FOR SALES AND SERVICE, PLEASE CONTACT DEALERS DIRECT. LIST IS ATTACHED.

Transcription

1 STATE OF UTAH CONTRACT NUMBER: AR pages Contract last updated on 7/1/2010 Revision number: 1 PURCHASING AGENT: BRENDA VELDEVERE (801) or bveldevere@utah.gov ITEM: BLACK & WHITE COPIERS RELATED SOFTWARE, CONSUMABLE SUPPLIES AND MAINTENANCE FOR SALES AND SERVICE, PLEASE CONTACT DEALERS DIRECT. LIST IS ATTACHED. Vendor: 94116A KONICA MINOLTA BUSINESS SOLUTIONS USA, INC. 500 DAY HILL ROAD WINDSOR CT REMITTANCE ADDRESS: PO BOX Vendor: 94116A DALLAS TX INTERNET ADDRESS: TELEPHONE: (703) FAX NUMBER: (703) CONTACT: ADDRESS: BRAND/TRADE NAME: PRICE: LARRY DOWNS coldowns@kmbs.konicaminolta.us KONICA MINOLTA SEE ATTACHED TERMS: NET 30 EFFECTIVE DATES: 12/14/2009 THROUGH 12/31/2012 (Potential Contract Renewals through 12/31/2014) DAYS REQUIRED FOR DELIVERY: ORIGINATING SOLICITATION: 30 DAYS ARO BV10020 REVISION #1: PRICE PAGES HAVE BEEN ADDED TO THE CONTRACT. STATE AGENCIES TO USE THIS CONTRACT PRE AUTHORIZATION IS REQUIRED. POLITICAL SUBDIVISIONS, HIGHER ED, PUBLIC ED NO PRE AUTHORIZATION IS REQUIRED.

2 STATE OF UTAH CONTRACT NUMBER: AR pages Contract last updated on 7/1/2010 STATE AGENCIES TO USE THIS CONTRACT PRE AUTHORIZATION IS REQUIRED. 1. All State Agencies are required to compare a minimum of three digital copier contracts and then make their purchasing determination based on a best value analysis taking in consideration their individual needs including, but not limited to, price, customer service, maintenance, delivery, etc. 2. State Agencies must then complete the 63A Copier Request Form and submit to Brian Jensen (with comparison documentation) for approval prior to ordering any copier from the contractor. Please fax your copier request form to Brian Jensen at (801) A copy of the copier request form is located at the end of this contract information sheet. FINET COMMODITY CODES: COPY MACHINES, DIGITAL (INCLUDING PARTS & CONSUMABLE SUPPLIES) COPIER MAINTENANCE AND REPAIR THIS CONTRACT COVERS ONLY THOSE ITEMS LISTED IN THE PRICE SCHEDULE. IT IS THE RESPONSIBILITY OF THE AGENCY TO ENSURE THAT OTHER ITEMS PURCHASED ARE INVOICED SEPARATELY. STATE AGENCIES WILL PLACE ORDERS DIRECTLY WITH THE VENDOR (CREATING A PG IN FINET) AND MAKE PAYMENTS FOR THE SAME ON A PV REFERENCING THE ORIGINAL PG. AGENCIES WILL RETURN TO THE VENDOR ANY INVOICE WHICH REFLECTS INCORRECT PRICING.

3 KONICA MINOLTA BUSINESS SOLUTIONS Utah State Contract Number: AR2053 For Black & White Copiers, Related Software, Consumable Supplies and Maintenance Utah State Contract # AR2053 Effective Date: 12/14/ /31/2012 Available Acquisition Plans: Outright Purchase Maintenance and Supplies Cost per Copy

4 General Ordering Information and Terms 1. ORDERING ADDRESS AND PROCEDURES Orders will be accepted for for the State of Utah State agencies and Political Subdivisions withing the state of Utah. All orders will be made out to and invoiced by the local authorized branch or dealer listed on page 11 of this catalog. 2. ORDERING PROCEDURES/PURCHASE ORDERS Please include the following information with your purchase order: a. The Contract Number: AR2053 b. The Purchase Order Number c. Product Number d. Quantity of items being ordered e. Description of Item f. Maintenance price, if applicable g. Delivery address, contact name and phone number h. Any additional items to be delivered with the copier i. Accessories and appropriate prices (if applicable) 4. PAYMENT ADDRESS Your local authorized branch or dealer will provide invoices under this contract. Please see listing on page 11 to locate your local branch or dealer. Billing inquiry information will be included on the invoice. 5. PAYMENT TERMS Net thirty (30) Days. 6. DELIVERY Thirty (30) days after receipt of order. 7. TRANSPORTATION, DELIVERY, INSTALLATION AND TRAINING FOB Destination. 8. CONTACT INFORMATION For orders, invoices, sales and service inquiries please contact your local authorized Konica Minolta branch or dealer. Please see listong on page RELOCATION FEES

5 General Ordering Information and Terms 10. AFTER HOUR SERVICE CHARGE Within 50 miles: M F, 5pm midnight (excluding holidays): Minimum Labor Charge $182.00/hour (including drive time); Hourly Labor Charge $182.00; Each Add'l 1/4 hour $45.50 Saturday 8:30am 5:00pm: Minimum Labor Charge $182.00/hour; Hourly Labor Charge $182.00; Each Add'l 1/4 hour $45.50 Sunday 8:30am 5:00pm: Minimum Labor Charge $242.00/hour (including drive time); Hourly Labor Charge $242.00; Each Add'l 1/4 hour $60.50 Beyond 50 miles open market 11. SERVICE RESPONSE TIME Service must be available between normal working hours of 8:00 am and 5:00 pm Monday Friday, except normal holidays. Four (4) hour maximum response time on inoperable copiers and six (6) hour maximum response time on operable service calls for Utah, Salt Lake, Davis, Weber, Cache, Summit and Wasatch counties. Service is to respond within no more than eight (8) hours an all other regions and counties. The servicing vendor or technician will call the customer within one half hour upon receipt of the service call giving the customer an estimated arrival time for service.

6 Konica Minolta bizhub 181 SPECIFICATIONS WHY YOUR BUSINESS NEEDS THE POWER OF BIZHUB. Costs are rising, workloads are growing, and information is flowing through new channels you need new tools to keep a step ahead. The bizhub 181 gives you fast, cost efficient digital document handling with built in TWAIN B&W scanning and GDI printing. You'll have versatile options like PCL printing, network scanning, and Super G3 fax. And you'll have more; a userfriendly LCD screen with 4 line display, more speed dial numbers, increased account tracking, USB 2.0 connectivity and advanced LDAP 3.0 functionality. *Plus PageScope software, to help you manage documents and devices from a single point. Put it all together, and bizhub 181 becomes the hub of your business a central workflow resource built for the productivity your business demands. Segment 1B Konica Minolta bizhub 181 Type: Print/Copy Process: Development System: Output Speed: Image Resolution: Warm Up Time: First Copy: Memory: Magnification: Standard Paper Supply: Paper Size: Maximum Paper Cap.: Power Requirements: Dimensions: Digital Copier/Printer Electrophotographic Printing System Micro Toning, high Grade (MT HG) 18 pages per minute 600 x 600 dpi 15 seconds or less 7 seconds or less 32 MB (Std.), 160 MB (maximum, optional) % 275 Sheet Universal paper tray (up to 11 x 17 ), Standard single sheet bypass 5 1/2 X 8 1/2 to 11 x 17 1,475 sheets (total, with options) 120 V, 60 Hz 23.5 x 24.5 x (WDH) Weight: lbs. Design & specifications are subject to change without notice. * Photo does not represent awarded configuration Built in GDI print control and TWAIN B&W scanning 1,475 Sheet maximum paper capacity (with options) Optional Super G3 fax for allin one productivity

7 Konica Minolta bizhub 181 PRICING SEGMENT 1B; COPY SPEED: 18 PAGES PER MINUTE Standard Configuration Includes: bizhub 181 / Automatic Document Feeder (DF 502) / Power Filter / 275 Sheet Paper Supply NO MINIMUM Item Number Item Description KMBS List Price UT Purchase Price Discount KMBS Service & Supplies Cost Per Copy A08E011 bizhub 181 Includes GDI Controller, TWAIN Driver, Mechanical Counter, USB 2.0 Port, Drum and Developer. $2, $1, % $ D5133NT Power Filter (120 volt, 15 Amps, 3 Outlets, Max Power Surge Suppression, Ground Noise Elimination, Network & FAX/Phone Line Protection. Designed for Digital Technology) $ $ % DF 502 Automatic Document Feeder $ $ % TOTAL CONFIGURATION $4, $1, % DOCUMENT HANDLING OPTIONS: #DIV/0! AD 504 Duplex Unit $ $ % OC 504 Original Cover $87.00 $ % DF 605 RADF $1, $ % MK 501 Mout Kit for DF 605 $53.00 $ % COPIER STAND OPTIONS: DK Drawer HT Cabinet $ $ % DK 702 Desk 2 Drawer Height $ $ % DK 703 Copy Table/Desk (Base Feet) $ $ % PAPER SUPPLY OPTION: PF 502 Paper Feed Cabinet (275 sheets), Up to 4 PF 502s can be equipped $ $ % MB 501 Multi Bypass Tray $ $ % OUTPUT OPTIONS: JS 503 Job Separator $ $ % SF 501 Shift Tray $ $ % MISC. OPTIONS: EM MB Expanded Memory bizhub 181 $ $ % Key Counter Mount Kit for Hecon Conventional Key Counter $86.00 $ % Key Counter Mount Kit 2 $86.00 $ % PRINT OPTIONS: A0CJ0Y1 IC 206 PCL Image Controller (w NC 503 NIC) $ $ % A0CJ0Y2 NC 503 Network Interface Card $ $ % FAX OPTIONS: A0CJ013 FK 506 Fax Kit $ $ %

8 Konica Minolta bizhub 362 SPECIFICATIONS HIGH SPEED, LOW COST MULTIFUNCTION PRODUCTIVITY. Moving information faster is the whole idea behind bizhub and for fast growing document demands, the bizhub 362 increases your power to print, copy, scan, even fax. At speeds up to 36 ppm, with workhorse 150,000 page monthly duty cycle, you ll be more productive right from the start. The builtin Emperon Print System gives you built in Windows Vista and Mac functionality. Security features provide bestin class protection to safeguard essential data and guard against unauthorized access. Sleek center office styling looks good anywhere and PageScope software provides seamless network management for documents and devices. If your workload keeps rising, let the bizhub 362 help keep you ahead of the curve. Segment 3B Konica Minolta bizhub 362 Type: Imaging System: Output Speed: Image Resolution: Warm Up Time: First Copy: Memory: Magnification: Standard Paper Supply: Paper Size: Maximum Paper Cap.: Power Requirements: Dimensions: Weight: Design & specifications are subject to change without notice. * Photo does not represent awarded configuration Digital Copier/Printer Simitri Polymerized Toner 36 pages per minute 600 dpi x 600 dpi seconds 5.3 seconds or less 192 MB (Std.), 40 GB (maximum, optional) % 500 sheet universal paper drawer (2), 150 sheet bypass 5 1/2 X 8 1/2 to 11 x 17 3,650 sheets (total, with options) 120 V, 60 Hz, 11.5 A 26 3/4 x 28 x 28 1/4 (W x D x H) Approx. 163 lbs. Sleek Dark Cabinet Design, Small Footprint Emperon Print System with PS/PCL Emulation ISO Certification, Enhanced Security Protection

9 SEGMENT 3B; COPY SPEED: 36 PAGES PER MINUTE Konica Minolta bizhub 362 PRICING Standard Configuration Includes: bizhub 362 / Reversing Automatic Document Feeder (DF 620) / Base Finisher (FS 530) / 500 x 2 Unviersal Cassette (PC 206) / Power Filter / 1,150 Sheet Paper Supply (including Bypass) NO MINIMUM Item Number Item Description KMBS List Price UT Purchase Price Discount KMBS Service & Supplies Cost Per Copy A11U011 bizhub 362 Includes 192MB RAM, PS/PCL controller, Network Scanning, Auto Duplex Unit, Drum Unit and Developer. $8, $3, % $ D5133NT Power Filter (120 volt, 15 Amps, 3 Outlets, Max Power Surge Suppression, Ground Noise Elimination, Network & FAX/Phone Line Protection. Designed for Digital Technology) $ $ % A0HNW22 FS 530 Base Finisher $1, $ % A124WY1 DF 620 Reversing Automatic Document Feeder $1, $ % A0RC0Y1 PC x 2 Universal Cassette $1, $ % TOTAL CONFIGURATION $13, $4, % PAPER SUPPLY OPTION: A0RCW24 PC Sheet Paper Feed Cabinet with Storage $ $ % A0RC0Y1 PC x 2 Universal Cassette $1, $ % A0RC011 PC Sheet Large Capacity Tray $1, $ % OUTPUT OPTIONS: JS 502 Job Separator $ $ % FINISHER OPTIONS: OT 602 Additional Tray for FS 519/522/530 $53.00 $ % MT 502 Maibin Kit for FS 519/522/530 $1, $ % PU 501 Punch Kit for FS 522/FS 530 $ $ % A0PGW21 SD 507 Saddle Kit $1, $ % MISC. OPTIONS: HD 504 Hard Disk Drive $ $ % EM 303 Expanded Memory Unit 32MB $ $ % EM 304 Expanded Memory Unit 64MB $ $ % EM 305 Expanded Memory Unit 128MB $ $ % SC 504 HDD Encryption Kit $ $ % PRINT CONTROLLER OPTIONS: EK 502 Local Interface Kit $ $ % FAX / SCAN OPTIONS : FK 503 Fax Kit $1, $ % ML 502 Fax Multi Line $1, $ % SP 501 Fax Stamp Unit $48.00 $ % Key Counter Mount Kit 2 $86.00 $ % Key Counter Mount Kit for Hecon Conventional Key Counter $86.00 $ % Key Counter Attachment Kit (legacy Minolta) $86.00 $ % Spare TX Marker Stamp 2 $27.00 $ %

10 Konica Minolta bizhub 361 SPECIFICATIONS DESIGN FOR SPEED, SECURITY AND COST EFFICIENCY. With center office design and 36 ppm performance, the bizhub 361 is a powerful, affordable document resource that speeds workflow and boosts productivity in high volume environments, its sleek styling, small footprint and hiddencable design look good from any angle and superb image quality, enhanced security and fast 70 opm scanning improve your output and protect your information. Modular finishing, fax, connectivity and software options also let you customize an affordable solution that serves your business today and grows with your needs tomorrow. GROUP A Segment 3 Konica Minolta bizhub 361 Type: Imaging System: Output Speed: Image Resolution: Warm Up Time: First Copy: Memory: Magnification: Standard Paper Supply: Digital Copier/Printer Simitri Polymerized Toner 36 pages per minute 600 dpi x 600 dpi Less than 30 seconds Less than 3.6 seconds 1,024 MB (Shared with main body.), 60 GB (Shared scan and copier HDD, optional) % 500 sheet universal paper drawer (2), 150 sheet bypass Sleek Dark Cabinet Design, Small Footprint Emperon Print System with PS/PCL Emulation Paper Size: Maximum Paper Cap.: Power Requirements: Dimensions: Weight: Design & specifications are subject to change without notice. * Photo does not represent awarded configuration 5 1/2 X 8 1/2 to 11 x 17 5,650 sheets (total, with options) 120 V, 60 Hz, 12 A 26.7 x 27.9 x 35.2 (W x D x H) Approx. 215 lbs. ISO Certification, Enhanced Security Protection

11 SEGMENT 3B; COPY SPEED: 36 PAGES PER MINUTE Konica Minolta bizhub 361 PRICING Standard Configuration Includes: bizhub 361 / (DF 613) Standard / Base Finisher (FS 522) / 500 x 2 Unviersal Cassette (PC 206) / Imaging Controller (IC 207) / Power Filter / 1,150 Sheet Paper Supply (including Bypass) NO MINIMUM Item Number Item Description KMBS List Price UT Purchase Price Discount KMBS Service & Supplies Cost Per Copy A0R bizhub 361 Includes Drum, Developer, DF 613, Duplex Unit, 1024 MB Memory (max), Tray 1(500 sheets), Tray 2 (500 sheets), Intelligent Bypass (150 sheets), Total D5133NT Power Filter (120 volt, 15 Amps, 3 Outlets, Max Power Surge Suppression, Ground Noise Elimination, Network & FAX/Phone Line Protection. Designed for Digital Technology) $9, $3, % $ $ $ % A0RC0Y1 PC x 2 Universal Cassette $1, $ % A0P80Y1 IC 207 Imaging Controller $1, $ % A0HN0Y1 FS 522 Base Finisher $1, $ % TOTAL CONFIGURATION $14, $5, % A0R90Y1 LU 203 Large Capacity Tray (2,000 sheets) $1, $ % A0RC0Y1 PC 206 Paper Feed Cabinet (500x 2) $1, $ % A0RC011 PC 407 Large Capacity Cabinet $1, $ % A0HN0Y1 FS 522 Base Finisher (Stapling Standard) $1, $ % JS 502 Job Separator Tray $ $ % A0PH0Y2 FS 523 Staple Finisher (2/3 Hole Punch and Stapling standard) $2, $1, % A0RD0Y1 RU 507 Relay Unit for FS 523 $ $ % MT 502 Mailbin Kit for FS 519/FS 522 $1, $ % A0PGW21 SD 507 Saddle Kit for FS 522 $1, $ % PU 501 Punch Unit 9 (For FS 508/FS 510/FS 522) $ $ % OT 602 Additional Output Tray for FS 519/FS 522 $50.00 $ % A0P6WY1 HD GB Hard Disk Drive $ $ % A0PAWY1 SC 505 HDD Encryption Kit $ $ % A0P80Y1 IC 207 Imaging Controller $1, $ % 15lbx004 Fax Kit includes FK 502 and MK 708 $1, $ % 16PA ML 503 Fax Dual Line Kit $ $ % SP 501 Stamp Unit $45.00 $ % Spare TX Marker Stamp 2 $25.00 $ % A0P4WY1 EK 703 USB Interface Kit $ $ % A09MWY0 AU 101 Biometric Authentication Unit $ $ % A07EWW0 WT 502 Working Table $ $ %

12 Konica Minolta bizhub PRO 950 SPECIFICATIONS A SUPERIOR SOLUTION THAT S BUILT FOR SPEED. LET A PRO HANDLE YOUR HIGH VOLUME PRODUCTION. Today s competitive, cost conscious world demands professional performance you can count on and the bizhub PRO 950 is purpose built for speed, quality and long running reliability. With 95 ppm print/copy output and a robust monthly duty cycle of 750,000 impressions, you ll have greater output power to satisfy high volume needs of corporate in plant facilities, data centers, print for pay and commercial customers. Built in print/scan control and onboard LCD touch screen provide simple operation and thumbnail document preview, with auto finishing options to deliver more documents in less time. And seamless interface with Konica Minolta s Printgroove Suite gives you end to end print management for total control of your production floor. Segment 6A Konica Minolta bizhub PRO 950 Type: Imaging System: Output Speed: Image Resolution: Warm Up Time: First Copy: Memory: Magnification: Standard Paper Supply: Paper Size: Maximum Paper Cap.: Power Requirements: Dimensions: Weight: Design & specifications are subject to change without notice. * Photo does not represent awarded configuration Digital Copier/Printer Simitri Polymerized Toner 95 pages per minute 600 X 600dpi (1200 X 600dpi 5.5 minutes or less 3.1 seconds or less 256 MB (Std.), 30 GB HDD (maximum, optional) % 500 sheet universal tray (2), 1,000 sheet universal Tray, 150 sheet bypass 5 1/2" x 8 1/2" to 12" x 18" 6,650 sheets (total, with options) 208V 240V, 16 A, 60HZ (DEDICATED LINE) 35" X 30 3/4" X 47 3/8 (WxDxH) 616 lbs. Large Color LCD Touch Screen, Thumb Nail Preview Advanced Security Features ISO Built In Image Control with PCL6 and optional PS3

13 Konica Minolta bizhub PRO 950 PRICING SEGMENT 6A; COPY SPEED: 95 PAGES PER MINUTE Standard Configuration Includes: bizhub PRO 950 / Large Capacity Tray (LU 407) / 100 Sheet Stapler (FS 528) / Power Filter / 2,150 Sheet Paper Supply (including Bypass) NO MINIMUM Item Number Item Description KMBS List Price UT Purchase Price Discount KMBS Service & Supplies Cost Per Copy bizhub PRO 950 Includes EDH, 256 MB Memory, 30 GB HDD, Embedded Image A0Y5011 Controller with 2 GB Memory, 80 GB HDD, PCLe/XL (PCL6), TIFF Direct Print, Scanto HDD, , FTP,SMB and Box:PC Drum, Developer, Tray 1 (500 sheets), Tray 2 $45, $13, % $ (500 sheets), Tray 3 (1,000 sheets), Bypass D524ZNT Power Filter (208 volt, 20 Amps, 1 Outlet, Max Power Surge Suppression, Ground Noise Elimination, Network & FAX/Phone Line Protection. Designed for $1, $ % Digital Technology) A0Y6WY1 LU 407 Large Capacity Tray (LTR) $2, $ % A10UWY1 FS Sheet Stapler Finisher $5, $ % TOTAL CONFIGURATION $54, $14, % PAPER SUPPLY OPTIONS: A0Y6WY1 LU 407 Large Capacity Tray (LTR) $2, $1, % A0Y7WY1 LU 408 Large Capacity Tray (12x18) $2, $1, % OUTPUT OPTIONS: A10VWY1 FS 611 Saddle Finisher $5, $2, % ADDITIONAL OUTPUT OPTIONS: A111WY2 ZU 607 Z Folding Unit $5, $2, % A110WY1 TU 502 Trimmer Unit $7, $3, % 15US PK 505 2/3 Hole Punch Kit $ $ % A10YWY1 PI 506 Post Inserter $1, $ % A10WWY1 MK 721 Mount Kit $1, $ % CONNECTIVITY OPTION: A10R011 PS 504 Post Script Upgrade $1, $ %

14 KONICA MINOLTA AUTHORIZED DEALERS the dealers listed are authorized for use under this contract. Only REGION COUNTIES PHYSICAL LOCATION AND ORDERING ADDRESS PHONE NUMBER Region 1 Box Elder Konica Minolta Direct Branch P Cache 268 South State, Suite 250 F Rich Salt Lake City, UT Weber Morgan Imaging Concepts P Region 2 Tooele 2355 South 1070 W F Davis Salt Lake City, UT Salt Lake Summit Pacific Office Automation P Utah 2371 South Presidents Drive, Suite B F Wasatch Salt Lake City, UT Juab Region 3 Duchesne Imaging Concepts P Uintah 2355 South 1070 W F Daggett Salt Lake City, UT Region 4 Millard Steamroller Copies, Inc. P San Pete 67 E. St. George Blvd. F Sevier St. George, UT Piute Wayne Region 5 Carbon The Copy Shop, Inc P Emery 20 West Main F Grand Cortez CO San Juan Steamroller Copies, Inc. P E. St. George Blvd. F St. George, UT Region 6 Beaver Steamroller Copies, Inc. P Iron 67 E. St. George Blvd. F Garfield St. George, UT Kane Washington

15 STATE OF UTAH 63A COPIER REQUEST FORM TO USE THE COPIER CONTRACTS, PRE-AUTHORIZATION IS REQUIRED. 1) All State Agencies are required to compare a minimum of three digital copier contractors for the appropriate segment and then make their purchasing determination based on a best value analysis taking in consideration their individual needs including, but not limited to, price, customer service, maintenance, delivery, etc. 2) State Agencies must then complete the 63A Copier Request Form and submit it to Brian Jensen (with comparison documentation) for approval prior to ordering any copier from the contractor. SUBMIT TO: PRINT SERVICES 5110 STATE OFFICE BUILDING FAX: (801) DEPARTMENT AGENCY ADDRESS CONTACT PERSON PHONE FAX DATE PREPARED DATE NEEDED EXPLAIN THE CIRCUMSTANCES LEADING TO THE PURCHASE OF THE NEW COPIER MINIMUM SPECIFICATIONS (FUNCTIONS/FEATURES) OF THE NEW COPIER COPIES PER MINUTE (CPM) FIRST COPY SPEED (Seconds) FEEDER/DOCUMENT HANDLER TYPE MONTLY VOLUME PAPER CAPACITY (Sheets) COPY THROUGHPUT (Paper Size and Weight) COLLATING TYPE STAPING TYPE DUPLEXING VARIABLE MAGNIFICATION PRESENT REDUCTION/ENLARGEMENT POWER REQUIREMENTS 1:2 2:2 2:1 OTHER % TO % COPIER SELECTED MAKE AND MODEL VENDOR CONTRACT # PURCHASE PRICE MAINTENANCE COST PER COPY SUPPLY COST PER COPY CURRENT COPIER MAKE AND MODEL PURCHASE DATE PURCHASE PRICES WE HAVE REVIEWED THIS REQUEST AND DETERMINED IT WILL PROVIDE CLEAR BENEFIT TO THE STATE. X X DIVISION DIRECTOR S SIGNATURE PRINT NAME DATE DEPARTMENT DIRECTOR S SIGNATURE PRINT NAME DATE APPROVED ADDITIONAL RECOMMEDATIONS ATTACHED X PRINT SERVICES MANAGER S SIGNATURE PRINT NAME DATE