HomeMy WebLinkAbout329098 08/22/18 9, CITY OF CARMEL, INDIANA VENDOR: 360022
® ONE CIVIC SQUARE THE HOOSIER CO INC CHECK AMOUNT: $****10,422.22*
INDIANAPOLIS=a, CARMEL, INDIANA 46032 P 0 BOX 681064 CHECK NUMBER: 329098
M,�TON-�o. INDIANAPOLIS IN 46268 CHECK DATE: 08/22/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2201 4350080 10,422.22 STREET LIGHT REPAIRS
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
Vendor# 360022
THE HOOSIER CO INC IN SUM OF$ CITY OF CARMEL
P O BOX 681064 An invoice or 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.
INDIANAPOLIS, IN 46268
Payee
$10,422.22
Purchase Order#
ON ACCOUNT OF APPROPRIATION FOR
Street Department Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
0 43-500.80 $10,422.22 1 hereby certify that the attached invoice(s),or 8/13/18 0 $10,422.22
2201 2201 2201 2201
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
Tuesday,August 14, 2018
Huffman, Dave
Director
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
20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Application and Certificate For Payment Page 1
To Owner: CITY OF CARMEL Project: CITY OF CARMEL Application No: 1 Date: 08/13/2018
ONE CIVIC SQUARE One Civic Square
CARMEL, IN 46032 Carmel, In 46032 Period ' 08/13/18
Architecctt's
Project No:
From THE HOOSIER COMPANY INC Contractor Job 733856-2
(Contractor): P.O. BOX 681064 Number: Contract Date:
5421 W. 86TH STREET
INDIANAPOLIS, IN 46268 Via(Architect):
Phone: 317 872-8125 Contract For:
Contractor's Application For Payment
Change Order Summary Additions _ Deductions Original contract sum 10,422.22
Change orders approved in 0.00
previous months by owner Net change by change orders
Date Contract sum to date 10,422.22
Number Approved
Change Total completed and stored to date 10,422.22
orders
approved Retainage
this month
0.0% of completed work 0.00
Totals 0.0% of stored material 0.00
Net change by change orders Total retainage 0.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge,information,and Total earned less retainage 10,422.22
belief the work covered by this Application for Payment has been completed in accordance with the
Contract Documents,that all amounts have been paid by the Contractor for work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current Less previous certificates of payment 0.00
payment shown herein is now due.
Current sales tax
Contractor:
7.000% of taxable amount 0.00
By: Date:
State of: County of: Current sales tax 0.00
Subscribed and sworn to before me this day of
Current payment due 10,422.22
(year). Notary public:
My commission expires Balance to finish, including retainage 0.00
Architect's Certificate for Payment
In accordance with the Contract Documents, based on on-site observations and the Architect:
data comprising the above application the Architect certifies to the Owner that to the
best of the Architect's knowledge, information and belief the Work has progressed as By: Date:
indicated, the quality of the Work is in accordance with the Contract Documents, and
the Contractor is entitled to payment of the Amount Certified. This Certification is not negotiable. The Amount Certified is payable only to the Contractor named herein. Issuance,
payment, and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this
Contract.
Amount Certified: $
Application and Certificate For Payment--page 2
To Owner: CITY OF CARMEL Application No: 1 Date: 08/13/18 Period To: 08/13/18
From(Contractor): THE HOOSIER COMPANY INC Contractor's lob-Number: 733856-2
Project: CITY OF CARMEL Architect's Project No:
Work Completed Work Completed Completed and Stored To Date
Previous Application This Period
Item Unit Contract Scheduled
Number Description Price Quantity UM Value Quantity Amount Quantity Amount Quantity Amount % Retention Memo
00
0001 REMOVE DAMAGE POLE 386.8100
1.00 386.81 .00 0.00 1.00 386.81 1.00 386.81 100.0 0.00
0002 SUPPLY&INSTALL NEW POLE 10,035.4100
1.00 10,035.41 .00 0.00 1.00 10,035.41 1.00 10,035.41 100.0 0.00
Total 10,422.22 0.00 10,422.22 10,422.22 0.00
Application Total 10,422.22 0.00 10,422.22 10,422.22 0.00