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Home My Public Portal About2011.05.10 Pitney Bowes Lease Agreementmulum Pitney Bowes Engineering the flow of communication - Your Business Information WSCA Installment Option A Agreement Account # 60 CAN # ORDER # 826000223 CITY OF MC CAI L Full Legal Name of renter 216 FAST PARK STRFFT Billing Address Ceatl Dro.- er Billing Contact Name 216 F PARK Installation Address (If different from billing address) DBA Name of renter Tax ID # (FEIN/TIN) MC CAI ID 83638-3832 City �y State Zip+4 � CYTO -- 3[+.� �j ~ —['teD 15886212883 Billing Contact Phone # Billing CAN # MC CALL JD 83638-3832 City State Zip+4 - 3(1-1{�79 Installation Contact Name Installation Contact Phone # 15473280889 Installation CAN # Credit Card # Name on Card Exp Date Type of Card Tax Exempt # Your Business Needs State Tax (if applicable) Fiscal Period (from - to) Qty 1 Business Solution Description Mail Stream Solution - 4 DM300C Digital Meter System 1 IntelliLink Interface / PSD for DM300C/ DM400C/DM450C 1 Accounting (50 Dept) Software 1 10 lb Integrated Weighing 1 Integrated Weighing Platform 1 IntelliLink Subscription Your Payment Plan Number of months Check items to be included in customer's payment ip Equipment Maintenance (1st year included) Provides service coverage including certain parts and labor Software Maintenance (1st year included) Provides revision updates and technical assistance x❑ Soft -Guard® Subscription Provides postal and tamer updates If you do not elect to include soft -Guard® protection with your lease. you will automatically receive updates at the then -current rates IntelliLinkT l Subscription/Meter Rental Provides simplified billing and includes ( )resets per year ( ) Confirmation Services ( ) Purchase Power Electronic access to postal confirmation service Receive an Invoice for postage.consolidaled blpry and enhanced management reporting Information. Monthly amount First 60 $100.12 Your Acknowledgement ( ) Required advance check of $ ( ) Tax Exempt certificate attached Initial rental term received By your signature below, you are entering into an Installment Lease Agreement pursuant to your Participating Addendum to the WSCA Contract # EPS050076-A2-2. The Terms and Conditions of such WSCA Installment Lease Agreement Option A govern this transaction. Signature Donald C Bailey`/ Print Name Laurie Cingari Date Mayor Title Email Address 473 Account Rep District Office PBGFS Acceptance WSCA OPTION A Form (Rev-04/08) Page 1 Equipment Vendor: Pilney Bowes See 6dditronel pages for terns and conditions For Sa/es and Semites car! 1-800-322-8000 Form 8038-GC Information Return for Small Tax -Exempt Government Bond Issues, Leases, and Installment Sales OMB NO. 1545-0720 (Rev- May 2009) Department of the Treasury Internal Revenue Service ► Under Internal Revenue Code section 149(e) Caution: If the issue price of the issue $100,000 or more. use Form 8038-G Part I Reporting Authority 1. Issuers name CITY OF MC CALL 3 Number and street (or P.O. Box if mail is not delivered to street address) 216 E PARK Check box if Amended 2 issuer's employer identification number R 2(000 3 Room/Suite 4. City. town. or post office. state, and ZIP code MC CAI L ID 83638-3832 6. Name and title of office or legal representative whom the IRS may call for more information 5 Report number (For IRS Use Only) 7. Telephone number of officer or legal representative liMiDescription of Obligations Check if reporting: a single issue ❑x or a consolidated return ❑ 8a. Issue price of obligation(s) (see instructions) b. Issue date (single issue) or calendar year (consolidated) Enter date in mm/dd/yyyy format (for example, 01/01/2009) (see instructions) ► // 9. Amount of the reported obligation(s) on line 8a that is: a. For leases for Vehicles b. For leases for office equipment c. For leases for real property d. For leases for other (see instructions) ... . e For bank loans for vehicles f. For bank loans for office equipment g. For bank loans for real property h. For Bank loans for other (see Instructions) I. Used to refund prior issue(s) j. Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) k Other 8a _ 9a 9b 9c 9d 9e 9f 9g 9h 9i 9j 9k 10. If the issuer has designated any issue under section 265(b)(3)(B)(i)(III), (small issuer exceptions) , check this box 11. If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) 12. Vendor's or bank's name PITNEY BOWES INC ► ❑ 13. Vendor's or bank's employer identification number- 06-0495050 Sign Here Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. • k Issuer's authorized representative Date Type or print name and title Paid Preparer's Use Only Preparers ' signature Date Check if ❑ Preparers SSN or PT IN Self-employed Firm-s name (or PO' if self-employed). address and ZIP code EIN Phone no. ( ) General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form Form 8038-GC is used by issuers of tax-exempt government obligations to provide the IRS with the information required by section 149(e) and to monitor the requirements of sections 141 through 150. Who Must File Issuers of tax exempt governmental obligations with issue prices of less than $100,000 must file Form 8038-GC. Issuers of tax exempt governmental obligation with an issue price of $100.000 or more must file Form 8038-G. Information Return for Tax -Exempt Governmental Obligations. Filing a separate return for a single issue. Issuers have the option to file a separate Form 8038-GC for any tax-exempt governmental obligation with an issue price of less than $100,000. An issuer of a tax exempt bond used to finance construction expenditures must file a separate Form 8038-GC for each issue to give notice to the IRS that an election was made to pay a penalty in lieu of arbitrage rebate (see the line 11 instructions). Filing a consolidated retum for multiple issues. For all tax-exempt governmental obligations with issue prices of less than $100,000 that are not reported on a separate Form 8038-GC. an issuer must file a consolidated information return including all such issues issued within the calendar year. Thus. an issuer may file a separate Form 8038-GC for each of a number of small issues and report the remainder of small issues issued during the calendar year on one consolidated Form 8038-GC. However a separate Form 8038-GC must be filed to give the IRS notice of the election to pay a penalty in lieu of arbitrage rebate. When To File To file a separate return for a single issue. file Form 8038-GC on or before the 15 h day of the second calendar month after the close of the calendar quarter in which the issue is issued. To file a consolidated return for multiple issues. file Form 8038-GC on or before February 15'h of the calendar year following the year in which the issue is issued. Late filing. An issuer may be granted an extension of time to file Form 8038-GC under Section 3 of Rev. Proc. 2002-48, 2002-2 C.B. 531. if it is determined that the failure to file on time is not due to willful neglect, Type or print at the top of the form. "Requested for Relief under Section 3 of Rev. Proc. 2002-48." Attach fo the Form 8038-GC a letter briefly stating why the form is not submitted to the IRS on time. Also indicate whether the obligation in question is under examination by the IRS. Do not submit copies of any bond documents, leases, or installment sale documents. See Where To File below. Where To File File Form 8038-GC. and any attachments. with the Department of the Treasury. Internal Revenue Service Center. Ogden. UT 84201. Other Forms That May Be Required For rebating arbitrage (or paying a penalty in lieu of arbitrage rebate) to the Federal Government, use Form 8038-T. Arbitrage Rebate. Yield Reduction and Penalty in Lieu of Arbitrage Rebate. For private activity bonds, use Form 8038. Information Return for Tax -Exempt Private Activity Bond Issues. Form 8038-GC Receipt Acknowledgement If you wish to request an acknowledgement receipt of this return by the IRS you must provide the following. Cat. No. 641088 • Form 8038-GC (rev.5-2009) WELTR6 12212006 "4-1P, Pitney Bowes - DONALD BAILEY Date: May 12, 2011 CITY OF MC CALL 216 EAST PARK STREET Rental Account No: 8736861 403 MC CALL ID 83638-3832 Thank you for your order and the opportunity to serve your company. Pitney Bowes and Pitney Bowes Global Financial Services LLC (PBGFS) are dedicated to your total satisfaction and are committed to providing you with the finest products, backed by the highest quality care and service. PBGFS is pleased to acknowledge acceptance of your offer to utilize our Term Rental Agreement program for your Pitney Bowes Equipment needs. If you would like a copy of the fully executed agreement, including a duplicate set of terms and conditions, please call 800-288-2357 . To expedite the process, please have your Customer Account Number listed at the top of this letter available. Shortly, you will receive your first invoice. Our records show that you agreed to the payment schedule (which includes the deferred interest), shown below. Please review this information at your earliest convenience and contact us at 1-800-288-2357, if you have any questions. Equipment Description: MAILING SYSTEM Equipment Location: 216 E PARK MC CALL ID 83638 Deferred Interest: $452.20 Payments Frequency Total Payment * First 20 Quarterly $300.36 * plus applicable sales and use taxes. Please note that your invoices will be sent to the mailing address of this letter. Return all remittances to: Pitney Bowes, P. O. Box 371887, Pittsburgh, PA 15250-7887. Our office hours are 8:00 a.m. to 6:00 p.m. Eastern Time. If you have any questions or comments, please call us at 1-800-288-2357. Sincerely, Richard Gabris Government Operations Manager 27 Waterview Dr. Shelton Connecticut 06484-4361 800-288-2357