HomeMy WebLinkAbout306112 CITY OF CARMEL, INDIANA VENDOR: 370664
ONE CIVIC SQUARE MILLER-EADS CO, INC. CHECK AMOUNT: $****15,825.20"
CARMEL, INDIANA 46032 4125 N.KEYSTONE AVE CHECK NUMBER: 306112
INDIANAPOLIS IN 46205 CHECK DATE: 12/12/16
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTIOOTHER EXPENSES N
659 5023990 3 15,825.20
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Miller-Eads Co., Inc.
MILLER EADS Invoice Number 20162584
® Y Invoice Date 09/14/2016
Customer Number 0210
Job Number 2016C107
Due Date 10/14/2016
CITY OF CARMEL 106TH ST LIFT STATION
BOARD OF PUBLIC WORK -
ONE CIVIC SQUARE
CARMEL,IN 46032
Attn: ACCOUNTS PAYABLE
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ORIGINAL CONTRACT: 152,720.00
APPROVED CHANGE ORDERS : 5,532.00
CURRENT CONTRACT: 158,252.00
EARNED TO DATE: 158,252.00 j
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TOTAL EARNED TO DATE _ 158,252.00
RETAINAGE TO.DATE.:
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TOTAL EARNED LESS RETAINAGE: 158,252.00
PREVIOUS INVOICES: 142,426.80
CURRENT BILLING AMOUNT: 15,825.20 j
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TOTAL AMOUNT DUE: 15,825.20
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4125 N. Keystone Ave. • Indianapolis, IN 46205• (317)545-7101 •Fax:(317)545-4660•www.miller-eads.com
' EXHIBIT D
CONTRACTOR'S AFFIDAVIT AND WAIVER OF LIENS AND CLAIMS
(?� FINAL (-_) PARTIAL (_) PAYMENT TO FOLLOW
.OWNER: City of Carmel, Indiana PROJECT: 106th Street P.S. Controls
Department of Public Works. Contract 80A
CONTRACTOR: Miller-FADS Company, Inc. CONTRACT
DATE:
T.Christopher Chastain being duly sworn states that he or she Is the President of
CONTRACTOR, whlch.was awarded Contract No._80A with the OWNER in accordance with
the contract terms and conditions to install and/or furnish certain materials and labor as follows:
electrical ("Work")for the Project,
DOES HEREBY STATE,WARRANT AND REPRESENT ON BEHALF OF THE CONTRACTOR the following:
PARTIAL WAIVER That the balance due from OWNER is the sum of($ )•
( ) Receipt of which is hereby acknowledged;or
( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF
LIENS AND CLAIMS and which Is given to and for said amount effective upon receipt of such payment.
FINAL WAIVER That the final balance due from OWNER is the sum of($ 15,825.20
-),
( ) Receipt of which is hereby acknowledged;or
(XJ Payment of which has been promised as the sole consideratlon for this AFFIDAVIT AND WAIVER OF
LIENS AND CLAIMS which is given to and for said amount effective upon receipt of such payment.
THEREFORE,through the date hereof,Contractor waives and releases the Owner and Project of all liens or claims,
Including, but not limited to, claims for materials, equipment, labor, superintendence and other services or Work
performed or fumished by Contractor and further affirms that no other party has any claim or right to lien on account
of any materials, equipment, labor, superintendence and other services or Work performed or furnished to or for.
Contractor for the Project. Contractor agrees to Indemnify, defend and hold the Owner and Project harmless,
including costs and attorneys'fees,from and against any and all claims or Ilene for any subcontractors, materials,
supplies, equipment or labor furnished for, in connection with or Incorporated Into the Project by,through or under
Contractor through the date hereof. This Affidavit and Waiver of Liens is given to Induce Owner to pay the amount
indicated above. Contractor represents that all employees, subcontractors or materialmen have been paid or will be
paid from these funds.
That through the date hereof,all Affidavits and Waiver of Liens and Claims are true, correct and unconditional and
that there is no claim either legal or equitable to defeat the validity of said Affidavits and Waiver of Liens and Claims.
That the following are the names of all parties who have furnished material or labor, or both,for said Work and 'all
parties having contracts or subcontracts for specific portions of said Work or for material used In the construction
thereof and the amount due or to become due to each, and that the items mentioned Include all labor and material
required to complete said Work according to Project plans and specifications:
1 2 3 4 5 6 7
CONTRACTOR TYPE OF AMOUNT OF TOTAL NET NET BALANCE
WORK CONTRACT RETAINED PREVIOUSLY AMOUNT TO
PAID THIS BECOME
PAYMENT DUE
N/A
f
TOTAL
AMOUNT OF ORIGINAL CONTRACT,152.720.00 WORK COMPLETED TO DATE 158,252.00
EXTRAS TO CONTRACT 5,532.00 LESS RETAINAGE .00
TOTAL CONTRACT&EXTRAS 158,252.00 NETAMOUNT EARNED 1584252.00
CREDITS TO CONTRACT . .00 NET PREVIOUSLY PAID 142.426.80
ADJUSTED TOTAL CONTRACT 158,22. 00 NET AMOUNT OF THIS PAYMENT, 15,825.20
BALANCE TO BECOME DUE .00
I CITY OF CARMEL Contractor's Affidavit and
1081°Street P.S.Controls/451-8733.001 A-21 Waiver of Uens and Claims
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This Instrument-has been executed as of the 20th day of Jul 2016_ 1
CONTRACTOR; Miller-RADS Company, Inc._ _
By:
Name: T. Christopher Chastain
Title: President J i
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STATE OF INDIANA
COUNTY II
OF MARION I i
Sworn to and subscribed before me the undersigned authority on this 29th day of i
November
�. BRINE g •, I
NQ.. 0: Not ry Publi , State
V;
. TgRY• ;T: of Indi
SEAL rine S Wycoff j
N��., PUe�/C * : Printed Name of 1
:'9�•'••... ...••'' P �: Notary
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My Commission Expires:
August 16,2023
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CIT h OF CARMEL Contractor's Affidavit and
106 Street P.S.Controls/451-6733.001 A-22 Waiver of Liens and Claims
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