Okaloosa County BOCC — November 16, 2013 — Motor Grader Attachment — reading text

year during which the Contract is executed and delivered as such “qualified tax-exempt obligations”. 2. Issuance Limitation. In compliance with the requirements of Section 265(b)(3)(C) of the Code, the Obligor hereby represents that the Obligor (including all subordinate entities of the Obligor within the meaning of Section 265(b)(3)(E) of the Code) reasonably anticipates not to issue in the calendar year during which the Contract is executed and delivered, obligations bearing interest exempt from federal income taxation under Section 103 of the Code (other than “private activity bonds” as defined in Section 141 of the Code) in an amount greater than $10,000,000, Okaloosa County Board of Commissioners Signature Printed Name and Title OPINION OF COUNSEL (Must be Re-typed onto attorney's letterhead) (Date, must be on or after the meeting date listed on Exhibit D, Obligor Resolution) Kansas State Bank of Manhattan 1010 Westloop; P.O. Box 69 Manhattan, Kansas 66505-0069 RE: Lease with Option to Purchase Agreement dated as of August 19, 2013, between Kansas State Bank of Manhattan (Obligee) and Okaloosa County Board of Commissioners (Obligor) Ladies and Gentlemen: As legal counsel to Obligor, | have examined the foregoing Contract and such other opinions, documents and matters of law as | have deeme necessary in connection with this Contract. Based on the foregoing, | am of the following opinions: 1. Obligor is a political subdivision of the State of Florida, or a constituted authority authorized to issue obligations on behalf of a politic subdivision of the State. 2. Obligor has the requisite power and authority to purchase the Equipment and to execute and deliver the Contract and to perform i obligations under the Contract. The Contract and the other documents either attached hereto or required herein have been duly authorizec approved and executed by and on behalf of Obligor, and the Contract is a legal, valid and binding obligation of Obligor enforceable i accordance with its terms. 3. The authorization, approval and execution of the Contract and all other proceedings of Obligor relating to the transactions contemplate thereby have been performed in accordance with all open meeting laws, public bidding laws and all other applicable state and federal laws. 4. There is no litigation, action, suit or proceeding pending or before any court, administrative agency, arbitrator or governmental body thi challenges the authority of the Obligor or any of the Obligor’s officers or employees to enter into the Contracts. 5. The above opinion is for the sole benefit of the Obligee listed above and can only be relied upon by the Obligee or any permitted assignee c subassignee or successor of Obligee under the Contract. Signature of Legal Couns: INSURANCE REQUIREMENTS Pursuant to Article V of the Lease with Option to Purchase Agreement, you have agreed to provide us evidence of insurance covering the Equipment. A Certificate of Insurance listing the information stated below should be sent to us no later than the date on which the equipment is delivered. Insured: Certificate Holder: Okaloosa County Board of Commissioners Kansas State Bank of Manhattan 302 N. Wilson Street, Suite 203 1010 Westloop, P.O. Box 69 Crestview, Florida 32536 Manhattan, Kansas 66505-0069 1. Equipment Description @ Four (4) Volvo G930B Motor Graders @ Please include all applicable VIN’s, serial numbers, etc. 2. Physical Damage ¢ Allrisk coverage to guarantee proceeds of at least $740,263.00. 3. Liability @ Minimum Combined Single Limit of $1,000,000.00 combined single-limit on bodily injury and property damage. 4. Additional Insured and Loss Payee @ Kansas State Bank and/or Its Assigns MUST be listed as additional insured and loss payee. Please forward certificate as soon as possible to: Fax: (785) 587-4016 or Email: jpaavola@ksstatebank.com Please complete the information below and return this form along with the Contract. Okaloosa County Board of Commissioners Insurance Company: Agent’s Name: Telephone #: Fax #: Address: City, State Zip: Email: *PREFERRED* *As an additional payment option for Obligor, we are now providing the option of ACH (Automatic Clearing House). By completing this for Obligor is authorizing Obligee to withdraw said payment amount on said date. DEBIT AUTHORIZATION | hereby authorize Kansas State Bank Government Finance Department to initiate debit entries, and, if necessary, to reinitiate returned entries to two additional times, to the account indicated below at the financial institution named below and to debit the same to such account for: Contract Number Payment Amount Frequency of Payments 3345087 $5,325.53 Monthly Begintitne Day of Month (please choose one) Month Year 4° im sth CL] 15% C] 20 oO Lacknowledge that the origination of ACH transactions to this account must comply with the provisions of U.S. law. Financial Institution Name Branch Address City State Zip Routing Number Account Number Type of Account [] Checking L] Savings This authority is to remain in full force and effect until Kansas State Bank has received written notification from any authorized signer of + account of its termination in such time and manner as to afford Kansas State Bank a reasonable opportunity to act on it. Obligor Name on Contract Okaloosa County Board of Commissioners Signature Printed Name and Title Tax ID Number : Date | 59-6000765 PLEASE ATTACH COPY OF A VOIDED CHECK TO THIS FORM! USA Patriot Act USA Patriot Act requires identity verification for all new accounts. This means that we may require information from you to allow us to mak proper identification. INVOICE BILL TO: Okaloosa County Board of Commissioners INVOICE DATE: August 19, 2013 Attn: Accounts Payable CONTRACT NUMBER: 3345087 302 N. Wilson Street, Suite 203 PAYMENT AMOUNT: $5,325.53 Crestview, Florida 32536 PAYMENT DUE DATE: At Closing DESCRIPTION AMOUNT Contract Payment $5,325.53 Lease with Option to Purchase Agreement Dated as of August 19, 2013 for Four (4) Volvo G930B Motor Graders Additional interest will be assessed on any payment received after the due date. $5,325.53 Please remit payment to: Kansas State Bank | Government Finance Dept. P.O. Box 69 Manhattan, KS 66505-0069 Forinquiries: (877) 587-4054 TOTAL DUE | | | SfateBank INVOICE BILL TO: Okaloosa County Board of Commissioners INVOICE DATE: August 19, 2013 Attn: Accounts Payable CONTRACT NUMBER: 3345087 302 N. Wilson Street, Suite 203 PAYMENT AMOUNT: | $5,325.53 Crestview, Florida 32536 PAYMENT DUE DATE: | September 19, 2013 DESCRIPTION AMOUNT Contract Payment $5,325.53 | | Lease with Option to Purchase Agreement Dated as of August 19, 2013 for Four (4) Volvo G930B Motor Graders Additional interest will be assessed on any payment received after the due date. $5,325.53 Please remit payment to: Kansas State Bank Government Finance Dept. P.O. Box 69 Manhattan, KS 66505-0069 For inquiries: (877) 587-4054 8038 REVIEW FORM The 8038 form attached hereto is an important part of the documentation package and must be properly filled out and submitted to the Department of the Treasury in order for you to receive the lower tax-exempt rate. Unless you instruct us otherwise, we have engaged a Paid Preparer to assist in the filling out of this form. The Paid Preparer has filled out the relevant portions of this form based on the current understanding of what is required by the Department of the Treasury. The responses on this 8038 form are based on the dates and amounts which you have requested (structure of the transaction) and which are on the Payment Schedule. 1. Please review our responses for accuracy. If anything is inaccurate, please contact our office so that we can make proper revisions. 2. If the information provided to you on this form is accurate, please sign where indicated and return with the document package. 3. If there are any changes to the structure of the transaction that occur prior to funding which require a change to the 8038 form, we will make such changes and provide notification to you. 4. Wewill return to you a copy of the 8038 form that was mailed to the Department of the Treasury. Important Note: The IRS is now requesting information regarding tax-exempt issuers’ and borrowers’ written policies and procedures designed to monitor post- issuance compliance with the federal tax rules applicable to tax-exempt obligations (boxes 43 and 44). Do not check items 43 and 44 on the 8038 form unless you have established written procedures in accordance with the instructions referenced directly below. If you choose to “check” items 43 and/or 44, please be prepared to provide copies of such written procedures to the Paid Preparer or any representatives of the IRS upon request. Written procedures should contain certain key characteristics, including making provisions for: ¢ Due diligence review at regular intervals; e Identifying the official or employee responsible for review; ¢ Training of the responsible official/employee; * Retention of adequate records to substantiate compliance (e.g., records relating to expenditure of proceeds); ¢ Procedures reasonably expected to timely identify noncompliance; and * Procedures ensuring that the issuer will take steps to timely correct noncompliance. For additional guidance on this 8038 form, you can refer to the Documentation Instructions located on the following government website: http://www.irs.gov/app/picklist/list/formsInstructions.html, or contact your local IRS office. rom 8038-6 Information Return for Tax-Exempt Governmental Obligations gem. Geptomiber ai) > Under Internal Revenue Code section 149(e) OMB No. 1545-0720 Department of the Treasury > See separate instructions. Internal Revenue Service Caution: /f the issue price is under $100,000, use Form 8038-GC. Gam Reporting Authority lf Amended Return, check here > LC 1 Issuer's name 2 _ Issuer’s employer identification number (EIN) Okaloosa County Board of Commissioners 59-6000765 3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions)} 3b Telephone number of other person shown on 3a 4 Number and street (or P.O. box if mail is not delivered to street address) Room/suite 5 Report number (For IRS Use Only) 302 N. Wilson Street, Suite 203 [3 | 6 City, town, or post office, state, and ZIP code 7 Date of issue Crestview, Florida 32536 08/19/2013 8 Name of issue 9 CUSIP number Lease with Option to Purchase Agreement None 10a Name and title of officer or other employee of the issuer whom the IRS may call for more information (seq 10b Telephone number of officer or other instructions) employee shown on 10a lagi Type of Issue (enter the issue price). See the instructions and attach schedule. 11. Education . 11 12 Health and hospital 12 13 Transportation 13 14 Public safety . . 14 15 Environment (including sewage bonds) 15 16 Housing 16 17 Utilities Loe 17 18 Other. Describe ® Four (4) Volvo G930B Motor Graders 18 743,161 | 48 19 If obligations are TANs or RANs, check only box 19a .- O If obligations are BANs, check only box 19b re > Oo 20 ‘If obligations are in the form of a lease or installment sale, check box > Vv] Description of Obligations. Complete for the entire issue for which this form is being filed. (a) Final maturity date (b) issue price (c) wioat nie gobce tony (e) Yield 21 08/19/2016 $ 743,161.48 $ N/A 3.080 years 2.370 % Uses of Proceeds of Bond Issue (including underwriters’ discount) 22 Proceeds used for accrued interest . 22 23 Issue price of entire issue (enter amount from line 21, column (b)) 23 24 Proceeds used for bond issuance costs (including underwriters’ discount) .. . .| 24 25 Proceeds used forcreditenhancement .............2... 2.2. { 25 26 Proceeds allocated to reasonably required reserve or replacement fund .... .| 26 27 Proceeds used to currently refund priorissues .........2.2.2.2.2. 2.4 27 28