158954 04/30/2008 CITY OF CARMEL, INDIANA VENDOR: 00352446 Page 1 of 1
i 0 ONE CIVIC SQUARE INFRASTRUCTURE CONTRACTORS, INC tHECK AMOUNT: $74,176.72
CARMEL, INDIANA 46032 16100ALLISONVILLE ROAD
o� NOBLESVILLE IN 46060 CHECK NUMBER: 158954
CHECK DATE: 4/30/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 1 74,176.72 OTHER EXPENSES
i
i
PAYMENT APPLICATION Page 1
TO: City of Carmel PROJECT Carmel Rosado Hill:Spring Mill APPLICATION 1 Distribution to:
Carmel Utilities 3450 W. 131st Street NAME AND Water Main Extension
Westfield, IN 46074 LOCATION: PERIOD THRU: 03/30/2008 OWNER
PROJECT #s: ARCHITECT
Attn: Accounts Payable CONTRACTOR
FROM: Infrastructure Contractors, Inc. ARCHITECT: DATE OF CONTRACT: 0 310 512 0 0 8
16100 Allisonville Road
Noblesville, IN 46060
FOR: Rosado Hill: Spring Mill Rd 106th St Water Main Extension
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
Application is made for payment as shown below. previously paid to Contractor under the Contract have been used to pay Contractor's costs for labor,
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 154,413.00 CONTRACTOR: Infrastructure Contractors, Inc.
2. SUM OF ALL CHANGE ORDERS $0.00 By: W Date: 03/27/2008
3. CURRENT CONTRACT AMOUNT (Line 1 2) $16
State of: Indiana
4. TOTAL COMPLETED AND STORED $82, 418.60
(Column G on Continuation Page) County of: Hamilton
5. RETAINAGE: Subscribed and sworn to before
a. of Completed Work me this 27th day of March 2008
(Columns D E on Continuation Page) L
b. of Material Stored Notary Public: Melissa C. Lawson
(Column F on Continuation Page)
My Commission Expires: September 6, 2015
Total Retainage (Line 5a 5b or
Column I on Continuation Page) $8,241.88 ARCHITECT'S CERTIFICATION
6. TOTAL COMPLETED AND STORED LESS RETAINAGE $74,176.72 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 $74 178,72 should not be made.
9. BALANCE TO COMPLETION CERTIFIED AMOUNT
(Line 3 minus Line 6) $80,236.28 (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 Y
B Date:
Total approved this month $0.00 $0.00
TOTALS $0.00 $0.00 Neither this Application nor payment applied for herein is assignable or negotiable. Payment shall
be made only to Contractor, and is without prejudice to any rights of Owner or Contractor under
NET CHANGES $O.Oo the Contract Documents or otherwise.
PAYMENT APPLICATION QSS, INC. DOCUMENT
CONTINUATION PAGE Page 1 of 1
PROJECT: Carmel /Rosado Hill:Spring Mill APPLICATION 1
Water Main Extension DATE OF APPLICATION: 03/30/2008
Payment Application containing Contractor's signature is attached. PERIOD THRU: 0313012008
Water Main Extension PROJECT #s:
A B C D E F G H I
COMPLETED WORK o
STORED TOTAL /o BALANCE
ITEM WORK DESCRIPTION SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMP. TO RETAINAGE
AMOUNT PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G C) COMPLETION (if Variable)
PERIODS (D E F) (C -G)
1 Mobilization Demobilization $1,585.50 $0.00 $792.75 $0.00 $792.75 50% $792.75 $79.28
2 20" H.D.P.E. Water Main $122,791.50 $0.00 $0.00 $60,362.25 $60,362.25 49% $62,42125 $6,036.23
3 20" Butterfly Valve $3,509.00 $0.00 $0.00 $3,326.40 $3,326.40 95% $182.60 $332.64
4 20" Connection $11,373.00 $0.00 $0.00 $7,553.08 $7,553.08 66% $3,819.92 $755.31
5 8" Connection $7,780.00 $0.00 $0.00 $4,655.89 $4,655.89 60% $3,124.11 $465.59
6 6" Tap Valve $2,533.00 $0.00 $0.00 $1,413.15 $1,413.15 56% $1,119.85 $141.32
7 Temporary Hydrant Assembly $4,841.00 $0.00 $0.00 $4,315.08 $4,315.08 89% $525.92 $431.51
(Complete)
TOTALS $154,413.00 $0.00 $792.75 $81,625.85 $82,418.60 53% $71,994.40 $8,241.88
CONTINUATION PAGE FOR PAYMENT APPLICATION QSS, INC. DOCUMENT
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 N
performed, dates of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
00352446
INFRASTRUCTURE CONTRACTORS, INC. Purchase Order No.
15530 STONEY CREEK WAY Terms
NOBLESVILLE, IN 46060 Due Date 4/15/2008
Invoke Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/15/2008 1 $74,176.72
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
X//
Date f' er
VOUCHER 081568 WARRANT ALLOWED
00352446 IN SUM OF
INFRASTRUCTURE CONTRACTORS, I
45530 STONEY CREEK WAY
'fyyOBLESVILLE, IN 46060
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
1 06- 1051 -88 $74,176.72
ilabiiity
61 0
�3
�o P
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Voucher Total $74,176.72
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`Cost distribution ledger classification if
'claim paid under vehicle highway fund