HomeMy WebLinkAbout2012-042 Agrmt - Associated Business Systems . ABS APPLICATION NO. CONTRACT N0.
QUICKLEASE AGREEMENT
This document Is written in"Plain English". The words you and your refer to the customer. The words we,us and our refer to ASS Finance.
• DESCRIPTION MODEL • SERIAL NO.
1 New Ricoh Digital Wide Format Product MP W3601
d
CREDIT • - •
LEGAL NAME OF BUSINESS ADDRESS
City of Ashland 20 East Main Street
CITY STATE ZIP PHONE
Ashland OR 97520 541-488-5300
TYPE OF BUSINESS NUMBER OFYEARS IN BUSINESS E-MAILADDRESS
0 Corporation 0 Partnership 0 Pmpdetomhip
NAME OF PRINCIPAL SOCIAL SECURITYg PERCENTAGE OWNERSHIP OF BUSINESS
�a
HOMEADDRESS CITY STATE ZIP PHONE
PRESENT BANK ACCOUNTIP BANKCONTACT PHONE
TRADE REFERENCE 1 CITYISTATE PHONE
TRADE REFERENCE 2 CITYISTATE PHONE
LEASE TERM I -• • INSTALLATION
60 Monthly Payments of$ 196.69 $ 0 $ 0
(Plus Applicable Taxes) (Plus Applicable Taxes) (Plus Applcable Taxes)
END OF LEASE OPT IONS: You wID have the following options of the end or the original term,provided the Lease has not terminaled early and no event of default under the Lease
has
occompandiscona nW. 1.Purchase the Equipment forfhe Fair Market Value. 2.Renew the Lease perparegmph 1. 3.Refum Equipmentespmvldedfn Paragraphe.
LEASE ACCEPTANCE
THIS IS A NONCANCELABLEIIRREVOCABLE LEASE. y S LEASE CANNOT BE CANCELED OR TERMINATED.
Bysignhg be..you acknowledge and swept all terms entl conditions on the back ofthis agreement pared ha byauth_odm yourbanW de reframo.1,and Mantel Institutions brelease credit
hkrmalbn over
Me phone M ABS Finance. \
/��/�/.✓rd��/1-txLi f'D� y'�2f/i
/{C fd F>
GATED CUSTOMER ,SIGNATURE" TITLE
93-6002117
FEDERAL TAX I.D.9 PRINT NAME
DELIVERY
You understnW and agree that N Meewnlyvu ere not satisfied with the Equipment you shall only look to parsons o or an ABS Finance,euN ea the monufecWrer,hahler orcartier,and shall
not awed against
ASS Finance any claim or defense Mat you may bays with reference b Me equipment or do nstaliatlon. F.Mar,yo authorae ABS Fn to pry the suppler for the equpment and understand
that paynvnt shat
begin on the same date Mat you execute this agreement and shot be continuous thereafter per Me terms aftha o L J
/✓//r/a: wig
DATE OF DELNERY CUSTOMER NATURE TITLE
As addMonal Inducement car us to enter into Me Agreement,the undersigned Noul unwnditlon illy,Jointly and snerely,personally guarantees that you wilt make all payments and meet.1
obligations required
under this Agreement and any supplements fully and morally. You agree that we may make other arrangements Including comgmrvse or..Maur ant with You and you wahm e5 defenses and
notice of Mae.
changes and we lemon responsible for Me payment and obngaW ns of this Agreement. We do not have to notty you d you ere n defauh. If you default you will Immediately pay M accordance
WM Me defaud
hvW l n of the Agreement OR sums due under the terms of the Agreement and will par m a all the obligations of Me Agreement. If it to necessary for us to proceed legally to enforce
the romony,you expreesly
consent to Me WrhdlLWn of Me coud at out In Paragraph 15 and agree b pay et cosh,IncMdhg atiomays fees honed M enforcement of ON guareny. It Is not necessary for us to proceed
fast against you
befonenfoscingthbguareny. Byslgnngthhguarsnty,you auto rae m to obtain ae2l bureau npvona for credit and collection purposes.
PRINT NAME OF GUARANTOR SIGNATURE DATED
i
I.LEASE AGREEMENT:You agree W base Nom n the parrnl prgpery descried under 1TEM DESCRIPTION and r owned by supplements W this Muter Agreement ham tYn W rim sgntl by you anal n
Such Import,
era any upgrtlr,repammerts,repairs and addhom wherM W as'Equpmrrt')for bsinrs wrpoer only.You Agree to as of Me bens and cuwitims contained In this Agreement and"eupplemm,which
together era a
complete sbtemnt of our Agreement regemhg Me Rated equlpmmt(Agreement)row suparstles any wItl.coder Cr mbbwinB invoice. Tills Agreement my bs nodded an,by ended age.mnt aw net
by course of
mdomsnrm.You surreal n to Met In We Agreement serial numbers end other ldrfificafion about M Equlpnnt,or and are other OnvtM scmal msurs.Tine Agreement Incomes amld upon execution
by n and AN with on
,Me rent conannnmem data shown and AN continue from Me Mt day arms folwAng month air Me number of co mado.monllu down.The mrtnvAX be extendtl autpmencay for li mmsWe 12 morn term
unless you sew n
womennotlmbetween MIty(30)awninety(BO)tla.tea/ere Mee pool errytermofyaurinventWwahreormWm Meequipmnt ANDcomplele MepuahaseorreWmWth Mdaysoftheewofrem Le mwith Sf.WWrhm.
options All not W renewed THE BASE RENTAL PAYMENT SHALL BE ADJUSTED PROPORTIONATELY UPWARD OR DOWNWARD,IF THE ACTUAL COST OF TICE EQUIPMENT EXCEEOS OR IS LESS THAN THE
ESTIMATE PRWIMD TO LESSEE. If any provision of this Agreement is declared unenmroeeble In any pritlation,the other prwblon herein shall mmeln In full tom and effect In that putlimon
and all OMam.You inhotae nto
Inset or coned miring Nsrmlion on this lease InGUding your propr legal name,serial marine and any other numbers describing me EgWmont.You Bgrer to prwWe Umettl annual OW/Or quarto*firncbl
sbtemnts W us
upon toque t.
2.RENT:Rent AN be payable in inctalanem,each N Me amount alms thank,rental payment shown plus any applicable sales,use or paper", Itwa pay aM to on your behan,you agree m mimbume
n pmmpty ate W Ath e
pcoeesing be.You will pay Me security depnit on me dew you sign this Agreement.Subsequent InabllmenlywlR be Payable an me first day al arch rental Payment prod shown baglnnLM
after me first morel payment petod or n
IMmbeagreed.We WllhwethedgMWapyatisumr NWfmmWubaMamuntsdusa owedWmunderthelemaa/this ABmment
3.COMPUTER SOFTWARE:Nmwhtoaing any othemerm eW coMloms of Me Agreemnt you agree Ne[n b wftwara onM e)We M1we rot M1tl,W tic M1we,rerwlti M1oe my mIe b aucM1 solMrem,b)You M1we
macuttl Or
MR.repo%a Gaye We conwm I hda gmmnt W we are not s Path to and M1we m respmoWilr whatsoever In lesions to such Irrms ignorant,d You hoe wMM such scro are and as par Agreement
prm,mph 5,
WE MAKE NO WARRANTIES OF MERCHANTABILITY FOR FITNESS FOR USE AND TAKE ABSOLUTELY NO RESPONSIBILITY FOR THE FUNCTION OR DEFECTIVE NATURE OF SUCH SOFTWARE
a.OWTERSNP OF EWIPMENT:Wes m be owner dMa eqWprent era M1we pale We W Me eqWpmm(udadrg rMaro).Ya agree W keep Me egWpmnt Nee eW char of ell Iw eW cMha.
5.WARRANY DISCLALMER:WE MAKE NO WARRANTY EXPRESS OR IMPLIED,INCLUDING THATTHE EQUIPMENT IS FR FOR A PARRCIRAR PURPOSE OR THAT THE EQUIPMENT IS MERCHANTABLE YOU AGREE
THATYOU HAVE SELECTED EACH ITEM OF EQUIPMENT BASED UPON YOUR CWNJLIIX:MENT AM)DISCINMANY RELIANCE UPON ANY STATEMENTS OR REPRESENTATIONS MADE BY US,
B. LOCATIONOFEQUIPMENT:YoupailkrpeWUr Maequpmentmlyetyouraddmmsha aboveaWyou AgreenMWaweItunlessweaimmIL Nine ew of Ne AgreamnCS term,you wi0 ramm Me Equlprenl toe
bmtlan we.Pady.tyagr eaPane,m repo mab.ble rmasaan,funwowre Omar,am N mrmlem revdr.
i.LOSS OR DAMAGE:Yaumraswrmlbb air Me risk of Maorbr mYtlesWCtlon dortlamge tO Ma equlpmrt No such ter or damage alone you Mmme payment obligation under this Agreement.YM.WrrmpwrM
notly n InA irgO/ew Ions ordamm and Pauwill Men panto us the Presentvalue of Me total ofm unpaid Jena psymmsu forthe con Jere ten Asa Me estimated lelrmarketvalue order Equipment
arms end ofthee originally
sameal term,all discounted at six percent(6%)Par year.My Proceeds of Inumnce will be paid tan and created,at our option,maim any was msamge.
0.COLLATERAL PROTECTION AND INSURANCE:You agree to amptheequlpmintmllyhodul eBonst ms mUe as has Ms.In an mount nor ter Manroplammentonl until this Agreements terminated.YouaMagme
to Obtaln a general puMc EBNBty insurer policy from anyone who b acceptable to n aid to Include was an Insured on the pop i.You agree to provide us moromres or other evidence
of lama.amsamble to us,before this
Agreement that w,at our sole discretion we may either,1)we may Obbin Insurance and you AN pay us for any lummnm Premium and related charges on which we my make a profit OR 2)we
my wave Me Insumae
requirement end chi you a ninthly damage surMage of up to.0035 of me Equipment trot and an which we also may make a profit NOTHING IN THIS PARAGRAPH WILL RELIEVE YOU OF YOUR RESPONSIBILITY
FOR
UABIUTY INSURANCE COVERAGE ON THIS EQUIPMENT.
g.INDEMNITY: We em not responsible for any ter or Inludes tours by Me Installation or use of Me equipment.You Agree to hold as hi muess and immune us ter ter and to defend n against
any calm Inv Mar or injury
mntl by Me Equlprm.
10.TAXES MID FEES:You agar to pay Anor iwotcetl as taxes onchul wrsarol Prow*tea,Bred and Pareses)row ten relating W Cos Agreement or Me Equipment.You prod W(a)mMwuWa n county
for e1 Madval
W rMmeMwu WrmWreyma prynO.W= WEquptnm orto emitmneacM1 mwdh ar estlmM dine mnMly puHabnt olM meal papa*MrWbe aarstl.We wiO fileel wrrcrel paw M.hYoulimor
W ramm ew you Agrro W pay n e paws M for mldrg eucM1 81rrp.In tldtim you Agree to WY n e UCC NAg M al S?.5.00 spa reirnburse n air ell mob InrvoNtl N dacurtowag ew revieag Mb
Agreement Yau m tit
mar.m pay u 588.00 m the ectt ore fiat blea ndb tlue n en otglretlm lea.Wes mane iW tgM1UO Wge a foe open remyregan o(thb Agreeromt elNer by Iredeap,bryod or EesuL Any fee cM1agetl
uwer Uus Agroemenl
mry Makes aDaln nd§rouged W applicable and.
11.ASSIGNMENT:YOU HAYS NO RIGHT TO SELL,TRANSFER,ASSIGNOR SUBLEASE THE EQUIPMENT OR THIS AGREEMENT.We myceA mslpn,or irereler cob Poreemnl wnWutnaticr. Yen.,rmthelfwreeq,
mdm,or herferthb Agmemnt Me new aver Pam have the rote rights aW Waft Mows have now an x1g nor have t0 person any of our oblgatlons. Ym agree MM Me right W Me new mnerw U nd M
ubled to any
cldm,dlyerses orsM aM Mdyou my hwe agalrt m.
12. DEFAULT AND REMEDIES: III or any guarantor of your obligations:(a)fall to cob any Leese payment w1Wn 10 days ofwhen due,or(b)became warrant or comments bankruptcy or remfvarsmp
proceedings or have
such Prcoetlings commenced agdret you,or(a)terminate your substance by merger,co odde ton,sale of substantially dI your agent,Or(d)otherwise bre.h any wemny,covenant or provblon
Of this Lease,you will M In Milan,
Irony cot data payment b late,you agme to pay a late Chage oils%of the payment"tai Is We orif Iese the maximum charge allowed by law.Ifyou are war In tlObUn,we may realty your
security deposit and at our ewon,we
can bmJrte or mnrml this Agreement aW require and you P.(1)the unpad ballance of me Agreement(discounts at Set);(2)the mound of any purchase option and If none Is specified,20%6
of me atglrel equipment wt which
repesmre our anticipated residual value In the maWmant:(3)and maim the equipment to n to a damon designated by as We my reorvolMrest on any undid batance at the rare 08%perannum.Wemyaboreanyol
Me
mmtlles wdlable to n under Prticle 2A arms UNlom Comments)Code n evaded In the State of Corer or us Awlgnrl pr ndpat place of bWnee or any other Im. Ilm rebr cob Agreemnt m m
emomay ror collection,you
agree m Pay our reasonable mmneye for and must court comb. Ilws M1we to take pmsrdon d the equipment,you agree b Forms cast of mP nnlon.TM1e net procetls o/Ma nla of ao reponentl
Equlpmon w10 be
atl8tl ag.I.t what you owe to under M Agreement. YOU AGREE THAT WE WILL NOT BE RESPONSIBLE TO PAY YOU ANY OONSEQtUENRAL OR INCIDENTAL DAMAGES FOR ANY DEFAULT BY US UNDER THIS
AGREEMENT.You Mires Mat any Ealay or fdlum to anlonte our rights uwerMb Agreemntdan not prevent n ham entomlAg any rights at a stardom.X b fuMerapretl and yao Agh6 aW remtlies
ere pwOmO OxcMMly by
this Agreement anal you wive Wan right under Article M(5084M)alter UCO.
13.UCC FILINGS:You Brant n a seamy imred In Me equipment If gds agreement to deenhtl a secured MrMbn and your authorise n W read a UCCGl RnamdAg sblemm m Omar inborem,aw appoint
us or
"d to exemb and debar duo h irtmmnt,In most m shsw our Insured In the equipment
1A.SECURITY DEPOSIT:no amwty deposit Is nor in nand beat,and Is to sewn your Afmmoce uW sr cob Agreement Amy seamy crowd make my be a.Dltl by n W racy aw amount awel by you,In
Ands oam
yov xil prmpr restore the decoy sapdt m Ib fun omrnt r set bM stove.Ilal cmaition Mrdn m fury canpitl xiM row prwldtl you M1eve rd war been In sufnt o/Bens Agmmnt per poagrepM1
13,ore eeanty depots
Mo W reluwtl b you goer Ma ramm o(Me eqWppaor N emomereewlM pmpmph B.
15. CONSENTTOLAW,.NRISDICT)ON,ANDVENUE:ThbAr.mnteha0bed.metlfullyezrcdtland,rmm NiMsbreof Lesrrcrib Assnraptndprlpbrof MinnsaWMalbegovemWbyrowws Win
s000manro MIblane. If Me Lessororits Aesign.shallbdnganyjudmalp Wirg InmhtonWanyn reds guwer Ma Agreemnt Ya Nrevacably Agree MaleMsudhmetiermaybetllutlgwordotaminw Inanynut
or rmur into state of me lessor or IN Assignees principal place otWamms,or In any court or courts N your stale of mslderal min any other court heMAg jurisdiction overyou or parasrts,all
at Me rte election of ore Lrwr.
Youhmebyln.rmblysubM Wnemyawunco llonsByOMOIuttllcdonofanysuch udsoolrcbdby LeesororlbA WmasrestlonWswhm m.YoumNotdalbylurylneryaMmb Mw nn.
1B. LESSEE GUARANTY:You agree to submit the otpleal master lame document with Me security deposit to the Lori overnight router Me same day of the tawlrNb Mm Salon arms base documents.Ghouldwe
Wllto
recaNe Mess,odginls,you agree m bound by the faxtl copy dihls Agromem wM eppapriab agnatu m.Len.weer Me rght to chamngs In pout the autherecly of a toed copy of MB agreement and
Me fotl copy shall be
condderm Me original end shah be Me NMlrg agreement for Me FuMmea of aw enforcement action under Mmgnpb 12.
17.POSTAGE METER Under USPS rrulstlare any postage metrr(s)provided you In smandlan pan this Lime(TOStge Mesrs7 sM1atl et e9 timm main the proper of Fencoyl+Prmlla,Inc.('FP').
The Prh.Mdee ere
not Pot of Ne pulpnem nmr Wa leas aW ee IreMS gwerrod by Your mien renal agreemnt(MRA]xiM FP. However the motor m n due m FP my be Indudal In Ma moment stated an the farm of Nis
Lane,In whin
mse We win form meler rental mymeMS to FP urn remipl Nom Veu.You ego.Me MRA wig ramin N effrct throughout Me remaf orb lease.
FOR MUNICIPALITIES ONLY
18A.CUSTOMER COVEN9MS:VOU mvmem spa wemenlMd(f)II hu,In ecmmma with Ma rmWmnrenb o1bw,Ny brim*eW eppaptlytl autttlem moth for Ne current Wtlget.erm coke Me PaYmom rcM1tluM m
wm due eW b art b omerobgatbn uWwM AyemntaW rch mmda M1we mat tern exp W W tar ather wmrr;aW
C2)sat Mere b co adim,wi4 ProcatlNp orhrvesgetlm mWirg.of Wrlentl N my taut w otlor W Wpal comnpbn(jurmNtlm,elide orltleM or befoe aM wilt(roam or body,whkM1 N ewmYwatl(q rrteN
prenldrr
Ns delver,of tM Agreement or Me atilt'd you to make Its Bee Payments(r set cadmium);(b)contest or affeod dra unmanly for Me execution or ,d eyary or,,or the vaHM of the Agmment
Or(c)coned the metal aW
Dowersofyav,nmbiMredenyF®b Mew aWhactlm,nun,pa ,MorRwesgatim;and
(3)Ylret the pWprent nt a opemM ere mnar o e you ew x11 x ntl sr¢scantily govamnon purprr row pool m re nseorial forthe tam dote Agreement
(q You M1we not prodonly bnWrWtl a renal Inv norhaPaapletlm,except as anedfiry tlercnlotl N a IeXer rpewetl ham.
1&B. SIGNATURES: EaM sgnor(Iwo emM bD pehmr u o n St$p0)airs:oat m a4 b my mnersent withuM r eMiw relevant em row Mule n of on ul M1m coo power and euuexd Won W NW you.
Slprer(s)ter yen fuMerwemnl(s)su gweMag boy M1n bkan Ne nermssery steps;Ndadag arty bgel btl rewbemnb,uwer applrmbb law to emAge Wen emubmon of Me Equlpmnt Me epprtrval era ezrcWOn
hr her in
lfi O.NONAP a0 PRIATI le amt a wen swa;m In Net a rnomtlme Agreement e e be body olym eNWridag nrcwon dine Agreemor M1n been duty eddPetl eW romlm In NI force eW arted
1.Fu NON nor appropriated!for re t Fail aetlefaunundere I hich Me bemuse:
1.Suweerendeppoplabd nor a Racal Patanwba.uenim Wad ofpu;M1itlh me Agreement and entered lord which am namdeniWrfky ad oly0urob8getiore under the Agreement during ads fiscal petty;
2.You ave eppaprietlan sld not result from ably M mpalyme Wad of War; ,
3.You M1ave o other l mnmum by evalleNe for all payment dos o Lessor.
Agreement and
0.TM1m vi no other legal vrocotlum n Lessen Paymrdmn be mesa to r
(10)dysvMr Met(a)you M1we given L.rcrwor Inmtlrm of the rentr of any ayM11shove PINTvicesore poor e such occurrence;(b)LearntterreceNtln wdnan opinbn from your tethrl!W aIo
Me same whin lee
(ID)days your thereafter,ew(p)you re not eirecly or default punthe to emi ate any way acquire any eervMa m nt MHW supplied is p oda i for hneuwn;own advance of en equipment deyertl
m e seat,b ld,we tit or
Me equ p your damned.Lessors remedies Ico sum default shall tea m terminate me Agreement at Me end air rent Patlod tlutlrg wbcM1 notice b Brven;rosin Me a*Orme Daymenb,If eny,anNOr
bell,tlbpOSe o/,mold,rte Or lent
Me equipment n Lessor In Ib safe sircregn meydrire,wIUwW any soy to account to you.
23913-03120/2009
LESSOR
ABS Finance
DATED LESSOR SIGNATURE TITLE
i
RECEIVED
JAN 18 2012
RICOHAssociated Business Systems
innovation
. I ,
Hy i�'tp
RICOH PROPOSED SOLUTION
, REVISED
DiThis proposal
supercedes the
proposal
submitted on
Community Development Nov. 21, 2011,
and Engineering Services
Proposal prepared for April Lucas,
Kenne Horton 541.941.1296 Global 100
kenne_horton @absricoh.com Most Sustainable Corporations
in the World atcoH
Office: 1912 United Way, Medford 97504 Ricoh was recently named to the Global 100
541.772.8222 fax 541.772.5566 for the sixth consecutive year.
R I CO H Associated
!'dnulkuLl Lw+i Srrniec
A N¢ox cnntcANY
ABS Performance Guarantees
Pre call and Post call:
• An ABS technician will respond to service calls by phone within 1 hour
after receipt of call. In addition, ABS will follow up with a post service
call to confirm user satisfaction.
Guaranteed Response Time:
• We guarantee an on site four(4) hour average response time on
copiers purchased from Associated Business Systems.or ABS will pay
one month's maintenance bill.
Guaranteed Uptime Performance:
• The new system provided by ABS will be operational with a quarterly
uptime of 95% or we will provide a loaner system within 24 hours of
request.
Performance Commitment:
• We guarantee your equipment to perform to manufacturer
specifications for a period of five (5) years or we will replace it with a
product of equal or greater value at no charge.
Guaranteed Service Loaner:
• If ABS is unable to fix a problem or if a customer is unhappy with the
performance of a machine, ABS will pick up the machine, bring it into
the shop for evaluation and provide a loaner at no charge.
Upgrade Guarantee:
• ABS acknowledges that business needs may change and the need to
upgrade equipment in the middle of a lease could occur. To meet our
customer requirements, ABS does provide the ability to upgrade or
downgrade equipment in the middle of a lease term.
RICOH
Associated
Fundlitul A&ui Scnice
A RIWHtOMPAHY
Proposed RICOH MFP Solution
Ricoh MP W3601
Standard Features:
6.4 pages per minute(DSize)
Maximum Original/Copy size 36"x 590"
160 GB HDD
HDD Data Encryption—encrypts data on the HDD so data is secure,even if stolen
Data Overwrite Security System—overwrites latent data on the system's hard drive after
copy,print and scan activity
Options included:
One-Roll Paper Feed Drawer(Type 3601A)
Roll Holder Type A—for quick change of paper roll sizes
Printer Option(Type 3601A)
Scanner Option(Type 3601 A)
File Format Converter—for document portability
VM Card
USB 2.0/SD Slot(Type E)—for"scan to"and"print from"media functions
RICOH Promotional Pricing
Ricoh MP W3601 as equipped above $196.69 60 month FMV lease
$240.98 48 month FMV lease
Full Maintenance Covers all toner, parts, labor, and service necessary to keep
your equipment in like new condition. Provides a guaranteed service response
time not to exceed four hours, and free same day loaners if needed.
• $0.074 per linear foot
-• r RECORDER Page 1 / 1
�. CITY OF
ASHLAND sHLAND DATE : PO NUMBER... .
20 E MAIN ST. 3/13/2012 10738
ASHLAND, OR 97520
(541)488-5300 -
VENDOR: 015920 SHIP TO: Ashland Planning Department
ABS FINANCE, ASSOCIATED BUSINESS SYS (541) 488-5305
PO BOX 790448 51 WINBURN WAY
ST LOUIS, MO 63179-0448 ASHLAND, OR 97520
FOB Point: Req.No.: --
Terms: Net Dept.: -.
Req. Del.Date: - Contact: April Lucas
Special Inst: Confirming? NO
Quantity.; .Unit .. ..
Description Unit Price :: Ext.Price
4.00 MO Ricoh MP W3601 - Planninq 196.69 786.76
Digital Wide Format-60 Month Rental
Monthly rental charge$196.69
(4) Months - March to June 2012
SUBTOTAL 786.76
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 786.76
ASHLAND, OR 97520
c.Account Number: Project Number [j': Amount Account Number `. "'Project Number _ ? 'Amount
E 110.09.27.00.60221 196.69
E 110.09.28.00.60221 196.69
E 690.11.06.00.60221 393.38
Authorized Signature VENDOR COPY
'FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 3/1/2012
Required date for delivery:
Vendor Name ABS FINANCE(Vendor#015920)
Address,City,State,Zip PO BOX 790448
Contact Name&Telephone Number ST.LOUIS,MO 63179-0448
Fax Number
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on f le) ❑ Written findings attached
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
❑ Direct Award Date approved by Council: Contract#
❑ Verbal/Written quote(s)or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
000 to 100 000 ❑ Written quote or proposal attached Agency
(3)Wrl en quotes attached ❑ Special Procurement Contract#
PERSONAL SERVICES ❑ Written Findings(Form #9 attached) Intergovernmental Agreement
$5,000 to$75,000 ❑ Written quote or proposal attached ❑ Agency
❑ Less than$35,000,by direct appointment Date approved by Council: Date original contract approved by Council:
❑ (3)Written proposals attached Valid until: Date (Date)
Description of SERVICES Total Cost
$
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
4 MONTHS MONTHLY LEASE CHARGE—Ricoh MP W3601 $196.69 $786.76
[� Per attached quotelproposal TOTAL COST:
Project Number____—_- Account Number: 110.09.27.00.602210(25%) $786.76
Account Number: 110.09.28.00.602210(25%) Account Number: 690.11.06.00.602210(50%)
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
(PDirec0 Date Support-Yes/No
By signing this
,requisition form,I certify that the City's public contracting requirements h `been satisfied.
Employee Signature: '�- ,'S A C� Department Head Signatur f�
(Equ I to or greater than$5,000)
Additional signatures(if applicable):
Funds appropriated for current fiscal year: YES / NO
Finance Director-(Equal to orgreaterthan$5,000) Date
Comments:
Form#3-Requisition