HomeMy WebLinkAbout231311 04/08/14 CITY OF CARMEL, INDIANA VENDOR: 191500
® it ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORS QWCK AMOUNT: $"""16,470.00"
+, CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 231311
:1 . P INDIANAPOLIS IN 46268 CHECK DATE: 04/08/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 1 16,470.00 OTHER EXPENSES
APPLICATION AND CERTIFICATE_ FOR PAYMENT AIA DOCUMENT 0702 '(Instructions on reverse side) PAGE ONE OF PAGES
/ TO (OWNER): City of Carmel PROJECT: Plant 4 Chemical Feed
APPLICATION rv0. Two (2) Distribution to:
One Civic Square Contract No. 83 G OWNER
Carmel, IN 46032 PERIOD TO: 03/31/14 C ARCHITECT
CONTRACTOR
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering
& Contracting, Inc. PROJECT NO: C
CONTRACT FOR: Invoice. No. 14-111. 02 CONTRACT DATE:
Application is made Payment. as elow, in
CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sh et,for AIA Document G703,�isatt chedconnection with the Contract..
CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ..........:...... .......$ 100,900.00
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) .... .......... $ 1002900-00
TOTAL 4. TOTAL COMPLETED & STORED TO DATE...... ... ... $ 31 ,810.81
Approved this Month (Column G on 6703)
Number Date Approved 5. RETAINAGE:
a. 10 % of Completed Work $ 2,067.50
(Column D+E on G703)
b 10 % of Stored Material $ 1,113.58
(Column F on G703)
Total Retainage (Line 5a+5b or
TOTALS Total in Column I of G703) ........... ...... .. .. $ 3,181.08
6. TOTAL EARNED LESS RETAINAGE 28,629.73
Netchan ebvChangeOrders ••••••••• •••••• •••• $
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)......... $ 1,147.50
paidby the Contractor for Work for which previous .Certificates for Payment were 8. CURRENT PAYMENT DUE ..... ... . ............. .... $ ---L7,482.23
issued and payments received from the Owner, and that current payment shown 9• BALANCE TO FINISH, PLUS RETAINAGE .. ... ........ $ 72,270.27
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
BY Date: March 31, 2014 Notary Public: ^ � ...
My Commission expires: October 28 , 2015 .
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED.. .................. ........ .... . $
(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 Bv: 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 any 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
191500
MADDOX INDUSTRIAL CONTRACTORS I Purchase Order No.
8731 AMERICANA BLVD Terms
INDIANAPOLIS, IN 46268 Due Date 4/2/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/2/2014 1 $16,470.00
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 f' r
VOUCHER # 134658 WARRANT # ALLOWED
191500 IN SUM OF $
MADDOX INDUSTRIAL CONTRACTOR:
8731 AMERICANA BLVD
INDIANAPOLIS, IN 46268
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1 07-1052-14 $16,470.00
CONtie(Ai° �
Voucher Total $16,470.00
Cost distribution ledger classification if
claim paid under vehicle highway fund