191573 11/10/2010 +M CITY OF CARMEL, INDIANA VENDOR: 363990 Page 1 of 1
ONE CIVIC SQUARE CADENCE MIT LLC
CHECK AMOUNT: $1,070.44
CARMEL, INDIANA 46032 2535 REAVEST DRIVE SOUTH
INDIANAPOLIS IN 46203 CHECK NUMBER: 191573
CHECK DATE: 11!1012010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
103 4460705 6- 5408.005 1,070.44 INLOW PARK
APPLICATION and CERTIFICATE for PAYMENT
To: Carmel Clay Parks and Project: Inlow Park Repairs and Application No: 006 5408.005 Distribution/to:
Recreation Improvements Project.
1411 E 116th St 6310 E 131 st St. App. Date: October 20, 2010 X OWNER
CONSTRUCTION MGR.
r.., tnt. Carmel, IN 46032
From: Cadence MTC LI_C Period to: October 31, 2010 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 APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Ap is made for p ayment, 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
ORIGINAL CONTRACT SUM received from the Owner, and that current payment shown herein is now due.
78;960.40
2. Net Change By;Change Orders 24,706.75 CONTRACTOR: Cadence MTC LLC
3. CONTRACT SUM TO DATE 103,667.15 By: Q C I Date: October 20, 2010
4. TOTAL COMPLETED. AND STORED TO DATE 103,667.15 Roxanne Bell
5. RETAINAGE: State of: Indiana County of: Marion
a. 10% Of Completed Work 0.00 Subscribed and sworn before me this 20th day of October 2010
b. of Stored Material Roxanne Bell personally appeared before me, the undersigned notary public, and provided
O.OQ satisfactory evidence of identification to be the person who signed this document in my
TOTAL RETAINAGE 0.00 Presence and swore or affirmed to me that the contents of this document are truthful and
accurate to the b f his /her knowledge and elief.
6. TOTAL EARNED LESS RETAINAGE 103,667.15
Notary Public: My Commission expires:��
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 1027596.71 ARCHITE &T'S CERTIFICATE FOR PAYMENT
8. CURRENT PAYMENT DUE 1 1•1071,44 "Ih- accordance with the Contract Documents, based on on -site observations and the data
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0 comprising this application, the Architect certifies to the Owner that to the best of the
.00 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
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
T otal approval this Month 0.00 0.00 ce I
TOTALSI 26,746.75 2,040.00: ARCHITECT:
NET CHANGES by Change Order 24,706.75 By Date: /0. ZG. Z'010
t ,,mo IM This Certific is not negotiable, The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
1010 prejudice to any rights of the Owner or Contractor under this Contract.
+•a
TORGO SOFTWARE http 01996 -2008 ALL RIGHTS RESERVED
CONTINUATION 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: 006 5408.005
Contractor's signed Certification is attached. APPLICATION DATE: October 20, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: October 31, 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 1PIumbing 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 0.00
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 0.00
18 CO #1 #5 Contingency for damage caused 2,500.001 2,500.00 0.00 2,500.00 100.00 0.00 0.00
20 CO 2 dated 6 -10 -10 7,646.001 7,646.00 0.00 7,646.001 100.00 0.00 0.00
PAGE 1 TOTAL: 102,907.151 102,907.151 0.001 1 102,90716F 0.00 0.00
A =Line Item Number 6 =13rief 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:/Avww.torgo.net 01996 -2008 ALL RIGHTS RESERVED
CONTINUATION 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: 006 5408.005
Contractor's signed Certification is attached. APPLICATION DATE: October 20, 2010
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: October 31, 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 CO #3 dated 6 -8 -10 2,800.00 2,800.00 0.00 2,800.00 100.001 0.001 0.00
22 lContingfency not used 1 2,040.00 2,040.00 0.00 -2,040.001 100,001 0.001 0.00
PAGE 2 TOTAL: 760.00 760.001 0.001 760.001 100.001 0.001 0.00
GRAND TOTAL: 1 )3,667.151 103,667.15 0.00 103,667.15 100.001 0.001 0.00
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: /www.torgo.net 01996 -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.
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
10/20/10 6- 5408.005 Inlow Park Repairs Improvements 20535 1,070.44
Total 1,070.44
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,
363990 Cadence MTC, LLC Allowed 20
2535 Reavest Dr. S.
Indianapolis, IN 46203
In Sum of
1,070.44
ON ACCOUNT OF APPROPRIATION FOR
103 PARKS CAPITAL FUND
PO# or INVOICE NO. kCCT W AMOUNT Board Members
Dept
20535 F 6- 5408.005 4460705 1,070.44 I 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
4 -Nov 2010
Signature
1,070.44 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund