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HomeMy WebLinkAboutLegacy TIF Draw request 20 100815 Ij� FALCON NEST II , LLC R 710 , August 17,2015 Diana L. Cordray Carmel Clerk Treasurer (317)571-2414 Via E-mail: DCordrav@carmel.in.aov; csheeks@carmel.in.gov; john.alexander@regions.com; jake.tavfor@starfinancial.com Re: Legacy TIF—Draw#20 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. 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. 20 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 $112,914.45 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 WITNESS WHEREOF, the authorized representative of the Company has set his hand as of the g day of 0 cAok r , 20 i Pursuant to Section 4.3 of the Indenture the foregoing disbursement request is hereby FALCON NEST II LLC, an Indiana limited liability company By: SALT, LLC, ember By. Rajai Z ot, Member of SALT, LLC approved: CITY o CARM , 0 0 if F` :z tr / ' - ' e Diana L.Cordra 1 ' . y,TAMC, C er reasurer 1 2 STATEMENT NO. 20 REQUESTING DISBURSEMENT OF FUNDS FROM PROJECT FUND PURSUANT TO SECTION 4.3 OF THE TRUST INDENTURE BETWEEN EN TilE 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 $112,914.45 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 arc 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 arc 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 WITNESS WHEREOF. the authorized representative of the Company has set his hand as of the day of , 20 Pursuant to Section 4.3 of the Indenture the foregoing disbursement request is hereby FALCON NEST II T,I,C. an Indiana limited liability company By: SALT, LLC, Member By: Rajai Gumot, Member of SALT. LLC approved: CLOY OF CARMEL, INDIANA Diana L. Cordray, TAMC, Clerk-Treasurer l 2 PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC INVOICE 1101 September 15, 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 September 2015 Construction Costs: Weihe Construction, Inc. $ 10,323.00 Rieth Riley Construction $ 81,382.57 Manley Finish Grading $ 1,093.50 County Line Construction $ 1,416.00 Luminaire Services $ 10,821.63 Total Monthly Costs $ 105,036.70 Development Fee @ 7.5% $ 7,877.75 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 Legacy TIF Draw Application No. ikc 20 --�--- - -- -_-,`Application Date: 14-Sep-15 Prepared -�-�—� �-�-- ----- By: --_� Tekukm Telephone No: ---- ' ---- - • ' - 317) 863-2052 ( -~__'-_- --_'-_- Amount - �--� --- ^ $ 112.014_45 Reference or Total Retainage Invoice Work This Invoice ---- -- -�--- Code Cun�onkor/Payeo Number � n --- Period - ---- - -------- - '------' � ���eo-_� �no Amount 4 VVeheCons�uo�on4483 - ���---- — -- - '-- — --- - Weihe $ 11.470.00 $ (1,147.00) $ 10.323.00 $ 11.47000 $ (1.147.00) $ 10\323i00 7 Rieth Riley 818.26��---- ---� '-----�- --- Riley Co=' Inc.|n32UO2OG4 $ $ (81.83) $ 736.43 $ 818.26 $ (81.83) $ 736.43 Q Rieth Riley Construction 32002884 $ 76.]007.40 $ `/.60 0 74)-' --' - --- $ 68.406.66 $ 76.007.40 $ (7,600.74) $ 68.406.66 10 Rieth Ri Con �uuionCo Inc. 2002664 ---- --- -�-- -----'-- ---- Riley Co., � • $ /.121.42 $ (712.14), $ 0.409.28 ' $ 7,121.42 $ (712.14) $ 8,409.28 11 ManleyFinish Grading � bO ' --� -' --- '--- �------ -_--- � / ���'S • �U $ $ 1.093.50 $ 1.09350 ____ _ __ S $ 1.093.50 $ 1.093.50 12 RiethRiley Conm0ncbonCoo� ---'--- ' � -- ---- ---- '--- -----�--_-~- �c|Inc. � 32002664 �� 6,478.00 (647.80) B 5830.20 CountyLineConstruction 3187 - ---' ------- z'==- $ $ 1,416.00 $ 1,416.00 Luminaire 63164 ��Z--�--- ---� � � 1h3 $ - $ 10.821.63 �_$ 17.299.63 $ 768.20 $ 18.067.83 Management Fees 1101 $ 8,453.75 $ (576.00) $ 7,877.75 $ 8,45375 • $ (676.00): $ 7,877.75 Total $ 121'170.48 $ (8.256.01) $ 112,914.45 0 1 of APPLICATION FOR PAYMENT PROJECT NAME:The Overtook at The Legacy Section 2 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4483 CONTACT: CONTACT:Tim Walter CONTACT: 15215 Stony Creek Way APPLICATION DATE: 813112015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:#REF! RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY: El Phone: Phone:(317)818-2900,590-8817(M} Phone:317-776-2966(ot 776-3050(1) DATE: 0/102015 A B Cr C2 D E I F G H=E+F+G 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 Md stored TO Date Comp!. Retainage This Period Retained PAY _ This Month - The Overlook at The Legacy Section 2 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 $18,697.00 $18,697.00 100% $1,869.70 $1,869.70 $1,869.70 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 $14,623.00 100% $1,462.30 $1,462.30 $1,462.30 Lgy P2 4g Site&Finish Grading NA $15,620.00 $10,620.00 $10,620.00 68% $1,062.00 $1,062,00 $6,062.00 Lgy P2 5c Sanitary Sewer Laterals NA $10,095.84 $10,095.84 $10,095.84 100% $1,009.58 $1,009.58 $1,009.58 Lgy P2 6b Subsurface Drains NA $31,452.50 $31,452.50 $31,452.50 100% $3,145.25 $3,145.25 $3,145.25 Lgy P2 7b Water Mains NA $111,797.95 $110,798.00 $110,798.00 99% $11,079.80 $11,079.80 $12,079.75 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 TOTAL Cherry Creek Blvd Constructlo Lgy TIF 4a Demolition NA $10,555.00 $10,555.00 $10,555.00 100% $1,055.50 $1,055.50 $1,055.50 Lgy TIF 4c Stripping Topsoil NA $5,428.00 $5,428.00 $5,428.00 100% $542.80 $542.80 $542.80 Lgy TIF 4e Mass Excvation and Mounding NA $17,733.00 $17,733.00 $17,733.00 100% $1,773.30 $1,773.30 $1,773.30 Lgy TIF 4h Soil Stabilization(roadway) NA $18,935.00 $18,935.00 $18,935.00 100% $1,893.50 $1,893.50 $1,893.50 Lgy TIF 4h Soil Stabilization(multi-use path) NA $10,284.00 $10,284.00 $10,284.00 100% $1,028.40 $1,028.40 $1,028.40 Lgy TIF 4g Site&Finish Grading NA $25,411.00 $20,411.00 $20,411.00 80% $2,041.10 $2,041.10 $7,041.10 Lgy TIF 6a Storm Sewers NA $148,171.95 $148,171.95 $148,171.95 100% $14,817.20 $14,817.20 $14,817.20 Lgy TIF 6b Subsurface Drains NA $3,895.00 $3,895.00 $3,895.00 100% $389.50 $389.50 $389.50 TOTAL Change Orders Tt Lgy P2 5b CO#1-Raise sanitary MH NA $1,245.29 $1,245.29 $1,245.29 100% $124.53 $124.53 $124.53 (J , 1 C,,,.-- Lgy P2 6b CO#1-Additional 8"SSD NA $1,722.00 $17,222.00 $17,222.00 100% $1,722.20 $1,722.20 $1,722.20 _( Lgy P2 7b CO#1-Add 12"GV&Elbow NA $3,298.50 $3,298.50 $3,298.50 100% $329.85 $329.85 $329.85 `, Lgy TIF 4e CO#2-UndercutCCBlvd NA $11,470.00 $11,470.00 $11,470.00 100% $1,147.00 $1,147.00 $1,147.00` $10323.00 I (// Lgy P2 7b CO#3-Ex sewer Lat Conflict NA $5,553.50 $5,553.50 $5,553.50 100% $555.35 $555.35 $555.35 -$4'98 1�5 Lgy P2 14h CO#4-Remove trash from site NA $912.83 $912.83 $912.83 100% $91.28 $91.28 $91.28r� _�$8 5 TOTAL $527,181.16 $513.744.88 $17,936.33 $531,681.21 100% $51,374.49 $1,793.63 $53,168.12 $64,168.07 $16442.70 b- ., AIA Doeleirnent G702Th — 1992 Application and CeFt ate for Payment OWNER: ••••,- --„. PROJECT: APPL1CATIQ 11_________, ..::- TO Distribution to: Platinic Prppertes Overlook at the Legacy Sec 2 483 9757 ptcstpoint Drive PERIOD.Td ' OWNER x❑ !,rrlSuite 600 CT FOR: ARCHITECT El FROM CbN,,IN 46256 VIA ARCHITECT: Weihe Construction,Inc. CONTRACT DATE: CONTRACTOR 0 ' 15215 Stony Creek Way PROJECT NOS201511-01 / I FIELD 0 Noblesville,IN 46069 OTHER a CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information Application is made£oras shown below,in connection with the Contract end belief the Work covered by this Application for Payment has been completed in accordance PP payment, with the Contract Documents,that all amounts have been paid by the Contractor for Work for AlA Document G703TM,Continuation Sheet,is attached. - which previous Certificates for Payment were issued and payments received from the Owner,and 1.ORIGINAL CONTRACT SUM $ 502,e79 04 that current payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS $ CONTRACTO Weihe Construction.Inc. 21,202.12 l 3.CONTRACT SUM TO DATE(Line 1 4 Z) $ BY: .eve ta-C. Date: "t3/tel�l-5 527-)82.16 4,TOTAL COMPLETED A STORED TODATE(Column C on G703) S 516,131.21 State a'Indiana 5.RETAINAGE: County ofHamilton s)0. 24,of C`,p^'mplated Work Subscribed and sworn to-bete (Cohan e D 4 E on G703) S egei2Q 4g me chi .day of V�20 IS b)„r)'.n of n G7 Material ,�{� ` r _ jolwrrn F on G703) S 1,743 63 Notary Public: t��ut�aaG My commission expires: ID/r�l5 Total Retainage(Lines 5a+56,or Total in Coharur I of G703) $ 51 61ii 17 IS.TOTAL EARNED LESS RETAINAGE $ 46d 5.61 nn_ ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 minus Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 470this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, 4R 19 9information and belief the Work has progressed as indicated,the quality of the Work is in (Line 6from prior Certificate) ' accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE ( �� $ 16 142 7n AMOUNT CERT!TIED. 9.BALANCE TO FiNISH,INCLUDING RETAINAGE `� AMOUNT CERTIFIED ...., $ • (Line 3 minus Line 6) S 6261 8 07 (Attach explanation if amount certified di„lers from the amount applied Initial all figures on this Applita6on and on the Continuation Shari that are changed to conform with the amount certified.) CHANGE ORDER SIJh4MA•LlY ADDITIONS DEDUCTIONS ARCHITECT: -• • Total changes ap�avoit in pi6vious months by Owner $ S By: Date: Total a etj tiisnionth S S This Certificate is etjt gegotiable.The AMOUNT CFRTIt'IED is payable only to the Contractor 'S' TOTAL S $ named herein,Isleeetcd,payment and acceptance of payment are without prejudice to any rights of NET C7IANGES by Change Order $ the Owner or Contractor under this Contract CAUTION:You should alga an original AIA Contract Document,on which this test appears In RED.An original assures that changes will not be obscured. AIA Document 0702.-1992.Copyright O 1951.1982 1985,1971.1978.1983 and 1992 by The American Institute of Architects.All right:reserved.WARNING:This AIA'Document la protected by U.S.Copyright Law and Internationet Treaties.Unauthorized reproduction or distribution of this AIA'Document,or any portion of it,may result in severe eve end criminal penalties.and WS be prosecuted to the maximum extent possible under the law.Purehosere are parmltled to tapmdum ten HO ooples of this doaamxxr wtwn completed.To report copyright violations of AlA Contract Documents,e-rate The American Institute of Architects'legal comsat,oopyright@ate.org. . CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractors signed Certification,IS attached. APPLICATION,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO:4483 Use Column I on Contacts where variable retainage for line items may apply, „ ARCHITECT'S PROJECT B NO.:8/31/2015 A ' C 0 E F G 2y1511.Oi I ' WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE NO. DESCRIPTION OF WORK FROM PREVIOUS To VALUE STORED IIN AND TO STOREDAT (G -C) FINISH (IF VARIABLE) APPLICATION THIS PERIOD RATE) (D + E) DOR E) (D+E+F) (C-G) 0'-00 Stripping Topsoil 4,267.00 4,267.00 4,267.00 100.00 426.70 0.-00 Frelim Erosion Control 18,697.00 18,597-00 18,697.00 100.00 1,869.70 03-00 Mass Excavation&Mounding 45,118.00 45,118.00 45,118.00 100.00 4,511.80 04-00 Solt Stabilization 14,623.00 14,623.00 14,623.00 100.00 1,462.30 Oh-00 Site&Finish Grading 15,620.00 10,620.00 10,620.00 67.99 5,000.00 1,062.00 06-00 Sanitary Sewer Laterals 10,095.84 10,095.84 10,095.84 10000 1,009.58 0T-00 Subsurface Drains 31,452.50 31,452.50 31452.50 100.00 3,145.25' 06-00 Watermains 111,797.95 110,798.00 110,798.00 99.11 999.95 11,079.80 09.00 Water Service Laterals 10,894.80 10,894.80 10,894.80 100.00 1,089.48 10-00 Cherry Creek Blvd Construction 11-00 Demolition 10,555.00 10,555.00 10,555.00 100.00 1,055.50 11-00 Stripping Topsoil 5,428.00 5,428.00 5,428.00 100.00 542.80 13-00 Mass Excavation&Mounding 17,733.00 17,733.00 17,733.00 100.00 1,773.30 14-00 Soil Stabilization(Roadway) 18,935.00 18,935.00 18,935.00 100.00 1,893.50 15-00 Soli stabilization(path) 10,284.00 10,284.00 10,284.00 100.00 1,028.40 13-00 Site&Finish Grading 25,411.00 20,411.00 20,411.00 80.32 5,000.00 2,041.10 17-00 Storm Sewers 148,171.95 148,171.95 148,171.95 100.00 14,817.20 1B-00 Subsurface Drains 3,895.00 3,895.00 3,895.00 100.00 389.50 CO-01 Change Order#1 6,265.79 6,265.79 6,265.79 100.00 -, 626.58 CO-02 Change Order#2 11,470.00 11,470.00 11,470.00 100.00 1,147.00 Cb-03 Change Order#3 5,553.50 5,553.50 5,553.50 100.00 555.35 C 3-04 Change Order#4 912.83 912.83 912.83 100.00 91.28 • oaA DOCUMENT CODs•CONRrrwTION SHEET •Q�jr�. ,ig92 EDIT •nRA�®r952•THE AMERICAN tmaclgl i( 97.91 10,999.95 51 6013 1992 Raabe,N.W.WASHINGTON,D.0 20006.5292•wp� ed pM�`l'i64tee U.S.copydaht lawn tad Mils fie Yierator to lepa( e CAUTION:You should use an original AIA document which hue this caution pointed(n red.An original assures that changes will not be obscured as may occur when documents are 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 2 Owner Platinum Properties Application Number 4483 Date 8/31/2015 Period From 8/1/2015 To 8/31/2015 Original Contract Sum $ 502,979.04 Net Change by Approved Change Orders $ 24,202.12 Contract Sum to Date $ 5270181.16 Total In-Place Work Completed $ 516,181.21 Value of Material Stored On Site $ - Total Earned to Date $ 516,181.21 Retained Percentage ........., $ 51,618.12 Total Earned Less Retainage $ 464,563.09 Less Previous Certificates for Payment.. $ 448,420.39 Current Payment Due $ 16,142.70 The undersigned hereby certifies that the amount Earned and Due the Undersigned for ail 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$ $ 16,142.70 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 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 $ 16,142.70 ,the receipt and sufficiency of which is hereby acknowledge. Dated this 31st day of August 2015 Weihe Construction,Inc. State of Indiana ) By:`'s)'bybG�rat1ta or u Nam� ) SS: !tY (/Usdersl )• County of Hamilton ) Title: HR/Accounting Assistant Before me,a Notary Public In and for said County and State,this 26 day of August 2015, personally appeared Kimberly Surleson known to me to be the HR/Acct Assistant 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 31st day of August 2015 My commission expires: Oct 2015 Notary Public My county of residence is: Hamilton Michelle Garcia (Printed) APPLICATION FOR PAYMENT PROJECT NAME: - 14.02 River load Reconstruction DEVELOPER: Falces Nest II,LI-C AGENT: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Rieth Riley Cond.Co.,Inc. INVOICE NC: 32002664 CONTACT: CONTACT:Tim Walter CONTACT:Mark Bentley APPLICATION DATE: 9/11/15 ADDRESS: 1358 Beverly Road,Suite 250 ADDRESS:9757WeslpointNye,Suite600 ADDRESS:1751 W.Minnesota Street RETAINAGE: Nt10% - MCLean.VA 22191 Indianapolis,IN 46256 Indianapolis,IN 46221 APPROVED BY: Phone: - Phone:J317818.2900.55088171M)_ Phone:(3171634561 5 (01,13171831E423(IL DATE: 9/11/15 J A 88 Cr Cr I) E L F G H=EcF.G I-H/D J K I LrI+ DH K _ M" - +L 'N i Cost Cost Work Description Unit Scheduled Work Completed Materials TotalCorepieted 7, Previous Retainage Total BRI..TO Net Pay Code Code Price Value Previous This Stored And stored To Date Comp1. Retainage This Period _ Retained _ PAY TNs Month Lgy TIF 3g Construction Engineering LS $15,200.00 $15,200.00 $1 5,200.00 100.0% $1,520.00 $1,520.00 $1,520.00 Lgy TIF 4a Demolition LS $18.375.00 $18,375.00 $18,375.00 100.0% $1.837.50 $1,837.50 $1,837.50 Lgy TIF 4b Tree Removal LS $2,025.00 $2,025.00 $2,025.00 boos 8202.50 6202.53 $202.50 Lgy TIF 4d Temporary Construction Entrance LS $8,960.00 $8,960.00 $8,960.00 loO.D% 9896.00 6890.00 5896.00 Lgy TIF 4e Site Prep and Common Excavation LS $1 67,640.45 $167,640.45 $167,640.45 100.0% 516,764.05 516.764.05 618,764.05 Lgy TIF 4h Subgrade Treatment LS $90,772.50 $90,772.50 $90,772.50 100.0% 89,077.25 59,07725 69,077.25 Lgy TIF 6a Storm Sewer LS $242,151.36 $242,151.36 $242,151.36 100.0% 924,215.14 924,215.14 624.215.14 Lgy TIF Sb S ub-surface Drain LS $26,283.75 $26,283.75 $26,283.75 100.0: 62,029,39 02,626.30 62.928.38 Lgy TIF Se Conduit LS $39,308.00 $39,308.00 $39,308.00 100.0% $3,930.80 $3330.80 $3,938.80 Lgy TIF "lb Water Main LS $8,191.26 $7,373.00 $818.26 $8,191.26 100.E 5737.30 581.83 9815.13 $819.13 $736 43 Lgy TIF 8a Curb and gutter LS $111,860.50 $111,860.50 $111,860.50 100.0% $11.186.05 611,155,55 011,186.05 Lgy TIF 8b Sidewalk LS $23,906.30 $23,906.30 $23,906.30 100.0% 42,390.63 62,390.63 42,390.63 Lgy TIF 9a Stone and Asphalt Base LS $309,105.50 $309,105.50 $309,105.50 1D0.0x $30,910.55 $30,510.55 630,910.55 Loy,TIF 9b Asphalt Surface LS $71,015.90 $71,015.90 $71,015.90 100.0% 57.101.59 $7,101.59 $7,101.59 $63,914.31 Lgy TIF 9e Asphalt Trail LS $55,256.75 $55,256.75 $55,256.75 100.0% 05,525.60 65,52568 55,525,68 Loy TIF 9h Pavement Markings LS $4.991.50 $4,991.50 $4,991.50 1001.0% 5493.15 $499.15 $499.15 $4,492.35 Lgy TIF 10a Erosion Control LS $13,796.23 $10,348.00 $3,448.23 $13,796.23 100.0% $1,034.80 5344.02 61,379.62 51,379.62 $3.103.41 Lgy TIF 12e Street Signs LS $5,840.00 $5,840.00 $5,840.00 1000% $584.00 $564.00 $584.00 $5,256.00 Change Orders Lgy TIF 6a CO#1-Add'I Storm to avoid Gas Main LS $3,908.00 $3,908.00 $3,908.00 100.0% 539183 9399.80 6390.80 $3,517.20 Lgy TIF 4e C0112-Additional Barricades LS $2,130.00 $2,130.00 $2,130.00 100.0% 5213.00 $213.00 $213.00 Lgy TIF 7b C0#3-Fire Hydrant LS $3,428.93 $3,428.93 $3,426.93 100.0% $342.89 634289 5342.89 Lgy TIF Bb CO#4•Concrete/Asphalt LS $1,750.00 $1,750.00 $1,750.00 (000% 6175.00 $175.00 5175.00 Lgy TIF 6a 0005•Credit for COO!(Pd by Utility) LS ($3.908.00) ($3,908.00) ($3,908.00) 100% 15390.801 1$390.801 ($390.00( ($3.51 7.20 ) Lys.TIF 10a CO146-Erosion Control&Signs LS $3,673.19 $3,673.19 $3,673.19 100. 5367.32 5367.32 9367.32 $3,305.87 Lgy TIF. 12e COOS-Street Signs LS $638.00 $638.00 $639.00 100% 963.80 $63.80 $6380 $574.20 • TOTAL $1,226,300.12 $1.135,875.04 $90,425.08 $1,226,300.12 $112,067.50 $9,042.51 $122,630.01 $122,630.01 $81,382.57 Itieth-Riley Construction Co.,Inc. I'.O.Box 276 Indianapolis,IN 46206 Telephone: (317)634-5561 FAX: (317)631-6423 Sold To: Falcon Nest II,LLC Progress Estimate#: 3I 1356 Beverly Road,Ste.250 Customer#: 716316 Mclean,VA 22101 Invoice#: 32002664 Date: 0/11/15 Period Covered: 8/7/15-9/11/15 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 #### 0.000 86,113.89 0.000 1,214,680.00 2 Change Orders 1 0.000 1.000 1.000 LSM 3,908.00 1.000 3,908.00 1.000 3,908.00 3 Change Orders 2 0.000 1.000 1.000 LSM 2,130.00 0.000 0.00 1.000 2,130.00 4 Change Orders 3 0.000 1.000 1.000 LSM 3,428.93 0.000 0.00r 1.000 3,428.93 5 Change Orders 4 0.000 1.000 1.000 LSM 1,750.00 0.000 0.00 1.000 1,750.00 6 Change Orders 4 0.000 1.000 1.000 LSM -3,908.00 1.000 -3,908.00 1.000 -3,908.00, 7 Change Orders 4 0.000 1.000 1.000 LSM 3,673.19 1.000 3,673.19 1.000 3,673.19 8 Change Orders 4 0.000 1.000 1.000 LSM 638.00 1.000 638.00. 1.000 638.00 Balance: 90,425.08 1,226,300.12 '.%.f L a x„ d i� ® .£_ C®NsTRuCTION Co. INC.._ P.O.Box 276 Indianapolis,iN 48206 Telephone: (317)834-5561 FAX: (317)631-8423 Progress Estimate No.: 3 Sad To; Falcon Nest II,LLC Customer No.: 716316 1356 Beverly Road,Ste.250 Job Number: 3200554 Mclean,VA 22101 Invoice Number: 32002664 Date: 0/11/15 Period Covered: 817/15-9/11/15 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 $11,620.12 (Co#6) 3 Contract Sum to Date (line 1 +line 2) $1,226,300.12 4 Total Contract Completed to Date $1,226,300.12 100.0% 5 Deductions: 10.00 % Retainage: $122,630.02 6 Total Earned Less Deductions (line 4-line 5) $1,103,670.10 7 Less Previous Billings $1,022,287.53 ,.....,---- -------. -1-4.1 p ,i 8 Invoice Amount Due (line 6-line 7) ( $81,382.57 . Balance Remaining „,...—$04 DA% A service charge of 1-1/2%per month(18%annual rate)will be made on all account balances not paid,according to the terms stated. I l I Moe Uaa Only(Current Eat,male Totals): Chenflo Order Summary Total Fatimata 590,425 08 Change Orders apreyby ; approved on loos estimates Owner Nt,820.12 Retainage 30,42.01 Approved Ulla Estimate SO 00 Current Payment Due 381,382.57 Total Net Change by Change Orden S11,820.12 i f 1 1 1t f' C C i t, C' CONTRACTOR AFFIDAVIT AND WAIVER OF LIEN FINAL X PARTIAL X PAYNE ENT TO FOLLOW Kevin A. Tussey being duly sworn,state that he/she is the Area Office Manager of Rieth-Riley Construction Co., Inc. having contracted with Falcon Nest, II, LLC to furnish certain materials,labor and/or equipment as follows: General Construction for a project known as 14-03 River Road located at Hamilton County ,and owned by Nest II LLC ,and further states: PARTIAL WAIVER: that the balance due from the owner is the sum of Eighty one thousand three hundred eighty two 57/100 Dollars($ 81,382.57 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 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 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. Rieth-Riley Construction Co. , Inc. Company Name uthoriz ed Representative 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.,LLCONTRACTOR: Manley Finish Grading INVOICE NO: 6059 CONTACT: Rajai Zumot CONTACT:Tire Walter CONTACT: John Manley APPLICATION DATE: 5/22/2015- ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS: 7437W.Banton Circle RETAINAGE: 10%i McLean,VA 22101 Indianapolis,IN 46256 New Palestine,IN 46163 APPROVED BY: J Ci—J! '„ Phone: Phone:(317)818-2900,590.8817(M) Phone: 317-895-8586 DATE: LIR,fr+t/M.5 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 t t Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code _ Price i Value Previous This Stored And stored To Date Comp'. Retainage This Period , Retained PAY , This Month The Playschool at Legacy-Legacy Developer Community Drive Right-of-Way Landscaping Lgy TIF(on-site 11a Street Trees NA $2,374.00 $2,374.00 $2,374.00 100% $237.40 ($237.40) $237.40 LgyTIF(on-site; 11a Shrubs NA $1,470.00 $1,470.00 $1,470.00 100% $147.00 ($147.00) $147.00 LgyTIF(on-site; 11a Perrenials NA $7,091.00 $7,091.00 $7,091.00 100% $709.10 ($709.10) $709.10 I f TOTAL 1 $10,935.00 $10,935.00 . $10,935.00 100% $1,093.50 ($1,093.50) $1,093.50 APPLICATION FOR PAYMENT P110)1371 NAME.The Playrdlool Al Leri goy-legacy Daveloper 1 OWNER:Falcon Nast II,:.LC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRR:ACTOManley Finish Grading INVOICE NO (u4.`s 7 CONTACT:Rajai Zurnol CONTACT:Tim Waller CONTACT:John Manley APPLICATION DATE ADDRESS.1356 SOrely Road.Culls,300 ADDRESS:3757 Westpoint Drive,Suite 000 ADDRESS:7437 W.Banta,Circo RETAINAGE 10% McLean.VA 22101 Indianapolis.IN 46256 Now Palesilnc.IN 46163 APPROVED By Phone. Phone: 317'818-2500 590-8817 Mt Phone:317.895.8586 DATE: A ' B C1 — Ca 0 E F 0 HnE*F+G 1=HID J K ' LnJ*K M.D•H*L N Coot Coal Work Descnption ting Scheduled Work Completed Materials Total Completed % Previous Retainage Totat BAL.TO Net Pay 1 Code Code Price Vague Previous TMs Stored And stored To Dale Comet. Retainage This Perim RMa,ned PAY This Month The Playschool at Legacy-Legacy Developer Community Drive Right-of-Way Landscaping , 02 3� Yr:, l, q�} r�I��/ G' e? ' 7 , c.Yr „k?.7 YZ) U�3t.i'c X37 T LgyTIF(on-site) 113 Street Trees NA $2.374.00 d,,1 11�'C •731-�� f3 1 A I �l � 'ray` �, 11x1 1. 11il/-1-'t' �1�1/r `<^t Lgy l IF(on-site) 113 Shrubs NA $1,470.00 /,3,P3. 7c J.. 6: ,ext?/ G'I jdu*lt j6„/r%c e 41c,';',4* /�,rr,c 7e/10 r �� 7 Lgy fir(on-site) 113 Perrenials NA $7,091.00 4 t i.'71) L TOTAL $h0,935.00_ itr3y'f-5 if' `i /rr'f337-i.e. 61l., O_t•g - -°? iila•f;"4,Ci `Z '//C/ 66 Manley Finish Gra:ling, Inr > rA That S�+ DATE INVOICE# lo .ff �..� 1 !; 5722/2015 6051 EN 7437 W. Banton Circle New Palestine, IN 46163 Phone & Fax (317) 895-8586 BILL TO FALCON NEST II LLC C/O PLATINUM PROPERTIES 9757 WESFPOINT DR. SUITE 600 INDIANAPOLIS, IN. 46256 P.O. NO. TERMS PROJECT PLAYSCHOOL NET 30 LEGACY QUANTITY DESCRIPTION RATE AMOUNT RETAINAGE 100%COMPLETE 1.093,50 1,093.50 THANK YOU FOR YOUR BUSINESS } Tota 04 .50 ..",„,) Erosion Control, Retaining Walls, " Straw Mulch, Slit Seeding, Wetland & Prarie Grass Seeding AFFIDAVIT AND WAIVER OF LIEN X FINAL _PARTIAL X l'AYMENT TO FOLLOW _ JOHN t,ANLEY being duly sworn,state that he/she is the PRESIDENT of MANLEY FINISH GRADIN INC.b wing contracted with FALCON NEST II LLC.____to fitrnish certain materials and/or labor as follows: INVOICE 605'1 for a project)mown as LEGACY PLAY SCHOOL located at CARMEL,IN .and owned by FALCON NEST II LLC ,an 3 further states: PARTIAL WAIVER: that the balance due by t:le owner is the sum of Dollars($ ). Receipt of which is hereby acknowledged;or The payment of which I las been promised as the sole consideration for it is 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 ONE THOUSAND NINETY-THREE ...50h00 Dollars($1,09150 — Receipt of which is hereby acknowledged;or X The payment of which Pas been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for sail amount,effective upon receipt of such paymen:. THEREFORE,the undersigned waives and releases unto the Owner of said premises any amid all lion or claims whatsoever or. the above-described property and improvements thereon on account of labor or material or.xrth,furnished by the undersigned thereto,and further certifies tl tat no other party has any claim or right to a lien an account of any work performed or material furnished to the and Wrsigned':or said project,and within the scope of this affidavit and waiver. MANLEY FINISH GRADING,INC. Co i.• Name A .. ..r /Authorized Rep>sentative j PRESIDENT Title 7 I WITNESS: Signature LYNDA MANLEY Printed Name of Witness APPLICATION FOR PAYMENT PROJECT NAME: The Playschool at Legacy-Legacy Developer ��{,,.(s OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt CO.,t4dC RACTOR: County Line Construction Co.,Inc. INVOICE NO: 3187(app#2) CONTACT: Rajai Zumot CONTACT:Tim Walter CONTACT: Greg Broady APPLICATION DATE: 7/31/2015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS: 9757 Westpoint Drive,Suite 600 ADDRESS: 5868 East 71st Street,Sutte E224 RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Indianapolis,Indiana 46220 APPROVED BY: '�r2:te: Phone: Phone:(317)818-2900,590-8817(M) Phone:317-714-7233 DATE: f:1105" A B G Cs ` D 5 1 F G H=E+F+G 1=1-1ID J K L=J+K M=D-H+L ty F Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Not 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 Limestone Planters in Communit Drive Right-of-Way Lgy TIF(on-site) 12a Wooden Sidewalk Forms NA $700.00 $700.00 $700.00 100% $70.00 ($70.00) $70.00 Lgy TIF(on-site) 12a Planter Curbs and Foundations NA $13,460.00 $13,460.00 $13,460.00 l00% $1,346.00 ($1,346.00) $1.346.00 TOTAL $14,160.00 $14,160.00 $14,160.00 100% $1,416.00 ($1,416.000± _ $1,416.00 Application and Certificate for Payment TO OWNER: PLATINUM PROPERTIES LLC PROJECT: PLAYSCHOOL©LEGACY APPLICATION NO: 3 Distribution to: CUST# PLAI 9757 WESTPOINT DR. PERIOD TO: 07131/2015 OWNER ❑ SUITE 600 INDIANAPOLIS IN 46254 CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: COUNTY LINE CONSTRUCTION VIA ARCHITECT: CONTRACT DATE: 10/04/2014 CONTRACTOR ❑ 5868 5 71ST ST CIVIL SITE GROUP,INC. SUITE E-224 PROJECT NOS: FIELD ❑ INDIANAPOLIS,IN 46220 PLAYSCHOOL @ LEGACY JOB n 214032 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The 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 completed in accordance Continuation Sheet is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 14,160.00 which previous Certificates for Payment were issued and payments received from the Owner,and 1.ORIGINAL CONTRACT SUM $ that current payment shown herein is now due. 2.Net change by Change Orders $ 0'00 _ CONTRACTOR: County Line Const. 3.CONTRACT SUM TO DATE(Line 1±2) $ 14,160.00 By: 1,''''''1`�,'"- \ Date: 7-31-2015 4.TOTAL COMPLETED&STORED TO DATE(Column G on 603L51) $ 14,160.00 State of: Indiana 5.RETAINAGE: County of: Marion 8. •DO %of Completed Work Subscribed and sworn to before (Column D+Eon 603LS1) $ 0.00 me this 31st day of July 2015 b. .00 %of Stored Material (Column F on 603LS1) $ 0.00 Notary Public: ;'�, My Commission expires: 5-5-2016 Total Retainage(Lines 5a+Sb or Total in Column 1 of 603LS1)... $ 0.00 6.TOTAL EARNED LESS RETAINAGE S 14,160.00 ARCHITECT'S CERTIFICATE FOR PAYMENT . (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 12,744.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the B.CURRENT PAYMENT DUE $ 1,416.00 7 AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED 5 /)1//6 .re:' (Line 3 less Line 6) $ 0.00 (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes a4pT°ved inrevious months by Owner $ 700.00 $ 700.00 By: —f-1-‘,4:,„i Date:--74r Total approved this Month $ 0.00 $ 0.00 TOTALS $ 700.00 $ 700.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 0.00 the Owner or Contractor under this Contract. REORDER FORM NO.6o4LS1 Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Page 1 of 1 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 3 containing Contractor's signed Certification,is attached. APPUCAT1ON DATE: 07/31/2015 In tabulations below,amounts are stated to the nearest dollar, Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 07/31/2015 ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS (IF VARIABLE) NO. VALUE STORED AND STORED (G a C) (NOT IN TO DATE ( SIH APPLICATION THIS PERIOD RATE) (D+E) D OR E) (D+E+F) 01 CMU LABOR 8,160.00 8,160.00 8,160.00 00.00 02 CMU MATERIAL 6,000.00 6,000.00 6,000.00 00.00 03 WOODEN FORMS 700.00 700.00 700.00 00.00 04 VOID WOODEN FORMS -700.00 -700.00 -700.00 00.00 JOB TOTALS: 14,160.00 14,160.00 .00 .00 14,160.00 _ .00 .00 1 G703-1992 INVOICE unty Line Construction0, inc. 3 219 usif 5868 E. 71st Street, Suite E224 • INDIANAPOLIS, INDIANA 46220 ph. (317) 926-9264 TO: Platinum Properties LLC Date 7-31-2015 9757 Westpoint Dr. Job No. 214032 Suite 600 Indianapolis, IN 46254 P.O. No. RE: Playschool @ Legacy ESTIMATE NO: 3 Labor, material, equipment and accessory appurtenances in place or stored to date at the above referenced project: 14,160.00 Less 00 % retained 0,00 Total earned less retainer 14,160.00 Less Previous applications 12,744.00 TOTAL DUE THIS ESTIMATE NO: 3 1,416.00 • Invoice �.. Service, Inc. Luminaire Service, Inc. --- 10652DeandraDrive CommrRC AL L GHTING Zionsville, IN 46077 (317) 808-7010 (317) 808-7015 (fax) Date: 8/21/2015 invoice No.: 63164 Bite to: Falcon Nest II, LLC Service at: Falcon Nest II, LLC c/o Platinum Properties 14471 Community Drive, Platinum Propertic Carmel, IN 46000 9727 Westpoint Drive, Suite 600 Indianapolis, IN 46256 Customer ID: 1204 Description: Work Order 25047 Projects Reference: Work Order 25047 Terms: Net 30 Days PO Number: Item Description Quantity Unit Price Amount Progress Billing 100.0% Complete toj 'P ti 4c- -c Lly. rnc - 12F Install 2 street lights and pillar lights Subtotal: $10,821.63 PER QUOTE Sales Tax: $0.00 Payments: $0.00 Total Due: $10,821.63 A I`. '6 AFFIDAVIT AND WAIVER OF LIEN X FINAL _ 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., LIC to furnish certain materials and/or labor as follows: Invoice No. 63164 for a project known as Falcon Nest II, 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 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. FINAL WAIVER: that the final balance due by the owner is the sum of ten thousand eight hundred twenty-one and 63/100 dollars($10,821.63). Receipt of which is hereby acknowledged X 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. Lumin.' e Service, Inc. Co •. y Na-'e Al horized Repres ative President Title WITNESS: Signature Deborah Ryan Printed Name of Witness