1991-04 Bid Award to Physio Control for EMS Equipment
' ABSOLUTION NO. 4-91
A RESOLUTION OF THE VILLAGE COUNCIL OF NORTH PALM BEACH, FLORIDA,
ACCEPTING THS BID OF PHYSIO CONTROL, ATLANTA, GA, FOR SKG
MONITOR/DEFIBRILLATOR/PACER IN THS AMOUNT OF X8,362.00, FUNDS TO BS
EXPENDED FROM ACCOUNT NO. A6416-66490 (MACHINERY & EQUIPMENT).
BE IT RESOLVED BY THS VILLAGE COUNCIL OF NORTH PALM BEACH, FLORIDA:
Section 1. The bid of Physio Control, Atlanta, Georgia, copy
of which is attached to this Resolution, is hereby accepted by the
village of North Palm Beach in accordance with its terms. The
appropriate Village officials are hereby directed to advise said
bidder of this acceptance. The monies are to be expended as
follows: X8,362.00 from Account No. A6416-66490 (Machinery &
Equipment).
' Section 2. This Resolution shall take effect immediately upon
passage.
PASSED AND ADOPTED THIS 24TH DAY OF JANUARY, 1991.
Mayor
ATTEST:
village Cler
1
PROPOSAL TO THE VILLAGE:OF•NORTH PALM BEACH, FLORIDA
Gentlemen:
The undersigned, as bidder, does declare that no other person other
than the bidder herein named has any interest in this proposal or in
the contract to be taken, and that it is made without any connection
with any other person or persons making proposal for the same article,
and is in all respects fair and without collusion or fraud.
The undersigned further declares that he has carefully examined the
specifications and is thoroughly familiar with its provisions and with
the quality, type and grade of meterial called for.
The undersigned further declares that he proposes to furnish the
articles called for within specified time set in this proposal for the
following price, and guarantees that parts and service for the arti-
cles listed below are available within the State of Florida, to wit:
DATE: November 29, 1990
MANUFACTURER: PHYSIO-CONTROL
LIFEPAK 10 WITH PACER
WARRANTY: 2 YEARS
PRICIfVG INCLUDES:
LIFEPAK 10 with pacer - $7,762.50
FASTPATCIl Adapter 135.00
PEDI PADDLES 99.00
CARRYING CASE 85.50
Pacing Electrodes 180.00
Defib Electrodes N/C
Service Cable 100.00
Extended one yr. warranty N/C
8,362.00
MODEL NO: 804200-28
DELIVERY: 45-60 Days ARO
PRICE: $ 8,362.00
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SWORN STATEMENT UNDER SECTION 2}t7.1~3(3)(n),
FLORIDA STATUTES. ON PUBLIC ENTITY CRIMES
THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER
AUTHORIZED TO ADMINISTER OATHS.
This sworn statement is submitted with Bid, Proposal or Contract No.
for Village of North Palm Beach, One (1) EKG Monitor/Defibrillator/Pacer
2. This sworn statement is submitted by PH SIO-CONTROL CORPORATION
(name o[ entity submitting sworn statement]
whose business address is 1777 PhnPnix Pkw,~,~ Cnitr l li], Atlanta f'A 40449
(if applicable) its Federal Employer Identification Number (FEIN) is 35-0470950
(If the entity has no FEIN, include the Social Security Number of the individual signing this sworn
sta[emenr. •)
3. My name is r inrfa r'ntmlvy and my relationship to the
[please print name of Individual signing]
entity named above is Sales Administrator II
4. I understand that a 'public entity-crime' as defined is Paragraph 287.133(1)(8), Florida Statutes.
means a violation of any state or federal law by a person with respect to and directly related [o the
transaction of business with any pubUc entity or with an agency or political subdivision of any other
state or with the United States, including, but not Umited to, any bid or contract for goods or
services to be provided to any public entity or an agency or political subdivision of any outer state
or of the United States and Involving antitrust, fraud, theft, bribery, collusion, racketeering,
conspiracy, or material misrepresentation.
5. I understand tha[ "convicted' or'convlction' as defined in Paragraph 287.133(1)(b) jrJorida Statutes.
means a finding of guilt or a conviction o[ a public entity crime, with or without an adjudication of
guilt, in any federal or state trial tour[ of record relating to charges brought by indictment or
information after July 1, 1989, as a result of a Jury verdict, nonJury trial, or entry of a plea of guilty
or nolo contendere.
6. I understand that an 'affiliate" as defined In Paragraph 287.133(1)(a), Florida Statutes. means:
1. A predecessor or successor of a person convicted of a pubUc entity crime: or
2. An entity under the control of any natural person who B active In the management of the
entity and who has been convicted of a public entity crime. The [erm 'affiliate' includes chose
officers, directors, executives, partners, shareholders, employees, members, and agents who are active
in the management of an affiliate. The ownership by one person of shares constituting a conuolling
interest in another person, or a pooling of equipment or income among persons when not for fair
market value under an arm's length agreement, shall be a prima facie case that one person controls
another person. A person who knowingly enters into a Joint venture with a person who has been
convicted of a public entity crime in Florida during the preceding 36 months shall be considered an
affiliate.
7, [understand that a "person' as defined in Paragraph 287.133(1)(e), Florida Statutes. means any
natural person or entity organized under the laws of any state or of the United States with the legal
power to enter into a binding contract and which bids or applies to bid on contracts for the provision
o[ goods or services let by a public entity, or which otherwise transacts or applies to transact business
with a public entity. The term 'person" includes those ofi'1cers, direc[ors, executives, partners,
shareholders, employees, members, and agents who are active in management of an entity.
8. Based on information and belief, the statement which I Gave marked below is true in relation [o the
entity submitting this sworn statement. [Please Indicate which statement applies.]
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' X Neither the entity submitting this sworn statement, nor any officers, directors, executives,
partners, shareholders, employees, members, or agents who are active la management of the entity,
nor any affiliate of the entity have been charged with and convicted of a public entity crime
subsequent to July 1, 1989.
The entity submitting this sworn statement, or one or more o[ the officers, directors,
executives, partners, shareholders, employees, members, or agen[s who arc active in managemen[ of
the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime
subsequent to July 1, 1989, ~{]Z [Please Indicate which additional statement eppl/es.]
There has been a proceeding concerning the conv(ctlon before a hearing officer of
the State of Florida, Division of Administrative Hearings. The final order entered by the
hearing officer did no[ place the person or affiliate oa the convicted vendor list. [Please
attach o copy o[ the lino! order.]
The person or affiliate was placed on the convicted vendor list. There has been a
subsequent proceeding before s hearing officer of the State of Florida, Division of
Adminisvative Hearings. The final order entered by the hearing officer de[ermined tha[ it
waz in the public interest to remove the person or affiliate from the convicted vendor list
[Please attach a copy of the Mal order.]
The person or affiliate has not been placed oa the convicted vendor list. [Please
describe any oction taken by or pending with the Department o[ General Services.]
[algnature] Lin. rumley
Date: November 29, 1990
STATE OF GEORGIA
COUNTY OF Ci AYTON
PERSONALLY APPEARED BEFORE ME, the undorsigned authority,
Linda Crumlev who, aher first being sworn by me, affixed his/her signature
[name of individual signing]
in the space provided above on this
My commission expires:
a
' Notary Public, Henry County, Georgia
My Commission Expires Jan. 3,1994
Form PUR 7063 (Rev. 11/89)
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29 day pf Novembrrg9 90
PROPOSAL TO THE VILLAGE OF NORTH PALM BEACH, FLORIDA
Gentlemen:
The undersigned, as bidder, does declare that no other person other
than the bidder herein named has any Interest in this proposal or in
the contract to be taken, and that it is made without any connection
with any other person or persons making proposal for the same arti-
cle, and is in all respects fair and without collusion or fraud.
The undersigned further declares that he has carefully examined the
specifications and is thoroughly familiar with its provisions and
with the quality, type and grade of material called for.
The undersigned further declares that he proposes to furnish the
articles called for within specified time set in this proposal for
the following pride, and guarantees that parts and service for the
articles listed below are available within the State of Florida, to
wit:
DATE : ,3J~ ~ ~ ~I D
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PROPOSAL '1'O THIi VILLAGE OP NORTH PALM• BEACFI, I'LORIllA (Coot inuodl
REMARKS/EXCEPTIONS:
Officers of Corporation or Members of Partnership:
NAME TITLE ADDRESS
_ Cilbc-rt W. Ariderson • President i 1811 Willows Rd NE • Redmond WA
Rill Hawkins Vice Pres. ~ " ~ " • • ' "• ' "
Christine S Fields Secretary "• - " "
Thomas F. Obsitnik Treasarer "• " "
FIRM: PHYSIO-CONTROL CORPORATION ~•
SIGNED BY
TITLE
WITNESSES:
~~~~
r,
~E ~ _
ADDRESS:
1'IfYS10-CONTROL CORPORATION•
1777 Phoenix Pkwv. Suite 110
Atlanta. GA 30349
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PHYSIO-CONTROL CORPORATION
1777 Phoenix Pkwy., Suite 110
Atlanta, GA 30349
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