181983 02/03/2010 CITY OF CARMEL, INDIANA VENDOR: 358569 Page 1 of 1
ONE CIVIC SQUARE KEYSTONE CONSTRUCTION
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L� CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR CHECK AMOUNT: $50,000.00
,o INDIANAPOLIS IN 46204 CHECK NUMBER: 181983
CHECK DATE: 2/312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460912 912 -05 50,000.00 PUNCH LIST
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YONE i t IZI.mer.:
CONSTRUCTION CORP
y
TO Carmel Redevelopment Commission JOB Carmel Lofts, LLC Invoice 912 -05
111 W. Main Street 47 5 Pennsylvania Street 10th Fl Invoice Date 26- Oct -09
Carmel, IN 46032 Indianapolis IN 46204 Project No: 912
Attn: Matt Worthley
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'Due upon Receipt L J Mr. Matt Worthely i
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t. s p y 6t 9 4 Y 1 '4" Y� w e ''t k 1 k! a s
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Foundations of Building $143,750.001 100% $143,750.00; $143,750.00;
{Shell of Building $143,750.00 100% $143,750.00, $143,750.00'
'Base Interterior Work $143,750.00 100% $143,750.001 $143,750.00;
Interior Finish $143,750.00 100% $143,750.00' $143,750.00,
!Completion of "Punch List" $50,000.00! 0% $0.00; $50,000.00 $50,000.00
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GRAND TOTAiS
$625,000.0 .Total completed $625,000.00
',Less Previous $575,000.00
TOTAI:iDUE $50,000.06
A late fee payment charge of 1 'h% per month or an annual percentage rate of 18 will be imposed monthly on past due balances. If collections or attorney fees are needed, they are recoverable.
GENERAL CONTRACTORS 47 S Pennsylvania St PI IONE: (317) 636 -2000
az rs 10th Floor FAX: (317) 635-1100
c CONSTRUCTION MANAGERS Indianapolis, IN 46204 E -MAIL: AR @keystone-corp.com
Thank you for your business!!!
r
AFFIDAVIT AND WAIVER OF LIEN
X Final n Partial n Payment to Follow
State of Indiana, County of Marion. SS:
Jason Ellis being duly sworn states that he is the Director of Construction of Keystone Construction
Corporation (Contractor) having contracted with Carmel Redevelopment Commission
to furnish certain materials and /or labor as follows for a project known as Carmel Lofts/
VFW Old Meridian located in Carmel, Indiana and does hereby further state on behalf
of the aforementioned contractor
(PARTIAL WAIVER)
that there is due from the owner the sum of
Dollars 1
1 receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit
and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be
effective only upon receipt of payment thereof by the undersigned
(FINAL WAIVER)
that the final balance due from the owner is the sum of
Fifty Thousand 00 /100 Dollars 50,000.00
receipt of which is hereby acknowledged; or
X] the payment of which has been promised as the sole consideration for this Affidavit
and Final Waiver of Lien which shall become effective upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or
claim whatsoever on the above described property and improvements thereon on account of LABOR or
MATERIAL or both, furnished by the undersigned thereto, subject to limitations or conditions expressed
herein, if any; 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 undersi: ed for said project, and within the scope of this
affidavit and waiver.
Keystone Construction Corporation By Title Director of Construction
(Company) p 11 vel
WITNESS MY HAND AND NO RIAL SEAL, this 26 day of October, 2009.
Signed: ANDREA M. ROELL
NOTARY PUBLIC
SEAL
ENE OF INDLAM
MARION COMM/
NW COMMISSION EIRE!
NOVEMBER 8, 2016
KEysTO NE :,l
W C S k. E.,I I,. T ir:3. i+ C 11 F} i'
TO Carmel Redevelopment Commission 306 Carmel Lofts, LLC Invoice 912 -05
111 W. Main Street 47 5 Pennsylvania Street 10th Fl Invoice Date 26- Oct -09
Carmel, IN 46032 Indianapolis IN 46204 Project No: 912
Attn: Matt Worthley
Due upon Receipt ;Mr. Matt Worthely :10/26/2009
Foundations of Building $143,750.00 100% $143,750.00 $143,750.00
Shell of Building $143,750.00 100% $143,750.00 $143,750,00
'Base Interterior Work $143,750.00 100% $143,750.00. $143,750.00
Interior Finish $143,750.00 100% $143,750.00• $143,750.00
Completion of 'Punch List" $50,000.00 0% $0.00 $50,000.00. $50,000.00
GRAND TOTALS $625,000.00 Total completed $625,000.00
Less Previous $575,000.00
TOTAL DUE $50,000.00
A late fee payment charge of 1 '/z% per month or an annual percentage rate of 18% will be imposed monthly on past due balances. If collections or attorney fees are needed, they are recoverable.
GENERAL CONTRACTORS 47 5 Pennsylvania St PI-IONE: (317) 636 -2000
L 10th Floor FAX: (317) 635-1100
ice= `CONSTRUCTION MANAGERS Indianapolis, IN 46204 E-MAIL: AR @keystone corp.com
Thank you for your business!!!
Prescribed Accounts ACCOUNTS P Y BLE VOUCHER City Form No. 201
g CITY OF CARM
a invoice mmeGn7e a,mmsho«<«mam#mperf _a dales service rendred, by
whom, rate s per day, number of hours, rate per hour, number 4 units, :yam
Payee
f o bs fi r Purchase Order No.
+2 S 55 V w» Terms
t me Due
Invoice Invoice Description Amount
Date Number (or meattached invoice(s) or bi
/0/2E/ '2 C /Aa 6/ t so 26.?
Total
I meby certify that the attached invo a#me#e(are)_and correct and I have audited same maccordance
with IC @9ya
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Clerk-Treasurer
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TO Carmel Redevelopment Commission 30B Carmel Lofts, LLC Invoice 912-05
111 W. Main Street 47 S Pennsylvania Street 10th Fl Invoice Date 26-Oct-09
Carmel, IN 46032 Indianapolis IN 46204 Project No: 912
Attn: Matt Worthley
Due upon Receipt :Mr. Matt Worthely 10/26/2009
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2
Foundations of Building $143,750.00 100% $143,750.00 $143,750.00
:Shell of Building $143,750.00 100% $143,750.00 $143,750.00
Base Interterior Work $143,750.00 100% $143,750.00 $143,750.00
Interior Finish $143,750.00 100°,'o $143,750.00. $143,750.00
Completion of "Punch List" $50,000.00 0% $0.00 $50,000.00 $50,000.00
GRAND TOTALS: $625,000.00 Total completed $625,000.00
Less Previous -$S7.5;600.00
TOTAL DUE $50,000 00
A late fee payment charge of 1 '/2% per month or an annual percentage rate of 18% will be imposed monthly on past due balances. If collections or attorney fees are needed, they are recoverable.
GENERAL CONTRACTORS 47 S Pennsylvania St PHONE: (317) 636-2000
e 10th Floor FAX: (317) 635-1100
CONSTRUCTION MANAGERS Indianapolis, IN 46204 E-MAIL: AR@keystone-corp.com
Thank you for your business!!!
AFFIDAVIT AND WAIVER OF LIEN
U Final 0 Partial Payment to Follow
State of Indiana, County of Marion. SS:
Jason Ellis being duly sworn states that he is the Director of Construction of Keystone Construction
Corporation (Contractor) having contracted with Carmel Redevelopment Commission
to furnish certain materials and /or labor as follows for a project known as Carmel Lofts/
VFW Old Meridian located in Carmel, Indiana and does hereby further state on behalf
of the aforementioned contractor
(PARTIAL WAIVER)
that there is due from the owner the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit
and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be
effective only upon receipt of payment thereof by the undersigned
(FINAL WAIVER)
that the final balance due from the owner is the sum of
Fifty Thousand 00/100 Dollars 50,000.00
receipt of which is hereby acknowledged; or
X] the payment of which has been promised as the sole consideration for this Affidavit
and Final Waiver of Lien which shall become effective upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or
claim whatsoever on the above described property and improvements thereon on account of LABOR or
MATERIAL or both, furnished by the undersigned thereto, subject to limitations or conditions expressed
herein, if any; 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 undersi: ed for said project, and within the scope of this
affidavit and waiver. 1 1 Keystone Construction Corporation By i Title Director of Construction
(Company) „I .lp fpWa:ye)
WITNESS MY HAND AND NO RIAL SEAL, this 26 day of October, 2009.
A itioAi D
Signed: ANDREA M. ROELL
NOTARY PUBLIC
SEAL
RAT OF IND144
MARION COUMY
MY COMMISSION EXPIREk
NOVEMBER 8, 2016
Prescribed by State Board of Accounts City Form 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
/)PJ.sfohy Purchase Order No.
4/ 7 S 57 �/ao Terms
-77./ ;Pilo/9 0s /2 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
io /22/2 9/2 -o o M. e1 9 z So, ceo ,ea
Total 50, o p
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
1 ALLOWED 20
/5 C oos /ra� IN SUM OF
Y 7 5 A� .75y/ 9
J /o
p
/4 1 /6 Y
50 000 -oo
ON ACCOUNT OF APPROPRIATION FOR
2
9 o 2 /".#7 0, /2_
Board Members
DEPT r INVOICE NO. ACC AMOUNT I hereby certify that the attached invoice(s), or
902 9/.2 —05 `/i/60 /2 5 06 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
26 20 /d
I►
Signature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund