STUDENT TECHNOLOGY FEE REQUEST FORM Procedure for ... · * Work place quality and cleanliness€ A Preventive Maintenance Quote will be sent to you from Scimedico referencing your

STUDENT TECHNOLOGY FEE REQUEST FORM Procedure for Submission: Form Updated: 9/05/17

1. Submitter must obtain required information from vendor(s). An official quote from the vendor must be attached. No website screen shots2. This request must be reviewed, approved, and submitted by the requesting program’s School Chair.3. The School Chair may email this request to the Tech Fee Director. Since some schools will have multiple requests, please rename request PDF files

in the following format: Schoolname# (rank, 1 being the highest priority) example - SocialJustice1, SocialJustice2, etc. Please submit as one PDF fileDept. making request: Requesting Faculty: Date Submitted:

IMPORTANT: Attach an official quote from the vendor. List one item OR group (for use as a “package”) per page.

Item Name Vendor info. (name, address, Web site URL, phone #, email, etc.)

Part or Model # Cost (each) Qty Total

Course(s) where item(s) will be used

Expected life of product (years)

# Students Impacted per Year

Location equipment or software will be used/stored

Will Tech Fee needed for annual renewal or maintenance? What is the annual cost?

Provide a brief description of the technology requested*:

Briefly describe how the technology will be used (function)*:

Provide a rationale that Tech Fee funds are appropriate for this request*:

*Keep in mind that the committee members come from a variety of educational backgrounds and may not be familiar with department specificlanguage. Please use concise, common terminology so that committee members reviewing this form will be able to fully understand the request.

• If you are submitting a request for computers, printers, scanners or software, you must consult with College Computing and the technology staff, to acquirea quote and to make sure that this equipment/software is supported by UT and compatible with existing technology.

Quotation: QOH57765.19A

Summary for College of Health ScienceProject:

Mopec RepresentativeLeah Rainey

[email protected](248) 515-2959

Qty Product No. Description Unit Price Ext Price

2 DC100CUST $3,395.00 $6,790.00CUSTOM AUTOPSY CART HYDR W/GA100 TOP

1 FRT01 $475.00 $475.00FREIGHT

PREVENTIVE MAINTENANCE FOR YOUR MOPEC EQUIPMENT

Mopec is pleased to introduce our exclusive Preventive Maintenance Partner, Scimedico. Preventive Maintenance for your Mopec equipment addresses:

* Staff safety * Lab hygiene and specimen control * Ongoing equipment maintenance needs * Maximization of warranty coverage* Work place quality and cleanliness

A Preventive Maintenance Quote will be sent to you from Scimedico referencing your Mopec equipment quote number. Your Mopec Sales Representative will follow up with you to discuss this exciting and important service. For more information, visit:

CLICK HERE FOR MORE INFORMATION ON SCIMEDICO PREVENTATIVE MAINTENANCE

Mopec.com | Office: (800) 362-8491 | Fax: (248) 291-205021750 Coolidge Hwy

Oak Park, MI 48237-3156

Tax ID #: 46-1471584CAGE Code 701J0DUNS Number: 07-889-1126

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http://www.scimedico.com/pm

FREIGHT AND INSTALLATION TO BE CALCULATED FOR FINALIZED QUOTE UPON CUSTOMER REQUEST

* Freight is prepaid and added to your invoice or applied to your company's freight account * Please advise your sales representative or Mopec customer service specialist if you would like to have freight quoted for your equipment * Mopec's installer will meet the truck at the loading dock, uncrate all equipment and dispose of crating materials * We will move the equipment from the loading dock to the desired location, set and level all equipment and install optional accessories * Please advise your sales representative or Mopec customer service specialist if you would like to have installation quoted for your equipment

All prices are in currency USD ($)


Oak Park, MI 48237-3156


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Date: Monday, February 18, 2019

David VelliquetteCollege of Health Science2801 W. Bancroft St.Room 2504A, Mail Stop 119Toledo, OH 43606 USAPhone: Fax: Email: [email protected]

Quotation Prepared For

Mopec RepresentativeLeah [email protected](248) 515-2959

2 DC100CUST $3,395.00 $6,790.00

* Includes GA100 Cart Top* High Impact PVC Chassis* Cart dimensions: 80-1/2" (204xcm) Long x 32" (81cm)Wide * Elevates from 30.5"(77cm) to 43-3/4"(109cm) * Twin pedestal hydraulics* Dual end wheel brake activators built-in* Tiltable top* Includes drain hole and plug* Weight capacity 700 pounds* Casters with locking mechanisms* ALL DA, DB, DC, DD, and DF series carts are compatible with all CA, CB, and CC series autopsy sinks. *****************MODIFICATION:* Marine edge similar to JA600 top in lieu of 90 Degree standard*****************

CUSTOM AUTOPSY CART HYDR W/GA100 TOP


Details of Quotation: QOH57765.19A

David VelliquetteCollege of Health Science2801 W. Bancroft St.Room 2504A, Mail Stop 119Toledo, OH 43606 USAPhone: Fax: Email: [email protected]

Customer Facility


Oak Park, MI 48237-3156


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1 FRT01 $475.00 $475.00

Mopec will ship equipment on standard 53’ tractor trailer (Semi / LTL)\Freight estimate valid for 30 days

SHIPMENT WILL INCLUDE: * Lift gate (if specified prior to shipping).* 24/48 hour call ahead notice to a single contact person (if specified before shipping).* Tractor trailer is fully enclosed and not exposed to outdoor elements.* Freight includes one shipment.* Additional or phased shipments are not included.

CUSTOMER RESPONSIBILITIES* Loading dock is required.* Unloading of equipment. * Uncrating of equipment.* Setting equipment in place.

FREIGHT


PREVENTIVE MAINTENANCE FOR YOUR MOPEC EQUIPMENT

Mopec is pleased to introduce our exclusive Preventive Maintenance Partner, Scimedico. Preventive Maintenance for your Mopec equipment addresses:

* Staff safety * Lab hygiene and specimen control * Ongoing equipment maintenance needs * Maximization of warranty coverage* Work place quality and cleanliness

A Preventive Maintenance Quote will be sent to you from Scimedico referencing your Mopec equipment quote number. Your Mopec Sales Representative will follow up with you to discuss this exciting and important service. For more information, visit:

CLICK HERE FOR MORE INFORMATION ON SCIMEDICO PREVENTATIVE MAINTENANCE



Oak Park, MI 48237-3156


Page 4 of 7



FREIGHT AND INSTALLATION TO BE CALCULATED FOR FINALIZED QUOTE UPON CUSTOMER REQUEST

* Freight is prepaid and added to your invoice or applied to your company's freight account * Please advise your sales representative or Mopec customer service specialist if you would like to have freight quoted for your equipment * Mopec's installer will meet the truck at the loading dock, uncrate all equipment and dispose of crating materials * We will move the equipment from the loading dock to the desired location, set and level all equipment and install optional accessories * Please advise your sales representative or Mopec customer service specialist if you would like to have installation quoted for your equipment


All prices are in currency USD ($)


Oak Park, MI 48237-3156


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All customers may be subject to applicable sales tax unless certificate of tax exemption is provided.

Quotation & Discount Valid for 90 Days Unless Superseded By Another Quotation.Major credit cards accepted with a 3% surcharge for orders exceeding $10,000.00Terms: Net 30 Days Upon Credit ApprovalTransportation: FOB Oak Park, MIFreight: Pre-Paid and Added to InvoiceWarranty: One-Year Delivery: INSTRUMENTS7-10 Days After Receipt of Purchase Order.STANDARD EQUIPMENTOur products will ship 90-120 days after receipt of order.CUSTOM/MODIFIED EQUIPMENTOur products will ship 120-150 days after receipt of signed approval drawings.

A 25% Deposit is required prior to production for orders exceeding $40,0000.00

Price as quoted DOES NOT INCLUDE freight costs, unless a freight line item is included in the quote. Freight will be pre-paid and added to the invoice after product shipment

Price as quoted DOES NOT INCLUDE installation. Please advise your sales representative or Mopec estimator if you would like to receive pricing for equipment installation.

Price as quoted DOES NOT INCLUDE any applicable sales and use taxes, which will be in addition to price quoted unless customer provides certificate of sales tax exemption.

Equipment to be manufactured per the specifications provided in the proposal presented by Mopec, if approval drawings have been completed these shall govern.

Please note that any request for a change in equipment design, or services to be provided, may result in additional charges. These changes and the monetary value associated with them (if any) will be executed through Mopec\'s Change Directive Form.

PLEASE REFERENCE QUOTE NUMBER WHEN PLACING YOUR ORDER.

Thank You,Mopec

Nick MilanovicCUSTOM MODIFIED ESTIMATINGE-mail: [email protected](800) 362-8491 X187

ALL QUOTATIONS ARE SUBJECT TO MOPEC TERMS AND CONDITIONS AS PER ATTACHED


Oak Park, MI 48237-3156


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mailto:[email protected]

PREVENTIVE MAINTENANCE FOR YOUR MOPEC EQUIPMENTMopec is pleased to introduce our exclusive Preventive Maintenance Partner, Scimedico. Preventive Maintenance for your Mopec equipment addresses: * Staff safety * Lab hygiene and specimen control * Ongoing equipment maintenance needs * Maximization of warranty coverage * Work place quality and cleanlinessA Preventive Maintenance Quote will be sent to you from Scimedico referencing your Mopec equipment quote number. Your Mopec Sales Representative will follow up with you to discuss this exciting and important service.For more information, visit: http://www.scimedico.com/pm


Oak Park, MI 48237-3156


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STUDENT TECHNOLOGY FEE REQUEST FORM Procedure for ... · * Work place quality and cleanliness€ A Preventive Maintenance Quote will be sent to you from Scimedico referencing your