Vg6 Ried FORM 4l22/25 a am FIN1510-01 For Accounts Payable Use Only Vendor Number CHECK REQUEST FORM Use this form to arrange for payment to individuals or businesses when a Purchase Order or P-card is not required. This form must be submitted in typed format only. Vendor Information Vendor or Employee Name 4.16.25 TSD MCCi, LLC Ift there is a Purchase Order issued for this expense, DO NOT USE THIS FORM. If so, submit invoice with a copy of the PO. Mailing Address If payment is to a Vendor, is a W-9 on PO Box 790379 file in the Purchasing Office? St. Louis, MO 63179-0379 If No, a completed W-9 MUST be attached. Email Shervondaelli@rockdalecountygagov in our Email Address Purchasing Division for a complete New Vendor Packet. mdinsiencmosts ammaesdre EXPENSE/ACCOUNT DETAILS Description (for individuals, Services, Date of General Ledger Account Expense Reimbursements) Service or Ciehercl wnd Amount Invoice Fund Function Account Dept. Software Support (LF) 4.10.25 100 1535 522200 05 $16,565.06 Subscription-Training Center (CS) 4.10.25 100 1535 522200 05 $2,840.00 Supplemental Support Subscription (LF) 4.10.25 100 1535 522200 05 $2,772.00 BUDGETED ( X) / NDT BUDGETED ( ) Total Check Amount $22,177.06 DESCRIBE FULLY THE NATURE OF THE PAYMENT Invoice# RN22353 MCCi - Laserfiche Renewal Reference: Annual Billing for 2025-2026 Coverage Period: 6/14 - 6/13 C-2022-130 Last wyean cost GNATURES/APPROVAIS tb 30 600,75 Dept. Designee Date Chief Financial Oficer/Designee Date Vapet Mod du w 09 OJN 424201 Accounting Officer/ Date Senior Procurement Manager Date V f LAL Malone 422105 CHECK HANDLING INSTRUCTIONS s.Mail 6.F Pick Up-Approval by! Finance Director 7. Send Inter-Department Mail (Enclosea attachmentsif required in letter size Availablea att the Finance Office Front Desk after Will be placed in mailbox after 2:00 p.m à riday envelope) 2:00 pm every Friday Revised 1/17/25 - 4.13.25 Please send this form with attachments to the Department of Finance. Each check request received Monday-Friday will be processed thet following Friday. 2F-235 * mcCi Bil To: Invoice Number RN22353 Rockdale County, Invoice Date 4/10/2025 Attentionn Tech Services 952 Mistead.Avenue PO Number Conyers, GA 30012 Payment Terms Net30 Customer ID ROCKDAGAD1 End Customer ID RockdaleCounty Reférence: Annual Biling for 2025-2026 Laserfiche Renewal Coverage Period: 6/14 6/13 Extended Description Amount Software Support (LF) Product Group $16,565.06 Total ubscription-fraining Center (CS) Product Group $2,840.00 Total Supplemental Support Subscription (LF) Preduct Group $2,772.00 Total Subtotal $22,177.08 Downpayment -$0.00 Applied Sales Tax $0.00 Total Due $22,177.08 Electronic, Payment Information:. Mail-in Payment Iriformation MCCI LLG MCCILLC c/0 Enterprise Bank Thank: you for your business, c/o Enterprise Bank ABA: 081006162 P.O, Box 790379 Accounts 1293909 Sts LouisMO 63179-0379 (B00) 342-2633 (800) 342-2633 3717 Apalachee Parkway, Suite 201 Tallahasses, Ft 32311 BUDGETARY NOTIFICATION * mcci 3717 Apalachee Parkway, Suite 201 Tallahassee, FL 32311 850,701.0725 850.564.7496 fax Client Name: Rockdale County Quote Date: April 18, 2025 Client Address: 962 Milstead Avenue, Conyers, GA30012 Estimate Number: 35776 Support Period: 06/14/2025 - 06/13/2026 Estimate Type: Annual Support Renewal Product Description: Qty, Unit Cost Annual Total ANNUAL SUPPORT/SUBSUBSCRIPTION Training Center for Laserfiche (25-49 Users) On-Premise 1 $2,840.00 $2,840.00 Laserfiche Avante SDK 1 $826.88 $826.88 Managed Support Services 1 $2,772.00 $2,772.00 Laserfiche Avante Midsized Public Portal 1 $7,717.50 $7,717.50 Laserfiche Avante Server for MS SQL with Workflow 1 $1,102.50 $1,102.50 Laserfiche Avante Named Full User with Web Access 25 $132.30 $3,307.50 Laserfiche Avante Standard Audit Trail 25 $16.54 $413.44 Laserfiche Avante Forms Professional 25 $11.03 $275.63 Laserfiche Avante Forms Authenticated Participant (1-49 Users) 15 $44.10 $661.50 Laserfiche Avante Records Management Module 1 $1,323.00 $1,323.00 Laserfiche Avante Import Agent 1 $429.98 $429,98 Laserfiche Avante Quick Fields 1 $132.30 $132,30 Laserfiche Avante Barcode and Validation Package 1 $374.85 $374.85 GRAND TOTAL - RECURRING ANNUAL SUPPORT/AUBSCHPTION $22, 177.06 Beginning on October 1, 2025, Laserfiche will implement a 5% price increase across all its platforms. This change will affect the pricing of perpetual software licenses, modules, annuai support, and subscription products.