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Home My WebLink About205872 01/31/2012 CITY OF CARMEL, INDIANA VENDOR: 365624 Page 1 of 1 ONE CIVIC SQUARE HIS CONSTRUCTORS INC CARMEL, INDIANA 46032 5150 E 65TH STREET SUITE B CHECK AMOUNT: $8,912.25 INDIANAPOLIS IN 46220 -4817 CHECK NUMBER: 205872 CHECK DATE: 1/31/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 R4462300 25806 4 8,912.25 WESTWOOD DRIVE BRIDGE CONSTRUCTION PROJECT INVOICE DATE: January 23, 2012 COMPANY NAME: HIS Constructors, LLC AND ADDRESS 5150 East 65`' Street, Suite B Indianapolis, Indiana 46220 TELEPHONE NO.: (317)-284-1195 w FAX NO.: (317)-284-1185 PROJECT NAME: Hamilton County Bridge 289 Westwood Drive over Mitchner Ditch PROJECT NO.: 11 -08 INVOICE NO.: 4 TOTAL EARNINGS TO DATE: 131,727.04 MINUS 10% RETAINAGE: O 13,172.70 TOTAL EARNED MINUS RETAINAGE: 118,554.34 MINUS PREVIOUS PAYMENTS: 109,642.09 TOTAL AMOUNT DUE: 8,912.25 aL Dan Greska p Construction Manager City of Carmel APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 3 PA TO: City of Carmel PROJECT: Carmel Bridge 289 APPLICATION NO: 4 Distribution to: One Civic Square PERIOD TO: 11/30/11 FJOWNER Carmel, IN 46032 PROJECT NOS: #11 -08 J1 ENGINEER PURCHASE ORDER: n CONTRACTOR OTHER FROM: HIS Constructors, Inc VIA: INVOICE DATE: x f2lTJ201'1 5150 E. 65th Street, Suite B Indianapolis, IN 46220 CONTRACT DATE: 8/3/2011 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 been Application is made for payment, as shown below, in connection with the contract paid by the Contractor for Work for which previous Certificates were issued and payments received from the Owner, and that Continuation Sheet, AIA Document G702, is attached. current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 154,800.00 SUBCONTRACTOR: HIS Constructors, Inc 2- Net change by Change Orders (21,152.96) By: Date: 1/20/2012 3. CONTRACT SUM TO DATE (Line 1 t 2) 133,647.04 State of Indiana 4. TOTAL COMPLETED TO DATE 131,727.04 (Column J on G703) minty of Marion 5. RETAINAGE: a. 10 of Completed Work 13,172.70 Subscribed and sworn to before me this 20th day of January, 2012 b. 0 of Stored Material Notary Public: My Commission a s: 8122120 Total Retainape (Line 5a 5b) 13.1.72.70 SUBCONTRACTORS CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 118,554.34 In accordance with the Contract Documents, based on on -site observations and the data comprising this application, (Line 4 less Line 5 Total) the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is (Line 6 from prior Certificate) 109,642.09 entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE 8,912.25 j 9. BALANCE TO FINISH 10. VARIANCE TO CONTRACT AMOUNT CERTIFIED 8,912.25 15, 092.70 21,152.96 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Application and i on the Continuation Sheet that are changed to conform to the amount certified.) 1 i CHANGE ORDER BY SUMMARY ADDITIONS DEDUCTIONS OWNER: CITY OF CARMEL Total changes approved in previous months by Owner (21,152,96) By: Date: Total approved this Month TOTALS 21,152.96 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and NET CHANGES by Change Order (21152961 acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contrad. AIA DOCUMENT 0702 APPLICATION AND CEMIFICATE FOR PAYMENT -1992 EDRION -ILA®- 01992- THE AMERICAN NSTITUTE OF ARCHITECTS, 1733 NEW YORK 1 AVENUE, N.W., WASHINGTON, D.C. 20006 -6292 WARNNOt G702 -1992 •Thb document has been reproduced electroulmilyvft the permicalm cf The Amedcen Ytstlhde of ArcNteda under Lherse 970003 Pftmv a Systems, brc. Reproduction of "is deaummR v,4hout poje,*Wci6e Wennstlon le rot pemdtted. Contact The American institute of AreMects to wMy the cummt "chin of it& document end kense stah9. Application and Certificate For Payment page 2 To Owner: CITY OF CARMEL Application No: 4 Date: 12/31111 Period To: 12/31/11 From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025 Project: CITY OF CARMEL BRID 289 Architect's Project No: Work Completed Work Completed Completed and Stored To Date Item Unit Contract Scheduled Previous Application This Period N umber Description Price Quantity UM Value Quantity Amount Quantity mount ty Quantity Amount Retention M emo 01 001 CONSTRUCTION ENGINEE 2,400.0000 1.00 LS 2,400.00 100.00% 2,400.00 0.00% 0.00 100.00% 2,400.00 100.0 240.00 RING 002 MOBILIZATION AND DEM 7,800.0000 1.00 LS 7,800.00 100.00% 7,800.00 0.00% 0.00 100.00% 7,800.00 100.0 780.00 OBILIZAMON 003 CLEARING RIGHT OF WAY 5,718.2000 1.00 LS 5,718.20 100.00% 5,718.20 0.00% 0.00 100.00 5,718.20 100.0 571,82 004 TEMPORARY IN-STREAM SILT 1,000.0000 .00 LSU 0.00 .35 350.00 -.35 350.00 .00 0.00 0.0 0.00 BASIN 005 EXCAVATION COMMON 55.0000 138.00 CYS 7,590.00 83.00 4,565,00 55.00 3,025.00' 136.00 7,590.00 100.0 759.00 006 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 52-00 1,820.00 52.00 1,820.00 100.0 18200 UNCLASSIFIED 008 TEMPORARY SILT FENCE 2.7500 .00 LFT 0.00 .00 0.00 .00 0.00 .00 0.00 0,0 0.00 UNDISTRIBUTED 009 AGGREGATE FOR END BE NT 70.0000 25.09 CYS 1,756.30 22.60 1,582.00 2.49 174.30 25.09 1,756.30 100.0 175.63 BACKFILL 010 COMPACTED AGGREGATE 53 30.0000 181.71 TON 5,451.30 .181.71 5,451.30 .00 0.00 181.71 5,451.30 100.0 545.13 BASE 011 HMA SURFACE TYPE A 119.0000 32.10 TON 3,819.90 32.10 3,819.90 .00 0.00 32.10 3,819.90 100.0 381.99 012 HMA INTERMEDIATE TYPE A 106.0000 59.61 TON 6,318.66 59.61 8,318.66 .00 0.00 59.61 6,318.66 100.0 631.87 013 HMA BASE TYPE A 88.0000 65.98 TON 5,804.48 65.98 5,804,48 .00 0.00 85.96 5,804.48 100.0 580.45 014 BENCHMARK 500.0000 1.00 EAC 500.00 1.00 600.00 .00 0.00 1.00 500.00 100.0 50.00 015 BURIED TIMBER GUARDRAIL 1,300.0000 4.00 EAC 5,200.00 4.00 5,200.00 .00 0.00 4.00 5,200.00 100.0 520.00 END SECTION INS 016 TIMBER GUARDRAIL INSTALL 41.0000 96.00 LFT 3,938.00 96.00 3,936.00 .00 0.00 96.00 3,936.00 100.0 393,80 ONLY 017 TIMBER BRIDGE RAIL INSTALL 48.0000 84.00 LFT 4,03200 84.00 4,032.00 .00 0.00 84.00 4,032.00 100.0 40320 ONLY 016 GEOTEXTILES 2.5000 390.00 SYS 875,00 .00 0.00 72.00 180.00 72.00 180.00 18.5 18.0D 019 RIPRAP CLASS 1 24 DEPTH 35.0000 21,02 TON 735.70 61.00 2,136.00 39.98 1,399.30 21.02 735.70 100.0 7357 020 SEED MIXTURE R 47.0000 42.50 LBS 1,997.50 .00 0.00 42.50 1,997.50 42.50 1,997.50 100.0 199.75 021 FERTILIZER 2,100.0000 .05 TON 105.00 .00 0.00 .05 105.00 .05 105.00 100.0 10.50 022 MULCHED SEEDING T 3.0000 .00 SYS 0.00 .00 0.00 .00 0,00 .00 0.00 0,0 0.00 UNDISTRIBUTED 023 TEMPORARY EROSION CO 4.0000 800.00 SYS 3,200.00 .00 0.00 800.00 3,200.00 800.00 3,200.00 100.0 320.00 NTROL BLANKET 024 MOBILIZATION AND DEM 265.0000 1.00 EAC 265.00 1.00 265.00 .00 0.00 1.00 265.00 100.0 26.50 OBILIZATION FOR SEED 025 END BENT DRAIN PIPE 6 13.0000 75.00 LIFT 975.00 75.00 975.00 .00 0.00. 75.00 975.00 100.0 97.50 DIAMETER 026 SAW CUT JOINT 13.0000 40.00 LFT 520.00 40.00 520.00 .00 0.00 40.00 520.00 100.0 52.00 I 027 PILING STEEL H PILES HP 65.0000 312.00 LFT 20,280.00 312.00 20,280.00 .00 0 312.00 20,280.00 100.0 2,028.00 12X53 i Application and Certificate For Payment page 3 To Owner: CITY OF CARMEL Application No: 4 Date: 12/31/11 Period To: 12/31/11 From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025 Project: CITY OF CARMEL BRID 289 Architect's Project No: Work Completed Work Completed Completed and Stored To Date Previous Appilcatlon Thls Period I[em Unit Contract Scheduled Number Description Price Quantity UM Value Quantity Amount Quantity Amount Quantity Amount Retention Memo 028 EPDXY COATED REINFOR 12000 4140.00 LBS 4,968.00 4140.00 4,968.00 .00 0.00 4140.00 4,968.00 100.0 496.80 CING STEEL 029 CONCRETE A SUBSTRU 950.0000 21.20 CYS 20,140.00 21.20 20,140.00 .00 0.00 21.20 20,140.00 100.0 2,014.00 CTURE 030 STRUCTURAL MEMBRANE 30.0000 150.00 SYS 4,500.00 150.00 4,500.00 .00 0.00 150.00 4,500.00 100.0 450.00 WATERPROOFING 031 WS 17 X4'-0 CONCRETE 7.0000 924.00 SFT 6,468.00 924.00 6,468.00 .00 0.00 924.00 6,469.00 100.0 646.80 BOX BEAMS INSTA 032 SURFACE SEAL 1,150.0000 1.00 LS 1,150.00 0.00% 0.00 100.00% 1,150.00 100.00% 1,150.00 100.0 115.00 i 033 FIELD TILE UNDISTRI BUTED 15.0000 .00 LFT 0.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00 034 CONSTRUCTION SIGN T YPE 130.0000 8.00 EAC 1,040.00 8.00 1,040.00 .00 0.00 8.00 1,040.00 100.0 104.00 A 035 CONSTRUCTION SIGN TYPE 70.0000 2.00 EAC 140.00 2.00 140.00 .00 0.00 2.00 140.00 100.0 14.00 B 036 STANDARD BARRICADE TYPE 13.0000 40.00 LFT 624.00 48.00 624.00 .00 0.00 48.00 624.00 100.0 62.40 IIIA 037 STANDARD BARRICADE TYPE 14.0000 48.00 LFT 672.00 48.00 672.00 .00 0.00 48.00 67200 100.0 67.20 IIIB 038 DETOUR ROUTE MARKER 140.0000 7.00 EAC 960.00 7.00 980.00 .00 0.00 7.00 980.00 100.0 98.00 ASSEMBLY D39 ROAD CLOSURE SIGN AS 160.0000 4.00 EAC 640.00 4.00 640.00 .00 0.00 4.00 640.00 100.0 63.99 SEMBLY Boo 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 133,647.08 121,824.54 9,902.50 131,727.04 13,172.70 Application Total 133,647.06 121,824.54 9,902.50 131,727.04 13,172.70 f 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)) 0112311-2-- 4 ed BF eveF Mitchner D Construction $8,912.25 Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in acodfdance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 HIS Constructors, IN SUM OF 5150 East 65th Street Suite B Indianapolis, IN 46220 $8,9 12.25 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 4 211 -"62300 $8,912.25 which charge is made were ordered and received except 20 Jdr Signature ct e Title Cost distribution ledger classification if claim paid motor vehicle highway fund