207898 04/10/2012 CITY OF CARMEL, INDIANA VENDOR: 365624 Page 1 of 1
ONE CIVIC SQUARE HIS CONSTRUCTORS INC CHECK AMOUNT: $13,975.03
CARMEL, INDIANA 46032 5150 E 65TH STREET SUITE B
INDIANAPOLIS IN 46220 -4817 CHECK NUMBER: 207898
CHECK DATE: 4/10/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
211 R4462300 25806 6 13,975.03 WESTWOOD DRIVE BRIDGE
CONSTRUCTION PROJECT INVOICE
DATE: April 4, 2012
COMPANY NAME: HIS Constructors, LLC
AND ADDRESS 5150 East 65' Street, Suite B
Indianapolis, Indiana 46220
TELEPHONE NO.:
FAX NO.: (317)-284-1185
PROJECT NAME: Hamilton County Bridge 289.
Westwood Drive over Mitchner Ditch
PROJECT NO.: 11 -08
INVOICE NO.: 6 (Final Release Retainage)
TOTAL. EARNINGS TO DATE: 139,750.34
MINUS 10% RETAINAGE: 0.00
TOTAL. EARNED: 139,750.34
MINUS PREVIOUS PAYMENTS: 125,775.31
TOTAL AMOUNT DUE: 13,975.03
Ac7��
an Greska
Construction Manager
City of Carmel
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUM ENT G702 P AGE 1 OF 3 PAGES
TO: City of Carmel PROJECT: Carmel Bridge 289 APPLICATION NO: 6 Distribution to:
One Civic Square PERIOD TO: 01/31/12 OWNER
Carmel, IN 46032 PROJECT NOS: #11 -08 MENGINEER
PURCHASE ORDER: FCONTRACTOR
R OTHER
FROM: HIS Constructors, Inc VIA: INVOICE DATE:
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 (15,049.66)
By., -6 a z y ,�c- 1 Date: 2/9/2012
3. CONTRACT SUM TO DATE (Line 1 t 2) 139,750.34
4. TOTAL COMPLETED TO DATE ................I.............. 139,750.34 State of: Indiana
(Column J on G703) Countyot Marion
5. RETAINAGE:
a. 10 of Completed Work Subscribed and sworn to before
me this 9TH day of February, 2012
b. 0 of Stored Material Notary Public:
My Commission expjr 8/ 2/2012
Total Retainaste (Line 5a+ 5b) SUBCONTRACTORS CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 139,750.34 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
progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
(Line 6 from nor Certificate entitled to payment of the AMOUNT CERTIFIED.
(L' p' 125,775.31
8. CURRENT PAYMENT DUE 13,975.03
9. BALANCE TO FINISH 10. VARIANCE TO CONTRACT AMOUNT CERTIFIED I....... 13,975.03
(15,049.66) (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 15,049.66 By: Date:
Total approved this Month
TOTALS 15,049.66 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and
NET CHANGES b Chan a Order 15,049.66 acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract
AIA DOCUMENT G702- APPLICATION AND CERTIFICATE FOR PAYMENT -1992 EDITION- AIA® ®1992 THE AMERICAN INSTITl17E OF ARCHrrECTs, 1735 NEW YORK
AVENUE, N.W„ WASHINGTON, D.C. 20006 -5292 WARNING: unsolicited photocopying laws and will abject the violator to legal prosecution. 6702 -1992
'TMs document has boon reproduced ekclronlcally with the permission of The American Ina tme ofArcldlecls under License 970003 Primavera Systems, Inc- Reproduction of the doannentwilhoul projectapeclf c Inlormatan Isnotpennitted. Contact The American hwrilute of Archleas to vedy the current version of this domment and roense
status'
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Application and Certificate For Payment page 2
To Owner: CITY OF CARMEL Application No: 6 Date: 02/09/12 Period To: 01/31/12
From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025
Pr oject: CITY OF CARMEL BRIDGE 289 Architect's Project No:
Work Completed Work Completed Completed and Stored To Date
Previous Applicetlon This Period
Item Unit Contract Scheduled
Number Description Price Quantity UM Value Quantity Amount Quantity Amount Quantity Amount Retention Memo
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 0.00
RING
002 MOBILIZATION AND DEM 7,600.0000 1.00 LS 7,800.00 100.00% 7,800.00 0.00% 0.00 100.00% 7,800.00 100.0 0.00
OBILIZATION
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 0.00
004 TEMPORARY IN-STREAM SILT 1,000.0000 .00 LSU 0.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00
BASIN
005 EXCAVATION COMMON 55.0000 138.00 CYS 7,590.00 138.00 7,590.00 .00 0.00 138.00 7,590.00 100.0 0.00
006 EXCAVATION WATERWAY 45.0000 .00 CYS 0.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00
007 EXCAVATION FOUNDATION 35.0000 52.00 CYS 1,820.00 52.00 1,820.00 .00 0.00 52.00 1,820.00 100.0 0.00
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 25.09 1,756.30 .00 0.00 25.09 1,756.30 100.0 0.00
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 0.00
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 0.00
012 HMA INTERMEDIATE TYPE A 106.0000 59.61 TON 6,318.66 59.61 6,318.66 .00 0.00 59.61 6,318.66 100.0 0.00
013 HMA BASE TYPE A 88.0000 65.96 TON 5,804.48 65.96 5,804.48 .00 0.00 65.96 5,804.48 100.0 0.00
014 BENCHMARK 500.0000 1.00 EAC 500.00 1.00 500.00 .00 0.00 1.00 500.00 100.0 0.00
015 BURIED TIMBER GUARDR AIL 1,300.0000 4.00 EAC 5,200.00 4.00 5,200.00 .00 0.00 4.00 5,200.00 100.0 0.00
END SECTION INS
018 TIMBER GUARDRAIL IN STALL 41.0000 96.00 LIFT 3,936.00 98.00 3,936.00 .00 0.00 98.00 3,938.00 100.0 0.00
ONLY
017 TIMBER BRIDGE RAIL INSTALL 48.0000 84.00 LFT 4,032.00 84.00 4,032.00 .00 0.00 84.00 4,032.00 100.0 0.00
ONLY
018 GEOTEXTILES 2.5000 72.00 SYS 180.00 72.00 180.00 .DO 0.00 72.00 180.00 100.0 0.00
019 RIPRAP CLASS 1 24 DEPTH 35.0000 21.02 TON 735.70 21.02 735.70 .00 0.00 21.02 735.70 100.0 0.00
020 SEED MIXTURE R 47.0000 42.50 LBS 1,997.50 42.50 1,997.50 .00 0.00 42.50 1,997.50 100.0 0.00
021 FERTILIZER 2,100.0000 .05 TON 105.00 .05 105.00 .00 0.00 .05 105.00 100.0 0.00
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 3,200.00 800.00 3,200.00 .OD 0.00 800.00 3,200.00 100.0 0.00
NTROLBLANKET
024 MOBILIZATION AND DEM 265.0000 1.00 EAC 265.00 1.00 265.00 .00 0.00 1.00 265.00 100.0 0.00
OBILIZATION FOR SEED
025 END BENT DRAIN PIPE 6 13.0000 75.00 LFT 975.00 75.00 975.00 .00 0.00 75.00 975.00 100.0 0.00
f DIAMETER
025 SAW CUT JOINT 13.0000 40.00 LFT 520.00 40.00 520.00 .00 0.00 40.00 520.00 100.0 0.00
027 PILING STEEL H PILES HP 65.0000 312.00 LFT 20,280.00 312.00 20,280.00 .00 0.00 312.00 20,280.00 100.0 0.00
12X53
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4
Application and Certificate For Payment page 3
To Owner: CITY OF CARMEL Application No: 6 Date: 02/09/12 Period To: 01/31112
From (Contractor): HIS CONSTRUCTORS, INC. Contractor's Job Number: 110025
Projec CITY OF CARMEL BRIDGE 289 Architect's Project No:
Work Completed Work Completed Completed and Stored To Date
Previous Applicatlon 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 4140.00 LBS 4,968.00 4140.00 4,968.00 .00 0.00 4140.00 4,968.00 100.0 0.00
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 0.00
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 0.00
WATERPROOFING
031 WS 17 X 4'-0 CONCR ETE 7.0000 924.00 SFT 6,468.00 924.00 6,468.00 .00 0.00 924.00 6,468.00 100.0 0.00
BOX BEAMS INSTA
032 SURFACE SEAL 1,150.0000 1.00 LS 1,150.00 100.00% 1,150.00 0.00% 0.00 100.00% 1,150.00 100.0 0.00
033 FIELD TILE UNDISTRIBUTED 15.0000 .00 LFT 0.00 .00 0.00 .00 0.00 .00 0.00 0.0 0.00
034 CONSTRUCTION SIGN TYPE 130.0000 8.00 EAC 1,040.00 8.00 1,040.00 .00 0.00 8.00 1,040.00 100.0 0.00
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 0.00
B
036 STANDARD BARRICADE TYPE 13.0000 48.00 LFT 624.00 48.00 624.00 .00 0.00 48.00 624.00 100.0 0.00
IIIA
037 STANDARD BARRICADE TYPE 14.0000 48.00 LFT 672.00 48.00 672.00 .00 0.00 48.00 672.00 100.0 0.00
1118
038 DETOUR ROUTE MARKER 140.0000 7,00 EAC 980.00 7.00 980.00 .00 0.00 7.00 980.00 100.0 0.00
ASSEMBLY
039 ROAD CLOSURE SIGN AS 160.0000 4.00 EAC 640.00 4.00 640.00 .00 0.00 4.00 640.00 100.0 0.00
SEMBLY
040 EWA2 GPR UTILITY LOC 880.0000 1.00 LS 880.00 100.00 880.00 0.00% 0.00 100.00% 880.00 100.0 0.00
041 EWA3 END BENT RR 5,676.5800 1.00 LS 5,676.58 100.00% 5,676.58 0.00% 0.00 100.00% 5,676.58 100.0 0.00
042 EWA4 ANCHOR BOLTS 673.5500 1.00 LS 673.55 100.00% 673.55 0.00% 0.00 100.00% 673.55 100.0 0.00
043 EWAS TIMBER RAIL 793.0700 1.00 LS 793.07 100.00% 793.07 0.00% 0.00 100.00% 793.07 100.0 0.00
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 139,750.26 139,750.24 0.00 139,750.24 0.00
Application Total 139,750.26 139,750.24 0.00 139,750.24 0.00
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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 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
Date Number (or note attached invoice(s) or bill(s) Amount
4/4/2012 6 (Final) 11 -08; Westwood Drive over Mitchner Ditch 13,975.03
Total 13,975.03
1 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.
HIS Constructors, LLC ALLOWED 20
IN SUM OF
5150 East 65th Street, Suite B
Indianapolis, IN 46220
13,975.03
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
DEPT#
25806 6 (Final) 211- R4462300 13975.03 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
4/9/2012
Signature
City Engineer
Cost Distribution ledger classification if claim paid motor Title
vehicle highway fund