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HomeMy WebLinkAbout2014 Comm Services schedule 21 pay request 1 012115 Lease 2014. — Sch # 21 (Community Services Dept.) Payment Request # 1 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 I, 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. f ? Payee: 0 ti}'\ ,j-)oCI -oa , , 1 JbS h pelit Amount: �� i 1,(,cV1 'kJ 4.9 Description of Equipm nt Item Cost: Dated: / . " LESSEE: City of Carmel One Civic Square Carmel, IN 46032 By: 41ftf_etlifie ' Name: I5iana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE PAY VIA WIRE TRANSFER: PAGE I 0 TOM WOOD VEHICLE ORDER AGREEMENT TOM WOOD SUBARU THE INFORMATION YOU SEE ON THE WINDOW FORM FOR THIS AUTOMOTIVE GROUP 330171 EAST 96"f H STREET VEHICLE IS PART OF THIS CONTRACT.'INFORMATION ON THE INDIANAPOLIS IN 46240 WINDOW FORM OVERRIDES ANY CONTRARY PROVISIONS IN THE VEHICLE ORDER AGREEMENT. DATE 12/08/2014 STOCK# 9695 DEAL# 9411. PURCHASER'S NAME CITY OF CARMEL EMAIL whohlt@carmel . in.gov PURCHASER'S ADDRESS 1 CIVIC SQUARE CARMEL IN 46032 (317)571-2418 RESIDENCE PHONE BUSINESS PHONE PLEASE ENTER MY ORDER FOR ONE XM NEW Q USED 2015 SUBARU FORESTER 0 CAR XM TRUCK SERIAL# JF2SJAAC3FH536408 BODY TYPE 4DR 2.51 AT PZEV COLOR SAT WHY PRL TO BE DELIVERED ON OR ABOUT 12/08/2014 MILEAGE SALESPERSON FILL OUT THIS SECTION IF USED CAR IS TO BE TRADED IN �(�A ry�r MAKE OF USED CAR FORD TRUCK YEAR 2006 CASH DELIVERED PRICE OF UNIT 22500.00 MODEL ESCAPE p� BODY TYPE ACCESSORIES AND OPTIONS SERIAL NO. 1 FMCU96H76 KA2o08 7 BALANCED OWED TO • ADDRESS AMOUNT GOOD UNTIL PER DIEM USED CAR ALLOWANCE 4500.00 BALANCE OWED ON CAR NET ALLOWANCE ON USED CAR 4500.00 INITIAL DOWN PAYMENT CASH UPON DELIVERY �F�q ryI TOTAL CREDIT(A-TRANSFER TO RIGHT COLUMN) 4500.00 SALES TAX 1260.00 ELECTRONIC FILING FEE 39.00 TITLE APPLICATION FEE 15.00 TIRE TAX 1.25 ***OTHER ITEMS*** TOTAL SALE 22500.00 TOTAL OTHER FEES(B-TRANSFERRED FROM LEFT COLUMN) 1315.25 1 TOTAL OTHER CREDITS(A-TRANSFERRED FROM LEFT COLUMN) 4500.00 LESS REBATES BALANCE DUE ON TIME OF SALE 19 315.25 TOTAL OTHER FEES(B-TRANSFER TO RIGHT COLUMN) 131 5 2,5 BALANCE TO BE FINANCED 1 411 q 2 5 L TRADE-IN CERTIFICATION: Customer agrees to deliver to Dealer good,clear and marketable title(s)to the trade-in vehicle(s)as part of the consideration for the vehicle ordered at the time of delivery.Customer warrants that the trade-in vehicle(s)are owned only by customer and are free and clear of all liens and encumbrances except as otherwise stated in writing herein. Customer certifies that the airbags, safety and emissions equipment in the trade-in vehicle(s)have never been disconnected and are operable.Customer also agrees that the trade-in vehicle(s)has/have never been and is/are not required to be titled in any state as a defective,rebuilt,salvage,flood,lemon or buy back vehicle and have never been damaged.CUSTOMER AGREES THAT THE TRADE-IN TERMS ON THE BACK OF THIS AGREEMENT ALSO APPLY. DISCLAIMER OF WARRANTIES Unless Dealer provides Customer with a separate written warranty or service contract made by Dealer on its own behalf,the DEALER HEREBY DISCLAIMS ANY AND ALL WARRANTIES ORAL, WRITTEN,EXPRESS OR IMPLIED,INCLUDING,BUT NOT LIMITED TO,THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE,THE VEHICLE IS SOLD"AS IS"WITH ALL FAULTS.Dealer further disclaims any and all liability for incidental or consequential damages incurred by Customer,including but not limited to,loss of profit,loss of use or inconvenience arising out of purchase,lease,operation,failure or use of the vehicle.The manufacturer of the vehicle may provide a warranty for the vehicle.The manufacturer of the vehicle is solely responsible for such warranty, if any. Dealer expressly disclaims liability arising from such warranty. Dealer also makes no representation or guaranty concerning the availability of any manufacturer's warranty.The manufacturer's warranty,if any,may not cover parts or accessories installed after manufacture of the vehicle.Dealer also makes no warranty or representation as to any parts or accessories.CUSTOMER ALSO AGREES WITH THE ADDITIONAL DISCLAIMER OF WARRANTY TERMS ON THE REVERSE SIDE OF THIS VEHICLE AGREEMENT. AGREEMENT TO ARBITRATE ANY CLAIMS READ THE FOLLOWING ARBITRATION AGREEMENT CAREFULLY BECAUSE IT LIMITS YOUR RIGHTS,INCLUDING YOUR RIGHT TO MAINTAIN COURT ACTION.The parties to this Vehicle Order Agreement are Dealer and Customer. No third party provider of services(by way of example and not by way of limitation: service contract providers or GAP insurance providers)or assignee of consumer obligations(by way of example and not by way of limitation:banks,finance companies,or credit unions)is a party to this Vehicle Order Agreement.This agreement to arbitrate is binding only upon the parties to this Vehicle Order Agreement.Dealer and Customer agree to arbitrate any claim,dispute,or controversy(collectively,"Claims"),including but not limited to all statutory Claims and any other Claims under state,federal,local laws and/or regulations or common law that may arise out of or are related to the purchase or lease of the vehicle identified in this Vehicle Order Agreement and the financing or leasing thereof,including the validity of this arbitration agreement.This arbitration agreement is made pursuant to a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,9 U.S.C.§1,et seq.,as amended,and not by state law regarding arbitration.By agreeing to arbitration,Customer and Dealer understand and agree that they are waiving their rights to maintain other available resolution processes(such as a court action or administrative proceeding)to settle their disputes.Customer and Dealer also agree to waive any right to pursue any Claims as a class action(whether as a class member or class representative),either in arbitration or through a lawsuit.There are no limitations on the type of Claims that must be arbitrated except for new car lemon claims under applicable state law,Claims arising from a dishonored check issued by any party hereto,and/or claims related to or arising from the validity,issuance,existence,form or correctness of any certificate of title to a motor vehicle.The arbitration shall be conducted in accordance with this arbitration agreement and with the Indiana Rules for Alternative Dispute Resolution(the"Rules")before a single arbitrator.If a conflict exists between the terms of this arbitration and the Rules,then this arbitration agreement shall govern.The costs incurred in the arbitration shall be shared as provided by the Rules.The arbitration shall take place in Indianapolis,Indiana at a mutually agreed upon location.The decision of the arbitrator shall be binding on Customer and Dealer,and may be enforced in any court of competent jurisdiction.THIS ARBITRATION LIMITS YOUR RIGHT TO MAINTAIN A COURT ACTION,HAVE A JURY TRIAL,OR PURSUE ACLASS ACTION CLAIM.PLEASE READ IT CAREFULLY PRIOR TO SIGNING. BEFORE SIGNING THIS VEHICLE ORDER AGREEMENT READ ALL TERMS ON THE FRONT AND BACK This written document and the accompanying written,signed documents,including but not limited to the finance/lease documents,contain the entire agreement of the parties.Customer agrees that this Vehicle Order Agreement includes all terms on both the front and back of this Agreement.Customer has read,understands and voluntarily agrees to all terms stated herein. Unless specifically referenced in this agreement,no other agreement or understanding has been made or entered into or will be recognized.The written terms supersede any prior agreement or understanding of the Dealer and Customer.The rights and obligations of the Customer and Dealer are limited to the written terms on the front and back of this Agreement and the accompanying documents signed by the parties including,but not limited to,the finance/lease documents,if any.I HAVE READ THE TERMS ON THE FRONT AND BACK OF THIS DOCUMENT AND THE ACCOMPANYING DOCUMENTAND AGREE TO THE WRITTEN TERMS.I CERTIFY I AM 18 YEARS OF AGE OR OLDER,HAVE VOLUNTARILY ENTERED INTO THIS AGREEMENT AND ACKNOWLEDGE RECEIPT OF COPY,QJHISAGGRREEMENT. Signed ii-) �`� r Dated 12/08/2014 Buyer Signed Dated Co-Buyer NOTICE:THIS AGREEMENT IS NOT VALID UNLESS ACCEPT /AND SIGNED BY DEALER OR ITS AUTHORIZED REPRESENTATIVE. ACCEPTED:Dealer/Authorized Representative t '04/1/44641d— Title/Position f,7ict r- (�'C(,I'- 13) TOM WOOD TOM WOOD SUBARU VEHICLE ORDER AGREEMENT 3300 EAST 96TH STREET THE INFORMATION YOU SEE ON THE WINDOW FORM FOR THIS AUTOMOTIVE GROUP INDIANAPOLIS I AJ 46240 ( V WINDOW FORM OVERRIDES AN CONTRACT. M F ONTRARYPROVIS PROVISIONS IN • THE VEHICLE ORDER AGREEMENT. 12/08/2014 9703 9413 DATE STOCK# DEAL# PURCHASER'S NAME CITY OF CARMEL • EMAIL whohlt@@carmel . in.gov PURCHASER'S ADDRESS 1 CIVIC SQUARE CARMEL IN 46032 (317)571-2418 RESIDENCE PHONE BUSINESS PHONE PLEASE ENTER MY ORDER FOR ONE NEW Q USED 2015 SUBARU FORESTER CAR )15 TRUCK SERIAL# JF2SJAAC2FH537856 BODY TYPE 4DR 2.5I AT PZEV COLOR SAT UHT PRL TO BE DELIVERED ON OR ABOUT 12/08/2014 MILEAGE 5 SALESPERSON - - FILL OUT THIS SECTION IF USED CAR IS TO BE TRADED IN �j Ct7((7� MAKE OF USED CAR FORD TRUCK YEAR 2006 CASH DELIVERED PRICE OF UNIT 22500.00 MODEL ESCAPE BODY TYPE ACCESSORIES AND OPTIONS SERIAL NO. 1FMCU96H36KA26085 BALANCED OWED TO ADDRESS AMOUNT GOOD UNTIL PER DIEM USED CAR ALLOWANCE OW W t0`WW BALANCE OWED ON CAR • NET ALLOWANCE ON USED CAR 6000.00 INITIAL DOWN PAYMENT CASH UPON DELIVERY �7r TOTAL CREDIT(A-TRANSFER TO RIGHT COLUMN) 6000.00 SALES TAX - ELECTRONIC FILING FEE 39.00 TITLE APPLICATION FEE 15.00 TIRE TAX 1.25 ***OTHER ITEMS*** TOTAL SALE 22500.00 TOTAL OTHER FEES(8-TRANSFERRED FROM LEFT COLUMN) 55.25 TOTAL OTHER CREDITS(A•TRANSFERRED FROM LEFT COLUMN) 6000.00 LESS REBATES BALANCE DUE ON TIME OF SALE 16555.25 TOTAL OTHER FEES(B-TRANSFER TO RIGHT COLUMN) 55.25 BALANCE TO BE FINANCED 16555.25 TRADE-IN CERTIFICATION: Customer agrees to deliver to Dealer good,clear and marketable title(s)to the trade-in vehicle(s)as part of the consideration for the vehicle ordered at the time of delivery.Customer warrants that the trade-in vehicle(s)are owned only by customer and are free and clear of all liens and encumbrances except as otherwise stated in writing herein. Customer certifies that the airbags, safety and emissions equipment in the trade-in vehicle(s)have never been disconnected and are operable.Customer also agrees that the trade-in vehicle(s)has/have never been and is/are not required to be titled in any state as a defective,rebuilt,salvage,flood,lemon or buy back vehicle and have never been damaged.CUSTOMER AGREES THAT THE TRADE-IN TERMS ON THE BACK OF THIS AGREEMENT ALSO APPLY. DISCLAIMER OF WARRANTIES Unless Dealer provides Customer with a separate written warranty or service contract made by Dealer on its own behalf,the DEALER HEREBY DISCLAIMS ANY AND ALL WARRANTIES ORAL, WRITTEN,EXPRESS OR IMPLIED,INCLUDING,BUT NOT LIMITED TO,THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE,THE VEHICLE IS SOLD"AS IS"WITH ALL FAULTS.Dealer further disclaims any and all liability for incidental or consequential damages incurred by Customer,including but not limited to,loss of profit,loss of use or inconvenience arising out of purchase,lease,operation,failure or use of the vehicle.The manufacturer of the vehicle may provide a warranty for the vehicle.The manufacturer of the vehicle is solely responsible for such warranty, if any. Dealer expressly disclaims liability arising from such warranty. Dealer also makes no representation or guaranty concerning the availability of any manufacturer's warranty.The manufacturer's warranty,if any,may not cover parts or accessories installed after manufacture of the vehicle.Dealer also makes no warranty or representation as to any parts or accessories.CUSTOMER ALSO AGREES WITH THE ADDITIONAL DISCLAIMER OF WARRANTY TERMS ON THE REVERSE SIDE OF THIS VEHICLE AGREEMENT. AGREEMENT TO ARBITRATE ANY CLAIMS READ THE FOLLOWING ARBITRATION AGREEMENT CAREFULLY BECAUSE IT LIMITS YOUR RIGHTS,INCLUDING YOUR RIGHT TO MAINTAIN COURT ACTION.The parties to this Vehicle Order Agreement are Dealer and Customer. No third party provider of services(by way of example and not by way of limitation:service contract providers or GAP insurance providers)or assignee of consumer obligations(by way of example and not by way of limitation:banks,finance companies,or credit unions)is a party to this Vehicle Order Agreement.This agreement to arbitrate is binding only upon the parties to this Vehicle Order Agreement.Dealer and Customer agree to arbitrate any claim,dispute,or controversy(collectively,"Claims"),including but not limited to all statutory Claims and any other Claims under state,federal,local laws and/or regulations or common law that may arise out of or are related to the purchase or lease of the vehicle identified in this Vehicle Order Agreement and the financing or leasing thereof,including the validity of this arbitration agreement.This arbitration agreement is made pursuant to a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,9 U.S.C.§1,et seq.,as amended,and not by state law regarding arbitration.By agreeing to arbitration,Customer and Dealer understand and agree that they are waiving their rights to maintain other available resolution processes(such as a court action or administrative proceeding)to settle their disputes.Customer and Dealer also agree to waive any right to pursue any Claims as a class action(whether as a class member or class representative),either in arbitration or through a lawsuit.There are no limitations on the type of Claims that must be arbitrated except for new car lemon claims under applicable state law,Claims arising from a dishonored check issued by any party hereto,and/or claims related to or arising from the validity,issuance,existence,form or correctness of any certificate of title to a motor vehicle.The arbitration shall be conducted in accordance with this arbitration agreement and with the Indiana Rules for Alternative Dispute Resolution(the"Rules")before a single arbitrator.If a conflict exists between the terms of this arbitration and the Rules,then this arbitration agreement shall govern.The costs incurred in the arbitration shall be shared as provided by the Rules.The arbitration shall take place in Indianapolis,Indiana at a mutually agreed upon location.The decision of the arbitrator shall be binding on Customer and Dealer,and may be enforced in any court of competent jurisdiction.THIS ARBITRATION LIMITS YOUR RIGHT TO MAINTAIN A COURT ACTION,HAVE A JURY TRIAL,OR PURSUE ACLASS ACTION CLAIM.PLEASE READ IT CAREFULLY PRIOR TO SIGNING. BEFORE SIGNING THIS VEHICLE ORDER AGREEMENT READ ALL TERMS ON THE FRONT AND BACK This written document and the accompanying written,signed documents,including but not limited to the finance/lease documents,contain the entire agreement of the parties.Customer agrees that this - Vehicle Order Agreement includes all terms on both the front and back of this Agreement.Customer has read, understands and voluntarily agrees to all terms stated herein. Unless specifically referenced in this agreement,no other agreement or understanding has been made or entered into or will be recognized.The written terms supersede any prior agreement or understanding of the Dealer and Customer.The rights and obligations of the Customer and Dealer are limited to the written terms on the front and back of this Agreement and the accompanying documents signed by the parties including,but not limited to,the financellease documents,if any.I HAVE READ THE TERMS ON THE FRONT AND BACK OF THIS DOCUMENT AND THE ACCOMPANYING DOCUMENTS AND AGREE TO TH WRITTEN TERMS.I CERTIFY I AM 18 YEARS OF AGE OR OLDER,HAVE VOLUNTARILY ENTERED INTO THIS AGREEMENT AND ACKNOWLEDGE RECEIPT F COP OF THIS AGR-EEMENT. Signed' lV'ti.�L. /�---- Dated 12/08/2014 Buyer Signed Dated Coo-Buyer NOTICE:THIS AGREEMENT IS NOT VALID UNLESS AC • PfED AND SIGNED BY DEALER OR ITS AUTHORIZED REPRESENTATIVE. �j 7 ACCEPTED:Dealer/Authorized Representative 1 !t ���/ J f/����1 Title/Position Rill. `J I!• VEHICLE ORDER AGREEMENT TOM WOOD TOM MOOD SUBARU THE INFORMATION YOU SEE ON THE WINDOW FORM FOR THIS AUTOMOTIVE GROUP 9300 EAST 96TH STREET VEHICLE IS PART OF THIS CONTRACT. INFORMATION ON THE INDIANAPOLIS IN 46240 WINDOW FORM OVERRIDES ANY CONTRARY PROVISIONS IN THE VEHICLE ORDER AGREEMENT. DATE 12/08/2014 STOCK# 9701 DEAL# . 9412 PURCHASER'S NAME CITY OF CARMEL EMAIL whop 1t @carme1 . in.gov PURCHASER'S ADDRESS 1 CIVIC SQUARE CARMEL IN 46032 RESIDENCE PHONE BUSINESS PHONE (317)571-2418 PLEASE ENTER MY ORDER FOR ONE XCI NEW Q USED 2015 SUBARU FORESTER .Lj CAR XJ TRUCK SERIAL# JF2SJAAC8FH536484 BODY TYPE 4DR 2.51 AT PZEV COLOR SAT WHT PRL TO BE DELIVERED.ON OR ABOUT 12/08/2014 MILEAGE 5 SALESPERSON FILL OUT THIS SECTION IF USED CAR IS TO BE TRADED IN �{�7r �Ay� MAKE OF USED CAR FORD TRUCK YEAR 2006 CASH DELIVERED PRICE OF UNIT 22500.00 MODEL ESCAPE �+ BODY TYPE e1 ACCESSORIES AND OPTIONS SERIAL NO. 1 FMCU96H96KA26091 BALANCED OWED TO ADDRESS AMOUNT GOOD UNTIL PER DIEM USED CAR ALLOWANCE 4500.00 BALANCE OWED ON CAR NET ALLOWANCE ON USED CAR 4500.00 INITIAL DOWN PAYMENT CASH UPON DELIVERY /fir �7{/7� TOTAL CREDIT(A-TRANSFER TO RIGHT COLUMN) 4500.00 SALES TAX ELECTRONIC FILING FEE 39.00 TITLE APPLICATION FEE 15.00 TIRE TAX 1.25 ***OTHER ITEMS*** TOTAL SALE 22500.00 TOTAL OTHER FEES(B-TRANSFERRED FROM LEFT COLUMN) /55.25/y TOTAL OTHER CREDITS(A-TRANSFERRED FROM LEFT COLUMN) 4500.00 LESS REBATES �r BALANCE DUE ON TIME OF SALE 18055.25 TOTAL OTHER FEES(B-TRANSFER TO RIGHT COLUMN) S .7¢ BALANCE TO BE FINANCED 1 R(A c c :?c TRADE-IN CERTIFICATION: Customer agrees to deliver to Dealer good,clear and marketable title(s)to the trade-in vehicle(s)as part of the consideration for the vehicle ordered at the time of delivery.Customer warrants that the trade-in vehicle(s)are owned only by customer and are free and clear of all liens and encumbrances except as otherwise stated in writing herein. Customer certifies that the airbags, safety and emissions equipment in the trade-in vehicle(s)have never been disconnected and are operable.Customer also agrees that the trade-in vehicle(s)has/have never been and is/are not required to be titled in any state as a defective,rebuilt,salvage,flood,lemon or buy back vehicle and have never been damaged.CUSTOMER AGREES THAT THE TRADE-IN TERMS ON THE BACK OF THIS AGREEMENT ALSO APPLY. DISCLAIMER OF WARRANTIES Unless Dealer provides Customer with a separate written warranty or service contract made by Dealer on its own behalf,the DEALER HEREBY DISCLAIMS ANY AND ALL WARRANTIES ORAL, WRITTEN,EXPRESS OR IMPLIED,INCLUDING,BUT NOT LIMITED TO,THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE,THE VEHICLE IS SOLD"AS IS"WITH ALL FAULTS.Dealer further disclaims any and all liability for incidental or consequential damages incurred by Customer,including but not limited to,loss of profit,loss of use or inconvenience arising out of purchase,lease,operation,failure or use of the vehicle.The manufacturer of the vehicle may provide a warranty for the vehicle.The manufacturer of the vehicle is solely responsible for such warranty, if any. Dealer expressly disclaims liability arising from such warranty. Dealer also makes no representation or guaranty concerning the availability of any manufacturer's warranty.The manufacturer's warranty,if any,may not cover parts or accessories installed after manufacture of the vehicle.Dealer also makes no warranty or representation as to any parts or accessories.CUSTOMER ALSO AGREES WITH THE ADDITIONAL DISCLAIMER OF WARRANTY TERMS ON THE REVERSE SIDE OF THIS VEHICLE AGREEMENT. AGREEMENT TO ARBITRATE ANY CLAIMS READ THE FOLLOWING ARBITRATION AGREEMENT CAREFULLY BECAUSE IT LIMITS YOUR RIGHTS,INCLUDING YOUR RIGHT TO MAINTAIN COURT ACTION.The parties to this Vehicle Order Agreement are Dealer and Customer. No third party provider of services(by way of example and not by way of limitation: service contract providers or GAP insurance providers)or assignee of consumer obligations(by way of example and not by way of limitation:banks,finance companies,or credit unions)is a party to this Vehicle Order Agreement.This agreement to arbitrate is binding only upon the parties to this Vehicle Order Agreement.Dealer and Customer agree to arbitrate any claim,dispute,or controversy(collectively,"Claims"),including but not limited to all statutory Claims and any other Claims under state,federal,local laws and/or regulations or common law that may arise out of or are related to the purchase or lease of the vehicle identified in this Vehicle Order Agreement and the financing or leasing thereof,including the validity of this arbitration agreement.This arbitration agreement is made pursuant to a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,9 U.S.C.§1,et seq.,as amended,and not by state law regarding arbitration.By agreeing to arbitration,Customer and Dealer understand and agree that they are waiving their rights to maintain other available resolution processes(such as a court action or administrative proceeding)to settle their disputes.Customer and Dealer also agree to waive any right to pursue any Claims as a class action(whether as a class member or class representative),either in arbitration or through a lawsuit.There are no limitations on the type of Claims that must be arbitrated except for new car lemon claims under applicable state law,Claims arising from a dishonored check issued by any party hereto,and/or claims related to or arising from the validity,issuance,existence,form or correctness of any certificate of title to a motor vehicle.The arbitration shall be conducted in accordance with this arbitration agreement and with the Indiana Rules for Alternative Dispute Resolution(the"Rules")before a single arbitrator.If a conflict exists between the terms of this arbitration and the Rules,then this arbitration agreement shall govern.The costs incurred in the arbitration shall be shared as provided by the Rules.The arbitration shall take place in Indianapolis,Indiana'at a mutually agreed upon location.The decision of the arbitrator shall be binding on Customer and Dealer,and may be enforced in any court of competent jurisdiction.THIS ARBITRATION LIMITS YOUR RIGHT TO MAINTAIN A COURT ACTION,HAVE A JURY TRIAL,OR PURSUE ACLASS ACTION CLAIM.PLEASE READ IT CAREFULLY PRIOR TO SIGNING. BEFORE SIGNING THIS VEHICLE ORDER AGREEMENT READ ALL TERMS ON THE FRONT AND BACK This written document and the accompanying written,signed documents,including but not limited to the finance/lease documents,contain the entire agreement of the parties.Customer agrees that this Vehicle Order Agreement includes all terms on both the front and back of this Agreement.Customer has read, understands and voluntarily agrees to all terms stated herein. Unless specifically referenced in this agreement,no other agreement or understanding has been made or entered into or will be recognized.The written terms supersede any prior agreement or understanding of the Dealer and Customer.The rights and obligations of the Customer and Dealer are limited to the written terms on the front and back of this Agreement and the accompanying documents signed by the parties including,but not limited to,the finance/lease documents,if any.I HAVE READ THE TERMS ON THE FRONT AND BACK OF THIS DOCUMENT AND THE ACCOMPANYING DOCUMENTS•AND AGREE TO THE WRITTEN TERMS.I CERTIFY I AM 18 YEARS OF AGE OR OLDER,HAVE VOLUNTARILY ENTERED INTO THIS AGREEMENT AND ACKNOWLEDGE RECEIPT OF 91COP Y OF�THIS AGREEMENT. Signed' u nY/ / � `� L��� "��-- Dated 12/08/2014 UBuyer Signed / Dated //Co-Buyer NOTICE:THIS AGREEMENT IS NOT VALID UNLESS AC�OEPTED AND SIGNED BY DEALER OR ITS AUTHORIZED REPRESENTATIVE. ACCEPTED:DealerlAuthorized Representative 14.d' / / Title/Position /7tlS• TOM WOOD TOM WOOD SUBARU 3300 EAST 96TH STREET VEHICLE ORDER AGREEMENT 0 THE INFORMATION YOU SEE ON THE WINDOW FORM FOR THIS AUTOMOTIVE GROUP INDIANAPOLIS IN 46240 WINDOW FORM OVVERRIDES ANY CONTRARY PROVISIONS hIN THE VEHICLE ORDER AGREEMENT. DATE 12/08/2014 STOCK# 9662 DEAL# 9410 PURCHASER'S NAME CITY OF CARMEL • EMAIL whoh 1 t@carme l .i n‘gov PURCHASER'S ADDRESS 1 CIVIC SQUARE CARMEL IN 46032 RESIDENCE PHONE BUSINESS PHONE (317)571-2418 PLEASE ENTER MY ORDER FOR ONE XCl NEW II USED 2015 SUBARU FORESTER 0 CAR XL TRUCK . SERIAL# JF2SJAAC5FH524258 BODY TYPE 4DR 2.5I AT PZEV COLOR SAT WHT PRL TO BE DELIVERED ON OR ABOUT 12/08/2014 MILEAGE 5 SALESPERSON FILL OUT THIS SECTION IF USED CAR IS TO BE TRADED IN �_C�y�( rye( MAKE OF USED CAR FORD TRUCK YEAR 2006 CASH DELIVERED PRICE OF UNIT 22500.00 MODEL ESCAPE BODY TYPE /7��y ACCESSORIES AND OPTIONS SERIAL NO. 1FMCU96H56KA26086 BALANCED OWED TO ' ADDRESS AMOUNT GOOD UNTIL PER DIEM USED CAR ALLOWANCE 3500.00 BALANCE OWED ON CAR NET ALLOWANCE ON USED CAR 3500.00 INITIAL DOWN PAYMENT CASH UPON DELIVERY 3500.00 TOTAL CREDIT(A-TRANSFER TO RIGHT COLUMN) SALES TAX - ELECTRONIC FILING FEE 39.00 TITLE APPLICATION FEE 15.00 TIRE TAX 1.25 . ***OTHER ITEMS*** TOTAL SALE 22500.00 TOTAL OTHER FEES(B-TRANSFERRED FROM LEFT COLUMN) 55.25 TOTAL OTHER CREDITS(A-TRANSFERRED FROM LEFT COLUMN) 3500.00 LESS REBATES BALANCE DUE ON TIME OF SALE 19055.25 1 TOTAL OTHER FEES(B-TRANSFER TO RIGHT COLUMN) 5 5.2.5 BALANCE TO BE FINANCED t 4955-1S-7 • J TRADE-IN CERTIFICATION: Customer agrees to deliver to Dealer good,clear and marketable title(s)to the trade-in vehicle(s)as part of the consideration for the vehicle ordered at the time of delivery.Customer warrants that the trade-in vehicle(s) are owned only by customer and are free and clear of all liens and encumbrances except as otherwise stated in writing herein. Customer certifies that the airbags, safety and emissions equipment in the trade-in vehicle(s)have never been disconnected and are operable.Customer also agrees that the trade-in vehicle(s)has/have never been and is/are not required to be titled in any state as a defective,rebuilt,salvage,flood,lemon or buy back vehicle and have never been damaged.CUSTOMER AGREES THAT THE TRADE-IN TERMS ON THE BACK OF THIS AGREEMENT ALSO APPLY. DISCLAIMER OF WARRANTIES Unless Dealer provides Customer with a separate written warranty or service contract made by Dealer on its own behalf,the DEALER HEREBY DISCLAIMS ANY AND ALL WARRANTIES ORAL, WRITTEN,EXPRESS OR IMPLIED,INCLUDING,BUT NOT LIMITED TO,THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FORA PARTICULAR PURPOSE,THE VEHICLE IS SOLD"AS IS"WITH ALL FAULTS.Dealer further disclaims any and all liability for incidental or consequential damages incurred by Customer,including but not limited to,loss of profit,loss of use or inconvenience arising out of purchase,lease,operation,failure or use of the vehicle.The manufacturer of the vehicle may provide a warranty for the vehicle.The manufacturer of the vehicle is solely responsible for such warranty, if any. Dealer expressly disclaims liability arising from such warranty. Dealer also makes no representation or guaranty concerning the availability of any manufacturer's warranty.The manufacturer's warranty,if any,may not cover parts or accessories installed after manufacture of the vehicle.Dealer also makes no warranty or representation as to any parts or accessories.CUSTOMER ALSO AGREES WITH THE ADDITIONAL DISCLAIMER OF WARRANTY TERMS ON THE REVERSE SIDE OF THIS VEHICLE AGREEMENT. AGREEMENT TO ARBITRATE ANY CLAIMS READ THE FOLLOWING ARBITRATION AGREEMENT CAREFULLY BECAUSE IT LIMITS YOUR RIGHTS,INCLUDING YOUR RIGHT TO MAINTAIN COURT ACTION.The parties to this Vehicle Order Agreement are Dealer and Customer. No third party provider of services(by way of example and not by way of limitation: service contract providers or GAP insurance providers)or assignee of consumer obligations(by way of example and not by way of limitation:banks,finance companies,or credit unions)is a party to this Vehicle Order Agreement.This agreement to arbitrate is binding only upon the parties to this Vehicle Order Agreement.Dealer and Customer agree to arbitrate any claim,dispute,or controversy(collectively,"Claims"),including but not limited to all statutory Claims and any other Claims under state,federal,local laws and/or regulations or common law that may arise out of or are related to the purchase or lease of the vehicle identified in this Vehicle Order Agreement and the financing or leasing thereof,including the validity of this arbitration agreement.This arbitration agreement is made pursuant to a transaction involving interstate commerce and shall be governed by the Federal Arbitration Act,9 U.S.C.§1,et seq.,as amended,and not by state law regarding arbitration.By agreeing to arbitration,Customer and Dealer understand and agree that they are waiving their rights to maintain other available resolution processes(such as a court action or administrative proceeding)to settle their disputes.Customer and Dealer also agree to waive any right to pursue any Claims as a class action(whether as a class member or class representative),either in arbitration or through a lawsuit.There are no limitations on the type of Claims that must be arbitrated except for new car lemon claims under applicable state law,Claims arising from a dishonored check issued by any party hereto,and/or claims related to or arising from the validity,issuance,existence,form or correctness of any certificate of title to a motor vehicle.The arbitration shall be conducted in accordance with this arbitration agreement and with the Indiana Rules for Alternative Dispute Resolution(the"Rules")before a single arbitrator.If a conflict exists between the terms of this arbitration and the Rules,then this arbitration agreement shall govern.The costs incurred in the arbitration shall be shared as provided by J the Rules.The arbitration shall take place in Indianapolis,Indiana at a mutually agreed upon location.The decision of the arbitrator shall be binding on Customer and Dealer,and may be enforced in'any court of competent jurisdiction.THIS ARBITRATION LIMITS YOUR RIGHT TO MAINTAIN A COURT ACTION,HAVE A JURY TRIAL,OR PURSUE ACLASS ACTION CLAIM.PLEASE READ IT CAREFULLY PRIOR TO SIGNING. • BEFORE SIGNING THIS VEHICLE ORDER AGREEMENT READ ALL TERMS ON THE FRONT AND BACK This written document and the accompanying written,signed documents,including but not limited to the finance/lease documents,contain the entire agreement of the parties.Customer agrees that this Vehicle Order Agreement includes all terms on both the front and back of this Agreement.Customer has read,understands and voluntarily agrees to all terms stated herein.Unless specifically referenced in this agreement,no other agreement or understanding has been made or entered into or will be recognized.The written terms supersede any prior agreement or understanding of the Dealer and Customer.The rights and obligations of the Customer and Dealer are limited to the written terms on the front and back of this Agreement and the accompanying documents signed by the parties including,but not limited to,the finance/lease documents,if any.I HAVE READ THE TERMS ON THE FRONT AND BACK OF THIS DOCUMENT AND THE ACCOMPANYING DOCUMENTS AND AGREE TO THE'WRITTEN TERMS.I CERTIFY I AM 18 YEARS OF A GE OR OLDER,HAVE VOLUNTARILY ENTERED INTO THIS AGREEMENT AND ACKNOWLEDGE RECEIPT OF' COP Y OF THIS A/GREEEE MENT. Signed: A I J ,' i/ ..A-.....-■ Dated 12/08/2014 I a ' Buyer I Signed Dated Cover NOTICE:THIS AGREEMENT IS NOT VALID UNLESS ACC,'ED AND SIGNED BY DEALER OR II,T/$T AUTHORIZED REPRESENTATIVE. /y, [1 �/ ACCEPTED:Dealer/Authorized Representative f ! t��l� (A� /C/// Title/Position +'/1!S '!F { — . Al DATE(MM/DD/YYYY) ,ACORO CERTIFICATE OF LIABILITY INSURANCE 1/20/2015 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: Marianne Uban Hylant Group fAC"r10.Exu:317 817 5136 (A/C ,N • 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDRESS:marianne,uban @hyjnt.com INSURER(S)AFFORDING COVERAGE NAIC# • INSURER A:CJfter Oak Fire InsuranQ.e Co 25615 INSURED CARME80 INSURER B: City of Carmel INSURER C: Migrated Location INSURER D: INSURER E: INSURER F: COVERAGES . CERTIFICATE J43 VIBER: 959680 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) LIMITS A GENERAL LIABILITY ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $0 PERSONAL&ADV INJURY $2,000,000 • GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY TNT LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF15 1/1/2015 1/1/2016 COMBINED`SINGLE LIMI r 000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE Per accidert) X Comp X Coll Comp/Coll Ded $2,500 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ • EXCESS LIAB —1 CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE l NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 named as Loss Payee Re:2015 Ford F250#40970 and 2015 Ford F250#40967(City of Carmel Street Dept.) Re:2015 Subaru Forester#4258, 2015 Subaru Forester#6408,2015 Subaru Forester#6484, 2015 Subaru Forester#7856 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(CNO1) • Cincinnati OH 45202 • AUTHORIZED REPRESENTATIVE tAY2 4 y I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD