181474 01/19/2010 CITY OF CARMEL, INDIANA VENDOR: 363787 Page 1 of 1
I. i f, ONE CIVIC SQUARE WALTEK COMPANY LTD CHECK AMOUNT: $1,827.00
{ti !r CARMEL, INDIANA 46032 2130 WAYCROSS ROAD
f CINCINNATI OH 45240 -2719 CHECK NUMBER: 181474
CHECK DATE: 1/19/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 09 -RI 1,827.00 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 11101!09 to 11/30/09
Subcontract: 2695=55 50 5550Acou ,Canopy
Job: 2695- Carmel RPAC Construction Vendor: 10042 WALTEK COMPANY, LTD.
777 3rd Ave. SW
Carmel, IN 46032
P
Item Units UM Unit Cost Amount Units/% Amount Units/% Amount
1 5550 Acoustical Canopy LS 1,360,000.00 10.43% 141,830.00 0.15 2,030.00
Total Contract Items 1,360,000.00 141,830.00 2,030.00
Subcontract Totals: 1,360,000.00 141,830.00 2,030.00
Total Billings: 141,830.00 2,030.00
Unpaid Retainage: 14,183.00 203.00
Discounts: 0.00 0.00
Net Billings: 127,647.00 1,827.00
98 SSC CMa Projects Page 1 11/19/09 12 PM
Date Format MM /DD /YY SLSubBillingReport rpt
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 /CMa Instruc ions On reverse side) 1...soF ON130F 2 ['Alms
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #09 -R1 Distribution to:
Carmel Performing Arts Center
Commission OWNER
777 Third Avenue SW 0 P ERIOD TO: 11 -30 200
One Civic Square ❑CONSTRUCTION
Carmel, IN 46032
Cannel, IN 46032 e PROJECT NOS.: 2695
MANAGER
Subcontract 2695 -555Q
�t� CONTRACT DATE: 02 27 -2009 ARCHITECT
FROM SUB-CONTRACTOR: WALTER Company, Ltd. J\\\'...
2130 Waycross Road CI CONTRACTOR
Cincinnati, OH 45240 -2719 VIA ARCI-IFfECT:CSO ARCHITECTS.
CONTRACT FOR: Acoustical Canop O0
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned G 91ri
ontraetor certif t to the best of the Contractor's knowledge, infor-
motion and belief tkWork covered by this Application for Payment has been completed
Application is made for payment, as shown below, in connection with the Contract.
in accordance with al Cont arc Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document 0703, is attached. Contractor for Ws P,. vrh.i: evious Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM s
$1,360,000.00 ments recci from tie Owner, an. hat current payment shown herein is now due.
2. Net Change By Change Orders $0.00 CONTRAC 0
3 CONTRACT SUM TO DATE (Line 1 2)
$1,360,000.00 By: 0- Da 11-16-2009
State of: Ohio
4 TOTAL COMPLETED STORED TO DATE $141,830.00
(Column G on G702) County of. Hamilton
Subscribed and sworn to before A
5. RETAINAGE: me this 16th day of Novemh o 0.
a. 10% `Yo of Completed Work g $14,183.00
(Columns D E on G703) e,
b. 1 0% of Stored Material $0.00 e My Commission expires:
(Column F on 0703) to 4 Pub11c:
Total Retainage (Line 5a 5h or
Total in column 1 of 0703) $14,183.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 8127,647.00 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Tess Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$125 820.00 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) b the Contractor is entitled to payment ol'the AMOUNT CERTIFIED(
8. CURRENT PAYMENT DUE S $1,827.00 AMOUNT CERTIFIED l 61 1 7
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.frorm the amount applied for.lnitial
(Line 3 less Line 6) S $1,237,970.81 all figures on Ibis Application and on the "rntinuationSheet that changed to conform
to the amount certified.)
CHANGE ORDER SUMMARY
ADDITEONS DEDUCTIONS CONSTRUCfIII MA AGER:
Total changes approved in 13y s �f.��, _V Dale: 1 Z E
previous months by Owner $0.00 $0.00 ARCIII It V Total approved this Month $0.00 $0.00 x �1 l -k�
TOTALS $0.00 $0.00 By: Date:
NET CHANGES by Change Order $D00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AI K T' A DOCUMENT C702 /CMa APILICAJ ION AND CERTIFICNI F FOR RoWMENT CONSTRUCTION MANAGER- ADVISH EDITION
R 19 EDITION AIA'- 1992 THE AMERICAN INSTITUTE OF ARCHITECS, I -i— NE \X YORK AVENUE. N. w. \XAS'IIINGA ON'
_4 a': DC 20006 -292 WARNING: Unlicensed photocopying violates U.S. copyright laws and ,iii subject the violator to legal prosecution. 07021CMa -1992
CARMEL PERFORMING ARTS CENTER AIA DOCUMENT G703
Construction Manager: Shiel Sexton
Job# 26.5 Contract 2695 -5550
APPLICATION NUMBER 9-R1
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION DATE: 4- Nov -2009
CONTRACTOR'S SIGNED CERTIFICATION IS ATTACHED. PERIOD TO: 30- Nov -2009
IN TABULATIONS BELOW, AMOUNTS ARE STATED TO THE NEAREST DOLLAR. REVISED DATE: 16- Nov -2009
USE COLUMN I ON CONTRACTS WHERE VARIABLE RETAINAGE FOR LINE ITEMS MAY APPLY. ARCHITECTS PROJECT NO:
A B c D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO VALUE FR PREVIOUS THIS PRESENTLY COMPLETED (G /C) TO FINISH 10.0%
APPLICATION PERIOD STORED STORED TO DATE
(DLL) (not in D or E) (D +E +F) (C -G)
1. ENGINEERING 190,000.00 139,800.00 200.00 140,000.00 100% 14,000.00
2. MOBILIZATION 10,000.00 0% 10,000.00
3. SPACE FRAME SYSTEM:
Material 269,000.00 0% 269,000.00
4. LAMINATED ACOUSTICAL GLASS:
Material 446,000.00 0% 446,000.00
5. ON -SITE INTALLATION 235,000.00 '0% 235,000.00
6. OWNER ALLOWANCE 1 250,000.00 1,830.00 1,830.00 10 248,170.00 183.00
7. OWNER ALLOWANCE 2 10,000.00 0% 10,000.00
TOTAL THIS APPLICATION 1,360,000.00 139,800.00 2,030.00 141,830.00 108 1,218,170.00 14,183.00
PARTIAL WAIVER AND RELEASE OF LIEN FINAL UNCONDITIONAL WAIVER OF LIEN
PROJECT: Carmel Performing Arts Center
Subcontract 2695 -5550
VENDOR/SUBCONTRACTOR: WALTEK 8c Company, Ltd.
WHEREAS, the undersigned company or individual has furnished materials and/or labor to the City of
Carmel for use in the fabrication and erection of, or improvements to, the above referenced project;
NOW, THEREFORE, the undersigned, for an in consideration of the sum of $8,820.00 and other good and
valuable consideration, the receipt of which is herby acknowledged, does hereby waive and release any and
all liens or right to or claim of lien it has now or may hereafter have on the above- described premises and
any improvements thereon, under any law, common or statutory, in the State of Ohio relating to
mechanic's, materialman, and /or labor liens, for the period of September 1, 2009 through September 30,
2009.
The undersigned further acknowledges that receipt of this payment from said Subcontractor constitutes full
and final payment for all goods and services supplied on this project through the date of September 30,
2009, except for the applicable retention balance due as of September 30, 2009.
The affiant deposes and says that he /she has the authority to execute this affidavit and release of lien on
behalf of the material supplier and/or labor or service supplier and that his /her execution hereof is effective
for the purposes for which this document is intended.
VENDOR/SUBCONTRACTOR: WALTEK Company, Ltd.
SIGNED: a.-.0.'•
SIGNED: /6. O 9
PRINT NAME AND TITLE: Richard A. Perkins, C.F.O.
PHONE: 513.577.7980
STATE OF: OH COUNTY OF: Hamilton
1
Sworn to and subscribed before me this i day of November 2009.
NOTARY PUBLIC ,L L. L.J. IC.P 4
My commission expires on:
"s+ ev
40
r'.g il I
U.S. Department of Labor PAYROLL
Employment Standards Administration (For Contractor's Optional Use; See Instructions at www.dol.gov /esa /whd /forms /wh347instr.htm) (,.y \V g arid Hour uit l.irur
Wage and Hour Division
Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. Rev. Dec. 2008
NAME OF CONTRACTOR OR SUBCONTRACTOR Er ADDRESS
U C OMB No.: 1215 -0149
l 4 0-- VIalt�4. i. .2 a o \t`1a. ..eb5s Q1c At 1 y &"1rJ Expires: 12/31/2011
PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO.a' 6�tS 550
KUP cgalY C al met Rec c c m.c u P Ck 111 Turd Ave., SW Ca.nmel. T u y 60 3 a
(1 (2) (3) (4) DAY AND DATE (5) (6) (7) (9)
(8)
0 N DEDUCTIONS
NET
NAME AND INDIVIDUAL IDENTIFYING NUMBER LL Oa o GROSS WITH- r WAGES
(e.g., LAST FOUR DIGITS OF SOCIAL SECURITY O h w WORK O TOTAL RATE AMOUNT HOLDING TOTAL PAID _ii z3w CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX t OTHER DEDUCTIONS FOR WEEK
NUMBER) OF WORKER
O
5
O
O
5
O
\\.,o t'_Ad y 1 \OG?-- 5
0
5
1 0
1 5
0
s
0
5
While completion of Fonn wit-347 is optional. it is mandatory for covered contractors and subcontractors performing work on Federally financed or assisted construction contracts to respond to the Information collection contained In 29 C. F. R, 3.3, 5.5(a). The Copeland Act
(40 U.S.G. 3145) contractors and subcontractors performing work on Federally financed or assisted construction contracts to "furnish weekly a statement with respect to the wages paid each employee during the preceding week." U.S. Department of Labor (DOL.) regulations at
29 C.F.R. 5.5(a)(3)(ii) require contractors to submit weekly a copy of all payrolls to the Federal agency Contracting for or financing the construction project, accompanied by a signed "Statement of Compliance" Indicating that the payrolls are correct and complete and that each laborer
or mechanic has been paid not less than the proper Davis -Bacon prevailing wage rate for the work performed. DOL and federal contracting agencies receiving this Information review the information to determine that employees have received legally required wages and fringe benefits_
Public Burden Statement
We estimate Ulat is will take an average of 55 minutes to complete this collection, Including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. if you have
any comments regarding these estimates or any other aspect of this collection, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, ESA, U.S. Department of Labor, Room 93602, 200 Constitution Avenue, N.W,
Washington. D.C. 20210
(over)
Date 1 4 D l (b) WHERE FRINGE BENEFITS ARE PAID IN CASH
I, evo Q TeY\ 1.' C. Each laborer or mec listed in the above referenced payroll has been paid,
(Name of Signatory Pa+t (Title) as indicated on the payroll, an amount not less than the sum of the applicable
do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed
in the contract, except as noted in section 4(c) below.
(1) That I pay or supervise the payment of the persons employed by
��p
(c) EXCEPTIONS
\kQK on the
(Contractor or Subcontractor) EXCEPTION (CRAFT) EXPLANATION
!d•1 to j rm. that during the payroll period commencing on the
I S 1— (�(�JY'L\1t�{(� (Building or Work
T day of ,Q ,and ending the, Jl/ day of Q M b �`v'\� �0
all persons employed on said project have been paid the full weekly wages earned, that no rebates have
been or will be made either directly or indirectly to or on behalf of said
(IA C vvc) from the full
(Contractor or Subcontractor)
weekly wages earned by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part
3 (29 C.F.R. Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,
63 Start. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 3145), and described below:
REMARKS:
(2) That any payrolls otherwise under this contract required to be submitted for the above period are
correct and complete; that the wage rates for laborers or mechanics contained therein are riot less than the
applicable wage rates contained in any wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he performed. v
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of
Apprenticeship and Training, United States Department of Labor, or if no such recognized agency exists in a
State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor.
(4) That:
(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS NAME AND TITLE SIGNATURE
in addition to the basic hourly wage rates paid to each laborer or mechanic listed in 1 t AM IQi11K1ba a. C 0.
the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR
have been or will be made to appropriate programs for the benefit of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION_ SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE
31 OF THE UNITED STATES CODE.
employees, except as noted in section 4(c) below.
F resnribed 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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
7 Purchase Order No.
2/3 d Terms
C,;-7‹-A-? a 7 C /7z I/52 fd 277 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
/(30 -0 moo C'9 F2. 76
t
Total !2 7.62%
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.":
20 5'
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
L/b, IN SUM OF
2 /3o /&q K q,
y' Un V 5 2 72
�'2 7 0
ON ACCOUNT OF APPROPRIATION FOR
Board Members
D p INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
c g -4/ 2 f 2 G 6',?c 7 J 2ZG' bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
/y 20 7G'
_MAffe
Sig ure
'ret* Operations
Cost distribution ledger classification it
claim paid motor vehicle highway fund