HomeMy WebLinkAboutPR 19221: 50 TICKET WRITERS FOR THE POLICE DEPARTMENT Memorandum
To: Brian McDougal, City Manager
From: Chief Blanton, Chief of Police
Date: 10/28/15
Re: PR 19221
RECOMMENDATION:
The Police Department recommends that the City Council approve the lease
agreement with CDW-G, through HP Financial for 50 ticket writers, for a
total amount of $88,671, with monthly payments of$1,602.01 for a term of
60 months. This is a TCPN Contract Price.
BACKGROUND:
The Police Department purchased ticket writers approximately eight years
ago. Since that time, these devices have become old and are no longer
supported by warranty. The new devices have new technology and will be
more economical by having built in Wi-Fi and faster processors. This allows
them to be downloaded in the field as opposed to having to come to the
police station to be docked. By utilizing a lease program, we will not be
facing the same problem in a few years when our "purchased" equipment is
outdated. Police received a quote from CDWG. The quote was based on the
TCPN Cooperative Contract.
BUDGETARY/FISCAL EFFECT:
Funds for this purchase are available in account # 001-1101-521.42-00.
STAFFING/EMPLOYEE EFFECT:
None.
SUMMARY:
The Police Department recommends that the City Council approve the lease
agreement with CDW-G, through HP Financial for 50 ticket writers, for a
total amount of$88,671, with monthly payments of$1,602.01 for a term of
60 months.
MB:sb
P.R. No. 19221
10/28/14 sb
RESOLUTION NO.
A RESOLUTION AUTHORIZING A LEASE AGREEMENT WITH CDW-G, THROUGH
HP FINANCIAL SERVICES, FOR 50 TICKET WRITERS FOR THE POLICE
DEPARTMENT FOR THE TOTAL AMOUNT OF $88 , 671 USING THE TCPN
COOPERATIVE CONTRACT, WITH MONTHLY PAYMENTS OF $1 , 602 . 01 FOR 60
MONTHS; FUNDING FOR THIS PURCHASE IS AVAILABLE IN ACCOUNT NO.
001-1101-521 . 42-00 .
WHEREAS, the Police Department wishes to enter into a lease agreement
for new ticket writers for the Police Department; and
WHEREAS, the Police Department has been utilizing ticket writers from
Brazos Technology, College Station, Texas, for the past several years; and
WHEREAS, the ticket writers have become old and are no longer covered
by warranty; and
WHEREAS, a copy of the contract pricing worksheet and the lease
agreement through HP Financial are attached as Exhibit A; and
WHEREAS, as an alternative to competitive sealed bidding or
proposals, a city may use a cooperative purchasing program as a
procurement method as stated in Subchapters D and F of Chapter 271 of
Texas Local Government Code; and
WHEREAS , pursuant to Resolution No . 03-223, the City of Port
Arthur entered into an Interlocal Agreement for cooperative
purchasing with Texas Cooperative Purchasing Network (TCPN) ; and
WHEREAS, funds for this purchase are available in account number 001-
1101-521 . 42-00 .
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PORT
ARTHUR:
Section 1 . That the facts and opinions in the preamble are true and
correct .
Section 2 . That the Police Department is hereby authorized to
enter into a lease agreement with CDW-G, through HP Financial Services for
50 ticket writers for the total amount of $88, 671, with monthly payments
of $1, 602 . 01 for 60 months .
Section 3 . That a copy of the caption of this resolution shall be
spread upon the Minutes of the City Council .
P.R. No. 19221
10/28/14 sb
READ, ADOPTED AND APPROVED on this day of
A. D. , 2015, at a Regular Meeting of the City Council of the
City of Port Arthur, Texas, by the following vote: AYES :
Mayor:
Councilmember:
NOES:
Deloris Prince, Mayor
ATTEST:
Sherri Bellard, City Secretary
APP�OQVED ASS TO FORM:
Val Tizeno, ' ty Attorney
APPROVED FOR ADMINISTRATION:
Brian McDougal, City Manager
APPROVED AS TO AVAILABILITY OF FUNDS :
Jerry Dale, CPA/GFOA
Interim Director of Finance ' 6
i, µ4
Clifton Williams, CPPB
Acting Purchasing Manager
P.R. No. 19221
10/28/14 sb
EXHIBIT "A"
1CDWG.com I 800.594.4239 OE400SPS
*gift SQO
QUOTEALES NO. ACCOUNTUOTATINO. N
DATE
GQFM167 0816598 11/18/2015
BILL TO: SHIP TO:
CITY OF PORT ARTHUR CITY OF PORT ARTHUR POLICE
PO BOX 1089 Attention To: DAVE MAI
645 4TH ST
Accounts Payable
PORT ARTHUR ,TX 77641-1089 PORT ARTHUR ,TX 77640-6455
Contact: DAVE MAI 409.983.8658
Customer Phone#409.983.8100 Customer P.O.#GPFD727 QUOTE
ACCOUNT MANAGER SHIPPING METHOD TERMS EXEMPTION CERTIFICATE
PETER MCGEE 877.708.8009 FEDEX Ground Net 30 Days Govt STATE
State/Local
QTY ITEM NO. DESCRIPTION UNIT PRICE EXTENDED PRICE
50 3544416 ZEBRA TC70 WLAN 802.11 KITKAT 4 1,356.54 67,827.00
Mfg#:TC700H-KC11 ES-NA
Contract:TCPN-Technology Solutions R5106
R5106
50 3757877 ZEBRA 3YR ONECARE ESSENTIAL SVC 288.83 14,441.50
Mfg#:SSE-TC70XX-30
Contract:TCPN-Technology Solutions R5106
R5106
Electronic distribution-NO MEDIA
4 3731789 ZEBRA TC7X SE BATT CHARGE 4-SLOT 138.30 553.20
Mfg#: SAC-TC7X-4BTYC1-01
Contract:TCPN-Technology Solutions R5106
R5106
4 2253155 ZEBRA CRADLE PWR SUP 100-240VAC 40.39 161.56
Mfg#: PWRS-14000-148R
Contract:TCPN-Technology Solutions R5106
R5106
4 1099094 ZEBRA CORD SET 18AWG SVT 7.5FT 6.96 27.84
Mfg#:23844-00-OOR
Contract:TCPN -Technology Solutions R5106
R5106
16 3672690 ZEBRA 4620MAH LI-ION BATT F/TC7X 70.62 1,129.92
Mfg#: BTRY-TC7X-46MA2-01
Contract:TCPN-Technology Solutions R5106
R5106
10 3620863 ZEBRA 5-SLOT CRADLE W/CHRG F/TC7X 333.83 3,338.30
Mfg#:CRD-TC7X-SE5C1-01
Contract:TCPN-Technology Solutions R5106
R5106
10 1099094 ZEBRA CORD SET 18AWG SVT 7.5FT 6.94 69.40
Mfg#:23844-00-OOR
Contract:TCPN-Technology Solutions R5106
R5106
10 1218440 ZEBRA DC PWR CAB F/PWR SUP 28.46 284.60
Mfg#:50-16002-029R
Contract:TCPN-Technology Solutions R5106
R5106
10 2266703 ZEBRA PWR SUP FOR 4-SLOT CRADLE 83.77 837.70
Mfg#: PWRS-14000-241 R
Contract:TCPN-Technology Solutions R5106
R5106
SUBTOTAL f 88,671.02
FREIGHT 0.00
TAX 0.00
Imm_ I i
TOTAL I} 88,671.02
Please remit payment to:
CDW Government
CDW Government 75 Remittance Drive
230 North Milwaukee Ave. Suite 1515
Vernon Hills, IL 60061 Fax:847.371.7753 Chicago, IL 60675-1515
This quote is subject to CDW's Terms and Conditions of Sales and Service Projects at
http://www.cdwg.com/content/terms-conditions/product-sales.aspx
For more information, contact a CDW account manager.
200 Connell Drive,Suite 5000
Berkeley Heights,NJ 07922
November 5,2015
City of Port Arthur
541 Brazos Avenue
Port Arthur,TX, 77642
ATTN:
STATE AND LOCAL GOVERNMENT SINGLE SCHEDULE LEASE PURCHASE AGREEMENT No.: 528225291823934USA2
(CUSTOMER PURCHASE ORDER No. )
Thank you for selecting HP Financial Services Company(HPFS)to provide financing for your technology acquisition. As per the request of
your HPFS representative, we have prepared the following the lease documents for review and execution by and appropriate authorized
officers execute(or initial)where indicated by the red arrows.
Then mail originals too:HP Financial,200 Connell Drive,Suite 5000,Berkeley Heights,NJ 07922.
1. ®❑State and Local Government Single Schedule Lease Purchase Agreement
The Lease Agreement contains the terms and conditions of the lease arrangement between the Customer and HPFS.
2. ®❑Attachment A(Amortization Schedule)
This document details the amortization of the payments.
3. ®❑Form 8038-G
The Customer must complete this form in order to comply with notice information requirements under Internal Revenue Code for
tax-exempt transaction.
4. ®❑Acceptance Certificate[should be signed only after the you have RECEIVED the equipment]
This document confirms that the Customer has received the Equipment, is satisfied with it and is ready to begin the Lease and start
making payments.
5. ®❑Exhibit A-Equipment Listing(Refer to HP Quote Attached)
This document is the detailed description of the leased equipment to be attached to and incorporated into the Equipment Schedule as
Exhibit A.
6. ®❑Billing Information Form - This form should be completed by the Customer to ensure efficient delivery and payment of
invoices.
®Federal Tax ID Number(FEIN):
Copy of Sales and Use Tax Exempt Certificate
Should you have any questions or comments regarding the enclosed documents or the procedure outlined above, please do not hesitate to
contact me at 908-898-4777.
Thank you,
Marc Lozandier
Marc Lozandier
Customer Delivery Specialist
HP Financial Services
Marc.Lozandier@hp.com
Telephone Number: 908-898-4777
BILLING INFORMATION REQUEST FORM - INVOICING INSTRUCTIONS
Customer ID Number: 5282252918
Schedule Number: 528225291823934USA2
IN ORDER FOR HEWLETT-PACKARD FINANCIAL SERVICES COMPANY TO PROPERLY BILL AND CREDIT YOUR ACCOUNT, IT IS
NECESSARY THAT YOU COMPLETE THIS FORM AND RETURN IT WITH THE SIGNED DOCUMENTS.
BILL TO ADDRESS:(CUSTOMER LEGAL NAME):City of Port Arthur
Dept Name:
Street:541 Brazos Avenue
City,State&Zip: Port Arthur,TX, 77642
BILLING CONTACT:
First,M.I.and Last Name:
Title:
Phone Number:
Fax Number:
Email:
PURCHASING CONTACT:
First,M.I.and Last Name:
Title:
Phone Number:
Fax Number:
Email:
PURCHASE ORDER NUMBER:
Do your Invoices require PO numbers: 0 YES 0 NO
FEDERAL TAX ID NUMBER:
ARE YOU SALES/RENTAL TAX EXEMPT?
OYES(Please return a copy of your Sales and Use Tax Exempt Certificate with this Form).IF NOT,YOU WILL BE ACCESSED TAXES ACCORDINGLI'
❑NO
POINT OF CONTACT FOR SURVEYS (from time to time we survey our customers to see HOW WE CAN BETTER SERVE YOUR
NEEDS ETC)
First, M.I. and Last Name:
Title:
Phone Number:
Email:
Customer Portal Administrator** The HP Financial Services Customer Portal is a free,web-based, self-service lease management
tool,that provides 24 hour access to your lease portfolio in real time. The HPFS Customer Portal also aggregates your global lease
information into a centralized tool and allows an administrator to manage internal user profiles.
Customer Portal Administrator First, M.I. and Last Name:
Name of individual who will control Portal access
Title:
Phone Number:
Email:
Some available features on The HP Financial Services Customer Portal include:
Lease Origination Contract Management Asset Information
`gyp,. tmw
ir in!
ap,
• Authorize Cert. of Acceptance •View Contract Information •Asset Detail Reports
online •View Invokes -Standard Reports
• Document Repository Single •Review End-of lease Options •Manage Custom Defined Data
location for lease documents _Accept End-of Lease Quotes Online
• Asset Detail at parent/child level
There are 3 Levels of Access to the Portal and they are Administrator, Approver and General User Access.
Administrator has complete control over who has access to the portal and their level of access. You can also
perform the following tasks:
• View and update personal profile information
• Add and manage individual user profiles and grant user access in the USER ADMIN section
• Notify individuals via email of admin, signatory or user access privileges
Approver access allows a user to approve documents within the portal for example Lease Acceptance
Certificates in addition to all the reporting capabilities
General User access allows the user to the reporting features and to view the features of the tools but they
cannot grant access to other colleagues or approve any documents.
You will be granted access to the tool once you have identified who you would like to be the Administrator
of your Customer Portal Account. Please let us know who you are designating and that person's contact
information, name, phone# and email address
For more information about the Customer Portal, please take a look at the Brochure and the Site Tour for a brief
demonstration of the Tool.
• Brochure
• Site Tour
We look forward to working with you as you explore the new Customer Portal and appreciate your business.
SIGNATURE AND DATE:
STATE AND LOCAL GOVERNMENT SINGLE SCHEDULE LEASE PURCHASE
AGREEMENT
When we use the words you and your in this Lease,we mean you,our customer,which is the Lessee indicated below.When we use the words we,us and our in this
Lease,we mean the Lessor,Hewlett-Packard Financial Services Company. Our address is 200 Connell Drive,Suite 5000,Berkeley Heights,NJ 07922
CUSTOMER Lessee Name Tax ID#
INFORMATION City of Port Arthur
Billing Street Address/City/County/State/Zip Phone No. Lease
541 Brazos Avenue,Port Arthur,TX,77642,UNITED STATES 528225291823934USA2
Equipment Location Street Address/City/County/State/Zip Phone No. Schedule#
528225291823934USA2
SUPPLIER Supplier Name("Supplier") Phone No. Fax No.
INFORMATION CDW-G
Street Address/City/State/Zip Contact Name:
EQUIPMENT Quantity Make/Model Price Each/Extension
DESCRIPTION Refer to CDW-G Quote#GPFD727 Attached
TERM AND Lease Term(Months) Lease Payment Documentation Fee Payment Timing(Check one) Plus
LEASE PAYMENT Applicable
SCHEDULE 60 $1,602.01 N/A ['Advance Taxes and
®Arrears Insurance
Additional Provisions Total Cash Price Payment Frequency(Check one)
®Monthly
N/A $88,671.02 ❑Quarterly
0 Semi Annual
❑Annually
['Other
Annual Rate of Interest Latest Commencement Date
3.22% November 30,2015
PART I
You agree to lease the equipment described above(collectively,"Equipment")on the terms and conditions of this lease agreement("Lease"). The term of this Lease is set forth above. This Lease shall
be effective with respect to the Equipment from and after the date of your acceptance of the Equipment. Each Lease Payment(singly,a Lease Payment and collectively,the"Lease Payments")are to be
made in the manner specified above and shall commence on the date the Equipment is accepted by you as evidenced by your execution and delivery to us of a Delivery and Acceptance Certificate with
respect to the Equipment. You must notify us of any change in the Equipment to be included in any proposed Lease and we reserve the right to accept or reject such change. Our acceptance of this
Lease shall be evidenced by our execution hereof.
PART II
1. TERMS AND CONDITIONS. In consideration of our purchase of the Equipment selected shall be excluded from gross income for federal income tax purposes,and you will do nothing
by you,we lease to you,and you lease from us,the Equipment identified above pursuant to to cause,nor fail to take action which results in,the interest portion of the Lease Payments
the terms and conditions set forth herein. THIS LEASE AND THE DOCUMENTS REFERRED being includible in gross income for federal income tax purposes; (e) NEITHER THE
TO HEREIN CONSTITUTE THE FULL AND ENTIRE AGREEMENT between you and us in SUPPLIER OF THE EQUIPMENT NOR ANY OF ITS SALESPERSONS ARE, OR HAVE
connection with the Equipment and MERGES ANY OTHER UNDERSTANDING. In no case ACTED AS,OUR AGENTS OR EMPLOYEES;(f)financial information and other statements
shall the preprinted terms and conditions on the Supplier's standard transactional provided to us are accurate and correct and will be updated upon our request during the term
documentation(e.g.,order forms and invoices)apply to us. Neither you nor we rely on any of this Lease;g)you are a political subdivision or agency or department of a State;(h)the
other statement,representation or assurance of cure. This lease can be neither canceled nor entering into and performance of this Lease are authorized under the laws and constitution of
modified except by a written agreement signed by both parties. your state and do not violate or contradict any judgement,law,order,or regulation,or cause
any default under any agreement to which you are a party; (i)you have complied with all
2. YOUR WARRANTIES TO US. You expressly represent and warrant to us,and we rely on, bidding requirements and,where necessary,have properly presented this Lease for approval
each of the following statements: (a)you have read and understood this Lease;(b)you have and adoption as a valid obligation on your part;j)this Lease is a legal,valid and binding
selected the equipment and specifications,and the equipment will meet your needs;(c) obligation enforceable in accordance with its terms;(k)you have sufficient appropriated funds
you will authorize us to pay for the Equipment only after you have received and accepted the or other moneys available to pay all amounts due under this Lease for your current fiscal
Equipment as fully operable for your purposes;(d)the interest portion of the Lease Payments period; (I)the use of the Equipment is essential for your proper, efficient and economic
Page 1 of 4
GEM SSLPA-04/03
operation,you will be the only entity to own,use or operate the Equipment during the term of chief executive, chief financial or administrative officer will provide for funding for such
this Lease and you will use the Equipment only for your governmental purposes;(m)You do payments in your annual budget request submitted to your governing body. You and we
not and will not:1)export,re-export,or transfer any Equipment,software,source code or any agree that your obligation to make Lease Payments under this Lease will be your current
direct product thereof to a prohibited destination, or to nationals of proscribed countries expense and will not be interpreted to be a debt in violation of applicable law or constitutional
wherever located, without prior authorization from the United States and other applicable limitations or requirements. Nothing contained in this Lease will be interpreted as a pledge of
governments;and 2)use any Equipment,software or technology,technical data,or technical your general tax revenues,funds or moneys.
assistance related thereto or the products thereof in the design,development,or production of
nuclear, missile, chemical, or biological weapons or transfer the same to a prohibited 6. NONAPPROPRIATIONS OF FUNDS. If(i) sufficient funds are not appropriated and
destination,or to nationals of proscribed countries,without prior authorization from the United budgeted by your governing body in any fiscal period for all Lease Payments and all other
States and other applicable governments.You are not an entity or person designated by the payments due under this Lease for such fiscal period,and(ii)you have exhausted all funds
United States government or any other applicable government with which transacting legally available for such payments, then you will give us written notice and return the
business without the prior consent of such government is prohibited.Upon our request,you Equipment to us,and this Lease will terminate as of the last day of the fiscal period for which
agree to provide us with an opinion of counsel as to clauses(g)through(j)above,a certificate funds are available to pay amounts due under this Lease. Such termination is without any
of appropriations as to clause(k)above,an essential use letter as to clause(I)above,and expense or penalty, except for the portions of the Lease Payments and those expenses
any other documents that we request, including information statements to be filed with the associated with your return of the Equipment in accordance with this Lease for which funds
Internal Revenue Service,with all such documents being in a form satisfactory to us. have been budgeted and appropriated or are otherwise legally available.
3. YOUR WAIVER OF DAMAGES AND WARRANTIES FROM US. YOU LEASE THE 7. TAXES,ASSESSMENTS AND FEES. You will pay when due,either directly or to us upon
EQUIPMENT FROM US"AS IS,WHERE IS." EXCEPT AS TO QUIET ENJOYMENT,WE our demand,all taxes,fines and penalties relating to this Lease or the Equipment at are now
MAKE ABSOLUTELY NO WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING ANY or in the future assessed or levied by any state,local or other govemmen hority. We will
WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IF file all personal property,use or other tax retu unless we notify •u otherwise in writing)
THE EQUIPMENT IS NOT PROPERLY INSTALLED, DOES NOT OPERATE AS and you agree to pay us a fee for m ing ch i.I. We d• •t have to ntest any axes,
REPRESENTED OR WARRANTED BY THE SUPPLIER,OR IS UNSATISFACTORY FOR fines or penalties. You , •a,st' - • property t- - with ea v ' or annu ly s
ANY REASON WHATSOEVER,YOU SHALL MAKE ANY CLAIM ON ACCOUNT THEREOF invoiced. In addit,•n, u a • e us to file at•- option financf tem nts an xture
SOLELY AGAINST THE SUPPLIER AND YOU HEREBY WAIVE ANY SUCH CLAIM filings without your sig e. If we re. -st, you will exe to such financf . s to ents
AGAINST US. ALL WARRANTIES FROM THE SUPPLIER TO US, TO THE EXTENT and/or fixture filings. To the extent. itted by law,yo by grant us a (u t interest in
ASSIGNABLE,ARE HEREBY ASSIGNED TO YOU FOR THE TERM OF THIS LEASE FOR all Lease Payments and Eq '- ant, and of ou interest th- J I pr eds and
YOUR EXERCISE AT YOUR EXPENSE. YOU SHALL HOLD US HARMLESS AND SHALL products thereof. You •ree to pa s ntation fee .iy�.r' with the first Lease
BE RESPONSIBLE FOR ANY LOSS,DAMAGE OR INJURY TO PERSONS OR PROPERTY Payments to co - accou t etu nd ministrative ou agree to reimburse us for
CAUSED BY THE EQUIPMENT. NO REPRESENTATION OR WARRANTY BY THE reasonabl: •sts incurr incting taxes,assess ts,or fees for which you are liable,
SUPPLIER OR SALESPERSON IS BINDING ON US NOR SHALL BREACH OF SUCH and-• collection charg ttributable thereto,including reasonable attorney fees.
WARRANTY RELIEVE YOU OF YOUR OBLIGATIONS TO US. IN NO CASE SHALL WE BE
LIABLE TO YOU FOR SPECIAL,INDIRECT OR CONSEQUENTIAL DAMAGES. 8. NOTICE. All notices shall be given in writing by the party sending the notice and shall be
effective when deposited in the U.S.mail,addressed to the party receiving the notice at its
4. PAYMENTS.You agree to make Lease Payments as set forth above and to pay such other address shown on page 1 of this Lease(or to any other address specified by that party in
charges as provided herein. IT IS SPECIFICALLY UNDERSTOOD AND AGREED THAT writing)with first class postage prepaid.
THIS LEASE SHALL BE NON-CANCELABLE(EXCEPT AS SET FORTH IN SECTION 6
HEREOF),AND THAT THIS LEASE IS A NET LEASE. YOU AGREE THAT YOU HAVE AN 9. SUCCESSORS AND ASSIGNMENTS. YOU AGREE NOT TO TRANSFER, SELL,
ABSOLUTE AND UNCONDITIONAL OBLIGATION TO PAY ALL LEASE PAYMENTS AND SUBLEASE, ASSIGN, PLEDGE OR ENCUMBER EITHER THE EQUIPMENT OR ANY
OTHER AMOUNTS WHEN DUE. You hereby authorize us to reduce the lease payments by RIGHTS UNDER THIS LEASE WITHOUT OUR PRIOR WRITTEN CONSENT,and even with
up to twenty percent(20%)in the event that the actual total cost of the equipment at the time our consent,you shall remain jointly and severally liable to the full extent with your assignee.
of closing is less than the estimate. Lease Payments shall be increased by any cost or WE WILL NOT SELL,DISCOUNT,FACTOR,HYPOTHECATE OR OTHERWISE DISPOSE
expense we incur to preserve the Equipment or to pay taxes,assessments,fees,penalties, OF OUR INTEREST IN THE EQUIPMENT OR THIS LEASE. .
liens,or encumbrances. Unless we give written notice of a new address,all payments under
this Lease shall be sent to us at the address provided at the beginning of this Lease. Each 10. OWNERSHIP AND TITLE,You will have title to the Equipment upon your acceptance of
payment received,at our discretion,will be applied first to the oldest charge due under this it; provided, however,that title will immediately vest in us or our assignee if this Lease is
Lease. YOU AGREE THAT TIME IS OF THE ESSENCE AND TO MAKE PAYMENTS terminated because you have not appropriated funds for payment of Lease Payments or other
REGARDLESS OF ANY PROBLEMS YOU MIGHT HAVE WITH THE EQUIPMENT amounts due hereunder,as provided in Section 6 of this Lease or if you are in default of this
INCLUDING ITS OPERATION, CAPABILITY, INSTALLATION, OR REPAIR AND Lease pursuant to the terms of Section 16 of this Lease. We have the right to inspect the
REGARDLESS OF ANY CLAIM,SETOFF, DEFENSE YOU MIGHT HAVE AGAINST THE Equipment, and have the right to affix and display a notice of our security interest in the
SUPPLIER,MANUFACTURER,SALESPERSON,OR OTHER THIRD PARTY. Without our Equipment. The Equipment shall remain personal property whether or not affixed to realty
prior written consent,any payment to us of a smaller sum than due at any time under this and shall not be part of any real property on which it is located. At our request,you shall
Lease shall not constitute a release or an accord and satisfaction for any greater sum due,or obtain a landlord and/or mortgage waiver for the Equipment. All additions,attachments,and
to become due,regardless of any endorsement restriction,unless otherwise agreed by both accessories placed on the Equipment become part of the Equipment unless removed prior to
parties in a signed writing. the termination of this Lease. You agree to maintain the Equipment so that it may be removed
from the property or building where located without damage.
5. FUNDING INTENT. You reasonably believe that funds can be obtained sufficient to make
all Lease Payments and other payments during the term of this Lease. You agree that your
Page 2 of 4
GEM SSLPA-01/16/14
11. OPERATION AND TERMINATION. You shall be solely responsible for the installation, greater of$.05 per dollar of each delayed sum or$15;plus(ii)a charge for every month after
operation, and maintenance of the Equipment,shall keep it in good condition and working the first month in which the sum is late to compensate us for the inability to reinvest the sum,
order,and shall use and operate the Equipment in compliance with applicable laws. If the such charge is stipulated and liquidated at 1 1/2%per month,or when less,the maximum
Equipment is of the type not normally maintained by you,then you,at your expense,shall allowed by law.
maintain in full force and effect throughout the term of this Lease Supplier's standard
maintenance contract. You agree to keep and use this Equipment only at the address 16. DEFAULT. You shall be in default of this Lease on the occurrence of any of the following
specified above,to never abandon or move the Equipment from that address,nor relinquish events: (a)you fail to pay any Lease Payment or any other amount due under this Lease
possession of the Equipment except to our agent. If you are required to return the Equipment within 10 days after it first becomes due; (b)you assign, move, pledge, sublease, sell or
to us for any reason,you shall,at your expense,wipe clean or permanently delete all data relinquish possession of the Equipment,or attempt to do so,without our written authorization;
contained on the Equipment, including without limitation,any data contained on internal or (c)you breach any other obligations under this Lease,or any other agreement with us,and
external drives, discs, or accompanying media, immediately crate, insure and return the fail to cure such breach within ten days after we send notice of the existence of such breach;
Equipment to the designated location in as good a condition as when you received it, (d)you breach any warranty to us;(e)any execution or writ of process is issued in any action
excepting only reasonable wear and tear.In the case of any item of Software to be returned to or proceeding to seize or detain the Equipment; or (f) you file a voluntary petition in
us,you will also deliver to us the original certificate of authenticity issued by the licensor of bankruptcy,you are adjudicated as a bankrupt,or any proceeding is filed against you under
such Software,if any. the bankruptcy or similar laws of the United States or the state where the Equipment is
located, and the proceeding is not dismissed within 60 days after filing.
12. RISK OF LOSS AND INSURANCE. During the term of this Lease,you bear the entire
risk of loss or damage to the Equipment. You shall immediately notify us of the occurrence of 17. REMEDIES. Should you default,we have the right to collect and to exercise any or all of
any loss or other occurrence affecting our interests and shall make repairs or corrections at the following: (a)we may cancel or terminate this Lease or any or all other agreements that
your expense. In such event,and to the extent permitted by law,you agree to continue to we have entered into with you or withdraw any offer of credit;(b)we may require you to pay
meet all payment and other obligations under this Lease. You agree to keep the Equipment us,as compensation for loss of our bargain and not as a penalty,all Lease Payments for the
insured at your expense against risks of loss or damage from any cause whatsoever. You remainder of your current fiscal period;(c)we have the right to immediately retake possession
agree that such insurance shall not be less than the replacement value of the Equipment. of the Equipment without any court order or other process of law and for such purpose may
You also agree that the insurance shall be in such additional amount as is reasonable to enter upon any premises where the Equipment may be, remove the same and apply any
cover us for public liability and property damage arising from the Equipment or your use of it proceeds from any sale or lease of the Equipment to the payment of amounts which would
You agree to name us as the loss payee and an additional insured. Upon our request,you have been due, if the default had not occurred; and(d)we have the right to exercise any
agree to furnish proof of each insurance policy including a certificate of insurance and a copy remedy at law or equity,notice thereof being expressly waived by you. Our delay or failure to
of the policy. The proceeds of such insurance shall be applied at our sole election toward the exercise a remedy constitutes neither a waiver of any other remedy or a release of your
replacement or repair of the Equipment or payment towards your obligations. If you so liability to return the Equipment or for any loss or Claim with respect thereto. You shall be
request and we give our prior written consent,in lieu of maintaining insurance as described liable for all reasonable costs and expenses incurred in the repossession,recovery,storage,
herein,you may self insure against such risks,provided that our interests are protected to the repair,sale,re-lease or other disposition of the Equipment
same extent as if the insurance had been obtained by third party insurance carriers and
provided further that such self insurance program is consistent with prudent business 18. SEVERABILITY. The provisions of this Lease are severable and shall not be affected or
practices with respect with such insurance risk. You will give us certificates or other evidence impaired if any one provision is held unenforceable,invalid,or illegal. Any provision held in
of such insurance on the commencement date of this Lease,and at such times as we request. conflict with any statute or rule of law shall be deemed inoperative only to the extent of such
Such insurance obtained will be in a form,amount and with companies acceptable to us,and conflict and shall be modified to conform to such statute or rule.
will provide that we will be given 30 days' advance notice of any cancellation or material
change of such insurance. 19. RELEASES. To the extent permitted by applicable law,you hereby waive your rights to:
(a)cancel or repudiate this Lease;(b)revoke acceptance of or reject the Equipment;(c)claim
13. INDEMNITY. You agree, to the extent permitted by law, to indemnify and hold us a security interest in the Equipment;(d)accept partial delivery of the Equipment;(e)sell or
harmless from and against, any and all losses, damages, injuries, claims, demands, and dispose of the Equipment upon rejection or revocation;(f)seek"cover"in substitution for this
expenses,including any and all attorney's fees and legal expenses("Claims")arising from or Lease from us.
caused by any actual or alleged use, possession, maintenance, condition(whether or not
latent or discoverable), operation, location, delivery or transportation of any item of /� 20. MITIGATION OF DAMAGES. Should we use or dispose of any returned or repossessed
Equipment. -6 44,0 £I,.004- 4<<O k)A b I �
L Y 0 p. t"�n L•JR r�Equipment,we will credit the amount that you owe with any excess which we actually recover
14.TRANSFER OF EQUIPMENT AT END OF TERM OF LEASE AND PURCHASE OPTION. over the cost of retaking and disposing of the Equipment. Any action under this Lease by you
When you have paid all Lease Payments and all other amounts due under this Lease and for claims against us for indemnity,misrepresentation,breach of warranty and contract default
have satisfied the other terms of this Lease, we shall transfer all of our interest in the or any other matter shall be commenced within one(1)year after any such cause of action
Equipment to you"AS IS,WHERE IS,"without any warranty, express or implied,from us. accrues. The provisions of this Section 20 shall be applied only to the extent permitted by the
With 30 days prior written notice,you may purchase the Equipment(other than software that laws of the state where the Equipment is located.
we may not be authorized to sell)on any Lease Payment date for an amount equal to the rent
due on the Lease Payment date, the remaining Lease Payments due under this Lease 21. MISCELLANEOUS. Regardless of any conflicting provisions in this Lease,this Lease will
discounted at the annual rate of 3%and all other amounts due under this Lease. You may be governed by the laws of the state in which the Equipment is located. Any change in any of
exercise this purchase option only if you are not in default under the terms of this Lease. the terms and conditions of this Lease must be in writing and signed by us. If we delay or fail
to enforce any of our rights under this Lease,we will still be entitled to enforce those rights at
15. COLLECTION CHARGES AND ATTORNEY'S FEES. If any part of any sum is not paid a later time. It is the express intent of the parties not to violate any applicable usury laws or to
when due,you agree to pay us: (i)in the first month,a late charge to compensate us for exceed the maximum amount of time price differential or interest,as applicable,permitted to
collecting and processing the late sum,such late charge is stipulated and liquidated at the be charged or collected by applicable law,and such excess payment will be applied to Lease
Page 3 of 4
GEM SSLPA-01/16/14
Payments in inverse order of maturity,and any remaining excess will be refunded to you. If and indemnities under this Lease, to the extent they are fairly attributable to events or
you do not perform your obligations under this Lease,we have the right,but not the obligation, conditions occurring or existing on or prior to the expiration or termination of this Lease,shall
to take any action or pay any amounts that we believe are necessary to protect our interests. survive such expiration or termination and be enforceable by us and our successors and
You agree to reimburse us immediately upon our demand for any such amounts that we pay. assigns.You agree that we may disclose any information provided by you to us or created by
All representations, warranties and covenants made by you hereunder shall survive the us in the course of administering this Lease to any of our parent or affiliates.
termination of this Lease and shall remain in full force and effect. All of our rights,privileges
BY SIGNING BELOW YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND ALL OF THE TERMS AND
CONDITIONS OF THIS LEASE.
CITY OF PORT ARTHUR HEWLETT-PACKARD FINANCIAL SERVICES COMPANY
X X
Authorized Signature Authorized Signature
Print Name&Title Date Print Name&Title Date
CERTIFICATION
I,the undersigned,DO HEREBY CERTIFY that I am a duly elected or appointed and acting officer(or duly authorized designee of such officer)of City of Port
Arthur(the "Customer"), a political subdivision or agency or department of the State of Texas and that I have custody of the records of the Customer; that the
individual executing the above State and Local Government Single Schedule Lease Purchase Agreement(the"Lease")on behalf of the Customer is incumbent in the
office printed or typed below his/her signature and is duly authorized to execute and deliver the Lease and all related documents, in the name and on behalf of the
Customer;and that the signature of such individual is his/her authentic signature.
IN WITNESS WHEREOF,I have hereto set my hands and affixed the seal of the Customer this day of ,20_.
Certifier's Signature To be executed by person other than individual executing above(eased
Print Name
Print Title
Page 4 of 4
GEM SSLPA-01/16/14
STATE AND LOCAL GOVERNMENT SINGLE SCHEDULE LEASE PURCHASE AGREEMENT
DELIVERY AND ACCEPTANCE CERTIFICATE
Schedule : 528225291823934USA2
CUSTOMER: LESSOR:
City of Port Arthur HEWLETT-PACKARD FINANCIAL SERVICES COMPANY
Address Address
541 Brazos Avenue 200 Connell Drive, Suite 5000
City/State/Zip City/State/Zip
Port Arthur, TX, 77642 Berkeley Heights, NJ 07922
Attention: Attention: Marc Antoine Lozandier
Capitalized terms which are not defined in this Certificate shall have the meanings given these terms in the Single
Schedule State and Local Government Lease Purchase Agreement and Schedule(together,the"Lease") numbered above.
In compliance with the terms and conditions of the Lease, you agree and notify us that all of the Equipment listed in the
Lease has been delivered and is fully installed; that you have inspected the Equipment and all testing you have deemed
necessary has been performed by you, the manufacturer of the Equipment or the Supplier; and as of the date of this Certificate,
the Equipment is fully operational for your purposes and you are fully satisfied with the Equipment and the Supplier who sold you
the Equipment.
The insurance policies required by Section 12 of the Lease have been obtained and are in full force and effect, and the
subject Equipment is located at the equipment location identified in the Lease.
By executing this Delivery and Acceptance Certificate the Customer agrees to the Lease commencement date and first
payment due date as set forth below.
If the Lease Payments are due in advance, then the first Lease Payment shall be due on the Acceptance Date. If
the Lease Payments are due in arrears, then the first Lease Payment shall be due at the end of the first Payment
Frequency period as selected on the first page of the Lease.
CITY OF Port Arthur
Customer
X
Customer's Authorized Signature
Print Name and Title
Acceptance Date
0-04)
NOTE: DO NOT SIGN AND RETURN THIS DOCUMENT UNTIL YOU HAVE RECEIVED ALL THE EQUIPMENT.
THEN fax to: (908)898-4489,Attn Public Sector Team
NO COVER SHEET IS NECESSARY
GEM 06-02
THEN MAIL THE ORIGINAL TO: 200 Connell Drive, Suite 5000, Berkeley Heights, NJ 07922
Form 8038-GC Information Return for Small Tax-Exempt
Governmental Bond Issues, Leases, and Installment Sales
(Rev.January 2012) OMB No.1545-0720
► Under Internal Revenue Code section 149(e)
Department of the Treasury
Internal Revenue Service Caution:If the issue price of the issue is$100,000 or more, use Form 8038-G.
Part I Reporting Authority Check box if Amended Return 110-
1
1 Issuer's name 2 Issuer's employer identification number(EIN)
City of Port Aruthur
3 Number and street(or P.O.box if mail is not delivered to street address) Room/suite
541 Brazos Avenue
4 City,town,or post office,state,and ZIP code 5 Report number(For IRS Use Only)
Port Arthur,TX,77642
6 Name and title of officer or other employee of issuer or designated contact person whom the IRS may call for more information 7 Telephone number of officer or legal representative
Lease Purchase 528225291823934USA2
Part II Description of Obligations Check one: a single issue ❑ or a consolidated return ❑ .
8a Issue price of obligation(s)(see instructions) 8a
b Issue date (single issue) or calendar date (consolidated). Enter date in mm/dd/yyyy format (for
example, 01/01/2009)(see instructions)►
9 Amount of the reported obligation(s)on line 8a that is:
a For leases for vehicles 9a
b For leases for office equipment 9b
c For leases for real property 9c
d For leases for other(see instructions) 9d
e For bank loans for vehicles 9e
f For bank loans for office equipment 9f
g For bank loans for real property 9g
h For bank loans for other(see instructions) 9h
i Used to refund prior issue(s) 9i
j Representing a loan from the proceeds of another tax-exempt obligation(for example, bond bank) . 9j
k Other 9k
10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III)(small issuer exception),check this box . . . . ► ❑
11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box(see instructions) ► ❑
12 Vendor's or bank's name:
13 Vendor's or bank's employer identification number:
Under penalties of perjury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge and belief,they are
Signature true,correct,and complete.I further declare that I consent to the IRS's disclosure of the issuer's return information,as necessary to process this return,to the person(s)
g that I have authorized above.
and
Consent
Signature of issuer's authorized representative Date Type or print name and title
Paid Print/Type preparer's name Preparer's signature Date Check [i] if
PTIN
Preparer self-employed
Use Only Firm's name ► Firm's EIN ►
Firm's address ► Phone no.
General Instructions Who Must File pay a penalty in lieu of arbitrage rebate(see
Issuers of tax-exempt governmental the line 11 instructions).
Section references are to the Internal Revenue
Code unless otherwise noted. obligations with issue prices of less than Filing a consolidated return for multiple
$100,000 must file Form 8038-GC. issues.For all tax-exempt governmental
What's New obligations with issue prices of less than
Issuers of a tax-exempt governmental $100,000 that are not reported on a separate
The IRS has created a page on IRS.gov for obligation with an issue price of$100,000 or
information about the Form 8038 series and more must file Form 8038-G, Information Form 8038-GC,an issuer must file a
its instructions,at www.irs.gov/form8038. Return for Tax-Exempt Governmental consolidated information return including all
Information about any future developments Obligations. such issues issued within the calendar year.
affecting the Form 8038 series(such as Filing a separate return for a single issue. Thus,an issuer may file a separate Form
legislation enacted after we release it)will be 8038-GC for each of a number of small issues
posted on that page. Issuers have the option to file a separate and report the remainder of small issues
Form 8038-GC for any tax-exempt
Purpose of Form governmental obligation with an issue price issued during the calendar year on one
of less than$100,000. consolidated Form 8038-GC.However, if the
Form 8038-GC is used by the issuers of tax- issue is a construction issue,a separate Form
exempt governmental obligations to provide An issuer of a tax-exempt bond used to 8038-GC must be filed to give the IRS notice
the IRS with the information required by finance construction expenditures must file a of the election to pay a penalty in lieu of
section 149(e)and to monitor the separate Form 8038-GC for each issue to give arbitrage rebate.
requirements of sections 141 through 150. notice to the IRS that an election was made to
Cat.No.641088 Form 8038-GC (Rev.1-2012)
Form 8038-GC(Rev.1-2012) Page 2
When To File multiple tax-exempt governmental obligations 1.At least 75%of the available construction
To file a separate return for a single issue,file if the form is used for consolidated reporting. proceeds of the issue are to be used for
Form 8038-GC on or before the 15th day of Tax-exempt obligation.This is any obligation construction expenditures with respect to
the second calendar month after the close of including a bond,installment purchase property to be owned by a governmental unit
the calendar quarter in which the issue is agreement,or financial lease,on which the or a 501(c)(3)organization,and
issued. interest is excluded from income under 2.All of the bonds that are part of the issue
To file a consolidated return for multiple section 103. are qualified 501(c)(3)bonds,bonds that are
issues,file Form 8038-GC on or before Tax-exempt governmental obligation.A not private activity bonds,or private activity
February 15th of the calendar year following tax-exempt obligation that is not a private bonds issued to finance property to be owned
the year in which the issue is issued. activity bond(see below)is a tax-exempt by a governmental unit or a 501(c)(3)
governmental obligation.This includes a bond organization.
Late filing.An issuer may be granted an issued by a qualified volunteer fire department In lieu of rebating any arbitrage that may be
extension of time to file Form 8038-GC under under section 150(e).
section 3 of Rev.Proc.2002-48,2002-37 owed to the United States,the issuer of a
I.R.B.531,if it is determined that the failure to Private activity bond.This includes an construction issue may make an irrevocable
file on time is not due to willful neglect.Type obligation issued as part of an issue in which: election to pay a penalty.The penalty is equal
or print at the top of the form,"Request for •More than 10%of the proceeds are to be proceeds of the amount of construction
Relief under section 3 of Rev.Proc.2002-48." that do not meet certain spending
Attach to the Form 8038-GC a letter briefly used for any private activity business use,and requirements.See section 148(f)(4)(C)and the
stating why the form was not submitted to the •More than 10%of the payment of principal Instructions for Form 8038-T.
IRS on time.Also indicate whether the or interest of the issue is either(a)secured by
obligation in question is under examination by an interest in property to be used for a private Specific Instructions
the IRS.Do not submit copies of anybond business use(or payments for such property)
P� In general,a Form 8038-GC must be
documents,leases,or installment sale or(b)to be derived from payments for completed on the basis of available
documents.See Where To File next. property(or borrowed money)used for a information and reasonable expectations as of
private business use. the date of issue.However,forms that are
Where To File It also includes a bond,the proceeds of filed on a consolidated basis may be
which(a)are to be used to make or finance completed on the basis of information readily
File Form 8038-GC,and any attachments, loans(other than loans described in section available to the issuer at the close of the
with the Department of the Treasury,Internal 141(c)(2))to persons other than governmental calendar year to which the form relates,
Revenue Service Center,Ogden,UT 84201. units and(b)exceeds the lesser of 5%of the supplemented by estimates made in good
Private delivery services.You can use proceeds or$5 million. faith.
certain private delivery services designated by Issue.Generally,obligations are treated as Part I—Reporting Authority
the IRS to meet the"timely mailing as timely part of the same issue only if they are issued
filing/paying"rule for tax returns and Amended return.An issuer may file an
payments.These private delivery services by the same issuer,on the same date,and as amended return to change or add to the
include only the following: part of a single transaction,or a series of information reported on a previously filed
• related transactions.However,obligations return for the same date of issue.If you are
DHL Express(DHL):DHL Same Day Service. issued during the same calendar year(a) filing to correct errors or change a previously
•Federal Express(FedEx): Priorityunder a loan agreement under which amounts
P ( ) filed return,check the"Amended Return"box
"draw-
Overnight,FedEx Standard Overnight,FedEx are to be advanced periodically(a g down loan")or(b)with a term not exceeding in the heading of the form.
2Day,FedEx International Priority,and FedEx 270 days,may be treated as part of the same The amended return must provide all the
International First. issue if the obligations are equally and ratably information reported on the original return,in
•United Parcel Service(UPS):UPS Next Day secured under a single indenture or loan addition to the new corrected information.
Air,UPS Next Day Air Saver,UPS 2nd Day agreement and are issued under a common Attach an explanation of the reason for the
Air,UPS 2nd Day Air A.M.,UPS Worldwide financing arrangement(for example,under the amended return and write across the top
Express Plus,and UPS Worldwide Express. same official statement periodically updated "Amended Return Explanation."
The private delivery service can tell you to reflect changing factual circumstances). Line 1.The issuer's name is the name of the
how to get written proof of the mailing date. Also,for obligations issued under adraw- entity issuing the obligations,not the name of
down loan that meets the requirements of the the entity receiving the benefit of the
Other Forms That May Be preceding sentence,obligations issued during financing.In the case of a lease or installment
Required different calendar years may be treated as
Q part of the same issue if all of the amounts to sale,the issuer is the lessee or purchaser.
For rebating arbitrage(or paying a penalty in be advanced under the draw-down loan are Line 2.An issuer that does not have an
lieu of arbitrage rebate)to the Federal reasonably expected to be advanced within 3 employer identification number(EIN)should
Government,use Form 8038-T,Arbitrage years of the date of issue of the first apply for one on Form SS-4,Application for
Rebate,Yield Reduction and Penalty in Lieu obligation.Likewise,obligations(other than Employer Identification Number.You can get
of Arbitrage Rebate.For private activity private activity bonds)issued under a single this form on the IRS website at IRS.gov or by
bonds,use Form 8038,Information Return for agreement that is in the form of a lease or calling 1-800-TAX-FORM(1-800-829-3676).
Tax-Exempt Private Activity Bond Issues. installment sale may be treated as part of the You may receive an EIN by telephone by
For a tax-exempt governmental obligation same issue if all of the property covered by following the instructions for Form SS-4.
with an issue price of$100,000 or more,use that agreement is reasonably expected to be Lines 3 and 4.Enter the issuer's address or
Form 8038-G. delivered within 3 years of the date of issue of the address of the designated contact person
the first obligation. listed on line 6.If the issuer wishes to use its
Rounding to Whole Dollars Arbitrage rebate.Generally,interest on a own address and the issuer receives its mail
You may show the money items on this return state or local bond is not tax-exempt unless in care of a third party authorized
as whole-dollar amounts.To do so,drop any the issuer of the bond rebates to the United representative(such as an accountant or
amount less than 50 cents and increase any States arbitrage profits earned from investing attorney),enter on the street address line
amount from 50 to 99 cents to the next higher proceeds of the bond in higher yielding "C/O"followed by the third party's name and
dollar. nonpurpose investments.See section 148(f). street address or P.O.box.Include the suite,
Construction issue.This is an issue of tax room,or other unit number after the street
Definitions address.If the post office does not deliver
exempt bonds that meets both of the mail to the street address and the issuer has a
Obligations.This refers to a single tax- following conditions: P.O.box,show the box number instead of the
exempt governmental obligation if Form
8038-GC is used for separate reporting or to
Form 8038-GC(Rev.1-2012) Page 3
street address.If a change in address occurs Lines 9i and 9j.For line 9i,enter the amount Paid Preparer
after the return is filed,use Form 8822, of the proceeds that will be used to pay
Change of Address,to notify the IRS of the principal,interest,or call premium on any If an authorized representative of the issuer
new address. other issue of bonds,including proceeds that filled in its return,the paid preparer's space
will be used to fund an escrow account for should remain blank.Anyone who prepares
Note.The address entered on lines 3 and 4 is this purpose.Several lines may apply to a the return but does not charge the
the address the IRS will use for all written particular obligation.For example,report on organization should not sign the return.
communications regarding the processing of lines 9i and 9j obligations used to refund prior Certain others who prepare the return should
this return,including any notices.By issues which represent loans from the not sign.For example,a regular,full-time
authorizing a person other than an authorized proceeds of another tax-exempt obligation. employee of the issuer,such as a clerk,
secretary,etc.,should not sign.
officer or other employee of the issuer to
Line 9k.Enter on line 9k the amount on line
communicate with the IRS and whom the IRS 8a that does not represent an obligation Generally,anyone who is paid to prepare a
may contact about this retum,the issuer described on lines 9a through 9j. return must sign it and fill in the other blanks
authorizes the IRS to communicate directly in the Paid Preparer Use Only area of the
with the individual listed on line 6,whose Line 10.Check this box if the issuer has return.A paid preparer cannot use a social
address is entered on lines 3 and 4 and designated any issue as a"small issuer security number in the Paid Preparer Use Only
consents to disclose the issuer's return exception"under section 265(b)(3)(B)(i)(III). box.The paid preparer must use a preparer
information to that individual,as necessary,to Line 11.Check this box if the issue is a tax identification number(PTIN).If the paid
process this return. construction issue and an irrevocable election preparer is self-employed,the preparer
to pay a penalty in lieu of arbitrage rebate has should enter his or her address in the box.
Line 5.This line is for IRS use only.Do not been made on or before the date the bonds The paid preparer must:
make any entries in this box. were issued.The penalty is payable with a •
of Obligations Form 8038-T for each 6-month period after Sign the return in the space provided for the
Part II—Description
9 preparer's signature,and
the date the bonds are issued.Do not make
Check the appropriate box designating this as
a return on a single issue basis ora any payment of penalty in lieu of rebate with •Give a copy of the return to the issuer.
gForm 8038-GC.See Rev.Proc.92-22,
consolidated return basis. 1992-1 C.B.736,for rules regarding the Paperwork Reduction Act Notice
Line 8a.The issue price of obligations is "election document."
under Regulations We ask for the information on this form to
generally determined
section 1.148-1(b). when issued for Line 12.Enter the name of the vendor or bank carry out the Internal Revenue laws of the
cash,the issue price is Thus,the price at which a who is a party to the installment purchase United States.You are required to give us the
agreement, loan,or financial lease.If there information.We need it to ensure that you are
substantial amount of the obligations are sold are multiple vendors or banks,the issuer complying with these laws.
to the public.To determine the issue price of should attach a schedule.
an obligation issued for property,see sections You are not required to provide the
1273 and 1274 and the related regulations. Line 13.Enter the employer identification information requested on a form that is
Line 8b.For a single issue,enter the date of number of the vendor or bank who is a party subject to the Paperwork Reduction Act
to the installment purchase agreement,loan, unless the form displays a valid OMB control
issue(for example,03/15/2010 for a single or financial lease.If there are multiple vendors number.Books or records relating to a form
issue issued on March 15,2010),generally or banks,the issuer should attach a schedule.
the date on which the issuer physically or its instructions must be retained as long as
exchanges the bonds that are part of the Signature and Consent their contents may become material in the
issue for the underwriter's(or other administration of any Internal Revenue law.
purchaser's)funds;for a lease or installment An authorized representative of the issuer Generally,tax returns and return information
sale,enter the date interest starts to accrue. must sign Form 8038-GC and any applicable are confidential,as required by section 6103.
For issues reported on a consolidated basis, certification.Also print the name and title of The time needed to complete and file this
the person signing Form 8038-GC.The
enter the first day of the calendar year during authorized representative of the issuer signing form will vary depending on individual
which the obligations were issued(for this form must have the authority to consent circumstances.The estimated average time is:
example,for calendar year 2010,enter to the disclosure of the issuer's return Learning about the
01/01/2010). information,as necessary to process this law or the form . . . . 4 hr.,46 min.
Lines 9a through 9h.Complete this section if return,to the person(s)that has been Preparing the form . . . . 2 hr.,22 min.
property other than cash is exchanged for the designated in this form.
obligation,for example,acquiring a police car, Copying,assembling,and
a fire truck,or telephone equipment through a Note.If the issuer authorizes in line 6 the IRS sending the form to the IRS . 2 hr.,34 min.
series of monthly payments.(This type of to communicate with a person other than an
obligation is sometimes referred to as a officer or other employee of the issuer,(such If you have comments concerning the
"municipal lease." Also complete this section authorization shall include contact both in accuracy of these time estimates or
if real property is directly acquired in writing regardless of the address entered in suggestions for making this form simpler,we
exchange for an obligation to make periodic lines 3 and 4,and by telephone)by signing would be happy to hear from you.You can
this form,the issuer's authorized write to the Internal Revenue Service,Tax
payments of interest and principal. representative consents to the disclosure of Products Coordinating Committee,
Do not complete lines 9a through 9d if the the issuer's return information,as necessary SE:W:CAR:MP:T:M:S,1111 Constitution Ave.
proceeds of an obligation are received in the to process this return,to such person. NW,IR-6526,Washington,DC 20224. Do not
form of cash even if the term"lease"is used send the form to this address.Instead,see
in the title of the issue.For lines 9a through Where To File.
9d,enter the amount on the appropriate line
that represents a lease or installment
purchase.For line 9d,enter the type of item
that is leased.For lines 9e through 9h,enter
the amount on the appropriate line that
represents a bank loan.For line 9h,enter the
type of bank loan.
ATTACHMENT A
TO
SCHEDULE TO STATE AND LOCAL GOVERNMENT SINGLE SCHEDULE LEASE PURCHASE AGREEMENT
NUMBER: 528225291823934USA2
The first payment of Rent will be due on the Acceptance Date and all payments will be due monthly thereafter.
Rent
No. Date Payment Interest Principal Balance
0 11/5/2015 88,671.00
1 12/5/2015 1,602.01 237.98 1,364.03 87,306.97
2 1/5/2016 1,602.01 234.32 1,367.69 85,939.28
3 2/5/2016 1,602.01 230.65 1,371.36 84,567.92
4 3/5/2016 1,602.01 226.97 1,375.04 83,192.88
5 4/5/2016 1,602.01 223.28 1,378.73 81,814.15
6 5/5/2016 1,602.01 219.58 1,382.43 80,431.72
7 6/5/2016 1,602.01 215.87 1,386.14 79,045.58
8 7/5/2016 1,602.01 212.15 1,389.86 77,655.72
9 8/5/2016 1,602.01 208.42 1,393.59 76,262.13
10 9/5/2016 1,602.01 204.68 1,397.33 74,864.80
11 10/5/2016 1,602.01 200.93 1,401.08 73,463.72
12 11/5/2016 1,602.01 197.17 1,404.84 72,058.88
13 12/5/2016 1,602.01 193.40 1,408.61 70,650.27
14 1/5/2017 1,602.01 189.61 1,412.40 69,237.87
15 2/5/2017 1,602.01 185.82 1,416.19 67,821.68
16 3/5/2017 1,602.01 182.02 1,419.99 66,401.69
17 4/5/2017 1,602.01 178.21 1,423.80 64,977.89
18 5/5/2017 1,602.01 174.39 1,427.62 63,550.27
19 6/5/2017 1,602.01 170.56 1,431.45 62,118.82
20 7/5/2017 1,602.01 166.72 1,435.29 60,683.53
21 8/5/2017 1,602.01 162.87 1,439.14 59,244.39
22 9/5/2017 1,602.01 159.00 1,443.01 57,801.38
23 10/5/2017 1,602.01 155.13 1,446.88 56,354.50
24 11/5/2017 1,602.01 151.25 1,450.76 54,903.74
25 12/5/2017 1,602.01 147.35 1,454.66 53,449.08
26 1/5/2018 1,602.01 143.45 1,458.56 51,990.52
27 2/5/2018 1,602.01 139.53 1,462.48 50,528.04
28 3/5/2018 1,602.01 135.61 1,466.40 49,061.64
29 4/5/2018 1,602.01 131.67 1,470.34 47,591.30
30 5/5/2018 1,602.01 127.73 1,474.28 46,117.02
31 6/5/2018 1,602.01 123.77 1,478.24 44,638.78
32 7/5/2018 1,602.01 119.80 1,482.21 43,156.57
33 8/5/2018 1,602.01 115.83 1,486.18 41,670.39
34 9/5/2018 1,602.01 111.84 1,490.17 40,180.22
35 10/5/2018 1,602.01 107.84 1,494.17 38,686.05
36 11/5/2018 1,602.01 103.83 1,498.18 37,187.87
37 12/5/2018 1,602.01 99.81 1,502.20 35,685.67
38 1/5/2019 1,602.01 95.77 1,506.24 34,179.43
39 2/5/2019 1,602.01 91.73 1,510.28 32,669.15
40 3/5/2019 1,602.01 87.68 1,514.33 31,154.82
41 4/5/2019 1,602.01 83.61 1,518.40 29,636.42
42 5/5/2019 1,602.01 79.54 1,522.47 28,113.95
43 6/5/2019 1,602.01 75.45 1,526.56 26,587.39
44 7/5/2019 1,602.01 71.36 1,530.65 25,056.74
45 8/5/2019 1,602.01 67.25 1,534.76 23,521.98
46 9/5/2019 1,602.01 63.13 1,538.88 21,983.10
47 10/5/2019 1,602.01 59.00 1,543.01 20,440.09
48 11/5/2019 1,602.01 54.86 1,547.15 18,892.94
49 12/5/2019 1,602.01 50.71 1,551.30 17,341.64
50 1/5/2020 1,602.01 46.54 1,555.47 15,786.17
51 2/5/2020 1,602.01 42.37 1,559.64 14,226.53
52 3/5/2020 1,602.01 38.18 1,563.83 12,662.70
53 4/5/2020 1,602.01 33.98 1,568.03 11,094.67
54 5/5/2020 1,602.01 29.78 1,572.23 9,522.44
55 6/5/2020 1,602.01 25.56 1,576.45 7,945.99
56 7/5/2020 1,602.01 21.33 1,580.68 6,365.31
57 8/5/2020 1,602.01 17.08 1,584.93 4,780.38
58 9/5/2020 1,602.01 12.83 1,589.18 3,191.20
59 10/5/2020 1,602.01 8.56 1,593.45 1,597.75
60 11/5/2020 1,602.01 4.26 1,597.75 0.00
Grand
Totals 96,120.60 7,449.60 88,671.00
r
Lessee Please Initial and date: