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Home My WebLink AboutStoops Freightliner/STREET/900/remaining balanceSwops Freightliner Street Department - 2014 Appropriation #0043 - 530.99; P.O. #32520 Contract Not To E_cceed $900.00 ADDITIONAL SERVICES AMENDMENT TO AGREEMENT FOR PURCHASE OF GOODS AND SERVICES THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT ( "Agreement ") entered into by and between the City of Carmel and Stoops Freightliner (the "Vendor'), as City Contract dated December 17, 2014 shall amend the terms of the Agreement by adding the additional services to be provided by Vendor consistent with the Scope of Work attached hereto and incorporated herein as Exhibit "A ". Furthermore, the terms of the Agreement shall be amended to include the E- verify requirement as stated in Indiana Code § 22 -5 -1.7 et seq., which is attached hereto and incorporated herein as Exhibit "6", as well as the required E- verify Affidavit, attached hereto and incorporated herein as Exhibit "C". Also, pursuant to I.C. § 5 -22 -16.5, Vendor shall certify that in signing this document, it does not engage in investment activities within the Country of Iran. The terms and conditions of the Agreement shall not otherwise be affected by this Additional Services Amendment and shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows: CITY OF CARMEL, INDIANA by and through its Board of Public Works and Safety By: James Brainard, Presiding Officer Date: — Mary A Date: Burke, Member /J Lori S. W .tsoii, ember Date: i/ 7 i ATTEST: D(na Cordray, AMC', Clerk- Treasurer Date: i- 7 -!5 (Y.0 nnan.W.n. S.<. h Gooch S.c. \SneeK:011 \tii.mpc G, nJ 3.n. STOOPS FREIGHTLINER Autho zed Signature j4,1/ 4 ASKS Printed Name Title FID(TIN: Last Four of SSN if Sole Proprietor: Date: f2-1 3n/ +L) I ' Ci of Carmel INDIANA RETAIL TAX EXEMPT CERTIFICATE NO. 003120155 002 0 FEDERAL EXCISE TAX EXEMPT 35-60000972 ONE CIVIC SQUARE CARMEL, INDIANA 46032 -2584 FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997 PAGE PURCHASE ORDER NUMBER 32520 THIS NUMBER MUST APPEAR ON INVOICES, AP VOUCHER, DELIVERY MEMO, PACKING SLIPS. SHIPPING LABELS AND ANY CORRESPONDENCE. 'PURCHASE ORDER DATE 12/18/2014 DATE REQUIRED VENDOR REQUISITION NO. VENDOR NO. DESCRIPTION The Huntington National Bank Equipment Finance Division P.O. Box 701096 Cincinnati OH 45270 -1096 SHIP TO Street Department 3400 W. 131st Street Carmel, IN 46074 (317) 733 -2001 QUANTITY 1 UNIT OF MEASURE DESCRI Account 0043- 530.99 1 Each Additional - Balance of 6th Salt Truck Send Invoice To: Street Department 3400 W. 131st Street Carmel, IN 46074- PLEASE INVOICE IN DUPLICATE $900.00 5900.00 Sub Total: $900.00 EXHIBIT I G AMOUNT DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT Carmel Street Department SHIPPING INSTRUCTIONS • SHIP REPAID. • C.O.D. SHIPMENTS CANNOT BE ACCEPTER • PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. • THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. DOCUMENT CONTROL NO. 32520 ORDERED BY TITLE ___teteef Own tier ,cione✓• CLERK - TREASURER VENDOR COPY PAYMENT $900.00 • AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OE. THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. • I HEREBY CERTIFY TH4T THERE IS AN UNOBLIGATED BALANCE IN THIS oPRIATIO UFFIC,EnTT O P$V FpR THE ABOVE ORDER. PAYMENT TERMS FREIGHT CONEM4A ON BLANKET CONTRACT l UNIT PRICE 1 EXTENSION QUANTITY 1 UNIT OF MEASURE DESCRI Account 0043- 530.99 1 Each Additional - Balance of 6th Salt Truck Send Invoice To: Street Department 3400 W. 131st Street Carmel, IN 46074- PLEASE INVOICE IN DUPLICATE $900.00 5900.00 Sub Total: $900.00 EXHIBIT I G AMOUNT DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT Carmel Street Department SHIPPING INSTRUCTIONS • SHIP REPAID. • C.O.D. SHIPMENTS CANNOT BE ACCEPTER • PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABELS. • THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. DOCUMENT CONTROL NO. 32520 ORDERED BY TITLE ___teteef Own tier ,cione✓• CLERK - TREASURER VENDOR COPY PAYMENT $900.00 • AP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OE. THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. • I HEREBY CERTIFY TH4T THERE IS AN UNOBLIGATED BALANCE IN THIS oPRIATIO UFFIC,EnTT O P$V FpR THE ABOVE ORDER.