227203 12/17/2013 CITY OF CARMEL, INDIANA VENDOR: 060000 Page 1 of 1
ONE CIVIC SQUARE CARMEL UTILITIES CHECK AMOUNT: $29,534.00
CARMEL, INDIANA 46032 WATER 8 SEWER UTILITIES
CARMEL IN 46032 CHECK NUMBER: 227203
CHECK DATE: 12117/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460899 31547 91225 29, 534 . 00 BUILDOUT LURIE BLDG
CARMEL UTILITIES INVOICE
300 Main Street
Carmel, IN 46032 DATE INVOICE #
Phone: 317/571-2443 11/18/20131 91225
Fax: 317/571-2265
BILL TO:
Carmel Redevelopment Department/Commission
Costs assocociated with Office Build Out
30 W Main Street
QUANTITY DESCRIPTION RATE AMOUNT
126% reimbursement of MAWR Design, Inc. $260.00
invoices for design of the 30 West Main Street Office
Buildout
26% reimbursement of JBM office build out cost $ 25,099.00
26% reimbursement of Taylored Systems cost $ 4,175.00
TOTAL $29,534.00
Please remit to Carmel Utilities.
d e s Yl. inc.
s
architecture. engineering, interior design
construction management
849 S.park drive
carmel in 46032
ph-765-453-1745
November 05, 2013
Owner:
Carmel Utilities
30 W. Main Street
Carmel, IN 46032
Invoice-1:1.0113
Re: Construction administration fees due
Project fee $1 , 000 . 00
Amount due this invoice $1 , 000 . 00
Thank you,
Whittney Beechy
i
APPLICATION AND CERTIFICATION FOR PAYMENT PAGEONEOF 1 PAGES z
TO OWNER: PROJECT: Proposed Renovations APPLICATION NO: 3 Distribution to:
City of Carmel,Indiana-Board of Public Works and Safety Second Floor Unit Located 30 W.Main St. =OWNER
One Civic Square Contract No.91 ARCHITECT
Carmel,IN 46032 PERIOD TO: 10/31/13 CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: MAWR Design,Inc.
IBM Contractors Corp 849 South Park Drive
5299 W Old 106th Street Carmel,Indiana PROJECT NOS: JBM 13-18
Zionsville,Indiana 46077
CONTRACT DATE:
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 connection 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 paid by
the Contractor for Work which previous Certifications for Payment were issued and
payments received from the Owner d that current payment shown herein is now due.
1 ORIGINAL CONTRACT SUM $ 164,918.00
2 Net change by Change Orders $ 14,338.00 CONTRACTOR:
3 CONTRACT SUM TO DATE(Une 1+2) $ 179,256.00 CONTRACTO .
4 TOTAL COMPLETED&STORED TO $ 179,256.00
DATE (Column G on G703) By: p a e:
5 RETAINAGE: I AEL JOHN bTLIERENBEHU
a. 5 %of Completed Work State /d.nl County of: SEA A(Column D+E on G703) $ 8,962.80 Subscr sworn to be ee e t 's da f ii L b. %of Stored Material N �"� Notary Public, State of Indiana
(Column F on G703) $ My Commission expires: My Commission Expires Feb.22,2020
Total Retainage(Line 5a+5b or
Total in Column I of G703) $ 8,962.80 ARCHITECT'S CERTIFICATE FOR PAYMENT
6 TOTAL EARNED LESS RETAINAGE $ 170,293.20 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application,the Architect certifies to the Owner that to the best of the
7 LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belle(the Work has progressed as indicated,
PAYMENT(Line 6 from prior Certificate) $ 73,858.70 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8 CURRENT PAYMENT DUE $ 96,434.50 is entitled to payment of the AMOUNT CERTIFIED.
9 BALANCE TO FINISH,INCLUDING RETAINAGE $ 8,962.80 96,434.50
(Line 3less Line 6) AMOUNTCERTIFIED.............................._...$ 96,434.50
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation ifomountcertifieddi(Jersfrom the amount applied.Initial atlFguresanthis
Total changes approved in Application and on the Continuation sheet that ore changed to conform with the amount certified.)
previous months by Owner 0.00 ARCHITECT:
Total aproved this Month 14,338.00 0.00 By: MAWR DESIGN, INC. Date: 10/30/2013
This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the
TOTALS 14,338.00 0.00 Contractor named herein.Issuance,payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 14,338.00
i TAYLORE® SYSTEMS, INC.
14701 Cumberland Road, Suite 100 INVOICE DATE1
10/31/2013
Noblesville, IN 46060 INVOICE N0038J49
(317) 776-4000 CUSTOMER NO ARMCH
SALES PERSONA/
PAGE
CARMEL"CITY HALL/UTILITIES DPT LISA KEMPA CARMEL UTILITIES .
30-W MAIN ST. 30 W MAIN ST
'CARIvIEL IN 46032 ` `- CARME'L,,IN 46032
°,W09858/_6598 NET=10 �TAY0139582`:,
� �-.mss„�e�s,� , � e• o e e o• o o e 5„ E
EQUIPMENTS EACH I ' ' -1:00 ;.+ 0 00 '� 1.00 - 1 810:20 1,810 20
'STRUCTUR
ED;CABLING EQUIPMENT;-
„CABLE=MATERIALS. EACH 1.00 0.00 ,- a,00 5 925.23 5;925.23
�` -CABLING MATERIALS -
r
�t 'LABOR°SCA]hE EACH. —+ 1:00 0.0 -1:00 8,323.56 `. ,8,323:56
SUB CABLE LABOR
- i n
I 'INSTALLATION PER'CONTRACT ;
p r
{ 3
I
3 T
IT
.
7
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t
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xt
-:Sales Total A6,058.99'
Tax.,Total 0 00
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
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.
Came fI Payee
I U I I I P Purchase Order No.
Terms
(nr inc { A 603 L Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
��-18-13 �IZ25
1'0A A1 rim CtseMCA � _W D P 2 513 4; 00
Total r'-9 5 3 ,@d
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
�amcI U 'il
IN SUM OF $
-3 0 V A
6 rmd , I/U 603
$ 2 9, 53q,"
ON ACCOUNT OF APPROPRIATION FOR
T�� qrJ�-/
Board Members
PO#or INVOICE NO. ACCT#/TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
31597 9112-5 F 21 S ff' 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
12 -13—,2 0
Sig ture
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund