The URL can be used to link to this page

Home My WebLink About160462 06/10/2008 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1 •r ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $488,335.39 CARMEL, INDIANA 46032 PO BOX 2533 ANDERSON IN 46018 CHECK NUMBER: 160462 CHECK DATE: 6/10/2008 DEPAR A CCOU NT PO NUMBER INVOICE NUMBER AMOUNT D 654 5023990 10 17,320.00 1050.79 654 R5023990 S10726 6 471,015.39 CONSTRUCTION r i I i s APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 0702 iinstructions on reverse side) PAGE ONE OF PAGES TO (OWNER): City of Carmel PROJECT: Blower/ Electrical Modification APPLICATION NO: Six (6) Distribution to: One Civic Square Contract 60 F_ OWNER Carmel, IN 46032 PERIOD TO: 04 30 08 ARCHITECT C CONTRACTOR FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C M. K. Betts Engineering PROJECT NO: L Contracting, Inc. CONTRACT FOR: Invoice No. 07 -262. 0 6 CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT Continua ion Sh et, Document G7 att ched connection with the Contract. CHANCE ORDER SUMMARY j 1. ORIGINAL CONTRACT SUM S 2, 349,000.00 Change Orders approved in I ADDITIONS DEDUCTIONS 2. Net change by Change Orders 5 —0— previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) S 2,349,000.00 TOTAL 4. TOTAL COMPLETED STORED TO DATE 5 690 ,844.33 Approved this Month (Column G on G703) 5. RETAINAGE: Number Date Approved a 10 of Completed Work 5 60,149.39 (Column D E on G703) b. 1 0 of Stored Material 5 8,935.04 (Column F on G703) Total Retainage (Line 5a 5b or TOTALS Total in Column I of G703) 5 69,084.43 Net than e by Change Orders 6. TOTAL EARNED LESS RETAINAGE S 621 ,759.90 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) 5 150, 744.51 paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT.-DUE S 471,015.39 issued and ayments received from the Owner, and that current payment shown 1 p p y 9. BALANCE TO FINISH, PLUS RETAINAGE 5 herein is now due. (Line 3 less Line 6) CONTRACTOR: M. K. Betts Engineering Contracting, Inc. State of: Indiana County of: Madison Subscribed and sworn to before me this 30th day of April 2008 Notary Public: 2 By: r Date: April 30, 2008 My Commission expires: October 28 201.5 AMOUNT CERTIFIED 5 ARCHITECT'S CERTIFICATE FOR PAYMENT (Attach explanation if amount certified differs from the amount applied rbr.) 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: indicated, the quality of the Work is in accordance with the Contract Documents, and This Certificate is not negotiab e. e AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMFNT G7(1: •.�,PPUCATI( AND CERTIFIC+ \Tf. FnR Pm'.vE\,'7 \tAV 1484 CDITION alA' I178} i CONTINUATION SHEET AIA D OCUME NT 0 Carmel Contract 60 P AGE OF P AGE AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Six 6 Contractor's signed Certification is attached. APPLICATION DATE: April 30, 2008 In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 04 -01 -08 Use Column I on Contracts where variable retainage for line items may apply. TO: 04 -30 08 ARCHITECT'S PROJECT NO: A B C D E F G H WORK COMPLETED t OTAL COMPLETED ITEM DESCRIPTION OF WORK SCHEDULED BALANCE RETAINAGE ^'o. VALUE This Application AND STORED TO FINISH Previous TO DATE (G =C) Stored Materials C —G) Applications Work in Place (not in D or E) (D +E +FI 1. Mobilization, Bond Insurance 75,000.00 25,000.00 3,000.00 0 28,000.00 38 47,000.00 2,800.0( 2. Generator Pad Platforr 40,000.00 5,250.00 5,500.00 0 10,750.00 27 29,250.00 1,075.0( 3. Generator 272,000.00 -0- 255,000.00 -0- 255,000.00 94 17,000.00 25,500.0( 4. Launder Covers 160,000.00 -0- 40,000.00 86,250.00 126,250.00 79 33,750.00 12,625.00 5. Switch Gear Building 39,000.00 12,400.00 17,500.00 -0- 29,900.00 77 9,100.00 2,990.00 6. Masonry 78,000.00 -0- 28,000.00 -0- 28,000.00 36 50,000.00 2,800.00 7. Roofing Sheetmetal 14,000.00 -0- -0- -0- -0- 00 14,000.00 -0- 8. Doors, Frames Hardware 16,000.00 -0- -0- -0- -0- 00 16,000.00 -0- 9. Aeration Tank Work 40,000.00 -0- -0- 3,100.43 3,100.43 08 36,899.57 310.04 10. Valves 1.0,000.00 6,615.00 -0- -0- 6,615.00 67 3,385.00 661.50 11 Blower Bldg Phase I 90,000.00 28,415.92 1,750.00 -0- 30,165.92 34 59,834.08 3,016.59 12. Blower Bldg Phase II 35,000.00 4,878.26 250.00 -0- 5,128.26 15 29,871.74 512.83 13. Pipe Insulation 5,400.00 -0- -0- -0- -0- 00 5,400.00 -0- 14. Acoustical Ceilings 21,000.00 -0- -0- -0- -0- 00 21,000.00 -0- 1.5. Roll Up Doors 7,100.00 -0- -0- -0- -0- 00 7,100.00 -0- 16. Signs Fire Extinguishers 1,500.00 -0- -0- -0 -0- 00 1,500.00 -0- 17. Instrumentation 90,000.00 19,621.30 19,621.30 22 70,378.70 1,962.13 J AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIA' J 1978 THE .�ti'.ERiC7.�' 1NSTI Or .RC'I:IT,CTS. 1735 :NEw vn3, ;,vc w .v. 1L I: CONTINUATION SHEET AIA DOCUMENT 0703 Carmel Contract 60 PAGE AAA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION `UMBER: Six (6) Contractor's signed Certification is attached. APPLICATION DATE: April 30, 2008 In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 04 -01 -08 Use Column I on Contracts where variable retainage for line items may apply. TO: 04 -30 08 ARCHITECT'S PROJECT NO: A B C D E F G H ITEM DESCRIPTION WORK COMPLETED T OTAL COMPLETED OF WORK SCHEDULED This Application AND STORED BALANCE RETAI`'-�GE ^:o. VALUE pp TO FINISH Previous TO DATE (G =C) Applications Work in Place Stored Materials (D +E +F) C —G) (not in D or E) 18. Control Commissioning 56,000.00 -0- -0- -0- -0- 00 56,000.00 -0- 19. Software Allowance 25,000.00 -0- -0- -0- -0- 00 25,000.00 -0- 20. HVAC 92,000.00 33,633.00 -0- -0- 33,633.00 37 58,367.00 3,363.30 21. Electrical 11.24,000.00 31,680.42 83,000.00 -0- 114,680.42 11 1009,319.58 11,468.041 i 22. Painting 13,000.00 -0- -0- -0- -0- 00 13,000.00 -0- 23. Miscellaneous 45,000.00 -0- -0- -0- -0- 00 45,000.00 -0- f I I 1 2349,000.00 167,493.90 434,000.00 89,350.43 690,844.33 30 1658,155.67 69,084.43 AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION .CIA' v 1978 THE A,v.:RIC INSTITUTE OF ARCHITECTS. 1735 .N'EI.v vOR'd �i Branch Account Salesperson Invoice Date Invoice Number 430 082615 LARRY SHIREMAN 4/04/08 6680479 Local Service, Nationwide Remit to: HDSWW INDIANAPOLIS IN -W Branch 430 HD SUPPLY WATERWORKS, LTD. 168 Exo Indianapolis 46214 INVOICE Chicago 60693 -1036 317/271 -1463 T otal Amount Due Shipped to: CARMEL W.W.T.P. 2,828.53 MK BETTS ENGINEER CONTRACTOR 005/0038 9609 HAZEL DELL PARKWAY PO BOX 2533 01541 INDIANAPOLIS, IN ANDERSON IN 46018 2533 Thank You For The Opportunity To Serve You. Return Top Portion With Payment For Faster Credit IVe appreciate your prompt payment. Date Ordered Date Shipped Customer PO No. Job Name Job No. ill of Ladin Shipped Via Order Number 1/25/08 1 4/03/08 CARMEL W. W. T. P. d ZOO 4 Our Truck 6680479 Product Code Descri lion Quantit uanmy Back price Per Amount P Ordered Sipped Ordered 2406FB 6 BLIND FLANGE DI C110 2 2 36.53000 EA 73.06 BID SEQ# 150 /20005802109 14X14 MJ TEE UNLINED DI C153 1 1 677.32000 EA 677.32 BID SEQ# 170 21AMF8141400D UFR1400 -D -14 RET. GLAND DIP 3 3 68.82000 EA 206.46 FORD WEDGE ACTION BID SEQ# 180 21AMG114 14" MJ REGULAR GASKET F /DI 3 3 7.81000 EA 23.43 BID SEQ# 190 21AMB10745CT 3/4X4 -1/2 COR -TEN T -HEAD B N 30 30 1.85000 EA 55.50 BID SEQ# 200 /20005802120 14 MJ L/P SLEEVE UNLINED C153 1 1 266.68000 EA 266.68 BID SEQ# 220 21AMF8141400D UFR1400 -D -14 RET. GLAND DIP 2 2 68.82000 EA 137.64 FORD WEDGE ACTION BID SEQ# 230 Terms Subtotal Freight Delivery Handling Restock Mise Tax Invoice Total CONTINUED THANK YOU FOR YOUR ORDER VISIT Pleasc pa) this amount WATERWORKS.HDSUPPLY.COM FOR OTHER SERVICES OFFERED HDSWW INDIANAPOLIS IN -W Branch 430 1680 Expo Lane Page: 1 Indianapolis IN 46214 Branch Account Salesperson Invoice Date Invoice Number 430 082615 LARRY SHIREMAN 4/04/08 6680479 Local Service, Nationwide Remit to: HDSWW INDIANAPOLIS IN -W Branch 430 N HD SUPPLY WATERWORKS, LTD. Indianapo 46214 INVOICE V ®IC Chicago9 60693 -1036 317/271 -1463 Total Amount Due Shipped to: CARMEL W.W.T.P. 2,828.53 MK BETTS ENGINEER CONTRACTOR 005/0038 9609 HAZEL DELL PARKWAY PO BOX 2533 01541 INDIANAPOLIS, IN ANDERSON IN 46018 2533 Thank You For The Opportunity To Serve You. Return Top Portion With Payment For Faster Credit If'e appreciate your prompt payment. Date Ordered Date Shipped Customer PO No. Job Name Job No. Bill of Ladin Shipped Via Order Number 1/25/08 1 4/03/08 I CARMEL W.W.T.P. Our Truck 6680479 Product Code Descri tio❑ Q"aruity Quanu Back- price Per Amount P Ordered Shipped Ordered 2 1AMG114 14 MJ REGULAR GASKET F /DI 2 2 7.81000 EA 15.62 BID SEQ# 240 21AMB10745CT 3/4X4 -1/2 COR -TEN T -HEAD B N 20 20 1.85000 EA 37.00 BID SEQ# 250 /20005802122 14 MJXPE 90 BEND UNLINED C153 1 1 548.70000 EA 548.70 BID SEQ# 270 21AMF8141114 14 MEGALUG MJ RESTR. BLK 1114 2 2 68.82000 EA 137.64 BID SEQ# 280 21AMG114 14" MJ REGULAR GASKET F /DI 2 2 7.81000 EA 15.62 BID SEQ# 290 21AMB10745CT 3/4X4 -1/2 COR -TEN T -HEAD B N 20 20 1.85000 EA 37.00 BID SEQ# 300 /20005802129 16X14 PEXPE RED UNLINED C153 1 1 411.82000 EA 411.82 BID SEQ# 320 /05005802133 6 FLGXFLG DI PIPE -NEED LENGTHS 1 1 198.53000 EA .00 W/1 11 TAP IN CENTER OF SPOOL BID SEQ# 340 Terms Subtotal Freight Delivery Handling Restock Misc fax Invoice 1`otal CONTINUED THANK YOU FOR YOUR ORDER VISIT Please pay this amount WATERWORKS.HDSUPPLY.COM FOR OTHER SERVICES OFFERED HDSWW INDIANAPOLIS IN -W Branch 430 1680 Expo Lane Page: 2 Indianapolis IN 46214 Branch Account Salesperson Invoice Date Invoice Number 430 082615 LARRY SHIREMAN 4/04/08 6680479 Local Setvice, Nationwide Remit to: HDSWW INDIANAPOLIS IN -W Branch 430 HD SUPPLY WATERWORKS, LTD. 168 Exo Indianapolis 46214 INVOICE Chicago9 60693 -1036 317/271 -1463 Total Amount Due Shipped to: CARME L W. W. T. P. 2,828.53 MK BETTS ENGINEER CONTRACTOR 005/0038 9609 HAZEL DELL PARKWAY PO BOX 2533 01541 INDIANAPOLIS, IN ANDERSON IN 46018 2533 Thank You For The Opportunity To Serve You. Return Top Portion With Payment For Faster Credit fVe appreciate your prompt payment. Date Ordered Date Shipped Customer PO No. Job Name Job No. ill of Ladin Shipped Via Order Number 1/25/08 4/03/08 CARMEL W. W. T. P. Our Truck 6680479 Product Code Description 0 ted Q p orde ed Price Per Amount i /05006257374 6 FLGXFLG DI PIPE -NEED LENGTHS 1 1 169.57000 EA .00 i W/1 "TAP IN CENTER OF SPOOL i A�,� Terms Subtotal NET 30 2 643.49 Freight Delivery Flandling Restock Misc Tax Invoice Total 2, 8 53— THANK YOU FOR YOUR ORDER VISIT Please pay this amount WATERWORKS.HDSUPPLY.COM FOR OTHER SERVICES OFFERED fIDSWW INDIANAPOLIS IN -W Branch 430 1680 Expo Lane Page: 3 Indianapolis IN 46214 v Branch Account Salesperson Invoice Date Invoice Number 430 082615 LARRY SHIREMAN 4/17/08 7046820 Local Service, Nafionwlde Remit to: HDSWW INDIANAPOLIS IN -W Branch 430 HD SUPPLY WATERWORKS, LTD. Indianapolis 46214 INVOICE Chicago9 60693 -1036 317/271 -1463 T otal Amount Due Shipped to: 1111 1111111111111111111111 CARMEL WWTP 488.93 MK BETT S ENGINEER CONTRACTOR 005/0228 96TH HAZELDELL PKWY PO BOX 2533 01731 CARMEL, IN ANDERSON IN 46018 2533 Thank You For The Opportunity To Serve You. Return Top Portion With Payment For Faster Credit fVe appreciate your prompt payment. Date Ordered Date Shipped Customer PO No. Job Name Job No. Bill of Ladin Shipped Via Order Number 4/11/08 4/16/08 I V CARMEL WWTP 7 L L OT 7046820 Product Code Description Q�tit va�tit Back- Price Per Amount P Ordered Sipped Ordered 21AMF8141400D UFR1400 -D -14 RET. GLAND DIP 2 2 68.82000 EA 137.64 FORD WEDGE ACTION 21AMG114 14" MJ REGULAR GASKET F /DI 2 2 7.81000 EA 15.62 21AMB10745CT 3/4X4 -1/2 COR -TEN T -HEAD B N 20 20 1.85000 EA 37.00 21I14S115T 14 MJ L/P SLEEVE(I) CP DI C153 1 1 266.68000 EA 266.68 TAR COAT OUTSIDE BARE INSIDE Terms Subtotal NET 30 456.94 Freight Delivery Handling Restock Misc Tax Invoice Total 4 R8. 53- THANK YOU FOR YOUR ORDER VISIT Please pay this amount WATERWORKS.HDSUPPLY.COM FOR OTHER SERVICES OFFERED r HDSWW INDIANAPOLIS IN -W Branch 430 1680 Expo Lane Page: 1 Indianapolis IN 46214 03458 Invoice: 7046820 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 6/5/2008 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/5/2008 6 $471,015.39 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 df fi c 66 'VOUCHER 085653 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 6 09- 1050 -61 $471,015.39 A.)us:.. 0 1b726 (P� Voucher Total $471,015.39 Cost distribution ledger classification if claim paid under vehicle highway fund APPLICATION AND CERTIFICATE FOR PAYMENT A! DOCUME 0702 (Instructions on reverse side) PACE ONE OF PACES TO (OWNER): City of Carmel PROJECT: Solar Drying APPLICATION NO: Ten (10) Distribution to: One Civic Square Contract 65 OWNER Carmel, IN 46032 Carmel, IN PERIOD TO: 04 30 08 C ARCHITECT CONTRACTOR FROM (CONTRACTOR): VIA (ARCHITECT): ARCHITECT'S r M. K. Betts Engineering Jones Henry Engineers, Ltd. PROJECT NO: Contracting, Inc. CONTRACT FOR: Invoice No. 07- 232.10 CONTRACT DATE: Application is made for Payment, as shown below, in connection with the Contract. CONTRACTORS APPLICATION FOR PAYMENT Continuation Sheet, ALA Document G703, is attached. CHANGE ORDER SUMMARY j 1. ORIGINAL CONTRACT SUM 5 696,450 Change Orders approved in ADDITIONS DEDUCTIONS 2. Net change by Change Orders 5 123,297.00 3. CONTRACT SUM TO DATE (Line 1 2) 819,747 .00 previous mo S nths by Owner 819,747.00 TOTAL 4. TOTAL COMPLETED STORED TO DATE S Approved this Month (Column G on G703) 5. RETAINAGE: Number Date Approved a. of Completed Work S CO #1 $110,499.00 0– (Column D +E on G703) CO#2 12,798.00 0– b. of Stored Material (Column F on G703) Total Retainage (Line 5a 5b or TOTALS 23 $1,297.00 O Total in Column I of G703) S 34,822.50 Net chan e by Change Orders $123,297.00 6. TOTAL EARNED LESS RETAINAGE S 784,924 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 767 604.50 paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 17,320.00 issued and payments received from the Owner, and that current payment shown 9 BALANCE TO FINISH, PLUS RETAINAGE S 34 ,822.50 herein is now due. (line 3 less Line 6) CONTRACTOR: M. K. Betts Engineering Contracting, Inc. State of: Indiana County of: `fadison Subscribed and sworn to before me this 0th day of April 2008 Notary Public' -a Bv: Date: April 30, 2008 My Commission expires: October 28 2015 ARCHITECT'S CERTIFICATE FOR PAYMENT AMOUNT CERTIFIED...... dif f S /Attach explanation if amount t cer tified ied diers from th amount applied roe.; 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: indicated, the quality of the Work is in accordance with the Contract Documents, and This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractcr named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. 4 O0 G:(r_' ?nitC-ATI( i7 rE. F.TIf I('4Tf r(1R Rw •,iF�1 t,\v 1•,q! FpiTi(\,v •in iv!!i N E FCO NEFCO, Incorporated INVOICE 4362 Northlake Boulevard Suite 213 Palm Beach Gardens, FL 33410 4/16/2008 27562 �'t1a t �6 a K •`�4T i 7e r a �'rs'. T; W�-N_ M K Betts Engineering Contracting, Inc. Carmel WWTP Contract 60 Post Office Box 2533 Indianapolis, IN 46280 Anderson, Indiana 46018 k Y M >plRCNASE ORDER; *TERMS �1� E PROEC -Ta�� 4/16/2008 07- 262.03 Net 30 27562 Carmel, IN DESCRIPTION PRICE QTY AMOUNT Launder Cover System 28,750.00 4 115,000.00 DD n 33�r X` h�� x��' e"et "'Y h ,'a Total $1 15,000.00 1.' PHONE FAX EMAIL WEBSITE 561.775.9303 Extension 205 561.775.6043 janice @nefcoinc.com www.nefcoinc.com Prescribed by State Board of Accounts City Form No. 201 (Rev 1995) ACCOUNTS PAYABLE VOUCHED 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 6/5/2008 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 6/5/2008 10 $17,320.00 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 ,i Date fi Wr VOUCHER 085652 WARRANT ALLOWED 3 -51429 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 10 09- 1050 -79 $17,320.00 �G Voucher Total $17,320.00 Cost distribution ledger classification if claim paid under vehicle highway fund CONTINUATION SHEET AIA DOCUMENT 0703 Carmel WWTP Sola Dry ing Contract 65 PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ten (10) Contractor's signed Certification is attached. APPLICATION DATE: April 30, 2008 In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 04 -01 -08 i Use Column I on Contracts where variable retainage for line items may apply. TO: 04 -30 -08 ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED TOTAL COMPLETED ITE,m DESCRIPTION OF WORK SCHEDULED This Application AND STORED BALANCE RETAINAGE ^:o. VALUE Previous TO DATE (G C) TO FINISH Applications Work in Place Stored Materials (not in D or E) (D +E +F) IC —G) 1, Mobilization, Bond Insurance 2.0,000.00 20,000.0 -0- -0- 20,000.00 100 -0- 2. Topsoil Embankment 850 cy $15.66/cy 13,311.00 13,311,00 -0- -0- 13,311.00 100 -0- 3. Removal of Biosolids 1.1.00 cy $6.48/cy 7,128.00 7,128.00 -0- -0- 7,128.00 100 -0- 4. Excavation, fill embankment 5900 cy $6.48/cy 38,232.00 38,232.00 -0- -0- 38,232.00 100 -0- 5. Site Demo, Piping, Etc. 79,000.00 77,435.00 1,565.0 -0- 79,000.00 100 -0- 6, Building Exc. Backfill 45,000.00 45,000.00 -0- -0- 45,000.00 100 -0- 7, Concrete Drying Bldg and Control 237,000.00 237,000.00 -0- -0- 237,000.00 100 -0- 8. Dock Extension 6,250.00 6,250.00 -0- -0- 6,250.00 100 -0- 9. Building Erection 84,200.00 84,200.00 -0- -0- 84,200.00 100 -0- 10. Hot Water Piping 33,800.00 33,800.00 -0- -0- 33,800.00 100 -0- 11, Waterlines 1.3,450.00 13,450.00 -0- -0- 13,450.00 100 -0- 12. Miscellaneous 7,579.00 7,579.00 -0- -0- 7,579.00 100 -0- 1.3. Asphalt Paving 24,000.00 24,000.00 -0- -0- 24,000.00 100 -0- 1.4. Electrical 87,500.00 87,500.00 -0- -0- 87,500.00 100 -0- AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIAt CJ 1978 r THE AMERICAN INSTITUTE OF ,ARCHITECTS, 1735 NEW YORI AVE., N.W.. WASHINGTON. D.C. 20006 197R CONTINUATION SHEET AIA DOCUMENT 0703 PAGE OF ?'G 5 AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ten 10) Contractor's signed Certification is attached. APPLICATION DATE: April 30, 2008 In tabulations below, amounts are stated to the nearest dollar. PERIOD FROIvt: 04 -01 08 Use Column I on Contracts where variable retainage for line items may apply. TO: 04 30 08 ARCHITECT'S PROJECT NO: A B C D E F G H I T E.vt DESCRIPTION Of WORK SCHEDULED WORK COMPLETED T OTAL COM o PLETED BALANCE FETAIN'NGE E p. VALUE This Application AND STORED TO FINISH Previous TO DATE G Cl Applications Work in Place Stored Materials (D +E +FI C —G) (not in O Or E) 15. Change Order No. 1 1. Backflow Preventor piping, found, etc 26,500.00 26,500.00 -0- 0- 26,500.00 100 -0- 2. Dock Lights 5,740.00 5,740.00 -0- -0- 5,740.00 100 -0- 3. Heating lines and Conduit 48,000.00 48,000.00 -0- -0- 48,000.00 100 -0- 4. 40 Amp Breaker 2,755.00 -0- 2,755.00 -0- 2,755.00 100 -0- 5. MCC Cover at Centri. 748.00 748.00 -0- -0- 748.00 100 -0- 6. Relocate Fence at firing range 1,256.00 1,256.00 -0- -0- 1,256.00 100 -0- 7. Additional Asphalt 22,780.00 9,780.00 +13,000.00 -0- 22,780.00 100 -0- 8. Remove Lift Station Structure 1,100.00 1,100.00 -0- -0- 1,100.00 100 -0- 9. Contour Eorth Edge of Lagoon 1,620.00 1,620.00 -0- -0- 1,620.00 100 -0- 16. 1. Excavation, fill embankment 1975 cy $6.48 12,798.00 12,798.00 -0- -0- 12,798.00 100 -0- 819,747.00 1 802,427.00 17,320.00 -0- 819,747.00 100 -0- 34,822.50 AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIA'- 1978 IV1T!-1�TE C�F'�RC: ^:I TrCTS. -,7 35 \ENV Yn K AVE.. .NAVN INA1HIVf,T.n`: