HomeMy WebLinkAbout2011-130 Agrmt - Pitney Bowes
.' Pitney Bowes
DARLOW TUNEBERG
CITY OF ASHLAND
20 E MAIN ST
ASHLAND
Date:
June
7, 2011
Rental Account No:
4803839 402
OR 97520-1850
Thank you for your order and the opportunity to serve your company. Pitney Bowes and
Pitney Bowes Global Financial Services LLC (PBGFSl are dedicated to your total satisfaction
and are committed to providing you with the finest products, backed by the highest
quality care and service. '
PBGFS is pleased to acknowledge acceptance of your offer to utilize our Term Rental
Agreement program for your Pitney Bowes Equipment needs. If you would like a copy of
the fully executed agreement, including a duplicate set of terms and conditions, please call
800-288-2357 . To expedite the process, please have your Customer Account Number
listed at the top of this letter available.
Shortly, you will receive your first invoice. Our records show that you agreed to the
payment schedule (which includes the deferred interest), shown below. Please review this
information at your earliest convenience and contact us at 1-800-288W~!J you have any
questions. ij /- " :/ Ib
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Equipment Description: MAILING SYSTEM ------- v
Equipment Location: 20 ~_MAJN>-S~ ASHLAND OR 97520
Deferred Interest: ( $192.39'/
Payiiien~ Frequency Total Payment ·
First 20 Quarterly $126.42
* plus applicable sales and use taxes.
Please note that your invoices will be sent to the mailing address of this letter. Return
all remittances to: Pitney Bowes, P. O. Box 371887, Pittsburgh, PA 15250-7887.
Our office hours are 8:00 a.m. to 6:00 p.m. Eastern Time. If you have any questions or
comments, please call us at 1-800-288-2357.
Sincerely,
Richard Gabris
Government Operations Manager
27 Waterview Dr. Shelton Connecticut 06484-4361 800-288-2357
. Pitney Bowes
Engineering the flow of communication"",
WSCA Installment Option A Agreement Account # 60
Your Business Information
CAN#
ORDER #
CITY OF ASHLAND
Full Legal Name of renter
DBA Name of renter
Tax ID # (FEINfTlN)
20 E MAIN ST
ASHLAND
Billing Address
City
OR
Slate
97520-1850
Zip+4
19265322867
BiI~ing Contact Name
Billing Conlact Phone #
Billing CAN #
20 E MAIN ST
ASHLAND
OR
97520-1850
Installation' Address (If different from billing address)
City
Slate
Zip+4
19265322867
Installalion Contact Name
Installation Contact Phone #
Installation CAN #
Credil Card #
Name on Card
ExpDale
Type of Card
Tax Exempt #
SlaleTax(ifapplicable}
Fiscal Period (from-to)
Your Business Needs
Qty Business Solution Description
Mall Stream Solution. 1
1 DM100 Desktop Mailing System wJMoistener
1 IntelliLink Interface I PSD for DM1 00
1 Accounting (10 Dept) Software
1 Sib Integrated Weighing
1 Integrated Weighing Platform
1 Professional Installation for DM1 00
1 IntelliLink Subscription
Check Items to be included in customer's payment
o Equipment Maintenance (1st year Included)
Provides service coverage including certain parts and labor
D
Software Maintenance (1st year included)
Provides revisiorl updates arid techrlical assistarlce
o
Soft-Guard@Subscrlption
Provides postal arid carrier updates
If you do not elect to loch.xll! Soft-Guand€l protection wrth y<lur tease, ;'(lu wiU automatically
receiveupdatesatlhelhen-currentrates
o
IntelJiLink TM Subscription/Meter Rental
Provides simplified bi/iing arid includes ( )resets per yeer
( )ConflnnallonServlces Electronic access to postal ronfirmation se/Vice
( ) Purchase Power Receive an Invoice for postage,ronsolidated billl~
and enhanced management reportlnll information.
Your Payment Plan
Number of months
First 60
Monthly amount
$42,14
) Required advance check of $
) Tax Exempt certificate attached
Initial rental term
received
Your Acknowledgement
By your signature below, you are entering into an Installment Lease Agreement pursuant to your Participating Addendum to the WSCA Contract #
EPS050076-A2-2. The Terms and Conditions of such WSCA Installment Lease Agreement Option A govern this transaction.
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EmailAcidress
Signature
D~Ltz.J
Dale
"AJ"ft\JCL
Print Name
TiUe
Paul DeSantis
473
Account Rap
DistriclOffice
PBGFS Acceptance
WSCA OPTION A Form (Rev.04/08)
P;;;)e1
s"ea:J'Jit~JrliJIPa\l(~ff)1hml'5:indruf)(jilions
f.QiJ;l.:memVendor.Pitney8(jw(,Sill<,:.
F,,,S.a!osiJl1,lS,Jrvic,,sr;ali1-lsDlJ<>22<!()IlJ,
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Form
8038-GC
(Re". MIIY 2009)
Depllrtment of the Treesury
Intemel Re~nue Service
, Information Return for Small Tax-Exempt
Government Bond Issues, Leases, and Installment Sales
OMS NO. 1545-0720
... Under Internal Revenue Code section 149(e)
Caution: "the issue price arthe issue $100,000 or more, use' Form 8038-G
Re ortln Authorit
1. Issuer's name
CITY OF A.<::;HI AND
3. Number and street (or P.O. Box if mail is not delivered to street address)
20 E MAIN 5T
4. City, town, or post office, state, and ZIP code
A~1-l1 ANn OR Q7fi?O_1RfiO
6. Name and title of office or legal representative whom the IRS may call for more information
Check box if Amended
2. Issuer's employer identification number
Room/Suite
5. Report number (For IRS Use Only)
7. Telephone number of officer or legal representative
lRl or a consolidated return D
8a
9a
9b
9c
9d
9.
9f
9
9h
91
9'
9k
8a. ISsue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . . . . . . . .
b. Issue date (single issue) or calendar year (consolidated) Enter date in mm/ddlyyyy format
(for example, 01/01/2009) (see instructions) ~ -.J-.J_
9. Amount of the reported obligation(s) on line 8a that is:
a. For leases for Vehides ................
b. For leases for office equipment. . . . . . . . . .
c. For leases for real property. . . . . . . , . . .
d. For leases for other (see instructions) . . . . . . . . . . .
e For bank loans for vehicles ,.. .,."..,.
f. For bank loans for office equipment, . . . , , , , , . ,
g. For bank loans for real property.
h. For Bank loans for other (see Instructions) . , . . . , , , , , , . ,
I. Used to refund prior issue(s) . . . , . . , , . , , , , , , , , , , . . . , , , , . , , , , . , , , , . . ,
j. Representing a loan from the proceeds of another taxMexempt obligation (for example, bond bank).
k~~"""""".."""""""" """"",.,
1 0, If the issuer has designated any issue under section 265(b)(3)(B)(i)(i1I), (small issuer exceptions) ,check this box,
11. If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) , . . . , , . . . . .
12, Vendor's or bank's name, , , , , , , PITNEY BOWES INC ,
13. Vendor's or bank's employer identification number: ,. . ,06-0495050. . , . . . .. . . . . . . . ..
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Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements. and to the bestaf my knowledge and
belief, they are true, correct, and complete,
~
Sign
Here
Paid
Preparer's
Use Only
Preparer's IIIilrr...
signature ,...
Firm's name (or
yours ilself-employed),
address and ZIP code
~
General Instructions
Section references are to the Internal Revenue Code
unless otherwise noted.
Purpose of Form
Form 8038-GC is used by issuers of tax-exempt
government obligations to pro\'ide the IRS with the
information required by section 149(e) and to monitor
the requirements of sections 141 through 150.
Who Must File
Issuers of tax exempt governmental obligations with
issue prices of less than $100,000 must file Form
8038-GC,
Issuers of tax exempt governmental obligation
with an issue price of $100,000 or more must file
Form 8038-G, Information Return for Tax-Exempt
Governmental Obligations
Filing a separate return for a single issue. Issuers
have the option 10 file a separate Form 8038-GC for
any tax-exempt governmental Obligation with an
issue price 01 less than $100,000.
An issuer of a tax exempt bond used to finance
construction expenditures must file a separate Form
8038-GC for each issue to give notice to the IRS that
1--IhLfl!5-:.
Date
Dale
an election was made to pay a penalty in lieu of
arbitrage rebate (see the line 11 instructions).
Filing a eonsolidatf!d ~tum for multiple issues.
For all tax-exempt governmental obligations with issue
prices of less than $100,000 that are not reported on a
separate Form 8038-GC, an issuer must file a
consolidated information return induding all such
issues issued within the calendar year.
Thus, an issuer may file a separate Form 8038-GC
for each of a number of small issues and report the
remainder of small issues issued during the calendar
year on one consolidated Form 8038-GC. Hov.rever a
separate Form 8038-GC must be filed to give the IRS
notice of the election to pay a penalty in lieu of
arbitrage rebate, .
When To File
To fiie a separate return for a single issue, file Form
8038-GC on or be/ore the 1Slh day of the second
calendar month after the close of the calendar quarter
in which the issue is issued.
To file a consolidated return for multiple issues, file
Form 8038-GC on or before February 15111 of the
calendar year follO'Ning the year in which the issue is
issued.
late filing. An issuer may be granted an extension of
time to file Form 8038-GC under Section 3 of Rev.
Type or print name and title
Check if 0
Self-employed
Pre parer's SSN or PT IN
EtNQZdOOD'J-1/7
Phone no. (
Proc. 2002-48, 2002.2 CB. 531, if it is determined that
the failure to file on time is not due to willful neglect
Type or print at the top of the form, "Requested for
Relief under secUon 3 of Rev. Proc. 2002-48: Attach
to the Form 8038-GC a letter briefly stating why the
form is not submitted to the IRS on time. AJso indicate
whether the obligation in question is under
examination by the IRS. Do not submit copies of any'
bond documents, leases, or installment sale
documents. See Where To File below
Where To File
File Form 8038-GC, and any attachments, with the
Department of the Treasury. Internal Revenue Service
Center, Ogden, UT 84201.
Other Forms That May Be Required
For rebating arbitrage (or paying a penalty in lieu 6f
arbitrage rebate) to the Federal Government, use
Form 8038-T, Arbitrage Rebate, Yield Reduction and
Penalty in lieu of Arbitrage-Rebate. For private
activity bonds, use Form 8038, Information Return for
Tax-Exempt Private Activity Bond Issues.
Form 8038-GC Receipt
Acknowledgement
W you wish to request an acknowledgement receipt of
this return by the IRS you must provide the following:
Cat. No. 641088
Form 8038-GC (rev.S-2009)
'United States Postal Service,
Postage ,Meter Activity Report
Check One .
.,0 Installation.
o W~hdrawal
/ Meter Manufacturer's Code
JZJ Replace~en~ 01' 0 /S.CO~. Hasler' ..03 0
, ' 02.J2f.F,jtneyBowes, 04 0
Postalia
Neopost.
050 Other
A, Reason for Meter Activity
,., ...
1. 0 New'
Meter
2. 0 License.
Revocation
10. Explanation/Description of Failure
3. 0 Mechanical
Failure
(Not QAR)
4. 0 Question of
Accurate
Registration
5.)!1"Model Change 7. D Electronic Failure
, , '(NotQAR)
6, 0 Fire/Flood 8. 0 Change of PO
9; 0 Cancellation
';'~
"
.'
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Affix Sample Meter Strip (1 per copy) or
Write In Information in the S aces Below
, Name of post Office/Classified Branch and State
7. Z~P Code Designation
5. Contact Person Signature (Op60nal)
'8. Military APO/FPO
Type of Meter (Check one)
Type' of Meter (Check one)
3. Serial Number
9. CMRS Account Number
4. 0 Decimal 0
, (.001)
5. 0 CMRS
10. Fed: Agency Code - Cost Code 6. 0 Penalty CMRS
Non-
Decimal (.01)
I
4. 0 Decimal
(,001)
5. 0 CMRS
6. 0 Penalty CMRS
o Non-
Decimal (.01)
9. CMRS Account Number
, 0, Fed. Agency Code - Cost Code
7, 0 Manual Set
11. Locking Seal Number
7.' 0 Manual Set
11. Locking Seal Number
8. 0 Penalty Manual Set
Register Readings at TIme of Withdrawal
12. Ascending 'Register
13. Descending Register
14. Control Total
8. 0 Penalty Manual Set
Register Readings at Time of Installation
12. Ascending Register
13. Descending Register
14. Control Total
1. 0 Amount of Refund *
$
$,
$
RefundfTransfer Was 4. D Issued 5.0 Not Issued
Not Issued Reason 6. 0 Exceeds Local Umit 7. 0 Not Determined
8. Refund Request Forwarded to USPS Office (City and State)
2 D Amount of Transfer to
. Installed Meter -
3 0 Amount of Credit to
. CMRS Account
10. CMRS Clear Code
d:
w
:;;
o
f-
rJl
:::J
o
-.N.
11. * If refund check is to be mailed to
a location other than the meter
location, Emter that address here
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3. Signature
~
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tj 2. Dealer/Branch, Office Code
~
o
CD
C')
E
is
u.
(I)'
Q.
4. Finance No.
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CITY RECORDER
CITY OF
ASHLAND
20 E MAIN ST,
ASHLAND, OR 97520
(541) 488-5300
Page 1/1
.
~~,
DATE
7/6/2011
II
PO NUMBER
10273
I
VENDOR: 000562
PITNEY BOWES
ACCT # 4803839
PO BOX 371887
PITTSBURGH, PA 15250
SHIP TO: Ashland Finance Deartment
(5411488-5300
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.:
Contact: Cindy Hanks
Confirming? No
"Qiiiintilv, .. ':~Unit .. .. . " .. Descriotion ,', , ::UriIH~rice -, Ext::Price '. ;:"
...
4.00 Qtr Pitney Bowes Mailing System 126.42 505.68
60 Month Agreement @ $42. 14/Month
Quarterly payments of $126.42
(Year 1 of 5 year agreement)
I
,
SUBTOTAL 505,68
BILL TO: Account Payable TAX 0,00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 505.68
ASHLAND, OR 97520
,-Account Number " ."Proje'c(Number,: . Amount- . Account Number Rroject Number- Amount .'
: .,
E 710.03.08.00.60221 505.68
dJZ.:7
'"
.~--
Au rized Signature
VENDOR COPY
I FORM.#3 I
A request for a Purchase Order
REQUISITION
~~ \')--
CITY OF
ASHLAND
E3
Vendor Name
Address, City, State, Zip
Contact Name & Telephone Number
Fax Number
Date of request:
Required date for delivery:
--9; ~l.-'} (bOUJt'.\
o
SOLICITATION PROCESS
o Exempt from Competitive Biddina
o Written Findings (Form attached)
o Quote or Pro osal attached
o Small Procurement
Less than $5,000
Note: Total contract amount, Including any
amendments may not exceed $6,000
Intermediate Procurement
GOODS & SERVICES
$5,000 to $100,000
o (3) Written quoles attached
PERSONAL SERVICES
$5,000 to $75,000
o Less than $35,000, by direct appointment
o 3 Written ro osals attached
Description of SERVICES
~ l-nhLl
Item #
Quantity
Unit
o Per attached QUOTE
Project Number ______. ___
o Invitation to Bid (Copies on file)
Date a roved b Councii:
o Emeraencv
o Written findings attached
o Quote or Pro sal attached
Coo rativ ment
State of Orego ''7;z.6 [) _p/,
ntractr r-c
o State of Washington
Contract #
o Other govemment agency contract
Agency
Contract #
o Intergovernmental Agreement
Agency
Contract #
Oate approved by Council:
Total Cost
o Reauest for Proposal (Copies on file)
Date approved by Council:
o Sole Source
o Written Findings (Form attached)
o Quote or Proposal attached
o Special Procurement
'0 Wrillen Findings (Form attached)
o Quote or Proposal attached
Date a roved b Council:
f5'b (Yl tl.l \ Yha. i l S y~ktY1
Description of MATERIALS
Unit Price
Total Cost
JJ/.p<-{ ;)..
Account Number ]j Q. P},.Qii'. . ~z:. . (p PLJi!P Account Number
. . . .
--- -- -- -- ------
Account Number ___. __. __. __. ______ Account Number ___. __. __. __. ______
.Expenditure must be charged to the appropriate account numbers for the financials to refiect the actual expendituras accurately. Attach axtra pages if needed,
By signing this requisition form, I certify that the informalion provided abova maets the City's public contracting requirements, and the documentation can be provided
upon request.
Employee Signature:
&pi '~Iv ~HuV1 LS
Department Head Signature:
N-~~
Additional signatures (if applicable):
Funds appropriafed for current fiscal year: €J NO
Comments:
~'?---.-
Finance Director
7~1::
G: Finance\ProcedureIAP\Forms\Form #3 - Requisition
Uodated on: Fi/171?n11