223665 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367204 Page 1 of 1
0 ONE CIVIC SQUARE TSW UTILITY SOLUTIONS INC
CARMEL, INDIANA 46032 1970 MIDWEST BLVD CHECK AMOUNT: $67,637.90
INDIANAPOLIS IN 46214 CHECK NUMBER: 223665
CHECK DATE: 8/27/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 193 67, 637 . 90 OTHER EXPENSES
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISOR EDITION
AIA DOCUMENT G702/Cma (Instructions on reverse side) PAGE ONE OF 3 PAGES
CONTRACTOR: TSW Utility Solutions,Inc. PROJECT: APPLICATION NUMBER: 193 Distribution to:
1970 Midwest Blvd. 96th and Towne Rd. PERIOD TO: 07/22/13 OWNER
Indpls.,IN 46214 Contract D PROJECT NOS.: CONSTRUCTION
MANAGER
SUBCONTRACTOR: CONTRACT DATE: 03/15/13 ARCHITECT
CONTRACTOR
VIA CONSTRUCTION MANAGER:
CONTRACT FOR: City of Carmel VIA ARCHITECT:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment,as shown below,in accordance with the Contract. information and belief, the Work covered by this Application for Payment has been
Continuation Sheet,AIA Document 6703,is attached. completed in accordance with the Contract Documents,that all amounts have been
I. ORIGINAL CONTRACT SUM $ 306,358.00 paid by the Contractor for Work for which previous Certiticates for Payment were issued
and payments received from the Owper and that curpmt payment shown herein is now due.
2. Net Change By Change Orders............................ $5,000.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1+2)...... $ 311,358.00 '
BY --�— DA 7/22/2013
4. TOTAL COMPLETED&STORED TO DATE.............. $311,358.00
(Column 6 on G703) ENotarjCftn8�te RAD A WEATORD
diana 5. RETAINAGE: Subscribed and sworn before me th � aY�mission h a. 0%%of Completed Work $o.00 Notary Public: September E29, 201 Expires 8
(Columns D&E on G703) My Commission Expires:
b. 0%%of Stored Material $0.00
(Column F on G703) CERTIFICATE FOR PAYMENT
Total Retainage(Line 5a+5b or
Total in Column 1 of G703) $0.00 In accordance with the Contract Documents,based on on-site observations
and the data comprising the above application,the Construction Manager
6. TOTAL EARNED LESS RETAINAGE........................ $311,358.00 certifies that to the best of his knowledge, information and belief the Work
(Line 4 less Line 5 Total) has progressed as indicated,the quality of the Work is in accordance with
the Contract Documents,and the Contractor is entitled to payment of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT AMOUNT CERTIFIED.
(Line 6 from prior Certificate) $243,720.10
AMOUNT CERTIFIED..................... $ 67,637.90
8. CURRENT PAYMENT DUE $67,637.90 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this
Application and on the Continuation Sheet that changed to conform to the amount certified.).
9. BALANCE TO FINISH,INCLUDING RETAINAGE CONSTRUCTION MGR:
(Line 3 less Line 6) $ - By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in By: Date:
Previous months by Owner This certificate is not negotiable.The AMOUNT CERTIFIED is payable only
Total Approved this Month $5,000.00 to the Contractor named herein. Issuance,payment and acceptance of
TOTALS $5,000.00 $0.00 payment are without prejudice to any rights of the Owner or Contractor under
NET CHANGES by Change Order $5,000.00 I this Contract.
CONTINUATION SHEET A A AIA DOCUMENT G703 (Instructions on reverse side) PAGE-201`3
AlA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO: 01101/00
containing Contractor's signed Certification is attached. APPLICATION DATE 05/16113
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:
Use column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A B C C C D E F G H I
ITEM DESCRIPTION OF WORK ESTIMATED UNIT SCHEDULED NORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
NO. QUANTITY PRICE VALUE TOTAL TOTAL ROM PREVIOU THIS PERIOD PRESENTLY COMPLETED (G/C) TO FINISH
QUANTITY QUANTITY APPLICATION - STORED AND STORED (C-G)
APPLICATION FROM PREV (D+E) (NOT IN TO DATE
APPLICATION D OR E) (D+E+F)
1 8"PVC Water Main Open Cut 25.00 $40.00 $ 1,000.00 25.00 $ - $0.00 $1,000.00 $1,000.00 $0.00 $0.00
2 8"DI Water Main Open Cut 35.00 $40.00 $ 1,400.00 35.00 $ - $0.00 $1,400.00 $1,400.00 $0.00 $0.00
3 16"DR-I I HDPE HDD 1,900.00 $111.70 $ 212,230.00 0.00 $ 1,900.00 $212,230.00 $0.00 $212,230.00 $0.00 $0.00
4 8"Gate Valve 2.00 $2,875.00 $ 5,750.00 0.00 $ 2.00 $5,750.00 $0.00 $5,750.00 $0.00 $0.00
5 16"Butterfly Valve 2.00 $2,829.00 $ 5,658.00 0.00 $ 2.00 $5,658.00 $0.00 $5,658.00 $0.00 $0.00
6 Fire Hydt.Assembly 4.00 $5,968.75 $ 23,875.00 0.00 $ 4.00 $23,875.00 $0.00 $23,87500 $0.00 $0.00
7 Temp.Blow Off Assembly 2.00 $600.00 $ 1,200.00 0.00 $ 2.00 $1,200.00 $0.00 $1,200.00 $0.00 $0.00
8 Cut and Cap Existing Water Main 4.00 $2,320.00 $ 9,280.00 4.00 $ - $0.00 $9,280.00 $9,280.00 $0.00 $0.00
9 Connect to Existing Mains 3.00 $6,100.00 $ 18,300.00 2.00 $ 1.00 $6,100.00 $12,200.00 $18,300.00 $0.00 $0.00
10 3/4"Short Side Service 2.00 $1,150.00 $ 2,300.00 2.00 $ - $0.00 $2,300.00 $2,300.00 $0.00 $0.00
11 Water Meter Pit 2.00 $160.00 $ 320.00 2.00 $ - $0.00 $320.00 $320.00 $0.00 $0.00
12 Disconnections 2.00 $1,000.00 $ 2,000.00 2.00 $ - $0.00 $2,000.00 $2,000.00 $0.00 $0.00
13 Remove Existing Meter Pit 2.00 $500.00 $ 1,000.00 2.00 $ - $0.00 $1,000.00 $1,000.00 $0.00 $0.00
14 Remove Existing Valves 1.00 $750.00 $ 750.00 1.00 $ - $0.00 $750.00 $750.00 $0.00 $0.00
15 Final Restoration 1.00 $12,845.00 $ 12,845.00 1.00 $ - $0.00 $12,845.00 $12,845.00 $0.00 $0.00
16 Mob/DeMobBonds/Ins. 1.00 $8,450.00 $ 8,450.00 0.50 $ 0.50 $4,225.00 $4,225.00 $8,450.00 $0.00 $0.00
.$ - 0.00 $ - $0.00 $0.00 $0.00 $0.00 $0.00
0.00 $0.00 $ - 1.00 $ - $0.00 $0.00 $0.00 $0.00 $0.00
$ - 0.00 $ - $0.00 $0.00 $0.00 $0.00 $0.00
$ - 0.00 $ - $0.00 $0.00 $0.00 $0.00 $0.00
$ 0.00 $ $0.00 $o.00 $0.00 $0.00 $0.00
$ 0.00 $ $0.00 $0.00 $0.00 $0.00 $0.00
TOTALS 1,988.00 $45,739.45 IS 306,358.00 77.50 $259,038.00 $47,320.00 $0.00 $306,358.00 100% $0.00 $0.00
VOUCHER # 132581 WARRANT # ALLOWED
367204 IN SUM OF $
TSW UTILITY SOLUTIONS INC
1970 MIDWEST BLVD
INDIANAPOLIS, IN 46214
Carmel Water Utility
ON ACCOUNT OF APPROPRIATION FOR
Board members
PO# INV# ACCT# AMOUNT Audit Trail Code
193 01-1420-00 $67,637.90
Voucher Total $67,637.90
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
367204
TSW UTILITY SOLUTIONS INC Purchase Order No.
1970 MIDWEST BLVD Terms
INDIANAPOLIS, IN 46214 Due Date 8/26/2013
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
8/26/2013 193 $67,637.90
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 Offi r