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Home My WebLink About243536 3 /24/2015 CITY OF CARMEL, INDIANA VENDOR: 191500 j; ONE CIVIC SQUARE MADDOX INDUSTRIAL CONTRACTORSCK AMOUNT: S'•"25,100.42' 4 =q CARMEL, INDIANA 46032 8731 AMERICANA BLVD CHECK NUMBER: 243536 9y...._.o, INDIANAPOLIS IN 46268 CHECK DATE: 03/24/15 k «ON DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 609 5023990 S 25,100.42 OTHER EXPENSES e AIA TM Docurn . _ent 6102 - 1992 Application and Certificate ic ate fo r Payment TO OWNER PROJECT: APPLICATION NCS Distribution to: ,CITY of CARMEL CARMEL WWTP FILTER ADD # 84 PERIOD T0._.. 2/16/2015 One Civic Square OWNER ❑ CARMEL; IN 46082 CONTRACT FORCARMEL WWTP FILTER ADD# 84 ARCHITECT ❑ FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATOJ6/2014 CONTRACTOR ❑ MADDOX INDUSTRIAL CONTRACTORS JONES &HENRY ENGINEERS, LTD. PROJECT NOS: 350401 7750 ZIONSVILLE RD, SUITE 300 431 OHIO PIKE, SUITE 305 FIELD ❑ INDIANAPOLIS, IN 46268 CINCINNATI, OH 45255 INVOICE NO: 00001256 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.............................. $ 17,831.00 CONTRACTOR:MADDOX INDUSTRIAL CONTRACTORS 3.CONTRACT SUM TO DATE(Line I f 2) ..................................... $ 806,131.00 By: 0-� Date: 2 17" Z�/S 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) ...... $ 806,131.00 State of: IN 5.RETAINAGE: County oNlarionHELII:,C DUNLAP a• 0 %of Completed Work k . (Columns.D+E on G703) $ Subscribed and sworn,to'before gt�iyiFublic„•State of Indiana b. 0 0.00 me this dayoC *.5 M,a'I)on County %o of Stored Material ..:s �s�.;: Ctorr Aigsion p 634883 (Column Fon G703) $ 0.00' Nota Public: j� �N, iy cVmhiission Expires ry Michelle C Dunlap FAprll 28. 2020 Total Retainage(Lines Sa+Sb,orTotal in Column I of G703)...... $ 0.00 My commission expires:4/25/2020 �. 6.TOTAL EARNED LESS RETAINAGE .................................... $ 806,131.00 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...................... $ 781,030.58 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, (Line 6 from prior Certificate) information and belief the Work has'progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE ............................................. $ 2511 AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED.............................................................................. $ (Line 3 minus Line 6). $ 0.00 (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: - Total changes approved in previous months by Owner $ 17,831.00. $ 0.00 By, Date: Total approved this month $ 0.00 $ 0.00 This Certificate isnot ,negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTAL $ 17 831.00 $ 0.00 named herein..Issuance;payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 17 831.00 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. VOUCHER # 151272 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 8 07-1052-14 $25,100.42 Voucher Total $25,100.42 Cost distribution ledger classification if claim paid under vehicle highway fund Prescribed by State Board of Accounts ICity 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 i MADDOX INDUSTRIAL CONTRACTORS I Purchase Order No. 8731 AMERICANA BLVD Terms INDIANAPOLIS, IN 46268 Due Date 3/20/2015 Invoice Invoice Description Date Number (or note attached invoices) or bill(s)) Amount 3/20/2015 8 $25,100.42 I �I 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 r Date fficer