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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. 36(#17 under this loan 00-50-B) <br /> Town of Mashpee <br /> PAYMENT PERIOD: From To <br /> CONSULTANT NAME&ADDRESS: 12/20/2011 2/16/2012 <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 59% $ 100,722.52 $1,180.00 60% $ 101,902.52 $ 68,383.48 <br /> MBEIWBE Subcontractors <br /> Welsh Assoc.Land Surveyors B $ 6,950.00 0% $ 6,950.00 $ - 100% $ 6,950.00 $ <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(WEE) $ 1,500.00 100% $ 1,500.00 $ - 100% $ 1,600.00 $ - <br /> Regina Villa(WBE) $ 13,000.00 53% $ 6,871.57 $ - 53% $ 6,871.57 $ 6,128.43 <br /> Totals $ 170,286.00 59% $ 100,722.52 $1,180 60% $ 101,902.52 $ 68,383.48 <br /> The Borrowers Consultant Engineer identified herein certifies as follows:9)the attached invoices and supporting documentation are for project <br /> costs forwork 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,Orin 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 Engineerin <br /> accordance with M.G.L.c30,ss391 and are project costs. <br /> BY THE CONSULTING ENGINEER <br /> Certified by: Date Signed �J 3 <br /> { k�7 . <br /> Type Name and Title: Telephone <br /> William R.Nall,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 />