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Home My WebLink AboutVerizon 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: C1 a ito 3 �� Department: Q a�. C\oQ rn C Vendor Name: -e ms\Z 0 0` Sign Date: ?-') a 6493 Ending Date: 7- AmountLi /7 d00 of Original Contract: / Is this an amendment or change order , to original contract? Yes or 1 O Amended Contract Amount: Purpose: For Clerk's Office to fill out Date uploaded to Gateway: verizon State of Indiana BPA # 9847 with GSA-Federal Supply Schedule Purchase Order (GS-35F-0119P) Date: July 26,2023 Vendor: Verizon Wireless Vendor Address: 10170 Junction Drive Annapolis Junction,MD 20701 Vendor Email: FederalAcctlmplementations{caVerizonWireless.com Phone: 1.800.561.6227 Option 3 FAX: 1.866.227.4978 Authorized By: I represent that the Agency named below is a Governmental Body(Agency)authorized to purchase under this State of Indiana Agreement(government, non-profit or education).I further represent that I am authorized to commit the Agency named below to purchase under the GSA Federal Supply Schedule and that the use of all products/services purchas d is for authorized government use.This commitment only authorizes me to enter into this transa i n on behalf of the Agency named below. It creates no commitment on the part of this ag n to purchase minimum or maximum quantity of goods or services.ANY RESELLING OF ROOU 'S/SERVICES RCHASED UNDER THIS ORDER ARE STRICTLY PROHIBITED,as the contrac an�go erning regula ns require that all FSS purchases will be used for governmental purpos o y d will not be old for personal use. Agency Name:JEFFERSONVILLE RED V OPMENT EPARTMENT Signature of Authorized Official:%( L Printed or typed name: Delyna Rutherford Printed or typed title:Grant Admin Contact Information: Email address:drutherford@cityofjeff.net Phone number: 812-380-3802 FAX number: Billing Information: JEFFERSONVILLE REDEVELOPMENT DEPARTMENT 500 Quartermaster Court Jeffersonville, IN 47130 Payment Terms: Net 30 Description of Cellular service on the accounts listed below(or attached)totaling up to 10 units in accordance Goods/Services; with the rate plans and terms and conditions now or in the future applicable to each of such lines Pricing: pursuant to GSA Federal Supply Schedule Number GS-35F-0119P, Rate Plan(s):Various Equipment:Various July 26, 2023 for 12 months through 2024 Term: (month)(day)(yr.) (#) (year) The quantities listed are estimates only and are based on past and future usage.You may Funds Authorized: purchase less than the amounts shown,but no more.Purchases in excess of the amount shown will need an updated order form.All services orders shall be on an"as needed" basis,subject to the availability of funding and budgetary considerations. Monthly Access Fees for service on up to 10 lines(Estimated) $1,000 Equipment charge(s)on up to 10 lines (Estimates) $5,000 Total Access and Equipment Fees on up to 10 lines(Estimate) $17,000 Plus applicable fees,taxes and charges Contract#: GSA Federal Supply Schedule Contract Number GS-35F-0119P,State of Indiana BPA#9847,all terms and conditions are incorporated by reference. Equipment None of the equipment listed a roducts listed on GSA Federal Supply Schedule Contract No.GS- (Open Market): 35F-0119P.All devices nd/or cc ssories a "Open Market"items.Various Specify Phones, Delive/,Etc: Pr file ID# 2 62793 (all accounts and sub-accounts) Miscellaneous: **please notify POO ty0 ys prior to nding document expiration date** Customer Acceptance: Signature:X el\� Date:—`-- a' For Verizon Wireless internal use only: Approval: ____ Date: verizonf State of Indiana BPA # 9847 with GSA-Federal Supply Schedule Purchase Order (GS-35F-0119P) Date: July 26,2023 Vendor: Verizon Wireless Vendor Address: 10170 Junction Drive Annapolis Junction,MD 20701 Vendor Email: FederalAcctlmplementations@VerizonWireless.com Phone: 1.800.561.6227 Option 3 FAX: 1.866.227.4978 Authorized By: I represent that the Agency named below is a Governmental Body(Agency)authorized to purchase under this State of Indiana Agreement(government,non-profit or education).I further represent that I am authorized to commit the Agency named below to purchase under the GSA Federal Supply Schedule and that the use of all products/services purchased is for authorized government use.This commitment only authorizes me to enter into this transaction on behalf of the Agency named below. It creates no commitment on the part of this age, to purchase a minimum or maximum quantity of goods or services.ANY RESELLING OF PROD S/SERVICES PU'CHASED UNDER THIS ORDER ARE STRICTLY PROHIBITED,as the contrac i:nd r• -rning regulati•I s require that all FSS purchases will be used for governmental purpose;onl d will not be re .Id for personal use. Agency Name:JEFFERSONVILLE RED'VE OPMENT I I PARTMENT Signature of Authorized Official:k ` — v V Printed or typed name: Delyna Rutherford Printed or typed title:Grant Admin Contact Information: Email address:drutherford@cityofeff.net Phone number: 812-380-3802 FAX number: Billing Information: JEFFERSONVILLE REDEVELOPMENT DEPARTMENT 500 Quartermaster Court Jeffersonville, IN 47130 Payment Terms: Net 30 Description of Cellular service on the accounts listed below(or attached)totaling up to 10 units in accordance Goods/Services; with the rate plans and terms and conditions now or in the future applicable to each of such lines Pricing: pursuant to GSA Federal Supply Schedule Number GS-35F-0119P, Rate Plan(s):Various Equipment:Various July 26,2023 for 12 months through 2024 Term: (month)(day)(yr.) (#) (year) The quantities listed are estimates only and are based on past and future usage.You may Funds Authorized: purchase less than the amounts shown,but no more.Purchases in excess of the amount shown will need an updated order form.All services orders shall be on an"as needed"basis,subject to the availability of funding and budgetary considerations. Monthly Access Fees for service on up to 10 lines(Estimated) $1,000 Equipment charge(s)on up to 10 lines (Estimates) $5,000 Total Access and Equipment Fees on up to 10 lines(Estimate) $17,000 Plus applicable fees,taxes and charges Contract#: GSA Federal Supply Schedule Contract Number GS-35F-0119P,State of Indiana BPA#9847,all terms and conditions are incorporat y reference. Equipment None of the equipment listed re roducts listed n GSA Federal Supply Schedule Contract No.GS- (Open Market): 35F-0119P.All devices a d/or accessories are"0 n Market"items.Various Specify Phones,Deliver Etc.: Pr 'He ID# 286 93 (all accounts and sub-accounts) Miscellaneous: **Please notify POC 60 prior to fund g document expiration date** Customer Acceptance: Signature:(' Date: 3 For Verizon Wireless internal use only: Approval: Date: verizon For Verizon Wireless internal use only: Approval: Date: