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AGMT - De Lage Landen Public Finance LLC
De Lage Landen Public Finance LLC ACCEPTANCE CENTIFICATE 1111 Old Eagle School Road Wayne, PA 19087 Ladles and Gentlemen: Re: State and Local Government Lease Purchase Agreement dated as of APRIL28 De Lage Landon Public Finance LLC, as Lessor, and CIT' OFSEAL BEACH 20 ?a ., between , as Lessee, In accordance with the State and Local Government Lease Purchase Agreement (the "Agreement "), the undersigned Lessee hereby certifies and represents lo, and agrees with Lessor as follows: 1. All of the Equipment (as such term Is defined In the Agreement) has been delivered, installed and accepted on the date hereof. 2. Lessee has conducted such Inspection and/or testing of the Equipment as it deems necessary and appropriate and hereby acknowledges that II accepts the Equipment for all purposes. 3. Lessee is currently maintaining the Insurance coverage required by Section 14 of the Agreement. 4. No event or condition that constitutes, or with notice or lapse of time, or both, would constitute, an Event of Default (as defined in the Agreement) exists at the date hereof. f=- Ot®NINpIRaemgd. RtbLbhU.6� °a'FlIeC6AYl 3� basso CITY OF SEAL BEACH nlntlav elf Mrr Lc Lef.bS —G� ^6,1 tale %f5,1°.J/srw f G Wtt Ot®NINpIRaemgd. RtbLbhU.6� °a'FlIeC6AYl 3� ATTACHMENT 1 STATE ANp LOCAL GOVERNMENT LEASE - PURCHASE AGREEMENT Lease Payment Schedule LESSOR: DE LAGS LANBEN PUBLIC FINANCE LLC LESSEE . CITY & SEAL BEACH LEASE NUNW: -PUB 16813 LEASE DATE: APRIL 28 --,20 16 I'aymenImunbw Pwrwa[We Renhl. Payment mlareSPaRon PAnclpal po*n Baleen - - Pak" Prim Lean 61172016 0.00 0.00 0.00 3,822.12 0100 1 61162018 119.33 24.38 09.07 3,727.15 3,838.06 2 7/182010 119.33 24.09 9524 3,631.91 3,740,87 3 6/1612016 119.33 23.47 05:00 3,636.05 3,042.13 4 91182016 110.33 22,85 96.46 3,439.67 3,642.78 5 10/182018 119.33 22.23 07.10 3,342.47 3,44234 6 11/162016 119.33 21.60 97.73 3,244.74 3,342.00 7 12/1812016 119,33 20.97 98.38 3,146.36 3,240.77 8 11182017 11993 20.33 99.0 3,047.38 31139.80 9 2/1612017 11933 19.69 99.04 2,947.74 3,036.17 10 31102017 110.33 19.65 10028 2,847.46 2,932.88 11 - 4/182017 110.33 16A0 t00.93 2,748.53 2,828.93 12 51162017 119,33 17.75 101.58 2,644.95 2.724.30 13 6/1812017 119.33 - 17.09 / 102.24 2,642.71 2,818.99 14 711612017 119.33 18A3 102.90 2,439.81 2,513.00 15 81182017 119.33 15.77 103.66 2,33825 2406.34 16 01182017 119.33 15.10 104.23 2,232,02 2,20806 17 10/1812017 11953 14.43 104.00 2,127.12 2,100.93 18 111182017 119.33 13.75 166.66 2,021.54 2.082.19 19 1211612017 '119.33 13.06 106.27 1,816.27 1,972.73 20 11162018 119.33 12.38 108.96 1,808.32 1,862.67 21 21162018 119.83 11.38 107.64 1;700.68 11761.70 22 3/182018 119.33 10.99 108.34 1,592.34 1,640.11 23 41162018 110.33 1029 100.04 1,483.30 1,527.80 24 511612018 110.33 0.59 100.74 1,373.56 1,444.77 25 6110/2018 1433 8.88 110,45 1,263.11 1,301,00 26 7162018 119.33 8.18 111.17 1,151.94 1,18650 27 81162018 119.33 7A4 111.80 1,04006 1,07126 28 91182018 119.33 6.72 112.61 927.M 05626 29 10/182018 119.33 5.99 11134 814.10 838.52 30 11/1012018 110.33 526 114.07 70003 721.03 31 12/162018 11833 4.52 114.81 66522 602.78 32 1/182019 119.33 3.98 - 11555 469.67 483.76 38 21162019 119.33 3.04 118.20 363.38 363.98 34 31182019 119.33 in WAS 236.33 243A2 35 41162019 118,33 1.63 117.60 118.53 122.09 36 51162018 119,33 0.00 118.53 0.00 OAO 4,295.88 473.76 3,622.12 0.60 Sets hs 01 $283.12 - is Inducted In 11v financed ammnl =MMpKe i4a ®veAl�as��.� A ra 1.1 Tide: P, I d ..1 ;026! 0 -.. nWdbae USA 00PFa0CM YIZ Jo", Io 1 I0► ) / ' De Lage Landen Public Finance LLC State and Local Government Lease - Purchase Agreement 1111 Old Eagle School Road PHONE: (800) 736 -0220 Mons, PA 11](1117 FACSIMILE: (800) 7OD -4643 Mle4aNaar CITY OF SEAL BEACH Bgs4Nwaxe 662 -431 -2527 pBANmu pl wdaw was Asone, Anbr V^Adpns 2118TH STREET Car rah ZIP SEALSEACH CA -90740 9ocimwaxm rewtlp�d _.. ... ham Nab Kyocera ModdNd. M6535ddn sawxmaa V , Ik%gLaaaGapm eeMae$ddgetl lkWNa .. . NEW KYOCERA M6635cidn DIGITAL COPIER WITH ATTACHMENTS to M650"OFF, 8656CId181 MEN�9-�-M� CPpvweLaa9oa mamas absml Lxq' ewe rya - Seeml2bp P) 0IN.YOURnMaaonesadmeeas a'pImadomlebo.l oust of'ae0.1NN By d(aIWnsfeatake; lhraeelddetmndsQUM NoRuMol dw nNads)e 6wemmleoINsamN loved bV YOU �w1Nm Paaaa ed,IN otraa Ica, vents M IMML rlsmblamNaNaWaAd berme Lip,eppeem. u 11"tlmatlaeaon Hodes 17 Lean pgeaAa: Sw Lm Pram wade Aaadea a llbavall Pe foxaWY Y'" 0oaaeah O Smea1"W't u ewwly u oda_ toe[ Lass one. e1 of this We and Lora 0ownm rdt Leasamuchms AOmdnent I'Leasal cuduEy and fed Iran to ask US easy quesmwm YOU may hare about P. Wwds'VOU' and 'YOUR' mkr m 'WE,' U6' and 'OUR' mlerte Be lope Limchol Rm6C RNrce LLDD, its aneceSeem eM ebSlpllR as lM'Laaanr' of me Equlpmad. to pose to YOU aid YOU agree to lease from US, dp egrdpm ra U04 eboan (and on My apeched adledub) btluMp all mpkoameM palw, mPaha, addetwis and mossorles or a on vfihh data Ulm halenra of the Leese Paymenkehd am additional Lease Paiamentsora etwoubkto YOUunddtMOLearearepWintm. Pa setloMmme Lease raymem smewae ,apomonawm sPaso r•aynwlN Is part n, and minesaas peymed d, kill asL YOUR dAgagoa to PAY the r.manatoments and YOUR other Lease oblle,,11" am absolute Mal ummdNlmal and wa rW suhfed to cancakdoo. Induction, aernll or coumemhlm except as d In Sedkn 6. THIS LEASE IS NONCANCELABLE EXCEPT AS PROM DIED W SEt110N 6. 8. LAZE CHANGES. re Lease Pa} manl in not Wage en The datewhm doe, YOU w1hpay US Into clearpe at the sate of 18% per award or the maximum amoom parmGledM law, wiscbrver to fm. tram such dale. ode prdstlumt admusl eA Walk de reWa+rseM appeetea It "all Portion oththee budget m not approved. N"N"etandmp Um lomp ea the de"adn"AM mbud�et or epproptme I ease Iw emy l iemh ta aopdyvdhW the dsirtlkn d YOUR povemmp hodj. RATION.VOU e donly to pay such Lease Paymxac wear titls(rase es may kwluby beWage ham IuMS budpewtl em approPrtaled IwthalpWpaae duanAVOUfl Uun cmmnl m epprlryrlab ke mane avdle6k lundsto Pay the lamer Payments mgdmdmha paid In the nee rsurRtg fterwwal Term, Nis Leese shtll he otemedmrmhTamtl atdm enddthe son w flenewd OU apree,la ddNer Wrlhm ndka to US of such manlnalkn d kid 90 data pdorte tiw end d Ua then currant Od81m Term a Noneaml7wm'b ut mpum a glue dehd Ihn krm d Vds learn 6eyorm the Then currant OrlpaW TM_ ar Rmowal Tarm. ll Ihk Leue k wMnaletl m aaadanm weh Ihk Sedloil YOU spree, d YOUR coal and egmma, m tdpelent m US al the mra0on orloraUdlw spoclGag ly US. _ WE am IPadaa the Eau6mad m YOU'ASTS" wd YVE A1ANE NO WMRANTIES, E)1PRES' WI IMPLIED, INCW OOIS WARRAMIES OF MENCMANNBBOY, 011 FITNESS FOfl A PAW (Terms and Condilons continued an the Iranian aide of INS Lease.) law we Bm.� L' P4a New Ttle For DE LADE LANDEN PUBLIC FINANCE LLC Le NNrMt PUB 15813 Lnmreeb APRIL 28 12016 _ ymaN LD. Naeecs KBU81 Plgald2 a. TITLE, PERSONAL PROPERTY, LOCATION, INSPECTION, NO MOOINCAIIONS OR ALTER- at teed 60 dais' prior within notice to US and paymml In lull to US of lire LOW Payments and 89 than due the BOB appicade P.umhW Wlco sa(forth an the Lam Payment ADONS. YOU have one o the Equipment; provided [hat is to the Equipment with lmmedaely ant VARmd any action by YOU vest In US, and YOU shoo lopm eaely surrender possession of the other amounts plus Schedule; or (c) If substantial dam la or destruction or candempatlon d substantially all of the has an the days aAced In YOUR written marine to US Of YOUR exerdw Of The E4WPmmHOUS,(aj upon any lerminellon d Mls Lease other than foundation pursuant to Sedim 17 or (b) If YOU are in default of this Lease. It is the Intent of the Indian Night Alai anytransfer at Equipment onsuned. mining opium upon at sed GO days' prior nabs be US red payment in ft to US of Ore Lease mounts Mad due plus the then applicable Punches° Plan set loin on that tine to US pursuant to this Section shall Occuraummaimi wlhmn Merecesalydarrybi9 of sale. oedlicate of Into or other Instrument of conveyance. YUll shah, nevedhelass, mute and deliver Payments so at other Lease Payment Sdtedule. REPRESENTATIONS WARRANTIES. YOU warrant and a falav (a) YOU any such Instruments res WE may Mai eviderme such lumi As security for YOUR oblige- Irons hereunder, WE grain a security interest in the Equipment and all proceeds thereof. YOU hays 1A. NANO under ca di n aeapubfiebadycoon, to and pdNctldy ogarAzetl and ers0ng untlerffecandiohan and laws ad YOUR Sake lull and auNOdty toenlahlo tins lease and tle transactions remtamplatad IM right l° use the Equipment ell the term of this Lease, excdptas ofmnWSeexpressy act Tooth In this Lease. AlAwugh Rae Equlpmanl may become atNGted to real estate, It remains personal with power hereby and to perform alt of YOUR ONI92UMS hereunder, let YOU have duly authorized the aldt- d this Lease 4' action by YOUR gassmhg hod) at a meeting defy tailen, propery. YOU agree not t° alter or madly the Equipment or ppgemolt a her to he placed upon the OUR wdlten emsanL II WE reel it Is nicer Iron and tldNery puller reMdarty mmpmd and attended throughout by The mgdmla maturity of Ue members thereof or by have Equipment or to remove the Equipment without prior nary , YOU agree to provide US with milwns of Internet or liens from aryma darning arty Interest ogler appropriate ollfdai approval, and ail requfremenls have been met and procedures omoned in to ensure the voliy andedmceablity of this Lean; (c) YOU have compiled with such pub- in 'the red estate on which any Items at Equipment Is laughed. WE also have Me right at reason- order lic bidding to ubstri as may he apphands to this Lease end the acquisition by Y0U d the Equipment. B. MAINTENANCE. YW ae required, al YOUR Own cost and expense, to Veep the Equipment OUlmongorda,axceptfor EquQmem; (it) of authorizations, came nts and approvals of governmental bodies or aganrks Will the eruunon and delivery by YOU Of this Lase or In connection who the In good repair mrdmon m ordbery wear and liar, and YOU Will sully al pads and sarvlrarp reguirhd. Ap replacomod parts uaed or Inso9ed ant reports made to AM required in mention Md YOU ijnp n of YOU ealorceable h accordance wlill Its termgs, except o the Equ�nent will became OUR property. YOU ACNNOWIFOGE THAT VJE ARE NOT RESPUNSIRtE fOR PROVIDING ANY the np alello eights limited byapplkaha ban accord rcewhi The requirement or diner laws budgeted d app O' bathehaant me FOR V- MAINTENANCE ANOfOR SERVICE FOR THEfOUIPMENT. YOU WILL MAKEALL CLAIMS FOR SUCH ICE PND/DR MAINl6dAfICE SOLELY TO THE SUPPLIFA AND7OR MANUFACNREN AND SUCH rghted snerahy; (funds year to make the Lmces under rth scheduled 1° cane funds for the morenl budget years makethenlsdlpw,fdlysudheteuledto CLAIMS WILL NOT AFFECT YWR OOLIGATION TO MANE ALL REOUIREO LEASE SIGN.P FAMENITS. PLEDGE 10. ASSIGNMENT. YOUAGRLE NOTTO TRANSFER,SELL,SUALEASF, ASSIGN, PL FOCEOR due du ingO me to me due during Om andthos funds and w omcelYOUR atmracotheanss;hq the Equipment s your and funds he SOM been mWovidloo ether enigma. Yf9uhaveanimmedr to YOUR hourlong l0lpgstM1dw YOU pmvleeso YOUR Ctlmm, 0 ENCUMAER EITHER THE E0UIPMENT OR ANYRIfilRS UNDER THIS LEASE WIINIXR WRdo,Me WRITTEN CONSENT. VOU agree Ina WE may seh, assign errtransla this am aavelo WE manual agreed and use of an ate For the to for the nedforanstem of the YOUR =it era tom of the dimh- formane new ovaer weft lave the same dghis and bemfl1s 11n1 WE mw have andw0l mat hnvh to perlatn any dOUR and the rkJhls of the new owner will ml bat suMecf o arrydams, counlerdams, t temporary YOUomakeuidthe h In the Equipment .mica and YOU VAR a used sin h the IaressabM future, Including Ina FOR Lease Tenn, and the allowed VAR be used by YOU a FOR Lade Tom, and [he YOURgovemmentalmppr °pdioryllncllons corn oGigaians Ntensesorsel -aAs Mat VOUmay naveagandUS.YW herehyeppahl Municipal fTegidrazSerdcs only f °rWrP°s°alpedoming em ormori of to scope olYelR mltadry ant wig nef he used In the trade err hudness of ( the "Regmbaf)as YOUR aged for the pmposa of maintaining evamm�rewdal each asdgnmed in ham necessoryto comply Will Seclim 149(a) of line interne Revenue Gads 41986, as amended. aslml wlhi hie hotels any olhermnlyor panson;and(hjYW ftem neverlahedloapmpdateor otherwise make avellaba coming due under airy lease PUrtltase, tslaAment No such assignment shall be binding on YOU mil the Registrar has medwd will noltce lmm the he sullident In remal or ohier payments mk or other sknya agrcamont asdwta at Um name ant address d Oro assl9nea 11. LOSS OA DAMAGE. YOU are responcdefwlhe dskdoss or destruction d,adamagelo 19. OCC FlLINGS 00 FINANCAAL STATEMENTS. YOU aNtlorlm USlo glaalNnnrgg ssto- lisped In the Equlpmem.lt WE fief A Is necessary, YOU agree to sufxnll financial state- stand the Equpmant. Na such ass m damage ulsws YOU from any ahlgalon aria IMS Loan. If any of The Equipment Is damaged by gm or other casually or olat to, a the IwnWaaY Use d, o°Y of ma teem with teens (audlthd V avalIt ) on a quadedy basis, 2A PROVISIONS. YOU agree Una lMSLnnshisa Rnamce Leon term Equipment is taken under hie exerdce of Me power of emInent domain. the nel Records ('Net lmurareadakn or cordemm0m awed will be apoled loihapromplrplaument 20. UCC- pRTIClE WE Is defined N ANde M doe Undom COmmardal Coda ("UCC YW admpwledge the WE taus her YOU that YOU may have Procads�ol airy opals resiaalim, modnfipiionorimprovemmidtlra Equipment artless YOUhaveexeniseeYOUfl ophon in purchase the Equipment pursuant o Section 17. Any bats= of hie Net Proceeds remain 4 Y0U tln mme of hie 6uppker of lire Eq0 am. WE rwAIy h be cor �gs 0°d8»— a that YOU an le Pe underths sup Hce°°anY �a50 waive arrya Nall rights irg altsr etch wok tens been nal responsible shat be pale to YOU. 12. INDEMNITY. WE are nal respanslte tar a(ry losses err InJmles caused by the mmnulacore, ad pgIng grpq� YOU under Sedions 2A508 through 2A-522 d the UCC. 21. TAT! EXEMPTION. YOU wig imply with all appCcebIn provisoes at hit osrtd Revenue acqulsi on, dehvory, Installation, oWlhaddp, use, lease, Psseeslon, maintenance, operating a m{etr Ion of the Equhvnanl or dialects in the Equipment. To lheextent permdied by law, YOU jague to rekn- Cade al 1986. an amended, Includig Mlhout 111 itim Sagas 103 and 146 bereol, end the apple ition thrriu ifr to of Me Interest poNm of die Lease Paymens bursa US for and to defend US against any claim for loswor tnlurls totaling o he Equipment. this cable regulation me [Or purposes dltain Yrrme samaon. Indemnl"11 continue new after the terentrulim of Ibis Lease, 13. TAXES. YOU agree to pay all eppAnxhle Ikanse and registration fees, We and usatues, pa- 22. BANK . Il YOU checked the "Bank OWITOCaUm Elected box an the front YOU and al VOUR svbodkmo ertiiss wail not ssua In excess of 510p00,000 d s°nal properly him and all offer Woes and charges, relating o the ownership, leaskp, re W sane, pad", passinkin or use at the Egpmant(mompt than based on OUR not tome)—YOU agree Page of Ins lease qualifotl faAexemPT OUfi0abns(oduanp this l�subdaxrnu6(q Private acDdy binds dine 9th bmds)dudnAlhealendaryearin vfikil WEtund lints eat H WE pay try been or chartem YOU will rdmbures US lot all such payments and Will pay US quaOfied 501(c)(3 municipal osr°biao- Imp naonay recogrszed counsel in the areadtaxexempt munidpa obligations tmmgada Nie rtlarge(asta cdaodln 5ecgm 3) m such payments with the Mad Una Payment or ol1R echnA and admmsledng am Calms, assessments err lees and reMdnp Mom amaplrion of accopNbs to US that the dedAnalion d 1Ns Lease as a °WaTAad laramnpt °boAaAOn° will nol be plus a fee In The appr°pulate authorities 14. INSURANCE. Durnulhe term of Ibis lease, YOUWill keep the Equipment Insured agaOStah adwrseH afeded. 23. CHOICE OF LAW; JURY TRIAL WAIVER. ThIS LSSe sinkmgovamad end consumer! In the sws al Iha stale whore YOU are teuaod. Ta Are ardent permuted by law, YOU risks of lass or damage N an amount not sas then the mgadmal and of the Equipment without deductible ant Wthoul co-insuranon. YOU will also obtain and maintain for the term of this Lease, ettadanca wiAa apnea t° xaioe YOUR dgtds o a big M f cry. 24. ENTIRE AORERAENi; SEVERABIIITY; WANERS. Thss Lhasa conTasfileeless agreement i mprehennum public IsNllly Insurance commit both personal Injury and property damage of a least 51OO,O0a Per person and 5704000 par Occurrence W bodily hU°y and $50,000 for Po damages. WE491 be the ads Amend ass payee on the property Insurance and mooed sanadd Ul on- In ant undeuonring. No agreanenta a understandings am bindng on the paHlee unless set i um N wiArrA and slgnedbytha perllas•AmProNSOn°IThstease whMfaarry mean hddunerr Ae lnellecG.s w7h°utinvaliduplheomaln- al lnsnaedm the pubis lshlHy Insurance. YOU win pay ail perluns(Of such klmmmandmud at Mer lomeadr In oyiudsdction man to suclludediGiat d this Lease. THIS LEASE IS OTINTI NOE0 FOR TRANSACTIONS WITH AN EQUIP peel of Insurance coverage satisfactory to U5. It YOU do Oct Pr°UOe $afi vsunon YOU to such Insu2rce and add" Insurance the due make Imp proMSOns �ZS.FACSIM E DOCUMENTATION. YOU agree that a MWITIis copy of this I use will folle i- 10 mount Iran you, en Much we a pr��n 15, DEFAULT. Meet to Section 5, YOU are In default of Ins Lease A any of the following Is signatures may be treated as an orgInal and will be admissible as evidmm of this Lease. ocews:(a)YOUial so pay airy Lease Paymemerr other sum when due; (b YOU bunch any warmn- oh9Aa0on titer ms Lease, err try o her au eernenl wth U5, (c) YOU become leve nl y or oher or urnde to pay VW R dabs when due, YW maim an assignment tithe berddd a°dters orYOU wdoMO a subdanlial detedootion in YOUR Ilrerciai caMHian, or (d) YW AN or have filed aBamet YOU a pdidon Lor Oquidalion, reorgari+atlm, enjusMent d debt err amila relief under the Federal Bankrptay Cade err airy diner present or fduu fedora a sloe bankmpoy or Insolvency laµ or a bastes, recdver orgguidaloris eppdnkd or VOU or a suhssnila pad of YOUR assets. 16. REMEDIES. WE have the fdlawig remeds it YOU era n /aauii of hits Lease: WE may declarathe anUm haUnea of Ile unpaid Leas° Paymerhs for the Thatncurrenl0dg'ra Term or Ratewal Team knmedlaey due and pa�z6k; sueforaM tmeNe a0laase Payments and ary other payments Inoost al monies due 113 at the role Awn aaruad a aaakmkd molder Atis Lease; chatAa YOU °n d elgM1lem percent (18%) per year Iran the dale of default until paid, but in no rvwt mom Than Iha madmen tae pemlued bylaw drazpa YW a ratan -dwck or mmsuAdaA funds charge ('NSF , Cha e j d 6025AO let a ch-m IhaL Is volumed for any mzscn; and Man®r tint YOU olurn the Equipment to US and, A YOU fall to return the EQuifmmd, aver upon the pmmtus Peaceably with or wlffoul fella prows wham The EQUipmenl s bated and mp°ssess lie Equipment. Such return or reposesaon d IM Equipment will rot camiHUO a IetmimUm of this Lease unless WE em nobly YOU In writing- if Aw Equipment is returned or repositioned by US and unites WE havetem - noted this Lease. WE will sal or event the Equipment to airy personsi try, IeOSVVE determine, at one or more public or private sales, with or WAlloutWill to YOU, andapply the rcl proceeds alter deducting the reds and mrpenses of such We at recent to YOUR obligations with YOU remadrp "en . its farany dgllderrcyand with any excess suer the amounts unaided In this Sal plus Ore then applicable Purchase Price to be paid to YOU. YOU nu also required to pay (1) all copies Incurred by US in divemo er with the enforcement ea at my remedies, Including al expamhs of upowageng, staring, supping, mpaldrp and selling [be ash Equipment, and ( reasonable a9orneys lees EO PnON. ProsiriedYOUamndindetaultyOUstdhav thoopumtopu (chase p • 17. PORCH abut nothess than aA err ffs Eguipinad (ai an the date me Iasi Lem Paxmentis due (assuming this a fibs ef the Origina7enn and each Renewal Too), U his lease Is SUP In effed sat_ a Lease Is renewed eird to that day, upon payment intuit of Lease Payments ad all other amounts then due and the payment of One Doliato US; (b) m the lost day of the Original Tenn or my Remwa Tam then in eNee, upon Paget alt ono aeu s PwAt Pddd In be US A 12PFDOf1A2 9112 BILLING INFORMATION PLEASE COMPLETE THIS FORM AND RETURN WITH DOCUMENTS In order for DE LAGE LANDEN PUBLIC FINANCE LLC to properly bill and credit your account, it is necessary that you complete this form and return R with the signed documents Nam; Billing Na: ` 1 " . ee Q Would you Igoe your invok; sVmO elled � VYES [j- NO Email Address(es): 0 SCX 6' c t; (. - 5w- Billing Ado Attention: Telephone FEDERAL SPECIAL INSTRUCTIONS Do you require a Purchase Order Numberon the Invoice? If so, please attach a copy of the purchase order (front 8 back) for our file.. El YES �" {1ro10 Is a new purchase order required for each new Ilscal period? Iryes, provide monih/year PO expires N ❑ YES CRNO Do you have multiple contracts, and would like them all blood on one twice (Summary Billing)? ,YES ❑ NO Are you tax exempt? Ryes, please allach a copy of exempt cedilicale of direct pay permit. EYES XO Do you require any almost Information to eslap sh a vendor number for ? ❑ YES KNO II yes, please ame: -A - Additional Comments: Would you prefer the same billing date for all contracts? *ES ❑ NO Contact Name: Title: — i'1G Contact Address: Contact Telephone Number: Email Address: V AND QUESTIONNAIRE FOR FORM 8038 -G FILINGS Written Tax Compliance Procedures The IRS Form 8035{i asks spedtic questions aboutwhetherwritlen procedures exist with regard to pompllance with the federal tax requirements fa tax-exempt Obligations. Please answer the following questions to help us complete the fare correctly prior to your signature. Please note that your answers to these questions will ml Impact ft terms or eotldttlons of the subled transaction: 1. Has the Lessee established written procedures designed to monllor compliance with federal lax resUMAloms for the tern of the lease? Among other matters, the written procedures should Identify a particular Individual wiUdn Lessee's oegartizabat to monitor compliance with the federal tax requirements related to use of the financed assets and describe actions to be taken In the event figure to raxnpfy with federal tax reshiclions Is contemplated or discovered. YES NO I* It YES, please adach/provlde a copy. Answer the following gaesllon only II proceeds of the cormd financing will he funded to an ESCROW Accoom. The IRS Form 8038 -0 asks specific questions about written procedures to merger the yield on the Investmentof gross proceeds of lax- axwnptobilpatlom end, as necessary, make payments of mbgrege rebate earned to the United States. 2. Has IM Lessee established written procedures to monom the yield an the irwestmteei of poceeds of the Lease on deposit In an escrow account or slmgm fund prior in being spent and to ensure that arty positive arbitrage rebels earned Is paid to the United States? YES ❑ NO ❑ If YES Please aeachlprovide a copy. N you have further questions, please consult your regular bond or legal counsel. Bens Nfllgb RrmrM.RaMONNaSA DaPFa0L9eGA1ra F.am 8038 -GCl Information Return for Small Tax - Exempt 3 Numbaand suesl(orP.0.box lrmell✓a not de wed to sheet address) Governmental Bond Issues, Leases, and Installment Sales (Aev. January 2mQ ► under Internal Revenue Code section 149(e) oaPanmmtdms n,,.,,,a s,.vmIas Cautlanay[he hsrre odce ol the laws ls $100.000 armors. use Form 01738 -G. OMB No. 1645 -0720 t Issuers name 2 Ig qe.., _ edlRelbn rsmiba (5P0 3 Numbaand suesl(orP.0.box lrmell✓a not de wed to sheet address) Roots @Jlo 4 Gly, town, or post oflke, stale, and ZIP code 6 Report h Y Use 8'Nemp ad tills of dlber or diver employee of bsuer or deaiguuetl oontaot person whom Oro Wmaycall formorelmommlbn 7 hmo num6adaalcer- el rupMeop4 Description of Opll ationa cnaCK one: a single issue U cyscon.swormeoreturn, - u. 8a Issue price of obligation(s) (see Instructions) XXXXMX b Issue date (single Issue) or calendar date (consolidated). Enter del in mm /4 format (for (L example ,01/01 /2009)(sse Instructions) 11- 9 Amount of the reported obligation(s) on line 86 that is: F leas f h' I -9e M X a or as or ve Ices . . . . . . . . . . . . . b For leases for office equipment . . . . . . . . . . . . 9b - - X XXX _ c For leases for real property . . . . . . . . . . . . .. . . 46 XxXXXXX If For leases for other (see instructions) . . . . 9d XXX a For bank loans for vehicles . . . . . -90 -. XXXXXXX f For bank loans for office equipment . . . . 9f- XXXXXXX g For bank loans for real property . . . . XXXXXXX It For bank loans for other (see Instructions) , 9h XXXXXXX I Used to refund prior Issues) . . . . . . . . .. . . . . . of XXXXXXX J Representing a loan franc the proceeds a tether tax -eX - obllg on (for.ex, bond bank) _ [911 XXXXXXX k Other . . . 9k I XXXXXXX 10 If the Issuer has designated any Issue s n 265(b)(3K IQ (s II issuer exc lion), check this box . ► ❑ 11 If the issuer has elected to pay ally Ileu of - rage reloate, eck hox (sea truotione) . . . . . . ► ❑ 12 Vendor's or bank's name: Signature l tit 1 1¢; I and Consent _XXXXXXXXX; ' $043114tvI Issuers Paid Rtntrr o WNrar ivne Preparer Use Only enema General What's New Form for enacted after we release IQ v1�1 be that pag° 150. Who IoK mot governmental Issue prices of less than at Nle Form 8038 -GG. if tax - exempt governmental with an Issue price of $1 D0,000 or file Form 0D3 8-0, Information Filing a:sepamte return for a single Issue. Issuers have the option to Me a separate Formi 8038 -GC for any tax- exompt governmental obligation with an Issue price of less than $100,000. An Issuer of a tax- exempt bond used to Chance construction expenditures must t0a a separate Form 8038 -GC for each Issue to give notice to the IRS that an election was made to 'SAMPLE DOCUMENT Type or print name and tale ' Check ❑ If I PnN pay a penalty in lieu . of arbitrage rebate (see the fine 11 instructions). Filing a consolidated Mum for multiple issues. For all tax - exempt governmental obligations with issue prices of lase than $100,000 that are not reported on a separate Form 8038 -GC, an issuer must Ole a consolidated Information return Including all such Issues issued within the calemdaryear. Thus, an Issuer may fib a separate Form 8038 -GC for esch 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, If the Issue is a constractlon Issue; a separate Form B038-GC must be Pled to give the IRS notice of the election to pay a penalty In lieu of arbitrage rebate. Car. No. 64108B Form 8038 -0G (ROV. 1 -2012) 8038 -DC IRev. 1 -2012) When To File To rue a separate return for a single Issue, file Form 8038 -GC on or before the 15th day of the second calendar month after the close of the calendow quarter In which the laws Is issued. To file a consolidated retum for multiple Issues, 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. 2002 -48, 2002 -37 I.R.B. 531, II 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, "Request for Relief under section 3 of Rev. Roo. 200248." Attach to the Form 8038 -GC a letter briefly stating why the form was cwt submlfted to the IRS on time- Also indicate whether the obligation M question Is under examination by the IRS. Do not submit copies of any bond documents, leases, or Installment sale documents. See Where To File next. Where To File File Forth 8038 -GC, and any attachments, with the Departrnent of the Treasury, Internal Revenue Service Canter, Ogden, N84201. Private delivery services. You can use certain private delivery services designated by the IRS to meet the "timely mainng as timely ning/payirlg" rule fortax returns and payments. These private delivery services Include only the following: •DHL Exlxess (DHU: PHIL isms Day S ce. • Federal Express (FadEx): FedEx Prl y Overnight, FedEc Standard Ovdml - , FedEx 2Day, FedEx International Pilodly FedEx International Fist. • United Parcel Service (UPS): UPS N Day Alr, UPS Next Day Air Sever, UPS 2nd p Air, UPS 2nd Day Alr A. PS Woddwlde Express Plus, and UP a Express. The private dally service can I u how to net Wrilt oroef of the mailing Other Fort Required bonds, use For0y603a, Infartnall8ig Return for Form to Whole Dollars e money It on Ihls amount from fiD 88 canlitfo than hlghi dollar. Definitions Obligations. This refers to a single tax- exempt governments] obligation If Form 8838 -OC Is used for separate reporting or to mullfple tax - exempt govemmental obligations it the form is used for consolidated reporting. Tex- exempt obligation. This Is any obligation Including a bond, Installment purchase agreement, a financial lease, an which the interest Is excluded from income under: section 103. Tex- 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(o). Private activity bond. This includes a obligation Iasuad as part of an Issue vAt • Mae than 10% of the proceeds to be used for any private act] bush s use, and • Mae than 10% of the payment of p ' ipal a Interest of Me Issue Is afthar-a 9eaure an Interest In Proper to a dva business use (a pay - a for such pr. ity) a (b) to be derived F mpayments for property (of ro d money) used fora private bushes sit. It also trial oa a bond, a prose a of which (a) a to be used to ilk or 11 once lows(other teens deacd In ecllod 141(0) to penile a other thang iferxYlepl, uric n excs the lesser of 5% of t P eedsar ml0lon. sue;Garerally, IgeB he ae part oftha samelse Vii are Issued by the sgitte Issuer, on same te, and as rattler the during as nits to as pad of the covered by :oected to be Qellvered within 3 years of the date of Issue o'. the first obligation. Arbitrage rebate. Generally, Interest on a state or local bond Is not tax - exempt unless the Issuer of the bond rebates to the United States arbitrage profits earned from investing prodeeds of the bond In higher yielding nonjewpose Investments. See section 148(f). Construction laws. This Is an Issue of tax - exempt bonds that meets both of the following conditions: PW2as Psgs 2 1. At least 75% of the available construction proceeds of the issue we to be used for conslivOon lures with respect to property t fr o d by a goyemmental unit or a 501 (3) gfge tlon, and 2. At of Chaos that are Dad of the Issue owed to United Slates, elssuerof canatrucllo uemay me Irevo )e electron to pay ally. The ` I s equal to 1 -1/2% of the a unl of dorlsI Ilon proceeds that do no set certain spend' qulr4maale. See aecg 148( C) end . e L 118fls for Forth I) 738 - Spa - In Instru 5 In general, e 8 8 -GC. M. be - mplated on sIs of ava- ble N atlon and reasonable pectelions as of the o of Issue. Howeva lorms that ere (tied on onsonclated Is may be complete Italia of information readily avallable to sou it the close of the calendar year to Ich the form relates, supplemented by estimates made In good Part I- Reporting Authority Amended return. An issuer may file an eAi return to change or add to the In Mn ition reported on a previously filed um for the came date of Issue. If you am 61ng to correct errors orchange a previously Ill return, check the "Amended Aetum" box In the heading of the form. The amended return must provide on the Infonnatlon reported on the original return, In addition to the new corrected information. Attach an explanation of the reason for the amended return and write across the top 'Amended Return Exptanatlom' Une 1. The Issuer's name Is the name of the entity issuing the obligatlons, not the name of The shitty receiving the benefit of the financing. In the case of a lease or Installment sale, the Issuer is the lessee or purchaser. Lim 2. An Issuer that does not have an employer idenllfioatlon number (EIN) should apply for one on Fain SS-4, Application for Fmpiuyer Idenfificatlon Number. You can get this form an the IRS website at IRS.gov or by calling 1 -800- TAX -FORM (1- 800- 82&3676). You may receive an EIN try.tefophone by following the Instructions for Form SS-4. hies 3 and 4. Enter the issuer's address or the address of the designated contact person listed on line 6. If the tesuer wishes to use Its own address and the lower receives Its mall In care of a third party authorized representative (such as an accountant or attorney), enter an the street address Ilce "C/D" (allowed by the third party's name and street address of P.O. box Include the suite, mom, or other unit number after the street address. if the post office does not deliver mail to the streal address and the issuer has a P.O. box show the box number Instead of the Form 9098 -GC (Rev. 1 -2012) street address. If a change in address occurs after the return Is Bled, use Form 8822, Change of Address. to notify the IRS of the new address. entered on lines 3 and 4 I t will use for all written gentling the processing of g my nations. By officer or other employee of the Issuer to communicate with the IRS and whom the IRS with the Individual listed on Ilne 6, whose address Is entered on lines 3 and 4 and consents to disclose the Issuer's return Information to that individual, as necessary, to process this return. Line 5. This fins is for IRS use only. Do not make any entries In this box, Part II— Description of Obligations Check the appropriate box designating this as a return on a single Issue basis or a consolidated return basis. Une Be. The issue price of obligations Is generally determined under Regulations section 1,148 -1(b). Thus, when Issued for cash, the Issue price Is the price at which a substantial amount of the obligations are sold to the public. To datermine the laws price of an obllgWlon Issued for property, see saoH 1273 and 1274 and the related rogula Lire Bb. For a single issue, enter the of Issue (for example, 03/152010 fa ogle 'Issue Issued on March 15, 2010), - nerally the data on Which the Issuer ph ily . exchanam the bonds that we cart o o purchasers) funds; for a ass or lnslall sale, enter the date Int - to nor For Issues reported a conso ell b enterthe first day' Itspalendarr, which the oblige ewe Iasued(for example , ler.deIII -er yea - O; enter 01/01/2010} Lines 9a Ihmugh 9 omPlefe Is property other than ce Is excha - _ 1 obligation farexample, Wring ap I e fI lelephope a marl i rim" moot ymenin is type i obligation is some as relen o as a "municipal lease' Also complete Is ru tire efty direcay acquired I ex' an obligation to make- - p - -ants of ml Do rho( pomolete Iirres 9a through .I proceeds of an obligation are re eeiv'ec form of cash even If the term "lease" Is t jefloe tit - 9a 111rd 9d, amounf or the a 7optla'te at represeSd a lerInat -nlFn d, lyppl is lease Ones Be In 9 ma emauar appropriat e Me represent. a ban an. For firm ,ante type of bank loan. Lines 91 and 81. Far line gl, enter the amount of the proceeds that will be used to pay principal, Interest, or call premium on any other issue of bonds, including proceeds that will be used to hind an escrow account for this purpose. Several time may apply to a particular obligation. For example, report on lines 91 and el obligations used to refund prior Issues which represent bans from the proceeds of another tex•exempt obligation. Line 9k. Enter on line 9k the amount an e' Be that does not represent an Zili described on lines 9a through 9j. Line 10. Check this box If the iea has designated any Issue as a "small IN exception" under section 285(b)(3)(0)(1) Line 11. Check this box B' as construction Issue and Irrevocable I to pay a penalty In Il of arbltrage rebate s been made on or ore the date the bontla' were Issued. Th coolly Is o with n Fomt 8038 T as 6- nth ps 'd offer the date (he nds are 1 . Do no make any paymen I penalty In3te f rob - with Form 8pp38�-Q all Rev. Prac: . 1992 -;K 736. IUteareeanfin Ute Y 12. Ester I anus he vendor er Bt Is a party to t nslall 1 purchase rmenL ban, a 0 181 I . If there bq�ALL and An a -� t _ lean Of owre of the uers return nee . 6 Process this io - ran I that has been nth id. 1 r authorizes In It-6 the IRS 1 a with -a pen.ar other than an er employee of the Issuer, (each rn ehs11 include contact both In ird1mrr of the address entered in 4, and by telephone) by signing to process this 3 Paid re Ilan odzed re esentallys of the Issuer return b aesfnot rge enkatlon , Id an the r um... sin others wh _ pant the - um should not . For oxample; arogU 'full-Ilene emplo of the Issuer, Su a clerk, secretary, „should -not -n. Generally, e a who is pis op area return must sign -nd fill In the of blanks In the Pant Pmparrer. Only area of the turn. A paid preperer _, mt use a Social , lynumber In the Pa 'paierllse MY boX. apaid preparermmt - a, pre j tax ba Ication number IN). - -aid preparar . oft -omit d; I 'rep _fei ' shoultl enter or h address the box. he paid preps r must: • SI he return In the sp ' provided for the prepare signature, an • Give a dopthpf the afurs to the Issuer. Paperwork Reduction Act Notice We ask for the Information on this form to carry out the Internal Revenue laws of the United Stated. You are required to give us the Information, We need B to ensure that you are mplying with these laws. ou are not required to provide the lomiationrequested on a form that is subject to the Paperwork Reduction Ad unless the form displays a valid OMB control number. Books or records relating to a form or Its instructions must be retained as long as their contents may become material In the administration of any internal Revenue law. Generally, tax returns and realm Infomtatbn era conffdentlal, as required by section 6103. The time needed to complete and file this form will vary depending on Individual clmumstances. The estimated average time is: Leaming about the few or the form . . . . 4 hr., 46 min. Preparing the form . . 2 hr., 22 min. Copying, assembling, and sending the form to the IRS 2 hr., 34 min. If you have comments corrceming the aocurecy of these time estimates or suggestions for making this form simpler, we would be happy to hear from you. You can write to the Internet Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW, -IR -8526, Washington, DC 20224. Do not send the form to this address. Instead, nee byheae To F71e. r.v,aaa exoreaiaW.e•nn.4 Wnnelnneuaw nepnxwosw mp Form 8 ®3$ °GC Information Return for Small Tax - Exempt loo -►ol iotfl (Rev. January 2012) Governmental Bond Issues, Leases, and Installment Sales OMB No. 1545 -0720 ► Under Internal Revenue Code section 149(e) Department of the Treasury Internal Revenue Service Caution: If the issue price of the issue is $100,000 or more, use Form 8038 -G. KM Reporting Authority Check box if Amended Return ► ❑ 1 Issuer's name 2 Issuer's employer identification number PN) City of Seal Beach 1 9 5 1 6 0 0 0 7 9 4 3 Number and street (or P.O, box if mail is not delivered to street address), Room/suite 211 8th Street 4 CiN. town, or cost office, state, and ZIP code 16 Report number For IRS Use Only) or designated contact person whom the IRS may call for more information 17 Telephone number one: a single Issue [✓j or a 8a Issue price of obligation(s) (see instructions) . . . . . . . . . . . . . . . . . . tsa 3,8221 1; b Issue date (single issue) or calendar date (consolidated). Enter date in mm /dd/yyyy format (for instructions) ► example, 01/01/2009) (see 0511712016'` �1 r 9 Amount of the reported obligation(s) on line 8a that is: a For leases for vehicles . . . . . . . . . . . . . . . . . . . . . . . . . 9a b For leases for office equipment . . . . . . . . . . . . . . . . . . . . . . 9b c For leases for real property . . . . . . . . . . . . . . . . . . . . . . . . 9c d For leases for other (see instructions) . . . . . . . . . . . . . . . . . . . ... 9d e For bank loans for vehicles . . . . . . . . . . . . . . . . . . . . . . . . 9e f For bank loans for office equipment . . . . . . . . . . . . . . . . . . . . . 9f g For bank loans for real property . . . . . . . . . . . . . . . . . . . . . . 99 h For bank loans for other (see instructions) . . . . . . . . . . . . . . . . 9h i Used to refund prior issue(s) . . . . . . . . . . . . . . . . . . . . . 91 j Representing a loan from the proceeds of another tax - exempt obligation (for example, bond bank) . . 9j kOther . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9k 3,822 1; 10 If the issuer has designated any issue under section 265(b)(3)(B)()(III) (small issuer exception), check this box . . . . ► ❑ 11 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check this box (see instructions) . . . . . . . ► ❑ 12 Vendor's or bank's name: De Lage Land an Public Finance LLC __ _ _ __ 13 \ /cndnr'c ,, hank's amnlnvar iriantificatinn mtmher 7 2 I 1 6 0 3 4 7 9 .SI nature tme, d, antl r c g that I have cone aNhoiz and Consent riems, and to the best of my knowledge and belief, they are nation, as necessary to process this return, to the person(s) Vic -,r,,o ff L Type or print name and title Paid Pmmn ype preparer's name rreparers sm name am v r- Check ❑ if Preparer Stephen R Kubick G-,�3 ,QC'16 seh- employed Use Only Firm's name ► De Lace Landon Public Finance LLC I Firm's EIN ► 72- 1603479 Ftm,ls ndmr ,, ► 1111 Old Eaele, School Road. Wavne. PA 19087 1 Phone no. 610.386 -5722 General Instructions Section references are to the Internal Revenue Code unless otherwise noted. What's New The IRS has created a page on IRS.gov for information about the Form 8038 series and its instructions, at www.irs.govlform8038. Information about any future developments affecting the Form 8038 series (such as legislation enacted after we release it) will be posted on that page. 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 for a single issue. 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 11 instructions). Filing a consolidated return for multiple issues. 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. 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, If the issue is a construction issue, 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. Cat. No. 64108B Form 8038 -GC (Rev. 1-2o12) ATTACHMENT 1 STATE AND LOCAL GOVERNMENT LEASE - PURCHASE AGREEMENT Lease Payment Schedule LESSOR: DE LAGE LANDEN PUBLIC FINANCE LLC LESSEE CITY OF SEAL BEACH LEASENUMBER: PUB 15813 LEASE DATE: APRIL 28 120 16 Payment Number Payment Dale Rental Payment Interest Portion Principal Portion Balance Purchase Price Loan 5/1712016 0.00 0.00 0.00 3,822.12 0.00 1 - 7/1612016 119.33 46.59 72.74 3,749.38 3,861.86 2 8116/2016 119.33 22.94 96.39 3,652.99 3,762.58 3 9/1612016 119.33 22.35 96.98 3,556.01 3,662.69 4 10/16/2016 119.33 21.76 97.57 3,458.44 3,562.19 5 11/16/2016 119.33 21.16 98.17 3,360.27 - 3,461.08 6 12/16/2016 119.33 20.56 98.77 3,261.50 3,359.35 7 1/1612017 119.33 19.95 99.38 3,162.12 3,256.98 8 2/16/2017 119.33 19.35 99.98 3,062.14 3,154.00 9 3/1612017 119.33 18.73 100.60 2,961.54 3,050.39 10 4/1612017 119.33 18.12 101.21 2,860.33 2,946.14 11 5/1612017 119.33 17.50 101.83 2,758.50 2,841.26 12 6/16/2017 119.33 16.88 102.45 2,656.05 2,735.73 13 7116/2017 119.33 16.25 103.08 2,552.97 2,629.56 14 8/1612017 119.33 15.62 103.71 2,449.26 2,522.74 15 9/16/2017 119.33 14.99 104.34 2,344.92 2,415.27 16 10/16/2017 119.33 14.35 104.98 2,239.94 2,307.14 17 11116/2017 119.33 13.70 105.63 2,134.31 2,198.34 18 12/16/2017 119.33 13.06 106.27 2,028.04 2,088.88 19 1/16/2018 119.33 12,41 106.92 1,921.12 1,978.75 20 2116/2018 119.33 11.75 107.58 1,813.54 1,867.95 21 3/16/2018 119.33 11.10 108.23 1,705.31 1,756.47 22 411612018 119.33 10.43 108.90 1,596.41 1,644.30 23 5/160018 119.33 9.77 109.56 1,486.85 1,531.46 24 6/16/2018 119.33 9.10 110.23 1,376.62 1,417.92 25 7/1612018 119.33 8.42 - 110.91 1,265.71 1,303.68 26 811612018 119.33 7.74 111.59 1,154.12 1,188.74 27 91162018 119.33 7.06 112.27 1,041.85 1,073.11 28 10/16/2018 119.33 6.37 112.96 928.89 956.76 29 11/162018 119.33 5.68 113.65 815.24 839.70 30 12/16/2018 119.33 4.99 114.34 700.90 721.93 31 11162019 119.33 4.29 115.04 585.86 603.44 32 2/1612019 119.33 3.58 115.75 470.11 484.21 33 3/162019 119.33 2.88 116.45 353.66 364.27 34 4/162019 119.33 2.16 117.17 236.49 243.58 35 5/162019 119.33 1.45 117.88 118.61 122.17 36 6116/2019 119.33 0.72 118.61 0.00 0.00 4,295.88 473.76 3,822.12 0.00 Sales tax of $283.12 is included in the financed amount shown above. Pape -d 1 ©2012uIRiwPseivd.Pinle6lnlhe USA 09PWOC155@W Vikki Beatley From: SKubick @leasedirect.com Sent: Thursday, June 23, 2016 9:21 AM To: Vikki Beatley Subject: Action Request: IRS Form 8038 -GC and Revised Payment Schedule for De Lage Landen Copier Lease 100 - 10110171 Attachments: 100 - 10110171 8038 -GC for Signature.pdf; 100- 10110171 Signed Lease Documents.pdf; Revised Payment Schedule (Attachment 1).pdf; July Payment Invoice.pdf Tax - Exempt Financing Agreement between City of Seal Beach and De Lage Landen Public Finance Lease Number: 100 - 10110171 Amount of Funding: $3,822.12 Date of Funding: May 17th, 2016 Dear Ms. Beatley, As you are aware, the above - referenced financing agreement regarding the City's recent purchase of One (1) Kyocera Copier commenced on May 17'h, 2016. This letter highlights two important components of the transaction. 1. Action Request Related to the IRS Form 8038 -GC We are required to prepare the Form 8038 -GC, obtain an original signature and file the form with the IRS. The attached IRS Form 8038 -GC form has been prepared based upon information obtained from the financing agreement. An executed copy of this lease purchase agreement is also attached for your reference. So that we may timely file the document in accordance with IRS regulations, we ask that within 7 days of receipt of this letter, you please take the following actions: C• On the 8038 -GC Form, please sign where indicated •:• Keep a signed copy for your records •: Return the 8038 -GC form (with your original signature) to my attention, at the address identified below: Stephen Kubick De Lage Landen Public Finance 1111 Old Eagle School Road Wayne, PA 19087 Once received, we will file the original signed 8038 -GC Form with the IRS, and a copy will be retained in our records. Should you receive any correspondence from the IRS regarding the above referenced Form 8038 -GC, please contact me. I will work with the IRS on your behalf as needed to resolve any issues, or answer any questions as they may relate to this matter. 2. Revised Lease Payment Schedule (Attachment 1) Because of the booking and funding date of this transaction, our invoicing system set the first payment to be due on July 16th versus what the original signed documents list as a first payment due date of June 16'h. The number of payments and the payment amounts do not change, it's only the due dates being pushed back by one month across the life of the agreement. We ask that you please sign, or have signed, the attached payment schedule reflecting this change. Also attached is a manually generated invoice for this first payment that will be due on July 16th. If that payment has not yet been made, you may use this invoice for reference. Our apologies for any inconvenience this may cause. If you have any questions at all please feel free to contact me via any of the methods listed within my signature below. Please note that we can accept the revised payment schedule as a digital copy, but we do have to receive the original signed 8038 -GC as it is an IRS requirement to file the original. Thank you again, and most sincerely, Stephen Kubick dLMM MM L financial solutions partner Stephen Kubick Senior Business Support Officer, Public Finance T +01610 386 5722 M +01 215 498 8779 E skubick(Ebleasedirect.com De Lage Landen Financial Services, Inc. 1111 Old Eagle School Road Wayne, PA 19087 United States of America F +01 866 355 9447 www.dIkircuo.com Follow us on Linkedln Please consider the environment before printing. See what counts. De Lage Landen Financial Services, Inc. has the right to use the DLL°, DLL Financial Solutions Partner`" and See what counts" service marks. DLL has offices in more than 35 countries throughout Europe, North America, South America, Australia and Asia. The company is part of the Rabobank Group. The information transmitted via this e-mail is intended only for the person or entity to which it is addressed and may contain confidential and /or privileged material. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer