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HomeMy WebLinkAboutSchutt-Lookabill/ENG/$7,180.16/CO 4/Monon Bridge over Carmel DriveTO: Mike McBride CONTRACT CHANGE ORDER NO. 4 Dick Hill DATE: 10/222/09 PROJECT NAME: Monon Bridge over W. Carmel Dr CITY REQ. NO.: CITY PO NO.: CITY PO DATE: 1. You are directed to make the following changes in this Contract: An emergency situation arrose on West Cannel Drive within the limits of the Monett bridge Project. A sink Hole devolped due to a failed pipe joint under Carmel Drive. The City of Carmel asked the Prune contractor to Shut Down the road and repair the damaged pipe and pave hack Carmel Drive. This Change Order reflects the work done to repair the pipe. close the lane of traffic and repave the roadway SCHEDULED ADJUSTMENT ITEM AMOUNT CL�Ni1[00 - - =- 1- �)Ki_��..D.1Y5 $7.180.16 11. The following referenced llocuments further describe the changes outlined in Paragraph 1, 0 and are to be considered a part of this Change Order: R.P.P.: �lr.11.C. NO • The changes result in the lullowing adjustment of Contract Price and Contract Time: Contract Price prior to this Change Order Contract Price will be increased /decreased by this Change Order �' 4`J0.16 �e Order 87180.16 New Contract Price including this Change Order 53,300,270.72 Contract Time prior to this Change Order Days 11,115/2009 Completion Date Net increased /decreased resulting from this Change Order 0 Days Current Contract 'lime including this Change Order _Days 11/15/2009 Completion Date This Change Order is for fid1 and final settlement of all direct, indirect, impact costs and time extensions incurred at any time resulting from the perlbrmance of the changed work. The Above Changes Are The Above Changes Are Approved Recommended Accepted "ar -ACES � ENGINEER -On i•eci Cy6v 4iny CONTRACTOR • Brain . Mae Citnslopher J. KILL, tJ S•l,u4- Leeka.6.1II Co. Address Address 1625 N. Post Rd, 4050 Rockville Rd City /Statc/Zip City /Slate /Zip Ilia:5e CITY OF C;,•11tb11 1_ APPROVED AS TO FORM BY Indi: lay Phone /IN/46229 India! p lis% '46222 y 317.•95.2585 Phone: 31 -454 -1500 Date: 10.22.201)9 Date: 012.1 hoof Ma Burke Member on \V'a \dct_.er iana Cordrayt;Icrk- Michael McBride, City Engineer Contract No:B -27185 INDIANA Department of Transportation Construction Change Order and Time Extension Summary Contract Information Contract No.: B -27185 District:GREENFIELD DISTRICT AE:Goldner, Rob Change Order Information Change Order No.: 004 Date Generated: 00 /00 /0000 Date Approved: 00 /00 /0000 Reason Code: SCOPE CHANGES, Local Agency Request Description: Failed Pipe and Sink Hole Repair Original Contract Amount $ 3,246,858.18 Current Change Order Amount $ 7,180.16 Total Previous Approved Changes $ 46,632.38 Total Change To -Date $ 53,812.54 Modified Contract Amount $ 3,300,670.72 Time Extension Information Date Initiated 00 /00 /0000 Original Contract Time Time Element Description: Current Time Extension Previous Time Approved Revised Contract Time Date Completed 00 /00 /0000 Change Order No.: 004 Page: 1 Letting Date:05/14/2008 PE /S:Miller, Christopher Status:Draft EWA: Y or Force Acct: N Percent: 0.221 Percent: 1.436 % Percent: 1.657 % SS Completion Date 00 /00 /0000 or SS Calendar/Work Days 0 SP Date 00 /00 /0000 or SP Days (SS = Standard Specification, SP = Special Provision) SS Days 0 SP Days 0 SP Days Value $ 0.00 SS Days by AE: DCE: SCE: DDCM: SS Days SP Days Value $ SS Completion Date 00 /00 /0000 or SS Calendar/Work Days 0 SS Date 00 /00 /0000 or SP Days 0 Contract No:B -27185 Change Order No.: 004 INDIANA Department of Transportation Page: 2 Construction Change Order and Time Extension Summary Review • and Approval Information Required Approval Authority AE: V DCE: SCE: ' DDCM: ($ per Change Order) (- LE $ 250K -) (- LE $ 750K -) ( -- LE $ 2 M -- ) ( -- GT $ 2 M -- ) (Days per Contract) (50 SS days ) ( 100 SS days ) ( 200 SS Days ) ( GT 200 SS days) Verbal Approval Required? ©/ N If Y, by LP �j o2y'p,07 y � Date Issued Total Change To- Date >5 %? Y /Oft Y , Copy to Program Budget Manager Scope /Design Recommendation Required? Y / N If Y, Referred to Project Manager(PM) Date to PM Date Returned Approval Authority Concurs with PM? Y / N If Y, Concurrence by Date If N,Resolution: Approved Disapproved Resolved by Date LPA Signatures Required? N If Y, Date to LPA Date Returned FHWA Signatures Required? Y / N If Y, Date to FHWA Date Retumed * Field Engineer Recommendation (Required for SCE or DDCM Approval) Field'' Engineer Date Comments: 1 Contract No:B -27185 INDIANA Date:09 /30/2009 Change Order No:004 Department of Transportation __._ ..�.... _..._..,...._,.�_._.... Page: 3 Contract: 8 -27185 .. - - - -- • -- _.._._ _. Project: 0300059 - State:0929036 Change Order Nbr: 004 Change Order Description: Failed Pipe and Sink Hole Repair Reason Code: SCOPE CHANGES, Local Agency Request CLN PCN PLN Item Code Unit Unit Prfce 00 O -�r ~Comment Amount Change 0104 0300059 0110 711-91996 h 91976 LS 7,180.100 1.000 C AmounC$ 7,180.16 Item Description: REPAIR EXISTING STRUCTURE Supplemental Descriptonl: Sink Hole and Existing Storm Structure Ropair Supplemental Descdpeon2: Total Value for Change Order 004 = $ 7.180.16 Whereas, the Standard Specifications for this contract provides for such work to be performed, the following change Is recommended. General or Standard Change Order Explanation During Final Construction a Sink hole was noticed by the PEJPS In the right West Bound Lane of Cannel Dr. Upon further inspection, the PE/PS noticed that all subbase under the roadway was no longer in existence and the only structural component of the roadway was the asphalt pavement. PE/PS contacted City of Carmel and requested City help to shut the lane down immodlallay. Cannot Street Department and local authorities assisted with the lane closure. Since the sink hold was within the limits of the Monon Bridge Project, City of Cannel requested the assistance of Schutt Lookabill in providing addtlonal traffic control as well as determining the origin of the sink holo. Schutt excavated the roadway and found a Metal Culvert Pipe had failed causing the roadway to collapse. Due to the need to repair the problem quickly the LPA requested the Prime Contractor repair the pipe structure and pave tho back the roadway. The pipe failure was not the prime contractors faunas the project did call ler underground work to be done near the failure. The failure did occur within the project limits therefore the LPA has requested this Change order be submitted for 80/20 consideration. Change Order Explanation for Specific Line Item It is the intent of the parties that this change order is full and complete compensation for the work describe above. Notification and consent to this change order Is hereby acknowledged. Contractor: ` X f'1 o . . / 4 ' J » / / 1/ c b . Date: q/3DADO�j Signed By: NOTE: Other required State and FHWA signatures will be obtained electronically through the SiteManager system. Contract No:B -27185 INDIANA Date:10/22/2009 Change Order No:004 Department of Transportation Page: 4 APPROVED FOR LOCAL PUBLIC AGENCY (SIGNATURE) (TITLE) G7/ 6ic/iJ (SIGNATURE) (TITLE) SUBMITTED FOR CONSIDERATION (DATE) / /7 /nt (DA E) APPROVED FOR INDIANA DEPARTMENT OF TRANSPORATION v Approval Level Name of Approver Date" Status 2] kA. \' ��.�, .... � Page 1 of 1 http://webmail.aol.com/28789/ao1-1/en-us/mail/get-attachment aspx?uid=1.276552788cfo... 10/22/2009 SCHUMLOOKABILL Co,, INC, CONTRACTORS 4050 WEST ROCKVILLE ROAD INDIANAPOLIS, INDIANA 46222 (317)484 -1500 September 17, 2009 RECEIVED SEP 1 8 2009 UNITED CONSULTING ENGINEERS, INC. Mr. Chris Miller Project Supervisor United Consulting Engineers & Architects 1625 N. Post Road Indianapolis, Indiana 46219 RE: INDOT Contract B- 27185 -A, Pedestrian Bridge on Monon Trail over Carmel Drive, City of Carmel, Hamilton Co., Indiana. Pursuant to your request, we are pleased to submit the following costs for extra work on the referenced project. Sink Hole Repair $7,180.16/Lsum The above work was required by the City of Carmel to repair a sinkhole that had developed on Carmel Drive. The sink hole was the result of a poor connection between a twenty -four inch pipe and the seventy -two inch cross pipe that remained under the portion of pavement that was not affected by this project. You will find enclosed a complete cost breakdown of the above lump sum price for your review and approval. The work was performed on June 24th, 25th and 26th, 2009. Please notify our office if you have any questions or if you need any further information. SCHUTT LOOKABILL CO., INC. tisk_ TED KENNEDY President cc: File 2809 AN EQUAL OPPORTUNITY EMPLOYER • SCHUTr-LooKABILL Project Item # CONTRACTORS g-ailb)C Atoino-. faci.nClark t (42_ Azioeve ("rc- AA) Date ar-L• i Page of _Citeeis 0 04 )__1 I I I I : 1 : 1 I I IQ 1 1 I i i I i I. 1 1.4-.1 r ■ ■ i 16 R i a ._ R 4050 Rockville Road Indianapolis, IN 46222 (317) 484-1500 Fax (317) 484-1561 SCBUTT- LO°'LL CO., INC, Project Item # CONTRACTORS 3- al 1 r s Alovo.i Wt-srr, (3 -r 5LKtCkQC_ 12.-pa e- Date Cs n Page Z. of 1 I l rUla"r OA I 1 ! CQ 1 'Lb ZD(. '�a(C(✓ �iD +4 °fyl[� X 4, LS c1 35`1.St] Cof0.uMIC_d i j3Ldcc�'. G��'1� E wl — X3361 I I I I SDI i— �� AC CQvc4 w , r 1 Q ( +ML 4 r I M' 2„213,„44')__ 1 (.5cC ow,.„.4 j u e K L�LWa4 L' r 1 i' o? r � 2 � ! Tn i a X 4 Rai- It -.,r ._ ( 1 cRi l2t� 's h w /J - 1 ; i L t s ?' c �, I , l I �___ ._ .._�__ T_ _ c r 4 T- +4-c-1,1.---C _ - 1 I__ I p �L , .%4-,LLI MHL �> <•Lz) z(P. Lct i — , 4 —r --t 1 ' I I I. Cr; 6.-Q /vl I ( cam{ 1 Z . D to I j I r • - T 1 -_1- i 1 1 ,D01 , I I I 1 r I-- Ji1 3w S� 2I S t lit- !Fluu,... 41-,44.14 tit. /vii -Ft ' 3'51•4'1—L I -i . °I I L S - 4i tfS" - _ c:14.12--'21 , 1 'To FAQ wP $ "Z at ; 2_? ' (4(ui - 1- R f “ -,!(4. S pa.r41 11.g!117: • IS)1k Ss' —S�L,o- t21,$:CC 7 I6, 1 4050 Rockville Road Indianapolis, IN 46222 (317) 484 -1500 Fax (317) 484 -1561 . SCHUTT - LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly hate: 6 /zi to y ` Job #: t 503 t Job Name: ,'% , 0 SUPERVISOR'S SIGNATURE DESCRIPTION AND LOCATION OF ITEM OF WORK EMPLOYEE NAME - CRAFT HOURLY RATE CODE CODE CODE - CODE TIME TOTAL HOURS WAGE CODE UNION CODE BASIS , [/J� // I\oo-, / --e Cl c.`-� DTN.7. _ 2, REG. ? C f! - -i t (iCw' - Jj i Z REG. DTOT. REG. D.TJO.T. REG. DTq.T. REG. D.TJO T. REG. D.T/G.T. REG. REG. - - D.TJO.T. REG. D.T.O.T. REG. DTOT. REG. D T q.T. REG. TOTAL HOURS BY CODE DAILY TOTAL HOURS a a- DAILY QUANTITIES BY CODE C - - to, a.Ee -s n. lto& rrr :C aPr/s4J b-'i tle MCV btl vi �c Cc g ✓+'CC .• -6o Lai g6- bo<.ir .n7. er. 0-4, 1 e ire a. - .L^4 r -.-r et Ntide C•�•.., n 7u, -c ie , -k. &. a nN$fS. ® O s+KS Yom: etvc& SCHUTT - LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly EQUIPMENT HOURS MATERIALS QUANTITY A-- „ca 10.0-0\ 2 7 INDOT APPROVAL SCHUTT- LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly Mate: 6 7G =J 1 DESCRIPTION AND LOCATION OF ITEM OF WORK tL/t% Job #: Job Name SUPERVISOR'S SIGNATURE EMPLOYEE NAME CRAFT HOURLY RATE CODE CODE CODE CODE TIME BASIS TOTAL HOURS WAGE CODE UNION CODE .i c.s - _se:.. i Cr D.TJO.T. 4.. REG. 4 ti. _? V,. . %G. 1/Z DTAT. f/ 7_ REG. e 0 D TJO.T A REG. AN .; :. . `°.. - ., P. 71- ( D.T./0.T. 1 - - . REG. _, PL. 11-a D.T./0.T. /L. / 1rl // � a ' Cc,/ ,s REG. p 1-10 / ("G!%: C_.�. 4 -- ( (-- fZ DTJO.T. r /x_ �. REG. ...._ . . - . D TJO.T. _ REG. OT/O.T. REG. D.TA.T. REG. D.TJD.T. REG. D.T./O.T. REG. D.T./O.T. REG. TOTAL HOURS BY CODE DAILY TOTAL HOURS --^- DAILY QUANTITIES BY CODE F'tL. h.o (6 t 7z " c.,. -r p ,>:..t s. 9 to C,X co. 0 c _ ✓.u_covc.� �4' rCrr' L,c. r J 0� co c-' s4 - -c_c c, f SCHUTT - LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly / INDOT APPROVAL EQUIPMENT HOURS MATERIALS QUANTITY ( 4, c.c •, ,".D./' 'kJ:: S pe.,4-(0,s.ei Cc.e.c a. .(... G._j, -?- ( ..S, D c Cs 8 ( r L 5 v c Soot c F g-(caC.(( ,4c. a. (s CA <.�r , -v r _4 :;rev a / e4 7 iJG._. 2 irJ t__ c_. lFW c..._ 2. .s r� � 0.4 u / INDOT APPROVAL SCHUTT- LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly Date: 6I26439 1 DESCRIPTION AND LOCATION OF ITEM OF WORK Job #: t 09 ?-`-r Job Name: /t%ko.- Tc SUPERVISOR'S SIGNATURE / / I i i EMPLOYEE NAME CRAFT HOURLY CODE CODE CODE CODE TIME -BASIS TOTAL HOURS WAGE CODE UNION CODE RATE • co_ /.� C-( oT.roT. 7 REG. a 7 447;----c7( REG. D.T.IO T. REG D.TA T. REG. D.TJO.T. REG. D.TJO.T. REG. D.T./0 T. REG. O T.IC.T. REG. DTJOT. REG. D.T./O.T. REG. DTJO T. REG. D.TJO.T. REG. TOTAL HOURS BY CODE DAILY TOTAL HOURS DAILY QUANTITIES BY CODE uK GaU m.i Ao grc_C. _ fiarCtc, Co44o 1 op C.c. SCHUTT- LOOKABILL CO., INC. DAILY TIME REPORT AND COST DISTRIBUTION SHEET Please print clearly EQUIPMENT HOURS MATERIALS QUANTITY PAL A - -0 bCaCe.e,c-\ n INDOT APPROVAL CALUMET September 14, 2009 CALUMET CIVIL CONTRACTORS, INC ;3177697404 # l/ b Attention: Ron Herald PROJECT: B -27185 LOCATION: Carmel Drive PLANS by: N/A PLAN DATE: N/A Attached find backup for surface patch work that we performed on 6- 30 -09. We are requesting a change order for $1,107.77. Call if you have any questions or need additional information. Respectfully submitted, Steven P. Mifboume CALUMET CIVIL CONTRACTORS, INC. 4898 Fieldstone Dr. Whitestown, IN 46075 317 - 769 -1900 FAX 317 - 769 -7424 09- 14 -09: 10: 56AM; JOB Description CALUMET JOB # T &M or Force Account Number ;3177697404 G 2/ 0 B -27185 Monon Trail 8066 6 -30 -09 T &M Surface Patch AMOUNT MARKUP TOTAL Summary of Labor $408.20 $81.64 $489.84 Summary of Bonds & Insurance $10.96 $1.10 $12.05 Summary of Materials $106.00 $12.72 $118.72 Summary of Equipment $277.82 $33.34 $311.16 Summary of Subcontracts $160.00 $16.00 $176.00 TOTAL $1,107.77 09- 14 -09; 10: 53AM;. LABOR WORKSHEET 6 -30 -09 TM Surface Patch ;3177697404 # 3/ 6 EMPLOYEE CLASS CODE DATE ST RATE HOURS OT RATE HOURS ST RATE OT RATE EXTENSION $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 S 1 554.60 $71.40 $54.60 F 2 $51.19 $69.37 $102.38 0 4 545.51 $61.67 5182.03 L 2 $34.60 $46.14 $69.20 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 50.00 50.00 $0.00 $0.00 .. _ 50.00 $0.00. 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 Class Codes: L= Labor,T= Teamster, O= Operator, S= Superintendent F= Foreman TOTALS 9 1 0 1 1 5408.201 09- 14- 09 ;10:56AM; -' MATERIAL WORKSHEET T &M Surface Patch ;3177697404 6 4/ 6 QTY U/M U/P Ext $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 9.5mm Surface 2 TN 40 $80.00 Propane 10 GL 2 $20.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 _ $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SUBTOTAL $100.00 Tax Y/N ggelgil $106.00 TOTAL =- •09- 14- 09;10.56AM; EQUIPMENT WORKSHEET 6 -30 -09 T &M Surface Patch Equipment Hours Rate Extension Broom Broce RJ -350 $0.00 $0.00 Compactor CAT CB -334D 2 $34.69 $69.38 Compactor CAT CB534 C $0.00 $0.00 Compactor CAT CS -563D $0.00 $0.00 Compactor CAT CB 634D $0.00 $0.00 Compactor IR SD 70D $0.00 $0.00 Compactor IR DD110 $0.00 $0.00 Compactor DD -24 $0.00 $0.00 Compactor IR ST -60 $0.00 $0.00 Dozer CAT D5M XL $0.00 $0.00 Dozer CAT D6M XL $0.00 $0.00 Excavator CAT 320CL $0.00 $0.00 Motor Grader CAT 120H $0.00 $0.00 Motor Grader Fiat 65C $0.00 $0.00 Paver CAT 1000B $0.00 $0.00 Paver CAT 655C $0.00 $0.00 Paver Lee Boy Model T 2 $40.38 $80.76 Widener Blaw -Know 100A $0.00 $0.00 Paver BG 225B $0.00 $0.00 Rubber Tire Backhoe CAT420 D $0.00 $0.00 Skid Steer Loader JD 260 $0.00 $0.00 Skid Steer Loader Gehl 5635 2 $26.66 $53.32 R T Loader Case 570L XT -2 $0.00 $0.00 Pickup Chevy 1500 2 $15.00 $30.00 Tack Truck $0.00 $0.00 Roadtec MTD $0.00 $0.00 Tack Wagon $0.00 $0.00 Skid Steer Case 440 w /Attach $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Subtotal Small Tools & Wear Parts TOTAL $233.46 $44.36 $277.82 ;3177697404 # b/ 09- 14- 09;1O:56AM; SUBCONTRACT WORKSHEET 6 -30 -09 T &M Surface Subcontractor QTY U/M U/P EXT $0.00 Triaxle 2 HR $80.00 $160.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 . $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL $160.00 ;3177897404 # 6/ 6 Date Job No Schutt - Lookabill Co., Inc. Field Purchase Order Z 8oJ Cost Code (0 0 0 0^ 0 a, l 4 --br Vendor Quantity Description Price Purchased By 5 _ Approved By WHITE COPY - OFFICE YELLOW COPY - FIELD / PINK COPY - VENDOR n t)ra Sock G (c�c, 9 D 46 -! c c:C_ C« .� <ta•0- oc 3 Z (cce t0 €a taact. ^01.(6 // A-se kilt �Pr Aa (� /cce.- iD:ca <-z4 e CCzcY ( . /6 °<' X130 3a Purchased By 5 _ Approved By WHITE COPY - OFFICE YELLOW COPY - FIELD / PINK COPY - VENDOR C keQUIPMENT RENTAL 410 W. Carmel Drive • Carmel, IN 46032 .�� LARMEL -FISHERS • INDIANAPOLIS 417 - 566 - 8888 FAX: 317-566-2990 "Don't be a tool - Rent one" www. runyonrental. com Open 7 Days a Week In consideration of the payment ofaddional rent dassifed as'damagewaiver by the Rentee, Renter agrees to, and hereby does waive its right, or any right it might have against the Herniae! arising from normal damage of the rental property, normal damage to be determined by Renter. The undersigned shall pay upon return of A property rented a sum equal to 5% of rental charge. This 'damage waiver' does not include damage or loss of the property as a result of the negligence of the Rentee or in the case of abusive damage, theft or other gross negfigertce of the Rentee. This damage waiver shall not apply to reddess, careless or abusive operation or use of the Equipment, use or operation of the Equipment exceedng its rated Fapadty, or damage to tires, tubes and wheels caused by blowout, bruises, arts, punctures or other causes inherent In the use of the Equipment It is understood the amount paid a not an insurance premium, and that this provision does not representan insurance policy or an agreement to insure. - The Reritee further acknowledges receipt of the aforementioned equipment and matenais, or covenants to use said popery in a careful and prudent manner and shall not loan, sublet, mortgage or in any manner dispose of same to any person without the written consent of the owner, and further agrees to return the equipment to Renter in substarivaly good condition as when received, natural wear and tear excepted. The parties agree Thar n the event the Rentee olaes any d the terms and m',Waco of Os agreement, the Ranter may collect damages together with reasonable attorney fees, court costs and irterelof one and ono half (1 02) percent per month actial to amours over ten (10) days old, refer:eg an a ruedpenorage rate degteeen (18)percent. The above equipment has been received by the undersigned for rental purposes only, and it is understood that Renter shall be held responsible for any aoident or damage resulting direly or indirectly from the leased equipment. The Renter expressly disclaims all warranties, either expressed or implied, including any implied warranties of merchantability or fitness tor a particular purpose, and neither assumes nor authorizes any other person to assume for it any Gabifiy connecton wih the use of this equipment. The Rentee agrees to indemnity Renter, from any claim, loss, damages to property, consequential damages, loss of income or any other indderal damages, even those damages caused by the negligence of Rentee, together with attorney fees for defending any action brought as a result of the lease of this equipment. Monday - Friday 7:00 am - 5:30 pm • Saturday 7:00 am - 4:30 pm • Sunday 9:00 am - 3:00 pm tENTEDI -Te ;CHUTT- LOOKABILL CO., INC. 1050 ROCKVILLE ROAD. INDIANAPOLIS IN 96222 O%?0B 12161 20492 CallytilBY'.; ARBELL, RON B'..LOCA'. 12161 PHONEf cGikTA #, Con# 130303 Leo 100 W (317) 484 -1500 E (317) 484 -1561 OUT 06/25/09 8:00 AM JR DUE 06/26/09 8:00 AM JR 1 0319-0001 AIR 575.00/9 Meter Reading Out: • Free Meter Units per Day: 1 0300 -0000 HOSE AIR 3/4.. $6.00 /D 1 0440 -0001 532.00/D 1 0311 -0000 $10.00 /D 1 8385 -0000 $10.00 /D 2 0302 -0000 $8.00 /D Rental Note(s) . COMPRESSOR 185 CFM 95.00 95.00 240 691.50 8.00 C 00 tional Unit: 59 00 HAMMER J7iCK..AiIR 9.o: ,100 32.:(17.0 AIR COMP O ILE 2 FOR HAMMER 10.0z0,041"130 00 ASPHALT SPADE FOR HAMMER .. }roe r 10.00`= ' 10.00 20.00 POINT & CHISEL' LARGE 8.00 8.00 8.00 DO NOT EXCEED 55 MPH WHILE TOWING TRAILER X CUSTOMER IS TOTALLY LIABLE FOR TIRE REPAIR,PLEASE CHECK TIRES PRIOR TO LEAVING LOT X EQUIPMENT IS FOR LOCAL RENTAL ONLY * *DO NOT GO OUT STATE WE HAVE NO INSURANCE * * *X F THE ECUPMENT IS NOT RETURNED BY'9VE Pr DAIS, YOU WILL BE SUBJECT TOA CHARGE OF CONVEASI N (THEFT} Use of alternative fuels, (Diodiesel, E85, etc.) In Runyon Equipment Rental, equipment is PROHIBITED. Customer is liable for all damages 8 repairs that resuh from alternative fuel. HAVE BEEN INSTRUCTED 8 DEMONSTRATED ON THE SAFE 8 PROPER OPERATION OF THE ABOVE EQUIPMENT AND ( 'UO-YUNQFRSTANDTHOSF INSTRUCTIONS I ALSO UNDERSTANDTRAT I AM THE PERSON RENTING THIS PROPERTY, AND THAT RUNYON EQUIPMENT RENTAL DOES NOT GIVE ME PERMISSION TO LEND THIS PROPERTY TO ANY OTHER PERSON. I JNDERSTAND THAT GIVING OR LENDING 11115 PROPERTY TO ANY OTHER PERSON FOR ANY REASON 15 UNAUTHORIZED 3Y RUNYON EQUIPMENT RENTAL .728.00 _ 4389..00 90.00 30.00 95.00 6.00 32.00 10.00 10.00 16.00 NE UNDERSIGNED, HAVING READ AND UNDERSTOOD THE ABOVE, HEREBY AGREES TO RENT THE ARTICLES NAMED 7N THE TERMS AND CONDITIONS SET FORTH IN THIS RENTAL AGREEMENT I HAVE READ THE ABOVE INFORMATION 1ND ACKNOWLEDGE THAT IT IS CORRECT, COMPLETE AND ACCURATE. I PROMISE THAT AS A CONDITION OF RENTING EOU'"< THAT IF MY EMPLOYMENT, ADDRESS OR PHONE NUMBER BE CHANGED, I WILL NOTIFY RUNYON EQI RENTAL IMMEDIATELY RUNYON EQUIPMENT RENTAL I5 AUTHORIZED TO BILL MY CREDIT CARD FOR ANY \ND .dSTS, FEES, AND/OR INTEREST CHARGES ASSOCIATED WITH ANY CLAIM, LOSS, OR DAMAGES TO 'flOPERTY AS A RESULT OF THE RENTAL OE THIS EQUIPMENT: EQUIPMENT �' CELL _EASED BYX ttt'a� i4r'n)rlw PHONE EQUIPMENT lETURNED BY X SIGNATURP • WE CHARGE FOR TIME OUT, NOT TIME USED. VON ARE RESPONSIBLE FOR ALL TIRES. 10.00 95.00 6.00 32.00 10.00 10.00 16.00 24- JUN -09 17:18:00 Equipment is clean and full of fuel please return as such or additional charges will apply. X NMI - ant# Ticket Nuin iei lI: i Mick .x L'iiLbadSizetfi ,...3rnit To: PO: Box 2303, Dept. 122- - Indianapolis, IN 46206 -2303 Concrete Delivery Ticket 1M] Irving Materials, It A'Sliimp :Use-0 Date:. t- • • Customer ?••:, of Tax Code Driver IMI Project No. Ielivery Address P.O. Number oad Quan QzS • 4z5 dater Added.. x Custotoers: equestt Total Ordered Quantity Product Code Product.Description Job No. Unit Price Amount 9. f7 6f. z5c.y 06e) cAL1 C4ICf. No Gallons1 PROPERTY DAMAGEfRELEASE „ _41-o' TO'BE s" logo IFcE MADEIWSfDE CUB& LINE) rearCustomer The Seller rsno'�t�responsrblefor Rico l"eiite;to which waterfor ar wt tiaseror at his request ,• _ �eEri�dersigned hereby authot¢s�frovl ropetiy formaking the: delivery et:tory1t e #.asss tiOAy any damage or injury due to the prenvsr�"""r`"°a -, he undersa'gned agrees to reimbursesad Compa f r os§=cSfiit ethernet byreasorfof hdehveryy also to ideThffyaannt3 ehar iles`s aid Companypoai, attyl rnandsandsuftsforoueraccouY-° f Oran ,�Y-� ��irom pmate- property .i.. off` Ivoryaad �spcesperlstor -any needed a Subtotal Tax P otai "WARNING -- -7-Irritating To The Skin and Eyes _ AFETY WARNING: Keep away from children. Contains Portland Cement. Irritating to he skin and eyes. - Weacrubber: boots, :gloves and - eye .protection: :Prolonged contact ay cause burns. In case of contact with skin or eyes. flush thoroughly.with ,water. f irritation persists, get medical attention. For additional information regarding the AZARDS OF READY MIX CONCRETE:consultthe Material Data-Safety Sheet (MSDS)' RODUCT NOTICE: Seller will not be held responsible for the final appearance of exposed ggregate, integral; coloring, stamped and.decorabve surfacing and all other forms of rchdectural and design concrete - _ r ft { DELIVERY NOTICE - Seller assumes no responsibility for deliveries beyond the public right of way. Buyer assumes responsibility for damages Inclutling but not limited to curb; sidewalk, driveway, or any property_ef the contractor or property own ,s property-wirier 1 -NOTICE : -MY SIGNATURE BELOW INDICATES THAT I HAVE:READ THE HEALTH WARNING NOTICE AND-ACCEPTANCE OF THE LOAD .:% signed X toad Received'By X. Increte - Sand - Gravel - Stone "We're Proud Of Our Work" CUSTOMER COPY General Office (317) 326 -3101 -ernitTo: PQ. Box 2303, Dept. 122 Iridiaimpolis, IN 46206-2303: iC• Concrete Delivery Ticket • Irving Materials, Ir ant # 1! Ticket NOMber rItirruck'.-1,4 LoaciSizeleifo9p.,4mi Date 141;4 Customer" T Tax Code - Driver IMI Project No. ielivery Address P.O. Number Job No. ■ 9Oc -;-.;c3C) oad Quantity 7.Ser Total 1- Ordered Quantity Product Code 13•CO, IES •:Cy Product Description Unit Price Amount ..-.. '; P.04-ILL OVE:E. T _ Hater Adde0:52Lif:' Customett,s-r.-. lequest tR.L.0 $Meter Realling . Gallonstnt At Job ; I • PROPERTY DAMAGE RELEASE (TO BE SIGNED IF DELl VERY TO BE MADE INSIDE CURB LINE) '4egj eittStcmdLctile*itejapdt tPporisibleli;i.,:shierips.stserldttioi-:titigAL -041"jiroffer matarfaXfias:been added:WAN; _. - ---- — iz• • - ;,..i..„::771!"7-',7,,,,i+3 tatigivoii- dPifirr-_,,,,a, :'■bility.fciraWEclarnabe-b? infbEttfuedoth&PleiniseV !ra, ‘. 4; Pa- - 13-iejaridersigned agrees to reirnbnrsajdeoaa 0 :Cjoipment by reason of such Oetratand Os 42,7 i.. ck Jaidatifit ardCompany from any and wrath-a: cisest(gticto7labbiaccoarit tf.difirifany manner causediSfasing ff,&121rprugigjajt— 4:fei-dT;py-,-'-- _.gk.,kr,•.i,:,;c, •71-f.7,1-4-7,--E.72tirs, .-- rheon0ersioned assumeetaiccootbility foi a sudattle-,Ciia,, Jiy,"'Ocrt g i> ughway to point of delntealaiefft:Pesponsible for any needetr wreck-, ierVice charges as a fagot-72,- c-414- . TV:=1' . . _..... ' 1=- ton.T's4s-&--: Signed X c- d 3ncrete - Sand - Gravel - Stone Subtotal Tax ' - WARNING I P 1=1"-'5-;;J• 3:7 Irntatirtg To The Skin aniltiei ,1:il2---;f-; tr. 5 . . AFETY WARNING: -Keep away from children. Contiins Portland Cement:--Irrilating he skin and eyesIVear rubber boots. gloves and eye protectioncRrolonged.contact ay cause burns..2.1n case of contact with skin or eyes, flush thoroughly with water. f irritation persists. get medical attention. For additional information regarding the AZARDS OF READY MIX CONCRETE. consult the Material Data Safehj Sheet (MSDS) RODUCT NOTICE: Seller will nit be held resnonsiblifor the final appearance of exposed ggregatecintegraLcoloring;:stamped and decorative surfacingc_and all otheriforms of rchitectural and design concrete. , • . , EL1VERY-NOTICE:-:Seller assumes no responsibilrty for_deliveries beyOnd ttie public ight of way.-Buyer assumes responsibility for damages including but not limited to curb iriewalk;-driveway,-or. any property of the contractor or property owner or agents .':it :-.NOTICE -MY SIGNATURE BELOW INDICATES THAT -I HAVE READ THE 7, 717 -7 HEALTH WARNING-NOTICE AND ACCEPTANCE OF_THE Lead Received By "We're Proud Of Our Work". General Office (317) 326-3101 ni ISTraluIr13 rnov emit To: PO. Dox 2303;-Dept 122 " ' Ticket - Indianapolis, IN 46206-2303 • ery etifittete Delivery lifl] • Irving Materials, 11 ant # Ticket Number .!116-61040 iifii.Load Size ie., !Mix ; sump it* r !Customeri Tax Code Driver NI Project No. )elivery Address P.O. Number .oad Quantity _ S 730_9 Job No. Amount Total" f Ordered Quantity 1 Product Code Product Description Unit Price fin o _Cy „ FIEF f Voter Added tt Customer's request No. Gallons tici” Artnie jt; 14.1 PROPERTY DAMAGE RELEASE , (TO BE SIGNED IF DELIVERY TO BE MADEllCISIDE CURB Dear Ctiatomer - The Seiler' is not responsi:bile:Jorisiump;is'rstr-f' 2Elgth- Hiar''. `City concrete to which watt-or alii9OiKer iurchaserierit 1ST _:;.- he.undersigrced: )ropetty-t01 .1i0itir, iipilitifor4artyciarrtat Injur9iicitt _ *1 Theitindersignedt-agreesiitoiTermblirsei sad ' -..___ an't tr .Iiibl. 9t trne = iquiprrientbiteassiii °Much dalivaryianir al§p4b.iiderirlylarid se IwT1esb .. oa:c.gniWaiii.Airataiient 4' id cuitst"tirotiaritertiu2j4- ifor4ri,:ai'lyz(rfkann ercaused .iyorarcstnQ froni •Leayailia-PiPPGINQe1.-, Iti ed sortable roa ii aMig, onejeriOPLan -Reed f, .... aiWatties , Signed X Subtotal Tax Load Received By 11" Dncrete - Sand - Gravel - Stone "We're Proud Proud Of Our Work" General Office (317) 326-310 CUSTOMER COPY WHITE'S ACE HARDWARE 731 S. RARGELINE RD CARNEL, TN. :53 0 '3 17714 NIL DUTY 56AL PV 6.12 2 @ 3.060 593 CONCRETE KIX 800 15.48 4t 3.870 5937 PORTLAND CEMENT 940 9.87 SUBTOTAL 31.47 TANI 2.20 TOTAL :33.. 67 CASH 50.00 CHANCE 16,33 1-HANK-YOU PAR 06/25105 8108AE 035733611 28 done & erodes :'Trucking (o., inc.. LOADS 2301 N. Winthrop Avenue • Indianapolis, Indiana 46205 • 317- 926 -3381 01'.11 21 Original: OFFICE Yellow: TRUCKER Pink: PAY COPY Goldenrod: HIRE - TRUCKER 66297 DAY: 77/-01 DATE: 6 6 5 02 12. 22 // 03 13 23 CONTRACTOR SC E.;; 44 (o ka b: f 0 04 14 24 TRUCK NO. kV/ CODE 2 RO9 TIME IN (U 06 14 ` RATE @ �Oo —�V � y 05 15 25 f, c TIME OUT ? TOTAL HRS LAC .2r M ;d /nail 06 16 26 TIME IN AMOUNT 07 17 27 TIME OUT p (- 0,,r; -S Cs, e k i s Pi - 08 18 28 ,TRUCK DRIVER // FOREMAN)) 09 19 29 JOB FI C)Aft7 N ) <i.,�-r • 7 d /c _ ii[ ,.._.2 10 20 30