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219328 04/24/2013 CITY OF CARMEL, INDIANA VENDOR: 366790 Page 1 of 1 ONE CIVIC SQUARE GERIG OTTENWELLER CONTRACTING OHECK AMOUNT: $23,109.00 CARMEL, INDIANA 46032 3010 INDEPENDENCE WAY •, o� FT WAYNE IN 46808 CHECK NUMBER: 219328 CHECK DATE: 4/24/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 R4462300 26567 1 23 , 109 . 00 RIVER ROAD CULVERT RE CONSTRUCTION PROJECT INVOICE DATE: April 9, 2013 COMPANY NAME: Gerig-Ottenweller Contracting, LLC AND ADDRESS 3010 Independence Dr. Fort Wayne, IN 46808 TELEPHONE NO.: (260) 484-9183 FAX NO.: (260) 484-9187c� PROJECT NAME: River road Culvert Replacement over !�&, Elizabeth Warren Drain. t/� ' PROJECT NO.: 11-07 PURCHASE ORDER: 26567, dated 02/06/2013 INVOICE NO.: 1 TOTAL EARNINGS TO DATE: ............................... $ 24,325.00 RETAINAGE :....................................................... -) 1,216.00 MINUS PERVIOUS PAYMENTS:............................. (-) 0.00 TOTAL NOW DUE:................................................$ 23,109.00 Step en A. Moore—VS Engineering, Inc. APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G70.2 PAGE L OF_2 PAGES APPLICATION NO: 1 Distribution to: TO(Owner): City of Carmel PROJECT: River Road Culvert Replacement OWNER PERIOD FROM: 1-Mar-13 ARCHITECT TO: 31-Mar-13 CONTRACTOR CONTRACTOR: Gerig-Ottenweller Contracting,LLC ATTENTION: Gary R Duncan 3010 Independence Drive ARCHITECTS Cripe City of Carmel Fort Wayne IN 46808 PROJECT NO: 11_07 CONTRACT DATE: 2/27/2013 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment,as shown below,In connection with the Contract. CHANGE ORDER SUMMARY Continuation Sheet,AIA Document G703,is attached. Change orders approved ADDITIONS DEDUCTIONS in previous months by The present status of the account for this Contract is as follows: Owner TOTAL ORIGINAL CONTRACT SUM........................................ $659,671.00 Ap roved this Month Number Date Approved Net change by Change Orders....................................... $0 1 2 CONTRACT SUM TO DATE ......................................... $659,671.00 3 4 TOTAL COMPLETED&STORED TO DATE...................... $24,325 5 (Column G on G703) 6 TOTALS $0.00 Retalnage 5%............................................. $1,216 Net change by Change Orders or total in Column I on G703 TOTAL EARNED LESS RETAINAGE.................................. $23,109 The undersigned Contractor to the best of his knowledge, information and belief the Work covered by this Application for LESS PREVIOUS CERTIFICATES FOR PAYMENT................ $0 Payment has been completed in accordance with the Contract Docu- ments,that all amounts have been paid to him for Work for which ......�\\Qa\0 .,,:..,., t i� previous Certlflcates for Payment were Issued and payments received CURRENT PAYMENT DUE........................ � tike&@A•�. � $23,109 from the Comer,and that current payment shown herein Is now due. CO ACTOR:Geri -Ottenwefler Contracting,LLC State of Indiana _ i _ ) Subscribed an wom to b ore me = S�a,k%` By; Date: 04901 I ad 13 Notary Public: A �E� Ma ing artner 'yi y l�expires: Q I a t 15 ARCHITECT'S CERTIFICATE FOR PAYMENT in accordance with the Contract Documents,based on on-site obser- AMOUNT CERTIFIED.......................................�!!!trrlll t I Ittt�� /0 Oo vations and the data comprising the above application,the Architect (Attach explanation if amount certified differs from the amount applied for.) certifies to the Owner that the Work has progressed to the point Engineeerr:`' — / �/� Indicated;that to the best of his knowledge,information and belief, _� t % the quality of the Work Is in accordance with the Contract DOCU- By: �-, �� -y rG Date: ments;and that the Contractor is entitled to payment of the AMOUNT This Certificate is not negotiable. the AMOUNT CERTIFIED is payable only to the Contractor CERTIFIED. named herein. issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract AIA DOCUMENT G702 • CONTINUATION SHEET • APRIL 1978 EDITION AIA® • ©1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.,N.W.,WASHINGTON, D.C.2006 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 Gerig-Ottenweller Contracting, LLC Purchase Order No. 3010 Independence Drive Terms Fort Wayne, IN 46808 Date Due Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s) Amount 4/9/2013 1 River Road Culvert Replacement Construction $ 23,109.00 I Totall $ 23,109.00 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 VOUCHER NC WARRANT NO. Gerig-Ottenweller Contracting, LLC ALLOWED 20 3010 Independence Drive IN SUM OF $ Fort Wayne, IN 46808 $ 23,109.00 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or INVOICE NO. ACCT#/TITL AMOUNT DEPT# I hereby certify that the attached invoice(s), 26567 1 211-R4462300 $ 23,109.00 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 4/22/2013 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund