Okaloosa County BOCC — January 5, 2016 — BID SHEET

BID SHEET Date Submitted: 11/23/2015 BID#: RFB EMS 99-15 BID TITLE: EMS Supplies and Inventory Management Software EMS Supplies Discount on Supplies Inventory Management Software Remarks: Bid Total Based on UoM Provided: $7,720.76 In Words: Seven Thousand Seven Hundred Twenty Dollars and Seventy-Six Cents. Bid pricing includes Operative IQ Inventory Management Software ANTI-COLLUSION STATEMENT: The below signed respondent has not divulged to, discussed or compared his bid with other respondents and has not colluded with any other respondent or parties to bid whatever. (Note: No premiums, rebates, or gratuities permitted either with, prior to, or after any delivery of materials. Any such violation will result in the cancellation and/or return of material (as applicable) and the removal from bid list(s). Bound Tree Medical, LLC Respondent’s Company Name &E’gd'Signature — Manual 5000 Tuttle Crossing Blvd Jeffery Prestel Authorized Signature — Typed Dublin, OH 43016 Sresidert Address Title 800.533.0523 877.311.2437 Phone # Fax # 31-1739487 Submitbids@boundtree.com Federal ID # or SS # E-mail address RFB Form-1 OKALOOSA COUNTY