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HomeMy WebLinkAbout2015 Police schedule 24 pay request 24 102715 Lease 2015 — Sch # 24 (Police Dept.) Payment Request # 24 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: Hewlett-Packard Company Amount: $2,691.00 Description of Equipment Item Cost: Zero Client Ethernet Dated: 10/26/15 LESSEE: City of Carmel One Civic Sq re Carmel,IN. x132- /t, I By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) Make check payable to: Hewlett-Packard Company 13207 Collections Center Drive Chicago,IL 60693 Invoice# Invoice Reference Invoice Date Remit Payment to: HEWLETT-PACKARD COMPANY 56494169 37459849 -001 10/14/15 13207 Collections Center Drive Chicago, IL 60693 Ship Date Due Date Total Amount(USD) D-U-N-S: 00-912-2532 10/14/15 11/13/15 2691.00 FED ID#: 94-1081436 / Purchase Order# Customer Number Contract Name Contract Number 33190 G20317 IN-STATE OF INDIANA 13079 CR/DR Authorization# Payment Terms Sales Order# Order Date Carrier Freight Terms Page NET 30 DAYS GOV 37459849 10/13/15 EAGLEAIR FOB Destination 1 of 1 Bill to: 1k4ttg 4.1.273 1 MB 0.436 95746S11.ps 1 of 1 G HIV i..IIII1IIII111111IIIII1II1"i111II1II' 11111l'IIIIIIIIII111111' Ship to: CITY OF CARMEL CARMEL POLICE DEPTARMENT PAT YOUNG CARMEL POLICE DPMT 33190 3 CIVIC SQUARE 3 CIVIC SQUARE CARMEL IN 46032-2584 CARMEL IN 46032 317 571 2559 Line Order Backorder Shipped Product# Product Description Unit Extended Number Quantity Quantity Quantity Price(USD) Price(USD) 001 9 9 C3G80AA#ABA t310,Tera2/Ethernet/ZC US 299.00 2691.00 SER#:2TG5320079 2TG5320317 SER#:2TG5291513 2TG5320316 SER#:2TG5320069 2TG5292648 SER#:2TG5292386 2TG5292381 SER#:2TG5290900 Track#:-CEVA AIR 1 DAY -CEVA AIR 1 DAY Track#:-CEVA AIR 1 DAY -CEVA AIR 1 DAY Track#:-CEVA AIR 1 DAY -CEVA AIR 1 DAY Track#:-CEVA AIR 1 DAY -CEVA AIR 1 DAY Track#:-CEVA AIR 1 DAY INQUIRIES TO: CT YOUR CUSTOME TOTAL USD 2691.00 \ J TERMS: Payment terms are NET 30. The sale and delivery of the product and/or service listed on this invoice are subject to Hewlett-Packard Company's standard sales terms and conditions in effect at the time the product or service is ordered. Any variance from those terms and conditions will be effective only if agreed to in writing by Hewlett-Packard prior to the time the product or service is ordered. PRICES: All orders will be billed at prices in effect at the time of the shipment. RETURNS& Exchange or returns must be requested within 30 days of receipt of your shipment. All returns require prior approval and a return authorization number(RMA) REFUNDS authorized returns or returns REFUNDS without a RMA number may be refused. Opened software and any purchases subject to abuse are not eligible for return. Freight charges are non-refundable. After receipt and inspection of returned merchandise,credit will be issued. CLAIMS: Claims for shortages,damages and invoice discrepancies must be made within 30 days of receipt. In case of shipping damage,please keep all packaging materials and damaged merchandise in the original outside shipping carton.We will file a claim with the carrier and replace the item at no cost to you. For any question please reach out to your customer care representative. HIVGinv HP encourages customers to recycle used electronic hardware,HP original print cartridges,and rechargeable batteries. For more information about recycling programs,go to www.hp.corn/recycle. DATE A CERTIFICATE OF LIABILITY INSURANCE 1/13/2015(MMIDD/YYYY) 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 O (AIC.No.Exu:317-817-5136 /c,No):317 817 5151 301 Pennsylvania Parkway,#201 Indianapolis IN 46280 E-MAILISS:marianne.uban h lant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARM E80 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) 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(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 7 POLICY PRO- 7 LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF15 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 LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N 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/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 r � �, IDS-�t. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD