HomeMy WebLinkAboutAccess Systems-6/20/2011access
Ss Y 5 7 i Pit
FLEET AGREEMENT
1050 Olson Drive
Waukee, IA 50263
515.987.6227
Account Executive:
Mitch Albert
Date:
Friday, May 27, 2011
See reverse for complete terms and conditions.
S
H
[
P
T
0
Company Name:
Waterloo Police Department
B
1
L
T
0
Company Name:
Department:
Street Address:
Street Address:
715 Mulberry Street
City:
City:
Waterloo
IA
Zip:
50703
State:
Zip:
Phone:
319-291-4500
Fax:
Phone:
Equipment Covered:
[ ] Copier [ ] Digital Printer [ ] Color Copier [ ] Fax Machine [ ] Other (Specify)
Equipment
Model/Serial #
Beginning
Meter
Supplies
Included
Copy
Allowance
Base
Charge
Overage
Rate
See attached Schedule for list of equipment
Y
B 26,595
$466.79
$0.02
Y
C 7,944
$636.86
$0.10
Billing Cycle: Monthly
Comments:
Authorization:
Authorized Signature: L, : ,_,,
� 1
Date: Tum ,Pod �I!
Access Systems Representative: Date:
Please Sign and Return with Your Remittance
Revision 3/13/07
Office Use Only
access
SYS T EMS
EQUIPMENT SCHEDULE
AGREEMENT NO.: 711039
DESCRIPTION` OF EQUIPMENT
MAKE, MODEL NUMBER & INCLUDED ACCESSORIES
NOT
FINANCED
UNDER THIS
SERIAL NO. AGREEMENT
BEGINNING METER
READING
MONTHLY IMAGE
ALLOWANCE PER
MACHINE
(IF NOT CONSOL DATED)
B&W
COLOR
B&W
COLOR
EXCESS PER IMAGE
CHARGE {PLUS TAX)
B&W p COLOR
HP Color LJ CP4024
JPBCB323W®
HP Color LJ CP4024
JPBCB9T04912]
HP Color LJ CP4024
JPBCB9T045IZI
HP Color LJ CP4024
JPBCC2H1DG ,l
HP LJ 4350
USBXN13745
❑
n
❑
n
❑
n
n
n
n
n
n
❑
TOTAL CONSOLIDATED MONTHLY IMAGE ALLOWANCE (IF CONSOLIDATED)
26,595
7,944
$ 0.02
$0.10
VERIFICATION
The undersigned hereby verifies that the information on this Schedule is complete and correct The undersigned also acknowledges having recslved a copy of this Schedule.
DATE
Waterloo, City of, DBA Waterloo Poiict
CUSTOMER
• P0305A_0810
611
SIGNATURE
PRINT NAME & TITLE
COST PER IMAGE AGREEMENT
access
S Y' S T NA ."S
AGREEMENT NO.: 711039
CUSTOMER. ("you".a"r your")
FULL LEGAL NAME Waterloo, City of, DBA Waterloo Police Department
ADDRESS: 715 Mulberry St Waterloo
EQUIPMENT AND PAYMENT TERMS
--
NOT
FINANCED
UNDER THIS
MAKE. MODEL NUMBER & INCLUDED ACCESSORIES SERIAL NO. AGREEMENT
BEGINNING METER
READING
MONTHLY IMAGE
ALLOWANCE PER
MACHINE
(IF NOT CONSOLIDATED)
EXCESS
CHARGE
PER IMAGE
PLUS TAX)
B&W
COLOR
B&W
COLOR
B&W
COLOR
Ricoh SP C430DN: PB1020 fi
Ricoh SP C430DN: PB1020 n
Ricoh SP C430DN n
Ricoh SP C430DN fi
Ricoh SP C430DN n
Ricoh SP C430DN ❑
Ricoh SP C430DNii
Ricoh SP C430DN n
Sharp MX -3110N: FN17, DE12 f
n
TOTAL CONSOLIDATED MONTHLY IMAGE ALLOWANCE (IF CONSOLIDATED)
26,595
7,944
$0.02
$0.10
EQUIPMENT LOCATION: 715 Mulberry St
M6 i tit FREQUENCY: MONTHLY IF NOT CHECKED® OTHER
TERM IN MONTHS: 63
SECURITY DEPOSIT: $ 0
®SEE ATTACHED EQUIPMENT OR GROUP BILLING SCHEDULE
MONTHLY BASE PAYMENT AMOUNT: $ 1,561.03
ADVANCE PAYMENT: $
(`PLUS TAX)
CONTRACT
TFI>S AGREEMENT IS NON -CANCELABLE AND IRREVOCABLE. IT CANNOT BE TERMNATED. PLEASE READ CAREFULLY BEFORE SIGNING. YOU AGREE THAT THIS
AGREEMENT AND ANY CLAIM RELATED TO THIS AGREEMENT SHALL BE GOVERNED BY THE INTERNAL LAWS OF THE STATE IN WHICH OUR (OR, IF WE
ASSIGN THIS AGREEMENT, OUR ASSIGNEE'S) PRINCIPAL PLACE OF BUSINESS IS LOCATED AND ANY DISPUTE CONCERNING THIS AGREEMENT'MLL BE
ADJUDICATED IN A FEDERAL OR STATE COURT IN SUCH STATE. YOU HEREBY CONSENT TO PERSONAL JURISDICTION AND VENUE IN SUCH COURTS AND
WAIVE TRANSFER OF VENUE. EACH PARTY WAIVES ANY RIGHT TO A JURY TRIAL.
CUSTOMER'S AUTHORIZED SIGNATURE
BY SIGNING THIS PAGE, YOU REPRESENT TO US THAT YOU HAVE RECEIVED AND READ THE ADDITIONAL TERM6 AND CONDITIONS APPEARING ON THE
SECOND PAGE OF THIS TWO-PAGE AGREEIVENT. THIS AGREEMENT IS BINDING UPON OUR ACCEPTANCE IEREOF.
�likA, (tI1II
3 ,
(As Stated Above) -
CUSTOMER SIGNATURE PRINT NAVE & ITLE 1 DATE
GOVERNMENTAL CERTIFICATE
1, THE UNDERSIGNED, HEREBY CERTIFY THAT, AS OF THE DATE OF THE AGREE NE NT, (A) THE INDIVIDUAL AH0 EXECUTED TIE AGREEMENT HAD FULL POWER
AND AUTHORITY TO EXECUTE THE AGREEMENT AND (B)THE REPRESENTATIONS SET FORTH IN THE AGREEMENT IN THE PARAGRAPH TITLED "APPLICABLE TO
GOVERNMENTAL ENTITIES ONLY" ARE TRUE AND ACCURATE IN ALL MATERIAL RESPECTS.4�
NAME & TITLE: .,J/7
SIGNATURE;
OWNED. ("we"', "us", "our")
Access Systems Leasing
OWNER
1050 SE Olson Dr Suite I
IFS h DATE: 1490M I l
Waukee
IA
SIGNATURE
PRINT NAME & TITLE
DATE
PO302AM_0810
PAGE 1 OF 2
aCCeSS
TERMS AND CONDITIONS
GENERAL SCOPE OF COVERAGE: In consideration for the payment by Customer of the maintenance charges set forth herein, except as provided herein,
Access Systems, Inc. ('ASI") shall provide all Tabor, parts and materials (except paper, staples, and freight) required for the maintenance and minor repair of the
equipment, set forth on the reverse side hereof, which adjustment and maintenance is caused by the Customer's normal, non-commercial use of the equipment.
Damage to the equipment or components arising out of misuse, negligence, neglect or causes beyond ASi reasonable control are not covered.
SERVICE CALLS: Service calls under this agreement wit be performed during normal business hours at the address where each leased or covered piece of
equipment is located. Travel and labor time for service calls after normal hours (normal business hours are Monday through Friday 8:00 a.m. to 5:00 p.m.), on
weekends and on holidays, If and when available, will be paid by Customer at the overtime rates in effect at the time the service call Is made. Customer agrees to
promptly notify ASi of any requests for service, by contacting the ASI Service Department. During the performance of ASI's maintenance services, Customer
agrees that ASI shall have the right to generate all copies necessary to properly perform its services without being required to credit Customer's account This
agreement does not Include mileage on service calls for customers outside of ASI normal service area. Service performed after the termination, expiration or
nonrenewal of this agreement will be paid for by Customer on a °Per Calf basis at ASI then published rates. Access will guarantee a four (4) business hour
emergency response time for service on the equipment. An emergency call is defined as the equipment is non-operative or print quality Is bad. Non -emergency
service calls wgl be responded to within eight (8) business hours.
CHARGES: The Initial charge for maintenance under this agreement shall be the amount set forth on the reverse side hereof. The rate for maintenance charges
will not increase during the term of this contract Customer agrees to pay the total of all charges for maintenance during the initial tern and any renewal term
within 10 days of the due date or of the date on which ASI invoices Customer for such charges, whichever is earlier. ASI reserves the right to withhold service or
supplies If any charges become past due, regardless of whether those charges are related to this Agreement or the equipment covered by this Agreement.
Customer understands that alterations, attachments, or specification changes to the equipment may require an increase in maintenance charges and agrees to
pay such charges promptly when due. Labor for the installation of memory upgrades or other upgrades and enhancements, or parts and supplies not provided by
ASI, are riot covered by this agreement and will be Installed on a Per Call' basis at ASI then published rates.
Image Flexibility: image volume may be increased or decreased upon the mutual consent of both ASI and Customer. Any change in volume may result in a
change in the per image rate.
METER READINGS: Customer agrees to provide ASI true and accurate meter readings monthly and in any reasonable manner requested by ASI. If accurate
meter readings are not provided, ASI reserves the right to estimate Customer's meter readings based upon previous meter readings and bill Customer based
upon such estimates or to send an ASI representative to visually inspect such meter readings, In which event Customer shall also pay ASI an additional charge for
such site visit.
Upgrade Guarantee: If after thirty six (36) months or thereafter, Customer desires to upgrade equipment, ASI agrees to allow Customer to add, upgrade or
exchange equipment by signing a new agreement with ASI. The payment terms of the new agreement, including total payment, included images, and service
rate, will be based on the products added and new image volume commitiment
RECONDITIONING: In the event Customer's equipment cannot be properly maintained by ASI, due to the age or condition of the egL.ipment, to perform on a
reasonably consistent and good quality basis, Customer's equipment may need to be replaced or reconditioned. ASI will replace the equipment at no cost to the
customer with equipment of equal or greater specifications.
TERM, TERMINATION AND RENEWAL: This agreement shall become effective upon the proper execution of thls Agreement by Customer and ASI, and shall
continue for a period to coincide with the term of the lease. This agreement shall automatically renew for a one year term unless written notice is received by the
non -terminating party 30 days prior to the expiration date, as extended, or approximately 30 days prior to the expected generation of the maximum number of
copies, as extended. ASI reserves the right to modify the maximum number of copies in any renewal in a good faith attempt to approximate the number of copies
Customer would generate during the covered period. Notice of the election not to renew this agreement shall be sent, by the terminating party to the non -
terminating party, by regular first class mail to the Customer contact name and address set forth on the on the reverse side of this agreement, if to Customer, or to
the President of ASI at ASI's address, if sent to ASI. In the event Customer desires to terminate service prior to the end of the term, all monthly service payments
remaining in the term of this agreement will be due immediately at the then current rate.
Notwithstanding anything to the contrary, ASI may terminate this agreement at any time in the event (a) the equipment is modified, damaged, altered, serviced by
personnel other than those employed by ASI, or If parts, supplies, accessories, or components not authorized by ASI are fitted to orused in the equipment; or (b) if
the Customer uses supplies other than ASI supplies and such supplies are defective or not acceptable for use in ASI equipment and cause abnormally frequent
service calls or service problems.
BREACH OR DEFAULT: if the Customer does not pay all charges, billed under the terms of this Agreement, promptly when due, in the event or in the event of a
breach of any of the other terms of this Agreement, ASI may: (a) refuse to service the equipment until remittance is made, (b) provide service on "Per Call" basis
rates, (c) require C.O.D. payment in full at the time of service at ASI's Per Call" basis rates, (d) require all remaining monthly service payments be due
immediately and cease service and (e) take any and all other actions as provided by law. Such remedies shall be cumulative, and the waiver of any one breach
by Customer shall not be deemed a waiver of any other or subsequent breach.
PRORATION AND TRANSFERS: If the covered equipment is upgraded with equipment purchased from ASI, any unused portion of a paid agreement may be
prorated and applied toward a service program for the new equipment. This agreement may not be assigned by the Customer without ASI prior written consent.
Customer specifically agrees that this agreement shall not terminate upon Customer's election to sell, transfer or remove from service any equipment covered by
this Agreement, unless ASI agrees in writing to terminate this agreement prior to such sale. transfer or removal from service.
MISCELLANEOUS: ASI expressly disclaims any duty as an insurer of the equipment herein and Customer shall pay for all costs or repair and parts or
replacement of the equipment made necessary by any casualty, theft, or negligent act of Customer or Customer's agents. Customer agrees to provide reasonable
space and proper and sufficient electrical power as specified or required for each machine. ASI's technicians must be able to access the machine from all sides.
Equipment relocation by ASI is not covered by this agreement. This Agreement represents the entire agreement between the parties and supersedes all prior oral
and written proposals and communications. Customer shall pay all of ASI costs and expenses (including legal fees and costs) incurred in the collection of any
amount due to ASI, or incurred in the enforcement of ASI rights and remedies under this Agreement, whether or not legal action is instituted. In the event any
amounts required to be paid by Customer under this Agreement are not paid when due. ASI may assess and collect a finance charge equal to 11/2% per month on
all outstanding amounts.
This Agreement shall be govemed by and construed according to the laws of the State of Iowa, and the jurisdiction and venue for any legal action shall be in the
City and County of Des Moines, Iowa.
ADDITIONAL' TERMS AND CONDITi3ONS
AGREEMENT. You want us to provide you the equipment referenced herein, excluding equipment marked as not financed under this Agreement ("Equipment°) and you agree to pay us the
amounts payable under the terms of this agreement (°Agreement°) each period by the due date. This Agreement will begin on the date the Equipment is delivered to you or any later date we
designate. We may charge you a reasonable fee to cover documentation and investigation costs. If any amount payable to us is not paid when due, you wig pay a late charge equal to: 1) the
greater of ten (10) cents for each dotter overdue or twenty-six (526.00) dollars; or 2) the highest lawful chargo, if less. My security deposit will be commingled with our assets, will not earn
interest, and will be returned at the end of the term, provided you are not in default If an advance payment is required, the amount exceeding one payment shall be applied to the last
payment(s) during the term or any renewal term.
NET AGREEMENT. THIS AGREEMENT IS NON -CANCELABLE FOR THE ENTIRE AGREEMENT TERM YOU AGREE THAT YOU ARE UNCONDITIONALLY OBLIGATED TO PAY
ALL AMOUNTS DUE UNDER THIS AGREEMENT FOR THE ENTIRE TERM YOU ARE NOT ENTITLED TO REDUCE OR SET-OFF AGAINST AMOUNTS DUE UNDER THIS
AGREEMENT FOR ANY REASON.
IMAGE CHARGES AND OVERAGES. You are entitled to make the total number of images shown under Monthly image Allowance Per Machine (or Total Consolidated Monthly Image
Allowance, If applicable) each month during the term of this Agreement If you make more than the allowed images in any month, you will pay us an additional amount equal to the number of
the excess images made during such month multiplied by the applicable Excess Per Image Charge. Regardless of the number of images made in any month, you will never pay less than
the Base Payment Amount. You agree to provide us with the actual meter readings on any business day of each month as designated by us, provided that we may estimate the number of
images used if such meter readings are not received vain five days after bebrg requested. We wtl adjust the estimated charge for excess images upon receipt of actual meter readings.
You agree that the Base Payment Amount and the Excess Per Image Charges may be proportionately inaeased at any time if our estimated average page coverage is exceeded. At the end
of the first year of this Agreement and once each successive twelve-month period, the Base Payment Amount and the Excess Per image Charges may be increased by a maximum of 10%
of the then existing payment or charge. Images made on equipment marked as not financed under this Agreement will be included In determining your image and overage charges.
EQUIPMENT USE. You will keep the Equipment in good working order, use it for business purposes only and not modify or move it from its initial location without our consent. You agree
that you wilt not take the Equipment out of senbce and have a third party pay (or provide funds to pay) the amounts due hereunder. You will comply with all laws, ordinances, regulations,
requirements and rules relating to the use and operation of the Equipment.
SERVICES5UPPUES. If we have entered into a separate arrangement with you for maintenance, service, supplies, etc. with respect to the Equipment, payments under this Agreement
may include amounts owed under that arrangement, whlch amounts may be invoiced as one payment for your convenience. You agree that you will look solely to us for performance under
any such arrangement and for the delivery of any applicable supplies.
SOFTWAREDATA. Except as provided in this paragraph, references to "Equipment° include any software referenced above or installed on the Equipment We do not own the software and
cannot transfer any interest in it to you. We are not responsible for the software or the obligations of you or the licensor under any license agreement. You are solely responsible for
protecting and removing any confidential datalimages stored on the Equipment prior to its return far any reason.
LIMTATION OF WARRANTIES. EXCEPT TO THE EXTENT THAT VIE HAVE PROVIDED YOU A WARRANTY IN VOTING, WE MAKE NO WARRANTIES, EXPRESS OR IMPLIED,
INCLUDING WARRANTIES OF MERCHANTABLITY OR FITNESS FOR A PARTICULAR PURPOSE. YOU CHOSE ANYlALL THIRD -PARTY SERVICE PROVIDERS BASED ON YOUR
JUDGMENT. YOU NAY CONTACT US OR TM MANUFACTURER FOR A STATEMENT OF THE WARRANTIES, iF ANY, THAT THE MANUFACTURER IS PROVIDING. WE ASSIGN
TO YOU ANY WARRANTIES GIVEN TO US.
ASSIGNMENT. You may not sell, assign, or sublease the Equipment or this Agreement without our written consent We may sell or assign this Agreement and our rights in the Equipment,
in whole or in part, to a third party without notice to you. You agree that if we do so, our asslgnee will have our assigned rights under this Agreement but none of our obligations and will not
be subject to any claim, defense, or set-off that may be assertable against us or anyone else.
LOSS OR DAMAGE. You are responsible for any damage to or ices of the Equipment No such loss or damage will relieve you from your payment obligations hereunder. Except for claims,
losses, or damages caused by our gross negligence or willful misconduct, you agree to indemnify us and our assignee, if applicable, against any claims, Tosses, or damages, including
attorney fees, in any way relating to the Equipment In no event will we be liable for any consequential or indirect damages.
INSURANCE. You agree to maintain comprehensive liabtiity insurance acceptable to us. You also agree to: 1) keep the Equipment fully insured against loss at its replacement cost, with us
named as loss payee; and 2) provide proof of insurance satisfactory to us no later than 30 days fogreving the commencement of this Agreement, and thereafter upon aur written request. If
you fail to maintain property loss insurance satisfactory to us and/or you fall to timely provide proof of such insurance, we have the option, but not the obligation, to secure property lass
insurance on the Equipment from a carrier of our choosing in such forms and amounts as we deem reasonable to protect our interests. If we secure insurance on the Equipment, we will not
name you as an insured party, your interests may not be fully protected, and you will reimburse us the premium which may be higher than the premium you would pay if you obtained
insurance, and which may result in a profit to us through an Investment in reinsurance. If you are current In all of your obligations under the Agreement at the time of loss, any insurance
proceeds received will be applied, at our option, to repair or replace the Equipment, or to pay us the remaining payments due or to become due under this Agreement plus our booked
residual, both discounted at 3% per annum
TAXES. We own the Equipment You will pay when due, either directly or by reimbursing us, at taxes and fees relating to the Equipment and this Agreement. Sales or use tax due upfront
wig be payable over the term with a finance charge.
END OF TERM At the end of the term of this Agreement (or any renewal term) (the "End Date"), this Agreement will renew month to month unless a) you provide us written notice of your
intent to relum the Equipment at least 60 days prior to the End Date, and b) you timely retum the Equipment to the location designated by us, at your expense. If the returned Equipment is
not immediately available for use by another without need of repair, you will reimburse us for all repair costs. You cannot pay off this Agreement or return the Equipment prior to the End
Gate without our consent. If we consent, we may charge you, in addition to other amounts owed, an early termination fee equal to 5% of the price of the Equipment.
DEFAULT AND REMEDIES. If you do not pay any sum within 10 days after its due date, or if you breach any other term of this Agreement or any other agreement with us, you wit be In
default, and we may require that you return the Equipment b us at your expense and pay us: 1) alt past due amounts and 2) alt remaining payments for the unexpired term, plus our booked
residual, both discounted at 4% per annum. We may also use at other legal remedies available to us, including disabling or repossessing the Equipment You agree to pay all aur costs and
expenses, including reasonable attorney fees, incurred In enforcing this Agreement. You also agree to pay interest an all past due amounts, from the due date, at t.51/4 per month,
UCC. If we assign rights in this Agreement For financing purposes, you agree that this Agreement, in the hands of our assignee, is, or shall be treated as, a 'Finance Lease' as that term is
defined in Article 2A of the Uniform Commercial Code ("UCC"). You agree to forgo the rights and remedies provided under sections 507-522 of Article 2A of the UCC.
MSCELLANEOUS. This Agreement is the entire agreement between you and us relating to our providing and your use of the Equipment and supersedes any prior representations or
agreements, including any purchase orders. Amounts payable under this Agreement may include a proflt to us. The original of his Agreement shall be that copy which bears your facsimile
or original signature, and which bears our original signature. If a court finds any provision of this Agreement unenforceable, the remaining terms of this Agreement shag remain in effect. You
authorize us to either insert or correct the Agreement number, serial numbers, model numbers, beginning date, and signature date. All other modifications to the Agreement must be in
writing signed by each party.
APPL1CA?LE TO GOVERNMENTAL ENTITIES ONLY
You hereby represent and warrant to us that as of the date of the Agreement: (a) the individual who executed the Agreement had Full power and authority to execute the Agreement on your
behalf; (b) all required procedures necessary to make the Agreement a legal and binding obligation against you have been followed; (c) the Equipment will be operated and controlled by you
and wig be used for essential government purposes for the entire term or the Agreement (d) that all payments due and payable for the current fiscal year are within the current budget and
are within an available, unexhausted, and unencumbered appropriation; (e) you intend to pay all amounts payable under the terms of the Agreement when due, if funds are legally available
to do so; (f) your obligations to remit amounts under the Agreement constitute a current expense and not a debt under applicable state law; (g) no provision of the Agreement constitutes a
pledge of your tax or general revenues; and (h) you will comply with any applicable information reporting requirements of the tax code, which may include 8038-G or 8038 -GC Information
Returns. If funds are riot appropriated to pay amounts due under the Agreement for any future fiscal period, you shall have the right to return the Equipment and terminale the Agreement on
the last day of the fiscal period for which funds were available, without penalty or additional expense to you (other than the expense of returning the Equipment to the location designated by
us), provided that at least thirty (30) days prior to the start of the fiscal period for which funds were not appropriated, your Chief Executive Officer (or Legal Ccunsef) delivers to us a
certificate (or opinion) certifying that (a) you are a state or a fully constituted political subdivision or agency of the state in which you are located: (b) Funds have not been appropriated for the
applicable fiscal period to pay amounts due under the Agreement (c) such non -appropriation did not result from any act or failure to act by you; and (d) you have exhausted all funds legally
available for the payment of amounts due under the Agreement. You agree that this paragraph shalt only apply if, and to the extent that, state law precludes you from entering into the
Agreement if the Agreement constitutes a multi-year unconditional payment obligation.
P0302Av1 0810
PAGE 2 OF 2
tenkta DePartnnentelleventle
wersr.staie..ia.uSitax
thin &Mimeo! is to Ise completed by a pouch wlienever defining exerrisliort from sedeafuse tax
Oerbficiates afe veld for trot, tree 'yews.: $eger Keep &1st ertilicatet in your Ries.
PKepecopyotthIs met fleate kg Your recon Do.not need thts to the Departmentor Nevem"
Iowa Sates Tax Exemption Certificate
Puichaser Name CITY OF WATERLOO
Atictre-%s 715 MULBERRY STREET
..
WATERLOO ' swe IA zog
°ell" Platt" cit 131*Iness. OPERATING Cirr-svat
1-14")'''''' "hunt' 31 DL291-4323
Furcilappr is dpitsg tweiressin as tg.
Oftetaller
Sales tax parasite°. : 1-07-015020
H
Wfmlesaier Farmer 0 Lessor
Manufacturers *Nonprofit. Hospital
Private NonpMrif Educational' institution
Governmental Agency (Ineluding public sOtincilS)
Qualifying Residential care Facility
Non -Profit Museum Mpth ..c:.
Description Ot .ftectiase: Amish add tionatinterteatton if rfocessarY.
Under penalty of grarjury. I ewer -or Signe turt thelatonnation on this form is true enti-conect.
: -
Signature OCPurehaset,')( 2I.J Title .
Seger Name
Address
1050 OLS ()ell DRIVIE
WAII1(KE
state
IA rfg Pcit
City
Purchaser Is Wareing exemption for the.1 °Hewing reason:
nResale DLaasfng Elt; tom:toeing
0 QuatifYing Farm Machinery/Equipment
Qualifying Industrial Machinery/Equipment
Quallfyin' Replacement Parts El Qualtrying Computer
Pollution tnnfrol 4111PrOenl n Equipment
Researbts and Develootrtairt quIprnent
EJ DireaPay. (perm it no .reSulred):.
Ei ober, GOVERNMENT
ITEMS FOR 00ERATION OPCITY SERVItES
Data 42 I / SI -01441 MAW) •
•
Entouptton Certificate lastractions
This eXemOinUt Oar tffinata.is to belielegeted,brY tlerraeset eaelngtes Ssm tax zed &yea to -the sem* tbe,eener Illeetrelebt (bit eerellleele
ornoTtina giremptionIsebee.arcoPeY sisinsed. TAP Ceetiticatenuesebe complete to :be atceeSil !TIM. seller -0e anger.= accept on exemption pettirmote
only ort property tial b qualified (set Ate exempelons ted.ow)ea be Me Itsis muse arsholawerltpxotemy or serviees purchased. ferassatenr preeciaing
ire used or. disPosed ofbt thentacheses isanonetertipt mitione, thoTissoisieSer Mita responsible lithe lex.
Exemptions;
Render Any.perStpthitlte husintss of Kling who re purobasirit Semite seedt .maj• Oki& tbit ciabotipri. Oilier -eke* inif billeting as claw a wooer
er-trbolcentur and may not .be required to'bevais sides jos penao,.Rioirs who itolieve a sales taxpenatt putuber must enter. 4Ein the space pruyirled.
rrocesstagt fiat:mist Puniest§ fin probe:skin include tents -hie perused pelpeity wbsic-kbyantsiaserrebtialfon. °appeal:fat elaueragar gemination
becomes on integral pat °tabu" tan&reparsinal roperty ultinsitely.sold atrehtk chernieels,eoivcnrs. soaves or insiten is oicd, collimated, dissipated or
depleted le processing parse* propexty intended to be =lit nlhmately at Sitid; fact used to.reale beat pfaver stoma for processing or used to mutate
elestric;cortenc and cfieminals used lithe prOduction af ciscwspapeat and *come
QsaltOing Farm. litifetthotriltplomith4Ttie famintfeehinerY arequip:tent most be *city and primaply used issegicatinest production; °ad =stile:
1 a self-peopalled baplenient sigh as enactor
Lis grain dryer Oa* anti:dower onty".
sislaiolerfilsue issatesmanly drawn or seediest to a Self-tuarlied 'implement in the perfonnon6C;offts *Ole*. suck as:if pto*.
4.nondinry. equipment. impravinpotety,maintimonee stniertoirtioy Mitts 1,
5 beli0ePereeeld PletagY tbset**710l**eme4ItleE ;IA4 IlloPertY Wed directly wateriness* in daisy anctlivestecknocrations
6. atittreettent port 141, 3,4, 5:
7...bailing *ire' twinc, vaspOhlg andatber sinflter' Items teed isierigadtarayivestockm ashy pnutuctiose
8..selgereYsleres, eetteinemth1sdps3sftt5s.fatt tuul but **ins, *gem alidsbutOr or inlet sy.stexas and.refOterelens used in gunstock
er dairy oroetiationerenduatiOn. fir the PrOduesivot flown*, organ:mist or vegdatfluplants..
Qualtqlegibedastriarlitstettinerytequipmen4•This snaFtsintay oreqptpzaeni iont
-Mod by.ta sisiliasturar eineotty.andplimenly.etcd cnintifeasingtangbile personalpropetty. cartaitinthir racer* festivities.
• =Joie seitacementparts toribealsove; tbis'.. does natinetude supplies
iZtleWeg.Celelle**
•sold to commensal oodorto•ke, &taxa/n*1:4,11pm% t0000iatiostitotroo. =min reploccotenrports; this &wool include supplies
l/treet tbox Busirte$SeP laiskilltrieidee*WbePay. Oeir 401e4 tlkccdy tot* Pevaliugnt r46./1:042u to tbe salter TPla#ecder 11* rireeqeY pernutinnnbcrbi
tb spaeleprovided;
Ittint:eNooprofttgAtiseiadossal Ind Weak EurctsaSeSioade by private nonprollt edtentional inspections used Tor ed ion paves= am exeintrt.
NOT EXEMPT &Walsall:II tam are masses bymOst nthee. private honorer& erganizatititit &nab s cluirebrest fraternal orgambettinits, ele.y far use
by those Organizations,. 31-014burzups