177602 09/29/2009 CITY OF CARMEL, INDIANA VENDOR: 358944 Page 1 of 1
ONE CIVIC SQUARE CENTRAL ENGINEERING CONSTRUCT1p�I
CARMEL, INDIANA 46032 3862 N COMMERCIAL PARKWAY CHECK AMOUNT: $11,686.00
GREENFIELD IN 46140
«o� CHECK NUMBER: 177602
CHECK DATE: 9/2912009
D EPART MENT AC PO NUMBER INVOIC NUMBER AMO UNT DESC RIPTION
W 106 R5023990 19616 6111 11,686.00 FOUNDERS PARK PHASE 1
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT
TO (OWNER): PROJECT: Founders Park Infrastructure Phase 1 APPLICATION NO. 8 DISTRIBUTION TO:
Carmel/ Clay Board of Parks and Recreation OWNER XX
Attn.: Mark Westermeier
1411 East 116th Street VIA (ARCHITECT): PERIOD TO: 8127/2009
Carmel, IN 46032
FROM: Central Engineering 8 Construction Associates, Inc. ARCHITECT'S
3862 N. Commercial Parkway S i 9 PROJECT NO:
Greenfield, IN 46140 r
CONTRACT FOR: SITE IMPROVEMENTS CONTRACT DATE: 22- May -08
r
Application made for Payment, as shown below, in connection
CONTRACTOR'$ 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 49,985.00 16,100.00 4. TOTAL COMPLETED STORED TO DATE $1,046,065.00
Approved this Month (Column G)
No. Date Approved 5. RETAINAGE:
a. of Completed Work $54,227.20
(Column D +E)
b. of Stored Material
(Column F) $0,00
TOTALS 49,985.00 16,100.00 Total Retainage (Line 5a +5b) or $54,22720
Net Change by Change Orders (Total in Column 1)
$33,885.00 6. TOTAL EARNED LESS RETAINAGE $991,837.80
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 $980,151.80
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 $11,686.00
for which previous Certificates for Payment were issued and payments 9. BALANCE TO FINISH, PLUS RETAINAGE $57,765.20
received from the Owner, and that current payment shown herein is (Line 3 less Line 6)
now due.
CONTRACTOR: CENTRAL ENGINEERING CONSTRUCTION ASSOC., INC.
State of: Indiana County of: Hancock
BY: DATE: o z� l O Subscribed and S m to before me this Z9VA d ay of August 2009
kanin Horth Powers, President Notary Public:
My Commission Expires: April 21, 20Z
AMOUNT CERTIFIED
ARCHITECT'S CERTIFICATE FOR PAYMENT (Attached explanation if amount certified differs from the
amount applied for.) ��p
In accordance with the Contract Documents, based on on -site observa- ARCHITECT: qa, f 50— A I (Ate J
tions and the data comprising the above application, the Architect certifies
to the Owner that to the best of the Architect's knowledge, information, By: 10 A ,4 Date: dr. f0 E` 1
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 payment of the AMOUNT CERTIFIED. Purchase FCUn ment and acceptance of payment are without prejudice to any
Description PAR K ro „r rno A ner or Contractor under this contract.
P.O. 1 9 G I (ot p r F yes c-
G.L. I Ob 5 023 9 9c7
Budget
Line Desr
Purchaser p
s
Approv al„Ti1�= Dataf
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES
PROJECT: FOUNDERS PARK INFRASTRUCTURE PHASE I APPLICATION NO.: 8
Job: 437 APPLICATION DATE: 27- Aug -09
PERIOD TO: 27- Aug -09
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 40,806.00 40,806.00 100%1 0.00 4080.60
2 Construction Staking 14,086.00 14,086.00 14,086.00 100%1 0.00 1408.60
3 Clearing 55,307.00 55,307.00 55,307.00 100% 0.00 5530.70
4 Earthwork 289,035.00 284,000.00 5,035.00 289,035.00 100% 0.00 28903.50
5 Erosion Control 38,151.00 36,500.00 1,651.00 38,151.00 100% 0.00 3815.10
6 Sanitary Sewer 35,110.00 35,110.00 35,110.00 100% 0.00 3511.00
7 Storm Sewer 104,921.00 104,921.00 104,921.00 100% 0.00 10492.10
8 Concrete Curbs /Sidewalk 177,447.00 177,447.00 177,447.00 100% 0.00 17744.70
9 Asphalt Paving 138,189-001 138,189.00 138,189.00 100% 0.00 13818.90
10 Seeding 82,038.00 73,500.00 5,000.00 78,500.00 96% 3538.00 7850.00
11 Bonds insurance 40,628.00 40,628.00 40,628.00 100% 0.00 4062.80
12 Change Order #1: Asphalt 7,100.00 7,100.00 7,100.00 100% 0.00 710.00
Concrete Curb /Sidewalks 9,000.00 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 50379.30
TOTALS: $1,049,603.001 $1,034,379.00 $11,686.00 $0.001 $1,046,065.00 100% $3,538.001 54,227.20
PERCENT: 1 98.55% 1.11%] 0.00%1 99.66% 0.34%
AFFIDAVIT AND WAIVER OF LIEN
Pinal 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 Carmel /Clay Board of Parks and
Recreation to furnish certain materials and /or labor as follows Site Improvement for a Project
known as Founders Park Infrastructure Phase I, located in Carmel, IN 46032 and owned by
the Carmel /Clay Board of Parks and Recreation and does further state
PARTIAL WAIVER: that the balance due from the owner is the sum of Eleven Thousand
Six Hundred. Eighty -Six and 00 /100 Dollars ($11,686.00)
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.
en Horth Powers
President
Title 4
Witness My Hand and Notarial Seal, this 2 da of A G1 U S4 2009.
Notary Public
Li China Wu
Notary Public Printed Signature
My Commission Expires
April 21, 2016
County of Residence
Hamilton
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.
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)) PO Amount
8/27109 6111 App 8 Founders park 19616 p 11,686.00
Total 11,686.00
I 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., It Allowed 20
3862 N Commercial Parkway
Greenfield, IN 46140
In Sum of
11,686.00
ON ACCOUNT OF APPROPRIATION FOR
106 Park Impact Fee Fund
PO# or INVOICE NO. COT #/TITLI AMOUNT Board Members
Dept
19616 6111 5023990 11,686.00 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
24 -Sep 2009
Signature
11,686.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund