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HomeMy WebLinkAbout2015 Police Schedule 24 pay request 4 042915 Lease 2015 — Sch # 24 (Police Dept.) Payment Request # 4 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: Express Graphics Amount: $390.00 Description of Equipment Item Cost: Vehicle lettering Dated: 04/24/2015 LESSEE: City of Carmel One Civic Square Carmel, IN 4 032 . F Y• Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Express Graphics 620 S Range Line Rd. Suite D Carmel, IN 46032 PAGE 1 Invoice PeiExpress Graphics Invoice: 88834 620 S. Range Line Rd. Suite D Carmel, IN 46032 ph.: (317) 580-9500 PO#: 32808 fax:. (317) 580-9550 email: Service @ExpressGraphicsUSA.com Description: 2015 Electra Glide Harley Graphics - Produced & Installed Customer: Johnathon Foster ph: (317) 571-2570 x Office Carmel Police Dept. fax: 571-2512 Sales Person: Vanessa Suiter email: jafoster @carmel.in.gov Product Font Qty Sides Height Width Unit Cost Item Total 1 Vehicle Lettering same as#85794 2 1 0 0 $195.00 $390.00 Color: 2mil Lt Navy/Silver Met/Shields Description: (2) 2014 Harley Davidson Electra Glides to be Lettered on Both Sides, Rear and Front+ Windshield with Highest Grade 3M Exterior Graphics + Full Color Digital Shields with UV Overlaminate. Price includes cost to personalize each bike with front fender"Officer Name'" graphics, per usual. Text: <Electra Glide Harley art> - same as 2014 design Names= C. Amos & S. Spillman (Both Titles = Officer) 1.A Installation 1 1 0 0 $0.00 $0.00 Color: Description: Installation of Graphics at Police Station Sallyport. Cost included in above. Text: Other Payments: Ordered: 3/24/2015 1:03:36PM Form of Payment / Amount / Initials PickedUp: 4/14/2015 4:35:15PM Printed: 4114/2015 4:35:25PM Notes: Status: Picked-Up Install Week of 3-30-15-Coordinate with John Foster Line Item Total: $390.00 Tax Exempt Amt: $390.00 Subtotal: $390.00 Taxes: $0.00 Total: $390.00 Total Payments: $0.00 Balance Due: $390.00 ATTN: Pat Young All Payments are due at our offices within 30 days of Carmel Police Dept. order completion or additional interest of 1.5%per 3 CIVIC SQUARE month will be assessed. CARMEL, IN 46032 ReceivedlAccepted By: l A World of Possibilities! A ® CERTIFICATE OF LIABILITY INSURANCE DtYYYY) 1/13/2015 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). PRODUCER CONTACT NAME: Marianne Uban Hylant Group (A I°PHONE FAX irvc,No317-817-5151 301 Pennsylvania Parkway,#201 -MIndianapolis IN 46280 pRess:marianne.uban h lant.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 D: 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 TYPE OF INSURANCE AODL SUBR POLICY EFF POLICY EXP LTR INSR WVD I POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $0 PERSONAL&ADV INJURY $2,000,000 I GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG_ $2,000,000 —1 POLICY PRO- JECT A AUTOMOBILE LIABILITY H8103036P64ACOF15 //112015 1/1/2016 COMBINE=D SINGLE LIMIT 000,000 (Ea accident) $2, X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) X Comp X Coll Comp/Co€I Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WRYT TU- I TH AND EMPLOYERS'LIABILITY Y I N ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 Equipment/Vehicles 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 itia1��,�,� ©1988-2010 ACORD CORPORATION. All rights reserved. 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