____ Patient Care _____ Non-Patient Care
BIOMED USE ONLY
SOPI # DATE RECEIVED W/O # TECH INITIAL TECH DATE COMPLETE ID# PURCHASE ORDER #
THIS SECTION TO BE COMPLETED BY ORDERING DEPARTMENT DEPT ACCT # REQUISITIONER’S NAME REQUISITION # DEPT EXT. END USE AREA MODEL/CATALOG # DESCRIPTION EST. COST $
THIS SECTION TO BE COMPLETED BY AUTHORIZED VENDOR/REPRESENTATIVE
VENDOR MANUFACTURER SERVICE SOURCE
NAME NAME NAME
ADDRESS ADDRESS ADDRESS
CITY, STATE, ZIP CITY, STATE, ZIP CITY, STATE, ZIP
PHONE # PHONE # PHONE #
FAX # FAX # FAX #
SERVICE WITH CONTRACT (CIRCLE COVERAGE PROVIDED) PARTS PROVIDED 24-HOUR SERVICE BUSINESS HOURS ONLY PREVENTIVE/CALIBRATION ______TIMES/YEAR ANNUAL CONTRACT EXPENSE RESPONSE TIME COPY OF SERVICE CONTRACT PROVIDED YES/NO SERVICE WITHOUT CONTRACT: PHONE # FOR TECHNICAL/OPERATOR ASSISTANCE Hourly Rate: Travel/Zone Charge Response Time
SPECIALIZED TEST/CALIBRATION/REPAIR EQUIPMENT REQUIRED INCLUDING PRICE AND SUPPLIER (attach additional sheet if necessary): PRODUCT COMPLIES WITH THE FOLLOWING CODES AND STANDARDS AS APPLY TO ITS INTENDED USE (circle):
FCC NFPA 99 UL 544 AAMI/ANSI CSA
WARRANTY LENGTH COPY OF WARRANTY ATTACHED Accessories/Disposables required for operation of equipment including catalog # and price. __________ Months | YES / NO | (Attach additional sheet if necessary)
OPERATOR TRAINING WILL BE PROVIDED FOR AT (location) $ per person | within the warranty period.
TECHNICAL SERVICE TRAINING WILL BE PROVIDED FOR AT (location) $ per person | within the warranty period.
FACILITIES REQUIRED FOR OPERATION/SITE PREPARATION Voltage Amperes Phase NEMA Plug Vacuum
Gas Cabling Exhaust
Ventilation/Cooling Water & Drain Are Required Utilities at End User Location Now? Yes No Unknown
SIZE CRATED: SIZE UNCRATED: W | L | H | LBS W | L | H | LBS
? No equipment will be delivered without at least one (1) complete copy of service documentation. Documentation is defined on the
reverse, section 11.
? Complete replacement parts will be available for at least seven (7) years after expiration of the initial warranty period. Parts will be sold
to the University of Toledo Medical Center their designated alternates by the closest/fastest source, including the local service
THIS INFORMATION AS PROVIDED FOR THE PRODUCT ABOVE IS ACCURATE AND CONDITIONS ON THE REVERSE
ARE ACCEPTABLE. I HEREBY SIGN AS AN AUTHORIZED REPRESENTATIVE. ____________________________________________ _______________________________________ _____________________________________________ SIGNATURE PRINT NAME TITLE ____________________________________________ _______________________________________ REPRESENTING VENDOR DATE
SELLER OBLIGATION MET OR PROVIDED FOR
BMES DATE FACILITIES MAINTENANCE DATE
SEE REVERSE SIDE FOR REQUIREMENTS OF SELLER OBLIGATION/PRODUCT INFORMATION
SELLER OBLIGATION / PRODUCT INFORMATION
NON-PATIENT CARE AND PATIENT CARE EQUIPMENT
1. There will be support personnel available from the vendor/manufacturer VIA telephone during normal business hours to
assist University of Toledo Medical Center(UTMC) personnel with operational and technical advice. There will be no charge
for this service unless stated.
2. Any specialized test equipment, interconnection cabling, extender cards or specialized test devices necessary for the use,
preventive maintenance, calibration or repair of the device by UTMC personnel will be itemized on this form showing
purchase price and supplier.
3. The vendor is responsible for installation and/or setup of their equipment. Any facilities such as vacuum, electrical power,
compressed gas, water, drain, cooling, exhaust, etc. required for equipment operation will be stated on this form. Where
necessary, such information will be supplied in sufficient detail to guide site preparation/renovation.
4. A copy of the warranty will be provided. Warranty period and invoiced terms will not start until the product has been
installed and operated sufficiently to verify operation in accordance with manufacturer specifications, applicable codes and
standards, and that it provides such services/functions as indicated by the sales representative.
5. UTMC has the right to use any service representative of his choosing, including in-house, third party or independent
contractor. These representatives have the right to repair, install, calibrate, maintain or repair all models of equipment
purchased from the vendor. UTMC’s representatives shall be afforded the privilege of ordering all necessary repair parts
and components from the vendor for each model of equipment purchased at a fair market price.
6. In the event that computer software or external devices are required for the operation, calibration or repair of the equipment,
then the vendor shall make available to the UTMC any and all software and hardware at a fair market price. All subsequent
updates for the software or hardware must be provided at a fair market price. The software may be in the form of ROM
type memory, magnetic media, software transmitted via telephone, or any new formats not yet available that may be
developed in the future. UTMC has the right to use and operate all hardware and software for the purposes of operating,
repairing, or calibrating the equipment. UTMC has the right to allow its designated service representative to use all
software for the repair and calibration of the equipment purchased.
7. Part or all payment will be withheld until all conditions stated herein are met or provided for and the product is officially
PATIENT CARE EQUIPMENT ONLY
IN ADDITION TO 1-7 ABOVE, THE FOLLOWING APPLY:
8. On-site operator training will be provided by the vendor at no cost unless stated otherwise on this form.
9. Technical service training will be made available to UTMC personnel or their designated alternates either on site or at
the vendor’s/manufacturer’s location within the warranty period. Cost and location of such training will be stated on this
form or will be provided at no expense.
10. UTMC has the right to send its designated service representative to the manufacturer’s service training schools to receive
sufficient, any or all, technical training to allow the representative to repair and calibrate the equipment purchased.
11. Service Documentation is defined as: Operator’s manuals, service manuals, schematics, software, trouble-shooting guides,
theory of operation, parts lists, recommended preventive maintenance/calibration procedures and other information as
furnished to the manufacturer’s/vendor’s own service personnel. UTMC will receive at no additional cost, all updates and
revisions of the manuals, schematics and documentation as they become available from the vendor, for each model of
THE REVERSE SIDE OF THIS FORM MUST BE COMPLETED, SIGNED AND DATED BY THE SELLER
REPRESENTATIVE INDICATING UNDERSTANDING AND ACCEPTANCE OF THE ABOVE
GUIDELINES AND REQUIREMENTS.
University of Toledo Medical Center
Purchasing Services Mail Stop 1077 3000 Arlington Avenue Toledo, OH 43614-5807 (419) 383-3649 FAX (419) 383-6250 Form 591