HomeMy WebLinkAbout223132 08/13/2013 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: $12,600.00
.�� INDIANAPOLIS IN 46219
CHECK NUMBER: 223132
CHECK DATE: 8/13/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4350100 26498 080713 12 , 600 . 00 PAINT DORMERS
:pD-*
(p I AIA Type Document
O i Z O S Application and Certification for Payment Page 1 of 2
I
TO(OWNER):City of Carmel PROJECT: Carmel City Hall Dormer Paint APPLICATION NO: 1 DISTRIBUTION
One Civic Square One Civic Square PERIOD T0:8/7/2013 TO:
Carmel, IN 46032 Carmel, IN 46032 _OWNER
_ARCHITECT
—CONTRACTOR
FROM(CONTRACTOR): PKS Construction Inc. VIA(ARCHITECT D /�" ARCHITECT'S
450 S. Ritter Avenue
PROJECT NO:
Suite 1A AUG 1 2 2013
Indianapolis, IN 46219
CONTRACT FOR:PO#26498 1 By CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below, in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM . . . . . . . . . . . . . . . . . . . .$ 12,600.00
2. Net Change by Change Orders . . . . . . . . . . . . . . . .$ 0.00 CONTRACTOR: PKS Construction Inc.
450 S. Ritter Avenue Suite 1A
3.CONTRACT SUM TO DATE (Line 1 +2). . . . . . . . . . . $ 12,600.00 Indianapolis, IN 46219
4.TOTAL COMPLETED AND STORED TO DATE . . . . . . $ 12,600.00 By: Date: 8/7/13
5. RETAINAGE: David Kojetin / Project Manager
a. 0.00%of Completed Work $ 0.00 State of: Indiana
Marion
County of:
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this 7th Day of August 2013
Total Line retains 9 a 5a+5b Notary Public:
( ). . . . . . . . . . . . . . . . . . . . $ 0.00
My Commission Expires: 6-17-16
6.TOTAL EARNED LESS RETAINAGE . . . . . . . . . . . . . . $ 12,600.00
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYMENT
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents, based on on-site observations and the data com-
prising the above application, the Architect certifies to owner that to the best of the Architect's
(Line 6 from prior Certificate). . . . . . . . . . . . . . . . . . . . .$ 0.00 knowledge, information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE . . . . . . . . . . . . . . . . . . . . .$
K 12,600.00 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE
(Line 3 less Line 6) $ 0.00 AMOUNT CERTIFIED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
(Attach explanation if amount certified differs from the amount applied. Initial all figures on this
1 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT:
previous months by Owner 0.00 0.00
BY: Date:
Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named herein. Issuance, Payment and acceptance of payment are without prejudice to any
TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 0.00
r' AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):City of Carmel PROJECT: Carmel City Hall Dormer Paint APPLICATION NO: 1 DISTRIBUTION
One Civic Square One Civic Square TO:
Carmel, IN 46032 Carmel, IN 46032 PERIOD TO:8/7/2013 _OWNER
=ARCHITECT
CONTRACTOR
FROM(CONTRACTOR): PKS Construction Inc. VIA(ARCHITECT): ARCHITECT'S
450 S. Ritter Avenue PROJECT NO:
Suite 1A
Indianapolis, IN 46219
CONTRACT FOR:PO#26498 CONTRACT DATE:
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL _ STORED % _ BALANCE RETAINAGE
1 Dormer Painting 12,600.00 0.00 12,600.00 0.00 12,600.00 100.00 0.00 0.00
REPORT TOTALS $12,600.00 $0.00 $12,600.00 $0.00 $12,600.00 100.00 $0.00 $0.00
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))
08/07/13 08.07.13 $12,600.00
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
VOUCHER NO. WARRANT NO.
ALLOWED 20
PKS Construction, Inc
IN SUM OF $
450 South Ritter Ave., Suite A
Indianapolis, IN 46219
$12,600.00
ON ACCOUNT OF APPROPRIATION FOR
Administration Department
PO#/Dept. INVOICE NO. ACCT#/TITLE AMOUNT Board Members
26498 I 08.07.13 I 43-501.00 I $12,600.00 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
Mond y, August 12, 2013
Director, 4ministration
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund