Loading...
181286 01/13/2010 CITY OF CARMEL, INDIANA VENDOR: 362779 Page 1 of 1 ,1 0 i ONE CIVIC SQUARE LEACH RUSSELL CHECK AMOUNT: $26,071.04 CARMEL, INDIANA 46032 9151 FORD CIRCLE off FISHERS IN 46038 CHECK NUMBER: 181286 CHECK DATE: 1/13/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 17 1,400.00 PERFORMING ARTS CENTE 902 4460807 18 24,671.04 PERFORMING ARTS CENTE APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION. 'AIA DOCUMENT G702 /CMa (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Carme]. City Ctr Energy Ctr APPLICATION NO.: 18 Distribution to: One Civic Square 3rd Av;?. SW City Center Dr. PERIOD TO:10/30/09 OWNER Carmel, IN 46032 Carmel. IN 46032 PROJECT NOS.: SS #2805 CONSTRUCTION MANAGER FROM CONTRACTOR: Leach Russell Mechanical CONTRACT DATE: 6 ARCHITECT 9151 Ford Circle CONTRACTOR Fishers, IN 46038 VIA CONSTRUCTION MANAGER: Shiel Sexton—. CONTRACT FOR: Mechanical VIA ARCHITECT: C: n Architects, Inc. INVOICE# 18268 (295) CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge; infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay 000,00 ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 1,554, 2. Net Change By Change Orders 180, 397.00 CONTRAC R: T Ch Russell Mechanical 3. CONTRACT SUM TO DATE (Line 1 2) $1,734,397.00 By: �!ir- t Date: 10/30/09 4. TOTAL COMPLETED STORED TO DATE $1,731,671.87 State of: Indiana (Column G on G702) County of: Hamilton Subscribed and sworn to before 5. RETAINAGE: me this 30t day of tuber 2009 a. 0 of Completed Work 0.00 (Columns D E on G703) Notary Pub i r b. of Stored Material My Commission expires: 03/05/09 (Column F on G703) Total Retainage (Line 5a 5b or Total in Column I of G703) 0.00 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $1,731,671,87 In accordance with the Contract Documents, based on on -site observations and the data (Line 4• less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as (Line 6 from prior Certificate) 1,707,000.03 indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 0(4 8. CURRENT PAYMENT DUE 24,671.04 AMOUNT CERTIFIED Z7 71 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied for Initial (Line 3 less Line 6) 2, 725 3 all figures on this Application and Olt the Continuation Sheet that changed to conform to the amount certified.) CONSTRU 0 0ANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in- By: Date: /1/30/11 previous months by Owner 192, 716.00 12, 319.00 ARCM E Total approved this Month TOTALS 192 716, 00 12 319.00 By: Date: L a This CerkTic- e is not negotiable. The AMOUNT CERTIFIED is payable only to the Con NET CHANGES by Change Order 180,397.00 tractor• ii• ed herein. Issuance, payment and acceptance of payment are without prej.etci• to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 /CMa APPLICATION ANr) CERTIFICATE FOR PAYMENT CON L'C STR rrON MANAGER�A .VISER EDITION t ri/ e 1992 E DITION AIA 1992 THE AMERICAN IN OF ARCHITE 1 NEW YORK A \;;NUE, NW., WASHING-ION, D I legal prosecution. C, 20(106 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the Jiolator to I G702 /CMa -1992 CAUTION: you shnulri nes: an nrir.innt dId rincumont which hac this eanti■n n,-into.t in rnA A ininok ett.,..... Iii. -tei ••ii 6.^ .+...........a W_.. ____.-,...._-a CONTINUATION SHEET G703 Carmel Energy Center SS #2805 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, Leach Russell APPLICATION NUMBER: 18 containing CONTRACTOR'S signed Certification is attached. APPLICATION DATE: Oct 30,2009 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Oct 30,2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G 1 H WORK COMPLETED 1 TOTAL COMP. STORED BALANCE TO ITEM SCHEDULED AND STORED RETAINAGE NO. DESCRIPTION OF WORK VALUE PREVIOUS THIS PERIOD MATERIALS (NOT FINISH o APPLICATIONS IN D OR E) TO DATE (G /C) (C G) 0 /o (D +F) Bond 19,900.00 19,900.00 19,900.00 100% MobilizationlSubmittals 5,400.00 5,400.00 5,400.00 100% Labor 8,000.00 8,000.00 8,000.00 100% Allowance 10,000.00 7,274.87 7,274.87 73% 2,725.13 SanitarylStorm Pipe, Material 11,722.00 11,722.00 11,722.00 100% Labor 18,264.00 18,264.00 18,264.00 100% Domestic Water Pipe 7,481.00 7,481.00 7,481.00 100% Labor 10,556.00 10,556.00 10,556.00 100% Buried Hydronic Pipe, Material 12,478.00 12,478.00 12,478.00 100% Labor 6,114.00 6,114.00 6,114.00 100% Above Grnd Hydronic Pipe, Mat 284,244.00 284,244.00 284,244.00 100% Labor 191,080.00 191,080.00 191,080.00 100% Plumbing Fixtures /Equipment 24,939.00 24,939.00 24,939.00 100% Labor 7,553.00 7,553.00 7,553.00 100% HVAC Equipment 762,839.00 762,839.00 762,839.00 100% Labor 60,118.00 60,118.00 60,118.00 100% Temporary Heat, Material 2,000.00 2,000.00 2,000.00 100% Labor 1,840.00 1,840.00 1,840.00 100% Sheet Metal, Material 5,300.00 5,300.00 5,300.00 100% Labor 12,000.00 12,000.00 12,000.00 100% Mechanical Insulation, Material 41,518.00 41,518.00 41,518.00 100% Labor 32,470.00 32,470.00 32,470.00 100% Balance 3,499.00 3,499.00 3,499.00 100% Excavation, Material 3,885.00 3,885.00 3,885.00 100% Labor 10,800.00 10,800.00 10,800.00 100% CO #1 21,310.00 21,310.00 21,310.00 100% CO #2 (12,319.00) (12,319.00) (12,319.00) 100% CO #3 5,587.00 5,587.00 5,587.00 100% CO #4 52,947.00 52,947.00 52,947.00 100% CO #5 107,000.00 107,000.00 107,000.00 100% CO #6 5,872.00 5,872.00 5,872.00 100% TOTAL 1,734,397.00 1,731,671.87 1,731,671.87 100% 2,725.13 AFFIDAVIT AND WAIVER OF LIEN PARTIAL XXX FINAL PAYMENT TO FOLLOW XXX State of Indiana, County of Hamilton, SS: Michael S. Russell being duly sworn states that he is the CFO of Leach Russell Mechanical Contractors, Inc. having contracted with CARMEL REDEVLOPMENT COMMISSION to furnish certain material, supplies, equipment or labor for mechanical services for the project known as CARMEL CITY CENTER, ENERGY CTR. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL) that there is due from the owner the sum of TWENTY FOUR THOUSAND SIX HUNDRED SEVENTY ONE AND 04/100 DOLLARS ($24,671.04). receipt of which is hereby acknowledged or (X) the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned: (FINAL) that the final balance due from the owner is the sum of receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall be effective only upon receipt of such payment THEREFORE, the undersigned, waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or materials, or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or rights to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. CLAIMANT: Leach Russell Mechanical By: 9151 Ford Circle Michae S. Russell Fishers, IN 46038 CFO SWORN to and subscribed before me this 30th day of October, 2009. Printed: Karen C. Brown My Commission Expires 03/05/17 Seal: Residing in Hamilton County. SL Subcontract Billing Report For Work Invoiced From 11/01/09 to 11130/09 Subcontract 2805 -010 Mechanteal HVAC Plumbing Job: 2805- Energy Center Carmel Vendor: 3923 LEACH RUSSELL MECHANICAL .Cq F To Aate `This !Period Item Units UM Unit Cost Amount UnitsI% Amount Units!% Amount 1 Mechanical, HVAC, Plumbing LS 1,554,000.0C 99.82% 1,551,274.87 0.00% 0.00 Total Contract Items 1,554,000.0C 1,551,274.87 0.00 ***Change Orders 2 CCR 1007 HVAC Controls LS 107,000.00 100.00% 107,000.00 0.00 0.00 4 CCR 2001 Boiler LS 12,319.0C 100.00% 12,319.00 0.00% 0.00 Combustion Air Modification 5 CCR 2011 -ASI #4 Revised LS 52,947.00. 100.00% 52,947.00 0.00% 0.00 Water Treatment System 6 CCR #2013 Eliminate Future LS 25,941.0C 100.00% 25,941.00 0.00% 0.00 HVAC Stubs 7 CCR #2013 Add Future LS 46,262.00 100.00% 46,262.00 0.00 0.00 HVAC Stubs to South 8 CCR #2013 Sleeve for LS 989.00 100.00% 989.00 0.00% 0.00 Future HVAC Stubs to South 9 CCR 1008 Relocate Gas LS 5,587.00 100.00% 5,587.00 0.00 0.00 Meter 10 ASI EC-008 LS 5,872.00 100.00% 5,872.00 0.00 0.00 Total Change Order Items 180,397.00 180,397.00 0.00 Subcontract Totals: 1,734,397.00 1,731,671.87 0.00 Total Billings: 1,731,671.87 0.00 Unpaid Retainage: 0.00 24,671.04 Discounts: 0.00 0.00 Net Billings: 1,731,671.87 24,671.04 98 SSC CMa Projects Page 1 11/30/09 10:40:27 AM Date Format MMIDD/YY SLSubBillingReport .rpt APPLICATION AND CEr-,T FICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION AIA DOCUMENT G702 /CMa (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Carmel City Ctr Energy Ctr APPLICATION NO.: 17 Distribution to: One Civic Square 3rd Ave SW City Center Dr. PERIOD TO: 10/30/09 OWNER Carmel, IN 46032 Carmel, IN 46032 PROJECT NOS.: SS #2805 CONSTRUCTION MANAGER FROM CONTRACTOR: Leach Russell Mechanical CONTRACT DATE: 6/27/07 ARCHITECT 9151 Ford Circle CONTRACTOR Fishers, IN 46038 VIA CONSTRUCTION MANAGER: Shiel Sexton. CONTRACT FOR: Mechanical VIA ARCHITECT: CSO Architects, Inc. INVOICE #18267 (295) CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge; infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $1,554,000.00 2. Net Change By Change Orders 180, 397.00 CONTRACTOR: Leach Russell Mechanical 3. CONTRACT SUM TO DATE (Line 1 2) 1 1 734,397.00 By: Date: 10/30/09 4. TOTAL COMPLETED STORED TO DATE 1 731,671.87 State of: Indiana (Column G on G702) County of: Hamilton Z,i, G7 I O 4 Subscribed and sworn to before 5. RETAINAGE: me this 30th •y of October 20 9 a. 1 of Completed Work (Columns 0 E on G703) Notary Public b. of Stored Material My Commission expires: 03/05/09 (Column F on G703) 7"1 .all Total Retainage (Line 5a 5b or Total in Column I of 6703) 0- CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE In accordance with the Contract Documents, based on on -site observations and the data (Line 4 less Line 5 Total) 1 7 07, 000. 11.3 comprising this application, the Construction Manager and Architect certify to the Owner 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 70 s 400 es that to the best of their knowledge, information and belief the Work has progressed as (Line 6 from prior Certificate) indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. o_� 8. CURRENT PAYMENT DUE 1,400 AMOUNT CERTIFIED 1. q� 9. BALANCE TO FINISH, INCLUDING RETAINAGE 28, 051. 53 (Attach explanation if amount certified differs from the amount applied for Initial (Line 3 less Line 6) all figures on this Application and on the Continuation Sheet that changed to conforin to the amount certified.) CONSTRU IO' ANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in By: Date: 11 /3o /x00 previous months by Owner 192, 716.00 12, 319.00 ARCHIT' CT: Total approved this Month By: -.der -.10' Date: 'I 1 TOTALS 192,716,00 12 319.00 T 's Certific not negotiable. The AMOUNT CERTIFIED is payable only to the Con NET CHANGES by Change Order 180,397 -00 ractor ed herein. Issuance, payment and acceptance of payment are without p Idice to any rights of the Owner or Contractor under this Contract. ,l AIA DOCUMENT G702 /CMa •APPLICATION AND CERTIFICATE FOR PAYMENT •CONSTRUCTION MANAGER- AD \`ISF.R EDITION �j 1 99 2 EDITION AIA' •©(992 •THE AMERICAN INSTITUT OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, ?d.` D.C. 200(16 5292 WARNING: Unlicensed photocopying violates copyright laws and will subject the violator to legal prosecution. G702 /CMa -1992 f'AII rIt I. Vnr h,.I.4 n.....ne1 AIA .Inn..mnn� ...h;..h brit ♦h:.. n..1; n.. ....n•...1 .n mr• w.. .............1 l. ....II ..M..,... -..r ...1... .1 ................1 O NTI N UATION SHEET G703 Carmel Energy Center SS #2805 PAGE 2 OF 2 PAGES AIA` Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, Leach Russell APPLICATION NUMBER: 17 containing CONTRACTOR'S signed Certification is attached. APPLICATION DATE: Oct 30,2009 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Oct 30,2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED TOTAL COMP. STORED BALANCE TO ITEM SCHEDULED AND STORED RETAINAGE DESCRIPTION OF WORK PREVIOUS MATERIALS (NOT FINISH NO. VALUE APPLICATIONS THIS PERIOD IN D OR E) TO DATE (G /C) C_G 1% (D +E +F) Bond 19,900.00 19,900.00 19,900.00 100% 290.60 Mobilization /Submittals 5,400.00 5,400.00 5,400.00 100% 78.85 Labor 8,000.00 8,000.00 8,000.00 100% 116.82 Allowance 10,000.00 5,874.87 1,400.00 7,274.87 73% 2,725.13 146.02 Sanitary/Storm Pipe, Material 11,722.00 11,722.00 11,722.00 100% 171.17 Labor 18,264.00 18,264.00 18,264.00 100% 266.70 Domestic Water Pipe 7,481.00 7,481.00 7,481.00 100% 109.24 Labor 10,556.00 10,556.00 10,556.00 100% 154.14 Buried Hydronic Pipe, Material 12,478.00 12,478.00 12,478.00 100% 182.21 Labor 6,114.00 6,114.00 6,114.00 100% 89.28 Above Grnd Hydronic Pipe, Mat 284,244.00 284,244.00 284,244.00 100% 4,150.66 Labor 191,080.00 191,080.00 191,080.00 100% 2,790.23 Plumbing Fixtures /Equipment 24,939.00 24,939.00 24,939.00 100% 364.17 Labor 7,553.00 7,553.00 7,553.00 100% 110.29 HVAC Equipment 762,839.00 762,839.00 762,839.00 100% 11,139.32 Labor 60,118.00 60,11 8.00 60,118.00 100% 877.87 Temporary Heat, Material 2,000.00 2,000.00 2,000.00 100% 29.20 Labor 1,840.00 1,840.00 1,840.00 100% 26.87 Sheet Metal, Material 5,300.00 5,300.00 5,300.00 100% 77.39 Labor 12,000.00 12,000.00 12,000.00 100% 175.23 Mechanical Insulation, Material 41,518.00 41,518.00 41,518.00 100% 606.26 Labor 32,470.00 32,470.00 32,470.00 100% 474.14 Balance 3,499.00 3,499.00 3,499.00 100% 51.09 Excavation, Material 3,885.00 3,885.00 3,885.00 100% 56.73 Labor 10,800.00 10,800.00 10,800.00 100% 157.70 CO #1 21,310.00 21,310.00 21,310.00 100% 311.18 CO #2 (12,319.00) (12,319.00) (12,319.00) 100% (179.89) CO #3 5,587.00 5,587.00 5,587.00 100% 81.58 CO #4 52,947.00 52,947.00 52,947.00 100% 773.15 CO #5 107,000.00 107,000.00 107,000.00 100% 1,562.46 CO #6 5,872.00 5,872.00 5,872.00 100% 85.74 TOTAL 1,734,397.00 1,730,271.87 1,400.00 1 1,731,671.87 100% 2,725.13 25,326.40 AFFIDAVIT AND WAIVER OF LIEN PARTIAL XXX FINAL PAYMENT TO FOLLOW XXX State of Indiana, County of Hamilton, SS: Michael S. Russell being duly sworn states that he is the CFO of Leach Russell Mechanical Contractors, Inc. having contracted with CARMEL REDEVLOPMENT COMMISSION to furnish certain material, supplies, equipment or labor for mechanical services for the project known as CARMEL CITY CENTER, ENERGY CTR. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL) that there is due from the owner the sum of ONE THOUSAND FOUR HUNDRED AND 00 /100 DOLLARS ($1,400.00). receipt of which is hereby acknowledged or (X) the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned: (FINAL) that the final balance due from the owner is the sum of receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall be effective only upon receipt of such payment THEREFORE, the undersigned, waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or materials, or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or rights to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. CLAIMANT: Leach Russell Mechanical By: 9151 Ford Circle Michael S. R sell Fishers, IN 46038 CFO SWORN to and subscribed before me this 30th day of October, 2009. .600 /AO Pr'n ed: Karen C. Brown My Commission Expires 03/05/17 Seal: Residing in Hamilton County. SL Subcontract Billing Report For Work Invoiced From 10/01109 to 1013//09 Subcontract 2805 -010, Mechanical, HVAC, Plumbing Job: 2805- Energy Center Carmel Vendor: 3923 LEACH RUSSELL, MECHANICAL Cone, To Da #e This Perrod W. Item Units UM Unit Cost Amount Units!% Amount Units/GA Amount 1 Mechanical, HVAC, Plumbing LS 1,554,000,0C 99.82% 1,551,274.87 0.09% 1,400.00 Total Contract Items 1554,000.00 1551,274.87 1,400.00 Change Orders 2 CCR 1007 HVAC Controls LS 107,000.00 100.00% 107,000.00 0.00% 0.00 4 CCR 2001 Boiler LS 12,319,OC 100.00% 12,319.00 0.00 0.00 Combustion Air Modification 5 CCR 2011 -ASI #4 Revised LS 52,947.0C 100.00% 52,947,00 0.00% 0.00 Water Treatment System 6 CCR #2013 Eliminate Future LS 25,941.0C 100.00% 25,941.00 0.00% 0.00 HVAC Stubs 7 CCR #2013 Add Future LS 46,262.00 100.00% 46,262.00 0.00 0.00 HVAC Stubs to South 8 CCR #2013 Sleeve for LS 989.00 100.00% 989.00 0.00 0.00 Future HVAC Stubs to South 9 CCR 1008 Relocate Gas LS 5,587.00 100.00% 5,587.00 0.00 0.00 Meter 10 ASI EC -008 LS 5,872.00 100.00% 5,872.00 0.00 0.00 Total Change Order Items 180,397.00 180,397.00 0.00 Subcontract Totals: 1,734,397.00 1,731,671.87 1,400.00 Total Billings: 1,731,671.87 1,400.00 Unpaid Retainage: 24,671.04 0.00 Discounts: 0.00 0.00 Net Billings: 1,707,000.83 1,400.00 98 SSC CMa Projects Page 1 12/01/09 10:56:27 AM Date Format MM /DD/YY SLSubBillingReport .rpt I PrescrOed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 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. Payee nc e4 4 Purchase Order No. /S Cr `k-c- Terms t 4 s /4) Y 3 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /7 /9 /f a r.�r, i c r���� Y 1 /Ul J 34 9 /D v `J 7 7 l r� ter' 2 61�/-0 Total .6 �7/- 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 VOUCHER NO. WARRANT NO. ALLOWED 20 41- 515?" IN SUM OF 99/5/ A "a,„ /6 /ti:slat' /A/ G' 38 ?-1\ 26 0 '7/ ON ACCOU e IATION FOR 111 Board Members Po# #/TITLE AMOUNT I hereby certify that the attached invoices or DEFY °r INVOICE NO ACCT b Y Y invoice( s), dot /7 2 /V6&5 7 /yea bill(s) is (are) true and correct and that the 90 2 78 2 ,71sT materials or services itemized thereon for which charge is made were ordered and received except 20c Director f!' ;S ffons Title Cost distribution ledger classification if claim paid motor vehicle highway fund