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201 Police Dept schedule 17 pay request 3 Lease 2014 — Sch # 17 (Police Dept.) Payment Request # 2014-03 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 sum set forth below in payment(of all/ofa 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 firmed the basis of any prior request I or payment. In addition,the undersigned acknowledges delivery, installation and receipt in good condition,and hereby accepts the Equipment described on the attached invoices. Payee: Bell Techlogix Inc Amount: $9.376.22 Description of Equipment Item Cost: Desk Top Computers x 14 Dated: April 23. 2014 LESSEE: City of Carmel One Civic Square Carmel, IN 46032 By: . Nance: iana , - I;` iii ; Title: Clerk"Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Bell Techlogix Inc P.O. Box 823342 Philadelphia, PA 19182-3342 R CERTIFICATE OF LIABILITY INSURANCE 4/21/2014 DnYYYI ACORD THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS , CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Mananrle Nban Hylanl Group -1A(C,,RIe Ean:3_' nel7-5136 y1Aic,Nor,317_817_5151 I 301 Pennsylvania Parkway, #201 E-MAIL Marianne ubanhylanl,com Indianapolis IN 46280 INSBRERl$(AFFORDING COVERAGE I NAIC# INSURER A(Charier Oak Fire Insurwnce_C4 25615 INSURED CA RM 680 INSuRER H: I City of Carmel INSURER c: One Civic Square INSURERD: I Carmel, IN 46032 INSURER C-, ___ . INSURER F: COVERAGES CERTIFICATE NUMBER:970829312 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. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'NTH RESPECT TO VVHICH 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. TT I TYPE or INSURANCE IAD INSR I WVD I POLICY NUMBER I IMMIDDIYYYYI I(MMJDDDnYYY) LIMITS A GENERAL LIABILITY Y IZLP14T62033 P111/2014 111!2015 I EACH OCCURRENCE 1 52,000,000 X DAMAGE TISKEFTEC ICOMMERCIALGENERALLIABILITY I PREMISES(La occurrenvei 550.000 I CLAIMS-MADE x I OCCUR I MED EXP(Any one person) I SExcluded I I PERSONAL&ADV INIUR',' 1 52,000,000 • I GENERAL AGGREGATE 1 52,000,000 GENE AGGREGATE LIMIT APPLIES PER. I PRODUCTS--COMPIOP AGG 52000,000 7 POLICY I I TERRE fl LOC I I S S A AUTOMOBILE LIABILITY H8103036P64ACOFlg 1f1!2014 CONLEERO IN(,LE LIMB 11112015 (Ea accident'. 82,000,000 ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED I BODILY INJURY(Per accident) 5 AUTOS AUTOS NON(CWIED PROPERTY DAMAGE 5 HIRED AUTOS AUTOS .(Pei accident) _. _— X Comp X Coll ComplColl DEC 52,500 I UMBRELLA LIAB I OCCUR EACH OCCURRENCE I S I EXCESS LIAB CLAIMS-MADE AGGREGATE 5 • ' DEO 1 I RETENT ION$ 5 WORKERS COMPENSATION I INC STAID- I OTH-I AND EMPLOYERS'LIABILITY YIN TORY_LIMTTS__EB_ ANY PROPRIETOR(PARTNER(ExEDUTIVE NIA E.L.EACH ACCIDENT I5 OFFICER,MEMBER EXCLUDED' /Mandatory in NH) EL.DISEASE-EA EMPLOYEE 5 If yes describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT I S • DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more spate 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 Certificate Holder is an Additional Insured re:Various Police EquipmentNehicles 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& It's Assignors 8 Assignees ACCORDANCE WITH THE POLICY PROVISIONS. eio American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZEDREPRESENTATIVE Sunderland MA 01375 ` Y,/y,,,<_ lf�j=©(11988-2010 ACORD CORPORATION- All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD II Tethlogix PAGE:1 INVOICE:B I 351975 REMIT TO: INVOICE DATE: 04/14/14 BELL TECHLOGIX INC DUE DATE: 05/14/14 P.O. BOX 823342 PHILADELPHIA PA 19182-3342 TERMS:Net 30 317-333-7777 Net 30 Days 866-782-2355 } SHIPTO: BILLTO: 1201825 Carmel Police Dept CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE Pat Young PO#31534 ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 ORDER: 712724 ORDERDATE: 03/27/14 , CUSTOMER P0: 31534 � CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: JUANA YOUNCE CURRENCY: United States Dollars ITEM QUANTITY • LINE UNIT PRICE I NET AMOUNT ' DESCRIPTION - • Carmel Police Dept Cust PO Num: 31534 Contact name: Terry Crockett Phone: 3175712567x Email : tcrockett @carmel . in.gov Prices are based on State of Indiana QP PA contract pricing or better. BELL SO 712724 - 20104771 1 BE750G 14 EA 1, 327 . 62 APC BACK-UPS ES 750VA 10OUT 94 . 83 EA 120 VOLT MASTER CONTROL 2 NQ576AT 14 EA 242 . 20 HP LCD SPEAKER BAR 17 .30 EA SPEAKER 3 C9V73A8#ABA 28 EA 4, 645 . 76 ELITEDISPLAY E201 LED MONITOR 165 . 92 EA 20IN 1600 X 900 Line Lot/Serial Details: CNC40600KQ EA 1 CNC40600KR EA 1 CNC40600KS EA 1 CNC40600KT EA 1 CNC40600KV EA 1 CNC40600KW EA 1 CNC40600KY EA 1 CNC40600KZ EA 1 CNC40600LB EA 1 CNC40600LC EA 1 CNC40600LD EA 1 CNC40600LF EA 1 CNC40600LG EA 1 CNC40600LH EA 1 CNC40600LJ EA 1 CNC40600LK EA 1 FREIGHT CHARGE: GROSS AMOUNT: INVOICE DISCOUNT: NET AMOUNT: TAX AMOUNT: DOWN PAYMENT: NET AMOUNT DUE: jTechIogix PAGE:2 INVOICE:BI 351975 ' INVOICE DATE: 04/14/14 REMIT TO: DUE DATE: 05 14 14 BELL TECHLOGIX INC / / P.O. BOX 823342 PHILADELPHIA PA 19182-3342 TERMS:Net 30 317-333-7777 Net 30 Days 866-782-2355 SHIP TO: BILL TO: 1201825 Carmel Police Dept CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE Pat Young PO#31534 ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 USA ORDER: 712724 ORDERDATE: 03/27/14 CUSTOMER PO: 315 3 4 CARRIER: FREIGHTTERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: JUANA YOUNCE CURRENCY: United States Dollars ® QUANTITY UNIT PRICE NET AMOUNT DESCRIPTION CNC40600LL EA 1 CNC40600LM EA 1 CNC40600LN EA 1 CNC40600LP EA 1 CNC40600LQ EA 1 CNC40600LR EA 1 CNC40600LS EA 1 CNC40600LT EA 1 .CNC40600LW EA 1 CNC40600LY EA 1 CNC40600L0 EA 1 CNC40600L1 EA 1 4 U0J10E 28 EA 703 . 36 CARE PACK NBD 4 YEARS 25 . 12 EA EXTENDED SERVICE AGREEMENT 5 ISR-760-0007 14 EA 700 . 00 HARDWARE CONFIGURATION 50 . 00 EA 6 XP612AA 14 EA 1, 757. 28 NVIDIA QUADRO NVS 300 GRAPHICS 125 . 52 EA CARD 512 MB PAST DUE ACCOUNTS CARRY INTEREST AT THE LESSER OF 1 . 5°s PER MONTH OR THE MAXIMUM LEGAL RATE IN THE JURISDICTION IN WHICH THE CUSTOMER'S PRINCIPAL PLACE OF BUSINESS IS LOCATED **************************************** ALL DELIVERY TERMS ARE F.O.B. ORIGIN **************************************** TO REQUEST A STATEMENT OF ACCOUNT PLEASE CONTACT 866-782-2355 EXT 7787 **************************************** FEDERAL TAX ID# 26-3683994 **************************************** • FREIGHT CHARGE: GROSS AMOUNT: INVOICE DISCOUNT: NET AMOUNT: TAX AMOUNT: DOWN PAYMENT: NET AMOUNT DUE: Techlogix PAGE:3 INVOICE:BI 351975 REMIT TO: INVOICE DATE: 04/14/14 BELL TECHLOGIX INC DUE DATE: 05/14/14 P.O. BOX 823342 PHILADELPHIA PA 19182-3342 TERMS:Net 30 317-333-7777 Net 30 Days 866-782-2355 } SHIP TO: BILL TO: 1201825 Carmel Police Dept CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE Pat Young PO#31534 ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 USA ORDER: 712 7 24 ORDER DATE: 03/27/14 CUSTOMER PO: 31534 CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: JUANA YOUNCE CURRENCY: United States Dollars QUANTITY UNIT PRICE I NET AMOUNT DESCRIPTION FOR SERVICE CALL 1-800-999-9813 FREIGHT CHARGE: 0 . 0 0 GROSS AMOUNT: 9, 376 . 22 INVOICE DISCOUNT: 0 . 0 0 NET AMOUNT: 9 , 376 . 22 TAX AMOUNT: 0 . 00 DOWN PAYMENT: 0 . 00 NET AMOUNT DUE: 9, 376 . 22