246806 06/30/15 4y u,C_p�R
CITY OF CARMEL, INDIANA VENDOR: 361395
l ONE CIVIC SQUARE GOLDMAN ELECTRICAL CONTRACTINGUNCCK AMOUNT: $****29,698.90*
0
CARMEL INDIANA 46032 4015 BLACKWOOD CT CHECK NUMBER: 246806
f
9 r:
INDPLS IN 46237 CHECK DATE: 06/30/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
106 5023990 38440 1098 29,698.90 OUTSIDE LIGHTING INST
Goldman Electrical Contracting, Inc.
2313 E.Washington StJUN 1-3 2015
Indianapolis, IN 46201
(317)787-9967 _ I
INVOICE
BILL TO INVOICE# 1098
Carmel/Clay Parks and DATE 06/12/2015
Recreation DUE DATE 07/12/2015
1411 E. 116th Street TERMS Net 30
Carmel, Indiana 46237 _
ACTIVIT, �' -
QTY RATE A"P�OIlNT '`
Services:AIA 1 29,698.90 29,698.90
AIA Billing for June#01
BALANCE DUE $29,698.90
Questions?Email Shannon@goldmanelect ical.com
Thank you
AIA
Application and Certificate for Payment t,neBliung -
TO: Carmel/Clay 000,9f Parks=and.Recreation.- PROJECT: Founders Park Lighting Project APPLICATION NO: 1. Distribution to:
1411 E'116th Street 1-1675 Hazel Dell Parkway PERIOD TO: 6/15F15 OWNER
Carmel;'IN 46278 Carmel•"IN 46033 - DATE OF CONTRACT 4/16/15 ARCHITECT
3176478000•, ' CONTRACTOR X
FIELD
MDPC PROJECT NO
w 1.
FROM: Goldman ElecErit al Contfacttng :GEC) �', ARCHITECT. The Sohnelder Gorporatron GEC PROJECT NO. 1036 OTHER
2313 EilNashlrigton Street ' 8901 Otls Avenue r SAI PROJECT NO.
Indianapolis,"IIV 46201" Indianapolis;IN 46216
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information
CONTRACTORS APPLICATION FOR PAYMENT and belief the Work covered by this Application for Payment has been
Application is made for payment,as shown below,in connection with the Contract. completed in accordance with the Contract Documents,that all amounts have been paid by the
Continuation Sheet,AIA Document G703,is attached. Contractor for Work for which previous Certificates for Payment were issued and
1. ORIGINAL CONTRACT SUM..........................................................$ 108 722.00 payments received from the O ne ,and the current) payment shown herein is now due.
2. Net change by Change Orders...................................................$ 0.00 CONTRACTOR L
3. CONTRACT SUM TO DATE(Line 1+/-2)..........................................$ 108;722:00 : By: :_W,Ilfiarn Goldman I :President.• , _ fz Date L '
4. TOTAL COMPLETED&STORED TO DATE(Column G on G703)...........$ 31",262.001 State of: Indiana r
5. RETAINAGE: County of: Marion
a. 5% of Completed Work Subscribed and sworn to before'
(Column D+E on G703)(Ln 5a times Ln 4).......... ..$ 1563.10 me this "; day ofyear of
*^*F
b. Amt of discretionary held back.......................$ 0.00. Notary Public:
SHA1StWNEYCUTT o
:,o ry Public, State of Indiana
Name: ,Shannon-HOney _ °` < Monroe County
Co Sion #623870
Total Retainage(Lines 5a+5b or Total in Column I of G703).............$ ;1;563.10 . My commission expires 1/26%2019 - _� mission Expires
JanuarX 26, 2011
6. TOTAL EARNED LESS RETAINAGE
(Line 4 Less Line 5 Total)........................................................$ 29,698';90 : ARCHITECT'S CERTIFICATE FOR PAYMENT
In accordance with the Contract
Documents,based on on-site observation and the data r
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT......................................$ 0.'001 comprising this application,the Architect certifies to the Owner that to the best of the
(Line 6 from prior Certificate) Architect's knowledge, information and belief the Work has progressed as indicated,the quality
8. CURRENT PAYMENT DUE..............................................................$ 29,698:90 of the Work is in accordance with the Contract Documents,and the Contractor
9. BALANCE TO FINISH,INCLUDING RETAINAGE is entitled to paytment of the AMOUNT CERTIFIED.
Line 3 Less Line 6 ...............................................................$ 79,023.1.
AMOUNT CERTIFIED ...........................................
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and
CHANGE ORDER SUMMARY ADDITIONS I DEDUCTIONS on the Continuation Sheet that are changed to conform with the amount certified.)
Total changes approved in previous months by Owner 0.001 ARCHITECT:
Total approved this Months By: Date:
TOTALS 0.00 0.00 This Certifiate is not negotiable; The AMOUNT CERTIFIED si payable only to the Contractor
NET CHANGES by Change Order I 0.00 named herein. Issuance,payment and acceptance of payment are without prejudice to any
ri hts of the Owner or Contractor under this Contract.
�d
FOUNDERS PARK LIGHTING PROJECT
AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO 1
Contractor's signed certification is attached. APPLI ATION DATE 5/3111:5
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A B D E F H-; 1
ITEM SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE
NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED G=C TO FINISH RETAINAGE
APPLICATION STORED AND STORED C-G
(D+E) or T D� ATE(D+E+F)
1 Mobilization&Submittals: 2,500.00 0.00 2,500.00 0.00 2,500.00 '100%, 0.00
2 Fixtures 49,000.00 0.00 0.00 0.00 000 0% 49,000.00
3 Fixtures Labor 2,300:00 0.00 0:00 0:00 c 0 OQ 0% 2,300.00:
4 Trenching,Boring,Concrete Bases 21,500.00 0.00 21,500.00 0.00 21 500 00 WO 0 00
5 Trenching Labor 2,000.00 0.00 2,000.00 0.00 2,000.0.0 0% 0.00
6 Lighting Controls 2,376.00 0.00 2,376.00 0.00 2.376.00 100% 0.00
7 Lighting Controls Labor 400.00 0.00 400.00 0.00 0.00 0% 400.00
8 Conduit 1,806.00 0.00 1,806.00 0.00 1 806 00 100%- 0.00
0 1 080 0o
9 Conduit Labor 1,080:00
10 Conductors 2,460.00 0.00 0,00 0.00 0.00 0% ',:':2460.00
11 Conductors Labor 1,800.00 0.00 0.00 0.00 0.00 0% 1,800.00
12 Allowance 20,000.00 0.00 0.00 0.00 0.00 0%0 201000.00
E4E
13 Close Out/Demobollze 1,500.00 0.00 0.00 '0.00 0:00 . 0% 1,500.00
Change Orders
I
PROJECT TOTAL 108,722.00 0.00 31,662.00 0.00 31,262.00 4.00 77,460.00 0.00
AQ
GOLDMAN
' � r
2313 E WASHINGTON ST INDIANAPOLIS,IN 46201
PHONE (317) 787-9967 • FAX (317) 784-6654
AFFIDAVIT&WAIVER OF LIEN
Final Partial X
AIA 41 (THRU 06/15/15)
State of IN County of MARION ,SS: WILLIAM GOLDMAN III (Name)being duly sworn states
that he is PRESIDENT(Title) of GOLDMAN ELECTRICAL CONTRACTING CO.INC. (company)and has
been hired by Carmel/Clay Board of Parks and Recreation(Owner)to furnish certain materials and/or labor as
follows; ELECTRICAL for a project known as Founders Park Lighting Project (Project Name) ocated in
- Carmel Indiana and does hereby further state on_behalfof-the.aforementioned subcontractor/supplier:
(PARTIAL WAIVER)that there is due from the contractor the sum$29,698.90
(TWENTY NINE THOUSAND SIX HUNDRED NINETY EIGHT DOLLARS AND 90/00)
receipt of which is hereby acknowledged,or
X the payment of which has been promised as the sole consideration for this Affidavit and partial waiver of
Lien which is given solely in respect to said amount, and which waiver shall be effective only upon
Receipt of payment thereof by the undersigned:
II
(FINAL WAIVER)that the final balance due from the contractor is the sum of
GOLDMAN ELECTRICAL CONRACTING INC. ��, -President
(Firm) (Signaturerritle)
WITNESS MY HAND AND NOTARIAL SEAL, this 12TH day of JUNE, 2015 .
My Commission Expires 01/26/19
(Notary Public)
Residing in MARION County SHANNON M HONEYCUTT
(Printed).
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Goldman Electrical Contracting, Inc. Date Due
2313 E Washington St
Indianapolis, IN 46201
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO# Amount
6/12/15 1098 Founders Park Lighting project 38440 $ 29,698.90
Total . $ 29,698.90
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
120
Clerk-Treasurer
Voucher No. Warrant No.
I
Allowed 20
Goldman Electrical Contracting, Inc. i
2313 E Washington St
Indianapolis, IN 46201 In Sum of$
$ 29,698.90
ON ACCOUNT OF APPROPRIATION FOR
106 Park Impact Fee
Po#or Board Members
Dept#
INVOICE NO. CCT#/TITL AMOUNT
38440 1098 5023990 $ 29,698.90 1 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
June 25, 2015
$ 29,698.90 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund