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Home My Public Portal About015-2018 - I&D - INSDOT - Grant Agreement - Transit BusINDOT 5339 GRANT MOTOR VEHICLE(S) PURCHASE AGREEMENT SELLER: Midwest Transit Equipment Inc. Joe Kizinski / Regional Commercial Sales Manager 4500 S. Indianapolis Rd. 574-612-4063 Whitestown, IN 46075 joe.kizinski@midwesttransit.com INDOT 5339 GRANT RECIPIENT / PURCHASER: City of Richmond 50 North 5th Street Richmond, IN 47374 Dave Snow Mayor 765-983-7207 1. Grantee is the grant recipient and will pass through the grant funds to the Sub -Recipient named below. 2. As the grant recipient, the Grantee name & address above must be shown as the Bill To on the Midwest Transit Equipment invoice. 3. The Grantee must provide a signed Tax Exempt form ST-105 to match the invoice.0 4. The Grantee does not make payment to Midwest Transit Equipment. INDOT 5339 GRANT SUB -RECIPIENT / OPERATOR / PURCHASER: Rose View Transit 401 South "Q" Street Richmond, IN 47374 Terri Quinter Manager 765-983-7227 The Sub -Recipient will receive the grant funds from the Grantee named above. If the Sub -Recipient issues a purchase orders on behalf of the Grantee, then the PO: A. Must be submitted with this Purchase Agreement signed by both the Grantee and Sub -Recipient. B. Must reference the Grant Recipient and the Sub -Recipient as named on this document.0 Payment must reference both the Sub -Recipient and the Grantee Name TITLE / LICENCE & REGISTRATION / FIN / LIENHOLDER / ALL PER PAGE 4 OF THIS AGREEMENT Please enter my order for vehicle(s) as defined on the QPA 15273 Price Form(s) following the pages of this Purchase Agreement and summarized as follows: PRICE PER TRANSIT BUS $57,213.00 VEHICLE QUANTITY SUBTOTAL PURCHASE AMOUNT $57,213.00 GRAND TOTAL PURCHASE AMOUNT $57,213.00 Payment terms are net 35 days upon delivery acceptance. All manufactures discounts, GPC (Government Price Concession) and Mobility Rebate have been taken and applied to obtain the agreed upon price above. This price does not include applicable sales tax, license, registration or Doc fees, insurance, maintenance or drivers. These are the responsibility of the purchaser. ALL WARRANTIES, IF ANY, BY A MANUFACTURER OR SUPPLIER OTHER THAN SELLER ARE THEIRS, NOT SELLER'S AND ONLY SUCH MANUFACTURER OR OTHER SUPPLIER SHALL BE LIABLE FOR PERFORMANCE UNDER SUCH WARRANTIES, UNLESS SELLER FURNISHES BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE CONTRACT MADE BY SELLER ON ITS OWN BEHALF, SELLER HEREBY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE: (A) ON ALL GOODS AND SERVICES SOLD BY SELLER, AND (B) ON ALL USED VEHICLES WHICH ARE HEREBY SOLD "AS IS - NOT EXPRESSLY WARRANTED OR GUARANTEED." The pages of this order and following QPA 15273 Price Form(s) comprise the entire agreement affecting this purchase and no other agreement or understanding of any nature concerning same has been made or entered into, or will be recognized. I hereby certify that no credit has been extended to me for the purchase of this motor vehicle except as appears in writing on the face of this agreement. I have read the matter printed on the second page and agree to it as a part of this order the same as if it were printed above my signature. I certify that I am of legal age, and hereby acknowledge receipt of a copy of this order. Contract No. 15-2018 Form ST 105 State Form 49065 R4/ 8-05 Indiana Department of Revenue General Sales Tax Exemption Certificate Indiana registered retail merchants and businesses located outside Indiana may use this certificate. The claimed exemption must be allowed by Indiana code. Exemption statutes of other states are not valid for purchases from Indiana vendors. This exemption certificate can not be issued for the purchase of Utd ie , Vehicles, W tercr t, or Aircraft. Purchaser must be registered with the Department of Revenue or the appropriate taxing authority of the purchaser's state of residence. Sales tax must be charged unless all information in each section is fully completed by the purchaser. Purchasers not able to provide all required information must pay the tax and may file a claim for refund (Form G /A-110L) directly with the Department of Revenue. j� Name of Purchaser Qt "' rr " y-1 Business Address / 9t City � r (/� 1 {� D ► V'` State 1� Zip -22 Purchaser must provide minimum of one ID number below.* Provide your Indiana Registered Retail Merchant's Certificate a U D 2 I2 l 1 Dq TID and LOC Number as shown on your Certificate ............................... t7 I TID# (10 digits) If not registered with the Indiana DOR, provide your State Tax ID Number from another State................................................................ *See instructions on the reverse side if you do not have either number. State ID# Is this a (blanket purchase exemption request or a ❑ single purchase exemption request? (check one) Description of items to be purchased. A-( ` frw; .6 S&V cc,S Purchaser must indicate the type of exemption being claimed for this purchase. (check one or explain) :1 Sales to a retailer, wholesaler, or manufacturer for resale only. Sale of manufacturing machinery, tools, and equipment to be used directly in direct production. Sales to nonprofit organizations claiming exemption pursuant to Sales Tax Information Bulletin #10. (May not be used for personal hotel rooms and meals.) 601 LOC# ( 3 digits) State of Issue ❑ Sales of tangible personal property predominately used (greater then 50 percent) in providing public transportation - provide USDOT#. A person or corporation who is hauling under someone else's motor carrier authority, or has a contract as a school bus operator, must provide their SS# or FID# in lieu of a State ID# in Section #1. USDOT# ❑ Sales to persons, occupationally engaged as farmers, to be used directly in production of agricultural products for sale. Note: A farmer not possessing a State Business License# may enter a FID# or a SS# in lieu of a State ID# in Section # 1. ❑ Sales to a contractor for exempt projects (such as public schools, government, or nonprofits). Sales to Indiana Governmental Units (agencies, cities, towns, municipalities, public schools, and state universities). ❑ Sales to the United States Federal Government - show agency name. Note: A U.S. Government agency should enter its Federal Identification Number (FID#) in Section #1 in lieu of a State ID#. ❑ Other -explain. I hereby certify under the penalties of perjury that the property purchased by the use of this exemption certificate is to be used for an exempt purpose pursuant to the State Gross Retail Sales Tax Act, Indiana Code 6-2.5, and the item purchased is not a utility, vehicle, watercraft, or aircraft. I confirm my understanding that misuse, (either negligent or intentional), and/or fraudulent use of this certificate may subject both me personally and/or the business entity I represent to thWe—im-1k, sition of tax, interest, and civil and/or criminal penalties. �= Signature of Purchaser t Date 0 I 3 ° f o Printed Name N 4/t/ Title MAGI 124- The Indiana Department of Revenue may request verification of registration in another state if you are an out-of-state purchaser Seller must keep this certificate on file to support exempt sales. ti •. ,< "OWQPA # 15273 PRICE FORM r�auiPcrEn�rf TRANSIT BUSES Click on yellow cells to enter information Customer City of Richmond Project 2018 INDOT Section 5339 Date 12/5/2018 For Options QTY, Only Enter For 1 Vehicle In Bold QTY Column Enter Quantity of Vehicles Here Grand Total Order Price is Shown Below Year 2 Pricing Effective 3/7/2017through 3/6/2018 Midwest Transit Equipment, Inc. 4500 S. Indianapolis Road Whitestown, Indiana 46075 Joe Kizinski / Regional Sales Manager 574-612-4063 ioe.kizinski@midwesttransit.com Option QP QTY c a 9 r PrbduCtDescnption PRICE'" EXTENDED' 1 34 1 Large Transit Vehicle - 16 Ambulatory & 2 Wheelchairs Ford E450 / 14,500 GVWR / WB 186" / 301" Overall (28.1') $55,013.00 $55,013.00 14 29 & 58 1 Accessory - Sure-Lok G02 Oxygen Tank Holder. Mounts in L-Track. $ 270.00 $270.00 39 15 & 44 1 Fare Box - Locking with Two Vaults Diamond XV $ 1,420.00 $1,420.00 59 25 1 Mirror - 6" x 16" Flat Adjustable Interior Mirror $ 25.00 $25.00 87 1 Stanchions & Modesty - Plexi Shield Added to Top of Driver Stanchion $ 135.00 $135.00 88 12 & 41 1 Stop Request - Passenger Call Bell System (Includes 2 WC's) $ 350.00 $350.00 towStandaf+d'RPA�Eianstuses./FNotStaptlard ar91d QPA j 114 NA 1 Braun Century Lift / Platform 34" Wide X 54" Long / 1000 Lb. Capacity / Old QPA Was 800 Lb. NC 115 NA 1 Wheelchair Restraint - QRT 360 L-Track WC 18 Wheel Chair Restraints NC 116 NA 1 Diamond Plate Aluminum Running Board - Driver Side Only NC 117 NA 1 Mirror - Exterior Heated and Remote Rear View Mirrors / Old QPA was Manual Non Heated NC 118 NA 1 LED Lighting Interior & Exterior (excluding OEM Chassis lighting) NC 119 NA 1 Fire Extinguisher and Reflector Triangles NC 120 NA 1 Grey FRP Headliner NC 121 NA 1 3/4" Marine Grade Plywood Floor NC 122 NA 1 LED Exterior Hooded Entrance Door light NC 123 NA 1 Alignment - Castor & Camber NC 124 NA 1 Battery Box - with Slide Out Tray NC 125 NA I 1 JAC Upgrade: New QPA 70k BTU AC/Old QPA was 60k BTU NC SUBTOTAL PER VEHICLE $57,213.00 VEHICLE QUANTITY 1 ORDER GRAND TOTAL $57,213.00 5339 Grant Recipeints awarded through INDOT / Todd Jennings 5339 Federal Share of 80% through INDOT applies ONLY to Award Amout Grant Recipient is responsible to pay Midwest Transit 100•/o above your awarded 20%. 80% Federal 20% Local Total Award As Ordered Enter Federal & Local Share in Bold Cells $44,258.00 $11,065.00 $55,323.00 $57,213.00 Total Award Per Bus You Have EXCEEDED your 20% Local Match by ($1,890.00) ($1,890.00) If you proceed with the order per the options you have chosen above, your 20% Local match of the total award PLUS 100% of the additional option costs will be $12,955.00 l71V` QPA # 15273 Transit Bus & Low Floor Mini Van / Order Information TRANSIT svol.& ENT Midwest Transit Equipment, Inc. Joe Kizinski / Regional Sales Manager 4500 S. Indianapolis Road 574-612-4063 Whitestown, Indiana 46075 ioe.kizinski@midwesttransit.com INDOT Section 5339 Grantee. if you also have a S310 grant, you must complete a separate form specific for the 5310. 1. Grant Recipient * Entity Name Address City, State ZIP Officer/Key Manager Title Phone Email City of Richmond 50 North Sth Street Richmond, IN 47374 Dave Snow Mayor 765-983-7207 dsnow@richmondindiana.gov 2. Sub -Recipient / Transit Operator Rose View Transit 401 South "Q" Street Richmond, IN 47374 Terri Quinter Manager 765-983-7227 tquinter@richmondindiana.gov * Grant Recipient Entity Name must match name as listed in the Indiana Secretary of State business entity database 3. Delivery Address (If Ordered $1.50 /mile) Entity Name NA Address City, State ZIP Delivery Contact Phone Email 5. License & Registration (Must match FIN) Entity Name City of Richmond Address 50 North 5th Street City, State ZIP Richmond, IN 47374 4. Transit System Name if Applicable Rose View Transit 401 South "Q" Street Richmond, IN 47374 6. Title City of Richmond 50 North Sth Street Richmond, IN 47374 8. PO Issuer (see blue notes below) City of Richmond SO North Sth Street Richmond, IN 47374 Midwest Transit requires a Purchase Agreement and Price Forms that will be sent to you at time of order. The Purchase Agreement must be completed, signed and emailed back to Midwest Transit. While a formal purchase order is NOT required from you, will you also issue a formal purchase order in addition to the agreement? Yes / No: YES If yes, complete 8 above & see notes below. INDOT 5339: If a Sub -Recipient issues a purchase order on behalf of the Grant Recipient, then: 1. PO must be submitted with the signed Purchase Agreement. 2. PO must reference the Grant Recipient and the Sub -Recipient.® 3. Midwest Transit must invoice 1005/oto the Grant Recipient. Invoice will reference your PO number. 4. Your payment of 100% must reference both the Grant Recipient and Sub -Recipient names. Midwest Transit wil email you a blank ST-105 Sales Tax Exempt form at time of order. This must be completed by the Grant Recipient, signed and emailed back to Midwest Transit FIN QK589 Provide your 5 character Ford Fleet Identification Number (FIN) if known (Example XY123). Low floor minivan only recipients can ignore this. Must Match License & Registration Entity Name and Address Exactly (5. Above). If it does not match, Joe will assist you with any discrepancies. DL m m O c D r.9 r 'i AyW�I'1y F9 y!'1� Z Z Z('IOrI"1 M c �oA�c m V) y OC�Z on V J A MDoy m o z �1 7 z E ayi<m �rpaoz m D ?a zoo c) aiy`ni C) -� A �A ZDO V AI'IAyZ 610 rD'ri=�OZ 0') I 1 Ga =i (A 0C) o ixZ�-ab �AiC rirxi I m Q e mo.rz oz pD OD I (D Q O p c r p o O D Ii r D Z (n y y ov cn rC m� :A'amz y i r-�c CDi-> c, m f n O CD. A m NCO _ m ;mC� C A(n mp A m m d N C d r n O T. z m o m { CD rn .. Z m N -0 m ri O i o z c� z c m OA O I D ° Q 0 G A O X V o Zt>c O °cn O N Z N O a70Aa C 0 w z X C m f h O � O � T i w � W � i o W 1=-1 Z N ` D m O � D n Cl) rl)- Gd c T3 V m -i M purchase Order Gj InTana Department of Transportation Approved by Encamp— Leadasudp Team -2011 N # 1 CHANGE ORDER Vendor 0000056586 REMIT001 4 Ship To CITY OF C MO Q p Remit to RICHMOND, CITY OF 50 N 5TH ST RICHMOND IN 47374 CITY OF RICHMOND Bill To Vendor RICHMOND, CITY OF Name 50 N 5TH ST Address RICHMOND IN 47374 Vendor Name: Buyer Contact eMail: Phone: Order # Rate Requlred Date Page 0018808456 01/03/2018 02/02/2018 1 of 1 Requisition Number: VendorlD: 0000056586 REMIT001 Agency: 00800 Transportation Pay Terms: Invoice Due Upon Receipt Fund/Object/Center: 632101573100/ 898180 Dept Of TranspoI ii lon Multi -Modal Planning & Program 100 N SENATE AVE RM N955 INDIANAPOLIS IN 46204 F nsportation pt Of Transportation counting 100 N SENATE AVE RM N749 INDIANAPOLIS IN 46204 Name: Bennett,Jennifer-800 eMail: jbennett@indot_IN.gov Purchase Orifer Instrutaion1 omments , ' Capital Grant Award - Financial assistance for eligible capital expenses in the provision of rural public transportation for City of Richmond. 1 Federal 1.0000 EA 44,258.0000 44,258.00 1 State 1.0000 EA 5,532.0000 5,532.00 Deliveries acceptable only between 8:00 AM and 3:00 PM, Monday through Friday, excluding State Holidays. The following UN/CEFACT Unit of Measure Common Codes are used in this document: EA Each Unitsf Measdre' Handlin "Totals`:Si start This area left blank Total PO Amt. $ 49,790.00 lssued by the Indiana Department of Transportation - I catilry that the Items Rated above were received- All commodltlec appeared to conform to specifications and showed no patent datacts except as otherwise noted. Signature of State Employee Receiver Date S19ned(Month9Day1Year) 01104/2018 FUNDING ENCUMBERED BY THE AUDITOR OF STATE I �porti that there Is suffklent unencuad red balam {e in the above account to cover the ampou{nt of this order, and that funds have been set melds for payment thereof. I11IIIoil1B1I111111111111IIIoi 11g1111111111�11I88II08I451S1III11111IIIII1111IINIITIN InduanaDprtnw"atTransportation MOTOR VEHICLE(S) PURCHASE AGREEMENT - CONTINUED THIS ORDER IS A BINDING CONTRACT AND IS NON -CANCELABLE City of Richmond ACCEPTED BY GRANT RECIPIENT / PURCHASER 3o I8 0 ER SIGN RE DATE' Dave Snow PRINT NAME Mayor TITLE Midwest Transit Equipment, Inc. ACCEPTED BY 1/9/18 SELLS UTHOR PRESENTATIVE DATE Joe Kizinski PRINT NAME Regional Commercial Sales Manager TITLE Rose View Transit ACCEPTED BY SUB -RECIPIENT / OPERATOR / PURCHASER PURCHASER SIGNATURE bATE Terri Quinter PRINT NAME Manager TITLE MOTOR VEHICLE(S) PURCHASE AGREEMENT - CONTINUED MOTOR VEHICLES ADDITIONAL TERMS AND CONDITIONS As used in this order the Terms (a) "Seller" shall mean the Seller to whom this order is addressed and who shall become a party hereto by its acceptance hereof, (b) "Purchaser" shall mean the party executing this order as such on the face hereof, and (c) "Manufacturer" shall mean the corporation that manufactured the vehicle or chassis, it being understood by Purchaser and Sellpr that Seller is in no respect the agent of Manufacturer, that Seller and Purchaser are the sole parties to this order and that reference to manufacturer herein is for he purpose of explaining generally certain contractual relationships existing between Seller and Manufacturer with respect to new motor vehicles. 2. Manufacturer has reserved the right to change the design of any new motor vehicle, chassis, accessories or parts thereof at any time without notice and without obligation to make the same or any similar change upon any motor vehicle, chassis, accessories or parts thereof previously purchases by or shipped to Seller or being manufactured or sold in accordance with Seller's orders. Correspondingly, in the event of any such change by Manufacturer, Seller shall have no obligations to Purchaser to make the same or any similar change in any motor vehicle, chassis, accessories or parts thereof covered this order either before or subsequent to delivery thereof to Purchaser. Seller shall not be liable for failure to deliver or delay in delivering the motor vehicle covered by this order where such failure or delay is due, in whole or in part, to any cause beyond the control or without the fault or negligence of Seller. 4. The price for the motor vehicle specified on the face of this order includes reimbursement for Federal Excise taxes, but does not include sales taxes, use taxes or occupational taxes based on sales volume, (Federal, State, or Local) unless expressly so stated. Purchaser assumes and agrees to pay, unless prohibited by law, any such sales, use or occupational taxes imposed on or applicable to the transaction covered by this order, regardless of which party may have primary tax liability therefore. 5. FACTORY WARRANTY: ANY WARRANTY ON ANY NEW VEHICLE OR USED VEHICLE STILL SUBJECT TO A MANUFACTURER'S WARRANTY IS THAT MADE BY THE MANUFACTURER ONLY. THE SELLER HEREBY DISCLAIMS ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. USED VEHICLE WHETHER OR NOT SUBJECT TO MANUFACTURER'S WARRANTY: UNLESS A SEPARATE WRITTEN INSTRUMENT SHOWING THE TERMS OF ANY SELLER'S WARRANTY OR SERVICE CONTRACT IS FURNISHED BY SELLER TO BUYER, THIS VEHICLE IS SOLD "AS IS - NOT EXPRESSLY WARRANTED OR GUARANTEED", AND THE SELLER HEREBY DISCLAIMS ALL WARRANTIES, EITHER EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. PURCHASER SHALL NOT BE ENTITLED TO RECOVER FROM SELLER ANY CONSEQUENTIAL DAMAGES, DAMAGES TO PROPERTY, DAMAGES FOR LOSS OF USE, LOSS OF TIME, LOSS OF PROFITS, OR INCOME, OR ANY OTHER INCIDENTAL DAMAGES. The purchaser, before or at the time of delivery of the motor vehicle covered by this order will execute such forms of agreement or documents as may be required by the terms and conditions of payment indicated on the front of this order. 8. The purchaser agrees to take possession of equipment and pay for them within 35 days of delivery acceptance. Terms and conditions read, understood and agreed to by: ( o ►g ClPlfNT IGNA RE DATE Dave Snow PRINT NAME SOB -RECIPIENT SIGNATURE DATE Terri Quinter PRINT NAME Form ST-105 General Information and Instructions All four (4) sections of the ST-105 must be completed or the exemption is not valid and the seller is responsible for the collection of the Indiana sales tax. A) This section requires an identification number. In most cases this number will be an Indiana Department of Revenue issued Taxpayer Identification Number (TID# - see note below) used for Indiana sales and/or withholding tax reporting. If the purchaser is from another state and does not possess an Indiana TID#, a resident state's business license, or State issued ID# must be provided. B) Exceptions - For a purchaser not possessing either an Indiana TID# or another State ID#, the following may be used in lieu of this requirement. Federal Government — place your FID# in the State ID# space. Farmer — place your SS# or FID# in the State ID# space. Public transportation haulers operating under another motor carrier authority, or.with a contract as a school bus operator, must indicate their SS# or FID# in the State ID# space. Nonprofit Organization — must show its FID# in the State ID# space. A) Check a box to indicate if this is a single purchase or blanket exemption. B) Describe product being purchased. A) Purchaser must check the reason for exemption. B) Purchaser must be able to provide additional information if requested. A) Purchaser must sign and date the form. B) Printed name and title of signer must be shown. Note: The Indiana Taxpayer Identification Number (TID#) is a ten (10) digit number followed by a three (3) digit LOC#. The TID# is also known as the following: a) Registered Retail Merchant Certificate b) Tax Exempt Identification Number c) Sales Tax Identification Number d) Withholding Tax Identification Number The Registered Retail Merchant Certificate issued by the Indiana Department of Revenue shows the TID# (10 digits) and the LOC# (3 digits) at the top right of the certificate.