221276 06/18/2013 CITY OF CARMEL, INDIANA VENDOR: 367204 Page 1 of 1
0 ONE CIVIC SQUARE TSW UTILITY SOLUTIONS INC CHECK AMOUNT: $243,720.10
CARMEL, INDIANA 46032 1970 MIDWEST BLVD
INDIANAPOLIS IN 46214 CHECK NUMBER: 221276
CHECK DATE: 6/18/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
610 5023990 1 243 , 720 . 10 OTHER EXPENSES
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISOR EDITION
AIA DOCUMENT G702/Cma (Instructions on reverse side) PAGE ONE OF 3 PAGES
CONTRACTOR: TSW Utility Solutions,Inc. PROJECT: APPLICATION NUMBER: 1 Distribution to:
1970.Midwest Blvd. 96th and Towne Rd. PERIOD TO: 05/01/13 OWNER
lndpls.,IN 46214 Contract D PROJECT NOS.: CONSTRUCTION
MANAGER
SUBCONTRACTOR: CONTRACT DATE: 03/15/13 ARCHITECT
CONTRACTOR
VIA CONSTRUCTION MANAGER:
CONTRACT FOR: City of Carmel VIA ARCHITECT:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment,as shown below,in accordance with the Contract. information and belief,the Work covered by this Application for Payment has been
Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been
1. ORIGINAL CONTRACT SUM $ 306,358.00 paid by the Contractor for Work for which previous Certificates for Payment were issued
and payments received from the Owner,and that current payment shown herein is now due.
2. Net Change By Change Orders............................ $0.00 CONTRACTOR-9'-��;,,,j 1,1,4' r"j., sc 16, 4C)" .5
3. CONTRACT SUM TO DATE (Line 1 +2)...... $ 306,358.00 )
;State Y DA 5/1/2013
4. TOTAL COMPLETED&STORED TO DATE.............. $259,038.00
(Column GonG703) ��s'^rFO BRAD A V�EATHERf,ORD
�tSf: a .�,- ; Notar Publ ,o3tB1�'61 Iii
5. RETAINAGE: Subscribed and sworn before 6 Co qpn County 0
lion 4 621286
a. 5%%of Completed Work $15,317.90 Notary Public: My Commissir,n Expires
(Columns D&E on G703) My Commission Expires: September 29, 2018
b. 0%%of Stored Material $0.00
(Column F on G703) CERTIFICATE FOR PAYMENT
Total Retainage(Line 5a+5b or
Total in Column 1 of G703) $15,317.90 In accordance with the Contract Documents,based on on-site observations
w1u u1�.uulu L+vult.rl lJU1YJ u11.uvV VL.ut.rNuL.uLlvu, ull.�:vuou ul.uvu nluuu�L.1
6. TOTAL EARNED LESS RETAINAGE........................ $243,720.10 Certifies that to the best of his knowledge, information and belief the Work
(Line 4 less Line 5 Total) has progressed as indicated,the quality of the Work is in accordance with
Ll l VllLlulit VVL.UIl Il.11LJ,Llllu L1 l.iV 1l LlLL-t 1J LV 1.1U.'1111.1IL V1 LIIV
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT AMOUNT CERTIFIED.
(Line 6 from prior Certificate) $0.00
AMOUNT CERTIFIED..................... $243,720.10
8. CURRENT PAYMENT DUE $243,720.10 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this
r1NNuul unu—Inc ♦.,vnunuuu vuc_Inu1 L,nunscu 1v—g—1n 1l/u1 wrly t-cr
9. BALANCE TO FINISH,INCLUDING RETAINAGE CONSTRUCTION MGR:
(Line 3 less Line 6) $ 62,637.90 By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in By: Date:
previous months by Owner This certificate is not negotiable. The AMOUNT CERTIFIED is payable only
Total Approved this Month to the Contractor named herein. Issuance, payment and acceptance of
TOTALS $0.00 $0.00 payment are without prejudice to any rights of the Owner or Contractor under
NET CHANGES by Change Order T $0.001 this Contract.
VOUCHER # 131870 WARRANT # ALLOWED
367204 IN SUM OF $
TSW UTILITY SOLUTIONS INC
1970 MIDWEST BLVD
INDIANAPOLIS, IN 46214
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
1 06-1052-10 $243,720.10
Availability
Voucher Total $243,720.10
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
367204
TSW UTILITY SOLUTIONS INC Purchase Order No.
1970 MIDWEST BLVD Terms
INDIANAPOLIS, IN 46214 Due Date 6/11/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
6/11/2013 1 $243,720.10
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
Date Officer