166792 12/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1
ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC
a 0 CHECK AMOUNT: $119,584.00
CARMEL, INDIANA 46032 PO BOX 2533
a� ao ANDERSON IN 46018 CHECK NUMBER: 166792
CHECK DATE: 12/10/2008
D= PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
654 R5023990 S10726 12 119,584.00 CONSTRUCTION
i
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ON OF PAGES
TO (OWNER): City of Carmel PROJECT: Blower /Electrical Modification APPLICATION NO: Twelve(12)Distribution to:
One Civic Square Contract 60 OWNER
Carmel, IN 46032 PERIOD TO: 10 31" =08 ARCHITECT
CONTRACTOR
FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
Contracting,.Inc.
CONTRACT FOR: Invoice No. 07 -262. 12 CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT
Applic n Sh et,fAIA Document G703, a c"hedcDnnection with the Contract.
CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM 5 2,349 ,000.00
Change Orders approved in I ADDITIONS DEDUCTIONS 2. Net change by Change Orders 295 ,205.00
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) S 2,
TOTAL 4. TOTAL COMPLETED STORED TO DATE 2,016
Approved this Month (Column G on G703)
Number Date Approved S. RETAINAGE:
a. of Completed Work
CO#1 $302,815.00 7,610.00 (Column D E on G703)
b. of Stored Material
(Column F on G703)
Total Retainage (Line 5a 5b or
TOTALS $302 7,610.00 Total in Column I of G703) S 132,210.25
6. TOTAL EARNED RETAINAGE 1,884
vet Chan e by Change Orders $295, 205.00
The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total)
information and belief the Work covered by this Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR
completed in accordance with the Contract Documents, that all amounts have been PAYMENT (Line 6 from prior Certificate)......... S 1
paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE g 119,584.00
issued and payments received from the Owner, and that current payment shown 9 BALANCE TO FINISH, PLUS RETAINAGE 5 759,830.72
herein is now due. (Line 3 less Line 6)
CONTRACTOR: M. K. Betts Engineering Contracting, Inc.. State of: Indiana County of: 1Iadison
Subscribed and sworn to before me this 31st day of Oct. 2008
Notary Public: e"
By: Date: October 31, ,2008 My Commission expires: October 28 201.5
ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED S pP
(Attach exp lanation If amount certified differs from the amount a fora
In accordance with the Contract Documents, based on on -site observations and the ARCHITECT:
data comprising the above application, the Architect certifies to the Owner that to the
best of the Architect's knowledge, information and belief the Work has progressed as Bv: Date: 1a��
indicated, the quality of the Work is in accordance with the Contract Documents, and This Certificate is not negotiable. The AvtOUNT CERTIFIED is payable only to the
the Contractor is entitled to payment or the AMOUNT CERTIFIED. Contractcr named herein. Issuance, payment and acceptance of payment are without
prejud to any rights of th Ow n e r o r COnrraCTor under this Contract.
AIA DOCUMENT 0702 APPLIC?,TIC u AND CERTIFICATE FOR PAY.VE.VT MAY 19ti EDITION AIA' 1981
CONTINUATION SHEET AIA DOCUh1ENT 0703 Car Cont ract 60 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Twelve 12
Contractor's signed Certification is attached. APPLICATION DATE: October 31, 2008
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 10 -01 -08
Use Column I on Contracts where variable retainage for line items may apply. TO: 10 31 -08
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WORK COMPLETED —TOTAL COMPLETED
ITEM DESCRIPTION OF WORK SCHEDULED This Application AND STORED a o BALANCE RETAINAGE
`:o. VALUE TO FINISH
Previous Stored Materials TO DATE (G =C) (C —G)
Applications Work in Place (not in D or E) fD +E) F)
1. Mobilization, Bond
Insurance 75,000.00 55,000.00 7,000.00: -0- 62,000.00 83 13,000.00
2. Generator Pad Platfor .40,000.00 40,000.00 -0- -0- 40,000.00 1100 -0-
3. Generator 272,000.00 261,000.00 11,000.00 -0- 272,000.00 100 -0-
4. Launder Covers 160,000.00 160,000.00 -0- -0- 160,000.00 100 -0-
5. Switch Gear Building 39,000.00 39,000.00 -0- -0- 39,000.00 100 -0-
6. Masonry 78,000.00 61,800.00 -0- -0- 61,800.00 80 16,200.00
7. Roofing Sheetmetal 14,000.00 14,000.00 -0- -0- 14,000.00 100 -0-
8. Doors, Frames
Hardware 16,000.00 16,000.00 -0- -0- 16,000.00 100 -0-
9. Aeration Tank work 40,000.00 39,000.00 1,000.00 -0- 40,000.00 100 -0-
1.0. Valves 10,000.00 9,600.00 400.00 -0- 10,000.00 100 -0-
11. Blower Bldg Phase.I 90,000.00 77,800.00 7,700.00 -0- 85,500.00 95 4,500.00
1.2. Blower Bldg Phase 11 35,000.00 6,128.26 -0- -0- 6,128.26 18 28,871.74
1.3. Pipe Insulation 5,400.00 -0- -0- -0- -0- 00 5,400.00
14. Acoustical Ceilings! 21,000.00 -0- -0- -0- -0- 00 21,000.00
1.5. Roll Up Doors 7,100.00 -0- -0- -0- -0= 00 7,100.00
16. Signs Fire
Extinguishers 1,500.00 -0- -0- -0- -0- 00 1,500.00
17. Instrumentation 90,000.00 19,621.30 -0- -0- 19,621.30 22 70,378.70
AIA DOCUMENT 6703 CONTINUATION SHEET APRIL 1978 EDITION AIA'- U 1978
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON'. D.C. 20006 G703 1978
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
351429
M.K. BETTS ENGINEERING CONTR Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 12/8/2008
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
12/8/2008 12 $119,584.00
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 er
VOUCHER 086864 WARRANT ALLOWED
351429 IN SUM OF
M. K. BETTS ENGINEERING CONTR
P.O. Box 2533
Anderson, IN 46018
Carmel Wastewater Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
12 07- 1050 -61 $119,584.00
P
�t CPS
Voucher Total $119,584.00
Cost distribution ledger classification if
claim paid under vehicle highway fund
C ONTINUATION S AIA DOCUMENT 0703 Carmel Contract 60 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Twelve (12)
Contractor's signed Certification is attached. APPLICATION DATE: October 31, 2008
In tabulations below, amounts are stated to the nearest dollar. PERIOD-FROM: 10 01 08
Use Column I on Contracts where variable retainage for line items may apply. TO: 10 -31 -08
ARCHITECT'S PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED
TOTAL COMPLETED BALANCE RETAINAGE
This Application AND STORED °o
`;o. VALUE Previous TO DATE (G =C TO FINISH Applications Work in Place Stored Materials (not in D or E) (D +E +F) (C G)
1.8. Control Commissioning 56,000.00 -0- -0- -0- -0- 00 56,000.00
19. Software Allowance 25,000.00 -0- -0- -0- -0- 00 25,000.00
20. HVAC 92,000.00 77,833.0 2,500.0 -0- 80,333.00 88 11,667.00
21.. Electrical 11.24,000.00 899,353.97 71,600.0 -0- 970,953.97 87 153,046.03
22. Painting 13,000.00 -0- 8,684.00 -0- 8,684.00 67 4,316.00
23. Miscellaneous 45,000.00 20,300.00 5,200.00 -0- 25,500.00 57 19,500.00
CO #1 Change Order No. 1
1. Eliminate EUH04,5,6 7,610.00 7,610.00 -0- -0- 7 100 -0-
2. Suspended Solids
Meter #10 4,992.00 -0- 4,500.00 -0- 4,500.00 91 492.00
3. PMQII Meter Plant
Feed 7,357.00 7,357.00 -0- -0- 7,357.00 100 -0-
4. Addition PMQII
Metering 3,445.00 3,445.00 -0- -0- 3,445.00 100 -0-
5. Misc. Electrical
Blower Building 508.00 508.00 -0- -0- 508.00 100 -0-
6. Solar Drying
Supplemental Heat 282,955.00 93,500.00 -0- -0- 93,500.00 33 189,455.00
7. Electrical Prat to
Aeartion 1,679.00 1,485.00 -0- -0- 1,485.00 89 194.00
AIA DOCUMENT G703 CONTINUATION SHEET APRIL 3978 EDITION AIA' U 1978
THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON. D.C. 70006 G703 1978
CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Twelve (12
Contractor's signed Certification is attached. APPLICATION DATE: October 31, 2008
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 10 -01 -08
Use Column I on Contracts where variable retainage for line items may apply. TO: 10 -31 -08
ARCHITECT'S PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED
VALUE This Application TOTAL COMPLETED BALANCE RETAINAGE
PP AND STORED TO FINISH
Previous Stored Materials TO DATE (G -C) (C —G)
Applications Work in Place (not in D or E) (D +E +F)
8. Remove Concrete
Lining Aeration
Tank #10 500.00 500.00 -0= 0 500.00 100 0-
9. Condenser Support
Trenwa 1,185.00 1,185.00 -0- -0- 1,185.00 100 -0-
10. Metal Halide Lights
Fixture ••C•' 194.00 194.00 -0- -0- 194.00 100 -0-
2644,205.00 1897,000.53 119,584.00 -0- 2016,584.53 77 627,620.47 132,210.2
AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIA't CU 1978
THE Ah ",'RICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W.. WASHINGTON. D.C. 20006 G703 1978