251364 11/09/15 (2) 0r -
q`('�,A,,f� CITY OF CARMEL, INDIANA VENDOR: 368941
® t"� ONE CIVIC SQUARE MIDWEST CONSTRUCTORS CHECK AMOUNT: $****82,135.96*
CARMEL, INDIANA 46032 2916 BLUFF ROAD,SUITE D CHECK NUMBER: 251364
+.y«oN INDIANAPOLIS IN 46225 CHECK DATE: 11/09/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 R4460807 ' 31784 3 41,881.70 PARCEL 7C-4 & 7C-9
902 R4460807 31784 4 40,254.26 PARCEL 7C-4 & 7C-9
AIA Type Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):30 West Main St. PROJECT.CRC-Mezz Building APPLICATION NO. 3 DISTRIBUTION
Ste..220 30 West Main St. PERIOD Tp;7/31f2015 TO:
Carmel.IN 46032 Ste..220 _OWNER
Carmel,IN 46032 _ARCHITECT
—CONTRACTOR
FROM(CONTRACTOR): Midwest Constructors LLC VIA(ARCHITECT): ARCHITECT'S
600 S.Kentucky Ave. PROJECT NO:
Ste.100
Indianapolis.IN 46225
CONTRACT FOR:Mezz Building CONTRACT DATE: 8/8/2014
The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
CONTRACTOR'S APPLICATION FOR PAYMENT
belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet,AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner.and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM ........ ............$ 236.510.00
2.Net Change by Change Orders ............:...S 14,444.17 CONTRACTOR: Midwest Constructors LLC
600 S.Kentucky Ave.Ste_100
3.CONTRACT SUM TO DATE (Line 1 +2)........;.. $ 250,954.17 ndiana of IN 46225
4.TOTAL COMPLETED AND STORED TO DATE _ S 188.578.67 By: Date: 7
Michael Jacobs / Project anager
5.RETAINAGE:
State of:IN
a. 5.00%of Completed Work S 9,428.94
County of: Johnson
b. 0.00%of Stored Material S 0.00 Subscribed and Sworn to before Z ay of 20
Total retainage(Line 5a+5b).................... S 9,428.94 Notary Public: r P
IJ
My Commission Expires: �— G1, - ��PPp1AN
6.TOTAL EARNED LESS RETAINAGE.............. S 179,149.73
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAY L 9
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observatio d th
(Line 6 from prior Certificate 137,268.03 prising the above application, the Architect certifies to owner that to the b I o he�0,RA
p )'''''''''''' ''''''"'S knowledge,information and belief the Work has progressed as indicated,lh FTA
8.CURRENT PAYMENT DUE ..... .... ............S 41,881.70 is in accordance with the Contract Documents, and the Contractor is entitle Q
N
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED. OF IS
(Line 3 less Line 6) S 71,804.44
AMOUNT CERTIFIED............................... S
(Attach explanation if amount cerlifred differs from the amount applied_Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT:
previous months by Owner 29,514.17 -15.070.00 By.
Date:
Total approved this Month 0.00 0.00 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
TOTALS 29,514.17 -15,070.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 14,444.17
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):30 West Main St. PROJECT: CRC:Mezz Building APPLICATION NO: 3 DISTRIBUTION
Ste.,220 30 West Main St. TO:
Carmel,IN 46032 Ste..220 PERIOD TO:7131/2015 _OWNER
Carmel,IN 46032 _ARCHITECT
-CONTRACTOR
FROM(CONTRACTOR):Midwest Constructors LLC VIA(ARCHITECT): ARCHITECTS
600 S.Kentucky Ave. PROJECT NO:
Ste.100
Indianapolis,IN 46225
CONTRACT FOR:Mezz Building CONTRACT DATE: 8/8/2014
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1 Mobilization 12.000.00 12,000.00 0.00 0.00 12.000.00 100.00 0.00 600.00
50 Earthwork 71,950.00 53,962.50 17,987.50 0.00 71.950.00 100.00 0.00 3.597.50
3 Demolition 31,540.00 23,655.00 4,731.00 0.00 28.386.00 90.00 3.154.00 1,419.30
4 Site Work Labor 28,170.00 14,085.00 7,042.50 0.00 21.127.50 75.00 7.042.50 1.056.38
5 Site Work Material 57,300.00 28,650.00 14,325.00 0.00 , 42,975.00 75.00 14,325.00 2.148.75
6 Landscaping 30.550.00 0.00 0.00 0.00 0.00 0.00 30,550.00 0.00
7 Demobilization 5.000.00 0.00 0.00 0.00 0.00 0.00 5.000.00 0.00.
8 Connection Path to Monon Trail 2,304.00 0.00 0.00 0.00 0.00 0.00 2,304.00 0.00
g American Way Temporary Dr 25.506.00 25,506.00 0.00 0.00 25,506.00 100.00 0.00 1,275.30
10 Deletion of Water Detail -15,070.00 -15,070.00 0.00 0.00 -15,070.00 100.00 0.00 -753.50
11 Demo Electrical Panel 1,457.00 1,457.00 0.00 0.00 1.457.00 100.00 0.00 72.85
12 Tree Swap 247.17 247.17 0.00 0.00 247.17 100.00 0.00 12.36
REPORT TOTALS 5250,954.17 $144,492.67 544.086.00 $0.00 $188,578.67 75.14 $62.37550 $9.428.94
AIA Type Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):30 West Main St. PROJECT:CRC-Mezz Building APPLICATION NO: a DISTRIBUTION
Ste.,220 30 West Main Sl. TO:
Carmel,IN 46032 Ste.,220 PERIOD TO:9/30/2015 _OWNER
Carmel,IN 46032 —ARCHITECT
FROM(CONTRACTOR):Midwest Constructors LLC VIA(ARCHITECT): ARCHITECT'S _CONTRACTOR
600 S.Kentucky Ave. PROJECT NO:
Ste.100
Indianapolis.IN 46225
CONTRACT FOR:Mezz Building CONTRACT DATE: 8/8/2014
CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractor's knowledge,information and
belief the work covered by this application for Payment has been completed in accordance with the
Application is made for Payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet.AIA Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM „_•,•.,•.,.,•.,,.,_S 236,510.00
2.Net Change by Change Orders ................$ 14,444.17 CONTRACTOR: Midwest Constructors LLC
600 S.Kentucky Ave.Ste, 100
3.CONTRACT SUM TO DATE (Line 1 +2).._........ $ 250.954.17 firiana 1' N 46225 `
4.TOTAL COMPLETED AND STORED TO DATE ... ...S 230,951.57 By: Date:
5.RETAINAGE: Michael Jacobs / Project Manager
a. 5.00%of Completed Work S 11,547.58 Slate of:IN
County of. Johnson
b. 0.00%of Stored Material S 0.00 Subscribed and Sworn to before me thisDay of
0 ] ``
y'J
- =s
5a+5b Notary Public:
Total retainage Line
9 ( ).................... S 11.547.58
My Commission 6pires
6.TOTAL EARNED LESS RETAINAGE.............. S 219,403.99 (tt 1� 9
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYME{�TAL
Johnson county
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations.aa-n �U).VdM=Ln=1
(Line 6 from prior Certificate).....................S 179,149,73 prising the above application, the Architect certifies to owner that to the beslre.Architect's•
knowledge,information and belief the Work has progressed as indicated,the gN!ty-ofYbeiwork
8.CURRENT PAYMENT DUE ..... ................S 40,254.26 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED.
(Line 3 less Line 6) S 31,550.18
AMOUNT CERTIFIED............................... S
(Attach explanation if amount certified differs horn the amount applied.h7itial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.)
Total changes approved in ARCHITECT.
previous months by Owner 29.514.17 -15,070.00
By: Date:
Total approved this Month 0.00 0.00 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
TOTALS 29.514.17 -15,070.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 14 444.17
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):30 West Main St. PROJECT:CRC-Mezz Building APPLICATION NO: 4 DISTRIBUTION
Ste.,220 30 West Main St. TO:
Carmel,IN 46032 Ste..220 PERIOD TO:9/30/2015 _OWNER
Carmel.IN 46032 _ARCHITECT
-CONTRACTOR
FROM(CONTRACTOR):Midwest Constructors LLC VIA(ARCHITECT): ARCHITECT'S
600 S.Kentucky Ave. PROJECT NO:
Ste. 100
Indianapolis.IN 46225
CONTRACT FOR:Mezz Building CONTRACT DATE: 8/8/2014
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1 Mobilization 12.000.00 12,000.00 0.00 0.00 12,000.00 100.00 0.00 600.00
50 Earthwork 71,950.00 71,950.00 0.00 0.00 71,950.00 100.00 0.00 3.597.50
3 Demolition 31,540.00 28.386.00 3.154.00 0.00 31,540.00 100.00 0.00 1.577.00
4 Site Work Labor 28.170.00 21,127.50 4,225.50 0.00 25.353.00 90.00 2.817.00 1,267.65
5 Site Work Material 57,300.00 42,975.00 8,595.00 0.00 ,51,570.00 90.00 5,730.00 2,578.50
6 Landscaping 30.550.00 0.00 24,440.00 0.00 24,440.00 80.00 6.110.00 1,222.00
7 Demobilization 5,000.00 0.00 0.00 0.00 0.00 0.00 5.000.00 0.00
8 Connection Path to Monon Trail 2,304.00 0.00 1,958.40 0.00 1.958.40 85.00 345.60 97.92
g American Way Temporary Dr 25.506.00 25.506.00 0.00 0.00 25.506.00 100.00 0.00 1,275.30
10 Deletion of Water Detail -15.070.00 -15,070.00 0.00 0.00 -15.070.00 100.00 0.00 -753.50
11 Demo Electrical Panel 1.457.00 1,457.00 0.00 0.00 1,457.00 100.00 0.00 72.85
12 Tree Swap 247.17 247.17 0.00 0.00 247.17 100.00 0.00 12.36
REPORT TOTALS 5250.954.17 5188.578.67 542,372.90 S0.00 5230,951.57 92.03 $20.002.60 511,547.58
i
Prescribed by State Board of Accounts City Forth No.201 (Rev.1995)
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
ftA W@ S'1' (bh 5jr*J%r i L-L Purchase Order No.
bon S' entu(k\l Ave - . 5u)+t I Terms
4 015 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1-3)-\ 5 6eZ2- �AP 14/Wk
e ' e i,Vak6 25�,z6
Total 22-A5."
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
20-
Clerk-Treasurer
0ClerkTreasurer
I
VOUCHER NO. WARRANT NO.
ALLOWED 20
�c10 , �Oh��raCo�S LL_ 6 IN SUM OF $
Q tk(kV &fe , �u'l e 11111
iok,6Ynq IV 4
R13
$ 1
ON ACCOUNT OF APPROPRIATION FOR
Board Members
D#r or INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s),
"j4LT 0907 4( 881,70 or bill(s) is (are) true and correct and that
the materials or services itemized thereon
for which charge is made were ordered and
received except
-- — 20 ,5
Signatur
Executive Director
Title
Cost distribution ledger classification if Carmel Redevelopment Commission
claim paid motor vehicle highway fund