ITC49_ITASSETLISTING_ACCEPTANCECERT_ESSENTIALUSECERT_CERTOFAPPROPRIATION_130417~1.doc

Commonwealth of Massachusetts - Statewide IT Asset Lease Services Contract ITC49

IT ASSET LISTING, ACCEPTANCE CERTIFICATE

ESSENTIAL USE CERTIFICATION, CERTIFICATE OF APPROPRIATION

IT ASSET LISTING

This listing identifies the IT Asset(s) that is being Leased pursuant to the Statewide IT Asset Lease Services Contract. This list will be used to reference all IT Assets to be financed, that will be subject to an Acceptance Certificate and is certified by the Lessee to be for the immediate and essential use of the Lessee. List each separate type of IT Asset (separate Model Number) on a separate line and indicate quantities, price, useful life and location where the IT Asset will reside. All IT Assets must be listed here and not by attachment. Insert as many additional rows as necessary. IT Assets to reside at different locations must be listed separately by location.

Asset Name/Description

Equipment Cost Subtotal

IT Asset De-Installation, Packaging, and Pick-Up

Eligible Entity indicate below if ITC49 Contractor (Lessor) will be responsible for de-installation, packaging, or pick-up of the IT Assets at lease termination. Contractor (Lessor) complete if requested by the Eligible Entity:

IT ASSET ACCEPTANCE CERTIFICATE

Lessee through their undersigned authorized representative below certifies that the Lessee: has received all of the IT Assets described herein in good condition and unconditionally accepts all of the IT Assets described herein; represents that no event which constitutes, or with the giving of notice or passage of time, or both, would constitute, an Event of Default shall occur and that no material adverse change in Lessee’s financial condition shall have occurred subsequent to this date hereof; confirms that it will commence payment as of the date of the Acceptance Certificate Lease Payment Schedule; and certifies that all of the representations, warranties and covenants of the Statewide Contract remain in full force and effect. The undersigned Statewide IT Asset Lease Services Contractor/Lessor, by its execution hereof, agrees to pay IT Asset Vendor the Acquisition Cost referenced herein in accordance with the Statewide Contract.

ESSENTIAL USE LETTER:

Lessee through their undersigned authorized representative below certifies that the IT Asset listed in this IT ASSET LISTING will be used by Lessee for the following purposes and the Lessee certifies that this use is and, throughout the Lease term, will continue to be an essential and necessary use to the Lessee’s proper, efficient and economic operation:

[Enter description of essential use for which IT Asset will be used.]

CERTIFICATE OF APPROPRIATION

Lessee through their undersigned authorized representative below hereby certifies: the Lessee is duly elected or appointed and has custody of the financial records and budget information of the Lessee; and that funding for the attached IT ASSET LISTING is available and reserved from unexhausted and unencumbered appropriations or other available funds within Lessee’s budget for the current fiscal year Lease payments; and that similar appropriations or other available funds have been designated or shall be sought and designated for the payment of those Lease payments that will come due under the Lease for in each subsequent fiscal year in accordance with the General Terms and Condition of the Statewide Contract ITC49.

AUTHORIZING SIGNATURE FOR THE LESSEE

X: . Date: ______________

(Signature and Date Must Be Handwritten At Time of Signature)

Print Name: .

Print Title: .

Revised: April 17, 2013