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Legacy TIF draw 15 033115
i 4, 1 FAL C ft N NES '; , 19 LLC March16, 2015 Diana L Cordray Carmel Clerk Treasurer (317)571-2414 Via E-mail: DCordraygcamietin.gov; csheeks c_,,...._.@,,,.. rriel.in. ov; john.alexandergregions.corr, jakeitaylorastarfinanciaLcom Re: Legacy"IV—Draw OM Dear Diana: Attached please find the Legacy TIF draw for the current month. If everything is in order, please sign the Request for Disbursement Form and forward this draw to the Trustee. Also attached is a budget sheet that will track all costs to date. Please let me know if you have any questions. er,702Z___ Sincerely, Rajai Zumot Member of SALT, LLC 1356 BEVERLY RD SUITE 250 • MCLEAN, VA .22101 PHONE: (703) 893-7233 • FAX (703) 893-5267 STATEMENT NO. 15 REQUESTING DISBURSEMENT OF FUNDS FROM PROJECT FUND PURSUANT TO SECTION 4.3 OF THE TRUST INDENTURE BETWEEN THE CITY OF CARMEL, INDIANA AND REGIONS BANK,AS TRUSTEE Pursuant to Section 4.3 of the Trust Indenture (the"Indenture") dated as of December 1, 2013, between the City of Carmel, Indiana(the "Issuer") and Regions Bank(the "Trustee"), the undersigned, as the Authorized Representative (as defined in the Indenture) of the Company, hereby requests and authorizes the Trustee, as depository of the Project Fund created by and as defined in the Indenture to pay to the Company or to the person(s) listed on the Disbursement Schedule attached hereto out of the moneys on deposit in the Project Fund,the aggregate sum of $35,45&21 to pay such person(s) or to reimburse the Company in full, as indicated in the Disbursement Schedule, for advances,payments and expenditures made by it in connection with the items listed in the Disbursement Schedule. In connection with the foregoing request and authorization, the undersigned hereby certifies that: (a) the costs of an aggregate amount set forth in this written request have been made or incurred and were necessary for the construction of the Project and were made or incurred in accordance with the construction contracts, plans and specifications,or purchase contracts therefor then in effect or that the amounts set forth in such written request are for allowable Costs of Construction of the Project; (b) the amount paid or to be paid, as set forth in this written request, is reasonable and represents a part of the amount payable for the Costs of Construction of the Project all in accordance with the cost budget; and that such payment was not paid in advance of the time,if any,fixed for payment and was made in accordance with the terms of any contracts applicable thereto and in accordance with usual and customary practice under existing conditions; (c) no part of said costs was included in any written request previously filed with the Trustee under the provisions hereof;and (d) such costs are appropriate for the expenditure of proceeds of the Bonds under the Act. This statement and all exhibits hereto, including the Disbursement Schedule, shall be conclusive evidence of the facts and statements set forth herein and shall constitute full warrant, protection and authority to the Trustee for its actions taken pursuant hereto;and This statement constitutes the approval of the Company of each disbursement hereby requested and authorized. IN WITESS WHEREOF, the authorized representative of the Company has set his hand as of the 50 day of Qzlea=r.,1 ,20 Pursuant to Section 4.3 of the Indenture the foregoing disbursement request is hereby FALCON NEST IJ LLC, an Indiana limited liability company By: SALT,LLC e I By: Rajai Zumot,Me?id er of SALT,LLC approved; CITY OF CARMEL ' IANA , r' f- , Diana L.Cordray,IAMC,Clerk-pf'el surer 2 Legacy TIF Draw 1 • Application 16 N6-.7.- Application Date: Prepared By: _ _ ! 16-Mar-15 _ _ Kathy Tekulve — Telephone Na (317)863-2052 _ Amount: $ 35,458.21 Reference or Total Retainage _ invoice Work • This invoice _ Code Contractor I Payee Number Completed Period Amount 3 CrossRoads Engineers 15167 • $ 300.00 $ - $ 300.00 $ 300.00 4 Weihe Construction, Inc. 4127 $. - $ 3,370.42 $ 3,370.42 $ - I $ 3,370.42 $ 3,370.42 8 Weihe Construction, Inc. 4127 165.80 $ 165.80 Hittle Landscaping 56682 $ 8,268:00 $ - $ 8,268.00 Weihe Construction, Inc. 4060 $ 5,020.00 $ (502.00) $ 4,518.00 $ 13,288.00 $ (336.2051 $ 12,951.80 9 E& B Paving, Inc. App 8 $ - $ 12,748.10 $ 12,748.10 $ - $ 12,748.10 $ 12,748.10 10 Manley Finish Grading 5984 $ 1,525.00 $ - $ 1,525.00 $ 1,525.00 $ - $ 1,525.00 12 Luminaire Service, Inc. 62028 $ 2,069.06 $ - $ 2,069.06 $ 2,069.06 $ - $ 2,069.06 15 E& B Paving, Inc. App 8 $ _ $ 20.00 $ 20.00 $ - $ 2000. $ 20.00 Management Fees 1082 $ _1,288.65 $ 1,185.17 $ 2,473.83 $ 1,288.65 $ 1,185.17 $ 2,473.83 Total _ $ 18,470.71 $ 16,987.49 $ 35,458.21 _ ____ ...$ - — 1 of 1 1 PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC INVOICE 1082 March 16, 2015 Zumot Real Estate Management, Inc. rzumot@zumot.net Falcon Nest II, LLC 1356 Beverly Road Suite 300 McLean, VA 22101 Re: Development Service Fees -The Legacy TIF Draw Summary of March 2015 Construction Costs: CrossRoads Engineers, PC 300.00 Weihe Construction, Inc $ 8,054.22 Hittle Landscaping $ 8,268.00 E & B Paving, Inc. $ 12,768.10 Manley Finish Grading $ 1,525.00 Luminaire Service, Inc. $ 2,069.06 Total Monthly Costs $ 32,984.38 Development Fee © 7.5% $ 2,473.83 Please remit payment to: Platinum Properties Management Company, LLC 9757 Westpoint Drive, Ste 600 Indianapolis, IN 46256 9757 Westpoint Drive,Suite 600,Indianapolis, IN 46256(317)818-2900 a. ; t s A ;... E'L'GI''EERS;PC CrossRoad Engineers, PC 3417 Sherman Drive Beech Grove, IN 46107 317-780-1555 Platinum Properties Management Co.,LLC Invoice number 15167 Timothy Walter,P.E. Date 03/04/2015 9757 Westpoint Drive, Suite 600 Indianapolis, IN 46256 Project RIVER ROAD RECONSTRUCTION TALL TIMBER RUN TO 146TH ST For services performed January 31, 2015 through February 27,2015. f F PROMPT PAYMENT OF INVOICE IS APPRECIATED!! The services were provided in accordance with our proposal dated February 14,2014,and our Professional Services Agreement dated March 20,2014. Amount 1.Topographic Survey Contract Amount 16,500.00 Percent Complete 100.00 Total Billed 16,500.00 Current Billed 0.00 2.Preliminary Design Contract Amount 8,100.00 Percent Complete 100.00 Total Billed 8,100.00 Current Billed 0.00 4.Phase I Final Design Contract Amount 37,500.00 Percent Complete 100.00 Total Billed 37,500.00 Current Billed 0.00 5.Phase I Drainage Permitting Contract Amount 2,000.00 Percent Complete 100.00 Total Billed 2,000.00 Current Billed 200.00 7.Phase I Rule 5 Permit Application Contract Amount 1,000.00 Percent Complete 100.00 Total Billed 1,000.00 Current Billed 100.00 Platinum Properties Management Co.,LLC Invoice number 15167 Invoice date 03104/2015 Page 1 of 3 l,..Platinu r1 Properties Management Co.,LLC Invoice number 15167 Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 03/04/2015 Amount 8.Roadway Legal Descriptions Contract Amount 3.00 5,400.00 Percent Complete 66.67 Total Billed 2.00 3,600.00 Current Billed 0.00 0.00 9.Phase I Monumentation Contract Amount 1,500.00 Percent Complete 0.00 Total Billed 0.00 Current Billed 0.00 10.Preliminary Design for RAB @ Cherry Creek Blvd. Contract Amount 9,500.00 Percent Complete 100.00 Total Billed 9,500.00 Current Billed 0.00 13.Maintenance of Traffic to close traffic during Construction Contract Amount 3,000.00 Percent Complete 100.00 Total Billed 3,000.00 Current Billed 0.00 14. Meetings Contract Amount 3.00 1,200.00 Percent Complete 100.00 Total Billed 3.00 1,200.00 Current Billed 0.00 0.00 16.Wetland Permitting Contract Amount 2,000.00 Percent Complete 0.00 Total Billed 0.00 Current Billed 0.00 16a.Williams Creek-Natural Resource Assessment Contract Amount 3,100.00 Percent Complete 100.00 Total Billed 3,100.00 Current Billed 0.00 16b.Williams Creek-Stormwater Consultation Contract Amount 5,700.00 Percent Complete 100.00 Total Billed 5,700.00 Current Billed 0.00 17 • .Construction Cost Estimate-Preliminary Design Area Contract Amount 1,500,00 Percent Complete 100.00 Total Billed 1,500,00 Current Billed 0.00 ................._. Platinum Properties Management Co.,LLC Invoice number 15167 Invoice date 03/04/2015 Page 2 of 3 Riatinu Ai Properties Management Co.,LLC Invoice number 15167 Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 03/04/2015 Amount 18.Construction Cost Estimate-Final CD Area Contract Amount 3,000.00 Percent Complete 100.00 Total Billed 3,000.00 Current Billed 0.00 • 19.Project Manual Contract Amount 2,500.00 Percent Complete 100.00 Total Billed 2,500.00 Current Billed 0.00 21.Topographical Information-Final CD Area Contract Amount 800.00 Percent Complete 100.00 Total Billed 800.00• Current Billed 0.00 23. 12"Water Main Relocation Design-new Eliz.Warner culvert to Community Dr. Contract Amount 4,900.00 Percent Complete 0.00 Total Billed 0.00 Current Billed 0.00 Total 300.00 ^c` Invoice total It 300 00 rci Invoice Summary 115 Prior Description Billed 1.TOPOGRAPHIC SURVEY 16,500.00 2.PRELIMINARY DESIGN 8,100.00 4.PHASE I FINAL DESIGN 37,500.00 5.PHASE I DRAINAGE PERMITTING 1,800.00 7.PHASE I RULE 5 PERMIT APPLICATION 900.00 8.ROADWAY LEGAL DESCRIPTIONS 3,600.00 9.PHASE I MONUMENTATION 0.00 10. PRELIMINARY DESIGN FOR RAB cj CHERRY CREEK BLVD. 9,500.00 13.MAINTENANCE OF TRAFFIC TO CLOSE TRAFFIC DURING CONSTRUCTION 3,000.00 14. MEETINGS 1,200.00 16.WETLAND PERMITTING 0.00 16A.WILLIAMS CREEK-NATURAL RESOURCE ASSESSMENT 3,100.00 16B.WILLIAMS CREEK-STORMWATER CONSULTATION 5,700.00 17. CONSTRUCTION COST ESTIMATE-PRELIMINARY DESIGN AREA 1,500.00 18. CONSTRUCTION COST ESTIMATE-FINAL CD AREA 3,000.00 19.PROJECT MANUAL 2,500.00 21.TOPOGRAPHICAL INFORMATION-FINAL CD AREA 800.00 23.12"WATER MAIN RELOCATION DESIGN-NEW ELIZ.WARNER CULVERT TO COMMUNITY DR. 0.00 Total 98,700.00 Platinum Properties Management Co.,LLC Invoice number 15167 Invoice date 03/04/2015 Page 3 of 3 APPLICATION FOR PAYMENT PROJECT NAME The Meadows at The Legacy Section 3 (I a OWNER: Falcon Nest.II,LLC NSTRUCTJON MANAGER: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4127 CONTACT: CONTACT:Tim Walter CONTACT:Alan Small APPLICATION DATE: 2/28/2015 ADDRESS: 1356 Beverly Road;Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS: 15215 Stony Creek Way RETAINAGE: 10% /41' McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY: litlaA, I *°' Phone: Phone: 317 818-2900 590-8817 M Phone:317-776-2966 o 776-3050 DATE: MallM s Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value IMIZEMMEIMMIENI Stored And stored To Date Com•I. Retainage This Period Retained PAY This Month The Meadows at The Legacy Section 3 On-site construction Lgy 0 4c Stripping Topsoil NA $5,179,00 $5,179.00 $5,179.00 100% $517.90 ($517.90) p Lgy 0 4d Prelim Erosion Control NA $9,181.00 $9,181.00 $9,181.00 100% $918.10 ($918.10) $91x.8 Lgy 0 4e Mass Excvation and Mounding NA $41,544.27 $41,544.27 $41,544.27 100% $4,154.43 ($4,154.43) ($0.00) ($0.00) $014=43 Lgy 0 4h Soil Stabilization NA $19,442.50 $19,442.50 $19,442.50 100% $1,944.25 ($1,944.25) °25 Lgy 0 4g Site&Finish Grading NA $10,841.00 $8,841.00 $8,841.00 82% $884.10 $884.10 $2,884.10 Lgy 0 5b Sanitary Sewer Mains NA $75,730.20 $75,730.20 $75,730.20 100% $7,573.02 ($7,573.02) .02 Y� Lgy 0 5c Sanitary Sewer Laterals NA $32,895.00 $32,895.00 $32,895.00 100% $3,289.50 ($3,289.50) 5p Lgy 0 6a Storm Sewers NA $36,051.80 $36,051.80 $36,051.80 100% $3,605.18 $3,605.18 $3,605.18 Lgy 0 6b Subsurface Drains NA $50,532.00 $50,532.00 $50,532.00 100% $5,053.20 $5,053.20 $5,053.20 Lgy 0 7b Water Mains NA $108,516.40 $108,516.40 $108,516.40 10o% $10,851.64 ($10,851.64) $1851'`64 Lgy 0 7e Water Service Laterals NA $26,837.60 $26,837.60 $26,837.60 100% $2,683.76 ($2,683.76) 527.6 Lgy 0 8a Roll Curb and Gutter $7.00/If $22,344.00 $22,344.00 $22,344.00 100% $2,234.40 ($2,234.40) ,dal Lgy 0 8b 5'Wheel Chair ramps $600/ea $1,200.00 $1,200.00 Lgy 0 8b Common Area Sidewalk $3.50/sf $2,625.00 $2,625.00 Cherry Creek Blvd Constructi Lgy TI" 4c Stripping Topsoil NA $3,184.00 $3,184.00 $3,184.00 100% $318.40 ($318.40) $318.40 Lgy TI' 4e Mass Excvation and Mounding NA $8,641.00 $8,641.00 $8,641.00 100% $864.10 ($864.10) $864.10 Lgy TI" 4h Soil Stabilization NA $12,428.50 $12,428.50 $12,428.50 100% $1,242.85 ($1,242.85) $1,242.85 Lgy TI" 4g Site&Finish Grading NA $13,253.00 $9,253.00 $9,253.00 70% $925.30 $925.30 $4,925.30 Lgy TI' 6a Storm Sewers NA $24,225.60 $24,225.60 $24,225.60 100% $2,422.56 $2,422.56 $2,422.56 Lgy TI' 8a Chair Back Curb and Gutter $7.60/If $12,600.80 $10,000.00 $10,000.00 79% $1,000.00 $1,000.00 $3,600.80 Lgy TI' Sb Multi Use Path Wheel Chair Ra +,1,100/e. $4,400.00 $4,400.00 Lgy TI' 8b Common Area Sidewalk $3.5OIsf $4,287.50 $4,287.50 CO#1-Cherry Creek Blvd Lgy T1' 4h Multi-use Path Stabilization NA $4,360.00 $4,360.00 $4,360.00 100% $436.00 ($436.00) $436.00 CO#2-Conduit Crossings Lgy O Se Utility Conduits NA $11,017.50 $11,017.50 $11,017.50 100% $1,101.75 ($1,101.75) $ ° CO#3-CC Blvd Spec Cond Lgy TI' 4i Subgrade Special Conditions NA $5,090.67 $5,090.67 $5,090.67 100% $509.07 ($509.07) ($0.00) ($0.00) ,$509.07 CO#4-Winter Protection Lgy Ti 8a CC Blvd-Curb concrete blanke $1.00J1f $1,658.00 . $1,658.00 $1,658.00 100% $165.80 ($165.80) $1.6580 Y L. 0 .:8a Onsite-Curb Concrete Blanket- .$1.00/if $2,937.00 $2,937.00 $2,937.00 100°io $293.70 $293.70 - — TOTAL $551,003.34 $529,890.04 $529,890.04 96% $52,989.00 $39,098.67 $13,890.33 $35,003.63 $39,098.67 11(:. 7;7 A 3;53 6.,-)., Z.,'Z- . . ,.. �r I '.. �. �- elk; Af ,--.. - ': - Application and Cer1IJea1e To fatinum Properties• PROJECT; Meadows O.Leeacv Section 3 • APPLICATION . 27 - 9757 Westpoint Drive Dis' ibtr tot�to: e **PERIOD Y0.: . ,Suite 600 OWNERx El �. ' iis„I 46256 CONTRACT FOR; •FROM CO ''1 R VIA ARC I" C�: ARCHITECT 0 eile Construction,Inc. CONTRACT DATE:RAFT DATE° CONTRACTOR 15215 Stony Creek Way 14 2-�1 ❑ PROJECT.NO Noblesville, 46060 1 1 FIELD s OTHER ❑ : 'RATOR'Sl P�..ICA�'rNaR PAYMENIT m undersigned .. _ A' Ixon is made for - and belief the Wad covered certifies that to the best of the Contractor's knowledge, information PP payment,as shown below,in connection with the Contract: by this Application for Payment has beep Gomm feted in AEA Document 070311m,Continuation Sheet,is attached. with the.Contract Doc : , p accordance eats, that all amounts have been paid by the Contractor for Work for 1.ORIGINAL CONTRAACT SU�1i.,. $ 525,94a.i? which previous Certi -,tes for,^ayment were issued and payments received from The Owner, - that Curren#.p$ymertt-. overt he ;�n js now due, and 2.NET CHANGE BY CHANGE ORDER& ... $ 25 063.17" CONTRACTOR:We , onstru'i o Inc. 4.TOTAL COMPLETED&ST9 D IODATE(Column 0 on G703)..,.... $ 529 894.04 State oandiana .RE�"AINAGE: ..�.�.. et .d Work County° amilton Columns - E on G763) $ -13,89634 - Subscribed and sworn to before b. �o of Stared Material me this day ofd{ ,? ;;72iF ter� l r on G2'03} . : �. • _ $ - Notary Public; V)..\1_0.0.1.0-L, ~, Total Retsina my commission expires: ✓_ :; , ::y " { •ge(Lines Sa+Sb,or Total In Column 1 of G703) $ 13 890.34 [ zisis _ - 6.TOTAL EARNED LESS • . _ RETAINAGE........: �, $ 515 999.70 ARCHITECT'S FOR (Line 4 ♦... CERTIFICATE ,PAY����' •Y._ (1• minus.Line S Total) In Co -., ,,•'- . . accordance with the Contract Docents,based on on-site observations 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 476 901.03 Ibis°NpI cation,the�t cert tes to the d t dsxa.co prising {L S froth prior Ce�•t frcate) t�farrn on and belief the Work has sir that t'°.the best of the Architect's othe knowledge,n accordance with the Con ct Documents, and the Contractor equality of the more �s in 8.CURRENT PAYMENT DUE [i_TT1 M-t)U3�I'f CERTiFEE. ctor is entitled to payment of the ....................... S.BALANCE TO FINISH,1N CLUDING RETAWat AMOUNT CERTIFIED........ 2 q o .- ae 3 minus dine 6) 35.003.64 (Attach /��y/� •} 6 4.- . ��� � differs from the amount applied,�rr�'tfrrl aTl�gatres orr!�� Application and on the Continuation Shut that are changed to conform with the amount certe�d) CHANCE ORDER d �., ADDITIONS DEDUCTIONS IONS ARCF{rrEcT: Total ch . appri ous moths by Owner - Total a . By: This Certificate is not rtetiabte,The AMOUrr CERTIFD is payable only t the ntractar NET A�� � TOTAL $ named herein.ISua,payment and acceptance o payment are without prejudice to any rights CES b Chem,a Order S the Owner or Contractor under this Contract CANON:You shoutd sign an.orlg!nat AlA Comet Document,on which this text appears In RED.An originat ass ures that changes win,1a#be obscured, •. •MA Document M0r! 1892.copyright 0 19530983,1985.1971,1978,191 �d 1992 by The n Institute of�AEI dghbs reserved.W,Ai till G:This ASA°emit International Tries.Upeuthorized repraductton or dist#ribu#ton ethic NA Document,or an Doc r is protected 6y U.S.i13 Do"night posetble under t e fattrr:r'ir.ha re ers Y gortlon at tt;may result in severe rlvii mnd critni l taltfes,�ar�d wilt be pros cutsd to ttee maxi pamItted to reproduce ten t10j copies of nuts document when completed.To report copyright v3eeations of AK Contract Documents o urrs�ex at caunsez,c�opYrtght��Ie.ero. ��The Amerir.�cn lrtstltute trF�►mhiterfs ....:,:.::... . .. .:,.. ... „,,,, ::"' . CONTINUATION SHEET A. A. DOCU ENT G703 (instruction on reverse side PAGE OF PhGES ALA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,- APPLICATION NO.; containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 4127 Use Column I on Contracts where variable retainage for Line items may apply. '. ARCHITECT'S PROJECT NO.: 2128/2015 A t J ' . C D E F c 4)1422-Q1 I . WORK COMPLETED • MATERIALS 'POLL ITEM NO. DESCRIPTION OF WORK ! SC •EDULED .FROM PREV30US PRESENTLY COMPLETED BALANCE RE'TAINAGE AWE ; APPLICATION 'MIS PERIOD ` C O'I IN TO I (G _ C) FINISH (IF•VARIABLE) I OD + B) D O (D+ELF) • (O-G) f •0 -CIO On-Site , 02-00 Stripping Topsoil 5,179.00 5,179'.00 5,1 79.00 100.00 03-00 Prelim Erosion Control 9,181.00 9,181.00 9,181.E •100.00 04-0Q 1,lass Exc&Mounding 41,544.27 41,544.27 ; 41,544.27 ,104.E 0 Soil Stabilization 19,442.50 19,442.50 19442.50 06-00 site&Finish Grading i 10,841.00 1 8,841.00 8,841.00 81.55 2,000.00 884.10 07-00. Sanitary Sewer Mains 75,730.20 i 75,730.20 75,73020 100.00 . 0800. Sanitary Sewer Laterals 32,895.00 32,895.00 32,895.00 100.00 00 Storm Sewers 36,051.80 , 38,051.80 - 36,051.80 100.00 3,6051 8 10-00 Subsurface Drains 50,532.00 , .50,532.00 50,532.00 100.00 , 5,053.20 1--00 Watermain 108,516.40 ' 108,516.40 108,516.40 100.00 11-00 Water Service Lateral 26,837.60 26,837.60 26,837.60 100.00 r 1" 00 Roll Curb and Gutter 22,344.00 22,344.00 22,344.00 100.00 1 -00 51 Wheel Chair ramps 1,2C00.0o I 1,200.00 1 -00 a ommon Area Sidewalk 2,625.00 2,625.00 1 -00 •henry Tree Blvd Construction 1 1 •00 tripping Topsoil 3,184.00 ' 3,184.00 3184.06 100.40 1 -00 Mass Exc&Mounding 8,6.11.00 8,641.00 8,641.00 ,100.00 1 -00 Soil Stabilization 12,428.50 12,428.50 12,428.50 100.00 2 -00 site&Finish Grading '13,253.00 9,253.00 9,253.00 69.82 4,000.00 925.30 2 -00 Storm Sewer 24,225.60 24,225.60 24,225.60 100.00 2,42.2.55 -o0 Chair Back Cu &Gutter 12,600.80 I 10,000.04 '10,000.00 ?9.36 2,600,80 1,004.00 2 -00 Multi Use Path Wheel Ramps 4,400.00 . 4,400.0Q ' 22-60 Common Area Sidewalk •,.: . 4,285 - - .�• CG-01 Ume Path _ 4,360.00 4,360.00 4,360.00 100.00 , 1 „,e f AIA DOcUM T�3•CONTINUA'i1ON SHEET Fon.6702* 199 EDI'I'UON•Ate° • €}1992•THE AMERICAN of ARCHITECTS,t73S NEW YQR] `,�r;f AVENUE,rtvf;,WASHINGTON,D.C.20006.5292•WANG; photocopying co s U.S copyright the la pion. G703-1992 CAUTION;You should use an original AIA document which has this caution printed in red.An original assumes that changes will not be obscured as may occur when documents are reproduced. •6 WTIN CONTINUATION SHEET AID. DOCUMENT G703 (Instructions. � (� ons an reverse aide) PAGE OF PAGES AIA Document G702,APPLICATION AND CERII1FiCATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,Is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 4127 Use Column I on Contracts where variable retainage for Brie items may apply. °. ARCHITEc T'S PROJECT NO.: 2l28I2015 1111 • • MEIN E D E F 0 I422-171 WORK COMPLETED • MATERIALS TOTAL ITEM •DESCRIPTION OF WORK SCHEDULED FROM.PREVIOUS` I' EN 'i.Y COMPLETED .BALANCE' RETAINAGE NO. VALUE APPLICATION THIS PERIOD R IN TO DATE (G - C) FINISH (IF ABLE + E) D OR.E) (D+E+F) (C` G) • C4.-02 I onduit Crossings 11,0 17.50 11,017.50 11,017.50 100.00 C4.-03 I harry Creek Subgrade Prep 5,090.67 5,090.67 5,090.67 100.00 C t ;. I oncrete Blankets 4,595.00 4,595.00 4,595.00 100.00 • Tintaillocumicr Gma CONnNumox SHEET 003.68402 EDI' 8 CI992•'=AMERICAN mania==of ARCInTE • � xC�95.17 2'i '313.30 la-a•.492 s `"},,,,,vs.! A�AVENUE,N.W.,WA Rust 7 DN,D.C.oc f. 292•MIN U` . +�4 �to legal ' ;'t.X 92 CAUTION:You should use an original AMA document which has this caution printed in red.An original assures that changes will not be obscured as may occur when documents are reproduced. APPLICATION FOR PAYMENT AND FINAL RELEASE OF LIEN Subcontractor or Supplier Name Weihe Construction Inc, Subcontractor or Supplier Address Noblesville IN 46080 Phone 1317 776-2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) Meadows @ Legacy Section 3 Owner Platinum P i es Application Number 4127 Date 2/1/2015 Period From ` 2/1/2015 To 4212121.§._ Original Contract Sum $ 525,94D.17 T� Net Change by Approved Change Orders... $ 25,0633,17 Contract Sum to Date.• $ 551,003.34 Total In-Place Work Completed......,.. $ S29,890.04 Value of Material Stored on Site Total Earned to Date 529 890.04 Retained Percentage ....,... $ 13,890.34. Total Earned Less Retainage _515,999.70 Less Previous Certificates for Payment.. $ 476,901.03 Current Payment Due $ 39,098.67 The undersigned hereby oertifles that the amount Earned and Due the Undersigned for all materials,supplies furnished,and labor and services of every nature performed by the Undersigned for the use on or in connection with the above named Project. 1) Has been paid in full as per shown(except Amount Due as listed below)through the above-mentioned pay period;and 2) The Undersigned hereby warrants that the premises of the above-earned job"cannot be made subject to any valid lien or claim by anyone who furnished materials,supplies, labor or services to the Undersigned for use in the above-named Project;and 3) The Undersigned hereby waives any and all claims of whatsoever kind or nature against the General Contract,and the Owner,and against the building(s),improvements or Project,and the and on which same is located for any labor,materials,or supplies furnished or services performed through the above-mentioned pay period. This release is given in order to induce payment in the Amount Due of$ 39 09B.67 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes valid,enforceable and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by the Owner or Mortgagee of the Project. Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all liens or rights Lu liens upon the premises,improvements thereto,or monies due in connection therewith, with respect to monies due the Undersigned for previous payment requests in the total sum of $ 39,098.67 _ ,the receipt and sufficiency of which Is hereby acknowledge. Dated this 28 day of Feb 2015 Weihe ConsIniction,Inc. (Subcontractor or supplier Name) State of Indiana ) 8y: • t A-0 ) SS: (Undersigned) County of Hamilton ) Title: CAO Before me,a Notary Public in and for said County and State,this 28 day of Feb 2015, personally appeared ,Devon Moon known to me to be the CAO of the Undersigned who acknowledge the execution of the foregoing for and on behalf of the Undersigned. WITNESS my hand and Notarial Seal. Dated this 28 day of Feb 2015 My commission expires: Oct 2015 '—'6‘ALANtat Notary Public My county of residence is: Hamilt Michelle Garcia (Printed) y s. is` •APPLICATION FOR PAYMENT PROJECT NAME: The Playschool at Legacy-Legacy Developer . OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co.,LLCONTRACTOR:Hitt le Landscaping INVOICE NO 56652 CONTACT: Rajai Zumot - CONTACT:Tim Walter CONTACT: Scott Roudebush APPLICATION DATE: 1/31/2015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS: 17778 Sun Park Drive RETAINAGE: —AT/0 McLean,VA 22101 Indianapolis,IN 46256 Westfield,IN 46074 APPROVED BY: Phone: Phone: 317 818-2900.590-8817 M Phone: 317-898-5697 DATE: '3 . A 0 Ci Project Cost Work Description Unit Scheduled Work Corn•feted Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value MMIIIIIIIIMMI Stored And stored To Date Corn 4. Retaina.a This Period Retained PAY This Month The Playschool at Legacy-Legacy Developer Community Drive Right-of-Way Lgy TIF ton site 8c Permeable Pavers-Walkways NA $8,268.00 $8,268.00 $8,268.00 100% $8,268.00 MI TOTAL $8,268.00 $8,268.00 $8,268.00 100% $8,268.00 T V IC 4 CLTIN- l � I -gsm 0,,. .zn": :° t .. ` '.,..=. CAP702 ,� Page:1 of 2 -- L -�- Platinum Properties Management Co., LAYSCHOOL.AT LEGACY 97§7�Illestpoint Drive •' :,,,,Pi611-6kildrii�l�o�:��ppliGa�ia-ri'=.Dati�� Svrte 600 The Piayschool at Legacy ._...:. ontraLff�a ; IN 46258 'f �#h and Community FEB 201 1 �:.. Indianapolis, Drive JAN M'. . rrtunity ,2015 OCT 21,2014 Project :Carmel, I N .. rthrri��oritra�r j�$J�tC E �;;; 1 iftleLandscapin , lnc. al tr`i i lori a#,' Owner Construction Mgr 1 7778 Sun Park rive : .�.:,= ::;�,.:�.� Westfield IN 4607 . Architect Field Phflne:�37}8g6,5697 0 Contractor E Other conrr r<>;o•R Permeable Pavers Contractors Application for Payment. coy TCTOR'S CERTIFICATION: Application is made for a p yrnent as shown below,with attached Continuation Sheet. The Contractors signature g e here certifies that,to the best of their knowledge, I. Original Contract Amount: $ 8,268.60 this document accurately reflects the work completed in this Application 2.Net of Change Orders: 0.00 for Payment.The Contractor also certifies that all payments have been made - - for work on previous Applications or P-merit and also that the Current 3.Net Amount of Contract: $ 8 268.00 Payment is Due. 4 L' .Total Completed&Stored to Date: $ 8 288.00 (Authorizing Signature) 5.Retainage Summary: Land caping,Inc. Date: FE %0.00 °o afi Completed WorFEB 16,201 ~— State Authorized: ZEBRA S L Indiana KULACaA b- 0.00 %of Stored Material $ 0;00 County of HAMILTON Notary Public-Seal Total Retainage: $� Subscribed a swo before Stalte of Inca me this Ific-w-day of ' Commis Nora 'vim -Y�.., E�ass��r 3D.2022 �. 6.Total Completed Less Retainage: $ 8,268.00 ry Public:Debra S IKulaga 'y °'° r '- 7.Less Previous My Commission expires:April 30,2022 •us Applications: $ 0.00 / i ARCHITECT'S CERTIFICATION: 8.Current Payment Due,This Application: $ 81268.00 The Architects signature here certifies 9 e certi that,based on their own observations, the Contract Documents and the information contained herein,this document 9.Contract BaianCe(Including Retainage): $ Q.40 accurately reflects the work completed in this Application for Payment. The Architect also certifies the Contractor is entitled C} GE ORDER l cavity.', ` ` Addlhions : ' —. to•the amount certified ��__�..;._.... ,�M �.^.,-��z�Suk�fractions= for payment. Tatar previously approved: 0,00 0 0..00 Total approved this Month: 0.0 0.00 A _c_ NT D I TIPi : , ,. ,, „ 6 Sub Totals: 0.00 :f::- ate. NET ofChsnge ar ers , f , 5 i 0a, „ . . , (Architects Signat ref Software by:PAM Software Systems,Inc. 1400-803-1315 Copyright 2012 0 m APPLICATION FOR PAYMENT - CONTINUATION SHEET CAP7O3 Page 2 g of 2 Pages From: To: Project: Application No: 1 Hittle Landscaping, Inc. Platinum Properties Management Co., PLAYSCO�OOL AT LEGACY Application Date: 2/1 61201 17778 Sun Park Drive 9757 Westpoint Drive The Playsohool at Legacy . Westfield, IN 46074 Suite 600 Period To: 1/31/2015 146th and Community Drive Phone:(317)896-5697 Indianapolis, IN 46256 Carmel, IN Contract Date: 1012//2014 Architects Project#: F .H I. ( • ..'.._ Work Cam feted .:•:::,;,:-...-... .- . 1Rem,..: .-Desctiptrfln'af V�lark :. .���. E,..---...-- '.�.' :: ...�.- ; ,.:-�ntraat �••� �rom �'rev�ocrs -....„P�rtenSls•_ - Taal Cornplete'd ; : Q � - '8alanc�- :,�: g• ....•. This Period resently. .and Stored R�tel a e No _. - . - - ..: - .-= . . Val :.-•- Application atoned(Not Ire' To Date "/: `To Finish (If Variable - ..... �e (D-r E) .. .D or E) .:: .(D+E�- .. . . ) (_C-�) : .. .......:-Rate) 1 Permeable Pavers 8,268.00 0.00 8,268.00 0.00E 8,268.00 100 0,00 0.00 r I , { j . 1 ._ 8,268.00 0.00 8,268.00 0.00 5,268.00 100 0.00 0.00 Software by PEM Software Systems,Inc. 1-800-803.1316 Copyright 2012 0 CO NT' F;,CTOR'S FINAL RELEASE AND WAIVER OF LIEN Project/Owner Contractor � school at Legacy Project: The y � y lame: aitrte Landscaping,Ine. .......... .. ...... Address: 146th Street&Community Drive,Carmel,IN Address: 17778 Sun Park Drive,Wcst6eld,IN 46074 Contractor Licence: Owner: Falcon Nest II,LLC Contract Date: 10 f 21 I 2014 To ALL WHOM IT MAY CONCERN,: For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged,the undersigned Contractor hereby waives, discharges, and releases any and all liens, claims, and rights to liens against the above-mentioned project, and any and all other property owned by or the title to which is in the name of the above-referenced Owner and against any and all funds of the Owner appropriated or available for the construction of said project, and any and all warrants drawn upon or issued against any such funds or monies,which the undersigned Contractor may have or may hereafter acquire or possess as a result of the furnishing of labor, materials, and/or equipment, and the performance of Work by the Contractor on or in connection with said project, whether under and pursuant to the above-mentioned contract between the Contractor and the Owner pertaining to said project or otherwise, and which said liens,claims or rights of lien may arise and exist. The undersigned further hereby acknowledges that the sum of Bight Thousand,Two Hundred Sixty Eight Dollars and 00/100 Dollars ($82B.00 )constitutes the entire unpaid balance due the undersigned in connection with said project whether under said contract or otherwise and that the payment of said sum to the Contractor will constitute payment in full and will fully satisfy any and all liens, claims,and demands which the Contractor may have or assert against the Owner in connection with said contract or project. Dated this loth day of February 20 15 Abe LcPII'AC• Witness to Signature: C tr:ctor Jeremy Kittle Title: President DEBRA t UAAGA Page 1 of 1 hrY WC•808, State of Indiana Hamilton County ti tily Commission Expires _... gftlttitidf#t � MICE 110• 414s* '-Ai ♦Wig ,+q%=ret-cgr 56682 '`�i4• L A N D S C A P I N G 17778 Sun Park Drive Westfield,IN 46074 317.896.5697 - 317.8.96.2471 fax www.HittleLandscape.com fob Location Legacy Playschool Community Drive St Sop Falcon Nest ii, LLC clo Platinum PMC 9757 Wesfpoint Drive,Suite 600 Bill to: Indianapolis, IN 46256 r a f e 3 r. t r. ...t r,.<,2, .,,,. 2>\. ..n.,r, at.,."f,.. 2..: '+i,. .:>.'t.i�.,�,2i>r2.. :�A•+r., ,�` P+ „♦ d SY:.ri'! w. ....a..a'x.tf ,,,.. 'I.T.. < �> £< ...i .> ro. �.... .....>,.....+ :+it., .., , r» ... ..E•:. m, '.f3 a.:f;.. ..,.,..,.,.,,,ry...,v.,b.. < ..,...-.,a:..n.v., tT,....., r.� .�. C ..Y. ,,.,,.._^..,,., ., ... x ��.v $:x alai• z,. t t, ..>a..<. .,r......, .Y ., w,., .», ..,.,., ..,.r .w�• .,. >.,. .... ... 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T,a,�, .. < a�. , r aT �2 : ..<.✓,,,....,.,�.^ ., � <?,f.:..:G 7 n.......«k,A,, ,.,\a ..Y,-� .,,Y-.,..i.X,a,..3. �., ,ft.A+ .,X. a0 ,.r... ... ..T .' •.Y> r. ,. ,.. �. v... ,,.z.n :>t>.«.1...............,.,....r,.n,e�.» ,:d,. ,e..z:...,Y. ;�., b_ ,:3.. x k :,a.., w. ..:� .,,,„ S .............. ..,,,,.... ^ .,,.`i..,.;.,., ,,..I..,..,,5:,, •..r,t.,,a.,r „$,. ..Y.. <..ar,.y,• GuN„ aa;,.,>S: .S Taxable Permeable Pavers 8,268.00 8,288.00 N Sal:TOT 8,268.00 Taxable 0.00 Tax 0.00 Buyer shall pay a late payment charge of 1 1/2%per month{which is an annual percentage of 18%)on any portion of account not paid within terms on invoice. all reasonable collection expenses including reasonable attorney's fees. 8 268.00 Buyer shall pay � g y s J f'f"s>f�-3�.#c3$F , '•`,�s.a;i}`2if �_...�_..__�.. •--'•—•-.....�...�,� ,.�__._. —�.,��.�� �...,>e.. ,Y.tr^�,�Siae�,�zr�kT,S$�'F.i£`♦a?��'. s�»`"f�4e Y�, APPLICATION FOR PAYMENT PROJECT NAME: The Playschool at Legacy-Legacy Developer OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4060 CONTACT: CONTACT:Tim Walter CONTACT:15215 Stony Creek Way APPLICATION DATE: 1/29/2015 ADDRESS: 1356 Beverly Road,Suite 250 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:#REF! RETAINAGE: 10%/ter Phone:McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY: •7) I. 1 50" -A-- 11CMIIIIMIIIIIIEIIIIIMIIIII.M.Mrgill.=MriiMMMIIIMIIIIIIIMIMMIIII=EMMMIEUEMEEFZffillnillfi=linIMIIIIEUMEMIIIIMMIMMMEZIIMI' Phone: 317 818-2900 590-8817 M Phone:317-776-2966 0 776-3050 DATE: w Project Cost Work Description Unit Scheduled Work Com•feted Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value - • � This Stored And stored To Date Com•I. Retaina•e This Period Retained PAY This Month The Playschool at Legacy-Legacy Developer On-ste Construction Lgy FN2' Site&Finish Grading NA $9,639.00 $9,639.00 $9,639.00 100% $963.90 $963.90 $963.90 Lgy FN2 5b Sanitary Sewer Laterals NA $8,046.25 $8,046.25 $8,046.25 100% $804.63 $804.63 $804.63 Lgy FN2 6a Storm Sewers NA $6,902.00 $6,902.00 $6,902.00 100% $690.20 $690.20 $690.20 Lgy FN2 6b Subsurface Drains NA $6,450.00 $6,450.00 $6,450.00 100% $645.00 $645.00 $645.00 Lgy FN2 8a Chair Back Curb and Gutter $14.15/If $7,541.95 $7,541.95 $7,541.95 100% $754.20 $754.20 $754.20 Lgy FN2 8a Depressed Curb and Gutter $29.39/If $11,199.05 $11,199.05 $11,199.05 100% $1,119.91 $1,119,91 $1,119.91 Lgy FN2 8c Heavy Duty Concrete Crosswalk$13.00/sf $3,718.00 $3,718.00 Lgy FN2 4h Soil stabilization NA $6,834.00 $6,834.00 $6,834.00 10o% $683.40 $683.40 $683.40 op 1W Community Drive R (TIF) C Lgy TIF 8b 6'Handicap Ramp with Curb $650/ea $1,300.00 $1,300.00 $1,300.00 100% $130.00 $130.00 $130.00 x$1;:170.0 Lgy TIF ; 8b 11'Handicap Ramp with Curd 4.1,250/ec $2,500.00 $2,500.00 $2,500.00 l00% $250.00 $250.00 $250.00 $2,250.00 Lgy TIF 8b 5'Handicap Ramp with Curb $610/ea $1,220.00 $1,220.00 $1,220.00 1oo°i° $122.00 $122.00 $122.00 $1.098.00 Lgy TIF 8b Standard Concrete Sidewalk $3,50/sf $21,021.00 $21,021.00 $21,021.00 10o% $2,102.10 ' $2,102.10 $2,102.10 I TOTAL $86,371.25 $77,633.25 $5,020.00 $82,653.25 96% $7,763.33 $502.00 $8,265.33 $11,983.33 $4,518.00 MI,M 4 S '&40.,.# .7.....1 Mk-, ''.-.4-0.N.,-- -- a'''' Document G702 — I * 92 ., Application and Cerfff4je for Payment TO OWNER, PROJECT: AHPLICATiON .- . Platinum Properties The Playschool 0a•Le�acvOt;Q Distribution to; 9757 Westpoint Drive PERIOD TO; OWNER 'Suite 600 )11:1 CONTRACT FOR: ARCHITECT FROM CO tfro'.P„IN 46256 VIA ARCHITECT. ■ Weihe Construction,Inc. CONTRACT DATE: CONTRACTOR 0 15215 Stony Creek Way PROJECT NOS: 201425-0 / f Noblesville,IN 46060 FIELD 0 COWTRACTOR'S APPLICATION FOR PAYMENT The undo . . OTHER Q. undersigned contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the work covered by this Application for Payment has been c MA Document G7O3TM,Continuation Sheet,is attached. Y completed to accordance with the.Contract Documents, that all amounts have been paid by the Contractor for work for �.ORIGINAL CONTRACT SUM. which previous Certificates for Payment were issued and payments received from the Owner,and S R447 ,5_,� that current payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS.. $ CoNT .._ sil5_________ CONTRACTOR: Weihe Construction,Inc. 3.CONTRACT SUM TO DATE(Line I±2) $ By: Date: a 4.TOTAL COMPLETED&STORED TO-DATE(Column G on G703) . $ ` 5,RE7`AIN � ) .- 5�,��3.��--- State of:Indiana AGE. a. %of C pleted Work County of aniilton 1 ltrmrrs.D+ on G703) Subscribed and sworn to before $ me this a� day of JcLr' b. Flo of Stored Material - . . r. Notary Public Paht...k.a.--, Total Retainage(Lines Sa Sb,or Total.in Column I o J -GJ\U ..-- My commission expires: fG703 _ $ 6.TOTAL EARNED LESS RETAtuAGE -_:.}� $ ARCHITECT'S CERTIFICATE PAI�MNT (Line 4.mirrus Line 5 Total) In accordance with the Contract Documents, - 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT.. znents based on on-site observations and the data comprising $--�--- 64, 9. this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, (Line�,from prior Certificate) information and belief the Work has progressed as indicated, the quality of the Work . accordance with the Contract Documents, and the Contractor is entitled to a rIt is in 8.CURRENT'PAYMENT DUE AMOUNT CERTIFIED. payment of the 9.BALANCE TO FINISH,INCLUDING RETAINAGE 41'-'2 AMOUNT CERTIFIED.... $ (Line 3 minus Line 6) ... S (Attach explanation if amount certed deers from the amount applied.Initial all figures - — Application and on the Continuation Sheet that are changed to conform +`es on(file CHANGE ORDER SUM.1 • ADDITIONS DEDUCTIONS ARCHITECT: .f m it1�the amount certified.) Total changes app icl i previous months by Owner $ $ ISIJ Total a vel n's Tri inth $ $y' Bate: $ This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to th Contractor TOTAL $ g named herein.ItSuanoe,payment and acceptance of payment are without prejudice to any rights of NET C1ANGES b Chan;e Order $ the Owner or Contractor under this Contract. CAUTION:You should sign an original AlA Contract Document,on which this text appears pp s its RED.An original assures that changes will not be obscured. • MA Document G702TM,—1992.Copyright 0 1953,'i9$3,1965,1971,197$,1983 and 1992 by The American institute of --------- and International Treaties.Unauthorized reproduction or distribution of this Al�hht°Document,or any Architects.AU rights�senred.WARNING:This AiA�'Document is protected icy U.S.Copyright Law and possible under the ta�ti:rt3�vheset'.are permitted to reproduce ten(10)copies of this document when completed.To� o result violations of civil and criminal penalties,and wiEi be prosecuted to the maximum extent counsel,copyrighi@ala.org. Pb copyright AIA Contract Documents,e-mail The American Institute of Etecs'legal • CONTINUATION SHEET MA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION Na.: containing Contractor's signed CertiFication, is attached. APPLICATION D,A,TE• In tabulations below, amounts are stated to the nearest dollar. � 400 PERIOD 'I'Q: 1/28/20 15 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S ECT'S PROJECT NO.: ii B D 1 WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED BALANCE NQ. DESCRIPTION OF WORK FROM PREVIOUS D °�a RETAINAGE VALUE APPLICATION THIS PERIOD (NOT IN A TO DATE (G C) FINISH (IF VARIABLE) (D + E) D OR (0+E+F) (C-G) RATE) .. 0 -00 ite&Finish Grading 9,039.00 9,539.00 9,639.00 100.05 903.915 0'-00 •anitary Sewer Laterals 8,046.25 8,046.25 8,045.25 1 00.00 804.63 0 00 •form Sewer 6,902.00 6,902.00 6,902.00 100.00 690.20 t I ubsurfaoe Drains 5,450.00 6,450.00 6,450.00 100.00 645.00 b .a 4 hair Back Curb&Gutter 7541.95 7,541.95 7,541.95 100.00 754.20 00 I I epressed Curb&Gutter 11 199.05 11,199.05 11,199.05 100.00 1,119.91 0 -00 eavy Duty Concrete Crosswall 3,718.00 3,718.00 0:-00 I ommunity Drive RiW cry) 0'-00 i r Handicap Ramp w/curb 1,300.00 1,300.00 1,300.00 1 00.00 130.00 10-00 1'Handicap Ramp w/curb 2,500.40 2,500.00 2,500.00 100.00 250.00 1 -00 Handicap Ramp w/curb 1,220.00 1,220.00 • 1,220.00 1 00.00 122.00 22.50 1,-00 tandard Concrete Sidewalk 21 021.00 21,021.00 21,021.00 100.00 2,102.10 1; 00 ime Stabilization 6,834.00 6,834.00 6,834.00 100.00 683.40 ii �4� CUlVIF.[11T G703•CONTINUATION SHEET F•11 .'4.�r . E �' I tX�•f -. �- .. .. ©1992 e INSTITUTE OF ARCHITECTS, I7� i�tE'W YORK � � ► -.-` _p :'. ,A AVENUE,I .W.,WASHINGTON,D.C.20006.5292•WARNING.Unlicensed photocopying violates U.S.copyright laws and will <,, erect the violator to agar prosecution. G703-1992 CAUTION;You should use an original AlA document which has this caution printed In red.An original assures that changes will not 9 be obscured as may occur when documents are reproduced. APPLICATION FOR PAYMENT AND FINAL RELEASE OF LIEN Subcontractor or Supplier Name _ Weihe Construction,Inc. Subcontractor or Supplier Address Noblesville.IN 46060 Phone 17)7 -2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) The Pla school C� a Owner Platinum Pro roes Application Number 4060 Date 1/1/2015 Period From 1/1/2015 _ , To 1/30/2015 Original Contract Sum .,, $ 86,371.25 Net Change by Approved Change Orders $ - Contract Sum to Date $ 86,371.25 Total In-Place Work Completed Value of Material Stored on Site Total Earned to Date... $ 82,65325 Retained Percentage $ 8,265.34 Total Earned Less Retainage. $ 74,387.91 Less Previous Certificates for Payment,. $ 69 869,91 Current Payment Due $ 4,518,00 The undersigned hereby certifies that the amount Earned and Due the Undersigned for all materials,supplies furnished,and labor and services of every nature performed by the Undersigned for the use on or in connection with the above named Project. 1) Has been paid in full as per shown(except Amount Due as listed below)through the above-mentioned pay period;and • 2) The Undersigned hereby warrants that the premises of the above-named job cannot be made subject to any valid lien or claim by anyone who furnished materials,supplies, labor or services to the Undersigned for use in the above-named Project;and 3) The Undersigned hereby waives any and all claims of whatsoever kind or nature against the General Contract,and the Owner,and against the building(s),improvements or Project,and the land on which same is located for any labor,materials,or supplies furnished or services performed through the above-mentioned pay period. This release is given in order to induce payment in the Amount Due of$ 4 518.00 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes yak,enforceable and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by the Owner or Mortgagee of the Project. Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all liens or rights to liens upon the premises,Improvements thereto,or monies due in connection therewith, with respect to monies due the Undersigned for previous payment requests in the total sum of 4 518,00 ,the receipt and suffidency of which Is hereby acknowledge. Dated this 22 day of Jan 2015 Weihe Construction,_Inc. IM State of Indiana (Su � or Supplier Name) } ) SS: (Linde County of Hamilton ) Title: HR Safe Director Before me,a Notary Public In and for said County and State,this 1 day of Jan 2015, personally appeared Brian Nifong known to me to be Safety Director of the Undersigned who acknowledge the execution of the foregoing for and on behalf of the Undersigned. WITNESS my hand and Notarial Seal. Dated this 1 day of Jan 2015 My commission expires: Oct.2015 ii\VAINAL 14M L1LA Notary Public My county of residence is: Hanhllitwi. Michelle Garcia (Printed) APPLICATION FOR PAYMENT Page 1 of 2 PROJECT NAME: Legacy-Residential Section 1,Master Infrastructure Phase 2 Meadows Section 1 and Overlook Section 1 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties,LLC CONTRACTOR:E&B Paving,Inc. APPLICATION NO: 8(retalnage) CONTACT: Rajai:Zurnot CONTACT:Tim Walter CONTACT:Matt Howard APPLICATION DATE: 2/17/2015 ADDRESS: 1356:Beverly Road,Suite.300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:296 W.300 North RETAINAGE: 10% McLean,Virginia 22101 Indianapolis,IN 46256 Anderson,IN 46012 APPROVED BY: Phone: Phone: 317 818-2900 590-8817 M Phone: 317 773-4132 o 73-4137 DATE: ; 1 5 A B Ci C2 D F 0 H=E+F+G 1=HID J K L=J+K M=D-H+L N Project Cost : Work Description Unit• Scheduled Work Completed Material- Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value__ _ _Previous I This Stored And stored To Date Compl. Retainage This Period Retained PAY This Month Residential Phase 1,Section 1 Lgy(FN)Al 9a: Stone Base,Asphalt Base&Binder NA $228,863.00 $228,863.00 $228,863.00 Lgy(FN)Al ; 9b Asphalt Surface Coat NA $64,323.00 $64,323.00 $64,323.00 100% Lgy(FN)Al 9c Accel/Decel&Left Turn Base to 1nt NA $50,667.00 $50,667.00 $50,667.00 ' 100% Lgy(FN)Al 9c Accel/Decel&Left Turn Surface NA $17,528.00 $17,528.00 I $17,528.00 100% Lgy(FN)Al 9e: 10'Multi-Purpose Path in R!W NA $11,867.00 $11,867.00 $11,867.00 100% Lgy(FN)Al 9h Thermoplastic Striping and Markings NA $3,399.00 $3,399.00 $3,399.00 100% Lgy(FN)Al 9h Raised Pavement Markers NA $2,362.00 $2,362.00 $2,362.00 100% Lgy(FN)Al 13r 8'Asphalt Path in CA NA $7,824.00 $7,824.00 $7,824.00 100% Lgy(FN)Al 15b Maintenance Bond NA $600.00 $600.00 $600.00 100% b 14171 ' Master Infrastructure Phase 2 Lgy Comm Dr 9a Stone Base,Asphalt Base&Binder NA $67,189.00 $67,189.00 $67,189.00 100% $6,718.90 ($6,718.90) $6.718.90, Lgy Comm Dr 9b Asphalt Surface Coat NA $18,966.00 $18,966.00 $18,966.00 100% $1,896.60 ($1,896.60) $1.;89660 Lgy Comm Dr 9c Accel/Decel Asphalt Base to Int NA $21,519.60 $21,519.60 $21,519.60 100% $2,151.96 ($2,151.96) $2,1.51.96 Lgy Comm Dr 9c Accel/Decel Asphalt Surface NA $7,090.20 $7,090.20 $7,090.20 100% $709.02 ($709.02) $709 02 Lgy Comm Dr 9c Accel/Decel Stone Shoulder NA $2,139.20 $2,139.20 $2,139.20 100% $213.92 ($213.92) $213.92 ' Lgy Comm Dr 9c Sawcut Edge of Existing Pavement NA $2,360.00 $2,360.00 $2,360.00 100% $236.00 ($236.00 ;9Y ) $230.00 Lgy Comm Or 9h Thermoplastic Striping and Markings NA $8,217.00 $8,217.00 $8,217.00 100% $821.70 ($821.70) $821.70 Lgy Comm Dr 15b Maintenance Bond NA $200.00 $200.00 $200.00 100% $20.00 ($20.00) $20.00 The Meadows at Legacy Sec 1 Lgy Oj 9a Stone Base,Asphalt Base&Binder : NA $157,321.00 $157,321.00 $157,321.00 100% Lgy 01 9b Asphalt Surface Coat NA $44,427.00 $44,427.00 $44,427.00 100% Lgy CCBlvd 9e 10'Multi-Purpose Path in RIW NA $9,945.00 $9,945.00 $9,945.00 100% • Lgy CCBlvd 9a Stone Base,Asphalt Base&Binder NA $9,952.00 $9,952.00 $9,952.00 100% Lgy CCBlvd 9b Asphalt Surface Coat NA $3,208.00 $3,208.00 $3,208.00 100°x6 Lgy CCBlvd 9h Thermoplastic Striping and Markings NA $1,100.00 $1,100.00 $1,100.00 100% Lgy 01 15b Maintenance Bond NA $350.00 $350.00 $350.00 100% APPLICATION FOR PAYMENT Page 2 of 2 PROJECT NAME: Legacy-Residential Section 1,Master Infrastructure Phase 2 Meadows Section 1 and Overlook Section 1 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties,LLC CONTRACTOR: E&B Paving,Inc. APPLICATION NO: 8(retainage) CONTACT: Rajai Zumot CONTACT:Tim Walter CONTACT:Matt Howard APPLICATION DATE: 2/17/2015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:286 W.300 North RETAINAGE: 10% McLean,Virginia 22101 Indianapolis,IN 46256 Anderson,IN 46012 APPROVED BY: Phone: Phone:(317)818-2900,590-8817(M) Phone:(317)773-4132 Jo),73-4137(f) DATE: A B Ci C2 D E F G H=E+F+G I I=H/D J K L=J+K M=D-H+L N Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO .- Net Pay Code Code Price Value Previous This Stored And stored To Date,Comp!. Retainag This Period Retained PAY i This Month The Overlook at Legacy Sec 1 Lgy P1 9a Stone Base,Asphalt Base&Binder NA $49,563.00 $49,563.00 $49,563.00 100% Lgy P1 9b Asphalt Surface Coat NA $13,532.00 $13,532.00 $13,532.00 100% Lgy Comm Dr 9e 10'Multi-Purpose Path in RfW NA $22,867.00 $22,867.00 - $22,867.00 100% Lgy P1 9h Temp Stone Culdesac NA $2,356.00 $2,356.00 $2,356.00 100% Lgy P1 15b Maintenance Bond NA $210.00 $210.00 $210.00 100% Change Orders Lgy(FN)Al 9c CO#1-Accel/Decel(Winter conditions) NA $8,783.97 $8,783.97 . $8,783.97 100% ($0.00) ($0.00) ($0.00) Lgy(FN)Al 9a ;O#2-Stone Base,Asphalt Base&BindE NA ($22,308.69) ($22,308.69) ($22,308.69) 100% $0.00 $0.00 $0.00 Lgy(FN)Al 9b CO#2-Asphalt Surface Coat NA ($6,355.44) ($6,355.44) ($6,355.44) ; 100% ($0.00) ($0.00) ($0.00) Lgy(FN)Al 9h CO#3-Additional RPM's NA $2,800.00 $2,800.00 $2,800.00 TOTAL $812,864.84 $812,864.84 $812,864.84 100% $12,768.09 ($12,768.10) ($0.011_ ($0.01) $12,768.10 APPLICATION A : CERTIFICATE FOR PAYMENT • AIA DOCUMENT G702 PAGE ONE OF 2 PAGES TO OWNER: Falcon Nest H,LLC PROJECT: Legacy Master infrastructure Phase 2 APPLICATION NO.: 5 Distribution to: PERIOD TO: 2117/15 OWNER PROJECT NOS.: ARCHITECT CONTRACTOR FROM CONTRACTOR:E&B Paving inc. VIA ARCHITECT: CONTRACT DATE: 286 VV.300 North J Anderson,IN 46012 1 CONTRACT FOR:. Stone,As.halt, Markinss ,...- ....... ...Th-e undersigned Co ntractor certifies thatit,t o the best of the Contractors knowledge,information and CONTRACTOR'S APPLICATION FOR PAYMENT belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AlA Documentation G703,is attached. certificates for Payment were issued and paym ieved from the Owner,and that current payment shown herein is now due. ,111 Yt i l iii 1.ORIGINAL CONTRACT SUM y•. :a , : . . .$ _ 127,681.00 `\\\\ NV !NG �'J/,, .$ (830.00) �~ �.,..........'4/PfJ 2. Net change by Change Orders. . .. . . . a } ;. *..0 i (Line ( } ) $ 126,851.00 CONTRACTOR: E&B Pav... c. ; 3.CONTRACT SUM TO DATE Lane I +- Z R .. ,, .4. .. . . . .., .• 4.TOTAL COMPLETED V STORED V DATE. n a n.s-r:":>. . 126,851.00 SEAL���� ,. - . .'.r O :"."- i S (Column G on 0703) By: A A .- 3 r,. ,: -.' Y,,.- f = Date: ® February 17, 2015 5. RETAINAGE: ~ a. %of Completed Work $ State of: . DIANA ��ffr t \ (Columns D+E on G703) County of: HAMILTON �o/I f fi i I l tll"\‘ b. %of Stored Material $ Subscribed and sworn to before (Column F on G703) me this 17 day of � ;.. ',: Total Ratainage(Line 5a+5b or v �,. S Total in Column I of G703) Y $ Notary Public: —.-� � �., , ,., 6.TOTAL EARNED LESS RETAINAGE . , . ,. . .. .$ 126,851.00 My Commission expires: 06/03/16 4 h n; Madison Coun40, 1, (Line 4 less Line 5 Total) _ �' "� ,.., ''', , M 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ARCHITECT'S CERTIFICATE FOR x��c� . , .. :: , ,.: (Line 6 from prior Certificate) . . ti:; w.. .$ 114,082.90 In accordance with the Contract Documents,based on on-site observations and the data comprising 8.CURRENT PAYMENT DUE this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, . . $ 12,768.10 . information and belief the Work has progressed as indicated,the quality of the Wrok is in accordance 9.BALANCE TO FINSH,INCLUDING RETAINAGE with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. (Line 3 less Line 6) $ AMOUNT CERTIFIED . ....,... $ i:I . 7,:.,,_ e , .., '..::,i ..'.µ.:......., (Attach explanation if amount certified differs from the amount applied for. initial all figures on this :CHANGE ORDER SEJ{�1MARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified. 9 certified.) Total changes approved in previous months b Owner $ 480 00 ARCHITECT: Total approved this Month . $ 1,310.00 By:. . Date: ` . TOTALS $ 480.00 $ 1,310.00 This certificate is not negotiable.The AMOUNT CERTIFIED is payable only to thy Con-tractor named NET CHANGES by Change Order (830.00}- herein. Issuance,payment and accpetance of payment are without prejudice to nay rights of the Owner or Contractor under this Contract. 6702-1992 CONTINUATION SHEET AlA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATIONS NC.: 5 Contractor's signed Certification,is attached.In tabulations below,amounts are stated APPLICATION DATE: 2/17/15 • to the nearest dollar. Use column t on Contracts where variable retainage for line PERIOD TO: items may ap ARCHITECT'S PROJECT NO,: A B C D E F G H . WORK COMPLETED ITEM MATERIALS TOTAL COMPLETED % RETAINAGE DECRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY STORED AND STORED TO BALANCE TO FINISH (IFVARIABLE NO. APPLICATION(D+E) THIS PERIOD (NOT IN D OR E) DATE(D+E+F) (C C' RATE) $ - $ - $ - $ $ �. 1 Stone Base,Asphalt Base&Binder $ 67,189.00 $ 67,189.00 $ 67,189.00 100% $ $ 6,718.90 $ $ - $ - $ $ • 2 Asphalt Surface Coat $ 15,966.00 $ 18,966,00 $ 18,966.00 100% $ - $ 1,896.60 $ - $ - $ - $ ,- $ .... 3 AccellDecel&Left Tum Base to Int $ 21,519.60 $ 21,5 1 9.60 $ 21,519.60 100% $ - $ 2,151.96 $ - $ - $ - - $ - $ 4 AccellDecel &Left Turn Surface $ 7,090.20 $ 7,090.20 . $ 7,090.20 100% $ $ 709.02 $ - $ : $ - $ - $ 5 Accel/Decel Stone Shoulder $ 2,139.20 $ 2,139.20 $ 2,1 39.20 100% $ $ 213.92 $ - $ - $ - $ - $ 6 Sewout Edge of Existing Pavement $ 2,360.00 $ 2,360.00 $ 2,360.00 100% $ - $ 236.00 $ - $ $ - $ $ - - 7 " Thermoplastic Striping&Markings $ 8,217.00 $ 8,217.00 $ 8,217.00 100% $ - $ 821,70 $ - $ - $ - $ $ 8 Maintenance Bond $ 200.00 $ 200.00 $ 200.00 100% $ - $ 20.00 $ - $ $ _... $ $ - 9 C.O.#1 Raised Pavement Markers $ 480.00 $ 480.00 $ 480.00 100% $ $ $ - $ $ $ - $ - 10 CREDIT MEMO $ (1,310.00) $ $* (1,310.00) $ (1,310.00) $ $ - $ _ $ $ - $ - $ - $ - $ -- $ - $ - $ - $ - $ :6i:: $ '::J $ ::.., $ - $ $ ..;:.: $ $ ... $ - $ $ - $ "ii: $ ..- $ - $ $ V. $ $ '.G.,... $ - $ $ - - $ - $ - TOTALS , $ 126 851.00 $ 128,161.00 ; $ (1 310 00) t $ - $ 126 85 1.00 ; 100% $ $...12..768.10 G703-1992 • FINAL WAIVER OF LIEN PAYMENT TO FOLLOW Whereas, E&B Paving, Inc., (Subcontractor)has been heretofore employed by Falcon Nest II, LLC (Contractor)to furnish certain material,supplies,equipment or labor for or in connection with improvements owned by Legacy MI 2 (Owner)and located at Carmel (hereinafter collectively referred to as the Premises);and Whereas,the undersigned is duly authorized to execute this Wavier of Lien for and on behalf of the Subcontractor; NOW; THEREFORE, Subcontractor,for and in consideration of Twelve thousand seven hundred sixty eight and 10 /100(Dollars) $12,76810 the receipt of which is to follow, Hereby waives, and releases the Owner, the Premises and the Contractor from,any and all liens, rights of lien and claims of whatsoever kind of character(including, but not limited to,equitable liens)which the Subcontractor may now or hereafter have on or against the Owner,the Contractor,the Premises or the improvements now or hereafter located thereon on account of any and all labor, supplies, equipment or material furnished for, in connection with or incorporated in the Premises by the Subcontractor on or before February 17,2015 ;represents,covenants and warrants to Owner and Contractor that no other person has any right to a lien(equitable or otherwise)or claim on account of any labor or work performed or material,supplies or equipment furnished by,to or through the Subcontractor, or on before the above stated date, and agrees to indemnify, defend and hold the Owner and the Contractor harmless for and against any and all liabilities, losses, costs, expenses and fees, including attorney fees and court costs, by reason of claims or liens(including equitable liens) for any labor, material or services furnished for or in connection w the lthbttppfated in the Premises by, through or to the Subcontractor on or before the above stated date. XN,G,I/� {�f� • E El Paving,Inc. Iw( ± Y % 'sy #:; ''•• •••••• �� =,.rkhJones Dated 2/17/2015 State of INDIANA SS: County of HAMILTON Before me,a Notary Public in and for said County and State, personally appeared Mark Jones a Project Manager of E&13 Paving, Inc.who acknowledged the execution of the foregoing Waiver of Lien,and who, having been sworn, stated that the representations therein contained are true. Witness my hand and Notarial Seal this 17 day of February 2015 -4 4 Notary Pu lc f ..:�... :., tfrzz*, OFFICIAL SEAL AV' 6./ APRIL N.RYAN 0 x a° I a T ;r7 PUBLIC INS 9 Printed Signature � . Madison My commission expires 6/3/2016 My county of Residence Madison .-- , -.,- it'd Manley Finish iarali a a. t 11if DATE INVOICE# ,t.„.. ' te,..-- ., 1.„___IkeNallt. Gnmmemi. , 2/17/2015 5934 7437 W. Banton Circle New Palestine, IN 46163 Phone & Fax (317) 895-8586 BILL TO Elb MMIMI.....Y.......•,...., FALCON NEST II LLC C/O PLATINUM PROPERTIES 9757 WESTPOINT DR. SUITE 600 --- pJTREE9 E E IND APOLIS,IN.46256 _._.......... P.O. NO TER ws ,: CJIERRYTR4 cliE:y 4 ,', NET 30 - I% QUANTITY DESCRIFnoN RAVE MOUNT . LOAD SOIL IN TRTCK AND FILL ISLAND ON 875 00 CHERRY BLVD.WHERE SOIL IS LOW. B ANKET SEED AND STRAvv SEED,FERTILIZE,i,kNi!MOUND)OuND AREA 650.00 650.00 'ADJACENT TO CHERRY TREE BLVD. INTERSECTION i 1 . , 4-fircomht ...___, ,,,..s. THANK Y6131 FOR YOUR BUSINESS -= Total ....._ .... Erosion Control, Retaining Walls, ital itr . Straw Mulch, Slit Seeding, Wetland & Prarie Grass Seeding AFFIDAVIT OF LI N FINAL X PARTIAL — 'AYMENT TO FOLLOW J being duly sworn,state that he/she is the PRaSIDENT ._..� of MANLEY FINISH GRADING INC.having contracted with FALCON NEST H LLC. to furnish certain materials and/or labor as follows: INVOICE 5985984,5985 . for a-proje;.t blown as LEGACY located at � l EL .�and owned by FALCON NEST II.LLC a and further • states: PARTIAL WAIVER: that the balance-due by the owner is the sum of pome i" • D THREP HUNDRED gjQBIy ..5o/ioo Dollars( ). Receipt of which is hereby acknowledged;or ]C The payment of which l las been promised as the sole consideration for tb.rs Affidavit and Partial Waiver of Lien which is given to and for said amount,effective upon receipt of such payment. FINAL.WAIVER: that the final balance du€.by the owner is the sum of Dollars($„ ). Receipt of which is hereby ackne wledged;or The payment of which has been promised as the sole consideration for ti is Affidavit and Final Waiver of . Lien which is:given to and for:said amoun,effective upon receipt of such payment_ THEREFORE,the undersigned waives alai releases unto the Owner of said premises any a Id all lien or claims whatsoever on the above-described property and improvements the reran on account of labor or material or both,wished by the undersigned thereto,and further certifies fiat no off er party has any claim or right to a lien on account of any work performed or material furnished to the u n c ersigned for said project,and within the scope of'this affidavit and waver_ MANLEY FINISH GRADING,INC. Con y Name ��..... Authorized Represe �•: ve ]PRESIDENT Title f. f, 5 f' r' f- WITNESS: AA& 1. _ 1r /gnature 55 . LEA MANLEY Printed Name of Withe 3s • rt .„, nvoice - .. 4 --, , ..._..., 1.---.::,' :; 7'''',",!' I::,,,,s,;:,',41 I --,,, ,,,,,_ , ServiCia, ..., Luminaire Service, Inc. Inc ..., , ,.. , ,. ... • 10652 Deandra Drive COMMERCI AL LICHTING Zionsville, IN 46077 (317) 808-7010 (317) 808-7015 (fax) Date: 1/22/2015 Invoice No.: 62028 Bill to: Falcon Nest II, LLC Service at: Falcon Nest II, LLC c/o Platinum Properties 14471 Community Drive, Platinum Properti( Carmel, IN 46000 9727 Westpoint Drive, Suite 600 Indianapolis, IN 46256 CustomerlD: 1204 Description: Work Order 23497 Projects Reference: Work Order 23497 Terms: Net 30 Days PO Number: - ... .... Item Description • Quantity Unit Price Amount Progress Billing 100.0%Complete ,.."--- /ir t ..Thg-r-re..." -:>r/Zg-g;r 1 ii-P.? iki>.5-Ac ;i'J r -b 1,1&:..1....) FLALe„..,se,,ovex.)L., 1t - (0A1 fii5 I T---) fit, , , ,,,, illic ‘;.. -- --f?-4-1-111: I 2_ -P Installed 5 street lights Subtotal: ,0$2160;-,, 5alance of quoted amount Sales Tax: $0.00 __,..Payments:._ I Total Due: , 5 1,0 6,61 c) -, AFFIDAVIT AND WAIVER OF LIEN FINAL x PARTIAL PAYMENT TO FOLLOW Charles Ryerson being duly sworn, state that he/she is the President of Luminaire Service,Inc. having contracted with Platinum Properties Management Co., LLC to furnish certain materials and/or labor as follows: Invoice No.61489 for a project known as Legacy Playschool Community Drive, located at Carmel, Indiana, and owned by Falcon Nest II, LLC,further states: PARTIAL WAIVER: that the balance due by the owner is the sum of two thousand eight hundred eighty dollars and twenty-three cents($2880.23). Receipt of which is hereby acknowledged; or x The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. FINAL WAIVER: that the final balance due by the owner is the sum of Receipt of which is hereby acknowledged The payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE,the undersigned waives and releases unto the Owner of said premises any and all lien or claims whatsoever on the above-described property and improvements thereon on account of labor or material or both,furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Luminaire Service, Inc. Com s- Name eef e, • - - 4• A orized Rep -sentative President Title / / ,410 WITNESS: ,1. Signature Deborah Ryan Printed Name of Witness