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Home My WebLink About159470 05/14/2008 CITY OF INDIANA VENDOR: 00351429 Page 1 of 1 ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $105,225.71 CARMEL, INDIANA 46032 PO BOX 2533 4 off ANDERSON IN 46018 CHECK NUMBER: 159470 CHECK DATE: 5/14/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 654 R5023990 S10726 5 104,225.71 CONSTRUCTION r 654 5023990 9 1,000.00 1050.79 I APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0 702 ilnstructions on reverse Side) ONE Or PAGES TO (OWNER): City of Carmel PROJECT: Blower/ Electrical Modification APPLICATION NO: Five (5) Distribution to. One Civic Square Contract 60 OWNER Carmel, IN 46032 PERIOD TO: 03 -31-08 C ARCHITECT CONTRACTOR FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C M. K. Betts Engineering PROJECT NO: C Contracting, Inc. CONTRACT FOR: Invoice No. 07 -262. 05 CONTRACT DATE: Application is made Payment, as CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sh et, Document G703 l is altt ched connection with the Contract. CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM S 2, 349,000.00 2. Net change by Change Orders 5 —0— Change Orders approved in ADDITIONS DEDUCTIONS 2 previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) 5 TOTAL 4. TOTAL COMPLETED STORED TO DATE 5 167 ,493.90 Approved this Month (Column G on G703) Number Date Approved S. RIETAINAGE: a. 1 of Completed Work 5 9,753.76 (Column D E on G703) b. 10 of Stored Material 6,995.63 (Column F on G703) Total Retainage (Line 5a 5b or TOTALS Total in Column I of G703) 5 16 ,749.39 Net chan e by Change Orders 6. TOTAL EARNED LESS RETAINAGE 5 150, 744.51 The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total) information and belief the Work covered by this. Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 from prior Certificate) 5 4 6,51 8.8 0 paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 104,225.71 issued and payments received from the Owner, and that current payment shown 9 BALANCE TO FINISH, PLUS RETAINAGE 5 2,198,255.49 herein is now due. (Line 3 less Line 6) CONTRA R: M. K. Betts Engineering Contracting, Inc. State of: Indiana County of Madison Subscribed and sworn to before me this 31st day of March 2008 Notary Public: Bv: Date: March 31, 2008 My Commission expires: October 28 207.5 AMOUNT CERTIFIED 5 ARCHITECT'S CERTIFICATE FOR PAYMENT (Attach explanation amount certified differs from the amount applied fora In accordance with the Contract Documents, based on on -site observations and the ARCHITECT: data comprising the above application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as Bv: J Date: indicated, the quality of the Work is in accordance with the Contract Documents, and This Certificate is not negotta le. The AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment or the AMOUNT CERTIFIED. Contractcr named herein. Issuance, payment and acceptance of payment are without `r prejudice to any rights of the Owner or Contractor under this Contract. qU DOCUMENT G:o_ C [RTlrl[ -\Tr Fna P,��.��c� 1 •,n; ED!rin. Form Prescrd No. ibe 1995) counts ACCOUNTS PAYABLE VOUCHER Form 301 1995) TO ADDRESS Invoice Date Invoice Number Item Amount I hereby certify that the attached invoice(s), or 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 1 19 Signature Title 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. 19 14 icer Title Voucher No. Warrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS SANITATION DEPARTMENT j ANOO. CARMEL, INDIANA 1 Favor Of Total Amount of Voucher Deductions Amount of Warrant 6) 7 Month of 19 Acct. VOUCHER RECORD No. Collection System Operation Plant Commercial General Undistributed N Construction Depreciation Reserve Stock Accounts Merchandise Total Allowed Board Members Filed BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325 APPLICATION AND CERTIFICATE FOR PAYMENT AIA D G7 02 (Instructions on reverse sides oNF of P\cEs TO (OWNER): City of Carmel PROJECT: Solar Drying APPLICATION NO: Nine (9) Distribution to: One Civic Square Contract 65 C OWNER Carmel, IN 46032 Carmel, IN PERIOD TO: 03 31 -08 E: ARCHITECT C CONITRAC70R FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S L M. K. Betts Engineering Jones Henry Engineers, Ltd. PROJECT NO: C Contracting, Inc. CONTRACT FOR: Invoice No. 07 232.09 CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT Cont nua ion Sh et, f AIA Document G703, a c'hedconnection with the Contract. CHANCE ORDER SUMMARY j 1. ORIGINAL CONTRACT SUM 5 696,450.00 Change Orders approved in I ADDITIONS DEDUCTIONS 2• Net change by Change Orders S 123,297.00 previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) S 819,747.00 TOTAL 4. TOTAL COMPLETED STORED TO DATE S 802,427-00 Approved this Month (Column G on G703) 5. RETAINAGE: Number Date Approved a. of Completed Work S CO#1 $110,499.00 —0— (Column D +E on G703) CO #2 12,798.00 —0— b. of Stored Material (Column F on G703) Total Retainage (Line 5a 5b or TOTALS 123,297.00 0 Total in Column I of G703) 34,822.50 Net change by Change Orders 123,297.00 6. TOTAL EARNED LESS RETAINAGE S 767,604.50 The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total) information and belief the Work covered by this Application for Payment has been 7• LESS PREVIOUS CERTIFICATES FOR completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 from prior Certificate)......... S 766,604.50 paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 1,000.00 issued and payments received from the Owner, and that current payment shown 9. BALANCE TO FINISH, PLUS RETAINAGE S 52,142,59 herein is now due. (Line 3 less Line 6) CONTRACTOR: M. K. Betts Engineering Contracting, Inc. State of: Indiana County of: Madison Subscribed and sworn to before me this 31st day of March 2008 Notary Public:,_ v In By: Date: March 31, 2008 My Commission expires: October 28, 2015 AMOUNT CERTIFIED S ARCHITECT'S CERTIFICATE FOR PAYMENT (Attach explanation if amount certified differs from the amount applied tor.) In accordance with the Contract Documents, based on on -site observations and the ARCHITECT: data comprising the above application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as By: Date: indicated, the quality of the Work is in accordance with the Contract Documents, and This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractcr named herein. Issuance, payment and acceptance of payment arc without prejudice to anv rights of the Owner or Contractor under this Contract. 1 DOCUMENT C;70 Pll(;, \ri( V ?:f) C [F.TIf IC \T1 FOR U, \Y f I +R: F[IITICIw •I• Olt Prescribed State Board Accounts ACCOUNTS PAYABLE VOUCHER Form No. 301 01-S (Rev. 1995) TO ADDRESS Invoice Date Invoice Number Item Amount k I hereby certify that the attached invoice(s), or 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 19 Signature Title 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. 19 ff icer Title Voucher No. W arrant No. ACCOUNTS PAYABLE DETAILED ACCOUNTS SANITATION DEPARTMENT A CARMEL, INDIANA n Favor Of Total Amount of Voucher Deductions /000 00 0 OS Amount of Warrant 1 000 b Month of 19 Acct. VOUCHER RECORD No. Collection System Operation Plant Commercial General Undistributed Construction Depreciation Reserve Stock Accounts Merchandise Total Allowed Board Members Filed BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325