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HomeMy WebLinkAbout2012 Police pay request 2012-16Lease 2012 — Sch #9 (Police Dept.) Payment Request # 2012 -16 EXHIBIT A PAYMENT REQUEST FORM / ACCEPTANCE CERT[F]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 payahleunder 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: Amount: Visual Computer Solutions. Inc. 523,893.89 Description of Equipment Item Cost: Scheduling System Dated: July 25, 2012 LESSEE: City of Carmel One Civic Square Carmel, IN 6032 By: Name: Diana Cord ray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO Visual Computer Solutions; Inc. 4400 US Highway 9 South, Suite 3500 Freehold, NJ 07728 PAGE1 14eR° CERTIFICATE OF LIABILITY INSURANCE OP ID: 79 DATE IMMIDDIYYYYI 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 pollcy(ios) 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, #201 Indianapolis, IN 46280 W. Michael Wells 800-678-0361 317-817-5151 INSURED City of Carmel % Steve Engelking One Civic Square Carmel, IN 46032 CONTACT Marianne Uban NAME: PHONE 317. 817 -5136 .(Alt, No, Exq' EMAIL ADDRESS: marianne.uban @hylant.com MAI PRODUCER CARME80 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE INSURER A: Travelers Insurance Companies FAX (A /C No): 317-8175151 NAIC # INSURER B: INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE PERTAIN, POLICIES. ADDLCSUBR JNSR WVD LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH RESPECT TO WHICH TI-118 THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFTPOUCY EXP IMMIDDflYYY) I(MMIDDTIYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL. GENERAL -MADE LIABILITY X OCCUR GP09315757 01/01/12 01/01/13 EACH OCCURRENCE 5 2,000,000 DAMGES O aeN1 tence) 5 50,000 CLAIMS MELD EXP (Any coo person) 5 0 PERSONAL S. ADV INJURY 5 2,000,000 GENERAL AGGREGATE 15 2,000,000 GENL AGGREGATE 1 POLICY LIMIT APPLIES PER'. f IF O [I LOC PRODUCTS - COMP/OP AGG 5 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL CAMEO AUTOS SCHEDULED AUTOS HIRED AUTOS NCNOWNED AUTOS 8103036P64A 01/01/12 01/01/13 COMBINED SINGLE LIMIT (E°aTOdanq 5 2,000,000 BODILY INJURY iPer person) 5 BODILY INJURY Per accident) 5 PROPERTY DAMAGE Per occident) S S 5 UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE 5 DEDUCTIBLE RETENTION 5 5 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y;N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) II yes describe under DESCRIPTION OF OPERATIONS belcw NIA I I 1 AC YTAIITS I IOER E.L. EACH ACCIDENT $ EL. DISEASE - EA EMPLOYEE 5 EL. DISEASE - POLCY LIMIT 5 A PROPERTY 630581M4076 01/01/12 01/01/13 SEE ATTACHED DESCRIPTION OF OPERATORS / LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule If more space Is required) ATTACHED. SEE CERTIFICATE HOLDER CANCELLATION HUNTI -2 The Huntington National Bank 8 its assignors and assignees C/O 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 (Yaj - : - -)& / _ n �C�cL 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 CARME80 PAGE 2 OP ID: 79 DATE 04/20112 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 INSUREDS NAME City of Carmel CARME80 OP ID: 79 PAGE 3 DATE 04!20112 The Huntington National Bank and its Assignors and Assignees, ATIMA are named as Lender's Loss Payee Re: Vanouc Police EquipmentNehicles Visual Computer Solutions, Inc. 4400 US I -ligIi vay 9 South Suite 3500 Freehold, N.1 07728 13i11'Co. Carmel Police 1)ept. (IN) Chief line Barlow 3 Civic Square Carmel. IN 46(132 Contract Holder GSA Contratt: GS-35F -00511( Invoice Dffi[. Invoice 5/11 /2012 3851 Cannel Police Dept. (IN) Chid lien Barlow 3 Civic Square Cannel. IN 46032 — .. Stiles Rep - ,- Fems.— ... ,P.O. Num berg - Poe-Date- - CM Nil Net 30 26143 WTI 0/2012 Quantify I)cserlpli =rn PFicc liach Alnoont 135 Software License Fees -SIN- 132 -32 119.90 16.186.50 1 Cnsite System Training - 119.- 5'I' -811W 2.397.85 2.397_85 1 Grisile System Training - E rit -S1 -8611] 1.198.93 1.198.93 1 Onsita System Training - ilR- ST- 81 -IXI) 1.198,93 1.108.93 1 Onsite System Training - E'IR -ST -81 -110 1.198,93 1.198.93 1 Onsitc System Training - GIMP - Wilt -61-I 1.712,75 1.71175 Purchase applied to GSA Contract C5- 35F -0051X Total- 523.893 89 Phone 732- 730 -9009 Fax 732-730-1661 13 -Mail in lnGiIvcssa lhtiurc. sm Web tvwVC.vcssollwurc. COnt