155324 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 360193 Page 1 of 1
q ONE CIVIC SQUARE HARCO ASPHALT PAVING CHECK AMOUNT: $97,690.04
CARMEL, INDIANA 46032 1650 HARCO WAY
INDIANAPOLIS IN 46217 CHECK NUMBER: 155324
«o
CHECK DATE: 111012008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
206 R4462705 16849 PAY APP #1 92,805.54 106TH ST CULVERT REPL
206 R4462705 16849 PAY APP #2 4,884.50 106TH ST CULVERT REPL
I D ORIGINAL
APPLIC O &Qm&RTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Inst ructions on reverse side) PAGE ONE OF 2 PAGES
TO OWNER: CITY OF CARMEL/ BOARD OF PUBLIC WORKS PROJECT: 106TH ST CULVERT REPLACEMENT APPLICATION NO.: 1 Distribution to:
ONE CIVIC SQUARE PERIOD TO: 12/12/2007 OWNER
CARMEL, IN 46032 PROJECT NOS.: ARCHITECT
CONTRACTOR
FROM CONTRACTOR: HARCO ASPHALT PAVING VIA ARCHITECT: CROSSROAD ENGINEERS CONTRACT DATE:
1650 HARCO WAY 3417 SHERMIN DRIVE
CONTRACT FOR:
INDPLS., IN 46217 BEECH GROVE, IN 46107
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 $96,684.08
CONTRACT arco A It Paving Inc.
2. Net change by Change Orders $1,005.96
3. CONTRACT SUM TO DATE (Line 1 t 2) $97,690.04 B Date: 12/1212007
Paul G. H V g, President &CEO
4. TOTAL COMPLETED STORED TO DATE $97,690.04
(Column G on G703) State of: INDIANA
County of: MARION
5. RETAINAGE: Subscribed and sworn to before
a. 5.00% of Completed Work 4,884.50 me this j,Z day of
(Columns D E on G703) /'7
b. of Stored Material
(Column F on G703) Notary Public: q
Total Retainage (Line 5a 5b or My Commision expires:
Total in Column I of G703) $4,884.50 ARCHITECTS CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $92,805.54
(Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Archtiect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) quality of the Work is in accordance with the Contract Documents, and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE $92,805.54 q 9
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED 4 Z rqs S
(Line 3 less Line 6) $4,884.50
(Attach explanation if amount certified differs from the amount applied for. Initial
all figures on this Application and on the Continuation Sheet that are changed to
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS confrom to the amount certified)
Total changes approved in CQO. Enr44
previuos months by Owner ARCH TECT:
Total approved this Month $1,005.96 By: 5 Date: Zl�j
TOTALS $1,005.96 This Certificate is not neg tiable. The AMOUNT CERTIFIED is payable only to th6 Con
NET CHANGES by Change Order 1 $1,005.96 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE, N.W., WASHINGTON, D.C. 20006 G702 -1992
SCHEDULE OF VALUES AIA DOCUMENT G703
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1
Contractor's signed Certification is attached. HARCO ASPHALT PAVING APPLICATION DATE: 12112/2007
In tabulations below, amounts are stated to the nearest dollar. PROJECT: 106TH STREET COLVERT PERIOD TO: 12112/2007
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: N/A
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 CONSTRUCTION ENGINEERING $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100% $0.00 $150.00
2 MOBILIZATION DEMOBILIZATION $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100% $0.00 $150.00
3 MAINTENANCE OF TRAFFIC $2,000.00 $0.00 $2,000.00 $0.00 $2,000.00 100% $0.00 $100.00
4 CLEARING RIGHT -OF -WAY $10,816.00 $0.00 $10,816.00 $0.00 $10,816.00 100% $0.00 $540.80
5 LINEAR DITCH GRADING $715.00 $0.00 $715.00 $0.00 $715.00 100% $0.00 $35.75
6 8'X 4' REIN. CONC. BOX CULVERT $37,220.25 $0.00 $37,220.25 $0.00 $37,220.25 100% $0.00 $1,861.01
7 B- BORROW FOR STRUCTURE BACKFILL $1,918.35 $0.00 $1,918.35 $0.00 $1,918.35 100% $0.00 $95.92
8 SURFACE MILLING 1 -1/2 $1,250.55 $0.00 $1,250.55 $0.00 $1,250.55 100% $0.00 $62.53
9 HMA SURFACE, 9.5MM $5,547.00 $0.00 $5,547.00 $0.00 $5,547.00 100% $0.00 $277.35
10 CONCRETE FOR STREET CUT REPAIR 12" $8,349.15 $0.00 $8,349.15 $0.00 $8,349.15 100% $0.00 $417.46
11 FLOWABLE FILL FOR ST. CUT REPAIR $9,779.78 $0.00 $9,779.78 $0.00 $9,779.78 100% $0.00 $488.99
12 STONE MASONRY WALL REPLACEMENT $3,000.00 $0.00 $3,000.00 $0.00 $3,000.00 100% $0.00 $150.00
13 CONCRETE CURB $1,000.00 $0.00 $1,000.00 $0.00 $1,000.00 100% $0.00 $50.00
14 SODDING NURSERY $600.60 $0.00 $600.60 $0.00 $600.60 100% $0.00 $30.03
15 EROSION CONT. BLANK. W /MULCHED $250.00 $0.00 $250.00 $0.00 $250.00 100% $0.00 $12.50
16 RIP RAP REVETMENT $4,500.00 $0.00 $4,500.00 $0.00 $4,500.00 100% $0.00 $225.00
17 TEMP ROCK CHECK DAM $750.00 $0.00 $750.00 $0.00 $750.00 100% $0.00 $37.50
18 BARRICADE, TYPE 111 $800.80 $0.00 $800.80 $0.00 $800.80 100% $0.00 $40.04
19 CONSTRUCTION SIGN A $1,019.20 $0.00 $1,019.20 $0.00 $1,019.20 100% $0.00 $50.96
20 DETOUR ROUTE MARKER ASSEMBLY $715.00 $0.00 $715.00 $0.00 $715.00 100% $0.00 $35.75
21 ROAD CLOSED SIGN ASSEMBLY $452.40 $0.00 $452.40 $0.00 $452.40 100% $0.00 $22.62
22 ROAD STRIPING EXTRA $1,005.96 $0.00 $1,005.96 $0.00 $1,005.96 100% $0.00 $50.30
23 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
24 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
25 $0.00 1 $0.00 1 $0.00 $0.00 0% $0.00 $0.00
TOTAL $97,690.04 $0.00 $97,690.04 $0.00 $97,690.04 100% $0.00 $4,884.50
AIA DOCUMENT G703, APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 G703-1992
AFFIDAVIT AND WAIVER OF LEIN
V 4Z
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 106 ST. CULVERT REPLACEMENT 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 NINETY TWO THOUSAND EIGHT HUNDRED FIVE
DOLLARS AND 541100 ($92,805.54) 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 Asph "lt avin c.
B
Paul G. Hardin resident
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 12 day Dece er 007.
Notary Public
Cynthia L. Sartain
County of Residence: Hamilton
Commission Expires 9/20/2009
ZJ ORIGINAL
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instruc on reverse side) PAGE ONE OF 2 PAGES
TO OWNER: CITY OF CARMEL/ BOARD OF PUBLIC WORKS PROJECT: 106TH ST CULVERT REPLACEMENT APPLICATION NO.: 2 Distribution to:
ONE CIVIC SQUARE PERIOD TO: 12/12/2007 OWNER
CARMEL, IN 46032 PROJECT NOS.: ARCHITECT
CONTRACTOR
FROM CONTRACTOR: HARCO ASPHALT PAVING VIA ARCHITECT: CONTRACT DATE:
1650 HARCO WAY
Indpls., IN. 46217
CONTRACT FOR:
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 96,684.08
CONTRACT ARCO A HALT PAVING
2. Net change by Change Orders 1,005.96
3. CONTRACT SUM TO DATE (Line 1 2) 97,690.04 By• Date: 12/12/2007
Paul G. Hard' g President CEO
4. TOTAL COMPLETED STORED TO DATE $97,690.04
(Column G on G703) State of: INDIANA
County of: MARION
5. RETAINAGE: Subscribed and ,✓orn to before
a. 5% of Completed Work me this day of
(Columns D E on G703)
b. of Stored Material
(Column F on G703) Notary Public:
Total Retainage (Line 5a 5b or My Commision expires:
Total in Column I of G703) ARCHITECTS CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 97,690.04
(Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data
comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Archtiect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) 92,805.54 quality of the Work is in accordance with the Contract Documents, and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE 4,884.50
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED ..............................4 4 Be4: SO
(Line 3 less Line 6)
(Attach explanation if amount certified differs from the amount applied for. Initial
all figures on this Application and on the Continuation Sheet that are changed to
CHAN ORDER SUMMARY ADDITIONS DE DUCTIONS confrom to the amount certified)
Total changes approved in I—A- CE Sr1aHL 0f N&ZgO -p Lw"411-WE¢5
reviuos months by Owner 1,005.96 ARCH ECT:
Total approved this Month By: Date: Z06
TOTALS 1,005.96 This Certificate is not ne otiable. The AMOUNT CERTIFIED is payable only tote on-
NET CHANGES by Change Order 1 1,005.96 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the O wn e r or Contractor under this Contract.
AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA O 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE, N.W., WASHINGTON, D.C. 20006 G702 -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 APPLICATION DATE: 12/1212007
In tabulations below, amounts are stated to the nearest dollar. 106TH ST CULVERT REPLACEMENT PERIOD TO: 12/1212007
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: N/A
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 CONSTRUCTION ENGINEERING $3,000.00 $0.00 $0.00 $0.00 $0.00 0% $3,000.00 $0.00
2 MOBILIZATION DEMOBILIZATION $3,000.00 $0.00 $0.00 $0.00 $0.00 0% $3,000.00 $0.00
3 MAINTENANCE OF TRAFFIC $2,000.00 $0.00 $0.00 $0.00 $0.00 0% $2,000.00 $0.00
4 CLEARING RIGHT -OF -WAY $10,816.00 $0.00 $0.00 $0.00 $0.00 0% $10,816.00 $0.00
5 LINEAR DITCH GRADING $715.00 $0.00 $0.00 $0.00 $0.00 0% $715.00 $0.00
6 8'X 4' REIN. CONC. BOX CULVERT $37,220.25 $0.00 $0.00 $0.00 $0.00 0% $37,220.25 $0.00
7 B- BORROW FOR STRUCTURE BACKFIL $1,918.35 $0.00 $0.00 $0.00 $0.00 0% $1,918.35 $0.00
8 SURFACE MILLING 1-1/2 $1,250.55 $0.00 $0.00 $0.00 $0.00 0% $1,250.55 $0.00
9 HMA SURFACE, 9.5MM $5,547.00 $0.00 $0.00 $0.00 $0.00 0% $5,547.00 $0.00
10 CONCRETE FOR STREET CUT REPAIR $8,349.15 $0.00 $0.00 $0.00 $0.00 0% $8,349.15 $0.00
11 FLOWABLE FILL FOR ST. CUT REPAIR $9,779.78 $0.00 $0.00 $0.00 $0.00 0% $9,779.78 $0.00
12 STONE MASONRY WALL REPLACEMEN $3,000.00 $0.00 $0.00 $0.00 $0.00 0% $3,000.00 $0.00
13 CONCRETE CURB $1,000.00 $0.00 $0.00 $0.00 $0.00 0% $1,000.00 $0.00
14 SODDING NURSERY $600.60 $0.00 $0.00 $0.00 $0.00 0% $600.60 $0.00
15 EROSION CONT. BLANK. W /MULCHED $250.00 $0.00 $0.00 $0.00 $0.00 0% $250.00 $0.00
16 RIP RAP REVETMENT $4,500.00 $0.00 $0.00 $0.00 $0.00 0% $4,500.00 $0.00
17 TEMP ROCK CHECK DAM $750.00 $0.00 $0.00 $0.00 $0.00 0% $750.00 $0.00
18 BARRICADE, TYPE III $800.80 $0.00 $0.00 $0.00 $0.00 0% $800.80 $0.00
19 CONSTRUCTION SIGN A $1,019.20 $0.00 $0.00 $0.00 $0.00 0% $1,019.20 $0.00
20 DETOUR ROUTE MARKER ASSEMBLY $715.00 $0.00 $0.00 $0.00 $0.00 0% $715.00 $0.00
21 ROAD CLOSED SIGN ASSEMBLY $452.40 $0.00 $0.00 $0.00 $0.00 0% $452.40 $0.00
22 ROAD STRIPING EXTRA $1,005.96 $0.00 $0.00 $0.00 $0.00 0% $1,005.96 $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 0 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00
$97,690.04 $0.00 $0.00 $0.00 $0.00 0% $97,690.04 $0.00
AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA 0 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 XX PARTIAL
WHEREAS, HARCO ASPHALT PAVING INC. 1650 Harco Way, Indianapolis, IN 46217
(Contractor) has been heretofore employed by CROSSROADS ENGINEERS to furnish certain material,
supplies 106 ST. CULVERT REPLACEMENT 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 FOUR THOUSAND EIGHT HUNDRED EIGHTY FOUR
DOLLARS AND 50 1100 ($4884.50) 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 Pavi Inc.
B.
Paul G. Hard
Koresident
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 12 day Dece e 2007.
4—
otary Public
Cynthia L. Sartain
County of Residence: Hamilton
Commission Expires 9/20/2009
December 17, 2007
Mr. Mike McBride, P.E.,
City of Cannel Engineer
City of Carmel Engineering Department
One Civic Square
Carmel, IN 46032
Re: Recommendation to accept completion of the #07 -04 —106` Street Culvert
Replacement Project.
Dear Mr. McBride,
Harco Asphalt Paving has completed the referenced project and we have inspected the
work and agree that the project is complete to our satisfaction and feel that the project can
be accepted with final payment to be made upon any further inspections and/or approvals
the City would like to make. The project was constructed close enough to the plans to
warrant no preparation of as- builts unless you would prefer to have a set of plans on file
that are marked "as- built" and we will be glad to prepare these at your direction. The
final cost of the project was $97,690.04, which is $1,580.21 under the original contract
amount of $99,270.25. This was due to some cost saving measures in materials.
Thank you and please feel free to contact us with any questions.
Sincerely,
s
Lance Stahley
CrossRoad Engineers, P.C.
3417 Sherman Drive
Beech Grove, IN 46107
cc: File
3417 Sherman Drive Beech Grove. Indiana 45107 Tel 317.780.1555 Fax 317.780.5525
CITY OF CARMEL
REPORT OF CONTRACT FINAL INSPECTION
AND RECOMMENDATION FOR ACCEPTANCE
Contract: 07 -04 Project: 106'' Street Culvert Replacement Project
Date Construction Substantially Complete: November 21, 2007
(The date all items were completed, except punch list and removal of traffic control devices.)
Intermediate Completion Date: November 21, 2007
Preliminary Inspection made by: Lance Stahlev, CrossRoad Engineers P C
Date: 1112112007
Date Punch List Items Completed: 1113012007
Sod Maintenance Expired on: 1213112007
Date Sod Repaired, if necessary: n/a
Date Failed Material Replaced: n/a
Final Inspection made by: Lance Stahlev, CrossRoad Engineers
on 1211112007 and all work was found to be
satisfactory from Station Entire project (no stationing to Station
required)
Date Construction Signs and Temporary Traffic Control Devices Removed: Final removals on 1211012007
Pavement Smoothness (does) comply with Specifications.
Pavement Markings (have) been placed in accordance with the IMUTCD manual or as directed by the
District Traffic Engineer. City of Carmel
Right -of -Way (is) clear of all encroachments.
Date of Last Work 1113112007
RECOMMEND ACCEPTANCE
City of Carmel, Hamilton County
Project Representative LOCAL PUBLIC AGENCY
Lance Stahley, CrossRoad Engineers By:
Michael McBride, City of Carmel Engineer
By:
By:
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
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))
Pay App #1 106th Culvert ReplaGeFnent
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. W RRANT NO.
ALLOWED 20
Harm Asphalt Pacing IN SUM OF
1650 Harco Way
Indianapolis, IN 46217
$97,690.04
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
16849 Pay App #1 06- R4462705 92,805.54 bill(s) is (are) true and correct and that the
16849 106-R4462705 materials or services itemized thereon for
which charge is made were ordered and
received except
//7 200
C naKye
-4 K=00:0:7��
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund