HomeMy WebLinkAbout200863 08/30/2011 CITY OF CARMEL, INDIANA VENDOR: 364048 Page 1 of 1
ONE CIVIC SQUARE GIBRALTAR CONSTRUCTION CORP
I CHECK AMOUNT: $7,979.00
CARMEL, INDIANA 46032 2932 N. WEBSTER AVENUE
INDIANAPOLIS IN 46219 CHECK NUMBER: 200863
CHECK DATE: 8/30/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 R4462401 27459 4 7,979.00 7A STREETSCAPE PALLAD
CS® Architects
Letter of Transmittal
TO: Carmel Engineering DATE: May 31, 2011
One Civic Square PROJECT NO: 10145G
Carmel, Indiana 46032
RE: Parcel 7A Streetscape.
ATTN: Mike McBride
CONTACT PHONE: 571 -2441
WE ARE SENDING YOU:
Air
COPrI,ES DATE, sx_ 9 k ,DESCRIPTION
M�.
3 5123111 Payment Request No. 4, Parcel 7A Streetscape, Construction Work,
By Gibraltar Construction, 7,979.00
IF ENCLOSURES ARE NOT AS INDICATED, PLEASE NOTIFY US AT ONCE.
THESE ARE TRANSMITTED:
For approval Reviewed as submitted Resubmit for approval
For your use As noted Submit for distribution
As requested Revise and Resubmit Return corrected prints
For review and comment Rejected Other:
REMARKS:
Payment Request for Parcel 7A Streetscape.
CC: FILE
By: Bob Olson
Courier Service: 1 -HR 3 -HR Same Day
FedEx Services: 8:30 A.M. Delivery 10:30 A.M. Delivery 3:00 P.M. Delivery
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Document9
ARCHITECTURE INTERIOR OL'SIGN
8831 Keystone Crossing Indianapolis, IN 46240 Main 317.848.7800 Fax 317.574.0957 csoinc.net
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Document G702ICMaTM 1992
a�osa
Application and Certificate for Payment Construction Manager Adviser Edition
TO OWNER: PROJECT: APPLICATION N0: Distribution to:
City of Carmel Carmel Parcel 7A Streetscape 4
One Civic Square PERIOD TO: 5130111 OWNER
Carmel, IN 46032
CONSTRUCTION MANAGER
FROM CONTRACTOR: Gibraltar Construction Corp 10!28114 VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT 11
2932 N. Webster Ave. PROJECT NOS: I CONTRACTOR
Indianapolis, IN 46219 VIA ARCHITECT: FIELD
CONTRACT FOR: Carmel Parcel 7A Streetscape CSO Architects, Inc. I
CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies 1 jAat to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below. in connection with the Contract, belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all am Lints have been paid by the Contractor for Work for which previous
Certificates for Payment were ssuc 1 and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM 206,200.00 payment shown herein is now
2. Net change by Change Orders 0.04 CONTRACTOR: Gibraltar C trrJCtion Corp
3. CONTRACT SUM TO DATE (Line I 2) 206,200.00 By: I t Date:
4. TOTAL COMPLETED 8 STORED TO DATE Column G on 6703 190,065.88 State of:
5. RETAINAGE: Count of:a��� R�
y AE BRIAN R. MGBRiDE
a. of Completed Work Subscribed and savor befo- S Res. of Hancock County
to (Column D E on G703) 10,310.00 me thi d o'f. COMM-
b. of Stored Nlateriai Notary Public: 11 -29 201 7
(Column F on G703) Any Commission expires: C�i CO(f1n11SSI0n 61 1862
Total Retainage (Lines 5a 5b or Total in Column 1 of 6703) CERTIFICATE FOR PAYMENT
17975588 in accordance with the Contract Documents. based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect ccrtifv to the Owner that to the best of the] r
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 171,776.88 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED,
8. CURRENT PAYMENT DUE S 7,979.00 AMOUNT CERTIFIED 7 7. 4 n0- ect
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explonation if amount certified di ers from the amowir applied. htitial all figures nit this
Application and on the Continuation Sheet that are changed to conform frith the amount certified.)
(Line 3 less Line 6) fi3,923.00 CONSTRUCTION MANAGER:
By Date:
CHANGE ORDER SUNIyfF1RY ADDITIONS DEDUCTIONS ARCHITECT:
o A hit c 5, in Sl31(1�
Total chances approved in previous months by Owner By: Date:
Total approved this Month This Certificate is not negotiable. The ArNIOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein. Issuance, payment and acceptance of payment are without prejudice to Lily rights of
NET CHANCES by Change Order S the Owner or Contractor under this Contract.
CAUTION: you should sign an original AiA Contract Document, on which this text appears in RED, All original assures that changes will not be obscured.
AIA Document G7021CMaTI. 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA' Decunrr. rr, is protected by U.S. Copyright Law and ante- r"ationof Treaties.
Unauthorized reproduction or disc it)ution of this AIA' Document or any poriion of it, may result in severe civil and criminal penaities, and will be prosecuted to the maximrtm extent possible under the laiv.
Purchasers are permitted to reproduce ten (1 D) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -maii The American Institute of Architects' legal counsel, copyright @aia.org.
CONTINUATION SHEET Page 2 of 2
APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION NO.: 4 APPLICATION DATE: 5!30!2011
attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where PERIOD TO: 5/30/2011
variable retainage for line items may apply. ARCHITECT'S PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
PRESENTLY COMPLETED AND BALANCE TO RETAINAGE
ITEM
DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS FINISH (IF VARIABLE
N0, APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G 1 C) (C G) RATE)
(D +E) DORE) (D +E +F)
1 Supervision $2,500.00 $2,300.00 $75.00 $2,375.00 95% 125.00
2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00
3 Bonds $2,576.00 $2,576.00 $2,576.00 100%
4 Misc. General Conditions $5,024.00 $4,621.88 $150.00 $4,771.88 95% 252.12
5 Earthwork $30,000.00 $28,800.00 $1,200.00 $30,000.00 100% 10,310.00
6 lAsphalt Paving $9,700.00 $9,700.00 $9,700.00 100%
7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100%
8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100%
9 Joint Sealants $300.00 $0.00 $0.00 0% 300.00
10 Limestone Retaining Wall $90,000.00 $87,000.00 $3,000.00 $90,000.00 100%
11 Landscaping $12,000.00 $10,200.00 $1,800.00 $12,000.00 100%
12 Irri ation $5,500.00 $4,675.00 $550.00 $5,225.00 95% 275.00
13 Change Order #1 $4,818.00 $3,614.00 $1,204.00 $4,818.00 100%
$211,018.00 $182,086.88 $7,979.00 $0.00 $190,065.88 90% $20,952.12 $10,310.00
ISA Form 1 -402
AFFIDAVIT AND WAIVER OF LIEN
FINAL PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Marion, SS
Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the
Owner to furnish certain materials and or labor for a project known as Carmel Parcel 7A- Streetscape and owned by City
of Carmel and does hereby further state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the Owner the sum of
Seven Thousand Nine Hundred Seventy Nine and Noll 00--------- Dollars ($7,979.00)
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 Owner is the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver
of Lien which shall become effective upon receipt f such payment.
THERFORE, the undersigned waives and releases unto the Q ied ner of said premises, any and all lien or claim whatsoever
on the above described property and improvements ther n a ount of LABOR or material or both, furnished by the
undersigned thereto, subject to limitations of conditions t prs herein, if any; and further certifies that no other party
has any claim or right to alien on account of any work 'rfor d or material furnished to the undersigned for said project,
and within the scope of this affidavit and waiver.
Gibraltar Construction Corp By Title President
WITNESS MY HAND AND NOTORIAL SEA //t is 23rday of May, 2011.
i
(Notary Public)
OE BRIAN R. MCBRIDE
Ha ,cock tour ty
c, 1979 iNDiANA SUBCQNTAACTOAS ASSOCIATION INCOAPOA&TED M Y omm, E�.11 -29 -2017 rry 1040 C"m"'On 9 111162
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A IA Document —1992
Application and Certificate -for Payment Construction Manager Adviser Edition
TO OWNER: PROJECT: APPLICATION NO Distribution to:
City of Carmel Carmel Parcel 7A Streetscape 4
One Civic Square PERIOD TO: 5130/11 OWNER
Carmel; IN 46032
CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Gibraltar Construction Corp 10/28/10
2932 N. Webster Ave: PROJECT NOS: 1 1 CONTRACTOR
Indianapolis, IN 46219 VIA ARCHITECT: FIELD
CONTRACT FOR: Carmel Parcel 7A Streetscape GSO Architects, Inc.
CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies at to the best of the Contractor's knowled information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Appl' ation for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all am unts have been paid by the Contractor for Work for which previous
Certificates for Payment were ssu and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM 206,200.00 payment shown herein is now
2. Net change by Change Orders 0.00 CONTRACTOR: Gibraltar C r roh Corp
3. CONTRACT SUM TO DATE Line 1 2
.206.200.00 By:. Date:
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 190,065.88 State of: ,)��p�
5.RETAINAGE County of:
BRIAN R. MCBRiDE
a• of Corn leted Work
P Subscribed and savor befo S R es: of Hancock County
10,310.00 oll
b (Column D E on G703) me this 1 ?5 of N M Y Comm• EXP, 11 -29 -2017
%of Stored Material Notary Public: I A COmf?IjSS10f1 fi11 ��2
(Column F on G703) My Commission expires: /i,�ff
Total Retaina (Lines 5a 5b or Total in column I of G703) CERTIFICATE FOR PAYMENT
179,755.88 In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 171,776.88 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED,
8. CURRENT PAYMENT DUE 7,979.00 AMOUNT CERTIFIED 7_� ;D O
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount�applied. Init�al all figures on this
Application and on the Cont' uation Sheet that are changed to conform with the amount certified.)
(Line 3 less Line 6) fi3,923.00 CONSTRUCTION MAN R:
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
SO Ar it Inc.
Total changes approved iii previous months by Owner By; Date:
Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein. Issuance;'' payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702/CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.
T11
Document G7021CMa -1992 Instructions
Application and Certificate for Payment Construction Manager Adviser Edition
A. General Information
AIA Document G7021CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A2011CMa, General
Conditions of the Contract for Construction, Construction Manager Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G7021CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G7021CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G7021CMa, Application and
Certificate for Payment, Construction Manager Adviser Edition.
The Contractor should sign G702/CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G7021CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G7021CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G7021CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G7021CMa, Application and Certificate for Payment,
Construction Manager- Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Mate_ rials Presently Stored for which payment is sought. The total of the column must be recalculated at lhii end`of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project,is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns 1), E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G7021CMa form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should -be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A2011CMa.
1 J
E. Making Payment
f
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G7021CMa,
Application and Certificate for Payment, Construction Manager Adviser Edition. The completed form contains the name and "ddress of the Contractor. Payment should
not be made to any other party unless specifically indicated on G702 /CMa.
AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
I
4CO3ITINUATION SHEET Page 2of2
APPLICATION NO.: 4
APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION DATE: 5/30/2011
attached. In tabulations below, amounts are stated to the nearest dollar. "Use Column I on Contracts where PERIOD TO: 5/30/2011
variable retainage for line items may apply.
ARCHITECT'S PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE TO RETAINAGE
ITEM
DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY COMPLETED AND FINISH (IF VARIABLE
NO. APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G C)
(D E) D OR E) (D.+ E F) (C G) RATE)
1 Supervision $2,500.00 $2,300.00 $75.00 $2,375.00 95% 125.00
2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00
3 Bonds $2,576.00 $2,576.00 $2,576.00 100%
4 Misc. General Conditions $5,024.00 $4,621.88 $150.00 $4,771.88 95% 252.12
5 Earthwork $30,000.00 $28,800.00 $1,200.00 $30,000.00 100% 10,310.00
6 Asphalt Paving $9,700.00 $9,700.00 '$9,700.00 100%1
7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100%
8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100%
9 Joint Sealants $300.00 $0.00 $0.00 0% 300.00
10 Limestone Retaining Wall $90,000.00 $87,000.00 $3,000.00 $90,000.00 100%
11 Landscaping $12,000.00 $10,200.00 $1,800.00 $12,000.00 100%
12 Irrigation $5,500.00 $4,675.00 $550.00 $5,225.00 95% 275.00
13 Change Order #1 $4,818.00 $3,614.00 $1,204.00 $4,818.00 100%
i
$211,018.00 $182,086.88 $7,979.00 $0.00 $190,065.88 90% $20,952.12 $10,310.00
ISA Form 1 -402
1=
AFFIDAVIT AND WAIVER OF LIEN
FINAL PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Marion, SS
Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the
Owner to furnish certain materials and or labor for a project known as Carmel Parcel 7A- Streetscape and ow by City
of Carmel and does hereby further state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the Owner the sum of
Seven Thousand Nine Hundred Seventy Nine and No /100--- Dollars ($7,979.00)
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 Owner is the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver
of Lien which shall become effective upon receipt f such payment.
THERFORE, the undersigned waives and releases unto the ner of said premises, any and all lien or claim whatsoever
on the above-described property and improvement s ther n a count of LABOR or material or both, furnished by the
undersigned thereto, subject to limitations of conditions pr ed herein, if any; and further certifies that no other party
has any claim or right to a lien on account of any work rfor ed or material furnished to the undersigned for said project,
and within the scope of this affidavit and waiver.
Gibraltar Construction Corp By f Title President
WITNESS MY HAND AND NOTORIAL SEA t is 23rd ay of May, 2011.
(Notary Public)
BRIAN R. MCBRIDE
H- ,cock County
SEA Res. c`
19 Ps sr�ois a su cc#r�eR,ccrgAS ASSOCIATION INLdRR£1RAAED I. My Comm. EXp, 11 -29 -2017 19W
urAau�no +rtBfl Pno+oeuct�n �b++rDrNd
CoMrniqZivn 61 RF2
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
�0 or he�x� �'c��� Purchase Order No.
2 9 Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4 av
Total ev
Y
1 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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
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
materials or services itemized thereon for
which charge is made were ordered and
received except
-Z 20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund