HomeMy WebLinkAbout329293 08/27/18 �%'�,q� CITY OF CARMEL, INDIANA VENDOR: 148000
Y' ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $*****3,069.39*
9 Q; CARMEL, INDIANA 46032 100 N SENATE AVE,RM IGC-N 725 CHECK NUMBER: 329293
''��roeT�°' INDIANAPOLIS IN 46204-2216 CHECK DATE: 08/27/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
202 4350900 000048721 3,069.39 OTHER CONT SERVICES
VOUCHER NO. WARRANT NO. Prescribed by state Board of Accounts City Form No.201 (Rev.1995)
Vendor# 148000 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
INDIANA DEPT OF TRANSPORTATION IN SUM OF$ CITY OF CARMEL
100 N SENATE AVE, RM IGC-N 725 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 46204-2216
Payee
$3,069.39
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Terms
Engineerinq
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
000048721 43-509.00 $3,069.39 1 hereby certify that the attached invoice(s),or 8/22/18 000048721 116th and Hazel Dell-Change Order 3 $3,069.39
2200 202 2200 202
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
A++-er,h ot-N , A94en+ Cox-&k'eP'
which charge is made were ordered and
received except
Thursday,August 23, 2018
Jeremy Kashman
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—
Clerk-Treasurer
20Clerk-Treasurer
INDIANA DEPARTMENT OF TRANSPORTATION
,a ' •� Driving Indiana's Economic Growth
T' INVOICE
- 100 North Senate Avenue
r Room IGC-N 749 Eric Holcomb,Governor
:};Tit Indianapolis, Indiana 46204-2216 Joe Mc Guinness,Commissioner
Customer No: CST000001 8 1.1
Bill To: Invoice: 000048721
Invoice Date: 8/22/2018
City of Carmel,
Invoice Type: LPA
ATTN: Jeremy Kashman
One Civic Square
Carmel IN 46032 AMOUNT DUE: $3,069.39
*** Payment is Due Upon Receipt of Invoice***
Line Description Quantity Unit Amt Net Amount
1 C/O Contract R-36341 1.00 3,069.39 3,059.39
Project#1297561 Change order 3
Subtotal: 3,069.39
AMOUNT DUE: $3,069.39
Payment Options
See Reverse Side
For billing questions, please call: 317-234-7727 Invoice: 000048721
• 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: 000048721
Attention:Agent Cashier 3 3
N749 IGCN Amount Paid: $ n Co�,,j
100 N.Senate Ave.
Indianapolis, IN 46204
❑ Visa ❑ Mastercard ❑ Discover ECheck/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: 000048721
Purchase Order Order# Date Required Date Page
Indiana
Chg Order Construction 0020003097 08117/2018 09115/2018 1 of 1
Department of Transportation Requisition Number:0000196912
Approved byEnvamnpa Leadership'r——2011 Vendor ID: 0000060827 REMIT001
Agency: 00800 Transportation
Pay Terms: 35 Days In Arrears
Fund/Ob' ctlCenter: 6320015716201897030
Vendor 0000060827 REMIT001 1
3D COMPANY INC Ship To Dept Of Transportation
Remit to 3200 E CR 350 N Construction Management
MUNCIE IN 47303 100 N SENATE AVE RM N925
INDIANAPOLIS IN 46204
3D COMPANY INC Bill To Transportation
Vendor 3200 E CR 350 N Dept Of Transportation
Name MUNCIE IN 47303 Accounting
Address 100 N SENATE AVE RM N749
INDIANAPOLIS IN 46204
Vendor Name: Buyer Name:Tepner,Roger-800
Contact eMail: entail: RTEPNER@indot.IN.gov
Phone:
..:-...: ,.._:..,:_ :.:...,,....... ....:.::..Purchase Order.lnstructions'&Cortiments' :::+:.;:;.: -.:::;::.;::::,.:,,;,.r::::.: , :;•..::;:::::::.:.'.::.:;:_:::...;:•.::-:.::.,' ._
CLOSED PO.R-36341 DES 1297561 Intersection Improvement Roundabout on ST1060 116th St&Hazel Dell Parkway in Hamilton
County Greenfield District (FR-0055583 CN)
:.-:.�:....•:;,..; _. ... Purcfiase.Order Llne D@ta1Js::' :. :::.:.:.... . ...... : ::.:_:.. •.
Item No" Description .-FOB bestination Ordered'r' Recd UOM Unk Price EiiEerided Amt
1- 1 100%LOCAL NON PARTICIPATING, 1.0000 0 EA 3,069.3900 3,069.39
CHANGE ORDER 3 PLN 0142$3069.39.
PE CASEY LYNCH
ciynch@structurepointcom APPROVED
BYAE KEITH MYERS.
Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State
Holidays.
:::;.;: :.>::......:.........:. .. ..,-... , "r:;UnitsofMeasure'HaniiiiTotals°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. $ 3,069.39
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 detects except as otherwise noted.
signature of State Emp;oyee Receiver Date SignedlMonthlOaylYear)
FUNDING ENCUMBERED BY THE AUDITOR OF STATE
I certLN 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.
111111111111111 ILII 111111111 VIII IN 111111111111111111111111111111111111111111111 IN IN indlana Department of Trampertedun
00800 0020003097