HomeMy WebLinkAbout20082516.tiff •
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1171 Production Dr. Van Wert, OH 45891
Phone: 419-238-1459 or 877-519-1459 * Fax: 419-238-1479
www . LifeStarRescue . com
PURCHASE AGREEMENT
Date: 9/11/08
Billing Information: Titling Information:
Name: Weld County Paramedic Service Name: Weld Co. Colorado
Address: 1121 M Street Address: 915 10i°Strut
Greeley,CO 80631 Greeley,CO 80631
Phone: 970-353-5700 x3206 Fax: 970-304-6408 Fed. ID# 84-6000813
Contact Person: Mitch Wagy Tax Exempt? Yes
If yes,fax or mail tax exemption form to Lite Star Rescue ASAP.
**If out of state and tax exempt,complete the following**
Driver's License ft: State: Exp. Dale:
Undersigned parties agree to the production and/or the subsequent purchase of a newly remounted Emergency Medical Ambulance as per
the terms described below:
Description:( 1 ) Remount of your Type III Braun Ambulance Module $ 44,250.00
Ford FIN# N/A Chassis: 2009 Chevy G4500 Cutaway (Includes all discounts) $ 34,000.00
Estimated Delivery: 12/23/08
Chassis prepayment $ 34,000.00 due
Additional Options Added: inverter,fog lights,grip strut runningboard inserts,scene&load lights,
rear bumper,air horns,front Iightbar, MasterTech III upgrade,delivery to&from LSRI $ 14,250.00
Trade-In Information: Allowance: (-)$ 2,500.011
Chassis Year,Make&Model:2005 Ford E450 Cutaway VIN#: I FDXE45P65HA09657
Module Make: N/A Module Ser#: N/A
Net Purchase Price (after discount—does not include any applicable taxes) $ 90.11011.011
TERMS: PAYMENT IN FULL ON ACCEPTANCE AND DELIVERY
F.O.B.: Greeley,Colorado(shipping included in above price)
Purchaser Signature: 2h, Date: 9/12/2008
Printed Name: William 11. Jerke Title: Chairman
cy
Life Star Rescue: .YJ7 // 't'l' Date: `/////04)'
Printed Name: Thomas J. Lehrman Title: TSS
IA/( V9
o?a47-.075/6
Must be original can not be faxed.
ST Form 14
POWER OF ATTORNEY
Van Wert County Clerk of Courfti, Van Wert of ic1
-
The undersigned hereby appoints:
Name — --
Address •-_ •
as my attorney-in-fact to make and execute the assignment of, or application for,
a Certificate of Title, Memorandum Certificate of Title, together with Si. Form No,
13 or Form Na.610, when required,for the following described motor vehicle or
house trailer:
Make - Year --
Motor No_ _ _ Serial-�� Serial No.
Price, including trade-in! �
[grant to the above attorney-in-fact full authority to do everything necessary egad
proper regarding the filing and execution of the above-named documents. The
above attorney-in-fart shall have full power of substitution and revocation and all
acts regarding the filing and execution of the above documents by the attorney-
en-fact or his substitute ititute shall be binding on men.
In Witness Whereof, the undersigned has caused his name to be subscribed
hereto this —,.day of 2.Ui
Sigleunb nt persons giving poww od Attorney
William H. Jerke Weld County
Printed Name / Customer Representing
ACKNOWLEDGMENT
STATE(*OHIO
Van Wert J ss
Before me a Notary Public in and for said County personally appeared
who acknowledged the
signing of the foregoing instrument and that such signing is his free ad and deed.
In Testimony Whereof, I have hereunto set my hand and affixed my official
seal this_ --- -. day of _.. 20
-
Rev. 3/9 nom. o4 Ch Notary Pohl ic
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