220290 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 366289 Page 1 of 1
ONE CIVIC SQUARE P K S CONSTRUCTIONS INC CHECK AMOUNT: $12,875.92
CARMEL, INDIANA 46032 450 S RITTER AVE SUITE A
'y,rod 60 INDIANAPOLIS IN 46219 CHECK NUMBER: 220290
CHECK DATE: 5/21/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 P1277 192 . 92 BUILDING REPAIRS & MA
1205 R4350100 26496 P1277 12, 683 . 00 NEW DOORS/COMM CENTER
APPLICATION AND CERTIFICATE FOR PAYMENT AiA DOCUMENT G702 (Instructions on reverse side) PAGE 1 OF 3 PAGES
TO OWNER: CITY OF CARMEL PROJECT: CARMEL COMMUNICATION BLDG JOB NUMBER: P1277 Distribution to:
ONE CIVIC SQUARE APPLICATION NO: o1 x❑ OWNER
CARMEL, IN 46032
PERIOD TO: 05/31/2013 ❑ ARCHITECT
ATTN: JEFF BARNES ❑ CONTRACTOR
FROM CONTRACTOR: PRS CONSTRUCTION INCORPORA-.ED VIA ARCHITECT: ARCHITECT'S
450 S. RITTER AVENUE STE A PROJECT NO: PO 26496
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 I. ORIGINAL CONTRACT SUM. . . . . . . . . . . . . . . . . . $ 12,683.00
Changes approved in 2. Net change b Change Orders $ 192.92
previous months by Owner 192.92 9 Y 9 • • • • •
3. CONTRACT SUM TO DATE (Line 1 +/-2). . . . . . . . $ 12,875.92
Approved this Month Q 4. TOTAL COMPLETED 11 STORED TO DATE . . . . .$ 12,875.92
Number Date Approved MAY 2 0 2013 5. RETAINAGE:
a. 0.000 %of Completed Work $ 0.00
(Columns D+E on G703)
By b. o.000 %of Stored Material $ 0.00
TOTALS1 0.00 1 0.00 (Columns F on G703)
NET CHANGES by Change Order 192.92 Total Retainage(Line 5a+5b or
Total in Column I of G703) . . . . . . . . . . . . . . . . . . . . $ 1,287.59
The undersigned Contractor certifies that to the best of the Contractor's knowledge, 6. TOTAL EARNED LESS RETAINAGE . . . . . . . . . . $ 11,588.33
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 Line 6
issued and payments received for the Owner,and that current payment shown here- ( from p rior Certificate) $ o.00
in is now due. 8. CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . $_ 11,588.33
CONTRACTOR: PxS C NSTRUCTION INCORPORATED 9. BALANCE TO FINISH, INCLUDING RETAINAGE $ 1,287.59
By: t Date: G I (Line 3 less Line 6)
ARCHITECT'S CERTIFICATE FOR PAYMENT State of. IN County of: MARION
Subscribed and sworn to before a this 02 day of MAY 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: —� —I
of the Architect's knowledge, information and belief the Work has progressed as LP
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. . . . . . . . . . . . . . . . . . . . . . . . . $ This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Con-
(Attach explanation if amount certified differs from the amount applied for.) tractor named herein. Issuance,payment and acceptance of payment without prejudice to
any rights of the Owner or Contractor under this Contract.
STATEMENT FROM: PKS CONSTRUCTION INCORPORATED JOB NO: P1277 PAGE 2 OF 3 PAGES
STATEMENT NO: of STATEMENT
TO: CITY OF CARMEL PROJECT NO: PO 26496 BEG-PERIOD: 05/01/2013
ONE CIVIC SQUARE ESTIMATE NO: of END-PERIOD: 05/31/2013
CARMEL, IN 46032 JOB NAME: CARMEL COMMUNICATION BLDG
ATTN: JEFF BARNES COUNTY: MARION
STATE: IN
A B C D E F G(D+E+F) H(C-G) I
ITEM DESCRIPTION /�SCHEDULED PREVIOUS THIS STORED COMPLETED o BALANCE
NO. VALUE APPLICATIONS APPLICATION MATERIALS &STORED TO FINISH RETAINAGE
001-1000 DOORS FRAMES 6 HARDWARE 11,408.00 .00 11,408.00 .00 11,408.00 100 .00 1,140.80
001-2000 PAINTING 911.00 .00 911.00 .00 911.00 100 .00 91.10
001-3000 SECUIRTY 364.00 .00 364.00 .00 364.00 100 .00 36.40
002-1000 REMOVE ROTTEN FRAMES 192.92 .00 192.92 .00 192.92 100 .00 19.29
*** JOB TOTAL *** 12,875.92 .00 12,875.92 .00 12,875.92 100 .00 1,287.59
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))
05/31/13 P1277 $192.92
05/31/13 P1277 $12,683.00
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
20
Clerk-Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
PKS Construction, IncIh
IN SUM OF $
450 South Ritter Ave., Suite A
Indianapolis, IN 46219
$12,875.92
ON ACCOUNT OF APPROPRIATION' FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
1205 P1277 43-501.00 $192.9 2 I hereby certify that the attached invoice(s), or
bill(s) is (are)true and correct and that the
26496 P1277 43-501.00 $12,683.00
materials or services itemized thereon for
which charge is made were ordered and
received except
Monday, May 20, 2013
Director, Administration
Title -
Cost distribution ledger classification if
claim paid motor vehicle highway fund