HomeMy WebLinkAbout233687 06/18/14 �N
v`® t`• CITY OF CARMEL, INDIANA VENDOR: 00353347
ONE CIVIC SQUARE ATLAS EXCAVATING INC CHECK AMOUNT: $****35,110.10*
r•. f?�; CARMEL, INDIANA 46032 4740 SWISHER ROAD BLDG A CHECK NUMBER: 233687
WEST LAFAYETTE IN 47906 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 4 35,110.10 OTHER EXPENSES
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AIA Type Document
Application and Certification for Payment
Pg 1 of 3
TO(OWNER):City of Carmel,Indiana PROJECT:CARMEL-PENNSYLVANIA PARKWAY APPLICATION NO: 4 DISTRIBUTION
One Civic Square PERIOD TO:4/30/2014 TO:
Carmel,IN 46032 _OWNER
_ARCHITECT
FROM(CONTRACTOR):Atlas Excavating,Inc. VIA(ARCHITECT): ARCHITECTS —CONTRACTOR
4740 Swisher Road PROJECT NO:Contract 66F
West Lafayette, IN 47906
CONTRACT FOR:Pennsylvania Parkway Water Transmission Main CONTRACT DATE: 12/18/2013
The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
CONTRACTOR'S APPLICATION FOR PAYMENT
belief the work covered by this application for Payment has been completed in accordance with
Application is made for Payment,as shown below,in connection with the Contract. the Contract Documents,that all amounts have been paid by the Contractor for Work for which
Continuation Sheet,AIA Type Document is attached. previous Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM ... . . .... ...........$ 1,022,860.00
2.Net Change by Change Orders . .... . ..........$ 42,349.00 CONTRACTOR: Atlas Excavating,Inc.
3.CONTRACT SUM TO DATE (Line 1 +2). .... . ..... $ 1,065,209.00 4740 Swisher Road West Lafayette, IN 47906 !�- 1141 /�
4.TOTAL COMPLETED AND STORED TO DATE ...... $ 977,523.86 By: ��� Date: p UV I"I
5.RETAINAGE: Andrew Dodson / Project Manager
a. 5.00%of Completed Work $ 48,876.20 State of: IN
County of: Tippecanoe (�/1 n 6d
b. 0.00%of Stored Material $ 0.00 Subscribed and orn to before me t is In Day of 20 /
� W"'
Total retainage(Line 5a+5b). ......... . . . . . . . ... $ 48,876.20
Notary Public:
My Commission Expi s: l�C ELIZABETH ic- DEN
Notary Pablic-Seal
6.TOTAL EARNED LESS RETAINAGE........... . .. $ 928,647.66 ARCHITECT'S CERTIFICATE nnpR�pp�S I na
(Line 4 less Line 5 Total) `'�Y 6nrt11i� Feb 11,2021
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7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based o - se aon a6 to o -
Line 6 from prior Certificate 893,537.56 prising the above application, the Architect certifies to owner that to the best of the Architect's
( )'' ' ' ' ''' '' ' ' '' ' ' ' ' ' ''$ knowledge,information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE . . ... .... . .... . ......$ 35,110.10 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) $ 136,561.34 AMOUNT CERTIFIED..... . ...... $
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Co ion Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCH]T �4Y/4previous months by Owner 13,401.00 0.00 Date:
By:
Total approved this Month 766.00 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 14,167.001 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 14,167.00
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VOUCHER # 135366 WARRANT # ALLOWED
00353347
IN SUM OF $
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ATLAS EXCAVATING INC.
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
4 06-1052-16 $35,110.10
Availability
Voucher Total $35,110.10
Cost distribution ledger classification if
claim paid under vehicle highway fund
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
ATLAS EXCAVATING INC. Purchase Order No.
4740 SWISHER ROAD BLDG A Terms
WEST LAFAYETTE, IN 47906 Due Date 6/10/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/10/2014 4 $35,110.10
1 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 Oifier