2012 Police pay request 2012-10 Lease 2012 Sch #9 (Police Dept.)
Payment Request 2012 -10
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 suns 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: Kelley Chevrolet LLC
Amount: $77,129.90
Description of Equipment Item Cost:
New Vehicles
Dated: May 31, 2012
LESSEE:
City of Carmel
One Civic S uare ant
Carmel, I 6032 By:
Name: Diana Cordray
Title: Clerk Treasurer
(Attached duplicate original of Payee's statement)
PLEASE MAIL CHECK TO: Kelley Chevrolet, LLC
500 E. State Boulevard
Fort Wayne, IN 46805
PAGE 1
OP ID: 79
AMMO' CERTIFICATE OF LIABILITY INSURANCE DATE 04/20/12
04/20/12
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 NAAMEQCT Marianne Uban
Hylent Group Inc- Indianapolis FAX
301 Pennsylvania Parkway, #201 317- 817 -5151 r2 N o, Ex B: 317 -817 -5136 I (AC, No): 317- 817 -5151
Indianapolis, IN 46280 E -MAIL marianne.uban@hylant.com Michael Wells ADDRESS: @y
PRODUCE lant.com
i b CARME80
h
CUSTOMER R ID
INSURER(S) AFFORDING COVERAGE NAIC
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. 77 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I LTR TYPE OF INSURANCE IINOR Iwvn 1 POLICY NUMBER I IMMJDD/YYYY) IIMM/DD//YYYYI I LIMITS
GENERAL LIABILITY EACH OCCURRENCE I 2,000,000
A X COMMERCAL GENERAL LIABILITY GP09315757 01/01/12 01/01/13 DAMAOET6RENcED
PREMISES {Ea occurrence) I 50,000
CLAIMS -MADE I X l OCCUR 1 MED EXP (Any one peracn) 0
PERSONALBADV INJURY 2,000,000
GENERAL AGGREGATE 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP /OP AGG 2,000,000
POLICY I 1 78 I LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000
A X ANY AUTO 8103036P64A 01/01/12 01/01/13 (Ea acatlenq
BODILY INJURY (Per person)
ALL OWNED AUTOS
BODILY INJURY (Per acadenl) I
I SCHEDULED AUTOS PROPERTY DAMAGE
I HIRED AUTOS (Per awtlent)
NONOWNED AUTOS
I 1
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB AGGREGATE
DEDUCTIBLE
RETENTION 1
WORKERS COMPENSATION I WC STATU- ER
AND EMPLOYERS' LIABILITY Y)N TORYLMIT$ I ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? l I N I A
(Mandatory In NH) E.L. DISEASE EA EMPLOYEE
If yes, descnbe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT
A PROPERTY '630581M4076 01/01/12 01/01/13 SEE
ATTACHED
DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If 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 8 ACCORDANCE WITH THE POLICY PROVISIONS.
its assignors and assignees
CIO American Lease Insurance AUTHORIZED REPRESENTATIVE
654 Amherst R. Ste 335
Sunderland, MA A 01375
1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
CARME80 PAGE 2
NOTEPAD
INSURED'S NAME City of Carmel OP (0:79 DATE 04/20/12
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
CC M'L ARTICLES: $875,830 W /$1,000 DEDUCTIBLE
FINE ARTS: $1,759,975 W /$1,000 DEDUCTIBLE
HOLDER CODE HUNTI -2 CARME80 PAGE
NOTEPAD: IN$UREp'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
...4 r -.t T .rf.r ..rl u irY -J :x
BUYERS ORDER FOR A MOTOR VEHICLE I
®NEW 'USED ebb DEMO (USED) MILEAGE 135 U JL�_JU Date MAY 2fiih 20I
-'.0 n EVR 0 L Cr
MAKE wrTCVAUt,tt MODEL l.LMJJ M.. KELLEY CHEW, LLC i.
YR. :,vie- ENG. STK. 43 t6 500 E. State Blvd.
a ,CYL „_,No. Fort Wayne, IN 46805 �}S T #:40I38
SERIAL ow t{LJU611.,( 3UO 260 -484- 5566.800 -553 -5539 {1EA1 :31152
No. C
COLOR TOP TRIM Please Print ME CITY OF CARI?fL
rUKt.Nhst I 25539.05
:TU. 414:Z1 CUVEli3 I bU. VU ADDRESS
Please Print 1 CIVIC S?
XIKN KUS 160.00 CITY STATE ZIP
N/A CARMEL IN 46032-2584
Phone Bus.
NIA (3171571 -2414 i317)571-2414
f A SS No. Email
dcordrayecarmel in.gav
NIA
TOTAL zss.u) SETTLEMENT AMOUNT AMOUNT
PURCHASE PRICE BROUGHT FORWARD g P5 t Ar
LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE DISCOUNT se is
This Lease/Purchase Omer lssubjec to the Following terms and conditions: TRADING DIFFERENCE 9£9£ -S or
1. TRADE -IN CERTIFICATION: It the customer has traded Ina motor vehicle on this purchase or lease. the customer
hereby warrants represents. and certifies to Dealer that the lade -in vehicle has never been tined or required to be INDIANA SALES TAX 1 n
add under any slate or federal law as a 'Rebuilt,' or "Salvage.' or'FIocd,: or "Defective; or 'Manufacturer Buyback' r
motor vehicle. If the customer has a trade -in vehicle. the customer further (H warrants, represent% and codifies to BALANCE 9£0£I a OG
Dealer that he trade -,n vehicle is 100 of any and all hens or encumbrances of any kind or nature whatsoever, other than w...
the specific balance owed ('d any) as set forth on this Purchase Order, and (2) the title to the trade -in vehicle shall be BALANCE DUE ON TRADE-IN A
delivered to the Dealer free and dear of all liens and encumbrances thereon at me hone the customer takes possession
of the motor vehicle purchasedAeased pursuant to this Purchase Order, provided. however, in the event the the is in GOOD UNTIL:
the possession of Iienholder being pad on as sot form on this Purchase Order, men title shall be ddrvared m the
Dealer within seven (7) days from the dale hereof. BAL. OWED TO:
2. WARRANTY INFORMATION:
a. NEW OR DEMONSTRATOR: If the motor vehicle I3 new or a demonstrator, the only warranty provided wtm respect
10 the motor vehicle and factory installed accessories' 10 the most recent applicable printed warranty which is made
solely by the Manufacturer of the motor vehicle and delivered to customer or found in the motor vehicle al the time
of delivery A demonstrator is xnsidered a used vehicle and not a rren molar vehicle. Dealer Mstalled Accessories
are not included In the Mandadurer's warranty on the molar vehicle and may or may Oo1 be included In separate
written warranties which are made solely by the manuhqurer. installer or supplier of the Accessories.
b. AS IS II the motor vehicle is a new demonstrator. or used motor vehicle. the motor vehicle is sold or leased by
theDealertothecustomerin" AS IS” condition, except for any printed warranty provided solely by the Manufacturer RUSTPROOFING- FAB. COAT SEALANT
wM respect to new or demonstrator motor vehicles, and except for any separate written warranty. if any, expressly n In
made or furnished by the Dealer on Its own behalf with respect to used motor vehicles, ro whim case, the only EXT. WARRANTY
nany provided is that specific express written warranty, if any. If the customer has purchased a service contract r �T
1 4
M the vehicle, the customer understands that the customer shall leek solely to the providerissuer of that service EVR FILING FEE i A
contract. and shah not look to Dealer For honoring or performance of that service contract. 1
a DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE IS NEW, A DEMONSTRATOR OR
USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE- LICENSE DLR N /4
CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND
WRITTEN, EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR q 1
VEHICLE DELIVERY CHARGE 1 tQ
A PARTICULAR PURPOSE. AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR
ANY CONSEQUENTIAL DAMAGE, LOSS OF TIME, OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 v,
OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR
CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL
ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW, ALL OF THE TERMS AND 1 0 C
CONBOTIONS OF THIS LEASE/PURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY
PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS. BALANCE "CtiCf
3. MISCELLANEOUS: In signing this Purchase Order rs to be understood that he customer Hn lake possession of PARTIAL PAYMENT
the motor vehicle within ten days aher nor that same is ready for delivery as per terms agreed upon. In the event of A
bus Purchase Order being canceled, the Oeater reserves the right to retain all deposits as liquidated damages. When D'
a motor vehicle is to be purchased on credit or leased, then the purchase/lease is contingent pon the Dealer obtaining BALANCE 2C*C( :ft
me consent and approval of the customers lendemesspr. If such consent rs not obtained, denied, or refused, customer
shall immediately return the motor vehicle to 1110 Dealer, and this Lease/Purchase Order shall be null and void. X
11110 M ownership to the motor vehicle shall not pass or be transferred until final full payment is made and dear tine
0 obtained to any motor ventde you traded in on the purchase/lease. Customer acknowledges and agrees that a
separate Ennis Selection and Arbitration Agreement has been executed and is corporated as pan of this
Lease/Purchase Order. This LeaPurchase Om old Order a the incorpo rated Forum Selection and Aratation Agreement CASH ON DELIVERY
contain the entire agreement between the customer and Dealer, and there are no verbal agreements or understandings 9 CRte r!+1
as to the purchase/lease of motor vehicle. BALANCE
This Purchase Omer Is presented on the basis of mmediate acceptance. In m used e event a motor vehicle is being x f A
traded In on a new or used motor vehicle purchase, this Purchase Omer is subject to the used motor vehicle being .1
delivered in the same condition and with the same equipment and substantially the same mileage as when appraised. LIEN TO:
When a new motor vehicle is ordered nom the factory the used motor vehicle trade-in Is subject lc reappraisal at the
lime of final delivery.
Any additional Federal or State Tax or extra delivery charges necessitated by Drive -aways or Express are to be paid
by the customer and all purchase orders are contingent upon strikes, delays of carrier or other causes beyond Our
control. All prices on new motor vehicles are subject to change without %Mice if the Manufacturer charges the prices.
If Dealer is providing customer with a free carwash pass, That pass and the right to a tree carwash extends to the
original purchaser only and is not assignable or transferable, voluntarily or unvoluntarily. Customer understands that
Lerida) vehicles, due to site or olhenwtse. may not be able to use the ca,wash at all or lime to time. Dealer reserves RECORD OF CAR TRADED IN
the rghl O to impose restrictions and conditions on the use of carwash, including me requirement X carwash lag
or pass: 8) to revise its restrictions and conditions from time to time, and (01) to modiry me hours of the carwash
operatton. the type of carwash equipment used, or to terminate the tree carwash program In its entirety.
If the customer is leasing the motor vehicle, the term customer, whenever used hereinahave, includes customers
slaws as a lessee, Year Make Type
YWE ACKNOWLEDGE READING the ABOVE TERMS AND CONDITIONS AND THAT THEY ARE BINDING UPON
ME/US AS A PART OF THIS PURCHASE OROER.THIS ORDER IS NOT BINDING UNLESS UNDERSIGNED BY AN
OFFICER OF THE COMPANY. 05 /25 /12 Color Sehal No.
a 8-F `../JJI
t a C p;A4:- atbj'. JDated: Mileage
Customer
N. ;1 T at;1 aeT r i irr"t eatl RECORD OF CAR TRADED IN
Customer
Year Make Type c.
Jintt f N%1UtDRALER OR HIS AUTHORIZED REPRESENTATIVE
Color Serial No.
SALESMAN SS No. Mileage
FORAM 437(208) lr The Reynolds and Reynolds Company FL620664 0 (01/12)
BUYERS ORDER FOR A MOTOR VEHICLE
pp� MILEAGE /L _/(_J J Date HAY 2 tit 2011
NEW 0 USED 80 DEMO (USED) 135
55.•' CH EVROS=E Mr
MAKE Lip: V KUL L MODELLLASSIC KELLEY CHEVY,LLC
YR. CUt1G ENG. ti STK. 4.3546 500 E. State Blvd.
Fort Wayne, IN 46805
SERIAL muirixbuzuLL6114bti 260- 484 5566.800 -553 -5539 COST 4:40138
IDEAL 4 0:31153
No.
COLORW711 t TOP RIM Plea e NAME CITY OF CARPIEL
PURCHASE PRICE 26539.05
;ULL It e.L UV .K) bU. UV ADDRESS
t Please Print I CIVIC S4
4 EXTRA KEYS 160.00 CITY STATE ZIP
IEIA CAMEL Ill 46032-2584
N/A Phone (317j571 --2414 Bus. (317)571'•2414
WA SS No. E mail
dcordrayecarmel.in.gov
N/A
T OTAL Cbtt3�.U5 SETTLEMENT AMOUNT AMOUNT
PURCHASE PRICE BROUGHT FORWARD 7cg'S t1c
LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE DISCOUNT NI A
This Lease/Purchase Order is subject to the louowing terms and conditions: TRADING DIFFERENCE 2500) OC
1, TRADE -IN CERTIFICATION: It the customer has traded in a motor vehicle on this purchase or lease. the customer
hereby wananis, represents, and centres to Dealer teal me vadein vehicle has never been Ivied or required to be INDIANA SALES TAX Al /A
)Ned under any state or federal law as a'Rebuilt or'Salvage, or 'Flood or 'Defective," or "Manufacturer Buyback"
motor vehicle. R the customer has a Trade -in vehicle, the customer further: (1 warrants, represents, and certifies to BALANCE 7Ci4( (tit{
Dealer that ear Trade-in vehicle is free of any and all liens or encumbrances W any kind or nature whatsoever, other than
the specific balance owed (it any) as set roan on this Purchase Order, and (2) the tale to the trade -in vehicle shall be BALANCE DUE ON TRADE -IN N A
delivered to the Dealer free and dear of all liens and encumbrances thereon at the time the customer takes possession
of the motor vehicle purchasedneased pursuant to this Purchase Order. provided, however, in the event me toe is in GOOD UNTIL:
the possession of the Iiennomer being paid on as set forth on this Purchase Order, men title shall be delivered to the
Dealer within seven (7) days from the dale hereof BAL. OWED TO:
R. WARRANTY INFORMATION:
a. NEW OR DEMONSTRATOR: II the motor vehicle Is new or a demonstrator, the only warranty provided with rasped
to the motor vehicle and factory installed accessories Is the most recent applicable printed warranty which is mado
s0ely by the Manufacturer of the motor vehicle and delivered to customer or found in the motor vehicle at the time
of delivery. A demonstrator is considered a used vehicle and not a new motor vehicle. Dealer Instated Accessories
are not Included in the Manufacturers warranty on the motor vehicle and may or may not be included in separate
when warranties which are made solely by the manufacturer, =taller or supplier of the Accessories.
P, "AS 15 If the motor vehicle's a new demonstrator, or used motor vehicle, the motor vehicle is sold or leased by
the oeaier to me customer in 'AS DS condition, except for any printed warranty provided solely by the Manufacturer RUSTPROOFING- FAB. COAT SEALANT gy#A
won respect t0 new or demonstrator motor vehicles, and except for am separate written warranty, II any. expressly
made or furnished by me Dealer on its own behalf with respect m used motor vehicles. in which case, the only EXT. WARRANTY
warranty provided 5 that spe(fic express wntten warranty. if any. If to customer has purchased a service contract 19/A
on the vehicle, the customer understands that the customer shall esok solely m the pmvweressuer of that service EVR FILING FEE
contract and shoo not look m Dealer tor honoring or performance of service contract .1/ ry
c. DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE IS NEW, A DEMONSTRATOR OR
USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE LICENSE Of R 1
CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND r�
WRIREN,EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR VEHICLE DELIVERY CHARGE lI /A
A PARTICULAR PURPOSE, AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR
ANY CONSEQUENTIAL DAMAGE. LOSS OF TIME, OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 7C
OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR
CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL
ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW. ALL OF THE TERMS AND ?C
CONDITIONS OF THIS LEASENURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY BALANCE
PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS, 9 C41c♦1t 11;
3. MISCELLANEOUS: In signing Ibis Purchase Order it is to be understood that the customer will lake possession of PART PAYMENT
me motor vehicle within ten days aver notice that same is ready for der ry as per terms agreed upon. In me event m P7 A
this Purchase Order being canceled, the Dealer reserves the righl to retain all deposits as liquidated damages. When
a motor vehicle is to be purchased on credit or leased, men the purchase/lease is contingent upon the Dever ob10ining BALANCE 7CRAli if
the consent and approval of the customers lender/lessor. If such consent is not obtained, denied. or refused. customer
shall immediately return the motor vehicle to the Dealer, and this Lease/Purchase Order shall be nun and void.
Tice of ownership to the motor vehicle shah not pass or be transferred until final full payment is made and dear tine
is obtained to any motor vehicle you traded in on the purchaseltease. Customer acknowledges and agrees that a
separate forum Selection and Arbitration Agreement has been executed and is corporated as part W this
L JPurchase Order. This Lease/Purchase Order and the incorporated Forum Selection and Arbitration Agreement CASH ON DELIVERY It
contain me entire between re agreement betweehe customer and Dealer, and there are no verbal agreements or understandings ?SRftI 'Z
as to the purchasellease of the motor vehicle. BALANCE
This Purchase Order is presented on the basis of immediate acceptance. In the event a used motor venbe Is hang N 1 A
traded in on a new or used motor vehicle purchase, this Purchase Order Is subject to the used motor vehicle being
delivered in the same condom and with the same equipment and substantially the same mileage as when appraised. LIEN TO:
When a new motor vehicle is ordered from the factory, the used mold vehicle trade-in is subject to reappraisal at the
tone of Final delivery.
Any additional Federal or State Tax or extra delivery charges necessitated by Drive -sways or Express are to be paid
by the customer and all purchase orders are contingent upon strikes, delays of carrier or other causes beyond our
02050. At peeps on new mow vehtdes are subset change wiwA notice a the Manufacturer changes me Prices. h
If Dealer is providing customer with a free ash pass, that pass and the right t0 a free carwash extends to the
original purchaser only and Is hit assignable or Transferable, voluntanly or uneoluntarily. Customer understands that
certain vehicles, duo t0 size or otherwise, troy not be able to use the carwash at all or from time t0 Gme. Dealer reserves
the right 0) to impose restrictions and conditions on the use W the carwash, including the requirement of cawash tag RECORD OF CAR TRADED IN
or pass: (0) to revise its restdc)iona and conditions from time to lime. and (n] to modify the hours of the carwash
operation, the type of cowrie equipment used or t0 terminate Ne Tree 005000h program in its entirety.
If the customer is leasing the motor collide. the term customer, whenever used horeinabove, includes customer's
status as a lessee. Year Make Type
W/E ACKNOWLEDGE READING the ABOVE TERMS AND CONDITIONS AND THAT THEY ARE BINDING UPON
ME/US AS A PART OFTHIS PURCHASE ORDER, THIS ORDER IS NOT BINDING UNLESS UNDERSIGNED BY AN
OFFICER OF THE COMPANY. COOP Serial No.
411 y -�F ;�:wlic 4,130,.so, 05 26 12
4 .-*Dated: Mileage
Customer
0' f h fri riCt Doted: RECORD OF CAR TRADED IN
Customer HARK T WRIGHT FINANCE MANAGER
Accepted by: Year Make Type
HARK WRIGHT EER OR HIS AUTHORIZED REPRESENTATIVE
IIARK T 4SG1 A Color Serial No.
SALESMAN 5S No. Mileage
FORMY 437 (208) The Reynolds and Reynolds Company FL6206640(01/12) r.
BUYERS ORDER FOR A MOTOR VEHICLE f HAY 25th 2012
®NE BUSED cP DEMO(USED) MILEAGE 135 Date
r. i$LviYULL I lLr .)IC LC N!C. fl O- 'L
MAKE MODEL KELLEY CHEVY, LLC
YR. 1 ENG. STK. i7 500 E. State Blvd.
y ,C,YL, No,,,, Fort Wayne, IN 46805 OUST N:40118
SERIAL I(l JVC. T'.L 260- 484 5566.800.553 -5539 DEAL 4 :31154
No.
COLOR''" TOP INT. CUST, NAME CITY OF CARREL
TRIM Please Print
rUKI.RHst rKllt. 25053•1./5
4 :ORA KC::, 163•03 ADDRESS
Please Print
1 CIVIC SO
utrt(LA r1MHHUALJ 195.1.1U
W/A CITY CARMEL STILE ZIP 46032 -2584
(r/A Phone (317)571-2414 Bus (317)571 -2414
diA
SS No. E or dray@carmei.irt.gov
N/A
4 ®4A(L t. vo• SETTLEMENT AMOUNT AMOUNT
PURCHASE PRICE BROUGHT FORWARD 25408.05
LEASE/PURCHASE ORDER TERMS AND CONDITIONS USED CAR ALLOWANCE/DISCOUNT N/A
TNS Lease/Purchase Order is subject to me lonowing tern am caxxLlions: TRADING DIFFERENCE 25400.05
1. TRADE -IN CERTIFICATION: II the customer bas traded Ina motor while on this purchase or lease. the customer a rA
W S
hereby warrants, represents. are certifies to Dealer that the vade'n vehicle has never been tided a required to be INDIANA SALES TAX
titled under any slate or federal law as a'Rebuilt: or ahrage. or 'Flood: M 'Defective: 0r'Mamtadurer Buyback' 25400.05
meta a vehicle. the customer has a tade'n vehicle, the Customer mnher: (1) warrants, represents. and certifies to BALANCE 1'
Dealer flat the bade -in vehicle is free of any and all iens or encumbrances of any kind or nature whatsoever. other than NIA
the specific balance owed (d any) as set forth on this Purchase Omer. and (2) the e to m
e e trade vehicle shall be BALANCE DUE ON TRADE -IN
delivered to the Dealer free and dear of al liens and encumbrances thereon at time the customer takes possession
DI the motor vehicle purchased/leased pursuant to this Purchase Omer, provided. however. in the event the tale a in GOOD UNTIL:
the possessor of the henhdder being paid off Easel myth on etas Purchase Order, then tote shall be ,havered to the
Dealer within seven m days Iran tie dam hereof. BAL. OWED TO:
2. WARRANTY INFORMATION:
a. NEW 011 DEMONSTRATOR: If the motor vehicle rs new or a denenatrala. the only warranty provided wah respect
(0 the motor vehicle and fadOry installed aaassones is the most Went applicable primed warranty which is made
solely by the Manufacturer of the moles vehicle and delivered to customer Or found in the motor vehicle at the time
Of defnrery. A demonstrator is considered a used vehicle and not a new motor vehicle. Dealer installed Accessories
are not included in Me Manufacturer's warranty on the motor vekde and may or may not be included in separate
written warranties which ere made solely by Ire manufacturer. installer or supplier of the Accessories.
b AS h5': If the motor vehicle is a new demonstrator, or used motor vehicle, the motor vehicle is sold 0 leased by
ale Dealer to the customer in 'AS IS' condition. except cur any printed warranty provided SOWN by re Manotanurer RUSTPROOFING FAB. COAT SEALANT 11 /A
with respect to new or demYYslalor motor vehicles. and except tor any separate written warranty, d any. expressly
made or furnished by Ire Dealer on is own behalf with respect to used motor vehicles. in whin case, the only EXT. WARRANTY N/A
warranty provided is that specific express wdben warranty, a any II the customer has purchased a service contract
on the venide. the customer understands that the customer shall look solely 10 the provider/Issuer of that service EXCISE TAX 1/ A
contract, and shall not look to Dealer for honoring or performance of that service contract.
c. DISCLAIMER OF WARRANTIES: ALL VEHICLES: WHETHER THE VEHICLE 15 NEW, A DEMONSTRATOR OR
USED: UNLESS DEALER FURNISHED BUYER WITH A SEPARATE WRITTEN WARRANTY OR SERVICE TITLE LICENSE UL I{ 111/4
CONTRACT MADE BY THE DEALER ON DEALER'S BEHALF, DEALER DISCLAIMS ALL WARRANTIES, DOCUMENT PREPARATION AND
WRITTEN, EXPRESS OR IMPLIED, INCLUDING ALL WARRANTIES OF MERCHANTABILITY OR FITNESS FOR VEHICLE DELIVERY CHARGE 11f A
A PARTICULAR PURPOSE, AND DEALER EXPRESSLY DISCLAIMS ANY LIABILITY TO PURCHASER, FOR
ANY CONSEQUENTIAL DAMAGE, LOSS OF TIME. OR INCONVENIENCE ARISING OUT OF THE PURCHASE TIRE TAX 1 25
OR OPERATION OF THE VEHICLE. THIS DISCLAIMER OF WARRANTIES AND FOR ANY INCIDENTAL OR
CONSEQUENTIAL DAMAGES APPLIES TO PERSONAL INJURY, BODILY INJURY OR WRONGFUL DEATH TOTAL 2S
ONLY TO THE EXTENT PERMITTED UNDER APPLICABLE STATE LAW, ALL OF THE TERMS AND
CONDITIONS OF THIS LEASE/PURCHASE ORDER ARE SEVERABLE, AND THE INVALIDITY OF ANY BALANCE 25401 30
PARTICULAR TERM SHALL NOT OPERATE TO VOID THE REMAINING TERMS.
3, MISCELLANEOUS: In signing Mrs Purchase Order 11 is to be rmbrsi004 that the customer will take possession of
the PARTIAL PAYMENT NIA
e motor vehicle M n t 01
e within ten days alter name at same is ready delivery as per ter agreed upon. In o event
NB Purchase Order being canceled. the Dealer reserves the rg1 to retain al deposits as liquidated damages. When
a motor vehicle s to be purchased on veto a leased, then the pumhasMease0 contingent upon the Dealer obtaining BALANCE 25409 -30
the consent and approval of Me customer's IeMernesaor. 11 such consent is not obtained, denied, 00 rewsed, customer
shall immediately return the mold veldde to the Dealer, and this Lease/Purchase Order loan be null and void.
Me of ownership to the motor veldde shall not pass or be banslerred until final mu payment is made and dear title
rs obtained IC any motor vehicle you traded in on the purchase/lease. Customer acknowledges and agrees That a
separate forum Selection and Arbitration Agreement has been executed and rs incorporated as part of this
Leasarard,ase Order. This Lease/Purchase Order and the incorporated Forum Selection and Arbitration Agreement CASH ON DELIVERY 2621. -30
contain the enure agreement between the customer and Dealer, and there are no verbal agreements or INersatdings
as to the wrdlasMease of the motor vehicle. a
This Purchase Order a presented an the basis m immediate acceptance. In e even) a used motor vehicle is being BALANCE
traded in on a new or used motor uehide purchase, this Purchase Order Is subject to the used motor vehicle being
ash/erect in the same condition and wen the same equipment and substantially the same mileage as when appraised. LIEN TO:
When a new motor vehicle rs ordered from the ladory, the used motor vehicle Irade -m Is saved (0 reappraisal at
time of final delivery
Any additional Federal or Slate Tax or extra delivery charges receasialed by Drive-aways or Express are to be paid
by the customer and all purchase orders are contingent upon sakes. delays of carder or other Causes beyond our
coned. Al prices on new motor vehicles are subject to large without notice it the Manuaclurer changes the Prices-
II Dealer rs providing 0Rlaner was a tree caM24n pass, that pass and NB right to a bee eaw2d1 extends m Me
oraRnal port ser only and is not assignable Or transferable. voluntarily or unvoluntariy. Customer understands Mat
certain vehicles, due (0 size or otherwise. may not be ede to use the canwasn at all or from time to time. Dealer reserves
the right(i)to Impose restrictions and conditions on the usa of the inward. including the requirement of a can wash as RECORD OF CAR TRADED IN
or pass: Oil to revise da restrictions and conditions from tore 10 time, 000 (it) to modify me hours of the carwesh
operated the type el canvash equipment used. or In terminate the bee canxash program in as entirety.
II me customer is leasing the motor vehicle. the term customer. whenever used hereinabovo, includes customer's i
status as a lessee. Year Make Type
UWE ACKNOWLEDGE READING the ABOVE TERMS AND CONORIONS AND THAT THEY ARE BINDING UPON
BENS AS A PART OF THIS PURCHASE ORDER,THIS ORDER 15 NOT BINDING UNLESS UNDERSIGNED BY AN
OFFICER OF THE COMPANY. 05/25/12 Color Serial No.
1 ewe' (i +lvl:L t :cubs ^.330__' Dated: Mileage
Customer
MARK T IJRIGHI FINANCE MANAGER
LAGER RECORD OF CAR TRADED IN
Customer
Algip'die T WRIGHT Year Make Type
DEALER OR HIS AUTHORIZED REPRESENTATIVE
Color Serial No.
SALESMAN SS No, Mileage
FORM# 437 (2 08) The Reynolds end Reynolds Company Fte250040