Kingwood Farms/DOCS/$6,182.52 Kingwood Farms
DOCS 2011
Appropriation #44- 624 -00; P.O. #27212
Contract Not To Exceed $6,182.52
ADDITIONAL SERVICES AMENDMENT TO
AGREEMENT FOR PURCHASE OF GOODS AND SERVICES mctt
THIS AMENDMENT TO THE GOODS AND SERVICES AGREEMENT "Agreement entered into by and
between the City of Carmel and Kingwood Farms (the "Vendor as City Contract 10.06.10.08 shall amend the
terms of the Agreement by adding the additional services to be provided by Vendor consistent with the Scope of
Work attached hereto and incorporated herein as Exhibit "A The terms and conditions of the Agreement shall not
otherwise be affected by his Additional Services Amendment and shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have made and executed this Amendment as follows:
CITY OF CARMEL, INDIANA KINGWOOD FARMS
by and through its Board of Public
Works and Safety
By: By:
mes Brainard, Presidi g Officer Authorize ture
Date:
A Printed Name 'LP
M.ry A Burke, Member
Date:
C �S
Title
Lori S. tson, Me ber FID/TIN: 32 i )3 1 3 (9 L a.
Date:
Last Four of SSN if Sole Proprietor:
ATTEST:
Date: aO
p ana Cordray, IA 'Clerk- Treasurer
/Date: (p i `17
[\\1 rappsl\user data admm\LAWVItartxl\ProfSvcs& GooL Svcs \DOCSVUNGWOOD FARMS Add" Svc. Amend Good1 Scvicr, 5- 19- 2011.dcx::5/19/20119:38 AM]
CARMEL CITY 'OF
JAMES BRAINARD, MAYOR
May 18, 2011
Kingwood Farms
P.O. Box 305
Westfield, IN 46034
Re: Additional Professional Services #1 (P.O. 27212)
Dear Ms.DuBois:
The City of Carmel has a need for additional professional services over and above those set out in the Agreement for Purchase of
Goods and Services between the City of Carmel and Kingswood Farms., dated October 6, 2010, (Contract 10.06.10.08) I have
requested and received from you the proposed scope of services and fee estimate for the following services:
Additional Services #1: Extension of current contract Not to Exceed: $6182.52
#10.06.06.08
Per our procedural requirements, I hereby approve this "Additional Professional Services" estimate, and grant you the Notice to
Proceed for the above services.
PLEASE NOTE:
Be advised that "Additional Professional Services" performed through agreement with the City of Carmel must be billed separately
from the original Agreement and other additional services. More importantly, the invoice must reference "Additional Services #1"
and include Purchase Order #27212.. Invoices submitted without this information will be returned to your office. Thank you for
your continued assistance in providing the City of Carmel with your professional, quality services. If you should have any questions,
please give me a call.
Sincerely,
Michael Hollibaugh 1
Director Reviewed and approved by:
cc: Mayor James Brainard
Diana Cordray, Clerk Treasurer ,,e,e/
Cindy Sheeks Steve Engel ing
Director of Administrat on
Exhibit r
DEPARTNIE.NT OF COMMUNITY SERVICES
ONE CIVIC SQUARE, CARMEL, IN 46032 PHONE 317.571.2417, FAX 317.571.2426
MICHAEL P. HOLLIBAUGH, DIRECTOR
TAX C iCity of C armed. CERTIFICATE NO! 20155 002 0 PAGE
PURCHASE ORDER NUMBER
FEDERAL EXCISE TAX EXEMPT 0 7-02
35- 60000972
ONE CIVIC SQUARE THIS NUMBER MUST APPEAR ON INVOICES, NP
CARMEL, INDIANA 46032 -2584 VOUCHER, DELIVERY MEMO, PACKING SLIPS,
SHIPPING LABELS AND ANY CORRESPONDENCE.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR CITY OF CARMEL 1997
PURCHASE ORDER DATE DATE REQUIRED REQUISITION NO. VENDOR NO. DESCRIPTION
l u)ddC� 7 S 4 n' h q-'77
c!p
h 6 SHIP wG S
VENDOR 605 TO 0111 L al 0 C
CONFIRMATION BLAN T CONTRACT PAYMENT TERMS FREIGHT
QUANTITY I UNIT OF MEASURE I DESCRIPTION UNIT PRICE EXTENSION /9- h 77 M irL Sertil C-64 e_ale7' d 61 rd -Ls ,.1--
a
414X i k.
I' A -4
t.,,,:,3 .u. ,i,
i r. 4
NI,, f'''
S
Send Invoice To: ya XS g q
Jj nl. 9 �9-� ,LL,L
cid b oc.s 21i/ Cod q Ov
c 1 al 6,- Ce -rdi v PLEASE INVOICE IN DUPLICATE
DEPARTMENT ACCOUNT PROJECT PROJECT ACCOUNT AMOUNT
PAYMENT
A/P VOUCHER CANNOT BE APPROVED FOR PAYMENT UNLESS THE P.O.
NUMBER IS MADE A PART OF THE VOUCHER AND EVERY INVOICE AND
VOUCHER HAS/Ta PROPER SWORN AFFI0 •VIT ATTACHED.
SHIPPING INSTRUCTIONS I HEREBY CE' H• .HERE IS AN U •BLIGATED BALANCE IN
THIS APPRO p ....FICIENT TO P•4. FOR THE ABOVE ORDER.
SHIP REPAID.
C.O.D. SHIPMENTS CANNOT BE ACCEPTED.
PURCHASE ORDER NUMBER MUST APPEAR ON ALL ORDERED BY
SHIPPING LABELS.
THIS ORDER ISSUED IN COMPLIANCE WITH CHAPTER 99, ACTS 1945 TITLE Agile
AND ACTS AMENDATORY THEREOF AND SUPPLEMENT THERETO.
CLERK TREASURER
DOCUMENT CONTROL NO. 27 212 VENDOR COPY