HomeMy WebLinkAbout162810 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 00352446 Page 1 of 1
e ONE CIVIC SQUARE INFRASTRUCTURE CONTRACTORS, INC CHECK AMOUNT: $273,300.69
CARMEL, INDIANA 46032 16100ALLiSONVIi,LE ROAD
NOBLESVILLE IN 46060 CHECK NUMBER: 162810
CHECK DATE: 8120/2008
DEPARTME ACCOUNT PO NUM I NUMBER T AMOUNT D
610 5023990 1� 273,300.69 OTHER EXPENSES
i
PAYMENT APPLICATION Page 1
TO: City of Carmel PROJECT 131st Street: Ditch Road to Sp APPLICATION 1 Distribution to:
Carmel Utilities 3450 W. 131st Street NAME AND Water
LOCATION: PERIOD THRU: 06130/2008 E] OWNER
Westfield, IN 46074 131st: Ditch to Springmill Rd PROJECT #s: ARCHITECT
Attn: Accounts Payable Carmel, IN CONTRACTOR
FROM: Infrastructure Contractors, Inc. ARCHITECT: DATE OF CONTRACT: 05112!2008
16100 Allisonville Road
Noblesville, IN 46060
FOR: 131st St:Ditch Rd to Spring Mill Rd
CONTRACTOR'S SUMMARY OF WORK Contractor's signature below is his assurance to Owner, concerning the payment herein applied for,
that: (1) the Work has been performed as required in the Contract Documents, (2) all sums
previously paid to Contractor under the Contract have been used to pay Contractor's costs for labor,
Application is made for payment as shown below. materials and other obligations under the Contract for Work previously paid for, and (3) Contractor is
Continuation Page is attached.
legally entitled to this payment.
1. CONTRACT AMOUNT 466,575.00 CONTRACTOR Infrastructur Con ct s Inc.
2. SUM OF ALL CHANGE ORDERS 7,597.84 By. Date: 0612712008
3. CURRENT CONTRACT AMOUNT (Line 1 2) 474,172.84 Jamer ohnson
State of Indiana
4. TOTAL COMPLETED AND STORED $303,66
(Column G on Continuation Page) County of: Hamilton
5. RETAINAGE: Subscribed and sworn to before
a. 10.00% of Completed Work $7,367.54 me this 27th day of. June 2008
(Columns D E on Continuation Page) t,n j C ws r
b. 10.00% of Material Stored $22,999.20 9 y
Notary Public: Melissa Laon
(Column F on Continuation Page)
My Commission Expires: September 6, 2015
Total Retainage (Line 5a 5b or
Column I on Continuation Page) $30,366.74 ARCHITECT'S CERTIFICATION
6. TOTAL COMPLETED AND STORED LESS RETAINAGE $273,300.69 Architect's signature below is his assurance to Owner, concerning the payment herein applied for,
(Line 4 minus Line 5 Total) that: (1) Architect has inspected the Work represented by this Application, (2) such Work has been
7. LESS PREVIOUS PAYMENT APPLICATIONS $0.00 completed to the extent indicated in this Application, and the quality of workmanship and materials
conforms with the Contract. Documents, (3) this Application for Payment accurately states the amount
of Work completed and payment due therefor, and (4) Architect knows of no reason why payment
8. PAYMENT DUE $273,300.69 should not be made.
9. BALANCE TO COMPLETION CERTIFIED AMOUNT
(Line 3 minus Line 6) $200,872.15 (If the certified amount is different from the payment due, you should attach an explanation.
Initial all the figures that are changed to match the certified amount.)
SUMMARY OF CHANGE ORDERS ADDITIONS DEDUCTIONS
Total changes approved in ARCHITECT:
previous months $0.00 $0.00 B Y: Date:
Total approved this month $22,184.84 ($14,587.00)
TOTALS $22,184.84 Neither this Application nor payment applied for herein is assignable or negotiable. Payment shall
($14,587.00) be made only to Contractor, and is without prejudice to any rights of Owner or Contractor under
NET CHANGES $7,597.84 the Contract Documents or otherwise.
PAYMENT APPLICATION QSS, INC. DOCUMENT
Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) g
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.
y
Payee
00352446
INFRASTRUCTURE CONTRACTORS, INC. Purchase Order No.
15530 STONEY CREEK WAY Terms
NOBLESVILLE, IN 46060 Due Date 8/13/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/13/2008 1 $273,300.69
hereby certify that the attached invoice(s), or bill(s) is (are) true and
:orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date fficer
VOUCHER 082675 WARRANT ALLOWED
00352446 IN SUM OF
INFRASTRUCTURE CONTRACTORS, 1
15530 STONEY CREEK WAY
NOBLESVILLE, IN 46060
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1 06- 1050 -50. $273,300.69
�bflrity
Voucher Total $273,300.69
-ost distribution ledger classification if
claim paid under vehicle highway fund