178573 10/27/2009 a- CITY OF CARMEL, INDIANA VENDOR: 359662 Page 1 of 1
ONE CIVIC SQUARE A T T CUSTOM WORK ORDER CENTER
CARMEL, INDIANA 46032 220 WISCONSIN AVE
eHECK AMOUNT: $60,344.85
WAUKESHA WI 53186 CHECK NUMBER: 178573
CHECK DATE: 10/2712009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460847 CR #113089 60,344.85 HEARTHVIEW OLD TOWN
05/0512009 11:49 2629700454 ATT CWD CENTER PAGE 01105
a$ l'hoiie: 885 -61$ -6815
Fax: 88$- 901 -2821
May 5, 2049
Sherry, Mielke
City of Carmel
11 1. West Main Street I
Carmel, 46032
Fax: 317- 571 -2789
RE CR4113089
P.TT4 6533490
Parcel 47
AT&T Facility Move
Sherry Mielke,
Enclosed is the Final Statement of Charges Amottnt: $60,344.85
AT &T Federal IDA 134924710.
Please forward your payment to AT Invdice As Fait bt e.'�
Please use the Customer Request Number (CR oo your correspondence.
if you have any questions, please feel free to contact me_
AT &T Enginieer: Steven Krebs
(317) 252-42,75
Please forwardpaTment fo AT &T Custom Work Or der Center
220 Wisconsin Avenue
Waukesha, W1 53186
Please feel free to contact me 588- 618 -6882.
Respectfully,
Beth M. Wittimann
Customer Contracts Specialist
AT&T Custom Work Order Center
4 pages follow
05/05/2009 11:49 2629708454 ATT CWO CENTER PAGE 02/05
AT &T INDIANA Estimate of Cost and Authority for Work A M44 08A
Special Construction Charge and Invoice
Customer Request Number 113089 Date 07/15/2008
Project Number 6533490 Customer ID 103093
Billing Information
Billing Party's Name: CARMEL REDEVELOPMENT COMMISSION PARCEL 47
Phone: (317) 571 2787
Billing Address 111 WEST MAIN STREET
SUITE 140
CARMEL, IN 46032
Contact Name SHERRY MIELKE
Phone (317) 571 -2787
Work Description RELOCATE AT &T FACILITIES AT 1 ST AVENUE NW TO 2ND AVENUE NW, THIS WORK REQUIRES UPFRONT
Engineering Remarks PAYMENT AND SIGNED CONTRACT. PLEASE REMIT PAYMENT TO: 220 WISCONSIN AVENUE, FLOOR 2,
WAUKESHA, WI 53186. COST IS VALID FOR 30 DAYS.
INVOICE
Expenses 1 Amount
Engineering Labor 3.317.63
Material Cost 19,898.97
Construction Lab La
9,043.79
Contractor Cost 28,084.46
Misc. Tax $0.00
Total Estimated Costs 60,344.85
OSPE Representative: BE THEL WIT PAST DUE
Title: C WO Manager A
Phone 888- 618 -6882 l O (L 0-
05/0512009 11:49 26297 08454 ATT CW0 CENTER PAGE 09/05
9 INDIANA RETAIL TAX EXEI pT PAGE
Uny of Ua- rme l CERTIFICATE NO. 0037 20155 402 0 I PURCHASE ORDER NUMSEq
FEDERAL EXCISE TAX EXEMPT
35- 60DO0972
ONE CIVIC SQUARE THIS NUMBER MUST' APPEAR ON INVOICrS AAA
VOUCHER, DEUVERY MEMO, PACKING SLIPS,
CARMEL, INDIANA 4,6032.2584 pFiIPPINQ LAIIELS AND ANY CORHFSPONDENCE.
FORM APPROVED BY STATE I30ARID Or ACCOUNTS FOR CITY OF CARMEI,. 1997
JRCHAo ORDER DATE DAT REQUIRED REQUI
N(7, VENDOA NQ. pE,,,CFi1F'TION
4
IIFNDOR Z b I.,a t c &A.F it SHIP 11( IrJ e /�'�r. n I S., i 1 LAO
iNrmr--T,ON I SLAN T CONTRACT PAYMFN7TEAM9 FREIGHT
QUANTITY UNIITOFMERSURE D[SCTiIF'TfON UNIT PRIDE €>(T
is
5'1 a� ra1x� c1Y�° 4
Send Invoice To c1411r'4e If Ka 1o�.��e..�-
j AJ
PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOU PROJECT PRQJEI TA 0OUNT AMOUNT
PAYMEN
A,P VbU4`ItFti GANN T BE ARhCiOVEO Fnq PAYMENT UNLESS THE P.O.
1�UMF3ER IS MADC A f�AR7 Ot= THE VOUCFIER AND F „Vp_RI' IN711O'CB ANb
VOUCHER HA$ THE d SWOAN AFFIQAVITATT'ACHEb.
SHIPPING INSTRUCTIONS IHEliEBY FpY TF1AT Tli[RE AN UNOgLIGATED flALANCI IN
HI 17P IAi10 aUEf Y j PAY FQRTHEAflOV� DRDER. v_
SHIP REPAID,
O O.O.$HIPM €NTG CANNOT AFAC=PTED. ORDER1nD BY
PURCHASE OROEA NUMBER MUST APPEAR ON ALL 'f
SKIPPING LABELS. ��j
T141S ORDER 1650th IN COMPLIANCE WITH rHAPTrR 99, ACTS 1943 TITLE •�fGr_`
AND ACts AMENDATOF1r HEAECF AND SUPPLE T T
1 9 8 G 5 CLERK- TREASURER -L
DOCUME=NT CONTROL NO. VENDOR COPY
05/05/2009 11:49 2629708454 ATT CWO CENTER PAGE 04105
AT&T INDIANA at &t Estimate of Cost and Authority for Work I s 08 A
Special Construction Charge and Invoice
Customer Request ivumber 113069 Date 07/15/2008
Project Number 6533490 Customer ID 103093
Work Authorization:
I acknowledge that the work described under this agreement is to be completed for my benefit and at my request, I understand
that according to the tariffs of Indiana Sell Telephone Company, Incorporated, d /b /a SOC Indiana, an Indiana corpora tion on file
with the Indiana Utility Regulatory Commission, or the FCC, as applicable, that it is my responsibility to pay those costs incurred
by AT&T INDIANA to complete the work requested,
i understand that if I cancel this work auth6ftation subsequent to acceptance, I am responsible for payment of all engineering
costs incurred by AT &T INDIANA prior to actual work being performed.
I further understand that if changes are required at my request, I will be responsible for any additional costs incurred by
AT &T INDIANA after the c estimate(s) have been prepared.
k o .4TF4
I understand that I must pFepey the estimated charges as stated on page one (9) of this contract prior to the commencement of
any work by AT&T INDIANA, I also understand that if actual charges exceed the estimated costs I will not receive any additional
billing unless I have pre authorized the additional billing due to a change requested by me or my representative(s).
rat sho lobe in the form of a certified check or money order, payable to AT&T INDIANA. 4
Oate
(Print)
For Businoss Customers Only
Corporations;
Agreement must be signed by an officer of the Corporation or Company and attested; or, be accompanied by a certified
resolution of the Board Of Directors authorizing execution by an official of the Corporation or Company
Partnership:
Agreement must be signed by all partners.
Municipalities or Governmental Agencies:
Agreement must be accompanied by a certified resolution authorizing the official signing the agreement to execute on behalf of
the ovemmental Entity. The resolution should hot be certified by the same official signing the executed agreement.
Name of Corporation/ Company /Pomership /Govornmental Entity 'r
Signature Date
(Print) Title
IF THIS AGREEMENT IS NOT SIGNED ANb ACCEPTED WITHIN THIRTY (30) DAYS OF THE DATE ON THIS CONTRACT.
THE ESTIMATrb CQST,*, A$SOGIATED WITH THIS CONTRACT ARE NULLIFICD AND INVALID.
.0510512009 11:49 2629708454 ATT CWD CENTER PAGE 45165
Frain:Urn,ei Redeve].apmenr Cams. 01104/2008 13 :38 #299 P. 0031004
JAM- 04-8Q08 15:10 FRDM:2 2629708453 TO.913175712789 P.081"801
CRO I MOM 1.4.2oLS F`.d," =F.571.2769
oca,te ATW saaBttfes (#3)
10 Ave. NW to 2nd Ave. SW
AUTHOMATION TO PREPARE COST BSTI 4 TE
I byre m- quested and anthorized AT&T to pre em a deWed coat eatimate aseod.ated vdth ng
changos to AT&T's 0�dstix Wet mr'k on my behaE Should. I determine riot to proceed, ura,cc thoso
costa hoe be-m calcWatod acid provided, to me, I understend I am responsible for eM w4i neeri,ng
rata auaoclated VAth prepar"ng the cast estimate.
The s Adpated englneerm. g costs jusaociated with this coat estimate ooWd, r&W mnywhere from
$300 $700 (averap range but not 1itialted to), however, T, a,raderstand. I wM be billod far t1e Actual
eogirecring time required to develop the umit cattmaw.
I fCxnhm a ndderatand that if l proceed. with the =gtiaciAcd, wor1c, the eaimg, chars arc ir�cl,uded
as past of thosc oasts.
Work aiw information
StMgt ad.dresa: II tl�l 7.._ r_st__(RJ� i ts ril rz t {�V �"Q b AV r Vv Np
WMAIUvt a� i
.7 Kk )rt rod O L Si r�7fid e-T VU
City, State, 8a UP; y`` a-A
��'L�11Un O� WQr,� 'Cf. be �Ll.d'I�CS�: t"`��•�f] C:.Q�'4. �rtCc E �.1
o6 C ES rS.t ,�.Nq:7 0.9.3 q 5q
Billing infQmaf4 on T�
c'L7rmpamy Name! t /p n v Q1 �dP_ L$4Qf�,� L ±rrti��3 1 s nrti
Street .Acl4rcas: __'�1.,1 4o s o� r+-
CAV, Stage 7. dip: r a L,
phrme Numbar(a) for contact:
Fax Number fox invoidaag
Print Name
Sfgn�tua Date: L 4
This doa=ent must be aigmed and, ro=wed before any design vwrk will be con .plated. Once
completed pXs oe f9r, or mail ta:
Roth Ill. WIt>tMAIM
Manager—Custom Work OR40X 00 ater
220 Wisconsin Avenne Mr. 2
Whukesha WI 88
Pa. ass.6119.6882
Fes. 888.901. k82
.Tau A4 -PRMP AF,:797M TEL ID)2 PAGE:003 R `96
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
14'7 El T Purchase Order No.
ao�0 (,vtsc.onsln �u�. �Ir.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
62 (13US 11vc.r_� r�ffl
Total (a O j,3 4 4 S
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
4 IN SUM OF
L O ��c�i hm tjor(C Orde-r
(�cJ t.1 Ccrnsl ,'4"c�c'aL. CIa oT •2._
1,0 T 53 i5
0 3 qe( F S_
ON ACCODU I OF APPROPRIATION FOR
T F ///L
Ga y
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT, I hereby certify that the attached invoice(s), or
df o Z� f�0,3u•�f"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 O 7
Signature
Director of Operations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund