HomeMy WebLinkAbout159332 05/14/2008 CITY OF CARMEL, INDIANA VENDOR: 358653 Page 1 of 1
ONE CIVIC SQUARE ENGLEDOW, INC
CARMEL, (;:DIANA 46032 CHECK AMOUNT: $6,808.86
CHECK NUMBER: 159332
CHECK DATE: 511412008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
404 R4462853 15376 5 6,808.86 GRAY ROAD LANDSCAPING
i
AIA Document G702 TIVI -1992®
Application and Certificate for Payment
TO OWNER: PROJECT: Gray Rd. 106th St. APPLICATION NO:` 5 Distribution to:
City of Carmel Roundabout #04 -1OL PERIOD TO 3/31/08 OWNER
CONTRACT FOR: Landscape Irrigation
ARCHITECT
FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE: 10/2/06 CONTRACTOR
Engledow Inc. Rundell Ernstberger PROJECT NOS: 15376 FIELD
OTHER
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
18 0 35364 which previous Certificates for Payment were issued and payments received from the Owner, and
1. ORIGINAL CONTRACT SUM that current payment shown herein is now due.
e Y Change Orders
9 led I
9
2. Net than b
0.00 C 7te: TOR: B
3. CONTRACT SUM TO DATE Line 1'+ 180,353.64 �y Date: �oZ
log
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 168,438.64 S
5. RETA INAGE: County of:
a• 10 of Completed Work Subscribed and sworn to before
(Co lumn D E on G703) 0.00 me this a day!of V
b• of Stored Material
(Column F on G703) 0.00 Notary Public::.: &Lkt
Total Retainage (Lines Sa Sb or Total in Column I 0.00 My Commission expires: of G703).......
6. TOTAL EARNED LESS RETAINAGE 168,438.64 ARCHITECT'S CERTIFICATE FOR PAYMENT
(Line 4 Less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data comprising
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 161,629.78 this application, the Architect certifies to the Owner that to the best of the Architect's knowledge,
information and belief the Work has progressed as indicated, the quality of the Work is in
(Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the
8. CURRENT PAYMENT DUE 6,808.86 AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED
11,915.00
(Line 3 less Line 6) (Attach explanation if amount certified differs from the amount applied. Initial all figures on this
Application- and on the Continuation Sheet that are changed to conform with the amount certified.)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner By: Date: '4 ?.S 0g
Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein: Issuance; payment and acceptance of payment are without prejudice to any rights of
NET CHANGES b Change Order 0.00 the Owner or Contractor under this Contract
CAUTION: You should sign an original AIA Contract Docu on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702TM 1992. Copyright 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law
and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
counsel, copyright @aia.org.
AIA Document 6702 -1992 Instructions
Application and Certificate for Payment
GENERAL INFORMATION
Purpose and Related Documents
AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document
G703, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct
Agreement with the Owner. Procedures for their use are coi eyed in AIA Document A201, General Conditions of the
Contract for Construction.
Use of Current Documents
Prior to using any ATA Contract Document, users should consult www.aia.org or a local AIA component to verify the
most recent edition.
Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written
permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The
American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702,
but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited
license for reproduction granted above, except upon written request and receipt of written permission from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult
the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
COMPLETING THE G702 FORM
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be
transferred to AIA Document G702, Application and Certi fcate for Payment.
The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect.
The Architect should review G702 and G703 and, if they are acceptable, complete the Architect's Certificate for
Payment on G702.
The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A201. The
Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount certified
03
and attach an explanation. The completed G702 and G7 should be forwarded to the Owner.
MAKING PAYMENT
The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA
Document G702, Application and Certificate for Payment. The completed form contains the name and address of the
Contractor. Payment should not be made to any other party unless specifically indicated on G702.
EXECUTION OF THE DOCUMENT
Persons executing the document should indicate the capacity in which they are acting (i.e., president, secretary,
partner, etc.) and the authority under which they are executing the document. Where appropriate, a copy of the
resolution authorizing the individual to act on behalf of the firm or entity should be attached.
AIA Document G702 TM— 1992. Copyright 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved.
WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this
AIO Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible
Under the law. Purchasers are permitted to reproduce ten (10) copies of!this document when completed. To report copyright violations of AIA Contract
Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
TM
Document G703 -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION. NO` 5
containing Contractor's signed certification is attached. APPLICATION DATE: 03/31/08
In tabulations below, amounts are stated to the nearest dollar.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 11/30/07
ARCHITECT'S PROJECT NO: 15376
A B C D E F G
H
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED (G VARIABLE
VALUE APPLICATION THIS PERIOD (G C) FINISH (NOT IN NO. (D E) D OR E) (D E +F) (C G) RATE)
1 Topsoil $17,206.20 $17,206.20 $0.00 $0.00 $17,206.20 100% $0.00 $0.00
2 Limestone, Endcap $5,060.00 $5,060.00 $0.00 $0.00 $5,060.00 100% $0.00 $0.00
3 Limestone, Venteer $6,280.00 $6,280.00 $0.00 $0.00 $6,280.00 100% $0.00 $0.00
4 Limestone, Block $17,271.60 $17,271.60 $0.00 $0.00 $17,271.60 100% $0.00 $0.00
5 Precast Urn $11,150.00 $11,150.00 $1 1,150.00 $0.00 $000 0% $11,150.00 $0.00
6 Compacted Aggregate, #53 $4,563.00 $4,563.00 $0.00 $0.00 $4,563.00 100% $0.00 $0.00
7 Aggregate, for Underdrains $475.20 $475.20 $0.00 $0.00 $475.20 100% $0.00 $0.00
8 Concrete A, Substructure $6,846.00 $6,846.00 $0.00 $0.00 $6,846.00 100% $0.00 $0.00
9 Pipe, PE, Corrugated, 4" $1,229.10 $1,229.10 $0.00 $0.00 $1,229.10 100% $0.00 $0.00
10 Sodding, Nursery $1,639.00 $1,639.00 $0.00 $0.00 $1,639.00 100% $0.00 $0.00
11 Mulch, Hardwood Shredded $2,372.50 $2,372.50 $0.00 $0.00 $2,372.50 100% $0.00 $0.00
12 Plant, Deciduous Shrub, 2 gal $12,810.00 $12,810.00 $0.00 $0.00 $12,810.00 100% $0.00 $0.00
13 Plant, Evergreen Shrub, 3 gal $360.00 $360.00 $0.00 $0.00 $360.00 100% $0.00 $0.00
14 Plant, Evergreen Shrub, B &B $1,302.00 $1,302.00 $0.00 $0.00 $1,302.00 100% $0.00 $0.00
15 Plant, Deciduous Tree, 2.5 -3" $13,520.00 $13,520.00 $0.00 $0.00 $13,520.00 100% $0.00 $0.00
16 Plant, Deciduous Tree, 2 -2.5" $31,350.00 $31,350.00 $0.00 $0.00 $31,350.00 100 $0.00 $0.00
17 Plant, Ornamental Grass, Igal $255.00 $255.00 $0.00 $0.00 $55.00 100% $0.00 $0.00
18 Plant, Perennial, 1 gal $8,627.50 $7,862.50 $0.00 $0.00 $7,862.50 91% $765.00 $0.00
Total $142,317.10 $141,552.10 $1 l ,150.00 $0.00 130,402. I 0 92% $11,915.00 $0.00
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA'Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
counsel, copyright @aia.org.
0
Document G703" -1 992 instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are
covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent
edition.
Reproductions. This document is a copyrighted work and may not be reproducl d or excerpted from without the express written permission of the AIA. There is
no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this
document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with
a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of
written permission from the AIA. Rights to reproduce the document may vary for' users of AIA software. Licensed AIA software users should consult the End User
License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel,
copyright @aia.org.
COMPLETING THE G703 FORM
Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule
of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by
Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract
Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous application). Values from
column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on
the previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment Is sought. The total of the column must be recalculated at the end of each pay
period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.
Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value
deducted from this column and incorporated into column E (Work Completed —This Period.)
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original
contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more
Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to
reflect actual construction costs.
A B C D R F Ci II I
WORK CONIPLI31'61)
MA'rF.KIALti i(lfAL BALANCE
I'K Ii51:\'TI.Y C;0ti1P7.1_I'I3U RFiI'AINAGL'
I O SC BEULJLL'D I NO!`9 PREVIOUS TO (11= VARIABLE
DI;SCNI!''1'll)N QF WORK STOREI) ANI)tiT()RF:D
NO, VALnE \PI'LIG1'77bN THI}PEKIVD A (O =Cj II NINH
INO'I" IN 'IO UA'rL' RA'llij
I
1 MOBILIZATION 5,000 5000 0 0 5,000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS MISC. CONIC, 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
8 PAVERS 20,000 0 0 10,000 10,000 50 10,000
9 BRICK WORK 5000 0 0 0 1 C 0 5,000
10
11 105,000 20,000 10,000 10,000 1 40,000 65,000
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978; 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
I
Document G703 TM 1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 5
containing Contractor's signed certification is attached. APPLICATION DATE: 03/31/08
In tabulations below, amounts are stated to the nearest dollar.
Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: 11/30/07
ARCHITECT'S PROJECT NO: 15376
A B C D E F G H
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED FINISH G C) (If VARIABLE
NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE RATE)
(D E) D OR E) (D +E +F) (C G)
19 Plant, Annual, 1 gal $684.00 $0.00 $684.00 $0.00 $684.00 100% $0.00 $0.00
20 Plant, Annual, Flat $320.00 $320.00 $0.00 $0.00 $320.00 100% $0.00 $0.00
21 Spade Edge $95.94 $95.94 $0.00 $0.00 $95.94 100% $0.00 $0.00
22 Irrigation Gray Rd. 106th $12,500.00 $12,500.00 $0.00 $0.00 $12,500.00 100%
$0.00 $0.00
23 Electrical Gray Rd. 106th $21,745.00 $21,745.00 $0.00 $0.00 $21,745.00 100% $0.00 $0.00
24 Directional Bore for Irrig. 1 $1,491.60 $1,491.60 $0.00 $0.00 $1,491:60 100% $0.00 $0.00
25 Mobilization and Demobilizat $500.00 $500.00 $0.00 $0.00 $500.00 100% $0.00 $0.00
26 Maintenance of Traffic $700.00 $700.00 $0.00 $0.00 $700.00 100% $0.00 $0.00
Subto als $38,036.54 $37,352.54 $684.00 $0.00 $3 100% $0.00 $0.00
Total $180,353.64 $178,904.64 $10,466.00 $0.00 168,438.64 93% $11,915.00 $0.00
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM -1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
counsel, copyright @aia.org.
PIT
Document G7o3TM -1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are
covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent
edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is
no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this
document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with
a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of
written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User
License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel,
copyright @aia.org.
COMPLETING THE G703 FORM
Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule
of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by
Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract
Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous application). Values from
column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on
the previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which paymeI is sought. The total of the column must be recalculated at the end of each pay
period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.
Mere payment by the Owner for stored materials does not result in a deductionlfrom this column. Only as materials are incorporated into the Project is their value
deducted from this column and incorporated into column E (Work Completed --This Period.)
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original
contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more
Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The following is an example of a Continuation Sheet for work in progress. Please note th dollar amounts shown below are for illustrative purposes only, and are not intended to
reflect actual construction costs.
A B C O 1: E G 11 1
WORK COMPLETED
�IA'I'I:F21 ti 'I'O'I'AI" BAI.. \N('I�
I'RESEN 11, 1" COMPLETED RE]AINAGE
IT{:M SCHEDULED FROM PREVIOUS 1 T
UESCRII'T'ION' OI' WORK ti'fCIRI:]) AND S-1 'ORf:U O Ilf VARIABLE NO. VALUE AI'I ION THIS PERIOD INO'1'IN '1'O DATE LO +C) FINISH RATE)
ID +1,) DOR E) (D +E +I 1C -1
1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15.000 10.000 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS 6 MISC. CONC. 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
8 PAVERS 20,000 0 0 10,000 10,000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10
11 1 105,000 20,000 10,000 10,000 1 40,000 1 65,000
AIA Document G703Tm 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
PARTIAL FINAL CONSTRUCTION PROJECT INVOICE
DATE: December 28, 2007
COMPANY NAME: Engledow Inc.
AND ADDRESS 1100 East 116 Street
Carmel, IN 46032
TELEPHONE NO.: 317 575 -1100
FAX NO.: 317 573 -7339
PROJECT NAME: Carmel Streetscape Gray Road, 96 to 106th
PROJECT NO.: 04 -10L (REA Project No. 1002)
INVOICE NO.: #5 PARTIAL FINAL
Construction pay items as per Partial Final Pay Estimate as shown on the attached
invoice for work completed between the dates of July 1, 2007 to November 30, 2007. In
addition, acceptance of the Partial Final Pay Estimate by the Contractor shall release
the City of Carmel from any further claims. financial, liable or otherwise, by the General
Contractor and/or its sub contractors, agents, personnel or otherwise. Acceptance of
the Partial Final Pay Estimate does not release the Contractor of it's responsibilities as
stated in the Contract Documents.
TOTAL PAY THIS ESTIMATE: $684.00
PLUS RETAINAGE DUE: $6124.86
TOTAL NOW DUE: $6808.86
Submitted by Rundell rnstberger Associates, LLC
4
ri ro e ct Represgntativ signed name Date
Project Representative printed name
ept d b o for/Name"
Pro ct Repres tative signed name Date
TGn1es L_ 1= n�l ed0w
Project Representative printed name
AFFIDAVIT AND WAIVER OF LIEN
FINAL 1� PARTIAL PAYMENT TO FOLLOW
CO I00 W being duly sworn, state that he/she is the P re 1 9 i 'de n+ of l Pd cd x n c
having contracted with 0 CA('vn e to furnish certain materials and /or labor as
follows: fora project known as 6-1 ,l kd /D!o 54 9 A B 41 D q /o L
located at 6N �d. d 1O(oi� 54 and owned by i)�y 0?"- Co
and further states:
PARTIAL WAIVER that the balance due by the owner is the sum of S X Mous4nal ejaH hw7dre4 C
Dollars 6 960
Receipt of which is hereby acknowledged; or
The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien
which is given to and for said amount, effective upon receipt of such payment.
FINAL WAIVER that the final balance due by the owner is the sum of
Dollars
Receipt of which is hereby acknowledged; or
The payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien
which is given to and for said amount, effective upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claims whatsoever on
the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned
thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material
furnished to the undersigned for said project, and within the scope of this affidavit and waiver.
ledou n C
Z pa Name
Authorized
Re r sentative
i'0'�SIGf�n+
Title
WITNESS:
ignature
1�G lre w
Printed Name of Witness
CITY OF CARMEL
REPORT OF CONTRACT FINAL INSPECTION
AND RECOMMENDATION FOR PARTIAL ACCEPTANCE
Contract: Carmel Streetscape: Gray Road: 96` to Project: 04 -1 OL
100 Streets
Date Construction Substantially Complete: June 20, 2007
(The date all items were completed, except punch list and removal of traffic control devices.)
Intermediate Completion Date: n/a
Preliminary Inspection made by: Cheryl Chalfant, Rundell Ernstberger Associates
Date: June 15, 2007
Date 'Punch List Items Completed: December 18, 2007, with exception of Cast Stone Urns
Sod Maintenance Expired on: September 20, 2007
Date Sod Repaired, if necessary: June 15, 2007
Date Failed Material Replaced: November 28, 2007, with exception of Cast Stone Urns
Final Inspection made by: Cheryl Chalfant, Rundell Ernstberger Associates
on December 18, 2007 and all work was found to be
satisfactory from Station 51 +00 to Station 100 +00
Date Construction Signs and Temporary Traffic Control Devices Removed: November 28, 2007
Pavement Smoothness (does) (does not) comply with Specifications. n/a
Pavement Markings (have) (have not) been placed in accordance with the IMUTCD manual or as directed by the
District Traffic Engineer. n/a
Right -of -Way (is) (is not) clear of all encroachments. n/a
Date of Last Work December 18, 2007
PARTIAL ACCEPTANCE
f
C_._. City of Carmel, Hamilton County
Project Representative LOCAL PUBLIC AGENCY
By:
By:
By:
Engledow, Inc. Invoice 40202
1100 East 116th Street Date 04/02/08
Carmel IN 46032 Page 1
Bill To: Ship To:
City of Carmel RAB Gray Road 106th St.
Board of Public Works Gray Rd. 106th St.
One Civic Square Carmel IN 46032
Carmel IN 46032
'Purchase Order N6 'r Customer ID Salesuerson ID Shi 'in Method7''- Paj ent Terms Req Shi Date Master No.
15376 11176 LOCAL DELIVERY Net 30 04/02/08 220
Ordered $hi ed" B /O' Item Number Des' c"H tion Discount Unit Price Ext -Price
1 1 0 EXT LANDSCAPE LABOI Exterior Landscape Labor $0.00 $3,235.20 $3,235.20
1 1 0 IRR INSTALL Irrigation Installation $0.00 $3,573.66 $3,573.66
Subtotal $6,808.86
Landscape and Irrigation Services -Misc• $0.00
through 3/31/08 Tax'
$0.00
Application V Freight
$0.00
Trade Discount 1 $0.00
Total $6
Prescribed 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
Engledow, Inc.
Purchase Order No.
1100 East 116th Street
Terms
Carmel, IN 46032
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
4/25/08 pp 5 Gray Rd 106th St RAB $6,808.86
Landscape and Iffigation
Total
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
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
Engledbw, lnr.. IN SUM OF
1100 East 116th Street
Carmel, IN 46032
$6,808.86
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
15376 4pp 5 04 R446285 $6,808.86 which charge is made were ordered and
received except
20 E�
S' n atu re
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund