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.