Date:



Subject: CSP14-10738

Date: September 10, 2014

Dear Potential Partner:

Based in Cleveland, Ohio and with roots dating back to 1837, The MetroHealth System (“MHS”) is one of the largest and most comprehensive public health systems in the country. MHS includes the 700-bed MetroHealth Medical Center which features Cleveland’s only Level I trauma center and the largest hospital-based rehabilitation facility in Ohio. For more information on our hospital, please visit .

MHS is a contracting authority within the meaning of Sections 307.86–92 of the Ohio Revised Code. For the products and services described in this document, MHS is seeking Offers in the form of Competitive Sealed Proposals (“CSP”) under section 307.862 of the Ohio Revised Code and would like to encourage your organization to participate in this process. You will find the CSP requirements and full instructions for submitting your Offer in this document.

To support this process, we have engaged the Advisory Board Company and will be leveraging their process and expertise to enable a transparent and collaborative bidding process designed to enable win-win award scenarios. This process will provide ample opportunities for suppliers to articulate a clear business case.

MHS will evaluate offers, conduct negotiations, and, where appropriate at its sole discretion, award contracts, all in the manner required by law and consistent with MHS policies and procedures.

Should you choose to participate, it is required that you send a “Notice of Intent to Submit an Offer” by Monday, September 15th, 2014 to:

Email: MHS-MedEquip@

In addition to an electronic submission via the e-mail address above, a complete hard copy of your CSP response must be returned to the address below by 1:00PM EST on Friday, October 3rd. Offers submitted after this time will be rejected.

ATTN: Purchasing Department, Patrick Vanderbilt, The MetroHealth System, MHS Bid Event #14-10738

4229 Pearl Road, SM2-50

Cleveland, OH 44109

We look forward to your response and thank you for your time and consideration.

Sincerely

Adrian Krisak

Director of Purchasing

Supply Chain Management Department

MetroHealth System

Competitive Sealed Proposal

CSP14-10738

For: Medical Equipment Support Services

CSP Issue Date: 9/10/2014

Intent to Bid Due: 9/15/2014

Inquiry Period Begins: 9/15/2014

Inquiry Period Ends: 9/19/2014

CSP Due Date: 10/3/2014

TABLE OF CONTENTS

EXECUTIVE SUMMARY 4

CSP PROCESS 4

INTENT TO SUBMIT AN OFFER 4

OFFER INSTRUCTIONS 5

OFFER REQUIREMENTS 5

CONFIDENTIAL INFORMATION 6

ADDENDA TO THE CSP 6

ADDENDA TO OFFERS 7

OFFER STRUCTURE 7

DOCUMENTATION 7

BIDDING 7

COMMUNICATIONS & INQUIRIES 8

ASSUMPTIONS / AVERSIONS 8

OFFER EVALUATION CRITERIA 8

EVALUATION PROCESS 8

SUPPLIER DIVERSITY 9

INTERVIEWS, DEMONSTRATIONS & PRESENTATIONS 9

CONTRACT AWARD 9

GENERAL REQUIREMENTS 10

IMPLEMENTATION & TRANSITION 10

SECURITY ACCESS 10

NEGOTIATIONS OF OFFERS 10

NEW TECHNOLOGY 10

TERMINATION OF CONTRACT 10

SURETY REQUIREMENT 11

FINANCING 11

COST CONTROL, PAYMENT & RECORD KEEPING 11

ACCESS TO BOOKS AND RECORDS 12

JCAHO REQUIREMENTS & STANDARDS 12

APPENDIX A: MHS SHIP-TO LOCATIONS 13

APPENDIX B: INTENT TO BID FORM 14

APPENDIX C: INQUIRY SUBMISSION FORM 15

APPENDIX D: SUPPLIER REFERENCE FORM 16

APPENDIX E: CONFLICT OF INTEREST FORM 17

APPENDIX F: SUPPLIER PERFORMANCE FORM 18

APPENDIX G: CERTIFICATION REGARDING DEBARMENT 19

APPENDIX H: NEW, REPLACEMENT AND UPGRADE TECHNOLOGY AMENDMENT 21

APPENDIX I: ASSUMPTIONS/AVERSIONS TO SPECIFICATIONS/REQUIREMENTS 22

APPENDIX J: SUPPLIER DIVERSITY PROGRAM 23

APPENDIX K: METROHEALTH PROCUREMENT PAYMENT CARD PROGRAM 25

EXECUTIVE SUMMARY

MHS is a contracting authority within the meaning of Sections 307.86–92 of the Ohio Revised Code. For the products and services described in this document, MHS is seeking Offers in the form of a CSP under section 307.862 of the Ohio Revised Code.

The purpose of this Competitive Sealed Proposal (CSP) is to solicit Offer proposals (each an “Offer”) that fulfill the product and/or service requirements and performance expectations outlined in this document and appending / attached schedules and specifications documents.

All submitted Offers will be received and kept sealed until the submission deadline has passed. The Offers will then be opened and analyzed for completeness. Upon analysis and review, MHS may enter into an agreement with one or more Supplier(s) to provide all or part of the requested Products or Services.

Except to the extent permitted by this CSP, Suppliers may not attach any other conditions or provisions to the Offers. Failure to comply with these requirements may be cause for rejection of the Offer.

This CSP is not intended, nor shall it be construed, to disregard any of MHS’s current contractual obligations to any Supplier.

ADVISORY BOARD’S ROLE

The Advisory Board Company is a leading provider of strategic sourcing services in the health care space. Our team has engaged with the Advisory Board Company to facilitate the bid process, provide visibility into market and product-level opportunities, and analyze proposals to uncover savings opportunities.

CSP PROCESS

INTENT TO SUBMIT AN OFFER

The Intent to Submit an Offer form (Appendix B) is required, and must be submitted for an Offer to be accepted.

Inquiry Period

Questions regarding the opportunity should be sent via e-mail to MHS-MedEquip@. Answers to questions will be provided to all vendors who submit an Intent to Submit an Offer form. The inquiry period begins on September 15th and concludes on September 19th.

OFFER INSTRUCTIONS

All Offers must be submitted in the format prescribed in this CSP. MHS evaluation of submitted Offers is based solely on the content of the Offer. MHS will not be liable for any costs incurred by a Supplier in response to this CSP, regardless of the outcome of the CSP evaluation process.

OFFER REQUIREMENTS

Supplier must submit an Offer that includes all of the following documents in order:

▪ Cover Letter

▪ CSP Instructions (Document A1)

▪ LOA (Document A2)

▪ Standard Contract Addendum (Document A3)

▪ BAA (Document A4)

▪ CSP Specifications (Document C1)

▪ Technical Offer (Workbook T1)

▪ Supplier Reference Form (Appendix D)

▪ Conflict of Interest Form (Appendix E)

▪ Supplier Performance Form (Appendix F)

▪ Certification Regarding Debarment (Appendix G)

▪ W9 Form (W1) and Instructions (W2)

▪ Product/Service brochures/catalogs or other supplemental product information

Additional Forms include (if applicable):

▪ Facility Services Insurance Requirements (F1)

▪ Security Specifications (S1)

▪ Assumptions/Aversions to CSP Specifications/Requirements (Appendix I)

Each Supplier’s response must include:

▪ Three (3) hard copies with original signatures (no copies).

▪ One (1) complete electronic copy sent to MHS-MedEquip@

By submitting an Offer, the Supplier acknowledges that Supplier has read, understands and agrees to be bound the requirements of this CSP terms and conditions. MHS reserves the right to disqualify a supplier’s Offer if:

▪ The Supplier takes exception to the terms and conditions herein,

▪ Fails to comply with response submission procedures, or

▪ If the Offer fails to meet any requirement of this CSP

CONTRACTING DOCUMENTS

▪ Our standard award Letter of Agreement (“LOA”) for the winning proposal is shown in Document A2. You may mark up this document, or propose an alternate contract document containing similar terms on your own forms, but you should be prepared to make your document available to us in an editable electronic format.

▪ Standard Contract Addendum shown in Document A3 and our Business Associate Agreement shown in Document A4 (BAA is needed only if your services will require you to receive or gain access to our protected health information). Should you choose to mark-up attachments B & C, please note that we reserve the right to preferentially evaluate submissions that accept these documents without changes.

▪ All mark-ups MUST be submitted in editable, redlined electronic format

CONFIDENTIAL INFORMATION

Suppliers must clearly identify any information that is considered confidential to the Supplier, e.g. trade secrets, or otherwise exempt from disclosure under Ohio’s Public Records Law[1]. For the hard copy Offer, Suppliers should place the identified documents in a "Confidential Exhibits" section of the indexed binder of the Offer.

For the purposes of this CSP, The Advisory Board is bound by terms of confidentiality to MetroHealth will treat the documents the same way MetroHealth would.

ADDENDA TO THE CSP

Addenda announcements may take place any time before 5:00 PM EST on the business day prior to the Offer due date. Suppliers may view addenda on the website listed the front page of this CSP. It is the responsibility of the Supplier to monitor the site or the Supplier’s designated email address for Addenda to the CSP.

ADDENDA TO OFFERS

Addenda to or withdrawals of Offers are allowed prior to the Offer due date only. Changes requested after the due date will be accepted at the discretion of MHS.

OFFER STRUCTURE

These instructions describe the required format for a responsive Offer. The Supplier may include any additional information it believes to be relevant. An identifiable tab sheet must precede each section of the Offer. All pages, except pre-printed technical inserts, must be labeled.

DOCUMENTATION

COVER LETTER

The cover letter must be in the form of a standard business letter and must be signed by an individual authorized to legally bind the Supplier. Suppliers should state its understanding and agreement with the Technical Requirements, as well as list its goals and objectives in response to the CSP. The letter must also have the following:

▪ The location(s) where all services will be performed.

▪ The location(s) where data applicable to the Contract will be maintained.

▪ The principal location of business for the Supplier(s).

Note: During the performance of this Contract, the Supplier must not change location(s) of the country where the services are performed or where data are maintained without written notification to MHS.

BIDDING

Please see CSP Specifications (Document C1) for detail regarding the required information and structure for bidding on Clinical Engineering Services and Externally Serviced Equipment Services.

Please note that while it is preferred by MHS to award to a single Supplier to support the medical equipment servicing requirements, suppliers should be prepared to provide bids that contemplate combined as well as split awards of the two scope areas outlined in the CSP Specifications (i.e., Clinical Engineering Services and Externally Serviced Equipment Services).

SUPPLIER REFERENCES

The Supplier is to provide three (3) client references, using the Supplier Reference Form (Appendix D), for which the Supplier has successfully provided services similar in nature, size, and scope of services required in this CSP within the last five (5) years.

CONFLICT OF INTEREST

Each Offer must include a Conflict of Interest statement (Appendix E) indicating whether the Supplier or any Subcontractor and their personnel have a real or perceived conflict of interest (e.g., employed by MHS) and, if so, the nature of that conflict. Prior to implementing any program or service for which Supplier(s) receives external funding, which may present a real or perceived conflict of interest, the Supplier(s) shall disclose the details of such program and such external funding to MHS.

SUPPLIER PERFORMANCE

The Supplier must complete the Supplier Performance Form (Appendix F).

CERTIFICATION REGARDING DEBARMENT

For Offer amounts in excess of $100,000, the Supplier must complete a Certification Regarding Debarment Form included in this Offer package. (Appendix G)

W-9 FORM

The Supplier must complete the W-9 Form (Document W1) in its entirety. One (1) original version of the W-9 attachment must be submitted. If a subsidiary company is involved, Suppliers must have an original W-9 for both the parent and subsidiary companies.

COMMUNICATIONS & INQUIRIES

Suppliers may submit inquiries via email, using the Inquiry Submission Form provided (Appendix C), and during the inquiry period only. Please address all inquiries to the contact listed at the beginning of this document. MHS will make every effort to respond to all inquiries within 48 hours of receipt.

If Supplier fails to comply with this section, MetroHealth may disqualify Supplier’s submission.

ASSUMPTIONS / AVERSIONS

The Supplier must submit all assumptions or specification aversions made in preparation of the Offer using Assumptions/Aversions to CSP Specifications / Requirements (Appendix I). No assumptions are implied at any time. MHS reserves the right to dismiss the Offer based upon Supplier aversions to CSP specifications.

OFFER EVALUATION CRITERIA

EVALUATION PROCESS

The evaluation process may consist of up to four phases: (1) Supply Chain evaluation, (2) Clinical or other MHS Staff evaluation, (3) Supplier presentations or additional information requests, and (4) Contract award.

SUPPLY CHAIN EVALUATION

A Supply Chain representative will review all Offers for proper format and completeness. Should any defects arise, the representative may, at his/her discretion, waive any defects, allow Suppliers to submit a correction, or reject the Offer.

Upon Supply Chain acceptance, and Cost Offer analysis completion, the Offer will move on to clinical evaluation.

TECHNICAL EVALUATION

MHS may create an evaluation committee consisting of clinical and/or other qualified staff members with expertise and knowledge pertinent to the proposed Service(s). The evaluation committee will evaluate each bid in accordance with the criteria contained in this CSP. Offers that meet the technical requirements will be deemed Qualified Offers. The most qualified Offer is the Offer that provides the best overall value to MHS in price, quality and patient safety.

SUPPLIER DIVERSITY

MetroHealth encourages participation of minority, women-owned, historically underutilized and other disadvantaged business enterprises, as well as local businesses and their employees. For more details on the program and how to qualify see Appendix J.

INTERVIEWS, DEMONSTRATIONS & PRESENTATIONS

MHS may request Suppliers to provide clarification or correction of information included in the Offer to ensure full understanding of, and responsiveness to, the requirements specified in the CSP. Presentations, demonstrations, and interviews will provide the Supplier with an opportunity to clarify its Offer and ensure a mutual understanding.

CONTRACT AWARD

MHS will, at its discretion, award a Contract to the Supplier whose Offer is deemed the most qualified. If more than one supplier is required to fulfill the CSP requirements, MHS may award multiple contracts.

In awarding the Contract(s), MHS will issue an Award Letter. A Contract is considered binding when:

▪ The Award Letter and all required CSP documents are fully executed and received by MHS,

▪ MHS issues a purchase order; and

▪ All other prerequisites identified in the Contract (if any) have been completed.

The Effective Date and term of the Contract will be identified in the Award Letter.

GENERAL REQUIREMENTS

IMPLEMENTATION & TRANSITION

In submitting an Offer, Supplier(s) indicates a commitment to assume responsibility to execute all CSP requirements. The Supplier(s) should describe its approach, methods, and specific steps required to pre-stage operations for implementation.

SECURITY ACCESS

MHS uses VendorMate ® as its vendor tracking software. Supplier must register with VendorMate ® annually, and maintain VendorMate ® compliance for their categories.

NEGOTIATIONS OF OFFERS

MHS may, at its discretion, conduct negotiations with one or more Suppliers, starting with the Supplier which submitted the most qualified Offer, as permitted by law and consistent with MHS procurement policies. Should negotiation results be less than acceptable to MHS, MHS may, at its discretion negotiate with one or more of the remaining Supplier(s) with qualified Offers until an acceptable Offer is reached.

NEW TECHNOLOGY

Supplier will permit MHS to supplement or add to the CSP product list, at its option, any (1) end-of-life replacements, (2) technology advancements, (3) life-cycle updates and (4) any products that represent functional upgrades to existing products in an effort to improve patient quality of care.  Making such changes require a written amendment to the CSP, which can be found in Appendix G of this document.

New technology product(s) are provided at the same price as the current, related product(s) through the term of the Contract. Products, replaced by the new technology, if still available for purchase, will be offered at an agreed upon reduced price.

TERMINATION OF CONTRACT

Any Contract that is awarded as a result of this CSP may be terminated at any time, by either party, with a 60-day written notice. Termination due to breach of agreement as specified in Section IV of document A2 – Standard Contract Addendum, may be immediate and without written notification.

SURETY REQUIREMENT

MHS, at its discretion, may require Supplier to submit any of the following sureties:

▪ An Offer Guarantee, in an amount equal to 10% of the aggregate cost of the Offer as originally proposed. A Supplier who withdraws or alters an Offer after the submission date may forfeit all or part of this surety based on MHS’s actual costs of having to consider another Offer.

▪ A Performance Guarantee, in an amount up to, but not exceeding the aggregate. A Supplier who is awarded a Contract, but fails to perform in substantial compliance with such contract within a reasonable time-frame as set by Contract, may forfeit all or part of this surety based on MHS’s actual costs of having to cover for Supplier’s non-performance.

FINANCING

Where this CSP contains products that represent capital goods, Supplier must be willing to extend the negotiated Offer to MHS’s then current Finance Lessor, who will act as the purchaser/lessor instead of MHS. MHS will notify Supplier regarding the Finance Lessor in writing. MHS, at its sole discretion, may reject the applicable portion of the Offer or the entire Offer where a Supplier refuses to agree to this requirement.

COST CONTROL, PAYMENT & RECORD KEEPING

Invoices must be submitted to the location in the purchase order designated as the "Bill to address". A payable invoice includes the following, at a minimum:

▪ Name and address of Supplier as designated in the CSP or Amendment

▪ Invoice remittance address as designated in the CSP

▪ MHS Supplier identification number

▪ CSP/Purchase Order number authorizing delivery of Products or Services

▪ Description of the actual Products or Services ordered

Billing is an all-inclusive monthly charge (summary billing) for MHS, regardless of the number of orders verified. MetroHealth offers the following payment methods and terms:

|Payment Method |Payment Term |

|Procurement Payment Card Program[2] |Net 60 |

|ACH Transfer |Net 60 |

|Check |Net 60 |

Payment terms shall start from the date of receipt of a payable from the Supplier and an approved delivery of all Products or Services in the Purchase Order have been received at the appropriate MHS System location.

Rebates are strongly discouraged, but if they are part of a winning bid package, they must be forwarded to the following address. A copy (only) of the rebate check must be mailed to the indicated Supply Chain representative along with documentation indicating the rebate amount, volume, spend, and time period covered.

The MetroHealth System

Attn: Rebate Coordinator

P.O. Box 73122

Cleveland, OH 44193

ACCESS TO BOOKS AND RECORDS

To the extent required by Section 1861(v)(i) of the Social Security Act, as amended, and by valid regulation which is directly applicable to that Section, SUPPLIER agrees that it shall retain and make available upon request for a period of (4) years after the completion of the Contract, any books, documents and records which are necessary to certify the nature and extent of the costs of such Services as requested by the Secretary of Health and Human Services or the Controller General, or any other duly authorized representatives.

Supplier further agrees that any subcontractors of Supplier, whose services exceed a cost or value of Ten Thousand Dollars ($10,000) or more over a twelve-month (12) period with a related organization, shall retain and make available upon request for a period of four (4) years after the completion of the Contract, such subcontract and any books, documents and records relating to any subcontract necessary to certify the nature and extent of the cost thereof when requested by the Secretary of Health and Human Services, Controller General or any of their duly authorized representatives.

JCAHO REQUIREMENTS & STANDARDS

The Supplier ensures compliance with all current and applicable JCAHO Standards as well as any future updates or iterations of JCAHO rules and regulations.

Offer Submitted by:

___________________________________

(Supplier Name)

___________________________________ __________________________

(Representative Name - Printed) (Title of Representative)

__________________________________ __________________________

(Signature of Representative) (Date)

APPENDIX A: MHS SHIP-TO LOCATIONS

|FACILITY |ADDRESS |PHONE NUMBER |

|MetroHealth Medical Center - Main Campus |2500 MetroHealth Drive |(216) 778-7800 |

| |Cleveland, OH 44109 | |

|MetroHealth Rehabilitation Institute of Ohio |2500 MetroHealth Drive |(216) 778-3867 |

| |Cleveland, OH 44109 | |

|The Elisabeth Severance Prentiss Center for Skilled Nursing Care at |3525 Scranton Road |(216) 957-8899 |

|MetroHealth |Cleveland, OH 44109 | |

|The Senior Health & Wellness Center |4229 Pearl Road |(216) 957-2000 |

|MetroHealth Old Brooklyn Campus |Cleveland, OH 44109 | |

|MetroHealth Outpatient Surgery Center |4330 West 150th Street |(216) 251-6990 |

| |Cleveland, OH 44135 | |

|MetroHealth West Park Medical Building |3838 West 150th Street |(216) 957-5000 |

| |Cleveland, OH 44111 | |

|MetroHealth Brooklyn Medical Group |5208 Memphis Avenue |(216) 398-0100 |

| |Cleveland, OH 44144 | |

|MetroHealth Strongsville Medical Group |16000 Pearl Road |(440) 238-2124 |

| |Strongsville, OH 44136 | |

|MetroHealth Asia Plaza Health Center |2999 Payne Avenue, Suite 216 |(216) 861-4646 |

| |Cleveland, OH 44114 | |

|MetroHealth Lee-Harvard Health Center |4071 Lee Road, Suite 260 |(216) 957-1200 |

| |Cleveland, OH 44128 | |

|MetroHealth Broadway Health Center |6835 Broadway Avenue |(216) 957-1700 |

| |Cleveland, OH 44105 | |

|MetroHealth Buckeye Health Center |2816 East 116th Street |(216) 957-4000 |

| |Cleveland, OH 44120 | |

|MetroHealth at The Courtlands |29125 Chagrin Boulevard., Suite 110 |(216) 591-0523 |

| |Pepper Pike, OH 44122 | |

|MetroHealth at Park East |3609 Park East Drive |(216) 957-9959 |

| |Beachwood, OH 44122 | |

|Thomas F. McCafferty Health Center |4242 Lorain Avenue |(216) 651-3740 |

| |Cleveland, OH 44113 | |

|J. Glen Smith Health Center |11100 St. Clair Avenue |(216) 249-3600 |

| |Cleveland, OH 44108 | |

APPENDIX B: INTENT TO BID FORM

Whether or not your organization intends to participate, please send the information below via email to MHS-MedEquip@ by Monday, September 15th, 2014. Your response is required to participate in the Inquiry Period.

If additional contacts exist, please duplicate the table below and attach to your submission.

Mark one of the following:

__________ We do plan to respond to this CSP with an Offer

__________ We do not plan to respond to this CSP

Reason if not responding: ______________________________________________________________________

|Company Name | |

|Contact Name | |

|Contact Title | |

|Address | |

|Contact Telephone | |

|Contact Email | |

|Main Telephone | |

APPENDIX C: INQUIRY SUBMISSION FORM

Suppliers may make inquiries regarding this CSP any time during the inquiry periods by sending it to the bid event email listed in the CSP document. To make an inquiry, suppliers must use the following format and instructions:

Inquiries are to be submitted in the format outlined below:

|Company Name | |

|Authorized Representative | |

|Representative Email Address | |

|Representative Phone Number | |

| |

|Question 1: | |

|Question 2: | |

|Question 3: | |

|Question 4: | |

|Question 5: | |

Responses to inquiries will be provided to all suppliers who submitted an Intent to Submit an Offer form by the prescribed deadline.

MetroHealth will attempt to respond to inquiries within 48 hours of receipt excluding weekends and holidays. MHS will not respond to inquiries received after the inquiry end date.

MHS will use its discretion in responding to questions about existing or past contracts. Suppliers are to base their CSP responses and the details and cost Offers, on the requirements and performance expectations established in this CSP for the future contract, not on details of any other potentially related contract or project.

MHS is under no obligation to acknowledge questions submitted through the Q&A process if those questions are not in accordance with these instructions or deadlines.

APPENDIX D: SUPPLIER REFERENCE FORM

Supplier Name:

Please provide three (3) client references for entities who have received similar services in the past five (5) years. The template below may be duplicated to provide additional information.

|Company Name: |Contact Name: |

|Address: |Phone Number: |

| |E-mail: |

|Beginning Service Date (Month/Year): |Ending Service Date (Month/Year): |

|Number of Eligible Employees: |Length of Relationship: |

|Description of related services provided, size, and complexity. |

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APPENDIX E: CONFLICT OF INTEREST FORM

Supplier hereby certifies that there are no persons, firms, associations or corporations who are known to have any material, financial or other interest in any contract that may be awarded pursuant to this contract, who are in any way affiliated with or related to The MetroHealth System, its trustees, Cuyahoga County Commissioners, Agencies of Cuyahoga County, or any of their employees, agents or representatives, except as noted below. "Material interest" as used above shall not include holdings of securities of publicly traded corporations.

|Authorized Representative: | |

|Title: | |

|Company Name: | |

|Date: | |

|Signature: | |

APPENDIX F: SUPPLIER PERFORMANCE FORM

The supplier must provide the following information for this section for the past seven (7) years. Please indicate yes or no in each column.

|YES/NO |DESCRIPTION |

| |The Supplier has had a contract terminated as a result of default or cause. |

| |The Supplier has been assessed penalties in excess of fifty thousand dollars ($50,000), including liquidated damages, |

| |under any of its existing or prior contracts with any organization (including any governmental entity). |

| |The Supplier was the subject of governmental action limiting the right of the Supplier to do business with that entity or |

| |any other governmental entity. |

| |Trading in the stock of the Supplier company has been suspended at any point. |

| |The Supplier, any officer or owner with a twenty percent (20%) interest or greater in the Supplier, has filed for |

| |bankruptcy, reorganization, debt arrangement, moratorium, or any proceeding under bankruptcy law, insolvency law, |

| |dissolution or liquidation proceeding. |

| |The Supplier, any officer or owner with a twenty percent (20%) interest or greater in the Supplier has been convicted of a|

| |felony or is currently under felony indictment. |

If the Supplier answered “Yes” to any of the above, the Supplier must provide complete details about the matter including: appropriate related names, addresses, contact information, dates and descriptions of the circumstances, causes and penalties.

APPENDIX G: CERTIFICATION REGARDING DEBARMENT

(REQUIRED ONLY IF OFFER AMOUNT EXCEEDS $100,000)

AUTHORITY

Executive Order 12549, February 18, 1986. Office of Management and Budget Common Rule, May 26, 1988. Department of Health and Human Services, 45 CFR part 76.

By signing and submitting this Offer, the prospective Supplier (“lower tier participant”) is providing the certification set out below:

The certification in this clause is a material representation of fact upon which reliance was placed if this transaction is entered into. If it is later determined that the prospective Supplier knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which the transaction originated may pursue available remedies, including suspension and/or debarment.

The prospective Supplier shall provide immediate written notice to the person whom this Offer is submitted if at any time the Supplier learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

The terms “covered transaction”, “debarred”, “suspended”, “ineligible”, “lower tier covered transaction”, “participant”, “primary covered transaction”, “principal”, “proposal”, and “voluntarily excluded”, as used in this clause, have the meanings set out in the Definitions and Coverage section of rules implementing Executive Order 12549.

The prospective Supplier agrees by submitting this Offer that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.

The prospective contractor further agrees by submitting this Offer that it will include this clause titled “Certification regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction”, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS

The prospective lower tier participant certifies, by submission of this Offer, that neither it not its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.

Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participation shall attach an explanation to this Offer.

CERTIFICATION

|Authorized Representative: | |

|Title: | |

|Company Name: | |

|Date: | |

|Signature: | |

APPENDIX H: NEW, REPLACEMENT AND UPGRADE TECHNOLOGY AMENDMENT

Date:       Supplier:      

CSP#: __-_____ CSP Name: Medical Equipment Support Services

Reason for amendment: __________________________________________________

______________________________________________________________________

______________________________________________________________________

Product(s) Replaced / Updated: Product(s) Added:

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Submitted by: Authorized by:

____________________________ The MetroHealth System__________

(Supplier Name)

___________________________________ __________________________

(Representative Name - Printed) (Representative Name - Printed)

___________________________________ __________________________

(Title of Representative) (Title of Representative)

__________________________________ __________________________

(Signature of Representative) (Signature of Representative)

__________________________________ __________________________

(Date) (Date)

APPENDIX I: ASSUMPTIONS/AVERSIONS TO SPECIFICATIONS/REQUIREMENTS

Where the prospective supplier has assumptions or aversions to any specification or stipulation described in this CSP or correlating attachments or addendum, please list them below for consideration.

CSP/Attachment Document & Section: Assumption or Aversion:

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Submitted by: Reviewed / Approved by:

____________________________ The MetroHealth System__________

(Supplier Name)

___________________________________ __________________________

(Representative Name - Printed) (Representative Name - Printed)

___________________________________ __________________________

(Title of Representative) (Title of Representative)

__________________________________ __________________________

(Signature of Representative) (Signature of Representative)

__________________________________ __________________________

(Date) (Date)

APPENDIX J: SUPPLIER DIVERSITY PROGRAM

The MetroHealth System wants to ensure that minority, women-owned, historically underutilized and other disadvantaged business enterprises, as well as local small businesses and their employees (together “Community Business Enterprises” or “CBEs”) have a fair and reasonable opportunity to participate in MetroHealth’s procurement activities. To this end, MetroHealth has developed a program for encouraging and including CBEs (“the CBE Program”).

MetroHealth encourages all contractors and vendors to compete for and/or make offers on any contracts issued by MetroHealth, and for subcontracts issued by MetroHealth’s general contractors where applicable. However, MetroHealth reserves the right to apply the CBE Program, or direct a general contractor to apply the CBE Program, for awarding contracts for equipment, supplies, and services.

The required qualifications for the CBE Program and the scoring methodology applicable to qualifying CBEs are detailed below.

Required CBE Qualifications

To qualify as a CBE, Supplier must be one of the two categories listed below. Supporting documentation is required.

|Category A: Minority or Disadvantaged Business Enterprise |

Supplier MUST submit a certification document or other certified record for one of the following:

1. A minority, women-owned, historically underutilized and other disadvantaged business enterprise certified under the MBE[3] or EDGE[4] programs of Ohio’s Department of Administrative Services.

2. A diversity supplier certification for:

a. Cuyahoga County

b. City of Cleveland

c. Cuyahoga Metropolitan Housing Administration

d. Ohio Turnpike Commission

e. Department of Veterans Affairs

f. Federal Small Business Administration (SBA)

g. Federal HUBZone Certification

h. Federal small disadvantaged business (SDB).

i. Federal women-owned small business (WOSB) concerns and economically disadvantaged women-owned small business (EDWOSB)

j. Women's Business Enterprise National Council WEBENC

k. Northern Ohio Minority Supplier Development Council

l. National Minority Supplier Development Council

m. The National Women Business Owners Corporation (NWBOC)

n. National Gay & Lesbian Chamber of Commerce (NGLCC) for Lesbian, Gay, Bisexual, and/or Transgender Business Enterprise (LGBTBE) Certification

o. Other state’s SBE/MBE certification similar to Ohio

|Category B: Local Business Enterprise |

CBEs that have a principal place of business located in Cuyahoga County, Ohio. Supplier must submit a properly completed IRS W-9 Form. MetroHealth reserves the right to reject PO boxes for the purposes of this classification.

CBE Program Scoring

The CBE Program will apply to this Project. During evaluation of your proposal, MetroHealth will assign bonus scores for Community Business Enterprise categories as shown below:

|Vendor CBE Category[5] |Bonus Score[6] |

|Category A |2 points on a 100 point scale or 2% favorable weight |

|Category B |2 points on a 100 point scale or 2% favorable weight |

APPENDIX K: METROHEALTH PROCUREMENT PAYMENT CARD PROGRAM

MetroHealth has implemented a new accounts payable (AP) initiative. As part of this effort, suppliers will no longer need to receive paper checks. Single Use Account, or SUA, electronic settlement will provide our suppliers with real-time access to credit card payment details and downloadable remittance information, via a secure, online portal.

 

To accomplish this, MetroHealth will be leveraging J.P. Morgan's Order-to-Pay. Order-to-Pay is an easy-to-use, Web-based tool for exchanging documents including SUA payment remittance information with MetroHealth System and any other buyers you may have using Order-to-Pay. As an industry leader in secure payment solutions, Order-to-Pay currently serves more than 100,000 suppliers. There is no cost to join the Order-to-Pay Network. However, standard credit card interchange fees from your merchant bank(s) apply. To view additional information please visit suasupplier.

MetroHealth reserves the right to preferentially evaluate proposals from suppliers who are willing to participate in this program.

 

Payment:

Order-to-Pay allows you to retrieve your Single Use Credit Card payment remittance via a secure online portal. Once a payment is processed, you will receive remittance information via e-mail or you can see all your payment information directly through your Order-to-Pay account. Your account gives you complete visibility into receivables with status of all paid invoices.

Enrollment Instructions:

Please go to register/otp to complete your online enrollment as soon as possible. Registration is easy, takes only a few minutes and detailed instructions are available on the site.

Access Credentials: 

MetroHealth will issue you a temporary username.

 

You will receive an e-mail shortly with your temporary enrollment password. You will be able to change both username and password during the enrollment process. This password is required to begin the enrollment process. For enrollment questions only call 877-263-5188. Please have your company's Federal Tax ID Number available.

 

Once enrolled, you can log-in to the Order-to-Pay Supplier Portal at  using the username and password you established during enrollment. If you have questions regarding Order-to-Pay functionality or the enrollment process, please review the FAQ at /otpfaq or contact Order-to-Pay Supplier Services at otp.supplier.services@ or 1-800-485-0671.

Also, once enrolled, you will receive notification regarding scheduled training on how to retrieve your payments.

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[1] See Ohio Revised Code § 149.43

[2] For more information about MetroHealth’s procurement payment card program, see Appendix K.

[3] For MBE information and certification instructions, see .

[4] For MBE information and certification instructions, see .

[5] Each category’s bonus score will be cumulative.

[6] Either points or weights will be used as applicable to the evaluation method indicated in the RFP.

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