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HomeMy WebLinkAbout2015 Police schedule 24 pay request 1 040815 Lease 2015 — Sch # 24 (Police 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 February 5, 2015 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: Ray Allen Manufacturing Amount: $1,959.98 Description of Equipment Item Cost: K9 Deployment&Heat Alert W/Pager Dated: 04/03/2015 LESSEE: City of Carmel One Civic Square Carmel,IN 46032 By: 41:4_if ., d, .e or. , Name( Tana Cor'7ray Title: Clerk Treasurer le (Attached duplicate original of Payee's statement) PLEASE PAY VIA WIRE TRANSFER: PAGE 1 k, RAY ALLEN MANUFACTURING, LLC Invoice F0. ''',,;,-=� '�., 975 FORD STREET Invoice#: 315394 4. ; COLORADO SPRINGS, CO 80915 l'v (800) 444-0404 Fax: (719) 380-9730 Date: 3/17/2015 :ot ecom @rayallen.com www.rayallen.com B 1 la L.,,TO.^ +> . . ,x"'� =�,��:.,�� ��"~ f,:; r � .�= .sue. ::S H l P �T O, CARMEL POLICE DEPARTMENT CITY OF CARMEL GARAGE ATTN: TERESA ANDERSON 3400 W 131ST STREET 3 CIVIC SQUARE CARMEL, IN 46074 CARMEL, IN 46032 Purchase Order#: 32803 EMAILED JASON Credit Terms NET RECEIPT Qty. Ite NQ __ . D e._k.e r�Ii t;_ ari T.- ` "• -,. --- - '-----Unit-Price------------ ;:--Ext rated 2 F3 K9 DEPLOYMENT& HEAT ALERT W/PAGER $930.99 $1,861.98 I SC SHIPPING CHARGES $98.00 $98.00 I Subtotal: $1,959.98 Discount Date: 3/20/2015 USA Tax: $0.00 IN State Tax: $0.00 Discount Amount: $0.00 CARMEL City Tax: $0.00 Account No: 1N2559 County Tax: $0.00 Other Tax: $0.00 Page: 1 www.rayallen.com TOTAL DUE: $1,959.98 ACCORD CERTIFICATE OF LIABILITY INSURANCE 111DATE 3(2015Onrrr) , ® 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). PRODUCER CONTACT NAME: Marianne Uban Hylant Group INC.No.ExtI:317-817-5136 FAX NeI:317 817 5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADORESS:marianne uban @hylant com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARME80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER O: Carmel, IN 46032 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:682333440 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMM!DD!YYYY) (MM!DD!YYYY) LIMITS A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED 850,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) CLAIMS-MADE .X OCCUR MED EXP(Any one person) $0 PERSONAL&ADVINJURY $2,000,000 - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 —1 POLICY PRO- -1 LOC A AUTOMOBILE LIABILITY H8103036P64ACOF15 1/1/2015 1/1/2016 EaaBBIdD SINGLE LIMIf 000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ 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 $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A 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 1 LOCATIONS!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 EquipmentNehicles 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&It's Assignors&Assignees ACCORDANCE WITH THE POLICY PROVISIONS. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD