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HomeMy WebLinkAbout2014 Street Dept Schedule 22 pay request 2 020915 Lease 2014 -- Sch # 22 (Street Dept._) Payment Request # ,ice EXHIBIT A PAYMENT REQUEST FORM I 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 aIlJof 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- Pe&rSOYI- q)-(-0/ Amount: . ( qTO s,;) ` on Description of Equipment item Cost: j1 1.ky, t1I 02_, 7l Dated: i ; -.) t 1` LESSEE; City of Carmel One Civic S uare Carmel. C 603-2 i. . . . Name: Diana Cordriy Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE PAY VIA WIRE TRANSFER: • r_,,.tom '' --\ E�l.k,.a 1-,(�\ PAGE I 1 Dave, Below is our wiring information. I 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 Barkdull Pearson Ford Commercial Account Manager 10650 North Michigan Road Zionsville, Indiana 46077 PH: 317.873.3333 FAX: 317,873.3152 cbarkdulI( mvindyford.com www.myindyford.com ACOR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIVYYY) 1/2'2/2015 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(los)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 NAME,ACT ,.,,_Maranne I_ipan ylant Group INC.No.Emr,317_-617-5138 I FAX Ns}:311.$17 515L.,.r............. 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 _Ap,o.e.g.ss..rnarianne.uban@hylant.com • INSURERISI AFFORDING COVERAGE .__ NAID a ._._—__ _...._..._. ._..._. ..._.._ INSURER Charter Oak.Fire Insurance.Co ... .. _ 5615_.._...___ ER B INSURED CARMESO I _.NSUR _.-.. ____... 1 City of Carmel INSURER C: i One Civic Square — Carmel, IN 46032 INSURER D: INSURER E: __...._................_.._ �.._.._..._....� INSURER F: COVERAGES CERTIFICATE NUMBER:1313742207 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 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 ....P Ata0L SIJBR ..'....'.-.._. POIJCY EFF r..POLICY E%P LTR i TYPE Of INSURANCE 1N6R 4VVp POLICY NUMBER (MWDDIY YY)=IMMIDDfrrYY) LIMITS A I GENERAL LIABILITY ZLP14T62033 /1/2015 1/1/2016 EACH OCCURRENCE S2000.coo €._._._ DAMAGE Ta"FFERTE6 _ _....._...._..... IX COMMERCIAL GENERAL LIABILITY I PREMISES iAR,a Occurrence) 1$50,000 1 I CLA''MS-MAD£. I X j OCCUR - MED EXP(Any one person) I$O I PERSONAL&ADV INJURY T$2,000.,000 GENERAL AGGREGATE J S2,000,000 GENL AGGREGATE LIMIT APPLIES FOR i PRODUCTS-COMP/OP AGO =S2 000,000 POLICY I }JECT LCD A AUTOMOBILE LUiBELITY 1 1/1/2013 /1/2016 COMBINED SINGLE LIMIT Ha103036P64ACOF15 (Ea acGaen , 02.000,000_,_ �h ,ANY AUTO [BODILY INJURY Tor person} $ 1 ALL GL',MED i"SCHEDULED I 1 ..... AUTOS .�,]AUTOS I ' BODILY INJURY[POT BCGdonl} 0 F-1 11 i i NON•OWNED ......._DAMAGE_ .. S --,....,.... I HIRED AUTOS I 1 AUTOS I I Peer aaa e t) :X 1Corno IX 1Coil Comp/Call Ded $2,500 I UMBRELLA LIAR I OCCUR [EACH OCCURRENCE $__._.._.........................._....._._...... EXCESS LEAK I CL CLAIMS-MADE AGGREGATE 0 WORKERS COMPENSATIONN$ I $ I �._.__.__.__.... AC STATU- CTH- 'TORY LIMITS ER_..,,._,,...,,.._._.._...._. I AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER,EXEC.UTIVE ':. E.L.EACH ACCIDENT $ OFFCER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II fyAt.describe uAABr _._._....._..._.__ _..._ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S / DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Rorrarka Schedulo,II moro apace la roquirod) 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#40967.2015 Ford F250#0969, 2015 Ford • F250#0968 (City of Carmel Street Dept) See Attached... 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 yy / L q- 'l+ I �� ©1988-2010 ACORD CORPORATION. All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • '1 r t ll E ikOrl A 0.01* t ' —� • ' # �' Date: /21/2015 Pearson Ford,inc. Name: City of Carmel Stree Department Attention: 10650:North Michigan Road Address: 3400 W. 131st St Zionsville,Indiana 46077 INVOICE City: Carmel, IN 46074 317.873.3333 . www.pearsonford.net Phone: - Fax: - ' _ V C/ ..,6 1,1. G��.i.,�,,A. �! "A . � �� ' ` � K MSRP/Selling Price $ $37,530.00 ® New Used ❑Demo Optional Accessories: Year: 2015 Make: Ford 1. 8' Boss ST Blade $ 4,850.00 Model: F-250 Reg Cab PU Color: Red 2. 4 Corner Strobes $ 530.00 Stock#: 23695 .Salesperson: B. Sawyers 3. 0 $ 0.00 V1N#: 1 FTBF2B67FEC40969 4 0 $ 0.00 MILEAGE: 35 Actual/Not Actual 1 5 0 $ 0.00 *NOTES: 6 $ 0,00 Sub-total $ 42,910.00 TRADE ALLOWANCE: () $ 0.00 s may+ v ro se.x f`1'a t.pi q. Fes' VA S •"'`,Fleet Discount isoR or � u� ,E.,;ao •Hht� , ;O.a� 0 {) $ 10,869.00 ' fis , A0 N►1Oai�i'r,rr*` i 40.1,tr` it. Fleet Incentive: (•) $ 0.00 {0”1,1il #�nevisria �AiI''hiENEHI tl P %AaligE G iii} ::-a i „of .", : Z . **0•,,, .,4Y_ :,1e,, �� 1,x &4 Oth er (-) $ 0.00 TRADE-IN VEHICLE INFORMATION TOTAL SELLING PRICE $ 32,041.00 1)Year: Make: 7% Sales Tax: (Y) $ 0.00 Model: Color: TRADE PAYOFF (+) $ VIN#: Service Contract (+) $ W Mileage: Tire Tax (+) $ Amount of Lien: Luxury Tax (+) $ Lienholder: Capped Acq Fee: (-) $ 0.00 Address: Other Amounts Owed (4) $ Total amount due (_) $ 32,041.00 Phone: Down payment/Deposit (-) $ 0.00 Stock#: Rebate (-) $ 0.00, (2)Year: Make: $ Model: Color: AMOUNT DUE AT DELIVERY $ 32,041.00_ VIN#: MILEAGE: Actual/Not Actual Amount of Lien: By signing this "Vehicle Order Agreement" I/We Lienholder: agree to the terms and conditions herein: Address: Company Name: Phone a r d V `„,�1 r . 4 � �� r ,,f g. - �i Authorized Signature: Y.3�`” °� +. ry "' r�� a ���rg� 6 �a s�, . � haw u", $� k« r��yy jy 4� ,t'!.�}y�y�'i4.�'+.#g.m�'°,,y0./i.i� f07- " Y� 1 . ' A"'a'' TnADE�N o64 l CAl?1�.7N - le`digs it a feaaliG$d err e iJ � 1E?c d lark r' .t ( vehlcie(s) ae'i'arrt oaf the ns' t;i6e#i1teiveairO artaered at the mo of`deihtery, `t istoto Ottr ' ftkl e s)"Vlnre Wgedj:nl caetoma andAAite¢free and,, clear tfatt italKitti >ehouPnrbn e . t1a,, thenwse staled i fOrifin "ha1'eh5 Custom er edifies that hit aitbagsrsa tend e" issions egui imerd ri tRs'triaii "ti vehleetsi`gaalhave_ novae eai 'fs,'ra-notrequired 10,4'tltted in'ea t IRorf f va r ld gealva9a,fticd: temnn or"l bade vehfede, h iVe�`er be .4`t? 4 1 ; s itt `v. . y X,-,�,s1" `g° q tr. .7;.,.tie ,,,,4%.,#,;•,„::4,: n5.0 t t *A T E ', z . as''� f �. . Date. 1/21/2015 Pearson Ford,Inc. Name: City of Carmel Stree Department Attention: 10650 North Michigan Road Address: 3400 W. 131st St INVOICE Zionsville,Indiana 46077 City: Carmel, IN 46074 317.873.3333 www.pearsonford.net Phone: - Fax: VEHC IE 3Ft$ NFIW' I ' 6ION—If-W..4. ` .' 1 r, MSRP/Seiii Price $ $37,530.00. ® New Used EDemo Optional Accessories: Year: 2015 Make: Ford 1. 8'Boss ST Blade $ 4,850.00 Model: F-250 Reg Cab PU Color: Red 2. 4 Corner Strobes $ 530.00 Stock#: Salesperson: B. Sawyers 3. 0 $ 0.00 VIN#: 1 FTBF2B67FEC40968 4 0 $ 0.00 MILEAGE:35 Actual/Not Actual 1 5 0 $ 0.00 *NOTES: 6 $ 0.00 Sub-total $ 42,910.00 TRADE ALLOWANCE: (•) $ 0.00 "J iv ,a.4 'e- xa MTV ,i � ' � a < i.<o' l Fleet Discount (-) $ 10,869.00 TNEINFOrMAT10NV,3USF.„sLOWTVI NDdINFQ 1 FOl�C , I J5,IWT0 ' Fleet Incentive: O $ O.flO ;mts cofitat*ACr ,1�NwPa�Ji�1'`O lL `+i orli4Ef"i aII``i Fi1lb,49-4 i ol^8'kJy1'' _� 0 0 "TRADE-IN VEHICLE INFORMATION TOTAL SELLING PRICE $ 32,041.00 (1)Year: Make: 7%Sales Tax: (+) $ 0.00 Model: Color: TRADE PAYOFF (+) $ VIN#: Service Contract (4-) $ Mileage: Tire Tax (.) $ Amount of Lien: Luxury Tax (.+) $ Lienholder: Capped Acq Fee: (+) $ 0.00 Address: Other Amounts Owed (+) $ Total amount due (=) $ 32,041.00 Phone: Down payment/Deposit (-) $ 0.00 Stock#: Rebate (-) $ 0.00 (2)Year: Make: $ Model: ,Color: AMOUNT DUE AT DELIVERY $ 32,041.00 VIN#: MILEAGE: Actual/Not Actual Amount of Lien: By signing this "Vehicle Order Agreement" I/We Lienholder: agree to the terms and conditions herein: Address: Company Name: Phone: f 'Ir 0 Pr 1'1r -f ',z art i ar s Authorized Signature: t it . a is fs AI`R. a s z r P 4. a r ,r, '^r i;..'kii irifai i 'rFc 0,, 1. re: A; ,, Nx T ADE IN`CE TIFICA`tCN‘i ��"-, ' r ,- Customer agrees to'detivver io:re"aler goods clear and morttatabie`tlre(`s: the,tradein' ,vehIde(s);ae part nt:ttre cot sidoratior, b the,v`ehk to �qg tergd;,,a 0'¢time of delivery.= 'Customer warrants that the ode-in tFehk3e(s are o o°biy byy,cu ornet and are free•end clear of all ite a ands outhbtcmcee excopt e o e'RG 'elated0 u fIkAilrein,Customer certittea that tha`alr3 s raifay and emissiotts equtpmen to th tr eOti v ictais) ash+ava never bean and talare rt ecjulred'to be titled in airy°state as d ectiv rebind ld aloe t'ood,' lemon ar buy b cie t o nvi'arb,err rdyaymn i . ! � ;� 'ti • ,gfMj'h?1(4: g �f SF�4 �,�+j��+� Pik" �` � �. s � x � # *PM I ` G'i �r art /.'-,' ,7. 1r.4 a<` .2r i�1. V-9: t i v '* *v•' - : °� ``tip ,x i ».. 4, .'1.19 : Icni's t� � � 6 l" `4�''*,tar�� .';',.,'''-94Ptli..?ii,H' 4.a"-Pf44'.. VI,., "l'A,..„.,..„.--,''.1„.go'' ..-".:'-,',:---'. -... 'L. ... . -.,,.: ' '.,..-:. .., . ,...‘:..- u. k$ r 541 d N{? ''' ' ravel= 68 . t EC40968 0 `A r 't - DECEMBER 05:,201 s1�; 'dLHi;LE I'7EPJT7-Ir ATiON�NC .YEAtt .M1AK£ ''r' 1FTBF2B67FEC4096$ 2015 FORD :`. , 4P it.G�.�E13h17 k• 4 3�1DY l Yt i; , 6 .36 LBS. 137 k 250 4X4 REG CAB SS SRirl p:iti a r,, r•'�'-'" hG:GY1,b SE' F B t� -- 51 60 10000 LBS B F2B�i ij NOMINAL 'TONNAGE 314 f. - tic fie+ '"' iifththat the$rie ehuche d`edr bt d aboveti s Eh�`tP opertyo4 t rerraidreomp y fo m or corborat n arndt cer- pp � w r 1,t e crrt^d on the above date and under th% Invoice Number indicated-to the'f Lowing di trabutor or dealer, , t AhAE OF 1"3 ST;ti JTt"R€7AtER E-'rC, 'a, ° Pearson Ford,, -Inca( 10650 North Michigan Road; z' 6nsville'. TAI h 4 60 7 7 3,§ 17 1 9E',"' y t�q 1r is fui3her certified that this was the fir t transfer of such new mater vehicle in ordinary trade and commerce. 7 7 ,m,<r < . FO J"MOTOR"COMPANY "{�tt; � FINANCE SOURCE 000001 ;4 ° Ford Rotor Credit Co'' �r�n,�r.F IA cA,..3. ��r AV2I ,,.; P•0• Box 1732,'.‘"...R oom .. ;��q,A`, MI DEARBORN, MICHIGAN £' "a .L. Dearxiorn � ': 48121 OIY ST4rE ICY .. � �r r � (1111 V UhillUflil liii 11111 till LIII V till 1111111111111111 11111 LIII 11111 11111 11111 11111 1111 III! 1 .., 6.�;,,.....„,, ,,,....itl.....04 .„.„,,,,F,...f., ,,.,_...,...„9,....,.. . „. .. --,......-... .,- ,trepw.,,oarfaadde-,,, ._ 4,„...,-- -. ,.- ,„:„...,,...„ .',A.4 ^,,,°; '-it'll ' - -` ` ��t�i. C R71F[ ,7�t3 CJ!RE N F i 1fEH1 A. �$4M � M ri',/,...,41,z.;,„:4:4 1,a its -om - Et a'- a � � ,,d F qt, t, �i 3'� f £ d e..\ 4 � a{e£Y3�3 v �, F S DhsC ' DECEMBER 05,2014 EC90969 0 g '- .3..,F,.,- r[ICLE tC3r3JT9FI ATKSN NO YHf7 NAKC tt; 1FT`BEF2.B65FEC909.G9 2015 "ORD DS TYPE 66 L$5. 137 F250 AX4 REL., CAB. SS SRW. ' , Nr 11. SERIC OF tdbJE L u Y l� ; 5 . . 60 10000 LBS S . F2BH t$* 1 r NOMINAL TONNAGE 3/4 4 g£K r f , the undersigned soft nriied re}sresentotw of the company fii m or corporntron named below,hereby cee .h,, tify that the new vehicle described aboae fs the property of tie sold company flrm.or carppardtion and is , ` t tronsfarred:on the above dote and tinder the invoice Number indicated to the following distributor or dealer. K4 "r I AME 01,Ot,STZ16U rOR,CCALER ETC,. Pears,oin Form, Inc 10650 =North` M .chigan 'ROad,.: x� . ,It:., iosvi la IN= 4607=7 7 � 47F033 ' It is1'further;c®rtified that thr ?was the first"transfer of suc}r new motor vehtcl'e m,cirdinory°trod antl'commerce. ' �_ 4 3 6 1 3 9 1 . ,,,,,,,p `` MEMO .DATA . FORD MOTOR, COMPANY`• FINANCE SOURCE 000001 j' Ib Ford Motor Credit Co t3E4OL 6,n SN t2 rpkr (AC£Nii t� • Box 1732, Room ' `i• '-47::)1¢ Dearbarn. MI DEAF$0RN MICHIGAN ,n ,r°. ,_: 7 , �;� + . 4 8121 � arty-Fir ATE �.�� -f 1111111111111 111111 hUhIII!1111 I l 11 I 11(1111111111111 Rut III 111111111111111111111111 : ' (.� �s t .4` 'yr a .n yr :ei, _�" a�..�-.J.�.,_....W... •