HomeMy WebLinkAboutIT11-105 - Supplement - ABS Finance - Copier Leases - 1 for the RFA - 07/08/2011 Records Management
ZKENO F Document
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CONTRACT ASNINCTON
CONTRACT COVER SHEET
This is to be completed by the Contract Manager prior to submission
to City Clerks Office. All portions are to be completed.
If you have questions, please contact City Clerk's Office.
Vendor Name: �SSaC <<,�Q� �� ����� �rsrnI=!;
Vendor Number: y(Qn r
ID Edwards Number
Contract Number: 105�
This Is assigned by City Clerk's Office Project Name: cO ter, p���� — r 1\ E A
I
Description: ❑ Interlocal Agreement ❑ Change Order [] Amendment P Contract
❑ Other:
Contract Effective Date: `7 OQ, 1 Termination Date: Ll p
Contract Renewal Notice (Days): tv I Q j
Number of days required notice for termination or renewal or amendment
Contract Manager: -HQ, Department: S,T
Detail: (i.e. address, location, parcel number, tax id, etc.):
S:Publlc\RecordsManagement\Forms\ContractCover\adcc7832 11/08
ABSVkc4gl ($41665 MUNICIPAL LEASE Po�Qy315 APPLICATION NO CONTRACT NO
(',
PURCHASE AGREEMENT
This document is written in "Plain English" The words you and your refer to the customer The words Lessor,we, us and our refer to ABS
Finance. Every attempt has been made to eliminate confusing language and create a simple,easy-to-read document
CUSTOMERa - •
FULL LEGAL NAME STREETADDRESS
KENT, CITY OF 220 4TH AVENUE
CITY STATE ZIP PHONE FAX
KENT WA 98032 J 3 5' ru s(r Li m co �2 S 3-< i S Lo 9 l o
FEDERAL TAX I D# E-MAIL ADDRESS
c\cwciiii�eCC-0 Qr, 1;eri� .lit cc, etS
DESCRIPTIONITEM •♦ NO. SERIAL NO.
RICOH MPC4501A
-;;k +4ua5 ti(� nua
❑Seethe attached Schedule"A" ❑See the attached Pool Billing Schedule ❑See the attached Grouped Pool Billing Schedule
AMOUNTLEASE TERMS LEASE PAYMENT -•
Term in Months 21 Payments of$ 49740
21 (Plus Applicable Taxes) 0
mos Lease Payment Period is Monthly Unless Otherwise Indicated (PlusApphcable Taxes)
THIS IS A NONCANCELABLE/IRREVOCABLE AGREEMENT,THIS AGREEMENT CANNOT BE CANCELED OR TERMINATED.
TERMS ♦ CONDITIONS
We hereby rent to You the personal property(the°Egwpmeni)described above on any attached Exhlbd A Orin any subsequent schedules which may hereinafter be made a part hereof upon the following terms and conditions
1 TERM AND RENT Tha term of and the rental amount(Rental Amount]due under this Municipal Lease Purchase Agreement(Agreeme r)shall beg n on the Acceptance Date noted below or as specs fled on an attached Property
Acceptance Certificate(Exhibit C)and,corvine for We term set above unless earlier terminated per paragraph 18 and end on the date all payments on Exhibit B or In any subsequent schedules which may hereafter be made a part
hereof have been made This Agreement will be deemed automatically renewed by You each year(Your fiscal year)unless earlier terminated by You due to non appropriation as provided In Paragraph 18 herein
The Rental Amount Includes specified amounts of pnnclpal and interest due on a specific date Upon full payment by You of the entire Rental Amount including interest due on this Agreement the security merest held by Us and Our
successors or assigns shall be released If any payment(or portion thereop Is not paid when due it will incur a monthly late charge of 1 5%of Na payment amount or the maximum amount peal by law whichever Is less You
covenant to pay all Renta'Amounts when due,and to perform all other covenants contained In this Agreement Rental payment obligations are absolute and unconditional and are net subject to cancellation,reduction,setoff or
counterclaim except as provided in Paragraph 18 herein
2 COVENA14TS OF LESSEE You warrant and rewesenl as follows; (a)You are a body pored and he,e solution,euthonty to enter Imo this transaclon and carry out its obligahons (b)You have authorized the execution of Ibis
Agreement by Your appropriate officials,(c)You have In accordance with life requirements of lave fully budgeted and appropriated sufficient unexhausted and unencumbered finds for the anent budget yearareJ to meet Your other
obligations under this Rental for the anent budget year,and those funds have not been expended for other purposes (d)the Equipment is essential to Your proper efficient,economic and continuing operation and well be used for
Your general business,(e)You have never felled to appropriate or otherwise make available funds sufficient to pay rental or other payments coming due order any rental pu,chase installment sale or other slmllaragreement If)You
warrant this Rental as a'bark qualified tax-exempt obligation'as defined in Secticr 255lby3)(B)of the Intemal Revenue Code and represent that the aggfega a face amount of all tax exempt obligations(e ockding privates iiy bonds
other than qualified 501(C)(3)bonds)issued or to be issued by You and Your subord la'ad entities owning the calendar year in which We fund this Rental is not ressonably expected to exceed$10000000,and(g)You and oil of Your
subordinate entities will not Issue In excess of S10 000,000 of qualified tax-exempt obliga Ions(including this Rental but excluding private activity tends other than qualified 501(C)(3)bands)during the calendaryear in which We fund
Rental without first obtaining an opinion of national recognized counsel In the area of tax exempt municipal obligations acceptable to Us that the designation of this Rental as a'bank qualified tax exempt obligation'will not be
a set affected
Yourinftfais (Conanuedoei the reverse side)
LESSOR ACCEPTANCE
ABS Finance
DATED LESSOR SIGNATURE A TITLE
CUSTOMER
r /1
�' KENT, CITY OF ( ) t
DA%ED CUSTOMER SIGNATURE TITLE
..s
I PRINT N E
1X_
DATED CUSTOMER SIGNATURE TITLE
PRINT NAME
ACCEPTANCE OF
You certify that all the equipment listed above has been furnished that delivery and mat dratmn has been fully completed and saLsfactory Fuller, If conditions and terms of this Agreement have been reviewed arrd acknowledged
Upon your signing below your promises herein wdl be Irrevocable and unconditional in all respects axe t as romded herein Your approval as irdicaled below fire
is a condition precedent to e effectiveness of this Agreement
KENT, CITY OF )C
DATEOFDELNERY CUSTOMER SIGNATURE TITLE
i
3 TITLE Title to the Equipment shall pass to You upon acceptance of delivery conditioned upon Your complete and full performance of Your undertakings as provided in this Agreement and also conditional upon
full payment by You of the entire Lease Amount including interest due on this Agreement Upon Your full performance,we will release our interest in the equipment for the nominal price of$1 00
4 EQUIPMENT INSPECTION LIENS PERSONAL PROPERTY and TITLE You have fully inspeOled and acknowledged that the Equipment is in good condition and repair,and that You are satisfied with and have
accepted the Equipment in such condition You will not create or assume any mortgage pledge ben encumbrance or claim on the Equipment and will,at Your awn expense,discharge any such claim The
Equipment is,and will at all times during the Agreement Term remain,personal property Title to the Equipment has been conveyed to You during the lease term in return for periodic payments,subject to the terms
and conditions herein
5 SECURITY INTEREST To secure payments and observance by You of the covenants expressed or implied herein,You grant a security interest in and a lien on the equipment to Us,our successors and assigns
6 USE AND MAINTENANCE You will use the Equipment in a careful and proper manner,in compliance with all applicable laws and regulations Equipment is to be used by You exclusively and not subleased,
loaned or otherwise used by entilies other than You At Your sole expense and cost,You will maintain the Equipment in good repair,condition and working order and in compliance with manufacturer's suggested
maintenance and so as to maintain manufacturer s and for suppliers warranties
7 DAMAGE OR DESTRUCTION OF EQUIPMENT You hereby assume and bear the entire risk of loss of and damage to the Equipment,whether or not insured from any and every cause whatsoever No loss or
damage to the Equipment or any pad thereof shall impart any of Your obligation under this Agreement,which shall continue in full force and effect If the Equipment is partially lost stolen,damaged or destroyed,
You will promptly repair and restore it to working order If net insurance proceeds(including proceeds of self-insurarce)are not sufficient to pay for repairs,You will nevertheless complete the work and pay the
costs You are not entitled to reimbursement onto any reduction of the payments or other amounts payable pursuant this Agreement If the Equipment is totally lost stolen damaged or destroyed,You shall pay to
Us or Our assignee a sum equal to the applicable remaining`Principal Balance'plus interest as stated on Exhibit B,if paid later than as regularly scheduled
6 DISCLAIMER OF WARRANTIES WE MAKE NO WARRANTY EXPRESS OR IMPLIED,INCLUDING THAT THE EQUIPMENT IS FIT FOR A PARTICULAR PURPOSE OR THAT THE EQUIPMENT IS
MERCHANTABLE YOU AGREE THAT YOU HAVE SELECTED THE SUPPLIER AND EACH ITEM OF EQUIPMENT BASED UPON YOUR JUDGEMENT AND DISCLAIM ANY RELIANCE UPON ANY
STATEMENTS OR REPRESENTATIONS MADE BY US OR ANY SUPPLIER WE DO NOT TAKE RESPONSIBILITY FOR THE INSTALLATION OR PERFORMANCE OF THE EQUIPMENT THE SUPPLIER
IS NOT AN AGENT OF OURS AND NOTHING THE SUPPLIER STATES CAN AFFECT YOUR OBLIGATION UNDER THE LEASE YOU WILL CONTINUE TO MAKE ALL PAYMENTS UNDER THIS
AGREEMENT REGARDLESS OF ANY CLAIM OR COMPLAINT AGAINST SUPPLIER
9 INSURANCE During the term of this Agreement,You will keep the Equipment Insured against all risks of loss or damage in an amount not less than the replacement cost of the Equipment,without deductible and
without co-insurance We will be the sole named loss payee on the property insurance We will be named as additional insured on public liability coverage You will pay all premiums for such insurance and must
deliver proof of insurance coverage satisfactory to Us If You do not provde such proof of such insurance before the Agreement commences You agree that We have the right,but not the obligation to enroll you to
our property damage coverage program and bill You a monthly property damage surcharge of up to 0035 of the total stream of payments to in part cover Our Increased administrative costs credit risk and other
costs and on which We may make a profit Nothing in this paragraph will relieve You of the obligation to provide public liability coverage
10 SURRENDER OF EQUIPMENT Upon termination of Ihts Agreement due to default or non-appropnatwns,You shall return the Equipment to Us in good repair,condition and working order,ordinary wear and
tear resulting from proper use thereof alone excepted and have been maintained in accordance with Paragraph 6 In the event of early termination of this Agreement,You will re-urn the Equipment In a condition
that permits Us to be eligible for the manufacturer's or suppliers standard maintenance contract without Incurring any expense to repair or rehabilitate such Equipment You will transfer ownership and title to the
Equipment to Us and guarantee and indemnify clear title You at your own expense,shall deliver the Equipment to such place as specified by Us
11 TAX INDEMNIFICATION It You lose Your eligibility for the"Small Issuer Exemption"during the calendar year a this transaction is deemed by any taxing authority not to be tax exempt from federal and/er state
income taxation,You agree the Implicit interest rate and corresponding monthly Interest payment in Exhibit B will be Increased to preseve Our engmal y anticipated yield
12 TAXES Unless You have provided Us with evidence of an exemption,You agree to pay any license or registration fees,gross receipts,taxes,assessments charges and sales use property,excise and other
taxes imposed by any governmental agency upon the Equipment Any fees,taxes or other lawful charges paid by Us or Our assigns for You shall become Immediately due from You to Us or Our assignee including
any transfer and taxes pursuant to Paragraph 11
13 EVENTS OF DEFAULT The default by You under any term,covenant or condition contained herein which is not cured within ten days after written notice(hereof from Us,shall,at Our option,terminate this
Agreement and Your right to possess on of the Equipment
14 REMEDIES ON DEFAULT Upon termination of this Agreement,We may without notice to or demand upon You,except as stipulated In paragraph 18 pursue one or more of(he following remedies(a)Take any
necessary or desirable action to collect all payments due under this Agreement,or to enforce performance of any obligation,agreement or covenant of You under this Agreement,including payment of any amounts
which You fad to pay(such as insurance premiums costs or repairs,taxes) We and Our assigns will also be entitled to recover all costs and expenses including attorney's fees incurred in connection with the
enforcement of any of Our or Our assigns rights or remedies against You (b)To sue for and recover all rents,and other payments,then accrued or thereafter accruing,with respect to any or all items of
equipment(c)To take possession of any or all items of equipment,wherever same may be located,without any court order or other process of law You hereby waive any and all damages occasioned by such
taking of possession Any said taking of possession shall not constitute a termination of this Agreement as to any or all items of equipment unless We expressly notify You in writing(d)To terminate this Agreement
as to any or all items of equipment(e)To pursce any ether remedy at law or in equity Nohwlhstarding any said repossession,or any other action which We may take You shall be and remain liable for the full
performance of all obligations on the part of You to be performed under this lease All such remedies are cumulative,and maybe exercised concurrently or separately
15 CONCURRENT REMEDIES No right or remedy of Ours Is exclusive of any other right or remedy Each Is cumulative of every other right or remedy given,or now hereafter exislsg al law,and maybe enforced
concurrently,separately or in sequence
16 ASSIGNMENT You agree not to sell,assign,lease,sublease,pledge or allow any lien or encumbrance against any interest in this Agreement or the Equipment without Our prior written consent which will be
withheld if(1)it would eliminate or decrease Our tax exempt yield or,(2)it would,in Our sole judgment diminish the prospects for repayment- You agree that We may assign,in whale or In part Our right,title and
interest in this Agreement or the Equipment to one or more third parties and shall be free of all defenses,set offs or counterclaims of any kind which You may be entitled to assert against Us Any such assignee will
have Our rights under the Agreement but not the obligations Any assignee of Us may reassign its Interest in this Agreement and for the Equipment to any other person who thereupon shall be deemed to be Our
assignee
17 UNIFORM COMMERCIAL CODE You acknowledge that this Agreement secures a purchase money secuny interest in such equipment as set forth and enforceable under the Uniform Commercial code,and
authorizes Us at Our option to g)file one or more financing statements signed only by Us or(a)rile a copy of this Agreement with the appropriate state and local authorities at any time as We shall deem necessary
to fully protect the security interest herein granted to it by You and charge you a fee of$3500 You hereby authorize Us as secured party of its agent or assignee to sign and execute on its behalf any and all
necessary UCC-1 forms to perfect the purchase money security interest herein granted to secured party Any fee charged under this Agreement may include a profit
16 NONAPPROPRIATION You may terminate this Agreement at the end of any fiscal year if the following events shall have occurred
(a)In the event funds are not budgeted and appropriated in any fiscal year for Lease Payments due under this Agreement for the succeeding fiscal year or for the acquisition Of services,equipment or functions
which in whole or In part are essentially the same as those being leased hereunder,this Agreement shall impose no obligation on You as to such succeeding fiscal year and shall become null and void except as to
the Lease Payments herein agreed upon for which funds will have been appropriated and budgeted,and no right of action or damage shall accrue to Our benefit,Our successors and assigns for any further
payments
(b)If the provisions of Section(a)are utilized by You,You agree to immediately notify Us or Our assignee of this Agreement that funds are not budgeted and appropriated,and to peaceably surrender possession of
the equipment to Us or Our assignee
(c)You made all payments due during the fiscal period immediately preceding the fiscal period for which sufficient funds were not appropriated
(d)Any early termination due to ruin-appropriation must be at the end of Your then-current fiscal year
\ .S
19 CHOICE OF LAW,JURY TRIAL WAIVER This Lease will be governed and construed In a ce the laws of the state whom ou are located To the extent permitted by law.You agree to waive Your
rights to a trial by jury
t _
ti
'1 C O
AT CUSTO R SIGNATURE TITLE
24678-07/09/2008
e
embank. APPLICATION NO CONTRACT NO
Fne w'j'amd L- Exhibit `B" 1493812
PAYMENT ANDAMORTIZATION TABLE
Payment# Principal Interest Payment Balance
Beginning Balance 9,62089
1 42429 7311 49740 9,196 60
2 42751 6989 49740 8,76909
3 43076 6664 49740 8,33833
4 43404 6336 49740 7,90429
5 43733 6007 49740 7,46696
6 44066 5674 49740 7,02630
7 44401 5339 49740 6,58229
8 44738 5002 49740 6,13491
9 45078 4662 49740 5,684 13
10 45421 4319 49740 5,22992
11 45766 3974 49740 4,77226 V
12 461 13 3627 49740 4,311 13
13 46464 3276 49740 3,84649
14 46817 2923 49740 3,37832
15 471 73 2567 49740 2,90659
16 47531 2209 49740 2,431 28
17 47892 1848 49740 1,95236
18 48256 1484 49740 1,46980 I
19 48623 11 17 49740 98357
20 48993 747 49740 49364
21 49364 376 49740 000
a
F
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i
I
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This Exhibit W is hereby verified as correct by the undersigned,who acknowledges receipt of a copy
Customer City of Kent Signature X Title
l
Form 8038'GC
Information Return for Small Tax-Exempt `
(Rev May2009) Governmental Bond Issues, Leases, and Installment Sales OMB No 1545-0720
► Under Internal Revenue Code section 149(e)
Department of the Treasury
Internal Revenue service Caution:If the issue price of the issue is$100,000 or more, use Form 8038-G
Reporting Authority Check box if Amended Return ► ❑
1 Issuer's name 2 Issuer's employer identification number
Kent, City of 91 6001254
3 Number and street(or P O box if mail is not delivered to street address) Room/suite
220 4th Avenue South
4 City,town,or post office,state,and ZIP code 6 Report number(For IRS Use Only)
Kent,WA 09-32 5
6 Name and title of officer or legal representative whom the IRS may call for more information 7 Telephone number of officer or legal representative
Dea Drake, Multimedia Manager ( 253 1 856-4646
Description of Obligations Check one: a single issue ❑✓ or a consolidated return ❑ .
8a Issue price of obligation(s) (see instructions) 8a $9,620 89
b Issue date(single issue)or calendar date (consolidated). Enter date in mm/dd/yyyy format
(for example, 01/01/2009) (see instructions) ► TBD
9 Amount of the reported obligation(s) on line 8a that is:
a For leases for vehicles 9a
b For leases for office equipment . . . . . . . . . . . . . . . . . . 9b $9,620 89
c For leases for real property . . . . . . . . . . . 90
d For leases for other (see instructions) . . . . . . . . 9d
e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . 9e
f For bank loans for office equipment . . . . . . . . . . . . . . . . . 9f
g For bank loans for real property . . . . . . . . . . . . . . . . . . . 9
In For bank loans for other (see instructions) . . . . . . . . . . . . . 911
i Used to refund prior issue(s) . . . . . . . . . . . . . . . . . 91
j Representing a loan from the proceeds of another tax-exempt obligation (for example, bond bank) 9t
k Other 9k
10 If the issuer has designated any issue under section 265(b)(3)(B)(t)(III) (small issuer exception), 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: ------------------------------------- ------------------------------------------------------------------------
13 Vendor's or bank's employer identification number' I
Under peri of perjury,I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Sign and belief,they are true,correct,and complete
Here / Robert Nachlinger, Finance Director
Issuer's authorized representative Date Type or print name and title
Paid Preparer's , Check if Preparer's SSN or PTIN
Date
signature 7 self-employed ❑
Preparer's Firm's name(or EIN
Use Onlyyours if self-employed),
address,and ZIP code Phone m ( )
an election was made to pay a penalty in lieu of Proc 2002-48,2002-2 C B 531,if it is determined
General Instructions
arbitrage rebate(see the line 11 instructions) that the failure to file on time is not due to willful
Section references are to the Internal Revenue Code Filing a consolidated return for multiple issues. neglect Type or print at the top of the form;'Request
unless otherwise noted For all tax-exempt governmental obligations with for Relief under Section 3 of Rev Proc 2002-48'
issue prices of mess than nment l that are not Attach to the Form 8038-GC a letter briefly stating
Purpose of Form reported on a separate Form$100,000 that re issuer why the form was not submitted to the IRS on time
Also indicate whether the obligation in question
Form 8038-GC is used by the Issuers of tax-exempt must file a consolidated information return including
governmental obligations to provide the IRS with the all such issues issued within the calendar year under examination by the IRS Do not submit copies
of any bond documents,leases,
information required by section 149(e)and to monitor installment sale
the requirements of sections 141 through 150 Thus,an issuer may file a separate Form o38-GC documents See Where To File below
for each of a number of small issues and report the
Who Must File remainder of small issues issued during the calendar
year on one consolidated Form 8033-GC However, Where To File
Issuers of tax-exempt governmental obligations with a separate Form 8038-GC must be filed to give the File Form 8038-GC,and any attachments,with the
issue prices of less than$100,000 must file Form IRS notice of the election to pay a penalty in lieu of Department of the Treasury,Internal Revenue service
8038-GC arbitrage rebate Center,Ogden,UT 84201
Issuers of a tax-exempt governmental obligation
with an issue price of$100,000 or more must file When To File Other Forms That May Be Required
Form 8038-G,Information Return for Tax-Exempt To file a separate return for a single issue,file Form For rebating arbitrage(or paying a penalty in lieu of
Governmental Obligations 8038-GC on or before the 15th day of the second arbitrage rebate)to the Federal Government,use
Filing a separate return for a single issue.Issuers calendar month after the close of the calendar Form 8038-T,Arbitrage Rebate,Yield Reduction and
have the option to file a separate Form 8038-GC for quarter in which the issue is issued Penalty in Lieu of Arbitrage Rebate For private
any tax-exempt governmental obligation with an To file a consolidated return for multiple issues, activity bonds,use Form 8038,Information Return for
issue price of less than$100,000 file Form 8038-GC on or before February 151h of the Tax-Exempt Private Activity Bond Issues
An issuer of a tax-exempt bond used to finance calendar year following the year in which the issue is Form 8038-GC Receipt
construction expenditures must file a separate Form Issued Acknowledgement
6038-GC for each issue to give notice to the IRS that Late filing An issuer may be granted an extension of If you wish to request an acknowledgement receipt of
time to file Form 8038-GC under Section 3 of Rev this return by the IRS you must provide the following
Cat No 64108E Form 8038-GC (Rev 5-2009)
Form 8038-GC(Rev 5-2009) Page 2
• A cover letter specifically requesting the Specific Instructions apply to a particular obligation For example,report
acknowledgement of this return on Imes 91 and 91 obligations used to refund prior
• A copy(or copies,if multiple acknowledgements In general,a Form 8038-GC must be completed on issues which represent loans from the proceeds of
are requested)of the return being filed,with the basis of available information and reasonable another tax-exempt obligation
"Acknowledgement Copy"written across the top of expectations as of the date of issue However,forms Line 9k Enter on line 91k the amount on line 8a that
the first page of each copy For multiple requests, that are filed on a consolidated basis may be does not represent an obligation described on lines
the copies must be stapled together completed on the basis of information readily 9a through 9j
e A self-addressed stamped envelope for each available to the issuer at the close of the calendar
P p year to which the farm relates,supplemented by Line 10 Check this box if the Issuer has designated
acknowledgement receipt recipient estimates made in good faith any issue as a"small issuer exception"under
Rounding to Whole Dollars Pali I—Reporting Authority section 265(b)(3)(B)(i)(III)
You may show the money items on this return as Line l l Check this box if the issue is a construction
whole-dollar amounts To do so,drop any amount Amended return.An Issuer may file an amended issue and an Irrevocable election to pay a penalty in
less than 50 cents and increase any amount from 50 return to change or add to the Information reported lieu of arbitrage rebate has been made on or before
to 99 cents to the next higher dollar on a previously filed return for the same date of the date the bonds were issued The penalty is
issue If you are filing to correct errors or change a payable with a Form 8038-T for each 6-month period
Definitions previously filed return,check the"Amended Return" after the date the bonds are issued Do not make
Obligations This refers to a single tax-exempt box in the heading of the form any payment of penalty in lieu of rebate with Form
governmental obligation if Form 8038-GC is used for The amended return must provide all the 8038-GC See Rev Proc 92-22,1992-1 C B 736,
separate reporting or to multiple tax-exempt information reported on the original return,in for rules regarding the"election document"
governmental obligations if the form is used for addition to the new corrected Information Attach an Line 12 Enter the name of the vendor or bank who
consolidated reporting explanation of the reason for the amended return is a party to the installment purchase agreement, e
Tax-exempt obligation.This is a bond,installment Line 1 The issuer's name is the name of the entity loan,or financial lease If there are multiple issuers or
purchase agreement,or financial lease,on which the issuing the obligations,not the name of the entity banks,issuers should attach a schedule
Interest is excluded from income under section 103 receiving the benefit of the financing In the case of a Line 13 Enter the employer identification number of
Private activity bond.This includes an obligation lease or installment sale,the issuer is the lessee or the vendor or bank who is a party to the installment
issued as part of an issue in which purchaser purchase agreement,loan,or financial lease If there
• More than 10%of the proceeds are to be used for Line 2.An issuer that does not have an employer are multiple issuers or banks,issuers should attach a
any private activity business use,and identification number(EIN)should apply for one on schedule
• More than 10%of the payment of principal or Form SS-4,Application for Employer Identification Signature
Interest or the issue is either(a)secured by an Number You can get this form on the IRS websde at g
interest in property to be used for a private business www us gov or by calling 1-800-TAX-FORM An authorized representative of the Issuer must sign
use(or payments for such property)or(b)to be (1-800-829-3676) You may receive an EIN by Form 8038-GC and any applicable certification Also
derived from payments for property(or borrowed telephone by following the instructions for Form SS-4 print the name and title of the person signing Form ,
money)used for a private business use Lines 3 and 4 Enter the issuer's address If the B038-GC $
It also Includes a bond,the proceeds of which(a) issuer receives its mad in care of a third party Paid Preparer
are to be used to make or finance loans(other than authorized representative(such as an accountant or If an authorized representative of the issuer filled in
loans described in section 141(c)(2))to persons other attorney) enter on the street address line"C/O" its return,the paid preparer's space should remain
than governmental units and b exceeds the lesser followed by the third party's name and street
o ( ) address or P O box Include the suite,room,or other blank Anyone who prepares the return but does not
of 5/0 of the proceeds or$5 million unit number after the street address If the post office charge the organization should not sign the return
Issue Generally,obligations are treated as part of does not deliver mad to the street address and the Certain others who prepare the return should not
the same issue only if they are issued by the same sign For example,a regular,full-time employee of
issuer,on the same date,and as part of a single Issuer has a P O box,show the box number instead the issuer,such as a clerk,secretary,etc,should
transaction,or a series of related transactions of the street address If a change in address occurs not sign
However,obligations issued duringthe same after the return is flied,use Farm ewa,Change of
calendar year(a under a loan agreement under Address,to notify trio IRS of the new address Generally,anyone who o pad to prepare a return
Y O 9 must sign It and till In the other blanks in the paid
which amounts are to be advanced periodically(a Line 5 This line Is for IRS use only Do not make preparer's Use Only area of the return
"draw-down loan")or(b)with a term not exceeding any entries in this box The paid preparer must
270 days,may be treated as part of the same issue if
the obligations are equally and ratably secured Part II—Description of Obligations • Sign the return In the space provided for the
under a single indenture or loan agreement and are Check the appropriate box designating this as a preparer's signature,
issued under a common financing arrangement(for return on a single issue basis or a consolidated return • Enter the preparer information,and
example,under the same official statement basis a Give a copy of the return to the issuer
periodically updated to reflect changing factual Line Be.The issue price of obligations is generally
circumstances) Also,for obligations issued under a determined under Regulations section 1 148-1(b) b
draw-down loan that meets the requirements of the Paperwork Reduction Act Notice
Thus,when issued for cash,the issue pace Is the
preceding sentence,obligations issued during price at which a substantial amount of the obligations We ask for the information on this form to carry out
different calendar years may be treated as part of are sold to the public To determine the issue price of the Internal Revenue laws of the United States You
the same issue if all of the amounts to be advanced an obligation issued for property,see sections 1273 are required to give us the information We need it to r
under the draw-down loan are reasonably expected and 1274 and the related regulations ensure that you are complying with these laws
to fi advanced within 3 years of the date of Issue of You are not required to provide the information
the Orsl obligation Likewise,obligations(other than Line 8b For a single issue,enter the date of Issue requested on a form that is subject to the Paperwork
private activity bonds)issued under a single (for example,03/15/2008 for a single issue issued on Reduction Act unless the form displays a valid OMB
agreement that is in the form of a lease or March 15,2008),generally the date on which the control number Books or records relating to a form
installment sale may be treated as part of the same issuer physically exchanges the bonds that are part or its instructions must be retained as long as their u
issue if all of the property covered by that agreement of the issue for the underwriter's(or other contents may become material in the administration
is reasonably expected to be delivered within 3 years purchaser's)funds,for a lease or installment sale, of any Internal Revenue law Generally,tax returns
of the date of issue of the first obligation enter the date interest starts to accrue For issues and return information are confidential,as required
Arbitrage rebate Generally,interest on a state or retorted n a consolidated basis,enter the first day by section 6103
local bond is not tax-exempt unless the issuer of the of the calendar year during which the obligations
bond rebates to the United States arbitrage p,ofits were issued(for example,for calendar year 2008, The time needed to complete and file this form will
earned from investing proceeds of the bond in higher enter 01/01l2008) vary depending ge individual circumstances The
yieldingnon ur ose investments See section 148 Lines 9a through 9h.Complete this section ifpropertyestimated average time is
p p (n 9 P Learning about the
Construction issue This Is an Issue of tax-exem t other than cash is exchanged for the obligation,for 9
p example,acquiring a police car,a Ore truck,or law or the farm 4 fir,46 min
bonds that meets both of the following conditions telephone equipment through a series of monthly Preparing the form 2 hr,,22 min
1 At least 75%of the available construction payments (this type of obligation is sometimes Copying,assembling,and
proceeds of the issue are to be used for construction referred to as a"municioal lease")Also complete this sending the form to the IRS 2 hr,,34 min
expenditures with respect to property to be owned by section if real property is directly acquired in exchange If you have comments concerning the accuracy of
a governmental unit or a 501(c)(3)organization,and for an obligation to make periodic payments of interest these time estimates or suggestions for making this
2 All of the bonds that are part of the issue are and principal For lines 9a through 9d,enter theamount on the appropriate line that represents a lease form simpler, would happy to hear from you
qualified 501(c)(3)bonds,bonds that are not private or installment purchase For line 9d,enter the type of You can write to to the Internal
al Revenue Service,Tax
activity bonds,or private activity bonds issued to item that is leased For lines ge through 9h,enter the Products Coordinating Committee,
finance property to be owned by a governmental unit amount on the appropriate line that represents a bank SE W CAR MP T T SP,1111 Constitution Ave NW,
or a 501(c)(3)organization loan For line 9h,enter the type of bank loan IR-6526,Washington,DC 20224 Do not send the form
In lieu of rebating any arbitrage that may be owed to the to this address Instead,see Where To File on page 1.
United States,the issuer of a construction issue may rocLines 9t and 91 For tine d enter the amount to the
make an irrevocable election to pay a penalty The penalty or alleprem pds re
mium on o be Ysoed to Psue of bondsay principal, ,
.�
is equal to 1/z/o of the amount of construction proceeds
that do not meet certain spending requirements See including proceeds that will be used to fund an
section 148(f)(4)(C)and the Instructions for Form 8038-T escrow account for this purpose Several lines may