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Home My WebLink About203021 10/25/2011 CITY OF CARMEL, INDIANA VENDOR: 365624 Page 1 of 1 tl ONE CIVIC SQUARE HIS CONSTRUCTORS INC CHECK AMOUNT: $44,753.98 CARMEL, INDIANA 46032 5150 E 65TH STREET SUITE B INDIANAPOLIS IN 46220 -4817 CHECK NUMBER: 203021 CHECK DATE: 10/2512011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462300 25806 2 44,753.98 WESTWOOD DRIVE BRIDGE CONSTRUCTION PROJECT INVOICE DATE: October 5, 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 289 Westwood Drive over Mitchner Ditch PROJECT NO.: 11 -08 INVOICE NO.: 2 �a\� TOTAL PAY THIS ESTIMATE: 49 MINUS 10% RETAINAGE 4,972.66 TOTAL NOW DUE: 44,753.98 Dan Greskamp Construction Manager City of Carmel APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 3 PAGES TO: City of Carmel PROJECT: Carmel Bridge 289 APPLICATION NO: 2 Distribution to: One Civic Square PERIOD TO: 10/02/11 OWNER Carmel, IN 46032 PROJECT NOS: #11-08 ENGINEER PURCHASE ORDER: FlCONTRACTOR []OTHER FROM: HIS Constructors, Inc VIA: INVOICE DATE: x10/4!2011; El 5150 E. 65th Street, Suite B Indianapolis, IN 46220 CONTRACT DATE: 8/312011 CONTRACT FOR: SUBCONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors 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: l/ Date: 10/4/2011 3. CONTRACT SUM TO DATE (Line 1 t 2) 154,800.00 State of: Indiana 4. TOTAL COMPLETED TO DATE 63,301.20 (Column J on G703) County of Marion 5. RETAINAGE: a. 10 of Completed Work 6,330.12 Subscribed and sworn to before me this 4th day of Oct�11 b. 0 of Stored Material Notary Public: My Commisslon expl s: 8/22/2012 Total Retainape (Line Sa+ Sb) 6,330.12 SUBCONTRACTORS CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 56,971.08 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 rior Certificate the Contractor is entitled to payment of the AMOUNT CERTIFIED. (L� P 12,217.10 8. CURRENT PAYMENT DUE 44,753.98 9. BALANCE TO FINISH 10. VARIANCE TO CONTRACT AMOUNT CERTIFIED 44,753.98 91,498.80 (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 p revious 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 Chan a Order acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. PIA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT -1992 EDITION AIAM -Ot 992- THE AMERICAN INSTITUTE OF ARCHITECTS, 1739 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 200055292 WARNING: Unsolicited photempying levee and Vlll ublect the violator to legal proaeadion. 6702 -1992 'Thls document hm been reprodlcsd eleclraNc0V wtth Dee permtsdon of The American InGtitute of Architects under Uceme 970003 Pdmavern Systems, Inc. ReproductIon of tNc dowmenl without project -apadfk Info mation is not Permitted. Contact The Amedcar, Institute of Architects to verify the aarcrd verelon of rids doaanent orrd Ycense etaWC.' Application and Certificate For Payment-- page 2 To Owner: CITY OF CARMEL Application No: 2 Date: 10/04/11 Period To: 10/02/11 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 q Item Unit Contract Scheduled F_ Number Description Price Quantity UM Value Quantity Amount Quantity Amount Quantity Amount Rete M 01 001 CONSTRUCTION ENGINEE 2,400.0000 1.00 LS 2,400.00 50,00% 1,200.00 0.00% 0.00 50.00 1,200.00 50.0 120.00 RING 002 MOBILIZATION AND DEM 7,800.0000 1.00 LS 7,800.00 1 DO.00 7,600.00 0.00% 0.00 100.00% 7,800.00 100.0 780.00 s OBILIZATION 003 CLEARING RIGHT OF WAY 5,718.2000 1.00 LS 5,718.20 80.00% 4,574.56 20.00% 1,143.64 100.00% 5,718.20 100.0 571.82 s 004 TEMPORARY IN- STREAM SILT 1,000.0000 1.00 LSU 1,000.00 .00 0.00 .35 350.00 .35 350.00 35.0 35.00 BASIN 005 EXCAVATION COMMON 55.0000 138.00 CYS 7,590.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 2 006 EXCAVATION WATERWAY 45.0000 25.00 CYS 1,125.00 .00 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 0.00 UNCLASSIFIED k. 008 TEMPORARY SILT FENCE 2.7500 300.00 LFT 825.00 .00 0.00 .DO 0.00 .00 0.00 0.0 0.00 y: UNDISTRIBUTED 009 AGGREGATE FOR END BE NT 70.0000 22.60 CYS 1,582.00 .00 0.00 43.00 3,010.00 43.00 3,010.00 190.3 301.00 BACKFILL 010 COMPACTED AGGREGATE 53 30.0000 168.00 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 .DO 0.00 .00 0.00 0.0 0.00 012 HMA INTERMEDIATE TYPE A 1D6.0000 57.00 TON 6,042.00 .00 0.00 W 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 0.00 .00 0.00 0.0 0.00 f END SECTION INS 016 TIMBER GUARDRAIL IN STALL 41.0000 96.00 LFT 3,936.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 ONLY 017 TIMBER BRIDGE RAIL INSTALL 46.0000 84.00 LFT 4,032.00 .00 0.00 .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 0.0 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 LEIS 376.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 021 FERTILIZER 2,100.0000 .10 TON 210.00 .DO 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 .OD 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 D.00 .00 0.00 0.0 0.00 NTROL BLANKET 024 MOBILIZATION AND OEM 265.0000 2-00 EAC 530.00 .00 0.00 .DO 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 75.00 975.00 75.00 975.00 93.8 97.50 DIAMETER f j 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 520.00 LFT 33,800.00 .00 0.00 312.00 20,280.00 312.00 20,280.00 60.0 2,028.00 12X53 a I Application and Certificate For Payment page 3 To Owner: CITY OF CARMEL Application No: 2 Date: 10/04/11 Period To: 10/02/11 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 Appllcatlon 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 4140.00 4,968.00 4140.00 4,968.00 120.6 496.80 CING STEEL 029 CONCRETE A SUBSTRU 950.6000 21.20 CYS 20,140.00 .00 0.00 20.00 19,000.00 20.00 19,000.00 94.3 1,900.00 CTURE 030 STRUCTURAL MEMBRANE 30.0000 150.00 SYS 4,500.00 .00 0.00 .DO 0.00 .DO 0.00 0.0 0.00 WATERPROOFING 1 031 WS 17 X 4'-0 CONCRETE 7.0000 924.00 SIFT 6,468.00 .OD 0.00 .00 0.00 .00 0.00 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 0.00% O.co 0.0 0.00 I 033 FIELD TILE UNDISTRIBUTED 15.0000 20.00 LIFT 300.00 .00 0.00. .DO 0.00 .00 0.00 0.0 0.00 034 CONSTRUCTION SIGN TYPE 130.0000 8.00 EAC 1,040.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 A 035 CONSTRUCTION SIGN TYPE 70.0000 2.00 EAC 140.00 .00 0.00 DO 0.00 .00 0.00 0.0 0.00 B 036 STANDARD BARRICADE TYPE 13.0000 48.00 LFT 624.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 IIIA 037 STANDARD BARRICADE TYPE 14.0000 48.00 LIFT 672.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 IIIB 038 DETOUR ROUTE MARKER 140.0000 7.00 EAC 980.00 .00 0.00 .00 0.00 .00 0.00 0.0 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% 0.00 0,00% 0.00 0.0 0.00 PIECES 900 OVERHEAD 0.0000 1.00 LS 0.01 0.00% 0.00 0.00% 0.00 0.00% 0.00 0.0 0.00 Total 154,800.02 13,574.56 49,726.64 63,301.20 6,330.12 Application Total 154,800.02 13.574.56 49,726.64 63,301.20 6,330.12 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 HIS Constructors, LLC Purchase Order No. 5150 East 65th Street Suite B Terms Indianapolis, IN 46220 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 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. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 HIS Constructors, LLC IN SUM OF 5150 East 65th Street Suite B Indianapolis, IN 46220 $44,753.98 ON ACCOUNT OF APPROPRIATION FOR Department of Engineering 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 25806 2 2114462300 $44,753.98 which charge is made were ordered and received except 20 Sigr1ature C�tv one �v�t.s�r' Title Cost distribution ledger classification if claim paid motor vehicle highway fund