220685 06/04/2013 CITY OF CARMEL, INDIANA VENDOR: 362779 Page 1 of 1
ONE CIVIC SQUARE LEACH&RUSSELL
_. CHECK AMOUNT: $1,697.29
CARMEL, INDIANA 46032 9151 FORD CIRCLE
FISHERS IN 46038 CHECK NUMBER: 220685
CHECK DATE: 6/412013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1208 4350900 26743 27937 1, 697 .29 ENERGY CENTER CONTRAC
T Leach & Russell
a Mechanical Contractors, Inc.
n 9151 Ford Circle Invoice
Fishers, Indiana 46038
= Phone: (317) 841-7877
H
M E C 12�
.: R U S A N I C A L S E L L Fax: (317) 841-7460
Invoice Number: 27937
o Carmel Redevelopment Commission Invoice Date: 05/13/2013
30 W. Main Street, Suite 220 Our Job Number: 136008
ED Carmel, IN 46032
Job Name: Carmel Energy Center
Your Purchase Order Number:
Labor and materials needed for plumbing service in above
location. Rebuilt the wall hydrant and added an isolation
valve. Cleared the trench drain as well. Tested the backflow
devices, made necessary repairs, retested and certified.
(See copy of work order and test results attached)
TOTAL AMOUNT DUE $1,697.29
D
Q o
JUN 03 2013
By
Terms: Due Upon Receipt
WORK ORDER 005351
TO: rr�.21 /'rt° e LEACH RUSSELL
.. ._.
MECHANICAL CONTRACTORS, INC.
9151 Ford Circle
Attention: Fishers, Indiana 46038-3000
Phone (317) 841-7877 Fax (317) 841-7460
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�y �L/�+ Date: ,l/ /`T
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Order Ta en —6/ 0 cy ®'Time&Material
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=Warranty
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Complete..... � ..........
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Order No.: Job Incomplete
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Our Job C ✓ V SerialNumber:
Number:
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OTHER CHARGES AMOUNT
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QTY MATERIALS AMOUNT
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TOTAL MATERIAL 2 2 TOTAL LABOR ISM' U
TOTAL MATERIAL, OTHER& LABOR Zq
Work Ordered By:
TAX
Signature:
TOTAL y 17 2
ere y ac no age a sa is ac ory comp a ion o e a ove escnbecTwork an
—
agree to render payment upon receipt of invoice.
LeachA Russell
Mechanical Contractors, Inc.
9151 Ford Circle Back-Flow
Fishers, Indiana 46038 Preventer Test
Phone: (317) 841-7877
R U S S E L L
M F C H A N I C A L Fax: (317) 841-7460
S et ce Address: Owner's Address: Serial rnber-
rw t..: k?— 1
Man fa urer-
3rav- t�ve- 0.1 /k
L IV E, Model:'i` 75Xl,
f Z_ Size: 1 vy,
S e�eOurnber:
Loc t* n
...........
Reduced Pressure Principal Assembly ?
........ RP SVB CD
C)
Double Check Valve DC DCDA o
C> PVB RPDA cD
Check Valve #1 Check Valve #2 Relief Valve PVB/SVB
Held at 7( PSID Held at PSID Opened at PSID Air Inlet
Closed Tight � Closed Tight Opened at PSID
Leaked ❑ Leaked Did Not Open ❑
❑ Cleaned ❑ Cleaned ❑ Cleaned Check Valve:
❑ Replaced ❑ Replaced ❑ Replaced Held at PSID
Leaked
❑ Cleaned
Replaced
M
0- 0
Q)
CU
_0
a)
>
"Fu -U) Held at PSID Held at PSID Opened at PSID Air Inlets PSID
C a)
[Z F- Closed Tight ❑ Closed Tight ❑ Check Valve PSID
Comments:
'FU Date 034.3 Time j 3 Certified Tester No. F17-1 Passed
Test By (Signature) Printed Name c ❑ Failed
Date Time Certified Tester No.
w Test By (Signature) Printed Name
76 Date Time Certified Tester No. ❑ Passed
C
iz Test By (Signature) Printed Name ❑ Failed
Water Authority:
Acknowledged By: Account Number:
Leach & Russell
Mechanical Contractors, Inc.
9151 Ford Circle Back-Flow
' Fishers, Indiana 46038
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Phone: (317) 841-7877 ��e�e��e�°
u s s f < <
M F C H A N I C A L Fax: (317) 841-7460
M
S ice Address: f Owner's Address: Sal Nu e
Cam,
a Manufacture: 1
Model
Size: j/
S ice Nur:
,2e a
L 9go tioni
-Reduced Pressure Principal Assembly � RP SVB o -�
Double Check Valve DC DCDA o
C) PVB RPDA o
Check Valve #1 Check Valve #2 Relief Valve PVB/SVB
N Held at 7 PSID Held at PSID Opened atS, 2- PSID Air Inlet
Closed Tight Closed Tight Opened at PSID
Leaked ❑ Leaked _ ❑ Did Not Open ❑
❑ Cleaned ❑ Cleaned ❑ Cleaned Check Valve:
❑ Replaced ❑ Replaced ❑ Replaced Held at PSID
Leaked
❑ Cleaned
U a
❑ Replaced
0_ 0
a� rn
a�
a�
C7
Held at PSID Held at PSID Opened at PSID Air Inlets PSID
TL F- Closed Tight El Closed Tight El Check Valve PSID
Comments:
Date ax/ o3,ze/_3 Time Z- cI Certified Tester No. _ assed
c I- Test By (Signature) - Printed Name Zc ff)gaaS 1 - ❑ Failed
cc Date Time Certified Tester No.
a i
Test By (Signature) Printed Name
m N Date Time Certified Tester No. ❑ Passed
C a)
Test By (Signature) Printed Name ❑ Failed
Water Authority: �1 t T,
Acknowledged By: Account Number:
Leach & Russell
Mechanical Contractors, Inc.
9151 Ford Circle Back-Flow
Fishers, Indiana 46038 Preventer Test
R U S S E L L Phone: (317) 841-7877
C H A N I C A L Fax: (317) 841-7460
S Address: Owner's Address: Se7_rial N U
-v_ 7
Ma
'27 Z7 7-A-kfive, 4 L,/ 'fl 71�? c"Ct
_Zkv Mode,,-,,,
Size:
Z
r,; b
.
>
Loon:on:,r
Reduced Pressure Principal Assembly
RP SVB
..........
Double Check Valve DC DCDA C)
C:> PVB
RPDA o
Check Valve #1 Check Valve #2 Relief Valve PVB/SVB
Held at PSID Held at PSID Opened at PSID Air Inlet
Closed Tight ❑ Closed Tight Opened at PSID
Leaked Leaked ❑ Did Not Open ❑
F-1 Cleaned ❑ Cleaned ❑ Cleaned Check Valve:
F-1 Replaced ❑ Replaced ❑ Replaced Held at PSID
Leaked
❑ Cleaned
❑ Replaced
M
0. 0
Q) U)
_0
76 Held at 7 1 7 PSID Held at PSID Opened at PSID Air Inlets PSID
a)
Closed Tight Closed Tight Check Valve PSID
Comments: _Z1,
7-
Da 0-7, Zo Time 1/ 7- Certified Tester No. 7-11S_5 El Passed
a) Date /25p
Test By (Signature) Printed Name ailed
Date WL3 Time Certified Tester No.
CL
0
w Test By (Signature) Printed Name eov-5-1
"Fu Date O Zo Time Z Certified Tester No. t four assed
ii H Test By (Signature) Printed Name 4, ❑ Failed
Water Authority: it,
Acknowledged By: Account Number:
VOUCHER NO. WARRANT NO.
Leach & Russell Mechanical Contractors, Inc ALLOWED 20
IN SUM OF $
9151 Ford Circle
Fishers, IN 46038
$1,697.29
ON ACCOUNT OF APPROPRIATION FOR
Building Operations Account
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26743 I 27937 I -509.00 I $1,697.29 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
Monday, June 03, 201
Director, 4minstration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
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))
05/13/13 27937 Energy Center $1,697.29
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