Business and Finance Division

Contracts and Procurement Department

Details of Purchase Order - 696-6-EU049814

Purchase Order
Texas Department of Criminal Justice
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Title Table

PURCHASE ORDER

TEXAS DEPARTMENT OF CRIMINAL JUSTICE
Tax Exempt Agency of Texas State Government

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Order Table
ORDER DATE:
04-15-16
INVITATION/REQUEST NO:
IT813073
PURCHASE ORDER NO:
696-6-EU049814
Agency Table
AGENCY NAME AND ADDRESS
TEXAS DEPT. OF CRIMINAL JUSTICE    
ACCOUNTS PAYABLE / 696-6-EU049814  
P.O. BOX 4018                      
HUNTSVILLE, TX 77342-4018          
DESTINATION OF GOODS
TDCJ                                   
HUMAN RESOURCES DIVISION               
TWO FINANCIAL PLAZA, SUITE 600         
HUNTSVILLE, TX  77340                  
Vendor Table
VENDOR NAME AND ADDRESS
MITCHELL COUNTY HOSPITAL DISTRICT
FAMILY MEDICAL ASSOCIATES

COLORADO CITY, TX 79512 3998
Vendor Data Table
VENDOR PHONE NO.
325 728 2693
VENDOR ID NO.
1751246488
PERSON CONTACTED:
MURRAY HALL
CASH DISCOUNT:
NET
%
DAYS OR NET 30
Data Table
Order Type:
E
F.O.B.:
DESTINATION
Freight Terms:
PREPAID
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Detail Table
ITEM          DESCRIPTION                 QTY       U/M        UNIT PRICE       EXTENSION
     THIS FOR THE PROCUREMENT OF DOT PHYSICALS FOR THE TDCJ DRIVERS
     IN THE COLORADO CITY AREA, IN ACCORDANCE WITH THE SPECIFICATIONS
     AND TERMS AND CONDITIONS INCLUDED HEREIN.
     THE TERM OF SUCH PO WILL BE APRIL 15, 2016 THROUGH AUGUST 31, 2016.
     ESTIMATED QUANTITIES:
     THE QUANTITIES INDICATED HERE ARE ESTIMATES ONLY AND SHALL NOT BE
     CONSTRUED AS A MINIMUM OR MAXIMUM THAT THE AGENCY MAY ORDER.  ORDERS
     WILL BE PLACED ON AN "AS NEEDED BASIS".  ANY QUANTITIES NOT ORDERED OR
     NOT DELIVERED BY AUGUST 31ST OF EACH CONTRACT YEAR WILL AUTOMATICALLY
     BE CANCELLED.
     THE TDCJ RESERVES THE RIGHT TO INCREASE/DECREASE THIS PO, INCLUDING
     ANY EXTENSION OPTIONS, AS DETERMINED TO BE IN THE BEST INTEREST OF
     THE STATE.  INCREASE SHALL NOT EXCEED 100% OF ORIGINAL ORDER.
     THE TDCJ RESERVES THE RIGHT TO INCREASE, DECREASE, CHANGE OR CANCEL
     THIS ORDER VIA PURCHASE ORDER CHANGE NOTICE (POCN).
     DEPARTMENT CONTACT:  DARLENE KELLEY 936-437-3664
001  948-74                               10.0000    EA         100.000000        1000.00
     DOT PHYSICALS FOR TDCJ DRIVERS IN THE COLORADO CITY AREA.
     SERVICE IS TO BE PROVIDED ON AN AS NEEDED BASIS.
     TDCJ DRIVERS OR THEIR SUPERVISORS WILL SET UP THEIR OWN APPOINTMENTS.
     IN ADDITION TO ACCOUNTS PAYABLE, PLEASE SEND A COPY OF THE INVOICE TO:
     HR HEADQUARTERS
     2 FINANCIAL PLAZA, SUITE 600
     HUNTSVILLE, TX 77340
     ATTN: CAROL WARREN
     PAYMENT:
      PAYMENT SHALL BE MADE THIRTY CALENDAR DAYS AFTER THE LATTER OF
      (1) THE DATE AN UNCONTESTED INVOICE IS RECEIVED, (2) THE DATE
      GOODS ARE RECEIVED, AND (3) THE DATE SERVICES ARE COMPLETED.
      REFER TO TEXAS GOVERNMENT CODE, CHAPTER 2251.
     VENDOR MAINTENANCE DIRECT DEPOSIT AND SUBSTITUTE W-9 FORM
     (ELECTRONIC FUNDS TRANSFER):
     GOVERNMENT CODE 403.016 (C) (3) ENCOURAGES STATE AGENCIES TO
     TRANSMIT PAYMENTS TO VENDORS THROUGH ELECTRONIC FUNDS TRANSFER
     (DIRECT DEPOSIT). TO SET UP YOUR ACCOUNT, CONTACT AGENCY ACCOUNTS
     PAYABLE AT (936)437-8761 OR (936)437-6357.
     REGARDLESS AS TO WHETHER DIRECT DEPOSIT IS CHOSEN, THE AWARDED
     VENDOR SHALL SUBMIT A COMPLETED VENDOR MAINTENANCE DIRECT
     DEPOSIT AND SUBSTITUTE W-9 FORM TO TDCJ ACCOUNTS PAYABLE. VENDORS
     WHO HAVE ALREADY SUBMITTED A FORM FOR ANOTHER SEPARATE PURCHASE
     ORDER ARE NOT REQUIRED TO SUBMIT ANOTHER FORM. THE VENDOR FORM AND
     INSTRUCTIONS ARE FOUND AT THE FOLLOWING LINK ON THE TDCJ WEBSITE:
     WWW.TDCJ.STATE.TX.US/DIVISIONS/BFD/ACCT_ACCTS_PAY.HTML
     TO ENROLL FOR ADVANCE NOTIFICATION OF ELECTRONIC FUNDS TRANSFER TO
     YOUR ACCOUNT, PLEASE CONTACT THE NUMBERS LISTED ABOVE. PAYMENT
     INFORMATION MAY BE OBTAINED BY CALLING THE COMPTROLLER OF PUBLIC
     ACCOUNTS TOLL FREE AT (800) 531-5441, EXT. 3-3660 OR IN AUSTIN, TEXAS
     CALL (512) 936-3461, SELECT OPTION 3 (PIN NOT REQUIRED) AND ENTER
     THEIR VENDOR IDENTIFICATION NUMBER AND 696 FOR THE AGENCY NUMBER.
     INFORMATION IS AVAILABLE VIA THE INTERNET AT:

     HTTPS://FMX.CPA.TEXAS.GOV/FMX/PAYMENT/INDEX.PHP
     (NOTE: THIS ADDRESS MUST BE IN LOWER CASE LETTERING WHEN ENTERED
     IN THE ADDRESS BAR OF YOUR BROWSER.)
     SHIPPING AND INVOICE INSTRUCTIONS:
     FAILURE TO FOLLOW THESE SHIPPING AND INVOICE INSTRUCTIONS MAY RESULT
     IN MERCHANDISE BEING REJECTED AT THE RECEIVING DOCK AND RETURNED TO
     THE VENDOR WITHOUT NOTICE.
     SHIPPING INSTRUCTIONS:
     1. ENSURE ITEM(S) IS SENT TO THE CORRECT UNIT/DEPARTMENT WITHIN THE
        TDCJ AS LISTED ON THE PURCHASE ORDER.
     2. DO NOT OVERSHIP. OVERAGES SHALL BE RETURNED AT THE VENDOR'S EXPENSE
        UNLESS ITEMS ARE OF INDETERMINABLE QUANTITY SUCH AS SAND OR GRAVEL.
     3. SHIP INDIVIDUAL LINE ITEMS COMPLETE.
     4. EACH PART SHIPPED SHALL HAVE A PART NUMBER OR BE TAGGED WITH A PART
        NUMBER AS IT APPEARS ON THE PURCHASE ORDER. IF ITEMS ARE SHIPPED
        WITHOUT A PART NUMBER, THEY WILL BE RETURNED TO THE VENDOR AT
        VENDOR'S EXPENSE.
     5. INCLUDE OR MARK PURCHASE ORDER NUMBER ON ALL PACKING SLIPS,
        CARTONS, PACKAGES, BUNDLES, ETC.
     INVOICING INSTRUCTIONS:
     1. THE INVOICE MUST BE ITEMIZED WITH THE DESCRIPTION, UNIT PRICE, UNIT
        OF MEASURE AND EXTENSION EXACTLY AS LISTED ON THE PURCHASE ORDER.
     2. ONLY ITEMS LISTED ON THE PURCHASE ORDER MAY BE BILLED AND PAID FOR
        BY THE TDCJ.
     3. ANY CHANGES TO THE PURCHASE ORDER ARE ONLY VALID UPON RECEIPT OF A
        PURCHASE ORDER CHANGE NOTICE (POCN) FROM THE AUTHORIZED PURCHASER.
     4. INVOICES MUST REFERENCE THE PURCHASE ORDER NUMBER.  ONLY ONE
        PURCHASE ORDER NUMBER ON AN INVOICE. (PURCHASE ORDER NUMBER ALWAYS
        BEGINS WITH AN 'E', EXAMPLE - EX000123)
     5. VENDOR MUST SUPPLY A VALID PAYEE IDENTIFICATION NUMBER (PIN) ON
        EACH INVOICE.
     6. INVOICES MUST BE SENT TO ACCOUNTS PAYABLE, P.O. BOX 4018
        HUNTSVILLE, TX 77342-4018.
        *ONLY DISCOUNTED INVOICES MAY BE EMAILED.
     7. DISCOUNTED INVOICES MUST BE EMAILED TO
        TDCJ.AP-INVSVS@TDCJ.TEXAS.GOV.
     8. SUBMIT SEPARATE INVOICES FOR EACH SHIPMENT/PER LOCATION.
     IN ACCORDANCE WITH SECTION 2252.907, GOVERNMENT CODE, THE VENDOR
     ACKNOWLEDGES THAT THIS CONTRACT AND INFORMATION CREATED OR
     MAINTAINED IN CONNECTION WITH THIS CONTRACT IS PUBLIC INFORMATION
     AND SUBJECT TO DISCLOSURE AS PROVIDED BY CHAPTER 552, GOVERNMENT
     CODE (TEXAS PUBLIC INFORMATION ACT).  THE PUBLIC INFORMATION ACT
     MAY REQUIRE THE VENDOR TO MAKE INFORMATION RELATED TO THIS CONTRACT
     AVAILABLE TO THE PUBLIC PURSUANT TO A REQUEST FOR PUBLIC INFORMATION.
     THE VENDOR AGREES, UPON REQUEST, TO MAKE INFORMATION RELATED TO THIS
     CONTRACT THAT IS NOT OTHERWISE EXCEPTED FROM RELEASE BY THE PUBLIC
     INFORMATION ACT AVAILABLE TO THE PUBLIC IN HARD COPY, UNLESS THE
     REQUESTOR OF THE INFORMATION CONSENTS TO RECEIVE THE INFORMATION IN
     ANOTHER MUTUALLY AGREEABLE FORMAT. THE VENDOR ACKNOWLEDGES THAT THE
     AGENCY SHALL NOT PROVIDE LEGAL COUNSEL RELATED TO THE VENDOR'S

     COMPLIANCE WITH THE PUBLIC INFORMATION ACT.
     FOR QUESTIONS OR INQUIRIES CONTACT:
     MARQUE FITTS, CTCD CTCM
     TDCJ CONTRACTS AND PROCUREMENT
     TWO FINANCIAL PLAZA STE. 525
     HUNTSVILLE, TX 77340
     PH: 936-437-7116  FAX:  325-223-0310
     EMAIL:  MARQUE.FITTS@TDCJ.TEXAS.GOV
ORDER TOTAL:$      1,000.00

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Authorization Table
Name of Authorized Purchaser Signature of Authorized Purchaser
All terms and conditions set forth in the referenced Invitation/Request become a part of this purchase order. In accordance with your bid/offer, item(s) must be received at the destination address on or before 04/15/2016
Seller agrees that any payments due under this contract will be applied towards any debt, including but not limited to delinquent taxes and child support that is owed to the State of Texas.
STATE AND CITY SALES TAX EXEMPTION: The undersigned claims an exemption from taxes under Chapter 151, Section 309, Texas Tax Code, for the purchase of services/tangible personal property purchased from the contractor and/or shipper listed above, as these are being secured for the exclusive use of the State of Texas.
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