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2015 Police schedule 24 pay request 3 042015 Lease 2015 — Sch # 24 (Police Dept.) Payment Request # 3 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 5, 2015. 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: American Aluminum Amount: $5,121.98 Description of Equipment Item Cost: Equipment for new K9 vehicles Dated: 04/16/2015 LESSEE: City of Carmel One Civic Square Carmel,IN 46032 By: :� ' . Name: Diana Cor ray ' Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: American Aluminum Accessories, Inc. 3882 South Byron Butler Parkway Perry, FL 32348 PAGE 1 Invoice ® 4/2/2015 Invoice# i AMERICAN ALUMINUM/s LUM�NUM Perry,FL/�i A I Date 73294 1-500-277-0$69 ACC E S S O R I E S , I N C. Website: ezrideronline.com Ship To Bill To Carmel Police Dept. I Carmel City Garage Pat Young j Brian Schmidt 3 Civic Square 3400 W 131st Street Carmel,IN.46032 Carmel, IN 46074 317-571-2500 317-571-2559 F.O.B. Via Rep ! P.O. No. Terms Ship S.O. Number origin Con-way Fre... MW 32804 Net 30 4/2/2015 71449 Quantity Item Code I Description Price Ea... Class BO Ordered Amount 2 E7_PF_INT... E/Z-Rider K9 Platform Unit for an 1,775.00 K9 0 2 3.550.00 Interceptor SUV *Includes Window Guards and Door Panels* ****CUT LID BACK 2"**** 2 PC_Matte FREE Optional Matte Black Powder 0.00 K9 0 2 0.00 Coating 2 Rubber Mat... Deluxe,Non-Toxic, Custom Fit Rubber 137.00 K9 0 2 274.00 Liner 2 Water Dish Spill-proof, bracket mounted aluminum 89.00 K9 { 0 2 178.00 water dish. 2 Lexan-Bloc... Lexan Block Out Kit 295.00 K9 0 2 590.00 Kit Includes: 2 Front.Panel Custom Fit Lexan Block Outs Rear Window Custom Fit Lexan Block Out i I Intended Purpose is to help keep canine hair from traveling through out the vehilce. 1 Freight Shipping 529.98 K9 I 529.98 I ConWay tracking#310-431391 2%discount is available when you pay withing 10 days from invoice date. Total I USD 5,121.98 **Please note that a 30% Re-Stocking Fee will be applied to Balance Due USD 5,121.98 all returns that are not covered by our Warranty Policy.** ACO DATE(MMIDD/Y'YYY) CO CERTIFICATE OF LIABILITY INSURANCE 1/13/2015 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 Uhan Hylant Group la°N.Extt:317-817-5136 FAc, 1:317-817-51 51 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDRESS:marianne.uban@hylant.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 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 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 -AWL BURR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MMIDOIYYYY) (MMIDD/YYYY) A GENERALLIABIUTY Y ZLP14T62033 1/1/2015 1/1/2016 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) $0 PERSONAL 8 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-7 LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF15 1/1/2015 1/1/2016 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 X ANY AUTO BODILY INJURY(Pei-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 WC STATU- OTH- AND EMPLOYERS'UABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 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&Assignees ACCORDANCE WITH THE POLICY PROVISIONS. do American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 fAuti 1-ft- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD