Laerdal Medical CorporationLaerdal Medical Corporation
Fire Department
De~brillation/2000
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES
THIS AGREEMENT FOR PURCHASE OF GOODS AND SERVICES ("Agreement") is hereby
made and entered into by and between the City of Carmel, Indiana, acting by and through its Board of
Public Works and Safety ("City"), and Laerdal Medical Corporation ("Vendor").
TERMS AND CONDITIONS
ACKNOWLEDGMENT, ACCEPTANCE:
Vendor acknowledges that it has read and understands this Agreement, and agrees that its
execution of same and/or its provision of any goods and/or services ("Goods and Services")
hereunder shall constitute Vendor's acceptance of all of the Agreement' s terms and conditions.
PERFORMANCE:
City agrees to purchase the Goods and Services described in attached Exhibit A, which is
incorporated herein by this reference, and Vendor agrees to provide same and to otherwise perform
the requirements of this Agreement and to execute its responsibilities hereunder by following and
applying at all times the highest professional and technical guidelines and standards.
PRICE AND PAYMENT TERMS:
The total price for the Goods and Services contemplated herein shall be no more than the amounts
set forth in attached Exhibit A. 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 thirty (30) 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 accordance 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. Subject to the
above, if the undisputed invoice amount is not paid within thirty (30) days of its receipt by City,
Vendor shall so notify City. If such amount as is not disputed is not thereafter paid within ten (10)
business days from the date such notice is received by City, 'then a late charge in a sum equal to
one percent (1%) of such unpaid and undisputed invoice amount shall accrue and be immediately
due and payable by City to Vendor as a separate debt for each month it remains unpaid. In the
event an invoice amount is disputed, City shall so notify Vendor. If such dispute is not resolved to
City's satisfaction within five (5) business days after notice of such dispute is given, City shall pay
such amount as is in dispute, under protest, into the Carmel City Court, which court shall hold
such monies until provided with a settlement agreement signed by both parties hereto or a final
judgment has been entered thereon.
[eb:msx%ord:z",law\e bass',my docun~ents',profscrvices\goods&services\~redePartment\laderalmedical.doc: I/6/00] 1
Laerdal Medical Corporation
f:ire Department
De~brillation/2000
,
o
,
WARRANTY:
Vendor expressly warrants that the Goods and Services covered by this Agreement will conform to
the specifications, drawings, samples, instructions, directions and/or descriptions thereof furnished
to Vendor by City and/or by Vendor to and accepted by City, that the Goods and Services will be
delivered in a timely, good and workmanlike manner and free from defect. In addition, Vendor
acknowledges that it knows of City's intended use and expressly warrants that the Goods and
Services covered by this Agreement have been selected and provided by Vendor based upon City' s
stated use and will be fit and sufficient for the particular purposes intended by City.
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.
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. Prior to and with 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 Goods and Services.
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. Vendor shall indemnify and hold harmless City from and against
any and all liabilities, losses, claims, costs and expenses, including, but not limited to, attorney
fees incurred by City in connection with any such lien and/or the removal thereof. This
indemnification obligation shall survive the termination of this Agreement.
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, files, or has filed
against it, a petition in bankruptcy, for receivership or other insolvency proceeding, makes a
general assignment for the benefit of creditors or, if Vendor is a partnership or corporation,
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; (2) obtain, upon such
terms and in such manner as City deems appropriate in its sole discretion, the same or similar
Goods and Services which were to be provided to City by Vendor, and Vendor shall be liable to
City for any excess costs of the City in obtaining same; and (3) exercise any other rights or
remedies as are available to City at law and/or in equity.
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Laerdal Medical Corporation
l~ire Depdrtment
De~brillation/2000
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 and reasonably acceptable to City, such
insurance as is necessary for the protection of City and Vendor from any and all claims for
damages or otherwise 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 and all of Vendor's agents, officers, employees, contractors,
subcontractors and other persons; because of any injury to or destruction of property, including,
but not limited to, loss of use resulting therefrom; or, otherwise. The coverage amounts shall be
no less than those amounts set forth in attached Exhibit A. Vendor shall cause its insurers to name
City as an additional insured on all 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. Vcndor shall indemnify ar~d.ho~harmless-City-from
- !.and against any attd all liabilitics, claims~ demands or cxpenses (incluc~i~g, but-not limited to,
11 - ' ' ~ ' ' ~' ' "'
-'C~C~ .~~grc~ement, Vendor's use of City ptupc, ty, or qtherwisc,-c~lecpt-/or--sh~q tiabilit_~._s, claims-or
~.~'d c~manas that arise--directly and solely out uf tl~ncgligcne~.--of~City. -Vcndoi-f'aS"fi'~,, agrees to
domnify defend and hold harmless City and its officers, officials, a~'~f~ and employees from all
/ claims an~i suits of whatcvcr typc, includi~,g, but not limited to, all c~sts, attorney fees, and
othcr cxp,enseg, ca,,.qect by any act or omission of Vendor and/or-4r>any of Vcndor's agcnts,
I .officers, employ~, contractors, subcontractors and othcr p~tsons' if'i> the performance of this
l~A-greement, or othcrwisc. Thege indemnification obligations shall su~kv_c the termination of this
-Agreoment.
10.
GOVERNMENT COMPLIANCE:
Vendor agrees to comply with all present and future federal, state and local laws, executive orders,
rules, regulations, codes and ordinances 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, codes and
ordinances. 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,
subcontractors and other persons shall comply with all existing and future 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 the hire, tenure, terms, conditions or privileges of employment and to
any other matter directly or indirectly related to employment or subcontracting because of race,
religion, color, sex, handicap, national origin, ancestry, age, disabled veteran status and/or
Vietnam era veteran status. City reserves the right to collect a penalty as provided in IC 5-16-6-1
for any person so discriminated against.
[eb Insword:z: ,lax~,c bass',m~, docu ne ~ts'\profservices',goods&services',~rcdepartment\laderalmedical,doc: 1/6/00]3
Laerdal Medical Corporation
Pire Department
De~brillation/2000
12.
13.
14.
15.
16.
17.
NO IMPLIED WAIVER:
The failure of either party at any time to require performance by the other of any provision of this
Agreement shall in no way 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 thereof.
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.
RELATIONSHIP OF PARTIES:
The relationship of the parties hereto shall be as provided for in this Agreement, and Vendor and
all of its officers, employees, contractors, subcontractors, agents and other persons are not and
shall not become employees of City, and the sole responsibility to pay to or for same all statutory,
contractual and other benefits shall remain exclusively with Vendor. The contract price set forth
herein to be paid hereunder by City to Vendor shall be the full and maximum compensation and
monies required of City to be paid to Vendor under or pursuant to this Agreement.
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 further agree that, in the event a
lawsuit is filed hereunder, they waive any fights to a jury trial they may have, 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.
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 such statute, regulation, ordinance, order or rule, and the
remaining provisions of this Agreement shall remain in full force and effect.
NOTICE:
Subject to paragraph 16 hereinabove, 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
One Civic Square
Carmel, Indiana 46032
ATTN: Douglas Callahan
(with a copy to City Attorney,
One Civic Square, Carmel, IN 46032)
If to Vendor:
Laderal Medical Corporation
167 Myers Comers Road
Wappingers Falls, New York 12590-8840
ATTN: .Dp,~tfl)/~O~Aff~bD
[eb:msword:z:',law',c bass\my documcnts\profsep,'ices',goods&services\~redcpanment\ladcrahncdical.doc: 1/6/00]4
Laerdal Medical Corporation
l~ire Department
De~brillation/2000
Notwithstanding the above, notice of termination under paragraph 18 hereinbelow shall be
effective if given orally, as long as written notice is then provided as set forth hereinabove within
ten (10) business days from the date of such oral notice.
18.
TERMINATION:
18.1 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 not appropriated 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.
18.2
Either party hereto may terminate this Agreement at any time upon thirty (30) days prior
notice to the other party. 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.
19.
REPRESENTATIONS AND WARRANTIES
The parties represent and warrant that they are authorized to enter into this Agreement and that the
persons or entities executing this Agreement have the authority to bind the party which they
represent.
20.
ADDITIONAL GOODS AND/OR SERVICES
Vendor understands and agrees that City may, from time to time, request Vendor to provide
additional goods and/or services to City. When City desires additional goods and/or services from
Vendor, the Mayor or his duly authorized representative shall notify Vendor of such additional
goods and/or services desired, as well as the time frame in which same are to be provided. Vendor
shall then provide, at no cost to City, an estimated cost for such additional goods and/or services,
as well as the date by which same will be provided to City. Only after City has approved
Vendor's time and cost estimate for the provision of such additional goods and/or services shall
Vendor be authorized to provide same, the identification of which shall be set forth in documents
which shall be numbered and attached hereto in the order they are approved by City.
21.
22.
TERM
Subject to the termination provisions set forth in Paragraph 18 hereinabove, this Agreement shall
be in effect from the Effective Date through December 31, 2000, 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.
FORCE MAJEURE
Any delay or failure of either party to perform its obligations hereunder shall be excused if, and to
the extent, same is caused by an event or occurrence beyond the reasonable control of the party
and without its fault or negligence, provided that notice of such delay (including the anticipated
duration of the delay) shall be given by the affected party to the other party within five (5)
business days after the first day of such event or occurrence. During any such period of delay or
failure to perform by Vendor, City, in its sole option, may purchase some or all of the same or
[eb ~ sv, ord:z: ,lav,',e bass',mv documcnts',profservices\goods&ser,'iccs\firedePartmentxladeralnmdicald°c: I/6/00]5
Laerdal M. edic al Corporation
l&ire Department
De~brillation/2000
23.
24.
25.
26.
27.
similar Services and/or additional services from other sources and reduce the Services requested of
Vendor hereunder by such degree, or have Vendor provide some or all of the Services and/or
additional services from other sources at times requested by City and at the prices set forth in this
Agreement.
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.
BINDING EFFECT
City and Vendor, and their respective officers, officials, agents, partners, successors, assigns and
legal representatives, are bound to the other with respect to this Agreement and to such other
party's officers, officials, agents, partners, successors, assigns and legal representatives in all
respects as to all covenants, agreements and obligations of this Agreement.
NO THIRD PARTY BENEFICIARIES
Nothing contained herein shall be construed to give any rights or benefits hereunder to anyone
other than City or Vendor.
ADVICE OF COUNSEL:
The parties warrant that they have read this Agreement and understand it, are fully aware of their
respective rights, have had the opportunity to obtain the advice and assistance of an attorney
throughout the negotiation of this Agreement, and enter into this Agreement freely, voluntarily,
and without any duress, undue influence, coercion or promise of benefit, except as expressly set
forth herein.
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 conflicts with
any term or condition contained in this Agreement, the term or condition contained in this
Agreement shall govern and prevail, unless the parties hereto, or their successors in interest,
expressly and in writing agree otherwise. This Agreement may only be modified by written
amendment executed by both parties hereto, or their successors in interest.
[remainder of page intentionally left blank]
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Laerdal Medical Corporation
iTire Department
De~brillation/2000
IN WITNESS WHEREOF, the parties hereto have made and executed this Agreement as follows:
CITY OF CARMEL, INDIANA
by and through its Board of Public
Works and Safety
LADERAL MEDICAL CORPORATION
ATTEST:
/
urer
By:
Authorized Signature
Printed Name
Title
Date:
FID/SSN:
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NOU-30-1999 14:01 LF:)ERDFL TECH SERUICE
QUOTE
'Laer~al Medical Corporation
167 Myers Corners Road
P.O.Box 1840
Wappingers Falls, NY 12B90-8840
USA
18005522495 P. 01
Page:
Master:
Quote: 100012
Order Date: 11/30/99
Print Date: 11/30/99
Start Date: 01/01/00
End Date: 12/31/00
Customer: 00111283
CARMEL FIRE DEPARTMENT
ATT: D~NISE BRISTOW
2 CIVIC SQUARE
CARMEL, IN 46032
United States of America
Salesperson: 00000003
DTYP-20 MTYP-J
Credit Terms: 16
2% 20 NET 60
Billing Cycle: YR Annual Billing
End User: 51005285
CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
CARMEL, IN 46032
united States Of America
DOUG CALIAF. AN,-~,~F~F ~II~
Expire:
Ship Via: UpS GROUND
FOB:
Service Type: SP6002
Remarks:
Coverage
SUN yes
MON yes
TUE yes
WED yes
THU yes
FRI yes
SAT yes
Holidays yes
Advanced Defib Coverage
start Time
00:00
00:00
00:00
00:00
00:00
00:00
00:00
00:00
End Time
23:59
23:59
23:59
23:59
23:59
23:59
23:59
23:59
Ln Invoice Sort
wk Code Svc Cat
Amount List Price Limit %Cv
Start: 01/01/00
Start: 01/01/00
SWO FREIGHT
End: 12/31/00
SWO LABOR
End: 12/31/00
SWO MATERIAL
0.00 O.O0 100
0.00 0.00 100
Start: 01/01/00 End: 12/31/00 0.00 0.00 !00
Your service agreement, Plan II, entitles you to the following benefits:
- All repair parts/labor [excluding instrument case)
- Free applicable upgrades at time of service
- certified calibration of unit
- Choice of one preventative maintenance or one battery (per unit/per term)
NOU-30-1999 14:02 LAERDAL TECH SERUICE
QUOTE
'Laer~al Medical Corporation
167 Myers Corners Road
P.O.Box 1840
Wappingers Falls, NY 12590-8840
USA
18005522495
Master:
Quote: 100012
Order Date: 11/30/99
Print Date: 11/30/99
Start Date: 01/01/00
End Date: 12/31/00
P. 02
Page:
Customer: 00111283
CARMEL FIRE DEPARTMENT
ATT: DENISE BRISTOW
2 CIVIC SQUARE
CARMEL, IN 46032
United States Of America
End User: 51005285
ARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
CARMEL, IN 46032
United States Of America
DOUG CALLAHAN, ~- CIIIE
- 24 hour loaner dispatch service for repairs
- 24 hour technical support
- Laerdal pays all freight (per event)
Please note that your choice of a preventative maintenance or battery is
indicated on page 3 of this agreement. If you have not yet selected your
choice, please contact our Customer Support Team at (800) 431-1055 to
specify. They are available to serve you from 8:00am-8:00pm. EST Monday
through Friday.
Enclosed is the invoice for the purchase of your Laerdal Heartstart Service
Agreement. If you have any questions regarding your agreement, please
contact our Customer Support Team at (800) 431-1055. They are available to
serve you from 8:00am-8:00pm EST Monday through Friday. Thank you very
much for your order. we look forward to fulfilling your service needs.
NOU-30-1999 14:02 LAERDAL TECH SERUICE
QUOTE
Laerdal Medical Corporation
167 Myers Corners Road
P.O.Box 1840
Wappingers Falls, NY 12590-8840
USA
18005522495
Master:
Quote: 100012
Order Date: 11/30/99
print Date: 11/30/99
Start Date: 01/01/00
End Date: 12/31/00
p. 03
Page
Customer: 00111283
CARMEL FIRE DEPARTMENT
ATT: DENISE BRISTOW
2 CIVIC SQUARE
CARMEL, IN 46032
United States Of America
End User: 51005285
CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
CARMEL, IN 46032
United States Of America
DOUG CALLAHAN, ~ ST ~.~t~'_
Ln Item
1 920054
Serial 08585
2 920054
Serial 08631
3 920054
Serial 08633
4 920054
Serial 08634
5 920054
Serial 08641
Item Qty Duration Net Price Ext Price
1.0 12.0 52.00 624.00
1.0 12.0 52.00 624.00
1.0 12.0 S2.00 624.00
1.0 12.0 52.00 624.00
1.0 12.0 52.00 624.00
Total:
3,120.00
Item
Contract Additional Charges
Item Qty Duration Net Price
SP602A 5.0
Preventative Maintenance
12.0 0.00
Ext Price
0.00
Total:
0,00
Line Schedule Call ID Actual
Visit Schedule
BOM Type Comments
os/i4/oo
NOU-30-1999 14:02 LAERDAL TECH SERUICE
QUOTE
Laerdal Medical Corporation
167 Myers Corners Road
P.O.Box 1840
Wappingers Falls, NY 12590-8840
18005522495 P. 04
Page:
Master:
Quote: 100012
Order Date: 11/30/99
Print Date: 11/30/99
Start Date: 01/01/00
End Date: 12/31/00
Customer: 00111283
CARbTEL FIRE DEPA2TMENT
ATT: DENISE BRISTOW
2 CIVIC SQUARE
CARMEL, IN 46032
United States of America
Line Schedule Call ID Actual
End User: 51005285
CARMEL FIRE DEPARTMENT
2 CIVIC SQUARE
C/~R/v[EL, IN 46032
United States Of America
DOUG CALLAMAN, ASST CHIE
Visit Schedule
BOM Type Comments
os/2e/oo
oe/0v/oo
10/. 9/0o
12/3 /oo
TOTAL P.04
Name of Company:
Address & Zip:
Telephone No.:
Fax No.:
EXHIBIT B
Professional Services Invoice
Date:
Project Name:
Invoice No:
Person Service Services Provided Hourly
Performing Date (Describe in detail in one-Rate
Service tenth hour units)
Hours
Worked
Total
GRAND TOTAL
Signature
Printed Name
EXHIBIT C
INSURANCE COVERAGES
Worker's Compensation & Disability
Statutory Limits
Employer's Liability:
Bodily Injury by Accident:
Bodily Injury by Disease
Bodily Injury by Disease
$100,000 each accident
$ 500,000 policy limit
$100,000 each employee
Property damage, contractual liability,
products-completed operations:
General Aggregate Limit (other than
Products/Completed Operations):
Products/Completed Operations:
$1,000,000
$1,000,000
Personal & Advertising Injury
Limit:
Each Occurrence Limit:
Fire Damage (any one fire):
Medical Expense Limit
(any one person):
$1,000,000
$1,000,000
$ 50,000
$ 5,000
Comprehensive Auto Liability
Owned, hired and non-owned
Bodily Single Limit:
injury and property damage
each accident
$1,000,000
Umbrella Excess Liability
Each occurrence and aggregate
Maximum Deductible
$1,000,000
$ 10,000
SAGIFAX 2/21/100 9:38AM THE ROLLI~I~J,~!~NG~r,tfN~. · ~, O/- ~ 4JZ~,~UlvlP'jJ
AnnRn CERTIFICATE OF LIABILITY INSURANCE
PRODUCER
'The Rollins Agency, Inc.
65 Main Street
Tuckahoe, NY 10707
914 337-1833
INSURED
Laerdal Medical Corp.
167 Myers Corners Road
P.O. Box 1840
Wappin~ers Falls , NY
COVERAGES
PAGE 1
DATE(MMIDD/'Y'Y}
02/21/00
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CER'j'iFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
12590
INSURERS AFFORDING COVERAGE
,NSURERA: Federal Insurance Company
INSURER B:
INSURERC:
INSURER D:
INSURER E:
THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURE) NAMED ABOVE FORT HE 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 POUCtES DESCI:~BED HERBN IS S~JBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POUCIES. A~GATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE POLICY NUMB ER
A GENER, LL,AB,L,TY 35309638
COMMERCIALGENERAL LIABILITY
CLAIMS MACES'] OCCUR
X Broad Form
Vendors End' t
G EN'L AGGR EGAT ELI MIT APPLIES PER:
t oL,cYt t JEc
AUTOMOBILE LIABILITY
ANYAUTO
A L L OWN ED AU TOG
SCHEDULED AUTOS
HIRED AUTOS
NON -OWN ED AUTOS
iPOLtCY EFFECTIVE POLICY EXPIRATION
OATE[MMIDD/YYI DATE[MMIDD/YY}
12/31/99 12/31/00
GARAGE LIABILITY
ANYAUTO
EXCESS LIABt LtTY
I OCCUR [""3 CLAIMS MADE
DEDUCTIB,E
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIA B I LITY
OTHER
L,M,TS
EACH OCCURRENCE $1,000,000
FIREOAMAaE[Anyonefire) sl, 000,000
MEDEXP(Anyoneperson) ~ 10 , 000
PERSONAL&ADVINJURY $1/, 000 f 000
GENERAL AGGREGATE S2,000,000
PRODUCTS -COMPIOPAGG S2,000,000
COMBINEDSINGLELIMIT $
(E~ ~cciden I)
BODILYINJURY
(Per ;~erson)
BODILYINJURY S
(Per acciden t)
AGGREGATE
PROPERTY DA MAG E
(Per acci den l)
AUTO ONLY - EA ACCIDENT
OTHER THAN EA ACC
AUTO ONLY: AGG
EACH OCCURRENCE
E.L. EACH ACCIDENT
E.L. DISEASE-EA EMPLOYEE
E.L. DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
It is hereby agreed that the certificate holder is included as additional
insured with respects to broad form vendors endorsement.
CERTIFICATE HOLDER ~ I ADDITIONAL INSURED; INSURER LETTER:
City of Carmel
Att: Douglas Callahan
One Civic Square
Carmel, IN 46032
I
ACORD25-S(7/97) 1 Of 2
FEB-21-2000 09: 41
~S17257/M16465
THE ROLL INS RGENCY,
CANCELLATION
SHOU LDANYOFTH EABOVEDESCRI BED POLICIES B ECANCELLED BEFORETH E EXPIRATION
DATETHEREOF, THEISSUING iNSURER WILL ENDEAVOR TO MAIL3 (~ DAYSWRll"rEN
NOTICETOTHE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DOSOSHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANYKIND UPON THE INSURER, ITS AGENTS OR
R EPR ES ENTATIV
AUTHOR IZ ED R EPR ES ENTATIV E
R_M..R e ACORD CORPORATION 1988
98X P. 02
SAGIFAX 2/21/100 9:36AM THEROLLINS AGENCY. ~NC. PAGE 2
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions ofthe 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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by tbe policies listed thereon.
ACOBDZS-S(?t97)2 Of 2 #S17257/M16465
FEB-21-2000 09: 42 THE ROLL I HS AGENCY,
P. 03
CONTRACT C~CKLIST
(for contracts NOT resulting from Bid Procedures)
Department: Fir~ Department
Department Head or designee and telephone no.: Douglas Calhhan/57 1-2602
Vendor name, contact, telephone/fax numbers and address:
Laerdal Medical Corporation, 800-43 1-1055
167 Myers Comers Road Wappingers Falls, NY 12590-8840
Requested BPW Date: January '00
Date & Initials
/- t/~O0 _~
(Dept.)
(Dept.)
Contract Type: a. Materials (supplies, equipment, etc.)
(circle one) Cl~ Service (consulting, training, etc.) ~'~1
1. ContraCt approved as to business te/ms by Department Director
or his/her dcsignee;
2. a. Line item and major budget classification, or
b. Request Board approval on condition precedent
that sufficient funds are appropriated (for Service
Contracts only);
(Clerk-Treas.)
m
a. Sufficiency of Funds approved by Clerk-Treasurer or
b. Line item and major budget classification if different than 2(a)
above or
c. Prior appropriation required;
(DOL)
4. Original of contract and two (2) copies and this checklist
delivered to DOL;
(DOL)
(Dept.)
(Clerk-Treas.)
5. dontract approved as to form by DOL;
6. Contract returned to sponsoring Department' (to obtain vendor's signatures);
7. Signed contract submitted to Clerk-Treasurer for placement on
BPW agenda (with copy to DOL);
(Clerk-Treas.)
8. BPW consideration:
Approved or
Disapproved
(Clerk-Treas.)
9. Frilly executed contract copy and completed checklist sent to DOL and
Department if approved.
City Carmel
April 6, 2000
Mr. David Brum~eld
LAERDAL MEDICAL CORPORATION
167 Myers Corners Road
Wappingers Falls, NY 12590-8840
Dear Mr. Brumfield:
On April 5, 2000, the Board of Public Works and Safety approved a contract to do
business with your company. Enclosed is a copy of the signed agreement.
Please review the enclosed sample invoice (Exhibit B). You do not need to use this
specific form, but we require you to submit the requested information in a similar layout.
This format replaces any other form previously used by the City and is effective upon
approval of your contract.
Please call Clerk-Treasurer Diana Cordray at 571-2414 if you have any questions.
Sincerely,
[' /' : ~' C~/.
"~-.-!._ . ~ i. ~ L.L ;~'~C:C ' ....
~, ,..
Carrie A,Groce '~
Deputy Clerk
Enclosure
pc: Chief Douglas Callahan, Carmel Fire Department
ONE CIVIC SQUARE
CARMEL, INDIANA 46032
317/5 ? 1 - 2400