PRC Housing Choice- submitted WF6-13-2019Payment Request Document - Input Form The Commonwealth of Massachusetts PRC OCD PVOCD 3210 0000 Action: N | Department of Housing and Community Development HEADER VENDOR Vendor Name and Address Document Name: Record Date: Budget FY: 20 Fiscal Year: 20 Period: Doc. Description: Doc Total: $225,300 Disbursement Options Sched. Paymnt Date: Single Payment: Handling Code: Vendor Cust.# VC600019 2124 City of Northampton 210 Main Street Northampton, MA 01060 Vendor’s Certification: I certify that the goods were shipped or the service rendered as set forth below. X___________________________________ (Please sign in ink) COMMODITY ACCOUNTING FUND ACCOUNTING Commodity Code: 841015010000 Line Type: Contract Amount: Service From: Service To: Reference Comm. Ref. Code: CT Comm. Ref. Dept.: OCD Comm. Ref. ID SC OCD 3210 0000 Comm. Reference VL: Comm. Reference CL: 1 Ref. Type Partial Invoice Information Vendor Invoice # : Vendor Invoice Line : 1 Vendor Invoice Date: Event Type: AP01 Fund: 0200 Budget FY: 20 Sub Fund: Fiscal Year: 20 Department: OCD Period: Unit: 3210 Line/Check Description: Approp Unit #: Object: PO1 Line Amount Detail Accounting Program: 19HCHOICE Program Period: EPP $ 225,300 Ref Acct. Line Ref Type: Partial TO THE COMPTROLLER OF THE COMMONWEALTH OF MASSACHUSETTS I hereby certify under the penalties of perjury that all laws of the Commonwealth of Massachusetts governing disbursements of public funds and the regulations thereof have been complied with and observed. Prepared by: _____________________________________________ Title Fiscal Representative Date_________________ Approved by: ____________________________________________ Title Fiscal Director Date _________________ Entered by: _____________________________________________ Title _________________________ Date _________________ rev10/20/2015
INOVICE
Housing Choice Capital Grant
Invoice Date June 13, 2019 Invoice No.
2019‐1
Municipality City of Northampton Vendor Code
VC6000192124
Municipal
Contact Name
Wayne Feiden, FAICP Other Project
Contact
Name
Address 210 Main Street, Planning
Northampton, MA 01060
Email
Email Wfeiden@Northamptonma.gov Phone
Phone 413‐587‐1265 Fax
Fax
Project Name: Housing Choice Northampton‐ Burts Pit Road
Contract document #:
See page 1 of DHCD contract
SCOCD321019820970000
Date(s) of Service: 12/21/2018 to 6/13/2019
Description of Service: Repaving Burts Pit Road to complement complete streets
efforts
Total Amount Due this Invoice: $225,300
See attached $175,785.29 (5/7/19) and $716,818.21 (5/31/19) vendor invoices from Palmer Paving
to the City of Northampton for this work. Of this total of $892,603.50, $225,300 is being paid for
from this Housing Choice grant and the other from municipal sources (primarily municipal bond).
Approved by:
Signature of Authorized Signatory
[Type name of authorized signatory]
In accordance with the Contract Documents, based on on-site observations and the
data comprising the above application the Architect certifies to the Owner that to the
best of the Architect's knowledge, information and belief the Work has progressed as
indicated, the quality of the Work is in accordance with the Contract Documents, and
the Contractor is entitled to payment of the Amount Certified.
1,409,272.50
0.00
1,409,272.50
185,037.15
9,251.86
175,785.29
0.00
0.00
0.00
9,251.86
0.00
Page 1
Contractor:
By: ____________________________________Date: _____________
State of: __________________County of: ______________________
Subscribed and sworn to before me this _____ day of ____________,
_________ (year). Notary public: _____________________________
My commission expires ____________________.
Original contract sum
Net change by change orders
Contract sum to date
Total completed and stored to date
Retainage
5.0% of completed work
0.0% of stored material
Total retainage
Total earned less retainage
Less previous certificates of payment
Current sales tax
0.000% of taxable amount
Current sales tax
Current payment due
Architect's Certificate for Payment
Architect:
By: _____________________________Date: ____________
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information, and
belief the work covered by this Application for Payment has been completed in accordance with the
Contract Documents, that all amounts have been paid by the Contractor for work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current
payment shown herein is now due.
Amount Certified:$ ___________________________
175,785.29
This Certification is not negotiable. The Amount Certified is payable only to the Contractor named herein. Issuance,
payment, and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this
Contract.
Date: 05/07/2019
PALMER PAVING CORPORATION
25 BLANCHARD STREET
P. O. BOX 47
PALMER, MA 01069
CITY OF NORTHAMPTON DPW
125 LOCUST STREET
NORTHAMPTON, MA 01060
To Owner:
From
(Contractor):
Phone:
Project:BURTS PIT RD NHAMPTON
BURTS PIT RD
CITY OF NORTHAMPTON
NORTHAMPTON, MA
Via (Architect):
Application No: 1
Architect's
Project No:
Contract For:
INVOICE #: 19-023* 1
Contractor's Application For Payment
Number
Date
Approved
Additions Deductions
Change
orders
approved
this month
Totals
Net change by change orders
Contractor Job
Number:19-023
Application and Certificate For Payment
Period To: 05/07/19
Change Order Summary
Change orders approved in
previous months by owner
413 283-8354
6.0000 0.00 0.00 .00 0.00 0.0 0.00
12.0000 0.00 0.00 .00 0.00 0.0 0.00
135.0000 0.00 135.00 1.00 135.00 1.0 6.75
30.0000 0.00 0.00 .00 0.00 0.0 0.00
150.0000 0.00 0.00 .00 0.00 0.0 0.00
25.0000 0.00 8,196.75 327.87 8,196.75 327.9 409.84
45.0000 0.00 5,769.90 128.22 5,769.90 284.9 288.50
4.0000 0.00 0.00 .00 0.00 0.0 0.00
400.0000 0.00 400.00 1.00 400.00 10.0 20.00
4,000.0000 0.00 4,000.00 1.00 4,000.00 12.5 200.00
2,500.0000 0.00 0.00 .00 0.00 0.0 0.00
3,800.0000 0.00 30,400.00 8.00 30,400.00 160.0 1,520.00
5,000.0000 0.00 0.00 .00 0.00 0.0 0.00
410.0000 0.00 0.00 .00 0.00 0.0 0.00
390.0000 0.00 0.00 .00 0.00 0.0 0.00
350.0000 0.00 0.00 .00 0.00 0.0 0.00
850.0000 0.00 0.00 .00 0.00 0.0 0.00
900.0000 0.00 0.00 .00 0.00 0.0 0.00
90.0000 0.00 0.00 .00 0.00 0.0 0.00
58.0000 0.00 77,517.00 1336.50 77,517.00 94.1 3,875.85
80.0000 0.00 0.00 .00 0.00 0.0 0.00
110.0000 0.00 0.00 .00 0.00 0.0 0.00
1,800.0000 0.00 0.00 .00 0.00 0.0 0.00
35.0000 0.00 0.00 .00 0.00 0.0 0.00
45.0000 0.00 0.00 .00 0.00 0.0 0.00
5.9500 0.00 0.00 .00 0.00 0.0 0.00
22.0000 0.00 0.00 .00 0.00 0.0 0.00
0.6500 0.00 0.00 .00 0.00 0.0 0.00
150.0000 0.00 0.00 .00 0.00 0.0 0.00
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/07/19 Period To: 05/07/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
BP
102.51 LF .00 .00 200.00
102.52 LF .00 .00 100.00
102.53 EAC .00 1.00 100.00
120.1 CY .00 .00 2000.00
144 CY .00 .00 25.00
151 CY .00 327.87 100.00
156 TON .00 128.22 45.00
170 SY .00 .00 2300.00
191.6 EAC .00 1.00 10.00
201 EAC .00 1.00 8.00
201.1 EAC .00 .00 2.00
202 EAC .00 8.00 5.00
203.9 EAC .00 .00 2.00
220 EAC .00 .00 82.00
220.2 VF .00 .00 9.00
220.95 EAC .00 .00 17.00
222.3 EAC .00 .00 4.00
222.4 EAC .00 .00 14.00
238.1 LF .00 .00 40.00
241.12 LF .00 1336.50 1420.00
241.15 LF .00 .00 12.00
241.24 LF .00 .00 57.00
242.24 EAC .00 .00 1.00
269.06 LF .00 .00 2400.00
402.11 TON .00 .00 700.00
403 SY .00 .00 30000.00
405.1 CY .00 .00 900.00
440 LB .00 .00 2000.00
443 MGA .00 .00 20.00
1,200.00
1,200.00
13,500.00
60,000.00
3,750.00
2,500.00
2,025.00
9,200.00
4,000.00
32,000.00
5,000.00
19,000.00
10,000.00
33,620.00
3,510.00
5,950.00
3,400.00
12,600.00
3,600.00
82,360.00
960.00
6,270.00
1,800.00
84,000.00
31,500.00
178,500.00
19,800.00
1,300.00
3,000.00
Application and Certificate For Payment -- page 2
Water for Roadway Du mporary
Fence
Tree Protection -Tre nch & Pruning
Tree Protection - Tr unk Protection
Unclassified Excavat ion
Class B Rock Excavat ion
Gravel Borrow
Crushed Stone
Fine Grading & Compa cting
Test Pit
Catch Basin
Special Catch Basin
Manhole
Deep Sump Manhole
Drainage or Sanitary Structure
Adjusted
Drainage Structure O r Sanitary
Structure Rebuilt Or Remodele
Adjust Water Gate Bo xes and
Services to Grade
Frame and Grate Muni cipal
Standard
Frame and Cover Muni cipal
Standard
10-In. Ductile Iron Pipe
12" Reinforced Concr ete (Class IV)
Pipe
15" Reinforced Concr ete (Class IV)
Pipe
24" Reinforced Concr ete (Class IV)
Pipe
24" Reinforced Concr ete Pipe
Flared End
Subdrain
Dense Grade Crushed Stone for
Shoulders
Reclaimed Pavement f or Base
Course
Processed Gravel
Calcium Chloride for Roadway Dust
Control
Water for Roadway Du st Control
Application No: 1
5.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
100.0000 0.00 16,406.00 164.06 16,406.00 164.1 820.30
1.5000 0.00 0.00 .00 0.00 0.0 0.00
4.5000 0.00 0.00 .00 0.00 0.0 0.00
22.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
50.0000 0.00 0.00 .00 0.00 0.0 0.00
300.0000 0.00 0.00 .00 0.00 0.0 0.00
5.0000 0.00 0.00 .00 0.00 0.0 0.00
175.0000 0.00 0.00 .00 0.00 0.0 0.00
160.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
85.0000 0.00 0.00 .00 0.00 0.0 0.00
32,500.0000 0.00 24,375.00 75.00 %24,375.00 75.0 1,218.75
5,000.0000 0.00 5,000.00 100.00 %5,000.00 100.0 250.00
55.0000 0.00 0.00 .00 0.00 0.0 0.00
0.8000 0.00 0.00 .00 0.00 0.0 0.00
10.0000 0.00 0.00 .00 0.00 0.0 0.00
3.5000 0.00 4,158.00 1188.00 4,158.00 59.4 207.90
5.7500 0.00 0.00 .00 0.00 0.0 0.00
25,000.0000 0.00 8,250.00 33.00 %8,250.00 33.0 412.50
3.4500 0.00 0.00 .00 0.00 0.0 0.00
0.7500 0.00 0.00 .00 0.00 0.0 0.00
0.7500 0.00 0.00 .00 0.00 0.0 0.00
150.0000 0.00 0.00 .00 0.00 0.0 0.00
20.0000 0.00 0.00 .00 0.00 0.0 0.00
235.0000 0.00 0.00 .00 0.00 0.0 0.00
325.0000 0.00 0.00 .00 0.00 0.0 0.00
65.0000 0.00 0.00 .00 0.00 0.0 0.00
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/07/19 Period To: 05/07/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
452 GAL .00 .00 1400.00
460 TON .00 .00 6400.00
472 TON .00 164.06 100.00
570.1 LF .00 .00 6200.00
570.2 LF .00 .00 7000.00
583 LF .00 .00 100.00
620.1 LF .00 .00 25.00
627.1 EAC .00 .00 1.00
630 LF .00 .00 25.00
632 EAC .00 .00 5.00
697 LF .00 .00 500.00
703 TON .00 .00 175.00
706.1 SY .00 .00 50.00
715.12 EAC .00 .00 96.00
734 EAC .00 .00 6.00
748 LS 0.00 % 75.00 % 1.00
748.9 LS 0.00 %100.00 % 1.00
751 CY .00 .00 45.00
765 SY .00 .00 4100.00
767.12 LF .00 .00 200.00
767.33 LF .00 1188.00 2000.00
767.8 LF .00 .00 200.00
851.1 LS 0.00 % 33.00 % 1.00
865.1 SF .00 .00 150.00
866.04 LF .00 .00 14000.00
867.04 LF .00 .00 18000.00
874 EAC .00 .00 3.00
874.4 EAC .00 .00 8.00
874.6 EAC .00 .00 26.00
874.8 EAC .00 .00 2.00
983 TON .00 .00 10.00
7,000.00
480,000.00
10,000.00
9,300.00
31,500.00
2,200.00
1,875.00
75.00
1,250.00
1,500.00
2,500.00
30,625.00
8,000.00
7,200.00
510.00
32,500.00
5,000.00
2,475.00
3,280.00
2,000.00
7,000.00
1,150.00
25,000.00
517.50
10,500.00
13,500.00
450.00
160.00
6,110.00
650.00
650.00
Application and Certificate For Payment -- page 3
Asphalt Emulsion for Tack Coat
Hot Mix Asphalt Pave ment
Hot Mix Asphalt for Patching
Removal Of Hot Mix A sphalt Curb
Hot Mix Asphalt Curb , Complete-In-
Place
Edging Removed and R eset
Steel W Beam Highway Guard
(Single Faced)
Steel W Beam Termina l Section
(Single Faced)
Highway Guard Remove d and
Reset
Individual Post Remo ved And Reset
Sedimentation Fence ? Silt Fence
Hot Mix Asphalt Driv eway
Brick or Flagstone W alk or
Driveway Removed and Relaid
Rural Mailbox Remove d And Reset
Sign Removed And Res et
Mobilization & Demob ilization
NPDES Storm Water Co nstruction
General Permit Compliance
Loam Borrow
Seeding
Filter Sock
Straw Wattle
Bales of Straw for E rosion Control
Safety Controls for Construction
Operations
Crosswalks and Stop lines
Reflectorized White (Thermoplastic
Four Inch Reflectori zed White Line
(Thermoplastic)
Four Inch Reflectori zed Yellow Line
(Thermoplastic)
Street Name Sign
Water for Roadway Du gn Removed
& Discarded
Traffic Warning Sign s (Type-2/2A)
Traffic Warning Sign s (Type-
3/3A/3B)
Dumped Riprap
Application No: 1
70.0000 0.00 0.00 .00 0.00 0.0 0.00
100.0000 0.00 200.00 2.00 200.00 4.4 10.00
60,000.0000 0.00 229.50 .00 229.50 0.4 11.47
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,409,272.50 0.00 185,037.15 185,037.15 9,251.86
1,409,272.50 0.00 185,037.15 185,037.15 9,251.86
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/07/19 Period To: 05/07/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
986 TON .00 .00 25.00
999.001 EAC .00 2.00 45.00
999.1 AL .00 .00 1.00
999.11 AL .00 .00 1.00
999.12 AL .00 .00 1.00
999.13 AL .00 .00 1.00
Total
Application Total
1,750.00
4,500.00
60,000.00
1,000.00
1,000.00
1,000.00
Application and Certificate For Payment -- page 4
Modified Rock Fill
Inlet Protection
Traffic Police
Monthly Price Adjust ment for Hot
Mix Asphalt Mixtures
Monthly Price Adjust ment For
Diesel Fuel And Gasoline
Monthly Price Adjust ment for
Portland Cement Concrete Mixes
Application No: 1
In accordance with the Contract Documents, based on on-site observations and the
data comprising the above application the Architect certifies to the Owner that to the
best of the Architect's knowledge, information and belief the Work 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 Amount Certified.
1,409,272.50
0.00
1,409,272.50
939,582.63
46,979.13
892,603.50
175,785.29
0.00
0.00
46,979.13
0.00
Page 1
Contractor:
By: ____________________________________Date: _____________
State of: __________________County of: ______________________
Subscribed and sworn to before me this _____ day of ____________,
_________ (year). Notary public: _____________________________
My commission expires ____________________.
Original contract sum
Net change by change orders
Contract sum to date
Total completed and stored to date
Retainage
5.0% of completed work
0.0% of stored material
Total retainage
Total earned less retainage
Less previous certificates of payment
Current sales tax
0.000% of taxable amount
Current sales tax
Current payment due
Architect's Certificate for Payment
Architect:
By: _____________________________Date: ____________
The undersigned Contractor certifies that to the best of the Contractor's knowledge, information, and
belief the work covered by this Application for Payment has been completed in accordance with the
Contract Documents, that all amounts have been paid by the Contractor for work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current
payment shown herein is now due.
Amount Certified:$ ___________________________
716,818.21
This Certification is not negotiable. The Amount Certified is payable only to the Contractor named herein. Issuance,
payment, and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this
Contract.
Date: 05/31/2019
PALMER PAVING CORPORATION
25 BLANCHARD STREET
P. O. BOX 47
PALMER, MA 01069
CITY OF NORTHAMPTON DPW
125 LOCUST STREET
NORTHAMPTON, MA 01060
To Owner:
From
(Contractor):
Phone:
Project:BURTS PIT RD NHAMPTON
BURTS PIT RD
CITY OF NORTHAMPTON
NORTHAMPTON, MA
Via (Architect):
Application No: 2
Architect's
Project No:
Contract For:
INVOICE #: 19-023* 2
Contractor's Application For Payment
Number
Date
Approved
Additions Deductions
Change
orders
approved
this month
Totals
Net change by change orders
Contractor Job
Number:19-023
Application and Certificate For Payment
Period To: 05/31/19
Change Order Summary
Change orders approved in
previous months by owner
413 283-8354
6.0000 0.00 0.00 .00 0.00 0.0 0.00
12.0000 0.00 0.00 .00 0.00 0.0 0.00
135.0000 135.00 0.00 1.00 135.00 1.0 6.75
30.0000 0.00 1,170.00 39.00 1,170.00 2.0 58.50
150.0000 0.00 0.00 .00 0.00 0.0 0.00
25.0000 8,196.75 8,044.00 649.63 16,240.75 649.6 812.04
45.0000 5,769.90 1,678.50 165.52 7,448.40 367.8 372.42
4.0000 0.00 0.00 .00 0.00 0.0 0.00
400.0000 400.00 4,000.00 11.00 4,400.00 110.0 220.00
4,000.0000 4,000.00 48,000.00 13.00 52,000.00 162.5 2,600.00
2,500.0000 0.00 0.00 .00 0.00 0.0 0.00
3,800.0000 30,400.00 7,600.00 10.00 38,000.00 200.0 1,900.00
5,000.0000 0.00 0.00 .00 0.00 0.0 0.00
410.0000 0.00 0.00 .00 0.00 0.0 0.00
390.0000 0.00 0.00 .00 0.00 0.0 0.00
350.0000 0.00 0.00 .00 0.00 0.0 0.00
850.0000 0.00 0.00 .00 0.00 0.0 0.00
900.0000 0.00 0.00 .00 0.00 0.0 0.00
90.0000 0.00 1,980.00 22.00 1,980.00 55.0 99.00
58.0000 77,517.00 20,445.00 1689.00 97,962.00 118.9 4,898.10
80.0000 0.00 280.00 3.50 280.00 29.2 14.00
110.0000 0.00 6,160.00 56.00 6,160.00 98.2 308.00
1,800.0000 0.00 1,800.00 1.00 1,800.00 100.0 90.00
35.0000 0.00 101,010.00 2886.00 101,010.00 120.3 5,050.50
45.0000 0.00 0.00 .00 0.00 0.0 0.00
5.9500 0.00 176,613.85 29683.00 176,613.85 98.9 8,830.69
22.0000 0.00 0.00 .00 0.00 0.0 0.00
0.6500 0.00 9,646.98 14841.51 9,646.98 742.1 482.35
150.0000 0.00 6,000.00 40.00 6,000.00 200.0 300.00
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/31/19 Period To: 05/31/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
BP
102.51 LF .00 .00 200.00
102.52 LF .00 .00 100.00
102.53 EAC 1.00 .00 100.00
120.1 CY .00 39.00 2000.00
144 CY .00 .00 25.00
151 CY 327.87 321.76 100.00
156 TON 128.22 37.30 45.00
170 SY .00 .00 2300.00
191.6 EAC 1.00 10.00 10.00
201 EAC 1.00 12.00 8.00
201.1 EAC .00 .00 2.00
202 EAC 8.00 2.00 5.00
203.9 EAC .00 .00 2.00
220 EAC .00 .00 82.00
220.2 VF .00 .00 9.00
220.95 EAC .00 .00 17.00
222.3 EAC .00 .00 4.00
222.4 EAC .00 .00 14.00
238.1 LF .00 22.00 40.00
241.12 LF 1336.50 352.50 1420.00
241.15 LF .00 3.50 12.00
241.24 LF .00 56.00 57.00
242.24 EAC .00 1.00 1.00
269.06 LF .00 2886.00 2400.00
402.11 TON .00 .00 700.00
403 SY .00 29683.00 30000.00
405.1 CY .00 .00 900.00
440 LB .00 14841.51 2000.00
443 MGA .00 40.00 20.00
1,200.00
1,200.00
13,500.00
60,000.00
3,750.00
2,500.00
2,025.00
9,200.00
4,000.00
32,000.00
5,000.00
19,000.00
10,000.00
33,620.00
3,510.00
5,950.00
3,400.00
12,600.00
3,600.00
82,360.00
960.00
6,270.00
1,800.00
84,000.00
31,500.00
178,500.00
19,800.00
1,300.00
3,000.00
Application and Certificate For Payment -- page 2
Water for Roadway Du mporary
Fence
Tree Protection -Tre nch & Pruning
Tree Protection - Tr unk Protection
Unclassified Excavat ion
Class B Rock Excavat ion
Gravel Borrow
Crushed Stone
Fine Grading & Compa cting
Test Pit
Catch Basin
Special Catch Basin
Manhole
Deep Sump Manhole
Drainage or Sanitary Structure
Adjusted
Drainage Structure O r Sanitary
Structure Rebuilt Or Remodele
Adjust Water Gate Bo xes and
Services to Grade
Frame and Grate Muni cipal
Standard
Frame and Cover Muni cipal
Standard
10-In. Ductile Iron Pipe
12" Reinforced Concr ete (Class IV)
Pipe
15" Reinforced Concr ete (Class IV)
Pipe
24" Reinforced Concr ete (Class IV)
Pipe
24" Reinforced Concr ete Pipe
Flared End
Subdrain
Dense Grade Crushed Stone for
Shoulders
Reclaimed Pavement f or Base
Course
Processed Gravel
Calcium Chloride for Roadway Dust
Control
Water for Roadway Du st Control
Application No: 2
5.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 324,898.50 4331.98 324,898.50 67.7 16,244.93
100.0000 16,406.00 4,384.00 207.90 20,790.00 207.9 1,039.50
1.5000 0.00 7,861.50 5241.00 7,861.50 84.5 393.08
4.5000 0.00 0.00 .00 0.00 0.0 0.00
22.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
50.0000 0.00 0.00 .00 0.00 0.0 0.00
300.0000 0.00 0.00 .00 0.00 0.0 0.00
5.0000 0.00 0.00 .00 0.00 0.0 0.00
175.0000 0.00 0.00 .00 0.00 0.0 0.00
160.0000 0.00 0.00 .00 0.00 0.0 0.00
75.0000 0.00 0.00 .00 0.00 0.0 0.00
85.0000 0.00 0.00 .00 0.00 0.0 0.00
32,500.0000 24,375.00 0.00 75.00 %24,375.00 75.0 1,218.75
5,000.0000 5,000.00 0.00 100.00 %5,000.00 100.0 250.00
55.0000 0.00 0.00 .00 0.00 0.0 0.00
0.8000 0.00 0.00 .00 0.00 0.0 0.00
10.0000 0.00 0.00 .00 0.00 0.0 0.00
3.5000 4,158.00 0.00 1188.00 4,158.00 59.4 207.90
5.7500 0.00 0.00 .00 0.00 0.0 0.00
25,000.0000 8,250.00 8,250.00 66.00 %16,500.00 66.0 825.00
3.4500 0.00 0.00 .00 0.00 0.0 0.00
0.7500 0.00 0.00 .00 0.00 0.0 0.00
0.7500 0.00 0.00 .00 0.00 0.0 0.00
150.0000 0.00 0.00 .00 0.00 0.0 0.00
20.0000 0.00 0.00 .00 0.00 0.0 0.00
235.0000 0.00 0.00 .00 0.00 0.0 0.00
325.0000 0.00 0.00 .00 0.00 0.0 0.00
65.0000 0.00 1,463.15 22.51 1,463.15 225.1 73.16
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/31/19 Period To: 05/31/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
452 GAL .00 .00 1400.00
460 TON .00 4331.98 6400.00
472 TON 164.06 43.84 100.00
570.1 LF .00 5241.00 6200.00
570.2 LF .00 .00 7000.00
583 LF .00 .00 100.00
620.1 LF .00 .00 25.00
627.1 EAC .00 .00 1.00
630 LF .00 .00 25.00
632 EAC .00 .00 5.00
697 LF .00 .00 500.00
703 TON .00 .00 175.00
706.1 SY .00 .00 50.00
715.12 EAC .00 .00 96.00
734 EAC .00 .00 6.00
748 LS 75.00 % 0.00 % 1.00
748.9 LS 100.00 % 0.00 % 1.00
751 CY .00 .00 45.00
765 SY .00 .00 4100.00
767.12 LF .00 .00 200.00
767.33 LF 1188.00 .00 2000.00
767.8 LF .00 .00 200.00
851.1 LS 33.00 % 33.00 % 1.00
865.1 SF .00 .00 150.00
866.04 LF .00 .00 14000.00
867.04 LF .00 .00 18000.00
874 EAC .00 .00 3.00
874.4 EAC .00 .00 8.00
874.6 EAC .00 .00 26.00
874.8 EAC .00 .00 2.00
983 TON .00 22.51 10.00
7,000.00
480,000.00
10,000.00
9,300.00
31,500.00
2,200.00
1,875.00
75.00
1,250.00
1,500.00
2,500.00
30,625.00
8,000.00
7,200.00
510.00
32,500.00
5,000.00
2,475.00
3,280.00
2,000.00
7,000.00
1,150.00
25,000.00
517.50
10,500.00
13,500.00
450.00
160.00
6,110.00
650.00
650.00
Application and Certificate For Payment -- page 3
Asphalt Emulsion for Tack Coat
Hot Mix Asphalt Pave ment
Hot Mix Asphalt for Patching
Removal Of Hot Mix A sphalt Curb
Hot Mix Asphalt Curb , Complete-In-
Place
Edging Removed and R eset
Steel W Beam Highway Guard
(Single Faced)
Steel W Beam Termina l Section
(Single Faced)
Highway Guard Remove d and
Reset
Individual Post Remo ved And Reset
Sedimentation Fence ? Silt Fence
Hot Mix Asphalt Driv eway
Brick or Flagstone W alk or
Driveway Removed and Relaid
Rural Mailbox Remove d And Reset
Sign Removed And Res et
Mobilization & Demob ilization
NPDES Storm Water Co nstruction
General Permit Compliance
Loam Borrow
Seeding
Filter Sock
Straw Wattle
Bales of Straw for E rosion Control
Safety Controls for Construction
Operations
Crosswalks and Stop lines
Reflectorized White (Thermoplastic
Four Inch Reflectori zed White Line
(Thermoplastic)
Four Inch Reflectori zed Yellow Line
(Thermoplastic)
Street Name Sign
Water for Roadway Du gn Removed
& Discarded
Traffic Warning Sign s (Type-2/2A)
Traffic Warning Sign s (Type-
3/3A/3B)
Dumped Riprap
Application No: 2
70.0000 0.00 0.00 .00 0.00 0.0 0.00
100.0000 200.00 0.00 2.00 200.00 4.4 10.00
60,000.0000 229.50 13,260.00 .22 13,489.50 22.5 674.46
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,000.0000 0.00 0.00 .00 0.00 0.0 0.00
1,409,272.50 185,037.15 754,545.48 939,582.63 46,979.13
1,409,272.50 185,037.15 754,545.48 939,582.63 46,979.13
To Owner:CITY OF NORTHAMPTON DPW
From (Contractor):PALMER PAVING CORPORATION
Project:BURTS PIT RD NHAMPTON
Date: 05/31/19 Period To: 05/31/19
Architect's Project No:
Contractor's Job Number:19-023
Item
Number Description
Unit
Price UM
Scheduled
Value
Work Completed
Previous Application
Quantity Amount
Contract
Quantity Quantity Amount
Work Completed
This Period
Completed and Stored To Date
Quantity Amount %Retention Memo
986 TON .00 .00 25.00
999.001 EAC 2.00 .00 45.00
999.1 AL .00 .22 1.00
999.11 AL .00 .00 1.00
999.12 AL .00 .00 1.00
999.13 AL .00 .00 1.00
Total
Application Total
1,750.00
4,500.00
60,000.00
1,000.00
1,000.00
1,000.00
Application and Certificate For Payment -- page 4
Modified Rock Fill
Inlet Protection
Traffic Police
Monthly Price Adjust ment for Hot
Mix Asphalt Mixtures
Monthly Price Adjust ment For
Diesel Fuel And Gasoline
Monthly Price Adjust ment for
Portland Cement Concrete Mixes
Application No: 2