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MEDICAL COLLEGE OF OHIO

By Julie Henderson,2014-01-20 02:07
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MEDICAL COLLEGE OF OHIO

    ____ 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

    OTHER:

    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

    representative.

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

    accepted.

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

    equipment purchased.

    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

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