HomeMy WebLinkAbout212632 09/12/2012 CITY OF CARMEL, INDIANA VENDOR: 148000 Page 1 of 1
ONE CIVIC SQUARE INDIANA DEPT OF TRANSPORTATION CHECK AMOUNT: $12,287.12
CARMEL, INDIANA 46032 100 N SENATE AVE,RM IGC-N 725
INDIANAPOLIS IN 46204-2216 CHECK NUMBER: 212632
CHECK DATE: 9/12/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 R4462862 21370 16085 12 , 287 . 12 HAZEL DELL ROAD
INDIANA DEPARTMENT OF TRANSPORTATION
Driving Indiana's Economic Growth
INVOICE
100 North Senate Avenue
r � qMitchell E. Daniels,Jr., Governor
Room IGC-N 725
OPTi Indianapolis, Indiana 46204-2216 Michael Cline, Commissioner
Customer No: CST000001811
Bill To: Invoice: 000016085
Invoice Date: 7/31/2012
City of Carmel Invoice Type: LPA
ATTN: Mike McBride
One Civic Square
Carmel IN 46032
AMOUNT DUE: $12,287.12
*** Payment is Due Upon Receipt of Invoice ***
Line Description Quantity UnitAmt NetAmount
1 Contract#: SRS-32650 1.00 12,287.12 12,287.12
Contract#: SRS-32650, Project#: 0901163, change order#: 1 (see
attached).
Subtotal: 12,287.12
AMOUNT DUE: $12,287.12
- - - - - - - - — — rpaym- - - - - - - - - - - - - s
s •^-*F Purchase Order Order# Date Required Date Page
' INDOT Chg Order Construction 0011815001 05/24/2011 10/20/2011 1 of 1
' Indiana Department of Transportation Requisition Number:0000057462
Approved by Encompass Leadership Team-2011 VendorlD: 0000051089REMIT001
Agency: 00800 Indiana Dept of Transportation
Pay Terms: 35 Days in Arrears
# 1 CHANGE ORDER
Vendor 0000051089 REMIT001 2
RIETH-RILEY CONSTRUCTION COMPANY INC Ship To Dept Of Transportation
Remit to RIETH-RILEY CONSTRUCTION Construction Management Divisi
PO BOX 276 100 N SENATE AVE RM N925
INDIANAPOLIS IN 46206 INDIANAPOLIS IN 46204
RIETH-RILEY CONSTRUCTION COMPANY INC Bill To Indiana Dept of Transportation
Vendor RIETH-RILEY CONSTRUCTION Dept Of Transportation
Name PO BOX 276 Accounting
Address INDIANAPOLIS IN 46206 100 N SENATE AVE RM N749
INDIANAPOLIS IN 46204
Vendor Name: Buyer Name:Tepner,Roger-800
Contact eMail: eMail: RTEPNER @indot.IN.gov
Phone:
w..�„�,k, :>�<.,.... ;,;;?;: -:,•.,;:.:.;.i" Pt ircha`se;.Orderllnstructioris'&'Corriments.?�''�u �'�: ,i:,r.:: :"::
14'
100%LPA.change order 3 PE Andy Wolf orig po 0010809994
Cost Change#1
Reference Document=RQ-0000061955 for$12287.12(aw)9/20/2011
100%LPA.PO 0011815001.Change Order 3.PE Andy Wolf
Purchase'Order,LiriejDetails:;
tl u ,m
tltern No,- De ri �w•�.;,'r.''..., .
sc tlon FOB De§tinaUon %"-Qt Orderedi:�`: Qf'�.Recd;�:�UOM':;�>Unit Price:. Extended Amt`:`.'`
1- 1 SRS-32650-A ASPHALT RESURFACE 1.0000 0 EA 121,000.0000 121,000.00
GREENFIELD DISTRICT PCN:0901163
0901163 PARTIAL 3R HAMILTON COUNTY
-ON HAZEL DELL PARKWAY FROM 116TH
STREET TO 146TH STREET
2- 1 Cost Change#1 SRS-32650-A ASPHALT 1.0000 0 EA 12,287.1200 12,287.12
RESURFACE GREENFIELD
Deliveries acceptable only between 8:00 AM and 3:00 PM,Monday through Friday,excluding State
Holidays.
-<- •: Units of Measure Handlin Totals Si`natures,.:'-`.'<'
The following UN/CEFACT Unit of Measure
Common Codes are used in this document:
EA Each
This area left blank
Total PO Amt. $ 133,287.12
Issued by the Indiana Department of Transportation CONFIRMATION OF RECEIPT
I certify that the items listed above were received. All commodities appeared to conform to
specifications and showed no patent defects except as otherwise noted.
Signature of Receiver Date Signed(Month/Day/Year)
FUNDING ENCUMBERED BY THE AUDITOR OF STATE
I certify that there is sufficient unencumbered balance in the above account to cover the amount of this order,and that funds have been set aside for payment thereof.
1 111111 11111 11111 11111 11111 111111 11111 1111 11111 11111 11111 11111 11111 11111 11111 11111 11111 1111 1111 Indiana Department of Transportation
00800 0011815001
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
INDOT Purchase Order No.
100 N Senate Ave, Room IGC-N 725 Terms
Indianapolis, IN 46204-2216 Date Due
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s) Amount
7/31/2012 16085 Hazel Dell and Cherry Tree construction $ 12,287.12
Total $ 12,287.12
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.
INDOT ALLOWED 20
100 N Senate Ave, Room IGC-N 725 IN SUM OF $
Indianapolis, IN 46204-2216
$ 12,287.12
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT# I hereby certify that the attached invoice(s), or
21370 16085 1205-R4462862 12287.12 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
Y-0- G 9/10/2012
Signature
City Engineer
Cost Distribution ledger classification if Title
claim paid motor vehicle highway fund