HomeMy WebLinkAboutbocc.con.131.2011 Rev. 08 -30 -11 jls
-111, COUNTY CLERK'S
CONTRACT COVERSHEET
CONTRACT #: 131 -2011
ORIGINATING DEPARTMENT: Fleet
PROCUREMENT OFFICER: James Gilliam PHONE #: - 9205765
PROJECT NAME: Tires CONTRACTOR: TDS
DOLLAR AMOUNT: $20,650.56 LINE ITEM # 505.52 00000 83753
CONTRACT EXECUTION DATE: 11/29/2011 CONTRACT END DATE:
AUTOMATIC RENEWAL: ❑ YES ® NO TERM:
❑ BOCC AGENDA ITEM (Grants, IGA) ® STAFF AUTHORIZED SIGNATURE
(Requires BOCC Signature) (Per Revised Procurement Code 7/2005)
❑ OVER $50,000 (Requires Section Leader & County Manager's Signature)
✓ CHECK PROCUREMENT TYPE:
❑ None ❑ Informal ❑ Formal ❑ Sole Source ❑ Emergency ® Outside Agency /State Bid
❑ Compliance with C.R.S. 8 -17 -5 -101, 102 as amended (Immigration Form) ❑ Exempt
❑ Contract Renewal
✓ CHECK CONTRACT TYPE: / 71-4-
❑ Services/Maintenance ❑ Employment
❑ License/Use ❑ Intergovernmental Agreement (Resolution Required)
❑ Lease ❑ Non - Profit
❑ Construction ❑ Quasi - Public (e.g. -AVH)
® Goods, Equipment, Supplies ❑ Grant Agreements (Notify Finance & Resolution Required)
❑ Other (e.g. revenue) ❑ Change Order /Contract Amendment
(C /O: 10% or $25K whichever is the lesser must have County Manager signature)
All Contracts should be proofed and all exhibits and notices must be attached for the following:
✓ ❑ No Pages Missing ✓❑ All Other Blanks Filled In
✓ ❑ If Page Left Intentionally Blank — Note on Page ✓❑ All Exhibits Attached
✓ ❑ Page numbered consecutively ✓❑ All Legal Descriptions attached (if applicable)
✓ ❑ All Original Signatures Affixed ✓❑ Notice of Award/Notice to Proceed Attached (?f applicable)
✓ ❑ All Dates Filled In ✓❑ Warranty (if applicable)
✓ ❑ Special Instructions for Finance Department: Paid by Credit Card
✓ ❑ Authorized Procurement Officer's Name: James Giliam
BY CHECKING ABOVE AND ENTERING NAME, THE AUTHORIZED STAFF PERSON INDICATES THAT
THE ATTACHED DOCUMENT HAS BEEN PROOFED AND READY FOR SCANNING.
NOTE: CLERK'S OFFICE WILL KEEP ORIGINAL DOCUMENTS IN COMPLIANCE WITH COLORADO STATE
ARCHIVES RETAINAGE SCHEDULE. ALL ATTACHMENTS MUST BE WITH THIS CHECKLIST!
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TIRE ��, r a $„ ¢,r$ qs` F,3 d :i.31f os
l GCR C ENTERS . �Lr 1"D S INVOICE DATE CUST. NO ORDER NO PAGE INVOICE NO.
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SOLD 1. 1 i '..114 t 1,11)111 a 111 „`r{' SHIP ' 1 1. €1 OHM 1 ' 11'1;
TO ,. '1(111'1 i
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'1' II, 1 111J'' '.iIT i{ 6 `Hi iI.Iblf', -_0111; V
PURCHASE ORDER NO. SALES PERSON PHONE SHIP VIA
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ITEM NO. DESCRIPTION QTY. ORDERED QTY. SHIPPED F.E.T. PRICE NET EXTENSION
d L7 .i i 1 �'' a ' 1,1,-'11W, 1
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s.: }�;� t1 f 111 I( 1I } .. 1 ! i �' 11. i1j. !�_, 7;;. , d3
!. ;! . ` l!'!!I 1,if', ( fi.iii.r, ,' ,!,iP'1; - N r. i? i ! 1.,.J,H.
Customer authorizes compa to j m the above written services to th 'r vehicle.
SEE INFORMATION T ,I�!,' REVERSE SIDE REGARDING CO ER CRE T CONTRACT AND SECURITY AGREEMENT
X NI / as
PRINT NAME / AUTHORIZED SIGNATURE
NOTE: In order to save all FINANCE CHARGES, the customer must pay, in full, the entire unpaid balance by the 10th of the following .I
110, month. FINANCE CHARGES are computed on amounts 30 days or more past due at the PERIODIC RATE of 1.5% PER MONTH a 'e j , .I { , 1 . i ,_ I f i . .; i;
(MINIMUM CHARGE OF $1.00) which is an ANNUAL PERCENTAGE RATE OF 18 %. The above credit terms have been set out
in accord with the Truth -ln- Lending requirements of the Federal Govemment and are for the customer's benefit and protection.
DELIVERY PAY FROM THIS INVOICE
PO#
Date Delivered: Disposition of Take Off Tires: 1 I Your wheel components have been inspected
Fleet Authorization # _ Ret'd w /Driver _ Ret'd w/ Dealer and it has been determined your wheel components
Credit Release # _ Ret'd to Customer Ret'd for Warranty require immediate attention.
Phone:
Customer /Fleet Acct # Tire Replacement Reason
Customer /Fleet Loc # t I A wheel assembly has been installed. Industry
guidelines require that the torque level of the
wheel nuts be rechecked between 50 and 100
Vehicle Information: For ERS Information Only: miles of operation and retorqued as necessary.
Hubometer ERS Work Order # Failure to do so may result in loss of this assembly.
Make Odometer DOT On Tires I a knowledge receipt of wheel assembly info.
Model Color DOT Off Tires o n 1
Vehicle # Lic# /State f, j�/
Trailer # Chassis # Driver Roll Time �Q/`�`
Tire/Wheel Pos: (Si ur
Container # SerialNIN# -J VIAP S C 1 11(4 i4A
(Name Printed)
is
. - --
SECURITY AGREEMENT
The buyer acknowledges receipt from GCR or TDS the merchandise shown on reverse aide. Buyer grants to the Seller
a security interest in the above merchandise until the indebtedness now or hereafter owed to seller by buyer, including
finance cha»ges, is paid in full. Until payment in full has been mado. Buyer agrees that:
( Seller shall retain title of said merchandise:
(2) Buyer will have the risk of loss or damage:
( BuyerwiU not sell, transfer possession or remove or encumber above merchandise without Seller's written
consent:
( if Buyer deftuits in the payrnent of any instaiirnent, Seiler may deciare the entire balance due and payable and
Seiler may at its option take back the merchandise or affirm the sale and hold Buyer iiabIe for the unpaid ba|anoe,
including any reasonable attorney fees or collection charges permitted by law;
( The seller shall have all the hghtu, options and duties under the Uniform Commercial Code of this state. Security
interest in the goods herein described shall terminate as the unpaid balance for them are paid.
(6) Buyer agrees that in the event that a petition in bankruptcy shall be filed by or against the buyer or the buyer shall
make an assignment for the benefit of creditors or in the event that any part of the aforesaid merchandise shall be
attached or levied upon under any legal process or taken into custody by any receiver; then in any such event at the
election of the seUer, the entire price and all sums owing by the buyer by virtue of the provision hereof shall be
forthwith due and payable in full and selier may at its option take back the merchandise or affirm the sale and hold
buyer liable for the unpaid ba|enoe, including any reasonable attorney's fees or coflection charges permitted by law.
NOTICE - ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS - AND DEFENSES
WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT
HERETO OR WiTH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED
AMOUNTS PAID BY THE DEBTOR HEREUNDER.
Thank you
For choosing GCR and TDS as your Full
}
Service Tire Dealer.
For After Hours Service: 1-800-541-TIRE (8473)
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