Fillable WHITE COUNTY, TENNESSEE RFP Package for RFP Number: (White County Tennessee)

Fill Online, Printable, Fillable, Blank WHITE COUNTY, TENNESSEE RFP Package for RFP Number: (White County Tennessee) Form

Use Fill to complete blank online WHITE COUNTY TENNESSEE (TN) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

WHITE COUNTY, TENNESSEE RFP Package for RFP Number: (White County Tennessee)

On average this form takes 11 minutes to complete

The WHITE COUNTY, TENNESSEE RFP Package for RFP Number: (White County Tennessee) form is 23 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 44 other fields

Country of origin: US
File type: PDF

U.S.A. forms for White County Tennessee

BROWSE WHITE COUNTY TENNESSEE (TN) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
WHITE COUNTY, TENNESSEE
DEPARTMENT OF FINANCE
COURTHOUSE ROOM 204
1 EAST BOCKMAN WAY
SPARTA, TENNESSEE 38583
PHONE (931)-836-3216 FAX (931)-836-3343
finance@whitecountytn.gov
WHITE COUNTY, TENNESSEE
RFP Package
for
RFP Number: 2020-0710-02-008
Emergency Medical Service
Devices and Equipment
RFP Opening:
July 10, 2020
2:00pm Central Time
RFP Opening Location:
White County Department of Finance
1 East Bockman Way, Room 204
Sparta, Tennessee 38583
Posted for public inspection at
whitecountytn.gov/bids
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 2 of 17
Table of Contents
I. Purpose and Overview ............................................................................................................................ 3
A. Purpose ............................................................................................................................................... 3
B. Project Description ............................................................................................................................. 3
C. Contract Term .................................................................................................................................... 3
D. Pricing ................................................................................................................................................ 3
E. Delivery and Training ........................................................................................................................ 4
F. Service and Warranty ......................................................................................................................... 4
G. References .......................................................................................................................................... 4
II. Detailed Specifications ........................................................................................................................... 4
A. Monitor Defibrillator .......................................................................................................................... 4
B. Automated CPR System ..................................................................................................................... 7
C. Portable Ventilator ............................................................................................................................. 7
D. Automated External Defibrillator (AED) ........................................................................................... 8
III. Evaluation of Proposals .......................................................................................................................... 9
A. Method of Source Selection ............................................................................................................... 9
B. RFP Timetable .................................................................................................................................... 9
IV. Instructions for Request for Proposal Responses .................................................................................... 9
A. Compliance with RFP ........................................................................................................................ 9
B. Delivery of RFP Response ............................................................................................................... 10
V. General Terms and Conditions ............................................................................................................. 10
A. Electronic Transmissions ................................................................................................................. 10
B. Laws and Regulations ...................................................................................................................... 10
C. Sub-contracts .................................................................................................................................... 10
D. Award of Contract ............................................................................................................................ 10
E. Title VI of the Civil Rights Act of 1964 ........................................................................................... 11
F. Errors in Proposals ........................................................................................................................... 11
G. Taxes ................................................................................................................................................ 11
H. Tie Bids ............................................................................................................................................ 11
I. Specification Details......................................................................................................................... 11
VI. Advertisement for RFP ......................................................................................................................... 12
VII. RFP Response Form ............................................................................................................................. 13
VIII. Exception Form .................................................................................................................................... 14
IX. References Form ................................................................................................................................... 15
X. Certification of Bidder Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion ... 16
XI. Iran Divestment Act .............................................................................................................................. 17
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 3 of 17
I. Purpose and Overview
A. Purpose
The White County Department of Finance, on behalf of the White County Emergency
Medical Service (EMS), is soliciting proposals for the purchase of various medical devices
and equipment, designed specifically for use in the emergency medical service
environment.
B. Project Description
The objective of this request for proposals is to provide for a multi-year contract with a
supplier or manufacturer (hereinafter referred to as vendor) of medical devices and
equipment, specifically designed for use in the emergency medical service environment.
The selected vendor must have a proven track record of providing high quality, durable
medical devices and equipment with exceptional customer service. Any response to this
RFP should provide information on the vendor’s history, qualifications, and market share
as it relates to the Emergency Medical Service environment.
White County Emergency Medical Service makes an estimated 4,200 calls per year while
servicing an estimated population of 27,000. The service consists of twenty-two (22) full-
time employees and eight (8) ambulances.
C. Contract Term
The contract issued as a result of this RFP will be for a one (1) year term, beginning on
July 1, 2020 and ending on June 30, 2021. The contract may be extended, by mutual
consent of both parties, for an additional four (4), one (1) year periods. In no event shall
the resultant contract be for more than five (5) years.
The contract issued as a result of this RFP may be terminated by either party for
convenience, upon 30 (thirty) days written notice.
D. Pricing
1. Best Pricing
White County requests that potential vendors respond to this RFP with the best pricing
available, and at rates lower than those found in the general marketplace.
2. Line-item pricing
This RFP is requesting a “line-item” pricing format. Line item pricing is a pricing format
in which individual products or services are offered at specific contract prices. The
products or services are individually priced and described by characteristics such as
manufacture name, stock or part number, size, or functionality.
3. Product and Price Changes
The awarded vendor may request product or price changes, additions, or deletions at any
time throughout the contract term. All requests must be made in writing to White County
and be signed by an authorized vendor representative. All changes are subject to review
and approval by White County.
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 4 of 17
a) Additions: Any product or service addition to this contract must be related to
products or services procured within the original scope of this RFP. Any such
addition is at the sole discretion of White County.
b) Deletions: Any product or service may be deleted from the contract when it is
no longer available from the awarded vendor.
c) Price Changes: The awarded vendor may request pricing changes by providing
reasonable justification for the change. White County is aware that changes in
pricing may be necessary form time to time due to raw material costs, etc.
However, vendors should make every reasonable effort to account for normal
costs changes by proposing pricing that can be effective throughout the
maximum duration of the contract. In no event shall price increase exceed the
industry standard. Additionally, price increase are limited to no more than one
(1) per year.
E. Delivery and Training
All prices quoted should include the cost of shipping to Sparta, Tennessee. In the event
training on the medical devices or equipment is required, separate pricing should be
quoted for this service.
Any response to this RFP should specify the average lead-time required for delivery of
any of the products proposed.
F. Service and Warranty
The response to this RFP should provide details on the standard warranty provided with
the products as well as any additionally warranty options. A minimum of a one (1) year
warranty is required on any product purchased through the contract as a result of this
RFP. Additional warranty requirements may be requested in the detailed specifications
of specific products. Where there is conflict, the greater warranty period will prevail.
Careful consideration should also be given to the process required for normal service of
devices and equipment, as well as warranty work. The response to this RFP should detail
how warranty items will be handled as well as the vendor’s ability to offer normal service
and maintenance to devices and equipment.
G. References
A minimum of three (3) EMS industry references should be provided in any response to
this RFP. For ease of response to this request, a reference sheet has been provided as part
of this RFP document. Additional references are welcome, but are not required.
II. Detailed Specifications
White County is requesting any proposing vendor be capable of providing the following
medical devices or equipment. The vendor may propose additional products not specifically
detailed in this section.
A. Monitor Defibrillator
1. General Requirements
a) For use on adult, pediatric, or neonatal patients
b) Capable of operating in temperatures between 32ºF and 122ºF
c) Vibration tested to meet EN1789 for ambulance operation
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 5 of 17
d) Built-in AC or DC power
e) Minimum six (6) hours of continuous ECG monitoring with lithium battery
f) GPC – clock sync feature
g) Tri-mode display type: color, black on white, or white on black
h) Display dynamic 12-lead ECG on screen
i) Display static ECG analysis results and dynamic ECG on screen concurrently
j) Liquid Crystal Display (LCD)
2. CPR Assistance Requirements
a.) CPR help feature required
b.) Real-time audio and visual CPR rate, depth, and release feedback with a perfusion
performance index
c.) CPR artifact filtering to see underlying rhythms
d.) Current AHA guidelines compliant and upgradeable to updated AHA guidelines
e.) Ability to record CPR data to internal memory
f.) Filter that allows continuous chest compressions to be done for the full duration
of the users CPR protocol
g.) CPR option must be able to be used in a moving environment, such as an
ambulance
h.) CPR option should allow for anterior-posterior and anterior-anterior pad
placement
3. Monitoring Requirements
a.) Patient monitoring through 3-lead, 4-lead, 5-lead, and 12-lead ECG cables, with
multi-function electrodes and paddles
b.) Impedance pneumography for monitoring respiratory rate via ECG Leads I or II
c.) Measure respiratory rate via capnography or impedance pneumography
d.) Ability to easily change leads
e.) Display of lead selected at all times
f.) Leads must be fully defibrillator protected
g.) Ability to detect most implanted pacer spikes
h.) Display standard marker of pacer spike on ECG trace
i.) Must have the following bandwidths: 0.67-20 Hz Limited mode, 0.67-40 Hz
Monitor mode, 0.5-40 Hz Filtered Diagnostic mode, and 0.05-150 Hz Diagnostic
j.) Must have the following ECG sizes: 0.125, 0.25, 0.5, 1, 2, 4 cm/mV and auto-
ranging
k.) Must have heart rate on display and contain user selectable alarms
l.) In AED mode, the device must be able to use any of the following monitoring
parameters: EtCO2, SpO2, SpMet, 12-lead ECG, or NIBP
4. Electrode Requirements
a.) Multifunction electrodes that allow pacing, defibrillation, cardioversion, and ECG
monitoring via one set of disposable pads
b.) Electrodes must include an accelerometer to enable CPR feedback and artifact
filtering functionality
c.) Adult paddles must incorporate pediatric paddles
5. Defibrillator Requirements
a.) Must utilize a high current, low energy rectilinear, constant current biphasic
waveform
b.) Unit should have energy selections available to provider in manual mode
operation of: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 30, 50, 70, 85, 100, 120, 150, and
200 joules
c.) Must meet current AHA specifications for biphasic defibrillation
d.) Display energy selected and delivered on monitor display, strip chart recorder,
and code summary
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 6 of 17
e.) Must contain a built-in defibrillator tester that tests energy output and continuity
of the multi-function cable and paddles documented on strip chart recorder and
internal memory
f.) Single “multi-function cable” that operates both multi-function electrodes and
external paddles
6. Recorder Requirements
a.) Thermal strip chart recorder
b.) Configurable print out modes offering manual or automatic recording options
initiated by alarm activation or defibrillator discharge
7. Pacemaker Requirements
a.) Utilize a constant current 40 ms pace pulse width duration waveform
b.) Continuously variable current level
c.) Continuously variable pacing rate form 30 – 180 ppm
d.) Pacer parameters must be maintained when switching back to defibrillation or
monitor mode
e.) Pacer must continue to deliver life-saving therapy in the event an ECG lead falls
off
8. 12-Lead ECG Requirements
a.) The 12-lead ECG must not require any special hardware or proprietary software
to view
b.) 12-lead ECG should allow user to easily insert patient name, age, and gender into
the device
c.) 12-lead patient cable must consist of 4 limb leads and a separate V-lead cable
9. Pulse Oximetry Requirements
a.) Integrated oxygen saturation (SpO2), carboxyhemoglobin saturation (SpCO), and
hear rate measurement.
b.) Ability to display HR, SpO, and SpCO values on the device screen without user
intervention
c.) Utilize pulse oximetry technology that has FDA 510(k) clearance for use during
patient motion and low profusion
10. Temperature Requirements
a.) Must have two (2) temperature channels and be able to monitor temperature
changes while monitoring invasive pressure channels
b.) Rectal, esophageal, skin, and ambient air temperature reading capability
c.) Must display T1, T2, and ΔT
11. Capnography Requirements
a.) Defibrillator must be capable of providing continuous EtCO2 and respiratory rate
readings as well as capnogram for on-screen display or print-out
b.) Capnography device must be fully operational within 20 seconds or less from
start-up
12. Non-Invasive BP Requirements
a.) Capable of acquiring blood pressure measurement on inflation with 30-seconds
b.) Capable of synchronizing the oscillation to the R-wave of the ECG
c.) Incorporate non-invasive oscillometric technology
d.) Display systolic, diastolic, and mean atrial (MAP) pressures
e.) Capable of taking automatic, stat, or manual measurements
f.) Automatic intervals should be adjustable
g.) Include an artifact indicator which is displayed when excessive artifact is detected
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 7 of 17
13. Battery/Charging Requirements
a.) Capable of using rechargeable lithium-ion batteries
b.) Recharge time of four (4) hours or less with integral charger
c.) Low battery indicator
d.) Battery management charger system capable of charging both sealed lead acid
and lithium ion batteries
e.) Battery management software program for maintenance and conditioning of the
batteries
f.) When plugged in, the AC charger must be able to recharge a depleted lithium ion
battery, operate the device without a battery or batteries in device, and
simultaneously recharge battery and operate device
B. Automated CPR System
1. General Requirements
a.) Must meet 2015 AHA guidelines
b.) Automatic sizing fitment to patient to prevent under compression
c.) Automatic adjustment to account for patient chest stiffness
d.) Ability to fit up to at least a 50 inch chest circumference
e.) Proven ability to accurately and appropriately perform compressions to enhance
the likelihood of survival. Clinically document, peer reviewed studies are
preferred.
f.) A carrying case should be provided, which is rugged in nature and is capable of
being easily sanitized.
g.) Ability to record and download event records from device
2. Chest Compression Parameter Requirements
a.) Provide circumferential chest compression around patient’s thoracic cavity of the
chest in accordance with AHA guidelines
b.) Circumferential compression at a rate of 80 compressions per minute, with a +/-5
compression tolerance
c.) Ability to choose patient-customized compressions
3. Device Operability Requirements
a.) Ability to lift and maneuver patient without being required to stop device from
providing compressions
b.) Ability to deliver compressions at an angle
c.) Ability to move patient with device on with as soft stretcher, carry sheet, or
backboard
d.) Automatically stop compressions if patient becomes misaligned in device or is in
an unsafe position
e.) The device should perform full circumferential compressions that create chest
displacement of the patient’s chest by 20% Anterior to Posterior compression
f.) Provides a maximum of 6lbs per square inch of pressure to avoid patient injury
4. Battery Requirements
a.) Rechargeable lithium-ion batteries are required
b.) Low battery indicator
c.) Battery charging system which can test battery output during each charge cycle
C. Portable Ventilator
1. General Requirements
a.) Must be capable of being utilized on infants to adults, with a minimum patient
size of at least eleven (11) pounds
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 8 of 17
b.) Capable of operating in temperatures between 32ºF and 122ºF
c.) Must be vibration, shock, and drop tested to meet MIL-STD 810F for use in an
EMS environment
d.) Compressor driven
e.) Unit must be able to operate with compressor alone, with high-pressure oxygen,
or with low-flow oxygen
f.) Unit must be easily calibrated and repaired in the field (under most circumstances)
g.) Operator should be able to operate unit without visible light or in low-light
conditions
h.) Liquid Crystal Display (LCD)
2. Clinical Requirements
a.) Unit should provide both volume and pressure targeted breaths
b.) Unit should have the following modes: Assist Control, Synchronized Intermittent
Mechanical Ventilation, Continuous Positive Airway Pressure, Noninvasive BL
Ventilation with IPAP and EPAP as primary setting
c.) Should measure plateau pressure
d.) Pulse oximeter
e.) FiO2 should be adjustable in 1% increments
f.) Unit should have both audible and visible alarm systems
3. Battery Requirements
a.) Rechargeable lithium-ion batteries are required
b.) Low battery indicator
c.) When plugged in, unit should be able to recharge while also operating at full
capacity
D. Automated External Defibrillator (AED)
1. General Requirements
a.) Must be for adult or pediatric use
b.) Should have a built in self-test mechanism
c.) Provide CPR monitoring capabilities
d.) Provide ECG monitoring capabilities
e.) Liquid Crystal Display (LCD)
f.) 20 second maximum delay from switch on to readiness
2. Clinical Requirements
a.) Adult automatic energy sequence: 120J, 150J, 200J
b.) Pediatric automatic energy sequence: 50J, 70J, 85J
c.) Single use electrode pads
3. Battery Requirements
a.) Rechargeable lithium-ion batteries
b.) Low battery indicator
c.) Battery charging system which can test battery output
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 9 of 17
III. Evaluation of Proposals
A. Method of Source Selection
White County will score all properly submitted proposals to this RFP based on the below
matrix. All proposals will be scored by at least two (2) scorers independently of each
other.
Criteria Possible Points
Price of equipment, services, and fees 25
Compliance with RFP requirements 20
Vendor qualifications and references 15
Functionality with existing equipment 10
Service, maintenance, and warranty 10
Prior experience with vendor 10
Delivery lead-time 10
The responder with the highest points after applying this matrix will be awarded the
resultant contact form this RFP.
B. RFP Timetable
Issue Request for Proposals June 25, 2020
Deadline for Written Questions July 2, 2020 @ 2PM
Amendment(s) Issued July 6, 2020
Proposals Due July 10, 2020 @ 2PM
Notification of Selected Proposer July 24, 2020
All times listed are Central Time.
IV. Instructions for Request for Proposal Responses
A. Compliance with RFP
Submissions must be in strict compliance with this Request for Proposals. Failure to
comply with all provisions of the RFP may result in disqualification.
Requests for additional information or clarifications by potential Proposers must be made
in writing. Proposers may email requests for additional information or clarifications.
Requests for additional information or clarifications shall be sent to:
Mike Kerr
Director of EMS
White County, Tennessee
mike.kerr@whitecountytn.gov
Prior to the due date, responses to inquiries and all RFP amendments White County deemed
necessary will be issued and published on the solicitation web page. Bidders should not
rely on any representations, statements, or explanations other than those made in any
written addendum to this RFP. Where there appears to be a conflict between the RFP and
any addenda issued, the last addendum issued shall prevail.
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 10 of 17
Addenda will be made available on the solicitation web page and it is solely the Proposer’s
responsibility to assure receipt of all addenda.
Solicitation Web Page is: www.whitecountytn.gov/bids
B. Delivery of RFP Response
Submissions will be accepted by the White County Department of Finance no later than
2:00 p.m. July 10, 2020 (local time).
All documents shall be submitted to the following:
Chad S. Marcum
Director of Finance
White County Department of Finance
1 East Bockman Way, Room 204
Sparta, Tennessee 38583
All submissions must be written, sealed, and labeled as a response to this RFP. Submission by
electronic means will not be accepted.
V. General Terms and Conditions
A. Electronic Transmissions
Electronic transmissions will not be accepted, except when in the course of the proposal
process addendums or other notifications of errors on behalf of the owner places an undue
hardship upon prospective proposer. Written notification by the owner must precede the
acceptance of facsimile or email transmissions.
B. Laws and Regulations
The proposer’s attention is directed to the fact that all applicable state laws, municipal
ordinances, and the rules and regulations of all authorities having jurisdiction over the
project shall apply to the contract throughout, and they will be deemed to be included in
the contract the same as though herein written out in full. Proposers may be required to
provide proof of valid business license and Workers Compensation Insurance if required
by law.
C. Sub-contracts
The Proposer is specifically advised that any person, firm, or other party to whom it is
proposed to award a sub-contract under this contract must be acceptable to White County.
D. Award of Contract
White County further reserves the right to reject any and all proposals, to waive any and
all informalities and to negotiate contract terms with the successful proposer, and the right
to disregard all non-conforming, non-responsive or conditional proposals. White County
may conduct such investigations as it deems necessary to assist in the evaluation of any
proposal to establish the responsibility, qualifications, and financial ability of the proposer,
proposed sub-contractors and other persons and organizations to perform the work in
accordance with the contract documents to the proposer who does not pass any such
evaluation to the owner’s satisfaction. The contract shall be awarded to the lowest, best
and most responsible bidder, whose evaluation by the owner indicates to the owner that the
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 11 of 17
award will be in the best interest of White County. It is also understood that the “apparent
low bidder” will be announced at the bid opening; however the “successful bidder”, who
may or may not be the lowest bidder, will not be announced until all issues, which include,
but are not limited to quality, service, conformity to specifications, etc. have been resolved
and until a period of review has been completed by the County. White County does not
enter into contracts which provide for mediation or arbitration.
E. Title VI of the Civil Rights Act of 1964
All interested parties, without regard of race, color or national origin, shall be afforded the
opportunity to bid and shall receive equal consideration. Title VI states “No person in the
United States shall, on the ground of race, color or national origin, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any
program activity receiving Federal financial assistance.” White County strives to protect
individuals’ civil rights through active compliance with the requirements of Title VI.
F. Errors in Proposals
When an error is made in extending total prices, the unit bid price will govern. Carelessness
in quoting prices or in preparation of proposal otherwise, will not relieve the bidder.
Erasures or changes to proposals must be initialed. Any alteration, erasure, addition to or
omission of required information, change of the specifications or bidding schedule, is made
at the risk of the proposer.
G. Taxes
White County is tax exempt except where T.C.A. §67-6-209 shall be applicable.
H. Tie Bids
If two or more proposers submit identical bids and are equally qualified; selection shall be
made at the discretion of the county based upon performance.
I. Specification Details
These specifications have been designed to meet a certain level of quality as well as to
standardize certain components. In numerous places reference to specific brands of
components may have been made. This has been done to establish a certain level of quality
and in no way is an attempt to write out venders of similar or equal equipment components.
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 12 of 17
VI. Advertisement for RFP
White County, Tennessee
Request for Proposals
RFP No. 2020-0710-02-008
Take notice that the Director of Finance for White County shall accept sealed written proposals for
emergency medical service devices and equipment.
Proposals, bids, or responses must be submitted to the office of the Director of Finance, Room 204,
White County Courthouse, Sparta, Tennessee, 38583, no later than 2:00 P.M. central time, July 10,
2020 at which time the proposals will be opened and considered.
Copies of RFP documents may be obtained at whitecountytn.gov/bids
The owner (White County) further reserves the right to reject any and all proposals, to waive any and
all informalities and to negotiate contract terms with the successful proposer, and the right to disregard
all non-conforming, non-responsive, or conditional proposals.
Chad S. Marcum
Director of Finance
Publication Date: 06/25/2020
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 13 of 17
VII. RFP Response Form
Project: Emergency Medical Service Devices and Equipment
Bid Date: July 10, 2020; 2:00p.m. Central Time
Company Name: _____________________________________________
Address: _____________________________________________
_____________________________________________
Phone Number: _____________________________________________
Contact: _____________________________________________
Email Address: _____________________________________________
Please include this page with the following items in your response:
1) Proposed solution for the project, in a format of your choosing, that
corresponds with the requirements as outlined in this RFP.
2) List of at least three (3) EMS industry references.
3) Line-item pricing for the required devices and equipment, as well as any
other devices or equipment your firm offers which corresponds with the
purpose of this RFP.
4) Exception form (if necessary)
5) Debarment certification form
6) Lobbying certification form
7) Non-Collusion certification from
8) Iran Divestment Act certification form
By signing below, I affirm that I am a duly appointed and authorized representative of the
company named herein. Furthermore, acting on behalf the named company I acknowledge
that I have read, understand, and agree to abide by all terms and conditions as outlined in this
request for proposal unless otherwise properly and specifically noted.
Signature: ___________________________________
Title: ___________________________________
Date: ___________________________________
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 14 of 17
VIII. Exception Form
Proposer has agreed to abide by all terms and conditions of this RFP, except for specific
exceptions as noted below. If taking exception, please note the page and section number
where exception is taken.
Use Additional Pages as Needed
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 15 of 17
IX. References Form
Use this form to provide details of at least three (3) references with firsthand knowledge of
the products your firm offers.
Reference #1:
Name of Client: _________________________________________________________________________
Procuring Entity (Federal Agency, State Agency, Local Government, Other)
Location (City, State): ___________________________________________________________________
Client Representative knowledgeable about the project work:
Name: _________________________________________ Title: ________________________________
Phone: _______________ Fax: ______________ Email: _____________________________________
Reference #2:
Name of Client: _________________________________________________________________________
Procuring Entity (Federal Agency, State Agency, Local Government, Other)
Location (City, State): ___________________________________________________________________
Client Representative knowledgeable about the project work:
Name: _________________________________________ Title: ________________________________
Phone: _______________ Fax: ______________ Email: _____________________________________
Reference #3:
Name of Client: _________________________________________________________________________
Procuring Entity (Federal Agency, State Agency, Local Government, Other)
Location (City, State): ___________________________________________________________________
Client Representative knowledgeable about the project work:
Name: _________________________________________ Title: ________________________________
Phone: _______________ Fax: ______________ Email: _____________________________________
Attach additional pages as necessary.
White County reserves the right to contact the client representative for this project.
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 16 of 17
X. Certification of Bidder Regarding Debarment, Suspension,
Ineligibility, and Voluntary Exclusion
Request for Proposals
RFP Number: 2020-0710-02-008
Emergency Medical Service Devices and Equipment
1
White County, Tennessee Page 17 of 17
XI. Iran Divestment Act
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

WHITE COUNTY, TENNESSEE RFP Package for RFP Number: (White County Tennessee)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document