ITS69_Exhibit1_ECF_Rev_V1_0~3.doc
DOC document 87 KB Posted
- Attached to
- ITS69 - Managed Print Services
- Solicitation number
- BD-19-1080-OSD03-SRC01-28236
- Issued by
- Massachusetts
About this file
This document is the Equipment Confirmation Form for the Statewide Contract ITS69 for Managed Print Services issued by the State of Massachusetts. The form must be used to confirm the selection of equipment, such as photocopiers, digital duplicators, scanners, and facsimile machines, covered under the contract. The contract terms and conditions are incorporated into the form, and conflicting or additional terms are superseded. The form includes details on the eligible entity, the contractor, the equipment description, quantities, monthly lease/purchase/rental costs, maintenance plans, and signatures acknowledging delivery, installation, start-up supplies, and training.
The related state and local contract opportunity, ITS69 - Managed Print Services, is a reopening of a previous procurement to add additional vendors. The contract is for the State of Massachusetts and has no specified end date or renewal options indicated in the provided information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| prompt-pay-frm_10~1.doc | DOC document | |
| CompanyName_ITS69_EPP~2.doc | DOC document | |
| ITS69_QA_June18.xlsx | XLSX spreadsheet | |
| Referenced_Forms~2.zip | ZIP file | |
| sdp-rplan-form-2-declaration~20.docx | DOCX document | |
| BidderCompanyName_ITS69_Recent_Experience~2.docx | DOCX document | |
| CompanyName_ITS69_Bidder Profile~2.docx | DOCX document | |
| Request for Response_ITS69_Managed Print Services_v1_7~1.docx | DOCX document | |
| sdp-plan-form-1-commitment~28.docx | DOCX document | |
| ITS69_CompanyName_AuthSvc~2.doc | DOC document |
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Text version
ITS69 Equipment Confirmation Form
Managed Print Services
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 ITS69. All of the terms and conditions of the Statewide Contract, ITS69 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included in or attached to this form, which conflict with the terms of the Statewide Contract shall be considered to be superseded and void.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: September 27, 2017
PAGE
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