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HomeMy WebLinkAbout2012 police lease 9 pay request 14Lease 2012 — Sch #9 (Police Dept.) Payment Request # 2012-14 EX Id 1131 T A PAYMENT REQUEST FORM / ACCEPTANCE CERTIF[CATE 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. En addition, the undersigned acknowledges delivery, installation and receipt in good condition, and hereby accepts the Equipment described on the attached invoices. Payee: Steven R. Jenkins Amount: $13,088.00 Description of Equipment Item Cost New Vehicle Equipment Dated: July 12, 2012 LESSEE: City, of Carmel One Civic Sgyare C.umd, l 46032' 13y: Name: Diana Cordray Title: Cleric Treasurer 6-1A-dad (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Steven R. Jenkins Co., Inc. 6680 E. 2V Street Indianapolis, IN 46219 ,4eszo CERTIFICATE OF LIABILITY INSURANCE OP ID: 79 DATE (MMIDCVVYY) 04120/12 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 Iho 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 Hylant Group Inc- Indianapolis 301 Pennsylvania Parkway, 8201 Indianapolis, IN 46280 W. Michael Wells INSURED 800- 678 -0361 317- 817 -5151 NAME. ' Marianne Llban NAME. City of Carmel % Steve Engelking One Civic Square Carmel, IN 46032 [An, NA, Ent!. 317-817-5136 I FAX sal, 317 - 8175151 EMAIL ADDRESS: marianne.uban h lant.com PRODUCER CARME80 CUSTOMER In C: INSURER(S) AFFORDING COVERAGE NAIC INSURER A: Travelers Insurance Companies INSURER B INSURER C INSURER 0: INSURER E : INSURER r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTVVITHSTANDING ANY REQUIREMENT. CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE PERTAIN, POLICIES. ADDL SUER MD LISTED BELOW HAVE BEEN ISSUED TO TERM OR CONDITION OF ANY CONTRACT THE INSURANCE AFFORDED BY THE POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY THE INSURED OR OTHER DESCRIBED PAID CLAIMS. EXP.— (MMtDEPYYVVI NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN 15 SUBJECT TO ALL THE TERMS, INSR OR TYPE OF INSURANCE POLICY NUMBER POLICY EFFTPOLICY IMMIDDIVYYV) A GENERAL LIABILITY X COMMERC'ALGENERALWIEILITY 1 CLAIMS -MADE 1 X OCCUR GP09315757 01/01/12 01)01/13 EACH OCCURRENCE 1 $ 2,000,000 DAh1AGETCYRENTED pREMISES1Eaocm,rencel 1 $ 50,000 ME ❑EYP(Any me perm) $ 0 GENL Ir1 1 PERSONAL A. ADV INJURY s 2,000,000 GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY f JFRCCT 1 I LOC PRODUCTS - CQMP:OP AGG $ 2,000,000 $ A AUTOMOBILE X — 1 LIABILITY ANY AUTO ALL OPINED AUTOS SCHEDULED AUTOS I HIRED AUTOS NON-DATED AUTOS 8103036P64A 01101!12 01/01/13 COMBINED SINGLE LIMIT' $ 2,000,000 (Ea accident; BODILY INJURY PEA oarsan) $ BODILY INJURY (per ecaegnU E PROPER DAMAGE Pere cUanl $ 1 $ UMBRELLA (JAB I I OCCUR ExCESSLIAB 1 1 CLAIMS -MADE EACH OCCURRENCE 1$ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE VIN OFFICERMEMBER EXCLUDED9 (Mandatory In NHl IF `es describe under DESCRIPTION OF OPERATIONS Sam NIA NC SIAIU- OTH. I TORY LIMITS I I ER EL EACH ACCIDENT 1$ EL, DISEASE - EA EMPLOYEE t E.L. DISEASE - POLICY LIMIT 1 $ A PROPERTY 630581M4076 01101/12 01/01/13 SEE ATTACHED DESCRIPTION OF DPERAnoN51 LOCATIONS I VEHICLES (Attach ACORD 101. Additional Remarks Schedule. Il more space is require* SEE ATTACHED. CERTIFICATE HOLDER CANCELLATION HUNTI -2 The Huntington National Bank & its assignors and assignees CJO American Lease Insurance 654 Amherst Rd. Ste 335 ,Sunderland, MA 01375 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE -k.� / i / - J LC�t7AsC� ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTEPAD INSURED 'S NAME City Of Carmel CARMESO PAGE 2 OP ID: 79 PATE 04120/12 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: $2,9,47,355 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: $080,591 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 INSURED'S NAME City of Carmel CARME80 PAGE 3 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 EguipmentNehicles STEVEN R JENKINS CO INC 6680 E 21ST ST INDIANAPOLIS IN 46219 1- 317 - 352 -0184 Bill To CARMEL POLICE DEPT 3 CIVIC SQUARE CARMEL, IN 46032 P.0 Number Terms Rep 26112 Net 30 SOUT invoice Date I jnvoice# 6/18/2012 173466PG Ship To CARMEL POLICE 3 CIVIC SQUARE CARME I„ IN 46032 Quant... Item Code Description Price Each Amount 8 2 10 1 40000 GEN... Pro Gard Procell Half Partition 2012 Impala 40000 GEN... Pro Gard Procell Half Partition 2012 Caprice 40000 GEN... Pro Gard 06300 AR 15 Vertical Gun Rack FREIGHT Shipping/Handling Sales Tax Ss, X. cgiggra 1,089.20 1,089.20 219.60 290.00 0.00% c c 8,713.60 2,178.49 2.196.00 290.00 0.00 SHOP srjco.ci lm Total $13,378.00