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2013 Police schedule 15 pay request 25 Lease 2013 — Sch # 15 (Police Dept.) Payment Request # 2013-25 EXI-IIBrr 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 undersignedacknowlcxlges delivery, installation and receipt in good condition,and hereby accepts the Equipment described on the attached invoices. Payee: Dell Marketing L.P. Amount: $3,267.80 Description of Equipment Item Cost: VLA Office Pro Plus 2013 software Dated: December 11, 2013 LESSEE: City of Carmel One Civic Square Cannel, IN/ lI By: Name: , Name: Diana Cordray Title: Clerk Treasurer (Attached duplicate original of Payee's statement) PLEASE MAIL CHECK TO: Dell Marketing L.P. c/o Dell USA L.P. P.O. Box 802816 Chicago, IL 60680-2816 PAGE I ® DATE IMMIOOIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 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). PRODUCER NAAME: Marianne_Uban Hylant Group Inc-Indianapolis PHONE Fa 317-817-5136 FAX 301 Pennsylvania Parkway, #201 E-MAIL Aq Neg3-1.7_817_5151 Indianapolis IN 46280 ADDRESS:mariaDn&uban @hylant.com INSURER(S)AFFORDING COVERAGE NAIC k INSURER A:Charter_Oak Fire-Insurance_C.o 25615 INSURED CARME80 INSURER 8: 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 $MTH 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. ADDL SUER POLICY EFF POLICY EXP INSR TYPE OF INSURANCE I IMMIOD/YYYYI IMM/DDIYYYYI LIMITS LTR INSR WVD POLICY NUMBER A GENERAL LIABILITY ZLP14T62033 1/1/2013 1/1/2014 EACH OCCURRENCE 82,000,000 RENTED X PREMISES SESO(Fe occurrence) $50,000 COMMERCIAL GENERAL LABILITY CLAIMS-MADE X OCCUR MED EXP(Any one person) sExcluded PERSONALS ADV INJURY $2,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY n PRO- n LOC $ JFCT LOMDINEU SINGLE LIMI t A AUTOMOBILE LIABILITY H8103036P64ACOF13 1/1/2013 1/1/2014 (Ea accident) $2,000,000 X ANY AUTO BODILY INJURY(Per person) $ — A O SCHEDULED BODILY INJURY Per accident) 8 AUTOS NOTOS PROPERTY DAMAGE NUTOS F.D (Per accidents X Comp % $ HIRED AUTOS Coll AUTOS Comp/Coll Ded I $2,500 I UMBRELLA LAB OCCUR EACH OCCURRENCE $ I EXCESS LIAB CLAIMS-MADE AGGREGATE $ I DED RETENTION $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY ^ I TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE I I NIA EE.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 It yes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it 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 EquipmenWehicles 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 do American Lease Insurance AUTHORIZED REPRESENTATIVE Amherst Rd., Ste. 335 Su 1w Sunderland MA 01375 �d4 - I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 m m your lnvvn.e Page -Il )*9.L HD Number 742616805 Customer Number: 965913265 Invoice Number: XJ91549X4 Sales Rep: Brenda Wade Purchase Order: 31389 For Sales: (800)981-3355 Order Number: 522286786 Invoice Date: 12/10/13 Sales Fax: 1600)433-9527 Order Date: 12/10/13 Payment Terms: NET DUE 30 DAYS Customer Service: (BOO)981-3355 Due Date: 01/09/14 Technical Support: (800)822-6965 830100100 N Shipped Via: STANDARD GROUND Dell Online: www.d el Loom Waybill Number: MS-VIRTUAL SOLD TO: SHIP TO: ACCOUNTS PAYABLE Terry Crockett IN-L CITY OF CARMEL POLICE DEP CITY OF CARMEL TERESA ANDERSON 31 1ST AVE NE 3 CIVIC SQUARE COMMUNICATIONS CTR CARMEL,IN 46032 CARMEL,IN 460321751 PLEASE REVIEW DELL'S TERMS 8 CONDITIONS OF SALE AND POLICIES ATwww.dell.comlus/Policy OR UPON REQUEST,WHICH GOVERN THIS TRANSACTION Ordered Shipped Item Number Description Unit Unit Price Amount 10 10 A6591288 VLA OFFICE PRO PLUS 2013 EA 326,78 3,267.80 MlgPartNum:79P-04712 MlgName_MICROSOFT CORPORATION 1 1 A3458532 ELECTRONIC LICENSE CONFIRMA I'10 N elec dwnld only EA - - MIBParINum.ELC MlgName:DELL SOFTWARE Ship.8/or Handling $ 000 Subtotal 3 3,267.80 FOR SHIPMENTS TO CALIFORNIA,A STATE ENVIRONMENTAL FEE OF UP TO$5 PER ITEM WILL BE ADDED TO INVOICE Taxable Tax S FOR ALL ORDERS CONTAINING A DISPLAY GREATER THAN 4 INCHES.PLEASE KEEP ORIGINAL BOX FOR ALL RETURN $ 000 $ 000 S.COMPREHENSIVE,ONLINE CUSTOMER CARE INFORMATION AND ASSISTANCE IS A CLICK AWAY AT WWW.DELLCOMIPU ENVIRO FEE $ 000 BLIC-ECARE TO ANSWER A VARIETY OF QUESTIONS REGARDING YOUR DELL ORDER. Invoice Total S 3,267.80 DETACH AT LINE AND RETURN WITH PAYMENT Ship,8lor Handling 5 0.00 Invoice Number: XJ91549X4 Subtotal S 3,267,80 Dal Customer Name: IN.L CITY OF CARMEL POLICE DEP Taxable Ta' Customer Number. 98598265 $ 002 $ 0.00 PumAaro Order: 31389 ENVIRO FEE $ 0.00 Order Number: 522286786 Invoice Total $ 3,267.80 MAKE CHECK PAYABLE/REMIT TO: $ $ DELL MARKETING L.P. 0/0 DELL USA L.P. $ PO BOx 802816 Balance Due $ 7.267.80 CHICAGO,IL.606802816 Amount Enclosed 000XJ91549X400000003267808300985982659