Loading...
HomeMy WebLinkAbout181466 01/19/2010 .4.1" 7 CITY OF CARMEL, INDIANA VENDOR: 362779 Page 1 of 1 ,i. ONE CIVIC SQUARE LEACH RUSSELL CHECK AMOUNT: $24,671.04 k CARMEL, INDIANA 46032 9151 FORD CIRCLE 3* c,$' FISHERS IN 46036 CHECK NUMBER: 181466 CHECK DATE: 1119/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 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: Carmel 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 O CONSTRUCTION MANAGER FROM CONTRACTOR: Leach Russell Mechanical CONTRACT DATE: 6/27/07 ID ARCHITECT 9151 Ford Circle CONTRACTOR Fishers, IN 46038 VIA CONSTRUCTION MANAGER: Shiel Sexton. CONTRACT FOR: Mechanical VIA ARCHITECT: CSO Architects, Inc. INVOICE# 18268 (295) CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor ertifies that to the best the Contractor's knowledge, l mation b n and belief [he e Work t covered by this Application for r Payment has been en 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. I. ORIGINAL CONTRACT SUM s 1,554,000.00 Leach 'ussell Mechanical 2. Net Change By Change Orders 8 180, 397.00 CONTRAC •R: 1,734,397.00 By: Date: 10/30/09 3. CONTRACT SUM TO DATE (Line 1 2) E 4. TOTAL COMPLETED STORED TO DATE g 1,731,671.87 State of: Indiana County of: Hamilton (Column G on G702) Subscribed and sworn to before 5. RETAINAGE: me this 30 day of tober 2009 a. 0 of Completed Work 0.00 (Columns D E on G703) Notary Pub i b. of Stored Material My Commission expires: 03/05/09 (Column F on G703) Total Retainage (Line 5a 5b or Total in Column 1 of G703) E 0.00 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE s1,731,671.87 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 indicated, the quality of the Work is in accordance with the Contract Documents, and (Line 6 from prior Certificate) $1,707,000.03 the Contractor is entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE E 24,671.04 AMOUNT CERTIFIED 2g 1 Co 11 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if arnount certified differs from the amount applied for Initial (Line 3 less Line 6) 2, 725 all figures on this Application and on the Continuation Sheet that changed to conform to the amount certified.) CONSTRU XANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in By: Date: 1 t/30f 9 9 previous months by Owner 192,716.00 1 2, 319.00 ARCHI E Total approved this Month Date: Z- TOTALS 192,716.00 1 2, 319.00 This Cer ic• e is not negotiable. The AMOUNT CERTIFIED is payable only to the Con NET CHANGES by Change Order 180, 397.00 Iracto• n. ed herein. Issuance, payment and acceptance of payment are without pre) di•• to any rights of the Owner or Contractor under this Contract. M a AIA DOCUMENT G702 /CMa APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER' WISER EDITION /b, 1992 EDITION AIA ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK A\ ;.NUE, N.W., WASHINGTON, a��cE: D.C. 20006-5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the ,iotator to legal prosecution. G702 /CMa -1992 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 i B C D E I F G H I WORK COMPLETED TOTAL COMP. STORED BALANCE TO ITEM SCHEDULED AND STORED RETAINAGE NO. DESCRIPTION OF WORK VALUE PREVIOUS THIS PERIOD MATERIALS (NOT TO DATE (G /C) FINISH O% APPLICATIONS IN D OR E) (C -G) I (D +E +F) Bond 19,900.00 19,900.00 19,900.00 100% Mobilization/Submittals 5,400.00 5,400.00 5,400.00 100% Labor 8,000.00 8,000.00 8,000.00 100% j Allowance 10,000.00 7,274.87 7,274.87 73% 2,725.13 Sanitary/Storm 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 1 191,080.00 100% I I Plumbing Fixtures /Equipment 24,939.00 24,939.00 24,939.00 100% Labor 7,553.00 7,553.00 1 7,553.00 100% I HVAC Equipment 762,839.00 762,839.00 I 762,839.00 100% Labor 60,118.00 60,118.00 I 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% 1 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 I 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% I CO #5 I 107,000.00 107,000.00 107,000.00 100% CO #6 5,872.00 5,872.00 5,872.00 100 1 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. Cl? f( 4 7 y 1 Printed: aren C. Brown My Commission Expires 03/05/17 Seal: Residing in Hamilton County. ..'u:- °..b •sr a S s s �..f'� a s H �.,,v�'fl"y'uy.- t .i f �y F ,,�.ry 'cwa^x, ct r 3�t 4- vn!': v it a F' ''SF ,c E s ro'c., SL Subcontract Billing Report For Work Invoiced From 11/01/09 to 11/30/09 •.Sufisontraet:. 28057010.=Mecha Moak HVAC .Plumbih Job: 2805- Energy Center Carmel Vendor: 3923 LEACH RUSSELL MECHANICAL :._r.::_: —:C' nt ct::. >3'o_Rate._:::: Ehs�P e ttod3:- Item Units UM Unit Cost Amount Units!% Amount Units!% Amount 1 Mechanical, HVAC, Plumbing LS 1,554,000.00 99.82% 1,551,274.87 0.00 0.00 Total Contract Items 1,554,000.00 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 12,319.00 100.00% 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 46,262.0C 100.00% 46,262.00 0.00 0.00 HVAC Stubs to South 8 CCR #2013 Sleeve for LS 989.0C 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 MM/DD/YY SLSubBillingReport .rpt 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: 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 El 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. I. ORIGINAL CONTRACT SUM 1,554,000.00 CONTRACT R: Leach Russell Mechanical 2. Net Change By Change Orders 180,397_00 3. CONTRACT SUM TO DATE (Line 1 2) 8 1,734,397.00 By: Date: 10/30/09 State of: Indiana 4. TOTAL COMPLETED STORED TO DATE 1 731,671.87 County of: Hamilton (Column G on G702) Z f (p 71. a y Subscribed and sworn to before 5. RETAINAGE: me this 30th •Y of Oct,•ber 2019 a. 1 of Completed Work (Columns D E on G703) .0 r Notary Public: b. of Stored Material My Commission expires: 03/05/09 (Column F on G703) 1. 6-1 o9 Total Retainage (Line 5a 5b or Total in Column I of G703) "2573215741 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Tess Line 5 Total) 1 7 07, o0O 93 comprising this application, the Construction Manager and Architect certify to the Owner 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 1 7o s 400. 83 that to the best of their knowledge, information and belief the Work has progressed as 2na dn5 n7. indicated, the quality of the Work is in accordance with the Contract Documents, and (Line 6 from prior Certificate) S the Contractor is entitled to payment of the AMOUNT CERTIFIED. o-2 8. CURRENT PAYMENT DUE S 1,400.00 AMOUNT CERTIFIED OD° 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 Sbeet that changed to conform to the amount certified.) CONSTRU I0 ANAGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in By: Date: /1/3e/zoo `f previous months by Owner 192, 716.00 12, 319.00 ARCHIT CT: Total approved this Month ZI C) By: Date: TOTALS 192, 716 00 12,319.00 017-- -ow T 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 .ice to any rights of the Owner or Contractor under this Contract. i 1 AIA DOCUMENT G702/CMa APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIA° ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1755 NEW YORK AVENUE, NW, WASHINGTON, 41 7 D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702 /CMa -1992 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: 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 I E F G H I WORK COMPLETED TOTAL COMP. STORED BALANCE TO ITEM SCHEDULED AND STORED RETAINAGE NO. DESCRIPTION OF WORK VALUE PREVIOUS THIS PERIOD MATERIALS (NOT TO DATE (G /C) FINISH 1% APPLICATIONS IN D OR E) (C -G) (D +E +F) Bond 19,900.00 19,900.00 19,900.00 100 %1 290.60 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 I 100% 171.17 I 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 I 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 I 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 I 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 i 762,839.00 100% 11,139.32 Labor 60,118.00 60,118.00 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 I 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 I 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) I CO #3 5,587.00 5,587.00 j 5,587.00 100% 81.58 CO #4 52,947.00 52,947.00 52,947.00 100% I 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 I I j I TOTAL 1,734,397.00 1,730,271.87 1,400.00 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. i 4 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 10/01/09 to 10/31/09 Sutico .t'r'act: 2805: =01 ;.:M n 0 echanica _HVAC..P..lambn Job: 2805- Energy Center Carmel Vendor: 3923 LEACH RUSSELL, MECHANICAL Co C1_�— _T=o= �a.e_:r rr���:::; °ahikiPerod €re.1= Item Units UM Unit Cost Amount Units/% Amount Units/% Amount 1 Mechanical, HVAC, Plumbing LS 1,554,000.00 99.82% 1,551,274.87 0.09 1,400.00 Total Contract Items 1,554,000.0C 1,551,274.87 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 12,319.00 100.00% 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 i Water Treatment System 6 CCR #2013 Eliminate Future LS 25,941.00 100.00% 25,941.00 0,00% 0.00 HVAC Stubs 7 CCR #2013 Add Future LS 46,262.0C 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 Prescribed 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 ll Lech And Rtt55e II ,ieCh H (i Purchase Order No. 15I FQd Cir(le Terms `I Sher) IA( L b o 38 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 11 -01 f g P 7C Itgc Le 2- 67/. cut r Y 'a t Total j d it I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same fi ,accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. rr 1 ALLOWED 20 Lek( r1ti1� 65 IN SUM OF 1151 Fo Circle Y fl/ '-\sd)V 14 6711'b ON ACCOUNT OF APPROPRIATION FOR Board Members Po or NO. #fTITLE AMOUNT hereby certify invoice( s), D ET N INVOICE NO ACCT I hereb certif that the attached invoices or 902 j u )7 24, (,71,01f 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 r .1)1 Signature Diroeto r of Operations Ti Cost distribution ledger classification if claim paid motor vehicle highway fund