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2014 Golf Car schedule 18 pay request 1 Lease 2014 — Sch # 18 (Brookshire Carts) Payment Request # 1 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 April 2, 2014 by and among the Escrow Agent, the Lessee and Lessor, to the person or corporation designated below as Payee,the suns 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: Midwest Golf&Turf Amount: $294,048 Description of Equipment Item Cost:68 golf carts and 2 utility vehicles Dated: April 30, 2014 • LESSEE: City of Carmel One Civic Square Carmel, CN 4 2 _ By: Name: Diana Cordray I Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE PAY VIA WIRE TRANSFER: PAGE I Invoice 105376 M O ® WES -T" Invoice Date 05/01/14 173 C::) L. F. ® r 1_.1 r Midwest Golf and Turf 10925 REED HARTMAN HIGHWAY SUITE 114 CINCINNATI,OH 45242-2840 USA Telephone:866/514-8873 Bill To: Ship To: CITY OF CARMEL CITY OF CARMEL BROOKSHIRE GOLF CLUB BROOKSHIRE GOLF CLUB 12120 BROOKSHIRE PARKWAY 12120 BROOKSHIRE PARKWAY CARMEL, IN 46033 CARMEL, IN 46033 Customer Ship Via F.O.B. Terms 20-039 CCI COLLECT ON DELIVERY Purchase Order Number Salesperson Order Date Our Order Number 20012 GRIF 04/30/14 86505 Quantity Ordered Quantity Shipped Item Number J Unit of Measure Unit Price Extended Price Back Ordered Item Description Discount /oI Tax 2 2 MISC EA 6604.00 13208.00 0 CARRYALL 300 GAS UTILITY VEHICLES N 68 68 CC105031301 EA 4130.00 280840.00 0 PRECEDENT 12 ELECTRIC HF CHG N Serial No. JE1441503597 JE1441503600 JE1441503603 JE1441503605 JE1441503610 JE1441503613 JE1441503616 JE1441503617 JE1441503619 JE1441503623 JE1441503627 JE1441503656 JE1441503657 JE1441503658 JE1441503659 JE1441503660 JE1441503661 JE1441503663 JE1441503664 JE1441503665 JE1441503667 JE1441503668 JE1441503669 JE1441503671 JE1441503672 JE1441503673 JE1441503675 JE1441503676 JE1441503677 JE1441503680 JE1441503681 JE1441503682 JE1441503684 JE1441503685 JE1441503686 JE1441503687 JE1441503689 JE1441503690 JE1441503691 JE1441503692 JE1441503693 JE1441503694 JE1441503695 JE1441503696 JE1441503697 JE1441503698 JE1441503699 JE1441503700 JE1441503702 JE1441503703 JE1441503704 JE1441503705 JE1441503707 JE1441503708 JE1441503709 JE1441503711 JE1441503712 (Continued) Customer Original Page 1 Invoice 105376 MIDWEST Invoice Date 05/01/14 C_r 0 I__ L ® .1-- L i !` F Midwest Golf and Turf 10925 REED HARTMAN HIGHWAY SUITE 114 CINCINNATI,OH 45242-2840 USA Telephone:866/514-8873 Bill To: Ship To: CITY OF CARMEL CITY OF CARMEL BROOKSHIRE GOLF CLUB BROOKSHIRE GOLF CLUB 12120 BROOKSHIRE PARKWAY 12120 BROOKSHIRE PARKWAY CARMEL, IN 46033 CARMEL, IN 46033 Customer Ship Via F.O.B. Terms 20-039 CCI COLLECT ON DELIVERY Purchase Order Number Salesperson Order Date Our Order Number 20012 GRIF 04/30/14 86505 Quantity Ordered Quantity Shipped. Item Number I Unit of Measure Unit Price Extended Price Back Ordered Item Description Discount%I Tax JE1441503713 JE1441503715 JE1441503716 JE1441503717 JE1441503718 JE1441503720 JE1441503721 JE1441503722 JE1441503723 JE1441503724 JE1441503725 1 1 CC105166801 EA 0.00 0.00 0 DEIONIZER-BATTERY-FLOWRITE N Nontaxable Subtotal 294048.00 Taxable Subtolal 0.00 Tax(7.000%) 0.00 Total Invoice 294048.00 Customer Original Page 2 A o®CERTIFICATE OF LIABILITY INSURANCE 417/2014 DATE(M MIDD_M/YY) _ 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(les)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). coNTAd1 PRODUCER NAME: Marianne Uban Hylant Group PHONE INC.No.Exu:317-817-5136 FAX(NC,No):317-817-5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 .ADORESS:marianne.uban@hylant corn INSURER(S)AFFORDING COVERAGE NAIC II INSURER A Chatter Qak Fire_Ins.utaDcR Co 75615 INSURED CARME80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER D: Carmel,IN 46032 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1974507391 REVISION NUMBER: ' PERIOD THIS IS TO THAT THE.NDICATED.CNOTTWITHSTANDINGOANYIREQUIREMENT, TERM OR CONDITION OF BANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLIWHICH THIS ,ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 APEX SUER POLICY EFF POLICY EXP LIMITS • LTR TYPE OF INSURANCE INSR MD POLICY NUMBER (MMIDD/YYYYL JMM/DDIYYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2014 111/2015 EACH OCCURRENCE 52,000,000 DAMAGE TO RENTED x50,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocwrrencel CLAIMS•MADE IX I OCCUR MED EXP(Any one person) SExduded PERSONAL d ADV INJURY $2,000,000 GENERAL AGGREGATE 52,000,000 PRODUCTS-COMP/OP AGG 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: — PRO S POLICY •�{;T LOC COMBINED SINGLt LIMI1 A AUTOMOBILE LIABILITY H8103036P64ACOF14 1/1/2014 1/1/2015 (Ea BINEDt) 52,000000 BODILY INJURY(Per person), S X ANY AUTO ALL OWNED — SCHEDULED BODILY INJURY(Per accident) S AUTOS — AUTOS NON OWNED PROPERTY DAMAGE S HIRED AUTOS _ AUTOS (Per accident) X Comp x Coll Comp/Coll Ded 52,500 UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S S DED RETENTION S - • OTH- WORKERS COMPENSATION I WC STATUTORY LIMITS - FR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT 3 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE•EA EMPLOYEEI S II yes,describe under E.L.DISEASE•POLICY LIMIT 1I S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace 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&Assignees ACCORDANCE WITH THE POLICY PROVISIONS. Go American Lease Insurance 654 Amherst Rd., Ste.335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 0-1 41 t- 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD •