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HomeMy WebLinkAbout240552 12/30/14 . ,y C.1q ,/ CITY OF CARMEL, INDIANA VENDOR: 358582 9 ONE CIVIC SQUARE PATTERSON HORTH INC CHECK AMOUNT: S""'53,734.41' ..__a ,= CARMEL, INDIANA 46032 5745 PROGRESS DRIVE CHECK NUMBER: 240552 c.. /_ti. INDIANAPOLIS IN 46241 CHECK DATE: 12/30/14 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 106 5023990 10 4,258.41 REIS CK 239595 106 5023990 3157 5,871.84 REIS CK 239595 106 5023990 36195 3157 25,037.96 REIS CK 239595 106 R5023990 36195 3157 18,566.20 REIS CK 239595 Patterson - Horth Inc. INVOICE 5745 Progress Drive Indpls., IN 46241 Invoice Number: 3157 Invoice Date: Oct 21, 2014 Page: 1 Voice: (317)243-6104 Fax: (317)243-6398 AA a Carmel Clay Board of Parks& Rec. Carmel Clay Board of Parks& Rec. 1411 E 116th St. 1411 E 116th St. Carmel, IN 46032 Carmel, IN 46032 CUSfOIfl@[� �t�SitOtTt@i"F f RON Carmel Clay Net 30 Days Courier 11/20/14 Progress Billing#9 52,080.00 Retainage -2,604.00 Subtotal 49,476.00 Sales Tax Total Invoice Amount 49,476.00 Check/Credit Memo No: Payment/Credit Applied TC1Tt i4 T �' 447600 CEIVD 1A Document G702TM - 1992 �" 4 Application and Certificate for Payment L Nov Y o zo�_ TO OWNER: Carmel Clay Board of Parks and PROJECT: Founders Park Pavillion Project APPLICATION NO: 009 Distribution to: Recreation 11675 Hazell Dell Parkway PERIOD TO.'October 21,2014 OWNER: 1411 E. 116th St. Carmel,IN 46032 Carmel,IN 46032 CONTRACT FOR:General Construction ARCHITECT: FROM VIA CONTRACT DATE: CONTRACTOR: CONTRACTOR: Patterson-Horth,Inc. ARCHITECT: PROJECT NOS' /21324/ FIELD: 5745 Progress Road Indianapolis,IN 46241 OTHER ' CONTRACTOR'S APPLICATION FOR PAYMENT 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 Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM $ 1,159,997.00 payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS......................................................... $ 207,905.58 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1 f 2)..................................................... $ 1,367,902.58 By: Date: October 21,2014 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703)........... $ 1,367,902.58 State of:Indiana 5. RETAINAGE: County of:Marion a. 0.311 JOYCE D.BRUMMETT 30945%of Completed Work Subscribed and sworn to beforeNotary Public (Column D+Eon G703) $ 4,258.41 me this f s, day of aC-M -20L SEAL b. 0 %of Stored Material State of Irxiiana Expires April (Column F on G703) $ 0.00 Notary Public:Jo .Brummett Commission11.2020 Total Retainage(Lines 5a+5b or Total in Column I of G703) ................ $ 4,258.41 My Commission expires:April 11,2020 6. TOTAL EARNED LESS RETAINAGE..........................................:................. $ 1,363,644.17 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .................................... $ 1,314,168.17 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated,the quality of the Work is in accordance (Line 6 from prior Certificate) with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT 8. CURRENT PAYMENT DUE.......................................................................... $ 49,476.0 CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .................................................................................. $ 49,476.00 (Line 3 less Line 6) $ 'I 4,258.41 (Attach explanation if amount certified d Pers from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) RANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITW: . Total changes approved in previous months by Owner $ 172,737.3 $ 0.0 By: i Date: (t TZOIJ Total approved this Month $ 35,168.21 $ 0.0 TOTALS $ 207,905.5 $ 0.0( This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of T CHANGES by Change Order $ 207,905.5E the Owner or Contractor under this Contract. ii AIA Document G702""—1992.Copyright©1953,1963,1965,1971,1978„`1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or,distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:11:02 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (1095394170) 1A Document[ G703TM - 1992 Continuation Sheet AIA Document, G702TM-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 009 Project Application and Project Certificate for Payment;Construction Manager as Adviser Edition, APPLICATION DATE: 10/21/2014 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. PERIOD TO: 10/21/2014 Use Column I on Contracts where variable retainage for'line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE(IF ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED,TO (G-C) FINISH VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (NOT IN D OR E) ( (D+E) D+E+F) 1 P&P Bond 15,584.00 15,584.00 0.00 0.00 15,584.00 100.00% 0.00 0.00 2 Supervision 23,068.00 23,068.00 0.00 0.00 23,068.00 100.00% 0.00 0.00 Misc. General 3 Conditions 2,675.00 2,675.00 0.00 0.00 2,675.00 100.00% 0.00 0.00 4 Earthwork 127,974.00 127,974.00 0.00 0.00 127,974.00 100.00% 0.00 0.00 5 Paving 6,993.00 6,993.00 0.00 0.00 6,993.00 100.00% 0.00 0.00 6 Landscaping 8,855.00 8,855.00 0.00 0.00 8,855.00 100.00% 0.00 0.00 7 Concrete 114,676.00 114,676.00 0.00 0.00 114,676.00 100.00% 0.00 0.00 8 Masonry 102,000.00 102,000.00 0.00 0.00 102,000.00 100.00% 0.00 0.00 9 Structural Steel 33,800.00 33,800.00 0.00 0.00 33,800.00 100.60% 0.00 0.00 10 Rough Carpentry 142,237.00 142,237.00 0.00 0.00 142,237.00 100.00% 0.00 0.00 11 Roofing 43,850.00 43,850.00 0.00 0.00 43,850.00 100.00%1 0.00 0.00 Doors,Frames, 12 Hardware . 14,133.0014,133.00 0.00 0.00 14,133.00 100.00% 0.00 0.00 13 Glass&Glazing 43,837.00 43,837.00 0.00 0.00 43,837.00 100.00% 0.00 0.00 Framing,Drywall, 14 Ceilings 132,100.00 132,100.00 0.00 0.00 132,100.00 100.00% 0.00 0.00 15 Flooring 26,442.00 i 26,442.00 0.00 0.00 26,442.00 100.00% 0.00 0.00 16 Painting 11,700.00 11,700.00 0.00 0.00 11,700.00 100.00% 0.00 0.00 17 Misc Specialties 36,073.00 36,073.00 0.00 0.00 36,073.00 100.00% 0.00 0.00 18 HVAC&Plumbing 103,000.00 103,000.00 0.00 0.00 103,000.00 100.00% 0.00 0.00 19 lElectrical 1 121,000.001 '121,000.001 0.00 0.001 121,000.00 100.00% 0.00 0.00 20 JAllowance 50,000.001 33,088.211 16,911.79 0.001 50,000.00 100.00% 0.00 2,500.00 AIA Document G703T"-1992.Copyright©1963,1965,1966,1967,1970',1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to I the maximum extent possible under the law.This document was produced by AIA software at 12:04:43 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (1517966185) A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY /o COMPLETED o BALANCE TO RETAINAGE(IF NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH VARIABLE APPLICATION THIS PERIOD DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) CO#1-Scope 21 Changes 92,737.37 92,737.37 0.00 0.00 92,737.37 100.00% 0.00 0.00 CO#1-Winter Conditions 22 Allowance 55,000.00 55,000.00 0.00 0.00 55,000.00 100.00% 0.00 0.00 CO#1-Additional 23 STM Allowance 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 0.00 24 C07 1,528.21 0.00 1,528.21 0.00 1,528.21 100.00% 0.00 76.41 25 CO 8 23,510.75 0.00 23,510.75 0.00 23,510.75 100.00% 0.00 1,175.54 26 ICO 9 1 10,129.25 0.00 10,129.25 0.00 10,129.25 100.00% 0.00 506.46 0.00 0.00% 0.00 0.00 GRAND TOTAL $1,367,902.58 $1,315,822.58 $52,080.00 $0.00 $1,367,902.58 100.00% $0.00 $4,258.41 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved:WARNING:This AIA®Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 12:04:43 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (1517966185) 7LLI PATTERSON HORTH GENERAL CONTRACTORS OWNER AFFIDAVIT AND WAIVER AND RELEASE OF LIEN AND CLAIMS The undersigned, being duly sworn upon his oath,states that he is the principal owner, officer, or authorized agent of Patterson-Horth, Inc. ("Contractor'),and is duly authorized to enter into this agreement and make these affirmations on behalf of the Contractor,which is contracted with Carmel Clay Board of Parks and Recreation to furnish materials, labor or services for a project known as Founders Park Pavillion Project (hereinafter"Project"), owned by Carmel Clay Board of Parks and Recreation and does hereby further state that the sum of $ 49,476.00 is due Contractor,the payment of which is made as consideration for this Affidavit and Waiver and Release of Liens and Claims and constitutes full and complete satisfaction of all sums owing to Contractor(less retainage) up to October 21,2014 (date of application). Therefore,as-to the following-entities: - -Patterson-Horth,Inc. - - Fidelity and Deposit Company of Maryland and all other entities have an interest in this project,the undersigned as duly authorized agent for Contractor hereby waives and releases any and all claims,Verified Statement of Claims and Mechanic's Liens,and further waives and releases any and all other liens or claims or rights to liens or claims whatsoever on the above-described property, on account of labor, materials or services furnished by Contractor. Contractor further certifies that all funds received from this project have been applied for the payment for labor, material and services furnished to this project by employees,subcontractors and material suppliers and that no other party has any lien or claim on account of any work performed or material furnished for said Project, and within the scope of this Affidavit and Waiver up to October 21,2014 (date of application). Printed: Jason Jeffries Title: Vice President of Operations STATE OF INDIANA ) SS: COUNTY OF MARION ) The foregoing, before me, a notary public, personally appeared Jason Jeffries as VP/Operations -,duly authorized officer or agent of Patterson-Horth, Inc._ who having been duly sworn,acknowledged the execution of the foregoing Affidavit and Waiver and Release of Liens and Claims,for and on behalf of-said----- corporation and stated that the representations therein contained are true. WITNESS my hand and notary seal this 21 day of October 20 14 Signed: Printed: yce Brummett Notary Public My Commission Expires: April 11,2020 My County of Residence is: Marion Contractor further certifies that upon receipt of payment listed above,the unpaid balance of materials, labor or services for the project is $ 4,258.41 JOYCE D.BRUMMETT Public P SEAL State of kidiana My Commission Expires Agri11.2020 `p�: ® FRECEIVED' Document G702 - 1992TI1 0 2014 Application and Certificate for Payment BY: TO OWNER: Carmel Clay Board of Parks and PROJECT: Founders Park Pavillion Project APPLICATION NO.010 Final Retainage Distribution to: Recreation 11675 Hazell Dell Parkway PERIOD TO:October 21,2014 OWNER: 1411 E. 116th St. Carmel,IN 46032 Carmel,IN 46032 CONTRACT FOR:General Construction ARCHITECT: FROM VIA CONTRACT DATE: CONTRACTOR: CONTRACTOR: Patterson-Horth,Inc. ARCHITECT: PROJECT NOS: /21324/ FIELD: 5745 Progress Road Indianapolis,IN 46241 OTHER:- CONTRACTOR'S APPLICATION FOR PAYMENT 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 Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM ......................................................................... $ 1,159,997.00 payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS ......................................................... $ 207,905.58 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1 f 2)..................................................... $ 1,367,902.58 By: Date: October 21,2014 4. TOTAL COMPLETED $ STORED TO DATE(Column G on G703)........... $ 1,367,902.58 State of:IndiaAa 5. RETAINAGE: County of:Marion a. 0 %of Completed Work JOYCE P.f�"Mm P Subscribed and sworn to before Notary PtMc (Column D+E on G703) $ 0.00 me this AI sr day of SEAL b. 0 %of Stored Material State of Indiana (Column F on G703) $ 0.00 Notary Public: oyce D.Brumm mett My Cwnnnission Expires Aprii 11.2020 Total Retainage(Lines 5a+5b or Total in Column I of G703) ................ $ 0.00 My Commission expires:April 11,2020 6. TOTAL EARNED LESS RETAINAGE............................................................. $ 1,367,902.58 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ..................................... $ 1,363,644.17 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, (Line 6 from prior Certificate) information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT 8. CURRENT PAYMENT DUE.......................................................................... $ 4,258.41 CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .................................................................................. $ 4,258.41 (Line 3 less Line 6) $ 0.00 (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) RANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHIT ,t Total changes approved in previous months by Owner $ 172,737.3 $ 0.0 By: Date: '151." Zo(q Total approved this Month $ 35,168.21$ 0.0 TOTALS $ 207,905.5 $ 0.0 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of T CHANGES by Chane Order $ 207,905.5 the Owner or Contractor under this Contract. ,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S. AJA Document G702Tm—1992.Copyright @ 1953,1963,1965,1971,19T Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:11:54 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (724584778) TM "r Document G703 - 1992 Continuation Sheet AIA Document, G702T4-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 010 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE: 10/21/2014 containing Contractor's signed certification is attached., ' In tabulations below, amounts are in US dollars. PERIOD TO: 10/21/2014 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE(IF NO. WORK VALUE PREVIOUS AND STORED TO FINISH VARIABLE APPLICATION THIS PERIOD STORED DATE (G-C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 1 P&P Bond 15,584.00 15,584.00 0.00 0.00 15,584.00 100.00% 0.00 0.00 2 Supervision 23,068.00 23,068.00 0.00 0.00 23,068.00 100.00% 0.00 0.00 Misc. General 3 Conditions 2,675.00 2,675.00 0.00 0.00 2,675.00 100.00% 0.00 0.00 4 Earthwork 127,974.00 127,974.00 0.00 0.00 127,974.00 100.00% 0.00 0.00 5 Paving 6,993.00 6,993.00 0.00 0.00 6,993.00 100.00% 0.00 0.00 6 Landscaping 8,855.00 8,855.00 0.00 0.00 8,855.00 100.00% 0.00 0.00 7 Concrete 114,676.00 114,676.00 0.00 0.00 114,676.00 100.00% 0.00 0.00 8 Masonry 102,000.00 102,000.00 0.00 0.00 102,000.00 100.00% 0.00 0.00 9 Structural Steel 33,800.00 33,800.00 0.00 0.00 33,800.00 100.00%1 0.00 0.00 10 Rough Carpentry 142,237.00 142,237.00 0.00 0.00 142,237.00 100.00%1 0.00 0.00 11 Roofing 43,850.00 43,850.00 0.00 0.00 43,850.00 100.00% 0.00 0.00 Doors,Frames, 12 Hardware 14,133.00 14,133.00 0.00 0.00 14,133.00 100.00% 0.00 0.00 13 Glass&Glazing 43,837.00 43,837.00 0.00 0.00 43,837.00 100.00% 0.00 0.00 Framing,Drywall, 14 Ceilings 132,100.00 132,100.00 0.00 0.00 132,100.00 100.00% 0.00 0.00 15 Flooring 26,442.00 26,442.00 0.00 0.00 26,442.00 100.00% 0.00 0.00 16 Painting 11,700.00 11,700.00 0.00 0.00 11,7010.00 100.00% 0.00 0.00 17 Misc Specialties 36,073.00 36,073.00 0.00 0.00 36,013.00 100.00% 0.00 0.00 18 HVAC&Plumbing 103,000.00 103,000.00 0.00 0.00 103,000.00 100.00% 0.00 0.00 19 Electrical 121,000.00 121,000.001 0.001 0.001 121,000.00 100.00% 0.001 0.00 20 Allowance 50,000.001 50,000.001 0.001 0.001 50,000.001 100.00%1 0.001 0.00 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 12:02:41 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (1752331361) i A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE(IF NO. WORK VALUE PREVIOUS AND STORED TO FINISH VARIABLE APPLICATION THIS PERIOD STORED DATE (G . C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) CO#1-Scope 21 Changes 92,737.37 92,737.37 0.00 0.00 92,737:37 100.00% 0.00 0.00 CO#1-Winter I Conditions 22 Allowance 55,000.00 55,000.00 0.00 0.00 55,000.00 100.00% 0.00 0.00 CO#1-Additional 23 STM Allowance 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 0.00 24 CO 7 1,528.21 1,528.21 0.00 0.00 1,528.21 100.00% 0.00 0.00 25 CO 8 23,510.75 23,510.75 0.00 0.00 23,510.75 100.00% 0.00 0.00 26 CO 9 10,129.25 10,129.25 0.00 0.00 10,129.25 100.00% 0.00 0.00 0.00 0.00% 0.00 0.00 GRAND TOTAL $1,367,902.58 $1,367,902.58 $0.00 $0.00 $1,367,902.58 100.00% $0.00 $0.00 i, AIA Document G703Tm-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 12:02:41 on 10/20/2014 under Order No.0733323674_1 which expires on 07/12/2015,and is not for resale. User Notes: (1752331361) rLIL PATTERSON HORTH GENERAL CONTRACTORS OWNER AFFIDAVIT AND WAIVER AND RELEASE OF LIEN AND CLAIMS The undersigned, being duly sworn upon his oath, states that he is the principal owner,officer,or authorized agent of Patterson-Horth, Inc. ("Contractor"),and is duly authorized to enter into this agreement and make these affirmations on behalf of the Contractor,which is contracted with Carmel Clay Board of Parks and Recreation to furnish materials, labor or services for a project known as Founders Park Pavillion Project (hereinafter"Project"), owned by Carmel Clay Board of Parks and Recreation and does hereby further state that the sum of $ 4,258.41 is due Contractor,the payment of which is made as consideration for this Affidavit and Waiver and Release of Liens and Claims and constitutes full and complete satisfaction of all sums owing to Contractor(less retainage) up to October 21,2014 (date of application). Therefore,as to the following entities: Patterson-Horth, Inc. Fidelity and Deposit Company of Maryland and all other entities have an interest in this project,the undersigned as duly authorized agent for Contractor hereby waives and releases any and all claims,Verified Statement of Claims and Mechanic's Liens,and further waives and releases any and all other liens or claims or rights to liens or claims whatsoever on the above-described property, on account of labor, materials or services furnished by Contractor. Contractor further certifies that all funds received from this project have been applied for the payment for labor, material and services furnished to this project by employees,subcontractors and material suppliers and that no other party has any lien or claim on account of any work performed or material furnished for said Project, and within the scope of this Affidavit and Waiver up to October 21,2014 (date of application). Printed: Jason Jeffries Title: Vice President of Operations STATE OF INDIANA ) SS: COUNTY OF MARION ) The foregoing, before me, a notary public, personally appeared Jason Jeffries as VP/Operations— -duly-authorized officer or agent of Patterson-Horth, Inc. who having been duly sworn,acknowledged the execution of the foregoing Affidavit and Waiver and Release of Liens and Claims,for and on behalf of said corporation and stated that the representations therein contained are true. WITNESS my hand and notary seal this 21 day of Octobert ,20 14 Signed: Printed: oyce Brummett Notary Public My Commission Expires: April 11,2020 My County of Residence is: Marion Contractor further certifies that upon receipt of payment listed above,the unpaid balance of materials, labor or services for the project is $ 0 ,oyEF_D.BRUMMETT Notary Public SEAL state of Indiana Fommission Expires Apr?11,2020 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service,where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. 358582 Patterson-Horth, Inc. Date Due 5745 Progress Road Indianapolis, IN 46241 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 10/21/14 3157 Founders Park Pavilion project 36195 (R) F $ 18,566.20 10/21/14 3157 Founders Park Pavilion project 36195 F $ 25,037.96 100114-- 3157 -Founders Park Pavilion-project $ 5,871.84 21-Oct Pay App# 10 Founders Park Pavilion project $ 41258.41 Total $ 53,734.41 1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 , 20 Clerk-Treasurer Voucher No. Warrant No. Allowed 20 358582 Patterson-Horth, Inc. 5745 Progress Road Indianapolis, IN 46241 In Sum of$ $ 53,734.41 ON ACCOUNT OF APPROPRIATION FOR 106 Park Impact Fee PO#or INVOICE NO. ACCT#/TITLE AMOUNT Board Members Dept# 36195 ( R ) F 3157 R5023990 $ 18,566.20 1 hereby certify that the attached invoice(s), or 36195 F 3157 5023990 $ 25,037.96 bill(s)is(are)true and correct and that the 106 3157 5023990 $ 5,871.84 1 materials or services itemized thereon for 106 Pay App# 10 5023990 $ 4,258.41 which charge is made were ordered and received except 20-Nov 2014 $ 53,734.41 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund