165702 11/12/2008 CITY OF CARMEL, INDIANA VENDOR: 358944 Page 1 of 1
ONE CIVIC SQUARE CENTRAL ENGINEERING CONSTRUC AMOUNT: $276,725.00
CARMEL, INDIANA 46032 3862 N COMMERCIAL PARKWAY
GREENFIELD IN 46140 CHECK NUMBER: 165702
CHECK DATE: 11/1212008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCR
106 5023990 18807 5 276 725.00 FOUNDERS PARKS TNTRAS
I
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APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT
TO (OWNER): PROJECT. Founders Park Infrastructure Phase 1 APPLICATION NO_ 5 DISTRIBUTION TO:
Carmel/ Clay Board of Parks and Recreation OWNER XX
Attn.: Mark Westermeier
1411 East 116th Street VIA (ARCHITECT): PERIOD TO: 10/24/2008
Cannel, IN 46032 �v Y F
FROM: Central Engineering S Construction Associates, In C ,t I �1 D ARCHITECT'S
3862 N. Commercial Parkway NOV Q 4 I PROJECT NO:
Greenfield, IN 46140 7008
CONTRACT FOR: SITE IMPROVEMENTS CONTRACT DATE: 22- May -08
�:t
Application made for Payment, as shown below, in connection
CONTRACTOR'S APPLICATION FOR PAYMENT with the contract.
Continuation Sheet is attached.
CHANGE ORDER SUMMARY
1. ORIGINAL CONTRACT SUM $1,015,718.00
Change Orders approved in ADDITIONS DEDUCTIONS 2. Net Change by Change Orders $33,885.00
previous months by owner 3. CONTRACT SUM TO DATE $1,049,603.00
TOTAL 23,560.00 16,100A0 4. TOTAL COMPLETED STORED TO DATE $924,822.00
Approved this Month (Column G)
No. Date Approved 5, RETAINAGE:
3 10/7/2008 26,425.00 a. of Completed Work $54,227.20
(Column D +E)
b. of Stored Material
(Column F) $0.00
TOTALSr 49,985.00 16,100.00 Total Retainage (Line 5a +6b) or $54,227.20
Net Change by Change Orders (Total in Column 1)
$33,885.00 S. TOTAL EARNED LESS RETAINAGE $870,594.80
The undersigned Contractor certifies that to the best of the Contractor's (Line 4 less Line 5 Total)
knowledge, information, and belief the Work covered by this Application 7. LESS PREVIOUS CERTIFICATES FOR $593,869.80
for Payment has been completed in accordance with the Contract Docu- PAYMENT (Line 6 from prior Certificate)
ments, that all amounts have been paid by the Contractor for Work for 8. CURRENT PAYMENT DUE $276,725.00
for which previous Certificates for Payment were issued and payments 9. BALANCE TO FINISH, PLUS RETAINAGE $179,008.20
received from the Owner, and that current payment shown herein is (Line 3 less Line 6)
now due.
CONTRACTOR: CENTRAL ENGINEERING CONSTRUCTION ASSOC., INC.
y State of: Indiana County of: Hancock
BY: DATE: 0 121 .'j Subscribed and 7.p. to before me this 1L' day of October 2008
Karen Horth Powers, President Notary Public:
My Commission April 21, 201
AMOUNT CERTIFIED
ARCHITECT'S CERTIFICATE FOR PAYMENT (Attached explanation if amount certified differs from the
amount applied for.) y
In accordance with the Contract Documents, based on on -site observa- ARCHITECT: PPRIW%�> Pte- ZZtO� bZ�
lions and the data comprising the above application, the Architect certifies a
to the Owner that to the best of the Architect's knowledge, information, By: LG 6 Date:
and belief the Work has progressed as indicated, the quality of the Work is This Certificate in not negotiable_ The AMOUNT CERTIFIED is
is in accordance with the Contract Documents, and the Contractor is payable only to the Contractor named herein. Issuance, pay-
entitled to paymentofthe A CERTIFIED. ment and acceptance of payment are without prejudice to any
DeSCCiptbrI r v 4 a T rights of the Owner or Contractor under this contract.
P.O. 1P18Q2 p F
U
Bu d r
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Purchaser Date_,,,,,,
3
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES
PROJECT: FOUNDERS PARK INFRASTRUCTURE PHASE I APPLICATION NO.: 5
Job: 437 APPLICATION DATE: 27- Oct -08
PERIOD TO: 24- Oct -08
ENGINEER'S PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
FROM PRESENTLY COMPLETED BALANCE RETAINAGE
ITEM DESCRIPTION OF WORK SCHEDULED PREVIOUS THIS STORED AND STORED TO (IF VARIABLE)
NO. VALUE APPLICATION PERIOD (NOT IN TO DATE (G C) FINISH RATE
(D E) D OR E) (D +E +F (C G)
1 Mobilization 40,806.00 31,306.00 4,000.00 35,306.00 87% 5540.00 3530.60
2 Construction Staking 14,086.00 14,086.00 14,086.00 100% 0.00 1408.60
3 Clearing 55,307.00 55,307.00 55,307,00 100% 0.00 5530.70
4 Earthwork 289,035.00 250,500.00 27,500.00 278,000.00 96%1 11035.00 27800.00
5 Erosion Control 38,151.00 24,000.00 24,000.00 63%1 14151.00 2400.00
6 Sanitary Sewer 35,110.00 35,110.00 35,110.00 100%1 0.00 3511.00
7 Storm Sewer 104,921.00 104,921.00 104,921.00 100%1 0.00 10492.10
8 Concrete CurbstSidewalk 177,447.00 43,079.00 129,000.00 172,079.00 97%1 5368.00 17207,90
9 Asphalt Paving 138,189.00 25,600.00 105,900.00 131,500.00 95% 6689.00 13150.00
10 Seeding 82,038.00 0.00 0.00 0% 82038.00 0.00
11 Bonds 8 Insurance 40,628.00 40,628.00 40,628.00 100% 0.00 4062.80
12 Change Order #1: Asphalt 7,100.00 0.00 7,100.00 7,100.00 100% 0.00 710.00
Concrete Curb/Sidewalks 9,000.00 0.00 9,000.00 9,000.00 100% 0.00 900.00
13 Change Order #2: Lime Stat 23,560.00 23,560.00 23,560.00 100%1 0.00 2356.00
Change Order #3:
14 asphalt material increase 26,425.00 26,425.00 26,425.00 100% 0.00 2642.50
Retainage reduction per
contract 1 38255.00
TOTALS: $1,049,603.00 $648,097.001 $276,725.00 $0.00 $924,822.00 88% $124281.00 $54,22,20
PERCENT: ri.75%1 26.36%1 0.0o%j 88.11% 11.89%
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
Purchase Order No. I"
358944 Central Engineering Construction Assoc., Inc. Terms
3862 N Commercial Parkway
Greenfield, IN 46140
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
10124108 App 5 5985 Founders park infrastructure phase 1 276,725.00
Total 276,725.00
1 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.
358944 Central Engineering Construction Assoc., h Allowed 20
3862 N Commercial Parkway
Greenfield, IN 46140
in Sum of
i
276,725.00.
ON ACCOUNT OF APPROPRIATION FOR
106 Park Impact Fee Fund
PO# or INVOICE NO. kCCT #rrITLI AMOUNT Board Members
Dept
18807 App 5 5985 5023990 276,725.00 1 hereby certify that the attached invoice(s), or
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
5 -Nov 2008
Signature
276,725.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund