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2012 Police pay request 7 Lease 2012 Sch #9 (Police Dept.) Payment Request 2012 -7 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: Bell Techlogix Amount: $6,810.70 Description of Equipment Item Cost: Computers Dated: May 21, 2012 LESSEE: City of Carmel One Civic Square Carmel, II 6032 By: Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Bell Techlogix Inc. P.O. Box 823342 Philadelphia, PA 19182-3342 PAGE �--Th OP ID: 79 "C 04 /20 /1 CERTIFICATE OF LIABILITY INSURANCE OAT Y) 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 800 678 0361 CONTACT Marianne Uban Hy /ant Group Inc- Indianapolis PHO FAX 301 Pennsylvania Parkway, #201 317.817.5151 -(AIgN ,.ES p: 317.817 -5136 (Pic, No) 317 817 -5151 Indianapolis, IN 46280 E-MAIL m erle nne.UbaO h IanLDOm W. Michael Wells ADDRESS: @Y PRODUCER CARME80 CUSTOMER 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR I TYPE OF INSURANCE INSR 'Mr) POLICY NUMBER (MMIDDIYYYY) IMMIDDI'IYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE 2,000,000 A X COMMERCIAL DAMAGE-10-RENTED L GENERAL LIABILITY GP09315757 01/01/12 01/01/13 PREMISES (Ea occurrence) S 50,000 CLAIMS -MADE 1 X I OCCUR I MED EXP (Any one person) 0 PERSONAL BADV INJURY 2,000,000 I GENERAL AGGREGATE 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG 1 2,000,000 POLICY 1 PF9T 1 I LOC 1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 2,000,000 (Ea acadent) A X ANY AUTO 8103036P64A 01/01/12 01/01/13 BODILY INJURY (Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON -OWNED AUTOS UMBRELLA LIAR _OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DEDUCTIBLE 1 1 RETENTION 1 1 WORKERS COMPENSATION WC STATU- I DTH- AND EMPLOYERS' LIABILITY YI �ORYLIMIT$ I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE EA EMPLOYEE If yes, describe order DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT 5 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 ACCORDANCE WITH THE POLICY PROVISIONS. its assignors and assignees C/O American Lease Insurance AUTHORIZED REPRECENTATIVE 654 Amherst Rd. Ste 335 6_ fce: )&7z-o_sC. ,Sunderland, MA 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 ID: 79 DATE 04/20/12 NAMED INSURED: CITY OF CARMEL CARMEL CLAY PARKS BUILDING CORPORATION CARMEL CLAY BOARD OF PARKS 6 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 CTUAL 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 ISC. 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 W /$1,000 DEDUCTIBLE NOTEPAD: HOLDER CODE HUNTI -2 CARME80 PAGES IN$URED'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 Equipment/Vehicles Bell Techlogix PAGE:1 Focused Skilled Reliable INVOICE: BI 319540 REMIT T0: BELL TECHLOGIX INC INVOICE DATE: 05 /09/12 P.O. BOX 823342 DUE DATE: 06/08/12 PHILADELPHIA PA 19182 -3342 TERMS: 317- 704 -6000 Net 30 866- 782 -2355 Net 30 Days SHIP TO: BILL TO: 1201825 Carmel Police Department CITY OF CARMEL 3 civic suare ONE CIVIC SQUARE attn: terry crockett ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 USA ORDER: 695109 ORDER DATE: 04/25/12 CUSTOMER P.O.: 2 614 7 CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD:FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: SETH SCHWARTZBACH CURRENCY: United States Dollars LINE ITEM QUANTITY UNIT PRICE NET AMOUNT DESCRIPTION Came Po ice Department terry crockett Cust PO Num: 26147 Contact name: Terry Crockett Phone: 3175712567x Email: tcrockett@carmel.in.gov prices are based on WSCA II contract pr racing or better city of carmel BELL SO 695109 20096631 1 A7L16UT #ABA 1 EA 569.38 6200 PRO MT PDC /2.7 2GB 500GB 569.38 EA W7P 32 SBY Line Lot /Serial Details: MXL2101QLC EA 1 2 QS208AA 1 EA 90.08 DVDR SATA 16X SUPERMULTI JB DR 90.08 EA 3 AT024AT 1 EA 27.72 HP 2GB PC -3 10600 (1333MHZ) 27.72 EA DIMM 4 U7897E 1 EA 70.42 UPG WARR CPE 4YR ND HE -DT 3/3/ 70.42 EA 3 STDWARR CPU 5 BE750G 1 EA 94.62 APC BACK -UPS ES 750VA 100UT 94.62 EA 120 VOLT MASTER CONTROL 6 NQ576AT 1 EA 16.58 HP LCD SPEAKER BAR 16.58 EA SPEAKER 7 XN374A8 #ABA 2 EA 335.76 LA2006X LCD DISPLAY TFT WLED 167.88 EA 20IN WIDESCREEN 1600X900 60HZ FREIGHT CHARGE: GROSS AMOUNT: INVOICE DISCOUNT: NET AMOUNT: TAX AMOUNT: DOWN PAYMENT: NET AMOUNT DUE: Techlogix PAGE: Focused• Skilled. Reliable INVOICE: BI 319540 REMIT TO: BELL TECHLOGIX INC INVOICEDATE:05 /09/12 P.O. BOX 823342 DUEDATE: 06/08/12 PHILADELPHIA PA 19182 -3342 TERMS: 317- 704 -6000 Net 30 866 782 -2355 Net 30 Days SHIP TO: BILL TO: 1201825 Carmel Police Department CITY OF CARMEL 3 civic suare ONE CIVIC SQUARE attn: terry crockett ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 USA ORDER: 695109 ORDER DATE: 04 /25/12 CUSTOMER P.O.: 2 614 7 CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: SETH SCHWARTZBACH CURRENCY: United States Dollars LINE ITEM QUANTITY UNITPRICE NETAMOUNT DESCRIPTION Line Lot Seria Detai s: CNC211PLDK EA 1 CNC211PL89 EA 1 8 U0J12E 2 EA 68.00 ELECTRONIC HP CARE PACK NBD 34.00 EA 9 ISR- 760 -0007 1 EA 28.00 HARDWARE CONFIGURATION 28.00 EA 10 F2CD000806 -E 1 EA 16.74 VIDEO /AUDIO CABLE DISPLAY PORT 16.74 EA (M) 6FT PAST DUE ACCOUNTS CARRY INTEREST AT THE LESSER OF 1.5% PER MONTH OR THE MAXIMUM LEGAL RATE IN THE JURISDICTION IN WHICH THE CUSTOMER'S PRINCIPAL PLACE OF BUSINESS IS LOCATED ALL DELIVERY TERMS ARE F.O.B. ORIGIN TO REQUEST A STATEMENT OF ACCOUNT PLEASE CONTACT 866 -782 -2355 EXT 56817 FEDERAL TAX ID# 26- 3683994 FOR SERVICE CALL 1 -800- 999 -9813 FREIGHT CHARGE: 0.00 GROSS AMOUNT: 1,317.30 INVOICE DISCOUNT: 0.00 NETAMOUNT: 1,317.30 TAX AMOUNT: 0.00 DOWN PAYMENT: 0.00 NET AMOUNT DUE: 1,317.30 Bed Techlogix PAGE 1 Focused Skilled •Reliable INVOICE: BI 319539 REMIT TO: BELL TECHLOGIX INC INVOICE DATE: 0 5 09/12 P.O. BOX 823342 DUEDATE: /08/12 PHILADELPHIA PA 19182 -3342 317 704 -6000 TERMS: Net 30 866- 782 -2355 Net 30 Days SHIP TO: BILL TO: 1201825 Carmel Police Department CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE attn: terry crockett ATTN: ACCOUNTS PAYABLE Carmel IN 46033 CARMEL IN 46032 USA ORDER: 695108 ORDER DATE: 04/25/12 CUSTOMER P.O.: 26146 CARRIER: FREIGHTTERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: SETH SCHWARTZBACH CURRENCY: United States Dollars LINE ITEM QUANTITY UNIT PRICE NET AMOUNT DESCRIPTION Carme Po ice Department terry crockett Cust PO Num: 26146 Contact name: Terry Crockett Phone: 3175712567x Email: tcrockett @carmel.in.gov prices are based on WSCA II contract pr racing or better city of carmel BELL SO 695108 20096632 1 A7L16UT #ABA 5 EA 2,846.90 6200 PRO MT PDC /2.7 2GB 500GB 569.38 EA W7P 32 SBY Line Lot /Serial Details: MXL2101QDM EA 1 MXL2101QDN EA 1 MXL2101QKZ EA 1 MXL2101QLZ EA 1 MXL2101QM4 EA 1 2 QS208AA 5 EA 450.40 DVDR SATA 16X SUPERMULTI JB DR 90.08 EA 3 AT024AT 5 EA 138.60 HP 2GB PC -3 10600 (1333MHZ) 27.72 EA DIMM 4 U7897E 5 EA 352.10 UPG WARR CPE 4YR ND HE -DT 3/3/ 70.42 EA 3 STDWARR CPU 5 BE750G 5 EA 473.10 APC BACK -UPS ES 750VA 100UT 94.62 EA 120 VOLT MASTER CONTROL 6 NQ576AT 5 EA 82.90 HP LCD SPEAKER BAR 16.58 EA FREIGHT CHARGE: GROSS AMOUNT: INVOICE DISCOUNT: NET AMOUNT: TAX AMOUNT: DOWN PAYMENT: NET AMOUNT DUE: Bell Techlogix PAGE: Focused• Skilled. Reliable INVOICE: BI 319539 REMIT TO: BELL TECHLOGIX INC INVOICEDATE:05 /09/12 P.O. BOX 823342 DUEDA /08/12 PHILADELPHIA PA 19182 -3342 TERMS: 317- 704 -6000 Net 30 866- 782 -2355 Net 30 Days SHIP TO: BILL TO: 1201825 Carmel Police Department CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE attn: terry crockett ATTN: ACCOUNTS PAYABLE Carmel IN 46033 CARMEL IN 46032 USA ORDER: 695108 ORDER DATE: 04/25/12 CUSTOMER P.O.: 26146 CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: FEDERAL EXPRESS ECONOMY TRANSPORTATION ID: SALESPERSON: SETH S CHWARTZBACH CURRENCY: United States Dollars LINE ITEM QUANTITY UNIT PRICE NETAMOUNT DESCRIPTION SPEAKER 7 XN374A8 #ABA 5 EA 839.40 LA2006X LCD DISPLAY TFT WLED 167.88 EA 20IN WIDESCREEN 1600X900 60HZ Line Lot /Serial Details: CNC211PLD2 EA 1 CNC211PLH2 EA 1 CNC211PLLX EA 1 CNC211PLMH EA 1 CNC211PL86 EA 1 8 U0J12E 5 EA 170.00 ELECTRONIC HP CARE PACK NBD 34.00 EA 9 ISR- 760 -0007 5 EA 140.00 HARDWARE CONFIGURATION 28.00 EA PAST DUE ACCOUNTS CARRY INTEREST AT THE LESSER OF 1.5o PER MONTH OR THE MAXIMUM LEGAL RATE IN THE JURISDICTION IN WHICH THE CUSTOMER'S PRINCIPAL PLACE OF BUSINESS IS LOCATED ALL DELIVERY TERMS ARE F.O.B. ORIGIN TO REQUEST A STATEMENT OF ACCOUNT PLEASE CONTACT 866 782 -2355 EXT 56817 FEDERAL TAX ID# 26- 3683994 FOR SERVICE CALL 1 -800- 999 -9813 FREIGHT CHARGE: 0.00 GROSSAMOUNT: 5,493.40 INVOICE DISCOUNT: 0.00 NETAMOUNT: 5,493.40 TAX AMOUNT: 0.00 DOWN PAYMENT: 0.00 NET AMOUNT DUE: 5,493.40