2014 Police Schedule 17 pay request 10 •
Lease 2014 — Sch # 17 (Police Dept.)
Payment Request # 2014-10
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 18,2014 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: Safety Systems
Amount: $65,401.43
Description of Equipment Item Cost:
Equipment for Police Vehicles
Dated: June 20, 2014
LESSEE:
City of Carmel
One Civic Square
Carmel,IN 46032 ..��
BY ^._/ . ®• _
Name: Liana Cord y
Title: Clerk Treasurer
(Attached duplicate original of Payee's statement)
PLEASE MAIL CHECK TO: Safety Systems
4113 Turner Rd.
Richmond, IN
47374
PAGE I
Safety Systems P
4113 Turner Road
Richmond, IN 47374 Invoice Number: 1461312
Invoice Date: Jun 13, 2014
Page: 1
Voice: 765-935-3566 Duplicate
Fax: 765-935-9713
Shipf3o y
Carmel Police Department
3 Civic Square
ATTN: Pat Young
Carmel, IN 46032
Customer ID::r �` b ,gCustomer PO °'° ` ' iPa mentTerms :. "
Carmel P.D. 31948 Net 30 Days
Hand Deliver 7/13/14
Quantity., . Er "' a Iterrt,`. (,. .,, ` f ' r P 'EDescriptiorl ,Unit Price ,.`, ,,. Amount
2.00 Whelen Flat Lighter 17300 346.00
18.00 Blue Whelen ION 74.90 1,348.20
18.00 Red Whelen ION 74.90 1,348.20
18.00 Pace Cabinet with Havis Lift 1,905.95 34,307.10
17.00 Havis Arm Rest(C-ARM-103) 72.77 1,237.09
14.00 Pro Guard Pro Cell 1/2 Cage 1,534.40 21,481.60
17.00 Whelen License Plate Bracket (RBKT6) 12.12 206.04
17.00 Whelen TIR3 Blue 48.50 824.50
17.00 Whelen TIR3 Red 48.50 824.50
17.00 Whelen Mirror Beams (MBFX11RB) 204.60 3,478.20
Subtotal 65,401.43
Sales Tax
Total Invoice Amount 65,401.43
Check/Credit Memo No: Payment/Credit Applied
TOTAL