079-14 - Microsoft - ContractMicrosoft `� Volume Licensing
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Program Signature Form
MBA/MBSA number
Agreement number 6013310
Note: Enter the applicable active numbers associated with the documents below. Microsoft
requires the associated active number be indicated here, or listed below as new.
This signature form and all contract documents identified in the table below are entered into between
the Customer and the Microsoft Affiliate signing, as of the effective date identified below.
Contract Document
<Choose Agreement>
Number or Code
<Choose Agreement>
<Choose Agreement>
<Choose Agreement>
<Choose Agreement>
Select Plus Affiliate Registration Form
X20 11691
<Choose Enrollment/Re istration>
<Choose Enrollment/Registration>
<Choose Enrollment/Re istration>
<Choose Enroll ment/Registration>
By signing below, Customer and the Microsoft Affiliate agree that both parties (1) have received, read
and understand the above contract documents, including any websites or documents incorporated by
reference and any amendments and (2) agree to be bound by the terms of all such documents.
Program vignl-orm(Fr1,,ig n)(NA, LatAm)ExBRA, M LI(ENG)(0ct2013)
Page 1 of 3
Name of Entity (m ,be le I entit n * ity of Port Orchard
Signature*
Printed First and Last Name* Raymond Vincent Tucker
Printed Title IT Manager/LAN Tech
Signature Date* 19 Sept 2014
Tax ID 91-6001487
• indicates required field
Optional 2"d Customer signature or Outsourcer signature (ifapplicabl)
Name of Entity (must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
`indicates required field
Name of Entity (must be legal entity name)*
Signature*
Printed First and Last Name*
Printed Title
Signature Date*
* indicates required field
If Customer requires physical media, additional contacts, or is reporting multiple previous Enrollments,
include the appropriate form(s) with this signature form.
After this signature form is signed by the Customer, send it and the Contract Documents to
Customer's channel partner or Microsoft account manager, who must submit them to the following
Program SignForm( MSS ign)(NA,LatAm )EXS RA,lsrt Ll (ENG)(Oc12013)
Page 2 of 3
address. When the signature form is fully executed by Microsoft, Customer will receive a confirmation
copy.
Microsoft Licensing, GP
Dept. 551, Volume Licensing
6100 Neil Road, Suite 210
Reno, Nevada 89511-1137
USA
ProgramSignForm(MSSign)(MA,LetAm)ExBRA,MLIa C--NGj(Oct2b13) Page 3 of 3
®� Microsoft
�.
Select Plus Affiliate Registration Form
Registration Type
Reseller to complete
Agreement Number
Microsoft or Reseller to complete
Qualifying Contract
Reseller to complete
Lead Affiliate ❑
Additional Affiliate
6013310
Volume Licensing
State and Local
Lead Affiliate Public Customer
Number (PCN)
Reseller to complete
Additional Affiliate Public
Customer Number (PCN)
Reseller to complete
Change Affiliate Anniversary
Month
Reseller to complete
85EB2AE5
June
By registering, Registered Affiliate accepts and agrees to be bound by the terms of the agreement and
any applicable attachments (the "Agreement"), and will be allowed to acquire Products in accordance
with the Agreement.
if Registered Affiliate registers as an Additional Affiliate, Registered Affiliate represents that the
Additional Affiliate is an eligible entity of the Lead Affiliate identified above.
This registration is valid when accepted by Microsoft and until it is terminated. Registered Affiliate will
receive an acceptance notification confirming the effective date of this registration. Microsoft may
refuse to accept a registration if there is a business reason for doing so: Either party may terminate
this registration for any reason with 60 days advance written notice: Terminating,this registration will
terminate the Registered Affiliate's ability to place Orders under the Agreement.
Each Registered Affiliate may qualify for and receive additional benefits. by _electing Software
Assurance membership.. By. electing Software Assurance membership, the Registered Affiliate is
committing to include ,Software Assurance with every eligible Order.. To make this election; complete
and submit the Select Plus Software Assurance Membership Election Form. :.
In order to use a third party to reimage the Windows Operating: System Upgrade, Registered Affiliate
must certify that it has acquired qualifying operating system licenses,: See the Product List for details.
1. Primary Contact Information.
Registered Affiliate.must identify an individual from inside its organization to serve as the primary
contact. This contact is also an Online Administrator for the Volume Licensing Service Center and
may grant online access to others.
Name of entity* City of Port Orchard
Contact name*: First R Vincent Last Tucker
Contact email address* rtucker@cityofportorchard.us
Street address* 216 Prospect St
City* Port Orchard
State* WA
Postal code* 98366-5326
Country* United States
Phone* (360) 876.4407
Tax ID
* indicates required fields
2. Notices contact and online administrator.
This individual receives contractual notices, They are also the online Administrator for the Volume
Licensing Service Center and may grant online access to others.
® Same as primary contact
Name of entity*
Contact name*: First Last
�b0� qC75
SelectPlus2013ARfGov(US)SLG(ENG)(0ct2013) Page 1 of 3
Document X2(1-11591
Contact email address*
Street address*
City*
State*
Postal code*
Country*
Phone*
❑ This contact is a third party (not the Registered Affiliate)
personally identifiable information of the Registered Affiliate.
* indicates required fields
3. Language preference.
Select the language for notices. English
4. Reseller information.
Warning: This contact receives
Reseller company name* CompuCom Systems, Inc.
Street address (PO boxes will not be accepted)* 7171 Forest Lane
City* Dallas
State* Texas
Postal code* 75230-2306
Country* United States
Contact name* Bruce Valentin
Phone* 972-856-4617
Contact email address* msadmin@compucom.com
* indicates required fields
The undersigned confirms thatthe information is correct.
Name of Reseller* CompuCom°Systems, Inc.
Signature*
Printed name* Wendy K. Griffin
Printed title* Microsoft Licensing Specialist
Date* 9/23/14
- inarcares requrrea neias
Changing a Reseller. If Microsoft or Reseller chooses to discontinue doing business .with one
another, Registered Affiliate must choose a replacement Reseller. If Registered Affiliate or Resellers
intends to terminate their relationship, the initiating party it must notify Microsoft and the other party,
using a form provided by Microsoft at least 90 days prior to the date on which the change is to take
effect.
5. Supplemental Contacts.
Customer's Notices Contact identified above is the default contact for administrative and other
communications. However, Customer may designate additional contacts using the Supplemental
Contact Information form.
6. Software Assurance Membership Election.
Each Registered Affiliate may qualify for and receive additional benefits with Software Assurance
membership. By electing Software Assurance membership below, Registered Affiliate is committing
for a minimum period of one year to include Software Assurance with every eligible Order, and to
maintain Software Assurance for all copies of Products licensed under this program for at least one
Product pool.
SeleetPlus20l3ARFGov(US)SLG(ENG)(Oct2013) Page 2 of 3
Document X20-11591
Product pools
Applications/1
Yes
No
�
►1
Note: If "Yes" is
marked, orders
for Licenses
without Software
Assurance will
not be accepted.
- - - -= -
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SeleciPius2013ARFGov(US)SLG(ENG)(Oct2013) Page 3 of 3
Document X20-11591