181460 01/19/2010 4 o' :4 CITY OF CARMEL, INDIANA VENDOR: 363793 Page 1 of 1
A ONE CIVIC SQUARE EBENISTERIOA BEAUBOIS LTEE
1 CHECK AMOUNT: $13,938.62
)o CARMEL, INDIANA 46032
CHECK NUMBER: 181460
CHECK DATE: 1/19/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
9 02 4460807 010 13,938.62 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 11/01/09 to 11130/09
Subcontract:, 2695 =5070 5070 Casework
Job: 2695- Carmel RPAC Construction Vendor: 9846 EBENISTERIOA BEAUBOIS LTEE
777 3rd Ave. SW
Carmel, IN 46032
i f1 a Contract c, To Date. E ci ATh(s T ift
Item Units UM Unit Cost Amount Units/% Amount Units Amount
1 5070 Custom Casework LS 3,174,070.00 9.63% 305,661.52 0.49 15,487.36
Total Contract Items 3,174,070.00 305,661.52 15,487.36
Change Orders
2 Bid Alternate Donor Amenity LS 17,479.00 0.00% 0.00 0.00 0.00
Upgrades
3 Bid Alternate Multipurpose LS 5,156.00 0.00% 0.00. 0.00 0.00
Room Upgrades
Total Change Order Items 22,635.00 0.00 0.00
Subcontract Totals: 3,196,705.00 305,661.52 15,487.36
Total Billings: 305,661.52 15,487.36
Unpaid Retainage: 30,566.16 1,548.74
Discounts: 0.00 0.00
Net Billings: 275,095.36 13,938.62
98 SSC CMa Projects Page 1 11/19/09 11:59:40 AM
Date Format MM /DD]YY SLSubBillingReport .rpt
e
Document G702 /CMa -1992
Application and Certificate for Payment Construction Manager Adv Edition
TO OWNER: PROJECT: APPLICAT NO Q10 Distribution to
C1 Fi O n (�I Cori �l J PQC Ccnsf PERIOD TO I t 0(i-PjY) 30 -HI 20109 OWNER
CONSTRUCTION MANAGER
FROM CONTRACTOR VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
ber115 }e,v e I I)&I r>° e 5'/ teAk PROJECT NOS: 6q 1 so I CONTRACTOR
VIA ARCHITECT: I I FIELD
CONTRACT FOR: IM i 1 11.Up(1' C 50 G rC 1 t1 5
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
c rO Certificates for Payment were issued and payments received from the Owner, and that current t. ORIGINAL CONTRACT SUM Pj I 'I rGlO payment shown herein is now due.
2. Net change by Change Orders �a Gl CONT TOR:
3. CONTRACT SUM TO DATE (Line I 2) $3 /96 705 a By: 't Q Date: 11 .1 MOO 9
4. TOTAL COMPLETED 8 STO TO DATE (Column G on G703) .3L e'b State P ill' C
5. RETAINAGE. aunty of: 8ea UCe Commissaire a I'Assermentation
a. of Completed Work 2 Subscribed and sworn to before Commissioner for oath
(Column D +Eon G70 �Xl 6�6 me this ((pih d ay of 'NI g gyyl 0_,r 1 Manon Pouiin
b. of Stored Material Notary Public:�(/f M me_ 163 85
(Column F on G703) My Commission expires: 10 Oi p
`I ntriet BOauc9 QuOboc
Total Retainage (Lines 5a+ 5b or Total in Column I of G703) $_..)jl') (p. i CERTIFICATE FOR PAYMENT Beauce- Quebec District
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE 27f) o /5. 36. this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7, LESS PREVIOUS CERTIFICATES FOR PAYMENT 2( /‘)6, 7 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 front prior Certificate) CERTIFIED. 2 �j R 2
8. CURRENT PAYMENT DUE /7) t (D z AMOUNT CERTIFIED 1 J L v
9. BALANCE TO FINISH, INCLUDING RETAINAGE..
(Attach explanation if amount certified differs .7 he amount applied. Initial all figures on this
Application and on he Continuatio heet Tat area hanged to conform with the 'mount certified.)
(Line 3 less Line 6) 2 Q2.140 w CONST' CTION
By: 74, 4 Date: 2 0
v
DD
AITIONS DEDUCTIONS
CHANGE ORDER SUMMARY ARCHIT`
f
Total changes appro in. previous months by Owner By I Dater t '0 al
Total approved this Month This Certificate rs not: negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein. Issuance,' payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10copies of this document when completed- To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
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
6 r q 6C7.5 L 7L-c/ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
M c7 /c /0 76 c /'7c /3,23P.6:2
.ti t
Total /3._9 3N -62
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same inaaccordance
with IC 5- 11- 10 -1.6.
,20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
//d
IN SUM OF
"3 62
ON ACCOUNT OF APPROPRIATION FOR
..2./76 7
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT hereby y invoice(s), DEPT. I hereb certify that the attached invoices or
'Y' 7 !3S3F.G2 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
511
Wan
Si nature
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund