Loading...
HomeMy WebLinkAbout247776 07/28/15 CITY OF CARMEL, INDIANA VENDOR: 368938 b I ONE CIVIC SQUARE C H A CONSULTING CHECK AMOUNT: $****23,106.47" CARMEL, INDIANA 46032 300 SOUTH MERIDIAN CHECK NUMBER: 247776 UNION STATION CHECK DATE: 07/28/15 • INDIANAPOLIS IN 46225 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 900 R4462867 31917 29139-08 12,093.43 MAIN ST PATH 203 R4462200 31918 29140-08 1,440.11 136TH PATH 900 R4462867 31918 29140-08 9,572.93 136TH PATH . '3i n �} CA Mr.Jeremy Kashman 9 pp �L-0-1 lo2$(a� July 14,2015 Project No: 29139 City of Carmel Department of Engineering Invoice No: 29139-08 One Civic Square Carmel, IN 46032 CONTACT: Michael Feltz (812)962-0683 Project 29139 Inspection for Path Construction along Main Street from Keystone to Gray Road DES#1383166 Professional Services from May 30,2015 through July 3,2015 Construction Inspection Professional Personnel Hours Rate Amount Senior Engineer 8.00 147.04 1,176.32 Sr. Inspector 105.00 92.59 9,721.95 Sr. Inspector OT 9.00 108.40 975.60 Totals 122.00 11,873.87 Total Labor $11,873.87 Reimbursable Expenses Miles Rate Amount Mileage 499 0.44 219.56 Total Expenses $219.56 Billing Limits Current Prior To-Date Total Billings 12,093.43 75,212.38 87,305.81 Limit 111,900.00 Remaining 24,594.19 Total This Invoice $12,093.43 DBE Goal=5% DBE Amount this Invoice=0.00 DBE Amount Complete=$705.00 DBE%of Amount Complete=1.11% Union Station, 300 S. Meridian Street, Indianapolis, IN 46225 T 317.786.0461 m f= 317.788.0957 ,n www.chacompanies.com Project : 29139 -- Insp Path-Main -Keystone to Gray Invoice# : 2913908 Phase : 1001 -- Construction Inspection Rate Schedule Labor Class/Employee Name Date Hours Rate Amount Chief Inspector Thomas A. Gentry 06/01/2015 4.00 92.59 370.36 06/02/2015 4.00 92.59 370.36 06/03/2015 4.00 92.59 370.36 06/04/2015 4.00 92.59 370.36 06/05/2015 4.00 92.59 370.36 06/08/2015 5.00 92.59 462.95 06/09/2015 5.00 92.59 462.95 06/10/2015 5.00 92.59 462.95 06/11/2015 5.00 92.59 462.95 06/12/2015 5.00 92.59 462.95 06/13/2015 4.00 92.59 370.36 06/15/2015 5.00 92.59 462.95 06/16/2015 5.00 92.59 462.95 06/17/2015 4.00 92.59 370.36 06/18/20157- 4.00 370.36 06/19/2015 2.00 92.59 185.18 06/20/2015 3.00 92.59 277.77 06/22/2015 4.00 92.59 370.36 06/23/2015 4.00 92.59 370.36 06/24/2015 4.00 92.59 370.36 06/25/2015 4.00 92.59 370.36 06/26/2015 1.00 92.59 92.59 06/29/2015 4.00 92.59 370.36 06/30/2015 4.00 92.59 370.36 07/01/2015 4.00 92.59 370.36 07/02/2015 4.00 92.59 370.36 ------------------ 105.00 9,721.95 Thomas A. Gentry 06/02/2015 0.50 108.40 54.20 06/03/2015 0.50 108.40 54.20 06/04/2015 0.50 108.40 54.20 06/08/2015 1.00 108.40 108.40 06/09/2015 1.00 108.40 108.40 06/10/2015 0.50 108.40 54.20 06/11/2015 1.00 108.40 108.40 06/12/2015 1.00 108.40 108.40 06/19/2015 3.00 108.40 325.20 -------------- ----------------------------- 9.00 975.60 Senior Engineer V Michael J. Feltz 06/09/2015 0.50 147.04 73.52 06/19/2015 0.50 147.04 73.52 06/23/2015 0.50 147.04 73.52 06/25/2015 0.50 147.04 73.52 2.00 294.08 Michael C. Gregg 06/09/2015 1.00 147.04 147.04 06/12/2015 1.00 147.04 147.04 06/17/2015 4.00 147.04 588.16 -------------- ----------------------------- 6.00 882.24 Total: Senior Engineer V 8.00 1,176.32 Page : 1 Project : 29139 -- Insp Path-Main -Keystone to Gray Invoice#: 2913908 Phase : 1001 -- Construction Inspection Rate Schedule Labor 11,873.87 Unit Pricing Expenses Vendor l Employee Name Doc Nbr Date Units Rate Amount Direct Travel DIR MILEAGE CHARGE BACK 4958 06/15/2015 24.00 0.44 10.56 Direct Miscellaneous -Mileage Thomas A. Gentry ER00205755 03/31/2015 39.00 0.44 17.16 ER00205755 04/02/2015 38.00 0.44 16.72 ER00208098 06/02/2015 41.00 0.44 18.04 ER00208098 06/04/2015 41.00 0.44 18.04 ER00208426 06/08/2015 38.00 0.44 16.72 ER00208426 06/10/2015 41.00 0.44 18.04 ER00208426 06/11/2015 39.00 0.44 17.16 ER00208747 06/15/2015 41.00 0.44 18.04 ER00208747 06/17/2015 39.00 0.44 17.16 ER00208747 06/19/2015 40.00 0.44 17.60 ER00209074 06/23/2015 39.00 0.44 17.16 ER00209074 06/25/2015 39.00 0.44 17.16 -------------- ----------------------------- 475.00 209.00 Unit Pricing 219.56 Total Phase : 1001 -- Construction Inspection Labor : 11,873.87 Expense 219.56 Total Project: 29139 -- Insp Path-Main -Keystone to Gray 12,093.43 Page : 2 LPA INVOICE -VOUCHER 1 State Form 52663(5-06) INDIANA DEPARTMENT OF TRANSPORTATION - - --Approved-by State Board of Accounts,2006 AUDITOR: DOC NBR Approved by Auditor of State,2006 Date of P.O. (Month,Day,Year) LPA'S NAME &ADDRESS PURCHASE ORDER NUMBER City of Carmel PO # Department of Engineering FUND OBJECT CENTER One Civic Square Carmel, IN 46032 STATE AGENCY: Department of Transportation 800 Appro Name STATE SHARE . . . . . . . . . I $ 2,418.69 SERVICE DATE: 5/30/15 - 1099 IND: FEDERAL SHARE . . . . . . . . . . $ 9,674.74 7/3/15 TOTAL DISBURSEMENT. . . . . . . . $ 12,093.43 TO: INDIANA DEPARTMENT OF TRANSPORTATION CARE OF: Brandye Hendrickson EXEMPT PER I.C. 5-17-5-2 32 South Broadway ADDRESS: Greenfield, IN 46140 DOC I.D. PV 800 VENDOR CODE 0 DATE (Month, Day, Year) ACCOUNTING LINE DISTRIBUTION INVOICE APPR JOB/PROJ LN PO NUMBER LN NUMBER FUND AGCY ORG UNIT ACTV OBJECT PRTY AMOUNT P/F NUMBER 01 00000000 2913908 800 $ 12,093.43 02 800 03 800 041 800 LINE NO. 1 Claim No. 8 Des No. 1383166 2 This claim voucher is for: (Preliminary) (RW) (Const.) Engineering, Force Account or R/W costs 3 Project Description: Con Insp Main St from Keystone to Gray CHA 29139 4 Period covered by this claim. From: 05/30/15 To: 07/03/15 5 Gross amount of previous claims $ 75,212.38 6 Net amount of previous claims $ 60,169.90 7 This(is) (is not)a final claim. is not 8 Gross amount of this Local Agency Claim $ 12,093.43 9 Federal Share Reimbursable (Line 8 x fed %) 80 % $ 9,674.74 10 Net amount of Claim. $ 9,674.74 RECOMMENDED FOR APPROVAL INDOT OFFICIAL INITIATING THE CHARGE DATE(Month, Day, Year) I certify that this claim is correct and valid and is a proper charge against the State Agency, Fund and Center indicated. Authorized Signature of State Agency Date (Month, Day, Year) Pursuant to the provisions of Indiana Code 5-1-10-1, 1 hereby certify that the foregoing Fund and Center is just and correct, that the amount claimed is legally due after allowing all just credits, and that no part of the same has been paid. Signature of Vendor Official Title Date (Month, Day, Year) Week Ending: 6/12/2015 Sheet I Vehicle Description: L125(2012 Chevrolet Silverado) Starting License Plate#: TK417LFZ Odometer WEEKLY MILEAGE Assigned Driver/Group: Mike Gregg REPORT Assigned Office Location: Indianapolis,IN Miles Proj Miles qjecfNqmbei/0.yerheaV', 1-s '40do- L 18,162.0 6IV2015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 1000 33000 25 18,182.0 6/2/2015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 1000 33000 20 18,219.0 6/212015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 1000 33000 37 18,243.0 6/3/2015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 1000 33000 24 V 18,275.0 6W412015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 — 1000 33000 32 18,288.0 6/5/2015 Mike Gregg Castleton-82nd St. Castleton-82nd St. Inspect Project 29203 1000 33000 13 18,312.0 6/5/2015 Mike Gregg Castleton-82nd St. Carmel Main St. Inspect Project 29139 1001 = 33000 24 Mike Gregg Inspect Project 1000 33000 Indy Indy Indy 0.0 0.0 0.0 ,77— 7: VOUCHER NUMBER Total Miles Ending Odometer Reading Mileage Log and Reimbursement Form design/construction solutions Employee Name Thomas Gentry Rate Per Mile $0.575 Employee ID 5357 For Period From 3/30/15 to 413/15 Vehicle Description Honda Element Total Mileage 194 Authorized By Total Reimbursement $111.55 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Org 3/302015 Jobsite Jobsite Inspection 60391 60429 38 $21.85 29140 1001 41300 $0.00 .. :$0;00 $000 3/312015 Jobsite - Jobsite - Inspection 60429 60468• 39 $22.43 23139 1001 41300 $0.00 .. ..... $0.00 $0.00 4/1/2015 Jobsite Jobsite Inspection 60468 60508 40 $23.00 29140 1001 41300 $0.00 $0.00, $0.00 4/2/2015 Jobsite Jobsite Inspection 60508 60546 38.. '$21.85 - 23139 1001 41300 $0.00 .. $0.00.., $0.00 4/32015 Jobsite Jobsite Inspection - 60546 60585 39 $22.43• 29140 1001 41300 $0.00 $0.00 $0.00 $o 00 $0.00 $0.00 koo $0.00 • —s 0.00:: $0.00 ' so.00 $0.00 $0.00 s0.0o so.00 Totals 194 $111.55 Mileage Log and Reimbursement Form design/construction solutions Employee Nz LLee Thomas GentryRate Per Mlle $0.676 Employee Ip 5367 For Period From 6/1115 to 616/15 Vehicle Descriptlo�n Honda Element Total Mileage 186 Authorized By Total Reimbursement $112.70 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Ur 6/1/2015 JobsHe .- Jobsile .. _• Inspection - - 63270_- 63305' 35.. "$20.3 - 29140,--_- 1001 - 41300 . - 50.00 _ - -- $0.00 -6/212,015 -Jobsile - Jobsile_ - - -Inspection - - .63305`" ' - " 63346 41 - "" $2358 ' _ -28139 ,1001 - 41300 $0.00 .- $0.00 6/3/2015 Jobsile Jobsite -Inspection _ - - . - 63346 _63.386' 39 $22.43 - _ 29140 1001 41.300 $0.00 '$O.DO $0.00 6/4/2015 ' JobsHe - - Jobsile _ Inspecllon 63426" -._41' ', _ $2358.. '-29138 10b1 41300 $0.00 $0.00 61512015 Jobsile - Jobsits. - I_nspectlon - - _ 63426 - ••:63466 _ 40' - .$23.00 °28140 1001 ' 41300 $0.00 $0!00. . $0.00 .$0.00„ - - - - - - - - $0.00 SOHO 50.00 .. '-'$0.00:. $0.00 $0.00 $0.00 _ $000_. SOAO - _ - $0.00.: - Totals 196 $112.70 Mileage Log and Reimbursement Form C44A---- design/construction solutions Employee NameThomas Gentry Rote Per Mlle $0.576 _ Employee ID 5357 For Perlod From 616116 to 6112116 r i 7 i i I Vehicle Description Honda Element Total Mileage 196 Authorized By Total Reimbursement II � Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Retmbursernent Project No. Phase Org _61812015.- Jobsite Jobsile-. - - Inspection ;' - 63952 .• - 63990 - - - 38- - $21.85 - 291.39 1001 41300- $0.00 - - .,$0.00 .. $0.00 61912015 -Jobsite- .Jobsite - Inspection - 63990 - 640.30 40 - _ $23.00 29140 1001 -41300 $0.00 - $0.00 -- $0.00 6/1012015 Jobslte Jobsite _ Inspection 64030 64071'- 41 . $23,58 29139 1001 41300 $0.00 _..,80.00 '. $040 611112015 Jobshe - Jobs" -_ Inspection - - 64D71 64109 38 - $21.85 j 29140 1001 41300- $0,00 $0.00 $0.00 WIWD15 Jobsite - - Jobsite. _ Inspection 64109 64148 39 - _$22.43 _ - 28139-. 1001 41300 $0.00 -$0.00 - --- $0.00 $0.00 - - - $0.00- $0.00 - $0.00 - .- - - $0.00 $0.00 - . - - $0.00 _ -- _ $0.00 -. Totals 186 $112.70 Mileage Log and Reimbursement Form r ,design/construction solutions Employee Name Thomas Gentry Rate Per Mile $0.675 Employee ID 5367 For Period From 6113/16 to 6119/16 Vehicle Description Honda Element Total Mileage 230 i Authorized By Total Reimbursement $132.26 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Org 6/13/2015 Jobsite Jobsite ' '::_'Inspection 63428 63463 -35'•, $20.13"' 23140 1001 '-41300 - $0.00 , ' .. F. .» ....». .,.... . .. .. .. .,. ... . ,. .. .. .... ......>...,.. $0.00 '' $0.00 6/1512615 Jobsite Jobsite :• Inspection _ 63463 ;',,63504` 41•,: 23139.• 1001 :41300. .:.:...�:_.a.... .. .._.._. � $0.00 6/16/2015 Jobsite Jobsite ;'•Inspection 63504 .. 63542 38 $21:65 29140 1001 41300 $0.00 ,$000.... $0.00 6/17/2015 Jobsite ,;Jobsite „'••:',Inspection 63542 63581 39;:--' a $22.43- 29139 1001 41300 $0.00 $0.00 6/16/2015 Jobsite ,Jobsite ;, Inspection 63581 ,•;:63618 37 $21.28 _ 29140 . 1001 ;,41300; $0.00 ._6/19/2015 Jobsite ,Jobsite ; ';''Inspection 63618 63658 40," '$23.00" 29139 1001 41300 $0.00 $0.00 $0.00 $0.00 .r ... .. '.i: •$0.00 .. • $0.00 00 $0.00 " $0.00 ::.: Totals 230 $132.25 M leage Log and Reimbursement Form design/construction solutions j Em loyee Name Thomas GentRate Per Mlle $0.676 Employee ID 6367 For Period From 620116 to 6126116 Vehicle Description Honda Element Total Mileage 226 •! iIdjll 4!l o!�f Authorized By Total Reimbursement $129.96 I Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Or 202015 Jobslle - - Jobsite - - - - Inspection - - _ 63428 - - - 63462 - 34 - - $19.55 - -29140 .1001 41300 60.00 "$Ono 222015 - -JobsOe Jobsite Inspection' - 63462- - 63500 - 38 $21.85 - - 2.9140 1001 41300 $0,00 $0.00 32015 Jotrsite Jobsite Inspection - 63500 63539 39' $22.43 - -29139 1001 413DO $0.00 _. .. - $0.00 $0.00 242015 Jobsite - Jobsite - - - Inspection- - .'63539 63575_ 36 - $20.70 - •29140 1001 : 41300 $0.00 .• - — ,.$0.00 - $0.00 1252015 Jobsite Jobsite _ Inspection.- - 63575 63614 - 39 $22.43 - 29139. 1001 41300 $0.00 1282015 Jobsite _ .. -Jobsite 'Inspection - - -- 63614 63654 40 -. ',:$23.00. 29140 -loot 41300 - $0.00 ___- -, 50.00 --- - - . $0.00 _ $0.00.. .. - - - - _ $0.00 $0.00 i •'50.00 $0.00 $0.00 30.00 MOO . Totals 226 $129.66 t Yt t 3 1 c1 S� July 14,2015 Mr.Jeremy Kashman City of Carmel CIO L+6 il,.Z .. Project No: 29140 Department of Engineering Invoice No: 29140-08 One Civic Square Carmel,IN 46032 CONTACT: Michael Feltz(812)962-0683 U, %I t g t K '2 c) 3 e 14 y u 22 OV Project 29140 Inspection for Path Construction along 136th Street from Keystone to Gray Road DES#1383165 Professional Services from May 30.2015 through July 3.2015 Construction Inspection Professional Personnel Hours Rate Amount Senior Engineer 2.00 147.04 294.08 Sr.Inspector 92.00 92.59 8,518.28 Sr.Inspector OT 18.00 108.40 1,951.20 Totals 112.00 10,763.56 Total Labor $10,763.56 Reimbursable Expenses Miles Rate Amount Mileage 567 0.44 249.48 Total Expenses $249.48 Billing Limits Current Prior To-Date Total Billings 11,013.04 59,467.07 70,480.11 Limit 86,300.00 Remaining 15,819.89 Total This Invoice $11,013.04 DBE Goal=5% DBE Amount this Invoice=$0.00 DBE Amount Complete=$705.00 DBE%of Amount Complete=1.42% Union Station,300 S. Meridian Street, Indianapolis,IN 46225 1 317.786.0461 • 317.788.0957 a www.chacompanies.com Project: 29140 - Insp Path-136th -Keystone to Gray Invoice# : 2914008 Phase : 1001 -- Construction Inspection Rate Schedule Labor Class/Employee Name Date Hours Rate Amount Chief Inspector Thomas A. Gentry 06/01/2015 4.00 92.59 370.36 06/02/2015 4.00 92.59 370.36 06/03/2015 4.00 92.59 370.36 06/04/2015 4.00 92.59 370.36 06/05/2015 4.00 92.59 370.36 06/08/2015 3.00 92.59 277.77 06/09/2015 3.00 92.59 277.77 06/10/2015 3.00 92.59 277.77 06/11/2015 3.00 92.59 277.77 06/12/2015 3.00 92.59 277.77 06/13/2015 2.00 92.59 185.18 06/15/2015 4.00 92.59 370.36 06/16/2015 4.00 92.59 370.36 06/17/201'5 3.00 92.59 277.77 06/18/2015 3.00 92.59 277.77 06/20/2015 3.00 92.59 277.77 06/22/2015 4.00 92.59 370.36 06/23/2015 4.00 92.59 370.36 06/24/2015 4.00 92.59 370.36 06/25/2015 4.00 92.59 370.36 06/26/2015 1.00 92.59 92.59 06/29/2015 4.00 92.59 370.36 06/30/2015 4.00 92.59 370.36 07/01/2015 7.00 92.59 648.13 07/02/2015 6.00 92.59 555.54 -------------- ---------------------------- 92.00 8,518.28 Thomas A. Gentry 06/02/2015 0.50 108.40 54.20 06/03/2015 0.50 108.40 54.20 06/04/2015 0.50 108.40 54.20 06/08/2015 0.50 108.40 54.20 06/09/2015 0.50 108.40 54.20 06/10/2015 0.50 108.40 54.20 06/11/2015 1.00 108.40 108.40 06/12/2015 1.00 108.40 108.40 06/19/2015 5.00 108.40 542.00 06/23/2015 1.00 108.40 108.40 06/24/2015 1.00 108.40 108.40 06/26/2015 6.00 108.40 650.40 ------------ ----------------------------- 18.00 1,951.20 Senior Engineer V Michael J. Feltz 06/09/2015 0.50 147.04 73.52 06/19/2015 0.50 147.04 73.52 06/23/2015 0.50 147.04 73.52 06/25/2015 0.50 147.04 73.52 ----------------------------- 2.00 294.08 Rate Schedule Labor 10,763.56 Unit Pricing Expenses Vendor /Employee Name Doc Nbr Date Units Rate Amount Direct Miscellaneous-Mileage Page : 1 Project : 29140 - Insp Path-136th -Keystone to Gray Invoice#: 2914008 Phase : 1001 -- Construction Inspection Unit Pricin Expenses Vendor_/Lmployee-Name----- Doc Nbr Date - Units Rate -- Amount- Direct Miscellaneous -Mileage Thomas A. Gentry ER00205755 03/30/2015 38.00 0.44 16.72 ER00205755 04/01/2015 40.00 0.44 17.60 ER00205755 04/03/2015 39.00 0.44 17.16 ER00208098 06/01/2015 35.00 0.44 15.40 ER00208098 06/03/2015 39.00 0.44 17.16 ER00208098 06/05/2015 40.00 0.44 17.60 ER00208426 06/09/2015 40.00 0.44 17.60 ER00208426 06/11/2015 38.00 0.44 16.72 ER00208747 06/13/2015 35.00 0.44 15.40 ER00208747 06/16/2015 38.00 0.44 16.72 ER00208747 06/18/2015 37.00 0.44 16.28 ER00209074 06/20/2015 34.00 0.44 14.96 ER00209074 06/22/2015 38.00 0.44 16.72 ER00209074 06/24/2015 36.00 0.44 15.84 ER00209074 06/26/2015 40.00 0.44 17.60 -------------- ----------------------------- 567.00 249.48 Unit Pricing 249.48 Total Phase : 1001 -- Construction Inspection Labor 10,763.56 Expense 249.48 Total Project: 29140 -- Insp Path-136th -Keystone to Gray 11,013.04 Page : 2 LPA INVOICE -VOUCHER o% s State Form 52663(5-06) -�. INDIANA DEPARTMENT OF TRANSPORTATION Approved by State Board of Accounts,2006 AUDITOR: DOC NBR Approved by Auditor of State,2006 Date of P.O. (Month,Day,Year) LPA'S NAME &ADDRESS PURCHASE ORDER NUMBER rity of Carmel PO # Department of Engineering FUND OBJECT CENTER One Civic Square Carmel, IN 46032 STATE AGENCY: Department of Transportation 800 Appro Name STATE SHARE . . . . . . . . . . $ 2,202.61 5/30/15 - FEDERAL SHARE . . . . . . . . . . $ 8,810.43 SERVICE DATE: 7/3/15 1099 IND: TOTAL DISBURSEMENT. . . . . . . . $ 11,013.04 TO: INDIANA DEPARTMENT OF TRANSPORTATION CARE OF: Brandye Hendrickson EXEMPT PER I.C. 5-17-5-2 32 South Broadway ADDRESS: Greenfield, IN 46140 DOC I.D. PV 800 VENDOR CODE 0 DATE (Month, Day, Year) ACCOUNTING LINE DISTRIBUTION INVOICE APPR JOB/PROJ LN PO NUMBER LN NUMBER FUND AGCY ORG UNIT ACTV OBJECT PRTY AMOUNT P/F NUMBER 01 00000000 2914008 800 $ 11,013.04 02 800 03 800 041 1 1 1 800 LINE NO. 1 Claim No. 8 Des No. 1383165 2 This claim voucher is for: (Preliminary) (RW) (Const.) Engineering, Force Account or R/W costs 3 Project Description: Con Insp 136th St from Keystone to Gray CHA 29140 4 Period covered by this claim. From: 05/30/15 To: 07/03/15 5 Gross amount of previous claims $ 59,467.07 6 Net amount of previous claims $ 47,573.64 7 This (is) (is not) a final claim. is not 8 Gross amount of this Local Agency Claim $ 11,013.04 9 Federal Share Reimbursable(Line 8 x fed%) 80 % $ 8,810.43 10 Net amount of Claim. $ 8,810.43 RECOMMENDED FOR APPROVAL INDOT OFFICIAL INITIATING THE CHARGE DATE(Month, Day, Year) 1 certify that this claim is correct and valid and is a proper charge against the State Agency, Fund and Center indicated. Authorized Signature of State Agency Date (Month, Day, Year) Pursuant to the provisions of Indiana Code 5-1-10-1, 1 hereby certify that the foregoing Fund and Center is just and correct, that the amount claimed is legally due after allowing all just credits, and that no part of the same has been paid. Signature of Vendor Official Title Date (Month, Day, Year) Mileage Log and Reimbursement Form design/construction solutions Employee Name Thomas Gentry Rate Per Mile $0.575 j Employee ID 5357 For Period From 3130115 to 4/3/16 Vehicle Description Honda Element Total Mileage 194 Authorized By Total Reimbursement $111.55 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Org 3/302015 , Jobsite Jobsite Inspection 60391 60429 38 $21.85 29140 1001 41300 $0.00 $0.00 _ 3/3112015 Jobsite Jobsite Inspection 60429 60468 39 $22,43 23139 1001 41300 $0.00 ,.•, .: ., .,, ' " :'., '.. : '•. ";,..$0.00. ' , .. .... $O.DO 4/1/2015 Jobsite Jobsite Inspection - 60468 60508 40 $23.00 29140 1001 41300 $0.00 $0.00 42/2015 Jobsite Jobsite Inspection 60508 60546 38 $21.85 - 23139 1001 41300 $o.OD $0.00 $O.OD 4/3/2015 Jobsile Jobsile . .. Inspeclion 60546 50585 39 $22.43 29140 1001 41300 $0.00 .. .. . ,.•., ..::......,$0.00:: $0.00 .. $0.00... $000 00,i $0.00 $0.00 $0.00 .. ..... $0.00 $0.00 ...... $0.00 $0.00 $0.00 $0.00 Totals 194 $111.56 i Mileage Log and Reimbursement Form design/construction solutions Employee Name Thomas Gentry Rate Per Mlle $0.676 Employee ID 5367 For Period From 6/1115 to 616116 Vehicle Description Honda Element Total Mileage 186 II. Authorized ey Total Reimbursement $112.70 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase I 8rci 6/112015 Jobsite - Jobsite - Inspection 63270: 35,. 63305 - , $20.13 -29140 -: 1001 1- 41300 $0.00 $0:00 $0.00 6/2/2015 "Jobsite _ - Jobsite_ - -Inspection: - - 633DS`- 63346 -41 - - $23.58= - 29139 - 1001 41300 $0.00 ''. _ .. . .. : ,- . . - - . _ '- .. •' ,$0:00-' -. _', $O.DO 613/20 5- Jobsite Jobsite -_ Inspection - _.'63346' - ,63385" 39 -- ._$22.43 - 29140 . 1001 41.300 $0.00 $0.00 6/4/2015 Jobslie - - - "Jotiaile - Inspection, - - 63385 - 63426 - - 41 $2358 - .29139 '-- 1001 141300 $0.00 $0.00 -6/512015 'Jobsite Jobsite Inspection 63426 :63468 _ r,40', _$23.00 -48140- 1001 ' 41300 $0.00 $0.00 $0.00 $0.00 - $OA0 $0:00 $0..00 $0.00 $0.00- - - _ _ 50.00 Totals 196 $112.70 i I Mileage Log and Reimbursement Form design/construction solutions Employee Name Thomas Gentry Rate Per Mlle $0.576 Employee!D 5357 For Period From 6/8/16 to 6/12116 Vehicle Description Honda Element Total Mileage 186 Authorized By Total Reimbursement $112.70 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Org 618/2015- .Jobsite, -" _ Jobsile - - Inspection -' - .. - 63952 -63990 - - 38_ $21.85 - 29.1.39 1001 41300- $0.00 $DAD.," - $0.00 61912.075' -Jobsite- - _ 'Jobsite_ -- Inspection - - - 63990 640.30 4.0• - $23,00 29140 1001 -41300 $0.00 _ _ - - - r• .$0.00 - -- $0.00 - 6/10/2015 - Jobsite _ - Jobsite-- - - Inspection - - - - 64030 54D71 41 .- '$23,58 29139 -_1001 41300 $0.00 $0.00 6/11/2015 JobsHe - Jobsite -- _ Inspection - - 64071 64109 36 - $21.85 29140 - 1001 41300 $0.00 _ 6/12/2015 - Jobsite _ Jobsite, Inspection - - 84109 64148 - 39 - _$22.43 29139- - 1001 41300 $0.00 $0.00 '-$0.00 so.ao - so.Do $0.00 $0.0b:, $0.00 $o-oo $0.00 30•.00, . $0.00 - - - - - $0.00 $0.00 - Totals 196 $112.70 Mileage Log and Reimbursement Form design/construction solutions Employee Name Thomas Gentry Rate Per Mile $0.575 Employee ID 6367 For Period From 6/13/15 to 6/19/16 Vehicle Description Honda Element Total Mileage 230 Authorized By Total Reimbursement $132.26 Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursement Project No. Phase Org 6/13/2015 Jobsite Jobsite Inspection - 63428 63463 35 $20.13 23140 1001 41300 $0.00 $000 ..$0.00 6/15/2015 Jobsite Jobsite. . .... Inspection - 63463 63504... 41- $23.58 23139 1001 - 41300 $0.00 ... „ .. . .. $0.00 " $0.00 6/16/2015 Jobsite Jobsite Inspection 63504 63542 38 $21:85 29140 1001 41300 $0.00 $0.00 6/172015 Jobsite Jobsite Inspection 63542 63581 39 $22.43 29139 1001 41300 $0.00 • •. $0.00 $0.00 6/18/2015 Jobsite Jobsite Inspection 63581 63618 37 '.'$21.28 29140 1001 41300 $0.00 6/19/2015 Jobsite Jobsite Inspection 63618 63658 40 $23.00"• 29139 1001 41300 $000 .. .. $0.00 , $0.00 .. .. .. $0.00 $0.00 ..... .. $0.00 .. ....$0.00 $0.00 $0.00 $0.00 :$0.00 Totals 230 $132.25 C]M leage Log and Reimbursement Form _ design/construction solutions j Eloyee Name Thomas Gerd Rate Per Mlle $0.676 Ern Employee ID 5367 For Period From 620116 to 6126115 Vehich i Description Honda Element Total Mileage 226 horized By Total Reimbursement $129.86 I -- I Date Starting Location Destination Business Purpose Odometer Start Odometer End Mileage Reimbursernent Project No. Phase Or 1202015 Jobslle Jobsite Inspection 63428 - _ 63462 34 - +:$19.55 -29140- 1001 41300 $0.00 4. $0110 /222015 Jobsite -- - Jobshe Inspection 63462 - 63500 - 38 $21.85'''.,: _ 29140 1001 41300 $0.00 $O.do - 232015 - Jobsite _ Jobsite inspection - 83500 _ . 63539 3B' $22.43 - 29139 _ 1001 41300 .. $0.00 _. $0.00 1242015 Jotieile ` Jobsite - Inspection- 63539' - 63575 - 36 - „ $20.70:,. •28140 1001 41300 $0.00 .' .. . . . $0.00. 252015 Jobrito Jobsite '' _ Inspection . '' 63575 63614' 39' ` $22.43 - - 29139 1001 413D0' $0.00 $0.00. 1262015 Jobsite •:Jobsite _ Inspection - _ 63614 63654 40' - '.$23.00 29140 1001 41300 $0.00 - _$0.00_:•:_ - - $0.00 ., .. .. , 5000.,,:,, $0.00 woo $0.00 - - .. - - . '•50.00-..,, $0.00 Totals 228 $129.96 Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee CHA Purchase Order No. Union Station, 300 S. Meridian Street Terms Indianapolis, IN 46225 Date Due Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s) Amount 7/14/2015 29139-08 Main Street Path-Keystone to Gray Des 1383166 $ 12,093.43 7/14/2015 29140-08 136th Street Path-Keystone to Gray Des 1383165 $ 9,572.93 7/14/2015 29140-08 136th Street Path - Keystone to Gray Des 1383165 $ 1,440.11 Total $ 23,106.47 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6. 20 Clerk-Treasurer VOUCHER NO WARRANT NO. CHA ALLOWED 20 Union Station, 300 S. Meridian Street IN SUM OF $ Indianapolis, IN 46225 $ 23,106.47 ON ACCOUNT OF APPROPRIATION FOR Board Members PD#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT# I hereby certify that the attached invoice(s), or 31917 29139-08 900-R4462867 $ 12,093.43 -bill(s) is (are) true and correct and that the materials or services itemized thereon for 31918 29140-08 900-R4462867 $-- 9.572.93 which charge is made were ordered and 31918 29140-08 203-R4462200$ 1.440.11 received except 7/27/2015 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund