HomeMy WebLinkAboutContract 57514 CSC No.57514
FORT WORTH
CITY OF FORT WORTH
COOPERATIVE PURCHASE AGREEMENT
This Cooperative Purchase Agreement ("Agreement") is entered into by and between Siddons-Martin
Emergency Group, LLC ("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—City's Terms and Conditions;
3. Exhibit B—Vendor Quote, Scope of Services or Purchase Order;
4. Exhibit C—Cooperative Agency Contract(e.g.,NJPA,DIR,BuyBoard); and
5. Exhibit D—Conflict Interest Questionnaire
Exhibits A, B, C, and D 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 B
pursuant to the terms and conditions of this Cooperative Purchase Agreement, including all exhibits thereto.
hi the event of a conflict between Exhibit A—City's Terms and Conditions,Exhibit B—Vendors Quote, and
Exhibit C— [Cooperative Agency Contract],then Exhibit A—City's Terms and Conditions shall control,but
only to the extent allowable under the [Cooperative Agency Contract].
City shall pay Vendor in accordance with the fee schedule in Exhibit B and in accordance with the
provisions of this Agreement. Total payment made under this Agreement for this one (1) time purchase by
City shall be in the amount of Two Hundred Twenty Four Thousand and Eight Hundred and Thirty
Three Dollars and Zero Cents ($224.833.00). 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 term of this Agreement shall be for one year beginning on the date signed by the Assistant City
Manager and ending on April 15,2023.
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: To VENDOR:
City of Fort Worth Siddons—Martin Emergency Group,LLC
Attn:Dana Burghdoff Attn:Travis Ownby
200 Texas Street Address: 1362 East Richey,Houston,TX 77073
Fort Worth,TX 76102-6314 Facsimile:281.442.0850
Facsimile:(817)392-8654
With copy to Fort Worth City Attorney's Office at OFFICIAL RECORD
same address
CITY SECRETARY
FT. WORTH, TX
The undersigned represents and warrants that he or she has the power and authority to execute this
Agreement and bind the respective Vendor.
CITY OF FORT WORTH:
CONTRACT COMPLIANCE MANAGER:
pang 24L hd%ff By signing I acknowledge that I am the person
By Dana Burghdoff ay 3,202213:09CDT) responsible for the monitoring and administration
Name: Dana Burghdoff of this contract, including ensuring all performance
Title: Assistant City Manager and reporting requirements.
Date: May 3,2022 ,
APPROVAL RECOMMENDED: By
Name: Kristine Caffey
Title: Sr.Buyer
By Steve7obke( ayes 15:32 CDT) APPROVED AS TO FORM AND LEGALITY:
Name: Steve Cooke
Title:Property Management Director
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ATTEST: 7 F F�Rraa� By:00 9° v
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�0 Name: Christopher Austria
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gip$ o=o Title: Assistant City Attorney
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By°annette s G°°da"(''_�2COI) aaa�rFXA5g4p CONTRACT AUTHORIZATION:
Name: Jannette Goodall M&C: 22-0165
Title: City Secretary 1295: 2022-853544
VENDOR:
Siddons-Martin Emergency Group,LLC
By: . :r..,.....66"
ame: Travis Ownb
Title: Fire Apparatus&
ARFF Sales Specialist
Date:
OFFICIAL RECORD
CITY SECRETARY
FT. WORTH, TX
EXHIBIT A
CITY OF FORT WORTH,TEXAS
STANDARD PURCHASING TERMS & CONDITIONS
1.0 DEFINITION OF BUYER
The City of Fort Worth,its officers,agents, servants,authorized employees, Sellers and subSellers
who act on behalf of various City departments,bodies or agencies.
2.0 DEFINITION OF SEI.LF.R
The consultant, Contractor(s), Vendor(s) supplier, or other provider of goods and/or services, its
officers,agents, servants, employees, Sellers and subSellers who act on behalf of the entity under
a contract with the City of Fort Worth.
3.0 PUBLIC INFORMATION
Any information submitted to the City of Fort Worth (the "City")may be requested by a member
of the public under the Texas Public Information Act. See TEx. Gov'T CODE ANN. §§ 552.002,
552.128(c)(West Supp. 2006). If the City receives a request for a Seller's proprietary information,
the Seller listed in the request will be notified and given an opportunity to make arguments to the
Texas Attorney General's Office (the "AG") regarding reasons the Seller believes that its
information may not lawfully be released. If Seller does not make arguments or the AG rejects the
arguments Seller makes, Seller's information will be released without penalty to the City.
4.0 PROHIBITION AGAINST PERSONAL INTEREST IN CONTRACTS
No officer or employee of Buyer shall have a financial interest, direct or indirect, in any contract
with Buyer or be financially interested, directly or indirectly, in the sale to Buyer of any land,
materials, supplies or services, except on behalf of Buyer as an officer or employee. Any willful
violation of this section shall constitute malfeasance in office, and any officer or employee found
guilty thereof shall thereby forfeit his office or position. Any violation of this section with the
knowledge, expressed or implied, of the person or corporation contracting with the City Council
shall render the contract invalid by the City Manager or the City Council.(Chapter XXVII, Section
16,City of Fort Worth Charter)
5.0 ORDERS
5.1 No employees of the Buyer or its officers, agents, servants, Sellers or subSellers who act
on behalf of various City departments,bodies or agencies are authorized to place orders for
goods and/or services without providing approved contract numbers, purchase order
numbers,or release numbers issued by the Buyer.The only exceptions are Purchasing Card
orders and emergencies pursuant to Texas Local Government Code Section 252.022(a)(1),
(2), or (3). In the case of emergencies, the Buyer's Purchasing Division will place such
orders.
5.2 Acceptance of an order and delivery on the part of the Seller without an approved contract
number, purchase order number, or release number issued by the Buyer may result in
rejection of delivery,return of goods at the Seller's cost and/ornon-payment.
6.0 SELLER TO PACKAGE GOODS
Seller will package goods in accordance with good commercial practice.Each shipping container,
shall be clearly and permanently marked as follows: (a) Seller's name and address: (b)Consignee's
name,address and purchase order or purchase change order number;(c)Container number and total
number of containers,e.g.,box 1 of 4 boxes; and(d)Number of the container bearing the packing
slip. Seller shall bear the cost of packaging unless otherwise provided. Goods shall be suitably
packed to secure lowest transportation costs and to conform to requirements of common carriers
and any applicable specifications. Buyer's count or weight shall be final and conclusive on
shipments not accompanied by packing lists.
7.0 SHIPMENT UNDER RESERVATIONPROHIBITED
Seller is not authorized to ship the goods under reservation, and no tender of a bill of lading will
operate as a tender of goods.
8.0 TITLE AND RISK OF LOSS
The title and risk of loss of the goods shall not pass to Buyer until Buyer actually receives and takes
possession of the goods at the point or points of delivery after inspection and acceptance of the
goods.
9.0 DELIVERY TERMS AND TRANSPORTATIONCHARGES
Freight terms shall be F.O.B. Destination,Freight Prepaid and Allowed,unless delivery terms are
specified otherwise in Seller's proposals.Buyer agrees to reimburse Seller for transportation costs
in the amount specified in Seller's proposals or actual costs, whichever is lower, if the quoted
delivery terms do not include transportation costs;provided,Buyer shall have the right to designate
what method of transportation shall be used to ship the goods.
10.0 PLACE OF DELIVERY
The place of delivery shall be set forth in the "Ship to"block of the purchase order,purchase change
order,or release order.
11.0 RIGHT OF INSPECTION
Buyer shall have the right to inspect the goods upon delivery before accepting them. Seller shall be
responsible for all charges for the return to Seller of any goods rejected as being nonconforming
under the specifications.
12.0 INVOICES
12.1 Seller shall submit separate invoices in duplicate, on each purchase order or purchase
change order after each delivery. Invoices shall indicate the purchase order or purchase
change order number. Invoices shall be itemized and transportation charges, if any, shall
be listed separately. A copy of the bill of lading and the freight waybill,when applicable,
should be attached to the invoice. Seller shall mail or deliver invoices to Buyer's
Department and address as set forth in the block of the purchase order, purchase change
order or release order entitled "Ship to." Payment shall not be made until the above
instruments have been submitted after delivery and acceptance of the goods and/or services.
12.2 Seller shall not include Federal Excise, State or City Sales Tax in its invoices. The Buyer
shall furnish a tax exemption certificate upon Seller's request.
13.0 PRICE WARRANTY
13.1 The price to be paid by Buyer shall be that contained in Seller's proposals which Seller
warrants to be no higher than Seller's current prices on orders by others for products and
services of the kind and specification covered by this agreement for similar quantities under
like conditions and methods of purchase. In the event Seller breaches this warranty, the
prices of the items shall be reduced to the prices contained in Seller's proposals, or in the
alternative upon Buyer's option,Buyer shall have the right to cancel this contract without
any liability to Seller for breach or for Seller's actual expense.Such remedies are in addition
to and not in lieu of any other remedies which Buyer may have
in law or equity.
13.2 Seller warrants that no person or selling agency has been employed or retained to solicit or
secure this contract upon an agreement or understanding for commission, percentage,
brokerage or contingent fee, excepting employees of an established commercial or selling
agency that is maintained by Seller for the purpose of securing business. For breach or
violation of this warranty,Buyer shall have the right,in addition to any other right or rights
arising pursuant to said purchase(s),to cancel this contract without liability and to deduct
from the contract price such commission percentage, brokerage or contingent fee, or
otherwise to recover the full amountthereof.
14.0 PRODUCT WARRANTY
Seller shall not limit or exclude any express or implied warranties and any attempt to do so shall
render this contract voidable at the option of Buyer. Seller warrants that the goods furnished will
conform to Buyer's specifications, drawings and descriptions listed in the proposal invitation, and
the sample(s)furnished by Seller,if any. In the event of a conflict between Buyer's specifications,
drawings,and descriptions,Buyer's specifications shall govern.
15.0 SAFETY WARRANTY
Seller warrants that the product sold to Buyer shall conform to the standards promulgated by the
U.S. Department of Labor under the Occupational Safety and Health Act (OSHA) of 1970, as
amended. In the event the product does not conform to OSHA standards, Buyer may return the
product for correction or replacement at Seller's expense. In the event Seller fails to make
appropriate correction within a reasonable time, any correction made by Buyer will be at Seller's
expense. Where no correction is or can be made, Seller shall refund all monies received for such
goods within thirty (30) days after request is made by Buyer in writing and received by Seller.
Notice is considered to have been received upon hand delivery, or otherwise in accordance with
Section 29.0 of these terms and conditions.Failure to make such refund shall constitute breach and
cause this contract to terminate immediately.
16.0 SOFTWARE LICENSE TO SELLER
If this purchase is for the license of software products and/or services,and unless otherwise agreed,
Seller hereby grants to Buyer,a perpetual,irrevocable,non-exclusive,nontransferable,royalty free
license to use the software.This software is"proprietary"to Seller, and is licensed and provided to
the Buyer for its sole use for purposes under this Agreement and any attached work orders or
invoices. The City may not use or share this software without permission of the Seller; however
Buyer may make copies of the software expressly for backup purposes.
17.0 WARRANTY AGAINST INFRINGEMENT OF INTELLECTUAL PROPERTY
17.1 The SELLER warrants that all Deliverables, or any part thereof, furnished
hereunder, including but not limited to: programs, documentation, software,
analyses,applications,methods,ways,and processes(in this Section each individually
referred to as a "Deliverable" and collectively as the "Deliverables,") do not infringe
upon or violate any patent, copyrights, trademarks, service marks, trade secrets, or
any intellectual property rights or other third party proprietary rights, in the
performance of services under thisAgreement.
17.2 SELLER shall be liable and responsible for any and all claims made against the City
for infringement of any patent, copyright, trademark, service mark, trade secret, or
other intellectual property rights by the use of or supplying of any Deliverable(s) in
the course of performance or completion of, or in anyway
connected with providing the services, or the City's continued use of the
Deliverable(s) hereunder.
17.3 SELLER agrees to indemnify, defend, settle, or pay, at its own cost and expense,
including the payment of attorney's fees, any claim or action against the City for
infringement of any patent,copyright,trade mark,service mark,trade secret,or other
intellectual property right arising from City's use of the Deliverable(s), or any part
thereof, in accordance with this Agreement, it being understood that this agreement
to indemnify, defend, settle or pay shall not apply if the City modifies or misuses the
Deliverable(s). So long as SELLER bears the cost and expense of payment for claims
or actions against the City pursuant to this section, SELLER shall have the right to
conduct the defense of any such claim or action and all negotiations for its settlement
or compromise and to settle or compromise any such claim; however, City shall have
the right to fully participate in any and all such settlement, negotiations,or lawsuit as
necessary to protect the City's interest,and City agrees to cooperate with SELLER in
doing so. In the event City, for whatever reason, assumes the responsibility for
payment of costs and expenses for any claim or action brought against the City for
infringement arising under this Agreement, the City shall have the sole right to
conduct the defense of any such claim or action and all negotiations for its settlement
or compromise and to settle or compromise any such claim; however, SELLER shall
fully participate and cooperate with the City in defense of such claim or action. City
agrees to give SELLER timely written notice of any such claim or action,with copies
of all papers City may receive relating thereto. Notwithstanding the foregoing, the
City's assumption of payment of costs or expenses shall not eliminate SELLER's duty
to indemnify the City under this Agreement.If the Deliverable(s),or any part thereof,
is held to infringe and the use thereof is enjoined or restrained or, if as a result of a
settlement or compromise,such use is materially adversely restricted,SELLER shall,
at its own expense and as City's sole remedy, either: (a) procure for City the right to
continue to use the Deliverable(s); or (b) modify the Deliverable(s) to make them/it
non-infringing,provided that such modification does not materially adversely
affect City's authorized use of the Deliverable(s); or (c) replace the Deliverable(s)
with equally suitable, compatible, and functionally equivalent non-infringing
Deliverable(s) at no additional charge to City; or (d) if none of the foregoing
alternatives is reasonably available to SELLER, terminate this Agreement, and
refund all amounts paid to SELLER by the City, subsequent to which termination
City may seek any and all remedies available to City under law.
18.0 OWNERSHIP OF WORKPRODUCT
Seller agrees that any and all analyses, evaluations, reports, memoranda, letters, ideas, processes,
methods,programs, and manuals that were developed,prepared,conceived,made or suggested by
the Seller for the City pursuant to a Work Order,including all such developments as are originated
or conceived during the term of the Contract and that are completed or reduced to writing thereafter
(the"Work Product")and Seller acknowledges that such Work Product may be considered"work(s)
made for hire" and will be and remain the exclusive property of the City. To the extent that the
Work Product, under applicable law, may not be considered work(s) made for hire, Seller hereby
agrees that this Agreement effectively transfers,grants,conveys,and assigns exclusively to Buyer,
all rights, title and ownership interests, including copyright, which Seller may have in any Work
Product or any tangible media embodying such Work Product,without the necessity of any further
consideration, and Buyer shall be entitled to obtain and hold in its own
name, all Intellectual Property rights in and to the Work Product. Seller for itself and on behalf of
its Sellers hereby waives any property interest in such Work Product.
19.0 NETWORK ACCESS
The City owns and operates a computing environment and network(collectively the "Network").
If Seller requires access, whether onsite or remote, to the City's network to provide services
hereunder, and the Seller is required to utilize the Internet, Intranet, email, City database, or other
network application,Seller shall separately execute the City's Network Access Agreement prior to
providing such services.A copy of the City's standard Network Access Agreement can be provided
upon request.
20.0 CANCELLATION
Buyer shall have the right to cancel this contract immediately for default on all or any part of the
undelivered portion of this order if Seller breaches any of the terms hereof,including warranties of
Seller.Such right of cancellation is in addition to and not in lieu of any other remedies,which Buyer
may have in law or equity.
21.0 TERMINATION
The performance of work or purchase of goods under this order may be terminated in whole or in
part by Buyer,with or without cause,at any time upon the delivery to Seller of a written"Notice of
Termination" specifying the extent to which performance of work or the goods to be purchased
under the order is terminated and the date upon which such termination becomes effective. Such
right of termination is in addition to and not in lieu of any other termination rights of Buyer as set
forth herein.
22.0 ASSIGNMENT/DELEGATION
No interest,obligation or right of Seller,including the right to receive payment,under this contract
shall be assigned or delegated to another entity without the express written consent of Buyer. Any
attempted assignment or delegation of Seller shall be wholly void and totally ineffective for all
purposes unless made in conformity with this paragraph. Prior to Buyer giving its consent, Seller
agrees that Seller shall provide, at no additional cost to Buyer, all documents, as determined by
Buyer, that are reasonable and necessary to verify Seller's legal status and transfer of rights,
interests,or obligations to another entity.The documents that may be requested include,but are not
limited to,Articles of Incorporation and related amendments, Certificate of Merger, IRS Form W-
9 to verify tax identification number, etc.Buyer reserves the right to withhold all payments to any
entity other than Seller, if Seller is not in compliance with this provision. If Seller fails to provide
necessary information in accordance with this section,Buyer shall not be liable for any penalties,
fees or interest resulting therefrom.
23.0 WAIVER
No claim or right arising out of a breach of this contract can be discharged in whole or in part by a
waiver or renunciation of the claim or right unless the waiver or renunciation is supported by
consideration in writing and is signed by the aggrieved party.
24.0 MODIFICATIONS
This contract can be modified or rescinded only by a written agreement signed by both parties.
25.0 THE AGREEMENT
In the absence of an otherwise negotiated contract, or unless stated otherwise, the Agreement
between Buyer and Seller shall consist of these Standard Terms and Conditions together with any
applicable proposal documents published by the Buyer and Seller's Response to such proposal
(the"contract documents").This Agreement is intended by the parties as a final expression of their
agreement and is intended also as a complete and exclusive statement of the terms of their
agreement.No course of prior dealings between the parties and no usage of trade shall be relevant
to supplement or explain any term used in this Agreement. Acceptance of or acquiescence in a
course of performance under this Agreement shall not be relevant to determine the meaning of this
Agreement even though the accepting or acquiescing party has knowledge of the performance and
opportunity for objection. Whenever a term defined by the Uniform Commercial Code (UCC) is
used in this Agreement,the definition contained in the UCC shall control.In the event of a conflict
between the contract documents, the order of precedence shall be these Standard Terms and
Conditions, the Buyer's published proposal documents and the Seller's response. If Buyer and
Seller have otherwise negotiated a contract,this Agreement shall not apply.
26.0 APPLICABLE.LAW/VENUE.
This agreement shall be governed by the Uniform Commercial Code wherever the term "Uniform
Commercial Code" or"UCC" is used. It shall be construed as meaning the Uniform Commercial
Code as adopted and amended in the State of Texas.Both parties agree that venue for any litigation
arising from this contract shall be in Fort Worth, Tarrant County, Texas. This contract shall be
governed,construed and enforced under the laws of the State of Texas.
27.0 INDEPENDENT CONTRACTOR(S)
Seller shall operate hereunder as an independent Contractor(s)and not as an officer,agent, servant
or employee of Buyer. Seller shall have exclusive control of, and the exclusive right to control,the
details of its operations hereunder,and all persons performing same,and shall be solely responsible
for the acts and omissions of its officers, agents,employees, Sellers and sub- Sellers. The doctrine
of respondeat superior shall not apply as between Buyer and Seller,its officers,agents,employees,
Sellers and subSellers.Nothing herein shall be construed as creating a partnership or joint enterprise
between Buyer and Seller,its officers,agents,employees, Sellers and subSellers.
28.0 LIABILITY AND INDEMNIFICATION.
28.1 LIABILITY-SELLER SHALL BE LIABLE AND RESPONSIBLE FOR ANY AND
ALL PROPERTY LOSS, PROPERTY DAMAGE AND/OR PERSONAL INJURY,
INCLUDING DEATH, TO ANY AND ALL PERSONS, OF ANY HIND OR
CHARACTER, WHETHER REAL OR ASSERTED, TO THE EXTENT CAUSED
BY THE NEGLIGENT ACT(S) OR OMISSION(S), MALFEASANCE OR
INTENTIONAL MISCONDUCT OF SELLER, ITS OFFICERS, AGENTS,
SERVANTS OR EMPLOYEES.
28.2 INDEMNIFICATION - SELLER HEREBY COVENANTS AND AGREES TO
INDEMNIFY,HOLD HARMLESS AND DEFEND THE CITY(ALSO REFERRED
TO AS BUYER), ITS OFFICERS, AGENTS, SERVANTS AND EMPLOYEES,
FROM AND AGAINST ANY AND ALL CLAIMS OR LAWSUITS OF ANY HIND
OR CHARACTER, WHETHER REAL OR ASSERTED, FOR EITHER
PROPERTY DAMAGE OR LOSS (INCLUDING ALLEGED DAMAGE OR LOSS
TO SELLER'S BUSINESS,AND ANY RESULTING LOST PROFITS)PERSONAL
INJURY,INCLUDING DEATH, TO ANY AND ALL PERSONS,AND DAMAGES
FOR CLAIMS OF INTELLECTUAL PROPERTY INFRINGEMENT, ARISING
OUT OF OR IN CONNECTION WITH THIS AGREEMENT, TO THE EXTENT
CAUSED BY THE ACTS OR OMISSIONS OF
SELLER,ITS OFFICERS,AGENTS,SUBCONTRACTOR(S)S, SERVANTSOR
EMPLOYEES.
29.0 SEVERABILITY
In case any one or more of the provisions contained in this agreement shall for any reason,be held
to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability
shall not affect any other provision of this agreement,which agreement shall be construed as if such
invalid,illegal or unenforceable provision had never been contained herein.
30.0 FISCAL FUNDING LIMITATION
In the event no funds or insufficient funds are appropriated and budgeted in any fiscal period for
payments due under this contract,then Buyer will immediately notify Seller of such occurrence and
this contract shall be terminated on the last day of the fiscal period for which funds have been
appropriated without penalty or expense to Buyer of any kind whatsoever,except to the portions of
annual payments herein agreed upon for which funds shall have been appropriated and budgeted or
are otherwise available.
31.0 NOTICES TO PARTIES
Notices addressed to Buyer pursuant to the provisions hereof shall be conclusively determined to
have been delivered three(3)business days following the day such notice is deposited in the United
States mail,in a sealed envelope with sufficient postage attached,addressed to Purchasing Manager,
City of Fort Worth, Purchasing Division, 200 Texas Street, Fort Worth, Texas 76102. Notices to
Seller shall be conclusively determined to have been delivered three (3) business days following
the day such notice is deposited in the United States mail, in a sealed envelope with sufficient
postage attached, addressed to the address given by Seller in its response to Buyer's invitation to
proposals. Or if sent via express courier or hand delivery, notice is considered received upon
delivery.
32.0 NON-DISCRIMINATION
This contract is made and entered into with reference specifically to Chapter 17,Article III,Division
3 ("Employment Practices"), of the City Code of the City of Fort Worth (1986),as amended, and
Seller hereby covenants and agrees that Seller,its employees,officers,agents,Sellers or subSellers,
have fully complied with all provisions of same and that no employee, participant, applicant,
Contractor(s)or subContractor(s)has been discriminated against according to the terms of such
Ordinance by Seller,its employees,officers,agents,Contractor(s)or subSellers herein.
33.0 IMMIGRATION NATIONALITY ACT
Seller shall verify the identity and employment eligibility of its employees who perform work under
this Agreement, including completing the Employment Eligibility Verification Form (I- 9). Upon
request by City, Seller shall provide City with copies of all I-9 forms and supporting eligibility
documentation for each employee who performs work under this Agreement. Seller shall adhere to
all Federal and State laws as well as establish appropriate procedures and controls so that no services
will be performed by any Seller employee who is not legally eligible to perform such services.
SELLER SHALL INDEMNIFY CITY AND HOLD CITY HARMLESS FROM ANY
PENALTIES, LIABILITIES, OR LOSSES DUE TO VIOLATIONS OF THIS
PARAGRAPH BY SELLER, SELLER'S EMPLOYEES,
SUBCONTRACTORS, AGENTS, OR LICENSEES. City, upon written notice to Seller, shall
have the right to immediately terminate this Agreement for violations of this provision by Seller.
34.0 HEALTH. SAFETY.AND ENVIRONMENTAL REQUIREMENTS
Services,products,materials,and supplies provided by the Seller must meet or exceed all applicable
health, safety, and the environmental laws,requirements, and standards. In addition, Seller agrees
to obtain and pay, at its own expense, for all licenses, permits, certificates, and inspections
necessary to provide the products or to perform the services hereunder.Seller shall indemnify Buyer
from any penalties or liabilities due to violations of this provision. Buyer shall have the right to
immediately terminate this Agreement for violations of this provision by Seller.
35.0 RIGHT TO AUDIT
Seller agrees that the Buyer,or Buyer's authorized representative,shall,until the expiration of three
(3)years after final payment under this contract,and at no additional cost to Buyer,have access to
and the right to examine and copy any directly pertinent books, computer disks, digital files,
documents, papers and records of the Seller involving transactions relating to this contract,
including any and all records maintained pursuant to Section 31 of this Agreement. Seller agrees
that the Buyer shall have access,during normal working hours,to all necessary Seller facilities,and
shall be provided adequate and appropriate workspace, in order to conduct audits in compliance
with the provisions of this section. Buyer shall pay Seller for reasonable costs of any copying in
accordance with the standards set forth in the Texas Administrative Code. The Buyer shall give
Seller reasonable advance written notice of intended audits,but no less than ten(10)business days.
36.0 DISABILITY
In accordance with the provisions of the Americans With Disabilities Act of 1990 (ADA), Seller
warrants that it and any and all of its subSellers will not unlawfully discriminate on the basis of disability
in the provision of services to general public, nor in the availability, terms and/or conditions of
employment for applicants for employment with,or employees of Seller or any of its subSellers. Seller
warrants it will fully comply with ADA's provisions and any other applicable federal, state and local
laws concerning disability and will defend,indemnify and hold Buyer harmless against any claims or
allegations asserted by third parties or subSellers against Buyer arising out of Seller's and/or its
subSellefs alleged failure to comply with the above-referenced laws concerning disability discrimination
in the performance of this agreement.
37.0 DISPITTE RESOLUTION
If either Buyer or Seller has a claim,dispute,or other matter in question for breach of duty,obligations,
services rendered or any warranty that arises under this Agreement, the parties shall first attempt to
resolve the matter through this dispute resolution process.The disputing party shall notify the other party
in writing as soon as practicable after discovering the claim,dispute,or breach.The notice shall state the
nature of the dispute and list the parry's specific reasons for such dispute. Within ten(10)business days
of receipt of the notice,both parties shall make a good faith effort, either through email,mail,phone
conference, in person meetings, or other reasonable means to resolve any claim, dispute, breach or
other matter in question that may arise out of,or in connection with this Agreement.If the parties fail to
resolve the dispute within sixty (60) days of the date of receipt of the notice of the dispute,then the
parties may submit the matter to non-binding mediation upon written consent of authorized
representatives of both parties in accordance with the Industry Arbitration Rules of the American
Arbitration Association or other applicable rules goveming mediation then in effect.If the parties cannot
resolve the dispute through mediation, then either party shall have the right to exercise any and all
remedies available under law regarding the dispute.
38.0 PROHIBITION ON CONTRACTING WITH COMPANIES THAT BOYCOTT ISRAF,I,
If Seller has fewer than 10 employees or the Agreement is for less than$100,000,this section 31 does not
apply. Seller acknowledges that in accordance with Chapter 2270 of the Texas Government Code,City is
prohibited from entering into a contract with a company for goods or services unless the contract contains
a written verification from the company that it: (1)does not boycott Israel; and(2)will not boycott Israel
during the term of the contract. The terms "boycott Israel" and "company" shall have the meanings
ascribed to those terms in Section 808.001 of the Texas Government Code. By signing this Addendum,
Seller certifies that Seller's signature provides written verification to City that Seller: (1)does not boycott
Israel; and(2)will not boycott Israel during the term of the Agreement.
39.0 PROHIBITION ON BOYCOTTING ENERGY COMPANIES
Seller acknowledges that in accordance with Chapter 2274 of the Texas Government Code,as added by
Acts 2021, 87th Leg.,R.S., S.B. 13, § 2,the City is prohibited from entering into a contract for goods
or services that has a value of$100,000 or more that is to be paid wholly or partly from public funds of
the City with a company with 10 or more full-time employees unless the contract contains a written
verification from the company that it: (1)does not boycott energy companies;and(2)will not boycott
energy companies during the term of the contract. The terms"boycott energy company" and
"company"have the meaning ascribed to those terms by Chapter 2274 of the Texas Government Code,
as added by Acts 2021,87th Leg.,R.S.,S.B. 13,§2. To the extent that Chapter 2274 of the Government
Code is applicable to this Agreement,by signing this Agreement,Contractor certifies that Contractor's
signature provides written verification to the City that Contractor: (1)does not boycott energy
companies; and(2)will not boycott energy companies during the term of this Agreement.
40.0 PROHIBITION ON DISCRIMINATION AGAINST FIREARM AND AMMUNITION
INDUSTRIES
Seller acknowledges that except as otherwise provided by Chapter 2274 of the Texas Government Code,
as added by Acts 2021, 87th Leg.,R.S., S.B. 19, § 1,the City is prohibited from entering into a contract
for goods or services that has a value of$100,000 or more that is to be paid wholly or partly from public
funds of the City with a company with 10 or more full-time employees unless the contract contains a
written verification from the company that it: (1)does not have a practice,policy,guidance,or directive
that discriminates against a firearm entity or firearm trade association;and(2)will not discriminate during
the term of the contract against a firearm entity or firearm trade association. The terms"discriminate,"
"firearm entity" and"firearm trade association"have the meaning ascribed to those terms by Chapter
2274 of the Texas Government Code,as added by Acts 2021, 87th Leg.,R.S., S.B. 19, § 1. To the extent
that Chapter 2274 of the Government Code is applicable to this Agreement,by signing this Agreement,
Contractor certifies that Contractor's signature provides written verification to the City that Contractor:
(1)does not have a practice,policy,guidance,or directive that discriminates against a firearm entity or
firearm trade association;and(2)will not discriminate against a firearm entity or firearm trade association
during the term of this Agreement.
EXHIBIT B
Siddons Martin Emergency Group, LLC
3500 Shelby Lane
Denton, TX 76207
GDN P115891
TXDOT MVD No.A115890
April 22, 2022
Josh Clark, Lieutenant
FORT WORTH FIRE DEPARTMENT
1000 THROCKMORTON ST
FORT WORTH, TX 76102
Proposal For: Shift Command truck
Siddons-Martin Emergency Group, LLC is pleased to provide the following proposal to FORT WORTH FIRE DEPARTMENT.
Unit will comply with all specifications attached and made a part of this proposal. Total price includes delivery FOB FORT
WORTH FIRE DEPARTMENT and training on operation and use of the apparatus.
Description Amount
Qty. 1 - CRU 71904 - Frontline Ford Transit
(Base Unit Price - $182,573.00)
Delivery within 1-2 months of order date
QUOTE # - SMEG-0002593-0 Vehicle Price $223,333.00
Fotokite included
Buy Board Detail - Model 32 71904 CRU 71904 - UNIT $223,333.00
Buy Board Base unit Price - $182,573.00 TOTAL
Published options - $ 30,186.00
Unpublished options $ 38,186.00
Contract Discount $ -27,612.00
Buy Board Fee $ 1,500.00 SUB TOTAL $223,333.00
Total Price $ 224,833.00 BuyBoard 651-21 $1,500.00
TOTAL $224,833.00
This unit has 6500 miles currently and comes with a full factory warranty. Price guaranteed for 28 days or unit is sold.
This is a stock unit available for immediate purchase. Changes as listed in specification are included.
A Fotokite tethered camera system is included.
Taxes:Tax is not included in this proposal. In the event that the purchasing organization is not exempt from sales tax or any
other applicable taxes and/or the proposed apparatus does not qualify for exempt status, it is the duty of the purchasing
organization to pay any and all taxes due. Balance of sale price is due upon acceptance of the apparatus at the factory.
Proposal Shift Command truck Page 1 of 2 August 23, 2021
Late Fee: A late fee of.033%of the sale price will be charged per day for overdue payments beginning ten (10) days after
the payment is due for the first 30 days. The late fee increases to .044% per day until the payment is received. In the event a
prepayment is received after the due date, the discount will be reduced by the same percentages above increasing the cost
of the apparatus.
Cancellation: In the event this proposal is accepted and a purchase order is issued then cancelled or terminated by
Customer before completion, Siddons-Martin Emergency Group may charge a cancellation fee.The following charge
schedule based on costs incurred may be applied:
(A) 10% of the Purchase Price after order is accepted and entered by Manufacturer;
(B) 20% of the Purchase Price after completion of the approval drawings;
(C) 30%of the Purchase Price upon any material requisition.
The cancellation fee will increase accordingly as costs are incurred as the order progresses through engineering and into
manufacturing. Siddons-Martin Emergency Group endeavors to mitigate any such costs through the sale of such product to
another purchaser; however, the customer shall remain liable for the difference between the purchase price and, if
applicable, the sale price obtained by Siddons-Martin Emergency Group upon sale of the product to another purchaser, plus
any costs incurred by Siddons-Martin to conduct such sale.
Acceptance: In an effort to ensure the above stated terms and conditions are understood and adhered to, Siddons-Martin
Emergency Group, LLC requires an authorized individual from the purchasing organization sign and date this proposal and
include it with any purchase order. Upon signing of this proposal, the terms and conditions stated herein will be considered
binding and accepted by the Customer. The terms and acceptance of this proposal will be governed by the laws of the state
of Texas. No additional terms or conditions will be binding upon Siddons-Martin Emergency Group, LLC unless agreed to in
writing and signed by a duly authorized officer of Siddons-Martin Emergency Group, LLC.
Sincerely,
Travis Ownby
I, , the authorized representative of FORT WORTH FIRE DEPARTMENT, agree to purchase the
proposed and agree to the terms of this proposal and the specifications attached hereto.
Signature & Date
Proposal Shift Command truck Page 2 of 2 August 23, 2021
CONTRACT PRICING WORKSHEET
Buy Board Contract 651-21 for motor vehicles only Contract No.: 651-21 Date: 1/24/2022
Agency: :Fort Worth Contractor: :Siddons-Martin Emergency Group
Contact: :Austin Walker Prepared: ;Jeff Doran
Phone: :817-392-2008 Phone: :281-442-6806
Fax: E1 Fax:
Email: :austin.walker(a�fortworthtexas.gov Email: idoranCc�siddons-martin.com
Prod.Code: 32 Description: Pierce Frontline CRU Unit
A.Product Item Base Unit Price Per Contractor's Buy Board Contract: $ 182,573.00
B.Published Options-Itemize below-Attach additional sheet(s)if necessary-Include Option Code in description if applicable.
Description Cost Description Cost
Subtotal From Additional Sheet(s): $ 30,186.00
Subtotal B: $ 30,186.00
Total Published Options $ 212,759.00
C.Unpublished Options-Itemize below tt a ,�xry.
Description os Description Cost
Subtotal From Additional Sheet(s): $ 38,186.00
Subtotal C: $ 38,186.00
Check:Total cost of Unpublished Options(C)cannot exceed 25%of the total of the Base Unit Price plus Published Options(A+B). 18%
D.Other Cost Items Not Itemized Above(e.g.Installation,Freight,Delivery,Etc.)
Description Cost Description Cost
Subtotal D: $
Total Cost Before Any Applicable Trade-I a/Other Allowances/Discounts(A+B+C+D) : $ 250,945.00
Quantity Ordered:11 X Subtotal of A+B+C+D: 250945 = 11
Subtotal E: : $ 250,945.00
F.Buy Board Fee Calculation(From Current Fee Tables) IF Subtotal F: E S 1,500.00
Description Cost Description Cost
Contract Discount : $ (27,6 22.00)
Subtotal of column : $ Subtotal of Column : $ (27,612.00) Subtotal G: : $ (27,612.00)
Delivery Date:: 2-4 months ARO H.Total Purchase Price(E+F+G): $ 224,833.00
Option Published Unpublished
Number Qty Description Options Options
286 1 Progressive p2180(per unit) $1,434.00
292 1 Transfer switch $731.00
581 4 Electrical Receptacle duplex(per each 15 or 20 am $1,496.00
509 1 LED Interior Lighting 8 $4,929.00
546 1 Diesel 7.5 KW $16,135.00
180 1 110 Volt cab A/C $2,767.00
1362 1 Interior work Stations,electronics and equipment rack $0.00 $38,186.00
100059 1 Ranchhand Bumper Black Powder Coat Steel $2,694.00
Base Bid $ 182,573.00
Published Options $ 30,186.00
Total with Published Options $ 212,759.00
Unpublished Options $ 38,186.00 17.95%
Total Options including Fee $ 250,945.00
EXHIBIT C
' Board® P.O. Box 400,Austin,Texas 78767
800.695.2919 •info@buyboard.com • buyboard.com
July, 29 2021
Sent Via Email: jdoran@siddons-martin.com
Jeffrey A. Doran
Siddons-Martin Emergency Group
1362 East Richey Road
Houston,TX 77073
Welcome to BuyBoard!
Re: Notice of The Local Government Purchasing Cooperative ContractAward;Proposal Invitation No. 650-
21,Ambulances
Congratulations,The Local Government Purchasing Cooperative (Cooperative) has awarded your company
a BuyBoard@ contract based on the above-referenced Proposal Invitation. The contract is effective for an
initial one-year term of October 1, 2021 through September 30, 2022 and may be subject to two possible
one-year renewals. Please refer to the Proposal Invitation for the contract documents,including the General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. [650-21] at:
www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract
award, and only those awarded items may be sold through the BuyBoard contract. All sales must comply
with the contract terms and must be at or below the awarded pricing as set forth in the General Terms and
Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s).You are reminded
that, in accordance with the General Terms and Conditions, all purchase orders must be
processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative's
administrator, you are not authorized to process a purchase order received directly from a Cooperative
member that has not been processed through the BuyBoard or provided to the Cooperative. If you receive
a purchase order directly from a Cooperative member that you have reason to believe has not been received
by the Cooperative or processed through the BuyBoard,you must promptly forward a copy of the purchase
order by email to info@buyboard.com.
A list of Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations
staff will be contacting you to assist with the resources available and to provide any support you may need
as an awarded BuyBoard vendor.
On behalf of the Cooperative, we appreciate your interest in the Cooperative and we are looking forward
to your participation in the program. If you have any questions, please contact Cooperative
Procurement Staff at 800-695-2919 (select option 112').
Sincerely,
Arturo Salinas
Asst. Division Director, Cooperative Purchasing
Texas Association of School Boards, Inc.,
Administrator for The Local Government Purchasing Cooperative
v.02.01.2021
Endorsed by IlU TASM M � 0
Board® ff National School
Nar;onar Furcnasmg cooperative Endorsed by 'NSBA' Boards Association
July, 29 2021
Sent Via Email:jdoran@siddons-martin.com
Jeffrey A. Doran
Siddons-Martin Emergency Group
1362 East Richey Road
Houston,TX 77073
Welcome to BuyBoard!
Re: Notice of National Purchasing Cooperative Award;Proposal Invitation No. 650-21,Ambulances
Congratulations, The National Purchasing Cooperative (National Cooperative) has awarded your company a BuyBoard@
contract based on the above-referenced Proposal Invitation. The contract is effective for an initial one-year term of October
1, 2021 through September 30, 2022, and may be subject to two possible one-year renewals. Please refer to the Proposal
Invitation for the contract documents, including the National Purchasing Cooperative Vendor Award Agreement and General
Terms and Conditions of the Contract.
To review the items your company has been awarded, please review Proposal Tabulation No. 650-21 at
www.buyboard.com/vendor. Only items marked as awarded to your company are included in this contract award, and only
those awarded items may be sold through the BuyBoard contract. All sales must comply with the contract terms and must
be at or below the awarded pricing as set forth in the General Terms and Conditions.
The contract will be posted on the BuyBoard website as an online electronic catalog(s). You are reminded that, in
accordance with the General Terms and Conditions,all purchase orders from National Cooperative members
must be processed through the BuyBoard. Except as expressly authorized in writing by the Cooperative's administrator,
you are not authorized to process a purchase order received directly from a National Cooperative member that has not been
processed through the BuyBoard or provided to the Cooperative. If you receive a purchase order directly from a National
Cooperative member that you have reason to believe has not been received by the National Cooperative or processed through
the BuyBoard, you must promptly forward a copy of the purchase order by e-mail to info@buyboard.com
A list of National Cooperative members is available on the buyboard.com website. The BuyBoard vendor relations staff will
be contacting you to assist with resources available and provide any support you may need as an awarded BuyBoard vendor.
On behalf of the National Cooperative,we are looking forward to your participation in the program. If you have any questions,
please contact Cooperative Procurement Staff at 800-695-2919 (select option 170.
Sincerely,
Arturo Salinas,Asst. Division Director, Cooperative Purchasing
Texas Association of School Boards, Inc.,
Procurement Administrator for the National Purchasing Cooperative
v.oz.oi.zozi
P.O. Box 400,Austin, Texas 78767-0400
800.695.2919•buyboard.com
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
PROPOSER'S ACCEPTANCE AND AGREEMENT
Proposal Invitation Name: Ambulances Proposal Due Date/Opening Date and Time:
April 29, 2021 at 4:00 PM
Location of Proposal Opening:
Texas Association of School Boards, Inc.
BuyBoard Department
Proposal Invitation Number: 650-21 12007 Research Blvd.
Austin,TX 78759
Anticipated Cooperative Board Meeting Date:
Contract Term: October 1, 2021 through July 2021
September 30, 2022 with two possible one-year
renewals.
By signature below, the undersigned acknowledges and agrees that you are authorized to submit this
Proposal,including making all acknow/edgements,consents,and certifications herein, on behalf of Proposer
and,to the best of your knowledge, the information provided is true,accurate,and complete.
Siddons-Martin Emergency Group 04/28/2021
Name of Proposing Company Date
SeabllysignedbyAmanda
1362 East Richey
Amanda Seabranch seabrancn
Date:2021.04.27 13:16:34-05'00'
Street Address Signature of Authorized Company Official
Houston, Texas, 77073 Amanda Seabranch
City, State, Zip Printed Name of Authorized Company Official
1 -800-784-6806 Order Management Analyst
Telephone Number of Authorized Company Official Position or Title of Authorized Company Official
281 -442-0850 27-433590
Fax Number of Authorized Company Official Federal ID Number
Page 11 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
PROPOSAL FORMS PART 1: COMPLIANCE FORMS
INSTRUCTIONS:
Proposer must review and complete all forms in this Proposal Forms Part 1:
■ Proposal Acknowledgements
■ Felony Conviction Disclosure
■ Resident/Nonresident Certification
■ Debarment Certification
■ Vendor Employment Certification
■ No Israel Boycott Certification
■ No Excluded Nation or Foreign Terrorist Organization Certification
■ Historically Underutilized Business Certification
■ Acknowledgement of BuyBoard Technical Requirements
■ Construction-Related Goods and Services Affirmation
■ Deviation and Compliance
■ Vendor Consent for Name Brand Use
■ Confidential/Proprietary Information
■ EDGAR Vendor Certification
■ Compliance Forms Signature Page
An authorized representative of Proposer must initial in the bottom right corner of each page where indicated
and complete and sign the Compliance Forms Signature Page. Proposer's failure to fully complete, initial,and
sign forms as required may result in your Proposal being rejected as non-responsive.
PROPOSAL ACKNOWLEDGEMENTS
The proposing company ("you"or"your') hereby acknowledges and agrees as follows:
1. You have carefully examined and understand all information and documentation associated with this Proposal Invitation,
including the Instructions to Proposers, General Information, General Terms and Conditions, attachments/forms,
appendices, item specifications, and line items (collectively"Requirements'l;
2. By your response ("Proposal's to this Proposal Invitation, you propose to supply the products or services submitted at
the pricing quoted in your Proposal and in strict compliance with the Requirements, unless specific deviations or
exceptions are noted in the Proposal;
3. By your Proposal, you acknowledge and certify all items set forth in the General Terms and Conditions, Section B.12
(Certifications), including all non-collusion certifications and certifications regarding legal, ethical, and other matters set
forth therein.
4. Any and all deviations and exceptions to the Requirements have been noted in your Proposal on the required form and
no others will be claimed;
Initial• AS
Page 12 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
5. If the Cooperative accepts any part of your Proposal and awards you a Contract, you will furnish all awarded products or
services at the pricing quoted and in strict compliance with the Requirements (unless specific deviations or exceptions
are noted on the required form and accepted by the Cooperative), including without limitation the Requirements related
to:
a. conducting business with Cooperative members, including offering pricing to members that is the best you offer
compared to similarly situated customers in similar circumstances;
b. payment of a service fee in the amount specified and as provided for in this Proposal Invitation;
c. the possible award of a piggy-back contract by the National Purchasing Cooperative or nonprofit entity, in which
event you will offer the awarded products and services in accordance with the Requirements; and
d. submitting price sheets or catalogs in the proper format as required by the Cooperative as a prerequisite to activation
of your Contract;
6. You have clearly identified on the included form any information in your Proposal that you believe to be confidential or
proprietary or that you do not consider to be public information subject to public disclosure under the Texas Public
Information Act or similar public information law;
7. The individual submitting this Proposal is duly authorized to enter into the contractual relationship represented by this
Proposal Invitation on your behalf and bind you to the Requirements, and such individual (and any individual signing a
form or Proposal document) is authorized and has the requisite knowledge to provide the information and make the
representations and certifications required in the Requirements;
8. You have carefully reviewed your Proposal, and certify that all information provided is true, complete, and accurate to
the best of your knowledge, and you authorize the Cooperative to take such action as it deems appropriate to verify such
information; and
9. Any misstatement, falsification, or omission in your Proposal, whenever or however discovered, will be grounds for
disqualifying you from consideration for a contract award under this Proposal Invitation,termination of a contract award,
or any other remedy or action provided for in the General Terms and Conditions or by law.
FELONY CONVICTION DISCLOSURE
Subsection (a) of Section 44.034 of the Texas Education Code (Notification of Criminal History of Contractor)
states: "A person or business entity that enters into a contract with a school district must give advance notice to the district
if the person or an owner or operator has been convicted of a felony. The notice must include a general description of the
conduct resulting in the conviction of a felony."
Section 44.034 further states in Subsection (b): "A school district may terminate a contract with a person or business
entity if the district determines that the person or business entity failed to give notice as required by Subsection (a) or
misrepresented the conduct resulting in the conviction. The district must compensate the person or business entity for
services performed before the termination of the contract."
Please check(36 one of the following:
❑ My company is a publicly-held corporation. (Advance notice requirement does not apply to publicly-held corporation.)
■❑ My company is not owned or operated by anyone who has been convicted of a felony.
❑ My company is owned/operated by the following individual(s) who has/have been convicted of a felony:
Name of Felon(s):
Details of Conviction(s):
Initial: AS
Page 13 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
RESIDENT/NONRESIDENT CERTIFICATION
Chapter 2252, Subchapter A, of the Texas Government Code establishes certain requirements applicable to proposers who
are not Texas residents. Under the statute, a "resident" proposer is a person whose principal place of business is in Texas,
including a contractor whose ultimate parent company or majority owner has its principal place of business in Texas. A
"nonresident"proposer is a person who is not a Texas resident. Please indicate the status of your company as a"resident"
proposer or a"nonresident"proposer under these definitions.
Please check M one of the following_
❑■ I certify that my company is a Resident Proposer.
❑ I certify that my company is a Nonresident Proposer.
If your company is a Nonresident Proposer, you must provide the following information for your resident state (the state in
which your company's principal place of business is located):
Company Name Address
City State Zip Code
A. Does your resident state require a proposer whose principal place of business is in Texas to under-price proposers
whose resident state is the same as yours by a prescribed amount or percentage to receive a comparable contract?
❑ Yes ❑ No
B. What is the prescribed amount or percentage? $ or
DEBARMENT CERTIFICATION
By signature on the Compliance Forms Signature Page, I certify that neither my company nor an owner or principal of my
company has been debarred, suspended or otherwise made ineligible for participation in Federal Assistance programs under
Executive Order 12549, "Debarment and Suspension," as described in the Federal Register and Rules and Regulations.
Neither my company nor an owner or principal of my company is currently listed on the government-wide exclusions in SAM,
debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory authority.
My company agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or seeking
to purchase from my company if my company or an owner or principal is later listed on the government-wide exclusions in
SAM, or is debarred, suspended, or otherwise excluded by agencies or declared ineligible under any statutory or regulatory
authority.
VENDOR EMPLOYMENT CERTIFICATION
Section 44.031(b) of the Texas Education Code establishes certain criteria that a school district must consider when
determining to whom to award a contract. Among the criteria for certain contracts is whether the vendor or the vendor's
ultimate parent or majority owner(i) has its principal place of business in Texas; or (ii) employs at least 500 people in Texas.
If neither your company nor the ultimate parent company or majority owner has its principal place of business in Texas, does
your company, ultimate parent company, or majority owner employ at least 500 people in Texas?
Please check(36 one of the following_
❑ Yes 0 No Initial: AS
Page 14 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
NO ISRAEL BOYCOTT CERTIFICATION
A Texas governmental entity may not enter into a contract with a value of $100,000 or more that is to be paid wholly or
partly from public funds with a company(excluding a sole proprietorship)that has 10 or more full-time employees for goods
or services unless the contract contains a written verification from the company that it: (1) does not boycott Israel; and (2)
will not boycott Israel during the term of the contract. (TEx. Gov CODE Ch. 2270). Accordingly, this certification form is
included to the extent required by law.
"Boycott Israel" means refusing to deal with, terminating business activities with, or otherwise taking any action that is
intended to penalize, inflict economic harm on, or limit commercial relations specifically with Israel,or with a person or entity
doing business in Israel or in an Israeli-controlled territory, but does not include an action made for ordinary business
purposes. TEx. Gov CODE§808.001(1).
By signature on the Compliance Forms Signature Page, to the extent applicable, I certify and verify that Vendor does not
boycott Israel and will not boycott Israel during the term of any contract awarded under this Proposal Invitation, that this
certification is true, complete and accurate, and that I am authorized by my company to make this certification.
NO EXCLUDED NATION OR FOREIGN TERRORIST ORGANIZATION CERTIFICATION
Chapter 2252 of the Texas Government Code provides that a Texas governmental entity may not enter into a contract with
a company engaged in active business operations with Sudan, Iran, or a foreign terrorist organization — specifically, any
company identified on a list prepared and maintained by the Texas Comptroller under Texas Government Code §§806.051,
807.051, or 2252.153. (A company that the U.S. Government affirmatively declares to be excluded from its federal sanctions
regime relating to Sudan, Iran, or any federal sanctions regime relating to a foreign terrorist organization is not subject to
the contract prohibition.)
By signature on the Compliance Forms Signature Page, I certify and verify that Vendor is not on the Texas Comptroller's list
identified above; that this certification is true, complete and accurate; and that I am authorized by my company to make this
certification.
HISTORICALLY UNDERUTILIZED BUSINESS CERTIFICATION
A Proposer that has been certified as a Historically Underutilized Business (also known as a Minority/Women Business
Enterprise or"MWBE"and all referred to in this form as a"HUB'J is encouraged to indicate its HUB certification status when
responding to this Proposal Invitation. The BuyBoard website will indicate HUB certifications for awarded Vendors that
properly indicate and document their HUB certification on this form. Please check(3n all that apply:
❑ I certify that my company has been certified as a HUB in the following categories:
❑ Minority Owned Business
❑ Women Owned Business
❑ Service-Disabled Veteran Owned Business (veteran defined by 38 U.S.C. §101(2),who has a
service-connected disability as defined by 38 U.S.C. § 101(16),and who has a disability rating
of 20% or more as determined by the U. S. Department of Veterans Affairs or Department of
Defense)
Certification Number:
Name of Certifying Agency:
0 My company has NOT been certified as a HUB.
Initial- /4S
Page 15 of 74
Proposal Forms COMM/SVCS v.03.01.2021
D: VBoard
URCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
ACKNOWLEDGEMENT OF BUYBOARD TECHNICAL REQUIREMENTS
Vendor shall review the BuyBoard Technical Requirements included in this Proposal Invitation. By signature on the Compliance
Forms Signature Page, the undersigned affirms that Proposer has obtained a copy of the BuyBoard Technical Requirements,
has read and understands the requirements,and certifies that Vendor is able to meet and will comply with those requirements
except as follows: [List and explain BuyBoard Technical Requirements, if any, to which your company cannot or will nat
comp/Y.]
Note: In accordance with the General Terms and Conditions of the Contract, to the extent Vendor is awarded a Contract
under this Proposal Invitation but is unable or unwilling to meet the applicable BuyBoard Technical Requirements, the
information available on the BuyBoard for Vendor's awarded products or services may be limited, potentially placing Vendor
at a disadvantage and impacting the ability of Cooperative members to search,find, review, and purchase Vendor's awarded
products and services on the BuyBoard website. Further,to the extent Vendor has acknowledged ability to meet and comply
with the BuyBoard Technical Requirements, any subsequent failure or refusal by Vendor to promptly provide information
upon request to the Cooperative administrator in accordance with those technical requirements may be deemed an event of
default under the Contract.
CONSTRUCTION-RELATED GOODS AND SERVICES AFFIRMATION
The Cooperative issued the BuyBoard Procurement and Construction-Related Goods and Services Advisory for Texas Members
("Advisory'l, which provides information specifically relevant to the procurement of construction-related goods and services
by Texas Cooperative members. The Advisory, available at buyboard.com/Vendor/Resources.aspx, provides an overview of
certain legal requirements that are potentially relevant to a Cooperative member's procurement of construction or
construction-related goods and services, including those for projects that may involve or require architecture, engineering or
independent testing services. A copy of the Advisory can also be provided upon request. Because many BuyBoard contracts
include goods or installation services that might be considered construction-related, Proposer must make this Construction
Related-Goods and Services Affirmation regardless of type of goods or services associated with this Proposal Invitation.
A contract awarded under this Proposal Invitation covers only the specific goods and/or services awarded by the Cooperative.
As explained in the Advisory ("Advisory'l, Texas law prohibits the procurement of architecture or engineering
services through a purchasing cooperative. This Proposal Invitation and any Contract awarded thereunder
does not include such services. Architecture or engineering services must be procured by a Cooperative
member separately,in accordance with the Professional Services Procurement Act(Chapter 22S4 of the Texas
Government Code) and other applicable law and local policy.
By signature on the Compliance Forms Signature Page, Proposer affirms that Proposer has obtained a copy of the Advisory,
has read and understands the Advisory,and is authorized by Proposer to make this affirmation. If Proposer sells construction-
related goods or services to a Cooperative member under a Contract awarded under this Proposal Invitation, Proposer will
comply with the Advisory and applicable legal requirements, make a good faith effort to make its Cooperative member
customers or potential Cooperative member customers aware of such requirements,and provide a Cooperative member with
a copy of the Advisory before accepting the member's Purchase Order or other agreement for construction-related goods or
services.
Initial• As
Page 16 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
DEVIATION AND COMPLIANCE
If your company intends to deviate from the General Terms and Conditions, Proposal Specifications or other requirements
associated with this Proposal Invitation, you MUST list all such deviations on this form, and provide complete and detailed
information regarding the deviations on this form or an attachment to this form. Prior to completing this form,Vendor
shall review the General Terms and Conditions section 13.4 (Deviations from Item Specifications and General
Terms and Conditions). Please note that, as provided in section 13.4, certain provisions of the General Terms
and Conditions are NOT subject to deviation, and certain deviations will be deemed rejected without further
action by the Cooperative. Any attempted deviation,whether directly or indirectly,to provisions identified in
this Proposal Invitation as not subject to deviation shall be deemed rejected by the Cooperative and, unless
otherwise withdrawn by Vendor, may result in Vendor's Proposal being rejected in its entirety.
The Cooperative will consider any deviations in its contract award decision and reserves the right to accept or reject a proposal
based upon any submitted deviation.
In the absence of any deviation identified and described in accordance with the above, your company must fully comply with
the General Terms and Conditions, Proposal Specifications and all other requirements associated with this Proposal Invitation
if awarded a Contract under this Proposal Invitation. A deviation will not be effective unless accepted by the Cooperative.
The Cooperative, by and through the Cooperative administrator, may, in its sole discretion, seek clarification from and/or
communicate with Proposer(s) regarding any submitted deviation, consistent with general procurement principles of fair
competition. The Cooperative reserves the right to accept or reject a Proposal based upon any submitted deviation.
Please check(3n one of the following_
■❑ NO; Deviations
❑ YeS; Deviations
List and fully explain any deviations you are submitting:
Initial• AS
Page 17 of 74
Proposal Forms COMM/SVCS v.03.01.2021
D: VBoard
URCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
VENDOR CONSENT FOR NAME BRAND USE
BuyBoard members seeking to make purchases using a Contract awarded under this Proposal Invitation may view information
regarding awarded Vendors, including but not limited to product catalogs, pricelists, pricing, and Proposals, through the
BuyBoard website. To improve and enhance the experience of BuyBoard members seeking to procure goods and services
under the Contract utilizing the BuyBoard website, any Vendor logo, product images, and similar brand and trademark
information provided by Vendor for purposes of the Contract('Vendor Information') may be posted on the BuyBoard website.
You acknowledge that, by submitting your Proposal, unless you specifically opt out below,you consent to use
of your company's Vendor Information on the BuyBoard website if awarded a Contract. You further acknowledge
that whether, where, and when to include the Vendor Information on the BuyBoard website shall be at the sole discretion of
the BuyBoard Administrator. Vendor retains, however, the right of general quality control over the BuyBoard Administrator's
authorized display of proprietary Vendor Information. Neither the BuyBoard nor its administrator will be responsible for the
use or distribution of Vendor Information by BuyBoard members or any other third party using the BuyBoard website. This
Vendor Consent shall be effective for the full term of the Contract, including renewals, unless Vendor provides a signed,
written notice revoking consent to contractadmin@buyboard.com. BuyBoard shall have up to thirty days from the date of
receipt of a termination or revocation of a Vendor Consent to remove Vendor information from the BuyBoard website.
This Vendor Consent is subject to the Terms and Conditions of the Contract, including, but not limited to, those terms
pertaining to Disclaimer of Warranty and Limitation of Liability, Indemnification, and Intellectual Property Infringement.
Vendor logo files must be submitted in one of the formats set forth in the BuyBoard Technical Requirements. Proposers are
requested to submit this information with Vendor's Proposal. (This consent shall not authorize use of your company's Vendor
Information by BuyBoard if your company is not awarded a Contract.)
OPT OUT:
If your company wishes to opt out of the Vendor Consent for Name Brand Use, you must check the opt out box below. DO
NOTselect this box unless your company is opting out of this Vendor Consent for Name Brand Use.
❑ By checking this box, Vendor hereby declines to provide consent for use of Vendor Information (as defined herein) on
the BuyBoard website. By opting out,Vendor acknowledges and agrees that, if Vendor is awarded a Contract
under this Proposal Invitation, information available on the BuyBoard for Vendor's awarded products or
services may be limited, potentially placing Vendor at a disadvantage and impacting the ability of
Cooperative members to search,find, review,and purchase Vendor's awarded products and services on the
BuyBoard website.
Initial• AS
Page 18 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
CONFIDENTIAL/PROPRIETARY INFORMATION
A. Public Disclosure Laws
All Proposals, forms, documentation, catalogs, pricelists, or other materials submitted by Vendor to the Cooperative in
response to this Proposal Invitation, may be subject to the disclosure requirements of the Texas Public Information Act(Texas
Government Code chapter 552.001, et. seq.) or similar disclosure law. Proposer must clearly identify on this form any
information in its Proposal (including forms, documentation, or other materials submitted with the Proposal) that Proposer
considers proprietary or confidential. If Proposer fails to properly identify the information, the Cooperative shall have no
obligation to notify Vendor or seek protection of such information from public disclosure should a member of the public or
other third party request access to the information under the Texas Public Information Act or similar disclosure law. When
required by the Texas Public Information Act or other disclosure law, Proposer may be notified of any third-party request for
information in a Proposal that Proposer has identified in this form as proprietary or confidential.
Does your Proposal (including forms, documentation, catalogs, pricelists, or other materials submitted with the Proposal)
contain information which Vendor considers proprietary or confidential?
Please check M one of the following:
❑E NO, I certify that none of the information included with this Proposal is considered confidential or proprietary.
YES, I certify that this Proposal contains information considered confidential or proprietary and all such information is
specifically identified on this form.
If you responded"YES", you must clearly identify below the specific information you consider confidential or proprietary. List
each page number,form number,or other information sufficient to make the information readily identifiable.The Cooperative
and Cooperative administrator shall not be responsible for a Proposer's failure to clearly identify information considered
confidential or proprietary. Further, by submitting a Proposal, Proposer acknowledges that the Cooperative and Cooperative
administrator will disclose information when required by law, even if such information has been identified herein as
information Vendor considers confidential or proprietary.
Confidential / Proprietary Information:
(Attach addifionaisheets if needed.)
Initial: AS
Page 19 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
B. Copyright Information
Does your Proposal (including forms, documentation, pricelists, catalogs, or other materials submitted with the Proposal)
contain copyright information?
Please check(36 one of the following_
❑E NO, Proposal (including forms,documentation, pricelists, catalogs,or other materials submitted with the Proposal)does not
contain copyright information.
❑ YES, Proposal (including forms,documentation, pricelists, catalogs,or other materials submitted with the Proposal)does
contain copyright information.
If you responded"YES", clearly identify below the specific documents or pages containing copyright information.
Copyright Information:
(Athxh additionaisheets if needed.)
C.Consent to Release Confidential/Proprietary/Copyright Information to BuyBoard Members
BuyBoard members (Cooperative and nonprofit members) seeking to make purchases through the BuyBoard may wish to
view information included in the Proposals of awarded Vendors. If you identified information on this form as confidential,
proprietary, or subject to copyright, and you are awarded a BuyBoard contract, your acceptance of the BuyBoard contract
award constitutes your consent to the disclosure of such information to BuyBoard members, including posting of such
information on the secure BuyBoard website for members. Note: Neither the Cooperative nor Cooperative administrator will
be responsible for the use or distribution of information by BuyBoard members or any other party.
D.Consent to Release Proposal Tabulation
Notwithstanding anything in this Confidential/Proprietary Information form to the contrary, by submitting a Proposal,Vendor
consents and agrees that, upon Contract award, the Cooperative may publicly release, including posting on the public
BuyBoard website,a copy of the proposal tabulation and award information for the Contract including Vendor name; proposed
catalog/pricelist name(s); proposed percentage discount(s), hourly labor rate(s),or other specified pricing;and Vendor award
or non-award information.
Initial• AS
Page 20 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
EDGAR VENDOR CERTIFICATION
(2 CFR Part 200 and Appendix II)
When a Cooperative member seeks to procure goods and services using funds under a federal grant or contract, specific
federal laws, regulations, and requirements may apply in addition to those under state law. This includes, but is not limited
to, the procurement standards of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for
Federal Awards, 2 CFR 200 (sometimes referred to as the"Uniform Guidance"or new"EDGAR'). All Vendors submitting a
Proposal must complete this EDGAR Certification Form regarding Vendor's willingness and ability to comply with certain
requirements which may be applicable to specific Cooperative member purchases using federal grant funds. Completed
forms will be made available to Cooperative members for their use while considering their purchasing options when using
federal grant funds. Cooperative members may also require Vendors to enter into ancillary agreements, in addition to the
terms and conditions of the BuyBoard contract, to address the member's specific contractual needs, including contract
requirements for a procurement using federal grants or contracts.
For each of the items below, Vendor should certify Vendor's agreement and ability to comply, where
applicable, by having Vendors authorized representative check the applicable boxes, initial each page, and
sign the Compliance Forms Signature Page, If you fail to complete any item in this form,the Cooperative will
consider and may list the Vendor's response on the BuyBoard as "NO,'the Vendor is unable or unwilling to
comply. A"NO" response to any of the items may, if applicable, impact the ability of a Cooperative member to purchase
from the Vendor using federal funds.
1. Vendor Violation or Breach of Contract Terms:
Contracts for more than the simplified acquisition threshold,which is the inflation adjusted amount determined by the Civilian
Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) as authorized by 41 USC 1908, must
address administrative, contractual, or legal remedies in instances where contractors violate or breach contract terms, and
provide for such sanctions and penalties as appropriate.
Provisions regarding Vendor default are included in the BuyBoard General Terms and Conditions, including Section E.18,
Remedies for Default and Termination of Contract. Any Contract award will be subject to such BuyBoard General Terms and
Conditions, as well as any additional terms and conditions in any Purchase Order or Cooperative member ancillary contract
agreed upon by Vendor and the Cooperative member which must be consistent with and protect the Cooperative member at
least to the same extent as the BuyBoard Terms and Conditions. The remedies under the Contract are in addition to any
other remedies that may be available under law or in equity. By submitting a Proposal, you agree to these Vendor violation
and breach of contract terms.
A YES, I agree. ❑ NO, I do not agree.
2. Termination for Cause or Convenience:
For any Cooperative member purchase or contract in excess of$10,000 made using federal funds,you agree that the following
term and condition shall apply:
The Cooperative member may terminate or cancel any Purchase Order under this Contract at any time, with or without cause,
by providing seven (7)business days advance written notice to the Vendor If this Agreement is terminated in accordance
with this Paragraph, the Cooperative member shall only be required to pay Vendor for goods or services delivered to the
Cooperative member prior to the termination and not otherwise returned in accordance with Vendors return policy. If the
Cooperative member has paid Vendor for goods or services not yet provided as of the date of termination, Vendor shall
immediately refund such payment(s).
If an alternate provision for termination of a Cooperative member purchase for cause and convenience, including the manner
by which it will be effected and the basis for settlement, is included in the Cooperative member's Purchase Order or ancillary
agreement agreed to by the Vendor, the Cooperative member's provision shall control. /�
YES, I agree. El NO, I do not agree. Initial: ~�
Page 21 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 - buyboard.com
3. Equal Employment Opportunity:
Except as otherwise provided under 41 CFR Part 60, all Cooperative member purchases or contracts that meet the definition
of"federally assisted construction contract" in 41 CFR Part 60-1.3 shall be deemed to include the equal opportunity clause
provided under 41 CFR 60-1.4(b), in accordance with Executive Order 11246,"Equal Employment Opportunity"(30 FR 12319,
12935, 3 CFR Part, 1964-1965 Comp., p. 339), as amended by Executive Order 11375, "Amending Executive Order 11246
Relating to Equal Employment Opportunity," and implementing regulations at 41 CFR Part 60, "Office of Federal Contract
Compliance Programs, Equal Employment Opportunity, Department of Labor."
The equal opportunity clause provided under 41 CFR 60-1.4(b) is hereby incorporated by reference. Vendor agrees that such
provision applies to any Cooperative member purchase or contract that meets the definition of"federally assisted construction
contract"in 41 CFR Part 60-1.3 and Vendor agrees that it shall comply with such provision.
11 YES, I agree. ❑ NO, I do not agree.
4. Davis-Bacon Act:
When required by Federal program legislation, Vendor agrees that, for all Cooperative member prime construction
contracts/purchases in excess of$2,000,Vendor shall comply with the Davis-Bacon Act(40 USC 3141-3144, and 3146-3148)
as supplemented by Department of Labor regulations (29 CFR Part 5, "Labor Standards Provisions Applicable to Contracts
Covering Federally Financed and Assisted Construction'). In accordance with the statute,Vendor is required to pay wages to
laborers and mechanics at a rate not less than the prevailing wages specified in a wage determinate made by the Secretary
of Labor. In addition,Vendor shall pay wages not less than once a week.
Current prevailing wage determinations issued by the Department of Labor are available at beta.sam.gov. Vendor agrees
that, for any purchase to which this requirement applies, the award of the purchase to the Vendor is conditioned upon
Vendor's acceptance of the wage determination.
Vendor further agrees that it shall also comply with the Copeland "Anti-Kickback"Act (40 USC 3145), as supplemented by
Department of Labor regulations(29 CFR Part 3,"Contractors and Subcontractors on Public Building or Public Work Financed
in Whole or in Part by Loans or Grants from the United States'j. The Act provides that each contractor or subrecipient must
be prohibited from inducing, by any means, any person employed in the construction, completion, or repair of public work,
to give up any part of the compensation to which he or she is otherwise entitled.
11 YES, I agree. ❑ NO, I do not agree.
5. Contract Work Hours and Safety Standards Act:
Where applicable, for all Cooperative member contracts or purchases in excess of$100,000 that involve the employment of
mechanics or laborers, Vendor agrees to comply with 40 USC 3702 and 3704, as supplemented by Department of Labor
regulations (29 CFR Part 5). Under 40 USC 3702 of the Act,Vendor is required to compute the wages of every mechanic and
laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided
that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in
excess of 40 hours in the work week.
The requirements of 40 USC 3704 are applicable to construction work and provide that no laborer or mechanic must be
required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These
requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or
contracts for transportation or transmission of intelligence.
YES, I agree. ❑ NO, I do not agree.
Initial• As
Page 22 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 • buyboard.com
6. Right to Inventions Made Under a Contract or Agreement:
If the Cooperative member's Federal award meets the definition of"funding agreement" under 37 CFR 401.2(a) and the
recipient or subrecipient wishes to enter into a contract with a small business firm or nonprofit organization regarding the
substitution of parties, assignment or performance or experimental, developmental, or research work under that "funding
agreement,"the recipient or subrecipient must comply with the requirements of 37 CFR Part 401,"Rights to Inventions Made
by Nonprofit Organizations and Small Business Firms Under Government Grants, Contracts and Cooperative Agreements,"
and any implementing regulations issued by the awarding agency.
Vendor agrees to comply with the above requirements when applicable.
11 YES, I agree. ❑ NO, I do not agree.
7. Clean Air Act and Federal Water Pollution Control Act:
Clean Air Act(42 USC 7401-7671q.)and the Federal Water Pollution Control Act(33 USC 1251-1387),as amended—Contracts
and subgrants of amounts in excess of $150,000 must contain a provision that requires the non-Federal award to agree to
comply with all applicable standards, orders, or regulations issued pursuant to the Clean Air Act (42 USC 7401-7671q.) and
the Federal Water Pollution Control Act, as amended (33 USC 1251-1387). Violations must be reported to the Federal
awarding agency and the Regional Office of the Environmental Protection Agency (EPA).
When required, Vendor agrees to comply with all applicable standards, orders, or regulations issued pursuant to the Clean
Air Act and the Federal Water Pollution Control Act.
A YES, I agree. ❑ NO, I do not agree.
8. Debarment and Suspension:
Debarment and Suspension (Executive Orders 12549 and 12689)—A contract award (see 2 CFR 180.220) must not be made
to parties listed on the government-wide exclusions in the System for Award Management (SAM), in accordance with the
OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR Part 1966 Comp. p. 189) and 12689 (3 CFR
Part 1989 Comp. p. 235),"Debarment and Suspension." SAM Exclusions contains the names of parties debarred,suspended,
or otherwise excluded by agencies, as well as parties declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
Vendor certifies that Vendor is not currently listed on the government-wide exclusions in SAM, is not debarred, suspended,
or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than Executive Order
12549. Vendor further agrees to immediately notify the Cooperative and all Cooperative members with pending purchases or
seeking to purchase from Vendor if Vendor is later listed on the government-wide exclusions in SAM, or is debarred,
suspended, or otherwise excluded by agencies or declared ineligible under statutory or regulatory authority other than
Executive Order 12549.
A YES, I agree. ❑ NO, I do not agree.
9. Byrd Anti-Lobbying Amendment:
Byrd Anti-Lobbying Amendment (31 USC 1352) - Vendors that apply or bid for an award exceeding $100,000 must file the
required certification. Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay
any person or organization for influencing or attempting to influence an officer or employee of any agency, a member of
Congress,officer or employee of Congress,or an employee of a member of Congress in connection with obtaining any Federal
contract,grant or any other award covered by 31 USC 1352. Each tier must also disclose any lobbying with non-Federal funds
that takes place in connection with obtaining any Federal award. Such disclosures are forwarded from tier to tier up to the
non-Federal award. As applicable, Vendor agrees to file all certifications and disclosures required by, and otherwise comply
with, the Byrd Anti-Lobbying Amendment (31 USC 1352).
YES, I agree. ❑ NO, I do not agree.
Initial• As
Page 23 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
10. Procurement of Recovered Materials:
For Cooperative member purchases utilizing Federal funds, Vendor agrees to comply with Section 6002 of the Solid Waste
Disposal Act, as amended by the Resource Conservation and Recovery Act where applicable and provide such information
and certifications as a Cooperative member may require to confirm estimates and otherwise comply. The requirements of
Section 6002 include procuring only items designated in guidelines of the Environmental Protection Agency (EPA) at 40 CFR
Part 247 that contain the highest percentage of recovered materials practicable, consistent with maintaining a satisfactory
level of competition, where the purchase price of the item exceeds $10,000 or the value of the quantity acquired during the
preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and
resource recovery, and establishing an affirmative procurement program for procurement of recovered materials identified in
the EPA guidelines.
A YES, I agree. ❑ NO, I do not agree.
11. Domestic Preferences for Procurements:
Where appropriate and consistent with law, 2 CFR §200.322 contains certain considerations for domestic preferences for
procurements which may be applicable to Cooperative members using federal funds. When required by a Cooperative
member, Vendor agrees to provide such information or certification as may reasonably be requested by the Cooperative
member regarding Vendor's products, including whether goods, products, or materials are produced in the United States.
A YES, I agree. ❑ NO, I do not agree.
12. Prohibition on Certain Telecommunications and Video Surveillance Services or Equipment
2 CFR §200.216 prohibits expending federal loan or grant funds to procure or obtain certain telecommunications and video
surveillance services or equipment. To the extent applicable and when required by a Cooperative member,Vendor agrees to
provide such information or certification as may reasonably be requested by the Cooperative member to confirm whether
any telecommunications or video surveillance services or equipment provided by Vendor is covered equipment or covered
services under 2 CFR§200.216.
A YES, I agree. ❑ NO, I do not agree.
13. Profit as a Separate Element of Price:
For purchases using federal funds in excess of the Simplified Acquisition Threshold, a Cooperative member may be required
to negotiate profit as a separate element of the price. See, 2 CFR 200.324(b). When required by a Cooperative member,
Vendor agrees to provide information and negotiate with the Cooperative member regarding profit as a separate element of
the price for a particular purchase. However, Vendor agrees that the total price, including profit, charged by Vendor to the
Cooperative member shall not exceed the awarded pricing, including any applicable discount, under Vendor's Cooperative
Contract.
A YES, I agree. ❑ NO, I do not agree.
14. General Compliance and Cooperation with Cooperative Members:
In addition to the foregoing specific requirements, Vendor agrees, in accepting any Purchase Order from a Cooperative
member, it shall make a good faith effort to work with Cooperative members to provide such information and to satisfy such
requirements as may apply to a particular Cooperative member purchase or purchases including, but not limited to,applicable
recordkeeping and record retention requirements.
YES, I agree. ❑ NO, I do not agree.
Initial• AS
Page 24 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
COMPLIANCE FORMS SIGNATURE PAGE
By initialing pages and by signature below, I certify that I have reviewed the following forms; that the information provided
therein is true, complete, and accurate; and that I am authorized by my company to make all certifications, consents,
acknowledgements, and agreements contained herein:
■ Proposal Acknowledgements
■ Felony Conviction Disclosure
■ Debarment Certification
■ Resident/Nonresident Certification
■ Vendor Employment Certification
■ No Israel Boycott Certification
■ No Excluded Nation or Foreign Terrorist Organization Certification
■ Historically Underutilized Business Certification
■ Construction-Related Goods and Services Affirmation
■ Acknowledgement of BuyBoard Technical Requirements
■ Deviation and Compliance
■ Vendor Consent for Name Brand Use
■ Confidential/Proprietary Information
■ EDGAR Vendor Certification
Siddons-Martin Emergency Group
Company Name
Amanda Seabranch Digitally signed by Amanda Seabranch
Data:2021.04.27 13:20:12-05'00'
Signature of Authorized Company Official
Amanda Seabranch; Order Management Analyst
Printed Name and Title
04-27-2021
Date
Page 25 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
PROPOSAL FORMS PART 2: VENDOR INFORMATION FORMS
INSTRUCTIONS:
Proposer must completely and accurately provide all information requested in the following Vendor Information Forms or
your Proposal may be rejected as non-responsive:
■ Vendor Business Name ■ National Purchasing Cooperative Vendor Award
■ Vendor Contact Information Agreement (vendors serving outs/de Texas only)
■ Federal and State/Purchasing Cooperative ■ Local/Authorized Seller Listings
Experience ■ Manufacturer Dealer Designation
■ Governmental References ■ Proposal Invitation Questionnaire
■ Company Profile ■ Vendor Request to Self-Report BuyBoard
■ Texas Regional Service Designation Purchases (optional)
■ State Service Designation
To the extent any information requested is not applicable to your company, you must so indicate on the form.
VENDOR BUSINESS NAME
By submitting a Proposal,Vendor is seeking to enter into a legal contract with the Cooperative. As such,Vendor must be an
individual or legal business entity capable of entering into a binding contract.
Name of Proposing Company: Siddons-Martin Emergency Group, LLC.
(List the legal name of the company seeking to contract with the Cooperative. Do NOT/1st an assumed name,dba,aka,etc.here. Such information may
be provided below. If you are submitting a joint proposal with another entity to provide the same proposed goods or services,each submitting entity should
complete a separate vendor information form. Separately operating legal business entities, even if afrI/fated entities, which propose to provide goods or
services separately must submit their own Proposals)
Please check(y)one of the following:
Type of Business: ❑ Individual/Sole Proprietor ❑ Corporation Limited Liability Company ❑ Partnership
❑ Other (Specify: )
State of Incorporation (if applicable): Texas
Federal Employer Identification Number: 27-433590
(vendor must include a completed IRS W- form with their Proposal)
Name by which Vendor,if awarded,wishes to be identified on the BuyBoard: (Note. ifdiffera?ntthan the Name ofproposing
Company listed above,only va/id trade names(dba,aka,etc)of the Proposing Company may be used and a copy of your Assumed Name Cerbficate(s),if
applicable,must be attached.)
Page 26 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Request for Taxpayer
Form W-9 Give Form to the
(Rev.October2018) identification Number and Certification requester.Do not
Dep of the Treasury
Iartment al Revenue Service 0-Go to www.irs.gov/FormWD for Instructions and the latest information, send to the IRS.
#Business
hown on your income tax return).Name is required on this line;do not leave this line blank.
artin Emer enc Grou LLC
ameldisregarded entity name,if different from above
o ate box for federal tax classification of the arson whose name is entered on line 1.Check onl one of the 4 Exem bons codes a onl to
Wi P Y P ( PPty Yven boxes. certain entities,not individuals;see
a instructions on page 3y
Cp ❑ Individual/sole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate
c single-member LLC Exempt payee code(if any) 5
�'� ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P-Partnership)► S
p I Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
N LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
- code(if any)
ri another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member L>_G that
is disregarded from the owner should check the ap
propriate box for the tax classification of its owner.
o ❑ Other(see instructions)► (Applies re acrnrn7s--tarn a od-ft USf
m
(n 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(option¢
d
�
1362 E.Riche Rd
6 City,state,and ZIP code
Houston,TX 77073
7 List account numbers)here(optional)
Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given an line 1 to avoid Social security number
backup withholding.For individuals,this is generally your social security number(SSN.However,for a
resident alien,sole proprietor,or disregarded entity,see the instructions for Part!,later.For other
entities,it is your employer identification number(Eli If you do not have a number,see Flow to get a
TIN,later. or
Note-If the account is in more than one name,see the instructions for line 1.Also see What Name and I Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
M27 - 4 1 3 3 3 5 9 0
NtraM Certification
Under penalties of perjury,I certify that:
1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and
2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am
no longer subject to backup withholding;and
3.1 am a U.S.citizen or other U.S.person(defined below);and
4.The FATCA codes)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply,For mortgage interest paid,
acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
other than interest and dividends,you are not required o sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
Sign Signature of f r �^,v I
Here: U.S.person► L V e0ata► Audingt
V
General Instructions •Form 1099-DIU(dividends,ise from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise o Form 1099-MISC(various types of income,prizes,awards,or gross
noted. proceeds)
Future developments.For the latest information about developments +Form 1099-B(stock or mutual fund sales and certain other
related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
after they were published,go to www.irs.gov/ForMW9. •Form 1099-5(proceeds[ram real estate transactions)
Purpose of Form •Form 1099-K(merchant card and third party network transactions)
An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
identification number(TIN)which may be your social security number .Form 1099-C(canceled debt)
(SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A{acquisition or abandonment of secured property)
taxpayer identification number(ATIN),or employer identification number
(Eli to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
amount reportable on an information return.Examples of information alien),to provide your correct TIN.
returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
•Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
later.
Cat.No.10231 x Form 1Af-9(Rev,10-2018)
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
VENDOR CONTACT INFORMATION
Proposal/Contract Contact:
Vendor Proposal/Contract Contact Name: Jeffrey A. Doran
Vendor Proposal/Contract Contact E-mail Address: jdoran@siddons-martin.com
Vendor Contact Mailing Address for Proposal/Contract Notices: 362 East Richey Road
Houston, Texas 77073
Company Website: wwW•siddons-martin.Com
Purchase Orders Contact Information: All Purchase Orders from Cooperative members will be available through the
Internet. Vendors need Internet access and at least one e-mail address so that notification of new orders can be sent to the
Internet contact when a new purchase order arrives. An information guide will be provided to Vendors to assist them with
retrieving their orders.
Please select options below for receipt of Purchase Orders and provide the requested information:
0 I will use the internet to receive Purchase Orders at the following address:
Purchase Order E-mail Address: jdoran@siddons-martin.com
Purchase Order Contact: Jeffrey A. Doran Phone: 800-784-6806
Alternate Purchase Order E-mail Address: aseabranch@siddons-martin.com
Alternate Purchase Order Contact: Amanda Seabranch Phone: 800-784-6806
❑ Purchase Orders may be received by the Designated Dealer(s)identified on my company's Dealer Designation
form as provided to the Cooperative administrator. I understand that my company shall remain responsible
for the Contract and the performance of all Designated Dealers under and in accordance with the Contract.
Request for Quotes rRFO"): Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses
for the receipt of RFQs:
RFQ E-mail Address: jdoran@siddons-martin.com
RFQ contact: Jeffrey A. Doran Phone: 800-784-6806
Alternate RFQ E-mail Address: aseabranch a@siddons-martin.com
Alternate RFQ contact: Amanda Seabranch Phone: 800-784-6806
Page 27 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
Invoices: Your company will be billed monthly for the service fee due under a Contract awarded under this Proposal
Invitation. All invoices are available on the BuyBoard website and e-mail notifications will be sent when they
are ready to be retrieved.
Please choose only one (1) of the following options for receipt of invoices and provide the requested
information:
■❑ Service fee invoices and related communications should be provided directly to my company at:
Invoice Mailing address: 1362 E. Richey Road Department: Accounts Payable
city: Houston State: Texas Zip Code: 77073
Contact Name: Kelli Metzger Phone: (281 ) 606-4933
Invoice Fax: Invoice E-mail Address: invoices@siddons-martin.com
Alternative Invoice E-mail Address:
❑ In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing
agent**:
Billing Agent Mailing Address: Department:
City: State: Zip Code:
Billing Agent Contact Name: Phone:
Billing Agent Fax: Billing Agent E-mail Address:
Alternative Billing Agent E-mail Address:
"If Vendor authorizes a billing agent to receive and process service fee invoices,in accordance with the General Terms and
Conditions of the Contract, Vendor specifically acknowledges and agrees that nothing in that designation shall relieve Vendor
of its responsibilities and obligations under the Contract including, but not limited to,payment of all service fees under any
Contract awarded Vendor
PLEASE PROVIDE THE FOLLOWING INFORMATION:
1. Shipping Via: ❑ Common Carrier ❑ Company Truck ❑ Prepaid and Add to Invoice ■❑ Other: Driven
2. Payment Terms: (Note: Vendor payment terms must comply with the BuyBoard General Terms and Conditions and the Texas
Prompt PaymentAct(Texas Government Code Ch. 2251).). Due upon,Acceptance
3. Vendor's Internal/Assigned Reference/Quote Number (optional):
4. State or attach your return policy. (Note: Only return requirements and processes will be deemed part of Vendor's return
policy. Any unrelated contract terms, terms of sale, or other information not specifically related to return requirements and
processes included in Vendor's return policy shall not apply to any awarded Contract unless specifically included as a
deviation in the Deviation and Compliance Form and accepted by the Cooperative):
5. Are electronic payments acceptable? ■❑Yes ❑ No 6. Are credit card payments acceptable? ❑Yes ❑ No
Page 28 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard 'Austin,Texas 78759-2439 • PH: 800-695-2919 ' buyboard.com
FEDERAL AND STATE/PURCHASING COOPERATIVE UPERIENCE
The Cooperative strives to provide Cooperative members with the best services and products at the best prices available from
Vendors with the technical resources and ability to serve Cooperative members. Please respond to the following questions.
1. Provide the dollar value of sales to or through purchasing cooperatives at or based on an established catalog or market
price during the previous 12-month period or the last fiscal year: $ . (The period of the 12-month
period is / ). In the event that a dollar value is not an appropriate measure of the sales, provide
and describe your own measure of the sales of the item(s).
2. By submitting a proposal, you agree that, based on your written discounting policies, the discounts you offer the
Cooperative are equal to or better than the best price you offer other purchasing cooperatives for the same items under
equivalent circumstances.
3. Provide the information requested below for other purchasing cooperatives for which Proposer currently serves, or in
the past has served, as an awarded vendor. Rows should be added to accommodate as many purchasing cooperatives
as required.
FORMERCURRENT D•' AWARDED
VENDOR?PURCHASING A' COMMODITY
GROUPD• • • •
1. Federal General Services Administration
2. T-PASS (state of Texas)
3. OMNIA Partners
4. Sourcewell (NJPA) Y 5 Fire Apparatus
5. E&I Cooperative
6. Houston-Galveston Area Council (HGAC) Y 32 Fire Apparatus
7. Choice Partners
8. The Interlocal Purchasing System (TIPS)
9. Other
❑ MY COMPANY DOES NOT CURRENTLY HAVE ANY OF THE ABOVE OR SIMILAR TYPE CONTRACTS.
CURRENT BUYBOARD VENDORS
If you are a current BuyBoard vendor in the same contract category as proposed in this Proposal Invitation, indicate the
discount for your current BuyBoard contract and the proposed discount in this Proposal. Explain any difference between your
current and proposed discounts.
Current Discount(%): 0% off list Proposed Discount(%): 0% Off list
Explanation: Prices are individually qouted on quote letter and spreadshet listing base and options
Page 29 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Board,
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
GOVERNMENTAL REFERENCES
For your Proposal to be considered, you must supply a minimum of five (5) individual governmental entity references. The
Cooperative may contact any and all references provided as part of the Proposal evaluation. Provide the information requested
below, including the existing pricing/discounts you offer each customer. The Cooperative may determine whether
pricing/discounts are fair and reasonable by comparing pricing/discounts stated in your Proposal with the pricing/discounts
you offer other governmental customers. Attach additional pages if necessary.
Quantity/
Entity Name Contact Phone# Email Address Discount Volume
1.
2.
3.
4.
5.
Do you ever modify your written policies or standard governmental sales practices as identified in the above chart to give
better discounts (lower pricing) than indicated? YES ❑ NO ❑■ If YES, please explain:
COMPANY PROFILE
Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your
company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you would
like to have included with your company profile on the BuyBoard website. Submit your company profile in a separate
file, in Word format,with your Proposal. (Note: Vendor is solely responsible for any content provided for inclusion on
the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole discretion, with or
without prior notice, including but not limited to any content deemed by the Cooperative to be inappropriate, irrelevant to
the Contract, inaccurate, or misleading.)
Page 30 of 74
Proposal Forms COMM/SVCS v.03.01.2021
D: VBoard
URCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • buyboard.com
TEXAS REGIONAL SERVICE DESIGNATION
The Cooperative (referred to as"Texas Cooperative"in this form and in the State Service Designation form) offers vendors
the opportunity to service its members throughout the entire State of Texas. If you do not plan to service all Texas Cooperative
members statewide, you must indicate the specific regions you will service on this form. If you propose to serve different
regions for different products or services included in your Proposal,you must complete and submit a separate Texas Regional
Service Designation form for each group of products and clearly indicate the products or services to which the designation
applies. By designating a region or regions, you are certifying that you are authorized and wi//ing to provide
the proposed products and services in those regions. Designating regions in which you are either unable or
unwilling to provide the specified products and services shall be grounds for either rejection of your Proposal
or,if awarded, termination of your Contract. Additionally, if you do not plan to service Texas Cooperative members
(i.e., if you will service only states other than Texas), you must so indicate on this form.
Regional Education Service Centers O I will service Texas
Cooperative members
statewide.
.w ❑ I will not service Texas
Cooperative members
statewide. I will only
service members in the
'-• �. f regions checked below:
m Region and Headauarters
❑ 1 Edinburg
� „ ❑ 2 Corpus Christi
- °°- '" ❑ 3 Victoria
-' "` ❑ 4 Houston
�, ' ❑ 5 Beaumont
" * ❑ 6 Huntsville
y - ❑ 7 Kilgore
.� F ❑ 8 Mount Pleasant
❑ 9 Wichita Falls
❑ 10 Richardson
❑ 11 Fort Worth
❑ 12 Waco
❑ 13 Austin
w `� ❑ 14 Abilene
.. ❑ 15 San Angelo
r ❑ 16 Amarillo
Siddons-Martin Emergency Group ❑ 17 Lubbock
❑ 18 Midland
Company Name ❑ 19 El Paso
❑ 20 San Antonio
❑ I will not service members of the
Texas Cooperative.
Page 31 of 74
Proposal Forms COMM/SVCS v.03.01.2021
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
STATE SERVICE DESIGNATION
As set forth in the Proposal Invitation, it is the Cooperative's intent that other governmental entities in the United States have
the opportunity to purchase goods or services awarded under the Contract, subject to applicable state law, through a piggy-
back award or similar agreement through the National Purchasing Cooperative BuyBoard. If you plan to service the entire
United States or only specific states,you must complete this form accordingly. (Note:Ifyoup/an to service Texas Cooperative
members, be sure that you complete the Texas Regional Service Designation form.) In addition to this form, to be
considered for a piggy-back award by the National Purchasing Cooperative, you must have an authorized
representative sign the National Purchasing Cooperative Vendor Award Agreement that follows this form.
If you serve different states for different products or services included in your Proposal, you must complete and submit a
separate State Service Designation form for each group of products and clearly indicate the products or services to which the
designation applies. By designating a state or states, you are certifying that you are authorized and willing to
provide the proposed products and services in those states.Designating states in which you are either unable
or unwilling to provide the specified products and services shall be grounds for either rejection of your
Proposal or,ifawarded, termination of your Contract.
Please check()n all that apply:
❑■ I will service all states in the United States.
❑ I will not service all states in the United States. I will service only the states checked below:
❑ Alabama
❑ Alaska ❑ Nebraska
❑ Arizona ❑ Nevada
❑ Arkansas ❑ New Hampshire
❑ California (Public Contract Code 20118 &20652) ❑ New Jersey
❑ Colorado ❑ New Mexico
❑ Connecticut ❑ New York
❑ Delaware ❑ North Carolina
❑ District of Columbia ❑ North Dakota
❑ Florida ❑ Ohio
❑ Georgia ❑ Oklahoma
❑ Hawaii ❑ Oregon
❑ Idaho ❑ Pennsylvania
❑ Illinois ❑ Rhode Island
❑ Indiana ❑ South Carolina
❑ Iowa ❑ South Dakota
❑ Kansas ❑ Tennessee
❑ Kentucky ❑ Texas
❑ Louisiana ❑ Utah
❑ Maine ❑ Vermont
❑ Maryland ❑ Virginia
❑ Massachusetts ❑ Washington
❑ Michigan ❑ West Virginia
❑ Minnesota ❑ Wisconsin
❑ Mississippi ❑ Wyoming
❑ Missouri
❑ Montana
Proposal Forms COMM/SVCS v.03.01.2021
Page 32 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
NATIONAL PURCHASING COOPERATIVE VENDOR AWARD AGREEMENT
In accordance with the Terms and Conditions associated with this Proposal Invitation,a contract awarded under this Proposal
Invitation may be "piggy-backed" by another governmental entity. The National Purchasing Cooperative is an
intergovernmental purchasing cooperative formed by certain school districts outside of Texas to serve its members throughout
the United States. If you agree to be considered for a piggy-back award by the National Purchasing Cooperative, you agree
to the following terms and agree to serve National Purchasing Cooperative members in the states you have indicated on the
State Service Designation form, in your Proposal.
By signing this form, Proposer(referred to in this Agreement as"'Vendor")agrees as follows:
1. Vendor acknowledges that if The Local Government Purchasing Cooperative ('Texas Cooperative'l awards Vendor a
contract under this Proposal Invitation ("Underlying Award'), the National Purchasing Cooperative ('National Cooperative')
may - but is not required to - "piggy-back"on or re-award all or a portion of that Underlying Award ('Piggy-Back Award'J.
By signing this National Cooperative Vendor Award Agreement ("Agreement'l, Vendor accepts and agrees to be bound by
any such Piggy-Back Award as provided for herein.
2. In the event National Cooperative awards Vendor a Piggy-Back Award,the National Cooperative Administrator('BuyBoard
Administrator'l will notify Vendor in writing of such Piggy-Back Award, which award shall commence on the effective date
stated in the Notice and end on the expiration date of the Underlying Award, subject to annual renewals as authorized in
writing by the BuyBoard Administrator. Vendor agrees that no further signature or other action is required of Vendor in order
for the Piggy-Back Award and this Agreement to be binding upon Vendor. Vendor further agrees that no interlineations or
changes to this Agreement by Vendor will be binding on National Cooperative, unless such changes are agreed to by its
BuyBoard Administrator in writing.
3. Vendor agrees that it shall offer its goods and services to National Cooperative members at the same unit pricing and
same general terms and conditions, subject to applicable state laws in the state of purchase, as required by the Underlying
Award. However, nothing in this Agreement prevents Vendor from offering National Cooperative members better(i.e., lower)
competitive pricing and more favorable terms and conditions than those in the Underlying Award.
4. Vendor hereby agrees and confirms that it will serve those states it has designated on the State Service Designation Form
of this Proposal Invitation. Any changes to the states designated on the State Service Designation Form must be approved
in writing by the BuyBoard Administrator.
5. Vendor agrees to pay National Cooperative the service fee provided for in the Underlying Award based on the amount of
purchases generated from National Cooperative members through the Piggy-Back Award. Vendor shall remit payment to
National Cooperative on such schedule as it specifies (which shall not be more often than monthly). Further, upon request,
Vendor shall provide National Cooperative with copies of all purchase orders generated from National Cooperative members,
vendor invoices, and/or such other documentation regarding those purchase orders as the Cooperative's administrators may
require in their reasonable discretion for purposes of reviewing and verifying purchase activity. Vendor further agrees that
National Cooperative shall have the right, upon reasonable written notice,to review Vendor's records pertaining to purchases
made by National Cooperative members in order to verify the accuracy of service fees.
6. Vendor agrees that the Underlying Award, including its General Terms and Conditions, are adopted by reference to the
fullest extent such provisions can reasonably apply to the post-proposal/contract award phase.The rights and responsibilities
that would ordinarily inure to the Texas Cooperative pursuant to the Underlying Award shall inure to National Cooperative;
and, conversely, the rights and responsibilities that would ordinarily inure to Vendor in the Underlying Award shall inure to
Vendor in this Agreement. Vendor recognizes and agrees that Vendor and National Cooperative are the only parties to this
Agreement, and that nothing in this Agreement has application to other third parties, including the Texas Cooperative. In the
event of conflict between this Agreement and the terms of the Underlying Award, the terms of this Agreement shall control,
and then only to the extent necessary to reconcile the conflict.
Proposal Forms COMM/SVCS v.03.01.2021
Page 33 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
7. This Agreement shall be governed and construed in accordance with the laws of the State of Rhode Island and venue for
any dispute shall lie in the federal district court of Alexandria,Virginia.
8. Vendor acknowledges and agrees that the award of a Piggy-Back Award is within the sole discretion of National
Cooperative,and that this Agreement does not take effect unless and until National Cooperative awards Vendor a Piggy-Back
Award and the BuyBoard Administrator notifies Vendor in writing of such Piggy-Back Award as provided for herein.
WHEREFORE, by signing below Vendor agrees to the foregoing and warrants that it has the authority to enter into this
Agreement.
Siddons-Martin Emergency Group 650-21
Name of Vendor Proposal Invitation Number
sinedAmanda
Amanda Seabranch Data:1ly 2021.04.27y1324:6 05'00'Seabranch Amanda Seabranch
Signature of Authorized Company Official Printed Name of Authorized Company Official
04-27-2021
Date
Proposal Forms COMM/SVCS v.03.01.2021
Page 34 of 74
BOard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
LOCATION /AUTHORIZED SELLER LISTINGS
If you have more than one location/authorized seller that will service a Contract awarded under this Proposal Invitation,
please list each location/authorized seller below. If additional sheets are required, please duplicate this form as necessary.
NOTE: Awarded Vendors shall remain responsible for all aspects of the Contract, including processing of Purchase Orders,
and shall be responsible for the performance of all locations and authorized sellers under and in accordance with the Contract.
If you are a product manufacturer and wish to designate Designated Dealers as defined in the General Terms
and Conditions to receive Cooperative member Purchase Orders on your behalf, you must complete the
Manufacturer Designated Dealer form,
Location/Authorized Contact Information
Seller Name Contact Person (Mailing Address, Phone, Fax, Email)
See attached Dealer Contact
List
Proposal Forms COMM/SVCS v.03.01.2021
Page 35 of 74
BOard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 - buyboard.com
MANUFACTURER DEALER DESIGNATION
If Vendor is a manufacturer that sells products through a dealer network and wishes to designate a dealer or multiple dealers
('Designated Dealers'l to receive Cooperative member Purchase Orders on Vendor's behalf,you must complete this form for
each dealer you wish to designate.
Regardless of any Designated Dealers submitted by Vendor, Vendor specifically agrees and acknowledges that any such
designations are for Vendor's convenience only and shall not, if Vendor is awarded a Contract, relieve Vendor of any
obligations under the Contract, including payment of Cooperative service fees on all Purchase Orders submitted to Vendor or
any Designated Dealer. In accordance with the General Terms and Conditions, an awarded Vendor shall remain responsible
and liable for all of its obligations under the Contract and the performance of both Vendor and any of Vendor's Designated
Dealers under and in accordance with the Contract and remain subject to all remedies for default thereunder, including, but
not limited to suspension and termination of Vendor's Contract for nonpayment of service fees.
If awarded,Vendor authorizes the Cooperative, in its sole discretion, to list any Vendor Designated Dealers in the BuyBoard
system and to receive Purchase Orders directly from Cooperative members on behalf of Vendor. To the extent a Vendor with
Designated Dealers receives a Purchase Order directly, it shall be the responsibility of Vendor to appropriately process such
Purchase Order in accordance with the Contract, including but not limited to timely forwarding such Purchase Order to a
Designated Dealer for processing.
The Cooperative reserves the right, in its sole discretion,to refuse addition of, or request removal of, any Designated Dealer,
and Vendor agrees to immediately require such Designated Dealer to cease accepting Purchase Orders or otherwise acting
on Vendor's behalf under the Contract. Further,the Cooperative administrator shall be authorized to remove or suspend any
or all Designated Dealers from the BuyBoard at any time in its sole discretion.
If you wish to designate a dealer to service a contract awarded under this Proposal Invitation, please list the Designated
Dealer below. If you wish to designate multiple dealers, please duplicate this form as necessary.
See Attached Dealer List
Designated Dealer Name Designated Dealer Contact Person
Designated Dealer Address
City State Zip
Phone Number Fax Number
Email address Designated Dealer Tax ID Number* (*attach W-9)
Proposal Forms COMM/SVCS v.03.01.2021
Page 36 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
PROPOSAL INVITATION QUESTIONNAIRE
The Cooperative will use your responses to the questions below in evaluating your Proposal and technical and financial
resources to provide the goods and perform the services("Work'l under the BuyBoard contract contemplated by this Proposal
Invitation ("Contract'l. Proposers must fully answer each question, numbering your responses to correspond to the
questions/numbers below. Proposers must complete below or attach your responses to this questionnaire and submit in one
document with your Proposal. You must submit the questionnaire and responses with your Proposal or the
Proposal will not be considered.
1. List the number of years Proposer has been in business and former business names (if applicable). Note whether your
company is currently for sale or involved in any transaction that would significantly alter its business or result in acquisition
by another entity.
1974 - Martin Apparatus
1999 - Siddons Fire
2011- to Present- Dealer merged to form Siddons-Martin Emergency Group
2. Describe the resources Proposer has to manage staff and successfully perform the Work contemplated under this
Contract. State the number and summarize the experience of company personnel who may be utilized for the Work,
including those who will be available to Cooperative members for assistance with project development, technical issues,
and product selection for Work associated with this Contract.
Siddons-Martin Emergency Group
3. Marketing Strategy: For your Proposal to be considered, you must submit the Marketing Strategy you will use if the
Cooperative accepts all or part of your Proposal. (Example: Explain how your company will initially inform Cooperative
members of your BuyBoard Contract,and how you will continue to support the BuyBoard for the duration of the Contract
term.)Attach additional pages if necessary.
Proposal Forms COMM/SVCS v.03.01.2021
Page 37 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
4. Describe Proposer's financial capability to perform the Contract. State or describe the firm's financial strength and rating,
bonding capacity, and insurance coverage limits. State whether the firm, or any of the firm's past or present owners,
principal shareholders or stockholders, or officers, have been a debtor party to a bankruptcy, receivership, or insolvency
proceeding in the last 7 years, and identify any such debtor party by name and relationship to or position with your firm.
5. Does your company have any outstanding financial judgments and/or is it currently in default on any loan or financing
agreement? If so, provide detailed information on the nature of such items and prospects for resolution.
6. List all contracts, if any, in the last 10 years on which Proposer has defaulted, failed to complete or deliver the work, or
that have been terminated for any reason. For each such contract, provide the project name, scope, value and date and
the name of the procuring entity. Fully explain the circumstances of the default, failure to complete or deliver the work,
or termination.
7. List all litigation or other legal proceedings(including arbitration proceedings), if any, in the last 10 years brought against
your firm, or any of the firm's past or present owners, principal shareholders or stockholders, officers, agents or
employees, that relate to or arise from a contract similar to this Contract or the Work contemplated under this Contract.
Provide the style of the lawsuit or proceeding (name of parties and court or tribunal in which filed), nature of the claim,
and resolution or current status.
Proposal Forms COMM/SVCS v.03.01.2021
Page 38 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 - buyboard.com
VENDOR REQUEST TO SELF-REPORT BUYBOARD PURCHASES
The General Terms and Conditions require that all Purchase Orders generated by or under any Contract awarded under this
Proposal Invitation be processed through the BuyBoard and, except as expressly authorized in writing by the Cooperative
administrator,Vendors are not authorized to process Purchase Orders received directly from Cooperative members that have
not been processed through the BuyBoard or provided to the Cooperative. In accordance with this provision, Vendor may
request authorization of the Cooperative administrator to self-report Cooperative member purchases if awarded a Contract
under this Proposal Invitation. By making such a request, Vendor acknowledges and agrees that self-reporting is specifically
subject to and conditioned upon (1)Vendor's agreement to the Additional Terms and Conditions for BuyBoard Self-Reporting
which are included in this Proposal Invitation and incorporated herein for all purposes and (2) approval of this request in
writing by the Cooperative administrator.
Note: This form is NOT required as part of your proposal. You should sign and return this form ONL Y if you
wish to request authorization to self-report BuyBoard purchases. Any request to self-report will not be effective,
and Vendor shall not be authorized to self-report BuyBoard member purchases, unless and until (1) Vendor is awarded a
Contract under this Proposal Invitation, and (2) the request has been approved in writing by the Cooperative administrator.
By my signature below, I hereby request authorization from the Cooperative administrator to self-report
BuyBoard purchases ifmy company is awarded a Contract. I certify thatl am authorized by the above-named
Vendor to approve this form,and I have received and read the Additional Terms and Conditions for BuyBoard
Self-Reporting included in this Proposal Invitation and do hereby approve and agree to such terms and
conditions on behalf of Vendor.
NAME OF VENDOR: Siddons-Martin Emergency Group
Digitally signed by Amanda
Amanda Seabranch Seabranch
Date:2021.04.27 13:25:44-05'00'
Signature of Vendor Authorized Representative
Printed Name: Amanda Seabranch
Title: Order Management Analyst
Date: 04-27-2021
(For Cooperative Administrator Use Only)
Approved by BuyBoard Administrator:
Effective/Start Date for Self-Reporting:
Proposal Forms COMM/SVCS v.03.01.2021
Page 39 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 • buyboard.com
REQUIRED FORMS CHECKLIST
(Please check()1)the following)
0 Reviewed/Completed: Proposer's Acceptance and Agreement
PROPOSAL FORMS PART 1:COMPLIANCE FORMS
0 Reviewed/Completed: Proposal Acknowledgements
0 Reviewed/Completed: Felony Conviction Disclosure
0 Reviewed/Completed: Resident/Nonresident Certification
0 Reviewed/Completed: Debarment Certification
0 Reviewed/Completed: Vendor Employment Certification
0 Reviewed/Completed: No Israel Boycott Certification
0 Reviewed/Completed: No Excluded Nation or Foreign Terrorist Organization Certification
0 Reviewed/Completed: Historically Underutilized Business Certification
0 Reviewed/Completed: Acknowledgement of BuyBoard Technical Requirements
0 Reviewed/Completed: Construction-Related Goods and Services Affirmation
0 Reviewed/Completed: Deviation and Compliance
0 Reviewed/Completed: Vendor Consent for Name Brand Use
0 Reviewed/Completed: Confidential/Proprietary Information
0 Reviewed/Completed: EDGAR Vendor Certification
0 Reviewed/Completed: Compliance Forms Signature Page
PROPOSAL FORMS PART 2:VENDOR INFORMATION FORMS
0 Reviewed/Completed: Vendor Business Name
0 Reviewed/Completed: Vendor Contact Information
0 Reviewed/Completed: Federal and State/Purchasing Cooperative Experience
0 Reviewed/Completed: Governmental References
0 Reviewed/Completed: Company Profile
0 Reviewed/Completed: Texas Regional Service Designation
0 Reviewed/Completed: State Service Designation
0 Reviewed/Completed: National Purchasing Cooperative Vendor Award Agreement(vi?ndorsserving outside Texas only)
0 Reviewed/Completed: Local/Authorized Seller Listings
0 Reviewed/Completed: Manufacturer Dealer Designation
0 Reviewed/Completed: Proposal Invitation Questionnaire
0 Reviewed/Completed: Vendor Request to Self-Report BuyBoard Purchases (optional)
0 Reviewed/Completed: Proposal Specifications Discount (%) off Catalog/Pricelist and/or other required pricing
information including Catalogs/Pricelis*s(or no bid response)must be submitted with the Proposal or the Proposal will not
be considered. Manufacturer Authorization Letters, Franchise Motor Vehicle Dealer Certificate from Texas
Department of Motor Vehicles,Applicable Dealer License.
Proposal Forms COMM/SVCS v.03.01.2021
Page 42 of 74
BOard�
PURCHASING COOPERATIVE
12007 Research Boulevard •Austin,Texas 78759-2439 • PH: 800-695-2919 • FAX: 800-211-5454 - buyboard.com
PROPOSAL SPECIFICATION SUMMARY
The categories and items specified for this Proposal Invitation are summarized below. For full Proposal
Specifications, you must review and complete the Proposal Specification information in the electronic proposal
submission system in accordance with the Instructions to Proposers(or, if submitting a hard copy Proposal,timely
request and complete the Proposal Specification Form in accordance with the Instructions to Proposers).
NOTE 1: Vendors should propose direct replacement models if a model type specified below has been
discontinued by the manufacturer.All ambulances must meet or exceed all requirements of the latest version
of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle Safety Standards, FMVSS.All vehicle
fees to be charged for any purchase from this contract with the exception of delivery fees (i.e. pre delivery
inspection, make ready, applicable state inspection fee, manufacturer destination fees, etc.) are to be included in the
base price(s). Vehicle fees not included in the base price(s) will not be allowed. The Cooperative service fee
for ambulances is not a"vehicle fee"and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service the brand of equipment
submitted. Proposers responding to this Proposal Invitation should submit an approval letter from each manufacturer.
Manufacturer authorization letters must include the regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from Texas Department of Motor
Vehicles and Manufacturer certificate from the Texas Department of Motor Vehicles or, if vendor proposes to serve states
outside of the State of Texas,the applicable dealer license(s) for such state(s).
Section I: Ambulances complete with Chassis
1. Type I Ambulance-Conventional truck,cab-chassis with modular ambulance body on various chassis(Ford, Chevrolet,
GMC, Freightliner, Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis), complete with all
manufacturer's standard equipment. Include separate sheet with upgrade options to include all manufacturer options
including alternative fuel and/or electric choice equipment (CNG, LPG, electric, etc.)
2. Type II Ambulance-Standard van, integral cab-body ambulance on various chassis(Ford,Chevrolet,GMC, Freightliner,
Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis), complete with all manufacturer's standard
equipment. Include separate sheet with upgrade options to include all manufacturer options including alternative fuel
and/or electric choice equipment (CNG, LPG, electric, etc.)
3. Type III Ambulance - Cutaway van, cab-chassis with integral or containerized modular body ambulance on various
chassis(Ford, Chevrolet, GMC, Freightliner, Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis),
complete with all manufacturer's standard equipment. Include separate sheet with upgrade options to include all
manufacturer options including alternative fuel and/or electric choice equipment (CNG, LPG, electric, etc.)
4. Type VII Ambulance - Cutaway van, cab-chassis with integral or containerized modular body ambulance on various
chassis(Ford, Chevrolet, GMC, Freightliner, Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis),
complete with all manufacturer's standard equipment. Include separate sheet with upgrade options to include all
manufacturer options including alternative fuel and/or electric choice equipment(CNG, LPG, electric, etc.)
5. Type IX Ambulance - Cutaway van, cab-chassis with integral or containerized modular body ambulance on various
chassis(Ford, Chevrolet, GMC, Freightliner, Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis),
complete with all manufacturer's standard equipment. Include separate sheet with upgrade options to include all
manufacturer options including alternative fuel and/or electric choice equipment (CNG, LPG, electric, etc.)
Proposal Forms COMM/SVCS v.03.01.2021
Page 40 of 74
Baard�
PURCHASING COOPERATIVE
12007 Research Boulevard -Austin,Texas 78759-2439 - PH: 800-695-2919 • FAX: 800-211-5454 - buyboard.com
Section II: OPTIONAL EQUIPMENT and PARTS- Options will be selected by the Cooperative member at the time of
order. A COMPLETE LIST OF ALL OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR
PROPOSAL TO BE CONSIDERED!
6. Discount (%) off all Original Equipment Manufacturer(OEM) Options.
7. Discount (%) off all Third Party(not OEM) and Unpublished Options and Equipment.
8. Discount (%) off all Original Equipment Manufacturer(OEM) Parts.
9. Discount (%) off all Extended Service Maintenance Agreements.
10. Discount (%) off all Floor Plan Insurance and Lot Insurance (dealer inventory ambulance).
11. Discount (%) off all Other Ambulance Products and Services (refurbishing, modification, uplifting, remounting
services and equipment).
Section III: Delivery Fees and Labor Rate for Installation and Repair Service of Ambulances
12. Hourly Labor Rate for Installation/Repair Service of Ambulance Equipment and Products- not to exceed
hourly labor rate for Installation/Repair Service of Equipment and Products.
13. Hourly Labor Rate for Paint and Body Repair of Ambulances - not to exceed labor rate for Paint and Body Repair.
14. Per Mile Delivery Fee for Ambulances - state the per mile delivery fee for Ambulances.
Proposal Forms COMM/SVCS v.03.01.2021
Page 41 of 74
oard'
PURCHASING COOPERATIVE
650-21
Siddons-Martin Apparatus and Equipment
Fire Apps
Supplier Response
Event Information
Number: 650-21
Title: Ambulances
Type: Request for Proposal
Issue Date: 3/19/2021
Deadline: 4/29/2021 04:00 PM (CT)
Notes:
i M
WBoard
The Local Government Purchasing Cooperative (BuyBoard)
Proposal Invitation No. 650-21
Ambulances
Proposal Due Date and Time: April 29, 2021 at 4:00 PM
Responding to this and future proposals online is easy with our online submission
system.
View and download the forms.
DO NOT log in to view and download the documents.
Visit vendor.buvboard.com and click on the"Current Proposal Invitations"button
shown below to view and download the forms for this proposal.
Page 1 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
As
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Curfent Proposal Iflvitations ►
2.To submit completed proposal.
• Visit vendor.buyboard.com and click"Register/Login/Submit Proposal" button
shown
below to submit your proposal online.
RegisterlLogirdSubmit Proposal lll� A
• For additional assistance click this link I View our Proposal Submission
Instructions.
New Vendor?Visit vendor.buyboard.com and click"Register/Login/Submit Proposal."
Click Resister now as a new supplier/vendor, so you don't miss future proposal
opportunities.
Any Addenda issued with this proposal will also be placed on the website, and it will
be the
vendor's responsibility to obtain the information.
Page 2 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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Siddons-Martin Apparatus and Equipment Fire Apps Information
Address: 14233 Interdrive West
Houston, TX 77032
Phone: (281) 442-6806
Fax: (281) 442-0850
By submitting your response, you certify that you are authorized to represent and bind your company.
Jeffrey A. Doran jdoran@siddons-martin.com
Signature Email
Submitted at 412912021 12:54:51 PM
Requested Attachments
BuyBoard Proposal Invitation No. 650-21 for Proposal-No-650-21 Siddons-Martin 2021-04-28.pdf
Ambulances
REQUIRED - In PDF format, upload all proposal invitation documents available for download at vendor.buyboard.com
including any additional pages, as necessary. (Please DO NOT password protect uploaded files.)
Catalog/Pricelist Pricing Docs All Bids.zip
REQUIRED - In PDF format, upload catalog/pricelist in proposal invitation instructions. File size must not exceed
100MB.(Please DO NOT password protect uploaded files.)
Company Profile Company Profile.zip
Information on awarded Cooperative Contracts is available to Cooperative Members on the BuyBoard website. If your
company is awarded a Contract under this Proposal Invitation, please provide a brief company description that you
would like to have included with your company profile on the BuyBoard website. Submit your company profile in a
separate file, in Word format, with your Proposal. (Note: Vendor is solely responsible for any content provided for
inclusion on the BuyBoard website. The Cooperative reserves the right to exclude or remove any content in its sole
discretion, with or without prior notice, including but not limited to any content deemed by the Cooperative to be
inappropriate, irrelevant to the Contract, inaccurate, or misleading.)
Detailed Information and Exceptions Related to Discount and/or Hourly Labor Pricing Docs All Bids.zip
Rate
In PDF format, define the services that are proposed to be provided and attach detailed information including
exceptions to pricing or discount percentage, NOTE: IF DETAILED INFORMATION IS NOT SUBMITTED, PROPOSAL
MAY NOT BE CONSIDERED. (Please DO NOT password protect uploaded files.)
Manufacturer Authorization Letter(s) Siddons Martin Emergency Group LLC Franchise License.pdf
REQUIRED - Upload Manufacturer Authorization Letter(s)in PDF format. Manufacturers responding to this proposal
invitation, in lieu of an authorization letter, must submit a response on company letterhead explaining that the
company is a manufacturer of products proposed. Dealers responding to this Proposal Invitation should submit an
approval letter from each manufacturer. Manufacturer authorization letters must include the regions and/or states in
which equipment may be sold.
Dealer Certificate(s) and/or License(s) Siddons Martin Emergency Group LLC Franchise License.pdf
In PDF format, upload Franchise Motor Vehicle Dealer Certificate from Texas Department of Motor Vehicles and
Manufacturer certificate from the Texas Department of Motor Vehicles or, if vendor proposes to serve states outside of
the State of Texas, the applicable dealer license(s) for such state(s).
IRS Form W-9 Request for Taxpayer Identification Number and Certification SMEG 2021 W-9.pdf
REQUIRED - In PDF format, upload W-9 form. (Please DO NOT password protect uploaded files.)
Bid Lines
Page 3 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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1
Section I: Ambulances complete with Chassis -Type I Ambulance - Conventional truck, cab-chassis with
modular ambulance body on various chassis (Ford, Chevrolet, GMC, Freightliner, Navistar, Dodge, International,
Peterbilt, Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include
separate sheet with upgrade options to include all manufacturer options including alternative fuel choice
equipment(CNG, LPG, etc.)
Quantity: 1 UOM: Each Price: $226,346.00 Total: $226,346.00
Manufacturer: I Braun
Manufacturer#: Braun
Item Notes:
NOTE 1:Vendors should propose direct replacement models if a model type specified below has
been discontinued by the manufacturer. All ambulances must meet or exceed all requirements of
the latest version of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle
Safety Standards, FMVSS. All vehicle fees to be charged for any purchase from this contract with
the exception of delivery fees (i.e. pre delivery inspection, make ready, applicable state inspection
fee, manufacturer destination fees, etc.) are to be included in the base price(s). Vehicle fees not
included in the base price(s)will not be allowed. The Cooperative service fee for ambulances is
not a "vehicle fee" and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service
the brand of equipment submitted. Proposers responding to this Proposal Invitation should submit
an approval letter from each manufacturer. Manufacturer authorization letters must include the
regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from
Texas Department of Motor Vehicles and Manufacturer certificate from the Texas Department of
Motor Vehicles or, if vendor proposes to serve states outside of the State of Texas, the applicable
dealer license(s) for such state(s).
Item Attributes
1. State Brand of Chassis and Body
All vendor
Alternate 1
Section I: Ambulances complete with Chassis - Type I Ambulance - Conventional truck, cab-chassis with
modular ambulance body on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar, Dodge, International,
Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include
separate sheet with upgrade options to include all manufacturer options including alternative fuel choice
equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $172,277.00 Total: $172,277.00
Manufacturer: Demers DE10
Manufacturer#: Demers
Page 4 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
Ip
Item Attributes
1. State Brand of Chassis and Body
Ford-Dodge-GM-FI-M ER-I NT
Alternate 2
Section I: Ambulances complete with Chassis - Type I Ambulance - Conventional truck, cab-chassis with
modular ambulance body on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar, Dodge, International,
Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include
separate sheet with upgrade options to include all manufacturer options including alternative fuel choice
equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $217,475.00 Total: $217,475.00
Manufacturer: Road Rescue RDR-11
Manufacturer#: Road Rescue
Item Attributes
1. State Brand of Chassis and Body
Ford-Dodge-GM-F L-Mer-I NT
Alternate 3
Section I: Ambulances complete with Chassis - Type I Ambulance - Conventional truck, cab-chassis with
modular ambulance body on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar, Dodge, International,
Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include
separate sheet with upgrade options to include all manufacturer options including alternative fuel choice
equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $160,804.00 Total: $160,804.00
Manufacturer: I Wheeled Coach WC05
Manufacturer#: Wheeled Coach
Item Attributes
1. State Brand of Chassis and Body
FORD-GM-DODGE-FL-MEC-INT
Page 5 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
Ip
2
Section I: Ambulances complete with Chassis -Type II Ambulance-Standard van, integral cab-body
ambulance on various chassis (Ford, Chevrolet, GMC, Freightliner, Navistar, Dodge, International, Peterbilt,
Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include separate
sheet with upgrade options to include all manufacturer options including alternative fuel choice equipment(CNG,
LPG, etc.)
Quantity: 1 UOM: Each Price: $91,320.00 Total: $91,320.00
Manufacturer: I Demers DE14
Manufacturer#: Demers
Item Notes:
NOTE 1:Vendors should propose direct replacement models if a model type specified below has
been discontinued by the manufacturer. All ambulances must meet or exceed all requirements of
the latest version of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle
Safety Standards, FMVSS. All vehicle fees to be charged for any purchase from this contract with
the exception of delivery fees (i.e. pre delivery inspection, make ready, applicable state inspection
fee, manufacturer destination fees, etc.) are to be included in the base price(s). Vehicle fees not
included in the base price(s)will not be allowed. The Cooperative service fee for ambulances is
not a "vehicle fee" and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service
the brand of equipment submitted. Proposers responding to this Proposal Invitation should submit
an approval letter from each manufacturer. Manufacturer authorization letters must include the
regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from
Texas Department of Motor Vehicles and Manufacturer certificate from the Texas Department of
Motor Vehicles or, if vendor proposes to serve states outside of the State of Texas, the applicable
dealer license(s) for such state(s).
Item Attributes
1. State Brand of Chassis and Body
Mer-Ford-GM
Alternate 1
Section I: Ambulances complete with Chassis - Type II Ambulance - Standard van, integral cab-body
ambulance on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar, Dodge, International, Peterbilt.
Kenworth, or other similar chassis), complete with all manufacturer's standard equipment. Include separate
sheet with upgrade options to include all manufacturer options including alternative fuel choice equipment(CNG.
LPG etc.
Quantity: 1 UOM: Each Price: $92,242.00 Total: $92,242.00
Manufacturer: I Wheeled Coach WC-13
Manufacturer#: lWheeled Coach
Page 6 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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Item Attributes
1. State Brand of Chassis and Body
Sprinter Plus-Ford-GM-Mer
3
Section I: Ambulances complete with Chassis -Type III Ambulance - Cutaway van, cab-chassis with integral
or containerized modular body ambulance on various chassis (Ford, Chevrolet, GMC, Freightliner, Navistar,
Dodge, International, Peterbilt, Kenworth, or other similar chassis), complete with all manufacturer's standard
equipment. Include separate sheet with upgrade options to include all manufacturer options including alternative
fuel choice equipment(CNG, LPG, etc.)
Quantity: 1 UOM: Each Price: $186,225.00 Total: $186,225.00
Manufacturer: I Braun BA18
Manufacturer#: Braun
Item Notes:
NOTE 1: Vendors should propose direct replacement models if a model type specified below has
been discontinued by the manufacturer. All ambulances must meet or exceed all requirements of
the latest version of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle
Safety Standards, FMVSS. All vehicle fees to be charged for any purchase from this contract with
the exception of delivery fees (i.e. pre delivery inspection, make ready, applicable state inspection
fee, manufacturer destination fees, etc.) are to be included in the base price(s). Vehicle fees not
included in the base price(s)will not be allowed. The Cooperative service fee is for ambulances
not a "vehicle fee" and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service
the brand of equipment submitted. Proposers responding to this Proposal Invitation should submit
an approval letter from each manufacturer. Manufacturer authorization letters must include the
regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from
Texas Department of Motor Vehicles and Manufacturer certificate from the Texas Department of
Motor Vehicles or, if vendor proposes to serve states outside of the State of Texas, the applicable
dealer license(s) for such state(s).
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Page 7 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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Alternate 1
Section I: Ambulances complete with Chassis -Type III Ambulance - Cutaway van, cab-chassis with integral
or containerized modular body ambulance on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar,
Dodge, International, Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard
equipment. Include separate sheet with upgrade options to include all manufacturer options including alternative
fuel choice equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $153,129.00 Total: $153,129.00
Manufacturer: I Demers DE17
Manufacturer#: Demers
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Alternate 2
Section I: Ambulances complete with Chassis -Type III Ambulance - Cutaway van, cab-chassis with integral
or containerized modular body ambulance on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar,
Dodge, International, Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard
equipment. Include separate sheet with upgrade options to include all manufacturer options including alternative
fuel choice equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $143,443.00 Total: $143,443.00
Manufacturer: I Wheeled Coach WC17
Manufacturer#: Wheeled Coach
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Alternate 3
Section I: Ambulances complete with Chassis -Type III Ambulance - Cutaway van, cab-chassis with integral
or containerized modular body ambulance on various chassis (Ford. Chevrolet. GMC, Freightliner, Navistar,
Dodge, International, Peterbilt. Kenworth, or other similar chassis), complete with all manufacturer's standard
equipment. Include separate sheet with upgrade options to include all manufacturer options including alternative
fuel choice equipment(CNG. LPG. etc.)
Quantity: 1 UOM: Each Price: $148,523.00 Total: $148,523.00
Manufacturer: I Road Rescue RDR-4
Manufacturer#: Road Rescue
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Page 8 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
Ip
4
Section I: Ambulances complete with Chassis -Type VII Ambulance - Cutaway van, cab-chassis with
integral or containerized modular body ambulance on various chassis (Ford, Chevrolet, GMC, Freightliner,
Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis), complete with all manufacturer's
standard equipment. Include separate sheet with upgrade options to include all manufacturer options including
alternative fuel choice equipment(CNG, LPG, etc.)
Quantity: 1 UOM: Each Price: $260,892.00 Total: $260,892.00
Manufacturer: Braun BA21
Manufacturer#: Braun
Item Notes:
NOTE 1: Vendors should propose direct replacement models if a model type specified below has
been discontinued by the manufacturer. All ambulances must meet or exceed all requirements of
the latest version of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle
Safety Standards, FMVSS. All vehicle fees to be charged for any purchase from this contract with
the exception of delivery fees (i.e. pre delivery inspection, make ready, applicable state inspection
fee, manufacturer destination fees, etc.) are to be included in the base price(s). Vehicle fees not
included in the base price(s)will not be allowed. The Cooperative service fee for ambulances is
not a "vehicle fee" and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service
the brand of equipment submitted. Proposers responding to this Proposal Invitation should submit
an approval letter from each manufacturer. Manufacturer authorization letters must include the
regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from
Texas Department of Motor Vehicles and Manufacturer certificate from the Texas Department of
Motor Vehicles or, if vendor proposes to serve states outside of the State of Texas, the applicable
dealer license(s) for such state(s).
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Page 9 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
As
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5
Section I: Ambulances complete with Chassis -Type IX Ambulance - Cutaway van, cab-chassis with
integral or containerized modular body ambulance on various chassis (Ford, Chevrolet, GMC, Freightliner,
Navistar, Dodge, International, Peterbilt, Kenworth, or other similar chassis), complete with all manufacturer's
standard equipment. Include separate sheet with upgrade options to include all manufacturer options including
alternative fuel choice equipment(CNG, LPG, etc.)
Quantity: 1 UOM: Each Price: $406,832.00 Total: $406,832.00
Manufacturer: Braun BA23
Manufacturer#: Braun
Item Notes:
NOTE 1: Vendors should propose direct replacement models if a model type specified below has
been discontinued by the manufacturer. All ambulances must meet or exceed all requirements of
the latest version of KKK-A-1822F and also comply with or exceed all Federal Motor Vehicle
Safety Standards, FMVSS. All vehicle fees to be charged for any purchase from this contract with
the exception of delivery fees (i.e. pre delivery inspection, make ready, applicable state inspection
fee, manufacturer destination fees, etc.) are to be included in the base price(s). Vehicle fees not
included in the base price(s)will not be allowed. The Cooperative service fee for ambulances is
not a "vehicle fee" and is not to be included in the base pricing.
NOTE 2: An awarded Vendor must be approved by the manufacturer to sell, install, and service
the brand of equipment submitted. Proposers responding to this Proposal Invitation should submit
an approval letter from each manufacturer. Manufacturer authorization letters must include the
regions and/or states in which equipment may be sold.
NOTE 3: Vendors must provide a copy of their Franchise Motor Vehicle Dealer Certificate from
Texas Department of Motor Vehicles and Manufacturer certificate from the Texas Department of
Motor Vehicles or, if vendor proposes to serve states outside of the State of Texas, the applicable
dealer license(s) for such state(s).
Item Attributes
1. State Brand of Chassis and Body
Ford-GM-Dodge-Fl-Int.-Mer
Page 10 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
6
Section II: OPTIONAL EQUIPMENT and PARTS - Discount(%)off catalog/pricelist for Original Equipment Manufacturer
(OEM)Options.Catalog/Pricelist MUST be included or proposal will not be considered.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
7
Section II: OPTIONAL EQUIPMENT and PARTS - Discount(%)off catalog/pricelist for Third Party(not OEM)and
Unpublished Options and Equipment.Catalog/Pricelist MUST be included or proposal will not be considered.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 11 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
8 Section II: OPTIONAL EQUIPMENT and PARTS- Discount(%)off catalog/pricelist for Original Equipment Manufacturer
(OEM)Parts.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as follows or proposal
may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
9
Section II: OPTIONAL EQUIPMENT and PARTS - Discount(%)off catalog/pricelist for Extended Service Maintenance
Agreements.Catalog/Pricelist MUST be included or proposal will not be considered.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Page 12 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
1
0 Section II: OPTIONAL EQUIPMENT and PARTS - Discount(%)off catalog/pricelist for Floor Plan Insurance and Lot
Insurance(dealer inventory ambulance).Catalog/Pricelist MUST be included or proposal will not be considered.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
Page 13 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
1
1 Section II: OPTIONAL EQUIPMENT and PARTS - Discount(%)off catalog/pricelist for Other Ambulance Products and
Services(refurbishing, modification, uplifting, remounting services and equipment).Catalog/Pricelist MUST be included or proposal
will not be considered.
Total: 0%
Item Notes:
Options will be selected by the Cooperative member at the time of order. A COMPLETE LIST OF ALL
OPTIONAL EQUIPMENT AND PARTS MUST BE SUBMITTED WITH PROPOSAL FOR PROPOSAL TO
BE CONSIDERED!
Vendors proposing various manufacturer product lines per line item must submit the information as
follows or proposal may not be considered:
• Vendor's must list one specific percentage discount for each Manufacturer listed.
• Additional/Alternate Manufacturer lines must submitted by selecting "Add Alternate."
Item Attributes
1. State Name of Catalog/Pricelist
0% off list price
1
2 Section III: Delivery Fees and Labor Rate for Installation and Repair Service of Ambulances - Hourly
Labor Rate for Installation/Repair Service of Ambulance Equipment and Products- not to exceed hourly
labor rate for Installation/Repair Service of Equipment and Products.
Quantity: 1 UOM: Hour Price: $145.00 Total: $145.00
1
3 Section III: Delivery Fees and Labor Rate for Installation and Repair Service of Ambulances- Hourly
Labor Rate for Paint and Body Repair of Ambulances - not to exceed labor rate for Paint and Body Repair.
Quantity: 1 UOM: Hour Price: $0.00 Total: $0.00
1
4 Section III: Delivery Fees and Labor Rate for Installation and Repair Service of Ambulances - Per Mile
Delivery Fee for Ambulances -state the per mile delivery fee for Ambulances.
Quantity: 1 UOM: Mile Price: $0.00 Total: $0.00
Response Total: $1 ,171 ,760.00
Page 14 of 14 pages Vendor:Siddons-Martin Apparatus and Equipment Fire 650-21
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EXHIBIT D
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date Received
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity not later
than the 7th business day after the date the vendor becomes aware of facts that require the statement to be
filed. See Section 176.006(a-1), Local Government Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code.An
offense under this section is a misdemeanor.
1J Name of vendor who has a business relationship with local governmental entity.
Siddons Martin Emergency Group, LLC
2
❑ Check this box if you are filing an update to a previously filed questionnaire.(The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local government officer about whom the information is being disclosed.
n/a
Name of Officer
4j Describe each employment or other business relationship with the local government officer, or a family member of the
officer,as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form
CIO as necessary.
n/a
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, from the vendor?
Yes F-1 No
B. Is the vendor receiving or likely to receive taxable income,other than investment income,from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received from the
local governmental entity?
Yes F-1 No
5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director,or holds an
ownership interest of one percent or more.
n/a
6
❑ Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts
as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).
71 V�"� �-
4/1/2022
Signatur nor doiro business with the.governmental entity Date
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
Acomplete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/
Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code§176.001(1-a):"Business relationship"means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal,state,or local governmental entity or an
agency of a federal,state,or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public;or
(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and
that is subject to regular examination by, and reporting to,that agency.
Local Government Code§176.003(a)(2)(A)and(B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the 12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
vendor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more than$100 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code§176.006(a)and(a-1)
(a) Avendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship
with a local governmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity,or a family member of the officer,described by Section 176.003(a)(2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer,one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B),excluding any
gift described by Section 176.003(a-1);or
(3) has a family relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator
not later than the seventh business day after the later of:
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application,response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity;or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer,described by Subsection(a);
(B) that the vendor has given one or more gifts described by Subsection (a);or
(C) of a family relationship with a local government officer.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021
M&C Review Page 1 of 2
Official site of the City of Fort Worth,Texas
CITY COUNCIL AGENDA FoTTI�
Create New From This M&C
REFERENCE **M&C 22- 21 EPR 22-00237 -
DATE: 3/8/2022 NO.: 0165 LOG NAME: SPRINTER VEHICLES -
FIRE - JA
CODE: G TYPE: CONSENT PUBLIC NO
HEARING:
SUBJECT: (ALL) Authorize Purchase of a Quick Response Mobile Command Unit from Siddon
Martin Emergency Group, LLC, in the Amount Up to $224,833.00 Using a Cooperative
Purchasing Contract 651-21 through BuyBoard for the Fire Department through Property
Management
RECOMMENDATION:
It is recommended that the City Council authorize the purchase of a quick response mobile command
unit from Siddon Martin Emergency Group, LLC, in the Amount Up to $224,833.00
using a Cooperative Purchasing Contract 651-21 through BuyBoard for the Fire Department through
Property Management.
DISCUSSION:
The Fire Department (FD) approached the Property Management Department for assistance with
buying a Quick Response Mobile Command Unit that is capable of being utilized early on in
emergency incidents in compliance with the National Incident Management System. The unit will
serve to ease the transition as a small scale incident grows into a large scale incident.
Property Management reached out to three (3) COOP vendors for cooperative quotes to determine
best cost value between Mobile Command Units. Two out of the three vendors did not provide a
quote. Daco Fire Equipment and Deep South Fire Trucks, Inc. The third COOP vendor, Siddons
Martin Emergency Group, LLC was able to provide a full quote which meets the minimum
specifications and requirements for the requesting department.
The unit meets required specifications and is expected to operate satisfactorily during its service life of
ten (10) years. Warranty information, manufacturers Statement of Origin and original sales invoice will
accompany the unit upon delivery.
Funding - The funds are available in the current capital budget, General Capital Projects Fund.
PRICE ANALYSIS - There is no previous purchase history for a unit with these specific
configurations; however the annual operational cost should not exceed $1,000.00 yearly. Staff has
reviewed the pricing and found it to be fair and reasonable based on current market values.
COOPERATIVE PURCHASE - State law provides that a local government purchasing an item under
a cooperative purchasing agreement satisfies state laws requiring that the local government seek
competitive bids for purchase of the item. Buy Board contract has been competitively bid to increase
and simplify the purchasing power of local government entities across the State of Texas.
BUISNESS EQUITY - an M/WBE goal is not assigned when purchasing from an approved
purchasing cooperative or other public entity.
DELIVERY - The new unit will be delivered within 45 days after receipt of a purchase order.
FISCAL INFORMATION/CERTIFICATION:
The Director of Finance certifies that funds are available in the current capital budget, as previously
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=29717&councildate=3/8/2022 5/5/2022
M&C Review Page 2 of 2
appropriated, in the General Capital Projects Fund for the Insurance Command Truck Replac project
to support the approval of the above recommendation execution of the contract. Prior to any
expenditure being incurred, the Fire Department has the responsibility to validate the availability of
funds.
TO
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (ChartField 2)
FROM
Fund Department Account Project Program Activity Budget Reference# Amount
ID ID Year (ChartField 2)
Submitted for City Manager's Office by: Dana Burghdoff(8018)
Originating Department Head: Steve Cooke (5134)
Additional Information Contact:
ATTACHMENTS
21 EPR 22-00237 SPRINTER VEHICLES FIRE.docx (CFW Internal)
EPR 21-00237 - FID Table.xlsx (CFW Internal)
Form 1295 Certificate.pdf (CFW Internal)
Siddons Martin Emergency Group -SAMS.pdf (CFW Internal)
http://apps.cfwnet.org/council_packet/mc_review.asp?ID=29717&councildate=3/8/2022 5/5/2022