RBV-004OmniPOD

Attention: Application Examiner Reviewing Engineer Intertek Testing Services Re: Request for Confidentiality Under 47 CFR § 0.457(d) and/or § 0.459 in Applicant, Insulet Corporation’s Application for Equipment Certification FCC ID: RBV-004 Dear Sir or Madam: Insulet Corporation hereby requests that the materials and information specified below in the above-referenced Application for Equipment Certification be withheld from public inspection. . This request for confidentiality is made pursuant to 47 C.F.R. § 0.457(d) and/or § 0.459. 47 CFR § 0.459(a): A copy of this request is attached to and covers all of the materials and information to which it applies, which materials and information are physically separate from any materials and information in the application to which the request does not apply. The materials and information to be kept confidential include, without limitation: • All Schematics • All Block Diagrams. • All Operational and/or Functional Design Descriptions • All Internal Photos (the device is sealed and disassembly would destroy the product) 47 CFR § 0.459(b): Insulet Corporation requests that the above-referenced materials and information be withheld from public inspection for at least the reasons set forth below. 47 CFR § 0.459(b)(1): The specific materials and information for which confidential treatment is sought is set forth above. All such materials and information are physically separate from any materials and information in the application to which the request does not apply. A copy of this request is attached to the materials and information covered by this request. 47 CFR § 0.459(b)(2): This request is made in connection with the above-referenced Application for Equipment Certification, FCC ID: RBV-004 . 47 CFR § 0.459(b)(3): The materials and information to which this request applies contain Insulet Corporation proprietary and confidential information, which information constitutes substantial Insulet Corporation trade secrets. 47 CFR § 0.459(b)(4): The materials and information to which this request applies do not concern a service. Formatted: Bullets and Numbering Deleted: Federal Communications Commission Deleted: [Address] Deleted: 1, and FCC ID: RBV-002 Deleted: 1, RBV-002 47 CFR § 0.459(b)(5): Insulet Corporation has invested considerable resources to produce the product described in the above-referenced application and to develop the trade secret information included in the materials and information covered by this request. Disclosure of those materials and information would reveal Insulet Corporation trade secrets and give competitors unfair commercial advantage in developing similar products. 47 CFR § 0.459(b)(6): Insulet Corporation has maintained the confidentiality of the trade secret information contained in the materials covered by this request by taking the customary measures for protecting proprietary and confidential trade secret information. 47 CFR § 0.459(b)(7): To the best of Insulet Corporation’s knowledge, the information contained in the materials covered by this request have not been made publicly available and have been disclosed to third parties only subject to non-disclosure agreements. 47 CFR § 0.459(b)(8): Insulet Corporation requests that the information formation contained in the materials covered by this request should not be available for public disclosure indefinitely as long as such information remains Insulet Corporation trade secrets or, in the alternative, as long as permitted under the relevant laws and regulations. If additional information or explanation is required to grant this request, please contact the undersigned. Sincerely, Mohsen Moghaddami Project Director, Electrical Engineering Insulet Corporation Deleted: Manager

Attention: Application Examiner Reviewing Engineer Intertek Testing Services Re: Request for placing the FCC ID number “FCC ID: RBV-004” on the packaging box of the device instead of the device itself, Insulet Corporation’s Application for Equipment Certification FCC ID: RBV-004 Dear Sir or Madam: Insulet Corporation hereby requests that the FCC ID label “FCC ID: RBV-004” be placed on the packaging box of the device due to the size and the nature off its application. This request is made pursuant to 47 C.F.R. § 15.19 paragraph (b)(3). Following are justification for placing the FCC ID label on the device-packaging box. • This is a disposable device with usage life of 3 days. • Each device is individually packaged. • The device is sterilized and can only be removed from the packaging box at the time of use (application). If additional information or explanation is required to grant this request, please contact the undersigned. Sincerely, Mohsen Moghaddami Project Director, Electrical Engineering Insulet Corporation Formatted Deleted: Federal Communications Commission Deleted: [Address] Deleted: Confidentiality Under 47 CFR § 0.457(d) and/or § 0.459 in Applicant Deleted: ¶ Deleted: 1, and FCC ID: RBV-002 Deleted: materials and information specified below in the above- referenced Application for Equipment Certification be withheld from public inspection. . This request for confidentiality is made pursuant to 47 C.F.R. § 0.457(d) and/or § 0.459.¶ ¶ 47 CFR § 0.459(a): A copy of this request is attached to and covers all of the materials and information to which it applies, which materials and information are physically separate from any materials and information in the application to which the request does not apply. The materials and information to be kept confidential include, without limitation:¶ Deleted: All Schematics Deleted: All Block Diagrams. Deleted: All Operational and/or Functional Design Descriptions Deleted: All Internal Photos 47 CFR § 0.459(b): Insulet Corporation requests that the above-referenced materials and information be withheld from public inspection for at least the reasons set forth below.¶ ¶ 47 CFR § 0.459(b)(1): The specific materials and information for which confidential treatment is sought is set forth above. All such materials and information are physically separate from any materials and information in the application to which the request does not apply. A copy of this request is attached to the materials and information covered by this request.¶ ¶ 47 CFR § 0.459(b)(2): This request is made in connection with the above- referenced Application for Equipment Certification, FCC ID: RBV-001, RBV- 002.¶ ¶ 47 CFR § 0.459(b)(3): The materials and information to which this request applies contain Insulet Corporation proprietary and confidential information, which information constitutes substantial Insulet Deleted: Manager ... [1] Page 1: [1] Deleted mmoghaddami 5/13/2005 10:35:00 AM All Internal Photos 47 CFR § 0.459(b): Insulet Corporation requests that the above-referenced materials and information be withheld from public inspection for at least the reasons set forth below. 47 CFR § 0.459(b)(1): The specific materials and information for which confidential treatment is sought is set forth above. All such materials and information are physically separate from any materials and information in the application to which the request does not apply. A copy of this request is attached to the materials and information covered by this request. 47 CFR § 0.459(b)(2): This request is made in connection with the above-referenced Application for Equipment Certification, FCC ID: RBV-001, RBV-002. 47 CFR § 0.459(b)(3): The materials and information to which this request applies contain Insulet Corporation proprietary and confidential information, which information constitutes substantial Insulet Corporation trade secrets. 47 CFR § 0.459(b)(4): The materials and information to which this request applies do not concern a service. 47 CFR § 0.459(b)(5): Insulet Corporation has invested considerable resources to produce the product described in the above-referenced application and to develop the trade secret information included in the materials and information covered by this request. Disclosure of those materials and information would reveal Insulet Corporation trade secrets and give competitors unfair commercial advantage in developing similar products. 47 CFR § 0.459(b)(6): Insulet Corporation has maintained the confidentiality of the trade secret information contained in the materials covered by this request by taking the customary measures for protecting proprietary and confidential trade secret information. 47 CFR § 0.459(b)(7): To the best of Insulet Corporation’s knowledge, the information contained in the materials covered by this request have not been made publicly available and have been disclosed to third parties only subject to non-disclosure agreements. 47 CFR § 0.459(b)(8): Insulet Corporation requests that the information formation contained in the materials covered by this request should not be available for public disclosure indefinitely as long as such information remains Insulet Corporation trade secrets or, in the alternative, as long as permitted under the relevant laws and regulations.

From: Roland Gubisch ES-Box Sent: Monday, May 09, 2005 4:39 PM To: 'Mohsen Moghaddami'; Terre Wolak ES-Atl; Jeff Goulet ES-Box; Nicholas Abbondante ES-Box; Danielle Fontaine ES-Box Subject: FCC Certification, FCC ID RBV-003 and FCC ID: RBV-004 Dear Mohsen, Review is complete on these two applications, and the following points are noted: FCC ID: RBV-003 ADMINISTRATIVE 1) No FCC ID number is shown anywhere on the device, nor in any separate exhibit. The FCC ID should appear on the label shown in photo DSC06787. The FCC requires that both the FCC ID and its location on the device be depicted in photos or drawings. 2) Only one side of the printed circuit board is shown, in photo DSCNO235. The FCC requires that photos of both sides of every PCB be provided. Please provide a photo of the opposite side of the PCB. TECHNICAL No comments. FCC ID: RBV-004 ADMINISTRATIVE 1) 1) No FCC ID number is shown anywhere on the device, nor in any separate exhibit. The FCC requires that both the FCC ID and its location on the device be depicted in photos or drawings. If an FCC ID will not be provided, this must be sufficiently justified. Please note that the FCC requests FCC ID labeling even for implantable devices. 2) Both sides of the printed circuit board are partially obscured in the photos provided. Please provide photos on the PCB with the device sufficiently disassembled so that all parts of both sides of the PCB are visible. TECHNICAL No comments Certification can proceed as soon as these points are addressed. Thank you, Sincerely, Roland Gubisch Intertek -----Original Message----- From: Mohsen Moghaddami [mailto:[email protected]] Sent: Monday, May 09, 2005 2:15 PM To: Terre Wolak ES-Atl; Roland Gubisch ES-Box; Jeff Goulet ES-Box; Nicholas Abbondante ES-Box; Danielle Fontaine ES-Box Subject: FCC Certification Terre, Can you give me an update on the FCC certification of RBV-003, RBV-004. Mohsen

1.0 Job Description 1.1 Client Information This EUT has been tested at the request of: Company: Insulet Corporation Contact: Mohsen Moghaddami Telephone: Fax: Email: 781-457-5000 781-457-5011 [email protected] 1.2 Equipment Under Test Equipment Type: Insulin Management System Model Number(s): OmniPod Serial number(s): PDM: See Individual Tests POD: See Individual Tests Manufacturer: Insulet Corporation EUT receive date: 2/16/2005 EUT received condition: Good Test start date: 2/16/2005 Test end date: 2/25/2005 1.3 Test Plan Reference: Tested according to the standards listed 1.4 Test Configuration 1.4.1. Cables: There are no cables associated with this device 1.4.2. Support Equipment: Name: Model No.: Serial No.: There is no support equipment. The POD and PDM are subcomponents of the OmniPod system and interact with each other. EMI Report for Insulet Corporation on the Model: OmniPod Report Number 3072605.EMI.FCCC Page 2 of 7 EMI Report for Insulet Corporation on the Model: OmniPod Report Number 3072605.EMI.FCCC Page 3 of 7 2.0 Test Summary TEST STANDARD RESULTS FCC CFR47 Part 15 Subpart C Section 15.225 SUB-TEST TEST PARAMETER COMMENT Radiated Emissions and RF Output Power Emissions below specified limits Pass Frequency Stability Transmit frequency must not deviate by more than 0.01% across the temperature range from – 20 to +50 celsius while powered from a fresh battery Pass Radiated emissions setup photos EMI Report for Insulet Corporation on the Model: OmniPod Report Number 3072605.EMI.FCCC Page 5 of 7 EMI Report for Insulet Corporation on the Model: OmniPod Report Number 3072605.EMI.FCCC Page 7 of 7 Emissions Site Description: Site 2C (Middle Site) is a 3m and 10m sheltered emissions measurement range located in a light commercial environment in Boxborough, Massachusetts. It meets the technical requirements of ANSI C63.4-1992 and CISPR 22:1993/EN 55022:1994 for radiated and conducted emission measurements. The shelter structure is entirely fiberglass and plastic, with outside dimensions of 33 ft x 57 ft. The structure resembles a quonset hut with a center ceiling height of 16.5 ft. The testing floor is covered by a galvanized sheet metal ground plane that is earth-grounded via copper rods around the perimeter of the site. The joints between individual metal sheets are bridged with a 2 inch wide metal strips to provide low RF impedance contact throughout. The sheets are screwed in place with stainless steel, round-head screws every three inches. Site illumination and HVAC are provided from beneath the ground reference plane through flush entry ports, the port covers are electrically bonded to the ground plane. A flush metal turntable with 12 ft. diameter and 5000 lb. load capacity is provided for floor-standing equipment. A wooden table 80 cm high is used for tabletop equipment. The turntable is electrically connected to the ground plane with three copper straps. The straps are connected to the turntable at the center of it with ground braid. The copper strap is directly connected to the ground plane at the edges of the turntable. The turntable is located on the south end of the structure and the antennas are mounted 3 and 10 meters away to the north. The antenna mast is a non-conductive with remote control of antenna height and polarization. The antenna height is adjustable from 1 to 4 meters. All final radiated emission measurements are performed with the testing personnel and measurement equipment located below the ground reference plane. The site has a full basement underneath the turntable where support equipment may be remotely located. Operation of the antenna, turntable and equipment under test is controlled by remote controls that manipulate the antenna height and polarization and with a turntable control. Test personnel are located below the ellipse when measurements are performed, however the site maintains the ability of having personnel manipulate cables while monitoring test equipment. Ambient radiated emissions are 6 dB or more below the relevant FCC emission limits. AC mains power is brought to the equipment under test through a power line filter, to remove ambient conducted noise. 50 Hz (240 VAC single phase), 60 Hz power (120 VAC single phase, 208 VAC three phase), and 60 Hz (480 VAC three phase) are available. Conducted emission measurements are performed with a Line Impedance Stabilization Network (LISN) or Artificial Mains Network (AMN) bonded to the ground reference plane. A removable vertical ground plane (2 meter X 2 meter area) is used for line- conducted measurements for tabletop equipment. The vertical ground plane is electrically connected to the reference ground plane. Parking Lot – Magnetic field emissions testing below 30 MHz is performed in the asphalt parking lot located next to site 2. There is no ground plane. Measurement Uncertainty: Note that the measurement uncertainty contained herein is ±4.0 dB for radiated emissions and ±2.0 dB for line-conducted emissions.

Radiated emissions setup photos