184198 04/14/2010 CITY OF CARMEL, INDIANA VENDOR: 363990 Page 1 of 1
h f ONE CIVIC SQUARE CADENCE MIT LLC CHECK AMOUNT: $13,008,60
CARMEL, INDIANA 46032 2535 REAVEST SOUTH DRIVE
INDIANAPOLIS IN 46203 CHECK NUMBER: 184198
CHECK DATE: 4/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
103 4460705 23313 0015406005 13,008.60 INLOW PARK REPAIRS
APPLICATION and CERTIFICATE for PAYMENT
To: Carmel Clay Parks and Project: Inlow Park Repairs and Application N 001 5408.005 Distribution to:
Recreation Improvements Project
1411 E 116th St 6310E 131st 5t. App. Date: March 16, 2010 0 OWNER
Carmel, IN st St. Pe t6 [I CONSTRUCTION MGR.
ri od r Mare *26 2q 0_- 0 ARCHITECT
From: CCadenceMTC.LLC CONTRACTOR
2535.Reavest_Dr:.S.. Project Nos: 5408.005 OTHER
I ndianpohs,:lN482 03 Contract Date: March 9, 2010
Contract For: Via Architect: Schneider Corporation
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for pay ment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been completed
pp p y meri in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and payments
1. ORIGINAL CONTRACT SUM 78,960.401 received from the Owner, and that current payment shown herein is now due.
2. Net Change By Change Orders 0.00 CONTRACTOR: Cadence MTC LLC
3. CONTRACT SUM TO DATE 7960.40 By: q 0�&& Date: March 29, 2010
4. TOTAL COMPLETED AND STORED TO DATE 14 ,454.00 Roxanne Bell
5. RETAINAGE: State of: Indiana County of: Marion
a. 10% of Completed Work 1,445.40 Subscribed and sworn before me this 29th day of March 2010
b. of Stored Material Roxanne Bell personally appeared before me, the undersigned notary public, and provided
0.00 satisfactory evidence of identification to be the person who signed this document in my
TOTAL RETAINAGE 1 ,445.40 presence and swore or affirmed to me that the contents of this document are truthful and
accurate to the besLof his/her knowledge an elief.
6. TOTAL EARNED LESS RETAINAGE 13,008.60
Notary Public: /�Cuvly Commission expires:
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT T ARCHITE 'S CERTIFICATE rOR PAYMENT
8. CURRE PAYMENT -DUIEQ 1.3', 008.60 -In accordance with the Contract Documents, based on on -site observations and the data
9. BALANCE TO FINISH, INCLUDING RETAINAGE comprising this application the Architect certifies to the Owner that to the best of the
65,951.80 Architect's knowledge, information and belief the Work has progressed as indicated, the
quality of the Work is in accordance with the Contract Documents, and the Contractor is
entitled to payment of the AMOUNT CERTIFIED.
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AMOUNT CERTIFIED
.3toog po
Total changes approved in (Attach explanation if amount certified differs from the amount applied for. Initial all figures
previous months by Owner on this Application and on the Continuation Sheet that are changed to conform to the amount
Total approval this Month certified.)
TOTALS1 0.001 0.00 ARCHITECT:
NET CHANGES by Change Order I 0.00 By: Date: 04V .6
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 �D It otIM 9 �p,�j 3
A P R 0 7 20010
TORGO SOFTWARE httpalwww.torgo.net 01998 -2008 ALL RIGHTS RESERVED
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CONTINUATION SHEET G703 PROJECT: Inlow Park Repairs and Improvements Project Cadence MTC LLC Page 1 of 1
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 001 5408.005
Contractor's signed Certification is attached. APPLICATION DATE: March 16, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: March 26, 2010
PROJECT NUMBER: 5408.005
A B C D E F G H I
Item Description of Work Scheduled Work Completed Materials Total Completed Balance Retainage
Value From Previous This Stored Used and Stored to Finish
Application(s) Period Prior Current To Date
1 Performance Bond 2,000.00 2,000.00 2,000.00 100.00 0.00 200.00
2 Start up Mobilization 3,800.00 3,800.00 3,800.00 100.00 0.00 380.00
3 Demo 8 8,000.00 8,000.00 100.00 0.00 800.00
4 Masonry 20,000.00 0.00 20,000.00 0.00
5 Concrete 6,369.00 0.00 6,369.00 0.00
6 Roofing 3,580.00 0.00 3,580.00 0.00
7 Carpentry 4,680.00 0.00 4,680.00 0.00
8 1Spray Features 14,170.00 0.00 14,170.00 0.00
9 Door Hardware 2,600.00 0.00 2,600.00 0.00
10 Excavation 1,090.00 654.00 654.00 60.00 436.00 65.40
11 Electric 3,491.40 0.00 3,491.40 0.00
12 Plumbing 1 2,180.001 1 0,001 2,180.001 0.00
13 JPainting 7,000.001 1 1 0.00 7,000.00 0.00
GRAND TOTAL: 78,960.401 1 14,454.001 1 14,454.001 18.311 64,506.401 1,445.40
A =Line Item Number B =Brief Item Description C =Total Value of item D =Total of D and E From Previous Application(s) (If Any) E =Total Work Completed For This Application
F= Materials Purchased and Stored for Project G =Total of All Work Completed and Materials Stored for Project H= Remaining Balance of Amount to Finish 1= Amount Withheld from G
TORGO SOFTWARE http: /A& ®1996 -2008 ALL RIGHTS RESERVED
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
Purchase Order No.
Cadence MTC, LLC Date Due
2535 Reavest Dr. S.
Indianapolis, IN 46203
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
3/26110 001 5408 -005 Inlow Park Repairs Improvements 23313 13,008.60
Total 13,008.60
1 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
1 20
Clerk- Treasurer
Voucher No. Warrant No.
Allowed 20
Cadence MTC, LLC
2535 Reavest Dr. S.
Indianapolis, IN 46203 In Sum of
13,008.60
ON ACCOUNT OF APPROPRIATION FOR
103 PARKS CAPITAL. FUND
PO# or INVOICE NO. CCT#/TITLI AMOUNT Board Members
Dept
23313 001- 5408 -005 4460705 13,008.60 1 hereby certify that the attached invoice(s), 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
8 -Apr 2010
I— P&
Signature
13,008.60 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund