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Purchase Order Dentist in United States Houston –Free Word Template Download with AI

Bayou City Dental Group, PLLC

4820 Westheimer Road, Suite 310, Houston, Texas 77056, United States

Phone: (713) 555-0142 | Fax: (713) 555-0143 | Email: [email protected]

Tax ID (EIN): 74-2839105 | Texas Dental Board License: TXD-2019-44871

PO No. BCD-2025-00472

Date of Issue: June 12, 2025 | Required Delivery Date: July 15, 2025

Vendor / Supplier

Gulf Coast Dental Supply Co.

2200 Industrial Boulevard, Building C

Houston, Texas 77032, United States

Contact: Mr. Harold Jenkins, Procurement Manager

Phone: (713) 555-0298

Email: [email protected]

Vendor ID: GCD-88214

Order Details

Department: Clinical Operations – Dentist Practice

Requested By: Dr. Angela M. Torres, DDS, Lead Dentist

Approved By: Mr. Robert C. Whitfield, Practice Administrator

Payment Terms: Net 30 Days

Shipping Address: Bayou City Dental Group, PLLC, 4820 Westheimer Road, Suite 310, Houston, TX 77056, United States

Incoterms: DDP (Delivered Duty Paid) – Houston, TX

Line Items – Dental Equipment and Consumables for Dentist Practice in Houston, United States

Item # Description SKU / Catalog Ref Qty Unit Price (USD) Extended Price (USD)
1 Digital Intraoral Camera System – 5MP Resolution, for Dentist diagnostic imaging in Houston clinic DIC-5MP-2025 2 $3,850.00 $7,700.00
2 Composite Resin Restorative Material, Universal Shade Kit (24 shades), 10g syringes – for Dentist restorative procedures CR-UNIV-24 12 $185.00 $2,220.00
3 Autoclave Sterilizer, 24L Capacity, Class B – for Dentist instrument sterilization per CDC guidelines AC-24L-B 1 $4,200.00 $4,200.00
4 Nitrile Examination Gloves, Powder-Free, Medium, Box of 100 – for Dentist patient care in Houston practice NG-MED-100 200 $8.50 $1,700.00
5 High-Speed Handpiece with Turbine, 4:1 Reduction – for Dentist operative dentistry HS-41-TURB 3 $1,120.00 $3,360.00
6 LED Curing Light, 1200 mW/cm², Cordless – for Dentist photopolymerization of composite materials CL-1200-C 4 $475.00 $1,900.00
7 Patient Dental Chair, Hydraulic, with Integrated Suction and Light – for Dentist operatory in Houston, TX DC-HYD-PRO 1 $12,500.00 $12,500.00
8 Sodium Hypochlorite 5.25%, 1 Gallon – for Dentist endodontic irrigation SH-525-1G 50 $14.75 $737.50
9 Dental Impression Material, Polyvinyl Siloxane (PVS), Heavy Body, 340g Cartridge – for Dentist prosthodontic work PVS-HB-340 60 $22.00 $1,320.00
10 Lead Apron, Full Body, 0.5 mm Pb Equivalent – for Dentist radiographic protection per FDA standards LA-FB-05 2 $310.00 $620.00
Subtotal $36,257.50
Texas Sales Tax (8.25% – Houston, TX) $2,991.24
Freight & Delivery (Houston, United States) $485.00
Installation & Calibration Fee (Dental Chair & Autoclave) $1,200.00
Grand Total (USD) $40,933.74

Terms and Conditions – Purchase Order for Dentist Practice, Houston, United States

  1. Acceptance: This Purchase Order constitutes a binding agreement between Bayou City Dental Group, PLLC (hereinafter "the Dentist practice") and Gulf Coast Dental Supply Co. (hereinafter "the Vendor") upon written acceptance by both parties. All goods and services described herein are intended for use in a licensed Dentist practice operating in Houston, Texas, United States.
  2. Delivery: The Vendor shall deliver all items listed in this Purchase Order to the Dentist practice facility located at 4820 Westheimer Road, Suite 310, Houston, Texas 77056, United States, no later than July 15, 2025. Delivery shall be made between the hours of 8:00 AM and 4:00 PM Central Time, Monday through Friday. The Vendor is responsible for all transportation costs within the Houston metropolitan area, United States.
  3. Quality and Compliance: All dental equipment and materials supplied under this Purchase Order must comply with the Food and Drug Administration (FDA) regulations, the Texas State Board of Dental Examiners standards, and all applicable United States federal and state health and safety codes. The Dentist practice reserves the right to reject any items that do not meet the specified quality standards or that are not properly labeled for use in a clinical dental setting in Houston, Texas.
  4. Payment: Payment of the full amount of $40,933.74 USD shall be made within thirty (30) calendar days of the date of receipt and acceptance of all goods. Payment shall be made via ACH transfer to the Vendor's designated bank account in the United States. Late payments shall accrue interest at a rate of 1.5% per month.
  5. Warranty: The Vendor warrants that all equipment and materials furnished under this Purchase Order are new, free from defects in material and workmanship, and fit for their intended use in a Dentist practice. The standard manufacturer's warranty shall apply, with a minimum of two (2) years for capital equipment (dental chair, autoclave, handpieces) and twelve (12) months for consumable items. The Dentist practice in Houston, United States, shall be provided with full warranty service and replacement parts at no additional cost during the warranty period.
  6. Installation and Training: The Vendor shall provide on-site installation of the dental chair, autoclave sterilizer, and digital imaging systems at the Dentist practice location in Houston, Texas. The Vendor shall also provide a minimum of four (4) hours of hands-on training for the Dentist staff, including Dr. Torres and two dental hygienists, on the proper operation, maintenance, and safety protocols of all installed equipment.
  7. Regulatory Compliance – Houston, United States: The Vendor acknowledges that the Dentist practice operates under the jurisdiction of the Texas State Board of Dental Examiners and the Harris County Department of Health in Houston, United States. All supplied items must carry appropriate FDA 510(k) clearance or PMA approval where applicable. The Vendor shall provide all necessary documentation, including certificates of analysis, material safety data sheets (MSDS/SDS), and compliance certifications, at the time of delivery.
  8. Insurance and Liability: The Vendor shall maintain commercial general liability insurance with a minimum coverage of $2,000,000 per occurrence and $5,000,000 aggregate, as well as product liability insurance, throughout the term of this Purchase Order. The Vendor shall indemnify and hold harmless the Dentist practice, its officers, employees, and patients from any claims arising from defective products or negligent delivery within the Houston, United States, service area.
  9. Force Majeure: Neither party shall be liable for failure to perform obligations under this Purchase Order due to causes beyond reasonable control, including but not limited to natural disasters (including hurricanes common to the Houston, Texas, United States, region), acts of government, or supply chain disruptions. The affected party shall notify the other in writing within forty-eight (48) hours of the occurrence.
  10. Governing Law: This Purchase Order shall be governed by and construed in accordance with the laws of the State of Texas, United States, without regard to its conflict of law principles. Any disputes arising from this Purchase Order shall be resolved in the state or federal courts located in Harris County, Houston, Texas, United States.
  11. Confidentiality: Both parties agree to maintain the confidentiality of all proprietary information, pricing structures, and patient-related data exchanged in connection with this Purchase Order. The Dentist practice in Houston, United States, shall ensure that all vendor interactions comply with the Health Insurance Portability and Accountability Act (HIPAA) and the Texas Medical Records Privacy Act.

Authorized by – Dentist Practice (Buyer)

Bayou City Dental Group, PLLC

Dr. Angela M. Torres, DDS
Lead Dentist / Principal
Date: ______________________

Accepted by – Vendor (Supplier)

Gulf Coast Dental Supply Co.

Mr. Harold Jenkins
Procurement Manager
Date: ______________________

This Purchase Order (PO No. BCD-2025-00472) was issued by Bayou City Dental Group, PLLC, a licensed Dentist practice in Houston, Texas, United States. This document is valid for a period of sixty (60) days from the date of issue. All communications regarding this Purchase Order should be directed to the procurement office at the Houston, United States, address listed above. This document is printed on recycled paper in accordance with the practice's environmental sustainability policy for the Houston, Texas, United States, community.

© 2025 Bayou City Dental Group, PLLC – All Rights Reserved. Houston, Texas, United States.

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