Triple Creek Community Development District

Board of Supervisors’ Meeting January 16, 2018

District Office:
9428 Camden Field Parkway Riverview, Florida 33578
813.533.2950

www.triplecreekcdd.com

TRIPLE CREEK
COMMUNITY DEVELOPMENT DISTRICT AGENDA
January 16, 2018 at 10:00 a.m.

Rizzetta & Company, Inc. located at 9428 Camden Field Parkway, Riverview, Florida, 33578.

District Board of Supervisors	Grady Miars	Chairman	
	Bruce Kaschyk	Vice Chairman	
	Ellen Johnson	Assistant Secretary	
	Bob Allen	Assistant Secretary	

District Manager	Keith Turney

Christine Perkins	Assistant Secretary

Rizzetta & Company, Inc.	
District Counsel	Jennifer Kilinski	Hopping Green & Sams, P.A.	
District Engineer	Jamie Scarola	Scarola Associates	

All Cellular phones and pagers must be turned off while in the meeting room.

The District Agenda is comprised of four different sections:

The meeting will begin promptly at 10:00 a.m. with the first section which is called Audience Comments. The Audience Comment portion of the agenda is where individuals may comment on matters that concern the District. Each individual is limited to three (3) minutes for such comment. The Board of Supervisors or Staff is not obligated to provide a response until sufficient time for research or action is warranted. IF THE COMMENT CONCERNS A MAINTENANCE RELATED ITEM, THE ITEM WILL NEED TO BE ADDRESSED BY THE DISTRICT MANAGER OUTSIDE THE
CONTEXT OF THIS MEETING. The second section is called Business Administration. The Business Administration section contains items that require the review and approval of the District Board of Supervisors as a normal course of business. The third section is called Staff Reports. This section allows the District Manager, Engineer, and Attorney to update the Board of Supervisors on any pending issues that are being researched for Board action. The fourth section is called Business Items. The business items section contains items for approval by the District Board of Supervisors that may require discussion, motion and votes on an item-by-item basis. Occasionally, certain items for decision within this section are required by Florida Statute to be held as a Public Hearing. During the Public Hearing portion of the agenda item, each member of the public will be permitted to provide one comment on the issue, prior to the Board of Supervisors’ discussion, motion and vote. Agendas can be reviewed by contacting the Manager’s office at (813) 533-2950 at least seven days in advance of the scheduled meeting. Requests to place items on the agenda must be submitted in writing with an explanation to the District Manager at least fourteen (14) days prior to the date of the meeting. The final section is called Supervisor Requests. This is the section in which the Supervisors may request Staff to prepare certain items in an effort to meet residential needs.

Public workshops sessions may be advertised and held in an effort to provide informational services. These sessions allow staff or consultants to discuss a policy or business matter in a more informal manner and allow for lengthy presentations prior to scheduling the item for approval. Typically no motions or votes are made during these sessions.

Pursuant to provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this meeting is asked to advise the District Office at (813) 533-2950, at least 48 hours before the meeting. If you are hearing or speech impaired, please contact the Florida Relay Service at 7-1-1, who can aid you in contacting the District Office.

Any person who decides to appeal any decision made by the Board with respect to any matter considered at the meeting is advised that this same person will need a record of the proceedings and that accordingly, the person may need to ensure that a verbatim record of the proceedings is made, including the testimony and evidence upon which the appeal is to be based.

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT DISTRICT OFFICE  9428 CAMDEN FIELD PARKWAY RIVERVIEW, FL 33578
Board of Supervisors	January 11, 2018
Triple Creek Community Development District
AGENDA
Dear Board Members:

The Regular meeting of the Board of Supervisors of the Triple Creek Community Development District will be held on Tuesday, January 16, 2018 at 10:00 a.m. at Rizzetta & Company, Inc. located at 9428 Camden Field Parkway, Riverview, Florida 33578. The following is the agenda for this meeting:

CALL TO ORDER/ROLL CALL
AUDIENCE COMMENTS
BUSINESS ADMINISTRATION
Consideration of the Minutes of the Board of Supervisors’
Regular Meeting held on December 19, 2017 ............................................ Tab 1
Consideration of Operations & Maintenance Expenditures
for November 2017..................................................................................... Tab 2
Ratification of Series 2017AB Construction Requisitions #193-214 ......... Tab 3
Ratification of Series 2017-2 Construction Requisitions #5....................... Tab 4
E.	Ratification of Change Order #5................................................................. Tab 5
STAFF REPORTS
Field Services Manager
Presentation of December 2017 Field Inspection Report .............. Tab 6
Presentation of Sitex Landscape Response to the December 2017
Field Inspection Report.................................................................. Tab 7
Consideration of Proposals for Landscape Enhancements ............ Tab 8
Sitex Aquatics
Presentation of January 2018 Sitex Aquatics Inspection Report ... Tab 9
District Counsel
District Engineer
District Manager
Clubhouse Manager
BUSINESS ITEMS
A.	Consideration of Hog Trapping Proposal ................................................... Tab 10
B.	Consideration of Proposal for an Additional Irrigation Well-pump
Control Meter.............................................................................................. Tab 11
SUPERVISOR REQUESTS
ADJOURNMENT

We look forward to seeing you at the meeting. In the meantime, if you have any questions,  please do not hesitate to call us at (813) 533-2950.

With Warm Regards,

Christine Perkins
Christine Perkins District Manager

Tab 1

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 1

MINUTES OF MEETING

Each person who decides to appeal any decision made by the Board with respect to any matter considered at the meeting is advised that the person may need to ensure that a verbatim record of the proceedings is made, including the testimony and evidence upon which such appeal is to be based.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

The regular meeting of the Board of Supervisors of Triple Creek Community Development District was held on Tuesday, December 19, 2017 at 10:01 a.m. at the offices of Rizzetta & Company, Inc. located at 9428 Camden Field Parkway, Riverview, FL 33578.

Present and constituting a quorum:

Grady Miars	Board Supervisor, Chairman (via phone)
Bruce Kaschyk	Board Supervisor, Vice Chairman
Ellen Johnson	Board Supervisor, Assistant Secretary
Keith Turney	Board Supervisor, Assistant Secretary
Bob Allen	Board Supervisor, Assistant Secretary

Also present were:

Joseph Roethke	Regional District Manager, Rizzetta & Company, Inc.
Christine Perkins	District Manager, Rizzetta & Company, Inc.
Scott Green	Field Services Manager, Rizzetta & Company, Inc. Lindsay Whelan	District Counsel, Hopping Green & Sams (via phone) Robert Nelson	Greenpointe Holdings, LLC
Kyle Thornton	District Engineer, Genesis Group
James Butler	Clubhouse Manager
Rick Herndon	Sitex

Audience

FIRST ORDER OF BUSINESS	Call to Order/Roll Call

Ms. Perkins called the meeting to order and read the roll call.

SECOND ORDER OF BUSINESS	Audience Comments

Mr. Timothy Walsh of 12310 Estuary Bend inquired about the possibility of extending the berm on the south side of Triple Creek Blvd. behind his home, as he remarked that everyone can see right into his back yard, while many of the surrounding homes have privacy via a natural berm that also acts as a sound barrier. Discussion ensued about the possibility of adding in a privacy fence, drainage, the lack of space in this area to add a berm, and there not being enough room to construct a sizeable berm. The consensus was that there potentially may be enough room between the swale and sidewalk, however, and Mr. Thornton would consult with Mr. Herndon to identify options for plantings in this area.

Mr. G. Alex Garces remarked that the Christmas decorations, plantings, and signs were looking good. Mr. Garces also provided a list of community questions, issues, and concerns (Exhibit A). Ms. Perkins requested that questions be received in advance of the meeting in writing to adequately have time to prepare for relaying responses. Discussion ensued regarding landscaping & irrigation items that would be addressed by Sitex Landcare, new lights being installed to illuminate the American flag pole, light repairs being underway, communication with Envera ahead of neighborhood meetings at the Clubhouse, pressure washing for the entrance towers/sidewalks/amenity/gazebos that will be scheduled quarterly, construction

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 2

trash, and issues regarding the school zone traffic.

Ms. Merritt inquired about the follow-up regarding her concerns from last month regarding the sidewalk sink hole. Mr. Thornton communicated that the contractor is working on a price, and that county approved the repair. Ms. Merritt also asked about the swampy area and if the county was going to scoop the ditch on the side. Mr. Thornton expressed that the county had other priorities at this time, and did not expect it to be addressed anytime soon. Ms. Perkins communicated that she would follow-up with Mr. Craig about the pond maintenance lines.

THIRD ORDER OF BUSINESS	Consideration of Minutes of the Board of Supervisors’ Regular Meeting held on November 21, 2017

On a Motion by Mr. Allen, seconded by Mr. Kaschyk, with all in favor, the Board approved the Supervisors’ Regular Meeting Minutes held on November 21, 2017 for the Triple Creek Community Development District.

FOURTH ORDER OF BUSINESS	Consideration of Operation and Maintenance
Expenditures for October 2017

On a Motion by Mr. Kaschyk, seconded by Ms. Johnson, with all in favor, the Board approved the Operation and Maintenance Expenditures for October 2017 in the amount of ($42,616.24) for the Triple Creek Community Development District.

FIFTH ORDER OF BUSINESS	Ratification of Series 2017AB Construction Requisitions # 155-192

REQUISITION NO.	

PAYEE	

AMOUNT	

SUBACCOUNT	
155-B	Atlantic TNG, LLC	$13.305.00	General B	
156-K	Atlantic TNG, LLC	$8,255.00	Village K	
157-B	Basham & Lucas Design Group, Inc.	$8,044.08	General B	
158-F1	Cement Treated Base, LLC	$21,649.60	Village F1	
159-K	Florida Soil Cement Co., LLC	$17,391.00	Village K	
160-L	Florida Soil Cement Co., LLC	$3,870.00	Village L	
161-F1	Genesis Group	$625.08	Village F1	
162-F2	Genesis Group	$625.08	Village F2	
163-G1	Genesis Group	$625.08	Village G1	
164-B	Genesis Group	$11,626.84	General B	
165-F2	Genesis Group	$1,564.72	Village F2	
166-G1	Genesis Group	$917.50	Village G1	
167-F1	Genesis Group	$2,067.50	Village F1	
168-K	Genesis Group	$5,355.00	Village K	
169-L	Genesis Group	$4,732.50	Village L	
170-K	Hayes Pipe Supply, Inc.	$4,137.60	Village K	
171-L	Hayes Pipe Supply, Inc.	$547.00	Village L	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 3

172-B	Hopping Green & Sams	$1,572.50	General B	
173-F1	RIPA & Associates, LLC	$164,041.74	Village F1	
174-G1	RIPA & Associates, LLC	$19,116.40	Village G1	
175-B	Atlantic TNG, LLC	$12,201.00	General B	
176-L	Atlantic TNG, LLC	$334.00	Village L	
177-B	Florida Soil Cement Co., LLC	$41,360.00	General B	
178-K	Florida Soil Cement Co., LLC	$10,010.00	Village K	
179-L	Florida Soil Cement Co., LLC	$19,097.96	Village L	
180-B	Hayes Pipe Supply, Inc.	$58,534.72	General B	
181-K	Hayes Pipe Supply, Inc.	$753.00	Village K	
182-B	The Kearney Companies, LLC	$215,196.98	General B	
183-K	The Kearney Companies, LLC	$126,996.71	Village K	
184-L	The Kearney Companies, LLC	$68,652.43	Village L	
185-B	Genesis Group	$9,444.34	General B	
186-F1	Genesis Group	$1,559.56	Village F1	
187-F2	Genesis Group	$7,570.00	Village F2	
188-G1	Genesis Group	$5,883.38	Village G1	
189-K	Genesis Group	$3,898.82	Village K	
190-L	Genesis Group	$2,092.50	Village L	
191-B	Hopping Green & Sams	$2,661.50	General B	
192-B	Mortensen Engineering, Inc.	$4,155.00	General B	

On a Motion by Ms. Johnson, seconded by Mr. Turney, with all in favor, the Board ratified the Series 2017AB Construction Requisitions #155-192 for the Triple Creek Community Development District.

SIXTH ORDER OF BUSINESS	Ratification of Series 2017-2 Construction Requisitions #3-4

REQUISITION NO.	
PAYEE	
AMOUNT	
Supp 3	Genesis Group	$11,542.50	
Supp 4	ECS Florida, LLC	$788.00	

On a Motion by Mr. Turney, seconded by Ms. Johnson, with all in favor, the Board ratified the Series 2017- 2 Construction Requisitions #3-4 for the Triple Creek Community Development District.

SEVENTH ORDER OF BUSINESS	Ratification of Change Order #4

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 4

On a Motion by Mr. Kaschyk, seconded by Mr. Allen, with all in favor, the Board ratified the Change Order #4 for the Triple Creek Community Development District.

EIGHTH ORDER OF BUSINESS	Staff Reports

Field Services Manager
Presentation of November 2017 Field Inspection Report
Mr. Green presented the November 2017 Field Inspection Report for the Board’s review, remarking that he had also was witness to a thorough irrigation inspection conducted by Sitex Landcare, to which several areas requiring attention are reflected by proposals included within the agenda. Mr. Green summarized recent plant and annual installations. Mr. Herndon mentioned that a tree Mr. Turney expressed some concern over would be removed by the end of the week.

Presentation of Sitex Landscape Response to November 2017 Field Inspection Report

Consideration of Proposals for Landscape Enhancements
Irrigation Proposal #1

On a Motion by Mr. Turney, seconded by Mr. Allen, with all in favor, the Board approved the Irrigation Proposal #1 in the amount of ($1,977.00) for the Triple Creek Community Development District.

Irrigation Proposal #2

	CHANGE
ORDER#	CONTRACTOR	DESCRIPTION	AMOUNT	
CONTRACT #		
	4	Kearney	Hayes Pipe Supply	($13,743.43)	0038-01		
	4	Kearney	Atlantic	($2,567.32)	0038-01		
	4	Kearney	Ferguson	($2,093.71)	0038-01		
	4	Kearney	Florida Soil Cement	($30,105.89)	0038-01		
On a Motion by Mr. Allen, seconded by Ms. Johnson, with all in favor, the Board approved the Irrigation Proposal #2 in the amount of ($2,519.00) for the Triple Creek Community Development District.	

Sitex Aquatics

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 5

Presentation of December 2017 Sitex Aquatics Inspection Report
Ms. Perkins distributed the December 2017 Sitex Aquatics Inspection Report to the Board. Mr. Allen inquired about a pond maintenance map that delineated the pond numbers. Discussion ensued about the murkiness in pond 38A, which was found to be caused by construction and subsequently will be treated.

District Counsel No report.

District Engineer No report.

District Manager
Ms. Perkins informed the Board that the next regularly scheduled meeting will be on Tuesday, January 16, 2018 at 10:00 a.m. and to be held at the offices of Rizzetta & Company Inc., located at 9428 Camden Field Parkway, Riverview, Florida 33578.

Clubhouse Manager No report.

NINTH ORDER OF BUSINESS	Ratification of Task Order #4 from Dennis Benham for Triple Creek Phase 1 Tract “N”

Mr. Thornton commented that this included the northwest area of main lake that was originally excluded.

On a Motion by Mr. Turney, seconded by Mr. Kaschyk, with all in favor, the Board ratified the Task Order #4 from Dennis Benham for Triple Creek Phase 1 Tract “N” for the Triple Creek Community Development District.

TENTH ORDER OF BUSINESS	Ratification of Task Order #1B from Dennis Benham for Triple Creek Village G2

On a Motion by Mr. Turney, seconded by Mr. Kaschyk, with all in favor, the Board ratified the Task Order #1B from Dennis Benham for Triple Creek Village G2 for the Triple Creek Community Development District.

ELEVENTH ORDER OF BUSINESS	Consideration of Pressure Washing Proposals

Fleetwash Pressure Cleaning Proposal

Gladiator Pressure Cleaning Proposal- Pool & Deck

Gladiator Pressure Cleaning Proposal- Community & Amenity Center

Grimebusters Pressure Cleaning Proposal

Discussion ensued regarding the three proposals received, type of chemicals utilized by each vendor, and concerns over the effect on any surrounding plants. Mr. Herndon communicated that based on experience he didn’t foresee any issues for the plants.

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
December 19, 2017 - Minutes of Meeting
Page 6

On a Motion by Mr. Turney, seconded by Ms. Johnson, with all in favor, the Board approved the Fleetwash proposal in the amount of ($665.00) per visit for the Triple Creek Community Development District.

TWELFTH ORDER OF BUSSINESS	Supervisor Requests

Mr. Allen distributed a letter to the Board (Exhibit B), to propose that the community construct a Bus Stop Shelter for the community’s students. Discussion ensued in support of this effort. Mr. Miars clarified  that the Hillsborough County School Board dictates locations of Bus Stops, as the shelter locations could be subject to changing each year. The consensus of the Board was to overall provide support to begin to investigating the possibility of construing a shelter, and Mr. Allen volunteered to contact the County Commission and the School Board directly to see if this were a feasible and worthwhile pursuit for the District.

THIRTEENTH ORDER OF BUSINESS	Adjournment

On a Motion by Mr. Kaschyk, seconded by Mr. Allen with all in favor, the Board adjourned the meeting at 10:57 a.m. for the Triple Creek Community Development District.

Secretary/Assistant Secretary	Chairman/Vice Chairman

Triple Creek CDD
EXHIBIT TO December 19, 2017 MINUTES:

Garces, Alex

Subject:	Triple Creek CDD Meeting - Community Questions, Issues, Concerns, Etc-Tue, Dec 19, 2017

Acknowledgements: Christmas Decorations look good (thanks for removing the wreath covering the Triple Creek name); all the new palms, new plants, fresh pine straw and new grass on TC Blvd look good. New signage looks pretty good too.

Field, playground, gazeebo, etc- maintenance plan and schedule?
SE corner missing grass, when will it get done?
New palm on east side still tied, when will it be untied?
Flag requires light all night (as per US Flag code), Who, how and when?
Flag pole base need pressure washing, who and by when?
Flag torn from protruding bolts who and when will it be remediate?
Play ground requires cleaning and maintenance, who and when?
Picnic tables cleaning and maintenance, who and when?
Gazeebo cleaning and maintenance, who and when?
Lights and walkways require cleaning, who and when?

Amenity Center, Club House and Pool Area- maintenance plan and schedule?
Club house interior light was not working, status?
Club house door locks, who and how resolves?
Community gym locked too early, who do we call?
Amenity center  and lights require pressure washing, when?
Amenity center  walkways require pressure washing, when?

Landscaping and Ponds- maintenance plan and schedule?
Trimming outside fenceline is often missed, al say should be Sitex?
Sprinkler running mid-day, mis-aligned, who and when addresses?
Several irrigation lines exposed and broken, pool/playground, when?
Fertilizing, Weeds and Pest control, how and when?

Construction vehicle, crews, equipment and activities -Actions and Accountability?
Construction crew littering, several FB pie/posts, who and when can address?
Construction vehicles blocking traffic, school routes, who and when can be addressed?
Accident this week involving construction vehicle, who enforced traffic rules?

Requests- How to fund and prioritize?
Can we have shading installed at playground in time for summer?
Can we request an ice maker installed in the club house?
Can we protect Gazeebo and picnic table from vandalism?
Can more traffic control be installed in school zone? Like flashing lights?
Can the amenity center manager maintain the common ground Utter free?

1

Christine Perkins District Manager

In Triple Creek on a rainy morning the middle schoolers are either sitting in their parent's car waiting for the bus to arrive or standing in the rain waiting with an umbrella to cover them. When the bus arrives it is a mad dash in the rain to get on the bus. It is not just a few kids it is a fully loaded bus even with 3 to several seats. ( In excess of safety guidelines)
I am proposing that the CDD look into a shelter to cover the kids on these rainy days. There are many months before we get to the rainy season so now is the time to start the process if we all agree.
The land would be at the corner of Triple Creek Blvd and Royal Pines. The cost for this project would be shared by all the home builders in Triple Creek and the COD.
I recognize that this will open a can of worms regarding the new homes being built in Triple Creek but that is a little too far in the future and I am not a fortune teller so it would be impossible at this point to know how many more will be middle school age or high school age.
With a new middle school and high school being proposed neither will be within walking distance so the busing issue will still be there.
If you have any questions, please don't hesitate to contact me.

Thanks very much
;fJ&t-
Bob Allen

CC: Grady Miars

Tab 2

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT	
DISTRICT OFFICE · 12750 CITRUS PARK LANE · SUITE 115 · TAMPA, FLORIDA 33625	

Operation and Maintenance Expenditures	
		November 2017	
For Board Approval	

Attached please find the check register listing the Operation and Maintenance expenditures paid from November 1, 2017 through November 30, 2017. This does not include expenditures previously approved by the Board.	
The total items being presented:	$34,731.01	

Approval of Expenditures:	

 		
Chairperson		
 		Vice Chairperson		
 		Assistant Secretary		

Triple Creek Community Development District	
Paid Operation & Maintenance Expenditures	
November 1, 2017 Through November 30, 2017	

Vendor Name	
Check Number	
Invoice Number	
Invoice Description	
Invoice Amount	

Ballenger & Company, Inc.	
001647	
17502	
SWFWMD Report & Pump Maint 10/17	
$	215.00	
BOCC	001639	8992542002 10/17	11920 Streambed Dr 10/17	$	162.97	
Bryan Taylor	001654	1584750	Install of 2 Pet Waste Stations & 2 Custom Signs	$	690.00	
Department of Economic
Opportunity	001640	70935	Special District Fee FY 17/18	$	175.00	
Doug Belden, Tax Collector	001642	A0776905722 - 2017	Ad Valorem Taxes - 2017	$	219.80	
Florida Department of Revenue	001643	Sales Tax 10/17	Sales Tax Payable 10/17	$	1.31	
Frontier Florida LLC dba Frontier	001644	81367159000430145
11/17	813-671-5900 11/17	$	189.88	
Genesis Group	001648	58768	Engineering Services 10/17	$	794.70	
Hopping Green & Sams	001649	96591	General Legal Services 09/17	$	1,097.50	
Mortensen Engineering, Inc.	001650	413-2263	Water Use Permit Consulting Support Services	$	1,385.00	
NewAgeTutors LLC	001646	1030-16-5	Website Fees 10/17	$	80.00	
NVirotect Pest Control, Inc.	001641	136673	Pest Control Acct #9501 10/17	$	60.00	
Rizzetta & Company, Inc.	001636	INV0000028131	District Management Fees 11/17	$	3,925.00	
Rizzetta Amenity Services, Inc.	001637	INV00000000004152	Amenity Services 10/17	$	1,090.91	
Rizzetta Amenity Services, Inc.	001645	INV00000000004178	Amenity Services 11/17	$	1,913.60	
Rizzetta Amenity Services, Inc.	001651	INV00000000004203	Out of Pocket Expenses 10/17	$	112.47	
Sitex Land LLC	001652	3607	Monthly Landscape Maintenance 08/17	$	9,945.17	
Tampa Electric	001638	Electric Summary 10/17	Electric Summary 10/17	$	6,281.44	
Tampa Electric	001653	Electric Summary 11/17	Electric Summary 11/17	$	6,391.26	

Report Total				
$	34,731.01	

Ballenger & Company, Inc. 2335 64th Pl N
St. Petersburg, FL. 33702

Invoice

Date	Invoice#	
10/30/2017	17502	

Bill To

Triple Creek CDD 12750 Citrus Park Lane Suite 115
Tampa, FL 33625

	P.O.No.	Terms	Project	
		
Net 15		
Quantity	Description	Rate	Amount	
	October Irrigation Water Use reporting to SWFWMD

RECEIVED
NOV O 1 2017
Da;J ,-.:,v d Hrzzetta & Co.I Inc.
0/M approval 	C'P		Date 11110117
Date entered	NOV  0 9 2017

Fund Cf.JI GL'S3=?00 OC
Check #·---·--· .	-	215.00	215.00	
Thank you for your business.	Total	$215.00	

CUSTOMER NAME	ACCOUNT NUMBER	BILL DATE I DUE DATE I

Hillsborough
County Florida

TRIPLE CREEK COD

Service Address: 11920 STREAMBED DR

8992542002	10/30/2017	11/20/2017

METER NUMBER	PREVIOUS DATE	PREVIOUS READ	PRESENT DATE	PRESENT READ	CONSUMPTION IN GALLONS	READ
TYPE	METER DESCRIPTION	
60842286	09/26/2017	4429	10/25/2017	4535	10600	ACTUAL	WATER	

Service Address Charges
Customer Bill Charge	
$4.11	Summary of Account Charges
Previous Balance	
$139.54	
Purchase Water Pass-Thru	$31.06	Net Payments - Thank You	($139.54)	
Water Base Charge	$21.38	Total Account Charges	$162.97	
Water Consumption Charge	$7.42	
Sewer Base Charge	$51.83	jAMOUNTDUE	$162.971	
Sewer Usage Charge	$47.17	
Total Service Address Charges	$162.97	

RECC!'IED
NOV O B Z017
U8tc hc:, ·c1 1,zzetta & Co., Inc.	..------
011v1 appruvw-... C?	..Date.111§11.L,.
Date entered	NO\/  0 6 201l _	_
Fun(J. /JJI	GL 31.({b OC YQD\ 

,nee.. t+

Consumption History x 100 Gallons

15

100

10125 9126 6125 7126 6126 5/23 4124 3127 2124 1126 12127 11123 10126
2017	2016

Hillsborough County Florida

Make checks payable to: BOCC ACCOUNT NUMBER: 8992542002

ELECTRONIC PAYMENTS BY CHECK OR
Automated Payment Line: (813) 276 8526 Internet Payments: HCFLGov.net/WaterBill Additional  Information:  HCFLGov.net/Water

111., I1  1I, 11 111 .,1 11  111 11111  I1  1II11 111I11111 1111111•1  11111111 1I  h
TRIPLE CREEK COD
12750 CITRUS PARK LN STE 115
TAMPA FL 33625-3784

5,195

THANK YOU/

DUE DATE	11/20/2017	
AMOUNT DUE	$162.97	
AMOUNT PAID		

0089925420021	00000162974

POOP 911
817 W Virginia Ave
Tampa, FL 33603

!Triple Creek
!Property Address:
j12116 Night Jasmine Cove

i

!Riverview, FL 33579
i
!Invoice: 1584750
l
j
jNovember 16th,2017
frnstallation of two pet waste stations.
;

ffwo custom signs.

RECEIVED
NOV 1 7 2017
,	•  t·	,.,,.,.    ,ua ex Co., me.----
0/Maµp:;C'P,_,.     Date  11111111
Oate entered	-rro-v-±i-20tt·_	--·
runctCOJ. GL2+cPQ.. oc_ Lim

$590.00

$100.00

Total	$690.00

Florida Department of Economic Opportunity, Special District Accountability Program
FY 2017/2018 Special District Fee Invoice and Update Form
Required by Sections 189.064 and 189.018, Florida Statutes, and Chapter 73C-24, Florida Administrative Code	
Invoice No.: 70935			Date Invoiced: 10/02/2017	
AnnualFee:$17 00	Late Fee: $0.00	Received: $0.00	Total Due, Postmarked b 12/04/2017: $175.00	
STEP 1: Review the following informa!1on, make changes directly on the form, and sign and date:
1. Special District's Name, Registered Agent's Name, and Registered Office Address:

FLORIDA    DEPARTMENT ef
Triple Creek Community Development District	ECONOMIC        OPPORTUNITY
Mr. W1lltam R1zzetta
3434 Colwell Avenue, Suite 200
Tampa, Fl 33614

2. Telephone:	(813) 933-5571
3. Fax:	(813) 935-6212
Email:	brizzetta@rizzeUa.com
Status:	Independent
Governing   Body:	Elected	•  /4	,k	/cl,
Website    Address:	l'llal DD  {ilQ f;l,Q?S9 ptolliBB.'	-l-rf'  e Cree  C	,C "J1..t.
County(ies):	Hillsborough
Function(s):	Community Development	_	OC1 0 6 2.t\\7
Boundary  Map on File:	06/14/2007
Creation   Document  on  File:	06/14/2007	Date Rec'd Rizzetta & Co., Inc. 		_
Date Established:	05/11/2007	O/M approval_ ,  l	J16117
Creation  Method:	Local Ordinance	Date entered_
Local Governing  Authority:	Hillsborough County
'15. Creation Document(s):	County Ordinance 07-14	Fund	GL l 300 OC L{cto
Statutory    Authority:	Chapter 190, Florida Statutes	Check"
Authority to Issue Bonds:	Yes
Revenue Source(s):	Assessments
Most Recent Update:	10/06/2015	

-

le and complete as of this date.
Date _.i.!jf f/1.-2---
	Pay the Annual Fee: Pav the annual fee online by following the instructions at www.Floridajobs.org/SpecialDistrictFee or by check payable to the Department of Economic Opportunity.
Or, Certify Eligibility for the Zero fee: By initialing each of the following items, I, the above signed registered agent, do hereby certify that to the best of my knowledge and belief, ALL of the following statements contained herein and on any attachments hereto are true, correct, complete, and made in good faith as of this dale. I understand that any information I give may be verified.
This special district and its Certified Public Accountant determined the special district is not a component unit of a local
general-purpose government.
This special district is in compliance with the reporting requirements of the Department of Financial Services.

2015/2016 A11nual Financial Report (if created since then, allach an income statement verifying $3,000 or less in revenues). Department Use Only: Approved:	Denied:	Reason: 	_ STEP 3: Make a copy of this form for your records.
STEP 4: Mail this form and payment (if paying by check) to the Department of Economic Opportunity, Bureau of Budget Management, 107 E Madison Street, MSC 120, Tallahassee, FL 32399-4124. Direct any questions to (850) 717-8430.

Tllis special district reported $3,000 or less in annual revenues to the Department of Financial Services on its Fiscal Year

Doug Belden, Hillsborousti CoU1ty Tax Collector
For Customer Service, please call 813.635.5200

Pay this amount	$219.80	$222.09	$224.38	$226.67	$228.96	
If paid by	Nov 30 2017	Dec 31 2017	Jan 31 2018	Feb 28 2018	Mar31 2018	

I  Account No. AOTT6905722	

TRIPLE CREEK COD

2017 Notice of Ad Valara11Ta:w and Non-Ad Valala11.AS&essments

Skip the Trip - Pay onllne at www.hlllstax.org
E-Check -A FREE electronic payment from your checking account

Credit Card - 2.35% fee Is charged

II. .:::. -	jVISA

Property Location TRIPLE CREEK COD 11920 STREAMBED DR
RIVERVIEW 33579

3434 COLWELL AVE STE 200
TAMPA, FL33614-8390

Legal Description: TRIPLE CRE E'<1r,V LffE A TRACTS A 8 CD E F STU V W X

NOVO 3 :t.Ul7

Ad Valorem Taxes	Tax District U
Taxing Authority	Telephone	Millage	Assessed Value	Exemption	Taxable Value	Tax Amount
COUNTY OPERATING	813-272-5890	5.7309	100	0	100	0.00
ENVIRONMENTAL LAND	813-272-5890	0.0604	100	0	100	0.00
COUNTY M.S.T.U.	813-272-5890	4.3745	100	0	100	0.00
LIBRARY-SERVICE	813-273-3660	0.5583	100	0	100	0.00
PARK BONDS- UNINCORPORATED	813-272-5890	0.0259	100	0	100	0.00

SCHOOL- LOCAL	813-272-4064	2.2480	100	0	100	0.00

ri:f ECEIV

SCHOOL· STATE	813-272-4064	0	100	0.00
PORT AUTHORITY	813-905-5132	0	100	0.00
HILI.S CO TRANSIT AUTHORITY	813-623-5835	0.5000	100	0	100	0.00

 Fund CZ)/	GL53-i·ctJ oc Lf:xss--

Total Millage
Total Ad Valorem Taxes

18.7480
$0.00

CHILDRENS BOARD	01a.m.2a84	o.458t0V  O 8 201	0	100	0.00

WATER MANAGEMENT

Date Re ifizze14&7 a & eo31.,3  nc.  	 D/M approval	C?	Date 11110117 Date entered		NOV 1 0 2017

0	100	0.00

Taxing Authority	Telephone	Tax Amount	
TRIPLE CREEK COD	813-933-5571	0.00	
SOLID WASTE DISPOSAL	813-964-2739	97.53	
SOLID WASTE COLLECTION	813-964-2739	131.43	

Total Non-Ad Valorem A11essm11nt1
Combined Taxes & Aues1ment1

$228.96
$228.96

Tax District U

Escrow

TRIPLE CREEK PHASE 1VILLAGE A TRACTS AB C D E F ST U V W X

Assessed Value 100
Exemptions

If paid by Nov 30 2017	Dec 31 2017	Jan 31 2018	Feb 28 2018	Mar 31 2018

J12t126-317107 935

Make checks payable in US funds to:
Doug Belden, Tax Collector PO Box30012
Tampa FL 33630-3012
043096	Remember to write your account number on your check,

1 A0776905722 2017 5

TRIPLE CREEK COD
3434 COLWELLAVE STE 200
TAMPA, FL 33614-8390
111h1•1•1111•11•11111111I111'1111111111•11,I 11111I11•1I1111111 h

3. Taxable Amount	4· Tax Due

Cert111cate #. 39-8016521260-7 SALES AND USE TAX RETURN	HD/PM Date:	/	/	DR-15 R. 01/15

Floi:lda
Saies/Ser,ices

Gross Sales	2. Cv, m,nt Sales

_-:._.::_._::.J:::'8'..=..·.;:_:·.-t;--9-··-;---·-·-	'.:   S. I

s. Taxable Purchases
c, Commercial Rentals

..!1,:,:,,::  .,:·,:-:"'!, ;: L,,:,t; ""'"•..,:!   J,,):r.<:·:r_::_',:.:h;;:.:  t?_-_-  · 7-•·•··········--··-· ..•  --···-··--·-··-_..::.--i--·-· 	--·

o. Transient Remais

Transient Renlal Rate: ,0600
TRIPLE CREEK COMMUNITY
11920 STREAMBED DR
RIVERVIEW FL 33579

-- ·,· ··..

Surtax Rafe; .0100

.,, ., .,-·"	 	

----·.····-··· ---···· ----·--··--:-::T. ::-0::-···-··---·· ·--····.·
Reporting Period	s. Total Amount or ax ue
OCT 2017	6. Less La,•.tul Dedwctons
N::t Tax Due
Less Est Ta, Pd i DOR Cr Me•'f,o

.......... . . ··-··-··-···

l - I

.

IIII nII,,,111 1111 11111 11 1111 1111111 I 111I11II111 l I I I I 11II
FLORIDA DEPARTMENT OF REVENUE 5050 W TENNESSEE ST TALLAHASSEE FL 32399-0120

Due: NOV 01 2017

n

Late After: NOV 20 2017

9, Plus Est 1ax DUB Currc ,t f;lonth iO. Arnount 0:Je
11     Lass Co11•-  t·i;m Mww;;iru;;;,....
Plus Pena!ty
Plus Interest
l4. Amount Due w,th Return

E-file/E-pciy 0nly_

L   • '!>I

Check here if payment was made electronically.

0500 □ 20171031 0001003031 8 4000001652 1260 1

---	-	.. :-;;L .,,,.,, ---·

Under penalties of perjury,I   declare that I have read this return and the facts stated in it are   true.

S,gnatureof foxpayar	Datn

Tnlephone Number	Et_(!,_ j -'1?? 5§'7 (
Telephone Number

Discretionary Sales Surtax ( Lines 15(a) through i5(d))
15(a}. Exempt Amount of Items Over $5,000 (included In Column 3)	15(a).
15(b).   Other Taxable Amounts NOT Subject  to Surtax (included in Column 3) ...........................................................,.	15(b).
15(c}.  Amounts Subject to Surtax ata  Rate Different Than Your County Surtax Rate 0ncluded in Column 3)	15(c).
i    5(d}.   Total Amount  of Discretionary Sales Surtax Due   ncluded in Column 4)	i. 5(d),
Total Enterprise Zone Jobs Credits (included in Line 6)	16.
17,	Taxable Sales/Untaxed Purchases or Uses of Electricity (included in Line A) ...............................,,	17.

18.

Taxable Sales/Untaxed Purchases of Dyed Diesel Fuel (included in Line A)	18.
Taxable Sales from Amusement  Machines (included  in Line A)	9.
Rural and/or Urban High Crime Area Job Tax Credits	20.
Other Authorized Credits	21.

Date

 	-	

RECEIVED
NOVO 7 2017
Date Rcz.·u R1zzetta & Co., Inc.
D/M approva1_£Lm17P te21Jll1

Date entered	NOV	----

Fund

GL	oc 		_

Check#  	

,  ;

••••••
Frontier·
COMMUNICATIONS

TRIPLE CREEK COD

Your Monthly Invoice

Paga 1 of 4

.,	.	.,	,	NOV 1 0 2017
Cla t8 ii6v w h!ZZeita & Go., Inc. 	_
D/M approval	..C Nr' l	(f OatzLUL10111
Date entered	OV	2017
Funct CDLGLS:tcrDJ	
Check i!	--··--·-
Important Information

Fronthar n99otlatea with video content provlc!Qrs for great Qlltertalnment at the b&at possible price. Due to the continuous rising oost of programming, beginning with your next blll thfi rate for video strvfces will Increase by $6 per
month. Increase don not apply to customers with
promotion or price protection plan untll their term expires.

Account Summary New Chargea Due Date Billing Date
Account Number PIN
Previous Balance
Payments Received Thru 10/26/17
Thank you for your payment! Balance Forward
New Charges
Total Amount Due

11/28/17
11/04/17
813-671-5900-043014·5
2197
189.88
·189.88

,00
189.88
$189.88

SBCURlf

Fro ier

1.844.563.7079
buslnHs,frontler.com/,ec:ure

24/7 phone support from U.S.-bosed experts for
hardware. networking and Windows software Issues,

Internet-connected device.

I Support

Helps protect your computers and mobile devices against viruses and malwore.
&conn•ct
Cloud-based storage to save and share data from any

Protect your vital business data with Frontier Secure.

0 Protoc:t

To Pay Your Bill
Jll.Online: Frontier.com	1.800.801.6652

Pay by Mall

To Contact Us
Chat: Frontier.com OOnline: Frontier.com/helpcenter
"'1.800.921.8102	II Emall: ContactBuslness@ftr.com

:,,,

......
Frontie
COMMUNICATIONS

PAYMENT STUB
Total Amount Due
New Charge Due Date
Account Number

2 a • a

$189.88
11/28/17
813•671-6900•043014·15

Pleau do not ■end cormpondanc1 with your paymant Make check• payabl1 to Fronlftr.

P.O. Box 5157, Tampa, FL 33676

AV 02 013557 95205B 80 A0     6DGT
11111 ,1111,,11ill 111,11111111,,,111I•1,,1111ll I II•111 lil11II1111 I
TRIPLE CREEK COD 127!50 CITRUS PARK LANE SUITE 115
TAMPA, FL 33625-3784

Amount Enclosed	$
To 1:h;ngeyour billing addreu, call 1-800-921-8102

FRONTIER
PO BOX 740407
CINCINNA Tl OH 45274-0407
I,I•I•111,,1,1111'111ll1 ' 1111,111111,11 11 hl1111' 11•111 llil111111

844□□ b813b7159□□□ 43□14□□□□a□□a□□□□□o1a9aas

Date of BIii Account Number

Paga 2 of 4
11/04/17
813-671•5900-043014•5

For Billing and Service Oueatlons, Call 1-B00-921-8102, 7 am•7 pm Monday-Friday, 9:30 am-4 pm Saturday or vtsit www.Frontler.com.

IF YOU HAVE ANY QUESTIONS, BILLING CONCERNS, OR A RECURRING ISSUE, PLEASE CONTACT OUR
FLORIDA-BASED CUSTOMER CARE TEAM AT 1-8138-457-4110. OUR FLORIDA TEAM IS EAGER TO HELP YOU GET SPECIALIZED ATTENTION.
PAYING YOUR BILL
Pay online, by phone, by mail or at any Authorized Payment Location. Paying by check authorizes Frontier to make a one-time electronic funds transfer from your account, as early as the day your check is received. Visit Frontier.com to set up recurring electronic payments to streamline bill payment.
LATE PAYMENTS, RETURNED CHECK FEES and PAST DUE BALANCES
You are responsible for all legitimate, undisputed  charges on  your  bill.  If  you  pay your  bill  after the  due date, you  may  be charged a fee (including a Treatment Charge if your account has been delinquent for 3  consecutive  months  and  your  past  due balance is greater than $99), your service may  be  interrupted  and  you  may  have to  pay  a  reconnection  charge to  restore  service. A fee may be charged for a  check that  is  returned  by the  bank for  any  reason.  Continued  nonpayment  of  undisputed  charges (incl. 900 and long distance charges) may result in collection  action and  a  referral to  credit  reporting agencies, which  may affect your credit rating. When making an online payment, please allow time for the transfer of funds. If the funds are not received  by Frontier by the due date, a fee may be assessed.
IMPORTANTCONSUMERMESSAGES
You must pay all basic local service charges to avoid basic local service disconnection. Failure to pay other charges will not cause disconnection of your basic service but this may cause other services to be terminated. Frontier Bundles may include charges for both basic and other services.
Frontier periodically audits its bills to ensure accuracy which may result in a retroactive or future billing adjustment.
Frontier Internet users may be charged a fee to receive a paper copy of their bill. An electronic copy of your bill is available for no charge at frontier.com/gopaperless.
SERVICE TERMS
Visit Frontier.com/terms, Frontier.com/tariffs or call customer service for information on applicable tariffs, price lists and other important Terms, Conditions and Policies ("Tarms") related to your Frontier services• voice, internet and/or video• including limitations of liability, and early termination fees and the effective date of and billing for the termination of service(s). Frontier's Terms, include a binding arbitration provision to resolve customer disputes (Frontier.com/terms/arbitration).We encourage you to review the Terms as they contain important information about your rights and obligations, and ours. By using or paying for Frontier services, you are agreeing to these Terms and that disputes will be resolved by individual arbitration.
Hard of Hearing, Deaf, Bllnd, Vii.ion and /or Mobility Impaired customers may call 1-817-462-6606 to reach a consultant trained to support their communication needs,

COMMUNICATIONS

TRIPLE CREEK CDD
Date of BIii
Account Number

Paga 3 of 4
11/04/17
813•671•5900-043014•5

CURRENT BILLING SUMMARY
Local S81'vloe from 11/04/17 to 12/03/17
Qty Description	B13/e71•!QOO,O
!ilHiC ChllrgH
Frontier Solutions for Business• 2 Vear Term Access Recovery Chrg-Bus
Federal subscriber Lina Charge. Bus Federal Excise Tax
Federal USF Recovery Charge
FCA Long Distance. Federal USF surcharge FL State communications services Tax
FL State Gross Receipts Tax
county communications services Tax FL Telecommunications Relay Service Hillsborough County 911 surcharge
Total saaic Charo••
Non Batie Charges
FiOS Internet 50/50 2Yr • Business
5 IP Addresses
Other Charges-Detailed Below Partial Month Charges-Detailed Below Federal Excise Tax
FCA Long Distance• Federal USF surcharge FL State Communications services Tax
FL state Gross Receipts Tax county communications services Tax
Total Non Basic charges
Video
FiOS Local TV Priv Cabla card Rental
Partial Month Charges-Detailed Balow FCC Regulatory Recovery Fee
FL Video communications service Tax FL State Gross Receipts Tax
county Video Communications Services Tax county Sales Tax
FL State Sales Tax
Total Video
Toll/Other
Other Charges-Detailed Below
FCA Long Distance• Federal USF surcharge FL state Communications services Tax
FL state Gross Receipts Tax
County Communications services Tax
Total Toll/Other

TOTAL

Oharga
87.00
2.04
6,60
.28
1.60
1.88
4.88
2.49
4.57
.10
.40

111.72

124.99
20.00
-17.07
-80,00
,09
,37
,91
.47
·,  86
46,14

28,99
4,99
-10,00
,08
.94
.48
.88
,06
,30
26,71

3,99
.75
.23
, 12
,22
8,31

189.88

CUSTOMER TALK
If your bill reflects that you ct-Ne a Ba!anoe Forward, you must ma.ka a paymlllnl lmmsdla!Qly In ordsr to avoid collootlon actlvlth11s. You must pay a minimum of $96.19 by your dua data to avoid dlsconneotion of your local service. All other charges should be paid by your di.IQ data lo keep your account current.

Frontier negotiates with video content providers for great entertainment at the bast posslbl41 price, Dua to the continuous rising cost of programming, beginning with your next blll the ratia for video servlc..s will fncreasa by $6 p(ilr
month. lncr..asa does not apply to oustom,m1 with promotion or prlca protection plan until tholr
term expires.

Important Equipment Information.,.
To continue providing you with quality service and product Innovation, on or after 30 days from the data of your blli, the monthly rate tor High Deflnl!lon and Standard Definition Set Top Boxes (non-DVR), digital adaptors, and cable cards will Increase $1 par box, Including Set Top Boxes that are part of an equipment package. This rate Increase will not apply to Sat Top Boxes that are subJoot to an equipment promotional offGr. If you would like to revl9W your current services and equipment options, please contact customer servlca.

If you have a question or concern about closed captioning on any program, p!sasia call Frontler at 1-877•482•6606, You can also sand written correspondanc9 by fax to 1·304·344·0435, by amatl to Vldeo.Closad.Caption@ttr.com, or by mall to Frontier, 1500 MacCorkla Avenu&, Charleston, WV 25396, Attn: Anthony Kasey, Manager.

For up-to-data chann..l Information plsase visit: http://fronUer.com/channelupdatas

Local Franchise Authority • FIOS TV Your FCC Community ID Is: FL1304

-------------- ------------------------------------
** ACCOUNT ACTIVITY**
Qty D11cription	
Business High Speed Internet Fae	AUTOCH 11/04
Frontier Road Work Recovery surcharge

1.99

AUTOCH 11/04
Solutions Bundle Discount	AUTOCH 11/04
Federal Primary carrier Single Line Charge
AUTOCH 11/04

.95
·22.00
1.99

carrier cost Recovery surcharge
813/671 •5900
Partial Month Charge&
FiOS Video Discount 99 MO FiOS Internet Bus 99 MO HSI Discount 24 MO
S13/!571•6GOO

AUTOCH 11/04
subtotal.
PROMOTION 11/04 12/03 PROMOTION 11/04 12/03 PROMOTION 11/04 12/03
aubtota:t.

Subtotal

3,99
•13,01
-10,00
-30.00
·60,00
•Q0,00

•103.08

• • • 9 II t ••

I
COMMUNICATIONS
CIRCUIT ID DETAIL
88/KOXA/491718/	/VZFL

TRIPLE CREEK COD
Date of Bill
Account Number

Page 4 of 4
11/04/17
813•671-5900-043014-5

Dstall of Frontier Com of America Charges
Toll charged to 813/671-tiOOO
--------------------- -----------------------------------------
Ligand Call Typae:
DD • Day
----------------	·---------------------------
Caller Summary Report

Main Number
0 •customer summary

Calls
10
10

lll:l.nutes
27
27

Amount
.oo
.oo

------------------------------------------------------------
Caller Summary Report

Interstate Intrastate
***Customer summary

Calls
6
4
10

M:l.nutH
18
9
27

Amount
.00
.oo
.oo

ISE	E

TO	REALITY

Landsrnpe Architecture Urban Design Engineering
Planning
rro1

1000 N. Ashley Drive
Suite 900
Tampa, FL 33502

Tel  813.620.4500

I

Fax  813.221.4980
www.GenesisGroup.com

INVOICE	Invoice Date :
Invoice#: Invoice Due : Project:

Triple Creek Community Devel. Dist 3434 Colwell Avenue, Suite 200
Tampa, FL 33614

11/15/2017
58768
12/15/2017
061980009
Page 1 of 1

kgallant@rizzetta.com	TOTAL DUE THIS INVOICE:	$	794.70
ATTN:	Joe Roethke

For Professional Services Rendered through: 10/29/2017
Triple Creek - COD Engineer

Phase: P01 -	Meetings/ Misc. Engineering Svcs.

GIS Specialist Ill Principal/Officer-Prof. Eng Ill Senior Landscape Designer Ill
Water use permit renewal (partial), on site CDD meeting (10/17).

HOURS

0.50

3.50

0.50

RECEIVED

RATE PER HOUR
70.00

195.00

95.00
Sub-Total Labor.

AMOUNT

35.00

682.50

47.50
765.00

•;
j't,_)        ---    _,...,_,    ,_.,,  •

Date entered

Fund (,...A.JI

.,.-....,-,,

REIMBURSABLES	AMOUNT

Mileage, Lodging, Parking, Airfare

Approved by:

Kyle L. Thornton, P.E.

GENESIS

NOV 1 6 2017

Check# 	"
WE APPRECL4TE YOUR BUSINESS

Sub-Total Reimbursables: INVOICE TOTAL

29.70

29.70

$794.70

For billing Inquiries, contact:
Dennis Henchen Project Accountant
DHenchen@GenesisGroup.com

Remit via Check: Genesis
1000 N. Ashley Drive Suite 900
Tampa, FL 33602-3718

Remit via ACH Payment: Wells Fargo Bank Routing#: 063107513
Account II: 8116094205

For additional assistance, please contact Tim Leal, CFO at (813) 620-4500 x5158 or contact your Genesis Project Manager

Genesis
Project Detail Charges

BST

GLOBAL
Grouped by:   Project	Repart as of Date: 11/16/2017
Period End Dates:	Thru 10/29/2017 Transaction Dates: 10/1/2017 Thru 10/29/2017
	Class/	Actv/ Bill Document	Detail Transaction Period End Reg /	Hours/	E..x..p.e..n..s.e	...C..o..s..t	Effort		
EVC Code / Name	GLAcct	Task/ Co/ Org	Unit  Ind	Number	Type	Date	Date	OT	Quantity	Rate	Amount	Rate	Amount	

Project: 061980009 -Triple Creek - COD Engineer
Project : 061980009 • Triple Creek• CDD Engineer Phase : P89 - Reimbursable Expenses
Task : -	- Default

5030	MIieage, Lodging, Parking, Airfare
DEFAULT	5030
MIieage Tnple CreekCDD Mtg - 55 - KT

Clnt: 08198 • Triple Creek Community Devel. Dist
GGI   150000	052	B	6086	u	10/17/2017	10/29/2017

Resp Org : 150000	Starl Date: 12113/2018
55.00	0.0000	0.00	0.5400	29.70

""'·-  -  ,.,...--,-•"-"""""'-,..,,,.,,,,,,_"'  "_,_,  ,,  ,         , """"'·' ,,,,. -- .

Triple Creek • COD Engineer Total

•V-  ),,..,c,...,._ • "' '-	·-	'=" '"'_...,,	H_.,..,,,.,,

Account 5030 Total	55.00		o.oo	29.70	
Expense Total	55.00		0.00	29.70	
Task	Total	0.00	(Hrs)	0.00	29.70	
Phase P89 Total	0.00	(Hrs)	0.00	29.70	
Project 061980009 Total
- -,.,-	--··	0.00	(Hrs)	0.00	29.70	

0.00  (Hrs)	0.00	29.70

 	

Generated : 11/16/2017  9:46:2BAM	Page:	2

opping Green & Sams
Attorneys and Counselors

119 S. Monroe Street, Ste. 300
P.O. Box 6526 Tallahassee, FL 32314
850.222.7500
================================= STATEMENT=================================
October 24, 2017
Triple Creek Community Development District	Bill Number	96591	
c/o Rizzetta & Company	Billed through	09/30/2017	
3434 Colwell Avenue, Suite 200		
Tampa, FL 33614		

General Counsel/Monthly Meeting
TCRCDD	00001	JLK		

FOR PROFESSIONAL SERVICES RENDERED
09/05/17	LON	Confer with staff regarding approval of work authorization for amenity center design work.

0.20 hrs

09/06/17	LON

09/08/17	JLK

09/18/17	LON

09/19/17	JLK

09/19/17	LON

09/21/17	LON

09/25/17	JLK

09/27/17	AHJ

Review tentative agenda and provide comments to same.

Draft resolution authorizing RFP and documents related to same.

Review final agenda; confer with staff regarding attendance at board meeting; prepare for same.

Final board meeting preparations; confer with Whelan on board direction for RFP and other related matters.

Prepare for and attend board meeting; follow-up from same. Review correspondence regarding well installation proposal. Review agenda package and prepare for meeting.
Prepare work authorization regarding additional landscape maintenance services.

0.10 hrs

0.60 hrs

0.50 hrs

0.80 hrs

1.50 hrs

0.10 hrs

0.60 hrs

0.50 hrs

09/28/17	AHJ	Finalize work authorization; confer with Raethke regarding same.

Total fees for this matter

0.20 hrs

$1,097.50

MATTER SUMMARY

Jaskolski, Amy H. - Paralegal		0.70 hrs	125	/hr	$87.50	
Kilinski, Jennifer L.		2.00 hrs	235	/hr	$470.00	
Whelan, Lindsay C.		2.40 hrs	225	/hr	$540.00	
	TOTAL FEES				$1,097.50	

TOTAL CHARGES FOR THIS MATTER

$1,097.50

Triple Creek CDD - General Cou	Bill No. 95591	Page 2
=======================================================================================

Jaskolski, Arny H. - Paralegal		0.70 hrs	125 /hr	$87.50	
Kilinski, Jennifer L.		2.00 hrs	235 /hr	$470.00	
Whelan, Lindsay C.		2.40 hrs	225 /hr	$540.00	
	TOTAL FEES			$1,097.50	

TOTAL CHARGES FOR THIS BILL	$1,097.50

Please include the bill number on vour check.

or1 .1 tJ 1u11
,_C_?	1116111
NOV O 2 2017 ,- -
cD(	S/400	3lui-

 
MORTENSEN ENGINIUtRING INC

TO:	Triple Creek COD
c/o Rizzetta & Company

INVOICE

PLEASE REMIT TO:
6408 West Linebaugh Avenue, Suite 111
Tampa, Florida 33625
(813) 908-5555

 3434 Colwell Avenue, Suite 200	
 Tampa, Florida 33614	                              Attention:  Mr. Joe Raethke	

Date: Invoice No. Project No. Terms:

November 8, 2017
 	413-2263 

13-10-07782

WATER USE PERMIT (WUP) CONSULTING SUPPORT SERVICES
Triple Creek
Riverview, Hillsborough County, Florida WUP No. 20008931.006
(Services From 8/11/17 to 11/8/17)

Description	Qty	Unit Price	Sub-Total	

FIJi Q1 LABQRATQRY aND PRQF5§§ION&: §EB &§	

15 hours
32 hours
10 hours	

$ 130.00 /Hr.
$ 85.00 /Hr.
$ 50.00 /Hr. Lump Sum	

$1,950.00
$2,720.00
$500.00
$370.00	
Per Contract dated 1/2/13 Michael T. Gagne, P.E.
Patrick W. Vincent, Project Manager ACAD Drafting and Secretarial Support SWFWMD WUP Renewal Fee (at cost)				
TOTAL AMOUNT DUE INVOICED TO DATE BUDGET AMOUNT	$5,540.00	
	$9,655.00	
	$12,500.00	

Federal Tax ID No. 59-2897307
SW

NOV 14 2017
Date Rec'd Rizzetta & Co., Inc. 		_
D/M approval	C'P	Date 11/17/17
Date entered	NOV 1 7 2811
Fund  ()J\	GL S'"}c)(D oc cc:y;iCj
Check# 	

THANK YOU!

 nthia Boccio	

From:
Sent:
To:
Subject:
Attachments:

Kaitlyn Gallant
Thursday, November 16, 2017 3:50 PM Cynthia Boccio
FW: Triple Creek Mortensen
TC Mortensen #413-2263 $5,540.pdf

Hi,

Please pay 25% of this invoice out of O&M. The remaining balance will be paid out of Construction. Thanks,
Kaitlyn Gallant
Staff Accountant

Rizzelta & Company 12750 Citrus Park Lane Suite 115
Tampa Florida 33625
Phone- 813.933.5571

kgall

Rizzetta  & Company
Pfflf naJs in Community Management

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This etectron!c message transmission and any attachments contain Information from Rlzzel!a & Company, Inc. which may be confidential or prlvHeged. The Information Is
:&olely intended for the use of the Individual or entity named above. If you are not the Intended recipient, be aware that any disclosure, copying, distribution or use of the contents of this lnforma!lon Is prohibited. If you have received this electronlc transmission In error, please Immediately notify us by return email or telephone at (813) 933- 5571 and delete the original message. Under Florida law, certain written communk:a!lons with !he sender of this message may be subject to public records disclosure requirements. Please be aware of this possibility when Including personal Information in your communications. Unless specifically Indicated, !he contents of this electronic message and Its related attachments (Including forwarded messages) do not constitute a legal opinion on behalf of the sender and/or Rlzzel!a  & Company, Inc.  Recipients  of this menage, whether directly addressed or no!, should not rely upon or otherwise construe this massage as legal advice. The sender is not a licensed financial advisor or securities broker, any financial topics addressed herein are for lnformaUonal purposes and do not constitute Investing advice. Thank you.

From: Kyle L Thornton, P.E. [mailto:kthornton@genesisgroup.com]
Sent: Thursday, November 16, 2017 3:33 PM To: Kaitlyn Gallant
Subject: RE: Triple Creek Mortensen

This is for the WUP renewal
I believe we split it 50/50 last time?
I think this round of effort was more heavily weighted toward the new areas.

25% to O&M Budget
75% to General for Current Issuance

1

VGlobalTech

636 Fanning Drive, Winter Springs, Florida 32708, USA
Phone: 321-947-7777

Email:contact@VGlobalTech.com,  Website:  YfYIW• VG!obalTech.com

Invoice# 1030-16-5
Date: October 30, 2017
COD Website Monthly Maintenance: Triple Creek COD - Community Care

Valued Customer: Joe Raethke
District Manager RIZZETTA & COMPANY INCORPORATED
3434 Colwell Ave., Suite 200, Tampa, FL 33614
PH: (813) 933-5571
Fax: (813) 935-3415
Email: Jroelhke@rlzzetta.com
www.rlzzetta.com

CDD content updates
0	Meeting Minutes
0	Agendas
0	Maps
0	BOD Info
0	Other documents as supplied 24 hours tum-around time
Site backend software updates
0	WP versions

RECEIVED

Care

80.00	80.00

Plugins

Date Aec'a R1zzena &

OCT 3 0 2017

(.;o., lnc. 	

--'-

Security Patches Site Backup and Archival Once a month

D/M approval	C'P	Date 1111 o 11
Date entered	NOV O 9 2017
Fund CO I GL53cn ocSlo3
Check # 	-J..

PEST CONTROL SERVICES

16210 North Florida Avenue Lutz, FL 33549

Office: 813.968.7031
Toll Free: 888.908.8388
www.Nvirotect.com

hHc cl	,,_ ,	ni9CT 2 4 ZD17	INVOICE

;! :;::	J rbt:Pfi10\'Hl_ C_1! 		0ate 1116117  Account Number:
Riverview  FL 33579fmtHed	OCT 2 7 2017	Invoice   Number:

9501
136673

,	0.	1u,,o_ @\_-	-si c?-·-	\l		Previous Balance:

Date: }0 I D   (	d	e	Commercial General Pests

$60.00

----- - ' ' ----·----- ------- '
Call for a FREE Lawn Care Quote!
Next service FREE for each referral!*

SalesTax:
Service Amount:

$0.00
$60.00

Save 10% with yearly prepayment!*
*Exclusions apply. Contact office for details.

Check/Cash: 	_ Technician(s):\\€{

Inspection Area
mercial
_Residential side
Inside

Bank Medical
fessional Retail Industrial

Frequency
Twice Per Month thly
_ Every Other Month
_ Quarterly Annual Additional

Type of Service
_ Bayng System
/4neral Household Rodent Control Termite Control Termite Renewal
_ Tube System

General Interior Pests/ Termite
Acrobat Ants	Ghost Ants

Treatment
Advion Ant Bait Station .1%

Maxforce Quantum ,03%

_ Argentine Ants Bees
_ Carpenter Ants
_ Crazy Ants Drain Flies
_ Drywood Termites Fire Ants
Fleas

_ Paper Wasps Pharaoh Ants ventative Roaches Silverfish
_ Spiders
Sub Termites Ticks

Advion Ant Gel Bait .05% Advion Roach Bait Stn .5% Advion Roach Gel Bait .6%
-· Alpine Aerosol
_ Avert Dry Flow Bait .054%. CM  Insect  Monitors Dekko S.F. Paks
_ Gentrol Liquid

Niban FG 5% rimeter Sweep us.06%
Talstar Xtra ,25%
_ Transport GHP 11%
_ Transport Mikron .11% Vector Bio · S
_ Wasp Freeze .249%

German Roaches	 		_/4spection	 	

Rodent Control
Exclusions	 	
Mice Rats

Treatment
Contrac Blox
_ Expansion Foam Final Blox

Glue Boards
Rodent Bait Stations
_ Snap Traps

PAYMENT DUE UPON RECEIPT.	We accept Visa, Mastercard and Discover.
Ask us about automatic payments and paperless billing/
Instructions:-------------------------------

Rizzetta & Company, Inc.
3434 Colwell Avenue
Suite 200
Tampa FL	33614

Bill To:

Invoice

Date	Invoice#	
11/1/2017	INV0000028131	

TRIPLE CREEK CDD
3434 Colwell Avenue, Suite 200
Tampa FL	33614

Services for the month of	Terms	Client Number
November	Upon Receipt	00535
District Management Services 510 1 Administrative Services 3fcx::)	Q
1.00
1.00	
$1,533.33
$375.00	Alllollnt
$1,533.33
$375.00	
Accounting Services 3,;;io l	1.00	$1,166.67	$1,166.67	
Financial & Revenue Collections 311 I	1.00	$300.00	$300.00	
Field Services '.::>31CC)-4 '2)4,	1.00	$550.00	$550.00	

!	

'			
C JJ	101211201
OCT.26  2017
COJ	lcob	LA-qCJ.2

$3,925.00

$3,925.00

Rizzetta Amenity Services, Inc
3434 Colwell Avenue
Suite 200
Tampa FL	33614

Bill To:

Invoice

Date	Invoice#	
10/20/2017	INV00000000004152	

Triple Creek COD 3434 Colwell Ave.
Suite 200
Tampa FL	33614

Services for the month of	Client Number
00035
···. Amount.-'
1.00	$1,090.91

,- !

$1,090.91

$1,090.91

Rizzetta Amenity Services, Inc
3434 Colwell Avenue
Suite 200
Tampa FL	33614

Bill To:

Invoice

Date	Invoice#	
11/3/2017	INV00000000004178	

Triple Creek COD 3434 Colwell Ave.
Suite 200
Tampa FL	33614

Descrl tlon

Services for the month of		Terms	Client Number November	Due on receipt		00035
Amount

Amenity Management Services

1.00

$1,913.60

f'.1......... •"•     ED

Date RE:2.'d Rizzena & Co. Inc.

0	2017
_

D/M approval	C 'f	Date 1111Of17

NOV O 9 2 tl	_

Check# 	_

Subtotal	$1,913.60

Total	$1,913.60

Rizzetta Amenity Services, Inc
3434 Colwell Avenue
Suite 200
Tampa FL	33614

Bill To:

Invoice

Date	Invoice#	
10/31/2017	INV00000000004203	

Triple Creek COO 3434 Colwell Ave.
Suite 200
Tampa FL	33614

Descriot.lon ;" Auto Mileage & Travel Cell Phone

I	Services for the month of	I	Tenns	Client Number
I	October	I	Due on receipt	00035

87.47	$1.00	$87.47
25.00	$1.00	$25.00

RECEIV:D
NOV 1 4 2 17
Date He;, u (,,;::::.,:,na °' Lu , inc _,,_-.,,.,,.,_- .,,-,--,- ---·

Subtotal	$112.47

Total	$112.47

SITEX

Sitex Land LLC
7643 Gate Parkway #104-127
Jacksonville, FL 32256

Invoice

Bill To

941-468-6267	II.... 

o_ffi_ce_@_s_it_ex_1a_n_ds_ca_p_e_.co_m	

Date	Invoice#	
8/1/2017	3607	

Triple Creek CDD
3434 Colwell Ave., Ste 200
Tampa, FL 33614

	P.O. No.	Terms	Project	
		
Due on receipt		
Quantity	Description	Rate	Amount	
	Monthly Common Area Landscape Maintenance

RECEIVED
·"	·	. ,::.:ea. & c_,0	Inc.NOV 1 7 2017
DIM appro,·,ai'--=-C-.:'I)..._'-Date  11/17/17
Date entered	NOV 1 7 2017
Funda)j_GL53Ckl) 0v,..1 11 ,.y	/
Cf ,eek	_tU,.   17(.,t·-:t-

 	

	9,945.17	9,945.17	
	Total	$9,945.17	

Triple Creek CDD
TECO Meter Reading 09/13/17 - 10/11/17 Due 11/07117

 	Account		Billing Date	Service Address	Code	Amount 	
211005281400	10/17/2017	Triple Creek Tract D	001-53100-4307	$	720.61	
211005281640	10/17/2017	Triple Creek Tract A	001-53100-4307	$ 1,315.90	
211005281160	10/17/2017	Balm Riverview/Trpl Crk PHI	001-53100-4307	$	763.24	
211005282317	10/17/2017	Triple Creek BL PH2	001-53100-4707	$	678.43	
211005282515	10/17/2017	Triple Creek PH 2	001-53100-4707	$	971.26	
211005282705	10/17/2017	Triple Creek PH C	001-53100-4707	$	720.61	
211005280915	10/17/2017	12198 Triple Creek Bl Pmp	001-53100-4301	$	227.60	
211005280683	10/17/2017	12141 Triple Creek Bl Pmp	001-53100-4301	$	28.44	
211005281889	10/17/2017	12113 Triple Creek BL	001-53100-4301	$	62.40	
221002207761	10/17/2017	13315 Dorado Shores Ave	001-53100-4301	$	667.29	
211005282127	10/18/2017	11920 Streambed Dr CLBHS	001-53100-4304	$	125.66	
			TOTAL	$ 6,281.44	

General Service	
Summary
1-53100-4307	

$ 5,170.05	
			1-53100-4301	$	985.73	
			1-53100-4304	$	125.66	
			TOTAL	$	6,281.44	

Date Rec'd Rizzetta & Co.j Inc. 		_
0/M approval	 C p	.	Date 10/27/2017
Date entered 	OCT n 2017		_

Fund CXJ I	GL S _< 	

OC L-t.Pr'f:?--lUJ-5.2

Check# 	_

...
.0..
i
j

i

J,

OCT 2 0 7017

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log Into tecoaccountcom or visit tampaelectric.com and select Pay Your BIii.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BILL	Account: 211005281400

TAMPA EL.ECTRIC

ANEMERA COMPANY

mail	phone online	pay agent
See reverse side for more information

684716177258

00004655 01 AB 0 40 33625 FTECO110171723185510 00000 05 01000000 011 Qt 33:343 002
·111··11·1111111·1·1hll11111l1l h·ll11111·•1·r11111·1·1111·h1•
TRIPLE CREEK CDD
12750 CITRUS PARK LN, STE 115
TAMPA, FL 33625-3784

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA. FL 33631-3318

TAMPA EL.ECTRIC		ACCOUNT STATEMENT	
ANEMERA COMPANY		tampaelectric.com  I	f W <p 8• I in	

TRIPLE CREEK CDD TRIPLE CREEK TRACT D		Statement Date: 10/17/2017 Account: 211005281400	
RIVERVIEW, FL 33579-0000			

Your Account Summary			
Previous Amount Due	$720,61		
Payment(sj Received Since Last Statement	-$720.61		
Current Month's Charges Due By 11/07/2017	$720.61		
Total Amount Due	$720.61		

6847161772582110052814000000000720616	Page 1 of4

TAMPA EI..ECTRIC
ANEMERA C□MPANY

Contact Information
Residential Customer Care
B1 J- JZH)clOCl (f-lii1'.i'.)0 ,0 U[l '1 Co:Yl'Y)
BG3-299 0800 (Poii, Courityi
m38 ;!23-0800 (Ai: other counties)

Commercial Customer Care

Hearing Impaired/TTY
/ l l
Power Outages Tall-Free

Energy-Saving Programs
e 1.-1 .;)1[:, :1noq

tampaelectric.com

Mail Payments to
TE( ()

All Other Correspondence
Tampa Eieclric
F.(J_ Box 11 ·1
Tc:,n-1pa.  r1_   3'.:ifi( 11  o ! 1,

Understanding Your Electric Charges

Average kWh per day The :JVE: m1,
per d;·iy
Basic Service Charge    i\  f:xed n1or  ii',y n 1H,t,;,:	ccvE1 !.',,., ::0:::,1 d

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Energy  Charge     Thi: t	(nxcno! lur-; "i (:f 1) rcd 1 c 11<] !r'1n '-<!H(,:·:c!1y
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b(: t,d5u:;;pd  ,: t-co   rd::· 10  1y.
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Fuel  Charge  Co:-f!  nf  ft.t i u  Hd  it;   ;:Fodcc(  elr-:ct11cdv  you pu11..);( ;1 d. Fcf•i cost::; (:l(t p,·1:::. : t=.:d t7:i"ouu;·: frcrt f\JC: sLpp1H;;:s c1 utJ;  cus\urno1s 1.v1 t h nc i~11arl·:t;p	rvof:t :c T:·Jm;).c:.1  E!fctr1c
Kilowatt-Hours (kWh) T':c· tk:;1c r':F.JH:re,,'"r:! cf r,'ec.:r c ,:,;n;;,!JY
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Your payment options are:
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Page 2 of 4

TAMPA ELECTAIC
ANEMERA COMPANY

ACCOUNT STATEMENT
tampaelectric.com  I f W f) 8• I in

Account:	211005281400
Statement Date:	10/17/2017
Current month's charges due  11/07/2017

Details of Charges - Service from 09/13/2017 to 10/11/2017
Service for: TRIPLE CREEK TRACT D, RIVERVIEW, FL 33579-0000	Rate Schedule; Lighting Service Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	i012  kWh  @$0.03224/kWh	$32.63

Fixture & Maintenance Charge Lighting Pole/ Wire
Lighting Fuel Charge Florida Gross Receipt Tax
Lighting Charges

23 Fixtures
23 Poles
1012 kWh @$0.02916/kWh

S3i6.02
$340.86
529.51
51,59

$720.61

Total Current Month's Charges	$720.61

Page 3 of 4

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W:al\o offer a Comprehensive Energy Audit 11 ,i n;inirnunHn,t of$7S fer
ror11mPrcia! or indwtridi f <ilitif''> As p.irt cfthi, c1ud1t, our ,IPdiy,1 w,li

a complete walk tluougl1 oi y,.iur fa,iiity. !n addith,n. we wi!I ,1,n mHer .i•.J monitor' up to two p:eces d equipment hr c1p1jr,)x'.t'H'.<2iy u11,: •Mnt!l. lire willevaluate proper sizing (Jf •:Q!lipm,nr ,111.J npri a!1JJ<l t;•,w1. 1dc. tify prr,,1:,s
inefficiencies and more. Once rm1Jitonng ,,,,11r ,1i:l't,'  v:r wii'. 11·1.1,;Pmer,c! ,1r:1cP1,
you can take to maximize your energy effir:t>ncy.
More energy-saving programs for your business
Results from your Energy Audit may show that your bu,lness wuld t·c!wtlt 1rom
Tampa Electric'sotherenergy-savlng programs. Our energy analys; Nil! i11;,nt:f;

areas where your business could be mor,' en('LJY ?f11w:cnt nJ 1PJ,rr1::i'ild tr"
following progrMns that can help:
Commercial Cooling Rebate program   lr1rn .i rebat>: md he1 p re-Jwrv :111
energy costs when you add or replace cooling equipment A Yl)Ur
Commercial Lighting Rebate program  Earn a rebate when yr,,, r,'pi,1c
1'x11,!ing incdndesrent  lamps ,'.1th high-efficiencycompact  fiuorescent lamv,
!!I hylH Prnilling diode lamps (LEDs) within conditioned ornan conditioned 1,,ce.
Conservation Value program- Offers rebates to commercial and industrial uJSH ners that implement conservation measures th<lt primarily reduce power rnn,umrtion rluring peak-demand periods.
Contact us today and schedule the type of audit that can help your
company boost ots bottom line.

TECO.
TAMPA 1!:LECTFl!IC
AN l!::MltAA COMPANY

The power tosave you money.SM
TampaElectric.com/BlzSave I 813-275-3909	i

Page4 of 4

TAMPA ELE:CTRIC
ANEMERA  C□MP ANY

TRIPLE CREEK COD TRIPLE CREEK TRACT A RIVERVIEW, FL 33579-0000

Your Account Summary		
Previous Amount Due	$1,315.90	
Payment(s) Received Since Last Statement	-$1,315,90	
Current Month's Charges Due By 11/07/2017	$1315.90	
Total Amount Due	$1,315.90	

RECEIVED
. _	.,,. OCT 2 3 11111
f'Si ( \J., ttiu. -

ACCOUNT STATEMENT
tampaelectric.com   I	f W fJ8• I in

Statement Date: 10/17/2017 Account: 211005281640

Amount not paid by  -d;,IQ may be assessed,§J_ati,,p  n·a•a•add·itio-nal deposit.

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

'j1":',•.-- •- C _,.,_..,.,-----

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BILL	Account: 211005281640

TAMPA ELECTRIC ANEMERA C□MP ANY

mail	phone online	pay agent
See reverse side for more information

684716177259

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772592110052816400000001315902	Page 1 of 4

TAMPA ELECTRIC AN EMERA COMPANY

Contact Information
Residential Customer Care
813-223 0800 (H1!isboro:1g:1 Counly)
863-299-0800 (Polk County)
BflB-2230800 (All olher cou'll!es)

Commercial Customer Care
BbG WQ6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
:317 '.>fl81010
Energy-Saving Programs
H1 s ?T -3909

tampaelectric.com

Mail Payments to
TECO
P O. Box 3 1318
T;-:irnpa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. E3ox 111
Tampa. FL 33601-0111

Understanding Your Electric Charges

Average kWh per day Tho a;,1r:raue nn1nun; •Jf e!ec:,-1c:;\1 purchased
c,,": day.
Basic Service Charge    A  fixed mor:U1iy  l-:! f':\ 1_  u n 1  lo   c  o  v 1:1 i    tf1t  co:;t  of
xcvirJ,no ,f!i'/iCt1 10 your ioc Ji:nn
Bright ChoicessM The r1t.1r:1be•· of liot;t f1xiures 1Jnd/()l )CHHt leased
: )rnpr: Ek"jct11c. nnd fY socir1 ed ff:=)( :\ FFKi ch :n(-•: .
Budget Billing Op!,onai ,;,c1:, :a:•''"" 'r,e hgh,, ,r,ci ·cv:'' ,,u: cJ
1 ?:1: Ctf:C  blils. This "l\)ve:!/'!f( b: 1  !,nq  p!i} - 1J·.'t·;  ,-,cv,_::-1  vnur l -.;si  -12
,,,-( ri?·:y  11'!1 09     pedods S(: yuu '.' r-:r. pdy dboui_ ;\-!f_:	/ T•Gui :t ft.11
\'i._,L· :.;t::::·.1:ce ( ,c.ich ntonth.
Energy Charge   The, cc:;r	e'u.t,,c.'y
Vl-u  ptJrct, ;[,ed1 1nc!utiino C(::: \f;rv;:1::cr:	d cc·:1x-1c11y
((.'.;(;()'/F!r'/  ch;-)rQHS.
Estimated   if T8rripa Ei1:1ct:·1c wast.!: -1!.JkJ,	c; :\; y1 '\;. :·· p,f:,·

'·EST!\/ir\Tf:D 11   1N1H Hppe;: (   Yuur  t;!t;cti c  Lise !'.t··
:kJS( d on ;,'HC'\'iUUS USCJ{Jf;. "".°hf) rn0:t r
•ronth. ;:;nd dr1y d\rferenLh Jf!l'·.ver n H·:n
uo ?Jdju ;'.( d /JCCOrdiriOfy.

Florida Gross Receipts Tax   .'\ !ax	,,;p, :+.d

cr1 u\1idy cer11pt]rHe -\ v,;h:cr coUHc( the  ax   fr<F"7	r ct·;t( :·;,e:·f.;. un;f t:;s

Florida State Tax    .A. p :::  1!E;iJ•'  L,:-: ;: ,pu;ed	H·:'
('r qa J 'S ;n !he hus.ne ;s of seihnq CJi rent:;10

(::,.:;t-: : iY, arid rerrnt tc !lH::' '1ln:r .
iJLi/:c  ;;:o;Je11y  fer  ihe pt!"pose c:f LYO'.tid1no  t;!(::rJ:1c	Le l. :;..:.c
! •::xc;;  J·:c  f••:e :s cc;liectr:d l>',- :,yr:pd   iucl11c t1 1d	p;: J ·,_,

Fuel Charge Cos! ofi1.,e! used u p1ccJuce eleci;-1c::}" y()u purc!·1ased. Fuei costs Dre pr s.sed ; :;·cuol f:on1 fu,al sur;pliei ·) '.c our custorn( rs ;,tviP1 no rnnrkup (Y pref:! ic :arnpa E!ec,ir:t.:

Late Payment Charge ""or p;:;,,! cit.1•, ;w,cur,ts mur e 1:,,,r, SI O. H1c;
;'.Jte pr1yi:-1en1 ch Jf[Je :s the CFE!a!f:r of S:i or ·1 .5(1/ ; o;- \ti pa :;t du: ..;
::H·'.10un'.. Fu:· pas'. dt;e amounts cf s·1O	iess, the lt3tt pay1ner1: charqe is i _5 ., ) o'. n· c: p:-Jsl due ;:::r-:-1ounL
Municipal Public Service Tax In acld!1,,w •o th:: Fra,·ci,.se ;:,!,·•
'17:Jny n1un c1pc-J!it1c :: !e'lY a tnx en :!1e ei •clr1c1!y you u;--;e. !l 1 ·.,
cc!it c!ed by TCHr1pa E:lectnc cJncl L1r1id tu Lf:e rr ur:iciDa!d ·
Past Du8 Pn::v.{)t.JS c ;arqes '.h;-)1 ore Das! due a,·e :;c,f);ect ic a ·a:e
pDyn1ent ct-1c:i1ge fef c.:nd may ,-estJlt ;i 1 dif'.!co11nect1cri,
Rate Schedula    ThP nrnc,.!nt   r";Jlf-/J yo•J  pay  d e pt-'1  nrJ;;	ycu!
cu(,!On!e"' C<Jtf:'.::DCJ:•r The ccsi c!  prcr11d tr io ser-.;1ce vn! +0,        \J.,rti"  \l·t.,
l:u :itur:·icr ui ou;J
Renewable Energysa.t Tt!t F•rcunt (1f elAC!ric1 y pu cha:' ed f·-<Ft:
'C:f!t-;\v;:;t):n .1nurce .
Share    /:-, p:oq·,: m C1. ) -•-;1) 0  :-1       or ed by  Tan1 Ja  f;ecl11c ,:t--d \Ix
Sr=ti'Jf:'.ion ;lrr ·:y v.iht: 1 e cu tor:·t r'S C.:Ji! r-1e)p pr.iy the E::!lP1qy )•!i:- (-J
custcn1( •::; :n need. ,t... eine-,;rni:- C(v1tribuiion cc::r b8 n1{Jde,	yc:tF
111(-ir1!:-,!y r l cted c;or,ti;rni1()n \.\_1·! r2ppn.:::ir on your b!lL You,
cur:!,-.lHJlic1 -: !  t;;x dr:cl c!1bie ;:;pd s rp;:.:.\ched by Tt:Jmiy:; Eh.c \ .-;c
Total Amount Due This  nionlh's  charoes  v./i//  be  pasi dut:1 ar:0 1 if·.e dt te s ·1crar1. THIS DATE DOES :"JOT EXTE JD Hf=: J.r\-;-F 0\ P•.hY PRE\IIC)L;S BAL/,J,JCE. !l 1: :n,po:t8;-.; J-al you ;)t y ;--,.Jc; 1;1:
i'>fJnre thi'.; d;::df: ;P rnde( to a\1rnd ;n!e(1uu1:cn cf sr::;v:ce
Zap Cap Systems· Surgf pi:Jlcc!;o,, fo: your r1crr1e 11 H :;1·: Lr,s
so!d :-;epar{:..:ic:!y H :t a J10f1 er-:H,\ Y ()'it.Hue::.

Your payment options are:
,.  Schedule  f1 ee one-tirne  or  reC\Jr 1no  payn e11ls  <Ji  tampaelectric.com tci:;!r:u a	er ;n,,.,;:,1ut::, acer uni
$l Mail you1· pay:ner·1( :n the Bnciosed enveiopt:L PieasG a,:cv: stJiic1t n: lin1e fc1 delivery.

,. P;:J)' ir1 pers1Y"' t"";i ,-J !ocr:'d auincr,ted pc}}!!':lCn! , oer.t. t=c:: ; ils!:r o cf ncthon.:::ed payrt1f::nt ;::qHn!;:; ·.11 ii tampaelectric.com or cc::i< CL :\(VIW;i
,    0  c1v LJy,  €0 ,f ! o.  cle!,,l <'.a,<l U!',;,,,J Clur;.i-.  D,,y -,; tampaelectric.com ("  c,/: 866-689-6469
:A. Cl f1':H0;er:c.(  fee  v-1ili  bt   chrJi(JGd  tt·1 J1 Cu i  l;ar'.k accoun:	crf:rJii. cc:111.JJ

Please note: !f you chrH·1; t-: tn p l'./ yCJ1., 1 t)::; nt a iLH'.t tic:·, r:cl_ !'.:;tecJ cY., cur '1/ft)Slif: c;: nu:;vidt;cJ i y1 T -::rnpa Ciel:t1it . yuti are pa'/nq
v: K:, :;=;	nulhor:.ted tr; nc1 /J:  21  pay:r1:::r 1 nu(·J:t ;:!  T;Jr":tk:  E:r1:: 111 c:  YnL bcn· ihr :.sk ;( :at PHS 1.1r1t Lthn:1: cd  Dt'..Fiy 1/.'li!   :ri 1Dy ·txJ p,- 1· :er:: 11

Ta:11p,; ;::1f:Ci i.C n; ,d de	we  :1n:e1y  i.;-;s:::c'.1. Ta:: ;K.i !="i;:r:  r;t'   :s r·t;! :ct·;p(,r,f;d)\t'.:: fc; rx::1yr;·H:: nls rn;JdF· lr!  unrJ _ 1hnn.::ed lJ[lr;r-,is,  :r1cH1tLn,J

Page 2 of 4

TAMPA ELECTRIC:
ANEMERA  C:□M P A N Y

Account:	211005281640	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/13/2017 to 10/11/2017

ACCOUNT STATEMENT
tampaelectric.com  I f -  'Pg. a in

Seivice for: TRIPLE CREEK TRACT A, RIVERVIEW, FL 33579-0000	Rate Schedule; Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1848  kWh @ S0.03224/kWh	S59.58

Fixture & Maintenance Charge Lighting Pole/ Wire
Lighting Fuel Charge Florida Gross Receipt Tax
Lighting Charges

42 Fixtures
42 Poles
1848 kWh @ S0.02916/kWh

$577.08
S62244
$53.89
S291

$1,315.90

Total Current Month's Charges	$1,315.90

Page 3 of 4

An audit you can look for	ard to!

Tampa Electric's FREE Commercial Energy Audit.
can save your company energy and money. Our nationally certified commercial energy ' analysts are ready to walk shoulder-to• shoulder with you as we evaluate your electric usage and provide you with
no-cost or low-cost suggestions tliat
can improve '.,l)Ur energy efficiency.
We aho offer a Comprehensive Energy Audit at ,1 rninirnurn CP\t or S7S f.Jr
(•i!!lll1Ph id! ,H indu't;i1! fc1ti!,lih. As p.irt :1f th!', aildit, our ,Hldlv,t -:,iii

,

a complete ;•1a!k-ti1muqh ol your ld:ility. In addition, we w1!1,i;t, 1:1rte1 .1nli moniior* up to two c,t equrpn,ent tiJr app,ot\rnateiy onr: ,11,Jr ,ti, l:,e will evaluate proper sizing ot rqwr,rncm and operaiinq h011rs, iriecury p•,-;, ,0     ;
Inefficiencies and more. Once mon,tor·ng is cornpirtc, we 't1il, rc,nrn;;,:-1\i d, n1n,• you can take to maximize your energy etfaiency.
More energy-saving programs for your business
Results from your Energy Audit may show that your blEiness coulrj t,em h1  h,;,,
Tampa Electric's other energy-saving programs. Our  energy analyst  11di v:w:iy

"A,aii,;;blrmtq<if;mtntvrporids s; 480volts.

areas where your business could be mor0, <"r1erqy 2th(!frt :in,i rcu:mrP<:'ild the following programs that can help:
Commercial Cooling Rebate program - [a:11 a rebdit:.ind l,eip redule ;cur
energy costs when you add or replace cooling equipment at your rar:i,ny
Commercial Lighting Rebate program - Earn a rebate wt1en y;1;, rrp!,K rx1stin9 infandescent lamps with high-efficiencycompact 0uorescent lanw, ( ;1,; e,,r1 1ti1 flnitting diode lamps (LEDs) within conditioned or non-conditioned space.
Conservation Value program - Offers rebates to commercial and industrial
,   , u trJ,11 e>,   that implement conservation measures thJt primarily reduce power
cr,ns.,mption during peak-demand periods.
Contact us today and schedule the type of audit that can help your
rnmpany boost ots bottom line.

TECO.
TAMPA  EL.ECT IC
AN£MERA  CC:ll'4F'ANV

..

The power tosave you mcney.SM TampaEledric.com/BizSave I 813·275-3909
i

Page 4 of 4

TAMPA ELECTRIC:
ANEMERA Ci;;JMPANY

ACCOUNT STATEMENT
tampaelectric.com   I	f ti rp8·I in

El-.

TRIPLE CREEK COD
BALM RIVERVIEW TRPL CRK PH1 RIVERVIEW, FL 33579-0000

Your Account Summary
Previous Amount Due
Payment(s} Received Since Last Statement
Current Month's Charges Due By 11/07/2017

OCT 231017

Total Amount Due	RECEIVED

$763.24
-$763.24
$763.24
$763.24

Statement Date: 10/17/2017 Account: 211005281160

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log Into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of thrs bill with your payment. Make checks payable to TECO.

TAMPA ELECTRIC: AN EMERA COMPANY

WAYS TO PAY YOUR BILL

mail	phone  online	pay agent
See reverse side for more mformat1on

Account:211005281160

684716177257

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772572110052811600000000763246	Page 1 of4

TEC

TAMPA ELECTRIC

ANEMERA COMPANY

Contact Information
Residential Customer Care
813-22'.HlB00 (H!:;sboro,.1oh Cot1nly1 863 299-0800 (Polk CocJnly)
888-:Zn 0800 (All olr1e: counties)

Commercial Customer Care

Hearing lmpairedffTY
111
Power Outages Toll-Free
B1i '.)88·1010
Energy-Saving Programs
e1::i ?iri-3909

tampaelectric.com

Mail Payments to
TfCCJ
P.O. Bn:, 31318 Tanlpa, FL 33631-3318
All Other Correspondence
Tampa Electric P 0. Box 111
Ta,n;xJ.Fl 3360H)ll1

Understanding Your Electric Charges

Average kWh per day    7hF: ave.-ags, ,0 1:·uur  ., ,1' ,;ic,c:,,c,,y purchnsed
pt;!- dcJy.
Basic Service Charge A f,xed n1or1thiy an ount o cov( r '.r'1f'.:: cost of
p:ov1d:r19 SEnviCF:! to your !ocal10:i.
Bright Choicesg,,. The ::urnbt r of ilfJh'. f1;.a;'.Ur't';s ;:0:--:dl(y po:r s ie,Jsed
t:('[li    rirnpa Electric, ,:incJ  "1sscc:::J'.t d fEl   :.  FJr1d  ci,n:ul:1  ',    ,

t:ntt ,y ) 1 ii ir g Pt !1Cds SA] /Ct.

Budget Billing    Optionni p!ari 1.n,<f'!::, 1 --c  '.::ght; c:.i: d 1ov1 , ()\jf  of
v•"":Ur '. f:!(\fiCe t:ach rnont;·-1
Energy Charge     The ccif)l  ft xcc,Dt fucii	p,uch,t.11:u ihf1 c:!ectr:()y
';CU )! J 1 Ch<JSf-;1.J 1i clud;no i: cr:t,( :-\<UCJn. t''"\\,,1::or,rr1nnL:J! Jr-:cl cap;;:.JC1ty

Fuel Charge Ct::si or fuel tJsed 10 prpduce e!ecir:ciiy you ptJCt'H:ised. Fuei costs <:!rt; pas:;ed !hrou i7 from fut1l upp;:1:?i'S to O!Jr custorner   \Vi'.h nc   rnarkuCJ er  nrcf1.  tu Ta rr1  p a  E!, c:.; :c
Kilowatt-Hours (kWh) The :J,1i·,,c ,,·1;,as1;:;.,,nc!:1t of P:if'.:C:":(, e:·wroy
use.
Late Payment Charge r:cr pa,; 1 du" ;:;n'O!,fllS rno'1:' :',,1•1 ·:, n, :t,P
1;: Jtf'..; payment ct--:d,f.lf-! ::~,; it-.t rerJter	S5 c< 1.5t /,:: of 1_t:r: ;-:J,:J :;i dur
;; mount. For pes'. duf c1rnounts er S 10 c-1- :e:,s, the lr:ne p 'J'.)'i'r'it-?;·1:
ch,:Fge is ·1 { :, er ir•f_, pas'. dur :'3n1ot..;1;;
Municipal Public Service Tax in ,JCJrkc·1 :u ti18 ::,;;111T••,;:, i'c•f'.
!r:ar:y rriunic:p?:L::c:s ,nvv tD>( on \hH c;!ectr:city you tJ::"-;e;_ Ji ! -..
ccHected l)y Ta(11nr1 :::8cl1 n..--  ,:Jr1d  1).a:d  tc, :t1           n1uri!c;x-1:11y

CU'.;( !'E?COvery ch;;roes.
Estimated jf Trl l'O;J Eh::e1r1c ·xas un/ UiE !o .t-;;;id /CU rrifler.
E:3Tlf.,,tA.TE[Y \,v;\1 a(.lpf:;J;- Your u:ec r:L ,;se r-,a "} Llner1 h ,t·rn/:ned
:.J::ised en  p1eviot; csag0:. 7 : 1 e    r ·,nir:: iS  2ci'ir- dult d	[·1c:  1r.:1;_n_j r-,t::;>>
rncn!t\ and 2ny cffferencf LH-;.i•:1t Pi1 \ne:, 0-:si·11,a1r:,1 r nd ;:-:c;ua: t.sri v;:

Past Due    P.-t  ' 1.ou s  c 1rir\Jt?!  i •.1a1 1:ne pns; (jue are  ·,ub:!-;c)  ru
payrnent c!;aror: '.t r and n1ay   t:)t5ul!  1"·;      cJ: ;(;unr:r1ct!cn.

-;u ::--i'.c  rT1 ( 1 ca'.t=;oo:y. ThH   cc:s cf r Yc\1:d ;:;q  [ t' rvicn '/ J;.c-.: ·; '.-\·m1
custo 1 r e r ix·c,up.

1,;1 l,?

!.}t; , dJUSlfld , ccord1:1o!y.
Florida Gross Receipts Tax ;\ :,ix.', 1rn;-.,c,:,HJ ,ir; LJ: c·,;:·, , rY,',,f-,\,;
fton1 ui1i1ty ::;ePJlC8S  that  (lt'H  cfr !iven-:d	;"HU-'.!!l  \:UStr:; '\(;:S  :n F1u1  !th":i,  ,:1
acc    o  i'dr:r 1c t;  v,;:lh Ct1,::iote: 2C!3 of  !t·,r   io,·idd SiD!ulC•'.;;  :r ,.,.:; ;;:y	:nv, -1cj
on   uLi1!y cornpr'Jnrt::;, vvi":icX; cc:lect  i•·,n iax   fro n·1   .J!! cu::.,tcr :e:-::. tu1:1..i ;f;
('XPrr1pt, and 11::rnit !o tf1E: "t :- !t .
Florida State Tax /., p,,v,,,.,q" :,:., ,·,i,u:·,ed ,.,r· ,.,·,(·• ,)•:":,,,:, \'J',,'
f,nqcJ(l(:S  Ir:  the bus1nes!; o!- sn.i::1q	·r:n::r:q u:1ntJ•bif"l per::-;crit/
pcnpr::r'.y /.it 1ntr.1ii	Xie Si )e, :!1 ,1c,:c:-d;J::c: \c'/·if-· Ct'tJp!c : 2 cf i:10
F:C;r 1dJ St ]tutes,

Renewable Energy""' Ti,c d'',Ol,;-'. (J( e!,•dric,ty pu;,,:,;:,'.,,:d r,0:1,
; f! r·tn\.\iiJ iJ!\ ;•JU:'(:(--!( .
Share /\ ;)roo1;Jn1 co-spc:r1 ·)ort- ci by :'/:r :p;J E:ec;iric ;J·-•<i the
S-a:,;/;!:on Ac:T1y v;tie:·e custorners c,J:  r~;(!:p  Day  the f:r;1:!.iJV  llii!(; Ct: ·;ttYi':8f ; 1r1 r:efKl A c;n1: tirne \:c;q;_r1hu'.:ot1 8tJfl be rr:,-2dn, nc v n,r r::cv \t iy t-}!ec!ecl corit,?-,ut·on ·..,;i.nl! appt:;:J on vour bi:!. Yuur
·-c;nltibuhm it; U3x dt duct;blr andIs ma c:1ed tJy Tnrrq1 0 E!8c:tric.
Total An1ount Due    -:-his 1:10.-1! 1\;  c:11af'oes vvi/1 t)e  pr1t i di f: 1Jfi1-1  i
the date sr•c:vH1 T iS DATE D()ES i\ OT EXTE!\JD TH! JP.,Tt= CY·J
/\i· Y PREVIOUS Bt .L. ;\JC::". H iS ;;Ti0 1:tn:1r lhat y(,u p::-1y )'1.)U - 1i··

Franchise Fee /; fr e ;pvied '.-1f1

;1,    -,unic.p.::-1!:1\- ft"· 1r·;r; riqt:i	L:1;:,,::f-

J8 cre  th:s datH	orde: :o r \:c,d ,;,1ec:unl1cn cf  sE: 1/ iCf

'Jti Jl!r: p:cpPdy for H1E pu:;JC::·j( l ! piov1cJr·:tJ	'•1 e

 tampaelectric.com.

Zap Cap Systems	Scrqf-; n:T:tectit_:n :o. yc1ur r·,c :1+ c:, :.it;:=i1 -1 :i:;::-:
soid sep; raleiy a -5 :::i non, e: 1 e ru y cr Hf'Gfl

Your payment options are;
*  Schedule rrefl one lin1e or rscurr1no  p aynHJ11  ts 1-11  tampaelectric.com t, .;;r\J 
11 rv181I your oayrr:f:n! ·n the Gr1c)csed err.:e!upe. PtP-1:i:;E' ai!C'.V suffic·t r·i !1n1fl :~c,r dt '.iVt ry.

,. Pi Y 1n person at a locc 1i aui •1on1ed payr:--ier;\ ;:20 :r·:t. 1='(,r Ls1,r·o or -1u1ho: i.:'r!d payrne(,, nqe ..1ls. ·-11s;t tampaelectric.com or c:11• Ct.,,-;'.( ; 1r 1•
";.,y  l:y  v  ,0  d:i ,·,1  d,·:bt'. cmcl u.:,,r,g Ou1c  0;  P.,y .,,  tampaelectric.com 0:  cc;·, 866-689-6469
{A,   ..c.n'-./en:fT:Ce f1:,t  \"/i::  t>t- ct-itHDt d :u '_r-(;tJ!  iJ; :1i\  ac1.,,::•  1l rr   cn di; e,:J: J  }

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:t -::.;nc r1:-:; '>ifl ft.11 PdJ·;11r:11t :... :-,ia(h-i \n CPdLthurized 11Lr;•-L -
f, .:,.1re le  ck;iiVCf  ni  1 ·r 1e ly  cJ•::•!,'ff>  !r:( - ;J,1y: 1en1   :(       u  -  --=:i, <·r-,  r,-;11t11PS  11:;-: y  ce ,\;i'	i JtF: na: 11:,-1,  ; ; : cl1ar!:JP ; :c  :,<n,1:  ti(.;::G\iPl  c1

d:SCUiJnnt.llOfL

f:;v,, , v,,..,,f. tampaelectric.com p.-,r;;
Page2 of4

TAMPA ELE:CTRIC

ANEMERA COMPANY		

Account:	
211005281160	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/13/2017 to 10/11/2017

ACCOUNT STATEMENT
tampaelectric.corn I f - tp S• a in

 	
Service for: BALM RIVERVIEW TRPL CRK PH1, RIVERVIEW, FL 33579-0000

Lighting Service Items LS-1 (Bright Choices) for 29 days	Rate Schedule: Lighting Service	
Lighting Energy Charge	1890 kWh @$0,03224/kWh	$60.93	
Fixture & Maintenance Charge	18 Fixtures	$213.66	
Lighting Pole/ Wire	18 Poles	$430,56	
Lighting Fuel Charge	1890 kWh @ $0,02916/kWh	$55.11	
Florida Gross Receipt Tax	S2.98	
Lighting Charges	$763.24	
Total Current Month's Charges	$763.24	

Page 3 of 4

An audit you	n look for	ard to!

0

0

"0'
"'
;:_
N
"N'
0g
i!

Tampa Electric's FREE Commercial Enugy Audit_

can save your company energy and money.
Our nationally certified commercial energy :
analysts are ready to walk shoulder-to­ shoulder with you as we evaluate your electric usage and provide you with
no-cost or low-cost suggestions that
can improve ,our energy efficiency.
WP abo offer a Comprehensive Energy Audit ,l! r1 rninim,:m rn,t cf 57'; r,,r v1mn11:tc i,i! cir induqrit1i facililit- . As p.irt rf tlli) t1udit, uur Jlidiyst will
a complete wa!k 1•1rJuu'1 ofyoUi facility. !nr1ddition, WP wiil sub ,11e,Pr .irlli monitor• up to two of equipmen L·r appro;.:ir 1ate!y one rn,:,n:h fl;,: will evaluate proper sizing or e uipm·,n' anci oper,1ting hmw;, '"''""'"'"'"''.
inefficiencies and more. Oncem onit,H1ng fr, c0n!pic1e, w,, wi!i n<r)n:n:er.d a, :!,Hh
you can take to maximize your energy pffiriency.
More energy-saving programs for your business

areas where your business could be 1noff• rm'i·.JY c-ftiriert anri reccmrr:e0,d ihE·
following programs that can help:
Commerdal Cooling Rebate program - [am d relMe d!id t:elp rp1Jure )'Lr
energy costs when you add or repiace cooling equipment at your 'aciii1y.
Commercial lighting Rebate program - Earn a rebate wt1en yo:1rep! it e ('Xiiting incandescent lamps with high-efficiency compact fluorescent l,,mr\ (C;t ,,1 tH l!iJhi emitting diode lamps (LEDs) within conditioned or narHonditionedspace.
Conservation Value program- Offers rebates to commercial and industrial
,u,tcrTH:r, that implement conservation measures thilt primarily reduce power
1 Gn'.L,rnption during peak-demand periods.
Contact us today and schedule the type of audit thatcan help your
company boost ots bottom line.

TECO.
TAMPA EL.ECTF,UC
ANE:MltrtA CH:lMFANV

g

0
g	Results from your Energy Audit may show that your business

could :,,.',.(iJ!

:r:;rn

The powertosaweyou money.™

Tampa Electric's other energy-saving programs. Our energy analyst ;\iii

TampaElectric.com/BizSave I 813·275-3909	i

Page4 of4

TAMPA ELE:CTRIC
ANE:MERA C:CJMPANY

Your Account Summary		
Pievious Amount Due	$678.43	
Payrnent(s) Received Since LastStalement	-$678.43	
Current Month's Charges Due By 11/0712017	$678.43	
Total Amount Due	$678.43	

TRIPLE CREEK COD TRIPLE CREEK BLVD PH2 RIVERVIEW, FL 33579-0000

RECEIVED

Datf, qpc'd f{izzetta & Go.; Inc

ACCOUNT STATEMENT
tampaelectric.com  I	f W tp S•LI in

Statement Date: 10/17/2017 Account: 211005282317

Ul"'\hf•t,  t:.· f),  ·,•l·,V·1va!f

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Dir1·  ..,   . nterti  	_

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Always assume that a downed power line is

HJ • ·---" ---····V --
r'h·"''  H	 		  

energized. Visit tampaelectric.com/safety
for more safety tips.

\Ji    ,Vt_,,:.  rt_,	------... ,--,

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub port,on of this bill with your payment. Make checks payable to TECO.

TAMPA ELE:CTRIC AN E:MERA C:□ M P A N Y

WAYS TO PAY YOUR BILL

mail	phone online	pay agent
See reverse side for more information

Account:211005282317

684716177262

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772622110052823170000000678431	Page 1 of4

TAMPA ELECTRIC ANEMERA C:□ M P A N Y

Contact Information
Residential Customer Care
B13-223-0800 (i J:ilsomo'.1 , 1 Counly) B63 2990800 (Poik Co:jn[y)
888 223-0800 (All Olrlef CO:Jn[,es)

Commercial Customer Care

Hearing Impaired/TTY
r·1 1
Power Outages Toll-Free
B /! b8fl 10 1 0
Energy•Saving Programs
31 i 2/b 390\J

tampaelectric.com

Mail Payments to
TECO
F O f3ox 3 1 :l 1 8
far'lpa, fL 33{331-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tamoa1 FL 33601-0111

Understanding Your Electric Charges

Average kWh per day n-,e averacv s::,ct,,,: ur e',-:ct,,c:ry pu:ct,:,,,ed
p8r d,1y.
Basic Servic" Charg" A f•xed rnrn;lhlv :,r1u1;i:t lo cu-;e,· trH-c ccst of
[YCN:d1no snrv1cc to your iocahon
Bright Choicessu TnP ntn1ber of ::gn'. f1xt1.Jr< !:; nnd'c:· poies !t=:iJ!:;ed
T8mpa  Elt'?c\nc,   ]nd (JS  ccir.Ht-:(j 'nr;s 1::.ind  c t1a1q   f  S.
Budget Billing    O p t!C1  DI plnn t;3kcs !'!(:  h:qh:_  H -:d !U1/!      out   cJ
:y c:eciric  bdls. Th:s·· 1e \ 1  f!; I ' " (   :>.! ::: ;	:_JvC1D 'jf'S y-rn r  1as t ·12
[)•!!ir;(J   Pf r;ccJS  S\,  you   C( n  p1iy	H_:i_)\ U':C· f:./F H:! ('.J'."nO JrE rnr
- ,- l1t1t Sf :v:ce snch rncntr

Fuel Charge Cost cf fuH: \J'.',ed ,c, ;i educe elec:.,c·1,- ycu
purc/:;-)i.:;ed. Fur l cos!s ri.e passe:d !h1ouD fror':'1 :-ufl! sup;)t:ers '.c
our· customtJrs \.Vdh no rncYkup or prcfi'. \o ·-:--nn1pc: F!ecioc.

Late Payment Charge f'c· par,: du,'3 ,111,oun!s rfa,:(., ,:·,,;,, '.': :c; 111(',
ia!e pr'.:jyrr;er,i ch8rfJf 1s !he irenter ur SS u; 1.5Sl0 o'. u·:e ;x;:; dlA
c-:irnount.  Ft1r pasi duR a:-noun: -:. of s-1G c,: less, tt·1e irJtri p :::1:10·:():':
cr1srg2 • 1 5°{. cf fht Pi--J(;! duf ;:;rc :r, L
Municipal Public Service Tax I:• ,·,dd t:o;• to lhe 

Energy Charge ThG
you nu1chr1 :;t;d, iPC!udTi(l cc·: 1er'.,t1'.·i."'-"·
cr s :·ecovrHv <)1a1ues

'City
:r;d  capacdy

!'11 jr:y n \1r-·1(: p;11:\;r;f, 'f'.'!Y i:1 j{j;,( iY'l thf':; t:if:C!lici!y yeti USt'.; I) :S
,_:oi!ecLec.i i>V TrJ:i1;)a Eiecir:c ;- r:d oa:d to ;f·1e n1un1c1DFJ:i'.y,
Past Due Ptt;v,cu;; cnr:irgP.s :nal ,Jrt=; f)DS! d\18 are subj(-: ,

Estimated If ir;rnpa E:t.:c;: ;C I.Ni-JS ur:(;:):E :o :'fi.Jr l }t:l:• 1t • 1

·· sTli'vit\TED:' \t\li't 1ppe 1: You! • it;ct, <· u::;P r-: 1:·1
''.iCirHh, c1rid (1ny d1fferer-;cd t)ei.1.t-ieen fl:f=; P:,i:·r ;-/t'· r r.c!	L;Jl ust<; v..'11:
k nd;us'.ed f'.JCCordin(Ji','.

paynier··t c 1;-:rofl i"r:fj r:!:·;d may result (n discxJr1nec :or1.

ClJS'.()f ':t:::- CtJteuc::/ Tnr: cn:;t of P'C'.-irJ.r o servi( E ·.,nr.1<; ','J,:; '.t:t'

custo-r,t;; 1'. cup.

Florida Gross Receipts Tax ,L\ td,

p::tf qt S 1n !tifl tJu ;:rie:·;
;·1 Ui')t-;t!'/ i-J'. rc [/ji! ,:·: ; ·;f;

.ac:ccrdar!c( ,

;,;::::q::·)e
:: i ; r

f··orn uiiiily )FC\!iC8S thi-'.d FJ:t-: deLvt !-cd c rt:lcJ:i 1:1ccnrch 2roct"; '.'.'Hr1 Ch;1Dt(  1 203 cf 1t·1 f1. Ficr:th1 SL '.1/c: en t_/;ii'.)' cnr!1p;Jn1es, '.'vt1'.cf co:!8C!  :he tax  ::\ir:: cxf:1ri ,p' ar":d :·ern: lu thE· sb/f!.
,..._ c.: ;d? St -Jtutns.

Franchise Fee /:., fee le;•i,d :'J\::; rr,ur·.,,.:1p;;:,:y
:x.:iJi c p·cp · :;y  for   j \f  pt)rpc:-;1-; c/ p:cv1c.f1nq
ii+: fr:{·i <:: coilec!Hd !))  .,..an:pa  !:iect:
r1t.rn > p,1: 1v.

:· '.·~.  , r:cc,pt ;
,:i F\111cin.
:;::ix ;:; :1,:v:2d

Share / prco:,.;:·n cu spon · G 't'. d bv T;1rnpt: E.ect-'ic aricJ r'. 1 e S;:Jjv,:jt;op i•rrny \V! 1 t 1: t1 custornerr, cai' t·1eip pay the e·\o,qy tr!: ;
r-u:_:;:crnt-;1::; :n :-.t;ect  /,  or:E--Lrne con'.1:but ion  cDn be r 1;.:1:'lc,	<:·r  vet:•
(r;e,r;\: .iy  f lccted ccr:!i:tJul ic1 n v;r\H t-Jppear on  your b1iL ·/uu;
crTt1<bu :cr; 1 ; 1;:.1x dedLctit)!s Eind	1:atcht?d t)y T;;y·r: )j- E\c:::r:!nc
Total Amount Due  ihfs rncn!h's c;t·1ai,ges 'Nil! l)e ;)a:/ duf-:· r!ft(-; -
t:11_ rt1te :;ricvvn. TH!S JATt ;]QES NOT EXTEND THt DP....,,,F CJi-
J\h(Y PRE\/IOUS BALANCE. I• is impodan: thcJl ye _; pz:_; , vcu: t:i1.!

uri"c t1 !h!S date :n cidet io .{J'/C!d ,rJt' rrup!:0:1 cf -,fT/ :-:iJ Zap Cap Systems· Su,gP D•Ciec!,,.c- "o yc'ur .c, 1,,, c sc;d si:::pcJ; ::!ltJiY ;::; ; a nor•~er,f_d[ly 1_ 1,JiD(<

tampae!ectric.com.

Your payment options are:
"' Schedule f:Pe one-un1t: ur rf:!Curring oayrnt ri!S 'J'. ta111paelectric.com us:nq c-1 chec) 1r •(J (V s::Jv:n )S .-:::cccu:1:
.. Mail your pay1; en1 1n !he enclosed en1.1fl !0 p E.  P!8dSC-'	suff:c1ent  i;rr~1t'	dehvery.
" Pay :n pt- rsc,..-1 ;..::3( ; iocn! r:n.ithor:.::t1d psy1r18r-,t Jnen\. :t';. <; :1s:i:-J .1 of ;;ut 1c-·,,:ed pdy:nt:r: f ue11! ; •-1.si! tampaelectric.com v cai: CL-3lcT!1C':
Ca··e -1i lho r ur--;f.Jer li::;[r:;d ;:-JlX.!'/0.
• P,1y by c.reci!	dElJ,i c,,·tl u,,. ,,J C!c.lt !•: P:1', ,-11  tampaelectric.com (', GJ:: 866-689-6469.
/'J... cc1-:\•fj;-1,fincH r{:e ·..:1!,! tH-1 chn.oed :c y(juf LJ;: :-.k accccr,t	cred:t ca(d.i

Please note: if ycc ,;r,c·,, ,f: l'l fHy y, ,1i:

\\d·10  i     r-,c t  atdhtJ; 1/t:d  tc
T.:irnp, F!i0:ct11c ;-3;·,d do sc T1 ,1 ti r:r1!y C;:;st;;t·•
f: : i1F f 1 to dt:l>./f>- c:· t1r1 r .\" dt- I
t i:':;\· cnr11.-'.; -::,l:n.

Page 2 of 4

TEG
TAMPA EI..ECTFIIC
ANE::MERA  C □MP A N Y

Account:	211005282317	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/13/2017 to 10/11/2017

ACCOUNT STATEMENT
tampaelectric.com I f W 'Pg el!, in

Service for: TRIPLE CREEK BLVD PH2, RIVERVIEW, FL 33579-0000	Rate Schedule: Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1680  kWh @ $0.03224/kWh	S54.16

Fixture & Maintenance Charge Lighting Pole/ Wire
Lighting Fuel Cr1arge Florida Gross Receipt Tax Lighting Charges

16 Fixtures
16 Poles
1680 kWh @ S0.02916/kWh

$189 92
$382.72
S48.99 S2.64

$678.43

Total Current Month's Charges	$678.43

Page 3 of 4

An audit you	n look forward to!

Tampa Electric's FREE Commercial Energy Audit:
can save your company energy and money. Our nationally certified commercial energy / andlysts are ready to walk shoulder-to­ shoulder with you as we evaluate your
electric usage and provide you with no-cost or low-cost suggestions that nnimprove )l'.)Ur energy efficiency.
\Ve abo offer d Comprehensive Energy Audit ,ll ,, minunurn c o t	: ,;
:,Hnmuddl :1r indu1tndl f:1,ilitie . As p.1rt of ihis,rndit, our dfldly)i wili

a complere wa1k-t1,r,iuqh of your facility. In oddition, we will q;b •11i:,:rr c1nd moni!or* up to two p:c,:t of equipment fl,r Jpf:r,.;1:mately (l!le ;n,,n'i1. 11k will evaluate proper sizing o/ equipment ilnd •T Uil1inql1oc1rs, 1rie;,rif,1 rro,- s•.:
Inefficiencies and more. Once monit!tng is u1n11i:e1c, 'liC' wil! 1i:(I,n.ri1"n.:t ,,,:i,,,,.. you can take to maximize your energy efficienLy.
More energy-saving programs for your business
Results from your Energy Audit may show that your business could llf'i r·f,r tr\:n1
Tumpa Electric's other energy-saving programs. Our energy analyst  viii id,1:uf y

areas where your business could be mor0  ,'!Nrjy dnclr:nt ar,d rernrrn11,,·KJ tt,?
following programs that can help:
Commercial Cooling Rebate program [drn r1 reb,,t d!ld I1e!p reduce y, u, energy costs when you add or replace cooling equipine1,tat your faci:ily.
Commercial lighting Rebate program - Earn a rebate when you rcp:ace ex1•.!•:1q 1rKandescent lamps with high-efficiencycompact fluorescent IJmps : Tl,) ur !,uli' "n1itling diode lamps (LEDs) within conditioned or non-condftloned spaer.
Conservation Value program- Offers rebates to commercial and industrial
::'.d;111er, that implement conservation measures that primarily reduce power
, ,wumption during peak-demand periods.
Contact us today and schedule the type of audit that can help yoor
company boostots bottom line.

TECO.
TAMPA ELECTRIC
AN  £:Mll!AA t:Of>,HWANV

The power tosave you money.™
TampaElectrlc.com/BlzSave I 813-275-390!1	I

Page 4 of4

TAMPA E:LE:C:TRIC AN EMERA l;;□MP ANY

TRIPLE CREEK CDD TRIPLE CRK PH2
RIVERVIEW, FL 33579-0000

ACCOUNT STATEMENT
tampaelectric.com   I	f '-# <j) 8+ I in

Your Account Summary		
Previous Amount Due	$971.26	
Payment(s) Received Since Last Statement	-$971.26	
Currl.1!ntMonth's ChargGs Due By 11/07/2017	$971.26	
Total Amount Due	$971.26	
	RECEIVED	

Statement Date: 10/17/2017 Account: 211005282515

: !l!J;T 2 3 2017
--------- \)(:\:?""'	.,,

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

t.

WAYS TO PAY YOUR BILL	Account 211005282515

TAMPA E:LE:C:TRIC AN EMERA C□MP ANY

mail	phone online	pay agent
See reverse side for more mformation

Amount Enclosed	$----  ---
684716177263

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

68471617726321100528251500□□000971262	Page 1 of4

'TEG
TAMPA E:I...ECTRIC AN EMERA COMPANY

Contact Information
Residential Customer Care
81 'l '.:'23-0800 (i lilisnnrough County)
863-299-0800 (Po!f\ County)
8fl8-223-0800 (Ail olher counties)

Commercial Customer Care
B66--d32-6249

Heai-ing Impaired/TTY
/ 11
Power Outages Toll-Free
H?7 :>B8-1010
Energy-Saving Programs
1-31 \ 2T"i-3909

tampaelectric.com

Mail Payments to
TtCC
P 0. Box 31318
Tarripa. r-L. 33G31-331 ts

All Other Con-espondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

Average kWh per day ;r:e a'..,eraoc, 1 n:0Ln! i.i Ic:cificdv ourchi•Jsed
!X : dny.
Basic Service Charge A r:xed rr1cnih!y a111nu:1t iJJ cu1er t ·:o cos! of
prt':vidtng service :o yotF locat:or:.
Bright Choicess,. The urr-L)r"r or i.;f•: rx!u,,,; ,Vid.c, puir;:o in,"secJ
T •"Jrnpt1 Electric, F.ind n::;soc:a'.t!( l iPt? 1 :ir1d cr·,r.1:-oe:·,.
Budget Billing  O )iionc";I p\/;n ic11\ t!·:;  thr:: !..,19'.:f'- and   !cv/ ) cu1 of r;h:;ctnc biits. Th, :; ''lt'.)'J•?:i: q" ulil!ri J p:cJr- r:r ,e1i'.j(Jt--:::- youi· lns: ·12
•t;J  1 ·y !Jl(i:-1 1 per,cds ;;_ : 'y(lt.1	

·,(:u )ur:-.i; :.ised, inc1ud1nu

\•;_:u' :-£cs...,:ce oner: mc:ir:'.h
((1 -;r ;·Ecove1y cn11rnes

1

Estimated !f T2r1,oa E\ectr:c ' / 1s IJf1dL;:rJ tc; re;1d ycu: iTe!er

''ESTIMATED'' v11:i i pi:ir at YlH1r r;!, t \:·1:.: L:-·:ie t:;::Js been f-j ;Lr1t-Jt( ;d
r:·1oqU1,   :ind nr ,y dJferenc1:1 be tv t:'c r:  n e    t:::! 10  : ;:i te  ar;d ;:;c:u :1, u:;e; ,.v:
bt! ndJustc d FJCC01\l1n(1iy.
Florida  Gross Receipts Tax  A i;Y<  .:c.  ,:;,;,u,;e,j ,'"-,  q:0,0°,  c' rJ  •:1)  ::, fron) utitily servic(1s thDi a 1  e df:i:vt?n/KJ	:e!;:J;i cu ,tc i:Hr:: :r, F!(:t:dd, 1•1cccHd,-,ince l,,'..,:1! , c:-iap!e:- 20: cf ._r,o F1c r:d; s\ :::tJ!ci -;. :"'r1c: tax 1::; i,;;'.,,ed nL ullili.y r:on1pnna ;, v1 ·1:ch c1.1!;f;ct tf.r: Lax frocr. aH tu; ;c,111e• -,. t.i''!:e :.; t'.;;w:en1 n, rJnd ren!il \o he :·;j;Jle.

Florida State Tax A. pri\,iir Ut: !.: >: .rnpc :;ed
h-·:o(·J JeS f.11 th8 ()usmess (1f' S(:i,!1r:q o.: i t:n' ••10 ,l_;r:(1:Li ! f), uptir!v at 1'fHD:l :1 · tr t: s:; :t:: ··-. accctdt1r1c1:' V'l tt1 C Flu''t.li:: Sr.1 iutns.

Franchise Fee    t, feE :;'v.,-.u uy :1   1 u ri ic1:,,  ; I !' {
'.)LifJ:!C proper'.y ior ,J--f pL: pc:-1t :_:;f ;)rov1d1r·q f?· ?C
i),'.t-<1 tile fer i · (.(;';t;Ci!: rj :;v : ,11':'r[)tJ E:f!f/'
:r:c 1:c ;x-J!,ty.

Fuel  Charge   Cos!  or  fu8l  use<i  :o   o;cduce  electr::city   y·uu purcha ";ecL Fuel cosls a.--e pc3ssed ihnJuol , r1-c)fll rue! 1u1)p:1f;;S o our cusiorr1ers 1;,;i!h no n1a kup er  urof11  o Tar-npa EIEc:Uic
Kilowatt-Hours (kWh) The bcJsic •neasuri::nr:enl or eleci;A: ene:qy use.
Late Payment Charge Fo; pa,,: di_;p, ;,r cur,ts 11icp,, ii:,F: S :r, ,',[-
i::1te payrnen! cr·1arrF=:: 1;:-.;  t t·1 e qieBir?r  of S:5	'i  ,5(>  oF tht; L•ast due
;:.:n"iour1 L  Foi- tX St  due arncunts of s·10 oi  lt:s ;, 1 1e  !atf p< yrnc:n!
cJ 1 1 rg e :;".; ,1,5(:.-; cf tnR p;: ;t due c;r:·ourit
Municipal Public Service Tax    In,   ,dd  1 t o r0   •o ihe  r',c :,< ti,,,l'  Fl:<:.
many 1r1tir1'.crp;;lf'.1r)S :tJvy ;_-) tr:1x Oli lf:e ei c:t:c:ly yot. ust 1
(:c!iected by Tan10,::J E!Ac t:1c 1n1d paid le P<e n1un1opcJhy.
Past Due    Prf:v;ous cti;:Ji\JP  !,--iar  a(( pa:;'. due are su:J;:--'!c'.	a
p;-3yr:1ent Cfit;i(J! fr e a;1cJ n;Dy 1t?Su!_ 1n d:s(:Orn11 Ct:0•1.

ctiSlOr.7f)t  c:att:gu,y   Th,; LJi:_;t	p1Cvid,r.q :;C!'"\11cc vn:·10; ·, v.:1'.h u:n
cus;or:1e1 oroup
Renewable Energys,. T!,c· ,:,-··:c(;,:i er e:,,,.,,:c,:y pu:(.r,,,,;,_,d

Share    A prnqr;_;1r1 L;(1-sp(r :;c:vr1 !.)'y  THri:pa E1f'..!C tr<c  ;-J:1d   i-it":

-

:3;;:-'.!i.Jl:ci:--11\:rny './/f  1t  r1? cu!3tc  11:e r:; car, t:t !p pny th(:; f'-•t:  qy t;;1i ·; of  r u   t o!1;(1;'. ,      'n net:d. 1\ or-1H  11P:t?  contrtHJl!On  can  be  rr1t:id:: , c( yi.:tr r;•r;.1: f-!y tiiHc.ted cnr triUtJ i( 11\.vi!i rJppt-!,-1!' on your bi!L Yuur
cc:-:1,-; ,u:,nr ::::, tr-Jx deduc ibi f.lf;d	ma'.1.")1ed by   Tamp;:; E!ec1r.c
Total  Arnount Due    Tr',: -;  n1(F ih's char{1es \vi!/ L>e pr1st dcr- ;:/;e:
P·e d/;1e r,01,vr·. Trns C/.\TE DOES ..ioT EXTEi,JD 11-iF :J1\-·r:: or
;  \jV rRi::'JIOUS BAL.AJ  CE. It 1s 1rnpn1lar1;  tr:8t  yuu prif  -;1;i;j t,,,!:

lH_-);'c:·e tni:; d:Jte in eirde1 to nvcid ir·)tenuotiot: of
Zap Cap Systems' St;rge, p,r,[,,,c'.·cn ;u:·
: (licJ  sepcJratcly  (JS   a non-er etgy  c  h:  11 uc.

tampaelectric.com

Your payment options are:
"Schedule freA or e-!irnH or i't:cu:(ino p;--1yrr1eqts ,:it tampaelectric.com usino c1·:ecK1nD o:- Sff-': .qs accct,:·::,
" tlit:!!i your pc;;yrne t n the tJr:clcst:Kl err-;r;!opc. Picase /.d!u.,.; :_,uff1cit. ni liTf:; fo1 de!i' t=:: y

" ?ay 1n perscr Dl t J '.oci::ii au1;1or:.led p ayn·1t;n1 i:"Jnc r11_ F;:·;t :! ;i1r10 cf :::iu!hc:--..::t d Ji·Jy;:·011\ aoer::::::, v1f-:;: tampaelectric.com or c,'.'ji: C1.1 :,rn:rie
• '-';:,1 by c:e,H c ,bi,,: ,.2,d u:,;,•,o Ou,,;,, D"'i	tampaelectric.com O' cai' 866-689-6469
(/.._ ccr:ve :iHflCf_-; ff!t-: VJ( lJt: t ha:i.Jt:d tc yC•t;r J;;r·: z. : ccct1r n, cr ;d;t c.JicL)

Page 2 of 4

TAMPA E:LE:C::TRIC:
AN E:ME:RA C□MP A NY

Account:	211005282515	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/13/2017 to 10/11/2017

ACCOUNT STATEMENT
tampaelectric.com I f 'll 'P 8• i!! in

Service for: TRIPLE CRK PH2, RIVERVIEW, FL 33579-0000	Rate Schedule; Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days

Lighting Energy  Chmge Fixture & Maintenance Charge Lighting Pole/ Wire
Lighting Fuei Charge Florida Gross Receipt Tax
Lighting Charges

1364 kWh @S0.03224/kWh
31 Fixtures
31 Poles
1364 kWh @ S0.02916/kWh

S43.98
$425.94
$459.42
$39.77
S2.15

$971.26

Total Current Month's Charges	$971.26

Page 3 of 4

An audit you can look for	ard to!

Tampa Electric's FREE Commercial Energy Audit"
can save your company energy and money. Our nationally certified commercial energy / analysts are ready to walk shoulder-to­ stJoulder with you as we evaluate your electric usage and provide you111ith	' . ; no-cost or low-cost suggestions that		--
c n improve your enerqy efficiency.
'Ne .il'io offt,r a Comprehensive Energy Audit at ,1 rninirnurn rn·,t of S7, f,,r
:11:11111erdd: or indtl'ilndl frKilitie\ A', p:Jrt ofthh audit, our analysr wili

a complere waik thr>Juqh of your facility. in addition, we will  ub (1 1eter d'1J monitor• up to two	ot ei1uiprnent i,,,r appro;<im:n-:iy onr: m•.111'.h. lir dttd ,)t will evaluate proper sizing ofequfrrnem il d cperatinq hnurs, :dr,n1  f1rrn,r:\S inefficiencies and more. Once monit,,r:ng !s cornpiet . W(' wil! ri·.:Pmmc11:! ;: U,fo
you can take to maximize your energy eft1r iency,
More energy-saving programs for your business
Results from your Energy Audit may show thdl your business could'. rwt:t l'Nn
Tampa Electric's other energy-saving programs. Our energy ana!ysr ·:. t i

areas where your business could be more· enrrqy effr1ent ;;rd rc,fJmrn°11d rhe following pro, rams that can help:
Commercial Cooling Rebate program l:arn :1 'i:'bdle md h !p re:Juu=' r,u,
energy costs when you add or replace cooiing equipment dt y1,u1 :aLi!ity.
Commercial lighting Rebate program- Earn a rebate when pi r p:11P
(•x,q:ng incandescent  lamps  with high-efficiencycompact  fluorescent  lamps ::J:))
"' i:qht  emitting diode lamps (LEDs) within conditioned or non-conditioned spdCt\
Conservation Value program- Offers rebates to commercial and industrial uJotu;ncrs that implement conservation measures th<1t primarily reduce power rnn;urnption during peak-demand periods.
Contact us today and schedule the type of audit that can help your
company boostots bottom line.

TECO.
TAMPA EL.ECTFUC
AN£MER:A COMPANY

The power tosave you money.SM
TampaElectric.com/BizSave I 813-275·3909

Page 4 of 4

ti;

TAMPA C:LEC:TFHC:
AN  EMERA COMPANY

TRIPLE CREEK COD TRIPLE CRK, PH C RIVERVIEW, FL 33579-0000

ACCOUNT STATEMENT
tampaelectric.com   j	f W'P 8• al in

Statement Date: 10/17/2017

Account: 211005282705

Your Account Summary
Previous Amounf Due
Payment(s) Received Since Last Statement

Current Month's Charges Due By 11/07/2017
Total Amount Due

RECEIVED
OCT 2 3 2017

$720.61

-$720.61
$720.61
$720.61

D,u.,.   ."i';"t'e.rH,,·.   -	---··

Always assume that a downed power line is energized. Visit tampaelectric.com/safety

..	uL---··r,[-

rb-:U, -

...;,.1_.

for more safety tips.

Amount not Ptf i("'.!ue; d# ,:,17,.!Y be ass§§§!Hi f!l1t"IJl'iarge an;;(;additional deposit,

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of thrs bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BtLL	Account: 211005282705

TAMPA ELECTRIC:

ANEMERA   t:lMPANY

mail	phone online	pay agent
See reverse side for more mformation

684716177264

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772642110052827050000000720615	Page 1 of4

TAMPA ELECTRIC AN EMERA COMPANY

Contact Information
Residential Customer Care
1313 2ZH)800 Jli!isbO(O,J(ri COcin'y)
863-299 0800 (Poik Co inly)
888 2; 3 0800 (Aii other counl,es)

Commercial Customer Care
i-Jt36 832-6249

Hearing Impaired/TTY
i11
Power Outages Toll-Free
B17 ,88-1010
Energy-Saving Programs
fl 1 :) 27:i 3909

tampaelectric.com

Mail Payments to
TEC:C)
P 0. f3ox 31318
Tarnpa. FL .33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, Fl. 3%01 Oi 11

Understanding Your Electric Charges

Average kWh per day   The ,lVe--8ge '"'',ui.,·,	c"uur,c,iy ,,u:d,ased
p,-,: cldy.
Basic Service Charge A, fixed n1onth!y arncun to co·.;t:r the co .;t of
p:nvid1rio  Sf: ( \.1 ice  lo ycur :ucr tion.

1

Bright ChoicesEu The nun1ber of iif]hi iixturFs ar d.'01 pol,:;s leasAd

Fuel Charge Cos! of fue! u :;ed to piodcce elect.-•c1ty you CJtjrchased. Fuei co .,ts are prJsst1d ih10Liqh  fiorn  fu8:  suppl:ers  !o OtJr cus(orner: v.rHh no rnarkup o,- prof:l to Tan1pa t:11: ct,.c,
Kilowatt-Hours (kWh)    The  t1cJSiC  rne;:Jstrfimt: n! cf  e 1f'.::Ci ,.ic  enp:·ov
use.

Lurr: Tsrnpr1 E!ec tric

nn,j ;Js :,oc111ted '.(::r; :; z c•·:d cf·1:;roe:;,

Late Payment Charge Fer D, sr du, ,.r11oun'.s ;::u,E lr1,":: S1f:. ,i,t'·

Budget Billing Opt:onat pi :in b Kt s the •·H:f; nnd :ov.1:;) cut nf

·qy1i:>iy  t-:'.HCinc  bins. Trrn; ''l fr-Jt::!1no    "   t,11l  ··,q
·,-e::1tt·:i'.i b;:Ln(J pencds ;c ycu

\'l:!j  pu:chi;st d. including s.,;( _ ;·•r> f  ;1.,;   :.t.  •

:,,u.1;- :·;t '\n,:f t::ach n:onlh

C(:ttl ,'f)CC,Vf;ry cf;(Jf[J8S

l:ate payrnen! ch1.1roe is the (rea:e er SS or· 1 .Ei(/ cJ 11-1e p Jst dLe
;rr1ount. For past due amour'1!s of s-10 oi loss, i :e la!e :"J,:1y:-r:e:r-:t
charoe 6 -1.5°1,> of the :):;st dee 1-1r·:ot.;n'.,
Municipal Public Service Tax ir:  ;;dd,'.,c,n  :o  !!:e  f':y,Lr-,,se  Fee. r,1nny n1unicipni!\!( S levy a tax 00 d·:e cit  ctricity  youu ;e_  H  :s cndected by :,1rr:pa f;Rc\:1c and n,J;d to : •-1e n1un!C>iJ;,J:::v
Past Due F'i8v!c-us cnaroHs :t'·!at af8 p;3 :,t due ;-;re : LiJ;< (:l tu c:'

Estirnated    ifTar' 1pr! E!r;ct,:c ·:·a:=  !.JrJ/jL:ie  tc  rt•:/Jd
··t:STl J!ATED'' \·;,!I {:.1ppezy·, Vct:i eincir;( us()

,neter,
\·!'.:.	'iP ;:1tPd

1J·yr:1t-?r1; C}kYGJO  ft '.n  Jnd   :11  ay  i·e )tJ!l  ;r1    d;sconn8ct1cri
Rate Schedule -:-r:p ,rir,ur-,; lra:e1 yuu oay dHpf'r'd"

)C1Sed  er:    p•f:V!OUS  U[Jf3UP,  Tt1f  rnr:de•	:;c,•·c_::dLied t( Ut: ·t; d (.e,-.:l
··::ontt·1  arxJ ;:1ny  ciiFE:enc : bot1..,,.,-f fn  \hr, t-;:;t:rtk1 t-· (:1:·d	;1;n'  Jsr-; v11 '.i
!>t; i djt.1S;1::d t1LCCircJinqly
Florida  Gross Receipts Tax    ,A  !ilx 1s ,,.,,,u,,,."1	
r:-crr: u\:!dy serv,ces thtlt E1:1:: deir1l:':i- d	1t U ,, (:tJ ;iurr:t' 1 ::	Fie;i:d/:. 111
rw.C<Fdar;ce  \v1ih Ci--1:.:;ptf:r  203 cf  !l1e  F!lv1dri S:diutf; ). :r,t' i;1_-:	!ff.:;ed

;·; ui;:•ry ccn1;)r1na  \  wr ,ch ccdt)C!  the 1c1x fic:rr:	 t:;xerr:o:, arxJ ·-t:irr:t le the st;'ltt:1
(;r-,rJa ·J,- s :;, th( bu ;ines::; er r;1:::11:\J or !·t-:riiino ::.·; {;:\1:f, )r,sc:r•;-J:

prcpt:1 ly  1::it  i't:!t.iil :nth(; s:;.:: c1, :n dCcc1drnce  \\	Cr	:hi?
Franchise Fee    /, 1ee  'r,.,it,d  tiy .l  r,.ur::c,rid,:':, ,,.,

; L!)i:( ;J;npe1iy :o:· the pi i•T)C-:;t c!~ ;YOV d,n1J H'flC''

;::;;..:t?: . ;hn f:_:;e i , coi!e:cted h) Tan:p,:.: E1ect.-·c ,,rd

tampaelectric.com.

1:ustcn:er c;:>reu(1ry. 1·1e cnst of prci:d:nu ,f.:rvice .1..-.: ,r:.
CU:3iOt'':f:;1 n1 C;U()
Renewable Energy u Tt12 cYncur:t cf e!ectrici:y   rer:e:,v;]b!n SOUi
Share /; ;;ro\Fa:--:1 co-spn:1so(f:Ki ny ";.:Jff1pr1 E:ect:·,c .:Jr-:d '.t-:n sa:v;:;ticn ,'\rTny '/'.1r f:tt!  custorne:s en   t·1f:ii JJ  oay     the    e  t 1 t·J1 Uv   i,1!:-; cus:c-rne:·s m r:t:!f•;d. /', ont ::-l;rr,e cor11riuut1on can bf; ;r;;_:.idr:	yni-jj
'."';1on\t1!y plec!rK1 c;: n!;-!butinri v1ill C1f);Y nr on your !yll. "{cu:
cunt,1utJior 1'.3 iax dcductibte n11d :s P"•<JtChBd by Ta;T nu Eiecl(!(
Total Amount Due  P:;'., :rn:-;t:i's cf,DrtJS'., v1:'I b," pa,,' du• :,;t,,,
(ht.:) dat( sh0\t.j(:_ TrilS J,;\TE DOES f'-JOT EXTEi\ [) Ti-:F ["');-\TE cx,.J
/ J...JY PREVIOUS B.AL!i.J CE. lt !S n11pcr t;r:t !h:.Jt yo, p ·,1y \ C1 ,.; '
UeforF! th1s cJa1.1? ·n 01de:· tc ,:Jvc,d :r'te:ruph.1n of se. ,.1:r e

Zap Cap Systems .,  Surge !J.-utt;c!•o:1 f'LY vot.ir 1·,cr 1t ql
:;old sr r)i:na!e!/ r1 =; ;3 r un-t rit ioy \)-,(H\Je.

Your payment options are:
* SchecJu!f; free one-t1rne or iecurr1ng psyrnents at tampaelectric.com Jsir10 ;: cht:,c:<.•, •G cv :;;;-: vinu ; <.iccr;ur:'..
11    Mc)i! ynut pay:nenl ;n l!le t::nc!tjsed enveiope. P!east: /;ilcv; : u:fic:en! 11:- :e  fer  dc :1ve.-y.
PcJy in )e:sor; at a ioca! r u!t1cn, ec:t payn1t nl auen!. ct:; !; ;:w.o {l ;,:iuLt1n1:.: f d pay'11e;:t nqRnts, ·1is!l tampaelectric.com or ca i Ct, · :cw:1:ir
C ;qj DiPipr.ur-,1t)nr ;:s:Pd aDO'lf:1.

* PDy !)y c1·edi1 cl,- dE:Dd cr uj us:r10 Ou1c D1,Jy :if tampaelectric.com O:
(A ccn·1!:1n,f;r·:cr ;\:;r; viii' ijL c11,::qt (i te ycu: '.,ia::k ,;C((;t 1 r:t l>,: rF ca;·cJ i

866-689-6469

Please note: If ·1cl  J u-1cosf;  le p JV  yt;ur  i):li at n	:, .:lt cl	ou, ,:·.:' :JJS'te C:1 ptc'11dt ci :'>v T;: rr;pa E1t cu	yoti /FE-; fJay1nu
v.:/'.:J ,:::; r1ui nu!!·1or, .:cd io ;_-,c:	n  p,:y:-cer,t  cJUCrr  {;r::-1:1 :);  E·t- l:!r;c.  Vcu   L;t:1d: n1 :; 11!:.;k  ltiiJt  '.f11s  t;r··1'lt1lf-HJ•'Lf;d  q,1ity  v.ri:i '( 1ay  •hn [)( yn;er1l I{;
T, ir:1.1,1 i:=!t;ct: :c ;-;r:d do	,;1 a; ;11e!)• fr shi(Y . Tf:::n ">(:	rcr,por·: .u:,.:J lei: n=1yr:1r:n!s :r::Jdt: to ur,n11thc,-1,/f'd agn°1ts int,:11,'l: ·:cJ fa::u1P   tc  dPi!V,::'.<'  (      t:rnt?!y  dt:hrf:•  '.:'j(;  '.) ;Jy 1r   t-;r ,1	,_r..   Su((; :~;:1:!U i·? :o  rn:::iy  n-?;.)\;:·	:.:Jf; payff,f;I"•'.  Ci',',i:'qes  lo  yc1_;/' ;-JCCl)ur:t  Cl(   :;1:;, \!i( (· d!!;c:unr·11"!Ctiu··1,

Page 2 of4

TAMPA ELECTRIC:

ANEMERA COMPANY

Account:	211005282705	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/13/2017 to 10/11/2017

ACCOUNT STATEMENT
tampaelectric.com I f W'P 8·di in

Service ior: TRIPLE CRK, PH C, RIVERVIEW, FL 33579-0000	Rate Schedule: Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1012  kWh @ S0.03224/kWh	S32.63

Fixture & Maintenance Charge Lighting Pole/ Wire
Lighting Fuel Charge Florida Gross Receipt Tax
Lighting Charges

23 Fixtures 23 Poles
1012 kWh @S0.02916/kWh

$316.02 5340.86
S29.51
S1.59

$720.61

Total Current Month's Charges	$720.61

Page 3 of4

An audit you can look	r	ard to!

Tampa Electric's FREE Commercial Energy Audit
can save your company energy and money. Our nationally certified commercial energy ;' analysts are ready to walk shouldeHo· shoulder with you as we evaluate your electric usage and provide you with
no-cost or low-cost suggestions that
can impmve your energy efficiency.
We also offer a Comprehensive Energy Audit al a minimum W\t cf $7r, r,lf 1u:rnr:e1d,,I c1r indu 1ric1! folilit,es. As fldit ofthis,iudit,nur dnaly<,t -..'i,I[ p,-rfurn, a complete walk l!:r11uqh cl your facility. In additi11  n, we wi!l ,ub me!!'r di'.tl

monitor• up to two pieces ot eq,1ipment t0r arprox;m:itely ')'le rn,Jntf1. fl;: a,,a1•,5t will evaluate proper sizing ofrquiprnenr and opcrii!inq l10urs, ider:rity pmcc,, Inefficiencies and more. Once monitoring:) 1;.:mpietc, we wil: 1H1,11,1:v:nd ,\( t,,,, ,., you can take to maximize your energy efficiency.
More energy-saving programs for your business
Results from your Energy Audit may show that your business could br:rf:! tr, m Tampa Electric's other energy-saving programs. Our energy analyst '':ii! 1·.knt!ly

areas where yoor business could be morr erwrqy ettlrient and rern1r.m::,nd fr1L'
followi™) pr()Jrams that can help:
Commercial Cooling Rebate program L1rn a r bd .rnd I eip reducl' :,Ju
energy costs when you add or replace cooling equipment at your ta,idty.
Commercial Lighting Rebate program - Earn a rebate when yDu rep,J<,:,
ex,c.t,ng mcandescent lamps withhigh-efficiency compact fiuorestent lampr,
nr l;qht <'111itiing diode lamps (LEDs) within conditkmed or non,conditio!X'd spdCi'.
Conservation Value program- Offers rebates to commercial and industrial Gn• ,rn(•r, that implement conservation measures that primarily reduce power c11n;;1rnpt1on during peak-demand periods.
Contad us today and schedule the type of audit that can help your
company boost ots bottom line.

TECO.
TAMPA IELEOTFUC
ANEMEIQA COMPANY

The power tosave you money.m
TampaElectric.com/BlzSave I 813-275·3!109

Page 4 of 4

TAMPA EL.E:CTRIC

AN E:MERA COMPANY

TRIPLE CREEK CDD C/OGREG COX
12198 TRIPLE CREEK BL
RIVERVIEW, FL 33579-0000

ACCOUNT STATEMENT
tampaelectric.com  I	f W tp 8• r1 in

Statement Date: 10/17/2017 Account:211005280915

Your Account Summary
Previous Amount Due
Paymant(s) Received Since Last Statement

Current Month's Charges Due By 11/07/2017
Total Amount Due

RECEIVED

OCT 2 3 201l

..   ,    ....,--·-,-

$224.59
$224.59
$227.60
$227.60

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR Bill	Account: 211005280915

TAMPA E:L.E:CTRIC AN E:MERA COMPANY

Amount Enclosed

mail	phone online	pay agent
See reverse side for more 111format10n

m

-

TRIPLE CREEK CDD C/OGREG COX
<	3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

684716177256

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772562110052809150000000227606	Page 1 of 4

TAMPA ELECTRIC:

ANEMERA Cl:IMFANY

Contact Information
Residential Customer Care
813-223-0800 (Hl!isboro,igh Couri:y)
863-299-0800 (Po!k Coun!yl
888-223-0800 (Ail otrier counl:es)

Commercial Customer Care
oGG 83 ' Gl49

Hearing Impaired/TTY
711
Power Outages Toll-Free
P7T--r1ae- 10-10
Energy-Saving Programs
813-??" _) 3909

tampaelectric.com

Mail Payments to
T[CO
1.CJ Hox J1]1(i

All Other Correspondence
Tampa Electric P.CJ. f-}ox 11 J
Tarn pa f I 33fj()1 O 1 1 i

Understanding Your Electric Charges

Average kWh per day Ti'JE ;1·11:c.·,,rw ,vy.,,,.:	,,'p, ::1c;iy p1:,d,w,ecJ
per day.

•

Basic Service Charge    /.'... fixe(j rrcritt1!y t:H:1cH;nt  to cnve 1     tt:e cost  cf p:0111d1n9	seivice lo your lucnticn.
Bright Choicasi1.1   The r·;urr,tJt r  cf Lof·;,  : x;1 _J  fi:·1      ;:1:  cF(!r  pt:!f!:'-;  li 1nt·1cd

Fuel Charge C,y;! (:[ fuc! usPci  i(•  Drt)dt1cf·:  r,:ec'.i  c:!y  )'\,,L pu:'LhrJSt?d. Fufil cost , ,-1rr; P<Y!t;t d li1iCtJ l·1 fror·1 fut:;! ·\uppi:Ers tc r;ur C\JStc:Hf'.:!rS \Vdl-1 no r-:!Fl1 ku;J o; proi!i to Tr:rr:oa f:it:ctriC

1

f,·crr Tnrnpn E!flc !ric nrnJ ;:J; :i ,oci;:J:, ci :eff.:i ;}:·.(J cf 1J.\JfJ'.:

Budget Billing Ol)t,o,·n1 ;, 1;; ; • :n e,, :r',:' 1°:q' i,; ,·,.J ,,'Vi", c1,: er
::'nntt~1ly  elt c!ric  t)H!S. This H:(,vcJ;; (   \ )(;!;'JU  pir1•.  a0.-n1  10 1::S   /(rUf  !rJ: :
r:·1crt 1!y L1iHi11g per!cth:; so voti ctir: p, y ;.:1t:,(;\;'. :h · :11':rnfl n:11CLI :! fu'
·yct;r r;ervite t i)Ch rnonH·:.
Energy Charge The cos: (?X( t:1/ . u:<i) er p1r,di CJ'q 1he ,:ft-'Ct11c
\ cu Pt rcbn:;Gd, !nciudin(J con: .er';;;::( .n, 1; ·1.,: ::·cr .1 :·: :,r:Ln! ::1rid capac!:y
cos i-er:overy charne:,.
Estimated If Tarnpn Elec'.r,c v.:';:;s ur1ab!H le tt"'iXJ vuur n•c !f (. 'FSTi i1\TED" uvH! c1ppHa1,  Yt'.;u:- f 1 !ec i· :c u :;t  1;n:., L'EHr·;  e lt:Ptn!ed bcJsecJ on previous us<Jgl'::. T:·:r: r;1(1!t;  ,() ;;c r 1H J 1.:le d 10 lJH 1f;ad : oxt
rnon!L, : r1d any differencn tJntwr:nr: '.hP e 1i.1 •1L1tn n ,d a1.)uai use 1.N<
()8 (JfJJu ;tt d fJCC()fCiingly.
Florida Gros5 Receipts Tax    .t.. !ax iS  ,, ,,po:,;0:1 l ,-;;· q•o s ,t,u.,pl:; frnrt ciiiity services  Ut!Jl  ;Jrc:  de!i· e•-f d	rr tD-! cu!;tuq11:i;:; 11:  F1ui·!drJ nccord1 nce vvdh Ch; ptt': 2(\i c,f th::: Fic•1di-J ::::,;;Jtde:_:;_ Tht'i t/]x	!f?\ 1 iecJ c•r utility cornpt)n1es, v,;hi1,.,h 1:(diect Uic: lax li(:ni n I t' uslo' 1 r;rt; 1 t niess HXt·inlpl, and ren;H to t 1t-i : t, lH.
Florida State Tax    A nr11::,0qe :,ix  ,-,·.:;:,';nd ,,,7  ,;v,,:y :XHS,,n  ,·/1:·1 enonnes in the bus.iness c:f :: ei[,-:n o:- rc:1rl;nq !, 11q 1bh; per 1or:r;i rvcfn:.r!y at n lt)ii !n lhe s\a1e. ;n .:·H,c(::d;'.J; Ct: \\'iih C11.apte,- ?'! of ti:e

t:!n1 cJ;_:; St;::i t, Hs.
ptJtric pr0per1y  ior  n·,t PLT)(J ';H {if    p;u,  .._ .d1:-10   \•):Hc!.-1c  st:::v 1cc   i  :i<t-:
tcJ:-.:()'.:t, :he  ff f !r; collected :>v T;-1r:·1p: J Eicct: ic .:, d	pnwJ to :j:F
lfiUn!Ctpal!ty

/JG'i(Jl;il!, :::er pf:i ;: dtJt; 1;:"i(}Ur:[;; (lf ; ·1c (., /J:;s, :he :1 p p;;vr:1.:
c.f:/J\qt-; 1 : ·1	i.l the pa .;! dut ar -1:Jur:!.

!11rF1y rn ;;::L·(k1i:\1t:;:- !e-.:y t1 tax \Ill ttJ•: H!r 1 c 1f, c i\y y".: ,; c:;,? i'. re \r( tRd !JV T;;;r p;-·! F•t c1rrc a:1d pr 1d le if:1.:1 trLrncip!'.-::h:y.

CL :tnrne,· catt:<;}(:!'/   Tnc: en -; cf  p:(;•1id:nq ,::=-,  11v  1c   t-  '.:;)1

cc :;!nn1f-:: Jnt:r.i
Renewable Energys,.,   T!:F! ,:1 n,c1    ,n t  t,. -:.decui<)y  pu1cha: t:!ci frorn
't'Pfh':Eib c· :,:;uu1(:es
Share    t, p 1 C(Jrl  n1  l.•;c•! ponsotud  tJ'f  T1·J:11pn  f:lt ct;·c  Jr1(i 1be S;)ivat!C1n /i,r:-; v v: 11t-:rc cu:-;t1-1rnr.:<: caii t:t 1p p;:;y t!·:i: eneifJY tYilr, nf cu ·-;!ornei' , in  1:( r:d. /\ on(!·!1mH	.uution CEin t)e rnade. er vou:· n un i:ly e!ftC\(:d C(Jn!:·:b,iticn v11li ;:;p p t-:;11    on  vc:;ur  f>!i!  You'
cor·trJ'nJ!:or; 1 }  inr: d1•duc!    1   Jit--: (·Jnd ::-, r: JlL icd i>y Tr;rnpi:i Flecir!c
Total A,nount Due    Th1s P nn!h's  ciin:qes ;vi;\ tw: fk.!51 duP  afh: ,
1hn d/Hc · r1c-:;•'..  THIS '.)/\.·ri:: DOES '.·- ()T  FXTc't'-JD TH     DAT ON

1 J Y PREViC) JS FV\ r , C . !1
i :<; d J:P ,fi ,·. \J ·.,
Zap Cap Systems· s ;cqH n:'CJl1:r.:t:U·, f(:r y,()U( hcrnr: c,r bu:::1riesf,
:;cld  ";Ci '>t11·a[p!y  n<:     ;:c:,r  +·r11: rqy <J:/::on

        tampaalectric.com.

Your payment options are:
,. Schedule  free on8-..tnne or recur; :ng pr:iyrnr;r1\t--; DI tampaelectric.com t,'.7;,no  a ct;t Ci'-. -.!] or :--;t1'.' 1n  1J ·; acc(it '"!
., Mc=J1 i your payrrier:! in  !he enc'.o ,c1d envE-1fo x:.  F)!(!n:;n ;:;iin\:'J '.)uffic:ihn/ !•nv1 fer  d8 1• vf'. ry,
.,  P:iy in  person al a loc<)i < tilhcv'..o:;cJ payr:1ent :J(Jcr·,L  Fort·)  fi G! i/ 1q	r:it1t 10;-,.:::E:d 1x1y:1:F::1! rJ y :-1; ;. ··.,15",:\ tarnpaelectric.con1 (P ca;i Cl!:;iun!C!
CcJrf; at 1hr, Pun1ht:;r hstc:d 1]tJuv1

radure ic dei1ve;1 ur t:rr1e!:-r d(;!:,/fd i:·:c..i Pli'yTH,; d ,o

,	Psy tJy C:f:d'i o, dr,l,ii c,,cJ u:s,r;q Oi:"-k F;:y ,.,, tampaelactric.com u, ,:ad 866-689-6469

(fo)C()f11'!f1i J:Oil.

Page 2 of4

TEG
TAMPA E!...EC:TF!IC

AN EMERA C:l:JMPANY

Account:	211005280915	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/15/2017 to 10/12/2017

ACCOUNT STATEMENT
tampaelectric.com I f 'JI <j) 8• rl in

Service for: 12198 TRIPLE CREEK BL, RIVERVIEW, FL 33579-0000	Rate Schedule: General ServicG - Non Demand

Meter

Number		Reading	Reading		Multiplier		
C16598	10/12/2017	53,754	51,552	2,202 kWh		28 Days	

Read Date

Current

Previous

=	Total Used

Billing Period

Basic Serv;ce Charge		S19.94	
Energy Charge	2,202 kWh @S0.06216/kWh	S136.88	
Fuei Charge	2,202 kWh @S0.02956/kWh	$65,09	
Florida Gross Receipt Tax	 		$5,69	

Electric Service Cost

$227.60

Tampi.t Electric Usage Hi,tory
Kilowatt-Hours Per Day

l!P-1------79

(Average)

--------120

AtJG	ma
JlJN
MAY    -""""""13:

Total Current Month's Charges	$227.60

APR-79
MAR.	04
FE!'l-60
J	50
DEC- 98
NOV.......,	98
OCT-fl.2
2010

Important Messages
The billing periods of the individual meters of 8 multi-metered account may differ from the dales displayed. All ihe meters on such an  account nmy not have been read on the same dote due to their iocalion on the property.

Page 3 of4

An audit you	nlook	rward to!

lampa Electrir's FREE Commercial Energy Audit can save your company energy and money	' Our nationally certified commercial energy / analysts are ready to walk shoulder-to•

areas where your business could be more ,0 rirr,Ji et1luf'r,t an;i recommend 1hr
following programs that canhelp:
Commercial Cooling Rebate program Um c1 rtbdt nrl ileip reciU(P ,c,t;r
energy costs when you add or replace cooling Nuip111er,t at your ta:iii'.y.

shou!der with you a we evaluate your electric usage and provide you with no-cost or low-cost suggestions that Cdn improve your energy efficiency.

·' ·,

Commercial Lighting Rebate program - Earn a rebate when ynL repia,c ('{l',1in9 inrandesrent lamps wllh high-efficiencycompact fiuorescent IJflljl\ (, fl\' r1r liu,h1 emitting diode lamps (LEDs) Within co,'Klitkmed or non conditioned pMe.

WP ah,i Dffer r1 Comprehensive Energy Audit di ;i rninimtw1 u,,i ,,r:,1 f:,r
,u:i:11•1:rd,\I (1r i!ld11sl1it11 idci!ilie\. A JUrt nfih:<, .JUdit, our c1i:r1iy\l ·.v1H

Conservation Value program- Offers rebates to commerci.il and industrial
! 1 i,S!i1w1,  r  tl1at implement conservation measures that primarily reduce power

a comp!ete hd:k-thr.i:1oh d your fad!it\. Ii; additi'.JI,. we v,iil ,1P
monitor* up to two

0

"'	will evaluate proper sizing

, n: 0 : t, -1i1,i

:   1,,rr. ;rnpt ion during peak-demiKld perioos.

ot nquip'llcn' ,111d

Contact us today and schedule tile tJpeof audit that can help your
company boostots bottom line.

"'	inefficiencies and more. Once monit,•r,ng ,s c'111;pi\+, w,, wiii ,r: r,n:P1cr,,1 ,,111 u1 ,,
;ou can take lo maximize your ener9y eftic!m( y.
More energy-saving programs for your business
Results from ',\lur Energy Audit may show thar your l1u,!11t>)'> u,uirl r',11c111 •,,,n
lamp,1Electric\; other energy-saving progr<Jrn . Our energy analys1 ,1,ii

TECO.

TAMPA ELECTRIC
AN Ml! A C:tlMPANV

The powertosa,eyou money.™
TampaElectrlc.com/BiISave I 813-275-3909

Page4 of 4

TAMPA EL.ECTRIC

ACCOUNT STATEMENT

ANEMERA COMPANY		

TRIPLE CREEK COD		
C/0 GREG COX
12141 TRIPLE CREEK BL		
RIVERVIEW, FL 33579-0000		

Your Account Summary		
Previous Amount Due	$21.58	
Payment(s) Received Since last Statement	-$21.58	
Current Month's Charges Due By 11/07/2017	$28.44	
Total Amount Due	$28.44	

tampaelectric.com   I	f W rp 8• al in

Statement Date: 10/17/2017 Account:211005280683

0

"'

RECEIVED 0Cil.S11J1r

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be 8SSBSsed1J late payment dhai{je and an additi'onaldeposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccountcom or visit tampaelectric.com and select Pay Your Bm.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BILL

'6

Account:211005280683

TAMPA EL.ECTRIC

AN la:MERA COMPANY

mail

phone online	pay agent

See reverse side for more mformat/On

00003315 02 AB 0 .«l 33614 FTECO110171723185510 00000 05 01000000 006 08 32003 004
IIr1•••1111 •11 111 ••1•11·1111 11•1111 1111·I1111 •111•1  ··I··1•111•11
TRIPLE CREEK COD
C/OGREG COX
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

684716177255

MAIL PAYMENT TO: TECO
P.O. BOX 31318
TAMPA, FL 33631-3318

6847161772552110052806830000000028448	Page 1 of4

TEC

TAMPA ELECTRIC

ANEMERA COMPANY

Contact Information
Residential Customer Care
<'313-223-0800 (lliiisboroug:1 Coun'.yJ
863-299-0800 (Polk County)
88B-223-0800 (Ail other counl!8Sj

Commercial Customer Care
tl66-832-6?49

Hearing Impaired/TTY
711
Power Outages Toll-Free
(177 i'i88 1010
Energy-Saving Programs
B 13--? r:)··3909

tampaelectric.com

Mail Payments to
Tl.CO
P.O Box '.l1311;
Tarnpa; i·:L J:i6:31 <1-18

All Other Correspondence
Tampa Electric
P.CJ_ f3nx 11-1
Ta,npa. f L 33601 (J'i 11

Understanding Your Electric Charges

Average kWh per day    Ti,n d'  GrD q o  arnc,c!:I	-: :r1 c /.'1C  ty  pu!()Jased
pe: day.
Basic Service Charge A f:;:.:.t3d n onth1y aniounl tr; covor !hG cc -;( c:i p1ovidin9 ;t!rv!ct: to your lncdticn,
Bright Choices...    Tt1c: nur--ibe!<  o'  ::ur:• i!x1v  .-,'.·, <J',d',;,  oc;e,0   i"n,;c!d
frcn·, Tani XJ ElHclric, ;:;n(j (j'. f")OCl1 !ecJ fHHS ;Jnd
Budget Billing Opt,011(Ji phJn U f.n ) :•:e h·qt ..; i:Jr:d 10'•:::; cu! c/
t:;c:r;t!dy e!Aclric b:l!r;. Th: \ " '.rr t·-.,L:1 / ' :·;·11:nq :)ir:;r :;-1vcrauc;s y{ u· lr:;;;t 1 '?
:·n1° ·11/,;y b1!1inq pf nods c yCJU c: -11 pay ;:1buu: H:t' ·,rirnt-; n:ncur·t fL:1 1cur :;t:rvict:; ench mo1 H-,
Energy Charge  The ccsi  (t!Xl':t0(Jt  fue!J  (1!  ;)•oduc,11t•1  tnc  f• if\;ctnc1ty you 1.Ju:cha:;, cL 1nclud1nn cor-s(-r\•ai:cw:, f;nvJ.o,J1 t•r:·.,J :'l:Kl c1Jp: 1( .:v cn1:.1 recovtny chrHg JS,
Estimated If Ta:npt Eir:c;rlc \,\'i-Y1 ur:,-1lJlt} lC; 1!·:,1d ynu• ;-r:rdt-:r,
"CSTl	ATED 11  v:!!: rJppr.:r;:·  Yot.r (;iuctr:c  u \1..:?  t:n ;  lJf;c:•1 r r;;t:rntJ!ed t);:,ised on !)ffJvious usage Tho r::r.;if ;r 1 , schl-=:dLicd le tJ :; rf ;-Jd nf'.?XL n1cH 1tri, r.1nd , ny diffe1e  nc1:1    br   !1:.,ee;·1 t -H-; f•is;:1·18ln ; r:d r c!uai u:;e Vl/;i1
bt < ldjuStt:ti accord1r:niy.
Florida Gross Receipts Tax /\. lax ,,s ,ri ,occ;c·ci < ,,. ,_,. ,·,:;,, ,!!U'if)':s
fror-;1 u\ildy services  thi"Jl c;re de!:\'1_.j!(;d !CJ  H:;1cJ 1l cu -:.;1un1e;[ in  r=!o:ich::, 1n accorc::h nce v1Hh Chaptei 203  ef  lfH Flor:rt1 Sia!Ltns  !h<-;  tax  1s  iev1ed nn u1i!1ly conip,1nies, vvh':ch ci:_ii!c1c! the tax fcn1n ;Ji! cu ;t(:n eis, ur;!p .;::, oxeri-1pt, and rern1t to the !-1'.dLt:.:
Florida State Tax    A p, i11<e:cy  1 !:Jx  :r,,p,::;r,, l < ,(:    •·,vC, 'y   l)(·"tiU1 wt10
tJG[idDt:: , in th(?. bu -;iness c;f sel11nq or renl:ruJ tnn ]!t>\·; _:)fli[<FHJ!
p:-c!perty at  rHld1i in ir:e s!ntr;, 1 1  tH:ccrth1f1Ct'.i 1ndh  C 1,:');'>tf-;1  2 12 c   :h-  1
FluridD S\n!Ltes
Franchise  Fee    A  fet?  lef:f•d \;·,., a  :-:;cr•:c ;:,;·! :1)	fl:r-:,     Jt;:	u:;; public ;=.1roper!y o;- l! f: pu'pose of pr,y.,;(Jin(J Hh'JC\i iL sr;rvice. L:kP iaxe:'I the ft e ts coli(:-:ctnd ;>y Tarnpn Elecii·,c ,1::d !S ;"Ja:d ;o tl e ir1un1clpnlity

Fuel Charge Cus! er fuel ur,t-:d tn u1r;cJucc c1i ec : ri1 ,'.V ·;1ou 1JtJ:chaSfl(J. ut i (.c<-;t ., ::He )n J 7l·Jd iniOl?_t: f1or:1 it,e: supp!:t r: , tu our   CUSl.CW:l(·H>  v 1:!h  1''()  '.T arktJU u:  D·cfd [(l  :a(r;p;:; F:eonc
Kilowatt..Hours (kWh) The bB :1c r;1e? · u1{-::-r;1-;nl c f:!cc ;!c Hne1qv
lj le
Late Payment Charg1,1 ;::r;, D.:i:,' due> WH•\ffi'S ;r,,..•;c ;:,,Jr ,; ,r;. :,,,,
!?Jr: :-.:i,'.JJd :1-:q:  ci;;):-q,: ;   tr··f•:   ft1;:le 1.l: SS	1 .0(:-': (if u·ic p ;-,t dtJt_ ·
;'l  '.T·1cu:· '.. -n   111:J:. 1  due 1:J;nc .;r:1 , er  /l() (,; it '.:;::;, P·1c• ;a:Pf  '>i·J1rn(•; 11!

Municipal Public Service Tax    i,., r,drl  , 11 ,.Jr   tut:+ F.:,r;c:;::,<: r''"
·1 t.ny t1:Lf'i.('::p,il!:,i:i"; l,;-..-y ,1 l;Jx en !ht t::ir:C!Ci(;!!'y you \::·1{:'. p cci:t-1c: d by T('Jn·,p;- F! c.11·1c r.H1d paid !o ir,f; 
Past Due    P rff, 1 it.1tit·   chC((Jt::s  th; J  (;1,(  :      fX.J ::/  dtH: a.rt·! r,ut\1cc: i{;  z:  '.,Jif
n::J}•!11er:l 1. .r:c-Jrun '.t!e r'H!d n1ay re:=;uH 111 d,:,c(1ri::f1ct·c-
Rate Schedule :' ht 1 rr:1uur:t ( 1 r::lc ) y(:t; pay 1h-:pc'.•;ds en yc•l :
Ci.r:'l!Ci!Yier cal€[JIY'y, T:,c CTiSt (!f u;(fr,<lwq :_'.'.; (:> ._1 :c f •,.1;1r:e:::. \' IH! :nF:
CUS!Of:lt"Y q'CHJp

Share /\ p1nqu1r'1 rJ1- -;pc.r1 ;nred uy Ta;::p,: Fiectr;c , nd 1t·k1 Sc:1ivat10:,, i',iTny vvt;eth cu:,tcr-nf;r::; can ht:1ip 1.X.iy thf•1 c•r c:i\JY [)iHs c< ctJt; orners :n n •;ricJ. /\ n:1t :-t11:H cnr·,ii'!tJcUon ctiri b cnddiJ, r.1 you; rnoriti;ly :;tc:cttrJ CtHn,r bu! 1f ir 1 \' ►' t;I DPrJt ar un your bdL Yen;:
c:r'r,ti-!l>ul:c;-, is 1,·1.1< dndtJ1:!!hic ,J:id !:1 r1u1chf1d r-,y Tnn pt-=J t!ecuic,
Total Arnount Due   Th,::; rnnnth's c-t:arpPs '1  dl  )H   past dtif: afh:r
1 i!C' diJtt? :·1 1u.11P. 'THIS Qf.T DOES t'·JOT XTr.:r\;:J THE DJ\TF 0'"'-J
Alo.JY PRE'\./!Cr.JS F-:,.'\t .:\ \JCE. It 1 ; :i:·pcft::F:i : ,;;'. yn1,.; p!::y ycu· b1j:

Your payment options are:
<! Schedul(:) free one-lin1e or n-;curr!no t)ay11it;q\r; <)t tan,paelectric.com L s:r:'.J ;J ct1rc;,;.r .q o ,;J\:·in;_r1 ;:;cc(1u11!
..  v18d your payn1ent 1n ihe f1r;ch.J ;ed  envelor:.i .  P1t ;1::,t:": ;11/cvv' su1 f,c1r:r1i  \i:nP fr,. d{-:/i·.;pry,
11 Pay 1r1 pt;r:3on ;JI e loccJi f,iuthor;.t_:( d payr'1e11! ;J(_Jf nL For r; !1:Sti 1n	;:Ju t i·1u riL.l'1d fH-)'yn:er,I ,:;qc-n\<, ·..n:,:t tan1paelectric.com c-,
C::-Jre a! ihf-i rium!Jcr 11s!r:d ;-:.ibo·.ce.

,	Pay by c:ed:: o: cJeti;t ,;,i•!l 11°,,r:u Ou,c.i, P,T1 :-:! tampaelectric.com nr ,.,:, 866-689-6469

di ;ct ,·\nc0c!ior-.

'/vho !! n(Jt (")U!hOnleCJ \(J :x,: n:- () D!.JJ•f )tii;i /J{j'-''.nl nf Tr.JY'PrJ Fiuc.iriC V\\I; (k'.r:: \ ,c
Tarnpn  t:IPcl11c  :Jnd do   ,c: 1:·; n   t1 n 1rJl y f;:i::.,/:;c:i  T, n n,i  f:if:Jc\cic: i ; 11c  :  q·•:::pu'1 ·;1r,it:''  ,+(1:   n;1y,1:i;r•i:-: .;:i.ldc  i,_, 1J:;;Jc;it1cnL('d iJtJt
fa:iuH•J  to (l.11':vt-:i  c,r lirr:f3iy  di:1\:'./(-:r  tr·,(  p ;:Jy   T  1i-1  r: 1  le; t(,_  Stief; friiiu:t· S  t;fr1y  1r:sui1 11·: 1r.11n

Page 2 of 4

TAMPA E:LECTFIIC

ANEMERA CCJMPANY		

Account:	
211005280683	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/15/2017 to 10/12/2017

ACCOUNT STATEMENT
tampaelectric.com I f 'JI 'P 8·LI in

Service for. 12141 TRIPLE CREEK BL, RIVERVIEW, FL 33579-0000	Rate Schedule: General Service - Non Demand

Number	Read Date	Reading	Reading	Total Used	Multiplier	Billing Peri	
C21063	10/12/2017	46,056	45,971	85 kWh	1	28 Days	

Meter

Current

Previous	=	od

Basic Service Charge Energy Charge
Fuel Charge
Florida Gross Receipt Tax
Electric Service Cost

85 kWh @ S0.06216/kWh
85 kWh @ S0,02956/kWh

S19.94 S5.28 S2.51 S0.71

$28.44

Tampa Electric Usage History
Kilowatt-Hours Per Day (Avemge)
£'1+-3
SEP ,0.-1
AUG t0.3
JUL.	,._.,.10

 		JUN	15
MAY	12

Total Current Month's Charges	$28.44

APR--.4
LIAR	,i
FEB-3
JA.N	22
oec.	,.e
Nov	a
OCT ..--◄
2016

Important Messages
The billing periods of the individual meters of a mult1-metered account may differ from the dates displayed. All the meters on such an account may not have been read on the same date due lo their location on the property.

Page 3 of 4

An audit you can look for	ard to!

Tamp.1He(lric's FREE Commercial Energy Audit
can save your company energy and money. Our nationally certified commercial energy analysts are ready to walk sliouldeHo­ shoulder with you JS we evaluate your electric US<Jge and provide you with
no-cost oclow-cost suggestions that
,an improve your enerqy eff:clency.
We alsn offPr" Comprehensive Energy Auditit ,1 rnirrnnurn u:\I J sr; t>r
:,;;rnnerddi ,,r indll\lr1c1i f,icilitiPs. A p,irt ,,f1i11•, •!1Jd1t, ,.11H ar\1iN 1•,il!
a complete wciik thrJUllh of y,)Ur faJity. !1• addit!1J11, .'ii' v:1li ,•,b nH r "r,d

monitor• up to two

\'tillevaluate proper sizing of equipnnit nd
inefficiencies and more. Once rnoniH,rmJ , ,:'.nnrt+'. ·1,1• AiJI '"'1,rr,, ,t ,,, i ,: tiur,;
)OU can take to maximize your energy efficiFnry
More energy-saving programs for your business
Results from yoor Energy Audit may show thar Y()Llf business ciiuld t,, r:, :i; fr;;r11
T.Jmpa Elecuic's other energy-saving programs. Our energy analys: 'l:i11 :,1,:r,t1ty

areas wheie your business rnuld be mor,, enPrJv ef'1de, , 11 m orrr'"'iid tne
following programs that (dnhelp:
Commercial CoolingRebate program I ,rrn I relJ,ite ,1qd /lt'!p rerJup }JU[
energy costs when you add or replace cooling equipme"t at your iad!ity
Commercial Lighting Rebate program- EJrn a rebate when ycu rep!He
,·x1\li!1fJ incandescent lamp With high-efociencyrnmpact fiuorescenl lamp) (C!! )'
(,r i1 1i11 ernitling diode lamps (lfDsi Y.;ithintonditioned or non-conditiont'd \fldC<'.
Conservation Value prognam-Offersreb.ites to commercial and industrial i:v,LPl(·''- that implemmt conservation measures that primarily reduce p:iwer (',w.urT'pt!onrluring peak-demaoo perioos.
Contact us today and schedule the type of audit thatcan help your
company boost ots bottom fine.

TECO.
TAMPA ELECTRIC
ANSMJtftA, t:!t:IMF'ANV

The power tosave you money.SM
TampaElertric.com/BlzSave I 813-275·3909

Page 4 of 4

TAMPA ELECTRIC::

ANEMERA COMPANY

TRIPLE CREEK COD 12113 TRIPLE CREEK BL
RIVERVIEW, FL 33579-0000

ACCOUNT STATEMENT
tampaelectric.com  I	f "# <j) 8• I in

Statement Date: 10/17/2017 Account: 211005281889

Your Account Summary
Previous Amount Due	
$71.06	
Payment(s) Received Since Last Statement	-$71.06	
Current Month's Charges Due By 11/07/2017	$62.40	
Total Amount Due	$62.40	

RECEIVED

IJt,"7'

.	lrJ·<-tt,a, , -Ott,\n,,'o' ',Hlt&7.-L,;v,:U•,d. C,:,i f',r,J.,  Rtn-.;:-.:,7:IJfC-

iJ._ C.:1l.:t- ,	·-----·

D•1   "	n "'""Oval	Oat,..

FL ,-..   	

GL 	C_,

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BILL	Account: 211005281889

TAMPA ELECTRIC:: AN EMERA COMPANY

mail	phone online	pay agent
S€e reverse side for more information

684716177260

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772602110052818890000000062407	Page 1 of 4

TAMPA ELEC::TRIC::
ANEMERA COMPANY

Contact Information
Residential Customer Care
FJ1 L!23 OHOO (H i!stxiroiJ9'1 c,1,irily,1
863 299-0BOO (Polk Crn,nlyJ
888-223-0800 (Ali other count:es'l

Commercial Customer Care
B66-B32-G249

Hearing impairedfTTY
/ 11
Power Outages Toll-Free
H? ;· Jdcl 1010
Energy-Saving Programs
fr! 3-27S--3909

tampaelectric.com

Mail Payments to
TECCJ
P.O. t3c;, 3131a
Tamr,.:l, FL 33ti31-3'.,18

All Other Correspondence
Tampa Electric P_(), Box 1 i 1
Tampa, FL 33ti0Hl111

Understanding Your Electric Charges

Average kWh per day    The averar;;, ,,,·:,1iri, uf c",,,.,c::,c1:1' pu  1d   : asnd
pc-::r dny.
Basic Service Charge /\ iixed rrc,rnt·1l'y ,,,,il'll"i iu vYv8' ,,,,,: c:ci,-! or
prcv1d1ng setvice to yotr iocatior:.
Bright Choices.sr.a Tilt:: ;1u "'n 1Pr of i;ti't "":x1urc,;:::. a11cl:'c,: :)cir::'.. ie;:Jst d
'.:(·J:-r: "far:10 :J EJeclric, nnd ns - ociatr-d r,_>•:-. nncJ cn,-:1rcJP ,.

Fuel Charge    Cci:,, of fuei used ic 1)1c  duc     e   e!cicL1c,ty :;ct, purchasod. Fue: ccsls are p;::1s; fld  th1oug ·-  f'"cn1 fut'.?! supp!1er s re ou1 cus!o:-riers v1dh no ri1arkup or prof1! :o T;,1:r1oa E!ect;1c.
Kilowatt-Hours (kWh)    The basic  n p;:1suren-1f;nt c'. e!ect	Pnt !OY
use,
Late Payment Charge    Fer  1X, ,'. i du"	a··,1o•J"lS  rnH, :t,a:· S 10  1 r: H
!;-::;te r1ayrr11: n; c 1CHOe is the greiJ!e(' of S5 er ' 1 .EJ { of tt';t u;_:1:-;1 dt ;t

•

a:-;-> c1u nt. For past du(-3 d01ouri:s cf  SHJ er  iest .  tne if'J!f ncJyt: t,

1·.1Jr'1 :f 0 'v u:H:no pt"!r!OdS SC ycu ( , ' ('ll.iV c..1hcut U1e :sa:-1:(: c-F1\{'L'![ \1;.

ch;JJf)e 1s ·1 .5?1

of tt'H past duE ;;rnount.

'!'C J;"  r:.f''   \- 1C8  each rnonlt'.
Energy Charge    Th;,	 "rf,U   )11:cf·1(  ;ed, !nc lu d 1!1' (l  (:(r'  ;r,:·.,,:Jlit:f'1,  (.,q, / :1( 1: ,P 1 {    ;·.        r)i     ( •.d c.:inr)c:\y ccs! :"t ccrvr;ry ch, rqes.

Esti111ated !f T;;Jn1p;:J Eit c
'ESTl /f,.TEQ" \:V.11 ipptt:F, Ycur

Municipal Public Service Tax i,, ,Yldd1"r t•_j t!,(-! F /,,,' ,,,r: ;:,,ro
:nany r"1urHciDa:;t1es !f.: vy , lax or: 1hr r lf:ct;rc1ty you L::'1F:. Lr
cc:iectecl  by Tar 1pc Eiec ric  { r:d ;x:11d  lo  d-;t.: n:uriic prJi·1 v
Past Due  F'ri::i,.1:cn1:; cl1a•of'.,:s lh Jt ;:)ie past due are suL,J;C.'. ;l	iaic
pdyr!;e11t c)1;-11ot'-'. fr1e ;.:ind r-;1ay resui!	d!scG:!nect1cr,

:.1asecJ er: p t:vious u( dGJt . 1 r:r
:1 on!h, ar:cJ any d!ff( 1enct.-; l'H_\ ad 1u ; t(id nccc:rd1:·1gi·'/.
Florida Gross Receipts Tax ,\

t: Ud rll?X'.
, r:d rJciu 1: lJ -;fi 'Nill

cu::: tcr )P,!' C,J'.equ•v, Tlie co ·,1 cf  0 1e v1d  1r:o   St r\l!i_. E;  -..,a;-;(,\S  1/.:1: 1-, tt:t•:
o::;:c,n:f3i ornup
Renewable Energys.. :,,,, .1:c,.•1;,: 
:t· :·:n1.·,r, :!Jlf-; S( ;u :-:._·:o(,.

:;n·---1  \1[.!:ty  servict;:; ltini c.irr d(· :·,,e:cd	,et;:J:! cu:·;t ·a:'h;<::; i :  F:u11d  tJ. I!\
,;;cccicLJr·:cfl ·nitt1 Ct·1rJp(E;1 20? of n·1t : !=":o. ,cJ/J S'.i:J,t1te'.;. '"."' :e :ax	ic-,,:t::d
er ut:'.ily comp(•J.!lie: J. v.th:ch cc:iect 1he ln::i:: f:r::11	

exf r;-1p1, {:1nd !·ernn o the '.1::;tf;.
1:;r-·0 1oe:-1 ir- tne t)t;sir:E<,s cf ::)ei!·:·:o ct rent;n(J '.,:::1(}L)!c, DH :,:,
nropf:;\v  at  rr '.aii 111  it'1c  s!rJ!t-;, :n / ccord::n;ce '•:.,;     c:;·;;J;;trr	.7 r-f '.i:ci
Flo:1da SU-rLitHS.

Franchise Fee    /\  iee iev1t.:d b\'  J  r-;1u '.n C1p  1::i 1,:.   /
pul)i!C o:oo8rty fo( l -J pt:·nn:;e of provid,::n
,ixr	Lr•G  ft:;r; ,s co! 1( c ted    hy Tr;  -:pi1 Elec\r
:urnc :·)a!;ty.

Share A p1cg1::Jrr1 cc,-spr:,11 :;orod lJ':,-' Tr1 11pn E:Hctr·r urn, :t.,c S.;1:vr t;on /\rt: y 1.t.tf· e 1e  cus:on1nrs	hcip pay '.tle 1 :"'H'D\'  l>!i:s cus1_or- ers !fl nepcJ. /:\ CHH?-im:e ccr; ti JL!t!On can be rnadtJ, er y·()U. rncntf1!y r:h c\ecl con!.:-tl)ut:Oil vv'd1   tJD;)et:J,  on  your  b1ii. '-:'ctJ( cc.1nlnbLti(Y1     t.<Jx dt-;duci•b:e ;:J;·;ci 1   f'71<Jtched  by TcJ1: 1  ;  )!	!ect:ic. Total Amount Due Th: . P'!\ nth's l 'laroes v,1!:I be pa::;t d H Jfiei
Pie d;J;e s1101.v ri  .  THIS DATE DOES NOT EXTEt,. D ;"t-'f:  D/:.iC CY<
/;J-JY  PREVl()US  B. LA\JCE.  It  : :;  m1oortf:1n!  !  la\  ynup;·J';  Y(JLi t).;i
efo:e '.1t :-; d,::itf! 11• (;cder ;c avt)1cJ ,r:tt 1rt1ol1or: of snr .,1ct:
Zap Cap Systems ·    Su··oE prctec!,ur:  fo · ycur hn  i(-	n1_,s: 1f::-:,s
so1d   sepf}rcJlf :y  ;:;:;     PCr1 e:1t?iflY rJ·, ,qe.

Your payment options are:
Schedu:e i:"ee (n·1e lirne  or  1ecur,·1 1g  payrrAnts nL ta,npaelectric.com usino  " MB.!! your payr11f:nt 1n the er;ciosfJd t=FT/t icpe. ?1r1; se i:/·1YN Sli'fic1or:i lir11(J fer dei:,:ery.
Pay  Yl persuri at a lcc2i auit1oriLi:KJ  payrnf n! ,;qf.:ni   Fn:· /i  !::;t;nD cf   r1t,tt;o:·iLE1d paynH:;n; .:0Genlt!. \'i:;d tampaelectric.com or C("J;! Cu  s!(Jn1 t.-? 1
Care at thr nurr:l>er !1s\t;d r:it;tT,Je,
•  P:"J·1  tJy cr,•r'i.: <'', deti:1 c;,:·d  u,,.:,u Du!Ci,  P:,y :i'  tampaelectric.com u  ,;::l 1i 866-689-6469.
(I-\ c •: r'.1 / Cr it;r:c t-i fee \!Vii! b0   chc: rnr,d le; yci=H l);·;r:J; nccc·ur-•l (:f	e(J: ca;d)

1."·c1 t-,o !:_;  r·!nt :Ju:!:r:>;.:.::cd in  1.J( !  ;::s ;:-1  [);Jyer1r nl 1:1 F::·;·	T(         -;·:D,J    !ectr,c.  You L'H::1-::,1  dit	1f11- !  \i1i:·; tJn:acH·H):''L('d pa:!·; v;,i: rei,-Jy :f·1e  fL)yP<t:i:!
T(:Jrn;xJ  fic:C(ii(: n::d de :,(:	.11.r,-.  ·;  r;yJ:ucr:-   ( 1(:l      V    ( !.=_-_:.:r  ·Sr      i'JI   -i:::)f1(-··'-,1'  .•:-··    (',   D(Jyr-: er1\  : ;;)(Ji;;   l)  UP(-)1_: U   ;  /:Pd ;: ucnt  .  1fH :udi ::_;
r,1'!u;t'.i	dc-=::r.:t;r  i  :i li!iit?iy  dn '.i'   f '. j   lht: :X)yir P: :  (('. t, ·-. Stii ii  l/1!\,c,:;s • ii-'.JV  rt   :; l; '.1    :rJ l;}[F.'  payr:H-::J! (;  :,v Jf:S	yt:t1r ,:,,:c ; ( \L!: 1! CF S(,H'/.C")
d,:;cc:, ·:t c 1nii.

Page 2 of 4

TE
TAMPA ELECTRIC:

ANE:MEAA COMPANY

Account:	211005281889	
Statement Date:	10/17/2017	
Current month's charges due	11/07/2017	

Details of Charges - Service from 09/15/2017 to 10/12/2017

ACCOUNT STATEMENT
tampaelectric.com   I ft#	<p 8• i!, in

Service  for: 12113  TRIPLE CREEK  BL, RIVERVIEW, FL 33579-0000	Rate Schedule; General Service • Non Demand

Number		Reading	Reading		Multiplier		
K23530	10/12/2017	34,147	33,701	446 kWh		28 Days	

Meter

Read Date

Current

Previous

Total Used

Billing Period

Basic Service Charge Energy Charge
Fuel Charge
Florida Gross Receipt Tax
Electric Service Cost

446 kWh @ S0,06216/kWh
446 kWh @S0,02956/kWh

S19,94 S27,72 S13.18
$1,56

$62.40

Tampa Electric Usage History
Kilowatt-Hours Per Day (Average)
fb'{t	• rn
SEP	16
AUG	16
JUL	16

MAR---------24

 		MAY  W-1	18

Total Current Month's Charges	$62.40

APR  -    --   --  --.:    1

C1'C---------25

FEB	:2-1

ocr--------22

JAN	26
NOV	24

2011'i

Important Messages
The billing periods of the individual meters of a multi-metered account may differ from the dates displayed, All the meters on such an account may not have been read on the same date due to their location on the properly,

Page 3 of4

An audit you can look for	ard to!

-

0..,
0

0

Tampa Electric's FREE Commercial Energy Audit

can save your company energy and money. Our nationally certified commercial energy analysts are ready to walk shoulder-to­ shoulder with you as weevaluate your electric usage and provide you with
no-cost or low-cost suggestlons that can improve your energy efficiency.
We aho offt1r a Comprehensive Energy Audit d! i1 rninirnurn (o<.t of'.:7'; f;,r 1.,,pn,tr ial er indu1tru! facilitiE',. s pirt oftii!s rltHilt, our d!liily t wiir p,,rfnr,1, a complete walk t,hr.)u11hcf your fadlity.111 addition. 'He will ·,ulHlh:'i r ,ind
monitor* up to two [':C(es of eq1.!ipm1:nt fw apprrJXnMel, one ;n•Jlitl!. Tile 3!1Jlys; will evaluate proper sizing of equipe1c:lt ,nd or,cratinq !m.irs, ;ckntif'i pr<11ff inefficiencies and more. Once monit,,ring !, , ,w;p,ftc, we 'Nil, ff,znrn,1r:11·i a,; 1011, you can take to maximize your energy efficiency.
More energy-saving programs for your business
Results from your Energy Audit may show that your business could t,refl! t',,rn
Tampa Electric's other energy-saving programs. Our energy analy'>t  1;1 /    id,:1,,,fi

areas where your business could be rno,r,' 'ner1;y ,,ftmn:t awi re, r,nirrcnd thf
following programs that can help:
Commercial Cooling Rebate program - Ldfli d rdJdte and h,:ip rpdrJCe yq[Jf
energy costs when you add or replace cooling equipment at your taciHty
Commercial lighting Rebate program Earn a rebate when you r('r 1, c c:,l't;ng incandescent lamps with high-efficiency compact fiuorescen! lamp)	,:: Pr Jrq!;, (·milting diode lamps (LEDs) within conditioned or non-conditioned spaw
Conservation Value program- Offers rebates to commercial and industrial
,J.t: ,n::\ that implement conservation measures tiklt primarily reduce power rnrn1n,rtion during peak-demand periods.
Contact ustoday and sdaedule the type of audit that can help your
company boost ots bottom line.

TECO.
TAMPA ELECTRIC
AN£MERA COMPANY

The power tosave you money.™
TampaElectrlc.com/BizSave I 813-275-3909

Page4 of4

TAMPA ELECTRIC

ANEMERA 01:JMPANY		

TRIPLE CREEK CDD
11920 STREAMBED DR, CLBHS		
RIVERVIEW, FL 33579-9315		

Your Account Summary		
Previous Amount Due	$718,07	
Payrnent(s) Received Sinca laslStatement	-$7i 8.07	
Current Month's Charges Due By 11/07/2017	$667.29	
Total Amount Due	$667.29	

RECEIVED

''·' .... -

lL	v1.,

Go., 1f!G.T 2 3 l!11Z_.

..-\ --,     	 nr-   _"

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

ACCOUNT STATEMENT
tampaelectric.com   I	f "#'P 8 4 a in

Statement Date: 10/17/2017 Account:211005282127

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Billing and payments made easy!
We offer many convenient and free ways to receive and pay your electric bill, such as Paperless Billing and Direct Debit. For more on our convenient options, log into tecoaccount.com or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt cred;t, please return stub port1on of this bill with your payment. Make checks payable to TECO.

TAMPA ELECTRIC ANEMERA C:l:IMPANY

WAYS TO PAY YOUR BILL

mail	phone  online	pay agent
See reverse side for more information

Account: 211005282127

684716177261

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6847161772612110052821270000000667298	Page 1 of 4

An audit you can look for	ard to!

g

..

0

a,
/f.
C

!

"N'

g g g

Tampa Electric's FREE Commercial Energy Audit

can save your company energy and money. Our nationally certified commercial energy ' analysts are ready to walk shouldeHo­ shoulder with you as we evaluate your electric usage and provide you with
no-cost or low-cost suggestions that can Improve ur energy efficiency.
We also offer a Comprehensive Energy Audit .1t a mi11im11m ,o,i	r,,r
CIJ'.rll!i'li i,:l ur inrlustndi f.Kilil1e\ As rwt Df this .1ud1t. rM dlldly¾t wili
a complete wa:k t!w1uo;1 of yuur facility. in addition, we will sub r;i,:>tfr di!,.! rnonimr• up to two cit(. 5 of equiorne:;t iv ap11ro/rnat!.:ly one :1;v11t!1  will evaluate proper sizing of rqqip;1wnt and nr rzi:,nq ilt0 ur,. ;dcr.titv p;,.;:r•·, inefficiencies and more. Once rnonit'.lling 1s	W<' wil: rc,.r,rnw:::! "' fr':r; you can take to maximize your energy Pfficimcy.
More energy-saving programs for your business
Results from your Energy Audit may show that your business could ,n-r:r
Tampa Electrlc'sotherenergy-savingprograms. Our energy anaiyst '.'iii! iii,•nt,!y

areas where ur  business could be more ,-r1,0 i•JY efm :cc,t a, :J v0rnrnrn2ndrip
following programs that can help:
Commercial Cooling Rebate program ld,n A 'd,.i!::> .ind i;r:!p reduct>;·.1 r
energy costs when you add or repiace cooling equipment ct your ia,:Wy
Commercial Lighting Rebate program - Earn a rebate when y,r1 rep· i• e
,•x;•:i:,g incandescent lamps with high-efficiencycompact fluorescent lamp i'°r! <,':
,,r	1nitting diode lamps (LEDs) withlnconditkmed or non-conditioned spdce.
Conservation Value program - Offers rebates to commercial and industrial
,u,r,; fl•:!) that implement conservation measures that primarily reduce power
,,,r,,1 ,rr,ption during peak-demand periods.
Contact ustoday and schedule the type of audit thatcan help yoor
company boost ots bottom line.

TECO.
TAMPA ELECTRIC
AN£M!:AA COMPANY

The power tosa,e you money.SI,\
TampaElectrlc.com/BlzSave I 813-275·3909

A,ai/at,/t OIi equifX1l(f)f or panels ,;;"80 .riti.

Page4 of 4

TAMPA t.;L.EC::TRIC::
AN EMERA C:CMf'ANY

TRIPLE CREEK CDD
13315 DORADO SHORES AVE RIVERVIEW, FL 33579

RECEIVED

:,.,. ocr 2 3 2011_

;,.,'•.,,:._,

ACCOUNT STATEMENT
tampaelectric.com   I	f W <;.> 8• I in

Your Account Summary		
Previous Amount Due	$1,076.49	
Payn,ent{s) Received Since Last Statement	-$1,076.49	
Current Month's Charges Due By 11/08/2017	$125.66	
Total Amount Due	$125.66	

Statement Date: 10/18/2017 Account:221002207761

Always assume that a downed power line is energized. Visit tampaelectric.com/safety for more safety tips.

Billing and payments made easy!
We offer many convenient and free ways to receive and  pay  your  electric  bill, such as Paperless Billing and Direct Debit. For more on  our convenient  options, log into tecoaccountcom or visit tampaelectric.com and select Pay Your Bill.

To ensure prompt credit, please return stub portion of this bill with your payment. Make checks payable to TECO.

WAYS TO PAY YOUR BILL	Account: 221002207761

TAMPA EL.E:C::TRIC::
AN  EMERA C:CMf'ANY

mail	phone online	pay agent
See reverse side for more mformation

655086552836

00000500 01 AV 0.37 33S2S FTECO110181723170510 00000 03 01000000 002 04 14488 002

R

11111• •1·1 11111111••I·11•11111111111111· 1·1111111 111111· ·11111•11

. ..:

TRIPLE CREEK COD
12750 CITRUS PARK LN, STE 115
TAMPA, FL 33625-3784

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6550865528362210022077610000000125669	Page 1 of4

TAMPA ELECTRIC AN EMERA C:□ M P A N Y

Contact Information
Residential Customer Care
g 1'.J-221-0800 (!-..lrl!s!;oro'...1gt1 c:cnJnLy) 863-299-0800 (Po!k Cou:1ly)
888-223-0800 (Ail olrier count.es)

Commercial Customer Care

Hearing Impaired/TTY
711
Power Outages Toll-Free
B7 7-!::JH8 1010
Energy-Saving Programs
813-27 , '.Elf)')

tampaelectric.com

Mail Payments to

P CJ Bnx 3 1318
fon,rJrJ, f-L 33631 3318

All Other Correspondence
Tampa Electric
P.C) 13ox -11-1
Tamna. f L 33fi01-0111

Understanding Your Electric Charges

Average kWh per day    1   he ave;r;-::g,  ;;;r:nL"•: ;/   f1!t"'.'cL-1c11y  pL  :·cf 1a::;ed
f_1( r day.
Basic Service Charge A f1xp,d n1cnthiy arT10l1n; lo CC''/8' U1E co::-:: cf
p:ovid:r·:9 SPf\,1Cf \G your !oct:l\;cn,
Bright Choicessu The !urr:l:n r Di '.1( i t~:1 :,x(Lff::::; ;:.Jr:d/o!· no::-::, \-:;: ,r d

1

Tr.::r.p; EiHc!nc (ff•d :-Js;)nc:;:J\(;( i fP( :S :Jr·d \ '. ;::roc t;.
Budget Billing    Opt;ona! p1,,<', ,a:q.,·, if'•', ,q:,s ,;n,·J ,uws ,·,.;,

z/ec[r:c  bd! ;, ih!s ;;!eve! r·r( U; i:1 ,q	a\."e:nuc s )1 CJU  ''  ·,;::;(   I
u di :r10   :.1cr:nds so  yz:i1i L::;,:  p;:1y n tJt1td	,,), ·,e aPK}u· '. i+o:

Energy Charge    T! 1c; cos! 1:e. -<.cf:   Dl   uo) cf  );cduci 1n tht::	:ci;y
y(,\.  p1-;.·1·:!1n ;( d. lfl(lt..icJ1no  ((; '•Sb'\·D(.(:;·:   1.-: n v 11(:i·:ni      e  r:i  1:)i    {jf;rj  (./j()r'J( ::.v
j ,1.•1 A; very ci·•t1" Je ;.

Fuel Charge Cosi of fuf;1 u r-:d :o u:uduce t lf:!C'.(iC1'.y ycc
:)UiGflfr_ ( :cl. :ue· costs are pt: ::<·;pd U·iicu Jt• frcrn furd ·1uppl1er , te;
OLr Cll:;tcr•:t:1s v1d:r nc :r,;:i:·i(u;)	profit to Tarnpr1 Elec!nc
Kilowatt-Hours (kWh) 'h,c l),·1"1c: r;', ;Jsurern101;i of HiEd·,c Pfi!-'rrJy L;;ofJ.
Late Payment Charge c:r:, 1:,;-"j dLe, J ,11ou r;(:; n1c,c, lh;;n SIO, 1:1F
!< le p.:y; :1-!r:( ct,1arqe if iht• f lft :iJif'..H nf Sf) c• '1.5t;'.) ol the pas! duf?
1Jrnotjr• ;:er ;x;s'. duH a:1'.Dc::;ts cf S"1 C er :ess, the 1a!e pi:Jyr:-c :( chc1roe :f, <	cf !f 1  t    pa::.is: dtx-; ar:1cu:-:t

C;U ;u rr:t: 1 CcJ!t:.:9e: ·:1. The

Municipal Public Service Tax Ir, .1dr:J.,,or1 ,o t',e, r • cJr c rc1:; ,0 f'Pe. q  ;:Jr;y  rc u  r:,c 1p  d  i 1;    1c s i(::)VY  ;:J  :;:;, (J   t:"'f  elnci 1 1c  11y   yoti USfJ. I!; ::; u1::eciecJ lJ\, ;rH in;:,i E·ec'.i'c r·!r-.d pa:d k 1 P1e rnun1cn)ai ;y.

'FSTl\'1ATED' \.' i\ 1 '.Jppz a: YcLr
:)r;r,ed ur1 nn=r•.,;c:u:; usar.F· .

u ;r:: •as been est,rn11ted
•:-; :·,ct:C:( luiHd tu bf1 rr::, d Pt-n<t

r::on!n. (Jtid  ,:-Jny  diffflrer!Le  i">(:l   \i\1t?.f'  r   ir,p e -;1,n Etf:  and ac uat  L '.;t?  ·.:-.:;
U : /.1d;uSt( d 
Florida Gross Receipts Tax    l\  ;a;. :s ,:';p,,,,HJ ,,,·, 11,oss ·,,('C',,.k,
rro;,·: ul,l:\y se:v!i: f;S th,Jt a-t-; de!i,,1P1r,d 1n 1 i ta !: customers ;r1 :c:, :dD
·,accoidcJnce 1.r; :th  Ch1::pte:· : 03 ('f  (t·,1.    :nrida S:Etules, 'held,<	iP--::,-,d
(:in t1t!ii(V cornpa 11f:)S, v,.rh1ch cc;: c: \ :t; t;;]x fror;-i ali cuslorriers. \ir::1?f; l
':-- -xernpi. a:-:c:! rt-,::·1i lO lh( :;i •Jte
Fiorida State Tax    /..., D:-:v!lrocl  LJx. :•11;)uSE d  or   e'·  tF V  pt r:1c-n vJf!O
e;·;q;J<:.F:!s ;q   iJ-:p L>u s1::es	;  er Sf!;!;r: J c,  -  :":r1r1g  tan91bit  pr r :;c •:Ji
prc;p1;:-;; ty r:n :e1u::	1f:f; si,"Jtt:1. ;n {'.jCC,J·dt nce V/:lh Chr:iple" '2 !2 cl !r11-?

Zap Cap Sysiems· St;:(JC,

F'fi, .de; Siutu1er,.

CtJS((;ff:(;, qr{)lJp,

Share    1-\ p:oqr::-J:li  cc-spc:·1::,c!ied b:, T/1n1pa Elt:ct! 1c  and   !ht
Sa,l1. ;,;t;u r1 /,,11 :r, \·1t1c:;n=; ct s:c rrcr : er.: -.E lp pay the era-J:\JY bd!s of
cus\c,rners ,n : flecL /\  c;r;r•-  u1H curdr;L>tJ!!OP Ct.:Jn  be  :n;:1d8, CH   you;
1::c,-;:hiy f;iC!Clt·?d cor1\ribui;c;: v 1 i;! r- pO•?ar un your bill. Ycu.-
c cn'.nuu,icr :s '.ax deduc'.1t)f,: and  s  --,aiched  by Tarn x:i E]Qc!ric.
Total Arnount Due Th•::: rnor;!h's c:;:Jq)e 1 \' ill be p,1sl dul ,1f!t;r
;:,eo rJ;l '., 0       ;,,n·;,,,   Tf-'iS D1\'E ::)OES r..;a, fXTE!IJD Tt•c' !JA:E 0'!
,.,;;·,J\-' PRC\/!0-..,1S 3A!..,J'.\i,JCF. It, ., ,n pc !,Jr l tt-,nl you pay y(:ur L>:l:

Franchise Fee    /\ fet; 'nv,,-;d,! ,1  r1  :•t,;;· c •;);::_: 1.iy   r(1;	:   1e;r-:i  '.ct/ ::/t
!)Lti:!c  c1,:) Jer\, fc:  1 -.f pu: ;Jtk;t;	);cv,cL • 1 eleclr.c SE1'\'1Cf:,
i:Jxcs :  -   1:1     foe  1 1  C(  ;ii•?Ctt:d  tY,< T;::; -ri )1-::    :1_:c ;ric  nr;d	;x1id tc  J;f;
:)a:

''J  , c:e	11a:.!_; ,,

nide·  c ,-f.'C;:C.f	:1;:JiiC'irt c; :, :·v1ct.:;

Your payment options are:
,. sc •eduiP f1ee l/1e-\in:z or f'{ curnr•u p;:;yrnf;r:!s ;-;i tampaelectric.com t.::-..,:nJ a c[:f'.JC:!<i:1 1 c,, :;,J·•-.1.r,q::·; CJ:'Cnts:t

_:

i, tv!a1: )"Our pc-JyTnt nl ;p the t:inc;osed enveiope. PiEJ;,Jse alic,.v ::.;t}; ;c 1t• 1 :1; 1 1' 1f ., :c: 1 h.: !:' i: ry.
,.  P:::1y  :r;     K?rso0 :::t n   iOCrJi  Du rl • c1.'  1L:ed  payrnent  ; JQf)r1L  Fe,:;-  :, ;li- \J i:,f a,1 :·:c:1·1.{t· d  p;)yr:: n'. cJ Jt'?C  -,, 1/ \ ~1;! tampaolectric.co1n C1·- caH Cus:01 11?:
Cr ((:	!(tf. nt,; 11L'Je: :\ :cd ;:J _)C\ 1 Q
P;iy l>y ,.,,!(!::	de'..,'. c > <J uc.:'1\J Quici, P:Jy at tampaelectric,com , , ,:;,;: 866-689-6469

,,,
•r\

Please note: If ynu l h(,c,sr;; !c pny ycur
•: r-n ;r r:ot  -Jt.l ;cr:.r:·Pd tn	;-i:, a );:Jy;:1{ ·

Tn;npa  r::ecl!':c .'!:-1d de, :-:;cw  a '.:nl  ly  f1.' j:.t1:c 01 . Tan1  prJ E!c:cl:

;L· ,._,-.; : i•:;I\(!	orCi\:.dc:d  hy Ta:T• ·:,  F::c< i:·:c,  ycu are payiriu su:1    f ' ( 1f!P
'.!11-:1 1r-,:; Lri,;ult• ;i :.<Fd r_;a1 ly •;.ri,! ;t hJy :.r-••: r-,, rt1lf!: 1
'.o: pdyr'a ;q "' rnt de :c u •:·1t1t!-t111/f:icJ r.19en1 , :ndud,n9 '.ire;f
;; !:·)h::J i.Jl:J\·T[";t r--:t (;h;1:u --!;	V('t,: '.J(C:(it:r1: t•1 :;ervtc,:,

Page 2 of 4

TAMPA ELECTRIC
ANEMERA C::CJMPANY		

Account:	
221002207761	
Statement Date:	10/18/2017	
Current month's charges due	11/08/2017	

Details of Charges - Service from 09/13/2017 to 10/16/2017

ACCOUNT  STATEMENT
tampaelectric.com  J    f W <p S• IJ in

Service for: 13315 DORADO SHORES AVE, RIVERVIEW, FL 33579	Rate Schedule; General Service• Non Demand

Read Date

Meter	Current	Previous
Number	Reading	Reading

C55855	10/16/2017	1,385	365
(Estimated)

=	Total Used
1,020 kWh

Multiplier

Billing Period
34 Days

Basic Service Charge			$19.94		
Energy Charge	1,020 kWh	@ S0.06216/kWh	$63.40		
Fuel Charge	1,020 kWh	@S0.02956/kWh	$30.15		
Florida Gross Receipt Tax
Electric Service Cost			S2.91
$116.40		
State Tax			$9.26		
Total Electric Cost, Local Fees and Taxes				$125.66	
Other Fees and Charges					
Deposit Paymenl(Receipl #100000692480")			-$960.00		
Keep this receipt as proof of payment for deposit					
Total Other Fees and Charges				$0.00	
Total Current Month's Charges				$125.66	

Tampa Electric Usage History
Kilowatt-Hours Per Day

(Average)

W-J--------3-0---61

Important Messages
The billing periods of the individual meters of a multi-metered account may differ from the dales displayed. All the meters on such an account may not have been read on the same date due lo their location on the property,

Page 3 of 4

An audit you can look forward to!

Tampa Electric's FREE Commercial Energy Audit. can save your company energy and money.
';';)
Our nationally certified commercial energy / :·
analysts are ready to walk shoulder -to· shoulder with you as weevaluate your electric usage and provide you with
no-cost or low-cost suggestions that
can improve your energy efficle1xy.
We also offer a Comprehensive Energy Audit di ,1 n:ininEim co,t of S7S for 1,J1111ner-J.1! ;n indu,msi! f,H i!itie'.,. /.,<, ran of t!i; ll(lit, c,ur ,if,,1lysi wili perfnrrn a comp!ele Wdik-ti1fl:ui1h of your fa:iiity. in ac!diri:11, 1,e w:!l cb nv:'ff Jnd

monitor* up to two pli)_cs of eqL)pment fo'. app:oxfmdt•:!y1) !'!1: rn1Jnth. ihe Jn?tlyst will evaluate proper sizing 01c uir:nrnt and	h•1:,r, ,jr tify r,r<',<J",·, inefficiencies and more, Once rnont.,ring is Lornpil'lc, w,, wiVi rccornm,:nd ,ii tirn,, you can take to maximize your energy efiicimcy.
More energy-saving programs for your business
Results from your Energy Audit may show that your business could ber1tfit f,ern
Tampa Electric'sotherenergy-saving programs. Our energy analyst '.':ii! i'lcn:ify

areas where 7'0Ur business could be moF' enH y eftlr;ert a,:c: rf,;nn ic,Pnrl th,' following programs that can help:
Commercial Cooling Rebate program [ar11 d rt<lidte 1nd hHp 't'lUCI: \'LUI
energy costs when you add or replace cooling equipment a1 four raci:i'i'.
Commercial lighting Rebate program - Earn a rebate when yot; rep! KP
<'Xi',tmg incandescent lamps wirh high-efficiencycompact  fiuorescent  l<lmp, (CFL\J
,ir h9h! :"!llilting diode lamps (Lf[J,j) within conditioned or non-conditionedspace.
Conservation Value program- Offers rebates to commercial and industrial
,:ust,.;m::s that implement conservation measures that primarily reduce power
r1'inzt,r.ip tion during peak-demand periods.
Contact us today and sd1eduk! the type of audit thatcan help your
company boost ots bottom line.

TECO.
TAMF"A 1!:l.1!:CTRIC
ANV:"'41tAA  C:t:H..f PANY

The power tosave you money.SM TampaElectrlc.com/BizSave I 813-275·3909

Page 4 of 4

Triple Creek CDD
TECO Meter Reading 10/12/17 -11/09/17 Due 12/06/17

 	Account		Billing Date	Service Address	Code	Amount 	
211005281400	11/15/2017	Triple Creek Tract D	001-53100-4307	$	720.61	
211005281640	11/15/2017	Triple Creek Tract A	001-53100-4307	$ 1,315.90	
211005281160	11/15/2017	Balm Riverview/Trpl Crk PHI	001-53100-4307	$	763.24	
211005282317	11/15/2017	Triple Creek BL PH2	001-53100-4707	$	678.43	
211005282515	11/15/2017	Triple Creek PH 2	001-53100-4707	$	971.26	
211005282705	11/15/2017	Triple Creek PH C	001-53100-4707	$	720.61	
211005280915	11/15/2017	12198 Triple Creek Bl Pmp	001-53100-4301	$	453.09	
211005280683	11/15/2017	12141 Triple Creek Bl Pmp	001-53100-4301	$	80.00	
211005281889	11/15/2017	12113 Triple Creek BL	001-53100-4301	$	66.92	
221002207761	11/15/2017	13315 Dorado Shores Ave	001-53100-4301		
211005282127	11/15/2017	11920 Streambed Dr CLBHS	001-53100-4304	$	621.20	
			TOTAL	$ 6,391.26	
			
Summary		
		General Service	1-53100-4307	$ 5,170.05	
			1-53100-4301	$	600.01	
			1-53100-4304	$	621.20	
			TOTAL	$ 6,391.26	

RECEIVED
Date Hec'cJ Hiaetta & Co., lnc OV 2 7 2017

Date ntered _'"_ OV 2 7 2017 --

D/M approval "'·· S} -•-.D te

oc..

..,. -..-.,............

TEc=a.
TAMPA ELECTRIC
ANE:MERA  COMPANY

TRIPLE CREEK CDD TRIPLE CREEK TRACT D RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f	<p 8• ii in

Statement Date: 11/15/2017 Account:211005281400

month's

Current

charges:	$720.61

Due By:

Payment

Total amount due:		$720.61 12/06/2017

...
0
i
g
.8..

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

l6 Rec'd Hizzetm &

$720.61
-$720.61
 	,!720.61 
$720.61

'I 1HQV 2 0 2017

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwbat'sbelow.	Utility lines can
Callbeforepdig. easily be damaged
by planting trees,

i	1/M approva1 	u1 1a-W====
"'	ate enter.ed _	_	_	_	= -
J--: nd,	GL 		oc_	i;::;;::
'< #

installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or   peoplesgas.com/callbeforeyoudig.

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc	facebook.com/tampaelectrtc	Youin
youtube.com/tecoenergytnc

To ensure prompt credit, p ease return stub portion of th is bill with your payment. Make checks payable to TECO.

TEc=a.
TAMPA ELECTRIC

ANEMERA COMPANY

WAYS TO PAY YOUR BILL

-	,181

mail	phone online	pay agent
See reverse side for more information

Account:211005281400

$720.6

Current	month's	charges	

:	1
Total amount due:	$720.61
Payment Due By:	12/06/2017
Amount Enclosed	$--------
695B27293138

00007116 01 AV  0 37 33625  FTECO111161703314810 00000 06 01000000  014 08◄2905    002
1111•I111•11 h·I·11111II11•1·111,11I  I,11111'1I·1  11'I I' 11111111•■ 1
TRIPLE CREEK CDD
12750 CITRUS PARK LN, STE 115
TAMPA, FL 33625-3784

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

69 5827293138211005281□4□□□□□□□□ 7 20611	Page 1 of4

TEc-0.
TAMPA ELECTRIC
ANEMERA CDMPANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877-588-1010
Energy-Saving Programs
813-275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

...
0
N
i
g...
E
I

Average kWh per day The average amount or electricity purc-hased per day.
Basic Service Charge A r:xed monthly amount lo cover the cost or providing service to your location.
Bright Choicessr.1   The number or,  l gh    t fixtures and/or poles leased from Tf:impa E eclnc, and assoc1.=ited fPes and charges.
Budget Billing    Optional plan takes  the h•ghs    and    lows out or monthly electric bills. This "leveling" ,b lhng plan averages your lasl 12 monthly billing periods so you can pc1y about the same amount for
your service each month.
Energy Charge The cost (except fue l) or producing the electric ity you purchased, including conservation, environmental and c,1pac1ly cost recovery charges.
Estimated If Tampa Electric was unab le lo read your meter, "ESTIMATED" will appear. Your elec tric use has been est1maled based on previous usage. The mete,r  s  scheduled to be read next month, and any difference between the estimate and actual use will be adjusted accord ngly.
Florida  Gross Receipts Tax   A  tax is imposed on gross rece pis from ul11ily services that are de,ivered to retail customers in Florida, ·n accordance with Chapter 203 of the Flor da Statutes. The tax 1s levied on utility companies, which co:l ect the tax from all customers, unless exempt, and remit to the state.
Florida State Tax A privilege tax imposed on every person who engages in the bus iness of selling or renting tang be personal property at retail in the slate, 1n accordance with Chapter 2·12 or the Florida Slatutes.
Franchise Fee    A fee le, v ed     by a mun 1cip   al1l y for the right  to utilize public properly for the purpose or  providing  electr'c  service.  Like taxes, the fee is collected by Tempo Electric and  is  paid lo  the municipa lity.

For more information abou t your bill, please vis l tampaelectric.com.

Fuel Charge Cost or fuel used to produce electricity you purchased. Fuel costs are passed through from fuel suppliers lo our customers w1lh no markup or pr oFil to Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement or electric energy use.
Late Payment Charge For past due amounls more than $10, the late payment charge 1s Ille greater or $5 or 1.5% or the past due amount. For past due amounts or $10 or less, the late payment charge ,s 1.5% of the past due amount.
Municipal Public Service Tax In ,1dd1t1on to the Franchise Fee, many munic1pal1l1es levy a tax on the electri,c l y you use. It is collected by Tampa Electric and paid to the municipality.
Past Due Previous charges that are past due are subject to a late payment charge fee and may resu lt in disconnection.
Rate Schedule The amount (rate) you pay depends on your customer category. The cost or prov ding service varies with the cust omer g oup.
Renewable Energysr.1   The amount or elec l·,ic ty purchased from renewable sources.
Share A program co sponsored by Tampa Elec tric  and  the Salvation Army where customers can hep pay the energy bills of customers 1n need. A one-time contribution can be made, or you monthly elected conlr bullon will appear on your l1ill. Your
con tribution is tax deductible and is matched by Tampa Elec tric
Total Amount Due Th s month's charges w II be past due after the dale shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. II is 1mporlanl lhal you pay your bill before tl11s dale in order to avoid 1nterrupt1on or service
Zap Cap Systems• Surge prolecl1on for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one -time or recu,r

ing p aymen ts at tampaelectric.com using a checking or savings account.

Mail your payment in the enclosed envelope. Please allow sumc,enl lime for delivery.
Pay in pe ,son al a local aulhor'zed payment agent. For a listing or authorized payment agents, visit tampaelectric.com or call Customer Care at the number listed above.
Pay by credit or deb1I card using Ou ck Pay al tampaelectric.com or call 866-689-6469.
(A convenience fee will be charged to your bank accoun t 0 1 credit card.)

When making your payme nt, please 1ave your bill or accoun . number available.

Please note: If you choose to pay your bill at a location not  isled on our welisile or prov'ded  by  Tampa Elec,  t 1c, you are paying someone who is not authorized lo acl as a payment agent or Tampa , E ec tnc You bear the nsk lhal this unauthorized p;i ly w I relay lhe payment lo Tampa Elecl r c a r c! do so 1n al mely fashion. Tampa Elec tric ,snot responsible for payments made t o unautho ,zed agents, including their f, a lu  re lo  de 1ver or time   y de ive( the payment to us  Such fa' ures may result in  8le payment charges 10  your account or service disconnection

Por fa vor,, v s1l e tampaelectric.com para ve   esla info, maci6n en c spafiol.
Page 2 of 4

TEGff
TAMPA ELECTRIC
ANEMERA  COMPANY

Account:	211005281400	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

Details of Charges -Service from 10/12/2017 to 11/09/2017

ACCOUNT INVOICE
tampaelectric.com	j f ti 'P 8• II in

Service for: TRIPLE CREEK TRACT D, RIVERVIEW, FL 33579-0000

Lighting Service Items LS-1 (Bright Choices) for 29 days	Rate Schedule: Lighting Service	
Lighting Energy Charge	1012 kWh @$0.03224/kWh	$32.63	
Fixture & Maintenance Charge	23 Fixtures	$316.02	
Ligh ting Pole/ Wire	23 Poles	$340.86	
L1ght1ng Fuel Cha rge	1012 kWh @ $0.02916/kWh	$29.51	
Florida Gross Receipt Tax	$1.59	
Lighting Charges	$720.61	
Total Current Month's Charges	$720.61	

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Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & Oil*	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than 1%

m

Page 3 of 4

Experience the power of nature at the Manatee Viewing Center
.. -..-...

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ia...
t8
i

Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572
(813) 228-4289 • Admission is free!

,:;,,	TAM- ELEDTRID	•	•

TEc<>.	I	Manatee
---	""    " ........ OCIMPANY	Viewing Center
tampaelectric.com/manatee

itat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
' s n acks • Environmental education • ADA-compliant

Page4 of4

TEc=a
TAMPA EL.ECTRIC
ANEMERA CIJMPANY

$1,315.90

12/06/2017

-

m

TRIPLE CREEK CDD TRIPLE CREEK TRACT A

ACCOUNT INVOICE
tampaelectric.com  I	f "I <p 8• c! in

$1,315.90

harges:

Statement Date: 11/15/2017 Account: 211005281640

Current	month's	c	
Total	amount	due:	
Payment	Due By:	

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RIVERVIEW, FL 33579-0000

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$1,315.90
-$1,3159. 0
 	.£1,,315.90 
$1,315.90

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwhat'sbelow.	Utility lines can
Gallbefomyoudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or  peoplesgas.com/callbeforeyoudig.

n

Amount not paid by due date may be assessed a late payment charga and an additional deposit.

Follow us and we'll keep you posted

twltter.comnampaelectric

facebook.cam/tampaelectric

Yo(ug
youtube.com/tecoenergyinc

To ensure prompt cred t, pleasereturn stub portion of th s b II with your payment. Make checks payab e to TECO.

TEc=a
TAMPA EL.ECTRIC
AN EMERA CIJMPANY

WAYS TO PAY YOUR BILL

rl81

mail	phone online	pay agent

See reverse side for more information

Account:211005281640

Current

month's charges:

$1,315 .90

Total amount due:	$1,31 5.90
Payment Due By:	12/06/2017
Amount Enclosed	$---------
695827293139

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA. FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6958272931392110052816400000001315907	Page 1 of 4

TEc-0.
TAMPA ELECTRIC ANEMERA CCMPANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County) 863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866 832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877-588-1010
Energy-Saving Programs
813-275 3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

.C.l

Understanding Your Electric Charges

0

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g

Average kWh per day The average amount or eleclric1ly purchased per day.
Basic Service Charge A fixed monlhly amounl lo cover the cost of providing service lo your location.
Bright Choicessu The number or lighl fixtures and/o poles leased from Tampa Electric, and associated rees and charges.
Budget Billing Optional plan takes the highs and lows out or monthly electric bills. This "level ing•·   billing plan ave,ages your lasl 12 month y billing periods so you can pay about the same amount for your service each month
Energy Charge    The cost (except fuel) of producing lhe eleclr, c ty you purchased, including conseNat1on, environmental clnd cap;:icIly cost recovery charges.
Estimated If Tampa Electric was unable to read your meter , "ESTIMATED" will appear. Your electric use hl'ls been estimated based on previous usage. The meter Is scheduled to be read next month, and any d1Fference between the estimate and actual use w II be adJusled accordingly
Florida  Gross Receipts Tax   A tax Is imposed on gross receipts from utiFly seNIces that are delivered to retail customers in Florida, in
,lccordance with Chapter 203 or the Florida Statutes. The tax Is levied on uti,ity comp8nIes, which collect lhe lax from all customers, unless exempt, and remit to the <;late
Florida State Tax A privilege lax imposed on every person who engages In the business of selling or renting t:mgible persorial property al retail In the state, in accordance w1lh Chapter 212 of the Florida St,llutes.
Franchise Fee A fee levied by a munic pality ror the right to ul11i,:e public property for the purpose of providing electric service Like taxes, the fee Is collected by Tampa Electric and is paid to the municipality

For more ·nro mat1on about your bill. please visit tampaelectric.com

Fuel Charge Cost or fuel used to produce electricity you purchased. Fuel costs a e passed through From fuel suppliers to our customers wI' h no markup or profit lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement or electric energy use.
Late Payment Charge For past due amounts more than $10, the late payment charge Is the greater of S5 or 1.5% or the past due
amount For past due amounts or $10 or less, the late payment ch,a ge Is 1.5°0 of the past due amount.
Municipal Public Service Tax In add1l1on to the Franchise Fee, many munIc pa'1t1es levy a tax on the electricity you use. ll is collected by Tampa Electric ,:.ind paid to the municipality.
Past Due Prev·ous charges that are past due are subject to a late payment charge fee and may result in disconnection.
Rate Schedule The amount (rate) you pay depends on your customer Lategor y The cost or providing service varies with the euc;tomer group.
Renewable EnergyaM The amount or electr c,ty purchased from rene wable sources.
Share A program co sponsored by Tampa Electric and the Salvation Army where customers can help pay the ene gy bds or customers in  need. A one-time con, tr buli    on can be made, or your monthly elected contribution wil appear on your bill. Your contribution is tax deductible and Is matched by Tampa E ectric.
Total Amount Due This month's charges will be past due after the dale shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. It :s impo tant that you pay your bill
before this dale in order to avoid interruption of service.
Zap Cap Systems• Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-time or recurring payments at tampaelectric.com using a checking or savings account.
Mail your payment in the enclosed envelope. Please allow sufficient t.1me for delivery.
Pay in person at a local authorized payment agent For a listing of authori,:ed payment agents, visit tampaelectric.com or call Customer Care al the number listed above.
Pay by credit or debit card using Quick Pay al tampaelectric.com or call 866-689-6469.
(A convenience fee ,w I  be  cha  ged  to your  bank  accoun t  or credit  card.) When making you payment, please have your bill o account number available.
Please note: If you choose to pay yo, u  b  i ll  at rl local'on not listed on our website or provided by Tampa Electric, you are paying someone
who s not .:iuthor zed to act as a payment agent of T,Jmp.:i Electric. You bear the risk that this unauthorized party will relay the payment to Tampa Electr c and do so 1ri ,l timely Fashion Tampa Electric Is nol responsible for payments made to unauthorized agents, including their fai uie lo deliver or timely deliver the payment to us. Such failures may result In late payment charges lo your account or service di5conneclion.

Por favor, v1s1te tampaelectric.com para ver esta nformaci6n en espaiiol.
Page 2 of 4

TEc-0
TAMPA ELECTRIC::
AN EMERA CCMF'ANY

Account:	211005281640	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

a

Details of Charges - Service from 10/12/2017 to 11/09/2017

ACCOUNT INVOICE
tampaelectric.com I f W <p 8• tl!J in

Service for: TRIPLE CREEK TRACT A, RIVERVIEW, FL 33579-0000	Rate Schedule; Lighting Service

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Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1848  kWh @ $0.03224/kWh	$59.58

Fixture & Maintenance Charge	42 Fixtures	$577.08		
Lighting Pole / Wire	42 Poles	$622.44		
Lighting Fuel Cha rge	1848 kWh @ $0.02916/kWh	$53.89		
Florida Gross Receipt Tax		$2.91		
Lighting Charges			$1,315.90	
Total Current Month's Charges			$1,315.90	

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & on•	60%
-Coal	34%
-Purchased Power	6%
•on makes up less than 1%

Page3 of4

Experience the	power of nature
.;,	the	anatee Viewing Center

_,_,	Open every
November I through April 15 10 a.m. to 5 p.m. daily

TEc<>.	I	Manatee

6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

.;!:

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..N  "'M"'R" aa..PANY	Viewing Center
tampaelectric.com/manatee

ltat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
Snacks • Environmental education • ADA-compliant

Page4 of4

TEc-0.
TAMPA ELECTRIC

ANEMERA CDMPANY

■

TRIPLE CREEK CDD
BALM RIVERVIEW TRPL CRK PH1 RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f ._ 'P 8• fl in

Statement Date: 11/15/2017 Account: 211005281160

month's

Current

charges:	$763.24
Total amount due:	$763.24
Payment Due By:	12/06/2017

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I

Your Account Summary
Previous Amount Due
Payment(s) Received Smee Last Statement
Current Month's Charges
Total Amount Due

$763.24
-$763.24
!,763.24
$763.24

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwbat's below.	Utility lines can
Gallbeforeyoudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or   peoplesgas.com/callbeforeyoudig.

n

Amount not paid by due date may be assessed a late payment charge and an additional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc

facellook.com/tampaelectric

You(m
youtube.comltecoenergyinc

To ensure prompt credit, p ease return stub port on of th is bil with your payment. Make checks payab le to TECO.

TEc-0.
TAMPA ELECTRIC

ANEMERA CDMPANY

WAYS TO PAY YOUR BILL

-	,181

mail	phone online	pay agent

See reverse side for more information

Account:211005281160

$763.24

due:	$763 .24

Current	month's	charges:	
Total	amount		

Payment Due By:	12/06/2017
Amount Enclosed	$--------
695B27293137

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6958272931372110052811600000000763241	Page 1 of4

TEc-0.
TAMPA ELECTRIC ANEMERA CCMPANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877 588 1010
Energy-Saving Programs
813 275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence Tampa Electr ic P.O.Box111
Tampa, FL 33601-0111

Understanding Your Electric Charges
!=I

0	Average kWh per day The average amount of electricity purchased per day.

I

i	Basic Service Charge A fixed monthly amount lo cover Lhe cost of providing service to your locati on.

I

Bright ChoicesaM The number of light fixtures .=ind/or poles .eased f1om Tamp0 E eclric , and associated fees .=ind ch8 ges.
Budget Billing Optional plan lakes Lhe highs and lows out of
n- ontl1ly electric bills. This "leveling" billing plan averages '.).-our Iasl 12 monthly billing periods so you can p8y about  the same  flmount  for you serv ce each month.
Energy Charge The cost (except fuel) of producing the elec tm..1ty you purch8sed 1nclud1ng conservation, environmental and capacity cost recovery charges.
Estimated If Tampa Electric w0s unable to read your meter, "ESTIMATED" will appear Your electric use hflS been eslimflled based on previous usage. The meter 1s scheduled to be read next month, and any difference between the esl1male .=ind ac tu al use will be adjusted accordingly.
Florida Gross Receipts Tax   A tax 1s imposed on gross rece1pls from utility services that are delivered lo retail customers in Flo rida, in accordance w1lh Ch0pter 203 or the Florida Slfllutes. The lflx 1s levied on utility companies, which collect the lax from all customers, unless exempt, and remit to the stale .
Florida State Tax A privilege tax imposed on every person who engages in lhe business of selling or renting tangible personal properly at retail 1n the slate, 1n accordance w1lh Ch0pter 212 of the Florida Statutes
Franchise Fee    A fee levied by a rnunic1palily for the r ght  to ut1li Le public properl y ro the purpo se or providing electric service. L,ke laxes, lhe fee 1s collected by T0mpa Electric and 1s paid to lhe municipa:ity

Fuel Charge Cost of fuel used to produe,e elec tricity you purchased. Fuel costs are passed through from fuel suppliers to our customers with no markup or pr ofit to Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge For past  due amounts  more  than S10,  the late payment charge 1s the greatf>r of $5 or 1.5% of the past due amount. For past due amounts of S1O o  less,  the late p8yment charge 1s 1.5% of the past due air ount
Municipal Public Service Tax    In 8ddi t1on to the Frnnch se Fee, many munic1p a·ilie  s levy a tax on the electricity you  usP. IL i s collected by Tampa Electric and paid to ! he municipally.
Past Due Previous charges that are past due are subject to a late payment charge fee and may result in disconnection
Rate Schedule The amount (rate) you pay depends on your customer category. The cost of prov1d1ng service varies w1ll 1 the customer group.
Renewable Energys.. The amounl or e: ec tncily pu -c hased from renewable sources.
Share A program co-sponsored by Tampa E·ec tri c and l he Salvation Army where customers can help pay the energy bills of customers 1n need. A one-time cont ·bution can be made, or your monthly elected contribution will appear on your bill. Your contribution is tax deductible and is matched by Tampa Elec tric .
Total Amount Due This month's charges will be past due after the d8te shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE It is important that you pay your bill before this date in order lo avo d interruption of service
Zap Cap Systems• Surge protection for your home or business sold separately as a non energy charge

For more info·mat1on about your bill, please v1s1t tampaelectric.com

Your payment options are:
Schedule free one-lime or recumng payments al tampaelectric.com using a checking or savings account.
Mail your payment 1n the enc osed envelope. Please al ow sufficient time for delivery.
Pay in person at a local authorized payment agent For a listing of authorized payment agents, visit tampaelectric.com or call Customer Care at the numbe r listed above
Pay by c red it or debit card using Quick Pay al tampaelectric.com or C811 866-689-6469.
(A convenience fee will be cha-ged to your bank accounl or credit card)

When making your payment, please have your b.JI o• ,1cc ounl number available.

Please note; If you choose lo pay your b'II at a ocal on nol  l1sled on our website or provided by Tampa Electric, you are paying someone who is not authoriLed lo acl as a payment agent of Tampa Elec tric. You bear the risk that this unauthorized party will relay lhe payment lo Tampa Electr c and do so in a timely fashion  Tampa Elec1 r c 1s not responsible for payments made to unauthorized agents, including their fai u•e lo deliver or li mely deliver the payment to us Such frnlures may result in late payment charges lo your account or service
disconr-ecl 1o n.

Par favor, visite tampaelectric.com para ve esta informac i6n en espaiiol.
Page 2 of 4

TEc-0.
TAMPA 11:LECTRIC
AN EMERA CCMPANY		

Account:	
211005281160	
Statemen t Dale :	11/15/2017	
Current month's charges due	12/06/2017	

m Details of Charges - Service from 10/12/2017 to 11/09/2017

ACCOUNT INVOICE
tampaelectric.com I f W'P 8• ti!, in

..

Service for: BALM RIVERVIEW TRPL CRK PH1, RIVERVIEW, FL 33579-0000

Lighting Service Items LS-1 (Bright Choices) for 29 days	Rate Schedule: Lighting Service	
Lighting Energy Charge	1890 kWh @$0 .03224/kWh	$60.93	
Fixture  & Maintenance Charge	18 Fixtures	$213 .66	
Lighting Pole/ w,re	18 Poles	$430.56	
Lighting Fuel Charge	1890 kWh @ $0.02916/kWh	$55.11	
Florida Gross Receipt Tax	$2.98	
Lighting Charges	$763.24	
Total Current Month's Charges	$763.24	

g 0
:;;
•

i

3.

I

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & on•	60%
-Coal	34%
-Purchased Power	6%
•on makes up less than 1%

Page 3 of4

Experience the power of nature at the Manatee Viewing Center

1il

Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

Viewing Center

TEc<>.	I	Manatee

a

.•..

N N

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g
g

I

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,:.

"fl

TAMPA ELECTRIC	•	.
AN	HA'"''""ANY

tampaelectric.com/manatee

#tat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
'snacks • Environmental education • ADA-compliant

Page4 of4

TEc-0.
TAMF'A ELECTRIC
ANEMERA C:DMPANY

•

TRIPLE CREEK CDD TRIPLE CREEK BLVD PH2 RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f W <p 8• I! in

harges:

Statement Date: 11/15/2017 Account:211005282317

Current	month's	c	
Total	amount	due:	
Payment	Due By:	

$678.43
$678.43 12/06/2017

!ii

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.0..
i•
I
I

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$678.43
-$678.43
$678,43
$678.43

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwhat's below.	Utility lines can
Gallbeforei,oudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or peoplesgas.com/callbeforeyoudig.

n

Amount not paid by dua data may ba assessed a late payment charge and an additional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc

facebooll.com/lampaelectrlc

You(m
youtube.com/tecoenergylnc

To ensure prompt credit, p lease return stub portion of this, b 11 with your payment. Make checks payab'e to TECO.
WAYS TO PAY YOUR BILL	Account: 211005282317

-	,181

TEaff
TAMF'A ELECTRIC ANEMERA C:DMPANY

mail	phone online	pay agent
- ---------
See reverse side for more mformat,on

$678.43

$678.43 12/06/2017

Current	month's	charges:	
Total	amount	due:	
Payment	Due By:	

Amount Enclosed	$ 	_
695827293142

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318
TAMPA, FL 33631-3318

6958272931422110052823170000000678436	Page 1 of 4

TEc-0.
TAMPA ELECTRIC ANEMERA CCMPANY

Contact Information
Residential Customer Care
813 223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877-588-1010
Energy-Saving Programs
813-275 3909

tampaelectric.com

Mail Payments to
TECO
P 0. Box 31318
Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges
g

0

l

•
.;,
:;;
I

g

g

Average kWh per day The average amount or elPctric1ty purchased per day.
Basic Service Charge A r1xed monthly amount lo cover the cost or providing service to your loca tion
Bright Choicess.. The number of light fixtures ,rnd/or  poles leased from Tampa Elec tric , and associated fees and charges.
Budget Billing    Op tiona l p 1an lakes the h.ghs  and lows out of monthly electric b lls. This "leveling" bi ling plan averages your last 12 monthly billing per;ods so you can pay about the same amount  for your service each month.
Energy Charge  The cost (except  ruel)  of  producing  the  electricity you purchrised, 1n c .ud 1ng conseNat1on, environmental 8ncl c,ipac1ty cost recovery charg es.
Estimated tr Tampa Electric was unable lo read your meter, "ESTIMATED" will appear. Your  electric  use  has been estimated based on previous usage . The meter 1s scheduled lo be read nexl month, and any difference between  the  estimate  and  actual use will be ad1usted 0ccord 1ngl y.
Florida Gross Receipts Tax A tax 1s imposed on gross receipts from utility seN· ces that are delivered to retail customers in Florida, 1n accordance with Chapter 203 of lhe Florida Statutes. The lax 1s levied on ut1 ity companies, which collect the tax from all customers, unles<; exempt, and rf'm t to the slate.
Florida State Tax A privilege tax imposed on every person who engages in the business or selling or renting tangible personal
prope·ty at etai in the state, 1n accordance with Chapter 212 of the Florida Statutes.
Franchise Fee    A fee  evied by a mun·  cipalily  for t h e righ t to ut'.lize publ c property for lhe purpose of  providing  electric  service.  Like taxes, the ree 1s c ollected by Ti:lmpa Elec tr ic and is pad to the mun1c1paFty

For morf' infor mation about your bd . p le ase vis;t tampaelectric.com.

Fuel Charge Cost of fuel used lo p·oduce electricity you purchased. Fuel costs are passed through from fuel suppliers lo our customers with no markup or profit to Tampa Elect ric.
Kilowatt-Hours (kWh) The basic measurement or electric energy use.
Late Payment Charge For past  due amounts  more  than S10  the late payment charge 1s the greater of S5 or 1.5% of the past due amount. For past due amounts of $10 or  less,  the late payment charge 1s 1.5% of the past due amount.
Municipal Public Service Tax In add1t1on to the Franchise Fee, many municipalities levy a t8x on the elec tricity you use. It is collected by Tampa Electric and paid lo the municipality.
Past Due - Previous charges that are past due are subject lo a late payment charge fee and may resu tin disconnection.
Rate Schedule - The amount (rate) you pay depends on your customer category . The cost or providing service vanes with the customer group.
Renewable Energye.. The amount or elec t. icily pu chased from renewable sources.
Share A program co-sponsored by Tampa E ectric and the Salvation Army where customers can help pay the energy b lls or customers in need. A one-lime contribution can be made, or your monthly elected contribution will appea r on your bill. Your contribution is lax deductible and 1s matched by Tampa 'Elec tric .
Total Amount Due    This month's charges w.11 be    past due after the dale shown. THIS  DATE  DOES NOT EXTEND  THE  DATE ON
ANY PREVIOUS BALANCE. It is important th at you pay your bt1i before lh1s dale 1n order lo avoid 1nlerrupt1on or seNice.
Zap Cap Systems•    Surge prolec l on fo  your home or bus:  nes     s sold sepa1alely	as a non energy charge

Your payment options are:
Schedule free one-time or recurr ing paymen ts at tampaelectric.com using a checking or savings account
Mail your payment in the enc osed envelope. Please allow suff1c1en    t lime fo  del'very
Pay 1n  person al a local aulhonzed payment age nt. For a listi ng or au·hor ized  payment agen ts, v1s1t tampaelectric.com or call Customer Car e at the number listed above.
Pay by cred1l or debit card using Quick Pay at tampaelectric.com or c,a 1 866-689-6469.
(A conve,n ence fee will be charged to your ban k account or credit ca d.) When making your payment, please  1 ave you· bi I or acc ount number availab1e.
Please note: If you choose to pay your b II al a location not listed on our website or provided by Tampa Electric, you are payir,g someone who is not authorized lo act as a payment agent or Tampa Electric. You bear the risk that this unauthorized party wd1 relay the payment lo Tampc1 Elec, t 1c  and     do    so in at  mely fashion  Tampa Eleclr c is not responsible for payments made to unautho ized agents, inc uding lhe1 failure to del iver or timely deliver the payment to us Such ra lures may result in late payment charges to you account or service disconnection

Por favor, vis 1e tampaelectric.com para ver esla 'nf ormac,6n en espaiiol.
Page 2 of 4

TEc-0.
TAMPA ELECTRIC
ANEMERA CCMPANY
Account:	211005282317
Statement Date:	11/15/2017

E

Current month's charges due  12/06/2017

Details of Charges - Service from 10/12/2017 to 11/09/2017

ACCOUNT INVOICE
tampaelectric.com  I f W'P 8	in

SeN1ce  for: TRIPLE CREEK  BLVD  PH2, RIVERVIEW, FL 33579-0000	Rate Schedule: Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Cha rge	1680  kWh @ $0.03224/kWh	$54.16

g
'o
1:1
i
i

Fixture & Maintenance Charge Lighting Pole/ Wire
Light ing Fuel Cha rge
Florida Gross Receipt Tax
Lighting Charges

16  Fixtures
16 Poles
1680 kWh @ $0.02916/kWh

$189.92
$382.72
$48.99
$2.64

$678.43

I	Total Current Month's Charges	$678.43

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & Oil*	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than   1%

Page 3 of 4

Experience the	power of nature
.;	the	anatee Viewing Center

   ..	-	Open every
November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

g	TEc<>.	I	Manatee

H.     o a M .. •NY	Viewing Center

0
g
•
l
"lgii '

i

g

,:.

"fl T....". M..PA   B:I.B:CTRIC	,
tampaelectric.com/manatee

g	1b lt at Trails • Rays Touch Tank • Observation Tower
Wildlife-watching • Gardens • Games
nacks • Environmental education • ADA-compliant

Page4 of4

TEGff
TAMPA ELECTRIC

ANEMERA C:CMPANY

TRIPLE CREEK CDD TRIPLE CRK PH2
Bl	RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f "I rp 8• t! in

Statement Date: 11/15/2017 Account:211005282515

Current	month's	
Total	amount	du	
Payment		

charges:	$971.26
e:	$971.26
Due By:	12/06/2017

lil
Q

i•
I
I

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$971.26
-$971.26
 	!971.26 
$971.26

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwhat'sbelow.	Utility lines can
Gallbefomyaudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or   peoplesgas.com/callbeforeyoudig.

E

Amount not p81d by due dete may be assesssd a late payment charge and an addtfional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc

ra..-11.comllampaetectrlc

YoulD
youtube.com/tecoenergylnc

To ensure prompt credit, p ease return stub port on of this b ill with your payment. Make checks payab e to TECO.
WAYS TO PAY YOUR BILL	Account: 211005282515

-	 	181

TEc-0.
TAMPA ELECTRIC

ANEMERA C:CMPANY

mail	phone onhne	pay agent
See reverse side for more information

$971.26

Current	month's	charges:	
Total	amount	due:	
Payment	Due By:	

$971.26 12/06/2017
Amount Enclosed	$ 	_
695827293143

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6958272931432110052825150000000971267	Page 1 of4

TE c-0. 
TAMPA ELECTRIC:
ANEMERA t:DMF'ANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing lmpairedrTTY
711
Power Outages Toll-Free
877 588-1010
Energy-Saving Programs
813 275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

..

0
\!!
•

I

3.

igi:
g
c:,

Average kWh per day The average amount of electricity purchased per day.
Basic Service Charge A fixed monthly amount lo cover lhe cost of prov1d1ng service lo your location.
Bright Choicessu The number of light fixtures and/or poles leased from Tampa Elec tric, and associated fees and charges.
Budget Billing Optional plan takes the highs and lows out of monthly electric  bi; l s. T, h s "leveling" billing plan averages your last ·1 2 monthly billing periods so you can pay about the same ;:im ounl  for your service each month.
Energy Charge The cost (except fuel) of producing the electr icity you purch )sed, 1nclud1ng conservr1l1on, environmental and capacity cost recovery charges.
Estimated If Tampa Electric was unable lo read your meter, "ESTIMATED" will appear. Your electric use has been est mated based on p evIous usage. The meter Is scheduled lo be read next month, and any difference between the estimate and ac tu al use will be adiusled accordingly.
Florida  Gross Receipts Tax   A lax  is imposed on gross  receipts from utility services that are delivered to retail customers In Florida, in accordance with Chapter 203 of the Florida Statutes. The lax Is levied on uli11ly companies, which collect lhe lax from all customers, unless exempt, and remit to the state.
Florida State Tax A privilege tax imposed on every person who engages in the business of selling or renting tangible personal properly al retail in the slate, In accord,mce wilh Chapter 212 of the Florida Statutes.
Franchise Fee A fee levied by ll mun cipalily for the right to utilize public properly for the purpose of provid ng electric service. Like laxes, the fee s collected by Tnmpa Electric and Is paid lo the mun1c1party.

For mo e information about your bill, please vi, :1 tampaelectric.com

Fuel Charge Cost of fue used lo produce electricity you purchased. Fuel costs are passed through from fuel suppliers to our custome r s w1lh no markup or profit lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge For past due amounts more than S10, tt1e tale payment charge Is the greater of $5 or 1.5% of the past due amount Fo· past due amounts of $10 or less, the late payment charge Is 1.5°·o of the pasl due amount.
Municipal Public Service Tax In add1t1on to the Franchise Fee, many munic1palit1es levy a tax on the elec tricity you use It is collected by Tampa Electric and paid to the munic ipali ty.
Past Due Previous charges th;:il are past due are subject lo a ate payment charge fee and may result :n disconnecl'on.
Rate Schedule - The arnounl (rate) you pay depends on your customer category. The cost of providing service vanes w1 lh   lhe customer group.
Renewable EnergysM The amount of eleclr city purchased fro m renewable sources.
Share A program co-sponsored by Tampa Electr c and the Salvation Army where customers can help pay the energy bills or customers in need. A one-time conlnbut1on can be made, or your monthly elected conlnbut1on will appear on your bill. Your contribution Is tax deductible and Is matched by Tampa Electric
Total Amount Due This month's charges will be past due after the date shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. ll Is important lhat you pay your bill before this date In order to avoid interruption of service.
Zap Cap SystemS" Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-time or recur ring paymen ts at tampaelectric.com using a checking or savings account
Ma1I  your payment in the enclosed envelope  Please allow suff1c1ent time for delivery.
Pay In person al a local authorized payment ngenL For a listing  of authoriLed payment agenls, v.s1l  tampaelectric.com or call Customer Care al the number listed above
Pay by cred ,t o debit card using Quick Pay al tampaelectric.com or call 866-689-6469
(A convenience fee will be charged to your  bank account or credit  carcJ.) When making your payment, piease have your L> II or 8ccou nt number ava1lr1ble.
Please note: If you choose to pay your bill at a local1on nol sled on our website or provided by Tampa  Electric, you are paying someone who is not authorized lo act as a payment agent of Tampa Elec tric. You bear the risk lhal this unauthoriLed party will relay the payment to Tampa Electric and do so in a limely fashion. Tampa Electric is not responsib e for payments made lo unauthorized agents, including their failure to deliver or timely deliver the payment to us Such failures may result in ale payment charges to your account or service
disconnec tion.

Par fav or, visile tampaelectric.com para ver esta informaci6n en espaFiol.
Page 2 of 4

i :

TEc-0.
TAMPA ELECTRIC
ANEMERA  CDMPANY		

Account:	
211005282515	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

ACCOUNT INVOICE
tampaelectric.com  I f ti 'P 8•IJ

B

Details of Charges - Service from 10/12/2017 to 11/09/2017

Service for: TRIPLE CRK PH2, RIVERVIEW, FL 33579-0000	Rate Schedule: Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1364 kWh @$0.03224/kWh	$43.98

'o

g	Fixture & Maintenance Charge Lighting Pole / Wire

i

i	Lighting Fuel Charg e
Florida Gross Rece ipt Tax
Lighting Charges

31 Fixtures
31 Poles
1364 kWh @$0 .0291 6/kWh

$425.94
$459.42
$39.77
$2.15

$971.26

i	Total Current Month's Charges	$971.26

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers
was:
-Natural Gas & ou•	60%
-Coal	34%
-Purchased Power	6%
•on makes up less than 1%

Page 3 of4

Experience the	power of nature at the	Manatee Viewing Center
Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

fil

,:.

TEc	>.

TAMPA ICL.ICCTRIC

I M,   a,  natee ft7

l!

0	•	.... ....H ....a......NY	Viewing Center

a

i	tampaelectric.com/manatee

ii:

I

I
blt at Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
Snacks • Environmental education • ADA-compliant

Page4 of4

TEcff
TAMPA ELECTRIC

harges:

ANEMERA C:CMPANY

ACCOUNT INVOICE
tampaelectric.com  I	f W 'P 8• 15 in

•

TRIPLE CREEK COD TRIPLE CRK, PH C RIVERVIEW, FL 33579-0000

Statement Date: 11/15/2017 Account: 211005282705

Current	month's	c	
Total	amount	due:	
Payment	Due By:	

$720.6

1

$720.6

1
12/06/2017

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
0

l

II

Total Amount Due
i
i
I

$720.61
-$720,61
,W0,6_1
$720.61

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwhat's below.	Utility lines can
Callbeforeyoudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or peoplesgas.com/callbeforeyoudig.

E

Amount not paid by dua data may be assessed a late payment charga and an additional deposit.

Follow us and we'll keep you posted

twitter.com/tampaelectrlc

fa-k.com/lampaelectrlc

Youin
youtube.com/tecoenergylnc

To ensure promp t cred it, p ease return stub portion of this bill with your payment. Make checks payable to TECO.

TEGff
TAMPA ELECTRIC

ANEMERA C:CMPANY

WAYS TO PAY YOUR BILL

rl81

mail	phone online	pay agent

See rever e side for more information

Account:211005282705

$720.6

Current	month's	charges:	

1
Total amount due:	$720.61
Payment Due By:	12/06/2017
Amount Enclosed	$---------
695827293144

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318
TAMPA, FL 33631-3318

6958272931442110052827050000000720610	Page 1 of 4

TEc=a
TAMPA ELECTRIC
ANEMERA  Ci;JMPANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877 588-1010
Energy-Saving Programs
813 275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631 3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges
g

..0...
i
i
I

Average kWh per day The average amount of electricity pur c hased per day.
Basic Service Charge A fixed monthly amount to cover the cost of providing service to your location.
Bright Choices.., The number of light fixtures and/or poies leased fro m Tampa Electric, and associa led fees and charges.
Budget Billing  Optional  plan lakes  the  highs and  lows out of monthly e lectr <.:. bills. This "level ng" bil'ng plan average s your last 12 monthly billi ng periods so you can  pay about the same amount for your service each month.
Energy Charge The cost (except fue) of produci ng  the electricity you purch,lsed, including conservat i on, environmental and c,lpacIty cost recovery charges
Estimated If Tampa Elec tr:c was unable lo read your meter, "ESTIMATED" will appear. Your electric use has been estimated based on prev:ous usage. The meter is scheduled to be read next month, and any d fference between the estimate and actual use will be ,)dJUSled acco ·d1ngl   y.
Florida  Gross Receipts Tax    A lax Is imposed on gross receipts from utility services that are delivered to rela1 customers In Florida, In accordance with Chapte r 203 of the Florida Statutes The lax Is levied on utility companies, which collec t the tax from all c,ustomers, unless exempt, and remit to the slate
Florida State Tax    A p·1vilege  tax imposed  on ewry person who engages in the business of selling or renting lang1blf' persona l properly at retail In the stale, In accordance with Chapter 212 of the F1onda Statutes
Franchise Fee A fee levied by a municipality for the right lo utilize public prope·Jy for lhe purpose of providing electric service. Like laxes, the fee Is collected by Tampa Electric and is paid lo the munic palily.

For more info·mat1on about your bill, please v1s1I tampaelectric.com.

Fuel Charge Cost of fuel used lo produce electricity you
p,u chased. Fuel cosls are passed through from fuel suppliers lo our customers with no markup or profit Lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge For past due amounts more lh,rn s·10, the late payment charge Is the greater of $5 or 1.5% of the past due amount. For past due amounts of $10 or less, the late payment charge is 1.5% of the past due amount.
Municipal Public Service Tax In addition to the Franchise Fee, many mun1c1 p alil1es levy a lax on the elec tricity  you use. ll Is collected by Tampa Electric and paid lo the munic1p , a 1l y.
Past Due Previous charges that aie past due are subJect to a late payment charge fee and may resull in disconnection
Rate Schedule The amount (rate) you pay depends on your customer category. The cost of providing ser vice vanes with the customer group.
Renewable Energysu The amount of electricity purchased from renewable sources.
Share A program co-sponsored by Tampa Electr,c and the Salvation Army where customers can help pay the energy bills of customers in need. A one-lime cont- 1bul1on can be made, or your monthly elected conlribulion will appear on your bill . Your contribution is tax deductible and Is matched by Tampa Electric.
Total Amount Due This month's charges will be past due after the date shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. It Is impo ,tant that you pay your bill before this dale in order to avoid 1nlerruplion of service.
Zap Cap Systems• Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-time or recurring payments at tampaelectric.com using a checking or savings account.
Mail your payment in the enclosed envelope. Please allow sufficient time for delivery.
Pay In person at a local authorized payment agent. For a listing of authorized payment agents, visit tampaelectric.com or call Customer Care at the number listed above.
Pay by cred1l o debit card using Quick Pay at tampaelectric.com or call 866-689-6469.
(A convenience fee wI I be charged to your bank  account or credit  card.) When making your paymenl, please have your bill or account number available.
Please note: If you choose to pay your bill at a location not I sled on our website or prov ided by Tampa Electric, you are paying someone who Is nol authoriLed lo ac t as a payment agent of Tampa Electric. You bear the risk that this unauthorized party will relay the payment lo Tampa Electric and do so Ir  a l.imely  fashion. Tampa Electric 1s not responsib e for pay ments madf' lo unaulho,  rLed     agents, including their failure to deliver o timely de live r the payment lo us. Such fa lures may result in ate payment charges lo your account or serv ce
disconnection.

Par favor, vis1le tampaelectric.com pa-a ver esla informaci6n en espa rio l.
Page 2 of 4

a

TEGff.
TAMPA ELECTRIC
ANEMERA COMPANY		

Account:	
211005282705	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

Details of Charges - Service from 10/12/2017 to 11/09/2017

ACCOUNT INVOICE
tampaelectric.com I f W'P 8•i!l In

SeNice for: TRIPLE CRK, PH C, RIVERVIEW, FL 33579-0000	Rate Schedule: Lighting Service

Lighting Service Items LS-1 (Bright Choices) for 29 days
Lighting Energy Charge	1012  kWh @ $0.03224/kWh	$32.63

Fixture & Maintenance Charge
0

i

i

Lighting Pole / Wire Lighting Fuel Charge Florida Gross Receipt Tax
Lighting Charges

23 Fixtures
23 Poles
1012 kWh @$0.02916/kWh

$316.02
$340.86
$29.51
$1.59

$720.61

Total Current Month's Charges	$720.61

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage offuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & ou•	60%
-Coal	34%
-Purchased Power	6%
•oil makes up less than 1%

Page 3 of 4

Experience the power of nature at the Manatee Viewing Center

..

.C.l.
.0..
•
l
;!

iii

I
I

Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free/

,:;;;,	TAMPA ICL.ECTRIC	,	,

TEco.	I	Manatee
-	-	-	ltMHA a..M........,	Viewing Center
tampaelectric.com/manatee

itat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
Snacks • Environmental education • ADA-compliant

Page 4 of 4

TEGff
TAMPA EL.ECTRIC

ANEMERA CCMPANY

TRIPLE CREEK CDD C/0 GREG COX
12198 TRIPLE CREEK BL
RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f W'P 8• IJ in

Statement Date: 11/15/2017 Account: 211005280915

month's

Current

charges:	$453.09
Total amount due:	$453.09
Payment Due By:	12/06/2017

..

..
.0,
•
.;,
!::
i
I

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$227.60
-$227.60
 	_._09	
$453.09

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwbat'sbelow.	Utility lines can
Calh1eforeyoudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or peoplesgas.com/ca   llbeforeyoudig.

Amount not paid by due date may be assessed a late payment charge and an additional deposit

Follow us and we'll keep you posted

twltter.com/tampaelectrlc	facebook.com/tampaelectrlc	Youlill
youtube.com/tecoenergyinc

To ensure prompt cre,d t,  p   ease return stub port on of this b ill with your payment. Make checks payable to TECO.

TEc=a
TAMPA EL.ECTRIC

WAYS TO PAY YOUR BILL

-	,181

mall	phone onllne	pay agent

Account:211005280915

$453.09

AN EMERA CCMPANY	 	
See reverse side for more information

a

TRIPLE CREEK COD C/OGREGCOX
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

12/06/2017

$453.09

---------

Current	month's	charges:	
Total amount due	:	
Payment	Due By:	

Amount Enclosed	$
695827293136

MAIL PAYMENT TO: TECO
P.O. BOX 31318
TAMPA, FL 33631-3318

6958272931362110052809150000000453090	Page 1 of4

TEC-0
TAMPA ELECTRIC
ANE;ME;RA   C□M F'A N Y

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877-588-1010
Energy-Saving Programs
813-275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

a,
0

N

"•' i i::
§
ig
c:,

Average kWh per day The average amount of electricity purchasPd per day.
Basic Service Charge -A fixed monthly amount to cover the cost of prov1d ng service lo your location.
Bright Choicesau·· The numbe- of .ghl fixtures and/or po es leased from Tampa Electric, and associated fees and charges.
Budget Billing    Optional plan takes the highs and  lows out of monthly electric bi Is. This " evellng" bill 'ng plan averages your last 2 monthly b1!11ng periods so you can pay about l11e same amount for your service each month.
Energy Charge The cost (excep • fuel) of producing the eleclric ,ly you purchased including  conse rvali on, environmen tal ,lnd c,1pac1ty cost r ec overy charges.
Estimated If Tampa Elec tr,c was unab e to read your meter, "ESTIMATED" will appear. Your elec l nc use has been estimated based on p revious usage. The mete s scll edu 'ed lo be read next month, and  any d1Fference between  hf' eslimate and ac tual use wll be adjusted accordi ngl y.
Florida  Gross Receipts  Tax  A  tax 1s  imposed on  gross rece1p · s from ulil1ly serv ices thal are delivered to rela ;I customers 1n Florida, n accordance w1l h Chapter  203 of the Flor da Statutes. The lax 1s  ev1ed on utility compan ies, which collect the lax from all customers, unless exempt, and remit lo the stale
Florida State Tax A pnv1lege tax imposed on every pe son whc engages 1n the business of selling or renting tangible personal property ot reta d 1n the  state, in accor d ance w lh Chapter 212 of Ihe F• orida Statu  tes
Franchise Fee A fee evied by a municipality for the right to utilize public properly for the purpose of provid ng electric service. Like
ta xes, the fee ,s collected by fampa Electric and is paid to the murnc1pahly.

For more information about your bill, please visit tampaelectric.com

Fuel Charge Cost of fuel used lo pr oduce elec tr city you purchased. Fuel costs ar e par,sed through from Fuel suppliers lo our  customers with no rr ar kup   or p of1t  l o Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge Fa, past due amounts more than $10, the late payment charge is the greater of SS or 1 5% of the past due amount. For past due amounts of $10 or ess, the late payment ctiarge 1s 1 5% of the past due amount.
Municipal Public Service Tax In addtion to the Franchise Fee, many munic1palil1es levy a tax on the electric ity you use. It is collected by Tampa Electric and paid lo the municipal ity.
Past Due Previous charges that a e past due are subJect to a late payment charge fee and may resu l 1n disconnection.
Rate Schedule The amoun (rati, ) you pay depends on your customer category. The cost of provid'ng service vanes with the customer group.
Renewable Energy,,. The amount of electncily purchased from renewable sources.
Share A program co sponsored by Tampa Electr'c and the Salvation Army where customers can help pay the energy bills of customers 1n  need. A one-time contr1bu  !i on can be made, or your monthly elec ted contribution wi I appear on your bill. Your contnbulion 1s tax deductible and 1s matched by Tampa Electric.
Total Amount Due This month's  charges will be past due after the date st1own. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. ll io:; i n po tant that you pay your bill before this dale 1n order lo avoid inlerruption of service.
Zap Cap SystemsN Surge protection for your home or business sold separately as a non energy charge.

Your payment options are:
Schedule Free one-time o,r ecur ring payments at tampaelectric.com using a check ing or savings account.
Mail your payment in the enclosed envelope. Please allow suffir1ent time for delivery.
P;.:iy 1n person al f.l  loca , auth orized  payment agent. For a listing of authori.1:ed payment agents, v1si1. tampaelectric.com or call Cuslomer Car e al the number hsted above.
Pay by credit or debit card using Quick Pay at tampaelectric.com or r a, 1866	-689-6469
(A convenience fee wl be charged to your bank account or credit cfird) When making you  paymen t,  please have your bill or account   un ber avr.1il ab1 e.
Please note: If you choose to pay your bid al a location not listed on our website or provided by Tampa  Electric, you are paying someone who is not aulho·ized lo act as a payment agent of Tampa Electric. You bear the nsk thal this unaulhon.1:ed party will relay the payment lo Tampa Eleclr'c and do so in a t'm, e y fashion. Tampa Eler lr c is not responsible  for payments made to unauthon.1:ed agents, including their failure to delive or timely de live the payn ent lo us. Such failures may result 1n late payment charges to your account or service disconnection.

Par favor, visite tampaelectric.com para ver esta 1r formaci6n en espanol.
Page 2 of 4

TEc-0.
TAMPA ELECTRIC
ANE:MERA  CIJMPANY
Account:	211005280915
Statement Date:	11/15/2017
Current month's charges due 12/06/2017

Detalls of Charges - Service from 10/13/2017 to 11/10/2017

ACCOUNT INVOICE
tampaelectric.com  I f W <p 8•	in

Service  for: 12198  TRIPLE CREEK  BL, RIVERVIEW, FL 33579-0000	Rate Schedule: General Service • Non Demand

Number	Read Date	Reading	Reading		Multiplier		
C16598	11/10 /2017	58,353	53,754	4,599 kWh		29 Days	

...
.'.a.
i
I

Meter

Current

Previous

Total Used

Billing Period

Tampa Electric Usage History

Basic Service Charge		$19.94		
Energy Charge	4,599 kWh @ $0.06216/kWh	$285.87		
Fuel Charge	4,599 kWh @$0.02956/kWh	$135.95		
Florida Gross Receipt Tax		$11.33		
Electric Service Cost			-$-4-53.09	
Total Current Month's Charges			$453.09	

Kilowatt-Hours Per Day (Average)

159

NOV
2017
OCT	70
SEP	84
AUG	108
JUL 	08
JUN	120

--	50 

MAY	132
APR	70
MAR	84
FEB	BO

DEC	06
NOV	08
201&

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers
was:
-Natural Gas & on•	60%
-Coal	34%
-Purchased Power	6%
•on makes up less than 1%

.

Page 3 of 4

Experience the power of nature
.,;: t e	atee Viewin pe:::ter

November I through April IS
10 a.m. to S p.m. daily

TEc	.	I	M

,

an

6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

...

,;	ELECTRIC	•

atee

.0 .
i
E

.;.

8
i

"fl "'""M"'"" .,.,,.PANY	Viewing Center
ta mpae le ctric.com/manatee

itat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
Snacks • Environmental education • ADA-compliant

Page4 of4

TEc=a
TAMPA ELECTRIC

ANEMERA COMPANY

TRIPLE CREEK CDD C/OGREG COX
12141 TRIPLE CREEK BL RIVERVIEW, FL 33579-0000

ACCOUNT INVOICE
tampaelectric.com  I	f W <p 8• I! in

Statement Date: 11/15/2017 Account:211005280683

Current	month's	
Total	amount	du	
Payment		

charges:	$80.00
e:	$80.00
Due By:	12/06/2017

Your Account Summary
Previous Amount Due
Peyment(s) Recerved Since Last Statement

-0

Current Month's Charges
"'
:.	Total Amount Due
i
E

$28.44
-$28.44
 	!!,O_J)O 
$80.00

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
1<noww11arsbelow.	Utility lines can
C8llblforeyoudig. easily be damaged

i

g	o e Rec'd Rizzetta & Co..1nMOV 2 1 2017
DIM approvaf 	oate,_	_
Da t&enter.ed 	_
f , rut	GL 		oc 		_
Cr	'< ft

n

Amount not paid by due date may be assessed a late payment charge and an eddit1onel de posit.

Follow us and we'll keep you posted

by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or   peoplesgas.com/callbeforeyoudig.

twitter.com/tampaelectrlc

facebook.com/lampaelecb1c

Yo(ug
youtube.comltecoenergylnc

To ensure prompt credit, please return stub portion of th is b ill w,th your payment. Make checks payable to TECO.

TEc-0.
TAMPA ELECTRIC

ANEMERA CDMPANY

WAYS TO PAY YOUR BILL

-	 	181

mail	phone onllne	pay agent
See reverse side for more information

Account:211005280683

Current	month's	charges:	
Total	amount	due:	
Payment	Due By:	

$80.00
$80.00 12/06/2017

■

00005359 02 AB  O◄O 3361 ◄ FT EC0111161    70331◄810     00000 09 01000000 00◄ 12    6 22◄8      00◄
111•I·1111I··1··I1·Ih1111•1111·1111h1•1  1111•1,.. 11•1r 11r ·111•
TRIPLE CREEK CDD
C/OGREGCOX
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

Amount Enclosed	$---------
65827219335

MAIL PAYMENT TO: TECO
P.O. BOX 31318
TAMPA, FL 33631-3318

6958272931352110052806830000000080006	Page 1 of4

TEc-0.
TAMPA ELECTRI IC
ANEMERA COMPANY

Contact Informatio n
Residential Customer Care
813-223-0800 (Hillsbo rough County) 863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866 832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877-588 1010
Energy-Saving Programs
813-275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box  31318 Tampa FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

...
0

N

•
1.
!:!
g

i

.;.

Average kWh per day The average amount of elec trici ty purchased per day.
Basic Service Charge A fixed monthly amount to cover the cost of providing service to your locat:on.
Bright ChoicesaM The number of light Fixtures and/or poles leased from Tflmpa Electric, and associated fees and charges.
Budget Billing    Optional plan takes the highs and lows out of monthly electric bills. This "leveling" billing pl.=m ,werages your las\ 12 monthly billing periods so you can  pay about  the same amount  ,fo your service each month.
Energy Charge The cost (except fuel) of producing the electricity you purchased, including conservation. environmental and capaci ty cost recovery charges.
Estimated If Tampa Electric was unable to read your meter, "ESTIMATED" will Flppear. Your electric use  has been esl1maled based on previous usage. The meter 1s scheduled to be read next month, Find FJny difference between the estimate and  actual use wi I be adiusted accord1ngty.
Florida Gross Receipts Tax    A tax is imposed on gross 1eceipls from ulr1ly services that are delivered lo retail customers in Flor'da,· n accordance with Chapter 203 of the Florida Statutes . The lax 1s levied on utility companies, which collect the lax from all customers, unless exempt, and remit lo the state.
Florida State Tax A privilege tax imposed on every person who engages n the business of selling or renting tangible personal properly al retail 1n the state, In accordance with Chapter 2·12 of the Florida Statutes.
Franchise Fee A fee levied by a mun1c1pality for the right to u til it: e pub11c properly fo t he purpose of providing electric service. Like taxes, the fee 1s c o\; ec ted by Tampa Electric and  s paid lo  the
mun·  c1p al ly.

For more inform<l t1on about your b111, please v sit tampaelectric.com.

Fuel Charge Cost of fuel used to produce etectncity you purchased. Fuel costs are passed through from fuel suppliers lo our customers with no markup or profit lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge For past due amounts more than $10, the late payment charge 1s the greater of SS or 1.5% of the past due amount. For past due amounts of $10 or less. the \ale payment charge 1s 1.5% of the past due amount.
Municipal Public Service Tax In addition lo the Franchise Fee, many municipalities evy a lnx on the eleclric 1ly you use. ll 1s collected by Tampa Electric and  paid to the mun1c 1p ality.
Past Due - Previous charges that are past due are subJect lo a late payment charge fee and may result in d1sc  onnecl1on.
Rate Schedule - The amount (ralei you pay depends on your customer category  The cost of providing service vanes w1lh   the customer group.
Renewable EnergysM- The amount of eleclric 1ly purchased from renewable sources
Share - A p ograrn co-sponsored by Tampa Electric and the Salvation Army where customers can help pay the energy bil's of customers in need. A one-lime contribution can be made, or your monthly elerled contr bulion will appear on your bill Your
contribu tion 1s  ta x deductib le and  is matched by Tampa  Electric.
Total Amount Due - This month's charges will be past due after the dale shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. It is important that you pay your bill
beFore this da te n order lo flvo·d interruption of service .
Zap Cap Systems•- Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-lime or recurring payments al tampaelectric.com using a checking or savings account.
Mail your payment in the enclosed enve ope. Please allow sufficient lime for delivery.
Pay n person at a local aulhonLed payment agent. For a listing of authorized payment agents, visit tampaelectric.com or call Customer Care al the number \isled above
Pay by c redi t or debit card using Quick Pay al tampaelectric.com or call 866-689-6469.
(A cor ven 1ence  fee w II be charged lo your bank accoun t or credit card.)

Wr en n' ak1ng    you  payment, please hrlve your bi\  or acc oun t number available.

Please note: IF you choose lo pay your bi ll al a location not \isled on our website , o prov ded by Tampa Electric, you are paying someone
who,   s not autho, r  t: ed lo act flS a payment agent of Tampa Elect 1c. You bear the r sk lhal this unaulhoriLed party wi I relay the payment lo Tampa Elect 1c and do  so 1n a,  t me   l y fashion. Tampa E ectric is not respons:tre For payments made lo unauthorized agen ts .  including lh,e r failure lo deliver o: l1meiy deliver  the payment lo us. Such Fa lu es may  esu   in  \ale payment charges lo your account or service d·sconnecl1on

Par  fav or  v,is te tampaelectric.com para ver esla informaci6n en espa iio l.

Page 2 of 4

TEc-0.
TAMPA ELECTRIC
AN EMERA CCJMPANY

Account:	211005280683	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

Details of Charges - Service from 10/13/2017 to 11/10/2017

ACCOUNT INVOICE
tampaelectric.com I f W <j) 8 I!, in

Service for: 12141 TRIPLE CREEK BL, RIVERVIEW, FL 33579-0000	Rate Schedule: General Service • Non Demand

Number	Read Date	Reading	Reading	Total Used	Multiplier	Billing Peri	
C21063	11/10/2017	46,689	46,056	633 kWh	1	29 Days	

...
.0..

i

•
a
ij
I

Meter

Current

Previous	=

od

Tampa Electric Usage History

Basic Service Charge		$19.94	Kil	
Energy Charge	633 kWh @ $0.06216/kWh	$39.35	(A	
Fuel Charge	633 kWh @ $0.02956/kWh	$18.71	NOV -
2017	
Florida Gross Receipt Tax		$2.00	OCT -
SEP 1 0.4	
Electric Service Cost			$80.00      AUG 1 0.3	
        Jil
JUN	

owatt-Hours Per Day verage)

-      -      -      -      -      -    -     -	22
3

l	10	

Total Current Month's Charges

$80.00	MAY	12

15

 	 -- 4
MAR -	4

---------2-2

FEB -	3
JAN
oec -	e
NOV -	6
2018

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers
was.
-Natural Gas & Oil*	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than  1%

B

..

Page 3 of 4

Experience the	power  of nature
 		t e	Manatee Viewin  pe e::ter

November I through April I 5
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

...

Iii,,

TEC<>.	I	Manatee

..

-.0 ,
•
G.

g
!g
g

T..NA"MMP"A"" ELME..C.......RIC	Vi•ewi•ng Center

a ..

tampaelectric.com/manatee

ltat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
'Snac ks • Environmental education • ADA-compliant

Page 4 of 4

TEc=a
TAMPA ELECTRIC

ANE:MEFIA CCMPANY

ACCOUNT INVOICE
tampaelectric.com  I	f ._'P 8• d! in

Statement Date: 11/15/2017 Account: 211005281889

12/06/2017

$66.92

$66.92

12113 TRIPLE CREEK BL
RIVERVIEW, FL 33579-0000

C
T

urrent	month's	charges:	
otal	amount	due:		
Payment	Due By:		

m	TRIPLE CREEK COD

g
.0...
i
I
*I

Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$62.40
-$62.40
 	!,66.92 
$66.92

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knoww11arsbelow.	Utility lines can
Gallbefomyoudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or peoplesgas.com/callbeforeyoudig.

n

Amount not paid by dua data may be assessed a late payment charge and an additional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc

facebook.tomnampaelectrtc

Youin
youtube.com/tecoenergyinc

To ensure prompt credit, p ease return stub portion of th s b II with your payment. Make checks payab e to TECO.

TEc=a
TAMPA ELECTRIC

ANEMEFIA CCMPANY

WAYS TO PAY YOUR BILL

•rJl 81

mail	phone online	pay agent
See reverse side for more mformat1on

Account:211005281889

Current	month's	charges:	
Total	amount	due:	
Payment	Due By:		

$66.92
$66.92 12/06/2017

Amount Enclosed	$---------
695827293140

TRIPLE CREEK COD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6958272931402110052818890000000066924	Page 1 of4

TEc-0.
TAMPA ELECTRIC ANEMERA CIJMPANY

Contact Information
Residential Customer Care
813 223-0800 (Hillsborough County)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toll-Free
877 588 1010
Energy-Saving Programs
813 275 3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318 Tampa, FL 33631- 3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

g
.0..
i
1
I

Average kWh per day The average amount of electricity purchased per day.
Basic Service Charge A fixed monthly amount to cover the cost of providing Sf'rv ce to your location.
Bright ChoicessM The number of light fixtures and/or  poles leasf'd from Tampa E ec tnc . and associated fees ;md charges
Budget Billing Opt,onal plan takes the highs and lows out of mont11ly electric bills. This "leveling" billing plan averages your last 12 monthly billing periods so you can pay about the same amount for your service each month.
Energy Charge The cost (except fuel)  of producing  the eleclncily you purchased, 1nclud1ng conservation, environmental and cap,1c ty cost recovery charges
Estimated If Tampa Electric was unable lo read your meter, "ESTIMATED" will appear. Your electric use has been estimated based on previous usage. The meter is schedu led to be read next month, and any difference between the estimate and actual use will be adjusted accordingly.
Florida  Gross Receipts Tax   A tax is imposed on gross  rece,pls from utility services that are delivered to relaol customers in Flor:cla, in accordance with Chaple 203 of the Florida Statutes. The lax is levied on utility compan·es, wh ch collect the lax from all customers, unless exempt, and rem,   l  to the slate.
Florida State Tax A pr vilege tax imposed on every person who engages in the bus,ness of selling or renting tangib le personal property at retail in the state, ,n accordance with Chapter 212 of lhe Florida Slalutes.
Franchise Fee    A fee le, v ed    by    a  mun     •c 1p ahty for the right lo ut1l' ze public properly for the purpose  of  providing  e ectric  service  L  ke laxes, the fee s collected by Tampa Elec tric and is paid to the municipality

For more info mat on abou your bill. please vis I tampaelectric.com.

Fuel Charge Cost of fuel used lo produce electricity you purchased. Fuel costs are passed through from fuel suppliers to our customers w1lh no markup or profi t lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge For past due amounts more than $10, the ate payment charge 1s the greater of $5 or 1.5% of the past due
,1mounl For pasl due amounts of S10 or less, the late payment charge is 1.5% or the past due amount.
Municipal Public Service Tax In add1t1on to the Franchise Fee, many mun1c1palilies levy a lax on the electricity you use. ll rs collected by Tampa Electric and paid to the municipa rily.
Past Due Previous charges that are past due are subject lo a late payment charge fee and may result in d sconnection.
Rate Schedule The r.1mounl (mte) you pc.ly depends on your customer category. The cost of providing service varies w1lh the customer group.
Renewable Energysu The amount of eleclric:ty purchased fron renewable sources.
Share A program co sponsored by Tampa Electric and the Salvation Army where customers can help pay the energy bi\ s of customers in need. A one- lim e contribution can be made, or your monthly elected contnbut,on will appear on your bill Your contribution is lax deductible and is matched by Tampa Electric.
Total Amount Due This month's  charges  will be  past due r.1fler the  dale shown. THIS  DATE DOES NOT EXTEND  THE DATE ON
ANY PREVIOUS BALANCE. ll rs 1mporlanl lhal you pay your bill before th,s dale n order to avoid inlerrupl,on or service.
Zap Cap Systems• Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-lime or recurring payments al tampaelectric.com using a checking or savings account
Mail your payment in the enclosed envelope. Please allow suff1L1ent lime for delivery.
Pay in person at a local aulhor1Led payment cJgenl. For a lislr ng of aulhoriLed payment agents, v1s1l tampaelectric.com or call Customer Care al the number \i sled above
Pay by c redi t or de,b t card using Quick Pay al tampaelectric.com or cal 866-689-6469.
(A c onven er ce fee will be chr.1rged to your bank account o: credit card.) When making your payment,  please have your  bill or accou nt number available
Please note; If you choose to pay your bi ll at a local1on no,t \ sled on our website or provided by Tampa Electric, you are paying someone who 1s not r.1uthonLed lo act as a pr.1yment agent of Tan pa E ectr:c. You bear \he risk that th,s unauthorized party w:11 relay the payment lo Tampa Elec tric and  do  so  n a t me y fashion. Tampa Eleclr c ,s not resp on, s b 'e for payments  made to unaulh,o  iLed  agents, including their failure lo deliver or timely del vf'   lhe payment lo us. Such fa, ures may result in  \ale payment ch, a ges	lo    your account or service d1sconriection .

Par favor, vrsile tampaelectric.com para ver esla rnformaci6n en espaiio·.
Page 2 of 4

TEc-0.
TAMPA ELECTRIC
ANEMERA CCMPANY		

Account:	
211005281889	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

ACCOUNT INVOICE
tampaelectric.com	j f W <p 8 LI in

m

.

Details of Charges - Service from 10/13/2017 to 11/10/2017

SeNice for: 12113 TRIPLE CREEK BL, RIVERVIEW, FL 33579-0000	Rate Schedule; General Service - Non Demand

!ii

..

.0..
•

Meter Number
K23530

Read Date

11/10/2017

Current Reading
34,641

Previous Reading
34,147

=	Total Used
494 kWh

Multiplier
1

Billing Period

29 Days

i

Tampa Electric Usage History

Basic SeN ice Charge		$19.94		Kilowatt-Hours Per	D	
Energy Charge	494 kWh @$0 .06216/kWh	$30.71		(Average)		
Fuel Charge	494 kWh @ $0.02956/kWh	$14.60		NOV	1	7	
Florida Gross Rece ipt Tax		$1.67		OCT	18
SEP	18		
Electric Service Cost			-$6-6-.92	      AUG	16
JUL	18
       JUN		

18	
Total Current Month's Charges			$66.92	MAY	18	
	APR
MAR		

ay
I	2017
21
24
       Fa!	24
JAN	26
      DEC		25
       NOV		24
201ft

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers
was:
-Natural Gas & Oil*	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than   1%

Page 3 of 4

.;!

Experience the	power of nature the ':"anatee Viewing Center

_,,,,_	,		Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

!:I
0

i

I

Ii!
*I

TEC<>.	I	Manatee

,:.	TAMPA  ELECTRIC	•	•

•	.... "'""'- ,,.,..p   •  ...,	V1ewmg Center
tampae le ct ric.com /manate e

itat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
'Sn acks • Environmental education • ADA-compliant

Page4 of4

TEGff
TAMPA ELECTRIC
ANEMERA  COMPANY

ACCOUNT INVOICE
tampaelectric.com  I	f W q> 8• lb in

Current	month's	
Total	amount	du	

Statement Date: 11/15/2017 Account: 221002207761

TRIPLE CREEK CDD		
13315 DORADO SHORES AVE			charges:	$33.16	
RIVERVIEW, FL 33579			e:	-$106.77	
	CREDIT	-		DO NOT PAY	

..

...
0
i

8

g
i

Currant Month's Charges

Total Amount Due

f

$33.16
-s1oa.n

1	 	

Help us avoid service interruptions

Your Account Summary		
Previous Amount Due	-$139.93	
Payment(s) Received Since Last Statement	$0.00	
Credit balance after payments and credits	-$139.93	

Call 811 two days before your project to have utility lines marked for free.
Knowwltat's below.	Utility lines can
Callbeforeyaudlg. easily be damaged
by planting trees,

: Ce  ReC 0 HIZZ8rut oc l,O., lr,  OV  2  0  201'7
1 /Mappr.oval 	Oa-w -	

installing fences, etc. Avoid potential service interruptions for you and your

ate enter._ed _	_	_	_
f	nd		GL  	
'< #

_	_	_
oc 	

neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or  peoplesgas.com/callbeforeyoudig.

n

Amount not paid by due date may be assessed a late payment charge and an addtfional deposit.

Follow us and we'll keep you posted

twltter.com/tampaelectrlc

facebook.convlampaelectrlc

YouiB
youtube.comltecoenergylnc

To ensure prompt credit, p lease return stub port on of th is b II with your payment. Make checks payable to TECO.

TEc=a
TAMPA ELECTRIC
ANEMERA COMPANY

WAYS TO PAY YOUR BILL

---

-	,181

mail	phone online	pay agent
----
See reverse side for more tnformat10n

Account:221002207761

Current	month's	charges	
Total	amount	due:	

:

CREDIT -

$33.16

-$106.77

DO NOT PAY

-   -   -   -·-·-           --   -   -	- -   -	--- --
Amount Enclosed	$--------
657555698567

00007119 01 AV 0 37 33625 FTECO111161703314810 00000 06 01000000 014 08 42908 002

I I

I,111•I·h•111,II' I' 11•1·,•1  •1•••111·,,1,, I·,111
TRIPLE CREEK CDD
12750 CITRUS PARK LN, STE 115
TAMPA, FL 33625-3784

,I1111    I··1I1111

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

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6575556985672210022077610 □□□□□□10677	4	Page 1 of4

TEc=a
TAMPA ELECTRIC
ANEMERA COMPANY

Contact Information
Residential Customer Care
813-223-0800 (Hillsborough Counly)
863-299-0800 (Polk County)
888-223-0800 (All other counties)

Commercial Customer Care
866-832-6249

Hearing lmpairedfTTY
711
Power Outages Toll-Free
877 588 1010
Energy-Saving Programs
813-275-3909

tampaelectric.com

Mall Payments to
TECO
P.O. Box 31318 Tampa, FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

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Average kWh per day The average amount of electricity purchased per day.
Basic Service Charge A fixed monthly amount lo cover the cost of providing service to your location
Bright Choices&u The number of light fixtures and/or poles leased from Tampa Elec tric,  and   a sso, c a ted fees and  charges
Budget Billing    Op•• onal	p  l an    lakes the highs and lows oul of monlhly elec tric b1 Is This "leve ling" b lhng plan averages your last 12 monthly billing periods so you  can  pay  about  lhf'  same  amount  for your service each month
Energy Charge    The cos I (except fuel) of producing the, e ec   tr city you purchased. 1nclud1ng conservat on, environmental and capacity cost recovery charges
Estimated If Tampa Electric was unable to read your meter, "ESTIMATED" will appear. Your electric  use  has  been estimated based on p revious usage. The meter is scheduled lo be read next month, and any difference between the esl1"1  ate and  actual use will be adJusted acc,o  d1ngly.
Florida  Gross Receipts  Tax  A  tax  is imposed  on g  oss receip  ts from ul1hly serv ces lhal are dehve·ed lo retail customers in Florida, 1n accordance with Chapter 203 of the Florida  Statutes. The tax  Is  ev ed  on utility companies, which collect the tax from all customers, unless exempt, and 1em1l  lo   lhe    stale
Florida State Tax A pr vi,ege lax imposed on every person who engages 1n the business of selling or renting tangible personal property at reta1  i n the state, 1n accordance with Chapter 212 of the Florida Statu tes
Franchise Fee A fee levied by a mu111cipalily for the right to ut1h,:e public properly for the purpose of  providing  electric  service.  Like taxes, the fee 1s collected by Tampa Electric and is paid to the municipality.

For more 1nformat1on about your bill, please v1sIt tampaelectric.com.

Fuel Charge Cost of fuel used lo produce electricity you purchased. Fuel costs are passed through from fuel suppliers lo our customers with no markup or profit lo Tampa Electric.
Kilowatt-Hours (kWh) The basic measurement of electric energy use.
Late Payment Charge Fur past due amounts more than $10, the late payment charge is the greater of $5 or 1 5% of lhe past due amount. For past due amounts of $10 or less, the late payment charge 1s 1.5% of the past due amount.
Municipal Public Service Tax In addition lo the Fmnch1se Fee, many mu111c1p   aht1es levy a tax on tre  elecldcily you use. It is collected by Ti-Jmpa Elect c and paid to the municipality.
Past Due Prev·ous charges that are past due are subject lo a late payment charge fee and may result n disconnection.
Rate Schedule The arnounl (rnte) you pay depends on your customer category. The cost of pmv1d1ng service vanes with the customer group.
Renewable Energysu Tire amounl of elec tricity pu chased from renewable source5
Share    A program co-spons,o  ed     by    Tampa Elec tric and  the Salvation Army where customers can he p pay the energy bills of customers 1n need. A one-lime cont·1bu   tion can be made, or your monthly elected contr but·on will appea r on your bill. Your contnbut1on is lax deduct,ble and is matched by Tampa Eleclr ,c.
Total Amount Due This month's charges will be past due after the dale shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE I s ,mportanl lh.-ll you pay your bill before this dale in o·der to avo1cJ interruption of service.
Zap Cap Systems•    Surge prolec t1on for your home or business sold separately as a non energy t ha ge.

Your payment options are:
Schedule free one-lime or recurring payments at tampaelectric.com using a checking or savings account.
Mail your payment in lhe enclosed envelope. Please allow sufficient lime for delivery.
Pay 1n person at a local authorized payment agent. For a  list ng  of authorized  payment  agenls,  visit tampaelectric.com  o,  call Customer Care al the number listed above.
Pay by credit or debit card using Quick Pay al tampaelectric.com or call 866-689-6469
(A convenience fee will be charged lo your bank  account  or credit  card.) When making your payment, please have your bill or account number available.
Please note: If you choose lo pay your bill al a location not hsled on our website o provided by Tampa Elect c, you are paying someone who 1s not aulhori,:ed lo act .-is a payment agent of Tampa Eleclr c. You bea lhe r sk that Iris unaulhor zed party will relay lhe payment to Tampa Electric and do so 1n ;i , t mely rash on. Tampa Electric 1s not respons be for payments madf' to unautho ,:ed agents, includ ng their
fa.lu re lo deliver or Line y de hve, the payment to us Such fa1lu es may esult in lat e paymer l charges to your account or service disconnection.

Por favor, vis1le tampaelectric.com para ver esta informaci6n en esp.-lnol.
Page2 of4

TEc-0.
TAMPA ELECTRIC
ANEMERA COMPANY
Account:	221002207761
Statement Date:	11/15/2017
Current month's charges due DO NOT PAY

Details of Charges - Service from 10/17/2017 to 11/13/2017

ACCOUNT INVOICE
tampaelectric.com  I f W <p 8•	in

Service  for: 13315  DORADO SHORES AVE,  RIVERVIEW, FL 33579	Rate Schedule: General Service • Non Demand

Number		Reading	Reading	Total Used	Multiplier	Billing Peri	
C558 55	11/13/2017	116	7	109 kWh	1	28 Days	

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Meter

Read Date

Current

Previous	=

od

Basic Service Charge		$19.94		
Energy Charge	109 kWh @ $0 .06216/kWh	$6.78	Kilowatt-Hours Per Day
NOV 	4	
Fuel Charge	109 kWh @ $0 .0295 6/kWh	$3.22	(Average)	
Florida Gross Receipt Tax		$0.77	- 0.2	

Tampa Electric Usage History

Electric Service Cost
State Tax
Total Electric Cost, Local Fees and Taxes

$30.71
$2.45

$33.16

SEP 0

Total Current Month's Charges	$33.16

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was.
-Natural Gas & ou•	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than 1%

Eili

Page3 of4

Experience the	power of nature at the Manatee Viewing Center
Open every November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572 (813) 228-4289 • Admission is free!

...

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TEc<	.	I	Manatee

AM- EL.ICCTRIC	,	,

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tampaelectric.com/manatee

ltat Trails • Rays Touch Tank • Observation Tower Wildlife-watching • Gardens • Games
Snacks • Environmental education • ADA-compliant

Page4 of4

TEc=a
TAMF'A ELECTRIC
ANEMERA COMPANY

ACCOUNT INVOICE
tampaelectric.com  I	f W'P 8•	in

Current	month's	
Total	amount	du	
Payment		

Statement Date: 11/15/2017 Account:211005282127

TRIPLE CREEK COD		
11920 STREAMBED DR, CLBHS		charges:	$621.20	
RIVERVIEW, FL 33579-9315		e:	$621.20	
		Due By:	12/06/2017	

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Your Account Summary
Previous Amount Due
Payment(s) Received Since Last Statement
Current Month's Charges
Total Amount Due

$667.29
-$667 29
 	1 1._2  Q 
$621.20

Help us avoid service interruptions

Call 811 two days before your project to have utility lines marked for free.
Knowwhat'sbelow.	Utility lines can

o t Rec'd Rizzetta & r.o., lmt.lOV z..1 .zD,17
I	D/M approval-	-	-	DatB-	-	
Dat&enteted 					_                F ·ndi--	_	GL 		oc 		_
Ct' : I{#	-	-  -	-	-	-	-

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Amount not paid by dua date may be assessed a late payment charge and an additional deposit.

Follow us and we'll keep you posted

Callbetore ,oudlg. easily be damaged
by planting trees, installing fences, etc. Avoid potential service interruptions for you and your neighbors. Digging on Saturday? Call 811 by Wednesday. Visit sunshine811.com or tampaelectric.com/callbeforeyoudig
or peoplesgas.com/callbeforeyoudig.

twltter.com/tampaelectrlc

taceboak.comllampaelectrlc

YouiD
youtube.comltecoenergylnc

To ensure prompt cred t, pleasereturn stub portion of th s b ill w th your payment. Make checks payab e to TECO.

TEc=a
TAMF'A ELECTRIC

WAYS TO PAY YOUR BILL

-	181

mail	phone online	pay agent

Account:211005282127

$621.20

ANEMERA C□MPANY	 	
See reverse side for more information

$621.20

12/06/2017

Current	month's charges:	
Total	amount	due	:	
Payment	Due By:	

Amount Enclosed	$---------
695827293141

TRIPLE CREEK CDD
3434 COLWELL AVE, STE 200
TAMPA, FL 33614-8390

MAIL PAYMENT TO: TECO
P.O. BOX 31318 TAMPA, FL 33631-3318

6958272931412110052821270000000621209	Page 1 of 4

TEc-0.
TAMF'A ELECTRIC

ANEMERA CCMPANY

Contact Information
Residen tial Customer Care
813-223-0800 (Hillsborough County)
863-299 0800 (Polk County)
888-223-0800 (All other counties)

Commercial C ustome r Care
866-832-6249

Hearing Impaired/TTY
711
Power Outages Toil-Free
877 588-1010
Energy-Saving Programs
813-275-3909

tampaelectric.com

Mail Payments to
TECO
P.O. Box 31318
Tampa , FL 33631-3318

All Other Correspondence
Tampa Electric
P.O. Box 111
Tampa, FL 33601-0111

Understanding Your Electric Charges

.0 ,
•
.i,,
I
I

Average kWh per day The average amount of electricity purchased per day.
Basic Service Charge A fixed monthly amount to cover the cost of prov1d1ng se 1 vice to your location.
Bright Choicess11 The number of light fixlureo, and/or poles leased from TAmpa E ectrc, andassociated fees and charges.
Budget Billing Optional plan takes the highs and lows out of
month ly elec, t  c  bills. This "leveling" billing plan averagt,s you   ast 12 monlhly bill ,ng periods so you can p<Jy about  the  same  amour !  for your service each month.
Energy Charge The cost (except fuel) of p oduc ng the electricity you pu,chased, including conserva, · on, environmen tal and capacity cost recovery chi'lrges
Estimated If Tampa E ectric was unable to 1e ad your meter,

Fuel Charge Cost of fuel used lo produce electricity you purchased. Fuel costs are passed through from fuel suppliers to our customers with no markup or profit to Tampa Electric.
Kilowatt-Hours (kWh) The basic measure ment of electric energy use.
Late Payment Charge For p,ist due ,imounls more than S10, the late payment charge 1s the greater of $5 or 1 5% of the past due amount. For past due amounts of $10 or less, the late payment charge is 1.5% of the past due amount.
Municipal Public Service Tax In add 1l1on to the Franchise Fee, many mun1c i pal   i t1es levy a tax on the elec tric it y you use  It is collected by Tampa Electric and  paid lo the mun1c1p  al1 l y
Past Due Previous charges that are past due are subJecl to a late payment charge fee and  may result in d1sconnect1on.

"ESTIMATED" w1'I appe,a

You electric use has been est mated

Rate Schedule The amount (rate) you pay depends on your

based on previous usage. The meter 1s scheduled to be read next month, and any difference between the eshmate and aclua use will be adiusled accord ngly.
Florida  Gross Receipts Tax   A lflx 1s imposed on gross receipts from utility services that are delivered lo reta I customers n Florida, 1n accordance w th Chapter 203 of the Florida Statutes. The tax is levied on utility companies, which collect the tax from ,ill customers, un ess exempt, and remit lo the state.
Florida State Tax A pr vilege lax imposed on every person who engages 1n the bus iness or sell ng or renting tangible pers onal proper!y al retail in the state, 1n accordance with Chapter 212 of the Florida Statutes.
Franchise Fee    A fee lc>v1ed    by a mun1c1p   ality for the right to utilize oubllc property fa the purpose  of  pr oviding  electric  service. L 1ke taxes  the  fee 1s  col  ecled by Tampa Elec tric  and  1s  paid to the munic pality

For more informal on about your u II, p 1 ea se v s,t tampaelectric.com.

customer catego y  The cost of prov1d 1ng    service vanes with lt1e customer group.
Renewable Energys11 The amount of elec tric11 y purcl ased from renewab le sources.
Share A program co-sponsored by Tampa E ec tric and the Salvation Army where customers can help pay the energy bills of customers in need. A one-time contribution can be made, or your monthly e erted contribution will appea r on your bill. Your contribution is tf'lx deductible and is 11atched by Tampa Electric.
Total Amount Due This month's charg es will be past due after the dale shown. THIS DATE DOES NOT EXTEND THE DATE ON
ANY PREVIOUS BALANCE. ll is important that you pay your bill before this date 111 order lo avoid interruption of service.
Zap Cap Systems Surge protection for your home or business sold separately as a non-energy charge.

Your payment options are:
Schedule free one-lime or recu rring payments at tampaelectric.com using a checking or savings account.
Mail your payment 1n the enclosed envelope. Please al ow sufficient time for delivery.
Pay in person at a loca authorized payment agent. For a lisllng of authorized payment agents, visit tampaelectric.com or call Customer Care ol lhe number listed above.
Pay by credit or debit card using Quick Pay at tampaelectric.com or call 866-689-6469.
! A convenience fee will be charged lo your bank  account  or credit  card.) When making your payment, please have your bill or account number available .
Please note; If you choose to pay your bill at a  ocat•on not listed on our website or provided by Tampa Electric, you are paying someon e who 1s not authorized to act as a payment agent or Tampa Elec tric You bear the risk that this unauth or·L ed party will relay the paym ent to
Tampa E ec:tnc and  do  so  n a timely fashion. Tampa Electric 1s not  esponsil)le r, o  payments made lo unauth or·Led  agen ts, including  the 11
failure to de l ver or timely de liver the payment to us. Such frnlures may resu lt in late payment rharges to your account or service d1sconnect1on.

Par favor, v1s1te tampaelectric.com para ver esta 1 n formac.6n en espafio
Page 2 of 4

TEc=a
TAMPA ELECTRIC

ANEMERA CCMPANY

Account:	211005282127	
Statement Date:	11/15/2017	
Current month's charges due	12/06/2017	

Ii

Details of Charges - Service from 10/09/2017 to 11/08/2017

ACCOUNT INVOICE
tampaelectric.com  I f W <p 8  i!, in

Service for: 11920 STREAMBED DR, CLBHS, RIVERVIEW, FL 33579-9315	Rate Schedule: General Service Demand - Standard

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Meter Number
L08008

Read Date

11/08/2017

Current Reading
65,269

Previous Reading
57,581

=	Total Used
7,688 kWh

Multiplier

Billing Period

31 Days

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L08008

11/08/2017

16.45	0

kW

31 Days

Tampa Electric Usage History
Kilowatt-Hours Per Day

Basic Service Charge Demand Charge

16kW @$10.25000/kW

$33.24
$164.00

(Average)

Energy Charge	7,688 kWh @ $0 .01754/kWh	$134.85	
Fuel Charge	7,688 kWh @$0 .02956/kWh	$227.26	
Capacity Charge	16 kW @ $0.27000/kW	$4.32	
Energy Conservation Charge	16 kW @ $0 .77000/kW	$12.32		
Environmental Cost Recovery	7,688 kWh @$0.00386/kWh	$29.68		
Florida Gross Receipt Tax		$15.53		
Electric Service Cost			-$6-2-1.20	
Total Current Month's Charges			$621.20	

NOV 2017 OCT

2-48

286

SEP	301
AUG	286
JUL	291
JUI	262
MAY 				276 APR 		289 MAR 	254 FEB 			275 JAN 		289 
DEC	258
NOV	281
2018

Billing Demand
(Kilowatts)

18

NOV 2017
NOV	18
2016

Load Factor
(Percentage)

62 81

NOV 2017

Important Messages
Fuel sources We Use to Serve You
For the 12-month period ending September 2017, the percentage of fuel type used by Tampa Electric to provide electricity to its customers was:
-Natural Gas & Oil*	60%
-Coal	34%
-Purchased Power	6%
*Oil makes up less than   1%

Page 3 of 4

a:

Experience the power of nature
t e	M  natee  Viewin p:::ter

November I through April 15
10 a.m. to 5 p.m. daily
6990 Dickman Rd. Apollo Beach, FL 33572

TEc	.	I	Manatee

(813) 228-4289 • Admission is free!

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..... ICMICRA aaMPANY	V1ewmg Center
tampaelectric.com/manatee

#tat Trolls • Rays Touch Tank • Observation Tower
Wildlife-watching  •  Gardens  •   Games Snacks • Environmental education • ADA-compliant

Page4 of 4

Tab 3

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SERIES 2017AB CONSTRUCTION REQUISITION RECAP FOR BOARD RATIFICATION JANUARY 16, 2018

REQUISITION NO.	

PAYEE	

AMOUNT	

SUBACCOUNT	
193-B	The Kearney Companies, LLC	$16,025.48	General B	
194-K	The Kearney Companies, LLC	$22,484.91	Village K	
195-L	The Kearney Companies, LLC	$13,666.32	Village L	
196-B	RIPA & Associates, LLC	$106,845.24	General B	
197-E	RIPA & Associates, LLC	$800.49	Village E	
198-F1	RIPA & Associates, LLC	$61,953.52	Village F1	
199-F2	RIPA & Associates, LLC	$44,668.19	Village F2	
200-G1	RIPA & Associates, LLC	$57,865.89	Village G1	
201-B	RIPA & Associates, LLC	$14,910.18	General B	
202-F1	RIPA & Associates, LLC	$137.416.27	Village F1	
203-F2	RIPA & Associates, LLC	$18,886.85	Village F2	
204-B	RIPA & Associates, LLC	$11,693.61	General B	
205-G1	RIPA & Associates, LLC	$67,875.95	Village G1	
206-G1	Newberg Irrigation, Inc.	$11,646.40	Village G1	
207-G1	Randy Suggs, Inc.	$15,609.72	Village G1	
208-B	Atlantic TNG, LLC	$2,422.00	General B	
209-K	Ferguson Waterworks	$1,956.74	Village K	
210-B	Florida Soil Cement Co., LLC	$28,401.78	General B	
211-B	Hayes Pipe Supply, Inc.	$12,965.50	General B	
212-B	The Kearney Companies, LLC	$234,825.50	General B	
213-K	The Kearney Companies, LLC	$119,575.51	Village K	
214-L	The Kearney Companies, LLC	$101,852.68	Village L	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

DISTRICT OFFICE · 9428 CAMDEN FIELD PARKWAY · RIVERVIEW, FLORIDA 33578

December 15, 2017

Thomas J. Radicioni
THE BANK OF NEW YORK TRUST COMPANY, N.A.
10161 Centurion Parkway
Jacksonville, FL 32256

RE:	Special Assessment Bonds, Series 2017AB Requisitions for Payment

Dear Thomas:

Below please find a table detailing the enclosed requisition(s) ready for payment from the Districts Acquisition/Construction Trust Account.

PLEASE EXPEDITE PAYMENT TO THE PAYEE(S) VIA UPS:

REQUISITION NO.	
PAYEE	
AMOUNT	
SUBACCOUNT	
193-B	The Kearney Companies, LLC	$16,025.48	General B	
194-K	The Kearney Companies, LLC	$22,484.91	Village K	
195-L	The Kearney Companies, LLC	$13,666.32	Village L	
196-B	RIPA & Associates, LLC	$106,845.24	General B	
197-E	RIPA & Associates, LLC	$800.49	Village E	
198-F1	RIPA & Associates, LLC	$61,953.52	Village F1	
199-F2	RIPA & Associates, LLC	$44,668.19	Village F2	
200-G1	RIPA & Associates, LLC	$57,865.89	Village G1	
201-B	RIPA & Associates, LLC	$14,910.18	General B	
202-F1	RIPA & Associates, LLC	$137,416.27	Village F1	
203-F2	RIPA & Associates, LLC	$18,886.85	Village F2	
204-B	RIPA & Associates, LLC	$11,693.61	General B	
205-G1	RIPA & Associates, LLC	$67,875.95	Village G1	
206-G1	Newberg Irrigation, Inc.	$11,646.40	Village G1	
207-G1	Randy Suggs, Inc.	$15,609.72	Village G1	

If you have any questions regarding this request, please do not hesitate to call me at (813) 933-5571. Thank you for your prompt attention to this matter.

Sincerely,
TRIPLE CREEK
COMMUNITY DEVELOPMENT DISTRICT

Christine Perkins District Manager

TRIPLE CREEK COMMlJNITY DEVELOPMENT DISTRICT
SPECJAL A.SSESSMENT BONDS
SERIES 2017B

The undersigned, a Responsible Officer of Trip le Creek Community Development' District (the " District" ) hereby s ubm its the following requisition for disbursement under and purs uant to the term s of the Master Trust lnde nture dated as of June I, 20 l 2 from the District to The Bank of New York Mellon Trust, N.A., as trustee (tl,e "Tr uste e"), as su pplemented by the Second Supplemental T rust Indent ure dated as of February I, 2017 (the ''Indenture"), {all capitalized terms used herein s hall have the meaning ascribed lo s uch tenn in
the Indentu re):
December 8, 2017

Requisi tion N1Jmber: CRJ 93-B

Name of Payee: The Kearney Companies, LL
962S Wes Kearney Way Riverview, FL 33578

Amount Payable: $16,025.48

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract invo lving progress payments , or, slate Costs of Iss uance, if applicable ): Pay Application #4 for Triple Creel< Villages K, L and Amenity Center

Fund or Account from which disbursement to be made: 2017B Acq uisition and C ons truct ion
Account

The undersigned hereby certifies that:
obligations in the siated amount set forth above have bee n incurred by the District, ot
this requis ition is for Costs of Jssu ance payable from the Acquisition and Const ruction Fund that have not previously been paid;

each disbursement se t forth above is a proper charge against the Acqu isition and Construction Fund;

each disb ursemen t set forth above was incurred in connection with the acqu isiti on and/or construction of th e Project;

each disbursement represents a Cost ofthe Project which has not previously been paid.

The undersigned hereby further certifies that there has not been tiled with or served upon lhe District notice of any lien, right to lien, or attachment upon, or claim a ffecting the right to receive payment of, any of the moneys payabl e to the Payc,-e set forth above, which has not been released or will not be re leased s im ultaneously wit h the paymen t hereof.
The undersig ned hereby further certifies that such requisition contains no item representing payment on account of any retained pe rcentage which the District is at th e date ofsuch certificate entitled to retain.
Attached hereto are originals of the invoice{s) from the vendor of the property acquir ed or the services rendered with respect to which dis bursement is hereby requested.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

 		7	
By: Ch ai		/	 Board ofSuperviso

CONSULTING ENGINEER'S APPROVA L FOR NO N-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a dis bursement from other than Costs of Issuance, the undersig ned Consu lti ng Engineer hereby certifies that this dis bursement is for a Cost of the Project and is consistent with: (i) the applicable acquis ition or construction contract; (ii) the plans and specifications for the portion of the Project with respect 10 which such disbursement is being made ; and (iii) the report of the Consultini; Engino<r, ,. soch report sh,J J h•"   b n   •mornlod m mod;fi<d oo lh< d'1	

 	neer

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERJES 2 017A, VILLAGE K

The undersigned, a Responsible Officer of Triple Creek Comm unity Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust lndenture dated as of June I, 20 t 2 !tom 1.he District to The Bnnk of New York Mellon Trnst , N.A., as 1rustee (the "Trustee"), as supplemented by the Second Supplemental Trust Indenture dated as of February I, 2017 (the "Indenture"), (all capitalized tenns used herein shall have the meaning ascribed to such term in the Indenture):

December 8, 2017

Requisition Number: CR194-K

Name of Payee: The I<earney Companies, LLC
9625 Wes Kearney Way Riverview, FL 33578
Amount Payable; $22,484,91

{D) Purpose for which paid or incurred {refer also to specific contract if amoun t is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable): Pay Application #4 for Triple Creek Villages K, Land Amenity Center

(E)	Fund or Accouflt from which disbursement to be made; 2017A Acquisition and Construction Account,
Subaccount Village K

The undersigned hereby certifies that;
l.	obligations in the stated amount set forth above have been incurred by the District. or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Fund that have not previously
been paid;

2.	each disbursement set forth above is a proper charge against lhe Acqu isition and Construction Fund;

3:	each disbursement set forth above was incurred in connection with the acquisi tion and/or construct ionof the Project;

4.	each disbursement rc'presentsa Cost orthe Project which has not previously been paid.

The undersigned hereby further ce-rtifles that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable lo the Payee set forth above, which has not been released or will not be releasedsimu ltaneously ,vith the payment hereof.
The undersigned hereby further certifies that such requisition contains no .i tem representing payment on account of any retained
percentage which the District is at lhe date of such certificate entitled !o retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the se rv ictIS rendered with respect to
which disbursement is hereby requested.
TRlPLE ClltEK COMMUNITY DEVELOPM NT DISTRICT

·

> .t(

7,....... ,, 

By: - 

CONSULTJNG ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

lf this requisition is for a disbursem ent from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and speciftcalions for the portion of the Project with,resp cct to which such disbursement is being made; and (iii) the report of the Consulting Engineer, as such report shalI have been amended or modified on the date hereof.
 	L	
su ltiflg Engineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
SPECIAL ASSESSMENT BONDS SERIES :Z017A,VILLAGE .L

The undersigned, a Responsible Officer of Triple Creek Comm unity Development District (the " Dist rict'') hereby submits the following requisition for disbursement under and pursuant to the terms of the Masler Trust Indenture dated as of June l, 2012 from the District to The :Bank of New York Mellon Trust, N.A., as trustee (the " Trustee') , as supplemented by the Second Supplemental Trust Indenture dated as of February I, 2017 (the " Indenture" ), (all capital ized terms used herein shall have the meaning ascribed lo such term in the Indenture):

December 8, 2017

Requisition Number : CR195-L

Name of Payee: The Kearney Companies, LLC
9625 Wes Kearney Way
Rivcn •iew , FL 33578

Amount Payable: $13,666,3l

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable): Pay Application #4 for Triple Creek Villages K, Land Amenity Center

Fund or Account rrom which disbursement to be made: 2017A Acqu isit ion imd Construelion Account,
Su bacco1mt Village L

The undersigned hereby certifies that:
I.	obligatjons in t he stateq amount .set forth above have been incurred by the District, or
this rnquisition is for Costs of Issuance payable from lhe Acquisition and Cons truction Fund that have not previously been paid;

each disb ursement set forth above is a proper charge against the Acquisition an d Construction Fund ;

each disbursement set forth above was inc urred in connection with the acquis ition and/or construction of the Project;

each disbursement represents a Cost of th-e Project which has not previously been paid.

The undersigned hereby further certifies !hat !here has not been filed with or served upon the District notke of any lien, right to lie n, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains □o item representing payment on account of any retained percentage which the District Js at the date of such certific ate entitled !o ret ain.
Attached hereto are orig[nals of the invoicc(s) from the vendor of the property acquired or the services rendered with respect to which d.isbursemen t is hereby requested.

By: cM;	Y 2:5

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

Board of Supervisors

CONSULTING ENGINEER ' S A.PPROVAL FOR
NON-COST OF ISSUAN CE. REQUESTS ONLY

If this requisition is for a disbursemen t from other than Costs of rssuance, the undersigned Consulting Engineer hereby certifies that this disbursemen t is for a Cost of the Project and is consistent with: (i) th applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is beinc made; and (iii) the report of the Consulting Engineer, as such report sha ll have been amended or modified on the date hereof.

_;<onsultingEnginee

•

KEARNEY
COMPANIES
Office (813) 421-6601

THE	KEARNEY COMPANIES, I.LC.
9625 Wes KcarnL-y Way, Riven•ic:w 1<1. 33578	Fax (813) 421-6701

Underground Utilities	Site Development

CONTRACTOR'S APPLICATION FOR PAYMENT

PROJECT:	TRIPLE CREEK  VILLAGES K & L, AMENITY CENTER	PROJECT NO.:

-0038-01 --

PAYMENT REQUEST NO.:	4	FOR PERIOD:	11/30/2017	TO	11/8/2017

1. ORIGINAL CONTRACT AMOUNT . .  . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . .  $	2,315,315.15
2.  APPROVED CHANGE ORDERS & CONTINGENCIES. . . . . . . . . . . . . . . . . . . . . .  .  .  .  .  .  .  ,  .  .  ._$;	_    ...(.,_2_8_.,1_9_36_.0_6_,)_

= = ===== ==== =

3.  CURRENT CONTRACT AMOUNT .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . .  .  $	2,033,379.09
4. VALUE OF WORK COMPLETED TO DATE  51%	$  1,043,534.52
5. LESS AMOUNT RETAINED	5%   .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . .  $	52,176.73
6. NET AMOUNT EARNED TO DATE .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . .  .  .  .  . .  .  .  .  .  .  . .	 $	991,357.79 

LESS AMOUNT OF PREVIOUS APPLICATIONS . . . . . . . . . . . . . .
TOTAL AMOUNT UNPAID TO DATE. . . . . . . . . . . . . . . . . . . . -$ -

4-63-,'0--2--2.8-3

   $	939,181.08 

9.  PREVIOUS APPLICATIONS UNPAID .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  $	410,846.1·2	 	
CURRENT PAYMENT DUE THIS APPLICATION. 	=$====52=,1=7=6.=71=
CERTIFICATION OF CONTRACTOR
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.

DATE:	11/8/2017
TITLE:	PROJECT MANAGER

STATE OF FLORIDA	} COUNTY OF HILLSBOROUGH	}
The foregoing instrument was acknowledged by Sherry Spurlock, Project Manager of THE KEARNEY COMPANIES, LLC., a Florida Corporation, on behalf of the corporation before me this 8th day of

MY COMMISSION# GG 103334

November	, 2017.  He/she is personally known to me or has produced 	as identification.

Nour,yStaJ11p

,. -:,,; ..._	JOYCE M. ZEVOLA

.:...	••i

 	*	 Tt;;-=>IDA

r

1

\z.	1	EXPIRES: June 13, 2021
•<,f((.f:; ..-• Bonded Tlvu Nolaly Pubffc: Underwrlle11

CERTIFICATION OF ENGINEER

Village K = $22,484.91
Village L = $13,666.32 Amenity= $16,025.48

 J J

I certify that I have checked and verified this Request for Pay ent and that it Is a true and correct statement, to the best of my knowledge, of work performed and/or m	rial su lied by the Contractor. In accordance with the terms and conditions of the Contract, the undersigned		d..Air§iii	U o the Contractor of Balance Due This Payment as
shown abo,/e_	'	, /
ENGINEER:  		-r<-:---r....,....  r=----  DATE:  		/   Cf-,1;£ !I_T_"  	_
B_Y:  _	 	   _	_	_	 	 ......... 	  TITLE:   		qt/  <..lo?c 5

COMPANIES
Office (813) 421-6601

- INVOICE -

KEARNEY•

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

N!! 17275

Fax (813) 421-6701

Underground Uti/;ties	Site Development

SOLD TO:   TRIPLE CREEK CDD	PROJECT:	TRIPLE CREEK VILLAGES K & L, AMENITY CENTER

INVOICE DATE

CLERICAL ERRORS ARE SUBJECT TO CORRECTION. DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.

JOB NO.
0038-01

CUST.NO.	W.O.NO.	PERCENTAGE COMPLETE

INVOICE NUMBER

Descr1pt,on	Amount

CONTRACTOR'S PAY APPLICATION # 4	
$		
RELEASE 50% RETAINAGE	$ 52,176.71		
TOTAL AMOUNT DUE	$ 52,176.71	$	52,176.71	
PLEASE REMIT TO:
THE KEARNEY COMPANIES, LLC.
Please add  tj	ATTN: Dept. AIR
9625 Wes Kearney Way
Riverview, FL 33578		
PLEASE PAY FROM THIS INVOICE - NO STATEMENT WILL BE RENDERED		
INVOICES DUE PER AGREEMENT - NO DISCOUNTS. UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH		
IS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS AND FEES FOR COLLECTION ON AC­		
COUNTS REMAINING UNPAID IN EXCESS OF 30 DAYS INCLUDING, BUT NOT LIMITED TO, ATTORNEYS' FEES AND ATTORNEYS'		
FEES ON APPEAL.		

BILL TO:	TRIPLE CREEK CDD
PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0039;01

THE KEARNEY COMPANIES, LLC.
9826 WES KEARNEY WAY RIVERVIEW, FL 33678
(813) 421-8801

SCHEDULE OF VALUES

APPLICATION ND.: APPLICATION DATE PERIOD TO: GCIOWNER'S NO:.

4
11/8/2017
11/8/2017

A	B	C

D	E	F	G	H

ITEM
NO.	DESCRIPTION
OFWORK	CONTRACT
VALUE	FROM
PREVIOUS APPLICATION	THIS
PERIOD	TOTAL
COMPLETED &STORED
TO DATE	
%	BALANCE
TO FINISH	RETAINAGE	

1.
2.
3.
4.
5.
6.	SCHEDULE A -AMENITY GENERAL CONDITIONS
MOBILIZATION
NPOES PERMIT & COMPLIANCE MAINTENANCE OF TRAFFIC
CONSTRUCTlON STAKEOUT/RECORD SURVEY GEOTECHNICAL & MATERIAL TESTING PAYMENT & PERFORMANCE BOND
TOTAL SCHEDULE A-AMENITY GENERAL CONDITIONS	

$	40,986.72
$	7,490.80
$	1,722.00
$	28,859 .00
$	12,484.50
s	17,147 .17			
$	40,886.72
$	3,745.40
$	516.BO
$	17,195.40
$	7,490.70
$	17,147.17	
100%
50%
30%
80%
60%
100%	
$	-
$	3,745.40
$	1,205.40
$	11,483 .80
$	4,993 .80
$	-	
$	2,049.34
$	187.27
$	25,83
$	859.77
$	374.54
$	857.38	
			$	40,986.72    $	-					
			$	3,745.40
$	518,60
$	17,195.40
$	7,490.70
$	17,147.17	$	-
$	-
$	-
$	-
$	-					
		$ 108,490.19	$	87,081.99	$	-	$	87,081.99	llO%	$	21,408.20	$	4,354.11	

1.
2.
3.
4.
5,
6.
7 ,
8,
9,
10.
11.	SCHEDULE B - AMENITY EARTHWORK
CLEARING & GRUBBING OISCSITE
CUT VOLUME (UNADJUSTED) FILL VOLUME (UNADJUSTED)
STOCKPILE ON ADJACENT AREA (UNADJUSTED) SODDING
SEEDING & MULCHING SILT FENCE
INLET PROTECTION DEWATERING FINAL GRADING
TOTAL SCHEDULE B · AMENITY EARTHWORK	
$	49,5 90.69
$	4,848.00
$	80,901.77
$	17,532.00
$	17,535.18
$	55,073.40
$	4,274.25
$	12,103 .00
$	1,276.88
$	19,264.44
$	17,186.90	
$	49,590.69
$	4,848.00
$	24,360.71
$	7,012.80
$	7,014.08
$
$
$	12,103.00
$	-
$	7,705.78
$	-	$	-
$	-
$	-
$	.
$	-
$	-
$	-
$	-
$	-
$	.
$	.	
$	49,590.69
$	4,848.00
$	24,360.71
s	7,012.80
$	7,014.08
$	-
$	-
$	12,103.00
$
$	7,705.78
$	-	
100%
100%
40%
40%
40%
0%
0%
100%
0%
40%
0%	$	-
$
$	$,541.06
$	10,519.20
$	10,521.10
$	55,073.40
$	4,274.25
$	-
$	1,276.BB
$	11,558.66
$	17,188 .90	
$	2,479.53
s	242.40
$	1,218.04
$	350.84
$	350,70
$	.
$	-
$	605 .15
$	-
$	385.29
$	-	
		$ 259,588.47	$ 112,835.04	$	.	s	112,835.04	43%	$ 146,951.43	$	5,631.75	

1.
2.
3,
4.
5.
6,
7.
8 .
9 .
10.
11.
1 2 .
13 .	SCHEDULE C • AMENITY ROADWAY
1 3/4" SP ASPHALTIC CONCRETE
8" CRUSHED CONCRETE
6" STABILIZED SUBGRAOE (LBR 40)
TYPE 'D' CURB
TYPE 'F' CURB W/STABILIZATION VALLEY GUTTER
5'X4" CONCRETE SIDEWALK
6'X4" CONCRETE SIDEWALK
10'X4" CONCRETE SIDEWALK ADA RAMPS (5' WIDE) DUMPSTER ENCLOSURE SIGNAGE & STRIPING PARKING LOT WHEEL STOPS
TOTAL SCHEDULE C • AMENITY ROADWAY	s	86,647.86
$	84,791.82
$	32,431 .14
$	9,500.22
$	40,268.80
$	3,106.12
$	52,675 .00
$	6,738 .38
$	3,565 .50
$	6,757.65
$	9,451.20
$	13,511.68
$	159.90		
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	.
$	.
$	.
$	-
$	.
$	-	
$	-
$	.
$	-
$	.
$	-
$	-
$	-
$	-
$	-
$	.
$	-
$	-
$	-			
$	-
$	-
s	.
$	-
s	-
$	-
$	-
$	.
$	.
$	.
$	-
$	-
$	-	
						0%  $	88,847.88
0%  $	84,791.62
0% $	32,431.14
0%  $	9,500.22
0%  $	40,266.80
0%   $	3,106.12
0%  $	52,675.00
0%   $	6,736 .38
0%   $	3,585.50
0%  $	6,757.65
0%  $	9,451.20
0%  $	13,511.68
0%  $	159.90		
		$ 329,821.07	$	-	$	-	$	-	0%	$ 329,621.07	$	-	

1.
2.
3.
4.
5.
6.
7.
8.
9,
10.
11.
12.
13,
14.
15,
16.
17.
18 .
19.
20.
21.	SCHEDULE D -AMENITY POTABLE WATER SYSTEM
CONNECT TO EXISTING 12" W/M 1"POLYETHYLENE WATERLINE
2: POLYETHYLENE SERVICE (LIFT STATION)
3/4" PE WATERLINE SERVICE & BACKFLOW PREVENTER ASSEMBLY
6" PVC, C-900
12" PVC PIPE C-800 'rBEND
2" TEE FITTINGS
2" GATE VALVE
6" GATE VALVE
BLOW-OFF ASSEMBLY
6" FIRE HYDRANT ASSEMBLY
1" TEMPORARY BLOW-OFF & GATE VALVE
6" TEE FITTINGS
12" GATE VALVE
12' BEND FITTINGS
12' TEE FITTINGS
SINGLE SERVICE, SHORT SIDE
2"METER ASSEMBLY
TEMPORARY CONSTRUCTION METER CHLORINATION & PRESSURE TESTING
TOTAL SCHEDULE O • AMENITY POTABLE WATER SYSTEM	
$	2,060.34
$	1,910.40
$	5,053 .62
$	3,592 .66
$	g&, tj 38
$	11,864.58
$	154.17
$	3,100.80
$	3,083.04
$	3,550.92
$	609 .08
$	3,744.84
$	815 .12
$	903.64
$	7,052.76
$	2,489 .13
$	498,25
$	2,782.45
$	2 ,204.29
$	10,816 .36
$	4,093 .93	
$	-
$	1,910.40
$	5,053.62
$	-
$	965 .36
$	11,684.58
$	154.17
$	3,100.60
$	3,083.04
$	3,550.92
$	609.08
$	3,744.64
$	615.12
$	903.64
$	7,052.76
$	2,469.13
$	498.25
$	2,782.45
$	-
$	-
$	.	
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	.
$	-
$	.
$	-
$	.
$	-
$	-
$	-
$	-
$	-
$	-
$	-	$	-
$	1,910.40
$	5,053.82
$	-
$	985 .38
$	11,884.58
$	154.17
$	3,100.80
$	3,083.04
$	3,550.92
$	609,08
$	3,744.64
$	615.12
$	903.64
$	7,052.78
$	2,489.13
$	498 .25
$	2,782.45
$	-
$
$	-			
$	-
$	95.52
$	252,68
$	-
$	46.27
$	594.23
$	7.71
$	155.04
$	154.15
$	177.55
$	30.45
$	187,23
$	30.76
$	45.16
$	352,64
$	124.46
$	24.91
$	139.12
$	-
$	-
$	.	
						0%  $	2,080.34
100%  $	-
100%   $	-
0%  $	3,592.68
100%  $	-
100%   $	-
100% $
100%  $	.
100%   $	-
100%   $	-
100%   $	-
100%   $	-
100%  $	-
100%   $	-
100%  $	-
100%   $	-
100%  $	-
100%  $	.
0%  $	2,204.29
0%  $	10,816.36
0%  $	4,093.93		
		$	71,165.56	$	48,397.96	$	-	$	48,397.98	68%	$	22,767.60	$	2,419.90	

1.
2.
3.
4.	SCHEDULE E - AMENITY SANITARY SEWER
8" PVC, SOR 26 (0'-6' CUT}
8" PVC, SOR 26 (6'-8' CUT} SANITARY MANHOLE (0'-6' CUT) SANITARY MANHOLE (6'-8' CUT)	
$	6,180.58
$	2,108,05
$	4,167.58
$	4,597.48	
$	6,160.56
$	1,475.64
$	4,167.56
$	3,218.24	
$	.	
$	6,160.56			
$	308.03
$	73.78
$	208.38
$	160.91	
						100% $
70%  $	632.42
100%  $	-
70%  $	1,379.24		
				$	(0.01)  $	1,475.83
$	$	4,167.58
$	$	3,218.24			
h nm11.n1 Trinh, r.......k VIIISlnR Kit.I -AmRnllv- Pav Aoo 4 800000	Paae 1 ors	11/8/2017 2:26 PM

BILL TO:	TRIPLE CREEK COD
PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC, 9625 WES KEARNEY WAY RIVERVIEW, FL 33578
(813) 421-8801

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

4
11/8/2017
11/8/2017

A	B	C	D	E	F	G	H
ITEM	DESCRIPTION	CONTRACT		FROM		THIS		TOTAL		BALANCE	RETAINAGE NO.		OFWORK		VALUE	PREVIOUS	PERIOD	COMPLETED	%	TO FINISH
APPLICATION	&STORED TO DATE
5.	SINGLE SERVICE (HILLSBOROUGH COUNTY)	$	402.57    $	402.57   $	-	$	402.57	100%  $	-	$	20.13
6.	DOUBLE SERVICE (HILLSBOROUGH COUNTY)	$	3,637.30   $	3,637.30   $	-	$	3,637.30	100%  $	-	$	181.87
7.	8" STUB & PLUG (GRAVITY SEWER)	$	111.54   $	111.54   s	-	$	111.54	100%  s	.	$	5.58
8.	DEWATERING	$	4,263.90   $	3,411.12   $	.	$	3,411.12	80%  $	852.78   $	170.56
9.	INFIIJEXFIL TESTING	$	1,645.36   $	-	$	.	$	.	0%  $	1,845.36   $	.
10.	TELEVISE SANITARY SEWER (CCTV)	$	2,062.05    $	.	$	.	$	-	0%  $	2,062.05   $	.
11.	PRIVATE PUMP STATION (48" DIA)	$	64,532,30   $	.	$	.	$	0%   $	64,532.30   $	.
12.	CONNECT TO EXISTING 8" FM	$	1,228.60   $	.	$	.	$	.	0%  $	1,228.60    $	.
13.	4" PVC, C-900 FM	$	276.80   $	278.80   $	.	$	276.80	100%  $	.	$	13.64
14.	4" PLUG VAlVE	$	713.99   $	713.99   $	.	$	713.99	100%  $	.	$	35.70
15.	4" X 2" REDUCER	$	198.04   $	198.04   $	.	$	198.04	100%  $	.	$	9,90
16.	8" PVC, C-900 FM	$	14,188.44    $	14,188.44   $	$	14,188.44	100%  $	.	$	709.42
17.	B"PLUGVALVE	$	4,458.45    $	4,458.45    $	-	$	4,458.45	100%  $	.	$	222.92
18.	B"BEND	$	3,623.52   $	3,623.52   $	.	$	3,623.52	100%  $	.	$	181.18
19.	8"TEE	$	512.16   $	512.16   $	.	$	512.16	100%  $	.	$	25.61
20.	8"CAP	$	133.44   $	133.44   $	-	$	133.44	100%  $	.	$	6.67
21.	TEMPORARY BLOW-OFF	$	325.74   $	325.74   $	.	$	325.74	100%  $	.	$	16.29
22.	PRESSURE TESTING (FM)	$	3,541A7   $	-	$	.	$	-	0%  $	3,541.47   $	-
TOTAL SCHEDULE E • AMENITY SANITARY SEWER	$     123,089.34   $	47,015.13   $	(0.01)  $	47,015.12	38%  $	76,074.22  $	2,350.77

SCHEDULE F -AMENITY STORM DRAINAGE
1.	15" CLASS Ill RCP	$	9,933.64   $	9,933.84   $	.	$	9,933.84	100%  $	-	$	496.69
2.	18" CLASS Ill RCP	$	18,170.32   $	18,170.32   $	.	$	18,170.32	100%  $	.	s	908.52
3.	24" CLASS Ill RCP	$	19,753.20   $	19,753.20   $	-	$	19,753.20	100%  $	.	$	987.88
4.	30" CLASS Ill RCP	$	12,048.20   $	12,048.20   $	.	$	12,048.20	100%  $	-	$	802.41
5.	HILLSBOROUGH CO. TYPE 1 CURB INLET	$	17,894.70   $	17,894.70   $	.	$	17,894.70	100%  $	.	$	894.74
6.	HILLSBOROUGH CO. TYPE 1 CURB INLET W/J-BOTTOM	s	3,578.94   $	3,578.94   $	-	$	3,578.94	100%  $	.	$	178.95
7.	FOOT "TYPE E" INLET	$	16,548.36   $	16,548.38   $	.	s	18,548.36	100%  $	.	$	827.42
8.	DITCH BOTTOM INLET, TYPE "C"	$	1,458.48    $	1,458.48   $	$	1,458.48	100%  $	.	$	72.92
9.	24" X 24" YARD DRAIN STRUCTURE	$	5,763.50   $	5,763.50   $	-	$	5,763.50	100%  $	.	$	288.18
10.	CONTROL STRUCTURE (FOOT MODIFIED TYPE "D" INLET)	$	4,112.07   $	4,112.07   $	.	$	4,112.07	100%  $	.	$	205.60
11.	6' PVC UNDERDRAIN	$	8,835.44   $	.	$	-	$	-	0%  $	8,835.44   $	-
12.	UNDERDRAIN CLEANOUT	$	862.28   $	.	$	.	$	.	0%  $	862.28   $	.
13.	30"FDOTFES	$	8,524.60   $	6,524.80   $	.	$	8,524.60	100%  $	.	$	426.23
14.	FOOT MANHOLE	$	6,189.42   $	6,189.42   $	-	$	6,189.42	100%  $	$	309.47
15.	TELEVISE STORM SEWER (CCTV)	$	9,993.75   $	-	$	.	$	.	0%  $	9,993.75   $	.
TOTAL SCHEDULE F AMENITY STORM DRAINAGE	$     143,667.10    $    123,975,63   $	-	$	123,975.63	88%  $	19,691.47   $	6,198.79 SCHEDULE G • AMENITY UNCLASSIFIED ITEMS
1.	TREE BARRICAOES	$	13,415.36   $	13,415.36   $	.	$	13,415.36	100%  $	.	$	670.77
2.	ROOT PRUNING	$	1,974.15   $	1,974.15   $	.	$	1,974.15	100%  $	.	$	98.71
3.	6" PVC, SOR 26 (6'-8' CUT)	$	339.56   $	339.56   $	.	$	339.56	100%  $	.	$	16.98
4.	6" PVC, SDR 26 (8'-10' CUl)	$	241.44   $	241.44   $	-	$	241.44	100%  $	.	$	12.07
5.	8" PVC, SDR 26 (6'-10' CUl)	$	1,197.96   $	1,197.96   $	.	$	1,197.96	100%  $	.	$	59.90
6,	8" PVC, SDR 26 (1O'•12' CUT)	$	1,177.98   $	1,177.98   $	.	$	1,177.98	100%  $	.	$	58.90
7.	SANITARY MANHOLE (8'-10' CUT)	$	2,470.:W   $	2,470.26  $	-	$	2,470.26	100%  $	.	$	123.51
8.	SANITARY MANHOLE (10'-12' CUl)	$	2,708.34   $	2,708.34   $	.	$	2,708.34	100%  $	-	$	135,42
9.	8" SANITARY CLEANOUT	$	308.90    $	308.90    $	.	$	308.90	100%  $	.	$	15.45
10.	2"POLYETHYLENE GREEN FM	$	3,200.00   $	3,200.00  $	-	$	3,200.00	100%  $	$	160.00
11.	8" PVC, SOR 35 • STORM	$	3,226.79   $	3,226.79   $	.	$	3,226.79	100%  $	.	$	161.34
12.	10" PVC, SDR 35 - STORM	$	4,068.00    $	4,088.00   $	.	$	4,068.00	100%  $	.	$	203.40
13.	5' VINYL COATED FENCE	$	15,498.00   $	-	$	$	.	0%  $	15,498.00   $	.
TOTAL SCHEDULE G • AMENITY UNCLASSIFIED ITEMS	$	49 ,828 .74     $	34,328.74    $	.	$	34,3287. 4	69%  $	15,498,00   $	1,716.45

SCHEDULE H • VILLAGE K GENERAL CONDITIONS
1.	MOBILIZATION	$	25,298.08   $	25,298.08  $	.	$	25,298.08	100%  $	-	$	1,264.90
2.	NPDES PERMIT & COMPLIANCE	$	6,253.15   $	4,889.86   $	.	$	4,689.86	75%  $	1,563.29   $	234.49
3.	MAINTENANCE OF TRAFFIC	$	8,302.50   $	6,642.00   $	.	$	6,642.00	80%  $	1,660.50   $	332.10
4.	CONSTRUCTION STAKEOUT/RECORD SURVEY	$	38,253.00   $	30,602.40  $	.	$	30,602.40	80%  $	7,650.60   $	1,530.12
5.	GEOTECHNICAL & MATERIAL TESTING	$	11,008.50   $	8,806.80    $	.	$	8,806.80	80%   $	2,201.70   $	440.34
6.	PAYMENT & PERFORMANCE BOND	$	12,814.51   $	12,814.51   $	.	$	12,814.51	100%  $	$	640.73
TOTAL SCHEDULE H • VILLAGE K GENERAL CONDITIONS	$    101,929.74   $	88,853.65   $	.	$	88,853.65	87%  $	13,076.09   $	4,442,68
SCHEDULE I • VILLAGE K EARTHWORK
1.	CLEARING & GRUBBING	$	5,856.40   $	5,856.40   $	.	$	5,856.40	100%  $	.	$	292.82
2.	SAW CUT EXISTING ASPHALT & REMOVAL	$	4,744.11   $	4,744.11   $	.	$	4,744.11	100%  $	.	$	237.21
3,	DEMO EXISTING SIDEWALK	$	1,101.32   $	1,101.32   $	-	$	1,101.32	100%  $	-	$	55.07
4.	OISCSITE	$	4,444.00   $	4,444.00    $	.	$	4,444,00	100%  $	-	$	222.20
h 0038-01 Trlole Creek ViUaae K&L-Amenllv • Pav ADD 4 800000	PaQe2 of 5	11/8/2017 2:26 PM

BILL TO:	TRIPLE CREEK COD
PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9625WES KEARNEY WAY RIVERVIEW, FL 33578
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GCIOWNER'S NO.:

4
11/8/2017
11/8/2017

A	B	C	D	E	F	G	H
ITEM
NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL
COMPLETED &STORED
TO DATE	
%	BALANCE
TO FINISH	RETAINAGE	
5.	CUT VOLUME (UNADJUSTED)	$	19,581.60	$	19,581.60	$	.
$	.
$	.
$	-
$
$	-
$	-
$	.	$	19,581.60
$	10,475.20
$	11,042..04
$
$	8,164.00
$	.
$	13,478.05
$	13,159.00	100%	$	.
$	-
$	-
$	23,390.52
$	-
$	1,767.96
$	.
$	-	$	979.0B
$	523.76
$	552.10
$	.
$	408.20
$	.
$	673.90
$	657.95	
6.	FILL VOLUME (UNADJUSTED)	$	10,475.20	$	10,475.20			100%			
7.	EXPORT TO VILLAGE I	$	11,042.04	$	11,042.04			100%			
B.	SODDING	$	23,390.52	$	-			0%			
9.
10.	SILT FENCE
INLET PROTECTION	$	8,184.00
$	1,767.96	$	B,184.00
$	.			100%
0%			
11.	DEWATERING	$	13,478.05	$	13,478.05			100%			
12.	FINAL GRADING	$	13,159.00	$	13,159.00			100%			
	TOTAL SCHEDULE I· VILLAGE K EARTHWORK	$ 117,204.20	$	92,045.72	$	.	$	92,045.72	79%	$	25,158.4B	$	4,602.29	
	SCHEDULE J · VILLAGE K ROADWAY		
$	.
$	47,576.89
$	19,126.17
$	44,017.05
$	1,383.06
$	2,479.20
$	-
$	-
$
$	.	
$	-
$	.
$	.
$	-
$	.
$	.
$	-
$	-
$	-
$	-	

$
$	47,576.89
$	19,126.17
$	44,017.05
$	1,383.06
$	2,479.20
$	-
$	-
$	-
$	-		

$	40,203.99
$	.
$	-
$	.
$	.
$	.
$	12,717.25
$	7,092.96
$	4,179.06
$	6,455.66	
$	-
$	2,378.84
$	958.31
$	2,200.85
$	69.15
$	123.96
$	-
$	-
$
$	-	
1.	1 3/4" SP ASPHALTIC CONCRETE	$	40,203.99				0%			
2.	6" CRUSHED CONCRETE OR LIMEROCK	$	47,576.89				100%			
3.	6" STABILIZED SUBGRADE (LBR 40)	$	19,126.17				100%			
4.	MIAMI CURB W/STABILIZATION	$	44,017.05				100%			
5.	TYPE 'F' CURB W/STABILIZATION	$	1,383.06				100%			
6.	VALLEY GUTTER	$	2,479.20				100%			
7.	5'X4" CONCRETE SIDEWALK	$	12,717.25				0%			
8.	ADA RAMPS {5' WIDE)	$	7,092.96				0%			
9.	ADA RAMPS (10' WIDE)	$	4,179.06				0%			
10.	SIGNAGE & STRIPING	$	6,455.66				0%			
	TOTAL SCHEDULE J -VILLAGE K ROADWAY	$ 185,231.29	$ 114,582.37	$	-	$	114,582.37	62%	$	70,848.92	$	5,729.11	
	SCHEDULE K - VILLAGE K POTABLE WATER SYSTEM			
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-			
$	1,848.04
$
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	2,225.51		
1.	CONNECT TO EXISTING 6" WIM	$	3,696.09	$	1,848.05		$	1,848.05	50%		$	92.40	
2.	6"' PVC, C-900	$	15,743.91	$	15,743.91		$	15,743.91	100%		$	787.20	
3.	6" GATE VALVE	$	5,326.38	$	5,326.38		$	5,326.38	100%		$	266.32	
4.	6" FIRE HYDRANT ASSEMBLY	$	6,663.12	$	6,663.12		$	6,663.12	100%		$	333.16	
5.	6" TEE FITTING	$	292.55	$	292.55		$	292.55	100%		$	14.63	
6.	SINGLE SERVICE, SHORT SIDE	$	10,024.00	$	10,024.00		$	10,024.00	100%		$	501.20	
7.	SINGLE SERVICE, LONG SIDE	$	5,013.18	$	5,013.18		$	5,013.18	100%		$	250.66	
8.	TEMPORARY CONSTRUCTION METER	$	10,209.52	$	10,209.52		$	10,209.52	100%		$	510.48	
9.	6'' BEND FITTING (ALL BENDS)	$	3,067.74	$	3,067.74		$	3,067.74	100%		$	153.39	
10.	CHLORINATION & PRESSURE TESTING	$	4,451.02	$	2,225.51		$	2,225.51	50%		$	111.28	
	TOTAL SCHEDULE K -VILLAGE K POTABLE WATER SYSTEM	$	64,487.51	$	60,413.96	$	-	$	60,413.96	94%	$	4,073.55	$	3,020.72	
	SCHEDULE L - VILLAGE K SANITARY SEWER			
$	-
$	-
$	-
$	-
$	-
$	.
$	-
$	-
$	-
$	.
$	-
$	-			

$	-
$	-
$	-
$	-
$	-
$	-
$	-
$	-
$
$	-
$	-
$	-		
1.
2.	8".PVC, SDR 26 (0'-6' CUT)
a• PVC, SDR 26 (6'-8' CUT)	$	4,323.20
$	8,749.20	$	4,323.20
$	8,749.20		$	4,323.20
$	8,749.20	100%
100%		$	216.16
$	437.46	
3.	8" PVC, SOR 26 (8'-1O' CUT)	$	4,809.72	$	4,809.72		$	4,809.72	100%		$	240.49	
4.	8" PVC, SDR 26 (10'-12' CUl)	$	5,361.84	$	5,361.84		$	5,361.84	100%		$	268.09	
5.	B" PVC, SOR 26 (12'-14' CUT)	$	4,263.10	$	4,263.10		$	4,263.10	100%		$	213.16	
6.	SANITARY MANHOLE (0'-6' CUl)	$	6,338.91	$	6,338.91		$	6,338.91	100%		$	316.95	
7.	SANITARY MANHOLE (6'-8' CUl)	$	7,125.57	$	7,125.57		$	7,125.57	100%		$	356.28	
8,	48" (DIA) SANITARY MANHOLE (12"-14" CUT)	$	3,452.19	$	3,452.19		$	3,452.19	100%		$	172.61	
9.	REMOVE OR REPLACE EXISTING MH (INCLUDE DISPOSAL)	$	27,373,10	$	27,373.10		$	27,373.10	100%		$	1,368.66	
10	SINGLE SERVICE (HILLSBOROUGH COUNTY)	$	3,878.30	$	3,876.30		$	3,876.30	100%		$	193.82	
11.	DOUBLE SERVICE (HILLSBOROUGH COUNTY)	$	16,887.12	$	16,887 12		$	16,887.12	100%		$	844.36	
12.	CONNECT TO EXISTING 8" STUB-OUT	$	4,930.10	$	4,930.10		$	4,930.10	100%		$	246.51	
	TOTAL SCHEDULE L -VILLAGE K SANITARY SEWER	$	97,490.35	$	97,490.35	$	-	$	97,490.35	100%	$	-	$	4,874.55	
	SCHEDULE M - VILLAGE K STORM DRAINAGE			
$	-
$	-
$	-
$	-
$	.
$	(0.01)			
$	-
$	-
$	-
$	-
$	-
$	2,137.13		
1.	15" CLASS Ill RCP	$	4,125.96	$	4,125.96		$	4,125.96	100%		$	206.30	
2.	18" CLASS Ill RCP	$	17,210.62	$	17,210.62		$	17,210.62	100%		$	860.53	
3.	HILLSBOROUGH CO. TYPE 1 CURB INLET	$	28,901.12	$	26,901.12		$	28,801.12	100%		$	1,445.06	
4.	FDOT TYPE C INLET	$	1,359.80	$	1,359.80		$	1,359.80	100%		$	67.99	
5.	18"FDOTFES	$	8,828.36	$	8,828.36		$	8,828.36	100%		$	441.42	
6.	TELEVISE STORM SEWER (CCTV)	$	4,274.25	$	2,137.13		$	2,137.12	50%		$	106.86	
	TOTAL SCHEDULE M - VILLAGE K STORM DRAINAGE	$	64,700.11	$	62,562.99	$	(0.01)	$	62,562.98	97%	$	2,137.13	$	3,128.16	
	SCHEDULE N - VILLAGE K OFFSITE ROADWAY		

$	4,089.55
$	-
Ii	-
$	-
$	4,279.28	
$	-
$	-
$	-
$	-
$	-	
$	4,089.55
$	-
$	-
$
$	4,279.26			

$	204.48
$	-
$	-
$	.
$	213.96	
1.
2.	REMOVE CURB
MILL AND RESURFACE	$	4,089.55
$	28,319.28				100%
0%	$	-
$	28,319.28		
3.	1" FC 9,5	$	2,837.25				0%	$	2,837.25		
4.	2"SP 12..5	$	3,798.00				0%   $	3,796.00		
5.	8" CRUSHED CONCRETE OR LIMEROCK	$	4,754.75				90% $	475.47		

11 0038-01 Triale Creek Villaoe K&L-Amenilv - Pav Aoo 4 800000	Paoe 3 of5	11/612017 2:26 PM

BILL TO:	TRIPLE CREEK COD
PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9626WES KEARNEYWAY RIVERVIEW, FL 33678
{813) 421--6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GCfOWNER'S NO.:

4
11/8/2017
11/8/2017

A	B	C

D	E	F	G	H

ITEM
NO.	DESCRIPTION
OFWORK	CONTRACT
VALUE	FROM
PREVIOUS APPLICATION	THIS
PERIOD	TOTAL
COMPLETED &STORED
TO DATE	
%	BALANCE
TO FINISH	RETAINAGE	
6.
7.
8.
9.	12: STABILIZED SUBGRADE (LBR 40) SIGNING AND STRIPING
TYPE •p CURB W/STABIUZATION
REMOVE AND REPLACE ADA RAMP	$	4,437.47
$	6,455.66
$	7,577.70
$	8,948.80	$	4,437.47
$	-
$	7,577.70
$	-	$	-
$	-
$	-
$	-	$	4,437.47
$
$	7,577.70
$	-	100%
0%
100%
0%	$
$	6,455.66
$	-
$	8,946.80	$	221.87
$	-
$	378.89
$	-	
	TOTAL SCHEDULE N • VILLAGE K OFFISTE ROADWAY	$	71,214A6	$	20,384.00	$	.	$	20,384.00	29%	$	50,930.48	$	1,019.20	
	SCHEDULE O • VILLAGE K UNCLASSIFIED ITEMS			
$	-
$	-
$	-			
$	2,653.96
$	-
$	-
..	,		
1.
2.	INFIL/EXFIL TESTING TELEVISESANrrARYSEWER(CClV)	$	2,653.96
$	4,935.35	$	-
$	4,935,35		$	-
$	4,935.35	0%
100%		$	-
$	246.77	
3.	15"FDOTFES

TOTAL SCHEDULE O -VILLAGE K UNCLASSIFIED ITEMS	$	1,934.27	$	1,934.27		$	1,934.27
..	,	100%
·		$	.71
..	.	
		ll ,.><J .:itl	b ,	11:.!	-	w- ww D.<		IL.	,.,.,i:,g	w O	
	SCHEDULE P - VILLAGE L GENERAL CONDITIONS			
$	-
$	.
$	-
$	-
$	-
$	-			$	-
$	1,"440.29
$	584.25
$	3,690.00
$	1,003.68
$	-		
1.	MOBILIZATION	$	19,574.20	$	19,574.20		$	19,574.20	100%		$	978.71	
2.	NPDES PERMIT & COMPLIANCE	$	5,761.15	$	4,320.86		$	"4,320.86	75%		$	216.04	
3.	MAINTENANCE OF TRAFFIC	$	5,842.50	$	5,258.25		$	5,258.25	90%		$	262.91	
4.	CONSTRUCTION STAKEOUT/RECORD SURVEY	$	24,600.00	$	20,910.00		$	20,910.00	85%		$	1,045.50	
5.	GEOTECHNICAL & MATERIAL TESTING	$	6,691.20	$	5,687.52		$	5,887.52	85%		$	284.38	
6.	PAYMENT & PERFORMANCE BOND	$	10,330.79	$	10,330.79		$	10,330.79	100%		$	516.54	
	TOTAL SCHEDULE P • VILLAGE L GENERAL CONDITIONS	$	72,799.84	$	88,081.82	$	-	$	66,081.62	91%	$	6,718.22	$	3,304.08	
	SCHEDULE Q - VILLAGE L EARTHWORK		
$	3,194.40
$	-
$	1,801.65
$	6,251.00
$	2,081,80
$	2,424.00
$	2,411.64
$	7,658.40
$	28,005.90
$	-
$	8,172.40
$	1,178.64
$	8,558.70
$	5,461.28	$	-
$	-
$	-
$	-
$	-
$	.
$	.
$	-
$	.
$	-
$	-
$	.
$	-
$	.			$	.
$	645.12
$	.
$	-
$	-
$	-
$	-
$	-
$	-
$	16,283.76
$	.
$
$
$	1,365.32	
$	159.72
$	-
$	80.08
$	312.55
$	103.09
$	121.20
$	120,58
$	382.92
$	1,400.30
$	-
$	308.62
$	58.93
$	327.94
$	273.08	
1.
2.	CLEARING & GRUBBING
SAW CUT EXISTING ASPHALT & REMOVAL	$	3,194AO
$	645.12			$	3,194.40
$	-	100%
0%			
3.	DEMO EXISTING CURB	$	1,601.65			$	1,601.65	100%			
4.	DEMO EXISTING SIDEWALK	$	8,251.00			$	6,251.00	100%			
5.	DEMO EXISTING STORM	$	2,081.80			$	2,081.80	100%			
8,	DISC SITE	$	2,424.00			$	2,424,00	100%			
7.	CUT VOLUME (UNADJUSTED)	$	2,411.64			$	2,411.64	100%			
8.	FILL VOLUME (UNADJUSTED)	$	7,658.40			$	7,658.40	100%			
9,
10.	IMPORT FROM ADJACENT STOCKPILE
SODDING	$	28,005.90
$	16,293.76			$	28,005..90
$	100%
0%			
11.	SILT FENCE	$	6,172.40			$	8.172.40	100%			
12.	INLET PROTECTION	$	1,178.64			$	1,178.64	100%			
13.	DEWATERING	$	6,558.70			$	6,558.70	100%			
14.	FINAL GRADING	$	6,826.80			$	5,481.28	80%			
	TOTAL SCHEDULE Q VILLAGE L EARTHWORK	$	91,274.01	$	72,979.81	$	-	$	72,979.81	80%	$	18,294.20	$	3,648.99	
	SCHEDULE R VILLAGE L ROADWAY		
$	.
$	21,400.10
$	8,390.50
$	18,978.65
$	1,677.80
$	.-
$
$	-
$	.
$	-
$	.
$	.
$	29,101.00	
$	.
$	-
$	.
$	-
$	-
$	.
$	.
$	.
$
$
$	-
$	.
$	-	
$
$	21,400.10
$	8,390.50
$	18,976.65
$	1,877.80
$	-
$	.
$	.
$	-
$	-
$	.
$	-
$	29,101.00		
$	18,891.80
$
$	.
$	-
$
13,091.70	$	-
$	1,070.01
$	419.53
$	948.83
$	83.88
$	.
$	-
$	.
$	-
$	.
$	.
$	-
$	1,455.05	
1.	1 3/4" S-1 ASPHALTIC CONCRETE	$	18,891.60				0%			
2.	6" CRUSHED CONCRETE OR LIMEROCK	$	21,400.10				100%			
3.	6" STABILIZED SUBGRADE (LBR 40)	$	6,390.50				100%			
4.	MIAMI CURB W/STABILIZATION	$	18,976.65				100%			
5.	TYPE 'F' CURB W/STABILIZATION	$	1,877.60				100%			
6.	5 FT WIDE SIDEWALK	$	13,091.70				0%			
7.
8,	8 FT WIDE SIDEWALK
ADA RAMPS (5' WIDE)	$	23,722.13
$	6,301.08				0%  '$	23,722.13
0% $	6,301.08		
9.	ADA RAMPS (6' WIDE)	$	8,598.24				0% $	8,598.24		
10.	1" MILL AND OVERLAY	$	18,174.00				0%  $	18,174.00		
11.	30" HIGH DRY STACK BLOCK WALL (W/COLUMNS & STEPS)	$	58,842.50				0%  $	56,842.50		
12.	SIGNAGE & STRIPING	$	861.00				0%	$	861.00		
13.	16 SPACE PARKING LOT (COMPLETE CONSTRUCTION)	$	41,572.86				70%	$	12,471.66		
	TOTAL SCHEDULER VILLAGE L ROADWAY	$ 238,499.96	$	79,545.85	$	-	$	79,545.85	33%	$ 158,954.11	$	3,977.30	
	SCHEDULES VILLAGE L POTABLE WATER SYSTEM			
$	.
$	.
$	.
$	-
$	.
$	.
$	-
$	-
$	.
$	-			

$	1,232.03
$	.
$	.
$	.
$	.
$
$	-
$	.
$	-
$	1,887.08		
1.	CONNECT TO EXISTING 6" W/M	$	2,464.06	$	1,232.03		$	1,232.03	50%		$	61.60	
2.
3.	8'" PVC, C-900
a• GATE VALVE	$	8,565.72
$	2,663.19	$	8,585.72
$	2,663.19		$	8,585.72
$	2,663.19	100%
100%		$	429.29
$	133.18	
4.	6" FlRE HYDRANT ASSEMBLY	$	3,331.56	$	3,331.56		$	3,331.56	100%		$	186.58	
5.	6"TEEFlmNG	$	292.55	$	292.55		$	292.55	100%		$	14.63	
6.	6" BEND FITTINGS (ALL BENDS)	$	2,510.70	$	2,510.70		$	2,510.70	100%		$	125.54	
7.	SINGLE SERVICE, SHORT SIDE	$	4,835.60	$	4,835.80		$	4,935.60	100%		$	241.78	
8.	SINGLE SERVICE, LONG SIDE	$	3,899.14	$	3,899.14		$	3,899.14	100%		$	194.96	
9.	TEMPORARY CONSTRUCTION BACKFLOW	$	10,209.52	$	10,209.52		$	10,209.52	100%		$	510.48	
10.	CHLORINATION & PRESSURE TESTING	$	3,974.12	$	1,9B7,06		$	1,987.06	50%		$	99.35	
	TOTAL SCHEDULES -VILLAGE L POTABLE WATER SYSTEM	$	42,766.16	$	39,547.07	$	-	$	39,547.07	92%	$	3,219.09	$	1,977.37	
h 0038-01 Trli>le Creek Villaae K&L-Amenllv • Pav Alli> 4 800000	P111164of5	11/8/2017 2:26 PM

BillTO;	TRIPLE CREEK COD
PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PRO JECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9626WES KEARNEY WAY RIVERVIEW, Fl 33578
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.; APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

4
11/812017
11/8/2017

A	B	C

D	E	F	G	H

ITEM
NO.	DESCRIPTION OFWORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL COMPLETED &STORED
TO DATE	
%	BALANCE TO FINISH	RETAINAGE	
									
	SCHEDULE T • VILLAGE L SANITARY SEWER		

$	7,878.48
$	5,472.18
$	7,208.82
$	3,  532.46
$	1,550.52
$	11,258.08
s	3,559.94
$	.
$	4,913.85	
$	.
$	-
$	.
$	.
$	.
$	.
$	.
$	.
$	.			
$	.
$	-
$	.
$	.
$	.
$	-
$	.
$	982.77
$		
1.	8" PVC, SDR 26 (0'-10' Cl/T)	$	7,876.48			$	7,876.48	100%		$	393.82	
2.	8" PVC, SDR 28 (10'-14' CUT)	$	5,472.18			$	5,472.18	100%		$	273.61	
3,
4.
5.	SANITARY MANHOLE (0'-10' Cl/T)
48" (DIA) SANITARY MANHOLE (10'-14" Cl/T) SINGLE SERVICE (HILLSBOROUGH COUNTY)	$	7,208.82
$	3,532◄.  6
$	1,550.52			$	7,208.82
$	3,532.46
$	1,550.52	100%
100%
100%		$	360.44
$	176.62
$	TT.53	
6.	DOUBLE SERVICE (HILLSBOROUGH COUNTY)	$	11,258.08			$	11,258.08	100%		$	562.90	
7.
8.	8" CONNECT EXISTING STUB-OUT
INRL/EXFIL TESTING	$	3,559.94
$	982.77			$	3,559.94
$	.	100%
0')1,		$	178.00
$	.	
9.	TELEVISE SANITARY SEWER (CCTV)	$	4,913.85			$	4,913.85	100%		$	245,89	
	TOTAL SCHEDULE T. VILLAGE L SANITARY SEWER	$	46,355.10	$	45,372.33	$	.	$	45,372.33	98%	$	982.77	s	2,288.61	
	SCHEDULE U • VILLAGE L STORM DRAINAGE			$	.
$	.
s	.
$	.
$	.
$	.			$	.
s	.
$	.
$	.
$	.
$	.		
1.	15" CLASS Ill RCP	$	3,206.18	$	3,206.18		$	3,206.16	100%		$	180.31	
2.	18" CLASS Ill RCP	$	5,310.34	$	5,310.34		$	5,310.34	100%		$	265.52	
3.	FDOT DITCH BOTTOM TYPE E INLET	$	2,636.49	$	2,638.49		$	2,838.49	100%		$	131.82	
4.	FOOT MANHOLE	$	3,842.04	$	3,842.04		$	3,842.04	100')1,		$	192.10	
5.	FOOT MANHOLE W/J..BOTTOM	$	3,448.02	$	3,448.02		$	3,,148.02	100%		$	172.40	
6.	15"FDOTFES	$	1,934.27	$	1,934.27		$	1,934.27	100%		$	96.71	
	TOTAL SCHEDULE U • VILLAGE L STORM DRAINAGE	$	20,377.32	$	20,377.32	$	.	$	20,377.32	100%	$	-	$	1,018.86	
	SCHEDULE V • VILLAGE L UNCLASSIFIED ITESM						
$	885.60
$	.
$	.		
1.
2.
3.	TELEVISE STORM SEWER (CCTV) CONNECT EXISTING RCP CONNECT EXISTING INLET	$	1,771.20
$	1,587.45
$	2,456.38	$	885.80
$	1,587.45
$	2,456.38	$	.
$	.
$	.	$	885.80
$	1,587.45
$	2,458.38	50%
100%
100%		$	44.28
$	79.37
$	122.82	
	TOTAL SCHEDULE V • VILLAGE L UNCLASSIFIED ITEMS	$	5,815.03	$	4,929.43	$	-	$	4,929.43	85% $	885.60	$	248.47	
	CONTRACT SUMMARY			
$	.
$	.
$	.
$	.					
1.	SCHEDULE A - AMENITY GENERAL CONDITIONS	$ 108,490.19	$	87,081.99		$	87,081.99	80%  $	21,408.20
43%  $	148,951 .-43
0%   $     329,821.07
68%  $	22,767.60
38%  $	76,074.22
86%  $	19,691.47
89%  $	15,498.00
87%  $	13,078.09
79%  $	25,158.48
62%  $	70,648.92
94%  $	4,073.55
100%  $	.
97%  $	2,137.13
29%  $	50,830.48
72%  $	2,853.96
91%  $	6,718.22
80%  $	18,294.20
33%  $    158,954.11
92%  $	3,219.09
98%  $	982.77
100')1,  $	.
85%  $	885.60	$	4,354.11	
2.
3.	SCHEDULE B • AMENITY EARTHWORK
SCHEDULE C- AMENITY ROADWAY	$  259,566.-47
$     329,821.07	$	11 2,635.04
$	.		$	112,635.04
$	.		$	5,631.75
$	.	
4.	SCHEDULE D- AMENITY POTABLE WATER SYSTEM	$	71,165.58	$	48,397.98		$	48,397.98		$	2,419.90	
5.	SCHEDULE E -AMENITY SANITARY SEWER	$ 123,089.34	$	47,015.13	$	(0.01)  $	47,015.12
$	.	$	123,975.63
$	.	$	34,328.74
$	.	$	88,853.65
$	-	$	92,045.72
$	.	$	114,582.37
$	.	$	60,413.96
$	.	$	97,490.35
$	(0.01)  $	62,562.98		$	2,350.77	
6.	SCHEDULE F - AMENITY STORM DRAINAGE	$ 143,667.10	$ 123,975.63			$	6,198.79	
7 .	SCHEDULE G• AMENITY UNCLASSIFIED ITEMS	$	49,828.74	$	34,328.74			$	1,718.45	
8.	SCHEDULE H • VILLAGE K GENERAL CONDITIONS	$ 101,929.74	$	88,853.65			$	4,442.68	
9.	SCHEDULE 1- VILLAGE K EARTHWORK	$ 117,204.20	$	92,045.72			$	4,602.29	
10.	SCHEDULE J - VILLAGE K ROADWAY	$ 185,231.29	$	114,582.37			$	5,729.11	
11.	SCHEDULE K• VILLAGE K POTABLE WATER SYSTEM	$	64,487.51	$	60,413.96			$	3,020.72	
12 .	SCHEDULE L- VILLAGE K SANITARY SEWER	$	97,490,35	$	97,490.35			$	4,874.55	
13.	SCHEDULE M • VILLAGE K STORM DRAINAGE	$	64,700.11	$	62,562.99			$	3,128.16	
14.	SCHEDULE N • VILLAGE K OFFSITE ROADWAY	$	71,214.46	$	20,384,00	$	.
$	-
$	.
$	.
$	.
$	.
$	.
$	.
$	.	$	20,384.00		$	1,019.20	
15.	SCHEDULE O• VILLAGE K UNCLASSIFIED ITEMS	$	9,523.58	$	6,869.62		$	6,869 .82		$	343.48	
16.
17.
18.
19.	SCHEDULE P • VILLAGE L GENERAL CONDITIONS
SCHEDULE Q • VILLAGE L EARTHWORK SCHEDULER • VILLAGE L ROADWAY
SCHEDULE S• VILLAGE L POTABLE WATER SYSTEM	$	72,799.84
$	91,274.01
$    238,499.98
$	42,768.16	$	66,081.62
$	72,979.81
s	79,545.85
$	39,547.07		$	66,081.62
$	72,979.81
$	79,545.85
$	39,547.07		$	3,304.08
s	3,648.99
$	3,977.30
$	1,977.37	
20.	SCHEDULE T - VILLAGE L SANITARY SEWER	$	46,355.10	$	45,372.33		$	45,372.33		$	2,268.61	
21.	SCHEDULE U • VILLAGE L - STORM	$	20,377.32	$	20,377.32		$	20,377.32		$	1,018.88	
22.	SCHEDULE V • VILLAGE L UNCLASSIFIED ITEMS	$	5,815.03	$	4,929.43		$	4,929.43		$	248.47	
	TOTAL ALL SCHEDULES	$ 2,315,315.15	$ 1,325,470.60	$	(0.02)	$ 1,325,470.58	57'1!,	$	98 9,844.57	$ 68,273.64	
	TOTAL CHANGE ORDERS	$ (281,936.06) $ (281,938.08)	$	.	$ (281,9 38.06)	0%	$	.	$ (14,096.81)	
	ADJUSTED CONTRACT TOTAL	$ 2,033,379.09	$ 1,043,634.64	$	(0.02) $ 1,043,634 .62	61% $	989,844.67	$ 62,178.73	
	CHANGE ORDERS	
$	(80,723.70)
$	(50,384 .24)
$     (150,828.12)
$	.
$	.			
$	(80,723.70)
$	(50,384.24)
$     (150,828.12)
$
$	.			
$	(4,038.19)
$	( 2,519.21)
$      (7,541.41)
$	.
$	.	
C0#1
C0#2	COD DIRECT PURCHASE MATERIALS
CDD DIRECT PURCHASE MATERIALS		$	(80,723.70)   $
$	(50,384.24)   $	.
.		100%  $
100'1!, $
100% $
°"' $
$	.
.
.
.		
C0#3	COD DIRECT PURCHASE MATERIALS		$ (150,828.12) $	.					
				$	.					
				$	.					
TOTAL CHANGE ORDERS	$ (281,936.06)	$ (281,938.06) $	.	$ (281,938.06)	0% $	.	$ (14,098.81	

h 0038-01 Triple Creek Village K&L-Amenltv - Pay App 4 800000	Page5of5	11/Bl2017 2:26PM

TRIPLE CREEK COMMUN ITY DEYELOPMEl'IT .DlSTRlCl' SPECIAL ASSESSMENT BONDS
SERIES 2017B

The undersigned, a Responsible Officer of Trip le Creek Commun ity Deve lopment District (the "District") hereby submits the following requisition for disbursement under and pursu ant to the term s of the Master Trust Indenture dated as of June I , 2012 from the District to The Bank of New York Mellon Trust, N.A., as: trustee (the "T rustee"), as supplemented by the Second Supplemental Trust Indenture dated as of February l , 2017 (the "Indenture"), (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

December 8, 2017

Requisit ion Number : CR196-B

{8)	Name of Payee: RIPA & Associates, LLC
1409 Tech Blvd., Ste I
Tampa , FL 33619

(C)	Amount Payable: $106,845.24

{D) Purpose for which paid or incurred (refer also lo specific contract if amount is due and payable pursuant to a contract involving progress payments, or, sta1e Costs of Issuance, if applicable): Pay Application #9RET for Project #01-l707A-Village El

Fund or Account from whi.c h disbursement to be made: 20178 Acquisitio n and Conslruclion Actount

The undersigned hereby certifies that:
.	obligations in the stated amount set forth above have been incu rred by the District, or
this requisition is for Costs of Issuance payuble from the Acquisi tion and Constniction Fund that have not previously been paid;

each disbursement set forth above is a proper charge agains t the Acqu.isition and Construction Fund;

each disbursement set fortb above was incurred in connection with the acquisition and/or construction of the Project;

each disburSernent represents a Cost of the Project which has not previously been paid.

Toe under sig ned hereby further certitiDs that there has not been filed with or served upon the District notice of any lien, right ro lien, or attachment upon, or claim affecting the right to r<,>.ceive payment of, any of the moneys payable 10 the Payee set forth above, which has not been released or will not be released simultansous ly with the paymsnt hereof.
The undersigned hereby f-urther certifies that such requisition contains no item represenring payment on account of any retaim:d percentage which the Distric t is at the date of such certiticate entitled to retain.

Ch ,;,m r	25

Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disbursement is hereby requested.
TRLPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By
Board ofSupervisorS

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consul ting Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (U) the plans and specifica tions for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consultin g Engineer, as such report sha ll have been amended or modified on the date hereof

:,:;&nsuifug Engineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DJSTRlCT SPECIAL ASSESSMENT BONDS
SERlES 2017A, VILLAGE E

lh: undersigned, a Res ponsib le Officer of Triple Creek Community Development District (the "District") hereby submits the following requisition for disbursement under and pursu ant to the tenns of thQ Master Trust Indenture dated as of June I, 2012 from the District to 111e Bank of New York Mellon Trust, NA. as trustee (the "Trustee"), as supplemented by the Second Supplem,mtal Trust Ind e nture dated as of February I , 2017 (the "Inde ntur e"), {all capitali.zed terms used herein shall have the meaning asc,:ribcd to s uch term in the Indenture):

December 8, 2017

Requisition Number: CRl  9 7-.E

Name of Payee.: RIPA & Associa tes, LLC
1409 Tech Blvd. , Ste l Tampa, FL 33619

Amount Payable: $800.49

Pui;pose for which paid or incurred (refer als o to specific ccmlract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if appli cable): Pay Applkatio11 #9RET for Project #0 l-1707A- Villagt E

Fund or Account from which disbursement to be made : 2017A Acquisition and Construction Aecou nt,
Subaccount Village E

The undersigned hereby certifies that:
l.	obligations in the stated amount se t forth above have been incurred by the District, or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Fund thllt have not previously been paid;

each disbursement set forth above is a proper charge against the Acquisition and Construction Fund;
each disbursement set forth above was incurred in connection with the acquisition and/or construclion of the Projec.,

each disbursement represi':ntS a Cost oftht Project which has nor previously been pitid.

The undersigned hereby further certifies that there has not been filed with or served upon the District notfce of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with lhe payment hereof.
The undersigned hereby funher certifies that such requi sition contains no item reprosentlng paJment on account of any retained
percentage which the District is at the date of such certificate entitled to retain..
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the serv.ices rendered with respect to

 23	

which disbursement is hereby requested.
TRirLE CREEK COMMUNITY DEVELOPMENT DISTRICT

B,y

cru,;rm ,05,a
Board of Supervisors

CONSULTING  ENGINEER'S APPROVAL FOR
NON-COST OF  ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certi.fles that this disbursement is for a Cost of lite Project and is consistent with: (i) 1he applicable acquisition or construction contract; (i.i) the plans and specifications for the portion of the Project with respect to which s uch disbursement is being made; and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof
@
ulting Eng ineer

TRJPL'E CREEK COMMUNITY DEVELOPMENT DISTRICT
SPECIAL ASSESSMENT BONDS
SERIES 2017A, VIL LAG E Fl

The underSigned, a Responsible Officer of Triple Creek Community Development District (the '' Disl ricf ') hereby submits the following requisition for disb ursemen t under and purs uant ro the terms of the Master Trust Indenture dated as of June I , 2012 from the District to The Bank or New York Mellon Trust, N.A., as irust ee (the "Trustee''), as supplemented by the Second Supplemental Trust Indenture dated as or February 1, 2017 (the "Indenture"), (all capit alized terms used he rein shall have tl1e meaning ascribed to such term in the Indenture):

December 8, 2017

Requisition Numb e.r: CRl.98 Fl

Name of Payee: IUPA & Associa tes, LLC
1409 Tei:h .Blv d., Ste 1
Tampa, FL 33619

Amount Payable: $61,953.Sl
Purpose for which paid or incurred (refer also to specific contract if amount is due 11nd payable pursuant to 11 contract i nvolving progress payments, or, state Costs ofl ssuance , if applicable): Pay Application #9RET for Project #01-1707A - Village Fl

Fund or Account from which disbursement to be made : 2017A Ai:quisitit'.m and Conslruelion
Acco11nt, Subaccount Village Fl

The unders igned hereby certifies th at:
I.	obligations in the stated amount set forth above have been incurred by the Dis trict, or
this requis ition is for Costs of Issuance payable from the Acquisi tion !illd Construction Fund that have not previously been paid;

each disbursement set forth above is a. proper charge against the Acqu isi tion and Construction Fund

each dis bursement set forth above was incurred in connection with the aoquisition and/or construction of the Project;

each disbursement represents a Cost or the Project which has not previously been paid.

The undersi gned hereb y further certifies that there has not been filed with or served upon the District notice or 81'\Y lien, right to lien, or attachment upon, or claim affecting  the right to receive   payment of, any of the moneys  payable to the Payee set forth above, which has not been released or will not be released simu lt11ne ously with the payment hereof.
The undersigned hereby further certifies that such requisi tion contains no item representing payment on actount of any retained percentage which tile Dis ll'h;it is at the date of such certificate entitled to r-etain.
Attached hereto ar-e origin als of the invoice(s} from the vendor of the property acquired or the services rendered with respect to
which disbursement is hereby requested.

By,	=6

1	 	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

*	Chai
BOM<I ofSopeN;m:

CONS(JLl1NG ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requis ition is for a dis bursement fr o m other than Costs of Issuance, the und ers igned Consulting Engineer he re by certifies that this disbursement is for a Cost of the Project and is consistent with: (i.) the applicable acquisition or construction contract; ( ii) the pl!llls and specificaiions for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engin eer, as such report shall have been amended or modified on the date hereof.

,..:::::ansulting Engineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
SPECIAL ASSESSMENT BONDS SERIES 2017A, VILLAGE F2

The undersigned, a Responsible Officer of Triple Creek Community Development District (the '' District"} hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture dated as of June 1, 2012 from I.he District to The Bank of New York Mellon Trust, N.A., as trustee (the ''Trustee''), as supplemented by the Second Supplementnl Trust

Indenture dated as of February 1, .201 7 (the "Indenture'•' the Indenture}:

December 8, 2017

Requisition Numl,)er: CR199-F2

(all cap ital ized terms U$ed herein shall have the meaning ascribed to such term in

Name-Of Payee: RIPA & Associates, LLC
1409 Tech Blvd., Ste l
Tampa, FL 33619

Amount Payable: $44,668.19

Purpose for which paid or incurred (refer also lo specific contract if amount is due and payable pursuant to a contract involving progress payments, or, slate Costs of Is suance, if applicable): Pay Application #9RET for Project #01-1707A - Village F2

Fund or Account from which disbursement to be made: 2017A Acquisition and Construction Account,
Subaccount Village F2

The undersigned hereby certifies that.
obligations in the stated amount set forth above have been incurred by the District, or
this requisition is for Costs of lssu!lilce payable from tli e Acquisition and Construction Fund that have not previously been paid;

each disbursement set forth above is a proper charge against the Acquisition and Construction Fund;

each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Project;

each disb ursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies that there has not ooen filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moheys payable 10 the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The und ersigned hereby further certifies thaJ such requisition contains no item rep1esenting paymeat on account of any retained percentage which the District is at the date of such certificate eniitled to retain.
Attached hereto are originals of the invoice{s) from !he vendor of the pr-operty acquired or the services rendered with respect to which disbu ement is hereby requested.

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By: -

::::-,, -

.  J,_4¢	>r 

CONSULTING  ENGINEER'S APPROVAL FOR
NON-COST OF ISSUANCE  REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of lhe Project and is consistent with: (i) the applioab le acquisitiQO or oonstruotion oontract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is being made ; and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.

Co ting Engineer

TRlPLE C.REl?K COMMUNI.TV DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE Gt

The undersigned, a Responsibl e Officer of Triple Creek Community Development Distriot (the "District") hereby submits the following requisition for disbursemeni under and pursuant to the iem1s of the Master Trust lnd .enlure dated as of June I, 2012 from the District to TI1e Bank of New York Mellon Trust, N.A., as trustee (the ''Trustee"), as supplemented by the Second Supplemental Trust Jndenture dated as of Februory 1, 2017 (the "Indenture"), (all capitalized terms used herein shall have the meaning ascribed to such tenn in the [ndenturo):

December 8,2017

Requis ition Numbe r: CR200.Gl

Name of Payee; RIPA & Associatc.s, LLC
1409 Tei:h Blvd., Ste 1
Tampa, FL 33619

Amount Payable: $571865.89
Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a conuact involving progress payments, or, state Costs ofissuance, if applicable): fay Application #9RET for rrojei:t #0M707A - Village GI

Fund or Account from which disbum,ment to bii: made; 2017A Acq11isitio11 and Construction Account,
Subaccount Village Gl

The undersigned hereby certifies that
obligations in the stated amount set forth above have been incurred by the Districl. or
this requisition is for Costs of Issuance payable from the Acquisition and Construction ,F1md that have not previously been paid;

each disb ursement set forth above is a proper charge agaiast the Acquisition and Construction Fund;

each disbursement set forth above was incurred in connection with the acquisition ind/or constrnction ofthe Project;

each disbursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any I ie n, right to lien, or attachment upon. or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such cenificate entitled to retain .
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disbursement is hereby requested.

.,	 Y6	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

Bootd of Su,etv.:.:

CONSULTING ENGfNEER'S APPROVAL FOR NON-CO ST OF ISSUANC E REQUESTS ONLY

If this requisition is for a dis bursement from other than Costs of lssuance, !he undersigned Consulting Engineer hereby certifies that thi s disbursement is for a Cost of the Project and is consistent with; (i) the applicable acquis ilion or construction co'ntract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting
:ngincer, as such report shall have been amended or modified on the date hereof.

ConetJf!Tng Engineer

APPLICATION AND CERTIFICATION FOR PAYMENT	AJA DOCUMENT G702

TOOWNER;

Triple Creek COD

PROJECT:	APPLICATION NO:	9RET	Distnoution to:
Triple Creek COD-Village E, F and Gl	C]OWNER
CJENGINEER
PERIOD TO:	t 1/30/17	c=JcoNTRACTOR

FROM CONTRACTOR:
RIPA & Asi1ociates, LLC 1409 Tech Blvd.. Ste. l Tampa. FL 33619
CONTRACT FOR:

VlA tNGINEER:	CJ
Genesis Group	c=J
1000 N Ashley Dt Ste 900	PROJECT NOS:	0l-1707A
Tampa, FL 33602
CONTRACT DATE:	RA171108

CONTRACTOR'S APPLICATION FOR PAYMENT
Applic.iticm is made for paymen1, as shown below, in connection with the C'ontrncl. C mtinua1i1;,n Shce1. AJA Document 0703. is anacltcd.

The undersigned Contract.or certifies that to lhe best orthe Conlractor's knowledge, infonnation and belief the Work covered by this Application for Payment has been eom11letcd in accordance with the Contract DooumenlS. thal all amounts have been paid by the Canrnu:tor for Work for which previous Certificates for Pnymcnl were issued and paymrots received from the Owner. and thnt current payment shown herein is now due.

ORTGlNAL CONTRACT SUM
NET CHANGES BY CHANGE ORDERS
CONTRACT SUM TO OATE,( Line I ± :?)
TOTAL COMPLETED & STORED TO DATE	(Column Ci on 0703)

S	7,737.870.2S
$	(2,166,326.15)
S	5.S71.544.lll
.S	5 ,442.668.43

CONTRACTOR:	RIPA & A sociales. LLC

 	
 		.,..\tr_•Hl   laiii !!t!!r

Date:   I\ btl--

l

S. RETAINACiE:	.	LAND OWNER
,11	ol'Completcd Work	S	272.133.53 RETAINAGE
/Column D+     E lln 0703 l	$ 9   240 00

b.	%ofStorcdMaterinl	s_ _
"icoiiiinn Fon Ci703I
Tolal Retainage (Lines Sa+ Sb or
Total in Column I of 0703)
TOTAL EARNED LESS RETAINAGE
I Line 4 Less Line 5 Total)
LESS PREVIOUS CERTlACA.TES FOR

8. CURRENT PAVMENT DUE THIS APPLICATlON	S	272.133.33	
9. BALANCE TO FINISH, INCLUDrNG RETAINAGE	$	401,009.21	
10. PREVIOUS APPLICAT[ONS UNPAJD	S	183 ,158 .14	
II. TOTAL AMOUNT UNPAID TO DATE	$	455,291.47	

PAYMENT (Line 6 rmm priorCertilicale)

_ _ _	'	·

S	::?72.133.53
S	5,170,534.9{)

S	4,898,401.56

In accordance with the Contr11el DotumcnlS, ba. on on-site (lbsctvations and the data comprising the application, the Engineer certifii:stc, the Owner that to the best of the Engineer's knowledge. information and belief the Work has progresi.cd as indicated.
the quality of the Work is in accordance with the-Contract Documents. end the Contractor is entitled lo payment of the AMOUNT CERTIFTED.

AMOUNT CERTIFIED . . . . . . .• . •.

S $ 272,133.33

CHANGEOKDERSUMMARY	ADDITIONS			
Total changes approved
in Dreviou.s months by Owner	
SO.OCl		
$2,166,326. 15	

Toial anr,mved this Month	
S0.00	so.oo	
TOTALS	S0.00	$2,166, 326.15	
NET CHANGES by Change Order	
($2,166,326.15)	

(Atlat:h explanation if a11101111/   E'11 flietj/diffm 1 f1'0111 1he amo11m applied  Initial all jigurc.t 011 lhis

.<fpplication- and onthe Cn')J/f ttati#o

ENGINEER:

h et thnt are d,ang d 10 conform with lht n1no,m/ Cf" lifie<I.J

By; ----+ =1--,......--+-------- Date:  • 7,_7,__,_.,,.. 	_
ThisCenifica	snot		otiable·. The AMOUNT CERTIF1ED is payable oMy 10dfc: Contractor named h	in. Issuance, pRyment and acceptance of payment ore without prejudice 10 any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702    APPLICATION AND CERTIFICATION FOR PAYMENT -  1992EDtTI0N • AIA • 01992	THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW VORK AVE.. N.W.. WASHlNGTON. DC.2000&-5292
Users may obtain validation of this document by requesting a completed AIA Document CM01 - CertlflcaUon of Oocurnant•s Authentlclty from the Licensee.
E1 (General) = $106,845.24	F2 - $44,668.19	LAND OWNER
F1 = $61,953.52	G1 - $57,865.89	$ 0.00
E2/E3 = $800.49

APPLICATION AND CERTIFICATION FOR PAYMENT	AJA DOCUMENT G702

TOOWN6R:	PROJECT:	APPLIC ATION NO:	9RET	Distribution  to:
Triple  Creek C DD	Triple Creek COD-Village I!:, F and G l	CJ	O W NER
C]	ENG INE ER
PERIOD TO:	I 1/30/ 17	c:::JCONTR ACT O R

RIP A & Associates, LLC	Genesis Group		
1409Tech Blvd. , Ste. I
Tampa. FL 33619	1000 N Ashley Dr Ste 900
Tampa, FL 33602	PROJECT NOS:	01-1707A	

FROM CONTRACTOR:	VIA ENGIN EE R:	CJ
c:::J

CONT RACT FO R:	CO NTRACT  DA TE:	RA17 1108

CONTRACTOR'S APPLICATION FOR PAYMENT
Applicatio n is made for payment, asshown below, in connection with the Contract. Continuation Sheet, AJA Document G703, is attached.

The undersigned Contr;ictor ce rtifies that to the best of the Contractor'sknowledge, infonnation and belief the Wo rk covered by this Application for Payment has been completed in accordance with the Comract Documents, that all amounts have been paid by the Con tractor for Work for which previous Certificates for Payment were issued and paymont received from the Owner, and that current payment shown herein is nowdue.

I. ORIGI NAL CONTRACT SUM
NET CHANGES BY CHANGE ORDERS
CONTRACT S UM TO DATE.( Line  I ± 2)
TOTAL CO MPLETED & STORED TO DAT E	(Column G on 0703)
RF.TA INAGE:
5%	of Completed Work	$   
(Co lumn D + E on G703)

$	7,737,870.25
$-     -	( ,2-  -,6-,6 -3 26   1 5-)

-	5.571,544.10 s- - - ,-s 4-4-2', 6-'_-6-8_ _.43

2_72_.1_3_3_.5_3_

CO NTRA CTOR:	RIPA & Assm:iates. LLC

% of Stored MateriBI	$  	
(Clumn Fon  G70J )
Total Retainagc (Lines Sa+ Sb or

Total in Column I of G703)
TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Tota ll
LESS PREVIOUS CERTIF1CATES FOR PAYMENT (Line 6 from prior Certificate)
CURRE-NT PAYME-NT DUE THIS APPLI C ATIO N
BALANCE TO FINISH. INC LUDING RETAJNAGE
PREVIOUS APPLICATIONS UNPAID
TOTAL AMOUNT UNPAID TO DATE

$	27'.l. 133 .53 
$	5.17 0.534 .90 

$	4,898 ,40 1.56
$	Z72 , 133.33
$	401,009.21 
s	183.158.14 
$	455 ,29 1.47

ln accordance with the Contract Documents, based on on-site observations and the data comprising the application. the Engin eer certifies 10 the Owner Ihat to the hesl nf the Engineer's knowledge. infonnation and belief the Work has progressed as indicated.
the quality of the Work is in accordance with the Contract Documents, and rhe Contractor is entitled10 payment of the AMOUNT CERTrFIED.

AMOUNT CERTIFIED . . . . , ......S    	

CHANGE ORDER SUMMAR Y	ADDITIONS	DEDUCTIONS	( Allach e.:,.p lan at ion if 0111011111 ccm/fi11d diffl'rs from 1/,e (rr,1011111applied. Ini tialall flgure.t 011 this Applicatio n and 0111/ie Co111im 1atio11 Sh e et that ore changed to confom, with //11) a mo1111t cer/ified.) ENG INEER:

By:	Date:	
Total changes approved
in previous months by Owner	
$0.00	
$2,166,326. 15		
Total approved this Month	S0.00	so.oo		
TOTALS	$0.00	$2, 166,326.15	This Ceni!icatc is not negotiable. The AMOUNT CERTIFIE D is payableonly to the Cont-rac tor named herein. Iss uance, payment and acce pta11cc o f pa y ment are without prejudi ce to any rights of the Owner or Contractor under this Contract.	

NET C HANGES by Change Order	
($2.166,326.15)		
AIA DOCUMENT G702   APPLICATION AND CERTIFICATION FOR PA YMENT· 1992EDITION · AIA  · ©1992	THE AMERICAN INSTITUTE OF ARCHITECTS. 1735NEW YORKAVE.•N.W.. WASHINGTON. DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document 0401 - Certification of Document's Authenticity from the Licensee.

ITEM
i'fO	

DESCRIPTION OFW011t<	

OTY	CONTRACT SUM TO DATE		
				
BASECONTRACT	
ESTIMATED OlJANTlTY	TOTAL
WORK IN PLACE	TOTAL WORK IN PLACE	TOTAL WORKIN PlACE	
PERCENT COMPLETE	
BALANCE
!O F/NISH	
5',
RETAIN.AGE	
			UNIT	UNIT
PRICE	VALUE	THIS
ESTIMATE	P EV
ESJIMATE	TOTAL
ESTIMATE	TH IS
PERIOD	PREV
APPlJCAllON	TO
D TE	TO
DA.TE	TO
OAT'E	TO
DAfE	
	SCHEDULE														
	PHASEE1														
	GENERAL CO NDITIONS E1														
1	Mobilization	1,00	LS	59.60000	S9,600.00	,0 00	1.00	1.00	so00	S9,600 . 00	$9,600 . 00	100%	S0,00	$480.00	
2	NPOESCo,mphance.	1 ,00	LS	SB,150 .00	SB,150.00	0110	1.00	1 00	SO.DO	S,8 150 .00	S8. 1 50 00	100%	50.00	$407.50	
3	Maintenanceol Trame	1.00	LS	$3,750,00	S3,750,00	000	100	1,00	S0.00	$3,750.00	$3,750.00	100%	S0,00	S187.50	
4	Coos! Stakeout f Recodr  Survey   ByContracior	1 00	LS	$44,50000	S44,500.00	O.DO	1 .00	, 00	S000	$44,500.00	$44,50000	100%	5000	S2.225 00	
5	Paym"'11& Perlormance Bor>d • B y'Contractc,	1 00	LS	$23,000.00	$23.000.00	000	1.00	1.00	50.00	52, 3 000 00	S23,000.00	100%	$0.00	$1,150.00	
	TOTAL GENERAL CONDITIONSE1				S89 ,000.00				S0.00	S89,000.00	$89,000.00	100¾	S0.00	$4,'150.00	
															
	EARTHWORK E1														
'	Clearing & Grubbing	300	'IC	$21,000.00	$63,000.00	0,00	3 00	3.00	50.00	S63,000.00	$6, 3000,00	100%	S0.00	$3,150.00	
2	SawCut Ex.lsUogAsphall & Removal	276.00	SY	sass	$2,387.40	0.00	276 00	27600	S0.00	52,387.40	$, 2 387 40	100%	S000	5119,37	
3	DemoExist Sioewatk (crushro.-reuse as0fl-site Rip Rap)	850 00	LF	S3.15	$,2 677.50	0.00	850.00	850.00	50,00	$2,677.50	$,2 677.50	100%	S0.00	5133.88	
•	O1.scSllc	4,00	AC	$35500	$,1 420 .00	000	4.00	4 00	SO.DO	$ 1 ,420.00	s ,1. 20 .00	100%	S0 ,00	57 1. 00	
5	Cut Volume	40000	CY	$2.45	$980 00	000	400 00	40, 0 00	$0 00	S980.00	S980,00	100%	sooo	549.00	
6	Fill Vo•ume	20,700.00	CV	$4.8	5	S100,395_0(}	0.00	2070000	20700 00	$0 00	S100.395.00	$100,395.00	100%	S0.00	S, 5 019 75	
1	Sodd,ng	7.600,00	S Y	$2.20	S16. 720.00	0 00	760000	7600 00	S0.00	$16,720.00	S16.720.00	100%	S0.00	5.836.00	
8	s ee ding & Mulch"1{J	1 2,6 1 5 00	SY	S0 . 25	$3, 1 53 7 5	0 00	126 1 5 00	1 2615 ,00	5000	53,153.75	53,153.75	100%	S0.00	S157 69	
9	Slit Fence	8.10000	LF	S1.20	S91720.00	0.00	8100,00	8100.00	sooo	$9 , 720 00	$9, 7 20 .00	100%	S0.00	$486.00	
10	lnlel Prtlle<llon	11.00	EA	$98 20	$1,080.20	0.00	,, 00	11.00	so00	$1,080.20	51,080.20	100%	S0.00	55,4 01	
11	Dewa1ering (Fo r All Aspec ts O f P(llject)	, 00	LS	$,9 200 00	$9,200 00	0.00	,1 00	1 00	5000	S9,200.00	$9,20000	!00%	S0.00	$460.00	
12	FinalGrading	1.00	LS	$21,500.00	$21,500,00	000	1.00	1.00	S0.00	$21,500 00	521,500.00	100%	5000	S1.0,7500	
	TOTAL EARTHWORK E1				$232,233.85				$0.00	S232,233.85	$232,233.85	100%	$0.00	$11,611.70	
															
	BASE AND PAVING E1														
1	1 31◄"S-1 AsphaltlcConcrete	77 43 00	SY	S9.25	571,622. 75	0.00	774300	7743,00	S0.00	$71,622.75	$71,62275	100%	sooo	S 3.581 ,1 4	
2	6" Cm shedco ncrete	7.743.D0	sv	$10.30	$ 79,752.90	0,00	7743.QO	774300	5,000	$7,9 752.90	$7, 9752.90	100%	S, 000	$3,987-65	
3	s· Slabillzed Subgrade (LBR 40)	,7 743.00	SY	S6,85	S53,039 55	,0 00	7743 00	7743,00	sooo	S5,3 0 3 9.55	S53, 039 5 5	1 00%	S0.00	S2,651,98	
•	Miam, Curb w/St3t>lllza tloo	5,500.00	LF	$11.05	$60,775.00	000	ssoo00	550000	so.oo	560, 775 .00	560 1 775.00	100%	$0.00	$3,038,75	
5	Type'F' Curow/Slablllzalion	770 00	LF	$12.50	$9,625.00	0.00	770.00	77000	50,00	$9,625.00	$.	9,625.00	100%	S0.00	$481.25	
6	Valloy Guuor	8,4 00	Lf	S21 45	$1,801.80	000	84.00	8400	S000	S, ,801,80	Sl.80180	100%	S0.00	$90.0ll	
7	5' x4• ConcreteStdewalk	2.250.00	LF	$19.50	$43,875 .00	0,00	2250.00	2250 .00	S0.00	$43,875.00	:143,875 .00	100%	S0 .00	52 ,193.75	
8	S"6" ConcreteSld<,walk	50 .00	LF	S25.65	$1,282 SO	000	50.00	5000	S0.00	$1,282 50	51,282.50	100%	$0,00	564 13	
9	1O'x4· Concre1es ,oewal	96 .00	LF	$39,05	$3,748,80	000	96.00	96 00	sooo	$3, 74 8 .80	$ 3,748.80	100%	$000	S187.44	
,o	10'xO C oncre1e Sidewalk	2,100.00	LF	S51.30	S10, 7 730.00	0,00	2100.00	210,0 00	so.oo	$ 1 0 7 ,730 00	S107 ,730.00	100,.	S0,00	S5,386S.O	
11	AOA Ramps (5' wide)	19.00	EA	584000	515,960.00	000	19.00	19.00	S0,00	S15,960.00	$15,960.00	100-4	S0.00	$798.00	
12	AOA Ramps ( 10' Wide)	5.00	EA	$1,200.00	$6,00 0 00	0 .00	5 .00	500	S0.00	S6,000 ,00	$6,000 ,00	100%	sooo	$300.00	
13	FOOT852 Alum in um HaO<l Rai l (Powde r Coaled Blk)	665.00	LF	S73.60	$4,8 944 00	000	665,00	665.00	so.oo	$48 ,9'14.00	5481 9<14.00	100%	S0,00	$,2 447.20	
14	FOOT Conorele wan (inc/odeSl ruc1mll)	550.00	LF	$310.00	S170,500,00	000	550.QQ	550 .00	so 00	S17 0,500 .00	$170,500 . 00	100%	5000	S8.52.500	
15	Pedoslrlan Bridge (Made by Yo<II Bridgoor Equivalen t)	, 00	LS	S240,000.00	S240.000.00	000	1 00	1.00	S0.00	$240,00000	5240,000.00	100%	S000	$12,000.00	

		 APPLICATION FOR PAYMENT			PAY AP.P
FROM		9RET
ll /1/17		
	
RIPA &ASSOCIATES PROJECT /I01•1707A			TO		11/30/17				

										

										

										

										

										

										

										

										

										

										

										

										

										

										

,,,.t., ,

Tnpl• Cree, COO.ml,'

9,  E, f and G1	APPLICATION FOR PAYMENT

PAV APP FROM TO

ET 11/1117
11130/17

RIPA ASSOCIAlES PROJECl #011107A

ITEM
NO	

OESCRIPTlON OFWcR,.	

OT'i	CO NT RA.CTSUM TODATE		
				SASE CONTRACT	
ES TIMATED QUANTITY	TOTAL
WORK.IN
PLACE	TOTAL.
WORK IN PLACE	TOTAL
WORK IN
PLACE	
PEROENT
COMPLETE	
BALANCE
TOFlNtSH	
5%
R.ETAJNAGE	
			
UNIT	UN.IT
PRICE	VALUE	TH IS
ESTIMATE	PREV
ESTIMATE	TOTAL
ESTIMATE	n«s
P ERIOD	PREV
APRUCATION	TO
OAf 'E	,o
OATE	TO
DATE	TO
DATE.	
16	SIOps Signs	200	EA	$335 .00	$67,0 00	, 0 00	2 00	2.00	so 00	.S670 .00	$670 .00	1 00%	sooo	533,50	
17	Speed Umit S,gn	roo	EA	5370.00	$3700	0	000	1 00	1.00	so.co	SJ70.00	$370.00	100%	S0.00	s,e50	
18	Road End Signs	24.00	EA	$2 45.00	55,880.00	000	2 4 00	2400	so.co	55, 880.00	S5,880.00	100%	S000	S294 00	
)9	Stret!I S,gns	2,00	EA	s•oo.oo	SB00.00	000	2.00	2 .00	S000	SBOOOO	SBOOOO	100 ¾	S,0 00	S 40 . 00	
	TOTAL BASEAND PAVING E1				$922.JTT.30				$0.00	S922,Jn ,30	$922.Jn. 30	100"/,	$0.00	$46,118.88	
															
	POTABLE WATER DISTRIBUTION E1														
1	Connec:lio ExistiOCJ 1T W/M	, 00	LS	S2,BOO.OO	S2B, OO,OO	0 ,00	1 ,00	1.00	so.co	S2.800 ,00	$2 ,80000	100 '¥.	S0.00	$140 00	
2	2"P o1ve1t1ylene ServK:e(UHs 1alion)	45,00	LF	$110.00	$4 ,950.00	000	45 00	45 00	$000	54,950.00	54.95000	100%	$0,00	$247. 50	
3	6" PV,C C-900	160,00	LF	512.85	$2 ,056 .00	0,00	160 00	160 .00	S0.00	52.05600	S2.05600	100%	$000	$102.80	
4	e· PVCPipeC..900	1.220 ,00	LF	514.60	S17.812.00	0,00	1220.00	1220.00	SO.Oil	517 ,812 .00	517 812 ,00	100%	so.co	$890 ,60	
5	12' PVC Pipe C-900	1,900,00	LF	531.80	S60A20.00	000	1900.00	190000	S0.00	560.420.00	$60.420.00	100%	SO.Oil	$3 ,02 1.00	
6	2· GateValve	1.00	EA	$49000	$490,00	0.110	1 00	1.00	S0.00	$490.00	549000	100o/,	SO.Oil	524 .50	
7	6"G a(a Vahtc	soo	EA	S870 00	$4,350.00	0.00	5.00	5.00	50.00	$4,350.00	54,350.00	100%	SO.Oil	$217 .50	
8	Blow -O Ii Assem by(SeeCo11n1V Orwg No. W,1;A)	BOO	EA	$1 ,200.00	S9,600 .00	0.00	800	8.00	S000	S9.600,00	$9,600.00	100%	50.00	5480.00	
g	6• Fire Hyarant Assembly	6 .00	EA	$3,700 00	$22.200 00	0 00	6 00	6.00	SQ.CO	$22 ,200.00	S22 . 200 .00	100%	SO.Oil	$1,110 .00	
10	8" Gate va1ve	8 ,00	EA	Sl .250 00	SI0.000 .00	0.00	8.00	800	so 00	$10.000.00	$10,000.00	100%	5000	S500,00	
11	a· reeFitting	200	EA	5400 .00	S800 .00	000	2,00	200	S0 .00	S800 .00	SB00.00	100%	50 .00	$40.00	
12	a• B end Fittings	200	EA	$26000	5520,00	0.00	2.00	2.00	$000	5520.00	S520.00	100%	so.co	526.00	
13	12·Gate Val\ie	7 00	EA	$2.250.00	S15.750.00	0.00	7 00	7.00	S0.00	$1,5 750.00	S16.750 00	100%	SQ.CO	5787 . 50	
14	12· BCO<I F ittings	9 . 00	EA	$ 460 ,00	$4 ,1 4000	0,00	9 .00	9 .00	so 00	$4 , 1 0.00	$ 4,140.00	100"/,	so00	520 7 00	
15	12 Tee FU.tings	3.00	EA	$1,100 00	$,3 300,00	000	3.00	3 ,00	S0,00	$3,300.00	S3,300 00	100%	S0.00	S16500	
16	12· CrossFittings	1 00	EA	585000	585000	0.00	1.00	1.00	$0,00	5850.00	sasooo	100%	so 00	S4 2. 50	
17	Srngte Service. Soor1Side	20 op	EA	$ 240.00	$4,800 .00	0.00	20 .00	20 .00	$0 .00	$4,800.00	$4,80000	100%	so.oo	$ 24 0 00	
1 8	Slngro Service. Long Side	1800	EA	5325,00	$5,850.00	0.00	18.00	18,00	SO.Oil	S 5 ,850 ,00	$5 ,850 .00	100%	sooo	5292 . 50	
19	TemPoraryConstructionMeter	1 00	EA	59.600 ,00	$, 9 600 00	0.00	1.00	1 ,00	so.co	$9 ,600 .00	$9,60000	100%	sooo	$4 80 .00	
20	Chlonnallon& Pressure Testing	1 00	LS	S6.15000	S6.150.00	0.00	1.00	1.00	SO.Oil	58, 150 ,00	$6, 150 .00	100%	30 00	S307 50	
	TOTAL POTABLE WATER DISTRIBUTIONE1				$186,438 .00				SO.OD	$186 ,431!.00	S186,438.00	100"1,	S0 ,00	$9,321 .90	
															
,	SANITARY SEWER E1														
	8" PVC. S OR 26 (0'•14' Cul)	730 00	LF	517 ,10	512.483,00	o.oo	730.00	730,00	so.co	$12 , dBJ.00	S12,483 .00	100%	so.co	$62 4.15	
2	8" P VC.SOR 26 (14'-16' Cul)	910.00	LF	S32.10	529,211 00	0.00	910.00	910 00	S0,00	$29,211 00	S29.211.00	100%	$0.00	$,1 46055	
3	8" PVC.S OR 26 (1,6' 18' Cul)	1,270.00	LF	3-11,20	$52,324.00	0.00	1270.00	1270.00	S0,00	S52.324.00	S52.324,00	100%	S0.00	$, 2 616.20	
4	8" PVC. C-900 (18'-20' Cur/LS)	170 00	LF	$54,70	S9,299.00	0.00	170.00	170,00	- SOOO	$9,29900	S9.299.00	100%	SD,00	$ 464 .95	
5	Sa nttmyManh ole (0'-14' Cul)	4.00	EA	$ 3,200 00	$1 2,800.00	0.00	4.00	4.00	S0,00	$12 ,800 00	S12.800.00	100%	SO.Oil	S64000	
6	!r (Ola) sanitaryManhDle t14' 16' Cul)	4.00	EA	S5.000 .00	S20,000 ,00	0.00	4.00	.00	sooo	$2 0 ,000 .00	52,0 000 00	100%	SO.Oil	$1 .000 ,00	
7	5' (O1a) Sa nl laf)I Manholc /16', 18' Cul)	4.00	EA	S5.2 Ei0,00	$2 1,000 ,00	000	00	4 .00	SO.Oil	$21 ,000 00	S21 000 00	10 0%	SO.Oil	$1.050 ,00	
B	s· (Dia)SanilaryManhole (18'-20' Cul)	1 00	EA	55,85000	$5,850.00	0.00	1.00	1.00	so.co	S5.850 00	55.850.00	100"1,	so.co	S292.50	
9	S ingle Service(Hilsl ooroughCounty)	5.00	EA	$595.00	S2.97500	0.00	5.00	5 00	S, 0 00	$2,975.00	$,2 075.00	100%	SO.Oil	SHB . 75	
10	Ooub lo Service (Hllisbor,,ugn Cou n!y)	1900	EA	$775 .00	$14.72500	000	1900	19.00	sooo	$1 4.725 ,00	S1 4. n S,00	100%	S0.00	$736 .25	
11	8" Slu l>& Plug	7.00	EA	S630.00	54,410.00	000	7.00	7 00	S000	S,4 410.00	S4.410.00	100%	S0.00	S22050	

1 ,,, ,11

Trip  lt  Cr eek COO-Vill191tE.F and G1	APPLCI  ATION FORPAYMEi,IT

RIPA &ASSOCUIIES PROJECU 01 1707A

PAY APP
fl10M
TO

9R8
1111117
11/30/17

'1EM
NO	

OESC Pl' ION OF WORK	

arv	CONTRACTSUM TO DA.iE		
				
BASEcoNtR.AcT	
ESTIMr\TEDOlJANTITY	TOTAL
WORK1N
Pt.ACE	l OT AL WORKIN
PL.ACE	TO TAL WO  KIN
PLACE	
"EFICE.NT
COMPLETE	
B LANCE
TO flNISH	
5'11
RETAIN A.CE	
			
UNIT	UNIT
PRICE	
VALUE	fH!S
l!:STIMA1E	F'REV
ESTIMATE	TOTAL
ESTIMATE	!"HIS
PERIOD	pqev
APPLICATION	TO
DATE	TO
DATE	TO
DATE	TO
CATE	
12	Oowatering	1 00	LS	$33,000.00	533.000,00	o.oo	1-00	1 00	so.oo	S33,000 ,00	$33.000 ,00	100%	so00	S1.650 00	
13	1nfi11Exfil Tes lrng	1 00	LS	S4,70000	$4,70000	000	1 00	1,00	S0 00	$4,700.00	$4.70000	100%	so00	$235 .00	
14	Tele vise Sanlla,y Sewer (CCTV)	3.080 00	LF	S3.05	$9,394.00	0.00	3080.00	3000,00	S0.00	$9,39400	59,394.00	100¾	so00	$<069 , 70	
1 5	Pump Sla llon (8' Ola.)	100	EA	5360,000.0	0	$360,000.00	000	1.00	1,00	S0,00	$360 ,000 .00	$360,000.00	100%	50.00	$18,000.00	
16	Connec.t toEx ing6" FM	1.00	LS	S4.100 00	5,1 100.00	0.00	1.00	1.00	S000	$, 4100.00	$4,100.00	100%	$,0 00	S20500	
17	4" PVC, C-900 FM	15700	LF	S8 10	S1,211.70	000	157 ,00	157 .00	S0.00	S1,271 70	51,271.70	100%	SODO	$63 , 59	
18	4• Plug Valve	200	EA	5675 .00	51. :!50.00	0.00	200	2,00	S0,00	$1,350.00	51.3!,0.00	100%	S000	567.50	
19	q· een<1	2.00	EA	5255 .00	$510 ,00	0.00	2.00	2.00	S0.00	5510.00	$51000	100%	S0,00	S2550	
20	6"PVC, C-900 FM	1,953.00	LF	$14.25	$27,830 .25	0,00	1953.00	1953.00	S0.00	527 83025	527.83025	100%	S0,00	$1,391.51	
21	6' Pk,g Vmv•	500	EA	$1,050.00	$5,250.00	0,00	5 ,00	5.00	S0.00	$5,250 .00	SS,250 00	100%	S000	S262.50	
22	5• Bend	14.00	EA	533000	S4,620 .00	000	14 00	14_00	$000	S,,,620,00	S4.620 00	100°/0	.so.co	5231 ,00	
23	6" Tee I1 C1A In Tee)	2.00	EA	$1.500,00	S3.000.00	0.00	2.00	2.00	S0.00	U.000.00	S3,00000	100%	S0,00	$150.00	
24	5·eap	100	EA	$20000	$20000	0,00	1.00	1.00	S0.00	5200,00	520000	100%	S000	S10,00	
25	FM Castng	28,00	LF	S68 80	51,926.40	000	28.00	2800	S0.00	S1.926,40	.$1,926◄O	100%	S000	$963. 2	
26	ARV SlruchJre & Assembly	, 00	EA	54.200.00	5 4.200.00	000	1 00	1.00	S0.00	S,,,200 ,00	S4,200,00	100%	$0,00	S21, 000	
27	Pressure Testing(FM)	1,00	LS	S3.900.00	53.900.00	000	1.00	100	S0,00	53.900 00	53.90000	100%	S0,00	$195.00	
	TOTAL SANITARYSEWER E1				$650,329.35				$0.00	$650.329.35	$650,329.35	100¾	so.co	$32,516.'.47	
															
	STORM DRAINAGE E1														
1	15•ClassIll RCP
,a·	s	42 00	LF	S2330	5978.60	0.00	42 00	42.00	50.00	$97660	597860	100%	so00	548 .93	
2	Clasm RCP	5800	LF	528 40	S1.647.20	000	5800	58,00	S0.00	51.647.20	51,647.20	100%	50.00	$82.36	
3	24" Class111 RCP	439 . 00	LF	544.60	519,579.40	000	439.00	439.00	50.00	519.579.40	S19.579,40	100%	so00	$9 78.97	
4	30" Class111RCP	158 00	LF	565.10	S10.285,80	0.00	158.00	158.00	50.00	510.285.80	S10,285,80	100%	SO00	$514,29	
5	36· Class111 RCP	51.00	LF	584 65	5,4 317 15	000	51 00	51,00	so.oo	54 . 31715	$4 , 317 ,1 5	100%	50.00	$215.86	
6	60" Classm  RCP	190 00	LF	S18500	53,5 150.0	0	0.00	190.00	190.00	50.00	$35,150.00	S35.150.00	100%	so00	51 ,7 57 .50	
7	(3) TMp le 58·,91"" Clas s Ill ERCP	5200	LF	51,200,00	562,400.00	000	52.00	5200	50.00	562.40.000	S62.00,00	100¾	so.co	53 ,1 20 ,00	
B	Hillsbomuhg Co Type1 Curt> Inlet	9 .00	EA	$>1,150 00	537.350DO	000	9 .00	9.00	S0 .00	$37,35000	537,350.00	100%	$0.00	$1,867.50	
9	Htllsborough Oo Type 1 Curt,Inlet w/ J·Bot1om	2.00	EA	55 .250.00	$10 ,500.00	0.00	2.00	2-00	so 00	510 ,500 00	$1 0.500 .00	,100%	S0.00	$525.00	
10	FOOT ManllOle W/ J. Bottom	100	EA	53.900.00	S3.900 ,00	o.oo	1 00	1 .00	50.00	53.900.00	S3.900oo		S000	S19500	
11	s·PVCUnderdraln	1 ,800 .00	LF	$11 .95	$2 1,510 .00	0 00	1800 .00	180000	S0,00	$21,510,00	S21,510,00	100%	S0.00	$1,075.50	
12	UnderdraioCleaoout	1300	EA	5185 .llO	$2 ,405 00	0.00	13.00	13.00	S0.00	$2,405 ,00	52.405.00	100,,	S, 000	S.12025	
13	FOOT Slratg hl Conetele End W.. I(Tr!pleP,po)	114 00	LF	5375.00	S42,750.00	0.00	1H .00	114.00	5000	$42,750.00	S4,2 75000	100%	sooo	$2, 137.50	
1'	Te4ev;sa Sto rm Sewer(CCTV)	1,052.00	LF	56,10	56, 417.20	000	1052.00	1052.00	S0.00	S6,417 20	SS,417 20	100%	S0.00	S320,86	
	TOTALS TOR M DRAINAGE E1				$259,190 .35				$0.00	$259,190.36	$259,190.35	10, 0  .	$0.00	f12,959.52	
															
	ROAD SLEEVE CROSSING El														
1	2" Sch40PVC	112.00	LF	$4 ,80	5537,60	0.00	112.00	112.00	sooo	5537 .60	S53 7 60	100%	5000	S26.68	
2	3' SCJ\40 P VC	11200	LF	55.55	5621.60	0.00	112 00	11, 200	$0 .00	5621.60	S621.60	00%	50 ,00	531 ,08	
3	•• SCll 40 PVC	140.00	LF	56.15	S861 00	0.00	14000	140,00	$0,00	5661,00	S861.00	11!0%	$0 .00	S43 .05	
4	6"S ch 40 P VC	112,00	LF	58.15	5912.80	0.00	112.00	11200	S0,00	5912,80	S912.80	100%	so.co	$45 ,64	
	TOTAL ROAD SLEEVE CROSSING e1				$2, 933.00				$0,00	$2,933.00	$2,933.00	100%	so.co	$146.65	

' ( ,u

Tripi•CrooCOD-Vi1119,  E.FondGI	APPLICATION FOR PAYMENT

Rll'A& ASSOCIATES PROJECT• 01-1707A

PAY APP FROM TO

9RET
11/1/17
11/30/17

IT E M
NO	

OESCRIPT NOF WORti:.	

Of'/	CONTRACT SUM TO DATE		
				
BASE CONTRACT	
EST1M,a.reo QUANTITY	TOTAL WORK IN PLACE	TOTAL. WO RK IN PLACE	lO iA L WO RK. IN PLACE	
PERCENT COMPLETE	
BALANCE
TO f'INISH	
5'11
R£TAIN11,GE	
			UNIT	UNIT
PRICE	VALUE	WIS
EST IMATE	PRE.V
ESTIMATE	TOTAL
ESTI MA TE	THIS
PERIOD	PREV.
APPLICA TION	TO
DATE	TO
DME	TO
OAtE	TO
DATE	
															
	C HANGE ORDER #2 • PHASEE1														
1	DPOCredi(. Fe<guso . Wale,	1 00	LS	($79.314.82)	($79.314.82)	000	1.00	1.00	sooo	(S 79,314 ,82)	($ 79 . 31 4 ,82)	100%	S000	($3,965.74)	
2	DPOCrcdil • Ferguso•nSewer	100	LS	(S2, 244268	)	($22,442.68	)	o.oo	1 00	1 00	S0.00	(S22.442.68)	($2.2,442,68)	100%	S0.00	(51,122.13)	
3	DPOCredtl - Ferguson• Force Ma:in	1.00	LS	($22,072J) )	(S22,072.05)	0 00	1 00	1.00	so.co	( $22 , 0n. Os )	(522 ,072.05)	100 %	S0,00	(S1,103 .60)	
4	CPO Cre<fil• Fer:guson - Uoderdraln	1 00	LS	($5 , 764.90)	($5, 764 .90)	0.00	1 .00	1 00	sooo	($5 , 764 . 90)	( 55 , 764 .90)	100%	S000	($288.25	
5	OPOCredit • Ferguson• Sleev es	1.00	LS	(S812.20)	($812.20)	o.oo	1 .00	1 . 00	S0.00	($812.20)	(S812.20)	100o/,	so.co	($ 40 .61 )	
6	CPOTax SaV!ngS	1 00	lS	(57 ,824 40 )	(S,7 82 4, 40)	0.00	1.00	1.00	S0.00	15, 7824 40)	(S7,824AO)	100%	SO.DO	(S 391 . 22)	
	TOTAL CHANGE ORDER #2 • PHASE E1				($138,231.05)				$0.00	($138,231.05)	($138,231.05)	100'Y.	$0 . 00	($6 ,911 .SS)	
															
	CHANGE ORDER #3- PHASE E1														
	E1 - Geoteehnlcalresting														
1	e, - fleid Technician Services	1 00	LS	$ 18.006 _00	5 18 .006 .00	0.00	1.00	1.00	sooo	$18 , 006 .00	518 ,006 .00	100%	$0 . 00	$900 .30	
2	E 1 • LaDra1ory Testing	1,00	LS	$4,932.00	$4,93200	0,00	1.00	,1 00	so.co	$4 ,9 32 00	$4 ,932 .00	100%	S0.00	$246.60	
3	E1 · Engineering & Projecl M anagemenl	1,00	LS	$2,520.00	S2,!'>,20 00	0 ,00	1 00	1 ,00	S0 .00	S2 ,520.00	S,2 520 ,00	100%	S0.00	S126.00	
	TOTAL CHA NGE ORDER #3 • PHASE E1				$25,458.00				$0.00	S25,d58.00	$25,458.00	100%	$0.00	$1,272.90	
															
	CHANGE ORDER #4 • PHASE E1														
1	OPOCredit- Rinker - Stonn Pipe	1 00	LS	(S38.646 .07)	($38,646 .07)	0 .00	I 00	1.00	SO 00	(S38 ,646 .07 )	($ 3,8 646 07)	100%	so.co	(51 ,932 30)	
2	OPOTax Savings	1.00	LS	($2,338 .76)	(S2,338.76)	0.00	1 00	100	so 00	(S2.338 ,76)	(S2.3-18,76)	100%	S0.00	(511694)	
	TOTALCHANGE ORDER #4 · PHASE E1				($40,984.83)				$0.00	($40,984.83)	1'40 ,984,83)	100%	$0.00	($2,049.24)	
															
	CHANGE ORDER #5 • PHASE E1														
1	DPOCled<I• Allanlol  TNG • s ewer Slruclufes	1 00	LS	($24 149.00)	($24.14900)	0.00	1 00	1.00	S000	($2, 414900)	($24,149.001	100'11	SO.DO	(S1.207 45 )	
2	DP O Credit• AUanllc TNG • LiftStation	100	LS	($2, 3755. 70)	(523.755,70)	o.oo	1 .00	t 00	so.co	(S23 ,755 .70 )	($23 ,755 ,70)	t00%	S0.00	($1,187 79)	
3	OPOCre t• Allr1nlcl  TN G  • Storm Stn,c1ures	1.00	LS	(517 ,84 4.80)	(S17 ,844 BO	)	0 ,00	1 ,0o	100	S0 ,00	(S17 ,844 .80)	($17,844 .80)	1000/,	S0,00	(S892.24)	
•	0PO Tax Savings	1.00	LS	(53,954.97)	(S3.954.97)	000	1 00	1 00	so.oo	($3, 954 .97)	(53 ,954 .97)	1000/,	S0.00	(S197 75)	
	TOTAL CHANGE ORDER #5 • PHASE E1				(S69,704,47)				so.oo	($69 ,704.47)	($69, 704 .47 )	100%	SO.OD	($3,485 . 23)	
															
	CHANGE ORDER 116 • PHASE E1														
	CTB DIRECT PURCHASE ORDER														
1	DPO Credo! • Soll Cemeo l Base	(2,98100	1 TN	S16.00	($47,696.00)	0.00	·2981.00	2981 00	S0,00	($4, 7696.00)	($4,7 696.00)	100%	so.co	(S2,384.801	
2	CPO Tax Savings	100	LS	(S2,861 76)	(S,2 861,76)	0.00	1 00	1.00	so.co	($2,86 1.76)	(5 2,861 76)	100%	S0 .00	($ 14, 3 09)	
,	EARTHWORK E1														
	Excavation ol Temporary Ponds	2,700 .00	CY	$2.45	56.615 00	000	2700.00	2700,00	SO.OD	SG,615 ,00	$6 ,61 5.00	100%	S0,00	$330.75	
	ROAD SLEEVE CROSSINGS E1														
1	2" Sch 40 PVC	940.00	Lf	$4a80	$4 ,5 12 ,00	000	940 . 00	940 ,00	sooo	S4 . 512 .00	$,4 512.00	1 00%	S,0 00	S225,60	
2	3" Sch40PVC	(112.00)	LF	$5.55	(S62, 160 )	000	·11200	·112,00	SO.OD	(S621 ,60)	($62160)	100%	sooo	( S3 1 08)	
3	4" Sct,40 PVC	2,340 00	LF	56.15	514.391.00	000	2340.00	234000	S000	$1',391,00	S14.39100	100%	S0.00	$719.55	
4	6"Sch 40 PVC	(112.00)	LF	S8.15	(S912.80)	0.00	112.00	·112.00	so 00	(S912 .80)	($912.80)	100%	S0.00	(&45.64)	
	STORM DRAINAGE E1														

)

TlipteCrMlilCOO.VillageE. F•rid G1	APPUCATIOl'iFOR PAYMENT RWA &ASSOCIATES PROJECT#01 1707A

PAY APP FROM TO

llRET
11/1/17
11/30/17

ITEM NO	

OESCR!DTIONOFWORI<.	

Ori	CONTRACTSUM TO DATE		
				
BA.SECONlRACT	
EST!MATEO QUANTITY	TOTAL WORK tN "LACE	TOTAL WORKIN PLACE	TOTAL WORKIN
PLACE	
PERCENT
COMPLETE	
B  L  NCE
TO FINISH	
5'11
RETAINA.GE	
			
UNIT	UNIT
PR E	VALUE	THIS
ESTlMATE.	>REV
SllMATE	lOTAL
ESnMATE	THIS
PERIOD	PREV
APPLICATION	TO
OATE	ro
OATE	TO
DATE	TO
DATE	
1	1S Classllt RCP	4800	LF	$'26.! 0	$ 1,252.80	000	4800	4800	50.00	S1,252,80	$1,25280	1001"	S000	$62.64	
2	18" Class Ill RCP	64 .00	LF	S29 .83	$ 1,909 .12	0.00	64 .00	64 ,00	so.oo	$1, 909 1 2	$1,909 .12	100%	S000	595.46	
3	24" Cl- Ill RCP	312. 00	LF	$47 92	$ 14,951 04	0.00	312.00	312.00	S0.00	$14,951,04	$14.951.04	100%	so.oo	$74755	
4	COl\trolS tmclure ( FOOT MO<llfie<l Tyi,e·o· lr>lel )	1 . 00	EA	$4,650.00	$4 ,650 .00	0.00	1 00	1.00	so00	$, 4 650 00	54, 650 .00	100o/,	S0.00	$232.50	
5	FOOT Manha	2 00	EA	SJ.250.00	$6 ,500.00	0 00	200	2.00	S0.00	$, 650000	S, 8500.00	100%	S0.00	$325.00	
6	RC> B(iek Plug	100	EA	S217.68	S277.68	0.00	1.00	1 00	50,00	$277.68	S277.68	100%	50.00	$1368	
7	15" RCP FES	1.00	EA	$ 1,500 .00	S l .500 .00	0 00	1 ,00	1 00	S0 .00	$1,50000	$1,500.00	100%	S0.00	$75.00	
8	18"RCP FES	1 00	EA	$ 1,650.00	Sl ,650.00	0.0Q	1.00	1 00	so 00	3,1 650 00	S1 .650.00	1 00%	S0 .00	$82 ,50	
9	PoslMountedFiberglassSkimmer	40.00	LF	S86.57	SJ,462 .80	0.00	40 00	40.00	S0.00	$3 ,462.80	53 .462.80	100%	S0.00	S173.14	
10	Televise Stonn Sower(CCTV)	424 00	LF	S6.10	$2,586.40	0.00	42400	424.00	.S0.00	$2,58640	S2,586AO	100%	S0.00	S129.32	
11	Oewatenng	1 00	LS	S,5 700 .00	$5,700.00	0.00	I 00	I 00	S0.00	S5,700.00	$5,700.00	100%	$0.00	S285.00	
	TOTAL CHAl'IGE ORDER #6 • PHASE E1				$17,865.68				S0,00	$17,865 .68	$1,7 865.68	100%	$0.00	$1193.28	
															
	TOTAL PHASE E1				$2,136,905.18				$0.00	$2,136,905.18	$2,136,905.18	100%	$0.00	$106,845.28	
															
	PHASEF1														
	GENERAL CO NDITIONS F1														
1	Mobilization	1 .00	LS	S9,600 00	$9.600,00	000	1 00	1.00	$,0 00	S9,600,00	$9,60000	100%	S0.00	S480.00	
2	NFJOE S Compliance	1 .00	LS	$4,85000	SA.85000	0.00	1.00	1.00	so.oo	$4 ,850 ,00	$4,850 . 00	100%	S0,00	$24250	
3	Mttmtenanceof Trafhc	1.00	LS	$,1 200.00	S1.200.00	000	1,00	1.00	sooo	s 1.200. 00	$1 ,200 .00	100%	so00	S60 . 00	
4	ConsL Stake. ou t J RecordSurvey - ByContrac.tm	1 .00	LS	s, s .000 .00	551.000 ,00	0 ,00	0 .95	0.95	S0.00	S48,450.00	$48,450.00	95%	S2,550.00	S2,422 50	
5	Payment & Performance Bond - ByConlraclot	1.00	LS	$1, 4 250 00	514,25000	0.00	1.00	1.00	S, 000	$1, 4250.00	$1, 4250,00	100%	so00	$712 .50	
6	Sill Fence	6,100.00	LF	$1.20	S7.320.00	0.00	6100.00	6100.00	sooo	57 ,320 .00	S7.320 00	100%	so 00	$366,00	
7	E xisting lnte1s- Erosk>n Protechon	8.00	EA	59820	$78,5 60	0.00	8.00	800	S0.00	1 785.60	578560	100%	$,0 00	S39.28	
	TOTALGENERAL CONDITIONS F1				$89,005 .60				10.00	$86,455.60	$86.455,60	97%	$2,550.00	$4,322.78	
															
,	EARTHWORK F1														
	C1eartng & G rubbing	3600	AC	$1,80000	$64,800.00	0.00	36.00	36.00	S0.00	S64,800,00	S64,800,00	100%	so.oo	S3.24000	
2	Disc Sile	3000	AC	S355.00	$10.650.00	0.00	30.00	3000	S0.00	$10,650.00	$10,65000	100"4	S0,00	$532,50	
3	Cuf Volume(Unadjusted)	108 ,900.00	CY	52.10	$228,690 00	0 00	10690000	10890000	so00	$2 28 ,690 .00	5228, 690 00	100%	S0 ,00	$1,1 434 50	
4	Sod<llng	25 .750 00	SY	5245	$6, 3087.50	0.00	21887.50	2188750	S0.00	55,3 624 38	553,624.38	85%	S9.463.13	S2.681 22	
5	SeeCling & Mulc log	6 ,114 00	SY	$0.25	51.528. 50	o.oo	o.oo	0 00	S0 . 00	S0 .00	S000	0%	S1 ,528.50	50 ,00	
6	Dewa tefiny	1 00	LS	540 .500 00	$4, 0 500.00	0.00	1.00	1 00	S0.00	$4,0 500.00	540.500 00	100%	sooo	S2 ,025.00	
7	FinalGrading	1 00	LS	520,000.00	520,000.00	0.00	0.80	0 80	sooo	S1,6 000 00	S1, 6 000 ,00	80%	S4 .000 .00	S800,00	
	TOTAL EARTHWORK F1				$429,256.00				$0.00	$414.264.38	$414,264.38	97¾	$14.991,63	$20,713.22	
															
	PAVING Al'IO BASE F1														
1	1 31-4  S·1 Asphaltic Concrete	5.705.00	SY	S9.20	$52,486.00	0 00	5705.00	5705.00	S0.00	$52,486.00	SS, 2 486.00	100%	S0,00	52.624.30	
2	s· Crushe<I co oc rcte Bas e	5,705,00	SY	$10.30	SSS,761.50	0.00	570500	70500	S0.00	S58.716,50	S5, 8761 50	100%	S0,00	S2.938.08	
3	6° Stabilized Subgrade(LBR40)	5,705.00	SY	S6 85	S39.079,25	0.00	570500	570500	S0.00	539.079.25	$39,079.25	100%	.sooo	$ 1 ,953.96	
•	Miami Curbw/Stabillla llon(f ull Depl )	5,00200	LF	$11_05	S55,272.10	0 00	5002_0Q	500200	S0.00	$55,272.10	S55.272 10	100%	S0.00	$2,76361	

r,.,f I

ITEM
"°	

DESCR IPTI O N O F WOR,	

OT't	CONTRACTSUM TO OATE		
				
BASECONTRACt	
ESTIMATED DUA,NTHY	TOTAL WORKIN
Pl.ACE	TOTAiL
WORKIN
PLACE.	1"0T.Al WORKJN PLACE	
PERCENT COMPLETE	
BALANCE TO FINISH	
5%
RtfAINAGE	
			UNIT	UNIT
DRICE	VA.LUE	THIS
ESTMI  ATE	PREV
ESTIMATE	TOTAi.
ESTIMATE	THSI
PERIOD	PREV
APPLICATION	TO
DAfE	TO
D.AJE	TO
DATE	TO
DATE	
5	£i" WideRibboncum	,3 013 00	LF	S9,80	S29,527AO	0.00	3013 .00	3013.00	S0.00	S29,527 40	S29,527.40	100%	S0,00	Sl .476 37	
6	5'x-4  Co11<:rete Sid ewakl	300.00	LF	$19.5	0	$5,850.00	000	15000	150,00	SO.DO	$2,925 .00	.S2.92500	50'II,	52,925.00	$1462-5	
7	10' Wide Asphall Pavemenl lwlbase &subgrnde)• Trail	1.663 00	SV	S25.90	543,071 70	000	1663.00	1663.00	S0.00	$43,071.70	.$43.07170	100%	S0.00	$2,153.59	
8	ADA Ramps (5' Wide)	4 00	EA	$840,00	$3, 360.00	0,00	2.00	2.00	S0.00	51,680 00	S1,68000	50%	S1,680, 00	$8400	
9	12"" Wide - Conr.rete EYoCk Wall	,1 430.00	LF	S94,10	S134,563.00	000	1430.00	1430.00	S0.00	S134.563.00	-S134,56300	100 %	sooo	$, 672815	
10	Wood Boar<!walk	1,300 00	SF	S45.25	S r.8,825.00	0.00	1300.00	1300.00	S0.00	S58.825,00	$58,825.00	,oo,.,	S0.00	$2 ,9412 5	
11	Slgf\OQO & S1nplog	I 00	LS	s2.200 .00	S2,200 .00	000	0 . 00	0.00	S0.00	$0 00	S0,00	0%	$2,20000	so.oo	
	TOTAL PAVING ANDBASE F1				$482,995.95				$0.00	$476,190.95	$476,190.95	99%	$6,805.00	$23,809,56	
															
	POTABLE WATER DISTRIBUTION F1														
1	Connect IO Exis ting6· WfM	1 00	EA	$1.250 .00	$1 ,250 .00	0.00	0.00	0.00	S0.00	so.oo	S0,00	0%	51.250.00	- 00	
2	6" PVC p;pcC·900	2,700,00	LF	510.50	S28.l50.00	0 00	2565.00	256. .oo	5000	$26,932.5	0	S26,932.50	95%	S1A17.50	S1,346.63	
3	s· Fife Hydran1Assem  vtwfTeeFlthng ConneclJOn	5 .00	EA	S3.700.00	518.500.00	0.00	4 75	475	S0.00	$17.575.00	S17,57500	95%	S925.00	$878.75	
4	s• Gate Valve	11 .00	EA	$87000	S9,570.00	0.00	10.45	10.45	S000	$, 909150	$9,091.50	95%	$47850	5454.SB	
5	6" Bef1<! Fotllngs	1 2.00	EA	$185.0	0	$2,220.00	0.00	11 40	11 40	S0.00	$2,109.00	5,2 109 00	95%	$111.00	5105.45	
6	6"' T ee Fittings	2.00	EA	S290 00	S58000	0.00	1.90	190	S0.00	$551.00	555100	95%	$29.00	$27. 5	
7	SingleServk:e. Shorl Side	41 ,00	EA	5240.00	59,840.00	0.00	38.95	38.95	so 00	$9.348.00	$9.348.00	95%	$492,00	$46740	
B	s 1ngre s e rvoce. L""9Side	;13,00	EA	S325.00	$10.725.00	0.00	31 35	31,35	S0.00	S10,188.75	S10,188.75	95%	S536.25	$509.44	
9	Temporary cons truction Me1er	1.00	EA	S9.900.00	S9.90000	0.00	0.95	0.95	$0.00	$9,405.00	S9.405.00	95%	$495.00	$470,25	
10	Chol itnatioo, sampling & Pressure Tesllng	1 00	LS	54,75000	54.750.00	0.00	0.50	050	so 00	S2,375.00	S2.37500	50%	52 ,375.00	5118 ,75	
	TOTAL POTABLE Wp.TER Dl$TlllBUT10N Fl				$95,685.00				SO.OD	$87,575.75	$87,575.75	92%	$8,109.25	$4,378.80	
															
	SANITARY SEWER F1														
1	Ir PVC. S OR 26(0'-10'Cul)	1.713.00	LF	515.00	25.695.00	0.00	171300	!713.00	S0,00	S25,695.00	S25.69.500	100%	S0.00	S1284.75	
2	Ir PVC $ DR 26 (10"-12' Cul)	424.00	LF	S11.10	$7250.<0	000	424 00	424 .00	S0 ,00	$ 7,250 .40	$7.250 40	100%	$0.00	S362.52	
3	a• PVC , SOR 26 (12"·1< ' Cul)	179 00	LF	$20.35	SJ,64,2 65	0.00	179.00	179.00	S0.00	SJ.642.65	SJ,642.65	100%	$0.00	5182,13	
4	Sanlta<y1,1.,,,.,,. (0'--8"CUI)	500	EA	$2,40000	s, 2.000.00	o.oo	5 00	500	S000	s12,ooo.oo	512.000.00	100%	S0.00	sooooo	
s	Sa nlta ,y Manhole (8'·10' Cul)	4.00	EA	S2.800 .00	s1 1 .200 .00	0 00	4 00	4 .00	S0 .00	S11 ,200 00	$11 ,200.00	1QO%	$0 00	S:;6000	
6	Sanitary Manoole (10'·12' Cut)	2 00	EA	$3 ,000 00	S6,000 00	0.00	2.00	200	so .oo	S6.0oo 00	S6.000 00	100%	$0 00	S300.00	
7	Sanl\a('f Mantoole (!Z-1•·Cul)	1 00	EA	$3 ,450.00	SJ.450,00	0 00	1 00	1 00	S0,00	S3.450 00	Sl. 450,00	100%	so.oo	$172.50	
8	Single SeMCe(HIiisbo rough County)	18 00	EA	$!;95,00	$10,710,00	000	18.00	18 00	S0.00	$10,710.00	S10,71Q.OO	100%	so.oo	$535,50	
9	Doullel  Service(Hillsboreugh Coonly)	29.00	EA	S775 .00	S22,475 ,00	000	2900	29.00	so.oo	$22.47,500	$22,475.00	100%	S0,00	$1,123.75	
10	a PVC Stub-out C()ll(lectron	1.00	EA	$450.00	$450.00	0 00	1.00	1 00	S000	$450,00	$45000	100%	so.oo	S22.50	
11	Dewa\cnng	1.00	LS	$27,500 00	$27.500.00	o.oo	1.00	1 00	S000	S27,500.00	$27.500.0	0	100%	so.oo	S1.375.00	
12	lofil/Exfil Testing	1 00	LS	$3,900-00	$3,900 00	0,00	0,00	0 00	S0.00	so.oo	SO.OD	0%	53,90000	S0.00	
13	TelcvlSeSanilarySewer(CCTV)	2,316 00	LF	53.05	S7.063.80	000	0.00	000	S000	S0.00	S0.00	0%	$7 ,063 80	S0.00	
	TOTAL SANITARY SEWER F1				$141.336.85				SO.OD	$130,373.0$	$130,373.05	92%	$10,963.80	56.518.65	
															
,	STORM DRAINAGE F1														
	15 Cl8SsIll RCP	35800	LF	$23 30	$8.341.• 0	0.00	35800	35800	so 00	S8,3'11.40	SB.341.40	100%	so.oo	, s 1101	
2	18" Class Ill RCP	183.00	LF	$2840	$5.197 20	0 00	183,00	183.00	S0.00	SS.197,20	ss .197.20	100%	so.oo	$259.86	

Ta pioCrHk CDO-'/lllagoE,f ond G1	APPLICATION FOR PAYMENT Rl?A &ASSOCIATES PRO.JECHm 1707A

PAYAPP FROM TO

9RET
11/1/17
11130117

T  pl• c,..  coom.v ..,.e. F•.., G1	APPLICATION  FOR PAYMENT

RtPA&ASSOCIATES PROJECT•  Ot-170/A

PAYA.PP FROM
m

9RET
11/1/17
11/30/17

ITE.M NO	

OESCRIP flON OF WOR I(	

QTY	CONTRACT SUM TO OA.TE		
				
BASE CONTRACT	
ESTIMATEcDO UANTlfV	TOl AL
WORKIN
li'LACE	TOTAL
WORK IN PLACE	TOTAL
WORK IN
PLACE	
PERCENT
COf,-1PLETE	
BALANCE
TO FINISH	
5"1
RETAINAGE	
			UNIT	UNIT
P RICE	VALUE	TM IS
ESTIMATE	P RE V
ESTIMATE	TOTAl
ESTIMATE.	THIS
PERIOD	PREV
APPLICATION	TO
DATE	ro
DATE..	,o
DA.TE	TO
OATE	
3	24" ClassIll RCP	,1 354 00	LF	$38 .30	551,858 20	0 .00	1354 .00	1354.00	S000	551,85820	$5, 1858.20	100%	S0.00	52,592,91	
4	30•ClassIll RCP	39000	LF	$52,5	0	S2, 04750	0	000	390.00	390.00	10 .00	520,475.00	520,475,00	100%	S0.00	S1,023,75	
5	:IB"ClaSs Ill RCP	175 ,00	LF	S72.10	512,617.50	o.oo	17500	17500	$000	512,61750	$126, 17,50	100%	sooo	S630.Ba	
6	lnle l Type1 (HC)	15 00	EA	$4,150.00	S62,250.00	0.00	9.75	9.75	$0 00	S40.462.50	$4,0 462.50	65%	S21.787.50	$2,023.13	
7	FOOT Man'101e	2,00	EA	$3,250.00	$6,500.00	0.00	190	UlO	so.co	S,6 175 00	$,6 17 5.00	95%	S32500	$308 75	
El	Co nt rol Struclure(F OOT ModlfiedType•o Inlet)	1,00	EA	S3.500 ,00	5,3 500 .00	0 00	0,95	U 95	sooo	S3 ,32 5 _00	S3 ,325 00	95%	S1 75.00	516,6 25	
9	Con lroi S ln,cl ure (FOOT MO<l,fied Type "H"lniel)	100	EA	59,650.00	$9,65000	0 00	095	095	S000	59.16750	$9,16750	95%	5482.50	$458,38	
10	E>osfing lnlel Type 1 (HC),(Tle In)	2.00	EA	$695.00	S, l  39000	0.00	2.00	2-00	so 00	S, 1 390 00	51,390.00	100%	S(l.00	$69 50	
11	E><,sung FOOT Manhole-(T;e In)	1,00	EA	$,4 000 .00	$4,000.00	0.00	1.00	1 00	S,Q00	S4,000 00	$ 4,000.00	100¾	so.co	5200 .00	
12	Existing Inlet TyPeC( Tie In)	1 00	E A	$4,650 00	54,650 ,00	0 00	1.00	1 00	1000	$,4650.00	S4,_65000	100%	so 00	S232.50	
13	Control S!ruclure-Concrete WeirWall(74 LF)	1,00	EA	$3, 8 000.00	S38,000.00	0.00	1 00	100	SOOD	S3,8 000 ,00	S38.00000	100%	S0.00	$1,900,00	
M	18" FOOT FES	1.00	EA	Sl,650.00	S1,650,00	000	,100	,1 00	S0.00	S1,65, 000	51,650_00	1 00%	so.oo	S82.50	
15	24" FOOT FES	1 00	EA	51,750 00	51,750.00	0,00	1,00	1,00	S0,00	51,750 00	51,750.00	100%	S0,00	587,50	
16	30" FOOT FES	1 00	EA	52,300.00	$2,300-00	000	1,00	1.00	S0,00	52,300.00	52.300.00	100%	sooo	S115 ,00	
!7	36" FO O T F ES	1 _00	EA	5,2 750 . 00	5 2 , 7 50 00	0 .00	1 00	1 ,00	S000	52,75,000	52,750.00	100%	S0,00	S137.50	
18	Oewatering	1 00	LS	518,500 00	S18, 500,00	0,00	1,00	1,00	so.oo	51 8 .500 00	S 1, 8 500 .00	100%	S, 000	S925.00	
19	TelevtseStorm Sewer(CCTV)	2,460.00	LF	$6 35	515,621-00	000	000	0,00	5,0 00	50,00	sooo	0%	S15 ,62 1 00	S0 .00	
20	FOO T Type -E Inlet	4,00	EA	52,550.00	S10. 200.00	0.00	360	3.60	S0,00	$9,180 00	$9,18000	90%	S1.020,00	$459.00	
21	6" Unde,-dratn ( F;ne 11,99 egal e)	150 .00	LF	$11.95	S1,792.50	0,00	150,00	150,00	5000	5,1 792.50	51,79250	100%	sooo	$1!9.63	
22	UndefdrainC1eanout	3.00	EA	S18500	S555.00	o_oo	300	3 ,00	S0 ,00	5555 .00	S555 .00	100%	sooo	$27 . 75	
	TOTAL STORM DRAINAGE F1				$283,547-80				$0,00	S2'4,136,80	$244,136.80	86%	$39,41.100	$12,20.686	
															
	ROAD SLEEVE CROSSING F1														
1	2" SCh 40 PVC	90.00	LF	54.80	$432 00	0.00	90.00	90.00	S0.00	5432.00	5432.00	100"/t	so 00	s2, _so	
2	•· Sch 40 PVC	120,00	LF	S6,15	5738.00	0,00	120.00	120,00	S0.00	S738.00	$738.00	100%	SO00	$36.90	
J	6" Sc h 40 PVC	30.00	LF	Sll.15	5244.50	0.00	3000	3000	so,oo	5 2 44 50	$2 4 4 .50	100%	so00	$12 . 23	
	TOTAL ROAD SLEEVE CROSSING f1				$1,414-50				S0.00	Sl ,414.50	$1,414.S0	100¾	$0.00	$7, 0 73	
															
	CHANGE ORDER - PHASEf1														
	CTB DIRECT PURCHASE ORDER														
1	0 PO Credll · Soilce mentBase	12,186.00)	TN	$16 00	(S3, 5136,00)	000	-2196.00	·2196.00	50.00	(S35,136.00)	($3, 5 136.00)	100%	S0.00	{S1,756.80)	
2	DPO Tax Savings	1 00	LS	($,2 108.16)	(S2. Hl8.16)	0.00	1 00	1 00	so.oo	($2 ,1 08 . 1 6)	( 52.108 1 6 )	100 ,	S0.00	($105.41)	
	TOTAL CHANGE ORDER /If;- PHASE F1				($37,244.16)				S0.00	($37,244.16)	($3, 7 244,16)	100%	$0.00	($1,862.21)	
															
	CHANGE ORDER #7 - PHASE F1														
	ATLANTIC T NG-VILLAGEF1														
1	OP  O Cred•t - s an11a,y Structures	1 00	LS	($1, 5 600 ,70)	($1, 5 600. 10)	0 .00	1 00	1 00	50 .00	(S1 5,600 .70 )	($ 1, 5 600 .70)	100",1,	S0.00	($ 780 04)	
2	CPO Cre<fil - S lonn S truc tures	1-00	LS	($22,364.50)	($22,364.50)	0.00	1 00	1 00	S0.00	(S22,364.50 )	($2, 2 364,50)	100%	S0,00	($1,116 23)	
	FERGUSON WATERWORKS-VILLAGEf1														
1	DPOCredit- WalerM ain	1 00	LS	(S40,895-70 )	(S40.895.70)	0,00	1 00	1 00	S0.00	(540,1195-70)	(540 ,119570)	100%	S0.00	(S,2 044-79)	
2	OPOCfeOfl- SanetarvPtpt!	1 00	LS	($ 22, 91\ _0 4 )	(522,9 11 .04)	0 .00	1 00	1 00	S0 .00	(S22 ,911 04)	( 522 ,911 .04)	100%	S0,00	(51,145.55)	

.""

T ple Crff k COO-'lllloge E. F and G1	APPLICATION FOR PAYMENT

RIPA&ASSOCIATESPROJECT O,Ol 1707A

PAV APP FROM TO

9RET
11 /1117
11/30/17

ITEM
NO.	

'DESCRIPTION OF WORM.	

OTV	CONTRACTSUM TOCATE		
				
BAS E C O N TRACT	
E STIMATED OUA NTffY	lOTAL
WORt( lN P LACE	lOTAL
WORK IN
PLACE_	TOTAL
WORKlN
PLACE.	
PERCENT
COMPLETE	
B• LANCE
i O FlNl SH	
5%
RETAJN AGE	
			
UHIT	UNIT
PRICE	VALU E	THIS-
EST IMATE	PREV
ESTlMATE	TOTAL
ESTIMATE	f HIS
PERICO	PRE:V
APPLICATION	TO
OAl E	TO
DATE	TO
DATE	TO
OATE	
3	DPO Credi! . UnderDrain	I 00	LS	(S442.66)	($442.66	)	0.00	I 00	I 00	s o.oo	(S4d2.66	)	($442.66)	100%	sooo	(52213	
	RINKER-VILLAGEF1														
I	OPO Credit. StormPipe	1.00	LS	($61,881.23)	(S61.BB.123)	0.00	,1 00	1.00	.S0,00	($6 1 ,881.23)	{$61.881.23)	100%	sooo	(S3.0 9'1.06J	
	TOTALCHANGE OROER #7 • PHASE F1				($164,095.83)				so.oo	($164,095.83)	($164,095.83)	100%	S0.00	{$8,204.80)	
															
	TOTALPHASEF1				$1,321,901.71				$0,00	$1,239,071.04	$1,239,071.04	94%	$82,830.68	$61,953.59	
															
	PHASEF2														
	GENERAL CONDITIONS F2														
1	Mohmzaoon	1.00	LS	$9.600 00	59 ,600.00	0.00	1.00	1 00	S0.00	.600 .00	$9.600 .00	100%	S0.00	548000	
2	NPOESPennft & Compliance	1.00	LS	$4,050.00	$4,050.00	0 00	1 00	1.00	so 00	$,4 050.00	$4.050.00	100%	S0,00	$202.liO	
3	Malnlenanceof Trame	,1 00	LS	s 1.200.oo	51,200.00	0.00	1.00	100	$000	$1,200.00	51,200DO	100%	sooo	$6000	
4	C<lOSI Sla k eo u t I Reco<d Survey• By ConlraclO(	I 00	LS	$33,000,00	SJJ .000.00	o.oo	I 00	100	SO.DO	533 ,000 .00	533.00000	100%	so.oo	$1.650 . 00	
5	P ayrrient & Perfonnaoce Bond • By Conlrack>r	1. 00	L S	510 ,100 .00	S10 ,100 . 00	0 . 00	1. 00	1 ,00	SO. DO	51 0.100 .00	s 1 0. 1 00 . oo	100%	SO.DO	$50500	
6	SitlFence	4.80000	LF	$1.20	55,760.0	0	0.00	4800.00	480, 000	$ODO	56.76000	S5.700.00	100%	sooo	5288.00	
7	Exf:sllng Inlets- El"OSIOn Protection	BOO	EA	598 .20	S589.20	o.oo	600	600	SO.DO	S689.20	5589.20	100%	so .oo	529.46	
	T OTAL GENERAL CONDITIONS F2				$64,299.20				S0.00	$64,299.20	$64,299.20	100¾	SO.DO	$3,214 .96	
															
	EARTHWORK F2														
1	Clcanng & Grubbing	21.00	AC	$2,250.00	$4, 7 250.00	0.00	21,00	21 00	50.00	547.25000	$47,250.00	1()0%	S0.00	$2.36250	
2	o,sc s 11e	17.00	AC	$35500	S6,035.00	0.00	17 00	1700	S0.00	$6,035.00	$6,035.00	100%	$0.00	$301 75	
3	Cul Volume (Una<!j1.15led)	2.050 ,00	CY	$2 10	$4 ,305 .00	0 .00	2050 00	2050 .00	S0.00	$,4 305 ,00	$4.305.00	100%	W.00	$215.25	
4	Sodding	9,760.0()	SY	S2 45	$23,912 00	0.00	9760,00	9760.00	S0.00	$23.912,00	$23.912.00	100%	S0.00	$1,195.60	
5	Seeoing 8 Mulching	6 ,864.00	sv	S0.25	S1,716.00	000	0,00	0.00	S0.00	S000	S0.00	0%	$1,716.00	so.oo	
6	Oewalering	1,00	LS	$7 2, 0 00	$72000	000	1 00	1 00	so 00	S720.00	5720.00	100%	!,0.00	s .oo	
7	Frna1Gradni g	1 00	LS	S1, 7 500.00	$1, 7 500.00	0.00	1.00	I 00	SO.OD	$ 17 .500 00	S1,7 500 00	100%	SO.DO	$875 .00	
8	Im porledFm for Pad Grading	7,400.00	CY	$7 00	$5, 1 800 00	0.00	7400.00	740000	$0,00	551,800.00	SS1,800.00	)00%	SO.DO	$2 ,590 00	
	TOTAL EARTHWORK F2				S153.238.00				SO.DO	$151,522.00	$151,522.00	99%	$1,716.00	$7,576.10	
															
	PAVING AND BASE F2														
1	1 314·5- 1 l'SPMlllcCooorele	6,621 00	SY	$920	560,913.2	0	0.00	662100	662100	.SO.DO	560,91320	$60,913.20	100%	sooo	$3,04.566	
2	s- CrushedConcreteBsse	6.821 00	SY	S10,30	588,196.30	0.00	6621-00	662100	S0,00	S68.196.30	$68,19630	100%	50.00	$3,409.82	
3	6" Slablllzed  St1t,grade(LB R,   10 )	6 ,621 .00	SY	S6 ,85	545 .35,3 85	0 .00	6621 .00	6621 ,00	SO.DO	$45,353.85	545,35385	100!1,	so 00	$2 ,267.69	
4	Miami Curb w/Stabilizalion (FullDepth)	5,616.00	LF	$11 05	562,056.80	0.00	5616.00	5616.00	S0.00	562,056.80	$62,056BO	100%	so 00	$3,102.84	
5	lnlersection• Valley Guner (County Oeu1tlTD-<i)	70,00	LF	550 .90	53 .563 .00	0.00	70.00	70.00	S0,00	$3,563.00	SJ.563.00	100%	SO.OD	5178 .15	
6	5'x4"Concrete Sidewalk	398.00	lF	S19 50	57,761.00	0.00	398,00	398.00	sooo	$7,76100	$7,781.00	100%	SO.DO	$388, 05	
7	io'x4 "ConcreleSidewalk	800 .00	LF	S39.05	$31.240 .00	0 .00	800 .00	80000	S0.00	$31,240.00	$3, 124000	100%	S0.00	$,1 562,00	
B	,o·x6" Shell Malerta! 4 Tra(w,SI,1FenceonBotti Side)	935 .00	LF	$2 5.50	523.842 . 50	0 .00	0 .00	0 .00	S0 ,00	SO.DO	S0 .00	0%	$23,84250	SO.DO	
9	ADA Ramps( 5' w,de)	7.00	EA	$84000	55,880,00	ODO	7.00	7 00	so .oo	55 ,880 .00	$5 ,880 .00	100%	SO.DO	$294 . 00	
10	AD A Ram ps ( 10' wl<le)	8.00	EA	$1.200 00	59,600.00	0.00	8.00	800	S0.00	59,600.00	$9,600DO	100%	S0,00	$480.00	
11	Slgnage& Slriplng	1,00	LS	$,6 250.00	56,250.00	ODO	1 00	1 00	sooo	SG.250.00	$6.25000	100%	S0,00	$312,50	

)

Triplt Crctd1COO•VillaQ• E.f and G1	APPLICATION FOR PAYMENT

RIPA&ASSOCIATESPROJECT# 01-1707A

PAY.   AP P FROM TO

9RET
11/1/17
llf.l0/17

1TEM
NO	

OESCRlPl !ON OF WOR'I(	

C lY	CONTRACT SUM TOOATE		
				
BASECONTflAC T	
E.STIMATEDOUANTITV	TOTAL WORK IN P LACE	TOTAL W ORK IN
et.ACE	fOTAL WOR K,IN
PLACE	
PERCENT CO MPLETE	
BALANCE
TO FIN I SH	
S"li
RETA)NAGl:	
			UNIT	UNlf
PRICE	VALUE	THIS
ESTIMATE	PRE:V
ESTiUAf E	TO TAL
ESiJMA TE	™'"
P ER IOD	-;;>REV
APPLIC>,T10N	,-0
DATE	TO
DATE	TO
DATE	TO
OA.TE	
	TOTALPAVING ANO BASEF2				.$324,65, 6 65				$0.00	$300,814,15	$300,814.15	93%	$23,842.50	$15,040.71	
															
	POTABLE WATER DISTRIBUTIO N F2														
1	COl14'e<1 to E ><t,st ng Ir W/M	2.00	EA	S1,250 ,00	$2,500.00	0.00	2.00	2.00	S0.00	$,2 500.00	S2,50000	100%	S000	$12500	
2	8" PVCPipe C-900	,3 128.00	Lf	S14.60	$45,668.80	o.oo	312800	3128.00	S0.00	545 668 80	S45.668 80	100%	S0.00	$2,283.44	
3	6" FireHi<Jran1 Assemt>ly/W/Tee FIIH119 Connection	5.00	EA	S3,700 00	$18,50000	000	5,00	5 00	S000	$18,500.00	$18.50000	100%	$0.00	S925.00	
4	a·Gate Valve	19 ,00	EA	S40000	$7,600.00	0.00	19,00	19 00	so 00	$ 7 ,600 .00	S,7 600 00	1 00%	S000	S38000	
5	8" Bc,1(1Flntngs	800	EA	S260 .00	$2 ,080 .00	000	8 .00	8 .00	$000	S2,08.00	S2.080,00	100%	S0.00	$104.00	
6	a-T ee F rttings	4.00	EA	5400 .00	$1 ,600 .00	000	4 00	4,00	5000	S1,600.00	$, 1600,00	100%	S0.00	$80 00	
7	srng1e SC:rvice. Short Side	47 00	EA	$240.00	S11,280 .00	0.00	47.00	47 00	so.oo	S 11 .280 .00	S11 , 280 00	100l',	S000	S564 00	
8	Single Service. Long S ,do	31 00	EA	5325.00	$10,075.00	0.00	31.00	31.00	S000	S10.07500	$1, 007500	1(!0%	S0.00	S503.75	
9	Temporary Constnctlnn Meter	1 .00	EA	S, 9 900.00	S,9 900 00	000	1.00	1.00	5000	S9,900.00	$9,900,00	100%	S0.00	S495 00	
10	Ctiloflnafion5, .ampUng& Pressure T     ing	1 00	LS	$5 400.00	S, 5 400.00	0.00	1.00	100	$0,00	SSA00,00	5,5 40000	100%	sooo	$270 .00	
	TOT AL POTABLE WATER DIST RIB UTIONF2				$114,603 .80				S0,00	S11,4 603 ,80	$ 11,4 603.80	100%	$0.00	$5,730.19	
															
	SANITARY SEWER F2														
1	8" PVC, SOR 26 (0'-10'Cut)	1.33700	LF	515.00	520 ,055 .00	0 00	133700	133 7.00	S000	S2, 005500	S20,05500	100%	SO.CO	$1 ,002.75	
2	8" PVC SOR 26 (10'-12' Cul)	323.00	LF	S17 10	55,523.30	0.00	323,00	323.00	so.co	S5 .523 .30	$,5 523 .30	100%	SO.OD	$276 .17	
3	s·PVC. SOR 26 (12·-◄1 ·Cul)	37900	LF	S20.35	57,712,65	0 00	379.00	379.00	S0.00	S7 71265	S7 712.65	100%	$0.00	$385.63	
4	8"PVC SOR 26 (14'-16' Cut)	39700	LF	529.60	S11 ,751 ,20	0.00	39700	39700	sooo	$11 ,751 .20	511 ,751 20	100%	so.oo	$58756	
5	Sa nl1aryMaoi., te (Q'-l!' C ut)	5.00	EA	S2.400.00	512,000.00	0 00	500	500	S0.00	51, 2 000 00	512.000,00	100%	5000	$600.0Q	
6	Sanitary Manno1e( A·' 10' Cut)	100	EA	52,800.00	S2,800,00	0 00	100	100	S0.00	$,2 800.00	5,2 800.00	100%	5,0 00	5140.00	
7	San,taf)'Man!lole(10'-12'Cut)	2.00	EA	S3,000.00	56,000.00	0.00	200	2.00	S0.00	56,000.00	$6,000.00	100%	S, 000	$300,00	
B	Sanotary Man/1040 ( 14'-16 ' cu1)	2,00	EA	$3,900.00	$7,800.00	000	2.00	2.00	SO 00	S7,80,0 00	57,800.00	100%	sooo	$39000	
g	Smg5ervice(Hillsborough County)	15 ,00	EA	559500	58.925.00	0.00	15.00	15.00	S0.00	SS,925,00	SS.925 ,00	100%	so.oo	$4 4 6.25	
10	Double Service(Hlllsborough Cou nly)	3200	EA	p 75.00	S2, 4 800 00	0,00	32.00	32.00	S0.00	S24.800.00	S24,800.00	100%	S0,00	5,1 240.00	
11	8" Stub-Out Coooe<lion	2.00	EA	$45000	S900.00	000	200	2.00	S000	S900.00	5900.00	100%	S000	$45.00	
12	Oewatering	1,00	LS	S29.500,00	529.500.00	0,00	1 00	1.00	S0.00	s .soo.oo	$29, 500 .00	100%	SO.OIi	5,1 475 .00	
13	lnfil/Exfil Tes1ing	1 00	LS	$4,150.00	$,4 150 00	0,00	I 00	100	S0.00	54.150 00	$4,150.00	100%	S0,00	520750	
1•	TeleviseSanitarySev,e,(CCTV)	2.436 .00	LF	S30	5	5, 7429.80	000	243600	243600	S0.00	$7,429.80	S7,429.80	!00%	S000	5371.49	
	TOTAL SANITARY SEW R F2				$149,346.95				$0.00	$149,346.95	$14, 9 346.95	100%	S0.00	$7,467.35	
															
	STORM DRAINAGE F2														
1	15" Class Ill RCP	6,5 00	LF	S23,30	$1,SH .50	00<)	65.00	65.00	S0.00	S1,514 ,50	51,514.50	100•4	S0.00	575.73	
2	1a- c 1as.s lll RCP	300.00	LF	S28,40	S8.520,00	0.00	300.00	300,00	S0,00	5, 8 520.00	S8.52000	100%	S0.00	$426.00	
3	2,r ClassU1 RCP	24,0 00	LF	538 .30	S9,192.00	0.00	240.00	240 ,00	S0.00	5,9 192 .00	S9.192 00	100%	SO 00	545960	
4	so· Class Ill RCP	87000	LF	S52.50	$45,675.00	000	870.00	870.00	S0.00	$45,675 00	$45,675,00	!00%	so 00	52 ,283 .75	
5	35• Class Ill RCP	320.00	LF	S72.10	S23,072.00	0 00	320.00	320.00	S0.00	$23,072.00	$23,07200	100¾	so00	S1.15360	
6	<Z-Class III RCP	475 .00	LF	$90 .65	$4 3, 058.75	0 00	475 .00	475 .00	sooo	543 ,058 .75	$ 4, 3 058 .75	100%	S0.00	52.152.94	
1	Inlet TyPe 1 (HC)	14.00	EA	$,4 150.00	558.100.00	0 00	14.00	14 00	S0.00	55,8 100.00	S5, 8 100,00	100%	sooo	$2 ,905 00	
8	FOOT Man hOlo	4.00	EA	5,3 250.00	S13,000.00	000	4 ,00	4 00	S0.00	513,000 .00	S1, 3 000 00	100%	S000	$650,00	

Tripi• c,.,,CO().V1II,v•  E, Fond G1	APPLICAT ION FOR PAYMENT R1PA & ASSOCl,\JESPRO.JECH01 1701A

PAYAPP FROM TO

9REr
1111117
11/30/17

COtlTRACT SUM TO OATE
	
DESC	
IPTK>NOF WORK			
BASECONTRACT	
ES TIMAl EO OUANnTY	TOTAi.
WORKIN	rot .AL
WORKIN	TOTAL
WORK"J	
P ERCENT	
BALANCE	s..	
ITl;l,I								PLACE	PLACE	PLACE	COMPL.ETE	TO FINISH	RETAINAGE	
NO.	orv		UNI T		TH IS	PREV	rOTAL	THIS	PREV	1 0	TO	ro	TO	
	UNIT	PRICE	VA.W E.	ESTIMATE	ESTIMATE	ESTIMATE	PE«IOD	APPUCAiK>N	DATE	DATE	OA TE	DATE	

B	Dewatering	1 00      LS	511i50000

.$18,50000	000	1,00	1 00	SO.DO	518,500.00	$18.50000	100%	S0.00	S925.00

Televise StOl!TI Sower(CClV)	2,270.00     LF	$6.35

S14,414.50

0.00	2270.00	2270 00	S0,00	$14,414.50	$14,414.f>O	100%	SO00	S720,73

&• UNDERORAIN (FINE AGGREGATE)	480.00    LF	Sll.95

$5,736.00

000	480.00

480.00	S0.00	$5,736,00	S5,736.00	100%	$0.00 	528680

UNDERDRAIN CLEANOUT	5.00 EA	518500

$925.00

0,00	5.00	5.00	S0.00	S925.00	$925 .00	100%	$000	S46.25

TOTALSTORMDRAINAGE F2	$241,707.75	SO.OD	$241,707.75	$241,707.75	100%	$0.00	$12.085.40

ROAD SLEEVE CROSSING F2
1	Z' Scn 40 PVC	90.00     LF	S480

5432.00

0.00	9000	90,00	so00	SA32,00	5432 .00	100%	S0,00	$21,60

2	4" Sch 40 PVC	270.00      LF	S6,15	$1,660.50	0 00	270.00	270.00	so 00	S1.660.50	S1,660.50	100%	S0.00	$83,03
3	6" Scn 40 PI/C	60.00       LS	$8,15	5489.00	0 00	60.00	60.00	SO.DO	$489 .00	S489 .00	100%	$0,00	524.45
TOTALROAD SLEEVECROSSING F2	$2,581.50	$0,00	$2,581.50	$2,581.50	100%	SO.OD	$129 .08

CHANGE ORDER #2 • PHASEF2
1	OPOCredit- FerglJSOn - Water	1 00      LS	(5103.57,0  92)	($1 03,570 92)	0.00	1 00	1.00	50 .00	(S103 .57 0 92)	($103 ,570 92)	100 %	S0.00	(S5.178 55 )
2	DPO C redit ,. FCJ9ll500 - sewer	1.00       LS	(S22.28S.2A)	(S22,285 24)	000	1 00	100	so.oo	($22.285 . 24)	($22.285 24)	iooo/o	S0.00	(51 .11 4 26)
3	DPOCredit- Ferguson- Steeves	1 00     LS	($686 40)	(S686.40)	0,00	1.00	1 00	S0,00	($686.40)	(5686.40)	100'11,	S000	(534.32)
4	OPO Tax 88'Vll1QS	1.00      LS	( S7, 592 .56)	( $7,592 , 56)	000	100	1. 00	S0 .00	($,7 592.56)	($7 ,592 .58)	100%	$0,00	(S379   63)
TOTAl    CHANGE ORDER #2 - PHASE n	jS134,135.12)	SO.OD	($134 ,13 5 .12)	($1 34 .135.12)	100 %	$0 . 00	($6 ,70 6.76)

C HANGE ORDER #3 • PHASE F2 EARTHWORK F2
1	FtllVolume(LongHaulFromBlv,ct ) - Replaces import	7,40000      CY	$2.75	$20.350 00	0.00	7400.00	7400 00	sooo	$20  . 350  .00	520,350.00	100%	SOOD	51,0 17. 50
2	Fttr Volume(long Haut FromBlvd)- Replaces Fill FannE2/E:l	46.SOO 00     CY	S2.75	$127,875.00	0.00	• 6500.00	4650000	SO.DO	$127.875 , 00	5127,875  ,00	'	S0 .00	$6 .393,75
3	lmp()l1edFill	( 7,400.00)      CY	S7.00	($51,800 00)	0 00	-7400.00	-7400.00	S0.00	I551,800.00)	(S51,80000)	100%	so.co	($ 2,590.00)
TOTAL EARTHWORK F2	$96,425.00	SO.OD	$96,425.00	S96.425.00	100"1.	SO.OD	S-4,821.25

GEOTECH NICAL TESTING F2
1	1-2-  Field Tech™clanSo,vlc05	'00	LS	S22,863.60	S22,863.60	0.00	1.00	1.00	S0,00	$22.863.60	S22,863.60	100%	$000	$1,143.18
2	F2• Lat>ralory Testtng	1.00     LS	$3,762.00	53.76,200	0.00	1 00	1.00	S0.00	$3,762.00	S3.762,00	100l',	S0.00	$188.10
3	F2- Enginccnng & P rojectManagement	1.00      LS	52,730 .00		$2,730.00	0,00	1.00	1 00	$0,00		52,730.00		S2,730.00	100%	$0.00		$13650 TOTALGEOTECHNICAL  TESTING F2			$29,355.60				$0.00	$29,355.60	$29, 355.60	100'11,	SO.OD	$1 ,. 67.78

SEEDING& MULCHING F2
1		Seedfng & Mulching	81.460 ,00       SY	$0.25	$20,365.00	0,00	81460.00	81460.00	S000	S20.36.500	$20.36500	 100%	sooo	S1 , 018  . 25 TOTAL•SEEDING  &  MULCHING  F2			$20,365.00				$0.00	$20,365.00	$20,365.00	100%	$0.00	$,1 018.25
TOTAL CHANGE ORDER #3 - PHASEF2	$146.145.60	SD.OD	$146.145.60	S146,145.60	100%	$0.00	$7,307.28 CHANGE ORDER #4- PHASEF2
1	CPOCredit - Rinker - Slorm Pipe	1 00     LS	($63,013,48)	(S63.013 48)	0.00	1.00	1.00	S0,00	1563.013.48)	(563 .013,48)	100%	$000	(SJ.150671
2	DPOT1n5a\/lf'!}S	1 00      LS	(S3,800,81)	(S3,800,81/	0.00	1.00	1 00	S0.00	($3.80081)	(S3.800,81I	100%	$000	(S190.04)

tli,l 'l'I

TritpeCfHkCOO-VWl.age E.Fand G1	APPLICATION FOR PAYMENT

RIPA& ASSOCIATESPROJECT• 0-! 1701A

PAV APP
!="F(O M
TO

9RET
11111/ 7
11/J0/17

ITE M
NO	

0£SC R IPTION Of' WORK	

OTY	CONTRA.C T SUM TO DA TE		
				
SASt; CONT ACT	
ESTIMA TEO OU Afl'.Tff V	TOTAL
WORKIN
P LACE	TOTAl WORK IN P LAC E	TOTAL W O" K IN
PLACE	
PE RCENT
C OMPLETE	
BAl.ANCE
TO FINISH	
S<;.
Er AINAGE	
			UNIT	UNIT
P UCE	
VALUE.	THIS
ES TIMATE.	PR.EV
ESTIMATE	TOTAl
ESTIMATE	TH1S
PE"1OO	PRE V
APP UC ,t\TION	TO
O  TE	TO
DATE	TO
OATE	ro
DATE	
	TOTAL CHANGE ORDER /14- PHASE F2				(S66,814.29 )				S0.00	($66,814.29)	(S6U 14.29)	100•1,,	$0 .00	(SJ,340 .11	
															
	CHANGE ORDER #5 - PHASE F2														
1	OPO Creelit- Atlan,-c TNG - Sewer Str\JCtures	1.00	LS	(S12,430.75)	( S12.130 .75)	0.00	1 00	1 ,0()	S0.00	(S12,4J0 ,75)	($1,2 430.75)	1()0%	SO.OD	($621 .54 )	
2	CPO Cfed it Atlanttc TNG · S1om1 Structures	1.00	LS	($19,141.55	)	($19,141.55	)	0.00	1,00	1.00	SO.OD	($1,9 141 55)	($19,141.55)	100%	SO.OD	(S957 .08)	
3	CPO TaxSavfogs	11)()	LS	(S1,904.33)	{$1,904.33 )	000	1 00	1.00	SO 00	($,1 904 .33)	($ 1 , 900 3)	100%	so 00	($95.22)	
	TOTAL CHA NGE ORDER #5 - PllASEF2				($33,476.63)				SO.DO	(SJJ,476.63)	(S33,476.63)	100%	$0.00	(S1,673.84)	
															
	CHANGE ORDER #6 • PHASE F2														
	CTB DIRECT PURCHASE ORDE.R														
1	OF'O Cre<Slt - SOil Cemetil Base	(2,549 .00)	TN	$16,00	(S40.784 00)	0.00	- 2549.00	·254900	S0,00	(S•0.76<1.00 )	(S40 , 784 00 )	1 00%	S0 .00	(S2 , 039 . 20)	
2	OPO Tax Savings	1.00	LS	(S2,4'7 ,04)	($2,447.04)	0 00	1 00	1.00	sooo	($2,447 . 04)	($,2 44 7.04)	100%	so 00	($122 35)	
	TOTAL CHANGE. ORDER #6 • PHASE F2				($0 ,231.04)				S0.00	($43,231.04)	($43,231.04)	100%	S0.00	($2,161.55)	
															
	TOTAL PHASEF2				$918,922.37				$0,00	$893,31;3.87	S893,3o3.87	97%	$25,558.50	$44,668.21	
															
	PHASE G1														
	GENERAL CO NDITIO NS G1														
1	MobilizalK>n	1 .00	LS	S9.600 .00	$9 ,600 .00	o.oo	1. 00	1 00	S0 ,00	S9.600, 00	$9.60000	100%	S0,00	S480 00	
2	NPDES Compliance	1 00	LS	$,5 250.00	S, S 250,00	0.00	1.00	1.00	SO.OD	SS ,250 ,00	S5 .250 00	100%	sooo	S262 . 50	
3	Malnlenance of Traffic	1.00	LS	51,200.00	Sl ,200.00	0.00	1.00	1,00	50.00	51,20000	s1.20000	100%	$0.00	560.00	
4	Const Slakeoul I Reooro Survey- ByContractof	1 00	LS	546,000.00	S46,000.00	o.oo	1 00	1 .00	S0 ,00	$46 ,000 00	$46, 000 . 00	100 %	so.oo	52.300 . 00	
5	Paym"'11& Perto rmanoe Bond . By Contractor	1 00	LS	S17,000.00	$17,000.00	o.oo	1 .00	1 ,00	S0 .00	$17,000 ,00	S17 . 000 .00	100 %	S O.DO	S850 .00	
6	Silt Fence	6,900.00	LF	51.20	$8,280.00	000	6900,00	6900,00	S0,00	S8.28000	S8,280.00	100%	S0.00	S414.00	
	TOTALGE NERAL CONDITIONS G1				$87, 330. 00				$0.00	S87,330,00	$87,330.00	10D%	SO.OD	S,4 366.5D	
															
	EARTHWORK G1														
1	Cleanog&Grubbing	28.00	AC	S, 2 000 00	55, 6 000.00	0 00	28 00	28.00	S0.00	$56,000 00	S56,000 00	100%	$0,00	52,800,00	
2	DiscSite	24.00	AC	5355.00	$8,520 00	0 00	2, 4 00	24.00	S0.00	S,S 520.00	58,52000	100%	50.00	5426.00	
3	Cul Volume(UnaOjuste<l)	3,5 800 .00	CY	5210	$75,34800	0.00	35880.00	35880.00	S0.00	$75,348.00	$75,348.00	100%	S0,00	53.767 40	
4	SOdding	2, 0 955.00	SY	S2 <5	S51,339 75	0.00	20955.00	20955.00	5000	55, 1339.75	$51,33975	100%	S0.00	S2,!IB699	
5	Seeding& Mufching	B.506 .00	SY	$025	$2,126.50	000	0.00	0.00	5000	S0.00	so 00	0%	S2,126.50	S0.00	
6	Dewatering	1 00	LS	52.00,0 00	S2,000,00	0.00	1.00	,1 00	SO.DO	$2,000 .00	S2 ,000 .00	100%	5000	$10000	
1	F1oa1Grading	1.00	LS	$21,500.00	$21,500.00	0.00	,1 00	1.00	SO.OD	S21,500 ,00	S21 .50000	100%	$0 .00	$1,075.00	
8	Imparted Flit	10 ,400 .00	CY	$7.00	572.800.00	0,00	10400.00	10400,00	sooo	$72 .800 .00	$72 ,800 .00	IOO'll,	so00	$3 ,640.00	
9	Impo rtedFill (0( PadGradiOCJ	5,80000	CY	S7,00	s-10,600.00	0.00	5800.00	5800.00	SO.OD	$4,0 600 00	$40,600 00	100o/,	so.oo	S2 .030 00	
	TOTAL EARTllWORK G1				$330,234. 25				$0.00	$328,107.75	$328,107.75	9991,	$2,126.50	$16,405,39	
															
	PAVING AND BASE G1														
!	1314" S·1Asphalltc Concrele	9,275.00	SY	S925	$85,793.75	000	9275.00	9275.00	$000	585.79375	585.79375	100%	SOOD	$4 ,289.68	
2	6"CrushedConcreteBase	9,275.00	SY	$10.30	$9,5 532.50	o.oo	927500	927500	$0.00	S95,532.50	S95.532,50	100%	SO,O()	$4,776 63	

I

Triple CrN k COO..Vlll1gf E,F a.nd G1	APPLICATION FOR PAYMENT

RIPA&ASSOCIATESPROJECT # 0H 707A

PAVAPI> FROM TO

SRET 11/1/17
11/30/17

CO NTRAC T SUM TO OATE

TOTAL	TOTAL	TOTAL

DESCRIPllONOF WO  I<	BASECONTRACT	ESTIMATEDOUANTI'TY	WORK IN	WOR><;tN	WORK IN	PERCENT	8AlANCE	S'1,
11 M	PLACE=	PLACE.	PLACE	COMPLETE	TO FINISH	llE1AINAGE
NO	OTY	UNrT	TMtS	PREV	TO'iAl	THlS	1'REY	TO	TO	TO	TO
UNIT	PRICE	V.AlUE	lts TIMATE      ESTIMATE	ESTIMAlE	PERIOD	APPLICATION	DATE	OA"'tE	DATE	DATE

3	6"Stab>l e<I Suograde(LBR 40)	9,275 Oil    sv	S6,85

563,533.75	0.00	927, 5 00	9275,00	S0.00	sro.533.75	563.$3.175	100%	$000	$3,11669

Miami Curbw/Slab1lization(Fu ll Depth)	6,960,00       LF	s 11.10	S77,256.00	0 00	696000	6960.00	sooo	577 . 256 . 00	577,25600	100%	S0.00	S3,862-80

6" Wide RibbonCuro	64200      l F	S11.05
l ler>e<IJOfl-ValleyGutter(Cot'11yDoloPTD-6)	140,00     LF	S5090

57,09410	ooa	84200	84200	so.oo	$7 , 094 .10	S7 , 09•U O	100%	S0.00	$      71
S7,126,00	0.00	140,00	140.00	S000	S7,126.00	57,126,00	100¾	S0,00	$356 ,30

7	5'x4· Coocre1e Sldewark	1 ,840,00       LF	$19.50	S'.!5,880.00	0,00	1840.00	184, 000	S0.00	S35,880.00	S35,88000	100%	S0.00	S1.794,00
8	10'x4"Coocrem Sidewalk	58600      LF	S39,05	522,883 30	0.00	seaoo	586  ,00	.$0 ,00	S22.883.30	522,883,30	100%	$000	S1,144.17

10'Wide AspllaU Pavemeol(w/base &subgrade)• Trail	346.00     SY	$25.90
1 0'x   6'   Shell Ma1orial- Trail (wfs,11 Fenceon BoiSide)	72000     LF	S25.50
11	ADA Ramps(5' wide)	1700      EA	$840.00

S8,961.40	0,00	34600	346.00	S, 0 00	S8.96 1.40	S8.961 40	100')4	sooo	$4◄8 ,07
518,360,00	0 00	000	000	sooo	so 00	S0 . 00	0%	S18 , 36-0.00	S0.00
514.280.00	0.00	1100	17 .00	sooo	$14 , 280 .00	S14 .280 . 00	100%	50.00	S714,00

12	ADA Ramps(10' wide)	4 00      EA	S1,200 00	SA,80,0 00	0 00	4.00	4 ,00	S0.00	S4,800 00	S4,800.00	100%	$0 00	S240.00

12" Wide - C<>ncre1<, Bloot< Wall	203 00       LF	$9260

518.797,80

o.oo	20:1.00	20300	S0,00	Sl,S 797.80	Sl8 79790	100%	SO.OD	5939 .89

Signage & S r,tplng

, 1 00      LS	$8.350 .00	S8,350 ,00	0 00	1.00	1 00	so.co	S, B350 00	58.350.00	100%	S000	S41750

TOTALPAVING AND BASE G1	$458,648.60	$0.00	$450,288.60	$450,288.60	96%	$18,360.00	$22,514.44

POTABLEWATER OISTRIBUllON G1
1	4·  PVCPVC C-900	79600      LF	$810	$6.447.60	0.00	796.00	796.00	SO.OD	56,  4 47  60	$,6  447  . 60	100%	so.co 	5322.38
2	6"PVCPipeC-900	1,880.00      LF	$1,0 50	$17,640.00	0.00	1680.00	1680,00	S0.00	517.64000	$17,640.00	100%	S0.00	$882.00

3	fJ' PVCPipec.!JOO

,1 842  00       LF	S14,60	52 6,893.20	0,00	1842.00	184200	S0,00	526,893,20	$2,6893 .20	100%	so.oo	51 ,3-44,66

4	&·Flre Hydran1 AssomblylwrreeFit!lrig Connect10n	1,00     EA	53,70000	$2,5 900,00	0,00	7.00	7.00	S0.00	S25.900,00	525,90000	100%	S0.00	51,29500
s	4..Gale Valve	4 00      EA	S7 15,00	S2 ,860.00	000	4 00	400	sooo	S2 .860 . 00	52 .860 00	100%	so.no	S1 43 .0()
6	G·Gale Valve	11.00    EA	S870,00	5,9 570,00	0 00	11.00	11.00	S0,00	59,570.00	S9,570.00	100%	SO.DO	S478,50
7	8" Ga1eVah1c	13 .00     EA	S400.00	S5,20000	000	13.00	1:100	50.00	$5,200.00	$5.20000	100%	S0.00	S260,00
8	4MBendFtlhngs	12.00       EA	S150.00	$1 ,800.00	0.00	12,00	12,00	$(l.00	$1,800.00	S, J 80,0 00	100%	S0.00	S90.00

9	6' 6eod Fi11111gs	1 6 .00	EA	5)8500

52.960,00	0,00	16.00	16.00	so 00	S2,!l60.00	S2.!l60,00	100%	$0.00	$14800

10	6"Tee Fittings	1,00      EA	S290.00	$29000	0 ,00	1,00	1.00	50.00	$29, 000	$290,00	100%	so.oo	$14 ,50

1 1	t· ,c us$ Fitt,ngs	1 00      EA	S39500	$395.00	0.00	1.00

,100	$0,00	S39S.OO	S395 .00	100%	sooo	51975

12	8"BendF ittings	6.00     E/\	S.?60,00	$1,56000	000	6.00	600	S0.00	$1,56000	$,1 560 00	100%	sooo 	57800
13    B"'Tee Fitt1r""9s	5 .00	EA	5400.00	S2,000 00	0,00	5,00	5.00	St>.oo	52,00000	S2,000,00	100%	SQ_OQ	Sl00 .00
14	8")c6·Reducer	1 00      EA	$235 .00	523500	0.00	1 00	1,00	S0,00	$235.00	S23500	100%	000	511.75
15          810w-0(1A5Semby(Sce C<>uoly Drwy No.  W•6A)	1.0Q     EA	s 1.200 00	$1,200 .00	000	100	1 ,00	S0 ,00	$1,200.00	$1 200.00	100%	so 00	$60,00
16	Single s..,,;ce,Shoo Side	61,00     EA	5240 .00	$1 4,640 ,00	0 00	6,1 00	61 ,00	S0.00	S14,64000	S14.64000	100%	50.00	$73200
17        SingleServl<:e,  Long Side	14,00         EA	$325.00	S4,550,00	o.oo	14,00	14 00	S0.00	$4.550.00	54,550,00	100',i,	so.co	S227 . 50
18	Temporary Construction Me ler	1 00      EA	$9,900 00	$9,90,0  00	0 ,00	1 ,00	1.00	sooo	S9.900 ,00	59 ,900 .00	1 00%	sooo	$ 4 95 .00

19	Chklnna Oon, Sampling & Pressure.Testing	1,00      LS	57,350 .00	$7 ,350 .00

,0 00	1.00	1.00	so .oo	$7;350 ,00	$7, 350.00	100%	sooo	$367 . 50

TOTAL POTABLE WATER DISTRIBUTION G1	S141,390.80	SO.GO	$14,1 390 . 80	$ 1 1. 390 ,80	10 0o/.	S0.00	S?.069.54

SANITARY SEWER G1
1	a· PVC, SOR 26 (0"-10'Cul)	3,584.00       LF	.$15,00	SSJ,760.00

,0 00	358400	358,4 00	S0.00	S53,76000	S63,76000	100'/4	sooo	$,2  688.00

2	San ilary  Manhole(0'·8'Cul)	24 00     EA	S2,400 .00	$57 ,600 .00	0.00	24. 00	2400	SO.OD	$57 ,600 .00	SS7 ,600 .00	100%	sooo	S2,Bao.00
S ano1ary  Manh01e(10'-12'Cul)	200      EA	S3,000 ,00	56 .000 .00	000	2.00	2-00	sooo	56. 000.00	56.000 00	100%	so 00	530000
4	Single 5e<vlce(H,lt.borougn C0"'11y)	16 .00     EA	S59500	S9,520.00	0.00	16.00	1600	S0.00	S9.520 00	$9.52000	100%	SO.CO	,weoo

T  pl,Creek C00.1/illog• E,F "1dGI	APPLICATION FOR PAYMENT Rll'A&ASSOCIATSEPROJ9:T#OT-1 707  A

PA,"1 APP FROM TO

9RcT
11/1117
11130/17

CO NTRA C T SUM TO DA TE

TOTAL	TOlAl	TOTAL

ITEM NO		
QT',	

UNIT	
UNIT PRICE	

VAL.  UE	
THIS
ESTIMATE	
PREV
ESTIMATE	
rorAL
ESTIMATE	PLACE
THIS
PERIOD		PU CE
"RE\/
AF>PUCATIOO	PLACE TO DATE	COMPLETE
TO
DATE	TO FINISH TO DATE	RE:TAtN,t.GE
TO
DATE	
5	DoubleService (Hillsboro<Jgh Goun\y)	33.00	EA	S175 .00	SZS,57500	0,00	33.00	33.00		S0.00	$25,575.00	525,57500	100%	50,00	S1,278,75	
6	e·S lub & Pl	1.00	EA	545000	5450.00	0.00	1.00	100		S0.00	$-1,5000	S450 .00	100%	S0 ,00	522 ,50	
7	Jn fil/Exfil Testmg	1 00	LS	54.900 .00	S4,9<IO.OO	0 .00	1.00	1.00		S0.00	54,900,00	$4.90000	100%	50.00	S245,00	
8	oewa1enng	1.00	LS	534,500,00	S3, 4 500 00	0.00	1(1()	1 00		S0.00	S34,500.00	$34,50000	100%	5000	S, 172500	
9	TeleviseSanitary Sewer (CCTV)	3,584 00	LF	SJ ,05	S1, 0 931.20	0.00	3584,00	3!;64,00		S0.00	$1,0 931;20	S10,931.20	100%	S0 ,00	S546 .56	
	TOTALSANITARY SEWER G1				S203,236.20					S0.00	$ 203,236.20	$203,236 .20	100%	$0.00	$10,161 ,81	
																
	STORM DRAINAGEG1															
1	15" Class III RCP	179 00	LF	$2330	$, 4170.70	o.oo	179 . 00	179 .00		5000	S4170,70	$4,17070	JOO%	$,0 00	5208 ,54	
2	18" ClassIll RCP	427,00	LF	S28.40	S12,126.80	000	427.00	427 00		S0,00	S,,2 126 80	512,126 80	100%	S0.00	S606,34	
J	24" Class Ill RCP	1,0Z4,00	LF	S38.30	539,219.20	0.00	1024.00	1024.00		S0.00	539,219.20	539,219.20	100%	5000	51,960.96	
4	JO'" Class Ill RCP	71400	LF	S52.50	537,485,00	0 ,00	714.00	71, 4 00	so.oo	$37,48500	S37,48500	100%	S0.00	51.8N25	
5	36"Class III RCP	33 ,00	lF	S72 10	S2.379.30	0,00	33,00	33,00	S0,00	$2,379.30	$2.379.30	100'1,	S, 0 00	S118.97	
6	Inlet T)'P61 (HC)	16,00	EA	54 ,150.00	$66,40000	000	1600	16.00	S000	s&G.400 ,00	566.400 .00	100%	S000	SU 20.00	
7	FOOT Type-C lnlel	100	EA	S,1 900 00	S1,900, 00	000	1.00	,1 00	$0 ,00	$1,900 00	S1,900 00	100%	50.00	S95.00	
8	FOOT Type- E Inlet	200	EA	S2 ,550.00	55, 100 00	000	2,00	2.00	$0,00	S5.100.00	S5.100.00	100%	$,0 00	5255.00	
9	ConlOI SlnJc1u,c(FOOT MO<Jjf,ed Type"D" lnlel)	2 .00	EA	53,500.00	$7,000.00	000	200	200	S0,00	57,000.00	7.000.00	100 %	S0 ,00	$35000	
10	FOOTMant'\Ole	4.00	EA	5,3 250.00	$13,000.00	0,00	4.00	4.00	$000	S13,00.00	513,00000	100%	S0.00	S650.00	
11	30" FES	5.00	EA	S2,300.00	51, 1 500 00	0,00	5.00	5 ,00	SO.O<l	511 .500 00	$1 1 ,500.00	100%	S0.00	557500	
12 36" FDOTFES	1.00	EA	$2,750.00	$2,750.00	0.00	1.00	1 00	S0,00	52.750.00	52,750.00	100%	S0.00	S!3750	
13	Dewaleiing	1.00	LS	$27,500.00	$27.500.00	0.00	1 00	100	S0.00	$27,500 00	$27,500,00	100%	S000	S1,37.500	
14 Tele.viI.6Stonn Sewer (CCTV)	2 ,377.00	LF	S6.35	S1, 5093.95	000	237700	2377,00	$,0 00	515.09'3.95	$1,5 093.95	100%	S0.00	$75410	
15	FOOT Mao hOle	1 ,00	EA	$3,250.00	53,250.00	0.00	1.00	100	$0.00	53,250.00	53,250.00	100%	so.oo	S1 62 .50	
16	6"  UNDERDRAIN( FINEAGGREGATE)	940.00	LF	$11 95	$11,233.00	000	940.00	940.00	S0.00	S11,233 00	S11,233.00	100%	S0.00	S561.65	
17	UNDERORAINCLEANOUT	11 00	EA	5185.00	$2,035.00	0 00	11.00	1100	S0.00	52.03500	$2,035.00	100%	S0.00	S101 75	
TOTAL STORM DRAINAGE G1				S262,142.95				$0.00	$262,142.95	$262,142.95	1009/4	$0.00	$13,107.16	
														
ROAD SLEEVE CROSSI NG G1														
1	2" Sc:n40 PVC	150.00	lF	$,4 80	$720.00	0.00	150.00	150.00	S0,00	5720.00	$720,00	TOQ%	50 .00	53600	
2	4"SCh40 PVC	300.00	LF	S615	51,84500	0.00	30000	300.00	S0.00	$1,845 .00	SJ ,845 00	100%	so.oo	$92;25	
3	6"SCh40PVC	60.00	LF	$8.15	5489.00	000	60,00	6000	5000	$489.00	548900	100%	50.00	524,45	
TOTAL RO AD SLEEVE CROSSING G1				SJ,054.00				S0.00	SJ,OSUO	SJ,OSU O	100%	SQ.00	$152. 70	
														
CHANGE ORDER 111• PHASE G1														
1	OPO Cre<1,1• Ferguso,, - Wa1er	1,00	LS	(S70.07916)	(S70,079. 16)	0.00	1.00	'00	$0,00	(570.079,16)	(570,07916)	100%	S0.00	($3,503.96)	
2	OPO Credil- Ferguson- sewer	1.00	LS	(546,522. )	(S46.522. I	0 00	1 00	1.00	$0.00	(S4M22.35)	(546,522.35)	100%	S0.00	($2,326.12)	
3	DPOCredit . Fel'gUSOfl - Sleeves	1 00	LS	(S153 ,<0)	(5753.40)	0.00	1 00	1.00	150.00	15753.40)	(S753,40)	100%	S0.00	(S37 67)	
4	DPO TIJltSav<ngs	1,00	LS	($7.041,29)	(S, 7 0412 9)	000	1 00	100	S0 .00	(57,041.29)	(57.041.29)	,ooi	so 00	(sa5 2. 06)	
TOTAL CHANGE ORDER #2· PHASEG1				(S124.396.20)				50.00	(S124,396.20)	(S124.396,20)	100%	so.oo	($6,21 9.81)	
														
CH ANGE ORDER #3 • PHASE G1														

DESCRIPTIONOFWOO!<.	BASE CONTRACT	ES TIMATEOQUANTITY	WORK IN	V/ORKIN	WORKIN	PERCENT	8.ALANCE.	s-.

ltt,I-,.,

TripleCree k COO.Vllllgt!E.F andG1	APPLICATION FOR PAYMENT RIPA&ASSOCIAT£SPROJEC1"  011707A

PAV APP FROM TO

9RET
1111117
11130/17

ITEM
NO	

DESCRIPTION OFWOR1o1.	

QT'r'	CONTRACTSUM TODATE		
				
SASE CONTRACT	
ES TIMATED QUANTITY	TOTAL
WORK IN
Pl.ACE	TOTAL
WORt(fN
PLACE	TOTAL WORK IN
PLACE	
P ERCENT
COMPLETE	
BALANCE
TOFIN1$H	
5%
RETAINAGE	
			
UNIT	UNIT
PRiCE	
VALUE	THIS
ESTIMATE	PREV ESTIMATE	TOTAL
ESTIMATE	THIS PERICO	PREV
APPUCATION	TO
DATE	TO
DATE	TO
DATE	TO
OATE	
	EARTHWORK G1														
1	Fm  Volume(LOr,g Haul Ftom Blvd. )• Replaceslmpon	16 ,200 .00	CY	$2.75	!,U .550.00	000	1620000	16200,00	S0.00	544,55000	$44.55000	100%	SO.DO	$2,227.50	
2	Imported Flli	(16.20000)	CY	S7,00	{S11J,400.00)	000	16200 00	16200 00	so.oo	(5113,400     .00)	($113 , 4 00 .00)	100 %	so.oo	{$5.670 00)	
	TOTAL EARTHWORK G1				($&8,850.00)				S0.00	($68 ,850 .00 )	(S68 ,850 .00)	100 %	$0.00	($3,442.50)	
															
	GEOTECHNICAL TESTING G1														
1	Gi  • F1elO TechnicianServ.ees	1 00	LS	521,952.80	521.952 80	0.00	1 00	1 00	sooo	S21.952 .80	$2 1 ,952 80	100%	S0,00	Sl.097 64	
2	Gl 4      LabratoryTesbng	1 00	LS	$,3 624.00	$3,624.00	000	1 00	1.00	sooo	$3,624 .00	$3,62 4 00	100%	S0.00	S181.20	
3	G1 • Eng1neenng & Pro)ecl Managemen 1	1 00	LS	$, 2 340.00	$2,340 00	O.OQ	1 .00	1 00	S0 .00	52 ,34 0.00	S2.340 00	100%	so 00	$117_00	
	TOTAL GEOTECHNICAL TESTING G1				$27,916 ,80				SO. DO	S27 ,91M O	$27,916.80	100%	SO.DO	$1,395 .84	
															
	Seeding & Mulchrng G1														
1	Seeding & Mulo lng	90,915.00	SY	50.25	522,728.75	0.00	90915.00	9091,5 00	S0.00	$22.728.75	522,728.75	100%	50.00	Sl ,136.44	
	TOTAL·SEEDI NG & MULCHING G1				$22.728.75				$0,00	$22,728.75	$22,728.75	100 -1.	$0,00	$,1 136.44	
															
	TOTAL CHANGE ORDER #J • PHASE G1				(S18,204.45)				SO.DO	($18 ,204 ,45)	(S18 ,204.45)	100 ¾	$0 .00	(S910.22)	
															
	CHANGE ORDER #4 • PHASEG1														
1	CPOCredit- Rinker - S1onnPtpe	1 00	LS	(S59,165.57)	($59,165.57)	000	1 00	1.00	S0.00	(S59.165,57)	($59.165.57)	100%	so 00	(52,958.28)	
2	0PO Tax Savings	1.00	LS	(53,559.94)	($3,559.94)	0.00	1.00	1 00	S0.00	($3.559,94)	(53.559.94)	100%	$0,00	(5178.00)	
	TOTAL CHA NGE ORDER lt4 • PHASEG1				(S62,725. 51)				$0.00	(S62,72S.51	)	(S6, 212s.s1l	100',',	SO.OD	(S3,136.28)	
															
	CHANGE ORDER #5 • PHASEG1														
1	OPO Credll- Altant!cTNG · Sewe,Structures	1 .00	LS	($20,720.45)	(52,0 720.45)	000	100	1.00	S0.00	(S2,0 720 45)	(52,0 720.45)	100%	50.00	(S1.036.02)	
2	DPO Credit. Allaotlc TNG• Storm Slrucrures	1 00	LS	($28.630 .15)	(528.630 .15)	0.00	1.00	1 00	S0.00	(528 ,630 .15)	(528,630 .15)	100%	SO.DO	($ 1 , 431 .5 1 )	
3	D P O Tax Sav,ngs	100	LS	($2,991.04)	(52.991 04)	0.00	1 00	1.00	so.oo	(52,99 1. 04)	{52.991 04)	100%	sooo	($ 149.55)	
	TOTAL CHANGE ORDER #5 • PHASE G1				($52,341.64)				$0.00	($52,341.64)	($52,341.64)	100%	SO.OD	(S2 ,617 .08)	
															
	CH ANGE ORDER #6· PHASEG1														
	CTB DIRECT PURCHASE ORDER														
1	DPO Credll · SOIiCe m<11I Base	(3.571.00)	TN	S16.00	($57,136.00)	0.00	·3571.00	•3571.00	50,00	($57,136.00)	(557,13600)	100¾	50.00	(52.85680)	
2	DPOTax Savtngs	1.00	LS	($3,428,16)	(S3,428.16)	0.00	1.00	1.00	S0,00	($3,428. 16)	(S3.428.16)	100%	50,00	($171,41 )	
	TOTALCHANGE ORDER #6· PHASE G1				(S&0.564.16)				so.oo	($60 ,564 .16)	(S60,564,16)	100¾	SD. OD	($3 ,028.21 J	
															
	TOTAL PHASE G1				$1,177,804.84				$0.00	$1,157,318.34	SI ,157.318.34	98o/,	$20,486.50	$57.865.94	
															
	PHASE E2/E3														
	GENERAL CONDITIONS E2/E3														
1	Moblllzallon	1 00	LS	56,400.00	$6 ,400,00	0.00	1.00	1.00	sooo	5 6,400 ,00	S6.40000	100%	SO 00	S320 .00	
2	NPOES P ennit a Compliance	I 00	LS	55,30000	SS,300.00	000	1,00	,1 00	S0.00	55,300.00	S5.300 00	100%	SO.DO	526500	
3	Marntenanceor name	100	LS	$86000	$86000	000	100	1,00	S0.00	$860,00	$860.00	100%	50.00	S43.00	

4\ «I .'"

ITEM NO	

DESCRIPT ION Of WORI(	

orv	CON fRAC T SUM TO DAl'E-.		
				
BASE.CO N TRA.CT	
EST II\AATEO OUAN TITY	TOTAL
WOR)(IN
CL.ACE	rO TAL WORK IN
PLACE-	TOTA L WoR,IN PLACE"	
P RCENT COM PLETE	
BALANCE
TO F•N t5H	
5'j,
.REfAJN AGE	
			UNIT	UNIT
PRICE	VALUE	nos
EST IMATE	PREV
ES TIMA TE	TOTAL
ESTIMATE	rMIS
PERIOD	PRE\'
APPLICATION	TO
DATE	TO
DATE	TO
OAlE	TO
OAtE	
•	Const StakeoutI Record Survey..ByContracior	1.00	LS	$39,500 l1	0	S39,500. 0	D	0.00	1 OD	1 .00	SO.OD	S39 . 500 . 00	539 ,500 00	100%	SO.OD	$1 ,975 .00	
5	Payment & Pcfformance8ond - avContractor	1 OD	LS	S,8 250 .00	s8 2sooo	0 . 00	1 .00	100	SO.OD	$8 ,250 .00	S8,25000	100 '11,	$000	$41250	
	TOT'IL GENERAL CONDmONS E2/E3				$6, 0310.0	0			SO.OD	$6,0 310.00	$60 , 310 ,DO	100 ¾	S0.00	$3 ,015 .50	
															
	EARTHWORK E2/E3														
1	Clearing & Grubbing	2500	AC	54,100 00	S102.500 0D	0.00	25.00	25,00	SO.OD	$ 102,500 00	$102, 500 . 00	1 00¾	5000	S5.12500	
2	c,nVolume(UnMjusted)	22, 700000	CY	so 70	5158.900.00	000	22700000	'227000,00	S0,00	5158.900,00	S158,900 00	100%	$0,00	$,7 945.00	
3	SOdding	u ,000,00	SY	S2-4	5	S115,150,00	000	7000.00	47000,00	S0 ,00	$115 ,150 ,00	$115 ,150.00	100%	SO.OD	$5 ,757 SO	
4	-Seeding& Mulching	25,000,00	SY	so 25	S6.25000	0.00	2500000	25000.00	SO.DO	S G,250.00	$6,250 00	100%	SO.OD	$3 1 2.50	
5	Silt Fence	,5 350.00	LF	$ 1.20	$6.42,0 00	0 00	535000	5350.00	SO.OD	S6.420 00	56.420.00	100%	SOOD	"2 1 .00	
6	TroeBamcades	40000	LF	S3.35	S1,340,00	000	400,00	400 00	SOOD	$1 ,340 ,00	Sl .340 00	100%	SO.OD	S67 ,00	
7	O ewalerlng(For all aspec1s orprojecl J	1,00	LS	S110.000 00	S110,000.00	000	100	1 00	SO.DO	5110 .000 00	s 11 0.000 00	1 00%	SOOD	$5,500 .00	
8	Final Grartl'ng	I 00	LS	S8.65, 0 00	$8,650 00	000	1. 00	1.00	SOOD	se .650 .oo	se ,650 .00	1 00%	SO.OD	S432 .50	
	T OT ALEARTHWORK E2/E3				S509.210.00				S0.00	$509,210.00	$ 509,210.00	100¾	S0.00	$2, 5 460.50	
															
	STORM ORAIN'IGE E2/E3														
1	15• Clas$ill RCP	203.00	LF	S23.30	54.72990	0,00	203.00	203,00	SO.OD	5,4 729 . 90	S4 ,729 90	100%	$000	5236.50	
2	1e· Class Ill RCP	1.647 00	LF	528 .40	S461TTd.8	0	0.00	1647.00	164 7.00	SO.OD	546, 774 . 80	$46 , 774 80	100%	SO.OD	S 2. 338 .74	
3	2 4" Cla,;s Ill RC P	394 .00	LF	$38.30	$15.090,20	0 00	394.00	394.00	S0,00	$15.090.20	$15,090 20	100%	SO.OD	S7 54 5 1	
4	30 C lass IHRC P	468 ,00	LF	$52.50	S24,570 00	0 00	468.00	468.00	SO.OD	S24 .570 00	$2 4,5 7 0.00	100%	SO.OD	S l , 228 50	
5	38" Clas s Ill RCP	5700	LF	$7, 210	54,109.7	0	0.00	57,00	57,00	SO.OD	5 4.109.70	$4 ,109 ,70	1 00%	SO .QI)	S 20 5 d 9	
6	60" Class Ill RCP	158.00	LF	S17500	527,650 00	0.00	158.00	15800	$000	$27,650.00	$2,7 65000	100%	SO.OD	Sl ,382 .50	
7	H lllsbo rougn co . Type1 Curb lnlel	13 00	EA	$3,600.00	$46,800.00	0.00	13.00	1300	so,oo	$ 46,800 .00	$ 46,800 00	100 %	so.co	S2 .340 .00	
8	Odr.hBottom Inlet. TyPeE	1 00	EA	52,550.00	S2,55000	0.00	1.00	1.00	SO.OD	S2,550.00	S2,550,00	100%	SO.DO	$ 1 27 ,50	
9	conir ot s1ruc1ure (F OOTModified Type· o· Inlet)	1 00	EA	53.50000	53,500.00	0.00	1.00	1.00	S, 000	$3,50000	S3.500 DO	100¾	SO.DO	5 17 5 00	
10	15" FOO T FES	3.00	EA	$1,500,00	$4,500.00	000	3.00	3.00	SO.OD	$4,50000	54,500,00	100•,4	$,0 00	5225 .00	
11	111" FDOT FES	900	EA	$1,650.00	S14,850,00	000	00	9.00	S0,00	S14,850.00	S14,85, 000	100%	SO.OD	S7 42 SO	
12	24" FDOTFES	3,00	EA	$1 ,750.00	$5.25000	0.00	3.00	3.00	SO.OD	S5 , 250 . 00	55 ,250 00	100%	so.oo	526 2.50	
13	30" FDOT FES	4 00	El\	$2,300 00	$9. 200 00	0 00	4,00	4.00	SO.OD	$,9 200.00	59 20 0.00	100o/o	SO .OD	5460 . 0 0	
1 4	36"FDOTFES	I.OD	EA	S2.7S0.00	S2,750 .00	D00	l.00	I DO	SOOO	$2 ,750 .00	$2,750 .00	100%	so 00	513750	
15	60"FDOT FES	1 00	EA	S5. 700 00	55 700.00	000	1 ,00	I 00	SO.DO	S 5.700 00	S,5 7 0,0 00	1 00%	SO.DO	S28500	
16	Mit!gaoon Area Pianl1ng	1 00	LS	$7,100.00	$7,100 00	000	100	1 OD	SD.00	$7 ,100 .00	$ 7,100 .00	100%	S0 ,00	$3 55 .00	
17	Tete"'5eStorm Sewer (CCTV!	2,927 00	LF	S,6 35	S18.586 45	0,00	2927.00	2927.00	SO.OD	$18,586 . 45	$18 ,586 4 5	100%	SOOD	$929.32	
18	FO OT M anhole	1.00	EA	S3.25000	S3,250.00	0,00	1.00	100	50.00	$3.250.00	53,250,00	100%	SO.DO	S162 .50	
1 9	ControlSlrucioreWetr Wall	1 00	EA	se. 400.00	$8.400.00	000	1 00	1,00	so00	$8,400.00	S8,400.00	100¾	SO.OD	$ 4 20 .00	
	TOTAL STORM OR'I INAGEE2/E3				$;1.55,361 .05				SO.OD	S255.361 ,05	$255 ,361.05	100%	S0.00	$12,768.0$	
															
	E2/E3ALTERN'ITEADD														
1	Cleanng & Grubbing	41.00	AC	$2,90000	5118.900.00	o.oo	., 00	41 .00	SO.OD	$118.900 ,00	$ 118 ,900 00	100%	SO. DO	55.94500	
2	Place& Compact EJi:cavatedMa1el1at	180,500.00	CY	Sl. 40	5252.700.00	0.00	180500,00	1805()0 00	SO.OD	$ 252,700 .00	S252 .700 00	100%	SO.OD	Sl2,63500	
3	S1ockplleOff.Phase (wolh1n 1.000 Feel)(adjusled)	46,50000	CY	ST.SO	569 ,750 .00	0.00	46500 .00	46500 00	S O.OD	$69 ,750 .00	S6,9 750 OD	100%	SD. DO	S3,487 SO	

Tripl, Creek COD•Vlll190E,FI/Id GI	APPLICATION FORP I\YMENT RIPA&ASSOCIME SP RO.IECH  OI  170 7A

PAY APP
FROM TO

9RET
tl lf/17
11130/17

Triple C,eell.CO-O Vif\ageE. Farid G1	APPLICATION FOR PAYMENT

RIPA &A SSOCIAIES PROJECT # 01-1701A

PAY APP FROM TO

9AET
1111171
11/30/17

ITEM NO	

DESCRIPTION OF WORK	

OTV	CONTRACT SUM TO DA TE		
				
BASE CO NTRACT	
EST IMATED QU ANTITY	TOTAL WOF\K IN
PlA CE	TOTAL
WORKIN PLACE	TOTAL WORK1N PLACE	
P ERCENT COMPLETE	
BALANCE
TO FINISH	
5%
R ETAINAGE	
			
UNIT	UN!T
PRICE	
VALUE	THIS
ESTIMATE	PREV
ESTIMATE	TOTAL
ESTIMATE	THIS
PERtOO	REV
APPLICATION	TO
CATE	TO
DATE	TO
OAi E	m
DATE	
4	Sodding	,4 000.00	SY	S2 45	S9,800.00	0,00	4000,00	4000.00	S0.00	
$9,800 00	
S9,800,00	
100%	sooo	
5490 ,00	
5	Seeding& Mulr.hlng(Addihonal)	1!)8. 50000	SY	$0.2	5	549,625.0	0	0.00	198500,00	19850000	S0,00	549,625.00	
S49,625 00	
100%	so00	
$2,481.25	
	TOTAL E2/EJ ALTERNATEADD				ssoo.n,os	o			S0. 00	$500 ,77 5.00	$500,775 .00	100%	$0.00	
S2S.OJ8.75	
															
	CHANGE ORDER #3 - PHASE E2/ES														
1	Geot?t;ll Cm>dillons E2/E3	(1 00	) LS	$52,060.00	($52.060.00)	0.00	1100)	(1 00)	so 00	(S52,060.00)	(S52.06000)	100%	
S0.00	
(52,603.00)	
2	Earthwoll< E2/E3	(100	) LS	5501.450,00	1$501,450 00)	0 00	(1.00	)	(1.00)	so 00	(5501.450,00)	($501,45000)	
100%	
S0.00	
1525.072.50)	
3
•	S nnOrillnago E2/E3	(1,00)	LS	5255.361,05	($255,361,05)	000	(1.00)	(1 00)	S000	($255,36105)	($255.361,05)	100%	
S0.00	
($1,2 768.05)	
	E2/E3 Altemale Add	(1,00)	LS	$500,775.00	(S500.775,00)	000	( 1,00)	1, 100)	S0,00	(S500.775.00)	($500,775 00)	100'.4	S0.00	
(S25,038.75)	
	TOTALCHANGEORDER #3 • PHASEE2/E3				($1,309,646.05	)			S0.00	(S1.309,646,05)	(S1,309,646.05)	100%	$0.00	(S65,48UO)	
															
	TOTALPHASE E2/EJ				$16,010.00				$0.00	$16,010.00	$16,010.00	100%	SO.OD	$800 .51	
															
	CONTRACT SUMMARY														
1	GENERAL CONDITIONSE1				S89.000.00				S000	S89.000.00	S89.000 00	100%	so,oo	
54 . 450 .00	
2	EARTHWORK El				$23,2 233.85				S0.00	$232.233.85	$232.233.85	100%	S0,00	$11,611 70	
:I	BASE ANO PAVING El				S922.377.30				S0.00	$922.377 30	$922.377 30	100%	S0,00	$46,118,88	
4	POTABLE WATER OISTRIBUTION E1				$186,438.00				S0,00	5186.438.00	$186,438.00	100%	S0.00	$9,321,90	
5	SANITARY SEWER E1				S650,32935				S0.00	S650,329,35	$650,329.35	100%	so 00	S.32, 516.47	
6	STORMDRAll"AGEEl				S259.190.35				S0.00	S259,190.35	$259,190 35	100%	so 00	S12.959.52	
7	ROAD SLEEVE CROSSING E 1				S2,93300				S0.00	$2,933.00	S2.933.00	100o/o	S0. 00	S1<6 ,65	
C0/12	C>iANGE ORDER #2 - PHASE El				(S138,231.05)				S0.00	($138,231.05)	($138,231.05)	100%	$000	(S6,911-55	
CO<r.l	CHANGE ORDER #3 • PHASE E1				525,458.00				S0.00	$25,458.00	$2,5 458.00	100%	S0.00	Sl .272.90	
C0#4	CHANGE ORDER /14• PH ASE   El				(540,984 63)				S0.00	(S40,984 63)	($40.984 83)	100%	S0.00	($,2 049.24)	
COR5	CHANGE ORDER #5 - PHASE E1				($69,704 47)				so 00	(S69,704.4n	(S69.70447)	100%	so.oo	($3 , 485 . 23)	
C0#6	CtlANGEORDER #6• PH,\SE El				$17,00568				so 00	S17.865 68	$17,86568	100%	sooo	S893 . 28	
	TOTAL PHASE E1				$2,136,905.18				SD.OD	$2 ,136 ,905 . 18	$2, 1 36.905. 18	100%	S0.00	S106.845.28	
															
8	GENERALCONDITIONS Fl				S890, 05.60				S0,00	S8, 6 455,60	$116.45560	97%	52.550.00	S4.322.78	
9	EAR THWORK F1				5429.256.00				sooo	S414.264 38	$414,264.38	97%	S14,991.63	$20,713.22	
10
,,	PAVING ANOBASE F1				$482,995 95				S0,00	5d76.190 95	$476.190.95	99%	S6.805 00	$23,809.56	
	POT,'.BLE WATER DISTRIBUTION Fl				S95,685.00				S0,00	587.575,75	S87.57575	92%	$8,109.25	54.378,80	
12	S ANITAR Y SEW ER F1				5141,336.85				sooo	$130 , 373 ,05	S130.37305	92%	S10,963.80	5,6 518 65	
13	STORMDRAINAGE Fl				$283.547 BO				sooo	$244 . 136 ,80	S244 . 136.80	86%	S39.411.00	512.206.86	
14	ROI\D SLEEVE CROSSING F1				S1.414.50				sooo	5 1 ,4 14 ,50	$1 , 414 .SO	1	S0.00	570.73	
C0/16	CHANGE ORDER #6• PHASE F1				($3,7 244.161				SO.DO	($37.244 . 16)	(S37.244 16)	100%	$000	(S1,86221)	
C0#7	CHANGE ORDER #7• PHASE F1				15164.095.83)				so 00	($164,095.83)	(S164,095.83)	100%	S0.00	ISB.204.80)	
	TOTAL PHASE F1				$, 1 485,997.54				$0.00	$1,403,166.87	$1,403.166.87	94•;.	$82,830.611	$70,158.39	
															
15	GENERAL CONDITIONS F2				$64,299.20				S0.00	564.299.20	S6".299.20	100%	so 00	S3, 2M . 96	
16	EARTHWORK F2				$153,238.00				$0 ,00	$151,522.00	S151.522.00	99%	Sl ,716 00	S7,57610	

)

11 ..t:,1

TrpileCretkCOO.Village E, F i nd<;;1	APPLICATION FOR PAYMENT

RIPA &ASSOCIATES PROJECT #Ol , 170 7A

DAY APP
FROM TO

!JAET
1111/17
111:l0/17

IIE',I NO,	

DESCRIPTION OFWOR•	

QTY	CONtRACT-SUMTO DATE		
				
BASE CONTRACT	
fSTIMATEO OUAunrv	TOTAL
WO KIN
P L.I\CE	TOTAL
WO«KIN
PLACE	TOTAL. WORK IN PU\CE	
PERCENT
COMPLETE	
BALANCE
roFINISH	
5%
RETAlNAGC	
			UNIT	Ut41T
PRICE	
VI.LUE	Tt·llS
ESTIMATE	P EV
ESTl'1AATE	TOTAL
ESTIMATE.	THI S
PERIOD	P REY
APPLICATION	TO
DA.TE	TO
DATE	TO
DATE	ro
DATE	
17	PAVING ANOBASE F2				S324,656.65				S0.00	5300,814.15	S300,81415	
93%	S23.8"2.50	$15,040 71	
18	POTABLE WATER DISTRIBUTION F2				$ 114,603 80				$0.00	S1H ,603.80	S114,603 80	100%	S0.00	$5.730.19	
19	SANITARYSEWER F2				S149,346.95				S0.00	S149,346.95	$149.346.95	100%	SO.DO	S7.467 35	
20	STORM DRAINAGE F2				S24 1 ,707 .75				S0.00	$241 ,707 75	S241.707 75	100%	sooo	S1 2 ,085 .4 0	
21	RO ADSLEEVECROSSING F2				$2.581.50				S0.00	52.581,50	$2,581 50	100%	S0.00	$129.08	
C0#2	C!-JANGE ORDER #2 • PHASE F2				($ 134. 135 .12)				S0 ,00	($134 ,13,5 12)	($134.135 .12)	100%	S0.00	(S6,70676)	
C0#3	CHANGE ORDER #3 • P HASE F2				S146 .145 ,60				S0.00	$1 4, 6 145 .60	$1 46,145 .60	0%	S0 .00	$,7 307.28	
C0 #4	CHANGE ORDER #4 • PHASE F2				(S66.814 .29)				50 .00	(566 ,8 14 29)	($6,6 814.29)	100%	S0.00	($3,34071)	
C0 #5	CHANGE ORDER 5 • P HASE F2				(S33. 476.63)				S0 .00	(S33. 476.63)	(533,476 .63)	100¾	S000	(S1,673 84)	
C0#6	CHANGE ORDER #6 • PHASE F2				(54,3 231.04 )				$0.00	(S43,231 .04)	($43,231 04)	100%	so.oo	(S 2,161 .55)	
	TOTAL PHASE F2				$918,922.37				$0.00	$893,363.87	$893,363.87	97%	$25,SSB.50	$44,GU .21	
															
22	GE NERAL CONDITIONS G1				$87,33,0 00				S0 00	SB7,330.00	SB7,330.00	100%	S000	5, 4366.50	
23	EARTHWORK G1				5330 ,234 .25				sooo	S328, 1 07 .75	$328 . 107 , 75	99%	S2.126 .50	S1,6 A05.39	
24	P AVINGANO BASE G1				5468,648.60				so.oo	S450,288.60	5450.288.60	96%	S18.360 00	S22.514 44	
25	POT ASLE WATERDISTRIBU TION G 1				5141.390 .80				S0 ,00	$1 41,390 .80	S141 390 80	100%	S000	57,069.54	
26	SANITARYS EWERG1				$203,236 20				S,0 00	S203,236.20	$203,236.20	100%	S0.00	$10,161 81	
27	STORMDRAINAGE G1				5262,142.95				S0.00	$262.142.95	5262.142.95	100%	so.oo	S13. 1 07 . 16	
28	RO AD SLEEVE CROSSING G1				$3 ,054.00				$,0 00	S3.0 54 00	$3.054 .00	100%	S0 ,00	S 152.70	
C0 #2	CHA NGE OR DER #2 • PHASE GT				($124.39,6 20)				S0.00	(S124.396 .20 )	($ 124,396 20)	1D0%	S000	(S6.21.981)	
C0#3	CHANGE ORDER #3 • PHASE G 1				(518,204.45)				S0.00	($18,204 45)	(S18.204 45)	100%	$000	($910.22)	
CQf/,0	CHANGEOR DER #4 • PHASE G1				(562, 725 51)				S0.00	(S62,725,51)	(562,725 51)	100%	so.oo	(53 .136 . 28)	
C0/15	CHANGE ORDER #5 - PHASE G1				(552.34164)				S0.00	(5£?,341,64)	(S52.341 64)	100%	$0,00	/62.617.08)	
C0#6	CHANGE ORDER #6 · P HASE G 1				($60, 564.16)				S0.00	(S60.564.16)	($60.5&0 16)	100%	$,0 00	(S3,028.21)	
	TOTAL PHASE G1				$1,177,804.84				S0.00	S-1,157 ,318 ,34	$1 ,157 ,318 .34	98%	$2, 0 486. 50	$57,865.94	
															
29	GENERAL COND ITIO NS E2/E3				S60,310.00				S0.00	$6, 03 10.00	560,310.00	100%	S000	S, J015.50	
30	EARTHWORK E 2/E3				S509,210.00				50.00	5509.21000	5509,210,00	100%	S0.00	S25,460.50	
31	STORMDRAINAGE E21E3				5255.361 05				S0,00	$255,361 05	S255,361.05	100%	SO.OU	512+168.06	
32	E2IE3 ALTERNATE ADD				SS00,775.00				S000	SS00.77.500	SS00,77500	100%	S0,00	525,03875	
C0#3	CHANGE O RDER # 3 • PHASE E21EJ				($1,309,646 05)				50.00	($,1 309,646 05)	(S1,309,64, 6 05)	100%	S0.00	(S65,482.30)	
	TOTAL PHASE E2/E3				$16,010.00				$0,00	$ 16,010 .00	$16,0 10.00	100 %	S0.00	$800 .51	
															
	TOTAL ALL SCHEDULES				$5,653,592.02				$0.00	$5,524,716.34	SS,524,716,34	98%	$128,875.68	$27, 6 235.93	
															
	ORIGINAL CONTRACT VALUE														
	PHASE El				$2.342.501,85				sooo	$2 ,342.50 1 .85	S, 2 342 ,50 1 ,85	100 %	so.oo	S117 . 1 2 5 12	
	PH A SE F 1				Sl . 523 . 2 41 70				S0 ,00	S1 . 44 0.411 ,03	S1 , 4 40 . 411. 03	95'4	$82.830 68	S72.020.60	
	PHASE F2				$1,050,43385				S0.00	51,02, 48 75.35	S1,024,875,35	98%	$25.558.50	$51,243.79	
	PHASEGI				S1,496.036.80				S0.00	St 1475.5S0.30	S l ,475.550.30	99%	S20.486.50	$73,777.54	
	PHASE.E2/E3				Sl,325,656.05				sooo	$1, 325,656 .05	$ 1,325 .656 .05	100%	SO.DO	566,282 .81	

TripleCreek CO-OVillfil l E, f and G1	APPLIC A TION FOR PAYMENT

ITE 1
NO	

OESCRIPTION Of  WOR11:.	

OTY	CONTRACT SUM TO DATE		
				
BASE CONTRACT	
E STIMATED QU ANTITY	TOTAL
WO RK IN
PLACE	TOTAl WO RK IN PLACE	TOTAL WOR   JN
PLACE	
P ER C E NT
COMPLEl E	
BALANCE:
I O F"lNI S H	
s •
RIT.AINAGE	
			
UNIT	UNIT
PRICE	
VA.LU E	THIS
ESTIMATE	PRCV
ES TIMATE	TOTAL
E STIMATE	THIS
f'E RIOD	PREV
APF LJCAT ION	10
DATE	TO
OATE	TO	TO	
	TOTAL ORIGINAL CONTRACT VALUE				S7,737,1170.25				S0.00	$7,608,994.58	S7,60, 8994.58	
98%	D ATE
$128,875.68	DATE
$380,449.86	
															
	CHANGEORDERS														
	CHANGE ORCER #2				($396.762.37)				S0.00	($396.762.37)	(S396.762 37I	100'4	S0,00	($19,83812)	
	CHANGEORDER0				(S1.156,246.90)				S0.00	(51,156,246.90	)	(S, 1156.246,90)	100%	S0.00	($5, 7812.34)	
	CHANGEORDER114				(5170 .524 .63 )				so.oo	($170 ,52 4.63 )	Is110,524 63)	100%	$000	(58,52.623)	
	CHANGEORDER 115				(S 15M 22.7 4 )				so 00	(S1 55 ,522.7 4 )	(S155 .52 2.7 4 )	100%	so00	($ 7,776 15)	
	Ctt AN GE O R DER #6				(5123,173.68)				so.oo	( 512 3 ,1 73 . 68 )	($123 .1 73 ,66 )	1 00%	S0.00	(Sti,158 69)	
	CH ANGE ORDER #7				(S164,095.83)				S0.00	($164,095.83)	(S164,095.83)	100%	S0.00	(58,204.80)	
	TOTAL CHANGE ORDERS				($2,166,326.15)				S0.00	($2,166,326.15)	($2,166,326.15)	100')1,	S0 .00	($10 8. 31 6.33)	
															
	ADJUSTED CONTRACT TOTAL				$5,571,544.1	0			S0.00	$5,442.668.43	$5,442,668.43	98•	$12,875.68	$27,233.53	

Rl"A&ASSOCIATES PROJECT# 01 1707A

PAV APP FROM TO

9RET
11 /1n7
11/30/17

TRIPLE CJlll;€K COMMUNITY DEVELOPMENT DJSTRIC'f SPECIAL ASSESSMENT BONDS
SERTES 2017B

The undersigned, a Responsible Officer of Trip le Creek Communi ty Development District (the "District'') hereby submits the following requisition for disbursement und er a(ld pursuant to the tenns of the Master Trust lndentuie dated as of June 1, 2012 from the District to The Bank of New York Mellon Trust, N.A., as rrustee (the "Trustee"), as supplemented by the Second Supplemental Trust Indenture dated as of February I , 2017 (the "Ind entu re''), (all capitalized tenns used herein shall have the meaning ascribed to s uch t.enn in the Indenture):

December 8, 2017

Requisition Number: CR201-B

Name or Payee: RIPA & Assoc iates, LLC
1409 Tech Blvd., Ste 1
Tnm pn, FL 33619

{C)	Amount Payable: $14,910.18

Purpose for which paid or incurr ed (refor als o to specific conlr.tot if amount is due and payable pursuant to a contract involvint progress payments, or, slate Costs of Issuance, if a ppli cable): l'ay Application #10 for Project #0 l -l 707A - V.illag c El

Fund or Account from which disbursement to be made: 2017B Acq uisition and Constructio n
Account

The undersigned hereby certifies that:
L	obligat jons in the stated amount set forth above have been inourred by the District, or
this requisition is for Costs of Issuan ce payable from the Acquisition and Construct ion Fund th.al have not previously been paid;

2.	each dis bursement set forth above is a proper charge agaimit the Acqu isition and Construction Fund;

.3.	each dis bursement set forth above was incurred in connection with the acquis ition and/or construction of tl1e Project;

4.	each disbursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies that !here has not been filed with or served upo n the District notice of any lien, right to lien, or attac hment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee se t forth above, which has not been released or will not be released simultaneously with the paymen t hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disburseme nt is he reby requested.

Ch rmm	¥	25

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

    By:
Board of Supervisors

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a dis bursement from other than Costs oflssuance, the undersigned Consulting Engineer hereby certifies that this disbursemen t is for a Cost of the Project and is consistent with : (i ) the applicable acquisition or constr uction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disburseme nt ls bein_g made; and (iii) the report of the Consulting Engin.eer, as such report s hall have  been amended or modified on the date hereof.
L ;pe:C	=
cj;?uiiing Eng ineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
S.PECJAL ASSESSMENT BONDS
SERIES 20l7A VILLAGE Fl

The undersigned, a Responsible Officer of Triple Creek Commun ity Development District (the "D is trict") hereby submits the following requisi tion for disbursement under and pursuant to the terms of the Master Trust Indenture dated as of June I , 2012 from the District to The Bank of New York Mellon Trust, N.A., as trustee (the " Trustee"), as supplemented by the Second Supplemental Trust Indentu re dated as of February 1., 2017 (the "lo.denture" ), (a ll capitaliied terms used herein shall have the meaning ascribed to such term in the Indenture):

DL\ctmber 8, 2017

Requis ition Number: CR202-Fl

Name of Paylle: RIPA & Associates, LLC
.	1409 Ted, Blvd., Ste l
Tampa, FL 33619

Amount Payable: $137,416.27

Purpose for which paid or incu.rred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress paymen ts, or, s tate Costs of Issuance, if applicable): Pay Application #10 for Project 1101- 1707A -  Village Fl

Fund or Account from which disbursememt to be made: 2017A Acquis ition and Construction
Account, Subacco11nt Vi.Hage Fl

The undersigned hereby certifies that:
I.	obligations in the stated amount set forth above have been incurred by th(! District, or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Fund that have not previo usly
been pai.d;

each disbursement set forth above is a proper charge against the Acquisition and Construction Fund:

each disbur sement set forth above was incurred in connection with the acquisition ancVor construction of the Proje ct;

each disbursement represents a Cost ofthe Project which has not previously been paid.

The unde rs:,gned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien. or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released sim ult aneously with the payment hereof.
The undersigned hereby further certifies that such requis iti on contains no item representlng payment on account of any retained
percentage which the District is at the date of such certifiC11te entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the servic es rendered with respect to which dis burseme nt is hereby requested.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT
ByC, h&rroM 	ff	
Board of Supervisors

CONSULTING  ENGlNEER'S APPROVAL FOR
NON-COST OF JSSUANCE  REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consul ting Engineer hereby certifies that this disbursement is for a Cost of the Project and is consis tent with: (i) the applicable a cquisi tion or c-0ns truction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is bei ng made ; and (iii) the report of the Consulting
Engineer , as such report shall have been amended or modified on the date hereof.
----

TRIPLE CREEK COMMUN.lTY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE F2
The undersigned, a Responsible Officer of Triple Creek Community Development District (the "District") hereby su bmits the following requisition for disbursement under and pursuant to the tenns of the Master Trust. Indenture dated as of June I, 2012 from the District to The Bank of New York Mellon Trus t, N.A., as trustee (the "Trustee''), as supplemented by the Second Supplemental Trust Indenture dated as of February I, 2017 (the ''Indentu re"), (all capitalized tenns used herein shall have the meaning ascribed to such term in
!he Indenture):

Dctembcr 8, 2017

(A)	Requi s iHon Number: CR203-F2

(8)	Name of Payee: RIPA & Associafos, LLC
1409 Tech Blvd., Ste 1
Tampa, FL 33619

Amount Payable: $18,886.85

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuan1 to a contract  inv olvi ng  progress  payments,  or,  state  Costs  of Issuance,  if applicable): Pay  Application  #10  for Project #01-1707A - Village F2

Fund or Account from which disbursemerit to be mad e: 2017A Acquisition and Construction Account,
Subaccount VIiiage F2

The undersigned hereby certifies that:
l.	obligations in the stated amount set forth above have been incurred by tbe District, or
this requisition is. for Costs of Issuance payable from the Acquisition and Construction Fund that have not previously been paid;

each disbursement set forth above is a proper charge against the Acquisition. and Construction Fund;

each disbursement set forth above was i ncurred in connection with the. acquisition and/or construction of the Project;
each disbursement represents a Cost of the Project which has nol previously been paid,

he undersigned hereby further certifies thnt there has not been filed with or served upon the District notice of any I ien , right to lien , or attachment upon, or claim affecting the right to receive payment of, any o:fthe moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the paymen t hereof.
The undersigned hereby furth.er certifies that such requisition contains no item rep.resenting payment on account of any retained percentage which the District is at the date orsuch cenificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which d.isbu.rsement is hereby requested.
TRlPLE CREEK COMMUNITY DEVELOPMENT DISTRJCT

·

> 

.. J.:%4?")('

, < >,

.B:y      ~

CONSULTJNG EN'GTN EER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consul tin g Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the pot1ion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer, as such report shall have beeo amended or modified on the date hereof.

.

Co	Engineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SER.JES 20178

The undersigne d, a Responsible Officer or Triple Creek Community Development District ( the "Dist rict''} hereby submits the following requisition for disbursement under and pursue.nt to the terms of the Master Trust Indenture dated as of June I , 2012 from the District to 111e Bank of New York Mellon Trust, N.A., as trustee (the "T rustee") , as supplemented by the Second Supplemental Trust Inden lu re dated as of February I , 20)7 {the '' lndenture''), (all capitalized tenns used herein shall have the meaning ascri bed to such term in the Indenture):

Dc.tcmbcr 8, 2017

(A)	Requis ition Number: CR204-II

(8)	Name of Payee: RIPA & Associates, LLC
1409 Tech Blvd., Ste 1
Tampa, FL 33619

Amount Payable: $I 1,693.61

Purpose for which paid or incurred (refer also lo specific contract if amoun t is due and payable pursuanl to a contnct involving progress payments, or, state Costs of Issull!lce, [f appli cable): Pay Application #IO for Project #0 l -l 707A - Village F2
{E)	fund or Account from which disbursement to oe mad e: 2017B Acquisition and Constructio n
Aecounl

The und ersigned hereby certifies that:
obligations in the stated amount set forth above have been incurred by the District, or
this  requisition .is for Costs of Issuance  payable  from  the Acquisition  and Construction  Fund  that have  not  previously
been paid;

each disbursement set forth above is a proper charge l!gainst Che Acquisi tion and Constrµction Fund;

each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Project;

each disbursement represents a Cost of the Project which has nol previously been pa,id

The undersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachmen t upon , or cla im affecting the right to receive payment of, MY of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment heroof.
The undersigned hereby further certifies that such requisition contains no item representing payme nt on account of any re1ained percentage which the District is at the date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to
which disbursement is hereby requested.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By:. 	---=	--4/=	=---,,"'r'--  ..........,,,,c;.. 	 	
Board of Supervisor:.

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance , the undersigned Consulling Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisiti on or construction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.
/	c::?	
ng Engineer

TRIPLE CREEK COMMUNITY DEVELOPME:NT DISTRICT
SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE Gt

The undersigned, a Responsible Officer of Triple Creek Commun ity Development District {the "District") hereby submits the following requis ition for disbursement under and purSuant to the terms of the Master Trust Inden ture dated as of June 1, 2012 from the Distric t. to The Bank of New York Mellon Trust, N.A., as trustee (the "T rustee" ), as su pplemented by the Second Supplememal Trust Indenture dated as of February 1, 2017 (the " Inde nture"), (all capitalized terms use d herein shall have the meaning ascribed to s uch term in the Indenture):

Decemb er 8, 2017

Requisition Number: C R20S-Gl

Name of Payee: RJ.PA & Associ.atcs, LLC
1409 Tech Bl\/d., Ste l
Tampa, FL 33619
Amount Payable: $67,875.95
Purpose for which paid or incurred (refer also to specific contract if amo unt is due and payabll.'l pursuant to a contract involvin g progress payments, or, state Costs of Issuance,, if applicable); 'Pay Application /HO for Project #0l- J 707A - Village GI

Fund  or  Account  from  whioh  disbursement  to  be  made:  2017A  Acq uisiti on  a nd   C ons truction   A.ccou n t.
Suba ccouot Village G1

The undersigned hereby certifies that:
obligations in the stated amount set forth above have been incurred by the Distric t. or
this r11quisition is for Costs of Issuance payable from the Aoquisition and Constl'\lction Fund that hitve not previously been paid;

each disbursemen1 set forth above is a proper charge against the Acquisi tion and Construction Fund;

each disbursement set forth above was incurred in connection with the acquis ition and/or construction ofthe Pl'ojet t;

each dis bursement represents a Cost oft Project which has not previ ous ly been paid.

T11e imders ig ned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to Lien, or attachment upon, or claim affecting the right to rec eive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing pl!yment on account of any retained
percentage which the District is at the date of such certificate entitled to retain.
Attached hereto are originals of the invoico(s) from the vendor of the property acquired or the services rendered with re pect to which dis bursem ent is hereby requested.
TRWLE CREEK COMMUNlTY DEVELOPMENTDISTRJCT

h.r	 	

By;	 		 	= 25
Chohmrn	
Board ofSuperv1sors

CONSULTING  ENGINEER'S  APPROVAL FOR
NON -COSTOF ISSUANCE REQUESTS ONLY

If this requisicion is for a dis bursement from other than Costs of Issuance, the undersigned Consulting Engineer hernby certi fies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contrac (ii) the plans and speoitications ror the portion of the Project with respect to which such disb ursmncot is being made; and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.

APPLICATION  AND CERTIFICATION FOR PAYMENT	AIA DOCUMENT G702

TO OWNER:
Triple Creek COD

PROJECT	APPUCATION NO;	lOREV	Distribution to:
Triple Creek COD-Village E, F and GJ	CJOWNER
C]ENGINEER
PERrODTO:	11/30/17	C]coNTRACTOR

FROM CONTRACTOR:
RIPA & Associates. LLC 1409 Tech Blvd., Ste. I Tampa. FL 33619
CONTRACT FOR:

VIA ENGINEER:	CJ
Genesis Group	CJ
1000 N Ashley Dr Ste 900	PROJECT NOS:	01-1707A
Tampa. Fl 33602
CONTRACT DATE:	R.Al71173

CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for pnyment. as shown below, in conna:tion with the Contract. Cnnlinuation Sheet. AIA D.ocuml'lll 0703, is attached.

The undersigned Contrectorcenific:; thnl to the best of the Contractor's knowledge, infonnation and belief the Woric covered by this Application for Payment hall been completed In qceordance with the Contract Documents, that all amounts have been paid hy tho Contractor for Woric for which previous Certificates for Payment were issued and payments receivt.'d frcnn the Owner, and that cUtTeRt payment shown herein is now due.

L. ORIGINAL CONTRACT SUM	S	7,737,870.25	
2. NET CHANGES BY CHANGE ORDERS	$	(2,014,3 54.21 )	CONTRACTOR:	
3. CONTRACT SUM TO DATE (Line I ± 2)	$ -	- S,723.516.04	
4. TOTAL C'OMPLETEO & STORED TO	S	S.nl,316.04	

RIPA & Associates., t t c·

DATE	(Column G on G703)
S, RETAINAGE:
Hl%	orcompleted Work	S
(Column D +Eon G703)
PA#9	Previously Billed Retainage
(Column Fon G703)
Total Re1ainage (Lines Sa + Sb or
Talal in Column I ClfG703)
TOTAL EARNED LESS R.ETAINAGE (Line 4 Less Line S Total)
LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate)
8, CURRENT 'PAYM ll'.N 1' 0\JE THIS APPLICATION
9, BALANCE TO FINISH. INCLUDING RETAINAGE IO. PREVIOUS APPLICATJONS UNPAID
TOTAL AMOUNT UNPAID TO DATE
MMAk Y

Total change.'l appmved
in previous months hy Owner

572,131.62 LAND OWNER
RETAINAGE
(272,133.33) $9,240.00

$	299,998.29
$	5.421,J17 .75

S	5,170,534.89
S	250,782.86
S	302,198.29
S	455,291.47
S	706,074.33

ADD ITION-S

S0.00	$2,16§,326.lS

In accordance with lhe Contract Documents, bBlilld an on-site observations and the data comprising the applicalion. the Engineer certifies lo the Owner that to the best of the Engineer's knowledge-, infunnation and belief the Work has progressed as indicated,

-irmn"  Elia.f.r.   A\  iJ!fit'nkai   izur

Da1e: /1-J'-1 /, 3

ENGINEER"S CERTIFICATE FOR PAYMENT

the quality or the Work is in accordance with lhe Contract Documents. and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
AMOUNT CERTIFIED . . . . . . . . . . . .S   $25, 0 782.86
•
'jrom the t111101mt npplied. Initial nil jig11re.v on this at a changed 10 conform with the omo11nt certified.)

S2..166,326.15

SISI,971.94

TOTALS

$0.00

5151,971.94

Total approved this Month

By:	/,/, 

'-:;7,	/ 	,/ 	Date: ----,..-r------

The AMOUNT CERTIFIED is payable onl j t f lhc

($2,014,354.21)

NET CHANGES by_Change Ordct

Contrac:tar named hen;iti.µfuancc, payment and acceptance of payment are without
lhe Owner or Contmctor under this Contract.
IIIADOC\JMENT G702 • APPLICATION ANO CERTIFICATION FOR PAYMENT· 1992 EDITION· AIA   " '1992	TI-IE AMERICAN INSTITVTEOF ARCHflECTS, tmNEW'l'ORI< AVE.. N,W,. WASHINGTON, DC'20006-5292
Users may obtain validation of this document by requesting a completed AJA Document 0401 - Certification of Documenrs Authenticity from the Licensee.
E1 (General). $14,910.18	F2 • $30,580.46	LAND OWNER
F1  • $137,416.27		G1 - $67,875.95	$ 0.00 E2/E3 • $ 0.00

TripleCtNk COD-Vnleg• E, f 1od Gl	APPLICAflON FOR PAY,,.ENT RIPA& ASSOCIATES PROJECT#01 1707A

PAYA'i'P FROM TO

10REV
11/1/17
11/30117

ITEM
NO	

DESCRIPTIONOF WORK	

ON	CONTRA CT SUM TO DATE		
				
B SECONT CT	
C:SflMATEO QUANTITY	TOTAL
WORK IN
PLACE	TOTAL WORK IN
PLACE	roTAL WORK IN Pl.ACE	
PE CENt
CO'MJLElE	
BALANCE
10FINISH	
10!1,
RETAINAGE	
			UNIT	UNlf
PR.CE	
\IA.LUE	TljlS
ESTIMATE	PREV
ESTIMATE	TOTAL
ESTIMATE	lHIS
PERIOD	PRE.V
APPLICATION	TO
DATE	70
DATE	TO
DATE	TO
DAJE	
	SCHEDULE														
	PHASE El														
	GENERAL CO NDITIONSEi														
1	Mobillwlton	1 00	LS	S9.600 00	S9.600.00	0.00	1.00	1.00	$0.00	S9,600,00	S9,600.00	100%	sooo	596000	
2	NPOESCompliance	,.o	o LS	sa. 150.00	S8.150 00	0.00	1 00	1,00	S0,00	SS.150.00	sa. 150 oo	100%	SOCIO	S815 .00	
3	Ma.lntonance o1Traffic	,1 1)0	LS	$3,750,00	$3,750.00	0.00	1.00	1,00	so.oo	$3 ,750 00	S3,750 . 00	1 00%	SO.DO	S375 .00	
4	COnsl Stakeout I RecordSurvey - ByCon tractot	1 00	LS	$44,500.00	$44 ,500.00	0.00	1 00	LOO	so.co	$44,50000	$44,500.00	100%	so.co	$4,450.00	
5	Payment & Perlormancs Bond• ByContractor	1 .00	LS	$2,3 000,00	S23,000 00	0,00	1.00	11)0	so .co	S23,000.00	S23,000,00	100%	s o.co	$2 300 00	
	TOTAL GENERAL CONDfTIONS E1				$89 ,000 .00				$0.00	S89,000.00	S89,000.00	100%	$0.00	$8,900.00	
															
	EARTHWORK E1														
1	CJearir,g & Grubb lr,g	3.00	AC	521,000 00	$63,000 00	0.00	3.00	3.00	so00	S63 ,000 .00	$63.000 .00	100%	so 00	56,300,00	
2	SawCut EX.Isling Asphalt &.Removal
'°'	276 ,00	SY	58 ,65	52,387,dO	0,00	276.00	276.00	SO.DO	$2, 387 .40	S2 .387.40	100o,/	S0.00	S23, 8 74	
3	Demo Exl$t Siaewask(on.mh reuseas on-siteRipRap)	850.00	LF	S3.15	52,677,50	0,00	850.00	850,00	so.oo	52,671 .50	S2,677 .50	100%	$0.00	5267.75	
A	OlsC'Stle	d 00	AC	S355.00	51,420 ,00	000	4 00	4 00	SO.DO	51 ,420 .00	$1,420 .00	100%	S0.00	514,2 00	
5	cu1V01umo	400.00	CY	$2 45	5980.00	0.00	400.00	40000	$0,00	S9ll0,00	S9ll0,00	100%	so.co	598 .00	
6	Fill Volume	20,700 00	CY	$,4 85	5100,395,00	0 00	20700 00	20700.00	S0,00	S100.395 00	S100,39,5 00	100%	SO.CO	S10 . 039.50	
1	Sodding	7,600.00	SY	$2.20	51, 6 720.00	,0 00	760000	7600,00	$000	$16,72.00	S16,72,00	100%	S0.00	S t.672.00	
8	Seed ing & Mulcl1in,g	12 ,615 00	SY	$0 .25	53 ,153 .75	0 00	1261500	12615.00	so.co	$,3 153 75	53 ,153 75	100%	sooo	5315 .38	
9	SillFence	8,100.00	LF	$1 20	$9 720.00	0.00	8100.00	8100.00	S0,00	$,9 720.00	$9,720.00	t00%	so.co	S972 00	
10	lnlel PmlectiOn	1100	EA	$98,20	5,1 080.20	0.00	11.00	11 00	SOCIO	$1,08020	s .oao.20	100",!,	SO00	S108.02	
11	Oewaterir,g ( For All Aspeci>orProject)	1.00	LS	S9.200.00	59.200 00	,0 00	1.00	1,00	$000	S9.20.000	59.20,00	100%	S0.00	$92000	
12	Final Graellng	1.00	LS	521,500.00	52,1 500.00	000	100	1 00	so.co	$21 500 ,00	$2,1 500.00	100%	so 00	$2.150,00	
	TOTAL EARTHWORK E1				S232,233 .8S				$0,00	$23, 2233,85	$232,233.8S	100%	$0.00	$23,223.39	
															
	BASEAND PAVING E1														
1	1 314"S-1 Aspl'laltic Co<1Ctele	7,743.00	SY	59 .25	$71 ,622 .75	000	7743 ,00	77 43,00	$,0 00	571,622 .75	S71,622 . 75	100%	S0,00	$,7 162.28	
2	6" CrushedConcrete	7,743.00	SY	S10.30	$79,752.90	000	774300	7743.00	SO.DO	579,752.90	S79.752.90	100%	SQ.Oil	S7,975 ,29	
3	s· S1abll1Zed Sul)grade(LBR 40 )	7,743.00	SY	56.85	553,039.55	0.00	774300	770 ,00	S0.00	$53.039.55	S53,039.55	100%	sooo	$5.303.96	
A	Miami Curb WIS tBblllzaUon	5.500 .00	LF	$ 1.05	$60,775.00	000	5500,00	5500,00	sooo	$60,77500	$60.775.00	100%	SO.Oil	S6,07,7 50	
5	Type'F' Curbw/S1al)IIIU11lon	770 .00	LF	512.50	$9,625.00	0.00	77000	770.00	S0.00	59,625,00	S9,625,00	100%	sooo	S9,6250	
6	ValleyG11Uer	84 . 00	LF	521.45	S1,801.80	0.00	84,00	84 00	SO.DO	$1 ,801 80	S1,801 ,80	100%	sooo	$ 18,0 18	
7	5' x4• Coocrele Sielewalk	22 50 .00	LF	519.50	S43,875.00	0 00	2250.00	2250.00	S,0 00	$43.875.00	$43,875.00	1()0%	S0.00	54,387 ,50	
8	s·xG Concre1e Sidewalk	50.00	LF	S25.65	$1,282.50	0.00	50.00	5000	S0,00	$, 1282.50	S1,282.50	100%	$000	s12a2s	
9	10'x◄ concrete Sidewalk	9600	LF	$39,05	$3.7◄8  80	0 , 00	9600	9600	S0.00	S3,748.80	S3,748 80	100%	sooo	5374 .88	
10	10· 5 Concrete Sidewalk	2 ,100.00	LF	$5130	S107,730.00	0,00	2100 00	2100.00	so.co	5107 ,730.00	S107 ,730.00	100%	S0.00	S10,773.00	
11	AOA Ramps(5' W1de)	19.00	EA	$84,0 00	515.960 00	0.00	19.00	19,00	SOOD	$15.960 .00	515 ,960 .00	100,0,	so .co	$,1 596 00	
12	AOA Ramp•(10' Wide)	5.00	EA	s1 .200.oo	$,6 000 00	0.00	500	5.00	SO.DO	$6,000 .00	$8 ,000 .00	100%	S0.00	S600.00	
13	FOOT852 Aluminum HanJI Rall(Powder Coated Blk)	665.00	LF	57360	$48,944.00	0,00	665.00	665.00	so.co	$48,944.00	548,944.00	100%	SODO	S◄, 894.40	
1  4	FOOT Concre1eWoll(tnciuoe S1,ve1ural)	55000	LF	$31000	$170.50000	0.00	550.00	550.00	so00	5170,500.00	S170,500.00	100%	SO.DO	$17 .050 ,00	
15	Peooslrlan Bri<!Qe (M"""byYor1< Bridgeor Equlvalen t)	1,00	LS	S240, 000,00	5240,000 ,00	0.00	1.00	1 00	S0.00	$240,00000	Si◄0 . 000.00	100%	S, 000	S24,000.00	

f , f l

ITEM
NO	

DESOl<IPTION OF WOR>(	

QTY	CONTRACT SUM l ODATE		
				
SASECONTRACT	
ESTIMATED QUANTITY	TOTAL WORKIN PLACE	TOTAL
WORl( IN
PLACE	TOTAL WOR IN PLACE	
PERCENT
COMRLElE	
BALANCE
TOFINISH	RETA"I'"NAGE	
			UNIT	UNIT
PRICE	VALUE	THCS
ESTIMATE	PREY
ESTIMATE	TOT AL
ESTIMATE	TI-il S
PERIOD	0 '1EV
APPLICATION	10
DATE	TO
OArE	TO
DATE.	TO
DATE	
16	SlopsSigos	200	EA	S335,00	S67000	0 00	2.00	2.00	S0.00	$670.00	S67000	100%	$000	S6700	
17	SpeedlimitSign	1.00	EA	$3700	0	$370.00	0.00	1.00	1.00	S0.00	$37000	$37000	100%	sooo	SJHlO	
18	Ro"'1EodSigns	24,00	EA	S245.00	SS.880 00	000	24 00	24.00	S0,00	S5.880.00	$5,88000	100%	sooo	$588.00	
19	StroolSigns	2 00	EA	s-100.00	S80000	0.00	2.00	2.00	S0.00	SB00.00	SB00.00	100%	S0.00	$8,0 00	
	TOTAL BASE ANO PAVING E1				$922 ,377 .30				$,0 00	£922 ,377.30	$922 ,377.30	100%	$0.00	$92,237.74	
															
	POTABLE WATER DISTRIBUTIONE1														
1	Conne<:t to E.11:iSting l2. WIM	1,00	LS	$2,800 ,00	S2.800 .00	0 .00	100	1 ,00	S0 .00	52,80000	52.800.00	100%	S0.00	$28000	
2	2' Polyelh)leoeSen/fee(LiftSlaliOn)	d5Jl0	LF	$110.00	$4,950.00	000	4500	4500	S-000	$4 ,950.00	S, 4 950 00	100%	S0.00	$495.00	
3	6" PVC,C-900	160,00	LF	$12.85	$,2 056.00	0.00	160,00	160.00	S0,00	$2,056.00	S2.056-00	100%	S0.00	$205.60	
4	8" PVCPipeC-900	1,220.00	LF	$14,60	517,812.00	0 00	1221)00	122000	S0.00	S17.B12.00	S17.81200	100%	S0.00	$1,7612 0	
5	12• PVC PipeC-900	1.900 00	LF	S31,80	S60.420.00	0.00	1900.00	1900.00	so.oo	$60,42000	$60,420.00	100%	S0.00	S6,04200	
6	2· GaloValve	1,00	EA	S49000	$490.00	0,00	1,00	1 00	S0.00	S490.00	$49000	100%	S0.00	$49,00	
7	6" Gato Valvo	5.00	EA	587000	$4,350.00	000	500	5.00	S0.00	$4.350.00	$4.350.00	100%	so00	5435 . 00	
B	Blow-OIi Assemby(SeeCOUil!'/ Drwg No. W-6A)	8.00	EA	Sl ,200,00	S9,60, 000	,0 00	8 00	8.00	$0.00	S9,6,0000	$9,600.00	ll)()o/,	S0 .00	S960 ,00	
9	e· FtfeH ydranl As.•;cmbly	6. 00	EA	S3,700,00	S22.200,00	0,00	6.00	6.00	S0.00	$22,20000	S22.200 00	100%	so 00	52220.0C)	
10	8" GaleVa1•e	8.0Q	EA	51,250 00	S l0,000.00	0,00	8 00	B.00	S0.00	s 10.ooo .oo	S10,000.00	100%	sooo	$1 ,000 00	
11	B" Tee FlU	2.0	0 EA	5400.00	$80, 000	000	2.00	2.00	S0,00	seoo.oo	$800 . 00	1 00%	S000	S80.00	
12	8" BeroFittings	2.00	EA	S260 .00	S520 .00	0 .00	2.00	2.00	S0.00	S520,00	$520 .00	100%	S0.00	$52 .00	
13	12· Gate Valve	7.00	EA	$2,25000	$15.750,00	000	7,00	7.00	S0.00	515,750.00	$15,75000	100%	SO.Oil	$1 ,575 .00	
14	12· 8"'1d F;rongs	9.00	EA	$460.00	S4,140.00	0.00	900	9,00	$0,00	54,140.00	S, 4 140.00	100%	S0.00	s-114.00	
15	1, Tee Fittings	3.00	EA	Sl.10000	$3,300.00	0.00	3.00	3.00	S000	53.300,00	S3,30000	100%	S0,00	S330.00	
16	12"' Cross F'i thngs	1.00	EA	$850.00	$850.00	0.00	1 ,00	1.00	so.co	$85000	585000	100%	$(100	SBS.00	
17	Single Service . SllOt1Side	20.00	EA	$240.00	S4,800 00	0 00	20.00	20,00	sooo	$4 ,800 .00	$,4 800,00	100o/o	S0 ,00	s-180.00	
18	SingleServic, e  Long Sid"	18.00	EA	$325.00	$5,850.00	0.00	18.00	1800	S0,00	55,850.00	S5,B50.00	100%	sooo	$585.00	
19	TemporaryConstruction MetCf	1 00	EA	S,9 600.00	S9.60CJ00	0 00	1.00	1.00	so00	$9 ,600 .00	59,60000	100%	S000	S960.00	
20	Colorinahon & PressuraTes-ling	1.00	LS	S8,)5000	S6.15000	0.00	1.00	100	50.00	$, 615000	S6,150.00	100%	so.co	S61 5.00	
	TOTAL POTABLE WATER DISTRIBUTION E1				$186,438,00				$0,00	!186,438.00	$186,4J, 8 00	100'1.	$0.00	$18,643.80	
															
	SANITARY SEWER E1														
1	8" p\/C,SOR 26 (0'•14'Cul)	730 00	LF	517.10	512,483.00	000	73000	730.00	S0.00	S12,483.00	S12,48300	10014	$0.00	S1 248.30	
2	8' PVC, $DR 26 (14'-16"CUt)	910 00	LF	$32,10	$29.211.00	0.00	910.00	10 ,00	S0 ,00	S 29,211.00	$29.2 \ 1.00	100%	S000	$ 2.921.10	
3
•	8"PVC, SDR 26 (1-6' 18' Clll)	,1 270 00	LF	$41 20	552,324,00	000	127, 0 00	127000	S000	$52,324,00	S52.324.00	100%	S0.00	S5,232.40	
	a· PVC, C-.900(18'-20' CuULS)	170 00	LF	$54.70	S9,299.00	0.00	17000	170,00	S0.00	S9,299.00	S9,299,00	100%	S0,00	$92990	
5	s..-;ia,y Manl-ole(0'-14' Cull	4.00	EA	$3,200.00	512,800.00	0.00	4.00	4 00	S000	$12,80.00	S12,BOO.OO	1Cl0%	sooo	Sl . 280 00	
6	s· (Oia)sa,,;1ary Manhole(14'-16' CUI)	400	EA	$5,000 ,00	520,000 ,00	000	, 4 00	4,00	S0.00	S20,000.00	S20.000,00	100%	S0.00	$2,000.00	
7	s· (Ola)San;1aryManholo(16'-18' Cul)	4,00	EA	$5,250.00	S21.000,00	0.00	4,00	4,00	S0 ,00	S21 000.00	$21,00000	100%	S0,00	$,2 100.00	
8	5' (DialSan;lary Manllole (18'-20' Cul)	,100	EA	S5.8.'iO 00	55.850 00	0.00	1,00	1.00	sooo	SS ,850 00	S5,850 . 00	100 %	S000	$585,00	
9	SingleService(Hillsborough CoU<1ty)	5 ,00	EA	5 595,00	S2 .975.00	0 00	5.00	5.00	S0.00	$2,975 00	52,975.00	100%	S0.00	$297,50	
10	DoubleSen1tre(Hi!lSbomug h Counl'/)	1900	EA	S775.00	S14.725.00	0,00	19 00	19.00	S0.00	$14,725.00	$1,1,725.00	100%	$0 00	s,.472.50	
11	8"Slub& Plug	7.00	EA	5630.00	S 4 410.00	0.00	7.00	7 00	sooo	s, 410 ,00	54.410 .00	100%	sooo	$441 ,00	

		 APPLICATION FOR PAYMENT			PAY APP
FROM		10REV
11/1/17		
	
Rf'A&ASSOCIATES PROJECT 0-1 l107A			iO		11/30/17				

										

										

										

										

										

										

										

										

										

										

										

										

										

										

t ,111

TripleCtffk COO-Village E. F md G1	APPLICATION FOi< PAYMENT

lll?AU  SSOCIATES PRO.IECH   0I  1707A

P A'i' APP
FROM
o

10REV
11/1117
11/30/17

l!EM NO.	

DE.SCRl f lON OF- WOR I(	

O"!Y	CONTRAC T SUM TO QA TE		
				
BASE COPIITRAC T	
ES TIMA T ED QUANTITY	TOTAL WOR IN PLACE	TOTAL
WORK IN
Pl.ACE	I OTAl WORK IN PLACE	
PERCEN'l COMP LETE	
BALANCE
TO FINISH	
10%
RE TAINAGE	
			UNIT	U NIT
PRJCE	VALUE	THIS
ESTl'AATE	PREV
ESl tMATE	TOTAL
ESTIMATE	THIS
PERIOD	PRE V
APPLtCAl lON	TO
DA.TE	TO
DATE	TO
DATE	TO
DATE	
12	Oewatenng	1 00	LS	$33,000.00	$33,00,0 00	000	1.00	1.00	50.00	S33,000.00	S33.000 00	100%	S0.00	S3 ,300 00	
13	lnfil	I Testing	1 00	LS	$4,700,0	0	$4,70000	0.00	1,00	1.00	so.oo	54 ,700 00	$4,700 ,00	1()0%	so.co	S47000	
14	Televise Sanila,ySewer(CCTV)	3,080.00	LF	SJ.O	S	$9, 394 .00	000	3080.00	3080.00	sooo	59,394 .00	$9.394 ,00	100%	so.co	593940	
15	Pump Stauon(8' Ola )	I 00	EA	S360,000 .00	$360,00000	0,00	1,00	,1 00	S000	S3,60000.00	$360.00,00	100%	S0.00	536.00,0 00	
16	eonoect to existing6'"FM	1.00	LS	$4 ,100 .00	$4,1000	0	000	1 00	1 00	S0.00	54,1()()00	$4,10000	100%	sooo	$410 .00	
17	4" PVC C-900 FM	157.00	Lf	S8.10	$1,271.70	0.00	157,00	157.00	S0.00	51,271.70	$ 1,271,70	100%	S0.00	5127,17	
18	44       Plug VaJve	2.00	EA	S675 .00	$1 ,360 ,00	0 .00	2,00	2.00	$000	$1,35000	S1.35, 000	100%	S0.00	S135.00	
19		2 .00	EA	$255.00	S510.00	000	2.00	2,00	so.co	551000	551000	JOO%	so.co	55 1 ,00	
20	6" P VC, C-900 FM	1.9 .oo	LF	514.25	S27.830 25	0.00	1953.00	1953,00	$000	527,83025	527.830.25	100%	S0.00	S2.783.03	
21	s·P1ug Valve	5.00	EA	SJ ,050 ,00	$5.250.00	0.00	5.00	500	SO.OD	SS,250,00	55.250.00	100 %	50.00	S52500	
22	O"B8'1d	14 .00	EA	$330 .00	$4,620 00	0.00	14 ,00	14 .00	sooo	$4 ,62,0 00	$4 ,620 00	100¾	so 00	$46200	
23	6M Tee(1 Cul In Toe)	2 00	EA	S1.500 00	SJ,000.QO	0.00	2.00	2 00	so.co	53.000 .00	$3 .000 .00	100¾	5000	S300 00	
2•	G" Gap	100	EA	S200 ,00	5200 ,00	0.00	1.00	1.00	S000	S200.00	$20000	100%	so 00	S2000	
25	FMCasing	2, 8 00	lF	S68.80	Sl.926.40	0.00	28.00	28,0()	so.co	51,926.40	$,1 926.40	100%	$000	S192.64	
26	AR\t Struct..-e3 Assembli	1 00	EA	$4,200 .00	S4.200.00	0.00	1,00	I 00	so.oo	S<.200.00	$4,200.00	100¾	so.oo	$ 4 20 . 00	
27	F>ressure Teshng (FM)	1 00	LS	SJ .900.00	S3,900.00	0.00	1.00	1 00	50.00	SJ.900.00	53,900.00	100%	S0,00	S390.00	
	TOTAL SA NITARV SEWER E1				$650,329.35				SO.OD	S650,329.JS	$650,329.35	100-.r	S0.00	$65,032.94	
															
	STORM DRAINAGE E1														
1	15"ClassIII RCP	42,00	LF	52330	5978.60	0.00	42 00	4200	so.co	$978 .60	5978 .60	100%	SO.OD	59786	
2	18'Class Ill RCP	58,00	LF	$28.40	S1,647.20	0.00	58.00	58.00	sooo	51 ,647 .20	$1 ,647 20	100%	5000	5164,72	
3	24"Class III RCP	439.00	LF	544.60	S19,579.40	000	439.00	439.00	50.00	$1,9 579.40	S19.579.40	100¾	so.co	$1,957.94	
4	30· Cl3Ss III RCP	158.00	LF	S65.10	S10,285.80	000	15800	158,00	S0,00	$10,285.80	S10,285.80	100%	so.co	51 ,028 58	
5	36" Class IURCP	51.00	Lf	584.65	S4,317 15	0.00	51.00	51.00	$000	$4,31715	$4,31715	100¾	so00	$431,72	
6	60" Class Ill RCP	190 ,00	LF	$185,00	$35.150,00	000	190 00	190.00	SO.CO	535,150 .00	S35 .150 00	1 00%	SO.DO	S!l.515 .00	
7	(3) Triple58 "x 91""Class IllERCP	52,00	LF	51,200.00	56, 2 40000	0,00	5200	52.00	S0,00	S62,400.00	562,400,00	100%	so.co	56 240 .00	
8	HUlsbo,ough Co Type1 CU1> Inlet	9. 00	EA	$4 ,150 00	$37, 350.00	o.oo	9 ,00	900	50 ,00	$37 ,350 00	$37,350,00	100¾	S0.00	53.735.00	
9	HillsbOrough CO Type 1 CWtl Inletw/ J-Bottom	2.00	EA	S5,250.00	510.500,00	0.00	200	2.00	S000	$10,50000	$10.500,00	100%	S0.00	S, l 050 00	
10	FOOTMannole w/ J· Bottom	1.00	EA	SJ,900.00	53,900,00	0,00	1.00	1,00	so.co	5,3 900 .00	$3,900 ,00	100%	so.co	539000	
11	6"PVC Undororaln	1,800 00	LF	$11,95	$21,51000	000	1800.00	180, 000	S0,00	$2,1 51000	521.510,00	100%	S0,00	$2,151.00	
12	Underorain Cleanout	1300	EA	S185.00	S2.405,00	000	13 00	13.00	S0,00	$,2 405.00	$2.405.00	100%	so.co	5240, 50	
1;i	FOOTSlralghl Concrete Eno Wall(TtiplePipe)	114.00	LF	5375.00	$42,750,00	000	114,00	114.00	50.00	S42,750,00	S42,750 00	100%	S0.00	54,275 00	
14	Tel-•Storm Sewe<(CCTV)	1,052.00	LF	$610	$64, 17.20	000	1052.00	1052,00	50,00	S6.417 20	$6.417. 20	100o/&	sooo	$ (;,,11 72	
	TOTALSTORM DRAINAGE E1				525,9 1 90 .35				$0.00	$259 ,190 ,35	$25 9,190.35	100"A.	SO.DO	$:15,919.04	
															
	ROAD SLEEVE CROSSI NGE1														
1	2"Sch 40 PVC	112.00	LF	S4 80	S537.60	0.00	112.00	112.00	$000	S537,60	S537,60	100%	5000	S53.76	
2	3"Sch 40 PVC
◄"	112.00	LF	$5.55	$621.60	0 00	11,2 00	112 00	S0.00	$621.60	S62160	100%	so.co	S6216	
3	Sch 40 PVC	140,00	LF	56_15	S861.00	0.00	140,00	140.00	SO.OU	586100	$861.00	100%	sooo	$8610	
4	6"Sch40PVC	112.00	LF	58 .15	$912.80	0.00	112.00	112.00	$0.00	5912.80	5912.80	100%	S0 ,00	591 .28	
	TOTAL ROADSLEEVE CROSSI NGE1				5,2 933.00				$0.00	$2,933.00	$_2,93 3 .00	10 0%	SO.OD	$2:93.JO	

··-

TripleCreekCOO.VtOa,ge E.F andG1	APPLICATION FOR PAYMENT

RIPA & ASSOCIATESPROJECT •0l -!707 A

PAY AflP FROM  TO

10REV i111/17 11/30/17

ITEM l'IO	
DESCRIPTIONo, WORK	

OTY	CONTRACTSUM TO OAlE		
				
BASECONTRACT	
ES flf,11\TEOOUANTlrY	TOTAL WOR t< IN PLACE	TOTAL
WORklN PLACE	TOTAL WORKIN
PLACE	
PERCENT COMPLETE	
BALANCE TOflNISH	
1<>'11
RETAINAGE	
			
UN IT	U NIT
PRICE	VALUE	n-11s
ESTIMATE	?RE V
ESTIMATE	TOT AL
ESTIMATE	THIS
F'ERIOO	PREV
APPLICATION	TO
DA.TE	TO
D ATE	TO
DATE	TO
DATE	
															
	CHANGE ORDER #2 • PHASE E1														
	DPO Credtl • Ferguson• Water	1.00	LS	(S79.314,82	)	(S79,314.82)	000	,.oo	, 00	S0.00	(S79.314.82)	(579,314.82)	100%	50.00	(S7.931,48)	
2	OPO Cred,I - Ferguson - sewer	100	LS	(522,442.68	(522,442.68)	0.00	1.00	1.00	S0.00	(S22,442,68)	(S22.442.68)	100%	$000	($2,24.427	
3	CPO Credit· Ferguson• Force Mato	1 oo	LS	($22,072.05	)	(S22,072.05)	0.00	1.00	, 00	so.oo	($22,07205)	(S22.072.05	)	100%	S0.00	(S2.207 21 )	
4	OPOCre<tll - Ferguson- Undetdfarn	1 00	LS	($5.764.90	(55,764.90)	0.00	1 00	1 00	S0.00	(S5.764.90)	($5,764.90)	100%	S0.00	(S576.49)	
5	CPOCreOit · Ferguson• SleeV85	1.00	LS	($812.20	)	($812,20)	0 00	1 00	1. 00	S0.00	($812.20)	($812.20)	100%	$000	(S81.22	
6	DPOTaxSavings	1.00	LS	(S7.824.40)	($7,824,40)	0.00	1.00	1.00	50.00	(57,824.40)	(S, 7824.40	100%	S0.00	(S782.44)	
	TOTALCHANGE ORDER #2 . PHASE E1				($138,231.05)				S0.00	($138.231.05)	($138,231.05)	100%	So.oo	(S13,823.11)	
															
	CHANGE ORDER #J • PHASE E1														
	E1 • Geotechnlc.al Testing														
1	E1 · FieldTechnicianServices	1 ,00	LS	S18 .006.00	S! B.006.00	0,00	1,00	1.00	$0 00	518.006.00	$18,006.00	100%	SO 00	$1 .800 .60	
2	E1. Laora!O<y res11ng	1.00	LS	$4 ,932 .00	$4.932 .00	0.00	1.00	1.00	$0.00	$4,932.00	54,932.00	100%	S0.00	$493.20	
3	E1 • Engioeering & Project Management	1 00	LS	S2.520 ,00	S2.520 ,00	0 .00	1.00	1.00	S000	S2,520.00	$2,520.00	100%	SO.CO	$252.00	
	TOTAL CHANGE ORDER #J • PHASE E1				$25,458 .00				S0.00	$25,458.00	S25,4S8.00	100 %	SD.DO	S2,545 .80	
															
	CH ANGE ORDER #4 • PHASE E1														
1	OPOCre<lil - Rinker- Slonn Pipe	100	LS	(S38,646.07)	($38,646.07)	0.00	1.00	1.00	5000	(5386, 46.07)	(538.64.607	)	100%	SO.CO	153 ,864.61	)	
2	OPO TaxSavings	1.00	LS	($2.338.76)	(52,338.76)	0.00	1.00	1.00	S0.00	(52,338.76)	(S2.33878)	100%	S0.00	(5233.88)	
	TOTAL CHANGE ORDE.R #4 • PHASE E1				($40,984.83)				$0.00	($40,984.83)	($40,984.83)	100%	$0.00	($4,098.49)	
															
	CHANGE ORDER #5 - PHASEE1														
1	DPO Cre<:hl  - Atlantic TNG- Sewer Structtres	1.00	LS	(52, 4 149 .00)	(S24 ,149 ,00)	0 00	1 00	1. 00	50 .00	1524 ,149 .00)	(52 4.1 49 00)	100'4	$000	(52.41.490)	
2	DPO Credit - Atlanrlc TNG- L1rtS 1at1on	1.00	LS	($23.755,70	)	1523.755.70)	0.00	1.00	100	$0.00	($23. 755,70)	($23.755.70)	100%	S0.00	(52.375.57)	
3	OPOCredit·Allantlc TNG· SIOrm Slruclu<es	1 00	LS	($1,7 844 80)	(S17.844 80)	o.oo	1 00	1 .00	S0 . 00	( S 1,7 844 .80)	1517 .844 ,80)	100%	so00	($ 1, 784.48)	
•	CPO raxSavings	1.00	LS	($3.954 .97)	(S3 .954 .97)	0 .00	100	1,00	so.co	(S3.954.97)	($,3 954 97)	100%	so 00	(5395.50)	
	TOTAL CHANGE ORDER #5 • PHASE E1				($69,704.47)				S0.00	($69.704.47)	($69.704.•7)	100'/4	SO.OD	($6,970 . 45)	
															
	CHANGE ORDER #6 • PHASEE1														
	CTB DIRECT PURCHASE ORDER														
1	OPO Credi! . So0 CementBase	(2.98! 00)	TN	516.00	($47,696.00)	0,00	-2981,00	·2981.00	S0.00	($47,696.00)	($47,696.00)	100%	S0.00	($4,769.60 )	
2	DPOTa,cSavings	1 00	LS	(S2.861.76)	(52.861.76)	0.00	1.00	1 00	S0.00	(52.861.76)	($2.86176)	100%	5000	(5286.18)	
	EARTHWORK E1														
1	E1<cava11on or Tem l)Orary Poods	2,700.00	CY	S2.45	$6.615 ,00	0.00	270000	270000	50.00	56,615.00	56.615.00	100%	S0.00	$66150	
	ROAD SLEEVE CROSSINGS E1														
1	'rSch40PVC	940.00	LF	$4.80	$4 ,512.00	0.00	940.00	940.00	50,00	54.512.00	54.512.00	100%	5000	S451 20	
2	3'" Sch 40 P VC	(112.00)	LF	$5.55	($621 60)	0.00	·112,00	-112.00	S0.00	(S621,60)	($62150)	100%	S0,00	(562.16)	
3	4"Sci140 PVC	2 ,340.00	LF	S6.15	S14,391.00	0 00	2340.00	2340.00	sooo	$14 .3 91 00	$14 .39,1 00	100%	S0.00	$1,439 10	
4	6" Sci140PVC	(112.00)	LF	$8.15	($912.80)	0.00	-112.00	-112.00	so.oo	(S912 .80)	(S912.80)	1 ()1)%	sooo	(S91 28)	
	STORM DRAINAGE E1														

)

)

.,,,,

TripleCreekCOO.V,Ua,ge E,-F tndG1	APPLICATION FOR PAYMENT

RIPA&ASSOCIA1ES PROJECT# Ol 1701A

PAY APP FROM TO

10REV
1111117
11/30/17

ITEM NO	

DESC RIPTION OF WORK	

Q]'(	CONTRAC TSUM TO DATE		
				
BASE CONTRACT	
ESTIMATED CUANTIT'I'	TOTAL WORK IN PLACE	TOTAL WORK IN Pl A.CE.	TO TAL WORI\IN PlA CE	
PE RC EN T COMPLETE	
BA LANCE
10  FINJS t'i	
10,,
R E.TAJN AGE	
			UNIT	UNJT
PRlCE	VALUE	THIS
ESl iMATE	P REV
ES TIMAT E	TOT AL
EST>MATE	fH IS
PERIOD	P REV
APPLICATION	10
DATE	ro
DATE	TO
DATE	TO
OATE	
1	15· Class Ill RCP	4800	LF	$26.10	$1 ,252.80	0.00	48,00	4800	5000	$, 1252.80	$1,252,80	100%	S0.00	5125.28	
2	18"Class Ill RCP	64 00	LF	S29.83	$1,909 12	0. 00	64.00	64 00	$0 00	5,1 909.12	S1,909,12	100%	sooo	S190,91	
3	24" Class IllRCP	312,00	LF	S47 92	$14 ,951.04	000	312 00	312.00	S000	$14,95104	S14,951.04	100%	so 00	S1,495,10	
4	Conlrol S\t\lcture (FOOTMOdified Type·o · Inlet )	1.00	EA	$4,650.00	S, 4 65000	0 00	1 00	1.00	so.oo	$4 ,650 .00	$4,650 .00	100%	S0.00	S465.00	
5	FOOTManhole	200	EA	$3,250.00	$,6 500.00	0.00	2.00	2.00	S0.00	S6,500.00	56,50000	100¾	so 00	$65000	
G	RCP BriOkP lug	1 .00	EA	S277 68	S277.68	0.00	1.00	1 00	S0,00	S277.68	$277.68	100%	S0.00	527 77	
7	15" RCPFES	1()0	EA	$1,500 00	$1.500,00	0 00	1.00	1 00	S0,00	Sl .500,00	51.500 00	100%	$0.00	$15, 000	
8	18" RCP FES	1(10	EA	51,650.00	S1,650,00	0,00	1.00	1.00	sooo	51,650.00	S1,65.00	100%	S0.00	S165.00	
9	PostMounted FibefglassSkimmer	40.(10	LF	$8657	53,462.80	000	40,00	40.00	$0.00	$3,462.80	53.462.80	100%	S0.00	$346,28	
10	Televise S lom, Sewer(CC'TV)	424 00	LF	S6.10	$2,586.40	0.00	424.00	42.4.00	S0.00	$2,586.40	£2.586.40	100%	S0.00	$258.64	
11	Dewalering	1. 00	LS	SS.700 00	ss ,700.00	0,00	1,00	1 .00	S000	$5.70000	SS.70000	100%	S0.00	$570,00	
	TOTAL CHANGE ORDER #I; . PHASE E1				$17,865.68				S0.00	$17,865.68	$17,865.68	100%	$0.00	$1,78, 6 56	
															
	CHANGE ORDER #9 • PHASE Et														
1	DPO Reconclllallon-Fcrguson--VillageE1	1 .00	LS	S15, 630 .64	$1,5 630 .64	1.00	0.00	1 .00	$15 ,630 .64	S0 ,00	$15 ,630 64	100%	S0.00	S1.563.06	
2	6% Ta,,on AbO,e	1.00	LS	S936.22	$936.22	1.00	0.00	1.00	$936.22	sooo	$93.622	100%	S0.00	S93.62	
	TOTALCHANGE ORDER #9 • PHASE E1				$16,566.86				$16,566.86	S0.00	$16,566.86	100%	S0.00	$1.656.68	
															
	TOTAL PHASE E.1				$2,153,472.04				$16 ,566'86	$2.136,905.18	$2,153,472.04	100¾	S0.00	5215,347.20	
															
	PHASE F1														
	GENERALCONDITIONS  F1														
1	Mobllilatlon	l.00	LS	S9.600.00	S9.600 00	0.00	1.00	1.00	S0.00	$9,600.00	S9.600.oo	100%	S0,00	S960.00	
2	NPDES Compliance	1.00	LS	S4,850,00	S4.850 00	0.00	1.00	, 00	S0.00	S4.85000	$4.850,00	100%	S000	$485.00	
3	Ml)lntena,,ce orTro tr.c	1.00	LS	S11 200    . 00	S1 , 200 00	000	1 00	1 , 00	S0 . 00	s, . 200 . 00	s1.2 00 , 00	100%	$000	$120.00	
4	COnst. Stakeout I Roc.ord Survey ..ByContractor	1.00	LS	$5 1 ,000 .00	$51 ,000 00	0 .05	0 .95	1 00	S2 .550 00	S48.450 .00	551 ,000 00	100¾	S0.00	$5,100.00	
5	Paymonl & Performance Sood   ByContraclor	1.00	LS	S1t 250,00	S14.250.00	0.00	1 00	1.00	S0.00	$14,250.00	$1, 4 25000	100%	S0.00	Sl,42500	
6	S1ltf"ence	,6 100.00	LF	51.20	$7,320.00	000	6100.00	610000	5000	S7,320.00	$7,320.00	100%	$0.00	$732.00	
7	Existing Inlets• ErosionProtection	8 ,00	EA	S98.20	$785.60	0.00	8.00	800	S0.00	5785.60	S785.60	100%	S0.00	$78.56	
	TOTAL GENERAL CONDITIONS Fl				589,005.60				$2,550.00	$86,455.60	$89.005.60	100%	SO.OD	$3.900.56	
															
	EARTHWORK Fl														
1	ClearirQ & Grubb	36.00	AC	$1.800.00	$64 ,800 00	0.00	3600	3600	S0.00	$64,800.00	564.800.00	100%	S0.00	S6.480.00	
2	OiS<;Slle	30.00	AC	$35500	$10,650.00	0 00	3000	30.00	S0,00	S10.65000	S10.65.00	100%	so.oo	S1 , 065 .00	
3	Cu t VOlume ( Unadjusted)	108,900.00	CY	S2.10	S228.690 00	0,00	108900.00	108900.00	S000	5228.690.00	5228.69000	100%	S0.00	S22.869.00	
4	Sodding	25.750,00	SY	$2.45	$63,087.50	3862.50	21887,50	25750.00	$9,463.13	$53 624,38	S63.087.50	100%	S0.00	56,308.75	
5	Seeding &Mulching	6,114 00	SY	S0 .25	$,1 528.50	6114 00	0.00	6114.00	S1.528.50	$,0 00	$1,528.50	100%	sooo	S152 .8S	
6	Oewatering	1.00	LS	$40,600 .00	$4,0 500 00	0.00	1.00	1 00	so .co	$4,0 500.00	540.500 00	100%	S0.00	S4,050 00	
7	Final Gra<f;ng	1 ,00	LS	520 ,000 .00	$20 ,000 .00	0 ,20	0 .80	1.00	$4 ,000 00	S16 ,000 00	$20 ,000 .00	100"/.o	$0 00	S Z,000.00	
	TOTAL EARTHWORK F1				$4 ,256.00				S14.991.63	$414,264.38	$4 ,256.00	100•1,	SO.OD	SA2.92S.60	

TripleCre-ek C OO-VlilagoE,FandG1	APPLICATION FOR PAYMENT ruPA&ASSOCIAIESP ROJECJ • Ol-1707A

PAYAf'P F"ROM TO

10REV
11/1117
11130117

CONTR.ACT'SUM TODATE
TOTAL	TOTAL	TOTAL
OESeRtPTION OF WOR,I(	BA.SECONTRACT	ESTIM.ATEOQUANTITY	WORK IN	WOAKIN	W0F(K1N	PERCENT	BALANCE	IOI.
ITEM	PLACE	PLACE	PLACE	COMPLETE	TOFINISH	RElAINAGE
NO	OTY	UNIT	TI-IIS	PREV	TOlAL	r.,_.1s	PREY	TO,	TO	TO	TO
UNIT	FRfCE	VALUE	ESTIMATE	ESTIMATE	ESTIMATE	PERICO	A?PLJC.O,TION	DATE	DATE	CATE	DATE

PAVING ANO BASE F1
1 3W S-1 AsP alllcCooorele	5,705.00     SY	S9.20
6" CrushedconcreteBase	5.705.00      SY	$10. 30
6"Slah,lize<I SUOgrllde (LBR 40 )	5,705,00     SY	S6.85

$52)18600	0.00	5705.00	5705.00	SOOD	$52,48600	S52.A86 ,00	1 00 %	so.oo	$5.24860
$58,761.50	0.00	5705.00	5705.00	SO.DO	55,8  7 61 .50	558,76 1 50	100%	sooo	S5.87615
539,079.25	0.00	5705 00	5705.00	SO.DO	539,07925	539.079.25	IOOo/o	SO.DO	S3 ,907  93

4	Miamicum wfSIBbillumon(Fu ll Depth)	5,00200      LF	s,,05	S55  .2 7 2 . 10	0 . 00	500200	5002.00	sooo	555.272    .1 0	555.272.10	100%	so.oo 	55 .527.21
5	e·  Wide RlbbOn CUl1>	3,0 1 3.00	LF	S9.80	S29.527.40	0.00	3013.00	3013.00	SO.DO	S29.52740	529.527 40	100%	so 00	S2.9527 4

S'.>1 ·Concrete S.dewalf<	300 .00	LF	$1950

S5,850.00	150.00	150.00	300.00	$2,925.00	$2,92500	55.850.00	Joo,/,	so.oo	S58500

10' WideAsphalt Pavement(wlbase& suograde)- Trail

,1 663,00     SY	S25.90	S43,0717 0	0.00	1663.00	166300	so 00	$43,0717()	543,071.70	100%	S0.00	$4.307 17

8	ADARamps(5' wide)	4_0Q	EA	$840 ,00	S.l.360 .00	2.00	2.00	4.00	51,680.00	S! .680.00	-$3.360.00	1(]0%	S000	$336.00

12· Wide-Concrete Blocl< Wall	1,430.00      LF	59410
Wood Boarowalk	1.300.00      SF	54525

5134,563,00	o.oo	14 30.00	H  30 . 00	S0 . 00	S134   ,563.00	S134,    563  .00	100%	sooo	513,  4 56.30
558,825-00	0.00	130000	1300.00	S0.00	S58,B25.00	S5,8 825 00	100%	SO.DO	$5,882 .50

11	s;gnage&S1rtp1ng	I 00       LS	52.200.00	S2,200 00	0.00	0.00	0.00	S0.00	S0.00	$0.00	0%	52.200.00	SO.DO
TOTAL PAVING ANO BASE F1	$482,995,95	54,605.00	$( 76.190.96	$480,79S.9S	100%	$2,200.00	S48,079.60

POTABLE WATER DISTRIBUTIONFl
1	COnnecl to Exis ting s·W/M	1.00     EA	S! .250 .00	$1 ,250 .00	1 00	0.00	1.00	S1.250.00	SO.DO	S l ,250 00	100%	S000	Sf25,00
2	6"PVC PipeC-900	2.700.00        LF	S10 SO	528,350.00	135.00	2565.00	2700.00	Sl ,417.50	52, 6 932-50	S28.350.00	100%	SO.DD	S2,835 00
3	6" FireHycJranl Assembly/wife.!F11tlng Conncct<>n	500    EA	$3 ,700.00	S18.50000	0,25	4 75	5,00	5925.00	S17575.00	$18,50000	100%	S0.00	5 1,850 00
s·Gate Valve	fl 00      EA	$870.00	59.57000	0,55	10.45	11.00	5478.50	59.091.50	$,9 570.00	100%	so.oo	5957 .00
5	6" BendFih,ngs	1 2.00     EA	$185.00	52,220.00	0.60	11.40	1200	5111.00	$2,109-00	$2.220.00	100%	S0.00	$222.00
6	6" Tee F,ntogs	2.00     EA	5290.00	$580,00	0,10	1.90	2.00	$29 00	$551.00	$580 00	!OO'li,	SO.DO	S58 .00
7	Slngfe Service, ShorlSdi e	4J 00      EA	S240.00	S9.840.00	205	38.95	41.00	5492 00	59.34800	59.840,00	100%	SO.DO	S 964,00
8	Single Service. Long Side	33_00	EA	$325,00	S10.725.00	1.65	31.35	3300	$536.25	$10.18875	S10.725,00	100%	S0.00	SJ.07,2 50
9	Temporary ConstrucliOn Meter	1.00      EA	S9,900.00	S9.900.00	0.05	0.95	1.00	5'195,00	S9.405 .00	S9.900 .00	100%	sooo	S990 .00
10	Chlori naUon, S mprlng & Pressure Testing	t 00       LS	S4.750.00	54,750.00	0.50	050	1.00	S2.375.00	$2,:17$.00	S.:.75, 0 00	,oo,i.	sooo	5475 .(JO
TOTAL POTABLE WATER DISTRIBUTIONF1	595 ,685.00	$,8  109.25	587,575 ,75	$95 ,685 .00	1 00 ¾	$0 ,00	$9,568 .50

SAN ITARYSEWE;R F1
1	11' PVC SOR 26 (0' -10' Culj

,1 713.00      LF	515.00	S25,695.00	0.00	1713.00	171300	SO.OD	$25.695   .00	S25.695 00	100¾	S0.00	S2.569.50

2	s·  PVC. SOR 26(10'·12' Cul)	424.QO    LF	$17 ,o

S7.250 40	0.00	424 00	424 00	SO.DO	$7,250.40	S7.25, 0 40	100%	so.oo	$725 .04

3	S- PVC. SOR 26112'-1•·Cuti	179.00      LF	520.35	S3,642.65	0.00	179 00	179.00	S0.00	$3,642.65	$,3 642.65	100%	S0 .00 	5 364. 26
4	Sanitary Manhole (O'.S 1 Cut)	500       EA	S2.400 00	$ 12,000.00	0.00	5.00	5,QO	sooo	$12 ,000 .00	s, 2.000 .00	100%	S0.00	$1.200.00
5	Senllary Manhole (8·' 1o·CUI)	400     EA	$2.80000	$11,200.00	0,00	dOO	4 00	S0 .00	$1,1 200 00	S11 . 200 .00	100 %	S000	s1.120,00
6	Sen<lary Mant,ole(10'·12' Cut)	2.00      EA	53,00000	SG.00000	000	2.00	2.00	S0.00	S6,000.00	$, 6000.00	100%	sooo	5600  .00
7	Sam   la ry MaMofe 112·-14•Col)	1 00     EA	$3, 450 00	53,450.00	0.00	100	100	SO.OD	$3 , 450 .00	$3.450.00	100%	S0.00	5345.00
8	SinglaService (HIIISbOrt>ughCoun1V)	16 .00      EA	S59500	Sl0.71000	0.00	18.00	18.00	S0.00	S10 ,710.00	S10 ,710.00	100%	5000	51.07100
9	Oou     le   Service(H,11' b0rough county)	29.00         EA	$775,00	$2,2 475.00	0,00	29.00	29.00	SQ_QO	$22,475 . 00	522. 4 75.00	100%	SO.DO	$2,247 .50
10	6" PVCSl ub-oul eoon..:tK>n	1 .00	EA	5450.00	545000	000	1.00	1.00	S0.00	5450.00	545000	100%	S000	545.00
11       Oewa1eriog	1.00      LS	$27.50000	$27,500_00	Q _OQ	1.00	1.00	SO.DO	$27 ,500 .00	S27 ,500 .00	100%	S0.00	$2,750.00
12	lnfli/EXITI T estlng	1.00       LS	S3.900.00	53,900 00	1 00	0.00	1.00	S3,90000	S0.00	53.900,00	100%	so.oo	$390.00
13	Televisas anilarysewer(CCTV)	2.316 00      LF	SJ.05	$7,063,BO	231600	0.00	2316.00	5 7,063.80	so_oo	$7 , 063 80	1 00%	S0.00	570638
l ot / t

Tdpl<CtHk COD-Vill111• E, F IOd G1	APPLICATION FOR PAYMENT
RIPA&ASSOCIATESRPOJECl • ,011707A

PAY APP FROM TO

lOREV
1111/17
11/30/17

ITEM NO.	

OESCR IPl lON Of WORK	

OTV	CONT RACT-SUM TO DA TE		
				
BASE CON'TAACT	
ESTIMATED QUANTITY	TOTAL
WORK IN
PLACE	TOTAL WORK IN PLACE	iO TAL
WOR Kl N
Pl.ACE	
PERC ENT COMPLETE	
BALANCE
TO FINISH	Rl:T'A°JN"AGE	
			UNIT	UNIT
PRICE	VALUE	THIS
ES TIW\ TE	PREV
ESTIMATE	TOTAL
ESTIUATE	THfS
PERIOD	PREV
APPLICATION	TO
CATE	TO
DATE	TO
DATE	TO
OATE	
	TOTAL SANITARY SEWER F1				$141, 336.85				Sl0, 963.80	$130 ,373.05	$141,336.85	100'Y.	$0.00	$14,133.68	
															
	STORM DRAINAGE F1														
1	1s·Class Ill RCP	35800	LF	S23.30	S8,341 40	0,00	358.00	358.00	S0,00	SB.341,40	$8,341.40	100%	S0.00	S834.14	
2	18" Clas s 11RCP	183.00	LF	$28.4	0	S5,197,20	0,00	183.00	18300	S0.00	S,5 19720	S5.197 20	1()()%	S0.00	5519,72	
3	24"Class Ill RCP	1.354 .00	LF	S383	0	$51,858,2	0	0,00	1354,00	1354.00	S0.00	$51,858.20	551,858 20	100¾	sooo	S5,185.82	
4	30' Class 111 RCP	390 , 00	Lf	S52 . 50	$20, 475 .00	0 . 00	39000	390.00	S0.00	520,47500	520,475.00	100'4	S0.00	52,047 50	
5	36"'C lass 111RCP	17500	LF	572,10	$1, 2 617 50	0.00	175.00	175.00	S0,00	$ 12,617.50	$12.617.50	100%	S0,00	51,261.75	
6	tnielType1 (HC)	15.00	EA	$4,150,00	S62.250.00	5.25	9.75	15.00	$21,787.50	$40,462.50	$62,250.00	100%	S0,00	SS,225.00	
1	FOOTManhoto	2 00	EA	5'.l,2500	0	56,500.00	0,10	1,90	2 00	S32500	$6,17500	S, 650, 000	100%	S000	S650.00	
8	ControlSrlucture (FOOT MOdifiedType·o·  Inlet)	I 00	EA	$3,500 .00	53,50000	0.05	0.95	100	$17500	$3,325.00	S3,SQ0.00	100%	SO.OD	S350 .00	
9	ControlStructure(FOOT M0<>m,<1 Type"H' INel)	1 .00	EA	S9.650 . 00	S9 ,650 . 00	0 05	0.95	1 .00	$48250	S9,167.50	S9,6SO 00	100%	SOOD	5965 .00	
10	Existing 1n1et Type, IHC)-1Tie In)	2 .00	EA	5695.0	0	$,1 390 00	0.00	2.00	200	S0.00	Sl ,390.00	S1,390,00	100%	S0.00	S139.00	
11	E.xistlng FOOT Manhol&{Tle In )	1 00	EA	$4,000 00	$4,00000	0.00	1.00	1 00	S0.00	S4,000.00	$4,000,00	100%	S0.00	$400.00	
12	Existing lnlcl TypeC-(TleIn)	1.00	EA	$4,650.00	$,4 650 00	0.00	1.00	1 00	SO.OD	$,4 650.00	S4,650,00	100%	SO 00	5465 .00	
13	Control S t""'1ure-concre1e Weir Wall(74 LF)	1.00	EA	538.000.00	$38,000.00	0.00	1.00	1 00	sooo	53,8 000,00	S3, 8 000,00	100%	S0.00	S3,800,00	
14	1a· FOOT FES	1.00	EA	S1,650.00	51,650.00	000	1 00	100	S0.00	S1,650.00	$,1 650.00	100%	S0.00	S165.00	
15	2•· FOOT FES	100	EA	S,1 750.00	$1,750,00	0.00	1.00	1 00	S0.00	S1,750.00	S1,750 00	100%	S0,00	S175.00	
16	30' FOOTFES	1.00	EA	$,2 300.00	$2,300.00	,0 00	1 00	1.00	so.oo	S2, 300 .00	S2 .300 .00	100%	S0.00	523000	
17	36"FOOT FES	1 00	EA	$2,750.00	S2,750.00	0.00	100	1.00	SO.OD	S2,750.00	S2,750.00	100%	$000	5275.00	
18	oewatenng	1 00	LS	$ 18,500 .00	518 ,500 .00	0.00	1.00	1,00	S0.00	S18.500 00	$18,500.00	1()()j4	so00	S l ,85,0 00	
19	TeJcvtseSlom, sewer(CCTV)	2,460.00	LF	S6.35	515,621.00	2460 00	000	246000	S15,621.00	S0.00	$15,621.00	100%	$0 00	S1,562,10	
20	FOOT rype ·E Inlet	4.00	EA	S2.550.00	S10,200.00	OAO	3 .60	4 .00	$1 ,020 . 00	59 ,180 00	$ 1 0200 . 00	100%	S0.00	5, 1020 OD	
21	6" Unde<draln ( Flne Aggregate)	150.00	LF	511.95	$1,792.50	000	15000	150,00	so.oo	S1 792 .50	51 ,792 50	100'4	50.00	5179.25	
22	Underdratn Cleaoout	3 ,00	EA	S185 OD	5555 .00	000	3.00	300	S0 .00	S555 ,00	S555 .00	100%	S0.00	555,50	
	TOTALSTORM ORAINAGE.F1				$283,547.80				Sl 9,411.00	$244,136.80	5283,547.80	100%	SO.DO	S28 ,JS, 4 78	
															
	ROADSLEEVE CROSSING F1														
1	2"Sch40 PVC	90.00	LF	S4,80	S432.00	000	90.llO	90.00	S0.00	$432 .00	$432,00	100%	S0,00	$43.20	
2	•· 5"140 PVC	120.00	LF	SG15	$ 738 ,00	0 .00	120 . UO	120.01)	SO.OD	S738 .00	S73800	100%	S0.00	573.80	
3	6" Sd140 PVC	30 .00	LF	-58.15	524 4.50	0.00	3000	30.00	so 00	S244 50	S244 50	100%	S0.00	524.45	
	TOTAL ROAD SLEEVECROSS ING F1				$1,414 ,50				$0 ,00	$,1 414.50	$1,414.50	100%	$0.00	$14U5	
															
	CHANGE ORDER 116-PHASE F1														
	CTB DIRECT PURCHASE ORDER														
1	CPOCredit- Soll Cemenl Base	(2 ,196 .00)	TN	S16.00	(S35.136 00)	0.00	·2196.00	-2196.00	S0.00	(S3,5 136 00)	($35,1;!6,00)	100%	S0.00	($, 3513.60)	
2	OPC Tax Savlngs	1.00	LS	(S2,108.16)	($2108.16)	0.00	1,00	1.00	SO.OD	($2,108 .16)	(S2,108 ,18)	100¾	S0.00	(S210.82)	
	TOTAL CHANGE OROER #6 • PHASE F1				($37,244 .16)				$0.00	($37,244.16)	($37,244,161	100%	$0.00	(Sl,724.421	
															
	CHANGE ORDER 117• PHASE F1														
	ATLANTIC TNG-VIL,LAGEF1														

Trpi le Creek CDO-VIJlageE,FandG1	APPLICATION  FOR PAYMENT RJPA& ASSOCIATI:S PROJECT•01 1707A

PA.YAPP FROM
TO

10REV
11/1/17
11/30/17

ITEM NO	

DESCRIPTION Of WOR	

OTY	CONTRACT SUM TO DATE		
				
BASECONTRACT	
ESTlM.ATEOQUANTITY	TOTAL
WORK IN Pl.ACE	TOTAi. WORK IN PLACE	TOTAL WORt(IN
PLACE	
PERCENT
COMPLETE	
BALANCE
TO F1NISH	
10l,
RETAINAGE	
			
UNIT	UNfT
PRICE	
VALUE.	TlilS
ESTIMATE	PREV
ESTIMATE	TOTAL
ES'lUt,ATE	THIS
PER.JOO	PREV
APPLICATION	i O
DATE	TO
DATE	'TO
DATE	TO
DATE	
t	OPO Credi! - Sanitary Structures.	I 00	LS	($ 15.600 ,70)	(5 15 ,600 . 70}	000	1. 00	1 .00	sooo	(515, 600 ,70)	($15,600 70)	100%	5000	($1.SW.07)	
2	OPO Cfe<fil • Storm Slructures	1.00	LS	(S223,64,50	)	(S22.364.50)	o.oo	1 00	1 00	W .00	(S22.364.50)	($22, 364.50)	100%	$0 00	(52.236.45)	
	FERGUSON WATERWORKS•VILLAGEF1														
1	OPO Creo,1- WaterMain	1.00	LS	($40.895,70)	(5-40,895.70)	0.00	1.00	1 00	S0.00	(5-40.895 ,70)	(S40 ,895 70)	100%	50.00	($4.089.57)	
2	DPOCredti- SantlatyPipe	1 00	LS	($22,911.04)	(S22,911.0 4)	0.00	1.00	1.00	S0.00	(S229, 11,04)	(5229, 11.04)	100%	S0.00	(S2.291.10	
3	OPOCredit- Under Drain	1.00	LS	($442.66)	(S442.66)	000	1,00	1.00	50.00	(544266)	($442.66)	100"A,	S0 ,00	(S44 27)	
	RINKER•VILLAGEF1														
1	OPO Credit• SIOrm Plpo	1,00	LS	($61,881.23)	($61,88123 )	0.00	1.00	1.00	SOOD	(561 ,881 .23 )	(S61.88L23)	100%	S0,00	(56 ,188 .12)	
	TOT AL CHANGE ORDER lfT • PHAS E F1				($164 ,095 .83 1				SO.OD	($164 ,09 5.83)	($164,095.83)	100%	SO.DO	($16,409.58 )	
															
	CH ANGE ORDER #8• PHASEF1														
	F1 GEOTECHNICAL TESTING														
1	Field Tec11nlc,ao Ser\'lces	1.00	LS	$11,750.00	511.75000	1 00	0.00	1.00	511,75000	S0.00	$11,75000	100%	S0.00	51,17500	
2	Lat>ora lOry Tes1,ng	1.00	LS	$3,106.00	S3,1B6.00	1.00	0 00	1.00	S3.186oo	so.co	S,3 186 00	100%	so 00	5318 60	
3	Eng1neerni g & Projecl Management	1,00	LS	S,1 400 .00	$1,40000	1 00	0 00	1,00	51,400.00	S0,00	S, 1 400 00	100%	SO.CO	S140 00	
	TOTALCHANGEORDER #8 • PHASEF1				$16,336.00				$16,336.00	SO.DO	$16 , 336 .0 0	100 o/,	$0.00	S1.633.60	
															
	CHANGE ORDER #9. PHASE F1														
	VILLAGE F1·DPO RECONCILIATION														
1	CPO Reconciliakl :m•Fergusoo-Village F1	1.00	LS	$22,031.79	S22,031,79	100	0,00	1.00	$22,031.79	5000	522.03.179	100%	S000	S2.203.18	
2	DPO ReconcihaliOll-RiOk.er v,oageF1	1,00	LS	518.762.28	$18,762.28	1.00	000	1 00	$18,762.28	S0.00	$18,762,28	100%	S0.00	S, ! 876 .23	
3	CPO Reconcmatrort-Atlanlk-VillageF1	1 00	LS	$1,760.55	$1,760.55	1 00	0.00	1.00	$1,760 55	S0,00	$1,760.55	100%	S0.00	5176.06	
4	OPO ReccncU,allon-CTS-Village F1	1. 00	LS	$10,009 60	S10,009.60	1.00	0.00	1.00	510.009.60	S0.00	S10.009.60	100%	S0.00	Sl.000.96	
5	6%Taxon At>ove	1 0Q	LS	$3,153.85	S3,153.85	1 00	0.00	1,00	53,153.85	S0,00	53,153.85	100o/o	S0,00	S31,5 39	
	TOTAL CHANGE ORDER #9 - PHASE Fl				$55,718.07				$55,718.07	50.00	$5, 5 718.07	100'1.	$0.00	$5,571.82	
															
	TOTAL PHASE F1				$1,39, 3 955.78				$152,684.75	$1,239,071.04	$1.391,755.78	100¾	$2,200 .00	$139,175.59	
															
	PHASEF2														
	GENERALCONDITIONS F2														
1	MObiliUttiOn	1.00	LS	S9,60000	S9,600,00	0,00	1 00	1,00	so.co	59,600,00	S9,600.00	100%	$000	S960.00	
2	NPOES Permll &Compliance	1.00	LS	54.05000	54,050.00	0,00	1.00	1 00	S0.00	54,050.00	$4,05000	100o/,	S0.00	540500	
3	Maintenance of Traffic	1,00	LS	S1.200.00	$,1 200.00	0.00	, 00	1.00	S0.00	$1,200.00	s 1.200.oo	100%	5000	S120.00	
4	Const Slakeoul / Reco rd Survey • By CCnlractor	1.00	LS	533,000.00	$33,000,00	0.00	1,00	1 00	so.co	$33,00000	$33,000 00	100%	S0.00	53.300 00	
5	Pavment & PCfformance8ood ByCootraclor	1 00	LS	s 10.100.00	$10,100.00	0.00	1.00	1.00	S0.00	510,100.00	s 10.100.00	100%	5000	s1.01000	
6	s111Fence	4,800.00	LF	$1.20	$5,760.00	0.00	4800.00	4800.00	SO.OD	55 ,760.00	S5.760,00	100%	sooo	5576 .00	
1	E>cisUng Inlets - Eros.on ProtecllOf't	6.00	EA	$9820	$589.20	0.00	6.00	6.00	so.oo	S58920	S589.20	100%	so.oo	$58 . 92	
	TOT AL GENERAL CONDITIONS F2				$64 ,299.20				$0.00	$6, 4 299.20	$64,299.20	100¾	$0.00	$6,429.92	
															
	EARTHWORK F2														
1	Cleartng & Grubbing	21.00	AC	$2,250.00	S47,250.00	0.00	21.00	21 00	so 00	547.250 00	$47 250,00	100%	sooo	$4,725 ,00	

}

Tripi, c, ..  k CDDV- ll1"11• E,F...  GI	APPLICATION FOR PAYMENT

RPI A&ASSOCIATESPROJECT #01 1I WIA

PA" AP P
ROM
TO

10RE\/
1111117
11130117

n'EM
NO	

DESCRIP TIO NOFWOR	

qry	COHTRA CT SU M TO DA TE		
				
BASE CONT RACT	
ESTlll'MEOOUAN"TITY	TOTAL
WORKIN
P(.ACE	TOTAi. WOR IN PLACE	TOTAL
WORKIN
PLACE	
P El,CENT'
CO MPLET E	
BALANCE
TOFINISH	
10%
RETAINAGE.	
			
UNfi'	U N!T
P IC£.	
VALUE	THIS
EST IMATE	P RE V
ESTIMATE	TO TAL
ESTtMAl E.	1H 1S
PERI OD	PRE V
AP PLICA TION	TO
DATE	-ro
DATE	TO
DATE	TO
OATE	
2	DtScSite	17,00	AC	$35, 500	S6.035.00	0 00	17.00	17.00	S000	S,603500	S6.035,00	100%	S000	$603.50	
i	Cul Volume( Unadjuslt!d l	2.050 00	CV	52.10	S4.305,00	0,00	2050.00	205000	S0.00	S4,305.00	$4,305.00	100%	sooo	$430 . 50	
4	Soddi'1!1	9.76000	SY	$24	5	523.912,0	0	0,00	9760,00	9760.00	$0,00	$23,91200	$2, 3912.00	100%	sooo	S2.391 . 20	
5	$Q<)(Jlng & Mulcnlng	6,864.00	SY	S0,25	51. 716 00	6864.00	0,00	6864 00	S1.716 00	$0 00	51 ,716 ,00	100%	$0.00	S1?1.60	
6	Oewa1erlng	1 00	LS	S720 .00	S720 .00	0 ,00	1 .00	100	sooo	S72000	S720,00	100%	S0,00	S7200	
7	FmalGrading	1.00	LS	$17,500.00	517.500 00	0.00	1 00	1.00	sooo	S17 ,50 Q.OO	S17.500 ,00	100 %	S0 ,00	5,1 750.00	
8	1111Ported All lO,-Pao Gr'3<1ing	7,400 00	CY	$700	$5, 1800.0	0	000	740000	740000	SO.DO	55,1 800 .00	$5 1,800 00	100%	S0.00	$5,180.00	
	TOTAL EARTHWORK F2				$15,3 238.00				$1,716.00	$151,522 ,00	S153,238.00	1ooy.	S0.00	$15,323.80	
															
	PAVING ANO BASEF2														
1	1 31,r  s. , Asphalfic:Coocr1ee	6,62100	SY	59.20	560.913.20	OllO	662100	6621 ,00	S000	SG0,913,20	S60.913 ,20	100 %	S0.00	56,091 .32	
2	6"Crus!led Conc,eteBase	l;,Q21.QO	SY	510.30	SGS.196.30	0.00	6621.00	6621,00	S000	! 68',196.30	$6, 8 196 30	100%	sooo	S6 .819 .6 3	
3	6" Sla b1llzed S ubg ra<Je (LBR 40)	6,621.00	SY	SG.85	$45,353.85	0.00	662100	662100	S0.00	S<5.353.85	S45.353.85	100%	5000	$4,535.3	
4	Miami Cu.-C w/Siab lllzalJOn ( Full Oeplh)	5,616.00	LF	51105	$62,056.80	0.00	5616.00	5616.00	sooo	S62 .056.B O	56,2 056.80	100%	S0.00	56,205.68	
5	ln,e,seclloo• VaileyGutter(CounryDelall TD-6)	70,00	LF	SS0.90	$3,563.00	000	70.00	70.00	S0.00	53.563.00	$3,563.00	100Yo	S0.00	5356.30	
6	5'x4· eonc,ete Sldewatk	398 .00	LF	$19 .50	$7 ,781 00	000	39800	398.00	S0.00	57.76100	57,761.00	100%	S0,00	5776.10	
7	1O'J1.4- Cooc:reteSiclew8'k	80000	LF	$39.05	531,2<0.00	0.00	800,00	800.00	S0.00	$31,24000	s J1,2• 0.oo	100%	S0,00	S3,124 .00	
8	10 '• 6" Shell MalOflal · Tra, I (w /S I Fenceon 80mSiOe)	935.00	LF	$25.50	S23.842 50	935.00	0.00	935.00	S23,8'12.50	S0.00	S23,842.50	100%	sooo	S2,384.25	
9	AOA Ramps(5' wide)	700	EA	S840.00	S5.880,00	0.00	7,00	700	SO.DO	5,5 880 .00	$5,880,00	100%	S0.00	$588.00	
10	ADA Ramps(10'wld<>)	8 . 00	EA	$1,200.00	$9,60000	0,00	8,00	e.oo	S0 .00	$9 ,600 . 00	59,600.00	100%	S0,00	S960.00	
11	Slgnage&.Sloping	1 00	LS	$6.25000	$6,250.00	0.00	1.00	100	S0,00	5,6 250.00	S6,250.00	100%	S0,00	S62500	
	TOTAL PAVING AND BASE:F2				$324,656.65				$23,8"2.50	SJ00,814.15	$32,4 656.65	100°/4	$0.00	$32,465.67	
															
	POTABLE WATER DISTRIBUTION F2														
1	Connec!lo ExiSHng 8"W/M	2,00	EA	51.250 00	5,2 500.00	0.00	2.00	2.00	S000	$2,500.00	S2.50000	100%	so.oo	S250 00	
2	8"F'VCPipe C-900	3,128,00	Lf	S14.60	$45,668.80	000	3128.00	3128.00	S0.00	S45,668,80	545.668 BO	1 00%	S0 . 00	$4 ,566 .88	
J	5- Fire Hydranl Assembly!w/TeeFitting Connectron	5.00	EP.	$3,700 .00	S18 ,50,0 00	000	5.00	5.00	sooo	$ 18,500 .00	S18 .50()00	100%	,sooo	$ 1 ,850 00	
4	a·GaleValve	1,9 00	EA	5400,00	$7,600,00	o.oo	1900	1900	S0.00	S7,600.00	S7,600.00	100%	so00	S76,0 00	
5	a BendFltt,ngs	8,00	EA	5 260.00	S, 2 080 00	0.00	8.00	8.00	S0.00	52,080.00	$2.08000	100%	S0.00	$20800	
6	8" TeeFit11ngs	4,00	EA	5400 .00	S1.600.00	0,00	00	00	S0.00	51,600.00	$1,600 00	100%	$0,00	S160 00	
7	SlnglH S etVlce. Shor!SIil•	1,00	EA	5240.00	S11,280,00	000	47 00	47 00	so 00	S11,280.00	$1,1 280.00	1()0¾	,o.oo	Sl ,1 28 , 00	
8	s1ng1e SCM ce , Lor,g Side	31 ,00	EA	$325,00	$ 0.075 00	000	31.00	31.00	so00	S10.075 ,00	$10 .075 .00	100%	S0.00	S1,007,50	
9	Temwa,yCon5truc;;t1Qn Meter	1 00	EA	S9.900.00	S9.900.00	0,00	1.00	1.00	SO.DO	$,9 900 .00	S9 .900 .00	100 %	sooo	599000	
10	Chk>rinalion1 Sampllog & PressureTesting	1.00	LS	55,400.00	S5.400,00	0,00	1.00	1.00	5, 000	$,5 400.00	S5,400 00	!00 %	S0,00	$540.00	
	TOTAL POTABLE WATER DISTRIBUTION F2				S114,603 .80				$0 ,00	$114,603 .80	S114.60J .80	100%	$0.00	$11.460,:lS	
															
	SANITARY SEWER F2														
1	8" PVC,SOR 26(0'-10-Cul)	1,337 00	LF	S15.00	520.055.00	000	153700	133700	S0.00	,    20,05,500	S20.055,00	100%	so.oo	52 ,005 50	
2	11' P\/C.SOR26(10'·12' Cul)	32300	Lf	S1710	SS.52330	0.00	'323,00	.323,00	sooo	$5 ,523 ,30	S.S,523.30	100%	so 00	$55233	
3	8"PVC, SOR 26 (12'·14' Cul)	379.00	LF	$20.35	$7,712.65	0,00	37900	379 00	S0,00	S-7. 712 65	57,712 85	100%	sooo	577,1 27	
4	8" PVC.SOR 26 (14'•16' Ctrt)	397 00	LF	SW.60	Sl l ,751.2()	0.00	397 00	397,00	S0,00	$11.751.20	S11 751 20	100%	S000	Sl,175.12	

9

111 ,1 •1

Trfpl•CreekCOO-Vi0e,ge E,FindGt	l' PPLICATION FOR PAYMENT

RIPH ASSOCIATES PllOJECH 011701A

PAYAPP FROM TO

10REV
1111171
11/30/17

CONTRACT SUM TO DATE
TOTAL	TOTAL	TOTAL
OESCRlPTION OF WOR;K	BA.SE CON'fRACT	ESTIMATED QUANTITY	WORK IN	WORK IN	WORl<"IN	PERCENT	BALANCE	100.

,o

ITEM	PLACE	PLACE	Pl.ACE	COMP\.ETE	r0FrN1SH	HETAINA.GE
NO.	OTY	UNH	THIS	PREV	TOlA L	THIS	PREV	TO	TO	TO
UNIT	PRICE	VALUE	ESTIMATE      ESTtMA.fE	ES TIMATE	PERIOD	APPLICATION	DATE,	DATE	DA.TE	DATE

5	SanrtaryMaotiole(0'-8' CU1)	5(10     EA	s2.400.00

S 12,00000	0,00	5 00	5.00	S0.00	S12,000.00	s12.ooo,oo	100%	sooo	S1 , 200 .00

6	SanitaryManhole(8'-10' Cut)	1.00       EA	$2,800 .00	S2 ,800.00	000	1 00	1.00	S0.00	52.8-0000	52 ,800 ,00	100%	sooo	$280 .00
I	Samta,v Manoole (10'-1Z Cul)	2.00      EA	$3,00000	S6,000.00	0.00	2.00	200	S0,00	S6,000.00	S6.000.IIO	1 00%	so.oo	$60000

8	Sanitary Manhole (14'•16' Cul)	2.QO    EA	$3.90000

S7,800.00	0.00	2.00	2.IIO	So.oo	S7,800 00	S1.8-00.00	100%	$0 00	5780 .00

9	Slogre Seo,lce(Hllls bOro<,gh County/	15.00     EA	$595 .00	SS.925 .00	000	15 ,00	15.00	5000	58,92500	58.92500	100%	so.oo	5892 . 50

10	Double Service(HillsbOrough County )	3200      EA	S77500

524,8-0000	000	32.00	32.00	$000	$24,80.00	524.800 00	100%	$0,00	S2.480.00

11	8" Slub-oul CooneciJOn	2.00      EA	$d50,00	$90000	0.00	2.00	2.00	so.co	5 900.00	$900.00	00%	sooo	S90,00

12,       Oewatenng	1 00     LS	529,50000

S29.500.00	0 00	1.00	1 00	so00	$29,50000	S29.500.00	100%	so.oo	S2.950 ,00

1 3	lnfll/E Xfil TesUng	1.00	LS	54.1.50.00	$4,150.00	0.00	1-00	1.00	S0.00	54.1.50.00	$4 150.00	100%	S0.00	S415,00
14	Tele'11se Sani ta ry Sewer(CCTV)	2,436.00      LF	S3,05	$7,429.80	0.00	2436 00	2436.00	so.oo	S?.429 .8-0	5,7 429.80	100%	S0.00	S742,98
TOTALSANITARY-  SEWER  F2	$149,346.95	so.oo	$149  ,346 .95	$149 ,346.95	100 %	$0 .00	$14 ,934 .70

STOR M DRAINAGE F2
1	15" Class IllRCP	6, 500      LF	S23 30	S1.514.50	0.00	65.00	65.00	S0.00	$,1 514.50	S1,514.50	lOO'll	S000	$151.45
2	18"ClassIll RCP	300.00      LF	S28.40	S8.520 00	000	300.00	300.00	so.oo	S8.520 . 00	S8.5ZO.OO	1 00%	S0 . 00	$852.00
'.I	24"Class Ill RCP	240.00      LF	$38 30	$9,192.00	0.00	240.00	240.00	S0.00	59,192.00	59,192.00	100%	S, 0 00	$919.20
4	30· ClassIll RCP	870.00         LF	$5250	.$45,675.00	0.00	870.00	870.00	sooo	S45, 6 7 5 . 00	545,675 . 00	100%	S0 .00	$,4  567 50
5	36"  Class Ill RCP	320 .00       LF	$72.10	S2, 3 072.00	o.oo	320  .00	320 . 00	sooo	S23,072.00	S23.072.00	100%	S0.00	$2,307.20
6	42" crassIll RC P	475 ,00       LF	$90.65	543,058.75	000	41500	475.00	S0.00	S43,058.75	S43.058.75	100%	S0.00	54,305.88
7	Inlet Type1 (HC)	14.00       EA	5,4 150.00	$58,100 00	0.00	14.00	14 00	S0.00	$58,100,00	$58 100.00	100%	S000	55,810.00
A	FOOT ManhOle	,,oo  EA	S3.250.00	S13,000.00	0.00	4 00	400	S0.00	$13,000.00	$13,000.00	100¾	S0.00	$1,300.00

9	Cewatefiog	1.00	LS	S18,500.00

S18.500.00	0.00	1 00	1.00	$0 00	S18, 500.00	S1, 8500,00	100%	S0.00 	51.850.00

10	Tele'l1seS\Om'l Sewer(CCTV)	2,270.00      LF	56.35	S14.414.50	0.00	2270.00	2270.00	so.co	S14,414 50	$14,414.50	100%	S0.00	$1.441.45
11	6" UNOERORAIN( FINE AGGREGATE)	48-0,00	LF	511.95	S51736.00	000	480.00	48000	sooo	SS.136.00	S5,736.00	100%	S0.00 	5573 .60
12	UNOERDRAIN CLEANOUT	5.00      EA	S185 .00	S925 .00	0.00	5 .00	500	S0.00	$925 .00	S925 .00	100%	S0.00	$92  50
TOTAL STORM DRAINAGE F2	$241,707 .75	S0.00	$241,707 .75	$241,707 .75	100'!.	S0.00	$24,170.78

ROAD SLEEVE CROSSING F2
1	2" Sci140 PVC	90.00       LF	54.8-0	5432 .00	0 ,00	90,00	90.00	S0.00	5432 .00	5432 .00	10011,	SO.DO	Sd320

2	4"Sch 40 PVC	270.00 LF	5615

$, 1660.50	0.00	270.00	27000	S0.00	$1,660.50	51.660.50	100%	S0.00	$166.05

3	6" Sc h l OPVC	60 00       LF	SB 15	$489 .00	0.00	6000	60.00	S0.00	S489 ,00	S489.UO	100%	S000	54, 8 90
TOTAL ROAD SLEEVECROSS ING F2	$2 ,581.50	$0.00	S2.581. 50	52,581.50	100%	$0 .00	S258.15

OHANGE ORDER #2 · PHASEF2

'

OPO Credil - Feryusoo • Water	1.00      LS	($103,570.92)	($103.570.92 )	000	, 00	1,00	S000	(5103.570.92)	[$103,570.92)	100%	S0.00	($10.357 09)
2	CPOCrEl(l!t - Ferguson- Sewer	1.00       LS	1S22,285 24I	(S2, 2 285.24)	0_00	1  00	1  00	S0-00	($22,285.24)	($22,28524)	100%	S0,00	(S2.228. 52)
3	OPOCredit- Ferguson- SJeeves	1.00      LS	(568, 6 40)	(S686.40)	0.00	1 00	1.0Q	so  00	(S686 ,40)	(S686.40)	100%	S0.00	($68.64)
4	CPOTax Savings	1 .00      LS	($ 7,592.56)	($ 7, 592 .56)	000	1 00	100	so00	(5, 7 592.56)	(S l .592 .561	100%	S0.00	(S759.26)
TOTALCHANGE ORDER #2 • PHASE F2	(5134,135.12)	$0,00	($134,135.12)	(St34,135.12)	100¾	$0.00	(113,413.51)

CHANGE ORDER #J • PHASE F2

j t,.1 11

Triple Creek COOV-ill1g• E,FandGt	APPLICATION FOR PAYMENT

RIPA& ASSOCIATES PROJEC,T ol- 1707A

PAY APP
ff OM
JO

10REV
1111117
11/30/1 7

ITEM NO	

DESCRIPTIO NOF WORK	

OTV	CONTRACT SUMTOOATE		
				
BASECONTRACT	esTIMATEOOUANTfTV	TOTAL WOOK IN PLACE:	TOTAL
WORl(IN
PLACE	TOTAL WORK IN
Pt.ACE	
PERCENT
COMPLETE	
BALANCE TO FINISH	
lo,I,
RETAM,GE	
			
UN<l	UN IT
PRICE	
VALUE	T HI S
ESTIMATE	PRE V
ESOMATE	TO TAL
E.STIMAT E	THIS
PERIOD	PR.EV
APPLICAl'!ON	TO
DAlE.	10
DATE	TO
DATE	TO
OAtE	
	EARTHWORK F2														
1	FmVotume (Long Haul From Blvd.)• ReplacesImport	7 ,oo.oo	CY	S27 5	SW.350,00	0.00	7400 .00	7400 .00	S000	520,350.0	0	S20.35000	100%	S0.00	$2 ,035.00	
2	FIii Volume (Loog Haul From81"'1.) • Replaces Flll Form E2/E3	46,500.00	CY	$2.75	5127,875.00	0,00	46500,00	46500.00	S0,00	S127,B75 00	$127.8 75.00	100,.	sooo	5 12.787 ,50	
J	lm poliodFIii	(7.400 ,00)	CV	S7 .00	(551 ,800 00)	000	- 7400.00	.1, 00.00	S0,00	(S51,800 00 )	(S51,800.00)	100%	S0.00	(SS.180,00)	
	TOTAL EARTHWORK F2				$96.425,00				$0.00	$96,425.00	$96,425.00	100%	$0.00	$9.642.SO	
															
	GEOTECHNICAL TESTING F2														
1	F2 • Flffld Techrnc,anServices	1 .00	LS	S22.863 ,60	$22,86360	0.00	1.00	1 00	S0.00	522.863.60	S22.863,60	100'1,	S0.00	52,286 36	
2	F2 • LabratoryTesting	1 00	LS	53.762 00	SJ.762.00	0 00	J,00	1 00	S0.00	$3.762.00	$3,762.00	100%	S0.00	5376.20	
3	F2 • Eogloeering & Pro)cclMaoagemeo1	1,00	LS	S2,730 00	$2,730.00	0.00	1.00	1 00	sooo	52.730 ,00	52 .730 .00	100%	S0.00	S273.00	
	TOTAL GEOTECHNICAL TESTING F2				$29.355.60				$0.00	$29.355.60	$29.355.60	101)¾	$0.00	$2,935.56	
															
	SEEDING& MULCHING F2														
1	SOO<hog & Mulching	81 .460,00	S ¥	S0.25	$20,365 .00	0 00	81' 60.00	81460.00	$0 .00	SW.365 ,00	$20,365.00	100%	so.oo	52.036.50	
	TOTAL ·SEEDING & MULCHING F2				$20.365.00				S0.00	520,365.00	$20.365.00	100%	50.00	$2,036.50	
															
	TOTAL CHANGE ORDER #3 • PHASE F2				$146,145 .60				$0.00	$146.145.60	5146,145.60	100¾	$0.00	514,614.56	
															
	CHANGE ORDER #4 • PHASEF2														
1	CPO c,echt - Rinker - Storm P ipe	1.00	LS	(S63,013.48)	(S63.013.48)	0,00	1 00	1 00	S0.00	(S63.013A8)	(563,013,48)	100%	S0,00	($6,301.35)	
2	CPOTaxSavings	1.00	LS	($3 ,800.81 )	(53.800 .81)	0.00	1.00	1.00	S0,00	(SJ,800,81I	($3 .800 ,81 )	100%	S0,00	($380 08)	
	TOTAL CHANGE ORDER #4• PHASE F2				($66,814.29)				S0.00	($66,814.29)	($66,814,29)	100 ¾	$0.00	($6.681.43)	
															
	CHANGE ORDER #5 • PHASE F2														
1	OPO Credi! . AUanucTNG. Sewe.- Struclures	1 00	LS	(S12,430 75)	($12. 430 75)	0.00	1.00	1,00	so 00	(S12.430,75)	(S12,430,75)	100%	S0.00	($1.243 081	
2	OPO Credit · AUanttc TN G • Stonn Structures	100	LS	(S19.141.55)	(S19.1' 1.55)	0.00	1,00	1.00	S0.00	(S19.141.55)	(S19.141.55)	100%	S0.00	($1,914 16)	
3	DPOTa, Savings	1. 00	LS	(S1,904.33 )	($1,904.33)	0.00	100	1.00	S0.00	(S1,904,33)	(51.904.33)	100%	so 00	($190 43)	
	TOTAL CHANGE ORDER #5 • PHASE F2				($33,476.631				$0.00	($33.476,631	($33,476.63)	100 ¾	so.oo	($3, 347.67)	
															
	CHA NGE ORDER #6• PHASE F2														
	CTB DIRECT PURCHASE ORDER														
1	OPO Cre<III. SoilCeme nl Base	(2.549.00)	TN	516.00	(540,784.00)	0 00	-2549,00	-2549.00	S0 .00	($40,784.00)	(540.784.00)	100%	S0.00	(S4.078.40)	
2	DPO Tax Savings	1.00	LS	($2,447.04)	(S2.447.04)	0.00	100	1 00	S0,00	(S2.447.04)	(S2.447 04)	100%	S0.00	($244.70)	
	TOTAL CHANGE ORDER #6· PHASE F2				($43,231.04)				so.oo	($43 , 231 .04 )	($43,231.04)	100%	$0 ,00	($4.323.10)	
															
	CHANGE ORDER #9 • PHASE F2														
	VILLAGE F2·DPO RECONCILIATION														
1	OPO Recono tiabOn..Rinker.V inage F2	1,00	LS	S7,943,20	S7.943.20	1,00	0.00	1 00	$7.943.20	S0.00	S7.943.20	100%	000	S79432	
2	6%Ta)( onAbOve	1.00	LS	5476.59	$476,59	1,00	0,00	1 00	$476. 59	S(l.00	$l 76.59	100 %	S0,00	$47.66	
	TOTAL CHANGE ORDER #9 • PHASE Fl				$8.419.79				$8.419.79	$0.00	$8.419.7'.l	100 '1,	$0 .00	$84,1 98	

l l r•)I

Triple Cree.k CDD-Villtgt,E F and Gf	APPLICAT ION FOR PAYMENT

RIPA &ASSOCIA1 ESMOJECT#Of 170 7A

PA.V APP
FROM
TO

10REV
11/1 /17
11130/17

ITEM NO	

DESCR IPTION OF WO J.ll'I.	

OTV	CONTRACTbUM TO DATE		
				
BASECONTRACT	
ESTIMATE.DQUANTITY	TOTAL
WORK IN
::JLACE	TOTAL WORK IN P LACE	TOTAL
WOR IN PLACE	
PERCENT
C OMPU :'.TE	
BALANCE
TOF  lMSH	

\O'J',
RETAINA1Gc	
			UNIT	Ur,.IIT
PRICE	VALUE	1HIS
ESTIMATE:	PREV
ESTlMAJE	TOTAL
ESTIMATE.	THIS
PERICO	f'f!EV
APPLICATION	TO
DATE'	TO
DATE	TO
OA"TE	TO
DATE	
	TOTAL PHASE F2				$927,342.16				$33,9711.29	$1193,363.37	$927 ,342.16	100¥,	$0.00	$92 ,734.23	
															
	PHASEG1														
	GENERAL CONDITIONS G1														
1	Mobitlzallon	100	LS	S,9 600.00	$9 ,600 00	0 ,00	1.00	1.00	S0.00	S9.600,00	S9,60, 000	100%	50.00	$96,0 00	
2	NPDES Compliance	1.00	LS	S5,250.00	S5.250.00	0,00	1.00	1 00	sooo	55.250 ,00	$5.250 .00	100%	$0.00	$525.00	
3	Malntooanco of Traffic	1 00	LS	S l.200.0	0	S1.200.00	000	1.00	1.00	S000	$1.200.00	51.200,00	100%	50.00	$12000	
d	Const StakeoutJRecordSurvey. ByConuactor	1 00	LS	$46,000 .00	546 .000 .00	0.00	100	100	S0 .00	$4,6 000 00	S46.00,0 00	100%	S0.00	$4,600.00	
5	Payment & Perfonnooce. Bones • ByContrnc:k>t	1 . 00	LS	517.00000	S H.000.00	0.00	1.00	1.00	sooo	$17,000 .00	$17,000 .00	100%	S0.00	$1.700,00	
6	Silt Fence	6,900 ,00	LF	51.2	0	SS.280.00	000	6900,00	6900.00	SO.OCI	SB.211000	$8.2110 00	100%	S0.00	S82800	
	TOTALGENERAL CONDITIONS G1				587,330.00				$0.00	S87.330.00	$87,330.08	100•4	S0.00	S8,733.00	
															
	EARTHWORK G1														
1	Cleanng &Grubbu19	28.00	AC	$2.000.00	$56,000 .00	0.00	28.00	28,00	S0.00	556.000.QO	S56 .00,0 00	100%	so 00	SS.600.00	
2	OiseSile	24.00	AC	S355,00	$8,520 00	0.00	24.00	2400	,sooo	58.52000	sa.s20.oo	100%	50.00	S852.00	
3	Cul Volume(Unadjusle<l)	35.880 00	CY	.S2,10	S75,348.00	0,00	35880.00	35880.00	sooo	5 75 ,348 . 00	$75 ,348 .00	100%	S0,00	S7.534 80	
4	SOdding	20.955.00	SY	52,45	$51 ,339 75	0.00	20955.00	2095500	S0.00	S51,33975	$51,339.75	100%	sooo	S5 ,133 98	
5	seed"'!)& Mulching	8.506 00	SY	S0.25	$2.12650	8506,00	0.00	8506.00	$2,126.50	SO.CO	$2 ,1 :,16 50	100 %	S0.00	$212 .65	
6	Dewalering	100	LS	S2,000.00	$2,000 00	0.00	1.00	1.00	S000	S2.000.00	$2,000.00	100%	S0.00	$200.00	
7	FfnalGrading	1 00	LS	521.500,00	$21,500.00	0.00	1110	1.00	$0.00	$2, 1500.00	$21.500.00	100%	sooo	S2 ,150 ,00	
8	Imported Fill	10,400 .00	CY	S700	S72.800 00	000	10400.00	10400.00	sooo	S72 .800 . 00	S72.BOO,OO	100%	sooo	S7.2S0.00	
9	lmponedFOirorPadGrading	5,800 .00	CY	S7 ,00	S,,0.60000	0.00	5800.00	5800.00	S0.00	$40,600.00	540,600.00	100%	S0,00	$4,060.00	
	TOTAL EARTHWORK G1				$330,234.25				$2,126.50	$328,107.75	$ 330,234.25	100%	$0.00	$33,023.43	
															
	PAVING AND BASE G1														
1	1 314"S- 1 Asphal!cl  Concrele	9.275 00	SY	S92	5	5857, 93.7	5	0,00	9275.00	9275.00	so00	585, 793 .75	S85 ,79.1.75	100%	S0.00	SS,579.37	
2	S- Crusoed Concrete Base	9.27500	SY	S10.30	S95,532.50	0 00	9275.00	9275.00	50.00	S95.532.50	$95,532.50	100%	50.08	S9,553.25	
1l	6" S1aolllzed Sut,gra<Je(LBR 40)	9.275.00	SY	$6.85	$63.533, 75	0.00	9275.00	927500	so 00	$63,533.75	S63,533.75	100%	S0.00	S6.35338	
4	Miami Curt> wlStat>llization(FullOeplh)	,6 960 00	LF	S1110	$ 77.256.00	o.oo	696000	6960.00	S000	S77.25600	$77,256.00	100%	S0.00	S7.725.60	
5	s· Wide RibbonCurt>	6,,j2 00	LF	$11.05	S7,094 10	0 .00	6,j200	642,00	S0.00	S, 7 094.10	$7,094,10	100%	S0.00	$70,9 41	
6	loters ec tloo • Valley Gu1ter (Couoly Delall TD-6)	1 0.00	LF	$50.90	U.126-00	0,00	140 00	14000	S,000	S712600	$7,12600	100%	S0.00	571260	
7	5'1t4- Concrele Sidewalk,	1, 840 .00	LF	S19.50	$35.880 00	000	tfl.10.00	1840.00	S0,00	S35.880,00	S35.IJBO.OO	100%	$000	$3.588.00	
8	10' J<4.  Concrete Sidewalk	586.00	LF	53905	522,883.30	0.00	586,00	586 00	sooo	522 ,883 ,30	S22 .883 ,30	100%	S0.00	$2.2,8833	
9	10' Wide Asphall Pavement (w/base & sut>grade),. Trait	346.00	SY	$25.90	$8.961.40	0,00	346,00	346,00	,sooo	58, 961 . 40	S8.961 40	100%	10 ,00	S89614	
,1,0	10'xs·ShellMate rial· Trall(W/SII\ Fenceon SOl!lSide )	720.00	LF	S25.50	$18,360.00	720,00	000	720,00	S18,360,00	S0,00	$18.360.00	100o/,	so.oo	$1.836.00	
	AOA Ramps(5' wide)	17,00	EA	5840.00	$14 .280.00	,0 (J(J	17 .00	17 .00	S0 ,00	S1' ,21,1000	S1 4.280.00	100%	$000	St.428.00	
12	AOA Ramps(10' -,\de)	4.00	EA	51,200.00	54,000 00	0.00	4.00	4.00	sooo	54,800,00	S4.SO0.OO	100%	$0.00	548000	
13	12"Wide• CoocreIeBtod< wa 1I	203.00	LF	$92.60	518.797.80	0.00	203,00	203.00	S0.00	$18.797.80	$18.797.80	100%	$0.00	S1.879. 78	
14	Signage &S triplng	1 00	LS	S8,350.00	SS,350.00	000	1 00	1,00	S0,00	S8,350,00	SS.350.00	100¾	S0.00	$835.00	
	TOTAL PAVING AND BASEG1				$<168 ,648.60				$18,360.00	$450,288.60	$4611,648.60	100 %	so.oo	$46,86,4 86	

Tripel Creek COD-ViUageE F and 01	APPLICATION FOR PAYMENT

RIPAP    SS OCIATESP=      C,T   01 1101A

PAV APP FROM TO

!OREV
1111117
11/30117

IT EM
NO	

0£ SCR IP TIONOF WORK	

OiV	CO NTR A.CT SUM TOOi.TE		
				
BASECONTRACT	
ESTIMATEDOVANTITY	TOTAL WORK.IN
P LACE	TOTAi. WORK!
PU C E	TOTAL
WORK IN
PLA C E.	
PERCENT
C OMPLETE	
BALANCE
TO FINISH	,o,.
REl AINAGE	
			UNIT	UNJT
PR ICE	
VALUE	T H I S
ESTIMATE	P RE V
ESTIMATE	TO TAL
ESTIMATE	I HIS
PERIOD	PRE V
APPLICATION	T O
DATE	TO
DATE	TO
DATE	TO
DATE.	
	POTABLE WATER DISTRIBUTION GI														
I	4" PVC PVCC-900	796.00	LF	S8.10	56,447 60	0.00	796.00	796.00	sooo	S0,44760	$, 6447.60	100%	S000	S64U6	
2	6"PVC Pope C - 900	1,680 .00	LF	$10 . 50	S17 . 640 ,00	,0 00	1680.00	1680.00	so.oo	SH ,640.00	S1, 7 640,00	100%	S0.00	Sl .764.00	
3	8" PVC Pipe v900	1,842.0	0 LF	S14.6	0	$26,89320	0.00	1842.00	1842.00	S0.00	S26,893 20	$26,893.20	100%	S0.00	S2.689,32	
4	6" FireHy<lranl AssemD ly/w/Tee F•lllng COnoection	7.00	EA	53,700 00	$25,900.00	O.l)O	7.00	700	sooo	S25,900 .00	$25 ,90,0 00	100%	S000	$2.59000	
5	4 Gate Valve	4 00	EA	$71500	S2.86000	0,00	4.00	4.00	5000	5, 286000	S2,86.00	100%	S0.00	S286.00	
G	s· GateValve	11.00	EA	587000	59.570,00	0.00	11.00	11 00	S0.00	S, 9 570.00	5 9.570,00	100%	S000	$957.00	
7	a• Gate Valve	13 .00	EA	S400.00	S,S 200,00	0 00	13.00	13.00	SO.DO	55,200 .00	55,200 .00	100%	so 00	$520.00	
8	•· Bend Fittings	12,00	EA	515000	$1,800.00	0.00	12.00	12.00	SO.DO	$ 1 ,800 .00	5 1,800 00	100o/,	so .co	S180 ,00	
9	s· Bono Flt1tngs	1600	EA	$185.00	$2.90000	0.00	16.00	16.00	S0,00	S.29, 00.00	52.96000	100%	SO.DO	$296.00	
10	6'" Tee Fittings	1 00	EA	S290.00	$290.00	0.00	1.00	1 00	S000	5290.00	529000	100%	S0.00	S2900	
11	6" Cmss Filfings	1.00	EA	$395.00	$395 ,00	0.00	1 00	I 00	S0.00	$'.195.00	S39,5 00	100%	SO.DO	S39 .SO	
12	8" Bend Fittings	6.00	EA	$260.00	51,560,00	0.00	6.00	600	SO.OD	S1.560 ,00	S1 ,560 00	100%	S0.00	S156,00	
13	8" Tee Flt!lngs	5.00	EA	$400 ,00	$2 ,000 ,00	o.oo	5.00	5 .00	SO.OD	$2 ,000 ,00	$2 ,000 ,00	100%	S0.00	$200.00	
14	8"x6- Reducer	1 00	EA	S135.00	$235.00	000	, 1 00	1.00	S000	5235.00	$23500	100%	SO.OD	523 .50	
15	B lo w-Off Assemby (SeeGounty Drwg No. W-6A)	1.00	EA	Sl ,200.00	s1 . 200 .00	000	100	I 00	S0 ,00	S,l 200 ,00	S1 ,200 00	100%	S0,00	S120,00	
16	S<ng1eSe,vice , ShoS1de	61,00	EA	$240 .00	514 ,640 00	0.00	61 .00	61 .00	sooo	$14, 640 ,00	S1 4 .640 ,00	100 %	S0.00	$1,464.00	
17	Single Service, Long Side	14,00	EA	S325 ,00	54,550 .00	0.00	14 00	1,4 00	S0.00	5,4 550 .00	54,550 ,00	100%	SQ,00	S455.00	
18	Temporary ConslruclionMeter	1.00	EA	S9,90Q.00	S9,900.00	0,00	100	1,00	SO.DO	$9 ,900 00	59.90000	100%	S000	S990,00	
19	ChlOnnat lo,o Samp ling & PressureTes ng	1,00	LS	S7,35000	57,350.00	0.00	1.00	1,00	S000	$, 7350.00	57,35, 000	100'11,	S0 .00	S735 00	
	TOTAL POTABLE WATER DISTRIBUTION G1				$ 141,390 .80				SO.DO	$141 , 390 . 80	$141,390 . 80	100 '1,	S0 . 00	$14 ,139 .08	
															
	S ANITARYSEWE G1														
1	8"PV,C SOR 26 (IJ\.10' Cul)	3.584,00	LF	S15.00	$53,760.00	0.00	3584 00	3584.00	SO.OD	S5,3 760 00	553.760.00	100%	SO.OD	SS.37o.00	
2	5aMary Manh<ll• (O'·B' Cut )	24.00	EA	$2 ,400.00	$57,600 .00	0.00	2,4 00	24,00	so.on	S57 60000	S57,60000	100%	so.oo	S5,700.00	
3	Sa'111ary Man'1o4e (10'·12'  Cut)	2.00	EA	S3.000.00	56,000.00	000	2.00	2,00	S0,00	$6,000,00	SG,000 .00	100%	sooo	$60,0 00	
4	srng10 Service(Hillsborough county)	1600	EA	$595,00	$9, 520.00	0.00	1600	16.00	S0.00	$9,520.00	$9,520.00	100%	sooo	S952 .00	
5	00\JbleService(Hillst>orough county)	33.00	EA	sn 5,00	$25,575 00	0.00	33 ,00	33.00	sooo	S25.57500	525.575,00	100%	$0,00	S2,557 50	
6	8" Stub & Plug	1 00	EA	$45000	>450.00	0.00	1 00	I 00	S0.00	5450.00	$450.00	100%	S0,00	$45.00	
7	lnftl/Exnl Tesl l119	I 00	LS	$4 ,900 .00	$4 ,900 .00	000	1 00	1.00	S0.00	$4,900.00	S4.90000	100%	S000	>490.00	
8	Dewatering	1.00	LS	S34.500,00	$34,500 00	0 00	1 .00	1 00	S0.00	s:34.50000	S3, 4 500 00	100%	50 00	SJ.450 00	
9	Telev,seSanllary Sewer(CCl''V)	'.1,584.00	LF	S3.05	$1, 0 931 20	000	3584,00	3584 00	S0.00	Sl0 ,931 20	510.931. 20	100%	$000	S1,093. 12	
	TOTALSANITARY SEWER G1				$203,2:lo.20				S0.00	$203,236.20	$203,236.20	100•;.	SO.OD	$20,323.62	
															
	STORM DRAINAGE G1														
I	15" ClassIll RCP	179.00	LF	$23 .J(l	$4,170.70	0.00	179 00	179.00	50 .00	$4 ,170 .7()	$4,170.70	100%	SO.OD	,4 17,07	
2	18" Class111 RCP	427.00	LF	528.40	512,126,80	0.00	427. 00	427.00	SOOD	s12 . 126 00	s, 2.12& .oo	100%	S0.00	S1,212.68	
3	24" ClassIll RCP	1,024 .00	l F	$3830	S39.219.20	0.00	1024.00	1024 DO	S0 .00	539.219 . 20	$39,219 .20	100%	S0.00	53.921.92	
4	30· ClassIll RCP	714.00	LF	S52.50	$37,485.00	000	714 00	71400	SO.OD	$37.48500	$3, 7 485.00	100%	SO.DO	5,3 748.SO	
5	36" ClassIII RCP	33 .00	LF	572 10	52.3 79 30	0.00	33 .00	33 .00	sooo	$2.379.3	0	$2,379.30	100%	so .oo	S237 93	
6	lnlel TypeI (HC)	1600	EA	$4,150.00	S66.400.00	0.00	1600	16.00	S0.00	$66,400.00	566,400,00	1cm.	SO.DO	55.640.00	

T,!pto CrHk COO-Vlltogt E, Fand 61	APPLICATION FOR PAYMENT RIPA&ASSOCIATESPROJECT #01-1707A

PAV APP FROM TO

10REII
1111117
11/30/17

CONTRACTSUMTO 0A TE

DESC RIPTION   Of W K	BASECONiRACT	ESTIM/1TEO QUANTITY

TOTAL	TOTAL	TOlA.L
WORK.IN	WOR:   IN	WORK.IN	PERCENT	BALANCE

ITEM	PLACE	PlACE	PLACE.	COMPLElE	TO FINISH	RET"AI"'NAGE
NO	QTY	UNJT	THI$	PREV	TOTAL	rHIS	PREV	TO	TO	ro	TO
UNIT	PRICE	VALUE	E.Srn.tATE     ESTIMATE	ESTIMATE	•ERIOO	APPLICATION	DATE	DATE	DATE	DATE
7	FOOT Type•C lnlc1	1,00      EA	S, 1900DD	S1,900 .00	0.00	1.00	1 00	S000	$1,900.00	ST,900   00	100%	so 00	$19000

FOOT TyPB E Intel

,2 00      EA	S2,550 00	$5.100 00	0 00	2.00	2.00	SO.OD	SS. l00 .00	S5,100 00	100%	SO.OD	S510 .00

C<lnlol Slruciure(FOOT M<>dlfied Tyv•·o·lnlel)	2,00      EA	S3.50000

$7,00000

0,00	2.00	200	SO.OD	S7,000 . 00	$7,000 00	100%	SO.OD	S700 .00

10	FOOTManhole	4.00       EA	$3,250.00	S13s00000	000	4 00

,4 00	SOOD	513 , 000 . 00	$13 ,000 .00	100%	so.co	Sl . 300.00

11	30" FES	5.00     EA	$2,300 . 00	$11 ,500 .00	0 . 00	fi.00	5.00	SOOD	511 ,500.00	S1 1,500.00	100%	S0,00	Sl ,150,00
12       36" FDOTFES	1.00      EA	$2,750.00	$,2 75000	0.00	1.00	100	SO.OD	S2,750.00	S2.750.00	100%	so.oo	$275.00
13       Oewarenng	1.00      LS	$27,500.00	$27,500.00	0.00	1,00	1.00	S0.00	$27,500.00	$27,500.00	100%	SO.DO	52 ,750.00

14       Televise Slorm Sewer (CCTV)	2.Jnoo      LF	$6,35

$15,09.935

0,00	23n.oo	2377.00	sooo	$ 15, 093  .95	S15,093  .95	100%	S0,00	S1,S(M.l40

15	FDOTMan   l'lOle	1 00      EA	$3,250 .00	53,25000	0.00	1,00	1,00	S0.00	SJ,250,00	$3.250,00	100%	S0,00	5325,00
16       6" UNDERDRAIN (FINE AGGREGATE)	940 00      LF	511.95	511,233.00	0,00	940.00	94000	SOOD	s11,233 .oo	$1,1 233,00	100%	sooo	S T,123  .30
17	UNDERDRA	I N  CLEANOUT	11.00     EA	5185.00		S2,035.00	o.oo	1 1 .00	11 ,00	 50 . 00		52,035.00		$2,035,00	 100%	S0.00		$20, 350 TOTALSTORMDRAINAGE      G1			$262,142.95				$,0  00	$262,142.95	$262,142.95	100%	$0,00	$26,214.30

ROAD SLEEVE CROSSING01

1	2" Sch40PVC	150.00      LF	$4.80	S720,00	0 00	150.00	15000	S0.00	$720.00	$720 00	100•,.	$,0 00	$72 00

z	4" Sch40PVC	300.00      LF	5615	$1,845.00

0.00	300,00	300.00	50,00	S1,845 00	51.84500	100%	so 00	S184.50

3	S-Sch40PVC	60,00        LF	SB.15	S4B900	0 00	60.00	60.00	S0,00	S48900	$489.00	100%	SO.OD	$48 .90

TOTALROAD SLEEVE CROSSINGG1	$3,054.00	50.00	$3,0$4.00	53,0$4.00	100 %	so.co

$305. 40

CHANGE ORDER • PHASE 01

1	OPOCredt, . FeflJUS<>n . Waler	1.00      LS	($70.01916)	($70,07916)	0.00	1 00	1 00	S0.00	(570,079.16)	($70,079 16)	100%	S0,00	($7,007.92)
2	OPOCrectil • FergU50n• Sewer	1.00      LS	($46, 522.35)	($46 ,522.35)	0,00	1,00	1,00	SO.DO	($46, 522 . 35)	($ 4,6 522 .35)	100',C,	SOOD	($4, 652.24)

CPO Cre,d t • Fe19uson • Sleeves	1.00      LS	($753.401

(S75340)	000	1. 00	1.00	$0.00	(5753.40)	($753.40)	100%	S0.00	(S75.34)

4		OPO TaxSavings	1.00       LS	($7,04  1. 29)		(S7.041  29)	0 ,00	1.00	1 00	SO.DO		(57,041  .29 )		(S7, 04l  .29)	100%	 5000		(S70.413) TOTALCHANGE ORDER   #2  • PHASE  G1			($12,4  396.20)				SO.OD	($12 4.396 .201	($124 , 396 . 20)	100'/,	S0.00	($12,439,63)

CHANGEORDER #3 • PHASEG1 EARTHWORK G1
I	FIiiVolume(LongHaul From Blvd.) • Rcjllocestmpon	16 20000      CY	$2.75	$4, 455000	000	16200,00	16200.00	SO.DO	$44.55000	5'14,550.00	100%	so 00	$4,455.00
2	Imported,,11	( 1,6 200 00)     CV	57.00	($ 113,400.00)	o.oo    - 16200.00	·16200.00	sooo	( S113.400    .00)	($ 11 3,400  . 00)	1 00%	SO.OD	(S11,340 00)
TOTA L EARTHWORK 01	($68,850.00)	50.00	($68,850,001	($68,850.00)	100'1'	50.00	($6,885.00)

GEOTECHNICAL TESTING G1

1	G1 - Fie4dTechf'Noan Services	1 00      LS	S21.952.80	S21,952.80	0.00	1.00	1.00	S0.00	$2,1 952.80	$21,952.80	100%	SOOD	$2 195 28
2	G1• Labrak>ry Testing	1 .00      LS	S3.62 4. 00	$3,624 .00	000	1 00	., 00	so.co	53 .624 00	S3,624 . 00	100%	SO.OD	5362 ,40
3	G 1  -E lneefing &ProjectManagement	1.00     LS	S2.340,IMI	S2,3d0.00	0.00	1 00	1.00	S0,00	S2.340,00	$2,340.00	100%	sooo	S234 00
TOTALGEOTECHNICAL TESTING G1	$27,916.80	$0.00	S2, 7916.80	$27,916.00	10Co/,	$0.0C	$2,791.68

Seedfng & Mulchl ng G1
I	Seeding &Mulct,lng	.90,915.00      SY	S0.25	 $22,728.75	0.00	9091500	9091500	SO.OD	$22,   728.75	S22.728 ,75	100%	SO.DO	S2,272.88 TOTAL-SEEDING & MULCHING G1			S22,728.75				 $0.00	 S22,728.75	 $22,728,75	100	 $0.00	 $2,272.88

Triple Cl'ffkCOO-VIiiage E.F andG1	APPLICATION FOR PAYMENT

RlPA6 ASSOCIAl ESPROJECl #Ot 170/A

PAYAPP FROM TO

HIREV 1111117
11130117

llEM
N,O	

DESCRIPTIONOf WORK	

ON	CONTRAC TSUM 10 DATE		
				
BASECONTRACT	
ES TIMATEOQUANTITY	TOTAL
WORi(IN
PlACE	TOTAL WORK IN PlACE	TOlAL WORK IN PLACE	
PERCENT
COMPLETE	
BALANCE
TOFINISH	,..,.
ETAIN GE	
			UNIT	UNIT
PRICE	VALUE	THIS
ESTIMATE	PREV
E.S.TIMAlE	TOTAL
ESTIMATE	THIS
PERICO	PREV
APPLICATION	ro
DATE	TO
DATE.	TO
DATE	TO
OAtE	
															
	TOTALCHANGE ORDER #3 • PHASE G1				($18.204.45	)			$0.00	($18,204.45)	($18,204.45)	100%	$0.00	($1,820.44	
															
	CHANGE ORDER #4 • PHASE G1														
1	OPO cre,m -Rinke< - s,o,m P , pe	1 00	LS	($59,165,57)	($59,165.57)	0.00	1,00	1,00	S0.00	(559,165.57)	{$5,9 165.57)	100%	$000	($5,91,566	
2	DPOTa>t Savings	1 00	LS	($3,559.94)	(53,55994)	000	100	100	sooo	(S3 ,559 .94)	(S3,559.94)	100%	S0.00	{$355.99)	
	TOTAL CHANGE ORDER #4 - PHASEGt				($62,725.51)				S0.00	($62,725.51)	($62,725.51)	100' /4	S0.00	($6,272.55)	
															
	CHANGE ORDER #5 - PHASE G1														
1	DPO Credit • Atlantic TNG • Sewer Slmcw,es	1,00	LS	($20, 720.45)	($20. 720.45)	0 00	1.00	1.00	so 00	($20,720.45)	(520,720.45)	100%	S0.00	(52,072 05)	
2	OPO Cr0d1I - AOan1lc TNG • s10011Structures	1.00	LS	($28 ,630 15)	($2,8 630.15)	0.00	100	1,00	so 00	(528,630 .15)	($28 ,630 .15)	100%	$000	($2,86302	
3	DPO Ta,i: Savings	100	LS	($2,991.04)	(52,991.04)	0,00	1 00	
1.()0	so00	(S2.99104	)	(52,99104)	100%	S0.00	(S299.10)	
	TOTAL Cl1ANGE ORDER #5 • PHASE G1				($52,341.64)				$0.00	($52,341.64)	($52,341.64)	100¾	S0.00	($5,234.17)	
															
	CHANGE ORDER #6 • PHASEG1														
	CTB DIRECT PURCHASE ORDER														
1	OPO Credi! • S011Cement Base	(,3 571 .00)	TN	$16,00	($57,136 00)	0.00	3571,00	-3571.00	S0,00	($57,13, 6 00)	($57,136.00)	100%	S0.00	($,5 71,3 60)	
2	OPO Tax savings	1.00	LS	(53,428.16)	($3,426.16)	0,00	1.00	1 00	S, 000	($3,42816)	($, 3 428,16)	100%	S0.00	(S34282)	
	TOTAL CHANGE ORDER #6 • PHASEG1				($60,564.16)				$0,00	($60,564.16)	($60,$64.16)	100%	S0.00	($6,056.42)	
															
	CHANGE ORDER #9• PHASE Gl														
	VILLAGE G1-0PORECONCILIATION														
1	OPO ReconciliaOOn•Fergusoo-Vil!ageG 1	1,00	LS	551,821.91	551.821.91	1.00	000	1,00	$51 ,821.91	$0.00	551,821. 91	100%	S0,00	$,5 182.19	
2	6% Tax on Abeve	1,00	LS	S3.109,31	$,3 109.31	1.00	0.00	1 00	$3,109.31	$0.00	$3,109.31	100%	sooo	$310 . 93	
	TOTAL CHANGE ORDER #9 -PHASE G1				S54,931.22				$54,931.22	$0.00	$54,931.22	100"1,	so.co	$5 , 493 .12	
															
	TOTAL PHASEG1				$1,232,736.06				$75,417.72	$1,157,.318.34	$1,232,736.06	100%	SO.OD	$123 , 273 . 60	
															
	PHASEE2/E3														
	GENERAL CO NDITIONS E21E3														
1	MObiRzatioo	1.00	LS	SS . 00 .00	56 ,400 .00	0.00	1,0()	1 00	S0.00	$6,400.00	$6,400.00	100%	$0,00	564, 000	
2	NPOESPetmll & Compliance	1 00	LS	55.300,00	$5,300.00	(1.00	1 00	1.00	S0.00	$5 ,300 00	55,300.00	100%	S0,00	S$30.00	
3	Maintenanceof Traffic	1.00	LS	$860.00	$86000	0.00	1,00	1.00	S0.00	$860.00	$860.00	100'/4	$0.00	$86,00	
4	Const Stakeout/Record Survev ByContraclor	1 00	LS	539 ,500 .00	539 ,500 .00	0 .00	100	1.00	so.oo	9,500.00	$39,500.00	100%	$000	53,950.00	
5	Payment & Performar,ce 8ooO- ByContrac10,	1100	LS	58,250,00	$8,250 00	0.00	1.00	1.00	S0.00	SB,250.00	SS.250 .00	100%	$0.00	5825,00	
	TOTAL GE.NERALCONDITIONS E2/E3				$60,310.00				$,0 00	$60,310.00	$6,0 310.00	100"1,	SO.OD	$6 ,031.00	
															
	EARTHWORK E2/E3														
1	Clearing & Grubbing	25,00	AC	$4,100.00	$102.500,00	0.00	25.00	25.00	S0.00	5102,500.00	$102,500.00	100%	S0.00	S10,250.00	
2	Cul Volume (UnadjUSled)	227.000 00	CV	S0.70	$158,900,00	0 00	22700000	227000.00	S0.00	S158,900.00	S15, 8900.00	100%	sooo	$15 ,890 00	
3	So<ICl1ng	4,7 000 ,00	SY	$2.45	$115.15000	0.00	47000.00	47000.00	so 00	$11,5 15000	$115,150 00	100%	S0.00	S11,51, 5 00	

)

1

)

Triplec,..,COO.Vill•g•E,Fond GI	APPLICATION FOR PAYMENT Rl'A&ASSOCIATESPROJECTOOl 1707A

P•VAPP FROM TO

10REV
1111/17
11/30/17

ITEM NO	

DESCRIPTIONOF \"/OR	

QTY	CONTRACT surv,TO DATE		
				
BASECONTJ<ACT	
ESTIMATED OUANTIT'f	TOTAL
\"/ORKIN
PLACE	TOTAL
\"/ORKIN
?LACE	TOTAL
WORKIN
PLACE	
PERCENT
COMPLETE	
BI\J.ANCE
fOFINISH	
1 0,,
RE1AINAGE	
			
UNIT	U.NIT
PRICE	
VALUE	TH I S ESTIMATE	P'REV
ESTIMATE	TOTAL
ESTIMATE.	THIS PERJOD	PREV
APPLICATION	TO
DATE	TO
DATE	TO
DATE	TO
DATE!.	
4	See<>ng & Mulching	25.000.00	sv	$0 .25	S6,250 .00	000	25000 .00	25000 .00	S0 ,00	S6,250.00	$6.250.00	100¾	sooo	S625.00	
5	SmFence	5.'350 .00	LF	Sl.2	0	SG.420,00	0.00	5350.00	535,0 00	S0.00	S6,42000	56.4,2000	100%	.sooo	S642 .00	
6	Tree Bamcades	400.00	LF	S3.	,s .340 00	o.oo	400 00	40,0 00	S0,00	$1,34000	51.340.00	100%	S0,00	5134.00	
7	De,vatenng (For a11as pects of p'()Ject )	1 00	LS	S110.000,00	S110,000.00	0.00	1. 00	1 00	so 00	s110 ,ooo.oo	$110.00, 0 00	10Q¾	S0 ,00	s11.ooo.oo	
8	Flnal Grading	1 00	LS	58,650.00	S8.650.00	000	1.00	1.00	so.co	SS.650.00	SB.650.00	100%	sooo	S865 . 00	
	TOT ALEARTHWORK E2/EJ				S509.210.00				$0.00	$509,210.00	$509,210.00	100'1,	$0.00	$50,921.00	
															
	STORM DRAINAGE E2/E3														
1	15· Class m RCP	203.00	LF	S23.JO	5'1,729.90	0.00	203.00	203 ,00	,a .co	54.729 .90	$4 ,729 90	100%	so.co	$472.99	
2	18"ClassIllRCP	1,647.00	LF	S2840	5'16,774 80	0,00	1647 00	1647.00	so .co	$46 774.80	S46,774.BO	100%	$0.00	$4,677◄8	
3	24" ClassIllRCP	394,00	LF	S38 JO	51,5 090 20	0.00	394.00	394.00	So.oo	515,090.20	S15,090,20	100%	$0.00	$1,509.02	
4	30· Class Ill RCP	468,00	LF	552.50	524,57000	0.00	68.00	468.00	S000	524,57000	S24,5,7000	100",-	S0.00	$2,457.00	
5	36"ClassIll RCP	57.00	LF	$72.10	5'1,109,70	0.00	57.00	57,00	5000	S41 109   . 70	$4,109 . 70	1 00'/4	so .co	541,0 97	
6	60" Ciass III RCP	158 .00	LF	S175 ,00	527.650.00	0.00	158.00	158,00	S0,00	S27,650.00	$27,650 00	100%	so.co	S2.765.00	
7	HUlsboioughCo. TyP&1 Curb Inlet	1300	EA	5,3 60,0 00	S46,800 00	0.00	13.00	13.00	SOOO	5'1, 680000	5'16,800,00	100%	S, 0 00	54,680.00	
8	PIich Bottom Intel. Type e	1.00	EA	$,2 550.00	S2,550 ,00	0 00	100	1 00	S0.00	52 ,550.00	$2,550.00	!00%	SO.OD	$255 .00	
9	Conln,I S lruolure (FOOTModlnedType·o· tnlell	1 00	EA	S3 ,500.00	$3,500.00	0.00	1.00	, 1 00	S0.00	S3,500 .00	S3.500 ,00	100%	S0 .00	S35000	
10	15" FOOT FES	,3 00	EA	Sl ,500.00	$,4 500 .00	000	3.00	.00	so 00	$,4 500,00	5'1,500.00	100%	S0.00	5450.00	
11	18" FOOT FES	9.00	EA	Sl ,650 ,00	S14 .850 .00	0.00	9.00	900	S0.00	$1,4 850.00	SM,    850 .00	100 %	sooo	S1 ,485 00	
12	24" FDOT FES	3.00	EA	S1 ,750.00	$,5 250 00	000	3 00	3 ,00	SO.DO	SS,250.00	$5,250.00	100%	so 00	$52500	
13	30·FOOTFES	4,00	EA	$2,300 .00	S9 ,200 .00	0.00	4.00	4 00	$0 00	59 ,200 00	S9.200<K1	100%	S0.00	592000	
14	:is·FOOT FES	100	EA	S2, 75, 0 00	$,2 750.00	a.co	1.00	1.00	so.co	S2.75000	S2,75, 000	100%	S0.00	$275.00	
15	00" FOOT FES	1.00	EA	SS,700 .00	55 ,700.00	0,00	1.00	1.00	SO.OD	55 , 700 .00	$5,700 .00	1 oo,4	S0.00	S570 00	
16	MitigatlOn Area Planting	1 .00	LS	S7 ,100 .00	S7 ,100 .00	0 00	1.00	1 .00	so.co	$, 7 100.00	$7,100.00	100%	sooo	S710,00	
17	Tel<M$e SIOfffl 5""or(CCTV)	2.927 ,00	LF	S6.35	S18,586 45	000	292, 7 00	292700	sooo	S18,586.4	5	S18,58.465	100%	SO.CO	$1,858,65	
18	FOOTManhole	,,oo	EA	$3 ,250.00	S:J,25000	0,00	1.00	1 00	so.co	SJ.250 00	S3,250 00	100%	$0,00	S32,5 00	
19	Contn,ISlructure WeirWall	1 00	EA	S8,400.00	58,40000	0,00	1,00	1,00	so.oo	58, 400 .00	S8,400 .00	100'/4	S0,00	$840.00	
	TOTAL STORM DRAINAGEE2/E3				$255,361.05				$0.00	$255,361,05	$255,361.05	100%	SO.OD	$25 ,536 ,11	
															
	E2/E3ALTERNATEADD														
1	Clennng & Grubbing	41,00	AC	52,900.00	S118,900.00	0,00	41,00	41 00	S0 ,00	$118,900.00	$118,900.00	100%	S0,00	$11,890.00	
2	P1ace & compact ExcavatedMa1eria1	100,500 . 00	CY	U40	S252,700,00	0.00	18050000	180500.00	S0,00	3252,700,00	S252,700.00	100%	so.oo	S25 ,27,0 00	
"3	S lockp ila Off-Phas e (wilh•o 1,000 Feel) (adjusted)	<6.50000	CY	S1.50	$69,750 .00	000	46500 ,00	46500.00	$0.00	$69,750,00	SG9,75.000	100%	sooo	$6,975.00	
4	Soddlng	, 4 000.00	SV	$245	$, 980000	000	4000,00	4000.00	S0.00	S9,80000	59,800.00	100%	S0,00	S9<10.00	
5	St,ed/ng & Mu!Ohing (Add1fi0nal)	19,8 500.00	sv	$025	$4,9625.0	0.00	1!16500.00	198500.00	$000	549,625,00	$49. 25.00	100%	S000	S4.S62.50	
	TOTAL E2/EJALTERNATE ADD				$500,775.00				$0.00	5500,775.00	$500,775.00	100•1,	$0.00	$50,077.50	
															
	CHANGEORDER #3 • PHASEE2/EJ														
1	General conditionsE2/E3	(1.00)	LS	$52,060 ,00	($52,060.00)	0.00	(1.00)	(1.00)	SO.CO	($52,060.00)	($52,060.00)	100%	sooo	(S5.206.00)	
2	Earthwork E2/E3	(1.00)	LS	S501.45000	($501,450.00)	0.00	(1 00)	(1.00)	so.co	($501,450.00)	(5501,450.00)	100'i,	so 00	(55, 0145.00)	
3	SIOrm DrainageE2/E3	(1.00)	LS	$255.361,05	(S255,361,05)	0.00	(1.00)	(1.00)	so.co	(S255.36105)	(S255.361 05)	100%	S, 0 00	(52, 5 536 11)	

,..,..,,

Tnpl e CietkCOD-Vllag• E. F •nd GI	APPLICATION FOR PAYMENT R1PA &ASSOCLATES PRO.IECTO011707A

PA, ' AP P"
FROM
TO

10REV
11/1/17
11/:l0/11

C ONTRACTSUMTODATE

TOTAL	TOTAL	TOTAL

DESCRIPT  ION 0  WC>fiK	8AS E CONTRACT	ESTIMATED OUANTITV	WORKIN	WORKIN	WORKIN	P CSNT	BALANCE	1 4
ITEM	PLACE	PlACE	PLACE	COMP  LETE	TO FINISH	RETAINAGE
NO	On'	UNIT	lHIS	PREV	TOTAL	TH ! S	PRE'/	TO	TO	TO	TO
UNIT	PRJCE	VALUE	ESnMATE.    ESTIMATE	ESTIMATE	PERIOD	APPLICATION	DATE	DATE	DATE	DATE

E2le.3Alternate l\d	(1.00)  LS      S50,7075.00

(S500,,0705)	0,00

(1.00)	(1.00)	sooo	($ 500,775001

(S500,775.00)	100%	SO.OD	(S50,077 ,50)

TOTAL CHANGE ORDER #3.  PHASEE2/E3	(S1,309,646.05)	S0.00	(S1,309,646.05)	(S1,3-,09 646.05)	100o/,	$0 .00	($1 30,964.61)

TOTAL PHASE E2/E3	$16,010.00	$0.00	$16,010.00	$16,010.00	100%	SO.OD	$1,601.00

CONTRACT SUMMARY
1	GENERAL CONOITIONS El	S89 ,000  00	$000	589,000.00	S89,000.00	100%	so.oo 	58.900.00
2	EAATHWOR  El	S232,23385	S0.00	S232,233,85	S232,233.85	100%	S0.00	$23,223.39

J	BASEANO PAVING El	S922,377.JO
POTABLE WATERDISTRIBUTIONEl	S1864, 38.00

S0.00	S922.377 JO	S922.377 JO	100%	50.00	592,237.74
$0,00	5186,438.00	5186,438.00	100%	SO.OD	518 , 64, 3 80

5	SANITARY SEWER E1	S650,329.35	SO.OD	$650,329.35	5650.329 35	11)0%	SO.OD	S66,032.94
6	STORM DRAINAGE E1	5259,190.35	SOOD	5259190 .35	S25, 9180.35	100%	SO.OD	$25 ,919.04
7	RO AD SLEEVECROSSINGEl	$2,933.00	50.00	52,933.00	52,933.0D	10D%	SO.OD	5293.30
C0/12   CHANGE ORDER112• PH  ASE  E1	($138,   231 .05)	s o 00	($ 1 38.231   05)	( S138.231.05)	100%	SO.OD	(S138, 2311)
C0/13   CHANGE ORDER /f3• PHASEE1	S25,458 00	SO.DO	$25  ,458. 0D	S25.458.0D	100%	so.DO	$2,545.80
C0#4    CHANGE ORDER #4 . PHASEEI	( 540,984.83)	SO.DO	($40 ,964 .83)	($40,984 83)	100%	SO.DO	(54,098.49)
CO#S    CHANGEORDER #5 • PHASEE1	(569,704.47)	SO.OD	($69,704.47)	( S69.704 47)	10D%	so 00	(S6.970.45)
CO#6   CHANGE ORDER11G• PHASEE1	$17,865.68	SOOD	S17  ,865  .68	S178, 65.68	10D%	S0.00	SI 786.56
CO#9   CHANGE ORDER #9 • PHASE E 1		$16,566.86	$16,56686		S0.00		$16.566.86	 100%	S0.00		$, 1 656.68 TOTAl  PHASEE1	n. 1s3,4n .04	$ 16,566.86	S2,1J 6,905.18	$2,153,472.04	100%	$0.00	$215,347.20

8	GENERAL CONDITIONS F1	S89,00560	S2,550,0D	586.455.60	.005.60	100'/.	SO.OD	5,8 900.56
9	EARTHWORK f1	$429.256.00	$1,4 99163	$414.264.38	S429,256.0D	100%	S0.00	S42.925.60

10	PAVING AI\IOBASE F1	$482,995.95

$4.60500	S476,190.95	S4,80795.95	10D%	521 200,00	S48,07960

11	POTABLEWATER DISTRIBUTION F1	595.685.00	58.109.25	$87,57575	S95,685.0D	100%	so.oo	$,9 568 50
12	SANITARY SEWER F1	$141,33685	$10,963.80	S130,373,05	SH l,336.85	100%	S0,00	$14,133.68
13	STORM DRAINAGE F1	$28, 3547.80	$39,411.00	5244,136.80	$283,54.780	100%	S0.00	$28,354.78
14	ROAD SLEEVECROSSING F1	$, 1 414.50	$0.00	$1 414.50	$1,414.50	100%	SO.OD	S14 1.45
COIIG   CHANGE ORDE R 11G- PHASEF1	(S37.244.16)	so00	($37,2  44.16)	($37,24,4 16)	100%	so 00	(S3.724.42)
C0#7   CHANGE ORDER117 -PHASE Ft	(S164.09.583)	$0.00	(5164.09583)	(S164,095.83)	!OD%	so 00	(S16.409.58)
C0/18   CHANGE ORDER #8 • PHASE.F1	$1,6 336.00	$16,336.00	SO.OD	$1 6,336.00	100%	SD.DO	51,633.60
C0#9   CHANGE ORDER 119• P HASE Fl		555,718.07		S55.718 07		SOOD		S55,718.07	10D%		SO.OD		S5,57182 TOTAL PHASEF1	$1,393,955.78	$152,684.75	$1,239,071.04	$,1 391,755.78	100¼	$, 2 200.00	$1,39175.59

15     GENERAL CONDITIONS F2	$64,299.20	SO.OD	$64,299.20	S64,299.20	100%	S0,00	$6,429.92
16       EARTHWORK F2	$153.23800	51,716.0D	s1s1.s22.oo	$153.238,00	100%	SOOD	S1, 5323.80
17	PAVING ANO BASE F2	S324,656.65	$23,842SO	5300,814.15	S324,656,65	10D%	SOOD	S32,465.67

1

18	POTABLE W ATERDISTRIBUTION F2	S114,603.80	S0.00	$114,603.80	$11,4 603.80	10D%	SO.OD	S11 1.60,38
19	SANI TAR Y SEWER F2	$149,346.95	so 00	$149,346.95	S149,346.95	100%	so 00	$14,934 70
20	STORM DRAINAGE F2	$241, 70775	SO.OD	$2 41,707.75	$241,707,75	100%	SO.OD	$2.4,170  78
21	ROADSLEEVECROSSING F2	S2,581.50	so 00	52,581.50	52,581. 50	10D%	S0.00	S258.15

1 rlple c,"kCOD-Vlll,gt E. F tndG1	APP LICAT IO N FOR PAYMENT

RIPA & ASSOCIAEl SPROJECT #0-1 170/A

PAY "PFI FROM TO

10REV
11/1/17
11/30/17

lfl,M
NO	

OESCRIRTION OF WORIC	

OTY	CONTRAC TSUM 10 DATE		
				
BASECONTRACT	
ESTIMArED OUAiI'TITY	TOTAL
WORK IN
Pl. ACE	TOTAl WORKIN PLACE	TOTAL WORKIN
PLACE.	
:>E RCENl
COMPLETE	
BALANCE
TOFl !ISH	
,oq.
RETAIMJ,GC	
			
lJNIT	UNIT
PRIC E.	
VALUE	TMIS
STIMATE	P REV
ES TIMAT E	TOTAL
EST JU ATE	fl-tlS
PERIOD	PREV
APPLICATION	TO
DATE	TO
DATE	TO
DATE	TO
OATE	
C0ff2	CHANGEORDER #2 • PHASE P2				(5134. 13512)				50.00	(S1 34,135 12)	(S134 .135.12)	100%	5000	(513,413.51)	
C0#3	CHANGE ORDER#3 - PHASEF2				$146.145 60				sooo	$ 1 46 ,1 45 . 60	$1 46 ,1 4 5 60	100 %	S0.00	$14,614.56	
C0 #4	CHANGEORDER114 - PHASE P2				1S66,8142  9	1			sooo	(566 , 81 4. 29)	( SGG,81429 )	100%	S0,00	(S6,681.43)	
CO#S	CHANGE ORDER #5 - PHASE F2				(533.476.63)				S0.00	($33,476,63)	($33,476.63)	100%	so.co	($3 ,347 .67)	
C0#6	CHANGEORDER·#6 - PHASE F2				(S43.231.04	)			S0.00	(S43,231.04	)	($43,231.04)	100%	S0,00	(S4,323.10)	
c	CHANGE ORDER #9 - PHASE F2				$8,419.79				SS.419.79	S0.00	58,419.79	100%	SO.DO	$841 ,98	
	TOTAL PHASEF2				$927.342.16				$33,978.29	$893,363.87	$927,342.16	100°/4	S0.00	$92.734.23	
															
22	GENERAL CONDITIONS G1				sa1.=.o	o			sooo	$87,330.00	587,330.00	100%	$0,00	SB,733.00	
23	EARTHWORK G1				S330.234.25				52.126,50	S328.107 75	$33,0 234.25	100%	sooo	$3,3 023 . 43	
2 4	P AV ING AND BASEG1				$468.64B.60				s, e.360.00	$450.288,60	$468.648.60	100%	SO.DO	$46,864.86	
25	POTABLE WATER DISTRIBUTION GI				$141.390 BO				sooo	S 141 .390 BO	S141,390.BO	JOO¾	SO.DO	51 4. 139 .08	
26	SANITARY SEWER Gl				$203,236.20				SO.Oil	5203.236 .20	$203.236 . 20	100%	SO.DO	$20.323 .62	
27	STO RM DRAINAGEG1				S262.1◄2 . 95				S0,00	S262.142,95	S262,142,95	100%	S0.00	$26,214.30	
28	ROADSLEEVECROSSING G1				$,3 054.00				sooo	53 ,0 54,00	$3,054.00	100%	SO.DO	$305,40	
COll2	CHANGE ORDER#2 • PHASEGl				(S124.39620 )				sooo	( $124.396.20)	(S 1 24 , 396 ,20)	100%	so.oo	($12.439,63)	
COl/3	CHANGE ORDER #3- PHASEGI				1518.204.4)5				SO.DO	(516,204 .d5)	($18.204.45 )	100%	SO00	(S1.820.44 )	
C0/14	CH ANGE ORDER f/4 • PHASEG1				(562,725.51)				SO.DO	($62,725 .51 )	(562,725 ,51)	100%	5000	(S6.272.55)	
G0#5	CHANGEORDER #5 • PHASEG1				(552,341.64	)			S0.00	(55,2 34I 64)	($52.341.64)	100%	SO.DO	(SS.234 17)	
C0#6	CHANGEORDER #6 • PHASEGI				(S60,564.16)				so 00	($60.564.16)	($60.564 18)	100%	$000	($6.05642)	
C0/19	CHANGE ORDER #9 • PHASEG1				554,931.22				$54.931.22	so 00	554,931.22	100%	SO.Oil	55 .493. 12	
	TOTAL PHASE G1				$1.232.736.06				$7,5 417.72	$1,157,318.34	$1,232,736.06	10091.	S0.00	$123, 273. 60	
															
29	GEN ERAL CO ND m ON S E2JE3				S60.310.00				S0.00	S60.310.00	560.310.00	100%	so,oo	$6 . 031 00	
30	EARTHWORK E.21E3				$509 .210 00				sooo	5509.21.000	5509210.00	100%	50,00	550.921,00	
31	STORM DRAINAGEE2/E3				$255.361.05				so.oo	S25,5 361 05	$255.361 05	100%	S0,00	$25,53611	
32	E2/E3ALTERNATE ADD				S500.776.00				SO.DO	5500.775.00	5500,775.00	100%	S000	50.077.50	
CO#J	CHANGE ORDER 3 • PHASE E21E3				ISl .309.6" 6.05)				SO.DO	(S1.309 , 6"6 .05)	($ 1 .309 ,646 .05 )	100%	S0.00	($130.964.61 )	
	TOTAL PHASE E2/E3				$16.010.00				so.oo	$16,010.00	$16,010.00	100%	$0.00	$1,601.00	
															
	TOTAL ALL SCHEDULES				$5,723,516.04				$278,647.62	SS,442,6E8.43	SS,721,316.04	1 00%	S2,200.00	$572,131 .62	
															
	OR IGINAL CONTRACT VALUE														
	PHASE E1				$2,342.501.85				sooo	52 .342,50 1 .85	52 .342 . 501 85	100%	S0. 00	$234 . 250 .21	
	PHASE F1				$1,523.241,70				580,630.68	S1,440,411.03	51,521,041 70	100%	S2.200.00	5152.104 17	
	PHAS E F2				$1,050.433.85				$25.558 50	s, 024,875.35	51,050,433.85	100%	SO.DO	$105 .043 40	
	PHASE GI				S1,•196.036.80				$20.• 86.50	$1.475.550.30	St,496,0:iG.BO	10 0%	S0,00	S 149.603.69	
	PHASE E2/c3				$,1325.656,05				so.oo	S1. 325 . 656 ,05	$1.325 ,656 ,05	1 00%	SO.DO	$132 , 565 . 61	
	TOTAL ORIGINALCONTRACT VALUE				$7,737,87025				$126.675.68	Sl ,608,994.58	$7,735.670. 25	100'1.	$2,200 .00	sn i.ss1.os	
															
	CHANGE ORDERS														

ITEM NO	

DESCRIPTION Of WORK	

orv	CONTRACT SUM TO DATE		
				
BASECONTRACT	
E.SllMATEDQUANTITY	TOTAi. WOR IN PLACE	TOTl'L
WORt<IN
Pl.ACE	TOTAL
WOR,<IN
PLACE	
PERCENT
COMPLETE	
BALANCE
TO f tNJSH	
1 .
RETAINAGE	
			UNIT	UNO
PRfCE	VALUE	THIS
ESTIMATE	PREV
ESTIMATE	10/AJ.
ESTIMI\T£	fHI.S
PERIOD	PR'l;V
A PLICA.TION	T'O
DATE	TO
DATE	TO
DATE	TO
CATE	
	CHANGE ORDER #2				(S396, 762.37)				S0.00	($396.762 37)	(S396,762.37)	10014	S0.00	
($39 ,676 25)	
	CHANGE OROER #3				(5 1,156,246.90)				S0,00	(S,l  156.246.90)	(S1 156,246.90)	100%	S0,00	(S11, 5624 69)	
	CHAN GE OflOER #A				(S17,0 524,63)				S0.00	($170,524 63)	(5170.524 63)	100%	sooo	(S17 052.47)	
	CHANGE ORO R #5				($155.522.74)				S0.00	($155.522.74)	(S155,522.74\	100%	S0.00	(S1,5 552.29\	
	CHANGE ORDER #6				(5123.173.68)				sooo	(S123 ,173 ,68)	(S 123 ,173 68)	100%	5000	(512,317.38	
	CHANGEORDER#7				($164,095 83)				S0.00	( S164,095.83)	(5164,09583)	100%	S0.00	(516,409.58)	
	Cl-tANGEORDER#8				$16,336.00				$16,336 00	S0.00	516,33,6 00	100%	so.uo	$1,633 . 60	
	CHANGE ORDER#9				$135.635.94				Sl:!5.63.594	S0.00	$135,635.94	100%	sooo	$13.56J.60	
	TOTALCHANGE ORDERS				($2,014,354.21)				$151,971.94	($2,166,326.15)	($2,014,354.21)	100 %	$0.00	($201,435.46)	
															
	ADJUSTED CONTRACT TOTAL				$5,723,516.04				$278,647,62	$5,442,668.43	$5,721,316.04	100%	$2,200,00	$572,131.62	

T plec,.. i COO-Viffagt E, FandG1	APPLICATION FOR PAVl!ENT RIPA &ASSOCIATES PROJECT# 01 170/A

AV APP FROM TO

lOREV
11/1/17
11130/17

)

1, t I

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE GI

The unders igned, a Responsib le Officer of Triple Creek Comm unity Development District (the "District" ) hereby submits the following requisition for disbursement under and pursua nt to the tenns of the Master Trust Indenture dated as of June I, 2012 from the Dlstrict to The Bank of New York Mellon Trust, N.A., as trustee- (the "Trustee"), as supplemented by the Second Supplemental Trust Indenture dated as of February I, 20l7 (the "Indenture"), (all capitalized terms used herein s hall have the meaning ascribed to suc h term in the Indenture ):	-

December 8, 2017

Requisition Number: CR206-GI

Name of Payee: New bcrf Irrigation, Inc.
3336 361 A,1cnuc No rlh St. Petersbu rg1 FL 33713
Amoun t Payable: $11,646.40

Purpose for which paid or incurred (refer als o to specific contract if amount is due and payable pursuant to a contract involvlng progress payments, or, state Costs of Issuance, if applicable): Pay Application #1 for Project #Triple Creek Irrigation - Village GI

{E)		fund or Account from which disbursement to be made: 20 1 7A Acquisilion  and  Cons trucl ion  Account, Suba   ount Village  GJ	-

The undersigned hereby certifies that:
obligations in the stated amount set forth above have been incurred by the District, or
this r-eguisition is for Costs of Issuance payable from the Acquisition and Construction Fund that have not previously
been paid;

each disbursement set forth above is a proper charge against the Acquisition and Construction Fund;

each disbursement set forth above was incurred in connection with the acquisition and/or construction of the P roject; 4-	each disbursement represents a Cost of the Project which h!I.S not previously been paid.
The undersigned hereby further certifies !hat there has not been filed with or served  upon the District. notice of any lien. right to lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be;: rnleased s imult aneously with the payment hereof.
The undersigned he reby further certifies that such requisition contains no Hem representing payment on account of any retained percentage which the District is at the date oFsuch certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disbursementis hereby requested.
TRIPL E CREEK COMMUNITY DEVELOPMENT DISTRICT

By: -  ·	.	::::,,  ef..   J.	)(0	,<'>  <

CONSULTING ENGINEER'S APPROVAL FOR NON•COST OF ISSUANCE REQUESTS ONLY

If Ibis requisition is for a disburSement from other than Costs of lssuam:e, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with : (i) the applicable acquisitio n or construction contract; (ii) the plans and specifications for the portion of the Project witb respect to which such dis bursement is being made; and (iii) the report of the Consulti ng Engine er, as such report shall have been amended or modified on the date hereof.

;::5:;.;c.;;	-
'        0ulting Engineer

License:

Newberg Irrigation, Inc.
3336 36th Avenue North St. Petersburg FL 33713 727-521-6620

Progress Billing
Application: 1 Period: 11/21/2017

Owner: Triple Creek COD
12750 Citrus Park Lane Suite 115
Tampa FL 33625

Job Location: Triple Creek Irrigation

Application For Payment On Contract
Original Contract......................................	291,081.00
Net Change by Change Orders................	0.00
Contract Sum to Date...............................	291,081.00
Total Complete to Date............................	11,646.40

Contractor's Certification of Work
The undersigned contractor certifies that, to the best of the contractor's knowledge, the work on the above named job has been completed in accordance with the plans and specifications to the level of completion indicated on the attached schedule of completion.

Total Retained..........................................

0.00

Contractor: :	·---=t

----·

:?"

Date: y/1- 2,I   -. \') 

Total Earned Less Retained....................	11,646.40

Less Previous Billings..............................	o.oo
Current Payment Due............................. I	11,646.401
Balance on Contract.................................	279,434.60

Terms: Invoices are due and payable 1DY from the date of invoice. All overdue amounts will be charged a service charge of
% per annum. Please make checks payable to: Newberg Irrigation, Inc.
Thank you for your prompt payment.

PROGRESS BILLING							Application: 1		
							Period: 11/21/2017		

Schedule of Work Completed									
Description of Work	Scheduled
Locate and Excavate	14,558.00	Changes	Contract
14,558.00	Previous	Current Comp.
11,646.40	Stored Mat.	Total Comp.
11,646.40	%	Balance
80.00	2,911.60	Retained	
Mainline, Conduit &	51,573.00		51,573.00					51,573.00		
Control System	49,725.00		49,725.00					49,725.00		
Spray Sprinkler Hea	17,534.00		17,534.00					17,534.00		
Lateral Pipe and Fitti	76,856.00		76,856.00					76,856.00		
Rotary Sprinkler Hea	12,784.00		12,784.00					12,784.00		
Drip Irrigation	45,218.00		45,218.00					45,218.00		
Well/Pump/Controls	19,375.00		19,375.00					19,375.00		
As Builts	3,458.00		3,458.00					3,458.00		
Totals:	291,081.00		291,081.00		11,646.40		11,646.40	4.00	279,434.60		

Page  2 of2

TRIPL'.E CREEK COMMUNITY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE GI

The undersigned; a Responsible Officer of Triple Creek Commun ity Development Dis trict (the ''District'') hereby subm its the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture dated as of June 1, 2012 from the District to The Bank of New York Mellon Trust, N.A., as tr ustee (the "Trus tee''), as supp.lemented by the Second Supplemental Trust Indenture dated as of February I, 2017 (the "Indenture") , (all capitalized terms used herein shall have the meaning ascri bed to such term in the Ind enture):

December 8, 2017

Requisition Number: CR207-Gl

{B)	Name of Payee: Randy Suggs, Inc.
3403 Roel, Springs Road
Apopka, FL 32712

Amount Payable: $15,609.72

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, slate Costs of Issuance, if :;ipplicable): Pay Application #1 for Project #Triple Creek- Village Gl

Fuhd or Account from which disbursement to be made: 2017A Acquisitfon and Construction Account,
Subaccount Village Gt

The undersigned hereby certifies that:
.	obligations in the slated amount set forth above have been_ incurred by the District, or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Fund that have not previously been pwd;

2,	each disbu rsement set forth above is a proper charge aga inst the Acquisition and Construction Fund:

J.	each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Projec;t

each disbursement representsa Cost of the Project which has not previously been paid.

The und ersigned hereby further certifies that there has not been filed with or served upon the District notice of any lion, right to lien, or ;i,ttachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above. which has not been released or will not be released simultaneously with the payment hereof
The und erSigned hereby further certifies that such requisition contains no item r presenting payment on accow1t of any retained percentage which the District is al the date of such certificate entitled to retain.
Attached hereto arc originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disbursement is hereby reques ted.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By, Cira;,		/	
1
Board of Supervisors

CONSULTING ENGINEER'S  APPROVAL FOR
NON-COST OF ISSUANCE REQUESTS  ONLY

ff this requisition is for a disbursement from other than Costs of Issuance, the underSigned Corumlling Engineer hereby certifies that th is dis bursement is for a Cost of the Project and is consistent with: (Q the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Project with respect t-0 which such disb ursement is bein g made; and (iii) the report of the Consulting Engineer, us s uch report shall have been amended Qr modified on the date hereof.

ConsuJti.

Customer:Project	Date	
Triple Creek	10/31/2017	

INV21752

Invoice #

Invoice
Randy Suggs, Inc.
P.O. Box 1141 Apopka FL 32704

Bill To

407-886-8835

Triple Creek Community Development District 12750 Citrus Park Lane
Suite 115
Tampa FL 33625

	Terms	Due Date	PO #	Project	
		11/25/2017		Triple Creek	
Item	Quantity	Description	Rate	Amount	

LS: Misc. Services	
1	Payment Application #1 Performance & Payment Bond	
15,609.72	
15,609.72	
	
Total	
$15,609.72	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

DISTRICT OFFICE · 9428 CAMDEN FIELD PARKWAY · RIVERVIEW, FLORIDA 33578

January 2, 2018

Thomas J. Radicioni
THE BANK OF NEW YORK TRUST COMPANY, N.A.
10161 Centurion Parkway
Jacksonville, FL 32256

RE:	Special Assessment Bonds, Series 2017AB Requisitions for Payment

Dear Thomas:

Below please find a table detailing the enclosed requisition(s) ready for payment from the Districts Acquisition/Construction Trust Account.

PLEASE EXPEDITE PAYMENT TO THE PAYEE(S) AS FOLLOWS:

ATLANTIC TNG AND FERGUSON WATERWORKS VIA USPS
ALL OTHERS VIA UPS

REQUISITION NO.	
PAYEE	
AMOUNT	
SUBACCOUNT	
208-B	Atlantic TNG, LLC	$2,422.00	General B	
209-K	Ferguson Waterworks	$1,956.74	Village K	
210-B	Florida Soil Cement Co., LLC	$28,401.78	General B	
211-B	Hayes Pipe Supply, Inc.	$12,965.50	General B	
212-B	The Kearney Companies, LLC	$234,825.50	General B	
213-K	The Kearney Companies, LLC	$119,575.51	Village K	
214-L	The Kearney Companies, LLC	$101,852.68	Village L	

If you have any questions regarding this request, please do not hesitate to call me at (813) 933-5571. Thank you for your prompt attention to this matter.

Sincerely,
TRIPLE CREEK
COMMUNITY DEVELOPMENT DISTRICT

Christine Perkins District Manager

TRIPLE CREEi( COMMUNITY DEVELOPMENT DISTRJCT SP£CIAL ASSESSMENT BONDS
SERIES 2017B

The und ersi gned, a Responsible Officer of Triple Creek Community Development District (the "District") hereby submits the following requis ition for disbursement under and pursuant to the tenns of the Master Trust Indenture dated as of June I, 2012 from the District to The Bank of New York Mellon Trust, N.A., as trustee (the '' Trustee"), as supplemented by the Second Supplemental Trust lndent1Jre dated as of February 1, 2017 (the ''I ndenture" ), (all capitalized tenns used herein shall have the meaning ascribed to such tenn in the Indenture):

December 27, 2017

Requis ition Numb er: CR208•B

Name of Payee: Atlantic TNG, LLC
1701 Myrllc Street
Sarasota, FL 34230

Amount Payable: $2,422.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs oflssuance, if applicable): Various invoice numbers per attached spreadsheet for Triple Creek Village K & LIAmenity Center

Fund or Account from which disbursement 10 be made: 2017B Acquisition and Construction
Account

The undersigned hereby certific.s that:
l.	obligations in the stated amoun 'l set fonh above have been incurred by the District, or
this requisition is for Costs of lssuo.noe payable from lhe Acquisition and Constrnction Fund that have not previously been paid;

each disbursement set forth above is a proper charge against the Acquisition and Constru.ction Fund;

each disbursement set forth above was incurred in connection with the acquisition and/or construction of the Project;

each disblllsement represents a Cost of the Project which has not previously been paid.

111e und ersigned hereby further certifies that there has not been filed with or served upon tbe District notice of any lien, right 10
lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that suc h requisition contaias no item representing payment on account of any retained percentage which the District is at the date ofsuch certificate entitled to retain.
Attached hereto are originals of the inv oice(s) from the vendor of the property acquired or the services rendered with respect to which disbursement is hereby requested.

>-<:	t} <i(_ ;>t(

>< '\

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRJCT

By:

CONSULTING ENGlNEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requis i1ion is for a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisi tion or construction contract; (ii) the plans and specifications for the portion of U1c Project with respect to which such disbursement is being made: and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.

J;erlsulUng Engineer

THE KEARNEY COMPANIES, LLC.
KFA1RI... EV	9625 Wes Kearney Way, Riverview FL 33578
COMPANIES

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K & L/AMENITY CENTER CHANGE ORDER NO. 4
THE KEARNEY COMPANIES PROJECT NO. 0038-01
Date:	30-Nov-17

Conditions: The changes described herein shall be governed by the terms and conditions of the Contract, and shall not in any way alter the terms of the Contract, but shall hereafter be a part of the Contract.

INV.NO.	
DESCRIPTION	Invoice Amount	
Sales Tax	TOTAL COST	
705273	HAYES PIPE SUPPLY 10/23/2017	$	2,271.00			
705481	HAYES PIPE SUPPLY 10/24/2017	$	3,714.00			
705643	HAYES PIPE SUPPLY 10/25/2017	$	2,423.00			
705875	HAYES PIPE SUPPLY 10/26/2017	$	297.00			
705894	HAYES PIPE SUPPLY 10/26/2017	$	1.139.00			
706334	HAYES PIPE SUPPLY 10/30/2017	$	1,119.50			
706957	HAYES PIPE SUPPLY 11/02/2017	$	2,002.00			
		$ 12,965.50	$	777.93	$	13,743.43	
			
114840	ATLANTIC TNG 10/23/2017	$	2,422.00			
		$	2,422.00	$	145.32	$	2,567.32	
			
1635673	FERGUSON 11/10/2017	$	468.00			
1636498	FERGUSON 11/17/2017	$	291.30			
1637410	FERGUSON 11/16/2017	$	1,197.44			
	DISCRETIONARY TAX:		$	19.57		
		$	1 956.74	$	136.97	$	2,093.71	
			
17094	FLORIDA SOIL CEMENT 11/29/2017	$	3,118.60			
17095	FLORIDA SOIL CEMENT 11/29/2017	$	4,035.19			
17096	FLORIDA SOIL CEMENT 11/29/2017	$	2 062.20			
17097	FLORIDA SOIL CEMENT 11/29/2017	$ 19,185.79			
		$ 28,401.78	$ 1,704.11	$	30,105.89	
			
TOTAL	..	$	(48.510.35)	

The Kearney Companies LLC hereby requests an extension of

---0

day(s) to the ongmal contract deadline for this work.

REASON FOR CHANGE: DIRECT PURCHASE OF MATERIALS BY CDD

Engineer

ACCEPTABLE TO:

Owner

DATE:---30--N-ov-17

DATE:

DATE:------

0038-01 C04 - COD Purchase Materials-4	Page 1 ofl

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL ATLANTIC TNG
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	30-Nov-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
114840	ATLANTIC TNG 10/23/2017	$	2,422.00	

			

			

			

			

			

			

			
TOTAL		$	2,422.00	

The Kearney Companies, LLC.

DATE:	30-Nov-17

Invoice Transmittal ATLANTIC TNG	Page 1 of 1

Attachment 1

PURCHASE REQUISITION REQUEST FORM

Contact Person for the material supplier. NAME:	Megan Kitchner / Atlantic TNG ADDRESS:		PO Box 729, Sarasota, FL 34230
TELEPHONE NUMBER:--9-41--355--29-88 --------------
Manufacturer or brand, model or specification number of the item.

Quantity needed as estimated by CONTRACTOR. --------
The price quoted by the supplier for the construction materials identified above.
$ 	2,422.00	
The sales tax associated with the price quote.$ 145.32 ------
Shipping and handling insurance cost. $_ 0._o_o  	_
Delivery dates as established by CONTRACTOR.	Per Schedule

Triple Creek

OWNER:

CONTRACTOR:  	

T_ h_e_K_e_a_rn_e_y.  C_o_m...p.__an_i_es_, _LC_ _C 	_

   11/30/2017	
Date

Attachment 2

PURCHASE ORDER

SEE	A'ITACHED	PURCHASE	REQUISITION	REQUEST	FORM DATED		November 30 , 2017.

Triple Creek Community Development District State of Florida sales tax exemption certificate number: 85-8013874191C-1

Triple Creek Community Development District is the Purchaser of the construction materials purchased pursuant to this Purchase Order. Supplier shall provide for the required shipping and handling insurance cost for delivery of the construction materials by the delivery date specified in this Purchase Order.

ri j;<J/21

Date

CONTRACTOR:  	

T_he_K_ ea_r_ne_yC__o_m_.p_a_n_ie_s_, L_L_C	_

11/30/2017

Date

CERTIFICATE OF ENTITLEMENT

The undersigned authorized representative of Triple Creek Community Development District (hereinafter "Governmental Entity"), Florida Consumer's Certificate of Exemption Number 85-8013874191C-1 , affirms that the tangible personal property purchased pursuant to a Purchase Order from Atlantic TNG (Vendor) will be incorporated into or become a part of a public facility as part of a public works contract pursuant to contract dated 2017 with The Kearney Companies, LCC, (Contractor) for the construction of public infrastructure associated with Triple Creek Villages K, L and Amenity Center

Governmental Entity affirms that the purchase of the tangible personal property contained in the attached Purchase Order meets the following exemption requirements contained in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C.:

ust initial each of the following requirements.
. The attached Purchase Order is issued directly to the vendor supplying the tangible personal property the
I I	Contractor will use in the identified public works.

tj

The vendor's invoice will be issued directly to Governmental Entity.
Payment of the vendor's invoice will be made directly by Governmental Entity to the vendor from public

R-

.	//	funds.

/µ

Governmental Entity will take title to the tangible personal property from the vendor at the  time of purchase or of delivery by the vendor.
7	5. Governmental Entity assumes the risk of damage or loss at the time of purchase or delivery by the vendor. Governmental Entity affinns that if the tangible personal property identified in the attached Purchase Order does not qualify for the exemption provided in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C., Governmental Entity will be subject to the tax, interest, and penalties due on the tangible personal property purchased. If the Florida Department of Revenue determines that the tangible personal property purchased tax-exempt by issuing this Certificate does not qualify for the exemption, Governmental Entity will be liable for any tax, penalty, and interest determined to be due.

I understand that if I of the sales tax plus the penalties of pe·r. are true.

udulently issue this certificate to evade the payment of sales tax I will be liable for payment pen   ty of 200% of the tax and may be subject  to conviction  of a third degree felony. Under
,   ffeclare that I have read the foregoing Certificate of Entitlement and the facts stated in it

District Engineer

Federal Employer Identification Number: FEIN# 45-0563644

Telephone Number: _ _ _ _

_ _ _ _

_ _ _

_ _ _ _ _

You must attach a copy of the Purchase Order to this Certificate of Entitlement. Do not send to the Florida Department of Revenue. This Certificate of Entitlement must be retained in the vendor's and the contractor's books and records. This form supplements and supersedes (to the extent of any conflict) any prior certificates addressing the same purchase.

A

JLANTIC

Atlantic TNG, LLC
PO Box 729 • Sarasota, FL 34230 Phone • (941) 355-2988

Invoice

&>'ll@

TNG U.C Fa,x

(941) 351-3765

Triple Creek Amenity Center Hillsborough County
PO#
Call Before Loading Contact: Eric 8I 3-927-1749

Triple Creek COD-Kearney c/o Rizzetta & Company 12750 Citrus Park Lane Suite 115
Tampa, FL 33625

}	!o.hVi!	©FJIW Jm

I 0/ 23/2017	25440	Net 30
l§l11!1.llnlD	® t::lillll'}	loc 'Aµ.Mll	w	.	u.ril.!Jm
SS-A2	1	4" Base	48" Diameter 6" Wall Sanitary Manhole	7340	1,208.00	1,208.00	
		Base					
	1	3' Riser Riser	48" Diameter 6" Wall Sanitary Manhole	3080			
	1	2' Cone	48" Diameter 6" Wall Sanitary Manhole	2040			
		Cone					
SS-A3	1	4'Base	48" Diameter 6" Wall Sanitary Manhole	7340	1,214.00	1,214.00	
		Base					
1	3.5' Riser	48" Diameter 6" Wall Sanitary	3600
Manhole Riser
2' Cone	48" Diameter 6" Wall Sanitary Manhole	2040
Cone

6" G3 Boot
8" G3 Boot	RECi :IV EO

6	48"  Sing le Offset Gasket	OCT 3 1 2017
TlIE KEARNE'r COMPANII:- ;;:

& rn\@CT11«rfi111	1     J

Subtotal	$2,422.00

Sales Tax  (0.0%)	$0.00

r	I iiw :WJ	
10/23/2017	114840	

u·u h l1J\.db • A

Balance Due	$2,422.00

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRJCT SPECIAL ASSESSMENT BONDS
SERIES 2017A, VILLAGE K

The undersigned, a Responsible Officer of Triple Creek Community Development District (the "District") hereby submits the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture dated as of June 1, 2012 from the District to The Bank of New York Mellon Trust, N.A., as trustee (the "Trustee"), as supplemented by the Second Supplemental Trust Indentur e dated as of February 1, 20t7 (the " Indenture''), (all capitalized tenns used herein shall have the meaning ascribed io such tem1 in the Indenture):
December 27, 2017

Requisilion Number: CIU09-K

Name of Payee: Ferguson Watenvorks
7816 Professional Place
Tampa, FL 336378

Amount Payable: $1 1956.74
Purpose for which paid or i ncurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance. if applicable): Various invoice numbers per attached spre11dsbect for Triple Creek Village I( & UAmcnity Center

Fund or Account from which disbursement to be made: 2017A Acquisition and Construction Account, Subaccount Village K

The undersigned hereby certifies that:
1,	obligations in the stated amount set forth above have been incu rred by th e District, or
this requisition is for Costs of lssuan.ce payable from the Acquisition and Construction Fund that have not previously been paid;

each disbursement set forth above is a proper charge gainst the Acquisition and Construction Fund;

each disbursement set fortb above was incurred in connection with the acquisition and/or construction ofU,e Project;

each disbursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies thnr there has not been filed with or served upon the District notice of any lien, tight to lien. or attachment upon. or cle.im affecti ng the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disburs eme nt is hereby requested .
TlUPLE CREEK COMMUNlTY DEVELOPMENT orSTR.ICT

Byc:	,,,		2)	
Board of Supervisors

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF TSSUANCE REQUESTS ONLY

I f this requisition is fot a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this dis bursement is for a Cost of the Project and ls consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of ihc Project with respect to which such disbursement is being made; and (iii} the report of the ConsultJng Engineer, assuch report shall have been amended or modified on the date hereof.	·

Constt!'tin g Engineer

THE	KEARNEY COMPANIES, LLC.
KFA1RI... EV	9625 Wes Kearney Way, Riverview FL 33578
COMPANIES

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K & L/AMENITY CENTER CHANGE ORDER NO. 4
THE KEARNEY COMPANIES PROJECT NO. 0038-01
Date:	30-Nov-17

Conditions: The changes described herein shall be governed by the terms and conditions of the Contract, and shall not in any way alter the terms of the Contract, but shall hereafter be a part of the Contract.

INV.NO.	
DESCRIPTION	Invoice Amount	
Sales Tax	TOTAL COST	
705273	HAYES PIPE SUPPLY 10/23/2017	$	2,271.00			
705481	HAYES PIPE SUPPLY 10/24/2017	$	3,714.00			
705643	HAYES PIPE SUPPLY 10/25/2017	$	2,423.00			
705875	HAYES PIPE SUPPLY 10/26/2017	$	297.00			
705894	HAYES PIPE SUPPLY 10/26/2017	$	1.139.00			
706334	HAYES PIPE SUPPLY 10/30/2017	$	1,119.50			
706957	HAYES PIPE SUPPLY 11/02/2017	$	2,002.00			
		$ 12,965.50	$	777.93	$	13,743.43	
			
114840	ATLANTIC TNG 10/23/2017	$	2,422.00			
		$	2,422.00	$	145.32	$	2,567.32	
			
1635673	FERGUSON 11/10/2017	$	468.00			
1636498	FERGUSON 11/17/2017	$	291.30			
1637410	FERGUSON 11/16/2017	$	1,197.44			
	DISCRETIONARY TAX:		$	19.57		
		$	1 956.74	$	136.97	$	2,093.71	
			
17094	FLORIDA SOIL CEMENT 11/29/2017	$	3,118.60			
17095	FLORIDA SOIL CEMENT 11/29/2017	$	4,035.19			
17096	FLORIDA SOIL CEMENT 11/29/2017	$	2 062.20			
17097	FLORIDA SOIL CEMENT 11/29/2017	$ 19,185.79			
		$ 28,401.78	$ 1,704.11	$	30,105.89	
			
TOTAL	..	$	(48.510.35)	

The Kearney Companies LLC hereby requests an extension of

---0

day(s) to the ongmal contract deadline for this work.

REASON FOR CHANGE: DIRECT PURCHASE OF MATERIALS BY CDD

Engineer

ACCEPTABLE TO:

Owner

DATE:---30--N-ov-17

DATE:

DATE:------

0038-01 C04 - COD Purchase Materials-4	Page 1 ofl

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL FERGUSON
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	30-Nov-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
1635673	FERGUSON 11/10/2017	$	468.00	
1636498	FERGUSON 11/17/2017	$	291.30	
1637410	FERGUSON 11/16/2017	$	1,197.44	

			

			

			

			

			

			
			
TOTAL		$	1,956.74	

The Kearney Companies, LLC.

DATE:	30-Nov-17

Invoice Transmittal FERGUSON	Page 1 of 1

Attachment 1

PURCHASE REQUISITION REQUEST FORM

l.	Contact Person for the material supplier.
NAME:	Renie Martin/Fer guson Waterworks
ADDRESS:	8008 E. Sligh Avenue, Tampa, FL 33610
TELEPHONE NUMBER: _	   ..,8_..l.3...-"_'"9"27..=_- 36.=.1..4 	_
Manufacturer or brand, model or specification number of the item.

Quantity needed as estimated by CONTRACTOR. --------
The price quoted by the supplier for the construction materials identified above.
$ 	1,956.74	
The sales tax associated with the price quote. $ 	  1_3_6.4_7	_
Shipping and handling insurance cost. $ 	_

Delivery dates as established by CONTRACTOR.	Per Schedule

Date

CONTRACTOR: -----------------------
	  	11/30/2017 
Date

Attachment 2

PURCHASE ORDER

I.	SEE	ATTACHED		PURCHASE	REQUISITION	REQUEST	FORM DATED  November 30	, 20_,g

2.	Triple Creek Community Development District State of Florida sales tax exemption certificate number: 85-8013874191C-1

Triple Creek Community Development District is the Purchaser of the construction materials purchased pursuant to this Purchase Order. Supplier shall provide for the required shipping and handling insurance cost for delivery of the construction materials by the delivery date specified in this Purchase Order.

r?µr/1
Date

CONTRACTOR: _

    =T,=h e""K"===aerne..,y.._""C"' o..m 	p.-="a"nies,_.  L_L_C 	_

11/30/2017

Date

CERTIFICATE OF ENTITLEMENT

The undersigned authorized representative of Triple Creek Community Development District (hereinafter "Governmental Entity"), Florida Consumer's Certificate of Exemption Number 85-8013874191C-1 , affirms that the tangible personal property purchased pursuant to a Purchase Order from Ferguson Waterworks (Vendor) will be incorporated into or become a part of a public facility as part of a public works contract pursuant to contract dated, 2017 with The Kearney Companies, LCC, (Contractor) for the construction of public infrastructure associated with Triple Creek Villages K, L and Amenity Center

Governmental Entity affirms that the purchase of the tangible personal property contained in the attached Purchase Order meets the following exemption requirements contained in Section 212.08(6), F.S., and Rule  12A-l. 094, F.A.C.:

3.

Yo must initial each of the following requirements .
The attached Purchase Order is issued directly to the vendor supplying the tangible personal property the Contractor will use in the identified public works.
The vendor's invoice will be issued directly to Governmental Entity.
Payment of the vendor's invoice will be made directly by Governmental Entity to the vendor from public

h

:/
4.
P-fs.

funds.
Governmental Entity will take title to the tangible personal property from the vendor at the time of purchase or of delivery by the vendor.
Governmental Entity assumes the risk of damage or loss at the time of purchase or delivery by the vendor.

Governmental Entity affirms that if the tangible personal property identified in the attached Purchase Order does not qualify for the exemption provided in Section 212.08(6), F.S., and Rule 12A-l.094, F.A.C., Governmental  Entity  will be subject to the tax, interest, and penalties due on the tangible personal property purchased. If the Florida Department of Revenue determines that the tangible personal property purchased tax-exempt by issuing this Certificate does not qualify for the exemption, Governmental Entity will be liable for any tax, penalty, and interest determined to be due.

I understand that if I fraudulently issue this certificate to evade the payment of sales tax I will be liable for payment of the sales tax  !us a  nalty of 200% of the tax and may  be subject to conviction  of a third  degree felony. Under the pena  ·es  fperj   , I declare that I have read the foregoing  Certificate  of Entitlement  and the facts stated  in it are tru

Ti't;W 	/4

District Engineer

Purchaser's Name (Print or Type)

Date	1	I-

Federal Employer Identification Number: FEIN# 45-0563644

Telephone Number: _

_ _ _ _

_ _ _

_ _ _ _ _ _ _ _

You must attach a copy of the Purchase Order to this Certificate of Entitlement. Do not send to the Florida Department of Revenue. This Certificate of Entitlement must be retained in the vendor's and the contractor's books and records. This form supplements and supersedes (to the extent of any conflict) any prior certificates addressing the same purchase.

FERGUSON®
WATERWORKS
FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

EMAIL DUPLICATE INVOICE

Deliver To:
From:	Michael Mcclain
Comments:

Invoice Number

Customer

Page

1635673

51547

1

Please Contact With Questions:
813-627-1240

Please refer to Invoice Number when making payment and remit to:	TOTAL DUE--->	500.76

FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA. GA 30384-0286

Sold To:
TRIPLE CREEK COD TRIPLE CREEK K & L
C/0 THE KEARNEY COMPANIES 9625 WES KEARNEY WAY

Ship To:
COUNTER PICK UP 8008 E SLIGH AVE TAMPA, FL 33610-0000

Ship Whse	Sell Whse	Tax	Customer
Code	Order Number	Sales	Job Name	Invoice Date	Batch	
44	44	FL2HIL	226425	027	TRIPLE CREEK K & L	11/10/2017	98638	
Ordered
6	Shipped
6	I	Item Number	I	Descrip tion	I  Unit Price  I  UM	I
I PSH  YD5GALFAS	IHYDRA PLUG CMNT FAST 50# PAIL RED.	I	78.0001	EA	I	Amount
468.00	

Person

Invoice Sub-Total Tax
Tota / Amt

468.00
32.76
500.76
TOTAL DUE--->	500. 76 l

&

, r·.-··,1 -,- v,'.,f r,l?	)	-
I       i l. d   , I , , ,,   .,Ii	, ·11

ijulW \1b .  .,	_.,)

uIr  u1! '11·ir 1t 1''i•1-,·	{_

ALL ACCOUNTS ARE DUE AND PAYABLE PER THE CONDITIONS AND TERMS OF THE ORIGINAL INVOICE. ALL PAST DUE AMOUNTS ARE SUBJECT TO A SERVICE CHARGE AT THE MAXIMUM RATE ALLOWED BY STATE LAW PLUS COSTS OF COLLECTION INCLUDING
ATTORNEY FEES IF INCURRED. FREIGHT TERMS ARE FOR OUR DOCK UNLESS OTHERWISE SPECIFIED ABOVE. COMPLETE TERMS AND
CONDITIONS ARE AVAILABLE UPON REQUEST OR CAN BE VIEWED ON THE WEB AT http://wo lseleyna.com/terms_conditionsSale.html GOVT BUYERS: ALL ITEMS QUOTED ARE OPEN MARKETUNLESS NOTED OTHERWISE.
LEAD LAW WARNING: IT IS ILLEGAL TO INSTALL PRODUCTS THAT ARE NOT "LEAD FREE" IN ACCORDANCE WITH US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION. PRODUCTS WITH *NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN NON-POTABLE APPLICATIONS. BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION.

FERGUSON®
WATERWORKS
FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

EMAIL DUPLICATE INVOICE

Deliver To:
From:	Michael Mcclain
Comments:

Invoice Number

1636498	Customer

51547	Page

1	

Please Contact With Questions:
813-627-1240
Please refer to Invoice Number when making payment and remit to:	TOTAL DUE--->	311.70

FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

Sold To:
TRIPLE CREEK COD TRIPLE CREEK K & L
C/O THE KEARNEY COMPANIES 9625 WES KEARNEY WAY

Ship To:
COUNTER PICK UP 8008 E SLIGH AVE TAMPA, FL 33610-0000

Ship Whse

44

Ordered
8
12
24
6	Sell Whse	Tax	Customer	Sales
Code	Order Number	Person
FL2HIL	226431	027	Job Name	Invoi ce Date	Batch	
	44		TRIPLE CREEK K & L	11/17/2017	98702	
	Shipped
8
12
24
6	Item Number	Description	Unit Price	UM	Amount	
		RBGVTMU	3 BRS GATE VLV ID - 6	15.000	EA	120.00	
		MUL040492	4 PVC SWR REC THRO CO PLUG	6.450	EA	77.40	
		PS67194	2 WOOD HDL CHIP BRSH	2.790	EA	66.96	
		PS67196	3 WOOD HDL CHIP BRSH	4.490	EA	26.94	

. li J,.	·'i·  t  It,/  ,•· •lj	t

j	.,:rn.::1-1 rJy.;J:.._t.·_fnr,.'t11",..".!/(r,)-,!r!::r-:i,nlj
U

Invoi ce Sub-Total
Tax
Total Amt

291.30
20.40

l

311.70

TOTAL DUE--->	,,,.10

, Q	.vu Lb :   /_,	'::)
-·
ALL	ACCOUNTS ARE DUE AND PAYABLE PER THE CONDITIONS AND TERMS OF THE ORIGINAL INVOICE. ALL PAST DUE AMOUNTS ARE SUBJECT TO A SERVICE CHARGE AT THE MAXIMUM RATE ALLOWED BY STATE LAW PLUS COSTS OF COLLECTION INCLUDING
AHORNEY FEES IF INCURRED. FREIGHT TERMS ARE FOR OUR DOCK UNLESS OTHERWISE SPECIFIED ABOVE. COMPLETE TERMS AND
CONDITIONS ARE AVAILABLE UPON REQUEST OR CAN BE VIEWED ON THE WEB AT http://wolseleyna.com1terms_con ditionsSale.html GOVT BUYERS: ALL ITEMS QUOTED ARE OPEN MARKETUNLESS NOTED OTHERWISE.
LEAD LAW WARNING: IT IS ILLEGAL TO INSTALL PRODUCTS THAT ARE NOT "LEAD FREE" IN ACCORDANCE WITH US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION. PRODUCTS WITH *NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN NON-POTABLE APPLICATIONS. BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION.

FERGUSON®
WATERWORKS
FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

EMAIL DUPLICATE INVOICE

Deliver To:
From:	Michael Mcclain
Comments:

Invoice Number

Customer

Page

1637410

51547

1

Please Contact With Questions:
813-627-1240

Please refer to Invoice Number when making payment and remit to:	TOTAL DUE···>	1281.26

FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

Sold To:
TRIPLE CREEK COD TRIPLE CREEK K & L
C/O THE KEARNEY COMPANIES 9625 WES KEARNEY WAY

Ship To:
COUNTER PICK UP 8008 E SLIGH AVE TAMPA, FL 33610-0000

Ship
Whse	Sell Whse	Tax	Customer	Sales	Job Name		Invoice
Date	Batch	
44	44	FL2HIL	226436	027	TRIPLE CREEK K	& L	11/16/2017	98687	
Ordered	Shipped	Item Number	Description	Unit Price	UM	Amount	
20	20	FC4444NL	LF 1 CTS X CTS COMP COUP	25.140	EA	502.80	
42	42	SDR26HWSPP14	4X14 SDR26 HW PVC GJ SWR PIPE	1.540	FT	64.68	
4	4	MUL067104	4 PVC HW SWR GXGXG TEE WYE	50.390	EA	201.56	
10	10	MUL067324	4 PVC HW SWR GXG 45 ELL	18.420	EA	184.20	
10	10	MUL067304	4 PVC HW SWR GXG 22-1/2 ELL	24.420	EA	244.20	
		Invoice Sub-Total			1197.44	
		Tax			83.82	
		Total Amt			1281.26	

Code	Order Number	Person

TOTAL DUE··->	'"'·"I

ALL ACCOUNTS ARE DUE AND PAYABLE PER THE CONDITIONS AND TERMS OF THE ORIGINAL INVOICE. ALL PAST DUE AMOUNTS ARE SUBJECT TO A SERVICE CHARGE AT THE MAXIMUM RATE ALLOWED BY STATE LAW PLUS COSTS OF COLLECTION INCLUDING
ATTORNEY FEES IF INCURRED.  FREIGHT TERMS ARE FOR OUR DOCK UNLESS OTHERWSI E SPECIFIED ABOVE.  COMPLETE TERMS AND
CONDITIONS ARE AVAILABLE UPON REQUEST OR CAN BE VIEWED ON THE WEB AT http :1/wolse leyna.c o mlterms _co nditionsSale.html GOVT BUYERS: ALL ITEMS QUOTED ARE OPEN MARKETUNLESS NOTED OTHERWISE.
LEAD LAW WARNING: IT IS ILLEGAL TO INSTALL PRODUCTS THAT ARE NOT "LEAD FREE" IN ACCORDANCE WITH US FEDERAL OR OTHER APPLI CABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION. PRODUCTS WITH *NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN NON-POTABLE APPLICATIONS. BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION.

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SPECIAL ASSESSMEN1' BONDS
SERIES 2017B

The undersigned, a Responsible Officer of Triple Creek Community Development District (the ''District"} hereby submits the following requisition for disbursement under and pursuant to the tenns of the Master Trust [ndenture dated as of June I, 2012 from the District to The Bank of New York MeHon Trust, N.A., as trustee (the "Trustee"), as supplemented by the Second SupplementaJ Trust Indenture dated as of February I, 2017 (the "lndenrure"), (all capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

Docember 27, 2017

Requisition Number : CR210-B

Name of Payee: Florida Soil Cement Co., LLC
9625 Wes Kearney Way
Riverview, FL 33578

Amount Payable ; $28,401.78

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, stale Costs oflssuance, if applicable): Various invoice numbe rs per attached spreadsheet for Triple Creek Village K & L/Amcnity Center

Fund or Account from which disbursement to be made: 20178 Ac ui.silion and Co11strudion Account

The unde rsibrned hereby c:ertilies that:
obligations in tho stated amount set forth above have been inc:urred by the District, or
this requisition is for Costs of Issuance payable from the Ai;quisition end Construction Fund that have not previously been pald;

each disbursement set forth above is a proper charge against the Acquisition and Construction Fund;

each dis bursemen t s et forth above was incurred in connection with the acquisition and/or construction of the Project;

each disbursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies that ther e has not been filed with or served upon the Dis.trict notice of any lien, right lo lien, or attachment upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The unde rsigned hereby further certifies that such requisition contains no ltem representing payment on account of any retained percentage which !he Oistrict is at the date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to whic h disbursement is hereby requested.

> tC _c.k fZ)(:

;o <',

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By:

CONSULTING ENGINEER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Iss uan ce, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Project 11nd is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.

Cons !:_

THEKEARNEY COMPANIES, LLC.
KFA1RI... EV	9625 Wes Kearney Way, Riverview FL 33578
COMPANIES

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K & L/AMENITY CENTER CHANGE ORDER NO. 4
THE KEARNEY COMPANIES PROJECT NO. 0038-01
Date:	30-Nov-17

Conditions: The changes described herein shall be governed by the terms and conditions of the Contract, and shall not in any way alter the terms of the Contract, but shall hereafter be a part of the Contract.

INV.NO.	
DESCRIPTION	Invoice Amount	
Sales Tax	TOTAL COST	
705273	HAYES PIPE SUPPLY 10/23/2017	$	2,271.00			
705481	HAYES PIPE SUPPLY 10/24/2017	$	3,714.00			
705643	HAYES PIPE SUPPLY 10/25/2017	$	2,423.00			
705875	HAYES PIPE SUPPLY 10/26/2017	$	297.00			
705894	HAYES PIPE SUPPLY 10/26/2017	$	1.139.00			
706334	HAYES PIPE SUPPLY 10/30/2017	$	1,119.50			
706957	HAYES PIPE SUPPLY 11/02/2017	$	2,002.00			
		$ 12,965.50	$	777.93	$	13,743.43	
			
114840	ATLANTIC TNG 10/23/2017	$	2,422.00			
		$	2,422.00	$	145.32	$	2,567.32	
			
1635673	FERGUSON 11/10/2017	$	468.00			
1636498	FERGUSON 11/17/2017	$	291.30			
1637410	FERGUSON 11/16/2017	$	1,197.44			
	DISCRETIONARY TAX:		$	19.57		
		$	1 956.74	$	136.97	$	2,093.71	
			
17094	FLORIDA SOIL CEMENT 11/29/2017	$	3,118.60			
17095	FLORIDA SOIL CEMENT 11/29/2017	$	4,035.19			
17096	FLORIDA SOIL CEMENT 11/29/2017	$	2 062.20			
17097	FLORIDA SOIL CEMENT 11/29/2017	$ 19,185.79			
		$ 28,401.78	$ 1,704.11	$	30,105.89	
			
TOTAL	..	$	(48.510.35)	

The Kearney Companies LLC hereby requests an extension of

---0

day(s) to the ongmal contract deadline for this work.

REASON FOR CHANGE: DIRECT PURCHASE OF MATERIALS BY CDD

Engineer

ACCEPTABLE TO:

Owner

DATE:---30--N-ov-17

DATE:

DATE:------

0038-01 C04 - COD Purchase Materials-4	Page 1 ofl

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL FLORIDA SOIL CEMENT COMPANY THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	30-Nov-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
17094	FLORIDA SOIL CEMENT 11/29/2017	$	3,118.60	
17095	FLORIDA SOIL CEMENT 11/29/2017	$	4,035.19	
17096	FLORIDA SOIL CEMENT 11/29/2017	$	2,062.20	
17097	FLORIDA SOIL CEMENT 11/29/2017	$	19,185.79	

			

			

			

			

			

			
TOTAL		$	28,401.78	

The Kearney Companies, LLC.

DATE:	30-Nov-17

Invoice Transmittal FSCC	Page 1 of 1

Attachment 1

PURCHASE REQUISITION REQUEST FORM

Contact Person for the material supplier.
NAME:	Alan Payne / Florida Soil Cement Co. LLC ADDRESS:		9625 Wes Kearney Way, Riverview, FL 33578
TELEPHONE NUMBER: --81-3-9-17--84-02 --------------
Manufacturer or brand, model or specification number of the item.

Quantity needed as estimated by CONTRACTOR. 	_
The price quoted by the supplier for the construction materials identified above.
$    28,401.78	
The sales tax associated with the price quote. $_   1_,7_0_4_.1_1  	_
Shipping and handling insurance cost. $ 		o_.o_o 	_
Delivery dates as established by CONTRACTOR.	Per Schedule

ft /Zxj;t
Date

CONTRACTOR:  	

T_h_e_K_e_a_rn_e_y,__C_o_m-=p-_an_i_es_, _LC_C	 _

   11/30/2017	
Date

Attachment 2

PURCHASE ORDER

SEE	ATTACHED	PURCHASE	REQUISITION	REQUEST	FORM DATED		November 30 , 2017.

Triple Creek Community Development District State of Florida sales tax exemption certificate number: 85-8013874191C-1

Triple Creek Community Development District is the Purchaser of the construction materials purchased pursuant to this Purchase Order. Supplier shall provide for the required shipping and handling insurance cost for delivery of the construction materials by the delivery date specified in this Purchase Order.

,   ;zI  /2£I /n

Date

CONTRACTOR:  	

T_h_e_K_ ea_rn_e_yC__o_m_.pa. n_ie_s,_L_L_C	_

11/30/2017

Date

CERTIFICATE OF ENTITLEMENT

The undersigned authorized representative of Triple Creek Community Development District (hereinafter "Governmental Entity"), Florida Consumer's Certificate of Exemption Number 85-8013874191C-1 , affirms that the tangible personal property purchased pursuant to a Purchase Order from Florida Soil Cement Co. LLC (Vendor) will be incorporated into or become a part of a public facility as part of a public works contract  pursuant to contract dated 2017 with The Kearney Companies, LCC, (Contractor) for the construction of public infrastructure associated with Triple Creek Villages K, L and Amenity Center

Governmental Entity affirms that the purchase of the tangible personal property contained in the attached Purchase Order meets the following exemption requirements contained in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C.:

must initial each of the following requirements.
,,,...,1.  The attached Purchase Order is issued directly to the vendor supplying  the tangible personal property the Contractor will use in the identified public works.
The vendor's invoice will be issued directly to Governmental Entity.
Payment of the vendor's invoice will be made directly by Governmental Entity to the vendor from public funds.
Governmental Entity will take title to the tangible personal property from the vendor at the time of purchase or of delivery by the vendor.
. Governmental Entity assumes the risk of damage or loss at the time of purchase or delivery by the vendor.

Governmental Entity affirms that if the tangible personal property identified in the attached Purchase Order does not qualify for the exemption provided in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C., Governmental Entity will be subject to the tax, interest, and penalties due on the tangible personal property purchased. If the Florida Department of Revenue determines that the tangible personal property purchased tax-exempt by issuing this Certificate does not qualify for the exemption, Governmental Entity will be liable for any tax, penalty, and interest determined to be due.

I understand that if  fraudulently issue this certificate to evade the payment of sales tax I will be liable for payment of the sales tax pl a p ty of 200% of the tax and may be subject to conviction of a third degree felony. Under

the penalties of	rjury, 1?/1

presentative

are true.	1{,/

re that I have read the foregoing Certificate of Entitlement and the facts stated in it

Federal Employer Identification Number: FEIN# 45-0563644

Telephone Number: _ _

_ _ _ _ _ _ _

_ _ _

_ _ _ _

You must attach a copy of the Purchase Order to this Certificate of Entitlement. Do not send to the Florida Department of Revenue. This Certificate of Entitlement must be retained in the vendor's and the contractor's books and records. This form supplements and supersedes (to the extent of any conflict) any prior certificates addressing the same purchase.

INVOICE NUMBER:	17094

9625 Wes Kearney Way Riverview, FL 33578 Phone: 813‐917‐8402

SOLD TO: Triple Creek CDD
C/‐ The Kearney Companies	PROJECT: Triple Creek
9625 Wes Kearney Way
Riverview, FL 33578‐0506	MATERIAL SOURCE: American Aggregates
ATTENTION: ariel@thekearneycompanies.com
PO NUMBER: 0038‐01‐06
PHONE: (813) 421‐8349

INVOICE DATE

INVOICE DATE

INVOICE DATE

CLERICAL ERRORS ARE SUBJECT TO CORRECTION. DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.
JOB	NO.

0038‐01	CUST. NO.	CONTRACT NO.	INVOICE DATE

11/28/2017	AGP/AK	
Item #	Date	Material	Qty	Unit	Cost/Unit	Amount	

1	
Wednesday August 30, 2017	
57 Limestone	
110.72	
TN	
$20.00	
$2,214.40	
2	Wednesday October 25, 2017	57 Limestone	45.21	TN	$20.00	$904.20	

Sub Totals:	155.93	$3,118.60

Sales Tax Exemption Certificate On File

TOTAL AMOUNT DUE:	$3,118.60

PLEASE REMIT TO:

INVOICE DUE ON OR BEFORE:

FLORIDA SOIL CEMENT CO., LLC
12/12/17	9625 Wes Kearney Way
Riverview FL 33578

PLEASE PAY FROM THIS INVOICE ‐ NO STATEMENT WILL BE RENDERED
INVOICES ARE DUE UPON RECEIPT. UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS AND FEES FOR COLLECTION ON ACCOUNTS REMAINING AND UNPAID IN EXCESS OF 30 DAYS, INCLUDING, BUT NOTLIMITED TO, ATTORNEYS' FEES AND ATTORNEYS' FEES ON APPEAL.

INVOICE NUMBER:	17095

9625 Wes Kearney Way Riverview, FL 33578 Phone: 813‐917‐8402

SOLD TO: Triple Creek CDD
C/‐ The Kearney Companies	PROJECT: Triple Creek Amenity
9625 Wes Kearney Way
Riverview, FL 33578‐0506	MATERIAL SOURCE: Cemex ‐ St. Catherine
Cemex ‐ Gator Mine
ATTENTION: ariel@thekearneycompanies.com
PO NUMBER: 0038‐01‐19
PHONE: (813) 421‐8349	0038‐01‐17

CLERICAL ERRORS ARE SUBJECT TO CORRECTION. DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.

INVOICE DATE

INVOICE DATE

INVOICE DATE

JOB NO.	CUST.  NO.	CONTRACT NO.	INVOICE DATE

0038‐01					11/28/2017		
Item #	Date	Material	Qty	Unit	Cost/Unit	Amount	

1	
Tuesday October 24, 2017	
FDOT Limerock	
221.55	
TN	
$8.50	
$1,883.18	
2	Tuesday October 24, 2017	Environmental Fee	9.00	LD	$3.00	$27.00	
3	Thursday November 02, 2017	FDOT Limerock	24.79	TN	$8.50	$210.72	
4	Thursday November 02, 2017	Environmental Fee	1.00	LD	$3.00	$3.00	
5	Monday November 06, 2017	FDOT Limerock	97.68	TN	$8.50	$830.28	
6	Monday November 06, 2017	Environmental Fee	4.00	LD	$3.00	$12.00	
7	Monday November 13, 2017	Underdrain Sand ‐ V	68.47	TN	$15.35	$1,051.02	
8	Monday November 13, 2017	Environmental Fee	3.00	LD	$6.00	$18.00	

AGP/AK

Sub Totals:	412.49	$4,035.19

Sales Tax Exemption Certificate On File

TOTAL AMOUNT DUE:	$4,035.19

PLEASE REMIT TO:

INVOICE DUE ON OR BEFORE:

FLORIDA SOIL CEMENT CO., LLC
12/12/17	9625 Wes Kearney Way
Riverview FL 33578

PLEASE PAY FROM THIS INVOICE ‐ NO STATEMENT WILL BE RENDERED
INVOICES ARE DUE UPON RECEIPT. UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS AND FEES FOR COLLECTION ON ACCOUNTS REMAINING AND UNPAID IN EXCESS OF 30 DAYS, INCLUDING, BUT NOTLIMITED TO, ATTORNEYS' FEES AND ATTORNEYS' FEES ON APPEAL.

INVOICE NUMBER:	17096

9625 Wes Kearney Way Riverview, FL 33578 Phone: 813‐917‐8402

SOLD TO: Triple Creek CDD
C/‐ The Kearney Companies	PROJECT: Triple Creek Amenity
9625 Wes Kearney Way
Riverview, FL 33578‐0506	MATERIAL SOURCE: Rinker Materials
ATTENTION: ariel@thekearneycompanies.com
PO NUMBER: 0038‐01‐21
PHONE: (813) 421‐8349

INVOICE DATE

INVOICE DATE

INVOICE DATE

CLERICAL ERRORS ARE SUBJECT TO CORRECTION. DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.
JOB	NO.

0038‐01	CUST. NO.	CONTRACT NO.	INVOICE DATE
11/28/2017	AGP/AK	
Item #	Date	Material	Qty	Unit	Cost/Unit	Amount	

1	
Wednesday October 18, 2017	
30X6' FES OUTLET TG MIA	
1.00	
PC	
$1,315.40	
$1,315.40	
2	Wednesday October 18, 2017	15X6' FES OUTLET TG MIA	1.00	PC	$217.00	$217.00	
3	Wednesday October 18, 2017	18X6' FES OUTLET TG MIA	2.00	PC	$264.90	$529.80	

Sub Totals:	4.00	$2,062.20

Sales Tax Exemption Certificate On File

TOTAL AMOUNT DUE:	$2,062.20

PLEASE REMIT TO:

INVOICE DUE ON OR BEFORE:

FLORIDA SOIL CEMENT CO., LLC
12/12/17	9625 Wes Kearney Way
Riverview FL 33578

PLEASE PAY FROM THIS INVOICE ‐ NO STATEMENT WILL BE RENDERED
INVOICES ARE DUE UPON RECEIPT.  UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS   AND FEES FOR COLLECTION ON ACCOUNTS REMAINING AND UNPAID IN EXCESS OF 30 DAYS, INCLUDING, BUT NOTLIMITED TO, ATTORNEYS' FEES AND ATTORNEYS' FEES ON APPEAL.

INVOICE NUMBER:	17097

9625 Wes Kearney Way Riverview, FL 33578 Phone: 813‐917‐8402

SOLD TO: Triple Creek CDD
C/‐ The Kearney Companies	PROJECT: Triple Creek K
9625 Wes Kearney Way
Riverview, FL 33578‐0506	MATERIAL SOURCE: Woodruff & Sons
ATTENTION: ariel@thekearneycompanies.com
PO NUMBER: 0038‐01‐14
PHONE: (813) 421‐8349

CLERICAL ERRORS ARE SUBJECT TO CORRECTION. DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.

INVOICE DATE

INVOICE DATE

INVOICE DATE

JOB NO.	CUST.  NO.	CONTRACT NO.	INVOICE DATE

0038‐01					11/28/2017		
Item #	Date	Material	Qty	Unit	Cost/Unit	Amount	

1	
Thursday November 02, 2017	
3/8" Concrete Fines	
176.00	
TN	
$13.00	
$2,288.00	
2	Friday November 10, 2017	Soil Cement Fines	1708.57	TN	$6.50	$11,105.71	
3	Tuesday November 14, 2017	Soil Cement Fines	357.66	TN	$6.50	$2,324.79	
4	Wednesday November 15, 2017	Soil Cement Fines	533.43	TN	$6.50	$3,467.30	

AGP/AK

Sub Totals:	2,775.66	$19,185.79

Sales Tax Exemption Certificate On File

TOTAL AMOUNT DUE:	$19,185.79

PLEASE REMIT TO:

INVOICE DUE ON OR BEFORE:

FLORIDA SOIL CEMENT CO., LLC
12/12/17	9625 Wes Kearney Way
Riverview FL 33578

PLEASE PAY FROM THIS INVOICE ‐ NO STATEMENT WILL BE RENDERED
INVOICES ARE DUE UPON RECEIPT. UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH IS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS AND FEES FOR COLLECTION ON ACCOUNTS REMAINING AND UNPAID IN EXCESS OF 30 DAYS, INCLUDING, BUT NOTLIMITED TO, ATTORNEYS' FEES AND ATTORNEYS' FEES ON APPEAL.

TRIPLE CREEK COMMUN IT Y DEVE LOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 2017B

The undersigned, a Responsi ble Officer of Triple Creek Communi ty Developmen1 Dis rrict (the " Distric t'') hereby sub mi ts the following requisi tion for disbu rse ment under and pursuant to the terms of the Master Trust Indenture dated as of June t, 2 012 from the District lo The Bank of New York Mellon Trust, N.A ., as trustee, (the "Trustee"), as supp lemented by the Second Supplemen tal Trust Indenture dated as of February I , 2017 (the "Indenture"), (all capitalized terms used herein shall have the meaning ascribed to such term in the Ind e ntu re):

December 27, 2017

Rciquisilio n Number: CR211-B

Name of Payee; Hayes Pipe Supply, In c.
950 Fi ber Glnss Rd.
P.O. Boi 10155 0
Nashville, TN 37224

Amount Payable: $12,965.50

Purpose for which paid or incurred (re fer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance , if applicable): Various invo ice num bers per a ttached spreadsheet for Triple Creek Village K & UAmcnity Center

Fund or Account  from  which dis bursemen t to be made: 2017B Acquisition  and Cons truction
Account

The undersigned hereby certifies that:
obligations in the stated amount set forth above have been incurred by the District, or
this requisition is for Costs of Iss uance payable from the Acquisi tion and Construction Fund that have not previously been paid;

each disb ursement set forth above is a proper charge against the Acquisition and Construct ion Fund;

each disbursement set forth above was incurred in connect ion with the acqui s i tion and/or construction of the Project; each disbursement represents a Cost of the Project which has not previously been paid.
The undersigned hereby further certifies that there has not been :filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecting the right 10 receive payment of, any of the moneys payable to the Payee set forth above, which h.as not been released or will not be rele ased sim ultaneously with the payment hereof.
he unders igned hereby further certifies that such requisition contains no item representing payment on aocount of any retained percentage which the District [sat the date of such certificate ent itled lo retai n.	·
Attached hereto are originals of the invoice(s) from the vendor of the property acqui red or the services rende red with respect to which disbursement is hereby requested.
TRJPLE C REEK COMMUNITY DEVELOP MENT DISTRICT

........._ ..C . )-<.?'-?'¥

/ 

By:	 	

CONSULTINO ENGINEER'S APPROVAL FOR
NON-COST OF ISSUAN CE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consult ing Engineer hereby certifies that this dis bursement is for a Cost of the Project and is cons is tent with: (i) the applicable acquisition or construction contract:; (ii) the plans and s pecifications for the portion of the Project with respect to which such disbur sement is being made; and (iir) the report of the Consulting Engi neer, as such report s hall have been ame nded or mo dified on the date he reof.

Cons ult	

THE KEARNEY COMPANIES, LLC.
KFA1RI... EV	9625 Wes Kearney Way, Riverview FL 33578
COMPANIES

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K & L/AMENITY CENTER CHANGE ORDER NO. 4
THE KEARNEY COMPANIES PROJECT NO. 0038-01
Date:	30-Nov-17

Conditions: The changes described herein shall be governed by the terms and conditions of the Contract, and shall not in any way alter the terms of the Contract, but shall hereafter be a part of the Contract.

INV.NO.	
DESCRIPTION	Invoice Amount	
Sales Tax	TOTAL COST	
705273	HAYES PIPE SUPPLY 10/23/2017	$	2,271.00			
705481	HAYES PIPE SUPPLY 10/24/2017	$	3,714.00			
705643	HAYES PIPE SUPPLY 10/25/2017	$	2,423.00			
705875	HAYES PIPE SUPPLY 10/26/2017	$	297.00			
705894	HAYES PIPE SUPPLY 10/26/2017	$	1.139.00			
706334	HAYES PIPE SUPPLY 10/30/2017	$	1,119.50			
706957	HAYES PIPE SUPPLY 11/02/2017	$	2,002.00			
		$ 12,965.50	$	777.93	$	13,743.43	
			
114840	ATLANTIC TNG 10/23/2017	$	2,422.00			
		$	2,422.00	$	145.32	$	2,567.32	
			
1635673	FERGUSON 11/10/2017	$	468.00			
1636498	FERGUSON 11/17/2017	$	291.30			
1637410	FERGUSON 11/16/2017	$	1,197.44			
	DISCRETIONARY TAX:		$	19.57		
		$	1 956.74	$	136.97	$	2,093.71	
			
17094	FLORIDA SOIL CEMENT 11/29/2017	$	3,118.60			
17095	FLORIDA SOIL CEMENT 11/29/2017	$	4,035.19			
17096	FLORIDA SOIL CEMENT 11/29/2017	$	2 062.20			
17097	FLORIDA SOIL CEMENT 11/29/2017	$ 19,185.79			
		$ 28,401.78	$ 1,704.11	$	30,105.89	
			
TOTAL	..	$	(48.510.35)	

The Kearney Companies LLC hereby requests an extension of

---0

day(s) to the ongmal contract deadline for this work.

REASON FOR CHANGE: DIRECT PURCHASE OF MATERIALS BY CDD

Engineer

ACCEPTABLE TO:

Owner

DATE:---30--N-ov-17

DATE:

DATE:------

0038-01 C04 - COD Purchase Materials-4	Page 1 ofl

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL HAYES PIPE SUPPLY
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	30-Nov-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
705273	HAYES PIPE SUPPLY 10/23/2017	$	2,271.00	
705481	HAYES PIPE SUPPLY 10/24/2017	$	3,714.00	
705643	HAYES PIPE SUPPLY 10/25/2017	$	2,423.00	
705875	HAYES PIPE SUPPLY 10/26/2017	$	297.00	
705894	HAYES PIPE SUPPLY 10/26/2017	$	1,139.00	
706334	HAYES PIPE SUPPLY 10/30/2017	$	1,119.50	
706957	HAYES PIPE SUPPLY 11/02/2017	$	2,002.00	

			

			

			

			

			
TOTAL		$	12,965.50	

The Kearney Companies, LLC.

DATE:	30-Nov-17

Invoice Transmittal HAYES PIPE SUPPLY	Page 1 of 1

Attachment 1

PURCHASE REQUISITION REQUEST FORM

Contact Person for the material supplier. NAME:	Matt Cogsdale / Hayes Pipe Supply
ADDRESS:	9416 E. Dr. Martin Luther King Jr. Blvd, Tam pa, FL 33610
TELEPHONE NUMBER: --81-3-2-41--404-0  --------------
Manufacturer  or brand, model or specification number of the item.

Quantity needed as estimated by CONTRACTOR. 	_
The price quoted by the supplier for the construction materials identified above.
$ 	12,965.50	
The sales tax associated with the price quote. $_7_7_7._93	_
Shipping and handling insurance cost. $_0_.o_o	_
Delivery dates as established by CONTRACTOR.	Per Schedule

CONTRACTOR:  	

Th_e_K_ e_a_rn_e...y__C_o_m-=p_a_ni_es_,_L_C_C 	_

   11/30/2017	
Date

Attachment 2

PURCHASE ORDER

SEE	ATI'ACHED	PURCHASE	REQUISIDON	REQUEST	FORM DATED		November 30 , 2017.

Triple Creek Community Development District State of Florida sales tax exemption certificate number: 85-8013874191C-1

Triple Creek Community Development District is the Purchaser of the construction materials purchased pursuant to this Purchase Order. Supplier shall provide for the required shipping and handling insurance cost for delivery of the construction materials by the delivery date specified in this Purchase Order.

unity Development District

Date

CONTRACTOR:  	

T_h_e_K_ e_a_rn_e_,y_  _C_o_m---'p,_a_n_ie_s,_L_L_C	_

11/30/2017

Date

CERTIFICATE OF ENTITLEMENT

The undersigned authorized representative of Triple Creek Community Development District (hereinafter "Governmental Entity"), Florida Consumer's Certificate of Exemption Number 85-8013874191C-1 , affirms that the tangible personal property purchased pursuant to a Purchase Order from Hayes Pipe Supply (Vendor) will be incorporated into or become a part of a public facility as part of a public works contract pursuant to contract datedl 2017 with The Kearney Companies, LCC, (Contractor) for the construction of public infrastructure associated with Triple Creek Villages K, L and Amenity Center

Governmental Entity affirms that the purchase of the tangible personal property contained in the attached Purchase Order meets the following exemption requirements contained in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C.:

1st initial each of the following requirements.
The attached Purchase Order is issued directly to the vendor supplying the tangible personal property the Contractor will use in the identified public works.
The vendor's invoice will be issued directly to Governmental Entity.

3.
P'f 4.
-'

Payment of the vendor's invoice will be made directly by Governmental Entity to the vendor from public funds.
Governmental Entity will take title to the tangible personal property from the vendor at the time  of purchase or of delivery by the vendor.
Governmental Entity assumes the risk of damage or loss at the time of purchase or delivery by the vendor.

Governmental Entity affirms that if the tangible personal property identified in the attached Purchase Order does not qualify for the exemption provided in Section 212.08(6), F.S., and Rule 12A-1.094, F.A.C., Governmental Entity will be subject to the tax, interest, and penalties due on the tangible personal property purchased. If the Florida Department of Revenue determines that the tangible personal property purchased tax-exempt by issuing this Certificate does not qualify for the exemption, Governmental Entity will be liable for any tax, penalty, and interest determined to be due.

I understand that if I fra ulently issue this certificate to evade the payment of sales tax I will be liable for payment nalty of 2    % of the tax and may be subject  to conviction  of a third degree felony. Under
, I decl	at I  h  ve read the foregoing Certificate  of Entitlement  and the facts stated in it

 	d

District Engineer
Titl(e  i  ;; f
Da  te	1	,J

Federal Employer Identification Number: FEIN# 45-0563644

Telephone Number: _ _ _ _

_ _ _ _

_ _ _

_ _ _ _ _

You must attach a copy of the Purchase Order to this Certificate of Entitlement. Do not send to the Florida Department of Revenue. This Certificate of Entitlement must be retained in the vendor's and the contractor's books and records. This form supplements and supersedes (to the extent of any conflict) any prior certificates addressing the same purchase.

INVOICE
HAYES PIPE SUPPLY, INC.
D Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Page:	1

D Murfreesboro, TN• (615) 217-3040

www.hayespip·e.com

Kooxviiie,T  N• (865) 525-1717 o

D  Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 D
D  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-9819 D
D Acworth, GA • (770) 529-8883	D Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 D
Mains - Main Line Accessories - Service Materials - Casing Pipe

I To:

Ship To:

RECEIVED

Invoice

TRIPLE CREEK CDD
cJo THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY
RIVERVIEW	FL 33578

TRIPLE CREEK CDD
AMENITIES CENTER

OCT 2 7 2017

., ...

Date
lC

16:46:13
/Cust. No.	. Or.der No.	Customer P.O.#	Ter.	sis.#	THE KEARNEY COMPANIES
uu00018145 J4 72t02 uoaa-01- Z: AMENITY	09	.;j
iUR  TRUCK  67	Terms	Net 30 Days	Ref#
Item Number I Description	U/M	Ordered	Shipped	l:ffi.l&:m:m	Total

VALVE

ECI.O_ _AQ

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-	-     -     -   -    -	-. u Q

.. 	l.000	181.00000  EA

.4 01. 		---

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8 IN..M•J ..4.5	-

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.oo

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224

PRODUCTS ARE WARRANTED  ONLY  TO  THE  EXTENT  OF  THE RANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE

&lWt®

>DUCTS ,   AND    PRODUCTS	ARE    INTENDED	FOR USAGE AND

•CONTINUED*

TALLATIONS	AS    STATED    IN	THE     MANUFACTURERS	WRITTEN
:OMMENDATIONS. ANY PRIOR WRITTEN OR IMPLIED WARRANTIES OR VICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS TEMENT.  THIS  ENTIRE  TRANSACTION  IS   EXPRESSLY   LIMITED  TO  THE MS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF PAGE. INTEREST  AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN
  EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.
CUSTOMER COPY

,
D Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

□ Murfreesboro, TN• (615) 217-3040

www.hayespipe.com

Knoxville, TN• (865) 525-1717 D

D  Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 o
D  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-9819 D
D  Acworth, GA• (770) 529-8883	D Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 D
Mains - Main Line Accessories - Service Materials - Casing Pipe

ill To:	Ship To:
TRIPLE CREEK COD
C/0 THE KEARNEY COMPANIES, LLC
9625 WES KEARNEY WAY
RIVERVIEW	FL 33578

TRIPLE CREEK COD RECEIVED
AMENITIES   CEN T1E  R
OCT 2 7 2017

Invoice

Date
lC

16:46:15
o/Cust. No.	Or.der No.	Customer P.O. #	Ter.
sis.# 1 fE KEARNEY COMPANIES

i,     OOOuvJ._8J.4S   .J...44 t !.    Ql	.1;,'.Y,? -1.Ji -_ .c._:    _A.M_g.   _I T Y	u9

:,.:,

(1UR TRUCK 6 7

Terms	Net ao Days	Ref#

405.l..6.0

REV.ERSIB

l QJ l'f -7 6 2 1 SHORT RING &

·

---

oso.oa. -- ---

_ EA

3I.N _ BRASS   RBCE S,SEP,  piRD _C/_O
p_LUG

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11.000	11.   000	48.00000 EA-=-----	--"-	-

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STOP

000000

EA	1.000	1.000	.00000 EA

INVOICE

•••

L   PRODUCTS    ARE   WARRANTED    ONLY    TO   THE    EXTENT    OF  THE
\RRANTIES  PROVIDED BY THE RESPECTIVE  MANUFACTURERS  OF THESE

ODUCTS, AND PRODUCTS ARE INTENDED FOR USAGE AND

;7

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224

SUBTOTAL:

TOTAL:

..0.0

TALLATIONS	AS    STATED	IN	THE     MANUFACTURERS	WRITTEN COMMENDATIONS. ANY PRIOR WRITTEN OR IMPLIED WARRANTIES OR

RVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS

TEME;NT. THIS ENTIRE TRANSACTION IS EXPRESSLY LIMITED TO THE AMS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF

S PAGE. INTEREST  AT THE MAXIMUM  LEGAL RATE WILL BE CHARGED IN EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.

nEPOSIT:

CUSTOMER COPY

.r DUE:	2, 27L 00

'	.....

-	-	-	-	·-	-	·-	-  r-------	-·-	-	-	-	--	---------·	-- - · -

-      -  -  -	--..:--....,.;:..	- -	-	-  ---	•

i	HAYES PIPE SUPPLY, INC.
,.,	0Corporate: 950 Fiber Glass Rd. •  P.O. Box 101550 •  Nashville, TN 37224
-..: oout.".,	(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Page:

□ Murfreesboro, TN• (615) 217-3040	www.hayespipe.com	Knoxville, TN• (865) 525-1717 □
□ Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 □
D  Tampa, FL •(813) 241-4040	Lake Helen, FL• (386) 228-9819 D
□ Acworth, GA• (770) 529-8883	□ Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 □
Mains - Main Line Accessories - Service Materials - Casing Pipe

Bill To:

RIPLE CREEK CDD

Ship To:	TRI LE CREEK CDD	RFCEIVl.=

Invoice

FL 33578

C/0  THE KEARNEY COMPANIES, LLC	TRIPLE CREEK AMENITY  CTR 9625 WES KEARNEY WAY		OCT 3 0 2017
RIVERVIEW

Date
10

Co/Cust. No.	Or.der No.	Customer P.O. #	Ter.	Sis.#
i,uvuuu18145	oio,v0 0u.:,o- i-Gdr	AMENITY ,.,c.  v9	.,.:,
UR l'RUCK	Terms	Net 30 Days

Ref#

16:48:3
E

Item  Number / Description	U/ M	Ordered	©,IIJ:Et!	l#t\11■;,jat§aj	ir.m1

027014
l  0.1N _x  .l .AF _L  S  D  R-.35 _PVC 
PIPE
456002	EA

ZIN MUELLER 0./L THRD GATE VAL WI NUT & 316 55 BOLTS

901118	.· EA

2.000

2.  000 J	165._Q_OJ.P Q_ EA   -..	  

ZIN	WILKINS 975XLZ REDUCED PRESSURE  BACKFLOW  PREVENTOR

901115	EA
3/4I.N	_ WI L	KIN	S _9J.5 XL .Z. Jt	EDUCED	
PRESSURE BACKFLOW PREVENTOR

3.000

1.000

3.000 J	232.00000 EA

1.001	382.00000 EA

3 .8 .Z.• 0

3 ,0Oc 

l 01557 -   --   .-
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832 29.9.9  _	,. 

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P.LU

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2.000

2. _0 .0 .0 

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.a._ooo_ /  . 	 		2s 	o_o_o_o_o  EA

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.B.J.1::.7 27..W::-.NL _F l  P_T _ JLF.IP.T.

ZxZ-1/ZIN BRASS METER BUSHING 322016	EA
BALL VALVE CURB STOP

1.000

1.  000	j	238.00000 EA

5Q_. OJ)

3 / ,4 l N 8,J..l -

322_09 5

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3 3.JW.- .

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2.000

2.000j	sz.00000 EA

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RAl.T	\f6J,llS. rin)s:l - T O 'P W/.1

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REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
L    PRODUCTS    ARE   WARRANTED    ONLY    TO   THE    EXTENT    OF THE
\RRANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE IODUCTS. AND PRODUCTS  ARE  INTENDED  FOR  USAGE  AND 3TALLATIONS     AS     STATED     IN     THE     MANUFACTURERS     WRITTEN
:COMMENDATIONS.   ANY  PRIOR  WRITTEN  OR  IMPLIED  WARRANTIES  OR RVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS 4>,TEMENT. THIS ENTIRE TRANSACTION 15 EXPRESSLY LIMITED TO THE RMS AND CONDITIONS OF SALE AS  STATED  ON THE  REVERSE  SIDE OF 15 PAGE. INTEREST AT THE MAXIMUM  LEGAL  RATE WILL BE  CHARGED IN E EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.

5\\:\  ,	L

*CONTINUED•

-	-	-	-

u \f t irJ \i t ®pv

   	_	_	_	_

_	_	_	_

_	_	_	_

_	_	_	_

_  CUSTOMERCOPY  -	-	-	-	-	·-  -	-	-	- -- -

INVOICE
HAYES PIPE SUPPLY, INC.
D Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224 (615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Pase:	2

D  Murfreesboro, TN•  (615) 217-3040	www.hay  espi  p.e c  om		Knoxville, TN•  (865) 525-1717 D D Lexington, KY • (859) 231-8323		Louisville, KY• (502) 454-8500 D
D  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-9819 D
D  Acworth, GA• (770) 529-8883	D Columbia, SC • (803) 695-2424	Lon gview, TX• (903) 753-5533 D
Mains - Main Line Accessories - Service Materials - Casing Pipe

I To:

Ship To:

Invoice

TRIPLE CREEK COD
G/0 THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578

TRI LE CRBEK CDD	RECEIVED
TRIPLE CREEK AMENITY CTR
OCT 3 0 2017

1

Date
lC 'L.4

/Gust.  No.	Or.der No.	Customer P.O. #	Ter.	Sis.#
OOOuO 18-145   J v U,'iLb   ,._uu,...v Oa a .-,    .a. - 6  3 t   .AMEN-ITY 1..t:.  u9	3	THE KEARNEY COMPANIE
~uR TRUCK	Terms	Net 30	ays	Ref#

16:48:30

Item Number/ Description	l'fl'Dj	Ordered	Shipped	Sell Price	im

nn.a1:1

Bil	DO

01 0 02._,		  		---	  		..		-·-	
5 _	:.1IA:.	..	2	f>t	_ 	l _	8 _-_2	4	 _S	

, _
_	RP.
W/" L I. D	 		 		 	

 		EA

2x48IN  STD BRASS   NI  P P LE    - -   --	-	 	

    --	330.00

3 8.o-YY-- 

0, 1 1.6.6

EA	.a . Jl OO	 	S '"'cll OO_\J 	

.1.0.....00,0 0 0

2x3IN

B.RAS_S

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0.0.0.0" 0 EA

----·

O.l .l,l 8

.EA

o_o.o

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3/4XlZIN STD BRASS NIPPLE

5Z.OO

01114

EA	4.000

j	_. -4 . JJ0P00 _EA

4.

 	   3•. _0 0 _0 _0 ,Q. _B A

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31 4 X3 I N _ Sl".D _ B RASS _ NI P P..LE

-	.1.6•. ..00

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3/4 2IN   STDBRAS  _NI' P.,PL E	 BIO	·

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!.  000	j	2.00000 EA

w	4.  ...	....        ..	I        l	-	'"'	t .......

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=IEMITTO: P.O. BOX 101550, NASHVILLE, TN 37224
PRODUCTS ARE WARRANTED ONLY  TO  THE  EXTENT  OF  THE RANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE

DUCTS, AND PRODUCTS ARE INTENDED FOR USAGE AND

CONTINUED •

ALLATIONS	AS    STATED	IN    THE     MANUFACTURERS	WRITTEN OMMENDATIONS.   ANY  PRIOR   WRITTEN  OR  IMPLIED  WARRANTIES   OR VICE / INSTALLATION INSTRUCTIONS ARE  SUPERSEDED  BY  THIS EMENT. THIS ENTIRE  TRANSACTION  IS  EXPRESSLY  LIMITED TO THE MS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF PAGE. INTEREST AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN
EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.
CUSTOMER COPY

HAYES PIPE SUPPLY, INC.
0 Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

P8i8:	3

0	Murfreesboro, TN • (615) 217-3040	www.hayespipe.com	Knoxville, TN• (865) 525-1717 O
□ Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 0
O  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-98190
□ Acworth, GA • (770) 529-8883	□ Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 □
Mains - Main Line Accessories - Service Materials - Casing Pipe

I nvo ice

ll To:
TRIPLE C.REEK CDD

Ship To:
TRIPLE CREEK CDD

RECEIVED

' I	1

C/0 THE KEARNEY COMPANIES, LLC 962 WESKEARNEY WAY
RIVERVIEW	· FL 33578

TRlPLE CREEK AMENITY CTR
OCT 3 0 2017	Date
10
1 6 : 4 8 : 3 01

/Cust. No.	Or.cler No .	Customer P.O. #

Ter  .	Sis.#	THEKEARNEYCOMPAN

/ 0 0 0 v-vl  a.J.4 5 - .:l ..:)D ,1..o ,...-.u   u.  ..u   u  .:, o  - --0 .1.,-,	.:,..:_.•   AMENITY,   ....c.    .0 _9  _	':I

OUR lRUCK	Terms	Net	3.0  Days	Ref#
Item  Number  /  Description	llDi'i1	t•ffifafa ]	Sh i pped	!:ffili:.Ifof:l	rr.m,J
	 00

-  -- -	-

B022i4

-     . EA	2 ._0 0 0	2.9 _00 -J	15.00000 EA

BRASS HEK..BUSHING

Zx31.4I.N	- J

302118 --

-	- -	-

-  - -     EA	2A 0 .0 0

--	z.0.00 _	_

.3.9•. O.OOQO _ EA

ZIN	. _BR  ASS _U   ;t PN   ....   	----  -	.--  -	-

- - --·	 	,  __     _:_ ...   	

7 8 '. 00

-

302174	--  EA	4.000	4.00	j	12.00000 EA

/4IN   BRAS.S  UNION	4B..• 0 .0 

- _,.,. ....
302140..	. - -·

.	-- ... ···-- ----- .-- '

- .....
--

- ·-	 	.EA	

ZIN BRASS 90 DEG BEND	I	84.00
- -- - ., - ,---- - --- --
J02136	EA	8.000	8. 000 'I	5.00000 EA

..	
	.z..oo.o	
---		

31 4 IN BRASS 9.0. DEG BEND

 D3.0 0.6

_ _ 	 	__

_·-	

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- -
-- 4.a . ..:O.  _O.O~O-O~ EA 	--·

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lZIN MJ WEDGE ACTION RESTRAINT	96.00

_P V C

FOR	V
)00000 _	-	EA	1.  ooo:	.1.000	•.000 .0.0. .EA

•••	J	.oo

REMITTO: P.O. BOX 101550, NASHVILLE, TN 37224
L PRODUCTS ARE WARRANTED ONLY  TO  THE  EXTENT  OF  THE RRANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE ODUCTS,  AND  PRODUCTS  ARE  INTENDED  FOR  USAGE  AND TALLATIONS AS STATED IN THE MANUFACTURERS WRITTEN COMMENDATIONS.   ANY  PRIOR   WRITTEN  OR  IMPLIED  WARRANTIES  OR RVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS ATEMENT. THIS ENTIRE TRANSACTION IS EXPRESSLY LIMITED  TO  THE RMS AND CONDITIONS OF SALE  AS  STATED  ON THE  REVERSE  SIDE OF S PAGE. INTEREST AT THE MAXIMUM  LEGAL  RATE  WILL BE CHARGED  IN E EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.

SUBTOTAL:

TOTAL:

DEPOSIT:

3,7"14.00

3,714.00

_ _

DUE:	3,714.00

 		CUSTOMERCOPY _ _

_   _   _  _  _	_ _ _ _ _ _ _ _ _

INVOICE
HAYES PIPE SUPPLY, INC.
0 Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224 (615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Page:	l

0	Murfreesboro, TN• (615) 217-3040	www.hayespipe.com	Knoxville, TN• (865) 525-17170	
0	Lexington, KY• (859) 231-8323		Louisville, KY• (502) 454-85000	
0	Tampa, FL• (813) 241-4040		Lake Helen, FL• (386) 228-98190	
O  Acworth, GA• (770) 529-8883	O  Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 0
Mains - Main Line Accessories - Service Materials - Casing Pipe
D

Bill To:

Ship To:

Invoice

rRIPLE CREEK CDD
C/0 THE KEARNEY COMPANIES, LLC.
9625 WES KEARNEY WAY

TRIPLE CREEK CDD
AMENITIES CENTER

OCT 3 0 2017

Date

RIVERVIEW	FL 33578

HE KEARNE	OMPANI

10
16:49:0

o/Cust. No.	Or.der No.

Customer P.O. #

Ter.	Sis.#

r,uuuuul81 5	Q

u	u u .::ra-  u ;1-.-.;   :- - AMENITY	u9

;::,

UR  TRUCK 67	Terms	Net 30 'Days	Ref#
lli4,,i mffl•i4ii•l414ilD	U / M	Ordere d	bi.J.fo:ifill	t£illiHiiJ	Total

803113	EA
81N ...DEZ.U.Rl K_MJ . PE E.. F.UL L _..P.ORT

LOOO	1.	ooo J	142.00000	EA	

12.000	000	J	
3.00000	
BA	

PLUG VALVE W/NUT & SS BOLTS

3.000

'3. 000j

725.00000 EA

11. 5 0 .0

I

507101

   	_ _

E A _

BX.ZIN MJ	TAPT .CAP PROTECIO 40
LESS_ ACC.  	
701146	.	EA
3IN SCH-40 PVC S/W x FIPT
ADAPTER

X 3/ A.I.N.....P...J__x

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323999	_	EA
.F...IP..T.

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1.000

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230.0000-0 EA·

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5-1/4 ZPC 18-24 SCRO VALVE BO

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/fuu lr Uu v lbillJ	\J

*	CONT I N..lHW •

REM IT TO: P.O. BOX 101550, NASHVILLE, TN 37224
PRODUCTS ARE WARRANTED ONLY TO  THE  EXTENT  OF  THE '1RANTIES  PROVIDED BY THE RESPECTIVE  MANUFACTURERS OF THESE
) DUCTS, ANO  PRODUCTS  ARE  INTENDED  FOR  USAGE  ANO TALLATIONS	AS    STATED    IN	THE     MANUFACTURERS	WRITTEN
:OMMENDATIONS. ANY PRIOR WRITTEN OR IMPLIED WARRANTIES OR IVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED  BY  THIS TEMENT.  THIS  ENTIRE  TRANSACTION  IS  EXPRESSLY  LIMITED  TO   THE
:MS  AND  CONDITIONS  OF SALE  AS STATED  ON  THE  REVERSE  SIDE OF
> PAGE. INTEREST AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.

.

T

CUSTOMER COPY

: ::D

INVOICE
6	HAYES PIPE SUPPLY, INC.
O Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, 1N 37224
" out"	(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Paie:	2

D  Murfreesboro, TN• (615) 217-3040  ·	www.hayespipe.com	Knoxville, TN• (865) 525-1717 0
0   Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 D
D  Tampa, FL (813) 241-4040	Lake Helen, FL• (386) 228-9819 D
O Acworth, GA • (770) 529-8883	D Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 D
Mruns - Main line Accessories - Service Materials - Casing Pipe

I To:

...

TRIPLE CREEf{ CDD
C/0	THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY
RIVERVIEW	FL 33578

Ship To:	RECEIVED
TRIPLE CREEK CDD
AMENITIES CENTER
OCT 30 2017

Invoice
-
Date
10 ;:.-; l
16:49:09

/Cust No.	Or.der No.	Customer P.O.#	Ter.	Sis.#	KEARNEY COMPAN'
Lr000001'8T4'5    J,.47-G,O.!    o o	- O·s:   t: t: !	AMEN.J.;f\'	u9	.:,

Terms	Net	30  Pays	Ref#

0 0 ,0 0 .0
•••

EA-		 	

.oo

 

EMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224

TALLATIONS	AS    STATED    IN	THE	MANUFACTURERS	WRITTEN

PRODUCTS ARE WARRANTED  ONLY  TO  THE  EXTENT  OF  THE RANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE DUCTS ,     AND     PRODUCTS     ARE     INTENDED     FOR     USAGE   AND

OMMENDATIONS.   ANY   PRIOR  WRITTEN  OR   IMPLIED  WARRANTIES OR

SUBTOTAL:
 	)

2 , 42 . _0 0

WICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS

TOTAL:

2,423.00

TEMENT.  THIS  ENTIRE  TRANSACTION  IS  EXPRESSLY   LIMITED  TO THE
MS  AND  CONDITIONS  OF SALE  AS  STATED  ON THE  REVERSE  SIDE OF

PAGE. INTEREST AT THE MAXIMUM LEGAL·RATE WILL BE CHARGED IN
 EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.

DEPOSIT:
.	r .DUE  :
CUSTOMER COPY

2,423.00

INVOICE
HAYES PIPE SUPPLY, INC.
0 Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

Paae:	l

D Murfreesboro, TN • (615) 217-3040	www.hayespipe.com	Knoxville, TN• (865) 525-1717D D  Lexington, KY• (859) 231-8323		Louisv ille, KY• (502) 454-8500 D
D  Tampa, FL•  (813) 241-4040	Lake Helen, FL•   (386) 228-9819 D
D  Acworth, GA• (770) 529-8883	D Columbia, SC • (803) 695-2424	Longview, TX• (903) 753-5533 D
Mains - Main Line Accessories - Service Materials - Casing Pipe

ill To:

962

COMPANIES, LLC

5

TRIPLE CREEK CDD
C/0 THE KEARNEY

WES KEARNEY WAY

RIVERVIEW

FL 33578

Ship To:	RECEIVF

o

TRIPLE CREEK CDD

3

AMENITIES   CENTER  OCT	2017

In voice
r f "7L
Date

1 0 . _ f

50:

OE

16:

o/Cust. No.	Or.der No.	Customer P.O. #	Ter.

sis.#	liE KEARNEY COMPANIES

l/Q('inno1A145   J"4.47Z/04    0038-01-ZZ	AMENITY	09	83

Net 30 Day

OUR TRUCK 67	Terms	s

Ref#

Item Number/ Description	U/M  	Ordered	Shipped	l#tlI■5at4@	Total

-SCH- 4 0 - -PVC S /.W

701146	EA '	. ..12

ADAPTER

3IN	-X --FI P:r

32 3 82.l. .

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323489

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3IN	. BR ASS RECESSED _T-HRD C/0 

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INVOICE  DUE:	U./   25 /.l -7

REMITTO: P.O. BOX 101550, NASHVILLE, TN 37224

L PRODUCT$ ARE WARRANTED ONLY TO THE EXTENT OF THE

f	"'""Alf r!? \ffi\. .

CONTINUED

RRANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE ODUCTS, AND PRODUCTS ARE INTENDED FOR USAGE AND

TALLATIONS	AS	STATED     IN    THE    MANUFACTURERS	WRITTEN

10

.•

l)}l f	ij	'[.ilJJ,2;9
COMMENDATIONS.   ANY  PRIOR  WRITTEN  OR  IMPLIED  WARRANTIES   OR RVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS ATEMENT. THIS ENTIRE TRANSACTION IS EXPRESSLY LIMITED TO THE RMS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF S PAGE. INTEREST AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN E EVENT PAYMENT IS NOT MADE WITHIN THE TERMS OF THIS INVOICE.
CUSTOMER COPY

INVOICE

HAYES PIPE SUPPLY, INC.
0   Corporate: 950 Fiber Glass Rd. •  P.O. Box 101550 •  Nashville,1N  37224 (615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836

P81il8:	z

0   Mur freesboro, TN• (615) 217-3040	www.hayespipe.com		Knoxville, TN• (865) 525-1717 0 O  Lexington, KY• (859) 231-8323		Louisville, KY•  (502) 454-8500 0
O Tampa, FL • (813) 241-4040	Lake Helen, FL• (386) 228-9819 0
o  Acworth, GA• (770) 529-8883	O  Columbia, SC • (803) 695-2424	Longview, TX•  (903) 753-5533 0

Mains - Main Line Accessories - Service Materials - Casing Pipe

Invoice

ll To:

TRIPLE

Ship To:

TRIPLE CREEK CDP

..,,..

CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY
RIVERVIEW	FL 33578

AMENITIES CENTER	RECEIVE
OCT 3 0 2017

lC . -

Date

/Cust. No.	Or.der No.	Customer P.O. #	Ter.	Sis.#

16::50:06

IO nOO01 R t ·4 5 cr·4·47-z· f 0'4 OQ3°13"""01-2 2 s:- - ,f\M,ENI ,-:v
CUR TRUCI:{ 67	Terms

09	•93	Tfi.E KEARNEY C	p A.f\ll S:.:
Net 30 Days	Ref#

Item Number / Descri tion	U/M	Ordered	Shipped	Sell Price	Total

\)

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
L PRODUCTS ARE WARRANTED ONLY TO THE EXTENT OF THE

ARRANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THESE

)	2 9 7 . _Q

ODUCTS,    AND    PRODUCTS	ARE INTENDED FOR USAGE AND

SUBTOTAL:

STALLATIONS   AS     STATED     IN   THE    MANUFACTURERS	WRITTEN

:COMMENDATIONS.  ANY  PRIOR   WRITTEN  OR  IMPLIED  WARRANTIES  OR

2.9 7 . 00

:RVICE / INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS

TOTAL:

ATEMENT. THIS ENTIRE TRANSACTION IS EXPRESSLY LIMITED TO THE

RMS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF

S  PAGE. INTEREST  AT THE  MAXIMUM LEGAL  RATE WILL BE CHARGED  IN

ri:.-posrr:

E EVENT PAYMENT IS NOT MADE WITHIN THE TERMS O.F THIS INVOICE.

CUSTOMER c opy' ' T	DUE;:

297-,00

l:'age:	.1

INVOICE
HAYES PIPE SUPPLY, INC.
0 Corpo.rate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4D40 • (800)342-1973 • Fax (615) 256-8836
D  .viurireesba,o, TN• (615) 217-3040	www.hayespipe.com	Knoxville, TN• (865) 525-1717 □
o Lexington, KY • (859) 231--8323	Louisville, KY•  (502) 454-8500 O
□ Tampa , FL• (813) 241-4040	Lake llelcn, FL• (386)  228-9819 □
D  Acworth, GA•  (770) 529-8883	o  Columbi.a,   SC • (803) 695-2424	Longvi \"\, TX•   (903) 753-5533  D
Mains - Main Line Ac-eessories - Service Materials - Casing Pipe

I To,
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Co/Cust. No.	Ordgr No.	Gustornsr P.O. it

Ship To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Ter.	Sis.#

Invoice

705894
Dale

10/26/17
16:50:07

l/0000018145 J6242/00	425753:TRIPLE CREEK	09	93
ShipVia  WILL CALL	Terms	Net 30 Days	Ref#
•	t	.:	•	·-	-	...	- 

llem Number I Description	U / M	Ordered	Shipped	Sell Price	Total

FOB Description:	WILL CALL

3503042	EA
BIN SERRATED BELL RESTRAINT FOR C900/DI
5004001	EA
l0AWG 500FT GREEN ROLL WIRE COPPER CLAD W/PE30MM JACKET

15.000

15.000	52.00000 EA

780.00

2.000	2.000	145.00000	EA	

1. 000	
1.000	
28.00000	
EA	

2.000	
2.000	
13.50000	
EA	

2.000

INVOICE	
2.000

DUE: 11/25/17	
7.00000	
EA	

290.00

2501376	EA
4x2IN IPT MJ TAPT CAP LESS ACC

28.00

3503002	EA
4IN MJ WEDGE ACTION RESTRAINT FOR PVC
3508041	EA
4IN NBG NUT, BOLT & GASKET KIT

27.00

14.00

"  1-,f1 .--:i-,, ',.'•,1 ·1 r 1-Pl 'J
,1	('   /\ \

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
/ILL PRODUCTS ARE WARRANTED ONLY TO THE EXTENT OF THE WARRANTIES  PROVIDED BY  THE RESPECTIVC  MANU f'ACTURERS or THESE
PRODUCTS, AND PRODUCTS ARE INTENDED FOR USAGE  AND INSTALLATIOl" S AS STATED IN THE MANUFACTURERS WRITTEN RECOMl\lENOATIO\IS. ANY PRIOR WRITTEN OR IMPLIED WARRANTIES OR SERVICE i INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THI S STATEMENT. THIS ENTIRE TRANSACTION IS EXPRESSLY LIMITW TO THE TERMS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF THIS PAGE.  INTEREST AT THE MAXIMUM LEGAL RC.TE WI LL BE  CHARGED IN
"7'jlr"' r"'IJr'"I.I riAVINl""...l'r li"o Ut"\T aAlP"'lr" IUI T'II HI T IU "' T'r't"U•r "' T I i i 11.111..-.,.,-..,-

ntill :r uu;0 VK. J -A\S>

SUBTOTAL:
TOTAL:
DEPOSIT: AMT DUE:

1,139.00 l,139.00

1,l39.00

.!:'age:	1-

INVOICE
HAYES PIPE SUPPLY, INC.
D Corpmate: 950 Fiber Glass Rd. • P.O. Bo:x 101550 • Nashville, TN 37224
(615)255-4040 • (800)342-1973 • Fax (615) 256-8836
D   _Vlurfrees  boro, TN• (615) 217-3040	WWlY,bayespipe.com.	Knoxville,  TN•   (865)  525-1717 D
D   Lexington, KY •(859) 231-8323	Louisville, KY• (502) 454-8500 □
D  Tampa, FL• (813) 241-41140	Lake Helen, FL• (386) 228-9819 0
O  Acworth, GA•  (770) 529-8883	O  Culumbia, SC • (803) 695-2424	Lung}•iew, TX•  (903) 753-5533 D
Mains - Main Line Accessories -Service Materials - Casing Pipe

Bill To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Go/Gust. No.	Order  No.	Customer P_O. #

pfu
TRIPLE CREEK CDD
c/o THE KEARNEY COMPANIES, LLC
9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Ter .	Sis.#

Invoice

706334
Date

10/30/17
16:49:45

1/0000018145 J6706/00	425753: TRIPLE CREEK 09	93
ShipVia   WILL CALL	Terms	Net 30 Days	Ref#
•:	I.	j,	•	•      -	-	•   ..._•..            -

Item Number/ Description	U / I.II

FOB Description:	WILL CALL
1102042	FT
lIN x l00FT BLUE CTS CL-200 SDR-9 ENDOPURE POLY TUBING
3323821	EA
2IN T444-777 -PJ -NL PJ CTS TEE
3323388	EA
2IN L44-77-PJ -NL CTS COMP 90 BEND CPLG
3323429	EA
2IN C84-77-PJ -NL MIPT x PJ CTS ADAPTER
4702015	EA
2IN STD GALV 90 DEG BEND

Total

O rdered	Shipped	Sell Price		

300.000	
300.000	
.40000	
FT	

3.000	
3.000	230.00000 EA	
1.000	1.000	205.00000	EA	

1. 000	
1.000	
72.00000	
EA	

1.000	
1.000	
7.50000	
EA	

1.000	
1.000	5.00000	EA	

1.000	
1.000	
20.00000	
EA	

INVOICE	
DUE: 11/29/17			

120.00

.690 . 00

205.00

72.00

7.50

4702312	EA
2xlIN STD GALV HEX BUSHING
3323412	EA

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
ALL PRODUCTS ARE WARRANTED ONLY TO THE EXiENT OF THE WARRANTIES PROVIDED BY THE PESPECTIVE MANUFACTURERS OF THESE PRODUCTS,   AND    ORODUCTS    ARE    INTENDED    FDR    USAGf    JI.ND INS TALL.!.TIOl S AS STATED IN THE MANUFACTURERS WRITTEN RECOWJENDATIO S. ANY PRIOR WRITTEN OR IMPUED WARRANTIES OR SERVICE .' INSTALLATI ON INSTRUCTIONS ARE SUPERSEDED BY THIS STATEMENT. THIS ENTIRE TRANSACTlON IS EXPRESSLY LIIAITED TO THE TERMS ANO CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE 01' THIS PAGE. INTEREST AT THE MAXIMUM LEGA L RATE WILL BE CHARGED IN
Tllr" r-Ur-LIT "'" "'' '" "'lt,IT ...... Uf"\"'P •· l '""1"" IUl"l"'IIIU -ru,- 'l"P-r"IU... ,..,... "l"I llt"o u u,,..._,....

lIN C84-44-PJ-NL MIPT x PJ CTS ADAPTER

5.00

20.00

*CONTINUED*

l:'age:

INVOICE
HAYES PIPE SUPPLY, INC.
D Corp01-ate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800)342-1973 • Fax (615) 256-8836
0   .vlurfreesboro, TN• (615) 217-3040	www.hayespipc.com	Knoxville, TN• (865) 525-1717 □
D    Lexingtrm, KY •(859) 231-8323	Louisville,  KY•  (502) 454-85D0 O
D  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-9819 D
o  Acworth, GA• (770) 529-8883	0   Cutumbia, SC• (803) 695-2424	Lungvirn; TX•  (903) 753-5533 0
Ma.ins - Main Line Accessories - Service Materials - Casing Pi-pe

Bill To.
TRIPLE CREEK CDD
C/0 THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Co/Gust. No.	Order Na.	customer P.O. .ft

Ship To:
TRIPLE CREEK CDD
C/0 THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Ter.	Sis.#

Invoice

706334
Dal e

10/30/17
16:49:45

2

1/0000018145 J6706/00	4 5753: TRIPLE CREEK 09	93

ccount

PayType A --

s R- -

bl-

ShipVia    WILL CALL	..

Terms	Net 30 Days	Reff.

llern Number/ Oescriplion	U / M	Ordere d	Shipped	Sell Price	Total
FOB Description:	WILL CALL

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
ALL PRODUCTS ARE WARRANTrn ONLY TO THE EXTENT OF THE WAARA IES  PAOVIDED BY  THE  RESPECTIVE  MANUFACTURERS  OF  THESE PRODUCTS,     AND     PRODUCTS     ARE     INTENDED     FOR     USAGE   AND
INS TALLATIOIJS    AS    STA"TED    IN     TH E     MANUFACTURERS     WRITTEl•J RE CO MNEN DATI0°, S. AN Y PRIOR WRITTEN OR IMPLIED WARAANTIES OR SERVICE   /   IN STALLATION   INST RUCTIONS    ARE    SUPERSEDED    BY   THIS s- ATEMEMT. THI S ENTIRE TRANSACTION  IS  EXPRESSLY  LI MITED  TO  Tl·IE TERMS AND CO NDITIONS  OF  SALE  AS  STATED  ON  THE  REVERSE  SIDE  OF Tl-il S PAGE. INTEREST AT THE: N AX IMUM    LE GA L  RATE WILL  BE  CHARGED  IN
Tflr- r"ll r"I.IT n AV l llt"',. I T I<"' l n T "" ',.,,,.. unT'I .. u IIP'" T,..,.,..... ,...,..T, 11 11.1, 1 ,_, .,.....

SUBTOTAL:	1,119 .50	
TOTAL:	1,119.50	
DEPOSIT: AMT DUE:	
1,119.50	

t'age :	.1
INVOICE
HAYES PIPE SUPPLY, INC,
0 Corporate: 950 Fiber Glass Rd. • P.O. Bo:x 101550 • Nashville, TN 37224
(615) 255-4040 • (800)342-1973 • Fax (615) 25&-8836
0 Murlreesboro, TN• (615) 217-3040	www.hayet;pipe.com	Knoxville, TN• (865) 525-1717 D	
o Lexington, K'i • (859) 231-8323
D Tampa, FL• (813) 241-4040		Louisville, KY•  (502) 454-8500 0
Lake  Helen, FL•  (386)  228-9819 □	
O Acworth, GA• (770) 529-8883	D Columbia, SC• (803) 695-2424	Longvie°" TX• (903) 753-5533 D	
Maim; - Main Line Accessories - Service Materials - Casing Pipe

Bill To
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Co/Cusl No.	Ordar Na.	Customer P.O.#

Ship To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY
RIVERVIEW	FL 33578
Ter.	Sis.#

Invoice

706957
Date

ll/02/17 16:50:15

1/0000018145 J7278/00
ShipVia WILL CALL

425753: AMENITIES CE 09	93
Terms	Net 30 Days	Ref Ii

•	I	•	•- -	•• -
llem Number/ Description	U / tJI	Ordered	Shipped	Sell Price	Total

FOB Description:	WILL CALL

3323429	EA
2IN C84-77-PJ-NL	MIPT x PJ CTS ADAPTER
3322100	EA
2IN B41-777 W-PJ -NL FIPT x PJ CTS BALL VALVE CURB STOP W/LW
2001037	EA
2IN BRZ SCRD 125# GATE VALVE

6.000

5.000

5.000

6.000

5.000

5.000

72.00000 EA

274.00000 EA

40.00000 EA

432.00

1,370.00

200.00

INVOICE DUE: 12/02/17

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
ALL PRODUCTS ARE WARRANTED ON LY TO TH E EXTENT OF THE WARRANTIES PROVIDED BY THE RESPECTI VE MANUFACTURERS OF THESE PRODUCTS,   AND    PRODUCTS    AF!E    IN TENDED    FDR    USAGE     P.ND IN STA LL ATIOl" S AS STATED IN THE MANUFACTURERS WRITTEN RECOMII.IENDATIO    S.   ANY  PRIOR   W TTEN  OR  IMPLIED  WARR ANTIE S  OR SERVICE I INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS STATEMENT. THIS ENTIRE TRANSAcnoN IS EXPRESSLY LIMITED TO THE TERMS AND CONDITIONS OF SP.LE AS STATED ON THE REVERSE SIDE OF THIS PAG.E, INTEREST AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN
Tllr- r-lJl"'I.IT f'\AVaAI"'.. , ... , 1.lr"IT .... ',..,.. u,r,-1nu Tllr- Tr-t"'lllr .....,.. Tl rre- IUIU'II,..,.

SUBTOTAL:
TOTAL:

DEPOSIT: AMT DUE:

2,002.00
2,002.00

2,002.00

-   r•      •	i   •	•	t I '

£ff: r"'.-·--;v:..::-, ,,1-i i ,-, .	·-
u	-·!..	,,,·=-	/

u 1:• ,    u'

,\t,,itdL.lu'J'i•

L v ,.

I L,

',J	-

TRIPLE CREEK COMM UN ITY DEVELOPMENT DISTRICT SPECIAL ASSESSMENT BONDS
SERIES 20178

The unde rsigned, a Responsible Ofticer of Triple Creek Community Development DislJ'ict (the " Dis trict'') hereby subm its the following requisition for dis burscmeni under and pursuant to the terms of the Master Trust Indenture dated as of June I, 2012 from the District to The Bank of New York Mellon Trust, N.A., as trustee (the ' 'Trustee"), as supplemented by the Second Sup plemental Trust Indenture dated as of February I, 2017 (the ''Indenture"), (all capitalized terms used herein shall have the meaning ascribed lo such lerm in the Indenture):

Dei:cmbcr27, 2017

Requisition Number: CR212-B

Name of Payee: The Kearney Companies, LLC
9625 Wes Kearn ey Way
Riverview, FL 33578

Amount Payable: $234,825.S0

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Issuance, if applicable): Pay Application #5 for Triple Creek Villages K, Land Amenity Center

Fund or Account from which disb ursement to be made : 20178 Acquisition and Construction
Account

The undersigned hereby certifies that:
l.	obligations in the stated amount sel forth above have been incurred by the District, or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Fund that have not previously been pa.id;

each disburaernent set forth above is a proper charge against the Acquisition and Construction Fund;

each disbursement set forth above was incurred in connection with the acquisition and/or construc tion of the Projec;t

each disbursement represents a Cost of the Project which has not previously been paid.

The undersigned hereby further certifies that there has nor been filed with or served upon the District notice of any lien. right to li en, or atta.ch.me nt upon, or claim affecting the right to receive payment of, any of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment hereof.
The un dersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District ls at the date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of the property acquired or the services rendered with respect to which disbursement is hereby ,equested.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By. 	

::::.....:;;c--..,,,,... ....,, =---  	

CONSUL TING ENGINE ER'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this dis burseme nt is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (ii} the plans and specifications for the portion of the Project with respect to which such disbursement is being made; and (iii) the report of the Consulting Engi neer , as such report shall have been amended or modified on the date hereof.

_p;;iitu1tin g Engineer

TRIPLE CREEK COMMUNITY DEVELOPMENT DIStRICT SPECIAL ASSESSMENT BONDS
SE:RlES20l7A, VILLAGE K

The undersigned, a Responsible Officer of Triple Creek Community Development District (the " District" ) hereby subm its the following requisition for disbursement under and pursuant to the terms of the Master Trust Indenture dated ns of June 1, 2012 from the District to The Bank of New York Mellon Trust, N.A., as trustee (the "Trustee"), as suppl emented by the Second Supplemental Trust Indenture dated as of February 1, 2017 (the '' Ind enture''), (a.II capitalized terms used herein shall have the meaning ascribed to such term in the Indenture):

December 27, 2017

(A}	Requisition Number : CR213-K

Name of Payee: The Kearney Companies, LLC
9625 Wes Kearney Way
Riverview. FL 33578
Amount Payable: $119,575.51

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pursuant to a contract involving progress payments, or, slate Costs of Issuance, if applicable): Pay Application #5 for Triple Creek Villages J(, Land Amenity Cent,r

Fund or Account from which disbursement to be made: 2017A Acquisition and Construct.ion Account,
Subaccount Village K

The undersiQT1ed hereby certiffos that:
I.	obligations in the stated amount set forth above have been incurred by the District, or
this requisition is for Costs of Issuance payable from the Acquisition and Construction Pund that have not previously been paid;

2.	each disbursement set forth above is II proper charge against the Acquisition and Construction Fund ;

J.	each disbursement set folih above was incurred in connection with the acquis ition and/or construction of the Projec-t;

4.	each disbursement represents e Costofthe Project which has not previously been paid.

The undersigned hereby further certifies that there has not been fi led with or served upon the District notice of any li en, right to lien, or attachment upon, or claim affecting the right to receive payment of, eny of the moneys payable to the Payee set forth above, which has not been released or will not be released simultaneously with the payment he.reo t:
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at lhc date of such certificate entitled to retain.
Attached hereto are originals of the invoice(s) from the vendor of 1he property acquired or the services rendered with respect to which disburs ement is hereby requested.
TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

By:._   _    _   .......a:.-:=--'r.	"-7''T""	=---;,,c.-	 	
Board of Supervisors

CONSULTING ENGINEE R'S APPROVAL FOR NON-COST OF ISSUANCE REQUESTS ONLY

If this requisition is for a disbursement from other than Costs of Issuance, the undersigned Consulting Engineer hereby certifies that this disbursement is for a Cost of the Project ruid is consistent with: (i} the applicable acquisition or construction contract; (ii) the plans and sp ecifications for the portion of the Project with respect to which such dis bursement is being made; and (iii) the report of the Consultin g Engin eer, as such report shall 11ave been amended or modified on the dale hereof.

Consulting	er

TRIPLE CREEK COMM UNITY DEVELOPMENT DISTRICT
SPECIAL ASSESSMENT BONDS SERIES 2017A, VILLAGE L

The undersigned, a Responsible Officer of Triple Creek Community Development Dis tricl (the " District" ) hereby submits the following requisition for disbursement und er and pursuant to the tenns of the Master Trust lnde ntut e da1ed as of June I , 2012 from the Dlstrict to The Bank of New York Mellon Trust, N.A., as trustee (the "Trustee"), as supplemented by the Second Supplemental Trust Jnd1mture dated as offebrnary 1, 2017 (the " Indenture"), (all oapital.ized terms used her-ein shall have the meaning ascribed IQ such term in the Indenture):

Dc:ecmbcr27, 2017

Requisition Number ; CIU14-L

Name of Payee: The Kearney Companies, LLC
9625 Wes Kearney Wa)1
Riverview, FL 33578
Amount Payable: $l01,852.68

{D)		Purpose for which paid or incurred (refor also ro specific contract if amount is due and payable pursuant to a contract involving progress payments, or, state Costs of Jssu ance, jf applicable): Pay Application #5 for Triple Creek Villages){, Land Amenity Center

(E)	Fund or Account ftom which disbursement to be made; l017A Acquisition and Construction Account,
Su bac coun t Village L

The undersigned hereby certifies that:
I .	obligations in the stated amount sel fonh above have been incurred by the District, or
this requisition is for Costs of Is suance payable from the Acquisition and Constroccion Fund that have not previously been paid;

each disbursement set forth above is a proper charge against the Acquisition 11nd Construction Fund ;

each disbursement set forth above was incurred in connection with the acqui sition and/or construclion oflhe Project:

each disbursement represents a Cost of the Project which has not previously been paid.

The und ersigned hereby further certifies that there has not been filed with or served upon the District notice of any lien, right to lien, or attachment upon, or claim affecti ng the right to receive payme nt of, m1y of the moneys payable to the Payee set forth above, which has not been releasedor will not be released simllltaneously with the payment hereof.
The undersigned hereby further certifies thal such requisiti on contains no item representin g payment on account of any retained
percentage which the District is at the date of such cenificalc entitled ro re1ain.
Attached here to ar-e originals of the invoice(s) from the vendor of the property acquired or the services rende red with respect to which disbursement is hereby requested.
l'RIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

-	.	> <...-J,.	{7)	y< '\

By·

CONSULTING ENGINEER ' S APPROVAL FOR
NON-COST OP ISSUANC E REQUESTS ONLY

If this rcquisi!ion is for a dis bursement !Tom other than Costs of Issuance, the under si gned Consulting Engineer hereby certifies lhat this disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of 1he Project with respect to which such disbursement is being mad e and (iii) the report of lhe Consulting Engin eer. as such report shall have been amended or modi tied on the dale hereof.

CO'flsulting Eogmeer

KEARNEY
COMPANIE$
Office (813) 421-6601

THE	KEARNEY COMPANIES, LLC.
9625 Wes Kcamey Way, Riverview FL 33578	Fax (813) 421-6701

Underground Utilities	Site Development

CONTRACTOR'S  APPLICATION FOR PAYMENT

PROJECT:	TRIPLE CREEK VILLAGES K & L, AMENITY CENTER
PAYMENT REQUEST NO.:	5	FOR PERIOD:

PROJECT NO.:--0038-01 --
11/8/2017	TO	11/30/2017

1. ORIGINAL CONTRACT AMOUNT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $	2,315,315.15
2. APPROVED CHANGE ORDERS & CONTINGENCIES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._$=--  ,,. ,(3=--=3'"'"0,44 6,,..,.4=1 )

=============

3. CURRENT CONTRACT AMOUNT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $	1,984,868.74
4. VALUE OF WORK COMPLETED TO DATE  78%	$ 1,550,483.08
5. LESS AMOUNT RETAINED	10%  *	.  . .  . .  .  .  .  .  .  .  .  .  .  .  .  .  . .  $	102,871.60
*PARTIAL RETAINAGE RELEASE
6. NET AMOUNT EARNED TO DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .•	. . .	$	1, 447.,,611.48

LESS AMOUNT OF PREVIOUS APPLICATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . -$ - -
8. TOTAL AMOUNT UNPAID TO DATE . . . . . . . . . . . . . . . . . . . .  $	608,430.40
9. PREVIOUS APPLICATIONS UNPAID .................... $	52,176.71

9-91-,357-.79-

\/:}¢.v't -ri  f PAYM.N.i.\t>v 'i i1"ij \ jfBkt Ki_lQN:<\\j \ {i\}t\'{t:\'it/tl'.;f;}  J:}}}:  tsf / \/45siZsa:s·9. :)

CERTIFICATION OF CONTRACTOR
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.

CONTRACTOR: T	COMPANIES, LLC.
BY:	,1	'> ::.1.ncM
uthorized Rep.resen1\1ve	w 

STATE OF FLORIDA	}
COUNTY OF HILLSBOROUGH	}

DATE:	11/30/2017
TITLE:	PROJECT MANAGER

The foregoing instrument was acknowledged by Sherry Spurlock, Project Manager of THE KEARNEY
COMPANIES, LLC., a Florida Corporation, on behalf of the corporation before me this 30th day of
November	, 2017.  He/she is personally known to me or has produced=	as identification.

CERTIFICATION OF ENGINEER

Village K = $119,575.51 Village L = $163,951.53 Amenity= $172,726.65

/z 	'./[

I certify that I have checked and verified this Req	for Payment and that it is a true and correct statement, to the best of my knowledge, of.work performed	or. aterial supplied by the Contractor. In accordance with the terms and conditions of the Contract, the unde   gn		PP.ro d payment to the Contractor of Balance Due This Payment as
shown above.	Ji:{ 

ENGINEER: _   _   _   _   -+,    ',--	-'- ----:::,     -	-	-	-	-	DATE:  	_// _1/--£,,;.i..    _

_	_	_	_	_

BY:	TITLE:

9
KEARNEY
COMPANIES
Office (813) 421-6601

- INVOICE -
THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Rive1view FL 33578

N!! 17292

Fax (813) 421-6701

Underground Utilities	Site Development

SOLD TO:     TRIPLE CREEK CDD	PROJECT:		TRIPLE CREEK VILLAGES K & L, AMENITY CENTER

CLERICAL ERRORS A

-

RE SUBJECT TO CORRECTION.
CUST. NO.

Description

DO NOT MAKE DEDUCTIONS FROM THIS INVOICE UNLESS AUTHORIZED.

W,O.NO.

PERCENTAGE COMPLETE

INVOICE DATE	INVOICE NUMBER
11/30/2017

Amount

CONTRACTOR'S PAY APPLICATION #	
5	
$506,948.54		
* LESS 10% RETAINAGE		$ 50,694.85		
TOTAL AMOUNT DUE		$456,253.69	$	456,253.69	

* RETAINAGE PARTIALLY RELEASED				
PLEASE REMIT TO:
THE KEARNEY COMPANIES, LLC.
Please add	ATTN: Dept. AIR
9625 Wes Kearney Way
Riverview, FL 33578		
PLEASE PAY FROM THIS INVOICE - NO STATEMENT WILL BE RENDERED		
INVOICES DUE PER AGREEMENT - NO DISCOUNTS. UNPAID AMOUNTS WILL BEAR INTEREST AT 1½% PER MONTH, WHICH lS AN ANNUAL PERCENTAGE RATE OF 18%. PURCHASER AGREES TO PAY ALL COSTS AND FEES FOR COLLECTION ON AC­
COUNTS REMAINING UNPAID IN EXCESS OF 30 DAYS INCLUDING, BUT NOT LIMITED TO, ATTORNEYS' FEES AND ATTORNEYS'
FEES ON APPEAL.		

BILL TO:	TRIPLE CREEK CDD
'PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9625 WES KEARNEY WAY RIVERVIEW, FL 33578
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

5
11/30/2017
11/30/2017

ITEM
NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL COMPLETED &STORED
TO DATE	
%	BALANCE TO FINISH	RETAINAGE	
	SCHEDULE A - AMENITY GENERAL CONDITIONS								
1.	MOBILIZATION	$	40,986.72	$	40,986.72	$	$	40,986.72	100%	$	$	4,098.67	
2.	NPDES PERMIT & COMPUANCE	$	7,490.80	$	3,745.40	$	1,123.62	$	4,869.02	65%	$	2,621.78	$	486.90	
3.	MAINTENANCE OF TRAFFIC	$	1,722.00	$	516.60	$	516.60	$	1,033.20	60%	$	688.80	$	103.32	
4.	CONSTRUCTION STAKEOUT/RECORD SURVEY	$	28,659.00	$	17,195.40	$	2,865.90	$	20,061.30	70%	$	8,597.70	$	2,006.13	
5.
6.	GEOTECHNICAL & MATERIAL TESTING PAYMENT & PERFORMANCE BOND	$	12,484.50
$	17,147.17	$	7,490.70
$	17,147.17	$	1,248.45
$	$	8,739.15
$	17,147.17	70%
100%	$	3,745.35
$	.	$	873.92
$	1,714.72	
	TOTAL SCHEDULE A -AMENITY GENERAL CONDITIONS	$ 108,490.19	$	87,081.99	$	5,754.57	$	92,836.56	86%	$	15,653.63	$	9,283.66	
	SCHEDULE B -AMENITY EARTHWORK		

$	49,590.69
4,848.00
$	24,360.71
$	7,012.80
$	7,014.06
$	.
$	.
$	12,103.00
$
$	7,705.78
$	•
$
$    36,541.06
$    10,519.20
$    10,521.10
$	.
$
$	.
$
$ 11,558.66
$					
1.	CLEARING & GRUBBING	$	49,590.69			$	49,590.69	100%	$	$	4,959.07	
2.	DISC SITE	$	4,848.00			$	4,848.00	100%	$	$	484,80	
3.	CUT VOLUME (UNADJUSTED)	$	60,901.77			$	60,901.77	100%	$	$	6,090.18	
4.	FILL VOLUME (UNADJUSTED)	$	17,532.00			$	17,532.00	100%	$	$	1,753.20	
5.	STOCKPILE ON ADJACENT AREA (UNADJUSTED)	$	17,535.16			$	17,535.16	100%	$	$	1,753.52	
6.
7.
8.
9.
10.	SODDING
SEEDING & MULCHING SILT FENCE
INLET PROTECTION
DEWATER!NG	$	55,073.40
$	4,274.25
$	12,103.00
$	1,276.86
$	19,284.44			$	.
$	.
$	12,103.00
$	.
$	19,264.44	0%
0%
100%
0%
100%	$	55,073.40
$	4,274.25
$	.
$	1,276.86
$	.	$
$	.
$	1,210.30
$	.
$	1,926.44	
11.	FINAL GRADING	$	17,186.90			$	0%	$	17,186.90	$	
	TOTAL SCHEDULE B -AMENITY EARTHWORK	$ 259,586.47	$ 112,635.04	$ 69,140.02	$	181,775.06	70%	$	77,811.41	$ 18,177.51	
	SCHEDULE C -AMENITY ROADWAY			
$	.
$    84,791.62
$    32,431.14
$
$    40,266.80
$	3,106.12
$
$	.
$
$	.
$	.
$	.
$	

$
$	84,791.62
$	32,431.14
$
$	40,286.80
$	3,106.12
$
$
$	.
$	.
$	.
$
$	.				
1.	1 3/4" SP ASPHALTIC CONCRETE	$	66,847.86				0%	$	86,847.86	$	
2.
3.	6" CRUSHED CONCRETE
6" STAB!UZED SUBGRADE (LBR 40)	$	84,791.62
$	32,431.14				100%
100%	$
$	.	$	8,479.16
$	3,243.11	
4.	TYPE 'D' CURB	$	9,500.22				0%	$	9,500.22	$	
5.
6.	TYPE 'F' CURB W/STABILIZAT!ON
VALLEY GUTTER	$	40,266.80
$	3,106.12				100%
100%	$
$	.	$	4,026.68
$	310.61	
7.	5'X4" CONCRETE SIDEWALK	$	52,675.00				0%	$	52,675.00	$	
8.	6'X4" CONCRETE SIDEWALK	$	6,736.38				0%	$	6,736.38	$	
9.	10'X4" CONCRETE SIDEWALK	$	3,585.50				0%	$	3,585.50	$	
10.	ADA RAMPS (5' WIDE)	$	6,757.65				0%	$	6,757.65	$	
11.	DUMPSTER ENCLOSURE	$	9,451.20				0%	$	9,451.20	$	
12.	SIGNAGE & STRIPING	$	13,511.68				0%	$	13,511.68	$	
13.	PARKING LOT WHEEL STOPS	$	159.90				0%	$	159.90	$	
	TOTAL SCHEDULE C-AMEN!TY ROADWAY	$ 329,821.07	$	.	$ 160,595.68	$	160,595.68	49%	$ 169,225.39	$ 16,059.56	
	SCHEDULE D -AMENITY POTABLE WATER SYSTEM			

$
$
$
$
$
$
$
$
$	.
$
$	.
$	.
$	.
$	.
$
$	.
$
$	.
$
$
$			

$	2,060.34
$	.
$	.
$	3,592.68
$	.
$	.
$	.
$
$
$	.
$
$
$
$
$	.
$	.
$	.
$	.
$	2,204.29
$	10,816.36
$	4,093.93		
1.	CONNECT TO EXISTING 12" W/M	$	2,060.34	$		$	.	0%		$	.	
2.	1" POLYETHYLENE WATERLINE	$	1,910.40	$	1,910.40		$	1,910.40	100%		$	191.04	
3.
4.	2: POLYETHYLENE SERVICE (LIFT STATION)
3/4" PE WATERLINE SERVICE & BACKFLOW PREVENTER ASSEMBLY	$	5,053.82
$	3,592.68	$	5,053.62
$		$	5,053.62
$	.	100%
0%		$	505.36
$	.	
5.	6" PVC, C-900	$	965.38	$	965.38		$	965.38	100%		$	96.54	
6.	12" PVC PIPE C-900	$	11,884.58	$	11,884.58		$	11,884.58	100%		$	1,188.46	
7.	2" BEND	$	154.17	$	154.17		$	154.17	100%		$	15.42	
8.	2" TEE FITTINGS	$	3,100.80	$	3,100.80		$	3,100.80	100%		$	310.08	
9.	2" GATE VALVE	$	3,083.04	$	3,083.04		$	3,083.04	100%		$	308.30	
10.	6" GATE VALVE	$	3,550.92	$	3,550.92		$	3,550.92	100%		$	355.09	
11.	BLOW-OFF ASSEMBLY	$	609.08	$	609.08		$	609.08	100%		$	60.91	
12.	6" FIRE HYDRANT ASSEMBLY	$	3,744.84	$	3,744.64		$	3,744.64	100%		$	374.46	
13.	1'' TEMPORARY BLOW-OFF & GATE VALVE	$	615.12	$	615.12		$	815.12	100%		$	61.51	
14.	6" TEE FITTINGS	$	903.64	$	903.64		$	903.64	100%		$	90.36	
15.	12"GATEVALVE	$	7,052.76	$	7,052.76		$	7,052.76	100%		$	705.28	
16.	12" BEND FITTINGS	$	2,489.13	$	2,489.13		$	2,489.13	100%		$	248.91	
17.	12" TEE FITTINGS	$	498.25	$	498.25		$	498.25	100%		$	49.83	
18.	SINGLE SERVICE, SHORT SIDE	$	2,782.45	$	2,782.45		$	2,782.45	100%		$	278.25	
19.
20.
21.	2" METER ASSEMBLY
TEMPORARY CONSTRUCTION METER CHLOR!NATION & PRESSURE TESTING	$	2,204.29
$	10,816.36
$	4,093.93	$
$	.
$		$
$	.
$	0%
0%
0%		$
$	.
$	.	
	TOTAL SCHEDULED -AMENITY POTABLE WATER SYSTEM	$	71,165.58	$	48,397.98	$	$	48,397.98	68%	$	22,767.60	$	4,839.80	
	SCHEDULE E -AMENITY SANITARY SEWER								
1.	8" PVC, SDR 26 (0'-6' CUT)	$	6,160.56	$	6,160.56	$	$	6,160.56	100%	$	$	618.06	
2.
3.	8" PVC, SOR 26 (6'-8' CUT)
SANITARY MANHOLE (0'-6' CUT)	$	2,108.05
$	4,167.58	$	1,475.64
$	4,187.58	$	632.41
$	.	$	2,108.05
$	4,167.58	100%
100%	$
$	$	210.81
$	416.76	
4.	SANITARY MANHOLE (6'-8' CUT)	$	4,597.48	$	3,218.24	$	1,379.24	$	4,597.48	100%	$	$	459,75	

A	B	C	D

h 003B-01 Triple Creek Village K&L-Amenily- Pay App 5 800000	Page1 of5

E	F	G	H

12/1/2017 3:15 PM

BILL TO:	TRIPLE CREEK CDD
"PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0036-01

THE KEARNEY COMPANIES, LLC.
9625 WES KEARNEY WAY RIVERVIEW, FL 33576
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

5
11/30(2017
11/30/2017

ITEM
NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICAT!ON	THIS PERIOD	TOTAL COMPLETED &STORED
TO DATE	
%	BALANCE
TO FINISH	RETAINAGE	
5.	SINGLE SERVICE (HILLSBOROUGH COUNTY)	$	402.57
$	3,637.30
111.54
$	4,263.90
$	1,845.36
$	2,062.05
$	64,532.30
$	1,228.60
$	276.80
$	713.99
$	198.04
$	14,188.44
$	4,458.45
$	3,623.52
$	512.16
$	133.44
325.74
$	3,541.47	$	402.57
$	3,637.30
$	111.54
$	3,411.12
$
$
$
$
276.80
$	713.99
$	198.04
$	14,188.44
$	4,458.45
$	3,623.52
$	512.16
$	133.44
$	325.74
$	$	.	$	402.57	100%	$	.
$	.
$	.
$
$	1,845.36
$	2,062.05
$	64,532.30
$	1,228.60
$
$
$
$
$	.
$
$	.
$	.
$
$	3,541.47	$	40.26
$	363.73
$	11.15
$	426.39
$
$	.
$	.
$
$	27.68
$	71.40
$	19.80
1,418.84
$	445.85
$	362,35
51.22
13.34
$	32.57
$	
6.	DOUBLE SERVICE (HILLSBOROUGH COUNTY)			$	$	3,637.30	100%			
7.	8" STUB & PLUG (GRAVITY SEWER)			$	.	$	111.54	100%			
8.	DEWATERING			$	852.78	$	4,263.90	100%			
9.	INFIUEXFIL TESTING			$	$	0%			
10.	TELEV!SE SANITARY SEWER (CCTV)			$	$	0%			
11.	PRIVATE PUMP STATION (48" DIA)			$	$	0%			
12.
13.	CONNECT TO EXISTING 8" FM
4" PVC, C-900 FM			$
$	.	$	.
$	276.80	0%
100%			
14.	4" PLUG VALVE			$	$	713.99	100%			
15.	4" X 2" REDUCER			$	.	$	198.04	100%			
16.	8" PVC, C-900 FM			$	.	$	14,188.44	100%			
17.	8" PLUG VALVE			$	$	4,458.45	100%			
18.	8" BEND			$	$	3,823.52	100%			
19.	8"TEE			$	$	512.16	100%			
20.	8"CAP			$	$	133.44	100%			
21.
22.	TEMPORARY BLOW-OFF
PRESSURE TESTING (FM)			$	.
$	.	$	325.74
$	.	100%
0%			
	TOTAL SCHEDULE E -AMENITY SANITARY SEWER	$ 123,089.34	$	47,015.13	$	2,864.43	$	49,879.56	41%	$	73,209.78	$	4,987.96	
	SCHEDULE F-AMENITY STORM DRAINAGE	

$	9,933.84
$	18,170.32
$	19,753.20
$	12,048.20
$	17,894.70
$	3,578.94
$	16,548.36
$	1,458.48
$	5,763.50
$	4,112.07
$	8,835.44
$	862.28
8,524.60
$	6,189.42
$	9,993.75	

$	9,933.84
$	18,170.32
$	19,753.20
$	12,048.20
$	17,894.70
$	3,578.94
$	16,548.36
$	1,458.48
$	5,763.50
$	4,112.07
$
$
8,524.60
$	6,189.42
$	

$
$
•
$	.
$	.
$
$
$
.
$
$	.
$
$
$	.
$	.	

$	9,933.84
$	18,170.32
$	19,753.20
$	12,048.20
17,894.70
$	3,578.94
$	16,548.36
$	1,458.48
$	5,763.50
$	4,112.07
$
$
$	8,524.60
$	6,189.42
$		

$
$	.
.
$
$
$	.
$
$
$
.
$	8,835.44
$	862.28
$	.
$	.
$	9,993.75	

$	993.38
$	1,817.03
$	1,975.32
$	1,204.82
$	1,789.47
$	357.89
$	1,654.84
$	145.85
576.35
$	411.21
$
$
$	852.46
$	618.94
$	
1.	15" CLASS !II RCP					100%			
2.	18" CLASS !II RCP					100%			
3.	24" CLASS Ill RCP					100%			
4.	30" CLASS Ill RCP					100%			
5.	HILLSBOROUGH CO. TYPE 1 CURB INLET					100%			
6.	HILLSBOROUGH CO. TYPE 1 CURB INLETW/J-BOTTOM					100%			
7.	FOOT 'TYPE E" INLET					100%			
8.	DITCH BOTTOM INLET , TYPE "C"					100%			
9.	24" X 24" YARD DRA!N STRUCTURE					100%			
10.	CONTROL STRUCTURE (FOOT MODIFIED TYPE "D" INLET)					100%			
11.	6" PVC UNDERDRAIN					0%			
12.	UNDERDRA!N CLEANOUT					0%			
13.	30" FDOTFES					100%			
14.	FOOT MANHOLE					100%			
15.	TELEVISE STORM SEWER (CCTV)					0%			
	TOTAL SCHEDULE F AMENITY STORM DRAINAGE	$ 143,667.10	$	123,975.63	$	$	123,975.63	86%	$	19,691.47	$ 12,397.56	
	SCHEDULE G -AMENITY UNCLASSIFIED ITEMS	

$	13,415.36
$	1,974.15
$	339.56
$	241.44
$	1,197.96
1,177.98
$	2,470.26
$	2,708.34
$	308.90
$	3,200.00
$	3,226.79
$	4,068.00
$	15,498.00	

$	13,415.36
$	1,974.15
339.58
$	241.44
$	1,197.96
$	1,177.98
$	2,470.26
$	2,708.34
$	308.90
$	3,200.00
$	3,226.79
$	4,068.00
$	.	

$
$
$
$
$	.
$	.
$
$	.
$	.
$	.
.
$
$			

$
$
$	.
$	.
$
$	.
$	.
$
$	.
$
$	.
$
$	15,498.00		
1.	TREE BARRICADES				$	13,415.36	100%		$	1,341.54	
2.	ROOT PRUNING				$	1,974.15	100%		$	197.42	
3.	6" PVC, SOR 26 (6'-8' CUT)				$	339.56	100%		$	33.96	
4.	6" PVC, SOR 26 (8'-10' CUT)				$	241.44	100%		$	24.14	
5.	8" PVC, SOR 26 (8'-10' CUT)				$	1,197.96	100%		$	119.80	
6.	8" PVC, SOR 26 (10'-12' CUT)				$	1,177.98	100%		$	117.80	
7.	SANITARY MANHOLE (8'-10' CUT)				$	2.470.26	100%		$	247.03	
B.	SANITARY MANHOLE (10'-12' CUT)				$	2,708.34	100%		$	270.83	
9.	6" SANITARY CLEANOUT				$	308.90	100%		$	30.89	
10.	2" POLYETHYLENE GREEN FM				$	3,200.00	100%		$	320.00	
11.	8" PVC, SOR 35 - STORM				$	3,226.79	100%		$	322.68	
12.	10" PVC, SOR 35- STORM				$	4,068.00	100%		$	406,80	
13.	5' VINYL COATED FENCE				$	0%		$	
	TOTAL SCHEDULE G • AMENITY UNCLASSIFIED ITEMS	$	49,826.74	$	34,328.74	$	$	34,328.74	69%	$	15,498.00	$	3,432.89	
	SCHEDULE H - VILLAGE K GENERAL CONDITIONS	

$	25,298.08
6,253.15
$	8,302.50
$	38,253.00
$	11,008.50
$	12,814.51			

$	25,298.08
$	5,940.49
$	8,302.50
38,253.00
$	11,008.50
$	12,814.51		
$	.
$	312.66
$	.
$	.
$
.	
$	2,529.81
$	594.05
$	830.25
$	3,825.30
1,100.85
$	1,281.45	
1.	MOBILIZATION		$	25,298.08	$	.		100%			
2.	NPDES PERMIT & COMPLIANCE		$	4,689.86	$	1,250.63		95%			
3.	MAINTENANCE OF TRAFFIC		$	6,642.00	$	1,660.50		100%			
4.	CONSTRUCTION STAKEOUT/RECORD SURVEY		$	30,602.40	$	7,650.60		100%			
5.
6.	GEOTECHNICAL & MATERIAL TESTING PAYMENT & PERFORMANCE BOND		$	8,806.80
$	12,814.51	$	2,201.70
$	.		100%
100%			
	TOTAL SCHEDULE H - VILLAGE K GENERAL CONDITIONS	$ 101,929.74	$	88,853.65	$ 12,763.43	$	101,617.08	100%	$	312.66	$ 10,161.71	
	SCHEDULE I -VILLAGE K EARTHWORK			

$
$	.
$	.
$			

$
$
.
$	.		
1.	CLEARING & GRUBBING	$	5,856.40	$	5,856.40		$	5,856.40	100%		$	585.64	
2.	SAW CLJT EXISTING ASPHALT & REMOVAL	$	4,744.11	$	4,744.11		$	4,744.11	100%		$	474.41	
3.	DEMO EXISTING SIDEWALK	$	1,101.32	$	1,101.32		$	1,101.32	100%		$	110.13	
4.	DISC SITE	$	4,444.00	$	4.444.00		$	4,444.00	100%		$	444.40	

A	B	C	D

h 0038-01 Triple Creek VIiiage K&L-Arnenily- Pay App 5 800000	Page 2 of 5

E	F	G	H

12/1/2017 3:15 PM

BILL TO:	TRIPLE CREEK CDD
'PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9625 WES KEARNEY WAY RIVERVIEW, FL 33578
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PER!ODTO: GC/OWNER'S NO.:

5
11/30/2017
11/30/2017

A	B	C

D	E	F	G	H

ITEM
NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL COMPLETED &STORED
TO DATE	
%	BAlANCE TO FINISH	RETAINAGE	
5.
6.	CUT VOLUME (UNADJUSTED) FILL VOLUME (UNADJUSTED)	$	19,581.60
$	10,475.20	$	19,581.60
$	10,475.20	$
$
$
$     21,051.47
$
$	1,767.96
$	.
$	.	$	19,581.60
$	10,475.20	100%
100%	$
$	.	$	1,958.16
$	1,047.52	
7.	EXPORT TO V!LlAGE I	$	11,042.04	$	11,042.04		$	11,042.04	100%	$	$	1,104.20	
8.	SODDING	$	23,390.52	$		$	21,051.47	90%	$	2,339.05	$	2,105.15	
9.
10.	SILT FENCE
INLET PROTECTION	$	8,164.00
$	1,767.98	$	8,164.00
$		$	8,164.00
$	1,767.96	100%
100%	$
$	$	816.40
$	176.80	
11.	DEWATERING	$	13,478.05	$	13,478.05		$	13,478.05	100%	$	$	1,347.81	
12.	FINAL GRADING	$	13,159.00	$	13,159.00		$	13,159.00	100%	$	$	1,315.90	
	TOTAL SCHEDULE 1- VILLAGE K EARTHWORK	$ 117,204.20	$	92,045.72	$ 22,819.43	$	114,865.15	98%	$	2,339.05	$ 11,486.52	
	SCHEDULE J • VILLAGE K ROADWAY						
$	.
$
$	.
$
$	.
$	.
$	1,907.59
$	7,092.96
$	4,179.06
$		
1.	1 3/4"SP ASPHALTIC CONCRETE	$	40,203.99	$	.	$ 40,203.99	$	40,203.99	100%		$	4,020.40	
2.	6" CRUSHED CONCRETE OR UMEROCK	$	47,576.89	$	47,576.89	$	$	47,576.89	100%		$	4,757.69	
3.	6'' STABILIZED SUBGRADE (LBR 40)	$	19,126.17	$	19,126.17	$	$	19,126.17	100%		$	1,912.62	
4.
5.
6.	MIAMI CURB W/STABILIZATION TYPE 'F' CURB W/STABILIZATION
VALLEY GUTTER	$	44,017.05
$	1,383.06
$	2,479.20	$	44,017.05
$	1,383.06
$	2,479.20	$
$
$	.	$	44,017.05
$	1,383.08
$	2,479.20	100%
100%
100%		$	4,401.71
$	138,31
$	247.92	
7.
8.
9.
10.	5'X4" CONCRETE SIDEWALK ADA RAMPS (5' WIDE)
ADA RAMPS (10' WIDE) SIGNAGE & STRIPING	$	12,717.25
$	7,092.96
$	4,179.06
$	6,455.66	$
$
$	.
$	.	$ 10,809.66
$
$	.
$	6,455.66	$	10,809.66
$	.
$	.
$	6,455.66	85%
0%
0%
100%		$	1,080.97
$	.
$
$	645.57	
	TOTAL SCHEDULE J - VILLAGE K ROADWAY	$ 185,231.29	$	114,582.37	$ 57,469.31	$	172,051.68	93%	$	13,179.61	$ 17,205.19	
	SCHEDULE K - VILLAGE K POTABLE WATER SYSTEM						

$	1,848.04
$
$	.
$
$	.
$	.
$
$	.
$	.
$	2,225.51	

$	184.81
$	1,574.39
$	532.64
$	666.31
$	29.26
$	1,002.40
$	501.32
$	1,020.95
$	306.77
$	222.55	
1.	CONNECT TO EXISTING 6" W/M	$	3,696.09	$	1,848.05	$	$	1,848.05	50%			
2.	6"' PVC, C-900	$	15,743.91	$	15,743.91	$	$	15,743.91	100%			
3.	6"GATEVALVE	$	5,326.38	$	5,326.38	$	$	5,326.38	100%			
4.	6" FIRE HYDRANT ASSEMBLY	$	6,663.12	$	6,663.12	$	$	6,663.12	100%			
5.	6" TEE FITTING	$	292.55	$	292.55	$	$	292.55	100%			
6.	SINGLE SERVICE, SHORT SIDE	$	10,024.00	$	10,024.00	$	$	10,024.00	100%			
7.	SINGLE SERVICE, LONG SIDE	$	5,013.18	$	5,013.18	$	$	5,013.18	100%			
8.
9.
10.	TEMPORARY CONSTRUCTION METER 6" BEND FITTING (ALL BENDS) CHLORINATION & PRESSURE TESTING	$	10,209.52
$	3,067.74
$	4.451.02	$	10,209.52
$	3,067.74
$	2,225.51	$
$	.
$	.	$	10,209.52
$	3,067.74
$	2,225.51	100%
100%
50%			
	TOTAL SCHEDULE K -VILLAGE K POTABLE WATER SYSTEM	$	64,487.51	$	60.413.96	$	$	60,413.96	94%	$	4,073.55	$	6,041.40	

1.
2.
3.	SCHEDULE L - VILLAGE K SANITARY SEWER
8" PVC, SOR 26 (0'-6' cun
8" PVC, SOR 26 (6'-8' cun
8" PVC, SDR 26 (8'-10' cun
6" PVC, SOR 26 {10'-12' cun S"PVC, SDR28 {12'-14' cun SANITARY MANHOLE (0'-6' cun SANITARY MANHOLE (6'-8' cun
48" (DIA) SANITARY MANHOLE (12"-14" cun
REMOVE OR REPlACE EXISTING MH (INCLUDE DISPOSAL) SINGLE SERVICE (HILLSBOROUGH COUNTY)
DOUBLE SERVICE (HILLSBOROUGH COUNTY) CONNECT TO EXISTING 8" STUB-OUT

TOTAL SCHEDULE L -VILLAGE K SANITARY SEWER	

$	4,323.20
$	6,749.20
$	4,809.72	

$	4,323.20
$	8,749.20
$	4,809.72	

$
$	.
$	.	

$	4,323.20
$	8,749.20
$	4,809.72	

100%
100%
100%	
$	.
$
$	

$	432.32
$	674.92
$	480.97
$	536.18
$	426.31
$	633.89
$	712.56
$	345.22
$	2,737.31
$	387.63
$	1,688.71
$	493.01	
4.		$	5,361.64	$	5,361.84	$	$	5,361.84	100%	$		
5.		$	4,263.10	$	4,263.10	$	$	4,263.10	100%	$		
6.		$	6,338.91	$	6,336.91	$	$	6,336.91	100%	$		
7.		$	7,125.57	$	7,125.57	$	$	7,125.57	100%	$		
8.
9.		$	3,452.19
$	27,373.10	$	3,452.19
$	27,373.10	$
$	$	3,452.19
$	27,373.10	100%
100%	$
$	.		
10.		$	3,876.30	$	3,676.30	$	$	3,876.30	100%	$		
11.		$	16,667.12	$	16,887.12	$	$	16,887.12	100%	$		
12.		$	4,930.10	$	4,930.10	$	$	4,930.10	100%	$		
		$	97,490.35	$	97,490.35	$	.	$	97,490.35	100%	$	.	$	9,749.03	
	SCHEDULE M -VILLAGE K STORM DRAINAGE			
$	.
$	.
$
$	.
$
$	(0.01)			

$
$
$	.
$
$	.
$	2,137.13	

$	412.60
$	1,721.06
$	2,890.11
$	135.98
$	882.84
$	213.71	
1.	15" CLASS Ill RCP	$	4,125.96	$	4,125.96		$	4,125.96	100%			
2.	18" CLASS Ill RCP	$	17,210.62	$	17,210.62		$	17,210.62	100%			
3.	HILLSBOROUGH CO. TYPE 1 CURB INLET	$	28,901.12	$	28,901.12		$	28,901.12	100%			
4.	FOOT lYPE CINLET	$	1,359.80	$	1,359.80		$	1,359.60	100%			
5.	18" FDOTFES	$	8,626.36	$	8,828.36		$	8,828.36	100%			
6.	TELEVISE STORM SEWER (CCTV)	$	4,274.25	$	2,137.13		$	2,137.12	50%			
	TOTAL SCHEDULE M • VILLAGE K STORM DRAINAGE	$	64,700.11	$	62,562.99	$	(0.01)	$	62,562.98	97%	$	2,137.13	$	6,256.30	
	SCHEDULE N • VILLAGE K OFFSJTE ROADWAY	

$	4,089.55
$	28,319.26
$	2,837.25
3,796.00
$	4,754.75	

$	4,089.55
$	.
$	.
$	.
$	4,279.28				

$
$	.
$	.
$
$	.	

$	408.96
$	2,831.93
$	283.73
$	379.80
$	475.48	
1.	
REMOVE CURB			$	.	$	4,089.55	100%			
2.	MILL AND RESURFACE			$ 28,319.28	$	28,319.28	100%			
3.	1"FC9.5			$	2,837.25	$	2,837.25	100%			
4.	2" SP 12..5			$	3,796.00	$	3,796.00	100%			
5.	8" CRUSHED CONCRETE OR LIMEROCK			$	475.47	$	4,754.75	100%			

h 0038-01 Triple Creek Vil!age K&L-Amenity- Pay App 5 800000	Page3of5

12/1/2017 3:15 PM

BILL TO:	TRIPLE CREEK COD
'PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9625WES KEARNEY WAY RIVERVIEW, FL 33578
(813) 421-6601

SCHEDULE OF VALUES

APPLICATION NO.: APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

5
11/30/2017
11/30/2017

A	B	C	D	E	F	G	H
ITEM NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL COMPLETED &STORED
TO DATE	
%	BALANCE TO FINISH	RETAINAGE	
6.	12: STABILIZED SUBGRADE (LBR 40)	$	4,437.47	$	4,437.47	$	$	4,437.47	100%	$	$	443.75	
7.	SIGNING AND STRIPING	$	6,455.66	$	,	$	6,455.68	$	8,455.66	100%	$	,	$	645.57	
8.	TYPE "Fn CURB W/STABILIZAT!ON	$	7,577.70	$	7,577.70	$	$	7,577.70	100%	$	$	757.77	
9.	REMOVE AND REPLACE ADA RAMP	$	8,946.80	$	$	$	0%	$	8,946.80	$	,	
	TOTAL SCHEDULE N -VILLAGE K OFFISTE ROADWAY	$	71,214.46	$	20,384.00	$ 41,883.66	$	62,267.66	87%	$	8,946.80	$	6,226.79	
	SCHEDULE O -VILLAGE K UNCLASSIFIED ITEMS								
1.	!NFJL/EXFIL TESTING	$	2,653.96	$	,	$	,	$	,	0%	$	2,653.96	$	,	
2.
3.	TELEVISE SANITARY SEWER (CCTV) 15" FDOTFES

TOTAL SCHEDULE O -VILLAGE K UNCLASSIFIED ITEMS	$	4,935.35
$	1,934.27	$	4,935.35
,.$	1,934.27	$
$	,	$	4,935.35
$	1,934.27	100%
100%	$
$	,	$	493.54
$	193.43	
		"'-- "'.;:10	-----.0£	•	,	Y,Y-v,0£		£,------	_,_,:,/	
	SCHEDULE P -VILLAGE L GENERAL CONDITIONS				

$	19,574.20
$	5,473.09
$	5,842.50
$	24,600.00
6,691.20
$	10,330.79				
1.	MOBILIZATION	$	19,574.20	$	19,574.20	$		100%	$	$	1,957.42	
2.	NPDES PERMIT & COMPLIANCE	$	5,761.15	$	4,320.86	$	1,152.23		95%	$	288.06	$	547.31	
3.	MAINTENANCE OF TRAFFIC	$	5,842.50	$	5,258.25	$	584.25		100%	$	$	584.25	
4.	CONSTRUCTION STAKEOUT/RECORD SURVEY	$	24,600.00	$	20,910.00	$	3,690.00		100%	$	$	2,460.00	
5.	GEOTECHNJCAL & MATERIAL TESTING	$	6,691.20	$	5,687.52	$	1,003.68		100%	$	$	669.12	
6.	PAYMENT & PERFORMANCE BOND	$	10,330.79	$	10,330.79	$	,		100%	$	$	1,033.08	
	TOTAL SCHEDULE P -VILLAGE L GENERAL CONDITIONS	$	72,799.84	$	66,081.62	$	6,430.16	$	72,511.78	100%	$	288,06	$	7,251.18	
	SCHEDULE Q - VILLAGE L EARTHWORK								
1.	CLEARING & GRUBBING	$	3,194.40	$	3,194.40	$	,	$	3,194.40	100%	$	,	$	319.44	
2.	SAW CUT EX!ST!NG ASPHALT & REMOVAL	$	645.12	$	$	645.12	$	645.12	100%	$	$	64.51	
3.	DEMO EXISTING CURB	$	1,601.65	$	1,601.65	$	$	1,601.65	100%	$	$	160.17	
4.	DEMO EXISTING SIDEWALK	$	6,251.00	$	6,251.00	$	$	6,251.00	100%	$	$	625.10	
5.	DEMO EXISTING STORM	$	2,061.80	$	2,061.80	$	$	2,061.80	100%	$	$	206.18	
6.	DISC SITE	$	2,424.00	$	2,424.00	$	$	2,424.00	100%	$	$	242.40	
7.	CUT VOLUME (UNADJUSTED)	$	2,411.64	$	2,411.64	$	$	2,411.64	100%	$	,	$	241.16	
8.	FILL VOLUME (UNADJUSTED}	$	7,658.40	$	7,658.40	$	,	$	7,658.40	100%	$	,	$	765,84	
9.	IMPORT FROM ADJACENT STOCKPILE	$	28,005.90	$	28,005.90	$	,	$	28,005.90	100%	$	$	2,800.59	
10.	SODDING	$	16,283.76	$	$ 15,469.57	$	15,469.57	95%	$	814.19	$	1,546.96	
11.	SILT FENCE	$	6,172.40	$	6,172.40	$	,	$	8,172.40	100%	$	$	617.24	
12.	INLET PROTECTION	$	1,178.64	$	1,178.64	$	,	$	1,178.64	100%	$	$	117.86	
13.	DEWATER!NG	$	6,558.70	$	6,558.70	$	$	6,558.70	100%	$	,	$	655.87	
14.	FINAL GRADING	$	6,826.60	$	5,461.28	$	1,365.32	$	6,826.60	100%	$	,	$	682.66	
	TOTAL SCHEDULEQ VILLAGE L EARTHWORK	$	91,274.01	$	72,979.81	$ 17,480.01	$	90,459.82	99%	$	814.19	$	9,045.98	
	SCHEDULER VILLAGE L ROADWAY								
1.	1 3/4" S-1 ASPHALTIC CONCRETE	$	18,891.60	$	,	$ 18,891.60	$	18,891.60	100%	$	$	1,889.16	
2.	6" CRUSHED CONCRETE OR LIMEROCK	$	21,400.10	$	21,400.10	$	,	$	21,400.10	100%	$	$	2,140.01	
3.	6" STABILIZED SUBGRADE (LBR 40)	$	8,390.50	$	8,390.50	$	$	8,390.50	100%	$	$	839.05	
4.	MIAMI CURB W/STABIUZAT!ON	$	18,976.85	$	18,976.65	$	$	18,976.65	100%	$	$	1,897.67	
5.	TYPE 'F' CURB W/STABILIZATION	$	1,677.60	$	1,677.60	$	$	1,677.60	100%	$	,	$	187.78	
6.	5 FT WIDE SIDEWALK	$	13,091.70	$	$ 13,091.70	$	13,091.70	100%	$	,	$	1,309.17	
7.	6 FT WIDE SIDEWALK	$	23,722.13	$	$ 23,722.13	$	23,722.13	100%	$	,	$	2,372.21	
8.	ADA RAMPS (5' WIDE)	$	6,301.08	$	$	5,670.97	$	5,670.97	90%	$	630.11	$	567.10	
9.	ADA RAMPS (6' WIDE)	$	8,598.24	$	,	$	7,738.42	$	7,738.42	90%	$	859.82	$	773.84	
10.	1" MILLAND OVERLAY	$	18,174.00	$	,	$ 18,174.00	$	18,174.00	100%	$	$	1,817.40	
11.	30" HIGH DRY STACK BLOCK WALL (W/COLUMNS & STEPS)	$	56,842.50	$	,	$ 56,842.50	$	56,842.50	100%	$	$	5,684.25	
12.	SIGNAGE & STRIPING	$	861.00	$	,	$	861.00	$	861.00	100%	$	$	86.10	
13.	16 SPACE PARKING LOT (COMPLETE CONSTRUCTION)	$	41,572.86	$	29,101.00	$ 10,393.22	$	39,494.22	95%	$	2,078.64	$	3,949.42	
	TOTAL SCHEDULER VILLAGE L ROADWAY	$ 238,499.96	$	79,545.85	$ 155,385.54	$	234,931.39	99%	$	3,568.57	$ 23,493.14	
	SCHEDULES VILLAGE L POTABLE WATER SYSTEM								
1.
2.
3.	CONNECT TO EX!ST!NG 6" W/M 6'" PVC, C-900
6" GATE VALVE	$	2,464.06
$	8,585.72
$	2,863.19	$	1,232.03
8,585.72
$	2,663.19	$	,
$
$	$	1,232.03
$	8,585.72
$	2,663.19	50%
100%
100%	$	1,232.03
$
$	$	123.20
$	858.57
$	266.32	
4.	6" FIRE HYDRANT ASSEMBLY	$	3,331.56	$	3,331.56	$	,	$	3,331.56	100%	$	$	333.16	
5.	6" TEE FITTING	$	292.55	$	292.55	$	$	292.55	100%	$	$	29.26	
6.	6" BEND FITTINGS (ALL BENDS)	$	2,510.70	$	2,510.70	$	$	2,510.70	100%	$	$	251.07	
7.	SINGLE SERVICE, SHORT SIDE	$	4,835.60	$	4,835.60	$	$	4,835.60	100%	$	,	$	483.56	
8.	SINGLE SERVICE, LONG SIDE	$	3,899.14	$	3,899.14	$	$	3,899.14	100%	$	,	$	389.91	
9.	TEMPORARY CONSTRUCTION BACKFLOW	$	10,209.52	$	10,209.52	$	,	$	10,209.52	100%	$	$	1,020.95	
10.	CHLORINATION & PRESSURE TESTING	$	3,974.12	$	1,987.06	$	1,987.06	$	3,974.12	100%	$	$	397.41	
	TOTAL SCHEDULES -VILLAGE L POTABLE WATER SYSTEM	$	42,766.16	$	39,547.07	$	1,987.06	$	41,534.13	97%	$	1,232.03	$	4,153.41	

h 0038-01 Triple Creek Village K&L-Amenity- Pay App 5 800000	Page4of5	12/1/2017 3:15 PM

BILL TO:	TRIPLE CREEK CDD
'PROJECT: TRIPLE CREEK VILLAGES K & L, AMENITY CENTER PROJECT#: 0038-01

THE KEARNEY COMPANIES, LLC.
9625 WES KEARNEY WAY RIVERVIEW, FL 33578
(813)421-6601

SCHEDULE OF VALUES

APPUCATION NO.: APPLICATION DATE PERIOD TO: GC/OWNER'S NO.:

5
11/30/2017
11/30/2017

ITEM
NO.	DESCRIPTION OF WORK	CONTRACT VALUE	FROM PREVIOUS APPLICATION	THIS PERIOD	TOTAL COMPLETED & STORED
TO DATE	
%	BALANCE TO FINISH	RETAINAGE	
									
	SCHEDULE T - VILLAGE L SANITARY SEWER	

$	7,878.48
$	5,472.18
$	7,208.82
$	3,532.46
••	1,550.52
11,258.08
$	3,559.94
982,77
$	4,913.85	

$	7,876.48
$	5,472.18
$	7,208.82
$	3,532.46
$	1,550.52
$	11,258.08
••	3,559.94
$	4,913.85	

$
$
$	.
$
$
.
.
.
$	

$	7,876.48
$	5,472.18
$	7,208.82
$	3,532.46
1,550.52
11,258.08
$	3,559.94
$	.
4,913.85		

$
$	.
$
$	.
.
.
$	982.77
$	

$	787.65
$	547.22
$	720.88
$	353.25
$	155.05
1,125.81
$	355,99
••	.
491.39	
1.	8" PVC, SOR 26 (0'-1O' CUT)					100%			
2.	8" PVC, SDR 26 (10'-14' CUT)					100%			
3.	SANITARY MANHOLE (0'-10' CUT)					100%			
4.	48" (DIA) SANITARY MANHOLE (10'-14" CUT)					100%			
5.	SINGLE SERVICE (HILLSBOROUGH COUNTY)					100%			
6.	DOUBLE SERVICE (HILLSBOROUGH COUNTY)					100%			
7.	8" CONNECT EXISTING STUB-OUT					100%			
8.	INFIUEXFIL TESTING					0%			
9.	TELEVISE SANITARY SEWER (CCTV)					100%			
	TOTAL SCHEDULE T -VILLAGE L SANITARY SEWER	46,355.10	$	45,372.33	$	$	45,372.33	98%	$	982.77	$	4,537.24	
	SCHEDULE U - VILLAGE L STORM DRAINAGE	

$	3,206.16
5,310.34
$	2,636.49
$	3,842.04
$	3,448.02
$	1,934.27	

$	3,206.16
5,310.34
2,836.49
3,842.04
$	3,448.02
$	1,934.27	

$
.
$
$
$
$	

$	3,206.16
$	5,310.34
$	2,636.49
$	3,842.04
3,448.02
$	1,934.27		

$
•
$	.
.
$	.
$	

$	320.62
$	531.03
$	263.65
$	384.20
344.80
$	193.43	
1.	15" CLASS JI! RCP					100%			
2.	18" CLASS !II RCP					100%			
3.	FDOT DITCH BOTTOM TYPE E INLET					100%			
4.	FOOT MANHOLE					100%			
5.	FDOT MANHOLE W/J-BOTTOM					100%			
6.	15" FDOT FES					100%			
	TOTAL SCHEDULE U • VILLAGE L STORM DRAINAGE	$	20,377.32	$	20,377.32	$	.	$	20,377.32	100%	$	$	2,037.73	
	SCHEDULE V • VILLAGE L UNCLASSIFIED ITEMS	

$	1,771.20
1,587.45
$	2,456.38			

$	1,771.20
1,587.45
$	2,456.38		•
$
.	

$	177.12
$	158.75
$	245.64	
1.	TELEVISE STORM SEWER (CCTV)		$	885.60	$	885.60		100%			
2.	CONNECT EXISTING RCP		$	1,587.45	$	.		100%			
3.	CONNECT EXISTING INLET		$	2,456.38	$		100%			
									
	TOTAL SCHEDULE V • VILLAGE L UNCLASSIFIED ITEMS	5,815.03	$	4,929.43	885.60	$	5,815.03	100%	$	581,51	
	CONTRACT SUMMARY	108,490.19
$	259,586.47
$     329,821.07
$	71,165.58
$     123,089.34
$     143,687.10
$	49,826.74
$     101,929.74
$     117,204.20
$     185,231.29
$	64,487.51
$	97,490.35
$	64,700.11
$	71,214.46
$	9,523.58
$	72,799.84
91,274.01
$    238,499.96
$	42,766.16
$	46,355.10
$	20,377.32
5,815.03	

$	87,081.99
112,635.04
$
$	48,397.98
47,015.13
$     123,975.63
$	34,328.74
$	88,853.65
92,045.72
$	114,582.37
$	60,413.96
$	97,490.35
62,562.99
$	20,384.00
$	6,869.62
$	66,081.62
$	72,979.81
$	79,545.85
$	39,547.07
$	45,372.33
$	20,377.32
$	4,929.43	5,754.57
$     69,140.02
$  160,595.88
•
$	2,864.43
$
•
$    12,763.43
$    22,819.43
$    57,469.31
$	.
$
$	(0.01)
41,883.66
$	.
$	6,430.16
$    17,480.01
$   155,385.54
$	1,987.06
$
$
$	885.60	

$	92,838.56
181,775.06
$	160,595.68
$	48,397.98
49,879.56
$	123,975.63
$	34,328.74
$	101,617.08
$	114,865.15
$	172,051.68
60,413.96
$	97,490.35
$	62,562.98
$	62,267.66
$	6,869.62
$	72,511.78
$	90,459.82
$	234,931.39
$	41,534.13
$	45,372.33
$	20,377.32
$	5,815.03		

$	15,653.63
$	77,811.41
169,225.39
22,767.60
$	73,209.78
19,691.47
$	15,498.00
$	312.68
$	2,339.05
$	13,179.61
$	4,073.55
$	.
$	2,137.13
$	8,946.80
2,653.96
$	288.06
$	814.19
$	3,568.57
$	1,232.03
$	982.77
$
•	

$	9,283.66
$    18,177.51
$     16,059.56
$	4,839.80
$	4,987.96
$    12,397.56
3,432.89
$    10,161.71
•• 11,486.52
17,205.19
$	6,041.40
$	9,749.03
$	6,256.30
$	6,226.79
$	686.97
$	7,251.18
$	9,045.98
$     23,493.14
$	4,153.41
$	4,537.24
$	2,037.73
$	581.51	
1.	SCHEDULE A -AMENITY GENERAL CONDITIONS					
86%			
2.	SCHEDULE B - AMENITY EARTHWORK					70%			
3.
4.	SCHEDULE C-AMEN!TY ROADWAY
SCHEDULE □- AMENI TY POTABLE WATER SYSTEM					49%
68%			
5.	SCHEDULE E-AMENITY SANITARY SEWER					41%			
6.	SCHEDULE F - AMENITY STORM DRAINAGE					86%			
7.	SCHEDULE G -AMENITY UNCLASSIFIED ITEMS					69%			
8.	SCHEDULE H - VILLAGE K GENERAL CONDITIONS					100%			
9.	SCHEDULE I- VILLAGE K EARTHWORK					98%			
10.	SCHEDULE J - VILLAGE K ROADWAY					93%			
11.	SCHEDULE K- VILLAGE K POTABLE WATER SYSTEM					94%			
12.	SCHEDULE L- VILLAGE K SANITARY SEWER					100%			
13.	SCHEDULE M - VILLAGE K STORM DRAINAGE					97%			
14.	SCHEDULE N - VILLAGE K OFFSITE ROADWAY					87%			
15.	SCHEDULE O - VILLAGE K UNCLASSIFIED ITEMS					72%			
16.	SCHEDULE P - VILLAGE L GENERAL CONDITIONS					100%			
17.	SCHEDULE Q -VILLAGE L EARTHWORK					99%			
18.	SCHEDULER- VILLAGE L ROADWAY					99%			
19.	SCHEDULES -VILLAGE L POTABLE WATER SYSTEM					97%			
20.	SCHEDULE T - VILLAGE L SANITARY SEWER					98%			
21.	SCHEDULE U - VILLAGE L - STORM					100%			
22.	SCHEDULE V- VILLAGE L UNCLASSIFIED ITEMS					100%			
	TOTAL ALL SCHEDULES	$ 2,315,315.15	$ 1,325,470.60	$ 555,458.89	$ 1,880,929.49	81%	$	434,385.66	$ 188,093.04	
	TOTAL CHANGE ORDERS	$ (330,446.41)	$ (281,936.06)	$ (48,510.35)	$ (330,446.41)	0%	$	$ (33,044.64)	
	ADJUSTED CONTRACT TOTAL	$ 1,984,868.74	$ 1,043,534.54	$ 506,948,54	$ 1,550,483.08	78%	$	434,385.66	$ 102,871.60	
	CHANGE ORDERS			
$
$
$
(48,510.35)
$	.					
CO#1	COD DIRECT PURCHASE MATERIALS	$	(80,723.70)	$	(80,723.70)		$	{80,723.70)	100%	$	$ (8,072.37)	
CO#2	COD DIRECT PURCHASE MATERIALS	$	(50,384.24)	$	(50,384.24)		$	(50,384.24)	100%	$	.	$ (5,038.42)	
C0#3	CDD DIRECT PURCHASE MATERIALS	$ (150,828.12)	$ (150,828.12)		$ (150,828.12)	100%	$	$ (15,082.81)	
CO#4	COD DIRECT PURCHASE MATERIALS	$	(48,510.35)
$			$	(48,510.35)
$	100%
0%	$
$	.	$	(4,851.04)
.	
	TOTAL CHANGE ORDERS	$ (330,446.41)	$ (281,936.06)	(48,510.35)	$ {330,446.41)	0%	$	.	$ (33,044.64)	

A	B	C	D	E	F	G	H

h 0038-01 Triple Creek Village K&L-Amenity- Pay App 5 800000	Page 5 of 5	12/1/2017 3:15 PM

Tab 4

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT SERIES 2017-2 CONSTRUCTION REQUISITION RECAP FOR BOARD RATIFICATION January 16, 2018

REQUISITION NO.	
PAYEE	
AMOUNT	
Supp 5	Dennis J Benham, P.S.M.	$19,516.00	

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT

DISTRICT OFFICE · 9428 CAMDEN FIELD PARKWAY · RIVERVIEW, FLORIDA 33578

January 9, 2018

RIZZETTA & COMPANY, INC.
Triple Creek CDD, Custody Construction Account Attn: Leslie Spock
5844 Old Pasco Rd Wesley Chapel, FL 33544

RE:		Custody Construction Account, S2017-2 Requisitions for Payment

Dear Leslie:

Below please find a table detailing the enclosed requisition(s) ready for payment from the Districts Construction Account.

PLEASE EXPEDITE PAYMENT TO THE PAYEE(S) VIA UPS

REQUISITION NO.	
PAYEE	
AMOUNT	
Supp 5	Dennis J Benham, P.S.M.	$19,516.00	

If you have any questions regarding this request, please do not hesitate to call me at (813) 533-2950. Thank you for your prompt attention to this matter.

Sincerely,
TRIPLE CREEK
COMMUNITY DEVELOPMENT DISTRICT

Christine Perkins District Manager

TRIPLE CREEK COMMlJNI.TY DEVELOPMENT OJSTIUCT SUPPLEMENTAL CONSTRUCTION ACCOUNT
SE:RJES 2017 2 PROJECT

The  undersigned, a Responsible  Officer of Triple  Creek  Community  Development. District  (the "District'')  hereby  submits  the
following requisition for disbursement:

December 8, 2017

Requisition Number: Supp S

Name of Payee: Dennis J Benham, P.S.M.
11921 Wandsworth Drive
Tampa, FL 33626

Amount Payable: $19,516.00

Purpose for which paid or incurred (refer also to specific contract if amount is due and payable pun;uant to a contract involving progress payments: Invoice #'s 102917 and 112917 for Topographic and Specific Purpose Survey for Village G2, I & J

Fundor Account from which disbursement to be made: Triple Creek Supplemental Account

The undersigned hereby certifies lhal:
I.	obligations in the state-0 amount set forth above have been incurred by the District;
t	each disbursement set forth above is a proper charge against the Custody Account;
each disbursement set forth above was incurred in connection with the acquisition and/or construcr[on ofihe Project;

each disbursement represents a Cost of the Project which has not previously been paid.

The und.ersigned hereby further certifies lhat there has not been filed with or served upon the District notice of any lien, righ to lien. or attachment upon, or claim affectingthe right to receive payment o(, any of the moneys payable to the Payee set forth above, which has not been rele ased or will not be released simultaneously with the payment hereof.
The undersigned hereby further certifies that such requisition contains no item representing payment on account of any retained percentage which the District is at the date of such certificate enrilled to retain.
Attached hereto are originals of the invoicc(s) ftom the vendor of the property acquired or the services rendered with respect to which disbursement is hereby requested.

--	-	..........

::,,

-   -	-

,,;.c&:-;;;-: "f

/C '\

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRI.CT

B•y
'

CONSULTING ENGINEE R'S APPROVAL

The undersigned Consulting Engineer hereby certifies that thi s disbursement is for a Cost of the Project and is consistent with: (i) the applicable acquisition or construction contract; (ii) the plans and specifications for the portion of the Project with respect to which such disbursement is being made, and (iii) the report of the Consulting Engineer, as such report shall have been amended or modified on the date hereof.

 	   nsulti n1f Engineer

Dennis J Benham, P.S.M.		INVOICE	

11921 Wandsworth Drive			
Tampa, FL 33626	DATE:	October 29, 2017	
	INVOICE #	102917	
Phone 813.403.0220			
	FOR:	Task Order #3 Village I & J	
djbenham@tampabay.rr.com	DJB Project #	2017066	
Bill To:			
Triple Creek Community Development District			
12750 Citrus Park Lane, Suite 115			
Tampa, Florida 33625			
Attn: District Manager			
DESCRIPTION	AMOUNT	

INTERIM INVOICE			

Topographic and Specific Purpose Survey		
15,936.00	
80% Complete		

15,936.00	

Make all checks payable to Dennis J. Benham			
Due and payable upon receipt			

THANK YOU FOR YOUR BUSINESS!

Dennis J Benham, P.S.M.		INVOICE	

11921 Wandsworth Drive			
Tampa, FL 33626	DATE:	November 29, 2017	
	INVOICE #	112917	
Phone 813.403.0220			
	FOR:	Task Order #1b Village G2	
djbenham@tampabay.rr.com	DJB Project #	2017039	
Bill To:			
Triple Creek Community Development District			
12750 Citrus Park Lane, Suite 115			
Tampa, Florida 33625			
Attn: District Manager			
DESCRIPTION	AMOUNT	

Topographic Survey		

3,580.00	
100% Complete		

3,580.00	

Make all checks payable to Dennis J. Benham			
Due and payable upon receipt			

THANK YOU FOR YOUR BUSINESS!

Tab 5

TRIPLE CREEK COMMUNITY DEVELOPMENT DISTRICT CHANGE ORDER SUMMARY
January 16, 2018

CHANGE ORDER#	
CONTRACTOR	
DESCRIPTION	
AMOUNT	CONTRACT #	

5	
Kearney	
Hayes Pipe Supply	
($1,449.02)	
0038-01	

5	
Kearney	
Atlantic	
($921.14)	
0038-01	

5	
Kearney	
Ferguson	
($8,670.19)	
0038-01	

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K & L/AMENITY CENTER CHANGE ORDER NO. 5
THE KEARNEY COMPANIES PROJECT NO. 0038-01
Date: 	31-Dec-17	

Conditions: The changes described herein shall be governed by the terms and conditions of the Contract, and shall not in any way alter the terms of the Contract, but shall hereafter be a part of the Contract.

INV. NO.	DESCRIPTION	Invoice Amount	Sales Tax	TOTAL COST	
707700	HAYES PIPE SUPPLY 11/08/2017	$	112.00			
707701	HAYES PIPE SUPPLY 11/08/2017	$	1,255.00			
		$	1,367.00	$	82.02	$	1,449.02	

114352	ATLANTIC TNG 9/21/2017	$	869.00			
		$	869.00	$	52.14	$	921.14	

1627318	FERGUSON 9/28/2017	$	7,764.48			
1629662	FERGUSON 10/10/2017	$	386.24			
	DISCRETIONARY TAX:		$	30.43		
		$	8,150.72	$	519.47	$	8,670.19	

TOTAL		$	(11,040.35)	

The Kearney Companies LLC hereby requests an extension of	 	0	day(s) to the original contract deadline for this work.

The Kearney Companies, LLC.

REASON FOR CHANGE: DIRECT PURCHASE OF MATERIALS BY CDD	

ACCEPTABLE TO:

DATE:	31-Dec-17

DATE:  	

Engineer

DATE:  	

Owner

0038-01 CO5 - CDD Purchase Materials-5	Page 1 of 1

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL HAYES PIPE SUPPLY
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	31-Dec-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
707700	HAYES PIPE SUPPLY 11/08/2017	$	112.00	
707701	HAYES PIPE SUPPLY 11/08/2017	$	1,255.00	

			

			

			

			

			

			

TOTAL		$	1,367.00	

The Kearney Companies, LLC.

DATE:	31-Dec-17

Invoice Transmittal HAYES PIPE SUPPLY	Page 1 of 1

!:'age:	.L

INVOICE
HA.YES PIPE SUPPLY, INC.
0 Corporate: 950 Fiber Glass Rd. • P.O. Box 101550 • Nashville, TN 37224
(615) 255-4040 • (800)342-1973 • Fax (615) 256-8836
0   .vlurireesboro, TN• (615) 217-3040	V.lv-h ayc i;pip e.  com	Knoxville, TN• (865) 525-1717 □
o   Lexington, KY• (859) 231-8323	Louisville, KY• (502) 454-8500 o
0  Tampa, FL• (813) 241-4040	Llke llelen, FL• (386) 228-9819 □
D  Acworth, GA• (770) 529-8883	O  Columbia, SC • (803) 695-2424	Longvi,:w, TX• (903) 753-5533 □
Mains - Main Line Accessories - Service Materials - Casing Pipe

Bill To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Co/Gus t. No.	Qrdgr No.	Custornsr P.O.#

Ship To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Ter.	Sis.#

Invoice

707700
Date

11/08/17
16:39:03

1/0000018145 J8262/00	GERARDO 5181	09	93
ShipVia   WILL CALL	Terms	Net 30·Days	Ref#
•   !	...  _,    _	•   -	-	...	-
Item Number/ Description	U / I.II	Ordered	Shipped	Sell Price	Total

FOB Description:	WILL CALL

3101556	EA
BIN SDR-35 PVC SEWER SPG PLUG
1102042	FT
lIN x l00FT BLUE CTS CL-200 SDR-9 ENDOPURE POLY TUBING

4.000

100.000

4.000	18.00000 EA

100.000	.40000 FT

72.00

40.00

INVOICE DUE: 12/08/17

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
ALL PRODUCTS ARE WARRANTED ONLY TO THE EXTENT OF THE WARRAITTIES  PROVIDED BY  THE  RESPECTIVE  MANUFACTURERS OF THESF­ PR ODUCTS, AN D PRODUCTS ARE INTENDED FOR USAGE AND INS TALU. TIOl  S      AS     STATED     IN     THE     MANUFACTURERS      VIRITTEI-J RECOl.1NEN OATIO\IS. ANY PRIOR WRITTEN OR IMPLIED WARR ANTIES OR
SEnVICE I INSTALLATION INSTRUCTIONS ARE SUPERSEDED BY THIS STATEMENT. TII IS ENTIRE TRANSACTION IS EXPRESSLY LIMITED TO THE TERMS AND CONDITIONS OF SALE AS STATED ON THE REVERSE SIDE OF THIS PAGE. INTER EST AT THE MAXIMUM LEGAL RATE \VILL  BE  CHARGED IN
"l'tlr r   1,r•1.1...   r.AVl,U"'hlT 111"'1  u    n   T     ••     t  nr-        U   ll'rl         IHI.,... ,.   ,..,..,....  ti- l"\r- .... Iii°" 1uu   .....,     ...

SUBTOTAL:
TOTAL:

DEPOSIT: AMT DUE:

112.00
112.00

112.00

l:'age:	1-

INVOICE
,	HAYES PIPE SUPPLY, INC.
"'	DCorporate: 950Fiber Glass Rd. •  P.O. Box 101550 •  Nashville, 1N  37224
\:_()ouc ,.,	(615) 255-4040 • (800) 342-1973 • Fax (615) 256-8836
D  .Vlurfreesboro, TN• (615) 217-3040	www.haye.spipe.com	Knoxville, TN•  (865) 525-1717 0
D  Lexington, KY• (859) 231-8323	Louisville, KY•  (502) 454-8500 o
D  Tampa, FL• (813) 241-4040	Lake Helen, FL• (386) 228-9819 0
□ AL'\vorth, GA• (770) 529-8883	□ Columbia, SC• (803) 695-2424	Longvi w, TX•  (903) 753-5533 0
Mams - Main Line Accesso1ies - Service Materials - Casing Pipe

Bill To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY RIVERVIEW	FL 33578
Co/Gust. No.	Order No.	Customer P.O. #

Ship To:
TRIPLE CREEK CDD
C/O THE KEARNEY COMPANIES, LLC 9625 WES KEARNEY WAY
RIVERVIEW	FL 33578
Ter.	SI&#

Invoice

707701
D.ate

11/08/17
16:39:03

1/0000018145 J8263/00
ShipVia WILL CALL

226413	09	93
Terms	Net 30 Days	Ref/I-

•:	•.        1	•	;    -	-	...	-

llem Number / Description	U / IJI	Ordered	Shipped	Sell Price	Total

FOB Description:	WILL CALL

1002007	FT
6IN SDR-21 CL-200 PVC PIPE
4401002	EA
5-1/4 2PC 18-24 SCRD VALVE BOX W/LID
5009206	EA
BRASS TAG 6IN MJGV 20TTO O/L WATER

60.000

20.000

20.000

60.000

20.000

20.000

4.25000 FT

35.00000 EA

15.00000 EA

255.00

700.00

300.00

INVOICE DUE: 12/08/17

J\':,

n_\i\ ::\\\	f\t t	I
\(\\" \11,(!}'xl

REMIT TO: P.O. BOX 101550, NASHVILLE, TN 37224
ALL PRODUCTS ARE WARRANTED ONLY TO TH E EXTENT OF THE WARRANTIES PROVIDED BY THE RESPECTIVE MANUFACTURERS OF THE SE PRODUCTS, AND PRODUCTS AHE: INTENDED FOR USAGE AND INSTALLATIONS AS STATED IN THE MANUFACTURERS  WRITTEN nECOWJENDA110 S. ANY PRIOR WlllTTEN OR IMPLIED WARRANTIES OR SEnVICE I IN ST-.".LLAT IDN INSTRUC110NS ARE SUPERSED ED BY THIS STATEMENT. TIII S ENTIRE TRANSACTION IS EXPRESSLY LIMITED TO THE TERMS AND CONDITIONS OF SALE AS STATED ON TIIE REVERSE SIDE OF

.,..llr  ruruTnAVl,l   Jl,IT     .,.. "'"'"' ••  l r"lf'" 1u  1 .. 111u.....,. ,,.,.,..II... l"\r'  Tl"""  ILlll,,..,1,..,..

THIS PAGE. INTEREST AT THE MAXIMUM LEGAL RATE WILL BE CHARGED IN

SUBTOTAL:
TOTAL:
DEPOSIT: AMT DUE:

1,255.00
1,255.00

1,255.00

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL ATLANTIC TNG
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	31-Dec-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
114352	ATLANTIC TNG 9/21/2017	$	869.00	

			

			

			

			

			

			

			
TOTAL		$	869.00	

The Kearney Companies, LLC.

DATE:	31-Dec-17

Invoice Transmittal ATLANTIC TNG	Page 1 of 1

A

LANTICJ

Atlantic TNG, LLC
PO Box 729 • Sarasota, FL 34230 Phone • (941) 355-2988

€nfW'iK!,

IDUI

lNG U.C Fax • (941) 351-3765

Invoice

m:e.,	I	lliW l>lIHft	
9/21/2017	I	114352	

Triple Creek COD-Kearney c/o Rizzetta & Company 12750 Citrus Park Lane Suite 115
Tampa, FL 33625

Tr iple Creek Amenity Cente r PH L
Hills bo rough County PO# 0038-01- 13
Ca ll Before Loading
Co ntact: Eric 813-927-1749

	@rillk 'tin i&.W	tM t J111	61.i"@-	
	
9/21 /2017		
Net 30	
@iji	lli)	lillWW'	dlJ(fum	•'il	i;l::ili)	/4).i.i@Jl'Ml	
	
1	HW PO# 8394 DIRECT SHIPPED BY FOUNDRY
USF #6616 Galvanized Grate	

T H E KE	
869.00

RECEIVED

SEP 2 8 2U

ARNEY CO i\	
869.00

1

P ANIES	
if'	®1\£1»\)	Subtotal	$869.00	
	Sales Tax  (0.0%)	$0 .00	
	Balance Due	$869 .00	

THE KEARNEY COMPANIES, LLC.
9625 Wes Kearney Way, Riverview FL 33578

Office (813) 421-6601
Fax (813) 421-6701

Underground Utilities	Site Development

PROJECT: TRIPLE CREEK VILLAGE K&L/AMENITY CENTER INVOICE TRANSMITTAL FERGUSON
THE KEARNEY COMPANIES PROJECT NO. 0038-01

Date: 	31-Dec-17	

INV. NO.	DESCRIPTION	TOTAL COST	
			
1627318	FERGUSON 9/28/2017	$	7,764.48	
1629662	FERGUSON 10/10/2017	$	386.24	

			

			

			

			

			

			

TOTAL		$	8,150.72	

The Kearney Companies, LLC.

DATE:	31-Dec-17

Invoice Transmittal FERGUSON	Page 1 of 1

FERGUSON®
WATERWORKS
FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

EMAIL DUPLICATE INVOICE

Deliver To:
From:	Diana Hoga n
Comments:

Invoice Number

Customer

Page

1627318

51547

1

Please Contact With Questions:
813-627-1240

Please refer to Invoice Number when making payment and remit to:	TOTAL DUE--•>	7764.48

FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

Sold To:
TRIPLE CREEK COD TRIPLE CREEK K & L
C/0 THE KEARNEY COMPANIES 9625 WES KEARNEY WAY

Ship To:
TRIPLE CREEK COD TRIPLE CREEK BLVD TRIPLE CREEK K & L RIVERVIEW , FL 33579

Ship Whse

44

Ordered
576	Sell		Tax		Customer		Sales Whse	Code	Order Number	Person
44	FL2HIL	0038-01-18	027
Shipped  I	Item Number	I	Description
576  IRCPP18	I18 CL Ill RCP PIPE	Job Name

TRIPLE CREEK K & L
I  Unit Price  I
I	t3.48oT	Invoice Date

09/28/2017
UM	I
FT	l	Batch

98170

Am ount
7764.48	

Invoi ce Sub-Total
Tax	7764.48	
Tota/Amt	7764.48	

TOTAL DUE --->	7764l.48

ALL	ACCOUNTS ARE DUE AND PAYABLE PER THE CONDITIONS AND TERMS OF THE ORIGINAL INVOICE. ALL PAST DUE AMOUNTS ARE SUBJECT TO A SERVICE CHARGE AT THE MAXIMUM RATE ALLOWED BY STATE LAW PLUS COSTS OF COLLECTION INCLUDING
ATTORNEY FEES IF INCURRED. FREIGHT TERMS ARE FOR OUR DOCK UNLESS OTHERWISE SPECIFIED ABOVE. COMPLETETERMS AND
CONDITIONS ARE AVAILABLE UPON REQUEST OR CAN BE VIEWED ON THE WEB AT http: //wolseleyna.com/terms condltionsSale.html GOVT BUYERS: ALL ITEMS QUOTED ARE OPEN MARKETUNLESS NOTED OTHERWISE.	-
LEAD LAW WARNING: IT IS ILLEGAL TO INSTALL PRODUCTS THAT ARE NOT " LEAD FREE" IN ACCORDANCEWITH US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION. PRODUCTS WITH *NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN NON-POTABLE APPLICATIONS. BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION .

FERGUSON®
WATERWORKS
FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

Please Contact With Questions:
813-627-1240

EMAIL DUPLICATE INVOICE

Deliver To:
From:	Diana Hogan
Comments:

Invoice Number	
Customer	
Page	

1629662	
51547	
1	

Please refer to Invoice Number when making payment and remit to:	TOTAL DUE--->	386.24

FEI-TAMPA, FL WATERWORKS #044 REMIT TO NEW ADDRESS:
PO BOX 100286
ATLANTA, GA 30384-0286

Sold To:
TRIPLE CREEK COD TRIPLE CREEK K & L
C/O THE KEARNEY COMPANIES
9625 WES KEARNEY WAY

Ship To:
COUNTER PICK UP 8008 E SLIGH AVE TAMPA, FL 33610-0000

Ship Whse

44

Ordered
8
6	Sell Whse

44	Tax	Customer	Sales
Code	Order Number	Person
FL2HIL	035590	027	Job Name

TRIPLE CREEK K & L	Invoice Date

10110/2017	Batch

98299	
	Shipped
8
6	Item Number	Description	Unit Price	UM	Amount	
		MUL067476	6 PVC HW SWR GXG REP COUP	34.900	EA	279.20	
		MUL067474	4 PVC HW SWR GXG REP COUP	17.840	EA	107.04	

Invoi ce Sub-Total
Tax	386.24	
Total Amt	386.24	

TOTAL DUE··->	"·'"I

ALL ACCOUNTS ARE DUE AND PAYABLE PER THE CONDITIONS AND TERMS OF THE ORIGINAL INVOICE. ALL PAST DUE AMOUNTS ARE SUBJECT TO A SERVICE CHARGE AT THE MAXIMUM RATE ALLOWED BY STATE LAW PLUS COSTS OF COLLECTION INCLUDING
ATTORNEY FEES IF INCURRED. FREIGHT TERMS ARE FOR OUR DOCK UNLESS OTHERWISESPECIFIED ABOVE . COMPLETE TERMS AND
CONDITIONSARE AVAILABLE UPON REQUEST OR CAN BE VIEWED ON THE WEB AT htt p://wolseleyna .com1terms_conditionsSale.html GOVT BUYERS: ALL ITEMS QUOTED ARE OPEN MARKETUNLESS NOTED OTHERWISE.
LEAD LAW WARNING: IT IS ILLEGAL TO INSTALL PRODUCTSTHAT ARE NOT "LEAD FREE" IN ACCORDANCEWITH US FEDERAL OR OTHER APPLICABLE LAW IN POTABLE WATER SYSTEMS ANTICIPATED FOR HUMAN CONSUMPTION. PRODUCTS WITH *NP IN THE DESCRIPTION ARE NOT LEAD FREE AND CAN ONLY BE INSTALLED IN NON-POTABLE APPLICATIONS. BUYER IS SOLELY RESPONSIBLE FOR PRODUCT SELECTION.

Tab 6

Triple Creek
FIELD INSPECTION REPORT

Dec.27th, 2017 Rizzetta & Company
L. Scott Green –	Field Services Manager

Triple Creek

The following are action items for Sitex Landscaping complete. Please refer to the item # in your response listing action already taken or anticipated time of completion. Red text indicates deficient from previous report. Bold Red text indicates deficient for more than a month. Green text indicates a proposal has been requested. Blue indicates irrigation.

   1		1. Reference Pic (1) Located at the front entrance to Triple Creek in the medians and throughout the property there are many active ant mounds that need to be treated and when dead the dirt disbursed of once mound is dead. Ask contractor to also submit proposal for ant control treatment for property for medians , front entrance , new turf areas and clubhouse broken down into sections.

   2	
Reference Pic (2) Annuals at the front entrance appear to be in good health and have good color and bed appears to be weed free at the time of this inspection. Ask contractor to submit date as to when next rotation will take place and possible what type of plant will be installed.

2

Triple Creek

   3	

Reference Pic (3) Located at front entrance ditch has been mowed, but could be cut lower when dry. Ask contractor to insure that when ditch is dry that it is maintained and mowed regularly.

   4	
Reference Pic (4) Located at the front
entrance to Triple Creek inbound lane it appears that a vehicle has driven over curb and damaged curb and turf in the median. Ask contractor to inspect the turf in this area and take necessary course of action to return the turf to good health and or submit proposal to replace turf if necessary.

Ask contractor to also submit Fert/Chem schedule and applications as
it appears the turf in the median at	5	
entrance is off color in areas and
adjustments in Fert/Chem applications may be necessary.

Reference Pic (5) Located in landscape bed at front entrance landscape up lighting needs to be adjusted as it is pointing directly into plant material. Ask contractor to submit date as to when up lighting will be completed and adjusted.

3

Triple Creek

   6	
Reference Pic (6) Located throughout the community there are many newly installed palm trees that are leaning and need to straightened up. Ask contractor to submit date as to when trees will be straightened up.

Reference Pic (7) Located along
outbound lane of Triple Creek area	7	
between sidewalk and road still does not
have sod installed and there is landscape up lighting that needs to be repaired and adjusted.

Reference Pic (7) There is also a old palm tree stump (indicated by yellow arrow) that needs to be removed. If out of scoop of work ask contractor to submit proposal to grid and or remove stump before any sod is installed.

   8	
Ask contractor to also ensure no
irrigation is damaged during removal or gridding of stump.

Reference Pic (8) Located along outbound lane same area as item (9) there is also landscape up lighting that needs to be repaired and adjusted for proper lighting.

4

Triple Creek

Reference Pic (09) Located in the median of Triple Creek Blvd. hedge row appears to be off in color and in possible decline. Ask contractor to inspect hedge row and submit assessment and course of action to promote healthier hedge row and good color in plant material. Landscape bed also needs to be edged and redefined and treat with herbicide for weed control. Landscape also has no pine straw installed as of the date of this report.

  09 

  10 

Reference Pic (10) Palm trees located at amenities center need to be trimmed. Ask contractor to submit date as to when palms will be trimmed.

Reference Pic (11) Located at the amenities center pavers around pool deck are inundated with crack weeds that need to be treated with herbicide for weed control. Ask contractor to ensure that pool deck remains free of all crack weeds.

  11 

5

Tab 7

TRIPLE CREEK CDD

  SITEX LANDSCAPE  –  DECEMBER  2017  LANDSCAPE INSPECTION REPORT FOLLOW UP	

Proposal sent
Next annual rotation will be in March
Understood
Turf has been treated and is recovering. Will continue to monitor
Next fert and IPM dates will be in February
Will complete in February
Will complete in February
Lighting to be adjusted asap- proposal will be sent asap
Proposal sent
Understood
Will complete in February
Straw is installed, we will hardcut the shrubs to rejuvenate growth in March
TBD
Complete

Tab 8

Sitex Landscaping

Rick Herndon (239)-200-9330

rick@sitexlandscape.com

Proposal
BILL TO
Triple Creek CDD

ACTIVITY	QTY	RATE	AMOUNT	

Proposal to install top choice fire ant control “per contract”	1 app	7,325.00	7,325.00 through all areas of turf. Also requested in item 1 in
Scott Greens report.

Sitex Landscaping

Rick Herndon (239)-200-9330

rick@sitexlandscape.com

Proposal
BILL TO
Triple Creek CDD

ACTIVITY	QTY	RATE	AMOUNT	

Requested proposal to install 4 pallets of bahia per Bob Allen	4	175.00	700.00
where wild pigs tore up grass area across from models.

Tab 9

Triple Creek CDD

Monthly Report Inspection Date: 1/01/18

Prepared For: Christine Perkins Rizzetta & Company

Prepared By:
Joe Craig
P: 407-717-5851
E: joe@sitexaquatics.com

Monthly Report

Pond 2a,2b

Ponds received treatment for shoreline grasses and invasive species as needed

Pond 4a,4b

Comments: Ponds received treatment for shoreline grasses and invasive species as needed.

Monthly Report

Pond 4c & 4d

Comments: Ponds received treatment for shoreline grasses and invasive species as needed.

Pond 5a & 5c

Comments: Ponds received treatment for shoreline grasses and invasive species as needed, 5c Algae blooms have slowed down

Monthly Report

Pond 14 & 14A

Comments: Ponds were treated for shoreline grasses & invasive species as needed

Pond16A & 16B

Comments: Treatment for shoreline grasses continue

Monthly Report

Pond 38A

Comments: Pond has filled back up & water looks good, trash was removed

Pond 38c

Comments: Shoreline Brush treated

SITEX
A  Q U  A T I C S

Monthly Summary Report

Another wild month for weather as usual in Florida! Algae growth was slowed at the beginning of the month but picked up towards the  end.  Pond  Sc  had minimal Algae this month & is holding dye a bit  better now. Pond 38a was filled  at time of treatment water is less turbid & looks good at the monment. Please don't hesitate to reach out to my staff or myself if you need anything at all.
Happy New Year!

As always please feel free to reach out to myself or one of my staff should you have any questions or concerns.

Regards Joe Craig President
Sitex Aquatics

Tab 10

Proposal	

FROM:	  Jerry State Wildlife Trapper NWT 14255 	Phone No.	  813-390-9578		
	  2103 W Rio Vista Ave				
	   Tampa FL, 33603				
PROPOSAL SUBMITTED TO: Triple Creek Community Development District

Name:	 	Christine Perkins, District Manager			
Phone:	     813-533-2950		Date:	     1-4-18		
Street:	 	9428 Camden Field Parkway			
City:    	Riverview				
State:     	FL		Zip:    	33578		

I propose to furnish all materials and perform all labor necessary to complete the following:

Hunt and trap all-inclusive feral hogs using state-of-the-art trapping equipment which includes Primary tools we use for feral hog control will be cage traps, snares, trail cameras, Wireless GPS camera systems, Night Vision, thermal images, and any other means necessary to control and eliminate feral hog population. Propriety and traps are monitored 24 hours a day along with onsite technicians 3 to 5 times a week to help eliminate and maintain and controlling the hog population.

We are actively monitoring several properties throughout Hillsborough, Pasco, and Lee Counties. Which include the following sub-divisions: Connerton, Ballantrae, Concord station, Channing Park, Fish Hawk , Panther Trace 1 – 2, and LEE County wildlife Preserve, Bexley community, River reach, Tanglewood CDD, South fork CDD.

We specialize in hog removal with 11 years of experience. We set the standards high in controlling the feral hog population. The purpose of this agreement is to assist CDD in controlling Wildlife, especially feral Hogs which cause property damage and human health and safety concerns.

If the CDD request us to assist with other wildlife that is causing damage such as raccoons, armadillos or other nuisance animals other than our traps are designs for we have other control methods and shall be discussed with the CDD controlling different species require different trap designs and methods. We will continue to work efficiently and effectively using an integrated approach to remove feral swine from CDD or HOA property.

Our monthly service fee $ 1,400.00 per month or $ 16,800.00 annually to include multiple traps and camera setups including bait and all necessities to attract and contain wild hogs to limit and prevent property damage endured by feral hogs. Monthly Invoices will be due the 1st of each month.

Any and all illegal activity that we notice will be reported to the appropriate authorities along with the property manager.

We are fully licensed and insured in the State of Florida to trap and remove all nuisance Wildlife. There is a set up & removal fee of $ 350.00 per trap location

www.socrates.com	Page 1 of 2	SS4301-340 • Rev. 05/04

All of the work is to be completed in a substantial and workmanlike manner for the sum of $
    1,400.00 	. The entire amount of the contract  $   1,400.00 		is to be paid within 10
days after completion or a 15% fee will be added. All payments are due first day of the month. Under no circumstance shall this contract be superseded by any other terms or conditions other than stated agreement.

Any alterations or deviation from the above specifications involving extra cost of material or labor will be executed, and will become an extra cost.

By signing this contract you acknowledge the term to be 12 months. If you choose to terminate this contract prior to the 12 month term, you will still be billed for the remaining months there are no prorated fees. By signing this contract you are agreeing to all terms and conditions.

Always striving to provide quality professional service at a reasonable price. Thank you for your business Jerry State Wildlife Trapper NWT - 14255

Authorized Signature    	

ACCEPTANCE

You are hereby authorized to furnish all materials and labor required to complete the work

mentioned in the above proposal for 	.	 pay the amount mentioned in said proposal and according to the terms thereof.

agrees to

  Jerry Richardson		    1-4-18		
Signature	Date	

www.socrates.com	Page 2 of 2	SS4301-340 • Rev. 05/04

Tab 11

September 20, 2017
TO:	TRIPLE CREEK CDD

RE:	TRIPLE CREEK IRRIGATION
VILLAGES F1, F2, G1, K & L

Newberg Irrigation, Inc. hereby submits a proposal for an additional irrigation Well- Pump-Controls-Meter.

1.  ADD WELL/PUMP/CONTROLS...........................	$ 18,986.00
Well: Estimated Depth 350 feet
Pump 7.5 HP
Goulds VFD controls
Backflow
Filter
Certified Meter

NOTES
Electrical service to pump and controls by others and hookup same
Well depth (350 ft.) is based on information from the WUP available from SWFWMD. Drilling in excess of 350’ shall be at a rate of $20.00/ft.
This Contractor shall provide a one year (1 yr.) warranty from date of acceptance of work.
This bid shall stay in effect for sixty days (60) from the date of proposal.

3336 36th  Avenue North * St. Petersburg, FL 33713-1537	*	9880 Sidney Hayes Road * Orlando, FL 32824-8127
St. Petersburg (727) 521-6620 * Fax (727) 521-0230	*	Orlando (407) 816-6393 * Fax (407) 816-6391