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Home My WebLink About329797 09/10/18 (9, CITY OF CARMEL, INDIANA VENDOR: 372379 ONE CIVIC SQUARE INLAND WATERS POLLUTION CONTROLgWK AMOUNT: $*****9,516.03* CARMEL, INDIANA 46032 ETROIT MIG�ANAVE. CHECK NUMBER: 329797 CHECK DATE: 09/10/18 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 651 5023990 2 9,516.03 OTHER EXPENSES VOUCHER NO. 186382 WARRANT NO. ALLOWED 20 Prescribed by State Board of Accounts City Form No.201(Rev 1995) Vendor# 372379 IN SUM OF$ ACCOUNTS PAYABLE VOUCHER Inland Waters Pollution Control Inc CITY OF CARMEL 4086 Michigan Ave An invoice or bill to be properly itemized must show: kind of service,where performed, Detroit, MI 48210 dates service rendered, by whom, rates per day, number of hours, rate per hour, numbers of units, price per unit, etc. Payee $9,516.03 372379 Purchase Order No. ON ACCOUNT OF APPROPRATION FOR Inland Waters Pollution Control Inc Terms Carmel Wasterwater Utility 4086 Michigan Ave Due Date BOARD MEMBERS I hereby certify that that attached invoice(s), Detroit, MI 48210 or bill(s)is(are)true and correct and that PO# ACCT# the materials or services itemized thereon for DATE INVOICE# Description DEPT# INVOICE# Fund# AMOUNT which charge is made were ordered and DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT 2 01-1420-00 $9,516.03 and received except 8/28/2018 2 $9,516.03 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 Cost distribution ledger classification if claim paid motor vehicle highway fund. 20_ Clerk-Treasurer APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF TWO PAGES TO: CITY OF CARMEL, IN PROJECT: APPLICATION NO: TWO DISTRIBUTION TO: ONE CIVIC SQUARE INVOICE NO: 82100100-2 SUPERIOR CARMEL, IN 46032 LOWES WAY SEWER LINER CONTRACT NO. 95 PERIOD TO: 8/10/2018 ENGINEER CARMEL, IN CONTRACTOR FROM: INLAND WATERS POLLUTION CONTROL, INC. 4086 MICHIGAN AVE. ENGINEER'S DETROIT, MI 48210 PROJECT NO: CONTRACT FOR: DIVISION A-BRICK SEWER REHABILITATION PHASE III CONTRACT DATE: Janua 15,2018 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information Application is made for Payment,as shown below,in connection with the Contract and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet,AIA Document G703,is attached. with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, ORIGINAL CONTRACT SUM $ 191,843.33 and that current payment shown herein is now due. NET CHANGE BY CHANGE ORDERS $ -1,522.76 CONTRACT SUM TO DATE $ 190,320.57 CONTRACTOR: INLAND WATERS POLLUTION CONTROL, INC. TOTAL COMPLETED&STORED TO DATE $ 190,320.57 (Column G on G703) RETAINAGE $ 0.00 BY: - DATE: AUGUST 13, 2018 Total in Column I of G703 JEREMYECKLEIN, DIRECTOR OF OPERATIONS TOTAL EARNED LESS RETAINAGE $ 190,32Q57 1 , LESS PREVIOUS CERTIFICATES FOR State of: MICHIGAN County of: WAYNE PAYMENT $ 180,804.54 Subscribed and sworn to before me this 13TH day of AUGUST, 2018 ub CURRENT PAYMENT DUE $ 9,516.03 Notary Public: JULIE A. LACKEY i.: BALANCE TO FINISH,PLUS RETAINAGE =; JJLIF.A.LACKEY $' 0.00' cry public,State of Michigan (Line 3 less Line s) My Commission Expires: August 16,2024 f=aun of Wsyne I y Comrttl5sion�iI 16.,'W4 I Acting in the Cougly,Of' ENGINEER'S CERTIFICATE FOR PAYMENT CHANGE ORDER SUMMARY In accordance with the Contract Documents,based on on-site observations and the Change Orders approved in ADDITIONS DEDUCTIONS data comprising the above application,the Engineer certifies to the Owner that to the previous months by Owner best of the Engineer's knowledge,information and belief the Work has progressed as TOTAL indicated,the quality of the Work is in accordance with the Contract Documents,and Approved'this Month the Contractor is entitled to payment of the AMOUNT CERTIFIED. To adjust over/under quantities 1,522.76 AMOUNT CERTIFIED ENGINEER: BY: DATE• 1aS TOTALS 0.00 1,522.76 This Certificate is not ne—g—Ot—lare-1 a AMOUNT CERTIFIED is payable only to the 114etch6ngetby Change e Orders -1,522.76 Contractor named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract, CONTINUATION SHEET Abi 1)(X'l/AlPNP(;7u3 PAGE TV40 OF TWO PACES MA D0ew-111 G AJ2,APPLICA FION AND CERTIFICATION FOR PAYMENT, i,uituch,�tl_ LOWES WAY SEWER LINER APPIACA110NNO TWO ill l2h,llJ(IOtiS h2IOw amounts ma±taT�.d ,,Ill,catos,d,,Ilh, PERIOD Bit IJNG 108mh 15-Aaguli 10 tje,!t oiuntrt 1011 C,mlracEs whirr variable retaina....c ib,tire Itcnn nlayaljply CONTRACT NO.95 APPLICAl ION DATE A.Lga�,1+-'_018 CARMEL,IN EINGINFER'S PROJF(['NIO A ITEM Dl-'S'CKIPTJON OF WORK UNIT EST QTY QUANTI'l'y UNIT PRICE RCIIEDIII-ED WORK CO.'QPL.FrTf-.1) MATERIALS '1`01'Ai, NO, B-M AN(T WL TO VALIJ. I RkAl PtU VIC)US 'I'llis N.R1100 PRESUCII), C'()W'LEILD (6 cl 10 1:11JISN Ing VAP lAltl-1 DX 11: aPwlrarlGryANDSIORED E. (NOVI., .1 0 f3ATr D Ok El Mohllizalioll LS 1 1.00 15,216.67 15.21667, 15,216.67- I(jo% ,50 1-29.44 T 25-888,00 —25134,96 -1-7-25434,90 Q8% 45,3 04 $ 2a 27"CIPP Lining 12�96 to 17-76 u 200 196 -7b '157-CIPP—Lilfillg 12-96 1.17-76 LI: 367 302,50 116.32 S 42.(189,44 S $ 12,166 00 S 42.166,00 99% $ 523.44 2c 27"CIPP Lining 12-96 to 17-76 LF 287 282,30 116.23 S 33,358.01 1; $ 32,81 L73 1 S 32,811,73 -98q0 $-546-2i' Polyurethane Coating Manhole 12-96 VF 22,50 2230 79U5 $ 17,780.63 $ $ 17,780.63 S $ 17.780.63 10o% s 36 C6iitmg Manhole 12-96 VIP —25,40 —25 4 0 S 7-5462 -19,16 73 5- S S 19,167.35 $ $ 19.167,35 100% 3c P01)'uretbalic Coating Manhole 12-96 VF 13.30 13.30 843,08 11,2121)6 $ 11,212,96 $ 11,21296 woo'. $ -i Bypass Polliplog, LS I 11,00 .1.26,53o,27 26,530.27 $ 5 '6,530:'-7 —241 -- 5.3(1.27 10() J To adjust over/under quantities S 2a 27"CIPP Lining 12-96 to 17-76 $ 1-1: -3.50 0.00 $ 129,44 (453,04) (453.04) $ 27"CIPP Lining 12-96 to 17-76 L17 4.50 0.00 S 116.32 $ (523.44) $ $ 0"N' $ (323,44) S —2c—T7-CIPPLining 12-)ti l0 174 - .7 6 LF 00 116.23 (54(1.28)8) $, $ 0% S (,540 28) $ GRAND TOTALS 190,320,57 190,320 57 $ S is 190.32()57 106% AIA DOCUMENT 6703-CONTINUATION SHEET FOR G702- 1992 EDITION AIA-C)1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE.N.W.WASHINGTON,D.C,20006-5292 G703-1992 INLAND WATERS POLLUTION CONTROL, INC. IWPC Job No: 82100100 4086 Michigan Ave. Detroit, MI 48210-3261 FULL CONDITIONAL WAIVER I/We have a contract with: CITY OF CARMEL, IN ONE CIVIC SQUARE CARMEL, IN 46032 to provide: Labor and/or Materials for the improvement of the property described as, LOWES WAY SEWER LINER CONTRACT NO. 95 CARMEL, IN Having been fully paid and satisfied, all my/our construction lien rights against subject property are hereby waived and released. eremy R lein, Director of Operations I ND ERS POLLUTION CONTROL, INC. Signed on: 4086 I,ichigan Ave. Detroit, MI 48210 (313) 899-3014 DO NOT SIGN BLANK OR INCOMPLETE FORMS.RETAIN A COPY. I 1 1 i SWORN STATEMENT STATE OF MICHIGAN) Invoice: 82100100-2 )SS COUNTY OF WAYNE ) Project: 82100100 JEREMY RECKLEIN being duly sworn,deposes and says: That INLAND WATERS POLLUTION CONTROL,INC. is the(contractor)for an improvement to the following described real property situated in County of Hamilton Indiana described as follows: LOWES WAY SEWER LINER CONTRACT NO, 95 CARMEL, IN That the following is a statement as of August 13,2018 of each subcontractor and supplier and laborer with whom the(contractor)(subcontractor)has(contracted)(subcontracted)for performance under the contract with the owner or lessee thereof,and that the amounts due to the persons as of the date hereof are correctly and fully set forth opposite their names as follows: Name of subcontractor Type of Total Amount Amount Balance supplier or improvement Contract Paid Currently to laborer furnished Price To Date Owing Complete INLAND WATERS POLLUTION CONTROL,INC MATLS/LABOR 190,321 0 190,321 0 CONCO SPRAY SOLUTION SUBCONTRACTOR 39,340 0 39,340 0 Totals: 190,3211 01 190.321 0. -WARNING(TO OWNER):AN OWNER OR LESSEE OF THE ABOVE DESCRIBED PROPERTY MAY NOT RELY ON THIS SWORN STATEMENT TO AVOID THE CLAIM OF A SUBCONTRACTOR,SUPPLIER,OR LABORER WHO HAS PROVIDED A NOTICE OF FURNISHING(OR A LABORER WHO MAY PROVIDE A NOTICE OF FURNISHING PURSUANT TO SECTION 109 OF THE CONSTRUCTION LIEN ACT)TO THE DESIGNEE OR TO THE OWNER OR LESSEE IF THE DESIGNEE IS NOT NAMED OR HAS DIED.— That the contractor has not procured material from,or subcontracted with,any person other than those set forth above and owes no money for the improvement other than the sums set forth above. Depondent further says that he or she makes the foregoing statement as the(contractor)(Subcontractor)or as of the(contractor)(subcontractor)for the purpose of representing to the owner,lessee or mortgagee of the above described premises and his or her agents that the above described property is free from claims of construction liens,or the possibility of contruction liens,except as specifically set forth above,and except for claims of construction liens by laborers which may be provided pursuant to Section 109 of the Construction Lien Act,Act No.497 of the Public Acts of 1980,as amended,being Section 570, 1109 of the Michigan Complied Laws. Deponent further says that Laborer wages,Fringe Benefits and Withholdings are paid,except: "`WARNING(TO DEPONENT):A PERSON,WHO WITH INTENT TO DEFRAUD,GIVES A FALSE SWORN STATEMENT IS SUBJECT TO CRIMINAL PENALTIES AS PROVIDED IN SECTION 110 OF THE CONSTRUCTION LIEN ACT,ACT NO.497 OF THE PUBLIC ACTS OF 1980 AS AMENDED,BEING SECTION 570,1110 OF THE MICHIGAN COMPLIED LAWS.— Date: August 13,2018 INLAND WATERS P LUTION CONTROL,INC. By: Jeremy _ cklein,Director of Operations Subscribed and sworn before me this a 13TH day of AUGUST,2018 �ie�,c Notary Public Wayne County,Michigan My Commission Expires: August 16,2024 JULIE A:Wftl�n Y Notary Public,SMichigan County 6 My CGMITIiSslon e"x .16,2024 Actingintna Counly o