Fillable AT&T and NPPGov Authorization Form Member Information To (City of Oakland)

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AT&T and NPPGov Authorization Form Member Information To (City of Oakland)

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customerservice@nppgov.com
877.329.8847
AT&T and NPPGov
Authorization Form
To ensure you get your AT&T discount in a timely manner,
please fill out the following form and return by email.
Phone: 877.329.8847
Email: forms@nppgov.com
Member Information
Organization Name
Organization Physical Address
If you are a current AT&T Customer please list
address as it appears on your AT&T Bill:
Address Line 1
Address Line 2
City
Zip CodeState
Point of Contact Information
If different from NPPGov Registration:
First Name Last Name
Point of Contact Title
Point of Contact Phone
Point of Contact Email
*NPPGov Member ID
*Federal Tax ID
If you are currently not an AT&T Customer, which carrier are you using?
Briefly describe the services you are looking to get from AT&T
Current AT&T Customers
AT&T Account Number or Mobile Telephone Number Number of Wireless Devices Currently with AT&T
Please check the box(es) below for program of interest, this
will allow AT&T to create the appropriate Discount Codes/
Foundation Account Numbers (FANs) necessary.
Corporate Individual Both
Please ensure to initial and complete section 4 of the Participation Agreement (PA) as enclosed below.
Version 2 3.15.18
PARTICIPATION AGREEMENT COVER PAGE
SELLER:
AT&T Corp.
CONTRACT NUMBER:
AS10296
NPPGov Member ID Number:
Customer Legal Name (“Participating Agency” or “Participant”)
D/B/A
Main Telephone Number
Street Address
City
State
Primary Contact Name and Email Address
Primary Contact Telephone Number
If applicable, Governmental entity of ____________________________________________
_________________________________________________________________________________________________________
Agreement: This Participation Agreement between Participating Agency, on behalf of itself, and AT&T Corp (“AT&T” or
“Seller”), on behalf of itself and its service providing Affiliates, consists of (a) this Participation Agreement Cover Page,
(b) the attached Participation Agreement Standard Terms, (c) applicable Pricing Schedule(s) attached as sub-Exhibits
to Exhibit A to the Master Price Agreement, (d) applicable terms and conditions posted or incorporated by reference on
the AT&T NPPGov Program Website and the relevant Sales Information and (e) all AT&T materials incorporated by
reference in the foregoing, including applicable Attachments found at the Service Publication identified in the selected
Pricing Schedules and the Sales Information including, without limitation those documents referenced in §§3(ii) and (iii)
(collectively, the “Participation Agreement”).
In the event of a conflict or inconsistency between the terms of the Participation Agreement and the terms contained in
the Pricing Schedule, the terms of the Pricing Schedule shall prevail.
By signing below, the parties agree to be bound by the terms and conditions of the Participation Agreement,
effective as of the last date written below (the “Participation Agreement Effective Date”).
By (Authorized Signature):
Print Name and Title of Person Signing:
Date:
AT&T Corp, on behalf of itself and its service providing Affiliates:
By (Authorized Signature):
Print Name and Title of Person Signing:
Date: ________________________________________
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Version 2 3.15.18
PARTICIPATION AGREEMENT STANDARD TERMS
SELLER:
AT&T Corp.
CONTRACT NUMBER:
AS10296
NPPGov Member ID Number:
1. Address for Notices. All notices, requests, demands and other communications to Participating Agency
required or permitted under this Participation Agreement shall be provided to the address set forth below:
Name:
Address:
Phone:
Fax: ________________________________
Attention:
Federal Tax ID: _______________________
2. Recitals.
2.1 AT&T and Public Procurement Authority (“PPA”) entered into that certain Master Price Agreement dated
November 18, 2015, as amended (the “Master Price Agreement”) (at times, the Master Price Agreement and the Participation
Agreement are referred to collectively as the “Agreement”).
2.2 Participating Agency is a governmental agency and/or a “Participating Agency” as defined under the
Agreement that wants to obtain Service from AT&T in connection with the Master Price Agreement. “Participating Agency”
and “Participant” shall be used interchangeably in this Participation Agreement.
3. Agreement. In consideration of the recitals set forth in §2 above, which are hereby re-stated and agreed to by the
parties, and for valuable consideration, the receipt and sufficiency of which is hereby acknowledged by the parties, AT&T
and Participating Agency hereby agree to the terms and conditions of (i) the Master Price Agreement; (ii) the Pricing
Schedule(s) attached as sub-Exhibits to Exhibit A to the Master Price Agreement that Participating Agency has selected in
§4–Pricing Schedules immediately below, which such selected Pricing Schedules are incorporated herein by this reference,
(iii) applicable terms and conditions posted or incorporated by reference on the AT&T NPPGov Program Website and the
relevant Sales Information for such selected Services that Participating Agency has selected, which such terms and
conditions are incorporated herein by this reference, and (iv) the AT&T/Participating Agency Product and Service Agreement
Terms attached as Exhibit C to the Master Price Agreement and incorporated herein by this reference (Exhibit C, at times,
referred to herein as the “Product and Service Agreement Terms”). Access to the Master Price Agreement including Exhibit
A and Exhibit C is available at www.NPPGOV.com. Unless otherwise defined, capitalized terms in this Participation
Agreement have the meanings ascribed to them in the Agreement or an attachment thereto, as applicable.
4. Pricing Schedules.
TABLE 4
PRICING SCHEDULES
Please Check Selected Pricing Schedule
Pricing Schedule
Participating Agency Initials
X
Sub-Exhibit A-1: Mobility Services
5. Adoption of Agreement. Participating Agency acknowledges and agrees that it is participating pursuant to the
Agreement and that PPA and AT&T may modify the Agreement at any time. Participating Agency acknowledges and agrees
that it has no right whatsoever to modify the Agreement including, without limitation, the Pricing Schedule(s) thereto.
Version 2 3.15.18
6. Service. AT&T agrees to provide Service to Participating Agency pursuant to the terms and conditions of the
Agreement. By signing this Participation Agreement, Participating Agency acknowledges and agrees that it is liable for all
charges incurred hereunder by Participating Agency.
7. Representations and Warranties. Participating Agency hereby represents and warrants that (i) it is a member in
good standing of NPPGov and will provide AT&T with verification of such membership upon reasonable request, and/or (ii) it
is a governmental agency and will provide AT&T with verification of such status upon reasonable request. Participating
Agency also hereby represents and warrants that it is not a non-profit entity as that term is defined by United States Tax
Code; provided, however, that Volunteer Fire Departments organized and established pursuant to all applicable state and
local laws and regulations and with all applicable orders issued by courts or other governmental bodies of competent
jurisdiction are eligible to receive Products and Services under this Participation Agreement and shall be treated as
Participating Agencies for all purposes herein.
8. Term. The term of this Participation Agreement will run concurrently with the term of the Pricing Schedules
identified in Section 4 above. In the event the Master Price Agreement is terminated prior to the expiration of the Pricing
Schedules, the term of each Pricing Schedule shall continue through the term identified in that Pricing Schedule. Any
Services identified on the AT&T NPPGov Program Website which, by their terms, are to exist for a specific period of time,
will survive any termination or expiration of this Participation Agreement.
9. Reserved.
10. Default and Termination of Participation Agreement.
10.1 Participating Agency Default; Termination by AT&T. Participating Agency agrees that it will be an
event of default hereunder if: Participating Agency is no longer a Participating Agency under the Agreement or otherwise
fails to perform or comply with any term or condition of the Agreement.
11. Liability. See Product and Service Agreement Terms.
12. Infringement. See Product and Service Agreement Terms.
13. Financial Responsibility. Participating Agency must pay for all charges incurred under the Participation
Agreement, provided that IRUs and individuals receiving service under “subscriber paid” plans shall be individually
responsible for all such charges incurred.
14. Invoicing Options. See the Pricing Schedule and the Product and Service Agreement Terms.
15. Termination/Cancellation Fee. See the Pricing Schedule and the Product and Service Agreement Terms.
16. Good Faith Cooperation. With respect to all marketing responsibilities set forth herein, Participating Agency and
AT&T agree to cooperate in good faith to assist AT&T in achieving its Service marketing goals, including but not limited to
making Participating Agency’s employees aware of the available discounts offered under this Participation Agreement.
17. Resale and Other Prohibited Uses. Participating Agency is not permitted to resell, reproduce, retransmit, or
disseminate Service or any other program components to third parties whether directly or indirectly including, without
limitation, through machine to machine transmissions.
18. Consent to Disclosure. Participating Agency consents to the disclosure by AT&T to PPA of information
regarding Participating Agency’s involvement and Services under this Participation Agreement, the amount of revenue
received by AT&T as a result of Participating Agency’s participation under the Agreement, and such similar information
arising in connection with the Agreement.
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AT&T and NPPGov Authorization Form Member Information To (City of Oakland)

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Completed 9 April 2021

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