2012 Police Lease pay request 1 Lease 2012 Sch #9 (Police Dept.)
Payment Request 2012 -1
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 March 8, 2012 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: General Dynamics Itronix
Amount: $132,166.06
Description of Equipment Item Cost:
Vehicle laptops
Dated: April 20. 2012
LESSEE:
City of Carmel
One Civic Square
Carmel, l 46032 '7
By: t7
Name: Diana Cordray
Title: Clerk Treasurer
(Attached duplicate original of Payee's statement)
PLEASE MAIL CHECK TO: General Dynamics Itronix
1000 Sawgrass Corporate Parkway, Suite 300
Sunrise, FL 33323
PAGE 1
GENERAL CJYNAMICS InvoiceTr_I:,.•. S0021112
tronix Date 'i`' 1 4/1/2012
Page a 1
000 Sawgrass Corporate Parkway Mail payments only to:
•uite 300 GENERAL DYNAMICS ITRONIX
unrise FL 33323 P.O. BOX 201451
DALLAS, TX 75320 -1451
Bill To: Ship To:
CARMEL POLICE DEPT, CITY OF CARMEL POLICE DEPT, CITY OF
THREE CIVIC SQUARE THREE CIVIC SQUARE
CARMEL IN 46032 CARMEL IN 46032
?ur`ihase'Oider.Nd. ..o Customer. ID_ Salespe ID 5tiipping Method „,.:L leg—Ship Date w ;i• Sales.Or'dera/
26109 22808 HOFFMAN SURFACE Net 30 days 3/30/2012 SS0012153
'.art .Number.nt'4�I•nu fl Desdn tion;e^ +♦s,`, .,tiYaOrdered_ P.nce ls:'. .�Ext.'Pr(ce •*1
3D8200 -106 GD8200 SKU I 26 26 3,756.30 97,663.80
'ZSJC2088ZZ0012 ZZSJC2088ZZ0013 ZZSJC2088ZZ0015 ZZSJC2088ZZ0016 ZZSJC2088ZZ0017
'ZSJC2088ZZ0018 ZZSJC2088ZZ0019 ZZSJC2088ZZ0020 ZZSJC2088Z20021 ZZSJ62088ZZ0022
'Z5JC2088ZZ0023 ZZSJC2088ZZ0024 ZZSJC2088ZZ0025 ZZSJC2088ZZ0027 ZZSJC2088ZZ0028
t I
'ZSJC2088ZZ0029 ZZSJC2088ZZ0030 ZZSJC2088ZZ0031 ZZSJC2088ZZ0032 ZZSJC2088ZZ0033
'ZSJC20882Z0034 ZZSJC2088ZZ0035 ZZSJC2088ZZ0036 ZZSJC2088ZZ0037 ZZSJ82088ZZ0038
"ZSJC2088ZZ0039
50- 0141 -006R VEH ADP,10- 32V/18.5V,90W 26 26 $62.61 1,627.86
32- 0781 -001R KIT,GD8K,MULTI DVD -RW 26 26 164.75 $4,283.50
BATTWARR5YR 5YR BATT REPLACEMENT 26 26 338.00 8,788.00
NFMAX5YR NO FAULT MAX SVC 5 YR f 26 26 531.00 13,806.00
32- 0827 -003R KIT,GD8K,GOBI WWAN 26 26 230.65 5,996.90
'DO NOT BUILD, REPLACING PRE -BUILD 5P0013575** Subtotal r,_ 132,166.06
Misc t';” 4 0.00
Tax11 $0.00
Freight3 0.00
1121403299 Trade Discount 0.00
'ayments received more than Net Terms, as stated on the invoice, shall be .Total -.zz' -F` 132,166.06
ubject to a late charge of three percent (3 per month on the unpaid balance.
Ve proudly welcome American Express cards for payment. To pay using your
�1 OP ID: 79
4CO n0/1
CERTIFICATE OF LIABILITY INSURANCE DATE{M
oao/1 z
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 800 678 0361 ConraCT Marianne Uban
Hylent Group Inc Indianapolis PH ONE FAX
301 Pennsylvania Parkway, #201 317- 817 -5151 111 No „Exp: 817.5136 I (A /C, No): 317- 817 -5151
Indianapolis, IN 46280 E-MAIL ianne.uban h lant.com
W. Michael Walls
ADDRESS: m @Y
-PRODUCER CARME80
_CUSTOMER 10 pMER
INSURER(S) AFFORDING COVERAGE NAIC It
INSURED City of Carmel INSURER A: Travelers Insurance Companies
Steve Engelking
One Civic Square INSURER B
Carmel, IN 46032 INSURER C:
INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 1 TYPE OF INSURANCE IADDCSUBRI I ID
POLICY EFTPOLICYEXP I LIMITS
LTR INSR IWyn POLICY NUMBER IMMDIYYYY) IIMMIDDIYYYY)
GENERAL LIABILITY EACH OCCURRENCE 5 2,000,000
A COMMERCIkL GENERAL LIABILITY GP09315757 01/01/12 01/01/13 DAMAGE TO RENTED 50,000
PREMISES( occurrence)
1 CLAIMS -MADE 1 X I OCCUR MED EXP (Any one person) 0
PERSONALS ADM INJURY 2,000,000
GENERAL AGGREGATE 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG 5 2,000,000
1 POLICY Li IF 0 fl LOC 15
AUTOMOBILE LIABILITY I (Ea COMBINED B Dl SINGLE LIMIT 5 2,000,000
A X ANY AUTO 8103036P64A 01/01/12 01/01/13 BODILY INJURY (Per person) 5
ALL OWNED AUTOS
BODILY INJURY (Per accident) 5
SCHEDULED AUTOS PROPERTY DAMAGE
HIRED AUTOS (Per acoden 5
t)
NON -OWNED AUTOS 5
5
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB
,CLAIMS -MADE AGGREGATE 5
DEDUCTIBLE
RETENTION 5
WORKERS COMPENSATION WC $TATU- OTH-
AND EMPLOYERS' LIABILITY YIN I TORY_LIMIT$ ER_
ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? N/A 1
(Mandatory in NH) E.L. DISEASE EA EMPLOYEE S
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE POLCY LIMIT I S
A PROPERTY 630581M4076 01/01/12 01/01/13 SEE
ATTACHED
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {Attach ACORD 101, Additional Remarks Schedule, 0 more space is required)
SEE ATTACHED.
CERTIFICATE HOLDER CANCELLATION
HUNTI -2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
The Huntington National Bank ACCORDANCE WITH THE POLICY PROVISIONS.
its assignors and assignees
C/O American Lease Insurance AUTHORIZED REPRESENTATIVE
654 Amherst Rd. Ste 335
,Sunderland, MA 01375
1988 2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
NOTEPAD INSDRED'S NAME City of Carmel CARME80 PAGE 2
DATE 041 OP ID: 79 20112
NAMED INSURED:
CITY OF CARMEL
CARMEL CLAY PARKS BUILDING CORPORATION
CARMEL CLAY BOARD OF PARKS RECREATION
CARMEL REDEVELOPMENT COMMISSION
CARMEL REDEVELOPMENT AUTHORITY
CARMEL CITY CENTER COMMUNITY DEVELOPMENT CORPORATION
PROPERTY LIMITS:
BLANKET BUILDING AND BUSINESS PERSONAL PROPERTY: $360,243,099
REPLACE COST, AGREED VALUE
SPECIFIC BUILDING LIMIT: $2,623,959 SPECIFIC BUSINESS PERSONAL PROPERTY
LIMIT: $150,000
BLANKET BUSINESS INCOME/EXTRA EXPENSE /RENTAL VALUE: $5,000,000
ACTUAL CASH VALUE, AGREED VALUE
SPECIAL CAUSE OF LOSS FORM
EQUIPMENT BREAKDOWN- INCLUDED
DEDUCTIBLE: $25,000
FLOOD LIMIT: $10,000,000 W /$50,000 DEDUCTIBLE
EQ LIMIT: $10,000,000 W /$50,000 DEDUCTIBLE
CONTRACTORS EQUIPMENT LIMIT: $2,9,47,385 W /$1,000 DEDUCTIBLE
CONTRACTORS LEASED EQUIPMENT: $100,000 W /$1,000 DEDUCTIBLE
MISC. SCHEDULED EQUIPMENT: $2,732,599 W /$1,000 DEDUCTIBLE
EDP LIMIT: $880,591 W /$1,000 DEDUCTIBLE
COMM'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE
FINE ARTS: $1,759,975 14/$1,000 DEDUCTIBLE
NOTEPAD: HOLDER CODE HUNTI -2 CARME80 PAGE
INSURED'S NAME City of Carmel OP ID: 79 DATE 04/20/12
The Huntington National Bank and its Assignors and Assignees, ATIMA are
named as Lender's Loss Payee Re: Various Police EquipmentNehicles