Case Solutions and SuperNova Statement of Understanding

Case Medical, Inc. will issue (Facility Name) ______Location______Point of Contact (Name) ______Dept.______Title______

PRODUCT CODE / DESCRIPTION / UNITS

Note: Please make sure you identify wide neck or regular neck bottles in the description and part ID.

If evaluation, complete below: If installation, identify start date:

Evaluation Purchase Order #______Date of install ______

Evaluation Period: From ______To______

The facility agrees to utilize Case Solutions/SuperNova cleaners for decontamination of the facility’s medical devices. Case Medical will provide the necessary product, hard goods, including proportioner, wall brackets, tubing, alarm system and connections at no cost to the facility. The hardware and cleaning products contain substantial trade secrets and may not be used in any manner detrimental to Case Medical Inc. The hardware and cleaning products may be used for evaluation [and/or demonstration] purposes only and may not be transferred or sublicensed in any form to any third party nor put into commercial production.

The facility will ensure that all machine pumps are functioning properly and all hoses are in working condition prior to installation. There is no need for any special or additional lines for electrical, water or other utility sources. The deter-gent lines will feed directly into your sink faucet outlets. Your equipment service tech with a Case Medical agent will calibrate flow to ensure precise and efficient concentrations.

I understand that the hard goods including wall brackets, proportioner, and alarm systems are the property of Case Medical, Inc. It is the hospital’s responsibility to maintain the equipment in working order. Should the hospital decide to terminate use of product, all related hard goods shall be returned directly to Case Medical within ten (10) working days. All hardware will be properly decontaminated for return with enzymatic detergent, and wiped down with alcohol. If the hard goods are not returned to Case Medical in a timely manner, I understand that our facility will be responsible for the purchase of these items. The current cost of alarm stand/wall bracket is $269.00. The cost of the pump is $493.00. The facility, at their option, may purchase these items directly from Case Medical, Inc.

Evaluation Team Leader: Name______Signature______Date______

Shipping Address: ______Telephone:______

City: ______State: ______Postal Code: ______

Dept.:______Telephone # ______E-Mail: ______

Case Medical, Inc. Rep.______Signature: ______Date: ______

Issued by: Sebastian Morales
First Issue Date: 03/18/2011
File: CMSRVR1:K//QC/ MF/MF # 91.1 Case Solutions/SuperNova Statement of Understanding Rev B / Revision No.: C
Changed by: SS Revision Date: 12/2/11
Verified & Approved by: TL Date: 12/2//2011

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