HomeMy WebLinkAboutLegacy TIF draw pay request 18 081015 FALCON NEST II , LLC ijr
1`0
•
July 16; 2015
Diana L. Cordray
Carmel Clerk Treasurer
(317)571-2414
Via E-mail: DCordravacarmel.in.gov; csheeksQcarmel,in.gov; iohn.alexandercregions.com;
jake.tavlor(c�starfinancial.corn
Re: Legacy Tl —Draw#18;
Dear Diana:
Attached:please find!the Legacy TJF draw:for the current:month. If!everything;:is In order,
please sign the:Request for:disbursement Forrn and:forward:this draw:to:the Trustee.
Also attached is a:budget$heef that-will track..all costs to date. Please let'me:know:if
you have any;questions: •
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. 18
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
$449,946.06 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 incuned 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 an y 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.
it
IAN WITNESS WHEREOF, the authorized representative of the Company has set his
hand as of the _jj) dayof_ %`,� 4 , 20 ; .
Pursuant to Section 4.3 of the II
Indenture the foregoing
disbursement request is hereby
FALCON NEST II LLC,
an Indiana limited liability company
By: SALT, LLC,Member
By:
Rajai Zumot, Mei •er of SALT,LLC
approved:
CITY OF CARMEL, I P I:ANA
it/
Di:na". Lordray, AMC,Clerk-'I urcr
2 :t
jl
9
• Legacy TIF Draw •
Application No.: 18_
Application Date: - ^16-Jul-15
Prepared By: : Kathy Tekulve
Telephone No: (317) 863-2052
•
Amount:_ $ 449,946.06
Reference or Total Retainage •
Invoice • Work This Invoice
Code Contractor/ Payee Number Completed Period • Amount
3 CrossRoad Engineers, PC 15552 $ 2,182.50 $ - $ 2,182.50
• $ 2,182.50 • $ - $ 2,182.50
4 Weihe Construction _ _ 4362 $ 5,010.00 $ (501.00L$ 4,509.00
Rieth-Riley Construction, Co. • 320002603 : $ 144,358.00 : $ (14,435.80) $ 129,922.20
$ 149,368.00 $ (14,936.80)_ $ 134,431.20
6 Weihe Construction 4362 $ 63,999.95 $ (6,400.00) $ 57,599.95
Rieth-Riley Construction, Co. • 320002603 • $ 2.42,151.36 ; $ (24,215.14). $ 217,936.22!
$ 306,151.31 $ (30,615.14): $ 275,536.17
•
7 r Rieth-Riley Construction, Co. 320002603 • $ 4,095.00 $ (409.50)• $ 3,685.50
$ 4,095.00 $ (409.50) $ 3,685.50
8 Weihe Construction • 4316 $ - $ 2,604.10 $ 2,604.10
— – _ , $ - $ 2,604.10 $ 2,604.10
15 CrossRoad Engineers, PC 15552 • $ 115.00 $ - • $ 115.00
$ 115.00 $ - : $ 115.00
•Management Fees 1095 $ 34,643.39 ' $ (3,251.80) $ 31,391.59
$ 34,643.39 $ (3,251.80) $ 31,391.59
Total $ 496,555.20 $ (46,609.14). $ 449,946.06
0
1of1
PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC
INVOICE 1095
July 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 July 2015 Construction Costs:
Cross Roads Engineers $ 2,297.50
Weihe Construction, Inc $ 64,713.06
Rieth-Riley Construction $ 351,543.92
Total Monthly Costs $ 418,554.48
Development Fee @ 7.5% $ 31,391.59
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
CR055RDAD
EX GIRCER5; C
CrossRoad Engineers,PC
3417 Sherman Drive
Beech Grove, IN 46107
317-780-1555
Platinum Properties Management Co.,LLC Invoice number 15552
Timothy Walter, P.E. Date 07/01/2015
9757 Westpoint Drive,Suite 600
Indianapolis, IN 46256 Project RIVER ROAD RECONSTRUCTION=TALL
TIMBER RUN TO 146TH ST.
For services performed May 30,2015 through June 26,2015.
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 I
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 0.00
7.Phase I Rule 5 Permit Application
Contract Amount 1,000.00
Percent Complete 100.00
Total Billed 1,000.00
Current Billed 0.00 II
Platinum Properties Management Co.,LLC Invoice number 15552 Invoice date 07/01/2015
Page 1 of 4
Platinum Properties Management Co.,LLC Invoice number 15552
Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 07/01/2015
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 15552 Involve date 07/01/2015
Page 2 of 4
Platinum Properties Management Co..LLC Invoice number 15552
Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 07/01/2015
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 0.00
25.Construction Administration/Drawing Reviews
Professional Fees
Billed
Hours Rate Amount
Senior Project Manager
Billable Time 1.50 125.00 187.50
Project Engineer
Billable Time 21.00 95.00 1,995.00
6/9—1 hr-Document Review
6/10—4.5 hr-Vectren Conflict
6/11—4 hr-Vectren Conflict
6/11—4 hr-Vectren Conflict
6/22—2 hr-AT&T Pedestal Coordination
6/24— 1.5 hrs-Misc.Utility/Contractor Coordination
6/25—3 hrs-Field Meeting/Citizens Hydrant Conflict
6/15— 1 hr-Permit Review
Professional Fees subtotal 22.50 _ 2,182.50
Phase subtotal y I f�t' i� 2,182.50
Reimbursables-Services by Owner
Reimbursables
Billed
Units Rate Amount
Fees&Permits 1.00 115.00 115.00
Rule 5 NOl Ly 1�tFc�t�cz —j5 11
Invoice total 2,290
J
Platinum Properties Management Co.,LLC Invoice number 15552 Invoice date 07/01/2015
Page 3 of 4
Platinum Properties Management Co.,LLC Invoice number 15552
Project RIVER ROAD RECONSTRUCTION-TALL TIMBER RUN TO 146TH ST. Date 07/01/2015
Invoice Summary
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 2,000.00
7.PHASE.I RULE 5 PERMIT APPLICATION 1,000.00
8.ROADWAY LEGAL DESCRIPTIONS 3,600.00
9.PHASE I MON UMENTATION 0.00
10. PRELIMINARY DESIGN FOR RAB @ 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
24.ADDITIONAL UTILITY COORDINATION DUE TO ATT 1,517.50
25. CONSTRUCTION ADMINISTRATION/DRAWING REVIEWS 925.00
REIMBURSABLES-SERVICES BY OWNER 373.29
Total 101,815.79
Aging Summary
Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120
15337 04/29/2015 32.89 32.89
15496 06/04/2015 2,782.90 2,782.90
Total 2,815.79 2,782.90 0.00 32.89 0.00 0.00
Platinum Properties Management Co..LLC Invoice number 15552 Invoice date 07/01/2015
Page 4of4
,
APPLICATION FOR PAYMENT
PROJECT NAME:The Overlook at The Legacy SectIon 3
OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weide Construction,Inc. INVOICE NO 4362
CONTACT: CONTACT:Tim Walter CONTACT:15215 Stony Creek Way APPUCATION DATE: 6130t2015
ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:#REF! RETAINAGE: 10%
McLoan,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY El
Phone: Phone:J317)_818.2900,590-6617(M) Phone:317-776.2966(0)776-3050 0 DATE: 7192015
A B Cr Cu D E I F G 1=E-F+G 1=H/0 J K L=J-K M=D•H+L N
Project Cost Work Doscriphon I Unit Scheduled Work Completed Materials Total Completed % Previous Retalnage Total BAL.TO Net Pay
Cade Code Price Value Previous This Stored Ano stored To Date Compl. Retainace This Period Retained PAY This Month
The Overlook at The Legacy Section 3
On-site construction
Lgy P2 4c Stripping Topsoil NA $4,267.00 $4,267.00 $4,267.00 100% $426.70 $426.70 $426.70
Lgy P2 4d Prelim Erosion Control NA $18,697.00 $5,697.00 $6,000.00 $11,697.00 63% $569.70 $600.00 $1,169.70 $8,169.70 $5,400.00 -'
Lgy P2 4e Mass Excvation and Mounding NA $45,118.00 $45,118.00 $45,118.00 100% $4,511.80 $4,511.80 $4,511.80
Lgy P2 4h Soil Stabilization NA $14,623.00 $14,623.00
Lgy P2 4g Site&Finish Grading NA $15,620.00 $15,620.00
Lgy P2 5c Sanitary Sewer Laterals NA $10,095.84 $10,095.84 $10,095.84 100% 51,009.58 $1,009.58 $1,009.58
Lgy P2 6b Subsurface Drains NA $31,452.50 $16,452.50 $16,452.50 52% $1,645.25 $1,645.25 $16,645.25 $14,807.25
Lgy P2 7b Water Mains NA $111,797.95 $61,798.00 $49,000.00 $110,798.00 99% $6,179.80 $4,900.00 $11,079.80 $12,079.75 $44,100.00
Lgy P2 7e Water Service Laterals NA $10,894.80 $10,894.80 $10,894.80 100% $1.089.48 $1,089.48 $1,089.48 $9,805.32
TOTAL $74,112.57
•F amisrm
Cherry Creek Blvd Constructio
LgyTIF 4a Demolition NA $10,555.00 $8,555.00 $2,000.00 $10,555.00 100% $855.50 $200.00 $1,055.50 $1,055.50 $1,800.00
LgyTIF 4c Stripping Topsoil NA $5,428.00 $2,428.00 $3,000.00 $5,428.00 100% $242.80 $300.00 $542.80 $542.80 $2,700.00
LgyTIF 4e Mass Excvation and Mounding NA $17,733.00 $17,723.00 $10.00 $17,733.00 100% $1,772.30 $1.00 $1,773.30 $1,773.30 $9.00 ..
LgyTIF 4h Soil Stabilization(roadway) NA $18,935.00 $18,935.00
LgyTIF 4h Soil Stabilization(multi-use path) NA $10,284.00 $10,284.00
LgyTIF 4g Site&Finish Grading NA $25,411.00 $25,411.00
LgyTIF 6a Storm Sewers NA $148,171.95 $84,172.00 $63,999.95 S148,171.95 100% $8,417.20 $6,400.00 $14,817.20 $14,817.20 $57,599.96 +
Lgy TIF 6b Subsurface Drains NA $3.895.00 $3,895.00
TOTAL $62,108.96
Change Orders
Lgy P2 5b CO#1-Raise sanitary MH NA $1,245.29 $1,245.29 $1,245.29 $124.53 $124.53 $124.53 $1,120.76 i
Lgy P2 6b CO#1-Additional 8"SSD NA $1,722.00 $1,722.00 $1,722.00 $172.20 $172.20 $172.20 $1,549.80 --
Lgy P2 7b CO#1-Add 12"GV&Elbow NA $3,298.50 $3,298.50 $3,298.50 $329.85 $329.85 $329.85 $2,968.65 .i
I TOTAL $509,244.83 $239,853.84 $157,623.04 $397,476.88 78% $23,985.38 $15,762.30 $39,747.69 $151,515.64 t..i._4$14
160574i
gel 'MI5 MnMoUJT i 42.pe kr
IA Document G702t"' — 1992
Application and Certificate for Payment
TO OWNER' -�
'Platinum Properties PROJECT: Overlook et the Leaacv Sec 3 APPLICATION N(1
9757�Yestpoint Drive 4362 Distribution to:
'PERIOD T0.
Suite 600 OWNER '7
FROM CON f Suite 6001}s^IN 46256 CONTRACT FOR:
ARCHITECT ❑
Weihe Construction,Inc. VIA ARCHITECT:
Stony Creek Way CONTRACT DATE: CONTRACTOR ❑
Noblesville,IN 46060 PROJECT NOS01511-01 / /
FIELD ❑
CONTRACTOR'S APPLICATION FOR PAY MENY The undersigned OTHER ❑
dersigned Contractor certifies that to the best of the Contractor's knowledge,information
Application is made for payment,as shown below,in connection with the Contract.
and belief the Work covered by this Application for Payment has been completed in accordance
AlA Document made for Continuation as s Sheet,is attached. with the Contract Documents,that all amounts have been paid by the Contractor for Work for
1.ORIGINAL CONTRACT SUM which previous Certificates for Payment were issued and payments received from the Owner,and
2:NE7 CHANGE BY CHANGE ORDER$ $- 502 979 04 that current payment shown herein is now due.
3.CONTRACT SUM TO DATE(Line l t 2)
$ rti0bt 79 _ CONiCTOR:1Ye' Construction Inc.4,TOTAL COMPLETED&ST S 397 476 Ri ay: t !! 6( /I5
4RgD TO DATE(Column G on 0703) s 397 476 RR State of anjk ��� Date: 1 l
5,RETAINAGE:
alp tin %of Coatpitmcl Went County o#Hnmilton
(CofumnrD+Eon G703) S Subscribed and sworn to before
b. 44 of Stored Material 39,747.69 methia �j0' day of �Urt�
(Column fi on G703) $ "
Notary P u b l i c h C CGt,
Total Retaiaage(Lines 5a+Sb,or Tomlin Cohrmn f ojG703).,,.,, $ My commission expires: }Q / `�j
39,747.69 I
-Co�, F T D a
Zl lctf f.TOTALEARNEDLESSRETtNAGE L $ 357.729,19 ARCHITECT'S CERTIFICATE FOR.PAYMENT(Line 4 PAWLS Line S Total)
PAYMENT accordance with the Contract Documents,based on on-site observations and the data comprising
7,LESS PREVIOUS CERTIFICATES FOR PAY
5 215,868 46 this application the Architect certifies to the Owner that to the best of the Architect's knowledge,in
(Line 6jrom prior Certificate)
information and belief the Work has G�r �/- 7-s,
('
accordance with the Contract Documen and the Contractor istent tled to payment ofsthe
-/ /
8.CURRENT PAYMENT DUE AMOUNT CERTIFIED.
9.BALANCE TOFIh'ISH,tNCLUDINGRETAIFidGi �`�,� I$ (41,860.73 p
(Line 3 minus Line 6) AMOUNT CERTIFIED $,t/' 9c4.74(
S 151.515.64 (Attach explanation if amount certified dijJert from the amount applied.initial figures on this
GRANGE ORDER Application and on the Continuation Sheer that are changed to conform wtfl the amount certified)
Total changes a SU,� ADDITIONS DEDUCTIONS I ARCHITECT:
ng ppP9ved i previous months by Owner$
S } /
Total apprey 3nionth S $ ny'---�� Jr= Date: `TOTAL s T is Crtate is Trot gegotieble 7 be AMO � !1 F Ca AA ` f? _TtoiJ
.� $ named herein.a b3 not n payment LINT CERTIFIED is payable only4 Contractor /
NET GRANGE$by Change Order $ P yment and acceptance of payment are without prejudice o any rights of
_ the Owner or Contractor under this Contract.
•
CAUTION:You should sign an original AIA Contract Document,on which this text a
MA Document G7a2°_1892.Co appears in RED.An original assures that changes will not he obscured, JQ1 !l
Ayrtght O 1953,1953,1965.1971,1976,1953 and 1992 b y The American Ineatuto of Architects.An rights reserved.WARNING;This AIA•Docnmox Is protected by U,S. --
�� Y�
and International 7raatloa.UnnuthorWd reproduction or distribution of this AIA•Document,or any portion of i may result In aevero civil and criminal
po male under the taw'.rar.tuden,are permitted m mrxeduce ten(to)copies of MN document when=Waited.To Co oPYdgM Law J
�'" •ruder tit leeorg. report oopyrtpnl vtotauons of AIA Contract penalties,and will be m eric utad to the Arehio maximum extent
Donmien�,e-mall The American Institute of Archrtnefs'tegai
CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE of PAGES
AIA 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:
Use Column I on Contracts where variable retainage for fine items may apply. ARCHITECT'S PROJECT NO.: 4362
6/30/2015
A ' a C D
E F G H
• `8+5.1 91 I
WORK COMPLETED MATERIALS TOTAL
ITEM SCHEDULED PRESENTLY COMPLETED BALANCE
FROM PREVIOUS STORED AND STORED TO RETAINAGE
APPLICATION THIS PERIOD (NOT IN TO DATE (G t C) FINISH (IF RA Le)
NO. DESCRIPTION OP WORK VALUE
(D + E) D OR E) (D+E+F) • (C-G)
•
C 1-00 stripping Topsoil 4,267.00 • 4267.00 4,267.00 100.00
C2-00 Prelim Erosion Control 18,697.00 5,697.00 6,000.00 426.70
11,697,00 62.56 7,000.00 1,169,70
0300 Mass Excavation&Mounding 45,118.00 45,118.00 45,118.00 100.00 4,571.80
04-00 Soil Stabilization 14.623,00 14,623.00
(5.00 Site&Finish Grading 15,620.00 15,620.00
C6-00 Sanitary Sewer Laterals 10,095.84 10,095.84 10,095.84 100.00 1,009.58
C7-00 Subsurface Drains 31,452.50 16,452.50 18,452.50 52.31 15,000.00 1,645.25
C8-00 Natermains 111,797.95 61,798.00 49,000.00 110,798.00 99.11 999.95 11,079.80
C9-00 Nater Service Laterals 10,894.80 10,894.80 10,894.80 100.00
10.00 'Cherry Creek Blvd Construction 1,089.48
41-00 Demolition 10,555.00 8,555.00 2,000.00 10,555.00 100.00
12 00 Stripping Topsoil 5,428.00 2,428.00 3,000.00 1,055.50
5,428.00 100.00 542.80
13-00 class Excavation&Mounding 17,733.00 17,723.00 10.00 17,733.00 100.00 1,773.30
'34-00 Soil Stabilization(Roadway) 18,935.00 18,935_00
15-00 Soil stabilization(path) 10,284.00 10,284.00
16-00 Site&Finish Grading 25,411.00 25,411.00
17-00 Storm Sewers 148,171.95 84,172.00 63,999.95 148,171.95 100.00 14,817.20
18-00 subsurface Drains 3,895.00 3,895.00
CO-01 Change Order#1 8,265.79 6,265.79 6,265.79 100.00 ' 626.58
•
. , $703•CONTINUATION SHEET ed "°�°P�Oee 2j. YS a d wpi ,
L,;; Fp�g, o ®1952• atN INTI'ITIJTS OF ARCHtTE
Vie .r+w,WASHINGTON,D.C.ztwoGSZSZ•wq>attFts ,� u,, �,ta 78.05 111,767.95 32 .
CAUTION:You should use an original AIA document which has this caution printed in red.An original assures Diet changes will not be obscured as may occur when documents em reproduced.
APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN
Subcontractor or Supplier Name Weihe Construction,Inc.
Subcontractor or Supplier Address Noblesville,IN 46060 Phone (317)776-2966
Type of Service Furnished Construction Construction Cost Division Number
Project(Building Number) Overlook at the Legacy Sec 3
Owner Platinum Properties
Application Number 4362 Date 6/30/2015
Period From 6/1/2015 To 6/30/2015
Original Contract Sum $ 502,979.04
Net Change by Approved Change Orders $ 6,265.79
Contract Sum to Date $ 509,244.83
Total In-Place Work Completed $ 397,476.88
Value of Material Stored on Site $ -
Total Earned to Date $ 397,476.88
Retained Percentage $ 39,747.69
Total Earned Less Retainage $ 357,729.19
Less Previous Certificates for Payment.. $ 215,868.46
Current Payment Due $ 141,860.73
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 vaild 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$ $ 141,860.73 and on
receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes vaild,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
$141,860.73 ,the receipt and sufficiency of which Is hereby acknowledge.
Dated thls 30 day of June 2015
Weihe Construction,Inc.
hea cia r Supplier Name)
State of Indiana ) By.
) SS: (Undersig d)
County of Hamilton ) Title: HR/Safety Air r
Before me,a Notary Public In and for said County and State,this 30 day of June 2015,
personally appeared Brian NIfong known to me to bet le/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 30 day of June 2015
MY commission expires: Oct 2075 �Lhk.UP Actil
Notary Public
My county of residence is: Hamilton Michelle Garcia 1
(Printed)
APPLICATION FOR PAYMENT
PROJECT NAME: 14-03 River Road Reconstruction
OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co., LLC CONTRACTOR: Rieth Riley Const.Co.,Inc. INVOICE NO: 32002603
CONTACT: CONTACT:Tim Walter CONTACT: Mark Bentley APPLICATION DATE: 6/3012015
ADDRESS: 1356 Beverly Road,Suite 250 ADDRESS: 9757 Westpoint Drive,Suite 600 ADDRESS: 1751 W.Minnesota Street RETAINAGE: 10%
McLean,VA 22101 Indianapolis,IN 46256 Indianapolis,IN 4622.1 APPROVED BY: Twalter
A Po __ne' CA _ Ca D Phone'(317)818-2900,590-8817(M) Phone: 317)634-5561 c)(317)631-6423(1) DATE: 7/5/2015
G H=E+FG l=H/D J K L=..1-,K M=D-H+L N
Project Cost Work Description Unit Scheduled Work Completed Materials Total Competed % Previous Retainage Total BAL.TO Net Pay
Code Code Price Value Previous This _ Stored And stored To Date Gomel. Retainage This Period Retained PAY TNs Month
Lgy TIF 3g Construction Engineering LS $15,200.00 $15,200.00
Lgy TIF 4a Demolition LS $18,375.00 $18,375.00 $18,375.00 100% $1,837.50 $1,837.50 $1,837.50 $16,537.50
Lgy TIF 4h Tree Removal LS $2,025.00 $2,025.00 $2,025.00 100% $202.50 $202.50 $202.50 $1,822.50
Lgy TIF 4d Temporary Construction Entranc LS $8,960.00 $4,480.00 $4,480.00 50% S448.00 $448.00 $4,928.00 $4,032.00
Lgy TIF 4e Site Prep and Common Excavati LS $167,640.45 $117,348.00 $117.348.00 70% $11,734.80 $11,734.80 $62,027.25 $105,613.20
Lgy TIF 4h Subgrade Treatment LS $90,772.50
$90,772.50
Lgy TIF 6a Storm Sewer LS $242,151.36 $242,151.36 $242,151.36 100% $24,215.14 $24,215.14 $24,215.14 $217,936.22
Lgy TIF 6b Sub-surface Drain LS $26,283.75 $26,283.75
Lgy TIF 6e Conduit LS $39,308.00 $39,308.00
Lgy TIF 7b Water Main LS $8,191.26 $4,095.00 $4,095.00 50% $409.50 $409.50 $4,505.76 $3.685.50
Lgy TIF 8a Curb and gutter LS $111,860.50 $111,860.50
Lgy TIF 8b Sidewalk LS $23,906.30 $23,906.30
Lgy TIF 9a Stone and Asphalt Base LS $309,105.50 $309,105.50
Lgy TIF 9b Asphalt Surface LS $71,015.90 $71,015.90
Lgy TIF 9e Asphalt Trail LS $55,256.75 $55,256.75
Lgy TIF 9h Pavement Markings LS $4,991.50 $4,991.50
Lgy TIF 10a Erosion Control LS $13,796.23 $13,796.23
Lgy TIF 12e Street Signs LS $5,840.00 $5,840.00
Change Orders
Lgy TIF 6a CO#1 -Add'Storm to avoid Gas LS $3,908.00 $3,908.00
Lgy TIF 4e CO#2-Additional Barricades LS $2,130.00 $2,130.00 $2,130.00 100% $213.00 $213.00 $213.00 $1.917.00
TOTAL $1,220,718.00 $390,604.36 $390,604.36 32% $39,060.44 $39,060.44 $869,174.08 $351,543.92
J L,
• ' 1 6a T' - , 1:,`®EEY CONSTRUCTION CO g, = INC.
.••X91.
P.O.Box 278 Indianapolis,IN 48206 Telephone: (317)834-5561 FAX: (317)831.8423
Progress Estimate No.: 1
Sold To; Falcon Nest II,LLC Customer No.: 716316
1356 Beverly Road,Ste.250 Job Number: 3200554
Mclean,VA 22101 Invoice Number: 32002603
Date: 7/6115
Period Covered: 5/19/15-6/30/15
Terms: Due upon receipt
Job: 14-03 River Road Construction
CONTRACTOR'S INVOICE
1 Original Contract Sum $1,214,680.00
2 Net change by Change Orders $6,038.00 (Co#2)
3 Contract Sum to Date (line 1 + line 2) $1,220,718.00
4 Total Contract Completed to Date $390,604.36 32.0%
5 Deductions: 10.00 % Retainage: $39,060.44
6 Total Earned Less Deductions (line 4-line 5) $351,543.92
7 Less Previous Billings $0.00
8 Invoice Amount Due (line 6-line 7) (1 � 6O%Balance Remaining
A service charge of 1-1/2%per month(16%annual rate)will be made on all account balances not paid,according to the terms stated.
office uee Only/Current Estimate-Intel.): Change Order Summarj '!
Total Estimate 53110,004.30 Change Ordeta approved on previous intimates by Owner 50.00
Retalnaga $30,050.44 Approved I his Estimate 50,0.0.00
Current Payment Due 0351,543.02 total Net Change by Change Orders $0,030.00
V }i
4
Rieth-Riley Construction Co.,Inc.
P.O.Box 276 Indianapolis,IN 46206 Telephone: (317)634-5561 FAX: (317)631-6423
Sold To: Falcon Nest II,LLC Progress Estimate#: 1
1356 Beverly Road,Ste.250 Customer#: 716316
Mclean,VA 22101 Invoice#: 32002603
Date: 7/6/15
Period Covered: 5/19/15-6/30/15
Job: 14-03 River Road Construction
This Estimate Job to Date:
Original Plan Change Order
item No. Item Description Quantity Quantity Total Quantity Units $per Unit Enter Units Total$ Units to Date $to Date
14-03 River Road
0 Construction 0.000 0.000 0.000 0.000 0.00 0.000 0.00 0.000 0.00
1 Original Contract 1.000 0.000 1.000 LSM ###N## 0.000 388,474.36 0.000 388,474.36
2 Change Orders 0.000 1.000 1.000 0.000 6,038.00 0.000 2,130.00 0.000 2,130.00
Balance: 390,604.36 390,604.36
CONTRACTOR
AFFIDAVIT AND WAIVER OF LIEN
FINAL X PARTIAL X PAYMENT TO FOLLOW
Kevin A. Tussey being duly sworn,state that he/she is the Area Office Manager of Rieth-Riley
Construction Co. , Inc. having contracted with Falcon Nest, II, LLC to
furnish certain materials, labor and/or equipment as follows: General Construction for a
project known as 14-03 River Road . located at Hamilton County ,and owned by
Falcon Nest II LLC ,and further states:
PARTIAL WAIVER: that the balance due from the owner is the sum of Three hundred fifty one thousand
five hundred forty three 92/100 Dollars($ 351,543.92
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
Licn which is given to and for said amount,effective upon receipt of such payment.
FINAL WAIVER: that the final balance due from the owner is the sum of
Dollars($
Receipt of which is hereby acknowledged;or
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.
THEREFORE,the undersigned waives and releases unto the Owner of said premises any and all lien or claims whatsoever on
the above-described property arid 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.
Rieth-Riley Construction Co. , Inc.
Company Name
Authorized R resentative
Kevin A. Tussey, Area Office Manager
Title
WITNESS: /,/ ./
Signature
Erin B. Newlin
Printed Name of Witness
' APPLICATION FOR PAYMENT
PROJECT NAME: The Playschool at Legacy-Legacy Developer
OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Welhe Construction,Inc. INVOICE NO 4316
f,, CONTACT: CONTACT:Tim Walter CONTACT: 15215 Stony Creek Way APPLICATION DATE: 6/26/2015
ADDRESS: 1356 Beverly Road,Suite 250 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:#REF! RETAINAGE: 100, ..r7
McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY: �r�
Phone: Phone.J317)818-2900,590-8817(M) Phone:317-776-2966(o),776-3050(f) DATE: ',7i�i•C�j y
A B Ci C2 D E I F G H=E+F+G 1=H/D J K L=J+K M=D-H+L F-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 Compl. Retainage _ This Period Retained PAY This Month
The Playschool at Legacy-Legacy Developer
'On-ste Construction
Lgy FN2 4g 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) (S0.00) ($0.00) $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) (S0.00) ($0.00) $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) (S0.01) ($0.01) $1,119.91
Lgy FN2 8c Heavy Duty Concrete Crosswalk$13.00/sf $3,718.00 $3,718.00 $3,718.00 100% $371.80 ($371.80) $371.80
Lgy FN2 4h Soil stabilization NA $6,834.00 $6,834.00 $6,834.00 100% $683.40 ($683.40) $683.40
pr./PIT-1r/
Community Drive WV(TIF) Cc
I.gy TIF Sb 6'Handicap Ramp with Curb $650/ea $1,300.00 $1,300.00 $1,300.00 100% $130.00 ($130.00) $130.00
Lgy TIF Sb 11'Handicap Ramp with Curb $1,250/e2 $2,500.00 $2,500.00 $2,500.00 100% $250.00 ($250.00) 3250.00
Lgy TIF 8t? 5'Handicap Ramp with Curb $610/ea $1,220.00 $1,220.00 $1,220.00 100% $122.00 ($122.00) $122.00
Lgy TIF Sb Standard Concrete Sidewalk $3.50/sf $21,021.00 $21,021.00 $21,021.00 100% $2,102.10 ($2,102.10) $2.102.10
TOTAL $86,371.25 $86,371.25 — $86,371.25 100% $8,637.13 ($8,637.14} ($0.02) ($0.02) $8,637.14
''V .I. Document G702r" — 1992 -�
Application and Cerifficete for Payment
•
TO OWNER: $ .
PROJECT; APPLICATION NU
Platinum Properties The Playschool!aZ Legacy i .4316 Distribution to:
9757 We
'PERIOD FQ OWNER XO
stpoint Drive
Suite 600 CONTRACT FOR:
FROM CON`I' Ticas, IN 46256 VIA ARCHITECT: ARCHITECT ❑
Well_to Construction,Inc. CONTRACT DATE:
CONTRACTOR q
15215 Stony Creek Way PROJECT NOS:
201425-01 / I
Noblesville,IN 46060 FIELD q
ER 0
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,iinnf{orrmatioon
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 completed In accordance
ALA Document made fo t,Continuation Sheet,is attached, with the Contract Documents,that all amounts have been paid
1.ORIGINAL CONTRACT SUM which previous Certificates for Payment were issued and paymeatsyreceeivednfrom the oOwner,and
T:NET CHANGE BY CHANGE ORDERS $ that current payment shown herein is now due.
S 8o3tI.iJ CONTRACTOR:
3.CONTRACT SUM DATE(Lore!t 1) $ 8.00 a nsiructiaty Inc.
4.TOTAL COMPLETED&STORED TO DATE(Column C on 0703) $ 8°0 1.25 g of: -- Date: zg IS
5.RETAINAGE tf.sn.15 County Indiana
a• %ofCtlmpietad Work Coun of
amilton
(CohrmnrD+Eon 0703) me this and sworn n before •
b. PA of Stored Material $ me this Zej• day of JUn2�
•
(Column F on 6703) S Notary Public:4 tI1V.14i f�L
Total Reiainage(Lines 512+5.5,or Total in Column l of G703) S My commission expires: 1:0) 15
•
6.TOTAL EARNED LESS RETAINAGE $ 6'0ti ARCHITECT'S CERTIFICATE FOR PAYMENT
•
(Line 4 minus Line 5 TorafJ So,3/1.2.)
In accordance with the Contact Documents,based on on-site observations and the data comprising r
T.LESS PREVIOUS CERTIFICATES FOR PAYMENT S this application,the Architect certifies to the Owner that to the best of the Architect's knowledge (4`'� `J 02:17:
(Line 6from prior Certificate)
77,734,11 information and belief the Work has progressed as indicated,the quality of the Work is in .15 accordance with the Contract Documents, and the Contractor is entitled to payment of the -t C�7J.Ci�
8.CURRENT PAYMENT DUE S 'I AMOUNT CERTIFIED.
9,BALANCE TO FINISH,INCLUDING RETARIAGE 8,637.14 _�`\
(Line 3 minus Line 6) AMOUNT CERTIFIED W S yj •
$ ((tract explanation ifamount certified drers from the amount applied lnlrlaf all figures on t
•
Qua
Application tntdon the Continuation Sheet that are changed to conform with the amount certified) /�
CHANGE ORDER SU� ADDITIONS DEDUCTIONS ARCHITECT:
To changes appmvtd ptbvieus months by Owner S S �F
Total appTed llr;Strionth S
$ gy' (— Date: p G N`Jf7�) T O�7 D/V�
,:.:�� TOTAL S This Certificate Is not negotiable.The AMOUNT CERTIFIED is payable only thekontmctor I'
•, ..
" {' $ named herein.Istuanoe,payment and acceptance of payment are without prejudice to any tights of i Z
NET CHANGES by Change Order S the Owner or Contractor under this Contract. \ t t L,01-1,/0
CAUTION:You should sign an original AlA Contract Document,on which this text appears In RED.An original assures that changes will not be obscured, \\•
\Document G7a2.-1892.Copyright o 1653,1863,1985,1971,1878,1983 and 1992 by The Amerkan Institute of Ardtltects.All rights reserved.WARNING:me AlAe Document la protected by U.S.Copyright lave \\\
and international Trestles,Uneuthodxed reproduction or distrIbuton or aria AIAe Document,or any patron of It.may mutt In cowry civil and criminal penalties,and will be prosecuted in the maximum extent
Possible under the lav:.?e,.3ureor.are pemrmsd to reproduce tan(10)moles of sirs document when mmpletod.7o report \�,_
counsel,copyrir tiro is aom. port copyright vbletimrs of AlA Contact tDacumenb,nlrrea The Amorimn Insrlaae of Arrlraocla'kgaf
•
CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side)
r PAGE OP PAGES
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,
containing Contractor's signed Certification,is attached. APPLICATION NO.:
In tabulations below,amounts are stated to the nearest dollar. APPLICATION,DATE:
PERIOD TO: 4316
•
Use Column I on Contracts where variable retainage for line isms may apply.
y , ARCHITECT'S PROJECT NO.: 6/26/2015
A " B. C D E
F G
■
101425.0E1T I
WORK COMPLETED MATERIALS TOTAL
ITEM SCHEDULED PRESENTLY COMPLETED BALANCE
NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS STORED AND STORED '� TO
(IF VARIABLE)
AGE
APPLICATION THIS PERIOD (NO.r.IN TO DATE (G+ C) FINISH (IF VARIABLE)
(D + E) D OR E) (D+E+F) (C-G) RATE)
01-00 .•ite&Finish Grading 9,639.00 9,639.00 9,639.00 100.00
0)-00 .•anitary Sewer Laterals 8,046.25 8,046.25 8,046.25 100.00
03-00 '.torm Sewer 6,902.00 6,902.00 6,902.00 100.00
04-00 •ubsurface Drains 6,450.00 6,450.00 6,450.00 100.00
05-00 ■hair Back Curb&Gutter 7,541.95 7,541.95 7,541.95 100.00
06-00 :repressed Curb&Gutter 11,199.05 11,199.05 11,199.05 100.00
07-00 eavy Duty Concrete Crosswall 3,718.00 3,718.00 3,718.00 100.00
08-00 ommunity Drive R/W(rIF)
09-00 •'Handicap Rampw/curb 1,300.00 1,300.00 1,300,00 100.00
1p-00 1'Handicap Ramp w/curb 2,500.00 2,500.00 2,500.00 100.00
11-00 ••Handicap Ramp w/curb 1,220.00 1,220.00 1,220.00 100.00
12-00 •tandard Concrete Sidewalk 21,021.00 21,021.00 21,021.00 100.00
13-00 'me Stabilization 6,834.00 6,834.00 6,834.00 100.00
•
,
t� .
!<II AIA tx)cu tEHT 6703•CONTINUATION SHEET FOg[,,7¢71 �p�• 01992•THE AMERICAN INSTITUIE OF ARCFUTP
. ' /TRlet)5,NW,WASHINGTON,DC.200065292•WA Cto. l- i�100.00
Mites U.S.copyright teem and real sub{ect the violator to(gigot
G703-1992
I
CAUTION:You should use an original AIA document which has this caution printed In rod.An original assures that changes will not be obscured as may occur when documents are reproduced.
i
i
•
APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN
Subcontractor or Supplier Name Weihe Construction,Inc
Subcontractor or Supplier Address Noblesville,IN 46060 Phone (317)776-2966
Type of Service Furnished Construction Construction Cost Division Number
Project(Building Number) The Playschool p Legacy
Owner Platinum Properties
Application Number 4316 Date 6/29/2015
Period From 6/1/2015 To 6/30/2015
Original Contract Sum $ 86,371.25
Net Change by Approved Change Orders $ -
Contract Sum to Date $ 86,371.25
Total In-Place Work Completed $ 86,371.25
Value of Material Stored on Site $
-
Total Earned to Date $ 86,371.25
Retained Percentage $
-
Total Earned Less Retainage $ 86,371.25
Less Previous Certificates for Payment.. $ 77,734.11
Current Payment Due $ 8,637.14
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 dalm 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$ $ 8,637.14 and on
receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes vaild,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
$ 8,637.14 ,the receipt and sufficiency of which Is hereby acknowledge.
Dated this 29 day of June 2015
Welhe Construction,Inc
State of Indiana (wbcon'-•.r or Supplier Name
) By: ___r_._•
SS: (undersigned) O •
County of Hamilton ) Title: HR/Safety Director
Before me,a Notary Public in and for said County and State,this 29 day of June 2015,
personally appeared Brian Nifong known to me to bet1R/Safety Director of the Undersigned
who acknowledge the executton of the foregoing for and on behalf of the Undersigned.
WITNESS my hand and Notarial Seal.
Dated this 29 day of June 2015 !1 r
My common expires: Oct 2015 1 y j L`,, J
Notary Public
My county of residence Is: Hamilton Michelle Garcia
(Printed)