LEASE $MART^® PARTICIPATION AGREEMENT

The following sample text will be prepared by the Lessor and executed by the State:

DATE: _____________________

AGENCY NAME: ________________________________________________________

AGENCY CONTACT/NUMBER: ___________________________________________

ADDRESS: _____________________________________________________________

CITY, STATE, ZIP: _______________________________________________________

RE: Purchase Order No. ___________ between ____________________ (State Agency)

and _______________________ (Supplier). The State has designated

________________________ (Lessor) as its Lessor for this transaction.

All payments and notices in connection with the Lease are to be sent to the Lessor designated in the Purchase Order at the following address:

Lessor/Paying Agent:_______________________________________

Contact Name/Phone Number:_______________________________

Address:________________________________________________

City, State, Zip:___________________________________________

The terms and conditions found in Lease $Mart^® specify that the Supplier shall continue to perform all performance obligations and duties under the Purchase Order and neither the Lessor/Paying Agent shall be responsible to perform any such obligations.

Pursuant to the Purchase Order, the State hereby certifies: (1) that the Leased Asset(s) described in the Purchase Order have been delivered to the State, have been inspected, have been found to be in conformance with the Purchase Order and in good working order and are therefore fully and finally accepted by the State, and; (2) the Date of

Acceptance for such assets is _________, 19___/20___ which coincides with the 10^th day after the date of delivery of the Leased Asset(s) per Lease $Mart^® terms and conditions.

The State is self-insured. The executing agency may carry additional insurance, and, if

so, is insured under policy # _____________ with _______________________________ (insurance company name).

The State further certifies, and the undersigned hereby represents, that the Leased Asset(s) found in the Lease are essential to the State's obligation to perform the following functions and were selected by the State to be used for the following purposes as indicated below or on the attached page(s):

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

STATE AGENCY APPROVAL:

Name (SIGNATURE): ________________________________________________

Name (PRINTED): ___________________________________________________

Title: ______________________________________________________________

Date: ______________________________________________________________

Telephone number:___________________________________________________