Common use of Additional Fields Clause in Contracts

Additional Fields. Contracted price with state per contract terms List price (Market + fee contracts use market price) Purchase Order, Payment Card, Other Delivered date to customer Order date Number of items purchased/provided Description of unit of measure (see example) Unit of Measure United Nations Standard Products and Services Code® State Agencies, Universities, Political Subdivisions, Other Eligible Users Additional detail for item Additional grouping for item Description of the product category Manufacturer, Publisher, Provider Given name of Item Your product part number if applicable Company State Term Contract No. Address Contract Expiration Date City Reporting Date State Zip Code Contact State of FL Vendor # Email Reporting Period Calendar Fiscal Year CQ12007 FYQ12007 Sample Contact Phone Number Total Sales (List) $0.00 (Calculated automatically) EA - Each Total Sales (Contract) $0.00 CS - Case ID Part Number/SKU Model Number/ Product Description MFG Item Category Item SubCategory Item / Service Name Customer, Agency, or Other Eligible UNSPSC Code UOM Order Date Purchase Order No. List Price Net Price Total ListPrice Total Net Price Total List Price Contract Price Total Contract Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 1372102103_U Invitation to Bid/Request for Proposal/Invitation to Negotiate/SPA No. Bidder/Respondent is required to furnish the percent (%) savings in prices offered compared to retail, list, published or other usual and customary prices that would be paid by the purchaser without benefit of a contract resulting from this bid. DATE COMPETITIVE PRICES OFFERED AVERAGE % SAVINGS. HOW CAN WE VERIFY THE CLAIMED SAVINGS (example: retail or other usual and customary prices published at [url], or other source of benchmark prices)? AUTHORIZED SIGNATURE: TELEPHONE NUMBER: BIDDER/RESPONDENT NAME: IF CONTRACT AWARDED, STATE PURCHASING ANALYST/SPECIALIST TOOK THE FOLLOWING STEPS TO VERIFY SAVINGS: WHAT WERE THE RESULTS? PURCHASING ANALYST/SPECIALIST: Pest Control Services Department of Management Page 1 of 1 Solicitation No: ITB 13-72102103-U Respondent Vendor Name: Xxxxxx XXXX: Vendor’s Authorized Representative Name and Title: Address: City: State: Zip: Phone Number: Email Address: _ Section 287.135, Florida Statutes, prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs. Certified By: , Authorized Signature Print Name and Title: Date: Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U ITB posted in the VBS and in the MFMP Sourcing Tool. 02/26/2015 Optional Site Visit Start 03/02/2015 Optional Site Visit End 03/13/2015 Deadline to submit questions via the MFMP Sourcing Tool Q&A Board. 2:00 PM 03/17/2015 Department’s anticipated posting of answers to Bidders’ questions within the MFMP Sourcing Tool. 03/24/2015 Deadline to submit bid and all required documents in MFMP Sourcing Tool. 2:00 PM 03/31/2015 Bid Opening-0000 Xxxxxxxxx Xxx, Xxxxxxxxxxx, Xxxxxxx 32399 2:01 PM 03/31/2015 Anticipated date to post Notice of Intent to Award. 04/07/2015 Anticipated contract start sate 12:00AM 05/03/2015 Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U

Additional Fields. Contracted price with state per contract terms List price (Market + fee contracts use market price) Purchase Order, Payment Card, Other Delivered date to customer Order date Number of items purchased/provided Description of unit of measure (see example) Unit of Measure United Nations Standard Products and Services Code® State Agencies, Universities, Political Subdivisions, Other Eligible Users Additional detail for item Additional grouping for item Description of the product category Manufacturer, Publisher, Provider Given name of Item Your product part number if applicable Company State Term Contract No. Address Contract Expiration Date City Reporting Date State Zip Code Contact State of FL Vendor # Email Reporting Period Calendar Fiscal Year CQ12007 FYQ12007 Sample Contact Phone Number Total Sales (List) $0.00 (Calculated automatically) EA - Each Total Sales (Contract) $0.00 CS - Case ID Part Number/SKU Model Number/ Product Description MFG Item Category Item SubCategory Item / Service Name Customer, Agency, or Other Eligible UNSPSC Code UOM Order Date Purchase Order No. List Price Net Price Total ListPrice Total Net Price Total List Price Contract Price Total Contract Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 1372102103_U Invitation to Bid/Request for Proposal/Invitation to Negotiate/SPA No. Bidder/Respondent is required to furnish the percent (%) savings in prices offered compared to retail, list, published or other usual and customary prices that would be paid by the purchaser without benefit of a contract resulting from this bid. DATE COMPETITIVE PRICES OFFERED AVERAGE % SAVINGS. HOW CAN WE VERIFY THE CLAIMED SAVINGS (example: retail or other usual and customary prices published at [url], or other source of benchmark prices)? AUTHORIZED SIGNATURE: TELEPHONE NUMBER: BIDDER/RESPONDENT NAME: IF CONTRACT AWARDED, STATE PURCHASING ANALYST/SPECIALIST TOOK THE FOLLOWING STEPS TO VERIFY SAVINGS: WHAT WERE THE RESULTS? PURCHASING ANALYST/SPECIALIST: Pest Control Services Department of Management Page 1 of 1 Solicitation No: ITB 13-72102103-U Respondent Vendor Name: Xxxxxx XXXXVendor FEIN: Vendor’s Authorized Representative Name and Title: Address: City: State: Zip: Phone Number: Email Address: _ Section 287.135, Florida Statutes, prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs. Certified By: , Authorized Signature AUTHORIZED SIGNATURE Print Name and Title: Date: Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U ITB posted in the VBS and in the MFMP Sourcing Tool. 02/26/2015 Optional Site Visit Start 03/02/2015 Optional Site Visit End 03/13/2015 Deadline to submit questions via the MFMP Sourcing Tool Q&A Board. 2:00 PM 03/17/2015 Department’s anticipated posting of answers to Bidders’ questions within the MFMP Sourcing Tool. 03/24/2015 Deadline to submit bid and all required documents in MFMP Sourcing Tool. 2:00 PM 03/31/2015 Bid Opening-0000 Opening-4050 Xxxxxxxxx Xxx, Xxxxxxxxxxx, Xxxxxxx 32399 00000 2:01 PM 03/31/2015 Anticipated date to post Notice of Intent to Award. 04/07/2015 Anticipated contract start sate 12:00AM 05/03/2015 Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U

Additional Fields. Contracted price with state per contract terms List price (Market + fee contracts use market price) Purchase Order, Payment Card, Other Delivered date to customer Order date Number of items purchased/provided Description of unit of measure (see example) Unit of Measure United Nations Standard Products and Services Code® State Agencies, Universities, Political Subdivisions, Other Eligible Users Additional detail for item Additional grouping for item Description of the product category Manufacturer, Publisher, Provider Given name of Item Your product part number if applicable Company State Term Contract No. Address Contract Expiration Date City Reporting Date State Zip Code Contact State of FL Vendor # Email Reporting Period Calendar Fiscal Year CQ12007 FYQ12007 Sample Contact Phone Number Total Sales (List) $0.00 (Calculated automatically) EA - Each Total Sales (Contract) $0.00 CS - Case ID Part Number/SKU Model Number/ Product Description MFG Item Category Item SubCategory Item / Service Name Customer, Agency, or Other Eligible UNSPSC Code UOM Order Date Purchase Order No. List Price Net Price Total ListPrice Total Net Price Total List Price Contract Price Total Contract Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 1372102103_U Invitation to Bid/Request for Proposal/Invitation to Negotiate/SPA No. Bidder/Respondent is required to furnish the percent (%) savings in prices offered compared to retail, list, published or other usual and customary prices that would be paid by the purchaser without benefit of a contract resulting from this bid. DATE COMPETITIVE PRICES OFFERED AVERAGE % SAVINGS. HOW CAN WE VERIFY THE CLAIMED SAVINGS (example: retail or other usual and customary prices published at [url], or other source of benchmark prices)? AUTHORIZED SIGNATURE: TELEPHONE NUMBER: BIDDER/RESPONDENT NAME: IF CONTRACT AWARDED, STATE PURCHASING ANALYST/SPECIALIST TOOK THE FOLLOWING STEPS TO VERIFY SAVINGS: WHAT WERE THE RESULTS? PURCHASING ANALYST/SPECIALIST: Pest Control Services Department of Management Page 1 of 1 Solicitation No: ITB 13-72102103-U Respondent Vendor Name: Xxxxxx XXXX: Vendor’s Authorized Representative Name and Title: Address: City: State: Zip: Phone Number: Email Address: _ Section 287.135, Florida Statutes, prohibits agencies from contracting with companies, for goods or services over $1,000,000, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. Both lists are created pursuant to section 215.473, Florida Statutes. As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs. Certified By: , Authorized Signature Print Name and Title: Date: Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U ITB posted in the VBS and in the MFMP Sourcing Tool. 02/26/2015 Optional Site Visit Start 03/02/2015 Optional Site Visit End 03/13/2015 Deadline to submit questions via the MFMP Sourcing Tool Q&A Board. 2:00 PM 03/17/2015 Department’s anticipated posting of answers to Bidders’ questions within the MFMP Sourcing Tool. 03/24/2015 Deadline to submit bid and all required documents in MFMP Sourcing Tool. 2:00 PM 03/31/2015 Bid Opening-0000 Opening-4050 Xxxxxxxxx Xxx, Xxxxxxxxxxx, Xxxxxxx 32399 00000 2:01 PM 03/31/2015 Anticipated date to post Notice of Intent to Award. 04/07/2015 Anticipated contract start sate 12:00AM 05/03/2015 Pest Control Services Department of Management Services Page 1 of 1 Solicitation No: ITB 13-72102103-U