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SHIEL SEXTON COMPANY, INC.- 002981- 6/21/2012 CARMEL REDEVELOPMENT COMMISSION 002981 Shiel Sexton Company, Inc. Check: 2981 902 N Capitol Avenue Date: 6/21/2012 Indianapolis, IN 46204 Vendor: SHIELSE1 Prior invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 69 550.00 550.00 0.00 0.00 550.00 May billable expenses • 4346-01 27,546.04 27,546.04 0.00 0.00 27,546.04 May expenses P7A 28,096.04 28,096.04 0.00 0.00 28,096.04 .. "�.j°'+�j�THE KEYTO DOCUMENT SECURITYw"(HEALACTIVATED THUMB?RINT7ADDITIONAL"SECURITY.FEATURES INCL'UDED;��SEE BACK F,OR DETAILS .?»i;q� E 6"% Carmel Redevelopment Commission REGIONS 002981 30 West Main Street 2o-142lneo At'1ti Suite 220 nif"`° Carmel, IN 46032 +ral�1 2981 DATE AMOUNT 6/21/2012 28,096.04 . PAY THE SUM OF TWENTY EIGHT THOUSAND NINETY SIX DOLLARS AND 04 CENTS TO THE ORDER OF Shiel Sexton Company, Inc. 902 N Capitol Avenue • Indianapolis, IN 46204 M ,,..- . :,h„„, /1'00 298 11• 1:0 740 14 2 1 31: 008 7 504 1 1 LEI' May 31,2012 fS ; Mr.Les Olds.Director r - -4,} Carmel Redevelopment Commission C 5 City of Carmel - "� 30 West Main Street, Suite 220 Carmel, IN 46032 RE: Parcel 7A, Regional Performing Arts Center Construction Management Services - Shiel Sexton Job#2695 Payment Application 69(May, 2012) The following is a summary at Shiel Sexton's billable expenses: CM STAFF May, 2012 2695-61 $ 550.00 CM GENERAL CONDITIONS May,2012 2695-61 $ - CM REIMBURSABLES May, 2012 2695-61 $ - TOTAL DUE I $ 550.00 If you have any questions please call me at 223-5011, Si , iteuitr.4 David C. B chard Construction Manager Shiel Sexton Company, Mc. 902 North Capitol Avenue Indianapolis, IN 46204 Invoice Disbursement Schedule Contract: 2695-CARMEL-PAC-CONSTRUCTION Invoice: 2695-61 05/31/12 Item: 10-CM Staff Labor 4 salary weeks 04/13/12 thru 05/10/12 Sr. PM- 1 man-salary 5.00 Hrs @ $110.00 550.00 Total Hours 5.00 TOTAL Labor 550.00 Material TOTAL Material - Subcontract TOTAL Subcontract - Item:10-CM Staff 550.00 Item:20-CM General Conditions Material TOTAL Material - Item: 20-CM General Conditions - Item: 30-CM Reimbursables Material TOTAL Material - Item:30-CM Reimbursables - Summary 10-CM Staff 550.00 20-CM General Conditions - 30-CM Reimbursables - CURRENT DUE: 550.00 May 3I,2012 r... Brandon Bogan t ,,,;� CSO Architects 280 E.96th Street, Suite 200 Indianapolis, IN 46240 RE: Carmel City Center—Parcel 7A Regional Performing Arts Center Payment Application #69 Mr. Bogan, Shiel Sexton has reviewed the attached Prime Contractor MA payment applications and requests payment of the amounts indicated. Also attached for review and approval are the Construction Management Services/Reimbursables and Construction Management Fee payment applications. Below is a Payment Request Summary. Upon review and approval, please forward to Les Olds for approval and payment. Shiel Sexton requests a copy of the Prime Contractor payment checks for the project files. Payment Request Summary 3000: Hagerman Construction Company(Concrete) S 0.00 3020: Purdy Masonry Inc. (Exterior Masonry) $ 0.00 3030: Steel Supply& Engineering(Structural Steel) $ 0.00 3110: Hagerman Construction Company(Limestone Cladding Install) $ 0.00 4300: General Piping, Inc. (HVAC Piping& Plumbing) $ 0.00 5170: J.R. Clancy, Inc.(Theater Equipment) $ 0.00 (IPC-01) Shiel Sexton Company. Inc.(Construction Management Services/ Reimbursables) $ 550.00 Shiel Sexton Company, Inc.(Construction Management Fee) $ 0.00 Sincerely, , I II'- .t. •yr v • David C. Burchard Construction Manager Shiel Sexton Company. Inc. :-' r s }I. �. ic' V ► I' • i •w May 29, 2012 Mr. Les Olds Carmel Redevelopment Commission 30 West Main, Suite 220 Carmel, IN 46032 RE: Cannel City Center— Parcel 7A Regional Performing Arts Center Landscape Hid Packages Payment Application #4346-01 Mr. Olds: Attached for your review and approval is the Construction Management Services / Reimhursahles and Construction Management Fee payment application. Payment Request Summary Shiel Sexton Company, Inc.. (Construction Management Services / Reimhursables) $27,546.04 Sincerely. .t, - Michael G. Anderson QI" Senior Project Manager Shicl Sexton Company, Inc. Invoice Disbursement Schedule Contract: 4346- PALLADIUM LANDSCAPING I� Invoice: 4346-01 05-31-12 (Period 3.7.12 to 5.31.12) Item: 1 -PALLADIUM LANDSCAPING • Labor SR PROJECT MANAGER 96.00 Hrs @ $53.41 5,127.36 25% Markup, 1,281.84 (per contract) TOTAL Labor 6,409.20 Material SPEEDWAY SUPERAMERICA LLC 050812 115.22 SPEEDWAY SUPERAMERICA LLC 040813 107A7 VERIZON WIRELESS SERVICES, LLC 2735783860A 76.62 VERIZON WIRELESS SERVICES, LLC 2721581411A 5563 TOTAL Material 354.64 Subcontracts BYBEE STONE COMPANY, INC PayApp# 1 $415,644.00 Fee= 5% 20,782.20 TOTAL Fee 20,782.20 Invoice: 4003-13 27,546.04 REMIT TO'. SHIEL SEXTON COMPANY, INC 902 N. CAPITOL AVENUE INDIANAPOLIS, IN 46204 ATTN: ACCOUNTS RECEIVABLE I 0,41-.... ,; _ _ - ._. - - - TKxNhon you prov3ou a check as payment, you authorize-Us'either'-to:uso the rtnlarrseqtlon- 1 -.-.:- - _ from your chock to maks a one-time electronic fund transfer. froal your.accourt. or:to-- SpeedivAJ - .. process-tho payment as a check transact ion.Kee +-A A -rr::. ACCOUNT NUMBER CUEDATC AMOUNT DUE AMOUNT PAID In I a ta ap"M1 t/ m 4. la' :i 100 0194 009 4 l O6 3 05 12 _$48304;;85 1000194009 MAIL PAYMENT TO: For questions or account P . O. BOX 740587 _ information: CINCINNATI, OH 45274—.0587 _ WRITE TO: Speedway LLC ATTN:Credit Customer Service R.O.Dcx 1590 SHIEL SEXTON INC Springfield,OH 45501 902 N CAPITOL AVE STREET ADDRESS CALL: 1.800428.4018 FAX: INDIANAPOLIS • IN 46204-1005 CITY STATE ZIP— Email:.(937)•864.3091 speedwaycreditcard @spoodway.com I1inliulnn1 il)Iuuii 111111111111111111)1111111:nD1r1111111 AREA CODE / PHONE NUMBER TAX ID: 31 •1551430 Complete above QNLY it address has changed. For overnight payments: Speedway LLC Credit Services 910001940096004830485 500 Speedway Drive Enon,OH 45323 1_ _ . -. Pay online @ www.suporlloet.net Pay by phone:14366431-1345 PLEASE,include your account number on all checks/correspondences. TRANS REFEREMCE: TIME CARD DESCRIPTION OF TRANSACTION - A610UNT DATE .NUMBER NUMBER TOTAL FOR CMG TO ID 4241 0215.01 04-11 12102 52 015044 07:53:22 0175 STR 6133 3510 S MERIDIAN ST INDIANAPOLIS IN $75.98 TOTAL FOR CHG TO ID 9999 $75.98 TOTAL FOR DRIVER MARK MCGUIRE 1360.53 04-18 ' 2109 52 002280 13:13:43 0131 STR 1326 6198 ALLISONVILLE RD INDIANAPOLIS IN $42.01 04-25 2116 52 002298 12:18:00 0131 STR 1326 6198 ALLISONVILLE RD INDIANAPOLIS IN $43,02 05-01 2122 52 002195.18:01:35 0131 STR 1331 3803 S SCATTERFIELD RD ANDERSON TN $50.20 TOTAL FOR CHG TO ID 4298 $$135.23 TOTAL FOR DRIVER MARK STANFIELD $135.23 04-12 '2103 52 017624 19:29:39 0181 STR 7288 1600 US-52 N HEST LAFAYETTE IN $250.00 ., 04-12 12103 52 017626 119:39:15 0181 STR 7288 1600 US-52 H HEST LAFAYETTE IN $63.64 04-17 12108 52 011282 07:34:02 0181 STR 5181 8202 ALLISONVIL LE RD INDIANAPOLIS IN $211.06 04-18 2108 52 031574 '06: 03:55 0181 STR 5181 8202 ALLISONVILLE RD INDIANAPOLIS IN $137.92 TOTAL.FOR CHG TO ID 4028 5662.62 • 04-09 2100 52 005492 13:02:34 0181 STR 3310 3879 SR 38 E LAFAYETTE IN $250.00 ' 04-09 ' 2100 52 005493 13:11:48 0181 STR 3310 3879 SR 38 E LAFAYETTE IN $54.58 04-09 12100 52 005494 13:14:52 0181 STR 3310 3879 SR 38 E LAFAYETTE IN $60.13 05-02 12123 52 013537 11:38:20 0181 STR 5517 7339 PENDLETON PIKE INDIANAPOLIS IN $205.52 05-02 12123 52 013538 11:48:18 0181 STR 5517 7339 PENDLETON PIKE INDIANAPOLIS IN $183.78 TOTAL FOR CHG TO ID 4078 $754.01 TOTAL FOR DRIVER MATT DUNN $1416.63 04-29 12120 52 000839 10:27:35 0220 STR 1316 1390 H OAK ZIONSVILLE IN $49.13 05-04 2125 52 002232 17:54:38 0220 STR 1316 1390 H OAK ZIONSVILLE 1N $66.09 TOTAL FOR CHG TO ID 4346 $115.22 U ce Aktersen f ACCOUNT NU:01MA. STATEMENT .PREVIOUS .;PAYMENTS/ ':CHARGESI ,; ...- CLOSING DATE BALANCE '' CREDITS ;- ADJ ..:;:J CHARGE .. BALANCE -.. :.Yf -.n , -- ANNUAL MONTHLY AVERAGE ONLY Ic AVOW Aoaulc"W rnn CREDIT AVAILABLE FINANCE PERCENTAGE PERIODIC BALANCE SUBJECT TO 'MIAMI tt "s9 PAGE LIMIT CREDIT CHARGE RATE INTEREST RATE FINANCE CHARGE MINCE aun II uurvtO >2 oF38 ay 1"r we CAPE s"aW Mad -- r_y e - KEEP THIS PAfit FOR YOUR RECORDS Ac==r_T: Wedway LLC OIC4F 0612011 NOTICE: SEE REVERSE SIDE FOR IMPORTANT ADDITIONAL INFORMATION .m3401R Rev.3111 S•• "t KNOHhen you provt e a check as payment, you.authorl;e us either to use the information �___.;¢ from your chock to make a one-tine elecQtronic fund transfer from your account or to fpeedWdy,! Process the payment as a check transaction.roei -`a;=ACCOUNokoKiePR : DUEDATI AMOUNi;DUF-C AMOUNT PAID TAcniei-X,.ail d,Xc tu[hrr3/TG�-ij�°'t �'..�_-^ - 10 Lt.. . .-g0.5 044; he_._ .68210.8= �, _- - 000194009 - MAIL PAYMENT TO: N questions or account , P.O. BOX 740587 'orma0on: 'CINCINNATI , __ OH 45274-0587 RITE TO: msdway LLC FTN:Credit Customer Sorvice O.Hex i590 SHIEL SEXTON INC ainglleld,OH 45501 902 N CAPITOL AVE STREETADORESS 1X1: 1.800.428.40111 1X: (937)864.3091 INDIANAPOLIS IN 46204-1005 CITY STATE ZIP mall:speedwaycredltcard @speedWay.com lilit 1111111111 Illilllliiliil i TI}lilt lili 111 IgI 1111111 iii li11' AREA CODE / PHONE NUMBER !X10: 31.1551430 Complete above ONLY it address has changed. 1r overnight payments: wodway LLC odlt Services I. 9100019400%005448208 0 Speedway Drive Ion,OH 45323 I_ - iy online®WWW.suportloot.neI y by phone:1 866 731 1345 PLEASEshcade your account number on all checks/corras ondences. _ RANS z iEFERE GD T1M i" CARD , r„ �'r"G` DEbCR PTION OAF THANSACtidth �' '�" - l-'.y+ ` "�AMOIfffirc :, LATE "A:101UMBER' ra,. ... 1_ NUMBER .'.. -i v-+' :. ,a:, ., :n.4,.ri '":4..-zz"r`,S.Y..:. v s+ r-> 3-12 12072 52 015668 11:30:16 0181 STR 7288 1600 US-52 H HEST LAFAYETTE IN. $11.58 3-12 2072 52 015669 11:32:10 0181 STR 7288 1600 115-52 H HEST LAFAYETTE IN . $206.72 ' 3-26 12086 52 005648 10:13:12 0181 STR 3310 3879 SR 38 E LAFAYETTE IN $250.00 3-26 12086 52 005649 10:23:05 .0181 STR 3310 3879 SR 38 E LAFAYETTE IN $60.50 3-26 2086 52 005650 10:26:09 0181 STR 3310 3879 SR 38 E LAFAYETTE IN $64.24 3-29 12089 52 015116 12:25:29 0181 STR 6120 401 KENTUCKY AVE INDIANAPOLIS IN $250.00 3-29 12089 52 015117 12:35:50 0181 STR 6120 401 KENTUCKY AVE INDIANAPOLIS IN 974.14 3-29 12089 52 015118 12:39:25 0181 STR 6120 401 KENTUCKY AVE INDIANAPOLIS IN $70.47 TOTAL FOR CHG TO ID 4078 $1237.65 TOTAL FOR DRIVER MATT DUNN $3039.36 4-01 12092 52 000832 12:02:36 0220 STR 1316 1390 H OAK ZIONSVILLE IN $78.50 4-08 ' 2099 52 000739 09:09153 0220 STR 1316 1390 H OAK ZIONSVILLE IN $71.70 TOTAL FOR CHG TO ID 9999 $150.20 3-23 12083 52 012435 07:01:39 0220 STR 5468 1032 N RANGELINE RD CARMEL IN $63.47 TOTAL FOR CHG TO ID 99999 063.47 ien' I TOTAL FOR ORIVER MIKE ANDERSON 9 67 • 3-08 12068 52 013685 9:46:21 0121 STR 6066 8895 E 116TH ST FISHERS IN $56.95 5-16 2076 52 009948 3:41:32 0121 STR 5016 3801 S MARTIN LUTHER K ANDERSON IN $54.99 3-21 12061 52 009997 9:27:59 0121 STR 5014 2945 N SCATTERFIELD RD ANDERSON IN $72.77 3-22 2082 52 010122 6:04:52 0121 STR 5014 2945 N SCATTERFIELD RD ANDERSON IN $46.00 3-24 12084 52 005662 2:10:40 0121 STR 5016 3801 S MARTIN LUTHER K ANDERSON IN $52.48 3-29 2088 52 030755 5:11:47 0121 STR 1331 3803 S SCATTERFIELD RD ANDERSON IN $91.19 3-30 . 2090 52 016889 08:15:24 0121 STR 7155 7167 S SR-67 PENDLETON IN $57.93 t-02 2093 52 014367 10:19:57 0121 STR 6066 8895 E 116TH ST FISHERS IN $62.76 1.05 12096 52 010442 13:38:34 0121 STR 5014 2945 N SCATTERFIELD RD ANDERSON IN $59.14 TOTAL FOR CHG TO ID 1205 0554.21 3 714 12674 52 002257 11:04:25 0121 STR 1331 3803 S SCATTERFIELD RD ANDERSON IN $68.75 ' • '''STATEMENT M PREVIOUS -! -.:;P.AYMENTSf C ARGES/ '4 FINANCE ' 'i = .{f NEW;?-4,4'?= ^COUNT NUMBER, .... -.S 'r CLOSINQ,DATE£ -.tALANCE :. ,CREDITS • AD , ,' CHARGE i BAANCE ,t --.- Y-T•O ANNUAL MONTHLY AVERAGE DAILY w AVOW ADMIRMn FIX�NtE CREDIT AVAILABLE FINANCE PERCENTAGE PERIODIC BALANCE SUBJECT To •1$I Of Or MM PAGE LIMIT CREDIT FINANCE CHARGE 'Teti MI a mm, tae ? OF4 CHARGE RATE INTEREST RATE n 1Xr DOL our WWI mcu 4 40 I J.r ' 'is -' KEEP THIS PART R_y`--2,;1.- FOR YOUR RECORDS I wedway UC GLOW 0E12011 NOTICE: SEE REVERSE SIDE FOR IMPORTANT ADDITIONAL INFORMATION Im 3401 R Rev.3/1-1 . t IIIIIIIIIIIIIIdII1Iil mi 111111 N III lInQnli: RM30?Vmalg* Rm“Ilrim pm 11 :flmiina2WIRNil. .5INIE2EWEE9 hail 1' IRMs7h6i4MN9Rf4RIxMGR E4in x .I I 1 811111111111 1/8 11RRR'3EME4 li 6 q BRIE 18 K %iffi�i g� - no rn� 4 El :!ii r� fy I IIIIII III I I I I I I I I IIIIIII I IIII I A li IMPAP MPLPH y 1515N5 >s � $^ r,�F p 7p 4 F xE,F s�^a �^ • Mil wHE{GF ITiiF iral»1:iM" l:l.NPAIdL�45LEGal 1 9lli IIIIIIIIIIIIIIIIIIIIIIIIIII111 • 1, . r rin;1IN$ I I I '`"` I I I I IiI I I Ij H I I I � IIp� so�N�sasYFFY��� ssec r,s �ss $$ r-s �ycy NeN Za4jjac Nc c ,sy� � I . PIF�:iiiinti'.F;;��II�''3. yr� ini`i Fl�;`FbtMainn 1;Y: p� � 4 .. :^uxca.manynnrimErizR7wRER • n�n F n F d ! 5 ro i a i n 2 n n 1R n•� pru n nF F F 4 n n Fn XFFF Fn Fn Invoice Number Account Number Date Due Page 721581411 480894.394-00001 --04/21/12 3 of 2061 • Overview of Lines YZW Mobile Surcharges Taxes, Current Current To - Monthly and Other Governmental Third-Party Plan Plan Mobile Night and Roa Page lonnee Usage Equipment Charges and Surcharges Charges Total Allowance Usage Usage Weekend Data Usage Us. Charges by Cost Center Number Charges Charges Charges Credits and Fees (includes Tax) Charges (minutes) (minutes) (minutes) (minutes). KB/MB/GB (min • No Cost Center 317-201-67431.7.Ni-card 13 $39.00 - - $.08 $.00 - $39.08 - - - - 1GB 317-220-4452 Superbowl Nrcard 14 $39.00 ' - - 5.08 5.00 - $39.08 - - - - 1GB - 317-220-4785 Richard Dawson - 15 $52.47 '5.50 -- $2.83 $2.61 - 558.41 200 218 2040 224 13,910KB - 317-223-4622 Aaron Martin 29 $159.89 5.25 - $10.48 $12.24 - 5182.86 6000 73 117 33 317-223--4623 Jeny Bergman 33 $185.07 $6.50 $27.81 $10.58 $12.58 - $242.64 5000 291 88 219 1.623,120K6 317-223-5011 Dave Burchard 38 $185.07 $.50 - $10.49 $12.26 - $208.32 6000 907 260 144 52,090KB - 317-223-6504 Steve Lehe 48 5188.07 57.50 - • $10.60 $12.75 - $218.92 6000 543 365 162 343,1241<8 317-223-6580 Chad Rosebrock 54 $185.07 $8.20 . - $10.61 $12.79 - 5216.67 6000 298 117 118 255,845KB 317-260-3176 Jeff Henning 59 $185.07 - - $10.48 $12.22 - $207.77 6000 23 57 62 • 43,726KB - 317-281-0743 Dave Brewer 62 $185.07 53.00 - $10.52 $12.43 - $211.02 6000 797 . 923 674 408,1241(5 317-281-0972 Jeff Faulkner 77 3205.07 - -- $10.84 $13.62 -- $229.53 6000 331 692 60 953,7611(3 - 317-281-1226 Bill Banker 85 $185.07 $2.50 - $10.52 $12.40 -- $210.49 6000 872 650 72 420,984KB • 317-281-1340 Tony iisenhut 100 $185.07 $33.05 -- $11.03 $14.54 - $243.69 6000 571 1895 276 123,722KB - 317-281-1342 Bill Henry 116 $205.07 - - 210.84 $13.62 - $229.53 6000 320 174 141 14,377KB - 317-281-1705 Mat.Jacques 123 $205.07 - $181.34 $10.64 $13.62 - $411 ; 6000 479 851 166 .355,089K8 -'> 317-281-1900 Mike Anderson 136 $195.07 - - $10.66 $12.92 - CM,r 6000 321 240 154 312,373KB - 317-281-2220 Warren Tetrick 141 $185.07 $3.00 $234.84 510.52 $12.43 - $445.85 6000 166 322 81 66,254KB - 317-281-2514 Rob Butcher 148 $185.07 5.25 - $10.48 $12.24 - $208.04 6000 381 410 56 336,066KB - 317-281-4759 Matt Dunn 154 $189.89 - - $10.66 $12.92 -- $213.47 6000 902 1089 300 6,184,686KB - 317-281-5472 Mark Cat( 181 $.00 - - 3.00 5.00 - 5.00 - - - - -- - 317-281-5622 Lane Keatts 182 5185.07 $1.00 - $10.49 $12.29 - $208.85 6000 • 1023 390 632 26,7351(8 - 317-281-9040 Jim Bennet 195 $179.69 -- -- $10.48 $12.22 - $202.59 6000 160 203 15 2839KB 317-281-9846 Steve Osbon 201 $52.47 - - $2.82 $2.57 - $57.86 200 336 276 . 20 23,196KB -- 317-286-8784 Travis Hackman 209 $52.47 -- -- $3.00 $2.27 - $68.74 200 431 905 207 945,7081(8 - 317-289-8014 Mke Green 225 $65.47 - - -- $3.00 $3.27 - $71.74 200 340 226 35 571,909KB - 317-339-0438 Jay Hosteller 231 552.47 $5.60 - $2.92 $2.97 - $63.96 200 780 802 153 554,485KB 317-339-0710 Greg Can ' 240 $62.47 - - $3.00 $3.27 -- $68.74 200 448 225 • 137 27,8981<8 - 317-339-1700 Dennis White 248 $32.29 - -- $3.11 $2.93 - $38.33 200 384 222 241 317-339-1701 Dave Pants 261 $52.47 - - $2.82 $2.57 - $57.86 200 109 130 7 97,460KB x..317-338-2396 Joe Brawn 264 579.42 - $202.74 $3.18 $3.97 - 89.31 200 1386 85 454 1,261,429KB _ - '317-339-2699 Jim Wenzler 287 $55.47 $8.75 - $2.95 $3.18 - 70.25 200 1079 1566 293 752,3921<8 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. / L Payee /ix . Purchase Order No. • 9n 0, op,' of /jvrayP Terms 41r/7944,0 5, iU 4626),i Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5�29�/ h 39‘—G/ /24l p 7/9 27 5W,vy Total 27, SY6,09 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. Co '673 , 20 R- reasurer 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 5`71 4 SavT'E (nrm ?.yr5 /22/ - Purchase Order No. 964 ti/. CO3 ,•f,/ M!/4//4", Terms /0/22 i9eip o i /dJ ;4,269 y Date Due Invoice Invoice Description Amount Date Number A., (or note attached invoice(s) or bill(s)) 3/-I.2 GS' fie,/ 20/2 h/I/QG/s P. JSrJ S SG UU r 7: ti Total 5 -'U I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. to —Ow , 201 fertc Treasurer