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HomeMy WebLinkAbout170735 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 359230 Page 1 of 1 b ONE CIVIC SQUARE BATTS CONSTRUCTION CHECK AMOUNT: $25,974.00 >a CARMEL, INDIANA 46032 8901 E RAWLES AVE 1�.8n �o.• INDIANAPOLIS IN 46219 CHECK NUMBER: 170735 CHECK DATE: 4/1612009 DEPAR ACCOU P NUMB INVO NU MBER AM OUNT DE SCRIPTIO N 902 4460848 2 25,974.00 4TH GATEWAY /RANGELTNE M I f TM %r j Document G7021CMa -1992 Application and Certificate far Payment Construction Manager- Adviser Edition r' TO OWNER: PROJECT: APPLICATION N0: Distribution to: ...CITY OF CARTEL, CARf�1EL ARTS DESIGN DES 2 C'US'F 4 9260;'': ONE CIVIC SQUA PERIOD TO:.,,,::, o: t3 uz009 OWNER El CONSTRUCTION MANAGER CAR vtEL IN 46032 FROM CONTRACTOR: BATTS CONSTRUCTIOiV R c CONSTRUCTION MANAGER: CONTRACT DATE: 09/01/2008 ARCHITECT 8901 RAWLES AVE, PROJECT NOS: 1 1 CONTRACTOR INDiANAP IN 462 JA ARCHITECT: FIELD CONTRACT FOR: CARM L ARTS 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 Continuation Sheet, ALA Document G703, is attached- Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payme were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM 49,800.00 payment shown herei is ow due. 2. Net change by Change Orders 4° CONTRACT 3. CONTRACT SUM TO DATE Lme 1 ±,2 ,80000 q p X3 By: Date: 4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 29.475.00 State of. 5. RETAINAGE: County of:1(v a• f ©0 ®/0 of Completed Work Subscribed and sworn to before Column D E on G703 ,97.50 me this 24 day of t a� b. v of Stored Material Notary Public (Column F on G703) 0.00 My Commission expires: \A TI Total Retaina (Lines 5a+ 5b or Total in Column I of G703). 2.947 -50 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE 26 52 7.50 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) CERTIFIED. 8. CURRENT PAYMENT DUE 2 .974 00 AMOUNT CERTIFIED d� Oo 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if arnount certified difj`ers front the arrtountapplied. Initial all tgures on this Application and on the Continuation Sheet that ar e changed to conform with the amount certified.) (Line 3 less Line 6) CONSTRUCTION R: By: Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS 00 ARCHITECT: Total changes approved in previous months by Owner 011 g Date: Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS OQ 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 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, a -mail The American Institute of Architects' legal counsel, copyright @aia -org. A BE AIA 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 G7021CMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G7021CMa, 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 G7021CMa 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). d' 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 should be incorporated intgone 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 Doibment G7021CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNINj :.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, andwill be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce te&i l0) copies of this document when completed. 7o report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. t= ask TM Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO: containing Contractors signed certification is attached. APPLICATION DATE: 03/19/2009 In tabulations below amounts are stated to the nearest dollar. 03/31/2009 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 I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE NO. VALUE APPLICATION THIS PERIOD STORED AND STORED (G +C) FINISH (IF VARIABLE (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 010 BOND FEE 615.00 615.00 615.00 100.00 61.50 020 MOBILIZATION 1 1,000.00 1.000.00 66.67 500.00 100.00 030 SUBMITTALS 500.00 500.00 500.00 100.00 50.00 040C MOCK -UP 900.00 900.00 900.00 100.00 90.00 050 BRICK MATERIAL 8,590.00 6.872.00 6.87100 80.00 1.718.00 687.20 060 BRICK LABOR.;. 22,380.00 7,833.00 7;833.00 35.00 14,547.00 783.30 070 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 090C STONE MATERIAL 8,025.00 8,025.00 8,025.00 100.00 802.50 100 :STONE LABOR 4.450.00 890.00 890.00 20.00 3.560.00 89.00 1 10 CHANGE ORDER 1 4.000.00 4,000.00 J:OB'TOTALS 51800.00 615.00 28,860.00 .00 29.475.00 24,325.00 2,947.50 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 Document G703" 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 00) 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. A nv �i TM =M� 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 ATA Contract. Document, users should consult www.ziia.org or a local AIA component to vcrify 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 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 (ELLA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @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 ofcompleted 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 1. 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 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 fLr work in progress. Please note that dollar atnounis shown heiow are for iliustrative proposes only, and are not intended io reflect ac9aral construction costs. A B C D B r WORK COMPLP717.1) MATERIALS TOTAL R, \CAWC PRPSIi1JTl.1' COMI'LITrru RF,TAItinGr, Est sClu.ouLHD FROM PREVlous i O nI ?SCRIP7'i0�`OP WORK S'r(REU AND STORED (IP VARI l0. VALUE APPI.ICA'1�19�' 'lIi IS PERIOD (NO r IN T6 bA "rE If -C) FINISH RAT (I) +E7 1) OR E) (ll +EH') (C G) 1 MORILIZATION 5,000 5000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTHWORK 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 CARS 6 MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER bRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER ORIVE 20.000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 C 10,000 10,000 50 10,000 9 BRICK WORK 5,C00 0 0 0 0 0 5,000 10 11 1 1 05,000 20,000 10,000 10,000 1 40,000 65,000 AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ate 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 counCel, copyright @aia.org. BATTS CONSTRUCTION INC Box 19134 lndianapolis, IN 46219 Phone (317) 890 -9078 Fax (317) 890 -9082 B at t s e ConstrLICtion I 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: $25,974.00 2 eceipt 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 Qiven 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 material furnished to undersigned for said project, and within the scope of this affidavit and waiver> Co: BATT ONSTRUCTION INC By: Title: PRESIDENT Witnessed My Hand and Notarial Seal, This 6TH Day of APRIL, 2009 My Commission Expires: 11/14/13 County of Residence: JOHNSON, INDIANA Z A ]1�k N�_CL" ti 1A.— DIANE RODGERS (Notary Signature) (Notary Print) Certified Payroll for Freedom of Information Act TOIA) Subcontractor BATTS CONSTRUCTION INC Proiect and Location Job Payroll Address 8901 RAWLES AVE, CARMEL ARTS DESIGN DIS 9260 Week Ending 03/24/2009 INDIANAPOLIS, IN 46219 N. RANGE LINE RD Page 1 Day and Date Employee Information Wed Thu Fri Sat Sun Mon Tue Total Pay 3/18 3/19 3/20 3/21 3122 3/23 3/24 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 137938 0.50 0.50 0.50 0.50 2.00 30.240 HODCARRIER Job Earn: 705.60 FICA: 66.32 FIT: 65.71 State: 25.55 Local /SDI: 23.58 Oth Deds: 149.00 Adj Net: 0.00 Tot Earn: 866.88 Tot Deds: 330.16 Un Vac: 0.00 Benefits: 410.76 Un Mise: 0,00 Un Dues: 26.00 Net Pay: 536.72 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 137939 Job Earn: 976.00 FICA: 92.71 FIT: 128.00 State: 41.21 Local /SDI: 13.94 Oth Deds: 47.20 Adj Net 0_00 Tot. Earn: 1,212.00 Tot Deds: 323.06 Un Vac: 0.00 Benefits: 391.60 Un Misc: 0.00 Un Dues: 47.20 Net Pay: 888.94 AMES, EDWIN Sex Eth, M 5 Caucasian S 0 8.00 8.00 28.050 MASON 137850 Job Earn: 224.40 FICA: 85.83 FIT: 207.08 State: 38.15 Local /SDI: 16.83 Oth Deds: 86.00 Adj Net: 0.00 Tot Earn: 1,122.00 Tot Deds: 433.89 Un Vac: 40.00 Benefits: 461.60 Un Misc: 0.00 Un Dues: 46.00 Net Pay: 688.11 FRICK, RALPH Sex Eth. M 5 Caucasian M 0 8.00 8.00 8.00 8.00 32.00 28.050 MASON 137882 .lob Earn: 897.60 FICA: 78.33 FIT. 149.78 State: 59.81 Local /SDI: 12.80 Oth Deds: 78.48 Adj Net: 0.00 Tot Earn: 1,023.83 Tot Deds: 379.20 Un Vac: 36.50 Benefits: 421.23 Un Misc: 0.00 Un Dues: 41.98 Net Pay: 644.63 Ernp. Count Job Hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net 4 106.00 2.803.60 323.19 550.57 164.72 1 ,466.31 4,224.71 0.00 2,758.40 Date 03/24/2009 (4) That: (a) Where fringe benefits are paid to approved plans, funds, or programs I, 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 annrondate 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 18 day of March 2009 paid, as indicated on the payroll, an amount not Jess than the sum and ending the 24 day of March 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 wanes 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 wane 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 1001 of Title 18 and Section 231 of Title 3lof the United States Code. 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 03/17/2009 INDIANAPOLIS, IN 462.19 N. RANGE LINE RD Page I. Day and Date Employee Information Wed Thu Fri Sat Sun Mon Tue Total Pay 3 /11 3/12 3/13 3/14 3/15 3/16 3/17 Hours Rate Work Classification Check# EVANS, EARL Sex Eth. M 5 Caucasian M 0 4.00 4.00 8.00 20.160 HODCARR.IER 137776 Job Earn: 16128 FICA: 64.70 FIT: 88.46 State: 28.76 Local /SDI: 13.96 Oth Deds: 25.38 Adj Net: 0.00 Tot Earn: 845.84 Tot Deds: 221.26 Un Vac: 0.00 Benefits: 397.06 Un Misc: 0.00 Un Dues: 25.38 Net Pay: 624.58 SIMPSON, STEVEN Sex Eth. M 5 Caucasian M 1 8.00 8.00 8.00 8.00 8.00 40.00 20.160 HODCARRIER 137836 0.50 0.50 1.00 30.240 HODCARRIER Job Earn: 836.64 FICA: 64.00 FIT: 76.55 State: 24.52 Local /SDI: 22.76 Oth Deds: 148.10 Adj Net: 0.00 Tot Earn: 836.64 Tot Deds: 335.93 Un Vac: 0.00 Benefits: 400.98 Un Misc: 0.00 Un Dues: 25.10 Net Pay: 500.71 GARN FEE 2.00 CHID SPT 121.00 STAFFORD, JOHN Sex Eth. M 5 Caucasian M 0 8.00 8.00 8.00 8.00 8.00 40.00 30.500 MASON 137837 Job Earn: 1,220.00 FICA: 93.33 FIT: 144.59 State: 41.48 Local /SDI: 14.03 Oth Deds: 47.20 Adj Net: 0.00 Tot Earn: 1,220.00 Tot Deds: 340.63 Un Vac: 0.00 Benefits: 391.60 Un Misc: 0.00 Un Dues: 47.20 Net Pay: 879.37 AMES, EDWIN Sex Eth. M 5 Caucasian S 0 8.00 8.00 8.00 24.00 28.050 MASON 137743 Job Earn: 673.20 FICA: 68.67 FIT: 161.23 State: 30.52 Local /SDI: 13.46 Oth Deds: 68.80 Adj Net: 0.00 Tot Eam: 897.60 Tot Deds: 342.68 Un Vac: 32.00 Benefits: 369.28 Un Misc: 0.00 Un Dues 36,80 Net Pay: 554.92 z 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; 03/17/2009 INDIANAPOLIS, IN 46219 N. RANGE LINE RD Page 2 Day and Date Employee Information Wed Thu Fri Sat Sun Mon Tue Total Pay 3/11 3/12 3/13 3/14 3/15 3/16 3/17 Hours Rate Work Classification Check# FRICK, RALPH Sex Eth. M 5 Caucasian M 0 8.00 8.00 8.00 24.00 28.050 MASON 137779 Job Earn: 673.20 FICA: 68.67 FIT: 146.23 State: 55.52 Local /SDI: 11.22 Oth Deds: 68.80 Adj Net: 0.00 Tot Eam: 897.60 Tot Deds: 350.44 Un Vac: 32,00 Benefits: 369.28 Un Mise: 0.00 Un Dues: 36.80 Net Pay: 547.16 Ernp. Count Job Hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net 5 137.00 3,564.32 359.37 617.06 1.80.80 1,590.94 4,697.68 0.00 3,106.74 gate 03/17/2009 (4) That: 1, EVAN IONES/PRESIDENT (a) Where fringe benefits are paid to approved plans, funds, 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 BAITS 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 1 I day of March 2009 paid, as indicated on the payroll, an amount not less than the sum and ending the 17 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 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 Star. 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 die 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 1001 of Title 1.8 and Section 231 .of Title 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 DES.IGN DIS 9260 Week Ending 03/[0/2009 INDIANAPOLIS, IN 46219 N. RANGE LINE RD Patre I Day and Date Employee Information Wed Thu Fri Sat Sun Mon Tue Total Pay 3/4 3/5 3/6 3/7 3/8 3/9 3 /10 Hours Rate Work Classification Check# DISHON, DAVID Sex Eth. M 5 Caucasian M 1 8.00 8.00 29.500 MASON 137666 Job Earn: 236.00 FICA: 86.72 FIT: 121.10 State: 29.72 I-ocal /SDI: 11.34 Oth Deds: 86.00 Adj Net 0.00 Tot Earn: 1,133.60 Tot Deds: 334.88 Un Vac: 40.00 Benefits. 461.60 Un Misc: 0.00 Un Dues. 46.00 Net Pay. 798.72 Emp. Count Job Hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net 1 8.00 236.00 86.72 1.21.10 29.72 334.88 1,133.60 0.00 798.72 Date 03/10/2009 (4) That. t. EVAN lONES/PRESiDENT (a) Where fringe benefits are paid to approved plans, funds, 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 he made to annropriate 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 BATTS CONSTRUCTION INC on the CARMEL ARTS DESIGI\ (b) Where fringe benefits are paid in Cash Each laborer it mechanic listed in the above referenced payroll has been that during the payroll period commencing on the 4 day of March 2009 paid, as indicated on the payroll, an amount not less than the sum and ending the 10 day of March 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. BAITS CONSTRUCTION INC from the full weekly wages eamed (c) Exceptions by any person and that no deductions have been made either directly or indirectly from the full wales 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 tinder this contract required to be submitted for the above period are correct and complete; that the wale 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 subiect the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 3 1of the United States Code. Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) a '1, ;r SA Total S' ?`f. ap 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. 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 Z yyGoS' sg 7 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 OGy) Sign re j or 0 42 n 7�' -5 Cost distribution ledger classification if Title claim paid motor vehicle highway fund