247402 07/15/15 aai..4�gy�
�� � CITY OF CARMEL, INDIANA VENDOR: 368941
( ® ONE CIVIC SQUARE MIDWEST CONSTRUCTORS CHECK AMOUNT: S••"•"2,187.85`
:� �" CARMEL, INDIANA 46032 2916 BLUFF ROAD,SUITE D CHECK NUMBER: 247402
9�Ir`mi�°'� INDIANAPOLIS IN 46225 CHECK DATE: 07/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460954 32952 3 2,187.85 NASH BLDG LANDSCAPE
AIA Type'Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):30 West Main St. PROJECT: Nash Building Streetscape APPLICATION NO: 3 DISTRIBUTION
Ste.,220 30 West Main St. PERIOD T0:6I30/2015 TO:
Carmel,IN 46032 Ste.,220 _OWNER
Carmel, IN 46032 _ARCHITECT
–CONTRACTOR
FROM(CONTRACTOR): Midwest Constructors LLC VIA(ARCHITECT): ARCHITECT'S
600 S.Kentucky Ave. PROJECT NO:
Ste.100
Indianapolis,IN 46225
CONTRACT FOR:Nash Building CONTRACT DATE: 9/23/2014
The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
CONTRACTOR'S APPLICATION FOR PAYMENT
belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,.and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM ... . .. ... .. . .. . . . . ..$ 203,890.00
2.Net Change by Change Orders ..... ...... .....$ 36,650.32 CONTRACTOR: Midwest Constructors LLC
600 S.Kentucky AveMe.. 100
3.CONTRACT SUM TO DATE (Line 1 +2). . .. . . .. ... $ 240,540.32 11 napoli ,1 4 5 —
4.TOTAL COMPLETED AND STORED TO DATE . .. . .. $ 240,540.32 By: Date: V ^/5
Michael Jacobs / /roject Manager
5.RETAINAGE: State of:IN
a. 5.00%of Completed Work $ 12,027.02
County of: Johnson
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before gie this ,.� Day of rLC 20 iS
Total retainage Line 5a+5b 12,027.02 Notary Public: / �'C/
My Commission xpires: U — _
6.TOTAL EARNED LESS RETAINAGE... . .... .... .. $ 228,513.30 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 less Line 5 Total)
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based.on on-site observations and the data com-
226,325.45 prising the above application, the Architect certifies to owner that to the best of the Architect's
(Line 6 from prior Certificate} . . ........ .. .... ... .$ knowledge,information and belief the Work has progressed as indicated,the quality of the work
B.CURRENT PAYMENT DUE ..... . ....... ... . . .. .$ 2,187.85 is in,accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE
(Line 3 less Line 6) $ 12,027.02 AMOUNT CERTIFIED. . . . . .. .. .... .. . .. ... ... ... . .. .
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.)
Total.changes approved in ARCHITECT:
previous months by Owner 35,336.00 -988.68 By. Date:
Total approved this Month 2,303.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named herein. Issuance,Payment and acceptance of payment are without prejudice to any
TOTALS 37,639.00 -988.68 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 36,650.32
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):30 West Main St. PROJECT. Nash Building Streetscape APPLICATION NO: 3 DISTRIBUTION
Ste.,220 30 West Main St. TO:
Carmel, IN 46032 Ste.,220 PERIOD TO:6/30/2015 _OWNER
Carmel, IN 46032 _ARCHITECT
CONTRACTOR
FROM(CONTRACTOR): Midwest Constructors LLC VIA(ARCHITECT): ARCHITECT'S
600 S.Kentucky Ave. PROJECT NO:
Ste. 100
Indianapolis, IN 46225
CONTRACT FOR:Nash Building CONTRACT DATE: 9/23/2014
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1 Mobilization 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00 0.00 500.00
2 Earthwork 59,650.00 59,650.00 0.00 0.00 59,650.00 100.00 0.00 2,982.50
3 Demolition 28,700.00 28,700.00 0.00 0.00 28,700.00 100.00 0.00 1,435.00
4 Site Work Labor 21,900.00 21,900.00 0.00 0.00 21,900.00 100.00 0.00 1,095.00
5 Site Work Material 46,440.00 46,440.00 0.00 0.00 46,440.00 100.00 0.00 2,322.00
6 Landscaping 32,200.00 32,200.00 0.00 0.00 32,200.00 100.00 0.00 1,610.00
7 Demobilization 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00 0.00 250.00
8 Aternate#1 Clay Pavers 31,926.00 31,926.00 0.00 0.00 31,926.00 100.00 0.00 1,596.30
9 South stoop&walk 3,410.00 3,410.00 0.00 0.00 3,410.00 100.00 0.00 170.50
10 Tree change -988.68 -988.68 0.00 0.00 -988.68 100.00 0.00 -49.43
11 Add sidewalk to the north of 1,300.00 0.00 1,300.00 0.00 1,300.00 100.00 0.00 65.00
building
12 Switched to mulch east of Nash 1,003.00 0.00 1,003.00 0.00 1,003.00 100.00 0.00 50.15
REPORT TOTALS $240,540.32 $238,237.32 $2,303.00 $0.00 $240,540.32 100.00 $0.00 $12,027.02
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City FormNo.201(Rev.1995)
CITY OF CARMEL
An invoice or 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
COLLC Purchase Order No.
6l1-j � �u�11 e . 1�At �
In, Terms
5 -1 A 12,5 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
pp VV pp i ALLOWED 20
IN SUM OF $
5, jCeY, Uk(\(N
$ 2-1i�'7aBs
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# r' I hereby certify that the attached invoice(s),
2. 5L
IMM959 9 �2,IS- 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
2016
Si at re
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund