HomeMy WebLinkAboutCanon Lease Agreement for Wastewater City of Jeffersonville
Government Contract Coversheet
Please note:All information MUST be completely filled out and submitted to Clerk's Office within
48 hrs of execution.
Date Submitted to Clerk: 10/10/2024
Department: Wastewater
Vendor Name: Canon Solutions America, Inc.
Sign Date: 10/9/2024
Ending Date: 10/9/2026
Amount of Original Contract: $271.21/mo. for 60 months
Is this an amendment or change order
to original contract?
Amended Contract Amount:
Purpose:
Lease agreement for multifunction printer in
new administration building.
For Clerk's Office to fill out
Date uploaded to Gateway:
Docusign Envelope ID:A2958206-BDDE-400E-97F1-FDDD7599B2EE
canon Lease Schedule("Schedule")-Blended (SER-800) Page 1 of 1
Customer: CITY OF JEFFERSONVILLE INDIANA CFS App#: 2028702 Salesperson:Michael Baldwin
Canon Solutions America,Inc.("CSA") Agreement#:MA30643 Transaction#: S21126469 Order Date: 10/09/24
One Canon Park,Melville,NY 11747 Payment Information Equipment Maintenance Information
(800)-613-2228 Listed Items Lease Term #of Lease Payments OPTIONAL MAINTENANCE:elected for all Equipment
Billing Information Customer Account. 1490510 60 Months 60 Excess Per Image Charge invoiced Monthly by CFS
Company: CITY OF JEFFERSONVILLE INDIANA -
DBA: Payment*(*Plus Applicable Taxes) CFS Invoicing Per Unit Coverage Plan
Address:423 LLWMAN WAY Total Lease Payment Fixed Price Plan_
Address 2: shall be invoiced$271.21 Monthly Other Transaction Details
City: JEFFERSONVILLE County: CLARK Purchase Option: Fair Market Value
State:IN Zip: 47130 Phone#: 812-285-6451 Due at Signing Tax Exempt(Certificate Attached)
Contact:Jay Thompson #of Payments in Advance Total Due at Signing
Email:jaythompson@cityofjeff.net
Rider A applies(Optional Maintenance for Office Equip/Cut Sheet Covered Images Included in Payment Excess Per Image Charge(s)
Production) B&W:00 Color:00 B&W: $0.00607 Color:$0.03775
Item Code Listed Items Description Qty Ship To&Maintenance Billing Information
3827C002 IMAGERUNNER ADVANCE DX C58401 1 Shipping:423 LEWMAN WAY Delivery Date:
6601C002 BOOKLET FINISHER-A2WITHTRI-FOLD 1 Address 2: Directors building
40300002 CASSETTE FEEDING UNIT-AC/1 1 City: JEFFERSONVILLE County:CLARK State: IN Zip:47130
0126C001 2/3 HOLE PUNCHER UNIT-Al 1 Primary Customer Contact:Jay Thompson
5546C002 BUFFER PASS UNIT-P2 1 Phone#:812-285-6451 Email:jaythompson@cityofjeff.net
4395V196 STANDARD POWER FILTER15A/120V 1 Meter Contact:
2368V120 MID VOLUME CONNECTIVITY 30.-PPMUPTO79PPM 1 Phone#: Email:
3923V843 INSTALL PAKDXC58701/C58801/C58501/C5840I 1 IT Contact:Jay Thompson
1424V777 IW ENTERPRISE MANAGEMENT CONSOLE PRO SERVICES BY LOCAL SYSTEMS ANALYST 6 Phone#: 812-285-6451 Email:jaythompson@cityofjeff.net
IntSupplies Pre-Installed Suppliee Installed inMaclane 1 Billing:
Address 2:
City: County: State: Zip:
Billing Contact:
Phone#: Email:
Elevator: No Loading Dock:No #of Steps:0 Hrs of Operation:9-5
Additional Requirements: Consumables:Toner Only Auto-Toner Fulfillment**
Meter Method:Remote Reporting Agent Corporate Advantage
For CSA USE ONLY:
OC:UNIVERSITY OF CALIFORNIA PURCHASING AGREEMENT#2020002755 Config:A 157305889
THIS SCHEDULE IS ENTERED INTO PURSUANT TO,AND INCORPORATES THE TERMS OF,THE MASTER SALES AND SERVICES AGREEMENT REFERENCED AS THE AGREEMENT#ABOVE("AGREEMENT"),INCLUDING THE MASTER LEASE TERMS SET FORTH AS
RIDER G THERETO WHICH SHALL CONTROL(THE"LEASE TERMS').TO THE EXTENT THE TERMS OF AN EXISTING CFS MASTER AGREEMENT ARE REFERENCED ON THIS SCHEDULE(THE"EXISTING MASTER CFS LEASE')AND ARE APPLICABLE TO THIS
SCHEDULE,THEY SHALL CONTROL OVER THE MASTER LEASE TERMS SET FORTH AS RIDER G TO THE AGREEMENT FOR SO LONG AS THE EXISTING MASTER CFS LEASE REMAINS IN EFFECT.STANDARD TERMS AND CONDITIONS AND APPLICABLE RIDERS
INCORPORATED HEREIN ARE AVAILABLE AT ESS.CSA.CANON.COM/CUSTOMERDOCUMENTS,AND SHALL APPLY TO THE EXTENT NOT MODIFIED BY THE AGREEMENT.THIS SCHEDULE CONSTITUTES A LEASE OF THE LISTED ITEMS,AND IS BINDING ON
CUSTOMER UPON SIGNING BY CUSTOMER,AND IS BINDING ON CSA AND LESSOR AS PROVIDED IN THE LEASE TERMS.THIS SCHEDULE IS NON-CANCELABLE BY CUSTOMER.CUSTOMER REPRESENTS THATEXECUTION OF THIS SCHEDULE HAS BEEN DULY
AUTHORIZED.BY YOUR SIGNATURE,CUSTOMER AGREES TO LEASE THE LISTED ITEMS AND,IF SELECTED,TO PURCHASE THE MAINTENANCE SERVICES DESCRIBED HEREIN.YOU ACKNOWLEDGE RECEIPT OF A COPY OF THIS SCHEDULE.
•^ Jay Thompson Assistant Director 10/09/2024 7:25 AM
Customer Authorized Signature ^ ��— Printed Name: Tide: Date:
ACCEPTANCE CERTIFICATE
To:CSA and Lessor: Customer certifies that(a)the Listed Items referred to in the above Schedule have been received,(b)installation has been completed,(c)the Listed Items have been examined by Customer and are in good operating order
and condition and are,in all respects,satisfactory to the Customer,and(d)the Listed Items are irrevocably accepted by the Customer for all purposes under the Agreement.Accordingly,Customer hereby authorizes billing under this Schedule.
Authorized Signature: Printed Name: Tide: Date:
For Internal Purposes Only:
CFS Authorized Signature: Printed Name: Tide: Date:
SER-800 Blended Lease June 2023
**Requires Remote Reporting Agent
DocuSign
Certificate Of Completion
Envelope Id:A2958206BDDE400F97F1 FDDD7599B2EE Status:Completed
Subject:CITY OF JEFFERSONVILLE INDIANA—Please sign the following Sales Document(Quote ID:S21126469)
CSA_SALES_BRANCH: LOUISVILLE
Source Envelope:
Document Pages: 1 Signatures: 1 Envelope Originator:
Certificate Pages:4 Initials:0 CSA Sales Documents
AutoNav: Enabled 1 Canon Park
Envelopeld Stamping: Enabled Melville,NY 11747-3036
Time Zone:(UTC-08:00)Pacific Time(US&Canada) CSASalesDocuments@csa.canon.com
IP Address: 146.184.0.84
Record Tracking
Status:Original Holder:CSA Sales Documents Location:DocuSign
10/9/2024 6:59:02 AM CSASalesDocuments@csa.canon.com
Signer Events Signature Timestamp
Jay Thompson ,--Signed by: Sent: 10/9/2024 6:59:04 AM
jaythompson@cityofjeff.net Viewed: 10/9/2024 7:23:58 AM
�O47A7B64A0514EB
Assistant Director Signed: 10/9/2024 7:25:30 AM
Security Level:Email,Account Authentication
(None) Signature Adoption:Drawn on Device
Using IP Address:98.102.0.130
Electronic Record and Signature Disclosure:
Accepted: 10/9/2024 7:23:58 AM
ID: 147208c7-0812-4fd7-a1d6-4bb762924718
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 10/9/2024 6:59:04 AM
Certified Delivered Security Checked 10/9/2024 7:23:58 AM
Signing Complete Security Checked 10/9/2024 7:25:30 AM
Completed Security Checked 10/9/2024 7:25:30 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on:9/30/2017 8:38:20 AM
Parties agreed to:Jay Thompson
CONSUMER DISCLOSURE
From time to time,Canon Solutions America,Inc. (we, us or Company)may be required by law
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send you paper copies of any such documents from our office to you, you will be charged a
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procedure described below.
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If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
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If you elect to receive required notices and disclosures only in paper format, it will slow the
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All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you.To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
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described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Canon Solutions America,Inc.:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: msinanian@csa.canon.com
To advise Canon Solutions America,Inc.of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at msinanian@csa.canon.com and in
the body of such request you must state: your previous e-mail address,your new e-mail address.
We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from Canon Solutions America,Inc.
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically,you must send us an e-mail to msinanian@csa.canon.com and in the
body of such request you must state your e-mail address, full name,US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Canon Solutions America,Inc.
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent,or you may;
ii. send us an e-mail to msinanian@csa.canon.com and in the body of such request you
must state your e-mail, full name, US Postal Address, and telephone number. We do not
need any other information from you to withdraw consent.. The consequences of your
withdrawing consent for online documents will be that transactions may take a longer time
to process..
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By checking the `I agree' box, I confirm that:
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• Until or unless I notify Canon Solutions America, Inc. as described above, I consent to
receive from exclusively through electronic means all notices,disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
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