Loading...
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