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DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> BUREAU OF RESOURCE PROTECTION <br /> PAYMENT REQUISITION <br /> (Consultant Engineer's Request and Certification) <br /> LOAN NO. CW-00-50-B DESCRIPTION OF PROJECT: <br /> DMS PROJECT NO. : CWSRF 581 <br /> CONTRACT No. CWMP/Nitrogen Mgmt Plan of Study <br /> LEGAL NAME OF BORROWER: REQUEST No. 26 (#7 under this loan 00-50-B) <br /> Town of Mash pee <br /> PAYMENT PERIOD: From To <br /> CONSULTANT NAME&ADDRESS: 12/20/2010 2/18/2011 <br /> GHD Inc. CONTRACT SERVICE DATES: From To <br /> 1545 I annou h Road, <br /> Hyannis, MA 02601 <br /> APPROVED PREVIOUS THIS ICUMMULATIVE REMAINING <br /> EXPENDITURE TYPE COST REQUESTS REQUEST REQUESTS BALANCE <br /> Technical Services S&W) $ 170,286.00 22% $ 37,998.36 $1,510.66 23% $ 39,509.02 $ 130,776.98 <br /> MBEIWBE Subcontractors <br /> Harvard Design &Mapping MBE $ - 0% $ - $ - 0% $ - $ - <br /> Green Seal Environmental (MBE) $ - 0% $ - $ - 0% $ - $ - <br /> KD&A(MBE) $ 15,000.00 0%, $ - $ - 0% $ - $ 15,000.00 <br /> Vantage Graphics(MBE) $ 249.00 0% $ - $ - 0% $ - $ 249.00 <br /> Welch Associates (WBE) $ 4,500.00 0% $ - $ - 0% $ - $ 4,500.00 <br /> Regina Villa(WBE) $ 13,000.00 45% $ 5,872.84 $ 998.73 53% $ 6,871.57 $ 6,128.43 <br /> Totals $ 170,286.00 22% $ 37,998.36 $1,511 23% $ 39,509.02 $ 130,776.98 <br /> The Borrowei's Consultant Engineer identified herein certifies as follows:1)the attached invoices and supporting documentation are for project <br /> costs for work actually performed or material or property actually supplied prior to the date of this requisition in conformity with the plans and <br /> specifications approved by the Department,or in the case of substantial deviations from the approved plans and specifications,the attached <br /> documentation demonstrates that all such deviations have been authorized and certified to by the Borrower or it's Consultant Engineer in <br /> accordance with M.G.L.c 30,ss391 and are project costs. <br /> BY THE CONSULTING ENGINEER <br /> Certified by: ir. Date Signed <br /> Type Name ar d Title 4-e,*11 Telephone <br /> DVilliam R.Hall,Jr,P.E.,BCEE (774)470-1632 <br /> Vice President <br /> i <br /> NOTE :HDM is no longer an MBE/WBE work now being performed by S&W as discussed with DEP <br /> Vantage Graphics is being use in place of Sir Speedy to meet MBE printing requirements <br /> FORM BMF-3000 <br />