HomeMy WebLinkAbout167264 12/23/2008 CITY OF CARMEL, INDIANA VENDOR: 359230 Page 1 of 1
i ONE CIVIC SQUARE BATTS CONSTRUCTION CHECK AMOUNT: $553.50
CARMEL, INDIANA 46032 8901 E RAWLES AVE
INDIANAPOLIS IN 46219 CHECK NUMBER: 167264
CHECK DATE: 12/23/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460848 1 553.50 4TH GATEWAY /RANGELINE
Z;
.-P 1A Document G702/C Ma TM -1992
Application and Certificate for Payment construction Manager-Adviser Edition
TO OWNER: PROJECT: APPLICATION NO: Distribution to:
(:1'[ ()17 CARIMLL, CARNILL AlO lict DESIGN DI'S
CIJST� 1260 ONE CIVIC SQIJ,\I4.-.- PERIOD TO: 1 1. 1 3012008 OWNER
CAItMIA. IN 46032 CONSTRUCTION MANAGER
FROM CONTRACTOR: 11XI CONS'l IttiC HOV) MA)11-008
MANAGER: CONTRACT DATE: ARCHITECT
8901 It A W LE S A V PROJECT NOS: CONTRACTOR
INDIAN AVOHS, IN 402WIA ARCHITECT: FIELD
CONTRACT FOR:
CARNIIJ. ARTS DESIGN DES JOB# 9260
0
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that 10 the best of [Ile Contractor's knowledge. informatimi and
belief the \Vork covered by Ihis Application for l':Ayl1IClII 11,11S been C0111111CICLI ill accordance wilt the Applicmion is made for payment. zis shown below. in conneciion v6th the C'011tNict.
Confl-l-lel Documents, that all allioullis have beell paid by the Contractor fur Work I'Or which previous
C0116111.1.16011 Sheet. AIA DOC11111CIlt G703. is attached. 49.800.00 Cerlil 1 l';IVI were iSSLICd Mid lXlytIlentS received 11'0111 the and That CLIrl
1. ORIGINAL CONTRACT SUM payment shown herein is now (lite.
0.00
2. Net change by Change Orders I 5 CONTRA TOR:
3. CONTRACT SUM TO DATE (Line: 1, 49,800.00 S BY.
4. TOTAL COMPLETED STORE TO DATE (Column on Oli-00 Stale
5. RETAINAGE: County of. \4
a 111 V¢ or ("onipleted Work Subscribed and sworn to before
G
703) S �W%>- (Column 1) E (ill 1 61.50
(Col lite this Ia y �ot
b. ofstofed Material Notary Plibli".
0.00 ollialissioll expire
t('011.11111) F oil (Y703) My C
Total lzetaiiiai- (L.hics Sa h or Tot. ill Column I of (1703) S 61.50 CERTIFICATE FOR PAYMENT
In accol with [lie I ontract Doctjtolellls. hxwd oil on-site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE -S' 553 ;t_. I I i s appl ication, t he Co i is tru c t i oil NI at)ag e r and A rc It i feel cc rt i I'v to t ic 0 er t tat it) t he hest ci t lie 11'
(t.Arte 4 Less Line 5 'Folol) knowled information mid heliel'the Work hzis progressed :is Indicated, lite quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 5 aCUORIUJICC with the Contract DOCLIJIMIUS. Mld 1110 ('011(rZICIOr is CillitiCLI to payment of the AIVIOUN'I'
(L•iiie 0 front prior Certificate)
8. CURRENT PAYMENT DUE i AMOUNT CERTIFIED S
(Allach explall, I/ im: if alljoillif cel•tilied Apph di /fi rsfi I/it (11110ifill (11plied, 117111111 allfigill (Ill this
9. BALANCE TO FINISH, INCLUDING RETAINAG
hatioii ilild on it ('oni'mafin Shvvi Thal it i /I fit( 1 11) (.1)/, 01 with Illi• alliolfill cc)
(Line 3 ICY, I-ine 6) 0.50 CONS RUC NM
44.2;1
B Date:
S4 N
C H AN ('iE. ORDER S L I NI WlAR Y' ADDITIONS I DEDLJCTI(')NS ).00 ARCHITECT:
4a,
at chwiges approkd iii previous alontlis by Owner ti S Date:
00
Proull apjlro� this Month 'I'llis Certi S 1101. is payable onl file Colill litl TOTA LS
S allied Issuance:, payment and :acceptance ol payment are wiLholit prejudice to any riol;ls of
44.' ('0
NET CH AdN by Cham Order
CAUTION: You should sign an Original AIA Contract D-3curnent, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G7021CMaTm 1992. Copyright (0 1992 by Tlie, AnieliCall Ifistitule of Architects. All rights reserved. WARNING: This AIA" Docurrielit is Protected by U.S. Copyright Low and International Treaties.
ktn.,itj,otiz* reproduction or distribution of this Ale DGeument, or any port Fort of it, may resoll in severe civil and criminal penalties, and will be Prosecuted to the maximum extent possible under the law.
Purchasers are perillitted Iq reptodur.e. tP11 (t O) COI.IiPS 01 INS (10C.0friont when compleied. To report nopyiight viahlions of AIA Conlrad Documents. e jj ,nil The AmOlican Institute of Aichilec!s' ",411 cotinsel, capyright(?),Iia ord.
Document 6703"' 1992
Continuation Sheet
AIA Doctiniciii G702 API UCATION AND C'ERTT11CATION FOR PAYMENT. APPLICATION NO:
colitilillill, Contractor's sivi ied certification is all'iclied. APPLICATION DATE: I 1 /19,.-'2008
In tabulations be low. it moll rit. are .qla led io [fie nearest dollar.
Use Colullill I oll C orllrac(s where Variable retainage fol. line items clay apply. "Pt TO: 11/3012008
ARCHITECT'S PROJECT NO:
Wo RK 7 TE 1) IMATERIALS TOTAL llAl.,AN('F
F 1) lz E- S F.-,N COMPI-FTED 1 71. I'(:) RVA'AINAGE
SCHEDULED FROM PRI-MOUS
IM:SCRIPTION OF WORK STORED kNDSTORIJ) (IFVARIAM1.
VALUE i APPIACATION THIS PF.R101) G C) FINISH
NO. NOT IN TO 1) ATF R A'1'1'-)
(D I
D OR f,"i
61.50
026 6 1 5.0( 11 100.0(
1 0 BOND FEE W) o0 615.00 l
0
MOBILIZATION 1,500.00 1,500.00
03 0 SUBMITTALS 500.00 500.00
04 0 MOCK-Ul 900.04
900.00
05�O BRICK MATERIAL 8.590.0( 8,590.00
06 0 BRICK LABOR —380.01 2
0700 BLOCK.MATERIAL. 630.0(
0840
BI-q(.'K,LABOR 210.0 2.2 10.00
09 0 STONF, MATERIAL 1 8,025.0
8025.00
10 0 STONE LABOR I 4,450-1)(Il 4.450,00
j I I I
l 1
40, 185.00 61.50
JOB TOTA 49.800.0� .(o 615.0(1 s7 1 6115.00
J
CAU'riON: You should sign an original AIA Contract Document, on which this text appears in'PED. An original assures that changes Will not be obscured.
AIA Document G703T" 1992. Copyright 10 a
c ivil 1963.) 965,1966.1967.1970.19" 1983 and 1992 by The American Institute of Aidiiiects. All rights reserved. WARNING: This AIA" g
Document is protected by U.S. Copyright
Law 00d;ntpl-nottorsai Treaties. l, ZLproduclion or disIributio of this AIA" Doc or ajl-y portion, r, of it. result in severe
V an d criminal penalties, and will he prusec�ufedlcl 111LIOTIAXiMOM (�xlenl
t'
POSSiblUndf-�r the 111W. Purchasers are permitted to reproduce len (10) copies of this dOCtimeill when completed. To report copyright viotatiolls of AIA Contract Documents. e-mail The American 111SMOIC of Architects legal
courlsel• copysighi ®rala.cig.
iJ
rescribed 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
L f
c �SUG7 i yl�l. nC Purchase Order No.
f'
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total t 5
3 ,5-0
1 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
1jc7As# On, /Y1 C IN SUM OF
Le Avc
l ).s ry LI ba 1 q
s 553, 5 0
ON ACCOUNT OF APPRQI2RLQ6UQN FOR
�oZ 'ILI &og
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
DZ jp4 I q4�O 1 -1 ,653,5 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
U Sig�iatl�re /1 60
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund