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HomeMy WebLinkAbout2012 Police pay request 2012-9 Lease 2012 Sch #9 (Police Dept.) Payment Request 2012 -9 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: Dell Marketing L.P. Amount: $4,574.92 Description of Equipment Item Cost: Software Dated: May 31,2012 LESSEE: City of Carmel One Civic Square Camel, IN 460 d By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CI IECK TO: Dell Marketing L.P. c/o Dell USA L.P. P.O. Box 802816 Chicago, IL 60680 -2816 PAGE 1 ------1 OP ID: 79 A`OR°- CERTIFICATE OF LIABILITY INSURANCE OA 04 /20 /12 Y) oanonz 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 =P Marianne Uban Hylant Group Inc Indianapolis PHONE FAX 301 Pennsylvania Parkway, #201 3 17 817 -5151 (Alc No..Exq: 317- 817 -5136 (AIC Noy 317- 817 -5151 Indianapolis, IN 46280 EMAIL marianne.uban h lant.com W. Michael Wells PRODUCE: @Y PRODUCER CA RME80 CUSTOMER ID INSURER(S) AFFORDING COVERAGE 1 NAIC INSURED City of Carmel INSURER A: Travelers Insurance Companies I e/a Steve Engelking One Civic Square INSURERS: Carmel, IN 46032 INSURER C: I INSURER D INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. POLICY EXP71 I LIR R TYPE OF INSURANCE I Iwv POLICY NUMBER (MMIDDIYYYY) I(MMIDD/YYYY) I LIMITS GENERAL LIABILITY EACH OCCURRENCE 2,000,000 DAMA�ETO EMED A COMMEROS GENERAL LIABILITY GP09315757 01/01/12 01/01/13 PREMISES E OCanence) 50,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) 1 0 PERSONAL B ADV INJURY 2,000, III GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG 2,000,000 POLICY I l WI I I LOC AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT 2,000,000 A ANY AUTO 8103036P64A 01/01/12 01/01/13 (Ea actldenp BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE I HIRED AUTOS (Per aeddenp NON-OWNED AUTOS I$ I$ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE 5 DEDUCTIBLE RETENTION WORKERS COMPENSATION WCSTATU- I DTH- AND EMPLOYERS' LIABILITY Y 1 N TORY LIMITS I -ER_ ANY PROPRIETOR/PARTNER /EXECUTIVE I NIA E.L. EACH ACCIDENT 5 OFFICER /MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE EA EMPLOYEE 5 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 ATTACHED DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it 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/0 American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Amherst Rd. Ste 335 0 Sunderland, MA 01375 sC -,C�� [�cc,� -K� ©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'SNAME 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 S 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 COMM'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE .FINE ARTS: $1,759,975 W /$1,000 DEDUCTIBLE NOTEPAD: HOLDER CODE HUNTI -2 CARME80 PAGE INSUREDS 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 Equipment/Vehicles This is your INVOICE Page: 1 of 1 FID Number: 74- 2616805 Customer Number: 098598265 Invoice Number: I XFRMKIJP5 u i L Sales Rep: KRISTIN N LANCASTER Purchase Order: 26163 y�/� For Sales: (800)981 -3355 Order Number 998086081 Invoice Date: 05/17/12 Sales Fax: (800)433 -9527 Order Date: 05/16/12 Payment Teams: NET DUE 30 DAYS For Customer Service: (800)981 -3355 Due Date: 06 /16/12 For Technical Support: (800)981 -3355 83 01 0 01 01 N Shipped Via: STANDARD GROUND Dell Online: http: /wvwv.dell.corn Waybill Number: MS- VIRTUAL m SOLD TO: SHIP TO: #BWNHKPV ACCOUNTS PAYABLE m #0985 982651# IN -L CITY OF CARMEL POLICE DEP i TERESA ANDERSON 3 CIVIC SQUARE J IN -L CITY OF CARMEL POLICE DEP CARMEL, IN 46032 -2584 a ACCOUNTS PAYABLE TERESA ANDERSON 3 CIVIC SQUARE CARMEL IN 46032 PLEASE REVIEW IMPORTANT TERMS CONDITIONS ON THE REVERSE SIDE OF THIS INVOICE I Order Shipped Item Number Description Unit Unit Price Amount I 14 14 A3741936 VLA OFFICE PRO PLUS 2010 EA 326.78 4,574.92 MfgPartNum: 79P -03586 MfgName: MICROSOFT CORPORATION 1 1 A3458532 ELECTRONIC LICENSE CONFIRMATIO N elec dwnld only EA MfgPartNum:ELC MfgName: DELL SOFTWARE Ship. 8 /or Handling 0.00 FOR SHIPMENTS TO CALIFORNIA, A STATE ENVIRONMENTAL FEE OF UP TO $10 PER ITEM WI Subtotal 4,574.92 LL BE ADDED TO INVOICES FOR ALL ORDERS CONTAINING A DISPLAY GREATER THAN 4 INCH Taxable: Tax: ES. PLEASE KEEP ORIGINAL BOX FOR ALL RETURNS. COMPREHENSIVE, ONLINE CUSTOMER C ARE INFORMATION AND ASSISTANCE IS A CLICK AWAY AT W W W.DELL COM/PUBLIC -ECARE TO 0.00 0.00 ANSWER A VARIETY OF QUESTIONS REGARDING YOUR DELL ORDER. ENVIRO FEE 0.00 Invoice Total 4,574.92 DETACH AT PERE AND RETURN WITH PAYMENT Ship. 8 /or Handling 0.00 r Subtotal 4,574.92 Taxable. Tax: Invoice Number: XFRMK1JP5 0.00 0.00 Customer Name: IN -L CITY OF CARMEL POLI ENVIRO FEE 000 MAKE CHECK PAYABLE /REMIT TO: Customer Number: 098598265 Invoice Total 4,57492 Purchase Order: 26163 DELL MARKETING L.P. Order Number: 998086081 0/0 DELL USA L.P. PO BOX 802816 CHICAGO,IL 60680 2816 Balance Due 4 574.92� IIIIIrIIIIr1I111irrItil 1 IIuluuII1II1nn111111IIINI Amt. Enclosed ',TH. �rnc 000XFRMKIJP500000004574928300985982650 (Rev 10/11) Lease 2012 Sch #9 (Police Dept.) Payment Request 2012 -8 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: Waymire Amount: $10,057.60 Description of Equipment Item Cost: New Vehicle Equipment Dated: May 31, 2012 LESSEE: City of Carmel One Civic Square Carmel, IN 46032 By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Waymire A.P.S., Inc. 820 Chadwick Street Indianapolis, IN 46225 PAGE 1 --Th OP ID: 79 ADO RO CERTIFICATE OF LIABILITY INSURANCE DATE 04 /20 12 YI 04/20/12 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 couItCT Marianne Uban Hylant Group Inc Indianapolis anpNE FAx 301 Pennsylvania Parkway, #201 317817 IAfc No�Eat 317 817 5136 I (Am, Nn): 317 817 5151 Indianapolis, IN 46280 E -MAIL W. Michael Wells ADDRESS: marianne.uban@hylant.com PRODUCER CARME80 10 OUSTOMER m INSURER(S) AFFORDING COVERAGE NAIC Ii INSURED City of Carmel INSURER A Travelers Insurance Companies Steve Engelking One Civic Square INSURER B: Carmel, IN 46032 INSURER C: INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILTR TYPE OF INSURANCE I I POLICY NUMBER IMMIDDIYYVYI (MMIDDNYYY) 1 LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 2,000,000 A COMMERCIAL GENERAL LIABILITY GP09315757 01/01/12 01/01/13 DAMAGET 50,000 PREMISES occurrence) 5 CLAIMS -MADE X OCCUR MEDEXP(Any one person) 0 PERSONAL B ADV INJURY 2,000,000 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS COMP /OP AGG 2,000,000 POLICY 1 I IIFST I I LOC I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 (Ea acoden() A El 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 (Peracadent) NON-OWNED AUTOS I I UMBRELLA LIAR OCCUR I EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DEDUCTIBLE RETENTION I 1 WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS' LIABILITY ITORfIMITS 1 I YIN ER ANY OFFICER /MEMBER EXCLUDEID? EXECUTIVE N E.L. EACH ACCIDENT (Mandatory In NH) E.L. DISEASE EA EMPLOYEE It yes, escribe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT A PROPERTY '630581M4076 01/01/12 01/01/13 SEE ATTACHED DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 (Y211.42.1.-x--0..—)&41_,.__—) ,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'SNAME 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 6 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 COMM'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE FINE ARTS: $1,759,975 W /$1,000 DEDUCTIBLE NOTEPAD: HOLDER CODE HUNTI -2 CARME80 PAGE INSURED'S NAME City of Carmel OP ID: 79 DATE 04/20/1 2 The Huntington National Bank and its Assignors and Assignees, ATIMA are named as Lender's Loss Payee Re: Various Police EquipmentNehicles WAYMIRE A.P.S., INC. 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 283627 DATE 05/23/12 PO 26110 Stk /Rel PURCHASED BY: SHIPPED /DELIVERED TO: CARMEL POLICE DEPT CARMEL CITY GARAGE 3 CIVIC SQUARE 3400 W 131st ST CARMEL, IN. 46032 WESTFIELD, IN. 46074 317 733 4600 317 733 -4600 TERMS: PAYMENT DUE IN FULL WITHIN 30 DAYS 'OF INVOICE DATE,THANK YOU! DESCRIPTION: LOCAL NORTH /JASON OGLE VEHICLE: YEAR 2012 WC CAPACITY: WDH CAPACITY: SLS PER: FLTMK Tag MAKE CHEVROLET GTW: N/A GTW: N/A MECH.. MODEL: IMPALA /TAHOE /CAPR TW N/A TW N/A WRNTY JS QTY PART ITEM DESCRIPTION MFG SRP COST EA PARTS LABOR TOTAL 4 LG45Y00009 45 "LGND RB LED TD /AL R 2835.25 1000.00 4000.00 4000.00 4 330104T "SMC1 "CONTROL 253.50 85.50 342.00 342.00 2 HKBCAP11* 11" CAPRICE HOOK 0.00 0.00 2 HKBIMP7* 06 IMPALA HOOK KIT 0.00 0.00 2 SSP3000 SMART SIREN PLATINUM 1699.00 999.00 1998.00 1998.00 6 ES100 DYNAMAX 100W SPEAKER 299.00 125.00 750.00 750.00 4 ESB -CAP11 ES100 11 CAPRICE BRKT 25.00 11.80 47.20 47.20 3 ESB -TAH08 ES100 03 -11 TAHOE BRKT 25.00 11.80 35.40 35.40 20 VTX609C VERTEX LED, iWHITE 123.00 59.25 1185.00 1185.00 20 RE7019 MAGLITE SYS NIMH 12V 142.22 85.00 1700.00 1700.00 IOn1� S 23 12 2W R 1 Call US for Q,►ALITY Prod Service! Ref: W# 105797 MERCHANDISE....$10057.60 SALES TAX 0.00 RECEIVED BY h 1 S &H /COD, ETC $ 0.00 Amount Meth d of Payme t INVOICE TOTAL $10057.60 Invoice Total 'Charged T0(Cu_tomer Account AMOUNT RCVD $ 0.00 BALANCE DUE $10057.60 Use of provided equipment in any vehicle is the driver's responsibility.