City of Austin Community PC Program Application

Please complete this form and agreement to request surplus computer equipment from the City of Austin Financial Services Department. The City provides this program to benefit the public in providing computer equipment to non-profit entities that serve Austinites. *Eligibility is open to local Austin nonprofit groups who either demonstrate a need for computer equipment or have a client base that has such a need. Disclaimer: All device awards are subject to item availability. Generally, our inventory consists of Dell computing devices, with other brands occasionally represented. Devices are distributed with mice, keyboard, and other peripherals as inventory allows. Recipient Organization Responsibility: *The Recipient Organization is responsible for ensuring compliance with The Children's Internet Protection Act-(https://www.fcc.gov/consumers/guides/childrens-internet-protection-act) which requires that organizations use Internet filters and implement other measures to protect children from harmful online content. For questions or comments, contact Jesse Rodriguez at jesse.rodriguez@austintexas.gov or 512-974-7676.

Organization Name

How will the requested devices be utilized?

Please check the applicable boxes below.

What is the IRS classification of the organization?

Please reference IRS Publication 557 for listing of nonprofit status: https://www.irs.gov/publications/p557

Attachment

Please use this field to attach proof of non-profit status.

Attach file

Drop files here

Organization's Physical Address

Eligibility is limited to organizations serving the residents of Austin. Please enter your organizations physical address.

Organization Website

Leave blank if you do not have a website.

Services Provided by the Organization

If you do not have a website, please describe the services provided by your organization.

{name}

Organization Contact Person

Please enter name of the primary contact for this request.

Contact Email

Contact Phone Number

Financial Contact

If you are requesting licenses, please provide the email address of the financial staff that will be handling the invoice for the cost of the licenses.

How did you hear about CPCP?

What computer equipment would you like to request?

Availability of computer equipment may be limited and dependent on supply.

Other peripheral or accessory needs

Printers and other accessories such as cases or laptop bags are only occasionally available.

{name}

Number of Microsoft Windows 10 (Pro) Operating System Licenses Requested

The fee is $6.00 per license requested. Requested licenses will be pre-installed on awarded devices.

Date Needed

By what date would you like to have the devices by?

Is this a hard deadline?

Please offer any detail on how hard your requested date is and any items that might illustrate how pressing your request is (e.g. the devices are needed for a class with a certain start date).

{name}

If you receive devices, do you have the ability/resources to maintain the equipment?

How will this equipment improve the quality of the services you deliver to residents of the City of Austin?

Please provide a description of the agency capacity to make use of the equipment as a public good and please list the specific functions and programs that the assets will be used for and how they will be used. Please add any other context that may help in review of this application

{name}

Notes on Request

Please let us know if you will accept desktops in lieu of your laptops, should we not have laptops available, as well as any other detail relating to your request not mentioned above.

{name}

When the City provides the requested equipment, you will be asked to execute a “Certificate of Transfer of Systems from the City of Austin Financial Services Department - Digital Inclusion Program.” This certificate will require you to agree to the following requirements: -The above referenced supplies and equipment are donated by the City of Austin on an “as-is, where-is” basis. The City disclaims all warranties, expressed or implied, as to the condition, quality, or fitness of the goods, including, but not limited to, warranties of fitness for a particular purpose. In no event shall the City of Austin be liable to the contractor on any claim or cause of action related to or concerning the goods or the solicitation for incidental, special, consequential, or punitive damages; -All equipment provided by the City shall be used by the applicant only for the non-profit’s work or by the non-profits clients in order to assist Austinites; -The applicant agrees that the City may conduct a site visit and/or to require electronic records to verify that the equipment is being used in accordance with this agreement; and -In the case of a records request the applicant must be able to provide data verifying that all devices were either distributed to eligible clients (including a log of distributions to valid Austin addresses), are currently in use by an eligible organization, or that the devices have been properly decommissioned. -If the applicant fails to use the equipment in compliance with this agreement, the City may reclaim the equipment.

By entering your name below, you are agreeing to the requirements of this document and are binding the organization to this agreement.

{name}

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