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ALGALCO/Street/25,000/Hydrogen Fuel Systems ALGALCO,LLC Street Department-2016 Appropriation#43-509.00; P.O.#335044 ofr Contract Not To Exceed$25,000.00 AGREEMENT FOR PURCHASE OF GOODS AND SERVICES THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is hereby entered into by and between the City of Carmel, Indiana, acting by and through its Board of Public Works and Safety ("City"), and ALGALCO, LLC an entity duly authorized to do business in the State of Indiana ("Vendor"). TERMS AND CONDITIONS 1. ACKNOWLEDGMENT,ACCEPTANCE: Vendor acknowledges that it has read and understands this Agreement, and agrees that its execution of same constitutes its acceptance of all of the Agreement's terms and conditions. 2. PERFORMANCE: City agrees to purchase the goods and/or services (the "Goods and Services") from Vendor using City budget appropriation number 43-509.00 funds. Vendor agrees to provide the Goods and Services and to otherwise perform the requirements of this Agreement by applying at all times the highest technical and industry standards. 3. PRICE AND PAYMENT TERMS: 3.1 Vendor estimates that the total price for the Goods and Services to be provided to City hereunder shall be no more than Twenty Five Thousand Dollars ($25,000.00) (the "Estimate"). Vendor shall submit an invoice to City no more than once every thirty (30) days detailing the Goods and Services provided to City within such time period. City shall pay Vendor for such Goods and Services within sixty (60) days after the date of City's receipt of Vendor's invoice detailing same, so long as and to the extent such Goods and Services are not disputed, are in conformance with the specifications set forth in Exhibit A, are submitted on an invoice that contains the information contained on attached Exhibit B, and Vendor has otherwise performed and satisfied all the terms and conditions of this Agreement. 3.2 Vendor agrees not to provide any Goods and Services to City that would cause the total cost of the Goods and Services provided by Vendor to City hereunder to exceed the Estimate, unless City has previously agreed, in writing, to pay an amount in excess thereof. 4. WARRANTY: Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to those certain specifications, descriptions and/or quotations regarding same as were provided to Vendor by City and/or by Vendor to and accepted by City, all of which documents are incorporated herein by reference, and that the Goods and Services will be delivered in a timely, good and workmanlike manner and free from defect. Vendor acknowledges that it knows of City's intended use and expressly warrants that the Goods and Services provided to City pursuant to this Agreement have been selected by Vendor based upon City's stated use and are fit and sufficient for their particular purpose. • • [S:\Contractc'ProLSvcs&Goals Svcs1Strcct\2016\ALGALCO,LLC Goals&Scrviccs FORM-WITH E-Vcrify Language doc 5/62016 3:25 PM] • ALGALCO,LLC Street Department-2016 Appropriation#43-509.00; P.O.#335044 Contract Not To Exceed$25,000.00 5. TIME AND PERFORMANCE: This Agreement shall become effective as of the last date on which a party hereto executes same ("Effective Date"), and both parties shall thereafter perform their obligations hereunder in a timely manner.Time is of the essence of this Agreement. 6. DISCLOSURE AND WARNINGS: If requested by City, Vendor shall promptly furnish to City, in such form and detail as City may direct, a list of all chemicals, materials, substances and items used in or during the provision of the Goods and Services provided hereunder, including the quantity, quality and concentration thereof and any other information relating thereto. At the time of the delivery of the Goods and Services provided hereunder, Vendor agrees to furnish to City sufficient written warning and notice (including appropriate labels on containers and packing) of any hazardous material utilized in or that is a part of the Goods and Services. 7. LIENS: Vendor shall not cause or permit the filing of any lien on any of City's property. In the event any such lien is filed and Vendor fails to remove such lien within ten (10) days after the filing thereof, by payment or bonding, City shall have the right to pay such lien or obtain such bond, all at Vendor's sole cost and expense. 8. DEFAULT: In the event Vendor: (a) repudiates, breaches or defaults under any of the terms or conditions of this Agreement, including Vendor's warranties; (b) fails to provide the Goods and Services as specified herein; (c)fails to make progress so as to endanger timely and proper provision of the Goods and Services and does not correct such failure or breach within five (5) business days (or such shorter period of time as is commercially reasonable under the circumstances) after receipt of notice from City specifying such failure or breach; or (d) becomes insolvent, is placed into receivership, makes a general assignment for the benefit of creditors or dissolves, each such event constituting an event of default hereunder, City shall have the right to (1) terminate all or any parts of this Agreement, without liability to Vendor; and (2) exercise all other rights and remedies available to City at law and/or in equity. 9. INSURANCE AND INDEMNIFICATION: ' Vendor shall procure and maintain in full force and effect during the term of this Agreement, with an insurer licensed to do business in the State of Indiana, such insurance as is necessary for the protection of City and Vendor from all claims for damages under any workers' compensation, occupational disease and/or unemployment compensation act; for bodily injuries including, but not limited to, personal injury, sickness, disease or death of or to any of Vendor's agents, officers, employees, contractors and subcontractors; and, for any injury to or destruction of property, including, but not limited to, any loss of use resulting therefrom. The coverage amounts shall be no less than those amounts set forth in attached Exhibit C. Vendor shall cause its insurers to name City as an additional insured on all such insurance policies, shall promptly provide City, upon request, with copies of all such policies, and shall provide that such insurance policies shall not be canceled without thirty(30) days prior notice to City. Vendor shall indemnify and hold harmless City from and against any and all liabilities, claims, demands or expenses (including, but not limited to, reasonable attorney fees) for injury, death and/or damages to any person or property arising from or in connection with Vendor's provision of Goods and Services pursuant to or under this Agreement or Vendor's use of City property. Vendor further agrees to indemnify, defend and hold harmless City and its officers, officials, agents and employees from all claims and suits of whatever type, including, but not limited to, all court costs, attorney fees, and other expenses, caused by any act or omission of Vendor and/or of any of Vendor's agents, officers, employees, contractors or subcontractors in the performance of this Agreement. These indemnification obligations shall survive the termination of this Agreement. [S:\Contracts\ProLSvts&Goods Svcs\Strcct'2016WLGALCO.LLC Goods&Scrviccs FORM-WITH E-Vcri(y Longuago.doc:5/62016 3:25 PM] 7 • ALGALCO,LLC Street Department-2016 Appropriation#43-509.00; P.O.#335044 Contract Not To Exceed$25,000.00 10. GOVERNMENT COMPLIANCE: Vendor agrees to comply with all federal, state and local laws, executive orders, rules, regulations and codes which may be applicable to Vendor's performance of its obligations under this Agreement, and all relevant provisions thereof are incorporated herein by this reference. Vendor agrees to indemnify and hold harmless City from any loss, damage and/or liability resulting from any such violation of such laws, orders, rules, regulations and codes. This indemnification obligation shall survive the termination of this Agreement. 11. NONDISCRIMINATION: Vendor represents and warrants that it and all of its officers, employees, agents, contractors and subcontractors shall comply with all laws of the United States, the State of Indiana and City prohibiting discrimination against any employee, applicant for employment or other person in the provision of any Goods and Services provided by this Agreement with respect to their hire,tenure, terms, conditions and privileges of employment and any other matter related to their employment or subcontracting, because of race, religion, color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or Vietnam era veteran status. 12. E-VERIFY Pursuant to I.C. § 22-5-1.7 et seq., as the same may be amended from time to time, and as is incorporated herein by this reference (the "Indiana E-Verify Law"), Vendor is required to enroll in and verify the work eligibility status of its newly-hired employees using the E-Verify program, and to execute the Affidavit attached herein as Exhibit D, affirming that it is enrolled and participating in the E-verify program and does not knowingly employ unauthorized aliens. In support of the Affidavit, Vendor shall provide the City with documentation indicating that it has enrolled and is participating in the E-Verify program. Should Vendor subcontract for the performance of any work under and pursuant to this Agreement, it shall fully comply with the Indiana E-Verify Law as regards each such subcontractor. Should the Vendor or any subcontractor violate the Indiana E-Verify law, the City may require a cure of such violation and thereafter, if no timely cure is performed, terminate this Agreement in accordance with either the provisions hereof or those set forth in the Indiana E-Verify Law. The requirements of this paragraph shall not apply should the E- Verify program cease to exist. 13. NO IMPLIED WAIVER: The failure of either party to require performance by the other of any provision of this Agreement shall not affect the right of such party to require such performance at any time thereafter, nor shall the waiver by any party of a breach of any provision of this Agreement constitute a waiver of any succeeding breach of the same or any other provision hereof. 14. NON-ASSIGNMENT: Vendor shall not assign or pledge this Agreement, whether as collateral for a loan or otherwise, and shall not delegate its obligations under this Agreement without City's prior written consent. 15. RELATIONSHIP OF PARTIES: The relationship of the parties hereto shall be as provided for in this Agreement, and neither Vendor nor any of its officers, employees, contractors, subcontractors and agents are employees of City. The contract price set forth herein shall be the full and maximum compensation and monies required of City to be paid to Vendor under or pursuant to this Agreement. [S:\ContractsTrof.Sves&Goods Svcs\Street\2016\ALGALCO.LLC Goods&Scrviccs FORM-WITH E-Verify L nguagc.doc:5/620I6 3:25 PM[ 3 ALGALCO,LLC Street Department-2016 Appropriation#43-509.00; P.O.#335044 Contract Not To Exceed$25,000.00 16. GOVERNING LAW; LAWSUITS: This Agreement is to be construed in accordance with and governed by the laws of the State of Indiana, except for its conflict of laws provisions. The parties agree that, in the event a lawsuit is filed hereunder, they waive their right to a jury trial, agree to file any such lawsuit in an appropriate court in Hamilton County, Indiana only, and agree that such court is the appropriate venue for and has jurisdiction over same. 17. SEVERABILITY: If any term of this Agreement is invalid or unenforceable under any statute, regulation, ordinance, executive order or other rule of law, such term shall be deemed reformed or deleted, but only to the extent necessary to comply with same, and the remaining provisions of this Agreement shall remain in full force and effect. 18. NOTICE: , Any notice provided for in this Agreement will be sufficient if it is in writing and is delivered by postage prepaid U.S. certified mail, return receipt requested, to the party to be notified at the address specified herein: If to City: City of Carmel AND Douglas C. Haney, One Civic Square Corporation Counsel Carmel, Indiana 46032 Department of Law One Civic Square Carmel, Indiana 46032 If to Vendor: ALGALCO, LLC PO Box 502768 Indianapolis, Indiana 46250 ATTENTION: Kurt Koehler Notwithstanding the above, notice of termination under paragraph 19 hereinbelow shall be effective if given orally, as long as written notice is then provided as set forth hereinabove within five (5) business days from the date of such oral notice. 19. TERMINATION: 19.1 Notwithstanding anything to the contrary contained in this Agreement, City may, upon notice to Vendor, immediately terminate this Agreement for cause, in the event of a default hereunder by Vendor and/or if sufficient funds are hot appropriated or encumbered to pay for the Goods and Services to be provided hereunder. In the event of such termination, Vendor shall be entitled to receive only payment for the undisputed invoice amount representing conforming Goods and Services delivered as of the date of termination, except that such payment amount shall not exceed the Estimate amount in effect at the time of termination, unless the parties have previously agreed in writing to a greater amount. 19.2 City may terminate this Agreement at any time upon thirty (30) days prior notice to Vendor. In the event of such termination, Vendor shall be entitled to receive only payment for the undisputed invoice amount of conforming Goods and Services delivered as of the date of termination, except that such payment amount shall not exceed the Estimate amount in effect at the time of termination, unless the parties have previously agreed in writing to a greater amount. 19.3 The City may terminate this Agreement pursuant to Paragraph 11 hereof, as appropriate. [S:\Contrncts\Prof.Svcs&Goods Svu\Strcct\20I6'ALGALCO,LLC Goods&Scrviccx FORM-WITH E-Vcrify Langonge.doc:5/6/2016 3:25 PMI 4 ALGALCO,LLC Street Department-2016 Appropriation#43-509.00; P.O.#335044 Contract Not To Exceed$25,000.00 20. REPRESENTATIONS AND WARRANTIES The parties represent and warrant that they are authorized to enter into this Agreement and that the persons executing this Agreement have the authority to bind the party which they represent. 21. ADDITIONAL GOODS AND SERVICES Vendor understands and agrees that City may, from time to time, request Vendor to provide additional goods - and services to City. When City desires additional goods and services from Vendor, the City shall notify Vendor of such additional goods and services desired, as well as the time frame in which same are to be provided. Only after City has approved Vendor's time and cost estimate for the provision of such additional goods and services, has encumbered sufficient monies to pay for same, and has authorized Vendor, in writing, to provide such additional goods and services, shall such goods and services be provided by Vendor to City. A copy of the City's authorization documents for the purchase of additional goods and services shall be numbered and attached hereto in the order in which they are approved by City. 22. TERM Unless otherwise terminated in accordance with the termination provisions set forth in Paragraph 19 hereinabove, this Agreement shall be in effect from the Effective Date through December 31, 2016 and shall, on the first day of each January thereafter, automatically renew for a period of one (1) calendar year, unless otherwise agreed by the parties hereto. • 23. HEADINGS All heading and sections of this Agreement are inserted for convenience only and do not form a part of this Agreement nor limit, expand or otherwise alter the meaning of any provision hereof. 24. BINDING EFFECT The parties, and their respective officers, officials, agents, partners, successors, assigns and legal representatives, are bound to the other with respect to all of the covenants, terms, warranties and obligations set forth in Agreement. 25. NO THIRD PARTY BENEFICIARIES This Agreement gives no rights or benefits to anyone other than City and Vendor. 26. IRAN CERTIFICATION: Pursuant to I.C. § 5-22-16.5, the Vendor shall certify that, in signing this document, it does not engage in investment activities within the Country of Iran. 27. ADVICE OF COUNSEL: The parties warrant that they have read this Agreement and understand it, have had the opportunity to obtain legal advice and assistance of counsel throughout the negotiation of this Agreement, and enter into same freely, voluntarily, and without any duress, undue influence or coercion. 28. ENTIRE AGREEMENT: This Agreement, together with any exhibits attached hereto or referenced herein, constitutes the entire agreement between Vendor and City with respect to the subject matter hereof, and supersedes all prior oral or written representations and agreements regarding same. Notwithstanding any other term or condition set forth herein, but subject to paragraph 16 hereof, to the extent any term or condition contained in any exhibit . attached to this Agreement or in any document referenced herein conflicts with any term or condition contained in this Agreement, the term.or condition contained in this Agreement shall govern and prevail. This Agreement may only be modified by written amendment executed by both parties hereto, or their successors in interest. [S:'Contrncts\Prof.Svcs&Goals Svcs\Strcct\2016WLGALCO,LLC Goals&Scrviccs FORM-WITH E-Vcrify L nguage doc.5/620163.25 PM[ 5 ALGALCO,LLC Street Department-2016 - Appropriation#43-509.00; P.O.#335044 Contract Not To Exceed$25,000.00 • • IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows: CITY OF CARMEL, INDIANA ALGALCO, LLC by and through its Board of Public • • Works and Safety By: By: • OLGO— Jam Brainard, Pr siding ffice Authorized Signature Date: �CV C, [CveLl rr Printed Name Mary An urke, M ber Date: "l b a v F�- � es N04- fr(6-ev4 Title Lori S. Watson, Member FID/TIN: 21 0 S a a `� f Date: • Last Four of SSN if Sole Proprietor: - A S Date: k 4y L3 L © t C • Christine S. P 1 y, Clerk-Treasu r • Date: • • (S:\ContrnctsAProf.Svc,&Goods Svcs\Sircct12016\ALGALCO,LLC Goods&Services FORM-WITH E-Vcrify Lnngoagc.dac:5/6/2016 3:25 PM] • * its t k¢ V E 7 h, 'a "-Y,$ AIGaICo LLC DATE: May 12,2016 Hydrogen on Tap TM INVOICE# 122 FOR: Hydrogen Fuel System PO#33504 ' P.O. Box 502768 Indianapolis, IN 46250 BILL TO: Attn: Dave Huffman Phone: 317.775.1094 Carmel Street Department Fax:317.423.8211 3400 W 131st Street Westfield, IN 46074 Phone:317.733.2001 DES'CRII?TION * ,, , V 4H , . _..�., �x.: � AMOUNT (5)Hydrogen on Tap Systems,Version 4.0: $5,000/Unit $ 25,000.00 Provides supplemental, on-demand hydrogen for enhancement of fleet vehicle performance. SUBTOTAL $ 25 000.00 Terms:Net 30-days. Make all checks payable to AIGaICo TAX RATE 0.00% If you have any questions concerning this invoice,contact: r Kim Morris SALES TAX ,, AIGalCo Business Development kmorrs@algalcoonline.com-or-317.340.0211. OTHER - THANK YOU FOR YOUR BUSINESS! TOTAL f�$, ,; 25,00000...A..... EX `I i 31T fo-rf EXHIBIT B Invoice Date: Name of Company: Address &Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Goods Services Person Providing Date Goods/Services Provided Cost Per Hourly Total Goods/Services Goods/ • (Describe each good/service Item Rate/ Service separately and in detail) Hours Provided Worked GRAND TOTAL Signature Printed Name EXHIBIT C INSURANCE COVERAGES Worker's Compensation &Disability Statutory Limits Employer's Liability: Bodily Injury by Accident/Disease: $100,000 each employee Bodily Injury by Accident/Disease: $250,000 each accident Bodily Injury by Accident/Disease: $500,000 policy limit Property damage, contractual liability, products-completed operations: General Aggregate Limit (other than Products/Completed Operations): $500,000 Products/Completed Operations: $500,000 Personal &Advertising Injury Policy Limit: $500,000 Each Occurrence Limit: $250,000 Fire Damage (any one fire): $250,000 Medical Expense Limit(any one person): $ 50,000 Comprehensive Auto Liability(owned, hired and non-owned) Bodily Single Limit: $500,000 each accident Injury and property damage: $500,000 each accident Policy Limit: $500,000 Umbrella Excess Liability Each occurrence and aggregate: $500,000 Maximum deductible: $ 10,000 EXHIBIT D AFFll A!-1'1' PI(Tel- C. ko eA4��. _--_-.-- -------._-�_--- . being first duly sworn. deposes and says that he/she is familiar with and has personal knowledge of the ['acts herein and. if called as a witness in this matter. could testify as ((1llows: 1. I ani over eighteen ( I Si years of age and ail[ co111petent to testily to the facts contained herein. . _'. I am now and at all times relevant herein have been employed by (the"Employer-) in the position of —40u N V Ea. )-_P sl o-e ?. I am familiar with the employment policies. practices. and procedures of the Employer and have the authority to act on behalf of the Employer. 1. The Employer is enrolled and participates in the federal E-Verify program. Documentation of this enrollment and participation is attached and incorporated herein. The hilPloer doe; nut knowingly employ any unauthorized aliens. (,. To the bcsi of my information and belief. the Employer dues not currently employ any unauthorircd aliens. 7. 1=I.`RTI ILiI: AFFl:\NT SAYETI I NOT. 112, EXECUTED on ,p the � V �!.et of ��tC� --- :(1 I I fI Primed: Y:ttelC ,. k.O6H Lee_ I certify under the penalties for perjury under the laws of the I'nitcd States of America and the State of Indiana that the foregoing tactual statements and representations are true and correct. .,)\\ - I Yr A1•Ga1•Co December 9, 2015 Dave Huffman Carmel Street Department 3400 W. 131st Street Westfield, IN'46074 Dave: AlGalCo, LLC has the exclusive license from Purdue Research Foundation (PRF)to commercialize a unique technology involving the generation of hydrogen on demand from a solid alloy comprised of standard P 1020 aluminum and certain other catalysts as denoted in the two patents below. The technology is protected by two issued patents owned by PRF and licensed exclusively to AlGalCo. The patents are: 1) 7,938,879 2) 8,080,233 I am aware of no other technology involving the de-passivation of solid aluminum capable of generating hydrogen on demand simply by adding water. After the alloy reacts with water, the resultant product is common aluminum oxide (alumina) which is nontoxic and used in a variety of everyday commercial and personal products including underarm antiperspirants and baby diapers. In the application related to commercial and fleet vehicles, removing the alumina from the vehicle involves unbolting the lid, removing the lid and lifting the 10 inch PVC containing the alumina from inside the stainless steel container. The 10 inch PVC is a self-contained standard gauge and size container with a strap. AlGalCo then takes the alumina inside the 10 PVC back for recycling. To reload the system, simply replace the 10 inch PVC container with a new one containing fresh alloy, replace the lid and bolt down the lid. No high pressure is involved and the only tool needed is a standard wrench. 'Only a few minutes is required for total refueling. Please advise what additional information would be of assistance. Thank you. Kwrf-G. Koe4i L r Founder& President AlGalCo 'Hydrogen on Tap' P.O.Box 502768,Indianapolis,IN 46250 Ph:(317) 775-1094 Fax:(317)423-8211 CONTRACT CHECKLIST Department: Carmel Street Department Department Head or designee and telephone number: David Huffman: 317-733-2001 Vendor name,contact,telephone/fax numbers and address: 4/ GA& Co G C pa aou .50,7&r 1�� y��s o gc, /te.e 7 5— /o 9 �� Request BPW Date: ASAP Contract Type: aterials (supplies,equipment, etc) b.Service (consulting,training,etc) 3[0-51° ° ' c.Public Works projects subject to formal bid package/procedures Date and Initials D.H. 1. Contract approved as to business terms by Department Director and/or designee �fGcr C. V,2 ef2d 572✓'vrce5 �'no,(9vIti D.H.2. W 3" ' a. Line Item and Major Budget Classification,or b. Request Board Approval on condition precedent that sufficient funds are appropriated (for Service Contracts Only). 3. Original of contract and this checklist to BPW Secretary 4. Contract approved as to form by DOL 5. Contract returned to sponsoring Department(to obtain vendor's signatures) 6. Signed contract submitted to BPW Secretary for placement on BPW Agenda 7. BPW consideration: Approved Disapproved p E-Verify- Employer\ x ® _ I=\j'I r ' 1'°,,I X J C I jig https://e-verify.uscis.gov/ernp/EmployerWizard.aspx Employment Eligibility Verification Kimberly Morris KMOR0902 10:04 AM-04/14/2016 Log Out a. !Click any®for help - - - - - - - Home Company Information r' My Cases New Case View Cases Company Name: AlGalCo LLC View/Edit ! Search Cases Company ID Number: 963369 My Profile Edit Profile Doing Business As(DBA) Name: Change Password DUNS Number: Change Security Questions My Company Physical Location: Mailing Address: Edit Company Profile Address 1: 6520 Castle Knoll Ct. Address 1: P.O. Box 502768 Add New User _ Address 2: Address 2: View Existing Users City: Indianapolis City: Indianapolis t__ Close Company Account State: IN State: IN My Reports Zip Code: 46250 Zip Code: 46250 View Reports County: MARION My Resources View Essential Resources Additional Information: Take Tutorial Employer Identification Number:270500919 View User Manual Total Number of Employees: 1 to 4 Share Ideas Parent Organization: Contact Us Administrator: Organization Designation: rik � ..:iLX- - LJLJ--L F� _ ::: i 11:OS AM E-Verify—Employer x rJ Employment Eligibili x " New Tab x '8 iii I 1' n J 4- c' https://e-verify.uscis.gov/enroll/Registration.aspx?JS=YES ' - E-Verify1 Employment Eligibility Verification Exit ,.... , ,r� USA�,.I 1111111 J,o,, Atli E-Verify Enrollment: You're Finished - ' You have enrolled your company in E-Verify.Your E-Verify program administrators will receive their user IDs and passwords by e-mail. 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If you ever have any questions,we're here to help—just give us a call at 888-464-4218 or e-mail us at E-Verifyndhs.gov.View Memorandum of Understanding U.S.Department of Homeland Security I U.S.Citizenship and Immigration Services Enable Permanent Tooltips Accessibility Download Viewers 4 r — —-- —^ — -- — — — -- —� INDIANA RETAIL TAX EXEMPT Page 1 of 1 cì City of Carmel CERTIFICATE NO.003120155 002 0 PURCHASE ORDER NUMBER FEDERAL EXCISE TAX EXEMPT 33504 ONE CIVIC SQUARE 35-6000972 THIS NUMBER MUST APPEAR ON INVOICES,AIP VOUCHER,DELIVERY MEMO,PACKING SUPS, CARMEL,INDIANA46032-2584 SHIPPING LABELS AND ANY CORRESPONDENCE FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL-1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION_ 4/14/2016 367107 Hydrogen Fuel Systems ALGALCO LLC Street Department VENDOR PO BOX 502768 SHIP 3400 W.131 st Street TO Carmel,IN 46074- INDIANAPOLIS,IN 46250- (317)733-2001 PURCHASE ID BLANKET I CONTRACT 1 PAYMENT TERMS I FREIGHT 4027I QUANTITY UNIT OF MEASURE DESCRIPTION UNIT PRICE EXTENSION Department: 2201 Account: 43-509.00 Fund: 201 Motor Vehicle Highway 1 Each Hydrogen Fuel Systems $25,000.00 $25,000.00 Sub Total $25,000.00 Y,1 r f J °war' �.�;,, 7 ss s - ( (\,. e.4 I.t ( i , ( Received Send Invoice To: \ 'Y V- _. L=cif / City of Carmel Street Department '`� ,,` r/ 0 5_2 ilep11l na/tab R C V D \ \ '� 3400 W.131st Street �` �g ._ Carmel,IN 46074- `�`�-Z2' `� y' �3 r,` (317)733-2001 PLEASE INVOICE IN DUPLICATE DEPARTMENT I ACCOUNT l PROJECT I PROJECT ACCOUNT I AMOUNT PAYMENT $25,000.00 SHIPPING INSTRUCTIONS 'AIP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN 'SHIP PREPAID. AFFIDAVIT ATTACHED. I HEREBY CERTIFY THAT THERE IS AN UNOBLIGATED BALANCE IN 'C.O.D.SHIPMENT CANNOT BE ACCEPTED. THIS APP PRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. 'PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABEL 'THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99,ACTS 1945 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY TITLE ` CONTROL NO. 33504 CLERK-TREASURER