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2014 Police Schedule 17 pay request 17 16Lease 2014 — Sch # 17 (Police Dept.) Payment Request # 2014-17 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 alllof 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: Motorola Solutions, Inc. Amount: $6,600.00 • Invoice: 13023503 Description of Equipment Item Cost: 8 x Covert Pack-N-Go Kit Dated: September 8, 2014 LESSEE: City of Carmel One Civic Square Carmel, IN 41 132 1 By:Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Motorola Solutions, Inc. 13108 Collections Center Drive Chicago, IL 60693 PAGE I MOTOROLA INVOICE Page 1 of 1 MOTOROLA SOLUTIONS,INC. 1301 E.Algonquin Road TOTAL INVOICE AMOUNT: $6,600.00 Schaumburg, IL 60196 MOTOROLA INVOICE NUMBER: 13023'503 INVOICE DATE: 08/13/2014 Visit our website at:www.motorola.com PAYMENT DUE: 09/12/20I4 CUSTOMER ACCOUNT NUMBER: 1036441509 0007 PURCHASE ORDER DATE: 0//21/2014 YOUR P.O.#: 32094 27 BILL TO CARMEL, CITY OF SHIP TO CARMEL POLICE DEPT 3 CIVIC SQUARE 3 CIVIC SQUARE CARMEL, IN 46032 CARMEL, IN 46032 For questions concerning this Invoice please contact Motorola at: 1-888-567-7347 00034-00034-00034 Payment Terms: NET 30 DAYS FROM INVOICE DATE Motorola Solutions, Inc. Federal Tax Id: 36-1115800 Sales Order Number: 0958180090269 __. -_U.itimate Destination:_ CARMEL POLICE DEPT, 3 CIVIC SQUARE, CARMEL, IN 46032 Invoice Detail Item Model Number Qty Description Unit Price Amount 1 RLN6501A 8 COVERT PACK-N-GO KIT, ADVANCED 825.00 6,600.00 SUBTOTAL 6,600.00 Carrier: ABF PLEASE PAY THIS AMOUNT (PAYMENT DUE: 09/12/2014) 6,600.00 Detach here and return bottom portion with your payment. Payment Coupon INVOICE NUMBER CUSTOMER ACCOUNT NUMBER PAYMENT DUE 13023503 1036441509 0007 09/12/2014 Invoice Total Amount Paid $6,600.00 c k000 oc Please put your Invoice Number and your Customer Account Number — on your check for prompt processing. Send Payment To: CARMEL, CITY OF ',£M_ MOTOROLA 3 CIVIC SQUARE MOTOROLA SOLUTIONS,INC. CARMEL, IN 46032 13108 COLLECTIONS CENTER DRIVE CHICAGO, IL 60693 0103000203050003 1036441509 0007 0000 081314 0000660000 08 Ac'° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) 4/210014 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 Itilco.No.E d):317-817-5136 (AIC,No):317-817-5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDRESS:marianne uban@hylant.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: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. 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 ADDL SUER I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER I(MMIDDIYYYY) (MMIDD!YYYY LIMITS A GENERAL LIABILITY Y ZLP14T62033 1/1/2014 1/1/2015 EACH OCCURRENCE $2,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrrence)_ $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) SExcluded 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 PRO- LOC $ JECT A AUTOMOBILE LIABILITY H8103036P64ACOF14 1/1/2014 1/1/2015 COMBINkD SINGLE LIMIT (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 $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE ,$ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y!N ,TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE r 1 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 I LOCATIONS I VEHICLES (Attach ACORD 101,Addttional 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 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. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 4M-1 tiv-ft ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD