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Home My WebLink About231310 04/08/2014 ♦u,C�gbf ,r CITY OF CARMEL, INDIANA VENDOR: 00351429 °' ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $****29,277.73* CARMEL, INDIANA 46032 PO BOX 2533 CHECK NUMBER: 231310 �,,�oN�.? ANDERSON IN 46018 CHECK DATE: 04/08/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 609 5023990 2 29,277.73 OTHER EXPENSES r APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G'02 onstructions on reverse side) PAGE ONE OF PAGES TO (OWNER): City of Carmel PROJECT: Well 30 APPLICATION NO: Two (2) Distribution to: One Civic Square Contract No. 82 E. OWNER Carmel, IN 46032 PERIOD TO: 03/31/14 ❑ ARCHITECT G CONTRACTOR FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C M. K. Betts Engineering PROJECT NO: C & Contracting, Inc. CONTRACT FOR: Invoice. No. 14-110. 02 CONTRACT DATE: CONTRACTOR'S APPLICATION FOR. PAYMENT Application is Continuation maet,de for PaymentDocument h own below el w, in connection with the Contract.. CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ........:.:...... ......5 246,100.00 Change Orders approved in ADDITIONS DEDUCTIONS 2. Net change by Change Orders ................ ..... $ —0— previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 -2) ........... ... $ 246,100.00 TOTAL 4. TOTAL COMPLETED & STORED TO DATE...... ...... S 5,487.00 Approved this Month (Column G on G703) Number Date Approved 5. RETAINAGE: a. 10 % of Completed Work 5 479.20 (Column D+E on G703) b. 10 % of Stored Material $ 69.50 (Column F on G703) Total Retainage (Line 5a+5b or TOTALS Total in Column I of G703) ..................... S 548.70 1 vet than e by Change Orders 6. TOTAL EARNED LESS RETAINAGE 4,938.30 j The undersigned Contractor certifies that to the best of the Contractor's knowledge, .(Line 4 less Line 5 Total) information and belief the Work covered by this Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 from prior Certificate).... ..... $ 3,142.80 paid by the Contractor for Work for which previous .Certificates for Payment were 8. CURRENT PAYMENT DUE ...... .. .................. $ 11795.50 >I issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE .. ...... ..... 5 2419161 .70 herein is now due. (Line 3 less Line 6) CONTRACTOR: M. K. Betts Engineering & Contracting, Inc.. State of: Indiana County of: Madison Subscribed and sworn to before me this 31st day of March 2014 Notary Public: ev: Date: March 31, 2014 My Commission expires: October 28 , 2015 . ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED...... .............. ............. S (Attach explanation if amount certified differs from the amount applied fora In accordance with the Contract Documents, based on on-site observations and the ARCHITECT: data comprising the above application,the Architect certifies to the Owner that to the best of the Architect's knowledge,information and belief the Work has progressed as By Date: indicated,the quality of the Work is in accordance with the Contract Documents,and This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractcr named herein. Issuance,payment and acceptance of payment are without prejudice to anv rights of the Owner or Contractor under this Contract. 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 351429 M.K. BETTS ENGINEERING & CONTRACTING Purchase Order No. P.O. Box 2533 Terms Anderson, IN 46018 Due Date 4/2/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 4/2/2014 2 $1,795.50 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 Date VCR&r VOUCHER # 134656 WARRANT # ALLOWED 351429 IN SUM OF $ M.K. BETTS ENGINEERING & CONTRA P.O. Box 2533 Anderson, IN 46018 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 2 07-1052-12 $1,795.50 (V0CF�a� Voucher Total $1,795.50 Cost distribution ledger classification if claim paid under vehicle highway fund "'ItAIA TM Document G702 ® 1992 Application and Certificate for Payment TO OWNER: PROJECT: APPLICATION,Nd::`'::.: Distribution to: CITY of CARMEL CARMEL WWTP FILTER ADD # 84 PERI OD:TO`.. :.:' 3/27/2014 One Civic_Square OWNER El TR CARMEL; IN 46082 CONACT FORCARMEL WWTP FILTER ADD# 84 ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE�/6/2014 MADDOX INDUSTRIAL CONTRACTORS JONES & HENRY ENGINEERS, LTD. CONTRACTOR ❑ PROJECT NOS: 350401 8731 AMERICANA BLVD 431 OHIO PIKE, SUITE 305 FIELD ❑ INDIANAPOLIS, IN 46268 CINCINNATI, OH 45255 INVOICE NO: 00001237 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for Continuation Sheet,AIA Document G703,is attached. which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM ................................................. $ 788,300.00 that current payment shown herein is now due. 2. Net change by Change Orders .......:......:.....:..................... $ 0.00 CONTRACTOR:MADDOXX INDUSTRIAL CONTRACTORS 3.CONTRACT SUM TO DATE(Lineal±2) ..................................... $ 788,300.00 By: ��L C/�G2Z/J/.tom Date: ( ) ...... $ 18 300.00 State of: 4.TOTAL COMPLETED 8 STORED TO�DATE(Column G on G703 , IN 5.RETAINAGE: County oNarion a. 1D—%of:completed Work Subscribed and sworn to before~" (Column D'+'E on G703) $ 1,830.00 me this day of b• r of Stored Material (Column F on G703) $ 0.00 Notary Public:`;BOnnle WhItiOCtC My Commission expires:6/20/2016 Total Retainage(Lines 5a+5b or Total in Colutrm I of G703)....... $ 1,830.00 6.TOTAL EARNED LESS RETAINAGE .................................... $ 16,470.00 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4,Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations,and the data comprising " this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... $ 0.00 PP g > information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the $ 16 470.00 AMOUNT CERTIFIED. 8.CURRENT PAYMENT DUE ........................... , 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED .............................................................................. $ (Line 3 less Line 6) $ 771,830.00 (Attach explanation if annount certified differs from the amount applied. Initial all figures on this Application and on the inuation Sheet.that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in:previous months by Owner $ 0.00 $ 0.00 By. Date: Z— Total approyed„this%Month $ 0.00 $ 0.00 This Certificate is.not'negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 0,00 $ 0.00 named herein.:Issiiance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 0.00 the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702TM—1992.Copyright ©1953,1963,1965,1971,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S.copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. t Prescribed by State goard 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 351429 M.K. BETTS ENGINEERING & CONTRACTING Purchase Order No. P.O. Box 2533 Terms Anderson, IN 46018 Due Date 4/2/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 4/2/2014 2 $27,482.23 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 Date O cer VOUCHER # 134657 WARRANT # ALLOWED 351429 IN SUM OF $ M.K. BETTS ENGINEERING & CONTRi P.O. Box 2533 Anderson, IN 46018 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 2 07-1052-15 $27,482.23 G9 (d"n, Voucher Total $27,482.23 Cost distribution ledger classification if claim paid under vehicle highway fund