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CITY OF CARMEL, INDIANA VENDOR: 371498
® ONE CIVIC SQUARE DEPARTMENT OF TRANSPORTATION CHECK AMOUNT: S"'""1,679.69`
CARMEL, INDIANA 46032 ATTN:AGENT CASHIER N749 IGCN CHECK NUMBER: 308089
100 N.SENATE AVENUE CHECK DATE: 02/13/17
INDIANAPOLIS IN 46204
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
203 4462200 000038077 1,679.69 SIDEWALK IMPROVEMENTS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995)
Vendor# 371498 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
DEPARTMENT OF TRANSPORTATION IN SUM OF$ CITY OF CARMEL
ATTN: AGENT CASHIER N749 IGCN An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46204
Payee
$1,679.69
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
000038077 44-622.00 $1,679.69 Ihereby certify that the attached invoice(s),or 10/24/16 000038077 Final amount due for bike/ped bridge over $1,679.69
2200 203 Prior Year 2200 203 Carmel Drive for Monon Trail
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, February 07,2017
Kashman,Jeremy
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
INDIANA DEPARTMENT OF TRANSPORTATION
s : . Driving Indiana's Economic Growth INVOICE
100 North Senate Avenue
Room IGC-N 749 Michael R.Pence,Governor
�. Brandye Hendrickson,Commissioner
Indianapolis, Indiana 46204-2216 y
Customer No: CST000001811
Bill To: Invoice: 000038077
Invoice Date: 10/24/2016
City of Carmel Invoice Type: LPA
ATTN: Jeremy Kashman
One Civic Square
Carmel IN 46032 AMOUNT DUE: $1,679.69
*** Payment is Due Upon Receipt of Invoice***
Line Description Quantity Unit Amt Net Amount
1 Contract#:&27185 1.00 1,679.69 1,679.69
Project#:9929036;DES:0300059. Final amount due to INDOT to close
project. _
Subtotal: 1,679.69
AMOUNT DUE: $1,679.69
Payment Options
See Reverse Side
oevw bike 1p e d bri d 9e ow-eft Co-%.r -%el D-'sva
Mon ort Tra i t
203 —
For billing questions, please call: 317-232-5363 Invoice: 000038077
• Online website: https://secure.in.gov/apps/dot/accountsreceivables/
• To create an account, use Customer#: CST000001811
• To make a credit card payment by telephone, call either:317-232-5364 or
317-232-5388
• OR RETURN THIS PORTION WITH YOUR PAYMENT
Department of Transportation Invoice: 000038077
Attention:Agent Cashier
N749 IGCN Amount Paid:$ 1 t loAct. bh
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: 397-232-5363 Invoice: 000038077