RFP_11956_503A_Pharmacy_Services.pdf

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Attachment A Contact Information Cover Sheet

Request for Proposals SFGOV-

All fields are required. This form must be completed and included with Electronic File #2.

A. Proposer Information

Legal Name of Company (Proposer):

Legal name must include any "Doing Business As" (DBA). The name provided here must exactly match the name used in all submitted documents.

Business Address:

Federal Employee Identification Number:

California Business Entity Number:

City Supplier ID (if registered):

Telephone:

Cell Phone:

Contact Person:

Email Address:

B. Certification of Authority

I hereby certify that I have the authority to submit this Proposal to the City and County of San Francisco for the above listed individual or company. I certify that I have the authority to bind myself/this company in a contract should I be successful in my Proposal.

Printed Name:

Title:

Signature:

Date:

C. Business Type

The following information relates to the legal contractor listed above, whether an individual or a company. If successful, the contract language should refer to me/my company as (select one):

☐ An individual

☐ A partnership. Partners' names:

☐ A company

☐ A non-profit. Fiscal Sponsor's name (if applicable):

☐ A corporation. If a corporation, organized in the state of:

D. Representation Regarding Good Standing, Licenses, Etc.

A representation that the Proposer is in good standing in the State of California and has all necessary licenses, permits, approvals and authorizations necessary to perform the work and to operate as a business in the State of California and the City and County of San Francisco.

Please check the item below; failure to check the item may result in the Proposal being deemed non-responsive.

☐ I hereby represent and certify that the above statement is true and correct.

E. Representation Regarding City Contracting Requirements

A representation that the Proposer is able and willing to comply with all the contracting requirements described in this RFP. Please check all items below; failure to check all items may result in the Proposal being deemed non-responsive.

☐ I hereby represent and certify that the Proposer will comply with all contracting requirements, including the City's Contract Terms, as described in this RFP. The City reserves the right to terminate negotiations with any candidate that does not execute the City's Contract Terms.

☐ I hereby represent and certify that the Proposer will comply with all requirements of the Business Associate Agreement (BAA) and any attestations and/or attachments as presented in Attachment J (City's Contract Terms) of this RFP. The City reserves the right to terminate negotiations with any candidate that does not execute or agree to the Business Associate Agreement.

☐ I hereby represent and certify that the Proposer will comply with all San Francisco labor laws for City contractors.

1. Minimum Compensation Ordinance (MCO)

☐ MCO Declaration completed For more information about the MCO, please visit the MCO website. The Declaration is required even if your firm qualifies for an exemption under OLSE's list of approved exemptions. The MCO applies to all subcontractors, and Proposers are responsible for ensuring that their subcontractors comply with all MCO requirements.

2. Health Care Accountability Ordinance (HCAO)

☐ HCAO Declaration completed For more information about the HCAO, please visit the HCAO website. The Declaration is required even if your firm qualifies for an exemption under OLSE's list of approved exemptions. The HCAO applies to all subcontractors, and Proposers are responsible for ensuring that their subcontractors comply with all HCAO requirements.

https://www.sf.gov/information--minimum-compensation-ordinance http://sf.gov/sites/default/files/2024-03/MCO%202015%20List%20of%20Exemptions%20for%20the%20Minimum%20Compensation%20Ordinance-no%20mayor.pdf http://sf.gov/sites/default/files/2024-03/MCO%202015%20List%20of%20Exemptions%20for%20the%20Minimum%20Compensation%20Ordinance-no%20mayor.pdf https://www.sf.gov/information--health-care-accountability-ordinance https://www.sf.gov/sites/default/files/2022-12/9494-HCAO%20List%20of%20Exemptions.pdf https://www.sf.gov/sites/default/files/2022-12/9494-HCAO%20List%20of%20Exemptions.pdf

3. Health Care Security Ordinance (HCSO) For more information about HCSO, please visit the HCSO website.

4. First Source Hiring Form (FSH) – select one option For more information about FSH, please visit the FSH Program website.

☐ FSH completed (proof included in Proposal)

☐ FSH exception submitted to First Source (proof included in Proposal)

F. Addenda Acknowledgment

Acknowledgment of receipt of any addenda issued by the City for this RFP is required by including the acknowledgment with your Proposal. Failure to acknowledge the addenda issued may result in your Proposal being deemed non-responsive. In the space provided below, please acknowledge receipt of each addendum.

Addendum Number(s) Acknowledged:

https://www.sf.gov/information--health-care-security-ordinance https://www.sf.gov/comply-first-source-hiring-program

A. Proposer Information

B. Certification of Authority

C. Business Type

D. Representation re Good Standing, Licenses, Etc.

E. Representation Regarding City Contracting Requirements

F. Addenda Acknowledgment

Legal Name of Company Proposer:

Business Address:

Federal Employee Identification Number:

California Business Entity Number:

City Supplier ID if registered:

Telephone:

Cell Phone:

Contact Person:

Email Address:

Printed Name:

Title:

Date:

Fiscal Sponsor's Name:

Parnter Name:

Solicitation Title: 503A Sterile Compounding Pharmacy Services

Business Type Company: Off

Business Type Individual: Off

Business Type Partnership: Off

Business Type Nonprofit: Off

Business Type Corporation: Off

State of Corporation:

Certify Compliance with Business Associates Agreement: Off

Certify Compliance wth San Francisco Labor Laws: Off

MCO Declaration Completed: Off

HCAO Declaration Completed: Off

First Source Hiring Completed: Off

First Source Hiring Exception Completed: Off

Acknowledgement of Addendum Numbers:

Sourcing ID: 0000011956

Certify Compliance with City Terms: Off

Certify in Good Standing to Perform Work: Off

Attachment B

Non-Collusion Affidavit

A. Non-Collusion Affidavit

The undersigned deposes and says that they are a duly authorized representative of the party making the foregoing Proposal. The Proposal is not made in the interests of, or on behalf of, any undisclosed person, partnership, company, association, organization, or corporation. The

Proposal is genuine and not collusive or sham. The Proposer has not directly or indirectly induced or solicited any other Proposer to submit a false or sham Proposal, and has not directly or indirectly colluded, conspired, connived, or agreed with any Proposer or anyone else to submit a sham Proposal, or to have anyone refrain from proposing. The Proposer has not in any manner, directly or indirectly, sought by agreement, communication, or conference with anyone to fix the Proposal price of the Proposer or any other Proposer, or to fix any overhead, profit, or cost element of the Proposal price, or of that of any other Proposer, or to secure any advantage against the public body awarding the contract or anyone interested in the proposed contract. All statements contained in the Proposal are true. The Proposer has not, directly or indirectly, submitted its Proposal price or any breakdown thereof, or the contents thereof, or divulged information or data relative thereto, or paid, and will not pay, any fee to any corporation, partnership, company, association, organization, Proposal depository, or any other member or agent thereof to effectuate a collusive or sham Proposal.

Legal Name of Company (Proposer):

Authorized Representative’s Printed Name:

Authorized Representative’s Title:

Date:

Authorized Representative’s Signature:

A. Non-Collusion Affidavit

Legal Name of Company Proposer:

Authorized Representatives Printed Name:

Authorized Representatives Title:

Date:

Solicitation Title: 503A Sterile Compounding Pharmacy Services

Sourcing ID: 0000011956

Attachment C Reference Form

A. Reference 1

Name of Firm that Provided Products/Services to Reference (Prime or Subcontractor's

Name):

Organization Name:

Contact Name and Title:

Email:

Phone Number:

Effective Date of Contract:

End Date of Contract:

Value of Contract:

Description of Products/Services Provided:

B. Reference 2

C. Reference 3

Attachment C Reference Form

Request for Proposals SFGOV-___________

A. Reference 1

B. Reference 2

C. Reference 3

Solicitation Title: 503A Sterile Compounding Pharmacy Services

Reference 1 Name:

Reference 1 Organization Name:

Reference 1 Contact Name and Title:

Reference 1 Email:

Reference 1 Phone Number:

Reference 1 Effective Date of Contract:

Reference 1 End Date of Contract:

Reference 1 Value of Contract:

Reference 1 Description of Products or Services Provided:

Reference 2 Description of Products or Services Provided:

Reference 3 Description of Products or Services Provided:

Reference 2 Name:

Reference 2 Organization Name:

Reference 2 Contact Name and Title:

Reference 2 Email:

Reference 2 Phone Number:

Reference 2 Effective Date of Contract:

Reference 2 End Date of Contract:

Reference 2 Value of Contract:

Reference 3 Name:

Reference 3 Organization Name:

Reference 3 Contact Name and Title:

Reference 3 Email:

Reference 3 Phone Number:

Reference 3 Effective Date of Contract:

Reference 3 End Date of Contract:

Reference 3 Value of Contract:

Sourcing ID: 0000011956

Attachment D

Administrative Code Chapter 12L Compliance

A. Non-Profit Entities

If a Proposer is a non-profit entity that receives a cumulative total per year of at least

$1,000,000 in City funds or City-administered funds and is a non-profit organization as defined in Chapter 12L of the S.F. Administrative Code, the Proposer must describe how Proposer will comply with Chapter 12L.

Failure to comply with the reporting requirements of Chapter 12L or material misrepresentation in Proposer’s Chapter 12L submissions shall be grounds for rejection of the Proposal and/or termination of any subsequent Agreement reached on the basis of the

Proposal.

☐ This form is not applicable to my organization. My organization is a non-profit that does not receive a cumulative total per year of at least $1,000,000 in City funds or City-administered funds.

☐ This form is not applicable to my organization. My organization is not a non-profit.

B. Item #1: Public Access to Meetings and Records

A statement describing its efforts to comply with the Chapter 12L provisions regarding public access to Proposer’s meetings and records.

C. Item #2: Complaints and Disposition

A summary and disposition of all complaints concerning the Proposer’s compliance with

Chapter 12L that were filed with the City in the last two years and deemed by the City to be substantiated. If no such complaints were filed, the Proposer shall include a statement to that effect.

If you need more space for your explanation, please attach a separate document.

A. Non-Profit Entities

B. Item #1: Public Access to Meetings and Records

C. Item #2: Complaints and Disposition

Sourcing ID: 0000011956

Solicitation Title: 503A Sterile Compounding Pharmacy Services

Non Applicable Below Threshold: Off

Not Applicable Not a Non-Profit: Off

Item #1 Response:

Item #2 Response:

- 11 -

11/01/2025

CITY AND COUNTY OF SAN FRANCISCO

CONTRACT MONITORING DIVISION

CHAPTER 14B

CMD ATTACHMENT 2

Architecture, Engineering, and Professional Services

FORM 2A: CMD CONTRACT PARTICIPATION FORM

Section 1: This form must be submitted with the proposal or the proposal may be deemed non-responsive and rejected. Proposer, each Joint Venture partner, Subconsultants, Vendors, and lower sub tiers must be listed on this form. The RFP/RFQ will state which LBE size category (e.g., Micro, Small, and/or SBA-LBE) can be used to meet the LBE sub participation requirement(s). All LBE Proposers/JVs with LBE participation must meet the LBE sub participation requirement(s). Any LBE Proposer/JV with LBE participation may not count its participation towards meeting the LBE sub participation requirement(s). Be sure to check the appropriate box for Rating Bonus under Section 2. If more space is needed for Section 1, attach additional copies of this form.

*Type: Identify if Prime (P), JV partner (J), Subconsultant (S), or Vendor (V)

TY

PE

Firm

Portion of Work

(Describe Scope(s) of

Work)

% of Work

Indicate LBE or Non-LBE. If LBE, Micro, Small, or

SBA.

% of LBE Subwork (Carry-Over from % OF

Work Column)

Micro Small SBA

Total % of Work: 100% Total LBE Sub Participation: % % %

I declare, under penalty of perjury under the laws of the State of California, that I am utilizing the above Consultants for the portions of work and amounts as reflected in the proposal for this Contract.

Owner/Authorized Representative (Signature): _____________________ Date: _________________________

Print Name and Title: _____________________________________________________________________________

** See CMD website: http://www.sfgov.org/cmd for each firm’s status

Contract No.:

Contract Title: LBE SUBPARTICIPATION REQUIREMENT(S)

Firm: Micro and Small-LBE Sub Requirement – ___%

Contact Person: Micro, Small, SBA-LBE Sub Requirement – ___%

Address: Micro-LBE Sub Requirement - ___%

City/ZIP: Small-LBE Sub Requirement – ___%

Phone, Email: SBA-LBE Sub Requirement – ___% http://www.sfgov.org/cmd

- 12 -

Section 2. Rating Bonus

Check applicable boxes.

A. NO Rating Bonus Requested 0%

B. Contracts with an Estimated Cost in Excess of $400,000 and Less Than or Equal to $10,000,000. See instructions in Sections 2.01 and 2.02.

Micro or Small-LBE 10%

Joint Venture 7.5%

Joint Venture 5%

Joint Venture (Micro or Small-LBEs only) 10%

SBA-LBE 5%

C. Contracts with an Estimated Cost in Excess of the Delegated Purchasing Amount ($20,000 as of July 1, 2024) and Less Than or Equal to $10,000,000. The below rating bonuses DO NOT apply to Chapter 21 contracts and only apply to Chapter 6 contracts, including Chapter 6.40. See instructions in Section

2.01 for details. This Neighborhood/Zip Code LBE Program shall apply to projects located within the jurisdictional boundary of San Francisco. The program shall not apply to Job Order Contracts (JOC), As- Needed contracts, or other contracts where no specific project location is specified at the time of proposal. The RFP/RFQ will clearly state whether the Pilot Neighborhood/Zip Code LBE Program is applicable to the specific project. A Proposer may receive up to a maximum rating bonus of 13% depending on the particular application.

Prime Neighborhood/Zip Code LBE rating bonus:

Prime Neighborhood LBE (or a JV where the Neighborhood LBE JV partner(s)’ participation is at least 40%) 1%

OR

Prime Zip Code LBE (or a JV where the Prime Zip Code LBE JV partner(s)’ participation is at least 40%) 1.5%

Subconsulting Neighborhood/Zip Code LBE rating bonus:

Sub Neighborhood LBE 0.5%

OR

Sub Zip Code LBE 1.5%

D. Contracts in Excess of $10,000,000 and Less Than or Equal to $20,000,000. See instructions in Section 2.01.

Micro, Small, or SBA-LBE 2%

E. Mentor-Protégé Program Bid Discount/Rating Bonus. The Mentor Protégé rating bonus is not applicable to professional services contracts. However, for this CMD Attachment 2, the Mentor Protégé rating bonus/bid discount is applicable for Design-Build and/or CM/GC projects only. See instructions in Section 2.01.

Mentors of the Mentor-Protégé Program 1%

- 13 -

Section 3. Proposer, Joint Venture Partners, Subconsultant, and Vendor Information

Provide information for each firm listed in Section 1 of this form. Firms which have previously worked on City contracts may already have a vendor number. Vendor numbers of LBE firms are located on the CMD LBE website at http://www.sfgov.org/cmd. Use additional sheets if necessary.

FIRM NAME: VENDOR #:

ADDRESS: FEDERAL ID #:

CITY, ST, ZIP: PHONE: EMAIL:

SERVICE:

http://www.sfgov.org/cmd

Contract No:

Contract Title:

Firm:

Contact Person:

Address:

CityZIP:

Phone Email:

Micro and SmallLBE Sub Requirement: Off

Text30:

Micro Small SBALBE Sub Requirement: Off

Text31:

MicroLBE Sub Requirement: Off

Text32:

SmallLBE Sub Requirement: Off

Text33:

SBALBE Sub Requirement: Off

Text34:

Text201:

FirmRow1:

Portion of Work Describe Scopes of WorkRow1:

Text205:

Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA:

Text35:

Text39:

Text45:

Text202:

FirmRow2:

Portion of Work Describe Scopes of WorkRow2:

Text206:

Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_2:

Text36:

Text40:

Text46:

Text203:

FirmRow3:

Portion of Work Describe Scopes of WorkRow3:

Text207:

Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_3:

Text37:

Text41:

Text47:

Text204:

FirmRow4:

Portion of Work Describe Scopes of WorkRow4:

Text208:

Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_4:

Text38:

Text43:

Text48:

Text42:

Text44:

Text49:

Text1:

Date:

Print Name and Title:

NO Rating Bonus Requested 0: Off

Micro or SmallLBE 10: Off

Joint Venture 75: Off

Joint Venture 5: Off

Joint Venture Micro or SmallLBEs only 10: Off

SBALBE 5: Off

Prime Neighborhood LBE or a JV where the Neighborhood LBE JV partners participation is at: Off

Prime Zip Code LBE or a JV where the Prime Zip Code LBE JV partners participation is at least: Off

Sub Neighborhood LBE 05: Off

Sub Zip Code LBE 15: Off

Micro Small or SBALBE 2: Off

Mentors of the MentorProtégé Program 1: Off

FIRM NAME:

Text50:

ADDRESS:

Text51:

Text53:

Text54:

Text52:

Text55:

FIRM NAME_2:

Text56:

ADDRESS_2:

Text57:

Text71:

Text76:

Text58:

Text81:

FIRM NAME_3:

Text59:

ADDRESS_3:

Text60:

Text72:

Text77:

Text61:

Text82:

FIRM NAME_4:

Text62:

ADDRESS_4:

Text63:

Text73:

Text78:

Text64:

Text83:

FIRM NAME_5:

Text65:

ADDRESS_5:

Text66:

Text74:

Text79:

Text67:

Text84:

FIRM NAME_6:

Text68:

ADDRESS_6:

Text69:

Text75:

Text80:

Text70:

Text85:

GENERAL SERVICES AGENCY

OFFICE OF LABOR STANDARDS ENFORCEMENT

PATRICK MULLIGAN, DIRECTOR

SF OFFICE OF LABOR STANDARDS ENFORCEMENT, CITY HALL ROOM 430 MCO/HCAO TEL (415) 554-7903 • FAX (415) 554-6291

1 DR. CARLTON B. GOODLETT PLACE • SAN FRANCISCO, CA 94102 WWW.SFGOV.ORG/OLSE

Minimum Compensation Ordinance (MCO) Declaration

What the Ordinance does. The Minimum Compensation Ordinance (MCO) became effective October 8, 2000, and was later amended by the Board of Supervisors, with an effective date for the amendments of October 14, 2007. The MCO requires City contractors and subcontractors to pay Covered Employees a minimum hourly wage and to provide 12 compensated and 10 uncompensated days off per year. The minimum wage rate may change from year to year and Contractor is obligated to keep informed of the then-current requirements.

The MCO applies only if you have at least $25,000 in cumulative annual business with a City department or departments and have more than 5 employees, including employees of any parent, subsidiaries and subcontractors.

The City may require contractors to submit reports on the number of employees affected by the MCO.

Effect on City contracting. For contracts and amendments signed on or after October 8, 2000 the MCO will have the following effect:

In each contract, the contractor will agree to abide by the MCO and to provide its employees the minimum benefits the MCO requires, and to require its subcontractors subject to MCO to do the same.

If a contractor does not agree to provide the MCO’s minimum benefits, the City will award a contract to that contractor only if the contractor has received an approved exemption or waiver under MCO from the Office of Labor Standards Enforcement (OLSE) through the contracting Department. The contract will not contain the agreement to abide by the MCO if there is an exemption or waiver on file.

What this form does. If you can assure the City now that, beginning with the first City contract or amendment you receive after October 8, 2000 and until further notice, you will provide the minimum benefit levels specified in the MCO to your covered employees, and will ensure that your subcontractors also subject to the MCO do the same, this will help the City’s contracting process.

If you cannot make this assurance now, please do not return this form.

For more information, (1) see our Website, including the complete text of the ordinance: www.sfgov.org/olse, (2) e-mail us at: MCO@sfgov.org, (3) Phone us at (415) 554-7903.

Where to Send this Form. Submit this form via San Francisco’s centralized vendor portal sfcitypartnersupport@sfgov.org or call the Supplier Support Desk at 415-944-2442, Ext 1

Declaration

In order to be a certified vendor with the City and County of San Francisco, this company will provide, if applicable, the minimum benefit levels specified in the MCO to our Covered Employees, and will ensure that our subcontractors also subject to the MCO do the same, until further notice. This company will give such notice as soon as possible.

I declare under penalty of perjury under the laws of the State of California that the above is true and correct.

Signature Date

Print Name Bidder/Supplier # - if known

Company Name Phone Federal Employer ID #

ATTACHMENT F

mailto:MCO@sfgov.org https://sfcitypartner.sfgov.org/ mailto:sfcitypartnersupport@sfgov.org?Subject=Question%20to%20User%20Support

MCO Federal Employer ID#:

MCO Bidder or Supplier Number:

MCO Date:

MCO Print Name:

MCO Company Name:

MCO Area Code:

MCO Phone Number:

GENERAL SERVICES AGENCY

OFFICE OF LABOR STANDARDS ENFORCEMENT

PATRICK MULLIGAN, DIRECTOR

SF OFFICE OF LABOR STANDARDS ENFORCEMENT, CITY HALL ROOM 430 MCO/HCAO TEL (415) 554-7903 • FAX (415) 554-6291

1 DR. CARLTON B. GOODLETT PLACE • SAN FRANCISCO, CA 94102 WWW.SFGOV.ORG/OLSE

Health Care Accountability Ordinance (HCAO) Declaration

What the Ordinance Requires. The Health Care Accountability Ordinance (HCAO), which became effective July 1, 2001, requires Contractors that provide services to the City or enter into certain leases with the City, and certain Subcontractors, Subtenants and parties providing services to Tenants and Subtenants on City property, to provide health plan benefits to Covered Employees, or make payments to the City for use by the Department of Public Health (DPH), or, under limited circumstances, make payments directly to Employees.

The HCAO applies only to Contractors with at least $25,000 ($50,000 for non-profit organizations) in cumulative annual business with a City department(s) and have more than 20 Employees (50 Employees for non-profit organizations) including Employees of any parent or subsidiaries.

The City may require Contractors to submit reports on the number of Employees affected by the HCAO.

Effect on City Contracting. For contracts and amendments signed on or after July 1, 2001, the HCAO requires the following:

Each contract must include terms ensuring that the Contractor will agree to abide by the HCAO and either to provide its employees with health plan benefits meeting the Minimum Standards set forth by the Director of Health or to make the payments required by the HCAO;

All City Contractors must agree to comply with the requirements of the HCAO unless the Contracting Department has obtained an approved exemption or waiver under the HCAO from the Office of Labor Standards (OLSE).

Contractors must require any Subcontractors subject to the HCAO to comply with the HCAO:

The Purpose of This Declaration. By submitting this declaration, you are providing assurances to the City that, beginning with the first City contract or amendment you receive after July 1, 2001 and until further notice, you will either provide the health plan benefits meeting the Minimum Standards to your covered employees or make the payments required by the HCAO, and will ensure that your Subcontractors also abide by these requirements. If you cannot provide this assurance, do not return this form.

To obtain more information regarding the HCAO, Visit our website, which includes links to the complete text of the HCAO, at www.sfgov.org/olse/hcao; send an e-mail to HCAO@sfgov.org; or call (415) 554-7903.

Where to Send this Form. Submit this form via San Francisco’s centralized vendor portal sfcitypartnersupport@sfgov.org or call the Supplier Support Desk at 415-944-2442, Ext 1

Declaration

In order to be a certified vendor with the City and County of San Francisco, the company named below will either provide, if applicable, health benefits specified in the HCAO to our covered employees or make the payments required by the HCAO, and will ensure that our subcontractors that are subject to the HCAO also comply with these requirements, until further notice. The company named below will provide such notice as soon as possible.

I declare under penalty of perjury under the laws of the State of California that the above is true and correct.

Signature Date

Print Name Bidder/Supplier # - if known

Company Name Phone Federal Employer ID #

ATTACHMENT G

http://www.sfgov.org/olse/hcao mailto:HCAO@sfgov.org https://sfcitypartner.sfgov.org/ mailto:sfcitypartnersupport@sfgov.org?Subject=Question%20to%20User%20Support

HCAO Area Code:

HCAO Print Name:

HCAO Company Name:

HCAO Phone Number:

HCAO Date:

HCAO Bidder Supplier ID:

HCAO Federal Employer ID#:

Attachment H

First Source Workforce Projection Form and Fact Sheet

A. Submission Instructions

1. Proposers must complete and submit the required First Source Workforce Projection Form and Fact Sheet.

2. Upon successful submission, Proposers will receive a copy of the completed form via email.

3. A copy of this form must be included in the Proposal as Attachment H to verify that the form was submitted correctly and on time.

Registration with the San Francisco Office of Economic and Workforce Development’s data system is not necessary to submit the form and should not be completed during the solicitation process.

For more information, please visit the First Source Hiring Program website.

https://na2.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=7fbba84c-c5d8-47c0-8e57-7203f75c0932&env=na2&acct=674ac644-8feb-497f-9e7c-73837ca1bebe&v=2 https://www.sf.gov/comply-first-source-hiring-program

A. Submission Instructions

Solicitation Title: 503A Sterile Compounding Pharmacy Services

Sourcing ID: 0000011956

RFP SFGOV-0000011956

503A STERILE COMPOUNDING PHARMACY SERVICES

ATTACHMENT “M”

CITY’S CONTRACT TERMS

City and County of San Francisco

Office of Contract Administration

Purchasing Division

City Hall, Room 430

1 Dr. Carlton B. Goodlett Place

San Francisco, California 94102-4685

Agreement between the City and County of San Francisco and

[Insert name of contractor]

[Insert agreement number (if applicable)]

[Insert agreement title or brief description]

. Page | i

Table of Contents

Article 1 Definitions

Article 2 Term of the Agreement

Article 3 Financial Matters

Article 4 Services and Resources

Article 5 Insurance and Indemnity

Article 6 Liability of the Parties

Article 7 Payment of Taxes

Article 8 Termination and Default

Article 9 Rights in Deliverables

Article 10 Additional Requirements Incorporated by Reference

Article 11 General Provisions

Article 12 Department Specific Terms

Article 13 Data and Security

Article 14 Appendices

Article 15 MacBride And Signature

P-600 (DPH 02-26) 1 of XX Contract ID #

[insert Date] [insert contractor name]

This Agreement is made this [insert day] day of [insert month], [insert year], in the City and

County of San Francisco, State of California, by and between [name of Contractor]

(“Contractor”) and the City and County of San Francisco (“City”), acting by and through its

Department of Public Health.

Recitals

WHEREAS, the Department of Public Health (“Department”) wishes to procure [insert short description of the services City intends to buy] from Contractor; and

WHEREAS, Contractor represents and warrants that it is qualified to perform the Services required by City as set forth under this Agreement; and

[RFP] WHEREAS, Contractor was competitively selected pursuant to a Request for Proposals

(“RFP’) entitled [enter RFP name] issued through Sourcing Event ID [Enter Number]; and

[LBE requirements waived] WHEREAS, this is an agreement for Services and the Local

Business Enterprise (“LBE”) subcontracting participation requirement for the Services has been waived pursuant to waiver CMD14BXXXXXXX; and

[Single Contract] WHEREAS, approval for the Agreement was obtained on [insert date of Civil

Service Commission action or DHR approval date if under $200K] from the [Civil Service

Commission or Department of Human Resources on behalf of the Civil Service Commission] under PSC number [insert PSC number] in the amount of [insert Dollar Amount] for the period of [insert number of years]; and

[Multiple Contracts] WHEREAS, approval for the Agreement was obtained on [insert date of Civil Service Commission action or DHR approval date if under $200K] from the [Civil Service

Commission or Department of Human Resources on behalf of the Civil Service Commission] under PSC number [insert PSC number] which authorizes the award of multiple agreements, the total value of which cannot exceed [insert dollar amount] and the individual duration of which cannot exceed [insert number of years]; and

WHEREAS, the Department has filed Ethics Form 126f2 (Notice of Submission of Proposal) because this Agreement has a value of $100,000 or more in a fiscal year and will require the approval of [Choose all that apply an elected officer of the City, a board on which an elected officer of the City serves, a state agency on whose board an elected officer of the City’s appointee serves, and/or the Board of Supervisors]; and

WHEREAS, the Department has filed Ethics Form 126f4 (Notification of Contract Approval) because this Agreement has a value of $100,000 or more in a fiscal year and will require the approval of [Choose all that apply an elected officer of the City, a board on which an elected officer of the City serves, a state agency on whose board an elected officer of the City’s appointee serves, and/or the Board of Supervisors]; and

P-600 (DPH 02-26) 2 of XX Contract ID #

WHEREAS, the City’s Health Commission reviewed this Agreement on [insert date of Health Commission meeting] in the amount of [insert Dollar Amount] for the period commencing

[Insert Start Date] and ending [Insert End Date]; and

WHEREAS, the City’s [Board of Supervisors] approved this Agreement by [insert resolution number] on [insert date of Commission or Board action] in the amount of [insert Dollar

Amount] for the period commencing [Insert Start Date] and ending [Insert End Date]; and

Now, THEREFORE, the parties agree as follows:

Article 1 Definitions

The following definitions apply to this Agreement:

1.1 “Agreement” means this contract document, including all attached Appendices, and all applicable City Ordinances and Mandatory City Requirements specifically incorporated into this Agreement by reference as provided herein.

1.2 “Appendices” means the appendices listed in Article 14 (“Appendices”) herein.

1.3 “Artificial Intelligence” or “Artificial Intelligence Model” means an engineered or machine-based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it receives how to generate outputs that can influence physical or virtual environments.

1.4 “Artificial Intelligence System” means a machine-based system that is designed to operate with varying levels of autonomy and that may exhibit adaptiveness after deployment, and that, for explicit or implicit objectives, infers, from the input it receives, how to generate outputs such as predictions, content, recommendations, or decisions that can influence physical or virtual environments.

1.5 “Business Associate” or “BAA” has the meaning given to such term under HIPAA and its implementing regulations, including 42 U.S.C. Section 17938 and 45 C.F.R. Section

160.103, as may be amended from time to time.

1.6 “City” means the City and County of San Francisco, a municipal corporation, acting by and through both its Director of the Office of Contract Administration or the

Director’s designated agent, hereinafter referred to as “Purchasing” and the

Department of Public Health.

1.7 “City Data” means, all data collected, used, maintained, processed, stored, and/or generated by or on behalf of City in connection with this Agreement. City Data includes, without limitation, Confidential Information and Deliverable Data.

1.8 “CMD” means the Contract Monitoring Division of the City.

1.9 “Confidential Information” means confidential City information including, but not limited to, personal identifiable information (“PII”), protected health information

(“PHI”), or individual financial information (collectively, “Proprietary or Confidential

Information”) that is subject to local, state or federal laws restricting the use and

P-600 (DPH 02-26) 3 of XX Contract ID # disclosure of such information. Confidential Information includes, without limitation, City Data.

1.10 “Contractor” means [insert name and address of contractor].

1.11 “Deliverable Data” means any data that is required to be delivered to City as a

Deliverable, or as a part of a Deliverable, under this Agreement.

1.12 “Deliverables” means Contractor’s or its subcontractors’ work product, including any partially-completed work product and related materials, resulting from the Services provided by Contractor to City during the course of Contractor’s performance of the Agreement, including without limitation, the work product described in the “Scope of

Services” attached as Appendix A.

1.13 “Generative Artificial Intelligence” means Artificial Intelligence that can generate derived synthetic content, such as text, images, video, and audio, that emulates the structure and characteristics of the Artificial Intelligence’s training data.

1.14 “Health Care Component” has the meaning given to such term under HIPAA and its implementing regulations, including 45 C.F.R. Section 164.103, as may be amended from time to time.

1.15 “Hybrid Entity” has the meaning given to such term under HIPAA and its implementing regulations, including 45 C.F.R. Section 164.103, as may be amended from time to time.

1.16 “Mandatory City Requirements” means those City laws set forth in the San Francisco

Municipal Code, including the duly authorized rules, regulations, and guidelines implementing such laws that impose specific duties and obligations upon Contractor.

1.17 “Party” and “Parties” means City and Contractor either individually or collectively.

1.18 “Personal Identifiable Information (PII)” means information that identifies, relates to, describes, is reasonably capable of being associated with, or could reasonably be linked, directly or indirectly, with a particular individual or household. Personal information includes, but is not limited to, the following if it identifies, relates to, describes, is reasonably capable of being associated with, or could be reasonably linked, directly or indirectly, with a particular individual or household as further defined in the California Consumer Privacy Act.

1.19 “Services” means the work performed by Contractor under this Agreement as specifically described in the “Scope of Services” attached as Appendix A, including all services, labor, supervision, materials, equipment, actions and other requirements to be performed and furnished by Contractor under this Agreement.

Article 2 Term of the Agreement

2.1 Term. The term of this Agreement shall commence on [insert Contractor’s start date] and expire on [insert expiration date], unless earlier terminated as otherwise provided herein.

P-600 (DPH 02-26) 4 of XX Contract ID #

2.2 Options to Extend. City has the option to renew the Agreement for a period of [enter number of years]. City may exercise this option at City’s sole and absolute discretion by modifying this Agreement as provided in Section 11.5, “Modification of this Agreement.”

Extensions may be for the whole or partial period provided for above.

Option

1:

MMDDYY-MMDDYY

Option

2:

MMDDYY-MMDDYY

Article 3 Financial Matters

3.1 Certification of Funds; Budget and Fiscal Provisions

3.1.1 Termination in the Event of Non-Appropriation. This Agreement is subject to the budget and fiscal provisions of Section 3.105 of the City’s Charter. Charges will accrue only after prior written authorization certified by the Controller, and the amount of City’s obligation hereunder shall not at any time exceed the amount certified for the purpose and period stated in such advance authorization. This Agreement will terminate without penalty, liability or expense of any kind to City at the end of any fiscal year if funds are not appropriated for the next succeeding fiscal year. If funds are appropriated for a portion of the fiscal year, this Agreement will terminate, without penalty, liability or expense of any kind at the end of the term for which funds are appropriated. City has no obligation to make appropriations for this Agreement in lieu of appropriations for new or other agreements. City budget decisions are subject to the discretion of the Mayor and the Board of Supervisors.

Contractor’s assumption of risk of possible non-appropriation is part of the consideration for this Agreement.

THIS SECTION CONTROLS AGAINST ANY AND ALL OTHER PROVISIONS OF THIS

AGREEMENT.

3.1.2 Maximum Costs. City’s payment obligation to Contractor cannot at any time exceed the amount certified by City’s Controller for the purpose and period stated in such certification. Absent an authorized emergency per the City Charter or applicable Code, no City representative is authorized to offer or promise, nor is City required to honor, any offered or promised payments to Contractor under this Agreement in excess of the certified maximum amount without the Controller having first certified the additional promised amount and the

Parties having modified this Agreement as provided in Section 11.5, “Modification of this

Agreement.”

3.2 Authorization to Commence Work. Contractor shall not commence any work under this Agreement until City has issued formal written authorization to proceed, such as a purchase order, task order or notice to proceed. Such authorization may be for a partial or full scope of services.

P-600 (DPH 02-26) 5 of XX Contract ID #

3.3 Compensation.

3.3.1 Calculation of Charges and Contract Not to Exceed Amount. The amount of this Agreement shall not exceed [insert whole dollar amount in numbers and words], the breakdown of which appears in Appendix B, “Calculation of Charges.” City shall not be liable for interest or late charges for any late payments. City will not honor minimum service order charges for any Services covered by this Agreement.

3.3.2 Payment Limited to Satisfactory Services. Contractor is not entitled to any payments until City approves the Services delivered. Payments to Contractor by City shall not excuse Contractor from its obligation to replace the unsatisfactory Services even if the unsatisfactory character was apparent or could have been detected at the time such payment was made. Non-conforming Services may be rejected by City and in such case must be replaced by Contractor without delay at no cost to City.

3.3.3 Withhold Payments. If Contractor fails to provide the Services in accordance with Contractor’s obligations under this Agreement, City may withhold any and all payments due to Contractor until such failure to perform is cured, and Contractor shall not stop work as a result of City’s withholding of payments as provided herein.

3.3.4 Invoicing. Contractor shall invoice the City for the

[Commodities/Services] provided under this Agreement on a timely basis, and in no event later than [30] days after delivery of the [Commodities/Services] or as specified in Appendix B, Calculation of Charges, except for the last invoice of the fiscal year which must be submitted within [15] days before the end of July. Invoices submitted by Contractor must be in a form acceptable to the Controller and City and include a unique invoice number and a specific invoice date. Payment shall be made by City as specified in Section 3.3.7, or in such alternate manner as the Parties have mutually agreed upon in writing. All invoices must show the PeopleSoft Purchase Order ID Number, PeopleSoft Supplier Name and ID, Item numbers (if applicable), complete description of Services performed, sales/use tax (if applicable), contract payment terms and contract price. Invoices that do not include all required information or contain inaccurate information will not be processed for payment.

3.3.5 LBE Payment and Utilization Tracking System. LBE Subcontracting

Participation Requirements apply to this Agreement. Contractor shall: (a) within three (3) business days of City’s payment of any invoice to Contractor, pay LBE subcontractors as provided under Chapter 14B.7(H)(9); and (b) within ten (10) business days of City’s payment of any invoice to Contractor, confirm its payment to subcontractors using City’s Supplier Portal

Payment Module, unless instructed otherwise by CMD. Failure to submit all required payment information to City’s Supplier Portal Payment Module with each payment request may result in the withholding of twenty (20%) of subsequent payments due. Self-Service Training is located at this link: https://sfcitypartner.sfgov.org/pages/training.aspx.

3.3.6 Grant Funded Contracts.

(a) Grant Terms. The funding for this Agreement is provided in full or in part by a Federal or State Grant to City. As part of the terms of receiving the funds, City is https://sfcitypartnersfgov.org/pages/training.aspx

P-600 (DPH 02-26) 6 of XX Contract ID # required to incorporate some of the terms into this Agreement. The incorporated terms may be found in Appendix [insert the appendix letter], “Grant Terms.” To the extent that any Grant

Term is inconsistent with any other provisions of this Agreement such that Contractor is unable to comply with both the Grant Term and the other provision(s), the Grant Term shall apply.

(b) Disallowance. If Contractor requests or receives payment from

City for Services, reimbursement for which is later disallowed due to Contractor’s non-compliance with the Grant Terms, Contractor shall promptly refund the disallowed amount to City upon City’s request. At its option, City may offset the amount disallowed from any payment due or to become due to Contractor under this Agreement or any other agreement between Contractor and City.

(c) Subgrantees. Contractor shall insert each Grant Term into each lower tier subcontract. Contractor is responsible for compliance with the Grant Terms by any subcontractor, lower-tier subcontractor or service provider.

3.3.7 Payment Terms.

(a) Payment Due Date. Unless City notifies the Contractor that a dispute exists, Payment shall be made within [≥ 30] calendar days, measured from (1) the rendering of the Services or (2) the date of receipt of the invoice, whichever is later.

Payment is deemed to be made on the date City issued a check to Contractor or, if

Contractor agreed to electronic payment, the date City has posted electronic payment to

Contractor.

(b) Payment Discount Terms. The Payment Discount Terms for this

Agreement are as follows: [___] %/[___]Days, Net [___]. The Payment Discount period begins upon date of completion of delivery of the Services on a purchase order for which payment is sought, or upon date of receipt of properly prepared invoices covering such items, whichever is later. Payment is deemed to be made, for the purpose of earning the discount, on the date City issued a check to Contractor or, if Contractor has agreed to electronic payment, the date City posted electronic payment to Contractor.

3.4 Audit and Inspection of Records. Contractor agrees to maintain and make available to City, during regular business hours, accurate books and accounting records relating to its Services. Contractor will permit City to audit, examine and make copies of such books and records, and to make audits of all invoices, materials, payrolls, records or personnel and other data related to all other matters covered by this Agreement, whether funded in whole or in part under this Agreement. Contractor shall maintain such data and records in an accessible location and condition for a period of not less than five years after final payment under this Agreement or until after final audit has been resolved, whichever is later. Contractor shall include the same audit and inspection rights and record retention requirements in all subcontracts.

3.4.1 Contractor shall annually have its books of accounts audited by a

Certified Public Accountant and a copy of said audit report and the associated management

P-600 (DPH 02-26) 7 of XX Contract ID # letter(s) shall be transmitted to the Director of Public Health or his /her designee within one hundred eighty (180) calendar days following Contractor’s fiscal year end date. If Contractor expends $1,000,000 or more in Federal funding per year, from any and all Federal awards, said audit shall be conducted in accordance with 2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. Said requirements can be found at the following website address: https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl.

3.4.2 If Contractor expends less than $1,000,000 a year in Federal awards, Contractor is exempt from the single audit requirements for that year, but records must be available for review or audit by appropriate officials of the Federal Agency, pass-through entity and General Accounting Office. Contractor agrees to reimburse the City any cost adjustments necessitated by this audit report. Any audit report which addresses all or part of the period covered by this Agreement shall treat the service components identified in the detailed descriptions attached to Appendix A and referred to in the Program Budgets of Appendix B as discrete program entities of the Contractor.

3.4.3 The Director of Public Health or his / her designee may approve a waiver of the audit requirement in Section 3.4.2 above, if the contractual Services are of a consulting or personal services nature, these Services are paid for through fee for service terms which limit the City’s risk with such contracts, and it is determined that the work associated with the audit would produce undue burdens or costs and would provide minimal benefits. A written request for a waiver must be submitted to the DIRECTOR ninety (90) calendar days before the end of the Agreement term or Contractor’s fiscal year, whichever comes first.

3.4.4 Any financial adjustments necessitated by this audit report shall be made by Contractor to the City. If Contractor is under contract to the City, the adjustment may be made in the next subsequent billing by Contractor to the City, or may be made by another written schedule determined solely by the City. In the event Contractor is not under contract to the City, written arrangements shall be made for audit adjustments.

3.5 Submitting False Claims. The full text of San Francisco Administrative Code Section 21.35, including the enforcement and penalty provisions, is incorporated into this

Agreement. Any contractor or subcontractor who submits a false claim shall be liable to City for the statutory penalties set forth in that section.

3.6 Payment of Prevailing Wages.

3.6.1 Covered Services. Services to be performed by Contractor under this

Agreement will involve the performance of work covered by Articles 101 through 107 of the San Francisco Labor and Employment Code, as applicable, including without limitation the

California Labor Code provisions incorporated therein (collectively, “Covered Services”), all of which is incorporated into this Agreement as if fully set forth herein and will apply to any

Covered Services performed by Contractor and its subcontractors.

3.6.2 Wage Rates. The latest prevailing wage rates for private employment on public contracts as determined by the San Francisco Board of Supervisors, as such prevailing https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl

P-600 (DPH 02-26) 8 of XX Contract ID # wage rates may be changed during the term of this Agreement, are hereby incorporated as provisions of this Agreement. Contractor agrees that it shall pay not less than the highest general Prevailing Rate of Wages to all workers employed by Contractor who perform Covered

Services under this Agreement. Copies of the Prevailing Rate of Wages as fixed and determined in accordance with Labor and Employment Code Section 103.2 are available from the City’s

Office of Labor Standards and Enforcement (“OLSE”) and are on file at the Department’s principal office or at the job site and shall be made available to any interested party on request.

3.6.3 Subcontract Requirements. Contractor shall insert in every subcontract for the performance of Covered Services under this Agreement a provision requiring subcontractor to pay all persons performing labor in connection with Covered

Services under the subcontract not less than the highest general prevailing rate of wages as determined by the Board of Supervisors for such labor and services.

3.6.4 Job Site Notices and Records. Contractor shall prominently post at each job site a sign informing employees that the work is subject to the City’s Prevailing Wage requirements and that these requirements are enforced by OLSE. Contractor shall also maintain a sign-in and sign-out sheet in a format prescribed by OLSE showing which employees are present on the job site.

3.6.5 Payroll Records. Contractor shall keep or cause to be kept, for a period of four years from the date of completion of the subject work, complete and accurate payroll records for all workers performing Covered Services, including without limitations time cards, trust fund reports, apprenticeship agreements, accounting ledgers, tax forms, proof of payment, and superintendent and foreperson daily logs for all trades workers performing work.