HomeMy WebLinkAbout252854 1 2/1 7/1 5 4'\f. CITY OF CARMEL, INDIANA VENDOR: 148000
® ; ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $"'*15,399.02"
s.. ,�� CARMEL, INDIANA 46032 100 N SENATE AVE,RM IGC-N 725 CHECK NUMBER: 252854
��'1roN INDIANAPOLIS IN 46204-2216 CHECK DATE: 12/17/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
203 4462200 31917 32909 15,399.02 MAIN ST PATH
P. o. 31 CI I-+
.:. INDIANA DEPARTMENT OF TRANSPORTATION
Driving Indiana's Economic Growth
INVOICE
100 North Senate Avenue
,. Michael R.Pence,Governor
Room IGC-N 749
Indianapolis, Indiana 46204-2216 Brandye Hendrickson,Commissioner
Customer No: CST000001811
Bill To: Invoice: 000032909
Invoice Date: 12/9/2015
City of Carmel Invoice Type: LPA
ATTN: Jeremy Kashman
One Civic Square
Carmel IN 46032 AMOUNT DUE: $15,399.02
*** Payment is Due Upon Receipt of Invoice***
Line Description Quantity Unit Amt Net Amount
1 Contract#: R-36869 1.00 15,399.02 15,399.02
Project#:1383166; Change order#'s:1,3,6,&7.
Subtotal: 15,399.02
AMOUNT DUE: $15,399.02
Payment Options
See Reverse Side
For billing questions, please call: 317-232-5363 Invoice: 000032909
• Online website: https:Ysecure.in_gov/apps/dot/accountsreceivables/
• To create an account, use Customer#: CST000001811
• To make a credit card payment by telephone, call either:317-232-5364 or
317-232-5388
• OR RETURN THIS PORTION WITH YOUR PAYMENT
Department of Transportation Invoice: 000032909
Attention:Agent Cashier
N749 IGCN Amount Paid: $ 15 3 q q. p 2
100 N. Senate Ave.
Indianapolis, IN 46204
❑ Visa ❑ Mastercard ❑ Discover I/Check/Money Order
Name on Card Card Number
(Name must appear as exactly as on card)
CID(3 or 4 digit security code) Expiration Date
Billing Address
Signature Required: Date
For billing questions, please call: 317-232-5363 Invoice: 000032909
Purcha a Order Order Date Required Date Page
OT '
INEPT 0015803954 09123/2014 01/07/2016 1 of 1
Indiana Department of Transportation Requisition Number:0000112852
Approved by Encompass Leadership Team-2011 VendorlD: 0000100067 REMIT001
Agency: 00800 Transportation
Pay Terms: 35 Days in Arrears
# 1 CHANGE ORDER I Fund/Ob'ect/Center. 632001571620 1467030
Vendor 0000100067 REMIT001 1
OLCO INC Ship To Department Of Transportation
Remit to 24053 VOTE ROAD Contract Admin Division
BATESVILLE IN 47006 100 N SENATE AVE RM N725
INDIANAPOLIS IN 46204
OLCO INC Bill To Transportation
Vendor 24053 VOTE ROAD Dept Of Transportation
Name BATESVILLE IN 47006 Accounting
Address 100 N SENATE AVE RM N749
INDIANAPOLIS IN 46204
Vendor Name: Buyer Name:Bennett,Tammy-800
Contact entail: entail: TBENNETT@indot.IN.gov
Phone:
. . .T....._. _.., ....�.. .�, .>...: � PurchaseOrrler-I sir cdons.&:Go me i`s_--.;4•.::,:::s!: _�:'=" -
PO 0015803954 R-36869 DES 1383166 800138316600LC3 Bike/Pedestrian Facilities on ST1074 MAIN ST PATH PROJECT FROM
KEYSTONE TO GRAY RD in Hamilton County Greenfield District(FR-0002397)(FR-0013604 CN)
_,.__...._.._,:•::�.....>.. _.. -----._>...._..__.._..._..._...__.._..._.._.t,.....-......._.. .urcha .O neDeta _ - -
_....._. r - - -
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item:Tto.._........._.__..........Cies trove, FO es r atr n
cn .. .....<.-:,:::•::-:::.::: B:Q . t o tr. ,-•:-:,:. :,Ordert3d::� �;4 :;Rt:cd'� UtuE:�Hrce�= '_•�1=zte•tled�lrxit
1- 1 20%LPA 80%Federal 1.0000 EA 821,339.9400 821,339.94
2 1 80%Federal 20%Local.CHANGE 1.0000 r EA 76,995.1000 76,995.10
ORDERS 13 6&7 PLUS OVERRUNS.PE
TOM GENTRY.
Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State
Holidays.
nlfs=ot;:Mea ur�.. ndLn: �otals-Sl n t re -•-
:r
The following UN/CEFACT Unit of Measure
Common Codes are used in this document:
EA Each
This area left blank
Total PO Amt. $ 898,335.04
Issued by the Indiana Department of Transportation CONFIRMATION OF RECEIPT
I certify that the Items listed above were received.All commodities appeared to conform to
specifications and stowed no patent defects except as otherwise noted.
Signature of State Employee Recelver Date Signed(MontWDay/Year)
FUNDING ENCUMBERED BY THEAUDITOR OF STATE
I certify that there is sufficient unencumbered balance in the above account to cover the amount of this order,and that funds have been set aside for payinentthemof.
1 Iillll�����!11111111!111111111 i 1111111111111111111111111111111111111111111111111111111111 IN Indiana 0epartrnent urTransportation
00800 0015803954
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
INDOT Purchase Order No.
100 N Senate Ave, Room IGC-N 749 Terms
Indianapolis, IN 46204-2216 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s)or bill(s) Amount
12/9/2015 32909 Main Street Path-Keystone to Gray Change Orders $ 15,399.02
Total $ 15,399.02
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.
INDOT ALLOWED 20
100 N Senate Ave, Room IGC-N 749 IN SUM OF$
Indianapolis, IN 46204-2216
$ 15,399.02
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
31917 32909 203-4462200 $ 15.399.02 bill(s) is (are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
12/14/2015
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund