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2013 Police Schedule 15 pay request 27 Lease 2013 — Sch # 15 (Police Dept.) Payment Request # 2013-27 EXHLBIT 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 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: L-3 Communications Amount: $28,795.00 Description of Equipment Item Cost: HP Rack Server, DVD/Blu Ray Back-up Robot Dated: March 20, 2014 LESSEE: City of Carmel One Civic Square Carmel, IN 132.. By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: L-3 Communications Mobile-Vision, Inc. 90 Fanny Road Boonton, NJ 07005 PAGE I 1 ACOR®� CERTIFICATE OF LIABILITY INSURANCE 3125 2013 OmYY) I 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 CONTACT NAME: Marianne Uban Hylant Group Inc-Indianapolis (AI/CO.Nro,Exn:317-817-5136 {a,c,lvo):317 817_5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDREss:marianne.ubanahylant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Charter Oak Fire Insurance_Co 25615 INSURED CARME80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER D: Carmel, IN 46032 INSURER E: INSURER F: 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 TYPE OF INSURANCE AODL SUBR I POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER IMMIDDIYYYY) (MM/DD/YYYY) A GENERAL LIABILITY ZLP14T62033 1/1/2013 1/1/2014 EACH OCCURRENCE I $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $2,000,000 POLICY I I PRO- JECT LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF13 1/1/2013 1/1/2014 COMBINED SINGLE LIMI r (Ea accident) $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 I OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ IDED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- i AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I I Ea_ ANY PROPRIETORIPARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 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 Aman Ste.335 Sunderland MA A 01375 01375 l O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 DI Communications Invoice Mobile-Vision, Inc. Invoice Number: 0208610-IN 90 Fanny Road Invoice Date: 2/4/2014 Boonton, NJ 07005 Phone: (800) 336-8475 Order Number: 0124505 Fax: (973) 257-3024 Order Date 12/9/2013 ax: ( ) Salesperson: CM Tracking Number: 1zx5x9890364258551; Customer Number: INCARME Sold To: Ship To: Carmel Police Department Carmel Police Department 3 Civic Square 31 1st Ave NW Todd Luckoski Todd Luckoski Carmel, IN 46032 Carmel,IN 46032 Confirm To: Todd Luckoski Page: 1 Customer P.O. Ship VIA F.O.B. Terms 31388 UPS GROUND BOONTON,NJ Net 30 Days Item Number Unit Ordered Shipped Back Order Price Amount LSMVDR617HP EACH 1.00 1.00 0.00 15,000.00 15,000.00 PRO R617 HP Server,Rack Rails, 17TB RAID 6 DASD,8 Core Xenon Processors, 16GB R Whse: 000 Serial Number: 2M24020130 LSMVDDVDBR2540 EACH 1.00 0.00 1.00 8,495.00 0.00 DVD/Blu Ray Backup Robot with Built-In Workstation: 100 Disk Capacity Whse: 000 MVD-DEP-BT2 EACH 1.00 0.00 1.00 4,450.00 0.00 Solution Configuration/Training: Whse: 008 MVD-DES-BTO-EOL EACH 1.00 1.00 0.00 750.00 750.00 Installation of Operating System and DES Application on End of Life Servers Whse: 000 PLEASE REMIT PAYMENT TO L-3 COM MOBILE VISION, INC Subtotal: 15,750.00 PO BOX 5580 NEW YORK NY 10087-5580 Ship/Handling: 100.00 Sales Tax: 0.00 Invoice Total: 15,850.00 These commodities are controlled under the Export Administration Regulations(EAR)and may not be exported without proper authorization by the US Dept of Commerce. Invoice communications Mobile-Vision, Inc. Invoice Number: 0209733-IN 90 Fanny Road Invoice Date: 3/6/2014 Boonton, NJ 07005 Phone: (800) 336-8475 Order Number: 0124505 Fax: (973) 257-3024 Order Date 12/9/2013 ax: ( 1 Salesperson: CM Customer Number: INCARME Sold To: Ship To: Carmel Police Department Carmel Police Department 3 Civic Square 31 1st Ave NW Todd Luckoski Todd Luckoski Carmel,IN 46032 Carmel,IN 46032 Confirm To: Todd Luckoski Page: 1 Customer P.O. Ship VIA F.O.B. Terms 31388 UPS GROUND BOONTON,NJ Net 30 Days Item Number Unit Ordered Shipped Back Order Price Amount LSMVDDVDBR2540 EACH 1.00 1.00 0.00 8,495.00 8,495.00 DVD/Blu Ray Backup Robot with Built-In Workstation: 100 Disk Capacity Whse: 000 Serial Number: 6507788 MVD-DEP-BT2 EACH 1.00 1.00 0.00 4,450.00 4,450.00 Solution Configuration/Training: Whse: 008 PLEASE REMIT PAYMENT TO L-3 COM MOBILE VISION, INC Subtotal: 12,945.00 PO BOX 5580 NEW YORK NY 10087-5580 Sales Tax: 0.00 Invoice Total: 12,945.00 These commodities are controlled under the Export Administration Regulations(EAR)and may not be exported without proper authorization by the US Dept of Commerce.