CM-08-02-037BLUE SHEET FORMAT
DATE: 31 January 2008
SUBJECT: City Manager - February 8, 2008
ITEM: Request that the City Manager sign documents required for Pitney
Bowes DI350/D1400 inserting system application agreement
Department: Finance
Staff Person: Cindy Demers, Finance Director
Justification:
These forms are required for the rental of a new Pitney Bowes DI350/DI400
finance department inserting system. This new system will be an upgrade to
the current inserting system that we are currently using.
Funding:
Cost: $5,848.00 per year
Source of funds: General Fund/Utility Fund
Blue Sheet Format
Updated 01/20/04
Form 8038 -GC
(Rev. November 2000)
Department of the Treasury
Internal Revenue Service
Part 1
Information Return for Small Tax -Exempt
Governmental Bond Issues, Leases, and Installment Sales
► Under Internal Revenue Code section 149(e)
Caution: If the issue price of the issue is $100,000 or more, use Form 8038-G.
OMB No. 1545-0720
Reporting Authority Check
box if Amended Return
1 Issuer's name
CITY OF ROUND ROCK
3 Number and street (or P.O. box if mail is not delivered to street address)
221 E MAIN ST
4 City town, or post office, state, and ZIP code
ROUND ROCK TX 78664-5271
NNrr,e and title of officer or legal representative whom th I S may call for more information
ex -
Part II Description of Obligations Chck if reporting: angle issue U
2 Iss's empbb /deficatioAr
( I Room/suite
5 Report number
5
7 Tr -ne number of officer or legal representative
( 2-) 7-i 8_ 4CO
or on a consolidated basis
u
8a Issue price of obligation(s) (see instructions)
b Issue date (single issue) or calendar year (consolidated) (see instructions) ►
9 Amount of the reported obligation(s) on line 8a:
a Used to refund prior issue(s) 9a
b Representing a loan from the proceeds of another tax-exempt obligation (e.g., bond bank) 9b
10 If the issuer has designated any issue under section 265(b)(3)(B)(i)(III) (small issuer exception), check this box. ►Lf
11 If any obligation is in the form of a lease or installment sale, check this box ►
12 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box
Sign
Here
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
and •- '`f, they are true, correct, and complete.
General
I uthorized representative
uctions
Section references a'e to the Internal
Revenue Code unless otherwise noted.
Purpose of Form
Form 8038 -GC is used by the issuers of
tax-exempt governmental obligations to provide
the IRS with the information required by section
149(e) and to monitor the requirements of sections
141 through 150.
Who Must File
Issuers of tax-exempt governmental
obligations with issue prices of less than
$100,000 must file Form 8038 -GC.
Issuers of a tax-exempt governmental
obligation with an issue price of $100,000 or
more must file Form 8038-G, Information
Return for Tax -Exempt Governmental
Obligations.
Filing a separate return. issuers have the
option to file a separate Form 8038 -GC for any
tax-exempt governmental obligation with an issue
price of less than $100,000.
An issuer of a tax-exempt bond used to
finance construction expenditures must file a
separate Form 8038 -GC for each issue to give
notice to the IRS that an election was made to pay
a penalty in lieu of arbitrage rebate (see the line 12
instructions).
Filing a consolidated return. For all
tax-exempt governmental obligations with issue
prices of less than $100,000 that are not reported
on a separate Form 8038 -GC,
an issuer must file a consolidated information
return including all such issues issued within the
calendar year.
Date '
�in65 u� (2,‘4 --,(Manager
Type or print name and title J
Thus, an issuer may file a separate Form 8038 -GC
for each of a number of small
issues and report the remainder of small issues
issued during the calendar year on one consolidated
Form 8038 -GC. However, a separate Form 8038 -GC
must be filed to give the IRS notice of the election to
pay a penalty in lieu of arbitrage rebate.
When To File
To file a separate return, file Form 8038 -GC on
or before the 15th day of the second calendar
month after the close of the calendar quarter in
which the issue is issued.
To file a consolidated return, file Form
8038 -GC on or before February 15th of the
calendar year following the year in which the issue
is issued.
Late filing. An issuer may be granted an extension
of time to file Form 8038 -GC under Section 3 of
Rev. Proc. 88-10, 1988-1 C.B. 635, if it is
determined that the failure to file on time is not due
to willful neglect. Type or print at the top of the
form, "This Statement Is Submitted in Accordance
with Rev. Proc. 88-10." Attach to the Form 8038 -
GC a letter briefly stating why the form was not
submitted to the IRS on time. Also indicate whether
the obligation in question is under examination by
the IRS. Do not submit copies of any bond
documents, leases, or installment sale documents.
See Where To File below.
Where To File
File Form 8038 -GC, and any attachments,
with the Internal Revenue Service Center, Ogden,
UT 84201.
Other Forms That May Be Required
For rebating arbitrage (or paying a penalty in lieu of
arbitrage rebate) to the Federal government, use
Form 8038-T, Arbitrage Rebate and Penalty in
Lieu of Arbitrage Rebate. For private activity bonds,
use Form 8038, Information Return for Tax -
Exempt Private Activity Bond Issues.
Rounding to Whole Dollars
You may show the money items on this
return as whole -dollar amounts. To do so,
drop any amount less than 50 cents and increase any
amount from 50 to 99 cents to
the next higher dollar.
Definitions
Obligations. This refers to a single
tax-exempt governmental obligation if Form 8038 -
GC is used for separate reporting or to multiple tax-
exempt governmental obligations
if the form is used for consolidated reporting.
Tax-exempt obligation. This is a bond,
installment purchase agreement, or financial lease,
on which the interest is excluded from income
under section 103.
Tax-exempt governmental obligation. A tax-
exempt obligation that is not a private activity bond
(see below) is a tax-exempt governmental obligation.
This includes a bond issued by a qualified volunteer
fire department under section 150(e)
Private activity bond. This includes an obligation
issued as part of an issue in which:
More than 10% of the proceeds are to be used
for any private activity business use,
and
Cat. No. 641086
Kal - 0 3'7
Form 8038 -GC (Rev.11-2000)
Pitney Bowes
DI350/DI400 Inserter Application Agreement
Thank you for your interest in the Pitney Bowes DI350/DI400 Inserting system.
To ensure your complete satisfaction, please review the following information about the DI350/DI400 inserter
system being provided to you.
Envelopes:
Customer requirement:
Minimum Envelope Size
3 1/2" (88mm) Depth
8 4/5 " (224mm) Width
Maximum Envelope Size
6 3/8" (164mm) Depth
9 1/2" (242mm) Width
Envelope Weight
17 Ib (65g/m2) Minimum
26 lb (100g/m2) Maximum
End Clearance
1/4" (6mm) Minimum
1/2" (12mm) Overall Min
Depth Clearance
Pl
1/8" (3mm) Min Unfolded
1/4" (6mm) Folded
ease note: For best performance, use only materials approved by Pitney Bowes. Materials
must be good quality and properly stored at recommended storage conditions of 65°F (18°C) to
77°F (25°C) with 40% to 60% relative humidity.
Paper: Customer requirement:
Fold
Minimum Sheet Size
Maximum Sheet Size
5" (127mm) Width
Paper Weights
9" (229mm) Width
5" (127mm) Length
16 lb (60g/m2) Minimum
16" (406mm) Length
32 lb (120g/m2) Maximum
Please note: Maximum thickness is 0.08" (2mm) for collated materials. NCR and Glossy/Coated
Material are NOT recommended.
Configurations: Material length limits before fold
Single Fold
5" — 12 2/5"
(127mm — 315mm)
"C" — Letter Fold
5 9/10" — 14"
(150mm — 356mm)
"Z" — Accordion Fold
7 9/10" — 14"
(201mm — 356mm)
Double Fold
9" — 16"
(305mm — 406mm)
Double Document Detector
Material Range
16 lb (60g/m2) Minimum
32 ib (120g/m2) Maximum
Insert: Customer requirement:
Minimum Insert Size
Maximum Insert Size
Paper Weights
5" (127mm) Width
9" (230mm) Width
19 lb (72g/m2) Minimum
3" (76mm) Length
6" (152mm) Length
48 lb (180g/m2) Maximum
Single Sheet
Please note: Document Groupings and OMR/Barcode Capabilities are not available with this
solution.
Installation: Professional installation and training are required with your DI350/DI400 Inserter by a Customer
Service Representative.
Rev A 4/2005
Pitney Bowes
DI3 50/DI400 Inserter Application Agreement
I have read this agreement and confirm that my use of the DI350/DI400 Inserter solution will be consistent with the
specifications and requirements listed above.
I agree that additional charges will apply for any products or other services provided by Pitney Bowes that do not
meet the above requirements.
Customer Signature: Date: _Yj - S
Customer Name: A hie;Ss,
Title: l�M � R -CA 7
Contact Name: Contact Phone Number:
Pitney Bowes Sales Representative:
Name/Employee #: District:
Signature: Date: / /
District Technical Sales Consultant:
Name/Employee #: District: #
Signature: Date: / /
Rev A 4/2005