170854 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 362753 Page 1 of 1
s` 0 1I ONE CIVIC SQUARE GAYLOR, INC CHECK AMOUNT: $40,500.00
j CARMEL, INDIANA 46032 17225 KRAFT COURT
NOBLESVILLE IN 46060 CHECK NUMBER: 170854
CHECK DATE: 4/16/2009
DEPA ACCOUNT PO NUMB INVOICE NUMBER AMOUNT DESCRIPTION
853 5023990 23 40,500.00 MONON FAMILY REC CENT
-S
Page 1 of4
To: Carmel /Clay Board of Parks and Recreation Project: Monon Family Recreation Center Application M 23
760 3rd Avenue, S.W., Suite 100
Carmel, Indiana 46032 Contract For: BP 4 MC Electrical Application Date: 1126/2009
Gaylor Job 1252530 Period Ending: 1/31/2009 2 5 2009 lJ
From: Gaylor, Inc. 91073701
17225 Kraft Court Architects
I Noblesville, IN 46060 General Contractor
APPLICATION FOR PAYMENT
Application is made for Payment, as shown below, in connection
CHANGE ORDER SUMMARY with the Contract. A Continuation Sheet, with a Schedule of Values
breakdown, is attached.
TOTAL CHANGE ORDERS APPROVED
ON PREVIOUS APPLICATIONS ADDITIONS DEDUCTIONS 1. ORIGINAL CONTRACT SUM $2,998,700.00
CHANGE ORDER DATE APPROVED 2. Net change by CHANGE ORDERS $487,111.00
Change Order 01 $11,934.00
Change Order 03 4,000.00 3. CONTRACT SUM TO DATE $3,485,811.00
Change Order 04 35,158.00
Change Order 05 254,672.00 4. TOTAL COMPLETED STORED TO DATE $3,445,771.00
Change Order 06 8,676.00 1 N a hange Order 07 $1,061.00 5. RETAINAGE: (.v C.
Change Order 08 11,233.00
Change Order 09 1,807.00 10.00% of completed work $4,500.00
Change Order 10 37 ,704.00
Change Order 11 9,782.00 0.00 of stored material $0.00
Change Order 12 37,834.00
Change Order 13 14,400.00 TOTAL RETAINAGE $4,500.00
Chagne Order 14 85,040.00
6. TOTAL EARNED LESS RETAINAGE $3,441,271.00
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $3,400,771.00
8. CURRENT PAYMENT DUE $40,500.00
9. BALANCE TO FINISH, PLUS RETAINAGE $44,540.00
TOTALS: 500,106.00 $12,995.00
NET CHANGE BY CHANGE ORDERS: $487,111.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge, the State of: Indiana
Work covered by this Application for Payment has been completed in accordance with County of: Hamilton
the Contract Documents and that current payment shown herein is now due.
Subscribed and sworn to before me this 26.00 day of
Jan 2,009.00
Notary Public:
Chefyl R. Gi h uai
B Date: 26- Jan -09
Name: Andrew Foreman My Commission expires on: 09/13116
Title: Project Manager 1
County of Residence: Hamilton
Page 2 of 4
4r
To: Carmel /Clay Board of Parks and Recreation Project: Monon Family Recreation Center Application 23
760 3rd Avenue, S.W., Suite 100
Carmel, Indiana 46032 Contract For: BP 4 MC Electrical Application Date: 1/26/2009
Gaylor Job 1252530 Period Ending: 1/31/2009
From: Gaylor, Inc. 91073701
17225 Kraft Court Architects
Noblesville, IN 46060 General Contractor
APPLICATION FOR PAYMENT CONTINUATION SHEET
A B C D E F G H I
ITEM SCHEDULED PREVIOUS COMPLETED STORED TOTAL CP BALANCE TO RETAINAGE
N0. DESCRIPTION OF WORK VALUE WORK THIS PERIOD MATERIALS STORED TO DATE (G /C) FINISH (C -G) 10.00%
1 Bonds 59,974.00 59,974.00 0.00 0.00 59,974.00 100.00% 0.00 5,997.40
2 Mobilization 20,000.00 20,000.00 0.00 0.00 20,000.00 100.00% 0.00 2,000.00
3 Demobilization 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
4 Insurance Safety 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
5 Submittals 15,000.00 15,000.00 0.00 0.00 15,000.00 100.00% 0.00 1,500.00
6 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
7 Temporary Labor 21,600.00 21,600.00 0.00 0.00 21,600.00 100.00% 0.00 2,160.00
8 Temporary Material 14,400.00 14,400.00 0.00 0.00 14,400.00 100.00% 0.00 1,440.00
9 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
10 ESCO General Conditions 2,555.00 2,555.00 0.00 0.00 2,555.00 100.00% 0.00 255.50
11 ESCO Submittals 13,840.00 13,840.00 0.00 0.00 13,840.00 100.00% 0.00 1,384.00
12 ESCO Sound Material 104,077.00 104,077.00 0.00 0.00 104,077.00 100.00% 0.00 10,407.70
13 ESCO Sound Labor 15,602.00 15,602.00 0.00 0.00 15,602.00 100.00% 0.00 1,560.20
14 ESCO Fire Alarm Material 42,790.00 42,790.00 0.00 0.00 42,790.00 100.00% 0.00 4,279.00
15 ESCO Fire Alarm Labor 9,744.00 9,744.00 0.00 0.00 9,744.00 100.00% 0.00 974.40
16 ESCO T/D Material 158,340.00 158,340.00 0.00 0.00 158,340.00 100.00% 0.00 15,834.00
17 ESCO T/D Labor 9,804.00 9,804.00 0.00 0.00 9,804.00 100.00% 0.00 980.40
18 ESCO Closeout 1,392.00 1,392.00 0.00 0.00 1,392.00 100.00% 0.00 139.20
19 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
20 Davis Security 139,545.00 139,545.00 0.00 0.00 139,545.00 100.00% 0.00 13,954.50
21 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
22 Service Entrance Sub 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00% 0.00 1,000.00
23 Service Entrance Material 45,650.00 45,650.00 0.00 0.00 45,650.00 100.00% 0.00 4,565.00
24 Service Entrance Labor 12,040.00 12,040.00 0.00 0.00 12,040.00 100.00% 0.00 1,204.00
25 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
26 Distribution Material 86,424.00 86,424.00 0.00 0.00 86,424.00 100.00% 0.00 8,642.40
27 Distribution Labor 84,960.00 84,960.00 0.00 0.00 84,960.00 100.00% 0.00 8,496.00
28 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
29 Generator Material 32,500.00 32,500.00 0.00 0.00 32,500.00 100.00% 0.00 3,250.00
30 Generator Labor 3,600.00 3,600.00 0.00 0.00 3,600.00 100.00% 0.00 360.00
31 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
32 Payne Sparkman Dimming System 98,400.00 98,400.00 0.00 0.00 98,400.00 100.00% 0.00 9,840.00
33 Lutron Dimming System 223,080.00 223,080.00 0.00 0.00 223,080.00 100.00% 0.00 22,308.00
34 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
35 West Side Ist Floor 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
36 Branch UG Material 14,500.00 14,500.00 0.00 0.00 14,500.00 100.00% 0.00 1,450.00
37 Branch UG Labor 5,800.00 5,800.00 0.00 0.00 5,800.00 100.00% 0.00 580.00
38 Wall RI Material 50,750.00 50,750.00 0.00 0.00 50,750.00 100.00% 0.00 5,075.00
39 Wall RI Labor 94,250.00 94,250.00 0.00 0.00 94,250.00 100.00% 0.00 9,425.00
40 O/H RI Material 43,500.00 43,500.00 0.00 0.00 43,500.00 100.00% 0.00 4,350.00
41 O/H RI Labor 79,750.00 79,750.00 0.00 0.00 79,750.00 100.00% 0.00 7,975.00
42 Branch Wiring Material 21,750.00 21,750.00 0.00 0.00 21,750.00 100.00% 0.00 2,175.00
Page 3 of 4
To: Carmel /Clay Board of Parks and Recreation Project: Monon Family Recreation Center Application 23
760 3rd Avenue, S.W., Suite 100
Carmel, Indiana 46032 Contract For: BP 4 MC Electrical Application Date: 1/26/2009
Gaylor Job 1252530 Period Ending: 1/31/2009
From: Gaylor, Inc. 91073701
17225 Kraft Court Architects
Noblesville, IN 46060 General Contractor
43 Branch Wiring Labor 47,130.00 47,130.00 0.00 0.00 47,130.00 100.00% 0.00 4,713.00
44 Devices Material 2,900.00 2,900.00 0.00 0.00 2,900.00 100.00% 0.00 290.00
45 Devices Labor 5,080.00 5,080.00 0.00 0.00 5,080.00 100.00% 0.00 508.00
46 Lighting Material 282,750.00 282,750.00 0.00 0.00 282,750.00 100.00% 0.00 28,275.00
47 Lighting Labor 121,800.00 121,800.00 0.00 0.00 121,800.00 100.00% 0.00 12,180.00
48 System Cabling Material 7,250.00 7,250.00 0.00 0.00 7,250.00 100.00% 0.00 725.00
49 System Cabling Labor 17,400.00 17,400.00 0.00 0.00 17,400.00 100.00% 0.00 1,740.00
50 FA Devices Labor 5,080.00 5,080.00 0.00 0.00 5,080.00 100.00% 0.00 508.00
51 Pool Equipment Material 10,880.00 10,880.00 0.00 0.00 10,880.00 100.00% 0.00 1,088.00
52 Pool Equipment Labor 7,540.00 7,540.00 0.00 0.00 7,540.00 100.00% 0.00 754.00
53 Kitchen Equipment Material 2,100.00 2,100.00 0.00 0.00 2,100.00 100.00% 0.00 210.00
54 Kitchen Equipment Labor 8,120.00 8,120.00 0.00 0.00 8,120.00 100.00% 0.00 812.00
55 HVAC Equip Material 2,180.00 2,180.00 0.00 0.00 2,180.00 100.00% 0.00 218.00
56 HVAC Equip Labor 2,900.00 2,900.00 0.00 0.00 2,900.00 100.00% 0.00 290.00
57 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
58 West Side 2nd Floor 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
59 Branch UG Material 72,500.00 72,500.00 0.00 0.00 72,500.00 100.00% 0.00 7,250.00
60 Branch UG Labor 11,600.00 11,600.00 0.00 0.00 11,600.00 100.00% 0.00 1,160.00
61 Wall RI Material 20,300.00 20,300.00 0.00 0.00 20,300.00 100.00% 0.00 2,030.00
62 Wall RI Labor 37,700.00 37,700.00 0.00 0.00 37,700.00 100.00% 0.00 3,770.00
63 O/H RI Material 31,900.00 31,900.00 0.00 0.00 31,900.00 100.00% 0.00 3,190.00
64 O/H RI Labor 31,900.00 31,900.00 0.00 0.00 31,900.00 100.00% 0.00 3,190.00
65 Branch Wiring Material 8,700.00 8,700.00 0.00 0.00 8,700.00 100.00% 0.00 870.00
66 Branch Wiring Labor 18,850.00 18,850.00 0.00 0.00 18,850.00 100.00% 0.00 1,885.00
67 Devices Material 1,160.00 1,160.00 0.00 0.00 1,160.00 100.00% 0.00 116.00
68 Devices Labor 2,030.00 2,030.00 0.00 0.00 2,030.00 100.00% 0.00 203.00
69 Lighting Material 116,300.00 116,300.00 0.00 0.00 116,300.00 100.00% 0.00 11,630.00
70 Lighting Labor 48,720.00 48,720.00 0.00 0.00 48,720.00 100.00% 0.00 4,872.00
71 System Cabling Material 2,900.00 2,900.00 0.00 0.00 2,900.00 100.00% 0.00 290.00
72 System Cabling Labor 6,960.00 6,960.00 0.00 0.00 6,960.00 100.00% 0.00 696.00
73 FA Devices Labor 2,030.00 2,030.00 0.00 0.00 2,030.00 100.00% 0.00 203.00
74 HVAC Equip Material 4,350.00 4,350.00 0.00 0.00 4,350.00 100.00% 0.00 435.00
75 HVAC Equip Labor 6,960.00 6,960.00 0.00 0.00 6,960.00 100.00% 0.00 696.00
76 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
77 East Side 1st Floor 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
78 Branch UG Material 7,250.00 7,250.00 0.00 0.00 7,250.00 100.00% 0.00 725.00
79 Branch UG Labor 1,740.00 1,740.00 0.00 0.00 1,740.00 100.00% 0.00 174.00
80 Wall RI Material 15,230.00 15,230.00 0.00 0.00 15,230.00 100.00% 0.00 1,523.00
81 Wall RI Labor 28,280.00 28,280.00 0.00 0.00 28,280.00 100.00% 0.00 2,828.00
82 O/H RI Material 13,050.00 13,050.00 0.00 0.00 13,050.00 100.00% 0.00 1,305.00
83 O/H RI Labor 23,930.00 23,930.00 0.00 0.00 23,930.00 100.00% 0.00 2,393.00
84 Branch Wiring Material 6,530.00 6,530.00 0.00 0.00 6,530.00 100.00% 0.00 653.00
85 Branch Wiring Labor 14;140.00 14,140.00 0.00 0.00 14,140.00 100.00% 0.00 1,414.00
86 Devices Material 870.00 870.00 0.00 0.00 870.00 100.00% 0.00 87.00
87 Devices Labor 1,520.00 1,520.00 0.00 0.00 1,520.00 100.00% 0.00 152.00
88 Lighting Material 214,600.00 214,600.00 0.00 0.00 214,600.00 100.00% 0.00 21,460.00
89 Lighting Labor 54,670.00 54,670.00 0.00 0.00 54,670.00 100.00% 0.00 5,467.00
90 System Cabling Material 2,180.00 2,180.00 0.00 0.00 2,180.00 100.00% 0.00 218.00
91 System Cabling Labor 5,220.00 5,220.00 0.00 0.00 5,220.00 100.00% 0.00 522.00
92 FA Devices Labor 1,520.00 1,520.00 0.00 0.00 1,520.00 100.00% 0.00 152.00
93 HVAC Equip Material 2,180.00 2,180.00 0.00 0.00 2,180.00 100.00% 0.00 218.00
s
Page 4 of 4
To: Carmel /Clay Board of Parks and Recreation Project: Monon Family Recreation Center Application 23
760 3rd Avenue, S.W., Suite 100
Carmel, Indiana 46032 Contract For: BP 4 MC Electrical Application Date: 1/26/2009
Gaylor Job 1252530 Period Ending: 1/31/2009
From: Gaylor, Inc. 91073701
17225 Kraft Court Architects
Noblesville, IN 46060 General Contractor
94 HVAC Equip Labor 2,900.00 2,900.00 0.00 0.00 2,900.00 100.00% 0.00 290.00
95 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
96 East Side 2nd Floor 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
97 Branch UG Material 2,900.00 2,900.00 0.00 0.00 2,900.00 100.00% 0.00 290.00
98 Branch UG Labor 870.00 870.00 0.00 0.00 870.00 100.00% 0.00 87.00
99 Wall RI Material 7,610.00 7,610.00 0.00 0.00 7,610.00 100.00% 0.00 761.00
100 Wall RI Labor 14,140.00 14,140.00 0.00 0.00 14,140.00 100.00% 0.00 1,414.00
101 O/H RI Material 6,530.00 6,530.00 0.00 0.00 6,530.00 100.00% 0.00 653.00
102 O/H RI Labor 11,960.00 11,960.00 0.00 0.00 11,960.00 100.00% 0.00 1,196.00
103 Branch Wiring Material 3,260.00 3,260.00 0.00 0.00 3,260.00 100.00% 0.00 326.00
104 Branch Wiring Labor 7,070.00 7,070.00 0.00 0.00 7,070.00 100.00% 0.00 707.00
105 Devices Material 440.00 440.00 0.00 0.00 440.00 100.00% 0.00 44.00
106 Devices Labor 760.00 760.00 0.00 0.00 760.00 100.00% 0.00 76.00
107 Lighting Material 32.953.00 32,953.00 0.00 0.00 32,953.00 100.00% 0.00 3,295.30
108 Lighting Labor 5,470.00 5,470.00 0.00 0.00 5,470.00 100.00% 0.00 547.00
109 System Cabling Material 1,090.00 1,090.00 0.00 0.00 1,090.00 100.00% 0.00 109.00
110 System Cabling Labor 2,610.00 2,610.00 0.00 0.00 2,610.00 100.00% 0.00 261.00
111 FA Devices Labor 760.00 760.00 0.00 0.00 760.00 100.00% 0.00 76.00
112 HVAC Equip Material 4,350.00 4,350.00 0.00 0.00 4,350.00 100.00% 0.00 435.00
113 HVAC Equip Labor 6,530.00 6,530.00 0.00 0.00 6,530.00 100.00% 0.00 653.00
114 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
115 Change Order 01 (11,934.00) (11,934.00) 0.00 0.00 (11,934.00) 100.00% 0.00 (1,193.40)
116 Change Order 03 4,000.00 4,000.00 0.00 0.00 4,000.00 100.00% 0.00 400.00
117 Change Order 04 35,158.00 35,158.00 0.00 0.00 35,158.00 100.00% 0.00 3,515.80
118 Change Order 05 254,672.00 254,672.00 0.00 0.00 254,672.00 100.00% 0.00 25,467.20
119 Change Order 06 8,676.00 8,676.00 0.00 0.00 8,676.00 100.00% 0.00 867.60
120 Change Order 07 (1,061.00) 0.00 0.00 (1,061.00) 100.00% 0.00 (106.10)
121 Change Order 08 11,233.00 11,233.00 0.00 0.00 11,233.00 100.00% 0.00 1,123.30
122 Change Order 09 1,807.00 1,807.00 0.00 0.00 1,807.00 100.00% 0.00 180.70
123 Change Order 10 37,704.00 37,704.00 0.00 0.00 37,704.00 100.00% 0.00 3,770.40
124 Change Order 11 9,782.00 9,782.00 0.00 0.00 9,782.00 100.00% 0.00 978.20
125 Change Order 12 37,634.00 37,634.00 0.00 0.00 37,634.00 100.00% 0.00 3,763.40
126 Change Order 13 14,400.00 14,400.00 0.00 0.00 14,400.00 100.00% 0.00 1,440.00
127 Change Order 14 85,040.00 0.00 45,000.00 0.00 45,000.00 52.92% K 40,040.00 )(4,500.00
128 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
129 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
130 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
131 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
132 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
133 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
134 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
135 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
TOTALS: 3,485,811.00 $3,400,771.00 $45,000.00 $0.00 $3,445,771.00 98.85% $40,040.00 $344,577.10
z er
Document G7011CMa TM -1992
Change Order Construction Manager Adviser Edition
PROJECT (Name -and address): CHANGE ORDER NUMBER: 014 OWNER:
Carmel /Clay Central Park:Carmel, INITIATION DATE: November 19, 2008 CONSTRUCTION MANAGER:
Indiana ARCHITECT:
CONTRACTOR:
TO CONTRACTOR (Nm
ae and address): PROJECT NUMBERS: 2722.002 FIELD: El
'.Gaylor in 03060 OTHER: El
17225 Kraft Court CONTRACT DATE: August 24, 2005
:Noblesville IN 46060 CONTRACT FOR: Monon Center
Electrical Power, Lighting and
Systems
THE CONTRACT IS CHANGED AS FOLLOWS:
Provide additional harking lot lights in the East Motion parking lots, circular drive, and walkway lighting per CWO #367, dated
11/19/08,: Add $85 04000,`
�A fully executed. Change Order shall constitute a final settlement of all matters relating to or arising out of the change in the
Work that is the of the Change Order, including, but in no way limited to, all direct and indirect costs associated with
such charige,and any and all adjustments to the Contract Sum and Contract Time.
The original Contract Sum was 2,998,700.00
Net change by pieyiously authorized Change Orders 402,071.00
The Contraet Suin,pnorto this Change Order was 3,400,771.00
The`Contract Sum will be increased by this Change Order in the amount of 85,040.00
The new: Contract Sum including this Change Order will be 3,485,811.00
The.Contract Time will be unchanged by Zero 0) days.
The, aid of Substantial Completion as of the date of this Change Order therefore is March 31, 2009.
NOTE: This summary does not reflect changes in the Contract Sum, Contract Time or Guaranteed Maximum Price which have
been authorized by Construction Change Directive.
NOT VALID UNTIL SIGNED BY.THE:OWNER, CONSTRUCTION MANAGER, ARCHITECT AND CONTRACTOR.
Geupel DeMars Hagerman, LLC Williams Architects
CONSTRUCTION MANAGER (Firm name) ARCHITECT (F irm name)
'7930 Castleway`Drive:(46250- 1952), P.O. Box 502710, 450 E. Gundersen Drive, Carol Stream, IL 60188
Indianapolis; IN 46250 -7710
ADDRESS ADDRESS
BY (Stgnantre) BY (Signature)
Jeffrey D. Schroeder Steve Mihelich
(Typed DATE: (Typed name) DATE:
Gaylor; Ine Carmel -Clay Board of Parks and Recreation
CONTRACTOR (Firm name) OWNER (Firm name)
17225 Kraft Court, Noblesville, IN 46060 760 3rd Avenue, S.W., Suite 100, Carmel, IN 46032
ADDRESS ADDRESS
BY (Signature) BY (Signature)
Justin Baker James L. Engledow
(Typed name) DATE: (Typed name) DATE:
AIA Document G701 /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 AIR 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. This document was produced
by AIA software at 15:57:20 on 11/19/2008 under Order No.1000352057_5 which expires on 4/29/2009, and is not for resale.
User Notes: (2961951586)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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.
t
Payee
Purchase Order No.
Gaylor, Inc. Terms
17225 Kraft Court
Noblesville, IN 46060
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
i
1/26/09 23 Bid pkg 4 -17 Lighting Systems 40,500.00
Total 40,500.00
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.
Gaylor, Inc. Allowed 20
17225 Kraft Court
Noblesville, IN 46060
In Sum of
40,500.00
ON ACCOUNT OF APPROPRIATION FOR
853 Gift Fund
PO# or INVOICE NO kCCT #/TITLl AMOUNT Board Members
Dept
853 23 5023990 40,500.00 1 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
9 -Apr 2009
Signature
40,500.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund