Agreement to Lease Multi-Function Copier

1 Agreement to Lease Multi-Function Copier Color Directions - T his form is for leasing a Multi-Function Copier . Monochrome Please complete this form entirely and return to Procurement Services as noted below. If you have any questions, please contact Norma Glennie, University of Michigan Contract Administrator, at or at 734-647-6450. This completed form and the Network Evaluation form can be sent electronically to or faxed to Norma at 734-615-6235. Please contact Norma Glennie if you have not received confirmation that we have received your order within 48 hours after you have submitted it to us. When filling in this form, please use black ink. Leasing Department - Authorization Information Today's Date _____ ShortCode _____ Authorized Person _____ Email Address _____ Department _____ School/Organization _____ Phone w/area code _____ Fax number _____ Copier Information Our current monthly volume is approximately: _____.

2 We would like to order Konica model: _____. Medical campus customers note: It is recommended that you work with your local MCIT support to enable print/scan functions . Please notify us if these features are to be disabled on your equipment order. Currently on MiWorkSpace? YES NO Scheduled to migrate to MiWorkSpace? YES NO DATE: _____ With the following functions : Copier print scan - please complete the Network Evaluation form also Copier fax printer scan - please complete the Network Evaluation form also Please see the contract price list to complete the following information before submitting both forms. We understand that the model we ordered has a minimum number of color copies of _____ per month and a minimum number of black copies of _____ per month (see pricing below).

3 The minimum charge on our ShortCode will be $_____ per month, unless more copies are made (see pricing below. If more than the minimum number of copies is made in a month there will be an additional charge. All maintenance and supplies (except paper) are included in this Lease . If a "rush" delivery for supplies is placed, we understand that our ShortCode will be charged for the freight. For all copiers leased please complete the Network Evaluation form and return it with this form. Please indicate if you would like a 4 year time commitment or a used Copier with no time commitment below. Time Commitment Agreement : To Lease a new Konica Minolta Copier , you are committing to the Lease Agreement for 4 years after the receipt of the new Copier . A signature at the bottom of this Lease is required.)

4 No Time Commitment Agreement : Please contact Norma Glennie for Copier availability if you would like a used Copier without a time commitment. A signature at the bottom of this Lease is required. If you have a leased Konica Copier to be picked up at the time of this delivery, provide the ID or serial number: _____? If this Copier is not replacing a Konica Minolta what brand & model number is this Copier replacing _____? What was the PO number _____? Contact and Delivery Information Contact Person _____ Email Address _____ Room Number _____ Building _____ Street Address _____ City _____ Zip _____ Does this building have an elevator that is accessible to the floor the Copier will be delivered? _____? Phone w/area code _____ Fax _____ We would like the Copier delivered on or by _____ (Delivery is usually within 10 -15 business days on Wednesday and Friday only).

5 Stipulations of this Agreement : Monthly meter readings are required. copiers will be prepared and installed by Konica Minolta personnel only. copiers must be moved by Konica Minolta personnel only. Authorized Person _____ Date _____ Signature is required NE TW O R K EV AL U AT IO N FO R M Please complete this form entirely and return it, together, with your Konica Lease Agreement . copiers and Printers will be prepared and installed for fax, print and scan by Konica Minolta personnel only. If you have questions, please contact Norma Glennie, UM Contract Administrator, at 734-647-6450 or by email at Department Name: Department Room & Building: _____ Departments Street Address: _____ City _____ Customer Contact: _____ Phone: _____ IT Contact Person: _____ Phone: _____ Does the IT person listed above have administrative rights to this network?

6 0 YES 0 NO Currently on MiWorkSpace? 0 YES 0 NO Scheduled to migrate to MiWorkSpace? 0 YES 0 NO DATE: _____ Equipment Model of Copier /Printer ordered: The below photos are examples of the electrical outlets required for each machine. Please make sure you have the correct electrical outlet for the machine you have ordered. Bizhub 20/25e Bizhub 36/36S, Bizhub 222/223/224e/227 Bizhub 283/284e/287 Bizhub 350/362/363/364e Bizhub 421/423/454e Bizhub 4700P Bizhub 501/554e Bizhub C280/C258 Bizhub C224/C224e Bizhub C364/C364e/C368 Bizhub C454e Bizhub C25 Bizhub C35P/C3100P/C3110 Bizhub 5650EN Bizhub 552 Bizhub 601/652/654/654e Bizhub 754/754e Bizhub C451/C452/C454 Bizhub C552/C554e Bizhub C652/C654/C654e Bizhub C754e Bizhub Pro 920/951 If you are currently on MiWorkSpace you do not need to fill out the information below.

7 Network Information Is there a live data/RJ-45 port for the machine to plug in to? 0 YES 0 NO For fax option, is there a live phone/voice port for the machine to plug in to ? 0 YES 0 NO Systems that require printing on the network: El Windows El Mac El Unix El Linux El AS400 El Other Assigned IP: _____ Subnet: _____ Gateway: The IP address, Subnet and Gateway are assigned by your department s IT staff. The IP address must be registered with ITS or MCIT. Scanning Information Scanning services to be installed (check all that apply): El Scan to SMB (scan to desktop) El Scan to E-Mail El Scan to Box El Scan to Fax KO NI CA MINO L TA CO P IE R LE ASE Price Sheet 1 1/28/16 Monochrome (Black & White) copiers New black & white copiers have a four year Lease commitment.

8 You will be signing a Lease for four years with no cancellation from the Managed Copier Program. You may Lease a used Copier equivalent to the model you choose without time commitments if one is available. Model and Features Cost per Copy Minimum Copies per Month Minimum Cost per Month (higher if min. exceeded) Konica 25e Copier with Print/Scan and Fax $ 1,800 $ Konica 227 w/o staple finisher Copier with Print/Scan Copier with Print/Scan and Fax $ $ 5,400 6,400 $ $ Konica 227 with staple finisher Copier with Print/Scan Copier with Print/Scan and Fax $ $ 5,900 6,800 $ $ Konica 284e Copier with Print/Scan Copier with Print/Scan and Fax $ $ 8,900 9,900 $ $ Konica 454e Copier with Print/Scan Copier with Print/Scan and Fax $ $ 11,800 12,800 $ $ Konica 554e Copier with Print/Scan Copier with Print/Scan and Fax $ $ 15,700 18,000 $ $ Konica 654e w/o large capacity tray Copier with Print/Scan Copier with Print/Scan and Fax $ $ 23,500 26.

9 350 $ $ KO NI CA MINO L TA CO P IE R LE ASE Price Sheet 2 1/28/16 Color copiers All color copiers have a four year Lease commitment. You will be signing a contract to Lease a Copier for four years with no cancellation from the Managed Copier Program. All color copiers are new. Model and Features Color Cost per Copy B&W Cost per Copy Color Minimum Copies per Month B&W Minimum Copies per Month Minimum Cost per Month (higher if min. exceeded) Konica C258 w/o staple finisher Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 1,500 1,500 4,215 5,060 $ $ Konica C258 with staple finisher Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 1,500 1,500 4,715 5,560 $ $ Konica C368 Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 2,500 2,500 6,325 7,170 $ $ Konica C454e Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 3,000 3,000 7,375 8,220 $ $ Konica C554e Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 5,000 5,000 9,000 9,850 $ $ Konica C654e Copier with Print/Scan Copier with Print/Scan and Fax $ $ $ $ 6,500 6,500 10,000 10.

10 850 $ $ Konica C754e Copier with Print/Scan/3-Hole Punch Copier with Print/Scan/Fax/3-Hole Punch $ $ $ $ 7,500 7,500 11,000 11,850 $ $ KO NI CA MINO L TA CO P IE R LE ASE Price Sheet 3 1/28/16 Color and Monochrome (Black & White) Printers All printers have a four year Lease commitment. You will be signing a contract to Lease a printer for four years with no cancellation from the Managed Copier Program. All printers are new. Model and Features Color Prints Billed Monthly at $ CPP B&W Included Monthly Volume Color Cost Per Page B&W Cost Per Page Minimum Cost per Month PLUS color copies (higher if min. exceeded) Konica Bizhub C3110 Color MFP Printer 25ppm B&W and Color Copier Fax Print Scan with Auto Duplexing Billed for actual color copies printed 3500 $ $ $ Konica Bizhub C3100P Color Printer 37ppm B&W and Color Printer with Auto Duplexing Billed for actual color copies printed 2500 $ $ $ Konica Bizhub 4700 Monochrome Printer ppm B&W Printer with Auto Duplexing N/A 2000 N/A $ $ The following applies to copiers and printers: Delivery is usually within 10 - 15 working days after receipt of Lease form.