171929 04/29/2009 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1
ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC
CARMEL, INDIANA 46032 PO Box 2633 CHECK AMOUNT: $111,656.19
ANDERSON IN 46018
d
CHECK NUMBER: 171929
CHECK DATE: 4/29/2009
D EPARTMENT ACC PO NUMBER INVOICE NUMBE R------ AMO D ESCRI PT ION
659 5023990 96,656.19 OTHER EXPENSES
659 5023990 17 15,000.00 OTHER EXPENSES
APPLICATION AND CERTIFICATE FOR PAYMENT AAA DOCUiVIENT G702 onstructions on reverse side) PAGE oNF or P \c[s
TO (OWNER): City of Canute]. PROJECT: Blower /Electrical Modification APPLICATION NO:Sixteen(16pistribution to:
One Civic Square Contract 60 L OWNER
Carmel, IN 46032 PERIOD TO: 02 28 09 L ARCHITECT
0 CONTRACTOR
FRONA iCONTRACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
Contracting, Inc.
CONTRACT FOR: Invoice No. 07- 262.16 CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT Continu l Sheet, for
AIA Document C703,Tis below, in atttacheClconnection with the Contract.
CHANGE O RDER SUMMARY 1. ORIGINAL CONTRACT SUM S 2, 349 ,000-00
I 2. Net change by Change Orders 344,347
Change Orders approved in ADDITIONS DEDUCTIONS
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) S 2, 347.00
TOTAL 4. TOTAL COMPLETED STORED TO DATE S 2,660
Approved this Month (Column G on 6703)
Number Date Approved S. RETAINAGE:
a. of Completed Work S
CO# 1 $302,815.00 7,610.00 (Column D E on G703)
CO#2 67,282.00 $18,140.00 b. of Stored Material
(Column F on 6703)
Total Retainage (.Line 5a -I 5b or
TOTALS I $370,097.00 $25,750.00 Total in Column I of G703) 132
Net change by Change Orders $344,347 6. TOTAL EARNED LESS RETAINAGE 2,528
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 2 ,432,033 .14
paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 96,656 .1 9__
issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE S 164
herein is now due. (Line 3 less Line 6)
CONTRACTOR: M. K. Betts Engineering Contracting, Inc. State or: Indiana County of: Madison
Subscribed and sworn to before me this 28th day of Feb. 2009
Notary Public:
By: Date: February 28, 20 09 My Commission expires: October 28 201.5
AMOUNT CERTIFIED S
ARCHITECT'S CERTIFICATE FOR PAYMENT (Attach explanation if certified differs from the amount applied for.)
In accordance with the Contract Documents, based on on -site observations and the ARCHITE
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 A1� t lOUN CERTIFIED is payable only to the
the Contractor is entitled to payment of the AMOU`JT 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 DOCUMrNI C.711? APPI ICAIIr AND C ERTIFIC \R. MR P \l'r.IF.�'T .�1, t'18t CDiTICQre AIA 1975.1
CONTINUATION SHEET AIA D G703 Carmel Contract 60 PAGE OF PP,GES
AIA Document G702. APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Sixteen (16)
Contractor's signed Certification is attached. APPLICATION DATE: February 28, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROtA: 02 01 -09
Use Column I on Contracts where variable retainage for line items may apply. TO: 02 28 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED W ORK COMPLETED —TOTAL COMPLETED BALANCE RETAIN ?,GE
This Application AND STORED
`:o. VALUE TO FINISH
Previous TO DATE IG =C1
Applications Work in Place Stored Materials tD +E +F) C —C,)
(not in D or E)
1. Mobilization, Bond
Insurance 75,000.00 74,000.00 500.00 -0- 74,500.00 99 500.00
2. Generator Pad Platforr 40,000.00 40,000.00 -0- -0- 40,000.00 100 -0-
3. Generator. 272,000.00 272,000.00 -0- -0- 272,000.00 100 -0-
4. Launder Covers 1.60,000.00 160,000.00 -0- -0- 160,000.00 100 -0-
5. Switch Gear. Building 39,000.00 39,000.00 -0- -0- 39,000.00 100 -0
6. Masonry 78,000.00 78,000.00 -0- -0- 78,000.00 100 -0-
7. Roo:Eing Sheetmeta.l 14,000.00 14,000.00 -0- -0- 14,000.00 100 -0-
8. Doors, Frames
Hardware 1.6,000.00 16,000.00 -0- -0- 16,000.00 100 -0-
9. Aeration Tank Work 40,000.00 40,000.00 -0- -0- 40,000.00 100 -0-
90. Valves 1.0,000.00 10,000.00 -0- -0- 10,000.00 100 -0-
1.I. Blower Bldg Phase T 90,000.00 90,000.00 -0- -0- 90,000.00 100 -0-
1.2. Blower Bldg Phase TT 35,000.00 35,000.00 -0- -0- 35,000.00 100 -0-
1.3. Pipe Tnsulation 5,400.00 5,400.00 -0- -0- 5,400.00 100 -0-
1.4. Acoustical Ceilings 21,000.00 21,000.00 -0- -0- 21,000.00 100 -0-
1.5. Roll Up Doors 7,100.00 7,100.00 -0- -0- 7,100.00 100 -0-
1.6. Signs Fire
Extinguishers 1,500.00 1,000.00 500.00 -0- 1,500.00 100 -0-
17. Tnstrumentati_on 90,000.00 90,000.00 -0- -0- 90,000.00 100 -0-
,11A DOCUMENT G703 CONIINL.'ATION SHEET APRIL 1978 EDITION AIA' J 1978
THE A,N'.ERiC'.N INSTITUTE OF ARCHITECTS, 1735 NEW YORK: ,AVE., N.M. WASHINGTON. D.C. 20006 G7113 —'1978
CONTINUATION SHEET AfA DOCUh1ENT 0703 Carmel Contract 60 PAGE OF P :%GES
AIA Document G702. APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Sixteen (16)
Contractor's signed Certification is attached. APPLICATION DATE: February 28, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 02 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 02 28 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
W ORK COM
ITEM DESCRIPTION OF WORK SCHEDULED TOTAL COMPLETED LANCE P,ET�JN: \GE
VALUE This Application AND STORED TO FINISH
Previous TO DATE iG =C
Applications Work in Place Stored Materials (D +E +F) (C —G)
(not in D or E)
1.8. Control Commissioning 56,000.00 56,000.00 -0- -0- 56,000.00 100 -0-
1.9. Software Allowance 25,000.00 7,552.58 -0- 1 -0- 7,552.58 30 17,447.42
20. HVAC 92,000.00 92,000.00 -0 0- 92,000.00 100 -0-
21., Electrical- 11,24,000.00 1092,454.00 30,546.00 -0- 1123,000.00 99 1,000.00
22. Painting 1- 3,000.00 13,000.00 -0- -0- 13,000.00 100 -0-
23. Miscellaneous 45,000.00 45,000.00 -0- -0- 45,000.00 100 -0-
CO#1 Change Order No. 1
1. Eliminate EUH04,5,6 7,61.0.00 7,610.00 -0- -0- 7,610.00 100 -0-
2_. Suspended Solids
Meter #10 4,992.00 4,992.00 -0- 0- 4,992.00 100 -0-
3. PMQII Meter Plant
Feed 7,357.00 7,357.00 -0- -0- 7,357.00 100 -0-
4. Addition PMQII
Metering 3,445.00 3,445.00 0 3,445.00 100 0-
5. Misc. Electrical
Blower Building 508.00 508.00 -0- -0- 508.00 100 -0-
6. Solar Drying
Supplemental bleat 282,955.00 209,620.00 59,835.00 -0- +269,455.00 95 13,500.00
7. Electrical Prat to
Aeartion 1,679.00 1,485.00 194.00 -0- 1,679.00 100 -0-
AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION ,�I,A''� U 1978
THE A,ti'.ERiCAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK; AVE— N.W.. \NASHINGTON. D.C. 20006 6703 1978
CONTINUATION SHEET AIA DOCUMENT G70 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Sixteen (16
Contractor's signed Certification is attached. APPLICATION DATE: February 28, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 02 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 02 28 09
ARCHITECT'S PROJECT NO:
8 C D E F G I I I
11 E.'.1 DESCRIPTION OF WORK SCHEDULED WOR COMPLETED TOTAL COMPLETED BALANCE RETAINAGE
VALUE This Application AND STORED n TO FINISH
Previous Stored Materials TO DATE (G =C1 (C —G)
Applications Work in Place (riot in D or El (D t E +F)
8. Remove Concrete
Lining Aeration
Tank #10 500.00 500.00 0 500.00 100 0-
9. Condenser Support
Trenwa 1,185.00 1,185.00 -0 -0- 1,185.00 100 -0-
10. Metal Halide Lights
Fixture "C" 194.00 194.00 -0- -0- 194.00 100 -0-
CO#2 Change Order No. 2
1. Relocate existing
conduit in East
Digest for boiler
flu 375.00 375.00 -0- -0- 375.00 100 -0-
2. Replace existing
MCC unit in Return
Bldg. 17,623.00 16,623.00 1,000.00 -0- 17,623.00 100 -0-
3. Install new feeds
PP AT for new HVAC
System. 4,200.00 3,900.00 300.00 4,200.00 100 0-
4. Deduct for Fiber
Optic not installed 6,345.00 6,345.00 -0- -0- 6,345.00 100 -0-
5. Deduct for new feeds
to Centrifuge Bldg.
not installed 5,500.00 5,500.00 -0- -0- 5,500.00 100 -0-
AIA DOCUMENT 6;113 CONTINUATION SHEET APRIL 1978 EDITION AIA'= J 1978
T 4J4 .1 n, +:'CII'1.1 I1.Ii TlT1 TC l C \rir'U—C/ TC I-JC �IC%AI V( DL IlrC 11 Inr 1•i11 iii ni r'T r,.i n r nnnr r.;n'z lv�st
CONTINUATION SHEET AI DOCU G703 PA GE OF PA GES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER:
Contractor's signed Certification is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM:
Use Column I on Contracts where variable retainage for line items may apply. TO
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WO RK COMPLETED TOTgj
1% DESCRIPTION OF WORK SCHEDULED This Application A BALANCE RETAMAGE
:o. VALUE Precious (G C) TO FINISH
Applications Work in Place Stored Materials (C—G)
(not in D or E)
6. Repair air leaks in
Aeration Basins
2 3 1,720.00 1,720.00 -0- -0- 1,720.00 100 -0-
7. Repair baffle wall
in Clarifier Tank
#3 939.00 939.00 -0 -0 939.00 100 -0-
8. Install insulation
on hot water piping
in Solar Drying
Bldg. 220.00 220.00 -0- -0- 220.00 100 -0-
9. Grade soil around
generator 1,020.00 1,020.00 -0- -0- 1,020.00 100 -0-
10. Install Rotork
modulating valve
in Aeration Tank
#6 8,825.00 8,825.00 -0- -0- 8,825.00 I00 -0-
11. Relocate 3 SSRVS for
new blowers. 7,555.00 7,555.00 -0- -0- 7,555.00 100 -0-
12. Repair existing bloc
on blower bI 0 11,070.00 -0- -0- 11,070.00 100 -0-
13. Omit acousti
ceiling, ti.
blower bldg
existing ce0 5,700.00 -0- -0- 5,700.00 100 -0-
AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIA' 1978
(.711'4 —107R
CONTINUATION SHEET AIA D OCUMENT 6703 PAGE of PAGES
AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Sixteen 16
Contractor's signed Certification is attached. APPLICATION DATE: February 28, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 02 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 02 -28 -09
ARCHITECT'S PROJECT NO:
A B C D E F G I1 I
WOR COMPLETED TOTAL COMPLEI ED
ITEhI DESCRIPTION OF WORK SCHEDULED This Application AND STORED BALANCE F.ETA11L1GE
VALUE
Previous TO DATE (G --C1 IO FINISH
Applications Work in Place Stored Materials (D4- E-4-r) lC —G)
(not in D or E)
14. Relocate existing
filtrate pumps feed
from west wall of
Blower Building. 2,892.00 2,892.00 -0 0 2,892.00 100 0-
15. Replace existing
homestead valves
with American ball
valves for supple-
mental heat. 380.00 380.00 -0- -0- 380.00 100 -0-
16. Repair existing
airlines in south
aeration tanks. 1,327.00 1,327.00 -0- -0- 1,327.00 100 -0-
17. Omit temporary
piping in blower
building. 595.00 595.00 -0- -0- 595.00 100 -0-
18. Install conduit feed
to Digester Bldg. 2,539.00 2,539.00 -0- -0- 2,539.00 100 -0-
19. Replace additional
Digester Valves 6,597.00 2,815.81 2,781.19 -0- 6,597.00 100 0
2,693,347.0 2564,243.39 96,656.19 -0- 2660,889.58 99 32,447.42 132,210.2
AIA DOCUMENT G703 CONTINUATION SHEET APRIL 1978 EDITION AIA'n U 1978
1 978
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 I�
M.K. BETTS ENGINEERING CONTR Purchase Order No.
P.O. Box 2533 Terms
Anderson, IN 46018 Due Date 4/23/2009
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/23/2009 16 $96,656.19
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 ffi r
VOUCHER 095551 WARRANT ALLOWED
351429 IN SUM OF
M.K. BETTS ENGINEERING CONTR
P.O. Box 2533
Anderson, IN 46018
Carmel Wastewater Utility
Q N ACCOUNT OF APPROPRIATION FOR
Board members
PO INV ACCT AMOUNT Audit Trail Code
16 07- 1050 -61 $96,656.19
G /0
1
p Voucher Total $96,656.19
Cost distribution ledger classification if
claim paid under vehicle highway fund
A PPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUh 670 (Instructions on reverse side) P. P ,cEs
TO (OWNERI: City of Carmel PROJECT: Blower /El-ectrical Modification. APPLICATION NO:Seventeen Distribution to:
One Civic Square Contract 60 17) F. O \,VNER
Carmel, IN 46032 PERIOD TO: 03 31 -09 C ARCHITECT
C CONTRACTOR
FROM ICONTR.ACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
Contracting, Inc.
CONTRACT FOR: Invoice No. 07 -262. 17 CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT Continuatio l a ma h Document G703, is attached
connection with the Contract.
ed
CHAN OR
Change DER SUMh1ARY 1. ORIGINAL CONTRACT SUM 2, 349,000.00
Chan Orders approved in ADDITIONS DEDUCTIO
I cha y B 2. Net th e b Change Orders 344,347.00
previous rnonths by Owner 3. CONTRACT SUM TO DATE (Lime 1 n 2 693.347
TOTAL 4. TOTAL COMPLETED STORED TO DATE 2 ,675,899.58
Approved this ti4onth (Column G on G703)
S. RETAINAGE:
Number Date Approved a. `yo of Completed \Mork
C0# 1 $302,815.00 7,610.00 (Column D E on 6703)
C0#2 67,282.00 $18,140.00 b. 1 of Stored Material
(Column F on G703)
Total Retainage (Line 5a 5b or
132,210.25
TOTALS $370,097.00 $25,750.00 Total in Column I of G7 03) 2,543,689.33
`Jet change by Change Orders $344,347 6. TOTAL EARNED LESS RETAINAGE
The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total)
information and belies 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) 2 528 689 .33
paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE 5 15,000.00
issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE 149,657.67
herein is now due.
(Line 3 less Line 6)
CONTRAC OR: hf. K. Betts Engineering Contracting, Inc. State of: Indiana County of: Madison
Subscribed and sworn to before me this 31st day of March 2009
Notary Public -<-o^ "7
BY: Date: March 31, 2009 My Commission expires: October 28 2015
AMOUNT CERTIFIED......
ARCHITECT'S CERTIFICATE FOR PAYMENT cer
(Attach explanation if amoun d differs ers fr the the he
amount applied for)
In accordance with the Contract Documents, based on on -site observations and the ARCHIT
data comprising the above application, the Architect certifies to the Owner that to the S
best of the Architect's knowledge, information and belief the Work has progressed as B 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 ANAOUNT CERTIFIED. Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract-
%I A DOCUNA(NI I C 'I Ii .A ^)D CLRTIF ICAri. FOR P,V1 I MAY EDITION 41A' 1Nto
I1it _r'u ''i iii tltl lr s4 itmCI
CONTINUATION SHEET A1A DOCUh1ENT 0703 Carmel Contract 60 PAGE OF PAGES
,AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Seventeen (17
Contractor's signed Certification is attached. APPLICATION DATE: March 31 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 03 01 -09
Use COlumn I on Contracts where variable retainage for line items may apply. TO: 03 -31 -09
-\RCHITECT'S PROJECT NO:
B C D E F G H I
WORK COMPLETED TOTAL COMPLETED
ITE :1 DESCRIPTION OF WORK SCHEDULED This Application AND STORED a BALANCE RETAINAGE
VALUE Previous pp TO DATE (G TO FINISH
Stored Materials (C G)
Applications Work in Place (not in D or E) (D-1-E+ F)
1. Mobilization, Bond
Insurance 75,000.00 74,500.00 500.00 0— 75,000.00 100 —0-
2. Generator Pad Platfory 40,000.00 40,000.00 —0— —0— 40,000.00 1 —0-
3. Generator 272,000.00 272,000.00 —0— —0— 272,000.00 100 —0-
4. Launder Covers 160,000.00 160,000.00 —0— —0— 160,000.00 100 —0-
5. Switch Gear Building 39,000.00 39,000.00 -0- -0- 39,000.00 100 -0-
6. Masonry 78,000.00 78,000.00 -0- -0- 78,000.00 100 -0-
7. Roofing Sheetmetal 14,000.00 14,000.00 —0 —0— 14,000.00 100 —0-
8 Doors Frames
Hardware 16,000.00 16,000.00 —0— —0— 16,000.00 100 —0-
9. Aeration Tank Work 40,000.00 40,000.00 —0— —0— 40,000.00 100 —0-
10. Valves 1.0,000.00 10,000.00 —0— 70 10,000.00 100 —0-
11. Blower Bldg Phase 1 90,000.00 90,000.00 —0— —0— 90,000.00 100 —0-
12. Blower Bldg Phase 11 35,000,00 35,000.00 —0— —0— 35,000.00 100 —0-
13. Pipe Insulation 5,400.00 5,400.00 —0— —0— 5,400.00 100 —0-
1.4. Acoustical Ceilings 21,000.00 21,000.00 —0— —0— 21,000.00 100 —0-
15. Roll Up Doors 7,1.00.00 7,100.00 —0— —0 7,100.00 100 —0-
1.6. Signs Fire
EXtiRguishers 1,500.00 1,500.00 —0— —0— 1,500.00 100 —0-
1.7. Instrumentation 90,000.00 90,000.00 —0— —0— 90,000.00 100 —0—
AIA DOCUi \1ENT G703 COiNTIiNL'.�TIUN SHEET P,PRIL 191 EDITION AIA iD 1978
TFiE A.titLRIC. =.ti INSTITUTE OF ARCHITECTS, 1733 1,E\%1 YORK. AVE., N.M. WASHINGTON. D.C. 2000G G703 1978
CONTINUATION SHEET /A DOCUNIENT 0703 Carmel Contract 60 PAGE OF P: \CES
Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Seventeen (17)
Contractor's signed Certification is attached. APPLICATION DATE: March 31 2009
In tabulations below, amounts are stated to the nearest dollar, PERIOD FROM: 03 01 -09
Use Column I on Contracts where variable retainage for line items may apply. TO: 03 31 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WORK COMPLETED TOTAL COMPLETED
ITE`.1 DESCRIPTION OF WORK SCHEDULED BALANCE RETAIN. -\GE
VALUE This Applica AND STORED 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 Coannissioning 56,000.00 56,000.00 -0- -0- 56,000.00 100 -0-
19. Software Allowance 25,000.00 7,552.58 -0- -0- 7,552.58 30 17,447.42
20. PVAC 92,000.00 92,000.00 0 0 92,000.00 100 0
21.. Electrical 11.24,000.00 1123,000.00 1,000.00 -0- 1124,000.00 100 -0-
?2. Painting 13,000.00 13,000.00 -0- -0- 13,000.00 100 -0-
23. Miscellaneous 45,000.00 45,000.00 -0- -0- 45,000.00 100 -0-
CO#1 Change Order No. .1
1. Eliminate EUH04,5,6 7,610.00 1,610.00 -0- -0- 7,610.00 100 -0-
2. Suspended Solids
Meter #10 4,992.00 4,992.00 -0- -0- 4,992.00 100 -0-
3. PMQ11 Meter Plant
Feed 7,357.00 7,357.00 -0- -0- 7,357.00 100 -0-
4. Addition PMQ11
Metering 3,445.00 3,445.00 -0- -0- 3,445.00 100 -0-
5. Misc. Electrical_
Blower Building 508.00 508.00 -0- -0 508.00 100 -0-
6. Solar Drying
Suppleiiiental Heat 282,955.00 +269,455.00 13,500.00 -0- +282,955.00 100 -0-
7. Electrical Prat to
Aeartion f 1,679.00 1,679.00 -0- -0- 1,679.00 100 -0-
AIA DOCUMENT 6703 CONTINLATIi)N SHEET APRIL 1978 EDITION I AIA'= C '1978
THE AraERIC, =.N INSTITUTE OF �,RCHITECTS, 1735 NEbV YORK AVE., N.W., VNASHINGTON, D.C. 70006 G703 1978
CONTINUATION SHEET A IA DOCUh1E 6703 PAGE OF PACES
,-\IA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Seventeen (17
Contractor's signed Certification is attached. APPLICATION DATE: March 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 03 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 03 31 -09
ARCHITECT'S PROJECT NO:
B C D E F G H I
WO RK COMPLETED
TE >•I DESCRIPTION OF WORK' SCHEDULED I'OTAL COMPLETED BALANCE RETAINAGE
V ALUE
This Application AND STORED TO FINISH
Previous 70 DATE (G -C)
Applications Work in Place Stored Materials (D_K -E +E) (C —G)
(not in D or E)
8. Remove Concrete
Lining Aeration
Tank #10 500.00 500.00 -0- -0- 500.00 100 -0-
9. Condenser Support
Trenwa 1,185.00 1,185.00 -0- -0- 1,185.00 100 -0-
10. Metal Halide Lights
Fixture "C" 194.00 194.00 -0- -0- 194.00 100 -0-
CO#2 Change Order No. 2
1. Relocate existing
conduit in East
Digest for boiler
flu 375.00 375.00 -0- -0- 375.00 100 -0-
2. Replace existing
MCC unit in Return
Bldg. 17,623.00 17,623.00 -0- -0- 17,623.00 100 -0-
3. Install new feeds
PP -AT for new HVAC
System. 4,200.00 4,200.00 -0- -0- 4,200.00 100 -0-
4. Deduct for Fiber
Optic not installed 6,345.00 6,345.00 -0- -0 6,345.00 100 -0-
5. Deduct for new feeds
to Centrifuge Bldg.
not installed 5,500.00 5,500.00 -0- -0 5,500.00 100 -0-
AIA DOCUMENT G703
CONTINUATION SHEET APRIL 19 -B EDITION AI A'" U 19713 G703 7978
THE'- i�.icRIC' -1 INSTITUTE OF ARCHITECTS, 1735 NE4V YORK AVE., N.W., WASHINGTON:, D.C. 26005
CONTINUATION SHEET ALA DOCUNIENl 0703 PAGE OF PAGES
,-\IA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Seventeen 17
Contractor's signed Certification is attached. APPLICATION DATE: March 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 03 01 -09
Use Column I on Contracts where Variable retainage for line items may apply. TO: 03 31 -09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
ITE> WO COMPLETED TOTAL COMPLETED •1 DESCRIPTION OF WORK SCHEDULED This Application o, BALANCE RETAINAGE
Application AND STORED
VALUE TO FINISH
Previous TO DATE (G =C)
Applications Work in Place Stored Materials (C —G)
PI (not in D or E) (D-i- E -1 -P)
6. Repair air leaks in
Aeration Basins
2 3 1,720.00 1,720.00 -0- -0- 1,720.00 100 -0-
7. Repair baffle wall
in Clarifier Tank
#3 939.00 939.00 -0- -0- 939.00 100 -0-
8. Install insulation
on hot water piping
in Solar Drying
Bldg. 220.00 220.00 -0- -0- 220.00 100 -0-
9. Grade soil around
generator 1,020.00 1,020.00 -0- -0- 1,020.00 100 -0-
10. Install Rotork
modulating valve
in Aeration Tank
#6 8,825.00 8,825.00 -0- -0- 8,825.00 100 -0-
11. Relocate 3 SSRVS for
new blowers. 7,555.00 7,555.00 -0- -0- 7,555.00 100 -0-
12. Repair existing bloc
on blower building. 11,070.00 11,070.00 -0- -0- 11,070.00 100 -0-
13. Omit acoustical
ceiling, tile in
blower bldg. pain
existing ceiling. 5,700.00 5,700.00 -0- -0- 5,700.00 100
AIA DOCUMENT 6703 COiNTIi;L', -\ViON SHEET APRIL 19 EDITION AIA'i �J 1978
THE A,%."RICAN INSHTU T E OF ARCHITECTS, 1735 MEW YORK. AVE., N.W.. WASHINGTON, D.C. '0005 6703 —1978
CONTINUATION SHEET A/A D OCUMENT G703 PAGE OF PAGES
,AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Seventeen 17
Contractor's signed Certification is attached. APPLICATION DATE: March 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 03 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 03 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WO RK COMPLETED
ITE'.t DESCRIPTION OF WORK SCHEDULED rOTAL COMPLETED B,g LANCE RETAINAGE
This Application AND STORED °'o
VALUE Previous Stored Materials TO DATE (G =C) TO H
Applic Work in Place (D +E +F)
(not in D or E)
14. Relocate existing
filtrate pumps feed
from west wall of
Blower Building. 2,892.00 2,892.00 -0- -0- 2,892.00 100 -0-
15. Replace existing
homestead valves
with American ball
valves for supple-
mental heat. 380.00 380.00 -0- -0- 380.00 100 -0-
16. Repair existing
airlines in south
aeration tanks. 1,327.00 1,327.00 -0- -0- 1,327.00 100 -0-
17. Omit temporary
piping in blower
building. 595.00 595.00 -0- -0- 595.00 100 -0-
18. Install conduit feed
to Digester Bldg. 2,539.00 2,539.00 -0- -0- 2,539.00 100 -0-
19. Replace additional
Digester Valves 6,597.00 6,597.00 -0- -0 6,597.00 100 -0-
2,693,347.0 2 15,000.00 0 2675,899.58 99 17,447.42 132,210.25
A14 DC)C1},ti1ENT 6703 CUiS Jl.'P,TJpN SHEET APRIL 1978 EDITION 197B
THE.,At:RICP,N IPJSrITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W.. WASHINGTON, D.C. 20006 G703— '19711
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 4/23/2009
Q
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
4/23/2009 17 $15,000.00
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 �f
Date is
VOUCHER 095550 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
17 07- 1050 -61 $15,000.00
Voucher Total $15,000.00
1�ost distribution ledger classification if
claim paid under vehicle highway fund