ITC66_Exhibit1_ECF_Rev_V1_2.doc
DOC document 87 KB Posted
- Attached to
- ITC66 - Statewide Contract for Copiers, Printers, Scanners, and Related Equipment and Services
- Solicitation number
- BD-17-1080-OSD03-SRC01-00000009791
- Issued by
- Massachusetts
About this file
This document is an Equipment Confirmation Form for the ITC66 Statewide Contract in Massachusetts, which is used to confirm the selection of equipment covered under the contract. The contract is for the acquisition of Photocopiers, Digital Duplicators, Scanners, and Facsimile Machines for Executive Agencies of the Commonwealth and other Eligible Entities. The form must be used for all lease or rental encumbrance documents and includes details such as the Eligible Entity, Contractor, equipment model numbers and descriptions, quantities, monthly lease/purchase/rental costs, maintenance plan selections, and signatures acknowledging delivery, installation, supplies, training, and payment terms.
The related state and local contract opportunity is the ITC66 - Statewide Contract for Copiers, Printers, Scanners, and Related Equipment and Services. This contract is the primary statewide contract used by Executive Agencies of the Commonwealth and other Eligible Entities for the covered goods and services. The contract term is not specified, but the lease or rental agreements have a maximum term of 60 months. Pricing details, set-asides, incumbent information, and funding sources are not included in the provided documentation.
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Other files
| File | Type | Posted |
|---|---|---|
| ITC66_CompanyName_AttachE_CostSheet_Cat2_DigDup.xls | XLS spreadsheet | |
| comm-termsconditions~10.doc | DOC document | |
| ITC66_CompanyName_AttachC_EPPform_ver1_0.doc | DOC document | |
| eo504~2.docx | DOCX document | |
| eo504.pdf | ||
| ITC66_CompanyName_AttachE_CostSheet_Cat3_Scanners.xls | XLS spreadsheet | |
| EFT_FORM~9.pdf | ||
| sdp-rplan-form-2-declaration~14.docx | DOCX document | |
| sdp-plan-form-1-commitment~22.docx | DOCX document | |
| ITC66_CompanyName_AttachA_BiddersResponse_V1_2.doc | DOC document | |
| ITC66_CompanyName_AttachB_AuthSalesSvc_V1_1.doc | DOC document | |
| ITC66_RFR_V1_3.doc | DOC document | |
| ITC66_CompanyName_AttachE_CostTables_Cat4_Supplies.xls | XLS spreadsheet | |
| newmass-w9~10.doc | DOC document | |
| ITC66_CompanyName_AttachE_CostSheet_Cat3_Micrographic.xls | XLS spreadsheet | |
| casl-form~8.rtf | RTF text file | |
| ITC66_CompanyName_AttachE_CostSheet_Cat3_Fax.xls | XLS spreadsheet | |
| standard-contract-frm~10.doc | DOC document |
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Text version
ITC66 Equipment Confirmation Form
Photocopiers, Facsimile/Multifunctional Equipment and Digital Duplicators
This form must be used for Photocopiers, Digital Duplicators, Scanners and Facsimile Machines and attached to each lease or rental encumbrance document to confirm the selection of equipment covered under the Statewide Contract number ITC66 on file at OSD. All of the terms and conditions of the Statewide Contract, ITC66 are incorporated herein and made a part hereof. Conflicting or additional terms, conditions or agreements included in or attached to this form, which conflict with the terms of the Statewide Contract shall be considered to be superseded and void.
P.O. or Encumbrance Document Number:
Fiscal Year:
| ELIGIBLE ENTITY (Buyer): |
| CONTRACTOR (Seller): |
| Contact Person: |
| Contact Person: |
| E-mail: |
| E-mail: |
| Phone: |
| Fax: |
| Phone: |
| Fax: |
| Billing Address: |
| Contractor Address: |
| Contact: |
| Phone: |
Delivery Address (If different from Billing Address Above):
If applicable:
Leasing Company:_____________________________________________
Authorized Dealer:_____________________________________________
| Contact: Phone: |
| If applicable: |
Leasing Company:_____________________________________________
Authorized Dealer:_____________________________________________
Term Lease: # Months: (Not to exceed 60 months) Rental (Not to exceed 6 months)
Purchase
Check off the applicable box(es) for equipment type:
Photocopiers: FORMCHECKBOX Scanners: FORMCHECKBOX Faxes: FORMCHECKBOX Digital Duplicators: FORMCHECKBOX
| Equipment Model Number |
| EQUIPMENT DESCRIPTION |
(e.g. Digital Black & White 35cpm)
| QTY |
| MONTHLY LEASE, PURCHASE or RENTAL COST |
| TRADE-IN ALLOWANCE |
| MONTHLY NET TOTAL LEASE, PURCHASE or RENTAL COST |
| MAINTENANCE PLAN SELECTED |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
| $ |
Special Instructions/Additional Information (e.g. equipment model traded, supplies exchanged):
Eligible Entity and Contractor signatures below acknowledge ONLY that the equipment order has been placed pending delivery, installation, start-up supplies and training.
ELIGIBLE ENTITY (Buyer):
CONTRACTOR (Seller):
Signature:
Signature
Name (Print):
Name (Print):
Title:
Title:
Date:
Date:
Eligible Entity and Contractor signatures below acknowledge acceptance, i.e. completion of the four (4) items below to the Eligible Entities satisfaction, and the payment start and termination dates.
Eligible Entity must initial all four (4) items below acknowledging completion prior to final approval.
Initial
| ____ |
| 1. Equipment delivered undamaged |
| ____ |
| 2. Received initial supplies including ESP Power Protection if required. |
| ____ |
| 3. Equipment is installed and operational and power management features are enabled. |
| ____ |
| 4. Received satisfactory training from the Contractor including instructions on how to use power management features. |
· Lease, Rental or Purchase payment terms do not begin until the items above have been approved by the Eligible Entity.
| Start Date of this Lease, Purchase or Rental Agreement: |
| Termination Date of this Lease, Purchase or Rental Agreement: |
Month
Day
Year
Month
Day
Year
| Payment Start Date: |
| Payment End Date: |
Month
Day
Year
Month
Day
Year
ELIGIBLE ENTITY (Buyer):
CONTRACTOR (Seller):
Signature:
Signature
Name (Print):
Name (Print):
Title:
Title:
Date:
Date:
The above signatures are authorized by their respective organizations to bind the said organization to the terms and conditions of the above agreement.
Form Revision Date: October 4, 2016
PAGE
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