Vyaire Medical, Inc.

Field Service Technician Agreement Form

RAFAEL A RAMIREZ
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HARTFORD HOSPITAL
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HARTFORD CT USA
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9/13,9/14,9/15/2022
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METTAWA IL
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Ventilator or RDx Product, Brand/Model BELLAVISTA VENTILATOR

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As part of my authorization to service the Vyaire Medical, Inc. (“Vyaire”) Ventilator or Respiratory Diagnostics Product (“RDx
Product”) brand and model set forth above (the “Ventilator” or “RDx Product”), I agree to the following:

1. I agree to follow all instructions as provided in the most current revision of stated Ventilator or RDx Product Service Manual.

2. I agree to abide by and follow all service bulletins as periodically issued by Vyaire.

3. I agree to use only Vyaire authorized and recommended parts, sub-assemblies and accessories when servicing a Vyaire Ventilator
or RDx Product.

4. I agree to service only Vyaire Ventilators or RDx Products that my organization owns or have been delegated/assigned by a
governmental agency for homeland security or emergency preparedness programs and that I have been trained to service unless I
obtain advance written permission from Vyaire to do otherwise.

5. I agree to not instruct or train other personnel on service and testing procedures for the Ventilator or RDx Product and related
accessories.

6. I agree to acquire/provide proper documentation, including return authorization numbers, reason for return, problem
resolution, parts replaced with proper lot numbers, and all other information required by Vyaire on its field service records and
field update forms or as otherwise requested by Vyaire. I agree to provide such information to Vyaire within seven (7) days
following service completion.

7. I will not represent to anyone that I am an agent, employee or authorized representative of Vyaire or any of its affiliates or
subsidiaries or that any of the services I provide are provided on behalf of, or otherwise in connection with, any warranty
provided by Vyaire.

8. I agree that if I do not abide by any of the above I will be subject to de-certification and I will no longer be able to purchase
service and repair parts from Vyaire or its authorized distributors.

Digitally signed by RAFAEL A RAMIREZ

RAFAEL A RAMIREZ Date: 2022.09.07 12:37:18 -04'00'
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Date: 9/10/2022
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