HomeMy WebLinkAbout327397 07/10/18 +o..
CITY OF CARMEL, INDIANA VENDOR: 365399
"} ONE CIVIC SQUARE INSITUFORM TECHNOLOGIES USA INC CHECK AMOUNT: $....16,270.89•
s9C�NII
Q CARMEL, INDIANA 46032 1088 VICTORY DRIVE CHECK NUMBER: 327397
�'R�oN i�. HOWELL MI 48843 CHECK DATE: 07/10/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
660 5023990 4 16,270.89 OTHER EXPENSES
VOUCHER NO. 185936 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995)
Vendor# 365399 IN SUM OF$ 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
$16,270.89 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
T# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEP
4 06-1050-97 $16,270.89 and received except 7/9/2018 4 $16,270.89
Availability
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.: 4
1980 E.116th St.Ste.260
Carmel,IN 46032 Period From: 03/01/18
Attn: Tom Schreiber Owner/Engineer: Period To: 03/31/18
http://ecomm.eastemenciineering-com/ViewMewJob asDx?JoblD=2922 Retainage Request Date 612612018
From: Insituform Technologies USA,LLC. Job# 126591
1088 Victory Dr. Prime Contractor: Contract 91•
Howell,MI 48843
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 I. ORIGINAL CONTRACT SUM $315,093.90
Change Orders approved in ADDITIONS DEDUCTIONS 2. Net change by Change Orders -$2,677.50
previous months by Owner 3. CONTRACT SUM TO DATE(Line 1+2) $317,771.40
TOTAL $0.00 $0.00 4. TOTAL COMPLETED&STORED TO DATE $162,708.90
Approved this Month 5. RETAINAGE;
Number Date Approved a. 0 %of Completed Work $16,270.89
FD1 $2,677.50 b. %of Stored Material $0.00
TOTAL RETAINAGE $16,270.89
6. TOTAL EARNED LESS RETAINAGE $146,438.01
(Line 4 less Line 5 Total)
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $146,438.01
TOTALS $2,677.50 $0.00 8. CURRENT PAYMENT DUE $16,270.89
Net Change by Change Orders $2,677.50 9. BALANCE TO FINISK PLUS RETAINAGE $0.00
The undersigned Contractor ccaffles that to the best of the Contractor's knowledge,information and belief,the work covered State of Michigan 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.
�, t � My commission expires:
Amount Certified:
Bim' i ' Date: 06/26/18
Brandon Steining,Project Matl�ager .f (Attachad arpfanation ifamount di ora rhe amount applied for)
ARCHITECT'S CERTIFICATE FQWPAYMENT Owner/Engi
In accordance with the Contract&.4 6-
based on on-sits observations and the data comprising Date--7-14e)
the above application,the Architect certifies to the Ownerthat to the best of the Architect's knowledge This Cdf-frca Is-hot negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named herein,
information,and belief,the work has progressed as indicated,the quality of the work is in accordance Issuance,payment'and acceptance of payments are without prejudice to any rights of the owner or contractor
with rbe contract documents,and the Contractor is entitled to payment ofAMOUNT CERTIFIED under this contract.