HomeMy WebLinkAbout210421 07/05/2012 CITY OF CARMEL, INDIANA VENDOR: 365399 Page 1 of 1
0 ONE CIVIC SQUARE INSITUFORM TECHNOLOGIES USA INC CHECK AMOUNT: $15,885.19
CARMEL, INDIANA 46032 ATTN: BOX 674060
Mio� 4400 AMON CARTER BLVD, SUITE 110 CHECK NUMBER: 210421
FT WORTH TX 76155
CHECK DATE: 7/5/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
211 4237001 26268 15,885.19 PIPE REPAIRS
Attn: David Huffman 777 INVOICE
TO: City of Carmel,IN Make Checks Payable to:
Street De partment 2012 INSITUFORM TECHNOLOGIES USA INC
3400 W. 131st Street Please Remit Pa ment to LOCK BOX rPamentApplic ation: One
Carmel, IN 46074 BBVA Com ass Bank Platform 26268
Main 317 571 -2400 Insituform Technolo tion 42- 370101
Direct 317 733 -2001 Attn: Box 674060 ieS 126355
Fax 317 733 2005 4400 Amon Carter Blvd., Suite 110
Ft. Worth ,Texas 76155 Work period: 4/1/2012 4/8/2011
INDY Office 317 489 3867 Direct Application Date: 418/2011
Pro Emer gency 15" CIPP Linin 12822 Cahating Crossin g/126th and Grey Rd.
Carmel,IN 46032
ITEM CONTRACT COMPLETED THIS PERIOD COMPLETED -TO -DATE
NO DESCRIPTION QUANTITY UNIT PRICE QUANTITY AMOUNT QUANTITY AMOUNT
1 15" Insituform® CIPP 343 LF 48.75 LF 343 LF 100% 16,721.25 343 LF 16,721.25
Contract 16 721.25 EARNED THIS PERIOD: $16,721.25 EARNED TO DATE: $16,721.25
CONTRACT SUMMARY Month Gross $16,721.25 Less: Relaina e 5% 836.06
Month Retention $836.06
Total Contract Earned 16,721.25 Month Open $15,885.19 Previous Invoices 0.00
Less Relaina a 836.06
Customer Other
Add:
Attention Davide Huffman Total Deductions from
Less: Earned to Date 836.06
cc: DeAnn Berr
Net Amount Due: $15
AMOUNT DUE I
Paid to Date: 0.00 THIS ESTIMATE: $15,885.19
TOTAL DUE: $15,885.19
If there are an questions re garding this payment application, please
AMOU14T PAST DUE: $0.00 contact Alex Sharpe at 317 -489 -3867 office 317- 281 -3767 mobil
Electronic Funds Transfer loll rnmtiun
BiwA Compass
For Overni ht oavments 18080 North Central E.pressoap Prepared by.
Uallas'I'e�as, 75206 Alex Sharpe Indiana, PM
Insituform Technologies USA, Inc. For AC11:111907445 Insituform Technolo ies USA, Inc.
Attn: Box 674060 For Fed. Wi re: I 1 1907445
4400 Amon Carter Blvd., Suite 110 Sssift Code: CPAS1JS44 Approved by:
Ft. Worth ,Texas 76155 Benficiary: Insituform Technolo ies,lnc.
Account No: 2520837755
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
06/22/12 $15,885.19
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 N O.
ALLOWED 20
Insituform Technologies USA LLC
bbva Compass Bank Platform Attn: Box 67406
IN SUM OF
4400 Amon Carter Blvd., Suite 110
Ft. Worth, TX 76155
$15,885.19
ON ACCOUNT OF APPROPRIATION FOR
Carmel Street Department
PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Member;
26268 I I 42- 370.01 I $15,885.19 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
n
Thursday, u4nV28, 2012
Street CommissionW
mppf
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund