218979 04/09/2013 CITY OF CARMEL, INDIANA VENDOR: 366289 Page 1 of 1
ONE CIVIC SQUARE P K S CONSTRUCTIONS INC
CARMEL, INDIANA 46032 450 S RITTER AVE SUITE A CHECK AMOUNT: $11,600.00
INDIANAPOLIS IN 46219
o„ o CHECK NUMBER: 218979
CHECK DATE: 4/9/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 26497 P1353 11, 600 . 00 REMOVE VINYL & PAINT
-Ja.
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE 1 OF 3 PAGES
TO OWNER: CITY OF CARMEL PROJECT: COURT OFFICE PAINTING/WAL JOB NUMBER: P1353 Distribution to:
ONE CIVIC SQUARE 07 APPLICATION NO: 01 x❑ OWNER
CARMEL, IN 46032 �C� k` PERIOD TO: 03/31/2013 ❑ ARCHITECT
ATTN: JEFF BARNES n'^ y.g'� �T-o ,S ❑ CONTRACTOR
FROM CONTRACTOR: PIGS CONSTRUCTION INCORPORATED VIA ARCHITECT: of lY ARCHITECT'S
450 S. RITTER AVENUE STE A 1 Z PROJECTNO: 26497
INDIANAPOLIS, IN 46219
CONTRACT FOR: CONTRACT DATE:
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 1. ORIGINAL CONTRACT SUM. . . . . . . . . . . . . . . . . . $ 11,600.00
Changes approved in
previous months by Owner 2. Net change by Change Orders . . . . . . . . . . . . . . . $ 0.00
3. CONTRACT SUM TO DATE (Line 1 +/-2). . . . . . . . $ 11,600.00
Approved this Month 4. TOTAL COMPLETED&STORED TO DATE . . . . .$ 11,600.00
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
TOTALS1 0.00 0.oo (Columns F on G703)
NET CHANGES by Change Order 0.00 Total Retainage(Line Sa+Sb 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 . . . . . . . . . . $ 11,600.00
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) . . . . . . . . . . . . . . . . . . . $ 0.00
in is now due. 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . $ 11,600.00
CONT CTOR: P c NS UCTION INCORPORATED 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ 0.00
Dat 2 (Line 3 less Line 6)
B e:
ARCHITECT'S CERTIFICATE FOR PAYMENT State of IN County of MARION
Subscribed and sworn to before me t1A 28 day of MARCH 2013
In accordance with the Contract Documents,based on on-site observations and the
data comprising this application,theArchitect certifies to the Owner that to the best Notary Public My commission expires:
of the Architect's knowledge,information and belief the Work has progressed as �4.
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.
By: Date:
AMOUNT CERTIFIED. . . . . . . . . . . . . . . . . . . . . . . Fa This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Con-
(Attach explanation if amount certified differs from th oun tractor named herein. Issuance,payment and acceptance of payment without prejudice to
any rights of the Owner or Contractor under this Contract.
'LUJ
LBy
STATEMENT FROM: PKS CONSTRUCTION INCORPORATED JOB NO: P1353 PAGE 2 OF 3 PAGES
STATEMENT NO: of STATEMENT
TO: CITY OF CARMEL PROJECT NO: 26497 BEG-PERIOD: 03/01/2013
ONE CIVIC SQUARE ESTIMATE NO: of END-PERIOD: 03/31/2013
CARMEL, IN 46032 JOB NAME: COURT OFFICE PAINTING/WAL
ATTN: JEFF BARNES COUNTY: MARION
STATE: IN
A B C D E F G(D+E+F) H(C-G) I
ITEM %SCHEDULED PREVIOUS THIS STORED COMPLETED BALANCE
NO. DESCRIPTION VALUE APPLICATIONS APPLICATION MATERIALS &STORED TO FINISH RETAINAGE
001-1000 PAINTING WALLS 6 DOOR FRAMES 2,800.00 .00 2,800.00 .00 2,800.00 100 .00 .00
001-2000 REMOVE VINYL SKIM WALLS PAINT 8,800.00 .00 8,800.00 .00 8,800.00 100 .00 .00
*** JOB TOTAL *** 11,600.00 .00 11,600.00 .00 11,600.00 100 .00 .00
VOUCHER NO. WARRANT NO.
ALLOWED 20
PKS Construction, Inc
IN SUM OF $
450 South Ritter Ave., Suite A
Indianapolis, IN 46219
$11,600.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26497 I P1353 I 43-501.00 I $11,600.00 1 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
Wedne ay, April 03, 2013
Director, Administrati n
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))
03/31/13 P1353 $11,600.00
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