Purchase Order Ophthalmologist in United States Houston –Free Word Template Download with AI
Memorial Ophthalmology Group, LLC
4820 Westheimer Road, Suite 310, Houston, Texas 77056, United States
Phone: (713) 555-0142 | Fax: (713) 555-0143 | Email: [email protected]
Tax ID (EIN): 74-2839156 | Texas Medical Board License: OPH-2019-44821
VENDOR / SUPPLIER INFORMATION| Vendor Name: VisionTech Medical Supply Co. | Vendor Contact: Dr. Alan Reeves, Procurement Manager |
| Address: 2200 Medical Center Drive, Houston, Texas 77030, United States | Phone / Email: (713) 555-0298 / [email protected] |
| Vendor Tax ID: 82-4471903 | Account Rep: Ms. Linda Tran, Senior Account Executive |
| Authorized Ophthalmologist: Dr. Sarah M. Caldwell, MD, FACS | Department: Comprehensive Ophthalmology & Retina Services |
| Facility: Memorial Ophthalmology Group – Houston Main Campus | Location: 4820 Westheimer Rd, Suite 310, Houston, TX 77056, United States |
| Receiving Contact: James Okafor, Facilities & Equipment Coordinator | Phone: (713) 555-0167 |
| # | Description | Item / SKU | Qty | Unit Price (USD) | Extended Price (USD) |
|---|---|---|---|---|---|
| 1 | Topcon TRC-NW7S Fundus Camera – Ophthalmologist diagnostic imaging system for retinal examination, including calibration and on-site installation at Houston facility | TC-TRCNW7S-2025 | 1 | $42,500.00 | $42,500.00 |
| 2 | Zeiss IOLMaster 700 Biometer – Optical coherence tomography device for intraocular lens power calculation, required by the Ophthalmologist for cataract surgery planning | ZS-IOLM700-25 | 1 | $38,750.00 | $38,750.00 |
| 3 | Alcon Centurion X1 Phacoemulsification System – Complete surgical unit with handpiece, foot pedal, and console for the Ophthalmologist's anterior segment surgical suite | AC-CENTX1-2025 | 1 | $67,200.00 | $67,200.00 |
| 4 | Disposable Phacoemulsification Tips (Pack of 100) – Single-use sterile tips compatible with Alcon Centurion system, 12-month supply for the Houston practice | AC-PHACO-TIP-100 | 12 | $1,850.00 | $22,200.00 |
| 5 | Topcon AutoRef RA-1000 Auto Refractor / Keratometer – For patient intake and refraction by the Ophthalmologist and optometric staff | TC-RA1000-25 | 2 | $14,300.00 | $28,600.00 |
| 6 | Annual Preventive Maintenance & Calibration Service Agreement – Covers all ophthalmic diagnostic and surgical equipment installed at the Houston, United States facility; includes 24/7 emergency response | VT-PM-AGREEMENT-25 | 1 | $12,400.00 | $12,400.00 |
| 7 | Continuing Medical Education (CME) Conference Sponsorship – American Academy of Ophthalmology Annual Meeting, 2025; allocated for the Ophthalmologist's professional development and peer networking | AAO-CME-2025-HOU | 1 | $5,800.00 | $5,800.00 |
| 8 | Custom Patient Education Display – 55-inch 4K medical-grade monitor with ophthalmology-specific software for the Ophthalmologist to demonstrate retinal conditions and surgical outcomes to patients in the Houston waiting area | VT-ED-55K-25 | 3 | $3,200.00 | $9,600.00 |
| Subtotal | $227,050.00 | ||||
| Texas Sales Tax (8.25%) | $18,731.63 | ||||
| Freight & Installation (Houston, TX) | $4,350.00 | ||||
| TOTAL PURCHASE ORDER AMOUNT (USD) | $250,131.63 | ||||
- This Purchase Order constitutes a binding agreement between Memorial Ophthalmology Group, LLC (hereinafter "Buyer") and VisionTech Medical Supply Co. (hereinafter "Vendor") for the procurement of ophthalmic equipment, consumable supplies, and professional services as itemized above. All transactions are governed by the commercial laws of the State of Texas and the federal regulations of the United States.
- The Ophthalmologist designated on this Purchase Order, Dr. Sarah M. Caldwell, MD, FACS, shall serve as the primary clinical authority for acceptance of all surgical and diagnostic equipment. No equipment shall be considered "delivered and accepted" until the Ophthalmologist has personally inspected, tested, and signed the equipment acceptance form in the presence of the Vendor's installation technician at the Houston, United States facility.
- All items listed in this Purchase Order must be shipped to the Buyer's facility located in Houston, Texas, United States. The Vendor is responsible for all packaging, crating, insurance, and freight charges until the equipment is physically installed and operational at the designated Houston address. Title and risk of loss transfer to the Buyer only upon written acceptance by the Ophthalmologist.
- Payment shall be made via ACH transfer to the Vendor's designated bank account within thirty (30) calendar days of the date of the Vendor's invoice, provided that all items have been accepted in accordance with Section 2. Late payments shall accrue interest at a rate of 1.5% per month, in compliance with Texas Business & Commerce Code Chapter 2412.
- The Vendor warrants that all equipment supplied under this Purchase Order is new, unused, and free from defects in materials and workmanship. The warranty period shall be a minimum of twenty-four (24) months from the date of acceptance by the Ophthalmologist. The annual maintenance agreement (Line Item 6) shall commence upon the expiration of the manufacturer's warranty.
- All ophthalmic devices and surgical instruments procured under this Purchase Order must comply with the Food and Drug Administration (FDA) regulations of the United States, including 21 CFR Part 820 (Quality System Regulation) and applicable 510(k) clearance requirements. The Vendor shall provide all FDA registration numbers, CE markings (where applicable), and device listing documentation prior to delivery in Houston.
- The Vendor acknowledges that the Ophthalmologist and all clinical staff at the Houston facility are subject to the Health Insurance Portability and Accountability Act (HIPAA) and Texas Medical Practice Act. Any training materials, software, or documentation accompanying the equipment must not contain or request access to protected health information (PHI) without a valid Business Associate Agreement (BAA) executed between the parties.
- In the event of a dispute arising from this Purchase Order, both parties agree to first attempt resolution through good-faith negotiation. If unresolved within thirty (30) days, the dispute shall be submitted to binding arbitration in Houston, Texas, United States, under the rules of the American Arbitration Association (AAA). The prevailing party shall be entitled to recover reasonable attorney's fees and costs.
- This Purchase Order may not be modified, amended, or supplemented except by a written addendum signed by both the authorized Ophthalmologist (or their designated delegate) and an authorized officer of the Vendor. Verbal agreements or email communications shall not constitute a valid modification of this document.
- The Vendor shall maintain adequate professional liability and product liability insurance, with a minimum coverage of $5,000,000 per occurrence, naming Memorial Ophthalmology Group, LLC as an additional insured. Certificates of insurance must be provided to the Buyer's risk management office in Houston prior to the first delivery.
For the Buyer – Memorial Ophthalmology Group, LLC
Authorized Ophthalmologist / Medical Director
Dr. Sarah M. Caldwell, MD, FACSSignature: ______________________________
Date: ______________________________
For the Vendor – VisionTech Medical Supply Co.
Authorized Representative
Dr. Alan Reeves, Procurement ManagerSignature: ______________________________
Date: ______________________________ ⬇️ Download as DOCX Edit online as DOCX
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