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Home My WebLink About167984 01/21/2009 CITY OF CARMEL, INDIANA VENDOR: 357899 Page 1 of 1 ONE CIVIC SQUARE F K CONSTRUCTION INC CHECK AMOUNT: $8,314.52 CARMEL, INDIANA 46032 zoss w iso s FLORA IN 46929 CHECK NUMBER: 167984 CHECK DATE: 1/21/2009 DEPARTMENT ACCOUNT P NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 610 5023990 5 8,314.52 1050.40 i APPLICATION AND CERTIFICATION FOR PAY MENT ALA DOCUME G70 PAG ONE OF 2 PAGES TO OWNER Board of Public Works Safety PROJECT: 141 st Street and Shelborne APPLICATION NO: 5 Retainage Distribution to: City of Carmel, IN Road Water Main =OWNER I Extension =CM PERIOD TO: 7/10/08 =CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: DESIGN BUILD i F K Construction, Inc. 2055 W. 150 S. PROJECT NOS: i Flora, IN 46929 CONTRACT FOR: CONTRACT DATE: 6/7/06 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached, completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and I payments received from the Owner, and that current payment shown herein is now due, 1. ORIGINAL CONTRACT SUM 164,360.00 2. Net change by Change Orders (40,583,77) CONTRACTOR: F K Construction, Inc, i 3. CONTRACT SUM TO DATE (Line 1 2) 123,776,23 j 4. TOTAL COMPLETED STORED TO 123,776,23 DATE (Column 0 on 0703) r By. Date: 7/10/08 5. RETAINAGE: a. 10 of Completed Work 0.00 State o£ Indiana County of: Carroll (Column D E on G703) Subscribed and n to bef re a this 10th day of Jul -08 b, 10 of Stored Material 0.00 Notary Publici i (Column F on G703) My Commissi expires: 8/7/11 Total Retainage (Lines 5a 5b or Total in Column I of 0703) 0.00 j 6, TOTAL EARNED LESS RETAINAGE 123776,23 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 115,461.71 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 8,314.52 is entitled to payment of the AMOUNT CERTIFIED, 9, BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED CHANGE 0717 SUMMARY ADDITIONS DEDUCT O S (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified.) in p revio us months by Owner $62,320.23 $102,904.00 OWNER: Field Project Mgr: 1 *Total approved this Month By: Date: By: Date: i TOTALS $62,320.23 ($102,904.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. issuance, payment and acceptance of payment are without NET CHANGES by Change Order $40 583.77 prejudice to any rights of the Owner or Contractor under this Contract. AIA G702. APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W„ WASHINGTON, DC 20005-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. i i CONTINUATION SHEET AIA PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 5 Retainage Contractor's signed certification is attached. APPLICATION DATE: 7/10/08 f In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 7/10/08 jUse Column I on Contracts where variable retainage for line items may apply. PROJECT NO: i A B C D E F G H I I E DESCRIPTION OF WORK SCHEDULED WORK CO MPLETED MATERIALS TOTAL 13ALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C G) RATE) (D E) (NOT IN TO DATE D ORE (D +E +F) 1 20" DI Pipe, Open Trench $875.00 $250.00 $250.00 $25.00 2 20" DI Pipe, Directional Drill $4,985.00 $4,985.00 $4,985.00 $498.50 3 20" HDPE, Directional Drill $100,409.00 $0.00 I 4 20" MJ Butterfly Valve $450.00 $450.00 $450.00 $45.00 I 5 20" X 20" MJ Tee $560.00 $280.00 $280.00 $28.00 6 20" 45 degree MJ Bend $790.00 $0,00 7 20" MJ Sleeve $0,00 $0.00 8 20" X 12" MJ Reducer $450.00 $450.00 $450.00 $45.00 9 20" MJ Plug $170.00 $170.00 $170.00 $17.00 10 12" DI Pipe, Open Trench $35,525.25 $35,525.25 $35,525.25 $3,552.53 11 12" MJ Gate Valve $495.00 $495.00 $495.00 $49.50 12 12" X 8" MJ Tee $495.00 $495.00 $495,00 $49.50 13 12" X 6" MJ Reducer $165,75 $165.75 $165.75 $16.58 14 8" MJ Gate Valve $495.00 $495.00 $495.00 $49.50 15 8" MJ Plug $75,00 $75.00 $75.00 $7.50 16 Fire Hydrant and 12" X 6 MJ Tee $1,950.00 $1,950.00 $1,950.00 $195.00 17 Fire Hydrant Without Tee $225.00 $225.00 $225.00 $22.50 18 Remove Relocate Fire Hydrant $800.00 $0.00 19 Granular Backfill $2,565.00 $2,565.00 $2,565.00 $256.50 20 1,5" Copper Service w /4" Sleeve $12,880.00 $12,880.00 $12,880.00 $1,288.00 21 C.O. 2 8" Tie -in at Overbrook $1,675.00 $1,675.00 $1,675.00 $167.50 22 CO #4- Install 20" DI in open trench $58,000.00 $55,500.00 $2,500.00 $58,000.00 $5,800.00 23 CO #5- Addtion of one service for 70' $2,645.23 $2,645.23 $2,645.23 $264.52 I GRAND TOTALS $226,680.23 $121,276.23 $2,500.00 $0.00 $123,776.23 $0.00 $12,377.62 i f Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity f prescribed by State Board of Accounts i.uy rUnn NU. Zu I (RCV I aya) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show, kind of service, where C performed, dates of service rendered, by whom, rates per day, number of units, price per unit, etc. Payee 357899 F K CONSTRUCTION INC Purchase Order No. 2055 W 150 S Terms FLORA, IN 46929 Due Date 12/29/2008 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/29/2001 5 $8,314.52 Q iereby certify that the attached invoice(s), or bill(s) is (are) true and )rrect and I have audited same in accordance with IC 5- 11- 10 -1.6 Date Of cer /QUCHER 084224 WARRANT ALLOWED 357899 IN SUM OF K CONSTRUCTION INC ?055 W 150 S =L IN 46929 Carmel Water Utility I ON ACCOUNT OF APPROPRIATION FOR Board members 'O INV ACCT AMOUNT Audit Trail Code 5 06- 1050 -40 $8,314.52 CAvaila6ility V� Voucher Total $8,314.52 :,ost distribution ledger classification if -laim paid under vehicle highway fund t i