167939 01/21/2009 CITY OF CARMEL INDIANA VENDOR: 358944 Page 1 of 1
ONE CIVIC SQUARE CENTRAL ENGINEERING CONSTRUCTION
CARMEL, INDIANA 46032 3862 N COMMERCIAL PARKWAY C�IECK AMOUNT: $76,500.00
GREENFIELD IN 46140 CHECK NUMBER: 167939
CHECK DATE: 1121/2009
DEPARTMENT_ ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
106 R5023990 18807 5997 76,500.00 FOUNDERS PARKS INTRAS
DEC 9 Z008
APPLICATION AND CERTIFICATE FOR PAYMENT 7-'-' AIA -O MENT a.-n V
TO (OWNER): PROJECT: Founders Park Infrastructure Phase 1 APPLICATION NO. 6 DISTRIBUTION TO:
Carmel/ Clay Board of Parks and Recreation OWNER XX
Attn.: Mark Westermeier
1411 East 116th Street VIA (ARCHITECT): PERIOD TO: 11/21/2008
Carmel, IN 46032
FROM: Central Engineering Construction Associates, Inc. ARCHITECT'S
3862 N. Commercial Parkway PROJECT NO:
Greenfield, IN 46140
CONTRACT FOR: SITE IMPROVEMENTS CONTRACT DATE: 22- May -08
Application made for Payment, as shown below, in connection
CONTRACTOR'S 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 $1,001,322.00
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 $54,227.20
Net Change by Change Orders (Total in Column 1)
$33,885.00 6. TOTAL EARNED LESS RETAINAGE $947,094.80
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 $870,594.80
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 $76,500.00
for which previous Certificates for Payment were issued and payments 9. BALANCE TO FINISH, PLUS RETAINAGE $102,508.20
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: Ha cock
BY' DATE: Z Oe] Subscribed and S n to before me this ZS— day of November 2008
K ren Horth Powers, President Notary Public:
My Commission Ex April 21, 201
AMOUNT CERTIFIED
ARCHITECT S CERTIFICATE FOR PAYMENT (Attached explanation if amount certified differs from the
amount applied for. r..e QFj�7i
In accordance with the Contract Documents, based on on -site observa- ARCHITECT:��
tions and the data comprising the above application, the Architect certifies 7
to the Owner that to the best of the Architect's knowledge, information, By: o Date: 2'S mct
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 AM00ff0fIFI r ment and acceptance of payment are without prejudice to any
Descri ICl9 rights of the Owner or Contractor under this contract.
PA. Or
ellud
Awmvd Pur�ase
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CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES
PROJECT: FOUNDERS PARK INFRASTRUCTURE PHASE I APPLICATION NO.: 6
Job: 437 APPLICATION DATE: 25- Nov -08
PERIOD TO: 21- Nov -08
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 I C) FINISH RATE
(D E) D OR E) (D +E +F) (C G)
1 Mobilization 40,806.00 35,306.00 1,000.00 36,306.00 89%1 4500.00 3630.60
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%1 0.00 5530.70
4 Earthwork 289,035.00 278,000.00 278,000.00 96%1 11035.00 27800.00
5 Erosion Control 38,151.00 24,000.00 7,000.00 31,000.00 81% 7151.00 3100.00
6 Sanitary Sewer 35,110.00 35,110.00 35,110.00 100% 0.00 3511.00
7 Storrs Sewer 104,921.00 104,921.00 104,921.00 100% 0.00 10492.10
8 Concrete Curbs /Sidewalk 177,447.00 172,079.00 172,079.00 97% 5368.00 17207.90
9 Asphalt Paving 138,189.00 131,500.00 131,500.00 95% 6689.00 13150.00
10 Seeding 82,038.00 0.00 68,500.00 68,500.00 83%1 13538.00 6850.00
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% 0.00 2356.00
Change Order #3:
14 asphalt material increase 26,425.00 26,425.00 26,425.00 100%1 0.00 264150
Retainage reduction per
contract 45905.00
TOTALS. $1,049,603.00 $924,822.00 $76,500.001 $0.00 $1,001,322.00 95% $48,281.00 $54,227.20
PERCENT: 88,11%1 7.29%1 0,00%1 95.40% 4.60%
AFFIDAVIT AND WAIVER OF LIEN
Final Partial Payment to Follow
STATE OF INDIANA
County of HANCOC
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 final balance due from the owner is the sum of Seventy -Six
Thousand Five Hundred and 00 /100 Dollars ($76,500.00)
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.
Karen Horth Powers
President
Title
Witness My Hand and Notarial Seal, this da of 9V O U 2008.
Notary Public
Li -Ching 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 th be properly itemized must show; kind of service, where performed, dates service rendered, by
whom, ratbs per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee Purchase Order No. 18807 P
358944 Central Engineering Construction Assoc., Inc.
Terms
3862 N Commercial Parkway
Greenfield, IN 46140
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
11121/08 A 6 1 5997 Founders park infrastructure phase I
76,500.00
Total 76,500.00
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., h Allowed 20
3862 N Commercial Parkway
Greenfield, IN 46140
In Sum of$
76,500.00
ON ACCOUNT OF APPROPRIATION FOR
106 Park Impact Fee Fund
PO #or INVOICE NO. CCT #1TITL1 AMOUNT Board Members
Dept
18807 App 6 1 5997 5023990 76,500.00 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
2 -Jan 2009
Signature
76,500.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund