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HomeMy Public PortalAboutAmendment No. 1 to Contract No. 85-2015 - Sanitary & Stormwater - Pitney Bowes - Leasing mailing equipmentORIGIN4L AMENDMENT TO CONTRACT NO.10-2015 THIS AMENDMENT is adopted this day of Mal ) 2017, by and between the City of Richmond, Indiana, a municipal corporation acting by and through its Board of Sanitary Commissioners (referred to as the "City"), and Pitney Bowes, 7701 W. Kilgore Ave., Yorktown, Indiana 47396 (hereinafter referred to as the "Contractor"). WHEREAS, on or about August 3, 2015, the City and Contractor entered into an Agreement for good and valuable consideration with said Agreement bearing Contract No. 85-2015. WHEREAS, Contract No. 85-2015, to which this Amendment is attached, requires Contractor to Lease to City a DI 500 Folder/Inserter for a 60-month term for the sum of One Thousand One Hundred Twelve Dollars and 00/100 ($1,112.00) per month, as more specifically set forth in the Agreement. WHEREAS, the City has determined that the above -described equipment is insufficient to meet its needs, and Contractor has advised that it is willing to exchange such equipment for a Relay 5000 Folder/Inserter, which both parties believe will meet the City's expectations when considering the current volume. WHEREAS, I.C. § 5-22-20-2, which contemplates contact modification, as defined by I.C. § 5-22-2-3, permits the parties hereto to modify the above -referenced Contract, in such a manner as the parties may agree. NOW, THEREFORE, for valuable consideration and passage by majority vote of City, the parties hereto now amend Contract No. 85-2015, to wit: Equipment. Contractor agrees that it shall retrieve the equipment that is the subject of the lease pursuant to Contract No. 85-2015, namely a DI 500 Folder/Inserter, and agrees that it shall deliver to City a Relay 5000 Folder/Inserter in its place. Said Relay 5000 Folder/Inserter shall be capable of inserting, folding and sealing up to four thousand (4,000) envelopes per hour using a simple, straight paper -path. Contractor shall ensure delivery of the equipment described herein in new working condition and with a warranty consistent with the terms of the DI500 Folder/Inserter. Contractor agrees that it shall not remove the existing DI 500 Folder/Inserter, contemplated within Contract No. 85-2015, until such time that the Relay 5000 Folder/Inserter is delivered and in working order. Lease Price. The parties acknowledge that the lease price set forth in Contract No. 85-2015 is the sum of One Thousand One Hundred Twelve Dollars and 00/100 ($1,112.00) per month, with billing statements issued on a quarterly basis. This same lease price and same payment schedule shall continue for City for the Relay 5000 Folder/Inserter. Lease Term. The original lease term set forth in Contract No. 85-2015 shall remain in full force and effect. Nothing herein shall be construed as extending said lease term. 1 1 Page ... .� , �, .pO� V • o IN WITNESS WHEREOF, the parties have executed this Amendment at Richmond, Indiana, as of the day and year first written above, although signatures may be affixed on different dates. "CITY" The City of Richmond, Indiana, by and through its Board of Sanitary Commissioners Sue Miller, President APPROVED: l ave Snow, i r Dated: 0S 2 I "CONTRACTOR" Pitney Bowes By: S.� Pam-- a (Printed): SAWofore Po liQtk-ek Title: ni rj.c.4or, CCg } � 0ew8u1ice! S Dated: aS t ao t rl 2 1 Page PITHEY OOWES LEASH AGREEMENT STATE AND LOCAL TERM RENTAL Your Business lnforftrailort Agrt3emettt Number j CITY OF RICHMONO Fun l,HpatName of t esseo DRA NAme of i eesee Tax Its # (FE(N/F1N) 2380LOV11TYAVE RIGHMOND - IN 47374.720 - 91ningAdtfresslSliest Ciiy 8Ia{e 444 20472047064 B111139 Confect Rain 8111109 contact Phone # 0109 CAN it 236OLIBEkTYAVE RICHMONt7 )N 4737q y2t32 InstenaltonAdditm(IfdP*renttrgmblWngaddr84 street city stale 0044 20472647864. 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TO V-1 ---- Pltney Hive S{griatere ,-d,e a:�9t-tttolSnil„a+waloCIAY.l11-1rRiira riuz£tu,t lari�,raorr3L:rantr�•:ler wa�.�,r3.r.-,aai:Cwa3.gr.��3cy C 3QF3YS�aofluYm3iTpP7dan�a»ra)rly;ua:d,lH�3n•;tINIU-Ei3t1a3jH Contract wid. v j4 Ft,4/ en,0 j d. }71 r-xrdF ri3:tYti. ?'r-S'IJl:Y1SPd7{Ai4C4lN E! ln.t V2i: ��y 3�2 yi:2�}CFS .SA:r}-J �G:.2f 8.t f fd lidf'j'i:/. R101 $038-GC Inforination Return fD r Small Tax -Exempt Gamrnmental Bond Now, Lnssus; and insta(ffmnl S.alaa r-D.1645 0 7 r• ilnderinfernarRe�mnaesattea tksn 14S(e) X;rr,�l a.:�ifes?:riap CoultowHthe ameusefimm8A48-t? "I attlntfAuthwity Check Box tfAmendedrteturn } 2880IJBEI YAVE Deseffutton orDblfae s Chack one: a shale issuer or a consalklated return 0 88 famepdce................................... d Issue date (s)rde tssue)nr colendardate (mnsolfdatad) EnterdeW in rtm'diflsW format (forexanple, O'!r lt2009) (see [ndaietlons) } 9 Antatxtt of fhe reported rbllgatbn(s) m lino 8a that Is: ttForlea�esfarVeiddes....................._..................._..........._........... b For leases for oltice egWpi mt .......:........ . .......... . ................ . .. . ......... c For leases far real praper[tr . ............. . .. .... ......... _ ....... . dForleasesfordher(sea ins n dons).. ................................................. . e Forbankklansforvehlcles.... ...................... . ...................._........ . f Farberticloaru foroilfce etfliprttert ............... . ................... .... .. ......................... . hFarBank las;rsfac rther(�e Irb�#rtrc#fans).............................. . ... _ ..... _,..... _ I Used to refund prior Issue(s).............................. ....... _ j Rtprg�niingatnanfiumttrdpmceeclsnranai�ertms-exampfnbffgatian•�forexampla,bondbetik}..... kOther................................................................,............ 10 If the Lmuer has deslOtafad any issue urrJar-aer,1w 26SthX3)(Bj(i)(I11), (Small l suarexceptions), chwkthb btnr............. b" O 14 tfth a is ter has elected fo {toy ;3 penalty In #tau of arbftrat�e rehata, rhecK thisboX (see lnsfructlons)........................ lr" 0 42 Vairtor'sorbarKsnarliq PUNEYBOWESINCw.....». ,......a».. ---- a: ,..W.».»...._..»...��r._..,...,.»,.»..»�.._...»... 13 Venloes orbaric e mplayer ftbrii#Wlon nunf er. D ti ; 0 d 9 5 0 5 0 lfn _ Ike s€p_ rjo3;1 eitdsre Ilst 1 we ex�mw fide t$ttrnand aomm n t� sdr=auleaaod tetf>=ni.A andto Nta OfarYl air SI[�riHlarE ardl #irtryae,anrtacdmrop>=talSrilnsd=_d3taft�ttco ntt>> R dLznWuPof tote er ztamfnbnrdE®na�nrreear3rt0 and prorpstldyrrttcn,latl�psr ,n(s)tttrtli►-tieaathar'aeisdnte S'y9,rlyj -A SQt?�/ Consent Cf TZ c.0 S aatut3sr€?ter, .s�Crs�-i�yn�.t�ii+e [?;te T3�arp'vtnanear�El� RWTW-.,=pamrs,n3w Pdli pr>rwerrs trarsa as Use 01113r Frn�dfa--s Y general Instructlono &ctiar renwiwars we to tax iri mar f�t�eC� urlassnli�r,r$esoled. Illrtlat's Metre The IRS has crud apagem IKsobvia hrnrr»slton about the Fosm.W3E ssrss end Is rMiudbns ,af VA1AV.iv.gmf=aav& arredrng &a Form SOM szlm -Vut* se 7=glitailra unedW arta wnelmsa.-R) %rll be pxfEdoafhntpaBe, Purpose of Forst F4r=W33-GC t; WLd by the j.4M cos jbf rsa,- ocaTV governmenisl obil8aftors to prirvide the IRS ♦Kith itte hrunm8rta req had ty ; awtia, 149(e) and to maniar the mqu)Tmwils Rlsetiu ;141 thnxrgh 95il. Preparees signature IM o Must Fild lankim of taxracen* gwermte" flblrgalhns With asur prlw of less Van VD0,600mastfireFan maid sa Issi,Es of a tarce,er=MFI _gaiarnn>E„isI abligafba w1h, an ksim prrtaear 810D,flatl.ar mate mist fik Fww Si &G Wdur dion gown for Tax-Fxempf Gwemnir_nlai iiil7patians, frrtng 41 Sepowie r htm fors S1101e issue. IssrFs hate the, ,optics to fife a :Msrate Form 4V.-w -SC far smj ta:c rxrr,rpt grrlfrm„e001 dsrgarycr, svah an ksua prim d less ihan4llS�,t1Dr1. An hSuEr of a tax€xernpl rand tsed fo� itnari a u6nsfrutfimt expenAvrr must rile a separate i'arat rurs"c frx Farb issue tr g1w AcdoetothsfRSilelaAEtaltonu rfrad+tu check ❑ Prw ifszlrertalt,� Frrars£1N } FWanenz payapens>hjin fiettai•arhtraaerebote {see thOWell rnstuctfnns). Fr6'ag a t:mwfifAcd ref pat for mik pte fss`ticS. For eI bx-apt govonam sr chiIinations t4A Lssm pdo2g id Irss Iban WMOW the# are ad aapnfted art a sepsrafe Form :?tlMW, am jamf nmf fib s conscedpfr;d 1niQrusilon tibua rndudraQ al sucrt Dues t�rt+:d n�hir the><talstciar yarn: 'this, on teem• mmy lb a sepsrata Fora Baza-GC rar each ors namba #smelt issues andrVtdrhssErnandssmal! issue, bsuscl diving the adwdar Yoe na one agrsalklated Farm MR-Cr. HjnU Va. T fire i,3ue b e waskariloA issue rq 54MMte Fflrm 4009-OC must be AM l4 gkW the IRS uagae cf the rjwkn #r pay s pmaly In It tr of srbikega Cot.1�0 0000 Farm 804SOG liar 1-2H2) Other. Forms Tilat lidfay Be Required For rebafing arjurage (or paying a penatyin lieu or Arbit>•aga rebate) to the federal t overman ow Form 8028T, Arbilroge Rebate Yee* Redo dran and Penaky hl Lien of .Arbfrage Rabolit- For pift4e adtf4ly boons, use Form 8fl38, In#yrnatb n Rdrrm fvr -T q{ptP.rnratbAcbvky Sondissupa For a L*x- rinpt goremmeniat.nbggafnn valh.$uiudeprfae or3T00,DG0 arfigre, rise Firrm•Pft38G. .- - FV' in 0133-6-C (ii-ii i 2012) Whon To Ho To No a_sepa 21N retim forn.aingleissue, flie Fouh 803"C on rrbabm Iha`15th tray of the aacotrd calEndarmoniti alierthe dcZ- of Us talender gwilor 'In ulrtGh the issue is. issued, 7-a fJe a r,vWOWAled rdum formutrife issues, ore: t ortn Sa38.G1; on or bafcre Fe6mlar)r (6th oftheaaloil yaertollovirig ,fie }grin which the issue "s Lsatett Late. 000. Ali Issuer may he gmanted a a°xionslan 6t &me to bla Fogn $038-M uila serllon 3 of Rev 3'fdo 2W2 i8, �002 iA.8.v3T, lflt lsdei>irrrtinedihatthF kfui�t Ro an tine is not due�.b 1011ili nmgl9d or print at the top of mi d ban, 1Qec iv4 io R614fundersecloa3arhe Pm4=62- 46;° �Afladi b The Famni 863" .e latter btiaAy dating i'ltyy the foml nos Sol sUWff d to the IRS' nn aline. Ako ,rndreate Vsbether fie obkggtian in 4uedWn ,b and sr t amTnefan by the IRS: Do not submit W%es of alai bond dommenis, leesrq nr litsfallniant sate doomeals. See i7 hoar Ta Fie prA VOhere To File Fie Faun 803t3. C, and any atirich meida, `%ih.the DepadmentarthOTiea.�U;%Mr mat ltevenua Stn&ce Genial, �gdan;11T8d2111: Privet& .delivery services. You can use todaln private dedr'.erysen3coa rrasitaated by the IRS to meet the lbelymoiing.as tkuti fling/haying° ivid fir ta:k returns and paymails. 7lrese private ddivay ssr:�tM rndude anlylh$ 5,fn�sbJ • OHLJ:Ws;5t0H4.-DM.SameDay SEWIM • Fedatal Epress ,(Fedfx): F*gx.Pdrniy i?vatnlght, FadEaSlandaii overribld; FadEz 2Day, Fadex intecmaacriol Priidty, Raid Fed�rtntrxrtatlanal Fhs1: • DOW Psuel S.eiPice VPS): Ups NMI Day Air. W-8 Nort.Day Ali Rwer, UFS grid DayM. tJF" Zed ii�j Aral M1l, UPS WC4140da EV fts. and Ut SWcrid'.Ylde E•tp'�;. Tim Private 01AVY srdVW to it tell yyou reesrr caangrag fecmal crarrnetaircas), Also, hovtogEt�ivttanproafaittre.rnal)tngdate f6ra�gthns ssuedunder it*w.,&vhlaro that mama, dug 1€qulraeroats ormo Immilh t4dance, nb$gafars Issued mutag 49"111 calendar, Y-vam mpy be treated as part aklhe same issue If dt of The tmpurts to he 116unwd under the d-avtdel4 loan ere Mfisaaatrty exlleded to bli t#" cad %thin 3 years of the dale of issue of the .W i}hliyatton uket se�,. abl�airane (other JIM private adrvaybondO) Issued under a -ergo s�ament that Is in `ire Alan of a !aria 'dr Itt§taimaiit lade mAy;he-tredad as pert o ftbe same Issue if rill artfie prapelly pavrasd by that agreeinent is 1Dasrxiably espaded la be delkarad YAI* 3.Warsuflbe entoufis sof the Grst-r bflgaitai Rounding to Whole Dollars Ariaitrege reWft agnetafy, intaost an a _ ran maystaatvthe fuoisey;t-in on ibis rduiA sfpia or local baid'is'pni t e sampl'un)ess is ubd b4otkr 6nrounis. To do so, drop tray iaiourddeSaihfip,ytt•terds and trictcasri en} ---- the ksnor of bond rebates to the United Sfstesaritrd9ePr�r-s enmedar! lnvEsiing . nor nEfrorn 50 b W cams toihanot higher proceeds of the band Ili hJgir �itli riQ. otar nouprupts to me Sea seotian ld$(>j� e#initioils trrrgatktns this mfare to a srngte. lax. =. -it . ro�ra ntal abligalon if Fcrir ,%-SC isased for3sparate roporling orla Callstiue0ob Inge. Thislsaa issue oftarc 001* ball* that maeis bath of the rallaillag mndlttons: Multipletalc-exempt go'TemnianialobIgetbns kfths terms tensed-tarronsagdatzdreporfiirg, Tax-�c otchlrgation, Vg is anyoEsJlgatlon Urchdiny` i bond, instollmerrt Puochssa $c��ceee)ncat at itnandal lipid on tsfiTch the 110. 51 Is efcluddd Ironflneome undarsedhrn 1 Q:l Tstr•�rerrp#govartterrieloblrga on.Atn•1• 0340pt abl4dred that Is not_ a Private adiyb bond (sea befov_3 b a IrA-v c�ipt n go+arinmentaf obfyalion,'ibislydaddsa.lignd r issued bya quallh'ad yolugteer bar drpaitment 7 undersecfon Iskij. o Private activity bond 7h1s Includes in e n:bltgetfontssuad sspart ofanissue In which: r lAore than 10% of the Puouteds are to he used fa1`anY^fil0 aditiltybudosss use and • idore then 10* of the Paymeot vfprindPaf orlrbm#ofvia bang is elWf(a) secured by an tatemst In prumv to bd. used rota private business: ass {orpaymealstbraudr p>oparty) or tbj is he dadgrrd ilom l tibia Ar Pi*tty (er bnmr►�ed money) used for a pmrvatc usiness uae� It also includes a bond, the pnacceds ur Mich (e) are to be- used to m0ii. or hanco loans.talber than corps described In sodloi 14i(c}t?j) to pemons other im.$n goY4tmmentat ,units Pad (b) mvaitt the lesser of5;'s ortha proraeda arS + iirifli)p:. 1ssr18, t391e13fy. Ablgatbns are treated as Part Of" sinre.Issue c914tf019y+ara issued bythosamalssuer, din the acme data, Andes pert a r a oingla traristcfoa, ar a ,settee bf roleIW rtiig tranaadlDrr5 tdov,eYet.aabirpsians dr'the adore orlertdr ls§ra1 ) (a) unders burl dgreerirerd under tshlcb unts aieio ba'Ad4icalfpadadrgl(y(u'dnrlti~amo faan! or41 b a term oat eracaeiing 270 Jule, may a haeted a$ psi# 9f the ssrAa tale¢ I1&e,cbj&ffons are eq6 cad. test j second urrtla a eloglo battnn or Man 000"1 and ate Issued ardara cormron Aar 2 I. At least M3 otlhe avalabb conat 4dion paaceeds of he lsmie-aR to be —used for d6natnrction mvendAvres igir respect to PrOPE4 to he Mined by a govenrmenlat unit vii;804c,X3) oiganizafcn, aid 2. Ail of the bonds that are part ortholasua AM qualified S¢1(cXS) bontts,.bonds that are nd pnYete edriri - Ibnda, or prIA48 acuvity bonds barred to 0panoepioperlyto he omed AY a governmental unit or a 601tc)($) organfmfon. In Yeuofrebolfng sly arearage that maybe avad to the iJnttad Slates the Issuer of a oonstni fah Issue may maiie an kimcabie elactlQt to traYa palolty,.Tbe ponaliy is eval b 119% of the amolrai of 0driswelon p(o(ands flint do not meet oemlain sponcong rPquirsmants see. seeftrn 141080) slid thelttslmaoria brl=oryn 8038-T. Spedi }C IrlStrtictfons !n yental. a Famt SO�C mud be compdsted' on the basks of avatlAle. lnratmallon_andraascnsble agtrxtatl S s of fro date aflame Itavwer, 5nnslhat are fled an a cunadldaled ba ifs pray bb conolded an Itebssls orbfrmmettan teaftavabbhrdo'the lsatier of Ire dosa �of.he calendar year to vhi� the roan roTatf% supplemented by aotimates rnada in _good 8 fir, Part ( Repo Who Authority Amended iedlm. An issuer may fle ten amendw return to, change 'or add to the lafonnaiton repoded on it Previously, fled return br b a same. date of tssuai if you are fib correct marls or ehwun a. trls*us& tied return dmrfC tars "Arrrarded f4aJun7r treat b the hedijnq ofthd irmr. The amendat return mt* provide all the hrfurmatiso reported an the arighiaf rstum, In addinair to the n1Yr rauaded kJarmolon, AltitDli: An mplana�lot, r I ire rameon for the amended realm and idle adioss the top �tnandad Return Uplanalbe -Line I. The Issuer's Acme Is he name of the: ar>flty laruririil flp abggattans, oaf the nave of fte enlltf rirti3Q *n the berieit of the InAadpi m the ease of a Jeaes ar hstafl!rretrt sate, fie fsaaer(s 8re lessee orPurdreaar. Une ;t. AD Tearer !bd .does not h6vo so omy foyer 1daditlion number (EJH) adm uld a��p far ate on Fume 60-4 Appllcalica for Fmp�oj+oi;rideirlifcatron Niintkiw. Yt u cart get ftlsfarm ontho:IRS-VA"la at 1RS.gcvorby c;athtg t-800-i�FORM {1-SCD-nc�-"a7Er You mey.mehe ,an -Eel by briPh¢ne by bfaufng the hrsta diorra rnr Fi rM SS-k I -Was 3 and 4. Enter Ire issuer's -address or thaesir4ess offrs deslgnatett c�ontacfPerson - tt cd in We & lffhe LswervAlies In use its Dili] adrfioss,and the Sauer jo-&4&s.as invf M care of a l ifid party" aiithwhW represeAiative t�cudl as an aoaouptaht or !Harney entethe_ street add s t1n9. _ - toomu, or oddreas.I b ire sir. . PA. boy{ s or P.O. box Inctrda the Suite er unt number glier the shoe; podtofiirco darS natdellmrmat addr-Ids and The,Ivilef has a vErdfbaxnunritrinstoad ofthi i ,r A fade £s ksc IRA;, 1-2014 street adfross- ifitdiangelna4dreseamuts titer the return is is 4 We Forat 3022, Change. ofAddm4A to notti;i the IRS of the nevuad4ress. dote 7be address erdpredon Imes 3 and 4 is the address the JO a use Or An rotten eommudcalfoas re -wing The prucosting of Tins. retaro, including any no& m ' By author(4ng.a perwn oharlban An oulhodoad afiear or other $01019 ee of the issuer To comnitrndnate %,Ali Jha 1R& andrfiem the IRS may contna about this rotum, the Iwor authorizes the IRS In morounl;,ats diredly vAh the ladhAdial bted on Ins A VMS* address Is entered on lines 3 and 4 and r.onsants to disclosb the Issuers Irian Infomallcn to that lndh1dirat as necessary; to process this raiurn. Line. S. This the is fir IRS use o* Do not make -any entries in this box Part It--Desanpfiryt'i of tltitigations Check ttid approprifita hex designating iris as a reluot. on a sh9le issue basis or a cohsondeted return bests. Line 8a. The issue price of AVOWS Is geaerany deterinined antler Reguhlon'-s section 1A48 3(b). Thus, moan Issued for cash. the issue price. 's. the price at ;Akh a substanthet. amount of the. obitgallons eat geld to the pu Mo. To daterinhre the Issue prit of an obligalm issued for~property, 390Satfons 1273 and 4274 and theiehiladreguiarorm Ltna six For a single Issue, abler the date of issue .(for eiampio, PY1812010 for a 49)e Issue issued on starch 15, 20101 ganeraly the date on vhldl Ihb. Issuer physically exchanges the bonds out are gait of fie Issue for the undervdlats (o. whet purehaeofs) funds for atofiseorhstdn"d sale, antertlie date laleodAfarfsto aeacaua, For bsuas reported on A crnao/dated bests, enter The first clay of the cgleadaryeerdudrig 114delr the obfigaborn;s 9ArB Issued (for example, ter calendar liar 2D10, enter 0i/01raid). LTrive as through eh, CompletaftsedbaIf proFedy Other than .cash is wchoMad fir iba bn 110 5 f sI edi LTnes81 and 91, Fortino 9. enter theanrounf of the proceeds that vfl be used to pays prindpal, interest, or call prembra on any Other issue of tanilk includfagpiamods that mAl ke used to fund an asctoVi Acmuilt for this purpose. Sdwial Ines may AWAY t4 Al pnitlaular obligalloo. For amrarle, report onlines tl and 91 obigatbns used braiurrd prior Issues v-bkdr rappment Iaans rmtn The proceeds ofanoft#rls*A=raptobfga§m- ISne 9k. Enteraninfi 0ktheamourton ire Sa that clues gal represent an obiga0en described an Ilnes 9a through &J. Line 10. Check ihii box If eha bsw hm ats degfp d any rssr� s; a ansais li—NW exeeFdan' undery *don 2M(bif'3td70)dss). line 11. Ghee, ibis b xc If the issue is construction Issue and soirowvableelection to ply a panalyln Geu etwNfroge rebale has been made on or behra he date tie bands s ere Issued. The psnanlr Is paialib @Alta A farm 003$:r fir each 8-month period attar the date The bonds are issued Do not aroke any pemtnf of penalty to Hail of wbate aih Fotm 1ki"CG see Rev. Pram 92-41 OV-1 G.H. rA for rules ragariny The selection document.! tine i2. Ehtarthe nsmeoftlieventdararbank vho Is a party to the hsiallment purchase agreement, lean, or Oranelal lease. If then: are munlple vendors or banks, the Issuer should allarh a echadule_ Une .43 tinter the employer Norillic4fion number of the Vendonk r or be vho is a party In are histetlroont putahoee egroemank. loan, orinendell0se. Ifthare rue mulnpla vendors orbanks, (be Issuarshould Attach a achadule. 819hatureand Consent An anthwizai iepieser"INU of the issuer' meat olgri Farm 809-0 G And My ippleable cedifcation. Also pool Oho name and ffila of Me pelon sWIngr Farr 0030-GC. The authorized reprssmlathm ofthe Issusral-00g Bds (can mt>st ha5e the authorRy fo 004011110 the cisdusum of The iesuarls Mum infamadon, as necassa to process this raturn, to he parsons 11al has been dw9flo edin this frnn: e ya n, r —MP , Owburg a p as car, }tote, If the issuer authorizes In Ina a the a Are feud" or161*1ione r:gtiMadbrough a series of inanibly pfiymrerts. Glib type of IRS bnommunlcata rA1lr a person other itt2n obpgeilwn is SOMC 03 cei rrsd b as A xa effm or other employee of the Issuer, ' nvaldpai foam Also tompide its sedan (such autimrfzetion shall Include coals dboth Ifrealproper tyIsd1wil/acrirtredIn. exdsangs in vribngrVa.Was ofltaaddrass on fated loran obllgd4an to make perioL'ic payrtrentri of th Jose 3 and d, and byidephonej byslgning for art a ihallo ezp>rl_ Ibis him, nib Issue °s authorized rejreceriatLa consents to fire dhdasuro of Do trot completalims. Va through 9d Ifthe the tsswes relaip informfilon, as necessary Proceeds of An Obligation are reavivcd in the to F CwsL ibb telm, to stieh parson. form orcash even if" won 'lmeisUsed in the (file of the Issue, For tares &a through 9d, enter the amount on the appmpiate free that represents a lease or i FdAilarert purdlase. For line 4 enterthe type ofttam —that Is'lessed For fines Je-O wcrgh O crier —the amount an. the appropriate ON ihA represents a bans; loan. Furnns Shtonlerthe type of bank loan. P=-2 3 Paid Preparor if an auibufto4T'vresenlothe aflhe Issuer tried is is wA rn; the ppdid prepows. space sharid reinahr blank. Anyone %ift prepares We retain tut does not charge the atpaWran should not dqn ore raluta, Certain a0rers vhaprhrere the netura should nd Sinn. For rMiA a regular. ful" ne empfoyea of the truer, such a.¢ a dark, secretary, etc, should notrYgn. Genera Ih ar prat vha is paid to prepays a retummu;.d sign R and IN in the otherb14 rik$ In The ftimy0firarllae G* area aftie retum. A paJd pteparar comot use a soeki security aumber In the PAU Preraarer Use 0061 bcuc, Tha paid prrparer must use a prepfirer tax idarrtslcatbn number (PT10 It lea paid wilder isorbaraddpie.as In Itch x stet Mould Thapaid preparermvst: * Shro the return In Yea space provided forthe pmpenrr'sslanalum, and GIN a copyof be. rebum to the Issuer. PapertrvarRHt~duoffon Act hlrlftce We eel; for fie Informalan ea th.s form to Gerry out the internal Rownus loins of The f)nd4A Sinter. Yau are required to 9tya us the Infarn norm Weneed Itto ansurethat you fine comphrin9 uIll these kvs. YOU ors not requted 10 proNdd the Informaiion requeabd an a fofm Ihat Is aukject to I ie PBppensork Redicflan Act Unless lho Bari obapisy4a Vathf olds control number_ Book" or records t+eiOM to a form o r 1h 1nsWo0oesmtrsl ba oaiahed is long era ltitr contents may beeama matedd In the tclailalsin6a of nary Internal Revenue law Ganff*' iexratrrris and tabu" loisrnra+trxi are arniderOaj as required bysedbin z183. The fine ,medal to crmpleta end ire this form Viet nary dependng on hdv4dral dreuunslacoa.7be estimated average time is. Leamrngaboatfie feworthe fans ... . 4 hr, 43min, PmpadggIbefrnm , . , . 2 hr.,22 ar)n. Copyirrt,, R;:aembtfiu� Brut Beerdmgthe idrinfo thelitf . 2 hr.,?4 min. It Y�u hava mmmmnts wncelring tt:- $=lacy d 1"e tens wradab or suaw irrs for "Stw fife Actor situp L arwwow be happi to hoer km yvu You osn 167$6 b 1ha ftdgwas Ramwe 9snrJoa. Tat i'todacts Caardinsft Ccmmittm 5120M 12 MP,T'his, 11" Ccn3al AlonAw- M IR-Me. Washkrgtrm. 0C 2924 Do riot saW the form b this -0&0 s_ ho kod sw Max To f-11e