OPS12.003 Medical Equipment Sample Agreement Addendum 3.Doc

8/12/2019 OPS12.003 Medical Equipment Sample Agreement Addendum 3.Doc

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STATE OF CALIFORNIA

STANDARD AGREEMENTSTD 213 (Rev 06/03) AGREEMENT NUMBER

ICM.XXXXX

REGISTRATION NUMBER

1. This Agreement is entered into between the State Agency and the Contractor named below:

STATE AGENCY'S NAME

California Department of Corrections and Rehabilitation (CDCR) See Exhibit A-4, List of Participating Institutions.CONTRACTOR'S NAME

XXXXX

2. The term of this Upon Approval through December 31, 2013A reement is:

3. The maximum amount The total est imated amount of this Statewide Agreement shal l not exceed $______ (spel lou t amount).There is no monetary obligation, either written or implied, created on this StatewideAgreement. Each participating Institution requesting services under this Statewide Agreement shalencumber funds on separate BIS Purchase Orders (not STD 65). The State makes no commitmenteither written or implied, as to the total amount to expend during the term of this StatewideAgreement.

of this Agreement is:

4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made apart of the Agreement.

This agreement is awarded based on IFB OPS12.003

Exhibit A Sco e of Work 1 a eExhibit A-1 Detailed Scope of Work 8 pages

Exhibit A-2, Equipment List 16 pages

Exhibit A-3, Service Report 1 page

Exhibit A-4, List of Participating Institutions 1 page

Exhibit B Budget Detail and Payment Provisions 1 page

Exhibit B-1 Rate Sheet X page

Exhibit C* General Terms and Conditions GTC 610

Check mark one item below as Exhibit D:

Exhibit - D Special Terms and Conditions (Attached hereto as part of this agreement) 6 pages

Exhibit E Additional Provisions, Insurance Requirements 1 pages

Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached hereto.These documents can be viewed at www.ols.dgs.ca.gov/Standard+Language

IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.

CONTRACTOR Cal i fornia Department of GeneralServices Use OnlyCONTRACTORS NAME (if other than an individual, state whether a corporation, partnership, etc.)

BY (Authorized Signature) DATE SIGNED(Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNING

ADDRESS

STATE OF CALIFORNIAAGENCY NAME

California Department of Corrections and Rehabilitation

BY (Authorized Signature) DATE SIGNED(Do not type)

PRINTED NAME AND TITLE OF PERSON SIGNINGExempt per:

Terrie Reese, Staff Services Manager I

ADDRESS

P.O. Box 4038, Suite 330Administrative Support Services/Office of Procurement ServicesSacramento, CA 95812-4038


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Contractors NameDepartment of Corrections and Rehabilitation OPS12.003SCOPE OF WORK Exhibit A

Addendum 3

Page 1 of 1

1. Contractor agrees to provide California Department of Corrections and Rehabilitation (CDCR)maintenance and repair services to CDCRs Medical Equipment listed in Attachment A-2.

2. The services shall be performed at the various CDCR adult institutions listed in the Exhibit A-4, List of Participating Institutions.

3. The term of this agreement will vary by institution in accordance to the following:

Institution Agreement Term Dates

Calipatria State Prison (CAL) Upon approval through December 31, 2013

California Institution for Women (CIW) Upon approval through December 31, 2013

Chuckawalla Valley State Prison (CVSP) October 1, 2012 through December 31, 2013

Ironwood State Prison (ISP) Upon approval through December 31, 2013

California State Prison, Los Angeles County (LAC) January 1, 2013 through December 31, 2013

R. J. Donovan State Prison (RJD) Upon approval through December 31, 2013

4. The services shall be provided during normal business hours from 7:00 AM to 5:00 PM,Monday-Friday, except State holidays.

5. The project representatives during the term of this agreement will be:

Contract Manager Project RepresentativeState Agency: CA Department of Corrections andRehabilitation

Contractor:

Name: Various, see participation list Name:Phone: Various, see participation list Phone:E-mail: Various, see participation list E-mail:

Fax: Various, see participation list Fax:

Direct all contract inquiries to:

Contract Analyst Contractor RepresentativeState Agency: CA Department of Corrections and

RehabilitationContractor:

Section/Unit: Office of Procurement Services Section/Unit:Attention: Chris Chilcott Attention:Address: P.O. Box 4038, Suite 330

Sacramento, CA 95812-4038Address:

Phone: 916-445-1393 Phone:E-mail: [email protected] E-mail:

Fax: 916-324-5645 Fax:

6. Contractor Agrees to provide services in the manner specified herein and as detailedin Exhibit A-1, Detailed Scope of Work.


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Contractors NameDepartment of Corrections and Rehabilitation OPS12.003DETAILED SCOPE OF WORK Exhibit A-1

Page 1 of 8

MEDICAL EQUIPMENT INSPECTION, PREVENTATIVE MAINTENANCEAND REPAIR SERVICES

1. INTRODUCTION

This is a California Department of Corrections and Rehabilitation (CDCR) Master Agreement inwhich the Contractor shall provide all labor, including travel and per diem, materials, non-consumable supplies, transportation, equipment, and every other item of expense necessary toperform maintenance, calibration, and repair services for the Medical Equipment at the variousCDCR adult institutions listed in the Exhibit A-4, List of Participating Institutions.

The State assumes no responsibility for any work commenced by the Contractor and willnot reimburse the Contractor for any work performed prior to approval and scheduling bythe Institution Contract Liaison or designee.

Contractor shall report to the Institution Contract Liaison or designee upon arrival at theinstitution/facility to pick up the Service Reports, Exhibit A-3. Upon completion of theservices, the Contractor shall return the Service Report for approval and signature to theInstitution Contract Liaison or designee. Invoices will be paid only when accompanied bythe approved/signed Service Report for the services performed.

Contractor must be available via phone or in person to participate at the kick-offmeeting once an executed agreement is in place. Services shall not be performeduntil after the kick-off meeting takes place.

2. SCOPE OF WORK

Upon the request of the Institutions Contract Liaison or designee, Contractor shall providepreventative maintenance, calibration and repair services for the institutions complete inventoryof medical equipment

All equipment specified in the Exhibit A-1 Equipment List

Services provided under this agreement shall be performed by the Contractor during normalbusiness hours 7:00 a.m. to 5:00 p.m., Monday through Friday, State holidays and weekendsexcluded, or as mutually agreed upon between the Contractor and the State.

The State reserves the right to add equipment similar to the list established at thecommencement of this agreement and delete equipment. Additional equipment will be servicedat the unit rates specified herein. Contractor will be notified in writing by the Institution ContractLiaison or designee of like equipment being added or removed from the equipment list.

The term of this agreement will vary by institution in accordance the listed terms date in Exhibit A,Scope of Work, Section 3.

3. PREVENTATIVE MAINTENANCE SERVICES

Contractor shall perform all preventative maintenance (PM) services as specified herein and asnecessary to maintain the optimum level of efficiency for each specified piece of equipment inaccordance to Original Equipment Manufacturer (OEM) instructions and/or recommendations.Services shall include, as applicable, but not be limited to: cleaning, oiling, lubrication,adjustment, calibration, mechanical and optical alignment, timing, replacement of any filters, andoperational testing of each piece of equipment, furnishing all necessary lubricants, cleaning


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Page 2 of 8

supplies, filters, and testing equipment, and providing any necessary repairs and partsreplacement as specified by the manufacturer. Any parts requiring replacement will be replacedin accordance with the Parts Replacement section specified herein.

Refrigerators listed in this agreement (Exhibit A-2, Equipment List) are for repairs only. No

PM services shall be performed on refrigerators.

If the equipment is deemed non-repairable upon completion of the PM Service, Contractor shalltie a card to the equipment to alert State personnel that the equipment is unsafe for use or notoperable. The card shall be printed on a 3x 6.5 red card stock stating in bold and large font,DO NOT USE DEFECTIVE EQUIPMENT. The card will provide the following informationabout the equipment:

Last date of service

Type of Equipment

Make/Model/Serial number of equipment

Description of problem

Contractors name

Contractors phone number

Preventative maintenance services shall be paid by the State at the ContractorsMaintenance/Inspection Service Rates specified in the Exhibit B-1 Rate Sheet.

(a) CDCR reserves the right to request additional preventative maintenance services atContractors bid rate and/or to decrease the number of scheduled preventativemaintenance services. Preventative maintenance services must be scheduled andapproved by the designee and/or contract liaison. No preventative maintenance servicesshall be performed without prior scheduling and approval. CDCR will not beresponsible for the cost of any unscheduled preventative maintenance servicesperformed.

4. CALIBRATION SERVICES

All equipment requiring calibration shall be identified by placing inspection stickers on theequipment. The sticker shall show the date of calibration and/or date of service, and signature ofservice technician servicing the equipment. All instruments used to calibrate the equipment shallbe certified and traceable to the National Institute of Standards Technology (NIST). Conductivitytests, proper voltage out-put, and leakage current amounts tests will be performed in accordancewith applicable rules and regulations of the Medical Industry.

The Contractor shall maintain an instrument log book and provide a calibration certificatesignifying that a continuing quality control program is in existence for each piece of equipment.The log book shall record each piece of equipment with the make, model, serial and/or propertynumber, date of preventative maintenance, and date of repair services. This instrument log bookwill be maintained at the institution and will be the property of the State.

5. SAFETY INSPECTIONS

Contractor shall perform safety inspections of the equipment in conjunction with the preventativemaintenance schedule established by the Institution Contract Liaison or designee. Contractorshall ensure, when applicable, that equipment meets the manufacturers specifications for safeoperation. Contractor shall notify the Institution Contract Liaison or designee of any potentialproblems related to equipment safety and make recommendation(s) to correct.


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Inspections shall be included in the maintenance cost and paid by the State at the ContractorsMaintenance/Inspection Service Rates specified in the Exhibit B-1 Rate Sheet.

6. SERVICE SCHEDULES

Contractor shall perform all services for the equipment listed on a monthly, quarterly, semi-annual, or annual basis as specified by OEM instructions and/or OEM recommendations. Datesof service will be established by the Institution Contract Liaison or designee. Contractor agrees toprovide the requested services on the dates specified or within two (2) working days, or asmutually agreed upon between the Contractor and the State.

The State reserves the right to request additional services at the Contractors bid rate or todecrease the scheduled number of services as the State deems necessary.

7. INSPECTIONS AND PERFORMANCE

a. Inspections: Equipment inspections shall be carried out by the Contract Liaison ordesignee at the completion of each service and at various times throughout the term ofthis Agreement to check on the quality of work and determine acceptability of work

performed. Authorization for payment of all or part of an invoice(s) for servicesperformed will be approved based on review and approval by the designee.

b. Failure to Perform: The CDCR and/or Institution will routinely evaluate the workperformance of the Contractor. Any Contractor who fails to perform or who are physicallyor mentally incapable of performing the required duties as required by this Agreementshall not be permitted to perform service. CDCR shall not pay for services by aContractors representative who is found to have been deemed incapable or unqualifiedto perform those services. Contractor will be required to provide an immediatereplacement of personnel that meets all requirements as outlined within this Agreement.

c. Liquidated Damages: In the event the Contractor fails to appear on the agreed-uponday without providing notification to the Contract Liaison or designee within two (2) hours

of the scheduled appointment, the Contractor will be considered a no-show, andliquidated damages will be imposed. The parties agree that the determination ofdamages to CDCR in the event of a no-show is difficult to establish and that this amountis a reasonable assessment of the damages that CDCR would sustain, based oncircumstances existing at the time of entering into this Agreement. CDCR reserves theright to apply liquidated damages of fifteen percent (15%), which will be deducted fromthe Contractors hourly rate (a minimum of four (4) hours) on the next invoice forsubsequent service performed for that institution. If or when the institution seeksliquidated damages, CDCR will exercise this provision of the agreement by disputing theinvoice through CDCR accounting unit.

d. Standard Notice and Termination: The Contractor is expected to respond to servicerequests (SR) in a timely manner. In the event Contractor is unable to perform a SR on

three (3) occasions and/or is a no-show (i.e., no calls, no cancellation, and norescheduling of appointment) on three (3) or more occasions in a six (6) month period,CDCR reserves the right to terminate this regional agreement. Contractor will not incurliquidated damages under security situations. Upon termination of the regionalagreement, CDCR will award the regional agreement to the next lowest responsiveresponsible bidder.

e. Inadequate Level of Service: Contractors shall diagnose and repair equipment to itsoperating condition, as per OEM specifications, in the most cost efficient but expeditiousmethod(s). Should Contractors service fail to remedy a corrective solution within five (5)


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Contract Liaison or designee. Contractor shall submit a written report with recommendation forrepairs to the Institution Contract Liaison or designee within twenty-four (24) hours of findings.

If the equipment is deemed non-repairable upon completion of the repair service, Contractor shalltie a card to the equipment to alert State personnel that the equipment is unsafe for use or not

operable. The card shall be printed on a 3x6.5 red card stock stating in bold and large font, DONOT USE DEFECTIVE EQUIPMENT. The card will provide the following information about theequipment:

Last date of service

Type of Equipment

Make/Model/Serial number of equipment

Description of problem

Contractors name

Contractors phone number

10. LOAN EQUIPMENT

When repair(s) made by the Contractor are anticipated to last longer than five (5) working days,

the State reserves the right to require the Contractor to provide loan equipment to the State at noadditional cost. The loan equipment provided shall be the same or equivalent to the equipmentbeing repaired. Contractor shall provide the loan equipment to the State within twenty-four (24)hours of request by the State.

Requests by the State for loan equipment shall only be made for those pieces of equipmentconsidered by the State to be vital to daily operations. Any loan equipment provided by theContractor to the State under this provision shall remain in the possession of the State until suchrepair(s) are completed and approved by the Institution Contract Liaison or designee.

The State shall be relieved of all risks of loss or damage during the entire time the loanequipment is in the possession of the State, except when loss or damage is due to fault ornegligence of the State. All loan equipment will be returned to the Contractor in good conditionsubject to reasonable wear and tear, except for any loss or damage arising from circumstances

beyond the control of the State.

11. EQUIPMENT REMOVAL

Contractor shall perform all services under this agreement on State premises. In the eventequipment must be removed from State premises for repair, prior written approval must beobtained from the Institution Contract Liaison or designee. The Institution ContractLiaison or designee and Contractor shall complete the Equipment Custody Transfer Formas hereby incorporated as Exhibit A-5. Written approval to remove equipment from Statepremises by the institution designee must accompany the equipment and the EquipmentCustody Transfer Form at the entrance/exit gate and shown to the correctional officer onduty.

The Institution Contract Liaison or designee shall keep a record as specified in the CDCRResponsibilities section of equipment being removed from State premises. The Contractor shallbe responsible to pick up the equipment from State premises and return the equipment to originallocation ready for use at the institution/facility.

Upon completion of repair, the Contractor will notify the Institution Contract Liaison or designee toschedule a return delivery date and time. Under no circumstances shall equipment removed fromState premises be kept by the Contractor longer than five (5) working days, unless prior writtenpermission has been obtained from the Institution Contract Liaison or designee.


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12. PARTS REPLACEMENT

This agreement includes replacement of parts that become worn or inoperable, or that otherwiseaffects the equipments operability. Contractor must notify the Contract Liaison or designee priorto ordering and/or installing any parts. A written estimate of the required repair part(s) must be

submitted by the Contractor to the Contract Liaison or designee and approved in writing beforereplacement. Contractor shall provide OEM part numbers for all replacement parts. Contractorwill be reimbursed for the actual cost of the part(s) with payment substantiation. Proof ofcost of parts, such as a copy of the actual invoice or receipt for the part from the companyfrom which it was purchased, must be attached to Contractors invoice for partsreimbursement. If proof of invoice or receipt is not attached to the invoice, the State willnot reimburse Contractor for the cost of parts.

The State shall retain the right to purchase repair part(s) independently. Parts with a dollar valueabove one hundred dollars ($100) may be replaced only with prior written approval from theInstitution Contract Liaison or designee.

All parts replaced by the Contractor shall be new, factory manufactured, or of equivalentmanufacturer quality. Contractor agrees to maintain an adequate supply and/or be able to obtain

within a reasonable amount of time any necessary replacement parts in order to perform repairsand maintenance as specified herein. Any parts that have been replaced by the Contractorbecome the property of the State.

The State assumes no responsibility and will not reimburse the Contractor for partsordered and/or installed prior to written authorization by the Institution Contract Liaison ordesignee. All approved parts must also be included on the Service Report. Invoices willbe paid only when accompanied by signed Service Report approved by either the

Institution Contract Liaison or designee.

Parts for Preventative Maintenance The cost for preventive maintenance (PM) kits or partsrecommended by manufacturer for preventative maintenance for each piece of equipment mustbe included in the preventative maintenance/inspection service cost per piece of equipment as

specified in Exhibit B-1 Rate Sheet.

13. QUALIFICATIONS

a. The Contractor technicians must be trained to service all the equipment specified inthe Exhibit A-2 Equipment List specified herein. The Contractor must provide tothe State:

1. List three (3) professional references for each service technician who will beproviding services as specified. The proposed service technician(s) must have atleast two (2) years experience within the last two (2) consecutive yearsmaintaining and repairing same or similar medical equipment listed in thisagreement. The references must include all the following:

Service Technicians name.

Medical equipment serviced by manufacturer and equipment description.

Services provided (e.g., maintenance and/or repair)

Term dates that services were provided.

Verification that the service was satisfactory.

Current contact information for each of three (3) references provided.


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References will be contacted and verified by CDCR to ensure that the service was satisfactory.Only service technician(s) meeting the above criteria shall perform services on the equipmentlisted herein. Apprentices or trainees are not acceptable to use under this agreement.

14. DOCUMENTATION REQUIREMENTS

After completion of service, prior to leaving the Institution, the Contractor or service technicianshall submit a complete and legible Service Report, hereby incorporated as part of thisagreement as (Exhibit A-3) to the Institution Contract Liaison or designee of the service provided,including any necessary repairs. Report shall include: Date of service, description of serviceprovided, including replacement of any worn parts, name and signature of Contractors servicetechnician, location of equipment, equipment make, model and serial number, description of anynoted deficiencies and suggested corrective action, total labor hours expended, and signature ofInstitution Contract Liaison or designee certifying indicated services were performed.

15. ACCIDENTS/DAMAGES

The Contractor shall be liable for damages arising out of injury and/or damage to the property ofthe State, employees of the State, and any other person(s) other than agents or employees of the

Contractor, designated by the State for any purpose, prior to, during or subsequent to del ivery,installation, acceptance and use of the deliverables either at the Contractors site or at the Statesplace of business, provided that the injury or damage was caused by the fault or negligence ofthe Contractor.

16. EXCLUSIONS

Services provided under this agreement do not include maintenance of accessories, attachments,machines or other devices not specified herein. Also excluded are painting or refinishing ofequipment, and the furnishing of supplies, accessories, or devices of any nature, except suchitems or equipment as may be necessary for the maintenance and repair of the equipment.This agreement does not include service, repair or replacement of parts required as a result ofaccident, neglect, abuse, misuse, alteration of equipment, or other improper operation, including

but not limited to operation of equipment outside of its specified environmental conditions.

17. GUARANTEE

The Contractor shall guarantee all maintenance/calibration and repair services performed byContractors service technician(s), including any replaced parts, for a minimum of ninety (90) daysfrom the date of service. If it is determined that failure has occurred due to defective parts orworkmanship, Contractor shall correct the failure at no additional cost to the State. Correctionshall occur during normal State business hours upon request for service by the InstitutionContract Liaison or designee within two (2) days of notification.

18. CDCR RESPONSIBILITIES

The Institution Contract Liaison or designee is the State representative responsible for themanagement of this contract for the State. All services performed by the Contractor are to beinspected by the Institution Contract Liaison or designee upon completion. The InstitutionContract Liaison or designee shall determine acceptability of services provided by the Contractorand approve all work prior to authorizing and approving invoices for payment.


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Contractor shall be escorted and supervised at all times by a State employee throughout theduration of the service.

When it is determined that the equipment must be removed from State premises for repairservices, the Institution Contract Liaison or designee shall record the brand, make, model

number, serial number(s), and property numbers inspect and note the condition of the equipment,and coordinate the equipment removal and return with the Contractor. Upon return, the InstitutionContract Liaison or designee shall verify the equipment identification and condition by inspectingthe equipment for acceptability and recording the data.

The Institution Contract Liaison or designee will notify the Contractor and the RegionalAccounting Office in writing of equipment that has been added and/or removed from the list.

All services performed by the Contractor are to be inspected by the Institution Contract Liaison ordesignee upon completion. The State is solely responsible for determining acceptability of themachine quality, operability, and satisfactory completion of services provided by the Contractor.

19. CDCR CONTACT INFORMATION

Should questions or problems arise during the term of this agreement, the contractor shouldcontact the following offices:

CDCR Scope of Service/Performance Issues:

Please refer to the agreement contact person or the appropriate Institution listed inExhibit A-4, List of Participating Institutions.

CDCR Billing/Payment Issues:

Department of Corrections and Rehabilitation

Sacramento Regional Accounting OfficeAttn: Accounts Payable A UnitP.O. Box 187015

Sacramento, CA 95818-7015 Phone Number 916-255-5463/ 916-255-2090/ 916-255-2092

Email: Medical Accounts Payable A Help [email protected]

.General Contract Issues:

Office of Procurement ServicesPhone Number: (916) 324-3269Fax Number: (916) 324-5645


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Contractors NameDepartment of Corrections and Rehabilitation OPS12.003EQUIPMENT LIST Exhibit A-2

Page 1 of 16

Calipatria State Prison (CAL)

EQUIPMENT QTY MANUFACTURER MODEL SERIAL

Blood Pressure Machine 1 Welch Allyn 0005169

Blood Pressure Machine 1 Welch Allyn *

Blood Pressure Machine 1 Welch Allyn 200804078Blood Pressure Machine 1 Welch Allyn 0003464


Blood Pressure Machine 1 Welch Allyn IA049818





Capillary Blood Measurer 1 Hemocue H6201 0920013289



Ceiling Mounted Tube 1 RS-580 4699

Centrifuge 1 Unico 0505008

Compressor Nebulizer 1 Phillips Respironic 004449Compressor Nebulizer 1 Phillips Respironic 004447

Compressor Nebulizer 1 Phillips Respironic 001686

Defibrillator, Automated External 1 Welch Allyn 003478

Defibrillator, Automated External 1 Drive *

Defibrillator, Automated External 1 Welch Allyn AED 20 NC230842

Defibrillator, Automated External 1 Welch Allyn AED 10 017832

Defibrillator, Automated External 1 Zoll X081173616

Defibrillator, Automated External 1 Zoll V081173550

Defibrillator, Automated External 1 AED Plus X08L169980

Defibrillator/Pacer 1MRL LITE

(BIPHASIC) 00003401

Dernatology Camera 1 AMD 2500 AMB 2789

ECG / EKG Test System 1 Burdick Atria 3100 0015237

ECG / EKG Test System 1 Burdick Atria 3100 *

EKG Machine 1 * 10003052

EKG Machine 1 Welch Allyn 10002440

EKG Machine 1 Welch Allyn 0005193

EKG Machine 1 Welch Allyn *

Endocoupler 1 AMD 500 415276

ENT Chair 1 Reliance 880HPC 0124558

Exam Table 1 UMF 5060 85337E

Exam Table 1 UMF 5050 85337B

Exam Table 1 UMF 5140 82443A

Exam Table 1 UMF 5140 82443C

Examing Chair/Bed 1 Ritter 230 *

Examing Chair/Bed 1 Ritter 230 *

Gleamer 1 Elite GL117951

Imaging/Illuminator P latform 1Welch Allyn AMD

3005 AMD 3005 EN 102523

Instrument Stand 1 Reliance 7720 0124274

IV Pump Machine 1 Braun 346893

Lateral Cassette Holder 1 QT-TCH *

Masimo Set B/P, VS 1 * 0003488

Medication Compressor 1 John Bunn 36637

Microscope 1 American Optical *


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Monitor, Vital Signs 1Welch Allyn 500

Series JA103745


Series JA103746


Series JA103744

Occular Equipment 1 Zoiss Humphrey 0003394

Occular/Optha/Odoscope 1 Welch Allyn 0003418

Odoscope 1 Welch Allyn *

Odoscope-RN 1 Welch Allyn *

Optamaloscope 1 Welch Allyn 0003453

Optha/Otoscope 1 Elite *

Optha/Otscope 1 * 0003466

Otoscope 1MODEL 7110CHARGER 0003490

Otoscope Set 1 Welch Allyn 0003453

O2 Oxygen Concentrator 1 * 60064609

O2 Oxygen Concentrator 1 Platinum Invacare *

O2 Oxygen Concentrator 1 Respironics EverFlow 0350712



Aspirator (Portable) 1 Elite 00052661

Reichert 1 * 0003397

Simulscope 1 Cardionics 718-7003 0709607

Smulscope Auscultation System 1 AMD Simulscope 0411811

Spiro Card/Spirometer 1 Spirocard 2011-13 D952081

Spiro Card/Spirometer 1 Spirocard 2011-13 D982109

Super Power Battery Pack 1 Zoll 8019-0535-01 ACOOK003116

Support 1 03072456 *

Temp Machine 1 Welch Allyn 0003411

Temp Machine 1 Welch Allyn 0009103

Thermometer 1 Welch Allyn SureTempPlus 0009096

Tonometer, Computerized 1 CT-80 1583721

Ultrasonic Cleaner 1 Sultan 600 *

Ultrasonic Cleaner 1 Sultan 61057 Prosonic 600 QCG070710663E

Ultrasonic Cleaner 1 Sultan 61057 Prosonic 600 QCG110710886F

Ultrasonic Cleaner 1 Sultan 61057 Prosonic 600 1QCG110710888F

View Boxes 7 * *

View Boxes 2 Carr *

Vital Sign Machine 1 Welch Allyn *

Vital Signs (Portable) 1 Welch Allyn *

Vital Signs Machine 1 Welch Allyn *






Vital Signs Machine 1 Welch Allyn JA069799


Vital Signs Machine 1 Welch Allyn JA069797

Vital Signs Machine 1Welch Allyn 5200-

101A 0003464


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Page 3 of 16

California Institution for Women (CIW)


Aspirator 3

Battery, Analyzer Charger 1

Bed, Electric 6

Centrifuge 1

Centrifuge 1 Statspin Express Tube 1222MS0108696

Coloscope (with Transformer) 1 Seiler 47390

Defibrillator, Automatic External 10

Defibrillator, Automatic External 1 Zoll AED Plus X11K527394

Defibrillator, Automatic External 1 Zoll AED Plus X11K525349

Defibrillator, Automatic External 1 Welch Allyn AED 10 20321

Defibrillator, Automatic External 1 Zoll AED Plus

Defibrillator, Monitor 4

Doppler, Blood Flow 5

Doppler, Hand Held 1 Summit LH010269Drive O2 Oxygen Regulator 1 Welch Allyn 18302G 4Y0810013632

Drive O2 Oxygen Regulator 1 18302G 4Y0810013622

ECG 1 Welch Allyn CP100 10012168

EKG, Multi-Channel 7

Exam Light, Medical (Portable) 1 Phillips Burton SN5269779




Exam Light, Medical (Portable) 1 Phillips Burton SN5269780Exam Light, Ultraviolet (HandHeld) 1 Phillips Burton UV502 SN5269689

Exam Table 1 Brewer ET026597



Glucometer 1

Gurney 5

Gurney 1 Stryker 610079517

Infant Warmer 1

Intensity Control 2

IV Stane (5 Leg) 6

Lamp, Exam 18

Lamp, Ultraviolet 2

Laryngoscope 4

Lift 1 Hoyer

Lift Mobile For Tub Immersion 2

Light Surgical Ceiling 6

Microscope Laboratory 2

Monitor, Antepartum 1

Monitor, Blood Pressure 1 W.A. Baum Co 8073279

Monitor, Blood Pressure (onStand) 1 W.A. Baum Co 10075062

Monitor, Blood Pressure (Wall) 1 Welch Allyn 110330184358


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Monitor, Digital Blood Pressure 1 ADC? 6008N

Monitor, Fetal Multiparameter 2

Monitor, Temperature Patient 2

Monitor, Vital Signs 1 Welch Allyn 6000 Series 103003862312

Monitor, Vital Signs 35

Nebulizer 1 DeVilbess PulmoAide 5650D 3D6039633

Nebulizer 1 DeVilbess PulmoAide 5650D 3D6039232

Nebulizer 1 DeVilbess PulmoAide 5650D D3924801




Nebulizer, Non-Heated 8

O2 Oxygen Concentrator 3

O2 Oxygen Regulator 1 Cramer Decker SREG8725-B2D 120101653O2 Oxygen Regulator 1 Cramer Decker AREG8725-B2D 120101507

O2 Oxygen Regulator 1 Cramer Decker AREG8725-B2D 120101531

O2 Oxygen Regulator 1 John Bunn 106-JB6150-081

O2 Oxygen Regulator 2

O2 Oxygen SAT Monitor 1 BCI Spectro2 I30 WW103EN 4004142

O2 Oxygen SAT Monitor 1 Invacare IRC400 ZB1A12290508



Opthalmoscope 1 Welch Allyn

Opthalmoscope 1 Welch Allyn

Opthamoscope/Otoscope 20

Otoscope 1 Welch Allyn

Otoscope 1 Welch Allyn

Overbed Table 8

Oximeter 1

Pill Counter 1

Pump, Food Enternal Feeding 1

Pump, Infusion 5

Quick Dray Hand Held Suction 1 SSCOR W02787

Quick Dray Hand Held Suction 1 SSCOR W02788

Scale, Mechanical 19

Sphygmomanameter Aneriod 10

Spot Blood Pressure Monitor 1 W elch Allyn 200710196Spot Blood Pressure Monitor 1 W elch Allyn 200710455

Spot Vital Sign Machine LXI 1 Welch Allyn 45NTO 20070300937

Standing Scale 1 Health O Meter 599KL 599T002261

Standing Scale 1 Health O Meter 599KL 599T002265

Sterilizer Steam Table Top 1

Suction 1 Schuco Inc 130 99900049280

Suction Machine 1 Schuco Inc 80300012533


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Table, Exam Treatment 22

Thermometer 1 Genius

Thermometer 4

Thermoscan 1 Welch Allyn Pro400 23611K04367




Ultrasound Diagnostic 1

View Box, Radiographic 10

Warming Cabinet 1Weighing Scale, Weighing (WallMounted) 1 Tronix Wall Mounted 6202-2227Weighing Scale, Weighing (WallMounted) 1 Tronix Wall Mounted Stow-A-Weigh 6202-2229

Weighing Scale, Weighing (WallMounted) 1 Tronix Wall Mounted Stow-A-WeighWeighing Scale, Weighing (WallMounted) 1 Tronix Wall Mounted Stow-A-Weigh 6202-2226

WheelChair Tracer EX 1 Invacare

WheelChair Tracer EX2 1 Invacare TREX28R-37774 11KJM00450

WheelChair Tracer EX2 1 Invacare TREX28R-37774 11KJM000420

WheelChair Tracer IV 1 Invacare ATO-T4 12CM004251

X-Ray Film Illuminator 1 S&S X-Ray Products 4X0042 11-98431




Chuckwalla Valley State Prison (CVSP)


Autoclave (M7 Speed Clave) 1 Ritter M7 Speed Clave Central Health

Blanket Warmer 1 Enthermic EC340

Centrifuge 3 Hamilton Bell Vanguard Central Health

Defibrillator 2 Welch Allyn PIC 50 Emergency Rooms

Defibrillator, Automatic External 8 Welch Allyn AED 10 Various

ECG / EKG Test System 6 Burdick Atria 3100 Various

Exam Lights, Surgical (TTA) 2 Armsco Steris Emergency RoomGurney, Stryker (Electric) 2 StrykerGurney, Stryker (Non-Electric) 2 Stryker

Hyfrecator Plus 1 Conmed/Birtcher 7-797 Emergency Room

Infusion Pump 8 Baxter Flo-Guard 6201 Infirmary

Microscope 1 Baush & Lomb Standard 25 Laboratory

Microscope 1 Carl Zeiss 313216 Laboratory

Monitor, Vital Signs 18 Welch Allyn 42NTB Various

Nebulizer (Aspirator Pulmo) 9 Invacare Startos Pro Various

O2 Oxygen Concentrator 2 Invacare IRC: 5LX02

Oto / Opthalmoscope 14 Welch Allyn 07120 Various

Refrigerator 2 Fischer Scientific ISO TEMP Lab & Pharmacy

Scale, Stand Up (Adult Patient) 7 Decto SP7044 Various

Scale, Stand Up (Adult Patient) 1 Health O Meter SP7044 Various

Suction, Portable AC/DC 7 Armstrong AE-6976 Various

Thermometer, HandHeld D/C 6 Welch Allyn Sure Temp Various


16/38


Page 6 of 16

Ironwood State Prison (ISP)


Aspirator 1 Gomeo G180Aspirator 1 Gomeo G180



Defibrillator, Automatic External 1 Welch Allyn AED 20 NC430866


Autoscope 1 Welch Allyn 728

Autoscope 1 Welch Allyn Wall Mount

Autoscope 1 Welch Allyn





Autoscope 1 Welch AllynAutoscope 1 Welch Allyn





Monitor, Blood Pressure 1 Welch Allyn 420 200405872




Monitor, Blood Pressure 1 Welch Allyn 53TD 6JA067728

Monitor, Blood Pressure 1 Welch Allyn 5580TD JA007730

Monitor, Blood Pressure 1 Welch Allyn

Defibrulator 1 Phillips Heart Start US00317497Defibrulator 1 Phillips Heart Start US00317496

Defibrulator 1 Welch Allyn AED 20 NC230869

Defibrulator 1 Welch Allyn MRL 201766

ECG 1 Atria Atria 6100 20043700

ECG 1 Burdick Atria 6100 A6100-001911



ECG 1 Burdick Eclipse 850 10670001600



Exam Light 1 Drung 1004067

Exam Light 1

Exam Light 1Examiniation Bed 1 Hill Adjustable HA080227

Examiniation Bed 1 Pedgio 750W SN021812

Examiniation Bed 1 Pedgio 750W SN021814

Examiniation Bed 1 Pedigo 750W SN021811

Glaucometer 1 Trutrack 4864031

Glaucometer 1 Trutrack 4864040

Gurney 1 Stryker MX Pro

Gurney 1 Stryker MX Pro

Gurney 1 Stryker Power Pro


17/38


Page 7 of 16

Gurney 1 Stryker Power Pro XT 70640723

Gurney 1 Stryker Power Pro XT 70540313

Oximeter, Pulse Hand Held 1 BCI 3301 AB07051326


Oximeter, Pulse Hand Held 1 BCI 3301 370315015Oximeter, Pulse Hand Held 1 BCI 3301 370315027

Oximeter, Pulse Hand Held 1 BCI 3301 370315024

Oximeter, Pulse Hand Held 1 BCI 3301 BB10070317







Hydrocolater 1 Chatanooga Cool

Hydrocolater 1 Chatanooga Heat

Hyfractor 1 Conmed 2000 07JGJ289

IV Infusion Pump 1 Baxter Flow Guard 6201 5011385F8ZIV Infusion Pump 1 B-Braun Vista 52368

Lift 1 Invicare 9805 06DLA100514

Lift 1 Sunrise G34972

MiniDoppler 1 Hadeco ES-100VX

Nebulizer 1 DeVilbiss 5650D D3143356

Nebulizer 1 DeVilbiss 5650D D2936056

Nebulizer 1 Sunrise 5650D D4113234

Ophthalmoscope 1 Welch Allyn Portable

Ophthalmoscope 1 Welch Allyn Portable

Ophthalmoscope 1 Welch Allyn Wall Mount

Ophthalmoscope 1 Welch Allyn


Ophthalmoscope 1 Welch AllynOphthalmoscope 1 Welch Allyn









O2 Oxygen Concentrator 1 DeVilbiss A570277DS



O2 Oxygen Concentrator 1 DeVilbiss A563642DSO2 Oxygen Concentrator 1 DeVilbiss A560896DS


O2 Oxygen Concentrator 1 Invicare IRCS1X02

Scale 1 Detecto

Scale 1 Detecto

Scale 1 Detecto

Scale 1 Detecto

Scale 1 Detecto

Scale 1 Detecto


18/38


Page 8 of 16

Scale 1 Healthometer



Tense Unit 1 Sonicator Plus 994

Thermometer 1 Exergen Tempral Scanner A30098

Thermometer 1 Exergen Tempral Scanner A53780Thermometer 1 Welch Allyn 679 1173307

Thermometer 1 Welch Allyn 679 173302

Thermometer 1 Welch Allyn 679 D117397







Thermometer 1 Welch Allyn Sure Temp 679 1173276

Exam Light, Ultraviolet 1 Burton 9721

Exam Light, Ultraviolet 1 Burton UV972139

Exam Light, Ultraviolet 1 Burton UV972142Monitor, Vital Sign 1 Welch Allyn 42NTB 200112612

Monitor, Vital Sign 1 Welch Allyn 42NTB 200712605







Monitor, Vital Sign 1 Welch Allyn 45NTO 20071004276

Monitor, Vital Sign 1 Welch Allyn 45NTO 20071004294

Monitor, Vital Sign 1 Welch Allyn 530TO JA067731

Water Distiller 1 PureWise 47243

Wheel Chair Scale Monitor 1 Detecto 758C E19807-0274Wheel Chair Scale Platform 1 Detecto BRW-1000 E20207-0047

California State Prison, Los Angeles County (LAC)


Defibrillator, Automatic External 1 Zoll A Series X08L183647

Defibrillator, Automatic External 1 Zoll AED Plus X08L183631





Defibrillator, Automatic External 1 Zoll AED Plus X08L183554Defibrillator, Automatic External 1 Zoll AED Plus X08L183573





Defibrillator, Automatic External 1 Zoll AED Plus AF08L006566

Defibrillator, Automatic External 1 Zoll AED Plus AF09L006343

Defibrillator, Automatic External 1 Zoll R Series

Light, Exam (Ceiling) 1 Amsco Examiner 10


19/38


20/38


Page 10 of 16

Scale 1 Detecto Stand Up Manual E02707-0302

Scale 1 Detecto Stand Up Manual

Scale 1 Health O Meter Stand Up Manual



Scale 1 Health O Meter Stand Up Manual E15307-0345Scale, Wheelchair 1 Detecto 758C A6-06951

Sterilizer 1 Pelton & Crane 78290560623

Suction Pump 1 Laerdal 4000 98520452606




Suction Pump 1 Laerdal 4000

Suction Pump 1 Laerdal 4000


Suction Pump 1 Sorensen 2110030 78130556153

Suction Pump 1 Sorenson 2110030 08450729

Suction Pump 1 Stirn Industries 2110030 78110555784

Thermometer 1 Welch Allyn 690 06269-528818Ultrasonic Cleaner 1 Mettler ME5.55 200819514

Ultrasonic Cleaner 1 Tuttnauer T1226 65B6790

Vital Signs Machine 1 Welch Allyn 420 Series 200705830









Vital Signs Machine 1 Welch Allyn 42NTB 200818948

Vital Signs Machine 1 Welch Allyn 42NTB 20050896Vital Signs Machine 1 Welch Allyn 42NTB 200705871












Vital Signs Machine 1 Welch Allyn 42NTB 200819513Vital Signs Machine 1 Welch Allyn 42NTB 200213831


Water Distiller 1 Tuttnauer W2616


21/38


Page 11 of 16

R. J. Donovan Correctional Institution


Air Flotation System / Air Pump 1 BioClinic 251169

Alternating Pressure Pad 2 BioClinic Bio Air 200 16864518

Alternating Pressure Pump 1 MaxHealth JACHE7320 O27625

Battery & Charger Systems 5 Zoll AC08K003006

BiPAP Machine 13 Respironics 1017343 4628584

Blood Pressure. Digital Auto 5 LifeClinic LC300 300003832

Cardio Messenger 1 Biotronike 45087480

Cast Cutter 1 Martin 4183-106 31533

CPAP Machine 15 Fisher & Paykel

Defibrillator 6 Zoll R Series ALS AF08L006273

Defibrillator, Automatic External 29 Welch Allyn AED 10 NA033991

Easyair Compressor 1 Preciso Medical PM15 OO46407

ECG Machine 14 Welch Allyn CP100 10007779

Exam Light, Ultraviolet 1 Spectroline EA140 332975

Exam Light, Ultraviolet 1 Spectroline EA140 332986

Exam Table 1 Clinton

Exam Table 1 Clinton Industries

Exam Table 1 Dynatronics

Exam Table 1 Ridter 204

Exam Table 1 UMF 5110 73242


Exam Table 1 UMF 5110 79271A


Exam Table 1 UMF 5140 92076Q


Exam Table 1 UMF 73242 5100D


Exam Table 1 UMF 73242 5110C

Exam Table 1 UMF 73242 5110F

Exam Table 1 UMF 73242 5110G

Exam Table 1 UMF 73242 5110I

Exam Table 1 UMF 73242 5110II

Exam Table 1 UMF 73242 5110J

Exam Table 1 UMF 73242 5110K

Exam Table 1 UMF 73242 5110K

Exam Table 1 Stryker

Exam Table 1 Stryker

Exam Table 1

Exam Table 1

Exam Table 1

Exam Table 1

Exam Table 1

Exam Table 1

Exam Table 1

Feeding Pump 1 Kangaroo 324 T9023556



Feeding Pump 1 Obrien KM70


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Page 12 of 16

Head Light 1 Welch Allyn 49003

Humidifier 1 Respironics 532053 1102524

Humidifier, Heated 1 Respironics 1005792 H1769064



Humidifier, Heated 1 Respironics 1005792 H2002735Humidifier, Heated 1 Respironics 1009491 H2018075




Hyfrecator 1 Conmed 7-900-115 O6HGJ030

Incubator 1 Curtain Matheson Equtherm

Irrigation System, Nasal 1 Grossan CN120 0810A01

Lift, Hoyer 1 Lumex

Light, Exam 1 Burton VH1469

Light, Exam 1 Burton VH1470

Light, Exam 1 Welch Allyn 794A HC73737

Light, Exam 1 Welch Allyn 794A

Light, Exam 1 Welch Allyn LS135Light, Exam 1 Welch Allyn LS135

Light, Exam 1 Welch Allyn LS135

Light, Exam 1

Monitor, Blood Pressure (Digital) 1 Omron HEM379AC O2OO2O7L

Nebulizer 1 DeVilbiss PulmoMate 4650D 235608

Nebulizer 1 DeVilbiss PulmoMate 4650D D1012273







Nebulizer 1 DeVilbiss PulmoMate 4650D D3312502Nebulizer 1 DeVilbiss Pulmo-Aid 5650D 235605

Nebulizer 1 DeVilbiss Pulmo-Aid 5650D 235607

Nebulizer 1 DeVilbiss Pulmo-Aid 5650D

Nebulizer 1 DeVilbiss Pulmo-Aid 5650D

Nebulizer 1 DeVilbiss PulmoMate 4650D 3312503

Nebulizer 1 DeVilbiss Pulmo-Aid 5650D D4143680

Nebulizer Machine 1 Schuco S3000 O60600044762

Nebulizer Machine 1 Schuco S3000 O6O6OOO44759

Nebulizer Machine 1 Schuco S5000 O4OO8144




Nebulizer Machine 1 Schuco S5000 O4OO8150O2 Oxygen Concentrator 1 Invacare IRC5LX 08JS2432534

O2 Oxygen Concentrator 1 Invacare IRC5LX 08JS2432536




O2 Oxygen Concentrator 1 Invacare IRC5LX O8JS2432544

O2 Oxygen Concentrator 1 Respironics 1020000 O172771

O2 Oxygen Concentrator 1 Respironics 1020000 O178144

O2 Oxygen Concentrator 1 Respironics 1020000 OO63817


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Page 13 of 16





O2 Oxygen Concentrator 1 Respironics 1020001 OO19O72O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 128271

O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 128429O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 128430O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 128431O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 128432

O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 130028O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 144940O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 144941O2 Oxygen Concentrator

(Portable) 1 Respironics EverGo 147270O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 115760O2 Oxygen Concentrator(Portable) 1 Respironics EverGo 119471O2 Oxygen Concentrator(Portable) 1 Respironics 150745

Ophthalmoscope 1 Propper 767

Ophthalmoscope 1 Welch Allyn 676 O8022

Ophthalmoscope 1 Welch Allyn 767 5067





Ophthalmoscope 1 Welch Allyn 767 7116Ophthalmoscope 1 Welch Allyn 767 7116







Ophthalmoscope 1 Welch Allyn 767





Ophthalmoscope 1 Welch Allyn 74710Ophthalmoscope 1 Welch Allyn 74710





Ophthalmoscope / Sure TempTermometer 1 Welch Allyn 76751 03407350A

Oximeter, Pulse 1 BCI 71000A1 390413246

Oximeter, Pulse (HandHeld) 1 BCI 3301 702386238


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Page 14 of 16

Oximeter, Pulse (HandHeld) 1 BCI 3301 AB06091992




Oximeter, Pulse (HandHeld) 1 BCI 3301 BB11080236

Oximeter, Pulse (HandHeld) 1 BCI 3301 BB11080237Oximeter, Pulse (HandHeld) 1 BCI 3301 BB11080238




Oximeter, Pulse (HandHeld) 1 Nellcor N180 21298689

Pump, Infusion 1 Baxter 6201 15013782FA

Refrigerator 1 AEGIS Scientific

Refrigerator 1 EdgeStar CRF150SS AAT2107076930177



Refrigerator 1 EdgeStar CRF150SS AAT210707893D134


Refrigerator 1 Emerson CRS19B 105001464HRSRefrigerator 1 GE GTS18FBMBRWW PA745684

Refrigerator 1 GoldStar 7768 11559

Refrigerator 1 GoldStar GR151SPF 006KR01417

Refrigerator 1 GoldStar GR-151SPF 105KR10960

Refrigerator 1 GoldStar GR-151SPF 105KR11559

Refrigerator 1 GoldStar GR-151SPF

Refrigerator 1 Haier Haier K2003600124

Refrigerator 1 Kelvinator TPK140EN

Refrigerator 1 Red Stage CRF150SS AAT21070078930140

Refrigerator 1 Summit A080700533

Refrigerator 1 Summit FF28

Refrigerator 1 Summit FF28L SU12037W512200043

Refrigerator 1 Summit FF28L SU12039W512200324Refrigerator 1 Summit FFAR2L A110200059

Refrigerator 1 Summit FFAR2L A110200484



Refrigerator 1 Summit SU12037W512200238


Refrigerator 1 Summit

Refrigerator 1 Summit

Scale, Weight 1 Detecto




Scale, Weight 1 DetectoScale, Weight 1 Detecto




Scale, Weight 1 Health O Meter 402KL 4020028728

Scale, Weight 1 Health O Meter

Scale, Weight 1 Health O Meter

Scale, Wheelchair 1 Detecto

Spot Vital Sign 1 Dynamapp 73F3 K1714


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Page 15 of 16

Spot Vital Sign 1 Welch Allyn 420 Series 20516527





Spot Vital Sign 1 Welch Allyn 420 Series 200301365Spot Vital Sign 1 Welch Allyn 420 Series 200301382






























Spot Vital Sign 1 Welch Allyn 420 Series GA104875





Spot Vital Sign 1 Welch Allyn 420 Series

Spot Vital Sign 1 Welch Allyn 420 SeriesSpot Vital Sign 1 Welch Allyn 420 Series

Spot Vital Sign 1 Welch Allyn 42NTB 20071254




Spot Vital Sign 1 Welch Allyn 530T0 JA067605

Spot Vital Sign 1 Welch Allyn 530T0 JA067726

Suction Machine 1 Laerdal 78050779531



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Page 16 of 16






Suction Machine 1 Laerdal 78130669776Suction Machine 1 Laerdal 78130669778



T Pump 1 Gaymar TP200 A1J98007

T Pump 1 Gaymar TP200 AIE98271

Thermometer 1 Sherwood 692 7244382

Thermometer 1 Sherwood F1500 L8817053






Thermometer 1 Welch Allyn 692 7244386Thermometer 1 Welch Allyn 692 12031952



Thermometer 1 Welch Allyn 692 O72444OO

X-Ray View Box, X-Ray 1 Carr 2 E5

X-Ray View Box, X-Ray 1 Carr 2 E5

X-Ray View Box, X-Ray 1 Carr

X-Ray View Box, X-Ray 1 Wolf 29602





X-Ray View Box, X-Ray 1 Wolf 29602X-Ray View Box, X-Ray 1 Wolf

X-Ray View Box, X-Ray 1 Wolf




27/38


Page 17 of 16


28/38

Contractors NameDepartment of Corrections and Rehabilitation OPS12.003SERVICE REPORT Exhibit A-3

Page 1 of 1

MEDICAL EQUIPMENT MAINTENANCE, INSPECTION, CALIBRATION, AND REPAIR SERVICEREPORT

Use one form for EACH piece of equipment serviced. If additional space is required, use back of formA com pleted, s igned co py of th is serv ice repor t along wi th al l appl icable maintenance check l is ts

mus t be submi t ted at the complet ion of each serv ice and m aintenance vis i t , and mus t accompany

a l l invo ice submiss ions . Fai l u re to do so may delay or prevent payment .

To be completed only by Institution Designee,prior to commencement of service

Time In Signature of Institution Designee

To be completed only by Institution Designee, immediatelyfollowing the completion of service

Time Out Signature of Institution Designee

Origination Point Total Travel Hours

Equipment Location Equipment Description

Equipment Make & Model Serial/Asset Tag Number

Preventative Maintenance Serviceand Inspection

Monthly Bi-Annual Annual

Calibration? (if yes, attach report ) Yes No

Provide explanation on all services performed and parts replaced. (All removed parts remain as institution property.)

Service RepairsService Completed? Yes No

Were Parts replaced? Yes NoProvide explanation on all services performed and parts replaced. (All removed parts remain as institution property.)

Describe any noted deficiencies and suggested corrective action:

I certify that, to the best of my ability, the equipment described above has been tested and/orrepaired/cleaned/certified according to the procedures as stated within the contract.

Name of Service Technician/Contractor Institution RT, HPM III, or designee

Print Name and Phone Number Print Name and Phone Number

Signature Date Signature Date


29/38


30/38

Contractors Name

CA Department of Corrections And Rehabilitation OPS12.003Equipment Transfer Form Exhibit A-5

Page 1 of 1

Equipment Custody Transfer Form (ECTF)

Institutions Name:

Pick-Up Date of Equipment: Estimated Return Date:

Equipment Description: Equipment Location:

Make/Manufacturer: Model:

Serial Number of Equipment:Property Number (if available):

TRANSFER TO

Name of Contractor:

By signature, Contractor agrees that above mentioned equipment is released to th

Picked-Up/Received by (PrintName):

Signature (required):

CDCR Personnel Authorized by(Print Name):

Signature (required):

Notes/Remarks:

TRANSFER TO INSTITUTION

FOR INSTITUTION PERSONNEL USE ONLY

Equipment Received Date:

Received by: Signature (required):

Notes/Remarks:


31/38

Contractors NameCA Department of Corrections And Rehabilitation OPS12.003BUDGET DETAIL AND PAYMENT PROVISIONS Exhibit B

Page 1 of 1

1. Invoicing and Payment

A. For services satisfactorily rendered, and upon receipt and approval of the invoices, the Stateagrees to compensate the Contractor for actual expenditures incurred in accordance with therates listed below or specified in Exhibit B-1, Rate Sheet, which is attached hereto and made a

part of this Agreement.

B. Invoices shall include the Agreement Number, sufficient scope and detail to define the actualwork performed and specific milestones completed, including a description of the activities of theContractor and Subcontractor, the hours allocated to those activities, the locations where workwas performed, the expenses claimed, any required reports, and shall be submitted in duplicatenot more frequently than monthly in arrears to the following address:

California Department of Corrections and RehabilitationSacramento Regional Accounting Office

Attn: Accounts Payable Unit AP.O. Box 187016

Sacramento, CA 95818-7016

(Invoices must reference the agreement number, PO number, date and time of work performed,and description of services performed. If either of this information is not on the invoice, it may

cause delays in payment processing.)

C. Invoice approval requires satisfactory completion of each service performed.

2. Budget Contingency Clause

A. It is mutually agreed that if the Budget Act of the current year and/or any subsequent yearscovered under this Agreement does not appropriate sufficient funds for the program, thisAgreement shall be of no further force and effect. In this event, the State shall have no liability topay any funds whatsoever to Contractor or to furnish any other considerations under this

Agreement and Contractor shall not be obligated to perform any provisions of this Agreement.

B. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program,the State shall have the option to either cancel this Agreement with no liability occurring to theState, or offer an agreement amendment to Contractor to reflect the reduced amount.

3. Prompt Payment Clause

A. Payment will be made in accordance with, and within the time specified in, Government CodeChapter 4.5, commencing with Section 927.

4. Travel Reimbursement

The State will not reimburse for Contractors travel expense against this Agreement.


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Contractors NameCA Department of Corrections And Rehabilitation OPS12.003CCHCS SPECIAL TERMS AND CONDITIONS INSTITUTIONS Exhibit D

Page 1 of 6

1. Blood borne Pathogens

Provider shall adhere to California Division of Occupational Safety and Health (CAL-OSHA) regulationsand guidelines pertaining to blood borne pathogens.

2. Clothing Restrictions

While on institution grounds, contractor and all its agents, employees, and/or representatives shall beprofessionally and appropriately dressed in clothing distinct from that worn by inmates at the institution.Specifically, blue denim pants and blue chambray shirts, orange/red/yellow/white/chartreuse jumpsuitsand/or yellow rainwear shall not be worn onto institution grounds, as this is inmate attire. The contractorshould contact the institution regarding clothing restrictions prior to requiring access to the institution toassure the contractor and their employees are in compliance.

3. Digest of Laws

If the requirements of the Agreement require the contractor to enter an Institution, the contractor shallsign the "Digest of Laws related to Association with Inmates", incorporated herein by reference, andensure that all his/her employees are aware of and abide by these rules. Employees of the Contractor,

while upon State grounds, are subject to the search of their person, property, and vehicle (Section 3288of the CDC Director's Rules).

4. Disclosure

Neither the State nor any State employee will be liable to the contractor or its staff for injuries inflicted byinmates or parolees of the State. The State agrees to disclose to the contractor any statement(s) knownto State staff made by any inmate or parolee which indicates violence may result in any specific situation,and the same responsibility will be shared by the contractor in disclosing such statement(s) to the State.

5. Employment of Ex-Offenders

Contractor cannot be and will not either directly, or on a sub-contract basis, employ in connection with this

Agreement:Ex-Offenders on active parole or probation;

o Ex-Offenders at any time if they are required to register as a sex offender pursuant toPenal Code Section 290 or i f such ex-offender has an offense history involving a "violent felony"as defined in subparagraph (c) of Penal Code Section 667.5; or

o Any ex-felon in a position which provides direct supervision of parolees.Ex-Offenders who can provide written evidence of having satisfactorily completed parole or probationmay be considered for employment by the contractor subject to the following limitations:

o Contractor shall obtain the prior written approval to employ any such ex-offender from theAuthorized Administrator; and Such ex-offender whose assigned duties are to involveadministrative or policy decision making, accounting, procurement, cashiering, auditing, or anyother business- related administrative function shall be fully bonded to cover any potential lossto the State or contractor.

6. Excise Tax

The State of California is exempt from federal excise taxes, and no payment will be made for any taxeslevied on employees' wages. The State will pay for any applicable State of California or local sales or usetaxes on the services rendered or equipment or parts supplied pursuant to this Agreement. Californiamay pay any applicable sales and use tax imposed by another state.


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Page 2 of 6

7. Fingerprinting

The contractor and any employees of the contractor may be subject to fingerprinting and clearance by theState through the Department of Justice, Bureau of Criminal Identification and Information.

8. Fo rce Majeu re

Neither party shall be liable to the other for any delay in or failure of performance, nor shall any suchdelay in or failures of performance constitute default, if such delay or failure is caused by Force Majeure.As used in this section, Force Majeure is defined as follows: Acts of war and acts of God such asearthquakes, floods, and other natural disasters such that performance is impossible.

9. Gate Clearance

Contractor and contractors employee(s) and/or subcontractor(s) must be cleared prior to providingservices. The contractor will be required to complete a Request for Gate Clearance for all personsentering the facility a minimum of ten (10) working days prior to commencement of service. The Requestfor Gate Clearance must include the persons name, social security number, valid state drivers licensenumber or state identification card number and date of birth. Information shall be submitted to the

Contract Liaison or his/her designee. CDCR uses the Request for Gate Clearance to run a CaliforniaLaw Enforcement Telecommunications System (CLETS) check. The check will include Department ofMotor Vehicles check, Wants and Warrants check, and Criminal History check.

Gate clearance may be denied for the following reasons: Individuals presence in the institution presentsa serious threat to security, individual has been charged with a serious crime committed on institutionproperty, inadequate information is available to establish positive identity of prospective individual, and/orindividual has deliberately falsified his/her identity.

All persons entering the facilities must have a valid state drivers license or photo identification card ontheir person.

10. Inspection of Services

Services performed by Contractor under this Agreement shall be subject to inspection by the CPHCS atany and all times during the performance thereof.

If the CPHCS official conducting the inspection determines that the services performed by Contractor(and/or materials furnished in connection therewith) are not in accordance with the specification, CPHCSmay, at its option, have the work performed by an alternate provider, charging the Contractor with anyexcess cost occasioned thereby.

11. Liability for Loss and Damages

Any damages by the contractor to the State's facil ity including equipment, furniture, materials or otherState property will be repaired or replaced by the contractor to the satisfaction of the State at no cost to

the State. The State may, at its option, repair any such damage and deduct the cost thereof from any sumdue contractor under this Agreement.

12. Liability for Nonconforming Work

The contractor will be fully responsible for ensuring that the completed work conforms to the agreed uponterms. If nonconformity is discovered prior to the contractor's deadline, the contractor will be given areasonable opportunity to cure the nonconformity. If the nonconformity is discovered after the deadline forthe completion of the project, CDC, in its sole discretion, may use any reasonable means to cure the


34/38


Page 3 of 6

nonconformity. The contractor shall be responsible for reimbursing CDC for any additional expensesincurred to cure such defects.

13. License and Permits

The Contractor shall be an individual or firm licensed to do business in California and shall obtain athis/her expense all license(s) and permit(s) required by law for accomplishing any work required inconnection with this contract.

A. If you are a Contractor located within the State of California, a business license from thecity/county in which you are headquartered is necessary; however, if you are a corporation, acopy of your incorporation documents/letter from the Secretary of States Office can be submitted.If you are a Contractor outside the State of California, you will need to submit to CPHCS a copy

of your business license or incorporation papers for your respective State showing that yourcompany is in good standing in that state.

B. In the event, any license(s) and/or permit(s) expire at any time during the term of this contract;Contractor agrees to provide CPHCS with a copy of the renewed license(s) and/or permit(s)within 30 days following the expiration date. In the event the Contractor fails to keep in effect at

all times all required license(s) and permit(s), the State may, in addition to any other remedies itmay have, terminate this contract upon occurrence of such event.

14. Primary Laws, Rules, and Regulations Regarding Conduct and Association with StatePrison Inmates

Individuals who are not employees of the California Department of Corrections and Rehabilitation(CDCR), but who are working in and around inmates who are incarcerated within Californiasinstitutions/facilities or camps, are to be apprised of the laws, rules and regulations governing conduct inassociating with prison inmates. The following is a summation of pertinent information when non-departmental employees come in contact with prison inmates.

By signing this contract, the Contractor agrees that if the provisions of the contract require the Contractor

to enter an institution/facility or camp, the Contractor and any employee(s) and/or subcontractor(s) shallbe made aware of and shall abide by the following laws, rules and regulations governing conduct inassociating with prison inmates:

a. Persons who are not employed by CDCR, but are engaged in work at any institution/facility orcamp must observe and abide by all laws, rules and regulations governing the conduct of theirbehavior in associating with prison inmates. Failure to comply with these guidelines may lead toexpulsion from CDCR institutions/facilities or camps.

SOURCE: California Penal Code (PC) Sections 5054 and 5058; California Code ofRegulations (CCR), Title 15, Sections 3285 and 3415

b. CDCR does not recognize hostages for bargaining purposes. CDCR has a NO HOSTAGE

policy and all prison inmates, visitors, and employees shall be made aware of this.

SOURCE: PC Sections 5054 and 5058; CCR, Title 15, Section 3304

c. All persons entering onto institution/facility or camp grounds consent to search of their person,property or vehicle at any time. Refusal by individuals to submit to a search of their person,property, or vehicle may be cause for denial of access to the premises.

SOURCE: PC Sections 2601, 5054 and 5058; CCR, Title 15, Sections 3173, 3177, and3288


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d. Persons normally permitted to enter an institution/facility or camp may be barred, for cause, bythe CDCR Director, Warden, and/or Regional Parole Administrator.

SOURCE: PC Sections 5054 and 5058; CCR, Title 15, Section 3176 (a)

e. It is illegal for an individual who has been previously convicted of a felony offense to enter intoCDCR institutions/facilities or camps without the prior approval of the Warden. It is also illegal foran individual to enter onto these premises for unauthorized purposes or to refuse to leave saidpremises when requested to do so. Failure to comply with this provision could lead toprosecution.

SOURCE: PC Sections 602, 4570.5 and 4571; CCR, Title 15, Sections 3173 and 3289

f. An encouraging and/or assisting prison inmate to escape is a crime. It is illegal to bring firearms,deadly weapons, explosives, tear gas, drugs or drug paraphernalia on CDCR institutions/facilitiesor camp premises. It is illegal to give prison inmates firearms, explosives, alcoholic beverages,narcotics, or any drug or drug paraphernalia, including cocaine or marijuana.

SOURCE: PC Sections 2772, 2790, 4533, 4535, 4550, 4573, 4573.5, 4573.6 and 4574

g. It is illegal to give or take letters from inmates without the authorization of the Warden. It is alsoillegal to give or receive any type of gift and/or gratuities from prison inmates.

SOURCE: PC Sections 2540, 2541 and 4570; CCR, Title 15, Sections 3010, 3399, 3401,3424 and 3425

h. In an emergency situation the visiting program and other program activities may be suspended.

SOURCE: PC Section 2601; CCR, Title 15, Section 3383

i. For security reasons, visitors must not wear clothing that in any way resembles state issuedprison inmate clothing (blue denim shirts, blue denim pants).

SOURCE: CCR, Title 15, Section 3171 (b) (3)

j. Interviews with SPECIFIC INMATES are not permitted. Conspiring with an inmate to circumventpolicy and/or regulations constitutes a rule violation that may result in appropriate legal action.

SOURCE: CCR, Title 15, Sections 3261.5, 3315 (3) (W), and 3177.

15. Right to Terminate (SCM 7.85)

A. The State reserves the right to terminate this Agreement subject to thirty (30) days written noticeto the Contractor. Contractor may submit a written request to terminate this Agreement only if the

State should substantially fail to perform its responsibilities as provided herein.

B. However, the Agreement can be immediately terminated for cause. (Refer to GTC, Exhibit C,Item 7. Termination for Cause)

C. This agreement may be suspended or cancelled without notice, at the option of the Contractor, ifthe Contractor or States premises or equipment are destroyed by fire or other catastrophe, or sosubstantially damaged that it is impractical to continue service, or in the event the Contractor isunable to render service as a result of any action by any governmental authority.


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16. Security Clearance

The State reserves the right to conduct a background check on the contractor and/or thecontractor's personnel as the State deems necessary prior to award or during the term of the

Agreement. The State further reserves the right to terminate the Agreement should a threat tosecurity be determined.

17. Security Regulations

a. Unless otherwise directed by the entrance gate officer and/or Contract Manager, the contractor,contractors employees and subcontractors shall enter the institution through the main entrancegate and park private and nonessential vehicles in the designated visitors parking lot.Contractor, contractors employees and subcontractors shall remove the keys from the ignitionwhen outside the vehicle and all unattended vehicles shall be locked and secured while oninstitution grounds.

b. Any State- and contractor-owned equipment used by the contractor for the provision of contractservices, shall be rendered temporarily inoperative by the Contractor when not in use, by lockingor other means unless specified otherwise.

c. In order to maintain institution safety and security, periodic fire prevention inspections and sitesearches may become necessary and contractor must furnish keys to institutional authorities toaccess all locked a

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