HomeMy WebLinkAboutContract 55805-A1 DocuSign Envelope ID:D4E68C40-OCEE-45A2-BDC3-OB5CE3578FAB
CSC NO. 55805-A1
FIRST AMENDMENT TO
CITY SECRETARY CONTRACT NO. 55805
This Amendment is entered into by and between the City of Fort Worth (hereafter
"City"), a home rule municipal corporation organized under the laws of the State of Texas, with
its principal place of business at 200 Texas St, Fort Worth, Texas, and Bound Tree Medical
LLC (hereafter"Vendor"), a limited liability company.
WHEREAS, City and Vendor entered into an Agreement identified as Fort Worth City
Secretary Contract No. 55805 beginning June 1, 2021 (the"Agreement"); and
WHEREAS, City and Vendor now wish to amend the Agreement to increase the
compensation amount from $7,137.00 to $32,137.00 and modify the Exhibit A attached to the
Agreement with the Exhibit A attached to this Amendment.
NOW, THEREFORE, City and Vendor, acting herein by the through their duly
authorized representatives, enter into the following agreement to amend the contract:
The Agreement is hereby amended as follows:
1. 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 by City
shall be in the amount not to exceed THIRTY-TWO THOUSAND ONE HUNDRED
AND THIRTY-SEVEN DOLLARS AND ZERO CENTS ($32,137.00). 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.
2. The Exhibit A attached to the Agreement is hereby replaced in its entirety with the
Exhibit A attached to this Amendment.
3. All other provisions of the Contract which are not expressly amended herein shall remain
in full force and effect.
OFFICIAL RECORD
[SIGNATURE PAGE FOLLOWS] CITY SECRETARY
FT.WORTH,TX
DocuSign Envelope ID:D4E68C40-OCEE-45A2-BDC3-OB5CE3578FAB
Executed on the day signed by the Assistant City Manager
ACCEPTED AND AGREED:
CITY OF FORT WORTH CONTRACT COMPLIANCE MANAGER:
By signing I acknowledge that I am the
person responsible for the monitoring and
administration of this contract, including
By: ensuring all performance and reporting
Name: Fernando Costa requirements.
Title: Assistant City Manager
Date: Jan 24, 2023
By:
APPROVAL RECOMMENDED: Name: Jacob Lohse
Title: Administrative Services Manager
� APPROVED AS TO FORM AND
By: Robeh)%[[en'n re'd aJr.(Jan 24,202307:06 CST) LEGALITY:
Name: Robert A. Alldredge Jr.
Title: Executive Assistant Chief \�)
ATTEST: p�oF FO1?r�y0do By:
d�o d Name: Taylor Paris
A*000
00= Title: Assistant City Attorney
By: 4 CONTRACT AUTHORIZATION:
Name: Jannette Goodall M&C: N/A
Title: City Secretary Date Approved:
Form 1295 Certification No.: N/A
BOUND TREE MEDICAL
DocuSigned by:
By. IS6ww Sa�(hr
FR._
Name: Shawn Saylor
Title: Chief Financial Officer
Date: 1/13/2023
OFFICIAL RECORD
CITY SECRETARY
FT.WORTH,TX
DocuSign Envelope ID:D4E68C40-OCEE-45A2-BDC3-OB5CE3578FAB
Exhibit A— Seller's Quote, Scope of Services or Purchase Order;
Bound Tree
Quotation#: 10/18/2022
Account Number: 151336-SHIP004
BILL-TO SHIP-TO
FORT WORTH POLICE DPT FORT WORTH POLICE DPT
2500 N HOUSTON ST 310 GULFSTREAM RD
FT WORTH,TX 76164-7147 FORT WORTH,TX 76106-2768
Ship Method: NO FRT
Payment Terms: NET 30
Contact Name
Phone Number
Item Llom Description Qty Price Ext.Price Exp.Date
373369 10/CS N E 2MG 2ML LUER JET 1029B
10EAJCS 50 $ 290.00 $14,500.00 12/31/2022
EA/CS
2170-20300 1lEA Curaplex DART,No Syringe,Latex Free 1/EA 25EA/CS 500 $ 6.83 $ 3,415.00 12/31/2022
1121-36645 100/CS Curaplex Fluff Bandage Roll 4.5"x4.lyds,6ply,Sterile,100r1lcs 1 $ 164.88 $ 164.88 12/31/2022
989803149981 1/PR DEFIB PAD SMART PADS III 1/PR 10 $ 47.51 $ 475.10 12/31/2022
0390-10 30/BX Ondansetron 4mg Orally Disintegrating Tablet 1 $ 27.93 $ 27.93 12/31/2022
3x10UD
101-25 25/BX Diphenhydramine 50mg,1ml vial 25/BX 1 $ 43.56 $ 43.56 12/31/2022
8-0436-11 251BT Nitroglycerin Sublingual Tabs 0.4mg 25/BTL 5 $ 12.25 $ 61.25 12/31/2022
17513 250/BX Extra Strength APAP,500mg Acetaminophen 1 $ 31.89 $ 31.89 12/31/2022
Tablets 2lpk 250pk/bx 12bxlcs
1122-14960 100/BX Curaplex Fabric Adhesive Bandage,1in x 3in,100/BX 60BX/Cs 10 $ 4.31 $ 43.10 12/31/2022
3710-16051 1lEA Emergency Tape, PediaTape,for Pediatric Patients,Measure length and estimate weight 5 $ 21.59 $ 107.95 12/31/2022
IV Start Kit-IV Guard, Lock,Flush
a600-o12aa 1lEA 1 $ 4.00 $ 4.00 12/31/2022
1920-51010 1/EA IV Flush Syringe,Normal Saline,10ml prefilled 30 $ 0.69 $ 20.70 12/31/2022
in 10ml Syringe 30ea/bx 6bx/cs
1012-47141 50/BX Curaplex TritonGrip EC Gloves,LG,Blue 5 $ 10.29 $ 51.45 12/31/2022
Nitrile, Powder Free 50/bx 10bxlcs
1012-47140 50lBX Curaplex TritonGrip EC Gloves,MED,Blue 5 $ 10.29 $ 51.45 12/31/2022
Nitrile, Powder Free 50/bx 10bxlcs
1012-47139 50/BX Curaplex TritonGrip EC Gloves,SM,Blue 5 $ 10.29 $ 51.45 12/31/2022
Nitrile, Powder Free 50/bx 10bxlcs
DocuSign Envelope ID:D4E68C40-OCEE-45A2-BDC3-OB5CE3578FAB
1012-47142 50/BX Curaplex TritonGrip EC Gloves,XL,Blue 5 $ 10.29 $ 51.45 12/31/2022
Nitrile, Powder Free 501bx 10bx/cs
372610 1/EA SCALPEL NUMBER 10 DISPOSABLE 10 $ 2.80 $ 28.00 12/31/2022
PROTECTED LOCKING RETRACTABLE
081540 5/PK Skin Closure Strips,Steri-Strip,1/8 in x 3 in, 50 $ 1.43 $ 71.50 12/31/2022
Adhesive,Sterile,5strips/pk,50pk/bx 4bx/cs
1123-54118 11PK Skin Closure Strips,Steri-Strip,1/4 in x 3 in, 50 $ 1.40 $ 70.00 12/31/2022
Adhesive,Sterile,3strips/pk,50pk/bx 4bx/cs
Mechanical Direct Pressure Device,iTClamp,
1211-31300 1/EA Sterile,Latex Free 15 $ 85.67 $ 1,285.05 12/31/2022
1121-36571 36/BX Curaplex Cohesive Elastic Bandage,2 in, 1 $ 42.47 $ 42.47 12/31/2022
Blue, Latex Free 36rl/bx 6bx/cs
1214-50019 1/EA Rhino Rocket, Medium,for Nosebleeds 10 $ 18.57 $ 185.70 12/31/2022
Quote Total $20,783.88
Comments:
Boundtree I
I
Phone: I Fax:
I
Sales tax will be applied to customers who are not exempt.
Shipping charges will be prepaid and added to the invoice unless otherwise stated.
This quotation is valid until the quote expires or the manufacturer's price to Bound Tree Medical increases.
To place an order, please visit our website at vww.boundtree.com, login and add to your shopping cart
or call(800)533-0523
fax (800)257-5713
Bound Tree Medical 15000 Tuttle Crossing Blvd., Dublin Ohiol Telephone 800.533-0523