HomeMy WebLinkAboutContract 55805CSC No. 55805
FORT WORTH -------.----
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Bound Tree
Medical ("Vendor") and the City of Fort Worth, ("City"), a Texas home rule municipality.
The Cooperative Purchase Agreement includes the following documents which shall be construed in the
order of precedence in which they are listed:
1.This Cooperative Purchase Agreement;
2.Exhibit A -Seller's Quote, Scope of Services or Purchase Order;
3.Exhibit B-Cooperative Agency Contract (e.g., NJPA, DIR, BuyBoard); and
4.Exhibit C -Conflict of Interest Questionnaire.
Exhibits A, B, and C which are attached hereto and incorporated herein, are made a part of this
Agreement for all purposes. Vendor agrees to provide City with the services and goods included in
Exhibit A pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all
exhibits thereto.
City shall pay Vendor in accordance with the fee schedule in Exhibit A and in accordance with
the provisions of this Agreement. Total payment made under this Agreement for the first year by City
shall be in the amount of seven thousand one hundred and thirty-seven dollars ($7,137.00). Vendor
shall not provide any additional items or services or bill for expenses incurred for City not specified by
this Agreement unless City requests and approves in writing the additional costs for such services. City
shall not be liable for any additional expenses of Vendor not specified by this Agreement unless City
first approves such expenses in writing.
The tenn of this Agreement shall be for one year beginning on June 1, 2021 and ending on May
31, 2022. City shall be able to renew this agreement for a one-year renewal options by written agreement
of the parties.
Vendor agrees that City shall, until the expiration of three (3) years after final payment under this
Agreement, or the final conclusion of any audit commenced during the said three years, have access to
and the right to examine at reasonable times any directly pertinent books, documents, papers and records,
including, but not limited to, all electronic records, of Vendor involving transactions relating to this
Agreement at no additional cost to City. Vendor agrees that City shall have access during normal
working hours to all necessary Vendor facilities and shall be provided adequate and appropriate work
space in order to conduct audits in compliance with the provisions of this section. City shall give Vendor
reasonable advance notice of intended audits.
Notices required pursuant to the provisions of this Agreement shall be conclusively determined
to have been delivered when (1) hand-delivered to the other party, its agents, employees, servants or
representatives, (2) delivered by facsimile with electronic confirmation of the transmission, or (3)
received by the other party by United States Mail, registered, return receipt requested, addressed as
follows:
To CITY: Ta VENBOR:
City of Fort Worth Bound Tree MedicaI
Attn: Jesus J. Chapa, Deputy City Manager 5000 TuttIe Crossing Blvd
200 Texas Street Dublin, Ohia 43016
Fort Worth, TX 76IO2-6314 Brian LaDuke, President, Emergency
Facsimile: (8I7) 392-8502 Preparedness
Facsimile: 877-311-2437
With copy to Fort Worth City Attorney's Office
at same address
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
[SIGNATURE PAGE FQLLQWS]
ACCEPTED AND AGREED:
CITY OF FORT WORTH
By:Jesu����S:47CDT)
Name: Jesus J. Chapa
Title: Deputy City Manager
APPROVAL RECOMMENDED:
By: Neil Noakes (Jun 7, 202115:44 CDT)
Name: Neil Noakes
Title: Chief of Police
ATTEST:
By: �9�
Name: Mary J. Kayser
Title: City Secretary
BOUND TREE MEDICAL (All CAPS)
By: �6:)
Name: B�i,;Duke
Title: President, Erne aredness
CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
ensuring all performance and reporting
requirements.
By: Sasha Kane (Jun 1, 202116:12 CDT)
Name: Sasha Kane
Title: Sr. Contra ct Compliance Specialist
APPROVED AS TO FORM AND LEGALITY:
�?_:-By: /
Name: Taylor Paris
Title: Assistant City Attorney
CONTRACT AUTHORIZATION:
M&C: (None Required)
Date Approved:
Form 1295 Certification No.: NIA
Exhibit A— Seller's Quote, Scope of Services or Purchase Qrder;
It�m Lhi for iort Wo nh PuRa� DeputreNiR
Exhibit B- Coaperative Agency Contract {e.g., NJPA, DIR, BuyBoard}
� Board' �
.� ���.�
�orseanr -, � ,��,��e«,n
�h� �� ��
Sent Yia Emeil: submitbids@baundtree.com
Cktris Fyffe
Baund Tree Medical
5000 Tuttle Crossing Blvd
��blirt, dH 43016
wekome to Buy soa�d!
Re: Nabae ofJi�bbns/ Pwrhasing Cao�eraWeAne�
Proposal P6me and Numbera Frst Wd, Emerge�q Medical, and AthlaticTroiner5uppfies and Equipme�, Proposal No.
610-ZQ
Congra�lations, The National Purchasing Cooperotive (Netiorsal Coaperative) has awarded your company a BuyBoerd@
corKract bnsed on the a6ove•referenoed Praposal. As provided for in the Pmposa! and your Na�onal Purchasfng
Coopemtive Vendor Award Ag�semeirt, you ara autfioriied to sell the gaods and services ev�arded under the Proposal ho
Nntional Cooperative members in sta�s otf�er than Tesas thiough the B�yBoard. The cantrbct 's eFfective 6(iJ2420
thmugh 5J31/20Z1, with fivo possible one-year renewals,
7'tie National Coaperative membership Iist is avaitable at onr wehsitg �mt,bs�vboard,cvmlvendor. The t�st identiiies the
currelrt members that may pur�hase awerded goods and services undaryaur National Cooperative BuyBoard contract
You are advlsed lhat receipt of a purchase order directly from a iVatlonal Cooperative member Is aot withYn
SuyBoard gufdelines. Accep�ng purchase orders directly from Cooperative members mey resuh in s violation of
applicnbie competitive procurement �ew and bertninatian of this NaSional Cooperativa 6uyBaard car�tract. Theref�e, al!
purchase orders frvm Natlonal Cooperative membere must be prvicessed through the BuyBoard. Pleasa
farwaid by e-ma�l Go infoa�buyboard,com a� order receired dimctly irom a Natbnal Cooperntive member. jf you
inadver�ntlr process a purzhese order seat directly ta yau 6y a National Cooperative member, please fax the order ta the
above n�mber ard m!e It as RECOi�D OiVLY to prevent duplication,
As an awarded vendor a BuyBoard user id and password wiil 6e sent via e-mai) I to 3 6usiness
days prior to the start of you� contrac�
dn behalf of the National Cooperative, we aie looking fon�vard m yo�r pnrticipation in the prog�am If yau have any
questiare, piease Wnt�lCt Caooera tive Prxurement S�ff at 500-,� j,� 2914,
Sinceiely�
;ti' �__
Arhrro Selnas
OepaRment Qiredor, Cooperative Procurement
..,
. ' � w- ��
F0. 8ax 4W. Ausbn Texas T8767-0400
800.&952919 • 6uybaard.��
� Board �
���e���
12607 Research Houkvard • AustkL To�as 78759•2439 • PFi: 8QQ-695-2919 • FAX: 8Q0�2I1•5454 •�
R P ER' A M N N AT
Pronosal Name• First Aid, Ernergency Medical,
and Athletic Trafner 5uppfies and Equipment
p�pasal 1Vumber: fi10-Zp
i ;
November Zi, 2014 a[ 9:OD PM
1
%ttas Assodadon of School Boards, inc
BWBoard Deparbnent
l2Q07 FtesearCh Blvd.
A�stln, TX 78759
C.4ntractTima Perlads ]ufle 1, 2020 through t+lay
31, 2a21 with two (2) posslble one-year renewals.
��� zozo
Bound Tree Medical
Name oP ProP�MJ �P�Y
'11 l21/2Q'I 9
pate
5Q00 Tuttle Crossing Blvd
street nddress
Dublin, Ohio, 43016
aty, smc�, z�p
soo-533-Q523
Tdephone Number of Aa�or3zed Comparry Offidel
877-3'11-2437
Fax Nwnber of Autharized Company Dflicial
��
SEpnature of Autt�a�ized Car�pany tNildal
Brian LaQuke
Printed Name oF Au#horized Cnmpany ORicJal
President, Emergency Prepa�eriness
Posltlen nr iide oE Autlwrized Campany Odidai
31 �1739487
Federal ID Nurr�r
PeQe 9 of 65
Prapns�l fomts mMW51IC5 v.Q9.12.20Y4
� Board �
��u� ��
izfl07 Researsh 9oulevard � Austin, Texas 78759-I434 • PH: BOff•695•2918 • FAX: BQO-2I1-5454 •�,�
The proposing company ('you" ar "your"} hereb}r acknowiedges and agrees as Follows�
1. You have rarefully examined and understand all CmperaHve infarmadan and documentadon assodated wlth thls
Propesal InvlbGan, Induding the Instructlons to Proposers, Gertieral TeRns and Condltlans, attachment�brms, Item
speciflcatlons, and Ilne Items (collectively "Requirements'�;
2. By Yaur respanse ("Proposal"} to th�s Proposal Invitatlon, you propose bo supply ti�e pr�d�s or servlces submlKed a[
the prloes quoted In your Proposa! and tn shict compliance wlth the Requlrements, unless specl�c deviatlons or
excepUvns are noted In t�e Propnsal;
3. My and a11 devla�ons and exceptions 6o the RequfrerrEenks have been nated in yaur Proposal and no others will be
dalmed;
4. lf t�e CaoperaHve acr�pts ar�y pa�t of your Pra�asal arid awards you a mntract, you will fumish all awaNed produ�s
or se�vloes at the prices quoted and in strlct mmpllante with the Requ(rements (unless sp�cific excepdons are noted ln
the Proposal and aaeptad by the Cooperativve), Induding wtthaut liml�tlon the Rrqulrements rdeted tn:
a. conducting business with Cooperative memi�ers, Iriduding ofTeri�9 prking tn members that Is th� best you affer
compared ta slmllar customers;
b. payment flf a seMa fee in the amount spedfled and as p�nvfded far In this Praposal Invl�Uon;
c. t�e possible award of a pl�gy-back cnntract by anothes govemmental entlty or nonpro�t entlry, In which event
yau will affer ttie awarded goods and servlces In acmrdance w�th the Requlrements; and
d. submittfny p�ice sheets or rak�logs fn the proper farmet as requlred by the Coopera�ve as a prerequisite to
adfvatlan af your contrac�
5. You have cEearly IdendNed on the lndurkd form any InFnrmatlan in ynur Proposal that you betteve to be cenfiidentlal ar
proprie�ry ar that you da not canslder to be pub;lc Infarrnatlon subject 4a puWk disclosure under a Texas Pubitc
InFormattan Act request or simtlar publk Infortnatlon law;
6. The Indhridual slgnlrg thls Agreement is duly auti�ortzed to e�ter into tfie corrtradual relatlnnshlp represented by thls
Proposal Trnitatlon on your behaif and bind you b the i�equirernents, and such individual (and any fndlvldual signlnq a
form) Is authorizrd a�d has tht requ�ite knuwledge to provtde the inFortnatlan and make ti�e represen�tlans and
certlfl�Uom rcqulred in dx Requlremenis;
r. You have rarefu�fy revl�wed your PropQsal, and cat�y that au inForrnatlon provlded Is trve, mm��e artia �►,race, and
you authorize the Conperaqve bs take such actlon as 1t deems appropriatr tn verify such lnformatlon; ar►d
e. My ml�tatement, faasiticatlaan, nr omission In your Praposal, whenever or however disawered, may dlsquaNfy yau
fram ccnsideration for a mntract award under thts Proposal Invltation � r�sutt in terml�aHon of an award ar any other
rernedY ar actlan p:ovided for in the General Terms and Conditloris or by law.
Page 10 of fi5
�0� Fome! C01�4WSNC5 v.419.12.20l9
� Board �
Caa�eraNre Purcdasfap
1204T Research Bauievard • Ausdn, Texas 78759-2439 • PH: 800-695-2914 • FAX: @Op�2l1•595a ��
��R CONTACT �NFORMATIQN
Name of Company: Baund Tree Medical
Vendor Prvpnsal/Coritract Contac[ Name: Chris#flpher Fyffe
Vendor Proposal/Contrad Gorttad E•mau nda►ess; submitbids@boundtree.com
Vaidor Contad MaHlrx� Address for ProposafJContraci Nqticts: ���a T�ttle Crossing Blvd, Dublin,
Ohio, 43016
Company Websit�e: �W•�OUlldt!'@G'.00171
Purchase Orders: All �wr�ase ortfers from Coaperative members wiN be a�at�able through the IntemeG Vendors need
Iniemet acaess and at least ork e-man address so that notlfiradon of new orders can be sent to the Interrset mnWd when
a new pur�hase order arrives. An Infarmatlan guide wIU be provlded to vendors ta asslst them with reb�ievinp ti�elr arders.
P�eas� sale� optiot�s befow for ree�3p! of purshase ordas and proWde the reqepsLed infarmation:
I�._-',�
❑
I wtfl use the fntemet to recelve purchase orders at the �ollow�ng address:
Purdtiase Order E-mall Address: GLiS�OR1E�5ENIC@ C�1 bOUlldtfB@.COI7i
P��� o� �„��: Customer Senrice �,Q: 800-533-0523
Altemate Purctiase Order E-mall Address:
Altembte Pttrtfiase Order Contact: Phane:
Purchase orders may be recelved by the Deslgnated dealer(s) Iden�f�ed on my company's Dealer
Deslgnatlon form as provlded ba the CaoperaEive administratar. I unders�nd that my company sha11
rert►ain resport5tble fw the Cantra� and khe performance of all �eslgnated Dealers under and in
accordance wtth �e Cantract.
u u ": Coaperatlye members wi31 send EtFQs to you by e-mail. Please provlde e-mail addr�sses
far tf�e retNpt of RFQs:
Rr� E-,r,a,i add�3: su�mitbids@boundtree.com
R� �„��; Su�mit Bids �,o�: 8�0-533-0523
Aiternate RFQ E-mall Add�ess: rYan,barr�a boundtree.com
Alternate RfQ Contad: brett.perz@boundtree.00171 p��e:
aage 1! ot 65
Propas�l For�M COI�YAlSYGSv,09.lI.IG19
i Board�
Caopsr�llar Pwrbsslap
12dQ7 Research Baulevard • Austln, TexaS 78754-2435 � PH: BQp-695-2914 • FAX; 80Qdii-5454 •
In : Yonr aompany wlll be dllkd montf�y for tf�e se�vloe fee due under a oontraet awa�ed under th�s Proposat
lnvitatlon, Al) invoices ara available on the BayBoaM wehs}te and e-mail notiBcations wilE be sent when they
era readY to be reMe�►ed. �lease Pror+lde the follawing add�s, contatt and e�mail inFormatlon far rtcdpt oi servla fee
Irnoices astid related communlcatlons:
Please choose �,�ne f11 of the follawing optians icr r�ceipt oE invoices and pro�ida the req�ested
E�formation:
� Service fee lrndces and related cnmmunicatlon5 should be prov�ded directly to my company ak:
Invaice iMailing addres9: 5000 Tuttle Crossing Blvd D���„�� Bids
�y,; Dublin 5��: Ohio �P ��� 4301 fi
Contact Name: pho��: 800-533-0523
Invoice Pax: S77"�� �-2437 Invotce E-mail AddrQss: �ustomerservice@boundtres.COCIi
Atternative �nvaice E-mall Addrass� submitbids@boundtree.COfl'!
❑ ln I�eu ot my comparsy, I requ�i and authorfze all servfoe Fee invo3c�s to be provided dirertiy to t�►e folloyv{ng bllEing
agent�•:
Bllling agent MaiiEng add�ess: De�sartrnen�
dhl- State' Zlp Coda:
Biiting Agent Contact Narne: Phone:
Biliing Aqent Pax: Billing Agent E-mafl Address:
Alternative Bll[ing Ageet E•mail Address:
x" !f �rndor �ufhoNzas a 6llling agent to �ecelve and process serv/ce fee lnvn/ces, !� amardance w!!h the
General Terms artd Condldons af the Contract, �utdor spedllcally acknowledyes artd agrees tha! narh/ny /n
that deslgna[IoR shall re/leve YeRdor of /ts respans/6111U�s and ahllgadons uRder the Cantrad Irx/udMg, but
�ot I/mlled to, paymenl ofall servfce fees under anyCa�tractawarded Vendor.
Psge 12 0! 65
Ptaposal Fanns �W/SVCS r.09.I2.24i4
! Board'
Cee�ersurs PnrcRsalap
12007 Researdt Baulevard • Austin, Texns 79759-2939 • PH: BpG�bgS-29i9 ' FAX, Bflp-ZIl•545A '�t�td.wm
F� Y NVi N D ARM�NT E TI N
FEiOHY CONVICTION DLSC�OSIJIi�
Subsection (a) af Sectlon 44.G34 of theTexas Edu�tian Code (Natiftmdcn of Criminal History af Contractor)
states: "A persan or twsines5 er��ty that enters [nta a �ontract with a scfioni dlsbict must yive advanoe no�te to the dlsbict
If dx pason or an owner ar uperator has been oonvisted of a felany. The natic� mtist fndude a general desaiptlari of the
aonduct resultlng in t#�e mnv;ctlon of a felony."
Secdan 4i.034 further states in Sybsectiop {b)t "A sct�ool dtsMtt may terrr�Inate a contrad wlth a persan or buslness
entlty If the distr3d determines that t�fie persan ar business ent�ty failed to �Ive natice as ►equlral by 5ubsect#on (a) ar
misrcpreseated the conduct rewltlng ln the aonvktlon. The dlsbict must rompensa� the persan or busin�ss endty for
services perForrned beFore the cerrnlnaklon of the contract."
Ptease die�c (J1 ane of the fotlowino:
❑ My eampany !s a pubNdy-hdd co�aradan. (Advarxe notice reqdree++ent doa rot apP�Y m WbidY•held capo►�tlan.�
0 My cornparn �s not awned or aperated 6y anyone who has heen co�victed of a felony.
0 iNy company !s ownedJoperated by the tnllawing indlvidual(s} who has/have been oonvicted of a fNony:
Narr�e ni FdarKs}: g--- � —� _
Detalls of Canvictlofi{s}:
By sEgnature bdow, I oertlfy that tt�e a6ove lnformadan Is Cve, compkte and aa�mate and that I am authorfzed by my
tarnpareY to make thls oeriiflcatlan.
Bound Tree Medica!
Company Wame
' Brian LaDuke
5ig re of Autttiarized Company offldal Printed Name
TI TI N
Neltltier my compatty nor an avvner or p�ipal of my aompany has been debar�cd, stlspended ar atherwlse made lnel�gible
for partldpatlan fn Federal Assisrance prngrams w�der Exec�ive Orde� 12549. 'Oebarment and 5uspension,' as descibed
fn the Federa[ Reylsber and Rulps and f�egulatlons. Neitt�er rny wmparry nor an �+rner er principal of my company Is
currenHy listed on the goverr�ment-wlde exd�fons in 5AM, dcbarred, suspendeci, or otherwise e�cduded by agendes or
dedared ineliglble under any statutory or rcgulatory aut#�ority. Nty company agrees to Imrnedlately noqfy the Cooperatlye
arxt aU Cooperative membe�s with pending purchases o� seeWng to p�rchase from my company fF my cor�pany o� an
owner ar p�iadpaf Is later listed on the govemment-wfde exduslons in SAM, ar Is debarred, suspended, ar otherwlsc
exdud�d by agendes or dedared ineHqlbie under any stah�tory or regulatory aukhorlty.
By �gnature below, i oertify tt�at the a6ove Is btie, complete and aaurate and tf�at I am autlwrized by my campar�y to
rsiake thts eectiRcati�ar►.
Bound Tree Medicaf
,�� ComRany Hame
� . Br�an LaD�ke
5ig -ture of Autharized ComP��1l Oi[idat � Printed Name
Page 13 of 65
P�co�1 Foras OOM�VryCS v.o4.12.1014
i Board�
sanFs.sura Pwahasrng
12067 ft�enrch Boulevard • AusUn, Te�s 78759-2434 • PH: B00•fi95•2919 • FA}(: BOp-2l1-5454 '�
T N NR YD TIFi fV
Chaptcr 2252, 5ubdiapter A, of the Texas Govemrnent Code establlsF�es tertain requlrcments appNc�able tn prapnsers who
are not Texas residents. Urrder the staWte, a"restder�Y' proposer Ls a person whose principal placP of buslnas is In Texas,
includlrg a c�nbacbor whose ultlmate parcnt cflmpany ar majority owner has its pdnclpal plaoe of h�siness In Texas. A
"nanresident" prvpos� Is a person who is not a Texas resld�nk. PJease ladimtn � stahu oE your oompany as a'�esldent"
PropoSer or a"nonre�dent" propeser under tf�ese de�nidons,
. z •...�■. � �., � � �•.. ,... �.�
❑ I�rUfy that my company Es a Resident Pmpas�r,
� I oer�fy that my oompany Is a Nonresident Propaser.
If your company Is a Nonres€dent Proposer, you must provide the fallrnv€r�g Informatlon for your resEdeat stake (the s�te in
whlch yaur oompany's principal place of busfness ls located):
Bound Tree Medical
Company Name
Dublin
ary
5000 Tuttle Crossing BEvd
Address
Ohio 43Q16
S�te ZIp Code
Does your resldent stnte rEquire a proposer whose prindpal place of husir�ess Is In Texas to under-price proposers
whose resldent state is the same as yours by a presa}bed amount ar percentage to reoe4ve a r�mparable contract7
❑ Yes � No
UYhat is tl�e presaibed amount ar peroentage? � ar q�
N MPL YM T N
Sedlon 44.431(b) of the 'Fexas Educatlon Code establ}shps ae�in criteria that a schooi disMd must mnsfder when
detenninfng ta whom to award a aontra�t. Among ihe vlteria for certaln contracts Is whether the vendor or the vendors
�dmate parent or majorkty owner (I) has its prindpai place of 6uslness ln Texas; or (II) empbays at least 500 people In
Te�5,
1F nelther your oompany nor the uklmate parent [flmpany or majoriry owner has its prindpal place af Iwsi�s in Tezas,
does your comPanY� ultlmate parent companY, or majarlry awrur employ at least SOQ peaple in �exas7
❑ Ya � No
BY �� �elow, I certify �at the InFo�matlon In Sectlo�u 1(ResWen�/Nanresl�ent Ce�fi�donf and 2(�errdasr
Emp/aYme�t CerArricabon) above Is bve, �ompleke and ao[urate and tfiat I am authorized hy my company to rrrake thls
certiflcatlan.
Bound Tree Medical
Comparry IVame
r�
Signature af A�ttwrized Comparry oFiiidal
Brian l.aDuice
Printed Name
Paqe 14 af 65
�►eDas�t Forms tqMMlSh+6 v.09.12.7C l9
� 6oard'
Coap�ratfrs Pnrc6aslny
22007 Rese�rch BCukvard • A�rstln,l"p�ls_ 78759-2h39 • PH: 8Q0-59S-2919 • FAX: 800-211-5454 '�,�
N OY TT ERTI TI N
�ffed(ve 5eptember 1, 2817, as amended effect[ve May 7, 20I4 (H.6. 793}, a Texas govemrnenta} eatlty may not enter
fnto a contract with a value flF;lOd�000 or more that Es ta be paid wtwlly or paR1y from public fEaids witlti a aomparry
(exdudfng a snle proprletarship) tfiat kws 10 or more full-dme employees fnr gaods or ser�lus unless t3�e cantrad contains
n wrttten veri�cadon From the wmpany that i� (1} does not bnycett israel; and (2) wlli nnt isoymtt Luad du�ing the term
of the cvnlracG {TEn. Gov'r ConE Ch. 2270). Aaerdingly, thls cerd�mtlon farm is induded ta the extent required by 1aw.
"Boycott Esrael' means refusing tn deat with, terminaUng buslness actlwtl�s wlth, ar otherwlse taking any adian that !s
fnteaded to penaflze, Inflkt econamfc harm on, or Nmit comMerzial relatlsons sgedfically with Isratl, or with a persan or
entlty ddng buslrtess In Lsrae! cr In an Israeli-tantrdled teriimry, but does not Indude an actlan rnade fsx ordlnary business
purposes. 7oc. Gov'rCooE §808.001{i).
By signature below, I c�rtl�yr and vert�y that Vcndor doa not boymtt IsraH and wlll rwt baycott Israel dwing the term of
arsy can�raci awarded under thls Proposal Irsvita�on, lt�at th3s certlfkatlon fs bve, complele and amrrate, and that t am
autt�orized by my cnmpany ko make tlHs certificatien.
Bound Tree Medical
[ompany Narne
��' Brian LaDuke
�
SEgnature of Autltiorized Company Oflidal Printed Name
�: If �cnda�doe.s not w/sh ta make th/s cert/fltat/o�r, retrrrn the 6/ank tornr /n !leu af a comp/eted
certlHcadon.
NQEX�LUDED NATiQ14 QR F�RQGN T�RRORI51' ORGANIZATION C�RTIFICATIQN
Effective September 1, 2D17, Criapter 2252 of the T�cas Govemment Cnde prov�des that a Texas gnvemmental en�ty may
not enter lnto a contrad w3th a tompany engaged In acdve business operatlor� wlth S�an, Tren, or a foreign bamrist
organlzatlon -- speclfi�lly, any company Iden��ed on a Itst prepared and maln�ined hy the Texas Comptroller under Texas
Government Cnde §§BO6.051, 807.Q5I� or 2252.153. (A company that ttse U.S. Gavemr�er�t a�imsativefy declares tn be
exduded from its ied�ra� sanctlons regfine rdatlrtg ro 5udan, Iran, or any [ederal sand�s regime relatlng to a fore3pn
terrerisk arganlaatlon Es rtiot subject Eo the contrad prohfbitlon.)
By siQnature below, I c.�rtiry and verfty ti�at Vendar Is not on the Texas Comptroile�s list identl�ed above; khat this
certllicatlan !s bve, complete and aaur�te; n�sd that I am auti�orized by my comparry to make tt�s ce�tlflmdon.
Bound Tree Medicai
Company Name
� � Brian LaDuke
51 ah�re of Authorized Comparry Ofiicial Rinted Mame
Pa4e 15 of 65
RaPaa1 Fonns �pFW/SVCS v.U9.tL2014
� Board'
���� ��
I2007 Researds Baslevard • Austln, TPxas 78759-2939 • PH: 9aQ-645•2919 • FA%: B00-ZIl-Si54 •
H T I Y N TILIZED B N E T I T N
A propos�r that has heers certifted as a Historical�y UnderutHtzed Busfness (aEsa known as a Minoriry/Wcmen Buslne5s
EnGerprise or `MWBE' and a(I referced to in thls fartn as a`HUB'� ls enoouraged to Indicate I� HlJB o�rtiflcatlon stahrs
wfien respor�ding ta thls Pmposal InWtatian. The el�honk catafogs wla [ndicata HUB cerqfkatlons for vendars that
properly Indkate and document tiieir HUB certificatlon on thls Fortn.
Plsase check fJ] all that anniv:
❑ I[ertify t37at my camparty has been eertlfied as a HUe !n the followlrtig categorles:
❑ Minatity Owned 8psin�ss
❑ Wamen Owned Business
❑ Smvice-Dis�6led Vetaran Owned BnsEnrss {vet.�ran defined by 38 u.S.C. g101{Z), who has a
servfce-connected disabl[ity as deilned by 38 US,C. § 1Dl,{k6), and who has a disabElky radng
of 20°� or more as determined by the U. S. Department of Veteraots Affalrs or Department af
Defense}
C�rtiticatian Nnmber:
Name aF Cert}fying Agency:
� Nly company has NOT been cerrt)fied as a FEue.
By signature below, I oerttfy that tt�e above Is true, cnmplebe and aoc�rate and that I am authorized by my
oompany to make t��;s certlficaffon.
Bound Tree Medical
Company NarrK m - — -
Brian LaDuke
Printed Namt
Slgnature oF Authorized Company Offfdaf
P�qe 16 of 65
PmP�I ��s COhFY'YL'S v.09.12 �!0 S9
� Board'
������ ���
ITfl07 Resee�h 9oulevatd • AusN�, Taas 78759-2439 � PH: BQO-695-2919 • FAX; 80Q-Zll•5454 '�i ,
,-- � � —
�.� �..�, �.
— T AN RVi A� MA N
A cantract awerded under t�ls Proposat Irnri�tion oovbs anEy the speclfic gaods and 5ervices awarded hy tf�e Buy9oard. As
exp{alned in the BuyBaard Pratvrerttent and Construttinn R�Jated Goods arxl Services Advisory for Texas Members
�'Advisory�'), Texas taw pmhiWts the procurement of arc�tiedure ar eagineeri�y setvices throngh a
purchasing coaperathre. This BuyBoard contract does �at taclude sach aerviccs. ArchEtecture or enylneerinq
servtces must be procured by a Cooperadve member sepa�ately, En aaordance with t3�e Prafessionml
Servi�s Procurement Act (Cf�apter 7Z54 af the 7axas Gavernment Code) and vther applicable law and toe�!
pof icy.
The Advlsary, avallable at . provldes an ovefvlew of oert�ln legal reqwrements that
are pot�ntlaliy relevant to a Cocperative membe�s procuremerit af mnstrucUan or aa�tstructlan-rellated gaods and services,
fndudlrg thase tar projeds that may involve nr requfre arci�ltect�e, englneering or Independent �stJng strvices, p oopy
of tltie AdvEsory pn also b� pro+dded upon requ�st,
By slgnatue below, tf�e undersigned a�irms that Prapaser t�as ob�irsed a capy of the Advisory, has read and unders�nds
the Advisary, and Is authorized by Prnposer tn make tt�ls afirmatlnn. ]l Propaser sells oonstrvctlon-r�latai goo�s or
serviaes to a Cooperative rtremher under a&ry8aard co�tract awarded under this Proposa! inv�tation, Pmposer will comply
wlth the Advisary and appl3cabfe leqal requfrem�ts, make a yaod falth effort bo make !ts Cooperaihne mtm6er custnmers
or potential Coop�raqve member customers aware of 5uch requlrements, and provide a Cnoperative member with a mPY
of the AdWsory �efore exca�tlnq a Member Consirucifon Cantract wlth the mtmber ar aaepUng the memt�er's p�dtiase
w�er for constructlon•relaGed goods oc secvices, whlct�ever cnmes firsL
Bound Tree Medicaf
Cnmpany Namc
_ .--,
�—�-- Brian LaDuke
Signature o( Autharized Car�Fany Oflida! Printed Name
11/21/2019
Date
Page 17 of 65
Prapmal femes OQMWSV6 r.09 t120t4
� Boa►�d �
CooperaNra PnrcbaslA/
12007 Researd� Baukvard � Austin, Tdras 78759�2439 • PH: B00•695-2919 • FAX: 840-211-5454 •�
� ,..�.�.,
�v�ATiaN AND C�MPLIA�iCE
If yaur mmpany inter�Cs to devlate from ti�e Ganeral Terms and Can�Hor�s, Proposal Specificatlons nr other requfrements
assadaGed wlth thls Praposal Irwi�tlon, you MUST Ilst all wch devlatians an thls farm, and p�wride compkte and detalled
inEorma�on regarding t�e dev{aqans on this Form ar an at#achment to t#�is iarm. The Cmpva�ve will conslder any
deviatl�ons in Its cnntrad award decision, and re�rves the right to acaept or rejxt a proposat trased upon any submittad
devla�an.
In the absesxe oF any devlatlon Identlfied arsd desoibed In accordana wlth the above, your company must fully comply
wlth the General Tem�s and Condltfans, Propnsal 5ped�ca�ans and all otlter requirements assoda�ed wlth this P�oposal
Irnl�tkn If awarded a wntraci under this Proposa� Imrl�tlon. A deviatlan wHl nat be effective unkss accepted by the
Cnoperadve. The Caoperative may, In Its sole dlsvetlors, seek darlflmtlan from andJor aommunlcate with prrsposer(s)
regardlnp any whmltted deviatian, cnnslstent with gesierel procurement prindpies of fair Campetitlon. The Gooperattve
rrserves the rlght to aczept cx reject a praposat based upon any submlttPd devkaUan.
8 Na; Deviatlons
D Yes; o��
Ust and fully eupfain any devkadons you are submlttlng:
: • /. � Xe _ � � �� � i � : u _ R � •
1. Shipping Via: 0[ammon Cartier ❑ Company Truck ❑�repald and Add to Inwl� ❑ Other.
2. Payment 1"erms; � Net 30 days ❑ 146 In 14/Net 30 days ❑ Other:
3. �tumtx� nf Days for DeNvery: 2�� pR0
4. Vendor Reference/Quote Nwnber: �� �-2a
5. State yaur reWm palicy:
http:llwww. boundtree.camlreturn-policy.aspx
6. Are �lectronlc paymenEs aoceptable7 �Yes ❑ No
7. vae aedlc caM payR,ents acoeptab�e7 �lres ❑ Na
Bound Tree Medica{
Company t�lame
�, B�ian LaDuke
Sig re cf R�thorized Company Offidal Printed Name
V�9e 1B of 65
PropOfLl FamS COMN/SVGS V.09.12.2019
� Board �
Coapsrstlrs Pprchstlap
l2007 Researth Baulevard � Ausdn, TBxas 78759-2439 • PH: 800-b95-2g19 ' FAX: 800-21I•3ASR • buvboard.mm
LOCATIQNI_AUTHORIZED SELLER LISTYNGS
If you have morr than one lomtion/authorized seller that will servic� a con� awarded under thls Proposal lnvitatlon,
please Hst each Eocadora/autf�rized sdler below. If addltlonal sheets are requlred, please duplkate thls form as neoessary.
NOi'E: Awarded Vendars shall remaln responslbte �ar a}f aspects af the �nGact, Induding processing of Purchase Ordds,
and shalt be r�spanslble for the perlormante of aq lo�tlons anQ autt�ized sellers under er�d in accardance wkh tl1e
Contract If ycu are a produd manufatt��rer and wEsh to d�gnate pesk3r�ated Dealers as defined in the General Terms
and Conditlar►s tr receive Coaperaffve member Purchase Orders an yaur behalf, you must comp�eie the Manufadurer
Deslgnated Oealtr fOrm.
Bound Tree Medicaf
Company Name
221 E. Arkansas i.ane Suite 'i45
�a�
Arlington Texas 7609 0
��Y SWtE Zip
800-533-0523 877-311-2437
Phone Number Fax N�mber
Chrisiopher Fyffe
Con�ct Person
Camparry tJame
Add�ess
��Y State ��p
Phort� Number Fax Nuinber
Ccntad Pason
Page 19 0l b5
arap��al Fmrm COMWSVGSv.09.lt.pl9
� Board �
CQiQQIaIJYC PDICEiYSIA�
12007 Research Boulevard • AusHn, Texas 79759-2439 ' PF{: B00-f�95•29l9 ' FAX: 800•211-545q ' bsiv6oard.com
AN FACTURER 4EALER DESIGNATiON,
If Vendor is a manuFacturer that seNs produds through a deakr neiwortc and wishes tn �grsate a dealer or multlple
dcalers ("Desiynated Dealers"} tc rrcdve Cooperative member Purzhase Orders on Vendo�s behalF, you must mmplehe
th3s fortrr for each deaMr you wlsh to designate.
Regardless of any Designated Qealers suhmitt�d 6y Vendor� Vendor spedfl�lly ag�es and atknawtedQ�s that any wch
designatlons are far Ver�dors convenlence only and shalf nat, If Vendor Is awarded a[onhact, relleve Vendor oE any
obligatlons �der tl�e Cantrad, I�duding payment of Cooperative service fees o� all Purehnse flrders suhmltbed to Ves�dor
or arry pesignaaed Dealer, In aaordance wlth the General Terms and Conditlons, an awarded Vendor shall re,naln
resparulbie and Ilable for a!I of tts obllgaUons under the Cen�act and the performanae of bath Vendor and any of Vendors
Desl9nated Dea1e+'s under and In acoordanae wtth the Canbad and rematn wbj�ct to ap rem�dles for default thereurxler,
induding, but not Ilmited m susprnsion and t�rrnlnatlo� of Vendor's Cantract For nonpayment nf servlre fees.
If awarded, Vendor auH�wizes the Coopera�ve, in 1� sole dfscreUon, ta 11st any Vendar Des3gnated pealers in the BuyBoard
sysbem and to reoeive PurcFiasc O�ders dlrectly fram Cnoperative members an behalf aF Vendor, To ttte extent a Ver�dar
wlth OPslgnabed Dealets recelves a Purd�ase Qrder dlr�qiy, k shaH be the responsibf�ty of Vendor to approprlately Proass
such Purthase Order in aaoordan� wlth the Con[ract, Ir�cEudsng but not llmfGed to tlme}y forwardlny such Purchase Ordv ho
a Des4gnated Dealer for processing,
The Coopesative reserves ttse r{ghi, in Its sole dlscetlon, tn reiuse addltion oF, or request remova! af, any Deslgnat�d
Dealer, and Vendor agrees io Immedlatdy requfre such Deslqnated pealer bo cease ac�ng Purchase Orders or othernlse
actlnq an Vendo�s behalf under the Contrad. Furtl�er, the Coop�rative's admtnlstratcx st�aA be auti�orized ho remove or
suspersd any or all Deslgnated D�ale�s from the BuyBoard at any bme i� Its sole dlsaetlon,
If you w£sh to deslgnate a dealer to serv�ce a condact awarded urtder thfs Proposal lrnl[adon, please Ilst the IIesignated
Dealer below and have �Is (orm signed by an aFtldal oF your company autharized Oo make such designaUon. If you wish
ta deslgnake multlple deaters, piease duplica� this ferm as necessary.
Desig�ted Dealer Name
Deslgna6ed Deafer Address
N �a
oN Sta� aP
Phane Flumber p� N�y�
£mall address bcs��nnted DeaierTax ID Numher� (*attar.i� W-9J
Dalgnated Deafer Contad Persan
Yo�x Company Name Signature of Authoriud Comparry OfHdal
Page 24 W 65
Prcpostl Fo+ms C0�4N�SVCS v.p9. [2�2019
� Board�
CeaRerrrlM Pr�rehasfup
1ZQD7 ReseaRh Bauievard • AustJn, Te�qs 78759-2434 • PH: 800�695-2919 ' FAX: B00-z1i-5454 '�j�{���q@
T�7�l,�,���S�ONAL SERVICE DESIGN,�TION
The Cooperative (referred to as "Texas Cooperattv�' En thls farm and tn the Sta4e Sendct Deslgnatlon Form) oR'ers vendors
the opGwrtunity to sen+ice Its members throuyhout tl�e entl� State of Texas. If you do nat plan to servkc all Texas
Coaperative members s�tew[de, yau � Indlcate the sp�d�c reglorts you wiil servlte on thls Form. !f yrou propose !o
serve dlffer�n[ regloRs tar dlfi�ereni pradLcts ar serv/cts Included !n your proposal, ynt► must camplete and
subm/t a separah Texas Re�lona! 3ervlce �u/ynatlon lform for each group of products and clearly Indlcatt
the products or serv/ces to wh/ch the drsl�nat/oR applles In the space prov/�ed at tlre end of th/s form. By
deslgnat/ng a rey/cn or rey/ons, ynu arc cert/fyln� Hrat you are authoNred and wlllMg to prov/de fhe
proposed products and serv/crs M lhose rcglans. Deslgnat/Rg r�g/ans In wh/ch you �rre dther uRab/e or
unwllllny to provlde the spedfled products and serv/tes shaq 6e grounds for e/drer reJecHon of yaur
proposa/ or, Ifawarded, term/natlan of your Contract AddiUonally, If you do nat pfan to servlt� Texas Cooperative
members (l.e., if you wll! servfce only s�tes odter than Texas), you must so Indfcate on this form,
� I w�'ll service Trxas
Cooperadve members
s�tewida
❑ t wit� not serrrise Texas
Cooperadve merttbers
staEewi�a I wEll onfy
sesvice mernaers in tha
regions checked bnlow:
Bound Tree Medical
Cnrcspany Name _ _
5lgnatcme of Aut�o�ized Compa�Y DiRdal
Brian LaDuke
Pdn6ed Name
D
❑
❑
❑
D
0
O
0
❑
a
�
❑
a
D
❑
a
0
0
a
❑
Reaion
1
2
3
a
5
fi
�
8
9
in
il
u
F3
!4
15
16
»
16
14
za
#�dauarters
Edfnhurg
Corpus Christl
VicEaria
Houstan
Bea�ont
Huntsvflle
Kllgore
Mount Pleasant
Wlddta FaUs
aid,ardson
Fort Worth
wam
AusUn
Abilene
5an Anqelo
AmarNla
��
Mldland
EI Paso
San Ant�nEa
� I wNl not strv�ce members
of tlte Texas Cooperative.
Page 21 a! 6;
RODawi fwni �119VC5 v.99.12.7919
Regional Educatlon Serv[ce Centers
� Board �
���,y. �,.��,�
12007 Reseantl Boulevatd ' Aust�t, Texas 78754-2439 ' Pli: 800-595-2919 • FA7(: 840-211-5454 '�
ir.
If thFs Texas Regiar�al Servfa Designatlon Porm applles to ordy one or some of the products and services prapos� by
Ver�dor, flst the products and servloPs ta which thls form applies here:
Psye 22 ai G5
Prepos�t Farmf COFMVSYCSY.Q9.t2.2D14
� Board�
Caopentlrr Pwebaslep
1200] Restarch Baukward' Austln, iexes 78759-2439 • PFf: BDO-695-2g19 • FAX: 800-2I1-5454 '�
�TATE SERVICE DE5IGNATION
The Cooperative oA`ers vendors the oppo►tunity to servicc other govemmental entldes !n the Unitcd 5tabes, Induding
intergavernmentai punfiasing cooperatives such as the Natlanal Purd�asing Caoperadve 6uyBoard. You must complete
thls Form if yau plan to servke We cntlre U�1Ged Statts, or witl scrvke only th� spedfic s�tes Indkated. (IVole: If ynu plan
M servic� Texas Cooperative membcrs, be susrr lhaf ynu comp�lefe Ure Texas Regronal.Servrcr Des/gnatlan /om�. j
If yau serve d/h'erent states for d/lferent products or serv/ces Induded /n your propasal, yau musr comp/ete
and s�bmli a srparaie State 5erv/ce pes/gnadon form for each group of pmducts and Uearly /nd/caie the
products a� serv/c�s to whlch lhe deslgnaden applles In the space prov/ded ee the end of lh/s 1brm, 8y
des/gnating a sL�te or stafes, you are cert/fylrrg tltat you e� authoNzed and wlll/dg to provlde the proposed
products and serv/tes In those states. Des/qnaf/ng states /n wh/ch yau are elther uRa61e or unwllllnQ to
pravlde the spec/fletf products and servlces aha/l be grotrnds 1%r dfher re�ectlon af yo�r proposa! or, If
awarded, termlrrat/an af yaur Confract
i z- : ��,�■. 1. y: ��,•.�
� I wlq serviae all states In the Unitea S[ates.
❑ 1 wiU not senAce all 5tates In the Un}ted 5tat�s. I wlil servlte only the stat�s checked bebw;
Alabama
Alaska
Arizona
Arlcansas
Califomia {Public C,ontrad Code 20118 & 20652)
CoEorado
ConneCtt[ut
Delaware
Dtstrkt af Columbla
Flodda
Geor�la
Hdwail
Idaho
E{Npols
Indiana
Iowa
Kdf15dS
Kentudcy
LoulSiana
Mafne
Marylartid
Massadiusetts
NSidslgan
Minnesob
Mlssissippl
Mlsso�ri
Ma�tana
NebrdS[ca
Nevacia
New Hampshire
New Jersey
New M�dm
New York
North Caralina
Nvrth Dakara
Ohla
Oklahoma
�90�
Pennsylvanfa
Rhode Island
South Carollna
Sa�th Dakota
TEf1Re55lC
Tcr�s
Utah
vermant
Vfrginla
wa5hingkon
West Vir�lnla
VYEsconsin
Wyoming
?ape 2] oF 65
9roCcsal Fmnf OOMM�SI+GS v.09.12.]Ot9
� Board m
C17apQ17lIYe PpfCA3SIAg
12007 Research Bouie+rard • Austln, Texas J8759•2439 � PH: 80Q�695-7919 • FAX: 80a-211�5A54 •�
ThIs form wl1l be uscd ta cr�,wre that you can service other govemmert�l entltla ttuoughout the Ur�ited S�bes as
fn�cated. Your slgnat�e below oonfirms that you understand your servEce commltrnents during the t�mt of a
contract awarded under Ws proposal.
Bound Tree Medical
Company Name
� Brian LaDuke
Slgnature of Autharizeci Cnmpany OFfidal Printed Name
If thEs State Servlce pesrgnatlan form ap�lies to pnly one or some oF thc produr.ts and servlces propcsed by Vendor,
iist the produds and sen+ites to whlch thls form applles here:
P�e 2� a165
RaDosd Form� CDrMV9VCSr.09.t2.2019
� Board �
Caaparaflm Pu�c6asJay
1i007 Rrsearch Bpulevard • Austln, %xas 78754-2939 • PH: BOO�fi95-2919 ' FNf: B00•211-5454 '�
Nar�oNA�PI RCHI�SING C�UPERATiVE VENpOR AWARD AGREEMENT
In aorordance with ttse 7erms and Conditlons a�sattated wlth thls Praposal lrnibdon, a aoritract awarded under thls
Proposal fivitatlon rs�aY be "piggybadced' by ano4her govemmental entlry. The Nadanal Purchasing Cooperativve is an
Intergov�rruner�tai purchasing co�peretive farmed by c�rtaln sct�ool disMds autside oF Texas tn serve i[� members
tt�rnughout the United 5tatrs. Ii you agree to be cor�5ldered for a piggy-badc award by the Natlanal Purthasl�
Coaperative� Yoti agrce to tl�e following terms and agree tn s�rve Nadonal P�xdtiasing Caoperative members In the states
you have indlmted an the 5bte Sesvice Deslynatlan form, ln yaur Prvposal.
By s1�ning tltis fotm, Proposer {rafarred to in thTs Aqreemer�t as "Vendor") egrees as foUows:
i. Vendor adu�awledges diak ff The Lnc�al Govemment Pcuchasing ��rative ("'fexas Cooperative� awards Vendar a
contract under tt�s Proposal Invi�tlon ("Underfyfng Award�, tfie Natlanal Purchasing Covperadve ('NaUonal Cooperaqve�
may - but ts nvt requlred to -"plggy-badc" an ar re-award a11 or a portlon of that Ur:derly�ng Award ("Piggy-Badc Awa�'j,
8y s{gNng tl�ls Natfanal Cooperative Vendor Award Aq�eement �'Agreement'�, Vendor aooepts and agrees to be bour�d hy
any such Plgqy-Back Award as provlded for hereln.
2, In t�e event Natlnnal Caoperadve awards Vendor a P{ggy-Sacic Award, the NaUanal Coopefa�ve Admfnls4-ator
{"&ryBaard Administratn� wlll nod(y Ver�ar In wri�ng of such P{ggy-Sadc Award, whlch award shall commence on the
eFfective date stated In the Nodce and aK! on the expiraHon daGe of the Ur►derlying Award, subject to a�ual renewals as
auti�wized In writlng by the BuySaard Adminlstrator, Veridor agrees that no further signature or uther actlon Es requlred of
Vendor In order far the Plggy-Badc Award and tl�ls Agreement to be binding upo� Vendor. Vendor Further agrees thak no
interllneatfons or changes ta thls Agreement by Vendnr wlll be binding on Natlorial Cflopera�ve, unless such changes are
agreed to by lts BuyBoard Adminlstra�or ln wriang.
3. Vandor agrees that It shall offer Its goods and servicts to t�atlnnal Caaperative members at the same uNt prldng and
same Qeneral terms and conditlans, subjxt to applEcahle state laws ln the state aF purdiase, as requlred by the Underiyfn9
Award. However� nott�ing In tfils Agretment pre�rents Vendar from offering Natlonai [ooperative memtaers heEter (I.e.,
lawer) competltive pricing and mare favorable terms and oor�diqons than those In the Ur+darlying Award.
4. Vendor hereby agrees and con8rm5 that it wHl serve tl�ose states ft has deslgnated on the Staqe Servi� Desfgnatlon
Farm ai thls Prapa�l irnitatfan. llny thartiges ta the states d�slynated on the State Service Deslgnation FaRn must be
appraved ln writlng by the &ryBoard Adminlstrabor.
5. Vendar agrees m pay Nadonai Cooperative th� servlce fee prnvided for ln the Undertying Award 6ased or� the amoint of
purthas� genPrated �ram Natlonal Cooperadve members ttuvugh the PlgqyBack Award. Vend� shall remlt pay+ment Go
NaUonal Cooperattve on such scfiedule as It spediies (whlch sha11 not be more oft.en than monihfy). Further, upon
request, Vendor shali pmvide Natlonal Coaperative witli oopies of all pur�hase orders �enerated from iVatlonal Coaperaqve
members far purposes pf revlewing and verifyfng purchase ac�vity. Vendor fustfier agrers that Na�onal Cooperativve shall
have the right, upor� �easonable written r�otics, bo revlew Vendors remrds pertalNng to purt#�ases made byr National
Cooperative members In order ta verify the accuracy oF servlce Fees.
5, Vmdor agrees thnt the Ur�ying Award, Mdudlny I� General Terms and Canditlans, are adopted by reEerence bo t#ie
fullest act�rit wdi provtsions can reasanably apply to the P��P�/�ntract award phase. The rights and
res�onsibilltles tf�at would or�inarily Inure to t#� Texas Cooperative pursuant !o the Underlying award sha11 Inure to
Natlona! Cooperative; and, wnversely, the rights and responsiblNtles tt�at wauld ardln�rHy inure to Vendor in the Underlying
Award sha![ fnure bQ yendor in thls Agreement Ver�dor rtKognlzes and agrees tliat Vendor arsd Natlonal Cooperative are tlx
anh' Partles to thls Agreement, and that nathing In this Ag�eement has applicaqon to otf�er thlyd pardes, {ncluding ti�e
Texas Cooperaqve. In the event of conflict between thls Agreement and tha berms oF the Elnderlylnq qward, qu p�ms of
tt�ls Agresment shail oonh�ol, and tf�en only ds t�e e�n# necessary to recQncile tht canflick
Vr000sal Ftrms tAMN1sVGsv.os 12.20�9
P89c 25 of b5
i Board�
CaepersNrer P�rckaslnB
12007 Res�atrh 8ptlkv3rd • Austltl, Te�qs 78754�2939 ' PH: 806�fi45•2919 • FAX: 84b-21 I-5454 •
7. This Agreement shall be govemed arsc! construed ln aocordar�[e with the laws oF tf�e State af REiode Islarid ancf ve�e
For any d:s�ute shall He In d�e federal distrid court af Alexandda, Virglnla,
8, Vendar acla�owledg� and agrees tf�at the award of a PlggyBark AwarcE is wlthln the sale disQetlion of Natlanal
Cooperative, arxl that thls A9r�ement dnes not take eRed unkss and untll National Ceeperative awarcts Vendar a Piggy-
Back Awacd and the BuyBoard AdminlsEratnr no��a Vendor !n writing af sucl� Plggy-Back Award as prvvided for hereln.
WFIEREf�RE� bY sl9nEng below Vendor agrc�s to the foregoing and warrants that Jt tw�s the authfl�ity ta mter into this
A9reement
Bound Tree Medical
Name of Ventbr
����
Signat�xe of Auth�xlzed Company Offldal
6'� 0-20
Proposal Invitaiton Number
BrIan LaDuke
Prinfied Name of Autharized Company QffldaE
� �i2�i�o�9
��
?39! 26 Oi 6$ ��� �S �by�VCS vA9.12.2019
� Board'
Caapersflrs Pu�chasGrg
12�47 Researrh Baulevard • Aasdn, T�xas 78759�2434 • PH: 800-695-2919 • FAX� BQ0.211•5454 '��
{ �� � � l � � '.i�l �l� 71 l.11. �1,' 1..�
The Cooperative sbi+res to provkle i� memtKrs with the besc servite, and products at the best prlces avallabfe from
vendors with u�e tecr,r�cal resources and ab�lty to serve caaperacive members. Piease �rspana m rhe fdlovving questions,
Provide the d�llar value nf sales ho ar through purd�asing cvoptradves a[ or tiased en an est�hl3shed catalog ar
market pri� da�ing the prevlaus 12-month period or ti�e last fiscai yesr: � .(The period of the 12
montf� perfod Es __ ./�. 1n the event that a doilar value Is not an appropriate measure of the sales,
provide and desaibe your own meas�re oF #�e sales af the I�em{5},
By subrnitting a prepasaE, you agree that, based on your wrftker► dlscoundng poNdes, the dlsoounhs you eff�r the
Coopera�ve are equaf Do o� better than the best prfce you offer other purchasinq woperatives For the same items
urtder egulvalent dr[umstanoes.
Provtdc the lnforrssallon requ�ted beiow for other purcltasing cooperatives for whith Proposer wrrently serves, or in
the past has served, as an awarded ves�dor. Rows should be added tn accnmmadat� as many purdiasing
coaperadves as requir�d.
Y
I! you are a arrent BuyBoard vendor fn tl�e same contract caUegary as proposed In ttNs Proposal Invftatlan, Indicate the
dlstount far yaur cutrent BtryBoard wn�act and the proposed dismunt in thfs Proposal. Explaln any+ di(ference belween
yvur current arsd proposed dismunts.
Current Oisr.ount (°�6): �� Proposad Discaunt (%): 2$
�; N/A
Page 21 af 65 � F°f°" �� v.o4.tz_2Dt9
� MY COMRANY DOE5 NOT CURRENTLY HIIVE Af+IY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
� Board'
Coopaatlro Pr+rckaslrtp
12007 Res�arth Boutevartf • Austln, Tdas 79759-2439 • PIi: BOO�lS-2914 • FAX: 800-221-5454 •� ,
��� �,
�4N�DENTiAL/PRDPR�ETARY INFQRMATIQN
bli D w
All Proposals, forms, documentatloa, or ather materials submltted by Venaor Go the Cooperattve In respnnse to this
Prnposal IrnitaHon, [ndu�nq catalogs and prloeUsts, may be subJect to tlie disciosure requlrcment� of the 7e�s Publk
Ir�fnrmatlon Act (Te�cas Covemment Code chapter 55Z001, ex se�.) or simHar disctosure law. Proposer must dea�ty
Fdentify on this %rm any Infomiadon in Its Proposal (Induding fom�s, documentatlon, or other maber�als s�,�6mltted with tl�e
Proposal) that Proposer cansfders prop�ietary or can�identlal. If Proposer falks bo pmperly idenqiy tt�e InFormation, the
Cooperative shaU have na nblbgatlan to rwtlfy Vendor or seek prntecdon oF sufi I�farrnatlon from publlc dlscfosure should a
member of the pubUc ar other thlyd party r2ques# acaess to the lnfortnatlon under tt�e T�xas PuWJc InformaUon Act a�
slmilar disdosure law. Proposer uvlil be notlffed of any tfilyd party request fnr Infarmatlan In a Praposai that �'oposer has
IdentlRed In tt�s form as proprletary ar mn�idenbial.
Ooes ynur Proposal (fndudkng forms, dowmentation, or ot3xr mate�ials submltted with 4he Proposal} corstaln fnformadon
wh€ch Vendor cor�siders proprietary or canfldendal7
� NO, [ certily Ihat none af the Infarmatlon included wlth tl�is Propcnal Is mnsldered confidentlal or proprietary.
� YES, I certNy �hat th$ P�oposal contains Infnrmatlor► mnqdered ronfidendal or proprletary and all such InformaUon Is
spedficaqy bdentlfled on thls fotm.
If you responded'YES", you must idendfy below the spedflc Infomtatlon you consider oon�dentlal or proprkbry. UsY ead�
page nurnber, form number, or other infortnatlon suffident m make the Infarmation readNy IdentlRable. The Cooperaqve
and its Adminlstrator will not be responslble for A Proposers fatlure m deady identlfy ]nFomiatlan [onsidered canffdentlal or
proprietary. Further, by �ubmitdng a Proposal, Pmposer adcnowiedg�s thai the Cooperative and its Admintstrator wNl
dlsclose Infortnatlon when requlred hy law, even If suth InforntatEon ha5 been kientlfled hereln as Informadon tlie vendar
considers coMiden�al or proprie�ry.
C�nfidcndal / Pmprietary Infaanaqan:
The percentage off catalag value would be considered confidential.
r����,�,� -
i�aape 31 nf 65 �fOQ"'� ���� v.os.t2.2o i9
i Board�
CacpersNra Pyrel►p�ln�
22007 ReSearch 8oulevard '/wSdn, 7exas 78759-2439 • PH: B0o�595-29l9 • FN{; 808-211-5454 '�.�
$. Coovriaht Ittfo atlort
Does your Proposai (�ndudlag fonns, documentaUon, or otl�er metrsfals submltted witt� ti�e Proposal) wntain copyright
[niwmattan7
� NO� Prnposai (including forms, dqtumcmtatlon, or ather materials submitted wRis the Proposal) does not
rontaia copyriqht tnFormation.
❑ YES� Proposal (Indudlnq (orms, dotumentatlon, or othrr materidls submitted with tlie Frpposal} doe5
conmin copyr&jht IntartnaUan.
]f you responded ~YF.S", Idcntlfy bdaw the specific documenhs or pages cantalning copyri�i►t InFarmatlon.
Gopyright 3nformaUon:
(Rfbdl dda4kTd�.7lSACM9Yncn7edJ
9WBoard membecs (Cooperat#ve and r�onprofit members) seeking to make purc#�ases th�ugh the 6uyeaard may wlsh to
view inFwmatlon inctuded In th� Proposais aF awarded Vendors. If you identlfled Infarmatlon on this form as oonfidentlal,
P�A�fY� or wbjecc W copyright, and yau are awanted a 6uyBoard contratt, yaw acaptance aF tfie BuyBoard contract
award cnrtstlkutes yaur mnsent to the d�sdowre of wch Infom�aGar� to BuyBoard mcmbers, Induding postlng af such
Informatlon nn the secure BuyBoard we5slte far members. Note: Ne{ther the Cooprrative nor its Administratnr will be
resporulb4e for tte� use or dls�thutlon af Informatlan hy BuyBoard rnembers or any other party.
b. Cansentta itelaase PranosaiTbbulation
NolwiNtstarxfing anytfiing In thls Con�dentla��Proprfetary lnformatlan form ta the matrary, by submlttlng a Proposaf,
Vendor consents and agrees that, upon C�ntract award, the Cooperative rnay publEqily release, Ind�ding postlnq on the
publfc BuyBaard websjte, a copy oF tf�e proposal tahulatlon for the Contract Indu�ng Vendor name; Rroposed
���o9/P�� ���(s); P�P�� Pe��J� dlsmurtt(sj, hn�xly labor rate{s), or ather sped8cd pric�g; and Vendor
award or nnn-award Infarmatlon.
9y slgnature bebw, I certify that the informaaan in thls fwm is true, mmplete, and accurate and that I am authorized by
my wmpar�y to make this certi�cation and alE consents artid agreements cnntalned her�ln.
Bound Tree Medica!
Cnrnpany Name
Stgnah�re oFAuthorized ComPany Otfldal
Brian LaDuke
Printed Name
'! 9/21/2019
Da�e
P.19! 32 0! 65 �� �� ��� v.09.12.20i9
� Board'
EoopersUra PwoAasing
12007 Reseatth 8otilevard • Auatlil, 7rxa5 78754�2434 • PH: BOO�fi95•24I9 • FA%: 800-211-5454 •
/1�NDOR BUSINE55 NAME
By submlttlng a Proposal, Propas�r Is seeWng tn enEer Int� a legal mr�Gad wlih tfie Caapera�ve. As such, a Proposer must
be an fndfvidual or kgal b�sslncss entlty capabk oF er�ing {nto a binding oon6ract Pm�scrs, must cwnpletely and
aca.rratelY P�de d�e Enformatton reques6ed beEow or your Proposal may be deemed non-responsive.
Name ot Proposing Cornpas�y: Bound Tree Medical
f� rhe%,a(,�r,e erax mrr��npaekyq tn cmtract wldr are coqoararhr. cw �� an eatr,kd rwn� a�f, a�rR cra nerr. sudr �i�l6r„rsdar m,y
a� �o,�d e�wy 1l ynu �re �g e Jobrt prqaasa/ niGh ar�aGher mb'ty b pvoridr fhe samv A�xpo�sa'd 9oo�ds or servk�, eaah subrNltin9 dikfY
� cerrpk+r a sqo�rafr veraobr hliarrrr�obn +Erm. Sepram'!' op�er�An9 kga! bu�s* ax�b� eve►i N u!►t�trd errd!ler. �ioh prqoasr fa A��e
poods rxra�vtrrs srparsla y mmt submlt tl+elr am pqaa�J
:..r..: ,�.... 1 . �: v u. .•.i....� � �
F �TI?�tl1�F?tiT'��
Indiv�dual/� Praprletar
Corparatlan
L3mlted LJahiilty Company x
Parir�ershlp
Other If qth�r, IdentiFy
State of Incarporatfon prapn�caWe): Qh��
Federal Empioyerldentffiratloa Number: �1-'�739487
(Verrdor must firdude a rnmp/eted jg,� jy� fcrm witfi� their prr�posal)
list the Name(s} by whkh Vendar, If awarded, wishes to be fdentlfled on the 6uyBo3rd: �nwre: J� dd�erdrr dan a,e n+emr o�
�g �r ��o � oror ���a r,�r ,�r fda,� ��� or rr� fiw� ��mv�+r �r a� �d x,d � mnr �+'rvu� a�„�a n�„:
eer6RcateYs� iI� m�utbeamdxr�J
PfWosd FortRs COMWS11C5 r.D4.122G19
Paqe 33 of @5
� Boarr��
coo,ra.a�w. pmehas,e�
12067 Researcts 6otdeverd •/Wstin, Texas 78759�2439 ' PH: BQO-695-2919 • FAX: 80a-211-545�k '�
F�Q�I�R V�NDOR C�R'TIFIC�'�9N
(2 CFR Pert 200 and Appendix II)
Whe� a Cooperative member seeks to P�rc 9flods and suvlces usfng funds cmdsr a federat grant or contract, spedfk
federaE lavrs, reg�atlans, and requiremenis may apply in additlon to thase under state law. 'ii�s lndudes, but �S not Nmited
to, the proaxement staridards af tlx Unkform Adminlstrative Requlrements, Cost Prindples and Audit Requirements for
Federa! Awar�s, 2 ffR 2�0 (sometime.s r�ferred tn as the'Ur�itorm Guidance" or new "EDGqFt'�. Ali Vendors su6m€tUng
proposals must camplete tids EDGAR Certifkatlon Fomt regarding Venda's wtilingness and abliity to comply witfi cer�ln
requiremerEts wtdch mey be appltcable te spedfic Cooperative rt�ember purchases �ing federal grant funds. This
complettd farm wlll be made avallabk Eo CooperaHve members for their use whNe mnsldering tfie[r pc�rzhasing op�ans
when tzsing federal grant fs.inris. Cooperadve members may also rec�.rl2 V�dars t� enter Entn anCfilary agreements, In
addltlon to th� BuyBoard oonhact's general terms and CondlHorts, to address the man6e�s spedRc mntracbual needs,
Inctuding contract requiremenLs for a procurement using fede�al grants or conlraets.
For � of tha Itsms be/ow, Vendor should cert/fy Vendar's agreement arrd ablllty ta camply, where
appllcable, by hav/ng Verrdors author/red represenfative comp/ete and In/t/a/ the appllca6le boxts and s/yn
!he arknow/edgment at lhc end of thls form. !f yau fa/l to rnmpleCr any Ilem In !h!s form, the Cooperaf/ve
wlll cons/der end may /lst the Yardor's response an the BuyBoar,d as "NO,'ttre Vertdnr Is unable or unwllling
to tomply. A"ND' response to any of the Items may, if applic�b�e, impa� ritie ab3Nty of a Coaperative member to
our�hase hnm the Vendnr ustng �Cderal funds.
1. Vertdor Violatian a� Breach aF Cvntrad Tcrms:
Cantrac� fnc more than tfie SimpNfled /u�ulsiti�on Threshnld, whlci� ls the inflatlon a�justed amuunt determined by the
Civillan Agency Acqulsitlon Ca►mc11 and the Defense Ac�uisldon Reyulatlans Coundl (Coundls) as authorized by 41 USC
1908, must address adminlstrative, contractval, nr legal r�medles In Instances wF►ere oantradars vFolaOe or hreach contract
terms, and pruvlde fnr such sanctlons and pesialtles as appropria�.
Provistans regarding Vendor defauit are Induded In the Buy+eoard General Terms aad Conditlons, Induding 5edfon E.16,
Remedies for Defa�t ar�d Tp.rmEnadorr of Cor:tract My Cantract award wlll be sub)ect to such euyBoard C�n�ral Terms
and Cor�ditlans, as well as any addltlonal terms and mnditions In any Purchase Qrder, Cooperativve memhes andllary
conbact, ar Member ConstruttiDn Contract agreed upon by Vendor and the Coaperadve mem6er which must be mnsistant
witfi and pro�ect the Coopera�ve member at least Go khe same exteni as tiie 8uyeaard Tams and Canditlons.
The rert►edies under the Cantrad a►e !n addltlon ta arry ott►cr r�nedks that may be available under law or ln equlty. ey
submlttfng a Proposal, you agree tn th�se Ver�dor violadan acsd hreach of mntract terms.
Z� Tertrdr�ation for Cause cr Canvenie.ncc:
For any Coaperative menber purchase ar aontrad In excess of;�0,000 made us�ng federal Funds, you agree that t�e
fallow�ng term and mndltlon sha31 apply:
71� Caop�eradve memb� may terminale or rar� any pc�drase drler �nder thls Covttracc at any t/me, wl� or w/tl�out
euse, 6Y P��n9 � i>> busli�ess days advan[i� wrltten nodce lo the �endar. If d�ls Rgrerment /s te�nH�alyd !n
aam�ance wleh aa�s Para�al�, are eaaperaLh� manb�r snan o�ry ae �eqw,�d m pay vendar rbr 9ooes or s�s
delf►�d m the ��aGiHe m�qmber prfar [o bhe termin�bhn artd rrot otfxnvlse retumed In acrnmanre wldr l�enao�'s
rrrt�^n pd�iy. rr ene caaperaa've mem6er has oald ver�dor �nr yoo�ds or servras nor y�t v+vNde�a as of e�re datr ei
r�rm�naG�au, ve,r�or shal! �m+ned�iarary r�efund seran pay,ne�rl�'sj.
It an altemaGe provision for terminatlan of a Cooperadv� member p�achas� for cause and cornenler�, Induding the
menrxr by whkh it wlM be effected and the 6asls for settfement, fs fnduded In the Coaperabve members pur�hase order,
andllary agreemerit, or Memtxr CortstrixtFon Con4act agreed to by thc Vcndor, the Cooperathre rtiernbers provision shall
cantraE.
Page 39 a� 65 �°�°= Fomn �IIi/�VCS r,09.11.1019
� Board�
Cospatstiva Purc6al�ry
12007 Research Baukvard ' Ausdn. Td�s 7B754-2439 • Pfi: BOD�695•2919 • FAX: 800�211•545A '�
3. Equal Emptoymen! Opportunity:
Exapt as ctf�awise pravided under 41 CFR Pa�t fi0, ail Coapera�ve member purdiases or ocntracts that meet the
defin�ian of "federally asslsted mnstruc�lon con7act' fn 41 CFR Part 60-1.3 shaH be deemed to lndude the equal
opporhxiity dause provEded under RI LF� 60-1.4(b), In aaocdance wlth Exewtive Order 11245, `Equal Employment
Opportunit�' (30 F[t 123i9� i2935, 3 GFR Part, 19641465 Cors�p., p. 339), as amended by Exeastive Order 11375,
`Amending Exeative drder 11246 Relating to Equal Employrnent Oppor#unity," and Implementlnq regulatlans at 91 C�it
Part b�, "OR4ce of Federal Contract Ccmpiiarxa Prng�ams, Equal Emplvyment Opporhmlty, pepafinent of Labar."
The equal appartunity dause pravided under 41 CFR 60•i.4(b) is hereby Inmrporete�i by reierence. Vendor agrees that
such prnvEslon applies to any CAoperedve member purchasc tx oontract ttrat meets the deANdon of `federally asslsted
constructlor� contracY' in 4! CFR Part 6Q-1.3 and Yendor agrees that It sfwp comply wlth suct� pravl.�on.
4. DaWs-Bacon Ac�
Wher► requfred by Federal progrem IeglslaHan, Vendor agrees that, for a11 Cooperative member prime tanstruClon
mnbacts/purchases In excess of ¢Z,UUO, Vendar shall r�mpiy with tt�e Davls•Baoon A� (4o USC 3141-3144, and 3146-
3148) as supplemer�ted by Department o� Labor regulatlons (29 CFR Part 5, "labor 5tar►dabs Pmvlslons Appllcabk tn
Contracts Caver{ng Federally Flnanced and As�d Canstnectlon"}, In aaordance wtth the sbtute, Va�dor Is required to
pay wages bo �aborers and mechanics at a rate not less tha� the prevafilnp wag�s spec�fied in a wage detertnlnate made 6y
the 5ecretary af l.abor. In addidon, Vendar shall pay rvages not las than oncr a week.
Curren[ prevaEHng wage determinatlons lssued by the Departrnent af Labor are avallable at wdol.aov. Vendor agrees that,
far any pur�hase tn which thls requirement applies, the award aF the purzhase to the Ver�da ks cur�ditloned upon Vendors
aaeptance of the wage detdminatlon.
Yendar further agrees that it shalt afso cemp�y wtih the Copeland "Antl•Kitkback' Act (40 USC 3145), as supplemes�bed by
Department oF Labor regulatiivns (29 CFR Part 3, "ContracGors and Subcontradors on Pubiic Bullding or publlc Work
Rnanced in Whole or In Part by Loaris or Grants from the lfnited 5�tes'. The Act provfdes tha[ each mntractor or
subredplent must he prnhiblt$d from Indudn9� bY any mearu, any person employed In tfie construction, tum�ldion, or
rcpeir oF publk work, to glve up any part of the compensatlan to whicn he or she is othernlse entltled.
5. Contraet Woric Hours a�d Safety 5tandards Act:
Where appllrahle, for ail Cooperative member mntracts ar pur�ases En e�ccess of $100,040 ttiaat Involve t�e cmployment af
media�ics or laborers, Vendor agrees 6o comply wlth 40 USC 37U� �nd 3704, as wpplemented by Depar�nent af Lahor
rcgulatIans (29 CFR Part 5). Ur�der 40 U5C 3702 of the Act, Vendor is requlred to oompute ti�e wag�s aF every mectianlc
and laborcr on the basls of a standard wark weelc of 40 hours. Work in excess oF the standard worlc week ts permEssible
provided that the worice� Is compensated at a rate of not less than one and a half tlmes the haslc rate aF pay far all twu�
worked In excess of 40 hours in the work week. The requlrements of 40 USC 37D4 are applkable ta cans�vcdnn work and
provlde tfsat no labarer or mechanlc must be requtred ta work in surraur►dings or under woiicing wndlt�ons whld� are
unsanitary, hazardous or dangervus. Ti►ese requlremenis do not appiy tn tfse puRhases of suppNes or maLerlals ar artides
ordina�ily avallable an the open mark�t, or contracls for transpar�tior� or transmisslan aF lntd!{9enc�.
6. R�ght to invenifons Made lfnder a Contraci ar AgreeMan�
]f the CooperaUve mem�s Federal award meets Ehe defiNUon oF "fur�ding agreemenC under 37 CFK 4D1.2(a} and the
redplent or subredpient wlsF�es to enter Into a contract wit}� a small pusiness firrr� or nonprafit argantzatlon regarding the
substitutlon of partles, asslgnment ar performana or experimental, devebpmrntnl, o� resea�ch wark under t�at "fiaiding
apr�ement," the redpient or subradpient must oomply with the regulrtmMts of 37 CFR Part 401, "Rlghts bo Inventlons
Made by Nonproflt Organlxatia�s and Small Bustness Firms Under Govemment Grar►hs, Conhacts and CooperaUve
Agreements," and arry Implemendng regulatlans issued by the awarding ag�ncy.
Vendor agrees to oomply wEth th� above requlrements when applfcable.
Page 35 of 65 P'0� F°r"'s L�wl5v�5 ",a9 sT Zal9
� Board�
CaoR�Hve FurakasMp
12007 Res�arch Boulevard • Ausdn, TexAs 78754-2439 • PH: 800�645-7919 • FAX: 800•211-5454 '�
7. Clean Atr Act and Federal Water Rollutiatt Control Ac�
CEean Air Act (42 U5C 7A01-7671q.j and tl�e Federal Waber PoUudon Contral Act (33 U5C iZSl-138�, as amertded —
�ontracts ar�d subgrants oF amounGs In e�ss af �15o,OQ0 must aantaln a proWslon t�at reqakes the non-Federai award to
agree to wm�ly wlth all appNcable standards, arders, or reguladons Issued pursuant to the pean Air Act (42 U5C 7401-
7671q.} and the Federal Water Pollution Conhnl Act, as amended (33 USC 1251-1387). Vtoladvots must be reported to the
Faderai awarding agency and the Eteg{onal Ofifce of the �nvironmental ProtecUon Agency (EPA}.
When required, Vendor agrees to oomply with alt appticab�e standards, orders, or regufa�ans iswed pursuant ta the Clean
Af� Act and the Federal Water Polfutlon Cantrd Act,
8. Debarrrtient and 5uspenslon:
DebamKnt and Suspension (Executive Or�ers 12549 and 12689) — A cantract award (see 2 CFR 180.220) must not he
made m partles Ilsted an tt�e govemment-wlde exduslons In tha Systan for Award Management (5AM), fn acrordance with
the QM8 guidellnes at 2 CFR 180 that Implemerst Executivve Qrders 12549 (3 CFit PaR 1966 Comp, p. 194) and 12689 {3
f�R Part 1989 Comp. p. 235), "Debarment and Susper►sFon.' SAM Exduslons contalns the nama of pardes deharred,
suspended, or otherwlse exduded hy agdides, as wdl as parties detlared Ineligible under Statutory or regulatory atrtttarky
otherthan ExecuUve Order 12549.
Vendor certifies that Vendor Is not currenUy+ Ilsied on the gov�mment-wide a�dus}ons in SAM, is nat debarred, suspended,
or otherwise exduded by agersdes or dedartd ine3lgihle under statutary or �gufatory a�tharity other tl�an F�eaitive Order
12549. Vendor furti�r agrees to knmediabely noHfy the Canperative and all Cooperat3vve memhers wtth pending pw�chases
or sedcing tn purchase fram Vendor if Vendor Is later Ilsted en tix govemment-wide e�cdusions in 5AM, or Is debarred,
suspended, ar othernlse ocduded by agenda or dedared Inellglble ander s�t�tory or regulatory autharity other than
Exe[utive Qrder l2549.
9. eyr� Anti-Lobbying Amendmen�
Hyrd Ar�ti•Lobbying Amendment (31 USC I352) -- Vendars that apply ar b{d far an award aceediny $i00,�00 mtast flle the
requtred tertlflpdon. Each tler certl8es to the tler abave that ft will not and has not used Federal appropriated funds ta
pay any person or organlzatlon for Influerxirx� or atternptlng tn InOuence an o�lcer or employee af arty ages�cy, a member
Of CtliKjT255� oH}�r or am�oyee oF Congress, or an employee of a memb�r of Cong�ess In connectlan wlth obtaining any
��� ��� 4�nt or arN other award oovered hy 31 USC 135z. Each Uer must also dlsdose any lobbying with non-
Federal funds tf�at takes plar.� In connatfon with obmining any Federal award, Such disdosures are Forwarded from tler to
tler up to the nan-Federal award. As applicab�e, Vendor agreas to file all cerbiflcatlons and �scfowres req�red by, and
otl�erwlse campiy wlth, tl�e Byrd An�•Lobbyfng Amendment (31 USC I35Z),
10. Procurement aF Recovered Materials:
For Cooperative rtsember purchases utilizing Federal funds, Vendor agr�es to mmply with 5ectlon GOOi of the 5olid Waste
asposal Ad, as amended by tt�e Resourte Conservatlon and Recavery A� where appllm6le and provfde sud� Inbrmatlon
and ce�tifiptlons as a CooperaUve member may requtre to wnflrm estlmates and otherwtse cort►pty, The requirements et
Sedion 6002 indude procurinq only ftems deslgnated M gufdeUnes of ttx Envlranmental Protectlon Agency (EPA) at 40 CFR
Part Z4T that cantain the hlghest percentage of recovered materiaEs practicat�le, mnsis#ent Hrlth maintaining a satisfac0ory
Ievel of competld�n, where the purchase pd� af tt� Ibem acceeds $1D,000 ar the value of the c}�ntity aoqulred during the
precedir�g flscal year exceeded �30,oa0; �ncuring solid waste management servlo�s in a menner that maxlmlza energy
and �esours� recovery, ar+d estabUshing an a�irn�atfvve �ocu�ement progrem far proarrement of recovered maber{als
identlfled In the EPA guldellnes.
ii. Profit as a Separate Eiement of Price:
For purchases using tederal funds In excess of tf�e 5lmpiffied AcgulsWon Thresho�d, a[aoperativve member may be requfred
tio negottate profit as a separate dement af the �icr. See, 2 CFR 200.373(b). When raqutred by a Caoperadve memher,
Vendo� agrees ba prouide inFarmatlon and negoUate with the Cooperattve member regar�r�g protit as a separate element
of the p:ioe far a pardctidar purdzase. Fiawever, Vendor agrees tiiat tt�e total price, induding p�vFit, chargecf by Vendor Go
the Caaperative member shali nat occeed the awarded pridng, induding any appl�aable dlscount, under Ver:do�s
Coopaative Conbact.
Ropos+l Wnns COMW51rG5 v.p9.I2.7D19
Pagt 36 d 65
s l�oard �
Ceopa�affra Porcbaalap
12007 Resc�rch Boukva►d ' Austtn. Tezas 78759-2439 � PH: 800�fi95•2919 • FAX: 800-211-5954 '�,.q�
iL �enerel CampHance and Caaperation with Ceoperative Members:
In addltlon [o the forrgoin9 sp�ciBc requtrements, Vendar agrees, in aaeptlnq any Purdsase Qrder from a CooperaUve
member, it shali make a good Eaitf� efiart ka wark wlth Cooperakivve members ta provide suct► Infom�atksn and to satlsfy
such requirements as may appiy ta a particular Cnoperative memher pur�hase or pur�hases lncEuding, but not Nmlted ta,
aQPfMaWe reaord�fepi�4 and reonr�f retentl� reaulrements.
— - Y�pLCertlflotion:
YES, Y astee or
V�d►x Ce�tlllratta't I__tern f+Fv. _ NO I N4T Initfa!
1. Venaor Vlolation or 8reath oF Cantrad Terms YES ��
2. Tertnlnatlon for Cause or Cawenler�ce YES [„
3, ERua! Emuloymentoppartur�ty �__-- �YES L
a. na�+Fs-saco�, �tct YES L �_
5, Gonbad worlc tiaurs ar� SaFety starxiards Act YE5 L
b. R1Qht to lrnteritlons Madt U�iv a Cantract ar Agreement YES
f�L
7. Clean A1r Act and Federat Water Pallutlon Cvntrol Act YES LLt�LL
8. Oebam�mt and Suspension _ YES
9. eyrd Mti-Lobbyksy M�er�dment YES �
�o. Procwemer,c oF aecovered r�acerta�s YES �'L
11. Profit as a separat� Element of Price YES �
lz. Genera� [ampllarice and Ceoperation wlth coaperative Members YES �l_.
8y slgnature bdow, I certlfy that the [nformadon In thls (ortn Is true, complete, and acarate and tt�at I am authorized by
my company bo make th�s certlfi��on and all ceiuents a�d agreements cnn�lned hereln,
8ound Tree Medical
Cartipany Name
�—
S { re af Authorfxed Company Offldal
Brian L.aDufce
Printed Name
PiQ� 37 Of 65 �� F°� ��5 v.09.12.2019
�Boart!"
Proposal Invitatian Na 61p-20-FirstAkl, Emergency Mr�nl, AthktkTratner5upplfes and Equipment
wa �
aQjjt Van6ars propaslnq nrSou� manuhGura p�aduct Ilnea per tlne iteen on d+e �roporal5peckM1otlan Form fnust su6mit tbe Infw�natbe n fellews er
proPo++� maY eot b� me�slder�d:
Q�la�uhcturos shaN be Ilsted In dphabetial crder
OJcndoYs must � it ene �pesJfk perQnt�pe dlsmunt for each M�nuh[turor Ufted.
If a ventloYs ees{wnse tn Pmpenl Speclf{qdon Fwm s�tes'pkw s�e atbchment sMft,' �tt Mfnuhd�rm N�sd m t1�e �tpchment fhe�t mwt IndluDe
psr manufKbwrsr tM Hm (hm Ihat corralaRes m Prov� � Fom� m Vedo�� P�Po� �Y not ba caaidcred.
' Fi�t Ald NN!
5� Pwse�rt {'Ii)
1� of DboolMk alf Stalr! fhllle of lsuptlq�q t9
t/o. 511olt PoC Plfodht• Arlu�sl� bh�a�R
�� �� � Band Tlce 110diCsl Ai4� antl
�� � PleiGe si7t� th� dbWu* {96) oR ablDqfpflcdkt for Hn! AW 28 � 9-2920 bt mfelf �
1 lqurpm�nta�ds�pp�t� p�r►,x�aMusrww,a.dr.rw+r.� � vdnwansa�oq.« ���
.0 rac �s w�ew.r.r.
��P� www.hdlfkYN.COm 1D'%Abm�ni
Baurd Tree 1AMfof AEOs ard
ot.�.�c cx� ar a� s�a �t+e �axK {a) s�r oeustw+��t ra �ra �►w 28 �aucu aaro9
2 caaVoqfpna�cnr wn�ihr.. ue,�r.r+c.wenvsre.ww.r.�.Mn.u.. 96 mtl�2o2oormro,! ��
Fir# Ald Finrx�re r�M.r.�. w�� n� � scax. uiu �..ro�t
w�rwbauM6aa.mm 10�1i e�nr+l�
ahmu+t (%} (Xf BouM T1ae Medal +�s w�d
������ � Pleese sbte tha �carK (Si) o1f otsbqJprfccGst for 6iNdlnp Conkoi 2$ Roducff CMsb9 �i�
3 ��d SbHORf. Gdql►rks��t MUSr be �ch�hd w P��� w4 n�t M 46 2019,202� or lelest Saw vitl Ls�M
S�SIOfK � �� ���' � M�U albre0 fa
www.6amdhe�,[om SO%ci�adrM
�Y �%� � BaLnd TrlE A/edkal ilEdL 8fld
UtabglPrkdtst fw AM Please sAsuc fhe dstinrk (96) off ataiaqlpf�lst for Ali Other Firat O ProduW Ca�abO ac�sssarles,
4 Other Rst AId,1H�lth 2[7 201 G�2QZ0 a lalm!
JUd. lS�slth, �nd Nurslny Producb. warsln+aie nar►� ra�w -- 'K p,� n�y�. Qr Curoplex iQt+,
andlarsMgRNnted .r•oro..i..qwcy.oande.r.i, www.bounCkes.co ���
� „� Laerdal items
. .--
� r�aras�� s►cnnunow eu�N
1. t1�6�1RMGt �re ra4� Oo be wbnitad Mh OFoposal ►qe ai a n
� oard'
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prvposal Invitatbn No. fi10-20-First AW, Em�rgan�Y Hedfal, AthleticTrainerSuPP�les and Equipment
: AllralleTnlner �nd 1
Stdv Pasv�t (�i)
!!an o! W+aow�t rlf it�ts Il�m� d 6cuptla�s fa
Ila S�t h�ll Ptiod4t+ � DFiaomd
�'"x (%� af N!A
,w,` �'r"�1'a'" vk.x xste n,� asca.,� t�� orr a4war� ror AM�tlC NIA
5 Tral��RehabHiSlien Equlpeeqnt �nA 3rP1�• �+�Yl�MK �
/i1CtaN6btlon �usr w hid.d.a w�rww+1 �.Iu �.e r m.rraK
E�4�I1C1[ Mltl
$I,qpA 'es
�k �� � WA
Cabby/Prlaekl ra pp� p� tlu �t ('h) atr cNaloQlp�iceYst tor J�tl�latk
6 tralnerlrtehab�onPu�ww�r►�wae►aare.r,e�a ni/{�----''�
l�� rw�.� •a �.e w �.wnd.
w�rwn..
�b�+�c (�h) Od' N!A
[a�hqlPr� far JW plea� smce Me dsmun �9�) alf taUlogJprfQlnt Kr Jtll OMar Athledc
1 �C�aAu,kx rraM..�a.h.bl�kasla,amauca. �,.to,r..+�xus.w�e..d N/A u
fakMllRd1lIb1�WGOfS �r�+� r1� u�t N anf14��A.
PtOdlr�
�iadfd �ad {�t
Ofs�rt {�N.) Off Baund Tree AAed'iral AED! Bld
�v PlCase SG7[c S�@ �a'asK (4LJ oR ofllop/P�� ��9�Y `Z8 �S��a a���,
a�+9��Y �� Medtal Equbatmt! atd Suppies. ouise!►�at wusT ba buu�d a 'E Curepler Kils,
Equlpmpst and p..pv.�.�a �ot w o�ou.,.d. iM� m�0. or Sccar, a�ld
� www.bound�e.cam
Laerdal fIB
olsmir�s <9c) art 8aundTrea I+kacd AEI]s end
oCdogl�'rkdKe rar �u aaase stsEe n,e aawx (9�y ar � rar xa on,u 28 �s ��a aeceaaorie�,
4 ��� EmeryencyMedlralPleduW. Gt.1y/Mai�tHUs►6,eMcl.idw q 2019-1Q20dNlest CUI'apiexi(ISS,
MOd�Q1 }4cduCts a��l wlp na Ye nnYMwO. wrw.dew�Eaf�.mm SQaf� 817d
Laerda! k
Y. O�WWhb�: are nquYrl e 6e c+la�wss! ..ap psVpW +,9. �,- ^' �r ra►aauw[anunw rwM
I � �
Proposal Imitatlan No. 61fl-20-FirstAid, Emergeney 4ledkal, AtfiledcTraM�rSupplks and EqulpmenC
.a �
: � «�d Y�aeG�
s�e pmeent (+ii}
� o! DboowE! elf StaFa fpuu� d F�eeeptlarr !o
Ilo. 61�o�t FuN rtfe�t� Dhea�r�t
9an+d in� hNdial AEQs ond
�rt ��? � Pl�esa ca0e 11w dkmr+t (9i) aff ca0ibq/C�'+a lor Pharnuwutlok 201�,2�OZ0 w 1ol�esl eaeaaa�ttra,
lo �� andVKcinai c.uruwfrr.�Musri.x+aw.drpw.��elweb. 28 -`w Frinledcalalop,or CuraplexiCits,
�� www.barWb�a.w �a• arKS
��� ,� Leerdal Re�r�s
oflered for
Bau�d Ties Medcat AEDn and
oem�� (yb) ox P�oaucu caia�og aaesso�3es.
�51�� � a�se scaue d�e aswu�c t�) oR oaioyRk�sc rar rntrrv.nous Zg 201 �7020 w lalesi Curo x Krts,
u Intra-veraa Pdarauaeudul SuvM� aexalm«�ue rwsr k r�wrea «w+�v+r _� pr4xed mintop. or �
Murm�eullnl ■ano�e.mwld.r.i www.tia�xidtraa.ea ScGar. and
5��pp�a m Lgerdalltsms
aNered (ar
Baund Trw M�dsccl AEDs and
Praluds Ca
�°�"�c� {a �,+� r� r� rou n+e e�.0 c�� ar c�oa�� w onro r�xw � 28 su � a.mlo a ���u �„r� `i�.
� Dr�+9 Tes1Yy IOts and �� �• �+�•olrrluk Nusr�e �r s pepa.�..a.�t b� - i Rm� ��9. a Seeer, end
�� www.hamdme eo Leerdal Hema
n
flered ior
t rd Otl�r A�tad ttana
WA
dsm�n� (1�) Oft
��0/�loeht Id Pkase sSMe Uie d�nt (96} d} mtalog/prl�qt far iu�oloyr
�s +�o,� �. �+�.,,�,►�,,.� � ��.� ��� N/A _ _,�
F�'�Af9 Aldl. Md dWMI/rMYK N17it M MOMC � A�ul �M m� �s m�1ew�
Ot1Y.f Rlliled Ita�
�B nno��swartunw raiw
t. r�rp/Aiarm .a �reR ao be si0meled w�t+ Prapesel r+ori ��1 �a
�Board'
Proposal tnHbtlon No. 530-�0-Fbst Aid, Emagenry Nedicat, AthlelicTrainu5upplirs and Fquipment
Q � a �
• L�tlatkn and 5�rrin
DadMad Cxe�tlau b
l�eee Nat ts l�era�A ful�eetea!!eu m NouM� ta6oe
lwo. 6i�ert Fadl ts0ar Ra� ta6er Rabe Ra1a
►mt m E� Nnrry NIA
tabor R�te for
irs�atloNReYak ��LabxRatahx=rtsbpWoal��afFhstAt4Atldalk
s"''°� °� �"�. TYa(nv/ Wh�bpksdon� �md lmW��a! M�dlwl Eq�dpeauK and NlA
i, ,ut�uc a,oaur.� - swe �e na e� r�a �,, w� nce ra s�rw�r
��� Ir�tlaVRepat Strvlr� d� md Rnc�xtr.
He�mlFqWpmeM
ud Prod��
WA
t�r�t m E�ed rarh
V���� xo�aly tabor wss ror Im�Oatbela.pai. of a,�olopY n1/pl
15 ����Y � � Qate���� hpulY IiLv 17W i ___ J Fiar
Eput�nt md
ProCirls
� rwrot�csnv�utroM ran
6� am iea� m b. u�d� w�m Pecpod r�,a � I6
�. Bou nd Tree
i'o Whom It May Cancem,
i000TW{h4w�InpN,rd Dublin,OHU616 61I7i0.S900 wwwyp�ndSrnwm
In response to your bid rec�usst, Bound Trez Medicul is plcased to ofFer 28"a off of the
prices f�om the current Bound Tree Mcdical Emergracy Medical Product Catatog. These
iicros nre ufso available far reftrence an aur website, www.bounduce.�om
In order to providc a pcncentnge off list disceunt, it is neeessary for Hound Trce to
rxcludc ccrtain product categories ar mannfecturer products. This is lar�ely due ta the
cost variebi}ity af thcsc itcros as a result oi markrt demand and rz�w matcrial costs.
Products exeludcd from the gercentage off bid include ihc t'allowin�;
We are pleased to provide you with a enmpetitive bid {'or the eme�ency mcciical
supplies anci equipment thnt yau are seeking. t'leese contact aur Bids and Contracts
Dcp�utmcnt at 8{}Q-533•0523 with any qucsliflns. Thank yott.
Sincerely,
����� �
c�;s�oFh� Fytr�
Manager* Bid & Can�rncts
1�� udditiori, Plran�racecr�ira! urrd 1�' Suhrtions prodr�c� raregaries tiv111 be v,(J'ered at o
Z83o discnuul from tl�e u�rrenl fisled prices or� a�t��►�.barir�drree.cam.
�; Bound Tree - -.
60007un1� Crc��kq 8.vd Du04n. OH t�pt6 61� 76p SpOp www bwind�raa com
Pharmaceutical Price Increase
It is Bound Tree's intent nat to increase pricing on pharmaceutit�l products for the inilial
contract term. However, manufacturers have recently heen signiftcanEly increasfng prices an
phaRnaceutical praducls due to market conditions and 1he associat�d costs to comply with
€ederat legislations. In t�e event such price increases occur after tt►e bid award, 6ound iree
wiil natify you of such increases and provide adequate documentation frorn the manufaciurer
to demonstraie evidence of ir�crease. ihe new pricing will then go tnto effect based an a
notification period provicled. If the cuslomer does nat accept ihe increase, Bound Tree
r�:serves !he right to remove 1he prpductts) fr�m the conlraci ar find an altemat�ve prat3uct at
na addi6onai cost to Bound iree,
Exhibit C— Canflict of Interest Questionnaire.
CONFLlCT OF INTEREST OUESTIONHAIR� FORM CIQ
For vendor dainp 6usiness with local govemmental entfly
Thh quptbnnaln r�M�cta ctunpea in�d� to tM Isw 6Y M.B. 2�� Mlfi Lep., Rpdr S�fslan.
This queslfonnaire ic 6einp fded In aocordance wfth Chapter i79. LcCdl Go�emmenS Code,
by a vendorwho has a busi�ass rele4onshlp as definod 6y Section 176.00t (1 �a) with a bcal
govemmerta! entlry and fhe vendor meets requhemenls undar Seetlon 176.006(a}.
9y law thls questlarvalra m�at be fied wilh Vta records administra�r ot Ihe bWl povpnrr�tal
eniiry not I.it¢r than the 7th buslness day aRer Iha date the vemlor becames aware ol taets
th81 regulre Mse statement W be flled. See Section 178.066(a-i), Local Government Code.
A vandor oommits an oflence i! Ihe vendor knowingly vidales Sectlon 176.D06, Loca)
Govomment Code. M oflenae urider Shls aection is a misdemeanpr.
� Narn�olwndwwho ha� ebu�►n�at ralAUonshl w{th local
p Qov�rtfinetHal�Mity.
you an tuuq en u pmt� to �
W�ICE llSE OIILY
baa Neaer�a
{The law nquiru fhat you lil� an upaatsd tomp3etad que�t-annaim wlth Sha appropriatr 11llnQ suSharEry nof
later than tM 71h Dwinesa day aRer th� dats on whids you h�cam� qwtue Cx�l Shs oriphaaly fded q�tionnaire rr,�
6�cantpkte or inacwrahJ
Nam+ot loeat govemment aMker ebout whom tAe inlamatbn in thls �ectton i� hfing d4eloutl.
N/A
Neme or ptftcm
Thia tecl�on (!em 3 irckdinp tt�paAa A, B, C, d D) mimt be conplottd lor e0d+ o:lca wkh wham tha vendor hm an
employm�r� or other hwinsu relatlarschfp aa detined hy Secllon 178.001(1 �aj, LOC�I CaOVBRirtI@N {'AtlP. At1iC11 iddltqfl�l
papas fa Nis Forcn CIO as nlcstcary.
A. la She bcd povemmert oHiur nemed in InIA sectlon 1aClivinp a�Ny ta recdve tuahle 6ccros, olh� than kwetimeM
i�n�, hom dso verda7
� Ya� � No
9. I� the wndor roeeMirq or ikely to reriivptasabla i�Co:rie, olhcr than YxtsbfMnl ircama, Irom orat the drc�ction d!he lowi
poVartunent olfcer nprned in lhls sedbn AND �e laxabie h�mma ia nal racbiwd hom C�e bcal povemmernaf enSity4
� Ye� � Na
C. !c the filar ot IhLL quest!onnaire employed by a ca�ornibn or o�her hue&�ess enlliy wIM respee; to which the local
govemm�M ollicar arvaa aa an oqieer ar d�reefor. or hald� an ovmanhi� inlamst of one perc�nl er morofi
�Yn aNa
D. 6escr;ba each emQbymeM a busvies� and hmy relationstup w�h ths ixal po+nmmeni a:l+eer nam�d in Iris saction.
_ _! 5 a � � 5/2$i?�2�
SfqM1fCp� vM06r Co MAC� L1� Q7YMT71MRil Ntlh' �L
aaopud enno�s