Intermed-Pal Service Order

Phone: 972-2-2409616
Fax: 972-2-2409790 Number: 16011
23 Atta Azier Street, Al-Bireh
Date: 4/14/2020
Ramallah, PL P.O.Box 2454

Account No. 39 ID: 324

AL-Razi Hospital Received: 11:33AM on 4/14/2020
ZAKAT FUND COMMITTEE
P.O. BOX 100
JENIN, Palestine
Account Phone: 042502653 Main
ENG. FO'AD ABU ZAID Service Zone: North

Desc.: PM CT 128 4/2020 Priority: Preventive Mainten Status: New Taken By: Samah I. Nakhleh
Type: Preventive Mainten Payment: Cash Assigned To: Suliman Abadi
Directions: Razi Hospital
Fingerprint: DC3C-F7BC
Name: Razi Hospital_IQVIEW_2.6_111229_SP_121229

Contract No. 116 CT 128 Basis: Time Period Time Remaining: -15 days
Note: This Contract has expired - the Expiration date has passed

Work Requested:

Record labor below Hours Record p art s used below Serial Number Quant it y

Date: ____/____/____

'To' Travel Time: ___________ Arrived at: __________ Departed at: __________ From' Travel Time: ___________

CUSTOMER SIGNATURE: __________________________________ TECH SIGNATURE: _____________________________

I hereby authorize the repair work hereinafter set forth to be done along with the necessary material and agree that you are not
responsible for any delays caused by unavailability of parts or delays in parts by the supplier o r t r a n s p o r t e r . I h e r e b y g r a n t y o u a n d / o r
your employees permission to operate the device herein described for the purpose of testing and/or inspection. I understand that I
have the right to know before authorizing my repairs what the repairs to device will be and what their costs will be. You need not
obtain approval from me prior to performing repairs .

serviceorder.rpt Printed: 4/15/2020 2:15:50AM Page 1