155244 01/10/2008 CITY OF CARMEL, INDIANA VENDOR: 358944 Page 1 of 1
ONE CIVIC SQUARE CENTRAL ENGINEERING CONSTRUC p VCK AMOUNT: $20,530.51
CARMEL, INDIANA 46032 3862 N COMMERCIAL PARKWAY
GREENFIELD IN 46140 CHECK NUMBER: 155244
CHECK DATE: 1/10/2008
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
654 5023990 7 20,530.51 OTHER EXPENSES
APPLICATION AND CERTIFICATE FOR PAY_ MENT AL4 DOCUMENT G702
TO: City of Carmel, IN PROJECT: Little Cool Creek Interceptor APPLICATION: Seven
Contract 53
Carmel, IN PERIOD TO: 12/14/07`
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, ATA Document G703, as attached.
CHANGE ORDERS APPROVED IN 1. CONTRACT SUM 469,9$6.20
PREVIOUS MONTHS BY OWNER ADDITIONS DEDUCTIONS 2. Net Change by Change Order 40,624.09
TOTAL S 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
NITMBER DATE APPR'D 5. Retainage of Completed Work: 5,000.00
6. Total Earned Less Retainage 505,610.29
7. Less Previous Certificates for Payment 485,079.78
8. Current Payment Due 20,530.51
TOTAL: S 40,624.09 S 9. Balance to Finish, Plus Retainage (line 3 less line 6) S 5,000.00
NET CHANGE BY C.O. 40,624.Q9
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 day of �)X �e YY\ .2007
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
B Date: to any rights of the Owner or Contractor under this Contract.
ren north Powers, President
ENGINEER'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED
In accordance with the Contract Documents, based on on -site observations (Attach explanation ;f amount certified differs from the amount applied for.)
and the data comprising the above application, the Engineer certifies to the ENGINEER
Owner 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 By. Date: l Z ZD�t�7
with the Contract Documents, and the Contractor is entitled to payment of the This Certificate 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 any rights of the Owner or Contractor under this Contract
fA Dacomco( 13702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing a Coal Cree Interceptor, Contract 53, Cara
Contractor's signed Certification is attached. In tabulations below, amosats are staled to the APPLICATION DATE: 1 1 /19200 7
nearest dollar. Use Column I oo Contracts where variable retainage for fine items may apply. PERIOD T0: I /112007
ENGINEER'S PROJECT NO.:
D E
A B C WORK COMPLETED F G H J
PAY STORED TOTAL
LINE ORIGINAL CURRENT PREVIOUS BALANCETO
ITEM DESCRIPTION OR WORK QTY UNIT' LfNii PRICE SCHEDULED Will COMPLETED COMP DUL6D ORDERS OF APRLCTN 7HI5 PERIOD FINISH RETAINAGE
VALUE OF VALUES (D+ E) (NOT IN D OR STORED TO (G /C) (C G) 10%
I Mobilization I LS E) RATE
S 30,841 S 30,840.00 S S 30,840.00 S 30,840.00 S S 30.840.00 100.0 S 30X4.00
2 Audio -Video Recording I LS 1,586.00 S 1,58690 S S 1,586.00 S 1,586.00 S 1.5216 00 IODO% S S 118.1"
3 Erosion control I LS S 9,456.00 S 9,456.00 S 9456,00 1 9,456,0 9,456.00 1000% S 5 945.6u
4a 10-In PVC SDR 35 1500 LF 62.78 S 94,170,00 94.170.00 S 94,170.00 S S 94,170.00 10000% S S 7,41700
4b 18 -in PVC 1430 LF S 70.95 101,458.50 S S 101,458.50 S 101458,50 S 5 101,4500 1110,00% S S 11,145,X5
5 Stream Crossing I LS S 9,14300 9,143.00 S S 9,143,00 S 9,143.00 S 9,143.00 100.1706, S 914.30
6 Sprinkler Replacement 100 LF S 16.69 S 1.669.00 S 1 1,669,00 1,669.00 S S 1,66900 1011.00% 0.017 S 166,90
7 Bored Casing 306 LF S 314.45 96,221.70 S S 96,221.70 96,221.70 S S 96,221.70 100.00% S S '1,622.17
8a Manholes 7 EA 3,874.50 S 27,121.50 S S 27,12L50 S 27,121.50 S 27,12150 100.00% S S 2,712. t5
Bb Manhole Drop (External) i EA S 5,488.00 S 5,488,00 S 5,488.00 5,488.00 S 5,488.0 100. mm S 548,80
9a Abandon Pump Station #I I LS S 9,45500 S 9,455,00 S S 9,455,00 S 9,455.00 S S 9,455,00 100,0% S S 945,50
9b Abandon Pump Station #2 1 LS S 15,821.0 S 15,821.00 S 15,821.0 15,82100 S S 15,821.00 100.0% S S 1,582.16
9c Reconfigure Manhole #I I LS 1,796,50 S 1,796.50 S 1,796.50 S 1,796,50 S S 1,796.50 100.00% S S 179.65
10 Special 8ockfill 1100 Cy 8.12 S 8,932.00 S S 8,73200 S 8,932.00 S 8,932.00 100.00% S X93.20
11 Dewatering I LS S 42,242.0 S 42,242.00 S 42,242.00 42,242.00 S S 42.242.00 100,011% S S 4,224.20
12. Sidewalk 200 SF S 8.34 S 1,668,00 S S 1.66800 1,668.00 S S 1,668,00 1017,00% 5 1 166,80
12b Curb Gutters 40 LF S 41.70 S t,668.00 S S 1,668.00 S 1,668 Off S S 1,668.0 100,00% S 166.30
13a Seed 300 Sy S 0.75 S 2,251 S S 2.250.00 S 2,250.00 S 2,250. 00 100.00% 5 225 Oo
!3b Sod 1800 Sy S 500 S 9,0000 S 9,00,00 9,00000 5 9,000.00 100.00% S 100.0
O I Manhole for Stu k3 *50 1 EA S 31174,50 S 3,874,50 S S 3,X74.50 S 3.974 50 S 3,0c% 1000("/0 S S 387,45
O 41 Cori 2" FM to MH I EA S 3,054.0 S 3.054.00 S 3,054.00 S 3,054 00 S 3,054.00 100.00°, S 305,40
O #1 8 Bedding between M 1-0 and M 1 -2 1 LS 5,640.00 S 5 640.0 S 5,640.0 S 5,640.00 S S 1,640.00 100.00% S 5 56400
O #1 Remove buried concrete struc. within french line I LS 5,663,91 S 5,663.91 S 5,663,91 S 5,663.91 S S 5,663.91 100.00", S 5 566.39
O# I Adjustment for final gtys I EA S 9,663,50 S 9663.50 S S 9,663.50 9,66350 S S 9663.50 10.OQ% S 966,35
O #1 Install flat top onThistlewood LS I EA S 3,834,00 3,83400 S S 31134.00 S 3,834,00 S S 3,834,00 10.00% S S 30.40
O #1 Install restraining joints on watermciin I L5 S 2,162.69 S 2,11 S 2,162.69 S 2,162.69 1 S 2,162.69 100.00% 216.27
O 01 Add barrel section to adjust for road grade 1 0 S 883.85 S 883.85 S 883.85 S 883.85 S S 8X3,85 1000(7% S 9X.39
O #1 Relocate main to center of existing road I LS 5,017 00 S 5,017.00 S 5,017.0 S 5,017.00 S 5017.00 100,00% S S 5(1.717
O #1 Adjust sewer main due to gas main relocation I EA S 2,687,50 S 2,6s7.50 S S 2,687,50 2,687.50 S S 2,687,50 1170.00 S S 26X.75
O I Connection of 2 FM, special litfing to M.H. I LS S 1,06.69 S 1,096.69 S S 1,06.69 1,09669 1 S I,U96.69 1110.0% S S 1W. 67
O If I Repair of wolermain damaged due to incorrect location I LS S 2,468.80 S 2,468.80 S 1 2,468.80 S 2468.80 S S 2,468,80 100.0% S S 246.89
O 1 Repair of Existing L.S. leak I L$ S 2.404.23 S 2,404.23 S 2,404.23 S 2,404.23 1 S 2404.23 100.00% S 2411.42
O I Reimbursement for Inlgation payments made to hospital t LS S (7,826.58) (7,826,58) S 5 (7,81 S (7826.58) 1 (7,826.58) 100(P/. S (782.66)
TOTAL BID PACKAGE VALUE S 510,610.29 1 S S 510,610,29 S 510,6!0.29 S S S 510,610.29 100.00% S 0.0 S 51,D61.03
Previously requested: S 25,530.52
This pay request: S 20,530.51
1•
AFFIDAVIT AND WAIVER OF LIEN
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 sum of Twenty Thousand
Five Hundred Thirty and 51 /100 Dollars ($20,530.51)
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 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 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.
aren Horth Powers
President
Title
Witness My Hand and Notarial Seal, this Onay of December 2007.
Notary Public
Li -China Wu
Notary Public Printed Signature
My Commission Expires
April 21, 2008
County of Residence
Hamilton
VOUCHER 076946 WARRANT ALLOWED
358944�� IN SUM OF
,CENTRAL ENGINEERING CONSTRU
'3862 N COMMERCIAL PARKWAY
"GREENFIELD, IN 46140
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
7 09- 1050 -65 $20,530.51
Construction
o A4
-1) Voucher Total $20,530.51
-.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
!r
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 12/28/2007
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/28/200; 7 $20,530.51
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
r�
Date f1 r