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Home My WebLink AboutDCG Indiana, Inc. dba Dillon Construction Group/Admin/$59,631/Data Center Project – On Site Superintendent NTECzTfshfzHsfdivlijobu22;47bn-Efd31-3132 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 1/6/2022 1/6/2022 1/6/2022 *Mayor Not Present* DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 EXHIBIT B Invoice Date: Name of Company: Address & Zip: Telephone No.: Fax No.: Project Name: Invoice No. Purchase Order No: Goods Services Person Providing Goods/Services Date Goods/ Service Provided Goods/Services Provided Describe each good/service separately and in detail) Cost Per Item Hourly Rate/ Hours Worked Total GRAND TOTAL Signature Printed Name DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 EXHIBIT C INSURANCE COVERAGES Worker’s Compensation & Disability Statutory Limits Employer’s Liability: Bodily Injury by Accident/Disease: $100,000 each employee Bodily Injury by Accident/Disease: $250,000 each accident Bodily Injury by Accident/Disease: $500,000 policy limit Property damage, contractual liability, products-completed operations: General Aggregate Limit (other than Products/Completed Operations): $500,000 Products/Completed Operations: $500,000 Personal & Advertising Injury Policy Limit: $500,000 Each Occurrence Limit: $250,000 Fire Damage (any one fire): $250,000 Medical Expense Limit (any one person): $ 50,000 Comprehensive Auto Liability (owned, hired and non-owned) Bodily Single Limit: $500,000 each accident Injury and property damage: $500,000 each accident Policy Limit: $500,000 Umbrella Excess Liability Each occurrence and aggregate: $500,000 Maximum deductible: $ 10,000 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4 CitRy ®f Carmel INDIANA RETAIL TAX EXEMPT CERTIFICATE NO. 003120155 002 0 Page 1 of 1 PURCHASE ORDER NUMBER Q., JL FEDERAL EXCISE TAX EXEMPT 105871 THIS NUMBER MUSTAPPEARON INVOICES,APONECIVICSQUARE35-6000972 CARMEL, INDIANA 46032-2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS, SHIPPING LABELS ANDANY CORRESPONDENCE FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL - 1997 PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION 12/6/2021 373719 IT Data Center Building Addition and Remodel - On Site Superintendent NTE DILLON CONSTRUCTION GROUP General Administration VENDOR 6828 HILLSDALE CT SHIP 1 Civic Square TO Carmel, IN 46032- INDIANAPOLIS, IN 46250 - PURCHASEID BLANKET CONTRACT PAYMENTTERMS FREIGHT 61661 QUANTITY UNIT OF MEASURE DESCRIPTION I UNIT PRICE EXTENSION Department: 1205 Fund: 0 Account., 44-628.71 1 Each Send Invoice To: Dept of Administration 1 Civic Square Carmel, IN 46032- 2021 IT Data Center Bond IT Data Center Building Addition and Remodel - On Site Superintendent NTE F PLEASE INVOICE IN DUPLICATE 59,631.00 Sub Total 59,631.00 59,631.00 DEPARTMENT I ACCOUNT I PROJECT PROJECTACCOUNT I AMOUNT PAYMENT $59,631.00 SHIPPING INSTRUCTIONS AJP VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O. NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND VOUCHER HAS THE PROPER SWORN SHIP PREPAID. AFFIDAVIT ATTACHED, I HEREBY CERTIFY THAT THERE ISAN UNOBLIGATED BALANCE IN COO SHIPMENT CANNOT BE ACCEPTED. THIS APPROPRIATION SUFFICIENT TO PAY FOR THE ABOVE ORDER. PURCHASE ORDER NUMBER MUST APPEAR ON ALL SHIPPING LABE THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 194 AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO. ORDERED BY TITLE CONTROLLER James Crider Director of Administration James Crider Director of Administration CONTROL NO. 105871 DocuSign Envelope ID: D379C9F9-2EE2-4335-A2F0-0AE1DED7B9D4