the limited liability company address changes. Should you have any questions regarding this matter, please contact this office at the address given below. Karen A Saly Regulatory Specialist II Regulatory/Qualification Section Division of Corporations Letter Number: 014A00022905 Account number: I20000000195 Amount charged; 902.50 www.sunbiz.org Division of Corporations- P.O. BOX 6327 -Tallahassee,Florida 32314 16E9 COVER LE ITER TO: Registration Section Division of Corporations SUI ; Midwest Medical Supply Co., L.L.C. Name of Limited Liability Company The enclosed'Application by Foreign Limited Liability Company for Authorization to Transact Business in Florida,"Certificate of Existence,and check are submitted to register the above referenced foreign limited liability company to transact business in Florida.. Please return all correspondence concerning this matter to the following: Paula L. Robinson Name of Person Bryan Cave, LLP Firm/Company 211 N. Broadway, Suite 3600 Add= St. Louis, MO 63102 G.ty/State and lip Code paula.robinson@bryancave.com E-mail address:(to be used for fugue amru 1 report notification) For further information concerning this matter,please call: Paula L. Robinson y_at(314 ) 259-2663 Name of Contact Person Area Code Daytime Telephone Number MAILING ADDRESS: STREET ADDRESS: Division of Corporations Division of Corporations Registration Section Registration Section P.O.Box 6327 Clifton Building Tallahassee,FL 32314 2661 Executive Center Circle Tallahassee,FL 32301 Enclosed is a check for the following amount: 0$125.00 Filing Fee 0$130.00 Filing Fee& 0$155.00 Filing Fee& 0$160.00 Filing Fee,Certificate Certificate of Status Certified Copy of Status&Certified Copy 16E9 APPLICATION BY FOREIGN LIMITED LIABILITY COMPANY FOR AUTHORIZATION TO TRANSACT BUSINESS IN FLORIDA IT✓COMPLIANCE WITH SECTION 605.0902,FLORIDA SZATUIEN THE FOLLO NG IS SUBMITI D 7O.RmS?ER A FOREIGN L121111..DLIABII,I7YCOMPANY?OTRA1 CFBUSWESS IN7HE STA7EOFFLORILA- 1. Midwest Medical Supply Co., L.L.C. (Name ofForeign Limited Liability Company;must include"I.inirt;3'Liabiity Company,""L.L.C.,"or {fl (If name unavailable,enter alternate name adopted far the purpose of transacting business in Florida The alternate name must include"Limited Liability Company,""LLC,"or"LLC.") 2.Missouri 3. (Jurisdiction under the law of which foreign limited liability (FEE ttumber,if applicable) company is organized) 4. October 30,2012 Date t transac nsrness to onda,i prior to registration.) r. (Sce actions 605.0904&605.0905,F.S.to determine penalty liability) S 13400 Lakefront Drive Earth City, MO 63045 .. (Street Address of Principal Office) 6. 13400 Lakefront Drive Earth City, MO 63045 _.._........ (Ma$'tngAddress) 7. The name,title or capacity and address of the person(s)who has/have authority to manage is/are: Managing Member. Gary P. Reeve, 13400 Lakefront Dr., Earth City, MO 63045 Managing Mils, 13400 Lakefront Dr., Earth City, MO 63045 8.Attached is an original certificate of existence,no more than 90 days old,duly authenticated by the official having custody of records in the jurisdiction under the law of which it is organized.(A photocopy is not acceptable.If the certificate is in a foreign language,a translation of the certificate under oath of the translator must be submitted) blitA /1/1,0/1/V Signature of an authorized person (in accordance with section 605.0203,FS.,the execution of this document constitutes en affnnation under the penalties of perjury that the facts stated herein are true.1 un aware that any false information submitted in a document to the Department of Slate constitutes a third degree felony as provided for in e.817.1.55,FS.) Authorized Person an behalf of Midwest Medical Supply Co.,L.L.C. ,b A V i b A4. F y At-AS �f QA- v i CE PA —gbEArr Typed or printed name of signee 16E9 CERTIFICATE OF DESIGNATION OF REGISTERED AGENT/REGISTERED OFFICE PURSUANT TO THE PROVISIONS OF SECTION 605.0113 or 605.0902(IXd),FLORIDA STATUTES,THE UNDERSIGNED LIMITED LIABILITY COMPANY SUBMITS THE FOLLOWING STATEMENT TO DESIGNATE A REGISTERED OFFICE AND REGISTERED AGENT IN THE STATE OF FLORIDA. I. The name of the Limited Liability Company is: Midwest Medical Supply Go., L.LC. If unavailable,the alternate to be used in the state of Florida is: 2. The name and the Florida street address of the registered agent and office are: Corporation Service Company 1201 Hays Street Merida Strut Address(P.O.Box.NOT ACC PTABLE) Tallahassee 32301 F' City/State/Zip Having been named as registered agent and to accept service ofprocess for the above stated limited liability company at the place designated in this certificate,I hereby accept the appointment as registered agent and agree to act in this capacity. Ifrcrther agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties, and I am familiar with and accept the obligations of my position as registered agent as provided for in Chapter 605,Florida Statutes. Corporation Service co .,=ny By: C1:4, N.� ,; uourtney Williams U (si ,,,e) Asst. Vice President S 100.00 Filing Fee for Application $ 25.00 Designation of Registered Agent $ 30.00 Certified Copy(optional) - $ 5,00 Certificate of Status(optional) 1 6 E 9 .--,,,k4...-;-,,:w..,...-.'-`4,;-•,,,,r-,14:-:"04.'-,-,,!... --:7_,,'.,,,t-:,-, ',.,....,',1 . ..+4.,4-,1:--,--f. ..,— s!,,-' -;•;,,' ',3 '--• ,k.1,.:' .,,<•-= L.',.%'...N..; ,, ,-1 '$,It?7,,. ,.--: .-.,,..-..-,,,, .,, 'r'•--.J.,,,,,-'a b...- •-.,i..--%..•.-1•,,•„:5•9;. ,,.- r.,i.,-_-, 1'.•, 1 •_-,,-„,,p 1 r•t.2 n2 -..,,,,,,,,,:p.s, --- ,.,....,, NTE OF MISS srr L---1... 3— -- ,,,,,....,A,,,,, -z- 5SCR147, , ,...„..„.„ I ,g, 4.1" ....A. is.:.b. "....., SS,. ..t....,,,,o ArISS01316- .1410,U‘w.,Na, ',,,,?,,'"';'17.1 `16'•04-rS: Jason Kander ,...,....... ,. Secretary of State ..... ^... ,-,...<..• ,„ CORPORATION DIVISION ' CERTIFICATE OF GOOD STANDING ..AtitZie • I,JASON KANDER,Secretary of State of the STALE OF MISSOURI,do hereby certify that the •%,!,•;<•• :::0: records in my office and in my care and custody reveal that .,,,..,,,, re. ;;;12;;.,A,t.• MIDWEST MEDICAL SUPPLY CO.,EEC 4-35V: P LC0007157 ....n.:, ,:•,;... ;•,2;tio ,i. was created under the laws of this State on the 12th day of April, 1996,and is active,having fully • complied with all requirements of this office. r..,•.-1:.,:r ,,,, ,,,;,..t.14.,.1 trf.,..-••'..-4. /,.4*;-'i' L 4,...,1,•g- ,$)‹ev,--,- S-,:,-*4,1,.•7'. .4..1:—•,.., ' 4, -...V.‘b.... IN TESTIMONY WHEREOF,I hereunto set my hand and ..„*.gtt...---26%"%l"H•vtEqNkr,t`.1,4,„ r'".6 '''k:`,,, cause to be affixed The GREAT SEAL of the State of ag, --,,,, -or ,4.-' -4-.iii-,I Missouri.Done at the City of Jefferson,this 23rd day of .. ** ** *** ** ',,,,?$.6 4:1> October,2014. 0T!' 1•17,-, ' 104 4. .,. .,..„,, ifi'....4%., ,,"-ki'l*"* P S' .. 'Orof '1*V•t'4•' „ ''". i -41/>, ' ' 0! / e,, ', Or ,...A.", . ' 71 0 ,..?H r.-- ''', Nyr, ' r:' '' at '''''..,04''''...1" , ii-e-V., -994 - :1,1,10\7'' AVA, . ,"4.00 :‘,:.:,;;,,i1;,,,''.•: - --,..7,-,-;..1 „sop/VW .../...41h, la cltAs,,, ,,,... -104?-44,.. ..,.., --,•T,--;.,' wg ,r-:---;V?: .N1,,,,E5.7.,-1 C •4,,,ts: •:.--'—r-:.--,',.:=,"C.,....7,"..., .10 ,..A....). , '...f5L.,. ,:•; Certification Number.CERT-10232014-0059 .remott, — _ .--;-----•'LT"''''.?' "'' ' L' 'E= r.-'a: ''. 'n i':1,' ''.,:ii'-'2,.'•'''.,,le Ei 1 ".; ''''''-i,'''•-:i''C''';', ' "i' ,,I -' %',,.:' `,,':;:',tP.'f,' ,.I IN', ".. ,,,,'''',, : ''.';I:' ,'' ' 'c ' " :\''''V'N'i N'' AZ''''''31‘ l' ' ' '`V ' ' A.- ',/- x , ,,,,, A AA:- ,,, • ,:, r,,; , ,,. 4,.V.• - ., •0 A, .,,,,, ' Isk;4-' ..,'2,.‹,i.:;,.f.-*4,, '..%"..,- ...,,, ' ','''.11. 44'.' --ei•i2'. ':,•,' ...>5 ..'Sc,./...,P ',...J.,„f ''-"E.-,-'ks-',0„'"-....z ''4' .1.9",,'f'' '';`;'' '..ie- ,,4'.., ,;_( ,tktZer 16E9 ,k till 1 (000000 ?0(6031 (Requestor's Name) 1 1 111 11 I !II 1111 (Address) 500283234475 (Address) (CitylState/ZiplPhone#) PICK-UP 0 WAIT 0 MAIL (Business Entity Name) 7.1 cA Cr, r0 "'C (Document Number) esti,,.•; ; �!'1`i Certified Copies Certificates of Status c;. :: _p ID„r P';t ' r L- aw r Special Instructions to Filing Officer: -77 • �4w r2lf1C t ! AlES ,r- Office Use Only s> 16E9*c_tc.), do Ind scp0_4-` C bec„,--Tclf CORPORATION SERVICE COMPANY 1201 Hays Street Talihassee, FL 32301 Phone: 850-558-1500 ACCOUNT NO. 120000000195 REFERENCE 048557 5017647 AUTHORIZATION : COST LIMIT $;.;130.00 ORDER DATE : March 8, 2016 ORDER TIME : 3 :24 PM ORDER NO. 048557-110 CUSTOMER NO: 5017647 FOREIGN FILINGS NAME: MIDWEST MEDICAL SUPPLY CO. , L.L.C. XXXX QUALIFICATION (TYPE: LL) PLEASE RETURN THE FOLLOWING AS PROOF OF FILING: CERTIFIED COPY PLAIN STAMPED COPY XX CERTIFICATE OF GOOD STANDING • CONTACT PERSON: Courtney Williams -- EXT# 62935 EXAMINER: 16E9 .. 2016 Florida Annual Resale Certificate for Sales Tax DR-13 R. 10/15 THIS CERTIFICATE EXPIRES ON DECEMBER 31,2016 FLORIDA Business Name and Location Address Certificate Number 78-8012464923-2 MIDWEST MEDICAL SUPPLY CO LLC 13400 LAKEFRONT DR EARTH CITY, MO 63045-1516 By extending this certificate or the certificate number to a selling dealer to make eligible purchases of taxable property or services exempt from sales tax and discretionary sales surtax, the person or business named above certifies that the taxable property or services purchased or rented will be resold or re-rented for one or more of the following purposes: • Resale as tangible personal property. • Re-rental as tangible personal property. • Resale of services. • Re-rental as commercial real property. • Incorporation into and sale as part of the repair of tangible personal property by a repair dealer. • Re-rental as transient rental property. • Incorporation as a material, ingredient, or component part of tangible personal property that is being produced for sale by manufacturing, compounding, or processing. Florida law provides for criminal and civil penalties for fraudulent use of a Florida Annual Resale Certificate. The Florida Annual Resale Certificate is issued to active, registered sales and use tax dealers. As a buyer, use your certificate to purchase or rent property or services tax exempt that you intend to resell or re-rent to your customers. You cannot use this certificate to purchase or rent property or services that you will use in your business. As a seller, you must collect sales tax and discretionary sales surtax imposed on retail sales or rentals of taxable property or services, unless the transaction is exempt. Seller Certificate Verification-Verify resale or exemption certificates using a customer's sales tax certificate number: • Phone: 877-FL-RESALE (877-357-3725) • Online: Go to www.myflorida.com/dor and select "More e-Services" and then "Verify resale and exemption certificates" • Mobile App: Florida Tax(FL Tax) mobile app for iPhone, iPad, Android phones and tablets, Windows Phone If you obtain an authorization number for each tax-exempt sale, or for all sales to a specific customer, you do not need to keep a copy of the customer's Florida Annual Resale Certificate. 16E9 ...._---, A e CERTIFICATE OF LIABILITY INSURANCE DATE(MM@D/TYYY) 4/5/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Hy ant-Toledo PHONE 'FAX 811 Madison Ave. (A/C.No.E,d):419 255-1020 JA,No1419-25.5-75.57..._ Toledo OH 43604 A oAREssioledo,_hmi(ghylant.com INSURERS)AFFORDING COVERAGE NAIC 0 INSURER A:Harif rd Fire lnsuranoe Comfy 19682 INSURED CONCHEA-02 INSURER a:Pennsylvania Mfrs Assn Ins Co 12262 Concordance Healthcare Solutions LLC INSURER C: Midwest Medical Supply Co,LLC — o Seneca Medical LLC INSURER D: d ____ 85 Shaffer Park Drive INSURER E: Tiffin OH 44883 INSURER F: �T COVERAGES CERTIFICATE NUMBER:1086859775 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL'SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DDrYYYY) IMM/DDIYYYY) LIMITS A GENERAL LIABILITY Y Y 33UENZB3863 3/25/2016 3/25/2017 EACH OCCURRENCE $1,000,000 NTAZETURENTED- X COMMERCIAL GENERAL LIABIUTY PREMISES(Ea occurrence) $1,000,000 1 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 -- PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 _.._ GEN'L AGGREGATE UMIT APPLIES PER: PRODUCTS-COMP/OP AGG $Excluded POLICY JJEECT LOC $ A AUTOMOBILE LIABILITY 33UENZB3862 3/25/2016 3/25/2017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 _ X _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED -SCHEDULED __ AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS ^AUTOS (Per accident) $ $ A X UMBRELLA LIAB X OCCUR 33RHUZB3828 3/25/2016 3/25/2017 EACH OCCURRENCE $10,000,000 AGGREGATE LIAB CLAIMS-MADE -_.�........._..........._._� $10,000,000 DED X ,RETENTION$10,000 - $ B WORKERS COMPENSATION 201600-0748350 3/25/2016 3/25/2017 X WC STATU- OTH- AND EMPLOYERS'LIABILITY V I N TORYIIMISSa ER__ _ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I E.L.EACH ACCIDENT N/A $1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$1,000,000 If describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCYUMIT $1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATION ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR`�IZED REPRESENTATIVE y� pp 1lAyt 0 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 16E9 �� • DATE(MM/DD/YYYY) ,4 o CERTIFICATE OF LIABILITY INSURANCE 11/29/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.If . SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this ,tea. certificate does not confer rights to the certificate holder in lieu of such endorsement(s). .c PRODUCER CONTACT 'a6 NAME: Aon Risk Services Northeast, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 m Columbus OH Office (NC.No.Ext): (NC.No.): R7 445 Hutchinson Avenue E-MAIL p Suite 900 ADDRESS: _ Columbus OH 43235 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Medmarc Casualty Ins CO 22241 Sarnova, Inc. INSURER B: Hartford Fire Insurance Co. 19682 Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd. INSURER C: Sentinel Insurance Company, Ltd 11000 Dublin OH 43016 USA INSURER D: Hartford Casualty Insurance Co 29424 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570074022208 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER ((MM/DDIYYYY MMIDDM'YY) LIMITS B X COMMERCIAL GENERAL LIABILITY V 33UUNVG3435 12/01/201812/01/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL 8 ADV INJURY $1,000,000 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 N o POLICY I X IPECT LOC PRODUCTS-COMP/OPAGG Excluded 0 OTHER: o N- C 33 UUN VG3435 12/01/2018 12/01/2019 COMBINED SINGLE LIMIT ,n AUTOMOBILE LIABILITY $1,000,000 (Ea accident) .. X ANY AUTO BODILY INJURY(Per person) 0 - z OWNED —SCHEDULED BODILY INJURY(Per accident) d AUTOS ONLY AUTOS PROPERTY DAMAGE A HIRED AUTOS —NON-OWNED J ONLY —AUTOS ONLY (Per accident) 'V--. t, CD D X UMBRELLA LIAB X OCCUR 33RHUvG1892 12/01/201812/01/2019 EACH OCCURRENCE $10,000,000 0 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION 910,000 WORKERS COMPENSATION AND PER OTH- EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Products Liab Y 180H380013 12/01/2018 12/01/2019 Aggregate Limit $10,000,000 Claims Made Agg Deductible $150,000 ME Per Occ Limit $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE: Contract No. 16-6593, EMS Expendables. Collier County Board of County Commissioners is included as Additional Insured in accordance with the policy provisions of the General Liability and Products Liability policies. N il CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE s"- POLICY PROVISIONS. iiil 11--r• Collier County Board of County AUTHORIZED REPRESENTATIVE Commissioners .a; 3295 Tamiami Trail E. 0.5 Naples FL 34112 USA i i��f- p� ,(/'� �iL Si/ �Lrttifc c// a J - ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 16E9 AGENCY CUSTOMER ID: 570000037575 LOC#: A ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Northeast, Inc. sarnova, Inc. POLICY NUMBER See Certificate Number: 570074022208 CARRIER NAIC CODE See Certificate Number: 570074022208 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S)AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information,refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SUER EFFECTIVEEXPIRATION LTR TYPE OF INSURANCE INSR R'\'U POLICY NUMBER LIMITS DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER A Products Liab Y 18oH380013 12/01/2018 12/01/2019 per occ $50,000 claims made Deductible ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD 16E9 SARNINC-01 CSOKOLOWSKI CORE, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY) 11/19/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Daniel R.Gunter PRODUCER NAME: Thompson Flanagan Executive Liability Group (a/c°,No,Ext):(312)239-2890I FAX No►:(312)263-1551 626 W.Jackson Blvd.5th Floor E-MAIL Chicago,IL 60661 ADDRESS:dgunter@thompsonflanagan.com INSURER(S)AFFORDING COVERAGE NAIC#_ INSURER A:Chubb National Insurance Company 10052 INSURED INSURER B:Chubb Indemnity Insurance Company 12777 Sarnova,Inc.Bound Tree Medical,LLC INSURER C: 5000 Tuttle Crossing Blvd. P.O. Box 8023 INSURER D: Dublin,OH 43016 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) (MM/DD/YYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 78-f LOC PRODUCTS-COMP/OP AGG $ OTHER: $ ACOMBINED SINGLE LIMIT AU LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTODS ONLY AUTOSWN p BODILY INJURY(Per accident) $ _ AUETOS ONLY AUOTO ONLY (POerr accidentDAMAGE $ — UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ERH 71744319 12/01/2018 12/01/2019 1,000,000 ANY AFFICER PRIETO R EXCLUDED?ECUTIVE N/A E.L.EACH ACCIDENT $ (Mandatory In NIH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Worker's Comp(MC&SC) 71745679 12/01/20181 12/01/2019 Limits of Insurance 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Other 1 -Policy#:71745679 applies to MS&SC For any and all work performed on behalf of Collier County Contract#16-6593 "EMS Expendables" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Collier County Boardof County Commissioners 3327Tamiami Trail,East 1Naples.FL 34112 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 16E 9 AGENCY CUSTOMER ID:SARNINC-01 CSOKOLOWSKI LOC#: ACC)REYADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Thompson Flanagan Executive LiabilityGroupSarnova,Inc.Bound Tree Medical,LLC P 9 5000 Tuttle Crossing Blvd. POLICY NUMBER P.O.Box 8023 SEE PAGE 1 Dublin,OH 43016 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Named Insureds: 1.Sarnova, Inc. FEIN: 262386055 2. Bound Tree Medical Products, Inc. FEIN: 731646550 3.Tri-Anim Health Services, Inc. FEIN: 952959155 4. Bound Tree Medical, LLC FEIN: 311739487 5.Sarnova HC LLC FEIN: 262549813 6. Emergency Medical Products Inc. FEIN: 391164909 7.Cardiovascular Concepts,Inc. FEIN: 751835412 8. Cardio Partners, Inc. FEIN: 800874694 ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD