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Home My WebLink About329658 09/05/18 CITY OF CARMEL, INDIANA VENDOR: 371368 J°e 1 ONE CIVIC SQUARE BAUMGARTNER &COMPANY, INC. CHECK AMOUNT: $****62,217.00* CARMEL, INDIANA 46032 15215 RIVER ROAD CHECK NUMBER: 329658 NOBLESVILLE IN 46062 CHECK DATE: 09/05/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1120 R4350100 100927 8028181 62,217.00 STA 42 CONCRETE ,REMOV VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201 (Rev.1995) Vendor# 371368 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER BAUMGARTNER 8r COMPANY, INC. IN SUM OF$ CITY OF CARMEL 15215 RIVER ROAD 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. NOBLESVILLE, IN 46062 Payee $62,217.00 Purchase Order# ON ACCOUNT OF APPROPRIATION FOR Carmel Fire 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 100927 082818-1 43-501.00 $62,217.00 1 hereby certify that the attached invoice(s),or 8/30/18 082818-1 Station 42 Concrete&Paving $62,217.00 1120 Encumbered 101 1120 101 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 Thursday,August 30,2018 David Haboush Fire Chief 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 Baumgartner& Company, Inc. 15215 River Road I N VO I C E Noblesville IN 46062- Invoice No:082818-1 (317) 296-7225 Date:8/28/2018 Due Date:8/28/2018 Bill To: Carmel Fire Department Job No:218002-LB 2 Civic Square Description:Carmel Fire Station#42 ED Carmel IN 46032 PO#: Description Extended Price Fire Department, 2 Civic Square, Carmel, IN - PO#100927 Concrete Removal & Paving 62,217.00 Thank You For Your Business! Amount Now Due: 62,217.00 Terms: BAUMGARTNER ASPHALT COMPANY,INC. d/b/a BAUMGARTNER& COMPANY ASPHALT SERVICES 15215 River Road Noblesville, IN 46062 AFFIDAVIT AND FINAL WAIVER OF LIEN (For use with final payment application) Notice: This Waiver is Contingent Upon Receipt of Payment to Follow STATE OF INDIANA,COUNTY OF HAMILTON,SS: Date: August 28,2018 TO: Owner: Carmel Fire Department 2 Civic Square Carmel,IN 46032 Project: Fire Department 2 Civic Square Carmel,IN Baumgartner Scope of Work:Asphalt Paving The undersigned, being duly sworn, deposes, certifies and says that: (i) he is an officer of, and is duly authorized to make this Affidavit and Final Waiver of Lien on behalf of BAUMGARTNER ASPHALT COMPANY, INC. d/b/a BAUMGARTNER& COMPANY ASPHALT SERVICES ("Baumgartner"); (ii) Baumgartner has contracted with General Contractor or Owner to furnish certain labor and/or materials as follows: Striping, for the above Project; (iii) the final balance due from General Contractor or Owner for - labor performed and material furnished to said Project is Sixty-two thousand two hundred seventeen and 00/100 Dollars ($62,217.00); (iv) the payment of this amount has been promised as the sole consideration for this Affidavit and Final Waiver of Lien; (v)this Affidavit and Final Waiver of Lien is given to and for this amount,and is effective only upon receipt by Baumgartner of such payment;and(vi) no other party has a valid claim or right to a lien on account of any work performed, materials or equipment furnished or services rendered for said Project for which this Affidavit and Final Waiver of Lien is given, provided the final balance due is paid to Baumgartner so that any indebtedness associated with the performance of the Contract and the amount due herein may be satisfied. FOR GOOD AND VALUABLE CONSIDERATION,and in anticipation of the payment to Baumgartner of the amount set forth above and effective upon receipt of this amount, Baumgartner, for itself and its employees, hereby waives and releases unto the General Contractor and Owner any and all rights to hold, assert, enforce or file any and all claims and liens which Baumgartner now has or may have against the Project (including without limitation the real property on which such Project is located and the 1 improvements thereon), for any and all labor performed, materials and equipment furnished, and services provided to or for the Project by or through Baumgartner to the extent of the payment received for which this Affidavit and Final Waiver of Lien is given. Date: 8/28/18 CONTRACTOR: BAUMGARTNER ASPHALT COMPANY,INC. d/b/a BAUMGARTNER& COMPANY ASPHALT SERVICES R By: Melissa R. Orr, Corporate Secretary STATE OF INDIANA ) SS: COUNTY OF HAMILTON ) Subscribed and sworn to before me, a Notary Public, in and for said County and State this 28th day of AL":" 8. BRACHO tate of Indiana,":::.ng County Signature: n#71264ras Kelli M.Bracho Notary Public sion Exp\ ,2026 My Commission Expires: 4/19/2026 My County of Residence Is: Hamilton 2