HomeMy WebLinkAbout217869 02/26/2013 a CITY OF CARMEL, INDIANA VENDOR: 366866 Page 1 of 1
\`f ONE CIVIC SQUARE YORK CONSTRUCTION&EXCAVATING
CARMEL, INDIANA 46032 6700 W ISANOGELCK AMOUNT: $24,900.00
MUNCIE IN 47304 CHECK NUMBER: 217869
CHECK DATE: 2/26/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 4 24, 900 . 00 OTHER EXPENSES
PAYMENT APPLICATION 'APPUCATION'NO4
FOR PERIOD1ENDINGi Oct 23,2012
FROM: York Construction&Excavation, Inc PROJECT: 36-inch Water Main (106th St.)
TO: City of Carmel, Indiana 6700 W. Isanogel NO: Contract 66B
One Civic Square Muncie, Indiana 47304 OWNERS PROJECT NO:
Carmel, Indiana 46032
PREPARED BY: Jason York WORK CATEGORY: Utility Services
ATTN: Mr.John Duffy PHONE: 765.760.9806 CATEGORY NO:
ORIGINAL �)i ��
CONTRACT CHANGES
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� ` ECOMPLETEDTO.DATE �I°m�`�`�-�'� I O• k '- , �`�� ���`�'� r��` N
RETAINAGE
COMPLETED LESS RETAINAGE
PREVIOUS APPLICATION f kc,
=�iz,�3�I�l -Sra AP�PROUED ADDITIONS DELETIONS NET �r
QTY AMOUNT IQTY AIVIOUNT,QTY 9 AMOUNT
CURRENT PAYMENT DUE-
„a 'Mao p PREVt APP PERIODS - - - -
THIS APP PERIODS - -
BALANCE TO FINISH; - -
yINCLUDING -
-
I hereby certify that the work for which this application is being submitted has been performed.
4
Jason York Date
I hereby confirm that to the best of my knowledge,this payment application accurately reflects the completion of work. I NOTES '
The Check is to be made out to York Construction&
e Excavation,Inc.
& r This App: 0 r Other. C / , �O'�.a-f°-
(Explain in Notes) Signature Date
Form ss7-custom Cmladcvng Pay—for E-1,Frn_i—[n dato PaY—cam
DISTRIBUTION: I> Engineer
Prescribed by State Board of Accounts
Form No.301(Rev.1995) ACCOUNTS PAYABLE VOUCHER
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
, 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
Y'014Z/-/7
ficer Title
i
Voucher No. Warrant No. ;
ACCOUNTS PAYABLE DETAILED ACCOUNTS
MUNICIPAL WATER DEPT. ACCT.
NO.
CARMEL, INDIANA
Favor Of
`jor � �'0ti5fQuc� iu�� '
Total Amount of Voucher $
q Deductions
L,
Amount of Warrant $ Q
Month of 19
VOUCHER RECORD Acct.
No.
Source of Supply
Water Treatment
Transmission and Dist.
Customer Accounts
Administrative and General f'
Operation-Maintenance
V
Utility Plant in Service r
Constr.Work in Progress
Materials and Supplies
Customers Deposits
Total
Allowed
Board of Control
Filed
Official Title
BOYCE FORMS•SYSTEMS 1.800-3828702 325