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Home My WebLink About202148 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 365624 Page 1 of 1 ONE CIVIC SQUARE HIS CONSTRUCTORS INC CHECK AMOUNT: $12,217.10 ti`,�'•io CARMEL, INDIANA 46032 5150 E 65TH STREET SUITE B I INDIANAPOLIS IN 46220 -4817 CHECK NUMBER: 202148 CHECK DATE: 9/27/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 44 25806 1 12,217.10 WESTWOOD DRIVE BRIDGE CONSTRUCTION PROJECT INVOICE DATE: September 12, 2011 COMPANY NAME: HIS Constructors, LLC AND ADDRESS 5150 East 65`" Street, Suite B Indianapolis, Indiana 46220 TELEPHONE NO.: (317) -284 -1195 FAX NO.: (317) 284 -1185 PROJECT NAME: Hamilton County Bridge 4 289 Westwood Drive over Mitchner Ditch PROJECT NO.: 11 -08 INVOICE NO.: 1 TOTAL PAY THIS ESTIMATE: 13,574.56 MINUS 10% RETAINAGE 1,357.46 TOTAL NOW DUE: 12,217.10 IJ'an Greskamp Construction Manager City of Carmel APPLICATION AND CERTIFICATE FOR PAYMENT AIA UocuR1ENT G702 PAGE 1 OF 3 PAGES TO: City of Carmel PROJECT: Carmel Bridge 289 APPLICATION NO: 1 Distribution to: One Civic Square PERIOD TO: 08/31/11 OWNER Carmel, IN 46032 PROJECT NOS: #11 -08 MENGINEER PURCHASE ORDER: CONTRACTOR OTHER FROM: HIS Constructors, Inc VIA: 5150 E. 65th Street, Suite B Indianapolis, IN -46220— CONTRACT DATE: 81312011 CONTRACT FOR: SUBCONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this application for Payment has been completed in accordance with the Contract Documents, that all amounts have Application is made for payment, as shown below, in connection with the contract. been paid by the Contractor for Work for which previous Certificates were issued and payments received from the Owner, Continuation Sheet, AIA Document G702, is attached. and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 154,800.00 SUBCONTRACTOR: HIS Constructors, Inc 2. Net change by Change Orders By: Date: 8131!2091 3. CONTRACT SUM TO DATE (Line 1 t 2) 154,800.00 State of: Indiana 4. TOTAL COMPLETED TO DATE 13,574.56 (Column J on G703) County oe Marion 5. RETAINAGE: a. 10 of Completed Work 1,357.46 Subscribed and sworn to before me this 3 day of Aug -11 b. 0 of Stored Material Notary Public: My Commission exp 8!2212012 Total Retainaae (Line 5a 5b) 1,357.46 SUBCONTRACTORS CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 12 In accordance with the Contract Documents, based on on -site observations and the data comprising this (Line 4 less Line 5 Total) application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and Line 6 from prior Certificate the Contractor is entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE I 12,217.10 9. BALANCE TO FINISH 10. VARIANCE TO CONTRACT AMOUNT CERTIFIED.-,. 12,217.10 141,225.44 (Attach explanation if amount certified differs from the amount applied for Initial all figures on this Application and on the Continuation Sheet that are Changed to conform to the amount certified.) CHANGE ORDER BY SUMMARY ADDITIONS DEDUCTIONS OWNER: CITY OF CARMEL Total changes approved in previous months by Owner By: Date: Total approved this Month TOTALS This Certificate is not negotiable The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and NET CHANGES by Change Order acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract, iy*ef AIA DOCUMENT 13702- APPLICATION ANO CERTIFICATE FOR PAYMENT -1992 EDITION AIA® -111992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1775 NEW YORK AVENUE, N.W., WASHINGTON, O.C. 20006 -5292 WARNING: Unsolicited photocopying laws and will subject me violator to legal prosecution_ G702 -1992 'This document has been reproduced electronically with the permission of The American institute of Archtects under License 970003 Primavera Systems, Inc. Reproduction of this document without project- specific information is not permitted. Contact The American Institute of Architects to verify the current version of this document and license status.' Application and Certificate For payment- page 2 To Owner: CITY OF CARMEL Application No: 1 Date: 08/31/11 Period To: 08/31/11 From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025 Project: CITY OF CARMEL BRIDGE 289 Architect's Project No: Work Completed Work Completed Completed and Stored To Date Previous Application This Period Item Unit Contract Scheduled N u m be r Description Price Quantity UM Value Quantity Amount. Quantity Amount Quantity Amount Retention Memo 01 -001 CONSTRUCTION- ENGINEE 2,400 -0000 1 -DOES- 2 0:00 -0:00 50:00 -1- 200:00- 50:00% 1. 200:00 -50:0 120.00 RING 002 MOBILIZATION AND DEM 7,800 -0000 1.00 LS 7,80000 0.00 0.00 10000% 7,800.00 100.00% 7,800.00 100.0 780.00 OBILIZATION 003 CLEARING RIGHT OF WAY 5,718.2000 1.00 LS 5,718.20 000 0.00 60.00 4,574.56 80.00 4,574.56 80.0 457.46 004 TEMPORARY IN- STREAM SILT 1,000.0000 1.00 LSU 1,000.00 .00 0.00 .00 0.00 .00 0.00 00 0.00 BASIN 005 EXCAVATION COMMON 55,0000 138.00 CYS 7,590.00 .00 0.00 DO 0.00 .00 0.00 0.0 0.00 006 EXCAVATION WATERWAY 45.0000 25.00 CYS 1,125.00 DO 0.00 .00 0.00 .00 0.00 0.0 0.00 007 EXCAVATION FOUNDATI ON 35.0000 52.00 CYS 1,820.00 00 0 -00 .00 0.00 .00 0.00 0.0 &OD UNCLASSIFIED 008 TEMPORARY SILT FENCE 2.7500 300.00 LFT 625.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 UNDISTRIBUTED 009 AGGREGATE FOR END BE NT 70.0000 22.60 CYS 1,582.00 .00 0.00 .00 0.00 .00 0.00 0.0 0 -00 BACKFILL 010 COMPACTED AGGREGATE 53 30.0000 158.00 TON 5,040.00 .00 0.00 .00 0.00 -00 0.00 0.0 0.00 BASE 011 HMA SURFACE TYPE A 119.0000 42.00 TON 4,998.00 .00 0.00 .00 0.00 .00 (100 0.0 0.00 012 HMA INTERMEDIATE TYPE A 106.0000 57.00 TON 6,042.00 00 0.00 .00 0.00 .00 0.00 0.0 0.00 013 HMA BASE TYPE A 88.0000 70.00 TON 6,160.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 014 BENCHMARK 500 -0000 1.00 EAC 500.00 .00 0.00 .00 0.00 .00 0,00 0.0 0.00 015 BURIED TIMBER GUARDR AIL 1,300.0000 4,00 EAC 5,200.00 .00 0,00 .00 (100 .00 0.00 0 -0 0.00 END SECTION INS 016 TIMBER GUARDRAIL IN STALL 41.0000 96 -00 LFT 3,936.00 00 000 .00 0.00 .00 0.00 0.0 0.00 ONLY 017 TIMBER BRIDGE RAIL INSTALL 48.0000 B4 00 LFT 4.03Z00 .00 000 00 0.00 .00 0.00 "0.0 0.00 ONLY 018 GEOTEXTILES 2.5000 390,00 SYS 975.00 .00 0.00 .00 0.00 .00 0.00 O.0 0.00 019 RIPRAP CLASS 1 24 DEPTH 35.0000 263 00 TON 9,205.00 .00 0.00 00 0.00 .00 0.00 0.0 0.00 020 SEED MIXTURE R 47.0000 8.00 LBS 376.00 .00 0.00 00 0.00 .00 0 -00 0.0 0.00 021 FERTILIZER 2,100.0000 110 TON 210.00 .00 0,00 .00 0.00 .00 0.00 0.0 0.00 022 MULCHED SEEDING T 3.0000 212.00 SYS 636.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 UNDISTRIBUTED 023 TEMPORARY EROSION CO 4.0000 212.00 SYS 848.00 .00 0 -00 -00 0.00 .00 0.00 0.0 0.00 NTROLBLANKET 024 MOBILIZATION AND DEM 265.0000 2.00 EAC 530.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 OBILIZATION FOR SEED 025 END BENT DRAIN PIPE 6 13.0000 80.00 LFT 1,040.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 DIAMETER 026 SAW CUT JOINT 13 -0000 49.00 LFT 637.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 027 PILING STEEL H PI LES HP 65.0000 52000 LFT 33,800.00 00 0.00 .00 0,00 .00 0.00 0.0 0.00 12X53 Application and Certificate For Payment page 3 To Owner: CITY OF CARMEL Application No: 1 Date: 08/31/11 Period To: 08/31/11 From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025 Project: CITY OF CARMEL BRIDGE 289 Architect's Project No: Work Completed Work Completed Completed and Stored To Date Previous Application This Period Item Unit Contract Scheduled Number Description Price Quantity UM Value Quantity Amount Quantity Amount Quantity Amount Retention Memo 028 EPDXY COATED REINFOR 1.2000 3434.00 LBS 4,120.80 .00 0.00 .00 0.00 .OD 0.00 0.0 0.00 CING STEEL 029 CONCRETE A SUBSTRU 950:0000 21.20 CYS 20;140.. 00 .00 0:00 .00 0:00 -00 0:00 00 000 CTURE 030 STRUCTURAL MEMBRANE 30.0000 150.00 SYS 4,500.00 00 0.00 00 0.00 .00 6.00 0.0 0,00 WATERPROOFING 031 WS 17 X X -0 CONCRETE 7.0000 924.00 SFT 6,468.00 .00 0.00 .00 0.00 00 000 0.0 0.00 BOX BEAMS INSTA 032 SURFACE SEAL 1,150.0000 1.00 LS 1,150.00 0,00% 0_00 0.00 0.00 000% 0.00 0.0 0.00 033 FIELD TILE UNDISTRI BUTED 15.0000 20.00 LFT 300.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 034 CONSTRUCTION SIGN T YPE 130.0000 800 EAC 1,040.00 .00 0.00 00 0.00 .00 0.00 0.0 0.00 A 035 CONSTRUCTION SIGN T YPE 70.0000 2.00 EAC 140.00 .00 0.00 .00 0.00 .00 0.00 00 0.00 B 036 STANDARD BARRICADE TYPE 13.0000 48.00 LFT 62400 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 IIIA 037 STANDARD BARRICADE TYPE 14.0000 48.00 LFT 672.00 00 0.00 .00 DAO .00 0.00 0.0 0.00 1118 038 DETOUR ROUTE MARKER 140.0000 7.00 EAC 980.00 .00 0.00 .00 0.00 .00 0.00 DA 0.00 ASSEMBLY 039 ROAD CLOSURE SIGN AS 160.0000 4.00 EAC 640.00 .00 0.00 00 0.00 .00 0.00 0.0 0.00 SEMBLY 800 LOAD AND TRANS WOOD RAIL 0.0000 1.00 LS 0.01 0,00% 0.00 0.00% 000 0.00% 0.00 0.0 0.00 PIECES 900 OVERHEAD 0.0000 1.00 LS 0.01 000% 0.00 000% GOD 0.00% 0,00 0.0 0.00 Total 154,800.02 0.00 13,574 56 13,574.56 1,357.46 Application Total 154,800.02 0.00 13,574.56 13,574.56 1,357.46 yrt LETTER OF TRANSMITTAL HIS Constructors, LLC 5150 E. 65th Street, Suite B Date: September 6, 2011 Job No. 1.10025 Indianapolis, IN 46220 Attention: Dan Greskamp Project: Carmel Bridge 289 Phone (317) 284 -1195 RE: Invoice 91 Fax (317) 284 -11.85 Sent Via: Hand Delivered I IMail Other: X lOvernight UPS Ground To: City of Carmel One Civic Square Carmel, IN 46032 WE ARE SENDING: XX Attached Under separate cover via Airborne Exp. the following items: e Shop Drawings Prints Plans Submittals Specifi cations Copy of Letter EChange Order ROther Copies Date No. Description 1 Invoice #1 THESE ARE TRANSMITTED as checked below: For approval Approved as submitted Resubmit 6 copies for approval For your use Approval as noted Submit copies for distribution As requested Returned for corrections Return corrected prints For review and comment X Submitted for Payment For Bids Due F7 PRINTS TO BE RETURNED REMARKS: Copy To: Thank you! SIGNED: JA ell hel s, Project Controls Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee 1 S c)%1 t�_ Purchase Order No. Terms Mf)6 9 Z Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Z e_- 0 o v 0�� 1 7 S I Total 2 2 t a I hereby certify that the Ittached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. 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 -Z 20 Signat re Cost distribution ledger classification if Title claim paid motor vehicle highway fund