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302169 08/22/16 CITY OF CARMEL, INDIANA VENDOR: 148000 ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $****39,079.31 CARMEL, INDIANA 46032 100 N SENATE AVE,RM IGC-N 725 CHECK NUMBER: 302169 INDIANAPOLIS IN 46204-2216 CHECK DATE: 08/22/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 203 R4462200 33409 1811 36,818.93 SIDEWALK IMPROVEMENTS 203 R4350900 33410 37133 2,260.38 OTHER CONTR SERVICES VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER CI TYOF-CARMEL Nd�r ��.e vee-idor, GENERAL FUND P' s- U-5e- 09 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service GENERAL FUND rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $36,818.93 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Engineering 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 33409 000037235 44-622.00 $36,818.93 1 hereby certify that the attached invoice(s),or 8/11/16 000037235 Dept of Transportation Attn:Agent Cashier $36,818.93 2200 Encrtn,bered 203 2200 203 N749 IGCN 100 N.Senate Ave. bill(s)is(are)true and correct and that the ru t t .Add.e_ss materials or services itemized thereon for 1 Y-rd iQ'-)a b ep ar•fs-n erg t which charge is made were ordered and of %rcLenspo_i-CJ+0-1 received except A++n: Ag e-t CC, N-4'}01 -1C-ACnJ lop N. s QruLk-r_ A—crnu c �hcki a-,'n 0.p o\%S ; IrJ 4(,204 Monday,August 15,2016 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 INDIANA DEPARTMENT OF TRANSPORTATION . . Driving Indiana's Economic Growth INVOICE -: 100 North Senate Avenue Room IGC-N 749 Michael R.Pence.Governor Indianapolis, Indiana 46204-2216 Brandye Hendrickson,Commissioner Customer No: CST000001811 Bill To: Invoice: 000037235 Invoice Date: 8/11/2016 City of Carmel Invoice Type: LPA ATTN: Jeremy Kashman One Civic Square Carmel IN 46032 AMOUNT DUE: $36,818.93 *** Payment is Due Upon Receipt of Invoice*** Line Description Quantity Unit Amt Net Amount 1 Contract#R-36021 1.00 36,818.93 36,818.93 Project#1006027;Change Order 1 &4.(See Attached) Subtotal: 36,818.93 I AMOUNT DUE: $36,818.93 is Payment Options See Reverse Side R�ctu cc. P.p, 2>SL4 )9 015J Si clevvak.le- Irnp►p..em�� 2Os - R44bZ1-00 For billing questions, please call: 317-232-5363 Invoice: 000037235 • Online website: https://secure.in.gov/apps/dot/accountsreceivables/ • To create an account, use Customer#: CST000001811 • To make a credit card payment by telephone, call either:317-232-5364 or 317-232-5388 • OR RETURN THIS PORTION WITH YOUR PAYMENT Department of Transportation Invoice: 000037235 Attention:Agent Cashier N749 IGCN Amount Paid:$ 100 N. Senate Ave. Indianapolis, IN 46204 0 Visa ❑ Mastercard 0 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: 000037235 1 I: �Q Purchase Order Order# Date Required Date Page -' INDOT Chg Order Coruction 0017802129 08/03/2016 08128/2016 1 of 1 Indiana Department of Transportation Requisition Number:0000151804 s AppmvedbyEncompa Leadership Team-2011 VendorlD: 0000267758REMIT001 Agency: 00800 Transportation Pay Terms: 35 Days in Arrears I; Fund/Object/Center: 632001571620 ►467030 Vendor 0000267758 REMIT001 1 HIS CONSTRUCTORS,INC Ship To Dept Of Transportation i Remit to 5150 E 65TH ST SUITE B Construction Management INDIANAPOLIS IN 46220 100 N SENATE AVE RM N925 INDIANAPOLIS IN 46204 I HIS CONSTRUCTORS, INC Bill To Transportation i Vendor 5150 E 65TH ST SUITE B Dept Of Transportation Name INDIANAPOLIS IN 46220 Accounting ! Address 100 N SENATE AVE RM N749 INDIANAPOLIS IN 46204 Vendor Name: Buyer Name:Tepner,Roger-800 Contact email: email: RTEPNER@indot.IN.gov ! Phone: - - - New PO R-36021 DES 1006027 800100602700000 Bike/Pedestrian Facilities on ST1055 W.of US 31 along 106th St.from Ditch Rd.to Illinois St in Hamilton County Greenfield District(FR-0022612 CN) ........_ FOS•15estnatlon ..::,.-Q -Ordered+:>-�>:. ;:Recd_sUSM31�i;;Unit�ilce=:�`�'>�ttendedalrnt I. 1- 1 100%LOCAL NON-PARTICIPATING. 1.0000 r EA 36,818.9300 36,818.93 CHANGE ORDERS 1&4 PLN 119 $15280.92;PLN 120$4437.90;PLN 123$13777,82;AND PLN 124 $3322.29.PE JASON UMLAUF.- APPROVED BYAE CHAD NIERMAN. Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State Holidays. - s The following UNICEFACT Unit of Measure Common Codes are used in this document: EA Each i This area left blank Total PO Amt. $ 36,818.93 Issued by the Indiana Department of Transportation CONFIRMATION OF RECEIPT 1 certify that the items fisted 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. 111111111111 VIII Illll I1111Ill/I I VIII IIII Illll(1111 VIII VIII VIII VIII III11 VIII VIII ILII IIII Ind an Pepe tment efTranapoda0on 00800 0017802129 VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995) ALLOWED 20 ACCOUNTS PAYABLE VOUCHER �GITY OF CARMEL iv v+ •I-h�vend c��'• GENERAL FUND PI s. u I— n n, 33 X1-10 IN SUM OF$ CITY OF CARMEL An invoice or bill to be properly itemized must show:kind of service,where performed,dates service GENERAL FUND rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc. $2,260.38 Payee ON ACCOUNT OF APPROPRIATION FOR Purchase Order# Engineering 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 33410 000037133 43-509.00 $2,260.38 1 hereby certify that the attached invoice(s),or 8/4/16 000037133 Department of TransportationAttn:Agent $2,260.38 2200 Errceimbered 203 2200 203 Cashier N749 IGCN 100 N.Senate bill(s)is(are)true and correct and that the materials or services itemized thereon for Fu 11 A dcl-est'. Ir�d'�ano� Dep-?• �F which charge is made were ordered and Po r-i-CL:h o•� received except A++" Ag en k- C C'<:h.er NrT4cl -LGCN A,rern LA -. 0rlcaq.0 L4 to?-0 Monday,August 15,2016 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 �« INDIANA DEPARTMENT OF TRANSPORTATION ,� '' ' •x Driving Indiana's Economic Growth INVOICE � J • 100 North Senate Avenue Michael R. Pence, Governor Room IGC-N 749 ' Indianapolis, Indiana 46204-2216 Brandye Hendrickson,Commissioner T� Customer No: CST000001811 Invoice: 000037133 Bill To: Invoice Date: 8/4/2016 City of Carmel Invoice Type: LPA ATTN: Jeremy Kashman One Civic Square Carmel IN 46032 AMOUNT DUE: $2,260.38 * * Payment is-Due Upon Receipt of Invoice *** Line Description Quantity UnitAmt NetAmount 1 Contract#R-35550 1.00 2,260.38 2,260.38 Project#1297165;Change Order 2. (See Attached) Subtotal: 2,260.38 AMOUNT DUE: $2,260.38 Payment Options See Reverse Side >z�ducc 2p3— P-43S09 00 l M Z co For billing questions, please call: 317-232-5363 Invoice: 000037133 • Online website: https://secure.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: 000037133 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: 000037133 EST4ip Purchase Order .Order# Date Required Date Page INDOT Chg Order Construction 0017802126 08/03/2016 08/28/2016 1 of 1 ' Indiana Department of Transportation Requisition Number:0000151801 ,:,+`_fir• Approved by Encompass Leadership Team-2011 Vendor ID: 0000051089 REMIT001 eE Agency: 00800 Transportation Pay Terms: 35 Days in Arrears Fund/Obiect/Center: 63200/571620 1467030 Vendor 0000051089 REMIT001 2 RIETH-RILEY CONSTRUCTION COMPANY INC Ship To Dept Of Transportation Remit to RIETH-RILEY CONSTRUCTION Construction Management PO BOX 276 100 N SENATE AVE RM N925 INDIANAPOLIS IN 46206 INDIANAPOLIS IN 46204 RIETH-RILEY CONSTRUCTION COMPANY INC Bill To Transportation Vendor RIETH-RILEY CONSTRUCTION Dept Of Transportation Name PO BOX 276 Accounting Address INDIANAPOLIS IN 46206 100 N SENATE AVE RM N749 INDIANAPOLIS IN 46204 Vendor Name: Buyer Name:Tepner,Roger-800 Contact eMail: eMail: RTEPNER@indot.IN.gov Phone: - - -- - — Purchase Order Instructions&Comments. New PO R-35550 DES 1297165 800129716500LC3 Other Intersection Improvement on ST1001 Intersection of 111th ST& Pennsylvania ST Carmel IN in Hamilton County Greenfield District(FR-0022381 CN) Purchase Order Line Details It"ern No `-Description FOB.Destinatiori ' '`'.Q N Ordered Q Recd <UOM . Unit Price :Extended Ami 1- 1 100%LOCAL NON-PARTICIPATING. 1.0000 0 EA 2,260.3800 2,260.38 CHANGE ORDER 2 PLN 137.PE CHRIS MILLER.APPROVED BY AE CHAD NIERMAN. Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State Holidays. Units of Measure`Handling,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. $ 2,260.38 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/DayNear) 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. 1111111111111111111111111111111111111111111111111111111111 IN Indiana Department of Transportation 00800 0017802126