Change Notice No. 4 Contract No. 071B9200294 the State Of
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Form No. DTMB-3521 (Rev. 4/2012) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract change will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET PROCUREMENT P.O. BOX 30026, LANSING, MI 48909 OR 525 W. ALLEGAN, LANSING, MI 48933 CHANGE NOTICE NO. 4 to CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR: PRIMARY CONTACT EMAIL Rotary Multiforms, Inc. Bill Condon [email protected] 2104 E. Eleven Mile Road, Suite 400 TELEPHONE CONTRACTOR #, MAIL CODE Warren, MI 48091 (586) 558-7960 STATE CONTACTS AGENCY NAME PHONE EMAIL CONTRACT COMPLIANCE INSPECTOR Treasury Darron Birchmeier (517) 241-3548 [email protected] BUYER DTMB Sue Cieciwa (517) 284-7007 [email protected] CONTRACT SUMMARY: DESCRIPTION: Tax Form Production & Personalization - Treasury INITIAL EXPIRATION INITIAL AVAILABLE EXPIRATION DATE BEFORE CHANGE(S) INITIAL EFFECTIVE DATE DATE OPTIONS NOTED BELOW September 5, 2009 September 4, 2012 2, one year September 4, 2014 PAYMENT TERMS F.O.B SHIPPED SHIPPED FROM Net 30 Days Delivered Per Specifications N/A ALTERNATE PAYMENT OPTIONS: AVAILABLE TO MiDEAL PARTICIPANTS P-card Direct Voucher (DV) Other Yes No MINIMUM DELIVERY REQUIREMENTS: Per Specifications DESCRIPTION OF CHANGE NOTICE: EXTEND CONTRACT EXERCISE CONTRACT EXTENSION BEYOND LENGTH OF EXPIRATION DATE EXPIRATION DATE OPTION YEAR(S) CONTRACT OPTION YEARS OPTION/EXTENSION AFTER CHANGE No Yes 5 months, 24 days February 28, 2015 VALUE/COST OF CHANGE NOTICE: ESTIMATED REVISED AGGREGATE CONTRACT VALUE: $125,000.00 $694,703.55 Effective September 5, 2014, this Contract is hereby EXTENDED from September 4, 2014 to February 28, 2015. All other terms, conditions, pricing, and specifications remain the same. Per agency request dated July 14, 2014, DTMB, Procurement request dated July 24, 2014, and vendor agreement by email dated July 25, 2014. Form No. DTMB-3521 (Rev. 4/2012) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract change will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET August 23, 2013 PROCUREMENT P.O. BOX 30026, LANSING, MI 48909 OR 530 W. ALLEGAN, LANSING, MI 48933 CHANGE NOTICE NO. 3 to CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR: PRIMARY CONTACT EMAIL Rotary Multiforms, Inc. Bill Condon bcondon@rmi‐printing.com 2104 E. Eleven Mile Road, Suite 400 TELEPHONE CONTRACTOR #, MAIL CODE Warren, MI 48091 (586) 558‐7960 STATE CONTACTS AGENCY NAME PHONE EMAIL CONTRACT COMPLIANCE INSPECTOR Treasury Darron Birchmeier 517‐241‐3548 [email protected] BUYER DTMB Jim Wilson 517‐241‐1916 [email protected] CONTRACT SUMMARY: DESCRIPTION: Tax Form Production & Personalization ‐ Treasury INITIAL EXPIRATION INITIAL AVAILABLE EXPIRATION DATE BEFORE CHANGE(S) INITIAL EFFECTIVE DATE DATE OPTIONS NOTED BELOW September 5, 2009 September 4, 2012 2, one year September 4, 2013 PAYMENT TERMS F.O.B SHIPPED SHIPPED FROM Net 30 Days Delivered Per Specifications N/A ALTERNATE PAYMENT OPTIONS: AVAILABLE TO MiDEAL PARTICIPANTS P-card Direct Voucher (DV) Other Yes No MINIMUM DELIVERY REQUIREMENTS: Per Specifications DESCRIPTION OF CHANGE NOTICE: EXTEND CONTRACT EXERCISE CONTRACT EXTENSION BEYOND LENGTH OF EXPIRATION DATE EXPIRATION DATE OPTION YEAR(S) CONTRACT OPTION YEARS OPTION/EXTENSION AFTER CHANGE No Yes 1 Year September 4, 2014 VALUE/COST OF CHANGE NOTICE: ESTIMATED REVISED AGGREGATE CONTRACT VALUE: $57,000.00 $569,703.55 Effective immediately, this Contract is utilizing the second option year. The new Contract end date is September 4, 2014. All other terms, conditions, pricing and specifications remain the same. Per vendor and agency agreement and DTMB Procurement approval. Form No. DTMB-3521 (Rev. 4/2012) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract change will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF TECHNOLOGY, MANAGEMENT AND BUDGET PROCUREMENT P.O. BOX 30026, LANSING, MI 48909 OR 530 W. ALLEGAN, LANSING, MI 48933 CHANGE NOTICE NO. 2 to CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR: PRIMARY CONTACT EMAIL Rotary Multiforms, Inc. Bill Condon [email protected] 2104 E. Eleven Mile Road, Suite 400 TELEPHONE CONTRACTOR #, MAIL CODE Warren, MI 48091 (586) 558-7960 STATE CONTACTS AGENCY NAME PHONE EMAIL CONTRACT COMPLIANCE INSPECTOR Treasury Darron Birehmeier BUYER DTMB Jim Wilson 517-241-1916 [email protected] CONTRACT SUMMARY: DESCRIPTION: Tax Form Production & Personalization - Treasury INITIAL EXPIRATION INITIAL AVAILABLE EXPIRATION DATE BEFORE CHANGE(S) INITIAL EFFECTIVE DATE DATE OPTIONS NOTED BELOW September 5, 2009 September 4, 2012 2, one year September 4, 2013 PAYMENT TERMS F.O.B SHIPPED SHIPPED FROM Net 30 Days Delivered Per Specifications N/A ALTERNATE PAYMENT OPTIONS: AVAILABLE TO MiDEAL PARTICIPANTS P-card Direct Voucher (DV) Other Yes No MINIMUM DELIVERY REQUIREMENTS: Per Specifications DESCRIPTION OF CHANGE NOTICE: EXTEND CONTRACT EXERCISE CONTRACT EXTENSION BEYOND LENGTH OF EXPIRATION DATE EXPIRATION DATE OPTION YEAR(S) CONTRACT OPTION YEARS OPTION/EXTENSION AFTER CHANGE No Yes VALUE/COST OF CHANGE NOTICE: ESTIMATED REVISED AGGREGATE CONTRACT VALUE: $0.00 $512,703.55 Effective October 2, 2012, the attached specifications and pricing are hereby incorporated into this contract. All other terms, conditions, pricing and specifications remain the same. Per vendor and agency agreement and DTMB Procurement approval. Form No. DMB 234 (Rev. 1/96) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF MANAGEMENT AND BUDGET November 9, 2011 PROCUREMENT P.O. BOX 30026, LANSING, MI 48909 OR 530 W. ALLEGAN, LANSING, MI 48933 CHANGE NOTICE NO. 1 OF CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR TELEPHONE: Bill Condon (586) 558-7960 Rotary Multiforms, Inc. CONTRACTOR NUMBER/MAIL CODE 2104 E. Eleven Mile Rd., Suite 400 Warren, MI 48091 BUYER/CA (517) 373-6535 Email: [email protected] William C. Walsh, CPPB Contract Compliance Inspector: Darron Birehmeier Tax Form Production & Personalization - Treasury CONTRACT PERIOD: 3 yrs. + 2 one-year options From: September 5, 2009 To: September 4, 2013 TERMS SHIPMENT Net 30 Days Per Specifications F.O.B. SHIPPED FROM Delivered N/A MINIMUM DELIVERY REQUIREMENTS Per Specifications MISCELLANEOUS INFORMATION: THIS CONTRACT IS EXTENDED TO LOCAL UNITS OF GOVERNMENT. NATURE OF CHANGE(S): Beginning Tax Year 2011, the Michigan Business Tax (MBT) Quarterly Estimate Form will be replaced with a Corporate Tax (CIT) Quarterly Estimate Form, and the addition of a Flow Through Withholding (FTW) Quarterly Return. Effective November 1, 2011, this contract is hereby EXTENDED to September 4, 2013 and INCREASED by $121,000.00. This is allowed under current contract language. All other terms, conditions, pricing and specifications remain the same. AUTHORITY/REASON(S): Per PRF request from Department of Treasury dated 10/21/2013, Vendor Agreement and DTMB Procurement approval. INCREASE: $121,000.00 TOTAL REVISED ESTIMATED CONTRACT VALUE: $512,703.55 Contract No. 071B9200294 Change Notice No. 1 Signature Block FOR THE CONTRACTOR: FOR THE STATE: Rotary Multiforms, Inc. Firm Name Signature Jeff Brownlee, Chief Procurement Officer Authorized Agent Signature Name/Title DTMB-Procurement Authorized Agent (Print or Type) Division Date Date Form No. DMB 234 (Rev. 1/96) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF MANAGEMENT AND BUDGET September 2, 2009 PURCHASING OPERATIONS P.O. BOX 30026, LANSING, MI 48909 OR 530 W. ALLEGAN, LANSING, MI 48933 NOTICE OF CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR TELEPHONE: Bill Condon (586) 558-7960 Rotary Multiforms, Inc. CONTRACTOR NUMBER/MAIL CODE 2104 E. Eleven Mile Rd., Suite 400 Warren, MI 48091 BUYER/CA (517) 373-7374 Email: [email protected] Joan Bosheff Contract Compliance Inspector: Darron Birehmeier Tax Form Production & Personalization - Treasury CONTRACT PERIOD: 3 yrs. + 2 one-year options From: September 5, 2009 To: September 4, 2012 TERMS SHIPMENT Net 30 Days Per Specifications F.O.B. SHIPPED FROM Delivered N/A MINIMUM DELIVERY REQUIREMENTS Per Specifications MISCELLANEOUS INFORMATION: THIS CONTRACT IS EXTENDED TO LOCAL UNITS OF GOVERNMENT. The terms and conditions of this Contract are those of ITB #071I9200199 this Contract Agreement and the vendor's quote. In the event of any conflicts between the specifications, and terms and conditions, indicated by the State and those indicated by the vendor, those of the State take precedence. Estimated Contract Value: $391,703.55 Form No. DMB 234 (Rev. 1/96) AUTHORITY: Act 431 of 1984 COMPLETION: Required PENALTY: Contract will not be executed unless form is filed STATE OF MICHIGAN DEPARTMENT OF MANAGEMENT AND BUDGET PURCHASING OPERATIONS P.O. BOX 30026, LANSING, MI 48909 OR 530 W. ALLEGAN, LANSING, MI 48933 CONTRACT NO. 071B9200294 between THE STATE OF MICHIGAN and NAME & ADDRESS OF CONTRACTOR TELEPHONE: Bill Condon (586) 558-7960 Rotary Multiforms, Inc. CONTRACTOR NUMBER/MAIL CODE 2104 E. Eleven Mile Rd., Suite 400 Warren, MI 48091 BUYER/CA (517) 373-7374 Email: [email protected] Joan Bosheff Contract Compliance Inspector: Darron Birehmeier Tax Form Production & Personalization