HomeMy WebLinkAboutCopiers Northwest - Customer Owned Equipment Removal ( ; COPIERS Customer Owned Equipment Removal Form
NORTHWEST Customer: City of Yakima
Address: 129 N 2nd St
615 S Alaska St, Seattle,WA 98108 City, State,Zip: Yakima, WA 98901
P: (206) 282-1200 F: (206) 282-2010
www.copiersnw.com Phone: '509) 575-6070
Account Rep: Travis McNeil!
This document must be completed prior to authorizing and scheduling any CUSTOMER OWNED "Trade-Ins"which includes any equipment
customer purchased from CNW or another Vendor. Leased Equipment originating from Copiers Northwest(CNW)does not require any forms.
Customer Owned Eguigment OnIQ.{CNW or other).
Please use the "NON-CNW Leased Equipment Removal Form" to authorize removal of NON-CNW leases.
Status I D# Make Model Serial
1 Customer Owned HF299 Canon 4545i UMV07649
2 Customer Owned HF300 canon 4545i UMV07650
3 Customer Owned HN652 canon IRC5535ii XUW05433
4 Customer Owned HN415 canon IRC3525ii XTK10139
5 Customer Owned HN416 canon IRC5560ii XTZ04872
6 Customer Owned HN425 canon IRC5540ii XUP08735
7 Customer Owned
8 Customer Owned All machines are to have
9 Customer Owned the hard drives wiped by
10 Customer Owned Copiers Northwest and
11 Customer Owned Copiers Northwest will
12 Customer Owned provide a Certificate to the
13 Customer Owned City of Yakima as
14 Customer Owned confirmation.
15 Customer Owned
16 Customer Owned
17 Customer Owned
18 Customer Owned
19 Customer Owned
20 Customer Owned
21 Customer Owned
22 Customer Owned
_ 23 Customer Owned
24 Customer Owned
25 Customer Owned
26 Customer Owned
27 Customer Owned
28 Customer Owned
29 Customer Owned
30 Customer Owned
31 Customer Owned _
32 Customer Owned
33 Customer Owned
34 Customer Owned
Please use a similar format to list additional CUSTOMER OWNED EQUIPMENT on supplementarypages.
THIS SECTION FOR CUSTOMER OWNED EQUIPMENT ONLY:
I the undersigned agree that all equipment marked and/or referred to as"Customer Owned""Trade In"or"Disposal"is free and clear of any liens or encumbrances.
The title and ownership of this equipment is transferred to Copiers MN, Inc. Copiers NW is under no circumstance responsible for any data,documents,images, or
other information stored m or n the device,the device hard drive(s),or any memory module(s). I understand and agree that Copiers NV will charge prevailing rates
for the pick up and disposal of each copier and/or round trip. Exceptions may be granted for pick ups identified and removed at the time of delivering new equipment
acquired from Copiers NW.Custom rates may be quoted for large loads,stairs,and contracting 3rd Party movers due to unique site requirements.
ACCE i ED B COPIE NORTHWEST PTE OMER
•orized Signature Required/Date Authoriz Signature Required/Date
OD 14"i I•X,wr'Y c,w 0 id-Clri c.. x �-) C-i t YY'L uti
Printed Name/Title ReMwon 24.07 Printed Name/Title
1o/f0
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CITY CONTRACT NO: 10?-(1-1cr0
RESOLUTION NO: NIA