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Home My WebLink About2012 Sewer Bond pay request 17 CITY OF CARMEL m. WATER-WASTEWATER UTILITIES 760 3RD AVENUE S.W., STE. 710 • CAMEL, INDIANA 46032 (317) 571-24=13 • FAX (317) 571-2265 EXHIBIT B Disbursement Direction # 17 E-Mail or FAX the signed Disbursement Direction to: The Huntington National Bank Corporate Trust Department (IN HP22) Attn: Kim Wilson Tel: (317) 229- 4094 Fax: (31 7) 229-4094 E-Mail: KintWilson(w.huntineton.com Re: Depositary Agreement between the City of Carmel and The Huntington National Bank, dated May 16. 2012 -Trust #4087000067 Dear Kim: On July 2, 2013 , you are hereby authorized and directed, as the Depositary under the above-referenced Agreement, to pay the amounts set forth on the attached Register of Claims from the above-referenced Trust account and overnight checks to: Carmel Utilities Alm: Lisa Kempa 760 Third Avenue SW Carmel, IN 46032 City of Carmel,�Indiana /4tme�lis�Gaa�vie By: Name: Diana L. Cordray Title: Clerk-Treasurer (*) Your Alternate contact at Huntington National Bank will he: Ellen Campbell-Tel # (616)235-5941 Ellen.Campbell@huntington.com CARMEL UTILITIES Register of Claims 7!212013 PAYMENT REQUISITION NO 17 AMOUNT OF Wire VENDOR ADDRESS FUND CLAIM MEMORANDUM Instructions 12431 Collections Center Dr Chicago, IL fiber install Graybar 60693 Cons 5 1,539.54 supplies 12431 Collections Center Dr Chicago, IL fiber install Graybar 60693 Cons $ 6,314.31 supplies 12431 Collections Center Dr Chicago,IL fiber install Graybar 60603 Cons $ 6,322.83 supplies 12431 Collections Center Dr Chicago. IL fiber install Graybar 60693 Cons $ 636.02 supplies 8109 Network Drive JDH Contracting Inc Plainfield, IN 46168 Cons 8 84,251.45 construction 3103 Executive Parkway Ste 300 Jones&Henry Engineers LTD Toledo,Oli 43606 Cons $ 16,524.16 engrg services 3103 Executive Parkway Ste 300 Jones 8 Henry Engineers LTD Toledo.OH 43606 Cons $ 29,262.90 engrg services 3103 Executive • Parkway Ste 300 Jones&Henry Engineers LTD Toledo,OH 43606 Cons $ 4,242,00 engrg services 3193 Executive Parkway Ste 300 Jones 8 Henry Engineers LTD Toledo, 01-143606 Cons $ 12,691.75 engrg services PO Box 664117 Kirby Risk Corp Indianapolis.IN 46266 Cons $ 2,097,88 supplies PO Box 2533 M.K.Setts Engineering Anderson, IN 46018 Cons $ 139,255.75 construction PO Box 2533 M.K.Seas Engineering Anderson, IN 46018 Cons $ 50,145.30 constriction TOTAL $ 353,253,91 ALLOWANCE OF CLAIMS We have examined the claims listed on the foregoing Register of Claims,consisting of 1 page,and except for claims not allowed as shown n the register suc laims are hereby allowed in the total amount of $353,26 91 444 � /� Joh uffy, tility tit for Date PLEASE OVERNIGHT CHECKS TO: Carmel Utilities Attn: Lisa Kempa 760 3rd Avenue SW Cannel,IN 46032 1ii;: 47:7 n"'M= =Ga€I o maiF' Remit To: B 12431 COLLECTEONS CENTER DRIVE CHICAGO IL 60693-2431 317-821-5700 or ARQuestionsC)graybar.com INVOICE Invoice No: 966787402 I% 01 002682 64205 8 16 A Invoice Date: 06/03/2013 J f l"I I I"l11I I I I I1 11111 .11111 I I I I I'I I I I I 11I I I y I I l r 1 i d I I I F I Account Number: 0 00 01 54106 CARMEL CLAY COMM CENTER Account Name: CARMEL CLAY COMM JANET ARNONE ACCOUNTS PAYABLE CENTER ONE CIVIC SQUARE CARMEL IN 46032-2584 r r CC Ship to: CARMEL CLAY COMM CTR PO#503037 31 FIRST AVE NW CARMEL IN 45032 - • Page 1 of 1 Order No:S03037 SO#:3433507611 Del. Doc.#: PRO# Routing Date Shipped Shipped From F.Q.B. Rt.To 0343350761 05(3112013 FACTORY Quantity Catalog#1 Description Unit Price / Unit I Amounts ?1 1 PTRW362424G2 HOFFMAN ENCLOSURES, INC 757.35 / 1 757.35 =' PTK SGL DR WD 36X24X24 GRAY I ;x 1 AS1032 HOFFMAN ENCLOSURES,INC 12.42 / 1 12.42 SCREW PKG RACK P QTY 20 1 PTRW482424G2 HOFFMAN ENCLOSURES,INC 757.35 / f 757.35 PTK SGL DR WD 48X24X24 GRAY 1 AS1032 HOFFMAN ENCLOSURES,INC 12.42 I 1 12,42 SCREW PKG RACK P.QTY 20 Terms of Payment Sub Total 1539.54 Freight 0.00 Net 30 Days Handling 0.00 8 As a condition of the sales agreement,a monthly service charge of the lesser of Tax 0.00 1-1/2%or the maximum permitted by law may be added to all accounts not paid Total Due 1539.54 by net due date.Visa,MasterCard,American Express, and Discover credit cards ate accepted at point of purchase only. Subject to standard terms and conditions on the reverse side. 'T �V L rir��,kje _.. Remit To: 49 12431 COLLECTIONS CENTER DRIVE . A a;i1 e1Qi sk6th , eese Calli,ntri CHICAGO IL 60693-2431 317-621-5700 or ARQuestion�te oraybar.com xmI INVOICE Invoice No; 966741563 MB 01 002674 62442 B 14 A Invoice Date: 05!30!2013 Illt'Ill"II'I'I€I11'I'111'IIB"1111111.Illll'I'II`I"11111"1'! Account Number: 0000154108 CARMEL CLAY COMM CENTER Account Name: CARMEL CLAY COMM JANET ARNONE ACCOUNTS PAYABLE CENTER ONE CIVIC SQUARE CARMEL IN 46032-2584 'fir -ACC I'• Ship to: CARMEL UTILITIES PO#S03037 760 THIRD AVENUE SW SUITE 110 CARMEL IN 46032 _ . _ . . . . -— ___ __ . - .. - - Page 1 of 1 --- - -. Order No:S03037 SO#:343350761 Def. Doc.#: PRO # Routing Date Shipped Shipped From F.O.B. I Rt.To -I 0856128559 17AT5858030554951 UPS-GROUND 05/30/2013 ZONE-SPRINCFIELD.MC S/P- F/A I Lam' Quantity Catalog#!Description Unit Price / Unit Amouni I 12 CCH-CP12-3C CORNING 69.54 1 1 834.48 -- 12 FIBER CCH PANEL W 12 SIMPLEX SC ADAPT =- •6 CCH-CP06-3C CORNING 3928 ! 1 235.68 L PANEL SM SIMPLES SC 12 CCH-CP12-3C CORNING 59.54 ! 1 83448 12 FIBER CCH PANEL W 12 SIMPLEX SC ADAPT 18 CCH-CP12-3C CORNING 69.54 / 1 1251.72 12 FIBER 001-1 PANEL W 12 SIMPLEX SC ADAPT Del. Doc.it: I PRO# Routing Date Shipped Shipped From F.O.B. Rt.To , 0856128820 FRT FORWARD 05130/2013 IZONE-JOLIET, IL S/P-F/A 1 CCH-CP12-A9 CORNING 72.99 ! 1 72.99 8 I CCH PNL W/6 LC DUPLEX SM 1 5500-190 LEVITON MANUFACTURING.COMPANY,INC 108.08 / 1 108.08 191N RACK MOUNT TV 5S 1 220 95-200-41 CORNING 13.04 / 1 2868.80 SINGLE MODE SC CONN - 1 5500-190 LEVITON MANUFACTURING.COMPANY, INC 108.08 ! 1 106.08 191N RACK MOUNT TV S5 3 Terms of Payment Sub Total 6314.31 Freight 0.00 Net 30 Days Handling 0.00 As a condition of the sales agreement,a monthly service charge of the lesser of Tax 0.00 1-1/2% or the maximum permitted by law may be added to all accounts not paid Total Due 6314.31 by net due date.Visa,MasterCard,American Express.and Discover credit cards are accepted at point of purchase only. Subject to standard terms and conditions on the reverse side. I IirivlCia 11es elirf7gIt of fn'a11 ` Remit To: 9 12431 COLLECTIONS CENTER DRIVE CHICAGO IL 6 06 93-2 43 1 (� 317-821-5700 or ARQuestionaa graybar.com 1 INVOICE Invoice No: 966773216 KB 01 002599 62809 B 15 A Invoice Date: 05/31/2013 41111.11111IIIII1 111111uI'iI11"111 uIui111I111'PIuI141111 Account Number: 0000154108 CARMEL CLAY COMM CENTER Account Name: CARMEL CLAY COMM JANET ARNONE ACCOUNTS PAYABLE CENTER ONE CIVIC SQUARE CARMEL IN 46032-2584 - F-: { Auk Ship to: CARMEL UTILITIES PO#S03037 31 first ave nw - CARMEL IN 46032 Page 1 of 2 Order No:503037 SO#:343350761 j Del. Doc.#: I PRO it I Routing Date Shipped Shipped From F.O.B. RL.To 0856128563 I I GB TRUCK 05/31/2013 INDIANAPOLIS,IN SIP- F/A I - . Quantity Catalog#1 Description I Unit Price / Unit Amounts , 1 CCH-041J CORNING 243.10 / 1 243.10 Y1 CLOSET CONN HODS 4 RCK SP 4 12 FAN-BT25-12 CORNING I 13.35 / 1 160.20 BUFFER TUBE FAN OUT KIT 148 95-200-41 CORNING 13,04 / 1 1929.92 SINGLE MODE SC CONN 1 CCH-04U CORNING 243.10 / 1 243.10 CLOSET CONN HOUS 4 RCK SP 6 FAN-BT25-12 CORNING 13.35 / 1 80.10 BUFFER TUBE FAN OUT KIT 75 95-200-41 CORNING 13.04 / 1 978.00 ES SINGLE MODE SC CONN PI 1 FAN-BT25-12 CORNING 13.35 7 1 1335 BUFFER TUBE FAN OUT KIT 15 95-200-99 CORNING 13.04 / 1 195.60 LC SENIOR UNICAM SM 1 CCH-04U CORNING 243.10 / 1 243.10 - CLOSET CONN HOUS 4 RCK SP 6 FAN-BT25-12 CORNING 13.35 / 1 80.10 BUFFER TUBE FAN OUT KIT 75 95-200-41 CORNING 13.04 / 1 97800 SINGLE MODE SC CONN 2 5G596-U24 LEVITON MANUFACTURING. COMPANY, INC 112.94 / 1 225.86 PATCH PANEL CATSE 24P 568A/B 2 CCH-04U CORNING 243.10 / 1 485.20 CLOSET CONN HOUS 4 RCK SP 18 FAN-BT25-12 CORNING 1335 / 1 240.30 BUFFER TUBE FAN OUT KIT 2 5G596-U24 LE VITON MANUFACTURING.COMPANY, INC 112_94 / 1 225.88 PATCH PANEL CATSE 24P 560A/B 1 Subject to standard terms and conditions on the reverse side. Remrt To: e 12431 COLLECTIONS CENTER DRIVE mom&guestorlsPJeaSeGa o 1 Graybaa CHICAGO IL 60693-2431 317-821-5700 or ARQuestiongraybartom INVOICE Invoice No: 966773216 Invoice Date: 05/31/2013 Account Number: 0000154108 3w:wus,., 3 Account Name: CARMEL CLAY COMM malt " CENTER Sa4iIsoU F PP e. LIN4' 60 :11:111111::: -^ nt, vi �, tiiX Ship to: CARMEL UTILITIES PC#503037 31 first aae nw CARMEL IN 46032 _ Page 2 of 2 Order No:503037 SO#:343350761 Terms of Payment Sub Total 6322.83 -_ Freight 0.00 Net 30 Days Handling 0.00 itt As a condition of the sales agreement,a monthly service charge of the lesser of Tax 0.00 1-12%or the maximum permitted by law may be added to all accounts not paid Total Due 6322.83 — by net due dale.Visa, MasterCard, American Express,and Discover credit cards are accepted at point of purchase only. w Subject to standard terms and conditions on the reverse side. r = -atteStf6Yti I�olejlk or EM-11l Remft To: 61 12431 COLLECTIONS CENTER DRIVE Tmx" " jelt CHICAGO IL 60693-2431 - 317-821-5700 or ARQuestiongravbar.com INVOICE invoice No: 967029817 MB 01 002432 70356 B 15 A Invoice Date: 06/1712013 IIII1"1 111IIII11111111'Illl1l'Il'1111"1111111.11II'"1111"II Account Number: 0000154108 CARMEL CLAY COMM CENTER Account Name: CARMEL CLAY COMM JANET ARNONE ACCOUNTS PAYABLE CENTER ONE CIVIC SQUARE CARMEL IN 46032-2584 Ship to: CARMEL CLAY COMM CTR PO#503037 31 FIRST AVE NW • CARMEL IN-46032 - - ----. Page 1 of 1 Order No:303037 SO#:343350761 Del. Doc.#: PRO # 'Routing Date Shipped Shipped From F.O.H. Rt.To 0343350761 05/31/2013 FACTORY Quantity 1Catalog#/Description 1 Unit Price / Unit Amount 1 CPS1500AVR CYBERPOWER SYSTEMS INC 322.73 1 1 322.73 CPS1500AVR 1500VA/900W UPS AVR RMfr 1 CPS1500AVR CYBERPOWER SYSTEMS INC 313.29 / 1 31329 CPS1500AVR 1500VA/900W UPS AVR RMfr Terms of Payment Sub Total 636.02 Freight 0.00 Net 30 Days Handling 0.00 As a condition of the sales agreement,a monthly service charge of the lesser of Tax 0.00 1-112%or the maximum permitted by haw may be added to all accounts not paid Total Due 636.02 by net due date.Visa,MasterCard,American Express,and Discover credit cards are accepted at point of purchase only. Subject to standard terms and conditions on the reverse side. • J D H 8109 Network Dr. INVOICE Plainfield IN 46168-9024 Phone:(317) 839-0520 Invoice No:44269 Contracting, Inc. Fax:(317) 838-0925 Invoice Date:6/2 8120 1 3 Due Date:7/28/2013 Bill To: City of Carmel 31 1st Ave NW PO No: Job No: 2013-00510 Carmel IN 46032 Job Description:Carmel Fiber Contract 78B RE.Contract 788 Quantity (Description I Unit Price (Extended Price( Attn. Terry Crockett-City of Carmel Fiber Optic Conduit Install-Contract 78B 1.00 1.) Mobilization&insurance(1) 945.00 945.00 1.00 2.) Survey-(1) 0.00 0.00 5,450.00 3.) Fiber Optic Duct Bank- (5,450'ft) 9.45 51,502.50 13.00 4.) Pull boxes-(13) 1,089.50 14,183.50 2.00 5.)Markers-(2) 70.86 141.72 1.00 6.)River Bore-(1) 17,498.73 17,498.73 Total Amount Due: $84,251.45 Thank You For Your Business! Amount Due: 84,251.45 Terms: Net Due 30 Days Janes & Henry Engineers, Ltd. 3103 Executive Parkway, Suite 300 Toledo, Ohio 43606 419.473.9611 CITY OF CARMEL Invoice number 63508 MR. JOHN DUFFY Date 06/11/2013 UTILITY DIRECTOR 760 3rd AVE S W. Project 00451-6770 SEWER REHAB CARMEL, IN 46032 Professional services performed through May 31,2013 Professional engineering services in connection with the review and evaluation of the collection system and assistance during sewer rehabilitation projects in conformance with our agreement No.4-12. The project fee is$130,000. 9-001 SEWER REHAB Labor Billed Units Rate Amount CONSTRUCTION SERV SPECIALIST 44.00 87.00 3,828.00 CONSTRUCTION SERV SPECIALIST 56.00 87.00 4,872.00 INTERN 29.50 45.00 1,327.50 PRINCIPAL 39.00 142.00 5,535.00 WORD PROCESSOR 0.20 53.00 10,60 Labor subtotal 168 70 15,576.10 Reimbursable Cost Billed Amount Multiplier Amount OTHER CONTRACT COST 62.93 1.10 69.22 PRINTING,COPYING,BLUEPRINTINC 184.39 1.10 202.63 Transportation Costs 384.77 1.10 423.24 Overhead- Lodging 229.81 1.10 252.79 Reimbursable subtotal 861.90 948.08 Phase subtotal 16,524.18 Invoice total 16,524.18 Contract Summary Prior Current Total Description Billed Billed Billed 9-001 SEWER REHAB Total 17,001 22 16,524.18 33,525.40 Thank you for your business_ Page 1 4 tit Jones & Henry Engineers, Ltd. 3103 Executive Parkway, Suite. 300 [wale Toledo, Ohio 43606 ;,„n, .e 419.473.9611 CITY OF CARMEL Invoice number 63505 MR JOHN DUFFY Date 06/112013 UTILITY DIRECTOR 760 3rd AVE. S W. Project 00451-6531 WWTP SECONDARY CARMEL, IN 46032 EXPANSION Professional services performed through May 31, 2013 Professional engineering services in connection with a new final calrifier,septage receiving, belt filter press, diversion structure covers and modifications to final clarifier 1 in conformance with our Letter Agreement No. 1- 12 as authorized by Professional Services Agreement dated November 3.The projected fee is$386,000. 9-001 DSGN-SECONDARY EXPANSION Labor Billed Units Rate Amount CONSTRUCTION SERV SPECIALIST 4.00 84.00 336.00 SENIOR ENGINEER 41.50 105.00 4,357.50 TECHNICIAN 9.50 69.00 555.50 WORD PROCESSOR 0.50 53.00 26.50 Labor subtotal 55.50 5,375.50 Phase subtotal 5,375.50 9-002 CONST-SECONDARY EXPANSION Labor Billed Units Rate Amount CONSTRUCTION SERV SPECIALIST 40.00 84.00 3,360.00 ENGINEER 3.00 65.00 255.00 PRINCIPAL 25.00 139.00 3,475.00 PRINCIPAL 11.00 139.00 1,529.00 SENIOR ENGINEER 19.00 105.00 1,995.00 SENIOR ENGINEER 124.00 105.00 13,020.00 SENIOR ENGINEER 0.50 105.00 52 50 SENIOR ENGINEER 0.50 105.00 52.50 WORD PROCESSOR 0.50 53.00 26.53 WORD PROCESSOR 2.00 53.00 106.00 WORD PROCESSOR 0.30 53.00 15.90 Labor subtotal 225.80 23,887 40 Phase subtotal 23,887.40 Invoice total 29,262.90 . Page 1 of 2 'CITY OF CARMEL Invoice number 63505 Project 00451-6531 WWTP SECONDARY EXPANSION Dale 06.1112013 Contract Summary Prior Current Total Description Billed Billed Billed 9-001 DSGN-SECONDARY EXPANSION 9-002 CONST-SECONDARY EXPANSION Total 205,812.63 29,262.90 235,075.53 Thank you for your business. Page 2 of 2 ith Jones & Henry Engineers, Ltd. 3103 Executive Parkway, Suite 300 • Toledo, 01110.43606 419.473. 611 CITY OF CARMEL Invoice number 63506 MR.JOHN DUFFY Date 06/11/2013 UTILITY DIRECTOR 760 3rd AVE. S.W. Project 00451-6714 106TH ST. PS ELECTRICAL CARMEL, IN 46032 IMPRV Professional services performed through May 31, 2013 Professional engineering services in connection with the construction of electrical improvements at the 106th St. Pump Station in conformance with our letter agreement 2-12 dated August 13.2012.The projected is$158,000. 9-001 CONST-106TH ST. PS ELECTR IMPR Labor Billed Units Rate Amount CONSTRUCTION SERV SPECIALIST 28.00 84.00 2,352.00 SENIOR ENGINEER 18.00 105.00 1,890_00 Labor subtotal 46.00 4,242.00 Phase subtotal 4,242.00 Invoice total 4,242.00 Contract Summary Prior Current Total Description Billed Billed Billed 9-001 CONST-106TH ST. PS ELECTR IMPR Total 137,790.66 4,242.00 142,032.66 Thank you for your busfness. Page 1 Jones & Henry Engineers, Ltd. 3103 Executive Parkway, Suite 300 Toledo, Ohio 43606 419.473.9611 CITY OF CARMEL Invoice number 63507 MR. JOHN DUFFY Date 06111/2013 UTILITY DIRECTOR 760 3rd AVE. S.W. Project 00451-6733 106TH ST. PUMP STATION CARMEL, IN 46032 INTERCEPTOR Professional services performed through May 31, 2013 Professional engineering services in connection with the design and construction of capacity improvements to the 106th St. Pump Station and the North-South Interceptor in conformance with our agreement no.4-12. The project fee is$280,000. 9-001 PUMP STATION IMPROVEMENTS Labor Billed Units Rate Amount SENIOR ENGINEER 23.00 105.00 2,415.00 TECHNICIAN 51.50 69.00 3,553.50 Labor subtotal 74.50 5,968.50 Phase subtotal 5,968.50 9-002 N-S INTERCEPTOR Labor Billed Units Rate Amount SENIOR ENGINEER 20.00 105.00 2,100_00 Consultant Cost Billed Amount Multiplier Amount OUTSIDE CONSULTANTS EARTH SOURCE 4,202.95 1.10 4,623.25 Phase subtotal 6,723.25 Invoice total 12,691.75 Contract Summary Prior Current Total Description Billed Billed Billed 9-001 PUMP STATION IMPROVEMENTS 9-002 N-S INTERCEPTOR 9-003 CONSTRUCTION Total 62,513.00 - 12,691.75 75,204.75 Page 1 of 2 CITY OF CARMEL Invoice number 63507 Project 00451-6733 106TH ST.PUMP STATION INTERCEPTOR Date 0 6/1 112 01 3 Thank you for your business. Page 2 of 2 KR Kirby Risk • INVOICE INVOICE DATE I INVOICE NUMBER f CUSTOMER# 1815 Sagamore Pkwy Lafayette, IN 47904 05/16/13 S106844149.001 74918 DUE DATE' TOTAL DUE I AMOUNT PAID 06/30/13 2097.88 PLEASE REMIT PAYMENT TO: KIRBY RISK CORPORATION P.O. BOX 664117 INDIANAPOLIS IN 46266-4117 SHIP TO: 705 1 M6 6.405 E0404% 10712 6701473563 81461903 6061'6002 �'I`II1��'Ill�illlll 'IIII'��If��l��'I""I111IIIII'I'Ifl�1'�ii CARMEL WWTP s7 CARMEL wwTP ATTN: BLAINE MALLABER ATTN: PAUL ARNONE 9609 HAZEL DELL PKWY 9609 HAZEL DELL PKWY INDIANAPOLIS IN 46280-2935 INDIANAPOLIS IN 46280-2935 DETACH UPPER PORTION AND RETURN WITH YOUR PAYMENT CUSTOMER NUMBER I CUSTOMER PO NUMBER :• j • RELEASE NUMBER TERMS - 74918 513548 PT 10TH PROX NET 30TH ORDERED BY -SALES OFFICE . PHONE NUMBER .SHIP DATE SALESPERSON SHIP VIA , I I I MARK 5 BAYS DIRECT JOE FAUCETT FISHERS 317-598-6170 05/16/13 ORDER OTYI SHIP OTY ' .. { DESCRIPTION' -. • • - � ITEM PRICE... ' UNIT _ -+ EXTAMOUN7 CASH DISC . lea lea ^LOT ITEM SIEMENS ITE SWITCHGEAR 2097.88 lea 2097.88 41.96 PER QUOTE# heitjxl0c_04041300_00_00_000 This Lot Shipment Consists of: Description 1 1 P1 PANELBOARD INTERIOR 1 1 B4X38 NEMA 4X ENCLOSURE Billing Questions: Billing_requesl @ kirbyrisk.com(765)446-3054 Invoice Number 3106844144.001 Subtotal 2097.88 If paid by 06/10/13 you may deduct$41.96 S&H Charges 0.00 Invoice is due 5y 06/30/13 not of any cash discount. Sales Tax 0.00 �j� AMOUNT>DUE 2097.86 0001:0602 1V( Kirby Risk Page 1 of 1 APPLICATION AND CERTIFICATE FOR PAYMENT "A IA DOCUMENT 0702 Onstructions on reverse side; PACE ONE of ',vas TO (OWNER]: City of Carmel PROJECT: 106th Street Pump Station APPLICATION NO: Nine (9) Distribution to: One Civic Square . Electrical Upgrade U OWNER Carmel, IN 46032 PERIOD TO: 06/30/13 0ARCHITECT . U CONTRACTOR FROM 1CONTRACTORI: VIA (ARCHITECT]: ARCHITECT'S C M. K. Betts Engineering PROJECT NO: C & Contracting, Inc. CONTRACT FOR: Invoice No. 12-238. 09 CONTRACT DATE: Application is made for Payment, as shown below, in connection with the Contract. CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sheet, AIA Document G703, is attached, j 1. ORIGINAL CONTRACT SUM • • S 1 ,077 ,000.00 CHANGE ORDER SUMMARY , , Change Orders approved in ADDITIONS DEDUCTIONS S 50;150.00 • 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1 =2) 1 i 50 150.00 previous months by Owner 4. TOTAL COMPLETED & STORED TO DATE s 1,059,950.62 TOTAL (Column C on G703) Approved this Month j 5. RETAINAGE: Number Date Approved a. , % of Completed Work 5 C0+11 + $51 ,280.00 - $ 2,250.00 (Column D+E on 0703) 00,12 + $ 5 ,170.00 - $ 4 ,050.00 h. _ % of Stored Material $ _ (Column F on G703) Total Retainage (Line 5a -Sb or TOTALS i + $56,450.00 - $ 6,300 .00 Total in Column I of G7031 S 56,301. 50 6. TOTAL EARNED LESS RETAINAGE , $ 1 ,003 ,604.12 Net change by Change Orders + $SD ,150.00 (Line 4 less Line S Total) The undersigned Contractor certifies that to?he hest of the Contractor's knowledge. 7. LESS PREVIOUS Line S Total) FOR information and belief the Work covered by this Application for Payment has been PAYMENT PREVIOUS 6 from prior Certificate)..,. .. ... S _864,348.37 completed in accordance with the Contract Documents, that all amounts have been p s 139,255.75 paid by the Contractor for Work for which previous Certificates for Payment were B. CURRENT PAYMENT DUE S 123,545.88 • issued and payments received from the Owner, and that current payment shown g, BALANCE TO FINISH, PLUS RETAINAGE. .. . herein is now due: (Line 3 less Line 61 State of: Indiana County of: Madison CONTRALTOS M. K. Betts Engineering & Contracting, Inc.. Subscribed and sworn to before me this 30th day of June , '2013 /� ` /� Notary Public ,,..-71. ,52t-t-- 47a 167 i"4 L✓/ate: June 30, 2013 My Commission expires: October 28 , 2015 . • AMOUNT CERTIFIED. S ARC �TECT'S CERTIFIITE FOR PAYMENT !Attach explanation if amount certified differs (corn die amount apphed rocs In accordance with the Contract Documents, based on on-cite obsenations and the ARCHITE data comprising the above application.the Architect certifies to the Owner that to the -�P-t best of the Architect's knowledge,information and belief the Work has progressed as t5y: t Date: indicated,the quality of the Work is in accordance with the Contract Documents,and This Certificate R not negotiable. The AMOUNT CERTIFIED is payable only to the the Contractor is entitled to payment of the AMOUNT 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 DOCU.MrNT cm•naruGFnCTN a.NO CiRnFICATE FOR PAY.,ENT•.MAY 1%I EDITION• vu' • c 1953 6702-1993 r APPLICATION AND CERTIFICATE FOR PAYMENT AM DOCUMENT G702 Instructions on reverse side) PACE ONE OF PAGES TO (OWNER): City of Cannel PROJECT: Final Clarifier & Misc. APPLICATION NO:Three (3) Distribution to: Once Civic Square Improvements — Contract 79 CI OWNER Cannel, IN 46032 PERIOD TO: 05/31/13 0 ARCHITECT • . C CONTRACTOR • EROM [CONTRACTOR). VIA (AR fiSEl* its ARCHITECT'S - - C . M. K. Betts Engineering Engineer: Jones & Henry Engineers PROIECT NO: IE S Contracting, Inc. - CONTRACT FOR: Invoice 13-124. 03 CONTRACT DATE; CONTRACTOR'S APPLICATION FOR. PAYMENT Application a n made for Document shown is below, in connection the Contract. CHANGE ORDER SUMMARY 1. ORIGINAL CONTRACT SUM • • $ 3,423,000.00 Change Orders approved in I ADDITIONS - DEDUCTIONS 2, Net change by Change Orders $ —0 previous months by Otsner - 3. CONTRACT SUM TO DATE (Line 1 =21 $ 3,423,000.00 TOTAL 4. TOTAL COMPLETED & STORED TO DATE... , .. . . , ... $ - 89;094.00 Approved this Month (Column G on G703) • Number Date Approved S. RETAINAGE: a. 10 % of Completed Work $ 8:909.40 (Column D+E on G703) b. 00 % of Stored Material $ -0- (Column F on G703) __ Total Retainage {Line Sa +Sb or _ _ TOTALS Total in Column I of C703) $ _ 8,909 .40 ,Vet change by Change Orders • C. TOTAL EARNED LESS RETAINAGE $ 80, 184 .60 . The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line S Total) information and heliet 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 (tine 6 from prior Certificate).. . . . .... $ -_ 30,039.30 paid by the Contractor for Work for which previous Certificates for Payment were B. CURRENT PAYMENT DUE $ _ 50,145. 30 issued and payments received from the Owner, and that current payment shown 9, BALANCE TO FINISH, PLUS RETAINAGE $ 3,342,815.40 herein is now due. - - (Line 3 less Line 51 CONTR4C7C EI . K. Beets Engineering & Contracring, Inc.. State of: Indiana County of: Madison • Subscribed and sworn to before me this 31st day of May , 2013 V Notary Public: \?—Ju--c.-a a--/7J`cs<«_0 ay Af C-- iiir • i/!i ft, . rate. May 317 2013 _ Mv'Cammission expires: October 28 , 2015 AMOUNT CER ARC TECT'S C ' TIFICA' E FOR PAYMENT nFIEn (Attach explanation if amount certified differs from the amount applied tom k accordance with the Contract Documents, based on on-site observations and the ARCHITECT: data comprising the above application, the Architect certifies to the Owner that to the 2-� best of the Architect's knowledgeiniormation and belief the Work has progressed as By r - Date: • indicated,the quality or 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 AMOUNT CERTIFIED, Contractor named herein. Issuanee, payment and acceptance of payment are without • • - pre{udice to any rights of the Owner or Contractor under this Contract. MA QOCIMEhn G741- -.PPt IC Art(-4=AND CSRTIFICXtr FOR Pn.siENt•,NY Via! EDITION•AIA' • c 19yt