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HomeMy WebLinkAboutCopiers Northwest - Customer Owned Equipment Removal & AddendumDocuSign Envelope ID. A685AC91-580E-4CEA-8662-D57549E6E961 COPIERS NORTHWEST New Ideas, New SWuilone 601 Dexter Ave N Seattle, WA 98109 P: (206) 282-1200 F: (206) 282-2010 www.copiersnw.com Customer Owned Equipment Removal Form Customer:. Address: City, State, Zip: Phone: Account Rep: This document must be completed prior to authorizing and uling any CUSTOMER OWNED "Trade -Ins" which includes any equipent customer purchased from CNW or another Vendor. Leased Equipment originating from Copiers Northwest (CNW) does not require any forms, City of Yakima 129 N 2nd St. Yakima, WA 98901 (sag) 575-6070 Travis McNeill Plea er Owned Eaularnent Only (C tote "NON-CNW Leased Equipmen G3Y G2QF BG00U G2 G4UD BG2TK HF2 HF287 HF2 H HF269 HF2 H HF2 HF29 Removal Form" to authorize ake non non h Ricoh n non non ncrn e Oi R2 C450 C450 R2 RC RCS2 RC 5 0 val of NON -CNW lea NR041.75 NR042 E1751 11077 E1'75f4811079 Ehfi13172 GNG12227 H02307 GNG302 C5 5 4 no non OWNED VP PR C700 7055 P-D455 4511 525 69 Uh1E02317 HZ50926 90455 AV MB318650 6080544 E130'26 0049 ON FOR R OWND PMENT ON underesg e title at all eoui in a o' re ent is tranei in the device, crier Owned" l rade In" or "111sposal" Is free and Gear of any liens or ers NW, Inc, Copiers NW is under no circumstance responsible for any data, hard drive(s), or any memory module(s). [1ocu51gnmd hACCEPTED BY COPIERS NORTHWEST 10/14/2021 33CEisaza2.374BtAuth0rized Signature Required / Date John Hines CFO Printed Name / Title Revision 19.05 ACCEPTED BY CUSTOMER Authorized Signature Requi CITY CONTRACT N RESOLUTION NO: Me 3 000uSig^Envelope ID, D210570*-1eo3-4-4Fo-9^46~o8pe2908s3*3 ADDENDUM T0"CUSTOMER OWNED EQUIPMENT REMOVAL FORM" This Addendum, between the City of Yakima and Copiers Northwest is an addendum to the "Customer Owned Equipment Removal Form ('the Form')" signed by a representative of Copiers Northwest onOctober 14,20I1. Indemnification. Copiers Northwest agrees torelease, indemnify, defend, and hold harmless the City of Yakima, its elected and appointed officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers from all liabilities, losses, damages, and expenses related toall claims, suits, arbitration actions, investigations, and regulatory mrother governmental proceedings arising from or in connection with the removal of surplus City property by Copiers Northwest, or any of Copiers Northwest's agents or subcontractors. The [lty's right to indemnification includes attorney'sfees costs associated with establishing the right toindemnification hereunder infavor ofthe City. VndwstriA|Insurance Act Waiver. It is specifically and expressly understood that the Copiers Northwest waives any immunity that may be granted toitunder the Washington State industrial insurance act, Title 51 RCVV, solely for the purposes of this indemnification. Copiers Northwest's indemnification shall not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. Copiers Northwest shall require that its subcontractors, and anyone directly or indirectly employed or hired by Copiers Northwest, and anyone for whose acts Copiers Northwest may be liable in connection with the removal of surplus City property, comply with the terms of this paragraph, waive any immunity granted under Title 51 RCW, and assume all potential liability for actions brought by their respective employees. The Parties acknowledge that they have mutually negotiated this waiver. CITY OFYAk]MA Bob Harrison, City Manager . Date: K�cv, '�l/ »nrCONTRACT wO� Rf,amUTION^O: Copiers Northwest pY "' JohnHines Il/9/282I Certificate Of Completion Envelope Id:D21057041BD344F©9A46C8F92908E3A3 Subject: Please DocuSign: Indemnification Addendum_Copiers Northwestpdf - City of Yakima. Source Envelope: Document Pages: 1 Certificate Pages: 1 AutoNav: Enabled Envelopeld Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time {US & Canada) Record Tracking Status: Original 11/9/2021 9:09:24 AM Signer Events John Hines jhines@copiersnw.com CFO Copiers Northwest, Inc. Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Editor Delivery Events Agent Delivery Events Intermediary Delivery Events Certified Delivery Events Carbon Copy Events Witness Events Notary Events Envelope Summary Events Envelope Sent Certified Delivered Signing Complete Completed Payment Events Signatures: 1 Initials: 0 Holder: Lisa Burke Iburke@copiersnw.com Signature wce,tiezaa37.nf. Signature Adoption: Pre -selected Style Using IP Address: 207,170,207.131 Signature Status Status Status Status Status Signature Signature Status Hashed/Encrypted Security Checked Security Checked Security Checked Status Status: Completed Envelope Originator: Lisa Burke 601 Dexter Ave N Seattle, WA 98108 tburke@copiersnw.cem IP Address: 73„42,228:100 Location: DocuSign Timestamp Sent: 11/9/2021 9:11:07 AM Viewed: 11/9/2021 11:29:37 AM Signed: 11 /912021 11:29:43 AM Tlmestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamp Timestamps 11/9/2021 9:11 °:07 AM 11/9/2021 11:29:37 AM 1119/2021 11:29,43 AM 11/9/2021 11:29:43 AM Timestamps