83-041 Xerox Standard Agreement XEROX
FEDERAL/STATE AND LOCAL GOVERNMENT July i 1981
X
L OX ! STANDARD AGREEMENT
Copiers/Duplicators/Engineering and Graphic Products/Accessories
C stomer Name(Bill To) ,- Customer Name(Installation)
i1-ti (Billy
J dTiok) ,
f fraerfr
Addressi
/30-0 2)XL C'' /961f4),I / Address -
City/etUnPr,1i„o C /9' Zipc/c5-D/..1— City/State Zip
Customs(-type:
D.—Official State Government/Political Subdivision 0 Prime Contractor to State/Local Government .
❑ Full Time Non-Profit School/College, University 0 Federal Cost Type Government Contractor
❑ Non-Profit Hospital
See reverse side for terms and conditions relative to eligibility requirements.
- This order is placed pursuant to Xerox Corporation's ' c
❑ State and Local Government Copying Equipment Price List(XRX l))//(9(ti 0 7 1 as revised from time to time. -CI
❑ GSA Federal Supply Service Authorized Federal Supply Schedule Price List(GS-00S- ) as revised from time to time.
Equipment/Price Plan/Period of Rental Description •
-
z. In-Place Equipment
Equipment Ordered Purchased/Price Converted/Replaced
Qty. Description Qty. Description Serial Number Meter Reads
n�IF t)a0lir� �
Artl ,G.� 74 ,�1�8 �q
. t/4/-N /Sao
O
Price Plan Description _ _ Period of Rental -1—GOD riff-- Bill Code
Initial to designate acceptance of EQUIPMENT/PRICE PLAN/PERIOD OF RENTAL described a ove. _ v(Initials)
Initlafto designate acceptance of Firm Annual Option 0 Fiscal Year Option 0 Fiscal Year Begins / / /p ?i (Initials)
Equipment Purchase/Maintenance Description - ..
Equipment Type: Equipment List Purchase Price $
❑ Newly Manufactured ' Less: Option to Purchase Credit Plan A 0 Plan B 0
❑ Remanufactured Or: Trade-In Allowance
❑ Reconditioned Or: Other
❑ In-Place Equipment Net Purchase Price -\`�/ $
Maintenance: Xerox Full Service Maintenance Plan A❑ Plan CP 0 Plan CETPk Time and Materials 0 Other ❑
Earliest Customer Acceptance Date ___�_�� l f ` Initial Supply Order
Tax Exempt 0""No 0 -Yes
Supply Item Quantity Reorder Number
Tax Exempt Certificate No. fie
/Equipment Purchase Order it e( No ❑ Yes Paper /��
_Equipment Purchase Order No. ! °=�" (.e�f.�,(C..-�/ Toner '(f//rf_\I///
f-nply Purchase Order No. Developer
Xerox-Supply Agreement No. Fuser Oil \
- K-12 Summer Option Code (See reverse)
Customer authorizes initial supplies: Yes No Pre-Packed
' "�"
-„ (initials) Other '
Customer agrees to hire and Xerox agrees to provide ❑ Reprographic ❑ Maintenance Services including the
. furnishing of the Xerox Equipment described above ("Equipment") and supplies, in accordance with the terms and
. ---_--, conditions set forth in the Price List noted above. -
tt'bustomer agrees to purchase‘17.and Xerox agrees to sell and deliver the Xerox Equipment described above ("Equip-
ment") and supplies, in accordance with the terms and conditions set forth in the Price List noted above. Breach of
this Agreement may subject Customer to payment of Termination Charges. See terms and conditions contained in
the Price List noted above. ,
CUSTO> //�� XEROX CORPORATION
By a 12 of v e0/f'ti` A-r U3 �j
/< / (Plea :Print f ^ r/��/,�/,'�� /.It)./v 1`2 / 4C-3 Signature ..����/� �/ Signature U-' �/ l ro" Date
Title l__�!/ -/ Date ›Ar_ Date
V
FOR OFFICE USE ONLY:Tp expedite delivery please complete the following: Delivery Hours: ,0,f,4'�, Floor:�+ , Room:
Is space available for installation Dr 0 No `,r I M ...La
Will correct wiring/repeptacle be available at installation time: 9� Yes 0 No
Is there any special preparation/rigging necessary for delivery? -
(i.e., stairs, door width, elevators etc. If so please specify)
Delivery Contact Name Telephone
FORM 58085(6181) CUSTOMER COPY
XEROX
Eligibility For State and Local Copying Equipment Price List
1. Official State Governments and Political Subdivisions. vided to Xerox with each order and resubmitted to Xerox at the
2. Full-time non-profit Schools, Colleges and Universities beginning of each price list period of the State Government or
(hereinafter Schools). An eligible school is defined as a full-time Political subdivision for whom the contractor is "acting"); and
school if it is a non-profit,tax-exempt institution,the primary (3) is a non-profit organization. Any Contractor qualifying under
purpose of which is to provide instruction through a full-time this section must provide Xerox with a copy of its Federal Tax
faculty to an enrolled body of students, and is licensed by an exemption certificate under section 501 (c) (3) of the Internal
appropriate State authority to confer degrees or diplomas which Revenue Code. All other Contractors are not eligible under this
are recognized as qualifying the student to pursue a course of provision.If a Customer loses the certification which made it eligi-
higher education. Prior to Xerox accepting any order, the ble to use the State and Local Government Price List, the
Customer requesting eligibility under this paragraph must provide Customer agrees to notify Xerox.
Xerox with a copy of its federal tax-exemption certificate under 5. The Customer represents he is eligible under these criteria. If
Section 501 lc) (3)of the Internal Revenue Code. this representation is inaccurate, or if Customer loses eligibility,
3. Non-profit Hospitals. An eligible hospital is defined as a non- Xerox reserves the right, upon 30 days written notice, to convert
profit hospital if it is a non-profit, tax exempt institution and is the Customer to a commercial price plan for an equivalent term.
listed as a hospital in the most current edition of the American NOTE:Customers qualifying under paragraph 2,3 or 4 who place orders with Xerox that
Hospital Association Guide to the Health Care Field. Prior to do not contain the required certification will be billed at the appropriate commercial
prices.If it is determined after shipment that the Customer is entitled to the State and
Xerox accepting any order, the Customer requesting eligibility Local Government Price List rata(but did not provide the necessary cenifications),
under this paragraph must provide Xerox with a copy of its federal adjustments or rebllling at this price list rate will not be permitted.
tax-exemption certificate under Section 501 (c) (3)of the Internal 6. Partial List (examples) of customers NOT ELIGIBLE to use
Revenue Code. this price list:
4. Certain prime Contractors to State Governments and their (a)Any"for-profit" organizations.
Political subdivisions (FOR RENTAL ONLY) provided all the (b) Recipients of grants-in-aid(Grantees)from State Governments
following conditions are met:The Contractor(1)is a State or Local or political subdivisions.
Government contractor whose total operating funds are secured (c) Federal Government Agencies,their contractors or grantees.
through The.Federal Government, State Governments or their (d)Youth Associations and part-time schools.
Political subdivisions, or from any combination of these Govern- (e)Trade Associations, Labor unions, or political parties.
ments; (2) has been granted authorization by the State or Local If) Social clubs, churches or charitable foundations.
Government Agency to"act for"that State or Local Government. (g) Doctor's Offices, Health Clinics, and Medical Laboratories:
This authorization must be in writing(a copy of which is to be pro- These examples are by way of illustration and are not all-inclusive.
Certification of Federal Cost Type Government Contractors:
a. All orders and renewals,authorized by U.S.Government Agencies in writing in the event that the authorization furnished hereunder is
accordance with Defense Acquisition Regulation(5-900)or Federal terminated. When authorization is terminated, Xerox shall com-
Procurement Regulations(FPR 1-5.9)concerning the'Use of GSA mence billing under commercial prices.
Supply Sources by Contractors' and placed by Federal Govern- c. Contractors placing orders with Xerox not containing the required
ment prime(only)cost type contractors under this GSA Contract, certification will be billed at the appropriate commercial(non GSA
shall be accompanied by a copy of the Government authorization. contract)prices. If it is determined after shipment occurs that the
Every purchase order shall contain a statement as follows: Contractor is entitled to GSA rates (but did no( provide the
"This order is placed pursuant to written authorization from necessary certification) adjustment or rebilling at GSA contract
(Name of Government Agency) rates will not be permitted.
Dated, a copy of which is attached.In the d. Federal grantees are not permitted to use this contract as a source
event of an inconsistency between the terms and conditions of of supply in accordance with FPR 1-5.9. Cost type subcontractors
this order and those of your Federal Supply Service Contract,the are not permitted by Xerox to place orders under the Xerox-GSA
latter will govern." contract.
b. Prime cost type contractors certified and using this contract as a e. Title to equipment purchased by authorized Prime Contractors will
source of supply will use items ordered only in the performance of pass to the Contractor.Transfer of title to the Government will be
the cost type Federal Contract and shall notify Xerox promptly in the responsibility of the Contractor.
K-12 Summer Option Code
3 — School open June, July,August 6 — School closed June only
4 — School closed June and July 7 — School closed July only
5 — School closed July and August 8 — School closed August only