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Home My WebLink About202323 09/27/2011 CITY OF CARMEL, INDIANA VENDOR: 363626 Page 1 of 1 s 0 ONE CIVIC SQUARE THIENEMAN CONSTRUCTION INC CHECK AMOUNT: $16,299.18 j CARMEL, INDIANA 46032 3313 EAST 83RD PLACE MERRILLVILLE RI 46410 CHECK NUMBER: 202323 CHECK DATE: 9/27/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE N AMOUNT DESCRIPTION 659 5023990 22.2 12,400.91 OTHER EXPENSES 659 5023990 24 3,898.27 OTHER EXPENSES AIA Type Document Application and Certification for Payment Page 1 of 8 TO (OWNER): City of Carmel PROJECT. Carmel Contract 70 APPLICATION NO: 24 DISTRIBUTION 760 3rd Avenue SW 9609 Hazeldell Pkwy TO: Suite 110 Carmel, IN 46032 PERIOD TO:7/30/2011 OWNER Carmel, IN 46032 _ARCHITECT CONTRACTOR FROM (CONTRACTOR): Thieneman Construction, Inc. VIA (ARCHITECT): Jones Henry, Ltd. ARCHITECT'S 3313 East 83rd Place PROJECT NO: SRF WW092829 01 Merrillville, IN 46410 CONTRACT FOR: City of Carmel WWTP Expansion CONTRACT DATE: 10/7/2009 CONTRACTOR'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 Application is made for Payment, as shown below, in connection with the Contract. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet, AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 5,454,500.00 2. Net Change by Change Orders 330,114.38 CONTRACTOR: Thieneman Construction, Inc. 313 ast 83rd Place Merrillville, IN 46410 3. CONTRACT SUM TO DATE (Line 1 2)........... 5,124,385.62 4. TOTAL COMPLETED AND STORED TO DATE 5,124,385.62 By: Date: t I 1 1 Jos orris 1 Project Manager netts SAC 5. RETAINAGE.: N�® a. 0.49 of Completed Work 25,000.00 State of IN .STAR y r County of: Hamilton my Comm. Expires b. 0.00 of Stored Material 0.00 Subscribed and Sworn to before me this q i+\ -0ay of'la' u r 2 2016 20 G A'� n f1 p Total retainage (Line 5a 5b) 25,000.00 Notary Public: U f ,4.,` i(,/� L`� My Commission Expires 1 I DOI i ix Q,��\�� 6. TOTAL EARNED LESS RETAINAGE 5,099,385.62 7 (Line 4 less Line 5 Total) ARCHITECTS CERTIFICATE FOR PAYN(LN 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents, based on on -site observations and the data com- (Line 6 from 5,095,487.35 prising the above application, the Architect certifies to owner that to the best of the Architect's p rior Certificate) knowledge, information and belief the Work has progressed as indicated,the quality of the work 8. CURRENT PAYMENT DUE 3,898.27 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED. (Line 3 less Line 6) .25,000.00 AMOUNT CERTIFIED (Attach explanation if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continnuu Lion Sheet t at are changed to conform to the amount certified.) Total changes approved in ARCHIT C w `z previous months by Owner 11,122.00 341,236.38 By: Date: Total approved this Month 0.00 0.001 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Payment and acceptance of payment are without prejudice to any TOTALS 11,122.00 341,236:38 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 330,114.38 AIA Type Document Application and Certification for Payment Page 1 of 8 TO (OWNER): City of Carmel PROJECT. Carmel Contract 70 760 3rd Avenue SW 9609 Hazeldell Pkwy APPLICATION N0: 22 DISTRIBUTION DI Suite 110 Carmel, IN 46032 PERIOD T0:6/30/2011 OWNER Carmel, IN 46032 ARCHITECT CONTRACTOR FROM (CONTRACTOR): Thieneman Construction, Inc. VIA (ARCHITECT): Jones Henry, Ltd. ARCHITECT'S 3313 East 83rd Place PROJECT NO: SRI= WW092829 01 Merrillville, IN 46410 CONTRACT FOR: City of Carmel WWTP Expansion ca CONTRACT DATE: 10/7/2009 CONTRACTOR APPLICATION FAR 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 Application is made for Payment, as shown below, in connection with the Contract. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet, AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner, and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM 5,454,500.00 2. Net Change by Change Orders 330,114.38 CONTRACTOR: Thieneman Construction, Inc. 33P East 83rd Place Merrillville, IN 46410 3. CONTRACT SUM TO DATE (Line 1 f 2)........... 5,124,385.62 n J� �`1 �i Q s 4. TOTAL COMPLETED AND STORED TO DATE 5,120,487.35 By: r Date: `may omm `xpiras J h Morris /Project fiAanager January 2o, 201 e 5. RETAINAGE: 5tat f: IN Boone Cooney a. 1.96 of Completed Work 100,410.67 County of: Hamilton] b. 0.00 of Stored Material 0.00 Subscribed and Sworn to before me this `�1'r1 Day ",_o U N5Q,\� Total retainage (Line 5a 5b) 100,4 10.67 Notary Public: aVqJJ3,-(Wz My Commission Expires 6. TOTAL EARNED LESS RETAINAGE 5,020,076.68 (Line 4 less Line 5Total) ARCHITECT'S CERTIFICATE FOR PAYMENT 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents, based on on -site observations and the data com- Line 6 from prior Certificate 4,920,122.77 prising the above application, the Architect certifies to owner that to the best of the Architect's (Line knowledge, information and belief the Work has progressed as indicated,the quality of the work 8. CURRENT PAYMENT DUE 99,953.91 is in accordance with,the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) 104,308.94 AMOUNT CERTIFIED (Attach explanation if amount certified differs from the amount applied. Initial all figures on this CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.) Total changes approved in ARCHITE E '��—S T previous months by Owner 11,122.00 341,236.38 By. �f�' Date: Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, Payment and acceptance of payment are without prejudice to any TOTALS 11,122.0 341,236.38 rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order 330,114.38 VOUCHER 115915 WARRANT ALLOWED 363626 IN SUM OF THIENEMAN CONSTRUCTION INC 3313 EAST 83RD PLACE MERRILLVILLE, IN 46410 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO INV ACCT AMOUNT Audit Trail Code 24 07- 1050 -75 $3,898.27 0N �I�c Voucher Total Cost distribution ledger classification if claim paid under vehicle highway fund 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 363626 THIENEMAN CONSTRUCTION INC Purchase Order No. 3313 EAST 83RD PLACE Terms MERRILLVILLE, IN 46410 Due Date 9/23/2011 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 9/23/2011 24 $3,898.27 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 Date Offi