187728 07/21/2010 CITY OF CARMEL, INDIANA VENDOR: 363990 Page 1 of 1
ONE CIVIC SQUARE CADENCE MIT LLC
CHECK AMOUNT: $14,295.85
CARMEL, INDIANA 46032 2535 REAVEST SOUTH DRIVE
INDIANAPOLIS IN 46203 CHECK NUMBER: 187728
CHECK DATE: 7/2112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
103 4460705 0045408.005 8,406.00 INLOW PARK
103 4460705 20535 0045408005 5,889.85 INLOW PARK REPAIRS
APPLICATION and CERTIFICATE for PAYMENT
To: Carmel Clay Parks and Project: Inlow Park Repairs and Application No: 004 5408.005 Distribution to:
Recreation Improvements Project
1411 E 116th St 6310 E 131st St. App. Date: June 18, 2010 H OWNER
0--i IM ecnrnn Carmel IN 46032 O CONSTRUCTION MGR.
From: Cadence MTC LLC Period to: June 18, 2010 0 []CONTRACTOR
2535 Reavest Dr. S. Project Nos: 5408.005 0 OTHER
Indianapolis, IN 46203
Contract Date: March 9, 2010 RECFAVED
Contract For: Via Architect: Schneider Corporation 2010
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's k wledge,
Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment h p completed
in accordance with the Contract Documents, that all amounts have been p
Continuation Sheet, G703 is attached. Contractor for Work for which previous Certificates for Payment were issued and payments
1. ORIGINAL CONTRACT SUM received from the Owner, and that current payment shown herein is now due.
78, 960.4
2. Net Change By Change Orders 24,706.75 CONTRA OR: Cadence MTC LLC
3. CONTRACT SUM TO DATE 103 ,667.15 I3y: 6e f do Date: June 18, 2010
4. TOTAL COMPLETED AND STORED TO DATE 1 103,667.15 Roxanne Bell
5. RETAINAGE: State of: Indiana County of: Marion
a. 10% of Completed Work 1 10,366.721 Subscribed and sworn before me this 18th day of June 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 presence and swore or affirmed to me that the contents of this document are truthful and
10,366.72 accurate to the best of his /her knowledge and belief.
6. TOTAL EARNED LESS RETAINAGE 93,300.43
Notary Publi My Commission expires:
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 79,004.58 ARCHITEEOT'S CERTIFICATE OR PAYMENT
8. CURRENT PAYMENT DUE 14,295.8N In accordance with the Contract Documents, based on on -site observations and the data
9. BALANCE TO FINISH, INCLUDING RETAINAGE 10 comprising this application, the Architect certifies to the Owner that to the best of the
,366.72 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 H 1 Z 8 5
Total changes approved in 16,300.75 0.00 (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
T otal approval this Month 10,446.00 2,040.00 certified.)
TOTALS 26,746,751 2,040.00 ARCHITECT:
NET CHANGES by Change Order 24,706.75 By: l QZ,419 Date:
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.
TORGO SOFTWARE http:ltwww.torgo.net 01996 -2008 ALL RIGHTS RESERVED
CONTINUATION SHEET 6703 PROJECT: Inlow Park Repairs and Improvements Project Cadence MTC LLC Page 1 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 004 5408.005
Contractor's signed Certification is attached.
APPLICATION DATE: June 18, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: June 18, 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
0.0
1 Performance Bond 2,000.00 2,000.00 0.00 2,600,00 100.00 0.00 200.0
2 Start up Mobilization 3,800.00 3,800.00 0.00 3,800.00 100.00 0.00 380.0
3 Demo 8,000.00 8,000.00 0.00 8,000.00 100.00 0.00 800.00
4 Masonry Labor 20,000.00 20,000.00 0.00 20,000.00 100.00 0.00 2,000.0
5 Concrete 6,369.00 6,369.00 0.00 6,369.00 100.00 0.00 636.90
6 Roofing 3,580.00 0.00 3,580.00 3,580.00 100.00. 0.00 358.0
7 ICarpentry 4,680.00 4,680.00 0.00 4,680.00 100.00 0.00 468.00
8 Spray Features 14,170.00 14,170.00 0.00 14,170.00 100.00 0.00 1,417.0
9 Door Hardware 2,600.00 2,600.00 0.00 2,600.00 100.00 0.00 260.0
10 Excavation 1,090.00 1,090.00 0.00 1,090.00 100.00 0.00 109.0
11 Electric 3,491.40 2,793.12 698.28 3,491.40 100.00 0.00 349.14
12 Plumbing 2,180.00 2,180.00 0.00 2,180.00 100.00 0.00 218.00
13 Painting 7,000.00 6,300.00 700.00 7,000.00 100.00 0.00 700.00
14 CO #1 #1 Remove replace concrete 1,386.00 1,386.00 0.00 1,386.00 100.00 0.00 138.6
15 CO #1 #2 Remove glazed block below 975.00 975.00 0.00 975.00 100.00 0.00 97.5
16 CO #1 #3 Drill Epoxy 4` Dowels where 600.00 600.00 0.00 600.00 100.00 0.00 60.00
17 CO #1 #4 Excavate form constrcut 2 piers 10,839.75 10,839.75 0.00 10,839.75 100.00 0.00 1,083.98
18 CO #1 #5 Contingency for damage caused 2,500.00 0.00 2,500.00 2,500.00 100.00 0.00 250.00
20 CO 2 dated 6 -10 -10 7,646.001 7,646.001 1 7,646.001 100.001 0.001 764.60
PAGE 1 TOTAL: 1 102,907,151 87,782.871 15,124.281 1 102,907.1 100.001 0.001 10,290.72
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:l /www.lorgo net 01996 -2008 ALL RIGHTS RESERVED
eh
C ONTIN UAT ION SHEET G703 PROJECT: Inlow Park Repairs and Improvements Project Cadence MTC,LLC Page 2 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 004 5408.005
Contractor's signed Certification is attached.
APPLICATION DATE: June 18, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: June 18, 2010
PROJECT NUMBER: 5408.005
A B C D E F G H I
Item Description of Work Scheduled Work Completed Materials Total Completed 0 /0 Balance Retainage
Value From Previous This Stored Used and Stored to Finish
Application(s) Period Prior Current To Date
21 ICO #3 dated 6 -8 -10 2,800.0 2,800,001 2,800.00 100.0 0.0 280.00
22 lContingfency not used 1 2,040.00 2,040.00 -2,040.01 100.001 0.00 204.00
PAGE 2 TOTAL: 1 760.0 760.00 1 760.001 100.0 0.00 76.0
GRAND TOTAL: _103,667.151 87,782.871 15,884.281 1 103,667.1 100.0 0.0 10,366.72
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 Compieted 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 i= Amount Withheld from G
TORGO SOFTWARE http:ltwww.torgo.net ®1998 -2008 ALL RIGHTS RESERVED
The Schneider Corporation
S chneider Historic Fort Harrison 8901 Otis Avenue Indianapolis, IN 4621.6-1037 Phone: 317.826.7100 Fax: 317.8263200
TRANSMITTAL
TO: Audrey Kostrzewa DATE: 2010.06.30
Carmel -Clay Board of Parks JOB 7628.001
1411 E 116 Street PROJECT: Inlow Park
Carmel, IN 46032 RE: Pay Application #4
FROM: Michael Krosschell FAX
FAX: NUMBER OF PAGES:
DIRECT DIAL: 826.7189 TELEPHONE
WE ARE SENDING YOU:
Attached Via: Mail Fed Ex UPS Courier Pick Up Other Fax
Copies Date Description
1 2010.06.30 Certified Copy of Pay Application #4
THE ABOVE ARE TRANSMITTED as checked below:
For approval As requested FOR BIDS DUE
For your use For review and comment Other
REMARKS:
Audrey: please call me if you have any questions.
Thanks
COPY TO:
File
y 7�
Jut l
If enclosures are not as noted, kindly notify us at once.
t:\7k1762810011docs\transmiflals\2010.06.30 kostrzewa inlow pay application 44.docx
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.
363990 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
6/18110 004 5408.005 Inlow Park Repairs Improvements 20535 5,889.85
6118110 004 5408.005 Inlow Park Repairs Improvements 20535 8,406.00
Total 14,295.85
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
,20
Clerk- Treasurer
Voucher No. Warrant No.
Allowed 20
363990 Cadence MTC, LLC
2535 Reavest Dr. S.
Indianapolis, IN 46203 In Sum of
14,295.85
ON ACCOUNT OF APPROPRIATION FOR
103 PARKS CAPITAL FUND
PO# or INVOICE NO. kCCT #/TITL1 AMOUNT Board Members
Dept
20535 004 5408.005 4460705 5,889.85 1 hereby certify that the attached invoice(s), or
103 004 5408.005 4460705 8,406.00 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
15 -Jul 2010
Signature
14,295.85 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund