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COPIERS
NORTHWEST
New Ideas. New Solutions,
601 Dexter Ave N Seattle, WA 98109
P: (206) 282-1200 F: (206) 282-2010
www.copiersnw.com
Customer Owned Equipment Removal Form
Customer: City of Yakima Police Department
Address: 200 S 3rd St
City, State, Zip: Ykinia, WA 98901
Phone: (509) 575-6070
Account Rep: Travis McNeill
rThis 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.
14
15
16
17
18
19
20
31
34
Customer Owned_Equipnient Only (CNIN or ottier).
Please use the "NON-CNW Leased Equipment Removal Form' to authorize removal of NON-CNW leases,
Status
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
Customer Owned
ID #
legal
Admin
Detectives
Special assault
Pro,serty
Copiers Northwes
Make
Ricoh
Ricoh
Ricoh
Ricoh
erase or return all hard
Model
5502
4503
3003
C305
C305
Serial
7(1r, 'op 0
c
Please use a similar format to list additional CUSTOMER OWNED EQUIPMENT on supplementary pages
THIS SECTION FOR CUSTOMER OWNED EQUIPMENT ONLY:
cmh,
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 NW, Inc. Copiers NW is under no circumstance responsible for any data,
documents, images, or other information stored on or in the device, the device hard drive(s), or any memory module(s).
ACCEPTED BY COPIERS NORTHWEST
DocuSigned by:
(12V/Pet•
141.44. 11/9/2022
33CE1982023748E Authorized Signature Required / Date
John Hines
C,F,0
Printed Name / Title
Revision 19.05
CEPTED BY CUSTOMER
11
Authorized Signature Required / Date
Name / Titk
CITY CONTRACT NO: ..()K
page 3
RESOLUTION NO: