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316510 09/26/17 CITY OF CARMEL, INDIANA VENDOR: 367204ONE CIVIC SQUARE TSW UTILITY SOLUTIONS INCCHECK AMOUNT: S""'4,000.00* CARMEL, INDIANA 46032 1970 MIDWEST BLVD CHECK NUMBER: 3165109, ) INDIANAPOLIS IN 46214 CHECK DATE: 09/26/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 610 5023990 997 4,000.00 OTHER EXPENSES E a� m 12 U- 0 O LU c=n o O O O O O O v V Q Z O Q o r-� N 2:� tL- d *t, N In o w U i O ' m b Z 3 Q Q C Q _ vNi v► L u N O Q O u c D1U J Z 12 L 78N. L *i W J u OOi > c # J R Z Q i d Z O L j O t^O N APPLICATION FOR PAYMENT Date; 8tZ5f2017 PO Number. W100015 Meador Imaloe Number. 947 Carmel Waiter Vendor I Contractor *hnz Accounts"Me T5W Utility SO Aceris,loc lesa Testern-vi,President 3120 W.Morris St Indianapolis,IN 46241 Caffnei PM:Jeff Carpenter Tel_13111 735.1491 Fiscal Year 90th-M7 Proiect Number: pirciect Nene: 106th,Spefnlmlll to lwh" InstaAaCon of approx.695 LF of 16 inch wanter main via HOD method,two water main connections as stovm on the Cannel Water p"mcled drawings. Original Contract Arnount: $ 152,390.OD Invoice Period BeVnnin$: 1-Apr-17 Change Order Amount: $ Invoice Period Ending: 25-Aus-17 Modified Contract Amount: $ 132,381106 Taal W4rfi Completed to Date: $ 142.738,50 tees:previous Payments: $ 338,73&5D ❑ Interim Payment Amount Due This Request 5 4.0W OD Final Payment Pkwe Pay This Amotatt: 4100 oo Should you have any questions regarding this application,please rater them to less Testerman at 13171735-1*11. TSW titlf N Sohi i ii,Inc,(Contrwotj certifies it h&ss satisfied aN or its obligations to its subcontractors,nswotoa men,equipment suppliers,v"dors,and employees for all tabor perfryrned,misterials and equipment furnished, and services rendered to the Project whose work was incorporated on prior Applications for Prymeat up to and rnduding the date hereof. CONTRAC[1M further certifies that all lower-tier subcontractors and suppiaess whose wort. in connection with the Project are incorporated in this Application lar Payment harm been pard or will he paid by Contractor upon or prior to payment to Contractor of the arrwurit requested heroin_ ey: 9y: Carmel Project fteproSentative AuthAh Representative Joss M.Testarrnan,President Printed Name and Title Panted Nanne and Title 8,r25J2DI7 Date Crate 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o p otnq qooq q q qo o0 5 q005o to to p O M. O to O O O O o 6 6 O O O o 6 6 6 6 00 00 .0 N 4 M O N to O O N N O o O O to to 0 0 0 0 M M Lr! vO 00 -4- tD M O M to M M to w O to N N to O to N N n 8 () r♦ M tI1 l6 t6 a-1 M N N M q N ri ri' N N N r♦ N00'00 00 O 00 `'i m N � iAiRthi/? iAiA �iANL} L? iANiAiAiAi/? L? L} iAV? L? N � � N a-1 ri a-i ri c-i ri ri ri ri O ri ri ri c-1 e-I r-I a--I e-I O O O 8 . . . . . . 8 . . . . . . . . . O �; pp P © O o 0 0 8 8 0 8 8 C C G 8 o 011 rq w M O M Ln m m to 00 O O to N n N O to M d' 00 to to to � M4 N M M 44 4 N N N tN V o0 V--11 d CL N i!►L?in•V1 iR V►i/F V►vl►i/►ih V1•vN V►ih U?N i/1• <A 4^1 ^ vv T �It � t+ In i 01 = 00 00 ri ri ri ri ri e-I ci a-i c-1 00 ri ri a-1 ri .-I ri ri ritD 3 O v m > C)7 r I 41 Y LL d C L m E r L N Q Q Q Q Q Q Q Q Q ~ N N N N N N N N 0U. Z J J W W W W W W W W W J J J J J J J J J H N U41 0) C O N L +� C Q- c ai c v > E m > a v 4! a + C C OO m 7 C _ - m +, a, N N C ri C :3 cu O tD 0 41 C W T ^ C C= U C O C C � r-I T _ _ LZ3 41 Ip i Gl w 41 Ol O1 Y m •C y v N O +m+ .0 U O h O ` C O O O p L c0 N v z � � � ° C = L � .� -a 0o p N L v L v w ,O. Q CO N N U m to to O 00 O w m O 00 UO , 00 m ,' C m .� � ate-. t 41 M 6 u H (0 N t0 d�0 to 0 t�0 w C CO CO 'p M n a a' cu 3 w m L v a: `-' a. a ., O O V m ;, tai N' cn O d 3 c l0 a v *' °' O a O U/ '_' °° c c O ° +� r�i r�1 v ca O O = p ri m In c m c c '� O +°1, In of r E U 2 2 0 U x H cLo 0 r0 m cc .n U o `m y i0 Co i0 i0 o i0 t T wc Q a, o m o co 11 U ri p.1 c 1 ri Z ri N ri N M W U U Q L L +t U W cG U L ri N '0 y U v '�° C ? 8 ri N M mt Ln l0 n 00 O1 O ri N M v to l0 N OO O1 ri N C Z ri ri ri ri ri ri ri ri ri ri Q m — u E W O E W— a O