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2015 Police schedule 24 pay request 14 063015 Lease 2 015 — Sch # 24 (Police Dept.) Payment Request # 14 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: Express Graphics Amount: $5,162.00 Invoice: 89015 & 88836 Description of Equipment Item Cost: Lettering for new police vehicles Dated: 06/29/15 0/0-1 LESSEE: City of Carmel One Civic Square - Carmel, IN 46032 By: Name: l iana or ay Title: Clerk Treasurer (Attached duplicate original of Payee's statement) Make check payable to: Express Graphics 620 S.Range Line Rd Carmel,IN 46032 PAGE 1 Invoice Page 1 oft IExpress Graphics Invoice: 88836 620 S Range Line Rd. Suite D 1 i Carmel, IN 46032 ph.: {317)580-9500 PO#: 32808 fax:. (317)580-9550 Due Date: Mon, 3/30/2015 email: Service @ExpressGraphicsUSA.com ATTN: Pat Young Install at Carmel Police Station/Sallyport Carmel Police Dept. 3 CIVIC SQUARE CARMEL, IN 46032 Description: Speed Traffic Trailer Graphics-Produced&Installed/2015 Customer: Johnathon Foster ph: (317)571-2570 x Office Carmel Police Dept. fax: 571-2512 Sales Person: Vanessa Suiter email: jafoster @carmel.in.gov Product Font Qty Sides Height Width Unit Cost Item Total 1 Graphics Pkg similar to 74607 1 1 0 0 $109.00 $109.00 Color: Navy/Silver/Shield on white trailer Description: Speed Traffic Trailer to be Lettered on 3 sides w/Highest Performance Exterior Grade 3M Vinyl Graphics+ Digitally Printed Shield w/UV Protective Overlaminate **NON-REFLECTIVE GRAPHICS** Text: <Speed Traffic Trailer Graphics-similar to 2011 design>-ADD: New 2014 Shield Art 1.A Installation 1 1 0 0 $0.00 $0.00 Color: Description: Installation of Graphics at Police Station Sallyport. Cost included in above. Text: 2 Graphics Pkg similar to 74607 1 1 0 0 $109.00 $109.00 Color: Navy/Silver/Shield on white trailer Description: Old Speed Traffic Trailer to be Stripped& ReLettered on 3 sides w/Highest Performance Exterior Grade 3M Vinyl Graphics+ Digitally Printed Shield w/UV Protective Overlaminate *`NON-REFLECTIVE GRAPHICS** Text: <Speed Traffic Trailer Graphics-similar to 2011 design>-ADD: New 2014 Shield Art 2.A Installation 1 1 0 0 $0.00 $0.00 Color: Description: Strip existing Shields from Olf Traffic Trailer, Prepare for New Graphics Text: ATTN: Pat Young All Payments are due at our offices within 30 days of order completion or additional interest of 1.5% per month will be assessed. Received/Accepted By: / / A World of Possibilities! Invoice Page2of2 Express Graphics Invoice: 88836 620 S. Range Line Rd. Suite D Carmel, IN 46032 ph.: (317)580-9500 PO#: 32808 fax:. (317)580-9550 Due Date: Mon, 3/30/2015 email: Service @ExpressGraphicsUSA.com ATTN: Pat Young Install at Carmel Police Station/Sallyport Carmel Police Dept. 3 CIVIC SQUARE CARMEL, IN 46032 Other Payments: Ordered: 3/24/2015 5:25:18PM Form of Payment 1 Amount I Initial; PickedUp: 6/26/2015 10:30:47AM Printed: 6/26/2015 10:45:44AM Notes: Status: Picked-Up Install Week of 3-30-15-Coordinate with John Foster Line Item Total: $218.00 Tax Exempt Amt: $218.00 Subtotal: $218.00 Taxes: $0.00 Total: $218.00 Total Payments: $0.00 Balance Due: $218.00 ATTN: Pat Young All Payments are due at our offices within 30 days of order completion or additional interest of 1.5% per month will be assessed. ReceivedlAccepted By: / A World of Possibilities! Invoice Page 1 of2 Express Graphics Invoice: 89015 7( 620 S. Range Line Rd. Suite D Carmel, IN 46032 ph.: (317)580-9500 PO#: 32808 fax:. (317)580-9550 Due Date: Tue, 5/19/2015 email: Service @ExpressGraphicsUSA.com ATTN: Pat Young Carmel Police Dept. 3 CIVIC SQUARE CARMEL, IN 46032 Description: Ford Utility Interceptor Patrol Vehicle Fleet&K-9 Unit Graphics for 2015-Prod&Installed Customer: Johnathon Foster ph: (317)571-2570 x Office Carmel Police Dept. fax: 571-2512 Sales Person: Vanessa Suiter email: jafoster @carmel.in,gov Product Font Qty Sides Height Width Unit Cost Item Total 1 Vehicle Lettering same as 2014 14 1 0 0 $309.00 $4,326.00 Color: Navy/Silver/Badge Description: (14)2015 Ford Utility Interceptor Patrol Vehicles to be lettered on 2 sides&rear w/Highest Performance Exterior 3M Vinyl Graphics+ Digital Print Shield& Crimestopper Graphics w/UV Protective Overlam. Cost includes installation. Text: <Ford Utility Interceptor Patrol Vehicle Graphics-same as 2014> ***Includes Crimestopper Decal.See A&CDR for unit#'s. 2 Vehicle Lettering similar to 2014 2 1 0 0 $309.00 $618.00 Color: Nvy/Slvr/030DkRd/Badge Description: (2)2015 Ford Utility Interceptor K-9 Patrol Vehicles to be lettered on 2 sides&rear w/Highest Performance Exterior 3M Vinyl Graphics+ Digital Shield&Crimestopper Graphics w/UV Protective Overlam. Cost Includes Crimestopper Decal&New Setup/Design of Graphics with K-9 Markings. Cost includes installation. Text: <Ford Utility Interceptor K-9 Patrol Vehicle Graphics-similar to 2014 Interceptor design> 2.A Installation 1 1 0 0 $0.00 $0.00 — Color: Description: NOTE:All installs/work to be performed at the city garage, located at 3400 W. 131st St Carmel, IN 46032. ***ALL PRICING INCLUDES INSTALLATION/LABOR/MATERIALS/DESIGN/TRIP CHARGES*** Text: ATTN: Pat Young All Payments are due at our offices within 30 days of order completion or additional interest of 1.5% per month will be assessed. Received/Accepted By: / / A World of Possibilities! Invoice Page2of2 I IExpress Graphics Invoice: 89015 620 S. Range Line Rd. Suite D Carmel, IN 46032 ph.: {317)580 9500 PO#: 32808 fax:. (317)580-9550 Due Date: Tue, 5/19/2015 email: Service @ExpressGraphicsUSA.com ATTN: Pat Young Carmel Police Dept. 3 CIVIC SQUARE CARMEL, IN 46032 Other Payments: Ordered: 4/9/2015 8:28:38PM Form of Payment / Amount / Initial; PickedUp: 6/25/2015 12:26:04PM Printed: 6/25/2015 12:26:37PM Notes: Status: Picked-Up Line Item Total: $4,944.00 Tax Exempt Amt: $4,944.00 Subtotal: $4,944.00 Taxes: $0.00 Total: $4,944.00 Total Payments: $0.00 Balance Due: $4,944.00 ATTN: Pat Young All Payments are due at our offices within 30 days of order completion or additional interest of 1.5% per month will be assessed. Received/Accepted By: / / A World of Possibilities! ACORCP CERTIFICATE OF LIABILITY INSURANCE 1/13/2015 DATE(MM/D/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: rl ne Uban Hylant Group (A/C"n.Ext1:317-817-5136 FAX,No):317 817 5151 301 Pennsylvania Parkway,#201 E-MAIL ss:marianne uban hvlant.com Indianapolis IN 46280 �? INSURER(S)AFFORDING COVERAGE NAIC B 4SURERA: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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER JMMIDD/YYYY) (MMIDDIYYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE MI ( RENTED _ PREEMISES S 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 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/Coll Ded $2,500 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- 1 OTH- AND EMPLOYERS'LIABILITY Y 1N TORY LIMITS I ER ANY PROPRIETORlPARTNER/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 I 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. c/o American Lease Insurance 654 Amherst Rd., Ste. 335 AUTHORIZED REPRESENTATIVE Sunderland MA 01375 hat 1 -©1988-2010 ACORD CORPORATION. All rights reserved. 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