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2013 Police schedule 15 pay request 18 Lease 2013 — Sch # 15 (Police Dept.) Payment Request # 2013-18 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 February 14, 2013 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: General Dynamics Itronix Amount: $25,240.95 Description of Equipment Item Cost: 6 In-Car Computers Dated: September 20, 2013 LESSEE: City of Carmel One Civic Square Carmel, IN 460 2 B),. � A ' Name: Diana Cord ray , Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: General Dynamics Itraux P.O. Box 201451 Dallas, TX 75320-1451 • PAGE ACORIJ CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDCIYYYY, 3/25/2013 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 en endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER I CONTACT NAME: Matlanne_U2an Hylant Group Inc-Indianapolis 1A+CNo.Fxn,317-817-5136 (NO,Noe317-817_5151 301 Pennsylvania Parkway, #201 E-MAIL Indianapolis IN 46280 ADDREss:marianpe.uban( hylant.com INSURER(S)AFFORDING COVERAGE NAIC INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARM E80 INSURER B: City of Carmel INSURER C One Civic Square INSURER D: Carmel, IN 46032 - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1271512319 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 HY 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. INSft A UB DDLSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR VIVD POLICY NUMBER (MMiDUs'YYYY) (MMIDD/YYYY)I LIMITS A I GENERAL LIABILITY LP14T62033 5!112013 '1A/2014 EACFI OCCURRENCE $2,000,000 X I;iAMAGE t RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence', $50.000 I I CLAIMS-MADE X OCCUR MED UP(Any one person! SExcluded ■ PERSONAL B ADV INJURY $2,000,000 ■ GENERAL AGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PEW. PRODUCTS-COMP/OP AGG $2,000,000 POLICY JFCT flT f I ' LOC I A I AUTOMOBILE LIABILITY H0103036P64ACOF13 I/1/2013 h/1/2014 COMBINED SINGLE LIMIT fEaacgat) $2000,000 X ANY AUTO BODILY INJURY(Per Cerson} 3 ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE �$ HIRED AUTOS AUTOS Per doodad) X Comp X Coll I ComplCell Deo $2,500 UMBRELLA JAB OCCUR EACH OCCURRENCE $ EXCESSLIAB , CLAIMS-MADE AGGREGATE kk$ I DED I RETENTION$ I $ I WORKERS COMPENSATION INC STATU- OIR- AND EMPLOYERS'LIABILITY YIN I TORY.LIMITS I PH I ANY PROPRIETORIPARTRER,EXECUIIVE NIA I E.L.EACH ACCIDENT Is OFFICER/MEMBER EXCLUDED? IManOelory in NN) E DISEASE-EA EMPLOYE S p yes,deseribe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Allach ACORD 101,Additional Remarys schedule,it more apse is required) ADDITIONAL NAMED INSUREDS: CARMEL CLAY PARKS BUILDING CORPORATION; CARMEL CLAY BOARD OF PARKS & RECREATION; CARMEL REDEVELOPMENT COMMISSION; CARMEL REDEVELOPMENT AUTHORITY; CARMEL CITY CENTER COMMUNITY DEVELOPMENT CORPORATION Re; Various Police EquipmentNehicles CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Huntington National Bank& its assignors and ACCORDANCE WITH THE POLICY PROVISIONS. assignees clo American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Ama Ste. 335 C- Sunun Sunderland MA A 01375 01375 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201(105) The ACORD name and logo are registered marks of ACORD 3ENERAL DYNAMICS invoice ; S0031051 t ;Date_ 9;10/2013 LronIx (Page 1 000 Sawgrass Corporate Parkway Mail payments only to: uite 200 GENERAL DYNAMICS ITRONIX unrise FL 33323 P.O. BOX 201451 DALLAS, TX 75320-1451 Bill To: Ship To: CITY OF CARMEL CITY OF CARMEL ATTN_ TODD LUCKOSKI THREE CIVIC SQUARE 31 1ST AVENUE NW Police Dept CARMEL IN 46032 CARMEL IN 46032•?hrchase Ordcr No: Customer ID;.. _' � SalespersorilD ' Method: '" .Payment Teems `Req`Ship Date Sales.Order ' :5677 228088 GARDNER _SURFACE Net 30 days 4/2312013 550016951 rPartlNumber .� JDi scrptioh -... . ' -`.y +O•dered ,I Shippedi I tlnitiprlce eit. Price 32-0886-001R KIT, WWAN-VERIZON 4G(GD8200 6 6 $230.65 5 1,383.90 s ERVICE UPSELL Subtotals k ‘ S 1,383.90 Misc. - x e $ 0,00 ik to partial Tax - _ $0.00 $6.22_ 166622032109214 Tradi:liscountif;;_ $0.00 'ayments received more than Net Terms, as staked on the invoice, shall be 'Total.-�! ;u: _z.:._+ $ 1,390.12 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 GENERAL QYNAI'V!IC S Invoice S0030898 } `.Date 8/29/2013 `rontx Page 1 000 Sawgrass Corporate Parkway Mail payments only to: •uite 200 GENERAL DYNAMICS ITRONIX unrise FL 33323 P.O. BOX 201451 DALLAS, TX 75320-1451 Bill To: Ship To: CITY OF CARMEL CITY OF CARMEL ATTN: TODD LUCKOSKI THREE CIVIC SQUARE 31 1ST AVENUE NW Police Dept CARMEL IN 46032 CARMEL IN 46032 ?urchase'Order No._ ' Customer ID Salesperson ID 'Shipping.Method Payment Terms ' , 'Req Ship Date - Sales-Order - :5677 22808B GARDNER SURFACE Net 30 days 4/23/2013 550016951 IrPart Number, _ . _I Description _. _ 'Ordered. I Shipped I. Unit'Price 'Ext. Price GD8200-106 GD8200 SKU 6 6 $3,287.76 $ 19,726.56 :ZKHH1335ZZ0067 ZZKHH1335ZZ0131 ZZKHH1335ZZ0146 ZZKHH1335ZZ0148 ZZKHH1335ZZ0175 ZKHH1335ZZ0197 50-0141-006R VEH ADP,10-32V/18.5V,90W 6 6 $62.61 $375.66 52-0781-002R KIT,GD8K,MULTI DVD-RW 6 6 $ 164.75 $988.50 3A1 IWARR3YR 3YR BATT REPLACEMENT 6 6 $ 195.75 $ 1,174.50 NFMAX3YR NO FAULT MAX SVC 3 YR 6 6 $256.65 $ 1,539.90 ;ERVICE UPSELL Subtotal _ _• $ 23,805.12 Misc . _.._. $0.00 ik to partial Tax -. . _' $0.00 Freight _ __' $45.71 66622032108422 -Trade Discount._ $ 0.00 'ayments received more than Net Terms, as stated on the invoice, shall be Total' -. _ I $23,850.83 ubject to a late charge of three percent (3%) per month on the unpaid balance. if proudly welcome American Express cards for payment. To pay using your ...-..;,-., c--..-.n n....1 ..1...-...,, ,,-.11 1 ono nra n4 An — 1 ono ncc ni 07