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Home My WebLink About160922 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 00350498 Page 1 of 1 e ONE CIVIC SQUARE INDIANA NEWSPAPERS, INC CHECK AMOUNT: $171.67 CARMEL, INDIANA 46032 307 N PENNSYLVANIA STREET Po sox 145 CHECK NUMBER: 160922 dioh INDIANAPOLIS IN 46206 -0145 CHECK DATE: 6!2512008 DEP ARTME NT ACCOUNT PO NUMBER INVO NU MBER AM DE 1701 T 4345500 42.50 PUBLICATION OF LEGAL 902 4345500 101.36 PUBLICATION OF LEGAL :1192 .4345500 81923- 523402 27.51 PUBLICATION OF LEGAL I i i i i Form Prescribed by State Board of Accounts 81923- 52340255 General Dorm No. 99 P (Rev. t')b7) i' CITY OF CARMEL To: INDIANAPOLIS NEWSPAPERS 307 N PENNSYLVANIA ST PO BOX 145 COUNTY, INDIANA INDIANAPOLIS, .IN 46206 -0145 PUBLISHER'S CLAIM LINE COUNT Display Matter (Must not exceed two actual lines, neither of which shall total more than four solid lines of the type in which the body of the advertisement is set). Number of equivalent lines Head Number of lines City Of Ca rrile, Body Number of lines w I R NAL I NV 3 Tail Number of lines [d 0 [dept. of Co CoMM ty S e ry I CE Cos Total number of lines in notice t, COMPUTATION OF CHARGES 70.0 lines 1.0 columns wide equals 70.0 equivalent S 27.51 lines at .393 cents per line Additional charge for notices containing rule and figure work (50 per cent of above amount) RECEIVED Charges for extra proofs of publication ($1.00 for each proof in excess of two) 110 S 00 TOTAL AMOUNT OF CLAIM DATA FOR COMPUTING COST S Width of single column 7.83 ems Size of type 57 point Number of insertions 1.0 S 27.51 Piu to the provisions and penalties of Chapter 155, Acts of 1953, l hereby certify that the foregoing account isjust and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. DATE: 06/06/2008 Docket No. 08060001 CA j Clerk I NOTICE OF PUBLIC Title HEARING BEFORE THE CARMEL PLAN COMMISSION Notice is here b99 given that I 81923 5234025 j Commisson A willll hold i PUBLISHER'S AFFIDAVIT ppublic hearing upon a Pet i- tidn To Amend the Monon main PUD Ordinance pursu State of Indiana SS: ant to the ap lication and plans filed wit tthe .Depart- MARION County ment of community Ser- vices as follows: Maoon &manPlarn Personally appeared before me, a notary public in and for said county and state, Development in order to al- low non residential uses on P I mary floors Area. o f uni 23 prop. the undersigned KIM ATNIP who, being duly sworn, says that SHE is clerk erties included in the Pri mary Areaa,, along the north side of Ma Street inclutle: 216W Main Street throuyhl of the INDIANAPOLIS NEWSPAPERS a DAILY STAR newspaper of general circulation 424 W Main street, -15 Third' r Avenue NW and 20 Third Designated No printed and published in the English language in the city of INDIANAPOLIS in state 08060001 OA, the hearing will be held on Tuesday, June 17, 2008 at 6:00 PM in the Council Chambers car. and county aforesaid, and that the printed matter attached hereto is a true copy, mel City Hall One civic Square, C armef IN o pp1 k 46��0pp32. o. 08060000 for this (Docket No. No which was duly published in said paper for 1 time(s), between the dates of. on file at.the Carmelo f partment of Community Services one civic square c „lndiana 46032, an 06/0612008 and 06/06 /2008 .may -:be- viewed Monday through Friday between the hours 0f 8:00 AM and 5:00 PM, Any written comments or Oblections to the proposal Clerk should be filed with the Secretary of the Plan earn- Title mission 'on or before the date of the Public Hearing. All written comments and objections will be pre- Subscribed and sworn to before me on 06 /06 /2008 sensed to the -oral Commission. 1 Any comments con• cem, the proposal will be heard by the Commission at the hearin according to 1 kits Rules'of�rocedure in l n the hearing may Ele LOUISE M. POWELL Not ry Public be continued from time to time by the commission as NOTARY PUBLIC it may find necessary. Ramona Hancock, SEAL Secretary Carmel Plan Commission STATE OF INDIANA Form G5 RGV I (317)571.2417 My commission expires: 9 a 28.2016 IFAX (317) 571 -2426 my Dated: June 6 2008 (S :6 /6 /0!j 523402 STATE PRESCRIBED FORMULA RATE PER LINE 7.83 PICA COLUMN 94 POINT PUBLISHED 1 TIME =339 94 POINTS 5.7 PT. TYPE 16.49 PUBLISHED 2 T.IM:ES= .509 16.49 EMS 250 -.06596 SQUARES PUBLISHED 3 T[MES= .679 .06596 SQUARES x $5.14 -.339 CENTS PER LINE PUBLISHED 4 T[MES= .848 VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF a. 6,�7-k q5 o� a 7:51 ON ACCOUNT OF APPROPRIATION FOR 40 cc5 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1 a 3 ag 5 a 7.5/ 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 a 20 6� Sign Cost distribution ledger classification if Title claim paid motor vehicle highway fund Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER 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 a /kntlfi:�� Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) x)90 &0oal 01q a 7. 5 Total a 7 J fI 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 Form Prescribed by State Board of Accounts 900549_ Gcneral Form No. 99 P (Rev. 10 7) CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS 307 N PENNSYLVANIA ST PO BOX 145 COUNTY, INDIANA INDIANAPOLIS, IN 46206 -01.45 PUBLISHER'S CLAIM LINE COUNT Display Matter (Must not exceed two actual lines, neither of which shall total more than four solid lines of the type in which the body of the advertisement is set). Number of equivalent lines Head Number of lines Body Number of lines Tail Number of lines Total number of lines in notice COMPUTATION OF CHARGES 103.0 lines 2.0 columns wide equals 206.0 equivalent S 101.36 lines at .492 cents per line Charges for extra proofs of publication (S 1 -00 for each proof in excess of two) S .00 00 TOTAL AMOUNT OF CLAIM DATA FOR COMPUTING COST 5 Width of single column 7.83 ems Size of type 5,7 point S S Number of insertions 1.0 S 101.36 Pursuant to the provisions and penalties of Chapter 155, Acts of I hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. City of Carmel, Indiana L_„artment:Carmel Redevelopment commission DATE: 06/0612 o e diana4603z Clerk .Project: PARCEL 7A, Reggional Performing Arts center Title Interior Finish Packagge P5 CSO Project No. 2531D Notice is hereby given that the Carmel Redevelopment Com, mission for the a7 c 7V�549 -5224 City of Carmel Hamilton COUnt1� PU AFFIDAVIT V 7 office e Ofthe Of Community Serve Indiana will Services, Thiirdl Floor, Carmel city Hall, One Civic Square, Carmel. Indiana 46032 unti15 :00p.m.ED Tonor before iuly16.2008 Bids Stale Of Indiana 55: be publicly opened read aloud at the meeting of the Carmel Redevelopment Commission the same day which' wI ll be in the Council Chambers located on the second floor Hamilton County taken under ad 6 emen N0late il be accepted the Owner s intent to award the contract after a two week Bidevaluationpesa ('el'SO All bids an roposalls s ll be Prof ty and completely exe- nally appeared before me, a notary public in and for said county and state, d phap spe c n the ationsproposal forms provided with the drawings and, specci fic. bidding Reguv nts eme will include the non collusion affidavitazrequved.b the State of Indiana. The the undersigned KINI ATNIP who, being duly sworn, says that SHE is clerk bid envelope must be sealed and the following label on the lower left corner: BID PARCEL 7A, REGIONAL PERFORMING ARTS CENTER INTERI FINISORFINISHPACK (Packae AGEPS BID PAC of the Noblesville Ledger a newspaper of general circulation gg q A bid bond made payat le to the City of Carmel will be re: drt percent 00 P mentbondwil printed and published in the English language in the city of NOBLESViLE in state required of the successful bidder upon execution of the Contract. It is Intended that actual construction Of all work divisions shall be started as soon as practicable, and each bidder shall be Prepared to enter promptly into aconstrue. i and county aforesaid, and that the printed matter attached hereto is a true copy, ,,tion contract, furnish a performance and labor and material !77ayment bond, and begin work when authorized by the IOwner in the event the award is made. 't iedttO thetoll ,but isnotnecessarilyJim -I which was duly published in said paper for 2 time(s), between the dates of PARCEL 7A, REGIONAL PERFORMING ARTS CENTER INTERIOR FINISH PACKAGE P5 'The g eneral scope of the Work consists'ni interior finishes 05/30/2008 and 0(i /0(i /200$ and technical equipment for a new Regional Performing. Arts Center. tlOntract Documen ts. for foll ing lo tions: Project may be examined at the owca Shlel Sexton Company, Inc 902140 h Capitol Avenue Indianapolis, IN 46204 I Clerk Construction Data, Inc. ree Title 1 437 N !Illinois Stre 3t7 et IndlanapoIrs,IN 462 63 ro 77 ppho 317. ho Subscribed and sworn to before e on 06/061. 008 re 3 77 ne m (317)637- 341Sfax obtained Rep Reprograp Inc., Project on otthe' r Constr o Inc.,at the address Stated abo ee upon ment of $200.00 for the set. Additional non refundable. ,deposit sets may bepurchazedfromReprographics Inc per L UI$E M. POWELL Notary public their pricing schedule. Payment must be by check. NO CASH' ACCEPTED. Make checks payable to ShielSexton Company, NOTARY PUBLIC Inc., and deliver them to Reprographics Inc. Deposit will be SEAL to Bidders who submit a bid and return bidding documents in good condition within 10 days from bid open- STATE OF INDIANA lin ddte. Form 65 REV 1 Bi dders shall assure that they have obtained complete sets MYcomnussion expires: of drawings and Contract Documents and shall assume the risk of any errors or omissions in bids prepared in reliance on Owner- Contractor Agreemen s beexeccufed by Carmel Redevelopment Commission. Wage rates for the Project shall not be less than the current c pr escnbed scale of wages as determined by the common cn�truction Wage Committee in accordance with LC. 5 -16 7 and included in the Project Manual. I dingrr equirements and othe mspp!artant the he he d on T u n e 25, 2008 at 1:00 p .m. EDT at the Shiel Sexton C o r n Pang lob site trailer located at the southeast comer Of 3rd Ave SW and City Center Dnve Carmel, Indiana. Ali prospea live bidders are invited to attend the pre-bid conference. There-bi confere i s not mandatory. N 0 op O7 anv.bid or mposal within a period 1 r BLgg 41NVh 59t for receiving bids 0 i IVAI _J&q GOmmisslOn 00 'S6 I Y73 Wbd �O�P1yZ for a A D0-QZI SbJ0 71A 00'Og� j O000 r s SIi Form Prescribed by State Board of Accounts 900549 522468 General Form No. 99 P (Rev. 1987) CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS 307 N PENNSYLVANIA ST PO BOX 145 COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145 PUBLISHER'S CLAIM LINE COUNT Display Matter (Must not exceed two actual lines, neither of which S shall total more than four solid lines of the type in which the body of the advertisement is set). Number of equivalent lines Head Number of lines S Body Number of lines S S Tail Number of lines Total number of lines in notice COMPUTATION OF CHARGES 103.0 lines 2.0 columns wide equals 206.0 equivalent S 101.36 lines at .492 cents per line Charges for extra proofs of publication 1.00 for each proof in excess of two) .00 S .00 TOTAL AMOUNT OF CLAIM S DATA FOR COMPUTING COST Width of single column 7.83 ems Size of type 5_7 point S Number of insertions 1.0 S 101.36 Pursuant to the provisions awl penalties of Chapter• 155, Acts of 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. S3�tl.ON 1�9111d S��IlOpN 31�9f1>d 1 DATE; 06106/2 Project. PARCE! 7A, Regional Performmg Arts Center l V Clerk Interior Finish Package 5 CSO Project No, 2531 Title Notice is hereby given that the Carmel Redevelopment Con• mission for the CdvofCarmel Hamilton County Indiana will receive sealed bidds for the above described Project at the office of the Depart ment of Community Services. Third PUBLISHER'S AFFIDAVIT 9Q0549 -5224 Floor Carmel City Hall, one Civic Square, Carmel, Indiana 4603 until 5:00 p.m. EDT on or before July Ill, 2008. Bids will he publicly opened and' read aloud at the meeting of the Carmel Redevelopment Commission the same day, which State of Indiana SS: will be in the Council Chambers located on the second Floor of City Hall at 6:30 "no., at which time such Bids will be HamiltonCOUnt taken under advisement. No late bids will be acrevvled. It is Y the Owner's intent to award the Contract after ahvo week BitlevaluationPer"d. Att bidsandproposalsshallhepropper lyandcompletelyexe PerSOnal1 appeared before me, a rotor p ublic in and for said county and state, cured on the proposal forms provided with the drawings and I Y pp Y P specifications. Bidding Regwrements will inclutle the non collusion affidavit as required b the State of Indiana. The the the lower sealed and the following label on, the undersigned KIM ATNIP who being duly Sworn, says that SHE is clerk BID PARCEL 7pp,, REGIONAL PERFORMING ARTS CENTER INTERIOR FINISH PACKAGE P5 BID PACKAGE P- (Packsg No.). •A bid bond made payable to the Cit of Carmel will be re-- of the Noblesvi I le Ledger a newspaper of general circulation V Qred in the amount of 5% of the total bid price. A one hun- tlred percent ((00%) performance and payment bond will be; re quired of thhe successful bidder upon execution of the antracLItis intended that actual construction of all work printed and published in the English language in the city of NOBLESVILLE in state divisions shall be started as soon as practicable. and each I bidder shall be prepared to enter promptly Into a construc- tion contract, furnish a performance and labor and material payment bond, and begin work when authorized by the wrier fn the eve nt the award is made. and county aforesaid, and that l'he printed matter matter attached hereto IS a true COPY, Dw The Project consists generally of, but is not necessarily lim- Recite,l110011owing P A RI 7A. SH PACKAGE P E R FORMING ARTS CENTER 1 which was duly published m said paper for 2 tirne(s), between the dates of. The general swpe of the Work consists of interior finishes and technical equipment fora new Regional Performing Arts Center. 05/30/2008 and 06/06/2008 Contract Documents for the Project may be examined at the (cliowing lOCahons: Shiel Sexton Company, Inc. 902 North Capitol Avenue indianapolis,IN46204 Reed Construction Data, Inc. reedconstructiondata.com I Clerk Rurtocigraphie' Inc. 431 N.Tlhnois Street Title Indianapolis, IN 46204 wwwgro raphixcom (317 637 -3377 phone (317) 637.3415 fax Subscribed and sworn to before nic on 06/061) 8 ONE COPY of such drawings and project manual be obtained from Reprographics Inc., acting on behalf of may the Construction Manager -as- Agent- fo•the•Owner, Shlei Sexton- Company, Inc., at the address stated above, upon the pay ment of $200.00 for the set: Additional non refundable deposit sets may be purchased from Reprographics Inc per their ppricing schedule. Payment must be by check. d0 CASH ACCEPTED. Make checks ,payabletoShiel Sexton Company LOUISE M. POWELL Notary I ublic Inc., and deliver them eprographics Inc. Deposit will he NOTARY PUBLIC re funded to Bidders wh R osubmlt a bid and re turn bidding documents in good condition within 10 days from bid open- SEAL inqdate. de Bidrs shall assure that they have obtained complete set STATE OF INDIANA Form 65- 1 -88 of drawings and Contract Documents and shall assume thel M commission ex risk of any errors or omissions in bids prepared in reliance Y Tres: P 2016 on incomplete sets of drawings and Contract Documents. Owner- Contractor Agreements will be executed by the Carmel Redevelopment Commission. Wage rates for the Project shall not be less than the current,) Prescribed scale of wages as determined by the Common Construction Wage Committee in accordance.with I.e. 5 -16 7 and included in the Pro {ect Manual. A pre-bid conference for discussions of the Project the bid- ding requirements and other im vortant matters will be held on June 25, 2008 at 1:00 p.m. EDT at the Shiel Sexton Com- pany 1'ob site trailer located at the southeast corner of 3rd Ave SW and City Center Drive Carmel, Indiana. All prospec- five bidders are invited to ahend the pre-bid conference. The pre -bid conference is not mandatory. No bidder may withdraw any bid or proposal within a period of ninety (90) da s following the date set for receiving bids or °proposals. The Carmel Redeveloppment Commission reserves the right t0 hold any oral) bitls or proposals for a Period of not mare than ninety (90) days and said bids or proposal shall remain in full force and effect during said period. The Carmel Redevelopment Commission reserves the right to re'ect and/or cancel, any and all bids, solicita- tions and /or offers in whole or In part as s ecified in the solicitations' when It is not in the best in�erests of the governmental body as determined by the purchasing agency in accordance with ICS- 22 -18 -2 Diana L.Cordray Clerk- Treasurer 1NL 5/3tl_ F/F S776Fr111. 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 7r nnz. l� S -r Purchase Order No. 30 1r7 ti 4 Terms C) 13 o 1 q I �M� c� z� t s =i tV oA o la— 0 1 uS Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) t� S: c a 6Y n �s4_�) Total +01,310 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 ��r�c.. 1Je ;,vsPa �es IN SUM OF 3 4 62a� ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or S 1 01 JiG 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 Title Cost distribution ledger classification if claim paid motor vehicle highway fund Form Uby State Board of Accounts 900549- 5232639 Gcncral Form INO. 99 I' (Rcv. 1957) CITY OF CARMEL- TOPICS LEGALS To: INDIANA NEWSPAPERS 307 N PENNSYLVANIA ST PO BOX 145 COUNTY, INDIANA INDIANAPOLIS, IN 46206 -0145 PUBLISHER'S CLAIM LINE COUNT Display Matter (Must not exceed two actual lines, neither of which S shall total more than four solid lines of the type in which the body of the advertisement is set). Number of equivalent lines Head Number of lines S Body Number of lines S Tail Number of lines S Total number of lines in notice COMPUTATION OF CHARGES 87.0 lines 1.0 columns wide equals 87.0 equivalent S 42.80 lines at .492 cents per line Charges for extra proofs of publication ($1.00 for each proof in excess of two) .00 S .00 TOTAL AMOUNT OF CLAIM DATA FOR COMPUTING COST 8 Width of single column 7.83 ems Size of type 5_7 point S Number of insertions 1.0 S 42.80 Pursuant to the provisions arld penalties of Chapter 155, Acts of 1953, 1 hereby certify that the foregoing account is just and correct, that the amount claimed is legally due, after allowing all just credits, and that no part of the same has been paid. DATE: 06/13/2008 Clcrk Title NOTICE TO TAVAYERS OF HEARING THE 900549 5232639 P UBL I SHE R 'S ED P UBLISHER 'S AFFI.DA.VVI.T RE �rABUS OF A CUMULATIVE CAPITAL DEVELOPMENT FUND State Of Indiana SS: Notice is herebq9 given the 'Car Hamilton co unty Hamilton County Indiana, that the Carmel Common Council will con. Sider at their Regular Meet- C 5 a; C armel city Han Personally appeared before me, a notary public in and for said county and state, Council Chambers at 6:06 p.m. on June 16, N", the c m alive c pital of the undersigned Karen Mullins who, being duly sworn, says that SH E is clerk opment Fund and its tax levvtlyyi undertho6provisionsOf s eq. a and 36 9.1551 et seq. of the Noblesville Led gel a newspaper of general circulation for the purposes as follows: Any and all uses and Dpui- poses permitted under Pr di ana Coe 3 -8.14 nd printed and published in the English language in the city of NOBLESVILLE in state equipment and police radio' equipment, under Indiana. Code 36- andri for ppublic and county aforesaid, and that the printed matter attached hereto is a true COP buildings and right of wa y" p, under Indiana Code 36.9- 16.3 for public ways and p a rks a nd rsewers, recreation, which was d P ublished said P aper for 2 time between the dates of parks and recreation, police,� hih dl blihd i id p p p i t land fire equipment, bond's retirement and. public transpDilation, under Indi -i ana Gode 36 -9 -16.5 for pub- 06/06/2008 and 06/13/2008 lic ways and sidewalks under Indiana Code 36.94 for the general improve me of streets, alleys, Sitl. alks, curbs, gutters, drains and sewers, under .Indiana Code 36.10.3.21 and /or Indiana Code 36.10 Till 4 -36 for parks recreation I and culture, and under Indi- aria Code 36-9- 15.5 -2 for 'any and all other uses and Subscribed gold sword to before ille oil 06 /13 O8 purposes for which propp- erty taxes�are authorized to be Imposed. The tax will be levied on all taxable real and personal property within the taxin district 'and will not exceed S.05g0 per $loo assessed LOUISE M. POWELL N tzu Public valuation. The propposed fund will be levied begin ning with the taxes due and NOTARY PUBLIC Payable in the year 2009. Tax ayers, appearing at'. SEAL Form 65 REV 1 88 Sin e i n tithe My commiss expires: STATE OF INDIANA T e proposal for re- estab- ishment of the Cumulative Capital Development Fund and its levy is suN1 t to approval by the Depart- 1 ment of Local Government Finance who will require a Notice of Submission to be given to the taxpayers by publication. After the pubb- cation of the Notice of Sub- mission, 5o or more taxpay- ers in the taxing district may file a petition with the Countyry Auditor not later than 30 days after publica- tion setting fort h their ,objections to the proposed levy. Diana L. erk ra, IAMC, Clerk Tre (NL 6/6,6/13 5232639) 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. Pay e 1 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) �D 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 IN SUM OF 1 r wpb o L4boo ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #[TITLE AMOUNT DEPT. I hereby certify that the attached invoices 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 -o -4 Y n Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund