Purchase Oder Cancellation Letter by ctv97403

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                  TO BID

            BID REFERENCE #




              TO BE OPENED:

     SEPTEMBER 10, 2010 AT 2:00 PM

              Mail sealed bid to:
Erlanger Health System, Purchasing Department
        979 East Third Street, Suite 708
            Chattanooga, TN 37403
         Bid Ref.#__________________
    Bid Opening Time:_________________
                                               ERLANGER HEALTH SYSTEM
                                            979 EAST THIRD STREET, SUITE 708
                                            CHATTANOOGA, TENNESSEE 37403


SECTION                                                                                                                                      PAGE

INSTRUCTIONS TO BIDDERS ................................................................................................................ 3
ADDITIONAL REQUIREMENTS: ............................................................................................................ 5
EVALUATION: ........................................................................................................................................... 7
GRIEVANCE PROCEDURE ....................................................................................................................10
SPECIFICATION SHEET .........................................................................................................................12
RESPONSE FORM ...................................................................................................................................13
INTENT TO QUOTE ................................................................................................................................16
MANUFACTURER INFORMATION ......................................................................................................17
VENDOR STATISTICAL DATA SHEET ...............................................................................................18
CHECKLIST/ACKNOWLEDGMENT .....................................................................................................20

                                                                 Page 2 of 20
                                      INSTRUCTIONS TO BIDDERS

 Please observe the following instructions to expedite the bidding process.              Failure to observe
 instructions may be grounds for rejection of your bid.

1.    You must submit your response on the enclosed Bid Response Form Only.

2.    You must return the original bid plus one (1) copy with ink signatures on each.

3.    Please do not telephone, fax, or attempt to submit your bid orally. We cannot accept any bid that is
      not original. Do not submit your bid in any type of binder, notebook, or report cover unless
      otherwise instructed.

4.    If you need to make changes prior to the bid opening date, please submit the entire package again
      prior to the bid opening date and time. Your original bid will then be returned to you unopened.

5.    Your bid must be in a sealed envelope with the bid number on the outer shipping envelope. If
      your bid is inadvertently opened due to your failure to identify it as a bid, your bid will be

6.    Your bid must arrive at the bid opening location no later than the bid opening date and time. This is
      your responsibility. Poor mail service or late courier service does not relieve you from this
      responsibility. We strongly suggest you hand deliver or use Fed Ex. Any other method of
      delivery puts the bid at risk of not making the deadline. Bids received after the bid opening date
      and time will be returned to you unopened.

7.    You may come to the bid opening, however, pricing information will not be provided to you at that
      time. The bid opening is a public event to demonstrate that we follow all the applicable laws in our
      process. Prices will be available only after the bid is awarded and then by appointment only.

8.    Following the bid opening, you may not have any further contact with the Technical Contact
      or other ERLANGER HEALTH SYSTEM personnel or affiliated physicians about the bid
      unless initiated or authorized by ERLANGER HEALTH SYSTEM. Any unauthorized contact
      shall not be used as a basis for responding to this bid and may result in the disqualification of the
      bidder's response. The responsibility for getting technical verification of any specification is prior to
      the bid opening. Any questions about the bid process at that point must be referred to the
      Procurement Manager.

9.    You or your company must be authorized representatives for the manufacturers you are bidding at
      the time of the bid. You may be requested to show proof within five (5) days if required.

10.   Following the bid opening, the bids will be evaluated as set forth hereinafter, and thereafter the
      proposed bid awardee will be identified. Then, an Erlanger Purchase Agreement or other
      appropriate contract will be forwarded to the bidder receiving the proposed contract award. That
      Erlanger Purchase Agreement will have to be executed by an authorized representative with the
      power to bind the successful bidder. No other agreement will be considered and any exceptions to
      that Agreement will have to be negotiated and, at the sole discretion of Erlanger Health System, may
      be grounds for rejection of your bid.

                                                Page 3 of 20
11.   If you have any complaints or objections about the bid procedure, bid specifications, the proposed
      contract, or contract award, you must follow our Grievance Procedure and submit appropriate
      documentation in accordance with procedure. A copy of the Grievance Procedure is set forth in
      Section E.

12.   In the event Erlanger Management determines, in its sole discretion, that additional bid responses
      are necessary for a competitive bidding process, Management may, with or without notice, extend
      the bid opening date for a period of time as it deems necessary or appropriate. In the event the bid
      opening date is extended pursuant to this paragraph, an updated copy of the bid will be made
      available upon request, and any respondent that submitted a response prior to the bid opening date
      extension may re-submit its bid response or rely upon its original bid response.

13.   Final evaluation with Erlanger Health System reserving the right to ask persons participating and
      providing Proposals to make a final and best offer on any particular Proposal or combination of
      several Proposals.

                                              Page 4 of 20

1. Prices are to be guaranteed for ninety (90) days during the evaluation process.

2. All forms must be signed for the bid to be considered valid.

3. Where percent of increase is requested for multi-year bids, this must be stated in a fixed percentage or a
   fixed range (Example: 5% or 0% - 5%). Price increases related to the Consumer Price Index or any
   other Government or private index cannot be accepted as a fixed price and will disqualify your bid.

4. ERLANGER HEALTH SYSTEM is exempt from all Federal, State and Local Taxes. An exemption
   certificate will be furnished to the successful bidder upon request.

5. Items bid differently from specifications must be accompanied by specifications and explanations which
   show that they are equivalent products. In addition, a list of health care facilities using the products
   should also be furnished. Product for evaluation may also be requested at no cost to ERLANGER
   HEATH SYSTEM. Additional information should be submitted on a separate sheet of paper, referenced
   as an amendment, and included with the sealed bid.

6. Contracts or Purchase Orders will be awarded after the due consideration of the suitability, cost, and the
   timeliness of delivery.

7. During the evaluation of the vendor’s bid, ERLANGER HEALTH SYSTEM may request any financial
   or reference information which may be needed to determine the company’s ability to provide the goods
   or services proposed in this bid.

8. ERLANGER HEALTH SYSTEM reserves the right to reject any/all bids, waive any irregularity in the
   bids received, and to accept either in whole or in part any one bid or combination of bids, which in its
   opinion may be for the best interest of ERLANGER HEATH SYSTEM. ERLANGER HEALTH
   SYSTEM does not obligate itself to accept the lowest priced or any other bid.

9. ERLANGER HEALTH SYSTEM will expect 100% fill rate.

   Fill rate is computed by dividing the total number of items filled by the total number of items ordered.

10. ERLANGER HEALTH SYSTEM will expect 100% “on time” percentage. Each order will be delivered
    by the agreed upon delivery date.

   On-time percentage is computed by dividing the stated delivery ARO by the actual days required to
   deliver product.

11. The payment terms for this agreement will be net 30 days. These are the only payment terms that will be
    accepted unless ERLANGER HEALTH SYSTEM enters into a separate agreement for terms for all
    products supplied by an individual vendor. Terms discounts should be applied to the bid price of
    products if no separate agreement exists.

12. If the vendor cannot comply or has an alternative to any specification listed, an exception must be made
    in writing. Any specification without a specific written exception will be assumed to be met by the
    bidding vendor. When a bid is awarded and a specification is later found not to be met, this may be
    grounds for the termination of the agreement between ERLANGER HEALTH SYSTEM and the vendor.
                                               Page 5 of 20
13. The warranty period for all equipment purchases will begin at the time of installation and acceptance and
    extend for the term of the warranty stated on the responses form.

14. Itemized pricing for all options, accessories, and/or consumables compatible with or for any quoted
    equipment must be attached to the bid response. Quoted pricing will become part of the bid package and
    gives Erlanger Health System the option of ordering accessories from the successful vendor during the
    term of the purchase agreement.

15. All invoicing must be itemized by line item according to purchase order. All invoices not itemized will
    be returned.

16. A monthly statement of our account is required. The monthly statement is to be sent to:

                                             Erlanger Health System
                                             Attn: Accounts Payable
                                              975 East Third Street
                                             Chattanooga, TN 37403

17. By submitting a response, bidder warrants that no amount to be paid under the contract has been or will be
    paid to or shared with, directly or indirectly, any employee, officer, agent, board member, Trustee, or official
    of Erlanger Health System as wages, compensation, gifts, or otherwise. In addition, each bidder agrees to
    disclose with their bid the name of any officer, director, employee, consultant, independent contractor, or
    agent of the bidder who is also an employee, officer, board member, Trustee, or official of Erlanger Health
    System or any of its subsidiaries. Further, each bidder agrees to disclose the name of any Erlanger Health
    System employee, officer, agent, board member, Trustee, or official who owns, directly or indirectly, any
    interest in the bidder’s company, or any of its branches or affiliates. Finally, each bidder agrees to avoid at
    all times any conflict of interest between his/her/its duties and responsibilities as a contractor with Erlanger
    Health System and his/her/its interests outside the scope of any current or future contracts with Erlanger
    Health System.

                                                 Page 6 of 20

ERLANGER HEALTH SYSTEM will evaluate the bids and proposals considering, without limitation,
some or all of the following, if applicable: price, quality, delivery time and schedules, quantity, any
exceptions taken to the bid documents, including any agreements accompanying such documents, any
warranties offered, and the bidder's demonstration of its good faith commitment for equal opportunity of
small business enterprises, minority businesses and individuals, and socially and economically-
disadvantaged individuals (collectively, "Minority Businesses") and any other items or things, which the
Authority considers important, applicable and in its best interest.

         So that ERLANGER HEALTH SYSTEM may evaluate each bidder's demonstration of its good
faith commitment for equal opportunity of Minority Businesses, each bidder is expected to submit
information which will emphasize the extent of the bidder's efforts to offer equal opportunity to Minority
Businesses to participate as contractors, sub-contractors, and suppliers of goods and services should the
bidder be awarded the contract. Each bidder should be aware that in evaluating the bidder's response,
ERLANGER HEALTH SYSTEM will evaluate each bidder's good faith commitment and demonstrated
effort to ensure equal opportunity for Minority Businesses.


       A.      The term "minority business" means a business:

               1.     In which at least fifty-one percent (51%) is owned by one or more minority
                      persons or socially and economically disadvantaged individuals, or in the case of a
                      corporation, in which at least fifty-one percent (51 %) of the stock is owned by
                      one or more minority persons or socially and economically disadvantaged
                      individuals; and

               2.     Of which the management and daily business operations are controlled by one or
                      more of the minority persons or socially and economically disadvantaged
                      individuals who own it.

       B.     The term "minority individual" means a person who is a citizen or lawful permanent
       resident of the United States and who is from a background described in the instructions for
       completion of Form EEO-1 and its appendix all as required by Section 709(c) of Title VII, and
       the applicable regulations, Sections 1602.7 1602.14, Subpart B, Chapter XIV, Title 29 of the
       Code of Federal Regulations, which include as presently drafted:

               1.     African-American (Black) (Not of Hispanic origin) - All persons having origins in
                      any of the Black racial groups of Africa;
                              2.      Female;
               3.     Hispanic - All persons of Mexican, Puerto Rican, Cuban, Central or South
                      American, or other Spanish culture or origin, regardless of race;
               4.     Asian or Pacific Islander - All persons having origins in any of the original
                      peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific
                      Islands. This area includes, for example, China, India, Japan, Korea, the
                      Philippine Islands, and Samoa;
               5.     American Indian or Alaskan Native - All persons having origins in any of the
                      original peoples of North America, and who maintain cultural identification
                      through tribal affiliation or community recognition;
       C.       The term "small business enterprise" includes a proprietorship, partnership, limited
       liability company, corporation, or other form of business, with annual gross revenues of less than
       the sum of Four Million Dollars ($4,000,000).
                                             Page 7 of 20
         D.      The term "socially and economically disadvantaged individual" means an individual who
         is within either or both of the following groups:

                1.     Socially disadvantaged individuals are those who have been subjected to racial or
                       ethnic prejudice or cultural bias because of their identity as a member of a group
                       without regard to their individual qualities.

                2.     Economically disadvantaged individuals are those socially disadvantaged
                       individuals whose ability to compete in the free enterprise system has been
                       impaired due to diminished capital and credit opportunities as compared to others
                       in the same business area that are not socially disadvantaged.

ERLANGER HEALTH SYSTEM utilizes a four-step evaluation process.                 A bid must satisfy the
requirements of all four steps to be considered for award.

Step 1

         Each bid will be evaluated first upon documented compliance with these specifications. Any
         non-compliant response may be cause for the rejection of a bid.

Step 2

         Erlanger Health System is a member of MedAssetts (Primary) and VHA (secondary) GPO’s.

Step 3

         Those bids found to be compliant (based upon the written documents) will then be ranked
         according to cost.

Step 4

         The lowest ranked bidder will be evaluated not only on the criteria set above, but also for
         performance within various areas of ERLANGER HEALTH SYSTEM. Dependent upon the
         results of this evaluation other bidders may or may not be evaluated. Erlanger Health System
         requires all bidders to submit their Quality Improvement Plan and how it specifically relates to
         the product and their demonstration of good-faith efforts for equal opportunity of Minority
         Businesses Contract Award. This quality and equal opportunity information will also be used by
         Erlanger Health System in its determination of which bidder is lowest and best.


        Erlanger Health System will award the contract without regard to race, color, religion, creed,
national origins, gender, age, or handicap condition. Nothing herein shall be construed to require
Erlanger Health System or its contractors to award contracts or subcontracts to, or to make purchases of
goods or services, materials or equipment from Minority Businesses, who do not submit the lowest and
best bid.

                                              Page 8 of 20

The vendor must identify the ordering technology currently available for receiving and confirming
orders. Vendors will be weighted for evaluation in the following priority sequence:

Priority 1

       Electronic Order Entry (EOE). The vendor's EOE system must be compatible with ERLANGER
       HEALTH SYSTEM's EOE system (X.12,ASAPIV).

Priority 2

       Electronic Facsimile (FAX). The vendor must be both capable of receiving a faxed hard copy of
       ERLANGER HEALTH SYSTEM's purchase order and also willing to accept the FAX without
       an authorizing signature.

Priority 3

       Phone Orders Only. The vendor must accept and ship verbal orders with a purchase order
       number but without a hard copy confirming purchase order.

Priority 4

       Phone Order w/Confirmation/Hard Copy P.O.'s only.

TECHNICAL CONTACT: Jeremy Luse, Environmental Services
                     Telephone Number: (423) 778-2278 or
                     EMAIL: jeremy.luse@erlanger.org

PROCUREMENT MANAGER: Jeffrey A. Loy, Telephone Number: (423) 778-4684
                  EMAIL: jeff.loy@erlanger.org

                                          Page 9 of 20
                                 ERLANGER HEALTH SYSTEM
                              979 EAST THIRD STREET, SUITE 708
                              CHATTANOOGA, TENNESSEE 37403


The intention of the ERLANGER HEALTH SYSTEM is to conduct all its business affairs in a fair and
impartial manner. In order to assure fairness to all prospective bidders we have developed this grievance
process to provide an organized and effective method of allowing each prospective bidder to present its
side of an issue and to resolve amicably any conflicts which may arise between ERLANGER HEALTH
SYSTEM and the prospective bidder.

If you initiate litigation prior to exhausting the grievance procedure, ERLANGER HEALTH SYSTEM
will plead your failure to exhaust as a defense.

Prior To Bid

1.     Challenges to the bid specifications must be requested in writing and received in the Purchasing
       Department no later than seven (7) days after the bid has been advertised.

2.     The request must contain the specific reasons for the challenge, contain the actual wording and
       give a specific reference found in the bid proposal.

3.     The request must be mailed or faxed to the Procurement Manager, 979 East Third Street, Suite
       708, Chattanooga, Tennessee 37403, fax number (423) 778-3909 by 4:00 P.M. any business day.

4.     The Procurement Manager will make a determination of merit for your request.               If the
       determination is in your favor, an addendum to the bid will be issued.

5.     If the decision of the Procurement Manager is negative, the bid opening will continue as

Following the Bid Award

1.     Should a Vendor have an objection to a bid award, a formal request must be submitted in writing.
       The request itself must be received in the Purchasing Department within five business days after
       the bid award has been announced.

2.     The request must specify the bid involved and clearly identify the basis for what is in dispute.
       Specific examples and exact wording should be used where applicable.

3.     The request must be sent to the Procurement Manager at 979 East Third Street, Suite 708,
       Chattanooga, Tennessee 37403.

                                            Page 10 of 20
Grievance Procedure
Page 2


1.    Within five (5) working days, the Procurement Manager will schedule a hearing date which is
      mutually acceptable and in a timely manner. At that time, the Vendor will be allowed to present
      all facts which led to the dispute.

2.    The Procurement Manager will evaluate all relevant facts which were in dispute and make a
      determination for the resolution of the dispute.

3.    The determination of the Procurement Manager will be made known to the Vendor in writing
      within three (3) working days.

4.    If the Procurement Manager determines that a cancellation of the original award and re-bid is
      warranted, the grievance process is deemed complete at that time for the vendor.


1.    If the Vendor is not satisfied with the response (other than a re-bid) in step 1, they may request a
      second review of the disputed facts by submitting a written, clearly defined statement of what is
      still in dispute for review to the Chief Financial Officer or designee, at 975 East Third Street,
      Chattanooga, Tennessee 37403. It must be limited to the same issues that were in dispute in the
      first step of the Grievance Procedure. No new or additional information will be considered.

2.    This request must be received at the Medical Center within five (5) calendar days after the
      response from the first hearing.

3.    Upon review of the written information, the Chief Financial Officer or designee can either
      request a meeting with the vendor or inform the vendor in writing of the final decision.

                                            Page 11 of 20
                                  ERLANGER HEALTH SYSTEM
                             979 EAST THIRD STREET, SUITE 708
                               CHATTANOOGA, TENNESSEE 37403

                                       SPECIFICATION SHEET

BID REFERENCE:        0006-1011


*Reference in this specification to equipment, and/or material, which is specified by name of
manufacturer or catalog number, shall be interpreted for the purpose of establishing a standard of quality
and shall not be construed as limiting competition.

If the bidder chooses to bid an equivalent product, the bid must include a complete set of specifications
for the item(s) offered. A reference list of users of the product must be furnished with the bid.


It is the intent of the ERLANGER HEALTH SYSTEM to enter into a 36-month agreement for
Environmental Services Supplies. Prices will remain firm for the term of the contract. Price
increases can be taken only on anniversary date of contract.

Requirements of ERLANGER HEALTH SYSTEM make it necessary to bid. No substitutions will be
accepted due to the nature of the specialized procedures performed at the Medical Center, as well as
physician preference.

Please provide a percentage discount from list price, in order to allow other line items to be added to the
agreement at a later date. Attach a copy of the currently published list price. As with the prices quoted
on the response form, the published price list will also remain firm for the term of the agreement.

The attached Response Form lists products currently in use and the estimated annual quantity if
available. Please offer pricing for the same item if possible. If an equivalent item is being offered, mark
the item “Equivalent” and list the catalog number, as well as the manufacturer’s name and number.

Erlanger Health System is a member of Med Assets (Primary), VHA/Novation (Secondary)

                                             Page 12 of 20
                                       ERLANGER HEALTH SYSTEM
                                  979 EAST THIRD STREET, SUITE 708
                                    CHATTANOOGA, TENNESSEE 37403

                                                RESPONSE FORM
                                                   (Exhibit A)

      Disinfectants Requirements:

             A        Tuberculocidal and Non-Tuberculocidal
             B.       Low Skin Irritability

        Price increases can only be taken on the anniversary date of contract.
        All dispensers will be provided at no charge in exchange for use of paper products.
        Empty sprayers, label and bottles will be provided at no charge for use of chemicals.
        Please disclose your cost plus mark-up that is included in the quoted prices. All pricing furnished
         below must include the cost plus mark-up.:

                                   Cost Plus Mark-up____________________%

                                                 PAPER SUPPLIES
                                         CURRENT               EQUIVALENT           ANNUAL
                  DESCRIPTION                        PART #                                      PRICE/UOM
                                            MFG                MFG/PART #         USAGE/UOM
     TISSUE, TOILET JUMBO ROLL 1000'    GA PACIFIC    13728                       18944 ROLL
     PAPER, TOILET ROLL DOUBLE PLY      GA PACIFIC    18280                       48480 EACH
     TOWELS, PAPER MULTI-FOLD           GA PACIFIC    20204                       91552 PACK
     TOWELS, PAPER ROLL                 GA PACIFIC    26601                         132 ROLL
     TOWEL, ENMOTION HQ 5X9             GA PACIFIC    89460                        2046 ROLL

                                                   CAN LINERS
                                                  CURRENT                      EQUIVALENT
           DESCRIPTION                 GAUGE                       PART #                   USAGE/    PRICE/EACH
                                                    MFG                        MFG/PART #
LINER, HIMOLENE 26 X 43 CLEAR          16 MIC    HERITAGE         S5243VNH                   590160
LINER, HIMOLENE RED 30 X 43            14 MIC    HERITAGE         S6043HRH                   94320
LINER, HIMOLENE 24 X 27 CLEAR          7 MIC     HERITAGE        Z4827RNHR02                359000
                                       7 MIC     HERITAGE        Z4833LRHR01                 56000
LINER, HIMOLENE 48 X 52 CLEAR          16 MIC    HERITAGE         Z9652VNH                  296550
LINER, HIMOLENE RED 48 X 52            22 MIC    HERITAGE         Z9652WRH                   82500

                                                 Page 13 of 20
           DESCRIPTION                 CURRENT MFG            PART #                  USAGE/    PRICE/EACH
                                                                         MFG/PART #
TAPE, SCOTCH BLUE 2 IN                        3M                2090                     192
PAD, POWER                                    3M               23162-9                   340
PAD, TOPLINE BURNISH 20"                      3M                3200                     165
PAD, NAT BLEND WHITE BURNISH 20"              3M                3300                     215
PAD, 3M 4100 SUPER POLISH 20" WHITE           3M                4100                     750
PAD, RED BUFF 20"                             3M                5100                     80
PAD, SCRUBBING 20" BLUE                       3M                5300                     215
PAD, STRIPPING BLACK 3M 20" 7200              3M                7200                     465
PAD, HI PRODUCTIVITY 20" BLACK                3M                8278                     185
PAD, DOODLEBUG BROWN MO/20                    3M                8541                     638
CLEANER, BASE HIT                          BUCKEYE           B.BASHITA                   15
FINISH, FLOOR CASTLEGUARD 5GL              BUCKEYE           B.CASTAP                    132
STRIPPER, FLOOR RIP SAW 5GL                BUCKEYE            B.RIPSAP                   77
CLEANER, WORKOUT MUSCLE 5 GL               BUCKEYE           B.WORKAP                    16
MOP, BOWL DELUXE                      IMPACT PRODUCTS            200                     181
PAIL, 5QT UTILITY POLYETHYLENE        IMPACT PRODUCTS           5506                     72
BOTTLE, PLASTIC 22 0Z                  SMITH CONTAINER          22631                    100
SPRAYER, TRIGGER RED 7"                SMITH CONTAINER          82042                    100
DETERGENT, LAUNDRY 5GL                SPARTAN CHEM CO          740226                    25
DISINFECTANT, HDQ NEUTRAL ONE STEP    SPARTAN CHEM CO          770695                  80 GAL
WIPE, STAINLESS STEEL (TUB)              CLAIRE MFG             C993                     288
CADDY, FOR MOP/CLEANER                CONTINENTAL MFG            780                     122
CLOTH, BRAWNY DUSTING                     GA PACIFIC            29624                   4600
KNIFE, PUTTY 1 1/4"                          HYDE               02050                    144
JACKET, KLEENGUARD XLG                 KIMBERLY CLARK           36244                    420
CURTAIN, WHITE VINYL SHOWER 70X71             N/A              2161590                   150

                                             Page 14 of 20
              DESCRIPTION                     CURRENT MFG          PART #                    PRICE/UOM
CARESTRIP, LOW ODOR 2.5GL                      ECOLAB, INC.       61183458       122 EA
CLEANER, A-456 DISINFECTANT 1.3L               ECOLAB, INC.       61166931       464 EA
CLEANER, BATHROOM QC98 1.3L                    ECOLAB, INC.       61166905       322 EA
CLEANER, QC-31 NEUTRAL 1.3L                    ECOLAB, INC.       61166808       906 EA
FINISH, PHAZER MONOSTAR FLOOR 2 GAL            ECOLAB, INC.       64895513       280 EA
PADS, PHAZER APPLICATOR 5 PK                   ECOLAB, INC.       92021031        65 EA
RESTORER, BRIGHT SPEED FLOOR 1.3L              ECOLAB, INC.       61166891       604 EA
RESTORER, FLOOR QC33 NPE 1.3L                  ECOLAB, INC.       61166813       184 EA
SPOTTER, RAMSEY PROF CARPET                 JOHNSONDIVERSEY        4359150        64 QT
CLEANER, EMEREL CREAM 32OZ                  JOHNSONDIVERSEY          5015        828 EA
CLEANER, SPITFIRE 32 OZ                     JOHNSONDIVERSEY          3702        396 EA
FINISH, FLOOR TIMESAVER                     JOHNSONDIVERSEY        3137731       80 GAL
RESTORER, SNAPBACK UHS GAL                  JOHNSONDIVERSEY         04134        20 GAL
SPOTTER, CARPET 32OZ                        JOHNSONDIVERSEY         04192         18 EA
STRIPPER, POWER FOAM BRAVO 32OZ             JOHNSONDIVERSEY        4966769        60 EA

Include any additional charges that will be incurred by Erlanger Health System. Any Charges found on
subsequent invoices that are not found here will be refused.

By signing this bid in the appropriate place on the Response Form, the bidder hereby certifies that this
bid is made without collusion or fraud of any kind.

              Signed                                              Printed


       Address                                      City          State          Zip Code

                                            Page 15 of 20
                            Intent to Quote
                          BID REF #0006-1011

                 Please fax this document to the Attention of:

                               Katherine Davis
                              Bid Coordinator
                           Erlanger Health System
                             (423) 778-3726 Fax

Contact Person                                 Company

Address                                City    State        Zip Code

Telephone                              Email Address

                               Page 16 of 20
                              MANUFACTURER INFORMATION

Please provide the following information for each manufacturer involved in your bid:

City:                                            State:                     Zip:
Phone:                                           Extension:

City:                                            State:                     Zip:
Phone:                                           Extension:

City:                                            State:                     Zip:
Phone:                                           Extension:

City:                                            State:                     Zip:
Phone:                                           Extension:

                                         Page 17 of 20
                                  ERLANGER HEALTH SYSTEM
                               979 EAST THIRD STREET, SUITE 708
                                    CHATTANOOGA, TN 37403

                           VENDOR STATISTICAL DATA SHEET

The following information is gathered for statistical use only:

1.     Type of Business:                (Check Appropriate)

       _______MANUFACTURING                   _______DISTRIBUTION                _______SERVICE

2.     List Specific Product Line(s):


3.     Type of Ownership:               (Check Appropriate)

               ______Male                                         ______Female

               ______White                                        ______African American

               ______Asian or Pacific Islander                    ______Hispanic

               ______American Indian or Alaskan Native            ______Small Business
               ______Socially & Economically Disadvantaged

             ______Minority Business                   _______Other: (Please Specify)

4.     Explain how you demonstrate your good faith commitment for equal opportunity for Minority
       Businesses (attach a detailed explanation, if additional space is needed).

                                              Page 18 of 20
        I, the undersigned, hereby certify that the foregoing statistical information and any attachments
hereto are true, accurate, and in accordance with the definitions set forth in this bid document to the best
of my knowledge, information and belief, and those made on information and belief are believed to be
true, accurate, and in accordance with the definitions set forth in this bid document.

                                                     Print Name:

CITY:                                                STATE:
ZIP:                                                 PHONE:

For EHS use only:

                                             Page 19 of 20
                                    ERLANGER HEALTH SYSTEM
                                 979 EAST THIRD STREET, SUITE 708
                                 CHATTANOOGA, TENNESSEE 37403


                                         Bid Reference #0006-1011


I hereby acknowledge receipt of one bid package including:

       1.      Instructions to Bidders
       2.      Additional Requirements
       3.      Evaluation
       4.      Grievance Procedure
       5.      Specification Sheet
       6.      Response Form
       7.      Intent to Quote
       8.      Manufacturer Information
       9.      Vendor Statistical Data Sheet
       10.     Checklist/Acknowledgment

I also certify acceptance of the above and all instructions and conditions contained herein
with____/without____exception. (Please note exceptions on Attachment)


Firm Name______________________________________________________

Please perform the following checklist to insure your bid response is complete:

1.     Signed Response Form Enclosed                                ________
2.     Signed Checklist/Acknowledgment Enclosed                     ________
3.     Signed Vendor Statistical Data Sheet Enclosed                ________
4.     All Documents in Sealed Envelope Enclosed                    ________
5.     Sealed Envelope Has Bid # on Exterior                        ________

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