CF-Sandy Station-CS 860623 CITY OF COPPELL
PAYMENT AUTHORIZATION MEMO
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Application for Payment
PAYMENT REQUEST NO. __ ONE SHEET 1 OF 3
FOR WORK COMPLETED THROUGH THE DATE OF: ~ta¥ 27~ 1986
PROJECT TITLE: SANDY L~k~ ROAD P~IP STAIION IMPRO\~-?4EN~FS DATE: June 2, 1986
LOCATION: Coppell, Texas
DESCRIPT~N: Install one 100 HP motor ~d p~p w/ electrical appurten~ces
OWNER/ENGINEER INFORMATION: CONTRACTOR INFORMATION:
CONTRACTOR: On'~.'*x Construction Co., Inc..
OWNER: ~it¥ o£ Co??e!! ADDRESS: P.O. Box 18765
ADDRESS: P.E)_ Rr~-~-.~7,q C~/STATE: Ft. ~orth: T~ 76248
C~Y/STATE: Coppell, Texas 75019 CO.ACT ~RSON: R. E. Josserand
CO. ACT PER~ON: Ed Powell PH~E ~.: ~817) 439-3335
462-0022
PHONE ~.:
IN~RANCE CO.: ~ited Fidelity
GI~, INC., ADDRE~:
ENG~EER:
CON~LTING ENGINEERS
AD~E~: ~5 PRESTON ROAD, CITY/STATE:
SUITE ~ O~
CI~/STATE: DALLAS, ~EXAS B~DING AGE~: Hi~hl~ds ~der,~riters
CO. ACT PERSON: Kevin Peiffer ADDRE~: 600 Jefferson
PH~E~.:(2~4) ~8~-~ CI~/~TATE: Houston, ~ 77002
CONTRACT NO.: CONTRACT DATE: PROJECT NO.:
TOTAL ORIGINAL CONTRACT AMOUNT: $ 4.5.960.00
TOTAL CHANGE ORDERS: 1 AMOUNT: $
TOTAL CONTRACT AMOUNT TO DATE: $
NOTICE TO PROCEED DATE: ~,L~y ~P, lpg6 COMPLETION TIME: :].5 CALENDAR DAYS
CONTRACT COMPLETION DATE: July 2, 1986
PERCENT TIME ELAPSED: 28.9 % PERCENT WORK COMPLETED: 69.2
TELEPHONE ONYX CU,qSTRUCTION CO, INC.
439-3335
430-1800 GENERAL CONTRACTOR & EQUIPMENT RENTAL
P. O. 80X !8765
FORT WORTH. TEXAS 76118
HAME OF PROJECT City of Coppell Existing Pump Station Improvements
ESTIMATE PERIOD: FROM May 1, ]986 TO May 27, 1986
CONTRACTOR ONYX CONSTRUCTION CO., INC.
CONTRACT AMOUNT $ 45,960.00 AMOUNT ESTIMATE 32,370.00
CHANGE ORDER 831.00 RETAINAGE 10% 3,237.00
TOTAL CONTRACT AMOUNT 46,791.00 LESS PREVIOUS PYMTS -O-
TOTAL THIS ESTIMATE 29,133.00
I
DESCRIPTION UNIl t~NIT CONTRACT _WORK DONE AMOUNT
PRICE PRICE T.O DATE
Electrical C.I.P. (i'ncl. '~nstrumen-
tation) LS 15,500,00 20 % 3,100.00
High service pump w/motor (IOOHP)
w/appurten. I EA 20,210,00 90 % 18,189.00
12" D.I. flanged Class 51 C.I.P. ~1 LF 4,100,00 100 4,100.00
12" 90° D.I. long rad, base bend
(flanged) C.I.P. I EA 750,00 100 750.00
12" x 10" reducer D.I. (flanged)C.I.P I EA 500.00 100 500.00
10" x 900 bend D.I. (flanged) C.I.P. I EA 300,00 100 300.nO
10" gate valve D.I. (flanged) C.I.P. I EA 900,00 100 900.00
10" check valve D.I. [flanged) C,I.P. I EA 2,500,00 100 2,500.00
Pressure gauge (0-200 ps ) I EAI 200'0'~ 'l 100 200.00
3" air release valve C.I.P, 1 EAi 1,000,001 100 1,000.00
Install 12" Valve & Box 1 Ea 831.00 100 831.00
fZ-'OSSER^NO
Sec~/I reas. I
PROJECT: SANDY LAK~ ROAD .oNP STATS'ON IMPROVEb~NTS ;aHEET 1 OF 3
· PAYMENT NO.
Accompanying Documentation: GROSS AMOUNT DUE ......... $ 32,370.00
LESS 10 % RETAINAGE ..... $ 3,237.00
AMOUNT DUE TO DATE ....... $ 29~133.00
LESS PREVIOUS PAYMENTS... $ -0-
AMOUNT DUE THIS APPLICATION $ 29,133.00
REVIEWED BY: ~,.~::::. DATE:
CHECKED BY: ~, ~). DATE:
CONTRA CTOR'$ CERTIFICATION:
The undersigned CONTRACTOR certifies that (1) all previous progress payments received f~om
OWNER on account of Work done under the Coutract referred to above have been applied to
discharge in full all obligations of CO,II, ACTOR incurred in connection with Work coverec
by prior Applications for Payment nuad~ered I through inclusive; and (2) title
all ~aterials and equipment incorporated in &sid Work or otherwise listed in or covered
-by this Application for Payment will paaa to OWNER at time of payment free and clear of
all liens, claims, s~curity interests ~d ~cu~br~nces (except such as covered by ~o~d
acceptable to
ENGIMEER'~ RECOMENDATION:
This Application (with accompanying documentation) meets the requirements of the
Contract Documents and payment of the above AMOUNT DUE THIS APPLICATION is reco~inended.
Title
OW#ER'$ APPROVAL: ·
^~p,-ov.~ ~or ~,.,,me~ on a~ ~"a~, of C~~, ~' ~/ ,
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