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Home My WebLink About2012 Police Pay request 2 Lease 2012 Sch #9 (Police Dept.) Payment Request 2012 -2 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 March 8, 2012 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: Laser Technology, Inc. Amount: $7,789.00 Description of Equipment Item Cost: Accident Mapping Laser and Accessories Dated: April 26, 2012 LESSEE: City of Carmel One Civic Square Carmel, IN 46032 Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Laser Technology, Inc. Key Bank P.O. Box 1068 Englewood, CO 80150-1068 PAGE 1 �1---.11 OP ID: 79 A CERTIFICATE OF LIABILITY INSURANCE DATE 04/2 04/20/1 2 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 800- 678 -0361 NAME: Marianne Uban Hylant Group Inc Indianapolis 3 17- 817 -5151 PONE 317- 817 -5 FAX 317 817 -5151 301 Pennsylvania Parkway, #201 (A No.Extl: 136 1 Ne Indianapolis, IN 46280 E -MAIL ianne.ubanh lant.com W. Michael Wells ADDRESS: m ar �:.Y PRODUCER CARME80 CUSTOMER It k#: INSURER(S) AFFORDING COVERAGE NAIC INSURED City of Carmel INSURER A: Travelers Insurance Companies Steve Engelking One Civic Square INSURER 9: Carmel, IN 46032 INSURER C: INSURER 0 INSURER E INSURER F I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 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 I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. 1 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 1 TYPE OF INSURANCE 'NCR LIAND POLICY NUMBER (MMD I/MMDDIYYYY) I LIMITS ADDL GENERAL LIABILITY EACH OCCURRENCE 5 2,000,000 A COMMERCNL GENERAL LIABILITY DAMAZ3ETCRENTED GP09315757 01/01/12 81/01/13 PREMISES (Ea ocmnence) 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) 0 C PERSONAL E. ADV INJURY 5 2,000,000 GENERAL AGGREGATE 5 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG 2,000,000 1 POLICY 1 I PR° nI LOC I AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT 2,000,000 I (Ea awdent) A 110 ANY AUTO 8103036P64A 01/01/12 01/01/13 BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON -0WNED AUTOS 5 I$ UMBRELLA LIAR OCCUR EACH OCCURRENCE 5 EXCESS LIAO CLAIMS -MADE AGGREGATE 5 DEDUCTIBLE 5 RETENTION 1 WORKERS COMPENSATION 1 VAC STATU- 10TH-I Y N AND EMPLOYERS' LIABILITY TORY LIMITS I �-ER_, ANY P ROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT I OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT I A PROPERTY i 630581M4076 01/01/12 01/01/13 SEE EEACHED DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 0 more space is required) SEE ATTACHED. CERTIFICATE HOLDER CANCELLATION HUNTI -2 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. its assignors and assignees C/O American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Amherst Rd. Ste 335 L t u4-fC> Sunderland, MA 01375 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD CARME80 PAGE 2 NOTEPAD INSURED'S NAME City of Carmel OP ID: 79 DATE 04/20/12 NAMED INSURED: CITY OF CARMEL CARMEL CLAY PARKS BUILDING CORPORATION CARMEL CLAY BOARD OF PARKS RECREATION CARMEL REDEVELOPMENT COMMISSION CARMEL REDEVELOPMENT AUTHORITY CARMEL CITY CENTER COMMUNITY DEVELOPMENT CORPORATION PROPERTY LIMITS: BLANKET BUILDING.AND BUSINESS PERSONAL PROPERTY: $360,243,099 REPLACE COST, AGREED VALUE SPECIFIC BUILDING LIMIT: $2,623,959 SPECIFIC BUSINESS PERSONAL PROPERTY LIMIT: $150,000 BLANKET BUSINESS INCOME/EXTRA EXPENSE /RENTAL VALUE: $5,000,000 ACTUAL CASH VALUE, AGREED VALUE SPECIAL CAUSE OF LOSS FORM EQUIPMENT BREAKDOWN- INCLUDED DEDUCTIBLE: $25,000 FLOOD LIMIT: $10,000,000 W /$50,000 DEDUCTIBLE EQ LIMIT: $10,000,000 W /$50,000 DEDUCTIBLE CONTRACTORS EQUIPMENT LIMIT: $2,9,47,385 W /$1,000 DEDUCTIBLE CONTRACTORS LEASED EQUIPMENT: $100,000 W /$1,000 DEDUCTIBLE MISC. SCHEDULED EQUIPMENT: $2,732,599 W /$1,000 DEDUCTIBLE EDP LIMIT: $880,591 W /$1,000 DEDUCTIBLE COI4]'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE FINE ARTS: $1,759,975 W /$1,000 DEDUCTIBLE NOTEPAD: HOLDER CODE HUNTI -2 CARME80 PAGES INSURED'S NAME City of Carmel OP ID: 79 DATE 04/20/12 The Huntington National Bank and its Assignors and Assignees, ATIMA are named as Lenders Loss Payee Re: Various Police EquipmentNehicles LI /ERs Laser Technology, Inc. Page Number TECI- MOLOGY INVOICE Date 4/26/2012 ORIGINAL Customer 78529 7070 S. TUCSON WAY CENTENNIAL, COLORADO 80112 Brn /Plt 10 TEL. (303) 649 -1000 FAX: (303) 649 -9710 Related P.O. Order Nbr 67717 TD Sold To: CARMEL POLICE DEPARTMENT Ship To: CARMEL POLICE DEPARTMENT Invoice 125419 RI 3 Civic Square 3 Civic Square ATTN: TERESA ANDERSON CARMEL IN 46032 CARMEL IN 46032 Attention: Attention: Description Certificate Request Date Customer P.O. F.O.B. Delivery Instructions UPS GROUND 5/9/2012 26141 FOB ORIGIN LT AMY STEIN 317.571.2500 Ln/Rq Dt Description Item Number UM Ship /Back/Cancel Price Extended Price Tax Any questions pertaining to this order? Please call 303.649.1000 x157 1.000 RECON 400X,W /0 BLUETOOTH 3255018 EA S 1 999.00 999.00 Y 2.000 ASSY,YOKE MOUNT,RIGHT,IMPULSE 7024835 EA S 1 57.00 57.00 Y 3.000 Cradle Assy,Recon 3504643 EA 5 1 89.00 89.00 Y 4.000 Plumb Bob,l2oz (340 grams) 3004667 EA S 1 15.00 15.00 Y 5.000 Bag,Tripod /Prism Sherpa,QMII 3123473 EA S 1 89.00 89.00 Y 6.000 Pole Bracket Assembly,AE 3504631 EA 5 1 79.00 79.00 Y 7.000 Tripod,Instrument,Aluminum,BLK 3504630 EA S 1 184.00 184:00' Y 8.000 Tribrach,Black 3003255 EA S 1 199.00 199.00 Y 9.000 OUICKMAP 3D V5.0 SOFTWARE PKG 7035066 EA S 1 495.00 495.00 Y 10.000 Fixed Tribach Adapter 3004670 EA 5 1 47.00 47.00 Y 11.000 KIT,TRUANGLE 7006000 EA 5 1 995.00 995.00 Y 11.010 ASSY,FINAL,TRUANGLE(LCAE) 7024832 EA S 1 .00 Y TA000223 11.020 BOX W /FOAM, TRUANGLE 3124673 EA 5 1 .00 Y 11.030 Warranty Information 0144699 EA 5 1 .00 Y 11.040 CABLE,INTERFACE,4704,RT,221N 4824163 EA S 1 .00 Y 11.050 Assy Cable,36 ",Turck to DB9, 7053038 EA 5 1 .00 Y 11.060 Non -Stock 0144848 EA 5 .00 Y 11.070 CD,MANUAL,TRUANGLE,W /PAPER SLV 0144849 EA S 1 .00 Y 11.080 ASSY,SIDEBRACKET,SHORT,LCAE 7024833 EA S 2 .00 Y 12.000 Impulse LR 200 7003383 EA S 1 2,795.00 2,795.00 Y I14503 13.000 TRAINING 3014653 EA S 1 1,200.00 1,200.00 Y 14.000 POWERBOOT, AA, MODULE 3255004 EA S 1 100.00 100.00 Y 15.000 Assy Cable,36'Turck to DB9,Rmt 7054223 EA S 1 101.00 101.00 Y REMIT TO: FOR PAYMENTS MADE BY WIRE TRANSFER REMIT TO: LASER TECHNOLOGY, INC. DOMESTIC WIRE TRANSFERS OR EFT'S: INTERNATIONAL WIRE TRANSFERS OR EFT'S: KEY BANK LASER TECHNOLOGY, INC. LASER TECHNOLOGY, INC. P.O. BOX 1068 ACCT 769681004370 ACCT 769681004370 ENGLEWOOD, CO 80150 -1068 ABA 307070267 KEY BANK, N.A. KEYBANK SWIFT CODE: KEYBUS33 LACER Laser Technology, Inc. Page Number 2 TECHf1OLOGY INVOICE Date 4/26/2012 ORIGINAL Customer 78529 7070 S. TUCSON WAY CENTENNIAL, COLORADO 80112 Brn /PII 10 TEL. (303) 649 -1000 FAX: (303) 649 -9710 Related P.O. Order Nbr 67717 TD Sold To: CARMEL POLICE DEPARTMENT Ship To: CARMEL POLICE DEPARTMENT Invoice 125419 RI 3 Civic Square 3 Civic Square ATTN: TERESA ANDERSON CARMEL IN 46032 CARMEL IN 46032 Attention: Attention: Description Certificate Request Date Customer P.O. F.O.B. Delivery Instructions UPS GROUND 5/9/2012 26141 FOB ORIGIN LT AMY STEIN 317.5711500 Lr'Rq Dt Description Item Number UM Ship /Back/Cancel Price Extended Price Tax 16.000 Case,Angle Encoder /Impulse 3124649 EA S 1 289.00 289.00 Y 17.000 Freight F EA S 1 56.00 56.00 N Sales Tax Total Order Net Due Date 5/26/2012 Tax Rate 0 7,789.00 Terms NET 30 (Override) REMIT TO: FOR PAYMENTS MADE BY WIRE TRANSFER REMIT TO: LASER TECHNOLOGY, INC. DOMESTIC WIRE TRANSFERS OR EFT'S: INTERNATIONAL WIRE TRANSFERS OR EFT'S: KEY BANK LASER TECHNOLOGY, INC. LASER TECHNOLOGY, INC. P.O. BOX 1068 ACCT 769681004370 ACCT 769681004370 ENGLEWOOD, CO 80150 -1068 ABA 307070267 KEY BANK, N.A. KEYBANK SWIFT CODE: KEYBUS33