HomeMy WebLinkAbout301628 08/08/16 CITY OF CARMEL, INDIANA VENDOR: 369232
') ONE.CIVIC SQUARE BLACKMORE&BUCKNER ROOFING LLCCHECK AMOUNT: $*****3,535.00*
CARMEL, INDIANA 46032 9750 E 150TH STREET CHECK NUMBER: 301628
PO BOX#4 CHECK DATE: 08/08/16
NOB LESVILLE IN 46060
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1206 R4350900 32571 SI13211 3,535.00 REFLECTING POOL REPAI
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VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
BLACKMORE & BUCKNER ROOFING LLC ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
9750E 150TH STREET IN SUM OF$ CITY OF CARMEL
PO BOX#4 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
NOBLESVILLE, IN 46060 rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
$3,535.00 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 S113211 43-509.00 $3,535.00 1 hereby certify that the attached invoice(s),or 7/25/16 S113211 $3,535.00
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-or ere -an --
received except
Tuesday,August 02,2016
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
20Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
INVOICE
A�IECTA NIER1rA COMPANY
Blackmore& Buckner Roofing, LLC Invoice Number: S113211
9750 E 150th St Ste 1700 PO Box# . Phone: 317-263-0707 Invoice Date: 07/26/16
Noblesville, IN 46060 . Fax:317-263-0727 Due Date 08/15/16
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
j United States
Ship Via Customer ID CAR135
Ship Date 07/26/16 i Customer P.O. 32571
Terms Net 20 Salesperson
Job Description: S113211, #14205 100% Project No. 14205
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Item/Description Unit Order Qty Quantity Unit Price Total Price
TOWER ROOF REPAIRS 1 1 3,535.00 3,535.00
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AT THE REFLECTING POOL
YOUR PO#32571 DTD 11/13/15
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CONTRACT AMOUNT$35,350.00
LESS PREVIOUS BILLED $31,815.00
Subtotal: 3,535.00
Amount Subject to Amount Exempt Invoice Discount: 0.00
Sales Tax from Sales Tax Tax: 0.00
0.00 3,535.00
Total: 3,535.00
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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 attomeys'fees incurred due to nonpayment.
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Blackmore and Buckner Roofing
�/—--TECTAAMERICA Roofinz Redefined
AFFIDAVIT AND WAIVER OF LIEN
X FINAL PARTIAL X PAYMENT TO FOLLOW
STATE OF INDIANA
COUNTY OF MARION, SS:
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Leslie Buckner being duly sworn states that he/she is the Accountin Manager
(Name of Officer) ' (Title)
of Blackmore-&-Buckner Roofing.-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 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 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 Three thousand five hundred thirty-five
and 00/100 dollars $3,535.00)
Receipt of which is hereby acknowledged;or
X 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 mat 'al 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 261 day of July ,2016.
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My Commission Expires: 11/02/2017
Lisa A.Rivera
Notary Public-Printed Signature
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Lisa A.Rivera
Hamilton CountyMy Commission Expires
November 2,2017