HomeMy WebLinkAbout174222 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 359230 Page 1 of 1
ONE CIVIC SQUARE BATTS CONSTRUCTION CHECK AMOUNT: $21,892.50
CARMEL, INDIANA 46032 8901 E RAWLES AVE
oh.to INDIANAPOLIS IN 46219 CHECK NUMBER: 174222
CHECK DATE: 7/8/2009
DEPARTMEN A CCOU NT PO N UMBE R INVOICE NUMBER AMO UNT DESCRIPTION
902 ^v 4460848 3 21,892.50 4TH GATEWAY /RANGELINE
7 2 M TM 2
Document G 0 IC a 199
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER: PROJECT: APPLICATION NO Distribution to:
CITY OF CARMEL CARMEL ARTS K DESIGN DES
PERIOD TO OWNER
CUS "I' 11 9260 ONE CIVIC SQUARE 04/30/2009
CONSTRUCTION MANAGER
CARMEL IN 46032
FROM CONTRACTOR: ��//��p�(; ONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Br1T "FS CONS IRUCTIt7�7 fNZ 09/01/2008
8901 RAWI_ES AVE. PROJECT NOS: I I CONTRACTOR
INDIANAPOLIS. IN 46R ARCHITECT: FIELD
CONTRACT FOR: CARM AR"I'S K DESIGN DES JOB 9260
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Contract Documents, that all amounts Have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM 49,800.00 payment shoU 'n is now due.
2. Net change by Change Orders 000.00 CONTRACTO
3. CONT RACT SUM TO DATE (Line 1 2)' 53.300.00 B Date:
4. TOTAL COMPLETED STORED TO DATE (Coluirm G on G703) 53.800.00 State of.
5. RETAINAGE: County of: w
a. I009of Completed Work Subscribed and sworn to before
(Col uinn D E on G703) 5.380.00 me this of t
b. 1 040o Stored Material Notary Public:
(Column F on G703) 0.00 My Commission expires: V I y L
Total Retainage (Lines 5a 5b or Total in Column I of G703).. 5.380.00 CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) 26.527. CERTIFIED.
8. CURRENT PAYMENT DUE 21.892.50 AMOUNT CERTIFIED ?4 0
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs front the, canount,applied. Initial all figures on this
Application an the Continuation Sheet that are changed to conform with the amount certified.)
(Line 3 less Line 6) CONS RU ION 1a Q
By: Date: �lA. 1
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
00
Total changes approved in previous months by Owner By: Date: 41.$°jo9
Total a roved Chis Month
PP This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 00 named herein. Issuance; payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Dpcument g702 /CMaTM" 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org.
Ix� TM A IA Document G702 /CMa -1992 Instructions
Application and Certificate for Payment Construction Manager- Adviser Edition
A. General Information
AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General
Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.
C. Completing the G702/CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and
Certificate for Payment, Construction Manager- Adviser Edition.
The Contractor should sign G702 /CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment,
Construction Manager- Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives shoOlp be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa.
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Doriiment G702 /CMa,
Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name andIddress of the Contractor. Payment should
not be made to any other party unless specifically indicated on G702/CMa.
AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @aia.org.
TM
1- Document 6703 ®1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 04/17/2009
containing Contractor's sig certification is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. 04/30/2009
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:
ARCHITECT'S PROJECT NO:
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL
PRESENTLY COMPLETED BALANCE RETAINAGE
ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS STORED AND STORED
NO. VALUE APPLICATION THIS PERIOD (G C) FINISH (IF VARIABLE
(D F) (NOT IN TO DATE (C G) RATE)
D OR E) (D +E +F)
0100 BOND FEE 615.00 615.00 615.00 100.00 61.50
0200 MOBILIZATION 1,500.00 1.000.00 500.00 1,500.00 100.00 150.00
0300 SUBMITTALS 500.00 500.00 500.00 100.00 50.00
0400 MOCK -UP 900.00 900.00 900.00 100.00 90.00
0500 BRICK MATERIAL 8.590.00 6,872.00 1.718.00 8,590.00 100.00 859.00
0600 BRICK LABOR 22,380.00 7,833.00 14,547.00 22380.00 100.00 2,238.00
0700 BLOCK MATERIAL 630.00 630.00 630.00 100.00 63.00
080 BLOCK LABOR 2210.00 2.210.00 2.210.00 100.00 221.00
0900 STONE MATERIAL 8.025.00 8,025.00 8.025.00 100.00 802.50
100 STONE LABOR 4,450.00 890.00 3.560.00 4.450.00 100.00 445.00
1 10 CHANGE ORDER 4 1 4,000.00 4,000.00 4,000.00 100.00 400.00
JOB TOTALS: 53.800.00 29,475.0 24,325.00 .0 53.800.00 .00 5.380.00
CAUTION: You should sign an original AIA Contract Document, on which this text appears i ED. An original assures that changes will not be obscured.
AIA Document G703 T11 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American titute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this A10 Document, or any of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under-the law. Purchasers are permitted to reproduce ten 00) copies of this document when complet o report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal
counsel, copyright @aia.org.
1. 1 -wAIA Document G703 1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA
Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the
Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify
the most recent edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the
AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further
rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed
G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction
granted above, except upon written request and receipt ol'written permission from the AIA. Rights to reproduce the doeumenl may vary for users
of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA
Contract Documents, e -mail The American Institute of Architects' legal counsel, copyi
aia.org.
COMPLETING G703 -1992
Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and
Certificate for Payment.
Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent
with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by
sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the
original Contract Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D. Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous
application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that
were listed on the previous application under Materials Presently Stored (column F).
Column F. Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end
of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet
incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials
are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed -This Period.)
Column G. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H. Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I. This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on
projects where a constant retainage is withheld from the overall contract amount.
Change Orders. Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the
Project, this is not normally done. Usually, Change Orders are listed separately, either on their own 6703 loan or at the end of the basic schedule.
The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into
one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown helow are for illustrative purposes only, and are
not intended to reflect actual conjunction costs.
A H C U E F G I I 1
\VO K COST PLE'F' D NIXI ERIALS 'IOTAL
BALANCE
PRESEN'I'L1' CUMI'Lf:I'IiD RE'I'AINAGE
I'II: \t SCIIEDULED FRO \I PREVIOUS l'O
NO. DESCRIPTION OF WORK VALUE APPLICAI ION THISPERIOD STORED AND STORED (G'C) FINISH (11: VARIABLE
(D +E) (NOT IN TODATI: (C.r
RA
D oR E) (D +E +r)
1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS 6 MISC. CONC. 5,000 0 0 0 0 0 5,000
b PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
8 PAVERS 20,000 0 0 10,000 10,000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10
it 105,000 20,000 10,000 1 0,000 40000 6 5,00 0
AIA Document G703TI 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org.
BATTS CONSTRUCTION INC
Box 19134
Indianapolis, IN 46219
Phone (317) 890 -9078
Fax (317) 890 -9082
Batts
Constructl'on
Inc.
AFFIDAVIT AND WAIVER OF LIEN
EVAN JONES duly sworn states that he is the PRESIDENT of BATTS
CONSTRUCTION INC. having contracted with CITY OF CARMEL, INDIANA to
furnish certain material and /or labor as follows: MASONRY for project known as
CARMEL ARTS DESISGN DISTRICT GATEWAY- SITE #4 located at NORTH
RANGE LINE RD SMOKEY ROW ROAD and owned by CARMEL
REDEVELOPMENT COMMISSION does further state:
Partial Wavier: that the balance due from the owner is the sum of: $21,892.50
Receipt of which is hereby acknowledge; or,
The payment of which has been promised as the sole consideration for this Affidavit and
Partial Waiver of Lien which given to and for said amount effective upon receipt of such
payment:
Final Waiver: that the final balance due from the owner has been paid: In the amount of
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 waivers 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, material of 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 mate furnished to undersigned for said project, and within the scope of this affidavit and waiver>
Co: B S NSTRUCTION INC
By:
Title: PR (ID NT
Witnessed My Hand and Notarial Seal, This 17TH Day of APRIL, 2009
My Commission Expires: _11/14/13 County of Residence: JOHNSON,
INDIANA
DIANE RODGERS
(Notary Signature) (Notary Print)
Certified Payroll for Freedom of Information Act (FOIA)
Subcontractor BATTS CONSTRUCTION INC Project and Location Job Payroll 1
Addressi 8901 RAWLES AVE. CARMEL ARTS DESIGN DIS 9260 Week Ending 04/14/2009
INDIANAPOLIS, IN 46219 N. RANGE LINE RD Pale I
Day and Date
Wed Thu Fri Sat Sun Mon Tue Total Pay
Employee Infornnation 4/8 4/9 4/10 4/11 4/12 4/13 4/14 Hours Rate Work Classification Check#
SIMPSON, STEVEN Sex Eth.
M 5 Caucasian
M 1 8.00 8.00 16.00 20.160 HODCARRIER 138240
.lob Earn: 322.56 FICA: 24.68 FIT: 0.00 State: 7.04 Local /SDI: 8.77 Oth Deds: 1 1 1.68 Adj Net: 0.00
Tot Eam', 322.56 Tot Deds: 152.17 Un Vac: 0.00 Benefits: 156.48 Un Misc:
0.00 Un Dues: 9.68 Net Pay: 170.39
GARN FEE 2.00 CHLD SPT 100.00
STAFFORD. JOHN Sex Eth.
M 5 Caucasian
M 0 8.00 8.00 8.00 4.50 8.00 36.50 30.500 MASON 138241
Job Earn: 1,113.25 FICA: 85.16 FIT: 113.19 State: 37.85 Local /SDI: 12.80 Oth Deds: 43.07 Adj Net: 0.00
Tot Earn': 1,113.25 Tot Deds: 292.07 Un Vac: 0.00 Benefits: 357.34 Un Misc: 0.00 Un Dues: 43.07 Net Pay: 821.18
FRICK, RALPH Sex Eth.
M 5 Caucasian
M 0 8.00 8.00 28.050 MASON 138196
Job Earn: 224.40 FICA: 17.16 FIT: 50.00 State: 32.63 Local /SDI: 2.81 Oth Deds: 17.20 Adj Net: 0.00
i
Tot Earn n: 224.40 Tot Deds: 1 19.80 Un Vac: 8.00 Benefits: 92.32 Un Misc: 0.00 Un Dues: 9.20 Net Pay: 104.60
I
I
i
Emp. Count Job Hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net
3 60.50 1,660.21 127.00 163.19 77.52 564.04
1,660.21 0.00 1,096.17
Data ;04/14/2009 (4) That:
1, EVAN JONES/PRESIDENT (a) Where fringe benefits are paid to approved plans, ftmds, or programs
In addition to the basic hourly wage rates paid to each laborer or mechanic
do hereby state: listed in the above referenced payroll, payments of fringe benefits as
listed in the contract have been or will be made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(1) That I pay or supervise the payment of the persons employed by (b) Where fringe benefits are paid in Cash
BATTS CONSTRUCTION INC on the CARMEL ARTS DESIGN Each laborer or mechanic listed in the above referenced payroll has been
that during the payroll period commencing on the 8 day of April 2009 paid, as indicated on the payroll, an amount not less than the sum
and ending the 14 day of April 2009 ,all persons employed of the applicable basic hourly wage rate plus the amount of the
on said project have been paid the full weekly wages earned, that no rebates have been required fringe benefits as listed in the contract, except as noted in
or will be made either directly or indirectly to or on behalf of said Section 4(c) below.
BATTS CONSTRUCTION INC from the full weekly wages earned (c) Exceptions
by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Exception (Craft) Explanation
Regulations, Part 3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland
Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and
described below:
Remarks
(2) That any payrolls otherwise under this contract required to be submitted for the
above period are correct and complete; that the wage rates for laborers
or mechanics contained therein are not less than the applicable wage rates
contained in any wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he
performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized
by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the
Bureau of Apprenticeship and Training, United States Department of Labor.
I
(Signature)
EVAN JONES/PRESIDENT
(Name and Title)
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231
of Title 3 1 of the United States Code.
i
Certified Payroll for Freedom of Information Act (FOIA)
Subcontractor BATTS CONSTRUCTION INC Proiect and Location Job Payroll 1
Address 8901 RAWLES AVE. CARMEL ARTS DESIGN DIS 9260 Week Ending 04/07/2009
INDIANAPOLIS, IN 46219 N. RANGE LINE RD Page 1
Day and Date
Wed Thu Fri Sat Sun Mon Tue Total Pay
Employee Information 4/1 4/2 4/3 4/4 4/5 4/6 4/7 Hours Rate Work Classification Check#
SIMPSON, STEVEN Sex Eth.
M 5 Caucasian
M 1 8.00 8.00 8.00 8.00 32.00 20.160 HODCARRIER 138152
0.50 0.50 0.50 0.50 2.00 30.240 HODCARRIER
Job Earn: 705.60 FICA: 53.98 FIT: 41.51 State: 20.07 Local /SDI: 19.19 Oth Deds: 144.16 Adj Net: 0.00
Tot Earn: 705.60 Tot Deds: 278.91 Un Vac: 0.00 Benefits: 332.52 Un Misc: 0.00 Un Dues: 21.16 Net Pay: 426.69
GARN FEE 2.00 CHLD SPT 121.00
STAFFORD, JOHN Sex Eth.
M 5 Caucasian
M 0 8.00 8.00 8.00 8.00 32.00 30.500 MASON 138153
Job Earn: 976.00 FICA: 74.66 FIT: 92.60 State: 33.18 Local /SDI: 11.22 Oth Deds: 37.76 Adj Net: 0.00
Tot Earn: 976.00 Tot Deds: 249.42 Un Vac: 0.00 Benefits: 313.28 Un Misc: 0.00 Un Dues: 37.76 Net Pay: 726.58
AMES, EDWIN Sex Eth.
M 5 Caucasian
S 0 8.00 8.00 28.050 MASON 138061
Job Earn: 224.40 FICA: 34.34 FIT: 63.51 State: 15.26 Local /SDI: 6.73 Oth Deds: 34.40 Adj Net: 0.00
Tot Earn: 448.80 Tot Deds: 154.24 Un Vac: 16.00 Benefits: 184.64 Un Misc: 0.00 Un Dues: 18.40 Net Pay: 294.56
FRICK, RALPH Sex Eth.
M 5 Caucasian
M 0 8.00 8.00 8.00 8.00 32.00 28.050 MASON 138095
.lob Earn: 897.60 FICA: 68.67 FIT: 130.84 State: 55.52 Local /SDI: 11.22 Oth Deds: 68.80 Adj Net: 0.00
Tot Earn: 897.60 Tot Deds: 335.05 Un Vac: 32.00 Benefits: 369.28 Un Misc: 0.00 Un Dues: 36.80 Net Pay: 562.55
Emp. Count Job Hours .lob Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net
4 106.00 2,803.60 231.65 328.46 124.03 1,017.62 3 ,028.00 0.00 2,010.38
Date 04 /07/2009 (4) That:
(a) Where fringe benefits are paid to approved plans, funds, or programs
1, EVAN JONES/PRESIDENT In addition to the basic hourly wage rates paid to each laborer or mechanic
do hereby state: listed in the above referenced payroll, payments of fringe benefits as
listed in the contract have been or will he made to appropriate programs
for the benefit of such employees, except as noted in Section 4(c) below.
(1) That I pay or supervise the payment of the persons employed by (b) Where fringe benefits are paid in Cash
BATTS CONSTRUCTION INC on the CARMEL ARTS DESIGN Each laborer or mechanic listed in the above referenced payroll has been
that during the payroll period commencing on the I day of April 2009 paid, as indicated on the payroll, an amount not less than the sum
and ending the 7 day of April 2009 all persons employed of the applicable basic hourly wage rate plus the amount of the
on said proiect have been paid the full weekly wages earned, that no rebates have been required fringe benefits as listed in the contract, except as noted in
or will be made either directly or indirectly to or on behalf of said Section 4(c) below.
BA17S CONSTRUCTION INC from the full weekly wages earned (c) Exceptions
by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Exception (Craft) Explanation
Regulations, Part 3 (29 CFR Subtitle A) issued by the Secretary of Libor under the Copeland
Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and
described below:
Remarks
(2) That any payrolls otherwise under this contract required to be submitted for the
above period are correct and complete; that the wage rates for laborers
or mechanics contained therein are not less than the applicable wage rates
contained in any wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he
performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized
by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the
Bureau of Apprenticeship and Training, United States Department of Labor.
(Signature)
EVAN JONESIPRESIDENT
(Name and Title)
The willful falsification of any of the above statements may subiect the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231
of Tide 31 of the United States Code.
Certified Payroll for Freedom of Information Act (FOIA)
Subcontractor BATTS CONSTRUCTION INC Project and Location Job Payroll I
Address 8901 RAWLES AVE. CARMEL ARTS DESIGN DIS 9260 Week Ending 03/31/2009
INDIANAPOLIS. IN 46219 N. RANGE LINE RD Page 1
Day and Date
Employee Information Wed Thu Fri Sat Sun Mon Tue Total Pay
3/25 3/26 3/27 3/28 3/29 ,3/3'O 3/31 Hours Rate Work Classification Check#
SIMPSON, STEVEN Sex Eth.
M 5 Caucasian
M 1 8.00 8.00 8.00 7.00 31.00 20.160 HODCARRIER 138046
0.50 0.50 0.50 0.50 2.00 30.240 HODCARRIER
Job Earn: 685.44 FICA: 52.44 FIT: 38.49 State: 19.38 Local /SDI: 18.64 Oth Deds: 143.56 Adj Net: 0.00
i
Tot Earn: 685.44 Tot Deds: 272.51 Un Vac: 0.00 Benefits: 322.74: Un Misc: 0.00 Un Dues: 20.56 Net Pay: 412.93
GARN FEE 2.00 CHLD SPT 12 L.00
STAFFORD, JOHN Sex Eth.
M 5 Caucasian
M 0 2.00 8.00 8.00 8.00 7.00 33.00 30.500 MASON 138047
Job Earn: 1,006.50 FICA: 76.99 FIT: 97.18 State: 34.22 Local /SDI: 11.57 Oth Deds: 38.94 Ad,j Net: 0.00
Tot Earn: 1,006.50 Tot Deds: 258.90 Un Vac: 0.00 Benefits: 323.07 Un Misc: 0.00 Un Dues: 38.94 Net Pay: 747.60
FRICK, RALPH Sex Eth.
M 5 Caucasian i
M 0 8.00 8.00 8.00 4.00 28.00 28.050 MASON 137987
Job Earn: 785.40 FICA: 60.08 FIT: 114.01 State: 51.70' Local /SDI: 9.82 Oth Deds: 60.20 Adj Net: 0.00
Tot Earn: 785.40 Tot Deds: 295.81 Un Vac: 28.00 Benefits: 323.12 Un Misc: 0.00 Un Dues: 32.20 Net Pay: 489.59
Emn. Count .lob Hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net
3 94.00 2,477.34 189.51 249.68 105.30 827.22 2,477.34 0.00 1,650.12
Date 03/31/2009 (4) That:
(a) Where fringe benefits are paid to approved plans, funds, or programs
1, EVAN JONES /PRESIDENT In addition to the basic hourly wage rates paid to each laborer or mechanic
do hereby state: listed in the above referenced payroll, payments of fringe benefits as
listed in the contract have been or will he made to appropriate programs
for the benefit of such employees except as noted in Section 4(c) below.
(1) That I pay or supervise the payment of the persons employed by (b) Where fringe benefits are paid in Cash
BATTS CONSTRUCTION INC on the CARMEL ARTS DESIGI` Each laborer or mechanic listed in the above referenced payroll has been
that during the payroll period commencing on the 25 day of March 2009 paid, as indicated on the payroll, an amount not less than the sum
and ending the 31 day of March 2009 all persons employed of the applicable basic hourly wage rate plus the amount of the
on said project have been paid the full weekly wages earned, that no rebates have been required fringe benefits as listed in the contract, except as noted in
or will be made either directly or indirectly to or on behalf of said Section 4(c) below.
BATTS CONSTRUCTION INC from the full weekly wages earned (c) Exceptions
by any person and that no deductions have been made either directly or indirectly
from the full wages earned by any person, other than permissible deductions as defined in Exception (Craft) Explanation
Reeulations, Part 3 (29 CFR Subtitle A) issued by the Secretary of Labor under the Copeland
Act, as amended (48 Stat. 948, 63 Stat. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and
described below:
Remarks
(2) That any payrolls otherwise under this contract required to be submitted for the
above period are correct and complete: that the wage rates for laborers
or mechanics contained therein are not less than the applicable wage rates
contained in any wage determination incorporated into the contract; that the
classifications set forth therein for each laborer or mechanic conform with the work he
performed.
(3) That any apprentices employed in the above period are duly registered in a bona fide
apprenticeship program registered with a State apprenticeship agency recognized
by the Bureau of Apprenticeship and Training, United States Department of
Labor, or if no such recognized agency exists in a State, are registered with the
Bureau of Apprenticeship and Training, United States Department of Labor.
(Signature)
EVAN JONES/PRESIDENT
(Name and Title)
The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 100 of Title 18 and Section 231
of Title 3 1of the United States Code.
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 service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
Terms
/y y 2 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2f O �+�7 /L r�
(f `3G �j �rrelC G�ci ✓K .501
Total 2�,�92
l 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
'CHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3 y5��o�r V '92 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
20
Di� Hor
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund