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R-1920 - 01/12/2021 - AGREEMENTS - Resolutions Supporting Documents - REVIEW OF CONTRACTS Awarding Ageyn�c : Type of Contra Department: Program/Account N ber: Awarded Contract Price: Budgeted Amount: Under $20,000 $500,001 - $1,000,000 $20,000 - $500,000 Over $1,000,000 K.(--)n i coy , Irl sol-{-iv.. z)>,. Name: Date: ` Name: Date: I z#q/Zozo Name: Date: Name: Date: Three (3) Originals signed by other party Date/Initiaisc) Original provided to staff member for other party Date/Initials( r 1 r� Original provided to Official Files Date/Initiai�� Village of Oak Brook I Approved by Board of Trustees- Date/Initials: REVIEW OF CONTRACTS Awarding Agency: T pe of Contract: Department: Program/Acc nt Number: Awarded Contract Price: Budgeted Amount: D a � Under $20,000 $500,001 - $1,000,000 I (� $20,000 - $500,000 0 Over $1,000,000 O)�t ��C�S I I Name: Date: 11 j Name: Date: /��[aq Name: Date: Name: Date: �,. Three (3) Originals signed by other party Date/InitialsCA Original provided to staff member for other party Date/Initial fi ( "i Original provided to Official Files DateJInitials!', r ✓'�Z Village of Oak Brook I Approved by Board of Trustees• Date/initials: KONICA MINOLTA Order Package:200527023 ovzznl 02 41 PM Page 023 of 023 Order Package Acceptance Agreement Customer Name/Address: VILLAGE OF OAK BROOK 1200 OAK BROOK RD OAK BROOK,IL 60523-2255 Customer's signature below constitutes Customer's acceptance of the preceding forms in this Order Package(as identified by Order Package ID 500587023 time stamped 01/22/21 02:41 PM). This Order Package is governed by the terms and conditions of the Master Agreement contract between Konica Minoha Business Solutions U.S.A.,Inc.and SOURCEWELL 083116-KON dated 10/19/2016 terms of which are incorporated into this agreement. If payment by credit card is indicated above,Customer hereby grants KMBS the authority to charge the Customer's credit card in the amount indicated(plus applicable taxes). KMBS assumes no responsibility to pick-up, return to any party, and/or resolve any financial obligations on any existing Customer equipment except as specifically stated in this Agreement or separately executed form. Not binding on KMBS until signed by KMBS Manager. Authorized Customer Representative KMBS Representative Name: L 1 C.Ud-d2Name: i (Ple rint) (Please Prin Signature: Signature' Title: Date: I L L Z Date: KMBS Manag�/e(y/�7 7�j� �//,� / Name: / ' ' "'��1 f'!` C G�✓/1 (Please P t Signature: Date: I Z KONICA MINOLTA BUSINESS SOLUTIONS U.A.,INC. 100 Williams Orive,Ramsey,NJ 0]446 (2011 254000 www.kmbs.konitamindla us form 3022MA-090115 OS Order Package:S00587023 KONICA MINOLTA 01/22/21 0247 PM Page 001 o/023 Order Agreement Check Applicable Box ❑ Purchase Lease ❑Other: • Account# • . Account#50 0000872901 • Account# t al Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK Le al Name VILLAGE OF OAK BROOK ttn Line 1 Ann Line 1 A8n Line 1 JIM FOX 1n Line 2 Ann Line 2 Atte Line 2 :rest Address 7310 MADRID SET 101 Street Address 1200 OAK BROOK RD Street Address 1200 OAK BROOK RD i MARSHALL State MN Zi 56258 Cit OAK BROOK Stale IL 2i zrerss; Ci! OAK BROOK Stale IL Zi 60523 ax Exempt ❑No X Yes I - 1 Tax Exempt# E99974381 .0.Required X No ❑Yes I, 1 P.O.# P.O.Expiration Date ayment Terms: e❑ Yes,I want to pay by Credit Card.Please provide contact name/phone below. Y Amount IEE LEASE $ ❑ Pay in Full(including applicable tax) ElPartial Payment.Amount S Contact Name: Phone. u Check# Requested Delivery Date: SEE ATTACHED Maintenance Contract X Ameated ❑oocuaed • • e ° 1 AA2M013 BIZHUB C2501 WITH DF-714 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640078094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PG-216 PAPER FEED CABINET 1 A2YUWY3 FS-533 INNER FINISHER A3EUW72 PK-519 PUNCH KIT FOR FS-533 1 1 7640006869 'EXT KEYBRD(CHERRY KEYBD G84-410 a 12 AU-205H GEN2 MULTI CARD READER W •1 A88AWY2 EK-608 LOCAL INTERFACE KIT A4NRWY2 KH-102 KEYBOARD HOLDER •1 A0W4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST 8 2ND LINE) 1 7640015657 BIZHUB SECURE 3 AA7N011 BIZHUB C6501 — 1 MV8430 TN-328C CYAN TONER N/A 1 AAV8130 TN-328K BLACK TONER N/A 1 AAV8330 TW328M MAGENTA TONER WA 1 AAV8230 TW328Y YELLOW TONER WA 3 ACV1430 TN626C CYAN TONER(YIELD;28K NIA 3 ACV1130 TN626K BLACK TONER YIELD:28K WA •a • lAddifloral Charges TOTAL ❑ Network ❑ Removal ❑Other (TOTAL Is excluslve o/applicable lases) Requested Removal Date: 01/29/2021 i A7R0011 "BIZHUB C258 A7R0011008264 1 A7RO011 "BIZHUB C258 A7R0011008265 1 A7R0011 "BIZHUB C258 A7R0011007920 1 A7R0O11 "BIZHUB C258 A7R0011007737 1 A79J011 'BIZHUB C658 A78J011001297 KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsey.NJ 07446 (201)825-0000 www.kmbs konicamirwha us Foml:3000-09011 S. Order Package:S00587023 KONICA MINOLTA 01/2289 0241 PM Page 002 of 023 Order Agreement Additional Equipment-Schedule B • EAccounl# APREMIERFINANCE • • • At#SO 0000812901 • • Account#al Name KLe al Name VILLAGE OF OAK BROOK Le al Name VILLAGE OF OAK BROOKdo Line 1 AAKn Line 1 JIM FOX]n Line 2 Attn Line 2 AIM Line 2:reetAddress Street Address 1200 OAK BROOK RD Street Address 1200 OAK BROOK RD Ity MARSHALCit OAK BROOK State IL Zi 2255 p Cd OAK BROOK Siala IL Zip so52s • _17670; MFP DELIVERY CHARGE-LEVEL TWO 3 764000718094 BASIC NETWORK SERVICE-GNS04 3 A87VW12 LU-302 LARGE CAPACITY UNIT •3 AAVSWY2 PC-216 PAPER FEED CABINET 3 AARSWYA FS-540 SD 100-SHEET BOOKLET FINISH •3 A7 OCWY2 JS-602 JOB SEPARATOR TRAY a 3 ACF5W11 PK-526 2/3-HOLE PUNCH UNIT FOR FS- -3 A87JWY2 RU-513 RELAY UNIT -3 2 ' s N AU-205H GEN2 MULTI CARD READER W c 3 A88AWY2 EK-608 LOCAL INTERFACE KIT z 3 G84410OLCMUS2 EXTERNALKEYBOARD •^3 1 A4NRWY2 KH-102 KEYBOARD HOLDER -3 AOW4WY3 WT-506 WORKING TABLE F 3 A883012 FK-514 FAX KIT(1ST 8 2ND LINE) ®3 7640015657 BIZHUBSECURE —1 AA7NO11 BIZHUB C6501 a 1 7670525507 MFP DELIVERY CHARGE-LEVEL TWO 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PC-216 PAPER FEED CABINET 1 AAR5WYA FS-540 SD 100-SHEET BOOKLET FINISH 1 A10CWY2 JS-602JOB SEPARATOR TRAY 1 ACF5W11 PK-526 2/3-HOLE PUNCH UNIT FOR FS-5 m 1 A87JWY2 RU-513 RELAY UNIT 1 2 AU-205H GEN2 MULTI CARD READER W - 1 A88AWY2 EK-608 LOCAL INTERFACE KIT _,.1 G84410OLCMUS2 EXTERNALKEYBOARD 1 A4NRWY2 KH-102 KEYBOARD HOLDER w 1 AOW4WY3 WT-506 WORKING TABLE 1 A79J011 A79JO11001360 1 A79J011 A79JO11001366 KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive,Ramsey.NJ 07446 (201)8254000 y—kmbs koMcaminolta us Form:30008-090115- Order Package:S00587023 KONICA MINOLTA 01/22/210241 PM Page 003 01023 Order Agreement Additional Equipment-Schedule B 7NameKONICA ccount# • . SO 0000812901 Account# ICA MINOLTA PREMIER FINANCE L al Name VILLAGE OF OAK BROOK Le al Name VILLAGE OF OAK BROOK Attn Line 1A-Une 1 JIM FOX Attn Line 2A8nLine 2 10 MADRID S7 STE 101 Street Atltlress 1200 OAK BROOK RO Street Atldress 1200 OAK BROOK RD State MN Zip 56258 Cit OAK BROOK State IL Zip 7255Cit OAK BROOK State IL Zip 60523 z; 1 A883012 FK-514 FAX KIT 1ST 8 2ND LINE 1 7640015557 BIZHUB SECURE _3 ACV1330 TN626M MAGENTA TONER(YIELD:28K 3 ACV1230 TN626Y YELLOW TONER IELM 28K 1 ACV1430 TN626C CYAN TONER YIELD:28K 1 ACV1130 TN626K BLACK TONER IELD:28K 1 ACV1330 TN626M MAGENTA INIE 1YIELD.28K 1 ACV1230 TN626Y YELLOW TONER IELD:28K KONICA MINOLTA BUSINESS SOLUTIONS U.SA.,INC. 100 W,11,_Drive.Ramsey.NJ 07446 (201)8254000 wmv..kmbs.konlC i—ta.us Form:300015-090115• AAAA! Order Package:S00587023 KONICAMINOLTA 01/22/21 02:41 PM Page 004 of 023 Order Agreement Check Applicable Box ❑ Purchase X Lease O Other: • • Account# • li • Account#SO 0000812901 • Account# al Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK Legal Name VILLAGE OF OAK BROOK :tn Line 1 Attn Line 1 Attn Line 1 JIM FOX In Line 2 Attn Line 2 Attn Line 2 :reet Address 1310 MADRID ST STE 101 Street Address 1200 OAK BROOK RD Street Address 2606 YORK RD' ity MARSHALL State MN Zip 56258 lCity OAK BROOK State IL Zi 22553 Cit OAK BROOK State IL Zip 60523 ax Exempt ❑ No 9 Yes 1 Tax Exempt# E99974381 0.Required O( No ❑ Yes I P.O.# P.O.Expiration Date ayment Terms: ❑ Yes, I want to pay by Credit Card. Please provide contact name/phone below. Y Amount 3EE LEASE U u ❑ Pay in Full(including applicable tax) ❑ Partial Payment,Amount$ i Contact Name: Phone: Check# Requested Delivery Date: SEE ATTACHED Maintenance Contract X Aawed ❑ Decur*d 1 AA2MO13 BIZHUB C2501 WITH DF-714 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PC-216 PAPER FEED CABINET 1 A2YUWY3 FS-533 INNER FINISHER 1 A3EUW12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 'EXT KEYBRD(CHERRY KEYED G84410 1 2 AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT 1 A4NRWY2 KH-102 KEYBOARD HOLDER 1 AOW4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST&2ND LINE) 1 7640015657 BIZHUB SECURE DESCRIPTION • 1 AAV8430 TN-328C CYAN TONER N/A 1 AAV8130 TN-328K BLACK TONER N/A 1 AAV8330 TN-328M MAGENTA TONER N/A 1 AAV8230 TN-328Y YELLOW TONER N/A NIA NIA • ® Additional Charges TOTAL ❑ Network ❑ Removal ❑ Other (TOTAL is exclusive of applicable taxes) Requested Removal Date: 01/29/2021 KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive,Ramsey,NJ 07446 (201)825.4000 www kmbs konicaminolta.us Form:3000-090115- Order Package:500587023 KONICA MINOLTA 01/22/21 0241 PM Page 005 of 023 Order Agreement Check Applicable Boa ❑ Purchase Rl Lease ❑Other: 71310 Account# e r • Account#50---------NICA MINOLTA PREMIER FINANCE Le al Name VILLAGE OF OAK BROOK Le al Name VILLAGE OF OAK BROOK Ann Line 1 Alin Line 1 JIM FOX Ann Line 2Attn Line 2 MADRID ST STE 101 Street Address 1200 OAK BROOK RD Street Address 3003 JORIE RD ity MARSHALL Slate MN Zip 56258 City OAK BROOK Slate IL Zi 2225s City OAK BROOK State IL Zip 60523 ax Exempt ❑No CK Yes I I Tax Exempt# E99974381 .O.Required ($No ❑Yes ( 1 P.O.# P.O.Expiration Date ayment Terms: 1= a❑ Yes,I want to pay by Credit Card.Please provide contact name/phone below, s Amount iEE LEASE U ❑ Pay io Full(including applicable tax) ❑ Partial Payment,Amount$ °o Contact Name: Phone: u Check# Requested Delivery Date: SEE ATTACHED Maintenance Contract X Accepted ❑Noned e e e T76400180 BIZHUB C2501 WITH DF 714 MFP DELIVERY CHARGE-LEVEL ONE BASIC NETWORK SERVICE-BNSO4 PC-216 PAPER FEED CABINET FS-533 INNER FINISHER t A3EUW12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 'EXT KEYBRD(CHERRY KEYBD G84-010 t z AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT 1 A4NRWY2 KH-102 KEYBOARD HOLDER 1 AOW4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST 8 2ND LINE) 1 7640075657 BIZHUB SECURE eIY DESCRIPTION PRICE EACH EXTENDE5 1 1 TN-328C CYAN TONER NIA 1 AAV8130 TN-328K BLACK TONER WA 1 AAV8330 TN-328M MAGENTA TONER WA 1 AAV8230 TN-328Y YELLOW TONER WA WA WA Me• Additional Charges TOTAL Network ❑ Removal C Other (TOTAL Is exclusive of apptkable taxes) Requested Removal Date: 01/29/2021 . a 1 A7RO011 —BIZHUB C258 A7R0011008154 KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsey,NJ 07446 (201)8254000 wwwAmbs.konicaminolta us Form:3000-090115. Order Package:S00587023 KONICA MINOLTA 01/22/21 0241PM Page 006 of 023 Order Agreement Check Applicable Box ❑ Purchase Lease ❑ Other: • Account# Account#SO 0000812901 • Account# Nal Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK fA. Name VILLAGE OF OAK BROOK in Line 1 Attn Line 1 ne 1 JIM FOX In Line 2 Attn Line 2 ne 2:restAddress 1310 MADRID ST STE 101 Street Address 1200 OAK BROOK RD Address 600 OAK BROOK RD ity MARSHALL State MN Zi 56258 Cit OAK BROOK State IL Zi zissAK BROOK State IL ZIP 60523 ax Exempt ❑No D(Yes ( 1 Tax Exempt# E99974381 .0.Required OK No ❑Yes 1- I P.O.# P.O.Expiration Date ayment Terms: p v❑ Ves,1 want to pay by Credit Card.Please provide contact namelphone below. Y Amount 3EE LEASE p ❑ Pay in Full(including applicable tax) ❑ Partial Payment,Amount$ g Contact Name: Phone: O Check# Requested Delivery Date: SEE ATTACHED Maintenance Contract X Awww ❑Ixxenec 1AA210013 BIZHUB C2501 WITH DF-714 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1AAV5WY2 PC-216 PAPER FEED CABINET 1 A2YUWY3 FS-533 INNER FINISHER 1 A3EUW12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 'EXT KEYBRD(CHERRY KEYED 4384410 1 z AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT 1 A4NRWY2 KH-102 KEYBOARD HOLDER 1 A0W4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST&2ND LINE) 1 764OD15657 BIZHUB SECURE i AA2MO13 I BIZHUB C2501 WITH DF-714 DESCRIPTION PRICE EACH EXTENDED 1 AAV8430 I TN-328C CYAN TONER WA 1 AAV8130 TW328K BLACK TONER WA 1 AAV8330 TN-328M MAGENTA TONER NIA 1 AAV8230 TN-328YYELLOWTONER N/A 1 AAV8430 TN-328C CYAN TONER MIA 1 AAV8130 TN-328K BLACK TONER NIA a• • Additional Charges TOTAL :.7 Network ❑ Removal ❑Other (TOTAL is exclusive of eppliceble taxes) Requested Removal Date: 01/29/2021 1 A7R0011 "BIZHUB C258 A7R0011008133 KONICA MINOLTA 6USINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsay NJ 07446 (201)8251000 w Afts.k.n!c lrwlta us Form:3000-090115. Order Package:S00587023 KONICA MINOLTA 01122/21 0241PM Page 007 01023 Order Agreement Additional Equipment-Schedule B • • Account# • • Account#SO 0000812901 Account# )gal Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK Le al Name VILLAGE OF OAKFBROOKto Line 1 AArtn Line 1 JIM FOX]n Line 2 Attn Line 2Attn L ne 2metAddress 1310MADRID STSTE101 Street Address 1200 OAK BROOK RD Street Address 600 OAK BROOII MARSHALL State MN Zi 56258 Cit OAK BROOKState IL Zi 3 Cit OAK BROOK S523 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PC-216 PAPER FEED CABINET 1 A2YU2 FS-5331NNER FINISHER 1 A3EUW12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 •EXT KEYBRD CHERRY KEYED G84-410 1 Z5421011136/66GEN AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT 1 A4NRWY2 KH-102 KEYBOARD HOLDER 1 AOW4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST 82ND LINE) 1 7640015657 BIZHUB SECURE 1 AAV8330 TN-328M MAGENTA TONER 1 AAV8230 TN-328Y YELLOW TONER SERIAL NUMBER KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsey,NJ 07446 (201)8254000 vrvnvkmbs konicam-Ita.us Form:30008-090115= Order Package:S00587023 KONICA MINOLTA 01/22/2102:41 PM Page 008 o/023 Order Agreement Check Applicable Box ❑ Purchase Lease ❑ Other: • Account# • • Account#SO 0000812901 • Account# 1.at Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK Legal Name VILLAGE OF OAK BROOK 1n Line 1 Attn Line 1 Alin Line 1 JIM FOX .In Line 2 Attn Line 2 Al1n Line 2 feet Address 1310 MADRID ST STE 101 Street Address 1200 OAK BROOK RD Street Address 725 ENTERPRISE RD try 0521 MARSHALL State MN L 56258 Cit OAK BROOK State IL ZI 82255 City OAK BROOK State IL ZJP 50523 3x Exempt ❑No CK Yes 1 - 1 Tax Exempt# E99974381 0.Required ($No ❑Yes I 1 P.O.# P.O.Expiration Date syment Terms: y e❑ Yes,I want to pay by Credit Card.Please provide contact name/phone below. r Amount SEE LEASE E ❑ Pay in Full(including applicable tax) ❑ Partial Payment,Amount$ Contact Name: Phone: Check# Requested Delivery Date: SEE ATTACHED Maintenance Contract X Amepted ❑ners a OTY MATERIAL,,' MATERIAL DESCRIPTION SERIAL NUMBER PRICE EACH FXTENn[E) 1 AA2M013 BIZHUB C2501 WITH DF-714 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PC-216 PAPER FEED CABINET 1 A2YUW`Y3 FS-533 INNER FINISHER 1 A3EUW 12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 'EXT KEYBRD(CHERRY KEYBD G84410 1 2 AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT 1 A4NRWY2 KH-102 KEYBOARD HOLDER 1 A0W4WY3 WT-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST&2ND LINE) 1 7640015657 BIZHUB SECURE • DESCRIPTIONPRICE EACH EXTENDED 1 AAV8430 TN-328C CYAN TONER 1 AAV8130 TN-328K BLACK TONER WA 1 AAV8330 TN-328M MAGENTA TONER WA 1 AAV8230 TN-328Y YELLOW TONER WA WA WA s Additional Charges TOTAL ❑ Network ❑Removal ❑Other (TOTAL is exclusive of applicable taxes) Requested Removal Date: 01129/2021 1 A7R0011 "BIZHUB C258 A7R0011007921 NAM KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsey.NJ 07446 (201)825-0000 w I mbs koni—nulla us Form:3000-01 1 e 5 KONICA MINOLTA Order Package:2/00587023 01122/21 0241 PM Page 009 of 023 Order Agreement Check Applicable Box ❑ Purchase 19 Lease ❑Other: • • Account# • • • Account#SO moll 12901 ' Account# t al Name KONICA MINOLTA PREMIER FINANCE Legal Name VILLAGE OF OAK BROOK Le at Name VILLAGE OF OAK BROOK ttn Line 1 Attn Line 1 Atte Line 1 JIM FOX In Line 2 Attn Line 2 Adn Line 2 :reel Address 1310 MADRID ST STE 101 Street Address 1200 OAK BROOK RD Street Address 800 OAK BROOK RD ity MARSHALL State MN Zi 56258 C OAK BROOK State IL mss Cit ax Exempt ❑ No OAK BROOK IL Slate IL Zi 60532 Yes ( 1 Tax Exempt# E99974381 .O.Required ($No ❑ Yes I I P.O.# P.O.Expiration Date ayment Terms: v❑ Yes,I want to pay by Credit Card.Please provide contact namelphone below. x Amount 3EE LEASE ❑ Pay in Full(including applicable tax) ❑ Partial Payment,Amount$ Contact Name: Phone: Cheek# Requested Delivery Date: SEE ATTACHED Maintenance Contract Accepted ❑oeceaed �m.j "'Millard MINIMUM;a 1 AA2M013 BIZHUB C25 WITH DF-714 1 7670525506 MFP DELIVERY CHARGE-LEVEL ONE 1 7640018094 BASIC NETWORK SERVICE-BNSO4 1 AAV5WY2 PC-216 PAPER FEED CABINET 1 A2YUWY3 FS-533 INNER FINISHER 1 A3EUW12 PK-519 PUNCH KIT FOR FS-533 1 7640006869 'EXT KEYBRO(CHERRY KEYBD G84-410 1 2 AU-205H GEN2 MULTI CARD READER W 1 A88AWY2 EK-608 LOCAL INTERFACE KIT i A4NRWY2 KH-102 KEYBOARD HOLDER 1 A0W4WY3 W1-506 WORKING TABLE 1 A883012 FK-514 FAX KIT(1ST 8 2ND LINE) 1 7640015657 BI2HU6 SECURE 1 1 AAV8430 TN-328C CYAN TONER NIA 1 AAV8130 TN-328K BLACK TONER N/A 1 AA 18330 TN-328M MAGENTA TONER NIA 1 AA 8230 TN-328Y YELLOW TONER NIA NIA NIA Additional Charges TOTAL ❑ Network ❑ Removal ❑Other (TOTAL Is exclusive M applicable taxes)Removal Date: 01/29/2021 1 A7R 11 "BIZHUB C258 A71R0011007504 KNIC 100 Williams Dn eORams y NIJ0MINOLTA46BUSINESS201)8 50 0001Ow kmbs ko iicaminolta us Form:3000-090115. Order Package:S00587023 0 KONICA MINOLTA 01 Page 0241 PM Page 010 of 023 Maintenance Agreement Sold 1.Acct N: 0000612901 P.I./Bill to Acct p: SKIP to Acct e Name: VILLAGE OF OAK BROOK Name: VILLAGE OF OAK BROOK Name: MULTIPLE SHIP TO LOCATIONS Ann/Dept AttNDePI: ANn/0ept: Ste/Rm: M./.-: Ste/Rm: Address: 1200 OAK BROOK RD Add-, 1200 OAK BROOK RD Address: aft: OAK BROOK C.": OAK BROOK Cay: 5tate: IL Zip: 60523-2255 stateIL Zip: 60523-2255 $1.11: zip: Tax Exempt Customer? ®res (3No Tan Exemption Number: 699974361 T..Exemption Certificate must be anached wnen apci-lhli, PO Raquked? D yes It No PO Number. PO Expiration Dale: PO must be attached when applicable. ❑Individual PO DBlanket PO PO Combo Email. Ph: Fleet Manager? ®res ❑No Name: JIM FOX Email:JFOX@OAK-BROOK.ORG M:6303665174 Owe"Be Optiom: MFP Wye Rampart selectopli SII—Option: ED SupPly InciuslvI D Toner IBlxk Only) D After Hours Service-Requires After Hours Agreement D 2011,60ml Roll Paper ®Decline Digital Connih:ted Suppon' D Decline Digital Corrected Support' 'Digital Connect Support will be added automatically billed at$12.00 per serial number monthly,unless declined above Billing Options: pepMile Format Wo.l Te.mm Months: D 36 ®as D 60 D Other O 36 Dee O W ❑OInei flat Rate Frequency', D Monthly ®Queerly D Annually D Montidy meb.Frequenry: D Monthly 19 Quarterly D Annually ❑Niuman Y Aggregate Vol— D B/W ❑Color NI Denim Effective Date: 19 D.Install D Date: Ruling Day: M Selected by WES ❑Preferred Da,_129th,30th,and 31st are not an available nlech.rI Imemal Use MAI MF► Monthly Minimum MondiNFbtRrtes Costper C"YRate$ Item Model Dettnplam Serial Number Type Volume Stan Melee Sub FkN Pike Plan 1 Color 0.03800 I 0 BIZHUB-1 B/W 0.00400 0 2 Color 0.03800 D BIZHUB C6501 B/W 0.00400 0 caor 0.03600 0 3 BIZHUB C6501 BN" 0.00400 0 W Additional Equipment on Schedule6 a1Ade Format Monthly Minimum Cost Per Square Foot Item Model Description Serkl Number T FINN Rat Rale$ ype Volume IS4.Fttt) pate$ Stan Meter Sub Fleet Price Plan 2 Cob. 8 V D Additional Equipment on Schedule C CPC COMMENTS- 4g MONTH TERM LOCK IN FOR 4 YEARS Maintenance: D with Equipment Order r]Maintenance Only D Billed by limits [I gilled by Lease Company r]Dealer5e,iced Sales Rep Number Sales Rep Name Sales Rep Email Address Saks District Originating: 123666 ZSPFAKER KM S.KONICAMINOLTA.US 24403 ager Taking: 123556 CHARY SPEAKER ZSPEAKER KMBS.KONICAMINOLTA.US vrocessed Sernems: 123558 CHARY SPEAKER ZSPEAKER KMBS.KONICAMINOLTA.US D Branch 0 winds.. 100 WilfiartK Drive,Ramsewww.k y,N!07446 (2011 B25A000 mDs.konipmirwlla.us Ofll1:10 1-050 S LW 17T. Maintenance Pricing --®-_----_- ca _--®--__-_--- --®-_--_---_ ®-_-_-_-_-_- Order Package:S00587023 --, KONICA MINOLTA 01/22/2102.41 PM Page 012 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C258 Model: ..BIZHUB C258 Serial Number A7R0011008264 Make: Model: Sedal Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that It has good title to the equipment,tree and clear of any Ilan,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,indemnify and hold Konica Minolta Business Solutions U-SA,Inc.('KMBS')harmless from any loss,damage claim, liability or expense of any kind(Including,but not limited to,court costs and attorneys hes)arising or resulting from a breach of this representation and wuranly of good title and/or the authority,expressed or apparent of Customer to trade4n or transfer the equlpmeM.Upon signing this Agreement Customer aumenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pickap at the same time that any new equipment Is delivered. K the surrendered equipment Is not available for pickap at time of new equipment delivery,customer will be Invoiced an additional charge for the separate plck.up. 01-ease Company Owned Asset: Lease Company Nam.: Lease e: ❑Upgrade to Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. OUpgrade to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below. []End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment listed above to the respective leasing company upon reciept of a written Return Authorization Letter and Shipping Instructions,In the event KMBS does not receive a Return Authorization Leiter and Shipping Instructions within BO days o/equipment pick up from Customers location,and Customer has not made additional arrangements with KMBS for storage,the equipment listed above will be returned to Customers bcabon of pick up. Unless itemized as part of the equipment order.KMBS will Invoice the Customer for the Shipping Fee(s)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between last meter billing and date the lease obligation Is satisfied or equipment is returned. Shipping Feels)to Be Invoiced to Customer: End of Lease Return requiring Interim storage of equipment requires pre-authodzathm loom the Regional Operations Manager and Market Vice President and is subject to availability of storage space in a KMBS warehouse or arrangamenr for affairs storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.SA.,INC. 100 Williams Drive,Ramsey,NJ 07446 (201)8254000 www.kmbs.konicaminolta us Order Package:S00587023 KONICA MINOLTA 0112212'0241 PM Q Page 013 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK IL 60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C258 Model: "BIZHUBC258 SertalNumber: A7R0011008265 Make: Model! Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that It has good title to the equipment,free and clear of any Ilen,mortgage,encumbrance or security Interest of any kind.Customer agrees to defend,Indemnify and hold Konica Minolta Business Solutions U.SA.,Inc.('KMBS')harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and atlomeys lees)arising or resulting from a breach of this representation and warranty of good title and/or the authority,expressed or apparent,of Customer to trade4n or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at the same time that any new equipment Is delivered. K the surrendered equipment Is not available for plck-up at time of new equipment delivery,customer will be Invoiced an additional charge for the separate pick-up. Lease Company Owned Asset: Lease Company Name: Lease#: Upgrade to Return KMBS will resolve current lease obligation,Asset belongs to the Lease Company.KMBS will ship back to Leese Company. []Upgrade to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise slated below. ❑Buyout to Keep KMBS will resolve wmenl lease obligabw Asset belongs to KMBS unless otherwise stated below. nEnd of Lease Return Asset belongs to the Lease Company.KMBS wit return equipment fisted above to the respective leasing rompany upon eciepl of a wnflen Return Authonzation Letter and Shipping Ins(ructions-In the event KMBS does nol receive a Return Authorization Letter and Shipping Instrudlens within 90 days of equipment pick up from Customers location,and Customer has not made additional arrangements with KMBS for storage,me equipment listed above will be returned to Customers location of pick up. Unless itemized as part of the equipment oder,KMBS will invoice the Customer for the Shipping Feels)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between last meter billing and date the lease obligation is satisfied or equipment is returned. Shipping Fools)to Be Invoiced to Customer: End of Lease Return requiring interim storage of equipment requires pre-authorisation from the Regional Operations Manager enc,Marks/vice President and is subject to availability of stoeage space in a KMBS warehouse or arrangement for offsite storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.SA.,INC. 100 Williams Drive,Ramsey.NJ 07446 (201)8254000 wwwAmbskoni—motte.us Order Package:S00587023 0 KONIU MINOLTA 0112212102 41 PM Page 014 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone; 630 368 5174 Equipment being removed from Customer's Location: Make: C258 Model: ..BIZHUB C258 SerlelNumber. A7R0011007920 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that h hes good title to the equipment,free and clear of any lien,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,Indemnify and hold Konica Minotta Business Solutions U.SA,Inc.("KMBS")harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and anorney+s fees)arising or resulting from a breach of this representation and warranty of good title andlor the authority,expressed or apparent of Customer to trade4n or transfer the equipment.Upon signing this Agreement,Customer surrendere possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at the same time that any new equipment is delivered. Kthe surrendered equipment is not available for pick-up at time of new equipment cWlwry,customer will be Invoiced an additional charge for the separate pickup. El Lease Company Owned Asset: Lease Company Name: Lease e: Upgrade to Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS wH ship back to Lease Company. E]Upgrade to Keep KMBS will resolve current tease obligation.Asset belongs to KMBS unless amemse staled below. Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise staled below. F]End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment listed above to dre respective leasing company upon -dept of a written Rehm Authomefion Lefler and Shipping Instructions In the evenl KMBS does not receive a Return Aumonnt Letter and Shipping Instructions within 90 days of equipment pick up from Customers localbn.and Customer has not made addibioaal arrangements with KMBS for storage,the equipment listed above will be reWmed w Customers location of pick up. Unless Kemixed as part of the equipment order.KMBS will invoice the Customer for the Shipping F"s)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between[.at meter billing and date the lease obligation is satisfied or equipment is returned. Shipping Feels)to Be Invoiced to Customer: End of Lease Return regWnng interim storage of equipment requires pre-authorization from the Regional Operations Manage.and Market Vice president and it subject to availability of storage space in a KMBS warehouse or arrangement for offasa stores.. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.SA.,INC. 100 Williams Drive,Ramsey,NJ 07446 (2D1)825-4000 www.kmbs.konicsminotta.us Order Package:S00587023 KONICA MINOLTA 01122121 0241 PM Page 01501023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,3003 JORIE RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 3685174 Equipment being removed from Customer's Location: Make: C258 Model: "BIZHUB C258 serial Number: A7R0011008154 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that It has good title to the equipment,free and clear of any Tian,mortgage,encumbrance or security Interest of any kind.Customer agrees to defend,Indemnity and hold Konica Minolta Business Solutions U.SA,Inc.("KMBS")harmless from any loss,damage claim, liability W expense of any kind(Including,but not limited to,court costs and attorneys fees)&rising or resuhing from a breach of this representation and warranty of good title andlor the authority,expressed or apparent,of Customer to trade-In or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at the same time that any new equipment Is delivered. K the surrendered equipment is rot available for pick-up at thee of new equipment delivery,customer will be Invoiced an additional charge for the separate pick-up. Lease Company Owned Asset: Lease Company Name: Lease It: Upgrade to Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. []Upgrade to Keep KMBS will resolve current lease 0131,98bon.Asset belongs to KMBS unless othemnse stated below. Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless Othervaze stated below. nEnd of Lease Return Asset belongs to the Lease Company.KMBS will return aquiporenl ksled above to the respective leasing company upon eciept of a written Retum Au th irizabon Letter and Shipping Instructions.In the event KMBS does not receive a Return Authorization Letter and Shipping Instructions within 90 days of equipment pick up from Customers location,and Customer has rot made additional arrangements with KMBS for storage,the equipment listed above all be returned to Customers location of pick up. Unless Itemized as part of the equipment order,KMBS will invoice the Customer fw the Shipping Fee(s)associated with return of the equipment to Udesignated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between last meter billing and date the lease obligation is satisfied or equipment is returned. Shipping Fee(a)to Be Invoiced to Customer: End of Lease Return requiring interim storage of equipment requires We.wdtwizNidin from the Regional Operations Manager and Market Vice prestdem and Is subject to availability of storage space in a KMBS warthouse or arrangement for offsite storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,tNC. 100 Williams Drive,Ramsey,NJ 07446 (201)825A000 wwwAmbs.konicaminolla us Order Package:S00587023 KONICA MINOLTA 01122121 02:41 PM Page 016 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,600 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C258 Model: etBIZHUBC258 serial Number: A7R0011008133 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that K has good title to the equipment,free and clear of any lien,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,Indemnity and hold Konica Minoha Business Solutions U.S.A.,Inc.("KMBS")harmless from any loss,damage claim, liability or expense of any kind(including.but not limited to,court costs and attorney's fees)arising or resulting from a breach of this representation and warranty,of good title and/or the authority,expressed or apparent,of Customer to Irsdean or transfer the equipment.Upon signing this Agreement.Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pickwp at the same time that any new equipment is delivered. N the surrendered equipment is not available for pickup at fine of new equipment delivery,customer will be Invoiced an additional charge for the separate pickup. Lease Company Owned Asset: Leas.Company Name: Lease e: Upgrade to Return KMBS will resolve wasad Mase obligation_Asset belongs to the Lease Company.KMBS will ship back to Lease Company. Upgrade to Keep KMBS wa resolve wnent Mase obkgation.Asset belongs l0 KMBS unless otherwise staled below, Buyout to Keep KMBS will resolve current lease obligation Asset belongs to KMBS unless otherwise slated below. F]End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment lusted above to the respective leasing company upon revept of a wrihen Return AuthorVaaon Letter and Shipping Instructions.In the event KMBS does hot receive a Return Authonzalion Leiter and Shipping Instructions within 90 days Of equipment pick up from Customer's location,ate Customer has nor made addilional arrangements win KMBS for storage.the equipment fisted above will be returned to Customer's location of pick up Unless Itemized as pan of the equipment order,KMBS will Invoice the Customer for the Shipping Fee(s)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout m upgrade quote may Include an estimate of pages produced between lest meter billing and date the lease obligation Is satisfied w equipment is returned. Shipping Feels)to Be Invoiced to Customer: End of Lease Return requiring interim storage of equipment requires preauthorization from the Regional Operations Manager And Market Vice president and Is subject to availability of storage some in a KMBS warehouse or arrangement for oHsits storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A..INC. 100 Williams Drive,Ramsey,NJ 07446 (201)8254000 www kintiaA nicamirlolte us APPLICATION NO. 2675835 Property Schedule to Tax-Exempt Lease/Purchase Agreement This Property Schedule is entered into pursuant to the Tax-Exempt Lease/Purchase Agreement between Lessor and Lessee. 1. Entire Agreement.Interoretabon: The terms and conditions of the Tax-Exempt Lease/Purchase Agreement(the"Agreement")are incorporated herein. The Agreement,this Property Schedule and the associated documents hereto constitute the entire agreement between Lessor and Lessee with respect to the Property and supersede any purchase order,invoice,request for proposal,response or other related document. 2. Commencement Date:The Commencement Date of this Property Schedule is the date that Lessor pays Vendor for the Property. 3. Property Description: The Property subject to this Property Schedule is described in Exhibit A,attached hereto. If includes all replacements,parts, repairs,additions,accessions and accessories incorporated therein or affixed or attached thereto and any and all proceeds of the foregoing,including, without limitation,insurance recoveries. 4. Term and Payments: Lease Term and Lease Payments are per the attached Exhibit B Amortization and Lease Payment Schedule. If the parties enter into an escrow agreement for the acquisition of the Property,then the escrow agreement shall be attached hereto as Exhibit F. In lieu of the Acceptance Date for commencement of Lease Payments,the date of deposit of the Property Cost into the escrow by Lessor shall be used. Lessee shall have the option to prepay the Lease Payments due under this Property Schedule by paying the Termination Amount shown in the attached Amortization and Lease Payment Schedule,plus any other amounts due and owing at the time of prepayment,subject to per diem adjustment. 5. Certificate of Acceptance:Attached as Exhibit C,hereto. 6. Expiration:Lessor,at its sole determination,may choose not to accept this Property Schedule it the fully executed,original Agreement(including this Property Schedule and all ancillary documents)are not received by Lessor at its place of business by 4/152021 7. Property Cost The total principal amount under this Property Schedule for the acquisition cost of the Property is$64,894.64, 8. Lessee's General and Incumbency Certificate: Lessee has provided the Lessee's General and Incumbency Certificate in the form attached as Exhibit D,hereto. 9. Lessee's Counsefs Opinion: If required by Lessor.Lessee has provided the opinion of its legal counsel substantially in the forth as attached as Exhibit E,hereto. 10. Private Activity Issue. Lessee understands that among other things,in order to maintain the exclusion of the interest component of Lease Payments from gross income for federal income tax purposes,n must limit and restrict the rights private businesses(including,for this purpose,the federal government and its agencies and organizations described in the Code§501(x)(3))have to use the Property. Each of these requirements will be applied beginning on the later of the Commencement Date or date each portion of the Property is placed in service and will continue to apply until earlier of the end of the economic useful life of the Property or the date the Agreement or any tax-exempt obligation issued to refund the Property Schedule is retired(the`Measurement Period"). Lessee will comply with the requirements of Section 141 of the Code and the regulations thereunder which provide restrictions on special legal rights that users other than Lessee or a state or local government or an agency or instrumentality of a state or a local government(an`Eligible User)may have to use the Property. For this purpose,special legal rights may arise from a management or service agreement,lease,research agreement or other arrangement providing any entity except an Eligible User the right to use the Property. Any use of the Property by a user other than an Eligible User is referred to herein as"Non-Qualified Use". Throughout the Measurement Period,all of the Property is expected to be owned by Lessee. Throughout the Measurement Period,Lessee will not permit the Non-Qualified Use of the Property to exceed 10%. 11. Bank Oualification:Lessee designates this Agreement and Property Schedule as a'qualified tax-exempt obligation'as defined in Section 265(b)(3)(B) of the Internal Revenue Code of 1986,as amended. Lessee reasonably anticipates Issuing tax-exempt obligations(excluding private activity bonds other than qualified 501(x)(3)bonds and including all tax-exempt obligations of subordinate entities of the Lessee)during the calendar year this regiment and Property Schedule was funded,in an amount not exceeding$10,000.000. &essee initial here,if Bank QualiBcauon is applicable. IN WITNESS WHEREOF,Lessor and Lessee have caused this Property Schedule to be executed in their names by their duty authorized representatives. KONICA MINOLTA PREMIER FINANCE Village of Oak Brook Lessor L ile Signature Date Signat Da l RICCARDO GINEX Village Manager Print Name Title P9pLy Title X a. ' Signature ^ _ Print Name Title Order Package:500587023 KONICA MINOLTA 01122/2102 41 PM Page 017 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,800 OAK BROOK RD,OAK BROOK IL,IL,60532 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customers Location: Make: C258 Model: "8IZHUBC258 serial Number: A7R0011007504 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that it has good title to the equipment,free and clear of any lien,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,Indemnity and hold Konica fill Business Solutions U.S.A.,Inc.('KMBS')harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and attorney's fees)arising or resumng from a breach of this representation and warranty of good title and/or the authority,expressed or apparent,of Customer to 9atle4n or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the :surrsurrendered equipment will be available for pick-up at the same time that any now equipment Is delivered. K me surrendered equipment is mol endered for pick-up at time of new equipment delivery,customer will be invoiced an additional charge for the separate pick-up. Lease company Owned Asset: Lease Company Name: Least t: []Upgrade to Return KMBS wig reedve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. Upgrade to Keep KMBS will resolve cunent lease obtigal*n Asset belongs to KMBS unless otherwise stateo below. Buyout to Keep KMBS will resolve current lease obligation.Assel belongs to KMBS unless other—stated below, []End of Lease Return Assel belongs to the Lease Company.KMBS will return equipment lead above to the respective leasing company upon reclept of a written Return Authonzalion Letter and Shipping Instructions.M the event KMBS does nit receive a Retum Authorization Letter and Shipping Instructions within 90 days of equipment pick Up from Customer's location,and Customer has not made additonal arrangements with KMBS for storage,the equipment ksled above will be returned to Customers location of pick up. Unless Itemized as pan of the equipment order,KMBS will invoice the Customer for the Shipping Feels)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages Produced between last mater billing and date the lease obligation Is satisfied or equipment Is returned. Shipping Feels)to Be Invoiced!to Customer: End of Lease Return requiring interim storage of equipment requires preauthorization hem We Regional Operations Manager and Market Vice President and is subject to availability of storage space in a KMBS warehouse or arraherm.nt for offsite storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.SA,INC. 100 Williams Drive.Ramsey,NJ 07446 (201)8254000 vnvwhirbs.konicamimolle us Order Package:S00587023 KONICA MINOLTA 01122210241 PM Page 018 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,725 ENTERPRISE RD OAK BROOK IL 60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C258 Mader "BIZHUB C258 Serial Number: A7R0011007921 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that It has good title to the equipment,free and clear of any lien,mortgage,encumbrance or security Interest of any kind.Customer agrees to defend,Indemnify and Mkt Konica Minolta Business Solutions U.S.A.,Inc.("KMBS")harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and attorney's Nes)arising or resulting from a breach of this representation and warranty of good this and/or the authority,expressed or apparent,of Customer to trade4n or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pickup at the same time that any new equipment Is delivered. If the surrendered equipment Is not available for pick-up at time of new equipment delivery,customer will be Invoiced an additional charge for the separate pick-up. Lease Company Owned Asset: Lease Company Name: Leas.e: Upgrade to Return KMBS will resolve current lease obligation Asset belongs to the Lease Company.KMBS will ship back to Lease Comber, Upgrade to Keep KMBS wit resolve current lease obligation.Asset belongs to KMBS unless otherwise staled below. Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below. F-]End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment fisted above to the respective leasing company upon reuapt of a written Return Authorization Lefler and Shipping Instructions.In the event KMBS does not receive a Return Authonzalion Letter and Shipping Instructions within 90 days of equipment pick up from Customer's location,and Customer has not made additional anangemenls with KMBS for storagethe equipment listed above will be returned to Customers laxation of pick up. Unless Itemized as part of the equipment order,KMBS will invoice the Customer for the Shipping Foes)associated with return of the equlpmem to the designated return address provided by the Lease Company.Buyout or upgrade quote may Include an estimate of pages produced between last meter billing and date the lease obligation is satisfied or equipment is returned. Shipping Fee(s)to Be Invoiced to Customer: End of tease Return requiring interim storage of equipment requires peauthoriention from the Regional Op.1.41-a Manager and Market Vice, President and is subject to avallability of storage spall in a KMBS wa,ah—or arrangement for offsite storage. Commenta: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Witiam5 Drive,Ramsey.NJ 07446 (201)825-0000 wwwkmbs kon-nurolta us Order Package:S00587023 KONICA MINOLTA g1Page 19 of 23 Page 01901023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customers Location: Make: C258 Model: "BIZHUB C258 serial Number: A7R0011007737 Make: Model: Serial Number: Make: Model: Serial Number. ®Customer Owned Asset: Customer represents and warrants that It has good title to the equipment,free and clear of any lien,mortgage,encumbrance or security Interest of any kind.Customer agrees to defend,Indemnify and hold Konica Minolta Business Solutions U,SA,Inc.('KMBS')harmless from any loss,damage claim, liability or expense of any kind(Including,but not limited to,court costs and attomeys fees)arising or resulting from a breach of this representation and mm my of good this and/or the authority,expressed or apparent,of Customer to trade-In or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein W KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at the same time that any now equipment Is delivered. N the sumndered equipment is not available for pick-up at time of new equipment delivery,customer will be Invoiced an additional charge for the separate pick-up. Lease Company Owned Asset: Lease Company Name: Lease It Upgrade to Return KMBS wi0 resolve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. Dupgrade to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless othermse staled below. Buyout to Keep KMBS will resolve current lease obligation Asset belongs to KMBS unless othawse stated below. nEnd of Lease Return Asset belongs to the Lease Company.KMBS will realm equipment listed above to the respective leasing company upon reciept of a written Return Aulhonrawn Letter and Shipping Insbuctionsin the event KMBS does not receive a Return Aumonratlon Letter and Shipping Instructions within 90 days of equipment pick up from Customers location,and Customer has not made additional arrangements with KMBS for storage.the equipment listed above will be returned to Customers location of pick up. Unless Itemized as pan of the equipment order,KMBS will invoice the Customer for the Shipping Fees)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages Produced between last meter billing and date the lease obligation is satisfied or equipment Is returned, Shipping Feels)to Be Invoiced to Customer: End of Lease Return requiring interim storage of equipment requires pre authorization from the Regional Operations Manager and Market Vice President and is subject to availability of storage space in a KMBS warehouse or arrangement for offs%.aW.V.. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive.Ramsey.NJ 07446 (201)8254000 wvww.kmbs.konicaminolla us Order Package:S00587023 KONICA MINOLTA 01/220210241 PM Page 020 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C658 Model: BIZHUB C658 SeriatNember: A79JO11001297 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that it has good title to the equipment,Ince and clear of any lien,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,indemnify and hold Konica Minolta Business Solutions U.SA,Inc.('KMBS')harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and adomeys fees)arising or resulting from a breach of this representation and warranty,of good title anwor the authority,expressed or apparent,of Customer to IraUean or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at the same time that any new equipment is delivered. K Me surrendered squipmenl is not available for pickup s1 time of new equipment delivery,customer will be Invoiced an additional charge for the separate pickap. r-ILease Company Owned Asset: Lease Company Name: Lease g: Upgrade m Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. Upgrade to Keep KMBS vnll resolve current lease obligation.Asset belongs to KMBS unless otherwee stated below. Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless o11—se stated below. ❑End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment listed above to the respective leasing company upon redept of i wnmen Return Authorisation Leper and Shipping Instructions.in the event KMBS does not receive a Return Aulhonzalion Lefler and Shipping Instructions within 90 days of equipment pick up tr m Customers location,and Customer has not made additional arrangements with KMBS for storage,the equipment listed above will be returned to Customers location of pick up. Unless Itemized as pan of the equipment order,KMBS will invoice the Customer for the Shipping Feels)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between last meter billing and date the lease obligation Is satisfied or equipment is returned. Shipping Feels)to Be Invoiced to Customer: Endof Lease Return requiring interim storage of equipment requires W"ushcouadon from tho Regional Operations Manager and Market Vice siresidanf and is subject to availablfity of Storage space in a KMBS warehouse tie anangament for offsite storage. Comment.: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive,Ramsey,NJ 07446 (201)8254000 www.kmbs konicaminolta.us Order Package:S00587023 KONICA MINOLTA 01/22/21 0241PM Page 021 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C658 Model: BIZHUB C658 Serial Number A79JO11001360 Make: Model: Serial Number: Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that it has good title to the equipment,free and clear of any lien,mortgage.encumbrance or security interest of any kind.Customer agrees to defend,Indemnity and hold Konica Minolta Business Solutions U.S.A.,Inc.("KMBS")harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and aHorneys fees)arising or resulting from a breach of this representation and warranty of good title and/or the authority,expressed or apparent of Customer to Irads4n or transfer the equipment.Upon signing this Agreement,Customer surrenders possession of the equipment and all components contained therein to KMBS.Customer further agrees that the surrendered equipment will be available for pick-up at fine same time that any new equipment is delivered. H the surrendered equipment l not available for pick-up at time of new equipment delivery,customer will be invoiced an additional charge for the separate pkk•up. F]Lease Company Owned Asset: Lease Company Name: Lease e: Upgrade to Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS will ship back to Lease Company. []Upgrade to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below. Buyout to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below E]End of Lease Return Asset belongs to the Lease Company.KMBS will return equipment listed above to the respective leasing company upon reciept of a written Return Aue ousilion Leder and Shipping Instruellons In the event KMBS does not receive a Return Authorization Leder and Shipping Instructions within 90 days of equipment pickup from Customers location,and Customer has not made additional arrangements with KMBS for storage,me equipment listed above will be returned to Customers location of pick up. Unless itemized as part of the equipment order.KMBS will Invoke the Customer for the Shipping Fees)associated with return of the equipment to the designated return address provided by the Lease Company,Buyout or upgrade quote may include an esllmale of pages produced between last meter billing and date the lease obligation is satisfied or equipment Is returned. Shipping Fee(a)to Be Invoiced to Customer: End of Lease Return requiring interim storage of equipment raquires preauthorization from the Regional Operations Manage,and Market Vice President and is subject to availability ofstorage space in a KMBS warehouse or arrangement for offsite storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.SA.,INC. 100 Williams Dme.Ramsey.NJ 07446 (201)8254000 wwwArobs.koniwminolta.us Order Package:S00587023 KONICA MINOLTA 0112Z2102:41 PM Page 022 of 023 Equipment Removal Authorization Customer: VILLAGE OF OAK BROOK Pick Up Address: VILLAGE OF OAK BROOK,1200 OAK BROOK RD,OAK BROOK,IL,60523 Contact Name: JIM FOX Contact Phone: 630 368 5174 Equipment being removed from Customer's Location: Make: C658 Model: 'BIZHUB C658 serial Number A79JO11001366 Make: Model: Serial Number. Make: Model: Serial Number: ®Customer Owned Asset: Customer represents and warrants that it has good title to the equipment,free and ober of any Ilan,mortgage,encumbrance or security interest of any kind.Customer agrees to defend,Indemnify and hold Konica Minoha Business Solutions U.SA,Mc.('KMBS")harmless from any loss,damage claim, liability or expense of any kind(including,but not limited to,court costs and attorney's fees)arising or resulting from•breach of this representation and warranty of good Utle andlor the authority,expressed or apparent,of Customer to trade-In or transfer the equipment.Upon eight ng this Agreement,Customer surrenders possession of the equipment and all components contained thereinto KMBS.Customer further agrees that the surrendered equipment will be available for pickup at the same time that any new equipment Is delivered. N the surrendered equlpmem Is not available for pickup at time of new equipment delivery,customer will be invoiced an additional charge for the separate pickup. Lease Company Owned Asset: Lease Company Name: Lease R: Upgrade to Return KMBS will resolve current lease obligation.Asset belongs to the Lease Company.KMBS will Ship back to Lease Company. Upgrade to Keep KMBS will resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below. Buyout to Keep KMBS wll resolve current lease obligation.Asset belongs to KMBS unless otherwise stated below. EjEnd of Lease Return Asset belongs to the Lease Company.KMBS will return equipment listed above to me respective leasing company upon reclept of a written Return Authorization Letter and Shipping Instructions.In the event KMBS tices not receive a Return Authorization Letter and Shipping Instructions within 90 days of equipment pck up from Customers location,and Customer has not made ad6tional arrangements with KMBS for storage.the equipment listed above will be returned to Customees location of pick up. Unless itemized u pan of the equipment order,KMBS will Invoice the Customer for the Shipping Fees)associated with return of the equipment to the designated return address provided by the Lease Company.Buyout or upgrade quote may include an estimate of pages produced between last meter billing and date the lease obligation is satisfied or equipment Is returned. Shipping Fee(s)to Be Invoiced to Customer: End of Leas"Return requiring interim storage of equipment requires preauthorization from the Regional Operations Manager and Market Vice President and to subiect to availability Of storage space In a KMBS warehouse or arrangement for offsiM storage. Comments: KONICA MINOLTA BUSINESS SOLUTIONS U.S.A.,INC. 100 Williams Drive,Ramsey,NJ 07446 (201)8254000 www kmbs.konicamirolta us Document Checidist ❑Tax-Exempt Lease/Purchase Agreement-Execute signature block at the top of the first page of the Agreement. ❑Addendum to Tax-Exempt Lease/Purchase Agreement-If required by Lessor,this document must be executed in the presence of an attester. The attesting witness does not have to be a notary but must be present at the time of execution. The attester will execute the signature block below the Lessee's signature block at the bottom right of the page. If computation is required,please submit a copy of the computation test with the addendum. ❑ Property Schedule-1)If the transaction can be designated as a"bank qualified"transaction-one where Lessee reasonably anticipates not issuing more than $10 million in tax-exempt obligations in a calendar year-then you should initial the line under this section; and 2) execute the signature block at the bottom of the page. This document must be executed in the presence of an attester. The attesting witness does not have to be a notary but must be present at the time of execution. ❑ Property Description-Exhibit A-Execute signature block at the bottom of the page. ❑Amortization and Lease Payment Schedule-Exhibit B-Execute signature block at the bottom of the page. ❑ Certificate of Acceptance-Exhibit C-1)if billing address is different than address shown on the Agreement,fill in billing information under p 2;2)the date that all equipment is delivered,installed and accepted is the date that should be placed on the"ACCEPTANCE DATE"line;and 3)execute signature block at the bottom of the page. ❑ Lessee's General and Incumbency Certificate-Exhibit D-The General Certificate must be signed by the person signing the Agreement. The Incumbency Certificate must be signed by an officer other than the person signing the Agreement. ❑ Lessee's Counsel's Opinion-Exhibit E-If required by Lessor,this document will need to be executed by your attorney,dated,and placed on his/her letterhead. ❑ Insurance Authorization and Verification-To be filled out by Lessee and returned with the executed documents. ❑ Notification of Tax Treatment-Please provide your State Sales/Use tax Exemption Certificate,if applicable. ❑ Form 8038-GC or G-Blank form provided to Lessee. Please consult your local legal/bond counsel or tax consultant with questions. ❑ Original Documents-Lessor will require original documents,including original 8038 form,prior to funding. ❑ Validation of Board Approval-If required by Lessor,a copy of board minutes or board resolution should be provided showing approval of the contract. ❑ Services and Supplies Rider-If Lessee has requested that Lessor,as a convenience to Lessee,invoice Lessee for certain service and supply payments Lessee owes to Vendor, this document must be executed by Lessee in the presence of an attester. The attesting witness does not have to be a notary but must be present at the time of execution. Tax-Exempt Lease/Purchase Agreement APPLICATION NO 2675835 ACCEPTED BY LESSOR: AGREED TO: Y LESSEE: FULL LEGAL NAME FULL LEGAL NAME KONICA MINOLTA PREMIER FINANCE Village of Oak Brook STREET ADDRESS STREETADDRESS 1310 Madrid Street,Suite 101 1200 OAK BROOK RD CITY STATE IIP CITY STATE ZIP Marshall MN 56258 OAK BROOK IL 60523 SIGNATURE DATE XIG TUR DATE ERIEPRINT NA E RICCARDO GINEX TELEPHONE NUMBER TITLE TELEPHONE NUMBER 800-328-5371 Village Manager 630.368.5174 AGREEMENT:Lessor hereby leases to Lessee and Lessee hereby leases from Lessor all he Property described in Property Schedule incorporated herein by reference,upon the lens and conditions set forth herein and as supplemented by the terms and conditions set forth in the Property Schedule. This Tax-Exempt Lease/Purchase Agreement together with the Property Schedule shall be defined as the'Agreement' LEASE TERM: The Lease Ten of the Property listed in the Property Schedule(the'Lease Tenn')shall commence upon the commencement date of the Property Schedule(the 'Commencement Date).The Lease Term shall consist of an original term(the'Original Term'),commencing on such Commencement Date and continuing through the end of Lessee's then-current fiscal year,and a series of successive renewal terms(each,a'Renewal Term),each contemporaneous with Lessee's budget year,with dna final Renewal Term ending as provided in the Property Schedule.This Agreement cannot be canceled or terminated by Lessee except as expressly prouded herein.This Agreement is a triple net lease. LEASE PAYMENTS:Lessee shall pay rent to Lessor for the Property in the amounts,and on the dates specified,in the Property Schedule.Lessor and Lessee intend that the obligation of Lessee to pay Lease Payments hereunder shall nal in anyway be construed 10 be a debt of Lessee in contravention of any applicable constredwal or slehday limitations or requirements concerning the creation of indebtedness by Lessee.nor shall arrything contained herein constitute a pledge of the general tax revenues,funds a morries of Lessee. NO OFFSET:SUBJECT TO THE RIGHT TO NON-APPROPRIATE,SET FORTH BELOW,THE OBLIGATIONS OF LESSEE TO PAY THE LEASE PAYMENTS DUE UNDER THE PROPERTY SCHEDULE AND TO PERFORM AND OBSERVE THE OTHER COVENANTS AND AGREEMENTS CONTAINED M THIS AGREEMENT SHALL BE ABSOLUTE AND UNCONDITIONAL IN ALL EVENTS WITHOUT ABATEMENT,DIMINUTION.DEDUCTION,SET-OFF OR DEFENSE,FOR ANY REASON,INCLUDING WITHOUT LIMITATION.ANY DEFECTS,MALFUNCTIONS. BREAKDOWNS OR INFIRMITIES IN THE PROPERTY OR ANY ACCIDENT,CONDEMNATION OR UNFORESEEN CIRCUMSTANCES. THIS PROVISION SHALL NOT LIMIT LESSEE'S RIGHTS OR ACTIONS AGAINST ANY VENDOR.Lessee shall pay when due all taxes,fees and governmental charges assessed or levied against or with respect to the Property. LATE CHARGES: Lessee shall pay a late charge of five cents per dollar or the highest amount permitted by applicable law,whichever is lower,on all delmquenl Lease Payments and interest on said delinquent amounts from the date such amounts were due until paid at the rate of 12%per annum or the maximum amount permuted by law,whichever is less. MAINTENANCE OF PROPERTY:At all times during the Lease Term,Lessee shall,at Lessee's own cost and expense,maintain,preserve,and keep the Property in good working order, and condition,and from time to time make or cause to be made of necessary and proper repairs,replacements,and renewals to the Property,which shall become part of the Property.The Property is and will remain personal property. INSURANCE OF PROPERTY:All risk of loss to the Property shall be horse by the Lessee.At all times during the Lease Term,Lessee shat,at Lessees own cost and expense.muse casualty.public liability,and property damage insurance to be tamed and maintained(or shall provide Lessor with a certificate stating that adequate seTrhsurertce has been provided)with respect to the Property,sufficient to protect the full replacement value of the Property and to protect from liability in all events for which insurance is cuslomanly available. Lessee shall fumish to Lessor certificates evidencing such coverage throughout the Lease Term.Any insurance policy to be carried and maintained pursuant to This Agreement shall be so wntlen a endorsed as to make losses,If any,payable to Lessee and Lessor as their respective interests may appear.All such liability insurance shall name Lessor as an additional insured Each insurance policy carried and maintained pursuant to this Agreement shall contain a provision to the effect that the insurance company shall not cancel the policy or modify t maleiially or adversely to the interest of the Lessor without first giving written notrce thereof to Lessor at least 30 days in advance of such change of status, OUIET ENJOYMENT AND TERMINATION OF LESSORS INTEREST: To secure Lessee's obligations hereunder,Lessor is granted a security interest In the Property,including substitutions,repairs,replacements and renewals,arch the proceeds thereof,which is a fast lien thereon.Lessee hereby authorizes Lessor to file aY finarrtirrg statements which Lasso deems necessary w appropriate to establish,maintain and pedes such security interest.Provided there does not exist an Event ze Ikeaut air file al ropnztron Event,en defined herein, the Lessee shall have the right of quiet enjoyment of he Property throughout the Lease Term.If lessee shall have performed all of its obligations and rc default shall have occurred and be continuing under this Agreement,and this Agreement shall not have been earlier terminated with respect to the Property,then,at the aria ions the Lease Tenn cath respect to any tem o1 Property.Lessor's interest in such Property shad temhinate.Unless otherwise required by law.title to the Property shall be in the name of Lessee.subject to lessor's interest hereunder. TAX EXEMPTION: The partes contemplate that interest payable under this Agreement will be excluded from gross income for federal income tan purposes under Section 103 of the Internal Revenue Code of 1956,as amended(the'Code).The tax�exempt status of[his Agreement provides the inducement for the Lessor to offer financing at the interest rate set forth herein,Therefore,should this Agreement be deemed by any taxing authority not to be exempt from taxation,Lessee agrees that the interest rate shall be adjusted,as of the date of loss of tax exemption,to an interest rate calculated to provide Lessor or its assignee an after lax yield equivalent to the tax exempt rate and Lessor shall notify Lessee of the taxable rate.Provided, however,that the provision of the preceding sentence shall apply only upon a final determination that the interest payments are not excludable from gross Income under Section 103(a)of the Code,and shall not apply a the determination is based upon the individual tax circumstances of the Lessor,or a finding that the parry seeking to excude such payments from gross income is not the owner and holder of the obligation under the Code. REPRESENTATIONS AND WARRANTIES OF LESSEE: Lessee hereby represents and warrants to Lessor that(a)Lessee is a State,possession of the United States.the Distrid of Columbia.or political subdivision thereof as defined in Section 103 of the Code and Treasury Regulators and Rulings related thereto,and if Lessee is incaporsted.it is duly organized and existing under the Constitution and laws of its jurisdiction of incorporation and will do w muse to oe done all things necessary to preserve and keep such organization and existence in full face and effect,(b)Lessee has been duty authonzed by the Constitution and laws of the applicable junsdiction and by a resolution of its governing body(which resolution,if requested by Lessor,is attached hereto).to exewte and deliver this Agreement and to carry out its obligations hereunder;(c)all legal requirements have been mel,and procedures have been followed, including public bidding,in order to ensure the enforceability of this Agreement;(d)the Property will be used by Lessee only for essential governmental a proprietary functions of Lessee consistent with the scope of Lessee's authority and will not be used in a trade or business of any person or entity,by the federal government or for any personal,family a household use. Lessee's need for he Property is not expected to diminish during the form of the Agreement;(e)Lessee has funds available to pay Lease Payments until the end of its anent appropriabon period,and it intends to request funds to make Lease Payments in each appropriation period,from now until the end of the term o1 this Agreement;(f)Lessee shall comply at all times with all applicable requirements of the Code,including but not limited to the registration and reporting requirements of Section 149,to maintain the federal taxexempt status of the Agreement, and Lessee shall maintain a system wth respect to this Agreement,which tracks the name,and ownership interest of each assignee who has both the responsibility for administration of, and ownership interest in this Agreement;(g)Lessee's exact legal name is as of forth on the first page of this Agreement.Lessee will not change its legal name in any respect without giving thirty(30)days prior written notice to Lessor. RISK OF LOSS COVENANTS:Lessee shall not be required to indemnify or hold Lessor hamless against liabilities arising from the Agreement.However,as between Lessor and Lessee, and to the extent permitted by law,Lessee shag bear the risk of loss for,shall pay directly,and shall defend against any and all claims,liabilities,proceedings,actions,expenses,damages or losses arising under or related to the Property,inckiding,but not limited to,the possession,ownership,lease,use or operation thereof,except that Lessee shall not bear the risk of foss of, nor pay for,any claims,liabilities,proceedings,actions,expenses,damages or losses that anse directly from events occurring after Lessee has surrendered possession of the Property in accordance with me terms of the Agreement to Lessor or that arise directly from the gross negligence or willful misconduct of the Lessor. NON-APPROPRIATION:If sufficient funds are not appropriated to make Lease Payments under this Agreement(such failure to appropriate,a`Nooepproprialion Event"),this Agreement shall terminale and Lessee Shan nor be obligated to make Lease Payments under tris Agreement beyond the then currml fiscal year for which funds have been appropriated.Upon Such a Nonappropnation Event,Lessee shall,no later than the end of the fiscal year for which Lease Payments have been appropriated,deliver possession of the Property to Lessor.If Lessee fails to deliver possession of the Property to Lessor,the termination shall nevertheless be effective but Lessee shall be responsible for the payment of damages in an amount equal to the portion of Lease Payments thereafter coming due that Is attributable to the number of days after the termination during which the Lessee fails to deliver possession and for any other loss suffered by Lessor as a result of Lessee's faikrre to deliver possession as required.Lessee shall notily Lessor in writing within seven(7)days after the failure of the Lessee to appropriate funds sufficient or the payment of the Lease Payments,but failure to provide such notice shall not operate to extend the Lease Tenn or result in any liability to Lessee.A Nonappropriaton Event shall net constitute an Event of Default hereunder. ASSIGNMENT BY LESSEE:Without Lessors prior written consent,Lessee may not,by operation of law a otherwise,assign,transfer,pledge,hypothecate or otherwise dispose of the Property,this Agreement or any interest therein. ASSIGNMENT BY LESSOR:Lessor may assign,sell or encumber all or any pan of this Agreement,the Lease Payments and any other rights a interests of Lessw hereunder without the necessity of providing notice to or obtaining the consent of Lessee;provided that Lessee shalt have no obligation to make payments to any assignee unless and until Lessee has received notice of the name,address and tax identification number of the assignee.The initial Lessor or its assgme(s)shall maintain a register of an assignees of this Agreement To the extent permitted by applicable law,such assignees may include trust agents for the benefit of holders of certificates of participation.Lessee agrees that t Lessor sells,assigns or transfers this Agreement Lessor's assignee will have the same fights and benefits that Lessor has now and will not have to perform any of Lessor's obligations.Lessee agrees that Lessor's assigns, will not be subject to any claims,defenses,or offsets that Lessee may have against Lessor. EVENTS OF DEFAULT: Lessee shall be in default under this Agreement upon the occurrence of any of he following events or conditions rEverds of Defaut°),unless such Event of Default shall have been specifically waived by Lessor in writing:(a)default by Lessee in payment of any Lease Payment or any other indebtedness or obligation now or hereafter owed by Lessee to Lessor under this Agreement or in the performance of any obligation,covenant or liability contained in this Agreement and the continuance of such default for ten(10)consecutive days after written notice thereof by Lessor to Lessee,of(b)any warranty,representation or statement merle or furnished to Lessor by Or on behalf of Lessee proves to have been fete in any material respect when made or furnshed,or(c)actual or attempted sale,lease or encumbrance of any of the Property,or the making of any levy,seizure or attachment thereof or thereon,or(d)dissolution,termination of existence,discontinuance of the Lessee,insolvency,business failure,failure to pay debts as they mature,w appointment of a receiver of any part of t e property of,or assignment for the benefit of creditors by the Lessee,w the commencement of any proceedings under any bankruptcy,reorganization or arrangement laws by or against the Lessee. REMEDIES OF LESSOR:Upon the occurrence of any Evml of Default and at any time thereafter,Lessor may,wthoul any further notice,exercise one Or more of the flowing remedies as Lessor in its sole discretion shall elect:(a)Terminale the Agreement and an of Lessee's rights hereunder as to any or all items of Property;(b)require Lessee,at Lessee's expense,to return any or all items of Property wherever found to Lessor at such place within the United States as Lessor may designate,and for this purpose Lessor may enter upon Lessee's premises where any item of Property is located and remove such item of Property free from all claims of any nature whatsoever by Lessee and Lessor may thereafter dispose of the Property; provided,however,that any proceeds from the disposition of the Property in excess of the sum required to(i)pay to Lessor an amount equal to the total unpaid principal component of Lease Payments under the Property Schedule,including principal component not otherwise due until future fiscal years,(ti)pay any other amounts than due under the Property Schedule and this Agreement and(iii)pay Lessors costs and expenses associated with the disposition of the Property and the Event of Default(including attorney's fees),Shan be paid to Lessee or such other creditor of Lessee as may be entitled thereto,and furter provided that no deficiency shall be stowed against Lessee,except with respect to Lessors costs and expenses associated with disposition of the Property;(c)proceed by appropriate court action or actions to enforce performance by Lessee of its obligations hereunder or to recover damages for the breach hereof or pursue any other remedy available to Lessor at law or in equity or otherwise;(d)declare all unpaid Lease Payments ant other sums payable hereunder during the current fiscal year of the Lease Term to be immediately due and payable without any presentment,demand or protest and I or take any and all actions to which Lessor shall be entitled under applicable law,No right or remedy herein contend upon or reserved to Lessor is exclusive of any night or remedy herein or at law or in equity or otherwise provided or pemuted,but each shall be cumulative of every other right or remedy given hereunder or now or hereafter existing at law or in equity or by statute or otherwise,and may be enforced concurrently tmerevth or from time to time.Lessee and Lessor hereby irrevocably waive all right to trial by jury in any action,proceeding or counterclaim(whether based on contracl,ort or otherwise)arising out of or relating to this Agreement. COSTS AND ATTORNEY FEES:Upon the occurrence of an Event of Default by Lessee in the performance of any term of this Agreement,Lessee agrees to pay to Lessor or reimburse Lessor for,in addition to all other amounts due hereunder,all of Lessors costs of collection,including reasonable attorney fees,whether or not suit or action is filed thereon.Any such costs shag be immediately due and payable upon written notice and demand given to Lessee,shall be secured by this Agreement until paid and shall bear interest at the rate of 12%per annum or the maximum amount pennited by law,whichever is less. In the event suit or action is instituted to enforce any of the terms of this Agreemml.the prevailing party shall be entitled to recover from the other party such sum as the court may adjudge reasonable as attorneys'fees at trial or on appeal of such suit or action or in any bankruptcy proceeding,in addition to all other sums provided by law. NOTICES:All notices,and other communications provided for herein shall be deemed given when delivered Or mailed by certified mail postage prepaid,addressed to Lessor or Lessee at their respective addresses set forth herein or such other addresses as either of the parties hereto may designate in writing to the other from time to fime for such purpose. AMENDMENTS:This Agreement may not be amended except in writing signed by both parties. CONSTRUCTION:This Agreement shall be governed by and construed in accordance with the laws of the Lesseas Stale.Titles of sections of this Agreement are for convenience only and shag not define or limit the terns or provisions hereof.Time is of the essence under this Agreement.This Agreement shall inure to the benefit of and shall be binding upon Lessor and Lessee and their respective successors and assigns.This Agreement may be simultaneously executed in counterparts,each shall be an original with all being the same instrument. Exhibit A APPLICATION NO 2675835 Property Description VENDOR KONICA MINOLTA BUSINESS SOLUTIONS STREET ADDRESS CITY STATE ZIP 2001 BUTTERFIELD RD DOWNERS GROVE IL 60515 PROPERTYa e OUANTRY DESCRIPTION SERIAL NUMBER PROPERTY LOCATION 4 KONICA MINOLTA BIZHUB C6501 1200 OAK BROOK RD OAK BROOK IL 60523 1 KONICA MINOLTA BIZHUB C2501 1200 OAK BROOK RD OAK BROOK IL 60523 2 KONICA MINOLTA BIZHUB C250I 600 Oak Brook Rd OAK BROOK IL 60523 1 KONICA MINOLTA BIZHUB C2501 800 Oak Brook Rd OAK BROOK IL 60523 1 KONICA MINOLTA BIZHUB C2501 2606 York Rd OAK BROOK IL 60523 1 KONICA MINOLTA BIZHUB C2501 3003 Jone St OAK BROOK IL 60523 1 KONICA MINOLTA BIZHUB C2501 725 Enterprise rd OAK BROOK IL 60523 LESSEE ACCEPTANCE Village of Oak Brook q X Village Manager !I / NAME OF LESSEE SIGNAT TITLE DATE APPLICATION NO. Exhibit s I 2675835 Amortization and Lease Payment Schedule Term:48 months Payment Structure: Monthly in arrears Interest Rate: 4.891 If the Lease Payment Dates are not defined in this Amortization and Lease Payment Schedule,the first Lease Payment shall be due 30 days after the Commencement Date and each subsequent Lease Payment shah be due monthly thereafter. Termination Amount(After Payment Lease Interest Principal Outstanding Making Said No. Payment Portion Portion Balance Payment) Beginning 64,894.64 Balance 1 1,491.28 264.51 1,226.77 63,667.87 65,577.91 2 1,491.28 259.51 1,231.77 62,436.10 64,309.18 3 1,491.28 254.49 1,236.79 61,199.31 63,035.29 4 1,491.28 249.45 1,241.83 59,957.48 61,756.20 5 1,491.28 244.38 1,246.90 58,710.58 60,471.90 6 1,491.28 239.30 1,251.98 57,458.60 59,182.36 7 1,491.28 234.20 1,257.08 56,201.52 57,887.57 8 1,491.28 229.08 1,262.20 54,939.32 56,587.50 9 1,491.28 223.93 1,267.35 53,671.97 55,282.13 10 1,491.28 218.76 1,272.52 52,399.45 53,971.43 11 1,491.28 213.58 1,277.70 51,121.75 52,655.40 12 1,491.28 208.37 1,282.91 49,838.84 51,334.01 13 1,491.28 203.14 1,288.14 48,550.70 50,007.22 14 1,491.28 197.89 1,293.39 47,257.31 48,675.03 15 1,491.28 192.62 1,298.66 45,958.65 47,337.41 16 1,491.28 187.33 1,303.95 44,654.70 45,994.34 17 1,491.28 182.01 1,309.27 43,345.43 44,645.79 18 1,491.28 176.67 1,314.61 42,030.82 43,291.74 19 1,491.28 171.32 1,319.96 40,710.86 41,932.19 20 1,491.28 165.94 1,325.34 39,385.52 40,567.09 21 1,491.28 160.53 1,330.75 38,054.77 39,196.41 22 1,491.28 155.11 1,336.17 36,718.60 37,820.16 23 1,491.28 149.66 1,341.62 35,376.98 36,438.29 24 1,491.28 144.20 1,347.08 34,029.90 35,050.80 25 1,491.28 138.70 1,352.58 32,677.32 33,657.64 26 1,491.28 133.19 1,358.09 31,319.23 32,258.81 27 1,491.28 127.66 1,363.62 29,955.61 30,854.28 28 1,491.28 122.10 1,369.18 28,586.43 29,444.02 29 1,491.28 116.52 1,374.76 27,211.67 28,028.02 30 1,491.28 110.91 1,380.37 25,831.30 26,606.24 31 1,491.28 105.29 1,385.99 24,445.31 25,178.67 32 1,491.28 99.64 1,391.64 23,053.67 23,745.28 33 1,491.28 93.97 1,397.31 21,656.36 22,306.05 34 1,491.28 88.27 1,403.01 20,253.35 20,860.95 35 1,491.28 82.55 1,408.73 18,844.62 19,409.96 36 1,491.28 76.81 1,414.47 17,430.15 17,953.05 37 1,491.28 71.04 1,420.24 16,009.91 16,490.21 38 1,491.28 65.26 1,426.02 14,583.89 15,021.41 39 1,491.28 59.44 1,431.84 13,152.05 13,546.61 40 1,491.28 53.61 1,437.67 11,714.38 12,065.81 41 1,491.28 47.75 1,443.53 10,270.85 10,578.98 42 1,491.28 41.86 1,449.42 8,821.43 9,086.07 43 1,491.28 35.96 1,455.32 7,366.11 7,587.09 44 1,491.28 30.02 1,461.26 5,904.85 6,082.00 45 1,491.28 24.07 1,467.21 4,437.64 4,570.77 46 1,491.28 18.09 1,473.19 2,964.45 3,053.38 47 1,491.28 12.08 1,479.20 1,485.25 1,529.81 48 1,491.28 6.03 1,485.25 0.00 0.00 71,581.44 6,686.80 64,894.64 This Amortization and Lease Payment Schedule is hereby verified as correct by the undersigned,who acknowledges receipt of a copy. LESSEE ACCEPTANCE Village of Oak Brook X Village Manager t NAME OF LESSEE NGMATURE TRIE pTE0 Exhibit CAPPLICATION NO 2675835 Certificate of Acceptance This Certificate of Acceptance is pursuant to Tax-Exempt Lease/Purchase Agreement dated as off�i ,nd the related Property Schedule,between Lessor and Lessee(the"Agreement"), t. Property Acceptance. Lessee hereby certifies and represents to Lessor that the Property referenced in the Agreement has been acquired,made,delivered,installed and accepted as of the date indicated below. Lessee has conducted such inspection and/or testing of the Property as it deems necessary and appropriate and hereby acknowledges that it accepts the Property for all purposes. Lessee will immediately begin making Lease Payments in accordance with the times and amounts specified herein. LESSOR MAKES NO(AND SHALL NOT BE DEEMED TO HAVE MADE ANY)WARRANTIES,EXPRESS OR IMPLIED,AS TO ANY MATTER WHATSOEVER,INCLUDING,WITHOUT LIMITATION,THE DESIGN,OPERATION OR CONDITION OF,OR THE QUALITY OF THE MATERIAL, EQUIPMENT OR WORKMANSHIP IN, THE PROPERTY, ITS MERCHANTABILITY OR ITS FITNESS FOR ANY PARTICULAR PURPOSE,THE STATE OF TITLE THERETO OR ANY COMPONENT THEREOF,THE ABSENCE OF LATENT OR OTHER DEFECTS(WHETHER OR NOT DISCOVERABLE),AND LESSOR HEREBY DISCLAIMS THE SAME;IT BEING UNDERSTOOD THAT THE PROPERTY IS LEASED TO LESSEE'AS IS"ON THE DATE OF THIS AGREEMENT OR THE DATE OF DELIVERY,WHICHEVER IS LATER,AND ALL SUCH RISKS,IF ANY,ARE TO BE BORNE BY LESSEE. 2. Billing Address. If billing address differs from the address listed on the Tax-Exempt Lease/Purchase Agreement please list below: BILLING NAME STREET ADDRESS CITY STATE ZIP IN WITNESS WHEREOF,Lessee has caused this Certificate of Acceptance to be executed by their duly authorized representative. ) WS: /�� Acce tante D e Vi71�Oak L ss X Signature RICCARDO GINEX Village Manager Print Name Title Exhibit DAPPLICATION NO 2675835 Lessee's General and Incumbency Certificate GENERAL CEof Re: Tax-Exempt Lease/Purchase Agreement and Properly Schedule datedted as as of tween Village of Oak Brook,as Lessee('Lessee")and KONICA MINOLTA PREMIER FINANCE as Lessor. The undersigned,being the duly elected,qualified and acting official of Lessee holding the title stated in the signature line below,does hereby certify as of the date of this Certificate and the date of the Agreement(as defined below),as follows i. If required by applicable law,Lessee did,at a meeting of the governing body of the Lessee,by resolution or ordinance duly enacted,in accordance with all requirements of law,approve and authorize the execution and delivery of the above-referenced Property Schedule(the"Property Schedule')and the Tax-Exempt Lease/Purchase Agreement(the-Agreement")by the undersigned. 2. If the aforementioned meeting(s)was required by applicable law,the meefing(s)of the governing body of the Lessee at which the Agreement and the Property Schedule were approved and authorized to be executed was duly called,regularly convened and attended throughout by the requisite quorum of the members thereof,and the enactment approving the Agreement and the Property Schedule and authorizing the execution thereof has not been altered or rescinded. All meetings required by applicable law of the governing body of Lessee relating to the authorization and delivery of Agreement and the Property Schedule have been:(a)held within the geographic boundaries of the Lessee;(b)open to the public,allowing all people to attend;(c)conducted in accordance with internal procedures of the governing body;and(d)conducted in accordance with the charter of the Lessee,if any,and the laws of the Stale. 3. No event or condition that constitutes,or with the giving of notice or the lapse of time or both would constitute,an Event of Default or a Nonappropriation Event(as such terms are defined in the Agreement)exists at the date hereof with respect to this Property Schedule under the Agreement. C The acquisition of all of the Property under the Agreement and the Property Schedule has been duty authorized by the governing body of Lessee. 5. Lessee has.in accordance with the requirements of law,fully budgeted and appropriated sufficient funds for the current budget year to make the Lease Payments scheduled to come due during the current budget year under the Agreement and the Properly Schedule and to meet its other obligations for the current budget year and such funds have not been expended for other purposes. 6. As of the date hereof,no litigation is pending,(or,to my knowledge,threatened)against Lessee in any court(a)seeking to restrain or enjoin the delivery of the Agreement or the Property Schedule or of other agreements similar to the Agreement(b)questioning the authority of Lessee to execute the Agreement or the Property Schedule,or the validity of the Agreement or the Property Schedule,or the payment of principal of or interest on,the Property Schedule;(c)questioning the censtit rtionatity of any statute,or the validity of any proceedings,authorizing the execution of the Agreement and the Property Schedule;or(d)affecting the provisions made for the payment of or security for the Agreement and the Property Schedule. IN WITNESS WHEREOF,the undersigned has signed this C to on the date ed below. Village of Oak Brook Village Manager Lessee Signature Peremrb sqn Aprann�nr'''ggg Print Tiee d Person to Sign Agreement RICCARDO GINEX PnM Name I P n b 5 �=-+ gn Agreement taste vpr Aeova Perron SgnaU fills CM,f le INCUMBENCY CERTIFICATE Re: Tax-Exempt Lease/Purchase Agreement and Property Schedule dated as of_,between Village of Oak Brook,as Lessee('Lessee')and KONICA MINOLTA PREMIER FINANCE as Lessor(`Agreement"), The undersigned,being the duly elected,qualified and acting Secretary.Clerk,or other duly authorized official or signatory of the Lessee does hereby certify,as of the date of this Certificate and the date of the Agreement(as defined in the General Certificate above),as follows: As of the date of the meeting(s)of the governing body of the Lessee at which the above-referenced Agreement and the Property Schedule were approved and authorized to be executed,and as of the date hereof,the belownamed representative of the Lessee held and holds the office set forth below,and the signature set forth below is his/her true and correct signature. NAME TITLE SIGNAT RE OF PERSON SIGNING AGREEMENT OF PERSON SIGNING PERSON SIG AGREEMENT AGREEMENT RICCARDO GINEX Villa a Mana er IN WITNESS WHEREOF,the undersigned has signed this Certificate on the date stated below. Seorabry.CkM1 or Dear EUIy eutllmiead WfiGal or signatory o/Lessee ICanmt pe u es Person s'Mng Pgreemem) sof parson tMs Caaaacete -M Name ar PsklMrxl INs c.rermale sin Msl ve pe on Sgnee leis CeM la APPLICATION NO, 2675835 Insurance Authorization and Verification Re: Tax-Exempt Lease/Purchase Agreement dated as of between Lessee and Lessor. Lessor: KONICA MINOLTA PREMIER FINANCE 1310 Madrid Street,Ste.101 Marshall,MN 56258 Lessee: Village of Oak Brook 1200 OAK BROOK RD OAK BROOK IL 60523 TO THE LESSEE: In connection with the above-referenced Tax-Exempt Lease/Purchase Agreement and the Property Schedule thereunder each dated�ra�(the"Agreement'),Lessor requires proof in the form of this document,executed by both Lessee`and Lessee's agent,that LeSw s insurable interest in the financed property(the"Property")meets Lessor's requirements as follows,with coverage including,but not limited to,fire,extended coverage,vandalism,and theft: LESSOR,AND ITS SUCCESSORS AND ASSIGNS,shall be covered as both ADDITIONAL INSURED and LENDER'S LOSS PAYEE with regard to all equipment financed or leased by policy holder through or from Lessor. All such Insurance shall contain a provision to the effect that such insurance shall not be canceled or modified without first giving written notice thereof to Lessor and Lessee at least thirty(30)days in advance of such cancellation or modification. Lessee must carry GENERAL LIABILITY (and/or, for vehicles, Automobile Liability) In the amount of no less than $1,000,000.00(one million dollars). Lessee must carry PROPERTY Insurance(or,for vehicles,Physical Damage Insurance)in an amount no less than the 'Insurable Value'$64,894.64,with deductibles no more than$10,000.00. 'Lessee.Please execute this form and return with your document package. Lessor will fax this form to your insurance agency for endorsement. In lieu of agent endorsement,Lessee's agency may submit insurance certificates demonstrating compliance with all requirements. Should you have any questions,please contact Konica Minolta Premier Finance at 800-328-5371. By signing,Lessee authorizes the Agent named below:1)to complete and return this form as indicated;and 2)to endorse the policy and subsequent renewals to reflect the required coverage as outlined above. NAME OF AGENCY NAME OF AGENT STREET ADDRESS EECiry STATE ZIP PHONE EF- E-MA L LESSEE ACCEPTANCE Village of Oak Brook v A Village Manager NAME OF LESSEE SIGNATUHE TITLEC DATE TO THE AGENT: In lieu of providing a certificate,please execute this form in the space below and promptly fax it to Lessor at 866405-8329. This fully endorsed form shall serve as proof that Lessee's insurance meets the above requirements. Agent hereby verifies that the above requirements have been met in regard to the Property listed below. AGENTACCEPTANCE X NAME OF AGENCv SIGNATURE PRINT NAME DATED Insurable Value:$64,894.64 ATTACHED: PROPERTY DESCRIPTION FOR THE AGREEMENT. Tax-Exempt Leaae/Pureha"Agreement APPLICATION NO. L. 2675835 Addendum(ILLINOIS) THIS ADDENDUM,which is entered into between KONICA MINOLTA PREMIER FINANCE("Lessor")and VILLAGE OF OAK BROOK ("Lessee").is intended to modify and supplement the Property Schedule(the"Property Schedule")to the Tax-Exempt Lease/Purchase Agreement between Lessor and Lessee dated as of LiEJ (the"Agreement"). Capitalized terms not otherwise defined herein shall have the meanings set forth in the Agreement. -r'1 1 1 1. The Agreement is amended and restated with respect to the Property Schedule as follows: (a) Notwithstanding anything to the contrary set forth in the Agreement,title to the Property subject to the Property Schedule shall remain in Lessor during the Lease Tenn for the Property Schedule,subject to Lessee's rights under the Property Schedule. follows* (b) The Section entitled'QUIET ENJOYMENT AND TERMINATION OF LESSOR'S INTEREST"is amended to read as "QUIET ENJOYMENT: Provided there does not exist an Event of Default or Nonappropriation Event, as defined herein,the Lessee shall have the right of quiet enjoyment of the Property throughout the Lease Term" 2. In addition to the representations, warranties and covenants of Lessee set forth in the Agreement, Lessee, as of the Commencement Date for the Property Schedule,represents,warrants and covenants for the benefit of Lessor as follows: (a) If Lessee is a county,the debt limitations applicable to Lessee,including but not limited to the limitations imposed by III. Ann.Stat.Ch.55,§§5/5-1012,5/5-1083(which provide in substance that the total amount of Lease Payments payable under the Property Schedule,when aggregated with existing indebtedness,may not exceed 5.75 percent of the value of the taxable property of Lessee),have not been exceeded and will not be exceeded as a result of Lessee entering into the Property Schedule[attach computation ofsuch test). (b) If Lessee is a municipality,the debt limitations applicable to Lessee,including but not limited to the limitations imposed by 111.Ann.Stat.Ch.65,§5/11-61-3(which provides in substance that the total amount of Lease Payments payable under the Property Schedule,when aggregated with existing indebtedness,may not exceed 8.625 percent of the value of the taxable property of Lessee), have not been exceeded and will not be exceeded as a result of Lessee entering into the Property Schedule[attach computation of such test]. (c) If Lessee is a school district,any debt limitations applicable to Lessee,including but not limited to the limitations imposed by III.Ann.Stat.Ch.105,§5/19-1 have not been exceeded and will not be exceeded as a result of Lessee entering into the Property Schedule[attach computation ofsuch test];and the Property Schedule has been approved by two-thirds of the members of the governing body of Lessee. (d) If Lessee is a fire district,any debt limitations applicable to Lessee,including but not limited to the limitations imposed by Ill.Ann.Stat.Ch.70,§705/12 have not been exceeded and will not be exceeded as a result of Lessee entering into the Property Schedule [attach computation ofsuch test]. (e) If Lessee is a hospital district,any debt limitations applicable to Lessee,including but not limited to the limitations imposed by III.Ann.Stat.Ch.70,§910/21.2 have not been exceeded and will not be exceeded as a result of Lessee entering into the Property Schedule[attach computation ofsuch test]. IN WITNESS WHEREOF,Lessor and Lessee have caused this Addendum to be executed in their names by their duly authorized representatives. KONICA MINOLTA PREMIER FINANCE Villa of ak Brook Lessor Les e Signature Date 3 gnature Date RICCARDO GINEX Village Manager Print Name Title Print Name Title X st By Signature i QIl Print Name Title ' —/ Fpmn 8038-GC Information Return for Small Tax-Exempt (Rev.January 2012) Governmental Bond Issues,Leases,and Installment Sales III Under Internal Revenue code section 149(e) OMB No.1545-0720 Department of the Treasury () Internal Revenue service Caution:If the issue price of the issue is s 100,000 or nom,use Form 8038-G. 1. Reportin Authority Check box it Amended Retum► ❑ 1 �m-se s�l/s mber 2 Issusi s ampbyer Identiflntion nuIN)I( k ro 3 mbar and st (or P.O.box 8 mall Is not delivered to street address) RooMsutte Kbrvc7t---?d4 ,Ry,town,or post office,state,and 21P code 5 Report number(For IRS Use avy) sok ZL. 6 d me of orh er or other empbyee of iswer tlesiQnated contact person vfiom the IRS may call for more into '1&725- 7 Tebphona nu W of of ter or opal representative t Lo—aa- -PJ tne�c lea 1�'Li ria & -3CQ Description of Obligations Gheckoncasinglelitsue ❑ ora Consolidated return ❑. Be Issue price of obligation(s)(see instructions) . . . . . . . . . . . . . . . . . 8a b Issue date(single issue)or calendar date(consolidated).Enter date in mm/dd/yyyy format(for example,01/01/2009)(see instructions)11- 9 9 Amount of the reported obligation(s)on line 8a that is: a For leases for vehicles . . . . . . . . . . . . . . . . . . . . . . . . . 98 b For leases for office equipment. . . . . . . . . . . . . . . . . . . . . . . 9b c For leases for real property . . . . . . . . . . . . . . . . . . . . . . . . 9C d For leases for other(see instructions). . . . . . . . . . . . . . . . . 9d e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . . 9e If For bank loans for office equipment . . . . . . . . . . . . . . . . . . . . . 9f g For bank loans for real property. . . . . . . . . . . . . . . . . . . . . . . If For bank loans for other(see instructions) . . . . . . . . . . . . . . . . . . 9h I Used to refund prior issue(s) . . . . . . . . . . . . . . . . . . . . . . . 91 j Representing a loan from the proceeds of another tax-exempt obligation(for example,bond bank) . , 9 kOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91k 10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(Ill)(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 em to er identification number: vine r pariah'and can ury, d I have examined this return and axartpanyeq schedules aro slatemens,and to the beat of my gwwladge antl balef,May are Signature that aye a horaed hovel fu We at I consent to the IRS's&w1osure of the issuer's return edornorson,as necessary to praaeas Mus retum,to tM penan(a) and ^ _ Consent , �,Of r yid ' gnature of issuers authorized rep native Date ' print name and tilt Paid Prid?ype preparers name Preparer's signature Date Check❑it 'TIN Preparer aa8-emw" Use Only Fm's name ► Fm's EIN► Fan's address► Phoria no. General Instructions who Must File pay a penalty in lieu of arbitrage rebate(see Section references are to the Internal Revenue Issuers of tax-exempt governmental the line 11 instructions). Code unless otherwise noted. obligations with issue prices of less than Filing a consolidated return for multiple $100.000 must file Form 8038-GC. issues.For all tax-axempt governmental tlVhet's Now Issuers of a tax�exempt governmental obligations with issue prices of less than The IRS has created a page on IRS.gov for obligation with an issue price of$100,000 or $100.000 that are not reported on a separate information about the Form 8038 series and more must fife Form 8038-6,Information Form 8038-GC,an issuer must file a its instructions,at www.bs.gov/f0rm8038. Return for Tax-Exempt Governmental consolidated information return including all Information about any future developments Obligations. such issues issued within the calendar year. affecting the Forth 8038 series(such as Filing a separate return for a single Issue. Thus,an issuer may file a separate Forth legislation enabled after we release N)will be Issuers have the option to file a separate 8038-GC for each of a number of small issues posted on that page. P eP and report the remainder of small issues Forth 8038-GC for any tax-exempt Purpose of Form govemmental obligation with an issue price issued during the calendar year on one of less than$100,000. consolidated Form BD38-GC.However,4 the Forth 6038-GC is used by the issuers of tax- issue Is a construction issue,a separate Form exempt governmental obligations to provideAn issuer of a tax-exempt bond used to 8038-GC must be filed to give the IRS notice the IRS with the information required by finance construction expenditures must file a of the election to pay a penalty in lieu of section 149(e)and to monitor the separate Forth 8038-GC for each issue to give arbitrage rebate. requirements of sections 141 through 150. notice to the IRS that an election was made to Cat,No 641088 Form 8038-GC(Rev 1.2o12) Form 8038-GC ftv.1-2ol2) Page 2 When To File multiple tax-exempt governmental obligations 1.At least 75%of the available construction To file a separate return for a single issue,file if the form is used for consolidated reporting. proceeds of the issue are to be used for Form 8038-GC on or before the 15th day of Tax-exempt obligation.This is any obligation construction expenditures with respect to the second calendar month after the close of including a bond,installment purchase Property to be owned by a governmental unit the calendar quarter in which the issue is agreement,or financial lease,on which the or a 501(CX3)organization,and issued, interest is excluded from income under 2.All of the bonds that are part of the issue To file a consolidated return for multiple section 103. are qualified 501(c)(3)bonds,bonds that are issues,file Form 8038-GC on or before Tax-exempt governmental obligation.A not private activity bonds,or private activity February 15th of the calendar year following tax-exempt obligation that is not a private bonds issued to finance property to be owned the year in which the issue is issued, activity bond(see below)is a tax-exempt by a governmental unit or a 501(c)(3) Late filing.An issuer may r granted C issued ba qualified obligation.This includes a bond organization. y qfied re department extension of time to file Forth 8038-GC under volunteerfidtt In lieu of rebating any arbitrage that may be section 3 of Rev.Proc.200248,2002-37 under section 150(e). owed to the United States,the issuer of a I.R.B.531,if It is determined that the failure to Private activity bond.This includes an construction issue may make an irrevocable file on time is not due to willful neglect.Type obligation issued as part of an issue in which: election to pay a penally.The penalty is equal or print at the top of the form,"Request for •More than 10%of the proceeds are to be to 1-1/2%of the amount of construction Relief under section 3 of Rev.Proc.2002-48." used for any private activity business use,and Proceeds that do not meet certain spending Attach to the Form 8038-GC a letter briefly requirements.See section 148M(4NC)and the stating why the form was not submitted to the •More than 10%of the payment of principal Instructions for Form 8038-T. IRS on time.Also indicate whether the or interest of the issue is either(a)secured by obligation in question is under examination by an Interest in property to be used for a private Specific Instructions the IRS.Do not submit copies of any bond business use(or payments for such property) documents,leases,or installment sale or(b)to be derived from payments for In general,a Form 8038-GC must be documents.See Where To File next, property(or borrowed money)used for a completed on the basis of available private business use. information and reasonable expectations as of the date of issue.However,forms that are Where To File it also includes a bond,the proceeds of filed on a consolidated basis may be File Form 8038-GC,and any attachments, which(a)are to be used to make or finance completed on the basis of information readily with the Department of the Treasury,Internal loans(other than loans described in section available to the issuer at the close of the Revenue Service Center,Ogden,UT 84201. 141(c)(2))to persons other than governmental calendar year to which the form relates, units and(b)exceeds the lesser of 5%of the supplemented by estimates made in good Private delivery services.You can use proceeds or$5 million. faith. certain private delivery services designated by Issue.Generally,obligations are treated as Part I—Re—Reporting Author) the IRS yi meet the'timely mailing as timely Po 9 tY f ling/peying"rule for tax returns and Part of the same issue only d they are issued by the same issuer,on the same date,and as Amended return.An issuer may file an pThese private delivery services Part of a single transaction,or a series of amended return to change or add to the inccludelude only the following: related transactions.However,obligations information reported on a previously filed •DHL Express(DHL):DHL Same Day Service. issued during the same calendar year(a) return for the same date of issue.If you are under a loan agreement under which amounts filing to correct errors or change a previously •Federal Express(FedEx):FedEx Priority are to be advanced periodically filed return,check the"Amended Return"box Overnight,FedEx Standard Overnight,FedEx down loan')ad a(b)with i term noted"draw- in the heading of the form. 2Day,FedEx International Priority,and FedEx 270 days,may be treated as art of the same The amended return must provide all the International First. P issue if the obligations are equally and ratably information reported on the original return,in •United Parcel Service(UPS):UPS Next Day secured under a single indenture or loan addition to the new corrected information. Air,UPS Next Day Air Saver,UPS 2nd Day agreement and are issued under a common Attach an explanation of the reason for the Air,UPS 2nd Day Air A.M.,UPS Worldwide financing arrangement(for example,under the amended return and write across the top Express Plus,and UPS Worldwide Express. same official statement periodically updated 'Amended Return Explanation." Therivate delivery service can tell you to reflect changing factual circumstances). p ry Also,for obligations issued under a draw- Lina 1.The issuer's name is the name of the how to get written proof of the mailing date. down loan that meets the requirements of the entity issuing the obligations,not the name of Other Forms That May Be preceding sentence,obligations issued during the entity receiving the benefit of the Required different calendar years may be treated as financing.In the case of a lease or installment Q part of the same issue if all of the amounts to sale,the issuer is the lessee or purchaser. For rebating arbitrage(or paying a penalty in be advanced under the draw-down loan are Line 2-An issuer that does not have an lieu of arbitrage rebate)to the Federal reasonably expected to be advanced within 3 employer identification number(EIN)should Government,use Form 8038-T.Arbitrage years of the date of issue of the first apply for one on Forth SS-4,Application for Rebate,Yield Reduction and Penalty in Lieu obligation.Likewise,obligations(other than Employer Identification Number.You can get of Arbitrage Rebate.For private activity private activity bonds)issued under a single this forth on the IRS webshe at IRS.gov or by bonds,use Form 8038,Information Return for agreement that is in the form of a lease or calling 1-800-TAX-FORM(1-800-829-3678). Tax-Exempt Private Activity Bond Issues. installment sale may be treated as part of the You may receive an EIN by telephone by For a tax-exempt governmental obligation same issue if all of the property covered by following the instructions for Form SS4. with an issue price of$100,000 or more,use that agreement is reasonably expected to be Linea 3 and 4.Enter the issuer's address or Form 8038-G. delivered within 3 years of the date of issue of the address of the designated contact person the first obligation. listed on line 6.If the issuer wishes to use its Rounding to Whole Dollars Arbitrage rebate.Generally,interest on a own address and the issuer receives its mail You may show the money items on this return state or local bond is not tad-exempt unless in care of a third party authorized as whole-dollar amounts.To do so,drop any the issuer of the bond rebates to the United representative(such as an accountant or amount less than 50 cents and increase any States arbitrage profits earned from investing attorney),enter on the street address line amount from 50 to 99 cents to the next higher Proceeds of the bond in higher yielding "C/O"followed by the third party's name and dollar. nonpurpose investments.See section 148(1). street address or P.O.box.Include the suite, Construction issue.This is an issue of tax- room,or other unit number after the street Definitions exempt bonds that meets both of the address.If the post office does not deliver Obligations.This refers to a single tax- following conditions: mail to the street address and the issuer has a exempt governmental obligation if Form P.O.box,show the box number instead of the 8038-13C is used for separate reporting or to Form 8038-GC(Rev.1-2012) Page$ street addressit a change in address occurs Lines 9i and 91.For line 9i,enter the amount Paid Preparer after the return is filed,use Form 8822, of the proceeds that will be used to pay Change of Address,to notify the IRS of the principal,interest,or call premium on any If an authorized representative of the issuer new address. other issue of bonds,including proceeds that filled In Its return,the paid preparer's space will be used to fund an escrow account for should remain blank.Anyone who prepares Note.The address entered on lines 3 and 4 is this purpose.Several lines may apply to a the return but does not charge the the address the IRS will use for all written Particular obligation.For example,report on organization should not sign the return. communications regarding the processing of lines 91 and 9j obligations used to refund prior Certain others who prepare the return should this return,including any notices.By issues which represent loans from the not sign.For example,a regular,full-time authorizing a person other than an authorized proceeds of another tax-exempt obligation. employee of the issuer,such as a dark, officer or other employee of the issuer to secretary,etc.,should not sign. communicate with the IRS and whom the IRS Uma 9k.Enteron line 9k the amount on line 8e that does not represent an obligation Generally,anyone who is paid to prepare a may contact about this return,the issuer described on lines 9a through 9j. return must sign it and fill In the other blanks authorizes the IRS to communicate directly in the Paid Preparer Use Only area of the with the Individual listed on line 6,whose Line 10.Check this box it the issuer has return.A paid preparer cannot use a social address is entered on lines 3 and 4 and designated any issue as a"small issuer security number in the Paid Pmparer Use Only consents to disclose the Issuer's return exception"under section 265(b)(3)(B)(Ixlll). box.The paid preparer must use a preparer information to that individual,as necessary,to Line 11 Check this box if the issue is a tax identification number(PTIN).If the paid process this return. construction issue and an irrevocable election preparer is seffj�employed,the preparer Line 5.This line is for IRS use only.Do not to Pay a penalty in lieu of arbitrage rebate has should enter his or her address in the box. make any entries in this box. been made on or before the date the bonds The paid preparer must: were issued.The penalty is payable with a Sign the return in the space Part II—Description of Obligations Form 8038-T for each 6-month Period after 9 P provided for the the date the bonds are issued.Do not make preparer's signature,and Check the appropriate box designating this as any payment of penalty in lieu of rebate with •Give a copy of the return to the issuer. a return on a single issue basis or a Form 8038-13C,See Rev.Proc.92-22, consolidated return basis. 1992-1 C.B.736,for rules regarding the Paperwork Reduction Act Notice Line Be.The issue price of obligations is "election document." generally determined under Regulations Ling 12 Enter the name of the vendor a bank We ask for the information on this toren to section 1.148-1(b).Thus,when issued forcarry out the Internal Revenue laws o1 the cash,the issue price is the price at which a who is a parry to the installment purchase United States.You are required to give us the substantial amount of the obligations are solo agreement, ban,or financial lease.If there Information.We need it to ensure that you are to the public.To determine the issue price of are multiple vendors or banks,the issuer complying with these laws. an obligation issued for ro should attach a schedule. 9a property.see sections You are not required to provide the 1273 and 1274 and the related regulations. Line 19.Enter the employer identification information requested on a form that is line 8b.For a single issue,enter the date of number of the vendor or bank who is a party subject to the Paperwork Reduction Act issue(for example,03/15/2010 for a single to the installment purchase agreement, loan, unless the form displays a valid OMB control issue issued on March 15,2010),generally or financial lease.If there are multiple vendors number.Books or records relating to a forth the dale on which the issuer physically or banks,the issuer should attach a scM1edule. or its instructions must be retained as long as exchanges the bonds that are part of the Signature and Consent their contents may become material in the issue for the underwriter's(or other administration of any Internal Revenue law. Purchaser's)funds;for a lease or Installment An authorized representative of the issuer Generally,tax returns and return information sale,enter the date interest starts to accrue. must sign Form 8038-GC and any applicable are confidential,as required by section 6103. For issues reported on a consolidated basis, certification.Also print the name and title of The time needed to complete and file this enter the first da of the calendar year durin the person signing Forth 8038-GC.The y y 9 authorized representative of the issuer signing form will vary depending at id average which the obligations were Issued(for this form must have the author) to consent circumstances.The estimated Avera a time is: exam01/01/2O1Or calendar year 2010,amen to the disclosure of the issuer's return Learning about the information,as necessary to process this law or the form . . . . 4 hr.,46 min. floes 9a through III Complete this section ff return,to the person(s)that has been preparing the norm 2 M.,22 min. property other than cash is exchanged for the designated in this form. obligation,for example,acquiring a pollee car, Copying,assemblin,and a fire truck,or telephone equipment through a Note.If the issuer authorizes in line 6 the IRS sending the forth to the IRS 2 hr.,34 min. series of monthly payments.(This type of to communicate with a person other than an obligation is sometimes referred to as a officer or other employee of the issuer,(such If you have comments concerning the "municipal lease.")Also complete this section authorization shall include contact both in accuracy of these time estimates or if real Property is directly acquired in writing regardless of the address entered in suggestions for making this form simpler,we exchange for an obligation to make periodic lines 3 and 4,and by telephone)by signing would be happy to hear from you.You can payments of interest and principal. this form,the issuer's authorized write to the Internal Revenue Service,Tax representative consents to the disclosure of Products Coordinating Committee, Do not complete lines 9a through 9d if the the issuer's return information,as necessary SE:W:CAR:MP:T:M:S,1111 Constitution Ave. proceeds of an obligation are receivedin the to process this return,to such person. NW,IR-6526,Washington,DC 20224.Do not forth of cash even If the term"lease"is used send the form 10 this address.Instead,see in the title of the issue.For lines 9a through Where To File. 9d,enter the amount on the appropriate fine that represents a lease or installment purchase.For line 9d,enter the type of item that is leased.For lines 9e through 9h,enter the amount on the appropriate line that represents a bank loan.For line 9h,enter the type of bank ban. "OFFICIAL DOCUMENT Y `<.,, Snk of Illpda V DeFertmot of Pwmnw OFFICIAL DOCUMEAT~� Illinois Sales Tax Exemption Certificate 's VILLAGE OF OAK BROOK 1200 OAK BROOK RD I OAK BROOK IL 60523-2255 Sales Tax Exemption Certificate Issue date: SaW Tax Exemption' E99974381 s 02/10/2020 Expiration date: O enizatl6n re type. Governmental 03/0112025 ' i c This entity is authorized under the Retailers'Occupation Tax Act to purchase tangible personal property for use or consumption tax-free. 8 �LI.LYQ15t� Director 5 r, $ OFfICIAI DOCUMENT•DO NOT DESTROY Fdrrr, W.9 Request for Taxpayer Give Form to the (Be,October 2018) Identification Number and Certificatlon requester.Do not Department Of the Internal Revenue Service Treasury ►0o to www.ks.gov/FormWO for instructions and the latest infonnatioru send to the IRS. 1 Name(as shown on yow income tax return).Name is required on this fine;do not leave this fine blank. VILLAGE OP OAK BROOK 2 Business name/disregaded entity name,If different from above y 3 beck appropriate box for federal tax Classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes appy only to loeowing seven boxes, certain"les,not individuals;sea instructions on page 3): a ❑hdividuaVsols proprietor or ❑C Corporation ❑S corporation ❑Partnership ❑TnaVenate in single-member LLC 8Exempt payee code(it any) 3 C ❑Limited liability company.Enter the tax classification(C=C Corporation S=S corporation,P=Partnership)► o Nota:Check the appropriate box in the line above for the tax claaaRcalmn of the single-member owner.Do not check Exemption from FATCA reporting LLC If the LLC is classified as a single-member LLC that is disregarded from the owner unbss the owner of the LLC is a anomer LLC that is not da,"tuded from the owner for U.S.federal tax purposes.Oahe-e,a single-member LLC that code pf arty) is disregarded from the owner should check the appropriate box for the tax classification of fie owner. yy Other(see instnartkxns)► MUNICIPALITY war,r•.u>.,a•x..,r,,.e woe.ro.us, y� a Atltlr (number,street,antl apt.or suite no.)See instructions. Requsrter's name and address(optionari N 2200 OAK BROOK RD. 8 Ciy,stale,and ZIP code OAK BROOK, IL 60523 7 List account numbers)here(optkmag RiMM Taxpayer Identification Number(rIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid social security number backup withholding.For individuals,this is d emit ty your social security number QiSN),However,for a resident ahem,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get e TIN,later. Or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name,no I EmPloyar Identification number Number To Give the Requester for guidelines on whose number to enter. 3 6 _ 6 FFF 5 3 4 JIM Certification Under penalties of perjury,I certify that: 1.The number shown on this form is my correct taxpayer identification number(or 1 am wailing for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)1 have not been notified by the Internal Revenue Service QRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has noted me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is torted. Certification instructions.You must doss out Rem 2 above R you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum.For real estate transactions,Rem 2 does not appy.For mortgage interest pad, acquisition or abandonment of secured properly,cancellation of debt,contributions to an individual retirement arrangement ORA).and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.Sea the instructions for Part II,later. Sign signattim of 2021 Here U.S.person I, iq Dsle► General Instrueti ns •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www1n.gov/FcrmW9. •Form 1099-5(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tultion) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(TIN),adoption taxpayer identification number(ATIN),or employer identification number •Form 1099-A(acquisition or abandonment of secured property) (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only R you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your torted TIN. returns include,but are not limited to,the following. 1I you do rot retum Frohn W-9 to the requester,with a TIN,you might •Form 1099-INT Qnterest earned or paid) be sub/ect to backup withltoldJng.See What is backup withholding, later. Cat.No.10231X I-W-9(Rev.10.2018)