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HomeMy WebLinkAbout2013 Police schedule 15 pay request 15 Lease 2013 — Sch # 15 (Police Dept.) Payment Request # 2013-15 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 February 14, 2013 by and among the Escrow Agent,the Lessee and Lessor,to the person or corporation designated below as Payee,the sung 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: Waym ire Amount: $2,380.00 Description of Equipment Item Cost: Equipment for new vehicles Dated: June 19, 2013 LESSEE: City of Carmel One Civic Square Carmel,IN 6032 By: diZttaUte Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Waym ire, A.P.S., inc. 820 Chadwick Street Indianapolis, IN 46225 PAGE 1 0:0 DATE CERTIFICATE OF LIABILITY INSURANCE M/DD/YYYY) 3/225/205/2013 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). CNTACT PRODUCER NAME: Marianne Uban Hylant Group Inc Indianapolis (A/C.No.Ext1;317-817-5136 (AAic,No):317-817-5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDRESS:marianne.uban @hylant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARM E80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER D: Carmel, IN 46032 INSURER E: INSURER P: COVERAGES CERTIFICATE NUMBER:1271512319 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. INSR ADDL SUBR I(MM/DDIYYYY) IMMIDD/YYYYI LTR TYPE OF INSURANCE ,INSR WVD POLICY NUMBER LIMITS A GENERAL LIABILITY ZLP14T62033 1/1/2013 1/1/2014 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED $50,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) $Excluded PERSONAL 8 ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY J T [1 LOC . $ A AUTOMOBILE LIABILITY 1/1/2013 1/1/2014 COMBINED SINGLE LIMIT H8103036P64ACOF13 (Eaaccident) $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE ■ $ HIRED AUTOS AUTOS (Per accident) X Comp X Coll Comp/Coll Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADDITIONAL NAMED INSUREDS: CARMEL CLAY PARKS BUILDING CORPORATION; CARMEL CLAY BOARD OF PARKS& RECREATION; CARMEL REDEVELOPMENT COMMISSION; CARMEL REDEVELOPMENT AUTHORITY; CARMEL CITY CENTER COMMUNITY DEVELOPMENT CORPORATION Re: Various Police Equipment/Vehicles CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Huntington National Bank& its assignors and ACCORDANCE WITH THE POLICY PROVISIONS. assignees c/o American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Amherst Rd., Ste. 335 Sunderland MA 01375 ����✓'t ���p � ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 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 # 290728 DATE 06/14/13 PO # : 25680 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 DELIVERY VEHICLE: YEAR : N/A WC CAPACITY: WDH CAPACITY: SLS PER: FLTMK Tag # : MAKE : N/A GTW: N/A GTW: N/A MECH. . : MODEL: N/A TW : N/A TW : N/A WRNTY # : QTY PART # ITEM DESCRIPTION MFG SRP COST EA PARTS LABOR TOTAL 4 ILSFD00359 ILS IMP REAR 5R/5B 1490 . 00 595 . 00 2380 . 00 2380 . 00 Call US for QUALITY Products & Service ! Ref : W# 109869 MERCHANDISE. . . . $ 2380 . 00 SALES TAX $ 0 . 00 RECEIVED BY S&H/COD, ETC. . . $ 0 . 00 Amount & Method of Payment . . . INVOICE TOTAL. . $ 2380 . 00 Invoice Total Charged To Customer Account AMOUNT RCVD. . . . $ 0 . 00 BALANCE DUE. . . . $ 2380 . 00 Use of provided equipment in any vehicle is the driver ' s responsibility. IniumArtIA r-i !AIL IAA t AtIVI1 rnlei of L., dit , i ewe/litty CERTIFICATE NO.003120155 002 0 . PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 35-60000g72 • 5660 ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES CARMEL, INDIANA:46032-2584 VOUCHER. DELIVERY MEMO, PACKING SL SHIPPING LABELS AN ANY:CORRESPONDS' 171M APPROVEDBY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1.997 _ _ _._........._ ;RASE ORDER DATE DATE REQUIRED REQUISITION NO. f VENDOR ND. DESCRIPTION 1i2013 Waymire A.P.S., Inc. Cwrnol Police.Department 1DOR SHIP 3 Civic Squan2 TO 20 Chadwick Street CE/T1101, IN 46032 indlanapolla, IN 46225 (317)5712550 FIMATION BLANKET CONTRACT PAYMENT TERMS FREIGHT , QUANTITY UNIT OF MEASURE DESCRIPTION 1 - UNIT PRICE I EXTENSION :ount 00-006,14 2 Each Federal Signal Spectralux ILS (Tahoe $805.00 $1,810.00/ front) 15 Each FederafSignal FHLP-INIP.headlight _ . $58.75 $851.25/ flasher _ 21 Each Federal Signal ES 100 siren speaker , - .,., $13.75 $288.75/ brackets 20 Each Mag Lite rechargeable flashlite,,,-. -,:` '''- Widirect wire Charger;.„, -, $85,00 $1,700.00/ ,,- 20. Each Whelan VTX609c clear LED tubes - • - $59.25 $1,185.00/ 4 Each ‘Aihelen Dominator D2RR. $127.50 ',. - ,.,. 1,` 'f,:,-: k..., -: -'', 4 Each Whelan Dominator D2BEt : ',.7 ,,,,,-, $127.50 $510.00V , - ',.;„ ,,,,,, . „, 10 Each Malan TIR 3Red ,.-,' -. $48.95 $489.50// ,., ''.' •-.7.,1/4' 'k 5:'; 3 , 20 Each Havis Chargeguard Select tG-X ,I '',.:,,:.,' , -, I" $67.32 $1,340,40f1 21 Each Federal Signal ES100 Siren speakers, Pz,,,,,,.. ,i,„, ,,-,-1; ,-, $120.75 $2,535.751/ '-,:, .. . N ,I*3-1. is%' „, 18 Each Federal Signal Smart Siren Platinum '-,-.,, ,:',,,-.,-.°-',,,,,i,,,,,t,-0 . ,,-- i:. , $835.00 $13,360.0V ,.. , •..-- -,,.,g,,,,,,,,,,,,,-;-n!•:4,:-,.,,,,,,,,,,,, k,,,-„,', - ,- 10 Each Whalen T1R 3 Blue 4..f., ,,,-',.1, ",, '44fr.fl!,:e:V-A.' ' '7'; ...' 1 $48 e95 $489.501 1 -\-: .4,‘„4.. ;.,--,,4..t, i ., C- ,..,,,V- ,; 4 nd Invoice To Carmel Police Department 'CO al) Attn: Toresa.Anderson 3 CivIc Square 3-%k‘ Cannel, IN 46032- PLEASE INVOICE IN DUPLICATE DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT nel Polite Dept. _ - PAYMENT $34,573.20 ''' • AT VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE PO NUMBER IS MADE A PART CF THE VOUCHER AND EVERY.INVOICEAND VOUCHER HAS THE PROPER 1NORN AFFIDAVIT ATTACREc, SHIPPING INSTRUCTIONS • I HEREBY CERTIFY TH 1'T E S AN UNOBLIGATED BALANCE IN THIS AFPROPRi AP LP ,' IEN r TO PAY FOR T E ABOVE ORDER. ;HIP REPAIEi. Ion;SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY .____ /' --' NRCHASE ORDER NUMBER MUST APPEAR ON ALL — 'NIPPING LABELS. HIS ORDER ISSUED IN COMPLIANCE WITH CHAP TER•99,ACTS 1945 TITLE 4P- lef of Police 11,10 ACTS A VIENUA-i-Ofiy THEREOF AND SUPPLEMENT THERETO 2 3 6 8 0 CLERK-TREASURER )CUIVIENT CONTROL NO. VENDOR COPY ity AIVUIHIYH:tiC IKtL IHA tArMt?1 ..,U— eoi CERTIFICATE NO:003120155 002'0 • PURGHASEORDER•NUME3ER FEDERAL EXCISE TAX EXEMPT 35-60000972 I 25 Cgyith deo' ONE CIVIC SQUARE — THIS NUMBER,MUST APPEAR ON INVOICES. CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO. PACKING SL RM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL- 1997 SHIPPING tr,BELS AND ANY coRrFSPONDEr :RASE ORDER DATE DATE REQUIRED REQUISITION.NO. VENDOR NO, DESCRIPTION 142013 _.._. i Waymire A,P.S., Inc. Carmel Police Department ODOR TOIP 3 Chile S uaen :020:"ChadvVIcli Street Cannel, IN Indianapolis, IN IN 46225 (317)571-2559 ....._..- CONTRACT PAYMENT TERMS RMATION BLANKET FREIGHT QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION 4 Each Federal Signal Spectralux ILS (Impala $495.50 $1,982.00✓ front) / 4 Each Federal Signal Spectralux ILS(Impala $585:00 $2,380.00✓ roar) 3 Each Havis C-1800 18' console . . . _ $174.22 $522.86 3 Each Havis CTMWGMCO228 Track Mount $90.68 $272. 3 Each Havis CARM-104 Folding Aral?Rets1 ,: £ "` ,' .i $82.15 $278.45x/ 1 'Each Federal Signal Legend Light5ar,iootc� = for Tahoe $30',50 $30.50✓ 1 Each Ameri.can Aluminum 14-9 Trarispor8 b K9PT47Ta$i - $1,887.25 $1,887.25✓ 1 Each 1(9'Cool Guard and Door:Po er .;.., ; ® y pp $82 �90� $825. 3 Each Whelen mirror light is (Tahoe)- '4', $506.75 $1,520.25; Sub Total: $34,573.20 ., a K .ic nd Invoice To Cannel.Police.Department Attn: Teresa Ahdeirnn 3 Civic Sqy Cirtil pi, iN 460T2- PLEASE INVOICE IN DUPLICATE DEPARTMENT I ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT net Police Dept. PAYMENT $34,57120 -� • NP VOUCHER.CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE,A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN AFFIDAVIT ATTACHED. SHIPPING INSTRUCTIONS • I HEREBY CERTIF�' r;AT THERE IS AN UAIOBLIGATED BALANCE IN >HIP REPAID. THIS 744 : SUFFICIENT TO PAY FOR THE ABOVE ORDER. T.O.D.SHIPMENTS CANNOT BE ACCEPTED. ORDERED BY j ,t _.-.,��..�,.--» * URCHASE ORDER NUMBER MUST APPEAR ON ALL s S -- IHIPPING LABELS. HIS ORDER ISSUED IN WITH CHAPTER 99,ACTS 1945 TITLE _........ Chlof of Paco ,ND ACTS:AMENDATORY THEREOF AND SUPPLEMENT THERE . 2 �M r_,..J 5 CLERIC TREASURER ICUMENT CONTROL NO.. VENDOR COPY