HomeMy WebLinkAbout213604 10/09/2012 CITY OF CARMEL, INDIANA VENDOR: 366289 Page 1 of 1
ONE CIVIC SQUARE P K S CONSTRUCTIONS INC
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CARMEL, INDIANA 46032 450 S BITTER AVE SUITE A CHECK AMOUNT: $5,600.00
INDIANAPOLIS IN 46219 CHECK NUMBER: 213604
CHECK DATE: 10/9/2012
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 26495 P1270 5, 600 . 00 PAINT RECEPTION DESK
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE I OF 2 PAGES
TO OWNER: CITY OF CARMEL PROJECT: PAINTING RECEPTION DESK L JOB NUMBER: P1270 Distribution to:
ONE CIVIC SQUARE APPLICATION NO: 01 ❑ OWNER
CARMEL, IN 46032 �O LJ/ []PERIOD TO: 09/30/2012 E] ARCHITECT
ATTN: JEFF BARNES L �'� CONTRACTOR
FROM CONTRACTOR: PKS CONSTRUCTION INCORPORATED VIA ARCHITECT: Z �o `} ARCHITECT'S
450 S. RITTER AVENUE STE A (�� PROJECTNO: 26495
INDIANAPOLIS, IN 46219
CONTRACT DATE:
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment,as shown below, in connection with the Contract.
Continuation Sheet,AIA Document G703, is attached.
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS I. ORIGINAL CONTRACT SUM. . . . . . . . . . . . . . . . . .$ 5,600.00
Changes approved in
previous months by Owner 2. Net change by Change Orders . . . . . . . . . . . . . . . $ 0.00
3. CONTRACT SUM TO DATE (Line 1 +/-2). . . . . . . . $ 5,600.00
Approved this Month 4. TOTAL COMPLETED&S'rORED TO DATE . . . . .$ 5,600.00
Number Date Approved (Column G on G703)
5. RETAINAGE:
a. 0.000 %of Completed Work $ 0.00
(Columns D+E on G703)
b. o.000 %of Stored Material $ 0.00
TOTALS 0.00 1 0.00 (Columns F on G703)
NET CHANGES by Change Order 0.00 Total Retainage(Line 5a+5b or
Total in Column I of G703) . . . . . . . . . . . . . . . . . . . .$ 0.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge, 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . $ 5,600.00
information and belief the Work covered by this Application for Payment has been (Line 4 less Line 5 Total)
completed in accordance with the Contract Documents,that all amounts have been 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT
paid by the Contractor for Work for which previous Certificates for Payment were
issued and payments received for the Owner,and that current payment shown here- (Line 6 from prior Certificate) . . . . . . . . . . . . . . . . . . . $ 00
in is now due. 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . $ 5,600.00
CONTRAC OR: P S CO RUCTION INCORPORATED 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ ..00•
(Line 3 less Line 6)
B Date: O
ARCHITECT'S CERTIFICATE FOR PAYMENT State of. IN County of: MARION
Subscribed and sworn to before me this la day of SEPT ER 2012
In accordance with the Contract Documents, based on on-site observations and the I
data comprising this application,theArchitect certifies to the Owner that to the best Notary Public:"LU-4 My commission expires:
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, ARCHITECT:
and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
n By: Date:
AMOUNT CERTIFIED. . . . . . . . . . . . . . . . . . . . . . . . .$ Q ►-] This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Con-
(Attach explanation if amount certified d ffers from the am applied for.) tractor named herein. Issuance,payment and acceptance of payment without prejudice to
Q c T U 8 2012 any rights of the Owner or Contractor under this Contract.
By
VOUCHER NO. WARRANT NO.
ALLOWED 20
PKS Construction, Inc
IN SUM OF $
450 South Ritter Ave., Suite A
Indianapolis, IN 46219
$5,600.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26495 P1270 43-501.00 $5,600.00 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
Monday, October 08, 2012
Director, Administration
Title
Cost distribution ledger classification if
claim paid motor 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s)or bill(s))
09/30/12 P1270 $5,600.00
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