HomeMy WebLinkAbout204413 12/06/2011 CITY OF CARMEL, INDIANA VENDOR: 363626 Page 1 of 1
ONE CIVIC SQUARE THIENEMAN CONSTRUCTION INC CHECK AMOUNT: $25,698.20
CARMEL, INDIANA 46032 3313 EAST 83RD PLACE
MERRILLVILLE RI 46410 CHECK NUMBER: 204413
CHECK DATE: 12/612011
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
659 5023990 25 25,698.20 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: 25 DISTRIBUTION
760 3rd Avenue SW 9609 Hazeldell Pkwy TO:
Suite 110 Carmel, IN 46032 PERIOD TO: 9126/2011 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 WWO92829 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, AIAType 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 304,416.18 CONTRACTOR: hie an Construction, Inc.
31 ast 83rd Place Merrillville, IN 46410
3. CONTRACT SUM TO DATE (Line 1 2)........... 5,150,083.82
4. TOTAL COMPLETED AND STORED TO DATE 5,150,083.82 1
By: Date: 1 �cQ C rl
J /f I N /M
25,000.00 orris Project Manager \\01111
5. RETAINAGE: i,P.tt�?
a. 0.49 of Com leted Work State o
p s
County of: Hamilton
b. 0.00 of Stored Material 0.00 Subscribed and Sworn to before me this es��ni}� -Day of,) r. _20
Notary Public: �.r.nnq J y
Total retainage (Line 5a 5b) 25,040.00 LP rsrtg uor,,rr
u
My Commission Expires L45j (l,a
1 j�L7,1 tiTaIJa J:,'.. .P
6. TOTAL EARNED LESS RETAINAGE 5,125,083.82
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR
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 5,099,38562 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 25,698.20 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) 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 Continuation Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHIT:aiNge!; X S'/i✓ifr°�`5
previous months by Owner 11,122.00 341,23638 By: Date: /p
Total approved this Month 25,698.20 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 36,820.20 341,236.38 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 304,416.18
VOUCHER 116287 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
25 07- 1050 -75 $25,698 -20
Voucher Total $25,698.20
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 11/28/2011
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
11/28/201' 25 $25,698.20
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
Date O