Pitney Bowes (2)RSCAL RJNDING I~ERIOD FROM TO
Your' BdSiness Needs'
STATE AND LOCAL GOVERNMENT TERM RENTAL AGREEMENT
~ Your Payment Plan
Initial Rental Term Billing
Frequency [] Monthly [] iluartedy [] Other (spec~__J
Next $' "
Next: $ -
Ne~ $
Next.- $ .
[] EqufpmentMaintenanceAgreemeetOnRe~al
dl Solhvam Malnt~e Agreemerit
[] Mete,' On Rental
Nental Terms and ConditionS: ;,-: '
.,:,:. PB SLR2 3(00)
~EC~ OEICE: 27 WATER~ DR · SHELTON CT ~64~-4361 · EQUIPMENT VENDOR: P~ BOWES iNC. · FOR SALES AND SERVICE ~LL 1-800-322-8000
WH~ COPY PBC~ ', PINK COPY Pl~ BOWES ~NC. · Y~Ow coPY CUSTOMER : ' ' ' ~
PAGE 1 · ""
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Pitney Bowes
Rental Account #
STATE AND LOCAL GOVERNMENT TERM RENTAL AGREEMENT
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CREDIT CARD ~EXP DATEL NAME ON GARb~PE
TAX EXEMPT #
FISCAL FUNDING PERIOD FROM
TO
SALES TAX (IF APPLICABLE)
RENTER P0 #
C~j~ Your Business Needs
/ / . z
CHECK ITEMS TO BE INCLUDED IN YOUR TOTAl, RENTAL PAYMENT
[~ Equipment Maintenance Agreement On Rental
[ Soft-G~ard Agreelaent
L3 SoffiNare Maintenance Agreement
D Meter On Rental
E3 RentOr Retains 'title
~ Your Payment Plan
~ Rental Terms and Conditions
Initial Rental Term Billing
Frequency Q Monthly h, guarterly D Other (specify ,)
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Next $
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Next $
/
PR,. .AMEL' ,':j :'-' /
PsADco..T.EP. M./t' l."vcu' r:, EMPLOYEE.
_PB ACCEPTED BY TITLE
By your signature as "Rentar' below, you request that we rent to you the equipment described above or on any schedule
aeached hereto (the "Equipment") for business or commercial purposes. Your oNer wig be binding on us when we accept
it by having an authorized employee sign it. All payments hereunder shall be payable only to us at our executive office,
unless we direct you otherwise in writing.
1 NON-APPROPRIATION: You warrant that you have [~nds available to pay the Total Payments until the end of your current
appropriation period, and shall use your best efforts to obtain funds to pay the Total Payments in each subsequent
appropriation period through the end of your Initial Term. If your appropriation request to yoGr legislative body. or funding
authorit~ CGovern~ng Body") for funds to pay the Total Payments is denied, you may terminate this Agreement on the last
day of the appmpriabon period for which funds have been approprBted, Upon: (i) submission of certified copies of your
funding request and the Governing Body's denial of the appropriation request, and (ii) satisfaction of all charges and
obligations under this Agreement incurred through the end of the appropriation period, including the return of t~e Equipment
at your expense. if you terminate this Agreement and return the Equipment Under this Section, you shall not purchase or
rent eqstpment performing substantially similar functions to those pedormed by the Equipment for a period of one year
following termination
" ' I _t' i/!%
TITLE(/ '/" ~ ~ , / r :'
DATEgSlO/
DISTRICT NAME & # [ , /
DATE
EXECUTIVE OFFICE.' 27 WATERVIEW DR · SHELTON, CT 06484-4361 ° EQUIPMENT VENDOR: PITNEY BOWES INC. ° FOR SALES AND SERVICE CALL 1-800-322-8000
WHITE COPY PBCC · PINK COPY PITNEY BOWES INC. ° YELLOW COPY CUSTOMER
PAGE 1
PB SLR2 (3/00) SEE PAGES 2 & 3 FOR ADDITIONAL TERMS AND CONDITIONS
Approved and Adopted this 5'7~ day of ,2001.
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
BY:
B
ard, Mayoresra
Date: ~ ' (~' "~ /
Bii.~ly~alker, Member
Date:
ATTEST:
Date:
City of Carmel
INDIANA RETAIL TAX EXEMPT
CERTIFICATE NO. 003120155 002 0
FEDERAL EXCISE TAX EXEMPT
35-6000972
ONE CIVIC SQUARE
CARMEL, INDIANA 46032
-"ORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CiTY OF CARMEL - 1997
9%'~0L4~g SHIP
VENDOR TO
PAGE
PURCHASE ORDER NUMBER
THIS NUMBER MUST APPEAR ON INVOICES. NP
VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE,
DESCRIPTION
OUANTITY I UNIT OF MEASUREI
PAYMENT TERMS
DEEcR,P,,o.
FREIGHT
UNIT PRICE ~ ~XTENSION
DEPARTMENT j ACCOUNT
SHIPPING INSTRUCTIONS
· SHIP PREPAID,
· C,O.D. SHIPMENTS CANNOT BE ACCEPTED
· PURCHASE ORDER NUMBER MUST APPEAR ON ALL
SHIPPING LABELS.
· THIS OR[)ER ISSUED IN COMPLIANCE WITH CHAPTER 99. ACTS 1945
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
DOCUMENT CONTROL NO. 10 3 6 iS
PLEASE INVOICE IN DUPLICATE
I PROJECT I P.GjEGT ACCOUNT
AMOUNT
PAYMENT
· NPVOUCHBRCANNOTBEAPPROVEDFORPAYMENTUNLESSTHEP.O.
NUMBER iS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED,
· tHEREBYCERTIPYTHATTHEREISANUNOELIGATEDBALANCEIN
THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER.
ORDERED BY
TITLE
CLERK-TREASURER