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Home My WebLink About04 Pay Application #4C~c~-~. - ~ reu.Sc~9r'p~ Jeffersonville BOW December 13, 2006 • Ken Ellis Senior Center - Kevco Construction -Pay Application #4 Total Pay Application - $145,483.64 (Grant - $87,639.34 Local Match - $57,844.30) $138,209.46 -paid to Kevco Construction Retainage of $7,274.18 will be withheld • • r C ~~c-'t~ ~ I re«s ~,~,rE RIVERH I LLS ECONOMIC DEVELOPMENT DISTRICT 8 REGIONAL PLANNING COMMISSION • Serving the Indiana Counties of: Clark, Floyd, Harrison, Scott and Washington MEMORANDUM DATE: December 13, 2006 TO: Mary Sue Ellenbrand /Redevelopment Commission CC: ~/ Peggy Wilder Clerk-Treasurer Barbara Hollis Clerk-Treasurer's Office FROM: Melissa Woods River Hills EDD & RPC RE: City of Jeffersonville CFF Grant No. CF-05-226 -Ken Ellis Senior Center -Draw Request #4 • I have enclosed a copy of the original Draw Request No. 4 for $87,639.34. This draw request, along with $57,844.30 in local match funds, will be used to pay Kevco Construction, LLC (enclosed). I will forward the original draw request to IOCRA for processing. Once you receive the check from the State, the following checks must be written no more than 3 days after the state check is deposited: Kevco Construction, LLC -Pay Application #4 $138,209.46 Kevco Construction, LLC - Retainage Fund $7,274.18 Total $145,483.64 Please mail `or fax me copies of the State Auditor check, City deposit receipt, fully executed accounts payable voucher/s and checks written to vendor/s. If you have any questions, please call me. Thank you. LJ 300 Spring Street, Suite 2A Jeffersonville, IN 47130 Ph: 812.288.4624 Fax: 812.288.8105 T`E n~~ ~ CLAIM -VOUCHER ~~, , k ~° State Form 11294 (R5 / 4-04) ~a~6 Approved by State Board of Accounts, 2004 Name of agency personnel who prepared this claim. Name: Lee Webb Phone: 233-3559 TRUCT/ONS: This agency is requesting disclosure or your Social Security Number in accordance with I.C. 4-1-8. VENDOR INFORMATION AGENCY INFORMATION Document Number Date (Month, Day, Year) Agency Name Lieutentant Governor's Office Vendor Name Cit of Jeffersonville Agency Number 38 Address (Number, Street) 500 Quartermaster Court Social Security Number or 1099 CODE Address (P.O. Box Number) Federal I.D. Number 1099 CODE 35-6001067 EX City, State and ZIP Code (00000-0000) Jeffersonville, IN 47130 Vendor Number AREA BELOW TO BE COMPLETED BY AGENCY. DATE AMOUNT FUND OBJECT CENTER LOAN / INV / NBR QTY. UNIT DESCRIPTION 12.13.2006 $ 87,639.34 6000 572500 113800 CF-05-226 Construction Services (11/1/2006 to 11/30/2006) GROSS AMOUNT:. $ 87,639.34 Furnished to: (Name of State Agency) I certify that this claim is correct and valid and is a proper charge against the S tate Agency, Fund and Center indicated. orized Signature of State Agency Date (Month, Day, Year) Pursuant to the provisions and penalties of Indiana Code 5-11-10-1, I hereby certify that the foregoing Fund and Center is just and correct, that the amount claim~Ed is legally due, after allowing all just credits, and that no part of the same haswbeen paid. Signature f endor Date (Month, Day, Year) /~ Presented by State Board of Accounts Town Form No. 17 (Rev. 1996) ACCOUNTS PAYABLE VOUCHER City of Jeffersonville ,INDIANA _ • 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 Kevco Construction LLC • P.O. Box 3243 Louisville, KY 40201-3243 Purchase Order No. Invoice #4 Terms Ken Ellis Senior Center CF-05-226 Date Due Invoice Date Invoice Number Description or note attached invoices or bill s Amount 12.7.2006 4 Construction Services 11.1.2006 to 11.30.2006 $ 138,209.46 Total $ 138,209.46 I hereby certify that the attached invoice(s), or um(s), is (are) true ana correct ana mat me maienats yr sit vitas itemized thereon for which charge is made were ordered and received except December 13, 2006 ` Community Development Specialist " Signat -'" Title I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in acxordance with IC 5-11-10-2. 2006 Signature ,,.Y, . t,~ ,. ~~, ~~ . Mayor, City of Jeffersonville Title • Presented by State Board of Accounts Town Form No. 17 (Rev. 1996) ACCOUNTS PAYABLE VOUCHER City of Jeffersonville ,INDIANA • 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 Kevco Construction LLC Retainage Fund Purchase Order No. Invoice #4 Terms Ken Ellis Senior Center CF-05-226 Date Due Invoice Date Invoice Number Description or note attached invoices or bill s Amount 12.7.2006 4 Construction Services 11.1.2006 to 11.30.2006 - Retains e $ 7,274.18 r' ~' r ~.% h~~ Total . $ 7,274.18 I hereby certify that the attached invoice(s), or Dugs), is (are) true ana correct ana tnat the ma>;enats or services itemized thereon for which charge is made were ordered and received except Decernber 13, 2006 2006 Signature Community Development Speaalist Title Mayor, City of Jeffersonville Title • 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 5-11-10-2. • CITY OF JEFFERSONVILLE KEN ELLIS SENIOR CENTER DRAW REQUEST WORKSHEET CF-05-226 Draw #4 Date Vendor Invoice # Admin./ER/Labor Standards $ _ Invoice Amount $ - Inspection Services $ _ CONSTRUCTION OF FACILITY 12.7.2006 Kevco Construction LLC PR #4 $ 347,022.35 $145,483.64 PR #3 $ 201,538.71 $ 7,274.18 $ 145,483.64 Payment $138,209.46 $ 145,483.64 x 5% Retainage $ 7,274.18 Payment $ 138,209.46 Retainage $ 7,274.18 $ 145,483.64 Total Draw Request $ 87,639.34 Local Match $ 57,844.30 Total 145,483.64 CHECKS TO BE WRITTEN Paid From Payable To: LM River Hills EDD & RPC LM The Estopinal Group CFF & LM Funds Kevco Construction LLC Retainage Kevco Construction LLC Check Amount $ - $ - $ 138,209.46 $ 7,274.18 Total $ 145,483.64 Kevco Construction, LLC P.O. Box 3243 Louisville, KY 40201-3243 Bill To CITY OF JEFFERSONVILLE 500 QUARTERMASTER CT. JEFFERSONVILLE, IN 47130 Invoice Date Invoice # 11/30/2006 K4578 P.O. No. Terms Project 2325 Due on receipt 2325 CITY OF JEFF... Quantity Description Rate Amount RE: KEN ELLIS SENIOR CENTER AIA APP #4 -OCTOBER 2006 138,209.46 138,209.46 Total $138,209.46 Phone # Fax # ( 502) 635-1641 (502) 635-1634