169522 03/04/2009 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1
ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC
1, CARMEL, INDIANA 46032 PO BOX 2533 CHECK AMOUNT: $270,814.54
ANDERSON IN 46018
CHECK NUMBER: 169522
CHECK DATE: 3/4/2009
DEPAR TMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
654 R5023990 S10726 15 270,814.54 CONSTRUCTION
i
A PPLICATION AND CERTIFICATI E FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE 0,'E 01 PAGES
TO (OWNER): City of Carmel PROJECT: Blower /Electrical Modification APPLICATION NO:Fif teen( 15) to:
One Civic Square i Contract 60 C OWNER
Carmel, TN 46032 PERIOD 10: 01 31 -09 C ARCHITECT
C CONTRACTOR
FROM (CONTR.ACTOR): VIA (ARCHITECT): ARCHITECT'S C
M. K. Betts Engineering PROJECT NO: C
Contracting, Inc.
CONTRACT FOR: Invoice No. 07 -262. 15 CONTRACT DATE:
Applicatn is CONTRACTOR'S APPLICATIOIN, FOR PAYMENT Continua ion Sh et, Document G703niss a j c Payment. as t� hedCCnneCtion with the contract.
CHANGE ORDER SUMMARY) 1. ORIGINAL CONTRACT SUM 5 29 349,000.00
Change Orders approved in ADDITIONS DEDUCTIONS 2• Net change by Change Orders 5 344 347.00
previous months by Owner 3. CONTRACT SUM TO DATE (Line 1 2) S 2,693.347.00
TOTAL 4. TOTAL COMPLETED STORED TO DATE 5 2, 564,2 43.39
Approved this Month (Column G on 6703)
Number Date Approved
S. RETAINAGE:
a. of Completed Work
C0111 $302,815 ..30 7,610.00 (Column D E on G703)
C0112 67,282 $18,140.00 b. "ro of Stored Material
(Column F on G703)
Total Retainage (Line 5a 5b or
T OTALS $370 097it00 25 750.00 Total in Column I of G703) 5 132,210.25
Vet than e by Change Orders $344,347.00 6. TOTAL EARNED LESS RETAINAGE 5 2,432 ,033.14
The undersigned Contractor certifies that to the best I (Line 4 less Line 5 Total) of the Contractor's knowledge, 7. LESS PREVIOUS CERTIFICATES FOR
completed and Work the Contact Documehlication for Payment has been
P 2 161 218.60
I 'nts, That all amounts have been PAYMENT (Line 6 from prior Certificate) 5
paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE S 270 8 14.54
issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE 261,313.86
herein Is now due_. ll (Line 3 less Line 6)
4
CONTRACTOR: I•i. K. Betts Engineering Contracting, Inc.. State of: Indiana County of: Madison
Subscribed and sworn to before me this 31st day of Jan. 2009
i) Notary Public:
Bv: (Date: January 31, 200 My Commission expires: October 28 2015
AMOUNT CERTIFIED b
ARCHITECT'S CERTIFICATE F OR PAYMENT (Attach explanation if amount certified differs from the amount applied fora
In accordance with the Contract Documents, based lon on -site observations and the ARCHITECT
data comprising the above application, the Architect certifies to the Owner that to the q
best of the Architect's knowledge, information and beliet 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 A,�IOUNT CERTIFIED is payable only to the
the Contractor is entitled to payment of the AMOU NT 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 DOCUMENT G7U2 APPUC: \l l( 1 AND C..EPTIFIC \TF. FOR 11M I EOITIC)N AIA 011,;
"IF .•.trl'IC n�\; •,,;.F: ...:i t•. nNt- ,Tilr: I ,n,,,,. G ?fl:! -19tH
CONTINUATION SHEET AIA DOCUMENT G703 Car Cont ract 60 PAGE O PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Fifteen 15)
Contractor's signed Certification is attached. APPLICATION DATE: January 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 01 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 01 31 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WO C O MP LETED --TOTAL COMPLETED
ITEM DESCRIPTION OF WORK SCHEDULED This Application AND STORED BALANCE RETAINAGE
VALUE TO FINISH
Previous TO DATE G =C)
Applications Work in Place Stored ti (not in D or C —G)
D or E) (D +E-i -F)
1., rlobilization, Bond
Insurance 75,000.00 73,000.00 1,000.00 -0- 74,000.00 99 1,000.00
2. Generator Pad Platforr 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 1.60,000.00 -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 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-
1.0. Valves 1.0,000.00 10,000.00 -0- -0- 10,000.00 100 -0
II. Blower Bldg Phase I 90,000.00 90,000.00 -0- -0- 90,000.00 100 -0-
12. Blower Bldg Phase IT 35,000.00 34,000.00 1,000.00 -0- 35,000.00 100 -0-
1.3. Pipe Insulation 5,400.00 -0- 5,400.00 -0- 5,400.00 100 -0-
1.4. Acoustical. Ceilings 21,000.00 -0- 21,000.00 -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 -0- 1,000.00 -0- 1,000.00 67 500.00
17. Instrumentation 90,000.00 23,121.30 66,878.70 -0- 90,000.00 100 -0-
ALA DOCUMENT C703 CONTINL'AIIO SHEET APRIL 191 EDITION AI,\ 1) 1978
TV{E A ?•tERIG =.N INSTITL' T E OF ARCHITECT5, 1735 NE\V 1'OR� AVE., N. \V., %vASHINGTON, D.C. 20006 6703 1978
Cb NT I NUAT!ON SHEET AIA DOCUMENT 07 03 Carmel Contract 6 PAGE OF PAGES
AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Fifteen 15)
Contractor's signed Certiiication is attached. ,APPLICATION DATE: January 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROti1: 01 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 01 -31 -09
ARCHITECT'S PROJECT NO:
6 C D E F G H I
TAL COMPLETED
ITE,�t DESCRIPTION OF WORK SCHEDULED WORK COMPLETED TO BALANCE RE'iAINAGE
o
o. VALUE This Application AND STORED TO FINISH
Previous TO DATE (G =C
Applications Work in Place Stored Materials C —G)
(not in D or E) (D +E -i-F)
18. Control Commissioning 56,000.00 -0- 56,000.00 -0- 56,000.00 100 -0-
1.9. Software Allowance 25,000.00 7,552.58 -0- -0- 7,552.58 30 17,447.42
20. 14VAC 92,000.00 80,333.00 11,667.00 -0- 92,000.00 100 -0-
21. Electrical_ 11.24,000.00 1060,953.97 31,500.03 -0- 1092,454.00 97 31,546.00
22 Painting 1.3,000.00 8,684.00 4,316.00 -0- 13,000.00 100 -0-
23. Miscellaneous 45,000.00 39,500.00 5,500.00 -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 4,500.00 492.00 -0- 4,992.00 100 -0-
3. PMQ1I Meter Plant
Feed 7,357.00 7,357.00 -0- -0- 7,357.00 100 -0-
4. Addition PMQI1
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
Supplemental Heat 282,955.00 188,620.00 21,000.00 -0- +209,620.00 74 73,335.00
7. Electrical Prat to
Aeartion 1,679.00 1,485.00 -0- -0- 1,485.00 88 194.00
ALA DOCUMENT 6703 CONTINUArIO,L SHEET APRIL 1978 EDITION AIA't U 1978
THE i, RIC. =.N INSTITUTE OF ,RCHITECTS, 1735 NEW YORK. VE., N.M. \vASHINGTON. D.C. '0006 6703 197a
CONTINUATION SHEET AIA DOCUMENT 0703 PAGE OF PAGES
\IA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Fifteen (15)
Contractor's signed Certification is attached. APPLICATION DATE: January 31 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 01 01 09
Use Column I on Contracts where variable retainage for line items may apply. TO: 01 31 09
ARCHITECT'S PROJECT NO:
A B C D E F G H I
ITEt.1 DESCRIPTION OF WORK SCHEDULED WO COMPLETED TOTAL COMPLETED
This Application BALANCE RETAINAGE
PP AND STORED
o. VALUE Previous TO DATE (G C) TO FINISH
Applications Work in Place Stored Materials (D +E +F) (C —G)
(riot 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 -0- 375.00 -0- 375.00 100 -0-
2. Replace existing
MCC unit in Return
Bldg. 17,623.00 -0- 16,623.00 -0- 16,623.00 94 1,000.00
3. Install new feeds
PP -AT for new HVAC
System. 4,200.00 3,900.00 0 3,900.00 93 300.00
4. Deduct for Fiber
Optic not installed 6,345.00 -0- 6,345.00 -0- 6,345.00 100 -0-
5. Deduct for new feeds
to Centrifuge Bldg.
not installed 5,500.00 -0- 5,500.00 -0- 5,500.00 100 -0-
AIA DOCUh1ENT 6703 COiNT I,*, I C), SHEET APRIL 1976 EDITION AIAt U 19713
TtfE A;.t RI C. =,N 1 T E, OF ARCHITECTS, 1735 NEW YORK AVE., N.W.. WASHINGTON, D.C. 20006 6703 —19713
CONTINUATION SHEET AIA D OCUMENT G 703
PAGE OF p�.GES
IA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Fifteen 15
Contractor signed Certification is attached. APPLICATION DATE: January 31, 2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 01 -01 -09
Use Column I on Contracts Where variable retainage for line items may apply. TO: 01 31 -09
ARCHITECT'S PROJECT NO:
B C D E F G H I
ITE`.1 DESCRIPTION OF WORK SCHEDULED WO COMPLETED TOTAL COMPLETED BALANCE RETAINAGE
o. VALUE This Application AND STORED
Previous
TO DATE (G +C TO FINISH Applications Work in Place Stored Materials (not in D or E) ID FE F) (C —G)
6. Repair air leaks in
Aeration Basins
2 3 1,720.00 -0- 1,720.00 -0- 1,720.00 100 -0-
7. Repair baffle wall
in Clarifier Tank
#3 939.00 939.00 0 939.00 100 0-
8. Install insulation
on hot water piping
in Solar Drying
Bldg. 220.00 -0- 220.00 -0- 220.00 100 -0-
9. Grade soil around
generator 1,020.00 -0- 1,020.00 -0- 1,020.00 100 -0-
10. Install Rotork
modulating valve
in Aeration Tank
#6 8,825.00 -0- 8,825.00 -0- 8,825.00 100 -0-
11. Relocate 3 SSRVS For
555.00 100 -0-
new blowers. 7,555.00 -0- 7,555.00 -0- 7,555.00
12. Repair existing bloc
on blower building. 11,070.00 -0- 11,070.00 -0- 11,070.00 100 -0-
13. Omit acoustical
ceiling, tile in
blower bldg. pain
existing ceiling. 5,700.00 -0- 5,700.00 -0- 5,700.00 100 -0-
.AIA DOCUtAENT 6703 I CON I INU',TIUN SHEET PRIL 1978 EDITION AIA`- J 1978 G703
I,JSTITU IE OF -RCHI FECTS, 1735 NEW YORK P\VE., .J. \N.. WASHINGTON, D,C. 20005
r
SERVICE PIPE SUPPLY, INC INVOICE
P.O. BOX 33805
INDIANAPOLIS, IN 46203 legmr.r. TIM
Phone 317- 639 -9308
Fax: 317 -639 -1335 Numtiec" 480711
Date 13/29/08
rpag6'. I
M. K. BETTS ENG. CONTR. INC. Ship`, M. h. BETTS ENG. d CONTI, INC.
BI TTSM MP CARI\IEL WASTE WATER
P.O. Box 2533 CARMEL PROJECT 60
ANDERSON. IT 46016
Anderson. IN 46018 -2533
:CUStOmer. PDF Shipped :Salesperson Terms. Tax Gone ➢oc Ewh Freight Ship 'Via
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Fbrm Prescr ibe 301 -S St Bo 1995) "ts ACCOUNTS PAYABLE VOUCHER
Form 301 1995)
TO
ADDRESS
Invoice Date Invoice Number Item Amount
i
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and that the materials or services
itemized thereon for which charge is made were ordered and received except
1 19
Signature Title
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.
19
7 Officer Title
Voucher No. Warrant No.
ACCOUNTS.- PAYABLE DETAILED ACCOUNTS
SANITATION DEPARTMENT ANOCT.
CARMEL, INDIANA
K n� S Favor Of
Total Amount of Voucher
Deductions
Amount of Warrant
Month of 19
VOUCHER RECORD Not
Collection System
Operation
Plant
Commercial
General
Undistributed
Construction
Depreciation Reserve
Stock Accounts Merchandise
Total
Allowed
Board Members
Filed
BOYCE FORMS SYSTEMS 1 -800- 382 -8702 325