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HomeMy WebLinkAbout186662 06/21/2010 CITY OF CARMEL, INDIANA VENDOR: 363789 Page 1 of 1 ONE CIVIC SQUARE CIRCLE B COMPANY, INC I* 0 CHECK AMOUNT: $3,644.10 CARMEL, INDIANA 46032 5636 S MERIDIAN ST c INDIANAPOLIS IN 46217 CHECK NUMBER: 186662 CHECK DATE: 6/21/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 APP 14 3,306.00 PERFORMING ARTS CENTE 902 4460807 F080020018 338.10 REPAIR PAC Apri{ 26, 2010 Mr. Les Olds Carmel Redevelopment Commission One Civic Square Carmel, IN 46032 RE: Carmel City Center Performing Arts Center Shiel Sexton Project #2645 EMERGENCY Circle B :Invoice No. F08002 -0018 Dear Mr. Olds: Based upon on -site observations and the data comprised in the billings, Shiel Sexton Company (Construction Manager) certifies to the owner that, to the best of their knowledge, information and belief, the Work has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the amount requested ($338.10). Circle B Invoice No. F08002 -0018 338.10 If you have any questions, please feel free to contact me. Sincerely, i Warren David Brewer Project Manager cc: Don Cleveland Mike Anderson Tony Eisenhut File pop Change Order Request CIRCLE C.O.R. F08002 -0018 Conatructlon syetems G.C. Date: 04/01/2010 Project Name: Carmel Performing Arts Center Fireproofing Project F08002 To: Shiel Sexton Company, Inc. From: Circle B Construction Systems, LLC. Attn: Teresa Farrow Dave Burchard 5636 South Meridian Street 777 3rd. Ave. SW Indianapolis, IN 46217 Carmei, IN 46032 Phone (317) 688 -6856 Fax: (317) 688 -6889 Phone: (317) 787 -5746 Fax: (317) 780 -2654 We hereby propose to make the following changes:. FIREPROOF PATCH ADDED STEEL INVOICE #5333 03/17/10 $338.10 Change Order Price $338.10 Original Contract Amount $348,425.00 This price is good for 10 days. If conditions change, this price is void. We are requesting a time extension of 0 days in conjunction with this change. Teresa Farrow 4/1/2010 Author Date Sent Accepted The above prices and specifications of this Change Order request are satisfactory and are hereby accepted. All work to be performed under same terms and conditions as specified in original contract unless otherwise specified. Authorized Signature Date of Acceptance Page 1 of 1 Presc; hed6y Stale Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 p& hour, number of units, price per unit, etc. Payee Purchase Order No. Terms loe'll r,�� //0 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) -3 i Total /D 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 IN SUM OF J �j� SO G'/Pr�G✓,r /v�� 7 ON ACCOUNT OF APPROPRIATION FOR Pay from TIF L Board Members PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or qd2 4 Geca.2 0alS Y 3 /o bills) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 20/0 Di rector s redevelopment Title Cost distribution ledger classification if claim paid motor vehicle highway fund 1 TM Document 0102 /CMa 1992 Application and Certificate for Payment Construction Manager- Adviser Edition q TO OWNER: PROJECT: APPLICATION NO 14 Distribution to: CARMEL REDEVELOPMENT COMMISSION CARMEL PERFORMING ARTS PERIOD TO OWNER ONE CIVIC SQUARE 4/15/2010 INDIANAPOLIS,: IN 46032 CONSTRUCTION MANAGER El FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT CIRCLE' :B CONSTRUCITN SYSTEMS 5636 S. MERIDIAN ST. SHIEL SEXTON COMPANY PROJECT NOS: 1 1 CONTRACTOR El INDIANAPOLIS, IN 46217 VIA ARCHITECT: 2695/3060 FIELD CONTRACT FOR: FIREPROOFING. CSO ARCHITECTS INC. 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 11 amounts have been, paid by the Contractor for Work for which previous Certificates fc a w e issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM 348,425.00 payments wn h e' due. 2. Net change by Change Orders 10 ,1.94.96 CON CONSTRUCTION SYSTEMS 3. CONTRACT SUM TO DATE (Line 1 1 358, 619. 96 B Date': 4. TOTAL COMPLETED STORED TO DATE Column G on G703 7- State of: 320,550." NDINA 2. 5. RETAINAGE County f: MA ON a. of Completed Work Subs ibed w rn� re CATHY A. CINDER (Column ,D E on G703) 17,931.00 me is da OTARY'PUBUC STATE OF INDIANA 4 b. of Stored Material Notary Public: SION JOHNSON COUNTY PJIY OOMMIS a~tXP. FEB. .2037 (Column F on G703) My Commission expire Total Retaina (Lines 5a 5b or Total in Column I of G703) 17,931.00 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE 3 ^v 2 619. 96 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 299 313 96 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8. CURRENT PAYMENT DUE 3, 3C6. 00 AMOUNT CERTIFIED t �4 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the.anibUnt applied. Initial all figures on this Application d on the continuation .Sheet that are changed 'to conform with the amount certified.) (Line 3 less Line 6) 6, COC CONSTRU TON A By: I Date: L ]moo D CHANGE ORDER SUMMARY' ADDITIONS DEDUCTIONS ARCHITECT' q Total changes approved in previous months by Owner By: Date: i Total approved this Month This Certificate is 6iA,ne.gotiable. The AMOUNT CERTIFIED is payable onl to the Contractor TOTALS named herein. Issuance 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 G7021CMaTM 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 Al a 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 (10) copies 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. *.AIA Document G702/CMa"'- 1992 Instructions Application and Certificate for Payment Construction Manager Adviser Edition A. General Information AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager Adviser Edition, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A2011CMa, General Conditions of the Contract for Construction, Construction Manager Adviser Edition, 1992 Edition, B. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org. C. Completing the G702ICMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702lCMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The Contractor should sign G702 /CMa, have it notarized and submit it, together with 3703, to the Construction Manager and Architect. The Construction Manager and Architect should review G7021CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G7021CMa. The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A2011CMa. They should then initial all figures on G7021CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G7021CMa and G703 should be forwarded to the Owner. D. Completing the G703 Form Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed This Period). Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule .,of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form t1fe of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 /CYa_ a Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201ICMa. E. Making Payment The Owner should make payment directly to the Contractor based on the amount certified by Construction Manager and Architect on AIA Document G702ICMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed °form contains the name an6 6ddress of the Contractor. Payment should not be made to any other party unless specifically indicated on G702lCMa. AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNWG: 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 (10) copies of this document when completed. To report copyright violations of AfA Contract Documents, e -mail The American Institute of Architects' legak counsel, copyright @aia.org. v D 7 Tm 1 2 ®cement 03 �9 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 14 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 04/20/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0: 04/20/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED %9 TO RETAINAGE NO FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) (D E) D OR E) (D +E +F) (C G) 700 NIOBILIZATION /DEMOBL 7,500.00 7,500.00 7,500.00 100.00 701 BOND PREMIUM 6,000.00 6,000.00 6,000.00 100.00 702 FIRLPROOF TESTING 5,500.00 4,125.00 4,1.25.00 75.00 1,375.00 703 1ST FL F/P LABOR 32,993.00 32,993.00 32,993.00 100.00 704 1 ST FL F/P MATERIAL 49,490.00 49,490.00 49,490.00 100.00 705 2ND FL F/P LABOR 31,856.00 31,856.00 31,856.00 100.00 706 2ND FL F/P MATERIAL 47,783.00 47,783.00 47,783.00 100.00 707 BALCONY F/P LABOR 26,167.00 26,167.00 26,167.00 100.00 708 BALCONY F/P MATERIAL 39,251.00 39,251.00 39,251.00 100.00 709 ATTIC F/P LABOR 22,754.00 22,754.00 22,754.00 100.00 710 ATTIC F/P MATERIAL 34,131.00 34,131.00 34,131.00 100.00 800 CONTRACT ALLOWANCE 45,000.00 5,000.00 3,306.00 8,306.00 18.46 36,694.00 801 CHANGE ORDER #1 4,825.00 4,825.00 4,825.00 100.00 802 CHANGE ORDER #2 5,007.00 5,007.00 5,007.00 100.00 803 CHANGE ORDER #3 5,000.00 5,000.00 5,000.00 100.00 804 CHANGE ORDER #4 15,376.96 15,376.96 15,376.96 100.00 3 17, 31: 0 CAUTION: You should sign an original AIA Contrac Docu ment, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM —1992. Copyright ©1963, 1965, 1966 1967, 1970, 1978, 1983 and 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 0 0) copies 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. AIA Document 3TM- 1992 Instructions G 0 Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a; particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the` AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. COMPLETING THE G703 FORM Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B, C:' These columns should,be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors,and should'remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled atihe bottom ,when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of °column C may, be adjusted by Change Orders during the Project. Column D: Enter in this column the amount,of completed Work covered by the previous application (columns D E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here -the `value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by. the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted fromAhis and incorporated into column E (Work Completed This Period). Column G: Enter here the -total of columns D; E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column,G (Scheduled Value) and the column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Alth6ugh_Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on the own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location of the G702 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining indispute`should be dealt with according to Section 7.3 in A201. The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown are for illustrative purposes only, and are not intended to reflect actual construction costs. A T C D E F G H WORK COMPLETED MATI?RIALS TUTAL BALANCE ITEM SCHEDULED FROM PRVM'N'1'LY COMPLETED TO RETAINAGE NO. DESCRn'r10N OF WORK VALUE PREVIOUS (IF VARIABLE: S'I'pREll AND SPORED (G s C} FINISH APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D +H} DORF) (D +E +F) (C G) 1 IAOBILIZATION 5,000 5.000 0 0 5.000 100 0 2 5TUMP REMOVAL 5.000 5.000 0 0 5.000 100 0 3 EARTH WGIM 15,000 10.000 5,000 0 15.000 100 0 4 LOWER DETAINING WALL 10.000 O 5,000 0 5.000 50 5.000 5 GUR65 MI5c: GONG 5.000 0 0 0 O 0 5,000 8 PAVING, UPPER PfdVE 20.000 O 0 0 0 0 20.000 7 PAVING, LOWER DRIVE 20.000 0 0 0 0 0 20.000 8 FAVE1 20.000 0 0 10.000 10.000 50 10.000 9 B'ICK WORK 5.000 O 0 0 0 0 5.000 i0 AIA Document G703 -1992. Copyright ©1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIAe Document is protected by U.S. Copyright law and International Treaties. Unauthorized reproduction or distribution on 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 (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright©ala.orig. AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M. ABBOTT BEING DULY SWORN THAT HE 1S THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FUP-NIS14 CERTAIN MATERIALS AND /OR LABOR AS FOLLOWS: FIREPROOFING FOR A PROJECT KNOWN AS: CARMEL PERF OIZMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER) TI -1AT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF TWO HUNDRED SEVENTY ONE THOUSAND SIX HUNDRED EIGHTY ONE DOLLARS AND 20 /100 ($271,681.20) XX RECEIPT OF WIIICH IS 1 -IREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH 1S GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER) THAT THIE FINAL BALANCE DUE IS THE SUM OF: RECEIPT OF W141CH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WFIICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED, ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH,, FURNISHED BY THE UNDERSIGNED THERETO, AND FURTHER THAT NO OTFIEIt PARTY 14AS ANY CLAIM OR RIGHT TO A LIEN ON ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR SAI ROJECT AND WIT14IN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR. SYSTEMS, LLC Y: TITLE: PRESIDENT I N Y rJ D N j RIAL SEAL THIS 20th DAY OF APRIL, 2010 A. IN NOTARY PUB IC MY COMMISSFO EXPIRES: 02/01/2017 RESIDENT OF JOHNSON COUNTY :OWNER: CARMEL.REDEVELOPM ENT .COMMISSION 04/20/2010 CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695 -3060 FIREPROOFING PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION NO.. AMOUNT PAID #1 29,560.72 #2 7,423.47 #3 12,619-94 #4 23,371.15 #5_ 13,669.42 #6 139,459.42 #7 25,845.02 #8 990.00 #9 1,485.00 #10 7,994.44 #11 6,318.80 #12 2,943.82 TOTAL PAID TO DATE: 271,681.20' i a I i CIRCLE B CONSTRUCTION SYSTEMS, j I i /soT,, PRESIDENT i 1 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 ,t f C �`rc�Pj �o�s /rv� Sy sf°� S Purchase Order No. 5_7Y�­l Terms /4-,� Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /,�9�� /Y P 7 3 _=r t .3 r Total t 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 IN SUM OF S 6 5 ./yrYd /A�s ON ACCOUNT OF APPROPRIATION FOR Pay from TIF I i 10 �1G2/�r�✓���'7 Board Members PO# or INVOICE NO. ACCT 3"ITLE AMOUNT DEPT. I he certify that the attached invoice Or �'jd2 ly Vi ,4 7 3 1600 bill(s) is (are) true and correct and that the ,f materials or services itemized thereon for which charge is made were ordered and received except 0 U 5 20 is Directo edevelopt®nt Title Cost distribution ledger classification if claim paid motor vehicle highway fund