HomeMy WebLinkAbout323797 04/06/18 CITY OF CARMEL, INDIANA VENDOR: 365369.
ONE CIVIC SQUARE INSITUFORM TECHNOLOGIES USA INC CHECK AMOUNT: $ 25,422.48
CARMEL, INDIANA 46032 1088 VICTORY DRIVE CHECK NUMBER: 323797
HOWELL MI 48843 CHECK DATE: 04/06/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER, AMOUNT DESCRIPTION
660 5023990 2 25,422.48 OTHER EXPENSES
VOUCHER NO. 185197 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995)
Vendor # 365399 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER
INSITUFORM TECHNOLOGIES CITY OF CARMEL
1088 VICTORY DR An invoice or bill to be properly itemized must show: kind of service,where performed,
HOWELL, MI 48843 dates service rendered, by whom, rates per day, number of hours, rate per hour,
numbers of units, price per unit, etc.
Payee
$25,422.48 365399 Purchase Order No.
ON ACCOUNT OF APPROPRATION FOR INSITUFORM TECHNOLOGIES Terms
Carmel Wasterwater Utility 1088 VICTORY DR Due Date
BOARD MEMBERS
I hereby certify that that attached invoice(s), HOWELL, MI 48843
or bill(s)is(are)true and correct and that
PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
2 �D6 1050=97 ,d 2 W8i4—and received except 3/29/2018 2 $25,422.48
XWAvail"bility dw
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
Cost distribution ledger classification if claim paid motor vehicle highway fund. 20
Clerk-Treasurer
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 Page 1 of 2
To: Jones&Henry Engineers,Ltd. Project: City of Carmel,IN.Concord Village Lining Contract 91,2017 Application NO.: 2
1980 E.116th St.Ste.260
Carmel,IN 46032 Period From: 11101117
Attn: Tom Schreiber Owner/Engineer: Period To: 11130117
httD://ecomm.easterneng ineeri ng.ciimNi ewNiewJob.aspx?Ji)bl D=2922
From: Insituform Technologies USA,LLC. Job# 126691
1088 Victory Dr. Prime Contractor: Contract 91
Howell,M148843
Contract For: City of Carmel,IN.Concord Village Lining Contract 91,2017
Application is made for Payment,as shown below,in connection with the Contract.
CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sheet,AIA Document G703,is attached.
Change Order Summary 1. ORIGINAL CONTRACT SUM $315,093,90
Change Orders approved in ADDITIONS DEDUCTIONS 2. Net change by Change Orders $0.00
previous months by Owner 3. CONTRACT SUM TO DATE(Line 1+2) $315,093.90
TOTAL $0.00 $0.00 4. TOTAL COMPLETED&STORED TO DATE $142,584.60
Approved this Month 5. RETAINAGE:
Number Date Approved a. 10 %of Completed Work $14,258.46
b. %of Stored Material $0.00
TOTALRETAINAGE $14,258.46 a
6. TOTAL EARNED LESS RETAINAGE $128,326.14
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $102,903.66
TOTALS $0.00 $0.00
Net Change by Change Orders $0.00 9. BALANCE TO FINISH,PLUS RETAINAGE $172,509.30
The undersigned Contractor certifies that to the best of the Contrador's knowledge,infonnhtion and belief,the work covered State of Mleltlsan County of. Wayne
by this Application for Payment has been completed in accordance with the Contract Documents,that all amounts have been
Owner,and that current payment shown herein is now due.
Notary Public;
CONTRACTOR: Insituform Technologies USA,Inc.
My commission expires:
Amount Certified:
By:k Date: 11/30/17
Duane Gi •s e,Project Manager (Annched explanation tjmnarwt t4ffe sjrom the amount apnliedfor)
ARCHITECT'S CERTIFICATE FOR PAYMENT Owner/Engineer:
In accordance with the Contract Documents,based on on-site observations and the data comprising By: Date:
the above application,the Architect certifies to the Owner that to the best of the Architect's knowledge This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named herein.
information,and belief,the work has progressed as indicated,the qualityo£the work is in accordance Issuance,payment,and acceptance of payments are without prejudice to any rights of the owner or contractor
with the contract documents,and the Contractor is entitled to payment of AMOUNT CERTIFIED under dtis contract.
s