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2014 Police Schedule 17 pay request 18 093014 Lease 2014 — Sch # 17 (Police Dept.) Payment Request # _18 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: L3 Communications Amount: $1,449.00 Description of Equipment Item.Cost: 12 Mount Antennas Dated: 09/25/14 LESSEE: City of Carmel One Civic Square Carmel,IN 46032 By: f!t Name:'Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE PAY: L3 Communications Mobile—Vision, Inc. 90 Fanny Road _ Boonton, NJ 07005 PAGE I ID Invoice communications .. Mobile-Vision, Inc. Invoice Number: 0216970-IN 90 Fanny Road Invoice Date: 9/16/2014 Boonton, NJ 07005 Phone: (800) 336-8475 Order Number: 0132815 Fax: /97311 257-3024 Order Date 9/15/2014 1 1 Salesperson: ZLMB Tracking Number: 1zx5x9890368440640; Customer Number: INCARME Sold To: Ship To: Carmel Police Department Carmel Police Department 3 Civic Square 3 Civic Square Attn:Brian Smith Attn:Brian Smith Carmel,IN 46032 Carmel, IN 46032 Confirm To: Brian Smith Page: 1 Customer P.O. Ship VIA F.O.B. Terms 32461 UPS GROUND BOONTON, NJ Net 30 Days Item Number Unit Ordered Shipped Back Order Price Amount MVD-DM2-24/55BK EACH 12.00 12.00 0.00 119.00 1,428.00 Stud mount antenna 18'cables(RF-195&RG-174)with SMA/SMA bolt configuration(not m Whse: 000 PLEASE REMIT PAYMENT TO L-3 COM MOBILE VISION, INC Subtotal: 1,428.00 PO BOX 5580 NEW YORK NY 10087-5580 Ship/Handling: 21.00 Sales Tax: 0.00 Invoice Total: 1,449.00 These commodities are controlled under the Export Administration Regulations(EAR)and may not be exported without proper authorization by the US Dept of Commerce. DATE(MWDDNYYY) ACoR[7 CERTIFICATE OF LIABILITY INSURANCE 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: Mariann Uban Hylant Group 301 Pennsylvania Parkway,#201 (A/C. Exu;317-817 5136 FAX No):317-817-5151 Indianapolis IN 46280 ADDRESS:marlanne.ubanan.hylant.com INSURERS)AFFORDING COVERAGE NAIC S INSURERA: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 S LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER I POLICY EFF POLICY EXP LIMITS (MMlDDlYYYY) (MMIDDlYYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2014 1)112015 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 POLICY JECT LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF14 1/1/2014 1/112015 COMBINED SINGLE LIMI (Ea accident) 000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTOS PROPERTY DAMAGE TOS $ (Per accident) Comp X Coll Comp/Coll Ded $2,500 UMBRELLA LIAR — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N!A EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS 1 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&Assignees ACCORDANCE WITH THE POLICY PROVISIONS. do American Lease Insurance 654 Amherst Rd.,Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375U ity,,,>< ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD