233800 06/18/14 .Coq .
`�' yF CITY OF CARMEL, INDIANA VENDOR: 00351429
,; ® ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $****30,511.03*
CARMEL, INDIANA 46032 PO BOX 2533 CHECK NUMBER: 233800
�,Ijf IUN�.i ANDERSON IN 46018 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 4 30,511.03 OTHER EXPENSES
APPLICATION AND CER
TO (OWNER): City of Carmel
One Civic :Square
Carmel, IN 46032
FROM (CONTRACTOR):
M. K. Betts Enginee
& Contracting, In
CONTRACT FOR:
CONTRACTOR'S APPLIC
CHANCE ORDER SUMMARY
Change Orders approved in AOC
previous months by Owner
TOTAL
Approved this Month
Number Date Approved
TOTALS
vet change by Change Orders
The undersigned Contractor certifies that to t.
information and belief the Work covered by
completed in accordance with the Contract C
paid by the Contractor for Work for which F
issued and payments received from the Ow
herein is now due.
CONTRACTOR: M. K. Betts Enginec
Bv:
ARCHITE T'S CERTIFICAI
In accordance with the Contract Documents,
data comprising the above application,the Arc
best of the Architect's knowledge,information
indicated,the quality of the Work is in accorda
the Contractor is entitled to payment of the i
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 6/12/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/2014 4 $30,511.03
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 icer
VOUCHER # 135402 WARRANT # ALLOWED
351429 IN SUM OF $
M.K. BETTS ENGINEERING & CONTRF
P.O. Box 2533
Anderson, IN 46018
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
4 07-1052-12 $30,511.03
C0NNe0�Iu"�
Voucher Total $30,511.03
Cost distribution ledger classification if
claim paid under vehicle highway fund
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 6702 (Instructions on reverse side) P"CE ONE Or PAGES `
TO (OWNER): City of Carmel PROJECT: Well 30 APPLICATION NO: Four (4) Distribution to:
One Civic Square Contract No. 82 L OWNER
Carmel, IN 46032 PERIOD TO: 05/31/14 C ARCHITECT
❑ CONTRACTOR
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S
M. K. Betts Engineering PROJECT NO: C
& Contracting, Inc.
CONTRACT FOR: Invoice. No. 14-110. 04 CONTRACT DATE:
ApplicatCONTRACTOR'S APPLICATION FOR. PAYMENT Continua ion Sh et,n is madefor AIA Document G703,Payment, astisatt chedelow, inconnection with the Contract.
CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ........:.:.............$ 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...... ...... $ 114,433.56
Approved this Month (Column G on 6703)
Number Date Approved 5. RETAINAGE:
a. 10 % of Completed Work $ 10,403.24
(Column D+E on G703)
b. 10 % of Stored Material $ 1,040. 12
(Column F on G703)
Total Retainage (Line 5a+5b or
TOTALS Total in Column I of G703) ..................... $ 11,443.36
6. TOTAL EARNED LESS RETAINAGE $ 102 990.20
Vet change by Change Orders ................... �
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)......... $ _ 72,479.17
paid by the Contractor for Work for which previous.Certificates for Payment were 8. CURRENT PAYMENT DUE .. .................. ...... S 30,511.03
issued and payments received from the Owner, and that current payment shown 9. BALANCE TO FINISH, PLUS RETAINAGE.. ........... $ 143,109.80
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 May 2014
Notary Public:
By: Date: may 31, 2014 My Commission expires: October 28 , 2015 .
AMOUNT CERTIFIED................................. $
ARCHITE T'S CERTIFICATE FOR PAYMENT
(Attach explanation if amount certified differs from the amount applied for;
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 gv; 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.