HomeMy WebLinkAbout233802 06/18/14 "f CITY OF CARMEL, INDIANA VENDOR: 191500
4/ 4! .
® ij ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORS QWCK AMOUNT: $...137,815.33*
CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 233802
��i„IIUN gip.= INDIANAPOLIS IN 46268 CHECK DATE: 06/18/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 3 137,815.33 OTHER EXPENSES
1.11wAIA
®current G702TM 1992
0
Application and Certificate for Payment
TO OWNER: PROJECT: APPLICATION NO: Distribution to:
CITY of CARMEL CARMEL WWTP FILTER ADD # 84 PERIOD T0:
5/30/2014 OWNER
One Civic Square El
CARMEL, IN 46082 CONTRACT FaR4RMEL WWTP FILTER ADD # 84 ARCHITECT ❑
FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DA3-A/2014 CONTRACTOR ❑
MADDOX INDUSTRIAL CONTRACTORS JONES & HENRY ENGINEERS, LTD. PROJECT NOS' / /
8731 AMERICANA BLVD 431 OHIO PIKE, SUITE 305 350401 FIELD ❑
INDIANAPOLIS, IN 46268 CINCINNATI, OH 45255 INVOICE NO: 00001240 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
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 ADDOX INDUSTRIAL CONTRACTORS
3.CONTRACT SUM TO DATELine I f? �.G% /����,� ,3G--Z.G; -
( ) ..................................... $ 788,300.00 By: i
Date: - -
4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) ...... $ 296428.14 State oiN
5.RETAINAGE: CountyM6rion
% f Completed Work ,.��;►O1e '"" MICHELLE C DUNLAP
a10 p Subscribed and sworn to before o e,.•••0"",
•„Notary Public, State of Indiana
Cohnzus D+Eon G703 24,480 88 N_. _ �j,f NaT��'•
( ) $ me this r►` � `C day of _t. '.t Marion County
b}_Q__%of Stored Material ' r '•,SEAQ Commission N 634883
(ColirrnnFonG703) $ \\�;j;:a ' � r�i��No�� ,������ My Commission Expires
5,132. 1 Notary Publimichelle C Dunlap Apr11 25, 2020
Total Retainage(Lines Sa +56, or Total in Column I of G703)...... $ 29,612.81 My commission expire 4/25/2020
6.TOTAL EARNED LESS RETAINAGE .................................... $ 266,515.33 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 ruinits Line S Total) In accordance with the Contract Documents,based on on-site observations and the data comprising
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... $ 128,700.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge,
(Line 6 fr•ain prior Certificate) information and belief the Work has progressed as indicated, the quality of the Work is:in
accordance with the Contract Documents, and the Contractor is entitled to payment of the
8.CURRENT PAYMENT DUE ............................................. 1137,815.33 AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED ............................................................................. $
(Line 3 minus Line 6) $ _ 521,784.67 (Attach explanation if anozmt certified differs fi-om the oinouni applied. Initial all figures on this
Application and on the Continuation 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:
Total approved this month $ $ o.nn —�
This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor
TOTAL $ $ n.no named herein. issuance,payment and acceptance of payment are without prejudice to any rights of
ET CHANGES by Change Order fl 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 G702T"— Document is protected by U.S.Copyright Law
1992.Copyright @ 1953, 1963, 1965,1971,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA`
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.
010711AGO44
1
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 6/12/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/12/2014 3 $137,815.33
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 icer
VOUCHER # 135401 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
3 07-1052-14 $137,815.33
C-0 Ni✓� �f,'n n/
�l
Voucher Total $137,815.33
Cost distribution ledger classification if
claim paid under vehicle highway fund