The URL can be used to link to this page

2013 Police Schedule 15 pay request 23 Lease 2013 — Sch # 15 (Police Dept.) Payment Request # 2013-23 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 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, Inc. Amount: $2,717.26 Description of Equipment Item Cost: Computer w/dual Monitors Dated: December 4, 2013 LESSEE: City of Carmel One Civic S i uare Carmel, 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 I AC®REP® CERTIFICATE OF LIABILITY INSURANCE M/DD/YYYY) �.� 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 an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONT PRODUCER NAMEACT Marianne Uban Hylant Group Inc-Indianapolis PHONE FAX 301 Pennsylvania Parkway,#201 lE MAC.No.Extr317-817-5136 (A/c,No):317-817-5151 Indianapolis IN 46280 ADDRESS:marianne.uban( Jhylant.com INSURER(S)AFFORDING COVERAGE 1 NAIC/1 INSURER A:Charter Oak Fire Insurance Co 25615 INSURED CARME80 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY ZLP14T62033 1/1/2013 1/1/2014 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $Excluded PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY PRO- LOC $ JEGT A AUTOMOBILE LIABILITY H8103036P64ACOF13 1/1/2013 1/1/2014 COMBINED SINGLE LIMI r (Ea accident) $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) X Comp X Coll Comp/Coll Ded $2,500 UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space 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 Equipment/Vehicles 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 c/o American Lease Insurance AUTHORIZED REPRESENTATIVE 654 Amherst Rd., Ste. 335 Sunderland MA 01375 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD la!! TechIogix PAGE:l INVOICE:BI 346415 REMIT TO: INVOICE DATE: 11/20/13 BELL TECHLOGIX INC DUE DATE: 12/20/13 P.O. BOX 823342 PHILADELPHIA PA 19182-3342 TERMS:Net 30 317-333-7777 Net 30 Days 866-782-2355 Y SHIP TO: BILL TO: 1201825 Carmel Police Dept CITY OF CARMEL 3 Civic Square ONE CIVIC SQUARE PO 25425 - Teresa Anderson ATTN: ACCOUNTS PAYABLE Carmel IN 46032 CARMEL IN 46032 USA ORDER: 709550 ORDER DATE: 09/23/13 CUSTOMER PO: 25425 CARRIER FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: UNITED PARCEL GROUND TRANSPORTATION ID: SALESPERSON: JUANA YOUNCE CURRENCY: United States Dollars ITEM QUANTITY LINE UNIT PRICE NET AMOUNT ' DESCRIPTION Carmel Police Dept Teresa Anderson Cust PO Num: 25425 Contact name: Terry Crockett Phone: 3175712567x Email : tcrockett @carmel . in.gov BELL SO 709550 - 20103028 1 D8D18UT#ABA 1 EA 1, 412 . 04 WORKSTATION Z220 XEON CMT 1412 . 04 EA 1 X XEON E3-1240V2 / 3 .4GHZ Line Lot/Serial Details: 2UA3160CPT EA 1 2 U1G37E 1 EA 77.38 CARE PACK 4 YEAR NBD ON-SITE 77 . 38 EA EXTENDED SERVICE AGREEMENT 3 AR482AA 1 EA 284 . 07 DISK DRIVE BD-RE 16X SERIAL 284 . 07 EA ATA INTERNAL 4 NK361AA 1 EA 49. 97 22-IN-1 MEDIA CARD READER USB 49 . 97 EA 3 . 5"/5.25" HI-SPEED 5 NK653AA 1 EA 79 . 95 FIREWIRE ADAPTER 3 PORTS 79 . 95 EA 6 XW477A8#ABA 2 EA 695 . 38 ZR2440W LED MONITOR 24 . 1IN 347 . 69 EA Line Lot/Serial Details: CN432504SN EA 1 CN43250664 EA 1 7 U0J12E 1 EA 32 . 26 ELECTRONIC HP CARE PACK NBD 32 .26 EA 8 FH973AA 1 EA 30 .21 DISPLAYPORT TO DVI-D ADAPTER 30 .21 EA FREIGHT CHARGE: GROSS AMOUNT: INVOICE DISCOUNT: NET AMOUNT: TAX AMOUNT: DOWN PAYMENT: NET AMOUNT DUE: RIE TechIogix PAGE:2 INVOICE:BI 346415 REMIT TO: INVOICE DATE: 11/20/13 BELL TECHLOGIX INC DUE DATE: 12/20/13 P.O. BOX 823342 PHILADELPHIA PA 19182-3342 TERMS:Net 30 317-333-7777 Net 30 Days 866-782-2355 y' SHIP TO: BILL TO: 1201825 Carmel Police Dept CITY OF CARMEL 3 C24 -2 Square ATTN: ACCOUNTS PAYABLE P PO 25425 Teresa Anderson CARMEL IN 46032 Carmel IN 46032 CAA ORDER: 709550 ORDER DATE: 09/23/13 CUSTOMER PO: 25425 CARRIER: FREIGHT TERMS: FREIGHT CHARGE 121 METHOD: UNITED PARCEL GROUND TRANSPORTATION ID: SALESPERSON: JUANA YOUNCE CURRENCY: United States Dollars ITEM. QUANTITY LINE UNIT PRICE NET AMOUNT• DESCRIPTION 9 ISR-760-0007 2 EA 56. 00 HARDWARE CONFIGURATION 28 . 00 EA **************************************** PAST DUE ACCOUNTS CARRY INTEREST AT THE LESSER OF 1 . 596 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 7787 **************************************** FEDERAL TAX ID# 26-3683994 **************************************** FOR SERVICE CALL 1-800-999-9813 FREIGHT CHARGE: 0 . 00 GROSS AMOUNT: 2, 717 . 26 INVOICE DISCOUNT: 0 . 00 NET AMOUNT: 2, 717 . 26 TAX AMOUNT: 0 . 00 DOWN PAYMENT: 0 . 00 NET AMOUNT DUE: 2 , 717 . 26