158828 04/30/2008 CITY OF CARMEN, INDIANA VENDOR: 358944 Page 1 of 1
t, ONE CIVIC SQUARE CENTRAL ENGINEERING CONSTRUCTJON
CARMEL, INDIANA 46032 3862 N COMMERCIAL PARKWAY CHECK AMOUNT: $5,000.00
GREENFIELD IN 46140 CHECK NUMBER: 158828
r• CHECK DATE: 4/30/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
654 5023990 8 5,000.00 OTHER EXPENSES
I
APPLICATION AND CERTIFICATE FOR PAYMENT ALA DOCUMENT G702 RETAINAGE
TO: City of Carmel, IN PROJECT: Little Coot Creek Interceptor APPLICATION: Eight 1�
Contract 53
Carmel, IN PERIOD TO: 04/15/08
FROM (CONTRACTOR):
Central Engineering Construction Associates, Inc.
3862 North Commerical Parkway
Greenfield, In 46140 CONTRACT DATE:
CONTRACT FOR: Little Cool Creek Interceptor, Contract 53
CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment, as shown below, in connection with the
CHANGE ORDER SUMMARY Contractors Continuation Sheet, AIA Document G703, as attached.
CHANGE ORDERS APPROVED IN 1. CONTRACT SUM 469,986.20
PREVIOUS MONTHS BY OWNER ADDITIONS DEDUCTIONS 2. Net Change by Change Order 40,624.09
TOTAL 40,624.09 3. Contract Sum to Date (line 1+ 2) 510,610.29
APPROVED THIS MONTH 4. Total Completed Stored to Date 510,610.29
NUMBER DATE APPR'D 5. Retainage of Completed Work:
6. Total Earned Less Retainage 510,610.29
7. Less Previous Certificates for Payment 485,079.78
8. Current Payment Due 5,000.00
TOTAL: 40,624.09 9. Balance to Finish, Plus Retainage (line 3 less line 6)
NET CHANGE BY C.O. I IS 40,624.09
The undersigned Contractor certifies that to the best of the Contractor's State of Indiana County of Hancock
knowledge, information and belief the Work covered by this Application for Subscribed and sworn to before me this I -S" day of to t 1 2008
Payment has been completed in accordance with the Contract Documents, that
all amounts have been paid by the Contractor for Work for which previous Notary_ Public:
Certificates for Payment were issued and payments received from the Owner, Li -Ching Wu
and that current payment shown herein is now due, My Commission expires: April 21, 2008
CONTRACTOR: Central Engineering Construction Associates, Inc. OWNER APPROVAL
By: Date:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein, payment and acceptance of payment are without prejudice to
B Date: 4 t I S f;38 a ny rights of the Owner or Contractor under this Contract.
Karen Horth owers, Presilent
ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED
In accordance with the Contract Documents, based on on -site observations and (Attach explanation ifamount certified differs from the amount applied far.)
the data comprising the above application, the Engineer certifies to the Owner ENGINEER
that to the best of the Engineer's knowledge, information and belief the Work
has progressed as indicated the quality of the work is in accordance with the By: Date:
Contract Documents, and the Contractor is entitled to payment of the This Certif ate is not negotiable. The AMOUNT CERTIFIED is payable only to the
AMOUNT CERTIFIED. Contractor named herein. Issuance, payment and acceptance of payment are without
nreiudice to anv rights of the Owner or Contractor under this Contract.
A Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, e0nUlning Little Coo Crerk n ercep r, "Mr- U CArmer "Mr- r
Contractor's signed Certification Is attached. In tabulations below, amounts are slated to the APPLICATION DATE: 4/15/2008
nearest dollar. Use Column I on Contracts where variable mtalnage for line items may apply. PERIOD TO: 4/15/2008
ENGINEER'S PROJECT NO.:
D E
A C WORK COMPLETED F G H J
PAY STORED TOTAL
LINE ORIGINAL CURRENT PREVIOUS BALANCE TO
DESCRIPTION OF WORK CHANGE MT 1) COMPLETED </o COMP. RET
ITEM QTY UNIT UNIT PRICE SCHEDULED SCHEDULE APPLCTN THIS PERIOD FINISH ORDERS OF VALUES (D E) (NOT IN D OR S STORED 70 (G!C) (C G) IOar6 E) DATE
I MobkQatlon I LS S 3.840.00 3 30,840.00 S S 30,840,00 S 30,840.00 3 S 30,84D.00 100100% S 3 3,084.00
2 AvdIOVidett Recording I LS S 1,586.00 3 1,586,00 S 1,586.00 3 1,586.00 S S 1586.00 100.00% S 158,60
3 Erosion control I LS 3 9,456.00 S 9,456.00 3 S 9,456,00 S 9,456,00 S S 9,4S6.00 100.00% S 945.60
4a lo-ln PVC SDR 35 1500 LF 62.78 S 94.170.00 S 94,170.00 94,170,00 S 94,170.00 100.00% S 3 9,417.00
4b 1 8-In PVC 1430 1F S 70.95 S 101,458.50 S S 101,458,30 3 101,458,50 S 101455.50 100.00 S S 10,145.85
5 Stream Crossing I LS 5 9,143.00 S 9,14300 S 9,143,00 S 9,143,00 3 3 9,143,00 100.00% S 3 914,30
6 Sprinkler Replacement 100 LF S 16.69 S 1,669,00 3 1,669.00 S 1,669.00 S 3 1,669.00 100.00% 3 0100 166.90
7 Bared Casing 306 LF S 314.45 S 96,221.70 3 S 96,221.70 S 96,221.70 3 96,221.70 100.00% S S 9,622.17
8a Manholes 7 EA S 3,874.50 3 27,121.50 S S 27,121.50 S 27,121.50 S S 27,121.50 100.00% 5 S 2,71215
8b Manhole Drop (External) I EA S 5,488.00 S 5,488.00 3 S 3,488.00 S 5,488.00 S S 5,488.00 100.00% $48.80
9a Abandon PvmpStation #1 1 LS S 9,455.00 S 9,435.00 3 S 9,455,00 S 9,455,00 S 3 9,455.00 100400% S S 945.50
9b Abandon Pump Station #2 1 LS S 15,821.00 S 15,821.00 S S 15,821.00 S 15,82100 S S 15.821.00 100.00% S S 1
9C Reconfigure Manhole #1 I LS S 1.796.50 S 1,796.50 S S 1,796.50 S 1,796.50 3 S 1,796.50 100.00% S 179.63
10 Special Backflll 1100 Cy s 8.12 S 9,932.00 3 S 8,932.00 S 5,932,00 S 8,932.00 100.00% S S 893.20
11 Dewaledng I LS 3 42.24200 S 42,242,00 S S 42,242,00 S 42,242,00 S S 42,242.00 100.00% S 4,224.20
12a Sidewalk 200 SF 3 8.34 1,668.00 S S 11668,00 S 1,668.00 S S 1,668.00 100.00% S 1 16610
12b COrb 8 Guifer5 40 LF S 41.70 3 1.668.00 S S 1,668,00 S 10800 3 S 1,668 00 100.00% S S 166.80
13a Seed 3000 Sy, 0.75 S 2,250.00 3 2,250.00 S 2,23000 S S 2,250400 100.00% S S 225.00
13b Sod 1800 Sy S 3100 S 9 S 3 9,000,00 S 9,000,00 S S 9,000.00 100.00% S S 900,00
0 I Manhole for Sid 13 +50 1 EA S 3,874.50 S 3,874.50 S 3,874,30 S 3,874,50 S S 3,874.50 100.00% S 387.45
0 #1 Connect 2" FM to MH 1 EA S 3,054.00 3 3,054400 1 3,054,00 S 3,054,00 S 3,054.00 100.00°/6 S S 305.40
O 3 B Bedding between MH 1.0 and MH 1 -2 1 LS 5 5,640.00 S 5,640.00 1 S 5,640.00 3 5,640.00 S 5.640.00 100.00 -A 3 364.00
0 Remove burled concrete struc, within trench line 1 LS S 5,663.91 S 5,663.91 S S 5,663.91 S 51663.91 S S 3,663.91 100,00°/. S S 566.39
0 1 Adjustment for final gtys 1 EA S 9,663.50 S 9,663.50 S 9,663.30 3 9,663.50 3 S 9,663.50 100, Dip/. S S 966.35
0 1 Install flat top anThlstfewood LS 1 EA 3 3,834.00 S 3,534.00 S S 3,834.00 3 3,834.00 3 3.834.00 10000% 3 S 383.40
O #1 Install restraining jofnts on watermaln 1 LS S 2,162.69 S 2,162.69 S S 2,162.69 2,162,69 S S 2,162.69 10000% S 216.27
0 I Add barrel section to adjust for road grade 1 LS 883.85 S 883.85 S S 883.85 S 883.85 S 583.85 10000% S S 8839
0 #1 Relocate main to center of eAsting road 1 LS 5,017.00 S 5,017.00 S 5.017,00 S 5,017.00 S S 5,917.00 100.00'/6 S 501.70
O Adjust sewer main due to gas main relocation 1 EA S 2,687.50 S 2,687.50 S S 2,687,50 S 2,687.50 S 1 2,687.50 100.00% S 3 268475
O #1 Connection of 2" FM, Special Milling to M,H. t IS 1,096.69 S 1,096.69 S S 1,096469 S 1,096.69 S S 111%,69 100.00% S S 109.67
O I Repair of watermain damaged due to Incorrect location 1 IS 2,468480 S 2,468.80 S S 2,468.80 S 2,468.80 S 3 1,468.80 100.00% S 5 246.88
O I Repair of EAsting L.S. leak 1 LS 2,404.23 S 2,404.23 3 S 2,404.23 2,404.23 S S 2,40423 100.00% S S 240.42
,0 I Reimbursement for Irrigation payments made 10 hosWtal 1 LS S (7,826.55 (7,826.58) S S (7,826.53) S 7,826.58) S S (7,826.38) 100.00% S 3 782.6
TOTAL BID PACKAGE VALUE S 510,610.29 1 S 1 510,610.29 1 S 510,610.29 1 S S S 510,610.29 100.00% S 0.00 S 51,061.03
Previously requested: 46,061.03
This pay request: S 5,000
AFFIDAVIT AND WAIVER OF LIEN
0 Final Partial Payment to Follow
STATE OF INDIANA
County of HANCOCK
Karen Horth Powers being duly sworn states that she/he is the President of Central Engineering
Construction Associates, Inc. having contracted with The City of Carmel to furnish certain
materials and/or labor as follows sanitary sewer extension for a Project known as Little Cool
Creek Interceptor, Contract 53 located in Carmel, IN 46032 and owned by The City of Carmel
and does further state
PARTIAL WAIVER: that the final balance due from the owner is the sung of Dollars
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 from the owner is the sum of Five Thousand and
00 /100 Dollars ($5,000.00)
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 shall become
effective upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all
lien or claim 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.
e Horth Powers
President
Title
Witness My Hand and Notarial Seal, this 15 day of Apri l 2008.
Notary Public
U -Ching Wu
Notary Public —Printed Signature
My Commission Expires
April 21, 2008
County of Residence
Hamilton
VOUCHER 085319 WARRANT ALLOWED
358944 IN SUM OF
CENTRAL ENGINEERING CONSTRU
j 962 N COMMERCIAL PARKWAY
GREENFIELD, IN 4610
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
8 09- 1050 -65 $40,6
(p�
%Ay Voucher Total 4.09
..Cost distribution ledger classification if
claim paid under vehicle highway fund
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 of service rendered, by whom, rates per day, number of units,
price per unit, etc.
Payee
358944
CENTRAL ENGINEERING CONSTRUCTION Purchase Order No.
3862 N COMMERCIAL PARKWAY Terms
GREENFIELD, IN 46140 Due Date 4/21/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/21/2008 8 $40,624.09
hereby certify that the attached invoice(s), or bill(s) is (are) true and
;orrect and I have audited same in accordance with IC 5- 11- 10 -1.6
Date fficer