1、_ Patient Care _ Non-Patient CareBIOMED USE ONLYSOPI # DATE RECEIVED W/O # TECH INITIALTECH DATE COMPLETE ID# PURCHASE ORDER # THIS SECTION TO BE COMPLETED BY ORDERING DEPARTMENTDEPT ACCT # REQUISITIONERS NAME REQUISITION # DEPT EXT. END USE AREA MODEL/CATALOG # DESCRIPTION EST. COST $THIS SECTION T
2、O BE COMPLETED BY AUTHORIZED VENDOR/REPRESENTATIVEVENDOR MANUFACTURER SERVICE SOURCENAME NAME NAMEADDRESS ADDRESS ADDRESSCITY, STATE, ZIP CITY, STATE, ZIP CITY, STATE, ZIPPHONE # PHONE # PHONE #FAX # FAX # FAX #SERVICE WITH CONTRACT (CIRCLE COVERAGE PROVIDED)PARTS PROVIDED 24-HOUR SERVICE BUSINESS H
3、OURS ONLY PREVENTIVE/CALIBRATION _TIMES/YEAR ANNUAL CONTRACT EXPENSE RESPONSE TIME COPY OF SERVICE CONTRACT PROVIDEDYES/NOSERVICE WITHOUT CONTRACT:Hourly Rate: Travel/Zone Charge Response Time PHONE # FOR TECHNICAL/OPERATOR ASSISTANCESPECIALIZED TEST/CALIBRATION/REPAIR EQUIPMENT REQUIRED INCLUDING P
4、RICE AND SUPPLIER (attach additional sheet if necessary):PRODUCT COMPLIES WITH THE FOLLOWING CODES AND STANDARDS AS APPLY TO ITS INTENDED USE (circle):FCC NFPA 99 UL 544 AAMI/ANSI CSA OTHER: WARRANTY LENGTH COPY OF WARRANTY ATTACHED Accessories/Disposables required for operation of equipment includi
5、ng catalog # and price. _ Months | YES / NO | (Attach additional sheet if necessary)OPERATOR TRAINING WILL BE PROVIDED FOR AT (location)$ per person | within the warranty period.TECHNICAL SERVICE TRAINING WILL BE PROVIDED FOR AT (location)$ per person | within the warranty period.FACILITIES REQUIRED
6、 FOR OPERATION/SITE PREPARATIONVoltage Amperes Phase NEMA Plug VacuumGas Cabling ExhaustVentilation/Cooling Water & Drain Are Required Utilities at End User Location Now?Yes No UnknownSIZE CRATED: W | L | H | LBS SIZE UNCRATED:W | L | H | LBS No equipment will be delivered without at least one (1) c
7、omplete 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 altern
8、ates 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 DATESELLER O
9、BLIGATION MET OR PROVIDED FORBMES DATE FACILITIES MAINTENANCE DATESEE REVERSE SIDE FOR REQUIREMENTS OF SELLER OBLIGATION/PRODUCT INFORMATIONSELLER OBLIGATION / PRODUCT INFORMATIONNON-PATIENT CARE AND PATIENT CARE EQUIPMENT1. There will be support personnel available from the vendor/manufacturer VIA
10、telephone during normal business hours toassist 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 nec
11、essary 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
12、 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 no
13、t 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 re
14、presentative 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. UTMCs representatives shall be afforded the privilege of ordering all nec
15、essary 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 a
16、ll 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 devel
17、oped 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.
18、7. Part or all payment will be withheld until all conditions stated herein are met or provided for and the product is officiallyaccepted.PATIENT CARE EQUIPMENT ONLYIN ADDITION TO 1-7 ABOVE, THE FOLLOWING APPLY:8. On-site operator training will be provided by the vendor at no cost unless stated other
19、wise on this form.9. Technical service training will be made available to UTMC personnel or their designated alternates either on site or atthe vendors/manufacturers location within the warranty period. Cost and location of such training will be stated on this form or will be provided at no expense.
20、10. UTMC has the right to send its designated service representative to the manufacturers service training schools to receivesufficient, any or all, technical training to allow the representative to repair and calibrate the equipment purchased.11. Service Documentation is defined as: Operators manua
21、ls, service manuals, schematics, software, trouble-shooting guides,theory of operation, parts lists, recommended preventive maintenance/calibration procedures and other information as furnished to the manufacturers/vendors own service personnel. UTMC will receive at no additional cost, all updates a
22、nd 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 CenterPurchasing Services Mail Stop 10773000 Arlington AvenueToledo, OH 43614-5807(419) 383-3649 FAX (419) 383-6250Form 591
