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2012 Fire department schedule 12 pay request 4 Lease 2012 — Sch # 12 (Fire Dept.) Payment Request # 4 EXHIE31TA PAYMENT REQUEST FORM /ACCEPTANCE CERTIE]CAm The Escrow Agent is hereby requested to pay from the Acquisition Fund established by the Escrow Agreement dated as of January ]0, 2013 by and among the Escrow Agent, the Lessee and Lessor, to the person or corporation designated below as Payee,the sure set forth below in payment (of aI11of 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: AMK Services Amount: $17.525.00 Description of Equipment Itent Cost: Mobile & Portable Radios Dated: September 19,2013 LESSEE: City of Cannel One Civic Square Carmel,iN Ito Name: Diana Cord ray 'title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE PAY VIA WIRE TRANSFER: PAGE k INVOICE AMK Services,�.c Invoice# 3245 15555 Stony Creek Way Noblesville, IN 46050 (317)774-1867 (317)774-1869(f) SOLD Carmel Fire Dept. TO Attn: Adam Harrington 2 Civic Square Carmel, IN 46032 LFCCOUNT NO_ _ -I PO NUMBER IL`SHIP VIA ,' .' li.DATE.SHIPPED II TERMS' r -- UN401GE_DATE WC PAGE ,' CARMFD 24362 I I Net 30 9/16/2013 1 1 ITEM NO >- 1 •1QUANTITY,IT DESCRIPTION 1 :-. '" -, . ' -... ....L..fi,UNIT PRICE: L. __.EXTENDED MAYR-NP7AT 23 TAC Feature, EDACS Analog to 530,00 12,190.00 P25 Trunking LABOR 22 Retune M7100 for P25 Operation 80.00 1,760.00 LABOR 1 Remove and Install radios into 12 existing 2475.00 2,475.00 r';.--,,. vehicles YRP,L1X "q, 4 TAC Feature,ProRoaming 235.00 940.00 LABOR ';e 2 Install ProRoaming Feature into 4 first 80.00 160.00 '!\ , generation M7300 Mobile Radios Sales Tax 0.00 TOTAL AMOUNT 17,525.00 f t 11 Please Recoil To: AMK Services LLC 9291 Crouse Willison Road Johnstown, 01-143031 This account may be Subject to delinquent)Cr,.,charms ul I Yr% per month(I 1%annum)of rfre unplud balance,when the invoice becomes 30 days past due. ACORD DATE IMMIDDIYrnYI EVIDENCE OF COMMERCIAL PROPERTY INSURANCE 9/20/2013 THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW.THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE ADDITIONAL INTEREST. PRODUCER NAME, ( PHONE ,317-817-$136 COMPANYNAME AND ADDRESS NAIC NO; 36161. CONTACT PERSON AND ADDRESS L(AIC-NO-EXtI Bylanc Group Inc-Indianapolis Travelers Property s Casualty Co. of America 301. Pennsylvania Parkway, #201 300 Arboretum Place Indianapolis IN 46260 Richmond VA 23236 Ftl C,Nef 317-817-6151 I AODRESS'martanne uleut:hy lane,corn IF MULTIPLE COMPANIES,COMPLETE SEPARATE FORM FOR EACH CODE, SUS CODE; POLICY TYPE AGENCY PACKAGE POLICY _CUSTOMER ICI 0' NAMED INSURED AND ADDRESS LOAN NUMBER POLICY NUMBER City of Carmel 11630581M4076TIL13 One Civic Square Carmel, IN 46032 EFFECTIVE DATE 'EXPIRATION DATE CONTINUED UNTIL 1/1/2013 1/1/2014 El TERMINATED IF CHECKED ADDITIONAL NAMED INSIREDIS) THIS REPLACES PRIOR EVIDENCE DATED; SEE REMARKS PROPERTY INFORMATION(Use REMARKS on page 2,if more space is required) ® BUILDING OR C BUSINESS PERSONAL PROPERTY LOCATIONIDESCRIPTIOIf SEE SCHEDULE ATTACHED TF APP7.I CABLE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. LIMITS SHOWN MAY HAVE BEEN REDUCED DT PAID CLAIMS. COVERAGE INFORMATION PERILS INSURED . I BASIC I BROAD IX SPECIAL I COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE' ;Stale 3 54,192 DEO: 25,000 YESINO NIA ®BUSINESS INCOME ❑ RENTAL VALUE X If YES,LIMIT: 5,000, 000 Actual Loss Sustained,Fof months: BLANKET COVERAGE 'x II YES,indicate valve(s)reported on property identified above,$ SEE REMARKS TERRORISM COVERAGE X Attach Disclosure NUllte(DEC IS WERE TERRORISM-SPECIFIC EXCLUSION? X IS DOMESTIC TERRORISM EXCLUDED? X LIMITED FUNGUS COVERAGE x If YES,LIMIT: DIED: FUNGUS EXCLUSION(II"YES".speedy organbatiori s form used) X REPLACEMENT COST X AGREED VALUE X COINSURANCE X II YES, °o EQUIPMENT BREAKDOWN((/Applicable) • X If YES,LIMIT: pOL LIMI'C OED: 25, 000 ORDINANCE OR LAW -Coverage for loss to undamaged pCRlon Df bldg x If YES,LIMIT: 250,000 DED: 25,000 •Demolition Costs X It YES, LIMIT: DEES Ince Cosi of Construction x If YES.LIMIT: DED EARTH MOVEMENT Of Applicable) X If YES.LIMIT: 10,000,000 DOD: 30,000 FLOOD(If Applicable; x It YES,LIMIT: 1D,ono,000 OED: 50, 000 WIND I HAIL(II Subject to Different Provisions) x If YES,LIMIT DED: PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS X CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST MORTGAGEE CONTRACT OF SALE LENDER SERVICING AGENT NAME AND ADDRESS LENDERS LOSS PAYABLE X Loss Payee - NAMEANDADDRESS AMK Services LLC 15555 Stony Creek Way Noblesville IN 46060 AUTHORIZED REPRESENTATIVE/�jlr //tt C-icis.kLa/.,.r.11Li(G C(EC.,c—) Page 1 of 2 ©2003-2011 ACORD CORPORATION. All rights reserved. ACORD 28(2011111( The ACORD name and logo are registered marks of ACORD EVIDENCE OF COMMERCIAL PROPERTY INSURANCE REMARKS-Including Special Conditions(Use only it more space is required) BLANKET REAL 6 PERSONAL PROPERTY LIMIT: $409,000,506. SPECIFIC LTMTT REAL 6 PERSONAL PROPERTY TOTAL: $1,475,544. BLANKET LIMIT STREET LIGHTS $1,599,500; BLANKET LIMI'1"TRAFFIC SIGNALS $3,279,642, ACTUAL CASH VALUE AND BSI-COINSURANCE APPLY TO THE SPECIFIC LINT REAL d PERSONAL PROPERTY. FLOOD SUB-LIMIT APPLIES TO CERTAIN LOCATIONS. ANY LOCATION IN PEMA ZONE A OR V IS EXCLUDED FROM FLOOD COVERAGE. ORDINANCE OF LAW LIMIT: $250,000 CONTRACTORS EQUIPMENT LIMIT: $2,920,276; MISC. SCHEDULE EQUIPMENT LIMIT: $2,804, 314; COMPUTERISED BUSINESS EQUIPMENT LIMIT: $1,060,591; COMMERCIAL ARTICLES LIMIT: $1, 257,236; FINE ARTS LIMIT; $1.924,975 ADDITIONAL NAMED INSUREDS CARMEL CLAY PARKS BUILDING CORPORATION; CARMEL CLAY BOARD OF PARKS 6 RECREATION; CARMEL REDEVELOPMENT COMNIORION; CARMEL REDEVELOPMENT AUTHORITY; CARMEL CITY CEN'T'ER COMMUNITY DEVELOPMENT CORPORATION - RE: TnvoiCe 3245 ' • ACORD 28 (2011111) Page 2 of 2