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Home My WebLink About314341 07/31/2017 4�,�,,,,F� CITY OF CARMEL, INDIANA VENDOR: 148000 �.a t, � ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $****41,114.11 41,114.11- ONE CARMEL, INDIANA 46032 100 N SENATE AVE,RM IGC-N 725 CHECK NUMBER: 314341 +,y, INDIANAPOLIS IN 46204-2216 CHECK DATE: 07/31/17 � /TON_� DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 203 4462200 000041613 8,224.00 SIDEWALK IMPROVEMENTS 202 4350900 00041044 32,890.11 OTHER CONT SERVICES < « ? m O B k 0 : O \ 2 � 2 2 D 2 � 0 C \ ° ^ k % / m \ O / M A m / < z / k 0 CD a Q a 2 < k \ / § k In ® . > \ 2 _ / # I. X \ / 1 k ƒ / 5 O » 2q / CD o Cl. n -u / 3 ~ \ # 7 a a k w k 22 \ / K - co O CD \ co j _ a % _ \ 2 E r- z < $ ƒ \k { i g D g / m 0 C ° ] q ƒ \ \ 2 0 CD / CD k c a E 2 (OD 2 / o J / ¥ 3 OR / § ;r, C $ 3 8 a) 7 \ �_ 0 7 / 7 2 C \ z k = ° = so C) Q� § - < , w ) g J \ = 7 £ ƒ § m » 2 ( \ / ƒ _0 %m § 2 m § E E § i/ 8j m ` a k E E m \ in 0 \ C 7 M } / � ¢ � 2 w [/ 02 m ƒ \ = C o Rg t ^ # # f C) Z Q CD 0= ° _ � 00 (oJf % \ & \_� E0 > , i / � o ■ }_ƒ § / �o \ \ o a E > _[\ & q 0 m -nz3-n z3 - § / $ / Caco.CD M o \ E @ f G n E� ± o , _ r- O 7 � $ ] ƒ E 2 C 77 2 § J = G G E $cr St. 2 / § k ° M - 2 8 (D f \ ] 0 ] a ° C - \ \ 2 § 2 k § 7 { 00 co 5 k ¥ / INDIANA DEPARTMENT OF TRANSPORTATION �o Driving Indiana's Economic Growth INVOICE 100 North Senate Avenue � Eric Holcomb,Governor Room IGC-N 749 O. � ' Indianapolis, Indiana 46204-2216 Joe McGuinness,Commissioner T F 1� Customer No: CST000001811 Bill To: Invoice: 000041044 Invoice Date: 4/26/2017 City of Carmel Invoice Type: LPA ATTN: Jeremy Kashman One Civic Square Carmel IN 46032 AMOUNT DUE: $32,890.11 *** Payment is Due Upon Receipt of Invoice *** Line Description Quantity Unit Amt Net Amount 1 Contract#R-35550 1.00 32,890.11 32,890.11 Project#1297165;Change Order 10.(See Attached) Subtotal: 32,890.11 AMOUNT DUE: $32,890.11 Payment Options See Reverse Side "�-oZ - 4-3SO9V0 For billing questions, please call: 317-234-2869 Invoice: 000041044 • Online website: https://secure.in.gov/apps/dot/accountsreceivables/ • To create an account, use Customer* CST000001811 • To make a credit card payment by telephone, call either:317-232-5364 or 317-232-5388 • OR RETURN THIS PORTION WITH YOUR PAYMENT Department of Transportation Invoice: 000041044 Attention:Agent Cashier N749 IGCN Amount Paid:$ 3��8 q 0• t 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: 317-234-2869 Invoice: 000041044 rRilat yse Or a Order# Date Required Date Page Q1 Order COf$�1'UCtIOn 0017817920 04/19/2017 05/13/2017 1 of 1 apartment o II ransportation Requisition Number:0000168846 +tlwrovadbyEneempwLs -rshlpTwe-M1 VendorlD: 0000051089REMIT001 • Agency: 00800 Transportation _ Pay Terms: 35 Days in Arrears Fund/Ob ect/Center: 6320015716201467030 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 PO Closed R-35550 DES 1297165 800129716500LC3 Other Intersection Improvement on ST1001 Intersection of 111th ST& Pennsylvania ST Carmel IN in Hamilton County Greenfield District(FR-0031754 CN) Purchase Order irine_Dstafls Item No. Descri tion FOB Destination .` .. Ordered =' Recd UOM Unit Price': Extended Amt 1- 1 100%LOCAL NON-PARTICIPATING. 1.0000 0 EA 32,890.1100 32,890.11 CHANGE ORDER 10 PLN 149.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. 71 finita of Measure Handlin Totals Signatures. The following UN/CEFACT Unit of Measure Common Codes are used in this document: EA Each This area left blank Total PO Amt. $ 32,890.11 issued by the Indiana Department of Transportation CONFIRMATION OF RECEIPT I certify that the llama 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(MonthlDay/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. 1111111111111111{11111111111111111111111111111111111111111111111111111111111111111111111111 IN Indiana Dopvsnant of Trarapodallon 00800 0017817920 < « ? m O b k % q ? B 22 2 > 2 & f } ° ^cr n > M > k 0 0 > m J / 2 2 7 m CO 3 m \ R ¥ 2 < k A 2 m m 0 # % a # _ ® _ 0 k � z @ \ 7 $ \ \ ƒ / 0 S E u ® X d > fkms - 7 Cil 2 kw 9 2 2 0 w 7z < 0 > O O } \ $ = o H ¥ 0 i / / \ § { i / CD r // 2 o m CD e n -n Q ID A a ; 7 % e = m m ¥ g 2 k c a E 2 / CD / 2 f + - C:"- C- 0 C-7 % 0 7 0/ 2 / A 2 e i ' a «E E C) = CD < m w g S /\ 2 a * ƒ § ; 3 2 0 7 e - ƒ c7 7 RQ _ kf § \ m \ cr 0) n CD - # _ CD / r D \ � - 0 \ 0 & � � \ 2 $ 2 m }/ j \ § 2 \ C \ ) / D o ) o \\ \ � Cl) & o< o q D \o 2. U) \ \ eee ) Q 7 > D 03 »E § q \ CD cl 2 CD r o k J 7 7 ) ) 7 0 / % K3 E / 7 2 rp 77 cD ƒ � E ] $ { CDC CD CD a) \ 7 CD 2 0 § \ \ p ƒ C CD cn - 8 - / f \ ] k0 7 e \ f K CD \ \ ro $ S ® \ INDIANA DEPARTMENT OF TRANSPORTATION +� Driving Indiana's Economic Growth y� INVOICE 100 North Senate Avenue Room IGC-N 749 Eric Holcomb,Governor Indianapolis, Indiana 46204-2216 Joe McGuinness, Commissioner Customer No: CST000001811 Bill To: Invoice: 000041613 Invoice Date: 6/7/2017 City of Carmel Invoice Type: ROE ATTN: Jeremy Kashman One Civic Square Carmel IN 46032 AMOUNT DUE: $8,224.00 *** Payment is Due Upon Receipt of Invoice *** Line Description Quantity Unit Amt Net Amount 1 Project#1006027 Overpayment 1.00 8,224.00 8,224.00 Subtotal: 8,224.00 AMOUNT DUE: $8,224.00 Payment Options See Reverse Side z03- 4L4tt2-2 oL� For billing questions, please call: 317-234-7727 Invoice: 000041613 • Online website: https:Hsecure.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: 000041613 Attention:Agent Cashier 0 0 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: 317-234-7727 Invoice: 000041613 Report Summary Printed On: 6/7/2017 9:15:16 AM Number of Invoices: 1 Process Instance: 16768438 For billing questions, please call: 317-234-7727 Invoice: 000041613 Indiana Department of Transportation Billing Request Form Date: 6/712017 From. GREENFIELD DISTRICT To: Ben Mauger Accounts Receivable Supervisor Division of Accounting&Control RE: Billing Request Overpayment ❑ Errors&Omissions Type of billing(check one): ❑ Audit Citation ❑ Miscellaneous Local Portion of Agreement Entity to be Billed CITY OF CARMEL Billing Street Address ONE CIVIC SQUARE Billing City,State,Zip. CARMEL,IN 46032 INDOT Point of Contact: SARAH SOBIESKI Phone#: 317-467-3477 Customer Point of Contact: KATE LUSTIG c Phone#: 317-571-2432 ❑ Reduction of Expenditures Type of funding(check one). Q Local Revenue State Revenue Other Chartfield Information Project A 1006027 Activity: " 17CSMIF Fund: 63200 Account: 583110 " Department: 65313 Program: ,`"46702 Locality: MP,1IN Amount to be billed: $ <'- 8,224.00 Reference PO#: 16802876 Attached supporting documents(e.g. Purchase Orders, Contracts,Letters of Agreement,Schedules or Spreadsheets, etc.)