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2015 Police Schedule 24 pay request 11 060115 Lease 2015 — Sch # 24 (Police Dept.) Payment Request # 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 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: Scanner Master Amount: $43,672.00 Description of Equipment Item Cost: police scanners Dated: 05/28/15 LESSEE: City of Carmel One Civic Square Carmel,IN 46132 By: a.r B - Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) Wire transfer information included on separate sheet. PAGE 1 E ti-NER MASTER 260 Hopping Brook Road INVOICE Holliston,MA 01746 Date: Order#: P: 508-474-6880 F:508-429-0800 04/24/2015 181526 www.scannermaster.com sales @scannermaster.wm Order Comments: Payment Terms: NET 30-price indudes 3 counties programming.Radios will ship without wifi dongles,ac adapters,usb cables and telescoping antennas.Scanner Master will provide out of the boxes 5 AC adapters and 5 USB cables. Bill To:(Customer ID#154221) Ship To: Cannel Police Dept City of Carmel Attn: Pat Young Carmel Police Dept. 3 Civic Square 3 Civic Square Carmel,IN 46032 Carmel,IN 46032 United States United States 317-571-2559 317-571-2559 tiuckosld @carmel.in.gov Payment Method: Shipping Method: Purchase Order#32841 U.P.S.Ground Code Description Qty Price Total 10-501854 Uniden Bearcat BCD536HP Police Scanner 80 $515.00 $41,200.00 10-531824 Uniden 4"External Speaker(BC15) 80 $27.50 $2,200.00 Subtotal: $43,400.00 Tax: $0.00 Shipping&Handling: $272.00 Grand Total: $43,672.00 Young, Patricia A From: Monique Bennet [monique @scannermaster.com] Sent: Thursday, May 28, 2015 12:56 PM To: Young, Patricia A Subject: Scanner Master wire instructions Hi Pat, Per your request below are the instructions for a wire to pay our invoice 181526 in the amount of $43,672.00. I am also putting the ACH Routing # incase you prefer that method. SWIFT# BOFAUS3N Acct# 004613565624 Account Name: Scanner Master Corp Wire Routing# 0260-0959-3 ACH Routing#011000138 Bank of America 209 East Main Street Milford, MA 01757 Have a great day! Monique Monique Bennet Scanner Master Corp. 260 Hopping Brook Road Holliston, MA 01746 P 508-474-6856 F 508-429-0800 scannermaster.corn Please Note: I am in the office Tuesday and Thursday only. �Ac E® CERTIFICATE OF LIABILITY INSURANCE 1I�3/2�15D/YYYY) 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 A/cC.NO.Exo:317-817-5136 FAX,No):317-817-5151 301 Pennsylvania Parkway,#201 o En SS:marianne.uban h lant.com Indianapolis IN 46280 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Chatter 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 ADDL S POLICY EFF POLICY EXP LTR TYPE OF INSURANCE N W SR VD POLICY NUMBER (MM1DDlYYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY 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&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY PRO- JECT LOC $ A AUTOMOBILE LIABILITY H8103036P64ACOF15 1/1/2015 1/1/2016 COMBINED 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/Co€I Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN CORY LIMITS ER — ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L EACH ACCIDENT $ OFFICERJMEMBER 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 1 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. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD