Document:

oxysure_ex1032.htm

EXHIBIT 10.32

 

	 	
Department of Veterans Affairs

Office of Acquisition and Logistics 

National Acquisition Center

P.O. Box 76

Hines, IL 60141

	 

 

 

	NOV 10,  2008	In Reply Refer To:

 

Mr. Julian Ross

OxySure Systems, Inc.

10880 John W. Elliott Road, Suite 600

Frisco, TX 75034

 

Dear Mr. Ross:

 

Enclosed is a copy of your Federal Supply Schedule Contract V797P-4153b effective November 15, 2008 through November 14, 2013 for items awarded under Solicitation Number RFP 797-FSS-99-0025-R5. This letter outlines the initial requirements of your newly awarded contract and also provides information on several clauses that you should be aware of for future contract actions.

 

ANNUAL REGISTRATION REQUIREMENTS1

 

You are required to file a VETS-100 report with the Department of Labor (DOL) by September 30th annually. The contractor is required to contact the Department of Labor by phone at (703) 461-2460 or website http://www.vet.s100.com to obtain the necessary information to complete the VETS-100 report (this website is best viewed using Internet Explorer 6.0 or above).

 

Contractors must also renew their Central Contractor Registration (CCR) once a year or the CCR database will cancel the registration. It is noted that OxySure Systems, Inc's registration is valid until July 11, 2009.   You may renew and update your CCR registration at: http://www.ccr.gov.

 

AFFIRMATIVE ACTION PLAN REQUIREMENTS2

 

As the estimated value of this contract exceeds $50,000 and your firm employs more than 50 your firm is required to develop and maintain a written Affirmative Action Plan (AAP) for each of its establishments within 120 days of contract award. You may seek technical assistance from the Office of Federal Contract Compliance Programs (OFCCP) at http://www.dol.gov/esa/ofccp/: this website provides useful contact information as well as a sample AAP for your reference.

 

The AAP is to be kept on file and implemented by the contractor - you are not required to submit it to the OFCCP unless they request it for the purpose of a compliance review; however, it is requested that you provide this office with confirmation of your compliance via fax or email.

 

 

 

1  FAR 52.222-37 Employment Reports on Disabled Veterans and Veterans of the Vietnam Era (Title 38 Section 4212)

2  Affirmative Action (AA) Compliance (41 CFR 60-1 & 60-2)(52.212-3(d))

 

  

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FSS PRICELIST REQUREMENTS

 

■      FSS Paper Pricelist

 

Contract Clause l-FSS-600, Contract Price Lists (pages 58-62 of your contract) requires you to prepare a VA Federal Supply Schedule Contract Price List for approval. Please carefully read and comply with the instructions covering the content and format of the VA FSS contract price list as stipulated in subparagraphs (2) and (3) (page 59) of this clause. Your VA FSS contract price list must contain all the information required and must be presented in the required format. If you choose to use your commercial catalog as your VA FSS contract price list all non-accepted/awarded items must be lined out or deleted and presented in acceptable manner determined by the Contracting officer. Please note that the use of this Government contract to solicit Government business for non-contract products is fraudulent and subject to prosecution.

 

Carefully read and comply with Clause l-FSS-600, Contract Price Lists subparagraph (5)3. This subparagraph requires that "proof copies of your Federal Supply Schedule Contract Price List, including cover letters, be submitted in duplicate to the Contracting Officer for review and approval prior to its formal printing and distribution. This action must be accomplished within 30 days after the date of award. Upon approval, one "proof copy will be returned to you with further instructions for formal printing and distribution. Failure to follow these instructions may cause you to reprint your FSS price list.

 

■      NAC-CM Pricelist

 

The contractor is also responsible for maintaining the NAC-CM database - a blank database template and instructions for completion shall be provided at time of contract award. Note that this database must be completed within 30 days after date of award and must be updated when the contract is modified.

 

■      GSA Advantage! Pricelist

 

In partnership with the General Service's Administration (GSA), VA will now maintain product data in GSA's online electronic ordering system, GSA Advantage! (pages 57-58). The VA/GSA Partnership now makes it possible for authorized VA Federal Supply Schedule (FSS) contractors to submit quickly and easily their contract product and pricing information electronically and for Federal government offices to shop and order via the Internet. Creating and submitting electronic catalogs (ECATs) is easy and at near zero cost using GSA's Schedule Input Program (SIP). Likewise, there is no additional charge to contractors or Federal government offices for orders placed through GSA Advantage! You may download the most recent release of the SIP by visiting http://vsc.fss.gsa.gov and linking to the "SIP Vendors" Section (at the top of the page). You have the choice of using SIP and the enclosed Start-up Kit, or you may make the decision to publish your contract information on GSA Advantage through third-party services. These companies charge a fee for their services.

 

This action must also be completed within 120 days after the date of award. Ordering facilities utilize the GSA Advantage program to search for and purchase products; therefore, it behooves you to complete these actions in a timely manner to make your products available for immediate purchase.

 

GSA ADVANTAGE! PO PORTAL

 

The "PO Portal" is a new website developed by GSA that allows you to easily view and print your GSA Advantage purchase orders. This site also allows you to download your orders in a number of formats including XLS, TXT, XML, or PDF. In addition, the PO Portal allows you to track your orders by submitting a status request to your customer via GSA Advantage. The PO Portal is available at https://www.poportal.qsa.gov.

 

3 I have included this specific text and a sample document for your reference.

  

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INDUSTRIAL FUNDING FEE AND REPORTING REQUIREMENTS

 

Contract Clause 552.238-74, Industrial Funding Fee and Sales Reporting (pages 63-64), requires that you submit, on a quarterly basis, the dollar value (in U.S. dollars and rounded to the nearest whole dollar) for all sales under the contract during the preceding 3-month period, to include any partial month. This report is required for each Special Item Number (SIN) under which you have been awarded items. The GSA Form 72, Contractor's Report of Sales provided with the award package, may be reproduced.

 

Reports are due on or before the 60th day following the completion of each quarter of the contract

(any partial month is to be considered as one month for reporting purposes). Sales for orders that extend beyond the contract period will be reported within 30 days of final payment.

 

Reports are required for all reporting periods even if no sales occurred; in addition a closeout report is required within 120 days after the expiration of the contract.

 

The Government reserves the right to inspect, without further notice, such records that pertain to sales under this contract. Further failure or refusal to furnish the required reports or falsification thereof, will constitute cause for terminating the contract for default in accordance with the provisions of your contract.

 

Contract Clause 552.238-74, Industrial Funding Fee and Sales Reporting, also requires that you pay the Department of Veterans Affairs (DVA) an Industrial Funding Fee (IFF) at the end of each contract quarter. The IFF shall be submitted at the same time as the GSA Form 72, Contractor's Report of Sales. The IFF equals 0.50% (one-half of one percent) of the total sales reported on the GSA Form 72. The IFF reimburses the DVA for the costs of operating portions of the Federal Supply Schedule Program and recoups its operating costs for ordering activities. This fee is included in the awarded price(s) and reflected in the total amount charged to ordering activities. Remittance for the IFF and your GSA Form 72 shall be submitted to our Fiscal Division. Remittance and Contractor's Reports of Sales should be addressed to:

 

Department of Veterans Affairs

C/O FSS Service (001AL-A2-2)

P.O. Box 76

Hines, IL 60141

 

The IFF amount due shall be paid by check or electronics funds transfer to the "Department of Veterans Affairs". Where multiple SIN(s) and/or contracts are involved, the IFF may be consolidated into one check. To ensure that the payment is credited properly, the Contractor should identify the check or electronic transmission as an "Industrial Funding Fee" and include the following information: contract number(s), report amount(s), and report period(s).

 

	
(1)    

	
If the IFF payment is made by check, it shall be forwarded to the address indicated above.

	
(2)    

	
If the IFF payment is to be made by electronic funds transfer through the Automated Clearing House (ACH), please refer to Clause 52.232-33 Payment by Electronic Funds Transfer - Central Contractor Registration, paragraph (c) for further instructions.

  

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IFF Payments shall be made via ACH Electronic Transfer of Funds using the following information:

 

	 	Receiver Information	 
	 	Company Name 

Street Address or P.O. Box

City, State, Zip Code

Company Contact

Contact Phone

Federal Taxpayer ID Number

	Department of Veterans Affairs 

P.O. Box 7005

Hines, IL 60141

Annette Crayton

708-786-7523

74 1612229

 

	 	Receiver Bank/Account Information	 
	 	Receiving Bank Name 

Receiving Bank Contact

Contact Phone

Receiving Bank City, State

Receiving Bank Routing/Transit Number

Receiving Bank Capability

Receiver's Account Number

Indicate version of 820 ACH format used by Receiving Bank

	Department of Treasury 

Cash Link ACH Receiver

301-887-6600

Richmond, VA

051036706

CCD+

220020 

Standard

	 	 	 	 
	 	Be sure to annotate the quarter being paid	
October - December 

January - March 

April - June

July -Sept

	1st Quarter 

2nd Quarter 

3rd Quarter 

4th Quarter

	 	 	 	 
	 	Be sure to include the contract number in addenda. Provide the last 5 digits of your contract number (4#s and the alpha)	e.g. V797P-XXXXB	 

 

NOTE: A report is required even when no sales occur during the reporting period.

 

NOTE: Vendor's sales report must include all Prime Vendor, Direct-to-Patient Distribution, and Department of Defense Distribution and Pricing Agreement (DAPA) program sales, as applicable.

 

If the full amount of the IFF is not paid within 60 calendar days after the end of the applicable reporting period, it shall constitute a contract debt to the United States Government under the terms of FAR 32.6. The Government may exercise all rights under the Debt Collection Act of 1982, including withholding or setting off payments and interest onto the debt (see FAR 52.232-17, Interest). Failure to submit sales reports, falsifications of sales reports and/or failure to pay the IFF in a timely manner may result in termination or cancellation of this contract. Willful failure or refusal to furnish the required reports, falsification of sales reports, or failure to pay the IFF in a timely manner constitutes sufficient cause to terminate this contract under FAR 52.212-4, paragraph (m) "Termination for Cause" (page 16).

  

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MODIFICATION CLAUSE REQUIREMENTS

In accordance with 552.243-72 Modifications (Multiple Award Schedule) (JUL 2000) (ALT I - SEP 1999) (page 64-66) contract modifications may be requested by the awardee at any time throughout the term of the contract. At a minimum every request shall describe the proposed change(s) and provide the rationale for the requested change(s). The Modification Request Form (a copy of which is enclosed with this award package) provides instructions on how to request, and what is required for the following types of modification actions:

	
-    

	
Product/SIN Additions

	
-    

	
Product Deletions

	
-    

	
Price Reductions

	
-    

	
Price Increases

	
-    

	
Administrative Changes

 

The effective date of the modification will occur on the 1st or 15th of the month.

 

Contractors are reminded that they must update their electronic pricelists (including the NAC-CM database and GSA Advantage!) and provide the CO with an updated paper pricelist for approval after receiving an executed copy of the requested modification.

 

ECONOMIC PRICE ADJUSTMENT CLAUSE REQUIREMENTS

 

Pursuant to 552.216-70 Economic Price Adjustment - FSS Multiple Award Schedule Contracts (SEP 1999) (ALT 1 - SEP 1999) (Local Deviation) (pg 66-67) contractors may request price increases when the following conditions are met:

	
-    

	
Increases result from a reissue or other modification of the Contractor's commercial catalog/pricelist that was used as the basis for contract award.

	
-    

	
Increases are requested before the last 60 days of the contract period.

	
-    

	
At least 30 days elapse between requested price increases.

 

The tracking customer's price must be disclosed with your request for increase. Note that the awarded tracking customer and the established ratio at the time of award will affect your ability to receive an increase.

 

The government reserves the right to accept the price increase as requested; negotiate better discount; or refuse the requested increase and remove the product(s) from the contract pursuant to the Cancellation clause of the contract.

 

PRICE REDUCTIONS CLAUSE REQUIREMENTS

 

In accordance with 552.238-75 Price Reductions (MAY 2004) (page 63-65) the contractor shall report all price reductions provided to the tracking customer within 15 days after the effective date of the reduction. A price reduction occurs if the contractor:

 

	
-     

	
Reduces awarded contract pricing by revising the commercial catalog, pricelist, schedule upon which contract award was predicated.

	
-     

	
Grants more favorable discounts or terms and conditions to the awarded tracking customer.

	
-     

	
Grants special discounts to the tracking customer and the change disturbs the price/discount relationship of the government to the tracking customer.

  

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Contractors are able to offer ad hoc discounts to the government without disturbing the tracking customer ratio. In addition, contractors are not required to pass on price reductions/special discounts provided to commercial customers other than the specified tracking ratio customer.

 

FSS CONTRACT NUMBER

 

The FSS contract number or other authorization for supplies delivered or services performed (including order number and contract line number) must be clearly identified on all invoices. In addition, all correspondence and documents pertaining to the contract shall be noted with the contract number.

 

ORDERING REQUIREMENTS

 

As appropriate, when goods are shipped to an ordering activity you are required to furnish to that activity, two (2) copies (unless otherwise specified in your contract) of a manual, handbook or brochure containing operation, installation and maintenance instructions (including pictures or illustrations, schematics and complete repair/test guides) as necessary. Where applicable, it will include electrical data and connection diagrams for all utilities. The instructions shall also contain a complete list of all replaceable parts showing parts showing part number, name and quantity required.

 

Products manufactured to metric dimensions will be considered on an equal basis with those manufactured using inch-pound units, providing they fall within the tolerances specified using conversion tables contained in the latest revision of Federal Standard No. 376 and all other requirements of this document are met.

 

EEO/FAIR LABOR STANDARDS ACT POSTERS

 

Finally, you are required to place the enclosed posters describing the Equal Employment Opportunity Act and the Fair Labor Standards Act in a prominent location for the duration of your contract.

 

The information in this letter and the documents referenced below are available the Medical Equipment & Supplies website: http://www1.va.gov/oamm/oa/nac/fsss/medequipsupfss.cfm.

 

Thank you in advance for your attention in these matters. If you have any questions, you may contact the undersigned at steen.corr@va.gov or (708) 786-5125.

 

 

Sincerely,

 

 

Enclosures:

1. Award/Contract (SF 1449)

2. Awarded Price List

3. Sample Paper Pricelist

4. GSA Advantage Start-Up Package

5. GSA Advantage Purchase Order Portal

6. GSA Form 72

7. Modification Request Form

 

  

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OxySure Systems, Inc.

Contract Number V797P-4153b

SUMMARY OF AWARD Addenda to SF 1449

 

The Contract consists of the following documents:

 

(a)   FAR 52.212-4 Contract Terms and conditions - Commercial Items and Addenda

 

(b)   GSA 552.212-72 Contract Terms and Conditions Required to Implement Statutes or Executive Orders - Commercial Item

 

(c)   OxySure Systems, Inc's offer signed May 19, 2008 and Amendment One dated 02/01/2007 signed June 30, 2008.

 

(d)   Revisions: Solicitation page 116 (7/24/08 & 9/18/08); and Solicitation page 117 (9/18/08).

 

(e)   Final Proposal Revision (FPR> Letter dated November 6, 2008.

 

(f)    Awarded discounts are taken from the OxySure Systems, Inc's Product Catalog Prices valid from June 19, 2008 through June 19, 2013 consisting on one (1) page.

 

A copy of the Discount Relationship (Government's Price vs. Most Favored Customer (MFC) Price) Ratio dated November 6, 2008 consisting of one (1) page, identifying those products accepted for award, is attached hereto and made a part hereof. Identification of awarded items is accomplished by a red "A".

 

(g)  Incorporated by reference: FAR 52.212-3 Offeror Representations and Certifications – Commercial Items

 

Terms and Conditions as agreed to are as follows:

 

(a)   Contract period of: November 15, 2008 through November 14, 2013

 

(b)   Discounts as identified on above cited Price List by Special Item Number (SIN) and /or Models and Maximum Order:

 

SIN                                                      Awarded Maximum Order

 

A-49                                                    $100,000

 

Product Number                                Basic Discount

615-00                                                    7.8%

615-01                                                  11.5%

615-03                                                  22.0%

615-04                                                  20.0%

615-05                                                    7.2%

 

(c) Minimum Order:                           None

 

  

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OxySure Systems, Inc. Contract Number V797P-4153b

 

(d)   Quantity Discount: Additional 3% taken off the FSS net price when 100 or more (mix or match) items are purchased.

 

(e)   Delivery Time: Within 30 days After Receipt of Order (ARO)

 

(f)    Expedited Delivery: Within 3 days After Receipt of Order (ARO). Government is responsible for the additional shipping charges between the normal surface rate and the expedited rate.

 

(g)   Prompt Payment: 1% 20 days, net 30

 

(h)   F.O.B. Destination Point(s): FOB Destination 48 contiguous States and the District of Columbia and point of exportation to destination in Alaska, Hawaii and Puerto Rico.

 

(i)    Warranty Provision: As stated in the attached Limited Warranty Information dated October 2008 consisting of three (3) pages.

 

(j)    Return/Exchange Goods Policy:

 

1.    Before any product may be returned, a Return Materials Authorization (RMA) Number must be secured. The RMA number can only be issued by OxySure's Customer Service. To assist in the return process, the ordering facility is required to provide Customer Service the following information:

(a)   OxySure Product Code and Lot Number

(b)  Quantity Customer wishes to return

(c)   Order Number Associated with the Product(s)

(d)  OxySure's Original Invoice Number

(e)   Reasons for Return

 

2.    All products returned shall be shipped to OxySure, freight prepaid, unless the return is due to OxySure error, such determination being made is the sole discretion of OxySure. On all international returns, OxySure will specify the method of shipment.

 

3.     Items eligible for full credit:

(a)   Products shipped in error

(b)   Products ordered in error, if authorized for return within thirty (3) days of receipt

(c)   Defective Products due to OxySure workmanship

 

4.     Items not eligible for return:

(a)   Custom products or products sold on a "No-return" basis

(b)   Goods held over ninety (90) days from the original invoice date

(c)   Partial cases or quantities less than minimum order quantity

(d)   Products unsalable due to re-design, preprocessing, revision, or obsolescence

(e)   Demonstration products

(f)   Products no longer in their original packaging, used, or damaged through no fault of OxySure

 

5.    A 15% Restocking Fee will be assessed on all returns authorized over thirty (30) days after the original invoice date.

  

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OxySure Systems, Inc.

Contract Number V797P-4153b

 

(k) Tracking Customer: In accordance with the Price Reduction Clause 552.238-72, the Government and OxySure Systems, Inc agree that City of Frisco is the identified tracking customer for whom the contract award is predicated. During the course of this contract, for any sales under the Maximum Order, the net price for any awarded item is reduced to the identified tracking customers the Government net price will be reduced proportionately.

 

The established ratios are shown on the attached spreadsheet titled Discount Relationship (Government Price vs. Most Favored Customer (MFC) Price) Ratio dated November 6, 2008 consisting of one (1) page.

 

(I) Annual Rebate: 1% annual rebate for sales under the contract that exceeds $500,000.00

 

(m) Exceptions: None

 

The lettered sections (a), (b), (c), (d), (e), (f), (g), (h),(i), and (j) above under "Terms and Conditions as agreed to" are required in the "Information for Ordering Activities" section of your Published Federal Supply Schedule Pricelist.

 

Your tax I.D. number is required to be included on the Published Price List to facilitate payment by ordering activities.

Please be advised, the sole purpose of funds provided by the accounting data in Block 25 of the Standard Form 1449 is to fund the guaranteed minimum of $2,500 as stated in contract clause l-FSS-106. However, the funds obligated at time of award do not constitute an order for supplies or services under this contract.

 

  

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Discount Relationship 

(Government's Price vs. Most Favored Customer (MFC) Price)

Ratio (Based on Lowest Quantity Pricing) 

SECOND AMENDMENT 

11/06/08

	

SIN

	 	

Product

Number

	 	

Product

Description

	

A-49

	 	

615-00

	 	

Model 615, Portable Emergency Oxygen Generator

	

A-49

	 	

615-01

	 	

Model 615, Disposable Replacement Cartridge

	

A-49

	 	

615-05

	 	

Surface Mounted Wall Box

	

A-49

	 	

615-03

	 	

Replacement Mask, ADULT

	

A-49

	 	

615-04

	 	

Replacement Mask, CHILD/PEDIATRIC

 

	

List

	 	 	

MFC

	 	 	

MFC

	 	 	

Gov't

	 	 	

Gov't

	 	 	 	 	 	

Net Gov’t

	 
	

Price*

	 	 	

Price

	 	 	

Discount

	 	 	

Price

	 	 	

Discount

	 	 	

Ratio

	 	 	

Price

	 
	$	361.00	 	 	$	361.00	 	 	 	0.0	%	 	$	333.91	 	 	 	7.5	%	 	 	0.92	 	 	$	333.91	 
	$	161.00	 	 	$	161.00	 	 	 	0.0	%	 	$	143.91	 	 	 	10.6	%	 	 	0.92	 	 	$	143.91	 
	$	374.00	 	 	$	374.00	 	 	 	0.0	%	 	$	362.03	 	 	 	3.2	%	 	 	0.92	 	 	$	362.03	 
	$	30.50	 	 	$	30.50	 	 	 	0.0	%	 	$	29.00	 	 	 	4.9	%	 	 	0.92	 	 	$	29.00	 
	$	32.50	 	 	$	32.50	 	 	 	0.0	%	 	$	32.00	 	 	 	1.5	%	 	 	0.92	 	 	$	32.00	 

 

* List Prices are FOB Frisco (OxySure's Headquarters), and include shipping charges.

 

Discount Relationship 

(Government's Price vs. Most Favored Customer (MFC) Price)

Ratio (Based on Highest Tier/Quantity Pricing)

 

	

SIN

	 	

Product

Number

	 	

Product

Description

	

A-49

	 	

615-00

	 	

Model 615, Portable Emergency Oxygen Generator

	

A-49

	 	

615-01

	 	

Model 615, Disposable Replacement Cartridge

	

A-49

	 	

615-05

	 	

Surface Mounted Wall Box

	

A-49

	 	

615-03

	 	

Replacement Mask, ADULT

	

A-49

	 	

615-04

	 	

Replacement Mask, CHILD/PEDIATRIC

 

	

List

	 	 	

MFC

	 	 	

MFC

	 	 	

Gov't

	 	 	

Gov't

	 	 	 	 
	

Price*

	 	 	

Price

	 	 	

Discount

	 	 	

Price

	 	 	

Discount

	 	 	

Ratio

	 
	 	361.00	 	 	$	361.00	 	 	 	0.0	%	 	$	323.08	 	 	 	10.5	%	 	 	 	 
	 	161.00	 	 	$	161.00	 	 	 	0.0	%	 	$	139.08	 	 	 	13.6	%	 	 	 	 
	 	374.00	 	 	$	374.00	 	 	 	0.0	%	 	$	350.81	 	 	 	6.2	%	 	 	 	 
	 	30.50	 	 	$	30.50	 	 	 	0.0	%	 	$	28.09	 	 	 	7.9	%	 	 	 	 
	 	32.50	 	 	$	32.50	 	 	 	0.0	%	 	$	31.03	 	 	 	4.5	%	 	 	 	 

* List Prices are FOB Frisco (OxySure's Headquarters), and inlcude shipping charges. ** Minimum order quantity per Purchase Order, 100 product units total, mix and match.

  

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GENERAL SERVICES ADMINISTRATION

Federal Supply Service

Authorized Federal Supply Schedule Price List

On-line access to contract ordering information, terms and conditions, up-to-date pricing, and the option to create an electronic delivery order are available through GSA Advantage!, a menu-driven database system. The INTERNET address GSA Advantage! is: GSAAdvantage.gov

Schedule Title: Medical Equipment and Supplies

Special Item Number (SIN) A-49

FSC Group 65, Part II, Section A

FSC Class(es): 6510, 6515, 6530, 6532

Contract Number: V797P-4153-b

For more information on ordering from Federal Supply Schedules click on the FSS Schedules button at fss.gsa.gov.

Contract period: November 15, 2008 through November 14, 2013

Contractor’s Name: Julian Ross, CEO

Contractor’s Address:              OxySure Systems, Inc.

                                                       10880 John W. Elliott Drive, Suite 600

                                                       Frisco, Texas   75034

Phone Number:                           (972) 294-6450

FAX Number:                              (972) 294-6501

Business Size:                            Small Business

  

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CUSTOMER INFORMATION

Prices Shown Herein are Net (discount deducted).

	
1a  

	
Table of Awarded Special Item Numbers:

 

	
SIN

	
Product Number

	
Product Name

	
A-49

	
615-00

	
Model 615, Portable Emergency Oxygen Generator

	
A-49

	
615-01

	
Model 615, Disposable Replacement Cartridge

	
A-49

	
615-03

	
Replacement Mask, ADULT

	
A-49

	
615-04

	
Replacement Mask, CHILD/PEDIATRIC

	
A-49

	
615-05

	
Surface Mounted Wall Box

 

	
1b 

	
Lowest Priced Model Number and Lowest Unit Price:

 

OxySure® Model 615, Portable Emergency Oxygen System                                                                                     Product No. 615-00

 

	 	OxySure® Model 615 Portable Emergency Oxygen System. Using OxySure's patented and revolutionary "oxygen from powder" technology, the OxySure® Model 615 produces medically pure oxygen for use BY A LAYPERSON in any medical emergency, prior to the first responders arriving on the scene. Just like an AED, Model 615 bridges the gap between the onset of an emergency and the time that the first responders arrive on the scene. It is safe for public display/storage and layperson use, requires no training and uses a simple 2-step actuation. Model 615 has been approved by the FDA for over-the-counter sale (no need for prescription or standing orders). The OxySure Model 615 system comes ready to be placed in service and includes a mask and OxySure's custom designed delivery tubing, both neatly stored in a custom plastic tray under the green cover. The system is reusable with Replacement Cartridges. See www.oxysurestore.com

 

	Product Specifications: 

Height: 12" (30.5 CM) | Width: 10" (25.4 CM) | Depth: 6" (15.2 CM) | Weight: 11 lbs.

Exposure Limits: Between 40°F and 160°F | Storage: Between 70°F and 86°F (Room Temperature)

Oxygen Volume: 90+ standard liters | Shelf Life: 2 Years

Approvals: FDA Clearance for Over-the-Counter Sale (no prescription or standing orders required)

	$333.91

 

OxySure® Model 615, Disposable Replacement Cartridge                                                                                        Product No. 615-01

 

	 	 OxySure® Model 615 Disposable Replacement Cartridge with Mask and Tray. OxySure's Replacement Cartridge is completely and safely disposable and easy to replace. The cartridge easily slides into the reusable outer housing. Its handle flips down when you close the housing lid, or flips up for easy lifting out of the housing. Each cartridge produces in excess of 15 minutes of medically pure (USP) oxygen at a minimum flow rate of 6 liters per minute, and is shipped with our standard Mask/Tray, which allows you to replace both these single-use items after use. The oxygen mask, with an easy quick connect, is stored neatly under the green cover so that it can be quickly accessed in the event of an emergency. Cartridges can be stored/stockpiled for medical or civil emergencies. Medical emergencies include cardiovascular, respiratory or general medical emergencies. For details see www.oxysurestore.com

 

	Product Specifications: 

Height: 10.00" (25.40 cm) | Width: 9.75” (24.76 cm) | Depth: 5.50" (13.97 cm) | Weight: 7.00 lbs

Exposure Limits: Between 40°F and 160°F | Storage: Between 70°F and 86°F (Room Temperature)

Oxygen Volume: 90+ standard liters | Shelf Life: 2 years

	$143.91

 

  

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Replacement Mask, ADULT                                                                                                                                            Product No. 615-03

 

		Model 615-03, OxySure® Replacement ADULT Mask with Tray. OxySure's ADULT Replacement Mask/Tray is a high concentration, partial re-breathing mask rated for oxygen flows of 6 to 15 liters per minute (LPM). The mask comes installed in our custom plastic tray that allows it to be stored neatly under the green cover so that it can be quickly accessed in the event of an emergency. The mask tray has a proprietary attachment that allows for a quick connection and guaranteed seal when attached to the system. The mask comes with OxySure's custom designed delivery tubing, which includes a 7 foot, kink-resistant safety tubing. Soft, clear anatomical form provides comfort for even hard-to-fit faces. Adjustable elastic band fits comfortably to hold mask snugly in place. See www.oxysurestore.com for details.

 

	Product Specifications (as installed in the mask tray): 

Height: 2 50" (6.35 cm) | Width: 9.75” (24.76 cm) | Depth: 5 00" (12.70 cm) | Weight: 0.35 lbs

Please note: OxySure's Replacement Mask/Tray is already included with each Model 615 System

as well as with each Replacement Cartridge order

	$29.000

 

Replacement Mask, CHILD/PEDIATRIC                                                                                                                     Product No. 615-04

 

	 	Model 615-04, OxySure® Replacement CHILD/PEDIATRIC Mask with Tray. OxySure's CHILD/PEDIATRIC Replacement Mask is an optional accessory. It is a high concentration, partial re-breathing mask rated for flows of 6 to 15 liters per minute (LPM). The mask comes installed on a plastic tray that is stored neatly under the green cover so that it can be quickly accessed in the event of an emergency. The proprietary attachment allows for a quick connection and guaranteed seal when attached to the system. The CHILD/PEDIATRIC mask must be requested as an add-on accessory, as the System and Replacement Cartridges come standard with an ADULT mask. See www.oxysurestore.com for details.

 

	Product Specifications (as installed in the mask tray): 

Height: 2.50" (6.35 cm) | Width: 9.75" (24.76 cm) | Depth: 5.00" (12.70 cm) | Weight: 0.35 lbs

	$32.00

 

Surface Mounted Wall Box                                                                                                                                              Product No. 615-05

 

	 	Model 615-05, OxySure® Surface Mounted Wall Box with Alarm. OxySure's Surface mounted wall box allows for easy access and promotes awareness of the availability of life saving oxygen in medical emergencies. Prominent, well labeled, accessible emergency oxygen could be the key in saving someone's life. Perfect for any public access location such as corporate offices, buildings, gymnasiums, schools, stadiums, and airports. The wall box comes with an Audible Alarm System (9-Volt Battery Operated) that will sound when door is opened. The door alarm can be deactivated by key. The rolled edge trim and white epoxy paint finish complement any décor, while offering excellent protection for the system. Mounting hardware not included. See www.oxysurestore.com for details.

 

	Product Specifications: 

Height: 17.50" (44.45 cm) | Width: 17.50" (44.45 cm) | Depth: 7.00" (17.78 cm) | Weight: 15 lbs

Cabinet Material: Steel

	$362.03

 

  

14 of 44

  

 

	
1c 

	
Hourly Rates: Not applicable

	
2. 

	
Maximum order: SIN: A-49              $100,000

	
3. 

	
Minimum order: None

	
4. 

	
Geographic coverage: FOB Destination 48 contiguous States and the District of Columbia and point of exportation to destination in Alaska, Hawaii and Puerto Rico.

	
5. 

	
Point of Production: Frisco, Collin county, Texas, 75034

	
6.  

	
Discount From List Prices:

	
Product Number

	
Product Name

	
Basic Discount

	
615-00

	
Model 615, Portable Emergency Oxygen Generator

	
7.5%

	
615-01

	
Model 615, Disposable Replacement Cartridge

	
10.6%

	
615-03

	
Replacement Mask, ADULT

	
4.9%

	
615-04

	
Replacement Mask, CHILD/PEDIATRIC

	
1.5%

	
615-05

	
Surface Mounted Wall Box

	
3.2%

	
7.  

	
Quantity discounts: Additional 3% taken off the FSS new price when 100 or more (mix or match) items are purchased.

	
Product No.

	
Product Name

	
Quantity Discount Net Government Price

	
615-00

	
Model 615, Portable Emergency Oxygen Generator

	
$       323.08

	
615-01

	
Model 615, Disposable Replacement Cartridge

	
$       139.08

	
615-03

	
Replacement Mask, ADULT

	
$         28.09

	
615-04

	
Replacement Mask, CHILD/PEDIATRIC

	
$         31.03

	
615-05

	
Surface Mounted Wall Box

	
$       350.81

	
8. 

	
Prompt payment terms: 1% 20 days, net 30

	
9. 

	
Government purchase cards are accepted at or below the micro-purchase threshold.

	
10. 

	
Government purchase cards are accepted at or above the micro-purchase threshold.

	
10 

	
Foreign items: None

	
11a 

	
Time of delivery: Within 30 days After Receipt of Order (ARO)

	
11b

	
Expedited Delivery: Within 3 days After Receipt of Order (ARO). Government is responsible for the additional shipping charges between the normal surface rate and the expedited rate.

	
11c 

	
Overnight and 2-day delivery: Within 3 days After Receipt of Order (ARO). Government is responsible for the additional shipping charges between the normal surface rate and the expedited rate.

	
11d 

	
Urgent Requirements: OxySure Systems, Inc. is a participant in the Federal Government Prime Vendor program. Clause I-FSS-140-B    URGENT REQUIREMENTS (JAN 1994) does not apply.

	
12 

	
FOB point: Frisco, Texas, 75034

	
13a 

	
Ordering address:                              OxySure Systems, Inc. 

10880 John W. Elliott Drive, Suite 600

Frisco, Texas   75034

 

	
13b 

	
Ordering procedures: FAR 8.405-3

	
14 

	
Payment Address:                               OxySure Systems, Inc. 

10880 John W. Elliott Drive, Suite 600

Frisco, Texas   75034

 

  

15 of 44

  

 

	
15.  

	
Warranty Provision:

Return/Exchange Goods Policy:

A. Before any product may be returned, a Return Materials Authorization (RMA) Number must be secured. The RMA number can only be issued by OxySure’s Customer Service. To assist in the return process, the ordering facility is required to provide Customer Service the following information:

	
(i)  

	
OxySure Product Code and Lot Number

	
(ii)  

	
Quantity Customer wishes to return

	
(iii)  

	
Order Number Associated with the Product(s)

	
(iv)  

	
OxySure’s Original Invoice Number

	
(v)  

	
Reasons for Return

B. All products returned shall be shipped to OxySure, freight prepaid, unless the return is due to OxySure error, such determination being made is the sole discretion of OxySure. On all international returns, OxySure will specify the method of shipment.

C. Items eligible for full credit:

	
(i)  

	
Products shipped in error

	
(ii)  

	
Products ordered in error, if authorized for return within thirty (30) days of receipt

	
(iii)  

	
Defective Products due to OxySure workmanship

D. Items not eligible for return:

	
(i)  

	
Custom products or products sold on a “No-return” basis

	
(ii)  

	
Goods held over ninety (90) days from the original invoice date

	
(iii)  

	
Partial cases or quantities less than minimum order quantity

	
(iv)  

	
Products unsalable due to re-design, preprocessing, revision, or obsolescence

	
(v)  

	
Demonstration products

	
(vi)  

	
Products no longer in their original packaging, used, or damaged through no fault of OxySure

E. A 15% Restocking Fee will be assessed on all returns authorized over thirty (30) days after the original invoice date.

	
16.

	
Export packing charges: None

	
17.

	
Terms and conditions of Government purchase card acceptance: None

	
18.

	
Terms and conditions of rental, maintenance and repair: None

	
19.

	
Terms and conditions of installations: None

	
20.

	
Terms and conditions of repair parts: None

	
20a  

	
Terms and conditions for any other services: None

	
21.

	
List of service and distribution points:                            OxySure Systems, Inc. 

10880 John W. Elliott Drive

Suite 600

Frisco, Texas   75034

 

  

	
22.  

	
List of participating dealers:

 

  

16 of 44

  

 

Abatix Corporation

2400 Skyline Drive

Suite 400

Mesquite, TX   75149-1972

Ph: 888.222.8499

Fax: 214.388.0443

www.abatix.com

Banyan International

P.O. Box 1779

Abilene, TX   79604

Ph: 888.782.8548

Fax: 1.325.677.1372

www.statkit.com

Dauterive Medical Inc.

27025 Polo Road

Folsom, LA   70437

Ph: 866.693.2237

Fax: 985.796.8661

www.dauterivemedical.com

Edwards Medical, Inc.

495 Woodcreek Drive

Bolingbrook, IL   60440

Ph: 800.358.2000

Fax: 877.358.2002

www.edwardsmedical.com

eMED America

10800 Financial Center Pkwy

Suite 340

Little Rock, AR   72211

Ph: 866.327.3633

Fax: 877.329.3633

www.emedamerica.com

 

Emergency Packs, LLC.

316 Mid Valley Center # 177

Carmel, CA   93923

Ph: 888.577.2257

Fax: 831.659.2477

www.emergencypacks.com

Enerspect Medical Solutions

35 E. Horizon Ridge Pkwy #110

PMB 50

Henderson, NV   89002

Ph: 888.522.5574

Fax: 702.586.4910

www.enerspect.com

Hagemeyer North America

1460 Tobias Gadson Blvd.

Charleston, SC   29407

Ph: 843.745.1845

Fax: 843.745.2400

www.hagemeyerna.com

 

  

17 of 44

  

HeartSafe America

13731 Omega Rd.

Dallas, TX   75244

Ph: 972.248.9477

Fax: 972.248.9417

www.heartsafeam.com

Legend Safety Solutions

400 Rella Blvd.

Suite #120

Suffern, NY   10901

Ph: 866.534.3635

Fax: 845.818.5100

www.legendsafety.com

 

Life Safety Solutions

725 North A1A

Suite 8102

Jupiter, FL   33477

Ph: 888.748.0004

Fax: 561.575.9937

www.lifesafetysolutions.com

LifeSecure

P.O. Box 2386

Northbrook, IL   60065

Ph: 877.877.5522

www.lifesecure.com

MedSafe

P.O. Box 1929

Marshall, TX   75671

Ph: 800.442.8839

Fax: 903.935.2117

www.gosafe.com

NKH Safety

P.O. Box 30088

Cincinnati, OH   45230

Ph: 888.347.3082

Fax: 513.688.0046

www.nkhaed.com

Safer America

226 East 54th Street

Suite #502

New York, NY   10022

Ph: 866.723.3799

Fax: 425.660.7779

www.saferamerica.com

School Health

865 Muirfield Drive

Hanover Park, IL   60133

Ph: 800.323.1305

Fax: 800.235.1305

www.schoolhealth.com

 

  

18 of 44

  

USMedeq

3411 Preston Road

Suite #C13-226

Frisco, TX   75034

Ph: 888.231.0350

Fax: 888.236.1008

www.usmedeq.com

Covin Sales

2055 Randolph Street

Huntington Park, CA   90255

Ph: 888.862.6846

Fax: 323.584.6095

www.covinsales.com

StopHeartAttack.com

1572 Montgomery Highway

Suite 202

Birmingham, AL   35216

Ph: 888.823.6967

Fax: 205.823.7817

www.stopheartattack.com

ASD Healthcare, Inc.

3101 Gaylord Pkwy 3S-M175

Frisco, TX   75034

Ph: 800.746.6273

Fax: 800.547.9413

www.asdhealthcare.com

	
23.  

	
Preventative maintenance: To be able to claim the limited warranty you need to follow the specific instructions for the products, including, but not limited to, the “Instructions for Use”.

 

If the system requires cleaning after use, we recommend a warm damp cloth to wipe down the exterior and interior of the housing. Do not use lubrication agents with the OxySure® System. The disposable cartridge, tubing and mask are single use items only and should be disposed of after each use. Using a mask or other accessories not specified for use with the OxySure® System may impair its performance and is strongly discouraged. Use only approved OxySure® components.

	
24a  

	
Special attributes: Non-toxic, Ergonomic Design

	
24b  

	
Section 508 compliance information: Not Applicable

	
25  

	
Data Universal Number System (DUNS) number: 615721029

	
26.

	
OxySure’s Central Contractor Registration (CCR) is valid until July 11, 2009.

  

19 of 44

  

 

OxySure® Model 615

Limited Warranty information

October 2008

© 2008 OxySure® Systems, Inc. All Rights Reserved Worldwide.

 

Disposable Cartridge: The OxySure® quality limited warranty lasts for 2 years in the case of the disposable cartridge or until it is used, whichever happens sooner.

 

Reusable Housing: The OxySure quality limited warranty lasts for 3 years in the case of the reusable housing or 25 uses, whichever happens first.

 

What will OxySure® do to correct the problem?

 

OxySure® will examine the product and decide, at its sole discretion, if it's covered under this limited warranty. OxySure® will then, at its sole discretion, either repair the defective product or replace it with the same or a comparable product. In these cases, OxySure® will pay for the cost of replacements, repairs, spare parts, labor and shipping costs, if and where applicable. This does not apply to any repair work or replacement not expressly authorized by OxySure® in writing. Replacement parts, if any, become the property of OxySure®. If the item is no longer sold by OxySure®, OxySure® will provide an appropriate replacement. It is OxySure® that, in its sole discretion, determines what constitutes an appropriate replacement. THIS REMEDY SHALL BE YOUR SOLE AND EXCLUSIVE REMEDY FOR ANY BREACH OF WARRANTY.

 

Conditions for Limited Warranties:

 

The limited warranties are valid from original date of acceptance by the end user of the product. The original purchase receipt or purchase order, together with proof of payment (if applicable) is required as proof of purchase.

 

The limited warranties do not apply to normal wear and tear of products or to products that have been stored or shipped incorrectly, including storage or shipment under environmental conditions outside of those conditions specified by OxySure®. Furthermore, the limited warranties do not apply to products that have been used inappropriately, abused, misused, altered, or cleaned with incorrect cleaning methods or incorrect cleaning products. The limited warranties do not cover normal wear and tear, cuts or scratches, or damage caused by impacts or accidents. The limited warranties do not cover defects in appearance, cosmetic, decorative items or any non-operative parts. The limited warranties do not apply if the product serial number has been removed, defaced or altered. Further, the limited warranties are not applicable if the products have been stored outdoors or in humid environments, or if the products have been otherwise not stored at room temperature.

 

Warranty coverage terminates if the original purchaser sells or otherwise transfers the product, unless the original purchaser is an authorized distributor of OxySure products; in such event, coverage is transferred to the original customer of such distributor (the"end user"). Warranty coverage also terminates if the end user sells or otherwise transfers the product. No OxySure reseller, agent, or employee is authorized to make any modification, extension, or addition to this warranty.

  

20 of 44

  

 

Some states and provinces do not allow the limitation or exclusion of incidental or consequential damage, so this limitation may not apply to you.

 

Care instructions:

 

To be able to claim the limited warranty you need to follow the specific instructions for the products, including, but not limited to, the "Instructions for Use".

 

How country, provincial and state law applies:

 

This limited warranty gives you specific legal rights, and you may also have other rights that vary from country to country, state to state or province to province.

 

Procedure for Claims Under Limited Warranties:

 

No product may be returned directly to OxySure® without first contacting OxySure® for a Return Material Authorization ("RMA") number. If it is determined that the product may be defective, you will be given an RMA number and instructions for product return. An unauthorized return, i.e. one for which an RMA number has not been issued, may be returned to you at your expense. Authorized returns are to be shipped prepaid and insured to the address on the RMA in an approved shipping container. Your original box and packaging materials should be kept for storing or shipping your product. To obtain warranty service, an original purchase receipt or purchase order, together with proof of payment (if applicable) is required as proof of purchase. OxySure® retains the exclusive right to either repair or replace the unit at its sole discretion.

  

21 of 44

  

 

Please complete these two easy steps:

 

STEP 1: Contact OxySure® Customer Service to receive a RMA number.

 

Call or e-mail OxySure® Customer Service to describe the problem you are experiencing and request a RMA number. You will need to provide the product's serial number (if applicable), your return shipping address, and a daytime telephone number.

 

Phone: 1-888-70XY-SURE

E-mail: service@oxysure.com

STEP 2: Ship the unit, along with the RMA number, to OxySure®.

 

Once you have received the RMA number, securely package the product and ship it (insured) to the following address:

 

OxySure Systems, Inc.

 

Attn: Customer Service

10880 John W. Elliott Road, Suite 600

Frisco, Texas 75034 USA

 

RMA Number: (insert your RMA number here - see above)

 

  

22 of 44

  

 

GENERAL SERVICE ADMINISTRATION CONTRACTOR'S REPORT OF SALES

 

Check one of the blocks to indicate the period (quarter) for which this report is being submitted

 

	1.  FY	o	1st Quarter (Oct - Dec)	o	2nd Quarter (Jan - Mar)	o	3rd Quarter (Apr - Jun)	o	4th Quarter (Jul - Sept)
	 	 	 	 	 	 	 	 	 

 

	This report is required quarterly regardless of whether orders under the contract were received. See instructions before preparing.	2.	
Contract No.: 

V797P-4153b

	 	 	 	 
	TO: 	
DEPARTMENT OF VETERANS AFFAIRS 

C/O FEDERAL SUPPLY SERVICES 

P.O. BOX 76, Bldg 37 

HINES, IL 60141

	3.	
Contractor (Name and Address including Zip Code)

 

OxySure Systems, Inc. 

10880 John W. Elliott Road, Suite 600

Frisco, TX 75034

 

	 4.	Class No. and Title of Contract: 	 5.	 Total Sales: 
	 	65IIA Medical Equipment & Supplies	 	 
	 	 	 	 
	6.	SALES RECEIVED annotate in corresponding blocks 6 (a-d), below. (If no sales whatsoever for items awarded under the above contract were received during the months covered by this report, enter $0 in the applicable columns below.

 

  

	

(a) Special Item No.

	

(b) VA Sales

	

(c) OGA Sales

	

(d) Disaster Recovery Sales

	

(e) Total Sales

	

A-49

	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  
	  	  	  	  	  

 

NOTE: This report is due no later than 60 days after the end of the quarter

 

CERTIFICATION

 

7.       AS REQUIRED BY THE CONDITIONS OF THE CONTRACT, THERE ARE REPORTED ABOVE ALL GOVERNMENT SALES FOR ITEM(S) UNDER THE CONTRACT IDENTIFIED. THIS REPORT IS ACCURATE TO THE BEST OF OUR KNOWLEDGE AND BELIEF.

 

	AUTHORIZED OFFICIAL (Signature and official title)	 
	 	Date: ________
	 	 
	Name and Phone Number for questions or clarifications:	Total Sales:_______
	 	 
	 	Dollar Amount IFF: ________
	 	 
	 	Date of Electronic Payment Submission: ________

 

  

23 of 44

  

 

GSA Form 72 (Rev. 2/04) (Adapted for VA Use)

 

 

FEDERAL SUPPLY SCHEDULE

65IIA Medical Equipment & Supplies

Request for Modification Form

 

 

 

 

  

24 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

 

 

 

 

 

	 YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:	 
	 	 	 
	ADDRESS:	
VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

	 
	 	 	 
	FAX:	
(708) 786-4974

(708) 786-4975

(708) 786-5828

	 
	 	 	 
	EMAIL:	EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER	 

 

  

25 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

Provide the following information for PRODUCT ADDITIONS

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	
o COMPLETE

o INCOMPLETE

 

	
DELIVERY TIME

	
Within                days after receipt of order (ARO)

 

	
o COMPLETE

o INCOMPLETE

	
MANUFACTURING NAME & ADDRESS

	
NAME

	 
	o NA	
ADDRESS

	 
	  	
POC

	 
	  	
PHONE

	 
	  	
EMAIL

	 
	
o COMPLETE

o INCOMPLETE

o NA

	
DATED COMMERCIAL PRICELIST

	
NOTE: If a dated commercial pricelist is not available provide the internal pricing documents that identify the list price of the items proposed and verify that this pricing is true and correct.  This document must be signed and dated by an authorized signatory.

 

	
o COMPLETE

o INCOMPLETE

 

	
ACTUAL ANNUAL COMMERCIAL SALES FOR THE LAST 12 MONTHS

	

 SIN

	 $
	 SIN	 $
	 SIN	 $
	 SIN	 $
	 SIN	 $
	
 COMPLETE

 INCOMPLETE

 

 

	
ESTIMATED OR ACTUAL ANNUAL GOVERNMENT SALES

	 SIN	 $
	 SIN	 $
	 SIN	 $
	 SIN	 $
	
 YES

 NO

	
PRIME VENDOR

	
Is/Are the product(s) offered for distribution under the VA Prime Vendor Program?

 

 

26 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	

o COMPLETE

o INCOMPLETE

 

	
MOST FAVORED CUSTOMER (MFC)

	
MFC:      

 

NOTE: If the MFC differs from the one upon which the contract award was predicated complete the enclosed Commercial Sales Practices Form (CSP-1)

 

o CSP-1 COMPLETE

 

o CSP-1 NOT REQUIRED

 

	

o COMPLETE

o INCOMPLETE

 

	
TRACKING CUSTOMER (TC)

	TC                        TC NAME
	o CURRENT TC
	o PROPOSED TC
	
o YES

o NO

 

	
PROPOSED PRICING

	
Based on your written discounting policies (standard commercial sales practices in the event you do not have written discounting policies), are the discounts and any concessions which you offer the Government equal to or better than your best price (discount and concessions in any combination) offered to any customer acquiring the same items regardless of quantity or terms and conditions?

 

o IF NO, complete the enclosed Commercial Sales Practices Form (CSP-1) and disclose all commercial customers receiving discounts greater than the proposed Government pricing.

 

	
o YES

o NO

 

	
DISCOUNT POLICIES

	
Do any deviations from your written policies or standard commercial sales practices disclosed in the above chart ever result in better discounts (lower prices) or concessions than indicated?

 

If YES, explain deviations in accordance with the instructions below:

 

Your explanation should include a discussion of situations that lead to deviations from standard practice, an explanation of how often they occur, and the controls you employ to assure the integrity of your pricing.  Examples of typical deviations may include, but are not limited to, one time goodwill discounts to charity organizations or to compensate an otherwise disgruntled customer; a limited sale of obsolete or damaged goods; the sale of sample goods to a new customer; or the sales of prototype goods for testing purposes.

 

 

 

 

27 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE

o INCOMPLETE

 

	
PRODUCT ADDITIONS PRICE PROPOSAL

	
Submit a spreadsheet that includes the following information:

 

o SIN#

o Item#

o Product Description

o Quantity/Unit of Measure

o Commercial List Price

o Proposed Gov’t Discount off Commercial List Price

o MFC Discount

o MFC Net Price

o Proposed NET FSS Price (w/ IFF & Freight)

 

	

o COMPLETE

o INCOMPLETE

 

	
QUANTITY DISCOUNTS

	
Identify any proposed additional quantity discounts offered to the Government

 

     

 

 

 

 

	

o COMPLETE

o INCOMPLETE

	
ADDITIONAL DISCOUNTS

	
Identify any proposed additional discounts/concessions, including prompt payment discounts, annual rebates, etc. provided to your commercial customers.

 

     

 

 

 

	

o COMPLETE

o INCOMPLETE

 

	
PROPOSED FOB TERMS

	
FOB DESTINATION

 

o 48 Continental States & DC w/ point of exportation (POE) to AK, HI, PR

 

o 50 States & DC w/ POE to PR

 

o 50 States, DC, & PR

 

 

28 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

Column 1—Identify the applicable customer or category of customer.  A "customer" is any entity, except the Federal Government, which acquires supplies or services from the Offeror.  The term customer includes, but is not limited to: original equipment manufacturers, value added resellers, state and local governments, distributors, educational institutions (an elementary, junior high, or degree granting school which maintains a regular faculty and established curriculum and an organized body of students), dealers, national accounts, and end users.  In any instance where the Offeror is asked to disclose information for a customer, the Offeror may disclose information by category of customer if the offeror's discount policies or practices are the same for all customers in the category.  (Use a separate line for each customer or category of customer.)

 

Column 2—Identify the discount.  The term “discount” is as defined in solicitation clause 552.212-70, Preparation of Offer (Multiple Award Schedule).  Indicate the best discount (based on your written discounting policies or standard commercial discounting practices if you do not have written discounting policies) at which you sell to the customer or category of customer identified in column 1, without regard to quantity; terms and conditions of the agreements under which the discounts are given; and whether the agreements are written or oral.  Net prices or discounts off of other price lists should be expressed as percentage discounts from the price list which is the basis of your offer.  If the discount disclosed is a combination of various discounts (prompt payment, quantity, etc.), the percentage should be broken out for each type of discount.

 

If the price lists which are the basis of the discounts given to the customers identified in the chart are different than the price list submitted upon which your offer is based, identify the type or title and date of each price list.  The contracting officer may require submission of these price lists.  To expedite evaluation, offerors may provide these price lists at the time of submission.

 

Column 3—Identify the quantity or volume of sales.  Insert the minimum quantity or sales volume which the identified customer or category of customer must either purchase/order, per order or within a specified period, to earn the discount.  When purchases/orders must be placed within a specified period to earn a discount indicate the time period.

 

Column 4—Indicate the FOB delivery term for each identified customer.  See FAR 47.3 for an explanation of FOB delivery terms.

 

Column 5—Indicate concessions regardless of quantity granted to the identified customer or category of customer.  Concessions are defined in solicitation clause 552.212-70, Preparation of Offers (Multiple Award Schedule).  If the space provided is inadequate, the disclosure should be made on a separate sheet by reference.

If deviations from your written policies or standard commercial sales practices disclosed in the chart on the Commercial Sales Practices Format are so significant and/or frequent that the Contracting Officer cannot establish whether the price(s) offered is fair and reasonable, then you may be asked to provide additional information.  The Contracting Officer may ask for information to demonstrate that you have made substantial sales of the item(s) in the commercial market consistent with the information reflected on the chart on the Commercial Sales Practice Format, a description of the conditions surrounding those sales deviations, or other information that may be necessary in order for the Contracting Officer to determine whether your offered price(s) is fair and reasonable.  In cases where additional information is requested, the Contracting Officer will target the request in order to limit the submission of data to that needed to establish the reasonableness of the offered price.

 

 

29 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

CSP-1 Commercial Sales Practices Format

 

	
 

Column 1—Customer

	
 

Column 2—Discount

	
 

Column 3—Quantity/Volume

	
 

Column 4—FOB Term 

(Destination or Origin)

	
Column 5—

Additional Discounts or Concessions (Include PPD & Annual Rebate)

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

	
     

 

 

30 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT ADDITION

 

I, ____________________________________ verify that items offered are not replacements for previously deleted items with a lower cost.

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification

 

 

 

31 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT DELETION

 

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:

ADDRESS:           VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

FAX:                      (708) 786-4974

(708) 786-4975

(708) 786-5828

EMAIL:                  EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER

 

 

 

32 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRODUCT DELETION

 

Provide the following information for PRODUCT DELETIONS

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE 

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	
o COMPLETE 

o INCOMPLETE

 

	
PRODUCT DELETIONS

	
Submit a spreadsheet that includes the following information:

 

o SIN#

o Item#

o Product Description

o Quantity/Unit of Measure

o Reason for Deletion

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification

 

 

33 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRICE INCREASE

 

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:

ADDRESS:           VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

FAX:                      (708) 786-4974

(708) 786-4975

(708) 786-5828

EMAIL:                  EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER

 

 

34 of 44

 

 

REQUEST FOR MODIFICATION FORM

PRICE INCREASE

 

Provide the following information for PRICE INCREASE

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	

o COMPLETE

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	

o COMPLETE

o INCOMPLETE

 

	
PRICE INCREASE PROPOSAL

	
Submit a spreadsheet that includes the following information:

 

o SIN#

o Item#

o Product Description

o Quantity/Unit of Measure

o Previous Commercial List Price

o Current Commercial List Price

o Current FSS Pricing

o Proposed NET FSS Price

o % FSS Change

o Previous Tracking Customer Price

o Current Tracking Customer Price

o % Tracking Customer Change

o Awarded FSS Tracking Customer Ratio

 

	

o COMPLETE

o INCOMPLETE

o NA

 

	
PRODUCT INFORMATION

	
Product was added at:

 

   o TIME OF AWARD

 

   o MODIFICATION#      

 

     o MODIFICATION EFFECTIVE DATE

 

	

o COMPLETE

o INCOMPLETE

o NA

	
DATED COMMERCIAL PRICELIST

	
NOTE: If a dated commercial pricelist is not available provide the internal pricing documents that identify the list price of the items proposed and verify that this pricing is true and correct.  This document must be signed and dated by an authorized signatory.

 

	
o YES

o NO

	
PRIME VENDOR

	
Is/Are the product(s) offered for distribution under the VA Prime Vendor Program?

 

  

35 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRICE INCREASE

 

I, ____________________________________ verify that not adverse change has occurred in the ratio between the awarded FSS price and the tracking customer price since the award of the item.

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification

 

  

36 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRICE DECREASE

 

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:

ADDRESS:           VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

FAX:                      (708) 786-4974

(708) 786-4975

(708) 786-5828

EMAIL:                  EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER

 

  

37 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRICE DECREASE

 

Provide the following information for PRICE DECREASE

 

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	

o COMPLETE

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	

o COMPLETE

o INCOMPLETE

 

	
REASON FOR PRICE REDUCTION

	
o Voluntary, to Government only

 

o Granted more favorable pricing than that contained in the commercial catalog, pricelist, or other document upon which the contract award was predicated

 

o Granted more favorable discounts/terms & conditions than those contained in the catalog, pricelist, or other document upon which the contract award was predicated

 

o Granted special discounts to the tracking that formed the basis of award.  This change disturbs the awarded ratio.

 

	

o COMPLETE

o INCOMPLETE

 

	
PRICE REDUCTION

	
o PERMANENT Price Reduction

 

o TEMPORARY Price Reduction

 

o Date Price Reduction Expires:      

 

	

o COMPLETE

o INCOMPLETE

o NA

	
DATED COMMERCIAL PRICELIST

	
Provide a copy of the applicable catalog, pricelist, contractor bulletin, letter, or customer agreement that details the effective date, duration, and terms & conditions of the price reduction.

 

	

o COMPLETE

o INCOMPLETE

 

	
PRICE INCREASE PROPOSAL

	
Include a spreadsheet including the following information:

 

o SIN#

o Item#

o Product Description

o Quantity/Unit of Measure

o Previous Commercial List Price

o Current Commercial List Price

o Current FSS Pricing

o Proposed NET FSS Price

o Previous Tracking Customer Price

o Current Tracking Customer Price

o Awarded FSS Tracking Customer Ratio

 

 

  

38 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRICE DECREASE

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification.

 

  

39 of 44

  

 

REQUEST FOR MODIFICATION FORM

TRACKING CUSTOMER CHANGE

 

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:

ADDRESS:           VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

FAX:                      (708) 786-4974

(708) 786-4975

(708) 786-5828

EMAIL:                  EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER

 

  

40 of 44

  

 

 

REQUEST FOR MODIFICATION FORM

TRACKING CUSTOMER CHANGE

 

Provide the following information for TRACKING CUSTOMER CHANGE

 

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	

o COMPLETE

o INCOMPLETE

 

	
COVER LETTER

	
Explain in detail why the proposed Tracking Customer or Category of Customer (TC) is an appropriate customer in terms of ensuring the Government price/discount remains representative of market prices and will continue to benefit from positive price changes.

 

	

o COMPLETE

o INCOMPLETE

 

	
COMMERCIAL SALES PRACTICE (CSP) INFO

	
Submit a spreadsheet that includes the following information:

 

o SIN#

o Item#

o Product Description

o Commercial List Price

o MFC Name

o MFC Discount

o MFC Net Price

o Proposed Government Discount off List Price

o Net FSS Price

o Awarded Tracking Customer Ratio

o Proposed Tracking Customer

o % Discount off List Price

o TC Net Price

o TC Sales (12 months)

	

o COMPLETE

o INCOMPLETE

 

	
QUANTITY DISCOUNTS

	
Identify any proposed additional quantity discounts offered to the Government

 

     

 

 

 

	

o COMPLETE

o INCOMPLETE

 

	
ADDITIONAL DISCOUNTS

	
Identify any proposed additional discounts/concessions, including prompt payment discounts, annual rebates, etc. offered to your commercial customers

 

     

 

 

 

  

41 of 44

  

 

REQUEST FOR MODIFICATION FORM

PRODUCT DELETION

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE

o INCOMPLETE

 

	
PRODUCT INFORMATION

	
Product was added at:

 

o TIME OF AWARD

 

o MODIFICATION#      

 

  o MODIFICATION EFFECTIVE DATE

 

	
o COMPLETE

o INCOMPLETE

	
COMMENTS

	
     

 

 

 

 

 

 

 

 

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification.

 

  

42 of 44

  

 

REQUEST FOR MODIFICATION FORM

ADMINISTRATIVE/OTHER CHANGE

	
CONTRACTOR NAME

 

	
     

 

 

	
CONTRACT#

	
     

 

 

	
ADDRESS1

 

	
     

 

 

	
ADDRESS2

 

	
     

 

 

	
CITY/STATE/ZIP

 

	
     

 

 

	
PHONE

 

	
     

 

 

	
EMAIL

 

	
     

 

 

	
DATE SUBMITTED TO VA-NAC

	
     

 

 

YOU MAY MAIL, FAX, OR EMAIL YOUR COMPLETED MODIFICATION REQUEST TO:

ADDRESS:           VA NATIONAL ACQUISITIONS CENTER

PO BOX 26, BLDG 37

MS 001AL-A2-2

1 BLOCK N 22ND STREET

HINES, IL 60141

FAX:                      (708) 786-4974

(708) 786-4975

(708) 786-5828

EMAIL:                  EMAIL DIRECTLY TO YOUR ASSIGNED CONTRACTING OFFICER

 

  

43 of 44

  

REQUEST FOR MODIFICATION FORM

ADMINISTRATIVE/OTHER CHANGE

 

Provide the following information for ADMINSTRATIVE/OTHER CHANGE

	
CONTRACTOR CHECKLIST

	
REQUIREMENT

	
COMMENTS

	
o COMPLETE

o INCOMPLETE

 

	
SPECIAL ITEM NUMBER (SIN) CATEGORY(IES)

	
     

 

 

	
o COMPLETE

o INCOMPLETE

 

	
REASON FOR MODIFICATION

	
o Change of Address

 

o Item Description Change

 

o Item Code Change

 

o Add/Delete Contract Administrator

 

o Warranty Terms

 

o Shipping Lead Times

 

o Add/Delete Distributor

 

o Other

	
o COMPLETE

o INCOMPLETE

	
DOCUMENTATION

	
Provide all appropriate documentation related to your request.

 

	 _______________________________________________	_______________________________________________
	AUTHORIZED REPRESENTATIVE   	DATE

 

 

o  APPROVED                 o  APPROVED AS AMENDED                o   DISAPPROVED

 

 

	 _______________________________________________	_______________________________________________
	CONTRACTING OFFICER  	DATE

 

_______________________________________________

EFFECTIVE DATE OF MODIFICATION

 

NOTE:  The effective date of the modification will be determined at the time of approval of the request by the Contracting Officer.  Effective dates will be assigned as either the 1st or 15th of the month.

 

Contractors are reminded that they must update their NAC-CM database and GSA Advantage! files and provide the CO with an updated paper pricelist for approval within 30 days of receiving an executed copy of the requested modification.

 

 

  

44 of 44oxysure_ex1033.htm

 

EXHIBIT 10.33

 

 

DISTRIBUTION AGREEMENT

 

This agreement (together with its related exhibits, the “Agreement”) is made and executed this __________ Day of _______________ , 2010, (the “Effective Date”) by and between OXYSURE SYSTEMS, INC. (“OxySure”), a Delaware corporation with its primary place of business located at 10880 John W. Elliott Road, Suite 600, Frisco, Texas, 75034 USA and ____________________ (the “Distributor”), located at ________________________________________.

 

OxySure and Distributor intend to establish Distributor as a distributor of those products (the “Products”) identified in Exhibit A within the territory (the “Territory”) and channel (the “Channel”) identified in Exhibit B.  Accordingly, OxySure and Distributor agree as follows:

 

	
1.

	
Appointment and Term

 

	
1.1

	
For the term of this Agreement, OxySure appoints Distributor as a non-exclusive distributor for the Products in the Territory and Channel.  Distributor’s appointment is for an initial term of one (1) year from the Effective Date, renewable thereafter for successive one-year periods unless terminated in terms hereof.

 

	
1.2

	
The appointment of Distributor is personal to Distributor and accordingly (a) the rights, duties and privileges of Distributor under this Agreement are not assignable in any way whatsoever without the prior written consent of OxySure, and (b) Distributor may not appoint, delegate to, authorize or in any way whatsoever empower any other party to act on Distributor’s behalf under this Agreement without the prior written consent of OxySure.

 

	
2.

	
Distributor Responsibilities

 

	
2.1

	
Both parties acknowledge that open communications and the sharing of information are important to fully develop the market, gain insight into the market’s needs and develop appropriate market strategies.  It is a further desire of OxySure to facilitate an open and direct communication between the end-user customer (“Customer”) and OxySure.  To this end, the parties agree to cooperate and openly communicate with each other in furtherance of these objectives, and Distributor further agrees to use its best efforts to facilitate such communication and contact between Customer and OxySure.

 

	
2.2

	
Distributor will maintain a reasonable number of demonstration Products for demonstration to prospective and existing Customers.

 

	
2.3

	
OxySure does not authorize Distributor to make, nor will Distributor make, any guaranty or warranty with respect to any Product.  OxySure will provide all Product warranties, if any, directly and in writing to the Customer.  Distributor will make no representations as to Product quality, performance, capabilities and the like except as OxySure expressly authorizes in writing, such as through published, product specifications.

 

	
2.4

	
Distributor agrees to avoid all activities that might place Distributor in a position of adverse interest or divided loyalty with OxySure or Distributor’s obligations as defined herein.

 

	
2.5

	
In addition to Section 8, Distributor will provide to OxySure upon discovery by Distributor and, on OxySure’s request, any information regarding:

 

	
  

	
(a)

	
the infringement, perceived infringement, unauthorized manufacture, use or marketing or misuse of OxySure’s intellectual property, Proprietary Information (as defined in Section 10 below), and/or Products;

 

	
  

	
(b)

	
any observations concerning recurrent issues with the Products;

 

	
  

	
(c)

	
any changes in the management or ownership of Distributor; and

 

  

1

  

 

	
  

	
(d)

	
in the event Distributor learns of information relating to an alleged malfunction of or an infliction of an injury by a Product, Distributor shall promptly notify OxySure and provide all known information as well as assist OxySure in any reasonable investigation concerning such allegations.  If necessary, Distributor will abide by all Distributor-specific governmental reporting requirements as imposed by the United States Food and Drug Administration or any other relevant governmental body.

 

	
2.6

	
Distributor will maintain information regarding the sale of each Product, including, but not limited to:  Customer names and addresses, product identification information (including but not limited to lot numbers, batch numbers, SKU numbers, and expiration dates) and a description of the products provided.  Distributor will also maintain all books of accounts, documents, correspondence, records, or the like, relating to any transaction involving the Products.  In the event OxySure desires to communicate regulatory or other information to Customers, or otherwise notify Customers for any reason, Distributor will use the Customer information that it maintains to send such notice or communication on behalf of OxySure in a timely manner.  Further, Distributor will make such Customer information available to OxySure to the extent necessary for OxySure to comply with relevant laws, rules, regulations, and judicial or administrative orders.

 

	
2.7

	
Distributor shall furnish to OxySure copies of all proposed advertising, technical, sales, and other materials relating to the Products and refrain from and/or discontinue the use of any such materials which in the opinion of OxySure are false or misleading or may subject OxySure to liability.

 

	
2.8

	
Distributor agrees to carry out all of its obligations to OxySure promptly and in good faith.

 

	
2.9

	
Distributor shall not take any action that may result in denigrating, tarnishing or otherwise adversely affecting the reputation or goodwill of OxySure. Without limiting the foregoing, Distributor agrees that it shall not (a) explicitly or implicitly misrepresent any feature or function of the Product, (b) make unauthorized claims or statements related to the Products, or (c) make any false statements related to the Product or OxySure.

 

	
2.10

	
In performing its obligations hereunder, Distributor shall comply with all relevant laws, rules and regulations.

 

	
2.11

	
Distributor may not market, promote, distribute, advertise, offer, sell or otherwise provide any Product through a Web site, email communications, or other electronic method or medium unless each of the parties have executed the “Internet Distribution Attachment” attached to this Agreement.  Notwithstanding the foregoing, Distributor may provide Product materials, pricing and invoices via email to a Customer, provided that such email communications are in response to direct Customer inquiries and are not part of a marketing or other promotional campaign or effort.

 

3.         OxySure’s Responsibilities

 

	
3.1

	
OxySure will provide technical and marketing information as OxySure deems appropriate, or upon Distributor’s request.  Any applicable costs for printed materials shall be borne by Distributor, unless otherwise agreed by the parties.

 

	
3.2

	
OxySure will provide training in the use, limited maintenance and technical aspects of the Products, including supplemental training relating to new products as introduced, at OxySure’s place of business identified hereinabove or as otherwise agreed by the parties.  The cost of transportation, meals, and lodging during the training shall be borne by the Distributor.

 

	
3.3

	
OxySure will be under no obligation to Distributor to manufacture, sell or supply, or to continue to manufacture, sell or supply any of the Products, or to continue or modify any model or type of any of the Products.

 

	
3.4

	
OxySure agrees to carry out all its obligations to the Distributor promptly and in good faith, and in every respect support Distributor’s authorized sales efforts in the Territory and Channel.

 

4.         Minimum Net Sales

 

To qualify as a distributor, an initial Purchase Order shall accompany a signed Agreement, with payment for said initial purchase order, and the size of such initial purchase order is set out in Exhibit C. After that, an annual minimum sales requirement is to be maintained as set out in Exhibit C.

 

  

2

  

 

5.         Products, Pricing, Packaging, Title

 

	
5.1

	
OxySure may, in its sole discretion, effect any change with respect to a Product or amend the Products of Exhibit A, provided, that with respect to any material change (e.g., amending the Products of Exhibit A) OxySure shall provide Distributor with thirty (30) days prior written notice.  OxySure will continue to honor orders for any Products removed from Exhibit A for three (3) months after the removal date if (a) the orders are submitted to fill quotes outstanding on the removal date, and (b) the removed Products have not been discontinued and are no longer available.

 

	
5.2

	
Prices for Products will be as set forth on Exhibit G, as amended from time to time in OxySure’s online price list (“Product Price List”).

 

	
5.3

	
Any suggested resale prices shown in the Product Price List are to be construed as a guideline only.  The Distributor is free to determine its own resale prices of the Products, provided that Distributor may not publish or display a price lower than the resale prices shown on the Product Price Lists on (a) any Internet site, unless the parties have executed the Internet Distribution Attachment set forth on Exhibit H, (b) any email advertisement, or (c) any newspaper, newsletter, magazine or other published source provided to more than 25 people.  Further, Distributor will clearly state if pricing is based on bulk or bundled purchases.  Distributor shall avoid any pricing policies that would adversely affect the image of the Products.

 

	
5.4

	
Distributor will abide by those terms for payment as set forth in Exhibit D.

 

	
5.5

	
Any credits issued by OxySure will be handled as a separate financial transaction from the original invoice, and payments under the invoice may not be withheld or delayed because of any credit.  Distributor shall not reduce any payment to OxySure to account for an anticipated, disputed or unauthorized credit, except in the instance of short shipments.  For credit, Distributor will submit a written credit request within one (1) month from the date of Distributor’s invoice for the related transaction.  Any credit request will be based on the price shown on the then current Product Price List, or the actual net price paid by Distributor, whichever is lower.  Upon notification by OxySure of a discrepancy in a credit request, Distributor has one (1) month to resolve such discrepancy and pay any amount due to OxySure.

 

	
  

	
5.6

	
All Products shall be delivered to Distributor F.O.B. OxySure’s principal place of business.

 

6.         Returns

 

Distributor may return Products in accordance with (a) any applicable limited warranty, if effective (see Section 7.1), or (b) the return policy set forth in Exhibit E.  OxySure may amend or change its return policy with thirty (30) days written notice to Distributor.

 

7.         Limited Warranty and Warranty Service

 

	
7.1

	
OxySure provides an end user limited warranty for the Products.  The terms of the end user limited warranty are set forth in the documentation provided with the Products, a copy of such being provided in Exhibit F.  Upon any amendment of or addition to the end user limited warranty, OxySure shall provide Distributor with written notice of such change.  Distributor shall strictly comply with the terms and provisions of Section 2.7 relating to the issuance of warranties, guaranties or representations.  OXYSURE MAKES NO OTHER WARRANTIES OF ANY KIND WHATSOEVER WITH REGARD TO THE PRODUCTS, EXPRESS OR IMPLIED, INCLUDING ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

 

	
7.2

	
Distributor shall not repair, attempt to repair, modify, attempt to modify, or the like, any Products.  Distributor shall return any defective or allegedly defective Product to OxySure for assessment and repair (if applicable).

 

	
7.3

	
For the purpose of technical support, OxySure hereby grants Distributor a license to use any OxySure-provided Proprietary Information supplied to carry out its obligations under this Agreement.  Such Proprietary Information, or any copies or versions in any form or language, shall in all cases remain the property of OxySure.  The confidentiality of such Proprietary Information is governed by Section 10.

 

  

3

  

 

8.         Reports and Audits

 

Intentionally omitted.

 

9.         Distributor’s Financial Condition

 

	
9.1

	
OxySure may withhold shipments due to Distributor’s general financial condition and/or conditions of Distributor’s account with OxySure.  In the event Distributor is in arrears per Exhibit D, OxySure may elect to place Distributor on credit hold, meaning no shipments may be made from OxySure to Distributor until such arrearages are satisfied.  In the event Distributor is in arrears for more than 60 days, or if Distributor is placed on credit hold more than two times in any twelve month period, OxySure may declare Distributor in default under this Agreement.

 

	
9.2

	
Wherein OxySure elects to establish a credit account for the Distributor, Distributor will provide OxySure with credit data sufficient to establish Distributor’s credit-worthiness.  The decision to offer such a credit account or to decline to establish such an account upon review of Distributor’s credit data is in the sole discretion of OxySure.  OxySure may periodically review Distributor’s credit worthiness and may withdraw any credit approval at any time, at OxySure’s option.

 

10.    Confidentiality/Non-Competition

 

	
10.1

	
During the term of this Agreement, Distributor and its employees may have access to OxySure’s Proprietary Information, such information, whether written or oral, being that which OxySure desires to protect against unauthorized use or disclosure.  The term “Proprietary Information” shall include, but is not limited to, information relating to research, marketing, developments, inventions, product lines, design, purchasing, finances and financial affairs, accounting, merchandising, selling, engineering, employees, Customers, consultants, trade secrets, business practices, merchandise resources, supply resources, service resources, system designs, procedure manuals, or pricing relating to the Products.  The term Proprietary Information does not include any information which is:  (a) in the public domain or that enters the public domain without a breach of this Agreement; (b) known by the receiving party prior to the disclosure; or (c) disclosed by a third party unrelated to or not in breach of this Agreement, or some other confidentiality agreement.

 

	
10.2

	
Distributor will treat all Proprietary Information as proprietary and confidential.  Distributor shall not disclose any Proprietary Information to anyone other than its own employees, directors, and consultants.  Distributor shall further use reasonable efforts to prevent any unauthorized use or disclosure, including, but not limited to, restricting access to the Information within its organization to those having a need to know and ensuring that everyone to whom it makes a disclosure complies with this Agreement by entering into an agreement that imposes a like obligation with each person to which a disclosure is made.  Distributor will not disclose any information to any party not enumerated above without obtaining prior written consent from OxySure.

 

	
10.3

	
Intentionally omitted.

 

	
10.4

	
Without limiting the obligation in Section 2.14, Distributor shall comply with all privacy and security laws relevant to the sale and distribution of Products, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA), and shall ensure that each employee, director, officer, and consultant of Distributor complies with such privacy laws at all times.

 

	
10.5

	
Distributor, upon termination of this Agreement, shall surrender to OxySure all Proprietary Information, (including:  training manuals, marketing updates, product literature, price lists, and product samples), whether originals, copies, English or non-English translations.

 

	
10.6

	
Distributor acknowledges that the OxySure may suffer irreparable damage in the event of a breach or threatened breach of any provision of this Section 10, and that therefore, OxySure may seek injunctive relief to prevent such breach, as well as any and all other applicable remedies at law or equity, including the recovery of damages.  This Section 10.7 controls over any conflict between this Section 10.7 and Section 19.8.

 

	
11.

	
OxySure Trademarks, Service Marks, and Trade Names; Intellectual Property

 

	
11.1

	
OxySure grants to Distributor a non-exclusive license to use OxySure’s trademarks, trade names, and service marks only in connection with the Products and in the performance of Distributor’s obligations under this Agreement.  All such uses are subject to OxySure’s prior review and consent, which will not be unreasonably withheld or delayed and such license may be withdrawn or revoked at any time by OxySure with or without cause.

 

	
11.2

	
All use of OxySure’s trademarks, trade names, and service marks will be in proper form, giving appropriate attribution to OxySure as the owner of such marks.  Distributor will not undertake any use of a mark that may jeopardize OxySure’s rights to use or register such mark, or OxySure’s rights to prevent unauthorized use.

 

  

4

  

 

	
11.3

	
All use of OxySure trademarks, service marks, and trade names by Distributor will inure to the benefit of OxySure.  At no time during or after the term of this Agreement shall Distributor attempt to register any trademarks, service marks, or trade names confusingly similar to any OxySure trademark, service mark, or trade name.  Distributor will cooperate, at OxySure’s expense, to assist OxySure in the registration or securing of rights in such marks.  Distributor will cooperate, at OxySure’s expense, in initiating and prosecuting any legal action against any infringer of any OxySure trademark, service mark, or trade name.

 

	
11.4

	
Distributor shall not, by reason of this Agreement or its provisions, acquire any interest in or right to any patent, trademark, service mark, trade names, copyright, Proprietary Information or any other form of OxySure intellectual property, whether relating to the Products or otherwise.

 

	
11.5

	
Any intellectual property, and any applications or methods related to any intellectual property, developed or discovered by either party, jointly or individually, under this Agreement or relating to the Products (including, but not limited to, patentable and/or copyrighted materials) are owned by OxySure, and Distributor hereby assigns and conveys all rights, title and interest in such intellectual property to OxySure.  At OxySure’s request, Distributor shall execute any instruments and documents necessary to confirm OxySure’s ownership of the intellectual property.

 

	
12.

	
Relationship Between the Parties

 

	
12.1

	
Both OxySure and Distributor are independent contractors, and no agency or other joint relationship is created.

 

	
12.2

	
Neither party has any authority to act for and/or to bind the other party in any way, or to represent that either is in any way responsible for the acts of the other.

 

	
13.

	
No Conflicts by Distributor

 

Distributor warrants and represents that Distributor is not subject to any contractual obligation or restraint which will interfere with Distributor’s right and ability to perform pursuant to the terms of this Agreement.

 

	
14.

	
Defaults; Remedies; and Termination

 

	
14.1

	
Either party may terminate this Agreement immediately by sending written notice if the other party becomes insolvent, or becomes the subject of any proceeding seeking relief, reorganization, or rearrangement under any laws relating to insolvency, or upon any assignment for the benefit of creditors, or upon the appointment of a receiver, liquidator, or trustee of any of its property or assets, or upon the liquidation, dissolution, or winding up of its business.

 

	
14.2

	
This Agreement may be terminated by the mutual agreement of OxySure and the Distributor.

 

	
14.3

	
If either party breaches any commitment contained in or arising from this Agreement (excepting Sections 14.1 and 14.2) and fails to remedy the breach within thirty (30) days from the date of written demand to cure, the breaching party shall be deemed to be in default hereunder.

 

	
  

	
 (a)

	
In reviewing Distributor’s financial condition under Section 9, the parties agree that OxySure may monitor Distributor’s credit through a variety of sources and means, including commercial credit companies.  Accordingly, a determination of credit worthiness may be based on third-party sources in addition to Distributor’s accounts and payment history with OxySure.

 

	
14.5

	
Either party may terminate this Agreement at any time prior to the expiration of the then-applicable term, without cause, by sending written notice to the other party at least ninety (90) days prior to the termination date.

 

  

5

  

 

	
14.6

	
Concerning the buy back of inventory from Distributor by OxySure upon a termination:

 

	
  

	
(a)

	
If this Agreement is terminated for any reason, OxySure shall have the option, to be exercised in OxySure’s sole discretion, to purchase any or all inventory of OxySure’s Products then held by Distributor.

 

	
  

	
(b)

	
The price of the Product being bought back, if at all, will be negotiated and mutually agreed on.

 

	
  

	
(c)

	
Section 14.6(b) does not encompass those Products which are discontinued or demonstration Products nor those Products determined, in OxySure’s sole discretion (including, at OxySure’s option and expense, an on-site inspection), to be damaged, non-sterile, expired, used or not in good condition.  Such Products may be repurchased by OxySure (in its sole discretion) for a discounted price mutually agreed upon by the parties.

 

	
14.7

	
Termination of this Agreement terminates all further rights and obligations of OxySure and Distributor hereunder other than the following obligations and sectional provisions, all of which shall survive any termination of this Agreement:

 

	
  

	
(a)

	
Neither OxySure nor Distributor shall be relieved of their respective obligations to pay any money due the other party; and

 

	
  

	
(b)

	
Sections:  7 (Limited Warranty), 8 (Reports and Audits), 10 (Confidentiality), 14 (Term; Remedies; and Termination); 15 (Indemnity and Insurance), 16 (Limitation of Liability), 17 (Intellectual Property Indemnity), 19.7 (Governing Law), and 19.8 (Negotiation, Mediation and Arbitration).

 

	
14.8

	
On termination of this Agreement for whatever cause, Distributor will immediately (a) cease to engage in marketing and distribution activities as a OxySure distributor, and (b) cease representing in any manner that it is a distributor of OxySure Products, including the immediate termination of all use of OxySure trademarks, service marks, or trade names.  Notwithstanding Distributor agrees that if OxySure so requests after the termination of this Agreement, Distributor shall pay for and distribute orders for Products which OxySure received and accepted during the term of this Agreement.

 

	
15.

	
Indemnity and Insurance

 

	
15.1

	
Distributor agrees to indemnify and hold OxySure harmless from any and all claims, demands, costs, liabilities and responsibilities, regardless of the claimant or his place of filing a claim, to the extent such result from or are associated with Distributor’s alleged negligent or intentional acts or omissions, any default by Distributor under this Agreement, or the provision of any warranty or guarantee of the Products given by the Distributor.

 

	
15.2

	
Distributor will maintain product liability insurance or the like for those claims enumerated in Section 15.1.

 

	
15.3

	
OxySure agrees to indemnify and hold Distributor harmless from any and all third party claims and demands to the extent they result from defective Products provided by OxySure to Distributor or the provision of any warranty or guarantee of the Products by OxySure to a Customer.  Distributor shall promptly notify OxySure of any such claim and demand, shall provide reasonable assistance to OxySure in the defense of such claims and demands, and shall give OxySure full authority to defend, settle or resolve the claims or demands on behalf of Distributor.

 

	
16.

	
Limitation of Liability

 

OxySure shall not be liable to Distributor for any indirect, punitive, consequential, special, incidental or loss of profit damages.

 

	
17.

	
Intellectual Property Indemnification

 

  

6

  

 

	
17.1

	
Distributor agrees that OxySure has the right to, and OxySure agrees that it will at its expense, defend or at its option, settle any claim, suit, proceeding, or other action brought against Distributor or its Customers for infringement of any United States copyright, trademark, or other United States intellectual property right related to the Products or their use, subject to the limitations set forth in Sections 17.2 and 17.3.  OxySure must have sole control of any such proceeding or settlement negotiations in order to be held liable.  OxySure will not be liable for any costs, settlements or expenses incurred without its prior written authorization.  OxySure will pay any final judgment entered against Distributor or its Customers based on such infringement so long as OxySure had complete control of the proceeding.

 

	
17.2

	
OxySure will be relieved of its obligations under Section 17.1 unless Distributor or its Customers notify OxySure promptly, in writing, of such action and gives OxySure full information and assistance to settle and/or defend any such action.  If relieved of its obligation under Section 17.1, OxySure may assume such obligation upon written notice to the Distributor.

 

	
17.3

	
OxySure assumes no liability for, and Distributor agrees to indemnify and hold OxySure harmless to the same extent as that indemnification identified in Section 17.1, for:

 

	
  

	
(a)

	
any infringements covering completed equipment or any assembly, combination, or method in which any of the Products may be used, but not covering such Products standing alone; or

 

	
  

	
(b)

	
any trademark infringement involving any marketing or branding not applied by OxySure or involving any marking or branding applied at the request of Distributor; or

 

	
  

	
(c)

	
any modification of the Products unless such modification was made by OxySure.

 

	
18.

	
Compliance.

 

	
  

	
(a)

	
Government Regulations.  Distributor and OxySure shall use their best efforts to ensure compliance with the requirements of any statute, ordinance, law, rule or regulation concerning, or order of any governmental or regulatory body having jurisdiction over, this Agreement.

 

	
  

	
(b)

	
Compliance.  The parties agree and represent and warrant to each other that nothing in this Agreement is intended to constitute remuneration of any kind whatsoever for referrals of patients and nothing in this Agreement is intended in any manner to violate any federal or state law, rule or regulation, including, without limitation, the federal Anti-Kickback Law (42 U.S.C. § 1320a-7b(b)), the Ethics in Patient Referrals law (42 U.S.C. § 1395nn) the “Stark Law”, the Texas Medical Practice Act (Texas Occupations Code Chapters 151 to 165), and Texas Occupations Code § 102.001.

 

	
  

	
(c)

	
Confidentiality of Records.  This Agreement shall comply with the Health Insurance Portability and Accountability Act of 1996, as amended from time to time (“HIPAA”) (45 C.F.R. Parts 160 and 164).

 

	
  

	
(iii)

	
Nothing in this Section 18 will constitute the waiver of the attorney-client or any similar privilege under applicable laws.

 

  

7

  

 

	
19.

	
General Provisions

 

	
19.1

	
Entire Agreement.  This Agreement, which includes the Exhibits, sets forth the entire agreement and understanding of the parties relating to the subject matter herein and supersedes all prior discussions between them whether written or oral.  The following Exhibits are attached hereto and made a part hereof for all purposes:

 

	 	Exhibit Letter	 	Name of Exhibit
	 	 	 	 
	 	A	 	Description of Products
	 	B	 	Description of Territory and Channel
	 	C	 	Minimum Net Sales
	 	D	 	Payment Terms
	 	E	 	Return Goods Policy
	 	F	 	Limited Product Warranty
	 	G	 	Pricing & Discount Schedule
	 	H	 	Internet Distribution Attachment

 

	
19.2

	
Assignment.  Distributor may not assign or transfer its right under this Agreement without the prior written consent of OxySure.

 

	
19.3

	
Modifications and Waiver.  This Agreement may be modified only in writing, signed within the authority granted by each party, and shall not be modified, varied, superseded or construed in a particular manner due to any course of conduct, trade usage, custom or dealing or any statute or common law.  It is expressly agreed and understood that the waiver by a party of its rights, or any portion of its rights, under this Agreement in any particular instance or instances, whether intentional or otherwise, shall not be construed as a continuing waiver which would prevent the subsequent enforcement of such rights, or as a waiver of any other rights hereunder.

 

	
19.4

	
Headings.  The headings of this Agreement are for convenience of reference only, and are not intended to be part of nor to affect the meaning or interpretation of this Agreement.

 

	
19.5

	
Notice.  All notices under this Agreement shall be deemed sufficient if sent by certified or registered mail (postage prepaid) with return receipt requested, overnight or air courier, facsimile, telex, or cable to the party, at the addresses identified hereinabove, to whom such notice is required or permitted to be given.  Any such notice shall be deemed to have been received on the next business day after transmission by facsimile, telex, cable or overnight or air courier, and on the third business day after transmission by certified or registered U.S. mail, return receipt requested.

 

	
19.6

	
Severability.  Whenever possible, each provision of the Agreement shall be interpreted in such a manner as to be effective and valid under applicable law, but if any provision of the Agreement should be prohibited or invalid, in whole or in part, under applicable law, such provisions shall be ineffective only to the extent of such prohibition or invalidity without invalidating the remainder of such provision or the remaining provisions of this Agreement.

 

	
19.7

	
Governing Law.  This Agreement is governed by the substantive laws of the State of Texas, U.S.A.  Any actions related to this Agreement must be brought in the courts located in Dallas County, State of Texas.

 

  

8

  

 

IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their respective authorized representatives or officers, effective as of the day and year indicated above.

 

	
DISTRIBUTOR:

	  	
OxySure:

	 
	
Name:

	  	
OxySure Systems, Inc..

	 
	
Company:

	  	
10880 John W. Elliott Road, Suite 600

	 
	
Address:

	  	
Frisco, Texas, 75034 USA

	 
	  	  	
PH: 972-294-6555

	 
	
PH:

	  	
FAX:

	 
	
FAX:

	  	  	 
	  	  	  	 
	
By:     _______________________________

	  	
By:     _________________________________

	 
	 	 	 	 
	 	  	
Julian T. Ross

	 
	Title:     President_____________________	  	
Chairman & CEO

	 
	  	  	  	 
	
Date:     _______________________________

	  	
Date:     _________________________________

	 

 

  

9

  

EXHIBIT A

Products

The Products shall be defined as all OxySure products and accessories for such products, including (but not limited to)

 

	
Part Number

	
Description

	
615-00

	
Model 615 Portable Emergency Oxygen Unit, complete system

	
615-01

	
Model 615 Replaceable Cartridge w/Mask

	
615-02

	
Replacement Adult Mask

	
615-03

	
Replacement Pediatric Mask

	
615-04

	
Display Cabinet with Alarm and Emergency Oxygen marking

	
615-05

	
Custom (Emergency Oxygen) Wall-mounted Display Cabinet w/Alarm

	
615-07

	
OxySure Wall Sign

	
615-09

	
OxySure Thermal Bag

	
615-10

	
Resuscitator Bag, Adult

	
615-11

	
Resuscitator Bag, Pediatric

	
615-12

	
Pulse Oximeter – Standard

	
615-13

	
Pulse Oximeter – Premium

 

  

10

  

EXHIBIT B

Territory and Channel

1.           The Territory is defined as (check all that apply):

 

	
  

	
□

	
The following areas within the United States:

 

	
  

	
The State of Florida

 

	
  

	
________________________________________

 

	
  

	
________________________________________

 

	
  

	
□

	
The following countries (requires Attachment B-1, International Terms, to be attached):

 

	
  

	
None

 

	
  

	
________________________________________

 

	
  

	
________________________________________

 

If the Territory includes any country other than the United States, Distributor hereby consents to and is bound by the terms of Attachment B-1, International Terms.

 

2.           The Channel is defined as:

 

All non-retail channels.

 

  

11

  

 

ATTACHMENT B-1

 

International Terms

 

If the Territory includes any country other than the United States, then this Attachment B-1 will be incorporated into and made part of the Distribution Agreement between OxySure® and Distributor.  All capitalized terms not defined in this Attachment have the definitions set forth in the Distribution Agreement

 

1.           Distributor shall be responsible for translating at its expense all marketing and promotional materials provided by OxySure®, including any manuals, into the language or languages used in the Territory.  Distributor shall promptly deliver to OxySure® a copy of such translation in the formats reasonably requested by OxySure®.  Such translations will be deemed a “work for hire” as such term is used in United States copyright law, and OxySure® will be considered the author and owner of all rights in and to such translation.  To the extent the translation is not a work for hire, Distributor hereby assigns to OxySure®, and agrees that OxySure® will have, all ownership rights in the manuals and translations created or provided by Distributor.  Distributor shall provide all documentation (including written assignments) reasonably requested by OxySure® to confirm its ownership of the manuals and translations.  Distributor shall make such changes to the marketing and promotional materials as are required to comply with the law of the countries, or political subdivisions in the Territory, but only with the prior approval of OxySure®.  Ownership of all marketing and promotional materials remain with OxySure®.

 

2.           OxySure® shall use commercially reasonable efforts to ship Products sold hereunder within the period and by a carrier designated in each accepted purchase order, and FOB the relevant OxySure® facility determined by OxySure®.  Distributor shall be responsible for obtaining all licenses required to import Products into the Territory.  OxySure® shall be responsible for obtaining all licenses required to export products from the United States.  All freight, transportation, rigging, crating, packing, drayage, insurance, and handling charges, as well as any other expenses that are not specifically allocated to OxySure® in this Attachment B-1, will be paid by Distributor.  Title, possession and risk of loss shall pass to Distributor upon delivery of the Products by OxySure to the designated carrier or freight forwarder.

 

3.           OxySure® and Distributor agree that if it is required by applicable law, this Agreement shall be approved by and/or registered with the appropriate governmental authorities.  The rights and obligations of OxySure® and Distributor under this Agreement are subject to any such government approval, registration or recordation, including import and export certificates (“Approvals”).  Distributor is responsible and shall bear the cost for promptly obtaining and maintaining any such Approvals from requisite government agencies in the Territory for Distributor and OxySure® to advertise, market, sell, distribute, license, and support the Products in the Territory.  To the extent additional Approvals are required for new or existing OxySure® Products, or to the extent countries other than those set forth in the Territory are now or hereafter included in the Territory, then Distributor shall bear the sole cost and responsibility for promptly obtaining such Approvals, including compliance with all local content requirements, effective as of the date of this Agreement, or as such requirements may subsequently be modified.  All costs of compliance, and whatever actions may be required (whether legal, manufacturing, assembly or otherwise) shall be the sole financial responsibility and obligation of Distributor.  To the extent any governmental approval would require OxySure® to change or modify its Products, OxySure® shall have no obligation to do so, and may at its discretion terminate this Agreement with Distributor with no further obligation hereunder, in order to avoid the threat of non-compliance with governmental regulations.  Distributor agrees that it shall not submit any information to governmental authorities with respect to this Agreement without the prior written approval of OxySure®; provided however, that the foregoing shall not apply in the event that formal or informal proceedings are instituted against Distributor or in the event that a dispute between OxySure and Distributor is submitted to any tribunal having jurisdiction over such matters.

 

4.           Distributor shall provide OxySure® with evidence of all government permits, certificates or approvals.  Distributor shall provide to OxySure promptly upon its request such evidence as OxySure® shall require, including, but not limited to, an opinion of counsel of the Territory (which counsel must be approved by OxySure® in its sole discretion although the costs of such opinion shall be borne by Distributor), of compliance by Distributor with the applicable import regulations of jurisdictions within the Territory or any other applicable jurisdiction, including those governing the filing of proper import documentation and the payment of all duties and fees of any nature whatsoever required for such import.

 

5.           Distributor shall comply with, and Distributor shall require its Customers to comply with, the United States Export Administration Act, the United States Anti-Boycott provisions and the United States Foreign Corrupt Practices Act (“FCPA”), as well as all applicable statutes, rules and regulations in the United States and the Territory, as the same may be amended from time to time.  Distributor represents and warrants to OxySure® that it is familiar with the terms and provisions of the FCPA and the purposes of the FCPA.  Distributor further represents and warrants that (a) except as otherwise disclosed in writing to OxySure® prior to execution of this Agreement, neither it nor any of its owners, staff members or Affiliates are officials, officers or representatives of any government or candidate for political office, and (b) that no part of the proceeds from sales of the Products will be used by it for any purpose or to take any action which will constitute a violation of any law of any government in the Territory or any part thereof or the United States, including the FCPA.

 

6.           This Agreement is an international transaction for the sale of goods in which the specification of United States Dollars and payment in Frisco, Texas is of the essence and United States Dollars shall be the currency of account in all events.   The payment obligations of distributor shall not be discharged by an amount paid by Distributor in another currency or at another place, whether pursuant to a judgment or otherwise, to the extent that the amount so paid on prompt conversion  to United States Dollars and transferred to Frisco, Texas under normal banking procedures does not yield the amount of United States Dollars in Frisco, Texas due hereunder.  If any payment by Distributor, whether pursuant to a judgment or otherwise, upon conversion and transfer does not result in payment of such amount of United States Dollars due hereunder in Frisco, Texas, Distributor shall compensate OxySure for the additional amount necessary to yield the amount due and owing to OxySure®.

 

7.           Distributor agrees specifically that it will not directly or indirectly export or re-export the Products or any technical data or service that is the direct product of the Products to any country outside the Territory without the written permission of OxySure®.

 

8.           The parties expressly agree that the International Convention for the Sale of Goods will not apply to this Agreement.

 

9.           The parties agree to mutually cooperate, one with the other, in notifying the other parties of any laws or of any changes in their respective domestic laws or laws of the Territory which might impact on any purchase orders, this Agreement or its exhibits, including but not limited to export/import controls, currency restrictions, competition requirements, and technology/licensing transfers.

 

10.           This Agreement (including any exhibits or attachments hereto) shall be executed in English only.  If any dispute or question of interpretation concerning this Agreement or any other materials related to this Agreement arises, the provisions of the English language version shall control.

 

	DISTRIBUTOR: Lifesaving Products, LLC.	 	OxySure® Systems, Inc.:	 
	
 

	 	
 

	 
	
 

	 	 	 
	 	 	 	 
	By:      _________________________	 	By:      _________________________	 
	 	 	    Julian Ross	 
	
Title:   _________________________

	 	    CEO	 
	 	 	 	 
	Date:	 	Date:	 

 

  

12

  

 

EXHIBIT C

Minimum Net Purchases

Upfront commitment: The equivalent of $25,000 in Product. Purchase Order and payment must accompany distribution agreement.  Must be drawn down within 3 months if OxySure drop ships.

Annual commitment: The equivalent of $100,000 in Product.

 

 

 

 

 

 

 

  

13

  

EXHIBIT D

Payment Terms

OxySure shall send the Distributor an invoice with respect to a shipment of Products no later than ten (10) days after the end of the month in which the shipment occurred.  The invoice shall set forth the Products, quantities, prices of the Products charged to the Distributor and the amount of any shipping, handling or insurance charges incurred by OxySure on behalf of Distributor.

 

PREPAID ON INITIAL QUALIFICATION ORDER. THEREAFTER, COD OR, IF APPROVED FOR CREDIT, WITHIN FOURTEEN (14) DAYS AFTER THE DATE OF INVOICE, THE DISTRIBUTOR SHALL PAY THE AMOUNTS DUE THEREUNDER TO OXYSURE AT THE ADDRESS FOR OXYSURE SET FORTH ON THE FIRST PAGE OF THIS AGREEMENT.

 

All payments to OxySure shall be in cash and in United States dollars.

 

 

 

 

 

  

14

  

EXHIBIT E

Return Goods Policy

THE FOLLOWING POLICY AND PROCEDURE ARE APPLICABLE TO THOSE PRODUCTS TO WHICH A LIMITED WARRANTY DOES NOT APPLY, THE PROVISIONS HEREINBELOW ARE TO BE CONSTRUED IN A MANNER CONSISTENT WITH THE TERMS AND CONDITIONS OF THE AGREEMENT AND DO NOT REPRESENT ADDITIONAL WARRANTIES, GUARANTIES OR REPRESENTATIONS:

 

	
1.

	
Before any product may be returned, a Return Materials Authorization number (RMA#) must be secured.  An RMA# can only be issued by OxySure Customer Service.

 

	
  

	
To assist in the return process, the Customer/Distributor is asked to provide Customer Service the following information:

 

	
  

	
(a)  OxySure Product Code and Lot Number

	
  

	
(b)  Quantity Customer/Distributor Wishes to Return

	
  

	
(c)  Order Number Associated with the Products

	
  

	
(d)  OxySure’s Original Invoice Number

	
  

	
(e)  Reasons for Return

 

	
2.

	
All Products returned shall be shipped to OxySure, freight prepaid, unless the return is due to OxySure error, such determination being made in OxySure’s sole discretion.  On all international returns, OxySure will specify the method of shipment.

 

	
3.

	
Items eligible for full credit:

 

	
  

	
(a)  Products shipped in error.

	
  

	
(b)  Products ordered in error, if authorized for return within thirty (30) days of receipt.

	
  

	
(c)  Defective Products due to OxySure workmanship.

 

	
4.

	
Items not eligible for return:

 

	
  

	
(a)

	
Custom products or products sold on a “No-return” basis.

	
  

	
(b)

	
Goods held over ninety (90) days from the original Invoice Date.

	
  

	
(c)

	
Partial cases or quantities less than minimum order quantity.

	
  

	
(d)

	
Products unsalable due to re-design, preprocessing, revision, or obsolescence.

	
  

	
(e)

	
Demonstration products.

	
  

	
(f)

	
Products no longer in their original packaging, used, or damaged through no fault of OxySure.

 

	
5.

	
A 20% Restocking Fee will be assessed on all returns authorized over forty five (45) days after the original Invoice Date.

 

  

15

  

EXHIBIT F

Limited Product Warranty

Refer to the Product literature packaged with each Product, such being incorporated by reference herein, for any applicable end user limited warranty.

 

 

 

 

 

 

 

  

16

  

EXHIBIT G

Pricing Schedule - Commercial

 

	  	 	
 

	 	 	
Volume Range Min

	 	 	
Volume Range Max

	 	 	
Unit Price, Authorized

	 
	  	 	MSRP	 	 	
#Units

	 	 	
#Units

	 	 	
Distributors Only

	 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Model 615, Base Systems (SKU 615-00)1:	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 
	Model 615, Cartridges (SKU 615-01)1:	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 

	Model 615, Mask/Tray (SKU 615-03):	 	 	 	 	 	 	1	 	 	 	499	 	 	 	 	 
	Model 615, Pediatric Mask/Tray (SKU 615-04):	 	 	 	 	 	 	1	 	 	 	499	 	 	 	 	 
	Custom (Emergency Oxygen) Wall-mounted Display Cabinet (SKU 615-05):	 	 	 	 	 	 	1	 	 	 	50	 	 	 	 	 
	OxySure Wall Sign (SKU 615-07):	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 
	OxySure Thermal Bag (SKU 615-09):	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 
	Resuscitator Bag, Adult (SKU 615-10):	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 
	Resuscitator Bag, Pediatric (SKU 615-11):	 	 	 	 	 	 	1	 	 	 	+	 	 	 	 	 
	Pulse Oximeter – Standard (SKU 615-12):	 	 	 	 	 	
Min order qty=12

	 	 	 	+	 	 	 	 	 
	Pulse Oximeter – Premium (SKU 615-13):	 	 	 	 	 	
Min order qty=12

	 	 	 	+	 	 	 	 	 
	 	 
	
Notes: (1) Cartridges come with standard Adult masks.

	 

Volume refers to purchase order volume. All Prices are FOB Frisco.

 

  

17

  

EXHIBIT H

Internet Distribution Attachment

To be effective, this Internet Distribution Attachment must be signed by both OXYSURE SYSTEMS, INC. (“OxySure”), and [DISTRIBUTOR] (the “Distributor”).  Once effective, this Exhibit H will be incorporated into and made part of the Distribution Agreement between OxySure and Distributor.  All capitalized terms not defined in this Attachment have the definitions set forth in the Distribution Agreement.

 

1.           Effective Date.  This Internet Distribution Attachment is effective as of _____________________________.

 

2.           Internet Promotion and Distribution.  This Internet Distribution Attachment governs all promotion, sale, advertising, marketing and other offers made via electronic means, including via the Internet.  Internet promotions includes the following: (a) offering or displaying the Product through any online channel, including but not limited to via the Web (HTTP), RSS, FTP, or other method, (b) email offers to multiple individuals or companies, (c) promotions and advertising embedded or appearing in software products, (d) promotions and advertising embedded in or associated with streaming or downloadable media, including audio and video media, and (e) any other methods or means similar or related to those currently available via the Internet.

 

3.           Distributor’s Promotion.  Distributor intends to promote, sell, advertise, market and otherwise offer the Products through the following websites and methods:

 

___________________________________________________________________________________

 

___________________________________________________________________________________

 

___________________________________________________________________________________

 

___________________________________________________________________________________

 

Distributor and OxySure may add additional websites and methods by mutual written agreement.

 

Distributor shall be solely responsible for all costs and charges associated with its Internet promotion, including all server and bandwidth charges.

 

4.           Territory.  Intentionally omitted.

 

5.           Pricing.  To the extent the pricing offered by Distributor through an Internet promotion is lower than the Manufacturer Suggested Retail Price, Distributor shall ensure that (a) the price may be viewed only by users on Distributor’s website that have logged in using a valid username and password, and (b) the price is not distributed via email, except in response to a valid inquiry requesting the price.

 

6.           Photos and Graphics.  Any Product photos or graphics used in an Internet promotion must accurately depict the Product, and must clearly display all trademarks that actually appear on the Product.  Distributor may use Product photos provided by OxySure, so long as such photos are not altered in any manner and all copyright notices appearing on the photo remain intact.

 

7.           Manuals and Documentation.  Distributor may not post any photos, scans or other versions of Product manuals or other documentation related to the Products without the prior written consent of OxySure.

 

8.           Product Reviews.  Distributor may allow Customers to post reviews of the Product, provided that Distributor will remove any Product review that OxySure reasonably believes is false, misleading, or not supported by verifiable evidence.

 

  

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IN WITNESS WHEREOF, the parties hereto have caused this Internet Distribution Attachment to be executed by their respective authorized representatives or officers, effective as of the day and year indicated above.

 

	DISTRIBUTOR:	 	OxySure:	 
	
 

	 	
 

	 
	
 

	 	 	 
	 	 	 	 
	By:      _________________________	 	By:      _________________________	 
	 	 	    Julian Ross	 
	
Title:   _________________________

	 	    CEO	 
	 	 	 	 
	Date: 	 	Date:	 

 

  

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