182716 03/02/2010 CITY OF CARMEL, INDIANA VENDOR: 362780 Page 1 of 1
ONE CIVIC SQUARE LITHKO CONTRACTING
"s CHECK AMOUNT: $125,100.00
CARMEL, INDIANA 46032 Po aox zoo
MONROEOH 45050 CHECK NUMBER: 182716
CHECK DATE: 312/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 1 125,100.00 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 12/01/09 to 12131/09
Subcaritract: '2695 -7300, 7300 Retaining,Wall
Job: 2695- Carmel RPAC Construction Vendor: 3935 LITHKO CONTRACTING, INC.
777 3rd Ave. SIM
Carmel, IN 46032
�e =To Date This Peri
od
Item Units UM Unit Cost Amount Units!% Amount Units Amount
1 7300 Retaining Wall LS 176,000.00 78.98% 139,000.00 78.98% 139,000.00
Total Contract Items 176,000.00 139,000.00 139,000.00
Subcontract Totals: 176,000.00 139,000.00 139,000.00
Total Billings: 139,000.00- 139,000.00
6npaid Retainage: 13,900.00 13,900.00
Discounts: 0.00 0.00
Net Billings: 125,100.00 125,100.00
98 SSC CMa Projects Page 1 12/17/09 02:36:08 PM
Date Format MM /DD /YY SLSubNWngReport .rpt
APPL AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION (07
A1A DOI UMENT G7O21CMa PAGE ONE OF PAGES
TO OWNER: PROJECT: CPAC RETAINING APPLICATION NO: I Distribution to:
CITY OF CARMEL. REDEVELOPMENT COMMISSION WALL PERIOD TO: December 31, 2009 OWNER
ONE CIVIC SQUARE PROJECT NO: CONSTRUCTION
CARMEL, IN 46032 BCCJ JOB# L5592 MANAGER
FROM CONTRACTOR: CHECK REryfITTANCE 4DDRESS:, CONTRACT DATE: ARCHITECT
LITHK.O CONTRACTING, INC. LITHKO CONTRACTINGJ NC 7CONTRACTOR
P.O. BOX 270 P.O SOX 270:.;
MONROE, OH 45050 MONROE; OHIO:45050
VIA CONSTRUCTION MANAGER: SH1EL SEXTON CO., INC
CONTRACT FOR: Place /Finish Concrete VIA ARCHITECT: CSO ARCHITECTS INC
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid
by the Contractor for Work for which previous Certificates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 176,000.00
2,%.Net change by Change Orders 0.00 CONTRACTOR: LITHKO CONTRACTING, INC.
3. CONTRACT SUM TO DATE (Line I f 2) 176,000.00
4. TOTAL COMPLETED STORED TO DATE 139,000.00 Y
(Column G on G703) By: P 1 1 Date: December 16, 2009
5. RETAINAGE: A D A GANNON, IffE 130,1191M&OR
a. 10 of Completed Work 13,900.00 State of: C un y fi R ARREN
Column D E on G703 ¢�t Subscribed and sworn to be ore a tuber, 2009.
IJotarY State Ohio
b. of Stored Material Notary Public: M Of nV Co mi x it
(Column F on G703) My Commission expires: I R e
Total Retamage (Lines 5a 5b or
Total in Column I of G703) 13,900.00 4
6. TOTAL EARNED LESS RETAINAGE 125,100.00 In accordance with the Contract Documents, based on on -site observations and the d
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) 0.00 progressed as indicated, the quality of the Work is in accordance with the Contract
CURRENT PAYMENT DUE 125,100.00 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 50,900.00
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied for. Initial all
T otal changes approveU figures on this Application and on the Continuation Sheet that changed to conform to the
in previous months by Owner $0.00 $0.00 amount cei 1
Total approved this Month $0.00 $0.00 C N MAN SHIEL SEXTON CO., INC. Date:
DAL �v9
A T S RCHITECTS INC.
TOTALS $0.00 $0.00 By: Date: ol
NET CHANGES by Change Order $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 rights of the Owner or Contractor under this Contract,
AIA MCM11711T a c a-
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W., WASHINGTON, DC 2000(3-5292
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
CONTINUATION SN EET AJA DOCUMENT G7 03 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 1.
Contractor's signed certification is attached. APPLICATION DATE: 12 /16/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 3658 -7300
CPAC RETAINING WALL ,N�.
L559
A B C D E F G I1 1
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C G) RATE)
(NOT IN TO DATE
D OR E) (D +E +F)
I MOBILIZATION JOB SETUP 10,000.00 0.00 10,000.00 0.00 10,000.00 100% 0.00 $1,000.00
2 PAYMENT PERFORMANCE BOND 2,000.00 0.00 2,000.00 0.00 2,000.00 100% 0.00 $200.00
3 FOUNDATIONS 34,000.00 0.00 34,000.00 0.00 34,000.00 100% 0.00 $3,400.00
4 RETAINING WALLS 80,000.00 0.00 68,000.00 0.00 68,000.00 85% 12,000.00 $6,800.00
5 BACKFILL 50,000.00 0.00 25,000.00 0.00 25,000.00 50% 25,000.00 $2,500.00
6 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
7 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
8 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
9 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
10 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0,00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00
GRAND TOTALS 176.000.001 0.00 139,000.00 0.00 139,000.00 79% 37,000.00 $13,900.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
Page 1 of 1 JMP92 -20 -F Effective -1 /31/01
Prescribed by State Board of Accounts ACCOUNTS PAYABLE v6ucH' ER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
L 1
'�jkt1 0 n�r� t" 1 1 '(1� h� C Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 12 5 16 0 0
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
L C�hfit�i�.aLc. IN SUM OF$
Q 2—
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ON ACCOUNT OF APPROPRIATION FOR
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Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice 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
2 20/0
Si n ture
Director f �eclevelopmen
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund