HomeMy WebLinkAboutbocc.con.125.2005 CHECK LIST
FOR CONTRACTS SUBMITTED TO CLERK AND RECORDER FOR
SCANNING/ARCHIVING
Originating Department/Division_.i J ~.~r~'t' ~
Contact Person~'~r~;~ll~ t~'O.S/~ ~1 ~,~ Phone #:
Project Name~~ Contract #:
BOCC AGENDA ITEM V
(BOCC signature required)
STAFF AUTHORIZED SIGNATURE
(per Revised Procurement Code7/2005)
Check Contract Type:
Services
Maintenance
License/Use
Lease
Construction
Grant Agreements (Requires BOCC Action)
__ Change Order/Contract Amendment
Other
Dollar Amount: $ ~_~Budget Line Item D~} tlO ..~1:~ I~ "~0~
Purchase
Employment
Intergovernmental Agreement (Requires BOCC Action)
Non Profit
__.Quasi-Public
Signatures Required:
Under 25K - Department Head
25,50K - Department Head (if appropriate), Section Leader
Over 50 K- Department Head (if appropriate), Section Leader, County Manager
CONTRACT
-- Contract End D~te: . _-
Term ear(s)'
Contractor/Business (Complete Name):
Contract Execution Date: ///~O././1:~
Automatic Renewal (Y/N): ' ~
All Contracts should be proofed for the following: · No Pages Missing
· If a Page is Left Intentionally Blank - Note on Page
· Page numbered consecutively
· All Signatures Affixed
· All Dates Filled In
· All Other Blanks Filled In
· All Exhibits Attached
· All Legal Descriptions Attached (if appropriate)
· Notice of Award/Proceed Attached (if appropriate)
STAFF AUTHORIZED
SIGNATURE
Sent to Clerk and Recorder for Scanning/Archiving
Date:
Signature of authorized staff person indicates that document has been proofed and ready
for scanning.
Note: Clerk's Office will keep original documents in compliance with Colorado State Archives retainage
schedule.
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Corporate Offices:
200~. Westland Road
Cheyenne, VVY 82001
307/637-6767
Fax No: 307/634-1200
BUSINESS SYSTEMS, INC.
STAFF AUTHORIZED
SIGN~
CONTRACT
PITKEN COUNTY C & R
530 EAST MAIN ST STE 101
ASPEN CO 81611
INVOICE NO
28419A 1
INVOICE DATE
11/30/05
TERMS:NET 10 DAYS
FROM INVOICE DATE
1 EA 1 I~INENOA
1 EA 1 NNBZ04
1 EA 1 NIqAN07
1 EA 1 NI~BZ05
THANK YOU FOR YOUR BUSINESS!
MINOLTA MS6000 MK II
SCAA/NER
PRODUCT# 0820-341
MK600 34014088
ZOOM LENS 9-16X
605Z/MS6000/2000/MSP2000
PRODUCT# 1360-210
FICHE CARRIER 5/NEW
N5 61028375
PRODUCT# 1357-611
ZOOM LENS 13-27X (605Z)
PRODUCT9 1360-220
GEOF LAMBERT/MI~
7,650.000 7650.00
665.000 665.00
SUBTOTAL
8,315.00
TOTAL DUE
8,315.00
CAPITAL BUSINESS SYSTEMS
PO BOX 508
CHEYENNE WY 82003-0508
COMMENTS
PITKEN COUNTY C & R
530 EAST MAIN ST STE 101
ASPEN CO 81611
PLEASE PAY FROM THIS INVOICE
OVERDUE ACCOUNTS WILL BE CHARGED A LATE
PAYMENT FEE OF 5% PER MONTH OR TO THE
EXTENT OF THE LAW
BUSINESS SYSTEMS, INC.
SALES ORDER AGREEMENT
~ level
document ~luflons
c~, sta~e, z~ coda
Telephcme Number
Req. Delivery Date
Trade-in Allowance {Make 8, Seffal Number)
SERVICE CONTRACT YES~ NO []
IZ{o- 20
~.~_! last ri.rations/Terms
SUB TOTAL
TERMS; All equik.~',ent, accessories and/or supplies indicated above are
purchased, under Capital Business Systems, [nc. standard terms.
Customer understands and hereby acknowledges that Capital Business
Systems, Inc. has not made and is not bound by any oral or writfen repm-
senta~ons made by its sales pemon which do not apFear on lhe face of
this sales order a~reement.
Agr-,==rm=,~i Approved By CBS E. xecu'~ve Officer Date Sales Representative Location
THI~ AG R EE3VIENT IS SUBJECT TO THE TERMS AND COND, ~
TIONS PRINTED ON THE REVERSE SIDE WHI~I'~y THIS REFERENCE ARE MADE A PART HEREOF.
/17
BUSINESS SYSTEMS, {NC.
Maintenance Agreement
~usinmer Name'
Mailing Address
City, State, .Zip
Telephone Number
(
Pumhase Order #
Model
Accessory
Accessory
Accessory
Make I Model
Serial #
Annual Base Rate
Dept / Floor I Room #
~-Partial Coverage
[] Full Coverage
Parts/Consumables Excluded:
s '%
Period:C°ntract ~t yr [] 2 yrs 1
[-13yrs r-]4yrs r-15yrs
i
From:
Month Day Year
Special Provisions:
Beginning Meter Reading:
Month Day
Prints/copies ind. at no charge:
Year [] Qtr/[] Yr
/
Additional prints/copies charge:
ea. Billed [] QI~ / [-I Yr
Capital Business Systems, I.nc. reserves the right to increase the cost of contract annually during the contract perio, d.
'~'"~r~'Custome~ . Title ' Date Cap,tal~r.s,nass Systems, Inc. Title Date
This is a non-cancelable contract. Customer acknowledges to have read the terms and conditions above and on the reverse s!de, and agrees to all of
these terms and conditions. Fon~ ReWsed: 12_707/01
Date of Transaction:
BUSINESS SYSTEMS, INC.
PRODUCT INSTALLATION / REMOVAL & ACCEPTANCE REPORT
/V',dC/6',f'/ZCE,~ Z~, ~ District Office: t/~,r~,~,/ L~'~,/~
CUSTOMER LOCATION
Address_
City / State / Zip
Contact
PRODUCT DELIVERED & INSTALLFr)
Model Number
Accessories
Accessories
Supplies
Supplies
PRODUCT REMOVED
Phone
S/N
S/N
Meter
Qty
Model Number
Accessories
SIN
Meter
S/N
DELIVERY & ACCEPTANCE AND/OR REMOVAL AUTHORIZFP
of the Sales A//~ment.
Signature
Print Na,.~me
Witness ~~'
(Legal Name of Firm)
(Capital Business Systems, Inc. Representative)
The customer hereby certifies that the equipment and supplies lis[ed above have been delivered and received. The
installation has been completed and the equipment is in good working order and is satisfactory and acceptable. I
hereby authorize Capital Business Systems, Inc. to commence billing in accordance with the terms and conditions
', INSTALLATION
[] REMOVAL
[] LOANER
[] TRADE-IN
Accessories S/N
Supplies Qty
Supplies Qty