HomeMy WebLinkAbout188310 08/03/2010 CITY OF CARMEL, INDIANA VENDOR: 360299 Page 1 of 1
0 I ONE CIVIC SQUARE DUNCAN ROBERTSON INC CHECK AMOUNT: $27,874.24
CARMEL, INDIANA 46032 PO BOX 457
•.q,� FRANKLIN IN 46131 CHECK NUMBER: 188310
CHECK DATE: 8/3/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
206 4462300 6 4,174.99 DRAINAGE IMPROVMTS
206 R4462834 19135 6 23,699.25 RANGELINE ROAD BRIDGE
CONSTRUCTION PROJECT INVOICE
DATE: 4127110
COMPANY NAME: Duncan Robertson Inc.
AND ADDRESS PO Box 457
Franklin, IN 46131
TELEPHONE NO.: 317- 736 -602
FAX NO.: 317- 736 -9121
PROJECT NAME: Rangeline Rd. over Little Cool Creek
PROJECT NO.: 08 -05
INVOICE NO.: 6 -FINAL r�
Construction pay items as per FINAL Pay Estimate No. 6 as shown on the attached
invoice for work completed between the dates of April 3, 2009 to April 1, 2010.
TOTAL PAY THIS ESTIMATE: $22,874.24
RELEASE OF COMPLETED RETAINAGE $5,000.00
RETAINAGE FOR INCOMPLETE ITEMS $0.00
TOTAL NOW DUE: $27,874.24
Submitted by: United Consulting
Project rkepr entative signed name Date
Christopher J Miller
Project Representative printed name
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S ICNATURE
I}^.TE Si(iidATI1RF
Interchange Corporate Center
Liberty 450 Plymouth Road, Suite 400
A a y Plymouth Meeting, PA. 19462 -1644
j� Ldl Ph. (610) 832 -8240
MAINTENANCE BOND
Bond Number: 354 -024 -300
KNOW ALL MEN BY THESE PRESENTS, that we DUNCAN ROBERTSON, INC., 785 S. STATE ST,
PO BOX 457, FRANKLIN, IN 46131
as principal (the "Principal
and Liberty Mutual Insurance Company, a Massachusetts stock insurance company, as surety (the "Surety are
held and firmly bound unto BOARD OF PUBLIC WORKS AND SAFETY FOR THE CITY OF CARMEL, IN
HAMILTON COUNTY 1 CIVIC SQUARE CARMEL IN 46032 as obligee (the "Obligee
in the penal sum of EIGHTY -ONE THOUSAND SEVEN HUNDRED FORTY -FOUR DOLLARS AND
FOURTEEN CENTS Dollars 81,744.14
for the payment of which sum well and truly to be made, the Principal and the Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has by written agreement dated AUGUST 5, 2008 entered into a contract (the
"Contract with the Obligee for RANGELINE ROAD BRIDGE REPLACEMENT
which contract is by reference made a part hereof.
NOW, THEREFORE, the condition of this obligation is such that if the Principal shall remedy without cost to the
Obligee any defect which may develop during a period of THREE year(s) from the date of completion and
acceptance of the work performed under the Contract, provided such defects are caused by defective or inferior
materials or workmanship, then this obligation shall be null and void; otherwise, it shall be and remain in full force and
effect.
PROVIDED AND SUBJECT TO THE CONDITIONS PRECEDENT:
1. Obligee shall provide both Principal and Surety with written notice of the discovery (Notice of Discovery) of
any item of defective or inferior materials or workmanship during the covered period (a "Covered Item"),
Should Principal improperly fail to remedy the Covered Item, then Obligee shall make a written demand
upon the Surety "Demand within ninety (90) days of the Obligee's issuance of the Notice of Discovery of
the Covered item.
2. The Notice of Discovery and the Demand shall be in writing and via certified mail to the Principal and to
the Surety. Notice to the Surety shall be delivered to the attention of the Surety Law Department at the above
address.
3. No suit or action may be commenced by the Obligee against the Surety after the expiration of one (1) year (or
such lesser time period as otherwise permitted by relevant law) from the date of Obligee's discovery of
a Covered item. If the provision of this paragraph is void or prohibited by law, the minimum period of
limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable.
DATED as of this 13TH day of JULY 2010
WITNESS /ATTEST DUNCAN ROBERTSON, INC.
(Principal) F
By: (6eaf 5
Name: f✓/' /G'f����1
Title: ,t5 ;1
LIBERTY MUTUAL INSURANCE COMPANY'
(Suret
By: R (Seal)d
Attorne in
David P. 0 Bryan, attorney in -fact'
LMIC -5300 Rev. 03104
2791414
THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to
the extent herein stated.
LIBERTY MUTUAL INSURANCE COMPANY
BOSTON, MASSACHUSETTS
POWER OF ATTORNEY
KNOW ALL PERSONS BY THESE PRESENTS: That Liberty Mutual Insurance Company (the "Company a Massachusetts stock insurance
company, pursuant to and by authority of the By -law and Authorization hereinafter set forth, does hereby name, constitute and appoint
DAVID P. O'BRYAN, CHRISTOPHER A :CYTERSKI, DAVID DOUGLAS;. -ALL OF THE CITY .OF LOUISVILLE, STATE
OF KENTUCKY..
each individually if there be more than one named its true and lawful attorney in. fact to make execute, seal, acknowledge and deliver, for and on its
behalf as surety and -as its act and d the penal sum not exceeding
eed, am and all undertakings, bonds, rec and other sure obliggatlons`ina
TWENTY MILLION AND 00 /1 *fifi.fir* .COLLARS::($ 20 Q0l) 00.00 )each, and the
execution of such undertakings, bonds recognizances'and other surety obligations in pursuance of these presents,: shall be as binding upon the
Company as if they had been duly signed by the president tand attested by the secretary of the Company: in their own proper persons.
That this power is made and executed pursuant to and by authority of the following By -law and Authorization
ARTICLE'XIII Execution of Contracts: Section 5. Surety Bonds and Undertakings.
Any. officer of the. Company authorized for that purpose in writing by the, chairman or the president, and subject to such limitations as.the
chairman or the president may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Company to make,
execute, seal; acknowledge. and deliver�as surety any and. all undertakings, bonds; recognizances and other surety obligations. Such 'C
attorneys =in fact, subject to the limitations set.forth.in their respective powers of attorney, shall have full.power.to bind the Company by their
0 signature and execution of anysuch instruments and to attach thereto the seal of the.Company. When so executed such instruments shall be W
CL
as binding as if signed by the president and attested by the secretary. y
By the following instrument the chairman or the president has authorized the officer or other official named therein to appoint attorneys -in -fact:
C
.93
a
C Pursuant.to Article XIII, Section 5 of the By -Laws, Garnet W. Elliott, Assistant Secretary of Liberty Mutual Insurance Company, is hereby
authorized to appoint such attorneys -in -fact as may be necessary to act in behalf of the Company to make, execute, seal, acknowledge and
aZ deliver as surety any and all undertakings, bonds, recognizances and other surety obligations.
3 That the By -law and the Authorization set forth above are true copies thereof and are now in full force and effect. a
yW
C
j IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Company and the corporate seal of G fl
Liberty.Mutual Insurance Company has been affixed thereto in Plymouth Meeting, Pennsylvania this 4th day of March
2010 Q M
C
O LIBERTY MUTUAL INSURANCE COMPANY C
G t4
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Garnet W. Elliott, Assistant Secretary s o
y COMMONWEALTH OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY 0 C
L
t! On this 4th day of March 2010 before me, a Notary Public, personally came Garnet W. Elliott to me known, and acknowledged d
G that he is an Assistant Secretary of Liberty Mutual Insurance Company; that he knows the seal of said corporation; and that he executed the above
Qi Power of Attorney and affixed the. corporate seal of Liberty Mutual Insurance Company thereto with the authority and at the direction of said corporation. M
0 to o
IN TESTIMONY WH P ve)�], unto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year ter
u first above written. Q. QNN1 N
COMMONWEAl7 tl OF PrNNSYC AU( co
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U :.Nasrrta Seal 1 .r3
,RaetW 2. Notary P.f�3 C T {2 l CO
0 OF Fy^ricwUrTivp MOmpormr; 0c By l 0 .0
Z V p Aiycarrrn s_onEzmresMaraiza,ZOt3 TEr sa P35tella, Notary Public' C1 r
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v f' bR P ruv 1, Assoc et_ of I:orafje
CERTIFICATE
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I, the undersigned, Assistan ecret of. Liberty Mutual Insurance Company do hereby certify that. the original power ".of attorney of which the foregoing
is a full, true and correct Copy, is in full. force and effect on the date of this certificate; and lido further certify that the officer or official who executed the
said power of attorney is an Assistant Secretary specially authorized by the chairman or .the president to, appoint attorneys -in -fact as provided in Article
XIII; Section 5 of the By -laws of Liberty Mutual Insurance Company.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the
following vote of the board of directors of Liberty Mutual Insurance Company at a meeting duly called and held on the 12th day of March, 1980.
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a
certified copy of any power of attorney issued by the company in connection with surety bonds, shall be valid and binding upon the company
with the same force and effect as though manually affixed.
IN T&5TrONY WHEREOF I have hereunto subscribed my name and affixed the corporate seal of the said company, this day of
U
I
l: By Z42 7, �4
Davi6 M. Carey, Ass lit Secretary
AFFIDAVIT AND WAIVED OF LIEN
Final Partial Pa }anent to Follow
State of Indiana, County of Monroe SS
Melissa Sims Pedigo Being duly sworn states that he is the President of
(Name of Officer) (Title)
Sims and Pedigo Co.. having contracted with Duiican Robertson to famish
certain materials and/or labor as follows C_on_c Bridge Rail TTX; Conc. Bridge Rail Trans Surfare Seal
(Description)
for the project known as d am 00 a' q 6omt�k
located at Rangeline Rd. in City of Carmel and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(PARTIAL WAIVER) that there is due from the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged; or
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 WAIVER) that the final balance due from the CONTRACTOR is the sure of
Dollars ($�1���•,5�'
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that ne other party has any claim or right 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. c�
Sims and Pedigo Co, Inc. �L1 7 d itle Preside
By
(fire) (Authorized Representative
WITNESS MY HAND AND NOTARIAL SEAL this 11th day of February 19 2010
•r
1
G
(Notary Public)
My Commission Expires 14 August 2013 Printed Laura E. Garwood
Residing in Morgan County
Page 28
HCHD FORM M1 10-22 -97
A FFIDAVIT AND WAIVER OF LIEN
FLORIDA Final 0 Partial Payment to Follow
State of4f�
HILLSSbROUGH S5 SENIOR CREDIT ANIALYST
Being duly sworn states that he is the of
(Name of Officer) (Title)
GERDAUAMERISTEEL having contracted D l.t�1 CAN Qrsr —kTS �y� to furnish
cont�r}a with
certain materials and/or labor as follows �T` s �5l1 'e-& C P-"6
(Description)
for the project known as q 4 Pi I
located at and owned by Hamilton County
(Owner)
and does hereby farther state on behalf of the aforementioned subcontractor /supplier:
4,PTreL y� s e TVFP1 that there is due from the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged or
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 WAIVER) that the final balance due from the CONTRACTOR is the sum of
Dollars (S I l n v
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein., if any, and further certifies that no other party has any claim or right 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.
GERDAU AMERISTEEL
A �LPU
TT ALL SEN I OR CREDIT ANIAL YST
By Title
(Firm) (Authorized Representative)
WITNESS MY HAND AND NOTARIAL SEAL this 1 day of J 0
(Notary Public)
M Y Commission Expires Printed
Residing in County
CHRIS Splli}IBY
MY COMMISSION N DD 759915
EXPIRES: June 7,2&.,--
f Bonded Thni Notary PJ*
HCHD FORM 9001 10 -22 -97
AFFIDAVIT AND WAIVER OF LIEN N ls'
Final Partial 1:1 Payment to Follow
State of Indi;{�a, County of SS l
h ttk Being duly sworn states that he is the D.���t� nr� l�Ay10. of
(Name of Officer) p l_ (Title)
R iA i� Navin contracted with V.nl' 1l,h J't r�-� h to furnish
certain materials and/or labor as follows K 1't tX R
h
(Description)
for
for the project known as d 0' q r am f�� 1
located at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(74RY1 WAIVE)?,) that there is due from the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged; or
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 WAITER) that the final balance due from the CONTRACTOR is the sum of
Dollars 1.t
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on
account of any work performed or material famished to the undersigned for said project, and within the scope of this affidavit and
waiver.
By Title dun mi na >!r
(Firm) (Authorized Representative)
WITNESS MY HAND AND NOTARIAL SEAL this day of
otary Public)
a
My Commission Expires l Printed
Residing in XV County
a 7NA
FRY DI V`!EBtTA PUB Pa e 28
SEAL g HCHDFORM900110 -22 -97 E OF IND
1. 2014 ion
r)u
AI'EIDANaT AND WAWER OF LIEN
Final 11 Partial 0 Payment to Follow
Kentucky
State of Ii4'�Pfrl3d�H4i At Large SS
Barry Barger Being duly sworn states that he is the Vice President, Sales of
(Name of Officer) (Title)
Prestress Services Industries, LLC having contracted with Duncan Robertson Inc. to famish
certain materials and/or labor as follows prestressed concrete beams
(Description}
for the project known as 0 0 q 4 1
located at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier
(PARTIAL WAIVER) that there is due from the CONTRACTOR the sum of
Dollars
receipt of which is hereby acknowledged; or
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 WAIVER) that the final balance due from the CONTRACTOR is the sum of 11I
Ninety six thousand Two hundred forty two dollars and forty six cents Dollars {1(�, 7cK -14
invoice 8252
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective upon receipt of such payment
THEREFORE, W
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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right 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.
Prestress Services Industries, LLC By Title Vice Pre Sa
(.Firm) (Authorized Re entative)
WITNESS MY HAND AND NOTARIAL SEAL this 2 day of ]anu 2010
(Notary Publi
My Commission Expires August 25, 2013 Printed M'Rae Patterson Cason 400965
Residing in Fayette County R J
a Of 4 Page 28
HCHDFOWl900i 10 -22 -97 L so
US t, s
i.
AFFIDAVIT AND WAIVER OF ]LIEN
Final Partial Payment to follow
State of I diana, C my of 0 SS'
Being duly sworn states that he is the
J� (r P a A of ff rr)
having contracted with u to furnish
certain materials and/or labor as follows l.a Cam– oyr—
(D
for the project ]clown as G Q r
0
located at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(P,4RTL4L WAI✓ER) that there is due a ozn the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged; or
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. WA -WER) that the final balance due from the CONTRACTOR is the sum of
Dollars (S
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further c ifies at no other party has any claim or right to a lien on
account of any work performed or material furnished to the undersignLresentativeve)
aid p oject and within the scope of this affidavit and
waiver.
`b' By Title
(Firm) (Aut e
WITNESS MY HAND AND NOTARIAL SEAL this day of J f}1J 19' �a
of u lie
My Commission Expires Printed
Residing in n County
HCHD FORM 9001 10-22 -97
Nt31ie:•
3177805030 HARMON STEEL 11:31:03 a.m. 01 -28 -2010 1 /1
AFFIDAVIT AND 'WAIVER OF (LIEN
Final Partial Payment to Follow
State of Indiana, County of Jennings SS
Michael Carnes Being duly sworn states that heisthe Contract Manager of
(Name of Officer) (Title)
H ar m on Stee Inc having contracted with Duncan Robertson to furnish
certain materials and/or labor as follows installation of reinforcing steel
�1
(Description)
for the project known as C, ��1�1 ►v Q' `1 1 �lV� 1
located at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(PARTIAL WAIVER) that there is due from the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged; or
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 WAIVER) that the final balance due from the CONTRACTOR is the sum of
Dollars (S MO M
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, famished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right 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.
Harmon Steel, Inc. By Title Contract Manager
(Firm) (Authorized Representative)
WITNESS MY HAND AND NOTARIAL SEAL this 28th day of J a n u'a r y t
11P V
(Notary Public)
My Commission Expires //y /aQ /5 Printed 4J (,�arrefi
Resi ding in Jennings County
Page 28
wcxrsfoanssoot io-as -s7
AFFIDAVIT AND WA18 ER OF LIEN (J (J
Final Partial Payment to Follow
S to of Indiana, County of SS
l Being duly sworn states that he is ihe_ of
r (Name of Offf)ccer) (Title)
i PVC L+'(P.vf I D�� having contracted with I to furnish
certain materials and/or labor as follows w i
(Description)
for the project known as 0 0 0 o 0 a at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(PARIL9L rYAIYER) that there is due om tl;e C01JaRnCT OR the sure of
Dollars (S
j receipt of which is hereby acknowledged; or
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 WAIVER) that the final balance due from the CONTRACTOR is the sum of
Dollars 1M.,96
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right 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_
1� f
B Title U`
(Fi m)
(Authorized Representative)
WITNESS MY HAND AND NOTARIAL SEAL this day of v^uvI 2D D
(Notary Public)
My Commission Expires 6r]'�o 3 tg,n -2 Printed V
Residing in i` County
Page 28
HCHD FORM 9001 10 -22 -97
AFFIDAVIT AND WAIVER OF !LIEN 0
Final El Partial El to Follow
State of Indiana, County of Hamilton SS
Matt Kelley Being duly sworn states that he is the Vice President of
(Name of Officer) (Title)
Shelly and Sands, Inc having contracted with Duncan Robertson to furnish
certain materials and/or labor as follows
(Description)
1
for the project known as q l r Pit
located at and owned by Hamilton County
(Owner)
and does hereby further state on behalf of the aforementioned subcontractor /supplier:
(P,�RT 4L that there is dice from the CONTRACTOR the sum of
Dollars (S
receipt of which is hereby acknowledged; or
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 WAIVER) that the final balance due from the CONTRACTOR is the sum of
Dollars (S
(�O receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for the Affidavit and Final Waiver
of Lien which shall become effective 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 material or both, furnished by the undersigned thereto,
subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on
account of any work performed or material furnished to the unders} ed for said project, and within the scope of this affidavit and
waiver.
Shelly and Sands, Inc By lit I hi Title Vice President
(Firm) Nuthodzed e epentative)
Matt Kelley
WITNESS MY HAND AND NOTARIAL SEAL this 29th day of January XXX 2010
(Notary Public
My Commission Expires 07/24/2014 Printed Brenda K Hargraves
Residing in Madison T County
Page 28
HCHD FORM 9001 10-22 -97
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
Duncan Robertson
Purchase Order No.
785 S. State Street
Terms
Franklin, IN 46131
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
04/27/10 Inv. No. 6 Rangeline Road Over Little Cool Creek $27,874.24
Final Invoice
Tota' Due. Total
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
Ili inr@n [Rnhartcnn IN SUM OF
785 S. State Street
Franklin, IN 46131
$27, 874.24
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
nv. No. b 206-F<4462834 .25 materials or services itemized thereon for
Inv. No. 6 2Ub-44b2300 99 which charge is made were ordered and
received except
Z 1D 20
i
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund