UPDATE ON PPE RESOURCES - Montana Hospital ...
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UPDATE ON PPE RESOURCES July 9, 2020 Here is your update on PPE resources for July 9, 2020. After a month of rising infection averages, the United States just charted a record number of 60,021 new cases on Tuesday, July 7th, exceeding the April 6 peak by over 30%. The country will exceed 3 million cases and 131,000 deaths today with a bleak projection line ahead of us. Unfortunately, during this spike in cases, Montana has moved from the lowest to the highest infection rate in the country. COVID is spreading faster in Montana than anywhere in the US (Rt 1.36) https://rt.live. This week alone, Montana has broken its daily new cases record three times. PPE Status: There has been an increase in domestic and foreign PPE manufacturing but this only slightly offsets the increase in demand due to resumption of elective procedures, regular hospital operations, and the surge in new COVID-19 cases. Given these complications, the Montana Hospital Association suggests an all-of-the-above strategy to address your PPE needs. Below is an outline of options to consider. Here’s what you can do to improve access to PPE and supplies: 1) Complete and submit the MHA Intalere Participation Agreement to access MHA’s negotiated PPE rates. MHA Ventures brings cost savings to our membership by grouping together equipment and supply purchasing volumes from around the state to achieve measurable savings. Intalere is provider owned (Intermountain Health) and managed (Virginia Mason). There is no cost to sign up or access these rates as our goal is to increase volume to improve access to better tier pricing. You can return a signed copy to Kristyn Egbert, kristyn.egbert@mtha.org. She can be reached at 406-457-8022 if you have any questions. Facilities may be able to purchase outside of the MHA agreement, but we cannot guarantee the lowest contracted rates. a) It is also worth noting that the Intalere Incident Command Group (ICG) task force has opened up their emergency management program and internal processes resource center to members and non-members in support of all COVID-19 impacted medical facilities. 2) Work with Montana based manufacturers to access locally produced products. This is a great solution for many reasons. We know where the product is coming from. Delivery is as close to guaranteed as possible. Your order puts Montanans back to work. Turnaround is quick. Pricing is competitive. And last but not least, this strengthens Montana’s capacity to repatriate foreign made products so we will be more resilient the next time our supply chains are tested. a) See the list below of Montana made COVID-19 response products. Page 1 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
3) Work through proven, established alternative purchasing channels. In an effort to bring more accountability and predictability to non-traditional PPE purchasing channels, MHA Ventures is working with https://www.ppe.exchange to establish the go-to purchasing platform for Montana’s hospitals. It’s worth looking into. Email info@ppe.exchange to request access and let them know you are a part of MHA. More info at the end of this document. a) BYD, one of the largest manufacturers of PPE in the world, is partnering with MHA to provide guaranteed lowest pricing to health care facilities across Montana. For more information contact Ernest Su at (213) 880-8598 or ernest.su@byd.com i) Here is a recent article about California’s PPE purchases though BYD before earning federal approval: https://www.latimes.com/california/story/2020-06-08/byd-earns-federal-approval- for-n95-masks ii) Here is BYD’s current pricing as of July 9, 2020: Product Name Product Description Unit Price (USD/unit) N95 NIOSH (10 days lead time) NIOSH-approved $3/mask (5M+ qty) KN95 Earloop (live US stock) CDC whitelisted FDA EUA $1.5/mask (5M+ qty) KN95 Headstrap (live US stock) CDC whitelisted FDA EUA $1.8/mask (5M+ qty) FE2311 Surgical Mask (live US stock) ASTM level 2 equivalent $0.25/mask (10M+ qty) FE2311X Surgical Mask ASTM level 3 equivalent $0.30/mask (10M+ qty) Hand Sanitizer (10 days lead time) 50ml $1/bottle (1M+ qty) 236ml $2.50/bottle (1M+ qty) 500ml $4/bottle (1M+ qty) 4) Work with vendors that have already been vetted. Many states are publishing their purchase orders on line. If you have to buy outside of normal medical supply channels, talk to customers that have received the products to verify fit, quality, timing, etc.. See the Vendor Questions vetting document at the end of this memo created by MHA and MT Disaster and Emergency Services. a) The Association for Health Care Resource & Materials Management (AHRMM) of the American Hospital Association has vetted alternative medical supply vendors, including PPE producers. That said, the products, terms, chain of custody and delivery have not been vetted as far as we know. b) See the list below of businesses that the State on Montana has been working with to acquire PPE and supplies. 5) Note that the state has implemented the Battelle mask decontamination program. Healthcare facilities wishing to utilize the free Battelle N95 Critical Care Decontamination System (CCDS) service can begin the 4-step sign-up process here. This no-cost service to Montana healthcare providers allows reuse of N95 masks up to 20x. Page 2 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
6) MHA collaborated with the Montana Contractors Association and the Montana Retail Association to collect donated PPE from industrial users across Montana. Twenty-two John Deere dealers have been serving as collection points. We have received about 1,000 N95 and KN95 masks to date. Thanks to a small grant from the Montana Bioscience Cluster 4th F Fund, MHA can be ship some of these masks out to your facility if you are in a pinch. Unfortunately, our supply is limited and intended to be used as a last resort. That said, let us know if you have a pressing need and we will send you out a package of masks ASAP. Contact me, Sean Becker, at 406-581-7571 or sean@mtha.org if we can help. 7) As always, follow your procurement policies and track COVID-19 related expenses for potential reimbursement. a) Contact Tim Thennis at tthennis@mt.gov and Sheri Medow at sheris@mt.gov with FEMA related questions. If you have any difficulty with the forms, process or requirements, please notify MHA at esf8@mtha.org. b) If you need assistance navigating the FEMA and other federal program tracking reimbursement process, MHA has engaged the Tidal Basin Group to assist the MHA membership. Tidal Basin can serve as a fiscal agent for FEMA funding. They will charge an at-risk fee of 5% net revenue. For more information contact Kristopher J. Prickett at (706) 767-2340 or kprickett@tidalbasin.rphc.com. 8) And last but not least, continue to submit your PPE needs to your local DES coordinator to receive allocation of supplies received from the Strategic National Stockpile and state acquired supplies. a) Your Regional Hospital Preparedness Coordinators work closely with Montana State DES officials to assist in your preparedness efforts. Please do not hesitate to reach out to them with any questions you may have. b) For log in information to EMResource, please contact your local Readiness and Response Coordinator. i) Healthcare Coalition Director: Cindee McKee cindee.mckee@mtha.org 406-457-8027 ii) HPP Director: Don McGiboney dmcgiboney@mt.gov 406-444-5942 iii) Healthcare Readiness and Response Coordinators (1) Central Healthcare Coalition: (a) Kitty Songer @ Kitty.songer@mtha.org 406-457-8025 (2) Western Healthcare Coalition: (a) Kyrsten Brinkley @ Kyrsten.brinkley@mtha.org 406-370-0875 (3) Eastern Healthcare Coalition: (a) Greg Simon@ greg.simon@mtha.org 406-478-2950 (4) Southern Healthcare Coalition: (a) Casey Driscoll casey.driscoll@mtha.org 406-457-8045 Page 3 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
(5) Montana Healthcare Coalition link: https://www.mthcc.org/ As always, let us know if you have any questions about the above or any of your hospital association’s resources. Yours in service, Sean Becker Montana Hospital Association VP Shared Services, MHA Ventures Office: (406) 457-8019 | Mobile: (406) 581-7571 | sean@mtha.org 2625 Winne Ave, Helena MT 59601 www.mtha.org | Facebook | Twitter Page 4 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
MONTANA MADE COVID19 RESPONSE PRODUCTS: The Montana Manufacturing Extension Center (MMEC) has been working with the manufacturing community to source COVID-19 related materials and supplies. Below is a list of local companies that have pivoted to support our hospitals’ response to the global pandemic. MHA is strongly encouraging you to reach out to our local partners to meet your supply needs. The combined impact of strengthening your supply chains and putting these local businesses back to work will help us #beatCOVID19inMT. Current Montana Based suppliers: Hand Sanitizer: Capacity: 50,000 100ml bottles per week • Diamond Products, Helena https://www.diamondproductsinc.com/ • All American Pharmaceutical https://allamericanpharmaceutical.com/staff-directory/ • Wildrye Distilling, Bozeman https://wildryedistilling.com/contact/ • Crawford Distillery, Havre https://www.facebook.com/crawforddistillery/ • Dry Hills Distillery, Bozeman https://www.dryhillsdistillery.com/ (406) 624-6713 • Bozeman Spirits, Bozeman https://www.bozemanspirits.com/welcome (406) 577-2155 • Montgomery Distillery, Missoula https://www.montgomerydistillery.com/ • Headframe Spirits, Butte http://www.headframespirits.com/contact/ • Glacier Distilling, Coram https://www.glacierdistilling.com/visit-us • Gulch Distillers, Helena https://gulchdistillers.com/contact/ • Willie’s Distillery, Ennis https://www.williesdistillery.com/contact/ • Spotted Bear Spirits, Whitefish http://www.spottedbearspirits.com/ Sewn face masks: Capacity: 3,000/week - No filter medium or filter medium other than N95 • Red Ants Pants/Bearpaw Outfitters, White Sulfur Springs https://redantspants.com/contact-us/ • Mystery Ranch, Bozeman https://www.mysteryranch.com/contact • West Paw, Bozeman https://www.westpaw.com/customer-service/our- team/customer-service#contactus • Pintlar Medical, Philipsburg http://www.pintlermedical.com/ • ReCreate Designs, Polson https://www.recreatedesigns.com/ Page 5 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
3D Printed Facemasks: Capacity: 1,500/week - No filter medium or filter medium • Montana Silversmiths, Columbus https://www.montanasilversmiths.com/contact-us • H-Parts Mining, Billings (406) 252-6682 https://www.h-eparts.com/sales-and-support/ • Thompson Precision, Kalispell http://thompsonprecision.com/contact/ • Tuscano Machining, Big Timber http://www.bigtimber.com/list/member/tuscano-machine- llc-244 • Autopilot, Bozeman https://www.autopilotdesign.com/ • Salient Technologies, Bozeman https://salient-tech.com/ Plastic Injection Molded Facemasks: 15,000/week - No filter medium • Spark R & D, Bozeman https://www.sparkrandd.com/contact/ • PDM, Manhattan https://www.makeitplastic.com/contact-pdm • Blackhawk, Manhattan https://blackhawk.com/contact-us/ • West Paw, Bozeman https://www.westpaw.com/customer-service/our- team/customer-service#contactus • Diversified Plastics, Missoula https://www.dpiplastics.com/contact-us/ • Cold Avenger, Missoula https://coldavenger.com/pages/contact-us • Salient Technologies, Bzn https://salient-tech.com/ • Creative Sales, Columbia Falls http://www.creativesalescompany.com/contact-us.html Sewn Surgical Gowns: Capacity: 100/week • Simms Fishing Products, Bozeman https://www.simmsfishing.com/ (888) 585-3570 • Red Oxx, Billings https://www.redoxx.com/travel/red-oxx-government- contract-capability-statement/ Plastic Face Shields: Capacity: 2,500/week • Ascent Vision, Belgrade https://ascentvision.com/contact-us/ • Coaster Cycles, Bonner https://www.coastercycles.com/ • Applied Materials, Kalispell http://www.appliedmaterials.com/ (406) 752-2107 Hospital Beds, Capacity: 50/week • SRS Crisafulli, Glendive https://www.crisafullipumps.com/ Wall Tents, Capacity 10/week • Montana Canvas, Belgrade https://montanacanvas.com/contact/ • Red Oxx, Billings https://www.redoxx.com/travel/red-oxx-government- contract-capability-statement/ If you are unable to make contact, are told that the company cannot fulfill the need, or don’t see what you are looking for, please contact Paddy Fleming at MMEC 406-249-9178 or pfleming@montana.edu. Page 6 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
ALTERNATIVE PPE, SUPPLIES AND EQUIPMENT VENDORS: Below is the list of vetted vendors that have either been passed to Montana Disaster and Emergency Services from other states and hospital associations or have completed purchase orders with the State of Montana. Earnest Su Josh Knoedler Robert Schaum BYD Care PPE 406-586-5970 40 Monroe Street BYD America jk@birddogdistributing.com Montgomery, Alabama 36104 (213) 880-8598 PPE 334-215-4440 ernest.su@byd.com bearmountaindevelopment@gmail.com 1800 S Figueroa St, Los Angeles, thermometers CA 90015 www.byd.com (See N95 info below) Derek Adams J.P. Neal Rhino Medical Supply 1340 Russell Cave Road 406-594-2983 www.rhinomedicalsupply.com Lexington, KY 40505 jp.n@fomsupplies.com Rod Puterbaugh 859-940-2492 thermometers Vice President of Sales Adams-Derek@galls.com rod@rhinomedicalsupply.com PPE Mike Coachys Cari Lautenschlaeger Garrett Grant 404-272-9196 303-921-5853 2721 Prosperity Ave. #300 mcoachys@litefighter.com Cari.Lautenschlaeger@grainger.com Fairfax, VA 22031 PPE PPE 571-378-1926 Garrett.grant@us21.com PPE Walter Morgan Freedom Medical Supply Turenne PharMedCo 3284 Northside Parkway, Suite 844-265-3206 https://www.turennepharmedco.com/ 600 Jeff Schweikert- dan.trahan@pmcoteam.com Atlanta, Georgia 30327 jschweikert@homecareppe.com ashley.barnett@pmcoteam.com 404-406-5710 wmorgan@medicraftsupply.com John Goodwin AND (605) 929-2998 Kerry O’Connell jgoodwin@nexvooinc.com Kerry@thesalesgroup.com www.nexvoo.com 406-930-2849 PPE/testing supplies PPE Page 7 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
NOTE ON NITRILE GLOVES: On July 6th, the Supply Chain Task Force received a situational briefing from one of the country’s largest distributors of nitrile gloves. Below is a summary of the discussion: Most nitrile gloves are produced in Malaysia (5-6 major factories), Vietnam, Thailand, and China. Most are currently running at 85-90% capacity after restarting production. These factories temporarily shut down for a few weeks when workers became ill from the COVID-19 outbreak in the March and April timeframe. Workers are now being monitored closely to prevent future shutdowns. Capacity in a normal year increases about 10% per year, as expansion of glove lines is very capital intensive. New capacity is coming online in Q4 2020 and Q1 2021. Bottom line: nitrile glove supply will remain very constrained into the near future. WHY DON’T WE PRODUCE NITRILE GLOVES IN THE U.S.? • Glove production is estimated to be 5-6x more expensive vs. gloves produced in the Pacific Rim • Impact to the environment — production utilizes a lot of fresh water • Timeline to start new production is 2+ years • High capital costs to start a new factory WHAT CAN YOU EXPECT IN THE NEXT 6 MONTHS: • Manufacturers are already indicating a price increase of 4% per month through December • Allocation process will remain in effect by major distributors to ensure widest availability across the nation • Secondary market prices are being driven up by speculators and brokers. Beware of secondary market scams. Brokers are buying inventory and capacity • New demand coming from a host of new customers due to COVID (i.e. schools, dental facilities, protein industry, etc., etc…) • Average demand is hovering around 4-6 billion pairs of gloves a month in the United States RECOMMENDATION: • Hospitals in need of gloves should submit a Resource Request Form through their state health departments to FEMA and HHS • Urge hospitals to follow the conservation recommendations put out by the CDC and HHS Resiliency Task Force as much as possible Page 8 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
NOTE ON REMDESIVIR: Remdesivir from Gilead, under the Emergency Use Authorization (EUA), has been approved for allocation and distribution in the US. Click here for more information on the five-step HHS and state health department allocation process. For more info on Remdesivir and the EUA, visit www.phe.gov. Availability & Allocation to Sites Remdesivir is not commercially available and is approved only through an EUA for the treatment of COVID-19. AmerisourceBergen is distributing Remdesivir at the direction of The Department of Health and Human Services (HHS) and state or territory departments of health. HHS will designate the amount of Remdesivir to each state, and in turn, the state health departments will allocate product to specific healthcare facilities in their states based on their COVID-19 hospital burden. Neither AmerisourceBergen nor Gilead can allocate product to health systems. Receiving Product at Designated Hospitals/Health Systems An AmerisourceBergen representative will proactively contact any site designated to receive product by their state health department. Sites must have an account with AmerisourceBergen’s specialty distribution business, ASD Healthcare, in order to purchase and receive allocated product. If a site does not currently have an existing relationship with AmerisourceBergen, they can proactively request an account setup by emailing sales@asdhealthcare.com and include their site name, address, and pharmacy license number. New accounts may either be directly billed by ASD Healthcare if the hospital does not use AmerisourceBergen as their primary wholesaler; or can be courtesy billed through AmerisourceBergen for current ABC customers. Pricing: Please see details from HHS and from Gilead for information on pricing of Remdesivir. Hospitals will receive the product shipped by AmerisourceBergen and will pay no more than Gilead’s Wholesale Acquisition Price (WAC). A treatment course of Remdesivir is, on average, 6.25 vials, which amounts to approximately $3,200 per treatment course and $520 per vial. Hospitals will be invoiced on the date of shipment. Given the unique circumstances around its distribution, Remdesivir will not be subject to any existing discounts or rebate programs offered by AmerisourceBergen or its subsidiaries. Remdesivir will be distributed by AmerisourceBergen at WAC or cost +0.00%. Delivery: The delivery of the purchased Remdesivir will be streamlined, going directly from AmerisourceBergen to the hospital, per the state or territory’s allocation decision. Timing: AmerisourceBergen expects this new process to begin within the first two weeks of July. Communication: With questions, sites can call the Remdesivir hotline at 877-987-4987 or email remdesivir@amerisourcebergen.com. Page 9 of 9 2625 Winne Ave | Helena, MT 59601 tel: 406.442.1911 | fax: 406.443.3894 | www.mtha.org
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N95 Particulate Respirator Foldable Non-sterile Very close facial fit ≥95% filtrations efficiency against solid and liquid aerosols free of oil. Picture is for reference only, actual product may have differences. Description The Particulate Respirator DE2322 is designed to help provide respiratory protection for the user. This product has a filter efficiency of 95% or greater against solid and liquid aerosols free of oil. This product contains no components made from natural rubber latex. Use instructions Suitable for protecting the mouth, nose, and chin to airborne particles and block 3-Step check before use liquid aerosols. 1. Do not use if packaging has been opened For adults use only. or damaged. Do not wash. 2. Check if elastic bands are in good condition Store in a cool, dry, clean place away from fire and contamination. and are not damaged. Store between -20℃ and 38℃ (-4°F and 100°F) with relative humidity below 80%. 3. Check that the metallic strip is not broken. Expiration date: 2 years after production. Wearing instructions Unfold the mask and hold it with both hands, with the metallic strip facing up. Place elastic bands around the neck and head respectively. Put the mask against your face covering both nose and mouth. Adjust the metallic strip cover bridge of the nose using two fingers to press down until achieving a close fit. Perform a fit check according to instructions. Fit check 1. Place both hands over mask. 2. Take a deep breath and hold your breath for a few seconds, making sure the mask collapses inward as you inhale. 3. Then exhale and hold your breath for a few seconds, making sure the mask bulges outward as you exhale. 4. If air leaks, reposition the mask, tighten the metallic strip and reposition the elastic bands for a better fit. Follow steps 1-3 again until a tight seal has been achieved. 5. Masks that have passed the fit check are now safe to use. 6. Facial hair or other facial features may prevent the mask from achieving a proper fit. If a tight seal is not achievable, please DO NOT use this product. 7. If you experience difficulty breathing, dizziness, or other symptoms, leave the contaminated area immediately.
N95 Particulate Respirator Foldable Non-sterile Specifications Nose clip Middle layer 1 Inner layer Polypropylene spunbond Aluminum nonwoven fabric Polypropylene Polypropylene Hot air cotton spunbond nonwoven Outer layer Elastic bands melt-blown nonwoven Middle layer 2 fabric Polypropylene melt-blown nonwoven Polypropylene Polyester/nylon spandex blend Hot air cotton spunbond nonwoven fabric Polypropylene spunbond nonwoven fabric Name Parameter Product name N95 Particulate Respirator Materials The following materials are used in the production of N95 Particulate Respirator. Inner layer: polypropylene spunbond nonwoven fabric; Middle layer: polypropylene melt-blown nonwoven + hot air cotton; Outer layer: polypropylene spunbond nonwoven fabric ; Elastic bands: polyester/nylon spandex blend; Nose clip: aluminum Product model DE2322 (Foldable) Packaging specification 1pc/bag; 20pcs/box; 960pcs/case WARNINGS 1. The mask does not eliminate the risk of contracting any disease or infection. 2. Improper use may lead to illness and even death. 3. Use this product immediately after package is opened. 4. Not recommended for more than 8 hours of use. 5. DO NOT sleep while wearing the mask. 6. Avoid hand contact within the interior part of the mask. 7. DO NOT use masks if they expired. 8. For one-time use only. Dispose the mask according to regulations. 9. DO NOT use if package is damaged. Time use limitation If the mask becomes damaged, soiled, or breathing becomes difficult, leave the contaminated area and replace and refit the new mask. Important notice 1. To the extent permitted by law, BYD shall not be liable for any loss or damage including any loss of business, loss of profits, or for any indirect, special, incidental or consequential loss or damage arising from reliance upon any information herein provided by BYD. Nothing in this statement will be deemed exclude or restrict BYD's liability for death or personal injury arising from its negligence. 2. Staples are used for strap fastening, it is normal that small punctures be found around the staples. Product sampling has been processed to ensure the respirators meet Part 84 approval requirement. 3. The process of the strap fastening has been strictly controlled. Any enlarged holes resulting from ripped filter material around staple punctures are considered as damage. 4. Filtering facepieces are to be inspected prior to each use to assure there are no holes in the breathing zone other than punctures around staples and no damage has occurred. 5. Before occupational use of this respirator, a written respiratory protection program must be implemented meeting all the local government requirements. In the United States, employers must comply with OSHA 29 CFR 1910.134 which includes medical evaluation, training, and fit testing.
N95 Particulate Respirator Foldable Non-sterile BYD Precision Manufacture Co.,Ltd. No.3001 Baohe Road, Baolong Industrial City, LongGang Street, LongGang District, Shenzhen, Guangdong Province, China +86-755-8988 8888 This respirator is approved only in the following configuration: TC- Protection1 Respirator Cautions and Limitations2 DE2322 84A-9221 N95 X ABCJMNOP 1. Protection N95 ‒ Particulate Filter (95% filter efficiency level). Effective against particulate aerosols free of oil; time use restrictions may apply. 2. Cautions and Limitations A- Not for use in atmospheres containing less than 19.5% oxygen. B- Not for use in atmospheres immediately dangerous to life or health. C -Do not exceed maximum use concentrations established by regulatory standards. J -Failure to properly use and maintain this product could result in injury or death. M-All approved respirators shall be selected, fitted, used, and maintained in accordance with MSHA, OSHA, and other applicable regulations. N-Never substitute, modify, add, or omit parts. Use only exact replacement parts in the configuration as specified by the manufacturer. O- Refer to User Instructions and/or maintenance manuals for information on use and maintenance of these respirators. P- NIOSH does not evaluates respirators for use as surgical masks. Approval and Standard GB 19083-2010 standard Distributed by Global Healthcare Product Solutions, LLC 1800 S. Figueroa Street, Los Angeles, CA 90015 1(800)293-2886 www.byd.care Scan and visit Scan and download Made in China BYD Care website BYD Care app
State of Montana, Vender Information Request for COVID19 1. In the table below, please identify item, total quantity and the minimum/maximum order you will accept. You may use the additional sheet attached if necessary. Total Quantity Minimum Maximum Item Description Available Purchase Order Purchase Order a. Where is the current location of the products? b. What is the estimated delivery time? 2. Is the delivery free on-board destination? Yes ☐ ☐No a. If no, what are the terms? b. Are the terms negotiable? Yes ☐ ☐No 3. What are your payment terms? a. Are the payment terms negotiable? Yes ☐ ☐No b. If payment upfront is required, are you opposed to setting up an escrow for payment? Yes ☐ ☐No c. Do you accept wire transfers? Yes ☐ ☐No i. If Yes, what is the process? ii. If Yes, who is your banking institution and location? d. Can you provide a valid and current W9? Yes ☐ ☐No 4. Do you currently have a contract with Montana, the Federal Government, Montana localities, other states, cooperative purchasing consortiums such as NASPO, US Communities, etc.? Page | 1
Yes ☐ ☐No 5. List company website and physical address of company. 6. Please provide up to three (3) references where similar goods have been provided. Each reference shall include: Reference 1: a. Organization name b. Mailing address c. Name of the contact person d. Telephone number e. Email address Reference 2: a. Organization name b. Mailing address c. Name of the contact person d. Telephone number e. Email address Reference 3: a. Organization name b. Mailing address c. Name of the contact person d. Telephone number e. Email address When submitting this form, please also include the following items: A price sheet for all available items. A product specification sheet denoting the Personal Protective Equipment (PPE) meets CDC, NIOSH, ANSI, FDA, USPHS, OSHA, etc. requirements. If payment is required up front, financial statements for the last two years. If necessary, use the attached table to identify additional resources. Additional Items may be listed in the Table Below Page | 2
Total Quantity Minimum Maximum Item Description Available Purchase Order Purchase Order Page | 3
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