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2014 Police Schedule 17 pay request 20 011515 16Lease 2014 — Sch # 17 (Police Dept.) Payment Request # 2014-20 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: All Traffic Solutions Amount: $16,215.00 Invoice: SIN0061.88 LESSEE: City of Carmel One Civic Square Carmel 46(132 � � By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: All Traffic Solutions 3100 Research Drive State College, PA 16801 PAGE I ALL TRAFFIC SOLUTIONS. r":4'1'k INVOICE A n;v of thefirrrua- A division of Intuitive Control Systems, LLC 3100 Research Drive, State College, PA 16801 Invoice No. Invoice Date Phone: 814-237-9005 Fax: 814-237-9006 SIN006188 12/29/2014 Tax ID: 25-1887906 DUNS: 001225114 Order No. Customer Purchase Order SO-006467 32232 Bill To: Ship To: City of Carmel City of Carmel Attn: Pat Young Michael Mabie 3 Civic Square 3400 W Main St Carmel, IN 46032 Carmel, IN 46074 Michael Mabie Payment Shipping Ship Via Terms Instructions Net 30 Item No. Description Qty Qty Qty Unit Ext Price Ord Ship Back Price 4000745 SpeedAlert 24 Radar Message Sign (RMS); base. 1.0 1.0 $9,000.00 $9,000.00 unit(select mount separately) 24975214016030 4000772 App, Traffic Suite (24mo); Equip Mgmt, Reporting, 1.0 1.0 $2,850.00 $2,850.00 Image Mgmt, Alerts, Mapping and PremierCare 4000762 Trade-in CREDIT: Non-ATS radar message display 1.0 1.0 ($1,650.00) ($1,650.00) 4000173 Trailer, ATS5 (select power separately) 1.0 1.0 $3,200.00 $3,200.00 1b9af5114ep825326 4000636 Trailer Battery kit, 470Ah deep cycle batteries 1.0 1.0 $990.00 $990.00 w/cover, hold down, cables& hdwr 4000275 Solar panel, 60W; includes bracket for trailer and 1.0 1.0 $895.00 $895.00 harness 4000874 All Options Activation: Bluetooth, Traffic Data, 1.0 1.0 $0.00 $0.00 Violator Alert, Pictures, ($3000 Value, requires Traffic or Message Suite) 4000740 Trailer Certificate of Origin 1.0 1.0 $0.00 $0.00 4000754 USB cable, 16ft, extra long for trailer or pole 1.0 1.0 $0.00 $0.00 4900041 crate, ATS-5 trailer shipping crate 1.0 1.0 $250.00 $250.00 4000829 GSM H5 3G communications prep 1.0 1.0 $0.00 $0.00 Sale Amount $15,535.00 Shipping $680.00 Sales Tax $0.00 Remit payment to the address listed above. Balance DUE: $16,215.00 A Finance Charge of 1.5% per month will be applied to overdue balances. A o CERTIFICATE OF LIABILITY INSURANCE 1/13/2015 TE(MMI Dpi 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 NAME: Marianne Uban Hylant Group INC.No.Exh317-817-5136 lac.No):317 817-5151 301 Pennsylvania Parkway,#201 E-MAIL s:marianne.uban h lant.com Indianapolis IN 46280 @ Y INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARM E80 INSURER B: City of Carmel INSURER C: One Civic Square INSURER D: Carmel, IN 46032 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:682333440 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 I 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 TYPE OF INSURANCE INSR WVD POLICY EFF POLICY EXP POLICY NUMBER R /Y LIMITS (MM/DDYYY) (MM/DDIYYYYI A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED $50,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) $0 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —I POLICY— PRO n LOC JECT A AUTOMOBILE LIABILITY H8103036P64ACOF15 1/1/2015 1/1/2016 COMBINED SINGLE LIMIF (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 I WO STATU- OTH- AND EMPLOYERS'LIABILITY Y I N I TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N 1 A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS!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. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 Ala ft. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD