09-076 Pitney Bowes Postage Machine ContractPitney Bowes
Engineering the flow of communicaHon•- WSCA Installment Option A Agreement Account # 60 r ~ I ~ I ~ ~ I
Your Business Information
CAN # ORDER #
rITY OF CUPERTINO
Full Legal Name of renter DBf~ Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
( ) ext 22884240205
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (1/different from billing address) City State Zip+4
Julia Knist (4Ci8) 777 3225 ext _ 22884240205
Installation Contact Name Installation Contact Phone # Installation CAN #
Credit Card # Nane on Card Exp Date Type of Card
Tax Exempt # Stale Tax (if applicable) Fiscal Period (from - to)
Your Business Needs
Qty
1 Business Solution De
Mail Stream Solution - 3
DM925 WOW Digital Mail g y
1 IntelliLink Intertace / PSD for DM500-DM1100 w/PP (NTF)
1 INVIEW Accounting - 100 Accounts
1 15 Ib Intertaced Weighing
1 USB Hub
1 e-Return Receipt Reference Number Feature Oniy
1 e-Return Receipt Reference Number Desktop Package w/ D
Additional Items on following page
Software Maintenance (lstyear included)
Provides revision updates and technical assistance
Soft-Guard®Subscription
Provides postal and carrier updates
I(you da not elect to include Soft-Guard® pmtedion with your lease, you will automatically
receive updates at the then-curcent rates
IntelliLinkTM Subscription/Meter Rental
Provides simplified billing and includes ()resets per year
(X) Confirmation Services ElecUOnic access to postal conflnnation service
(X) Purchase Power Receive an Invoice for postage,consolidated billing
end enhanced management reporting Information.
Your Payment Plan
Number of months Monthly amount
First 60 $641.08
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.
Signature Dale ~
Carol Atwood Dir of Admin Services
Print Name Title Email Address
Nancy Phillips 004
Account Rep District Office PBGFS Acceptance
SCflptiOn Check items to be Included in customer's payment
Equipment Maintenance (1st year included)
In S stem Provides service coverage inducting certain parts and labor
()Required advance check of $
( )Tax Exempt certificate attached
Initial rental term
Pugs:, 1 Fy~~ ~~mein V~nacr 'iti~~y Hewes r~
WSCA OPTION A Force (Rev.04Pod) ~~u ~;a t g i i pa.~as ~ uis an 1 ~o~~.io s F,r ilc~ ,~,~ 1 ~.~~s c~ ~ . L'a000
Pitney Bowes
Engineering the flaw of communication° WSCA Installment Option A Agreement Account # 60
Your Business Information
CAIJ # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CI,iPERTINO CA 95014-3255
Billing Address City State Zip+4
( 1 ext 22884240205
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CI,iPERTINO CA 95014-3255
Installation Address (ll different Irom billing address) City State Zip+4
Julia Knist (4C18) 777 3225 ext _ 22884240205
Installation Contact Name Installation Contact Phone # Installation CAN #
Credit Card # Name on Card Exp Date Type of Card
Tax Exempt #
Sta°.e Tax (if applicable) Fiscal Period (from - to)
Your Business Needs
1 Confirmation Services Training (DM800/900/1000)
1 15/30 Ib Weighing Platform
1 Drop Stacker for DM900, DM1000
1 IntelliLink Subscllption with Value Based Services
1 INVIEW MMS Setup Fee
1 INVIEW -Single Meter
1 INVIEW Reporting
1 TPM - up to 5 non-PB meters
Additional Items on following page
Pitney Bowes
Engineering the flow of communication ^' WSCA Installment Option A Agreement Account # 60
Your Business Information
CAIJ # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CI,iPERTINO CA 95014-3255
Billing Address City State Zip+4
( l ext 22884240205
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CIIPERTINO CA 95014-3255
tnstallation Address (Ifdiflerentirom billing address) City State Zip+4
Julia Knist (4(18) 777 3225 ext _ 22884240205
Installation Contact Name
Installation Contact Phone # Installation CAN #
Credit Card #
Narne on Card Exp Date Type of Card
Tax Exempt #
Stare Tax (if applicable) Fiscal Period (from -to)
Your Business Needs
1 I INVIEW Subscription
Form 8038-GC Information Return for Small Tax-Exempt
Governmental Bond Issues, Leases, and Installment Sales OMB No. 1545-0720
(Rev. November 2000)
Under Intemal Revenue Code section 149(e)
Department of the Treasury
Internal Revenue Service Caution: If the issue price of the issue is 9100,000 or more, use Form 8038-G.
Reporting Authority Check box if Amended Return ^
1 Issuer's name 2 Issuer's employer identification number
CITY OF CUPERTINO
3 Number and street (or P.O. box if mail is not delivered to street address) Roomisuite
10300 TORRE AVE
4 City town or post office, state, and ZIP code 15 Report number
Cl1PERtINO CA 95014-3255 5
6 Name and title of officer or legal representative whom the IRS may call for more information 7 Telephone number of officer or legal representati~
Description of Obligations Check if reporting: a single issue lJ or on a consolidated basis LJ .
8a Issue price of obligation(s) (see instructions) ............................................... 8a
b Issue date (single issue) or calendar year (consolidated) (see instructiDns) ~ ................. .
9 Amount of the reported obligation(s) on line 8a:
a Used to refund prior issue(s) ........................................................... 9a
b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) ........... 9b
10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III; (small issuer exception), check this box ...... ........ .
11 If any obligation is in the form of a lease or installment sale, check this box ................................. ........ .
12 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box .................................... .
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belie hey are true, correct, and complete. ~ ~ ~^ o~
Here ' ~~ ~ ~a~_ _ _ 7 - T~.~ '~rol A ,f~-c.~ood ~Q.n.'~ ~~cS
Issuer' authorized representa~ Date Type or print name and title
General Instructions
Section references are to the Intemal
Revenue Code unless otherwise noted.
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 file Forth 8038-GC.
Issuers of atax-exempt governmental
obhgation 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. Issuers have the
option to file a separate Fonn 8038-GC for any
tax-exempt governmental obligation with an issue
price of less than $100,000.
An issuer of atax-exempt bond used to
finance construction expenditures must file a
separate Form 8038-CiC for each issue to give
notice to the II2S that an election was made to pay
n penalty in lieu of arfiitrage rebate (see the line 12
instructions).
Filing a consolidated return. 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 s separate Form 8038-GC
for each of a number of small
issues and report the remainder of small issues
issued during the calendar dear on one consolidated
Form 8038-GC. However, .t separate Form 8038-GC
must be filed to give the II2S notice of the election to
pay a penalty in lieu of arbitrage rebate.
When To File
To file a separate return, file Form 8038-GC on
or before the 1 Sth day of the second calendar
month after the close of the calendar quarter in
which the issue is issued.
To file a consolidated return, 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 ma}• be granted an extension
of time to file Form 8038-CiC under Section 3 of
Rev. Proc. 88-10, 1988-1 C.B. 635, 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, `"This Statement Is Submitted in .Accordance
with Rev. Proc. 88-10:' Afseh to the Fonn 8038-
GC aletter briefly stating why the form was not
submitted to the IRS on time. Also indicate whether
the obhgation in question i:i under examination by
the II2S. Do not submit curies of any bond
documents, leases, or instal Invent sale documents.
See Where To File beloN.
Where To File
File Forth 8038-GC, and auy attachments,
with the Internal Revenue ;iervice Cen[er, Ogden,
UT 84201.
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 and Penalty in
Lieu of Arbitrage Rebate. For private activity bonds,
use Fomt 8038, Information Return for Tax-
Exempt Private Activity Bond Issues.
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 if Form 8038-
GC is used for separate reporting or to multiple tax-
exempt governmental obligations
if the form is used for consolidated reporting.
Tax~xempt obligation. This is a bond,
installment purchase agreement, or financial lease,
on which the interest is excluded from income
under section 103.
Tax~exempt governmental obligation. Atax-
exempt obligation that is not a private activity bond
(see below) is atax-exempt gavemmental 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
Cat. No. E~4108B Form 8038-GC (Rev.11-2000)
Form 8038-GC (Rev. I 1-2000)
' 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 arcangement (e. g., under the
same official statement periodically updated to
reflect changing factual circumstances). Also, for
obligations issued under adraw-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 Srst
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 States arbitrage
profits earned from investing proceeds of the
bond in higher yielding nonpurpose investments.
See section 148(f).
Construction issue. This is an issue of
tax-exempt bonds that meets both of the
following conditions:
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
qual~ed 501(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(cx3) organization.
In lieu of rebating any arbitrage'~Zt may be owed
to the United States, the issuer of a construction
issue may make an ircevoeable election to pay a
penalty. The penalty is equal to 1 % of the
amount of construction proceeds that do not meet
certain spending requirements. See section
148(fx4XC) 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 thr. date the issue is
issued. 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 I-Reporting /authority
Amended return. If this is an amended Form
8038-GC, check the amended return box.
Complete Part [and only those lines of Farm
8038-GC that are being amended. Do not amend
estimated amounts previously reported once the
actual amounts are determined. See the Part II
instructions below. )
L'Ine 1. The issuer's name is thr, name of the
entity issuing the obligations, not the name of the
entity receiving the benefit of the financing. Tn
the case of a lease or installmen: 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 Fomt SS-4, Application for
Employer Identification Number. This form may
be obtained at Social Security Administration
offices or by calling 1-800-TAR-FORM. If the
EIN has not been received by the due date for
Form 8038-GC, write "Applied for" in the
space for the EQ~I.
Line 5. After the preprinted 5, safer two self-
designated numbers. Number reports
consecutively during any calendar year (e.g.,
534, 535, etc.).
Part II-Description
of Obligations
Line 8a. The issue price of obligations is
generally determined under Regulations section
1.148-1(b). Thus, when issued 1'or 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.
L'Ine 8b. For a single issue, enter the date of
issue, generally the date on whi~~h 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
calendar year during which the obligations were
issued
Page 2
L'Ines 9a and 9b. For line 9a, 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. Both
line 9a and 9b may apply to a particular
obligation. For example, report on line 9a and 96
obligations used to refund prior issues which
represent loans from the proceeds of another tax-
exempt obligation.
Line 11. Check this box if property other than
cash is exchanged for the obligation, e. g.,
acquiring n police car, a fire truck, or telephone
equipment through a series of monthly payments.
(This type of obligation is sometimes refereed to
as a "municipal lease. ") Also check this box if
real property is directly acquired in exchange for
an obligation to make periodic payments of
interest and principal. Do not check this box if
the proceeds of the obligation are received in the
form of cash, even if the term "lease" is used in
the title of the issue.
Line 12. 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 on or before the date the bonds were issued.
The penalty is payable with a Form 8038-T for
each 6-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."
Paperwork Reduction Act Notice
We ask for the information on this form to carcy
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 a form 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 varies depending on individual
circumstances. The estimated average time is:
Learning about the
law or the form .....................1 hr., 58 min.
Preparing the form .................3 hr., 3 min.
Copying, assembling, and
sending the form to the IRS ...........16 min.
If you have comments concerning the
accuracy of these lime estimates or suggestions
for making this form simpler, we would be happy
to hear from you. You can write to the Tax
Forms Committee, Western Area Distribution
Center, Rancho Cordova, CA 95743-0001. Do
not send the form to this address. Instead, see
Where To File on
page 1.
PURCHASE ORDER
10300 Torre Avenue
Cupertino, CA 95014-3255
(408)777-3219
CUPERTINO
V ~ 546
N PITNEY BOWES INC
p P O BOX 856179
p LOUISVILLE KY 40285-6179
R~
PURCHASE ORDER NO. 00056429
PAGE NO. 1
H ~ CITY OF CUPERTINO
1 CITY HALL
P
10300 TORRE AVENUE
TO ~ CUPERTINO CA 95014
ATTN:
ORDER DATE: 07~03~09 BUYER: GRACE SCHMIDT REQ. NO.: 0 REQ. DATE:
TERMS: NET 30 DAYS F•O•B•~ DESTINATION DESC.:
ITEM# QUANTITY UOM DESCRIPTION UNIT PRICE EXTENSION
.:b1< 1 00 ''DM925 WOW DIGITAL MAILING SYSTEM 1ST OF $t~~:(~,>~~IfJ~1` 8, 000.00
'`<5 YEAR LEASE
BEG OCT 1. THIS PO COVERS 7/1/09-6/30/10
.MONTHLY AMOUNT $640.09 NOT TO EXCEED
,'$8,000 ANNUALLY
ACCOUNT
0111104310
AMOUNT
7013 8,000.00
APPROVED 13Y
PROJECT CODE PAGE TOTAL $
TOTAL $
8,000.00
8,000.00
UNITED STATES
POSTAL SERVICE e
Bulk Proof of Delivery Application
Bulk Proof of Delivery provides mailers the opportunity to receive proof of delivery (delivery record) Information in bulk. Participation is limited to mailers who
use a Mailer ID in their labels or in an electronic file. Mailers previously registered with the Postal Service may use their existing DUNS Number as their Mailer
ID. Customers not previously registered with the Postal Service will be assigned a Mailer ID. Mailers must complete a certification process and/or authorization
process to participate. See Pub. 80, Bulk Proof of Delivery Program, for general program details. See Pub. 91, Confirmation Services Technical Guide, for
certification details. The company/mail owner (not a third -party designee) must complete this form. See Page 2 for instructions on completion. Please print or
type when completing this form.
B. Mailer Information
1. Company Name7.
Ct-� 61 Cts er-h no
(Please print or type)
Today's Date
Jvne 18, 200
2 Mailer ID (obtained from Po tal Service)
8. Point of Contact
Krnbe6r
3. Street Address (Number, street, suite. apt., etc.)
9. E-mail Address of Company Point of Contact
10300 -Torre, Pr\jenue
ki+mberlLy s®(ru e.cfitnc) or
10. Telephone Number and Extension
40 6 - 7 77- 3 2.1-7
4. City 5. State IP+4�
11. Fax Number/Vendor Software or Shipping System
CvperA-ino GfA N5,ciH-32S5
408- 777- 33&Q a fa./c
C. Delivery Preferences and Methods
12. Delivery Preference
13. Electronic File Submission
® Send Records to Third -Party Designee ❑ Send Records to Mailer
I ❑ Yes, by Mailer 0 Yes, by Third -Party Designee ❑ No
14. Are you currently certified to print your own labels or to send and/or receive files electronically with the Postal Service?
❑ a. Yes, I am certified to print my own labels and/or send my own electronic files (if applicable). X b. No, a third -party designee prints my labels
and/or sends my electronic files (if applicable) If you selected option 14b, or if you selected the third -party designee option in item 12, provide the
information on your third -party designee below.
PITNEY BOWES
(Third -party Designee Company Name)
203-460-9905 082133393 'This number must be
(Thad -party Designee Fax Number) (Third -party Designee DUNS NumbeNMailer IDI) different than your
DUNS Number.'Mager
ID, which must be listed
in Section B, above.
(Third -party Contact Name) (Third -party Telephone Number)
15. Mailers with more than one DUNS Number/Mailer ID or mailing location may wish to consolidate all proof of delivery records into one Signature Extract
File or CD-ROM. if you are interested in this feature, please complete this section. Use an extra formlattachment if necessary.
❑ I want records for the DUNS numbers/Mailer IDs listed below consolidated into the DUNS Number/Mailer ID listed in Item 2 above:
16a. Method of Record Delivery (ED1 is not available at this time.) I
16b. Record Grouping:
ElCD-ROM® Signature Extract file (via File Transfer Protocol --FTP) ❑ Individual Records ❑ Combined Records (default)
17. Express Mail and/or Special Services(* -Users must pay additional fees for each record for the four services indicated --see Pub. 80 for details.)
❑ Express Mailt (manifest mailers only) ® 'Certified Mail Tee
❑ Signature Confirmation"' Service ❑ *COD Mail
❑ *Insured Mail
❑ *Registered MailTt^
18. Payment Methods (Select payment method a or b) For additional information, see instructions for item 18 on Page 2 of this form.)
® a. Payat Mailing ® Meter ❑ PC Postage
❑ b. Pay as Compiled f1 Credit Card (Must complete PS Form 5054, BPOD Payment Authorizatie
tx, nwn ui nieu wniNt=rcu iuuu ru.
Questions about completing this farm? Call Confirmation
CONFIRMATION SERVICES SUPPORT Services Support at 877-264-9693, Option 1.
NATIONAL CUSTOMER SUPPORT CENTER
UNITED STATES POSTAL SERVICE 20. Notes/Comments: (Use an attachment if necessary.)
6060 PRIMACY PARKWAY SUITE 201
MEMPHIS TN 38188-0001
Fax Number: 901-821.6244 21, Requesto'r's Signature
DELIVERY.CON FI RMATION@ USPS. GOV v/ " — _. /,_0 A 1"
Name and Title 123. Phone Number and Extension 124. Area and District
PS Form 5053, November 2007 (Page 1 of 2) Privacy Notice: See our Privacy Policy on usps.con-P
Pitney Bowes
11 rr--
Engineei•liig the flow ofcornmunication-
Your Business Information
WSCA Installment Option A Agreement Account # 60
CAN # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # IFEIN/TIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
Billing Contact Name
Billing Contact Phone #
Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (Ifdifferentfrom billing address)
C ity
State Zip+4
Kc rnb f I(ri t Z V� �Jo a - �7 7 7 - 3 a -7 22884240205
Installation Contact Name Installation Contact Phone # ' Installation CAN #
444418 aa9 a 73?9 5436 KrrnJ' etrie. SmA o1/il
Credit Card # Name on Card Exp Date Type of Card
t!o0,.1, 7342 If -SUne,
Tax Exempt #
Your Business Needs
1 I INVIEW Subscription
State Tax (if applicable)
Fiscal Period (from - to)
Pitney Bowes
Engineering the flow of communication-
WSCA Installment Option A Agreement Account# 60
CA
95014-3255
Installation Address (If different from billing address)
Your Business Information
State
Zip+4
K i Yy►b e,f I y S m tTn
H08-777- 3 Z i
22884240205
Installation Contact Name
4fyr a aaQa 7379 5 38
Installation Contact Phone #
Klmmarie Sm1
CAN #
ORDER #
CITY OF CUPERTINO
Name on Card
Exp Date
Full Legal Name of renter
DBA Name of renter
Tax ID # (FEIN/TIN)
10300 TORRE AVE
CUPERTINO
CA 95014-3255
Billing Address
City
State Zip+4
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE
CUPERTINO
CA
95014-3255
Installation Address (If different from billing address)
City
State
Zip+4
K i Yy►b e,f I y S m tTn
H08-777- 3 Z i
22884240205
Installation Contact Name
4fyr a aaQa 7379 5 38
Installation Contact Phone #
Klmmarie Sm1
Installation CAN #
OI/tt
✓1.50 -
Credit Card #
Name on Card
Exp Date
Type of Card
Tax Exempt # —�� 7 3 lY / 9 State Tax (if applicable) Fiscal Period (from - to)
—7'u ly -J-L) vie.
Your Business Needs
Qty Business Solution Description Check Items to be Included In customer's payment
Mail Stream Solution - 3 n Equipment Maintenance (1st year Included)
1 DM925 WOW Digital Mailing System Provides service coverage including certain parts and labor
1 IntelliLink Interface / PSD for DM500-DM1100 vv/PP (NTF)
1 INVIEW Accounting - 100 Accounts
1 15 Ib Interfaced Weighing
1 USB Hub
1 e -Return Receipt Reference Number Feature Only
1 e -Return Receipt Reference Number Desktop Package w/ D
Additional Items on following page
Your Payment Plan
Number of months
=Monthly amount
First 60
$640.09
Your Acknowledgement
Software Maintenance (1st year Included)
Provides revision updates and technical assistance
x❑ Soft -Guard® Subscription
Provides postal and carrier updates
If you do not elect to Include Soft -Guard® protection with your lease, you will automatically
receive updates at the then -current rates
❑x InteIIILinkTM Subscription/Meter Rental
Provides simplified billing and includes( )resets per year
(X) confirmation Services Electronic access to postal confirmation service:
(X) Purchase Power Receive an invoice for postage,consolidated billinl
and enhanced management reporting information.
() Required advance check of $ received
( ) Tax Exempt certificate attached
Initial rental term
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.
-3-one- I,8' -?_C09
Signature r, - Date
}� mbe'6� Smt`ya k( Mbe.rl s coPeft lno.or9
Print Name Title Email Address
Nancy Phillips
Account Rep
WSCA OPTION A Form (Rev.04/08)
004
District Office
Sar.:aoc�. .. I:dy.s o .i. url G�irns
PBGFS Acceptance
Pitney Bowes
Engineering the flow of communication- WSCA Installment Option A Agreement Account # 60
Your Business Information
CAN # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (Ifdifferent from billing, address) 408 City Stale Zip+4
l i m b of ly S m; F - -777-3 Z 0 22884240205
Installation Contact Name Installation Contact Phone # Installation CAN #
Credit Card # Name on Card Exp Date Type of Card
�H18 aa9ot 73775`f 38 Kimmarie Smth 01/11 �65a
Tax Exempt #_ �O State Tax (if applicable) Fiscal Period (from - lo)
q14 -J -o ty - Su vie
Your Business Needs
1 Confirmation Services Training (DM800/900/1000)
1 15/30 Ib Weighing Platform
1 Drop Stacker for DM900, DM 1000
1 IntelliLink Subscription with Value Based Services
1 INVIEW MMS Setup Fee
1 INVIEW - Single Meter
1 INVIEW Reporting
1 TPM - up to 5 non -PB meters
Additional Items on following page
INSTALLMENT LEASE AGREEMENT OPTION A
Pitney Bowes Global Financial Services LLC may serve as a sub -contractor under EPS050076-
A2-2 and be the financing parry under such Installment Lease Agreements.
The pricing plan for the Installment Lease Agreement is as follows:
Monthly Billing:
Quarterly Billing:
Term
Lease Rate
Term
Lease Rate
36
.0317
36
.0960
48
.0247
48
.0750
60
.0205
60
.0625
The terms and conditions are as follows:
1. GENERAL. All Installment Lease Option A Agreements (each referred to herein as
"Installment Agreement") consist of the following terms and conditions in addition to the
applicable terms and conditions of EPS050076-A2-2. By issuing a Purchase Order under the
Installment Agreement, the Participating Agency is requesting that Contractor leases the
referenced equipment (the "Equipment") for essential governmental purposes. Such
Equipment does not include any referenced IntelliLinkTM Control Center or postage meter,
which remains the property of Contractor or one of its wholly owned subsidiaries. Any
IntelliLinkTM Control Center or postage meter is subject to the applicable USPS regulations
and meter terms and conditions as may be provided by Contractor.
2. TERM. Each Installment Agreement shall commence upon acceptance of the Equipment
and shall continue until the earlier of. (i) termination at Contractor's Option upon the
Participating Agency's failure to pay when due the amount required or failure to perform any
other obligation under an Installment Agreement or under EPS050076-A2-2, (ii) the
occurrence of an event of non -appropriation or termination for Contractor default under
EPS050076-A2-2, (iii) termination in accordance with paragraph 3 below, or (iv) the
expiration of the specified term.
3. CANCELLATION OR TERMINATION. The Participating Agency intends to enter into
an Installment Agreement for the entire agreed upon term and Contractor relies upon such
represented intention when determining the applicable pricing plan. If the Participating
Agency cancels or terminates an Installment Agreement prior to its expiration (other than for
non -appropriations or Contractor default pursuant to EPS050076-A2-2), the Participating
Agency shall pay a termination charge equal to the net present value of the monthly payments
remaining through the completion of the term, discounted to present value at a rate of 6% per
year.
4. REMEDIES. If the Participating Agency fails to pay when due any amount required, or fails
to perform any other obligation under an Installment Agreement or under EPS050076-A2-2
and fails to cure the same within thirty (30) days of the Participating Agency's receipt of
written notice thereof, Contractor may, at its option and without further demand or notice,
take one or any combination of the following actions: terminate the relevant Installment
Agreement, take possession of the relevant Equipment (and the meters), declare the entire
amount of all payments, and other amounts due and to become due, for the then current fiscal
WSCA OPTION A Form (Rev. 4/08) 1
period for which funds have been appropriated to be immediately due and payable, and
pursue any other remedy permitted by applicable law.
5. REPRESENTATIONS; MISCELLANEOUS. The Participating Agency represents and
warrants that: (a) it shall timely file an information reporting return (e.g. Form 8038 - GC or,
as necessary, Form 8038 - G) with the Internal Revenue Service in accordance with Section
149(e) of the Internal Revenue Code of 1986, as amended (the "Code"), and the regulations
thereunder and the Participating Agency hereby appoints Contractor as its Agent for the
purpose of maintaining a registration system as required by Section 149(a) of the Code; and
the Participating Agency is (and shall continue to be) a State or local government entity, and
that any obligation arising out of this Agreement constitutes an obligation by or on behalf of a
state or political subdivision thereof, within the meaning of Section 103 of the Code and the
regulations thereunder. The Participating Agency acknowledges that the Installment
Agreement is entered into based on the assumption that the interest portion of each Period
Payment is not includible in gross income of the owner thereof for Federal income tax
purposes under Section 103(a) of the Code. A portion of each Period Payment that the
Participating Agency shall pay includes interest. If any interest is determined not to be
excludible from gross income in accordance with Section 103(a) of the Code, the
Participating Agency's Period Payment shall be adjusted in an amount sufficient to maintain
Contractor's original after tax yield utilizing Contractor's consolidated marginal tax rate,
which adjusted Period Payments the Participating Agency agrees to pay as provided in this
Agreement. The rate at which the interest portion of Period Payments is calculated is not
intended to exceed the maximum rate or amount of interest permitted by applicable law. If
such interest portion exceeds such maximum, then at Contractor's option, if permitted by law,
the interest portion will be reduced to the legally permitted maximum amount of interest, and
any excess will be used to reduce the principal amount of the Participating Agency's
obligation or be refunded to the Participating Agency.
6. ASSIGNMENT. The Participating Agency may not assign, transfer or sublet any interest in
an Installment Agreement or the Equipment without Contractor's prior written consent.
7. TITLE. Title to the equipment passes to the Participating Agency at the time and place of
acceptance of each unit of equipment. The Contractor or its duly authorized assignee shall
have a purchase money security interest in the equipment, until payment of all installments
are made. Upon payment of the final installment, or any concluding payment option, the
Contractor or his duly authorized assignee shall have no further interest in the equipment.
8. PURCHASE OPTION. The Participating Agency shall have the option to purchase the
Equipment at any time during the Term "as is, where is" by paying the remainder of all
installment payments.
RISK OF LOSS. The Participating Agency is responsible for Equipment loss, damage or
destruction from any cause, whether or not insured from the date of acceptance and for the
entire term. No Equipment loss, theft or damage shall relieve the Participating Agency of its
obligation to make the payments or perform its obligations under an Installment Agreement.
Notwithstanding the foregoing, the Participating Agency shall not be responsible for
Equipment loss, damage or destruction if Contractor has delivered non -conforming
goods.
WSCA OPTION A Form (Rev. 4108) 2
Form 8038 -GC Information Return for Small Tax -Exempt
(Rev. November 2000) Governmental Bond Issues, Leases, and Installment Sales
Department of the Treasury
Under Internal Revenue Code section 149(e)
Internal Revenue Service Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
OMB No. 1545-0720
Reporting Authority Check box if Amended Return ❑
1 Issuer's name
CITY OF CUPERTINO
2 Issuer's em loyer identification number
9H- boa. 73 & 8
3 Number and street (or P.O. box if mail is not delivered to street address)
Room/suite
10300 TORRE AVE
4 City, town, or Post office, state, and ZIP code
CUPERTINO CA 95014-3255
5 Report number
5
6 Name and title of officer or legal representative whom the IRS may call for more information
k1 nberl ShnlA Ci
7 Telephone number of officer or legal representath
C-lerk
(J{oe ) 777-3al7
- Description or Obligations Check it reporting: a single issue Li or on a consolidated basis U .
8a Issue price of obligation(s) (see instructions) ............................................... 8a
b Issue date (single issue) or calendar year (consolidated) (see instructions) ..................
9 Amount of the reported obligation(s) on line 8a:
a Used to refund prior issue(s)........................................................... 9a
b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) ........... 9b
10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box ...... ......... ►
11 If any obligation is in the form of a lease or installment sale, check this box ................................. ......... ►
12 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box ..................................... ►
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief, they are true, correct, and comp) te.
Here '-18-aq ' FClrnberty Srr>t�llr� Cc L'le�k
Issuer's authorized representfive Date Type or print name and title
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
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 file 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 Govemmental
Obligations.
Filing a separate return. 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 12
instructions).
Filing a consolidated return. For all
tax-exempt govemmental 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, 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 file a separate return, 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, 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. 88-10, 1988-1 C.B. 635, 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, "This Statement Is Submitted in Accordance
with Rev. Proc. 88-10." 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 File below.
Where To File
File Form 8038 -GC, and any attachments,
with the Internal Revenue Service Center, Ogden,
UT 84201.
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 and Penalty in
Lieu of Arbitrage Rebate. For private activity bonds.
use Form 8038, Information Return for Tax -
Exempt Private Activity Bond Issues.
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 if 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 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 obligatior
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
Cat. No. 64108B Form 8038 -GC (Rev. 11-2000)
PitneyBowes
Enaineeringthe rlov✓ofcommunication— WSCA Installment Option A Agreement Account # 60
Your Business Information
CAN # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEINrrIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (If different from billing address) City State Zip+4
Installation Contact Name
Credit Card #
22884240205
Installation Contact Phone # Installation CAN #
Name on Card Exp Date Type of Card
Tax Exempt # State Tax (if applicable) Fiscal Period (from - to)
Your Business Needs
Qty Business Solution Description Check items to be included in customer's payment
Mail Stream Solution - 3 E] Equipment Maintenance (1st year included)
1 DM925 WOW Digital Mailing System Provides service coverage including certain parts and labor
1 IntelliLink Interface / PSD for DM500-DMI100 WIPP (NTF)
Software Maintenance (1st ear included)
1
1
1
1
1
INVIEW Accounting - 100 Accounts
15 Ib Interfaced Wei
USB Hub
e -Return Receipt Reference Number Feature
e -Return Receipt Reference Number Desktop
Additional Items on following page
Your Payment Plan
Y
Provides revision updates and technical assistance
E] Soft -Guard® Subscription
Provides postal and carrier updates
If you do not elect to Include Soft -Guard® protection with your lease, you will automatically
receive updates at the then -current rates
w/ D x❑ IntelliLinkTM Subscription/Meter Rental
Provides simplified billing and includes ( )resets per year
(x) confirmation Services Electronic access to postal confirmation service.
(x) Purchase Power Receive an invoice for poslage,consolidated billinj
and enhanced management reporting Information.
Number of months
Monthly amount
First 60
$640.09
() Required advance check of $ received
( ) Tax Exempt certificate attached
Initial rental term
Your Acknowledgement i .
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.
Signature f� Date U
�l�r
f0 UO �l/ O -F � A�/C�. CfLroil�2 .1 o^�i
Print Name Title Email A ress
Nancy Phillips 004
Account Rep District Office PBGFS Acceptance
Page 1 Equipment Vendor: Pliney Bowes Inc.
WSCA OPTION A Form (kev.04/08) See additional pages for terns and conditions For Sales and Services call 1-800-322-8000
PitneyBowes
Enginee-ingthe flow ofcommunication" WSCA Installment Option A Agreement Account # 60
Your Business Information
CAN # ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
Billing Contact Name Billing Contact Phone # Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (If different from billing address) City State Zip+4
Installation Contact Name
Credit Card #
22884240205
Installation Contact Phone # Installation CAN #
Name on Card Exp Date Type of Card
Tax Exempt # Slate Tax (if applicable) Fiscal Period (from - to)
Your Business Needs
1 Confirmation Services Training. (DM800/900/1000)
1 15/30 Ib Weighing Platform
1 Drop Stacker for DM900, DMI 000
1 Intellil-ink Subscription with Value Based Services
1 INVIEW MMS Setup Fee
1 INVIEW - Single Meter
1 INVIEW Reporting
1 TPM - up to 5 non -PB meters
Additional Items on following page
71
Pitney Bowes
Engineering the flow of communication— WSCA Installment Option A Agreement Account # 60
Your Business Information
ORDER #
CITY OF CUPERTINO
Full Legal Name of renter DBA Name of renter Tax ID # (FEIN/TIN)
10300 TORRE AVE CUPERTINO CA 95014-3255
Billing Address City State Zip+4
Billing Contact Name
Billing Contact Phone #
Billing CAN #
10300 TORRE AVE CUPERTINO CA 95014-3255
Installation Address (If different from billing address) City State Zip+4
Installation Contact Name
Credit Card #
Tax Exempt #
Your Business Needs
1 1 INVIEW Subscription
22884240205
Installation Contact Phone # Installation CAN #
Name an Card
State Tax (if applicable)
Exp Date Type of Card
Fiscal Period (from - to)
Form 8038 -GC Information Return for Small Tax -Exempt
Governmental Bond Issues, Leases, and Installment Sales
(Rev. November 2000)
Department of the Treasury 10* Under Internal Revenue Code section 149(e)
Internal Revenue Service Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
OMB No. 1545-0720
[i=111 Reporting Authority Check box if Amended Return 11100
1 Issuer's name
CITY OF CUPERTINO
2 Issuer's employer identification number
3 Number and street (or P.O, box if mail is not delivered to street address)
10300 TORRE AVE
Room/suite
4 City town or post office, state, and ZIP code
CUPERtINr st 95014 3255
5 Report number
5
6 Name and title of officer or legal representative whom the IRS may call for more information
7 Telephone number of officer or legal representati%
Description of Obligations Check if reporting: a single issue LJ or on a consolidated basis LJ .
8a Issue price of obligation(s) (see instructions) ................................... . ........... 8a
b Issue date (single issue) or calendar year (consolidated) (see instructions) ...... I ...........
9 Amount of the reported obligation(s) online 8a:
a Used to refund prior issue(s)........................................................... 9a
b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) ........... 9b
10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(lll) (small issuer exception), check this box ...... .........
11 If any obligation is in the form of a lease or installment sale, check this box ........ . ........................ ......... ®[
12 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box .....................................
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belie hey are true, correct, and complete. + r
Here'n -7 - T -D? 'Nrvl A,A-wg,,J Q,,,),, Svcs
Issuer authorized representative Date Type or print name and title
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
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 file 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. 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
e penalty in lieu of arbitrage rebate (see the line 12
instructions).
Filing a consolidated return. 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, 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 file a separate return, 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, 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. 88-10, 1988-1 C.B. 635, 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, "This Statement Is Submitted in Accordance
with Rev. Proc. 88-10." 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 File below.
Where To File
File Form 8038 -GC, and any attachments,
with the Internal Revenue Service Center, Ogden,
UT 84201.
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 and Penalty in
Lieu of Arbitrage Rebate. For private activity bonds,
use Form 8038, Information Return for Tax -
Exempt Private Activity Bond Issues.
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 if 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 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
Cat. No. 64108B Form 8038 -GC (Rev.11-2000)
Form 8038 -GC (Rev. 11-2000)
6 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
m illion.
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 (e.g., 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 fust
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 States arbitrage
profits earned from investing proceeds of the
bond in higher yielding nonpurpose investments.
See section 148(f).
Construction issue. This is an issue of
tax-exempt bonds that meets both of the
following conditions:
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 501(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(cx3) organization.
In lieu of rebating any arbitrage '/2 t 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 % of the
amount of construction proceeds that do not meet
certain spending requirements. See section
148(f)(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 the issue is
issued. 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 I—Reporting Authority
Amended retum. If this is an amended Form
8038 -GC, check the amended return box.
Complete Part I and only those lines of Form
8038 -GC that are being amended. Do not amend
estimated amounts previously reported once the
actual amounts are determined. (See the Part II
instructions below.)
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. This form may
be obtained at Social Security Administration
offices or by calling 1 -800 -TAX -FORM. If the
EIN has not been received by the due date for
Form 8038 -GC, write "Applied for" in the
space for the EIN.
Line 5. After the preprinted 5, enter two self -
designated numbers. Number reports
consecutively during any calendar year (e.g.,
534, 535, etc.).
Part II—Description
of Obligations
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, 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
calendar year during which the obligations were
issued
Page 2
Lines 9a and 9b. For line 9a, 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. Both
line 9a and 9b may apply to a particular
obligation. For example, report on line 9a and 9b
obligations used to refund prior issues which
represent loans from the proceeds of another tax-
exempt obligation.
Line 11. Check this box if property other than
cash is exchanged for the obligation, e.g.,
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 check this box if
real property is directly acquired in exchange for
an obligation to make periodic payments of
interest and principal. Do not check this box if
the proceeds of the obligation are received in the
form of cash, even if the term "lease" is used in
the title of the issue.
Line 12. 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 on or before the date the bonds were issued.
The penalty is payable with a Form 8038-T for
each 6 -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."
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 a form 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 varies depending on individual
circumstances. The estimated average time is:
Learning about the
law or the form .....................1 hr., 58 min.
Preparing the form .................3 hr., 3 min.
Copying, assembling, and
sending the form to the IRS ...........16 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 Tax
Forms Committee, Western Area Distribution
Center, Rancho Cordova, CA 95743-0001. Do
not send the form to this address. Instead, see
Where To File on
page 1.
PURCHASE ORDER NO. 00056429
PURCHASE ORDER
10300 Torre Avenue
Cupertino, CA 95014-3255 PAGE NO. 1
(408) 777-3219
CUPERTINO
546
H
E
CITY OF CUPERTINO
PITNEY BOWES
INC
i
CITY HALL
P 0 BOX 856179
p
P
10300 TORRE AVENUE
LOUISVILLE KY
40285-6179
pL
I—
TO � CUPERTINO CA 95014
ATTN:
ORDER DATE: 07/03/09
BUYER: GRACE SCHMIDT
REQ. NO.: 0
REQ. DATE:
TERMS: NET 3 0 DAYS
F.O.B.: DESTINATION
DESC.:
ITEM# QUANTITY I UOM
I DESCRIPTION
UNIT PRICE EXTENSION
D1 1' DO'
-DM925 WOW DIGITAL MAILING
..
SYSTEM 1ST OF Ba00 t3Q0t3
8'000.:00 '
5 YEAR LEASE
..
BEG OCT 1. THIS PO COVERS
7/1/,09-6/30/10
. .
MONTHLY AMOUNT $640.09 NOT
TO EXCEED
$8,000 ANNUALLY
_:.,. :.::.
ITEM#
ACCOUNT
AMOUNT
PROJECT CODE
PAGETOTAL $
8,000.00
TOTAL $
8,000.00
01
1104310
7013
8,000.00
APPROVED BY
IRECTOR OYIURCHASING
For D1380/D1425
prepared for
1 1 l
by Chris Gallagher
Date: September 29, 2009
IC011 87.1,DI380/DI425 Site Survey 20090127
PitneyBewes DI380/DI425 Inserter Statement of Work
This Statenient of Work provides detailed infor7nation about the work that will be
pe7 for7ned at the City of Cuperdizo installation site to complete this order. City of
Cupertino is sometianes referred to as "customer" in this document.
Please note that changes to these specifications and/or incomplete site preparation by
City of Cuperti7to will result in delayed implementation and additional charges to City of
Cupertino.
In the event changes to these specifications are required by City of Cupertino, the
following procedures will be ianplemented:
Pitney Bowes personnel will communicate the reasons, scope, timing and costs
associated with the change in specification to City of Cupertino prior to proceeding with
the change.
City of Cupertino must for7nally approve the change, including associated tinting and
costs, prior to implementing the change.
Pitney Bowes will implement the specified change and invoice City of Cupertino as
previously agreed.
NO REPRESENTATION OR WARRANTY, EXPRESS OR IMPLIED, STATUTORY
OR OTHERWISE, IS GIVEN IN THIS STATEMENT OF WORK RELATING TO
ANY SOFTWARE, EQUIPMENT AND/OR SERVICES PROVIDED BY PITNEY
BOWES; AND ALL SUCH REPRESENTATIONS AND WARRANTIES,'
INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF
MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ARISING
FROM OR RELATED TO THE STATEMENT OF WORK ARE HEREBY
DISCLA M[ED. THE ONLY REPRESENTATIONS OR WARRANTIES GIVEN BY
PITNEY BOWES, IF ANY, ARE AS STATED IN THE WRITTEN SOFTWARE
LICENSE AND MAINTENANCE AGREEMENT, SALE AGREEMENT OR LEASE
AGREEMENT THAT MAY BE APPLICABLE TO THE SOFTWARE, EQUIPMENT
AND/OR SERVICES PROVIDED BY PITNEY BOWES.
[C0114487.1 IDI380/DI425 Site Survey 20090127
To ensure your complete satisfaction, please review the following information about the DI380/DI425 inserter
system beim provided to you.
Envelopes: Customer requirement:
Paper:
Minimum Envelope Size
3 1/2" (88mm) Depth
8 4%5 " (220mm) Width
Maximum Envelope Size
6 3/8" (164mm) Depth
9 1/2" (242mm) Width
Envelope Weight
17 lb (65-/m) Minimum
26 lb (100g/m ) Maximum
End Clearance
1/4" (6mm) Minimum
1/2" (12mm) Overall Min
Depth Clearance
1/8" (3mm) Min Unfolded
1/4" (6m n) Folded
Please note: Nor best pe7jronnance, use 077.ly 771ate7-tals approved by Pitney Bowes. Materials
must be good quality and properly stored at rec0771777,ended storage conditions of 65°F (18°C) to
77°F (25°C) with 40% to 60%- relative humidity.
Customer requirement:
Minimum Sheet Size
5" (127mm) Width
5" (127mm) Length
Maximum Sheet Size
9" (229mm) Width
16" (406mm) Length
Paper Weights
16 lb (60-/177) Minimum
32 lb (1208/m )Maximum
Paper Weights for OMR
16 lb (70a/m2) Minimum
32 lb (1208/m) Maximum
Please note: MafiiMU777. thickness is 0.08" (2771777) for collated Materials. NCR and Glossy/Coated Material are NOT
rec07?v777e7?.ded.
Configurations: Material length limits before folding:
Insert
Single Fold
5" — 12 2/5"
(127mm
— 315mm)
"C" — Letter Fold
5 9/10" — 14"
(150mm
— 356mm)
"Z"— Accordion Fold
7 9/10" — 14"
(201mm
— 356mm)
Double Fold
9" — 16"
(305mm
— 406mm)
Double Document Detector
Material Range
16 lb (6000) Minimum
32 lb (1200m) Maximum
L:ustomer reauirement:
Minimum Insert Size 5" (127mm) Width 3" (82mm) Length
Maximum Insert Size 9" (230mm) Width 6" (152mm) Length
Paper Weights 19 lb (72g/m) Minimum 48 lb (180-/m) Maximum
Sinale Sheet
Please note: Uocu771e7lt Groupings anal OMR/Barcode Capabilities are not available with this
solution.
Paper weight for inserts are as follows:
75g/m2 Minimum(non folded cut sheet)
180g/m2 Maximum ( Single sheet)
60-/M2 Minimum ( Folded Material)
And inserts of up to a maximum compressed thickness of 2MM.
[CO114a87.1 )DI380/DI425 Site Survey 20090127
ALL SPECIFICATIONS ARE SUBJECT TO CHANGE WIT'HOUT
NOTIFICATION AND ARE SUBJECT TO TEST
Installation: Professional installation and training are required with your DI380/DI425 Inserter by a Customer
Service Representative.
I have read this agreement and confirm that my use of the DI3801DI425 Inserter solution will be consistent with the
specifications and requirements listed above.
I agree that will not dispute my obligation to make all payments when due as reflected in the applicable lease or
sales agreement when Pitney Bowes determines that the DI380/DI425 Inserter solution is "Ready for Beneficial
Use." The DI380/DI425 Inserter solution is Ready for Beneficial Use when each of the following conditions is met:
1) Hardware is set up and functional;
2) At least one mail creation job, either test or live, is processed successfully; and
3) End user training is ready for scheduling or is complete.
If multiple sites are deployed then I agree that I will not dispute my obligation to make all
payments when due when 50% of the sites are Ready for Beneficial Use.
I further agree that additional charges will apply for any products or other services provided by Pitney Bowes that do
not meet the above requirements.
Customer Signature: Date: Qc-- l S, a 00 �f
Customer Name: YY1 h e SYnt`i Title: C -+y C� � C , cup &- f F► n o
Contact Name: Contact Phone Number: 'f08--7-7-7-1310
Pitney Bowes Sales Representative:
Name/Employee #:
Signature:
Solutions Consultant:
Name/Employee #:
Sianature:
District: #
Date:
District: _ #
Date:
Icoiia 87.1 >DI380/DI425 Site Survey 20090127
Form 8038 -GC Information Return for Small Tax -Exempt
Governmental Bond Issues, Leases, and Installment Sales
(Rev. November 2000)
Department of the Treasury 01,Under Internal Revenue Code section 149(e)
Internal Revenue Service Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
OMB No. 1545-0720
Reporting Authority Check box if Amended Return 111,13
1 Issuer's name
CITY OF CUPERTINO
2 Issuer's employer identification number
3 Number and street (or P.O. box if mail is not delivered to street address)
10300 TORRE AVE
Room/suite
4 City, town, or post office, state, and ZIP code
CUPERTINO CA 95014-3255
5 Report number
5
6 Name and title of officer or legal representative whom the IRS may call for more information
7 Telephone number of officer or legal representati%
Description of Obligations Check if reporting: a single issue d or on a consolidated basis LJ
8a Issue price of obligation(s) (see instructions) ............................................... 8a
b Issue date (single issue) or calendar year (consolidated) (see instructions) ► ..................
9 Amount of the reported obligation(s) on line 8a:
a Used to refund prior issue(s) ...... ..................................................... 9a
b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) ........... 9b
10 If the issuer has designated any issue under section 265(b)(3)(13)(i)(III) (small issuer exception), check this box ...... ......... ►
11 If any obligation is in the form of a lease or installment sale, check this box ................................. ......... ►[
12 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box ..................................... ►
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief, they are true, correct, and copkplete.
Here ' 101171001 ' Srnt-t�, r -k
Issuer's authorized represe to Date Type or print name and title
General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
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 �\ith issue prices of less than
$100.000 must file Form 8038-(_T('.
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. Issuers have the
option to file a separate Form 8038 -Cit' for any
tax-exempt governuuental 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 803843C 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 12
instruction,.,,).
Filing a consolidated return. For all
tax-exempt governmental obligations with issue
prices of less than $101.1,000 that are not reported
on it separate Form 803843C,
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, a separate Form 8038-(3C.
must be filed to give the IRS notice of the election to
pay a penalty in lieu of arbitrage rebate.
When To File
To file a separate return, 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, file Form
80+8-GTC 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. 88-10. 1988-1 C.B. 635. if it is
determined that the fanilure to file on time is not due
to willful neglect. Type or print at the top of the
form, "This Statement Is Submitted in. Accordance
with Rev. Proc. 88-10." Attach to the Form 8038 -
GC a letter briefly stating wl1v the form was not
submitted to the iRS on tine. 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 Wbere To File below.
Where To File
File Form 8038 -GC, and mnv attachments,
with the Internal Revenue Service (.'enter, Ogden,
tTT 84201.
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 and Penalty in
Lieu of Arbitrage Rebate. For private activity bonds.
use Form 8038, Information Return for Tax -
Exempt Private Activity Bond Issues.
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 cent~ 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 if 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 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
fine department under section 150(e)
Private activity bond. This includes an obligation
issued as part of an issue in vnlnieh:
• 1\ lore than 10° o of the proceeds are to be used
for any private activity business use,
and
Cat. No. 64108B Form 8038 -GC (Rev.11-2000)
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Pitney Bowes
Engineering the flow of communication- WSCA Installment Option A Agreement Account # 60
Your Business Information
CITY OF CUPERTINO
Full Legal Name of renter
DBA Name of renter
Tax ID # (FEINITIN)
10300 TORRE AVE
CUPERTINO
CA
95014-3255
Billing Address
City
State
Zip+4
( ) ext
22884240205
Billing Contact Name
Billing Contact Phone #
Billing CAN #
10300 TORRE AVE
CUPERTINO
CA
95014-3255
Installation Address (If different from billing address)
City
State
Zip+4
Julie (408) 777 324Tem 13 ) a-. 22884240205
Installation Contact Name Installation Contact Phone # Installation CAN #
Credit Card # Name on Card Exp Date Type of Card
Tax Exempt # State Tax (if applicable) Fiscal Period (from - to)
Your Business Needs
Qty Business Solution Description Check items to be included in customer's payment
Mail Stream Solution - 2
1 3 Station D1425 without OMR
1 Operator Training for D13800425, 1 hour
Your Payment Plan
Number of months Monthly amount
First 48 $386.40
Your Acknowledgement
Equipment Maintenance (1st year included)
Provides service coverage including certain parts and labor
Software Maintenance (1st year included)
Provides revision updates and technical assistance
❑ Soft-Guard(D Subscription
Provides postal and carrier updates
If you do not elect to include Soft -Guard® protection with your lease, you will automatically
receive updates at the then -current rates
F lntel[!LinkTm Subscription/Meter Rental
Provides simplified billing and includes ( )resets per year
( Confirmation Services Electronic access to postal confirmation service
( Purchase Power Receive an invoice for postage,consolidated billirn
and enhanced management reporting information.
() Required advance check of $ received
( ) Tax Exempt certificate attached
Initial rental term
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.
Signature
p&t. 15, aoo9
Date
Kimberly Smith MMC City Clerk kimberlys@cupertino.org
Print Name Title Email Address
Chris gallagher
Account Rep
WSCA OPTION A Form (Rev.04/06)
004
District Office
Page 1
See additional pages for term= and conditions
PBGFS Acceptance
Equipment Vendor Pitney Bowes Inc.
r -,,r Sales and Services call 1 -BOO -322 -ROOD
INSTALLMENT LEASE AGREEMENT OPTION A
Pitney Bowes Global Financial Services LLC may serve as a sub -contractor under EPS050076-
A2-2 and be the financing party under such Installment Lease Agreements.
The pricing plan for the Installment Lease Agreement is as follows:
Monthly Billing:
Quarterly Billing:
Tenn
Lease Rate
Term
Lease Rate
36
.0317
36
.0960
48
.0247
48
.0750
60
.0205
60
.0625
The terms and conditions are as follows:
1. GENERAL. All Installment Lease Option A Agreements (each referred to herein as
"Installment Agreement") consist of the following terms and conditions in addition to the
applicable terms and conditions of EPS050076-A2-2. By issuing a Purchase Order under the
Installment Agreement, the Participating Agency is requesting that Contractor leases the
referenced equipment (the "Equipment") for essential governmental purposes. Such
Equipment does not include any referenced IntelhLinkTM Control Center or postage meter,
which remains the property of Contractor or one of its wholly owned subsidiaries. Any
IntelliLinkTM Control Center or postage meter is subject to the applicable USPS regulations
and meter terms and conditions as may be provided by Contractor.
2. TERM. Each Installment Agreement shall commence upon acceptance of the Equipment
and shall continue until the earlier of: (i) termination at Contractor's Option upon the
Participating Agency's failure to pay when due the amount required or failure to perform any
other obligation under an Installment Agreement or under EPS050076-A2-2, (ii) the
occurrence of an event of non -appropriation or terminationor Contractor default under
EPS050076-A2-2, (iii) termination in accordance with paragrapJ 3 below, or (iv) the
expiration of the specified term.
3. CANCELLATION OR TERMINATION. The Participating Agency intends to enter into
an Installment Agreement for the entire agreed upon tenni and Contractor relies upon such
represented intention when determining the applicable pricing plan. If the Participating
Agency cancels or terminates an Installment Agreement prior to its expiration (other than for
non -appropriations or Contractor default pursuant to EPS050076-A2-2), the Participating
Agency shall pay a termination charge equal to the net present value of the monthly payments
remaining through the completion of the terms, discounted to present value at a rate of 6% per
year.
4. REMEDIES. If the Participating Agency fails to pay when due any amount required, or fails
to perform any other obligation under an Installment Agreement or under EPS050076-A2-2
and fails to cure the same within thirty (30) days of the Participating Agency's receipt of
written notice thereof, Contractor may, at its option and without further demand or notice,
take one or any combination of the following actions: terminate the relevant Installment
Agreement, take possession of the relevant Equipment (and the meters), declare the entire
amount of all payments, and other amounts due and to become due, for the then current fiscal
WSCA OPTION A Form (Rev. 4/06) 1
period for which funds have been appropriated to be immediately due and payable, and
pursue any other remedy permitted by applicable law.
5. REPRESENTATIONS; MISCELLANEOUS. The Participating Agency represents and
warrants that: (a) it shall timely file an information reporting return (e.g. Form 8038 - GC or,
as necessary, Form 8038 - G) with the Internal Revenue Service in accordance with Section
149(e) of the Internal Revenue Code of 1986, as amended (the "Code"), and the regulations
thereunder and the Participating Agency hereby appoints Contractor as its Agent for the
purpose of maintaining a registration system as required by Section 149(a) of the Code; and
the Participating Agency is (and shall continue to be) a State or local government entity, and
that any obligation arising out of this Agreement constitutes an obligation by or on behalf of a
state or political subdivision thereof, within the meaning of Section 103 of the Code and the
regulations thereunder. The Participating Agency acknowledges that the Installment
Agreement is entered into based on the assumption that the interest portion of each Period
Payment is not includible in gross income of the owner thereof for Federal income tax
purposes under Section 103(a) of the Code. A portion of each Period Payment that the
Participating Agency shall pay includes interest. If any interest is determined not to be
excludible from gross income in accordance with Section 103(a) of the Code, the
Participating Agency's Period Payment shall be adjusted in an amount sufficient to maintain
Contractor's original after tax yield utilizing Contractor's consolidated marginal tax rate,
which adjusted Period Payments the Participating Agency agrees to pay as provided in this
Agreement. The rate at which the interest portion of Period Payments is calculated is not
intended to exceed the maximum rate or amount of interest permitted by applicable law. If
such interest portion exceeds such maximum, then at Contractor's option, if permitted by law,
the interest portion will be reduced to the legally permitted maximum amount of interest, and
any excess will be used to reduce the principal amount of the Participating Agency's
obligation or be refunded to the Participating Agency.
6. ASSIGNMENT. The Participating Agency may not assign, transfer or sublet any interest in
an Installment Agreement or the Equipment without Contractor's prior written consent.
7. TITLE. Title to the equipment passes to the Participating Agency at the time and place of
acceptance of each unit of equipment. The Contractor or its duly authorized assignee shall
have a purchase money security interest in the equipment, until payment of all installments
are made. Upon payment of the final installment, or any concluding payment option, the
Contractor or his duly authorized assignee shall have no further interest in the equipment.
8. PURCHASE OPTION. The Participating Agency shall have the option to purchase the
Equipment at any time during the Tenn "as is, where is" by paying the remainder of all
installment payments.
RISK OF LOSS. The Participating Agency is responsible for Equipment loss, damage or
destruction from any cause, whether or not insured from the date of acceptance and for the
entire term. No Equipment loss, theft or damage shall relieve the Participating Agency of its
obligation to make the payments or perform its obligations under an Installment Agreement.
Notwithstanding the foregoing, the Participating Agency shall not be responsible for
Equipment loss, damage or destruction if Contractor has delivered non-conforming
goods.
WSCA OPTION A Form (Rev. 4/08) 2