Physio Control/Addl Serv 1/409,770.60/Ambulance Equipment Fhysio Control
Fire Department 2012
Bond: P.O. #24326
Contract Not To Exceed 8409,770.60
ADDITIONAL SERVICES AMENDMENT TO
4 t
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES iktik
THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT "Agreement") entered into by and
between the City of Carmel and Physio Control (the "Vendor"), as City Contract dated 317/2012 shall amend the
terms of the Agreement by adding the additional services to be provided by Vendor consistent with the Scope of
Work attached hereto and incorporated herein as Exhibit "A Furthermore, the terms of the Agreement shall be
amended to include the E- verify requirement as stated in Indiana Code 22 -5 -1.7 et seq., which is attached hereto
and incorporated herein as Exhibit "B as well as the required E- verify Affidavit, attached hereto and incorporated
herein as Exhibit "C". The terms and conditions of the Agreement shall not otherwise be affected by this Additional
Services Amendment and shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows:
CITY OF CARMEL, INDIANA PHYSIO CONTROL
by and through its Board of Public
Works and Safety
1
By i By:
hi
Ames Brainard, Presiding OffjcA Authorized Signatur:/
Date: S
4 �o�J t p ST, .F a sR-T,
P rinted Name
Mary A Burke, tv1emp9r
Date: 5 /6 -A C r f ��.as�c �.,L. OT'f
Title
Lori W Member FID/TIN: 'P 1 0 6 9 7 9 I
Date: .c 1 6 t
Last Four of SSN if Sole Proprietor:
ATTES
Date: 5 4-1 l
ana Cordray, IAMC, Treasurer
Date: 5 t
ur ovnlrna dm sthunA A %Wase.TPror5x Caad. S.c tine t t2d I2NHYSIO CC MIioL MITI Sva Amgd 4.19.201: enr *I9l2012 A.12 PM)
Physio- Control, Inc.
u 11811 Willows Road NE
H Y SI O Redmond, WA 98073 -9723 U.S.A
C 011 Tit 0 L www.physio-control.com
-.a www.medtronic.com
tel 800.442.1142
t .rk p
fax 800.732.0956
To: Mark Hulett
EMS Chief Quote 1- 21 06631 46
Carmel Fire Department
2 Carmel Civic Sq Rev#: 6
Carmel, IN 46032 Quote Date' 12/06/2011
Phone (317) 571.2663 Sales Consultant: Joe King
Fax: (317) 571 -2615 800 -442 -1142 x 72618
mhuiett@carmel.in.gov FOB: Redmond, WA
Terms: Net 30, all quotes subject to credit approval
and the following terms conditions
Trade -in S /N's listed below.
Contract: None Exp Date: 03/05/2012
x� h f Trad e'-In U f C e a `r
Llne ,,Clo
atag ll r
o i4 N4 -Q ty u Pric Unrilsc
�D', 3 to
1 99577 -000046 LP15 MONITOR/DEFtB, CPR, 15 $33,295.00 56,659.00 53,166 67 $23,469.33 5352,040,00
Pace, to 360J, SPO2 /CO, 12L GL, NIBP, CO2,
Trend, 8T
INCLUDED AT NO CHARGE: 2 PAIR QUtK -COMBO
ELECTRODES PER UNIT 11996 000091, TEST LOAD
21330- 001365, Service Manual CD -ROM 21340-
000438, ShipKit- (RC Cable) 41577-000007. HARD
PADDLES, BATTERIES AND CARRYING CASE NOT
INCLUDED.
2 21330 001176 LI-10N BATTERY 5.7 AMP 48 5390.00 $78.00 $0.00 5312.00 514,976.00
HOUR CAPACITY
RECHARGEABLE LITHIUM -ION, WITH FUEL GAUGE
3 11140 -000052 LP 15 ADAPTER- REDI- 8 5175.00 $35.00 $0.00 5140.00 $1,120.00
CHARGE BATTERY CHARGER
LP 15 ADAPTER- REDI CHARGE BATTERY CHARGER
4 11171 -000049 RAINBOW DCI ADT 21 $750 00 5150.00 $0.00 5600.00 512,600.00
REUSABLE SENSOR, REF 2696
RAINBOW DCIADT REUSABLE SENSOR, REF 2696
5 11171 -000050 RAINBOW DCIP PED 21 $800.00 $160.00 $0.00 5640.00 513,440.00
REUSABLE SENSOR, REF 2697
RAINBOW DCIP PED REUSABLE SENSOR, REF 2697
6 11996 -000020 INFANT CUFF, 6X18CM 15 519 00 S3.80 $0.00 $15.20 5228.00
REUSABLE
NIBP CUFF- REUSABLE,tNFANT,6X18CM
7 11996 -000022 CHILD CUFF (PEDIATRIC), 15 522.00 S4.40 50.00 $17.60 $264.00
9X27CM REUSABLE
NIBP CUFF- REUSABLE,CHILD,9X27CM
8 11996 -000025 LARGE ADULT CUFF, 15 530.00 56.00 $0.00 $24.00 5360.00
16X42CM REUSABLE
NIBP CUFF REUSABLE,LARGE ADULT 16X24CM
9 11577 -000002 KIT CARRY BAG, MAIN BAG 16 $260 00 $52.00 $0.00 $208.00 53,328.00
ACCESSORY 11577 -000002 LP15 KIT CRY BAG.
Includes shoulder strap 11577- 000001
10 11220 -000028 Top Pouch 15 547 00 $9.40 $0.00 537,60 5564 00
Storage for sensors and electrodes. Insert in place of
standard paddles.
F.hi A
f I'
'Quote#:
1- 210663146
Rev# 6
Quote Products (continuedf Quote Date: 12/06/2011
Line Catal g:x/ Descnptton Qty x' P Unnit Disc Tratle;jn Unit Price Fxt Total
11 11260 -000039 KIT CARRY BAG, REAR 16 $67.00 $13.40 $0 -00 $53.60 $857.60
POUCH
KIT- CARRY BAG, REAR POUCH
12 11141 -000115 BASE -REDI- CHARGE MOBILE 6 $1,295.00 $259.00 $0,00 $1,036.00 $6,216.00
BATTERY CHARGER
BASE- REDI- CHARGE BATTERY CHARGER
13 11140 -000015 -AC POWER CORD 6 $67.00 $13.40 $0.00 $53.60 $321 60
14 11171-000037 RC-4, PATIENT CABLE, 4FT, 6 $235.00 $47.00 $0.00 $188.00 $1,128.00
REF 2406
RC-4, PATIENT CABLE, 4FT, REF 2406
15 11111-000018 CABLE, 4 WIRE LIMB LEAD 4 $320.00 $64.00 $0.00 $256.00 $1,024,00
5FT AHA. 12 LEAD ECG
CABLE, 4 WIRE LIMB LEAD 5FT AHA, 12 LEAD ECG
16 11111.000022 CABLE, 6 WIRE PRECORDIAL 6 $128.00 $25.60 $0.00 $102.40 $614.40
AHA, 12 LEAD ECG
CABLE, 6 WIRE PRECORDIAL AHA, 12 LEAD ECG
17 11113 -000004 QUIK -COMBO THERAPY 2 $315.00 $63.00 $0 00 $252.00 $504,00
CABLE
FOR USE WITH LIFEPAK 15
MONITOR/DEFIBRILLATOR
SUB TOTAL $409,585.60
ESTIMATED TAX $0.00
ESTIMATED SHIPPING HANDLING $185.00
GRAND TOTAL $409,770.60
Trade -in Detail
Product Qty Unit Value Total Value
Pricing Summary Totals
List Price: $571,357 -00
Trade -ins: $47,500.00
Cash Discounts: $114,271.40
Tax S &H: $185.00
GRAND TOTAL FOR THIS QUOTE $409,770.60
2
y
Physio Control
Fire Department 2012
Bond: P.O. #24326
Contract Not To Exceed $409, 770.60
EXHIBIT "B"
E- verify requirement
All terms defined in I.C. 22 -5 -1.7 et seq. are adopted and incorporated into this section of the Amendment.
Pursuant to I.C. 22 -5 -1.7 et seq., Vendor shall enroll in and verify the work eligibility status of all of its newly -hired
employees using the E -Verify program, if it has not already done so as of the date of this Addendum. Vendor is further
required to execute the attached Affidavit, herein referred to as "Exhibit C which is an Affidavit affirming that: (i) Vendor is
enrolled and is participating in the E -verify program, and (ii) Vendor does not knowingly employ any unauthorized aliens. This
Addendum incorporates by reference, and in its entirety, attached "Exhibit C." In support of the Affidavit, Vendor shall
provide the City with documentation that it has enrolled and is participating in the E -Verify program. This Agreement shall not
take effect until said Affidavit is signed by Vendor and delivered to the City's authorized representative.
Should Vendor subcontract for the performance of any work under this Addendum, the Vendor shall require any
subcontractor(s) to certify by affidavit that: (i) the subcontractor does not knowingly employ or contract with any unauthorized
aliens, and (ii) the subcontractor has enrolled and is participating in the E -verify program. Vendor shall maintain a copy of such
certification for the duration of the term of any subcontract. Vendor shall also deliver a copy of the certification to the City
within seven (7) days of the effective date of the subcontract.
If Vendor, or any subcontractor of Vendor, knowingly employs or contracts with any unauthorized aliens, or retains
an employee or contract with a person that the Vendor or subcontractor subsequently learns is an unauthorized alien, Vendor
shall terminate the employment of or contract with the unauthorized alien within thirty (30) days "Cure Period Should the
Vendor or any subcontractor of Vendor fail to cure within the Cure Period, the City has the right to terminate this Agreement
without consequence.
The E -Verify requirements of this Agreement will not apply, should the E- Verify program cease to exist.
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Physio Control
Fire Department 2012
Bond: P.O. #24326
Contract Not To Exceed $409,770.60
Exhibit "C°
E- Verify Affidavit
z rA A(° z being first duly sworn, deposes and says that
he/she is familiar with and has personal knowledge of the facts herein and, if called as a witness in this
matter, could testify as follows:
1. I am over eighteen (18) years of age and am competent to testify to the facts contained
herein.
2. I am now and at all times relevant herein have been employed by
Pis s 1 1 c (the "Company in the position
of ,9;: e, gc
3. I am familiar with the employment policies, practices, and procedures of the Company and
have the authority to act on behalf of the Company.
4. The Employer is enrolled and participates in the federal E -Verify program. Documentation
of this enrollment and participation is stated in the Addendum, "Exhibit B," to the original
City Contract and is incorporated herein.
5. The Company does not knowingly employ any unauthorized aliens.
6. To the best of my information and belief, the Company does not currently employ any
unauthorized aliens.
7. FURTHER AFFIANT SAYETH NOT.
EXECUTED on the 2 day of 4-,f 20 12-
Printed: ec
I certify under the penalties for perjury under the Iaws of the United States of America and the State of
Indiana that the foregoing factual statements and representations are true and correct.
Printed: b9./ l S
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