STATE OF CONNECTICUT UNIVERSITY OF CONNECTICUT

REQUEST FOR PROPOSALUCHC RFP-10 FormNEW Rev. 10/08Prev. Rev. 5/07, 1/07ADDENDUM TO RFP8. Question: RFP-02, pg 1, #4: If required, the amount of proposal surety has been checked and the surety has beenincluded. Can you explain what this means and the “surety” that needs to be included?UCHC Reply: 5-2247 Large Infusion Pumps will not require a surety. RFP-02 is a general checklist for proposer’s use asa guide in the preparation of their response.9. Question: RFP-02, pg 2, #10: Refers to OPM Ethics Form on page 1, #7. Do they mean #8?UCHC Reply: Yes, this is a typographical error. Please refer to page one (1), item number eight (8).10. Question: RFP-03: Does this Document need to be completed? I don’t see this document indicated anywhere onthe RFP checklist? Just want to confirm.UCHC Reply: RFP-02 is a general checklist for proposer’s use as a guide in the preparation of their response. Please besure to read and follow any instructions included on each RFP form. RFP03 states in the text:IMPORTANT: ALL pages of this form, Sections 1 through 4, must be completed, signed and returned by the proposer aspart of the proposal package. Failure to complete and submit all pages of this form may constitute grounds for rejection ofyour proposal.”11. Question: Form C (11.1 or 11.3) and Form D (11.4) please clarify if these documents are only to be filled out uponaward of contract.UCHC Reply: Please refer to the table on page fifty-eight (58) of the RFP document for instructions on the required OPMethics forms that must be submitted with the response and/or at the time of actual contract execution. Form C and FormD are both Non-Discrimination certificates. Please refer to the information contained on each form to determine whichform is applicable to your company. Please note the form will be required at contract execution.12. Question: OPM Ethics Form 5 Please confirm what dates we are to use for Start Date and End Date.UCHC Reply: Please refer to the specific instructions printed on the Ethics Form. Additional information about the OPMEthics forms is available on the OPM website.(http://www.ct.gov/opm/cwp/view.asp?a 2982&q 386038&opmNav GID 1806#Definitions)a.b.If the bidder or vendor has entered into a consulting agreement, as defined by Connecticut General Statutes § 4a81(b)(1): Complete all sections of the form. If the bidder or vendor has entered into more than one suchconsulting agreement, use a separate form for each agreement. Sign and date the form in the presence of aCommissioner of the Superior Court or Notary Public.If the bidder or vendor has not entered into a consulting agreement, as defined by Connecticut General Statutes §4a-81(b)(1): Complete only the shaded section of the form. Sign and date the form in the presence of aCommissioner of the Superior Court or Notary Public.The dates would refer to the dates the consultant was under agreement with your company.12. Question: On RFP Form 2, you ask that form RFP Form 4 be included with the proposal, but then in RFP Form 4 Section16.1 it states the RFP should not be included. Do you just want the Technical Specifications pages 16-27 returned?UCHC Reply: Section 16.1 intends to inform Proposers they should not include a copy of the entire RFP ITSELF. (Thismeans a copy of the RFP instructions or other informational sections such as RFP timeline, etc.) Proposers DO have toinclude a complete RESPONSE to the RFP REQUIREMENTS, however,13. Question: If the Bid is returned on-line, will PDF copies be acceptable when signatures are required?14. Question: If the bid is returned on-line, will the pages have to be numbered, or just send the appropriate completedforms, and the other pertinent attachments, such as pricing, company information, and product literature?Page 6 of 9

REQUEST FOR PROPOSALUCHC RFP-10 FormNEW Rev. 10/08Prev. Rev. 5/07, 1/07ADDENDUM TO RFPUCHC Reply: To clarify for questions 13 and 14, the online submission should contain a PDF version of the response theproposer has signed and executed. UCHC requires proposers to submit the hard copy documents soon after electronicsubmission, no later than three (3) business days following a successful on line submission.RFP Section15.1 To submit a responsive proposal, proposers shall provide UCHC with one original complete responsesincluding itemized equipment list, equipment description/technical product data specifications and acceptance testprocedures (clearly marked) and two exact, legible copies of the proposal in clearly identified sealed envelopes or sealedboxes by the stated due date/time. In addition, fifteen exact electronic copies (compact disk or jump drive) of the entireproposal in a non-PDF format must be submitted with the original. Those required documents that are unable to beconverted into electronic format may be excluded from the electronic copy. All materials must be in Word or Excel exceptthose items such as pictures or signatures that cannot be scanned into a Word document.The remainder of this page is left intentionally blank.Pricing Proposal Summary to follow this page.Page 7 of 9

REQUEST FOR PROPOSALUCHC RFP-10 FormNEW Rev. 10/08ADDENDUM TO RFPPrev. Rev. 5/07, 1/07JDH 500 Channels5-2247 Large Volume IV PumpsProposal Pricing SummaryIV Pump Service MaintenanceCost Proposal for 500 IV PumpsWith WirelessSolutionProposal 1: Outright Capital PurchaseEquipment includes costs of tubing sets, servers,software and licensing for a five (5) year period.Replacing existing Alaris Medley Model 8000programming control units and model 8100 pumpmodules. 500 IV pumps channels configured as 200 IVpumps controllers and 200 pump modules and 200 IVpump standsCOST FOR 500 CHANNEL CONFIGURATION TOTAL: Cost per additional pumps: Proposal 2: Disposable or Lease Agreement Cost ScheduleTubing set up-charge or lease proposal to cover the costof the IV Pump System (pumps, servers, software andlicensing) under a 5 year agreement for 500 channelconfiguration.Cost per IV set: Lease cost per unit: Cost per additional pumps: Proposal 3: Combined IV Pump and IV Solutions and Sets AgreementAcquire both the new IV pump system (effective10/1/2010) and to commit to a new IV Solutions & Setsagreement at the expiration of UCHC's existing IVSolutions Agreement (effective 6/1/10)Cost per pump: Cost per IV set: Cost per solution: Total: Cost per additional pumps:Note: For Years 2-5 after initial warranty periodWithout WirelessSolutionFull ServiceTime and Materials Page 8 of 9

REQUEST FOR PROPOSALUCHC RFP-10 FormNEW Rev. 10/08ADDENDUM TO RFPPrev. Rev. 5/07, 1/07NICU and CMHCOption #1Large volume IV pumps without the drug librarycapability and without wireless connectivity. 21 singlechannel and 22 dual channel for use in the State ofConnecticut Correctional Institutions and 32 singlechannel for use in the UCHC NICU.Cost per pump:Trade in proposal to replace approximately 78 existingsingle and double channel large volume IV pumps(without drug libraries) which are owned by the clinics,NICU, CMHC and UCHC.Trade in amount:Option #2Proposal 1Proposal 2Outright Capital PurchaseDisposable or LeaseAgreement Cost ScheduleProposal 3Combined IV Pump and IVSolutions and SetsAgreement Proposal to use the Large Volume IV pumps to replaceexisting 130 Bard Model 300XL syringe pumps, currentlyused to administer antibiotics and other low volumesyringe pump administrationsCost:ALL OTHER TERMS, CONDITIONS AND REQUIREMENTS REMAIN UNCHANGEDEND OF ADDENDUMDate Issued: [January 22, 2010]Page 9 of 9

REQUEST FOR PROPOSALUCHC RFP-01 FormNEW Rev. 10/08Prev. Rev. 5/07, 12/06ACKNOWLEDGMENT: RECEIPT OF RFP DOCUMENTSSTATE OF CONNECTICUTUNIVERSITY OF CONNECTICUT HEALTH CENTERLynn BrownBuyer NamePURCHASING SERVICES DEPARTMENT263 Farmington Avenue, MC4036Farmington, CT 06032-4036lybrown@uchc.eduBuyer E-mail AddressRFP NUMBERPROPOSAL DUE DATE:PROPOSAL DUE TIME:5-2247February 2, 20103:30 PM Eastern Standard TimeRFP TITLE:Large Volume Infusion (IV) PumpsNOTE: This acknowledgement is crucial for proposal follow-up procedures. Once completed please fax this documentto 860-679-2508.Please check one of the following boxes:YES, submitting a proposalPLEASE TYPE THE FOLLOWING INFORMATION:COMPANY NAME:STREET ADDRESS:CITY, STATE, ZIP CODE:CONTACT NAME/TITLE:PHONE:E-MAIL:FAX:Page 1 of 1NO, not submitting a proposal

REQUEST FOR PROPOSALUCHC RFP-02 FormNEW Rev. 07/09Prev. Rev. 10/08, 5/07PROPOSER’S CHECKLISTSTATE OF CONNECTICUTUNIVERSITY OF CONNECTICUT HEALTH CENTERLynn BrownBuyer Namelybrown@uchc,eduBuyer E-mail AddressPURCHASING SERVICES DEPARTMENT263 Farmington Avenue, MC4036Farmington, CT 06032-4036RFP NUMBERPROPOSAL DUE DATE:PROPOSAL DUE TIME:5-2247February 2, 20103:30PM Eastern Standard TimeRFP TITLE:Large Volume Infusion (IV) PumpsREAD CAREFULLYCheckIT IS SUGGESTED THAT YOU REVIEW AND CHECK OFF EACH ACTION ITEM AS YOU COMPLETE IT1.Form UCHC RFP-01 (Acknowledgement: Receipt of RFP Documents) must be completed and returned at least48 hours before the proposal due date and time listed above.2.Form RFP-04 (Scope of Work) must be included with your proposal and contain the following:a.Vendor’s name must be in the upper right corner of all price schedule pagesb.The delivery information has been included with the proposal. Be specific: In most cases, “as ordered”or “as required” is not complete information.c.The proposal prices you have offered have been reviewed and verified.d.The price extensions and totals have been checked. In case of discrepancy between unit prices and totalprices, the unit price will govern the proposal evaluation.e.Any errors, alterations, corrections or erasures to unit prices or total prices must be initialed by theperson who signs the proposal or his/her designee. Such changes made and not initialed shall meanautomatic rejection of that portion of the proposal.f.The payment terms are Net 45 Days. You may offer cash discounts for prompt payment. Cashdiscounts for net terms less than 45 days may be considered when evaluating proposal pricing.Exception: State of CT Small Business Set-Aside proposal payment terms shall be in accordance withConnecticut General Statutes §4a-60j.3.Any technical or descriptive literature, drawing or proposal samples that are required have been included withthe proposal.4.If required, the amount of proposal surety has been checked and the surety has been included.5.Any addenda (UCHC RFP-09, UCHC RFP-10 Forms) to the RFP have been signed and included.6.Form UCHC RFP-11 (Proposer’s BOD Meeting Schedule Form) must be completed and returned with yourproposal7.Form UCHC RFP-05 (SEEC, CHRO, & W-9 Compliance) must be completed in its entirety and submitted witheach proposal, even if the Proposer’s company is family owned or operated, and regardless of the number ofemployees. Non-compliance may result in proposal rejection.8.If applicable, the following OPM Ethics Form(s) have been completed and attached:a) OPM Ethics Form 5 (Consulting Agreement Affidavit) – Contract Value of 50,000 or moreb) OPM Ethics Form 6 (Affirmation of Receipt of State Ethics Laws Summary) – Contract Cost of 500,000 or morePage 1 of 2

REQUEST FOR PROPOSALUCHC RFP-02 FormNEW Rev. 07/09Prev. Rev. 10/08, 5/07PROPOSER’S CHECKLIST9.The proposal is to be mailed or hand-delivered in time to be received no later than the designated opening dateand time. Late proposals are not accepted under any circumstances. Please allow enough time if you aremailing in your proposal.a) Please use the mailing label format below when submitting your proposal via mail.SEALED RFPNUMBER:5-2247NOT TO BE OPENEDUNTIL:February 2, 2010 3:30 PM ESTRETURNPROPOSAL TO:University of Connecticut Health Center263 Farmington Avenue MC 4036Farmington, CT 06032-4036b)Hand delivered proposals are to be presented at the following address:University of Connecticut Health CenterPurchasing Services Department16 Munson Road 2nd FloorFarmington, CT 0603210.Your submitted proposal may be rejected if the following requirements are not met:a) All proposal forms must be signed by a duly authorized representative of the company.b) Applicable OPM Ethics Forms referenced in item number (7.) above must be signed, notarized (whereapplicable), and returned with proposal.c) A duly authorized representative of the successful Proposer must sign Form UCHC-11.1 or UCHC-11.3 (NonDiscrimination Certification) and Form UCHC-11.4 (Certification of Resolution) upon execution of contract. Ifthe successful Proposer refuses to sign this form upon execution of the contract, UCHC will have the option tomake the award to the next Proposer or Proposers whose proposals UCHC deems to be the most advantageousto the State, in accordance with the criteria set forth in the RFP.11.PLEASE NOTE:- All proposals shall become the sole property of the University of Connecticut Health Center and will not bereturned.- Vendor may be asked to submit a UCHC RFP-08 Form (Proposer’s Statement of Qualifications) should UCHCdeem it necessary- You can register and submit your bid online at S FORM IS FOR YOUR USE AND IS NOT TO BE RETURNED WITH YOUR PROPOSALPage 2 of 2

REQUEST FOR PROPOSALUCHCRFP-03 FormNEW Rev. 07/09Prev. Rev.10/08, 8/07, 5/07PROPOSER’S INFO, OSHA & DEBARMENTSTATE OF CONNECTICUTUNIVERSITY OF CONNECTICUT HEALTH CENTER[Lynn Brown]Buyer NamePURCHASING SERVICES DEPARTMENT263 Farmington Avenue, MC4036Farmington, CT 06032-4036[lybrown@uchcc.edu]Buyer E-mail AddressRFP NUMBERPROPOSAL DUE DATE:PROPOSAL DUE TIME:5-2247February 2, 20103:30 PM Eastern Standard TimeRFP TITLE:Large Volume Infusion (IV) PumpsTERM OF CONTRACT: September 1, 2010 to August 31, 2015 with potential for two (2) two-year renewalperiods at the sole discretion of UCHC.REQUEST FOR PROPOSAL: Pursuant to the provisions of Sections 10a-151a, 10a-151b and 4a-57 of the Connecticut GeneralStatutes as amended, sealed proposals will be received by the Purchasing Services Department of the University of Connecticut HealthCenter, at the address above, for furnishing the commodities and/or services described above under RFP Title.IMPORTANT: ALL pages of this form, Sections 1 through 4, must be completed, signed and returned by the proposer as partof the proposal package. Failure to complete and submit all pages of this form may constitute grounds for rejection of yourproposal.SECTION 1 of 4: PROPOSER INFORMATIONCOMPLETE LEGAL BUSINESS NAME:P RI NT /T YPE LE GAL BUS I NE S S NAM ETAXPAYER ID # (TIN):A BOVEP RI NT /T YPESSNFEINSSN/FEIN A BOVEBUSINESS NAME, TRADE NAME, DOING BUSINESS AS (IF DIFFERENT FROM ABOVE):PRINCIPAL PLACE OF BUSINESS (IF DIFFERENT FROM ABOVE):BUSINESS AL/SOLE PROPRIETORSHIPTYPE OF CORPORATION:STATE ORGANIZED IN:NOTE: IF INDIVIDUAL/SOLE PROPRIETOR, INDIVIDUAL’S NAME MUST APPEAR IN THE LEGAL BUSINESS NAME BLOCK ABOVE.NOTE: IF YOUR BUSINESS IS A PARTNERSHIP, YOU MUST ATTACH THE NAMES AND TITLES OF ALL PARTNERSBUSINESS TYPE:A. SALE OF COMMODITIESB. MEDICAL SERVICESC. LEGAL SERVICESD. RENTAL OF PROPERTY(REAL ESTATE OR EQUIPMENT)E. NON-MEDICAL PROFESSIONAL SERVICESF. OTHER (DESCRIBE IN DETAIL)UNDER THIS TIN, WHAT IS THE PRIMARY TYPE OF BUSINESS YOU PROVIDE TO THE STATE?UNDER THIS TIN, WHAT OTHER TYPES OF BUSINESS MIGHT YOU PROVIDE TO THE STATE?BUSINESS ADDRESS:(ENTER LETTER ABOVE)(ENTER LETTER ABOVE)REMITTANCE ADDRESS:ADDRESS:CITY, STATE, ZIP CODE:Page 1 of 5

REQUEST FOR PROPOSALUCHCRFP-03 FormNEW Rev. 07/09Prev. Rev.10/08, 8/07, 5/07PROPOSER’S INFO, OSHA & DEBARMENTWEBSITE:IS YOUR BUSINESS CURRENTLY A DAS CERTIFIED SMALL BUSINESS ENTERPRISE?YES (Attach a copy of Certificate)NOIF SO PLEASE INDICATE WHAT TYPE OF SMALL BUSINESS ENTERPRISE?IS YOUR COMPANY REGISTERED WITH THE STATE OF CONNECTICUT SECRETARY OF THE STATE’S OFFICE TO DO BUSINESS IN THEYESNOSTATE OF CT?IF YOU ARE A CURRENT OR PREVIOUS STATE EMPLOYEE, INDICATE THE POSITION, AGENCY, AND AGENCY ADDRESS:FOR PURCHASE ORDER DISTRIBUTION :1) CHECK ONLY ONE BOX BELOWE-MAIL2) INPUT E-MAIL ADDRESS OR FAX# (IF CHECKED)FAXCONTACT NAME:E-MAIL ADDRESS:TELEPHONE NUMBER :TOLL FREE PHONE:FAX NUMBER:FOR RFP DISTRIBUTION :1) CHECK ONLY ONE BOX BELOWE-MAIL2) INPUT E-MAIL ADDRESS OR FAX# (IF CHECKED)FAXADD FURTHER BUSINESS ADDRESS, E-MAIL, & CONTACT INFORMATION BELOW IF REQUIRED:AFFIRMATION OF PROPOSERI being a duly authorized representative ofhereby certify as follows:1. agrees to be bound by all terms and conditions included in RFP# 5-2247dated December 15, 2009;2. If selected, further agrees to execute a contract with UCHC in a form provided byUCHC, containing all of UCHC’s terms and conditions (see sample contract attached as Exhibit A), and to execute all Stateof Connecticut affidavits and certifications (see forms included with this RFP), which are required at the time ofcontracting.3. The authority for the undersigned to bind is appended hereto.SIGNATURE OF PERSON AUTHORIZED TO SIGN ON BEHALF OF THE ABOVE NAMED PROPOSER:SIGN HERENAME OF AUTHORIZED PERSON:TITLE OF AUTHORIZED PERSON:P RI NT /T YPE NAME OF AUT HO RI ZE D P E RS ONP RI NT /T YPE TI T LE OF AUT HORI ZE D P E RS ONPage 2 of 5DATE EXECUTED:

REQUEST FOR PROPOSALUCHCRFP-03 FormNEW Rev. 07/09Prev. Rev.10/08, 8/

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