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2015 Police Schedule 24 pay request 18 092915 Lease 2015 — Sch # 24 (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 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: Best Buy Business Advantage Amount: $983.95 Description of Equipment Item Cost: Ipad Air 2 Wi-Fi and accessories Dated: 09/28/15 LESSEE: City of Carmel One Civic Square Carmel, /- 1 032 J By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) Make check payable to: Best Buy Business Advantage Account PO Box 731247 Dallas,TX 75373-1247 PAGE 1 BESTo Customer Number 9181 Business Advantage Account Invoice Number 2005385 Invoice Date 09/09/2015 Invoice Amount $833.96 Payment Options Account Number 605126******2537 Check ACH/Wire Page 2 of 2 Please detach and send this remittance slip Please send payments to: Due Date: 10/18/2015 with your payment to: JPMorgan Chase Best Buy Business Advantage Account ACH ABA Number:103000648 PO Box 731247 Wire ABA Number:021000021 Dallas,TX 75373-1247 Account Number:837393818 USA City of Carmel Police Department Please make checks payable to:Best Buy Business Advantage Account Pat Young Remittance advice can be included with a check payment or emailed to 3 Civic Square remittance@bbadvantage.com. Carmel IN 46032 CCR Duns+4 number:09 675 4882 BB09; Cage Code: 5PKR4 United States 009720013525109092015 231145000 Bill To: Ship To: City of Carmel Police Department PAT YOUNG Pat Young 3 CIVIC SQ 3 Civic Square CARMEL IN 46032 • Carmel IN 46032 United States United States Invoice Number: Account Number: Purchase Order Number: Reference Number: 2005385 605126******2537 33056 009720013525109092015 Order Number: Contract Number: Project Number: Location: 231145000 INVOICE DETAIL Manufacturer Extended Qty SKU Manufacturer Name Number Model Description Rate/Price Amount 1 BB19624607 Apple-iPad Air 2 Wi-Fi 128GB $699.99 $699.99 1 BB12443233 Apple®Lightning to VGA $49.99 $49.99 1 BB12435751 Apple®Lightning Digital $44.99 $44.99 1 BB10999177 Logitech-Presentation Pointe $38.99 $38.99 Total $833.96 Product: $833.96 FULLY TAX EXEMPT Total: $833.96 Account updates&billing inquiries may be submitted via our Best Buy Business Advantage Account website at https://bestbuybusinessadvantageaccount.com or call Customer Support at 800-201-4882 Send mail to 8650 College Boulevard, Overland Park, KS 66210 or Customer.Support@bbadvantage.com For sales inquiries call 800-373-3050 Confidential ©Multi Service Technology Solutions, Inc. 2015 BESO T Customer Number 9181 BUYBusiness Advantage Account Invoice Number 2013390 Invoice Date 09/09/2015 Invoice Amount $149.99 Payment Options Account Number 605126****"2537 Check ACH/Wire Page 3 of 3 Please detach and send this remittance slip Please send payments to: Due Date: 10/25/2015 with your payment to: JPMorgan Chase Best Buy Business Advantage Account ACH ABA Number:103000648 PO Box 731247 Wire ABA Number:021000021 Dallas,TX 75373-1247 Account Number:837393818 USA City of Carmel Police Department Please make checks payable to:Best Buy Business Advantage Account Pat Young Remittance advice can be included with a check payment or emailed to 3 Civic Square remittance@bbadvantage.com. Carmel IN 46032 CCR Duns+4 number: 09 675 4882 BB09; Cage Code: 5PKR4 United States 009720013525109092015 231145000 Bill To: Ship To: City of Carmel Police Department PAT YOUNG • Pat Young 3 CIVIC SQ 3 Civic Square CARMEL IN 46032 Carmel IN 46032 United States United States Invoice Number: Account Number: Purchase Order Number: Reference Number: 2013390 605126******2537 33056 009720013525109092015 Order Number: Contract Number: Project Number: , Location: 231145000 INVOICE DETAIL Manufacturer Extended Qty SKU Manufacturer Name Number Model Description Rate/Price Amount 1 BB19759563 ClamCase-Pro Keyboard Cas $149.99 $149.99 Total $149.99 Product: $149.99 FULLY TAX EXEMPT Total: $149.99 Account updates&billing inquiries may be submitted via our Best Buy Business Advantage Account website at https://bestbuybusinessadvantageaccount.com or call Customer Support at 800-201-4882 Send mail to 8650 College Boulevard, Overland Park, KS 66210 or Customer.Support@bbadvantage.com For sales inquiries call 800-373-3050 Confidential ©Multi Service Technology Solutions, Inc. 2015 ,4 ® DATE(MM/1/13/2015 CERTIFICATE OF LIABILITY INSURANCE 1/1 DATE 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 PHONE FAX o.Exti:317-817-5136 / ,No):317-817-5151 301 Pennsylvania Parkway,#201 E-MAIL Indianapolis IN 46280 ADDRESS:marianne.uban(alhylant.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: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 SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A GENERAL LIABILITY Y ZLP14T62033 1/1/2015 1/1/2016 EACH OCCURRENCE _ $2,000,000 DAMAGE TO RENTED X 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- 1 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- OTH- AND EMPLOYERS'LIABILITY y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER 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/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. do 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