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' ONESOURCE LABORATORY <br />SERVICES <br />PerkinElmer° <br />For the Better <br />PerkinElmer Health Sciences, Inc. <br />710 Bridggepor Avenue <br />SHELTON CT 06484-4794 <br />USA <br />TEL: (800) 762-4000 FAX: (203) 944-4983 <br />Quotation Number <br />Quotation Date <br />40588139 <br />12/07/2016 <br />Your Prior Agreement <br />Quote Expiration Date <br />35409584 <br />03/18/2017 <br />Customer Contact <br />Your Prior PO Number <br />MICHELLE SMITH <br />227054 <br />Telephone Number <br />574-235-5994 <br />QUOTATION - SEE COVERAGE PLANS <br />Site Address: <br />MICHELLE SMITH <br />CITY OF SOUTH BEND <br />WASTEWATER TREATMENT PLANT <br />3113 RIVERSIDE DR <br />SOUTH BEND IN 46628 <br />USA <br />Site Number <br />100021642 <br />Fax Number <br />BELOW <br />Invoicing Address (if different) <br />CITY OF SOUTH BEND <br />ACCOUNTS PAYABLE <br />227 W JEFFERSON BLVD <br />SOUTH BEND IN 46601 <br />USA <br />Customer Number <br />4013875 <br />Payment Terms Coverage Period Billing Plan Page Number <br />Net 30 days 04/01/2017 to 03/31/2018 Yearly 4 of 4 <br />Additional Notes: <br />1. This quotation is subject to the terms and conditions attached and is valid until the expiration dale shown above. <br />2. Customer is responsible for applicable taxes, including sale, use and/or excise tax unless otherwise noted above. <br />3. If Preventative Maintenance is covered under your agreement, please indicate any special date requirements below. <br />PM#1 <br />PM#2 <br />If any information presented on the document is incorrect e.g Billing address, serial numbers, please Indicate the required changes below: <br />PLEASE SIGN THIS MAINTENANCE AGREEMENT QUOTATION AND RETURN ORIGINAL COPY ALONG WITH YOUR PURCHASE <br />ORDER TO: <br />By Mail: - By Fax: 203-944-4983 <br />PerkinElmer Health Sciences, Inc. OR <br />710 Bridgeport Avenue By E-mall: sarah.enos@perkinelmer.com <br />Mail Stop 75 <br />Shelton, CT 06484-4794 <br />YOUR SIGNATURE BELOW CONFIRMS THAT YOU HAVE READ AND UNDERSTAND THE ABOVE STATEMENTS AND THAT THE <br />INFORMATION INCLUDED THEREIN IS CORRECT TO THE BEST OF YOUR KNOWLEDGE. <br />IN ORDER TO AVOID A LAPSE IN SERVICE COVERAGE, PLEASE FORWARD A PURCHASE ORDER PRIOR TO THE EFFECTIVE <br />START DATE OF THE CONTRACT. <br />Accepted By: <br />Signature of Authorized Individual <br />Print Name and Title <br />Soord ofP riep <br />Works <br />--`�'— Date <br />Customer Purchase Order Number <br />PerkinElmer Representative <br />