HomeMy WebLinkAbout238436 10/21/14 air C4A*
��: � CITY OF CARMEL, INDIANA VENDOR: 00351429
® ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $ 11,983.40'
f. �� CARMEL, INDIANA 46032 PO BOX 2533 CHECK NUMBER: 238436
+MiFoN"�°�. ANDERSON IN 46018 CHECK DATE: 10/21/14
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 8 11,983.40 OTHER EXPENSES
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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0702 (Instructions on reverse side) PACE ONE of PAGES
TO (OWNER): City of Carmel PROJECT: Well 30 APPLICATION NO: Eight (8) Distribution to:
One Civic Square Contract No. 82 C OWNER
Carmel, IN 46032 PERIOD TO: 09/26/14 C ARCHITECT
G CONTRACTOR
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
& Contracting, Inc.
CONTRACT FOR: Invoice. No. 14-110. 08 CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR. PAYMENT Application is made Continuation Sheet,for PaymentDocument h osn bel w, in connection with the Contract..
CHANGE ORDER SUMMARY j 1. ORIGINAL CONTRACT SUM ........:.:.............g 246,100.00
I 2. Net change b Chane Orders ................. ..... $
6,983.40
Change Orders approved in ADDITIONS DEDUCTIONS g y S
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 =2).......I... ... $ 253,083.40
TOTAL 4. TOTAL COMPLETED & STORED TO DATE....... ..... $ 253,083.40
Approved this Month (Column G on G703)
Number Date Approved 5. RETAINAGE:
C0#1 + $8,733.40 – $1,750.00 a. — % of Completed Work $
(Column D+E on G703)
b. — % of Stored Material $
(Column F on 6703)
Total Retainage (Line 5a+5b or
TOTALS + $8-733 '-40 – $1 ,750.00 Total in Column I of G703) ....... .............. $ 12,305.00
Net change by Change Orders + $6,983.40 6. TOTAL EARNED LESS RETAINAGE .. ....... .......... $
240,778.40
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)......... $ _ 228,795.00
paid by the Contractor for Work for which previous.Certificates for Payment were 8. CURRENT PAYMENT DUE ..... .... ................. 5 11,983..40
issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE .. ........... S 12,305.00
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 26th day of Sept. 2014
Notary Public: �--- -?I
Bv: Date: 'Sept. 26, 2014 My Commission expires: October 28 , 2015 .
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED.. ...... ............ ............. S
(Attach explanation if amount certified differs from the amount applied for.)
In accordance with the Contract Documents, based on on-site observations and the ARCHITECT:
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 By: Date:
indicated,the quality of the Work is in accordance with the Contract Documents,and
the Contractor is entitled to payment of the AMOUNT CERTIFIED. This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
i
Contractcr named herein. Issuance,payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
All n/1r1IMC\IT.!`-m. .�n.ir♦t.i..i .....�.nr.•�.�• ��... _. _ - .
R # 142122 WARRANT # ALLOWED a Prescribed by state Board of Accounts City Form No. 201 (Rev 1995)
ACCOUNTS PAYABLE VOUCHER
IN SUM OF $ CITY OF CARMEL
TS ENGINEERING & CONTRI
2533 An invoice or bill to be properly itemized must show, kind of service, where
N 46018 ` performed, dates of service rendered, by whom, rates per day, number of units,
{ price per unit, etc.
armel Water Utility 351429 Payee
UNT OF APPROPRIATION FOR M.K. BETTS ENGINEERING & CONTRACTING Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 10/16/2014
Board members
Invoice Invoice Description
# ACCT# AMOUNT Audit Trail Code I Date Number (or note attached invoice(s) or bill(s)) Amount
i
10/16/201, 8 $11,983.40
07-1052-12 $11,983.40 +
Cd Nr✓Pc7��Ory �
i
I
i
oucher Total $11,983.40 i 1 hereby certify that the attached invoice(s), or bill(s) is (are) true and
j correct and I have audited same in accordance with IC 5-11-10-1.6
tion ledger classification if
rider vehicle highway fund
Date icer