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Home My WebLink About232845 05/21/14 r . ": CITY OF CARMEL, INDIANA VENDOR: 191500 ® i'r ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORS QWCK AMOUNT: $...112,230.00* t�q CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 232845 9M��TON G��a INDIANAPOLIS IN 46268 CHECK DATE: 05/21/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 610 5023990 2 112,230.00 OTHER EXPENSES s TM Document 6702 ® 1992 Application and Certificate for Payment TO OWNER• PRp,1ECT APPLICATION NO• Distribution to: CITY of CARMEL CARMEL WWTP FILTER ADD # 84 4/30/2014 One Civic Square PERIOD TO:. OWNER L1 CARMEL, IN 46082 CONTRACT FOR:CARMEL WWTP FILTER ADD # 84 ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE3/6/2014 CONTRACTOR ❑ MADDOX INDUSTRIAL CONTRACTORS JONES & HENRY ENGINEERS, LTD. 8731 AMERICANA BLVD 431 OHIO PIKE, SUITE 305 PROJECT NOS: 350401 / / FIELD ❑ INDIANAPOLIS, IN 46268 CINCINNATI, OH 45255 INVOICE NO: 00001239 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 AIA Document G703TM,Continuation Sheet,is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 788,300.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM ................................................. $ that current payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS .............................. $ CONTRACTOR/:'MADDOX�IN�D/US/TRIAL CONTRACTORS 3.CONTRACT SUM TO DATE(Line 1 f 2) ..................................... $ 7 By: ,��J� '� Date: 15- 4. —4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) ...... $ 143,000.00 State of: IN 5.RETAINAGE: County of:Marion a. 10 %of Completed Work Subscribed and sworn to before ++ �� (Columns D+E on G703) $ 14,300.00 me this ` day of aft®^�� MICHELLE C DUNLAPNotary Public, State of Indiana b• 0 %of Stored Material Marion County (Column Fon G703) $ 0.00 NotaryPublic: Michell&Dunlap 1t�'� Commission a 634883 �, ,• �• My commission Expires Total Retainage(Lines 5a+5b, or Total in Column I of G703)...... $ 14,300.00 My commission expires: 4/25/2020 fp®�� om25, 2020 6.TOTAL EARNED LESS RETAINAGE .................................... $ 128,700,00 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 minus Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... $ 16,470.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of,the Work is in (Lime 6fr•on7 prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE ............................................. $ 112, AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED .......................... . (Line 3 n7inus Line 6) $ 659,600.00 (Attach explanation if amount certified differs fr-on7 the an7ount applied Initial all figures on this Application and on the Continuation Sheet that are changed to conform ivith the amount certified) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in previous months by Owner $ $ By. Date: Total approved this month $ 0.00 $ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTAL $ 0.00 $ 0.00 named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of ET CHANGES by Change Order :7 $_o-0 0 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 G702'"—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. 010711AC044 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 5/15/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 5/15/2014 2 $112,230.00 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 ficer VOUCHER # 135162 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 2 07-1052-14 $112,230.00 0©�,c I Voucher Total $112,230.00 Cost distribution ledger classification if claim paid under vehicle highway fund