The URL can be used to link to this page

Home My WebLink About2012 Police pay request 2012-10 Lease 2012 Sch #9 (Police Dept.) Payment Request 2012 -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 March 8, 2012 by and among the Escrow Agent, the Lessee and Lessor, to the person or corporation designated below as Payee, the suns 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: Kelley Chevrolet LLC Amount: $77,129.90 Description of Equipment Item Cost: New Vehicles Dated: May 31, 2012 LESSEE: City of Carmel One Civic S uare ant Carmel, I 6032 By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Kelley Chevrolet, LLC 500 E. State Boulevard Fort Wayne, IN 46805 PAGE 1 OP ID: 79 AMMO' CERTIFICATE OF LIABILITY INSURANCE DATE 04/20/12 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 NAAMEQCT Marianne Uban Hylent Group Inc- Indianapolis FAX 301 Pennsylvania Parkway, #201 317- 817 -5151 r2 N o, Ex B: 317 -817 -5136 I (AC, No): 317- 817 -5151 Indianapolis, IN 46280 E -MAIL marianne.uban@hylant.com Michael Wells ADDRESS: @y PRODUCE lant.com i b CARME80 h CUSTOMER R ID INSURER(S) AFFORDING COVERAGE NAIC 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. 77 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR TYPE OF INSURANCE IINOR Iwvn 1 POLICY NUMBER I IMMJDD/YYYY) IIMM/DD//YYYYI I LIMITS GENERAL LIABILITY EACH OCCURRENCE I 2,000,000 A X COMMERCAL GENERAL LIABILITY GP09315757 01/01/12 01/01/13 DAMAOET6RENcED PREMISES {Ea occurrence) I 50,000 CLAIMS -MADE I X l OCCUR 1 MED EXP (Any one peracn) 0 PERSONALBADV INJURY 2,000,000 GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG 2,000,000 POLICY I 1 78 I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 A X ANY AUTO 8103036P64A 01/01/12 01/01/13 (Ea acatlenq BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per acadenl) I I SCHEDULED AUTOS PROPERTY DAMAGE I HIRED AUTOS (Per awtlent) NONOWNED AUTOS I 1 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB AGGREGATE DEDUCTIBLE RETENTION 1 WORKERS COMPENSATION I WC STATU- ER AND EMPLOYERS' LIABILITY Y)N TORYLMIT$ I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? l I N I A (Mandatory In NH) E.L. DISEASE EA EMPLOYEE If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT A PROPERTY '630581M4076 01/01/12 01/01/13 SEE ATTACHED DESCRIPTION OF OPERATIONS 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 8 ACCORDANCE WITH THE POLICY PROVISIONS. its assignors and assignees CIO American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Amherst R. Ste 335 Sunderland, MA A 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 (0:79 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 CC M'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE FINE ARTS: $1,759,975 W /$1,000 DEDUCTIBLE HOLDER CODE HUNTI -2 CARME80 PAGE NOTEPAD: IN$UREp'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 Lender's Loss Payee Re: Various Police EquipmentNehicles ...4 r -.t T .rf.r ..rl u irY -J :x BUYERS ORDER FOR A MOTOR VEHICLE I ®NEW 'USED ebb DEMO (USED) MILEAGE 135 U JL�_JU Date MAY 2fiih 20I -'.0 n EVR 0 L Cr MAKE wrTCVAUt,tt MODEL l.LMJJ M.. KELLEY CHEW, LLC i. YR. :,vie- ENG. STK. 43 t6 500 E. State Blvd. a ,CYL „_,No. Fort Wayne, IN 46805 �}S T #:40I38 SERIAL ow t{LJU611.,( 3UO 260 -484- 5566.800 -553 -5539 {1EA1 :31152 No. C COLOR TOP TRIM Please Print ME CITY OF CARI?fL rUKt.Nhst I 25539.05 :TU. 414:Z1 CUVEli3 I bU. VU ADDRESS Please Print 1 CIVIC S? XIKN KUS 160.00 CITY STATE ZIP N/A CARMEL IN 46032-2584 Phone Bus. NIA (3171571 -2414 i317)571-2414 f A SS No. Email dcordrayecarmel in.gav NIA TOTAL zss.u) SETTLEMENT AMOUNT AMOUNT PURCHASE PRICE BROUGHT FORWARD g P5 t Ar LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE DISCOUNT se is This Lease/Purchase Omer lssubjec to the Following terms and conditions: TRADING DIFFERENCE 9£9£ -S or 1. TRADE -IN CERTIFICATION: It the customer has traded Ina motor vehicle on this purchase or lease. the customer hereby warrants represents. and certifies to Dealer that the lade -in vehicle has never been tined or required to be INDIANA SALES TAX 1 n add under any slate or federal law as a 'Rebuilt,' or "Salvage.' or'FIocd,: or "Defective; or 'Manufacturer Buyback' r motor vehicle. If the customer has a trade -in vehicle. the customer further (H warrants, represent% and codifies to BALANCE 9£0£I a OG Dealer that he trade -,n vehicle is 100 of any and all hens or encumbrances of any kind or nature whatsoever, other than w... the specific balance owed ('d any) as set forth on this Purchase Order, and (2) the title to the trade -in vehicle shall be BALANCE DUE ON TRADE-IN A delivered to the Dealer free and dear of all liens and encumbrances thereon at me hone the customer takes possession of the motor vehicle purchasedAeased pursuant to this Purchase Order, provided. however, in the event the the is in GOOD UNTIL: the possession of Iienholder being pad on as sot form on this Purchase Order, men title shall be ddrvared m the Dealer within seven (7) days from the dale hereof. BAL. OWED TO: 2. WARRANTY INFORMATION: a. NEW OR DEMONSTRATOR: If the motor vehicle I3 new or a demonstrator, the only warranty provided wtm respect 10 the motor vehicle and factory installed accessories' 10 the most recent applicable printed warranty which is made solely by the Manufacturer of the motor vehicle and delivered to customer or found in the motor vehicle al the time of delivery A demonstrator is xnsidered a used vehicle and not a rren molar vehicle. Dealer Mstalled Accessories are not included In the Mandadurer's warranty on the molar vehicle and may or may Oo1 be included In separate written warranties which are made solely by the manuhqurer. installer or supplier of the Accessories. b. AS IS II the motor vehicle is a new demonstrator. or used motor vehicle. the motor vehicle is sold or leased by theDealertothecustomerin" AS IS” condition, except for any printed warranty provided solely by the Manufacturer RUSTPROOFING- FAB. COAT SEALANT wM respect to new or demonstrator motor vehicles, and except for any separate written warranty. if any, expressly n In made or furnished by the Dealer on Its own behalf with respect to used motor vehicles, ro whim case, the only EXT. WARRANTY nany provided is that specific express written warranty, if any. If the customer has purchased a service contract r �T 1 4 M the vehicle, the customer understands that the customer shall leek solely to the providerissuer of that service EVR FILING FEE i A contract. and shah not look to Dealer For honoring or performance of that service contract. 1 a DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE IS NEW, A DEMONSTRATOR OR USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE- LICENSE DLR N /4 CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND WRITTEN, EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR q 1 VEHICLE DELIVERY CHARGE 1 tQ A PARTICULAR PURPOSE. AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR ANY CONSEQUENTIAL DAMAGE, LOSS OF TIME, OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 v, OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW, ALL OF THE TERMS AND 1 0 C CONBOTIONS OF THIS LEASE/PURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS. BALANCE "CtiCf 3. MISCELLANEOUS: In signing this Purchase Order rs to be understood that he customer Hn lake possession of PARTIAL PAYMENT the motor vehicle within ten days aher nor that same is ready for delivery as per terms agreed upon. In the event of A bus Purchase Order being canceled, the Oeater reserves the right to retain all deposits as liquidated damages. When D' a motor vehicle is to be purchased on credit or leased, then the purchase/lease is contingent pon the Dealer obtaining BALANCE 2C*C( :ft me consent and approval of the customers lendemesspr. If such consent rs not obtained, denied, or refused, customer shall immediately return the motor vehicle to 1110 Dealer, and this Lease/Purchase Order shall be null and void. X 11110 M ownership to the motor vehicle shall not pass or be transferred until final full payment is made and dear tine 0 obtained to any motor ventde you traded in on the purchase/lease. Customer acknowledges and agrees that a separate Ennis Selection and Arbitration Agreement has been executed and is corporated as pan of this Lease/Purchase Order. This LeaPurchase Om old Order a the incorpo rated Forum Selection and Aratation Agreement CASH ON DELIVERY contain the entire agreement between the customer and Dealer, and there are no verbal agreements or understandings 9 CRte r!+1 as to the purchase/lease of motor vehicle. BALANCE This Purchase Omer Is presented on the basis of mmediate acceptance. In m used e event a motor vehicle is being x f A traded In on a new or used motor vehicle purchase, this Purchase Omer is subject to the used motor vehicle being .1 delivered in the same condition and with the same equipment and substantially the same mileage as when appraised. LIEN TO: When a new motor vehicle is ordered nom the factory the used motor vehicle trade-in Is subject lc reappraisal at the lime of final delivery. Any additional Federal or State Tax or extra delivery charges necessitated by Drive -aways or Express are to be paid by the customer and all purchase orders are contingent upon strikes, delays of carrier or other causes beyond Our control. All prices on new motor vehicles are subject to change without %Mice if the Manufacturer charges the prices. If Dealer is providing customer with a free carwash pass, That pass and the right to a tree carwash extends to the original purchaser only and is not assignable or transferable, voluntarily or unvoluntarily. Customer understands that Lerida) vehicles, due to site or olhenwtse. may not be able to use the ca,wash at all or lime to time. Dealer reserves RECORD OF CAR TRADED IN the rghl O to impose restrictions and conditions on the use of carwash, including me requirement X carwash lag or pass: 8) to revise its restrictions and conditions from time to time, and (01) to modiry me hours of the carwash operatton. the type of carwash equipment used, or to terminate the tree carwash program In its entirety. If the customer is leasing the motor vehicle, the term customer, whenever used hereinahave, includes customers slaws as a lessee, Year Make Type YWE ACKNOWLEDGE READING the ABOVE TERMS AND CONDITIONS AND THAT THEY ARE BINDING UPON ME/US AS A PART OF THIS PURCHASE OROER.THIS ORDER IS NOT BINDING UNLESS UNDERSIGNED BY AN OFFICER OF THE COMPANY. 05 /25 /12 Color Sehal No. a 8-F `../JJI t a C p;A4:- atbj'. JDated: Mileage Customer N. ;1 T at;1 aeT r i irr"t eatl RECORD OF CAR TRADED IN Customer Year Make Type c. Jintt f N%1UtDRALER OR HIS AUTHORIZED REPRESENTATIVE Color Serial No. SALESMAN SS No. Mileage FORAM 437(208) lr The Reynolds and Reynolds Company FL620664 0 (01/12) BUYERS ORDER FOR A MOTOR VEHICLE pp� MILEAGE /L _/(_J J Date HAY 2 tit 2011 NEW 0 USED 80 DEMO (USED) 135 55.•' CH EVROS=E Mr MAKE Lip: V KUL L MODELLLASSIC KELLEY CHEVY,LLC YR. CUt1G ENG. ti STK. 4.3546 500 E. State Blvd. Fort Wayne, IN 46805 SERIAL muirixbuzuLL6114bti 260- 484 5566.800 -553 -5539 COST 4:40138 IDEAL 4 0:31153 No. COLORW711 t TOP RIM Plea e NAME CITY OF CARPIEL PURCHASE PRICE 26539.05 ;ULL It e.L UV .K) bU. UV ADDRESS t Please Print I CIVIC S4 4 EXTRA KEYS 160.00 CITY STATE ZIP IEIA CAMEL Ill 46032-2584 N/A Phone (317j571 --2414 Bus. (317)571'•2414 WA SS No. E mail dcordrayecarmel.in.gov N/A T OTAL Cbtt3�.U5 SETTLEMENT AMOUNT AMOUNT PURCHASE PRICE BROUGHT FORWARD 7cg'S t1c LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE DISCOUNT NI A This Lease/Purchase Order is subject to the louowing terms and conditions: TRADING DIFFERENCE 2500) OC 1, TRADE -IN CERTIFICATION: It the customer has traded in a motor vehicle on this purchase or lease. the customer hereby wananis, represents, and centres to Dealer teal me vadein vehicle has never been Ivied or required to be INDIANA SALES TAX Al /A )Ned under any state or federal law as a'Rebuilt or'Salvage, or 'Flood or 'Defective," or "Manufacturer Buyback" motor vehicle. R the customer has a Trade -in vehicle, the customer further: (1 warrants, represents, and certifies to BALANCE 7Ci4( (tit{ Dealer that ear Trade-in vehicle is free of any and all liens or encumbrances W any kind or nature whatsoever, other than the specific balance owed (it any) as set roan on this Purchase Order, and (2) the tale to the trade -in vehicle shall be BALANCE DUE ON TRADE -IN N A delivered to the Dealer free and dear of all liens and encumbrances thereon at the time the customer takes possession of the motor vehicle purchasedneased pursuant to this Purchase Order. provided, however, in the event me toe is in GOOD UNTIL: the possession of the Iiennomer being paid on as set forth on this Purchase Order, men title shall be delivered to the Dealer within seven (7) days from the dale hereof BAL. OWED TO: R. WARRANTY INFORMATION: a. NEW OR DEMONSTRATOR: II the motor vehicle Is new or a demonstrator, the only warranty provided with rasped to the motor vehicle and factory installed accessories Is the most recent applicable printed warranty which is mado s0ely by the Manufacturer of the motor vehicle and delivered to customer or found in the motor vehicle at the time of delivery. A demonstrator is considered a used vehicle and not a new motor vehicle. Dealer Instated Accessories are not Included in the Manufacturers warranty on the motor vehicle and may or may not be included in separate when warranties which are made solely by the manufacturer, =taller or supplier of the Accessories. P, "AS 15 If the motor vehicle's a new demonstrator, or used motor vehicle, the motor vehicle is sold or leased by the oeaier to me customer in 'AS DS condition, except for any printed warranty provided solely by the Manufacturer RUSTPROOFING- FAB. COAT SEALANT gy#A won respect t0 new or demonstrator motor vehicles, and except for am separate written warranty, II any. expressly made or furnished by me Dealer on its own behalf with respect m used motor vehicles. in which case, the only EXT. WARRANTY warranty provided 5 that spe(fic express wntten warranty. if any. If to customer has purchased a service contract 19/A on the vehicle, the customer understands that the customer shall esok solely m the pmvweressuer of that service EVR FILING FEE contract and shoo not look m Dealer tor honoring or performance of service contract .1/ ry c. DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE IS NEW, A DEMONSTRATOR OR USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE LICENSE Of R 1 CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND r� WRIREN,EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR VEHICLE DELIVERY CHARGE lI /A A PARTICULAR PURPOSE, AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR ANY CONSEQUENTIAL DAMAGE. LOSS OF TIME, OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 7C OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW. ALL OF THE TERMS AND ?C CONDITIONS OF THIS LEASENURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY BALANCE PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS, 9 C41c♦1t 11; 3. MISCELLANEOUS: In signing Ibis Purchase Order it is to be understood that the customer will lake possession of PART PAYMENT me motor vehicle within ten days aver notice that same is ready for der ry as per terms agreed upon. In me event m P7 A this Purchase Order being canceled, the Dealer reserves the righl to retain all deposits as liquidated damages. When a motor vehicle is to be purchased on credit or leased, men the purchase/lease is contingent upon the Dever ob10ining BALANCE 7CRAli if the consent and approval of the customers lender/lessor. If such consent is not obtained, denied. or refused. customer shall immediately return the motor vehicle to the Dealer, and this Lease/Purchase Order shall be nun and void. Tice of ownership to the motor vehicle shah not pass or be transferred until final full payment is made and dear tine is obtained to any motor vehicle you traded in on the purchaseltease. Customer acknowledges and agrees that a separate forum Selection and Arbitration Agreement has been executed and is corporated as part W this L JPurchase Order. This Lease/Purchase Order and the incorporated Forum Selection and Arbitration Agreement CASH ON DELIVERY It contain me entire between re agreement betweehe customer and Dealer, and there are no verbal agreements or understandings ?SRftI 'Z as to the purchasellease of the motor vehicle. BALANCE This Purchase Order is presented on the basis of immediate acceptance. In the event a used motor venbe Is hang N 1 A traded in on a new or used motor vehicle purchase, this Purchase Order Is subject to the used motor vehicle being delivered in the same condom and with the same equipment and substantially the same mileage as when appraised. LIEN TO: When a new motor vehicle is ordered from the factory, the used mold vehicle trade-in is subject to reappraisal at the tone of Final delivery. Any additional Federal or State Tax or extra delivery charges necessitated by Drive -sways or Express are to be paid by the customer and all purchase orders are contingent upon strikes, delays of carrier or other causes beyond our 02050. At peeps on new mow vehtdes are subset change wiwA notice a the Manufacturer changes me Prices. h If Dealer is providing customer with a free ash pass, that pass and the right t0 a free carwash extends to the original purchaser only and Is hit assignable or Transferable, voluntanly or uneoluntarily. Customer understands that certain vehicles, duo t0 size or otherwise, troy not be able to use the carwash at all or from time t0 Gme. Dealer reserves the right 0) to impose restrictions and conditions on the use W the carwash, including the requirement of cawash tag RECORD OF CAR TRADED IN or pass: (0) to revise its restdc)iona and conditions from time to lime. and (n] to modify the hours of the carwash operation, the type of cowrie equipment used or t0 terminate Ne Tree 005000h program in its entirety. If the customer is leasing the motor collide. the term customer, whenever used horeinabove, includes customer's status as a lessee. Year Make Type W/E ACKNOWLEDGE READING the ABOVE TERMS AND CONDITIONS AND THAT THEY ARE BINDING UPON ME/US AS A PART OFTHIS PURCHASE ORDER, THIS ORDER IS NOT BINDING UNLESS UNDERSIGNED BY AN OFFICER OF THE COMPANY. COOP Serial No. 411 y -�F ;�:wlic 4,130,.so, 05 26 12 4 .-*Dated: Mileage Customer 0' f h fri riCt Doted: RECORD OF CAR TRADED IN Customer HARK T WRIGHT FINANCE MANAGER Accepted by: Year Make Type HARK WRIGHT EER OR HIS AUTHORIZED REPRESENTATIVE IIARK T 4SG1 A Color Serial No. SALESMAN 5S No. Mileage FORMY 437 (208) The Reynolds and Reynolds Company FL6206640(01/12) r. BUYERS ORDER FOR A MOTOR VEHICLE f HAY 25th 2012 ®NE BUSED cP DEMO(USED) MILEAGE 135 Date r. i$LviYULL I lLr .)IC LC N!C. fl O- 'L MAKE MODEL KELLEY CHEVY, LLC YR. 1 ENG. STK. i7 500 E. State Blvd. y ,C,YL, No,,,, Fort Wayne, IN 46805 OUST N:40118 SERIAL I(l JVC. T'.L 260- 484 5566.800.553 -5539 DEAL 4 :31154 No. COLOR''" TOP INT. CUST, NAME CITY OF CARREL TRIM Please Print rUKI.RHst rKllt. 25053•1./5 4 :ORA KC::, 163•03 ADDRESS Please Print 1 CIVIC SO utrt(LA r1MHHUALJ 195.1.1U W/A CITY CARMEL STILE ZIP 46032 -2584 (r/A Phone (317)571-2414 Bus (317)571 -2414 diA SS No. E or dray@carmei.irt.gov N/A 4 ®4A(L t. vo• SETTLEMENT AMOUNT AMOUNT PURCHASE PRICE BROUGHT FORWARD 25408.05 LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE/DISCOUNT N/A TNS Lease/Purchase Order is subject to me lonowing tern am caxxLlions: TRADING DIFFERENCE 25400.05 1. TRADE -IN CERTIFICATION: II the customer bas traded Ina motor while on this purchase or lease. the customer a rA W S hereby warrants, represents. are certifies to Dealer that the vade'n vehicle has never been tided a required to be INDIANA SALES TAX titled under any slate or federal law as a'Rebuilt: or ahrage. or 'Flood: M 'Defective: 0r'Mamtadurer Buyback' 25400.05 meta a vehicle. the customer has a tade'n vehicle, the Customer mnher: (1) warrants, represents. and certifies to BALANCE 1' Dealer flat the bade -in vehicle is free of any and all iens or encumbrances of any kind or nature whatsoever. other than NIA the specific balance owed (d any) as set forth on this Purchase Omer. and (2) the e to m e e trade vehicle shall be BALANCE DUE ON TRADE -IN delivered to the Dealer free and dear of al liens and encumbrances thereon at time the customer takes possession DI the motor vehicle purchased/leased pursuant to this Purchase Omer, provided. however. in the event the tale a in GOOD UNTIL: the possessor of the henhdder being paid off Easel myth on etas Purchase Order, then tote shall be ,havered to the Dealer within seven m days Iran tie dam hereof. BAL. OWED TO: 2. WARRANTY INFORMATION: a. NEW 011 DEMONSTRATOR: If the motor vehicle rs new or a denenatrala. the only warranty provided wah respect (0 the motor vehicle and fadOry installed aaassones is the most Went applicable primed warranty which is made solely by the Manufacturer of the moles vehicle and delivered to customer Or found in the motor vehicle at the time Of defnrery. A demonstrator is considered a used vehicle and not a new motor vehicle. Dealer installed Accessories are not included in Me Manufacturer's warranty on the motor vekde and may or may not be included in separate written warranties which ere made solely by Ire manufacturer. installer or supplier of the Accessories. b AS h5': If the motor vehicle is a new demonstrator, or used motor vehicle, the motor vehicle is sold 0 leased by ale Dealer to the customer in 'AS IS' condition. except cur any printed warranty provided SOWN by re Manotanurer RUSTPROOFING FAB. COAT SEALANT 11 /A with respect to new or demYYslalor motor vehicles. and except tor any separate written warranty, d any. expressly made or furnished by Ire Dealer on is own behalf with respect to used motor vehicles. in whin case, the only EXT. WARRANTY N/A warranty provided is that specific express wdben warranty, a any II the customer has purchased a service contract on the venide. the customer understands that the customer shall look solely 10 the provider/Issuer of that service EXCISE TAX 1/ A contract, and shall not look to Dealer for honoring or performance of that service contract. c. DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE 15 NEW, A DEMONSTRATOR OR USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE LICENSE UL I{ 111/4 CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND WRITTEN, EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR VEHICLE DELIVERY CHARGE 11f A A PARTICULAR PURPOSE, AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR ANY CONSEQUENTIAL DAMAGE, LOSS OF TIME. OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 25 OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL 2S ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW, ALL OF THE TERMS AND CONDITIONS OF THIS LEASE/PURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY BALANCE 25401 30 PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS. 3, MISCELLANEOUS: In signing Mrs Purchase Order 11 is to be rmbrsi004 that the customer will take possession of the PARTIAL PAYMENT NIA e motor vehicle M n t 01 e within ten days alter name at same is ready delivery as per ter agreed upon. In o event NB Purchase Order being canceled. the Dealer reserves the rg1 to retain al deposits as liquidated damages. When a motor vehicle s to be purchased on veto a leased, then the pumhasMease0 contingent upon the Dealer obtaining BALANCE 25409 -30 the consent and approval of Me customer's IeMernesaor. 11 such consent is not obtained, denied, 00 rewsed, customer shall immediately return the mold veldde to the Dealer, and this Lease/Purchase Order loan be null and void. Me of ownership to the motor veldde shall not pass or be banslerred until final mu payment is made and dear title rs obtained IC any motor vehicle you traded in on the purchase/lease. Customer acknowledges and agrees That a separate forum Selection and Arbitration Agreement has been executed and rs incorporated as part of this Leasarard,ase Order. This Lease/Purchase Order and the incorporated Forum Selection and Arbitration Agreement CASH ON DELIVERY 2621. -30 contain the enure agreement between the customer and Dealer, and there are no verbal agreements or INersatdings as to the wrdlasMease of the motor vehicle. a This Purchase Order a presented an the basis m immediate acceptance. In e even) a used motor vehicle is being BALANCE traded in on a new or used motor uehide purchase, this Purchase Order Is subject to the used motor vehicle being ash/erect in the same condition and wen the same equipment and substantially the same mileage as when appraised. LIEN TO: When a new motor vehicle rs ordered from the ladory, the used motor vehicle Irade -m Is saved (0 reappraisal at time of final delivery Any additional Federal or Slate Tax or extra delivery charges receasialed by Drive-aways or Express are to be paid by the customer and all purchase orders are contingent upon sakes. delays of carder or other Causes beyond our coned. Al prices on new motor vehicles are subject to large without notice it the Manuaclurer changes the Prices- II Dealer rs providing 0Rlaner was a tree caM24n pass, that pass and NB right to a bee eaw2d1 extends m Me oraRnal port ser only and is not assignable Or transferable. voluntarily or unvoluntariy. Customer understands Mat certain vehicles, due (0 size or otherwise. may not be ede to use the canwasn at all or from time to time. Dealer reserves the right(i)to Impose restrictions and conditions on the usa of the inward. including the requirement of a can wash as RECORD OF CAR TRADED IN or pass: Oil to revise da restrictions and conditions from tore 10 time, 000 (it) to modify me hours of the carwesh operated the type el canvash equipment used. or In terminate the bee canxash program in as entirety. II me customer is leasing the motor vehicle. the term customer. whenever used hereinabovo, includes customer's i status as a lessee. Year Make Type UWE ACKNOWLEDGE READING the ABOVE TERMS AND CONORIONS AND THAT THEY ARE BINDING UPON BENS AS A PART OF THIS PURCHASE ORDER,THIS ORDER 15 NOT BINDING UNLESS UNDERSIGNED BY AN OFFICER OF THE COMPANY. 05/25/12 Color Serial No. 1 ewe' (i +lvl:L t :cubs ^.330__' Dated: Mileage Customer MARK T IJRIGHI FINANCE MANAGER LAGER RECORD OF CAR TRADED IN Customer Algip'die T WRIGHT Year Make Type DEALER OR HIS AUTHORIZED REPRESENTATIVE Color Serial No. SALESMAN SS No, Mileage FORM# 437 (2 08) The Reynolds end Reynolds Company Fte250040