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W R DUNKIN & SON, INC.- 002590- 1/18/2012
CARMEL REDEVELOPMENT COMMISSION 0 02590 W R Dunkin& Son, Inc. Check: 2590 PO Box 2247 Date: 1/18/2012 Anderson, IN 46018 Vendor: DUNKINW1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paic 39A 35 4,754.00 4,754.00 0.00 0.00 4,754.0C App 39A 4,754.00 4,754.00 0.00 0.00 4,754.0C r THE KEYTO DOCUMENT SECURITY „HEATACTIVATEDTHUMBPRINT•ADDITIONALSECURITYFEATURESINCLUDED•SEE BACK FOR DETAILS , s&D Carmel Redevelo ment Commission "` s Ppt 1 , ' 30 West Main"Street op men , ; 002590 ® 20 1427nao e . 13(t:. Suite 220 i { `"a 1` Carmel,IN 46032 2590 , DATE AMOUNT 1/18/ 012 4,754:00 PAY THE SUM'OF_F.OUR THOUSAND SEVEN HUNDRED'FIFTY.FOUR DOLLARS AND NO CENTS ******* . TO THE ORDER• • OF . W R Dunkin & Son, Inc. . ,. PO`Box 2247 sENS-., Anderson, IN 46018' „, -" i 11'002590o' 0:0 7 4 0 L 4 2 L 31: 00 8 7 5 0 4 L L Log CARMEL REDEVELOPMENT COMMISSION 0 02590 W R Dunkin & Son, Inc. Check: 2590 PO Box 2247 Date: 1/18/2012 Anderson, IN 46018 Vendor: DUNKINW1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Pal( 39A 35 4,754.00 4,754.00 0.00 0.00 4,754.01 App 39A 4,754.00 4,754.00 0.00 0.00 4,754.01 (X-11;52 COMPUTEREASE FORMS DIVISION(877)5775791 T-37228 4.� *AIA TMDocument 6732 — 2009 Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: Cannel Rcdevpt Comm PROJECT: Parcel 7A,#4050 CPA APPLICATION NO:039A DISTRIBUTION TO: One Civic Square 777 3rd Ave. S . OWNER Carmel.IN 46032 Carmel, IN 46032 PERIOD TO January 06.2012 CONSTRUCTION MANAGER FROM W.R. Dunkin& Son,Inc. VIA CONSTRUCTION Spiel Sexton Co., Inc. CONTRACT DATE:May 08,2008 ARCHITECT CONTRACTOR: I'O Box 2247 MANAGER: PROJECT NOS:25310/2695-4050/2695 CONTRACTOR Anderson,IN 46018 FIELD CONTRACT FOR: Bid Package 114050-General VIA ARCHITECT: CSO Architects OTHER Trades CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application &Pa}anent has been completed in accordance with the Application is made for payment.as shown below,in connection with the Contract. Contract Documents.that all amounts hay/ices > • } the Contractor lbr Work for which previous AIA Document 67031m,Continuation Sheet,is attached. Certificates for Payment ,ere issuC id p ie nts received limn the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 9,966,300.00 paynset ..witlteTein i. ow du . / . 2.NET CHANGES IN THE WORK $ -598.686.00 CONTRA ! W ' DUNK ' & .0 INC. 3.CONTRACT SUM TO DATE(Line 1:1.2) $ 9.367,614 00 By: t+qmilb Date: January 06,2012 4.TOTAL COMPLETED AND STORED TO DATE(Column G on 6703) $ 9,367,614.00 S • eof•Indiana 5.RETAINAGE: County of:Madison a. 0 %of Completed Work Subscribed and sworn to before ri%der MARTHA A.CARPENTER Column E) t L:on G703) $ 0.00 me this 06th day of January 06, 20192 �� NOTARY PUBLIC ( ��y� R� INDIANA in,-1 8 b. 0 %of Stored Material Notary Public:Martha A.Carpenter ///�1G�i.-�..:r.�yr 4 a, l F•piret;a a 17 (Column F on 6703) $ 0.00 My Commission expires:January 08,2017 Tntal Retaintge(Lines 5cr i 5n. or Fatal in Column 1 on 6703) $ 0.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE ....$ 9,367,614.00 In accordance with the Contract Documents, based on evaluations of the Work and the data (Line 4 minus line 5 7•otal) comprising this application,the Construction Manager and Architect certify to the Owner that to the 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 9,362,860.00 best of their knowledge, information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents,and the Contractor is entitled to p,i)mart of (Line 6from pt ior•C'erfi/uate) the AMOUNT CC RTIFII D. 8.CURRENT PAYMENT DUE • $ 4.754.00 AMOUNT CERTIFIED .. $ 4,754.Ot) 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanatio 7 if amount certified 'flers )0,ilr amount applied. Initial all jigru es on this Application and., re Continuation S et 11 it are el,7nged to caufor•m with the amount certi fied) (Line 3 minis Line 6) $ 0.00 CON 1'UCTION AG •se SUMMARY OF 0IANGf,S IN'I'LI[?.WORK i\C.)DCI'IONS Dl DC1C:I IONS ARC ECT:(N ""r1/,fuItiple Pi line Conn•actoic ire Iesponsihle jrn performing poi ti.ncofthe Pinjee, Ce+nficati, 1 is not rec/mired) l itchi. .� y J Total changes approved in previous months by Owner $ 699,466.00$ 1.199.728.00 By � . - � Date: /♦ f� I owl approved this month including Construction 5 0.00 5 98,424 00 Change Directives Has Certificate is not negotiable. The AMOUNT CIA(!MILD is payable only to the Contractor TOTALS $ 699.466.00$ 1,298.152 00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor tinder this Contract. NGf'C l IANGES IN TILE WORK $ -598.686.00 AIA Document G732''—2009(formerly G702r CMa—1992).Copyright©1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This NA' Document Is protected by U.S. Copt,right Law and lutemat£onal Treat1e ,Unai thorixerl retuNitu:tioo or distribution of th£s NA', Docurnerrt,or any parboil of d,may result in severe civil and crier inai penalties,and wilt be prosecuted 1 to the maximum extent possible under the law.This document was produced by ALA software at 10 32.30 on 01/06/2012 under Order No.0215931572_1 which expires on 05!10/2012,and is not tar resale. //Yi User Notes: (911178296) f/ IlitAIA Document G703 - 1992 Con tinuation Sheet AIA Document,G702 t''t-1992,Application and Certification for Payment,or G736Tm-2009, APPLICATION NO:039A Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE:01/06,12012 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. PERIOD TO:01/06/2012 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:25310 A B _ C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED ai BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G±C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) PERFORMANCE 01010 BOND 106,000.00 106,000.00 0.00 0.00 106,000.00 100.00% 0.00 0.00 MOBILIZE/DEMOB 01015 ILIZE 29,000.00 29,000.00 0.00 .0.00 29,000.00 100.00% 0.00 0.00 SUPERVISION/CO 01020 ORDINATION 361,000.00 361,000.00 0.00 0.00 361,000.00 100.00% 0.00 0.00 GENERAL 01025 CONDITIONS-M 380,000.00 380,000.00 0.00 0.00 380,000.00 100.00% 0.00 0.00 GENERAL 01026 CONDITIONS-L 98,000.00 98,000.00 0.00 0.00 98,000.00 100.00% 0.00 0.00 GENERAL 01027 CONDITIONS-O 262,990.00 262,990.00 0.00 0.00 262,990.00 100.00% 0.00 0.00 ALLOWANCE- STONE 140A0 WALKWAY 8,500.00 0.00 8,500.00 0.00 8,500.00 100.00%, 0.00 0.00 ALLOWANCE- TEMPORARY 140B0 HANDRAIL 38,000.00 37,039.00 961.00 0.00 38,000.00 100.00% 0.00 0.00 ALLOWANCE- TEMPORARY DOORS/FRAMES/H 14000 ARDWARE 10,000.00 5,972.00 4,028.00 0.00 10,000.00 100.00% 0.00 0.00 140D0 ALLOWANCE-ICE 13,500.00 2,943.00 10,557.00 0.00 13,500.00 100.00% 0.00 0.00 ALLOWANCE- 140E0 SECURITY 31,000.00 63,836.00 -32,836.00 0.00 31,000.00 100.00% 0.00 0.00 140F0 ALLOWANCE- 191,700.00 128,934.00 62,766.00 0.00 191,700.00 100.00% 0.00 0.00, MA Document G703'"-1992.Copyright©1963,1965,1966,1967,1970.1978,1983 and 1992 by The American Institute of Architects.All rights reserved.+V/Af2NING This A ' cc.m i i;is protected ht U.S.Uopyright Law a_o i„te=nalienal Treaties Unauthorized reprodu tior n,di_.. c,:ioo of r.}is A A i:'oe lime:t,or any portion of it.may result m severe civil ar,d c? renal penalties.and v<II e, 1 p'ncecute,rt to the tn,axinmo-,eKleilt passible under Cie lave.This document was produced by AlA software at 10-10 56 on 01/06/2012 under Order No 0215931572_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G -C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) DUMPSTERS ALLOWANCE- TRAILER 140G0 CONNECTOR 34,000.00 33,500.00 500.00 0.00 34,000.00 100.00% 0.00 0.00 ALLOWANCE- TRAILER 140H0 CLEANING 19,169.00 15,720.00 3,449.00 0.00 19,169.00 100.00% 0.00 0.00 ALLOWANCE-SITE 140I0 SIGNAGE/SAFETY 22,000.00 1 1,623.00 10,377.00 0.00 22,000.00 100.00% 0.00 0.00 ALLOWANCE- 140J0 GENERAL LABOR 320,000.00 332,191.00 -12,191.00 0.00 320,000.00 100.00% 0.00 0.00 ALLOWANCE- TEMPORARY FENCE 140K0 MODIFICATIONS 5,000.00 4,008.00 992.00 0.00 5,000.00 100.00% 0.00 0.00 ALLOWANCE-#2 140L0 OR#53 STONE 37,900.00 48,226.00 -10,326.00 0.00 37,900.00 100.00% 0.00 0.00 ALLOWANCE- WAREHOUSE 140M LEASE/LAYDOWN 0 /PARKING 500,000.00 500,000.00 0.00 0.00 500,000.00 100.00% 0.00 0.00 ALLOWANCE- PARKING LOT INSTALL/MAINTAI 140N1 N 100,000.00 80,519.00 19,481.00 0.00 100,000.00 100.00% 0.00 0.00 ALLOWANCE- MAINT.-OFF SITE STAGING/PARKIN 140N2 G _ 35,000.00 25,115.00 9,885.00 0.00 35,000.00 100.00% 0.00 0.00 ALLOWANCE- PARKING LOT REMOVE/REFURBI 14000 SH 100,000.00 2,745.00 • 97,255.00 0.00 100,000.00 100.00% 0.00 0.00 AIA Document G703TM-1992.Copyright©1963, 1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: A` 3oc.i ri s pi rc ed by i;�pyEigi1i.La...aed iri'e:national I rea£es.Unat,thorizsci repro u. c,,.n or d. fr_r,u•:n of trhs A:A' Docernent er any oorhon of,t rosy result e:severe ci,d and et rr inai her Mess nod,,,ift be 2 nroeeci.rei9 to the?nay:imu■7 extei;t nossihis once the Ia.a.This document was produced byAlA software at 10:10:56 on 01/06/2012 under Order No 021 5931 57 2_1 which expires on 05/10/2012.and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) ALLOWANCE- HAUL/DISPOSE UNSUITABLE 140P0 MATERIAL 25,000.00 14,794.00 10,206.00 0.00 25,000.00 100.00% 0.00 0.00 ALLOWANCE-6 OZ.GEOTECH 140Q1 FABRIC 4,700.00 0.00 4,700.00 0.00 4,700.00 100.00% 0.00 0.00 ALLOWANCE- 140Q2 TENSAR GEOGRID 8,500.00 8,126.00 374.00 0.00 8,500.00 100.00% 0.00 0.00 ALLOWANCE-42 140R0 STONE 26,200.00 23,580.00 2,620.00 0.00 26,200.00 100.00% 0.00 0.00 ALLOWANCE- CABLE PASS- 140S0 THRU(FOH) 6,456.00 6,456.00 0.00_ 0.00_ 6,456.00 100.00% 0.00 0.00 r-- ALLOWANCE- CABLE PASS- 140T0 THRU(BOH) 5,165.00 5,165.00 0.00 0.00 5,165.00 100.00% 0.00 0.00 ALLOWANCE- 140U CABLE PASS- O THRU(FLOOR) 17,217.00 17,217.00 0.00 0.00 17,217.00 100.00% 0.00 0.00 ALLOWANCE- TEMPORARY ELEVATOR 140V0 USAGE 200,000.00 162,328.00 37,672.00 0.00 200,000.00 100.00% 0.00 0.00 ALLOWANCE- 140W DONOR 0 RECOGNITION 100,000.00 100,000.00 0.00 0.00 100,000.00 100.00% 0.00 0.00 GENERAL 140X0 ALLOWANCE 400,000.00 526,550.00 -126,550.00 0.00 400,000.00 100.00% 0.00 0.00 ALLOWANCE-AS- 140Y0 BUILD/CAD 5,000.00 4,242.00 758.00 0.00 5,000.00 100.00% 0.00 0.00 FIELD 01501 OFFICE/STORAGE 16,400.00 16,400.00 0.00 0.00 16,400.00 100.00% 0.00 0.00 AIA Document G703r"-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This ALCM Document is protected by J.S.Copyright Law and Intarr:anonal Treaties.Uoauthoelzed coproduction or,a stribution of this Atk" Docuwerr,or any portion of;t,m[sy result in severe :vIt and c^minai penalties,and.vill be 3 prosecu*.e:i to the maximum nzteni possible:Inner thc'.am•.This document was produced by AIA software at 10:10:56 on 01!06/2012 under Order No.02 1 59 31 57 2_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE ' (C-G) RATE) (D+E) (D-*E+F) "FRAILER-M FIELD OFFICE/STORAGE 01502 TRAILER-L 5,500.00 5,500.00 0.00 0.00 5,500.00 100.00% 0.00 0.00 TEMPORARY TOILETS/WASHIN 01503 G STATIONS-M 41,800.00 41,800.00 0.00 0.00 41,800.00 100.00% 0.00 0.00 TEMPORARY "TOILETS/WASHIN 01504 G STATIONS-L 7,600.00 7,600.00 0.00 0.00 7,600.00 100.00% 0.00 0.00 FIRE PROTECTION/EME 01505 RG.STATIONS-M 19,300.00 19,300.00 0.00 0.00 19,300.00 100.00% 0.00 0.00 FIRE PROTECTION/EME 01506 RG.STATIONS-L 4,000.00 4,000.00 0.00 0.00 4,000.00 100.00% 0.00 0.00 FURNISH/MAINTA 01507 IN TRASH CANS-M 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 0.00 FURNISH/MAINTA 01508 IN TRASH CANS-L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 0.00 TEMPORARY ROAD/MAINTENA 01510 NCE 148,000.00 148,000.00 0.00 0.00 148,000.00 100.00% 0.00 0.00 TEMPORARY FENCING- REMOVE/RELOCA 01520 TE 15,800.00 15,800.00 0.00 0.00 15,800.00. 100.00% 0.00 0.00 TEMPORARY 01521 FENCING-GATES 6,500.00 6,500.00 0.00 0.00 6,500.00 100.00% 0.00 0.00 TEMPORARY FENCING- 01522 SCREENING 8,744.00 8,744.00 0.00 0.00 8,744.00 100.00% 0.00 0.00 AIA Document G703"-1992.Copyright©1963,1965,1966,1967.1970,1978.1983 and 1992 by The American Institute of Architects.All rights reserved.VvAt i!N, Fria A1A" Document is protected by U.S.Gopyighs Las and'.ntarit";oral r e.,:as.Unautborizad"cprcduct'r:n or r•sstribution of tt^u Alt' Dccon,en',or any portion of it may result in seve■s civil r.r0 criminal penalties and will bO: 4 presnc.:,tad tc she maxis-,,Tr;exi?ni aoss.hh.unnor tOn:rnA This document was produced by AIA software at 10.10.56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012 and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G--C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) _ (D+E+F) TEMPORARY 01523 BARRIERS-M 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 0.00 TEMPORARY 01524 BARRIERS-L 7,500.00 7,500.00 0.00 0.00 7,500.00 100.00% 0.00 0.00 TEMPORARY 01530 ENCLOSURES-M 10,800.00 10,800.00 0.00 0.00 10,800.00 100.00% 0.00 0.00 TEMPORARY 01531 ENCLOSURES-L 14,000.00 14,000.00 0.00 0.00 14,000.00 100.00% 0.00 0.00 SCAFFOLDING- SET UP/CONSUMABLE 01540 S 398,000.00 398,000.00 0.00 0.00 398,000.00 100.00% 0.00 0.00 SCAFFOLDING- MONTHLY RENTAL/INSPECTI 01541 ONS 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 0.00 SCAFFOLDING- DISMANTLE/REM 01542 OVE 55,000.00 55,000.00 0.00 0.00 55,000.00 100.00% 0.00 0.00 STAIR TOWERS- 01543 SETUP 54,000.00 54,000.00_ 0.00 0.00 54,000.00 100.00% 0.00 0.00 STAIR TOWERS- MONTHLY 01544 RENTAL 28,500.00 28,500.00 0.00 0.00 28,500.00 100.00% 0.00 0.00 STAIR TOWERS- 01545 DISMANTLE 6,700.00 6,700.00 0.00 0.00 6,700.00 100.00% 0.00 0.00 HOIST-EXTERIOR- 1546.1 SETUP 14,300.00 14,300.00 0.00 0.00 14,300.00 100.00% 0.00 0.00 HOIST-EXTERIOR- RENTAL/OPERATI 1546.2 ON 139,040.00 139,040.00 0.00 0.00 139,040.00 100.00% 0.00 0.00 HOIST-EXTERIOR- 1546.3 DISMANTLE 8,000.00 8,000.00 0.00 0.00 8,000.00 100.00% 0.00 0.00 AIA Document G703"'-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The Am erican Institute of Architects.All rights reserved. WARNING:This A.OA° Document is protected y U.S.Copyrig:t La,�.and international Tr&atias.Unauthorized reprod action or distribution of this Al-i Document.or any portion et it;ma;result in severe civil and cri:-nina!petatcies and will be 5 pros°cuted tc the maximum extent possible under the law.This document was produced by AIA software at 10.10:56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012.and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETA[NAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) HOIST-STAIR2-SET 1547.1 UP 14300.00 14,300.00 0.00 0.00 14,300.00 100.00% 0.00 0.00 HOIST-STAI R 2- RENTAL/OPERATI 1547.2 ON 139,040.00 139,040.00 0.00 0.00 139,040.00 100.00% 0.00 0.00 HOIST-STAIR 2- 1547.3 DISMANTLE 8,000.00_ 8,000.00 0.00 0.00 8,000.00 100.00% 0.00 0.00 HOIST-ROOM 100- 1548.1 SET UP 95,000.00 95,000.00 0.00 0.00 95,000.00 100.00% 0.00 0.00 HOIST-ROOM 100- RENTAL/OPERATI 1548.2 ON 21 1,000.00 21 1,000.00 0.00 0.00 21 1,000.00 100.00% 0.00 0.00 HOIST-ROOM 100- 1548.3 DISMANTLE 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00% 0.00 0.00 HOIST- ALLOWANCE-SET 1549.1 UP 9,830.00 9,830.00 0.00 0.00 9,830.00 100.00% 0.00 0.00 HOIST- ALLOWANCE- RENTAL/OPERATI 1549.2 ON 97,500.00 97,500.00 0.00 0.00 97,500.00 100.00% 0.00 0.00 HOIST- ALLOWANCE- 1549.3 DISMANTLE 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00% 0.00 0.00 01556 TRASH CHUTES-M 52,000.00 52,000.00 0.00 0.00 52,000.00 100.00% 0.00 0.00 01557 TRASH CHUTES-L 58,000.00 58,000.00 0.00 0.00 58,000.00 100.00% 0.00 0.00 GENERAL CLEAN 01560 UP-M 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 0.00 GENERAL CLEAN 01561 UP-L 60,000.00 60,000.00 0.00 0.00 60,000.00 100.00% 0.00 0.00 01562 FINAL CLEANING 65,000.00 65,000.00 0.00 0.00 65,000.00 100.00% 0.00 0.00 02110 EXCAVATION/BA 12,019.00 12,019.00 0.00 0.00 12,019.00 100.00% 0.00 0.00 AIA Document G703"-1992.Copyright©1963,1965,1966,1967.1970,1978,1983 and 1992 by The Am_erican Institute of Architects.All rights reserved.WARNING'Ibis AIA Document.is praected 7y 1)S,CopyrcgIt Lam.and!nteri,a.:0aai Trealies.v 13litf'.OYo Zed?oprodluO cn or dietribu1 00 or ln.s ALO' L ocom ooI.or airy pertfoo of It May esuli in 50h ore:.i0,I all;;rirnirai peg antes cod will be 6 prosocuteo to the maxitnual extent presihle under the 1.3w.This document was produced by AIA software at 10.10.56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G 1-1 I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED COMPLETED BALANCE TO RETATNAGE FROM PRESENTLY NO. WORK VALUE THIS PERIOD AND STORED TO FINISH (IF VARIABLE PREVIOUS STORED DATE �G�C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D I E) (D+E+F) CKFILL-SUMPS-M EXCAVATION/BA CKFILL-SUMPS-L 02111 EQ 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 0.00 02240 SHORING 209,800.00 209,800.00 0.00 0.00 209,800.00 100.00% 0.00 0.00 CAST IN PLACE 03301 CONCRETE-M 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00% 0.00 0.00 CAST IN PLACE 03302 CONCETE-L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 0.00 PRECAST PLANKS-12" 03410 HOLLOW CORE 161,000.00 161,000.00 0.00 0.00 161,000.00 100.00% 0.00 0.00 PRECAST PLANKS-12" 03411 SOLID 898,000.00 898,000.00 0.00 0.00 898,000.00 100.00% 0.00 0.00 PRECAST 03412 PLANKS-6" SOLID 107,000.00 107,000.00 0.00 0.00 107,000.00 100.00% 0.00 0.00 PRECAST 03413 TRUCKING 82,000.00 82,000.00 0.00 0.00 82,000.00 100.00% 0.00 0.00 PRECAST 03414 ERECTION 186,000.00 186,000.00 0.00 0.00 186,000.00 100.00% 0.00 0.00 INTERIOR METAL FABRICATIONS- 05504 SUBMITTALS 102,000.00_ 102,000.00_ 0.00 0.00 102,000.00 100.00% 0.00 0.00 STEEL STAIRS 05505 WITH RAIL-M 179,000.00 179,000.00 0.00 0.00 179,000.00 100.00% 0.00 0.00 STEEL STAIRS 05506 WITH RAIL-L 80,000.00 80,000.00 0.00 0.00 80,000.00 100.00% 0.00 0.00 05507 LADDERS-M 26,000.00 26,000.00 0.00 0.00 26,000.00 100.00% 0.00 0.00 05508 LADDERS-L 12,500.00 12,500.00 0.00 0.00 12,500.00 100.00% 0.00 0.00 CATWALK 05509 FRAMING-M 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 0.00 AlA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING 711:e,4 A Document s protected by 7 U.S.Copy right i_aw and!ntef=.nt:onai Treaties L!r an thc.rized reproduction Cr distribution of fhfs AlA` Document,c:r an portion of it.may result in se,ere.;ie 1 and c:nmin !penolf:es,and nril be prosecuted to the maximum extent poss:blr:ur:ise ti-,e,svr.This document was produced by AIA software at 10:10:56 on 01/06/2012 under Order No.0215931572 1 which expires on 05/10/2012,and is not for resale. (963661671) User Notes: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO KETAINAGE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE (G_C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) CATWALK 05510 FRAMING-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 0.00 MISCELLANEOUS 05511 METALS-M 441,000.00 441,000.00 0.00 0.00 441,000.00 100.00% 0.00 0.00 MISCELLANEOUS 05512 METALS-L 275,000.00 275,000.00 0.00 0.00 275,000.00 100.00% 0.00 0.00 INTERIOR ROUGH 06100 CARPENTRY-M 31,000.00 31,000.00 0.00 0.00 31,000.00 100.00% 0.00 __ 0.00 INTERIOR ROUGH 06101 CARPENTRY-L 44,000.00 44,000.00 0.00 0.00 44,000.00 100.00% 0.00 0.00 FOUNDATION WATERPROOFING 07110 -M 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00% 0.00 0.00 FOUNDATION WATERPROOFING 1 -L 6,600.00 6,600.00 0.00 0.00 6,600.00 100.00% 0.00 0.00 07210 DUCT LINERS-M 97,000.00 97,000.00 0.00 0.00 97,000.00 100.00% 0.00 0.00 07211 DUCT LINERS-L . 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 0.00 07810 FIRESTOPPING-M 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00% 0.00 0.00 07811 FIRESTOPPING-L 16,000.00 16,000.00 0.00 0.00 16,000.00 100.00% 0.00 0.00 JOINT SEALANTS- 07910 M 35,000.00 35,000.00 0.00 0.00 35,000.00 100.00% 0.00 0.00 JOINT SEALANTS- 07911 L 80,000.00 80,000.00 0.00 0.00 80,000.00 100.00% 0.00 0.00 STEEL DOORS& 08110 FRAMES-M 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 STEEL DOORS& 08111 FRAMES-L 0.00 0.00 0.00 0.00 0.00% 0.00 FLUSH WOOD 08140 DOORS-M 0.00 • 0.00 0.00 0.00 0.00% 0.00 FLUSH WOOD 08141 DOORS-L 0.00 0.00 0.00 . 0.00 0.00% 0.00 AIA Document G703TM-1992.Copyright 01963.1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.W 1r NiN:; Tr�is AAA. Document is protecter/I;y v.5 C t;yr ght.L•..,and Interna*anal Treaties.Lnauthcrizeu-enroduction or distritutio!,of bins A;A;\ Dccu;nesi or any oorUor of it,may result k!r severe cis and c7imr,ai l:enaltias.2sY./::il!t:f. 8 pr es.eCot to the m.-,,o-nun,oxtuit possit;ie u;;der the!xw This document was produced by AIA software at 10.10,56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G H 1 WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D-i-E-I F) STILE&RAIL 08143 WOOD DOORS-M 0.00 0.00 0.00 0.00 0.00% 0.00 STILE&RAIL 08144 WOOD DOORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 SOUND CONTROL DOORS& 08347 WINDOWS-M 0.00 0.00 0.00 0.00 0.00% 0.00 SOUND CONTROL DOORS& 08348 WINDOWS-L 0.00 0.00 0.00 0.00 0.00% 0.00 OVER COILING 08355 DOORS-M 0.00 0.00 0.00 0.00 0.00% 0.00 OVERHEAR 08356 COILING DOORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 ALUM.FRAMED ENTRANCES/STOR 08410 EFRONTS-M 0.00 0.00 0.00 0.00 0.00% 0.00 ALUM.FRAMED ENTRANCES/STOR 08411 EFRONS-L 0.00 0.00 0.00 0.00 0.00% 0.00 INTERIOR ALUM. DOORS& 08413 FRAMES-M 0.00 0.00 0.00 0.00 0.00% 0.00 INTERIOR ALUM. DOORS& 08414 FRAMES-L 0.00 0.00 0.00 0.00 0.00% 0.00 REVOLVING DOOR 08423 ENTRANCES-M 0.00 0.00 0.00 0.00 0.00% 0.00 REVOLVING DOOR 08424 ENTRANCES-L _ 0.00 0.00 0.00 0.00 0.00% 0.00 08440 GLAZED ALU,. 325,000.00 325,000.00 0.00 0.00 325,000.00 100.00% 0.00 0.00 MA Document G703' -1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.MI rights reserved.WARNING:This AEA" Document is protected by U.$.Copyright Law and h wrnatio,al T reties,unauthorized reproduction or disl.ribution of this Ale Document,or any portion of it.may result in se'ere civil and criminal p mefbes and will be 9 prosecuted to the sria'cnwm extent pcssinle under the law.This document was produced by AlA software at 10:10:56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G H I T WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) CURTAIN WALLS- M GLAED ALUM. CURTAIN WALLS- 08441 L 148,000.00 148,000.00 0.00 0.00 148,000.00 100.00% 0.00 0.00 08710 HARDWARE 525,000.00 525,000.00 0.00 0.00 525,000.00 100.00% 0.00 0.00 INTERIOR 08810 GLAZING-M 11,000.00 11,000.00 0.00 0.00 11,000.00_ 100.00% 0.00 0.00 INTERIOR 08811 GLAZING-L 8,000.00 8,000.00 0.00 0.00 8,000.00 100.00% 0.00 0.00 FIRE PROTECTION 10440 SPECIALTIES-M 7,580.00 7,580.00 0.00 0.00 7,580.00 100.00% 0.00 0.00 FIRE PROTECTION 10441 SPECIALTIES-L 1,800.00 1,800.00 0.00 0.00 1,800.00 100.00% 0.00 0.00 10450 KNOX BOX 650.00 650.00 0.00 0.00 650.00 100.00% 0.00 0.00 LOADING DOCK 11130 EQUIPMENT-M 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00% 0.00 0.00 LOADING DOCK 11131 EQUIPMENT-L 3,800.00 3,800.00_ 0.00 0.00 3,800.00 100.00% 0.00 0.00 ELEC.TRACTION ELEVATORS- 14210 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ELEC.TRACTION ELEVATORS- MATERIAL/EQUIP 14211 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ELEC.TRACTION 14212 ELEVATORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 HYDRAULIC ELEVATOR- 14241 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 14242 HYDRAULIC 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AiA° Rocument is protected by U.S.Copyright l..avw and int:'nafion.al Trestles.Unriut.norizku reproduction or distribution 01 this FlA" Document,or any portion of it,may result ir,se,ere cdv•i and cr mina penalties and will be 10 urosccutecf to the mMYinu:n extent uossibie under the law.This document was produced by AIA software at 10.10:56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) _A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE PREVIOUS AND STORED TO FINISH (IF VARIABLE-+-NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) ELEVATOR- MATERIAL/EQUIP MENT - HYDRAULIC ELEVATOR- 14243 LABOR 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR LIFT- MATERIAL/EQUIP 14421 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WI-IEELCHAIR 14422 LIFT-PERMITS 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR 14423 LIFT-LABOR 0.00 0.00 0.00 0.00 0.00°%0 0.00 0.00 CHANGE ORDER 17001 NO. 01 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 0.00 CHANGE ORDER 17002 NO. 02 9,031.00 9,031.00 0.00 0.00 9,031.00 100.00% 0.00 0.00 CHANGE ORDER 17003 NO. 03 2,196.00 2,196.00 0.00 0.00 2,196.00 100.00% 0.00 0.00 17000 CHANGE ORDER 4 NO. 04 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 17000 CHANGE ORDER 5 NO. 05 98,741.00 98,741.00 0.00 0.00 98,741.00 100.00% 0.00 0.00 17000 CHANGE ORDER 6 NO. 06 17,527.00 17,527.00 0.00 0.00 17,527.00 100.00% 0.00 0.00 17000 CHANGE ORDER 7 NO. 07 11,292.00 11,292.00 0.00 0.00 11,292.00 100.00% 0.00 0.00 17000 CHANGE ORDER 8 NO. 08 44,936.00 44,936.00 0.00 0.00 44,936.00 100.00% 0.00 0.00 17000 CHANGE ORDER 9 NO. 09 14,683.00 14,683.00 0.00 0.00 14,683.00 100.00% 0.00 0.00 AlA Document G703'-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA' Doci;m r.t is p-otrr.teu by U.S.Copyright Law ono Intern t;o naI',reat■es. unautncr.zr,d rcprocuctico or c stribu`ino of Shs!Up.' Document or any pans�in s i t,may result in se\ere:n,,I acct cr:mina.penal'ies.and wit?be 11 prosecuted:c tI o Maxi ou.m ox-tent prssib!_;,nu^r the taw.This document was produced by AIA software at 10.10:56 on 01/06/2012 under Order No.0215931572_1 which expires on 05/10/2012 and is not for resale. User Notes: (963661671) • A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE%ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) 17001 CHANGE ORDER 0 NO. 10 -760,330.00 -760,330.00 0.00 0.00 -760,330.00 100.00% 0.00 0.00 17001 CHANGE ORDER 2 NO. 12 49,062.00 49,062.00 0.00 0.00 49,062.00 100.00% 0.00 0.00 17001 CHANGE ORDER 3 NO. 13 3,801.00 3,801.00 0.00 0.00 3,801.00 100.00% 0.00 0.00 17001 CHANGE ORDER 4 NO. 14 787.00_ 787.00 0.00 0.00 787.00 100.00% 0.00 0.00 17001 CHANGE ORDER 5 NO. 15 _ 34,158.00 34,158.00 0.00 0.00 34,158.00 100.00% 0.00 0.00 17001 CHANGE ORDER 6 NO. 16 7,529.00 7,529.00 0.00 0.00 7,529.00 100.00% 0.00 0.00 17001 CHANGE ORDER 7 NO. 17 7,083.00 7,083.00 0.00 0.00 7,083.00 100.00% 0.00 0.00 17001 CHANGE ORDER 8 NO. 18 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 0.00 17001 CHANGE ORDER 9 NO. 19 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 0.00 17002 CHANGE ORDER 0 NO. 20 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 0.00 17002 CHANGE ORDER 1 NO. 21 22,591.00 22,591.00 0.00 _ 0.00 22,591.00 100.00% 0.00 0.00 17002 CHANGE ORDER 2 NO.22 _ 68,760.00 68,760.00 0.00 0.00 68,760.00 100.00% 0.00 0.00 17002 CHANGE ORDER 3 NO. 23 4,562.00 4,562.00 0.00 0.00 4,562.00 100.00% 0.00 0.00 17002 CHANGE ORDER 4 NO. 24 6,954.00 6,954.00 0.00 0.00 6,954.00 100.00% 0.00 0.00 17002 CHANGE ORDER 5 NO. 25 -439,398.00 -439,398.00 0.00 0.00 -439,398.00 100.00% 0.00 0.00 17002 CHANGE ORDER 6 NO. 26 -97,255.00 0.00 -97,255.00 0.00 -97,255.00 100.00% 0.00 0.00 AlA Document G703T°-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.Vti'AP.N!NG:This AlA" Document is protected ny ...5.Co,y!•i-ht Low Snc Inie caticnai Treaties. Unauthorized reproduction c;distribution of this AL.a' ttooun,ent,or airy portion of it,may result.n severe c,vil and crim:na:pena+.ties,ore win be 12 rosecuted to iha tn,^.±:imur,,extent possible under tt5e:+a,o.This document was produced by AIA software at 10:10:56 on 01/06/2012 under Order No.021 5931 57 2_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED oho BALANCE TO RETAINAGE PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED (G-C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+ E) (D+E±F) 17002 CHANGE ORDER 7 NO.27 -1,169.00 0.00 -1,169.00 0.00 -1,169.00 100.00% 0.00 0.00 GRAND TOTAL $9,367,614.00 $9,362,860.00 $4,754.00 $0.00 $9,367,614.00 100.00% $0.00 $0.00 AIA Document G703".—1992.Copyright O 1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING•This A!Ar' Document is protected try J.S.Cop, ciht Lam,and international Treaties.Urautil:,rieed reprocueiion ■r distr:butio: of fk■ .A1A Documar,U or any portion ct it may resutt xi severe-iv ii and crimesai penalt+es,ano'witl be 13 crosecutcc1 to the maximum extent possibiS:ruder the iaww._This document was produced by MA software at 10:10:56 on 01/06/2012 under Order No.021 5931 57 2_1 which expires on 05/10/2012,and is not for resale. User Notes: (963661671) 1 AFFIDAVIT AND WAIVER OF LIEN [X]FINAL [ ] PARTIAL [X] PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Payment for Application # for work performed through , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of dollars and 00/cents (0.00 ) Payment for Application # for work performed through , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of dollars and 00/cents ( $ 0.00 ) Application for Payment # 39A has been received for work performed through 01/06/12. (FINAL WAIVER)that the final balance due from the Owner is the sum of Four Thousand Seven Hundred Fifty-four dollars and 00/cents($ 4,754.00 ) THEREFORE,the undersigned waives and releases unto the Owner of said premises,any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work perforrtOd or material furnished to the undersigned for said project,and within the scope of this affidavit and waiver.; W. R. Dunkin&Son, Inc. 137-.- -� Title: Project Manager J WITNESS MY HAND AND NOTARIAL SEAL,this 06th day of January ,2012 (Notary`Publ ic) My Commission Expires:January 08,2017 Printed Martha A.Carpenter Residing in Madison County o`%�e� MARTHA A.CARPENTER , <�_ o NOTARY PUBLIC �'� STATE OF INDIANA Poly Commission Expires 1-8.17 Preuribed 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. ox 22 Terms , /'l/ 4 2// Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /—G —iv 39 y 7 y(25-0 ,75-71_a) Total 477 51-(--(V.-- 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. • l- IS , 20 12— /._1/) _f.surer VOUCHER NO. WARRANT NO. ALLOWED 20 /(71 044714 e- 2.51 7 IN SUM OF $ 7�cmr5d r /JiJ ic2/ f� • $ /{/ 754/. 06/ ON ACCOUNT OF APPROPRIATION FOR 9 2 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or �Gy 39 /9 Yi/&o c% z(,77/-cv 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 10'43 Si.nature Executive Director Title Cost distribution ledger classification if claim paid motor vehicle highway fund Cannel Redevelopment Commission