162417 08/07/2008 CITY OF CARMEL, INDIANA VENDOR: 00351429
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 M.K. BETTS ENGINEERING INC Page 1 of 1
PO BOX 2533
ANDERSON IN 46018 CHECK AMOUNT: $162,016.00
CHECK NUMBER: 162417
CHECK DATE: 8/7/2008
DEPARTM ACCOUNT PO NUMBER INVOICE NUM A
654 DES
R5023990 S10726 8 162,016.00 CONSTRUCTION
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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0702 (Instructions on reverse Side) PAGE O�'E Or P�C�Es
TO (OWNER): City of Carmel PROJECT: Blower /Electrical Modification APPLICATION NO Eight (8) Distribution to:
One Civic Square Contract 60 L; OWNER
Carmel, IN 46032 PERIOD TO: 06 30 08 C ARCHITECT
'ii C CONTRACTOR
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
Contracting, Inc.,
CONTRACT FOR: Invoice No. 07- 262. CONTRACT DATE:
Application is made for Payment, as shown below, in connection with the Contract.
CONTRACTOR'S APPLICATION FOR. PAYMENT Continuation Sheet, AlA Document G703, is attached.
CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM 5 2,349,000-00
Change Orders approved in I ADDITIONS DEDUCTIONS 2 Net change by Change Orders y 295,205.00
previous months by Owner 3. CONTRACT SUM TO DATE (line 1 2) 5 2 ,644,205.00
TOTAL 4. TOTAL COMPLETED STORED TO DATE 5 1,262,329.11
I Approved this Month (Column G on G703)
5. RETAINAGE:
Number Date Approved 10 120,719.63
t a. of Completed Work 5
.K C0#1 $302,815.00 7,610.00 (Column D E on G703)
b. 1 0 of Stored Material 5 5,513.28
(Column F on G703)
Total Retainage (Line 5a 5b or
l '3 TOTALS $302,815.001 7 "610.00 Total in Column I of G703) 5 126,232.91
Net thane by Change Orders $295,205.00 6. TOTAL EARNED LESS RETAINAGE 5 1 ,136 ,096 .20
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) 5 974,080.20
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paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE 5 162,016.00
j i issued and payments received from the Owner, and that current payment shown g BALANCE TO FINISH, PLUS RETAINAGE 5 1,508,108.80
herein is now due. (Line 3 less Line 6)
CONTRACT M. K. Betts Engineering Contracting, Inc. State of: Indiana County of Madison
j Subscribed and sworn to before me this 30th day of June 2008
!i Notary Public`
I By: d Date: June 30, 2008 My Commission expires: October 28, 2015
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED S
I s (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
N c best of the Architect's knowledge, information and belief the Work has progressed as B Date:
indicated, the quality of the Work is in accordance with the Contract Documents, and
i.j This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice To any rights of the Owner or Contractor under this Contract.
AtA oOCU`AFNT C:; ?n: it �Tlr ..,•err cri n,r <�c n...
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
351429
M.K. BETTS ENGINEERING CONTR Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 8/1/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/1/2008 8 $162,016.00
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
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Date O cer
VOUCHER 086037 WARRANT ALLOWED
J
351429 IN SUM OF
M.K. BETTS ENGINEERING CONTR
P.O. Box 2533
Anderson, IN 46018
Carmel Wastewater Utility
_l
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
oZ
8 .A9- 1050 -61 $162,016.00
rONNecj
P
Voucher Total $162,016.00
"Cost distribution ledger classification if
claim paid under vehicle highway fund