HomeMy WebLinkAbout234263 07/01/2014 CITY OF CARMEL, INDIANA VENDOR: 368347
ONE CIVIC SQUARE CSU INC CHECK AMOUNT: $***142,837.00*
CARMEL, INDIANA 46032 3919 CLARKS CREEK ROAD CHECK NUMBER: 234263
PLAINFIELD IN 46168 CHECK DATE: 07/01/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 1 142,837.00 OTHER EXPENSES
Contractor's Application for Payment No. I
Application Period: Application Dale:
17-Mar-14 to 9-May-14 5/9/2014
To(Owner): From(Coutmctor): Via(Engineer):
Carmel Water Utility CSU,Inc Crossroad Engineers
Project: 106th&Illinois Water Main Extension Contract:
Owner's Contract No.: Contractor's Project No.: 'CWU140037 Engineers Project No.: N/A
Application For Payment
Change Order Summa ry
Ae2roved Chane Orders I. ORIGINAL CONTRACT PRICE.......................................................... S S116,501.00
Number Additions Deductions 2. Net change by Change Orders....._..---..---.._........................................ $ 526,336.00
1-8"Addition 26336 3. Current Contract Price(Line 1:1-2)........................................................ S S142,837.00
4. 'TOTAL COMPLETED AND STORED TO DATE
(Column F on Progress Estimate)........................__............................... S 5142,837.00
S. RETAINAGE:
1.'0% X 5142,837.00 Work Completed......».. S $0.00
b.0"A X 50.00 Stored Material............ 5 50.00
c.Total Retainage(Line 5a+Line 5b).................... ..--. S $0.00
6. AMOUNT ELIGIBLE TO DATE(Line 4-Line Sc)............................. S 5142,837.00
TOTALS $26,336.00 $0.00 7. LESS PREVIOUS PAYMENTS(Line 6 from prior Application)........ S
NET CHANGE•BY 426,336.00 8• AMOUNT DUE THISAPPLICATION................................................. S $142,837.00
CHANGE ORDERS 9.BALANCE TO FINISII,PLUS RETAINAGE
(Column G on Progress Estimate+Line 5 above)................................... S $0.00
Contractor's Certification
The undersigned Contractor certifies that to the best of its knowledge:(1)all previous progress
payments received from Owner oil account of Work done water the Contract have been applied on Payment of $ 5142,837.00
account to discharge Contractors legitimate obligations incurred in connection with Work covered
by prior Applications for Payment;(2)title of all Work,materials and equipment incorporated in (Line 8 or other-nttpclt explanation of the other amount)
said Work or otherwise listed is or coveted by lids Application for Paymetd will pass to Owner at
time of paynnen t free and clear of oil Liens,security interests and encumbrances(except such as are
covered by a Bond acceptable(o Owner indemnifying Owner against any such Liens,security is recommended by:
interest or encumbrances);and(3)all Work covered by this Application for Payment is in (Engineer) (Date)
accordance with the Contract Documents and is not defective;(4)all items and amounts on the
face of this Couvacio's Application for Payment are correct(5)all Work has been oerfomnod
and/or material supplied in full accordance with the rcamirements of the reforoneod Contract and/or Payment of: $ S142,837.00
duly authorized devirntions substitutions.alterations-and/or additions:(6)the foregoing is a Iruc
and correct statement of the Contract account up to and including the last day of the period covered (Line 8 or outer-attach explanation of die other amount)
by this Periodic Estimate_(7)no part of the"Balance Die This Payment"has been received and
(8)the undersigned and his subcontractors have-(check applicable line):
a (x ) Complied with all labor provisions of said Contract is approved by:
b( 1 Complied with all labor provisions of Raid Contract excent in those (Owner) (Date)
IIl5Ia11eeS
were an honest dis uic exists with respect to said labor provisions(if fb)is
checked describe btcilly mturc of dispute on an attached steed Approved by:
Funding Agency(if applicable) (Dale)
By: Date:
Endorsed by the Construction Specifications Institute.
EJCDC C-620 Contractor's Application for Payment
0 2007 National Society of Professional Diginecrs for EJCDC. All rights reserved.
Page 1 of 4
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
368347
CSU INC Purchase Order No.
3919 CLARKS CREEK ROAD Terms
PLAINFIELD, IN 46168 Due Date 6/30/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/30/2014 1 $142,837.00
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
/ 1
Date Officer
VOUCHER # 135536 WARRANT# ALLOWED
368347 IN SUM OF $
CSU INC
3919 CLARKS CREEK ROAD
PLAINFIELD, IN 46168
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1 06-1052-20 $142,837.00
Availability
Voucher Total $142,837.00
Cost distribution ledger classification if
claim paid under vehicle highway fund