T2555 Offer and Acceptance Page Signed Redacted.pdf

OFFER AND ACCEPTANCE PAGE

STATE OF NEW JERSEY

DEPARTMENT OF THE TREASURY - DIVISION OF PURCHASE AND PROPERTY

33 WEST STATE STREET, P.O. BOX 230 TRENTON, NEW JERSEY 08625-0230

BID SOLICITATION # AND TITLE:

TO THE STATE OF NEW JERSEY:

Name of Bidder/Contractor Address

City, State, Zip Code Phone Number

Fax Number Email Address

FEIN

Print Name & Title of Authorized Representative

Signature Authorized Representative

By submitting a Quote the Bidder certifies and confirms that:

1. It has read, understands, and agrees to all terms, conditions, and specifications set forth in the Bid Solicitation and the State of New Jersey Standard Terms and

Conditions and agrees to furnish the goods, products, and/or services in compliance with those terms;

2. It has complied, and will continue to comply, with all applicable laws and regulations governing the provision of State goods and services, including the New Jersey

Conflicts of Interest Law, N.J.S.A. 52:13D-12 to 28;

3. The price(s) and amount of its Quote have been arrived at independently and without consultation, communication or agreement with any other Contractor/Bidder or any other party;

4. Neither the price(s) nor the amount of its Quote, and neither the approximate price(s) nor approximate amount of this Quote, have been disclosed to any other firm or person who is a Bidder or potential Bidder, and they will not be disclosed before the Quote submission;

5. No attempt has been made or will be made to induce any firm or person to refrain from bidding on this Contract, or to submit a Quote higher than this Quote, or to submit any intentionally high or noncompetitive Quote or other form of complementary Quote;

6. The Quote is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive Quote;

7. The Bidder, its affiliates, subsidiaries, officers, directors, and employees are not, to Bidder’s knowledge, currently under investigation by any governmental agency for alleged conspiracy or collusion with respect to bidding on any Contract and have not in the last five (5) years been convicted or found liable for any act prohibited by state or federal law in any jurisdiction involving conspiracy or collusion with respect to bidding on any Contract;

8. The Bidder's failure to meet any of the terms and conditions of the Contract shall constitute a breach and may result in suspension or debarment from further State bidding; and

9. A defaulting Contractor may also be liable, at the option of the State, for the difference between the Blanket P.O. price and the price bid by an alternate Vendor {Bidder} of the goods or services in addition to other remedies available.

ACCEPTANCE OF OFFER (For State Use Only) The Offer above is hereby accepted and now constitutes a Contract with the State of New Jersey. The Contractor is now bound to sell the goods, products, or services in accordance with the terms of the Bid Solicitation and the State of New Jersey Standard Terms and Conditions. The Contractor shall not commence any work or provide any good, product, or service under this Contract until the Vendor Contractor complies with all requirements set forth in the Bid Solicitation and receives written notice to proceed.

Effective Date

Contract/Master Blanket Purchase Order Number ward Date

State of New Jersey Authorized Signature Print Name and Title

DPP Rev. 1 . 3.202 e e

25DPP01119 - Internet-Based Patient Safety Adverse Event Reporting System

Mathtech, Inc.

One AAA Drive, Suite 102 Hamilton, NJ 086901 609-689-8520 609-689-8505 bwarden@mathtechinc.com

Steven Young

25-DPP-118918

09/18/2025 12/30/2025

Michael Dunn, Assistant Director

N.J.S.A. 47:1A-1, N.J.S.A. 1A-1.1 Personal identifying information