189086 08/18/2010 CITY OF CARMEL, INDIANA VENDOR: 363990 Page 1 of 1
ONE CIVIC SQUARE CADENCE MIT LLC
CARMEL, INDIANA 46032 2535 REAVEST DRIVE SOUTH CHECK AMOUNT: $9,296.28
INDIANAPOLIS IN 46203 CHECK NUMBER: 189086
CHECK DATE: 8/18/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
103 4460705 005 5408.005 9,296.28 INLOW PARK
APPLICATION. and CERTIFICATE for PAYMENT
To: Carmel Clay Parks and Project: Inlow Park Repairs and Application No: 005 5408.005 Distribution to:
Recreation Improvements Project
1411 E 116th St 6310 E 131 st St. App Date: July 2, 2010 OWNER
CONSTRUCTION MGR.
r%1 tr+t ecnon Carmel, IN 46032
Period to: June 30, 2010 9 ARCHITECT
From: Cadence MTC LLC CONTRACTOR
2535 Reavest Dr. S. Project Nos: 5408.005 OTHER
Indianapolis, IN 46203
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,
Ap is made for p ay 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 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 received from the Owner, and that current payment shown herein is now due.
,960.40
2. Net Change By Change Orders 24,706.7 CONTR Cadence MTC LLC
3. CONTRACT SUM TO DATE 103,667.1 s j arwuc� By: Date: July 2, 2010
4. TOTAL COMPLETED AND STORED TO DATE 103,667.15 Roxanne Bell
5. RETAINAGE: State of: Indiana County of: Marion
Subscribed and sworn before me this 2nd day of July 2010
a. 10% of Completed Work 1,070.4
b. of Stored Material Roxanne Bell personally appeared before me, the undersigned notary public, and provided
O.0 satisfactory evidence of identification to be the person who signed this document in my
TOTAL RETAINAGE 1,070.44 presence and swore or affirmed to me that the contents of this document are truthful and
accurate to the best of his /her knowledge and belief.
6. TOTAL EARNED LESS RETAINAGE 102,596.71
Notary Publi My Commission expires: 3121 IS
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 93 ,300.4 ARCHIT CERTIFICAT FOR PAYMENT
8. CURRENT PAYMENT DUE 9,296.28 In accordance with the Contract Documents based on on site observations and the data
comprising this application, the Architect certifies to the Owner that to the best of the
9. BALANCE TO FINISH, INCLUDING RETAINAGE F 1,070.441 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. G�
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AMOUNT CERTIFIED
Total Changes approved in 26,746.75 2,040.00 (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
Total approval this Month 0.00 0.00 certified.)
TOTALS 26,746.751 2,040.00 ARCHITEC
NET CHANGES by Change Order 24,706.75 By: Date: 7,Z3 10,110 Purchase
Description TnIov PARK 5 m rcmw en >_5
V t��ertificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
P.O. tor named herein. Issuance, payment and acceptance of payment are without
ag �y 20 `U G. 101 H LA GO p rejudice to any rights of the Owner or Contractor under this Contract.
6d F u U
e�c I n IOV4 Paa-Ih
Purchaser Date
TORGO SOFTWARE http:l/www.t°rgo ts0199ri- �2bf)8 ALL RIGHTS RESERVED pprov 0
CONT INUATION SHEET G703 PROJECT: Inlow Park Repairs and Improvements Project Cadence MTC LLC Page 1 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 005 5408.005
Contractor's signed Certification is attached. APPLICATION DATE: July 2, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: June 30, 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
0.00
1 Performance Bond 2,000.00 2,000.00 0.00 2,000.00 100.00 0.00 0.00
2 Start up Mobilization 3,800.00 3,800.00 0.00 3,800.00 100-00 0.00 0.00
3 Demo 8,000.00 8,000.00 0.00 8,000.00 100.00 0.00 0.00
4 Masonry Labor 20,000.00 20,000.00 0.00 20,000.00 100.00 0.00 0.00
5 Concrete 6,369.00 6,369.00 0.00 6,369.00 100.00 0.00 0.00
6 Roofing 3,580.00 3,580.00 0.00 3,580.00 100.00 0.00 0.00
7 Carpentry 4,680.00 4,680.00 0.00 4,680.00 100.00 0.00 0.00
8 Spray Features 14,170.00 14,170.00 0.00 14,170.00 100.00 0.00 0.00
9 Door Hardware 2,600.00 2,600.00 0.00 2,600.00 100.00 0.00 0.00
10 Excavation 1,090.00 1,090.00 0.00 1,090.00 100.00 0.00 0.00
11 Electric 3,491,40 3,491.40 0.00 3,491.40 100.00 0.00 0.00
12 Plumbing 2,180.00 2,180.00 0.00 2,180.00 100.00 0.00 0.00
13 Painting 7,000.00 7,000.00 0.00 7,000.00 100.00 0.00 0.00
14 CO #1 #1 Remove replace concrete 1,386.00 1,386.00 0.00 1,386.00 100.00 0.00 0.00
15 CO #1 #2 Remove glazed block below 975.00 975.00 0.00 975-00 100.00 0.00 0.0
16 CO #1 #3 Drill Epoxy 4' Dowels where 600.00 600.00 0.00 600.00 100.00 0.00 0.00
17 CO #1 #4 Excavate form constrcut 2 piers 10,839.75 10,839.75 0.00 10,839.75 100.00 0.00 0.0
18 CO #1 #5 Contingency for damage caused 2,500.00 2,500.00 0.00 2,500.00 100.00 0.00 0.0
20 CO 2 dated 6 -10 -10 1 7,646.09 7,646.00 0.001 7,646.001 100.001 0.001 1,070.44
PAGE 1 TOTAL: 1 102,907.151 102,907.15 0.0 F 02,907.151 100.001 0.001 1,070.44
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:M ww.torgo.net ®1996 -2008 ALL RIGHTS RESERVED
CONTINUATION SHEET 6703 PROJECT: Inlow Park Repairs and Improvements Project Cadence MTC LLC Page 2 of 2
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 005 5408.005
Contractor's signed Certification is attached.
APPLICATION DATE: July 2, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: June 30, 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
21 ICO #3 dated 6 -8 -10 2,800.00 2,800.00 0.001 2,800.00 100.00 0.00 000
22 lContingfency not used 2,040.00 2,040.00 0.0 2,040.00 100.00 0.001 020
r
PAGE 2 TOTAL: 760.00 760.001 O.001 760.001 100.001 0.00 0.00
GRAND TOTAL: 1 103,667.151 103,667.15 0.00 103,667.151 100.001 0.001 1,070.44
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 I= Amount Withheld from G
TORGO SOFTWARE http;l /www.torgo. net 01996 -2008 ALL RIGHTS RESERVED
The Schneider Corporation
S chneider Historic Fart Harrison 8901 Otis Avenue Indianapolis. IN 46216 -1037 Phone: 317.826.7100 Fax: 317.826.7200
TRANSMITTAL
TO: Audrey Kostrzewa DATE: 2010.07.23
Carmel -Clay Board of Parks JOB 7628.001
1411 E 116 Street PROJECT: Inlow Park
Carmel, IN 46032 RE: Pay Application #5
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 2010.07.23 Certified Copy of Pay Application #5
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
JUL 7 2010
By.
If enclosures are not as noted, kindly notify us at once.
t:1 7k1 762810011docsllransmitlals12010 .07.23 kostrzewa inlow pay application #5.docx
r
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
2535 Reavest Dr. S. Date Due
Indianapolis, IN 46203
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) PO Amount
712110 005 5408.005 Inlow Park Repairs Improvements 20535 9,296.28
Total 9,296.28
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.
363990 Cadence MTC, LLC Allowed 20
2535xReavest`
.Indlanapolts, IN 46203:'
In Sum of
9,296.28
ON ACCOUNT OF APPROPRIATION FOR
103 PARKS CAPITAL FUND
PO# or INVOICE NO. kCCT#fTITLI AMOUNT Board Members
Dept
20535 005 5408.005 4460705 9,296.28 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
12 -Aug 2010
�GL L //znw
Signature
9,296.28 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund