HomeMy WebLinkAbout310680 04/24/17 1�.u,C.Iq�`
�• CITY OF CARMEL, INDIANA VENDOR: 367204
s ONE CIVIC SQUARE TSW UTILITY SOLUTIONS INC CHECK AMOUNT: $***138,738.50*
�; CARMEL, INDIANA 46032 1970 MIDWEST BLVD CHECK NUMBER: 310680
+M. INDIANAPOLIS IN 46214 CHECK DATE: 04/24/17
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DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 FY16-19 138,738.50 OTHER EXPENSES
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y �'- APPLICATION FOR PAYMENT
Date: 3/9/2017
Carmel PO Number: W10006 Vendor Invoice Number:
Carmel Water Vendor/Contractor
Attn:Accounts Payable TSW Utility Solutions,Inc.
Jess Testerman,President
1970 Midwest Blvd.
Indianapolis,IN 46214
Carmels'PM:Jeff Carpenter Tel:(317)735-1491
Fiscal Year 2016-2017
Proiect Number: Proiect Name: 106th:Springmill to Illinois
n gf
Installation of approx.685'f 16"water main via HDD method along with two water main connections as shown on the Carmel Water
provided drawings.
Original Contract Amount: $ 152,380.00 Invoice Period Beginning:
Change Order Amount: $ - Invoice Period Ending:
Modified Contract Amount: $ 152,380.00
Total Work Completed to Date: $ 138,738.50
Less:Previous Payments: $ - El Interim Payment
Amount Due This Request: $ 138,738.50 ❑ Final Payment
Please Pay This Amount: $ 138,738.50
Should you have any questions regarding this application,please refer them to Jess Testerman at(317)735-1491.
TSW Utility Solutions,Inc.(Contractor)certifies it has satisfied all of its obligations to its subcontractors,materialmen,equipment suppliers,vendors,and
employees for all labor performed, materials and equipment furnished, and services rendered to the Project whose work was incorporated on prior
Applications for Payment up to and including the date hereof.
CONTRACTOR further certifies that all lower-tier subcontractors and suppliers whose work in connection with the Project are incorporated in this Application
for Payment have been paid or will be paid by Contractor upon or prior to payment to Contractor of the amount requested herein.
By: By: "f
Carmel Water Project Representative TS uthorize epresentative
Jess M.Testerman-President
Printed Name and Title Printed Name and Title
3/21/2017
Date Date