Request for Funds-SeniorRemodel
sag{~
10624 W. Executive Dr. ,
Boise, ID 83713
T 208.322.7033
800.859.0321
F 208.322.3569
TTYffDD
1.800.377.3529
EEO/AA Employer
"'H"" """,idaha.com
RECEIVED
JUN - 7 2005
City of Meridian
City Clerk Office
June 3, 2005
Will Berg
Meridian City Clerk
City of Meridian
33 E. Idaho
Meridian, ill 83642
RE: City of Meridian Request for Funds #3
ICDBG-04-111-01-SR
Will:
Attached please find three copies of the City of Meridian's Request for Funds
#3 for the Senior Center Project.
Please have Mayor DeWeerd sign two copies, keep one for your records and
return the two-signed copies to Sage immediately for processing.
If you have any questions, feel ffee to can the office or email me at
j tomlinson@sageidaho.com.
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J e£1~linson
Grant Administrator
Chapter HI
ICDBG Progress Report
Financial Management
Grantee: I ~eport No.:
City of Meridiau, Idaho
Date: Date of !DOC Contract: Grant No.:
June 3, 2005 July 17,2004 ICDBG-04-IIl.1-SR
Report Period From: Report Period To: Telephone:
April 15, 2005 June 3, 2005 (208) 322-7033 ext. 234
Grant Amount: Project Match Expended to Date: Tax !D No.:
$100,000 $5,000.00 82-6000225
Second Public Hearing: Y/(N) (Circle One) I Published Notice Submitted: Y/(N)
Date of Second Public Hearing: Yet to be held Minutes Submitted: Y/(N)
List of Attendees Submitted: Y/(N)
PROJECT START UP
Environmental Release:
Send copy of ERR
Bid Documents Reviewed and
Approved:
Procurement for Admin Contract
Reviewed and Approved:
Admin Contract Reviewed and
Approved:
Contact Person:
Phone:
Procurement for Eng/ Arch Contract
Reviewed and Approved:
Eng/Arch Contract Reviewed and
Approved:
Contact Person:
Phone:
Acquisition (voluntary or eminent
domain):
Date of Purchase/Transfer of Title:
Relocation (business or resident):
Exhibit C
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Complete. Submitted 06.04
Complete
Complete. Part of Applicatiou
Complete. Part of Applicatioo
Complete. Publicatiou affidavits, solicitation
information, ranking summary, Contrad
Comptete.
If the project includes acquisition, it must be monitored. Ongoing progress
report schedule for acquisition activities must be established individually
between grant administrator and project coordinator at !DOC
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1/5
Chapter HI
FAIR HOUSING PROGRESS
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Designate Fair Housing Resource
Person:
Fair Housing Review Committee:
Fair Housing Resolution:
Fair Housing Plan/Analysis of
Impediments:
Communications of Fair Housing
Activities:
Grantee Fair Housing Poster:
SECTION 504 PROGRESS
Designate Responsible Employee:
504 Committee Established:
Non-Discrimination Policy Adopted:
Grievance procedure Established:
504 Self-Evaluation Completed:
504 Transition Plan:
Exhibit C
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Establish committee
Repubtish annually duriug project
Develop Fair Housing Plan.
Ongoing
Ongoing
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Develop Transition Plan
2/5
Chapter 1II
CIVIL RIGHTS PROGRESS
Community Profile:
EEO Policy Statement:
EEO Grievance ProcedureÆEO
Complaints:
Grantee Employment Form:
Contract/Subcontract Activity Report:
Senior Center Participants Form:
Section 3 Certifications:
Grantee EEO Poster:
ACQUISITION PROGRESS
No acquisition in this pwject
Exhibit C
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Financial Management
3/5
Chapter III
CONSTRUCTION AND LABOR PROGRESS
Contract Award:
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Debarred List Checked:
10.04
Preconstruction Conference:
Minutes & Checklists
10.04
Bid Tabulations:
10.04
Notice to Proceed:
10.04
Wage Rate Number:
10.04
Ten-day Wage-rate update:
10.04
Additional Classifications Required:
10.04
CERTIFICATION:
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Complete and submit
I. the undersigned, do hereby certify that the above information contained in this report, including the attached
payroll review and the attached disbursement report, is correct and accurately reflects the progress and status of the
grant project.
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Signature of ICDBG Certified Grant Administrator
(208) 322-7033 ext. 227
Phone
Date
CERTIFICATION:
3.05
4.15.05
None
None
I, the undersigned, do hereby certify that the above information contained in this report, including the attached
payroll review and the attached disbursement report, is correct and accurately reflects the progress and status of the
grant project.
Authorized Signature for Chief Elected Official
Exhibit C
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III-I 6
Title
Date
4/5
DISBURSEMENT REPORT
DISBURSEMENT LOG. City of Meridian
Request for Funds this Period: $17,812.00 Paid to Date $5,000.00
T T
REQUEST FOR FUNDS #2
DATE DATE DATE
RECEIVED DEPOSITED DISBURSED CHECK # AMOUNT PAID TO WHOM
31-Jan-05 31-Jan-05 4-Feb-05 61406 $ 2.500.00 Sage
6-May-05 6-May-05 10-May-05 62710 $ 2,500.00 Sage
Grantee Name: City of Meridian Contract #ICDBG-04-111-1-5R Contact Person Jennifer Tomlinson phone (208) 322-7033 ext 22
Address: 33 E. Idaho Ave. Meridian, ID 83642 Report Period: 4.15.05-6.03.05 Date of Request 6.03.05 Request #3
1 2 3 4 Total 5 6 7 8 Current
ICDBG Total of Program Funds Requested + Total Funds Unexpended Balance Accrued Requests for
Budget Previous Income Earned Program Income Disbursed of Funds Req.+ (unpaid) Bills & Funds Col
A. Administration $ 10,000 $ 5,000 $ $ 5,000 $ 5,000 $ 1,000 $ 1,000
B. Architectural $ - $ - $ - $ - $ -
C. Construction:
Materials & Fencing $ 90,000 $ - $ - $ - $ - $ - $ 16,812 $ 16,812
$ $ - $ $ - $ - $ -
$ - $ $ - $ - $ - $ -
E. Legal $ - $ - $ - $ $ $ -
F. Audit $ - $ - $ - $ - $ - $ -
TOTALS $ 100,000 $ 5,000 $ - $ - $ 5,000 $ 5,000 $ 17,812 $ 17,812
Idaho Community Development Block Grant Program Request for Funds
(Return to Idaho Department of Commerce, Community Development Division, 700 W. State St., PO Box 83720 Boise, ID 83720-0093)
* This category includes SCADA software but no other accessories nor installation of equipment.
Note: Furnishing false information may constitute a violation of applicable state and federal law.
Certification of Financial Officer: I certify that the above data is correct, based on the grantee's official accounting system and records,
consistently applied and maintained, and that expenditures shown have been made for the purposes of, and in accordance with applicable
contract terms and conditions. The funds requested are for reimbursement of actual expenditures during the report period.
Signature
Typed Name
Title
ReqFundL3_M eridSeniors
Contractorl
Subcontractor
KMO, InC.
RM Mechanical
ACE Construction
SBI Contracting
DeB est Fire
Protection
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INVOICE
DATE
1 INVOICE NO. i
5524
AMOUNT
1,000.00
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$1,00000
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PAYMENT APPLICATION
CI1Y OF MERIDIAN
33E.IDAHOAVENUE
MERIDIAN IDAHO 83642
WIL BERG
FROM: KMO INC
923 16TH AVENUE SOUTH,SUITE-A
NAMPA IDAHO 83651
MERIDIAN SENIOR CENTER REMODEL
TO:
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FOR:
CONTRACTOR'S SUMMARY OF WORK
Appticatlon is made fnr payment as shown below.
Continuetion Page is attached.
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1. CONTRACT AMOUNT
2. SUM OF ALL CIIANGE ORDERS
(Line 1 +1- 2)
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3. CURRENT CDNTRACT AMOUNT
4. TOTAL COMPLETED AND STORED
(Column G on Continuation Page)
5. RETAINAGE:
a- 5.00% of Completed Work
(Columns D + E on Continuation Page)
b. 5.00% of Malerial Stored
(Column F on Continuation Page)
Total Retalnage (LIne 5a + 5b or
Column I nn Cornlnuation Page)
6. TOTAL COMPLETED AND STORED LESS RETAINAGE
(Line 4 minus LIne 5 Total)
7. LESS PREVIOUS PAYMENT APPLICATIONS
Page 1
PROJECT POI 25-79 MERIDIAN SENIOR
NAME AND MERIDIAN SENIOR CENTER REMODEL
LOCATION: 133 BROADWAY AVE, MERIDIAN ID 83642
APPUCATION #
PERIOD THRU:
PROJECT#S:
DATE OF CONTRACT:
1 Distributlnn to:
0610112005 0 OWNER
P0#25-79 DARCHITECT I
0412512005 0 CONTRACTOR
0
0
ARCHITECT: JOHNSON ARCHITECTS
440 E. CORPORATE DRIVE SUITE #102
MERIDIAN IDAHO 83642
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$17,698.40
$840.07
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8. PAYMENT DUE
g. BALANCE TO COMPLETION
(LIne 3 minus Line 8)
~188.42
ADDITIOF'
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SUMMARY OF CHANGE ORDERS
Total changes approved In
previous months
Totai approved this month
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NET CHANGES
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PAYMENT APPLICATION
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$44.75
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By:
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State of:
County of:
Subscribed and swom to before
me this day of
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Notary Public:
My Commission Expires:
$864.82 ARCHITECT'S CERTIFICATION
$16,811.58 Architect's signature below is hio assurance to Owner, conceming lI1e payment herein applied for,
that: (1) ArchRect has Inspected the Work represented by this Application, (2) such Work has been
completed to the extent Indicated In this Application, and the quar~y of workmanship and materials
$0.00 I confnnns with ths Contract Documenis, (3) this Application for Payment accurately states lI1e amount
of Work completed and payment due therefor, and (4) Architect knows of no reason why payment
I $16,811.58 I 'ShOUld not be made.
CERTIFIED AMOUNT...--..-....-.........""""""""""""""""""-""""""""'-"...... ?j/~ N/.G"'5
$0.00
$Qõõ
$Qõõ
$0.00
DEDUCTIONS
$0.00
$Qõõ
$Qõõ
(Ir the cerlffied amount is different from the payment due, you should attach an explanaüon.
Initial all the "gUteS that ate changed to match the certified amount.)
Date:
1L.f5.6
moOt applied for herein is assignabie or negotlable. Payment shall
d is without prejudice to any rights of Owner or Contrac:tor under
erwlse.
ass, INC. DOCUMENT
:') Page2of 3
0.. CONTINUATION PAGE
PROJECT: POll 25-79 MERIDIAN SENIOR APPLICATION 11-: 1
MERIDIAN SENIOR CENTER REMODEL DATE OF APPLICATION: OS/25/2005
Payment Application containing Contrac\Q~s signatu", Is attached. PERIOOTHRU: 06/01/2005
PROJECT lis: P0#25-79
A B C D T E F G H
:') COMPLETED WORK STORED TOTAL % BA~~CE I RETAINAGE
:rJ ITEM I/- WDRK DESCRIPTION SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMPo
::J AMOUNT PREVIOUS THISPERJOD (NOT IN DORE) STORED (GIC) COMPLETION (If Variable)
:» PERIODS (D+E+F) (c-G)
:0
...
::c 1. BOND FEE $2,790.00 $0.00 $2,790.00 $0.00 $2,790.00 100% $0.00
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::J 2. MOBILIZATION $1,000.00 $0.00 $1,000.00 $0.00 $1,000.00 100% $0.00
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3. SUPERVISION $2,500.00 $0.00 $875.00 $0.00 $815.00 35% $1,625.00
4. TEMPORARY FACILITIES $1,500.00 $0.00 $750.00 $0.00 $750.00 50% $750.00
:.J 5. EXCAVATION-CONCRETE $8,000.00 $0.00 $7,200.00 $0.00 $7,200.00 90% $800.00
1.
:n 8. METAL HANDRAIL-LINTEL $7,000.00 $0.00 $700.00 $0.00 $700.00 10% $6,300.00
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.1J 7. SAWCUTTING $400.00 $0.00 $400.00 $0.00 $400.00 100% $0.00
-
....
1: 8. SELECTIVE DEMOLITION $4,600.00 $0.00 $1,920-00 $0.00 $1.920.00 40% I $2,860.00
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J! $250.00 $50.00 $0.00
1: 9. EPOXY & REBAR $0_00 $50.00 20% $200.00
z: 10- ROUGH CARPEN1RY $4,000.00 $0.00 $400.00 $0.00 $400.00 10% $3.600.00
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z: 11. LUMBER-MATERIALS $1,400.00 $0.00 $0.00 $0.00 $0.00 0% $1,400.00
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., 12. !MASONRY $800.00 $0.00 $0.00 $0.00 $0.00 0% $800.00
13. IELECTRICAL $8,400.00 $0.00 $0.00 $0.00 $0.00 0% $8,400.00
0.. 14. MECHANICAL $4.600.00 $0.00 $0.00 $0.00 $0.00 0% $4,600.00
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15. PLUMBING $10,000.00 $0.00 $0.00 $0.00 $0.00 0% .10,000.00
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16. FIRE SPRINKlERS $7,634.00 $0.00 $0.00 $0.00 $0.00 0% $7,834.00
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:J $16,085.00125% T
') SUB-TOTALS $65.274.00 $0.00 $16,085.00 $0.00 $49.189.00
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CONTINUATION PAGE FOR PAYMENT APPLICATION ass, INC. DOCUMENT
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II.. CONTINUATION PAGE
PROJECT: pot 25-79 MERIDIAN SENIOR APPUCATION #: 1
MERIDIAN SENIOR CENTER REMODEL DATE OF APPLICATION: 05n5l2005
payment Appllca~on containing COnlTacto~. signaiUle ¡s ailachad. PERIODTHRU: 06/0112005
PROJECT#S: P0#25-79
A B C D E F G H
;<¡ COMPLETED WORK STORED TOTAL ¡Ii % BA~~CE I RETAINAGE
;<¡ ITEM # WORK DESCRlPTtON SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMPo
:::¡ AMOUNT PREVIOUS THIS PERIOD (NOTINDORE) STORED (G I C) COMPLETION (II Variable)
:n PERIODS (D+E+F) (c-G)
:D
~
:D 17. INSULATION $350.00 $0.00 $0.00 $0.00 $0.00 0% $350.00
:D DRYWAll. $2,200.00 $0.00 $0.00 $0.00 $0.00 0%
::¡ 18. $2,200.00
:IJ I
19. PAINfING $4,610.00 $0.00 $0.00 $0.00 $0.00 0% $4,610.00
20. VINYL FLOORING $400.00 $0.00 $0,00 $0.00 $0.00 0% $400.00
:oJ 21. !cERAMIC TILE $9,957.00 $0.00 $0.00 $0.00 $0.00 0% $9,957.00
)..
:n 22. FINISH CARPENfRY $8.00.00 $0.00 $80.00 $0.00 $80.00 10% $720.00
-
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.1J 23. DOORS & HARDWARE $3,007.00 $0.00 $601.40 $0.00 $601.40 20% $2,405.60
I: 24. GLAZING $250.00 SO.OO $0.00 $0.00 $0.00 0% $250.00
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:Ii: 25. BATH PARTITIONS $2,000.00 $0.00 $0.00 $0.00 $0.00 0% $2,000.00
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~ 26. BATH ACCESSORIES $1,226.00 $0.00 $0.00 $895.00 $895.00 73% $331.00
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~ 27. FRP $2.576.00 $0.00 $0.00 $0.00 $0.00 O"/, $2,576.00
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"") 26. JANITORIAL $350.00 $0-00 $35.00 $0.00 $35.00 10% $315.00
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." TOTALS $75,303.60
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CONfINUATION PAGE FOR PAYMENf APPLICATION ass, INC. DOCUMENT
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SOl Contracting, Inc.
228 E. Plaza #193
Eagle, 10 83616
Phone: (208) 376-5200
Fax: (208) 376.5201
/
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INVOICE
I
INVOICE #1315
DATE:MAY 17,2005
FOR: MERIDIAN SENIOR CENTER
TO:KMO
DESCRIPTION AMOUNT
\ section 10801: toilet accessories - stored @ 58! warehouse 895.00
\
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NET 30
Less retention <44.95>
TOTAL 850.05
(,,:' ~ ro' -=)