HomeMy WebLinkAbout178524 10/26/2009 CITY OF CARMEL, INDIANA VENDOR: 105285 Page 1 of 1
ONE CIVIC SQUARE GAYLOR ELECTRIC INC
CARMEL, INDIANA 46032 PO BOX 3757 CHECK AMOUNT: $10,079.00
+.ru CARMEL IN 46082
CHECK NUMBER: 178524
CHECK DATE: 10/26/2009
DEPARTM ACCOUNT P O NUMBER IN VOICE NU MBE R A MOU NT DESCRIPTI
902 4460807 90173 10,079.00 ENERGY CENTER
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SHIEL SEXTON
i ransmittal
I 7/29/2009
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Transmitted To:
LES OLDS
CITY OF CARMEL
1 CIVIC SQUARE
CARMEL, IN 46032
FAX: 317.571.2789
Owner: CITY OF CARMEL Transmittal 10
Project
ENE C ENTER CARMEL SSC p 2805
Reason For
Architect CSO ARCHITECTS Delive FOR YOUR REVIEW AND APPROVAL
Delivered MAIL Sent B
VW y: THOMAS PLAHITKO II
Phone (317)688 -6894 Fax (317) 849 -6314
Reference:
Subject:
CARMEL ENERGY CENTER DUKE ENERGY UTILITY INVOICES
Document Type Document Copim Status Remarks /Comments a
Gaylor Invoice #90173 1 Submitted
for Duke Energy Utility For
Invoices Approval
Notes:
Includes:
Gaylor CP #52 Duke Energy Invoice for Period 3/5 thru 4/3 for $1,727
Gaylor CP #53 Duke Energy Invoice for Period 4/3 thru 5/5 for $1,384
Gaylor CP #54 Duke Energy Invoice for Period 5/5 thru 6/4 for $2,036
Gaylor CP #57 Duke Energy Invoice for Period 6/4 thru 7/6 for $4,932
Total: $10,079
THOMAS PLAHITKO 11
M. File
902 N Capitol Avenue, Indianapolis IN 46204
Phone: 317 423 -6000 FAX: 317 423 -6300
Y I LD REMIT T vrsm_ rm0
P.O. Bo 3757 W
to GLADLY ACCEPT
Corporate Offices Carmel, IN
Visa MasterCard American Express
317.843.0577 Fax 317.848.0364 Carmel, IN 46082 -3757
800.878.0577
http: /www.gaylor.com
FED ID# 20- 3727689
Invoice 90173
Bill to: Job: 91051802
City of Carmel Carmel City Ctr Energy Ct
Redevelopment Commission 777 3rd Avenue SW
One Civic Square South of City Center Drive
Carmel, IN 46032 Carmel, IN 46032
Invoic 9 0173 Date: 07/28 Customer P.O.
Payment Terms: NET 30 Salesperson:
Customer Code: CITCAR
Remarks: CP# 52, 53, 54, 57
Energy Center Parcel 7C
See attached paperwork 10,079.00
Subtotal: 10,079.00
Total: 10,079.00
Page: 1
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June 4, 2009 CP #52
CCC Energy Center
CHANGE PROPOSAL
Tom Plahitko
Shiel Sexton
902 North Capitol
Indianapolis, IN 46204
Proposal: RFQ #XXX /CP #52
Duke Energy Invoice from March 5th thru April 3rd. 2009 for the power service for the Carmel Energy
Center.
Dear Tom Plahitko:
Per your request, we have reviewed the documents provided related to this change in scope request
and prepared an estimate of the costs involved. The documents received to define the change in
scope are as follows:
1 RFQ #XXXX Dated: 6/4/2009
We have determined the value of the work involved in this change to be 1,727
We request a Change Order be issued in that amount to authorize us to include this work in our contract.
To expedite implementation of this change, please return a copy of this letter signed as noted below to
acknowledge acceptance of our Change Proposal.
Attached is a scope summary and cost breakdown for your review to be sure we have accurately interpreted
the work we are required to perform by this Change Proposal.
Thank you for your consideration of Gaylor Group, Inc. We look forward to meeting your needs.
Sincerely,
:lor, Inc. S ence
Project Manager
PROPOSAL ACCEPTANCE:
ADD:
ACCEPTED IN THE SUM OF $1,727
THIS DAY OF 1 20
FOR BY
COMPANY NAME AUTHORIZED AGENT NAME TITLE
NOTE: This proposal is valid for 30 days from the proposal date or until work has progressed to the
point that this proposal would not be valid. Please sign and return the original proposal and retain a
copy for your files.
Page 1 of 2 Date: 61412689 Time: 19:67 AM
r
June 4, 2009
Number: CP #52
SCOPE OF WORK FOR:
RFQ #XXX /CP #52
Alterations, specifications, remarks and exceptions are as follows:
1. No cutting or patching of the existing surfaces are included, if applicable.
2. Sales Tax is not included.
3. All work in above quote is based on straight time.
NOTE: The above price is based on attached Duke Energy Invoice. See attached Invoice
for scope of work.
Page 2 of 2 Date: 6/4/2009 Time: 10:57 AM
CHANGE PROPOSAL PRICING SUMMARY
Project CCC Energy Center RFQ #XXX /CP#52
Division Electrical DATE 6/4/2009
Contractor Gaylor
Page Trade Labor Labor Material Equipment Subs
Breakdown Classification Mantiours Rate Cost/Credit Cost/Credit Cost/Credit Cost/Credit
Duke En rgy Electrical 1 45.33 45.33 1.88 9,597.19
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electricai 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
i
Electrical 45.33
Electrical 45.33
Electrical 45.33
NET TOTALS 1 45.33 45.33 1 1.88 Is 1,597.19
NET TOTAL LABOR COST OF 45.33 X 1.10 49.86
NET TOTAL MAIL COST OF X 1.10
NET TOTAL EQUIPMENT COST OF 1.88 X 0.00
NET SUBCONTRACTOR COST OF 1,597,19 X 1.05 1,677.05
NET SMALL TOOLS COST OF 45.33 x 0.00
(WE W OR COST)
NET TOTAL SALES TAX 1,599.07 X 0.00
(BARE MAT'L COST)
BOND COSTS 1,726.91 x 0.00
TOTAL COST 1,727
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A t 28;2009 $1,597.19 r .S�
Account Number 1900-3694 -01.4 Cm 03 1 h
For more detailed billing Information on
Your monthly bill, check box on right
He! in band Contribution Amount Enclosed
(for Customer Assistance) s
00023180 PS11 ZA 09097- ZIPCODE 07 YNNNNN Ioa
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GaylorElec ;tic
Carmel Energy Center x soul 076 s
PO Box 3757
11fe KY 40290 1076
Carmel IN 46082 -3757
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900 00001597191 19003694014 042820091 00001641972
I PLEASE RETURN THE TOP PORTION WITH YOUR PAYMENT. f
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9
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8 Duke Energy 1 -800- 521 -2232 1900 3694 -01.4
913 r:4• i e�.
Carmel IN 46032
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PO Box 9001076 Payments after Apr OQ not Included 1310 prepare
Louisville KY 40290- d on Apr 06, 2089
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1076
Last payment received Mar 30 Next meter reading May OS 2009 �1lr,y H >u,� '�,g,�� s����� #1RY,.�zl`y �96�$��M.6' 6 te ��:r e2 �kr��
Mar 05
Elec 106943187 ^z r p3 29
AP 4 17,759
On Peak
113.60 tt
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.£EF? y, .f..�.; "z`�:a �j a �S s,.`,= 1r�
Usage 17,759 kWh 47.20 kVar Amt Due Previous Bill w 1,781.72 �a
Energy 1,492.70 Payment(s) Received 1 781.72 s
Duke Ener Rate LSNO 1•: r
Current Electric Charges
$1,492.75 Balance Forward 0 .00
Cure a H
r nt Electric Charges 1,992.70
Taxes
�°=^M s: id8 �k 01
Current Amount Due 1,59.
Taxes 104.49
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Average Cost. 0.0841 per kWh Apr 28, 2009 1,597.19 1,641.97 x v t
D u k e E nergy. visit us at: ,duke r .com
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June 4, 2009 CP #53
CCC Energy Center
CHANGE PROPOSAL
Tom Plahitko
Shiel Sexton
902 North Capitol
Indianapolis, IN 46204
Proposal: RFQ #XXX /CP #53
Duke Energy Invoice from April 3rd thru May 5th, 2009 for the powerservfce for the Carmel Energy
Center.
Dear Tom Plahitko:
Per your request, we have reviewed the documents provided related to this change in scope request
and prepared an estimate of the costs involved. The documents received to define the change in
scope are as follows:
9 RFQ #XXXX Dated: 6/4/2009
We have determined the value of the work involved in this change to be 1,384
We request a Change Order be issued in that amount to authorize us to include this work in our contract.
To expedite implementation of this change, please return a copy of this letter signed as noted below to
acknowledge acceptance of our Change Proposal.
Attached is a scope summary and cost breakdown for your review to be sure we have accurately interpreted
the work we are required to perform by this Change Proposal.
Thank you for your consideration of Gaylor Group, Inc. We look forward to meeting your needs.
Sincerely,
Gaylor, Inc
P aniel ence
Project Manager
PROPOSAL ACCEPTANCE:
ADD:
ACCEPTED IN THE SUM OF $1,384
THIS DAY OF 20
FOR BY
COMPANY NAME AUTHORIZED AGENT NAME TITLE
NOTE: This proposal is valid for 30 days from the proposal date or until work has progressed to the
point that this proposal would not be valid. Please sign and return the original proposal and retain a
copy for your files.
Page 1 of 2 Date: 6!4!2009 Time: 10:59 AM
June 4, 2009
Number: CP #53
SCOPE OF WORK FOR:
RFQ #XXX/CP #53
Alterations, specifications, remarks and exceptions are as follows:
1. No cutting or patching of the existing surfaces are included, if applicable.
2. Sales Tax is not included.
3. All work in above quote is based on straight time.
NOTE: The above price is based on attached Duke Energy Invoice. See attached Invoice
for scope of work.
Page 2 or 2 Date: 6/412009 Time: 10:59 AM
CHANGE PROPOSAL PRICING SUMMARY
Project CCC Energy Center RFQ #XXX/CP #53
Division Electrical DATE 6/412009
Contractor Gaylor
Page Trade Labor Labor Material Equipment Subs
Breakdown Classification Manhours Rafe Cost/Credit Cost/Credit Cost/Credit CostlCredit
Duke Ener Electrical 1 45.33 45.33 1.88 1,270.42
Electrical 45.33
Etectrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
NET TOTALS 1 45.33 45.33 1.88 1,270.42
i
NET TOTAL LABOR COST OF 45.33 x 1.10 49.86
NET TOTAL MAIL COST OF X 1.10
NET TOTAL EQUIPMENT COST OF 1.88 x 0.00
NET SUBCONTRACTOR COST OF 1,270.42 X 1.05 1,333.94
NET SMALL TOOLS COST OF 45.33 x 0.00
JMRE LIBOR COST)
NET TOTAL SALES TAX 1,272.30 x 0.00
WE uAiLCOST)
BOND COSTS 1,383.80 x 0.00
TOTAL COST 1,384
Account (dumber 1900- 3694 -01 -4 CAA 03 Jun 1, 2009 $1,270.42
For more detailed billing information on
your monthly bill, check box on right Helping Hand Contribution Amount Enclosed
(for Customer Assistance)
1. loll 1II, I114 61164 111111 Irrlir1 loll IIII III IIIIIIIII I$111IIlml
00=663 Psi I ZA09129- ZIPCODE 11 YNNNNN Ioz
Gayior Electric
Cannel Ener Center PO Box 9001076
PO Box 3757 Louisville KY 40290 -1076
Carmel IN 46082 -3757
900 00001270427 19003694014 060120099 00001306049
I PLEASE,RETURN THE TOP PORTION WrtH YOUR PAYMENT. t Page 1 o1 1
I4A
Gaylor Electric Duke Energy 1- 800 -521 -2232 1900- 3694 -01 -4
891 3Rd Ave SW
Carmel IN 46032
z.. .r- l= >:xi `:ivs; n .v -r.• '`xw �R.!i..:_ ..F. ?.1� �l._ <i %''.r<�f�i?
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PO Box 9001076 Payments after May 08 not included 801 prepared on May 08, 2009
Louisville KY 40290 -1076 Last payment received Apr 24 Next meter reading Jun 04, 2009
3M #�saitifEi'`
Elec 106943187 Apr 03 May 05 32 13,734
On Peak 167.20
Usage 13,734 kWh 98.40 kVar Amt Due Previous Bill $1,597.19
Duke Energy Rate LSNO $1,187.31 Payment(s) Received 1,597.19
Current Electric Charges 1, 87.31 Balance Forward 0.00
Current Electric Charges 1,187.31
Taxes
Current Amount Due 2
1 270.4
Taxes 83.11
REC M AY I 2U09
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Average Cost: 0.0865 per kWh Jun 1, 2009 $1,270.42 1,306.04
DukeEnergy. visit us at www .duke- energy.com
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Billpayer 2000 Automatically pay from your checking account for 300/transaction enroll at 1.800.991.7771
Speedpay% Pay by phone 1- 877 596 -5068 with credit card or check a convenience fee will be charged.
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June 29, 2009 CP #54
CCC Energy Center
CHANGE PROPOSAL
Tom Plahitko
Shiel Sexton
902 North Capitol
Indianapolis, IN 46204
Proposal: RFQ #XXX /CP #54
Duke Energy Invoice from May 5th thru June 4th 2009 for the power service for the Carmel Energy
Center,
Dear Tom Plahitko:
Per your request, we have reviewed the documents provided related to this change in scope request
and prepared an estimate of the costs involved. The documents received to define the change in
scope are as follows:
1 RFQ #XXXX Dated: 6/29/2009
We have determined the value of the work involved in this change to be 2 ,036
We request a Change Order be issued in that amount to authorize us to include this work in our contract.
To expedite implementation of this change, please return a copy of this letter signed as noted below to
acknowledge acceptance of our Change Proposal.
Attached is a scope summary and cost breakdown for your review to be sure we have accurately interpreted
the work we are required to perform by this Change Proposal.
Thank you for your consideration of Gaylor Group, Inc. We look forward to meeting your needs.
Sincerely,
Z A.ppence
Project Manager
PROPOSAL ACCEPTANCE:
ADD:
ACCEPTED IN THE SUM OF $2,036
THIS DAY OF 20
FOR BY
COMPANY NAME AUTHORIZED AGENT NAME TITLE
NOTE: This proposal is valid for 30 days from the proposal date or until work has progressed to the
point that this proposal would not be valid. Please sign and return the original proposal and retain a
copy for your files.
Page 9 of 2 Dale: 612912009 Time: 1:55 PM
June 29, 2009
Number: CP #54
SCOPE OF WORK FOR:
RFQ #XXX/CP #54
Alterations, specifications, remarks and exceptions are as follows:
1. No cutting or patching of the existing surfaces are included, if applicable.
2. Sales Tax is not included.
3. All work in above quote is based on straight time.
NOTE: The above price is based on attached Duke Energy Invoice. See attached Invoice
for scope of work.
Page 2 of 2 Date: 6!2912009 Time: 1:55 PM
CHANGE PROPOSAL PRICING SUMMARY
Project CCC Energy Center RFQ #XXX/CP#54
Division Electrical DATE 6/29/2009
Contractor Gaylor
Page Trade Labor Labor Material Equipment Subs
Breakdown Classification Manhours Rate CosUCredit CosUCredit Cos CosUCredit
Duke Energy Electrical 1 45.33 45.33 1.88 1,891.94
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 4533
NETTOTALS 1 45.33 45.33 1.88 1,891.94
NET TOTAL LABOR COST OF 45.33 x 1.10 49.86
NET TOTAL MAIL COST OF x 1.10
NET TOTAL EQUIPMENT COST OF 1.88 X 0.00
NET SUBCONTRACTOR COST OF 1,891.94 x 1.05 1,986.54
NET SMALL TOOLS COST OF 45.33 x 0.00
ISAAE ueors COST)
NET TOTAL SALES TAX 1,893.82 x 0.00
(PARE NAIL COST)
BOND COSTS 2,036.40 x 0.00
TOTAL COST 2,036
DukeEnergy,
Account Number 1900 3694 -01.4 CM 03 Jun 29, 2009 $1,891.94
For more detailed billing information on
Your monthly bill, check box on right HelpingHand Contribution Amount Enclosed
(for Customer Assistance)
I doll 1111111111.1111 111111111111111111 oil 11111 1111JgoI111111
00024305 PSII ZA 09157 ZIPcODE 03 YNNNNN iot
Gaylor Electric
Carmel Ener y Center PO Box 9001076
PO Box 375 Louisville KY 40290 -1076
Carmel IN 46082 -3757
900 00001891944 19003694014 062920092 00001944991
t PLEASE RETURN THE TOP PORTION WITH YOUR PAYMENT, t Page 1 of 1
Gaylor Electric Duke Energy 1- 800 -521 -2232 1900 3694 -01.4
891 3Rd Ave SW
Carmel IN 46032
MK 1i1:'lti�•
n.: i....._...-............-,:. -.i mow: v..: i.).
PO Box 9001076 Payments after Jun 05 not Included Bill prepared on Jun 05, 2009
Louisville KY 40290 -1076 Last payment received May 26 Next meter reading Jul 06, 2009
Elec 106943187 May 05 Jun 04 30 20,975
On Peak 169.60
Usage 20,975 kWh 73,60 kVar Amt Due Previous Bill 1,270.42
Duke Energy Rate LSNO 1,768.17 Payment(s) Received 1,270.42cr
Current Electric Charges 1,7681 Balance Forward 0.00
Current Electric Charges 1,768.17
Taxes 7
Current Amount Due 1,891.94
Taxes $123. 77.
6� RECD JUN 10 2009
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Average Cost: 0.0843 per kWh Jun 29, 2009 5,891.94 $1,944.99
DukeE ergy® visit us at www.duke- energy.com
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July 23, 2009 CP #57
CCC Energy Center
CHANGE PROPOSAL
Tom Plahitko
Shiel Sexton
902 North Capitol
Indianapolis, IN 46204
Proposal: RFQ #XXX /CP #57
Duke Energy Invoice from June 4th thru July 6th, 2009 for the power service for the Carmel Energy
Center.
Dear Tom Plahitko:
Per your request, we have reviewed the documents provided related to this change in scope request
and prepared an estimate of the costs involved. The documents received to define the change in
scope are as follows:
1 RFQ #XXXX Dated: 6/29/2009
We have determined the value of the work involved in this change to be 4,932
We request a Change Order be issued in that amount to authorize us to include this work in our contract.
To expedite implementation of this change, please return a copy of this letter signed as noted below to
acknowledge acceptance of our Change Proposal.
Attached is a scope summary and cost breakdown for your review to be sure we have accurately interpreted
the work we are required to perform by this Change Proposal.
Thank you for your consideration of Gaylor Group, Inc. We look forward to meeting your needs.
Sincerely,
Gaylor in
kanielJ. Spence
Project Manager
PROPOSAL ACCEPTANCE:
ADD:
ACCEPTED IN THE SUM OF $4,932
THIS DAY OF 1 20
FOR BY
COMPANY NAME AUTHORIZED AGENT NAME TITLE
NOTE: This proposal is valid for 30 days from the proposal date or until work has progressed to the
point that this proposal would not be valid. Please sign and return the original proposal and retain a
copy for your files.
Page 1 of 2 Date: 7/23/2009 Time: 10:32 AM
s
July 23, 2009
Number: CP #57
SCOPE OF WORK FOR:
RFQ #XXX /CP #57
Alterations, specifications, remarks and exceptions are as follows:
1. No cutting or patching of the existing surfaces are included, if applicable.
2. Sales Tax is not included.
3. All work in above quote is based on straight time.
NOTE: The above price is based on attached Duke Energy Invoice. See attached Invoice
for scope of work.
Page 2 0 2 Date: 7123/2009 Time: 10:32 AM
CHANGE PROPOSAL PRICING SUMMARY
Project CCC Energy Center RFQ #XXX/CP#57
Division Electrical DATE 7/23/2009
Contractor Gaylor
Page Trade Labor Labor Material Equipment Subs
Breakdown Classification Manhours Rate I Cost/Credit Cost/Credit Cost/Credit Cost/Credit
Duke Energy Electrical 1 45.33 45.33 1.88 4,650.07
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 1 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Electrical 45.33
Etectrical 45.33
Electrical 45.33
NET TOTALS 1 45.33 45.33 1 1.88 4,650.07
NET TOTAL LABOR COST OF 45.33 x 1.10 49.86
NET TOTAL MAIL COST OF x 1.10
NET TOTAL EQUIPMENT COST OF 1.88 x 0.00
NET SUBCONTRACTOR COST OF 4,650.07 x 1.05 4,882.57
NET SMALL TOOLS COST OF 45.33 x 0.00
4% RE VZOR COST)
NET TOTAL SALES TAX 4,651.95 x 0.00
twE VATS, C.OS7)
BOND COSTS 4,932.43 x 0.00
TOTAL COST 4,932
aekeEnerg�.
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Account Number 1900. 3694 -01 -4 CAA. 03 Jut 29, 2009 4,554.07
For more detailed billing Information on
your monthly bill, check box on right HelpingHand Contribution Amount Enclosed
(for Customer Assistance)
11111 111111 111 1111111 loll 111 111 oil 1 11 01111 11111 1111 I III I
00023641 PSII ZA Mt89- ZIPCODE 03 YNNNNN tot
Gaylor Inc
Carmel Ener y Center PO Box 9001076
PO Box 375 Louisville KY 40290 1076
Carmel IN 46082 -3757
900 00004650077 19003694014 072920090 00004780450
t} PLEASE RETURN THE TOP PORTION WITH YOUR PAYMENT, t Pag 1 O f 1
....1.11::1.;
Gaylor Inc Duke Energy 1 -800 -521 -2232 1900 3694 -01 -4
891 3Rd Ave SW
Carmel IN 46032
;'::t% <�iC &t7#7ntrtnl`Q n tiQtk>:;';::;;:';<_
...vi .:i »J.n }:.i::.:i< +5'.':: j.: <j :.;:iii �6
PO Box 9001076 Payments after Jul 07 not included Bill prepared on Jul 07, 2009
Louisville KY 40290.1076 Last payment received Jun 17 Next meter reading Aug 04, 2009
Vie#!:= <<;:•N.0 .�t`:;.: •.::<To::::.::':r ...D s -1:?
Elec 106943187 Jun 04 Jul 06 32 52,218
On Peak 255.20
tt'I1�t�d
I�: ^i :<'i'':'Sr �:i��ij ::jai i��'
Usage 52,218 kWh 131.20 kVar Amt Due Previous Bill 1,891.94
Duke Energy Rate LSNO 4,345.86 Payment(s) Received 1,891.94
Current Electric Charges $4,345. 66 Balance Forward 0.00
Current Electric Charges 4,345.86
Taxes
<F<:
Current Amou un Due
4,650.07
Taxes 304.21
JUL 1 0
1
Average Cost: 0.0832 per kWh Jut 29, 2009 4,650.07 4,780.45
Duke Energy. visit us at www.duke- energy.com
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
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Lo r ��oC7 i Purchase Order No.
�✓�a' 3 757 Terms
/x/ Y6 09 2 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
e
i
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.
y ALLOWED 20
IN SUM OF
Z7 00 2 --3757
ON ACCOUNT OF APPROPRIATION FOR
C! 3
Board Members
PO# or DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
X �l�/73 �/y6o�� 16, 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
200
Sign ure
Director 4 Operations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund