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2014 Police Schedule 17 pay request 11 Lease 2014 — Sch # 17 (Police Dept.) Payment Request # 2014-11 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: Best Buy Business Advantage Account Amount: $3,061.99 Description of Equipment Item Cost: iPad Air& accessories x 3 Dated: June 20, 2014 LESSEE: City of Carmel One Civic Square Carmel,IN 46032 By: 1 _� Name: liana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Best Buy Business Advantage Account PO Box 731247 Dallas, TX 75373-1247 PAGE I Ate® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) 4/21/2014 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: .Mar(anne__Jban Hylant Group (A/c..PHONE NO ialc, ei:31 7 817 5151 301 Pennsylvania Parkway,#201 E-MAIL ndianapolis IN 46280 ss:marianne.uban h lant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Charter Oak Fire Insurance Co 25615 INSURED CARME80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER 0: Carmel, IN 46032 INSURER E: 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 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 ADDL INSR SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS {M M ID DIYYYYI I M MID DlYYYY) A GENERAL LIABILITY Y ZLP14T62033 11112014 1/1/2015 EACH OCCURRENCE $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 7 POLICY PRO LOC $ JECT A AUTOMOBILE LIAB€LITY H8103036P64ACOF14 1/1/2014 1/1/2015 COMBINED SINGLE LIMIT- (Ea accident) $2.000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS PROPERTY DAMAGE(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 M3 STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE- N!A 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!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 Certificate Holder is an Additional Insured 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& It's Assignors&Assignee$ ACCORDANCE WITH THE POLICY PROVISIONS. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 M1 { ,t JD�y ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD o BES11. Customer Number 9181 WayBusiness Advantage Account Invoice Number 1620495 Invoice Date 06/11/2014 Invoice Amount $3,061.99 Account Number 605126 2537 Page 2 of 2 Please send payments 10: \ (--;\C'1•Bell Buy Business Advantage Account Amount Paid: PO Box 731247 Dallas,IX 7.5373-1247 USA CITY OF CARMEL POLICE TERESA ANDERSON 3 CIVIC SQUARE CARMEL IN 48032 United States CDR Duns+4 number:09 6754882 8809;Cage Code:6PKR4 009720019883506112014 228444335 Bill To: I Ship To: CITY OF CARMEL POLICE ' PAT YOUNG TERESA ANDERSON 3 CIVIC SQ 3 CIVIC SQUARE CARMEL IN 46032 CARMEL IN 46032 United States United States Invoice Number: Account Number. Purchase Order Number: Reference Number: 1620495 605126 2537 31994 009720019883506112014 Order Number: I Contract Number: Project Number: Location: _2284.94Z3.5__....- INVOICE DETAIL Manufacturer Extended Qty SKU Manufacturer Name Number Model Description RatelPrice Amount 3 6819301875 Logitech-Uttrathin Portfolio $80.01 $240.03 13/319325654 Apple?-iPad?Air with 1M-Fi $799.99 $799.99 3 8811616211 Dynex?-6'HDMI Cable $19.99 $59.97 3 B812202126 Apple&6174:TV-digital multi $99.99 $299.97 2 BB19325545 Apple?-Pad?Air with WM-Fi $799.99 $1.599.98 Shipping $62.05 Total $3,061.99 Product: $2,999.94 FULLY TAX EXEMPT Shipping s3,$61 .05 Account updates&billing inquiries may be submitted via our Best Buy Business Advantage Account website at https://bestbuybusinessadvantageaccount.com or call Customer Support at 800-201-4882 Send mail to 8650 College Boulevard,Overland Park,KS 66210 or Customer.Supportibbadvantage.com For sales inquiries call 800-373-3050 Confidential CO Multi Service Technology Solutions, Inc. 2014