259687 06/14/16 `�''�,,,,�° CITY OF CARMEL, INDIANA VENDOR: 369739
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ONE CIVIC SQUARE SIGNWORKS CHECK AMOUNT: $*****8,650.00*
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CARMEL, INDIANA 46032 5349 WEST 86TH STREET CHECK NUMBER: 259687
9.i;,�TON INDIANAPOLIS IN 46268 CHECK DATE: 06/14/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4239030 15751 8,650.00 TRAFFIC SIGNS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
SIGNWORKS ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
5349 WEST 86TH STREET IN SUM OF$ CITY OF CARMEL
An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
INDIANAPOLIS, IN 46268 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$8,650.00 Payee
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
15751 42-390.30 $8,650.00 1 hereby certify that the attached invoice(s),or 6/3/16 15751 $8,650.00
2201 201 2201 201
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,June 07,2016
Stmetmmtssioner
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
REQUEST FOR PAYMENT
Indianapolis signworks Inc. To: City of Carmel Invoice: 15751
5349 West 86th Street 3400 W.131st Street Draw: 1
Indianapolis,Indiana 46268 Carmel,Indiana 46032 Invoice Date: 6/3/16
317.872.8722 Period Ending Date: 6/3/16
Project: Arts&Design District Signs
Address: 3400 W.131st Street
Request for payment:
Original contract amount $ 17,300.00
Approved changes $
Revised contract amount $ 17,300.00
Contract completed to date $ 8,650.00
Less previous requests $ - CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Changes approved in previous months by
Owner _
Current amount due Total approved this period
TOTALS
Remaining contract to bill $ 8,650.00 NET CHANGES by Change Order _
I hereby certify that the work performed and the materials supplied to date,as shown on the above represent the actual value of the accomplishment under the terms of the Contract(and all
authorized changes thereof)between the undersigned and City of Carmel relating to the above referenced project.
SERVICE P ,dE I,dianapolis Slgnworks Inc. state of Indiana County of Marion
By: AA Subscribed and sworn to before me this day of
Date: �/a&A� ry
Nota Pu
bli
My commission ex ares:
NOTARY PUBLIC
SEAL '
STATE OF INDIANA
MY Comm.Expires December 20,2018