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HomeMy WebLinkAbout2015 Police Schedule 24 pay request 10 060115 Lease 2015 — Sch # 24 (Police Dept.) Payment Request # 10 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: The Waymire Group Amount: $34,411.09 Description of Equipment Item Cost: New vehicle equipment Dated: 05/28/15 LESSEE: City of Carmel One Civic Square Carmel, IN 41032 a By Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) Wire transfer information included on separate sheet. PAGE I Young, Patricia A Subject: FW: Waymire's Wire Account From: Trudi Lux imailto:trudilux22(1gmail.com] Sent: Wednesday, May 20, 2015 4:08 PM To: Young, Patricia A Subject: Waymire's Wire Account Fifth Third Bank 251 N. Illinois St. Indianapolis, IN 46204 Please wire funds to account #7650034494 ABA #042000314 Thank you! Trudi Lux Controller THE WAYMIRE GROUP trudilux22 @gmail.com (317)634-4824 X 221 fax(317) 634-4833 1 • WAYMIRE A. P .S . , INC . 4e! d/b/a THE WAYMIRE GROUP 820 Chadwick Street, Indianapolis, IN 46225 TEL: (317) 634-4824 FAX: (317) 634-4833 Warehouse Tel : (317) 631-7551 / Fax: (317) 631-7552 BUSINESS HOURS : 8 : 00-5 : 00 MON-FRI CLOSED SAT/SUN ACCOUNT # CPD50 INVOICE # 302550 DATE • 05/04/15 PO # : 32807 Stk/Rei# : PURCHASED BY: SHIPPED/DELIVERED TO: CARMEL POLICE DEPT CARMEL CITY GARAGE 3 CIVIC SQUARE 3400 W 131st ST CARMEL, IN. 46032 CARMEL, IN. 46074 317 571-2546 317 571-2546 USE OF PROVIDED EQUIPMENT IN ANY VEHICLE IS THE DRIVER' S RESPONSIBILITY! DESCRIPTION: NORTH WEDNESDAY ATTN: JASON OGLE VEHICLE : YEAR : 2015 WC CAPACITY: WDH CAPACITY: SLS PER: FLTMKMF Tag # : MAKE : FORD GTW: N/A GTW: N/A MECH. . : MODEL: INTERCEPTOR UTIL . TW : N/A TW : N/A WRNTY # : QTY PART # ITEM DESCRIPTION MFG SRP COST EA PARTS LABOR TOTAL 4 SILSS103 1421782202 15-TAHOE 1570 . 00 769 . 75 3079 . 00 3079 . 00 1 SILSS105 1424353978 13-1NT UTIL 1570 . 00 769 . 75 769 . 75 769 . 75 8 CNSM-RBK1 CN SIGMSTR MNT 11"EXPL 30 . 00 16 . 95 135 . 60 135 . 60 6 SSP2000 SMART SIREN PLATINUM 1250 . 00 637 . 00 3822 . 00 ! 3822 . 00 18 CVS1400INU T, 14 "CONSOLE INT UTILT 288 . 75 187 . 69 3378 . 42 3378 .42 18 CARM103 FOLDING ARM REST 103 . 95 67 . 57 1216 . 26 1216 . 26 18 CCUP2IA15 5 . 5"DL CUP 15DEG ANGLE 44 . 10 28 . 67 516 . 06 516 . 06 18 EB4OSSP1P* EQUIP BRKT (1 PC) 0 . 00 ---- 0 . 00 18 FP-25* 2 . 5"FILL PLATE 0 . 00 - -- - 0 . 00 18 FP-2* 2 "FILL PLATE 0 . 00 -- -- 0 . 00 5 P1OUINT13A 13"SUV PROCEL 1/2PART 2258 . 00 1490 . 00 7450 . 00 7450 . 00 5 P1OUINT13A 13"`SUV PROCEL 1/2PART 2258 . 00 1490 . 00 7450 . 00 7450 . 00 3 P1OUINT13A 13"SUV PROCEL 1/2PART 2258 . 00 1490 . 00 4470 . 00 ' 4470 . 00 1 NOTE W/ POLYCARB WINDOW BARS 0 . 00 - - - - 0 . 00 4 G6300S VERTIL MNT GUNRACK (1) 361 . 00 238 . 50 954 . 00 954 , 00 4 B4705UNT13 UTILITY BARRIER WIRE 443 . 00 292 . 50 1170 . 00 1170 . 00 1 NOTE CARM103 ARE ON BACK ORDER 0 . 00 ---- 0 . 00 Call US for QUALITY Products & Service ! Ref : W# 115078 MERCHANDISE. . . . $34411 . 09 SALES TAX $ 0 . 00 RECEIVED BY � {" S&H/COD, FTC $ 0 . 00 Amount & Method !I Payment : : . INVOICE TOTAL $34411 . 09 Invoice Total Ch,.irged TolCustomer Account AMOUNT RCVD $ 0 . 00 BALANCE DUE $34411 . 09 TERM ACCOUNTS : PLEASE PAY IN FULL WITHIN 30 DAYS OF INVOICE DATE, ' THANK YOU! Arta®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1!1312015 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 A!e°.NN.Ext1:317-817-5136 FAX B31 7-817-5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDREss:marianne.uban @hylant.com INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Charter Oak Fire Insurances Co 5615 INSURED CARM E80 INSURERS 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR I INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(My 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 PRO- JECT LOC $ A AUTOMOBILE LIABILITY 1-18103036P64ACOF15 1/1/2015 1/1/2016 COMBINED SINGLE LIMIT (Ea accident) _$2,000,000 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/Coll Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ , WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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 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. do American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 hatti, ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD