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HomeMy WebLinkAbout236930 09/10/14 / \. CITY OF CARMEL, INDIANA VENDOR: 191500 Ig ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORS CK AMOUNT: $***121,364.86* =Q; CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 236930 ���ruia�°' INDIANAPOLIS IN 46268 CHECK DATE: 09/10/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 609 5023990 5 121,364.86 OTHER EXPENSES Docurnent G702TM 1992 Application and Certificate for Payment' TO OWNER: PROJECT,: APB.LICATION:NO 5 :Distribution to: CITY of CARMEL CARMEL WWTP FILTER ADD # 84 PERIOD TO 7/31/2014 OWNER El One CIVIc;Square' CONTRACTfOR: CARMELCARMEL WWTP FILTER ADD# 84 ARCHITECT Eli,IN 46082 l FROM CONTRACTOR: VIA ARCHITECT: CONTRACT'DATE:3/6/2014 CONTRACTOR ❑ MADDOX INDUSTRIAL CONTRACTORS JONES &HENRY ENGINEERS, LTD. " PROJECT NOS: 350401 / � .. 8731 AMERICANA::BLVD 431 OHIO PIKE, SUITE 305 .FIELD El INDIANAPOLISf IN 46268 CINCINNATI,.OH 45255 INVOICE NO: 00001242 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 ' amounts have been; aid b the Contractor for Work for `AIA Document G103TM,:Continuation Sheet is attached t were:issued and payments received from the Owner, and P Y '1:ORIGINAL CONTRACT SUM...... ....... $ 788,300.00 that current a ent shown herem is now due.'; with the Contract Documents that all ••• •• which previous Certificates for..Pa men • p Ym 2.,NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: MADDOX N USTRIAL CONTRACTORS ........... 3.CONTRACT SUM TO DATE(Line 1 t 2 $ B (L ) 788,300.00 Y' ��� y�2 Date: A.TOTAL COMPLETED&'STORED TO-DATE;(Column G on G703) ...... $ 757,770.00 State of: IN .5..RETAINAGE: County of:Marion ,.��"° MICHELLE"C DUNLAP' P E �� • 5..... a a. S �5 %of Completed Work Subscribed and sworn to before e No %Notary'Puari Stote of lndlonai (Columns:D+*E on G703) $ 2q a1 n� me.this �� day of �}Lh�l�' S* Commisslon 63on 4993 . b• 0.%of Stored Material My Commlaslono xpBlr®® ., �a�: Aprll'2S., 2 2 (ColzrmnFon 6703) $ n-nn Notary Public:' Michelle C DunlapP. M ..commission expires:'. \\!\`\ Y4/25/2020 Total Retainage(Lines Sa+Sb, of Total in Column Lof G703)....:. $ 39,415.06 6.TOTAL EARNED:LESS•RETAINAGE.:................................... $ 718 354.94 ARCHITECT'S_CERTIFICATE FOR-PAYMENT (Line 4 minus Line 5 Total) In accordance with the Contract'Documents,based on on-site observations and'the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ......•.............:.. $ 596,990.08 this application,the-Architect certifies to the Owner thatfo,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 from prior Certificate) - accordance with the Contract,Documents, and the Contractor is entitled.to-payment of the 8.CURRENT PAYMENT DUE :...........:. .:............ •••.• Is 121 364.86 AMOUNT CERTIFIED: 1'9.BALANCE TO FINISH,'INCLUDING RETAINAGE. AMOUNT CERTIFIED .....................:............ $ I. (Line 3 minus Line.6) $ 69;945.06 (Attach explanation ifomz amount certified differs frihe.amount•,applied.Initial all figures on.this Application and'on,thd Continuation Sheeti that are changed to conform with the amount certified) CHANGE ORDER SUMMARY ADDITIONS bEDiJCTIONS ARCHITECT: otal changes approved ir b revious months ` P . Y Owner $ 0.00 $ 0.00; By; Date: li Total approved'ahis mo'nth $ $ This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only,to the Contractor TOTAL $ 0.00 $ 0,00, named herem Issuance,payment and acceptance of payment are without prejudice to any rights of ET CHANGES by Change'Order $ 0.00 the,Owner or Contractor under this Contract. `I 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 G7021-1992.Copyright ©1.953,1963,1965,1971,1978,1983 and 1992 b The American Institute of Architects.All rights reserved.WARNING:This AIA® Y 9 Document isY rotected b U.S.Copyright ri ht Law P 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. 010711ACD44 .I i VOUCHER # 141702 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 5 07-1052-14 $121,364.86 00l C()QJP- f r`0,4) i Voucher Total $121,364.86 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 191500 MADDOX INDUSTRIAL CONTRACTORS I Purchase Order No. 8731 AMERICANA BLVD Terms INDIANAPOLIS, IN 46268 Due Date 9/4/2014 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/4/2014 5 $121,364.86 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 Al Date 60cer