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Home My WebLink About229387 2/25/2014 CITY OF CARMEL, INDIANA VENDOR: 00353347 Page 1 of 1 i' ONE CIVIC SQUARE ATLAS EXCAVATING INC CARMEL, INDIANA 46032 4740 SWISHER ROAD BLDG A CHECK AMOUNT: $356,711.41 WEST LAFAYETTE IN 47906 ,o„ o CHECK NUMBER: 229387 CHECK DATE: 2/25/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 610 5023990 1 356, 711 . 41 1052 . 16 AIA Type Document Application and Certification for Payment Pg 1 of 3 i TO(OWNER):City of Carmel, Indiana PENNSYLVANIA PARKWAY-CARMEL i ( ) PROJECT: APPLICATION NO: 1 DISTRIBUTION One Civic Square PERIOD TO:1/31/2014 TO: Carmel, IN 46032 _OWNER _ARCHITECT FROM(CONTRACTOR): Atlas Excavating, Inc. VIA(ARCHITECT): ARCHITECT'S —CONTRACTOR 4740 Swisher Road PROJECT ANO:Contract 66F West Lafayette, IN 47906 i I CONTRACT FOR:Pennsylvania Parkway Water Transmission Main CONTRACT DATE: 12/18/2013 CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies�that to the best of the Contractor's knowledge,information and belief the work covered by this application for Payment has been completed in accordance with Application is made for Payment,as shown below,in connection with the Contract. the Contract Documents,that all amounts have been paid by the Contractor for Work for which Continuation Sheet,AIA Type Document is attached. previous Certificates for Payment were issued and payments received from the owner,and that 1.ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . .$ 1,022,860.00 current payment shown herein is nowIdue. 2. Net Change by Change Orders . . . . . . . . . . . . . . . .$ 0.00 CONTRACTOR: Atlas Excavating, Inc. 3.CONTRACT SUM TO DATE (Line 1 +2). . . . . . . . . . . $ 1,022,860.00 740 Swisher Road West Lafayette, IN 47906 4.TOTAL COMPLETED AND STORED TO DATE . . . . . . $ 375,485.70 A z 1 l/n/ ��/ BY: Date: C I V1 7 5. RETAINAGE: Casey Dillo / Project Manager a. 5.00%of Completed Work $ 5,698.68 State of: IN i County of: Tippecanoe I R b. 5.00%of Stored Material $ 13,075.61 Subscribed and w9rn to before me this ABY Total retainage(Line 5a+5b). . . . . . . . . . . . . . . . . . . . $ 18,774.29 Notary Public: Notaiy Public-Seal State.of Indiana My Commission E"esO MY Commission Expires F eb 11 onn.L 6.TOTAL EARNED LESS RETAINAGE. . . . . . . . . . . . . . $ 356,711.41 1 # (Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FO A 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data com- (Line 6 from prior Certificate). . . . . . . . . . . . . . . . . . . . .$ 0.00 prising the above application, the Architect certifies to owner that to the best of the Architect's knowledge,information and belief the iWork has progressed as indicated,the quality of the work 8.CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . .$ 356,711.41 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED. � Line 3 less Line 6 ( ) $ 666,148.59 AMOUNT CERTIFIED. . . . . .. . . . . .i. . . . . . . . . . . . . . . . . . . $ (Attach explanation if amount certified,differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.) Total changes approved in ARCHITEC previous months by Owner 0.00 0.00 Y B j Date: Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Payment and acceptance of payment are without prejudice to any TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 0.00 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 of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 00353347 Purchase Order No. 4740 SWISHER ROAD BLDG A Terms WEST LAFAYETTE, IN 47906 Due Date 2/24/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 2/24/2014 1 $356,711.41 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5-11-10-1.6 Date Off ic r Y � VOUCHER # 134218 WARRANT # ALLOWED 00353347 IN SUM OF $ 045 cmdv'0", j 4740 SWISHER ROAD BLDG A WEST LAFAYETTE, IN 47906 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 1 06-1052-16 $356,711.41 Availability Voucher Total $356,711.41 Cost distribution ledger classification if claim paid under vehicle highway fund -'TIJNSWKM731XMHEP�� - -