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HomeMy WebLinkAbout2014 Police schedule 17 pay request 5 Lease 2014 — Sch # 17 (Police Dept.) Payment Request # 2014-05 EXHIBIT A PAYMENT REQUEST FORM /ACCEPTANCE CERTIFICATE The Escrow Agent is hereby requested to pay from the Acquisition Fund established by the Escrow Agreement dated as of February 14, 2013 by and among the Escrow Agent, the Lessee and Lessor, to the person or corporation designated below as Payee, the sum set forth below in payment (of all/of a portion) of the Acquisition Costs described below. The amount shown below is due and payable under a purchase order or contract with respect to the Equipment described below and has not formed the basis of any prior request for payment. In addition,the undersigned acknowledges delivery,installation and receipt in good condition,and hereby accepts the Equipment described on the attached invoices. Payee: Visual Pro 360 Inc Amount: 4:.0toll:! 4 f' 111505, Description of Equipment Item Cost: 4 In Car Computers Dated: April 28, 2014 LESSEE: City of Carmel One Civic Square Carmel,IN 6032 By: r :' F," ` . • «'' Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Visual Pro 360 Inc 1747 Holbrook Lane Tempe, AZ 85281 PAGE I DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 4/21/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Mailanne Uban Hylant Group (A/CC...N,Ext):317-817-5136 IA/ ,No1517-817-5151 301 Pennsylvania Parkway,#201 -Indianapolis IN 46280 nMRESS:marianne.uban h lant.com INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Charter Oak Fire_Insurance Co 2 5.515 INSURED CARME80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER D: Carmel, IN 46032 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:970829312 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDLISUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2014 1/1/2015 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE 52,000,000 GENII_AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 52,000,000 POLICY JECT I LOC 5 A AUTOMOBILE LIABILITY H8103036P64ACOF14 1/1/2014 1/1/2015 C O aocideDtSINGLE LIMI r 000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) 5 AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) X Comp X Coll Comp/Coll Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTIONS S WORKERS COMPENSATION TORY WC LIMITS 0TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADDITIONAL NAMED INSUREDS: CARMEL CLAY PARKS BUILDING CORPORATION; CARMEL CLAY BOARD OF PARKS& RECREATION; CARMEL REDEVELOPMENT COMMISSION; CARMEL REDEVELOPMENT AUTHORITY; CARMEL CITY CENTER COMMUNITY DEVELOPMENT CORPORATION Certificate Holder is an Additional Insured re: Various Police Equipment/Vehicles CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Huntington National Bank& Its Assignors&Assignees ACCORDANCE WITH THE POLICY PROVISIONS. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 /Ivyt ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD woVisualPro "44360 Invoice PROVIDING TOMORROW'S SOLUTIONS TODAY Visual Pro 360 Inc 1747 Holbrook Lane Date Invoice# Tempe AZ 85281 4/1/2014 31996 480-621-3395 Bill To Ship to City ofCarmel Carmel Police Dept Todd Luckoski 3 Civic Square 31 Ist Ave NW Carmel,IN 46032 Carmel, IN 46032 317-571-2559 Sales Rep P.O. Number Terms Due Date IM 31529 Net 20 4/21/2014 Item Description Quantity Price Each Amount CF-31 WI3NLI-ILM Win7(Win8 COA).Intel Core i5-3340M 2.70GI-Iz.vPro, 4 3,979.12 15.916.48 13.1 in XGA Touch, 128GB SSD,4GI3,Intel WiFi a/b/g/n. "IPM, Bluetooth. Dual Pass (Upper:WWAN/Lower:Selectable),4G LTF Multi Carrier, GPS,Emissive Backlit Keyboard;No Drive,Toughbook Preferred Serial#s 4CTYA96335.4CTYA96458,4CTYA96503, 4CTYA96504 Shipped on 04/01 Balance Due $15,916.48 Payments/Credits $0.00 Total $15,916.48 rVisualPro 4'-.44360 Invoice PROVIDING TOMORROW'S SOLUTIONS TODAY Visual Pro 360 Inc 1747 Holbrook Lane Date Invoice# Tempe AZ 85281 3/20/2014 31858 480-621-3395 Bill To Ship to City of Carmel Carmel Police Dept Todd L,uckoski 3 Civic Square 31 I st Ave NW Carmel, IN 46032 Carmel, IN 46032 317-571-2559 Sales Rep P.O. Number Terms Due Date • EM 31529 Net 20 4/9/2014 Item Description Quantity Price Each Amount CF-I.,NDDC120 Lind Input Car Adaptor 120 Watt 12-32 Volt 4 118.21 472.84 CF-VDM3I2U Multi Drive for CF-3Imk3 4 279.13 1,116.52 FI DEX GROUND tracking#s 013840267422542, 075570018062399 shipped on 03/20 Balance Due $1,589.36 Payments/Credits woo Total $1,589.36