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249702 09/23/15 Coq. `V ';' CITY OF CARMEL, INDIANA VENDOR: 361395 ,_ b ONE CIVIC SQUARE GOLDMAN ELECTRICAL CONTRACTINGgNNK AMOUNT: $*****4,436.10* CARMEL, INDIANA 46032 2313 E WASHINGTON ST CHECK NUMBER: 249702 �'�frgN c�;g, INDIANAPOLIS IN 46201 CHECK DATE: 09/23/15 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 106 5023990 38440 1112 4,436.10 OUTSIDE LIGHTING INST Goldman Electrical Contracting, Inc. 2313 E. Washington St AUG - 6 2015 Indianapolis, IN,46201 L' (317)787-9967 INVOICE BILL TO INVOICE# 1112 Carmel/Clay Parks and DATE 08/03/2015 Recreation DUE DATE 09/02/2015 1411 E. 116th Street TERMS Net 30 Carmel, Indiana 46278 RAI F AN, Services:AIA 1 4,436.10 4,436.10 Final Retention Billing BALANCE DUE $4,436.10 Questions 7 Email Shannon@goldmanelectricaI.com Thank you t 1 'I IdSH Description P.O.# PorF �~rr-IG-7F'R13 r C [in';bescr SEP Oq 2015 AIA Purchaser Date Application and Certificate or PPaymen t .1RE'TENTIM BILL11 y -- ep G •--•---• Distribution to: TO: CarmeyClay Boardof Parka and Recreation PROJECT: Founders Park Llghting.Project APPLICATION NO: 3 1411 E.116th Street 11675 Hazel D611 Parkway ' ;:r PERIOD 70: 7/31/15 OWNER 4'1 Carmel,IN 46278 Cannel,IN 46033, `DATE OF CONTRACT: 4116/15 ARCHITECT 'T CONTRACTOR X 317-547-8000 , =' 1�• ..._ FIELD >� MDPC PROJECT NO. ' rOTHER I FROM: Goldman Electrtcal Contracting (GEC) ARCHITECT:The Schneider,Corporation GEC PROJECT NO. 1036' m 2313 E Washington Street 8901 Otis Avenue SAI PROJECT NO. Indianapolis,IN 46201 Indianspolls,IN 46216 WKKW1", 11 The undersigned Contractor certifies that to the best of the Contractors knowledge,information * CONTRACTOR'S APPLICATION FOR PAYMENT Pub and belief the Work covered by this Application for Payment has been �,Application is made for payment,as shown below,in connection with the Contract. completed in accordance with the Contract Documents,that all amounts have been paid by the t`t Continuation Sheet,AIA Document G703,is attached. ��Contractor for Work for which previous Certificates for Payment were issued and s N, 1. ORIGINAL CONTRACT SUM..........................................................$ .108,722.00 ''4 pay mems received from the Owner,and the current payment shown herein is now due. 2. Net change by Change Orders...................................................$ -20,000.00 CONTRACTOR: William Goldman II-President Date: 8/312015 3. CONTRACT SUM TO DATE(Line 1+1-2)..........................................5 68722.00 ;, By. }' State of: Indiana f' r� ( � r 4. TOTAL COMPLETED 8 STORED TO DATE Column G on G703)...........� 88'722.00 �•,� County of: Marion 5. RETAINAGE: 0,% a. 5% of Completed Work` Subscribed and sworn to before P ' 1. (Column D+E on G703)(Ln 5a times Ln 4)..............$ 0.00 Pt,.t me this 3rd day of August year of 2015 $ 0.00 Notary Public: Signature n� b. Amt of discretionary held back............. c l l Name: Shannon Honeycutt .f Total Retainage(Lines 5a+5b or Total in Column I of G703).............$ 0.00 tit r.My commission expires: 112612019 Date 6, TOTAL EARNED LESS RETAINAGE t„ (Line e .......................... ...$ 86,722.00 Li4 Less Line 5 Total) ........................... ARCHITECT'S CERTIFICATE FOR PAYMENTrl In accordance with the Contract Documents,based on on-site observation and the data ? } ; V, 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT......................................$ 84,285.90 i;','m• comprising this application,the Architect certifies to the Owner that to the best of the �# Architect's knowledge,information and belief the Work has progressed as indicated,the quality (Line 6 from prior Certificate) B. CURRENT PAYMENT DUE.................... .........................................$ 4,436.10 ;; of the Work is in accordance with the Contract Documents,and the Contractor +z is entitled to paytment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE �W Line 3 Less Line 6)................... ...................... ........$ 0.00 r �� •l c AMOUNT CERTIFIED .........l.................I............... (Attach explanation if amount terrified diners from the amount appfled. Initial all figures on this Application and 11 ADDITIONS DEDUCTIONS on the Continuation a that it ed to c torm th r amount certified.) . CHANGE ORDER SUMMARY J� i Total changes approved in previous months by Owner 0.00 ARCHITECT: GIG ' Total approved this Month 20,000.00 By: Date: CO#1 Deduct for Allowance TOTALS 0.00 20,000.00 This Certifinte is of negotiable. The AMOUNT CERTIFIED si payable only to the Contractor 131!NET CHANGES b Chan a Order 20,000.00 named herein. Issuance,payment ar:•1 acceptance of payment are without prejudice to any ri hts of the Owner or Contractor under this Contract. i • 2OLDMAN 2313 E WASHINGTON ST.INDIANAPOLIS, IN 46201 PHONE (317) 787-9967 • FAX (317) 784-6654 AFFIDAVIT & WAIVER OF LIEN X Final Partial AIA #3 (THRU 07/31/15) 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 Carmet/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 (Prosect Name) Located in Carmel Indiana and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER)that there is due from the contractor the sum$ 54.587.00 (FIFTY FOUR THOUSAND FIVE HUNDRED EIGHTY SEVEN DOLLARS AND 00/00) X receipt of which is hereby acknowledged,or _ 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: (FINAL WAIVER)that the final balance due from the contractor is the sum of $4.436.10 GOLDMAN ELECTRICAL CONRACTING INC. 1� n ti _- President (Finn) (Signaturerritle) WITNESS MY HAND AND NOTARIAL SEAL, this 3RD day of JULY, 2015 . My Commission Expires 01/26/19 (Notary Public) � Residing in MARION County SHANNON MrHed). TT i j - - - - - 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. 361395 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 8/3/15 1112 Founders Park Lighting project 38440 $ 4,436.10 Total $ 4,436.10 1 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 20_ Clerk-Treasurer Voucher No. Warrant No. Allowed 20 361395 Goldman Electrical Contracting, Inc. 2313 E Washington St In Sum of$ Indianapolis, IN 46201 $ 4,436.10 ON ACCOUNT OF APPROPRIATION FOR 106 Park Impact Fee Board Members PO#or INVOICE NO. =T#/TlTLl AMOUNT Dept# 38440 F 1112 5023990 $ 4,436.10 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 September 17, 2015 $ 4,436.10 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund I