184116 04/13/2010 CITY OF CARMEL INDIANA VENDOR: 358569 Page 1 of 1
s4� ONE CIVIC SQUARE KEYSTONE CONSTRUCTION CHECK AMOUNT: $9,463.39
CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR
INDIANAPOLIS IN 46204 CHECK NUMBER: 184116
CHECK DATE: 4/1312010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460847 1008 -1 7,846.71 1007 -1 LOFT BACKFILL
902 4460847 1008 -1 1,616.68 1008 -SUMP PUMP
APPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUMENTG702 PAGE 1 OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 1 Distribution to:
Carmel Redevleopment Comm. Parcel 47 Sump Pump Storm Sewer F_X_� O W NER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 2122110 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Keystone Construction Corp. CSOArchitects
The Majestic Building I Oth Floor PROJECT NOS: 1008
47 S. Pennsylvania Street
Indianapolis, IN 46204
CONTRACT FOR GENERAL CONSTRUCTION CONTRACT DATE:
CONTRACTOR 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 1,616.68
2. Net change by Change Orders CONTRACTOR: Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line I f 2) 1,616.68
4. TOTAL COMPLETED STORED TO 1,616.68
DATE (Column G on G703) By:� Date: 2/22/10
5. RETAINAGE:
a. 10 of Completed Work State of Indiana County of. Marion
(Column D E on G703) Subscribed and sworn t before me this .1.Q day of
b. 10 of Stored Material Notary Public: X:az; A, (J
(Column F on G703) My Commission expires: November 8, 2016
Total Retainage (Lines 5a 5b or
Total in Column I ofG703) 0.00 ARCHITEUT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 1,616.68 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated,
PAYMENT (Line 6 from prior Certificate) the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 1 ,616.68 is entitled to payment of the AMOUNT CERTIFIED.
4. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanatio fa ount certified differs from the amount applied. Initial all figures on this
Total changes approved Application an nthe ontif n Sheet that are changed to conform with the amount certified)
in previous months by Owner ARCHITECT
Total approved this Month By: Date: 2�Za5�o
TOTALS $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
NET CHANGES by Change Order t $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
r. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA .01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE,, N.W., WASHINGTON, DC 20006 -5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 1
Contractor's signed certification is attached. APPLICATION DATE: 2/22/2010
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 2/22/2010
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 1008
A B 7SCHEDULED D E F G H I
ITEM DESCRIPTION OF WORK WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C G) RATE)
(D E) (NOT IN TO DATE
D OR E) (D +E +F)
1 General Conditions To Date $446.89 $446.89 $446.89 100.00% 0.00 $0.00
2 5% Construction Management Fee To Date $1,169.79 $1,169.79 $1,169.79 100.00% 0.00 $0.00
PAGE TOTAL $1,616.68 $0.00 $1,616.68 $0.00 $1,616.68 100.00% $0.00 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCVIEwTG702 PAGE OF3PAGES
TO OWNER: PROJECT: APPLICATION NO: I Distribution to:
Carmel Redevleopment Comm, Parcel 47Site Backftll F X OWNER
One Civic Square =ARCHITECT
Carmel, Indiana 46032 PERIOD TO: 2122110 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: 0
Keystone Construction Corp. CSOArchitects
The Majestic Building 10th Floor PROJECT NOS: 1007
47 S. Pennsylvania Street
Indianapolis, IN 46204
CONTRACT FOR: GENERAL CONSTRUCTION CONTRACT DATE:
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. OR]GINAL CONTRACT SUM 7,846.71
2. Net change by Change Orders CONTRACTOR: Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 f 2) 7,846.71
4. TOTAL COMPLETED STORED TO 7,846.71
DATE (Column G on G703) By: Date: 2/22/10
5. RETAINAGE:
a. 10 of Completed Work State of =n►olA N A County of 0A A iZ- .O F)
(Column D +E on G703) Subscribed ands orn to be a me this -A900 da of �etiiZu eta y, a01 G
b. 10 of Stored Material Notary Public: rC��
(Column F on G703) My Commission expires:
Total Retainage (Lines 5a +5b or I L —e l(v
Total in Column I of 6703) 0.00 T I A 11C
6. TOTAL EARNED LESS RETAINAGE 7,846.71 In accordance with the Contract Documents, basc J on on -site observationshe data
(Line 4 Less Line 5 Total) comprising the application, the Architect certifie to the Owner that t6W Est►
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief th Work has pros
PAYMENT (Line 6 from prior Certificate) the quality of the Work is in accordance with the on tract Documen$iM V CRES:
8. CURRENT PAYMENT DUE 7,846.71 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SU MMARY ADDITIONS DEDUCTIONS (Attach expla to if amount certified d f<ers from the amount applied. Initial all figures on this
Total changes approved Applicatio and o the Conti on Sh that are changed to conform with the amount certified.)
in previous months by Owner ARC CT.
Total approved this Month By: Date: ZITS [ID
TOTALS $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
NET C14ANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE., N.W., WASHINGTON, DC 2000&5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF2 PAGES
AIA Document 6702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 1
Contractor's signed certification is attached. APPLICATION DATE: 2/22/2010
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 2/22/2010
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 1007
A 8 C D E F G H I
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)
(D E) (NOT IN TO DATE
D OR E) (D+E +F)
1 General Conditions To Date $185.68 $185.68 $185.68 100.00% 0.00 $0.00
2 5% Construction Management Fee To Date $7,661.03 $7,661.03 $7,661.03 100.00% 0.00 $0.00
PAGE TOTAL $7,846.71 $0.00 $7,846.71 $0.00 $7,846.71 100.00% $0.00 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
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
K eV. ge C a r j f ru jj Dh CD r 6. Purchase Order No.
Ti M1 )es�i c B,, j 10 Fj �7 S Pews �yA n;4 5f, Terms
Z. fl Lo boli's I M D Date Due
l
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s)) rr
2`Z 10 som 6 '[1h t 6�
2 -2z• 1 7
Total vl `A
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
Kr?vS7ct1�° CanS�JUC- 4h
or Ik. IN SUM OF
A N I71 P thAiY1V hiA -S
ON ACCOUNT OF APPROPRIATION FOR
90�% 6 OP47
Board Members
POO or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
02 1 m -1 �H 7 bill(s) is (are) true and correct and that the
X02 Doi' I`+60 7 $�E,71 materials or services itemized thereon for
which charge is made were ordered and
received except
201
Si nature
NrwOpof Redevelopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund