HomeMy WebLinkAboutOffice H2O 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: 12/18/2024
Department: Wastewater-Admin
Vendor Name: Office H2O
Sign Date: 10/2/2024
Ending Date: 10/2/2029
Amount of Original Contract:
Is this an amendment or change order
to original contract? Yes or No
Amended Contract Amount: $ 229.00
Purpose: New contract for larger machine, Everything was cycled
to be on the same billing with Sewer Billing.
For Clerk's Office to fill out
Date uploaded to Gateway:
Customer Satisfaction Guarantee
This warranty covers all water purification systems serviced by Office H2O per the attached rental
agreement.
Office H2O will provide all service and support for the system(s) during the entire rental period to
include the below items:
• All Service Calls
• All Parts
• All Labor (including travel)
• All Required Filter Changes
Our Preventative Maintenance Program will strictly follow manufacturer guidelines for system
sanitization intervals. If repairs cannot be made, Office H2O will replace the equipment with another
model of equal or greater capabilities at no additional cost to the customer.
In the event that the customer becomes aware that the equipment does not meet minimum
performance standards,customer agrees to notify Office 1120 in writing within ten (10) business days
of first knowledge of unsatisfactory performance.Office 1120 shall have five (5) business days to
correct the specified problem. In the event the specified problem is not corrected, as provided herein,
customer shall be issued a check from Office H2O equal to the amount of one month's rental payment
per non-performing system.
Customer agrees to provide normal care for the unit(s).Damage to the water purification unit(s)
outside of normal wear and tear and/or attempts to move the unit(s) or to alter their performance,
may void the warranty.
Customer • Office H2O Representa2
•
.gnature: • Signature: •
•
Print Name: I r . 1 Q Cr""IJ'1 4 Print Name:
Title:ea(il‘ ]t'01'01.(`Q`I Date: IrC) 0?uv0-1
Items Not Included: Reference#
• Water Only Preventative Program- $99ea
• Water/Ice Preventative Program-$199ea
• Industrial Ice Bi-Annual Preventative Program - $250ea
• Equipment Relocation -$19Sea
• CO2 Exchange- $195
www.officeh2o.com
•
•
j Office H2O ♦ purewaterpart^ens
40ffice
HQ 7402 E 90th St,
H2O Indianapolis, IN 46256
9 Offices Serving Indiana, Kentucky,Ohio,Greater Chicago,
and Milwaukee
(866) 621-6910
Customer Name: Li A, 1 \D Pfe-j'S v 111 1 h ,_ L x_ ;i,[ jr( nL
u
DELIVERY AND ACCEPTANCE CERTIFICATE
Customer and Distributor certify that all Equipment described in the Rental Agreement has been delivered
and properly installed according to the Rental Agreement Customer acknowledges that the Equipment is in
good condition and is performing satisfactorily Customer hereby accepts the equipment unconditionally and
irrevocably in accordance with the Rental Agreement and understands that invoicing will commence upon
receipt of this Certificate showing execution by Customer Distributor acknowledges its obligation to provide
maintenance services in accordance with any maintenance agreement separately entered into between
Dist(------ ributor,and Customer.
I �i(- CL. Clm,n-, ,t }1, d C�,-�
us 'r(Aut ized Sign ur Name(Pant) Title Date
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cia. ievys 30,t-fi-)rnriNlv ib-a- ;.'( ‘-i
(stributor(Authori ed Signature) Nam (Print) Title S Date ,
MODEL SERIAL #
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Statement of Assurance
Distributor is committed to providing you with quality equipment,quality service and quality drinking water. If for any
reason you are not satisfied with the performance of your equipment or the level of service provided,please contact us
directly for prompt assistance.
Reference Number _ - - (for internal use only) 0 See attached Equipment Schedule (if applicable)
4 Office H2O
; Off ice H2O HQ 7402E 90th St, 6 pure water partners
Indianapolis, IN 46256
www.officeh2o corn 9 Offices Serving Indiana,Kentucky,Ohio,Greater Chicago,
and Milwaukee
(866) 621-6910
CUSTOMER INFORMATION BILLING INFORMATION (Same as customer info)
y.o 1pany Full LegalName: Company Name:
r ^ �- t l n i•.c("k1r()n r\t�
Contact) Phone#: Contact: Pone#:
G 41 L‘a1N<, t3 a�1
Eq ipment Location Address. Billing Address:
Cit , State, Zip:
City, State,Zip:
3r IA 11 3
Email: TINU: Email: Purchase Order:
Org Type: ❑ Corp hC ❑ Partnership ❑ Other State incorporated/organized:
Tax Exempt. ❑yes—please include certificate
RENTAL TERM MONTHLY PAYMENT BILLING FREQUENCY/TYPE SPECIAL INSTRUCTIONS
❑ Monthly
60 mos. _,/
Plus tax Lam" Quarterly Preventative Maintenance Plan invoiced as recommended by manufacturer
EQUIPMENT SCHEDULE ACCOUNT SETUP FEES
Installation Fee
-- — $ -20e / Unit = $ ttA)
Industrial Ice Instafla��tionl,F
❑See attac g equipment schedule(if applicable). $ ey Unit = $
Ag ced a d •ccepted by: ,
Cu o • n
cif �(Y r1.T
Aut 'zed Signature Name Printed
t ,: DA.._,n;S '0 i 1 aft t4
Title Date
Distributor: 1 ("
DAd„/ /1C/C.—�( �'`r411116\ m
Signature Ttt Date
r ,
Customer acknowledges having read and understood all of the terms of this Rental Agreement,including page 2 hereof,and
agrees to be bound by all of the terms herein upon execution of this Rental Agreement.
Transaction Number (for internal use only)
PWP RA S-2o24
4 pure water partners
Customer Payment Preferences
Thank you for choosing your Pure Water System. Please tell us how you prefer to pay your invoices.
Customer Name: C C'C h_L
Transaction Number: new renewal rewrite I Irefi dealer buyout
Payables Department Information: ,r1
Payables Contact Name: 1 LAN. Cv.ri_ilt-Ci ► `
Billing address: 40L3 ��` � ��1C' \�4 t--\ t1\,}L�,,� �� \ 11V-3
Phone: E`0Z' 1 P10 ' 3 34 Email: ` y-i C\
Are You Tax Exempt? ❑No des If Yes, please attach completed tax exemption certificate.
Vendor Form: Do you require the completion of a Vendor Form? U,d"1VO DYes If Yes, please provide Vendor Form.
Payment Method:
❑Recurring ACH (standard) Pure Water Partners will contact you for banking information.
['Check -$3.00 processing fee applies
❑ACH Payments—Direct Deposit to Pure Water Partners.
If you would like to set up automatic payment into our bank account, please check this option and we will
send you our banking information
❑ Credit Card/Debit Card/eCheck—processing fees will apply
Invoicing Preference: Eif Email (Email address for invoices )r9`1 6Q42 , � LCC-r.
Payment Inquiry Email: .Sine CS cL\T cE e
Invoice Capture/Portal dNo ❑Yes (provide portal name or ICS email)
Is a PO#required onVo 0 Yes PO
invoices?
Trans Number: Dealership:
Account Rep:
123 South Third Avenue,Suite 28• Sandpoint,ID 83864. 208 255 2525 •customerservice@purewaterpartners.com