158451 04/15/2008 CITY OF CARMEL, INDIANA VENDOR: 148000 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $4,781.53
'f CARMEL, INDIANA 46032 100 N SENATE AVE, RM N725
ATTN: CASHIER CHECK NUMBER: 158451
INDIANAPOLIS IN 46204
CHECK DATE: 4115/2008
DEPARTME ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
202 4350900 4,781.53 OTHER CONT SERVICES
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INDIANA DEPARTMENT OF TRANSPORTATION INVOICE
100 NORTH SENATE AVENUE, ROOM N725
�J o INDIANAPOLIS, INDIANA 46204 -2216
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Customer No: CST000001811
Bill To: Invoice: 000001813
Invoice Date: 3/27/2008
Carmel Invoice Type: LPA
Dept. Of Engineering
One Civic Square
Carmel IN 46032 AMOUNT DUE: $4,781.53
Payment is Due Upon Receipt of Invoice
PLEASE RETURN TOP PORTION WITH YOUR PAYMENT, ATTN: CASHIER
Line Description Quantity Unit Amt Net Amount
1 Contract R -26586 1.00 4,781.53 4,781.53
Project #IN48031, Contract #R- 26586, Added travel lanes on 116th
Street from Rangeline Road to Keystone Avenue final quantities (see
attached)
Subtotal: 4,781.53
AMOUNT DUE: $4,781.53
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For billing questions, please call: 317- 232 -5384 Invoice: 000001813
Indiana. Department of Transportation, 100 North Senate Avenue, Indianapolis, Indiana 46204 -2216
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Purcha a Order Order Date Required Date Page
INDOT Ghg Order Construction 08803874 10/02/2007 10/28/2007 1 of 1
Indiana Department of Transportation
State Form 45449(11816 -07) f=und /Object/Center: 40001564400 1108160
Approved by State soardofACCounta,.2e87; Requisition Number 0000004404
Approved by Auditor of State. -2087 Federal ID: 351917625
Vendor 0000050992 000001 1 Agency: 00800 Indiana De of Transp ortation
MILESTONE CONTRACTORS LP Ship To Dept Of Transportation
Remit to PO BOX 421459 Construction Management Divisi
INDIANAPOLIS IN 46242 -1459 100 N SENATE AVE RM N855
INDIANAPOLIS IN 46204
MILESTONE CONTRACTORS LP Bill To Indiana Dept of Transportation
Vendor PO BOX 421459 Dept Of Transportation
Name INDIANAPOLIS IN 46242 -1459 Accounting
Address 100 N SENATE AVE RM N725
INDIANAPOLIS IN 46204
Vendor Name: Buyer Name: Sweeney,Cheryl -800
Contact eMail: entail: CSWEENEY @indot ;IN.gov
Phone:
_,a., r 4,me Pu�cFiasa =.Orde'r'InstruCti onsa'�GOfnmelllSt�� ,p sue'
20% LPA 80% FEDERAL. final quantities PE Jon Lenglade orig Po 03022387
,.Item No�'� .��-,aDescri tion,Mx� ^,�F�,�r.�',,;�: FOB�Destinatton E�.Qt �Ordered� _�Qt ,�Recc1�,. =��UOfVI'��ilJriit P ice�g��Exlend "ed�Amt
1- 1 R 26586 -A ADDED TRAVEL LANES 1.0000 EA 23,907.6400 23,907.64
GREENFIELD DISTRICT PCN:9980510
IN26001 ADDED TRAVEL LANES Ap' -S
HAMILTON COUNTY ON 116TH ST FROM
RANGELINE RD TO KEYSTONE AVE 0 710
Deliveries acceptable only between 8:00 AM and 3:00 PM, Monday through Friday, excluding State
Holidays. y T/✓���
Un(ts of Me
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�.xasre�Nandlln �Totals�Si'
The following UN /CEFACT Unit of Measure Date Invoice Received: (MonthlDayNear)
Common Codes are used in this document: Goods /Services Received Date: (MonthlDayNear)
EA Each Internal Contract Terms and Conditions Satisfied: (Month /DayNear)
Exempt:lntergovernmental (Pursuant to IC 5- 17 -5 -2)
Good Faith Dispute (Dispute Pursuant to IC 4- 13 -2 -20 IC 5- 11 -10 -2)
Total PO Amt. 23,907.64
Issued by the the Indiana Department of Transportation rUNDING ENCUMBERED BY THE AUDITOR OF STATE
1 certify that there is sufficient unencumbered balance In the above
account to cover the amount of this order, and that funds have been set
aside for payment thereof.
Authorized Signature, Auditor of State
1
a n Date SigWed(MrfnthlClayNcar)
r r a xra.r
P
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CONFIRMATION OF RECEIPT APPROVAL FOR PAYMENT
certify that the items listed above were received. All commodities I certify that the vendor has performed in accordance with the terms and
appeared to conform to specifications and showed no patent .p contract obligations pertaining to this Purchase Order, and hereby
elects except as otherwise noted. ,p a y authorize an`G a Love amen( o[the claims.
S ignature of Receiver Date Signed(Month)baylYej i Atl7horize(DS!Lnaturn for Agency
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I Ililll �I! Ili). t��ll ��I�! ���I I I I�ki� �I�I ��I�I ��I I ill I�I'I II I! I II III�I I ■II
11111 till 1111 copy (Agency) 3rd copy (Auditor)
00800 0008803874
181�i
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
Ma%1 AWg6 6WMjh o (yff hours ra e. er hour, number of units, price per unit, etc. nsportation
ATTN: Cashier Payee
r i Purchase Order No.
100 N. Suate Avenue, Room N725
nd IN_ Terms
r
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
N/A Project #IN48031, Contract #R -26586 $4,781.52
116th Street, Range Line to Keystone final quantities
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.
Inc�Oapa- ALLOWED 20
�ATIN (achicr IN SUM OF
100 N. Senate Avenue, Room N72
Indianapolis, IN 46204 -2216
$4,781.53
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
n/a 3/27/2008 202 -509 $4,781.53
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 l�
A
S ion e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund