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Home My WebLink About211849 08/14/2012 CITY OF CARMEL, INDIANA VENDOR: 00351429 Page 1 of 1 ONE CIVIC SQUARE M.K. BETTS ENGINEERING INC CHECK AMOUNT: $81,096.25 �o CARMEL, INDIANA 46032 PO BOX 2533 o� ANDERSON IN 46018 CHECK NUMBER: 211849 CHECK DATE: 8/14/2012 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 609 5023990 3 5, 500 . 00 OTHER EXPENSES 609 5023990 5 73 , 696 . 25 OTHER EXPENSES 609 5023990 6 1, 900 . 00 OTHER EXPENSES ti APPLICATION AND CER.TIFICAV ff FOR PAYMENT T6 (004p-ILR); City of Carmel- PROJECk Gray Road Booster Srati-ciii APPl-l(-ATl0,',l NO Th ree (3) Distribution lo: One Square carille], IN G OWNER Carmel , TN 46032 PERIOD TO: 06/30/12 El ARCHITECT M. K. Betts Engineering cnnrractj.ng, Inc , Invoice No. 12-126 .04 C0t,11'RACT 0'111; �,,pplication is made loc Payment, as 5hown helov,,, k� connccuon wilh ilic Contra:t. f-Clit�,FMACTOR'S APPIACAT10- N FOR PAYMENT COnfil-Illaticull Sheet, AIA 6ocument G703, k auachccl. CH 1-t ICE ORDER I. ORIGINAL. CONTRA" SUM . . .. . . . . . .. .. .. . . . . . .. 5 117,890.00 8125-00 Change Orders- approved if-, 2 , AA�DITIOHS DEDUCTIONS . Hel change by Change Orders . . . . .. . . . . . . .. . . . I . . . $ — pr vii us Qlomhs by C), 126,015.00 vnEr 3. CONTRACT SUM TO DATE 0.in� I m?I . . . . . .. . . . . . .. I TOTAL COMPI.FTEF-) & STORED TO DATE . . . . . . . . . . 125,315-00 ;Pi-)I-CjVtcl this Date �'Fjproved C,(0,1 + $ 21 , 150.00 -0- 00#2 + $ 3 ,975.00 -0- 8 125 .00 -0- change I)y Ci,an clyders + $ 8, 125.00 -I'lle undersigned Contractor certifies that it) the hest of the Conn-actor's knowledge, inlorma(ion and heher the ki\lc)rk covered i,y this ',pplicalian ior Na ,mem has peen LESS PREVIOUS CERTIFICATES FOR cl-'alpictcd in accordance hilt the Ct)mrLici DOCLIMeMS, Iflat all afl)GLIIIIS have been PAYMENT -119,815.00 ,aid by the Contractor 1(,-)f ��)Cjrk ml. which pravioils Certificates lor Payment were CURRENT PAYMEHT DUE . . . . . . . . . .. . . . . . . . . . . . . . . . 5 5 ,500.00 i r f 1 l, "F 1vl BAIANCE TO 11NISH, PLUS R-fAINAGE . . . . . . . . . . . 5 700 00 hlefeil) is no,v due. C F) 11 R-�,(-TO R: If . ice Betts -c I rl 9 Contracting, Inc . Stale of: Indiana C00111Y C)I: Madison SLA)SCI-ibed and. sworn to before me this 36th clay of June 2012 L"./; Dale: June 30, 2012 t,i v Commission e x p i f e s:' October 28, 2015 :+cs 0 p^ce !APPU[AT|/]NoUxx8[K: Three (]) Cray Road Booster Station APPLICATION DAW June 38, 2012 Carmel, 78 pEK|UDFKOt,4� 06/01/12 ' TO: 06/38/12 1 . EnLaVaLion and BacH i 11, r3 ,-500.00 3,500.00 Nip LE ED 00 oo 00 00 5 . Miscellaneous Metals 2,200.00 —0— 2,200.00 —0— 2,200.00 100 —0— 12 . Additional 20" Butterfly 13 . HWY Reducers for 126 ,015 .00 119 ,815.00 5 ,500.00 —0— j25 ,315.00 99 700-00 ~ ` VOUCHER # 121728 WARRANT # ALLOWED 351429 IN SUM OF $ M.K. BETTS ENGINEERING & CONTRi P.O. Box 2533 Anderson, IN 46018 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 3 07-1052-02 $5,500.00 CO/0 �eo��c��✓ Voucher Total $5,500.00 Cost distribution ledger classification if claim paid under vehicle highway fund 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 & CONTRACTING Purchase Order No. P.O. Box 2533 Terms Anderson, IN 46018 Due Date 8/7/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/7/2012 3 $5,500.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6 Date cer APPLICMIONAND CERTIFICATE FOR PAYMENT oo(-uA,,iENTG702 (Instriw-lions onjevefse sicle) P;'I,CE ONE Of City of Carmel PROIFCT: Wells 27 & 28 APPLIC,'JION 1`10: Five (5) DistriboliDn to: One Civic Square Contract 77 E. om',lER Carmel., IN 46032 PERIOD TO: 06/30/12 F_', ARCHITECT CONTRA0OR FROM 0__0NTR.-1,CTGR): Vl,-% (ARCHITECT): ARCHITECT'S M. K. Betts Engineering PROJECT NO: & Contracting, Inc. C(-_)t,1TR,-'.CT FOR. Invoice No. 12-122.05 CONTRACT DATE: Application is rnacle for Paynient, as shown below, in connection with (lie Contract. CONTRACTOR'S AMICATiON FOR PAYMENT co.tintiati0ii Sheet, AIA Document 6703, is aktached. 844,1 2.00 CH,-"NGE ORDER 'I. ORIGINAL CONTRACT SUM . . . . . . . . . . . .. . . . . . . . . . . $ Change I ". Net change by Change Ortlers . . . . . . .. . . . . .. . . . . . . . $ 165,9-5.00 hani)e Olders approved in A D t--)I T I C)N,S DEDUC-HONS k- (--�"S 3, CONTRACT SUM TO DAT E (Line -1 =-2) . . . . .. . 1,010,147.00 pre'Q.ioils months by :iV11ner . . . . .. I --- A. TOTAL COMPLETED & STORED TO DATE . . . .. . . . . .. i869,197 .00___ Approved [his �'lonth (Column G on G703) ��-1 5. RETAINAGE; Number Daie Approved a. 5 % of Completed `Voik $ 43,459.85 CO#I + $165 ,985.00 -0- (Column D+E on G703) C,""N'_ _`an�le '�Iclers a 1r"o UY '_ TOTAL 1). 0 IN, of Stored Material $ -0- (Column F on G703) Total Retainage (Line Sa+51) or 43,459.85 TOT-11� + $165 .985.00 -0- Total in Cohirrin I of G703) . . ... .. . . . . . . .. . . . . . .. $ 825,737. 15 let cf'�n�e by 11an ,.e Orders $_16'55985 .00 6. TOTAL EARNED LESS RETAINACE . . . .. . . . . . . . . . . . . . . $ The undersigned Contractor cerlliic-5 that to the hest of the Contractor's knowledge, (Line A less Line 5 Total) and beher the 4V(wk' covered by this Application for Payment has heen 7. LESS PREVIOUS CERTIFICATES FOR completed in accordance the Contract DoCLin-ients, that all amounts have been PAYMENT (Line 6 from prior Cerntic.ate).. . . . . .. . $ __ 52,040.90 paid b�' the Contractor [or Work for vJhich previous Curtirwates for pa,/nIerit were 8. CURRENT PAYMENT DUE . . . . . . . . .. . . . . . . . . . . . . . . . $ _._73,696-.2 5 is.'[J-ed and paywients received from the Owner, and that CLI(reni payment shown 9, HAI• NCE TO FINISH, PLUS RETAINAGE . . . . . . . . . . . . $ 184,409.85 due. (Line 3 less line 6) -Bet Sate or. Indiana C001-1tV Of: Hadi-son CONFRAC OR! At. 'K Betts FligineerjBg Contracting, Inc . Subscribed and sworn to before me this .30th day of June 2012 Notary Puhlic: I B,r. Date. June 3 0, 2012 _ ty1v Commission expires: OcLober 28 2015 AMOUNT CERTIFIED. . .. .. .. .. .. . . . . ... . . . . . . .. . . ... . i ARCHITECT'S CERTIFICATL FOR PAYMENT (Altach explanation d amount certified differs from the anmow ippheJ for.) In accardance with the Contract Documents, based on on-site observations and (he ARCHITEC-71l'- cJata comprising the above application, the certifies to the Owner(hat to the n hest(,-if theAt-chiteci's knowledge, information and belief the Work has piogres5acl as by: Date: - indicated,the quahi,,,ur 1heWork is in accordance with the Contract Documents,and -lie AN CERTIFIED This Certificate is not negotiable. I AGUNT CERI is payable only io the lhe Cal1jr-acto, is Ln(jjje(j to pa,,11-ner-11 or the ANAC)UNT CERTIFIED. r payment are will-i'All Contractcr named herein. Issuarwe, payinent and acceptance o" prejudice io any rights or the Owner of Contractor under this Coolract. >i A 0 • 1,161 EL)jj*i )r4 I A' G702-19811 (�ONTINUATIIOH SHEET AIA DOCUMENT 6703 Wells #27 & #28 — Contract 77 PAGE OF tlAC.Es SIP, DocumEnt G701, APPUCATIOr\I AND CERTIFICATE FOR PAYMENT, containing APPLIG\TION HUM UK: Five (5) Contractor's signed Certification is attachecl. APPLICATION DATE: June 30, 2012 In tabulations below; amounts are stated to the nearest dollar. PERIOD FROM: 06/01/12 Use Column I on Contracts ,,,,here variable retainage for line items may apply. TO: 06/30/12 ARCHITECT'S PROJECT HO: G II I WORK COMPLETED_ TOTAL COMPLETED ITE .1 DESCRIPTION OF \ ORI: SCHEDULED This Application A\HD STORED B.�LANCE RETAIrIAGE VALUE TO FINISH Previous Stored Materials TO DATE (C C) IC G) Applications Work in Place (not in D or E) (D I E i F) 1 . Mobilization 36 ,000 .00 36 ,000.00 —0— —0— 36 ,000.00 100 —0— 1 ,800.00 2a. Well Platform 27 & Appurtenances 140,700.00 138,700.00 2,000.00 —0— 140,700.00 100 —0— 7,035.00 2b. Well Platform 28 & Appurtenances 149,200.00 85,200.00 64,000.00 —0— 149,200.00 100 =0— 7,460.00 2c . Underground Electri-cal Conduit, [dire and Pull- Boxes 48,000.00 48,000.00 —0— —0— 48,000.00 100 —0— 2,400.00 2d . Electric Utility Allow. 25 ,000.00 —0— —0— —0— —0— 00 25 ,000.00 —0- 2e. 60--ft. Utility Tower 5,200.00 5,200.00 —0— —0— 5,200.00 100 —0— 260.00 3 . Dewatering 2 ,700 .00 2 ,700.00 —0— —0— 2,700.00 100 —0— 135 .00 4a. 16" Class 350 DIP Water Main 65,184.00 65, 184.00 —0— —0— 65,184 .00 100 —0— 3,259 .20 4b. 20" Class 350 DIP Water Main 196,238.00 137 ,288.00 —0— —0— 137,288.00 69 58,950.00 6,864.40 4c. Connection to Existing Raw Water Main 22,700.00 22,700.00 —0— —0— 22,700.00 100 —0— 1, 135.00 4d . 30" Bored Steel Casing 55,000.00 —0— —0— —0— —0= 00 55,000.00 —0- 5a. 16'' Butterfly Valve 7,220.00 7,220.00 —0— —0— 7 ,220.00 100 —0— 361 .00 5b. 20" Butterfly Valve 15,945.00 15 ,945.00 —0— —0— 15,945.00 100 -0— 797.25 6a. Earthwork 15 ,700.00 14,700.00 1 ,000.00 —0— 15 ,700.00 100 —0— 785.00 AIA. DOCUNiENT G703 CO'tTt ;l_'r.TIO;I SHEFF APRIL 1976 EDITION ALA' '1978 THE ,-.,,'. RIC,='I hNSTITUTE OF .-.RCHITECTS, 1735 "IEW 1'ORh: AVE., '4.\V.. 1.,703— 19713 CONTINUAT!ON SHEET AM DOCUMENT 0703 Wells #27 & #28 — Contract 77 P.-\GE OF PACES \I, UOCUment C%0?. aPPLICATiC)N ,AND CERTIFICATE FOR PAYMENT, containing APPLI&\TION NUMBER: Five (5) Contractor's signed Certification Is attached. APPLICATION DATE: June 30, 2012 In tabulations below, amounts are stated to the nearest dollar. PERIOD FROM: 06/01/12 Use Column I on Contracts where variable retainage for'line items may apply. TO: 06/30/12 -�RCHITECVS PROJECT NO, B C D E F C H I WORK COMPLETED _ tOT�L COMPLETED ITE`.I DESCRIPTION OF WOR[,. SCHEDIIl.ED This Application AND STORED �- BALANCE RETAINAGE n. VALUE Previous TO DATE (C C) TO FINISH Applications �\,Vork in Place Stored Materials (D+E+F) (C G) (not in D or E) 6b. Tree & Stump Removal —0— —0— —0— —0— —0— 100 —0— —0- 7a. No. 2 Aggregate 13,200.00 13,200.00 —0— —0— 13,200.00 100 —0— 660.00 7b. No. 53 Aggregate 12,300.00 12,300.00 —0— —0— 12,300.00 100 —0— 615.00 8a . Erosion Control 2,800.00 —0— 2,800.00 —0— 2,800.00 100 —0— 140.00 8b. Erosion Control Blanket 3,100.00 —0— 3,100.00 —0— 3 ,100.00 100 —0— 155.00 9 . Seed & Mul-ch 4,675.00 —0— 4,675.00 —0— 4 ,675.00 100 —0— 233.75 10. Stream Crossing 21 ,300.00 21 ,300.00 —0— —0— 21 ,300.00 100 —0 1 ,065.00 11 . Record Drawings 2 ,000.00 —0— —0— —0— —0— 00 2,000.00 —0- CO#1 Change Order No. 1 FD1 Stainless Steel Tapping Sleeve + 4 ,250.00 + 4,250.00 —0— —0— + 4,250.00 100 —0— 1- 212.50 FD2a Horz . Drill Hazel Dell + 59 ,980.00 + 59 ,980.00 —0— —0— + 59 ,980.00 100 —0— 2,999.00 b Connection to HDPE & Reducers + 16 ,100.00 + 16 ,100.00 —0— —0— + 16 ,100.00 100 —0— F 805 .00 c Owner keep 20" Pipe (200 if) + 13 ,260.00 + 13 ,260.00 —0— —0— + 13,260.00 TOO —0— 1- 663.00 d Work completed on bore pit + 25 ,600.00 + 25 ,600.00 —0— —0— + 25 ,600.00 100 —0— v 1 ,280.00 e Horz. drill creel: + 16 ,000.00 + 16,000.00 —0— —0— + 16 ,000.00 100 —0— t- 800.00 f Owner keep 20'' pipe (250 if) + 16 ,575 .00 + 16 ,575 .00 —0— —0— + 16 ,575 .00 100 —0— t• 828.75 Owner keep 30"Casin.9-Pi e + 14 220.00 t 14,220.00 — —0— —0— + 14,220.00 100 —0— F 711 .00 1010, 147 .00 791 ,622.00 77,575.00 —0— 869,197.00 86 140,950.00 43,459.85 CIA DOCU`.1ENT 0703 CO71TIr:l_'.\TIO,`! SHEET a,PRIL 1973 EDITION ALA` 1978 THE =.,.t RiC rI iNi TVTUiE OF nRCI-iITECT:. 1735 'NEW YORK AVE., ,!.\v., \V, SI IINGTOP;, D.C. 2000,. 6703--197B VOUCHER # 121727 WARRANT # ALLOWED 351429 IN SUM OF $ M.K. BETTS ENGINEERING & CONTRI P.O. Box 2533 Anderson, IN 46018 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 5 07-1052-01 $73,696.25 CONNecktod Voucher Total $73,696.25 Cost distribution ledger classification if claim paid under vehicle highway fund 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 & CONTRACTING Purchase Order No. P.O. Box 2533 Terms Anderson, IN 46018 Due Date 8/7/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/7/2012 5 $73,696.25 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 Date er APPLICATION AND CERTIFICATE FOR. PAYMENT AIA DOCOMENT (Insinictions oil feverse sideIl PACE O'd 01: flv,ft' TO City of Carmel PfR0IF(--I-: Wells 27 & 28 APi1uCmi0,,i r,-10: Six (6) Distribution to: One CiViC Square Contract 77 C O1VNER Carmel, IN 46032 PERIODIC): 07/3012 C ARCHITECT Cj' CGNTRAC**I-OR VROM ICONTRACTC-)R): VIA (,- RCHITECT): ARCI-11TICT'S H. K. Betts Engineering PROJECT NO: & Contracting, Inc. FOR: Invoice No. 12-122.06 CONTRACT DATE: "kpPlication is made tor Pavinent, as shavvii helow, in connection with the (-onlrac.l. CONTRACTOR'S APPLICATION FOR PAYMENT Con(intiation Sheet, AIA 6ocitment G703, is atia(hed. 844 CFI N G F ORDER SUMMARY 1. ORIGINAL CONTRACT SUVA . . . . . . . . . . . . .. . . . .. . ,162.00 165,9� 00 _- Change Ofder�, approved in 2. Net change by Change Orders . . . . . . . . . . . . .. . . . . . $ I L 7 DEDUCTIONS D li CT 10 N S previous months by (-)%vner 3, CONTRACT SUM TO DATE (Line I :=2) . . . . .. . . . 1,010,147.00 TOTAL Io 4. TOTAL COMPLETED & STORED TO DATE . . . . .. . . . ... j _871 ,197.00 Approved this (C011,111111 G on 6703) Number Da–le 1pprovecl 5. RETAINAGE; 43,559.85 a. 5 % of Completed Work $ — C0#1 + $165 ,985.00 –0– (Column D+E on 6703) 1). _0 ",,. of Stored Material $ 0– (Column F on 67031 Total Relainage ti-ine Sa A 5b or 431559.85 00 Total in Colijmn I of G703).. . . .. .. . . .. . . . . . . . . . $ et I OTA L 3 + $ 165_,985. –0– change by Change C)rder5 + $165 ,985.00 6. TOTAL EARNED LESS RETAINAGE . . . .. . . . . . ... . . . . $ 827,637.15 The Lmd&isigned Contractor cerililes that fo the best of the Contractor's knowledge, (1-ine 4 less Line 5 Total) Intormalion and belief the Work covered by this Application for Payment has been 7. LESS PREVIOUS CERTIFICATES FOR 825,737.15 completed in accordance 1.vilh the Contract Documents, Ilia( all amounts have been jntr ct Doco PAYMENT (Line 6 from prior Certificate) . . . . . . .. . $ p:iid I)v the Contractor tor tVnrk for WhICh I)CeViOLIS Certificates tor'Payment were 8. CURRENT PAYMENT DUE . . . . . . .. . .. . . . . . . . . . . . . . . . S 1,900.00 i-s(Jed lHcj pa"In-1111-115 Iel:&I\ed ri-Oill [Ile Owner, and Ilia( current payment shown 182, M-85 J. BALANCE TO FINISIA, PLUS RETAINAGE . . . . . . . . . . . $ hercln is now 00C. (Line 3 less Line 6) P,-"CTO R 11 .. K Betts Enginee ri-Tig ContuacLi-rig, Inc . State or: Ind Lana COUnly ot: Nadison Stibscribed and sworn to betore me [Ills 31st: day of July 2012 Notary P Li I)I i C; C_-� By: Date: July 31 , 2012 My Commission expires: October 28 , 2015 AMOUNT CERTIFIED.. .. .. . . .. . . . I . . . .. . .. . . . . . . . . ARCHITUCT'S CERTIFIC/M FOR PAYMENT (Attach explanation if amount cernfied differs from the amount 3f)J)hed for.) In accordance" th the Contract Documents, based an on-5tte observations and the ARCHITE n- -: data comprisin2 the abova application, the Architect certifies to the 0\,ner I hat lj the hest of ihe,-vchiiects knowledge, inn-wmation and helief [lie Work has progressed as bv: Date: --- indicaied,the quality of the Work is in accordance�Vllh the Contract Documents, and This Certificate is not negoliahle. The �A,,-AOUNT CEIZ-FIFIED is payahle only to the the Contractor is entitled tc) payment of the -ki,,ti'DUNT CERTIFIED. contracic ranec herein. Issuance, payment and acceptance are Willl')Ul prejudice io any rights of the Owner or Contractor under [Ills Contra(:[. A IA 0(_)CU'AEH1 (_7b'! Ii N F) C LF,Y I I I C'Y I, I 1.11 iij j f[)111 C)r4 IA I'104 H I IV o.v % _11m FUTI, 1. 1 :,1' ,11 111' '01101 CONTINUATION SHEET A/A DOCUNIENT 0703 Wells #27 & #28 — Contract 77 PAGE OF PAGES \IA Docurnent 0,70), ,�PPUC,',TIOfJ ,;ND CERTIFIC,-\TE FOR PAYMENT, containing APPLICATION NUIIMBER: Six (6) Contractor's signed Cer6rlcation is attached. APPLICATION DATE: July 31 , 2012 In tahUlations below, amounts are stated to the nearest dollar. PERIOD FROM: 07-01-12 Use Column I on Contracts where variable retainage for line items may apply. TO: 07-31-12 ARCHITECT'S PROTECT NO: B C D E F G it I -- — WORK COMPLETED —TO7AL COn-IPLE7ED ITE'.I DESCRIPTION OF WORK SCt-IEDU(.ED BALAl1lCF. RETAIHAGE This Application AND STORED o VALUE TO FINISH Previous TO DATE tG=C) j Stored Materials (C—G) Applications work in Place (not in D or E) (1)+E+F) i I 1 . Mobilization 36 ,000.00 36,000.00 —0 —0— 36 ,000.00 100 —0— 1 ,800.00 2a. Well Platform 27 & Appurtenances 140,700.00 140,700.00 —0— —0— 140,700.00 100 —0— 7,035.00 2h. Well Platform 28 & Appurtenances 149,200.00 149,200.00 —0— —0— 149,200.00 100 —0— 7,460.00 2c. Underground Electrical Conduit, Wire and Pull Boxes 48,000.00 48,000.00 —0— —0— 48,000.00 100 —0— 2,400.00 2d . Electric Utility Allow. 25 ,000.00 —0— —0— —0— —0— 00 25,000.00 —0= 2e.. 60—ft. Utility Tower 5 ,200.00 5 ,200.00 —0— —0— 5 ,200.00 100 —0— 260.0.0 3 . Dewatering 2,700.00 2,700.00 —0— —0— 2,700.00 100 —0— 135.00 4a. 16" Class 350 DIP Water Main 65,184.00 65, 184.00 —0— —0— 65, 184.00 100 -0— 3,259.20 4b . 20" Class 350 DIP [dater Main 196,238.00 137,288.00 —0— —0— 137,288.00 69 58,950.00 6,864.40 4c. Connection to Existing Raw Water Main 22,700.00 22,700.00 —0— —0— 22,700.00 100 —0— 1, 135 .00 4d . 30" Bored Steel. Casing 55 ,000.00 —0— —0— —0— —0— 00 55 ,000.00 —0- 5a. 16" Butterfly Valve 7,220.00 7 ,220.00 —0— —0— 7,220.00 100 —0— 361 .00 5b. 20" Butterfly Valve 15,945.00 15 ,945.00 —0— —0— 15,945.00 100 —0— 797.25 6a . Earthwork 15 ,700.00 15 ,700.00 —0— —0— 15 ,700.00 100 —0— 785.00 I I AIA D(DCL1,AENT 6703 CO3N1-1,1H SHEET r.PRIL 1918 EDITION AIA"� S1 "1978 _— ---`- 1 IE �,.',:Rtt=,=. 1 I ISTITU TE OF .;RCHITECTS, 1735 t•:E\V YORK; AVE, ;I.\V.. \V,,\SHINGTO,N;, D.C. 2000,6 6743—1973 CONTJNUAT!ON SHEET AIA DOCUMENT G703 Wells #27' 27 & #28 — Contract 77 PAGE OF _ PA(-,[S AIA Doct.tment (=it1?, aPPIJC,�TIC�ti , ND CERTIFIC.\TE FOR PAYMENT, containing y� APPLICATION-NUMBER: Six (6) Contractor's signed Certification Is attached. APPLICATION DATE: July 31 , 2012 In tabulations below, amounts are stated to the nearest dollar. PERIOD FRONI: 07-01-12 Use Column I on Contracts ,%,Iiere variable retainage for line items may apply. TO: 07-31-12 ARCIIITECf'S PROJECT NO: B C D E F G H I WORK COMPLETED ITE%i DESCRIPTION OF %VORK SCHEDULED YOTAt_ MMILETED BALANCE RETAINAGE This P.>>lication AND STORED I .o. VALUE t I °u TO FINISH Previous — TO DATE (G=C) Applications Work in Place Stored aterials (D t_F_f-f) lC—G) (not in D or E) j61). Tree & Stump Removal —0— —0— —0— —0— —0 100 —0— - —0- I 7a. No. 2 Aggregate 13,200.00 13,200.00 —0— —0— 13,200.00 100 —0— 660.00 7b. No. 53 Aggregate 12,300.00 12,300.00 —0— —0— 12,300.00 100 —0— 615.00 8a . Erosion Control. 2,800.00 2,800.00 —0— —0— 2,800.00 100 —0— 140.00 8b. Erosion Control Blanket 3,100.00 3,100.00 —0— —0— 3, 100.00 100 —0— 155.00 9. Seed & Mulch 4,675.00 4,675.00 —0— —0— 4 ,675.00 100 —0— 233.75 �i 10. Stream Crossing 21 ,300.00 21 ,300.00 —0— —0— 21 ,300.00 100 —0— 1 ,065.00 11 . Record Drawings 2,.000.00 —0— 2,000.00 —0— 2,000.00 100 —0— 100.00 COIEl Change Order No. 1 FD1 Stainless Steel. Tapping Sleeve + 4 ,250.00 + 4,250.00 —0— —0— + 4,250.00 100 —0— 4- 212.50 FD2a Horz. Drill Hazel Dell. + 59,980.00 + 59,980.00 —0— —0— + 59,980.00 100 —0-1 1 2,999.00 b Connection to IIDPE & Reducers + 16 ,100.00 + 16 ,100.00 —0— —0— ► 16,100.00 100 —0— + 805 .00 c Owner. keep 20" Pipe (200 11) + 13,260.00 + 13,260.00 —0— —0— -1- 13,260.00 TOO —0— 1- 663.00 d Work completed on bore pit + 25,600.00 + 25,600.00 —0— —0— -1- 25,600.00 100 —0— F 1 ,280.00 e Horz, drill creel: + 16,000.00 + 16,000.00 —0— —0— + 16,000.00 100 —0— 1- 800.00 f Owner keep 20" pipe (250 1) 16,575.00 + 16,575.00 —0— —0 + 16,575.00 .100 —0— F 828 .75 Owner keep 30"Casi.n Pg i.pe + 14 ,220.00 + 14,220.00_ —0— —0— _ + 14,220.00 100 —0— + 71.1 .00 1010, 147 .00 869,197.00 2,000.00 —0— 871 ,1.97.00 86 138,950.00 43,559.85 CIA DOCWOENT c7t13 _ CONTI :L' .TIiiN SHEET APRIL 1979 EDITION ;IP;= ,_i 1978 THE ,;.tcRiC.=.^I IruTITU iE OF ;RCHITECTS. 1735 ',tE�V YORK AVE, �I.%v.. 4v,;5FiINGTn;•;, D.r_. 10006 G703— I'�7fi VOUCHER # 121726 WARRANT # ALLOWED 351429 IN SUM OF $ M.K. BETTS ENGINEERING & CONTRA P.O. Box 2533 Anderson, IN 46018 Carmel Water Utility ON ACCOUNT OF APPROPRIATION FOR Board members PO# INV# ACCT# AMOUNT Audit Trail Code 6 07-1052-01 $1,900.00 C� N A C. �o-✓ Voucher Total $1,900.00 Cost distribution ledger classification if claim paid under vehicle highway fund 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 & CONTRACTING Purchase Order No. P.O. Box 2533 Terms Anderson, IN 46018 Due Date 8/7/2012 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 8/7/2012 6 $1,900.00 I hereby certify that the attached invoice(s), or bill(s) is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6 Ur Date Off