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Home My WebLink About257938 04/26/16 CITY OF CARMEL, INDIANA VENDOR: 148000 ONE CIVIC SQUARE INDIANA DEPT. OF TRANSPORTATION CHECK AMOUNT: $*****5,540.22* =Q; CARMEL, INDIANA 46032 N749 IGCN 100 N SENATE AVENUE CHECK NUMBER: 257938 M,?roN'c� ATTN: AGENT CASHIER CHECK DATE: 04/26/16 INDIANAPOLIS IN 46204 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 203 R4350900 33410 000035147 5,540.22 OTHER CONTR SERVICES prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL M invoice or bill to be properly itemized must show: kind of service,where performed, dates service rendered,by Nhom, rates per day, number of hours, rate per hour, number of units, price per unit,etc. Payee Purchase Order No. Terms Date Due Invoice Date Invoice# Description Amount Dept. Fund# (or note attached invoice(s)or bill(s)) 03/16/16 I 000035147 I Department of Transportation-Attn:Agent Cashier N749 IGCN 100 N. I $5,540.22 2200 203 Senate Depa.-%+r,-,e-)t- off- 7*-0.x^1SI:>ortCL7fi 0e) A ter,ti o.-) ef-,�- Cct N g-9 T G crJ . l oo N. 5e.-,c Ave. I nck"o--,cx.P 0 1 i ' I N 4 to 204 - 221 b I hereby certify that the attached invoice(s),or bill(s), is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 CITY OF CARMEL GENERALFUND IN SUM OF$ GENERAL FUND e�_� 5c � $5,540.22 ON ACCOUNT OF APPROPRIATION FOR Engineering PO#/Dept. INVOICE NO. ACCT#/Fund AMOUNT Board Members 33410 I 000035147 I 43-509.00 I $5,540.22 1 hereby certify that the attached invoice(s), or 2200 Encrunbered 203 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 Tuesday,April 12, 2016 Cost distribution ledger classification if claim paid motor vehicle highway fund �,en,Ts Purchase Order Order# Date. Required Date Page a INDOT Construction 0015803947 09/23/2014 04/07/2016 1 of 1 Indiana Department of Transportation Requisition Number:0000112853 Approved by Encompass Leadership Team-2011 VendorlD: 0000080450 REMIT001 Agency: 00800 Transportation Pay Terms: 35 Days in Arrears # 1 CHANGE ORDER Fund/Ob'ect/Center: 63200/571620 /467030 Vendor 0000080450 REMIT001 1 YARDSBERRY LANDSCAPE Ship To Department Of Transportation Remit to 9940 S 1000 WEST Contract Admin Division ANDERSON IN 46017 100 N SENATE AVE RM N725 INDIANAPOLIS IN 46204 YARDSBERRY LANDSCAPE Bill To Transportation Vendor 9940 S 1000 WEST Dept Of Transportation Name ANDERSON IN 46017 Accounting Address 100 N SENATE AVE RM N749 INDIANAPOLIS IN 46204 Vendor Name: Buyer Name:Bennett,Tammy-800 Contact eMail: entail: TBENNETT@indot.IN.gov Phone: Purchase.Order Instructions&Comments' PO 0015803947 R-36889 DES 1383165 800138316500LC3 Bike/Pedestrian Facilities on IR1012 136th St.Keystone Ave to Grey Rd Path in Hamilton County Greenfield District(FR-0002398)(FR-0016602 CN) Purchase Order Line Details Item No Descri tion." FOB°Destination "`Qt "Ordered ,Qt Recd, UOM Unit Price_ Extended'Amt 1- 1 20%LPA 80%Federal 1.0000 0 EA 666,736.5000 666,736.50 2- 1 80%Federal 20%Local.CHANGE 1.0000 0 EA 27,701.1000 27,701.10 ORDERS 12&4.PE TOM GENTRY. Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State Holidays. Units of.Measure Handlin Totals Si natures The following UN/CEFACT Unit of Measure Common Codes are used in this document: EA Each This area left blank Total PO Amt. $ 694,437.60 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 showed no patent defects except as otherwise noted. Signature of State Employee Receiver Date Signed(Month/Day/Year) FUNDING ENCUMBERED BY THE AUDITOR 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 payment thereof. I'Illlll 11111111111111111111 IIID I IIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII'IIIII IIIII IIII IIII Indiana Department of Transp"tion "00800 0015803947 • Online website: https:Hsecure.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: 000035147 Attention:Agent Cashier N749 IGCN Amount Paid: $ 100 N. Senate Ave. Indianapolis, IN 46204 ❑ Visa ❑ Mastercard ❑ Discover ❑ 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: 000035147 INDIANA DEPARTMENT OF TRANSPORTATION `�•� Driving Indiana's Economic Growth INVOICE 100 North Senate Avenue Michael R.-Pence, Governor ,._..,.__.,... Room IGC-,N 749.. . Brandye Hendrickson,Commissioner Indianapolis, Indiana 46204-2216 Customer No: CST000001811 Bill To: Invoice: 000035147 Invoice Date: 3/16/2016 City of Carmel Invoice Type: LPA ATTN: Jeremy Kashman One Civic Square Carmel IN 46032 AMOUNT DUE: $5,540.22 *** Payment is Due Upon Receipt of Invoice*** Line Description Quantity Unit Amt Net Amount 1 Contract#R-36889 1.00 5,540.22 5,540.22 Project#1383165; Change Order 1, 2, &4. (See Attached) Subtotal: 5,540.22 AMOUNT DUE: $5,540.22 Payment Options See Reverse Side n CU For billingquestions, please call:. 317-232-5363 ;{ Invoice: 000035147