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Request a Sales Evaluation or Loaner I <br />.stryker <br />To request a sales evaluation or loaner, please complete the fields below, have the customer sign/date, and attach the completed form to the request in EIM. If you have any questions, contact rs.evaldemo@stryker.com. <br />If data products or modems are required for this eva luat i on, please check the LIFENET agreement box and email this form to implementationorderinbox@stryker.com. <br />Request Specifics <br />Request Type <br />Facility Name & Account Number <br />Facility Address (street, city, state, zip) <br />Facility Contact Name <br />Facility Contact Email <br />Desired Delivery Date <br />Stryker Sales Rep <br />Product & Quantity Requested <br />Modem Requested <br />Data Products Requested <br />Additional Accessories: <br />Evaluation (Trial) <br />City of Everett Fire 20037125 <br />2811 OAKES EVERETT, Washington 98201-3629 United States <br />Grady Persons <br />gpersons@everettwa.gov <br />Kyle Howell <br />LP35 -Temp/IP (99335-000013) <br />Select all that apply �ptional) <br />LJFENETJ1sset(requile<\t<>lJllii:.--..Ll.'AA=--sva1s,=c=-a.-w=1·sstreaming==·cc--=-�=cc.l----------------- <br />LP35fls Streaming Transmissions (LP15 reqwres v4/v4+, Data cable, & 4G MultiTech modern) <br />LIFENET Care Browser/LIFENBT Care App <br />LIFENET Care Analytics <br />CODE-STAT Data Reviewer (requires software install) <br />LUCAS with Wi-FI connectivity (LUCAS SUrnrnary Report transmission receipt) <br />These accessories are not included in the standard LP35 evaluation package. Please select from the below options if these are needed for your evaluation. [Z] MVA -Oral/nasal Filter Line, Adult (Box of 25)[Z] 15-Lead Patient Simulator <br />[Z] MVAI -Intubated Filter Line, Adult/Ped (Box of 25) <br />[Z] NIBP Assorted Cuff Sizes (Infant, Ped, Small & XL Adult) <br />[Z] IJFEPAK Invasive Pressure Adapter Cable, 2.44 m (8 ft), ICU <br />(Packages default to Edwards unless otherwise noted} <br />[Z] Temperature Probes (Qty 10) <br />[Z] LNCS-II Reusable Rainbow Sensor <br />LIFENET agreement: IZI By checking this box you agree to the terms of the attached LIFENET System evaluation agreement. <br />By signing below, you agree to the following terms: <br />I acknowledge that Stryker is loaning the above-referenced equipment to me for a temporary period of time. I agree to return the equipment <br />within the time period(*) designated below, after a request to return is received. I agree to to return the equipment in the same condition and in the <br />same packaging as it was provided to me. I agree to assume full responsibility for the equipment including, but not limited to, full responsibility <br />for any and all loss, theft or damage (excepting normal wear and tear) to the equipment during the term of this agreement. If I fail to return the <br />equipment, I acknowledge that this agreement shall constitute a Purchase Order and that I will be invoiced at prices at https://www.savvik.com/ <br />wp-content/uploads/2024.02.SAVVIK.PRICE-LIST.EFF-Feb-1-2024-v4-valued-1.pdf. I agree to pay said invoice within 30 days of receipt thereof <br />or be subject to all late payment or interest charges permitted by law. (*) Sales Evaluation loaned units shall not exceed a term of 90 days. <br />Received By: <br />Signature: Date: <br />*In the Field Transfer: <br />Serviced By: <br />Signature: Date: <br />Print Name: <br />Stryker or its affiliated entities own, use , or have applied for the following trademarks or service marks: EDGE System, LIFENET, OUIK-COMBO, Stryker. Masimo, the Radical logo, <br />Rainbow and SET are registered trademarks of Masi.mo Corporation. All other i:rademarks are i:rademarks of their respective owners or holders. <br />EC-GSNPS-FORM-1149258_REV-0_en_us@ 2024 Stryker <br />Cassie Franklin, Mayor <br />08/21/2024