HomeMy WebLinkAboutclaimcit20admin_Final_08_07_2020Prescribed by State Board of Accounts County Form No. 17 (Rev. 1996)
ACCOUNTS PAYABLE VOUCHER
ST. JOSEPH COUNTY, INDIANA
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
The City of South Bend Purchase Order No.
227 W. Jefferson Blvd. Terms
South Bend, IN 46601 Date Due
Invoice Invoice Description
Date number (or note attached invoice(s) or bill(s)) Amount
For purchase of right-of-way for Douglas Road Reconstruction
Project/Des. No.: 1400639
Parcel: 20 Parcel ID: 71-04-32-103-001.000-003 &
71-04-32-104-001.000-003
Land & Improvements: $ 3,850.00 _
Administrative Settlement $ 47,880.00
Damages: $ 1,125.00
Total: $ 52,855.00
Total Due $52,855.00
I 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
, 20 _____
Signature Title
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 5-11-10-2.
, 20 _____
County Auditor
The City of South Bend, Indiana, by and through its Board of Park Commissioner
, 2020 By
Mark Neal, President
By
Consuela Hopkins, Vice President
By
Aimee Buccellato, Member
By
Attest: Dan Farrell, Member
Eva Ennis, Clerk