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Home My WebLink About195370 03/16/2011 CITY OF CARMEL, INDIANA VENDOR: 353974 Page 1 of 1 1 ONE CIVIC SQUARE CASEY BERTRAM CONSTRUCTION INC CHECK AMOUNT: $8,250.00 -v CARMEL, INDIANA 46032 5780 E 25TH STREET INDIANAPOLIS IN 46218 CHECK NUMBER: 195370 CHECK DATE: 3/16/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1192 R4350900 21657 1611 8,250.00 OTHER CONT SERVICES i e Inv oice Date Invoice 2/21/2011 1611 Bill To City of Carmel One Civic Square Carmel, IN 46032 -2584 P.O. No. Terms Due Date Project 21657 30 days 3/23/2011 3138-10 1, 146... Description Qty Rate Amount Billing 1: 4927 E 146th Street 8,250.00 8,250.00 See Attached AIA Forms Total $8,250.00 Payments /Credits $0.00 Balan Du $8,250.00 5780 East 25th Street Indianapolis, Indiana 46218 1317) 546 -3366 (317) 546 -6680 FAX APPLICATION FOR PAYMENT CAP702 Page: 1 of 2 To, PROJECT_ City of Carmel 3138 -10 Application No.: Application, Date: Period To: Contract Date: One Civic S uare 4927 E 146th Street Carmel, In 4032 1 FEB 21,2011 FEB 21,2011 DEC 31,2010 Project Nos: 21657 From Contractor: ylAARCHITECT: Owner Construction Mgr Case Bertram Construction, Inc. Distribution List:. 5780. 25th Street E] Architect Field Indianapolis, IN 46218 Contractor Other CONTRACTFOR: Demolition Contractor's Application for Payment CONTRACTOR'S CERTIFICATION: Application is made for payment as shown below, with attached Continuation Sheet. The Contractor's signature here certifies that, to the best of their knowledge, 1. Original Contract Amount: 8,250.00 this document accurately reflects the work completed in this Application for Payment. The Contractor also certifies that all payments have been made 2. Net of Change Orders: 0.00 for work on previous Applications for Payment and also that the Current 3. Net Amount of Contract: 8,250.00 Payment is Due. 4, Total Completed Stored to Date: 0.00 (Authorizing Signature) 5. Retainage Summary: Casey- Bertram Construction, Inc. Date: FEB 21,2011 a. 0.00 of Completed Work 0.00 State Authorized: Indiana b. 0.00 of Stored Material 0.00 County of: Marion Subscribed and sworn to before Total Retainage: 0.00 me this 21st day of Febr4ce 6. Total Completed Less Retainage: 0.00 Notary Public: Terri A. Cas My Commission expires: D 1, 2014 7. Less Previous Applications: 0.00 8. Current Payment Due, This Application: 0.00 9. Contract Balance (Including Retainage): 8,250.00 CHANGE= ORDER Activity Additions Subtractions Total previously approved: 0.00 0.00 Total approved this Month: 0.00 0.00 Sub Totals: 0.00 0.00 NET of Change Orders: 0.00 I Software by: PEM Software Systems, Inc. 1 -800- 803 -1315 copyright 2007 APPLICATION FOR PAYMENT CONTINUATION SHEET CAP703 Page 2 of 2 Pages From: To: Project: Application No: 1 Casey Bertram Construction, Inc. City of Carmel 3138 -10 Application Date: 2/21/2011 5780 E. 25th Street One Civic Square 4927 E 146th Street Period To: 2/21/2011 Indianapolis, IN 46218 Carmel, In 46032 Contract Date: 12/31/2010 Architects Project#: 21657 A B C D E F G H I Work Completed Materials TotalCompleted Balance Retainage Item Descri lion of Work Contract From Previous Presently and Stored To Finish Description (If Variable No Value A(DI +aE) This Period n Store In (o Date (G 1 C) (C G) Rate) 1 Demolition services 8,250.00 0.00 0.00 0.00 0.00 0 8,250.00 0.00 8,250.00 0.00 0.00 0.00 0.00 0 8,250.00 0.00 Software by: PEM Software Systems, Inc. 1 -800 -803 -1315 copyright 2007 p APPLICATION FOR PAYMENT J CAP702 Page: 1 of 2 T� PROJECT: City of Carmel 3138 -10 Applicatlor_f.No. Application Date: Period -To: Contract Date: One Civic Sq uare 4927 E 146th Street Carmel, In 46032 1 FEB 21,2011 FEB 21,2011 DEC 31,2010 Project Nos: 21657 FromContractor: ViAA CHITECT: Case Bertram Construction Inc. Distribution List: Owner Construction Mgr 5780. 25th Street Architect Field Indianapolis, IN 46218 Contractor Other CONTRACT FoR: D Contractor's Application for Payment CONTRACTOR'S CERTIFICATION: Application is made for payment as shown below, with attached Continuation Sheet. The Contractors signature here certifies that, to the best of their knowledge, 1. Original Contract Amount: 8,250.00 this document accurately reflects the work completed in this Application for Payment. The Contractor also certifies that all payments have been made 2. Net of Change Orders: 0.00 for work on previous Applications for Payment and also that the Current 3. Net Amount of Contract: 8,250.00 Payment is Due. 4. Total Completed Stored to Date: 0.00 (Authorizing Signature) 5. Retainage Summary: Casey- Bertram Construction, Inc. Date: FEB 21,2011 a. 0.00 of Completed Work 0.00 State Authorized: Indiana b. 0.00 of Stored Material 0.00 County of: Marion Subscribed and sworn to before Total Retainage: 0.00 me this 21st day of February 2 1 6. Total Completed Less Retainage: 0.00 Notary Public: Terri A. Case My Commission expires: Decem er 1, 2014 7. Less Previous Applications: 0.00 8 Current Payment Due This Application 0.00 9. Contract Balance (Including Retainage): 8,250.00 f CHANGE.ORDERActivity Additiorjs Subtractions r._ I j Total previously approved: 0.00 0.00 Total approved this Month: i 0.00 0.00 I Sub Totals: T 0.00 0.00 NET of Change ©rders 0:00 Software by: PEM Software Systems, Inc. 1- 800 803 -1315 Copyright 2007 FOR _PAYMENT CONTINUATION SHEET �j CAP703 Page 2 of 2 Pages From To: Pr oject: Application No: 1 Casey- Bertram Construction, Inc. City of Carmel 3138 -10 Application Date: 2/21/2011 5780 E. 25th Street One Civic Square 4927 E 146th Street Period To: 2/21/2011 Indianapolis, IN 46218 Carmel, In 46032 Contract bate: 12/31/2010 Architects Project#: 21 657 A B C D E F G H I Work Completed Materials TotalCompleted Balance Retainage Item Description of Work Contract From Previous This Period Presently and Stored To Finish (If Variable No Value Application Stored (Not In To Date (G C) (C G) Rate (D E) D or E) (D +E +F) 1 Demolition services 8,250.00 0.00 0.00 0.00 0.00 0 8,250.00 0.00 8,250.00 0.00 0.00 0.00 0.00 0 8,250.00 0.00 Software by: PEM Software Systems, Pic. 1. 800 803 1315 copyright 2007 C) VOUCHER NO. WARRANT NO. ALLOWED 20 Casey Bertram IN SUM OF 5780 E. 25th Street Indianapolis, IN 46218 $8,250.00 ON ACCOUNT OF APPROPRIATION FOR Carmel DOGS Department PO# Dept. INVOICE NO. ACCT /TITLE AMOUNT Board Members Encumbered I hereby certify that the attached invoice(s), or 21657 1611 43- 509.00 I $8,250.00 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 Friday, March 11, 011 4 i rector, CS Title Cost distribution ledger classification if claim paid motor vehicle highway fund 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 02/21/11 1611 Demolition 4927 E. 146th St. $8,250.00 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 2D Clerk- Treasurer