Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: Exhibit A: Contract Terms Prompt Payment and Invoicing. Prompt Payment. The State will pay the Contractor pursuant to Minn. Stat. § 16A.124, which requires payment within 30 days following receipt of an undisputed invoice, or merchandise or service, whichever is later. Terms requesting payment in less than 30 days will be changed to read “Net 30 days.” Notwithstanding the foregoing, the State may pay the Contractor in advance for purchases as allowed pursuant to Minn. Stat. §16A.065. The payment for each order will only be made for goods received or services actually performed that have been accepted by the ordering entity, and meet all terms, conditions, and specifications of the Contract and the ordering document. Invoicing. At a minimum the invoice must meet the requirements found on Exhibit D which provides a list of minimum invoice requirements.
Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: Exhibit A: Contract Terms
Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: Exhibit A: Test Kit Information Ordering Entity: Ordering Authorized Representative: Ordering Entity Representative Contact Information: Delivery Address: [Attach spreadsheet if shipping to multiple addresses, indicate how many tests kits to each location] Date Purchase Requested: Funding String: Is a Courier Requested? [Indicate “Yes” or “No”. (Indicate “Yes” only if testing as a group with onsite supervision)] HIPAA Consent Do these tests require HIPAA consent to release data to organization in addition to patient? [Indicate “Yes” or “No”. ] Who Should Have Access to Dashboard Results? [Indicate name and email address of individual] When are tests needed by? [Please give the vendor at least 7 days] What frequency would you like the tests mailed to your entity or to participants? [Please describe how this should be done. Vendors likely are not going to deliver six months of tests at once. The order below should be for one installment of tests (e.g. if you need 100 tests a month, you should specify monthly here and the number below should be for 100 tests] What is the invoice schedule? [Vendor may invoice upon receipt of tests, or monthly based on tests taken] [Type of Test Definition and Directions At-Home—Test kits are sent to an individual’s home Bulk Order—Test kits are sent to a single location and distributed by the employer Employer-Proctored or Self Administered—Employer sets up and proctors testing Self Administered—Employee takes the test with no proctoring (check with your agency’s HR if this is an option and how it needs to be done to comply with Policy 1446)] Test Type Quantity Price per test Shipping (if not included with price per test) Total Cost Bulk Order, Employer Proctored or Self Administered $74.50-81 (depending on volume) $25 per shipment Bulk Order, Vendor Proctored $50 Included for weekday bulk return shipments of greater than 20 samples Program Administration Fees (dashboards, IT set-up, per person testing fee) N/A N/A Training N/A Included N/A Total State Obligation Vendors please add any notes you have about your pricing. For instance, minimum quantities ordered, cost of individual return bags, etc.) EXHIBIT B Data Privacy
Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: THIS SOLICITATION IS A ONE-TIME BUY AND WILL RESULT DIRECTLY IN A PURCHASE ORDER. NO SIGNATURES WILL BE REQUIRED. THE BELOW LANGUAGE WILL BE ADDED TO THE PURCHASE ORDER. This purchase order (PO) incorporates by reference all terms, conditions, and specifications of the Draft Contract attached to SWIFT Event [#####]. In case of a conflict of terms, the order of precedence shall be: First this PO and second the Draft Contract. Exhibit A: Contract Terms
Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: Exhibit A: Contract Terms Prompt Payment and Invoicing. Prompt Payment. The State will pay the Contractor pursuant to Minn. Stat. § 16A.124, which requires payment within 30 days following receipt of an undisputed invoice, or merchandise or service, whichever is later. Terms requesting payment in less than 30 days will be changed to read “Net 30 days.” Notwithstanding the foregoing, the State may pay the Contractor in advance for purchases as allowed pursuant to Minn. Stat. §16A.065. The payment for each order will only be made for goods received or services actually performed that have been accepted by the ordering entity, and meet all terms, conditions, and specifications of the Contract and the ordering document. Invoicing. The invoice must be in the same format as the sample invoice form approved as Exhibit D, Supplement 1 with the Contract, unless an alternative format is approved in writing by the State Authorized Representative, or delegate. See Exhibit D, Supplement 1 for a list of minimum invoice requirements. Assignment, Amendments, Waiver, and Contract Complete.
Commissioner of Administration As delegated to The Office of State Procurement. Print name: Print name: Signature: Signature: Title: Date: Title: Date: Distribution: Agency Contractor State’s Authorized Representative – photo copy Exhibit A: Contract Terms Prompt Payment and Invoicing. Prompt Payment. The State will pay pursuant to Minn. Stat. § 16A.124, which requires payment within 30 days following receipt of an undisputed invoice, or merchandise or service, whichever is later. Terms requesting payment in less than 30 days will be changed to read “Net 30 days.” Notwithstanding the foregoing, the State may pay the Contractor in advance for purchases as allowed pursuant to Minn. Stat. §16A.065. The payment for each order will only be made for goods received or services actually performed that have been accepted by the ordering entity, and meet all terms, conditions, and specifications of the Contract and the ordering document. Invoicing. The invoice must be in the same format as the sample invoice form submitted with the solicitation response and approved as an attachment with the Contract, unless an alternative format is approved in writing by the Contract Administrator. Each invoice should at a minimum include:
