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R2023-282 2023-11-27RESOLUTION NO. R2023-282 A Resolution of the City Council of the City of Pearland, Texas, authorizing the City Manager to participate in an interlocal pricing arrangement with Buyboard for the purchase of Fire Department medical supplies in the estimated amount of $140,000, from Bound Tree Medical for the period of November 23, 2023 through November 22, 2024. BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PEARLAND, TEXAS: Section 1. That the City obtained competitive pricing for the supply of fire medical supplies through the Buyboard cooperative purchasing program. Section 2. That the City Council hereby awards a contract to Bound Tree Medical, in the unit price amounts reflected in Exhibit “A” attached hereto. Section 3. The City Manager or his designee is hereby authorized to execute a unit supply contract for Fire Department medical supplies. PASSED, APPROVED and ADOPTED this the 27th day of November, A.D., 2023. ________________________________ J.KEVIN COLE MAYOR ATTEST: ________________________________ FRANCES AGUILAR, TRMC, MMC CITY SECRETARY APPROVED AS TO FORM: ________________________________ DARRIN M. COKER CITY ATTORNEY DocuSign Envelope ID: 9C6481DB-6A6F-4686-9A62-E3CA0610C0C3 v.02.01.2021 April 17, 2023 Sent Via Email: Submitbids@Boundtree.com Christopher Fyffe Bound Tree Medical (Bound Tree Medical LLC) 5000 Tuttle Crossing Blvd. Dublin, OH 43016 Welcome to BuyBoard! Re: Notice of The Local Government Purchasing Cooperative Contract Award; Proposal Invitation No. 704- 23, First Aid, Emergency Medical, and Athletic Trainer Supplies and Equipment 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 June 1, 2023, through May 31, 2024, 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. 704-23 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, feel free contact me at 800‐695‐2919. Sincerely, Ava Benford, Cooperative Procurement Manager Texas Association of School Boards, Inc., Administrator for The Local Government Purchasing Cooperative April 17, 2023 Sent Via Email: Submitbids@Boundtree.com Christopher Fyffe Bound Tree Medical (Bound Tree Medical LLC) 5000 Tuttle Crossing Blvd. Dublin, OH 43016 Welcome to BuyBoard! Re: Notice of National Purchasing Cooperative Award; Proposal Invitation No. 704-23, First Aid, Emergency Medical, and Athletic Trainer Supplies and Equipment 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 June 1, 2023, through May 31, 2024, 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. 704-23 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, feel free to contact me at 800-695-2919. Sincerely, Ava Benford, Cooperative Procurement Manager Texas Association of School Boards, Inc., Procurement Administrator for the National Purchasing Cooperative v.02.01.2021 J’BoardPURCHASINGCOOPERAT1VE12007ResearchBoulevardAustin,Texas78759-2439-PH:800-695-2919buyboprdcpmPROPOSER’SACCEPTANCEANDAGREEMENTProposalInvitationName:FirstAid,EmergencyMedical,andAthleticTrainerSuppliesandEquipmentProposalInvitationNumber:704-23ProposalDueDate/OpeningDateandTime:January26,2023,at4:00PMLocationofProposalOpening:TexasAssociationofSchoolBoards,Inc.BuyBoardDepartment12007ResearchBlvd.Austin,TX78759ContractTerm:June1,2023,throughMay31,2024,withtwopossibleone-yearrenewals.AnticipatedCooperativeBoardMeetingDate:April2023Bysignaturebe/ow,theundersignedacknowledgesandagreesthatyouareauthorIzedtosubmitthisProposal,includingmakIngallacknowledgements,consents,andcertificationsherein,onbehalfofProposerand,tothebestofyourknow/edge,theInformationprovided/strue,accurate,andcomplete.BoundTreeMedical,LLCNameofProposingCompany5000TuttleCrossingBlvd.StreetAddressDublin,OH43016City,State,Zip800-533-0523TelephoneNumberofAuthorizedCompanyOfficial877-311-243701/25/2023Date1niwSi9na?o\eofAuthorizedCompanyOfficialJonMcGrewPrintedNameofAuthorizedCompanyOfficialAssociateVicePresident,PricingPositionorTitleofAuthorizedCompanyOfficial31-1739487FederalIDNumberFaxNumberofAuthorizedCompanyOfficialPage10of71ProposalFormsCOMM/SVCSvO8.tt.2021 jJ7BoardPURCNASINSCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comPROPOSALFORMSPART1:COMPLIANCEFORMSINSTRUCTIONS:ProposermustreviewandcompleteallformsinthisProposalFormsPart1:•ProposalAcknowledgements•FelonyConvictionDisclosure•Resident/NonresidentCertification•DebarmentCertification•VendorEmploymentCertification•NoBoycottVerification•NoExcludedNationorForeignTerroristOrganizationCertification•HistoricallyUnderutilizedBusinessCertificationaAcknowledgementofBuyBoardTechnicalRequirements•Construction-RelatedGoodsandServicesAffirmation•DeviationandCompliance•VendorConsentforNameBrandUseaConfidential/ProprietaryInformation•EDGARVendorCertification•ComplianceFormsSignaturePageAnauthorizedrepresentativeofProposermustinitialinthebottomrightcornerofeachsagewhereindicatedandcompleteandsigntheComplianceFormsSignaturePage.Proposer’sfailuretofullycomplete,initial,andsignformsasrequiredmayresultinyourProposalbeingrejectedasnon-responsive.PROPOSALACKNOWLEDGEMENTSTheproposingcompany(“you”or“your”)herebyacknowledgesandagreesasfollows:1.YouhavecarefullyexaminedandunderstandallinformationanddocumentationassociatedwiththisProposalInvitation,includingtheInstructionstoProposers,GeneralInformation,GeneralTermsandConditions,attachments/forms,appendices,itemspecifications,andlineitems(collectively“Requirements”);2.ByyourresponseC’Proposal”)tothisProposalInvitation,youproposetosupplytheproductsorservicessubmittedatthepricingquotedinyourProposalandinstrictcompliancewiththeRequirements,unlessspecificdeviationsorexceptionsarenotedintheProposal;3.ByyourProposal,youacknowledgeandcertifyallitemssetforthintheGeneralTermsandConditions,SedionB.12(Certifications),includingallnon-collusioncertificationsandcertificationsregardinglegal,ethical,andothermatterssetforththerein.4.AnyandalldeviationsandexceptionstotheRequirementshavebeennotedinyourProposalontherequiredformandnootherswillbeclaimed;Initial:c’k?Page11of71ProposalFormsCOMM/SVCSvOS.11.2O21 iff1J1BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comS.IftheCooperativeacceptsanypartofyourProposalandawardsyouaContract,youwillfurnishallawardedproductsorservicesatthepricingquotedandinstrictcompliancewiththeRequirements(unlessspecificdeviationsorexceptionsarenotedontherequiredformandacceptedbytheCooperative),includingwithoutlimitationtheRequirementsrelatedto:a.conductingbusinesswithCooperativemembers,indudingofferingpricingtomembersthatisthebestyouoffercomparedtosimilarlysituatedcustomersinsimilarcircumstances;b.paymentofaservicefeeintheamountspecifiedandasprovidedforinthisProposalInvitation;c.thepossibleawardofapiggy-backcontractbytheNationalPurchasingCooperativeornonprofitentity,inwhicheventyouwilloffertheawardedproductsandservicesinaccordancewiththeRequirements;andd.submittingpricesheetsorcatalogsintheproperformatasrequiredbytheCooperativeasaprerequisitetoactivationofyourContract;6.YouhavedearlyidentifiedontheindudedformanyinformationinyourProposalthatyoubelievetobeconfidentialorproprietaryorthatyoudonotconsidertobepublicinformationsubjecttopublicdisclosureundertheTexasPublicInformationActorsimilarpublicinformationlaw;7.TheindividualsubmittingthisProposalisdulyauthorizedtoenterintothecontractualrelationshiprepresentedbythisProposalInvitationonyourbehalfandbindyoutotheRequirements,andsuchindividual(andanyindividualsigningaformorProposaldocument)isauthorizedandhastherequisiteknowledgetoprovidetheinformationandmaketherepresentationsandcertificationsrequiredintheRequirements;8.YouhavecarefullyreviewedyourProposal,andcertifythatallinformationprovidedistrue,complete,andaccuratetothebestofyourknowledge,andyouauthorizetheCooperativetotakesuchactionasitdeemsappropriatetoverifysuchinformation;and9.Anymisstatement,falsification,oromissioninyourProposal,wheneverorhoweverdiscovered,willbegroundsfordisqualifyingyoufromconsiderationforacontractawardunderthisProposalInvitation,terminationofacontractaward,oranyotherremedyoractionprovidedforintheGeneralTermsandConditionsorbylaw.FELONYCONVICTIONDISCLOSURESubsection(a)ofSection44.034oftheTexasEducationCode(NotificationofCriminalHistoryofContractor)states:“Apersonorbusinessentitythatentersintoacontractwithaschooldistrictmustgiveadvancenoticetothedistrictifthepersonoranowneroroperatorhasbeenconvictedofafelony.Thenoticemustindudeageneraldescriptionoftheconductresultingintheconvictionofafelony.”Section44.034furtherstatesinSubsection(b):“AschooldistrictmayterminateacontractwithapersonorbusinessentityifthedistrictdeterminesthatthepersonorbusinessentityfailedtogivenoticeasrequiredbySubsection(a)ormisrepresentedtheconductresultingintheconviction.Thedistrictmustcompensatethepersonorbusinessentityforservicesperformedbeforetheterminationofthecontract.”Pleasecheck(Vioneofthefollowing:üMycompanyisapublidy-heldcorporation.(Advancenoticerequirementdoesnotapplytopublidy-h&dcorporation,)•Mycompanyisnotownedoroperatedbyanyonewhohasbeenconvictedofafelony.OMycompanyisowned/operatedbythefollowingindividual(s)whohas/havebeenconvictedofafelony:NameofFelon(s):n/aDetailsofConviction(s):n/aInitial:_______Page12of71ProposalFormsCOMM/SVCSv.08.11.2021 K2BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comRESIDENT/NONRESIDENTCERTIFICATIONChapter2252,SubchapterA,oftheTexasGovernmentCodeestablishescertainrequirementsapplicabletoproposerswhoarenotTexasresidents.Underthestatute,a“resident”proposerisapersonwhoseprincipalplaceofbusinessisinTexas,induthngacontractorwhoseultimateparentcompanyormajorityownerhasitsprincipalplaceofbusinessinTexas.A“nonresident”proposerisapersonwhoisnotaTexasresident.Pleaseindicatethestatusofyourcompanyasa“resident”proposerora“nonresident”proposerunderthesedefinitions.Pleasecheck(V)oneofthefollowing:ElIcertifythatmycompanyisaResidentProposer.•IcertifythatmycompanyisaNonresidentProposer.IfyourcompanyisaNonresidentProposer,youmustprovidethefollowinginformationforyourresidentstate(thestateinwhichyourcompany’sprincipalplaceofbusinessislocated):BoundTreeMedical,LLC5000TuttleCrossingBlvd.CompanyNameAddressDublinOH43016CityStateZipCodeA.DoesyourresidentstaterequireaproposerwhoseprincipalplaceofbusinessisinTexastounder-priceproposerswhoseresidentstateisthesameasyoursbyaprescribedamountorpercentagetoreceiveacomparablecontract?ElYesElNoB.Whatistheprescribedamountorpercentage?$_n/aorn/aDEBARMENTCERTIFICATIONBysignatureontheComplianceFormsSignaturePage,1certifythatneithermycompanynoranownerorprincipalofmycompanyhasbeendebarred,suspendedorotherwisemadeineligibleforparticipationinFederalAssistanceprogramsunderExecutiveOrder12549,“DebarmentandSuspension,”asdescribedintheFederalRegisterandRulesandRegulations.Neithermycompanynoranownerorprincipalofmycompanyiscurrentlylistedonthegovernment-wideexclusionsinSAM,debarred,suspended,orotherwiseexcludedbyagenciesordeclaredineligibleunderanystatutoryorregulatoryauthority.MycompanyagreestoimmediatelynotifytheCooperativeandallCooperativememberswithpendingpurchasesorseekingtopurchasefrommycompanyifmycompanyoranownerorprincipalislaterlistedonthegovernment-wideexclusionsinSAM,orisdebarred,suspended,orotherwiseexcludedbyagenciesordeclaredineligibleunderanystatutoryorregulatoryauthority.VENDOREMPWYMENTCERTIFICATIONSection44.031(b)oftheTexasEducationCodeestablishescertaincriteriathataschooldistrictmustconsiderwhendeterminingtowhomtoawardacontract.Amongthecriteriaforcertaincontractsiswhetherthevendororthevendor’sultimateparentormajorityowner(i)hasitsprincipalplaceofbusinessinTexas;or(U)employsatleast500peopleinTexas.IfneitheryourcompanynortheultimateparentcompanyormajorityownerhasitsprincipalplaceofbusinessinTexas,doesyourcompany,ultimateparentcompany,ormajorityowneremployatleast500peopleinTexas?Pleasecheck(‘/)oneofthefollowing:CYesNoInitial:______Page13of71PmposalFormsC0MM/SVCSv.08.11.2021 jJ’BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.comNoBoconVERIFICATIONATexasgovernmentalentitymaynotenterintoacontractwithavalueof$100,000ormorethatistobepaidwhollyorpartlyfrompublicfundswithacompany(excludingasoleproprietorship)thathas10ormorefull-timeemployeesforgoodsorservicesunlessthecontractcontainsawrittenverificationfromthecompanythatit:(1)doesnotboycottIsraelandwillnotboycottIsraelduringthetermofthecontract(TEx.GovtCODECh.2271),(2)doesnotboycottenergycompaniesandwillnotboycottenergycompaniesduringthetermofthecontract(TEx.GovtCODECh.2274effectiveSeptember1,2021),and(3)doesnothaveapractice,policy,guidance,ordirectivethatdiscriminatesagainstafirearmentityorfirearmtradeassociationandwillnotdiscriminateduringthetermofthecontractagainstafirearmentityorfirearmtradeassociation(TEX.GovtCODECh.2274effectiveSeptember1,2021).Accordingly,thiscertificationformisindudedtotheextentrequiredbylaw.“BoycottIsrael”meansrefusingtodealwith,terminatingbusinessactivitieswith,orotherwisetakinganyactionthatisintendedtopenalize,inflicteconomicharmon,orlimitcommercialrelationsspecificallywithIsrael,orwithapersonorentitydoingbusinessinIsraelorinanIsraeli-controlledterritory,butdoesnotincludeanactionmadeforordinarybusinesspurposes.TEX.GovtCODE§808.001(1).“Boycottenergycompany”means,withoutanordinarybusinesspurpose,refusingtodealwith,terminatingbusinessactivitieswith,orotherwisetakinganyactionthatisintendedtopenalize,inflicteconomicharmon,orlimitcommercialrelationswithacompanybecausethecompany:(A)engagesintheexploration,production,utilization,transportation,sale,ormanufacturingoffossilfuel-basedenergyanddoesnotcommitorpledgetomeetenvironmentalstandardsbeyondapplicablefederalandstatelaw;or(B)doesbusinesswithacompanydescribedbyParagraph(A).TEx.GovtCODE§809.001(1)(effectiveSeptember1,2021).“Discriminateagainstafirearmentityorfirearmtradeassociation”means,(A)withrespecttotheentityorassociation,to:(i)refusetoengageinthetradeofanygoodsorserviceswiththeentityorassociationbasedsolelyonitsstatusasafirearmentityorfirearmtradeassociation;(H)refrainfromcontinuinganexistingbusinessrelationshipwiththeentityorassociationbasedsolelyonitsstatusasafirearmentityorfirearmtradeassociation;or(iN)terminateanexistingbusinessrelationshipwiththeentityorassociationbasedsolelyonitsstatusasafirearmentityorfirearmtradeassociation;and(B)doesnotinclude:(i)theestablishedpoliciesofamerchant,retailseller,orplatformthatrestrictorprohibitthelistingorsellingofammunition,firearms,orfirearmaccessories;and(H)acompany’srefusaltoengageinthetradeofanygoodsorservices,decisiontorefrainfromcontinuinganexistingbusinessrelationship,ordecisiontoterminateanexistingbusinessrelationship:(aa)tocomplywithfederal,state,orlocallaw,policy,orregulationsoradirectivebyaregulatoryagency;or(bb)foranytraditionalbusinessreasonthatisspecifictothecustomerorpotentialcustomerandnotbasedsolelyonanentity’sorassociation’sstatusasafirearmentityorfirearmtradeassociation.TEx.GovtCoDE§2274.001(3)(effectiveSeptember1,2021).BysignatureontheComplianceFormsSignaturePage,totheextentapplicable,IcertifyandverifythatVendordoesnotboycottIsrael,boycottenergycompanies,ordiscriminateagainstafirearmentityorfirearmtradeassociationandwillnotdosoduringthetermofanycontractawardedunderthisProposalInvitation,thatthiscertificationistrue,completeandaccurate,andthatJamauthorizedbymycompanytomakethiscertification.Initial:______Page14of71ProposalFormsOMIVSVC5v.02.15.2021 7BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comNoEXCLUDEDNATIONORFOREIGNTERRORISTORGANIZATIONCERTIFICATIONChapter2252oftheTexasGovernmentCodeprovidesthataTexasgovernmentalentitymaynotenterintoacontractwithacompanyengagedinactivebusinessoperationswithSudan,Iran,oraforeignterroristorganization—specifically,anycompanyidentifiedonalistpreparedandmaintainedbytheTexasComptrollerunderTexasGovernmentCode§806.0S1,807.051,or2252.153.(AcompanythattheU.S.GovernmentaffirmativelydeclarestobeexdudedfromitsfederalsanctionsregimerelatingtoSudan,Iran,oranyfederalsanctionsregimerelatingtoaforeignterroristorganizationisnotsubjecttothecontractprohibition.)BysignatureontheComplianceFormsSignaturePage,IcertifyandverifythatVendorisnotontheTexasComptroller’slistidentifiedabove;thatthiscertificationistrue,completeandaccurate;andthatIamauthorizedbymycompanytomakethiscertification.HISTORICALLYUNDERUTILIZEDBUSINESSCERTIFICATIONAProposerthathasbeencertifiedasaHistoricallyUnderutilizedBusiness(alsoknownasaMinority/WomenBusinessEnterpriseor“MWBE”andallreferredtointhisformasa“HUB”)isencouragedtoindicateitsHUBcertificationstatuswhenrespondingtothisProposalInvitation.TheBuyBoardwebsitewillindicateHUBcertificationsforawardedVendorsthatproperlyindicateanddocumenttheirHUBcertificationonthisform.Pleasecheck(-/)allthatapply:EIcertifythatmycompanyhasbeencertifiedasaHUBinthefollowingcategories:CMinorityOwnedBusinessjWomenOwnedBusinessCService-DisabledVeteranOwnedBusiness(veterandefinedby38U.S.C.§101(2),whohasaservice-connecteddisabilityasdefinedby38u.s.c.§101(16),andwhohasadisabilityratingof2O°kormoreasdeterminedbytheU.S.DepartmentofVeteransAffairsorDepartmentofDefense)CertificationNumber:___________________________________________________________NameofCertifyingAgency:_______________________________________________CMycompanyhasNOTbeencertifiedasaHUB.ACKNOWLEDGEMENTOFBUYBOARDTECHNICALREQUIREMENTSVendorshallreviewtheBuyBoardTechnicalRequirementsincludedinthisProposalInvitation.BysignatureontheComplianceFormsSignaturePage,theundersignedaffirmsthatProposerhasobtainedacopyoftheBuyBoardTechnicalRequirements,hasreadandunderstandstherequirements,andcertifiesthatVendorisabletomeetandwillcomplywiththoserequirementsexceptasfollows:[ListandexplainBuyBoardTechnicalRequirements,ifany,towhichyourcompanycannotorwillnotcomply.]BoundTreeMedical.LLCcancomplywiththetechnicalrequirementsprovided.Note:InaccordancewiththeGeneralTermsandConditionsoftheContract,totheextentVendorisawardedaContractunderthisProposalInvitationbutisunableorunwillingtomeettheapplicableBuyBoardTechnicalRequirements,theinformationavailableontheBuyBoardforVendor’sawardedproductsorservicesmaybelimited,potentiallyplacingVendoratadisadvantageandimpactingtheabilityofCooperativememberstosearch,find,review,andpurchaseVendor’sawardedproductsandservicesontheBuysoardwebsite.Further,totheextentVendorhasacknowledgedabilitytomeetandcomplywiththeBuyBoardTechnicalRequirements,anysubsequentfailureorrefusalbyVendortopromptlyprovideinformationuponrequesttotheCooperativeadministratorinaccordancewiththosetechnicalrequirementsmaybedeemedaneventofdefaultunderTheContract.Initial:______Page15of71ProposalFormsCOMM)SVCSv.08.11.2021 PURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comCONSTRUCTION-RELATEDGOODSANDSERVICESAFFIRMATIONTheCooperativeissuedtheBuyBoardProcurementandConstruction-RelatedGoodsandServicesAdvisoryforTexasMembers(“Advisory”),whichprovidesinformationspecificallyrelevanttotheprocurementofconstruction-relatedgoodsandservicesbyTexasCooperativemembers.TheAdvisory,availableatbuyboard.com/Vendor/Resources.aspx,providesanoverviewofcertainlegalrequirementsthatarepotentiallyrelevanttoaCooperativemember’sprocurementofconstructionorconstruction-relatedgoodsandservices,includingthoseforprojectsthatmayinvolveorrequirearchitecture,engineeringorindependenttestingservices.AcopyoftheAdvisorycanalsobeprovideduponrequest.BecausemanyBuyBoardcontractsincludegoodsorinstallationservicesthatmightbeconsideredconstruction-related,ProposermustmakethisConstructionRelated-GoodsandServicesAffirmationregardlessoftypeofgoodsorservicesassociatedwiththisProposalInvitation.AcontractawardedunderthisProposalInvitationcoversonlythespecificgoodsand/orservicesawardedbytheCooperative.AsexplainedintheAdvisory(“Advisory”),Texaslawprohibitstheprocurementofarchitectureorengineeringservicesthroughapurchasingcooperative.ThisProposalInvitationandanyContractawardedthereunderdoesnotincludesuchservices.ArchitectureorengineeringservicesmustbeprocuredbyaCooperativememberseparately,inaccordancewiththeProfessionalServicesProcurementAct(Chapter2254oftheTexasGovernmentCode)andotherapplicablelawandlocalpolicy.BysignatureontheComplianceFormsSignaturePage,ProposeraffirmsthatProposerhasobtainedacopyoftheAdvisory,hasreadandunderstandstheAdvisory,andisauthorizedbyProposertomakethisaffirmation.IfProposersellsconstruction-relatedgoodsorservicestoaCooperativememberunderaContractawardedunderthisProposalInvitation,ProposerwillcomplywiththeAdvisoryandapplicablelegalrequirements,makeagoodfaithefforttomakeitsCooperativemembercustomersorpotentialCooperativemembercustomersawareofsuchrequirements,andprovideaCooperativememberwithacopyoftheAdvisorybeforeacceptingthemember’sPurchaseOrderorotheragreementforconstruction-relatedgoodsorservices.Initial:______Page16of71ProposalFormsCOMM/SVCSv.08.11.2021 JJ7BoardPURCHASINGCOtP(R4TIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comDEVIATIONANDCOMPLIANCEIfyourcompanyintendstodeviatefromtheGeneralTermsandConditions,ProposalSpecificationsorotherrequirementsassociatedwiththisProposalInvitation,youMUSTlistallsuchdeviationsonthisform,andprovidecompleteanddetailedinformationregardingthedeviationsonthisformoranattachmenttothisform.Priortocompletingthisform,VendorshallreviewtheGeneralTermsandConditionssectionB.4(DeviationsfromItemSpecificationsandGeneralTermsandConditions).Pleasenotethat,asprovidedinsectionB.4,certainprovisionsoftheGeneralTermsandConditionsareNOTsubjecttodeviation,andcertaindeviationswillbedeemedrejectedwithoutfurtheractionbytheCooperative.Anyattempteddeviation,whetherdirectlyorindirectly,toprovisionsidentifiedinthisProposalInvitationasnotsubjecttodeviationshallbedeemedrejectedbytheCooperativeand,unlessotherwisewithdrawnbyVendor,mayresultinVendor’sProposalbeingrejectedinitsentirety.TheCooperativewillconsideranydeviationsinitscontractawarddecisionandreservestherighttoacceptorrejectaproposalbaseduponanysubmitteddeviation.Intheabsenceofanydeviationidentifiedanddescribedinaccordancewiththeabove,yourcompanymustfullycomplywiththeGeneralTermsandConditions,ProposalSpecificationsandallotherrequirementsassociatedwiththisProposalInvitationifawardedaContractunderthisProposalInvitation.AdeviationwillnotbeeffectiveunlessacceptedbytheCooperative,TheCooperative,byandthroughtheCooperativeadministrator,may,initssolediscretion,seekclarificationfromand/orcommunicatewithProposer(s)regardinganysubmitteddeviation,consistentwithgeneralprocurementprinciplesoffaircompetition.TheCooperativereservestherighttoacceptorrejectaProposalbaseduponanysubmitteddeviation.Pleasecheck(-)oneofthefollowing:INo;DeviationsQYes;DeviationsListandfullyexplainanydeviationsyouaresubmitting:n/a________________________________________Initial:______Page17o171ProposalFormsCOMM/SVcSv.08.11.2021 J’BoardPURCNASINOCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboardcomVENDORCONSENTFORNAMEBRANDUSEBuyBoardmembersseekingtomakepurchasesusingaContractawardedunderthisProposalInvitationmayviewinformationregardingawardedVendors,includingbutnotlimitedtoproductcatalogs,pricelists,phdng,andProposals,throughtheBuyBoardwebsite.ToimproveandenhancetheexperienceofBuyBoardmembersseekingtoprocuregoodsandservicesundertheContractutilizingtheBuyBoardwebsite,anyVendorlogo,productimages,andsimilarbrandandtrademarkinformationprovidedbyVendorforpurposesoftheContract(“VendorInformation”)maybepostedontheBuysoardwebsite.Youacknowledgethat,bysubmittingyourProposal,unlessyouspecificallyoptoutbelow,youconsenttouseofyourcompany’sVendorInformationontheBuyBoardwebsiteifawardedaContract.Youfurtheracknowledgethatwhether,where,andwhentoincludetheVendorInformationontheBuyBoardwebsiteshallbeatthesolediscretionoftheBuyBoardAdministrator.Vendorretains,however,therightofgeneralqualitycontrolovertheBuyBoardAdministrator’sauthorizeddisplayofproprietaryVendorInformation.NeithertheBuysoardnoritsadministratorwillberesponsiblefortheuseordistributionofVendorInformationbyBuyBoardmembersoranyotherthirdpartyusingtheBuyBoardwebsite.ThisVendorConsentshallbeeffectiveforthefulltermoftheContract,includingrenewals,unlessVendorprovidesasigned,writtennoticerevokingconsenttocontractadminathuyboard.com.BuysoardshallhaveuptothirtydaysfromthedateofreceiptofaterminationorrevocationofaVendorConsenttoremoveVendorinformationfromtheBuyBoardwebsite.ThisVendorConsentissubjecttotheTermsandConditionsoftheContract,including,butnotlimitedto,thosetermspertainingtoDisclaimerofWarrantyandLimitationofLiability,Indemnification,andIntellectualPropertyInfringement.VendorlogofilesmustbesubmittedinoneoftheformatssetforthintheBuyBoardTechnicalRequirements.ProposersarerequestedtosubmitthisinformationwithVendor’sProposal.(Thisconsentshallnotauthorizeuseofyourcompany’sVendorInformationbyBuyBoardifyourcompanyisnotawardedaContract)OPTOUT:IfyourcompanywishestooptoutoftheVendorConsentforNameBrandUse,youmustchecktheoptoutboxbelow.DONOrselectthisboxunlessyourcompanyisoptingoutofthisVendorConsentforNameBrandUse.DBycheckingthisbox,VendorherebydeclinestoprovideconsentforuseofVendorInformation(asdefinedherein)ontheBuyBoardwebsite.Byoptingout,VendoracknowledgesandagreesthatifVendorisawardedaContractunderthisProposalInvitation,informationavailableontheBuyBoardforVendor’sawardedproductsorservicesmaybelimited,potentiallyplacingVendoratadisadvantageandimpactingtheabilityofCooperativememberstosearch,find,review,andpurchaseVendoVsawardedproductsandservicesontheBuyBoardwebsite.Initial:______Page18of71ProposalFormsCOMM/SVCSv.OS.11.2021 1J!BoardPURCHASINGCoOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.comCONFIDENTIAL!PROPRIETARYINFORMATIONA.PublicDisclosureLawsAllProposals,forms,documentation,catalogs,pricelists,orothermaterialssubmittedbyVendortotheCooperativeinresponsetothisProposalInvitation,maybesubjecttothedisdosurerequirementsoftheTexasPublicInformationAct(TexasGovernmentCodechapter552.001,et.seq.)orsimilardisclosurelaw.ProposermustclearlyidentifyonthisformanyinformationinitsProposal(includingforms,documentation,orothermaterialssubmittedwiththeProposal)thatProposerconsidersproprietaryorconfidential.IfProposerfailstoproperlyidentifytheinformation,theCooperativeshallhavenoobligationtonotifyVendororseekprotectionofsuchinformationfrompublicdisclosureshouldamemberofthepublicorotherthirdpartyrequestaccesstotheinformationundertheTexasPublicInformationAdorsimilardisclosurelaw.WhenrequiredbytheTexasPublicInformationAdorotherdisclosurelaw,Proposermaybenotifiedofanythird-partyrequestforinformationinaProposalthatProposerhasidentifiedinthisformasproprietaryorconfidential.DoesyourProposal(includingforms,documentation,catalogs,pricelists,orothermaterialssubmittedwiththeProposal)containinformationwhichVendorconsidersproprietaryorconfidential?Pleasecheck(‘/1oneofthefollowing:NO.IcertifythatnoneoftheinformationincludedwiththisProposalisconsideredconfidentialorproprietary.JYES,IcertifythatthisProposalcontainsinformationconsideredconfidentialorproprietaryandallsuchinformationisspecificallyidentifiedonthisform.Ifyouresponded“YES”,youmustclearlyidentifybelowthespedficinformationyouconsiderconfidentialorproprietary.Listeachpagenumber,formnumber,orotherinformationsufficienttomaketheinformationreadilyidentifiable.TheCooperativeandCooperativeadministratorshallnotberesponsibleforaProposer’sfailuretoclearlyidentifyinformationconsideredconfidentialorproprietary.Further,bysubmittingaProposal,ProposeracknowledgesthattheCooperativeandCooperativeadministratorwilldiscloseinformationwhenrequiredbylaw,evenifsuchinformationhasbeenidentifiedhereinasinformationVendorconsidersconfidentialorproprietary.Confidential/ProprietaryInformation:Theattachedpricingrilewilhcatalogpriceanddiscountislobecon&deredconfidentialandForBuyBoardMemberuseonly,andshouldnotbesharedwithotherbidders.(Attathat*ftWonaltheeifneeded)Initial:_______Page19of71ProposalFarmsCOMMISVCS.Qt11.2021 f107BoardPURCNASINGCOCPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comB.CopyrightInformationDoesyourProposal(includingforms,documentation,pricelists,catalogs,orothermaterialssubmittedwiththeProposal)containcopyrightinformation?Pleasecheckfv’)oneofthefollowing:[JNO,Proposal(includingforms,documentation,pricelists,catalogs,orothermaterialssubmittedwiththeProposal)doesnotcontaincopyrightinformation.i::iYES,Proposal(includingforms,documentation,pricelists,catalogs,orothermaterialssubmittedwiththeProposal)doescontaincopyrightinformation.Ifyouresponded“YES”,clearlyIdentifybelowthespecificdocumentsorpagescontainingcopyrightinformation.CopyrightInformation:(Attachadditionalsheetsifneeded.)C.ConsenttoReleaseConfidential/PropdetaryfCopyrightInlonnationtoBuyBoardMembersBuyBoardmembers(Cooperativeandnonprofitmembers)seekingtomakepurchasesthroughtheBuyBoardmaywishtoviewinformationincludedintheProposalsofawardedVendors.Ifyouidentifiedinformationonthisformasconfidential,proprietary,orsubjecttocopyright,andyouareawardedaBuyBoardcontract,youracceptanceoftheBuyBoardcontractawardconstitutesyourconsenttothedisclosureofsuchinformationtoBuyBoardmembers,includingpostingofsuchinformationonthesecureBuyBoardwebsiteformembers.Note:NeithertheCooperativenorCooperativeadministratorwillberesponsiblefortheuseordistributionofinformationbyBuyBoardmembersoranyotherparty.D.ConsenttoReleaseProposalTabulationNotwithstandinganythinginthisConfidential/ProprietaryInformationformtothecontrary,bysubmittingaProposal,Vendorconsentsandagreesthat,uponContractaward,theCooperativemaypubliclyrelease,includingpostingonthepublicBuyBoardwebsite,acopyoftheproposaltabulationandawardinformationfortheContractincludingVendorname;proposedcatalog/pricelistname(s);proposedpercentagediscount(s),hourlylaborrate(s),orotherspecifiedpricing;andVendorawardornon-awardinformation.Initial:cPage20of71ProposalFormsCOMM/SVCSvOa.1l2021 j7BoardPURCHASJNGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comEDGARVENDORCERTIFICATION(2CERPart200andAppendixU)WhenaCooperativememberseekstoprocuregoodsandservicesusingfundsunderafederalgrantorcontract,specificfederallaws,regulations,andrequirementsmayapplyinadditiontothoseunderstatelaw.Thisincludes,butisnotlimitedto,theprocurementstandardsoftheUniformAdministrativeRequirements,CostPrinciplesandAuditRequirementsforFederalAwards,2CFR200(sometimesreferredtoasthe“UniformGuidance”ornew“EDGAR”).AllVendorssubmittingaProposalmustcompletethisEDGARCertificationFormregardingVendor’swillingnessandabilitytocomplywithcertainrequirementswhichmaybeapplicabletospecificCooperativememberpurchasesusingfederalgrantfunds.CompletedformswillbemadeavailabletoCooperativemembersfortheirusewhileconsideringtheirpurchasingoptionswhenusingfederalgrantfunds.CooperativemembersmayalsorequireVendorstoenterintoancillaryagreements,inadditiontothetermsandconditionsoftheBuyBoardcontract,toaddressthemember’sspecificcontractualneeds,includingcontractrequirementsforaprocurementusingfederalgrantsorcontracts.ForcizoftheItemsbelow,VendorshouldcertifyVendor’sagreementandabIlItytocomply,whereappilcabie,byhavingVendor’sauthorizedrepresentativechecktheapplicableboxes,initialeachpage,andsigntheComplianceFormsSignaturePage.Ifyoufalltocompleteanyiteminthisform,theCooperativewillconsiderandmayfisttheVendor’sresponseontheBuyBoardas‘WO/theVendorIsunableorunwillingtocomply.A“NO”responsetoanyoftheitemsmay,ifapplicable,impacttheabilityofaCooperativemembertopurchasefromtheVendorusingfederalfunds.1.VendorViolationorBreachofContractTerms:Contractsformorethanthesimplifiedacquisitionthreshold,whichistheinflationadjustedamountdeterminedbytheCivilianAgencyAcquisitionCouncilandtheDefenseAcquisitionRegulationsCouncil(Councils)asauthorizedby41USC1908,mustaddressadministrative,contractual,orlegalremediesininstanceswherecontractorsviolateorbreachcontractterms,andprovideforsuchsanctionsandpenaltiesasappmpHate.ProvisionsregardingVendordefaultareincludedintheBuyBoardGeneralTermsandConditions,includingSectionE.18,RemediesforDefaultandTerminationofContract.AnyContractawardwillbesubjecttosuchBuyBoardGeneralTermsandConditions,aswellasanyadditionaltermsandconditionsinanyPurchaseOrderorCooperativememberancillarycontractagreeduponbyVendorandtheCooperativememberwhichmustbeconsistentwithandprotecttheCooperativememberatleasttothesameextentastheBuyBoardTermsandConditions.TheremediesundertheContractareinadditiontoanyotherremediesthatmaybeavailableunderlaworinequity.BysubmittingaProposal,youagreetotheseVendorviolationandbreachofcontractterms.IYES,Iagree.NO,Idonotagree.2.TerminationforCauseorConvenience:ForanyCooperativememberpurchaseorcontractinexcessof$10,000madeusingfederalfunds,youagreethatthefollowingtermandconditionshallapply:TheCooperativemembermayterminateorcancelanyPurchaseOrderunderthisContractatanytime,withorwithoutcause,byprovidingseven(7)businessdaysadvancewrittennoticetotheVendor.IfthisAgreementisterminatedinaccordancewiththisParagtaph,theCooperativemembershallonlyberequiredtopayVendorforgoodsorservicesdeliveredtotheCooperativememberpriortotheterminationandnototherwisereturnedinaccordancewithVendor’sreturnpolicy.IftheCooperativememberhaspaidVendorforgoodsorservicesnotyetprovidedasofthedateoftermination,Vendorshallimmediatelyrefundsuchpayment(s).IfanalternateprovisionforterminationofaCooperativememberpurchaseforcauseandconvenience,includingthemannerbywhichitwillbeeffectedandthebasisforsettlement,isincludedintheCooperativemember’sPurchaseOrderorancillaryagreementagreedtobytheVendor,theCooperativemember’sprovisionshallcontrol.aYES,Iagree.NO,Idonotagree.Initial:cJ\Page21of71ProposalFormsCOMM/SVcSv.O8.11.2O2L JBoardPURCHASINGCOCPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.com3.EqualEmploymentOpportunity:Exceptasotherwiseprovidedunder41CFRPart60,allCooperativememberpurchasesorcontractsthatmeetthedefinitionof“federallyassistedconstructioncontract”in41CFRPart60-1.3shallbedeemedtoincludetheequalopportunityclauseprovidedunder41CFR60-1.4(b),inaccordancewithExecutiveOrder11246,“EqualEmploymentOpportunity”(30FR12319,12935,3CFRPart,1964-1965Comp.,p.339),asamendedbyExecutiveOrder11375,“AmendingExecutiveOrder11246RelatingtoEqualEmploymentOpportunity,”andimplementingregulationsat41CFRPart60,“OfficeofFederalContractCompliancePrograms,EqualEmploymentOpportunity,DepartmentofLabor.”Theequalopportunityclauseprovidedunder41CFR60-1.4(b)isherebyincorporatedbyreference.VendoragreesthatsuchprovisionappliestoanyCooperativememberpurchaseorcontractthatmeetsthedefinitionof“federallyassistedconstructioncontract”in41CFRPart60-1,3andVendoragreesthatitshallcomplywithsuchprovision.IYES,Iagree.flNO,Idonotagree.4.Davis-BaconAct:WhenrequiredbyFederalprogramlegislation,Vendoragreesthat,forallCooperativememberprimeconstructioncontracts/purchasesinexcessof$2,000,VendorshallcomplywiththeDavis-BaconAct(40USC3141-3144,and3146-3148)assupplementedbyDepartmentofLaborregulations(29CFRPart5,“LaborStandardsProvisionsApplicabletoContractsCoveringFederallyFinancedandAssistedConstruction”).Inaccordancewiththestatute,VendorisrequiredtopaywagestolaborersandmechanicsataratenotlessthantheprevailingwagesspecifiedinawagedeterminatemadebytheSecretaryofLabor.Inaddition,Vendorshallpaywagesnotlessthanonceaweek.CurrentprevailingwagedeterminationsissuedbytheDepartmentofLaborareavailableatbeta.sam.gov.Vendoragreesthat,foranypurchasetowhichthisrequirementapplies,theawardofthepurchasetotheVendorisconditioneduponVendor’sacceptanceofthewagedetermination.VendorfurtheragreesthatitshallalsocomplywiththeCopeland“Anti-Kickback”Act(40USC3145),assupplementedbyDepartmentofLaborregulations(29CFRPart3,“ContractorsandSubcontractorsonPublicBuildingorPublicWorkFinancedinWholeorinPartbyLoansorGrantsfromtheUnitedStates”).TheActprovidesthateachcontractororsubredpientmustbeprohibitedfrominducing,byanymeans,anypersonemployedintheconstruction,completion,orrepairofpublicwork,togiveupanypartofthecompensationtowhichheorsheisotherwiseentitled.IYES,Iagree.UNO,Idonotagree.5.ContractWorkHoursandSafetyStandardsAct:Whereapplicable,forallCooperativemembercontractsorpurchasesinexcessof$100,000thatinvolvetheemploymentofmechanicsorlaborers,Vendoragreestocomplywith40USC3702and3704,assupplementedbyDepartmentofLaborregulations(29CFRPart5).Under40USC3702oftheAct,Vendorisrequiredtocomputethewagesofeverymechanicandlaboreronthebasisofastandardworkweekof40hours.Workinexcessofthestandardworkweekispermissibleprovidedthattheworkeriscompensatedatarateofnotlessthanoneandahalftimesthebasicrateofpayforallhoursworkedinexcessof40hoursintheworkweek.Therequirementsof40USC3704areapplicabletoconstructionworkandprovidethatnolaborerormechanicmustberequiredtoworkinsurroundingsorunderworkingconditionswhichareunsanitary,hazardousordangerous.Theserequirementsdonotapplytothepurchasesofsuppliesormaterialsorarticlesordinarilyavailableontheopenmarket,orcontractsfortransportationortransmissionofintelligence.IYES,Iagree.CNO,Idonotagree.Initial:..pPage22of71ProposalFormscoMM/svcsv.08.112021 fgiBoardPVCHAS)NGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.com6.RighttoInventionsMadeUnderaContractorAgreement:IftheCooperativemember’sFederalawardmeetsthedefinitionof“fundingagreement”under37CFR401.2(a)andtherecipientorsubredpientwishestoenterintoacontractwithasmallbusinessfirmornonprofitorganizationregardingthesubstitutionofparties,assignmentorperformanceorexperimental,developmental,orresearchworkunderthat“fundingagreement,”therecipientorsubredpientmustcomplywiththerequirementsof37CFRPart401,“RightstoInventionsMadebyNonprofitOrganizationsandSmallBusinessFirmsUnderGovernmentGrants,ContractsandCooperativeAgreements,”andanyimplementingregulationsissuedbytheawardingagency.Vendoragreestocomplywiththeaboverequirementswhenapplicable.IYES,Iagree.CNO,Idonotagree.7.CleanAirActandFederalWaterPollutionControlAct:CleanAirAct(42usc7401-7671q.)andtheFederalWaterPollutionControlAct(33USC1251-1387),asamended—contractsandsubgrantsofamountsinexcessof$150,000mustcontainaprovisionthatrequiresthenon-Federalawardtoagreetocomplywithallapplicablestandards,orders,orregulationsissuedpursuanttotheCleanAirAct(42USC7401-7671q.)andtheFederalWaterPollutionControlAct,asamended(33USC1251-1387).ViolationsmustbereportedtotheFederalawardingagencyandtheRegionalOfficeoftheEnvironmentalProtectionAgency(EPA).Whenrequired,Vendoragreestocomplywithallapplicablestandards,orders,orregulationsissuedpursuanttotheCleanAirActandtheFederalWaterPollutionControlAct.IYES,Iagree.CNO,Idonotagree.8.DebarmentandSuspension:DebarmentandSuspension(ExecutiveOrders12549and12689)—Acontractaward(see2CFR180.220)mustnotbemadetopartieslistedonthegovernment-wideexclusionsintheSystemforAwardManagement(SAM),inaccordancewiththe0MBguidelinesat2CFR180thatimplementExecutiveOrders12549(3CFRPart1966Comp.p.189)and12689(3CERPart1989Comp.p.235),“DebarmentandSuspension.”SAMExclusionscontainsthenamesofpartiesdebarred,suspended,orotherwiseexcludedbyagencies,aswellaspartiesdeclaredineligibleunderstatutoryorregulatoryauthorityotherthanExecutiveOrder12549.VendorcertifiesthatVendorisnotcurrentlylistedonthegovernment-wideexclusionsinSAM,isnotdebarred,suspended,orotherwiseexcludedbyagenciesordeclaredineligibleunderstatutoryorregulatoryauthorityotherthanExecutiveOrder12549.VendorfurtheragreestoimmediatelynotifytheCooperativeandallcooperativememberswithpendingpurchasesorseekingtopurchasefromVendorifVendorislaterlistedonthegovernment-wideexclusionsinSAM,orisdebarred,suspended,orotherwiseexcludedbyagenciesordeclaredineligibleunderstatutoryorregulatoryauthorityotherthanExecutiveOrder12549.IYES,Iagree.CNO,Idonotagree.9.ByrdAnti-LobbyingAmendment:ByrdAnti-LobbyingAmendment(31USC1352)-Vendorsthatapplyorbidforanawardexceeding$100,000mustfiletherequiredcertification.EachtiercertifiestothetierabovethatitwillnotandhasnotusedFederalappropriatedfundstopayanypersonororganizationforinfluencingorattemptingtoinfluenceanofficeroremployeeofanyagency,amemberofCongress,officeroremployeeofCongress,oranemployeeofamemberofCongressinconnectionwithobtaininganyFederalcontract,grantoranyotherawardcoveredby31USC1352.Eachtiermustalsodisdoseanylobbyingwithnon-FederalfundsthattakesplaceinconnectionwithobtaininganyFederalaward,Suchdisdosuresareforwardedfromtiertotieruptothenon-Federalaward.Asapplicable,Vendoragreestofileallcertificationsanddisclosuresrequiredby,andotherwisecomplywith,theByrdAnti-LobbyingAmendment(31USC1352).IYES,Iagree.CNO,Idonotagree.Initial:._.NV\Page23of71ProposalFormscoMM/svcsv.08.11.2021 fyBoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.com10.ProcurementofRecoveredMaterials:ForCooperativememberpurchasesutilizingFederalfunds,VendoragreestocomplywithSection6002oftheSolidWasteDisposalAct,asamendedbytheResourceConservationandRecoveryActwhereapplicableandprovidesuchinformationandcertificationsasaCooperativemembermayrequiretoconfirmestimatesandotherwisecomply.TherequirementsofSection6002indudeprocuringonlyitemsdesignatedinguidelinesoftheEnvironmentalProtectionAgency(EPA)at40CFRPart247thatcontainthehighestpercentageofrecoveredmaterialspracticable,consistentwithmaintainingasatisfactorylevelofcompetition,wherethepurchasepriceoftheitemexceeds$10,000orthevalueofthequantityacquiredduringtheprecedingfiscalyearexceeded$10,000;procuringsolidwastemanagementservicesinamannerthatmaximizesenergyandresourcerecovery,andestablishinganaffirmativeprocurementprogramforprocurementofrecoveredmaterialsidentifiedintheEPAguidelines.IYES,Iagree.ElNO,Idonotagree.11.DomesticPreferencesforProcurements:Whereappropriateandconsistentwithlaw,2CFR§200.322containscertainconsiderationsfordomesticpreferencesforprocurementswhichmaybeapplicabletoCooperativemembersusingfederalfunds,WhenrequiredbyaCooperativemember,VendoragreestoprovidesuchinformationorcertificationasmayreasonablyberequestedbytheCooperativememberregardingVendor’sproducts,includingwhethergoods,products,ormaterialsareproducedintheUnitedStates.IYES,Iagree.ElNO,Idonotagree.12.ProhibitiononCertainTelecommunicationsandVideoSurveillanceServicesorEquipment2CFR§200.216prohibitsexpendingfederalloanorgrantfundstoprocureorobtaincertaintelecommunicationsandvideosurveillanceservicesorequipment.TotheextentapplicableandwhenrequiredbyaCooperativemember,VendoragreestoprovidesuchinformationorcertificationasmayreasonablyberequestedbytheCooperativemembertoconfirmwhetheranytelecommunicationsorvideosurveillanceservicesorequipmentprovidedbyVendoriscoveredequipmentorcoveredservicesunder2CFR§200.216.IYES,Iagree.ElNO,Idonotagree.13.ProfitasaSeparateElementofPrice:ForpurchasesusingfederalfundsinexcessoftheSimplifiedAcquisitionThreshold,aCooperativemembermayberequiredtonegotiateprofitasaseparateelementoftheprice.See,2CFR200.324(b).WhenrequiredbyaCooperativemember,VendoragreestoprovideinformationandnegotiatewiththeCooperativememberregardingprofitasaseparateelementofthepriceforaparticularpurchase.However,Vendoragreesthatthetotalprice,includingprofit,chargedbyVendortotheCooperativemembershallnotexceedtheawardedpricing,includinganyapplicablediscount,underVendor’sCooperativeContract.IYES,Iagree.ElNO,Idonotagree.14.GeneralComplianceandCooperationwithCooperativeMembers:Inadditiontotheforegoingspecificrequirements,Vendoragrees,inacceptinganyPurchaseOrderfromaCooperativemember,itshallmakeagoodfaithefforttoworkwithCooperativememberstoprovidesuchinformationandtosatisfysuchrequirementsasmayapplytoaparticularCooperativememberpurchaseorpurchasesincluding,butnotlimitedto,applicablerecordkeepingandrecordretentionrequirements.IYES,Iagree.ElNO,Idonotagree.Initial:______Page24of71ProposalFormsCOMM/SVCSvOa.11.2011 1zBoardPURCNASINGCOGPtRATIYE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comCOMPLIANCEFORMSSIGNATUREPAGEByinitialingpagesandbysignaturebelow,IcertifythatIhavereviewedthefollowingforms;thattheinformationprovidedthereinistrue,complete,andaccurate;andthatIamauthorizedbymycompanytomakeallcertifications,consents,acknowledgements,andagreementscontainedherein:•ProposalAcknowledgements•FelonyConvictionDisclosure•DebarmentCertification•Resident/NonresidentCertification•VendorEmploymentCertification•NoBoycottVerification•NoExcludedNationorForeignTerroristOrganizationCertification•HistoricallyUnderutilizedBusinessCertification•Construction-RelatedGoodsandServicesAffirmation•AcknowledgementofBuyBoardTechnicalRequirements•DeviationandCompliance•VendorConsentforNameBrandUse•ConfidentialjProprietaryInformation•EDGARVendorCertificationBoundTreeMedical,LLCCompayNameSigna$4eof’AuthohzedCompanyOfficialJon(MGrew-AssociateVicePresident,PricingPrintedNameandTitle01/25/2023DatePage25of71ProposalFdnnsCOMM/SVCSvCSll2021 INSTRUCTIONS:f17Boar&PURCHASINGCOOPCRATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comPROPOSALFORMSPART2:VENDORINFORMATIONFORMSProposermustcompletelyandaccuratelyprovideallinformationrequestedinthefollowingVendorInformationFormsoryourProposalmayberejectedasnon-responsive:•VendorBusinessName•VendorContactInformation•FederalandState/PurchasingCooperativeExperience•GovernmentalReferences•CompanyProfile•TexasRegionalServiceDesignation•StateServiceDesignation•NationalPurchasingCooperativeVendorAwardAgreement(VendorssewingoutsideTexasonly)•Local/AuthorizedSellerListings•ManufacturerDealerDesignation•ProposalInvitationQuestionnaire•VendorRequesttoSelf-ReportBuyBoardPurchases(Optional)Totheextentanyinformationrequestedisnotapplicabletoyourcompany,youmustsoindicateontheform.VENDORBUSINESSNAMEBysubmittingaProposal,VendorisseekingtoenterintoalegalcontractwiththeCooperative.Assuch,Vendormustbeanindividualorlegalbusinessentitycapableofenteringintoabindingcontract.NameofProposingCompany:__________________________________________________________________(ListthegfnameofthecompanyseekingtocvntraawiththeCooperative.DoQIlistanassumedname,dba,a/ca,etc.heraSuchinformationmaybeprovidedbelow.Ifyouaresubmittingajointproposalwithanotherentitytoprovidethesameproposedgoodsorsewices,eachsubmittingentityshouldcompleteaseparatevendorinformationfttw.Separatelyoperatinglegalbusinessentities,evenifaffiliatedentities,whichproposetoprovidegoodsorservicesseparatelymustsubmittheirownProposals.)Pleasecheck(/)oneofthefollowing:TypeofBusiness:CIndividual/SoleProprietorCCorporationILimitedLiabilityCompanyCPartnershipUOther(Specify:—StateofIncornoration(ifapplicable):OhioFederalEmployerIdentificationNumber:31-1739487(VendormustIncludeacompletedIRSW-9formwiththeirProposal)NamebywhichVendor,ifawarded,wishestobeidentifiedontheBuyBoard:(Note:ffdifferentthantheNameofProposingcompanylistedabove,onlyvalidtradenames(dba,aka,etc.)oftheProposingcompanymaybeusedandacopyofyourAssumedNameCertificate(s),ifapplicable,mustbeattached.)Page26of71PmposalFormsCOMM/SVCSv.08.11.2021 RequestforTaxpayerIdentificationNumberandCertificationGotowwwjrs.govlFormW9forinstructionsandthelatestinformation.2Businessname/disregardedentityname,ifdifferentfromabove3Checkappropriateboxforfederaltaxclassificationofthepersonwhosenameisenteredonline1.Checkonlyoneofthe4Exemptions(codesapplyonlytofollowingsevenboxes,certainentities,notindividuals;seeinstructionsonpage3):ElIndividual/soleproprietororElCCorporationElSCorporationElPartnershipElTrust/estatesingle-memberLLCExemptpayeecode(ifany)__________Limitedliabilitycompany.EnterthetaxclassificationfC=Ccorporation,S=Scorporation,P=Partnership)PNote:Checktheappropriateboxinthelineaboveforthetaxclassificationofthesingle-memberowner.DonotcheckExemptionfromFATCAreportingLLCiftheLLCisclassifiedasasingle-memberLLCthatisdisregardedfromtheownerunlesstheowneroftheLLC5code‘fananotherLLCthatisnotdisregardedfromtheownerforU.S.federaltaxpurposes.Otherwise,asingle-memberLLCthat“‘____________________isdisregardedfromtheownershouldchecktheappropriateboxforthetaxclassificationofitsowner.ElOther(seeinstructions)AIIS(00000Uflt,m&ntoThedouidethoU.S.)5Address(number,street,andapt.orsuiteno.)Seeinstructions.Requester’snameandaddress(optional)5000TuttleCrossingBlvd6City,state,andZIPcodeDublin,OH43016IiJ’ITaxpayerIdentificationNumber(TIN)EnteryourTINintheappropriatebox.TheTINprovidedmustmatchthenamegivenonline1toavoidSocialsecuritynumberbackupwithholding.Forindividuals,thisisgenerallyyoursocialsecuritynumber(SSN).However,foraresidentalien,soleproprietor,ordisregardedentity,seetheinstructionsforPartI,later.Forother——entities,itisyouremployeridentificationnumber(EIN).Ifyoudonothaveanumber,seeHowtogetaTIN,later.orNote:Iftheaccountisinmorethanonename,seetheinstructionsforline1.AlsoseeWhatNameandEmployeridentificationnumberNumberToGivetheRequesterforguidelinesonwhosenumbertoenter.31—1739487I1lICertificationUnderpenaltiesofperjury,Icertifythat:1.Thenumbershownonthisformismycorrecttaxpayeridentificationnumber(orIamwaitingforanumbertobeissuedtome);and2.Iamnotsubjecttobackupwithholdingbecause:(a)Iamexemptfrombackupwithholding,or(b)IhavenotbeennotifiedbytheInternalRevenueService(IRS)thatIamsubjecttobackupwithholdingasaresultofafailuretoreportallinterestordividends,or(c)theIRShasnotifiedmethatIamnolongersubjecttobackupwithholding;and3.IamaU.S.citizenorotherU.S.person(definedbelow);and4.TheFATCAcode(s)enteredonthisform(ifany)indicatingthatIamexemptfromFATCAreportingiscorrect.Certificationinstructions.Youmustcrossoutitem2aboveifyouhavebeennotifiedbytheIRSthatyouarecurrentlysubjecttobackupwithholdingbecauseyouhavefailedtoreportallinterestanddividendsonyourtaxreturn.Forrealestatetransactions,item2doesnotapply.Formortgageinterestpaid,acquisitionorabandonmentofsecuredproperty,cancellationofdebt,contributionstoanindividualretirementarrangement(IRA),andgenerally,paymentsotherthaninterestanddividends,youarenotrequiredtosignthecertification,butyoumustprovideyourcorrectTIN.SeetheinstructionsforPartII,later.SignSignatureofHereU.S.person,DatectIC’%IGeneraIInstructions•Form1099-DIV(dividends,includingthosefromstocksormutualfunds)SectionreferencesaretotheInternalRevenueCodeunlessotherwise•Form1099-MISC(varioustypesofincome,prizes,awards,orgrossnoted,proceeds)Futuredevelopments.Forthelatestinformationaboutdevelopments•Form1099-B(stockormutualfundsalesandcertainotherrelatedtoFormW-9anditsinstructions,suchaslegislationenactedtransactionsbybrokers)aftertheywerepublished,gotowww.irs.gov/FormW9.•Form1099-S(proceedsfromrealestatetransactions)PurposeofForm•Form1099-K(merchantcardandthirdpartynetworktransactions)Anindividualorentity(FormW-9requester)whoisrequiredtofilean•Form1098(homemortgageinterest),1098-E(studentloaninterest),informationreturnwiththeIRSmustobtainyourcorrecttaxpayer1098-T(tuition)identificationnumber(TIN)whichmaybeyoursocialsecuritynumber•Form1099-C(canceleddebt)(SSN),individualtaxpayeridentificationnumber(ITIN),adoption•Form1099-A(acquisitionorabandonmentofsecuredproperty)taxpayeridentificationnumber(ATIN),oremployeridentificationnumber(EIN),toreportonaninformationreturntheamountpaidtoyou,orotherUseFormW-9onlyifyouareaU.S.person(includingaresidentamountreportableonaninformationreturn.Examplesofinformationalien),toprovideyourcorrectTIN.returnsinclude,butarenotlimitedto,thefollowing.IfyoudonotreturnFormW-9totherequesterwithaTIN,youmight•Form1099-INT(interestearnedorpaid)besubjecttobackupwithholding.SeeWhatisbackupwithholding,later.Cat.No.10237XFormW—9(Rev.70-2018)IName(asshownonyourincometaxreturn).Nameisrequiredonthisline;donotleavethislineblank.BoundTreeMedicalLLC7Listaccountnumber(s)here(optional)—Form••(Rev.October2078)DepartmentoftheTreasuryInternalRevenueService5)0)a0.C0•50a0aaU,GiveFormtotherequester.DonotsendtotheIRS. J7Board®PURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comVENDORCONTACTINFORMATIONVendorshallprovidetherequestedVendorContactInformat/onIntheelectronicproposalsubmissionsystemincludingcontract,purchaseorder,RFQ,andinvoicecontacts(or,ifsubmittingahardcopyProposal,timelyrequestandcompletetheVendorContactInformationforminaccordancewiththeInstructionstoProposers).FEDERALANDSTATE/PURCHASINGCOOPERATIVEEXPERIENCETheCooperativestrivestoprovideCooperativememberswiththebestservicesandproductsatthebestpricesavailablefromVendorswiththetechnicalresourcesandabilitytoserveCooperativemembers.Pleaserespondtothefollowingquestions.1.Providethedollarvalueofsalestoorthroughpurchasingcooperativesatorbasedonanestablishedcatalogormarketpriceduringtheprevious12-monthperiodorthelastfiscalyear:$$6,290.SSI.(Theperiodofthe12-monthperiodis01/01/2022/12/31/2022).Intheeventthatadollarvalueisnotanappropriatemeasureofthesales,provideanddescribeyourownmeasureofthesalesoftheitem(s).2.Bysubmittingaproposal,youagreethat,basedonyourwrittendiscountingpolicies,thediscountsyouoffertheCooperativeareequaltoorbetterthanthebestpriceyouofferotherpurchasingcooperativesforthesameitemsunderequivalentcircumstances.3.ProvidetheinformationrequestedbelowforotherpurchasingcooperativesforwhichProposercurrentlyserves,orinthepasthasserved,asanawardedvendor.Rowsshouldbeaddedtoaccommodateasmanypurchasingcooperativesasrequired.CURRENTFORMERVENDOR(V/N)?—AWARDEDPURCHASINGVENDOR?IFYES,USTYEARSCOMMODITYGROUP(V/N)ASVENDORQThGORV(IES)1.FederalGeneralServicesAdministrationNN2.T-PASS(StateofTexas)NN3.OMNIAPartnersNN4.Sourcewell(NJPA)NN5.E&ICooperativeNN6.Houston-GalvestonAreaCouncil(HGAC)7.ChoicePartners8.TheInterlocalPurchasingSystem(TIPS)9.OtherYMedicalSuppliesoMYCOMPANYDOESNOTCURRENTLYHAVEANYOFTHEABOVEORSIMILARTYPECONTRACTs.CURRENTBUYBOARDVENDORSIfyouareacurrentBuyBoardvendorinthesamecontractcategoryasproposedinthisProposalInvitation,indicatethediscountforyourcurrentBuyBoardcontractandtheproposeddiscountinthisProposal.Explainanydifferencebetweenyourcurrentandproposeddiscounts.CurrentDiscount(%):28%+SomeexclusionsProposedDiscount(%):28%+SomeexclusionsExplanation:Slightvariancesisthemanufacturersexcludedexistsduetoproducttypeandunderlyingcosts.Page27of71ProposalFarmsCCMM/SVCSv.08.11.2021 llZJlBoardPURCHASINGCOOPERATIfl12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.comGOVERNMENTALREFERENCESForyourProposaltobeconsidered,youmustsupplyaminimumoffive(5)individualgovernmentalentityreferences.TheCooperativemaycontactanyandallreferencesprovidedaspartoftheProposalevaluation.Providetheinformationrequestedbelow,includingtheexistingpricing/discountsyouoffereachcustomer.TheCooperativemaydeterminewhetherpricing/discountsarefairandreasonablebycomparingpricing/discountsstatedinyourProposalwiththepricing/discountsyouofferothergovernmentalcustomers.Attachadditionalpagesifnecessary.Quantity!EntityNameContactPhone#EmailAddressDiscountVolume1.SanFranciscoFireDepartmentAndyZanoff,415-717-6876Andy.Zanoffsfgov.org.NetPriced—$500KAnnually2.FireDepartmentCityofNewYorkDouglaslsaacs,718-999-2790doug.isaacsfdny.nyc.govNetPriced—$500KAnnuallyPriorityAmbulanceSteveBlackburn,614-354-4702sblackburn@priorityambulance.comNetPriced—$2MAnnuallyCityofColumbusDivisionofFireScottEllis,614-221-3132seelIiscolumbus.govNetPriced—$1MAnnuallyBaltimoreCityFireDepartmentFFPMLamontNIClarkIl,410-396-2716Lamont.clarkii@baltirnorecity.govNetPriced—$750KAnnuallyDoyouevermodifyyourwrittenpoliciesorstandardgovernmentalsalespracticesasidentifiedintheabovecharttogivebetterdiscounts(lowerpricing)thanindicated?YESflNOIfYES,pleaseexplain:COMPANYPROFILEInformationonawardedCooperativeContractsisavailabletoCooperativeMembersontheBuyBoardwebsite.IfyourcompanyisawardedaContractunderthisProposalInvitation,pleaseprovideabriefcompanydescriptionthatyouwouldliketohaveincludedwithyourcompanyprofileontheBuyBoardwebsite.Submityourcompanyprofileinaseparatefile,inWordformat,withyourProposal.(Note:VendorissolelyresponsibleforanycontentprovidedforinclusionontheBuyBoardwebsite.TheCooperativereservestherighttoexcludeorremoveanycontentinitssolediscretion,withorwithoutpriornotice,includingbutnotlimitedtoanycontentdeemedbytheCooperativetobeinappropriate,irrelevanttotheContract,inaccurate,ormisleading.)Page28of71ProposalFormsCOMM/SVCSv.08.112021 www.boundtree.com Why Choose Bound Tree? As Your Partner in EMS for over 45 years, we've made it our mission to help you save minutes and lives. We strive to understand your unique needs and provide you with the right products, services and support to best meet those needs. The Right Products Bound Tree offers a full line of emergency medical supplies, equipment and pharmaceuticals from some of the industry's leading healthcare manufacturers. • Curaplex® Products Curaplex® by Bound Tree offers a robust portfolio of everyday products and specialty solutions at an extraordinary value. • Kitting Solutions Pre-assembled kits provide a cost-effective, convenient way to prepare for a wide variety of emergency scenarios. • Pharmaceuticals Bound Tree offers a full line of EMS pharmaceuticals and accessories, including Class II and Class IV drugs. The Right Services Bound Tree offers valuable services to increase efficiency and accuracy, reduce liability and positively impact your bottom line. Services such as inventory and asset management, online ordering for controlled substances and emergency disaster support can save time and reduce overall costs. • Asset Management Solutions Bound Tree Medical's asset management solutions, UCapIt and Operative IQ, can help you with the challenges you face today. Both solutions offer unique ways to streamline your operations making them more efficient and effective. • Emergency Disaster Support A 24-hour resource for agencies that encounter incidents that require immediate deployment of emergency medical supplies. . The Right Support Bound Tree is dedicated to providing best-in-class support. This includes a dedicated Account Manager and a team of highly-knowledgeable Customer Service Representatives as well as additional educational resources and continuing education through Bound Tree University. • Nationwide Distribution Six distribution centers are strategically positioned across the nation for operational efficiency and disaster response. • Dedicated Account Managers Our EMS-experienced Account Managers know state and local requirements, best practices, industry information and innovative product offerings. • Bound Tree University The educational hub for EMS that provides free online CEUs and hundreds of articles, videos, e-Books and more to learn about critical topics in EMS. ç’BoardPURCNASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439-PH:800-695-2919-buyboard.comTEXASREGIONALSERVICEDESIGNATIONThisformmustbecompleted/ntheelectron/cproposalsubmissionsystem(or.IfsubmittingahardCODYProposal,timelyrequestandCompletetheformInaccordancewiththeInstructionstoProposers).TheCooperative(referredtoas“TexasCooperative”inthisformandintheStateServiceDesignationform)offersvendorstheopportunitytoserviceitsmembersthroughouttheentireStateofTexas.Intheelectronicproposalsubmissionsystem,youmustindicateifyouwillserviceTexasCooperativemembersstatewideor,ifyoudonotplantoserviceallTexasCooperativemembersstatewide,youmustindicatethespecificregionsyouwillservice.IfyouproposetoservedifferentregionsfordifferentproductsorservicesindudedinyourProposal,youmustcompleteandsubmitaseparateTexasRegionalServiceDesignationformforeachgroupofproductsandclearlyindicatetheproductsorservicestowhichthedesignationapplies.(Additionalformscanbeobtainedbycontactingbidsbuyboard.comatleastfive(5)businessdaysoriortotheProDosalDueDate.)Bydesignatingaregionorregions,youarecertifyingthatyouareauthorizedandwillingtoprovidetheproposedproductsandservicesinthoseregions.Designatingregionsinwhichyouareeitherunableorunwillingtoprovidethespec/fledproductsandservicesshallbegroundsforeitherrejectionofyourProposalor,Ifawarded,term/nationofyourContract.Additionally,ifyoudonotplantoserviceTexasCooperativemembers(i.e.,ifyouwillserviceonlystatesotherthanTexas),youmustsoindicateontheformintheelectronicDronosalsubmissionsystem.RegionandHeadquarters1Edinburg2CorpusChristi3Victoria4Houston5Beaumont6Huntsville7Kilgore8MountPleasant9WichitaFalls10Richardson11FortWorth12Waco13Austin14Abilene15SanAngelo16Amarillo17Lubbock18Midland19ElPaso20SanAntoniotCanSupportAllRegionsRegionalEducationServiceCentersPage29of71ProposalFormsC0MM/SVv.08,11.2021 J’BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2’139PH:800-6g5-2919buyboard.comSTATESERVICEDESIGNATIONThisformmustbecompleted/ntheelectronicproposalsubmissionsystem(or.ifsubmiftincahardcopyProposal,timelyrequestandcompletetheinaccordancewiththeInstructionstoProposers).AssetforthintheProposalInvitation,itistheCooperative’sintentthatothergovernmentalentitiesintheUnitedStateshavetheopportunitytopurchasegoodsorservicesawardedundertheContract,subjecttoapplicablestatelaw,throughapiggybackawardorsimilaragreementthroughtheNationalPurchasingCooperativeBuyBoard.IfyouplantoservicetheentireUnitedStatesoronlyspecificstates,youmustcompletetheStateServiceDesignationinformationintheelectronicproposalsubmissionsystem.(Note:Ifyoup/antoserviceTexasCooperativemembers,besurethatyoucompletetheTexasRegionalServiceDesignationform.)Inadditiontothisform,tobeconsideredforapiggy-backawardbytheNationalPurchasingCooperative,youmusthaveanauthorizedrepresentativesigntheNationalPurchasingCooperativeVendorAwardAgreementthatfollowsthispage.IfyouservedifferentstatesfordifferentproductsorservicesindudedinyourProposal,youmustcompleteandsubmitaseparateStateServiceDesignationformforeachgroupofproductsandclearlyindicatetheproductsorservicestowhichthedesignationapplies.(Additionalformscanbeobtainedbycontactingbids@buvboard.comatleastfive15’)businessdayspriortotheProposalDueDate.)Bydesignatingastateorstates,youarecertifyingthatyouareauthorizedandwllllngtoprovidetheproposedproductsandservicesinthosestates.DesignatingstatesinwhichyouareeitherunableorunwllllngtoprovidethespecifiedproductsandservicesshallbegroundsforeitherrefectionofyourProposaior,ifawarded,terminationofyourContract.X•IwillserviceallstatesintheUnitedStates.IwillnotserviceallstatesintheUnitedStates.AlabamaAlaskaNebraskaArizonaNevadaArkansasNewHampshireCalifornia(PublicContractCode20118&20652)NewJerseyColoradoNewMexicoConnecticutNewYorkDelawareNorthCarolinaDistrictofColumbiaNorthDakotaFloridaOhioGeorgiaOklahomaHawaiiOregonIdahoPennsylvaniaIllinoisRhodeIslandIndianaSouthCarolinaIowaSouthDakotaKansasTennesseeKentuckyTexasLouisianaUtahMaineVermontMarylandVirginiaMassachusettsWashingtonMichiganWestVirginiaMinnesotaWisconsinMississippiWyomingMissouriMontanaProposalFormsCOMM/SVCSv.08.112021Page30of71 147BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas7875g-2439PH:800-695-2919buyboard.comNATIONALPURCHASINGCOOPERATIVEVENDORAWARDAGREEMENTInaccordancewiththeTermsandConditionsassociatedwiththisProposalInvitation,acontractawardedunderthisProposalInvitationmaybe“piggy-backed”byanothergovernmentalentity.TheNationalPurchasingCooperativeisanintergovernmentalpurchasingcooperativeformedbycertainschooldistrictsoutsideofTexastoserveitsmembersthroughouttheUnitedStates.Ifyouagreetobeconsidered[orapiggy-backawardbytheNationalPurchasingCooperative,youagreetothefollowingtermsandagreetoserveNationalPurchasingCooperativemembersinthestatesyouhaveindicatedontheStateServiceDesignationform,inyourProposal.Bysigningthisform,Proposer(referredtointhisAgreementas“Vendor”)agreesasfollows:1.VendoracknowledgesthatifTheLocalGovernmentPurchasingCooperative(“TexasCooperative”)awardsVendoracontractunderthisProposalInvitation(“UnderlyingAward”),theNationalPurchasingCooperative(“NationalCooperative”)may-butisnotrequiredto-“piggy-back”onorre-awardalloraportionofthatUnderlyingAward(“Piggy-BackAward”).BysigningthisNationalCooperativeVendorAwardAgreement(“Agreement”),VendoracceptsandagreestobeboundbyanysuchPiggy-BackAwardasprovidedforherein.2.IntheeventNationalCooperativeawardsVendoraPiggy-BackAward,theNationalCooperativeAdministrator(“BuyBoardAdministrator”)willnotifyVendorinwritingofsuchPiggy-BackAward,whichawardshallcommenceontheeffectivedatestatedintheNoticeandendontheexpirationdateoftheUnderlyingAward,subjecttoannualrenewalsasauthorizedinwritingbytheBuyBoardAdministrator.VendoragreesthatnofurthersignatureorotheractionisrequiredofVendorinorderforthePiggy-BackAwardandthisAgreementtobebindinguponVendor.VendorfurtheragreesthatnointerlineationsorchangestothisAgreementbyVendorwillbebindingonNationalCooperative,unlesssuchchangesareagreedtobyitsBuyBoardAdministratorinwriting.3.VendoragreesthatitshallofferitsgoodsandservicestoNationalCooperativemembersatthesameunitpricingandsamegeneraltermsandconditions,subjecttoapplicablestatelawsinthestateofpurchase,asrequiredbytheUnderlyingAward.However,nothinginthisAgreementpreventsVendorfromofferingNationalCooperativemembersbetter(i.e.,lower)competitivepricingandmorefavorabletermsandconditionsthanthoseintheUnderlyingAward.4.vendorherebyagreesandconfirmsthatitwillservethosestatesithasdesignatedontheStateServiceDesignationFormofthisProposalInvitation.AnychangestothestatesdesignatedontheStateServiceDesignationFormmustbeapprovedinwritingbytheBuyBoardAdministrator.5.VendoragreestopayNationalCooperativetheservicefeeprovidedforintheUnderlyingAwardbasedontheamountofpurchasesgeneratedfromNationalCooperativemembersthroughthePiggy-BackAward.VendorshallremitpaymenttoNationalCooperativeonsuchscheduleasitspecifies(whichshallnotbemoreoftenthanmonthly).Further,uponrequest,VendorshallprovideNationalCooperativewithcopiesofallpurchaseordersgeneratedfromNationalCooperativemembers,vendorinvoices,and/orsuchotherdocumentationregardingthosepurchaseordersastheCooperative’sadministratorsmayrequireintheirreasonablediscretionforpurposesofreviewingandverifyingpurchaseactivity.VendorfurtheragreesthatNationalCooperativeshallhavetheright,uponreasonablewrittennotice,toreviewVendor’srecordspertainingtopurchasesmadebyNationalCooperativemembersinordertoverifytheaccuracyofservicefees.6.VendoragreesthattheUnderlyingAward,includingitsGeneralTermsandConditions,areadoptedbyreferencetothefullestextentsuchprovisionscanreasonablyapplytothepost-proposal/contractawardphase.TherightsandresponsibilitiesthatwouldordinarilyinuretotheTexasCooperativepursuanttotheUnderlyingAwardshallinuretoNationalCooperative;and,conversely,therightsandresponsibilitiesthatwouldordinarilyinuretoVendorintheUnderlyingAwardshallinuretoVendorinthisAgreement.VendorrecognizesandagreesthatVendorandNationalCooperativearetheonlypartiestothisAgreement,andthatnothinginthisAgreementhasapplicationtootherthirdparties,includingtheTexasCooperative.IntheeventofconflictbetweenthisAgreementandthetermsoftheUnderlyingAward,thetermsofthisAgreementshallcontrol,andthenonlytotheextentnecessarytoreconciletheconflict.ProposalFormscOMM/svcs‘.00.11.2821Page31of71 BoardPURCNASINr3COOPCflTIYE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.com7.ThisAgreementshallbegovernedandconstruedinaccordancewiththelawsoftheStateofRhodeIslandandvenueforanydisputeshalllieinthefederaldistrictcourtofAlexandria,Virginia.8.VendoracknowledgesandagreesthattheawardofaPiggy-BackAwardiswithinthesolediscretionofNationalCooperative,andthatthisAgreementdoesnottakeeffectunlessanduntilNationalCooperativeawardsVendoraPiggy-BackAwardandtheBuyBoardAdministratornotifiesVendorinwritingofsuchPiggy-BackAwardasprovidedforherein.WHEREFORE,bysigningbelowVendoragreestotheforegoingandwarrantsthatithastheauthoritytoenterintothisAgreement.BoundTreeMedical,LLC704-23NameqfVendorProposalInvitationNumber(,4rv’JonSinaGjeofAuthorizedCompanyOfficialPrintedNameofAuthorizedCompanyofficial01/25/2023DateProposalFormscoMF/svcsv0811202tPage32of71 J.’BoardPURtNASJNGCOOPERATLVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.comLOCATION/AUTHORIZEDSELLERLISTINGSIfyouhavemorethanonelocation/authorizedsellerthatwillserviceaContractawardedunderthisProposalInvitation,pleaselisteachlocation/authorizedsellerbelow.Ifadditionalsheetsarerequired,pleaseduplicatethisformasnecessary.NOTE:AwardedVendorsshallremainresponsibleforallaspectsoftheContract,includingprocessingofPurchaseOrders,andshallberesponsiblefortheperformanceofalllocationsandauthorizedsellersunderandinaccordancewiththeContract.IfyouareaproductmanufacturerandwishtodesignateDesignatedDealersasdefinedintheGeneralTermsandConditionstoreceiveCooperativememberPurchaseOrdersonyourbehalf,youmustcompletetheManufacturerDesignatedDealerform.Location/AuthorizedContactInformationSellerNameContactPerson(MailingAddress,Phone,Fax,Email)ThiscontractwillbeservicedbyBoundTreeMedicalChIhF’5000TutlIeCrossingBlvd.andproductwi:lbeshppedfromclosestwarehouse.nsoper.eDubl,Ohio43016ailWarehouselocationsareatlachedforreference.614-760-5374877-311-2437Page33of71ProposalFormsCOMM/SVCSv.05.11.2021 J1BoardPUPCNASWGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919•buvboard.comMANUFACTURERDEALERDESIGNATIONIfVendorisamanufacturerthatsellsproductsthroughadealernetworkandwishestodesignateadealerormultipledealers(“DesignatedDealers”)toreceiveCooperativememberPurchaseOrdersonVendor’sbehalf,youmustcompletethisformforeachdealeryouwishtodesignate.RegardlessofanyDesignatedDealerssubmittedbyVendor,VendorspecificallyagreesandacknowledgesthatanysuchdesignationsareforVendor’sconvenienceonlyandshallnot,ifVendorisawardedaContract,relieveVendorofanyobligationsundertheContract,includingpaymentofCooperativeservicefeesonallPurchaseOrderssubmittedtoVendororanyDesignatedDealer.InaccordancewiththeGeneralTermsandConditions,anawardedVendorshallremainresponsibleandliableforallofitsobligationsundertheContractandtheperformanceofbothVendorandanyofVendor’sDesignatedDealersunderandinaccordancewiththeContractandremainsubjecttoallremediesfordefaultthereunder,including,butnotlimitedtosuspensionandterminationofVendor’sContractfornonpaymentofservicefees.Ifawarded,VendorauthorizestheCooperative,initssolediscretion,tolistanyVendorDesignatedDealersintheBuy8oardsystemandtoreceivePurchaseOrdersdirectlyfromCooperativemembersonbehalfofVendor.TotheextentaVendorwithDesignatedDealersreceivesaPurchaseOrderdirectly,itshallbetheresponsibilityofVendortoappropriatelyprocesssuchPurchaseOrderinaccordancewiththeContract,includingbutnotlimitedtotimelyforwardingsuchPurchaseOrdertoaDesignatedDealerforprocessing.TheCooperativereservestheright,initssolediscretion,torefuseadditionof,orrequestremovalof,anyDesignatedDealer,andVendoragreestoimmediatelyrequiresuchDesignatedDealertoceaseacceptingPurchaseOrdersorotherwiseactingonVendor’sbehalfundertheContract.Further,theCooperativeadministratorshallbeauthorizedtoremoveorsuspendanyorallDesignatedDealersfromtheBuyBoardatanytimeinitssolediscretion.IfyouwishtodesignateadealertoserviceacontractawardedunderthisProposalInvitation,pleaselisttheDesignatedDealerbelow.Ifyouwishtodesignatemultipledealers,pleaseduplicatethisformasnecessary.n/aDesignatedDealerNameDesignatedDealerContactPersonn/aDesignatedDealerAddressn/an/an/aCityStateZipn/an/aPhoneNumberFaxNumbern/an/aEmailaddressDesignatedDealerTaxIDNumber*(*aftachW-9)PmposalFormsCOMM/SVCSv.08.112021Page34of71 JBoard®PURCNA3INCOOPtRAlIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard.comPROPOSALINVITATIONOUESTIONNAIRETheCooperativewilluseyourresponsestothequestionsbelowinevaluatingyourProposalandtechnicalandfinandalresourcestoprovidethegoodsandperformtheservices(“Work”)undertheBuyBoardcontractcontemplatedbyThisProposalInvitation(“Contract”).Proposersmustfuliyanswereachquestion,numberingyourresponsestocorrespondtothequestions/numbersbelow.ProposersmustcompletebeloworattachyourresponsestothisquestionnaireandsubmitinonedocumentwithyourProposal.YoumustsubmitthequestionnaireandresponseswithyourProposalortheProposalwillnotbeconsidered.1.ListthenumberofyearsProposerhasbeeninbusinessandformerbusinessnames(ifapplicable).Notewhetheryourcompanyiscurrentlyforsaleorinvolvedinanytransactionthatwouldsignificantlyalteritsbusinessorresultinacquisitionbyanotherentity.BoundTreeMedicaloriginated45yearsago.WeincorporatedatBoundTreeMedical,LLCin2000.2.DescribetheresourcesProposerhastomanagestaffandsuccessfullyperformtheWorkcontemplatedunderthisContract.StatethenumberandsummarizetheexperienceofcompanypersonnelwhomaybeutilizedfortheWork,includingthosewhowillbeavailabletoCooperativemembersforassistancewithprojectdevelopment,technicalissues,andproductselectionforWorkassociatedwiththisContract.BoundTreeMedicaloffersdedicatedsales,customerservice,andpricingteamstoproperlyserveourcustomerswithquestions,orderplacement,anddelivery.With6Warehousescountry-wide(includingGrandPrairie,TexasandFlowerMound,TX),productisdeliveredinatimelymanner.3.MarketingStrategy:ForyourProposaltobeconsidered,youmustsubmittheMarketingStrategyyouwilluseiftheCooperativeacceptsallorpartofyourProposal.(Example:ExplainhowyourcompanywillinitiallyinformCooperativemembersofyourBuysoardContract,andhowyouwillcontinuetosupporttheBuyBoardforthedurationoftheContractterm.)Attachadditionalpagesifnecessary.Ifawarded,weintendtosendaprofessionallycreatedPDF“Announcement”informingourcustomersofourBuyBoardparticipationandqualificationasWellasourcatalog.WeWillalsocontinuetoreviewcustomerrequestsforpricingagainstBuyBoardtosharetheprogramandsavingstheyareeligiblefor.ProposalFormsC0MM/S!CSv08.t12021Page35of71 VZJ’BoardPURCHASINGCOOflRATIVZ12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.com4.DescribeProposer’sfinancialcapabilitytoperformtheContract.Stateordescribethefirm’sfinancialstrengthandrating,bondingcapacity,andinsurancecoveragelimits.Statewhetherthefirm,oranyofthefirm’spastorpresentowners,principalshareholdersorstockholders,orofficers,havebeenadebtorpartytoabankruptcy,receivership,orinsolvencyproceedinginthelast7years,andidentifyanysuchdebtorpartybynameandrelationshiptoorpositionwithyourfirm.AsaleaderintheEMSmarket,wewehavethenetworkandfinancialcapacitytosupportBuyBoardandit’smembers.Ourfirmandit’sowner’shavenotbeenthedebtorpartytoabankruptcy,receivership,orinsolvency.OurInsuranceinformationisattachedforreview.Letusknowifadditionalinformationisneeded.5.Doesyourcompanyhaveanyoutstandingfinancialjudgmentsand/orisitcurrentlyindefaultonanyloanorfinancingagreement?Ifso,providedetailedinformationonthenatureofsuchitemsandprospectsforresolution.Wehavenooutstandingfinancialjudgmentsorloans/financingindefault.6.Ustallcontracts,ifany,inthelast10yearsonwhichProposerhasdefaulted,failedtocompleteordeliverthework,orthathavebeenterminatedforanyreason.Foreachsuchcontract,providetheprojectname,scope,valueanddateandthenameoftheprocuringentity,Fullyexplainthecircumstancesofthedefault,failuretocompleteordeliverthework,ortermination.n/a7.Ustalllitigationorotherlegalproceedings(includingarbitrationproceedings),ifany,inthelast10yearsbroughtagainstyourfirm,oranyofthefirm’spastorpresentowners,principalshareholdersorstockholders,officers,agentsoremployees,thatrelatetoorarisefromacontractsimilartothisContractortheWorkcontemplatedunderthisContract.Providethestyleofthelawsuitorproceeding(nameofpartiesandcourtortribunalinwhichfiled),natureoftheclaim,andresolutionorcurrentstatus.n/a______________________________________ProposalFormsCOMM/SVcSv08.11.2022Page36of71 1J/BoardPURCHASINGCOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buvboard,comREQUIREDFORMSCHECKLIST(Pleasecheck(V)the1&Iowrg)ElReviewed/Completed:Proposer’sAcceptanceandAgreementPROPOSALFORMSPART1:COMPLIANCEFORMSElReviewed/Completed:ProposalAcknowledgementsElReviewed/Completed:FelonyConvictionDisclosureElReviewed/Completed:Resident/NonresidentCertificationElReviewed/Completed:DebarmentCertificationReviewed/Completed:VendorEmploymentCertificationElReviewed/Completed:NoBoycottVerificationElReviewed/Completed:NoExcludedNationorForeignTerroristOrganizationCertificationElReviewed/Completed:HistoricallyUnderutilizedBusinessCertificationElReviewed/Completed:AcknowledgementofBuyBoardTechnicalRequirementsElReviewed/Completed:Construction-RelatedGoodsandServicesAffirmationElReviewed/Completed:DeviationandComplianceElReviewed/Completed:VendorConsentforNameBrandUseElReviewed/Completed:Confidential/ProprietaryInformationElReviewed/Completed:EDGARVendorCertificationElReviewed/Completed:ComplianceFormsSignaturePagePROPOSALFORMSPART2:VENDORINFORMATIONFORMSElReviewed/Completed:VendorBusinessNameElReviewed/Completed:VendorContactInformation(completeinelectronicproposalsubmiss/onsystem)ElReviewed/Completed:FederalandState/PurchasingCooperativeExperienceElReviewed/Completed:GovernmentalReferencesElReviewed/Completed:CompanyProfileElReviewed/Completed:TexasRegionalServiceDesignation(completehielectronicproposalsubmissionsystem)ElReviewed/Completed:StateServiceDesignation(completehielectronicproposalsubmissionsystem)ElReviewed/Completed:NationalPurchasingCooperativeVendorAwardAgreement(Vendorsservingou&deTexasonly)ElReviewed/Completed:Local/AuthorizedSellerListingsElReviewed/Completed:ManufacturerDealerDesignationElReviewed/Completed:ProposalInvitationQuestionnaireReviewed/Compteted:VendorRequesttoSelf-ReportBuyBoardPurchases(Optional)ElReviewed/Completed:ProposalSpecificationsDiscount(%)offCatalog/Pricefistand/arotherrequiredpricinginformationindudingCata/ogs/Price/ists(ornobidresponse)mustbesubmittedwiththeProposalortheProposalwillnotbeconsidered.ProposalFormscOMM/svcsvDB.1t.2021Page39c(71 JBoardPURCHASINECOOPERATIVE12007ResearchBoulevardAustin,Texas78759-2439PH:800-695-2919buyboard.comPROPOSALSPECIFICATIONSUMMARYThecategoriesanditemsspecifiedforthisProposalInvitationaresummarizedbelow.ForfullProposalSpecifications,youmustreviewandcompletetheProposalSpecificationinformationintheelectronicproposalsubmissionsysteminaccordancewiththeInstructionstoProposess(or,ifsubmittingahardcopyProposal,timelyrequestandcompletetheProposalSpecificationForminaccordancewiththeInstructionstoProposers).PROPOSALNOTE:Vendorsshallsubmitcatalog(s)/pricelist(s)withtheirProposalresponseortheProposalwillnotbeconsidered.Vendorsshallsubmitcatalog(s)/pricelist(s)withtheProposalinareadilyavailableandreadableelectronicformat,withExcelorsearchablePDFpreferred.Nopaoercatalogsormanufacturer/vendorwebsiteswillbeaccepted.SectionI:FirstAidEquipment.Products,andSupplies1.Discount(%)offcatalog/pricelistforFirstAidEquipmentandSupplies.2.Discount(%)oftcatalog/pricelistforFirstAidFurniture.3.Discount(°k)oftcatalog/pricelistforBleedingControlStations.4.Discount(°k)oftcatalog/pricelistforAllOtherFirstAid,Health,andNursingProducts.SectionII:AthleticTrainer/RehabilitationEquipment,Products,andSupplies5.Discount(%)offcatalog/phcelistforAthleticTrainer/RehabilitationEquipmentandSupplies.6.Discount(%)offcatalog/phcelistforAthleticTrainer/RehabilitationFurniture.7.Discount(%)offcatalog/pricelistforAllOtherAthleticTrainer/RehabilitationProducts.SectionIII:EmergencyMedicalEquipmentProducts,andSupplies8.Discount(°k)oftcatalog/pricelistforEmergencyMedicalEquipmentandSupplies.9.Discount(%)offcatalog/phcelistforAllOtherEmergencyMedicalProducts.SectionIV:PharmaceuticalsandVaccines10.Discount(°k)offcatalog/pricelistforPharmaceuticalsandVaccines.11.Discount(°k)offcatalog/pricelistforIntra-VenousPharmaceuticalSupplies.12.Discount(%)offcatalog/pncelistforDrugTestingKitsandSupplies.SectionV:AudiologyEguiDmentandOtherRelatedItems13.Discount(%)offcatalog/pricelistforAudiologyEquipment,HearingAids,andOtherRelatedItems.SectionVI:Drua/DiaqnosticlLaborato.vTestingServices14.Discount(°Io)offcatalog/pricelistforDrugandAlcoholDiagnosticTestingServices(onsiteandoffsiteincludinglaboratoryservices).SectionVII:InstallationandRepairService15.HourlyLaborRateforInstallation/RepairServiceofFirstAid,AthleticTrainer/Rehabilitation,andEmergencyMedicalEquipmentandProducts-NottoExceedhourlylaborrateforInstallation/RepairServiceofEquipmentandProducts.16.HourlyLaborRateforInstallation/RepairofAudiologyEquipmentandProducts-NottoExceedhourlylaborrateforInstallation/RepairServiceofEquipmentandProducts.ProposalFormsCOMM/SVCSv.08.11.2021Page38ci71 Bound Tree Medical Information Contact:Chris Fyffe Address:5000 Tuttle Crossing Blvd Dublin, OH 43016 Phone:(800) 533-0523 Fax:(877) 311-2437 Toll Free:(800) 533-0523 Email:submitbids@boundtree.com Web Address:www.boundtree.com By submitting your response, you certify that you are authorized to represent and bind your company. Christopher Fyffe Christopher.Fyffe@Boundtree.com Signature Email Submitted at 1/25/2023 04:11:04 PM (CT) Requested Attachments Exceptions and/or Detailed Information Related to Discount % and/or Hourly Labor Rate Proposed Discount - Additional Detail.pdf In PDF format and if necessary, vendor shall attach detailed information regarding exceptions to pricing and/or discount percentage and define the services that are proposed to be provided. NOTE: IF DETAILED INFORMATION IS NOT SUBMITTED, PROPOSAL MAY NOT BE CONSIDERED. (Please DO NOT password protect uploaded files.) BuyBoard Proposal Invitation No. 704-23 First Aid, Emergency Medical, and Athletic Trainer Supplies and Equipment Submission BuyBoard Proposal No 704-23_Signed.pdf REQUIRED-In PDF format, upload all proposal invitation documents available for download at vendor.buyboard.com including any additional pages, as necessary. NOTICE: DO NOT complete proposal forms in internet browser. No data will be stored. Download file to computer and complete proposal forms prior to submitting. (Please DO NOT password protect uploaded files.) Catalog/Pricelist 2022-2023 Bound Tree Catalog.pdf REQUIRED-In Excel or PDF format, upload catalog(s)/pricelist(s) in accordance with proposal invitation instructions. Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or Proposal will not be considered. No paper catalogs or manufacturer/vendor websites will be accepted. File size must not exceed 250MB. (Please DO NOT password protect uploaded files.) Company Profile Bound Tree Medical Company Profile.docx REQUIRED-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.) IRS Form W-9 Request for Taxpayer Identification Number and Certification Bound Tree Medical, LLC W-9 2023.pdf REQUIRED-In PDF format, upload W-9 form. (Please DO NOT password protect uploaded files.) Vendor: Bound Tree Medical 704-23Page 3 of 31 pages Response Attachments BuyBoard Item List.pdf Detailed Item list with discount and pricing. Bid Attributes 1 Federal Identification Number Federal Identification Number 31-1739487 2 HUB/No Israel Boycott Certification/No Excluded Nation or Foreign Terrorist Certification HUB/No Israel Boycott Certification/No Excluded Nation or Foreign Terrorist Certification 3 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’T 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’T 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. Yes 4 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. Yes 5 MWBE/HUB Status 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”) 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. I certify that my company has been certified as a MWBE/HUB in the following categories: (Please check all that apply) Vendor: Bound Tree Medical 704-23Page 4 of 31 pages 6 Minority Owned Business Minority Owned Business Minority Owned Business (Yes) 7 Women Owned Business Women Owned Business Women Owned Business (Yes) 8 Service-Disabled Veteran 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) Service-Disabled Veteran Owned Business (Yes) 9 Certification Number Certification Number No response 1 0 Name of Certifying Agency Certifying Agency No response 1 1 Non-MWBE/HUB My company has NOT been certified as a MWBE/HUB Non-HUB (Yes) 1 2 Vendor General Contact Information Proposal/Contract General Contact Information 1 3 Vendor Proposal/Contract Contact Name Vendor Proposal/Contract Contact Name Christopher Fyffe 1 4 Vendor Proposal/Contract Contact E-mail Address Vendor Proposal/Contract Contact E-mail Address Submitbids@Boundtree.com 1 5 Vendor Proposal/Contract Mailing Address Vendor Proposal/Contract Mailing Address 5000 Tuttle Crossing Blvd. 1 6 Vendor Proposal/Contact Mailing Address - City Vendor Proposal/Contact Mailing Address - City Dublin 1 7 Vendor Proposal/Contact Mailing Address - State Vendor Proposal/Contact Mailing Address - State (Abbreviate State Name) OH Vendor: Bound Tree Medical 704-23Page 5 of 31 pages 1 8 Vendor Proposal/Contact Mailing Address - Zip Code Vendor Proposal/Contact Mailing Address - Zip Code 43016 1 9 Vendor Proposal/Contact Phone Number Vendor Proposal/Contact Phone Number (xxx-xxx-xxxx) 614-760-5374 2 0 Vendor Proposal/Contact Extension Number Vendor Proposal/Contact Extension Number 800-533-0523 X 5374 2 1 Company Website Company Website (www.XXXXX.com) www.boundtree.com 2 2 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: I will use the internet to receive Purchase Orders at the following address Yes 2 3 Purchase Order E-mail Address Purchase Order E-mail Address Submitbids@Boundtree.com 2 4 Purchase Order Contact Name Purchase Order Contact Name Customer Service 2 5 Purchase Order Contact Phone Number Purchase Order Contact Phone Number (xxx-xxx-xxxx) 800-533-0523 2 6 Purchase Order Contact Extension Number Purchase Order Contact Extension Number No response 2 7 Alternate Purchase Order E-mail Address Alternate Purchase Order E-mail Address ordersoh@boundtree.com Vendor: Bound Tree Medical 704-23Page 6 of 31 pages 2 8 Alternate Purchase Order Contact Name Alternate Purchase Order Contact Name Customer Service 2 9 Alternate Purchase Order Contact Phone Number Alternate Purchase Order Contact Phone Number (xxx-xxx-xxxx) 800-533-0523 3 0 Alternate Purchase Order Contact Extension Number Alternate Purchase Order Contact Extension Number No response 3 1 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: 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. Yes 3 2 Request for Quotes (RFQ) Cooperative members will send RFQs to you by e-mail. Please provide e-mail addresses for the receipt of RFQs: 3 3 Request for Quote (RFQ) E-mail Address Request for Quote (RFQ) E-mail Address submitbids@Boundtree.com 3 4 Request for Quote (RFQ) Contact Name Request for Quote (RFQ) Contact Name SubmitBids 3 5 Request for Quote (RFQ) Contact Phone Number Request for Quote (RFQ) Contact Phone Number (xxx-xxx-xxxx) 800-533-0523 3 6 Request for Quote (RFQ) Contact Extension Number Request for Quote (RFQ) Contact Extension Number No response 3 7 Alternate Request for Quote (RFQ) E-mail Address Alternate Request for Quote (RFQ) E-mail Address ordersoh@boundtree.com Vendor: Bound Tree Medical 704-23Page 7 of 31 pages 3 8 Alternate Request for Quote (RFQ) Contact Name Alternate Request for Quote (RFQ) Contact Name No response 3 9 Alternate Request for Quote (RFQ) Contact Phone Number Alternate Request for Quote (RFQ) Contact Phone Number (xxx-xxx-xxxx) No response 4 0 Alternate Request for Quote (RFQ) Contact Extension Number Alternate Request for Quote (RFQ) Contact Extension Number No response 4 1 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. 4 2 Invoices Please choose only one (1) of the following options for receipt of invoices and provide the requested information: (a) Service fee invoices and related communications should be provided directly to my company at: or (b) In lieu of my company, I request and authorize all service fee invoices to be provided directly to the following billing agent: 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. Service fee invoices and notices direct to company 4 3 Invoice Company Name Invoice Company Name Bound Tree Medical, LLC 4 4 Invoice Company Department Name Invoice Company Department Name Customer Service 4 5 Invoice Contact Name Invoice Contact Name Customer Service 4 6 Invoice Mailing Address Invoice Mailing Address (P.O. Box or Street Address) 5000 Tuttle Crossing Blvd. Vendor: Bound Tree Medical 704-23Page 8 of 31 pages 4 7 Invoice Mailing Address - City Invoice Mailing Address - City Dublin 4 8 Invoice Mailing Address - State Invoice Mailing Address - State (Abbreviate State Name) OH 4 9 Invoice Mailing Address - Zip Code Invoice Mailing Address (Zip Code) 43016 5 0 Invoice Contact Phone Number Invoice Contact Phone Number (xxx-xxx-xxxx) 800-533-0523 5 1 Invoice Contact Extension Number Invoice Contact Extension Number No response 5 2 Invoice Contact Fax Number Invoice Contact Fax Number (xxx-xxx-xxxx) No response 5 3 Invoice Contact E-mail Address Invoice Contact E-mail customerservice@boundtree.com 5 4 Invoice Contact Alternate E-mail Address Invoice Contact Alternate E-mail Address No response 5 5 Billing Agent Company Name Billing Agent Company Name No response 5 6 Billing Agent Department Name Billing Agent Department Name No response 5 7 Billing Agent Contact Name Billing Agent Contact Name No response 5 8 Billing Agent Mailing Address Billing Agent Mailing Address (P.O. Box or Street Address) No response Vendor: Bound Tree Medical 704-23Page 9 of 31 pages 5 9 Billing Agent Mailing Address - City Billing Agent Mailing Address - City No response 6 0 Billing Agent Mailing Address - State Billing Agent Mailing Address - State (Abbreviate State Name) No response 6 1 Billing Agent Mailing Address - Zip Code Billing Agent Mailing Address - Zip Code No response 6 2 Billing Agent Contact Phone Number Billing Agent Contact Phone Number (xxx-xxx-xxxx) No response 6 3 Billing Agent Contact Extension Number Billing Agent Contact Extension Number No response 6 4 Billing Agent Fax Number Billing Agent Fax Number No response 6 5 Billing Agent Contact E-mail Address Billing Agent Contact E-mail Address No response 6 6 Billing Agent Alternative E-mail Address Billing Agent Alternative E-mail Address No response 6 7 Shipping Via Common Carrier, Company Truck, Prepaid and Add to Invoice, or Other Common Carrier 6 8 Payment Terms Note: Vendor payment terms must comply with the BuyBoard General Terms and Conditions and the Texas Prompt Payment Act (Texas Government Code Ch. 2251). 0% Net 30 6 9 Vendor's Internal/Assigned Reference/Quote Number Vendor's Internal/Assigned Reference/Quote Number 7679/19912 Vendor: Bound Tree Medical 704-23Page 10 of 31 pages 7 0 State or Attach 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. See bid response for return policy 7 1 Electronic Payments Are electronic payments acceptable to your company? Yes 7 2 Credit Card Payments Are credit card payments acceptable to your company? Yes 7 3 Texas Regional Service Designation Texas Regional Service Designation - Refer to Form in Proposal Invitation 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 willing 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. 7 4 Company Name Company Name Bound Tree Medical, LLC 7 5 Texas Regional Service Designation Select only one of the following options. If you select "I will NOT serve all Regions of Texas", you must then check the individual Regions you wish to serve. All Regions 7 6 Region 1 Region 1 - Edinburg Region 1 (1) 7 7 Region 2 Region 2 - Corpus Christi Region 2 (2) 7 8 Region 3 Region 3 - Victoria Region 3 (3) Vendor: Bound Tree Medical 704-23Page 11 of 31 pages 7 9 Region 4 Region 4 - Houston Region 4 (4) 8 0 Region 5 Region 5 - Beaumont Region 5 (5) 8 1 Region 6 Region 6 - Huntsville Region 6 (6) 8 2 Region 7 Region 7 - Kilgore Region 7 (7) 8 3 Region 8 Region 8 - Mount Pleasant Region 8 (8) 8 4 Region 9 Region 9 - Wichita Falls Region 9 (9) 8 5 Region 10 Region 10 - Richardson Region 10 (10) 8 6 Region 11 Region 11 - Fort Worth Region 11 (11) 8 7 Region 12 Region 12 - Waco Region 12 (12) 8 8 Region 13 Region 13 - Austin Region 13 (13) 8 9 Region 14 Region 14 - Abilene Region 14 (14) 9 0 Region 15 Region 15 - San Angelo Region 15 (15) Vendor: Bound Tree Medical 704-23Page 12 of 31 pages 9 1 Region 16 Region 16 - Amarillo Region 16 (16) 9 2 Region 17 Region 17 - Lubbock Region 17 (17) 9 3 Region 18 Region 18 - Midland Region 18 (18) 9 4 Region 19 Region 19 - El Paso Region 19 (19) 9 5 Region 20 Region 20 - San Antonio Region 20 (20) 9 6 State Service Designation State Service Designation - Refer to Form in Proposal Invitation. 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: If you plan 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, if awarded, termination of your Contract. 9 7 Company Name Company Name Bound Tree Medical, LLC 9 8 State Service Designation Select only one of the following options. If you select "I will NOT serve all States", you must then check the individual States you wish to serve. All States 9 9 Alabama Alabama Alabama (AL) Vendor: Bound Tree Medical 704-23Page 13 of 31 pages 1 0 0 Alaska Alaska Alaska (AK) 1 0 1 Arizona Arizona Arizona (AZ) 1 0 2 Arkansas Arkansas Arkansas (AR) 1 0 3 California California (Public Contract Code 20118 & 20652) California (CA) 1 0 4 Colorado Colorado Colorado (CO) 1 0 5 Connecticut Connecticut Connecticut (CT) 1 0 6 Delaware Delaware Delaware (DE) 1 0 7 District of Columbia District of Columbia District of Columbia (DC) 1 0 8 Florida Florida Florida (FL) 1 0 9 Georgia Georgia Georgia (GA) 1 1 0 Hawaii Hawaii Hawaii (HI) 1 1 1 Idaho Idaho Idaho (ID) Vendor: Bound Tree Medical 704-23Page 14 of 31 pages 1 1 2 Illinois Illinois Illinois (IL) 1 1 3 Indiana Indiana Indiana (IN) 1 1 4 Iowa Iowa Iowa (IA) 1 1 5 Kansas Kansas Kansas (KS) 1 1 6 Kentucky Kentucky Kentucky (KY) 1 1 7 Louisiana Louisiana Louisiana (LA) 1 1 8 Maine Maine Maine (ME) 1 1 9 Maryland Maryland Maryland (MD) 1 2 0 Massachusetts Massachusetts Massachusetts (MA) 1 2 1 Michigan Michigan Michigan (MI) 1 2 2 Minnesota Minnesota Minnesota (MN) 1 2 3 Mississippi Mississippi Mississippi (MS) Vendor: Bound Tree Medical 704-23Page 15 of 31 pages 1 2 4 Missouri Missouri Missouri (MO) 1 2 5 Montana Montana Montana (MT) 1 2 6 Nebraska Nebraska Nebraska (NE) 1 2 7 Nevada Nevada Nevada (NV) 1 2 8 New Hampshire New Hampshire New Hampshire (NH) 1 2 9 New Jersey New Jersey New Jersey (NJ) 1 3 0 New Mexico New Mexico New Mexico (NM) 1 3 1 New York New York New York (NY) 1 3 2 North Carolina North Carolina North Carolina (NC) 1 3 3 North Dakota North Dakota North Dakota (ND) 1 3 4 Ohio Ohio Ohio (OH) 1 3 5 Oklahoma Oklahoma Oklahoma (OK) Vendor: Bound Tree Medical 704-23Page 16 of 31 pages 1 3 6 Oregon Oregon Oregon (OR) 1 3 7 Pennsylvania Pennsylvania Pennsylvania (PA) 1 3 8 Rhode Island Rhode Island Rhode Island (RI) 1 3 9 South Carolina South Carolina South Carolina (SC) 1 4 0 South Dakota South Dakota South Dakota (SD) 1 4 1 Tennessee Tennessee Tennessee (TN) 1 4 2 Texas Texas Texas (TX) 1 4 3 Utah Utah Utah (UT) 1 4 4 Vermont Vermont Vermont (VT) 1 4 5 Virginia Virginia Virginia (VA) 1 4 6 Washington Washington Washington (WA) 1 4 7 West Virginia West Virginia West Virginia (WV) Vendor: Bound Tree Medical 704-23Page 17 of 31 pages 1 4 8 Wisconsin Wisconsin Wisconsin (WI) 1 4 9 Wyoming Wyoming Wyoming (WY) Bid Lines 1 Section I: First Aid Equipment, Products, and Supplies Discount (%) off catalog/pricelist for First Aid Equipment and Supplies. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 18 of 31 pages 2 Section I: First Aid Equipment, Products, and Supplies Discount (%) off catalog/pricelist for First Aid Furniture. Catalog/Pricelist MUST be included or proposal will not be considered. No Bid Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". No response Vendor: Bound Tree Medical 704-23Page 19 of 31 pages 3 Section I: Equipment, Products, and Supplies Discount (%) off catalog/pricelist for Bleeding Control Stations. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 20 of 31 pages 4 Section I: Equipment, Products, and Supplies Discount (%) off catalog/pricelist for All Other First Aid, Health, and Nursing Products. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 21 of 31 pages 5 Section II: Athletic Trainer/Rehabilitation Equipment, Products, and Supplies Discount (%) off catalog/pricelist for Athletic Trainer/Rehabilitation Equipment and Supplies. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 22 of 31 pages 6 Section II: Athletic Trainer/Rehabilitation Equipment, Products, and Supplies Discount (%) off catalog/pricelist for Athletic Trainer/Rehabilitation Furniture. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 23 of 31 pages 7 Section II: Athletic Trainer/Rehabilitation Equipment, Products, and Supplies Discount (%) off catalog/pricelist for All Other Athletic Trainer/Rehabilitation Products. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 24 of 31 pages 8 Section III: Emergency Medical Equipment, Products, and Supplies Discount (%) off catalog/pricelist for Emergency Medical Equipment and Supplies. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 25 of 31 pages 9 Section III: Emergency Medical Equipment, Products, and Supplies Discount (%) off catalog/pricelist for All Other Emergency Medical Products. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 26 of 31 pages 1 0 Section IV: Pharmaceuticals and Vaccines Discount (%) off catalog/pricelist for Pharmaceuticals and Vaccines. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 27 of 31 pages 1 1 Section IV: Pharmaceuticals and Vaccines Discount (%) off catalog/pricelist for Intra-Venous Pharmaceutical Supplies. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 28 of 31 pages 1 2 Section IV: Pharmaceuticals and Vaccines Discount (%) off catalog/pricelist for Drug Testing Kits and Supplies. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 29 of 31 pages 1 3 Section V: Audiology Equipment and Other Related Items Discount (%) off catalog/pricelist for Audiology Equipment, Hearing Aids, and Other Related Items. Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Select items at 10% off Vendor: Bound Tree Medical 704-23Page 30 of 31 pages 1 4 Section VI: Drug/Diagnostic/Laboratory Testing Services Discount (%) off catalog/pricelist for Drug and Alcohol Diagnostic Testing Services (onsite and offsite including laboratory services). Catalog/Pricelist MUST be included or proposal will not be considered. Total:28% Item Notes:PROPOSAL NOTE: Vendors shall submit catalog(s)/pricelist(s) with their Proposal response or the Proposal will not be considered. Vendors shall submit catalog(s)/pricelist(s) with the Proposal in a readily available and readable electronic format, with Excel or searchable PDF preferred. No paper catalogs or manufacturer/vendor websites will be accepted. Vendors proposing multiple manufacturer product lines and/or catalog/pricelist per line item must submit the information as follows or proposal may not be considered: Select "Add Alternate" for each additional manufacturer product line and/or catalog/pricelist proposed Vendor’s must list one specific percentage discount for each manufacturer and/or catalog/pricelist listed Item Attributes 1.State Name of Catalog/Pricelist Proposed with Discount Percentage NOTE: Do not include SKU, Reference Numbers, Websites, and/or "See Attached/Enclosed". Supplies Only 1 5 Section II: Installation and Repair Service Hourly Labor Rate for Installation/Repair Service of First Aid, Athletic Trainer/Rehabilitation, and Emergency Medical Equipment and Products - Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. Quantity:1 UOM:Hourly Labor Rate No Bid 1 6 Section II: Installation and Repair Service Hourly Labor Rate for Installation/Repair Service of Audiology Equipment and Products - Not to Exceed hourly labor rate for Installation/Repair Service of Equipment and Products. Quantity:1 UOM:Hourly Labor Rate No Bid Response Total: $0.00 Vendor: Bound Tree Medical 704-23Page 31 of 31 pages Nationwide Distribution For operational efficiency and faster disaster response, Bound Tree operates 5 distribution centers nationwide plus a dedicated kitting facility. 96% of all our customers can be reached using UPS Ground within 2 business days. OFFICES Bound Tree Medical 5000 Tuttle Crossing Blvd. Dublin, OH 43016 DISTRIBUTION CENTERS Grand Prairie, TX Bound Tree Medical 2911 S. Great Southwest Parkway Suite 200 Grand Prairie, TX 75052 Flower Mound, TX Bound Tree Medical 1420 Lakeside Parkway Suite 105 Flower Mound, TX 75028 Elizabethtown, PA Bound Tree Medical 1605 Zeager Road Elizabethtown, PA 17022 Greenwood, IN Bound Tree Medical 1033 Collins Road, Suite A Greenwood, IN 46143 Visalia, CA Bound Tree Medical 2243 N. Plaza Drive Visalia, CA 93291 Jacksonville, FL Bound Tree Medical 2619 Ignition Drive, Suite 2 Jacksonville, FL 32218 Customer Service Bound Tree Medical is focused on providing service to meet the needs of our customers throughout the United States. We have a deep commitment to help those that help others. The specialized market that we serve drives us to create the best possible solutions for our customers. We are here to serve you. Our nationwide toll-free Customer Service line is 800-533-0523. Bound Tree Medical routes calls by origin of the zip code of the caller which, results in more customer awareness among those agents responding to customer calls. There are a variety of methods to place orders and verify pricing: 1) Internet: Customers have access to real-time pricing and stock availability 24 hours a day, 7 days a week. www.boundtree.com 2) Email: Orders may be emailed to customer service at customerservice@boundtree.com. 3) Phone: Our dedicated team of customer service representatives can answer questions or take your orders from 7:30 AM to 8:00 pm EST. 4) Fax: Our nationwide toll-free fax line is available 24 hours a day at 800-257-5713. 5) Mail: Orders may be mailed to our corporate office. An order form is included in the back of our catalog for convenience. The Customer Service Department is comprised of 27 staff members. Customer Service Representatives respond to inbound calls and make outbound calls to customers to provide information regarding product availability, shipment and delivery schedule changes. These same representatives are available to answer questions about shipments or process returns when necessary. If an item goes onto a long term backorder, Bound Tree will work to find equivalent substitute items for the backorder. If it is the customer preference to approve all substituted items, Bound Tree Customer Service will seek approval prior to shipping sub items. Bound Tree Medical is proud to offer our customers access to an Emergency Disaster Support line at 800-863-0953, which operates 24 hours a day, 7 days per week. It is staffed by on-call managers, who are accessible through routing of calls to cell phones. After leaving a message, a return call is originated within 20 minutes. Bound Tree Medical allows customers to purchase on open account. The proper account application must be completed and submitted. Bound Tree Medical will assign an account number to each application. Each account has one billing/payables address but may have several shipping/receiving addresses. In addition, the Federal Drug Administration (FDA) requires Bound Tree Medical to retain a Medical Director (physician) signature, contact information and license photocopy when purchasing legend items and/or pharmaceuticals. Customers may purchase by Master Card, VISA, Discover or American Express. Prepaid orders are also accepted Return Policy Prior to returning a product, please contact Bound Tree’s Customer Service Department at 800.533.0523 within 7 days of receiving the product to obtain a return merchandise authorization (“RMA”) number. This will help us expedite your return and allow us to give you the proper credit. Once you have received your RMA number please follow the return policy guidelines below. Subject to the guidelines below, Bound Tree will accept returns and rectify the error at no cost to you if: (i) you received expired product; or (ii) Bound Tree makes an error in fulfilling or shipping your order. In such case, you must notify us within 15 days of receiving the product. Please follow the return policy guidelines below: Non-returnable Items Include: 1. A product that is "buy to order." 2. A product that is "non-stock." 3. Items listed as "non-returnable." 4. Items that have been marked or engraved. 5. Items returned with broken packaging or not in original packaging. 6. Any sterile product that has been opened or items determined by Bound Tree not to be in resalable condition. 7. Product that is more than 60 days older than the shipment date. 8. Recertified equipment. 9. Pharmaceutical products. Return Policy Guidelines: 1. Items returned within 45 days of the shipment date will not be subject to a restocking fee. 2. Items returned 46-60 days from the shipment date may be subject to a restocking fee. 3. Items older than 60 days from the shipment date will not be accepted in our warehouse and will be returned to the customer at customer's expense. 4. Please write the RMA number clearly on the package label. 5. Send the package freight prepaid. Please reference the RMA to locate the return address. 6. Returns must be received by Bound Tree within 15 days of issuance of RMA number. 7. Items received without an RMA number will not be eligible for credit. RETURN FOR REPAIRS Items returned for repair must be prepared according to the most recent OSHA requirements. Items must be properly cleaned and verified with a statement on the outside of the package. Proof of purchase must also be included with all manufacturer warranty repairs. Please contact our Customer Service Department for additional information. CLAIMS All claims for damage occurring in transit must be made upon receipt of goods by customer directly to the carrier and documented with photos. Please save all boxes and packing material. All shipment errors must be reported immediately upon receipt to Bound Tree Customer Service. Online Ordering Capabilities a. Bound Tree Medical provides a user-friendly online ordering system with advanced features that restrict user access to predefined products that can be approved for purchase using a predefined purchasing path with maximum or minimum users as defined by the contracted customer. b. The advanced user platform of BoundTree.com allows customers to self-administer (add/delete) their specific product offering based on the entire Bound Tree Medical online catalog. c. Users on BoundTree.com can gather information and prepare self-administered reports based on up to two years of historical data.  Trends can be tracked by running reports that can include all shipping locations, or that can be tailored to a specific shipping address.  A purchase summary report can be self-generated to view total products purchased over a selected period of time.  The purchase summary report can be sorted in ascending order by total sales per item.  Purchase summary reports and items per month reports can be self-exported in spreadsheet format for additional evaluation.  The purchase summary report provides item usage totals based on monthly, quarterly and yearly expenditures.  Reports can be self-exported in spreadsheet format. d. Product name, short description and detailed descriptions are maintained for items on BoundTree.com. Product photography is uploaded to the website based on manufacturer availability. Custom photography is also available to supplement manufacturer-supplied items. e. A “sold by” column is available on product detail pages to clearly describe available units of measure. f. Purchase requisition and order processing paths are predefined and self-administered by an online administrator. User roles include “order submitters" and “order approvers". Multiple-levels of approvers can be established with the option to auto-forward orders awaiting approval with no activity. g. Unit and total price for each order are displayed in the shopping cart checkout process. h. A web administrator can setup and self-administer user IDs which trigger an' e-mail to the user for password setup. Self-administered password reset tools are available to users. i. The system does permit an administrator to specify maximum quantities that can be ordered for a given item on a single order. Quotas provide a way for an administrator to self -administer total purchases. To maintain maximum item thresholds, order approvers can monitor and adjust each item on purchase requests throughout the approving and purchasing process. j. The purchase requisition process provides date and time stamps for all purchase requisition activities. k. Invoice history is posted on BoundTree.com for user access. Holder Identifier : 7777777707070700077763616065553330763735776037544707762035770436110073660775146301120736041311043211207142277530276710073400557126743100716207577227655007766617714074750077727252025773110777777707000707007 6666666606060600062606466204446200622200604204002006022226040060222060220262620402000602222624024022006220004240260200062200040600620200620002406220240006020044222660062066646062240664440666666606000606006Certificate No :570096605134CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/29/2022 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PRODUCER Aon Risk Services Northeast, Inc. Columbus OH Office 445 Hutchinson Avenue Suite 900 Columbus OH 43235 USA PHONE (A/C. No. Ext): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # (866) 283-7122 INSURED 17400ProAssurance Specialty Insurance CompanyINSURER A: 20281Federal Insurance CompanyINSURER B: INSURER C: INSURER D: INSURER E: INSURER F: FAX (A/C. No.):(800) 363-0105 CONTACT NAME: Sarnova, Inc. Emergency Medical Products, Inc. 5000 Tuttle Crossing Blvd. Dublin, OH 43016 USA COVERAGES CERTIFICATE NUMBER:570096605134 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.Limits shown are as requested POLICY EXP (MM/DD/YYYY) POLICY EFF (MM/DD/YYYY) SUBR WVD INSR LTR ADDL INSD POLICY NUMBER TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR POLICY LOC EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG X X X GEN'L AGGREGATE LIMIT APPLIES PER: $1,000,000 $1,000,000 $10,000 $1,000,000 $2,000,000 Excluded B 12/01/2022 12/01/202336073395 PRO- JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON-OWNED AUTOS ONLY BODILY INJURY ( Per person) PROPERTY DAMAGE (Per accident) X BODILY INJURY (Per accident) $1,000,000B12/01/2022 12/01/2023 COMBINED SINGLE LIMIT (Ea accident) 7363-09-65 EXCESS LIAB X OCCUR CLAIMS-MADE AGGREGATE EACH OCCURRENCE X DED $10,000,000 $10,000,000 $10,000 12/01/2022UMBRELLA LIABB 12/01/202378197881 RETENTION X E.L. DISEASE-EA EMPLOYEE E.L. DISEASE-POLICY LIMIT E.L. EACH ACCIDENT OTH- ER PER STATUTE Y / N (Mandatory in NH) ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED?N / A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY If yes, describe under DESCRIPTION OF OPERATIONS below Aggregate LimitN22OH38002112/01/2022 12/01/2023 Claims Made $150,000Agg Deductible Per Occ Limit $10,000,000 Products LiabA $10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Coverage All Bound Tree Medical warehouse locations are covered. CANCELLATIONCERTIFICATE HOLDER AUTHORIZED REPRESENTATIVESarnova, Inc. Bound Tree Medical 5000 Tuttle Crossing Blvd. Dublin OH 43016 USA ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AGENCY CUSTOMER ID: ADDITIONAL REMARKS SCHEDULE LOC #: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:ACORD 25 FORM TITLE:Certificate of Liability Insurance EFFECTIVE DATE: CARRIER NAIC CODE POLICY NUMBER NAMED INSUREDAGENCY See Certificate Number: See Certificate Number: 570096605134 570096605134 Aon Risk Services Northeast, Inc. 570000037575 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSURER INSURER INSURER INSURER INSURER(S) AFFORDING COVERAGE Page _ of _ NAIC # Sarnova, Inc. TYPE OF INSURANCE POLICY NUMBER LIMITS OTHER A Products Liab N22OH380021 12/01/2022 12/01/2023 Per Occ Deductible $50,000 Claims Made ADDL INSD INSR LTR SUBR WVD POLICY EFFECTIVE DATE (MM/DD/YYYY) POLICY EXPIRATION DATE (MM/DD/YYYY) ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 11/16/2022 (312) 239-2890 (312) 263-1551 25674 Sarnova, Inc. Bound Tree Medical, LLC 5000 Tuttle Crossing Blvd. P.O. Box 8023 Dublin, OH 43016 A UB 3P279151 12/1/2022 12/1/2023 1,000,000 1,000,000 1,000,000 Sample Certificate. Sample Certificate SARNINC-01 JGOLDBERG Thompson Flanagan Executive Liability Group 626 W. Jackson Blvd. 5th Floor Chicago, IL 60661 Daniel R. Gunter dgunter@thompsonflanagan.com Travelers Property Casualty Co. of America X