HomeMy WebLinkAbout385168 OLYMPUS SURGICAL - PURCHASE ORDER - 6602225n
City of Fort Collins City of Fort Collins
Page Number: 1
Note:
Date: 04/06/06
Purchase Order Number: 6602225
tsuyer: UUNNETTE, ED
-. ---- --- -.- - ---_.....� ...11� W, "U... w, dnu du corresponaence.
�� .� /ram
Line Qty/Units Description Extended Price
1 Quote C113844-2 8,678.00
Colposcope/adaptor
WITH ONE-YEAR WARRANTY.
SHIPPING IS PREPAID TO FORT COLLINS, COLORADO.
PLEASE SHIP TO ATTN: CRAIG HORTON
CONTACT #(970)224-6020.
SETUP AND INSTALLATION WILL BE PROVIDED BY
JOHN SEDGELEY, PH. 303-886-7900.
john.sedgeley@olympussurgicai.com
Total $8,678.00
O'
City of Fort CqWjnj Director of Purchasing and Risk Management City of Fort Collins
This order is rtQlhalid over $2000 unless signed by James B. O'Neill II, CPPO, FNIGP Accounting Department
City of Fort Collins Purchasing, PO Box 580, Fort Collins, CO 80522-0580 PO Box 580
Phone: 970-221-6775 Fax: 970-221-6707 Email: purchasing@fcgov.com Fort Collins, CO 80522-0580
_icz,
0LYMPUS OLYMPUS SURGICAL AMERICA Quotation
One Corporate Drive
Orangeburg, New York 10962 C113844-2
Your Vision, Our Future Telephone: 800 548 5515 Fax: 800 833 1482
www.olympussurgical.com Please refer to this number on all
correspondence, or other communications.
CLIstomer Information
Customer:Craig Horton, M.D. Name:John Sedgeley
Attention:Craig Horton
Address:300 LaPorte Avenue Phone:800 548 5515
FORT COLLINS CO 80521 UNITED STATES
Phone:970-224-6020
Fax:800 833 1482
Fax:970-221-6639 I E-a:john.sedgeley@olympussurgical.com I:CHortonta7fcaov.com
Line
No.
Quotation
Item ! Description
F
List Price
$
Your Price
$
Qty
Extended Price
$
10
N1010642: OCS-500 COLPOSCOPE ZOOM 6X - 120V
8,347.50
6,678.00
1
6,678.00
20
2298030: OCS5-DCAD2 DIGITAL ADAPTOR
2,500.00
2,000.00
1
2,000.00
I. riiw quotes ana me total package prices are for listed items only. tYou!rTo!ta:1:P7rice:
il 10 847.50
II. Charges, additions or deletions from this package quotation may cause pricing adjustments.
III. Service manuals and additional operator manuals are not included and may be ordered by $ 8,678.00
contacting the Customer Service Department at 800 548 5515.
----------------------------------------------------------------------------------------------------------------------------------------
To place a purchase order, simply sign below, list your Purchase Order number and fax it to 800 833 1482. Acceptance to your
purchase Order by Olympus will be subject to prod t availability, Olympus' then -current credit criteria and Olympus' Terms and
Conditio of sale ttache ^
Sign k/ Name: a).AAlf-S Q /�irGti li
e r
PO#: 640 2,2,7,5 Title:
KMF 3396 ISSUE 7 07/07=05 f A I
Page: 1 -of- 7 ,U/S �!
City of Fort Collins
Administrative Services
Finance Department - Accounting Division
BLANKET EXEMPTION CERTIFICATE
(For use by States, Territories, or political subdivision thereof)
Date: April 5, 2006
The undersigned hereby certifies that she is Joyce Grenz, Accounts Payable
Representative of City of Fort Collins to execute this certificate and that the article or
articles specified in the accompanying orders, or on the reverse side hereof, are purchased
from OLYMPUS SURGICAL AMERICA for the
exclusive use of the City of Fort Collins of the State of Colorado.
It is understood that the exemption from tax in the case of sales of articles under this
exemption certificate to a State, etc., is limited to the sale of articles purchased for its
exclusive use, and it is agreed that if articles purchased tax free under this exemption
certificate are used otherwise or are sold to employees or others, such fact will be
reported by me to the manufacturer of the article or articles covered by this certificate. It
is also understood that the fraudulent use of this certificate to secure exemption will
subject the undersigned and all guilty parties to a fine of not more than $10,000.00 or to
imprisonment for not more than five years, or both, together with costs of prosecution.
State of Colorado Department of Revenue, Certificate of Exemption
Identification Number 98-04502.
(Signature
Accounts Payable Rep — Accounting Dept.
(Title of Officer)
215 North Mason Street • 2nd Floor • P.O. Box 580 • Fort Collins, CO 80522-0580 • (970) 221-6770 • FAX (970) 221-6782