HomeMy WebLinkAbout167085 12/17/2008 CITY OF CARMEL, INDIANA VENDOR: 360193 Page 1 of 1
ONE CIVIC SQUARE HARCO ASPHALT PAVING
I€ CHECK AMOUNT: $84,804.16
CARMEL, INDIANA 46032 1650 HARCO WAY
INDIANAPOLIS IN 46217 CHECK NUMBER: 167085
CHECK DATE: 12/17/2008
L? EPARTMENT ACCO PO NUMBER INVOI NUMBER AMOUNT DESCRIPTION
203 4462200 19134 1 84,804.16 PATH PROJECT CARMEL /A
•GY
CONSTRUCTION PROJECT INVOICE
DATE: December 4, 2008
COMPANY NAME: Harco Asphalt Paving Inc.
AND ADDRESS 1650 Harco Way
Indianapolis, Indiana 46217
TELEPHONE NO.: (317)- 791 -6700
FAX NO.: (317)- 791 -7570
PROJECT NAME: Carmel Drive Adams Street
Path Project
City of Carmel
PROJECT NO.: 08 -04
PURCHASE ORDER: 19134
INVOICE NO.: 1
Construction pay items as per Progress Pay Estimate No. 1 as shown on the
attached invoice for work completed between the dates August 13, 2008 to
September 24, 2008.
TOTAL EARNINGS TO DATE: 94,226.85
RETAINAGE 9,4
22.69
MINUS PERVIOUS PAYMENTS 0.00
TOTAL NOW DUE: 84,804.16
Dan GreskamVanager
Construction
City of Cannel
a
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION
AIA DOCUMENT G702 1CMa PAGE ONE OF PAGES 2
TO OWNER: CROSSROADS ENGINEERS PROJECT: CARMEL DRIVE ADAMS ST. PATH APPLICATION NO.: 1 Distribution to:
3417 SHERMAN DRIVE PERIOD TO: 9122/2008 OWNER
BEECH GROVE, 46107 22 PROJECT NOS.: CONSTRUCTION
��o� MANAGER
FROM CONTRACTOR: Harco Asphalt Paving Inc CONTRACT DATE: ARCHITECT
1650 HARCO WAY CONTRACTOR
INDIANAPOLIS, IN 46217 VIA CONSTRUCTION MANAGER:
CONTRACT FOR ASPHALT VIA ARCHITEC
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the contractor's knowledge infor-
Application is made for payment, as shown below, in connection with the Contract. mation and belief the Work covered by this Application for Payment has been completed
Continuation Sheet, AIA Document G703, is attached. in accordance with the Contract Documents, that all amounts have been paid by the
Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 97,895.09
CONTRACTOR: Harco Asphalt Pay g Inc
2. Net change by Change Orders (3 ,668.24)
3. CONTRACT SUM TO DATE (Line 1 2) 94,226.85 By: Date: 9/26/2008
Paul G. Harding, President CE
4. TOTAL COMPLETED STORED TO DATE 94,226.85
(Column G on G703) State of: INDIANA
County of: MARION
5. RETAINAGE: Subscribed and sworn to before�,�Z ��vd
a. 10% of Completed Work 9,422.69 me this j ay of
(Columns D E on G703)
H 1
b. of Stored Material
(Column F on G703) Notary Public: eta
Total Retainage (Line 5a 5b or My Commision
Total in Column I of G703) 9, 422.69 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 84,804.11p 6
(Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
(Line 6 from prior Certificate) indicated, the quality of the Work is in accordance with the Contract Documments, and
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE 84,804.1
AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied for. Initial
(Line 3 less Line 6) 9,422.60 9 all figures on this Application and on the Continuation Sheet that are changed to
confrom to the amount certified)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTION MANAGER:
Total changes approved in By: Date:
reviuos months by Owner ARCHITECT:
Total approved this Month 94.21 3,762.45 By: Date:
TOTALS 94.21 3,762.45 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con
NET CHANGES by Change Order 1 3,668.24 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the O or Contractor under this Contract.
AIA DOCUMENT G702 /CMa APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIA 1992
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W. WASHINGTON, DC 20006 -5292 G702 /CMa -1992
S CREE OF VALUES AIACUMENT G703
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1
Contractor's signed Certification is attached. HARCO ASPHALT PAVING APPLICATION DATE: 9/26/2008
In tabulations below, amounts are stated to the nearest dollar. CARMEL DRIVE ADAMS ST. PATH PERIOD TO: 9/26/2008
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH
APPLICATION STORED AND STORED (C G)
(D E) (NOT IN TO DATE
DORE) (D +E +F)
1 MOBILIZATION DEMOBILIZATION $2,659.50 $0.00 $2,659.50 $0.00 $2,659.50 100% $0.00 $265.95
2 MAINTENANCE OF TRAFFIC $1,773.00 $0.00 $1,773.00 $0.00 $1,773.00 100% $0.00 $177.30
3 CLEARING RIGHT OF WAY $11,642.70 $0.00 $11,642.70 $0.00 $11,642.70 100% $0.00 $1,164.27
4 LINEAR GRADING FOR PATH $6,672.60 $0.00 $6,672.60 $0.00 $6,672.60 100% $0.00 $667.26
5 3" DIAMETER TREE, RELOCATE $236.40 $0.00 $236.40 $0.00 $236.40 100% $0.00 $23.64
6 STRUCT., SANITARY MANHOLE, RECONSI $2,364.00 $0.00 $2,364.00 $0.00 $2,364.00 100% $0.00 $236.40
7 HMA SURFACR FOR PATH $18,840.60 $0.00 $18,840.60 $0.00 $18,840.60 100% $0.00 $1,884.06
8 HMA INTER. FOR PATH $25,203.42 $0.00 $25,203.42 $0.00 $25,203.42 100% $0.00 $2,520.34
9 COMPACTED AGG. NO. 53, BASE $13,328.15 $0.00 $13,328.15 $0.00 $13,328.15 100% $0.00 $1,332.82
10 4" CONCRETE SIDEWALK $851.04 $0.00 $851.04 $0.00 $851.04 100% $0.00 $85.10
11 CONCRETE CURB RAMP, TYPE G $12,056.45 $0.00 $12,056.45 $0.00 $12,056.45 100% $0.00 $1,205.65
12 ITEM DELETED $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
13 EROSION CONTROL MEASURES $1,140.63 $0.00 $1,140.63 $0.00 $1,140.63 100% $0.00 $114.06
14 MULCHED SEEDING $1,126.60 $0.00 $1,126.60 $0.00 $1,126.60 100% $0.00 $112.66
15 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
16 overage on #7 .90 $94.21 $0.00 $94.21 $0.00 $94.21 100% $0.00 $9.42
17 DEDUCT #8 ($3,017.62) $0.00 ($3,017.62) $0.00 ($3,017.62) 0% $0.00 ($301.76)
18 DEDUCT #9 ($744.83) $0.00 ($744.83) $0.00 ($744.83) 0% $0.00 ($74.48)
19 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
20 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
21 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
22 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
23 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
24 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
25 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 1 $0.00
TOTAL $94,226.85 $0.00 $94,226.85 $0.00 $94,226.85 100% $0.00 1 $9,422.69
AIA DOCUMENT 0703 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA O 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORE:
AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 G703 -1992
AFFIDAVIT AND WAIVER OF LEIN
FINAL PARTIAL xx
WHEREAS, HARCO ASPHALT PAVING INC. 1650 Harco Way, Indianapolis, IN 46217
(Contractor) has been heretofore employed by CROSSROADS ENGINEERS to furnish certain material,
supplies CARMEL DRIVE ADAMS ST. PATH hereinafter collectively referred to as the "premises and
WHEREAS, the undersigned is duly authorized to execute this Waiver of Lien for and on behalf of the
Contractor.
Now, therefore, the Contractor, for EIGHTY FOUR THOUSAND EIGHT HUNDRED FOUR
DOLLARS AND Lp/100($84804.1 herby waives and releases the Owner of the Premises and the Company
from any and all liens., rights and in consideration of the receipt of lien or claims of whatsoever kind or
character on or against the Premises or the improvements located thereon on account of any and all labor,
supplies, equipment or material furnished for, in connection with or incorporated in the Premises by the
Contractor on or before the date hereof; represents and warrants that no other person or has any right to a lien or
claim on account of any labor worked performed or material, supplies or equipment furnished by, to or through
the Contractor, on or before the date hereof, and agrees to indemnify, defend and hold the Owner and The
Company harmless from and against any and all claims or lien for any labor, material or services furnished or in
connection with or incorporated on the Premises by through or to the Contractor prior to the date hereof. This
Waiver of Lien is given in order to induce the Company to pay the amount indicated above, and upon receipt of
such amount by the Contractor, this release may be recorded, becomes valid, enforceable and of full effect.
Harco Asphalt Paving Inc.
By:
Paul G. Harding, President
STATE OF Indiana) ss.
COUNTY OF Marion)
Before me, a Notary Public in and for said County and State, personally appeared Paul G. Harding, who
acknowledged the execution of the foregoing Waiver of Lien, and who, having been sworn, stated that the
representation therein contained are true.
Witness my hand and Notarial Seal this 26 day Septe er 008.
No ary Public
Cynthia L. Sartain
County of Residence: Hamilton
Commission Expires 9/20/2009
t
CONSTRUCTION PROJECT INVOICE
DATE: December 4. 2008
COMPANY NAME: Harco Asphalt Paving Inc.
AND ADDRESS 1650 Harco Way
Indianapolis, Indiana 46217
TELEPHONE NO.: (317)- 791 -6700
FAX NO.: (317)- 791 -7570
PROJECT NAME: Carmel Drive I Adams Street
Path Project
City of Carmel
PROJECT NO.: 08 -04
PURCHASE ORDER: 19134
INVOICE NO.: 2
Construction pay items as per Progress Pay Estimate No. 1 as shown on the
attached invoice for work completed between the dates August 13, 2008 to
September 24, 2008.
TOTAL EARNINGS TO DATE: 99,695.84
RETAINAGE 9,969.58
MINUS PERVIOUS PAYMENTS: 84,804.16
TOTAL NOW DUE: 4,922.10
Dan Greskamp
Construction Manager
City of Carmel
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION
AIA DOCUMENT G702 1CMa PAGE ONE OF PAGES 2
TO OWNER: CROSSROADS ENGINEERS PROJECT: CARMEL DRIVE I ADAMS ST. PATH APPLICATION NO.: 2 Distribution to:
3417 SHERMAN DRIVE PERIOD TO: 121112008 OWNER
BEECH GROVE, IN 46107 PROJECT NOS.: CONSTRUCTION
MANAGER
FROM CONTRACTOR: Harco Asphalt Paving Inc CONTRACT DATE: ARCHITECT
1650 HARCO WAY CONTRACTOR
INDIANAPOLIS, IN 46217 VIA CONSTRUCTION MANAGER: 0
CONTRACT FOR ASPHALT VIA AR C HIT ECT:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the contractor's knowledge, infor-
Application is made for payment, as shown below, in connection with the Contract. mation and belief the Work covered by this Application for Payment has been completed
Continuation Sheet, AIA Document G703, is attached. in accordance with the Contract Documents, that all amounts have been paid by the
Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 97,895.09
CONTRACTOR: HARCO ASRHXLT PAVING
2. Net change by Change Orders X893 -3� 800.7.6
3. CONTRACT SUM TO DATE (Line 1 2) �3,f�99�49 99,695. Byt�6_ Date: 12/1/2008
4. TOTAL COMPLETED 8 STORED TO DATE $9949649• 99�695.
(Column G on G703) State of: INDIANA
County of: MARION
5. RETAINAGE: Subscribed and sworn to before /J� w ten'
a. 10% of Completed Work •8.969 $4 9., 1 76 9. 5 8 me this day of ter Zo
(Columns D E on G703)
b. of Stored Material
(Column F on G703) Notary
Total Retainage (Line 5a 5b or My Com expires:
Total in Column I of G703) 4,46"4 9 96 9. 58 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 89..726 Z6
(Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
(Line 6 from prior Certificate) .6+ SQ[� I6 indicated, the quality of the Work is in accordance with the Contract Documments, and
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE 11 $,92$$9- 4 5 1, 9 9,
AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied for. Initial
(Line 3 less Line 6) 9, 9 6 9, 5 8 all figures on this Application and on the Continuation Sheet that are changed to
confrom to the amount certified)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTION MANAGER:
Total changes approved in y#: By: Date:
reviuos months by Owner '94.21- 3,762.45 ARCHITECT:
Total approved this Month 5,707.95 236.40 By: Date:
TOTALS $ee 5,302 1 5 3,998.85 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con
NET CHANGES by Change Order 4,888 -8 1 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the O wner or Contractor under this Contract.
AIA DOCUMENT 6702 /CMa APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIA 1992
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W. WASIIINGTON, DC 20006 -5292 6702 /CMa -1992
CONTINUATION SHEET AIA DOCUMENT G703 (Instruction on reverse side) PAGE 2 OF 2 PAGES
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 2
Contractor's signed Certification is attached. HARCO ASPHALT PAVING INC APPLICATION DATE: 12/1/2008
In tabulations below, amounts are stated to the nearest dollar. CARMEL DRIVE ADAMS ST. PATH PERIOD TO: 12/1/2008
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL 0% BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH
APPLICATION STORED AND STORED (C G)
(D E) (NOT IN TO DATE
DORE) (D +E +F)
1 MOBILIZATION DEMOBILIZATION $2,659.50 $2,659.50 $0.00 $0.00 $2,659.50 100% $0.00 $265.95
2 MAINTENANCE OF TRAFFIC $1,773.00 $1,773.00 $0.00 $0.00 $1,773.00 100% $0.00 $177.30
3 CLEARING RIGHT OF WAY $11,642.70 $11,642.70 $0.00 $0.00 $11,642.70 100% $0.00 $1,164.27
4 LINEAR GRADING FOR PATH $6,672.60 $6,672.60 $0.00 $0.00 $6,672.60 100% $0.00 $667.26
5 3" DIAMETER TREE, RELOCATE $236.40 $236.40 $0.00 $0.00 $236.40 100% $0.00 $23.64
6 STRUCT., SANITARY MANHOLE, RECOt $2,364.00 $2,364.00 $0.00 $0.00 $2,364.00 100% $0.00 $236.40
7 HMA SURFACR FOR PATH $18,840.60 $18,840.60 $0.00 $0.00 $18,840.60 100% $0.00 $1,884.06
8 HMA INTER. FOR PATH $25,203.42 $25,203.42 $0.00 $0.00 $25,203.42 100% $0.00 $2,520.34
9 COMPACTED AGG. NO. 53, BASE $13,328.15 $13,328.15 $0.00 $0.00 $13,328.15 100% $0.00 $1,332.82
10 4" CONCRETE SIDEWALK $851.04 $851.04 $0.00 $0.00 $851.04 100% $0.00 $85.10
11 CONCRETE CURB RAMP, TYPE G $12,056.45 $12,056.45 $0.00 $0.00 $12,056.45 100% $0.00 $1,205.65
12 ITEM DELETED $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
13 EROSION CONTROL MEASURES $1,140.63 $1,140.63 $0.00 $0.00 $1,140.63 100% $0.00 $114.06
14 MULCHED SEEDING $1,126.60 $1,126.60 $0.00 $0.00 $1,126.60 100% $0.00 $112.66
15 0 $0.00 $0.00 $0.00 $0.00 $0.00 0%
94.2o '9g 20 $0.00 $0.00
16 overage on #7 .90 $94.2q. $0.00 $0.00 $94 -2-1- 100% $0.00 42
17 DEDUCT #8
$0.00 $0.00 0 ('302 7 (3 (3020.1 f302 .O ft
{$3- 9}62} 6s} /o $0.00
18 DEDUCT #9 ($744.83) ($744.83) $0.00 $0.00 ($744.83) 0% $0.00 ($74.48)
19 CHANGE ORDER #1 $5,707.95 $0.00 $5,707.95 $0.00 $5,707.95 100% $0.00 $570.80
20 credit #5 ($236.40) $0.00 ($236.40) $0.00 ($236.40) 0% $0.00 ($23.64)
21 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
22 $0.00 $0.00 $0.00 $0.00 $0.00 0%
$0.00 $0.00
23 0 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
24 0 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
25 1 $0.00 1 $0.00 1 $0.00 1 $0.00 1 $0.00 1 0% $0.00 1 $0.00
$94 (r8r $5,471.55 $0.00 =4�,95 100% $0.00 $9,969.84 qa 695.E X94.224.9 X9 ,9,969.58
AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA O 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 G703 -1992
AFFIDAVIT AND WAIVER OF LEIN
FINAL PARTIAL XX
WHEREAS, HARCO ASPHALT PAVING INC. 1650 Harco Way, Indianapolis, IN 46217
(Contractor) has been heretofore employed by CROSSROADS ENGINEERS to furnish certain material,
supplies CARMEL DRIVE ADAMS STREEThereinafter collectively referred to as the "premises and
WHEREAS, the undersigned is duly authorized to execute this Waiver of Lien for and on behalf of the
Contractor.
Twe
Now, therefore, the Contractor, for FOUR THOUSAND NINE HUNDRED TWENTY
DOLLARS AND /100 a berby waives and releases the Owner of the Premises and the Company
from any and all liens., rig�ts nin cdnsideration of the receipt of lien or claims of whatsoever kind or
character on or against the Premises or the improvements located thereon on account of any and all labor,
supplies, equipment or material furnished for, in connection with or incorporated in the Premises by the
Contractor on or before the date hereof, represents and warrants that no other person or has any right to a lien or
claim on account of any labor worked performed or material, supplies or equipment furnished by, to or through
the Contractor, on or before the date hereof, and agrees to indemnify, defend and hold the Owner and The
Company harmless from and against any and all claims or lien for any labor, material or services furnished or in
connection with or incorporated on the Premises by through or to the Contractor prior to the date hereof. This
Waiver of Lien is given in order to induce the Company to pay the amount indicated above, and upon receipt of
such amount by the Contractor, this release may be recorded, becomes valid, enforceable and of full effect.
Harco la t Paving Inc.
Y
B r/
Paul G. Harding, Presiden
STATE OF Indiana) ss.
COUNTY OF Marion)
Before me, a Notary Public in and for said County and State, personally appeared Paul G. Harding, who
acknowledged the execution of the foregoing Waiver of Lien, and who, having been sworn, stated that the
representation therein contained are true.
Witness my hand and Notarial Seal this 1 day December
CGC -cam
N ary Public
Cynthia L. Sartain
County of Residence: Hamilton
Commission Expires 9/20/2009
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (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
Harco Asphalt Paving
Purchase Order No.
1650 Harco Way
Terms
Indianapolis, IN 46217
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1914108 P;iV App #1 C'nrmial Drive/Ariams Street Paths RnA -1 6
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
Harco Asphalt Paving IN SUM OF
1650 Harco Way
Indianapolis, IN 46217
$84,804.16
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
19134 Pay App #1 203- 4462200 $84 ,804.16 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
Signature
6
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund