HomeMy WebLinkAbout198472 06/22/2011 a CITY OF CARMEL, INDIANA VENDOR: 00352259 Page 1 of 1
ONE CIVIC SQUARE CORBITT SONS CONSTRUCTION INC
CHECK AMOUNT: $45,000.00
CARMEL, INDIANA 46032 8728 BOBBINS ROAD
INDIANAPOLIS IN 46268 -1021 CHECK NUMBER: 198472
CHECK DATE: 6122/2011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
659 5023990 39221 45,000.00 1050.85
e=
AIA Document 6702 —1992
Application and Certificate for Payment
TO OWNER: City of Carmel. Indiana Board of Public PROJECT: ALL ?XANDIA DR APPLICATION NO: 3922 -1 Distribution to:
Work's and Safety PERIOD TO: June 03. 2011 OWNER: X
760 Third Avenue SW
Carmel, IN 46032 CONTRACT FOR: General Construction ARCHITECT:
FROM Corbin Sons Constructions Company VIA CONTRACT DATE: CONTRACTOR:
CONTRACTOR: Inc. ARCHITECT: PROJECT NOS: S12054 FIELD:
8728 Robbins Road
Indianapolis. IN 46268 OTHER:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the hest orthe Contractor's knowled information and
belief the Work covered by this Application for Payment has been completed in accordance with the
Application is made for payment, as showy below, in connection with the Contract. Contract Documents. that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet. ATA Document G703, is attached. Certificates for Payment were issued and payments received from the Owner. and that current
1. ORIGINAL CONTRACT SUM 60.000.00 payment iz 'ow d
2. NET CHANGE BY CHANGE ORDERS 0.00 CONT
3. CONTRACT S UM TO DATE (Line I f 2) 60,000.00 By: Date: June 0 2011
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 45.000.00 State o Indiana
5. RETAINAGE: County of: Marion
a. 0 of Completed Work Subscribed aq sworn to before
(Column D E on G703) 0.00 me this day o Ot O1 1
b• 0 of Stored Material 3
(Column F on 6703) 0.00 Notary Public: Stacie M. Helm
Total Retains e (Lines 5a+ 5b or Total in Column I ot'G703 My Commission ex ices: April 04. 2014
g 0.00 ii p P
6. TOTAL EARNED LESS RETAINAGE
45,000.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 Less Line 5 Total) In accordance with the Contract Documents. based on on -site observations and the data comprising
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 0.00 this application, the Architect certifies to the Owner that to the best of the Architect's knowledge,
(Line G from prior Certificate) information and belief the Work has progressed as indicated, the quality ol'the Work is in accordance
p with the Contract Documents, and the Contractor is entitled to pa}mlent of the AMOUNT
8. CURRENT PAYMENT DUE 45.000.0 CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED 45.000.00
(Line 3 less Line 6) S 15.000.00 (Attach explanation if ainount certified di f enc from the amount applie(r'. Initial all ligwes on this
Application and on the Continuation Sheet that are changed to Conform faith the anrotnrt certified.)
CHANGE ORDER SI)MMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner 0.0 0.0 By: Date:
Total approved this Month 0.0 0.0
TOTALS 0 0 0 This Certificate is not negotiable. The AMOIJNT CERTIFIED is payable only to the Contractor
named herein. Issuance, payment and acceptance of payment are without prejudice to am rights of
ET CHANGES by Change Order 0.0 the Owner or Contractor under this Contract.
AIA Document G702 1992. Copyright Q 1953, 1963, 1965, 1971, 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. This document was produced by AIA software at 14:50:21 on 06/03/2011 under Order No.5792802235_1 which expires on 12/13/2011, and is not for resale.
User Notes: (1333220440)
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
352259
CORBITT SONS CONSTRUCTION, INC. Purchase Order No.
P.O. Box 66975 Terms
Indianpolis, IN 46266 Due Date 6/15/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/15/2011 39221 $45,000.00
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
Date er
i VOUCHER 115323 WARRANT ALLOWED
352259 IN SUM OF
CORBITT SONS CONSTRUCTION, I1�
P.O. Box 66975
Indianpolis, IN 46266
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
39221 06- 1050 -85 $45,000.00
fj Availability
Voucher Total $45,000.00
Cost distribution ledger classification if
claim paid under vehicle highway fund