HomeMy WebLinkAbout216110 01/09/2013 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1
ONE CIVIC SQUARE M.K.BETTS ENGINEERING INC
CARMEL, INDIANA 46032 Po BOX 2533 CHECK AMOUNT: $43,783.95
ANDERSON IN 46018 CHECK NUMBER: 216110
CHECK DATE: 1/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
609 5023990 9 43 , 783 . 95 1052 . 01
APPLICATION AND CERI MICAYE FOR PAYMENT AAA D(_ -UNIENl '(,'I2 iinsiructions on reverse sides P. CtorrFOl r.c;Es
Ti=, ;O1nJNFRI Citv of Carmel Wells 27 & 28 C APPLIGVIION NO: Nine (9) Distribution to:
One Civic Square Contract 77 Retainage E OWNER
Carmel, IN 46032 PERIOD l"O: 11/30/12 (' AK(=FiITECI
C0NI RACI'C?R
ERi)r.t Ii:iaiJlK.'�C1GRI: VIA I,ARCHILEGT-1 ARCHI-SECTS C
M. K. Betts Engineering PROJECT NCB: C
& Contracting, Inc.
(lh'� Invoice No. 12-122.09 Retaina e CONTR.-\CT DATE:
(__'O TRAl l OR'' AI� 1�I_�l_,A ION FOR 1-AI MENT cOnllif-Mal ,l,511cet,lAIA Documen C,t7�3, is a►(ta(hcdcunnl'ctlun �tillll, Ike. t_.(�nlydr:l.
^-- � ----------- -_--^— 844 162,00
--------- --- -
CI1,=.NGF C?RI:,ER 51.1P.tf'L,.R1" I. ORIGINAL CONTRACT SUM . . . . . . . . . . 5 --L - --
------
-- -` - - 31 517 00
Ch,,ngc l_)rders appi-n"'ed in ;DC)Iflt',NS DLDIJCfIi:,NS _'. Net change by Change Orders . . . . . . . . . . . . . . . . . . $ --._-_.—__--
prcvluus months by t",wncr 3. CONTRACT sUh1 TO DATE (Line I -?) . . . . . . . . . . . . . . $ 875 ,679 .00 __-
_ 1C,TAL 4. TOTAL COMPLETED & STORED TO DATE _ . . . . . . . . . $ 875_,679_OQ---
,Ap1)10'�rd this r,lc;nth — - — (Column G on 6703j
[dumb er DL,te ,Appruvcd�
5. RETAINAGE:
a. _—_ r6 of Completed VVurk $ _C0#1 + $165 ,985 .00 -0- (Column D+E on (;703)
F'D#3-FD 7 -I- $ 4,482 .00 -0- b. — % of Stored Material $ _
FD#8 -0- - $138 ,950.00� lColl.unn F un G7031
Total Ketainage (Line 5a -I-5b or
T,-,l-S + $170,467 .00—L -_$138,950.00 ~ Total in Column I of 6703) . . . . . . . . . . . . . . . . . . . . $ -0- ----
-- _ --i - -- —� 875 679 .00
Icl 1_h.Illz e h; t hatliv !)rdcn + $ 31 ,517 .00 h. TC7TAL EARNED LESS RETAINAGE $
Ih� undtei.igned Contratcr cenlfles that to the hest of the Contractor's knowledge, (Line -1 less Line 5 Tolah
utrl.,nnalil,rl and belief the l'Vork t:o,ercd by tills ,Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR
ct,ntpl�t d In acl.r,fi.lanl.,' h the t ,1n[r,tt.t Doc-uments, that all antut.tnts have heen PAYMENT (.Line (, frurn prior Certifica(e) . . . . . . . S831 895.05
I;Llld b"' tllr. ( n[13i for rt_lr I,Vc:,lk Fur ',vhlCII previous Celuhcales for Payment were B. CURRENT PAYMENT DUE . . . . . . . . . . . . . 43,783.95
I_,u,_d and pc".rnents feces' erl rrr,n, the C),.`rncr, and that current payrn nt shc,wll 9. BALANCE TO FINISH, PLUS RETAINAGE . . 5 _---0 -------
h�fcUi i� Il,-,,.`, due. (Lineij less Line 6)
fl '.t='T' R: M . R. Bens Etig:inaering u (;untracting, Inc. 5tateof: Indiana Countyut: Madison
Subscribed and sworn to before me t�illls� 330th flay or Nov. 2012
Notary PubliC:` 1.11'
N`;': _� _ Date: November 30, 2012 illy Commission expires: October '!8 21115
ARCI-11TECT 'S CERTIFICATE FOR PAYMENT antact, CERTIFIED, . . miac: ri&c .. . . . . . . . . . . . b __— --- --
(Attach cxnlanafion it amount cerurie'd clirie;s rrurn riff amounc a(�!>Irc,i rllr.r
In acl_r,r,lance`.'.Ith [fit: FoCIIlaCI Dl,c_urncnts, L,a5td tin I_ut-site ubsenau0n5 and the ARCHITECT:
elUtlt cuMpnsing IIIC: above application, II-,e.ArCilileCt Certffie; to the Ov:ner[flat to the
bC�l n[th1..Arcl-litecf's f;n„4�ledgi=, inrr_,rn�auon and belief the Work has proprtssscd as 13s,; ---
Intllcaled, the of the Work Is In accordance%vlih the Connact Documents, and -11 lis Certificate is not nebutiahle. The ,'-%A,101JN l CERFIFIED is payable only Ill the
the Conli iCCIC r IS elultled to l:,avment Of thu AP:II=)t- N I CERTIFIED. Cunuactcr,lanled herein. Issuance, payn-lent and acceptance rri payrllcI" al e W11116ul
prejudice ti) anv rights of the Otivner or Contractor under [flu t_un[ntct.
uf" GOCu•mm—I C,7u1 '.l'PL11.=.Ili ,r:G �.[P,III II_ Jt- Yilh I'��•i•.IF,.-'r �,IA'I 1'Yrls EGITI I.,rJ •n1,A' - Iv6.t
' _ (-,70'?-I:Jt3',1
11 l`C -�,1;:I,_''''1 I:•.I II I1-i'I I I_It =<� t-I I I''__l`, 1-,4 i 'll,,�, ,l,hF. ..ill t '�. �`. .`.li"I :':(..II Ir.,' l 1. _III II.II�
VOUCHER # 123199 WARRANT # ALLOWED
351429 IN SUM OF $
M.K. BETTS ENGINEERING & CONTRA
P.O. Box 2533
Anderson, IN 46018
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
9 07-1052-01 $43,783.95
CD AIM A/
✓w// I
Voucher Total (VV//VV $43,783.95
Cost distribution ledger classification if
claim paid under 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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
351429
M.K. BETTS ENGINEERING &CONTRACTING Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 12/28/2012
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/28/201; 9 $43,783.95
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
Date Officer