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Home My WebLink About235616 08/06/14 1y qr.G�A,Mf u; �.� CITY OF CARMEL, INDIANA VENDOR: 191500 ;; 31 ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORS QWCK AMOUNT: $.••330,474.75' _� CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 235616 9�'Crtiri.i�'` INDIANAPOLIS IN 46268 CHECK DATE: 08/06/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 609 5023990 4 330,474.75 OTHER EXPENSES SAIA Document G702T11 _ 1992 Application and Certificate for Payment TO OWNER: PROJECT: APPLICATION NO:4 Distribution to: CITY of CARMEL CARMEL WWTP FILTER ADD # 84 PERIOD TO: 6/30/2014 OWNER ❑ One Civic Square CARMEL, IN46082 CONTRACT FOR: CARMEL WWTP FILTER ADD # 84 ARCHITECT ❑ FROM,CONTRACTOR: VIA ARCHITECT: CONTRACT DATE:3/6/2014 CONTRACTOR ElMADDOX INDUSTRIAL CONTRACTORS ]ONES &HENRY ENGINEERS, LTD. PROJECT NOS: 8731 AMERICANA BLVD 431 OHIO PIKE, SUITE 305 350401 / FIELD ❑ INDIANAPOLIS, IN 46268 CINCINNATI, OH 45255 INVOICE NO: 00001241 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 CONTRA7>— MADDOX INDUSTRIAL CONTRACTORS 3.CONTRACT SUM TO DATE(Line 1 f 2) ..................................... $ 788,300.00 By:� P�Z� Date: �tiE 30_ ZU/¢ 4.TOTAL COMPLETED&STORED TO DATE(Colum G on G703) ...... $ 636,405.00 State of: IN 5.RETAINAGE: County of:Marion a•6.25 %of Completed Work Subscribed and sworn to before (Columns D+E on G703) $ '39414.92 me this �Slo day of�V, b. 0 %of Stored Material 'MICHELLE C DUNLAP (Colzrrnrs F on G703) $ 0.00 Notary Public: Michelle C Dunlap �� S`• �"�'.Notary Public, State of Indiana .NornMarion County My commission expires: 4/25/2020 °* '*O commission a 63a883 Total Retainage Lines Sa+Sb, or Total in Column 1 o G703 ...... $ 39 414.92 Wii�Z g ( f ) � My Commission Expires 6.TOTAL EARNED LESS RETAINAGE .................................... $ 596,990.08 ARCHITECT'S CERTIFICATE FOR PAY mpill 401 'a (Lime 4 minus Line S Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ...................... $ 266,515.33 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 firom prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the ,l 8.CURRENT PAYMENT DUE ............................................. $ 330,474.75 AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED ............................................................................. $ (Line 3 minus Line 6) $ 191,309.92 (Attach explanation if amount certified differs from the amount applied Initial all figures on this Application and on the Contin cation 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 $ 0.00 $ 0.00 This Certifi e is nonnegotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTAL $ 0.00 $ 0.00 named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of T CHANGES by Change Order $ 0.00 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 G702TM—1992.Copyright @ 1953,1963,1965,1971,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA° Document is protected by U.S.Copyright Law 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. 010711AC044 Prescribed by State Board of Accounts Form No.301(Rev.1995) ACCOUNTS PAYABLE VOUCHER TO ADDRESS Invoice Date Invoice Number Item Amount I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except Mo. Day Yr. Signature Title I hereby certify that the attached invoice(s), or bill(s), is (are)true nd correct and I have audited same in accordance with IC 5-11-10-1.6. Mo. Day Yr. officer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS MUNICIPAL WATER DEPT. ACCT. CARMEL, INDIANA 1 �I fikox —114 Favor Y, Total Amount of Voucher $ Deductions 336y7y 75 Amount of Warrant $ Month of Yr VOUCHER RECORD Acct. No. 'i Source of Supply Water Treatment Transmission and Dist. Customer Accounts Administrative and General Operation-Maintenance t utility P4 in Service Constr.Work in Progress Materials and Supplies Customers Deposits r Total Allowed Board of Control Filed Official Title BOYCE FORMS•SYSTEMS 1-800-382-8702 325