211774 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 360766 Page 1 of 1
QJ� ONE CIVIC SQUARE HARVEY CONSTRUCTION CO CHECK AMOUNT: $44,684.20
CARMEL, INDIANA 46032 9125 E 146TH ST
NOBLESVILLE IN 46060 CHECK NUMBER: 211774
CHECK DATE: 8/14/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 2 44 , 684 . 20 OTHER EXPENSES
% AND CERTIFICATE FOR PAYMENT
TO OWNER CITY OF CARMEL/ENGINEER PROJECT CONTRACT 112- CARMEL WAAPPLICATION NO: 2
CUST# CARMEL One Civic Square
Clerk Treasurer
Carmel IN 46032 VIA ARCHITECT DLZ INDIANA. LLC PERIOD TO: 06/29/2012
FROM CONTRACTOR Harvev Construction PROJECT NO DISTRIBUTION TO:
9125 E. 146th Street �� I F 1 OWNER
F 1 ARCHITECT
Noblesville, IN 46060 I �{ F ] CONTRACTOR
F 1
CONTRACT FOR CONTRACT 112 -CARMEL WA JOB# 12-1274 CONTRACT DATE : 03/21/2012 F 1
C O N T R A C T O R'S APPLICATION FOR PAYMENT Application is made for payment,as shown below,in connection with the
*** CHANGE ORDERS *** contract. A Continuation sheet is attached.
PLEASE SEE THE ATTACHED CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM ................. $ 242,580.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the 2. NET CHANGE BY CHANGE ORDERS........ $ 0.00
Work covered by this Application for Payment has been completed in accordance with the Contract Documents, ----------------------------
that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were 3. CONTRACT SUM TO DATE........ $ 242,580.00
issued and payments received from the Owner,and that current payment shown herein is now due.
4. TOTAL COMPLETED&STORED TO DATE.... $ 221,376.00
CONTRAC OR: Harvey Constru tion 5. RETAINAGE:
a. 5.00 %of Completed Work $ 11,068.80
///��� �O �i b. 00 % of Stored Material $
By: Date. 29_� 0.00
-- — / /
r, TOTAL RETAINAGE............................... $ 11,068.80
State of. Qh, 44,k.. unty of 41k Q Y)I.C.Q4[)l
6. TOTAL EARNED LESS RETAINAGE....... $ 210,307.20
Subscribed and sworn to before riie this day of
7. LESS PREY CERTIFICATES FOR PAYMENT.... $ 165,623.00
Notary Public:
8. CURRENT PAYMENT DUE.................. $ 44,684.20
My Commission ires: �l�ZD2
9. BALANCE TO FINISH, PLUS RETAINAGE $ 32,272.80
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED..........................................................
In accordance with the Contract Documents,based on on-site observations and the data comprising of the (Attach explanation if amount certified -----------------------------
above application,the Architect certifies to the Owner that to the best of the Architect's knowledge, differs from the amount applied for.)
information and belief the Work has progressed as indicated,the quality of the Work is in accordance ARCHITECT: DLZ INDIANA, LLC
with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. By: Date
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 rights of the Owner or Contractor under this Contract.
*** BILLING WORKSHEET. NOT INTENDED TO REPLACE AIA DOCUMENT G702 **�
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
360766
HARVEY CONSTRUCTION CO Purchase Order No.
9125 EAST 146TH STREET Terms
NOBLESVILLE, IN 46060 Due Date 8/9/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/9/2012 2 $44,684.20
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
Date fficer
VOUCHER # 121825 WARRANT # ALLOWED
360766 IN SUM OF $
HARVEY CONSTRUCTION CO
9125 EAST 146TH STREET
NOBLESVILLE, IN 46060
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
2 06-1052-07 $44,684.20
Availability
Voucher Total $44,684.20
Cost distribution ledger classification if
claim paid under vehicle highway fund