HomeMy WebLinkAbout20181623.tiffCustomer Purchase Order for John Deere Construction and Forestry Products - USA,
JOHN DEERE
PURCHASER NAME AND ADDRESS (First Signer)
NAME (First Midcle Initial. Last)
Weld County
STREET OR RR
1150 O Street
CITv
Greeley
PHONE NUMBER
(970) 356-4000
STATE
CO
EMAIL ADDRESS
IP CODE
80631
jlol soma, weldgov . com
COUNTY
Weld
PURCHASER NAME AND ADDRESS (Second Signer
NAME (First. Middle. Lash
STREET OR RR
CITY
PHONE NUMBER
EXTENDED WARRANTY IS
•
STATE
ZIP CODE
OUNTY
EMAIL ADDRESS
Accepted ri Rejected
(initials)
LOCATION OF FIRST
WORKING USE ►
DEALER NAME AND ADDRESS
DEALER NAME
4 Rivers Equipment, LLC
DEALER ACCOUNT NO
17-7476
STREET or RR
125 John Deere Drive
C! T
Fort Collins
DEALER ORDER NO
STATE
CO
ZIP CODE
80524
Date of Order:
04/05/18
TYPE OF SALE
■
CASH
LEASE C
TIME SALE
PURCHASER TYPE
4 County Government
MARKET USE CODE
49 Highways & Streets
Add purchaser to Mailing list (Check One or More'
Construction
Utility
Forestry D Government
PURCHASER IS
•
F''SINESS JAt
PURCHASER ACCT
109005
SOCIAL SECURITY I I IRS TAX ID
NO
EIN
COUNTY
Weld
Greeley
Ultimate Uptime Package Purchased
Yes
•
No
STATE
CO
COUNTY CODE
QTY
NEW DEMO RENT USED
EQUIPMENT (Give Model, Size &
Description) (Hours of Use)
PIN or Serial Number DELIVERED CASH PRICE
1
7
E
2018
John
Deere 772GP
Motor
Grader
Lift
Group
5
DW772GPPJF686456
$279,979.99
w/
❑
Options:
A,
B,
D,
E, F, G,
H
Bid
Award
.1
per
G
■
■
■
■
,
i
❑
❑
❑
Um
❑
LI
II
❑
❑
[.
Sales Price Used to Determine Lease Payment and Residual
IL__.
■
H.
1000
Hourr
Per Year
Lease - $1750.00
a month
4yr/5000hr FULL MACHINE WARRANTY
(1) TOTAL CASH PRICE $279 979.99
QTY
TRADE-IN (Model,
Size, Description) (Hours
of Use)
PIN OR SERIAL NUMBER AMOUNT
,
ACKNOWLEDGEMENTS: Purchaser offers to sell, transfer and convey the items(s) listed
or pnor to the time of delivery of the above product(s), as a "trade-in" to be applied against
represents that each "trade-in" item shall be free and clear of all security interests, liens,
transfer to the Dealer except to the extent shown below The price to be allowed for each
document The Purchaser promises to pay the balance due (line 9) shown hereon in cash,
Agreement (Retail Installment Contract), or a Loan Agreement for the purchase price of the
charges showr thereon or to execute a Lease Agreement, on or before delivery of the equipment
delivery of the oroduct(s) to the Purchaser, title shall remain with the Seller until one of the
Purchaser and the Dealer agree the this Purchase Order is not a security agreement and
the Purchaser pursuant to this Purchase Order will not constitute possession of the Products
for the purposes of the purchase money security provisions in any statutes relating to personal
equivalent Purchaser understands that its rights in connection with this purchase are limited
order
as "Trade In" to the Dealer at
the cash price Purchaser
and encumbrances at the time of
"trade-in" item is listed o this
or to execute a Time Sale
Product(s► plus additional
ordered herein Despite
foregoing is accomplished The
that delivery of the Product(s) to
by the Purchaser as a debtor
property security of its
as set forth in this purchase
(2) TOTAL TRADE-IN ALLOWANCE
$0.�0
(3) RENT APPLIED
(4) BALANCE (1-3)
$279,979.99
(5) SALES TAX
I
$0.00
(6) ADDITIONAL FEES
(7) SUB TOTAL
$279,979.99
(8) TRADE PAYOFF
(9) CASH WITH ORDER
(10) BALANCE DUE (7+8-9)
- ---e 19
•
apv
2:5 Ac (64.14e)
if
2018-1623
/ktotc2,
DISCLOSURE OF REGULATION APPLICABILTY: When operated in California, any off -road diesel vehicle may be subject to the California Air Resources Board In -Use Off -Road Diesel Vehicle
Regulation. It therefore could be subject to retrofit or accelerated turnover requirements to reduce emissions of air pollutants More information is available on the California Air Resources Board website
at http //www arb.ca.gov/msprog/ordiesel/ordiesel htm
IMPORTANT WARRANTY NOTICE: The Standard Warranty for new John Deere construction and forestry products is set forth in a separate document provided by the dealer Please read the Standard
Warranty carefully before signing No express warranty is made unless specified in the Warranty Statement PUCRCHASER'S RIGHTS AND REMEDIES PERTAINING TO THIS PURCHASE ARE
LIMITED AS INDICATED IN THE STANDARD WARRANTY AND PURCHASE ORDER. WHERE PERMITTED BY LAW, NO IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS IS MADE
TERMS & CONDITIONS VERIFICATION STATEMENT
Use of John Deere Data Services, if applicable, and all rights and obligations of John Deere and the Purchaser (or "Customer" as identified in the applicable agreement), are governed by the terms and
conditions outlined in the Warranty Statement and the applicable John Deere Construction & Forestry Company Subscriptions & Data Services Dealer Agreement and/or Customer Data Services
agreements available at www JohnDeere.com/Agreements Purchaser agrees to be bound by these terms and conditions if Purchaser activates or otherwise uses any of the Data Services If Purchaser
does not agree to these terms and conditions Purchaser must not activate or otherwise use the Data Services
The undersigned purchaser(s) (the "Purchaser") hereby orders the product(s) (the "Product") described above from the Dealer. The Dealer shall not be liable for failure to provide the
Product or for any delay in delivery if such failure or delay is due to the Dealer's inability to obtain such Product from the manufacturer or supplier or other cause beyond the Dealer's
control The cash price shown above is subject to the Dealer receiving the Product from the manufacturer or supplier prior to any change in price by the manufacturer or supplier and is
also subject to any new or increased taxes being imposed upon the sale of the Product after the date of this Purchase Order
Purchaser's signature below acknowledges the Purchaser has received a copy of the Standard Warranty, Version
Purchaser (First Signer)
Purchaser (Second Signer)
Dealer Representative
Salesperson
Weld County
Carlos Koons
Signature
Signature
Signature
Signature
(Initials) and understands its terms and conditions
thoett,-1-gr
Date
Date
Date
Date
MAY z 1 20%8
To the extent the equipment described herein has previous rental hours, notice is hereby given that 4 Rivers Equipment, LLC, has assigned its rights
to 4 Rivers Equipment Exchange, LLC to sell the rental equipment assigned herein.
�?a��- /2o
JOHN ' /EE
FINANCIAL
I
LEA*
LEASE AGREEMENT
Application ID 12582871
Version Number 3
Governmental
I FSSFE'S NAME AN!) PHYSICAL ADDRF.°,
WELD COUNTY
1150 0 ST
GREELEY, CO 80631-9596
LESSEES
TAX ID NUMBER
**-***0813
LESSEES
PHONE NO
970-356 4000
TYPE OF
BUSINESS
Municipality
LESSEE RESIDES IN (County/State) ;
WELD, CO
LESSEE AGREES TO KEEP GOODS IN Countylstate)
See Equipment Location and County for each Item of Equipment below
NAME AND TITLE OF SIGNING OFFICER
STEVE MORENO CHAIR -WELD COUNTY BOARD OF COMMISSIONERS
LESSOR'S NAME AND ADDRESSI
Deere Credit, Inc
P O Box 6600
Johnston IA 50131-2945
PHONE NUMBER
800.828-8297
This Lease Agreement ("Lease Agreement") is entered into between Deere Credit, Inc , as Lessor ("we", "us" or "our"), and the Lessee
and any Co -Lessee identified above ("you" or "your") ?
Each Lessee and Co -Lessee shall be jointly and severally liable for all obligations under this Lease Agreement
EQUIPMENT LEASED
Year
Make
Model
Equipment Description ,
Hour
Limit Per
Year
Excess
Hour
Charge
Equipment
Location
County
Outside
City Limits
2018
JD
772
772GP Motor Grader ,
1000
$65 00,
GREELEY CO
WELD
Yes
ADDITIONAL DETAILS ,
Product ID
Hour Meter
Asset Level Payment'
Purchase Option Price
1DW772GPPJF686456 W 772GP PJF686456
5i
$1,714 47
$267,200 00
Total Purchase Option Price ,
$267,200 00
'Asset Level Payments may not include applicable sales taxes For purposes of this Lease Agreement, "Lease Payments means the Lease Payment
as identified below
LEASE PAYMENTS
LEASE TERM START DATE May 18, 2018
LEASE TERM END DATE May 18, 2021 '
j
The first Lease Payment Due Date is May 18, 2018 and each successive Lease Payment is due on the same day of the Month thereafter, (the
"Billing Period'), unless otherwise provided below
NUMBER OF PAYMENTS
AGGREGATE OF ASSET
LEVEL PAYMENTS
SALES/USE F
TAX
SMM
LEASE PAYMENT
) DUE DATE
36
$1,714 47
$0 00
$34 29
$1,748 76
May 18, 2018
RECEIVED
MAY 2 9 2018
DEERE CREDIT, INC,
THE TERMS OF THIS CONTRACT ARE CONTAINED ON MORE THAN ONE PAGE
DOC7000
Settlement Nbr 12582871
Application ID 12582871
Equipment Type Construction & Forestry Commercial
Version Number 3 - 05/08/2018 11 38 AM
Page 1 of 5
Revision Date 15 January 2017
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TERMSEAND CONDITIONS
1 Lease Term. Payments You agree to lease from us the Equipment described in this Lease Agreement for the Lease Term The
Lease Term will begin on the Lease Term Start Date and end on the Lease Term End Date All attachments and accessories itemized in
this Lease Agreement and all replacements, parts and repairs to the Equipment shall form part of the Equipment This Lease Agreement
is not accepted by us until we sign it even if you have made a payment to us You agree to remit the Lease Payments each Billing Period
and all other amounts (including applicable sales, use and property taxes) when due to DEERE CREDIT INC P O Box 4450 Carol
Stream IL 60197-4450, even if we do not send you a bill or an invoice YOUR PAYMENT OBLIGATIONS ARE ABSOLUTE,
UNCONDITIONAL, AND ARE NOT SUBJECT TO CANCELLATION, REDUCTION OR SETOFF FOR ANY REASON WHATSOEVER
For any payment which is not received by its due date, you agree to pay a late charge equal to 4 000% of the past due amount (not to
exceed the maximum amount permitted by law) as reasonable collection costs, plus interest from the due date until paid at a rate of 1 5%
per month, but in no event more than the maximum lawful rate Restrictive endorsements on checks you send us will not change or
reduce your obligations to us If a payment is returned to us by the bank for any reason; you agree to pay us a fee of $25 00 or the
maximum amount permitted by law, whichever is less Lease Payments and other payments may be applied, at our discretion, to any
obligation you may have to us or any of our affiliates If the Total of all payments made dunng the Lease Term exceeds the total of all
amounts due under this Lease Agreement by less than $25Y00 we may retain such excess Lease Payments may be based on the
assumption that we will be entitled to certain tax benefits as the owner of the Equipment If you take or fail to take any action that results
in a loss of such tax benefits you will pay us on demand the amount we calculate as the value of such lost tax benefits You certify that
the hour meter reading on each Item of Equipment is accurate as of the date you sign this Lease Agreement If you use any Equipment
dunng the Lease Term for more than the Hour Limit indicated;above for that Item of Equipment, you will pay to us within 10 days of the
Lease Term End Date (or any earlier termination of this Lease Agreement) an amount equal to the Excess Hour Charge for that Item of
Equipment for each hour in excess of the Hourly Limit If this 'Lease Agreement is terminated, canceled or extended for any reason the
Hour Limit will be prorated by us in our sole discretion r
2 Security Deposit If a Security Deposit is indicated in the Advance Lease Payment Invoice, the Security Deposit will be held by us
in a non -interest -bearing account commingled with other funds We may apply the Security Deposit to any amounts due under this
Lease Agreement and, if we do so, you agree to promptly remit to us the amount necessaryito restore the Security Deposit to the original
amount The Security Deposit will be returned to you within 30 days of termination of this Lease Agreement and final inspection by us,
provided you are not in default
3 Taxes Although you may be exempt from the payment of certain Taxes, you agree to pay us when invoiced (a) all sales, use,
rental, gross receipts and all other taxes which may be imposed on the Equipment or its use, and (b) all taxes and governmental
charges associated with the ownership, use or possession of the Equipment including, but not limited to, personal property and ad
valorem taxes ("Taxes") Taxes do not include those measured by our net income If applicable law requires tax returns or reports
to be filed by you, you agree to promptly file such tax return and reports and deliver copies to us You agree to keep and make
available to us all tax returns and reports for Taxes paid by you
4 Ownership. Missing Information We are the owner of the Equipment and you have the right to use the Equipment under the
terms of this Lease Agreement You agree to keep the Equipment free and clear of liens and encumbrances except those in our favor,
and promptly notify us if a lien or encumbrance is placed or threatened against the Equipment You irrevocably authonze us, at any time
to (a) insert or correct information on this Lease Agreement, including your correct legal name, serial numbers and equipment
descnptions, (b) submit notices and proofs of loss for any required insurance, and (c) endorse your name on remittances for insurance
and Equipment sale or lease proceeds
5 Eauloment Maintenance. Operation and Use You agree to (a) USE THE EQUIPMENT ONLY FOR AGRICULTURAL,
BUSINESS OR COMMERCIAL PURPOSES AND NOT FOR PERSONAL, FAMILY OR HOUSEHOLD PURPOSES, (b) not permanently
move the Equipment to another county or state without notifying us within 30 days, (c) operate and maintain the Equipment in
accordance with all (i) laws, ordinances and regulations (ii) manuals and other instructions issued by the manufacturer(s) and supplier(s),
and (iii) insurance policy terms and requirements, (d) perform' (at your own expense) all maintenance and repairs necessary to keep the
Equipment in as good a condition as when delivered to you, 'reasonable wear excepted, (e) not install any accessory or device on the
Equipment which negatively affects the value, useful life or the originally intended function 'or use of the Equipment in any way unless it
can be removed without damaging the Equipment, (f) allow us and our agent(s) to inspect the Equipment and all of your records related
to its use, maintenance and repair at any reasonable time, (g) keep any metering device installed on the Equipment connected and in
good working condition at all times, (h) affix and maintain, in a prominent place on the Equipment, any labels, plates or other markings
we may provide to you, and (i) not permit the Equipment to be used by, or to be in the possession of, anyone other than you or your
employees
6 insurance You agree, at your cost, to (a) keep the Equipment insured against all risks of physical damage for no less than its
Termination Value (as such term is defined in Section 7 below), naming us (and our successors and assigns) as sole loss payee, and (b)
maintain public liability insurance, covering personal injury and property damage for not less than $1,000,000 per occurrence, naming us
(and our successors and assigns) as additional insured All, insurance must be with companies and policies acceptable to us Your
obligation to Insure the Equipment continues until you return the Equipment to us and we accept it Each insurance policy must provide
that (a) our interest in the policy will not be invalidated by apy act, omission, breach or neglect of anyone other than us, and (b) the
insurer will give us at least 30 days' prior wntten notice before any cancellation of, or matenal change to, the policy
Unless you provide us with evidence of the required insurance coverages we may purchase insurance, at your expense to protect
our Interests in the Equipment This insurance may not (a) protect your interests, or (b) pay any claim that you make or any claim that is
made against you in connection with the Equipment You may later cancel any insurance purchased by us, but only after providing us
with evidence that you have obtained the insurance required I?y this Lease Agreement The cost of the insurance may be more than the
cost of insurance you may be able to obtain on your own kk;
THE TERMS OF THIS CONTRACT 'ARE CONTAINED ON MORE THAN ONE PAGE
DOC7000
Settlement Nbr 12582871
Application ID 12582871
3
Equipment Type Construction & Forestry Commercial
Version Number 3 05/08/2018 11 38 AM
Page 2 of 5
Revision Date 15 January 2017
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7 Loss or Damage Until the Equipment is returned to us in satisfactory condition, you are responsible for all risk of loss, damage,
theft, destruction or seizure of the Equipment (an "Event of Loss") You must promptly notify us of any Event of Loss If the Equipment
can be repaired or replaced you agree to promptly repair or replace the Equipment, at your cost, and the terms of this Lease Agreement
will continue to apply If the Equipment cannot be repairedlor replaced, you agree to pay us, within 10 days of the Event of Loss, its
Termination Value as of the day before such Event of Loss occurred Upon receipt of the Termination Value, we will transfer to you (or
the insurance company) all of our rights, title and Interest in such Item(s) of Equipment (each, an "Item of Equipment ) AS -IS, WHERE -
IS, WITHOUT ANY WARRANTY AS TO CONDITION OR VALUE
All insurance proceeds must be paid directly to us, and we may apply any excess insurance proceeds to any other amounts you owe
us or any of our affiliates "Termination Value' for any Item of Equipment shall be the net book value calculated as the sum of (a) all
Lease Payments and any other amounts then due and payable to us, plus (b) the present value of all remaining Lease Payments and
other amounts, discounted at the, Internal Rate of Return or,' if a discount rate is set forth in this Lease Agreement, such discount rate
(the "Discount Rate"), plus (c) the unamortized amount of our:direct costs of onginating and administering this Lease Agreement plus (d)
cost to repair and refurbish the Item so that it is in satisfactory condition in accordance with Section 10, plus (e) the present value of the
Purchase Option Price (or, if there is no Purchase Option Price, the residual value that we assumed in calculating the Lease Payments)
discounted at the Discount Rate "Internal Rate of Return" shall be calculated using standard finance techniques with the equipment cost
Lease Payments, Lease Term and Purchase Option Pnce (or residual value assumption)'as the variables "Discount Rate" shall mean
the Internal Rate of Return minus two percentage points (2%);
8 Purchase Option In the event you desire to purchase an Item of Equipment at the Lease Term End Date and you are not in
default, you agree to pay us the applicable Purchase Option Price (plus applicable Taxes including estimated property taxes) for each
Item of Equipment Upon receipt of the Purchase Option Price and any other amounts yiou owe us on or before the Lease Term End
Date, we will transfer to you all of our right, title and interest in such Item(s) of Equipment AS -IS, WHERE -IS, WITHOUT ANY
WARRANTY AS TO CONDITION OR VALUE
9 Early Payoff In the event you desire to purchase an Item of Equipment prior to the Lease Term End Date, are not in default, and
you request a payoff amount quote, you agree to pay us the payoff amount Upon receipt of the payoff amount, we will transfer to you all
of our right, title and interest in such Item of Equipment AS -IS, WHERE -IS, WITHOUT' ANY WARRANTY AS TO CONDITION OR
VALUE r
10 Return of Equipment If this Lease Agreement is terminated for any reason and you do not (a) return the Equipment to us, or, (b)
exercise any Purchase Option, you agree to remit to us, until such time as the Equipment is returned to us in accordance with the
provisions of this Section, lease payments each month equal to the higher of (i) the monthly fair market rental value of the Equipment, as
determined by us in our sole discretion or (ii) the monthly Lease Payment (or the monthly lease payment equivalent if the Lease
Payments are other than monthly (e g , for annual Lease Payments the monthly lease payment equivalent would be calculated by
dividing the annual Lease Payment by 12)) All Equipment must be returned to the nearest John Deere dealer that sells equipment
substantially similar to the Equipment, at your expense and in satisfactory condition, along:with all use, maintenance and repair records
Equipment is in satisfactory condition if it is in as good a condition as when the Equipment was delivered to you, reasonable wear
excepted Unsatisfactory condition shall include any condition described below ("Excessive Wear and Tear')
fa) Mechanical (A) Computer systems or safety and emission control equipment =not in proper working order, (B) mechanical
components that are missing, broken or unsafe or that do not operate normally, given the age of the Equipment (C) wear on power
train assembly that exceeds manufacturer's standardsifor normal wear and tear, i(D) any air filters not within manufacturer's
specifications, (E) any gauges or fluid indicators that are damaged or do not function, (F) the electrical system fails to operate
properly, (G) the battery fails to hold a charge, (H) any wire harnesses not tied down and kept secured, dry and clean (I) any pumps,
motors, valves or cylinders not in good operating condition or that fail to meet manufacturer's rated specifications (J) hydraulic
system exceeds manufacturer's then -current contaminant standards (as shown by oil'sample analysis), (K) equipment not serviced
according to manufacturer's operating manual, and/or (L) any lubricant water or A/C seal leaks
fb) Exterior (A) Dents larger than 2 inches in diameter; (B) excessive number of dents or scratches, (C) any scratch 8' or longer
that reaches the metal skin (D) any single chip the size of a quarter or larger or multiple small chips within one square foot (E)
substandard paint repairs, such as peeling, bubbling of mismatched shades that evidence poor condition in comparison to the
onginal paint and require repainting at a cost in excess of $200 (F) rust holes in the body metal or a rust spot that covers more than
a 4 -inch square area, (G) any glass that must be replaced due to cracks or missing glass and any windshield damages cracked or
broken glass must be replaced (H) all frame damage and substandard frame repairs and/or (I) any tires or tracks that (i) have
broken side walls or excessive cuts or damages, (ii) have less than 50% of the original useful life remaining, or (iii) are not of the
same size, type grade or equivalent quality manufacturer as were originally included on`the Equipment
(cl Cab/Operator Platform (A) Heavy interior soil or strong odors, such as manure Jthat cannot be removed by general cleaning
(B) unclean condition of operator environment and/or i(C) holes tears or burns on the dash floor covers, seats headliners,
upholstery or interior
(d) General (A) Equipment not operated or maintained in accordance with manufacturer's specifications or if components, fuels or
fluids, on or in connection with the Equipment that do not meet manufacturers standards were used, and/or (B) any other damage
that in the aggregate costs $250 or more to repair or that makes the Equipment unlawful or unsafe to operate
(e) Other (A) All warranty and PIP ("Product Improvement Program") work relating to the Equipment must be completed pnor to the
Lease Term End Date, (B) the Equipment must be cleaned prior to its return i
ff) Hour Meter For each Item of Equipment returned with a broken or missing hour meter, you shall accept an invoice from us and
remit to us an amount equal to $1 000 You agree that the hour meter included with the Equipment is conclusive of the number of
hours of Equipment use
fa) Invoices for Excess Wear And Tear. Upon any return of the Equipment, we shall, in our sole discretion determine the existence
of any Excessive Wear and Tear In the event any Item of Equipment is returned to us with Excessive Wear and Tear, you shall, at
our sole discretion (A) accept an invoice from us and remit to us the cost of repairing or replacing the affected component(s) which
we determine necessary to return the Equipment to its required condition, and/or (B) accept an invoice from us and remit to us an
amount equal to our estimate of (i) the cost of new tires or tracks if the tires or tracks are damaged due to broken side walls or
excessive cuts or damage, or (ii) the cost of new tires or tracks multiplied by they difference between (a) our estimate of the
percentage of the useful life of the tires and tracks then (remaining, and (b) 50% For example, if you return Equipment with tires
having 20% of their useful life remaining, you would remit to us an amount equal to 30% of the cost of new tires ((50% - 20%)
multiplied by the cost of new tires) Your failure to remit the required payment to us within 10 days of demand shall constitute a
default by you under the terms of this Lease Agreement
THE TERMS OF THIS CONTRACT ARE CONTAINED ON MORE THAN ONE PAGE
Settlement Nbr 12582871 Equipment Type Construction 8 Forestry Commercial
DOC7000
Application ID 12582871
Version Number 3 05/08/2018 11 38 AM
Page 3 of 5
Revision Date 15 January 2017
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11 Default You will be in default if (a) you fail to remit to us any Lease Payment or other payment when due, (b) you breach any
other provision of this Lease Agreement and fail tD cure such breach within 10 days, (c) you remove any Equipment from the United
States, (d) a petition is filed by or against you or any guarantor under any bankruptcy or insolvency law, (e) a default occurs under any
other agreement between you (or any of your affiliates) and us (or any of our affiliates), (f) you or any guarantor is acquired by, merges
with or consolidates into another entity, sells substantially all its assets, dissolves or terminates its existence or (if an individual) dies, or
(g) you fail to maintain the insurance required by Section 6 Tyne is of the essence under this Lease Agreement
12 Remedies If a default occurs, we may to the extent permitted by applicable law, do one or more of the following (a) require you
to return the Equipment in the manner outlined in Section 10, or take possession of the Equipment, (b) recover from you, AS
LIQUIDATED DAMAGES FOR LOSS OF BARGAIN AND NOT AS A PENALTY (i) if the Equipmeht is returned to to us, the sum of (1) all
Lease Payments and any other amounts then due and payable to us, (2) the present value of all remaining Lease Payments and other
amounts, discounted at the Discount Rate, (3) the cost to repair and refurbish the Item of Equipment so that it is in satisfactory condition
in accordance with Section 10, and (4) the unamortized amount of our initial direct costs of onginating and administering this Lease
Agreement (ii) if the Equipment is returned to us and this Lease Agreement is deemed to be a secured transaction and not a lease in our
sole discretion, the difference between (1) the Termination Value as of the date of such default, and (2) the net proceeds we receive from
any sale lease or other disposition of the Equipment (after (deducting all of our costs and expenses) or (iii) If the Equipment is not
returned to us, the Termination Value as of the date of such default, (c) declare any other agreements between you and us (or any of our
affiliates) in default, (d) terminate any of your rights (but none 'of your obligations) under this Lease Agreement and any other agreement
between you and us (or any of our affiliates), (e) charge you for the expenses incurred in connection with the enforcement of our
remedies including, without limitation repossession, repair and collection costs attorneys', fees and court costs (f) exercise any other
remedy available at law or in equity, and (g) take on your behalf (at your expense) any action required by this Lease Agreement which
you fail to take These remedies are cumulative, are in addition to any other remedies provided by law and may be exercised
concurrently or separately Any failure or delay by us to exercise any right shall not operate as a waiver of any other nght or future right
13 Assianment You will not assign, pledge or otherwise transfer any of your rights or interests in this Lease Agreement or any
Equipment without our pnor written consent Any assignment without our consent will be void This Lease Agreement shall be binding
upon any successor or permitted assignee We may assign this Lease Agreement or our interest in the Equipment at any time without
notice to you and without your consent We may provide information about you to any prospective assignee or participant You agree
not to assert against our assignee any claims, offsets or defenses which you may have against us
14 Indemnity You are responsible for all losses, damage, claims injuries to or the death of an individual, and attorneys' fees and
costs ("Claims ), incurred or asserted by any person, in any manner related to the Equipment or this Lease Agreement thereof, including
its use condition or possession You agree to defend and indemnify us and hold us harmless, against all Claims, although we reserve
the right to control the defense and to select or approve defense counsel You will promptly notify us of all Claims made Your liability
under this Section is not limited to the amounts of insurance required under this Lease Agreement This indemnity continues beyond the
termination of this Lease Agreement for acts or omissions which occurred during the Lease Term
15 Representations and Warranties You represent and warrant to us, as of the date of this Lease Agreement and covenant to
us so long as this Lease Agreement is in effect, that a) you are a State, or a political subdivision thereof, for purposes of Section
103 of the Internal Revenue Code of 1986, as amended (the "Code"), (b) any documents required to be delivered in connection
with the Lease (collectively, the "Documents") have been `,duly authorized by you in accordance with all applicable laws rules,
ordinances, and regulations, (c) the Documents are valid, legal, binding agreements, enforceable in accordance with their terms and
the person(s) signing the Documents have the authority to do so, are acting with the full authorization of your governing body, and
hold the offices indicated below their signatures, (d) the Equipment is essential to the immediate performance of a governmental or
proprietary function by you within the scope of your authonty and shall be used during the Lease Term only by you and only to
perform such function (e) you intend to use the EquipmentIlforthe entire Lease Term and shall take all necessary action to include
in your annual budget any funds required to fulfill your obligations each fiscal period during the Lease Term, (f) you have complied
fully with all applicable law governing open meetings, public bidding and appropnations, required in connection with the Lease and the
debt under applicable state law, (g) your obligations to remit Lease Payments and other amounts due and to become due under
the Lease constitute a current expense and not a debt under applicable state law, (h) all financial information you have provided is
true and a reasonable representation of your financial condition, (i) you shall not do or cause to be done any act which shall cause
or by omission of any act allow the interest portion of and Lease Payment to become includible in our gross income for Federal
income taxation purposes under the Code, (I) you shall maintain a complete and accurate account of all assignments of the Lease
in the form sufficient to comply with book entry requirements of Section 149(a) of the Code and the regulations prescribed
thereunder from time to time, and (k) you shall comply with the information reporting requirements of Section 149(e) of the Code
Such compliance shall include, but not be limited to, the execution of 8038-G or 8038 -GC Information Returns
You acknowledge and agree that (a) we did not select, manufacture or supply any of the Equipment, (b) we acquired the
Equipment at your direction, (c) you selected the supplier of the Equipment, (d) you 'are entitled to all manufacturer warranties
("Warranty Rights") and we assign all Warranty Rights, to, you, to the extent assignable, (e) you may request an accurate and
complete statement of the Warranty Rights, including any disclaimers and limitations, directly from the manufacturer, and (f) you
assign to us all your rights (but none of your obligations) under all purchase orders, purchase agreements or similar documents
relating to the Equipment You waive all rights and remediei conferred upon a lessee under Sections 508 - 522 of Article 2A of the
Uniform Commercial Code
16 Governing Law. Jurisdiction. Venue. THIS LEASE AGREEMENT WILL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF IOWA, WHERE THIS LEASE AGREEMENT IS ACCEPTED AND ENTERED INTO, except for its
conflict of laws provisions You irrevocably submit to the non 'exclusive Jurisdiction and venue of federal and state courts located in Des
Moines, Iowa and will not claim it is an inconvenient forum far legal action YOU AND WE IRREVOCABLY WAIVE ANY RIGHT YOU
AND WE MAY HAVE TO A JURY TRIAL
17 Miscellaneous WE HAVE NOT MADE, AND DO NIOT MAKE, ANY REPRESENTATION OR WARRANTY, EXPRESS OR
IMPLIED, AS TO THE EQUIPMENT'S MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, SUITABILITY, OR
OTHERWISE WE ARE NOT LIABLE FOR CONSEQUENTIAL OR SPECIAL DAMAGES ; You acknowledge that no supplier or dealer
of the Equipment Is an agent of ours, or authorized to act for o,r bind us You agree not to withhold any amount you owe us if you believe
you have a claim against us, or any Equipment supplier(s) or manufacturer(s), but to pursue that claim independently Any claim you
have against us must be made within two years after the event that caused it All notices must be in writing and will be deemed given 5
days after mailing to the intended recipient at Its address indicated above, unless changed by a notice given in accordance with this
Section This Lease Agreement supersedes and replaces alliprior understandings and communications (oral or written) concerning the
t
THE TERMS OF THIS CONTRACT ARE CONTAINED ON MORE THAN ONE PAGE
DOC7000
Settlement Nbr 12582871
Application ID 12582871
Equipment Type Construction & Forestry Commercial
Version Number 3 05/08/2018 11 38 AM
Page 4 of 5
Revision Date 15 January 2017
ll1Hi
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subject matter thereof Except as otherwise provided in Section 12(d) no part of this Lease Agreement can be amended, waived or
terminated except by a wnting signed by both you and us Any part of this Lease Agreement may be signed in separate counterparts
that, together, will constitute one document If a court finds any part of this Lease Agreement to be invalid or unenforceable, the
remainder of this Lease Agreement will remain in effect YoU permit us to monitor and record telephone conversations between you and
us By providing any telephone number, including a mobile phone number to us, any of,our affiliates or any debt collectors we retain,
we, such affiliates and such retained debt collectors can contact you using that number, including calls using an automatic dialing and
announcing device and prerecorded calls and that such calls are not "unsolicited" under state or federal law All of our rights under this
Lease Agreement shall remain in effect after the expiration of,the Lease Term or termination of this Lease Agreement
Notwithstanding any other election you make, you agree that (a) we can access, retain and use, at any times we elect any
information regarding the location, maintenance, operation and condition of the Equipment, (b) you irrevocably authonze anyone in
possession of that information to provide all of that information to us upon our request until our secunty interest in the Equipment is
terminated, (c) you will not disable or otherwise interfere with any information gathering or transmission device within or attached to the
Equipment, and (d) we may reactivate any such device o
You acknowledge and agree that our right to sell the Equipment under this Lease Agreement will be, at our sole discretion, assigned
to John Deere Exchange, LLC Notwithstanding anything above to the contrary regardless of our assignment of these rights you
acknowledge and agree that all obligations of you and us under this Lease Agreement shall govern the relationship between you and us
hereto
18 Non-Annronriatlon of Funds You Intend to remit to us all Lease Payments and other payments for the full Lease Term if
funds are legally available In the event you are not granted an appropnation of funds at any time during the Lease Term for the
Equipment or for equipment which is functionally similar to the Equipment and operating funds are not otherwise available to you to
remit Lease Payments and other payments due and to become due under this Lease Agreement, and there is no other legal
procedure or available funds by or with which payment can be made to us, and the non -appropriation did not result from an act or
omission by you, you shall have the right to return the Equipment in accordance with Section 10 of this Lease Agreement and
terminate this Lease Agreement on the last day of the fiscal period for which appropnations were received without penalty or
expense to you, except as to the portion of the Lease Payments for which funds shall have been appropriated and budgeted At
least 30 days prior to the end of your fiscal period, your chief executive officer (or legal counsel) shall certify in writing that (a) funds
have not been appropriated for the fiscal period, (b) such non -appropriation did not result from any act or failure to act by you, and
(c) you have exhausted all funds legally available to pay Lease Payments If you terminate the Lease because of a non -
appropriation of funds, you may not, to the extent permitted by applicable law, purchase, lease, or rent, during the subsequent fiscal
period, equipment performing the same functions as or functions taking the place of, those performed by the Equipment This
Section 18 shall not permit you to terminate the Lease in order to acquire any other equipment or to allocate funds directly or
indirectly to perform essentially the application for which the Equipment is intended
If you terminate the Lease because of a non -appropriation of funds, the provisions of Section 8 shall not apply
THE TERMS OF THIS LEASE AGREEMENT SHOULD BE, READ CAREFULLY BEFORE SIGNING BECAUSE ONLY THESE
WRITTEN TERMS ARE ENFORCEABLE NO OTHER TERMS OR ORAL PROMISES MAY BE LEGALLY ENFORCED BY
SIGNING THIS LEASE AGREEMENT, YOU AGREE TO ALL OF THE TERMS AND CONDITIONS SET FORTH IN THIS LEASE
AGREEMENT THIS LEASE AGREEMENT IS THE COMPLETE AND EXCLUSIVE STATEMENT OF THE AGREEMENT BETWEEN
YOU AND US, EXCEPT AS WE MAY LATER AGREE IN WRITING TO MODIFY IT
NOTICES TO THE LESSEE- DO NOT SIGN THIS LEASE AGREEMENT IN BLANK YOU ARE ENTITLED TO A COPY OF THE
LEASE AGREEMENT AT THE TIME YOU SIGN IT TO PROTECT YOUR LEGAL RIGHTS
WELD COUNTY
IVIAY 21 2018 By
(Date Signed)
STEVE MORENO CHAIR -WELD COUNTY BOARD OF COMMISSIONERS
Accepted By Deere Credit, Inc (Lessor)
6400 NW 86th Street, Johnston, IA 50131.6600
Cp)1)/
(Date Agreement Signed) (Authorized Signature)
By (
i
THE TERMS OF THIS CONTRACT ARE CONTAINED ON MORE THAN ONE PAGE
DOC7000
Settlement Nbr 12582871
Application ID 12582871
Equipment Type Construction & Forestry Commercial
Version Number 3 05/08/2018 11 38 AM
Page 5 of 5
Revision Date 15 January 2017
IIIIIII
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Aavance Lease rayment invoice
Cei JOHN DEERE
FINANCIAL
Due Date
05/18/2018
Total Due
$1,748 76
Purchase Order
Number
Billing Address
Updated Billing Information,
WELD COUNTY
PO BOX 758
GREELEY, CO 80632-0758
Please Note All future invoices will be sent to the billing address shown unless you update your billing information above
Mfg
Model
Product ID
Due Date
Payment
Sales/Use
Tax
Security
Deposit
'vTotal Due AC
Signing '
JD
772
1DW772GPPJF686456
05/18/2018
$1,748 76
$0 00
$0 00
a .$1-,748-76
Correspondence Only
Remit Checks Payable To, -
Deere Credit, Inc
Attn Lease Administration
PO Box 6600
Johnston, IA 50131-6600
Phone (800) 828-8297
Fax (800) 254-0020
Deere Credit, Inc
Attn Acct Dept - ALP Processing
PO Box 6600
Johnston, IA 50131-6600
TO ENSURE PROPER CREDIT, STAPLE CHECK AND RETURN THIS INVOICE WITH THE LEASE AGREEMENT
DOCUMENTS
STAPLE ADVANCE LEASE PAYMENT CHECK HERE
Every dishonored check will result In a fee of $25 00 or an amount not to exceed the highest amount permitted by law
Revision Date 15 January 2017
FORM0716
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IIIM
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JOHN DEERE
FINANCIAL
Delivery and Acknowledgment
LESSEE
IWELD COUNTY
1150 O ST, GREELEY, CO 80631-9596
LESSOR
DEERE CREDIT, INC
6400 NW 86th ST, PO BOX 6600, JOHNSTON, IA 50131-6600
Capitalized terms shall have the meanings set forth in the Lease Agreement
You hereby represent and warrant that (a) all of the Equipment more fully described in the Lease Agreement was selected by you, (b) all of
the Equipment and the Operator's Manuals have been delivered to, and received by, `you, (c) you received the manufacturer's written
warranty applicable to the Equipment and you understand that your rights are subject to the limitations outlined therein, (d) the safe
operation and the proper servicing of the Equipment has been `explained to you, (e) all of the Equipment has been inspected by you and is
in good working order and repair (operating or otherwise), (f) the Equipment shall be used only for the purpose indicated in the Lease
Agreement, (g) all of the Equipment is unconditionally and irrevocably accepted by you for all purposes under the Lease Agreement, and (h)
all information you provide to us is true and correct
Signed by Lessee's duly authorized representative on the date shown below
WELD COUNTY
RAY 21 2013 By
(Date Signed)
STEVE MORENO CHAIR -WELD COUNTY BOARD OF COMMISSIONERS
f
Revision Date 25 February 2018
DOC7009
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t
O.JOHN DEERE
FINANCIAL
Physical Damage/Liability Insurance
LESSEE:
1150
WELD
COUNTY
O ST,
GREELEY,
CO 80631-9596
LESSOR:
6400
DEERE
NW
CREDIT,
86th
ST,
INC.
PO
BOX 6600,
JOHNSTON,
IA
50131-6600
LIABILITY
INSURANCE
on
the
Lease
Agreement
will
be
provided
by
the following
insurance agency:
Name
of
Agency:
enury
r
.--------
f wtrwm
`
cA
cc/Limes Zlic
Phone
Number
of Agency:
303 16i-- & Cc) 7
y
Mailing
Address
of
Agency:/
Fax
Number
of
Agency:
.-, _
Clio'
c,i
_
g
oo �
f
,- A
"
5ra.) O3
PHYSICAL
DAMAGE
INSURANCE
on
the
Lease
Agreement
will
be
provided
by
the
following
agency:
Name
of
Agency:
a
/14.e---
Phone
Number
of
Agency:
Mailing
Address
of
Agency:
Fax
Number
of
Agency:
If
an insurance
certificate
is
ADDITIONAL
available,
Its
6400
Johnston,
Deere
Successors
in
NW
INSURED
Credit,
place
86th
IA
50131
of
Inc.
St
&/or
the
above
and
Assigns
information,
LOSS
PAYEE:
it
should
be
provided
to.
I
insurance,
successors
agree
and
understand
covering
and
assigns)
personal
that,
as
pursuant
injury
additional
and
to
insured:
the
property
provisions
and
damage
(b)
of
keep
Section
for
the
not
Equipment
6
less
of
than
the
Lease
$1,000,000
insured
Agreement,
against
per
occurrence,
all
I
must
risks
of
at
physical
all
naming
times
damage
(a) maintain
Deere Credit,
for
no
public
Inc.
less
(and
liability
than
its
its
Termination
as
NOTICES
OF
sole
THE
loss
PHYSICAL
TO
Value
payee.
LESSEE-
(as
such
DAMAGE/LIABILITY
DO
term
NOT
is defined
SIGN
THIS
INSURANCE
in
Section
PHYSICAL
7
of
AT
the
DAMAGE/LIABILITY
THE
Lease
TIME
Agreement).
YOU
SIGN
INSURANCE
naming
IT
TO
PROTECT
Deere
IN
Credit,
BLANK.
YOUR
Inc
YOU
LEGAL
(and
ARE
its
RIGHTS.
successors
ENTITLED
and
TO
assigns)
A COPY
WELD COUNTY
MAY 212018
(Date Signed)
STEVE MORENO. CHAIR -WELD COUNTY BOARD OF COMMISSIONERS
Revision Date 15 January 2017
Apps cation ID 1258287
Version Number 3
2t/t /L013
FORM0717
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Page 1of1
DR 5002 (06/19/15)
COLORADO DEPARTMENT OF REVENUE
Standard Colorado Affidavit of Exempt Sale
This form is required by the State of Colorado for any transaction on which an exemption from state tax is claimed for
charitable and government entities. The seller is required to maintain a completed form for each tax-exempt sale.
Furnish this form to the seller. Do not return this form to the State of Colorado.
Purchase
Details
❑
Purchase
for resale
- or -
❑
Purchase
for wholesale
(see instructions)
State
license
number
(not
FEIN
number):
Issuing
state
Expiration
(Attach
a
copy
of
state
license)
❑
I
affirm
items
purchased
are
for resale/wholesale
in
the
ordinary
course of
business.
Initial
❑
Purchase
by
religious
or charitable
organization
(exemptions
may vary
by jurisdiction)
State
tax-exempt
number
(not
FEIN
number):
(Attach
a
copy
of
state
exemption
certificate)
Payment
information
(required
to
meet
one
of
the
following):
❑
Paid
by
cash
and
accompanied
by
a
purchase
order
from
the
organization
❑
Paid
by
check
drawn
on
funds
of
the
exempt
organization
❑
Paid
by
purchasing
card
bearing
information
of
the
exempt
organization
The
embossed
name
of
the card
is:
❑
Paid
by
commercial
card
not
a
personal
credit
card
-
card's
last
four digits:
2
Purchase
Credit
card
by
number
federal,
(first
state,
six
or
and
local
last
government
four
only:
-
xx-xxxx-
.
Federal
government
(payment
information
- required
to
meet
one of
the
following):
❑
GSA
SmartPay2
card
—
fleet
card
with
picture
of a road
and
flag
❑
GSA
SmartPay2
card
—
purchase
card
with
picture
of
a
keyboard
and
flag
❑
GSA
SmartPay2
card
—
travel
card
with
picture
of
an airplane
and
flag
❑
GSA
SmartPay2
card
—
integrated
card
with
picture
of
an eagle
and
flag
❑
Dept
of
Interior
agency issued
card
— agency
name
Stat
Zr
Paid
nd
local
by check
government
issued
by
(payment
and
drawn
information
on
funds
from
- required
the
government
to meet
agency
one
of
the
following):
❑
Paid
by government
purchase
card
as designated
on the
card
State
tax-exempt
number
printed
on
the
card
(Colorado
only):
❑
Check
if
the card
states
"for
official
state
use
only"
or "tax
exempt"
■
Purchase
by
foreign
and
diplomatic
exemptions
(required
to
meet the
following):
❑
Purchaser
presents
a state
department
issued
card
with
the
name/photo
of
the
bearer on the
card.
If
presented
with
this card,
documentation
of
form
of
payment
is not
required
(excluding
mission card).
Purchaser
Information
Legal
WELD
Name
COUNTY
of
Company/Organization;Agency
Name
Purchaser
Name (Printed)
fd
G A r
rer.tce
,3oc c A.'
≤ft
c/c
Address
1150
O
ST
City
GREELEY
State
CO
Zip + 4
80631-9596
Phone
(970)
356-4000
State/Driver License #
Description
CONSTRUCTION
of
Normal
Course
of Business
Under
tax-exempt
applicable
penalty
penalty
will
of
perjury,
be used
or
for
interest
I swear or
official
if my
affirm
business
purchase
that the
of the
is found
information
above
on
-named
to not qualify
this
organization
for
form
the
is true
or
exemption
and correct
agency
or if
as to every
I accept that
the information
material
I remain directly
asserted
matter
in this
liable
form
I affirm
for the
is deemed
that the items
taxes and any
fraudulent
purchased
Signature
�''
lekt7-1.-42.41--
Date
MAY
21 2018
Seller
Verification
Seller
DEERE
Name
CREDIT,
INC.
Location
17-7473
#
Date
05/08/18
Transaction
12582871
ID
Employee ID#
: Initials
[Description
of
Items
Purchased or Attach Duplicate
Receipt'lnco;ce
Exempted Amount of Purchase
MOTOR
GRADER
+
oto/8 /4,023
DR 5002 (06/19/15)
COLORADO DEPARTMENT OF REVENUE
Instructions for State of Colorado Affidavit of Exempt Sale
These instructions are specific to the State of Colorado in which this purchase has been made Qualifying for an
exemption may be different for each local jurisdiction, and these instructions are not intended to set forth the requirements
of any local jurisdiction
General instructions
Purpose of Form
This form is used to certify to sellers that a purchase
qualifies for exemption under Title 39, Article 26 of the
Colorado Revised Statutes
For Sellers, accepting and keeping this document helps
you get correct information about the purchaser, which
helps you prove this is an exempt sale during a tax audit
For Purchasers, completing this document and giving it to
a seller helps to speed up your purchase process
Reminders
Furnish to seller This form should be furnished to the
seller charging the tax Do not send this form to the State
of Colorado This form is not for organizations to request
certification of their tax exempt status
Direct payment required Purchases must be billed to and
paid directly by the funds of the organization or agency in
order to qualify for exemption Payment in cash (without
a purchase order) or by personal check or personal credit
card disqualifies a purchase from exemption even if the
purchaser is subsequently reimbursed Purchases made
on credit cards issued by the organization, but where the
cardholder receives and pays the bill and is subsequently
reimbursed, also do not qualify for exemption
Reimbursement disqualifies exemption If the
organization or agency will be reimbursed, in whole or
in part, the purchase is disqualified from exemption For
example, the purchase of food for a banquet for which the
organization sells tickets as a fundraiser would not qualify
for exemption
Disputed tax must be collected If there is a dispute
between the purchaser and the seller as to whether
tax applies, the seller that collects the tax must give
the purchaser a receipt showing the tax collected The
purchaser may apply to the applicable municipality directly
for a refund by filing a Claim for Refund form along with the
appropriate documentation
Signature required. The individual making the purchase
must sign and date the form at the bottom A separate
affidavit is required for each transaction General purchaser
or store information may be completed in advance and kept
on file by the seller or purchaser for ease of use
Purchaser Instructions
Purchase details Identify the accurate qualified exemption
reason and complete the required information for that
exemption
Purchaser information Print the legal name of the
organization or agency Governmental agencies should
include both the name of the government and the
department or agency, for example, US Department of
Transportation, Colorado Department of Education, or
Adams County Human Services Abbreviations such as
"Dept " are acceptable but do not use acronyms List the
organization's or agency's mailing address, municipality,
state, and zip code
Declaration of affiant The individual making the purchase
on behalf of the exempt organization or agency (the affiant)
must complete the declaration
Separate form required A separate affidavit is required
for each transaction For ease of use, Purchase Details and
Purchaser Information may be completed in advance and
the partially completed form kept on file by the purchaser
for completion at time of each transaction
Signature You are swearing, under penalty of perjury,
to the accuracy of the statements made in this affidavit
Carefully read and ensure that you understand each item
before signing this affidavit After reviewing the form for
accuracy, sign and date the form Furnish this form to the
seller Do not send a copy to the State of Colorado
Seller Instructions
Sellers have the burden of proving that a transaction
was properly exempted If an exemption is subsequently
disallowed by the State of Colorado, you (the seller) could
be liable for the tax plus penalties and interest This form
is provided to help you determine if a sale qualifies for
exemption The sale is not exempt from taxes simply
because this affidavit is completed The responsibility
for proper collection of taxes remains with the seller You
are encouraged to obtain this form for each transaction
and complete all of the information in the lower Seller
Venficafion section
(continued on next page)
1
Instructions for State of Colorado Affidavit of Exempt Sale
(continued)
These instructions are specific to the State of Colorado in which this purchase has been made Qualifying for an
exemption may be different for each local jurisdiction, and these instructions are not intended to set forth the requirements
of any local jurisdiction
Resale/Wholesale transactions — To qualify as an exempt
purchase for resale or wholesale, the items purchased
must be reasonably deemed to be for sale in the ordinary
course of business of the purchaser For resale/wholesale
transactions the seller is required to not only collect the
applicable license information, but to exercise sound
judgment and a reasonable amount of skepticism to
ensure the items purchased are reasonably for sale in the
purchaser's ordinary course of business For example, a
restaurant would not be allowed to purchase dish soap
for resale because restaurants do not sell dish soap in the
ordinary course of business, but rather use the dish soap in
the operat on of the business
The affidavit needs to be completed in its entirety Be
sure information is complete, accurate and legible Review
the information, and particularly verify that the driver
license number and purchaser's name are correct Also,
be sure that the digits that are required from the credit
cards are correct Only record and keep those digits from
the credit card that the affidavit requires The signature of
the purchaser should be the same as on the driver license
Sellers should review guidance on accepting
government credit cards. Not all cards qualify for
exemption, even though they bear certain characteristics of
exemption See FYI Sales 63 for more information
Collection of this form does not provide a safe -harbor
from disallowance by the State of Colorado Retain this
form for at least 3 years
State of
CoBorado Specific Instructions
Charitable & Religious Organizations — The State of ,
Colorado provides an exemption for organizations that
have been certified exempt under 501(c)(3) of the Internal
Revenue Code A Certificate of Exemption is issued to the
organization when granted exemption by the Colorado A
copy of the Certificate of Exemption should be retained with
this completed Affidavit For organizations located outside
of Colorado, a copy of the letter from the IRS certifying
exemption as a 501(c)(3) organization may be accepted
in lieu of a State issued Certificate of Exemption See FYI
Sales 2 for more information
Government and Diplomatic Exemption — Please see
FYI Sales 83 for information related to government and
diplomatic purchase exemptions
Wholesale/Resale Transactions - A copy of the State
Wholesale or Retail License should be retained with this
completed affidavit See FYI Sales 1 for more information
Out of State Exempt Entities — This affidavit may be used
by an out of state chantable organization or government
entity as long as both of the following are met
Payment is made from the organization's funds and no
reimbursement will be made to the organization through
direct payment, collection or donation from any person(s)
for the use or consumption of the goods or services,
and The items or services purchased are used in
conjunction with the organization's regular religious,
charitable, educational or governmental activities
See FYI Sales 3 for more information
2
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