HomeMy WebLinkAboutCrossmatch~
CROSSMATCH'" -
Account Manager: Don Sutton
Phone:
Mobile: +1647 746 7559
Quote Number: 01792806
Quote Created: June 14 , 2018
Quote Expiration: July 31, 2019
Sales Channel: GSA
Fax: +1 561828 7717
Email: Don.Sutton@Crossmatch .com
Bill To Name: Kittitas County Sheriff's Office
Contact: Sharrie McPherson
Ship To Name: Kittitas County Sheriff's Office
Contact: Karra Bailey
Phone: (509) 962 -7525
Email: _shfiscal@co.klttltas.wa.us
Bill To: 307 W. Umptanum Rd
Ellensburg, Washington 98926
United States
Item Product
1 SHIPPING ASSEMBLY, GUARDIAN
200, LSE RUNTIME LICENSE, NO
SPOOF DETECTION LICENSE,
SILICONE PAD
***** This product has a delayed
delivery date exceeding 30 days,
Check with your Sales Representative
to confirm delivery dates. ******
2 CMT ADVANTAGE MAINT, YR 1, HW -
GUARDIAN 200, GUARDIAN 300,
DEVICE ONLY DOMESTIC
3 WORKSTATION DESKTOP FOR USB 10
PRINT LIVESCAN W/LSMS
4 CMT ADVANTAGE MAINT,YR 1, HW,
ALL SYSTEM PERIPHERALS
INTEGRATED AND PROVIDED BY
CMT, DOMESTIC
5 SOFTWARE, SUBMISSION,
WASHINGTON
6 SOFTWARE, LSMS CONFIGURATION,
WASHINGTON OPS
7 CMT ADVANTAGE MAINT,YR 1,
STANDARD CMT SW, LSMS
"
Phone: (509) 607-9698
Email: karra .bailey@co.kittitas .wa.us
Ship To: 205 West 5th Street Suite 13
Ellensburg, Washington 98926
United States
Part Number Quantity ~ales "Total Price
Price
920191-01 1 $3,029 .68 $3,029 .68
930173 1 $335.50 $335.50
925244-003 1 $2,100.00 $2,100 .00
930158 1 $272.03 $272.03
850181-024 1 $500.00 $500.00
850391-024 1 $0.00 $0.00
950083 1 $272.03 $272.03
1
Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http://www.cr ossmatch.com
Price Basis
GSA Contract
GS-35F-0199R
GSA Contract
GS-35F-0199R
Open Market
GSA Contract
GS-35F-0199R
Open Market
Open Market
GSA Contract
GS-35F-0199R
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CROSSMATCH™ -
8 CMTADVANTAGE MAINT,YR
1,STANDARD CMT SW, LSMS
SUBMISSION SOFTWARE
9 IMPLEMENTATION, FIRST DAV ON-
SITE
10 FREIGHT
950084
930100-01
FREIGHT
1
1
1
Quote Number : 01792806
Quote Created : June 14, 2018
Quote 6xplrrl(io11 : July 31, 2019
$90.68 $90 .68
$2,266.88 $2,266 .88
$50.00 $SD .OD
GSA Contract
GS-35F-0199R
GSA Contract
GS-35F-0199R
Open Market
Grand Total: $8,916.80
Notes: Please note: As of today, all Guardian 200 units have a lead-time of 8 weeks. We have a delay in production.
We apologize for any inconvenience this may have caused you and appreciate your understanding.
This Quote Is subject to and governed by Crossmatch's Standard Sales Terms and Conditions for Purchase of Crossmatch
Products, which can be found at www.crossmatch.com/l egat/.
Freight may not be included on this quote but will be charged if applicable.
PURCHASER ACKNOWLEDGEMENT:
Signature:
Print Name: ---,;,=:;.;;..........;=.......,"""".:..;O-..:::-=--
Title:
Date:
2
Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http:l/www .cross m atch .co m
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CROSSMATCH'" -
Purclmse Order# A f>l9 ,. '-\:I 4-
Quote Number: 01792806
STANDARD SALES TERMS AND CONDITIONS
1) Terms of Order. If the purclmser is an Eligible Ent ity authorized to use GSA sources of supply and services and is purchnsing the
specified items 1mder Crossmatch's GSA Schedule Number GS-35F-O l 99R;, the tenns and conditions of GSA Schedule Number GS-35F-0l99R
will govern and these Standard Sales Tenns and Conditions will not apply. For nil other purchasers, the tenns contained herein shall govem
unless there is an existing signed agreement between Purchaser and Crossmatch with respect to the products to be purchased. Notwithstanding
any term or provision to the contrary contained in any Purchase Order, upon Purchaser's written acknowledgement below, the tenns of this
Agreement shall apply to Purchaser's Purchase Orders for the quoted products. In no event shall the pre-printed tenns and conditions of any
Purchase Order alter, amend or supersede any provision of this Agreement. In the case of any conflict between the tenus ofa Purchase Order and
the tenns of this Agreement, the tenns of this Agreement shall prevail. An omission of reference to this Agreement inn Purchase Order shall not
a ffect the application of this Agreement to such Purchase Order.
2) Prices, Unless otherwise indicated, pdces for products and associated support services are film fixed price (FFP). Pricing remains
valid for 90 calendar days frorn the date of quotation, unless otherwise specified by Quote Expiration above. All sales are final; no refunds,
credits or exchanges will be accepted. The price for the products does not include sales, use, excise or similar taxes assessed at any time. All
applicable taxes shall be paid by Purchaser including applicable sales tax unless a valid sales taJC exemption certificate is provided.
3) Shipment: Shipment date(s) provided in the quotation or in confinnntion of the Purchase Order is/ure approximate and subject to
change. Cross 11111tcli shall 110L be li n~fo for any dcl ny~ in shipm uht wh ic h nre caused by om:nls beyond tho control of Crossmntch inoluding, but
not limit<:d to , dcl nya caused by ln1.1c~111:nl o or in com plete data, clUlnges or revisions in th.e work to be perforn ,ed , Purchase r's insu ffi cii:rtt en:d!t or
financing, acts of Purchaser or Purchaser's agent, Force Majeure, accidents, strikes, inability to obtain labor or materials, or delay in
transportation.
4) Storage: Once Purchaser has been notified that its order is ready for shipment, if Purchaser requests that the order (in whole or in part)
not be shipped until a later date , the equipment will be segregated from other inventory . Purchaser will be required to execute Crossmatch's
Transfer of Title fonn evidencing transfer of title and transfer of risk of loss from Crossmatch to Purchaser. Purchaser is responsible for all costs
associnted with shipping the equipment to a storage facility or from said storage facility to the destination point in addition to all costs associnted
with insurance and storage fees.
5) Title & Risk of Loss: Crossmatch's prices are F.O.B. Crossmatch's Factory and are exclusive of taxes, shipping, handling and
insurance. Title to all equipment and risk of loss, deterioration or damage shnll pass to Purchaser upon delivery to a carrier; except that a security
interest in the equipment or any replacement shall remain in Crossmatch's name until the full pucchase price has been received by Crossmatcb .
Any claim by Purchaser against Crossmatch for shortage or dnmage occurring p1ior to delivery must be made in writing within ten (10) calendar
days after receipt of shipment and accompanied by an otiginal trnnspmtation bill signed by the carrier noting that carrier received goods from
Crossmatch in the condition claimed. Crossmatch shall have the right to ship all goods at one time or in portions, within the time for shipping
provided in such order, unless specifically requested in wdting by the Purchaser that these shipments be made in total by a date certain. Any
shipments returned to Crossmatch as a result of Purchaser's unexcused delay or failure to accept delivery will require Purchaser to pay all
additional costs incurred by Crossmatch, including any storage costs as discussed above.
6) Excusable Delnys: Crossmatch shall not be liable for any failure to continue to perfonn as required or meet the delivery date if such
failure is due to the non-perfonnance of the Purchaser or third party and/or due to a reason beyond its reasonable control. Such events also
include without limitation, acts or omissions of carriers, labor difficulties, shortages, Force Majeure, lnck of, incomplete or inaccurate infonnation
provid ed by the Purchn sor, or any other cttuse lhnL is ou!~id o of Cross mulQ h 's cont ro l. In an y such event the Parties will mutually develop a
crit!Qll l-palh in which per foon ance ancVor sclJ!)d nl,e is re -cJe lin~d and any cqui tnble 11ttjushnent In price is finalized.
7) Changes: Purchaser may rnake changes to the specific products/services being ordered , quantity, schedule and/or, the customization
requirements of a product or service or any other pmvision of the Purchase Order or quotation providing such change is communicated in
advance and in wdting to Crossmatch. If any such change causes a change in the price, schedule or other provision of the quote or Purchase
Order, Crossmatch shall notify Purchaser in w1iting no later than five (5) days from the date of receipt by Crossmatch of such request from
r,uro_hllS!\r. Cross mntch will ~11t,1i1it n R.:q ueil fu,r Eq11ilnble Aclju stmon1 or Change Ordqr ll,l'Ot tnsal which Ute Ptutics shall mm11111l y negotiate and
si1cl i will be J11oorp Qmt1:d into. the P1lrol.1usc Order or qu otation by wri tt en bi-lalero l i'i'mCJ1dm cnl or Change (;)rder ("Change -Orde r"'),
8) Installation and Training. If installation and training services are purchased, Purchaser shall appoint a contact person to coordinate
the 1µ;11dlnt_ q_11 to be f>~'l'fom1 0:d by C:rossmnt ch , lw agent or co111mct\lf. 'fho number of.days allocated, and cl.inrges for i11stollatlo11 and !m in ing oro
stntcd h1;i-cl, , If Orossu mtch ,.annot complete th e in$IOlln tion or ex tens ions in to nd ditlonal days or add itional trips are caused by P\irobascr 's
fniluro to complolc its nssi gncd trud<.ii, or iss ues boyoml the reas onable control of Crossmatch such as, but not limited to, Purchnser network
problems, Purchaser firewall problems or delays of schedule due to unavailability of Purchaser resources, Purchaser shall be responsible for
additional charges required to complete the installation. Such charges shall be billable at Crossmatch's rates in effect at the time of the service
extension or additional trip. A minimum charge of$500 will be assessed if Purchaser cnncels or re-schedules on-site installation and/or training
within 14 days of the originally scheduled installation. Upon completion of installation and training (including delivery of the training materials),
Purchaser agrees to sign Crossmatch 's Professional Services Acceptance Form acknowledging receipt of installation and training services within
fifteen (15) days from the completion date. If Purchaser fails to respond within fifteen (15) days from the completion date, installation and
training will be deemed accepted.
9) Limited Warranty: Crossmatch warrants that the hardware products purchased will be free from defects in material and
workmanship in nonnal service and under nonnal conditions for a period of one ( l) year from the date of shipment. Normal service and nonnal
3
Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http://www.crossmatch.com
November 2011
~
CROSSMATCH'" -Quote Number: 01792806
conditions are defined within the product documentation. The Limited Wmrnnty is subject to the specific tenns and conditions set fmth in the
watTanty documentation, which is hereby made pmt of and incorporated into the quotation.
10) Silicon Product Use Restrictions: TouchChip Silicon Fingerprint Sensor Products, including but not limited to touch and swipe
products, related software, developer kits and tools ("TouchChip Product Line") are subject to field of use restrictions ("Field of Use
Restr ic tions") unnchetl hereto as Su1iplcmcnt11l Terms ond Ctln dit ions of Sale for Silicon l'rotlucts (''S4111>lemcnt11I T.f,Cs) and incorporated by
,·cRiLlll\CQ harcin. When 111,pll~nblli prod l,Wls nn: p1m:hnsi:d, l'urQhn~cr shall adh ere to the Fio l1t of Use Resl rictiollll set forth in the Supplemental
T&Cs n11d shn ll requi re u1iy of il8 clisln'b uto iv, l\lllullet~, ilev,elol!t:IS or sales representatives to comply with such Field of Use Rest1ictions. Any
material or repetitive breach of the restrictions contained in the Supplemental T&Cs by Purchaser or Purchaser's direct or indirect distributors,
resellers or sales representatives shall constitute a material breach.
11) Software License. The term "Software" refers to the Software installed on the equipment or hardware product, any custom software
or interfaces developed by Crossmatcb for Purchaser and if applicable, Crossmatch's Software Development Kit (SDK) software. Purchaser will
bu ""<Juired to ·nccept Crossmntcl1 's sta ndllro llccnie og1tcmc11t prior to using any Son,wrc. 1J1e tcm111 ond condirions which govern the right and
umigu of the software are set fo1'1h . in U1c lictnse docum.cntnt _iqo , which is hereby madu 11,111 oC ~nll (ncorpomtcd i1110 the quotation.
12) Equipment Upgrnde: Eq11ipment upgrades are not covered under the limited warranty and are subject to independent pdcing and
tenns and conditions, as deemed applicable by the nature of the upgrade activity.
13) Equipment Maintenance Plan: Purchaser may purchase n Crossmatch Advantage Maintenonce Plan for U1e hardware products. The
Maintenance Plan is contracted for annually at the then prevailing price and can be renewed for a period of years mutually agreed to by the
Parties, The Maintenance Plan is subject to the specific tenns and conditions set forth in the Maintenance Plan docume11tation, which is hereby
made part of and incorporated into the quotation.
14) Softwiirc Maintenance Pinn: Purchaser must buy the Crossmatch Advantage Software Maintenance plan for nll applicable
Cross match software products . Crossmatch will provide maintenance services for the cun-ent and future Major Release of the Software for a
period of twelve ( 12) months for each tenn of the Software Maintenance plan . As used herein, a "Major Release" is any version of the Software
that in Crossmatch's sole detennination provides substantial new features, additional functionality, or makes use of different architecture.
Crossmatch will receive Company reported detects or issues 24 hours a day, 7 days a week and acknowledge any such repo1ted defect or issue
within two (2) hours and use best efforts to address and remedy such defect or issue. At no additional cost to Company, Cross match will deliver
to Company, as made commercially available by Crossmatch, bug fixes, Maintenance updates, state-mandated updates and Major Releases for
the Software ("Updates")
15) Invoicing nnd Payment. Crossmatch will invoice Purchaser for all Products, (including services), and Mnintenance Plans. All
Maintenance Plans are invoiced annually in advance are non-refundable. All Crossmatch invoices for Products must be paid in full by Purchaser
prior to shipment. AJJ.y other payment ammgement must be pre-approved by Crossmatch in writing. All sales are final; no refund, credits or
·cxch1111(t!lll will b.e m;ci?pk:d by C1'0.JS1niit0b. A lnte cht11&Q of the lllSSCf <>( 1.5% per month or the maximum mnou11tpcnnitted by law, will be
Rd<letl to 1i;~I due 111,"t;u1111\s. All t~Hsom1blc costs nod expenses, inclmlfng but not limited to attorn eys ' fees, co\lr\ cbslil nnrl service chufjles
[ncU!Tdl. by Crmsmntch in collecting pllymcnt will bo Pll t:xpcnse ol'tmd charged to Purchaser.
Puroluls~r may Ix, n:<1uiretl to co111plete II credit DPt>.llCatiu11 . C l'O$smatch reservi:s the right to extend credit to the Purchaser based upon
credit determim1tion, Spec ific nnuucing ammgemcnrs will be .cous idc r,e,lon a case by case basis and the (CllDS 11Dd conditlous for such will be
defined by Crossmatch and binding upon the Purchaser.
Crossmatch shall have the right to suspend pe1fonnance, including the non-shipment of product, under a specific Purchase Order
and/or any other Purchase Order(s) where Purchaser has failed to maintain its account within agreed to credit tenns. Crossmatch shall resume
performance under said Order(s) upon verified receipt of the required funds, as detennined by Crossmatch. Purchaser hereby agrees to waive all
rights to seek damages and/or other remedies against Crossmatch ifCrossmatcn's actions taken under this provision have an adverne impact upon
Purchaser and/or its ability to perfonn and/or meet business obligations. In addition, Crossmatch shall have the Light to cancel or hold any and/or
all orders placed by Purchaser and any and/or all shipments of the Product, regardless of any prior confinnation or acceptance by Crossmatch, if:
(a) Purchaser is or becomes insolvent, (b) Purchaser makes an assignment for the benefit ofcreditors, or a receiver or trustee is appointed to take
charge of any of Purchaser's assets; or (c) Purchaser is the subject of a bankrnptcy or reorganization proceeding, whether voluntary or
involuntary.
16) Indemnification. Bt-11m'Ch;t§l/l'., Purchaser shall indemnify, defend and hold Crossmatch and its respective directors, officers,
employees and agents harmless against any and all losses, claims, damages or expenses (including reasonable attorneys' fees) arising out of or
related to: (i) any personal injury to or death of any person or persons, any loss or damage of any property or any inte1ruption of services which
are caused or claimed to have been caused directly or indirectly from Purchaser's (including its employees or independent contractors) negligent
operation and/or related use or misuse of the Product; (ii) use of any equipment not provided or approved for use with the Product by Crossmatch.
Bv Cmssmnlch. Crossmatch hereby agrees to indemnify, defend and hold Purchaser hannless from and against any and all claims,
demands, actions, costs, liabilities and losses resulting from the Software or other Product infringing a United States patent, copyright or
trademark or misopproptiating the trade secret of n third patty provided that: (i) Pul'Chaser promptly notifies Crossmatch in writing of the claim;
(iJ) Crosmnn tch hns ~ntrol of 11," clef01\s~ and a,11 rclpted l;l:tl _h!lllCl,t 11cgoti11tions, provided howe ver that Putchnser .mus t npprove in writuig IHI)'
s~1/emc111s beforo they me executed (provided, howevOf, thnl Porohnsa·shull not unrensonably wilbJ1old its app1'0vnl 1hc1rcof): and (iii) Purclmser
fuUy ·,cooper.ilcs wilh Cmssmntoh, a.i Crossmntolt's C-OSI., lu U1c defense or,settlement of such actions. Crossmatch's obligation under this Article is
concllt!oued on Purchaser's agn:umonl that if the Softw11re, or the use or op t1 mtio11 U1u1:co f, becomes, or in Ctoss match's 01111 \i_on is likely to
becmue, the subject of such n claim, Purchaser will pcnnft Crossmatch at Cro,,;.11nnlch's option and expense, either to procura. the right for
4
Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http:Hwww .cross match. com
November 2017
~
CROSS MATCH"' -Quote Number: 01792806
l'u1•0J1~s0J· to euntim1e \µ;log tho SoRwnro or to . replace or. m.udiry the sumo so th11( it -bl!Comcs uon infii ngiug. If neithe1· of.the fci1'Cgoing
n_Uon:mtives is 11vn.Jlnb lo 011 tenns whiclt nrc 1cnso11nblo in Cross111ntch!i rcnsnn11(.!l11 Judglllcnt, tb1:n (.1) l'uci.hn6iir will rotum or dcstmy the
Sonwuro on ,wtiuen request ofCr<1ss1nntcit1 and {2) Cross m1\tch ,shnll t111y l'urclin1:cr 11n ninousll equul to the amount 11<1id (or 1110 SoOwnro loss an
AmQUnl cqunl lo lhc c111-roi1t dul)reclot lo n of such SoOwilrc (~uoh dcifiecin t~on amou nt catculnted on n stmight fine basis · over four years
com111cneing on th~ Bffi:ctivi: Dnte). The foregoing indemnity extends to l'w·clms~r only und slntcs (he sole nnd exclusive liubility and mm~dy of
th e parties hereto for patentinfringcment, nnd is in lieu of all wmnnllcs, cxp1i:ss : lmplicd, 01· stn1u10_1)', In rtl(ll)n.l lhcrcto.
l 7) Llmltation of Linblllty, IN NO EVENT SHALL CROSSMATCH BE LIABLE TO PURCHASER FOR ANY CONSEQUENTIAL
OR SPECIAL DAMAGES, INCLUDING BUT NOT LIMITED TO ANY LOST PROFITS, LOST SAVINGS, BUSINESS INTERRUPTION
OR OTHER INCIDENTAL DAMAGES ARISING OUT OF THE USE OR INABrLITY TO USE, OR THE DELIVERY OF, OR FAILURE TO
DELIVER, THE PRODUCT, EVEN IF CROSSMATCH HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. FURTHER,
THE ENTIRE LIABILITY OF CROSSMATCH FOR ANY CLAIM OR CAUSE OF ACTION ARISING HEREUNDER (WHETHER IN
CONTRACT, TORT, OR OTHERWISE) SHALL NOT EXCEED THE PURCHASE PRICE PAID FOR THE PRODUCT THAT IS THE
SUBJECT OF SUCH CLAIM OR CAUSE OF ACTION. EXCEPT AS TO TITLE, ALL SUCH LIABILITY SHALL TERMINATE UPON THE
EXPIRATION OF THE ORIGINAL APPLICABLE WARRANTY PERIOD,
18) Intellectual Property and Use Limitations, The sale of the Product to Purchaser does not convey to Purchaser any intellectual
1n'opc1ty ngh~ in the _Pf'l)dUl:l or ofiwnr:e, inclmli11& but not limited to nny copyri11llt; patent or lmdcmnrk ri11hts (exce1,t for nuy lioon c. rights
gmntcd hcr;cund cr). Pmtlier, lhe s111:l or !hu PNcfocts ,confcmi on. Purchaser 110 liccl)jjc; express or implied, by csto1111el or othurw1$c, umfc:r iiuY.
patents ofCros~matcl1 or ,0~1ers cov<lring or rcJnting rn ~ny oth er :product or bivcntion or ~ny 11mnbin11tlo11, 111110hine, or proc!:.,s iu which ~ch
Product mighr b~ used. All b1telltmlunl projlcrty rights ln the '1'1'0d11cJG nnd Software, any documentation therefore, and other matedals supplied
by Crossmatch, are owned by Crossmatch and are protected by United States copyright laws, other applicable copyright laws, and international
treaty provisions.
19) Choice of Low and Forum. This Agreement shall be governed by aml construed under the laws of the State of Florida, withont
reference to its conflict of laws provisions. All disputes arising hereunder shall be heard only by a Flmida State Cou1t or U.S. District Court with
competent jurisdiction in Palm Beach County, Florida.
20) Compliance with Laws. Each party to the Agreement sh all comply with all applicable laws and regulations. Purchaser will not
directly or indirectly export or re-export any Products or "technical data" furnished to Purchaser under this Agreement without obtaining
appropriate authorizations from the U.S. Department of Commerce or other U.S. government agency and will otherwise comply with all U.S.
export control laws applicable thereto.
21) En1ire Ag.-ccmcnt. These tcnns and cond !t lons coostltutc rile cnlin: gcll<),mc:il IM:t_1vccn Crossmntch nd Pul,'Cha~r w1U1 ·respect to
the snlo nnd purcl111se of the Products nnd licunll'o of lhc Sol\wun: nucl s~RII s111l{lrsc(le all I)ri\Jr 11gm:m_u,,1 ls, undennondlng,s nnd represc ntn tioll!I
between Putchn ser und Cros~11rn1cli, both writte11 ond o.ml, wll(i ~ect 10 lhc subject m11tter hef'eof. No · ndc!ilirm~-or mo<lUicntions of this
Agreement or any Exhibit hereto shall he effective unless made in writing and signed by the authorized representatives of Crossmatch and
Purchaser. Crossnmrch's delay or foi1urc 10 e1tCorco n.t any time uliy provision or lhis Agreement shnll not eons_1itute a waiver of Crossmntch's
right thcrO?Clor to enfotcc cnch nnd cive1)' Jll'Ovision of 11.1~ A!l,nicmonl. rr any of the prov~~iort(s) Qf th i, Ai:11:Q1}1ent is detennlned 10. bo invalid,
llli:g11l , oroH11:rwi ·e unc 11 fo1'ccnbl11, 1be re11i11inl11g,prov.ision$orU1e Ai,eai111:111 Jlmll remnln in fi11l force JtDJ.l effect
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Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http://www.crossmatch.com
November 2017
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CROSSMATCH'" -Quute Number: 01.l~2H06
CREDIT CARD AUTHORIZATION FORM
By signing this form you confirm you are an authorized representative to make binding commitments on
behalf of your company/firm.
It Is therefore by your signature below that you are authorizing Cross Match Technologies, Inc. to charge
the below credit card for the amount stated below In addition to any applicable tax.
If your company Is a tax exempt entity, please provide your tax exemption certificate.
Company Name: K,,:r t1Mi l-DU.uT'{ S*Ge-tt:r's 0t=f1c..G:
Invoice/SO#: A,P\9 ~ L\l¼
Amount Authorized: USD$ 8 9 llo 80 ·
'
Credit Card Type: '/'if! Visa O Master Card O American Express
Is this a Government wide Commercial Purchase Card? OYes ONo
Credit Card Number:
Sec Code:
Credit Card Complete BIi/ing Address:
Signature:~
8ltf'-$Clf: VL,) @:.C,li A:S 1 ,IJ lr
l< irru:::/lc s t Pu u :c '{
c::5D7 w l)MPIAr-lUM QD
£'v..£,1.JS~U\U.,..1 loA 9~',.Q.lo
oare.-f/-21; )or7
Printed Name_,...,Sb.........,'?V~,Q__...__.R~n..n--='-=a:,_.Af..,.__Dl\~i __
Title ¾t,
6
Crossmatch 3950 RCA Blvd Suite 5001, Palm Beach Gardens, FL 33410
http://www.crossmatch.com