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Home My WebLink About228051 1 /14/2014 CITY OF CARMEL, INDIANA VENDOR: 367514 Page 1 of 1 ONE CIVIC SQUARE JBM CONTRACTORS CORP CHECK AMOUNT: $96,634.50 CARMEL, INDIANA 46032 5299 W OLD 106TH ST ZIONSVILLE IN 46077 CHECK NUMBER: 228051 CHECK DATE: 1/14/2014 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 652 5023990 13-18 200 . 00 OTHER EXPENSES 652 5023990 3 96, 434 . 50 OTHER EXPENSES i APPLICATION AND CERTIFICATION FOR PAYMENT PAGE ONE OF 1 PAGES 2 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 OCONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: MAWR Design,Inc. JBM 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(Line 1+2) $ 179,256.00 CONTRALTO .. 4 TOTAL COMPLETED&STORED TO $ 179,256.00 DATE (Column G on G703) By: a e: 5 RETAINAGE: I AEL a. 5 %of Completed Work State of: Juntyof: SEAL (Column D+E on G703) $ 8,962.80 Subscrlb d and sworn to bef re a t b. %of Stored Material Notary ublie: ✓� Notary Public, State!Feb.22, a(Column F on G703) $ MyCommission/expires: y Commission Expires 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 4less 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 belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 73,858.70 the quality of the Work isin accordance with the Contract Documents,and thecontractor 8 CURRENT PAYMENT DUE $ 96,434.50 Is entitled to payment of the AMOUNT CERTIFIED. 9 BALANCE TO FINISH,INCLUDING RETAINAGE $ 8,962.80 (Une 3less Line 6) AMOUNT CERTIFIED.............................._...$ 96,434.50 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation ifamount certifieddi//ersfrom the amount applied.lnitiolollfgureson this Total changes approved in Application and on the Continuation Sheet that ore changed to conform with the amount terrified.) previous months by Owner 0.00 ARCHITECT: Total aproved this Month 14,338.00 0.00 By: Date: 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 VOUCHER # 137173 WARRANT # ALLOWED 367514 IN SUM OF $ JBM CONTRACTORS 5299 W Old 106th st Zionsville, IN 46077 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 3 02-2308-00 $96,434.50 Depreciation r rt 9-. Voucher Total $96,434.50 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 367514 JBM CONTRACTORS Purchase Order No. 5299 W Old 106th st Terms Zionsville, IN 46077 Due Date 12/30/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/30/201: 3 $96,434.50 hereby certify that the attached invoice(s), or bill(s) is (are) true and ;orrect and I have audited same in accordance with IC 5-11-10-1.6 iZl-�L-1 Date Officer OI( 5299 W,Old 106th St- Sequential no.: P.O.BOX 515 Zionsci'=e Indiana 46077-05',5 20-13-01 Phone 317-344-2732 Facsirmle:317-3A4-2735 CONTPACTOPS CORP. Invoice Job Name: Carmel Utilities Job Number:13-18 Address 30 W.Maint Street-Carmel,IN Date:11/13/2013 Bill To: John Duffy Construction Work Order(CWO)No.: Customer Field Work Order(FWO)No.: Description: Sand and restain hand rail in North stairwell $200.00 Labor: Reg OT Reg Trade: Employee Name: Mo Tu We Th Fr Sa Hrs Hrs Rate OT Rate Amount $ Total Labor: 0 Sub(s),Material and/or Equipment: Amount ($) Price/Unit Description: Of . Price Vision Painting 400.00 Total Sub(s),Material an&''or Equipment: 400 'Sub-total 400 Approved by: Michael Stuerenberg Overhead&Profit 0 `Sub-total 400 Date: 11/13/2013 Bond&Insurance 0 Total 200 Notes: MAKE ALL CHECKS PAYABLE TO JBM CONTRACTORS CORP-TOTAL DUE IN 15 DAYS OVERDUE ACCOUNTS SUBJECT TO A 1%A MONTH SERVICE CHARGE rounded to the nearest dollar VOUCHER # 137172 WARRANT # ALLOWED 367514 IN SUM OF $ JBM CONTRACTORS 5299 W Old 106th st Zionsville, IN 46077 Carmel Wastewater Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 13-18 02-2308-00 $200.00 Depreciation .f 1 Voucher Total $200.00 Cost distribution ledger classification if claim paid under vehicle highway fund X (3 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 367514 JBM CONTRACTORS Purchase Order No. 5299 W Old 106th st Terms 'Zionsville, IN 46077 Due Date 12/30/2013 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 12/30/201; 13-18 $200.00 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 Date Officer