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SUPPLY AGREEMENT NO. 1295
Corpus Christi Fire Department Medications
•
1852
THIS Corpus Christi Fire Department Medications Supply Agreement ("Agreement")
is entered into by and between the City of Corpus Christi, a Texas home-rule municipal
corporation ("City") and Life-Assist, Inc. ("Supplier'), effective upon execution by the
City Manager or the City Manager's designee ("City Manager").
WHEREAS, Supplier has bid to provide Corpus Christi Fire Department Medications
in response to Request for Bid No. 1295 ("RFB"), which RFB includes the required scope
of work and all specifications and which RFB and the Supplier's bid response are
incorporated by reference in this Agreement as Exhibits 1 and 2, respectively, as if each
were fully set out here in its entirety.
NOW, THEREFORE, City and Supplier agree as follows:
1. Scope. Supplier will provide Corpus Christi Fire Department Medications in
accordance with the attached Scope of Work, as shown in Attachment A, the
content of which is incorporated by reference into this Agreement as if fully set
out here in its entirety. "Goods," "products", and "supplies", as used in this
--- ----Agreement, refer to and have the same meaning.
2. Term. This Agreement is for 12 months. The parties may mutually extend the term
of this Agreement for up to zero additional zero-month periods ("Option
Period(s)"), provided, the parties do so in writing and prior to the expiration of the
original term or the then-current Option Period. The City's extension authorization
must be executed by the City Manager or designee.
3. Compensation and Payment. The total value of this Agreement is not to exceed
$142,298.14, subject to approved extensions and changes. Payment will be made
for goods delivered and accepted by the City within 30 days of acceptance,
subject to receipt of an acceptable invoice. All pricing must be in accordance
with the attached Bid/Pricing Schedule, as shown in Attachment B, the content
of which is incorporated by reference into this Agreement as if fully set out here in
---- --its-entirety.
4. Contract Administrator. The Contract Administrator designated by the City is
responsible for approval of all phases of performance and operations under this
Agreement, including deductions for non-performance and authorizations for
payment. The City's Contract Administrator for this Agreement is as follows:
2017-305 wm Page 1 of 7
11/14/17 2/17
M2017-181
Life-Assist Inc.
INDEXED
Brandon Stowers
Corpus Christi Fire Department
361.826.3941
BrandonSt@cctexas.com
5. Insurance. Before performance can begin under this Agreement, the Supplier
must deliver a certificate of insurance ("COI"), as proof of the required insurance
coverages, to the City's Risk Manager and the Contract Administrator.
Additionally, the COI must state that the City will be given at least 30 days'
advance written notice of cancellation, material change in coverage, or intent
not to renew any of the policies. The City must be named as an additional insured.
The City Attorney must be given copies of all insurance policies within 10 days of
the City Manager's written request. Insurance requirements are as stated in
Attachment C, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
6. Purchase Release Order. For multiple-release purchases of products to be
provided by the Supplier over a period of time, the City will exercise its right to
specify time, place and quantity of products to be delivered in the following
manner: any City department or division may send to Supplier a purchase release
order signed by an authorized agent of the department or division. The purchase
release order must refer to this Agreement, and products will remain with the
Supplier until such time as the products are delivered and accepted by the City.
7. Inspection and Acceptance. Any products that are delivered but not accepted
by the City must be corrected or replaced immediately at no charge to the City.
If immediate correction or replacement at no charge cannot be made by the
Supplier, a replacement product may be bought by the City on the open market
and any costs incurred, including additional costs over the item's bid price, must
be paid by the Supplier within 30 days of receipt of City's invoice.
8. Warranty. The Supplier warrants that all products supplied under this Agreement
are new, quality items that are free from defects, fit for their intended purpose,
and of good material and workmanship. The Supplier warrants that it has clear
title to the products and that the products are free of liens or encumbrances. In
addition, the products purchased under this Agreement shall be warranted by the
Supplier or, if indicated in Attachment D by the manufacturer, for the period
stated in Attachment D. Attachment D is attached to this Agreement and is
incorporated by reference into this Agreement as if fully set out here in its entirety.
9. Quality/Quantity Adjustments. Any quantities indicated on the Bid/Pricing
Schedule are estimates only and do not obligate the City to order or accept more
than the City's actual requirements nor do the estimates restrict the City from
ordering less than its actual needs during the term of the Agreement and including
Supply Agreement Standard Form Page 2 of 7
Approved as to Legal Form 10/2/17
any Option Period. Substitutions and deviations from the City's product
requirements or specifications are prohibited without the prior written approval of
the Contract Administrator
10. Non-Appropriation. The continuation of this Agreement after the close of any
fiscal year of the City, which fiscal year ends on September 30th annually, is subject
to appropriations and budget approval specifically covering this Agreement as
an expenditure in said budget, and it is within the sole discretion of the City's City
Council to determine whether or not to fund this Agreement. The City does not
represent that this budget item will be adopted, as said determination is within the
City Council's sole discretion when adopting each budget.
11. Independent Contractor. Supplier will perform the work required by this
Agreement as an independent contractor and will furnish such products in its own
manner and method, and under no circumstances or conditions will any agent,
servant or employee of the Supplier be considered an employee of the City.
12. Subcontractors. Supplier may use subcontractors in connection with the work
performed under this Agreement. When using subcontractors, however, the
Supplier must obtain prior written approval from the Contract Administrator if the
subcontractors were not named at the time of bid. In using subcontractors, the
Supplier is responsible for all their acts and omissions to the same extent as if the
subcontractor and its employees were employees of the Supplier. All
requirements set forth as part of this Agreement, including the necessity of
providing a COI in advance to the City, are applicable to all subcontractors and
their employees to the same extent as if the Supplier and its employees had
performed the work.
13. Amendments. This Agreement may be amended or modified only by written
change order signed by both parties. Change orders may be used to modify
quantities as deemed necessary by the City.
14. Waiver. No waiver by either party of any breach of any term or condition of this
Agreement waives any subsequent breach of the same.
15. Taxes. The Supplier covenants to pay payroll taxes, Medicare taxes, FICA taxes,
unemployment taxes and all other related taxes. Upon request, the City Manager
shall be provided proof of payment of these taxes within 15 days of such request.
16. Notice. Any notice required under this Agreement must be given by fax, hand
delivery, or certified mail, postage prepaid, and is deemed received on the day
faxed or hand-delivered or on the third day after postmark if sent by certified mail.
Notice must be sent as follows:
Supply Agreement Standard Form Page 3 of 7
Approved as fo Legal Form 10/2/17
IF TO CITY:
City of Corpus Christi
Attn: Brandon Stowers
Battalion Chief
2406 Leopard Street, Corpus Christi, TX 78408
Fax: 361.826.4287
IF TO SUPPLIER:
Life-Assist, Inc.
Attn: Michael Murray
Pricing Analyst
11277 Sunrise Park Drive
Fax: 800.290.9794
17. SUPPLIER SHALL FULLY INDEMNIFY, HOLD HARMLESS AND DEFEND THE
CITY OF CORPUS CHRISTI AND ITS OFFICERS, EMPLOYEES AND AGENTS
("INDEMNITEES) FROM AND AGAINST ANY AND ALL LIABILITY, LOSS,
CLAIMS, DEMANDS, SUITS, AND CAUSES OF ACTION OF WHATEVER
NATURE, CHARACTER, OR DESCRIPTION ON ACCOUNT OF PERSONAL
INJURIES, PROPERTY LOSS, OR DAMAGE, OR ANY OTHER KIND OF
INJURY, LOSS, OR DAMAGE, INCLUDING ALL EXPENSES OF LITIGATION,
COURT COSTS, ATTORNEYS' FEES AND EXPERT WITNESS FEES, WHICH
ARISE OR ARE CLAIMED TO ARISE OUT OF OR IN CONNECTION WITH A
BREACH OF THIS AGREEMENT OR THE PERFORMANCE OF THIS
AGREEMENT BY THE SUPPLIER OR RESULTS FROM THE NEGLIGENT ACT,
OMISSION, MISCONDUCT, OR FAULT OF THE SUPPLIER OR ITS EMPLOYEES
OR AGENTS. SUPPLIER MUST, AT ITS OWN EXPENSE, INVESTIGATE ALL
CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT OR OTHER
DISPOSITION, DEFEND ALL ACTIONS BASED THEREON WITH COUNSEL
SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL CHARGES OF
ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF ANY KIND
ARISING OR RESULTING FROM ANY SAID LIABILITY, DAMAGE, LOSS,
CLAIMS, DEMANDS, SUITS, OR ACTIONS. THE INDEMNIFICATION
OBLIGATIONS OF SUPPLIER UNDER THIS SECTION SHALL SURVIVE THE
EXPIRATION OR EARLIER TERMINATION OF THIS AGREEMENT.
18. Termination.
(A) The City Manager may terminate this Agreement for Supplier's failure to
perform the work specified in this Agreement or to keep any required insurance
policies in force during the entire term of this Agreement. The Contract
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Approved as to Legal Form 10/2/17
Administrator must give the Supplier written notice of the breach and set out a
reasonable opportunity to cure. If the Supplier has not cured within the cure
period, the City Manager may terminate this Agreement immediately thereafter.
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Supplier. The City
Manager may also terminate this Agreement upon 24 hours written notice to the
Supplier for failure to pay or provide proof of payment of taxes as set out in this
Agreement.
19. Assignment. No assignment of this Agreement by the Supplier, or of any right or
interest contained herein, is effective unless the City Manager first gives written
consent to such assignment. The performance of this Agreement by the Supplier
is of the essence of this Agreement, and the City Manager's right to withhold
consent to such assignment is within the sole discretion of the City Manager on
any ground whatsoever.
20. Severability. Each provision of this Agreement is considered to be severable and,
if, for any reason, any provision or part of this Agreement is determined to be
invalid and contrary to applicable law, such invalidity shall not impair the
operation of nor affect those portions of this Agreement that are valid, but this
Agreement shall be construed and enforced in all respects as if the invalid or
unenforceable provision or part had been omitted.
21. Order of Precedence. In the event of any conflicts or inconsistencies between this
Agreement, its attachments, and exhibits, such conflicts and inconsistencies will
be resolved by reference to the documents in the following order of priority:
A. this Agreement (excluding attachments and exhibits);
B. its attachments;
C. the bid solicitation document including any addenda (Exhibit 1); then,
D. the Supplier's bid response (Exhibit 2).
22. Certificate of Interested Parties.Supplier agrees to comply with Texas Government
Code Section 2252.908, as it may be amended, and to complete Form 1295
"Certificate of Interested Parties" as part of this Agreement.
23. Verification Regarding Israel. In accordance with Chapter 2270, Texas
Government Code, the City may not enter into a contract with a company for
goods or services unless the contract contains a written verification from the
company that it: (1) does not boycott Israel; and (2) will not boycott Israel during
the term of the contract. The signatory executing this Agreement on behalf of the
Supplier verifies that the company does not boycott Israel and will not boycott
Israel during the term of this Agreement.
Supply Agreement Standard Form Page 5 of 7
Approved as fo Legal Form 10/2/17
24. Governing Law.This Agreement is subject to all federal, State, and local laws, rules,
and regulations. The applicable law for any legal disputes arising out of this
Agreement is the law of the State of Texas, and such form and venue for such
disputes is the appropriate district, county, or justice court in and for Nueces
County, Texas.
25. Entire Agreement. This Agreement constitutes the entire agreement between the
parties concerning the subject matter of this Agreement and supersedes all prior
negotiations, arrangements, agreements and understandings, either oral or
written, between the parties.
(SIGNATURE PAGE FOLLOWS)
Supply Agreement Standard Form Page 6 of 7
Approved as to Legal Form 10/2/17
SUPPLIER
Signature:
Printed Name: /`':c17ce( Afurna /
Title: pr;c.'nc9 Anaiysf
Date: I 0//V.20/7
CITY OF CORPUS CHRISTI
Signature: OrN,
Printed Name:
Title: Pro o c-t r
Date: 1 L / 1 571 7
ATTEST: k �-►
Attached and Incorporated by Reference: RE:ECCA ETARY
Attachment A: Scope of Work CITY SECRETARY
Attachment B: Bid/Pricing Schedule
Attachment C: Insurance Requirements
Attachment D: Warranty Requirements
Incorporated by Reference Only:
Exhibit 1: RFB No. 1295
Exhibit 2: Supplier's Bid Response
' € 3°
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SECRETARY J�
Supply Agreement Standard Form Page 7 of 7
Approved as to Legal Form 10/2/17
Attachment A: Scope of Work
1. General Requirements/Background Information
The Contractor shall provide medications in accordance with the specifications listed
herein. These medicines will be utilized by the Corpus Christi Fire Department,
Emergency Medical Services technicians, to treat patients. This contract will provide
needed medications to be purchased on an "as needed" basis by the Emergency
Medical Services (EMS) Division of the Corpus Christi Fire Department.
2. Scope of work
A. Delivery
1. Contractor shall make inside delivery to City locations within five calendar days
to the addresses specified. All prices will be quoted F.O.B. destination, inside
delivery to City of Corpus Christi facility, freight prepaid. Expedited forty-eight
hour delivery services will be required in some instances; therefore, Contractor
must be able to provide such service. Additional freight will be paid only when
the City has made a request for expedited delivery.
2. Delivery, as used in this section, means the goods ordered and received by the
City. Receipt of goods that do not conform to specifications will not be
accepted by the City. Contractor understands and agrees that the City may,
at its discretion, cancel any backorders due to the Contractors inability to
deliver the product within the five calendar day stipulation. Cancellations shall
be in writing and sent to Contractor by email, fax, or mail. No restocking fee or
payment of any kind shall be owed for orders canceled due to Contractors
inability to meet the five day delivery deadline. Returns to Contractor of late
orders received after the cancellation notice has been sent shall be at
Contractor's expense. The City may seek the products from another party if
Contractor fails to deliver on time.
3. Delivery must be made during normal working hours, Monday through Friday,
8:00 am to 5:00 pm CT.
B. Defective Goods - Contractor shall pay for return shipment on any goods that
arrive in a defective, unusable or inoperable condition. Contractor must arrange
for the return shipment of damaged goods.
C. Product Expiration - Contractor shall provide medical supplies with a minimum
expiration date of twelve months after the delivery date. Any materials delivered
with an expiration date of less than 12 months will be returned to Contractor for
credit or replacement at Contractor's expense.
Page I of 3
D. Change on Unit of Measure -Contractor may change unit of measure as long as
individual unit price remains consistent.
E. Discontinued Items - In the event that a manufacturer discontinues particular
product(s), the City may allow Contractor to provide a substitute for the
discontinued product(s) or delete the product(s) from the contract altogether. If
Contractor requests permission to substitute a new product, Contractor shall
provide the following to the City:
1. Documentation from the manufacturer that the product has been
discontinued.
2. Documentation that names the replacement product.
3. Documentation that provides clear and convincing evidence that the
replacement product meets or exceeds all specifications of the original
product.
4. Documentation that provides clear and convincing evidence that the
replacement product will be compatible with all the functions or uses of the
discontinued product.
5. Documentation confirming that the price for the replacement is the same as or
less than the discontinued product.
6. These providers related to product discontinuance apply only to products
specifically listed in this solicitation document.
3. Special Instructions
A. Monthly orders of required medications (except for controlled medications listed
below in special instructions section), will need to be shipped to:
Corpus Christi Fire Department
Attention: EMS Supply Coordinator
1501 Holly Road
Corpus Christi, TX 78417
B. All controlled medications to be shipped as per DEA regulations to address on
DEA Certificate.
Corpus Christi Fire Department
2406 Leopard Street, Suite 300
Corpus Christi, TX 78408
Page 2 of 3
Controlled Medication: Diazepam (Valium)
Midazolam (Versed)
Morphine Sulfate
C. Contractor must process electronic Schedule II narcotic forms (e222).
Page 3 of 3
Attachment B: Bid/Pricing Schedule
mus c •
a :;, � CITY OF CORPUS CHRISTI
�, BID FORM
PURCHASING DIVISION
RFB No. 1295
:ssa Corpus Christi Fire Department Medications
PAGE 1 OF 4
Date: 9/29/2017
Authorized
Bidder: Life-Assist, Inc. Signature: -
1. Refer to "Instructions to Bidders" and Contract Terms and Conditions before
completing bid.
2. Quote your best price for each item.
3. In submitting this bid, Bidder certifies that:
a. the prices in this bid have been arrived at independently, without consultation,
communication, or agreement with any other Bidder or competitor, for the
purpose of restricting competition with regard to prices.
b. Bidder is an Equal Opportunity Employer, and the Disclosure of Interest information
on file with City's Purchasing office, pursuant to the Code of Ordinances, is current
and true.
c. Bidder is current with all taxes due and company is in good standing with all
applicable governmental agencies.
d. Bidder acknowledges receipt and review of all addenda for this RFB.
Item Description UOM QTY Unit Price Total Price
Acetaminophen Box $1.00 $30.00
1 500mg/tablet PK 30
NDC # N/A Bid as specified
Packaged: 50 box sold in BT/100
Acetaminophen Elixer Bottle $4.96 $148.80
2 l6mg/5m1 EA 30
NDC # 57896-0180-16
Packaged: bottles
Adenosine $73.00 $2,920.00
3 6mg/2m1 PK 40
NDC # 25021-301-02
Packaged: 10 vial/carton
Albuterol $6.30 $441.00
4 1.5 mg/3m1 PK 70
NDC # 0487-9501-01
Packaged: 30 pouch/carton
Page 2 of 4
Item Description UOM QTY Unit Price Total Price
Asprin
81 mg/1 tablet $1.08 $311.04
5 NDC # 0904-4040-73 EA 288
Packaged: 36 tabs/bottle
Atropine Sulfate
lmg/5m1 $10.66 $746.20
6 NDC # 0409-4910-34 BX 70 Bid as specified,
Packaged: 1 syringe/carton sold as CS/50
CA Gluconate 10% IV $210.00 $2,520.00
7 1 gm/10m1 PK 12
NDC # 63323-311-19
Packaged: 25 vial/tray
CA Gluconate 2.5% Gel $35.50 $2,840.00
8
2g/1 tube EA 80
NDC # N/A
Packaged: N/A
Dextrose 50% $78.50 $7,065.00
9 25g/50m1
BX 90
NDC # 0409-7517-16
Packaged: 10 syringe/container
Diazepam $310.00 $6,200.00
10 10mg/2m1 BX 20
NDC # 0409-1273-32
Packaged: 10 cartridge/carton
Diphenhydramine $25.00 $500.00
11 50mg/1 ml BX 20
NDC # 0641-0376-25
Packaged: 25 vial/package
Dopamine $72.50 $580.00
12 200mg/5m1 BX 8
NDC # 0409-5820-01 Bid as specified,
Packaged: 25 vial/tray sold as CS/50
Epinephrine 1:1000 $410.00 $8,200.00
13 1 mg/1 ml BX 20
NDC # 42023-159-25
Packaged: 25 vial/carton
Epinephrine 1:10,000 $50.00 $4,700.00
14 1 mg/10m1 BX 94
NDC # 0409-4921-34
Packaged: 10 syringe/package
Page 3 of 4
Item Description UOM QTY Unit Price Total Price
Furosemide $82.00 $1,968.00
15 40mg/4m1 BX 24
NDC # 0409-6102-04
Packaged: 25 vial/tray
Glucagon $178.00 $32,040.00
16 l mg/l ml EA 180
NDC # 0597-0260-10
Packaged: 1 kit/per kit
Glucose Paste $1.20 $720.00
17 15g EA 600
NDC # N/A Bid as specified,
Packaged: N/A sold as PK/3
Labetalol
20mg/4m1 $80.50 $1,610.00
18 NDC # 0409-2339-34 BX 20
Packaged: 10
cartridge/package
Lidocaine $30.00 $1,680.00
19 100mg/5ml BX 56
NDC # 0409-4903-34
Packaged: 10 syringe/container
Lidocaine (pre-mixed) $184.80 $739.20
20 2g/500m1 CS 4
NDC # 0264-9594-10
Packaged: 24 container/case
Magnesium Sulfate 50%
5g/10m1 $60.00 $420.00
21 NDC # 63323-064-10 BX 7
Packaged: 25 vial/tray
Methylpred $255.00 $3,825.00
22 125mg/2m1 BX 15
NDC # 0009-0047-22
Packaged: 25 vial/carton _
Naloxone $330.00 $42,240.00
23 2mg/2m1 BX 128
NDC # 76329-3369-1
Packaged: 10 syringe/box
Midazolam $27.00 $432.00
24 5mg/5m1 BX 16
NDC # 0409-2305-05
Packaged: 10 vial/carton
Page 4 of 4
Item Description UOM QTY Unit Price I Total Price
Morphine Sulfate $35.00 $1,680.00
10mg/2m1
25 NDC # 0409-1893-01 BX 48
Packaged: 10 cartridge/carton
Nitrostat Spray $146.00 $14,308.00
0.4mg/60m dose
26 NDC # 45802-210-01 EA 98
Packaged: 1 bottle/carton _
Ondansetron $13.68 $1,778.40
4mg/2m1
27 NDC # 0409-1120-11 BX 130
Packaged: 10 syrja eJcarton
Sodium Bicarbonate $13.50 $229.50
50mg/50m1
28 NDC # 0409-6637-34 BX 17
Packaged: 50m1/1 syringe
Tranexxamic Acid $14.20 $426.00
29 1000mg/10mi EA 30
NDC # 42192-605-10
Packaged: vials
Allowance: Expedited deliveries for
Medications is to be issued by the LS 1 $1,000.00 $1,000.00
Contract Administrator via task orders
Total $142,084.94'
$142,298.14
* Mathematical error on vendor side. Corrected total amount was verified with
vendor.
Attachment C: Insurance Requirements
A. CONTRACTOR'S LIABILITY INSURANCE
1. Contractor must not commence work under this contract until all
insurance required has been obtained and such insurance has been
approved by the City. Contractor must not allow any subcontractor, to
commence work until all similar insurance required of any subcontractor
has been obtained.
2. Contractor must furnish to the City's Risk Manager and Contract
Administrator one (1) copy of Certificates of Insurance with applicable
policy endorsements showing the following minimum coverage by an
insurance company(s) acceptable to the City's Risk Manager. The City
must be listed as an additional insured on the General liability and Auto
Liability policies by endorsement, and a waiver of subrogation
endorsement is required on all applicable policies. Endorsements must
be provided with Certificate of Insurance. Project name and/or number
must be listed in Description Box of Certificate of Insurance,
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-day advance written notice of Bodily Injury and Property Damage
cancellation, non-renewal, material Per occurrence - aggregate
change or termination required on all
certificates and policies.
Commercial General Liability $1,000,000 Per Occurrence
including: $1,000,000 Aggregate
1. Commercial Broad Form
2. Premises - Operations
3. Products/Completed Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
AUTO LIABILITY (including) $1,000,000 Combined Single Limit
1. Owned
2. Hired and Non-Owned
3. Rented/Leased
WORKERS'S COMPENSATION Statutory and complies with Part II
(All States Endorsement if Company is of this
not Exhibit.
domiciled in Texas)
Employer's Liability $500,000/$500,000/$500,000
Page 1 of 3
3. In the event of accidents of any kind related to this contract, Contractor
must furnish the Risk Manager with copies of all reports of any accidents
within 10 days of the accident.
B. ADDITIONAL REQUIREMENTS
1. Applicable for paid employees, Contractor must obtain workers'
compensation coverage through a licensed insurance company. The
coverage must be written on a policy and endorsements approved by
the Texas Department of Insurance. The workers' compensation
coverage provided must be in statutory amounts according to the Texas
Department of Insurance, Division of Workers' Compensation. An All
States Endorsement shall be required if Contractor is not domiciled in the
State of Texas.
2. Contractor shall obtain and maintain in full force and effect for the
duration of this Contract, and any extension hereof, at Contractor's sole
expense, insurance coverage written on an occurrence basis by
companies authorized and admitted to do business in the State of Texas
and with an A.M. Best's rating of no less than A- VII.
3. Contractor shall be required to submit renewal certificates of insurance
throughout the term of this contract and any extensions within 10 days
of the policy expiration dates. All notices under this Exhibit shall be given
to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
4. Contractor agrees that,with respect to the above required insurance, all
insurance policies are to contain or be endorsed to contain the following
required provisions:
• List the City and its officers, officials, employees, and volunteers, as
additional insureds by endorsement with regard to operations,
completed operations, and activities of or on behalf of the named
insured performed under contract with the City, with the exception
of the workers' compensation policy;
• Provide for an endorsement that the "other insurance" clause shall
not apply to the City of Corpus Christi where the City is an additional
insured shown on the policy;
Page 2 of 3
• Workers' compensation and employers' liability policies will provide a
waiver of subrogation in favor of the City; and
• Provide thirty (30) calendar days advance written notice directly to
City of any, cancellation, non-renewal, material change or
termination in coverage and not less than ten (10) calendar days
advance written notice for nonpayment of premium.
5. Within five (5) calendar days of a cancellation, non-renewal, material
change or termination of coverage, Contractor shall provide a
replacement Certificate of Insurance and applicable endorsements to
City. City shall have the option to suspend Contractor's performance
should there be a lapse in coverage at any time during this contract.
Failure to provide and to maintain the required insurance shall constitute
a material breach of this contract.
6. In addition to any other remedies the City may have upon Contractor's
failure to provide and maintain any insurance or policy endorsements to
the extent and within the time herein required, the City shall have the
right to order Contractor to stop work hereunder, and/or withhold any
payment(s) which become due to Contractor hereunder until
Contractor demonstrates compliance with the requirements hereof.
7. Nothing herein contained shall be construed as limiting in any way the
extent to which Contractor may be held responsible for payments of
damages to persons or property resulting from Contractor's or its
subcontractor's performance of the work covered under this contract.
8. It is agreed that Contractor's insurance shall be deemed primary and
non-contributory with respect to any insurance or self insurance carried
by the City of Corpus Christi for liability arising out of operations under
this contract.
9. It is understood and agreed that the insurance required is in addition to
and separate from any other obligation contained in this contract.
2017 Insurance Requirements
Fire Department
EMS Medication Supplies
08/10/2017 sw Risk Management
Page 3 of 3
ATTACHMENT D: WARRANTY REQUIREMENTS
Section 8. is null for this Supply Agreement.
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
I Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2017-272192
Life-Assist,Inc
Rancho Cordova,CA United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 10/13/2017
being filed.
City of Corpus Christi Date Acknowledged �!
ji1-II11 Ir
3 Provide the identification number used by the governmental entity or state agency to track or identify the contrao,and provide a
description of the services,goods,or other property to be provided under the contract.
1295
Corpus Christi Fire Department Medications
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
6 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT I swear,or affirm,underenalof
p ry perjury,that the above disclosure is true and correct.
l MAN NGUYEN I
NOTARY PUBLIC•CALWORNM .
SACRAMENTO COUNTY !IILL./1 GC/1z- _
G-mm o sJJUNNE&2021
S r nature of aurhoriz .agent of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE r`�1I{/ 1 / 'In\'1p��(y,IEy/tea r1I
Sworn to and subscribed before me,by the said �\KC% 1 Ukkifg ` ,this the \� day of c I ,
20 \-1 ,to ceniy which,wimess my hand and seal of office.
12)
s',.; -e of officer.,n'-'_ g oath Punted name of officer adminism ing..tlr Title of office isteririg oath
—_—=----
orms by Texas Ethics Commission www,ethics.state.,.u Version V1.03337