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HomeMy WebLinkAboutContract FormsSTATE CONTRACT CHANGE FORM This form will be used by awarded Contractor(s) when requesting a change to the State Contract or the vendor maintained website. Changes may include price changes, addition or deletion of products, change in ordering instructions and changes to servicing dealers. Reminder: No changes may be made to Contractor's State Contract Web Page without prior written approval from State Purchasing. Non-compliance with this condition may be cause for immediate termination of Contract. Requests for pricing and product changes should be accompanied by the corresponding price lists and literature and may only be made at the time specified in the solicitation. CONTRACTOR: Contact Person: Title: Street Address: City, State, Zip: Phone: Fax: Email: REQUESTING REVISION TO (select Price List Add Product(s) Delete Product(s) Change Servicing Dealer(s) Change Ordering Instructions ENCLOSED ATTACHMENTS INCLUDE (select): Price List Literature Servicing Dealer Revisions Ordering Instruction Revisions REMINDER: (1) Include the FEIN if dealers are accepting orders on behalf of the manufacturer. (2) Once a website change has been approved, please update your website information as soon as possible. (3) If you are making any changes to products, prices and dealers, update your eProcurement catalog within Ariba. If you are adding a dealer who will be accepting orders on behalf of the manufacturer, make sure they are registered in MyFloridaMarketPlace AND are listed on the Ordering Instructions as an approved dealer. If you have difficulties updating your catalog template, contact Omar Ali at Accenture at email address omar.s.ali .accenture.com or telephone at 919/850-2943 ext. 237. (For use by State Purchasing — do not mark below the line) Request Approved Request Denied Date Contract Analyst Comments: Contractor Notified Via: Fax: Email: Mail: QUARTERLY STATE TERM CONTRACT (STC) SALES SUMMARY REPORT Vendor Name: FEID#: Contact Person: Phone Number: Email: Contract Title: Contract #: EMAIL form to: Dawn Gunter Email: Dawn.Gunter©dms.myflorida.com Report reflects all sales for the CALENDAR QUARTER ending: 1st Quarter Period Ending March 31st 3rd Quarter Period Ending September 30th 2"° Quarter Period Ending June 30th Quarter Period Ending December 30th ENTITY TOTAL DOLLARS STATE AGENCIES: Report total dollar amount sold to all State Agencies for goods and services during specified Quarter under this state term contract. $ OTHER POLITICAL SUBDIVISIONS: Report total dollar amount sold to other Political Subdivisions [including but not limited to, Counties, Cities, Schools, Universities, Colleges and Utilities] for goods and services during specified Quarter under this state term contract. $ GRAND TOTAL: $ Under penalties of perjury, I declare that this is a true and accurate report of all sales due under the terms and conditions of this state term contract for the specified quarterly reporting period. AUTHORIZED TYPED OR ELECTRONIC SIGNATURE Reminder: 1) A quarterly report is required even if there are no sales for the specified Quarter. 2) This form is for the reporting of Quarterly sales only. This form is not related to the reporting and payment of vendor transaction fees. 3) For information concerning the use of this form, please contact Dawn Gunter, State Purchasing at (850) 488-4946. CONTRACT This Contract, effective the last day signed below, is by and between the State of Florida, Department of Management Services (`Department"), an Agency of the State of Florida with offices at 4050 Esplanade Way, Tallahassee, Florida 32399-0950, and the entities identified below as Contractor (individually, "Contractor") (the Contract is executed in counterparts; see attached sheets to identify all Contractors). The Contractor responded to the Department's ITB No. 9-490-000-G. Laboratory and Safety Supplies and Equipment. The Department has determined to accept the Contractor's bid and to enter into this Contract in accordance with the terms and conditions of the solicitation. The specific items awarded to Contractor, and the maximum rates Contractor may charge Customers, are identified on the attached Price Sheet. Accordingly, and in consideration of the mutual promises contained in the Contract documents, the Department and the Contractor do hereby enter into this Contract, which is a State term Contract authorized by section 287.042(2)(a) of the Florida Statutes (2001). The term of the Contract is effective for sixty (60) months from the last date signed below. The Contract consists of the following documents, which, in case of conflict, shall have priority in the order listed, and which are hereby incorporated as if fully set forth: • Any written amendments to the Contract • This Contract document, including Price Sheet • Original Invitation to Bid solicitation document • Any written Addendums issued during solicitation period • Contractor's Invitation to Negotiation submittal documents • Any purchase order under the Contract State of Florida, Department of Management Services By: Linda South, Secretary Date: Contractor Name: (Seal) Street Address or P.O. Box: City, State, Zip: By: (Signature): Printed Name: Date: Its: (Title)