Loading...
HomeMy WebLinkAbout2014 Street Dept Schedule 22 pay request 1 Lease 2014 — Sch # 22 (Street Dept.) Payment Request # I 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 October 1,2014 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: Vt.i.)', Amount: S t` k, 31F Description of Equipment Item Cost: N cr (. t`� ! ' •1\1.0,,`: Dated: HC:�.._. ......_. LESSEE: City of Carmel One Civic Square Carmel, IN 460 1 Name: Diana Cordray 1 Title: Clerk Treasurer (Attached duplicate original 0f Payee's statement) PLEASE PAY VIA WIRE TRANSFER: PAGF,3 Dave, Below is our wiring information. will be sure the C of 0 has that will have that info on it. Beneficiary Bank: Lake City Bank 202 East Market Street Warsaw, In.46580 Routing Number:074903719 Account Number:1011170639 Account Name: Pearson Ford, Inc. Account Address: 10650 N. Michigan Road,Zionsville, Indiana 46077 Thanks, Chad Chad Barkduli Pearson Ford Commercial Account Manager 10650 North Michigan Road Zionsville, Indiana 46077 PH: 317.873.3333 FAX: 317.873.3152 cbarkduiiaa mvindyford.cam www.myindyford.com s"--i ''''''''' •'•','--. - • . - • - -4 :• ...,., ..-.."--•,..A.; •2:,`,.:..!'!.'*.:•:!-1,4.' ' Date: 1/12/2015 Pearson Ford,Inc. Name: City of Carmel Street Department Attention: 0 10650 North Michigan Road Address: 3400 W. 131st St INVOICE Zionsville,Indiana 4eirr7 City Carmel,IN 48074 .. 317.873.3333 www,paareontord.net — Phone: - Fax: -VB.-HtibtRINK0;tilAVAW:- . :07`1 '14.4"11*4fWP:.'1'MSR .,,. ,,, „„..t„,-4,4,, •,.4,,,, .. ,.,,.. - 0,,,,,,,,,,,,-, ,,,k P/SellInt, Price $ $37,530.00 Go New Used ODemo Optional Accessories: Year 2015 Make: Ford 1. 8'Boss at blade $ 4,85000 Model: F-250 Reg Cab PU Color: 2. 4 corner strobe $ 530.00 Stock 0: 23693 Salesperson: C. Barkdull 3. 0 $ 0.00 VIN 0: I FT0F21365FEC40970 4 0 $ 0.00 MILEAGE: 45 ActuaVNot Actual 111.111111111111111111115 0 $ 0.00 NOTES: 6 $ 0.00 Sub-total $ 42,910.00 TRADE ALLOWANCE: (-) $ 0.00 ...,,1-•.:•stwg•:-,,,,,,,4- .,- >,„4,-. 44.?..,-A,00-wg2gegiilt•Oie4yre:ea'r.''IA fairer,.....':''' Fleet Discount TetviettemAri''''Oe_motleteGlyytt004ww:'.- , „ iei,0-k, J.,1 ,z. ,„ARTmri — (.1 $ 10,8..4.00 "i1"6)6":7tgromMTW4:04,,, •,. -,'—- ,, ,..... '.'...,,, ;i: Fleet Incentive: cornteMAY*ForitibtittliOttpfitctlenbillM0330L ,..1:414"p,74,x4 'oth et TRADE-IN VEHICLE INFORMATION TOTAL SELUNG PRICE $ 32 041.00 1 Year Make: 7%Sales Tax: (1-) $ 0.00 Model: Color TRADE PAYOFF (*) $ VIN Service Contract ( ) $ Milea tie: Tire Tax $ Amount of Lien: _ • Luxury Tax (+1 $ Uenhotcler: Ca..:. Ac. Fee: i- $ 0.00 Address: Other Amounts Owed S*) $ Total amount due .-• $ 32 041.00 Phone: Down payment/Deposit (-) $ 0.00 Stock#: Rebate - $ 000 (2)Year. Make: $ Model: Color: AMOUNT DUE AT DELIVERY $ 32,04100 MILEAGE: Actual/Not Actual I Amount of Lien: By signing this°Vehicle Order Agreement°I!We Lienhoider agree to the terms and conditions herein: Address: •Company Name:_ Phone: ..,......„2.7,,,, , •,.—,•.•,,„,,,,,,,;,,.. .,,,,,,,n1-1-4 -,rv,,-; ----104e-V4Pa-...,%.-.,..7—,,- :, Authorized SI g nature. '4'...?.:4„n,g0A,..V4:;1<i,oz-rkfre'r.i4•6MS-,.'1.4-,.1 .,'.',.' : OreirAtr,,,,i.... . - ,.,,,,-, ,..,g•:,-:,.4-2,.. :41.,O., .,..A.,lit:f4.9.; .''reg•-•if--i, ,•,',.e Y-1!••••,w;''....4m-',. . 4Motik ..,•-• 4'.? ;•..,4e,tr.4..w.ttkUO3..•1,, ,:--'..•. , ...,gx..0.41 .,,INslittitiMg,s•t.1,:e.• .,tik:-. 'D.. Rilui,A,4%,,-4-4,77.-0,,,, ' dielaiWertiiriii(tikir: ,".-'":".7',. •tia0314.. 0.1t-t6'''rtg''' weieteettoteevermeT4inedertotirosellW : ,-,,foitil4fOrio00,4 ilie-,,,,' '„ ' ■'' ObettOvictiitetints' Vitarthlivisfign7,"II-11,10,041)fie• . •:' A,.■"A.Isititi*lifilMs Nee gild oartmeitut ItteCILAsfetVOIC'',..-- .40APP606,4inideiret,00 Olettave neithr,btterc -eii000400m0sra putted IA=606304,02 "; „awl:rt.* ,c1i0ii. Rirettint0AVAA0tvet,40040011010: lt,"1";000:,, ., '.:i*ni!it;i74i ,gi-ti --:iiiiri-,.'' . r..,e,1,,,';".•,-;',',Y.,-,:`,',.s.,,Y'A.'",'' '''''s,-7t•---;,-;41m.W.N,-ii,),,,,,,....,,, ..-,.----'--•. . , . • a , . tetFt ,' ,:' Date: 1/121'2015 Pearson Ford,Inc. Name: City of Carmel Street Department Attention: 0 10050 rth Michigan Road Address: 3400 W. 131s1 St INVOICE ziorsviila,Indiana O rr C Carmel,IN 46074 317.873.3333 www.pearsontord-rset . Phone: - Fax: 1 r" ' ' 4';' -'''''',-i.nr . $37 ,00 FASAPI�eliin• price $$3. 530 ® New Used ODemfl Optional Accessories: Year 2015 Make: Ford 1. 8'Boss st blade $ 4,850.00 Model: F-250 Reg Cab PU Color: 2. 4 corner strop $ 530.00 Stock#: 23708 Salesperson: C.Barkdull 3. 0 $ 0.00 YIN it: I FTBF2B65FEC40967 4 0 $ 0.00 MILEAGE: 47 Actual/Not Actual 5 0 $ 0.00 oTES; 6 $ 0.00 Sub-total $ 42,910.00 TRADE ALLOWANCE: (-) $ 0.00 u ,,, '-„ .e , re .� Fleet Discount (-) $ 10 35 9 00 ax - . .1•6'1 ,.. � . : _ ; Fleet Incentive: 1 $ 0.00 y` , - ,� 4N Other O $ 0.00 7. ,_ t- m F RADS.114 VEHICLE INFORMATION TOTAL SELLING PRICE $ 32,041.00 (1)Year. Make: 7%Sales Tax: (+) $ 0.00 Model: Color: TRADE PAYOFF ( ) $ , VINE: Service Contract (+) $ , Milea•e: - Tire Tax .__,.. Amount of Lien: Luxury Tax (+) $ , Lienholder: Capped Ace Fee: (+i $ 0.00 Address: Other Amounts Owed + $ Total amount due (_) $ 32,041.00 Phone: Down payment 1 Deposit (°l $ 0.00 Sock#: Rebate (-) $ 0.00 (2)Year. Make: . $ Model: E Color: AMOUNT DUE AT DELIVERY $ 32,041.00 VIN#: MILEAGE: Actual/Not Actual Amount of Lien: By signing this"Vehicle Order Agreement" I/We agree to the terms and conditions herein: Uenhold Address: Company Name: Phone: " 1. ,�, Authorized Signature. �4i�rs I*a„- ""#`�s V ,F 4 ,"`� 3 . .,;,4,..„ ,L,.,,*:` 4 <' L kj Y EINt.EI Q . 1r. "i p�3ii ^ a4 f wl r- .: at' e1i o - •o- a•i,., - e4 A t e j cleir d.I"yqula #',3 , �y �tdr nP7 A 2 8� Or'i13 .,in ?<, F c€7-W,4 era'sp+^m, a x v .., .gyp A O D CERTIFICATE OF LIABILITY INSURANCE 11D DATE MJDOIYYYY) • 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 poilcy(les)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). PRODUCER CONTACT . NAME: .__.__B anannl?LitS2n Hylent Group PIqNJCO No.e4):317-817-5136 I mr.317-817-5136 FAX N4317-81 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 45280 ADDRESS:Mari,;l0,Q,,,ub�ltlthylant.com.._._._ INSURER($)AFFORDING COVERAGE I NAIC a INSURER A:Charier Oak Eire_tn*S.IatanGe Co 25615_._._......_... INSURED CARME80 INSURERB: ___.._..........,__,..__,� I City of Carmel INSURER C One Civic Square __...................._______. INSURER D: Carmel, IN 46032 INSURER E: ENSURER F: w COVERAGES CERTIFICATE NUMBER:654224000 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, NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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 .___._—._._ ADM SUM" [[ POLICY EFF POLICY EXP •_......_._.. Lp1 TYPE OF INSURANCE INSR wVD! POLICY NUMBER €IMMIDOIYYYYI IMMIODIYYYY) LIMITS ff A GENERAL.LIABILITY j j L.P14762033 1112015 1/1/2016 EACH OCCURRENCE $2,000,040 .. ! DAMAGE TO PE>'drFS '.X COMMERCIAL GENERAL.LIABILITY I i P,j2.C.M]SES(Ea odcursncg) $50,000 CLAIMS-MADE 3X OCCUR MED EXP(An one on SO _.. Y person) ' PERSONAL&ADV INJURY !!52,000,000 • •......_........._.......__........._.-.—__.-- GENERAL AGGREGATE 52,000,000 GE '.,AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP A:rtd 52,000,000 POLICY 17 JILT i 1 LOC 1 1 S A AUTOMOBILE LIABIUTY 171/2015 )172016 COMBINED SINGLE LIMI,' H6103038P84ACOF16 _ja_eccitlena) 52,000,000 __..,__........ X ANY AUTO BODILY INJURY(Par Person) i S `-,,..,.... ALL OWNED ....... SCHEDULED AUTOS AUTOS E BODILY INJURY(Per acadent) S i AUN-OWNED PROPERTY DAMAGE ._._....__ . HIRED AUTOS �AUTOS ; Par ar„rident) __ IX Comp [X 1C013 iComplCall Ded I$2,500 UMBRELLA LIAR OCCUR 1 EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE i I AGGREGATE i$ WORKRCOMPENSATION I I5 �, 1 PENSATEON I V4 STATUS I IOTH- EMPLOYERS'UABIUTY I TORY i IMiTS. ._.:_.ER I AND _........................._..._.....__....._.._.._.. YIN I ANY PROPRIETOR/PARTNER/EXECUTIVE i I N I A ,E.L.EACH ACCIDENT !S OFFICER/MEMBER EXCLUDED? (Mandatery In NH) E.L.DISEASE-EA EMPLOYEE 5 Byes,describe under ..- ...._....................... DE.SCRIPTICN OF OPERATIONS beIo 1 E.L.DISEASE-POLICY LIMIT 15 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,Ir more apace Is requtrod) 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 named as Loss Payee re:2015 Ford F250#40970 and 2015 Ford F250#40967(City of Carmel Street Dept.) 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 ACCORDANCE WITH THE POLICY PROVISIONS. 105 East 4th Street(CN01) Cincinnati OH 45202 AUTHORIZED REPRESENTATIVE muilyt. , _ ©1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(20110105) The ACORD name and logo are registered marks of ACORD