181469 01/19/2010 l p c CITY OF CARMEL, INDIANA VENDOR: 363785 Page 1 of 1
J 0
ONE CIVIC SQUARE PURDY MASONRY, INC
CARMEL, INDIANA 46032 7601 INDIANAPOLIS ROAD CHECK AMOUNT: $28,695.00
`'z --6-/ Z IONSVILLE IN 46077 CHECK NUMBER: 181469
CHECK DATE: 1/19/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 13 28,695.00 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 11/01/09 to 11/30/09
Subcontract 2695 3020.:3020 Exterior Ma (CMU)
Job: 2695- Carmel RPAC Construction Vendor: 4833 PURDY MASONRY, INC.
777 3rd Ave. SW
Carmel, IN 46032
Contract To Date k F This Period
Item Units UM Unit Cost Amount Units/% Amount Units/%. Amount
1 3020 Exterior Masonry (CMU) LS 1,450,000.01 97.31% 1,410,932.50 1.98% 28,695.00
Total Contract Items 1,450,000.01 1,410,932.50 28,695.00
Change Orders
2 ASI PAC -091 Dome LS 243,977.3• 0.00% 0.00 0.00 0.00
Connection Remediation
3 3020 Exterior Masonry LS 243,977.3• 0.00% 0.00 0.00 0.00
Total Change Order Items 0.01 0.00 0.00
Subcontract Totals: 1,450,000.00 1,410,932.50 28,695.00
Total Billings: 1,410,932.50 28,695.00
Unpaid Retainage: 72,500.00 0.00
Discounts: 0.00 0.00
Net Billings: 1,338,432.50 28,695.00
98 SSC CMa Projects Page 1 11/19/09 12:01:51 PM
Date Format MM /DDIYY SLSubBillingReport .rpt
TM
Document G702 /CMa 1992
Application and Certificate for Payment Construction Manager Adviser Edition
TO OWNER: PROJECT: Parcel 7A -Reg. Perf. Arts Cntr APPLICATION NO: 13 Distribution to:
`CITY OF CARMEL BY AND THROUGH 11!3012009
ITS REDEVELOPMENT COMMISSION PERIOD TO OWNER 0
CARMEL "IN
CONSTRUCTION MANAGER Ill
FROM CONTRACTQR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 1/8/2008 ARCHITECT
urdy Masonry, s Road SHIEL SEXTON COMPANY 2695
7601 Indianapolis Road PROJECT NOS: 1 CONTRACTOR
Zionsville, IN 46077 VIA ARCHITECT: CSO ARCHITECTS FIELD
CONTRACT FOR:. EXT. CMU
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
1,450,000.00 Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM payment shown herein is now due.
2. Net change by Change Orders 0.00 CONTRACT Purdy Mast:). ry, Inc.
3. CONTRACT SUM TO DATE (Line 1 2) 1,450,000.00 By 1.. 11 t Date: i) K.
4. TOTAL COMPLETED STORED T O DATE (Column G on G703) 1,410,932.50 State of IN
BOONE
5. RE County of: 1 Stefanie Purdy
a. To of Completed Work Subscribed and sworn to'before Notary Public Seal State of lndlana
(Column D E on G703) 7a 5( m e thi f Q day of yC]U Hendricks County
My Commission Expires 0$12812017
b 10.00 %O of Stored Material f Notary Public: 1
(Column F on 0703) 0 My Commission ex s s
Total Retainage (Lines 5a 5b or Total in Column I of G703) 791 C CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE I) 33g/ .52 this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 1 1 tO accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED. r
8. CURRENT PAYMENT DUE a t 0`15 AMOUNT CERTIFIED Z2),(215
9. BALANCE TO FINISH, INCLUDING RETAINAGE, (Attach explanation if amount certified differs from the amount Initial all figures on this
Application at on the C ntinuation Sheet that are changed' to conform with the amount certified.)
(Line 3 less Line 6) l'i 1 CONSTRU TIC N MA r
By: Date: i 2.4' 1
n
ADDITIONS DEDUCTIONS a�
CHANGE ORDER SUMMARY A RCHITE
Total changes appred in previous months by Owner 0.00 0.00 By: W
ov k J Date: `c 01
Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 0.00 named herein. Issuan and acceptance of payment are without prejudice to any rights of
I: NET CHANGES by Change Order 0.00 the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G7021CMaTe 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproductiiin or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aiaorg.
Document G7O3TM -1992
Continuation Sheet
AEA Document G702TM� Applicatio a Certification for Payment, APPLICATION NO 13
containing Contractors signed certification is attached. APPLICATION DATE: 11/10/2009
In tabulations below, amounts are stated to the nearest dollar.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO 11/30/2009
ARCHITECT'S PROJECT NO 2695
A B C D E F G I-I
WORK COMPLETED TOTAL
MATERIALS BALANCE
SCHEDULED FROM PREVIOUS COMPLETED
PRESENTLY TO RETAINAGE
ITEM DESCRIPTION OF WORK AND STORED
NO. VALUE APPLICATION THIS PERIOD STORED TO DATE (G C) FINISH (If variable rate)
(D +E) (Not inDorE)
(D+E+F) (C G)
1 BOND 14,500.00 14,500.00 0.00 0.00 14,500.00 100.00 0.00 1,450.00.
2 SUBMITTALS 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00 0.00 2,400.00
3 MOCK UP 1,000.00 1,000.00 0 -00 0.00 1,000.00 100:00 0.00 100.00
4 MOBILIZATION 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00 0.00 1,000.00
5 CLEAN UP 20,000.00 19,000.00 0.00 0.00 19,000.00 95.01 1,000.00 1,900.00
6 SAFETY 20,000.00 19,000.00 0.00 z
0.00 19,000.0C 95.01 1,000.0C 1,900.00
7 ORIENTATION 3,000.00 3,000.00 0.00 0.00 3,000 .0C 100.00 0.0C 300.00
8 REBAR MATERIAL 59,000.00 0.00 0.00 59,000 00 59,000.00 100.00 0.00 5,900.00
9 REBAR LABOR 40,000.00 38,000.00 1,200.00 0.00 39,200.00 98.01 800.00 3,920.00
10 GROUT MATERIAL 105,000.00 99,750.00 3,150.00 0.00 102,900.00 98.00 2,100.00 10,290.00
11 GROUT LABOR 200,000.00 190,000.00 6,000.00 0.00 196,000.00 98.01 4,000.0C 19,600.00
12 JOINT REINFORCEMENT 23,000.00 0.00 0.00 23,000.00 23,000.0C 100.01 0.00 2,300.00
13 WELD ON ANCHORS MATERIAL 14,000.00 0.00 0.00 14,000.00 14,000.00 100.00 0.00 1,400.00
14 WELD ON ANCHORS LABOR 19,000.00 18,050.00 570.00 0.00 18,620.00 98.01 380.00 1,862.00
15 NORTH SIDE 0.00 0.00 0.00 0.00 0.00 0.0i 0.00 0.00
16 CMU MATERIAL 40,000.00 40,000.00 0.00 0.00 40,000.00 100.0! 0.0C 4,000.00
17 CMU LABOR 130,000.00 130,000.00 0.00 0.00 130,000.00 100.0o 0.00 13,000.00
18 EAST SIDE 0.00 0.00 0.00 0.00 0 -00 0 €01 0.00 0.00
19 CMU MATERIAL 45,000.00 45,000.00 0.00 0.00 45,000.00 100.00 0.00 4,500.00
20 CMU LABOR 137,625.00 137,625.00 0.00 0.00 137 625.00 100.00 0.0C 13,762.50
21 SOUTH SIDE 0.00 0.00 0.00 0 00 0.00 0.00 0.0C 0.00
GRAND TOTAL
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM -1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S- Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
tt 4i� G7O3TM ate Document G703 -1992
Continuation Sheet
AIA Document G702TTM Payment, APPLICATION NO:
G7O2TM, Application and Certifi for Pa ment, 13
containing Contractors signed certification is attached. APPLICATION DATE: 11!10/2009
In tabulations below, amounts are stated to the nearest dollar.
Use Column I on Co tracts where variable retainage for line items may apply. PERIOD TO 11/30/2009
ARCHITECT'S PROJECT NO 2695
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS BALANCE
COMPLETED
SCHEDULED FROM PREVIOUS PRESENTLY TO RETAINAGE
ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED AND STORED (G +C) FIN]SH (If rate)
NO. (D E) (Not inDorE) (D TO DATE -G)
22 CMU MATERIAL 50,000.00 40,000.00 2,500.00 0.00 42,500.00 85.00 7,500.01 4,250.00
23 CMU LABOR 145,250.00 108,937.50 14,525.00 0.00 123,462.50 85.00 21,787.51 12,346.25
24 WEST SIDE 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00
25 CMU MATERIAL 45,000.00 45,000.00 0.00 0.00 45,000.00 100.00 0.01 4,500.00
26 CMU LABOR 130,625.00 130,625.00 0.00 0.00 130 625.00 100.00 0.01 13,062.50
27 MORTAR SAND 25,000.00 23,750.00 750.00 0.00 24,500.00 98.00 500.01 2,450.00
28 ACCESSORIES 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00 0.01 1,000.00
29 UPPER DRUM 0.00 0.00 0.00 0.00 0.00 0.00 0.01 0.00
30 CMU MATERIAL 15,000.00 15,000.00 0.00 0.00 15,000.00 100.00 0.01 1,500.00
31 CMU LABOR 90,000.00 90,000.00 0.00 0.00 90,000.00 100.00 0.01 9,000.00
32 GROUT MATERIAL 11,500.00 11,500.00 0.00 0.00 11,500.00 100.00 0.01 1,150.00
33 GROUT LABOR 20,000.00 20,000.00 0.00 0.00 20,000.00 100.00 0.01 2,000.00
34 MORTAR SAND 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00 0.01 250.00
GRAND TOTAL $1,450,000.00 $1,286,237.50 $28,695.00 $96,000.00 $1,410,932.5C 97.31 $39,067.51/ $141,093.25
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970., 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduct or d of th AIeDocument, or any portion of it, may result in severe civil and criminal penalties and will be prosecuted to the maximum extent
possible under the law. F.3urchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
WAIVER OF LIEN
FINAL PARTIAL X PAYMENT TO FOLLOW X
DON PURDY BEING DULY SWORN THAT HE IS PRESIDENT OF PURDY
MASONRY, INC. AND HAVING CONTRACTED WITH CITYOF .CARMEL BY AND
THROUGH IT'S REDEVELOPMENT COMMISSIONTO FURNISH CERTAIN
LABOR MATERIAL FOR THE PROJECT KNOWN AS PARCEL 7A- REGIONAL
PERFORMING ART'S CENTER LOCATED IN CARMEL, IN AND OWNED BY
CITY OF CARMEL BY AND THROUGH IT'S REDEVELOPMENT COMMISSION
DOES FURTHER STATE:
MASONRY
THE AMOUNT PAID TO DATE FROM THE OWNER IS THE SUM OF: ONE
MILLION FOUR HUNDRED SEVENTY THREE THOUSAND SIX HUNDRED
THIRTY FOUR DOLLARS AND 78/100. $1,473 634.78
THE PAYMENT WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION
FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN WHICH IS GIVEN TO
AND FOR SAID AMOUNT, EFFECTIVE UPON RECIEPT OF PAYMENT.
PURDY MASONRY, INC.
..,►a/
"P' ESI II ENT
WITNESS MY HAND AND NOTORIAL SEAL THIS 12 AY OF NOVEMBER 2009.
STEFANIE PURDY g
MY COMMISSION EXPIRES: 6/29/17
COUNTY OF RESIDENCE: HENDRICKS Stefanie Purdy
Notary Public Seal State of Indiana
Hendricks County
My Commission Expires 06129/2017
11/12/2009 03:11:05 PM Purdy Services, Inc. Page 1 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
10/14/09 To 10/20109 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10/14 10/15 10/16 10/17 10/18 10/19 10/20 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
ADAMS, MICHAEL 20T 8.00 8.00 20.760 249.12 892.68 76.45 1020
1428 W. 9TH STREET REG 7.00 8.00 8.00 8.00 31.00 20.760 643.56 892.68 68.29 18.56 WHT /M
MUNCIE, IN 47302 TOT 39.00 322.09 27.08 144.00 19975
9.37 343.75 548.93
HOD CARRIER JOURNEYMAN
CHARLESWOOD, KOREY 10T 8.00 8.00 29.850 358.20 746.25 128.25 1251
4311 W. THOMPSON ROAD REG 5.00 8.00 13.00 29.850 388.05 1,223.85 57.09 11.07 WHT /M
INDIANAPOLIS, IN 46221 TOT 21.00 138.97 24.38 20055
12.09 232.88 513.37
BRICKLAYER JOURNEYMAN
CLOUD, JAMES R 5OT 8.00 8.00 28.050 336.60 1,206.15 94.05 1253
144 TIPPECANOE DRIVE REG 7.00 8.00 8.00 8.00 31.00 28.050 869.55 1,206.15 92.27 49.46 WHT /M
NOBLESVILLE, IN 46062 TOT 39.00 396.49 32.84 19977
12.06 280.68 925.47
BRICKLAYER JOURNEYMAN
CORDRAY, THOMAS OT 8.00 8.00 26.270 315.24 1,142.75 133.58 1259
550 EAST OVERPECK ROAM REG 7.50 8.00 8.00 8.00 31.50 26.270 827.51 1,142.75 87.42 23.97 WHT /M
MOORESVILLE, IN 46158 TOT 39.50 327.29 38.85 19978
31.08 314.90 827.85
HOD CARRIER JOURNEYMAN
BOYD, PATRICK W 2OT 8.00 8.00 23.850 286.20 1,025.55 144.41 1285
P.O. BOX 504 REG 7.00 8.00 8.00 8.00 31.00 23.850 739.35 1,025.55 78.45 46.64 WHT /M
GAS CITY, IN 46933 TOT 39.00 396.49 33.23 19976
23.07 325.80 699.75
BRICKLAYER APPRENTICE LE
DYKES, JEREMY 4REG 4.00 8.00 8.00 20.00 20.760 415.20 415.20 1368
237 N. JEFFERSON TOT 20.00 415.20 31.76 16.61 WHT /M
BROWNSBURG, IN 46112 207.80 5.94 19979
5.81 60.12 355.08
HOD CARRIER JOURNEYMAN
HUGHES, EDDY 10T 8.00 8.00 26.270 315.24 1,247.83 216.32 1749
7018 MARSTELLA LANE REG 4.00 7.50 8.00 8.00 8.00 35.50 26.270 932.59 1,247.83 95.46 27.88 WHT /M
BROWNSBURG, IN 46112 TOT 43.50 368.85 42.43 19980
17.47 399.56 848.27
HOD CARRIER JOURNEYMAN
KIRBY, BRETT 5REG 8.00 8.00 8.00 24.00 28.050 673.20 673.20 19.24 2052
2510 S. WEST STREET TOT 24.00 673.20 51.50 53.11 WHT /M
YORKTOWN, IN 47396 306.96 14.72 19981
7.07 145.64 527.56
BRICKLAYER JOURNEYMAN
MANLEY, ERNEST OOT 8.00 8.00 26.870 322.44 1,155.41 209.56 2167
6557 E. CO. ROAD 151 N. REG 7.00 8.00 8.00 8.00 31.00 26.870 832.97 1,155.41 88.39 24.91 WHT /M
AVON, IN 46123 TOT 39.00 331.39 39.28 19964
16.18 378.32 777.09
BRICKLAYER APPRENTICE LE
NEFF, BRAD 1OT 8.00 8.00 29.850 358.20 1,283.55 144.89 2253
206 E. MAIN STREET REG 7.00 8.00 8.00 8.00 31.00 29.850 925.35 1,283.55 98.19 26.91 WHT /M
JAMESTOWN, IN 46147 TOT 39.00 331.39 42.01 19982
12.84 324.84 958.71
BRICKLAYER JOURNEYMAN
11112!2009 03:11:05 PM Purdy Services, Inc. Page 2 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
10/14/09 To 10/20/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10(14 10/15 10(16 10/17 10/18 10/19 10/20 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
RAMSEY, JEFF OT 7.00 7.00 17.910 188.06 447.76 63.59 2706
5234 E. 350 N. REG 7.50 7.00 14.50 17.910 259.70 734.32 34.26 9.12 WHT /M
DANVILLE, IN 46122 TOT 21.50 155.01 15.23 20057
6.27 128.47 319.29
BRICKLAYER APPRENTICE LE
SPEITEL, CHARLES OT 8.00 8.00 31.350 376.20 909.15 168.00 2853
3136 EAST 116TH STREET REG 8.00 8.00 1.00 17.00 31.350 532.95 909.15 69.55 12.45 WHT /M
CARMEL, IN 46033 TOT 25.00 181.73 30.91 19983
9.09 290.00 619.15
BRICKLAYER FOREMAN
WHYDE, JASON 10T 8.00 8.00 31,850 382.20 1,512.88 188.08 3204
100 S. 16TH STREET REG 4.00 7.50 8.00 8.00 8.00 35.50 31.850 1,130.68 1,512.88 115.74 33.53 WHT /M
BEECH GROVE, IN 46107 TOT 43.50 379.50 49.80 19984
24.51 411.66 1,101.22
BRICKLAYER FOREMAN
WILSON, ANTHONY 40T 8.00 8.00 20.760 249.12 643.56 67.78 3255
11730 N. BETHESDA ROAD REG 4.00 7.00 8.00 19.00 20.760 394.44 999.88 49.23 11.85 WHT /M
MOORESVILLE, IN 46158 TOT 27.00 197.41 23.00 20058
17.51 169.37 474.19
HOD CARRIER JOURNEYMAN
DEDUCTIONS
Job Job Pay NonTax Fringe FIT State Union
Hours Tot Gross Taxable Fringe FICA Local Miscellaneous Tot Deductions Job Net
460.00 13,301.92 4,041.37 1,654.20 419.70 366.07 3,805.99 9,495.93
14,422.40 1,017.60 204.42 144.00
WEEK NUMBER: 62
DATE: 11/12/09 (4) That:
I, STEFANIE PURDY PAYROLL (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,
(Name of signatory party) (Title) FUNDS, OR PROGRAMS
do hereby state: X In addition to the basic hourly wage rates paid
to each laborer or mechanic listed in the above
(1) That I pay or supervise payment of the persons employed by referenced payroll, payments of fringe benefits
Purdy Services, Inc. on the CARMEL REGIONAL PERF. ARTS as listed in the contract have been or will be
made to appropriate programs for the benefit of
that during the payroll period commencing on the 14 th day of such employees, except as noted in Section 4(c)
October 2009 and ending the 20th day of October 2009 below.
all persons employed on said project have been paid the full
weekly wages earned, that no rebates have been or will be made
either directly or indirectly. On behalf of said
Purdy Services, Inc. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
from the full weekly wages earned Each laborer or mechanic listed in the above
by any person and that no deductions have been made either referenced payroll has been paid, as indicated
directly or indirectly from the full wages earned by any .person, on the payroll, an amount not less than the sum
other than permissible deductions as defined in Regulations, of the applicable basic hourly wage rate plus
Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor the amount of the required fringe benefits as
under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, listed in the contract, except as noted in
72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Section 4 (c) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
(2) That any payrolls otherwise under this contract required
to be submitted for the above period are correct and complete;
that the wage rates for laborers or mechanics contained therein REMARKS:
are not less than the applicable wage rates contained in any
wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic
conform with the work he performed.
(3) That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with
a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor,
or if no such recognized agency exists in a State, are registered
with the Bureau of Apprenticeship and Training, United States
Department of Labor.
STEFANIE PURDY
PAYROLL
wa Signature: �Oi
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS
MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL
OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND
SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.
11/12/2009 03:11:17 PM Purdy Services, Inc. Page 1 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
10/21/09 To 10/27/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10/21 10/22 10/23 10/24 10/25 10/26 10/27 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
ADAMS, MICHAEL 2REG 8.00 8.00 8.00 5.50 29.50 20.760 612.42 612.42 34.41 1020
1428 W. 9TH STREET TOT 29.50 612.42 46.85 24.50 WHT /M
MUNCIE, IN 47302 306.51 17.55 144.00 20091
6.43 273.74 338.68
HOD CARRIER JOURNEYMAN
CHARLES WOOD, KOREY 1 REG 8.00 8.00 6.00 22.00 29.850 656.70 656.70 90.35 1251
4311 W. THOMPSON ROAD TOT 22.00 850.73 50.24 26.48 WHT /M
INDIANAPOLIS, IN 46221 235.18 21.07 20092
10.64 198.78 457.92
BRICKLAYER JOURNEYMAN
CLOUD, JAMES R 5REG 8.00 8.00 28.050 224.40 224.40 12.94 1253
144 TIPPECANOE DRIVE TOT 8.00 940.80 17.17 11.11 WHT /M
NOBLESVILLE, IN 46062 102.32 5.68 20127
2.24 49.14 175.26
BRICKLAYER JOURNEYMAN
CORDRAY, THOMAS REG 8.00 8.00 8.00 24.00 26.270 630.48 630.48 56.74 1259
550 EAST OVERPECK ROM TOT 24.00 630.48 48.23 25.22 WHT /M
MOORESVILLE, IN 46158 249.36 21.44 20093
17.15 168.78 461.70
HOD CARRIER JOURNEYMAN
BOYD, PATRICK W 2REG 8.00 8.00 16.00 23.850 381.60 381.60 41.14 1285
P.O. BOX 504 TOT 16.00 787.52 29.19 24.47 WHT /M
GAS CITY, IN 46933 204.64 12.18 20125
8.59 115.57 266.03
BRICKLAYER APPRENTICE LE
DYKES, JEREMY 4REG 8.00 8.00 8.00 5.00 29.00 20.760 602.04 602.04 18.67 1368
237 N. JEFFERSON TOT 29.00 602.04 46.06 24.08 WHT /M
BROWNSBURG, IN 46112 301.31 12.30 20094
8.43 109.54 492.50
HOD CARRIER JOURNEYMAN
HUGHES, EDDY 1REG 8.00 8.00 26.270 210.16 210.16 25.55 1749
7018 MARSTELLA LANE TOT 8.00 744.64 16.08 8.41 WHT /M
BROWNSBURG, IN 46112 83.12 7.15 20137
2.94 60.13 150.03
HOD CARRIER JOURNEYMAN
KIRBY, BRETT 5REG 8.00 8.00 8.00 8.00 32.00 28.050 897.60 897.60 47.77 2052
2510 S. WEST STREET TOT 32.00 897.60 68.67 70.81 WHTIM
YORKTOWN, IN 47396 409.28 22.35 20095
9.42 219.02 678.58
BRICKLAYER JOURNEYMAN
MANLEY, ERNEST 0 REG 8.00 8.00 26.870 214.96 214.96 27.31 2167
6557 E. CO. ROAD 151 N. TOT 8.00 644.88 16.44 8.92 WHT /M
AVON, IN 46123 85.52 7.31 20142
3.01 62.99 151.97
BRICKLAYER APPRENTICE LE
NEFF, BRAD 1 REG 8.00 8.00 8.00 8.00 32.00 28.050 897.60 897.60 87.00 2253
206 E. MAIN STREET TOT 32.00 897.60 68.67 36.80 WHT /M
JAMESTOWN, IN 46147 342.08 28.88 20096
8.98 230.33 667.27
BRICKLAYER JOURNEYMAN
11/12/2009 03:11:17 PM Purdy Services, Inc. Page 2 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
10/21/09 To 10127/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10/21 10122 10/23 10/24 10(25 10/26 10/27 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
RAMSEY, JEFF REG 8.00 8.00 16.00 17.910 286.56 286.56 36.11 2706
5234 E. 350 N. TOT 16.00 617.90 21.92 13.53 WHT /M
DANVILLE, IN 46122 171.04 9.74 20097
4.01 85.31 201.25
BRICKLAYER APPRENTICE LE
SPEITEL, CHARLES REG 2.00 3.50 5.50 31.350 172.43 172.43 27.97 2853
3136 EAST 116TH STREET TOT 5.50 423.23 13.19 6.87 WHT /M
CARMEL, IN 46033 58.80 5.86 20098
1.72 55.61 116.82
BRICKLAYER FOREMAN
WHYDE, JASON 1 REG 8.00 8.00 8.00 7.00 31.00 31.850 987.35 987.35 100.46 3204
100 S. 16TH STREET TOT 31.00 987.35 75.53 39.18 WHT /M
BEECH GROVE, IN 46107 331.39 31.94 20099
16.00 263.11 724.24
BRICKLAYER FOREMAN
WILSON, ANTHONY 4REG 8.00 8.00 8.00 24.00 20.760 498.24 498.24 32.85 3255
11730 N. BETHESDA ROAD TOT 24.00 643.00 38.12 19.93 WHT /M
MOORESVILLE, IN 46158 249.36 18.28 20100
13.55 122.73 375.51
HOD CARRIER JOURNEYMAN
DEDUCTIONS
Job Job Pay NonTax Fringe FIT State Union
Hours Tot Gross Taxable Fringe FICA Local Miscellaneous Tot Deductions Job Net
285.00 7,272.54 3,129.91 639.27 221.73 340.31 2,014.78 5,257.76
10,280.19 556.36 113.11 144.00
WEEK NUMBER: 63
DATE: 11/12/09 (4) That:
I, STEFANIE PURDY PAYROLL
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,
(Name of signatory party) (Title) FUNDS, OR PROGRAMS
do hereby state: X In addition to the basic hourly wage rates paid
to each laborer or mechanic listed in the above
(1) That I pay or supervise payment of the persons employed by referenced payroll, payments of fringe benefits
Purdy Services, Inc. on the CARMEL REGIONAL PERF. ARTS as listed in the contract have been or will be
made to appropriate programs for the benefit of
that during the payroll period commencing on the 21 st day of such employees, except as noted in Section 4(c)
October 2009 and ending the 27th day of October 2009 below.
all persons employed on said project have been paid the full
weekly wages earned, that no rebates have been or will be made
either directly or indirectly. On behalf of said
Purdy Services, Inc. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
from the full weekly wages earned Each laborer or mechanic listed in the above
by any person and that no deductions have been made either referenced payroll has been paid, as indicated
directly or indirectly from the full wages earned by any person, on the payroll, an amount not less than the sum
other than permissible deductions as defined in Regulations, of the applicable basic hourly wage rate plus
Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor the amount of the required fringe benefits as
under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, listed in the contract, except as noted in
72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Section 4 (c) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
(2) That any payrolls otherwise under this contract required
to be submitted for the above period are correct and complete;
that the wage rates for laborers or mechanics contained therein REMARKS:
are not less than the applicable wage rates contained in any
wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic
conform with the work he performed.
(3) That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with
a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor,
or if no such recognized agency exists in a State, are registered
with the Bureau of Apprenticeship and Training, United States
Department of Labor.
STEFANIE PURDY
PAYROLL
Signature: .1 .0 .ALA
IIP
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS
MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL
OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND
SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.
11/12/2009 03:12:00 PM Purdy Services, inc. Page 1 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERE. ARTS
10/28/09 To 11/03/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10/28 10/29 10/30 10/31 11/01 11/02 11/03 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
ADAMS, MICHAEL 2REG 8.00 8.00 7.00 6.50 8.00 37.50 20.760 778.50 778.50 59.32 1020
1428 W. 9TH STREET TOT 37.50 778.50 59.56 31.14 WHT /M
MUNCIE, IN 47302 389.63 23.20 144.00 20179
8.17 325.39 453.11
HOD CARRIER JOURNEYMAN
CHARLESWOOD, KOREY 1REG 8.00 8.00 7.00 8.00 8.00 39.00 29.850 1,164.15 1,164.15 195.40 1251
4311 W. THOMPSON ROAD TOT 39.00 1,164.15 89.06 46.95 WHT /M
INDIANAPOLIS, IN 46221 416.91 37.95 20180
18.86 388.22 775.93
BRICKLAYER JOURNEYMAN
CORDRAY, THOMAS REG 8.00 8.00 7.00 8.00 8.00 39.00 26.270 1,024.53 1,024.53 115.84 1259
550 EAST OVERPECK ROM TOT 39.00 1,024.53 78.38 40.98 WHT /M
MOORESVILLE, IN 46158 405.21 34.83 20181
27.87 297.90 726.63
HOD CARRIER JOURNEYMAN
KIRBY, BRETT 5REG 8.00 8.00 7.00 8.00 8.00 39.00 28.050 1,093.95 1,093.95 77.22 2052
2510 S. WEST STREET TOT 39.00 1,093.95 83.69 86.30 WHT /M
YORKTOWN, IN 47396 498.81 29.02 20182
11.49 287.72 806.23
BRICKLAYER JOURNEYMAN
NEFF, BRAD 1 REG 8.00 8.00 7.00 8.00 8.00 39.00 29.850 1,164.15 1,164.15 126.98 2253
206 E. MAIN STREET TOT 39.00 1,164.15 89.06 46.95 WHT /M
JAMESTOWN, IN 46147 416.91 37.95 20183
11.64 312.58 851.57
BRICKLAYER JOURNEYMAN
RAMSEY, JEFF REG 8.00 8.00 7.00 8.00 31.00 17.910 555.21 555.21 68.45 2706
5234 E. 350 N. TOT 31.00 555.21 42.47 26.22 WHT /M
DANVILLE, IN 46122 331.39 18.88 20184
7.77 163.79 391.42
BRICKLAYER APPRENTICE LE
SPEITEL, CHARLES REG 8.00 7.00 8.00 8.00 31.00 31.350 971.85 971.85 183.67 2853
3136 EAST 116TH STREET TOT 31.00 971.85 74.35 38.72 WHT /M
CARMEL, IN 46033 331.39 33.04 20185
9.72 339.50 632.35
BRICKLAYER FOREMAN
WHYDE, JASON 1REG 8.00 8.00 6.00 8.00 8.00 38.00 31.850 1,210.30 1,210.30 133.90 3204
100 S. 16TH STREET TOT 38.00 1,210.30 92.59 48.03 WHT /M
BEECH GROVE, IN 46107 406.22 39.52 20186
19.61 333.65 876.65
BRICKLAYER FOREMAN
11/12/2009 03:12:00 PM Purdy Services, Inc. Page 2 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
10/28/09 To 11/03/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union MinlGndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 10/28 10/29 10/30 10/31 11/01 11/02 11103 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
WILSON, ANTHONY 4REG 8.00 8.00 7.00 8.00 8.00 39.00 20.760 809.64 809.64 67.39 3255
11730 N. BETHESDA ROAD TOT 39.00 809.64 61.94 32.39 WHT /M
MOORESVILLE, IN 46158 405.21 29.26 20187
22.02 213.00 596.64
HOD CARRIER JOURNEYMAN
DEDUCTIONS
Job Job Pay NonTax Fringe FIT State Union
Hours Tot Gross Taxable Fringe FICA Local Miscellaneous Tot Deductions Job Net
332.50 8,772.28 3,601.68 1,028.17 283.65 397.68 2,661,75 6,110.53
8,772.28 671.10 137.15 144.00
WEEK NUMBER: 64
DATE: 11/12109 (4) That:
I, STEFANIE PURDY PAYROLL
signatory {Title) (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,
Name of g Hato ry p art y} FUNDS, OR PROGRAMS
do hereby state: X In addition to the basic hourly we rates paid
to each laborer or mechanic listed in the above
(1.) That I pay or supervise payment of the persons employed by referenced payroll, payments of fringe benefits
Purdy Services, Inc. on the CARMEL REGIONAL PERF. ARTS as listed in the contract have been or will be
made to appropriate programs for the benefit of
that during the payroll period commencing on the 28 th day of such employees, except as noted in Section 4(c)
October 2009 and ending the 3 rd day of November 2009 below.
all persons employed on said project have been paid the full
weekly wages earned, that no rebates have been or will be made
either directly or indirectly. On behalf of said
Purdy Services, Inc. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
from the full weekly wages earned Each laborer or mechanic listed in the above
by any person and that no deductions have been made either referenced payroll has been paid, as indicated
directly or indirectly from the full wages earned by any person, on the payroll, an amount not less than the sum
other than permissible deductions as defined in Regulations, of the applicable basic hourly wage rate plus
Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor the amount of the required fringe benefits as
under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, listed in the contract, except as noted in
72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Section 4 (c) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
(2) That any payrolls otherwise under this contract required
to be submitted for the above period are correct and complete;
that the wage rates for laborers or mechanics contained therein REMARKS:
are not less than the applicable wage rates contained in any
wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic
conform with the work he performed.
(3) That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with
a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor,
or if no such recognized agency exists in a State, are registered
with the Bureau of Apprenticeship and Training, United States
Department of Labor.
STEFANIE PURDY
PAYROLL
Signature: �I 1 .1111'
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STA EMENTS
MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL
OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND
SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.
11/12/2009 03:12:11 PM Purdy Services, Inc. Page 1 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
11/04/09 To 11/10/09 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 11/04 11105 11/06 11107 11/08 11109 11/10 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
ADAMS, MICHAEL 2REG 8.00 5.50 8.00 8.00 8.00 37.50 20.760 778.50 778.50 59.32 1020
1428 W. 9TH STREET TOT 37.50 778.50 59.56 31.14 WHT /M
MUNCIE, IN 47302 389.63 23.20 144.00 20287
8.17 325.39 453.11
HOD CARRIER JOURNEYMAN
CHARLESWOOD, KOREY 1REG 8.00 5.50 8.00 21.50 29.850 641.78 641.78 105.61 1251
4311 W. THOMPSON ROAD TOT 21.50 1,119.38 49.09 25.89 WHT /M
INDIANAPOLIS, IN 46221 229.84 20.88 20332
10.39 211.86 429.92
BRICKLAYER JOURNEYMAN
CORDRAY, THOMAS REG 8.00 5.50 8.00 8.00 8.00 37.50 26.270 985.13 985.13 109.93 1259
550 EAST OVERPECK ROM TOT 37.50 985.13 75.36 39.41 WHT /M
MOORESVILLE, IN 46158 389.63 33.49 20298
26.80 284.99 700.14
HOD CARRIER JOURNEYMAN
ENGLAND, DARREL REG 3.00 3.00 22.270 66.81 66.81 8.73 1460
2055 MODESTO CT. TOT 3.00 924.21 5.11 2.58 WHT /M
GREENFIELD, IN 46140 31.35 2.27 20299
0.80 19.49 47.32
HOD CARRIER JOURNEYMAN
KIRBY, BRETT 5REG 8.00 5.50 8.00 8.00 29.50 28.050 827.48 827.48 37.25 2052
2510 S. WEST STREET TOT 29.50 827.48 63.30 65.28 WHTIM
YORKTOWN, IN 47396 377.32 19.96 20300
8.69 194.48 633.00
BRICKLAYER JOURNEYMAN
NEFF, BRAD 1REG 8.00 5.50 8.00 21.50 29.850 641.78 641.78 48.62 2253
206 E. MAIN STREET TOT 21.50 641.78 49.10 25.88 WHT/M
JAMESTOWN, IN 46147 229.84 20.19 20301
6.42 150.21 491.57
BRICKLAYER JOURNEYMAN
RAMSEY, JEFF REG 7.50 8.00 8.00 23.50 17.910 420.89 420.89 52.07 2706
5234 E. 350 N. TOT 23.50 564.17 32.20 19.87 WHT/M
DANVILLE, IN 46122 251.22 14.31 20302
5.89 124.34 296.55
BRICKLAYER APPRENTICE LE
SPEITEL, CHARLES REG 8.00 6.00 8.00 8.00 30.00 31.350 940.50 940.50 175.84 2853
3136 EAST 116TH STREET TOT 30.00 940.50 71.95 37.47 WHT /M
CARMEL, IN 46033 320.70 31.98 20303
9.41 326.65 613.85
BRICKLAYER FOREMAN
WHYDE, JASON 1REG 8.00 8.00 8.00 7.50 8.00 39.50 31.850 1,258.08 1,258.08 141.07 3204
100 S. 16TH STREET TOT 39.50 1,258.08 96.24 49.92 WHT /M
BEECH GROVE, IN 46107 422.26 41.14 20304
20.38 348.75 909.33
BRICKLAYER FOREMAN
1 03:12:11 PM Purdy Services, Inc. Page 2 of 2
20- 8068915
Payroll Certification Report
1255 CARMEL REGIONAL PERF. ARTS
11/04/09 To 11!10109 DEDUCTIONS
Name Exmp Job Pay FIT Emp No
Address HOURS WORKED Tot Pay FICA Union Min /Gndr
SS.No EARN WED THU FRI SAT SUN MON TUE WEEK PAY JOB Nontax Frg ST TAX Misc. Check
Trade Desc CODE 11/04 11/05 11/06 11/07 11/08 11!09 11 /10 TOTAL RATE WAGES Tax Frg LOC TAX Total Job Net
WILSON, ANTHONY 4REG 8.00 5.50 8.00 21.50 20.760 446.34 446.34 36.89 3255
11730 N. BETHESDA ROAD TOT 21.50 802.66 34.14 17.85 WHT /M
MOORESVILLE, IN 46158 223.39 16.14 20362
12.14 117.16 329.18
HOD CARRIER JOURNEYMAN
DEDUCTIONS
Job Job Pay NonTax Fringe FIT State Union
Hours Tot Gross Taxable Fringe FICA Local Miscellaneous Tot Deductions Job Net
265.00 7,007.29 2,865.18 775.33 223.56 315.29 2,103.32 4,903.97
8,841.89 536.05 109.09 144.00
WEEK NUMBER: 65
DATE: 11/12/09 (4) That:
I, STEFANIE PURDY PAYROLL
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,
(Name of signatory party) (Title) FUNDS, OR PROGRAMS
do hereby state: X In addition to the basic hourly wage rates paid
to each laborer or mechanic listed in the above
That I pay or supervise payment of the persons employed by referenced payroll, payments of fringe benefits
Purdy Services, Inc. on the CARMEL REGIONAL PERF. ARTS as listed in the contract have been or will be
made to appropriate programs for the benefit of
that during the payroll period commencing on the 4 th day of such employees, except as noted in Section 4(c)
November 2009 and ending the 10th day of November 2009 below.
all persons employed on said project have been paid the full
weekly wages earned, that no rebates have been or will be made
either directly or indirectly. On behalf of said
Purdy Services, Inc. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
from the full weekly wages earned Each laborer or mechanic listed in the above
by any person and that no deductions have been made either referenced payroll has been paid, as indicated
directly or indirectly from the full wages earned by any person, on the payroll, an amount not less than the sum
other than permissible deductions as defined in Regulations, of the applicable basic hourly wage rate plus
Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor the amount of the required fringe benefits as
under the Copeland Act, as amended (48 Stat. 948, 63 Stat. 108, listed in the contract, except as noted in
72 Stat. 967, 76 Stat. 357, 40 U.S.C. 276c), and described below: Section 4 (c) below.
(c) EXCEPTIONS
EXCEPTION (CRAFT) EXPLANATION
(2) That any payrolls otherwise under this contract required
to be submitted for the above period are correct and complete;
that the wage rates for laborers or mechanics contained therein REMARKS:
are not less than the applicable wage rates contained in any
wage determination incorporated into the contract that the
classifications set forth therein for each laborer or mechanic
conform with the work he performed.
(3) That any apprentices employed in the above period are duly
registered in a bona fide apprenticeship program registered with
a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor,
or if no such recognized agency exists in a State, are registered
with the Bureau of Apprenticeship and Training, United States
Department of Labor.
STEFANIE PURDY
PAYROLL
A
Signature: J.&
THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE S T MENTS
MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL
OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND
SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE.
Prescribed'oy 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.
��JJ
Payee
r /q C Purchase Order No.
7C o` r y� r4 �S Terms
/4./ 7 Date Due
Invoice Invoice Description Amount
-Date Number (or note attached invoice(s) or bill(s))
//73c/o) /41 /3 a r 7 C 24;6 l s:da
Total 25o
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accgrdance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
/r o`'� IN SUM OF
76W .Cu.7,, l ac /i3 q., -7
rayfc �GC2
2
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or I NVOICE NO. ACC AMOUNT hereby certify invoice( s), DEPT I hereb certif that the attached invoices or
qvz /3 5'4oY0 7 2 d s0J 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
20/6)
_MN
11 11■ Ski ature
Director of s.erations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund