HomeMy WebLinkAbout234341 07/01/14 :4a"�'tagbf
�/ CITY OF CARMEL, INDIANA VENDOR: 00351429
® ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $*****5,045.00*
r.. a CARMEL, INDIANA 46032 PO BOX 2533 CHECK NUMBER: 234341
9M@`TO'N�` ANDERSON IN 46018 CHECK DATE: 07/01/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 5 5,045.00 OTHER EXPENSES
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 6702 -'(Instructions on reverse side) PAGE ONE OF PAGES ,
-TO (OWNER): City of Carmel PROJECT: Plant 4 Chemical Feed APPLICATION NO: Five (5) Distribution to:
One Civic Square Contract No. 83 Retainage G OWNER
Carmel, IN 46032: PERIOD TO: 05/31/14 Q ARCHITECT
❑ CONTRACTOR'
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering I
& Contracting, Inc. PROTECT NO: C
CONTRACT FOR: Invoice. No. 14-111. 05 Ret. CONTRACT DATE:
Application is made for Payment, as shown below, in connection with the Contract..
CONTRACTORS APPLICATION FOR. PAYMENT Continuation Sheet,AIA Document.G703, is attached.
CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ........:.:.............$ 100,900.00
Change Orders approved in ADDITIONS DEDUCTIONS 2. Net change by Change Orders ..................... $ –0
g PP � 100 900.00
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 =2).............. $
TOTAL 4. TOTAL COMPLETED &STORED TO DATE............ $ 100,900.00
Approved this Month (Column G on G703)
5. RETAINAGE:
Number Date Approved
a.— % of Completed Work $
(Column D+E on G703)
b.— % of Stored Material $
(Column F on G703)
Total Retainage (Line 5a+5b or
TOTALS Total in Column I of G703) ..................... $
by Change Orders 6. TOTAL EARNED LESS.RETAINAGE ................... $ 100,900.00
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)......... $ 95,855.00
:- 5045.00
paid by the Contractor for Work for which previous.Certificates for Payment were 8. CURRENT PAYMENT DUE .......................... S
issued and payments received from the Owner, and that current payment shown 9• BALANCE TO FINISH, PLUS RETAINAGE............. $ –0–
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: o �'Y✓cC
Bv: Date: May 31, 2014' Mv-Commission expires: October 28 , 2015 . I
67
ARCHITECT'S CERTIFICATE FOR PAYMENTAttO NT CERTIFIED.!
.. . .............•.... $
explanationifunt certified differs from the amount app lied for.)
In accordance with the Contract Documents, based on on-site observations and the ARCHIertiTECT:
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 Date:
indicated,the quality of the Work is in accordance with the Contract Documents,and This Cficate is not negotiable. The A,YIOUNT CERTIFIED is payable only o 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.
VOUCHER # 135518 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
5 07-1052-15 $5,045.00
lJ� 9
Cp!iec vti
Voucher Total $5,045.00
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
351429
M.K. BETTS ENGINEERING &CONTRACTING Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 6/25/2014
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/25/2014 5 $5,045.00
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
'a
Date Officer