Loading...
HomeMy WebLinkAbout196475 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 364522 Page 1 of 1 0 ONE CIVIC SQUARE AUBREY S AND JANIE D NARAINE CARMEL, INDIANA 46032 12727 DEVON LANE CHECK AMOUNT: $1,060.00 CARMEL IN 46032 CHECK NUMBER: 196475 CHECK DATE: 4/13/2011 DEPARTMENT ACCOUNT PO NUMBE INVOICE NUMBER AMOUNT DESCRIPTIO 2200 4460500 1,060.00 RIGHTS -OF -WAYS s i^f Ci Y.-34 C 4 t CIT 04ZMEL JAMES BRAINARD, MAYQR UNIFORM EASEMENT ACQUISITION OFFER DATE: December 13, 2010 Aubrey S. Naraine PROJECT: Guilford Road Improvements Janie D. Naraine City Center Drive to Main Street 12727 Devon Lane PARCEL: 6A Carmel, IN 46032 TEMPORARY EASEMENT: 0.014 ACRE The CITY OF CARMEL, INDIANA is authorized by Indiana law to obtain an easement across your property for certain public purposes. The City of Carmel needs an easement across your property for a public improvement entitled Guilford Road Improvements —City Center Drive to Main Street and needs to take the easement as described on the attached legal description. See Exhibit A .It is our opinion that the fair market value of the easement we want to acquire from you is $1,060.00 and, therefore, we offer you $1,060.00 for the above described easement. You have thirty (30) days from this date to accept or reject this offer. If you accept this offer, you may expect payment in full within ninety (90) days after signing the documents accepting this offer and executing the appropriate instruments, and provided there are no difficulties in clearing liens or other problems with title to land. Possession will be required thirty (30) days after you have received your payment in full. DEPARTMENT OF ENGINEERING ONE CIVIC SQUARE, CAP -MEL, IN 46032 OFFICE 31.7.371.2441 FAZ 317.5712439 EMAIL engineering@carmel.in.gov Cross Reference to Prior Deed of Record: Warranty Deed, Instrument Number 943942, in the Office of the Recorder of Hamilton County, Indiana TEMPORARY EASEMENT AGREEMENT This Temporary Easement Agreement (this "Agreement") is made and entered into this day of `:_g 2011 by and between Aubrey S. Naraine and Janie D. Naraine. husband and Wife, ("Grantors and the City of Carmel, Indiana "Grantee RECITALS A. Grantors own certain real property (the ``Grantors' Parcel located in Hamilton County, Indiana, more particularly described as follows: See Exhibit 1 attached hereto and incorporated herein. B. Grantee, in corinection with Grantee's public improvement project entitled Guilford Road Improvements City Center Drive to Main Street (the "Project requires a temporary easement for the duration of the Project for purposes of constructing that portion of the Project located upon and /or adjacent to the Grantors' Parcel. Such temporary easement area (herein referred to as the "Temporary Easement Parcel is more particularly described as follows: See Exhibit A which is attached hereto and incorporated herein. NOW, TH REFORE, in consideration of the foregoing recitals, all of which are incorporated herein by this reference, and of the grant of easement and the mutual promises and covenants set forth herein, the parties hereto agree as follows: 1. Temporary Rights Acquired by Grantee During the term of the Project, Grantors hereby grant and convey to Grantee the exclusive right to utilize the Temporary Easement Parcel for all purposes related to the construction of the Project, including, but not limited to, the storing of equipment and the staging of the construction of the Project. Upon the earlier of the date of Final completion of the Project or three (3) years from the date hereof, such temporary easement shall terminate and Grantee shall return the Temporary Easement Parcel to Grantors in substantially the same condition as existed prior to the commencement of the Project, except as reasonably modified by the Project. 2. Rights Retained by Grantors Grantors shall retain ruIto themselves, and their grantees, heirs, successors and assigns, and all others to whom Grantors may grant rights or easements, the right to use the Temporary Easement Parcel for any and all purposes and uses not inconsistent with the foregoing easement acquisition by Grantee, including without limitation the right to install, use, maintain, repair and replace existing driveways and curbing not removed by Grantee as part of the Project, as well as the right of access over and across the Temporary Easement Parcel to and from public streets adjacent to the Temporary Easement Parcel via Grantors' existing driveway. 8323G5v1 1 Easement and Covenants Appurtenant The easement granted, created and made herein, together with all the benefits thereof, shall rum with the Grantors' Parcel and inure to the benefit of Grantee and its grantees, successors and assigns. The easement granted, created and made herein, together with the burdens thereof, shall rum with and bind the Grantors' Parcel, and shall bind Grantors and their grantees, successors and assigns. All covenants and agreements of the Grantors and Grantee hereunder. together with the benefits and burdens thereof. shall be deemed to be real covenants which touch and concern the Grantors' Parcel and the Temporary Easement Parcel, as applicable, shall run with the Grantors' Parcel and the Temporary Easement Parcel, and shall inure to the benefit of and be binding upon Grantors and Grantee, as applicable, and their respective grantees, successors and assigns. 4. Governin,- Law This Agreement shall be governed by and construed in accordance with the laws of the State of Indiana, except for its conflict of laws provisions. IN WITNESS WHEREOF, Grantors and Grantee have executed this Agreement as of the date first written above. GRANT R GRANTEE By: ub► S. Naraine Printed: Title: Janie D. Naraine STATE OF SS: COUNTY OF C- C' k'' Before tne, a Notary Public in and for said County and State, personally appeared Aubrey S. Naraine, the Grantor, and who, having been duly sworn, acknowledged the truth and accuracy of the representations made herein and the execution of the foregoing Agreement. Witness my hand and Notarial Seal this day of 011. M} commission expires: Notary Public y f' I am a resident of i v t County Printed Name 'ussy ARID t leuoliEN 4 PQPU08 MM Oa uolSSaurwo� S LOZ 'EZ nary sajldx3 wwo�3 An epijolj to ams 3l►4nd AMON '3 8323651 KmHOS I S3Wdr %s ko%', STATE OF 7''': L SS: COUNTY OF Before me, a Notary Public in and for said County and State, personally appeared .lame D. Naraine, the Grantor, and who, having been duly sworn, acknowledged the truth and accuracy of the representations made herein and the execution 01-the foregoing Agreement. Witness my hand and Notarial Seal this I day of C1 '1%Q f- 201 1. My commission expires: C' NA ry Public I am a resident of County ,.;;�'r'a'•8,,, JAMf131'i'ri�EidlJtl� Notary Public State of Florida R. STATE OF INDIANA My Comm. Expires Nov 23, 2013 Commission DD 93`1648 SS: °E O Bonded Through National Notary Assn. COUNTY OF HAMILTON Before me, a Notary Public in and for said County and State, personally appeared the of the Grantee, who, having been duly sworn, acknowledged the truth and accuracy of the representations made herein and the execution of the foregoing Agreement for and on behalf of said Grantee. Witness my hand and Notarial Seal this day of 2011. My commission expires: Notary Public I am a resident of County :Printed Name This instrument was prepared by: Douglas C. Haney, Carmel City Attorney, One Civic Square, Carmel, Indiana 46032 I affirm, under the penalties for perjury that i have taken reasonable care to redact each and every Social Security number in this document, unless it is required by law. Douglas C. Haney 832365vi by State Board of Amounts ACCOUNTS PAYABLE VOUCHER City form No. 291 (Rev. 1995) CARMEL, INDIANA 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 Aubrey S. Naraine and Janie D. Naraine Purchase Order No. 12727 Devon Lane Terms Carmel. IN 46032 Date Due Invoice Invoice Description Date number or note attached invoices or bills Amount PROJECT: Guilford Road Improvements Parcel 6A TernDorary Easement: 0.014 acre X: A u b rey S. Nar ine X: v- Janie D. Naraine One Thousand Sixty and 001100 Dollars 1 060.00 hereby certify that the attached invoice(s), or 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 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. e ALLOWED 20 IN THE SUM OF ON ACCOUNT OF APPROPRIATION Board /Council Members FOR COST DISTRIBUTION LEDGER CLASSIFICATION IF CLAIM PAID MOTOR VEHICLE HIGHWAY FUND Acct. Account Title Amount No. Form III -9 Request for Taxpayer Give form to the (Rev_ October requester. Do not e Trea sury Id Number and Certification send to the IRS. neparinlent of the Treasury h1emal Revenue service Name (as shown on your income tax return) m Aubrey S. Narajne c9 Business name, if different from above a c a a c Check appropriate box: Individual/Sole proprietor Corporation Partnership Exempt Limited Limited liability company. Enter the tax classification (D--disregarded entity, Cxorporation, P= partnership) payea o Other (see instructions) F Address (number, street, and apt. or suite no.) Requester's name and address (optional) u 12727 Devon Lane 3 City, state, and ZIP code to Carmel, IN 46032 y List account numbers) here (optional) Q) Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number backup withholding. For individuals, this is your social security number (SSW However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Ert�loyer idemification number number to enter. Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service ORS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions, on page 4. Sign lsignatur of p Here I U.S. p'arson Date General Instructions Definition of a U.S. person, For federal tax purposes, you are considered a U.S. person if you are: Section references are to the Internal Revenue Code unless otherwise noted. An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number (TIN) 9 An estate (other than a foreign estate), or to report, for example, income paid to you, real estate e A domestic trust (as defined in Regulations section transactions, mortgage interest you paid, acquisition or 3D1.7701 -7), abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a contributions you made to an IRA. trade or business in the United States are generally required to Use Form W -9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W -9 requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U-S. person that is a partner in a 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a income. U.S, person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases substantially similar to this Form W -9. The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form W -9 (Rev. 10 -2007) Form w °9 Request for Taxpayer Give form to the (Rev. October 2007) Identification Number and Certification requester. Do not Depanment of the Treasury send to the IRS. Intemal Revenue Service Name (as shown on your income tax return) v Janie D, Naraine a Business name, if different from above c 0 n 2 Check appropriate box: Individual/Sole proprietor Corporation Partnership Exempt Z! r- El Limited liability company. Enter the tax classification p tY part y (D =d sregartled entity, C= corporation, P- partnership) payee 0 2 Other (see instructions) C c Address (number, street, and apt. or suite no.) Requesters name and address (optional) a 12727 Devon Lane City, state, and ZIP code to Carmel, IN 46032 y List account number(s) here (optional) N Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid sociar alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, It is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose Employe. identirication number number to enter. F M-11 Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am wafting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature of Here U.S. person 0 Date I 2- General Instructions Definition of a U.S. person. For federal tax purposes, you are Section references are to the Internal Revenue Code unless considered a U.S. person if you are: otherwise noted. An Individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or Purpose of Form organized in the United States or under the laws of the United A person who is required to file an information return with the States, IRS must obtain your correct taxpayer identification number (TIN) An estate (other than a foreign estate), or to report, for example, income paid to you, real estate o A domestic trust (as defined in Regulations section transactions, mortgage interest you paid, acquisition or 301.7701 -7). abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Special rules for partnerships. Partnerships that conduct a. Use Form W -9 only if you are a'U.S. person (including a trade or business in the United States are generally required to resident alien), to provide your correct TIN to the person pay a withholding tax on any foreign partners' share of income requesting it (the requester) and, when applicable, person from such business. Further, in certain cases where a Form W -9 has not been received, a partnership is required to presume that 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax. waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States, provide Form W -9 to the partnership to establish your U.S. 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee. If applicable, you are also certifying that as a income. U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected Income. purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership Note_ If a requester gives you a form other than Form W -9 to conducting a trade or business in the United States is in the request your TIN, you must use the requester's form if it is following cases: substantially similar to this Form W -9. The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231X Form W-9 (Rev. 10.2007) If you decide to accept this offer of $1,060.00, sign your name below and mail this form to the address indicated above. An additional copy of this offer has been provided for your file. ACCEPTANCE OF OFFER We, Aubrey S. Naraine and Janie D. Naraine, landowners of the above- described property or interest in property, hereby accept the offer of $1,060.00 made by the City of Carmel on this 5 l day of 2011. brey S. Naraine ENV Janie D. Naraine NOTARY'S CERTIFICATE STATE OF )SS: COUNTY OF t�Ul1��� Z 0C Subscribed and sworn to before me this day of 2011 My commission expires: .t za Zo County of residence: F MES T. SCHULZE Slgnat Notary Public State of Florida My Comm. Expires Nov 23. 2013 Commission DD 931648 OF "d Bonded Through National Notary Assn. Printed STATE OF FI ON ct. )SS: COUNTY OF G ,)l A r Subscribed and sworn to before me this day of 2011 My commission expires: County of residence: C'() r S ign t re 4 JAMES T SCHULZE Printed i f4 Notary Public State of Florida My Comm. Expires Nov 23. 2013 Commission DD 931648 �'EO Bonded Through National Notary Assn, �i�i��.� 1',. �r.., n,in.^ t: I s S j ey.Gt� ¢pf,NwO: .�,.rr•11 "P� .n:aY,. ^9 ^6,r .C� n.. Z 10 STATEMENT OF THE BASIS FOR JUST COMPENSATION Code NA 1. This is a written statement of, and summary of the basis for, the establishment of the amount believed to be, through a valuation process, just compensation for the purchase of this right -of -way for highway purposes. The amount set forth in Item 5 below is not less than the approved estimate of value. In accordance with Public Law 91 -646 as amended, the "Uniform Act and as codified in Indiana at IC 8- 23 -17 -1 through 8- 23- 17 -35, this value disregards any decrease or increase in fair market value of the property prior to the date of valuation caused by the public improvement for which the property is acquired other than physical deterioration within reasonable control of the owner. 2. The legal description of this acquisition is set forth in the instrument of conveyance in the following identified parcel and this acquisition is identified in the Acquiring Agency's records as: Des. 06 -17 Parcel 6 Road Guilford Rd County Hamilton Owner(s) Aubrey S. Janie D. Naraine 3. The area and type of interest being acquired: 0.014 Temporary R/W The amount in Item 5 below includes payment for the purchase of all interests in the real property and no separately held interest is being acquired separately in whole or part, except as may be explained in Item 8 below. 4. This acquisition is (Check one): a. C A total acquisition of the real property. b. A partial acquisition of the real property. 5. The Agency's Offer: Just compensation has been determined to be and the Acquiring Agency's offer for the purchase of this real property is as follows: a. Total Land, Land Improvements and Buildings $100 b. Severance Damages (i.e.: Setback, Loss in Value to the Residues, etc) c. Other Damages (itemize) Cost -To -Cure estimates: Temporary RNV $0 Total Damages $960 d. Perpetual Easement Total amount believed to be Just Compensation offered for this Acquisition is: $1,060 6. The amount in Item 5 above may include payment for the purchase of certain buildings and improvements and their ownership shall pass to the Acquiring Agency. These buildings and improvements are identified as follows: none 7. The amount in Item 5 above may include payment for the purchase of certain Land Improvements, Fixtures, Equipment, Machinery, Signs, Etc., and their ownership shall pass to the Acquiring Agency. These items are identified as follows: Landscaping /ground cover 8. Items owned by others (i.e.: lessee, tenants, etc.) included in Item 5 above are identified as follows: None 9. Remarks: none Indiana Department of Transportation Approval: Reviewer: Signature: Signature: nn ��r C. rke2 Name Printed: d'2-4-i�t Name Printed: Joseph C. Traynor, GAA/RAA Title: �GC� Company: Traynor Associates, Inc. Date: l S f �4 C� Date: October 20, 2010 Exhibit 1 part oft 5eRctHalf oftheSoethwzstQuarterofSz ,;ion25,Towa5lup38A]art6,HanBt3 t ja C1ay Tow stzip, Hu3R Caun% Indiana, mare partladariy dtsrn A as follaa 13eginr inng at the intmS= u of the Nortb line of the East Half of the 5ontht;tst ouarter of Section 25, Tafvrship 38 North, ItaaSe 3 East and the West line of Wnsorr Tetznae, it subdivWon in Hamilton County, Indiana, she Plat of wbicb is rocordeed in Platt RCOIC 10 86 M and I27, in the OMP of the P.twrdcr of Hamilton North t Half o So 88 degrees 51 mimttea 03 5twads West (assumed ixaria Section, 740.00 feet to the: Northwest corner therea., g) th== Sauth 00 dcg; tts 05 meanies 47 seconds Pest on the West line of said Half Quamr, 20b o0 feet to the Noah right -af4q 11ne of Ellison T Court as looted by the plat of said. WRwu Ten= Subdfvislaa; thence Nortb 89 degrees 54 rdautes 13 seconds Past on said north tight -of-way line, 134.74 feet to iha point of arrvatnre o£ a calve having a radius length of moo feet whf cb bears North 00 degrees I minuses 47 seconds West; thence Nbrtheasserl; as said North l i g ht- o f- w ay line aid wave 5.24 feet to a West tine ofsald Vinson thence Naith 00 degrees as minutes 47 seconds West oa said West ]lne, 208.90 feet to the Beginning Paint. 832365v1 EXHIBIT "A" Project: Guilford Road (City Center Maui Street) Sheet 1 of 1 Project No.: 06 -17 Parcel: 6A Temporary Right of Way for Driveway Construction A PART OF THE EAST HALF OF THE SOUTHWEST QUARTER, SECTION TWENTY -FIVE (25), TOWNSHIP EIGHTEEN (18) NORTH, RANGE THREE (3) EAST, HAMILTON COUNTY, INDIANA, MORE FULLY DESCRIBED AS FOLLOWS: Commencing at the Northwest corner of the East Half of said Southwest Quarter; thence South 00 degrees 06 minutes 57 seconds West along the West line of said East Half a distance of 206.00 feet; thence South 89 degrees 53 minutes 03 seconds East a distance of 40.00 feet to the PLACE OF BEGINNING; thence North 00 degrees 06 minutes 57 seconds East a distance of 40.00 feet; thence South 89 degrees 53 minutes 03 seconds East a distance of 15.00 feet; thence South 00 degrees 06 minutes 57 seconds West a distance of 40.00 feet; thence North 89 degrees 53 minutes 03 seconds West a distance of 15.00 feet to the PLACE OF BEGINNING. CONTAINING 0.014 ACRES (600.000 SQ. FT.) MORE OR LESS. 1, TRENT E. NEWPORT, a Registered Land Surveyor in the State of Indiana, do hereby certify that this description was prepared by me on July 21, 2010, from the original deed records ofthe property described. I further certify that to the best of my belief and knowledge this description is in accordance with Title 865, Article 1, Rule 12 of the Indiana Administrative Code. r r� Z E. NE �y TRENT E. NEWPORT INDIANA LAND SURVEYOR NO. LS 29600021 No. 29600021 STATE OF s, 41 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Aubrey S. and Janie D. Naraine Purchase Order No. 12727 Devon Lane Terms Carmel, IN 46032 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) n/a n/a ROW Acquisition (Naraine Parcel 6) $1,060.00 approved by Council Resolution CC-07-20-09-03 I emporary Lasement please send check o Lngineering Uepartment for p u 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 Aubrey S. and Janie D Naraine IN SUM OF 127 Devon La C armel, IN 46032 $1,060.00 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 Wo.00 materials or services itemized thereon for which charge is made were ordered and received except 20 i Signature C;'N_E�nc� Title Cost distribution ledger classification if claim paid motor vehicle highway fund