HomeMy WebLinkAboutHardware Lease - AT&T Capital Services Inc - Tablets for Various City Depts1316 COUNTY -CITY BUILDING
227 W.JEFFERSON BOULEVARD
SOIJTH BEND_ INDIANA 46601-1930
CITY OF SOUTH BEND PETE BUTTIGIEG, MAYOR
BOARD OF PUBLICWORKS
April 23, 2019
Jodi Ramsey
AT&T Capital Services, Inc.
36 S. Fairview Ave.
Park Ridge, IL 60068-4016
RE: Hardware Lease
Dear Ms. Ramsey:.
PHONE 574/235-9251
FAx 574/235-9171
The Board of Public Works, at its meeting held on April 23, 2019, approved the above
referenced lease for fifteen (15) mobile tablets for the Fire Department, Mayor's Office and
Venues, Parks and Arts in the amount of $262.37 per month for thirty-six (36) months, for a
total of $9,445.32.
Enclosed please find the original of the lease for your signature. Please sign and return the
original agreement to our office and retain a copy for your records.
If you have any further questions regarding this matter, please call this office at (574) 235-
9251.
Sincerely,
Linda M. Martin, Clerk
Enclosure
GARY A. GILOT GENEVIEVE E. MILLER ELIZABETH A. MARADIK LAURA L. O'SULLIVAN THERESE J. DORAU
INTER -OFFICE MEMORANDUM
Department of Innovation & Technology
City of South Bend 227 W Jefferson Blvd
TO: Board of Public Works, Linda Martin
CC: Dan O'Connor, Dan Parker, Michael Schmidt, Sandi Kennedy, Clara McDaniels
FROM: Shawn Delahanty
SUBJECT: Lease of iPads and Surfaces
DATE: 4/4/19
Linda and Members of the Board
We are submitting for review and approval the Lease of 11 iPads and 4 Microsoft Surfaces with
accessories. The total cost for 36 months will be $9445.32 ($262.37/month).
The iPads will be used by the below departments:
• VPA Facilities & Grounds —mowing (8)
• VPA Recreation for use with Square credit card readers (3)
The Surfaces will be used by the below departments:
• Mayor's Office (1)
• Fire Department (3)
Thank you.,
Shawn Delahanty
aINNOVuw` AT&T AT&T Capital Services, Inc.
Direct: (847 720-0633
BUSIllG55 Jodi Ramsey )
36 S. Fairview Avenue, Floor 1 Fax: (847) 326-0559
Park Ridge, IL 60068-4016 Email: jk2674@att.com
April 2, 2019
THE CITY OF SOUTH BEND, INDIANA
227 WEST JEFFERSON BLVD.
SOUTH BEND, IN 46601
Opportunity #: 1-84331064
AT&T Capital Services, Inc. is pleased to provide a proposal for the lease of the equipment and/or services as submitted to us. The proposed
lease terms are as follows:
NOTE: AT&T EQUIPMENT/SERVICES CONTRACT IS REQUIRED BEFORE ORDER CAN BE PROCESSED.
Payment Option., 36 Months, Muni $1 Buyout
Equipment
city
Cost/Each
Total Cost
Lease Rate
Monthly
Monthly
Initial
Description
Factor
Payment
Payment/Unit
Option
Microsoft Surface Pro
4
$961.80
$3,847.20
0.02996
$115.26
$28.82
Surface Dock
4
$142.50
$570.00
0.02996
$17.08
$4.27
Keyboard Cover
4
$94.50
$378.00
0.02996
$11.32
$2.83
iPad 6th Gen 9.7" 32GB
11
$359.99
1 $3,959.89
0.02996
$118.64
$10.79
Amount Requested: $8,755.09
Rates quoted are for commercial leases only.
Subject to execution of Mutually Acceptable Documentation.
Quoted Lease Payments Exclude Any Applicable Taxes.
Payments may be indexed up until lease commencement.
Customer agrees to allow AT&T Capital Services, Inc. to file UCC Financing Statements.
Credit Approval will be withdrawn 120 days following the date of this letter if the lease has not commenced.
Approval is pending verification of corporate name and final verification of credit information.
Shipping Charges are not included in Data Equipment.
$250.00 processing fee for lease cancellation prior to commencement if PO is issued„
Lessee's failure to execute mutually acceptable documentation relative to this lease within ninety (90) days of the
lessee's first functional use of the system will result in this lease converting to cash.
En
$1 Purchase Option
Customer purchases the equipment for $1 at the end of the lease term.
Thank you for this leasing opportunity. I am looking forward to working with you,
Sincerely,
TO AMQACCLPTED Ay:
joddv92a mey THE CITY OF SOUTH BEND, INDIANA t� '
Name:
AT&T Capital Services, Inc. Title:
Date: 77
w ,
AT&T Capital Services, Inc.
36 S. Fairview Ave. AT&T Muni Mobility
aw Park Ridge, IL 60684016
Office; 800/323-7312 Financing Agreement
Fax: 847Y326-0573 Number: 001-2340900-006
Dated: April 4, 2019
Lessee
Fgall pment Detail . . . . ........... . .....
Equlpment Description
Mobility- I I Wads and 4 Surface Tablets
Equipment Suppfler AT&T Mobility Corporation
Schedule of Rental Pa wents
Purchase option
29e Dona,
Down Payment fit applicable16 Term fin months) Total number of payments., 36 in Arrears
1 36
'Payable to AT&T Capital Services, Inc. and due upon execution of this Agreement.
PaymentiiiquenW. Payments"": "' , 36 at $262.30
Monthly Remaining at $- (plus applicable taxes)
Acknowledgement
Customer Vereby certifies that helsh e has read and agrees to all of the terms and
'
oordifons set for0i on pages 1-3 of this AT&T Ailftk y Flnandng 'Agreement
CustomerNameTHE CITY OF SOUTH BEND, INDiAN)
DBA:
Name and Title Iplease
a
Accepted By
THIS AGREEMENT IS NOT BINDING UNTIL ACCEPTED BY LENDER.
Lender Name
AT&T CAPITAL SERVICES, INC.
Name and Title (please print]
Signature
Form. Rev. 2-16-2017 Page 1 of3
Terms and Conditions
1. AGREEMENT - Subject to the terms and conditions of this AT&T Muni
Mobility Financing Agreement (the "Agreement'), Customer agrees, to finance
from Lender the equipment (the "Equipment") described on page 1 of this
Agreement. The Agreement shall commence on the date the Equipment is
delivered to the customer ("Commencement Date") and shall continue for the
number of months specified in the Agreement ("Term").
Customer's failure to execute this Agreement within ninety (90) days of the
delivery of the Equipment will result in this Agreement converting to a cash
sale, with payment due and payable immediately.
2. PAYMENTS - During the Term of the Agreement, Customer agrees to
pay Lender the total number of payments multiplied by the amount of each
payment (plus taxes) specified on page 1 of the Agreement. The due date of
the first payment is the date upon which the Equipment is delivered to
Customer or any later date designated by tender. Restrictive endorsements
on checks sent to Lender will not reduce Customer's obligations to Lender.
The payment amount specified is Indexed to like -term US Treasury Bills, and
any increase or decrease in the corresponding US Treasury Bills will cause the
payment to be adjusted point for point at the time of the Commencement Date,
The payments do not Include any additional interest expense for progress
payments which are required by Lender on all transactions with installations
exceeding fah days Progress payments will be financed through Lender at
Prime Rate plus 2% at time of funding.
3. NON -CANCELABLE AGREEMENT - Customer's obligation to make
payments and to pay any other amounts due hereunder shall be ABSOLUTE
AND UNCONDITIONAL and shall not be subject to any delay, cancellation,
termination, reduction, set-off, defense, counterclaim or recoupment for any
reason whatsoever. This is an irrevocable Agreement for the full Term and
cannot be cancelled, other than for Non -Appropriation, as hereinafter defined.
4. NON -APPROPRIATION: This Section is applicable only if the inclusion
of such a non -appropriation provision is legally required. Customer's
obligations to pay Payments and any other amounts due for each fiscal period
is contingent upon approval of the appropriation of funds by its governing
body. In the event funds are not appropriated for any fiscal period equal to
amounts due under the Agreement, Customer may terminate the Agreement
effective on the first day of such fiscal period {"Termination Date"), if: (a)
Customer has used due diligence to exhaust all funds legally available; and (b)
Lender has received written notice from Customer at least thirty (30) days
before the Termination Date. Upon the occurrence of such non -appropriation,
Customer shall not be obligated for Payments for any fiscal period for which
funds have not been so appropriated, and Customer shall deliver the
Equipment to Lender on the Termination Date, packed for shipment in
accordance with the manufacturer's specifications, freight prepaid and insured
to any location in the continental United States designated by Lender. If
Customer terminates an Agreement pursuant to this Section, unless the
following would affect the validity of a Agreement, Customer will not purchase,
lease, rent, seek appropriations for, or otherwise obtain equipment serving the
same function as the Equipment for the fiscal period in which such termination
occurs or the next succeeding fiscal period and such an obligation will survive
termination of this Agreement.
5. DELIVERY AND ACCEPTANCE - Customer understands that Lender
is not responsible for delivery of Equipment, Customer holds Lender harmless
from specific performance of this Agreement and from any damages if for any
reason the manufacturer, supplier, vendor or distributor (coilectivefy referred to
in this Agreement as "Vendor") delays in delivery, or if the Equipment is
unsatisfactory.
6. WARRANTY DISCLAIMER - CUSTOMER AGREES THAT IT HAS
SELECTED THE VENDOR AND PRODUCT BASED UPON ITS OWN
JUDGEMENT AND DISCLAIMS ANY RELIANCE UPON ANY
STATEMENTS OR REPRESENTATIONS MADE BY LENDER. LENDER
MAKES NO WARRANTY WITH RESPECT TO THE PRODUCT, EXPRESS
OR IMPLIED, AND LENDER SPECIFICALLY DISCLAIMS ANY WARRANTY
OF MERCHANTABILITY AND OF FITNESS FOR A PARTICULAR
PURPOSE AND ANY LIABILITY FOR CONSEQUENTIAL DAMAGES
ARISING OUT OF THE USE OF OR THE INABILITY TO USE THE
PRODUCT, WARRANTIES MADE BY THE VENDOR TO THE LENDER
SHALL INURE TO THE BENEFIT OF THE CUSTOMER, TO THE EXTENT
ASSIGNABLE. IF THE EQUIPMENT DOES NOT OPERATE AS
REPRESENTED, WARRANTED OR GUARANTEED BY VENDOR, OR ARE
UNSATISFACTORY FOR ANY REASON, CUSTOMER SHALL MAKE ITS
CLAIM AND ANY COMPLAINT THEREFOR AGAINST VENDOR, AND NOT
AGAINST LENDER AND SHALL CONTINUE TO MAKE ALL PAYMENTS
REQUIRED HEREUNDER. CUSTOMER ACKNOWLEDGES THAT VENDOR
IS NOT AN AGENT OF LENDER AND STATEMENTS OR
REPRESENTATIONS OF THE VENDOR SHALL NOT BIND OR AFFECT
LENDER, AND SHALL NOT AFFECT THE CUSTOMER'S OBLIGATIONS
UNDER THIS AGREEMENT.
7. NO AGENCY - Customer acknowledges that (1) there is no agency or
joint venture between Lender and the Vendor; (2) neither the Vendor nor any
other person is authorized to act an Lender's behalf, and (3) ONLY AN
INDIVIDUAL AUTHORIZED BY LENDER IS PERMITTED TO WAIVE OR
ALTER ANY TERM OR CONDITION OF THIS AGREEMENT.
B. ASSIGNMENT - LENDER MAY ASSIGN ITS INTEREST IN THIS
AGREEMENT WITHOUT CUSTOMER'S CONSENT. CUSTOMER AGREES
THAT IN ANY ACTION BROUGHT BY AN ASSIGNEE AGAINST
CUSTOMER TO ENFORCE LENDER'S RIGHTS HEREUNDER, CUSTOMER
WILL NOT ASSERT AGAINST SUCH ASSIGNEE, AND EXPRESSLY
WAIVES AS AGAINST ANY ASSIGNEE, ANY BREACH OR DEFAULT ON
THE PART OF LENDER HEREUNDER OR ANY OTHER DEFENSE, CLAIM
OR SET-OFF WHICH CUSTOMER MAY HAVE AGAINST LENDER EITHER
HEREUNDER OR OTHERWISE. NO SUCH ASSIGNEE SHALL BE
OBLIGATED TO PERFORM ANY OBLIGATION, TERM OR CONDITION
REQUIRED TO BE PERFORMED BY LENDER HEREUNDER.
9. QUIET ENJOYMENT - Provided that no Event of Default (as defined in
Section 12 herein) has occurred or is continuing hereunder, Lender shall not
interfere with Customer's right of quiet enjoyment and use of the Equipment.
10. TAXES AND FEES - Customer shall pay when due and shall indemnify
Lender for, and hold Lender harmless from and against all federal, state, and
total filing fees, assessments, taxes including without limitation, sales, lease,
use, excise and personal property taxes (excluding only taxes payable with
respect to Lender's net income) which may be imposed on the Lender arising
in any way out of the use or leasing of the Equipment„ Such amounts shall be
considered additional rent and shall be payable by Customer upon demand by
Lender.
The obligations under this section shall survive the expiration or termination of
this Agreement.
11. INDEMNITY - Customer hereby indemnifies Lender and holds Lender
harmless from any and all claims, actions, suits, proceedings, costs,
expenses, damages and liabilities, including attorneys fees„ arising out of or
connected with the Equipment or the use thereof, including without limiting the
generality of the foregoing, its manufacture, selection, delivery, possession,
use, leasing, fitness operation, return, or latent or other defects, whether or not
discoverable, or arising out of any failure by Customer to perform or comply
With any of the terms and conditions of this Agreement. The indemnities
contained herein shall continue in full force and effect notwithstanding the
termination of this Agreement, whether by expiration of time, by operation of
law, or otherwise.
12. DEFAULT AND REMEDIES - If Customer (a) does not pay rent within
ten (10) days after the same becomes due, (b) breaches any of its
representations, warranties or other obligations under the Agreement, (c) is in
default under any other agreement between Customer and Lender (d)
becomes insolvent or assigns its assets for the benefit of its creditors, or (e)
enters (voluntarily or Invoiuntafily) a bankruptcy proceeding ("°Event(F) of
Default")„ Customer will be In default, Upon the occurrence of an Event of
Default, Lender may require that Customer pay the remaining balance of all of
the rental payments due under this Agreement, present valued using a 3% per
year discount rate. Customer also represents to Lender that Interest an all
sums due Lender from the date of default until paid will be at the rate of one
and one-half percent (1-112%) per month, but only to the extent permitted by
law. In addition, Lender shall be entitled to recover from Customer any of the
remedies available under the Uniform Commercial Code ("UCC") or any other
Taw. If Lender refers this Agreement to an attorney or collection agency for r
enforcement or collection, Customer agrees to pay the cost of recover
including, but not limited to, legal fees and expenses, it I
Page 2 of
Form. Rev. 2-16-2017
Customer initials
�r
13. OTHER RIGHTS - Customer agrees that any delay or failure to
enforce Lender's rights under this Agreement does not prevent Lender from
enforcing any rights at a later time. Customer and Lender intend this
Agreement to be a valid and legal document, and agree that if any part is
determined to be unenforceable, all other parts will remain in full force and
effect.
14. ENTIRE AGREEMENT; CHANGES - This Agreement contains the
entire agreement between Customer and Lender and supersedes all
previous discussions and the terms and conditions of any purchase orders
issued to and/or by Customer and it may not be altered, amended, modified,
terminated or otherwise changed except in writing and signed by Customer
and Lender. The descriptive headings hereof do not constitute a part of the
Agreement and no inferences shall be drawn there from. Whenever the
context of the Agreement requires, the masculine gender includes the
feminine or neuter, and the singular number includes the plural, and
whenever the word Lender is used herein, it shall include all assignees of
Lender. If there is more than one Customer named in the Agreement, the
liability of each shall be joint and several.
15. NOTICES - All of Customer's notices to Lender must be sent by
certified mail or recognized overnight delivery service, postage prepaid, to
Lender's address stated in this Agreement, or by facsimile transmission to
our facsimile telephone number, with oral confirmation of receipt. Lender's
notices to Customer may be sent first class mail, postage prepaid, to
Customer's address stated in this Agreement.
OPINION OF COUNSEL
16. MISCELLANEOUS - Customer and Lender intend and agree that a
photocopy or facsimile of this Agreement and all related documents, with
their signatures thereon shall be treated as originals, and shall be deemed
to be as binding, valid, genuine and authentic as an original signature
document for all purposes. This Agreement is a "Finance Agreement" as
defined in Article 2A of the UCC.
17. JURISDICTION - This Agreement shalt be governed by the laws of
the state in which the Customer is located.
18. CUSTOMER REPRESENTATIONS - Customer represents and
warrants that (i) It has complete and unrestricted power to enter into this
Agreement, (ii) the persons executing this Agreement have been duly
authorized to execute this Agreement on Customer's behalf, (iii) all
information supplied to Lender is true and correct, including all credit and
financial information and (iv) it is able to meet all its financial obligations,
including the rent payments hereunder.
THE LOGO APPEARING ON THIS DOCUMENT IS A FEDERALLY REGISTERED TRADEMARK
AND MAY NOT BE USED IN ANY WAY NOR MAY THIS DOCUMENT BE ALTERED DR
MANIPULATED WITHOUT THE PRIOR EXPRESS WRITTEN CONSENT OF AT&T CAPITAL
SERVICES, INC. CUSTOMER MAY TRANSFER THIS DOCUMENT FROM ELECTRONIC FORMAT
TO ATANGIBLE ONE BY PRINTING IT IN ITS UNALTERED STATE.
Customer lnibals, �
With respect to that certain AT&T Muni Mobility Financing Agreement (the "Agreement°) dated by and between AT&T Capital Services, Inc, and the Customer, I
am of the opinion that: (i) the Customer is, within the meaning of Section 103 of the Internal Revenue Code of 1986, as amended, a State or a fully constituted
political subdivision or agency of the State of the Equipment location described herein; (ii) the execution, delivery and performance by the Customer of the
Agreement have been duly authorized by all necessary action on the part of the Customer, and, (iii) the Agreement constitutes a legal, valid and binding
obligation of the Customer enforceable in accordance with its terms.
7 I . (tL
Attorney for Customer
Page 3 of 3
Form. Rev. 2-16-2017
AT&T Capital Services, Inc. AT&T Muni Mobility SM
o�J ��� 36 S. Fairview Ave.
Park Ridge, IL 6068-4016 Financing Agreement
Office: 800/323-7312
Fax: 847/326-0573 Number: 001-2340900-006
Dated: April 5, 2019
Lessee
Customer full legal name
THE CITY OF SOUTH BEND, INDIANA
Telephone number Fax number
Federal Employer Id Number (Required)
(574) 245-6205
Contact Name
E-Mail Address
SHAWN DELAHANTY
I sdelahan@southbendin.gov
Headquarter Address
City
State Zip County
227 WEST JEFFERSON BLVD.
SOUTH
BEND IN 46601 ST JOSEPH
Location, if different from above
City
State
Zip
County
227 WEST JEFFERSON BLVD,
SOUTH BEND
IN
46601
ST JOSEPH
Equipment Detail
Equipment Description
Mobility - 11 iPads and 4 Surface Tablets
Equipment Supplier AT&T Mobility Corporation
Schedule of Rental Payments
«wawa
Purchase option
One Dollar
Down Payment (if applicable)" Term (in months)
Total number of payments: 36 in Arrears
36
"Payable to AT&T Capital Services, Inc. and due upon execution of this Agreement..
Payment frequency:
Payments"': 36 at $262.30
Monthly
Remaining at $ (plus applicable taxes)
"Pavments may be indexed up until agreement commencement.
Acknowledgement
Customer hereby certifies that he/she has read and agrees to all of the
terms and conditions set forth on pages 1-3 of this AT&T Mobility
Financing Agreement.
Customer Name THE CITY OF SOUTH BEND, INDIANA
DBA:
Name and Title (please print) 'We p_r
X . n, x p"4 0 f N[?� 1
Signature ,
x
Accepted By
THIS AGREEMENT IS NOT BINDING UNTIL ACCEPTED BY LENDER.
Lender Name
AT&T CAPITAL SERVICES, INC.
Signature
Form. Rev. 2-16-2017 Pagel of 3
Terms and Conditions
1. AGREEMENT - Subject to the terms and conditions of this AT&T Muni
Mobility Financing Agreement (the "Agreement"), Customer agrees to finance
from Lender the equipment (the "Equipment") described on page 1 of this
Agreement. The Agreement shall commence on the date the Equipment is
delivered to the customer ("Commencement Date") and shall continue for the
number of months specified in the Agreement ("Tenn").
Customer's failure to execute this Agreement within ninety (90) days of the
delivery of the Equipment will result in this Agreement converting to a cash
sale, with payment due and payable immediately.
2. PAYMENTS - During the Term of the Agreement, Customer agrees to
pay Lender the total number of payments multiplied by the amount of each
payment (plus taxes) specified on page 1 of the Agreement. The due date of
the first payment is the date upon which the Equipment is delivered to
Customer or any later date designated by Lender. Restrictive endorsements
on checks sent to Lender will not reduce Customer's obligations to Lender.
The payment amount specified is indexed to like -term US Treasury Bills, and
any increase or decrease in the corresponding US Treasury Bills will cause the
payment to be adjusted point for point at the time of the Commencement Date,
The payments do not include any additional interest expense for progress
payments which are required by Lender on all transactions with installations
exceeding 60 days., Progress payments will be financed through Lender at
Prime Rate plus 2% at time of funding.
3. NON -CANCELABLE AGREEMENT - Customer's obligation to make
payments and to pay any other amounts due hereunder shall be ABSOLUTE
AND UNCONDITIONAL and shall not be subject to any delay, cancellation,
termination, reduction, set-off, defense, counterclaim or recoupment for any
reason whatsoever. This is an irrevocable Agreement for the full Term and
cannot be cancelled, other than for Non -Appropriation, as hereinafter defined.
4. NON -APPROPRIATION: This Section is applicable only if the inclusion
of such a non -appropriation provision is legally required. Customer's
obligations to pay Payments and any other amounts due for each fiscal period
is contingent upon approval of the appropriation of funds by its governing
body. In the event funds are not appropriated for any fiscal period equal to
amounts due under the Agreement, Customer may terminate the Agreement
effective on the first day of such fiscal period ("Termination Date"), if: (a)
Customer has used due diligence to exhaust all funds legally available; and (b)
Lender has received written notice from Customer at least thirty (30) days
before the Termination Date.. Upon the occurrence of such non -appropriation,
Customer shall not be obligated for Payments for any fiscal period for which
funds have not been so appropriated, and Customer shall deliver the
Equipment to Lender on the Termination Date, packed for shipment in
accordance with the manufacturer's specifications, freight prepaid and insured
to any location in the continental United States designated by Lender. If
Customer terminates an Agreement pursuant to this Section, unless the
following would affect the validity of a Agreement, Customer will not purchase,
lease, rent, seek appropriations for, or otherwise obtain equipment serving the
same function as the Equipment for the fiscal period in which such termination
occurs or the next succeeding fiscal period and such an obligation will survive
termination of this Agreement.
5. DELIVERY AND ACCEPTANCE - Customer understands that Lender
is not responsible for delivery of Equipment. Customer holds Lender harmless
from specific performance of this Agreement and from any damages if for any
reason the manufacturer, supplier, vendor or distributor (collectively referred to
in this Agreement as "Vendor") delays in delivery, or if the Equipment is
unsatisfactory.
6. WARRANTY DISCLAIMER - CUSTOMER AGREES THAT IT HAS
SELECTED THE VENDOR AND PRODUCT BASED UPON ITS OWN
JUDGEMENT AND DISCLAIMS ANY RELIANCE UPON ANY
STATEMENTS OR REPRESENTATIONS MADE BY LENDER. LENDER
MAKES NO WARRANTY WITH RESPECT TO THE PRODUCT, EXPRESS
OR IMPLIED, AND LENDER SPECIFICALLY DISCLAIMS ANY WARRANTY
OF MERCHANTABILITY AND OF FITNESS FOR A PARTICULAR
PURPOSE AND ANY LIABILITY FOR CONSEQUENTIAL DAMAGES
ARISING OUT OF THE USE OF OR THE INABILITY TO USE THE
PRODUCT. WARRANTIES MADE BY THE VENDOR TO THE LENDER
SHALL INURE TO THE BENEFIT OF THE CUSTOMER, TO THE EXTENT
ASSIGNABLE. IF THE EQUIPMENT DOES NOT OPERATE AS
REPRESENTED, WARRANTED OR GUARANTEED BY VENDOR, OR ARE
UNSATISFACTORY FOR ANY REASON, CUSTOMER SHALL MAKE ITS
CLAIM AND ANY COMPLAINT THEREFOR AGAINST VENDOR, AND NOT
AGAINST LENDER AND SHALL CONTINUE TO MAKE ALL PAYMENTS
REQUIRED HEREUNDER. CUSTOMER ACKNOWLEDGES THAT VENDOR
IS NOT AN AGENT OF LENDER AND STATEMENTS OR
REPRESENTATIONS OF THE VENDOR SHALL NOT BIND OR AFFECT
LENDER, AND SHALL NOT AFFECT THE CUSTOMER'S OBLIGATIONS
UNDER THIS AGREEMENT.
7. NO AGENCY - Customer acknowledges that (1) there is no agency or
joint venture between Lender and the Vendor; (2) neither the Vendor nor any
other person is authorized to act on Lender's behalf; and (3) ONLY AN
INDIVIDUAL AUTHORIZED BY LENDER IS PERMITTED TO WAIVE OR
ALTER ANY TERM OR CONDITION OF THIS AGREEMENT.
B. ASSIGNMENT - LENDER MAY ASSIGN ITS INTEREST IN THIS
AGREEMENT WITHOUT CUSTOMER'S CONSENT. CUSTOMER AGREES
THAT IN ANY ACTION BROUGHT BY AN ASSIGNEE AGAINST
CUSTOMER TO ENFORCE LENDER'S RIGHTS HEREUNDER, CUSTOMER
WILL NOT ASSERT AGAINST SUCH ASSIGNEE, AND EXPRESSLY
WAIVES AS AGAINST ANY ASSIGNEE, ANY BREACH OR DEFAULT ON
THE PART OF LENDER HEREUNDER OR ANY OTHER DEFENSE, CLAIM
OR SET-OFF WHICH CUSTOMER MAY HAVE AGAINST LENDER EITHER
HEREUNDER OR OTHERWISE. NO SUCH ASSIGNEE SHALL BE
OBLIGATED TO PERFORM ANY OBLIGATION, TERM OR CONDITION
REQUIRED TO BE PERFORMED BY LENDER HEREUNDER.
9. QUIET ENJOYMENT - Provided that no Event of Default (as defined in
Section 12 herein) has occurred or is continuing hereunder, Lender shall not
interfere with Customer's right of quiet enjoyment and use of the Equipment.
10. TAXES AND FEES - Customer shall pay when due and shall indemnify
Lender for, and hold Lender harmless from and against all federal, state, and
local filing fees, assessments, taxes including without limitation, sales, lease,
use, excise and personal property taxes (excluding only taxes payable with
respect to Lender's net income) which may be imposed on the Lender arising
in any way out of the use or leasing of the Equipment. Such amounts shall be
considered additional rent and shall be payable by Customer upon demand by
Lender.
The obligations under this section shall survive the expiration or termination of
this Agreement.
11. INDEMNITY - Customer hereby indemnifies Lender and holds Lender
harmless from any and all claims, actions, suits, proceedings, costs,
expenses, damages and liabilities, including attorney's fees, arising out of or
connected with the Equipment or the use thereof, including without limiting the
generality of the foregoing, its manufacture, selection, delivery, possession,
use, leasing, fitness operation, return, or latent or other defects, whether or not
discoverable, or arising out of any failure by Customer to perform or comply
with any of the terms and conditions of this Agreement. The indemnities
contained herein shall continue in full force and effect notwithstanding the
termination of this Agreement, whether by expiration of time, by operation of
law, or otherwise.
12. DEFAULT AND REMEDIES - If Customer (a) does not pay rent within
ten (10) days after the same becomes due, (b) breaches any of its
representations, warranties or other obligations under the Agreement, (c) is in
default under any other agreement between Customer and Lender (d)
becomes insolvent or assigns its assets for the benefit of its creditors, or (e)
enters (voluntarily or involuntarily) a bankruptcy proceeding ("Event(s) of
Default"), Customer will be in default. Upon the occurrence of an Event of
Default, Lender may require that Customer pay the remaining balance of all of
the rental payments due under this Agreement, present valued using a 3% per
year discount rate. Customer also represents to Lender that interest on all
sums due Lender from the date of default until paid will be at the rate of one
and one-half percent (1-1/2%) per month, but only to the extent permitted by
law. In addition, Lender shall be entitled to recover from Customer any of the
remedies available under the Uniform Commercial Code ("UCC") or any other
law. If Lender refers this Agreement to an attorney or collection agency for
enforcement or collection, Customer agrees to pay the cost of recovery
including, but not limited to, legal fees and expenses.
Page 2 of 3
Customer initials X
Form. Rev. 2-16-2017
13. OTHER RIGHTS - Customer agrees that any delay or failure to
enforce Lender's rights under this Agreement does not prevent Lender from
enforcing any rights at a later time. Customer and Lender intend this
Agreement to be a valid and legal document, and agree that if any part is
determined to be unenforceable, all other parts will remain in full force and
effect.
14. ENTIRE AGREEMENT; CHANGES - This Agreement contains the
entire agreement between Customer and Lender and supersedes all
previous discussions and the terms and conditions of any purchase orders
issued to and/or by Customer and it may not be altered, amended, modified,
terminated or otherwise changed except in writing and signed by Customer
and Lender. The descriptive headings hereof do not constitute a part of the
Agreement and no inferences shall be drawn there from. Whenever the
context of the Agreement requires, the masculine gender includes the
feminine or neuter, and the singular number includes the plural, and
whenever the word Lender is used herein, it shall include all assignees of
Lender, If there is more than one Customer named in the Agreement, the
liability of each shall be joint and several.
15. NOTICES - All of Customer's notices to Lender must be sent by
certified mail or recognized overnight delivery service, postage prepaid, to
Lender's address stated in this Agreement, or by facsimile transmission to
our facsimile telephone number, with oral confirmation of receipt. Lender's
notices to Customer may be sent first class mail, postage prepaid, to
Customer's address stated in this Agreement.
OPINION OF COUNSEL
16. MISCELLANEOUS - Customer and Lender intend and agree that a
photocopy or facsimile of this Agreement and all related documents, with
their signatures thereon shall be treated as originals, and shall be deemed
to be as binding, valid, genuine and authentic as an original signature
document for all purposes. This Agreement is a "Finance Agreement" as
defined in Article 2A of the UCC.
17. JURISDICTION - This Agreement shall be governed by the laws of
the state in which the Customer is located.
18. CUSTOMER REPRESENTATIONS - Customer represents and
warrants that (i) It has complete and unrestricted power to enter into this
Agreement, (ii) the persons executing this Agreement have been duly
authorized to execute this Agreement on Customer's behalf, (iii) all
information supplied to Lender is true and correct, including all credit and
financial information and (iv) it is able to meet all its financial obligations,
including the rent payments hereunder.
THE LOGO APPEARING ON THIS DOCUMENT IS A FEDERALLY REGISTERED TRADEMARK
AND MAY NOT BE USED IN ANY WAY NOR MAY THIS DOCUMENT BE ALTERED OR
MANIPULATED WITHOUT THE PRIOR EXPRESS WRITTEN CONSENT OF AT&T CAPITAL
SERVICES, INC. CUSTOMER MAY TRANSFER THIS DOCUMENT FROM ELECTRONIC FORMAT
TO A TANGIBLE ONE BY PRINTING IT IN ITS UNALTERED STATE.
Customer initials
�v
With respect to that certain AT&T Muni Mobility Financing Agreement (the "Agreement") dated by and between AT&T Capital Services, Inc. and the Customer, I
am of the opinion that: (i) the Customer is, within the meaning of Section 103 of the Internal Revenue Code of 1986, as amended, a State or a fully constituted
political subdivision or agency of the State of the Equipment location described herein; (ii) the execution, delivery and performance by the Customer of the
Agreement have been duly authorized by all necessary action on the part of the Customer; and, (iii) the Agreement constitutes a legal, valid and binding
obligation of the Customer enforceable in accordance with its terms.
Attorney for Customer
Page 3 of 3
Form. Rev. 2-16-2017
Farm 8038-GIC Information Return for Small Tax -Exempt
Governmental Bond Issues, Leases, and Installment Sales
(Rev. January [he T 1■ under Internal Revenue Code section 149(e) OMB No. 1545 0720
Department of the Treasury
Internal Revenue Service Caution: ff the issue price of the issue is $100, 000 or more; use Form 8038-G.
lorting Authority Check box it Amended Return I
THE ICiT"P 47F SC�'Tff 13FNb IWk3111r�V. ........ �� �..
lssirar"s e arptaaywr i¢krnl6l capon rrorertak:r Ih1y
it
3 Number and street ('or P.O. trox al malC is notdefivered to street address) Raomrsuile
227 WEST J EFFERSON EBLVD,
4 City,.
_..... _ _
-town, po or sl office, stale. and 21P code 5 Report number (For IRS Use Only)
or o0un employes of issuer or designated coMict person whom the IRS may call for more inlormation 17 Telephone number of officer or legal
Description of 0bll atioins C he'Ck one: a single issue El or a consolidated return I� ,
8a Issue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . .
88
b Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format (for
example, 01/01/2009) (see instructions) ►
9 Amount of the reported obligations) on line 8a that is;
a For leases for vehicles . . . . . . . . . . . . . . . . . . . .
92
b For leases for office equipment - . . . . . . . . . . . . . . . . . . . .
9b
c For leases for real property . . . . . . . . . . . . . . . . . . . . . .
9c
d For leases for other (see instructions) . . . . . . . . . . . , . . _ _ _ _
9d
e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . .
9e
f For bank loans for office equipment . . . . . . . . . . . . . . . . . .
91!
g For bank loans for real property . . . . . . . . . . . . . . . . . . . . . . .
9i
h For bank loans for other (see instructions) . . . . . . . . . . . . . . . . .
9h
i Used to refund prior issue(s) . . . . . . . . . . . . . . . . , . . . ..
9i
i Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank)
9-
k Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9k
10 If the issuer has designated any issue under section 265(b)(3)(13)(i)(III) (small issuer exception), check
............
this box . . - . ►
11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions)
. ► I_e)
12 Vendor's or bank's name:
^ 13 Vnnr1nr'9 nr hqintr"c nrnnInvrssr erfnnt fre^afennruimhrrr°
under penalties of per)ury, I decare that i have examined trvs return and accompany!n schedules and statements, and to the feast of'ruy kmvhealga and belief„ ffley are
Sinature Itue, correct, and complete I hpnher declare that I ooaeaRM to the IRS's d'is,01"rro of t issuer's return information, as necessary to process tCvfg roturn, to theperacrt(�
g that I have authorized above.
and _ p 74
_._
Consent Signature of issuer's authorized representative Date Type or print name and bile
Paid Print/T"ype preparer's name Preparers signature rJate Check ❑ if JiPTIN
Prepare' self-employed
Use Only rir "s name ► Flint's EIN ■
Frr, ' at�ttlna� q ► Phone na.
General Instructions
Section references are to the Internal Revenue
Code unless otherwise noted.
What's New
The IRS has created a page an IRS.gov for
information about the Form 8038 series and
its instructions, at www.irs.gov/formBO38.
Information about any future developments
affecting the Form 8038 series (such as
legislation enacted after we release it) will be
posted on that page_
Purpose of Form
Form 8038-GC is used by the issuers of tax-
exempt governmental obligations to provide
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 Tile Form 8038-GC.
Issuers of a 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 to file a separate
Form 8038-GC for any tax-exempt
governmental obligation with an issue price
of 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 an election was made to
pay a penalty in lieu of arbitrage rebate (see
the line 11 instructions).
Filing a consolidated return 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 including 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. However, if the
issue is a construction issue, 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.
Cat. No. 64108B Form 80W-GC (Rev, 1 2012)
Form 8038-GC (Rev. 1-2012)
When To File
To file a separate return for a single issue, file
Form 8038-GC on or before the 15th 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 15th of the calendar year following
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. Proc. 2002-48, 2002-37
I.R.B. 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, "Request for
Relief under section 3 of Rev. Proc. 2002-48."
Attach to the Form 8038-GC a letter briefly
stating why the form was not submitted to the
IRS on time. Also 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 Fife next.
Where To File
File Form 8038-GC, and any attachments,
with the Department of the Treasury, Internal
Revenue Service Center, Ogden, UT 84201.
Private delivery services. You can use
certain private delivery services designated by
the IRS to meet the "timely mailing as timely
filing/paying" rule for tax returns and
payments. These private delivery services
include only the following:
• DHL Express (DHL): DHL Same Day Service.
• Federal Express (FedEx): FedEx Priority
Overnight, FedEx Standard Overnight, FedEx
2Day, FedEx International Priority, and FedEx
International First.
• United Parcel Service (UPS): UPS Next Day
Air, UPS Next Day Air Saver, UPS 2nd Day
Air, UPS 2nd Day Air A.M., UPS Worldwide
Express Plus, and UPS Worldwide Express.
The private delivery service can tell you
how to get written proof of the mailing date.
Other Forms That May Be
Required
For rebating arbitrage (or paying a penalty in
lieu of 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.
For a tax-exempt governmental obligation
with an issue price of $100,000 or more, use
Form 8038-G.
Rounding to Whole Dollars
You may show the money items on this return
as whole -dollar amounts. To do so, drop any
amount less than 50 cents and increase any
amount from 50 to 99 cents to the next higher
dollar.
Definitions
Obligations. This refers to a single tax-
exempt governmental obligation it Form
8038-GC is used for separate reporting or to
multiple tax-exempt governmental obligations
if the form is used for consolidated reporting.
Tax-exempt obligation. This is any obligation
including a bond, installment purchase
agreement, or financial lease, on which the
interest is excluded from income under
section 103.
Tax-exempt governmental obligation. A
tax-exempt obligation that is not a private
activity bond (see below) is a tax-exempt
governmental obligation. This includes a bond
issued by a qualified volunteer fire department
under section 150(e).
Private activity bond. This includes an
obligation issued as part of an issue in which:
• More than 10% of the proceeds are to be
used for any private activity business use, and
. More than 10% of the payment of principal
or interest of the issue is either (a) secured by
an interest in property to be used for a private
business use (or payments for such property)
or (b) to be derived From payments for
property (or borrowed money) used for a
private business use.
It also includes a bond, the proceeds of
which (a) are to be used to make or finance
loans (other than loans described in section
141(c)(2)) to persons other than governmental
units and (b) exceeds the lesser of 5% of the
proceeds or $5 million.
Issue. Generally, obligations are treated as
part of the same issue only if they are issued
by the same issuer, on the same date, and as
part of a single transaction, or a series of
related transactions. However, obligations
issued during the same calendar year (a)
under a loan agreement under which amounts
are to be advanced periodically (a "draw -
down loan") or (b) with a term not exceeding
270 days, may be treated as part of the same
issue if the obligations are equally and ratably
secured under a single indenture or loan
agreement and are issued under a common
financing arrangement (for example, under the
same official statement periodically updated
to reflect changing factual circumstances).
Also, for obligations issued under a draw -
down loan that meets the requirements of the
preceding sentence, obligations issued during
different calendar years may be treated as
part of the same issue if all of the amounts to
be advanced under the draw -down loan are
reasonably expected to be advanced within 3
years of the date of issue of the first
obligation. Likewise, obligations (other than
private activity bonds) issued under a single
agreement that is in the form of a lease or
installment sale may be treated as part of the
same issue if all of the property covered by
that agreement is reasonably expected to, be
delivered within 3 years of the date of Issue of
the first obligation.
Arbitrage rebate. Generally, interest on a
state or local bond is not tax-exempt unless
the issuer of the bond rebates to the United
Slates arbitrage profits earned from investing
proceeds of the bond in higher yielding
nonpurpose investments. See section 14B(f).
Construction issue. This is an issue of tax-
exempt bonds that meets both of the
following conditions:
Page 2
1. At least 75°% of the available construction
proceeds of the issue are to be used for
construction expenditures with respect to
property to be owned by a governmental unit
or a 501(c)(3) organization, and
2. All of the bonds that are part of the issue
are qualified 601(c)(3) bonds, bonds that are
not private activity bonds, or private activity
bonds issued to finance property to be owned
by a governmental unit or a 501(c)(3)
organization.
In lieu of rebating any arbitrage that may be
owed to the United States, the issuer of a
construction issue may make an irrevocable
election to pay a penalty. The penalty Is equal
to 1-1/2% of the amount of construction
proceeds that do not meet certain spending
requirements. See section 148(0(4)(C) and the
Instructions for Form 8038-T.
Specific Instructions
In general, a Form 8038-GC must be
completed on the basis of available
information and reasonable expectations as of
the date of issue. However, forms that are
filed on a consolidated basis may be
completed on the basis of information readily
available to the issuer at the close of the
calendar year to which the form relates,
supplemented by estimates made in good
faith.
Part 1—Reporting Authority
Amended return. An issuer may file an
amended return to change or add to the
information reported on a previously filed
return for the same date of issue. It you are
filing to correct errors or change a previously
fled return, check the "Amended Return' box
in the heading of the form.
The amended return must provide all the
information reported on the original return, in
addition to the new corrected information.
Attach an explanation of the reason for the
amended return and write across the top
"Amended Return Explanation."
Line 1. The Issuer's name is the name of the
entity issuing the obligations, not the name of
the entity receiving the benefit of the
financing. In the case of a lease or installment
sale, the issuer is the lessee or purchaser.
Line 2. An issuer that does not have an
employer identification number (EIN) should
apply for one on Form SS-4, Application for
Employer Identification Number. You can get
this form on the IRS website at IRS.gov or by
calling 1-800-TAX-FORM (1-800-829-3676).
You may receive an EIN by telephone by
following the instructions for Form SS-4.
Lines 3 and 4. Enter the issuer's address or
the address of the designated contact person
listed on line 6. If the issuer wishes to use its
own address and the issuer receives its mail
in care of a third party authorized
repre„ ntative (such as an accountant or
attorney), enter on the street address line
"C/O" followed by the third parry's name and
street address or P.O. box. Include the suite,
room, or other unit number after the street
address. If the post office does not deliver
mail to the street address and the issuer has a
P.O. box, show the box number instead of the
Form 8038-GC (Rev. 1-2012)
street address. If a change in address occurs
after the return is filed, use Form 8522,
Change of Address, to notify the IRS of the
new address.
Note. The address entered on lines 3 and 4 is
the address the IRS will use for all written
communications regarding the processing of
this return, including any notices. By
authorizing a person other than an authorized
officer or other employee of the issuer to
communicate with the IRS and whom the IRS
may contact about this return, the issuer
authorizes the IRS to communicate directly
with the individual listed on line 6, whose
address is entered on lines 3 and 4 and
consents to disclose the issuer's return
information to that individual, as necessary, to
process this return.
Line 5. This line is for IRS use only. Do not
make any entries in this box.
Part I]— Description of Obligations
Check the appropriate box designating this as
a return on a single issue basis or a
consolidated return basis.
Line 8a. The issue price of obligations is
generally determined under Regulations
section 1.148-1(b). Thus, when Issued for
cash, the issue price is the price at which a
substantial amount of the obligations are sold
to the public. To determine the issue price of
an obligation issued for property, see sections
1273 and 1274 and the related regulations.
Line 8b. For a single issue, enter the date of
issue (for example, 03/15/2010 for a single
issue issued on March 15, 2010), generally
the date on which the issuer physically
exchanges the bonds that are part of the
issue for the underwriter's (or other
purchaser's) funds; for a lease or installment
sale, enter the date interest starts to accrue.
For issues reported on a consolidated basis,
enter the first day of the calendar year during
which the obligations were issued (for
example, for calendar year 2010, enter
01101/2010).
Lines 9a through 9h. Complete this section if
property other than cash is exchanged for the
obligation, for example, acquiring a police car,
a fire truck, or telephone equipment through a
series of monthly payments, (This type of
obligation is sometimes referred to as a
"municipal lease.") Also complete this section
if real property is directly acquired in
exchange for an obligation to make periodic
payments of interest and principal.
Po not complete lines 9a through 9d if the
proceeds of an obligation are received in the
form of cash even if the term "lease" is used
In the title of the issue. For lines ga through
9d, enter the amount on the appropriate line
that represents a lease or installment
purchase. For line 9d, enter the type of item
that is leased. For lines 9e through 9h, enter
the amount on the appropriate line that
represents a bank loan. For line 9h, enter the
type of bank loan.
Lines 91 and 9j. For line 9i, enter the amount
of the proceeds that will be used to pay
principal, interest, or call premium on any
other issue of bonds, including proceeds that
will be used to fund an escrow account for
this purpose. Several lines may apply to a
particular obligation. For example, report on
lines 9i and 91 obligations used to refund prior
issues which represent loans from the
proceeds of another tax-exempt obligation.
Line 9k. Enter on line 9k the amount on line
8a that does not represent an obligation
described on lines 9a through 9j.
Line 10. Check this box if the issuer has
designated any issue as a "small issuer
exception" under section 265(b)(3XR)(1)(III)_
Line 11. Check this box if the issue is a
construction issue and an irrevocable election
to pay a penalty in lieu of arbitrage rebate has
been made an or before the date the bonds
were issued_ The penalty is payable with a
Form 8038-T for each &month period after
the date the bonds are issued. Do not make
any payment of penalty in lieu of rebate with
Form 8038-GC. See Rev, Proc. 92-22,
1992-1 C.B. 736, for rules regarding the
"election document."
Line 12. Enter the name of the vendor or bank
who is a party to the installment purchase
agreement, loan, or financial lease. If there
are multiple vendors or banks, the issuer
should attach a schedule.
Line 13. Enter the employer identification
number of the vendor or bank who is a party
to the installment purchase agreement, loan,
or financial lease, If there are multiple vendors
or banks, the issuer should attach a schedule.
Signature and Consent
An authorized representative of the issuer
must sign Form 8038-GC and any applicable
certification. Also print the name and title of
the person signing Form 8038-GC. The
authorized representative of the issuer signing
this form must have the authority to consent
to the disclosure of the issuer's return
information, as necessary to process this
return, to the person(s) that has been
designated in this form.
Note. If the issuer authorizes in line 6 the IRS
to communicate with a person other than an
officer or other employee of the issuer, (such
authorization shall include contact both in
writing regardless of the address entered in
lines 3 and 4, and by telephone) by signing
this form, the issuer's authorized
representative consents to the disclosure of
the issuer's return information, as necessary
to process this return, to such person.
Page 3
Paid Preparer
If an authorized representative of the issuer
filled in its return, the paid preparer's space
should remain blank. Anyone who prepares
the return but does not charge the
organization should not sign the return.
Certain others who prepare the return should
not sign. For example, a regular, full-time
employee of the issuer, such as a clerk,
secretary, etc., should not sign.
Generally, anyone who is paid to prepare a
return must sign it and fill in the other blanks
in the Paid Preparer Use Only area of the
return. A paid preparer cannot use a social
security number in the Paid Preparer Use Only
box. The paid preparer must use a preparer
tax identification number (PTIN). If the paid
preparer is self-employed, the preparer
should enter his or her address in the box,
The paid preparer must:
• Sign the return in the space provided for the
preparer's signature, and
• Give a copy of the return to the issuer.
Paperwork Reduction Act Notice
We ask for the information on this form to
carry out the Internal Revenue laws of the
United States. You are required to give us the
information. We need it to ensure that you are
complying with these laws.
You are not required to provide the
information requested on aform that is
subject to the Paperwork Reduction Act
unless the form displays a valid OMB control
number. Books or records relating to a form
or Its instructions must be retained as long as
their contents may become material in the
administration of any Internal Revenue law.
Generally, tax returns and return information
are confidential, as required by section 6103.
The time needed to complete and file this
form will vary depending on individual
circumstances. The estimated average time is:
Learning about the
law or the form . , . 4 hr., 46 min.
Preparing the form . . . . 2 hr., 22 min.
Copying, assembling, and
sending the form to the IRS , 2 hr.. 34 min.
If you have comments concerning the
accuracy of these time estimates or
suggestions for making this form simpler, we
would be happy to hear from you. You can
write to the Internal Revenue Service, Tax
Products Coordinating Committee,
SE:W:CAR:MP:T.M:S, 1111 Constitution Ave,
NW, IR-6526, Washington, 00 20224. Do not
send the form to this address. Instead, see
Where To File.
BOARD OF PUBLIC WORKS
AGENDA ITEM REVIEW REQUEST FORM
Date 4/4/2019 ............................... ........ ...
Department
Innovation &
Name Shawn Delaha Technolo
BPW Date 4/23/19 Phone Extension 6205
NEWMN
Re ulred Prior to Submittal to Board
BPW Attorney ® Attorney Name McDaniels
Dept. Attorney 0 Attorney Name Kennedy
.... _................____�
Purchasing 0 Schmidt
Check the A
Professional Services Agreement
❑ Open Market Contract
❑ Bid Opening
F1 Quote Opening
EJ Proposal Opening
Chg. Order, No.
Other: Flardwa.re Lease
Company or Vendor Name
New Vendor
MBE/WBE Contractor
Project Name
Project Number
Funding Source
Account No.
Amount
Terms of Contract
Purpose/Description
;te Item i..:y_p.�L_
Contract
n Amendment/Addendum
El Bid Award
(l Quote Award
n C/O & PCA No.
❑ Traffic Control
tired. Information
All Submissions
Lf Proposal
Special Purchase, QPA
Req. to Advertise
FJ Reject Bids/Quotes
PCA
Resolution
Ease./Encroach
❑ Title Sheei
AT&T Mobility
.. ._._....................
❑ Yes❑ If Yes, Approved by Purchasing
Z No
EJ MBE Completed E-Verify Form Attached El Yes
❑ WBE] No
Mobile Tablet Lease
IT Lease accounts
279-0672-415.38-01 (principal) and 38-02 (interest)
$9445.32
............................._
36 months
.—Mobile tablet lease for Fire Department, VPA, and Mayor's
Office.
For Chan a Orders Onl
❑ Amount of Increase $ ...
_ .................. ._.
❑ Decrease ($ )
Previous Amount
$
Increase
%
Current Percent of Change:
Decrease��%
New Amount
$
Increase
%
Total Percent of Change:
Decrease
%
Time Extension Amount:
New Completion Date: