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Home My WebLink About300917 07/25/16 �r_C4q CITY OF CARMEL, INDIANA VENDOR: 369232 j ® ONE CIVIC SQUARE BLACKMORE&BUCKNER ROOFING LLCCHECK AMOUNT: $....14,140.00" s =� CARMEL, INDIANA 46032 9750 E 150TH STREET CHECK NUMBER: 300917 PO BOX#4 CHECK DATE: 07/25/16 NOBLESVILLEIN 46060 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1206 R4350900 32571 SI13032 14,140.00 REFLECTING POOL REPAI VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) BLACKMORE& BUCKNER ROOFING LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER 9750 E 150TH STREET IN SUM OF$ CITY OF CARMEL PO BOX#4 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service NOBLESVI LLE, IN 46060 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $14,140.00 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 32571 S113032 43-509.00 $14,140.00 I hereby certify that the attached invoice(s),or 6/29/16 S113032 $14,140.00 1206 Encumbered 101 1206 101 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,July 12,2016 Dave Huffman Director 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 Ecr eERICA ICUMPANY INVOICE A I Blackmore&Buckner Roofing, LLC Invoice Number: S113032 9750 E 150th St Ste 1700 PO Box# . Phone: 317-263-0707 Invoice Date: 06/29/16 Noblesville, IN 46060 . Fax:317-263-0727 Due Date 07/19/16 www.blackmorebuckner.com Page No: 1 Bill Ship To: CARMEL STREET DEPARTMENT To: Carmel City Center 3400 W 131 ST STREET Mr.David Huffman CARMEL, 46074 762 3rd Ave United States Carmel, 46074 United States Ship Via Customer ID CAR135 Ship Date 06/29/16 Customer P.O. 32571 Terms Net 20 Salesperson Job Description: S113032#14205 90% Project No. 14205 Item/Description Unit Order Qty Quantity Unit Price Total Price TOWER ROOF REPAIRS 1 1 14,140.00 14,140.00 AT THE REFLECTING POOL YOUR PO#32571 DTD 11/13/15 CONTTRACT AMOUNT$35,350.00 i LESS PREVIOUS BILLED$17,675.00 Subtotal: 14,140.00 Amount Subject to Amount Exempt Invoice Discount: 0.00 Sales Tax from Sales Tax Tax: 0.00 0.00 14,140.00 Total: 14,140.00 Payments are due on the date specified above as the Due Date. Unpaid invoices shall bear interest at the rate of 1 1/2%per month. Customer shall be responsible for all costs of collection,including reasonable attorneys'fees incurred due to nonpayment. Blackmore and Buckner Roofing "-'-�TECTAAMERICA Rooflng Redefined AFFIDAVIT AND WAIVER OF LIEN FINAL X PARTIAL X PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION, SS: Leslie Buckner being duly sworn states that he/she is the Accounting Manager (Name of Officer) (Title) of Blackmore&Buckner Roofing,Inc.having contracted with Carmel Street Department to furnish certain materials and/or labor for a project known as Carmel Reflection Pool located in Indianapolis,IN and does further state; PARTIAL WAIVER: that the balance due from the owner is the sum of Fourteen thousand,one hundred foriv dollars and 00/100 dollars(1_14 140.00) Receipt of which is hereby acknowledged;or X The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien,which is given to and for said full amount,effective upon receipt of such payment. FINAL WAIVER: that the final balance due from the owner is the sum of and 00/100 dollars($ .00) Receipt of which is hereby acknowledged;or The payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien,which is given,to and for said full amount,effective upon receipt of such payment. THEREFORE,the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon account of labor or material or both,furnished by the undersigned thereto,and further certifies that no other party has any claim or right to a lien on account of any work performed or erial furnished to the undersigned for said project, - -- ---- -and-within the-scope-of-this-affidavit and-waiver. —-- - --- --- -- -- - -- - ------ __ __ Blackmore&Buckner Roofing,Inc. Company Name Authorized Representative Leslie Buckner,Accounting Manager Name/Title WITNESS MY HAND AND NOTARIAL SEAL,this 30'- day of June ,2016. My Commission Expires: 11/02/2017 Lisa A.Rivera Notary Public-Printed Signature - Lisa A. Rivera +=t SEAL * Hamilton County My Commission Expires November 2,2017