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226672 12/03/2013
CITY OF CARMEL, INDIANA VENDOR: 366790 Page 1 of 1 ONE CIVIC SQUARE GERIG OTTENWELLER CONTRACTING LLLLB� CARMEL, INDIANA 46032 3010 INDEPENDENCE WAY CTiECK AMOUNT: $140,621.00 noH c t' FT WAYNE IN 46808 CHECK NUMBER: 226672 CHECK DATE: 12/3/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462300 26567 4 140, 621 . 00 RIVER ROAD CULVERT RE CONSTRUCTION PROJECT INVOICE DATE: November 13, 2013 COMPANY NAME: Gerig-Ottenweller Contracting, LLC AND ADDRESS 3010 Independence Dr. Fort Wayne, IN 46808 TELEPHONE NO.: (260) 484-9183 FAX NO.: (260) 484-9187 PROJECT NAME: River Road Culvert Replacement over Elizabeth Warren Drain. PROJECT NO.: 11-07 PURCHASE ORDER: 26567, dated 02/06/2013 INVOICE NO.: 4 ? TOTAL EARNINGS TO DATE: ............................... $ 674,432 RETAINAGE :......................................................... 33,722 MINUS PERVIOUS PAYMENTS:............................ O 500,099 — TOTAL NOW DUE:................................................$ 140,621 November 20, 2013_ Stephen A. Moore—VS Engineering, Inc. Date APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 2 PAGES APPLICATION NO: 4 Distribution to: TO (Owner): City of Carmel PROJECT: River Road Culvert Replacement OWNER PERIOD FROM: 1-Oct-13 ARCHITECT TO: 31-Oct-13 CONTRACTOR CONTRACTOR: Gerig-Ottenweller Contracting, LLC ATTENTION: Gary R Duncan 3010 Independence Drive ARCHITECT'S Cripe City of Carmel Fort Wayne IN 46808 PROJECT NO: 11_07 CONTRACT DATE: 2/27/2013 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for Payment,as shown below, in connection with the Contract. CHANGE ORDER SUMMARY Continuation Sheet,AIA Document G703,is attached. Change orders approved ADDITIONS DEDUCTIONS in previous months by The present status of the account for this Contract is as follows: Owner TOTAL ORIGINAL CONTRACT SUM........................................ $659,671.00 Approved this Month Number Date Approved Net change by Change Orders ....................................... $0 1 2 CONTRACT SUM TO DATE ......................................... $659,671.00 3 4 TOTAL COMPLETED&STORED TO DATE...................... $674,43*2, 5 (Column G on G703) 6 TOTALS $0.00 Retainage 5 % ............................................. $33,722 Net change by Change Orders or total in Column I on G703 TOTAL EARNED LESS RETAINAGE.................................. $640,709 The undersigned Contractor to the best of his knowledge, information and belief the Work covered by this Application for LESS PREVIOUS CERTIFICATES FOR PAYMENT......,.,.? $500,089 Payment has been completed in accordance with the Contract Docu- \\\\ e e�8 w////// ments,that all amounts have been paid to him for Work for which �p� .`.... Ede/ice previous Certificates for Payment were issued and payments received CURRENT PAYMENT DUE.......................... \...�•:�F\�lAt SF'.�°� $140,621 from the Owner,and that current payment shown herein is now due. 0 9! CONTRACTOR: Gerig-Ottenweller Contracting, LLC State of: Indiana = TATE®bdtYSt�WAue� =_ l Subscribed arOsworn to fore me I ALLEN COUNTY By: Date: I �)�`C)t Notary Public: V O��bMan Partner Wq%� r �xpires:o_f)^'l ARCHITECT'S CERTIFICATE FOR PAYMENT '1 iini��� In accordance with the Contract Documents,based on on-site obser- AMOUNT CERTIFIED..............................................,........ � 1401 w.U 0 vations and the data comprising the above application,the Architect (Attach ex lanation if amount certified differs from the amount applied for.) certifies to the Owner that the Work has progressed to the point Engineer indicated;that to the best of his knowledge,information and belief, the quality of the Work is in accordance with the Contract Docu- By: S L Date: ments;and that the Contractor is entitled to payment of the AMOUNT This Certific to is not negotiable. the AMOUNT CERTIFIED is payable only to the Contractor CERTIFIED. named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract AIA DOCUMENT G702 • CONTINUATION SHEET • APRIL 1978 EDITION AIA@ ©1978 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W.,WASHINGTON, D.C. 2006 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NUMBER: 4 Contractor's signed Certification is attached. APPLICATION DATE: 31-Oct-13 In tabulation below,amounts are staled to the nearest dollar. PERIOD FROM: 1-Oct-13 Use Column I on Contracts where variable retainage for line items may apply. TO: 31-Oct-13 PROJECT NO: 1107 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED PERCENTAGE WORK COMPLETED TOTAL COMPLETED RETAINAGE No. VALUE OF This Ap plication AND STORED BALANCE SUM Previous Stored Materials TO DATE % TO FINISH Applications Work in Place (not in D or E) D+E+F G/C C-G 1 Construction Engineering 1 LS $3,000.00 $3,000 0.45% $3,000.00 $3,000 $0 $150 2 Mobilization and Demobilization 1 LS $36,000.00 $36,000 5.43% $30,000.00 $6,000.00 $36,000 $0 $1,800 3 Third Party Testing Agency 1 LS $3,000.00 $3,000 0.45% $2,500.00 $500.00 $3,000 $0 $150 4 Maintaining Traffic 1 LS $2,000.00 $2,000 0.30% $1,500.00 $500.00 $2,000 $0 $100 5 Con-Span Bridge System 1 LS $281,000.00 $281,000 42.38% $266,000.00 $15,000.00 $281,000 $0 $14,050 6 Precast Concrete Footing 1 LS $135,800.00 $135,800 20.48% $135,800.00 $135,800 $0 $6,790 7 Cast-in-Place Concrete Footing 1 LS $8,000.00 $8,000 1.21% $8,000.00 $8,000 $0 $400 8 Dewatering 1 LS $10,000.00 $10,000 1.51% $10,000.00 $10,000 $0 $500 9 Temporary Pumparound 1 EACH $3,000.00 $3,000 0.45% $3,000.00 $3,000 $0 $150 10 Clearing Right of Way 1 LS $7,500.00 $7,500 1.13% $7,500.00 $7,500 $0 $375 11 Guardrail,Remove 256 LFT $6.00 $1,536 0.23% $1,536.00 $1,536 $0 $77 12 Existing Concrete Culvert Removal 1 LS $14,000.00 $14,000 2.11% $14,000.00 $14,000 $0 $700 13 Riprap Remove 1 LS $5,500.00 $5,500 0.83% $5,500.00 $5,500 $0 $275 14 Asphalt Remove 220 SYS $15.00 $3,300 0.50% $3,300.00 $4,395.00 $7,695 -$4,395 $385 15 Tree and Vegetation Remove 1 LS $2,000.00 $2,000 0.30% $2,000.00 $2,000 $0 $100 16 Sign and Post Remove 6 EACH $100.00 $600 0.09% $600.00 $600 $0 $30 17 Sign and Post Remove and Reinstall 0 EACH $300.00 $0 0.00% $0 $0 $0 18 Excavation Common 1350 CYS $7.00 $9,450 1.43% $9,450.00 $9,450 $0 $473 19 Excavation Waterway 550 CYS $11.00 $6,050 0.91% $6,050.00 $6,050 $0 $303 20 Excavation Foundation Unclassified 650 CYS $9.00 $5,850 0.88% $5,850.00 $5,850 $0 $293 21 Linear Ditch Grading 158 LFT $7.00 $1,106 0.17% $1,106.00 $1,106 $0 $55 22 Compacted Aggregate 53 Base 0 TONS $40.00 $0 0.00% $0 $0 $0 23 Saw Cut Asphalt 68 LFT $3.50 $238 0.04% $238.00 $238 $0 $12 24 Milling Asphalt 2 inch 560 SYS $10.00 $5,600 0.84% $650.00 $650 $4,950 $33 25 HMA Bituminous Surface,Type"C"9.5mm 80 TONS $115.00 $9,200 1.39% $9,775.00 $9,775 -$575 $489 26 HMA Bituminous Intermediate,Type"C"19mm 55 TONS $113.00 $6,215 0.94% $12,543.00 $12,543 -$6,328 $627 27 HMA Bituminous Base,Type"C",25mm 75 TONS $111.00 $8,325 1.26% $16,983.00 $16,983 -$8,658 $849 28 Handrail 197 LFT $178.00 $35,066 5.29% $35,066.00 $35,066 $0 $1,753 29 Filter Fabric 5301 SYS $2.50 $1,325 0.20% $1,325.00 $1,325 $0 $66 30 Riprap Class 1 7201 TONS $37.00 $26,640 4.02% $26,640.00 $26,640 $0 $1,332 31 Seed Mixture,R(170 Ibs per acre) 100 LBS $35.00 $3,500 0.53% $3,500.00 $3,500 $0 $175 32 Fertilizer 300 LBS $1.00 $300 O.05% $300.00 $300 $0 $15 33 Re-spread Topsoil 1 LS $2,000.00 $2,000 0.30% $2,000.00 $2,000 $0 $100 34 Erosion Control Blanket 2300 SYS $1.75 $4,025 0.61% $4,025.00 $4,025 $0 $201 35 Concrete Washout 1 EACH $750.00 $750 0.11% $750.00 $750 $0 $38 36 Temporary Ditch Inlet Protection 0 EACH $750.001 $0 0.00% $0 $0 $0 37 Temporary Silt Fence 475 LFT $3.00 $1,425 0.21% $1,425.00 -$1,425.00 $0 $1,425 $0 38 Mobilization and Demobilization for Seeding 1 EACH $750.00 $750 0.11% $749.00 $749 $1 $37 39 Bicycle and Diagonal Arrow Sign and Post 2 EACH $500.00 $1,000 0.15% $0 $1,000 $0 40 Construction Sign,Type A 8 EACH $140.00 $1,120 0.17% $1,120.00 $1,120 $0 $56 41 Construction Sign,Type C 8 EACH $250.00 $2,000 0.30% $2,000.00 $1,500.00 $3,500 -$1,500 $175 42 Standard Barricade,Type IIIA 100 LFT $15.00 $1,500 0.23% $1,080.00 $1,080 $420 $54 43 Detour Route Marker Assembly 24 EACH $150.00 $3,600 0.54% $3,600.00 $3,600 $0 $180 44 Road Closure Sign Assembly 8 EACH $170.00 $1,360 0.21% $1,360.00 $1,360 $0 $68 45 4 Inch White Epoxy Line with Reflective Beads 560 LFT $2.00 $1,120 0.17% $1,120.00 $1,120 $0 $56 46 4 Inch Yellow Epoxy Line with Reflective Beads 560 LFT $2.00 $1,120 0.17% $1,120.00 $1,120 $0 $56 47 Left Curve Warning Sign and Post 1 EACH $500.00 $500 0.08% $500.00 $500 $0 $25 48 End School Zone Sign and Post 1 EACH $500.00 $500 0.08% $0 $500 $0 49 Bicycle Warning Sign,Diagonal Arrow and Post 2 EACH $600.00 $1,200 0.18% $0 $1,200 $0 50 Bicycle Warning Sign and Post 1 EACH $600.00 $600 0.09% $0 $600 $0 51 Coir Los 1 LUMP SUM $3,400.00 $3,400 0.51% $3,400.00 $3,400 $0 $170 $663,0711 100% 1526,409 $148,022 $674,43 a -$11,360 $33,722 AIA DOCUMENT G702 • CONTINUATION SHEET • APRIL 1978 EDITION • AIA® • ©1978 SpN THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,D.C.2006 Total Qty This Total This Qty To Amount To No. Item Est Qty Unit Unit Price Bid Qty Est Est Date Date 1 Construction Engineering 1 LS $3,000.00 $3,000.00 0.33 $1,000.00 0.33 $1,000.00 2 Mobilization and Demobilization 1 LS $36,000.00 $36,000.00 0.40 $14,400.00 0.40 $14,400.00 3 Third Party Testing Agency 1 LS $3,000.00 $3,000.00 $0.00 $0.00 4,Maintaininci Traffic 1 LS $2,000.00 $2,000.00 $0.001 $0.00 5 Con-S an Bridge System 1 LS $281,000.00 $281,000.00 $0.00 $0.00 6 Precast Concrete Footing 1 LS $135,800.00 $135,800.00 $0.00 $0.00 7 Cast-in-Place Concrete Footing 1 LS $8,000.00 $8,000.00 $0.00 $0.00 8 Dewatering 1 LS $10,000.00 $10,000.00 $0.00 $0.00 9 Temporary Pum around 1 EACH $3,000.00 $3,000.00 $0.00 $0.00 10 Clearing Right of Way 1 LS $7,500.00 $7,500.00 1.00 $7,500.00 1.00 $7,500.00 11 Guardrail,Remove 256 LFT $6.00 $1,536.00 $0.00 $0.00 121Existing Concrete Culvert Removal 1 LS $14,000.00 $14,000.00 $0.00 $0.00 13 Riprap Remove 1 LS $5,500.00 $5,500.00 $0.00 $0.00 14 Asphalt Remove 220 SYS $15.00 $3,300.00 $0.00 $0.00 15 Tree and Vegetation Remove 1 LS $2,000.00 $2,000.00 $0.00 $0.00 16 Sign and Post Remove 6 EACH $100.00 $600.00 $0.00 1 $0.00 17 Sign and Post Remove and Reinstall 0 EACH $300.00 $0.00 $0.00 $0.00 18 Excavation Common 1350 CYS $7.00 $9,450.00 $0.00 $0.00 19 Excavation Waterway 550 CYS $11.00 $6,050.00 $0.00 $0.00 20 Excavation Foundation Unclassified 650 CYS $9.00 $5,850.00 $0.00 $0.00 21 Linear Ditch Grading 158 LFT $7.00 $1,106.00 $0.00 $0.00 22 Compacted Aggregate 53 Base 0 TONS $40.00 $0.00 $0.001 $0.00 23 Saw Cut Asphalt 68 LFT $3.50 $238.00 $0.00 $0.00 24 Milling Asphalt 2 inch 560 SYS $10.00 $5,600.00 $0.00 $0.00 25 HMA Bituminous Surface,Type"C"9.5mm 80 TONS $115.00 $9,200.00 $0.00 $0.00 261 HMA Bituminous Intermediate,Type"C"1 9m 55 TONS $113.00 $6,215.00 $0.00 $0.00 27 HMA Bituminous Base,Type"C",25mm 75 TONS $111.00 $8,325.00 $0.00 $0.00 28 Handrail 197 LFT $178.00 $35,066.00 $0.00 $0.00 29 Filter Fabric 530 SYS $2.50 $1,325.00 $0.001 $0.00 30 Riprap Class 1 720 TONS $37.00 $26,640.00 $0.00 $0.00 31 Seed Mixture,R 170 Ibs per acre 100 LBS $35.00 $3,500.00 $0.00 $0.00 32 Fertilizer 300 LBS $1.00 $300.00 $0.00 $0.00 33 Re-s read Topsoil 1 LS $2,000.00 $2,000.001 $0.00 $0.00 34 Erosion Control Blanket 2300 SYS $1.75 $4,025.00 $0.00 $0.00 35 Concrete Washout 1 EACH $750.00 $750.00 $0.00 $0.00 36 Temporary Ditch Inlet Protection 0 EACH $750.00 $0.00 $0.001 $0.00 37 Temporary Silt Fence 475 LFT $3.00 $1,425.00 475.00 $1,425.001 475.00 $1,425.00 38 Mobilization and Demobilization for Seeding 1 EACH $750.00 $750.00 $0.00 $0.00 39 Bicycle and Diagonal Arrow Sign and Post 2 EACH $500.001 $1,000.00 $0.00 $0.00 40 Construction Sign,Type A 8 EACH $140.00 $1,120.00 $0.00 $0.00 41 Construction Sign,Type C 8 EACH $250.00 $2,000.00 $0.00 $0.00 42 Standard Barricade,Type IIIA 100 LFT $15.00 $1,500.00 $0.00 $0.00 43 Detour Route Marker Assembly 24 EACH $150.00 $3,600.00 $0.00 $0.00 44 Road Closure Sign Assembly 8 EACH $170.00 $1,360.00 $0.00 $0.00 45 4 Inch White Epoxy Line with Reflective Beads 560 LFT $2.00 $1,120.00 $0.00 $0.00 46 4 Inch Yellow Epoxy Line with Reflective Beads 560 LFT $2.00 $1,120.00 $0.00 $0.00 47 Left Curve Warning Sign and Post 1 EACH $500.00 $500.00 $0.001 $0.00 48 End School Zone Sign and Post 1 EACH $500.00 $500.00 $0.00 $0.00 49 Bicycle Warning Sign,Diagonal Arrow and Post 2 EACH $600.00 $1,200.00 $0.00 $0.00 50 Bic cle Warning Sign and Post 1 EACH $600.00 $600.00 $0.00 $0.00 Total i 1 1 $659,671.001 $24,325.00 $24,325.00 AFFIDAVIT AND WAIVER OF LIEN ; State of Indiana, County Allen SS Ryan Ottenweller Being duly sworn states that he is the Managing Partner of (Name of Officer) (Title) Geri g-Ottenweller Contracting LLC. having contracted with City of Carmel, IN to furnish certain materials and/or labor as follows: installing new water treatment plant. Labor for the project known as: River Road Culvert Replacement Over Elizabeth Warren Drain—Project No 11-07 (Description) located at River Road and owned by City of Carmel, IN and does hereby further state on behalf of the aforementioned subcontractor/supplier: (Owner) (PARTIAL WAIVER) that there is due from the CONTRACTOR is the sum of One Hundred Forty Thousand Six Hundred Twenty One Dollars & 00/100------------ ($140,621.00) ( ) receipt of which is hereby acknowledged: or (x) the payment of which has been promised as the sole consideration of this affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned: (FINAL WAIVER)that the final balance due from the CONTRACTOR is the sum of O receipt of which is hereby acknowledged: or ( ) the payment of which has been promised as the sole consideration of this affidavit and Final Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of such payment THEREFORE, the undersigned waives and releases unto the OWNER of said premises, and any and all lien or claim whatsoever on the above-described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Geri g-Ottenweller Contracting, LLC. By Managing Partner (Firm) (Aa&rized Representative) WITNESS MY HAND AND NOTARIAL SEAL this 13_�24L day of r C a se Angela S. Wedlr E fIppIgNq My Commission ExpiresC�w�(tir;�� ( 15 Printed ` j� Residing in ����,J� County /�llllflllllil����` 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 service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Gerig-Ottenweller Contracting, LLC Purchase Order No. 3010 Independence Drive Terms Fort Wayne, IN 46808 Date Due Invoice Invoice Description Date Number (or note attached invoice(s)or bill(s) Amount 11/13/2013 4 River Road Culvert Construction $ 140,621.00 Total $ 140,621.00 1 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. ,20 Clerk-Treasurer VOUCHER NC WARRANT NO. Gerig-Ottenweller Contracting, LLC ALLOWED 20 3010 Independence Drive IN SUM OF $ Fort Wayne, IN 46808 $ 140,621.00 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITL AMOUNT DEPT# I hereby certify that the attached invoice(s), 26567 4 211-4462300 $ 140,621.00 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 s 12/2/2013 0 Signature City Engineer Cost Distribution ledger classification if Title claim paid motor vehicle highway fund