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09-119 Seattle King County Public Health for AED Purchase - City of ...

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REQUESI TO PURCHM3E FORMGoods (DV) — to Site DV Log AdministratorGoods (PC) - to Distribution Center DTR-PH-0100 Date: 11/5/<strong>09</strong><strong>Public</strong> <strong>Health</strong><strong>Seattle</strong> & <strong>King</strong> <strong>County</strong>,SUPPLIES & SERVICES UNDER $ 5,000 (including Tax & Freight; Excluding Computing — See Below)(Supplies should use a "52000" series Expense Account and Services should use a "53000" series Expense Account)1:1 CONTROLLED SUPPLIES UNDER $ 5,000 (Defibrillators) (requires a PO — Use EXitserAccq)t 62871)SUPPLIES (CAPITAL) & SERVICES $ 5,000 OR MORE (Including Tax & Freigkt Compating)teriseeb-elOW)-COMPUTER HARDWARE/SOFTWARE (Requires MIS approval)O SOFTWARE Less than $25,000 initial purchase or upgrade (Non Capital Account 52190) NOV 9 20<strong>09</strong>O SOFTVVARE $25,000 or more initial purchase or upgrade (Capital Account 56742)o SOFTWARE Annual License Fee <strong>for</strong> existing s<strong>of</strong>tware (Service Account 53636)El HARDWARE (Laptops, Desktops, Projector, Servers) Less than $5,000, requires a PO (Department Controlled Equipment Account 52187)o HARDWARE $5,000 or more (Capital Account 56741)o IT Equipment — Repair/Maintenance <strong>for</strong> existing s<strong>of</strong>tware or hardware (Service Account 53634)o Consulting IT Services (Service Account 53127)Item# Org Account Option Project1 8812 53105 DRPAD2vt550Vendor Name & Address:<strong>City</strong> <strong>of</strong> Woodinville17301 133w Ave. NEWoodinville, WA 98072Contact: Justine K. TatePhone: 425-877-2266o Check here to confirm this work is not part <strong>of</strong> a body <strong>of</strong> work per<strong>for</strong>med by a <strong>King</strong> <strong>County</strong> classified employee, Pleaseprovide detail on the work to be conducted by any individual and why this work cannot be per<strong>for</strong>med by a <strong>King</strong> <strong>County</strong>employee (SIT, TLT or Career Service). Use attachment if necessary, For individual vendors use acct code 53104 or 53105ITEM QTY UNIT DETAILED DESCRIPTION: . UNIT PRICE. TOTAL COSTProvide CPR/<strong>AED</strong> training and education and promote theplacement and registration <strong>of</strong> Automatic External Defibrillators(<strong>AED</strong>S) in community settings at high risk <strong>for</strong> cardiac events, as a1 1 participant <strong>of</strong> <strong>King</strong> <strong>County</strong> Project RAMPART 3,978.00 $ 3,978.002 -2 603456 $7 $a $Waiver Attached Services (DVS or P0) - to CPRES CNK-PH-1300 Printed NaQuotes Attached Emergency (DVE) - Division Finance Manager .::$1 natu re;SHIPPINGSUB-TOTALTAXTOTAL 3,978.00Bid/RFQ Ro uestod Pro aid DVF - to Accounting CNK-PH-1200 Phone #: 20. -263.8567Does this service involve Protected <strong>Health</strong> In<strong>for</strong>mation (PHI)? Mailstop/Pro fiNJAH.v.9,0,//CionnmProg(Under HIPAA, PHI means individually identifiable Yes Program Atithoriza on: Date: // -6 ..- 0health in<strong>for</strong>mation . No x Printed Name: Li ,,Culley )CAPITAL ASSET SITE CODESSite # 8171MIS Authoriza 'on: Date:Building # B6<strong>09</strong>Area # 0704(Div Mgr, Assist Div Mgr or Div Fin Mgr) 3 Division Authorization ($5000 or more only)REV 04/20<strong>09</strong>DV, Contract or<strong>Purchase</strong> Order # I k../..2 550


<strong>AED</strong> State contract Page 1 <strong>of</strong> 2Jennifer KuhnFrom: Culley, Linda [Linda.Culley@kingcounty.gov ]Sent: Wednesday, December 02, 20<strong>09</strong> 12:10 PMTo: Jennifer KuhnSubject: <strong>AED</strong> State contractImportance: HighAttachments: 1588_001.pdfJenny,Here is the in<strong>for</strong>mation <strong>for</strong> the WA state contract <strong>for</strong> purchasing defibrillators at a discount (includes prices lists,etc.):State contract <strong>for</strong> DEFIBRILLATORS, AUTOMATIC EXTERNAL (<strong>AED</strong>'S)Here is the Web link https : //<strong>for</strong>tre ss .wa.gov/ga/apps/ContractS earch/ContractSurnmary. aspx?c=01904The contract number is 01904 and 3 vendors are under contractPhillips MedicalZoll MedicalCardiac Science***************Below is a 'sample' email showing how <strong>King</strong> <strong>County</strong> ordered <strong>AED</strong>s <strong>of</strong>f the state contract. We were told thatgovernment agencies are to use theaed.market@philips.com in the email below to order equipment (<strong>AED</strong>s and/or trainers or batteries)If you need a <strong>Purchase</strong> Order <strong>for</strong> the city <strong>of</strong> Woodinville, you will need to replace the number below with yourown.Hope this helps. Deadline <strong>for</strong> delivery <strong>for</strong> your equipment is December 31st. We ordered ours from Philips onNov 19th and we will receive deliver on Dec 7th. If you have any questions, please call.Linda Culley, ManagerCommunity Programs<strong>King</strong> <strong>County</strong> Emergency Medical ServicesPhone: 206-263-8562Cell: 206-818-3436linda.culley@kingcounty.govFrom: Doctorello, LeahSent: Thursday, November 19, 20<strong>09</strong> 2:36 PMTo: 'aed.market©phlips.com'Cc: Culley, LindaSubject: <strong>AED</strong> <strong>Purchase</strong>Importance: HighGood afternoon,12/3/20<strong>09</strong>


A ED State contract Page 2 <strong>of</strong> 2We are interested in purchasing 10 <strong>AED</strong>s and 1 wall mounted <strong>AED</strong> cabinet. (Replace with your equipment order)<strong>King</strong> <strong>County</strong> <strong>Public</strong> <strong>Health</strong>, Emergency Medical Services is a <strong>County</strong> government agency there<strong>for</strong>e we haveprepared a <strong>Purchase</strong> order piggy backing the State contract #01904.Our <strong>Purchase</strong> Order # is: R34681 R (Replace with your city <strong>of</strong> Woodinville PO number)I've attached a copy <strong>of</strong> our PO <strong>for</strong> your reference. (Attach your own PO)1588_001.pdf»I need to find out what you need from me to place this order, as well as, I need to confirm that we would be ableto order these devices (and wall cabinet) and have them shipped, received and invoiced by December 31, 20<strong>09</strong>.Please feel free to contact at 206-263-8567 if you have any questions. (Replace with your own contact name andnumber.)Thank you,—Leah12/3/20<strong>09</strong>


REQUECT TO PURCHASE .-ORMRequest Specifics ✓Waiver AttachedQuotes AttachedGoods (DV) — to Site DV Log AdministratorGoods (PO) - to Distribution Center DTR-PH-0100Services (DVS or PO) - to CPRES CNK-PH-1300Emergency (DVE) - Division Finance ManagerBid/RFQ Requested Prepaid (DVF) - to Accounting CNK-PH-1200Does this service involve Protected <strong>Health</strong> In<strong>for</strong>mation (PHI)?(Under HIPAA, PHI means individually identifiable Yeshealth in<strong>for</strong>mation).NoCAPITAL ASSET SITE CODESSite # 8171Building # B6<strong>09</strong>Area # 0704(Div Mgr, Assist Div Mgr or Div Fin Mgr)xxContact In<strong>for</strong>mation:Date:10/29/<strong>09</strong>,Printed Na - Leah Dictoxello/Linda C IleyPhone #: 206-263-867/8562Mailstop/Program: CNK/PH.1200/CommProgProgram Authorization: Date:,Printed Name: Linda CugnatuFer...-<strong>Public</strong> <strong>Health</strong><strong>Seattle</strong> & <strong>King</strong> <strong>County</strong>r7 SUPPLIES & SERVICES UNDER $ 5,000 (including Tax & Freight; Excluding Computing — See Below)(Supplies should use a "52000" series Expense Account and Services should use a "53000" series Expense Account)CONTROLLED SUPPLIES UNDER $ 5,000 (Defibrillators) (requires a P0- Use Expense Account 52187)❑ SUPPLIES (CAPITAL) & SERVICES $ 5,000 OR MORE (Including Tax & Freight; Computing items —see below)COMPUTER HARDWARE/SOFTWARE (Requires MIS approval)❑ SOFTWARE Less than $25,000 initial purchase or upgrade (Non Capital Account 52190)❑ SOFTWARE $25,000 or more initial purchase or upgrade (Capital Account 56742)❑ SOFTWARE Annual License Fee <strong>for</strong> existing s<strong>of</strong>tware (Service Account 53636)❑ HARDWARE (Laptops, Desktops, Projector, Servers) Less than $5,000, requires a PO (Department Controlled Equipment Account 5? 167)El HARDWARE $5,000 or more (Capital Account 56741)❑ IT Equipment-- Repair/Maintenance <strong>for</strong> existing s<strong>of</strong>tware or hardware (Service Account 53634)❑ Consulting IT Services (Service Account 53127)...11111023111111111 Org Account Option Project Vendor. Name & Address:IIIIIIIBIIIIIIII 8812IIIIIIIIIIIIIIIII52187 DRPAD2 Philips Medical S stemsP.O. Box 406538Atlanta, GA 30384-6538IIIIIIIIIContact: Vince WalkerMIMI Phone: 206-664-5211s'' •,‘ \- ,,,,, w,,,,,,,, •..,,w,,,,,,,..\\ ,A • .x.,,,,,,,,,,od,n clastified employee. Please', O N4;;: %.,,''',provide V 4detail,on the work;to be conducted by any individual and w:thts\,,,,,mpr canrfot be pet<strong>for</strong>rned by a Kind Countk., : ,...,cmployee STT; TLT or Career Service).W: *, VUse attachment if necessary. Formd v4dual vendors useacct code 53104 or 53105 .ITEM QTY• UNIT DETAILED DESCRIPTI : UNIT PRICE TOTAL COSTM5066A-CO1 Defibrillator, biphasic, automatic external defibrillatorwith one pair adult defibrillator pads, standard carry case (C01),user guide and battery pack. HeartStart OnSite Defibrillator1 10 ea M5066A $ 1,013.35 $ 10,133.502 1 ea PFE7024D <strong>AED</strong> Cabinet, Wall Meount $ 227.50 $ 227.501161111111111111111111 $ -4 MEE Products are to be • urchased usin. the State Contract: $ -5 #01904 Automatic External Defibrillators AEU's IIMIIIIIIIII $ -6 0.10.1. Contract Period: June 15, 20<strong>09</strong> - June 14, 2010 IIIIIIIIIIIIIIIIII IIIEIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIMIIIIIIIIIMIIIIIIIIIIIIIIIIMI $ -89 1111111111,ika,,1011111111111111111111111111111111111111111111111111SHIPPINGSUB-TOTALTAXf ,,aTOTALTs1 rsJ^'•,,,,,$ -$ -$$ 10,361.00$ 984.30$ 11,345.30Printed Name:SignatureDivision Authorization ($5000 or more only)


"RRFinance andBusiness Operations DivisionProcurement and Contract Services SectionDepartment <strong>of</strong> Executive ServicesCNK-ES-0340PURCHASE ORDERNO. R34681RTHIS oRoEn NUMBER MUST APPEAR ON ALL401 venue 3rd FLoorINVOICES, PACKING SLIPS, PACKAGES, ETC.<strong>Seattle</strong>, i362 6 y44 90801 64 - 1 8 1 8rURCHASB ORDER DATE DEUVERY DATE BID NUMBER REQUISMON NUMBER—\<strong>King</strong> CountY 11/17/<strong>09</strong> 12/17/<strong>09</strong>.Y50101YBILL TO IN DUPLICATE 'SHP TO' ADDRESS('VENDOR NAME AND ADDRESS , VENDOR . , _ , NO, .113968 U,NLESS OTFISSWISE NOTED . , , . . .. .PHILIPS MEDICAL SYSTEMSLEAH DOCTORELLO/206-263-85672301 5TH AVENUE, SUITE 200 EMERGENCY MEDICAL SERVICES401 FIFTH AVE, SUITE 1200SEATTLE WA 98121 SEATTLE WA 98104. -CONTACTTERMSNET. 30 DAYSF.O.B. POINT SHIP VIATEL NO. 800/263-3342 EXT 8411DESTINATIONITEM QUANTITYUNIT•DESCRIPTION . .. '• PRICE AMOUNT1 10 EA CARDIOVASCULAR INSTRMNTS 1,013,3500 10,133,50EIEARTSTART ONSITE DEFBRILLATOR M5066A-00012 1 EA CARDIOVASCULAR INSTRMNTS 227.5000 227.50<strong>AED</strong> CABINET, WALL MOUNTED PFE7024D_TERMS;FURNISH IN ACCORDANCE WITH WASHINGTON STATECONTRACT NUMBER 01904, INCORPORATED BY REFERENCEAS IF FULLY SET FORTH HEREIN.•. . . ..• . . .'. .. .. .. ..LINE P.O. NO &SUFFIX, ARMS CODING BLOCK •.oRo. UNIT. . , ACCOUNT : .. TASK 'OPTION •. f,y'RaniriPHR.' 'AMP"T . SUB TOTAL 10,361.00BUYERR34661R 8612 52187 .111 --DRPAD2 . 11,345.29 W.S.S.T 984.29•.• .' . •.•. FREIGHT'..... ... .•. TOTAL .•.11 345,29P.I.R. AFF A,A.W. M.W.B.W.1105 1105WANDA WILLIAMS PURCHASING MANAGERNO DELIVERIES ACCEPTEDD. R. LEACHUNLESS ACCOMPANIED BYsEi , Y ://..i.--&-:4 .l. -/- i.L11...1 _ PACKING SLIP OR WAYBILL. .;.. //BY I fiLLi.. , .,...,_,THIS PURCHASE ORDER IS SUBJECT TO THE TERMS AND CONDITIONS ON THE REVERSE SIDE HEREON AND ANY SPECIAL PROVISIONS,CONDITIONS OR SPECIFICATIONS AS INVOKED IN THE BODY OF THIS PURCHASE ORDER. FEDERAL EXCISE TAX EXEMPTION CERTIFICATEWILL BE FURNISHED UPON REQUEST.VENDOR


<strong>King</strong> <strong>County</strong> EMS Division<strong>City</strong> <strong>of</strong> Woodinville/Woodinville Fire & Life SafetyProject RAMPART BudgetPAD/<strong>AED</strong>'s3 M5066A-CO1$1,013.35 $3,040.05Tax $289.00Shipping(Approximate)$.00$3,330 $3,330TrainingCPR/<strong>AED</strong>class asapproved byAHAInstructor cost(FireDepartment toprovidetraining inkind)TrainingSuppliesTrainingsupplies toincludeCPR/<strong>AED</strong>cards, manuals,trainingcartridges <strong>for</strong>defib units etc.would beapproximately(with tax andshipping)2 M5085A-PhilipsHeartStart Trainer,M5066-91900Instructions <strong>for</strong> Use,HeartStart On-SiteDefibrillator@$191.75/eaTax $372 Batteries <strong>for</strong>HeartStart @$81.25/ea$ $648Tax $15AHA Cards @ $1.81each = $50Total20<strong>09</strong>Budget$3,978Revised 10/28/<strong>09</strong>


Objective:<strong>King</strong> <strong>County</strong> Project RAMPARTA Regional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and TrainingJuly, 20<strong>09</strong>The purpose <strong>of</strong> this project is to pilot strategies to improve and enhance the existing <strong>King</strong> <strong>County</strong> <strong>Public</strong>Access Defibrillation (PAD) Program. This will be accomplished by creating a partnership with <strong>King</strong><strong>County</strong> and several local municipalities to provide incentives to maintain and expand their county and cityPAD programs. The pilot program will include systematic registration <strong>of</strong> municipal <strong>AED</strong>s in the regionalregistry, effective guidance and placement <strong>of</strong> devices in higher-incidence/higher risk settings wheresudden cardiac death is more likely to occur, purchase <strong>of</strong> <strong>AED</strong>s, and provision <strong>of</strong> CPR/<strong>AED</strong> Training <strong>for</strong>county and city participants.Specific objectives are to:■ promote better inclusion <strong>of</strong> <strong>AED</strong>s in the PAD Registry used by EMS and dispatch agencies (911call centers), as required by state law;■ provide an incentive and guidelines <strong>for</strong> purchase and most efficient placement <strong>of</strong> <strong>AED</strong>s in higherincidence/higherrisk locations;■ promote training in use <strong>of</strong> <strong>AED</strong>s (related to a legal requirement).Pilot approach• Select 3-5 municipalities and <strong>King</strong> <strong>County</strong>;• Determine partnership possibilities <strong>for</strong> sharing PAD enhancement , e.g. identifying criticallocations, placement criteria, equipment purchase, ongoing PAD training• Funding allocations to be determined• July 1, 20<strong>09</strong> to June 30, 2010.This proposal <strong>for</strong> a pilot project is complementary to the 2008-2013 Strategic Initiative promoting <strong>Public</strong>Access Defibrillation and increasing <strong>AED</strong> registration through public awareness. Funds are available <strong>for</strong>a public awareness campaign focused on citizens and private business. This proposal was presented to theEMS Advisory Council in March, 20<strong>09</strong>, and received overwhelming support to move <strong>for</strong>ward.High Incidence Locations in <strong>King</strong> <strong>County</strong>A study conducted by the EMS Division in 1998 reviewed locations <strong>of</strong> cardiac arrest in <strong>King</strong> <strong>County</strong> overa 4 year period. 4 Ten location categories with 172 sites were identified as having a higher incidence <strong>of</strong>cardiac arrest (>.03 per year, per site). The study concluded that placement <strong>of</strong> 276 <strong>AED</strong>s in the 172higher incidence sites would have provided treatment <strong>for</strong> 134 cardiac arrest patients in a 5 year period,60% <strong>of</strong> whom were in VF. The authors estimated that between 8 and 32 lives could be saved in 5 years.The ten location categories with higher incidence <strong>of</strong> cardiac arrest included public locations such asinternational airport, county jail, large shopping mall, public sports venue, large industrial site, golfcourse, shelter, ferries/train terminal, health club/gym, and community senior center. The EMS Divisionis currently reviewing 5 years <strong>of</strong> more recent cardiac arrests to determine if these higher incidencelocations have changed.<strong>King</strong> <strong>County</strong> PAD Program and PAD Registry<strong>King</strong> <strong>County</strong> EMS administers the <strong>Seattle</strong>/<strong>King</strong> <strong>County</strong> <strong>Public</strong> Access Defibrillation program, acombined ef<strong>for</strong>t by <strong>King</strong> <strong>County</strong> EMS and <strong>Seattle</strong> Fire Department. The program includes support <strong>for</strong>sites that desire to purchase and place an <strong>AED</strong>, including medical direction if needed and support <strong>for</strong> sitecoordination. The Program includes a PAD Registry which includes a listing <strong>of</strong> all <strong>AED</strong>s, contactin<strong>for</strong>mation and cardiac arrest event in<strong>for</strong>mation. In<strong>for</strong>mation on the location <strong>of</strong> <strong>AED</strong>s is sent to 911communication centers <strong>for</strong> entry into their CAD premise in<strong>for</strong>mation. This allows the dispatcher to bealerted when an <strong>AED</strong> is present in the vicinity <strong>of</strong> a cardiac arrest. There are currently 2,194 <strong>AED</strong>s in theRegistry.


<strong>King</strong> <strong>County</strong> Project RAMPARTRegional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and TrainingProject Mission: Provide incentives <strong>for</strong> <strong>King</strong> <strong>County</strong> and select municipalities to promote theplacement and registration <strong>of</strong> <strong>Public</strong> Access Defibrillators and proper training in public facilitiesand other settings at high risk <strong>for</strong> cardiac arrest events.Scone <strong>of</strong> ResponsibilitiesResponsibility <strong>of</strong> MunicipalityResponsibility <strong>of</strong> <strong>King</strong> <strong>County</strong>Provide a Project RAMPART Liaison to Administer <strong>King</strong> <strong>County</strong> Communitycoordinate with <strong>King</strong> <strong>County</strong>.Responder <strong>AED</strong> ProgramCoordinate your city <strong>Public</strong> Access Administer Project RAMPART PilotDefibrillation ef<strong>for</strong>ts.Project and provide a liaison to the city.Ensure that all existing and newly placed Conduct PAD <strong>Public</strong> Awareness Campaign<strong>AED</strong>s within your city are registered with Strategic Initiative as directed in the EMS<strong>King</strong> <strong>County</strong> PAD Registry2008-2013 Strategic PlanCoordinate any private foundation, Maintain <strong>King</strong> <strong>County</strong> PAD Registrysponsorship, donation, and/or volunteeractivities related to the purchase andplacement <strong>of</strong> <strong>AED</strong>s and <strong>AED</strong> training inprivate residences or private facilitieswithin your municipality.Provide training in CPR/<strong>AED</strong> to cityemployees and other public agencyemployees. Training <strong>for</strong> employees <strong>of</strong>agencies meeting the RCW definition <strong>of</strong>`<strong>Public</strong> Agency' may be reimbursed byProject RAMPART funding.Provide <strong>AED</strong> site coordination, as needed,activities related to proper placement,training and maintenance <strong>of</strong> the <strong>AED</strong>s <strong>for</strong>all <strong>AED</strong> in facilities within your city.Coordinate contract activities with <strong>King</strong><strong>County</strong> EMS to receive RAMPARTfunding. Contract can be with the firedepartment or with the city administration.Directly purchase <strong>AED</strong>s <strong>for</strong> publicagencies from the manufacturer, using theWA State Contract #01904. <strong>AED</strong>s <strong>for</strong>public agencies may be funded byRampart.Revised 8/17/<strong>09</strong>Send Quarterly PAD Registry Reports tocity Fire DepartmentSend Quarterly PAD Premise Info reportsto Valley Communications.Provide incentive funding to Municipalitiesvia contract; Funding allocation to bebased on city public employee count,number <strong>of</strong> <strong>Public</strong> <strong>AED</strong>s registered andnumber <strong>of</strong> private <strong>AED</strong>s registered.Provide cardiac arrest data <strong>for</strong> trending andidentification <strong>of</strong> high risk locations withina municipality.Provide a contract monitor to administerthe contract."Building a Defense Against Cardiac Arrest"


Lia-HER. . ::GAW, OrW liQN .Finante:& Busines§:Operations DivisionDepartment <strong>of</strong> , Exetutive ServicesAccOuntS Payable ARMS491 Fiftb , r9omnu, RQ071,:31:0.<strong>King</strong> <strong>County</strong> —cattle, WA 98144 , 1818, . •7,tavu, cut* duadd, oute adore/vide aftizir"CENTSCITY OF WOODINVILLE17301 133RD AVEWOODINVILLE WA 98072-8563 y' uthorized Sib^n:atrn e.•AMOUNT$503,926.7204E116 0 L 3 20E, 5 L61: L 5 3 2 L000 /0 3 511°REMITTANCE ADVICEDATE WARRANT NO.01-15-10 0486011PAYEECITY OF WOODINVILLEVOUCHER P.O. NO. INVOICE DISCOUNT AMOUNT81927(11)/, 051 .<strong>09</strong>0881<strong>09</strong>01 1


PHILIPS LIIlk I in,4% /1.1 _Li, L__ _Issue Date12/21/20<strong>09</strong>la "Due Date01/20/2010Philips <strong>Health</strong>care3000 Minuteman Road, MS 0400Andover, MA 01810<strong>Purchase</strong> Order Number:Remit To Address 103530Philips <strong>Health</strong>carePayment terms:PO Box 100355Atlanta, GA 30384-0355Phone: (800) 934-7372Ship to: 94039165<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESSold to: 94039165<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESNet 30 DaysINVOICEREPRINTContact Person:Shelly <strong>King</strong>x3539Phone: 800-934-7372Invoice to:Attn : Accounts PayableInvoice number93710294 Page 1 / 3Order Date12/08/20<strong>09</strong><strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESOrder number6300449243Customer Number94039165ACH/EFT funds to:Bank <strong>of</strong> America1850 Gateway BlvdABA Number 111000012Account 3750202223Concord, CA 94520-3282Email notification to cashmgmt.inquiries@Philips.comFax remittance to: (425) 482-8856 Attn: Cash Mgmt Dept.Special CommentsFederal EIN: 13-3429115Shipping Terms: FOB DESTINATIONUnit AmtTotal amountItem Article - / type number / description Qty Unit ( USD) ( USD)0010 M5066A HeartStart Defibrillator, HS1 3 PCE 1,460.00 4,380.00861282CO1 HS1 Standard Carry Case 3 99.00 297.00Agreement Discount -35.00 % -1,636.95Net Value Not Including Freight 3,040.05Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEXCommodity code : 9018906400Agreement #: MH175Serial number(s):AO9L-03075AO9L-03433Please pay on this invoice. No statement will be issued.


Issue Date12/21/20<strong>09</strong>Invoice number93710294Page 2 / 3Philips <strong>Health</strong>care3000 Minuteman Road, MS 0400Andover, MA 01810Due Date01/20/2010Order Date12/08/20<strong>09</strong><strong>Purchase</strong> Order Number:103530Order number6300449243INVOICEREPRINTPayment terms:Net 30 DaysItem Article - / type number / description Qty UnitUnit Amt( USD)Total amount( USD)AO9L-030660020 M5085A HS1 Trainer, Philips, Guidelines 2005861295Agreement Discount2 PCE 295.00 590.00-35.00 % -206.50Net Value Not Including Freight383.50Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEXCommodity code : 9023000000Agreement #: MH1750030 M5070A HS1 Battery Pack989803121381Agreement Discount2 PCE 125.00 250.00-35.00 % -87.50Net Value Not Including Freight162.50Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEXCommodity code : 8506100000Agreement #: MH175Ot ‘)(2-0;e6. bY\k- 04 1,00ocunNoWLs10(:)\ - Dt-k - 2 01.0Please pay on this invoice. No statement will be issued.Total Gross Value 5,517.00Discount Amount -1,930.95Net Value 3,586.05Total tax 340.67Total 3,926.72


Page 1 <strong>of</strong> 2Jennifer KuhnFrom: McCarthy, Linda [linda.mccarthy©philips.com ] on behalf <strong>of</strong> <strong>AED</strong> Market[<strong>AED</strong>.Market@philips.com ]Sent: Tuesday, December 08, 20<strong>09</strong> 3:24 PMTo: Jennifer KuhnSubject: <strong>AED</strong> <strong>Purchase</strong>Attachments: <strong>City</strong> <strong>of</strong> Woodinville PO 103530 <strong>AED</strong>.pdfHi Jennifer,Your purchase order 103530 has been processed. Your order confirmation is 6300449243. I will let you knowwhat the estimated delivery date is once I receive an acknowledgement.Thanks,Linda McCarthyCommercial Operations SpecialistPhilips <strong>Health</strong>care3000 Minuteman RdAndover, MA 01810Office: 978-659-4751Fax: 978-856-3531linda.mccarthy@philips.comHours 9:00am to 5:30pmFrom: Jennifer Kuhn [mailto:jenniferk©ci.woodinyille.wa.us ]Sent: Monday, December 07, 20<strong>09</strong> 1:38 PMTo: <strong>AED</strong> MarketCc: Culley, LindaSubject: <strong>AED</strong> <strong>Purchase</strong>We are interested in purchasing the following items:Quantity PART NUMBER DESCRIPTION PRICEDefibrillator, biphasic, automatic external$1013.35defibrillator with one pair adult defibrillator pads,M5066A C013standard carry case (C01), user guide and batterypack. HeartStart OnSite Defibrillator M5066A2 M5085A Philips HeartStart Trainer $191.752 M5070A Battery <strong>for</strong> HeartStart (HS1) $81.25<strong>City</strong> <strong>of</strong> Woodinville is a <strong>City</strong> government agency; there<strong>for</strong>e we have prepared a purchase orderpiggy backing the State Contract #01904.Our purchase order number is 103530. I've attached a copy <strong>of</strong> our PO <strong>for</strong> your reference.12/8/20<strong>09</strong>


Page 2 <strong>of</strong> 2Is there any thing else you need from me to place this order? Please confirm that we will beable to order these devices, have them shipped, received and invoiced by December 31, 20<strong>09</strong>.See contact in<strong>for</strong>mation below.Sincerely,Jennifer Kuhn<strong>City</strong> Clerk/CMCjenniferk@ci.woodinville.wa.us* * * * * * * * * * * *<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Avenue NEWoodinville, WA 98072* * * * * * * * * * * * * * * * * * * * *425.489.2700, ext 2262425.489.2705 (fax)Please visit our website at www.ci.woodinville.wa.usNOTE: This email is considered a public record and may be subject to public disclosure.ini mation may be con' i ,.!:- .1 and leghlly d Linder. If you a: c,ipient, you are 1 ebcrY -WI I the ir.t,:nded r.•:The message is intended solely <strong>for</strong> heon, or reproduction <strong>of</strong> thisL -mail and destroy ail copi.a,12/8/20<strong>09</strong>


PH I 1p,laill■*CrpH L'PsIssue Date12/21/20<strong>09</strong>Due Date01/20/2010Philips <strong>Health</strong>care3000 Minuteman Road, MS 0400Andover, MA 01810<strong>Purchase</strong> Order Number:Remit To Address 103530Philips <strong>Health</strong>carePayment terms:PO Box 100355Atlanta, GA 30384-0355Phone: (800) 934-7372Ship to: 94039165<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESSold to: 94039165<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESNet 30 DaysINVOICEREPRINTContact Person:Shelly <strong>King</strong>x3539Phone: 800-934-7372Invoice to:Attn : Accounts PayableInvoice number93710294 Page 1 / 3Order Date12/08/20<strong>09</strong><strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESOrder number6300449243Customer Number94039165ACH/EFT funds to:Bank <strong>of</strong> America1850 Gateway BlvdABA Number 111000012Account 3750202223Concord, CA 94520-3282Email notification to cashmgmt.inquiries@Philips.comFax remittance to: (425) 482-8856 Attn: Cash Mgmt Dept.Special CommentsFederal EIN: 13-3429115Shipping Terms: FOB DESTINATIONUnit AmtItem Article - / type number / description Qty Unit ( USD)Total amount( USD)0010 M5066A HeartStart Defibrillator, HS1 3 PCE 1,460.00 4,380.00861282CO1 HS1 Standard Carry Case 3 99.00 297.00Agreement Discount -35.00 % -1,636.95Net Value Not Including Freight 3,040.05Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEXCommodity code : 9018906400Agreement #: MH175Serial number(s):AO9L-03075AO9L-03433Please pay on this invoice. No statement will be issued.


PHILIPSPhilips <strong>Health</strong>care3000 Minuteman Road, MS 0400Andover, MA 01810Issue Date Invoice number12/21/20<strong>09</strong> 93710294 Page 2 / 3Due Date Order Date Order number01/20/2010 12/08/20<strong>09</strong> 6300449243<strong>Purchase</strong> Order Number:103530INVOICEREPRINTPayment terms:Net 30 DaysItem Article - / type number / description Qty UnitUnit Amt( USD)Total amount( USD)AO9L-030660020 M5085A861295HS1 Trainer, Philips, Guidelines 2005 2Agreement DiscountPCE 295.00 590.00-35.00 % -206.50Net Value Not Including Freight383.50Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEX0030 M5070A989803121381Commodity code : 9023000000Agreement #: MH175HS1 Battery Pack 2Agreement DiscountPCE 125.00 250.00-35.00 % -87.50Net Value Not Including Freight162.50Bill <strong>of</strong> Lading: 411624536154Ship Date :Route :Carrier : FEDEXCommodity code : 8506100000Agreement #: MH175Total Gross Value 5,517.001 cer—Li that these goods or serviceshave been recejlved161KAu crazed Signaturedoh <strong>09</strong> 5 6 go-Acct No. or PC No. Cancel no? ❑Discount Amount -1,930.95Net Value 3,586.05Total tax 340.67Total 3,926.72Please pay on this invoice. No statement will be issued.


PHILIPSPhilips <strong>Health</strong>care3000 Minuteman Road, MS 0400Andover, MA 01810Issue Date12/21/20<strong>09</strong>Invoice number93710294Due Date Order Date Order number01/20/2010 12/08/20<strong>09</strong> 6300449243<strong>Purchase</strong> Order Number:103530Page 3 / 3INVOICEREPRINTPayment terms:Net 30 DaysUnit AmtTotal amountItem Article - / type number / descriptionQty Unit( USD)( USD)Seller represents that these goods were produced in compliance with all applicable requirements <strong>of</strong> section 6, 7 and12 <strong>of</strong> theFair Labor Standards Act, as amended herein regulations and orders <strong>of</strong> the United States Department <strong>of</strong> Labor issued undersection 14 there<strong>of</strong>.The following clause only refers to US-origin products as indicated in this document:These commodities, technology or s<strong>of</strong>tware were exported from the United States <strong>for</strong> ultimate destination United States inaccordance with the Export Administration Regulations. Diversion contrary to U.S. law is prohibited.<strong>Health</strong> Care Providers are reminded that if the purchase <strong>of</strong> goods or services includes a discount, such as a price reduction ora loan <strong>of</strong> goods at reduced cost, they must fully and accurately report such discount on cost reports or other applicable claims<strong>for</strong> payment submitted under any Federal <strong>Health</strong> Care Program, including but not limited to Medicare and Medicaid as requiredby Federal law (see 42 USA 1320a - 7(b)(3) and 42 CFR 1001.952(h)).Please pay on this invoice. No statement will be issued.


CITY OF WOODINVILLE17301 133RD AVENUE NEWOODINVILLE,WA 98072woc;b iN v EL _ E (425) 489-2700\y/DATE12/7/20<strong>09</strong>PO NUMBER103530Page 1 / 1VENDOR: 002089PHILIPS MEDICAL SYSTEMSP.O. BOX 406538ATLANTA, GA 30384-6538SHIP TO: CITY OF WOODINVILLE17301 133RD AVE NEWOODINVILLE, WA 98072FOP EffINATIONAN1Vet 30Required Delivery DateSpecial hist:Req. No003782Dept.:ContactFAVA, LINDAConfirmingNoQuantity Unit Description Unit Price Ext. Price3.00 ea DEFIBRILLATORS AND SUPPLIES: 1,013.3500 3,040.053 DEFIBS(Vendor: Phillips Medical Systems, POBox 406538, Atlanta, GA 30384-6538Contact: Vince Walker (206) 664-5211)1.00 EA <strong>AED</strong> TRAINING SUPPLIES 596.9500 596.951.00 ea TAX 341.0000 341.00SUBTOTAL 3.978.00BILL TO: CITY OF WOODINVILLE TAX 0.0017301 133RD AVE NE FREIGHT 0.00WOODINVILLE, WA 98072 TOTAL 3,978.00Account NumberAmountAccount NumberAmountE 001.<strong>09</strong>0.519.90.31.313,978.00


Packing ListPHILIPSCUSTOMER INFORMATIONShip To:<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESDeliver To:SHIPPER INFORMATIONShipped From:Philips Medical SystemsCRS <strong>Seattle</strong> Primary2301 5th Avenue, Suite 100SEATTLE WA 98121UNITED STATES800-934-7372Contact person: Linda McCarthySold To:<strong>City</strong> <strong>of</strong> Woodinville17301 133rd Ave NEWOODINVILLE WA 98072-8563UNITED STATESAttention <strong>of</strong>:Inc° terms: FOB DESTINATIONPhilips Order No: 6300449243Philips Delivery No: 87328722Carrier Ref No:Carrier: FEDERAL EXPRESS CORPORATIONCustomer P.O. No: 103530Ship Date: 12/18/20<strong>09</strong>Order DeliveryItem Item Qty Product Description Box No. Box Weight10 10 3 M5066A HeartStart Defibrillator, HS1861282 Dept Code : 1466M5066A With the Following Features:ABA - U.S. English101774221327.0 LB12.2 KG20 20 3 M5066A-ABA HS Onsite Defibrillator, US English989803128161 Dept Code : 1466Page 1 / 3


Packing ListPHILIPSPHILIPSCUSTOMER INFORMATIONShip To: <strong>City</strong> <strong>of</strong> WoodinvilleCustomer P.O. No: 103530SHIPPER INFORMATIONPhilips Order No: 6300449243Philips Delivery No: 87328722Order DeliveryItem Item Qty Product Description Box No. Box WeightSN: AO9L-03066SN: AO9L-03075SN: AO9L-0343330 30 M5075A989803121431Standard Carry Case <strong>for</strong> HeartStart HS1Dept Code 1467M5066A End <strong>of</strong> Features40 40 2 M5085A HS1 Trainer, Philips, Guidelines 2005861295 Dept Code : 1467M5085A With the Following Features:ABA - U.S. English101774221350 50 M5085A-ABA Philips HeartStart Trainer - US English989803129911 Dept Code : 1467M5085A End <strong>of</strong> Features60 60 j 2 M5070A HS1 Battery Pack989803121381 Dept Code : 14671017742213Page 2 / 3


Packing ListPHILIPSCUSTOMER INFORMATIONShip To: <strong>City</strong> <strong>of</strong> WoodinvilleCustomer P.O. No: 103530SHIPPER INFORMATIONPhilips Order No: 6300449243Philips Delivery No: 87328722Order DeliveryItem Item Qty Product Description Box No. Box WeightTotal Box Count: 1 Total Box Weight:27.0 LB12.2 KGThese item(s) may be subject to export controls, if so they may not be sold or otherwise disposed <strong>of</strong> withoutprior written approval <strong>of</strong> the Seller. Where these commodities, technology or s<strong>of</strong>tware are subject to exportregulations, the export or re-export without proper export licenses or export license exceptions is strictly<strong>for</strong>bidden.These commodities, technology or s<strong>of</strong>tware when exported from the United States <strong>for</strong> ultimate destinationUnited States, are in accordance with Export Administration Regulations. Diversion contrary to US law isprohibited.


SHIPPER'S DECLARATION FOR DANGEROUS GOODSShipper PHILIPS MEDICAL SYSTEMS2301 5TH AVENUE SUITE 100SEATTLE, WASHINGTON 98121UNITED STATESAir Waybill No.Page 1 <strong>of</strong> 1 Pages(Provide at least two copies to the airline.Shippers Reference Number 87328722(optional)Consignee RECEIVINGCITY OF WOODINVILLE17301 133RD AVENUE NEWOODINVILLE WA 98072-8563UNITED STATESTwo completed and signed copies <strong>of</strong> this Declaration must behanded to the operatorWARNINGocER? 4.0o" ---VA .,I,iPowered by Ship•Hazmat®TRANSPORT DETAILSThis shipment is within thelimitations prescribed <strong>for</strong>(delete non-applicable)RAMMER CARGOARID•COOXASKI AIRCRAFTXMOWOOKKX ONI YAirport <strong>of</strong> DestinationAirport <strong>of</strong> DepartureSEATTLE - TACOMAINTERNATIONALAIRPORTNATURE AND QUANTITY OF DANGEROUS GOODSDangerous Goods IdentificationUNOrProper Shipping NameIDNo.UN3<strong>09</strong>0UN3<strong>09</strong>1Lithium metal batteriesLithium metal batteries packed withequipmentr Classor Division(SubsidiaryRisky99Failure to comply in all respects with the applicableDangerous Goods Regulations may be in breach <strong>of</strong>the applicable law, subject to legal penalties.Shipment Type (delete non-applicable)Packing1 GroupIIIINON-RADIOACTIVEI XRX10,111101XWETQuantity and Type<strong>of</strong> Packing1 FIBREBOARD BOXx 0.9 kg G3 FIBREBOARD BOXESx .4 'cgOverpack usedFPackingInst.968969rAuthorizationAdditional Handling In<strong>for</strong>mationEmergency Response Telephone Number: 18002553924Lithium Batteries: In case <strong>of</strong> fire avoid using water, use a Class D fire extinguisher, copper powder, or dry sand. If package is damaged, donot ship. Inspect internal contents and contact the shipper.Offered by Philips <strong>Health</strong>care Inc. 24 Hour ChemTel Emergency Contact Numbers:Domestic: 1-800-255-3924 (toll free)International: +001-813-248-0585(collect)I hereby declare that the contents <strong>of</strong> this consignment are fully andaccurately described above by the proper shipping name, and areclassified, packaged, marked and labelled/placarded, and are in allrespects in proper condition <strong>for</strong> transport according to applicableinternational and national governmental regulations. I declare thatall <strong>of</strong> the applicable air transport requirements have been met.Name/Title <strong>of</strong> SignatoryDexter Phanekham / Material HandlerPlace and Date<strong>Seattle</strong>, WA 12/18/20<strong>09</strong>Signature(see warning above)


SHIPPER'S DECLARATION FOR DANGEROUS GOODSShipper PHILIPS MEDICAL SYSTEMS2301 5TH AVENUE SUITE 100SEATTLE, WASHINGTON 98121UNITED STATESAir Waybill No.Page 1 <strong>of</strong> 1 PagesProvide at least two copies to the airline.Shipper's Reference Number 87328722(optional)Consignee RECEIVINGCITY OF WOODINVILLE17301 133RD AVENUE NEWOODINVILLE WA 98072-8563UNITED STATESTwo completed and signed copies <strong>of</strong> this Declaration must behanded to the operatorWARNING,aGE/io'C u'c,o9.4,;.._. 41' , 'Powered by Ship•HazrnatOTRANSPORT DETAILSThis shipment is within thelimitations prescribed <strong>for</strong>(delete non-applicable)RANNIFJCZERANDXXIXBILSKIii*XXfKIKIMXCARGOAIRCRAFTONI YAirport <strong>of</strong> DestinationAirport <strong>of</strong> DepartureSEATTLE - TACOMAINTERNATIONALAIRPORTNATURE AND QUANTITY OF DANGEROUS GOODSDangerous Goods IdentificationUN -]r Classoror DivisionProper Shipping NameID(SubsidiaryNo. iUN3<strong>09</strong>0 Lithium metal batteriesL Risk)9UN3<strong>09</strong>1Lithium metal batteries packed withequipment9Failure to comply in all respects with the applicableDangerous Goods Regulations may be in breach <strong>of</strong>the applicable law, subject to legal penalties.Shipment Type (delete non-applicable)PackingGroupIIIINON-RADIOACTIVE I XRXINIEUXEMETQuantity and Type<strong>of</strong> Packing1 FIBREBOARD BOXx 0.9 kg G3 FIBREBOARD BOXESx .4 kgOverpack usedrPackingInst.9689691-AuthorizationAdditional Handling In<strong>for</strong>mationEmergency Response Telephone Number: 18002553924Lithium Batteries: In case <strong>of</strong> fire avoid using water, use a Class D fire extinguisher, copper powder, or dry sand. If package is damaged, donot ship. Inspect internal contents and contact the shipper.Offered by Philips <strong>Health</strong>care Inc. 24 Hour ChemTel Emergency Contact Numbers:Domestic: 1-800-255-3924 (toll free)International: +001-813-248-0585(collect)I hereby declare that the contents <strong>of</strong> this consignment are fully andaccurately described above by the proper shipping name, and areclassified, packaged, marked and labelled/placarded, and are in allrespects in proper condition <strong>for</strong> transport according to applicableinternational and national governmental regulations. I declare thatall <strong>of</strong> the applicable air transport requirements have been met.Name/Title <strong>of</strong> SignatoryDexter Phanekham / Material HandlerPlace and Date<strong>Seattle</strong>, WA 12/18/20<strong>09</strong>Signature(see warning above)Fl ulil_ <strong>Health</strong>care


RAMPART GrantPurpose: The RAMPART Grant is funded through <strong>King</strong> <strong>County</strong> as a pilot program topromote placement and registration <strong>of</strong> <strong>Public</strong> Access Defibrillators, and proper training inpublic facilities.Flies: M:\EXEC DEPT\Grants\RAMPART grant\20<strong>09</strong>Contact: Linda CulleyLinda.Culley@kingcounty.govNote: Linda Culley will be contacting Zach or Jeannie with additional in<strong>for</strong>mation.Responsible Department: ExecutiveStatus <strong>of</strong> Grant: The <strong>City</strong> has submitted a final budget to Linda Culley; subsequentlyshe submitted the Direct Voucher. When this is approved, Linda will notify the <strong>City</strong> andthe <strong>City</strong> can purchase the <strong>AED</strong>'s and supplies listed in the budget. The budget identifieswhat <strong>AED</strong> and supply items to purchase. M:\EXEC DEPT\Grants\RAMPARTgrant\20<strong>09</strong>\Final. Grant.doc<strong>Purchase</strong> and Invoicin . Once we receive approval <strong>of</strong> the Direct Voucher, purchase thesupplies, because we must be in receipt <strong>of</strong> the supplies and equipment no later thanDecember 31, 20<strong>09</strong>. Once we have received equipment invoice Linda Culley by earlyJanuary.


Form' 7-4I..,(Rev. October 2007)Department <strong>of</strong> the TreasuryInternal Revenue Servicec.ieFITa.a0a) 'C'la. o ..p, o6 2. c 2rL '99A-aiC/)Name (as shown on your income tax return)C i 7"( pp- WooppilyaLFBusiness ame, if different from aboveRequest <strong>for</strong> TaxpayerideItif:lation Number and CertificationCheck appropriate box: 1111 Individual/Sole proprietor i•Corporation U Partnershipit Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) 11%.El---Other (see instructions) to- Ili go 1011,411yAddress (number, street, and apt. or suite no.)173o1 133rA /-/E IVE-<strong>City</strong>, state, and ZIP codet000PoloilE ,List account number(s) here (optional)1,ij A q O7 AGive <strong>for</strong>m to therequester. Do notsend to the IRS.Tr/ExemptpayeeRequester's name and address (optional)tiainia.,:iiTaxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoidbackup withholding. For individuals, this is your social security number (SSN). However, <strong>for</strong> a residentalien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it isyour employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.Note. If the account is in more than one name, see the chart on page 4 <strong>for</strong> guidelines on whosenumber to enter.Part IISignHereCertificationUnder penalties <strong>of</strong> perjury, I certify that:Signature <strong>of</strong>U.S. person I.-4AAGeneral Instruct'Section references are to e Internal Revenue Code unlessotherwise noted,Purpose <strong>of</strong> FormA person who is required to file an in<strong>for</strong>mation return with theIRS must obtain your correct taxpayer identification number (TIN)to report, <strong>for</strong> example, income paid to you, real estatetransactions, mortgage interest you paid, acquisition orabandonment <strong>of</strong> secured property, cancellation <strong>of</strong> debt, orcontributions you made to an IRA.Use Form W-9 only if you are a U.S. person (including aresident alien), to provide your correct TIN to the personrequesting it (the requester) and, when applicable, to:1. Certify that the TIN you are giving is correct (or you arewaiting <strong>for</strong> a number to be issued),2. Certify that you are not subject to backup withholding, or3. Claim exemption from backup withholding if you are a U.S.exempt payee. If applicable, you are also certifying that as aU.S. person, your allocable share <strong>of</strong> any partnership income froma U.S. trade or business is not subject to the withholding tax on<strong>for</strong>eign partners' share <strong>of</strong> effectively connected income.Note. If a requester gives you a <strong>for</strong>m other than Form W-9 torequest your TIN, you must use the requester's <strong>for</strong>m if it issubstantially similar to this Form W-9.Date 111-Social security numberorEmployer identification number/5793831. The number shown on this <strong>for</strong>m is my correct taxpayer identification number (or I am waiting <strong>for</strong> a number to be issued to me), and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the InternalRevenue Service (IRS) that I am subject to backup withholding as a result <strong>of</strong> a failure to report all interest or dividends, or (c) the IRS hasnotified me that I am no longer subject to backup withholding, and3. I am a U.S. citizen or other U.S. person (defined below).Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backupwithholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.For mortgage interest paid, acquisition or abandonment <strong>of</strong> secured property, cancellation <strong>of</strong> debt, contributions to an individual retirementarrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you mustprovide your correct TIN. See the 'nstructions on page 4.Definition <strong>of</strong> a U.S. person. For federal tax purposes, you areconsidered a U.S. person if you are:• An individual who is a U.S. citizen or U.S. resident alien,• A partnership, corporation, company, or association created ororganized in the United States or under the laws <strong>of</strong> the UnitedStates,• An estate (other than a <strong>for</strong>eign estate), or• A domestic trust (as defined in Regulations section301.7701-7).Special rules <strong>for</strong> partnerships. Partnerships that conduct atrade or business in the United States are generally required topay a withholding tax on any <strong>for</strong>eign partners' share <strong>of</strong> incomefrom such business. Further, in certain cases where a Form W-9has not been received, a partnership is required to presume thata partner is a <strong>for</strong>eign person, and pay the withholding tax.There<strong>for</strong>e, if you are a U.S. person that is a partner in apartnership conducting a trade or business in the United States,provide Form W-9 to the partnership to establish your U.S.status and avoid withholding on your share <strong>of</strong> partnershipincome.The person who gives Form W-9 to the partnership <strong>for</strong>purposes <strong>of</strong> establishing its U.S. status and avoiding withholdingon its allocable share <strong>of</strong> net income from the partnershipconducting a trade or business in the United States is in thefollowing cases:• The U.S. owner <strong>of</strong> a disregarded entity and not the entity,Cat. No, 10231X Form W-9 (Rev. 10-2007)


<strong>King</strong> <strong>County</strong> Project RAMPARTRegional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and Training<strong>City</strong> <strong>of</strong> Woodinville/Woodinville Fire DepartmentMeeting 8/26/<strong>09</strong>1. Introductions2. Project Overview3. Responsibilities4. Funding Model/WA State Contract5. Training6. Device Registry — Devices to be registered with KC PAD Registry maintained byKC EMS. Benefits include:➢ Compliance with WA RCW➢ Premise in<strong>for</strong>mation reports sent to NORCOM➢ Quarterly Registry reports sent to Fire Department7. Other Discussion


Objective:<strong>King</strong> <strong>County</strong> Project RAMPARTA Regional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and TrainingJuly, 20<strong>09</strong>The purpose <strong>of</strong> this project is to pilot strategies to improve and enhance the existing <strong>King</strong> <strong>County</strong> <strong>Public</strong>Access Defibrillation (PAD) Program. This will be accomplished by creating a partnership with <strong>King</strong><strong>County</strong> and several local municipalities to provide incentives to maintain and expand their county and cityPAD programs. The pilot program will include systematic registration <strong>of</strong> municipal <strong>AED</strong>s in the regionalregistry, effective guidance and placement <strong>of</strong> devices in higher-incidence/higher risk settings wheresudden cardiac death is more likely to occur, purchase <strong>of</strong> <strong>AED</strong>s, and provision <strong>of</strong> CPR/<strong>AED</strong> Training <strong>for</strong>county and city participants.Specific objectives are to:■ promote better inclusion <strong>of</strong> <strong>AED</strong>s in the PAD Registry used by EMS and dispatch agencies (911call centers), as required by state law;■ provide an incentive and guidelines <strong>for</strong> purchase and most efficient placement <strong>of</strong> <strong>AED</strong>s in higherincidence/higherrisk locations;■ promote training in use <strong>of</strong> <strong>AED</strong>s (related to a legal requirement).Pilot approach• Select 3-5 municipalities and <strong>King</strong> <strong>County</strong>;• Determine partnership possibilities <strong>for</strong> sharing PAD enhancement , e.g. identifying criticallocations, placement criteria, equipment purchase, ongoing PAD training• Funding allocations to be determined• July 1, 20<strong>09</strong> to June 30, 2010.This proposal <strong>for</strong> a pilot project is complementary to the 2008-2013 Strategic Initiative promoting <strong>Public</strong>Access Defibrillation and increasing <strong>AED</strong> registration through public awareness. Funds are available <strong>for</strong>a public awareness campaign focused on citizens and private business. This proposal was presented to theEMS Advisory Council in March, 20<strong>09</strong>, and received overwhelming support to move <strong>for</strong>ward.High Incidence Locations in <strong>King</strong> <strong>County</strong>A study conducted by the EMS Division in 1998 reviewed locations <strong>of</strong> cardiac arrest in <strong>King</strong> <strong>County</strong> overa 4 year period. 4 Ten location categories with 172 sites were identified as having a higher incidence <strong>of</strong>cardiac arrest ( per year, per site). The study concluded that placement <strong>of</strong> 276 <strong>AED</strong>s in the 172higher incidence sites would have provided treatment <strong>for</strong> 134 cardiac arrest patients in a 5 year period,60% <strong>of</strong> whom were in VF. The authors estimated that between 8 and 32 lives could be saved in 5 years.The ten location categories with higher incidence <strong>of</strong> cardiac arrest included public locations such asinternational airport, county jail, large shopping mall, public sports venue, large industrial site, golfcourse, shelter, ferries/train terminal, health club/gym, and community senior center. The EMS Divisionis currently reviewing 5 years <strong>of</strong> more recent cardiac arrests to determine if these higher incidencelocations have changed.<strong>King</strong> <strong>County</strong> PAD Program and PAD Registry<strong>King</strong> <strong>County</strong> EMS administers the <strong>Seattle</strong>/<strong>King</strong> <strong>County</strong> <strong>Public</strong> Access Defibrillation program, acombined ef<strong>for</strong>t by <strong>King</strong> <strong>County</strong> EMS and <strong>Seattle</strong> Fire Department. The program includes support <strong>for</strong>sites that desire to purchase and place an <strong>AED</strong>, including medical direction if needed and support <strong>for</strong> sitecoordination. The Program includes a PAD Registry which includes a listing <strong>of</strong> all <strong>AED</strong>s, contactin<strong>for</strong>mation and cardiac arrest event in<strong>for</strong>mation. In<strong>for</strong>mation on the location <strong>of</strong> <strong>AED</strong>s is sent to 911communication centers <strong>for</strong> entry into their CAD premise in<strong>for</strong>mation. This allows the dispatcher to bealerted when an <strong>AED</strong> is present in the vicinity <strong>of</strong> a cardiac arrest. There are currently 2,232 <strong>AED</strong>s in theRegistry.


<strong>King</strong> <strong>County</strong> Project RAMPART -Regional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and TrainingProject Mission: Provide incentives <strong>for</strong> <strong>King</strong> <strong>County</strong> and select municipalities to promote theplacement and registration <strong>of</strong> <strong>Public</strong> Access Defibrillators and proper training in public facilitiesand other settings at high risk <strong>for</strong> cardiac arrest events.Scope <strong>of</strong> ResponsibilitiesResponsibility <strong>of</strong> MunicipalityResponsibility <strong>of</strong> <strong>King</strong> <strong>County</strong>Provide a Project RAMPART Liaison to Administer <strong>King</strong> <strong>County</strong> Communitycoordinate with <strong>King</strong> <strong>County</strong>.Responder <strong>AED</strong> ProgramCoordinate your city <strong>Public</strong> Access Administer Project RAMPART PilotDefibrillation ef<strong>for</strong>ts.Project and provide a. liaison to the city.Ensure that all existing and newly placed Conduct PAD <strong>Public</strong> Awareness Campaign<strong>AED</strong>s within your city are registered with Strategic Initiative as directed in the EMS<strong>King</strong> <strong>County</strong> PAD Registry2008-2013 Strategic PlanCoordinate any private foundation, Maintain <strong>King</strong> <strong>County</strong> PAD Registrysponsorship, donation, and/or volunteeractivities related to the purchase andplacement <strong>of</strong> <strong>AED</strong>s and <strong>AED</strong> training inprivate residences or private facilitieswithin your municipality.Provide training in CPR/<strong>AED</strong> to cityemployees and other public agencyemployees. Training <strong>for</strong> employees <strong>of</strong>agencies meeting the RCW definition <strong>of</strong>`<strong>Public</strong> Agency' may be reimbursed byProject RAMPART funding.Provide <strong>AED</strong> site coordination, as needed,activities related to proper placement,training and maintenance <strong>of</strong> the <strong>AED</strong>s <strong>for</strong>all <strong>AED</strong> in facilities within your city.Coordinate contract activities with <strong>King</strong><strong>County</strong> EMS to receive RAMPARTfunding. Contract can be with the firedepartment or with the city administration.Directly purchase <strong>AED</strong>s <strong>for</strong> publicagencies from the manufacturer, using theWA State Contract #01904. <strong>AED</strong>s <strong>for</strong>public agencies may be funded byRampart.Revised 8/26/<strong>09</strong>Send Quarterly PAD Registry Reports tocity Fire DepartmentSend Quarterly PAD Premise Info reportsto your Communications Center.Provide incentive funding to Municipalitiesvia contract; Funding allocation to bebased on city public employee count,number <strong>of</strong> <strong>Public</strong> <strong>AED</strong>s registered andnumber <strong>of</strong> private <strong>AED</strong>s registered.Provide cardiac arrest data <strong>for</strong> trending andidentification <strong>of</strong> high risk locations withina municipality.Provide a contract monitor to administerthe contract."Building a Defense Against Cardiac Arrest"


<strong>King</strong> <strong>County</strong> Project RAMPARTRegional Approach to Municipal <strong>Public</strong> <strong>AED</strong> Registry and TrainingFunding ModelTotal funding available <strong>for</strong> the pilot project is $60,000. $30,000 will be allocated in 20<strong>09</strong>and $30,000 in 2010.Prior to allocation <strong>of</strong> the funding to participating county/city agencies, the $60,000 willbe initially divided into three parcels <strong>of</strong> $20,000 each. These parcels will be divided upbased on 1) the number <strong>of</strong> employees in the county and each participating city to benefitfrom CPR/<strong>AED</strong> training; 2) The number <strong>of</strong> existed registered devices owned by thecounty and each participating city; and 3) the number <strong>of</strong> <strong>AED</strong>s registered by the public,non-pr<strong>of</strong>it or other government agencies within the county or each city jurisdiction.Initial funding <strong>for</strong> 20<strong>09</strong>/2010 will be based on the counts as <strong>of</strong> August, 20<strong>09</strong>.Funding allocation to each city will be based on a <strong>for</strong>mula which uses the percentage <strong>of</strong>the overall project total that each city maintains in the above categories. Future fundingwill be incentive based, the more <strong>AED</strong>s placed and registered, the more funding availableto your city the following year.Project RAMPART funding is public dollars from the <strong>King</strong> <strong>County</strong> EMS Levy. <strong>Public</strong>dollars may not be used to benefit private industry. There<strong>for</strong>e, funding may be used <strong>for</strong>training <strong>of</strong> public employees but may not be used to train workers from private businessor non-pr<strong>of</strong>it agencies. Fire departments can provide the training <strong>for</strong> these sites usingFD resources or use part <strong>of</strong> the Pilot funding allocation to pay fire fighters to train inthese settings. Project funding may be used to purchase and place <strong>AED</strong>s in publicsettings only.Municipalities may purchase <strong>AED</strong>s <strong>of</strong>f <strong>of</strong> the WA State Contract #01904<strong>for</strong> <strong>AED</strong>s. <strong>AED</strong>s are available from three vendors, Philips, Cardiac Science and Zoll.Details are available from the EMS Division.<strong>Purchase</strong> <strong>of</strong> <strong>AED</strong>s <strong>for</strong> high-risk private settings (restaurants, golf courses, athletic clubs,dialysis centers, medical facilities, etc,) will be encouraged as a part <strong>of</strong> the project,however, would have to be paid <strong>for</strong> by private dollars, private donations, fund raising,etc. Training would have to be paid <strong>for</strong> by these sites or by a manufacturer or some othersource or provided by your city fire department. Cities can help with ef<strong>for</strong>ts in order toincrease the number <strong>of</strong> <strong>AED</strong>s in their cities. Cities are encouraged to expand their PADef<strong>for</strong>ts to include high risk settings that are not publicly owned facilities.


RCW 42.30.020: Definitions. Page 1 <strong>of</strong> 1How To Use This Site I About Us I Contact Us SearcLegislature Home I Senate I House <strong>of</strong> RepresentativePrint Version I No es/A discInside the LegislatureFind Your LegislatorVisiting the LegislatureAgendas, Schedules andCalendarsBill In<strong>for</strong>mationLaws and Agency RulesLegislative CommitteesLegislative AgenciesLegislative In<strong>for</strong>mationCenterE-mail Notifications(Listserv)Students' PageHistory <strong>of</strong> the StateLegislatureOutside the Legislature* Congress - the OtherWashington* TV WashingtonWashington CourtsOFM Fiscal NoteWebsiteAccessI-AkWashingtonoRCWs > Title 42 > Chapter 42.30 > Section 42.30.02042.30.010 « 42.30.020 » 42.30.030RCW 42.30.020Definitions.As used in this chapter unless the context indicates otherwise:(1) "<strong>Public</strong> agency" means:(a) Any state board, commission, committee, department, educational institution, or otherwhich is created by or pursuant to statute, other than courts and the legislature;(b)Any county, city, school district, special purpose district, or other municipal corporatiorsubdivision <strong>of</strong> the state <strong>of</strong> Washington;(c) Any subagency <strong>of</strong> a public agency which is created by or pursuant to statute, ordinanclegislative act, including but not limited to planning commissions, library or park boards, conagencies;(d) Any policy group whose membership includes representatives <strong>of</strong> publicly owned utilitiEpursuant to the laws <strong>of</strong> this state when meeting together as or on behalf <strong>of</strong> participants who t<strong>for</strong> the output <strong>of</strong> generating plants being planned or built by an operating agency.(2) "Governing body" means the multimember board, commission, committee, council, orrule-making body <strong>of</strong> a public agency, or any committee there<strong>of</strong> when the committee acts on Igoverning body, conducts hearings, or takes testimony or public comment.(3) "Action" means the transaction <strong>of</strong> the <strong>of</strong>ficial business <strong>of</strong> a public agency by a governiiincluding but not limited to receipt <strong>of</strong> public testimony, deliberations, discussions, consideratilevaluations, and final actions. "Final action" means a collective positive or negative decision,vote by a majority <strong>of</strong> the members <strong>of</strong> a governing body when sitting as a body or entity, uponproposal, resolution, order, or ordinance.(4) "Meeting" means meetings at which action is taken.[1985 c 366 § 1; 1983 c 155 § 1; 1982 1st ex.s. c 43 § 10; 1971 ex.s. c 250 § 2.]Notes:Severability Savings -- 1982 1st ex.s. c 43: See notes following RCW 43.52,374.Glossary <strong>of</strong> Terms I Comments about this site I Privacy Notice I Accessibility In<strong>for</strong>mation I Dischttp://apps.leg.wa.gov/RCW/default.aspx?eite=42.30.020 8/18/20<strong>09</strong>


Contract Summary Page 1 <strong>of</strong> 1About GA I JobsHomePurchasing Doing business Canstrudion Fachrty& Travel, T Visit&Contracts with the state & <strong>Public</strong> Works Offi r.e Services Cars & Parking the CapitolPurchasing Contracts >> Contras : .Printable VersionDEFIBRILLATORS, AUTOMATIC EXTERNAL (<strong>AED</strong>'S)Contract#: 01904 Replaces: 08798Defibrillators, automatic external, <strong>AED</strong>'s, heart, resuscitation, cardiac arrest.Designated as convenience-use.• Maximizes the state's collective buying power• Extremely competitive pricingCurrent Term Start Date: 06- 15-2008 Award Date: 06-01-2004 Est. Annual Worth: $178,<strong>09</strong>1Current Term Ends On: 06-14-2010 Final Term Ends On: 06 - 14-2010 Commodity Code(s): 6513,6515Diversity: 0% WBE 0% MBE # <strong>of</strong> Bids Received: 11Contact In<strong>for</strong>mation: Office <strong>of</strong> State Procurement - Customer Service (360) 902-7400 or vWho can use this contract?Washington State agenciesro Qualified Cooperative Members (Political Subdivisions/Non-Pr<strong>of</strong>it Organizations)Participating Colleges, Universities, Community & Technical CollegesOregon Coop MembersContract Documents & ResourcesPricing &Solicitation AddendumxL,,lentr Ormationatios (CCContractor(s):PHILIPS MEDICAL SYSTEMSCARE. - SCIENCE CORPORATIONL CORPORATIONIn<strong>for</strong>mation about the number <strong>of</strong> bids received is included to show:• Vendors which contracts would benefit from more competition.• Assure our customers that we sought the best overall value through as many competitive bids as possible.I_Copyright © 2006 Washington State Department <strong>of</strong> General Administration All Rights Reservedhttps://<strong>for</strong>tress.wa.gov/ga/apps/ContractSearch/ContractSummary.aspx?c=01904 8/26/20<strong>09</strong>


State <strong>of</strong> WashingtonCurrent Contract In<strong>for</strong>mationEffective date: June 1, 20<strong>09</strong>Contract number:Contract title:Purpose:01904 (replaces 08798) Commodity code: 6515AUTOMATIC EXTERNAL DEFIBRILLATORS (<strong>AED</strong>'S)1) Contract Amendment2) To remove the Philips Medical; HeartStart FR2+ <strong>AED</strong>; models: M3860Aand M3861A from the contract.3) FR2 supplies, training accessories and technical support will continue tobe available.Original award date:Current period:Contract term:Contract type:SCOPE OF CONTRACTMay 24, 2004June 15, 20<strong>09</strong> through: June 14, 2010Not to exceed six years or June 14, 2010This contract is designated as use.This contract is awarded toe contractor(s).For use by: All State Agencies, Political Subdivisions <strong>of</strong> Washington and Oregon State,Qualified Non-pr<strong>of</strong>it Corporations, Materials Management Center, ParticipatingInstitutions <strong>of</strong> Higher Education (College and Universities, Community andTechnical Colleges).Contractors: PHILIPS MEDICAL See pages 3- 6ZOLL MEDICAL See page 7 — 9CARDIAC SCIENCE See pages 10 — 13Products/Services available: Portable, External Automatic Defibrillators, <strong>AED</strong>'s and accessoriesOrdering in<strong>for</strong>mation: See Contractor In<strong>for</strong>mationOrdering procedures: See page 2 Note II and Contractors' In<strong>for</strong>mationSpecial notes: See price sheets <strong>for</strong> quantity price breaks.This page contains key contract features. Find detailed in<strong>for</strong>mation on succeeding pages. For morein<strong>for</strong>mation on this contract, or if you have any questions, please contact your local agency PurchasingOffice, or you may contact our <strong>of</strong>fice at the numbers listed below.Contract Specialist:Phone Number:Fax Number:E-Mail:Rosalind Knox(360) 902-7489(360) 586-2426Contracts Assistant: Shawna PettittPhone Number: (360) 902-7342Fax Number: (360) 586-2426E-Mail:Visit our Internet site: 7 /Washington State Department <strong>of</strong> General AdministrationOffice <strong>of</strong> State Procurement, PO Box 41017, Olympia, WA 98504-1017The State <strong>of</strong> Washington is an equal opportunity employer. To request this in<strong>for</strong>mation in alternative <strong>for</strong>mats call (360) 902-7400, or TDD (360) 664-3799.1


Current Contract In<strong>for</strong>mationContract No. 01904Page 2Minimum orders: noneShipping destination: Free On Board (FOB) DestinationFreight: Prepaid and included in unit pricingContract pricing: See Contractor In<strong>for</strong>mationTerm worth:Current participation:$695,980.00/Year$0.00 MBEMBE 0%$0.00 WBEWBE 0%$695,980.00 OTHER $0.00 EXEMPTOTHER 100% EXEMPT 0%NOTES:I. Best Buy: Does not apply to Convenience use contracts.II.State Agencies: Submit Order directly to Contractor <strong>for</strong> processing. Political Subdivisions: Submit ordersdirectly to Contractor referencing State <strong>of</strong> Washington contract number. If you are unsure <strong>of</strong> your status in theState Purchasing Cooperative call (360) 902-7415.Only authorized purchasers included in the State <strong>of</strong> Washington Purchasing Cooperative (WSPC) andOregon Cooperative Purchasing Prograt SCPP/ORCPP) listings published and updated periodically by OSPand DAS may purchase from this contract. It is the contractor's responsibility to verify membership <strong>of</strong> theseorganizations prior to processing orders received under this contract. A list <strong>of</strong> Washington members is availableon the Internet WI ' ' cr, ).C1) and a list <strong>of</strong> the Oregon members is available at,,orcgon.'coon-i .u.s1 contractors shall not process state contract orders fromunauthorized users.IV. Contract Terms: This Document includes by reference all terms and conditions published in the original IFB,including Standard Terms and Conditions, and Definitions, included in the Competitive Procurement Standardspublished by OSP (as Amended).2


Current Contract In<strong>for</strong>mationContract No. 01904Page 3SPECIAL CONDITIONS:1. 5/29/<strong>09</strong>: Contract Amendment to discontinue the Philips HeartStart FR2+ <strong>for</strong> <strong>AED</strong>; models: M3860A andM3861A from the contract. Supplies, training accessories, and technical support <strong>for</strong> the FR2+ will continue tohe available.2. 5/6/20<strong>09</strong>: Contract Amendment to extend the <strong>AED</strong> contract <strong>for</strong> Philips Medical, Cardiac Science and Zoll Medical.Also update obsolete part numbers <strong>for</strong> Philips Medical as well. Update new contact in<strong>for</strong>mation <strong>for</strong> Philipsrepresentative.3. Philips Medical and Cardiac Science have extended additional discounts with this contract extension, effective June15, 20<strong>09</strong>. Zoll Medical's pricing remains unchanged.4. 2/17/20<strong>09</strong>: Delete obsolete product items from contract and update part numbers <strong>for</strong> Cardiac Science.5. 1/1/20<strong>09</strong>: Update contract product pricing and extend Cardiac Science discount through 6/15/20<strong>09</strong>.6. 07/31/08: Contract update to replace Philips Heartstart FR2+ Defibrillator Pads with new item product numbers.Effective immediately;DP2 2Pk and DP6 6Pk are being replaced with new product numbers 98803158211 and98903158221, located under FR2+ Accessories, on page 6.7. 06/10/2008: Contract Amendment to extend contract <strong>for</strong> 12 months, effective 6/14/2008 through 6/15/20<strong>09</strong>.8. 06/10/2008: Update Philips Medical <strong>AED</strong> pricing <strong>for</strong> #861304 FRx Defibrillators and update Cardiac Sciencepricing to reduce Power -Heart <strong>AED</strong> accessories <strong>for</strong> six months; effective 6/15/08 through 12/15/2008.9. 04/11/2008: Update contact person <strong>for</strong> Cardiac Science, effective immediately.10. 11/13/2007: Update Philips Medical ordering guidelines effective immediately.11. 7/12/2007: Update contract to add additional Philips Medical <strong>AED</strong> accessories product list <strong>for</strong> the HeartStart OnsiteDefibrillator, now available effective 7/1/2007.12. 6/18/2007: Update contract to remove Zoll Basic <strong>AED</strong> P/N 20100100202000010 @ $755/00.13. 6/6/2007: Effective June 15, 2007, this contract has been extended <strong>for</strong> an additional 12 month period with allterms, conditions and specifications remaining unchanged. Pricing <strong>for</strong> Cardiac Science remains unchanged.<strong>AED</strong> pricing <strong>for</strong> Philips has been decreased <strong>for</strong> item #861304 <strong>AED</strong>; new price $1,326.50 (see page 4).14. 2/27/2007: Update contract product in<strong>for</strong>mation with enhanced (upgrade) versions <strong>of</strong> the Powerheart <strong>AED</strong> G3; FullyAutomatic and Semi-Automatic packages from Cardiac Science. The old models are: 9300A-501P and 9300E-501Pand the replacement models are: 9390A-501P and 9390E-501P15. 2/27/2007: Update contract contact in<strong>for</strong>mationAdministrative Change: To update Cardiac Science Corporation Alternate Contact In<strong>for</strong>mation.16. Effective immediately (November 28, 2006), Part number <strong>for</strong> Cardiac Science have been updated to align withAHA/ERC Guidelines. Also, the Territory Sales Manager <strong>for</strong> Cardiac Science has been added as an alternate contact.See page 10 - 13.17. Effective June 15, 2006, this contract has been extended <strong>for</strong> an additional 12-month period with all teems, conditionsand specifications remaining unchanged. Pricing <strong>for</strong> Cardiac Science and Zoll products remains unchanged. <strong>AED</strong>pricing <strong>for</strong> Philips has decreased (see pages 4).18. Effective immediately (March 10, 2006), there has been a change <strong>of</strong> address <strong>for</strong> Cardiac Science. See page 10 <strong>for</strong>updated infoiniation in bold. Sec pages 11 and 12 <strong>for</strong> updated items and pricing.19. Effective June 1, 2005, pricing <strong>for</strong> a number <strong>of</strong> Cardiac Science's items has been reduced, new items have beenadded and several items have been deleted. See items in bold on page 11 and 14.20. Effective April 11, 2005, pricing <strong>for</strong> a number <strong>of</strong> Philip's items has been reduced. See page 4 and 5 <strong>for</strong> new pricingin bold.21. Administrative Change: To update State Procurement Officer, and update Office Assistant Senior.22. Effective November 22, 2004, a Zoll <strong>AED</strong> has been added to the contract. See Zoll items in bold on pages 7.23. Effective immediately corrections have been made to Philips portion <strong>of</strong> this contract. See Bold item on pages 3-524. Effective June 15, 2004 this contract replaces Contract 08798.3


Current Contract In<strong>for</strong>mationContract No. 01904Page 425. The local EMS county <strong>of</strong>fice is to be notified <strong>of</strong> the location <strong>of</strong> the purchased <strong>AED</strong>. This is a requirement per RCW70.54.310 (2-d).A phone call to the local EMS <strong>of</strong>fice may save you from paying additional fees. When agencies place a machine inThurston <strong>County</strong>, the Thurston <strong>County</strong> medical program director may be willing to sign the medical authorizations<strong>for</strong> purchase <strong>of</strong> the machines. For other counties, check with your local EMS.Thurston <strong>County</strong> EMS <strong>of</strong>fers free training/certification classes <strong>for</strong> machines placed in the community For theThurston <strong>County</strong> EMS, call Alan Provencher, Purchasing Agent/<strong>Public</strong> Education Coordinator, at 360-704-2788.4


CONTRACTOR INFORMATIONContractor: PHILIPS MEDICAL SYSTEMS2301 Fifth Avenue, Suite 200<strong>Seattle</strong>, WA 98121Contract Administration Contact:Phone: 206-664-5211Fax: 206-664-5001Email:Internet address:Federal ID No.: 13-3429115Supplier No.: W72Order placement address: Same as aboveCustomer Service/Order Placement: Customer Service Fax: 206-664-2000Phone: 800-263-3342Technical Support: Customer Service Fax: 206-664-2000Phone: 800-263-3342Usage Reporting: Cielo Jimenez Fax: 206-664-5001Phone: 206-664-54<strong>09</strong> Email: — .°10 j i men(Payment address: Philips Medical SystemsP.O. Box 406538Atlanta, GA 30384-6538Credit card acceptance: YesMinimum orders: NoneDelivery time: 30 Days AROPayment terms: Net 30 DaysShipping destination: Freight on Board (FOB) DestinationFreight: Freight prepaid & include in item pricingRecommended Training . CPR/<strong>AED</strong> training by any certified center and physician approval <strong>of</strong><strong>AED</strong> purchase.Warranty 5 year limited Warranty5


PRICE SHEETS — PHILIPS MEDICAL SYSTEMSPART NUMBER DESCRIPTION PRICEM5066A-001Defibrillator, biphasic, automatic externaldefibrillator with one pair adult defibrillator pads,standard carry case (C01), user guide and batterypack. HeartStart OnSite Defibrillator M5066A861304Defibrillator, biphasic, automatic externaldefibrillator with one pair adult defibrillator pads,users guide and battery pack. HeartStart FRxDefibrillator 861304$1231.75PHILLIPS MEDICAL: ACCESSORIES (HEARTSTART ONSITEDEFIBRILLATOR)DISPOSABLES68-PCHAT Fast Response Kit $26.65M5070A Battery <strong>for</strong> HeartStart (HS1) $81.25M5071A Adult SMART Pads, HeartStart (HS1) $31.85M5072A Infant/Child SMART Pads, HeartStart (HSI) $54.60DATA MANAGEMENT (can be used with OnSite, FR2+ & FRx <strong>AED</strong>s) $81.25861311 Option A01 — HeartStart Express Connect S<strong>of</strong>tware $55.25M3834A HeartStart Event Review s<strong>of</strong>tware — Single PC $256.7598980 HeartStart Event Review S<strong>of</strong>tware — Organization-wide License $646.7586143 9- OP .- ',$841.75861431- 1,pI Au3 _Icense $3,246.75CABINETS/WALL MOUNTS989803136531 Defibrillator Cabinet, Basic $148.85PFE7023D <strong>AED</strong> Cabinet, Recessed $239.85PFE7024D <strong>AED</strong> Cabinet, Wall Mounted $227.50M3859A Secure-Pull Seal <strong>for</strong> Wall Mount, 10/Pack $6.50ONSITE CASESM5075A Standard Carry Case <strong>for</strong> HeartStart HS1 $81.25*M5076A Slim Carry Case <strong>for</strong> HeartStart HS1 $64.35**These case prices are applicable to cases purchased alone (without an OnSiteDefibrillator). Standard Case (C01 opt. equal to M5075A case) ships withpurchase <strong>of</strong> the OnSite (M5066A) Defibrillator.M3857A Wall Mount Brackets $57.85PHILLIPS MEDICAL: ACCESSORIES (HEARTSTART ONSITEDEFIBRILLATOR)M3858A <strong>AED</strong> Wall Sign $20.80ONSITE TRAIING MATERIALSM5066 -89100 HeartStart HS1 and FR2 Toolkit $31.85M5066-91900 Instructions <strong>for</strong> Use, HeartStart On-Site Defibrillator $13.00M5066-97800 Quick Reference, HeartStart HS1 $3.25M5073A Adult Training Pads, HeartStart (HS1) $48.75M5074A Infant/child Training Pads, HeartStart (HS1) $52.00M5085-91900 IFU, Philips Heart Start Trainer $6.50M5085A Philips HeartStart Trainer $191.75M5087A HeartStart Trainer Replacement Carry Case $16.256


M5089A External Manikin Adapter, 5-pack $32.50M5<strong>09</strong>3A Replacement Adult Training Pads (HS1) $19.50M5<strong>09</strong>4A Replacement Infant/Child Training Pads (HSI) $19.5<strong>09</strong>89803139281 Infant/Child Pads Placement Guide $16.25/4. 'ETACCESS( 17' FR2+ A.EDDISPOSABLES68-PCHAT Fast Response Kit $26.65989803158211 FR2+ Pads (1- Pack) $22.43989803158221 FR2+ Pads (5- Pack) $94.79M3849A Charger <strong>for</strong> FR2+ Rechargeable Battery (REF M3848A) $97.50M3848A Battery, Rechargeable LiION <strong>for</strong> FR2+ (FR2+ shipped be<strong>for</strong>e 11/12/01 needs a $172.25s<strong>of</strong>tware upgrade to use.)M3863A Battery, Long Life LiMNO2, FR2 $135.85M3870A FR2 <strong>AED</strong> Infant/Child Defibrillator Pads (1-pack) $54.60M3873A FR2 ECG Assessment Module, AAMI $195.00CARDSM3524A Data Card Reader $97.50M3853A Tray <strong>for</strong> Data Card, FR2 <strong>AED</strong> $5.85M3854A Data Card, FR2 <strong>AED</strong>s (includes Tray) $57.85M3858A <strong>AED</strong> Wall Sign $20.80SDCF-05 Adapter, Data Card to PCMCIA $19.50DATA MANAGEMENTM3834A HeartStart Event Review S<strong>of</strong>tware - Single PC $256.75989803141881 HeartStart Event Review S<strong>of</strong>tware - Organization-wide License $646.75861. 431 Option A01-HeartStart Event Review Pro S<strong>of</strong>tware, Single PC $841.75CASES/CABINETS989803133171 Temperature Control Carrying Case (FR2+ only) $247.00M3859A Secure-Pull Seal <strong>for</strong> Wall Mount, 10 Pack $6.50M3868A Carrying Case, Heartstream FR2 series $81.25M3869A Carrying Case, Vinyl - <strong>for</strong> FR2 series $81.25989803136531 Defibrillator Cabinet, Basic $148.85PFE7023D <strong>AED</strong> Cabinet, Recessed $239.85PFE7024D <strong>AED</strong> Cabinet, Wall Mount $227.50M3857A Wall Mount Bracket $57.85YC Carrying Case, Plastic Waterpro<strong>of</strong> Shell $130.00COMPATIBLES05-10000 Quik Combo Adapter $19.50PHILLIPS MEDICAL: ACCESSORIES (HEARTSTART ONSITEDEFIBRILLATOR)05-10100 Zoll Electrode Adapter $19.5005-10200 HeartStart Pads Adapter/Converter to Philips $19.50TRAINING07-1<strong>09</strong>00 <strong>AED</strong> Training Pads: 1 set $16.2507-11000 <strong>AED</strong> Trainer Carrying Case $16.25M3752A <strong>AED</strong> Trainer 2 (includes carrying case, 1 set <strong>of</strong> Defibrillator Training Pads) $211.25M3753A Remote Control <strong>for</strong> <strong>AED</strong> Trainer 2 $31.85M3754A Programming Kit <strong>for</strong> <strong>AED</strong> Trainer (Includes PC Cable & CD with s<strong>of</strong>tware) $19.50M3755A Little Anne Training Pads - 1 set $17.55M3756A Little Anne <strong>AED</strong> Training System $376.357


M3855A-903 Charger, Training & Admin Pack, FR2 (includes US power cord-RED M3864A) $81.25M3860-91900 User's Guide, Heartstream FR2, English $13.00M3860-987800 Quick Reference Card, Heartstream FR2 $3.25M3864-90001 Reference Guide, Training & Admin Pack, FR2 $13.00M3864A Training & Admin Pack <strong>for</strong> FR2 Defibrillator -(Rechargeable with m3855A-903) $130.00M3871A FR2 Pediatric Training pads $29.25M5066-89100 HeartStart HS1 and FR2 Toolkit, NTSC $31.85ACCESSORIES FOR FRX DEFIBRILLATORPART NUMBER DESCRIPTION UNIT PRICEM5070A Battery, Long Life LiMnO2 <strong>for</strong> HS1/FRx $87.75989803139261 HeartStart SMART Pads II (1 set) $31.85989803139311 Infant/Child Key $52.0068-PCHAT Fast Response Kit $26.65CASES AND WALL MOUNTS989803130531 Defibrillator Cabinet, Basic $148.85PFE7023D Defibrillator Cabinet, Semi-recessed $239.85PFE7024D Defibrillator Cabinet, Wall Surface $227.50M3857A Wall Mount Bracket $57.85M3858A Defibrillator Wall Sign $20.80M3859A Secure Pull Seal, 10-pack $6.5<strong>09</strong>89803139251 Carrying Case, FRx Defibrillator $81.25FRX TRAINING MATERIALS AND LEARNING PRODUCTS861306 HeartStart FRx Trainer $211.25989803139321FRx Training Toolkit (includes Powerpoint presentations, presenter's guide, studentguide and training DVD)$31.85989803139341 FRx Product Training DVD $9.75989803138731 FRx Owner Manual $13.0<strong>09</strong>89803138601 FRx Quick Reference Guide $3.25989803139271Training Pads II (Note: <strong>for</strong> Infant/Child training applications, buy the Infant/ChildKey separately)$48.75989803139291 Replacement Training Pads II (includes pads, wire and plug) $19.50M5088A Internal Manikin Adapters (Compatible w/FRx Trainer 861306 only) $19.50M5089A External Manikin Adapter, 5-pack $32.50M5<strong>09</strong>0A Adult Pads Placement Guide $16.25989803139281 Infant/Child Placement Guide $16.25M5089A External Manikin Adapter, 10-pack $32.50PHILLIPS MEDICAL: ACCESSORIES (HEARTSTART ONSITEDEFIBRILLATOR)FRX-CROSS - COMPATIBILITY05-10000 Quik Combo Adapter $19.5005-10100 Zoll Electrode Adapter $19.5005-10200 HeartStart Pads Adapter/Converter to Philips $19.50HEARTSTART EVENT REVIEW SOFTWARE - FRXACT-IR Infrared Data Cable $84.5<strong>09</strong>89803143051 HeartStart Case Capture palmOne data download s<strong>of</strong>tware $51.35989803143041 HeartStart Configure palmOne configuration s<strong>of</strong>tware $51.358


CONTRACTOR INFORMATIONContractor: ZOLL MEDICAL CORPORATION269 Mill roadChelms<strong>for</strong>d, MA 01834Contract Administration Contact: Main Contact Alternate ContactElizabeth McCaugheyPam AldermanPhone: 800-348-9011 x9568 253-927-1279Fax: 978-421-0005 253-927-8<strong>09</strong>1Email: emccaughey@zoll.comInternet address:Federal ID No.: 04-2711626Supplier No.: 110601Customer Service/Order Placement: Customer Service Fax: 978-421-0015Phone:800-348-9011 x440Technical Support: Peter Dezak Fax: 978-421-0010Order placement address:Payment address:Credit card acceptance:Minimum orders:Delivery timePayment terms:Shipping destination:Freight:Recommended Training:Phone: 800-348-9011 x9455 Email: , 'LoomWarrantySame as aboveZoll Medical Corp.P.O. Box 33080Newark, NJ 07188-0081Visa, MasterCard, American Expressnone60-90 days After Receipt <strong>of</strong> Order (ARO)Net 30 daysFreight on Board (FOB) destinationPrepaid and included<strong>AED</strong>'s are sold as medical devices in most states and require aphysician's prescription. The American Heart Associationrecommends having a physician or other qualified health careprovider provide medical oversight <strong>for</strong> your program.5 years — A copy <strong>of</strong> the warranty is to be included with itemsdelivered under this contract.9


PRICE SHEETS — ZOLL MEDICAL CORPORATIONITEM NUMBER DESCRIPTION, <strong>AED</strong>S UNIT PRICE1.Defibrillator, biphasic, automatic external defibrillator with defibrillator pads,user guide and battery pack. ZOLL <strong>AED</strong> PLUS 20100000102011010 $1,301.502.Defibrillator, biphasic, automatic external defibrillator with defibrillator pads,user guide and battery pack. ZOLL <strong>AED</strong> PLUS 2010000010211010 $1,374.25PART NUMBERACCESSORIES — Disposables8900-0802-01 Stat-padz II HVP multi-function electrodes 1 case (12 pair/case) $370.508900-0801-01 stat-padz II HVP Multi-function Electrodes (1 pair) $42.908900-0800-01 CPR-D Padz one piece defibrillation and CPR System with compression, depthand rate sensors. Supplied with gloves, barrier mask, scissors, razor, wet wipeand dry wipe. Four (4) year shelf life. Special "long-life armor pack" <strong>for</strong> storagein s<strong>of</strong>tpak carry case. $116.228900-0808-01 CPR-D accessory kit contains CPR barrier mask, scissors, gloves, prep razor,towel and a moist towelette in a small zip-lock pouch, one case <strong>of</strong> 50 ea. $585.008900-0807-01 CPR-D accessory kit contains CAP barrier mask, scissors, gloves, prep razor,towel and a most towelette in a small zip-lock pouch, one each. $13.26ACCESSORIES — Battery Support8000-0807-01 Type 123 Lithium Batteries, quantity <strong>of</strong> ten (10) with storage sleeve. $58.50ACCESSORIES — Miscellaneous8000-0837-01 Large pelican Case with cut-outs <strong>for</strong> <strong>AED</strong> Plus, CPR-D Padz & Pedi-Padz $139.628000-0836-01 Small Pelican Case with cut-outs <strong>for</strong> <strong>AED</strong> Plus only $108.428000-0802-01 Replacement S<strong>of</strong>t case $81.908000-0806-01 Replacement S<strong>of</strong>t case — POLICE $81.908000-0812-01 Replacement <strong>Public</strong> Safety PASS Cover designed <strong>for</strong> CPR-D Padz andaccessories. $39.008000-0808-01 Replacement <strong>Public</strong> Access PASS Cover (Graphic Interface Label) designed <strong>for</strong>CPR-D Padz and accessories. $39.008000-0803-01 Compact Low Pr<strong>of</strong>ile <strong>Public</strong> Safety Cover (not <strong>for</strong> use with CPR-D Padz andaccessories). $39.008000-0804-01 Defibrillator Analyzer Adapter Cable — connects <strong>AED</strong> Plus to defibrillatoranalyzer. $76.448000-0819-01 Simulator/Tester —connects to <strong>AED</strong> Plus to demonstrate operation $117.008000-08<strong>09</strong>-01 Mounting Bracket (used to mount unit on the wall) $39.008000-0817 Surface Wall Mounting Box $233.228000-0814 Recessed Wall Mounting Box $233.228000-0811 Flush Wall Mounting Box $233.228000-0813-01 ZOLL Data Review S<strong>of</strong>tware — Physical copy $69.428000-0815 USB IrDA Adapter $76.448000-0816 RS-232 IrDA Adapter $76.449650-0300-01 Operator's Guide <strong>for</strong> individual operators or <strong>for</strong> use as wall poster $3.9<strong>09</strong>650-0301-01 Administration Guide $3.9<strong>09</strong>650-0850-01 EMS/<strong>Public</strong> Safety <strong>AED</strong> Plus Promotional Video (VHS) $19.5<strong>09</strong>650-0851-01 First Responder <strong>AED</strong> Plus Promotional Video (VHS) $19.5<strong>09</strong>658-0401-01 EMS/<strong>Public</strong> Safety <strong>AED</strong> Plus Promotional Video — Mpeg file on CS $19.508000-0825 <strong>AED</strong> Plus Wall Sign (8-1/2" X 11") $7.8010


PRICE SHEETS — ZOLL MEDICAL CORPORATION (continued)PART NUMBER DESCRIPTION UNIT PRICEZOLL <strong>AED</strong> Plus Trainer & Accessories8008-0104-01 ZOLL <strong>AED</strong> Plus Training UnitThe <strong>AED</strong> Plus trainer is <strong>for</strong> use by Trainers to train in the use <strong>of</strong> the <strong>AED</strong> Plus.Supplied with Training Remote Control, hand held cord, one set CPR-D trainingelectrodes, one pair <strong>of</strong> replacement gels, operator manual, administration guide &one (1) year limited warranty. $295.62ZOLL <strong>AED</strong> Plus Trainer Accessories8900-00804-01 CPR-D Padz Training Electrodes — with reusable "Z-design" electrode with CPRhand placement indicator and one (1) pair <strong>of</strong> disposable adhesive gels. (Note: thedisposable gels must be applied to the reusable pad be<strong>for</strong>e use.) $66.308900-0803-01 Replacement Adhesive gels <strong>for</strong> CPR-D Padz — Training Electrode replacements,5 pair. $22.628000-0821 Trainer Phone Cord (replacement) $14.828000-0822 Trainer US AC Adapter $39.008008-0104-01 Trainer remote (replacement) $117.0<strong>09</strong>650-0304-01 Trainer Operator's Guide (replacement) $7.8<strong>09</strong>650-0850-01 <strong>AED</strong> Plus EMS and <strong>Public</strong> Safety Video — VHS $19.5<strong>09</strong>650-0851-01 <strong>AED</strong> Plus First Responder Video — VHS $19.5011


CONTRACTOR INFORMATIONContractor: CARDIAC SCIENCE CORPORATION3303 MONTE VILLA PARKWAYBOTHELL, WA 98021-8969Contract Admin. Contact: Primary: Tina Baer-Olson Alternate: Jeff HoytPhone: 425-402-2321 360-280-6394 (cell)Fax: 425-402-2005Email:or.dd 1Internet address:Federal ID No.: 94-3300396Supplier No.: W1830Order placement address: Same as abovePayment address: Cardiac Science CorporationDept. 0587P.O. Box 120587RepairFacility:Cardiac Science Corporation500 Burdick BarkwayDeerfield, WI 53531Dallas, Texas 75312-0587Customer Service/Order Customer Service Fax: 425-402-2001Placement:Phone: 800-426-0337 ext. 2494 Email custtanen L liac .Technical Support: Technical Support Fax 425-402-2022Phone: 800-426-0337 or 888-466-8686 Email lisupp( rdiacscicr ColnTerritory Sales Manager: Jeff HoytPhone: Cell: 360-280-6394Credit card acceptance: Visa, Discovery, Mastercard, American ExpressMinimum orders: NoneDelivery time:Payment terms:Shipping destination:Freight:Recommended Training:Warranty14 DAYS ARONET 30 DAYSFOB DestinationPrepaid and included in item pricingDefibrillation training and other training as required by state, province or countyregulations. Training on operation and use <strong>of</strong> the <strong>AED</strong>. Additional training asrequired by the physician or Medical Director.7 year limited warranty, 4-year full replacement guarantee on batteryAccessories & electrodes are warranted <strong>for</strong> a period <strong>of</strong> approximately 1 year.12


PRICE SHEETS — CA IAC SCIENCEA J,EDITEM NO. DESCRIPTION PRICE1-10 'UNITSPRICE11+ UNITS9390A-501P Defibrillator, biphasic, automatic external defibrillator with$1250.00 $<strong>119</strong>5.00defibrillator pads, user guide and battery pack(2005 Powerheart <strong>AED</strong> G3 (fully automatic) with voice and text display:AHA/ERC biphasic wave<strong>for</strong>m and internal memory; 7-year device warranty, 4-Protocols) year full replacement guarantee on battery. Package includes:• Defibrillator (1) (#9390A-501P)• IntelliSense® lithium battery (1), #9146• Pair <strong>of</strong> Adult defibrillation electrodes (1), #9131-001• Quick Start Tool Kit (1). Includes Quick Start Guide, CD-ROM with <strong>AED</strong> Manual, Training Video, RescueLink andMDLink and serial communication cable.• S<strong>of</strong>t-sided carrying case (1) #168-6000-001• Ready Kit (1) with Nitrile gloves, razor, scissors, towel, wipes,gauze, and one-way filter mask.• Rescue Coach instructive prompts and Metronome <strong>for</strong> properCPR com ression frequency.9390E-501P(2005AHA/ERCProtocols)9300P-501P(2005AHA/ERC)Defibrillator, biphasic, automatic external defibrillator withdefibrillator pads, user guide and battery packPowerheart <strong>AED</strong> G3 (Semi-Automatic) with voice & text display &internal multiple rescue memory, 7-year device warranty, 4-year fullreplacement guarantee on battery.Package includes:• Defibrillator (1) #9390E-501P• IntelliSense® lithium battery (1), #9146• Pair <strong>of</strong> Adult defibrillation electrodes (1), #9131-001• Quick Start Tool Kit (1). Includes Quick Start Guide, CD-ROM with <strong>AED</strong> Manual, Training Video, RescueLink andMDLink and serial communication cable.• S<strong>of</strong>t-sided carrying case (1) #168-6000-001• Ready Kit (1) with Nitrile gloves, razor, scissors, towel, wipes,gauze, and one-way filter mask.• Rescue Coach instructive prompts and Metronome <strong>for</strong> properCPR compression frequency.Defibrillator, automatic external defibrillator with defibrillator pads,user guide and battery packPowerheart <strong>AED</strong> G3 Pro Package with color ECG display, Biphasicwave<strong>for</strong>m, and internal memory.Package includes:• Defibrillator (1) #9300P-501• Pair <strong>of</strong> Adult defibrillation electrodes (1), #9131-001• S<strong>of</strong>t-sided Carrying Case (1) #168-6000-001;• Ready Kit (1) with Nitrile gloves, razor, scissors, towel, wipes,gauze, and one-way filter mask.<strong>AED</strong> ACCESSORIES13$1250.00 $<strong>119</strong>5.00$2150.00


,91.31-001 $24.0<strong>09</strong>610-001 Defibrillation/pacing electrodes (adult), one year shelf life. $32.006.875111-I,, Zolli 77,00' 4.0000' -901 )<strong>09</strong>144-00191/ 7 101 Pro i_ nr ,re f , 1 R1,.75,,—75DELIVERY SYSTEMS:168-6000-001 Carrying Case <strong>for</strong> 9300 series <strong>AED</strong> G3. $80.00$11 4.00' 5ve1,i , -lit.1664,-, , 8-001 ',/ case. _, .5587-0015588-001 "550-0 Vi _t550-0 ',5security170-'1' .TRAIN IN G75:(0JI L 0 7 Arr) m $30L1-0153018-00101 1, Full ' <strong>AED</strong> Tray i,•I0101014


PERFORMANCE REPORT FORTo OSP Customers:Please take a moment to let us know how our services have measured up to your expectations on this contract.Please copy this <strong>for</strong>m locally as needed and <strong>for</strong>ward to the Office <strong>of</strong> State Procurement Purchasing Manager.For any comments marked unacceptable, please explain in remarks block.Procurement services provided:➢ Timeliness <strong>of</strong> contract actions➢ Pr<strong>of</strong>essionalism and courtesy <strong>of</strong> staff)=- Services provided met customer needs➢ Knowledge <strong>of</strong> procurement rules and regulations➢ Responsiveness/problem resolution➢ Timely and effective communicationsComments:Excellent Goodn n111Acceptable UnacceptablenAgency:Prepared by:Contract No.: 01904 Title:Automatic External DefibrillatorsContract Title: (<strong>AED</strong>s)Date:Phone:Send to:UNIT ManagerOffice <strong>of</strong> State ProcurementPO Box 41017Olympia, Washington 98504-101715


PERFORMANCE REPORT FORTC 'ICEComplete this <strong>for</strong>m to report problems with suppliers or to report unsatisfactory product or services. You are alsoencouraged to report superior per<strong>for</strong>mance. Agency personnel should contact suppliers in an ef<strong>for</strong>t to resolve problemsthemselves prior to completion and submission <strong>of</strong> this report.Contract number and title: 01904, Automatic External Defibrillators (<strong>AED</strong>'s)Supplier's name:Supplier's representative:[11 Contract item quality higher than required ❑Contract item quality lower than required.❑III Other:PRODUCT/SERVICESUPPLIER/CONTRACTOR PERFORMANCEDamaged goods deliveredItem delivered does not meet P.O./contract❑ specifications❑❑❑Late deliveryIncorrect invoice pricing.Other:❑ Slow response to problems and problem resolution1:1 Superior per<strong>for</strong>manceCONTRACT PROVISIONS111 Terms and conditions inadequate❑ Specifications need to be revised❑ Other:ri Additional items or services are required.n Minimum order too high.Briefly describe situation:Agency Name:Delivery Location:Prepared By: Phone Number: Date: Supervisor:Address:Email:Send To:ROZ KNOXCONTRACTS SPECIALISTOFFICE OF STATE PROCUREMENTPO BOX 41017OLYMPIA WA 98504-101716


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