173927 06/24/2009 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1
ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC
CHECK AMOUNT: $13,685.00
CARMEL, INDIANA 46032 PO BOX 2533
ANDERSON IN 46018 CHECK NUMBER: 173927
CHECK DATE: 6/24/2009
Q EPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 W08744 09- 172.01 3,000.00 VALVES
659 5023990 18 10,685.00 OTHER EXPENSES
I
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G,702 (Instructions on rever side) PAcE o,:E OF P\GES
TO io�VNER): City of Carmel PROJECT: Blower /Electrical Modification APPLICATION NO: Eighteen Distribution to:
One C -i.Vic SgHare Contract 60 (18)E OWNER
Carmel, IN 46032 PERIOD TO: 05 -22 -09 C ARCHITECT
CONTRACTOR
FROM tCONTR.ACTORI: VIA (ARCHITECT): ARCHITECT'S
M. K. Betts Engineering PROJECT NO: C
Contracting, Inc.
CONTRACT FOR: Invoice No. 07- 262.18 CONTRACT DATE;
CONTRACTOR'S APPLICATION FOR PAYMENT
Applicat i n Sh et,tAIA Doct,menl G703nisalt[a lh ln ri connection with the Contract.
CHANCE ORDER SU,'0AARY 1. ORIGINAL CONTRACT SUM 2, 000.00
Change Orders approved in I ADDITIONS DEDUCTIONS 2. Net change by Change Orders 337,584.58
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) 2 ,686,584.58
TOTAL 4. TOTAL COMPLETED STORED TO DATE Z 686 584.58
Approved this Mon (Column G on G703)
N umber D ate Approved 5. RETAINAGE,
a. of Completer) Work
COlkl $302,815.00 7,610.00 (Column D +E on G703)
CG#2 67,282.00 $18,140.00 b. "ro of Stored Material
CO#3 I 10,685.00 $17,447.42 (Column F on G703)
Total Retainage (Line 5a 5b or 132 210.25
TOTALS $380,782.00 $43 187.42 Total in Column I of G703) 2,554,374.33
Net chan by Change Order $337,584.58 6. TOTAL EARNED LESS RETAINAGE
The undersigned Contractor certifies that to the best of the Contractor's knowledge, .(Line 4 less Line 5 Total)
iniorrnation and belief the Work covered by this Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR
completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 from prior Certifica(e)......... 5 2,543,689.33
paid by the Contractor for Work ror which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 10,685.
issued and payments received rrom the Owner, and that current payment shown 9. BALANCE TO FINISH, PLUS RETAINAGE ____132,210.26
herein is now due. (Line 3 less Line 6)
CONTRACTOR: M. K. Betts Engineering Contracting, Inc. State of: Indiana County of; Hadison
Subscribed and sworn to before me this 22nd day of May 2009
Notary Public: O��Lw c�C�
Bv: Date; May 22, 2009 My C ommission expires; October 28 2015
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED ro b
(Attach explanation if amount certified ied diiie n i rom t he arnount applied ior.r
In accordance with the Contract Documents, based on on -site observations and the ARCHITECT:
data comprising the above application, the Architect certifies to the Owner that to the
best or the Architect's knowledge, information and belief the Work has progressed as Bv; Date: sL
indicated, the quality or the Work is in accordance with the Contract Documents, and This Certificate is nonnegotiable. The Ah10UNT CERTIFIED is payable only to the
the Contractor is entitled to payment or the Ah10UNT CERTIFIED. Contractcr named herein. Issuance, payment and acceptance of payrnenr are withow
prejudice ro any rights of the Owner or Conrractor under this Contract.
f�
AIA oUtUntENT G7tr2 .I C.:, ^1D CLRIIFIC"II. PQk PAl',IE`:I mA1 ive; EDITIDr •.;IA' 190.t
tPiF ',.i1Gll <nri.lr ;.r .R- tirPiT� i 'f�• YiRF. v'•.i >_I:i .;ic:C,Tiir: iii iuip. (7112- 1`-iti.l
,a
r x3
Pre by State Board of Accounts ACCOUNTS PAYABLE VOUCHER
Form No. 301 -S (Rev. 1995)
TO
ADDRESS
Invoice Date Invoice Number Item Amount
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
1 19
Signature Title
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.
19
Office Title
Vitucher No. Warrant No.
r
ACCOUNTS PAYABLE DETAILED ACCOUNTS
L SANITATION DEPARTMENT ACCT.
CARMEL, INDIANA NO.
My- Re H5 5 Favor Of
Total Amount of Voucher
Deductions
..l Aso G i
Amount of Warrant
Month of 19
Acct.
VOUCHER RECORD No.
Collection System
Operation
Plant
Ca h.
Commercial
General
Undistributed
r
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1- 800- 382 -8702 325
INVOICE
Area Code: 765
Telephone: 649 -1294 M. K. Betts P.O. Box 2533
Engineering Contracting, Inc.
ANDERSON, INDIANA 46018
June 11, 2009
Invoice No. 09- 172.01
IN ACCOUNT WITH PROJECT:
City of Carmel Butterfly Valve Installation
3450 W. 131st. Street Plant 5
Westfield, IN 46074
Attn: Rob Lovell
Terms: Net 20 days
Labor and equipment to remove two (2) existing
eighteen (18) inch butterfly valves in the
existing valve pit and install two (2) new
butterfly valves. Owner to furnish new valves,
remove existing actuators and reinstall actuators.
M. K. Betts Eng. Cont., Inc. will furnish new
bolts and nuts and install actuator plates on top o
valves. $3,000 00
Total Amount Due This Invoice $3,000 00
Paid r -i Cp q 7 :•,02
lw.
CLAIMS, IF ANY, MUST BE MADE IMMEDIATELY
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.
f
Payee
351429
M.K. BETTS ENGINEERING CONTRACTING Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 6/15/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/15/2009 09- 172.01 $3,000.00
I hereby certify that the attached invoice(s), or bill(s) is (are) true and n
correct and I have audited same in accordance with IC 5- 11- 10 -1.6
5, VL
Date Officer
VOUQ.J -IER 092069 WARRANT ALLOWED
d"
351429 IN SUM OF
M'.K. BETTS ENGINEERING& CONTRA
P O. Box.2533
A derson, IN 46018 U)
J O
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
09- 172.01 01- 6360 -04 $3,000.00
Voucher Total $3,000.00
Cost distribution ledger classification if
claim paid under vehicle highway fund