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181464 01/19/2010 CITY OF CARMEL, INDIANA VENDOR: 363790 Page 1 of 1 ONE CIVIC SQUARE J R CLANCY, INC CARMEL, INDIANA 46032 7041 INTERSTATE ISLAND ROAD CHECK AMOUNT: $200,759.72 SYRACUSE NY 13209 CHECK NUMBER: 181464 CHECK DATE: 1/19/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 C08004 -MLD 200,759.72 PERFORMING ARTS CENTE SL Subcontract Billing Report For Work Invoiced From 11101/09 to 11/30/09 Subcontract: 269 =51:70 5170 Theatre =Equip Package; #1 Job: 2695- Carmel RPAC Construction Vendor: 9932 JR CLANCY, INC. 777 3rd Ave. SW Carmel, IN 46032 Contract To Date This Peri Item Units UM Unit Cost Amount Units!% Amount Units Amount 1 5170 Theatre Equip Package LS 7,515,800.0C 7.29% 548,126.60 2.97% 223,066.35 #1 Total Contract Items 7,515,800.0C 548,126.60 223,066.35 Change Orders 2 ASI PAC -077 Delete LS 194,000.00 0.00% 0.00 0.00 0.00 Orchestra Risers 3 RFI PAC -0686 Slack Line LS 12,548.00 0.00% 0.00 0.00 0.00 Deletion Total Change Order Items 206,548.00 0.00 0.00 Subcontract Totals: 7,309,252.00 548,126.60 223,066.35 Total Billings: 548,126.60 223,066.35 Unpaid Retainage: 54,812.66 22,306.63 Discounts: 0.00 0.00 Net Billings: 493,313.94 200,759.72 98 SSC CMa Projects Pane 1 11/19/09 12:03:09 PM Date Format MM /DD /YY SLSubBilGngReport .rpt APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION AIA DOCUMENT G702/CMa (Instructions on reverse side) PAGE ONE OF PAGES TO OWNER:�IM t'r�e ke U2A0py e -1` Corm, PROJEC1 2I C16 APPLICATION NO.: 1 Distribution to: e {_.t V 1 C.. 1 51- C' j PERIOD TO: j I;?3(1.16 (I OWNER ar MCI --Fri SW PROJECT NOS.: DJ 9 CONSTRUCTION tt p l t o �7 MANAGER FROM CONTRACTOR: ;.J •R.C�C.IVICI j, y1C �Q� a CONTRACT DATE: 21 12(1 ARCHITECT -164 t .}ey Q,k Zs`c(,a O._ CONTRACTOR yat; USQt 1V' 13ZOC1 VIA CONSTRUCTION MANAGER:% 1.21 V1 CONTRACT FOR: cti -IA r i,Pjr,1'"Onyll Ailapi IV1A ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor Certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay 1. ORIGINAL CONTRACT SUM 5 V r�ments received from the Owner, and that current payment shown herein is now due. 5 2. Net Change By Change Orders CONTRA 'e 3 .e...-C l h Zr-)c.: j I a G� G By: eiu._st .....1111C. Date: f 1 O I 3. CONTRACT SUM TO DATE (Line 1 2) 5i -1-�6 191 0,0 State of: New cJ> tz 4. TOTAL COMPLETED STORED TO DATE t County of (Column G on G702) Subscribed and sworn to be re me this 5. RET O NAGS: I 44P-Col p RADLEY R. RIVERS j i %1 J �t 7 Q VP/NW Notary Public. State of New York (Columns 0 E on G703) d �ay of Qualified n Onondaga County Notary Public: No 01 R13U18349 b. of Stored Material O v My Commission expires: f? m sion Expires a. of Completed Work September 27, y (Column F on G703) "Total Retainage (Line 5a 5b or C7 t PLO in Column I of G703) 1 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE `"t y 1 31 In accordance with the Contract Documents, based on on-site observations and the data (Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the hest of their knowledge, information and belief the Work has progressed as (Line 6 from prior Certificate) 2 5'4.12_ indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 1 S. CURRENT PAYMENT DUE 2 1 54 12-- AMOUNT CERTIFIED zoo:1Sn 9. BALANCE TO FINISH, INCLUDING RETAINA ��77 (Attach explanation if amount certified differs from the afnount applied for. Initial (Line 3 less Line 6) S UL. 4 O all figures on this Application and on the Continuation Sheet that changed to conform to the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CO STIZUCTy�i N M NAGE/ Total changes approved in 13y: i 1 1... f, Date: previous months by Owner 1 cT W ARCH' r�. Total approved this Month a, 0 I F,. L 3 0 rX/ TOTALS C> Qd O ,On By: Date: �u This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- NET CHANGES by Change Order CY.00 tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. k tri4 AIA DOCUMENT G702/CMa APPI-ICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIA ©I992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NF,W YORK AvPNUE, NW.., WASI- IINGTON. :2Tk D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702 /CMa -1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 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. Payee rJ R 2/c c2 (h Purchase Order No. 7 44- 7- (5 4zr °mac' Terms (Cif Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) i( /3 2 7 .g 7 p 7 7G- 2C.K 7s,.7Z Total 2c 7: 72 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 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 fW (2'7 Z7 IN SUM OF 7c/ To 7 -rte 1 AC:= /l/t /2c $2 P, 72 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 9z 7 4/'7/ 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 20 /c 11,...■ r Si.� ature w Y 9 Cost distribution ledger classification if claim paid motor vehicle highway fund