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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. 31 (#12 under this loan 00-50-B) <br /> Town of Mashpee <br /> PAYMENT PERIOD: From To <br /> CONSULTANT NAME&ADDRESS: 6/23/2011 8/19/2011 <br /> GHD Inc. CONTRACT SERVICE DATES: From To <br /> 1545 lyannough 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 50% $ 84,375.02 $3,062.00 51% $ 87,437.02 $ 82,848.98 <br /> MBE/WBE Subcontractors <br /> Harvard Design &Mapping (MBE) $ - 0% $ - $ - 0% $ - $ - <br /> Green Seal Environmental (MBE) $ - 0% $ - $ - 0% $ - $ - <br /> Meranda Excavating (MBE) $ 23,130.00 100% $ 23,130.00 $ - 100% $ 23,130.00 $ - <br /> Vantage Graphics (MBE) $ 249.00 0% $ - $ - 0% $ - $ 249.00 <br /> PEER Consulting (WBE) $ 1,500.00 100% $ 1,500.00 $ - 100% $ 1,500.00 $ - <br /> Regina Villa (WBE) $ 13,000.00 53% $ 6,871.57 $ - 53% $ 6,871.57 $ 6,128.43 <br /> Totals $ 170,286.00 50% $ 84,375.02 $3,062 51% $ 87,437.02 $ 82,848.98 <br /> The Borrowers 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: �! � Date Signed <br /> Type Name and Title: Telephone <br /> William R.Hall,Jr,P.E.,BCEE (774)470-1632 <br /> Vice President <br /> NOTE :Meranda Excavating Contract value changed per Amendment 1 -so total paid=total invoiced of$23,130) <br /> PEER contract value adjusted to reflect signed agreement. <br /> FORM BMF-3000 <br />