162704 08/20/2008 CITY OF CARMEL, INDIANA VENDOR: 356511 Page 1 of 1
ONE CIVIC SQUARE DAWSON INC
CARMEL, INDIANA 46032 6221 S HARDING ST CHECK AMOUNT: $15,304.04
INDIANAPOLIS IN 46217 CHECK NUMBER: 162704
CHECK DATE: 8/20/2008
D EPARTMENT ACCOUNT PO NUMBER INVOICE NUMB AMOUNT DESCRIPTION
902 4460805 1606 15,304.04 RETAIL SITE #5
i
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGEONEOF PAGES
TO OWNER: Carmel Redevelopment C OMMiSsion PROJECT: Carmel Parcel 5 APPLICATION NO: 0008 Distribution to:
One Civic Square PERIOD TO: 7/30/2008 OWNER
Carmel, IN 46032
PROJECT NOS.: ARCHITECT
FROM CONTRACTOR: Dawson Incorporated ARCHITECT: CSO Architects CONTRACTOR
6221 S. Harding Street 280 E. 96th Street
Indianapolis, IN 46217 Indianapolis, IN 46280 CONTRACT DATE: 6/23/2005
C ONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information
and belief the Work covered by this application for Payment has been completed in accordance
Application is made for payment, as shown below, in connection with the contract. with the Contract Documents, that all amounts have been paid by the Contractor
Continuation Sheet, AIA Document G703, is attached. for Work for which previous Certificates for Payment were issued and payment received
1. ORIGINAL CONTRACT SUM $392,700.00 from the Owner, and that current payment shown herein is now due.
CONTRACTOR: Dawson Incorporated
2. Net change by Change Orders $34,268.00 B A n il
Y !ll`=`e�" Date: 7/24/2008
3. CONTRACT SUM TO DATE (Line 1 ±2) $426 ,968.00
4. TOTAL COMPLETED STORED TO DATE $420.504.00 State of INDIANA
(Column G on G703) County of: MARION
5. RETAINAGE: Subscribed and sworn to before
a. 5.000 %of Completed Work $21,025'20 me this 7/24/2008
(Columns D E on G703) Notary Publi /o
b. 0 of Stored Material $0.00
(Columns F on G703) My Commis expires: 7/14/2009
'Total Retainage (Line 5a 5b or 21,025 20
Total in Columns I on 0703)
ARCHITECTS CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $399 ,478.80 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) 384,174.76 quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 15 304.0 is entitled to payment of the AMOUNT CERTIFIED.
9. (BALANCE TO FINISH, INCLUDING RETAINAGE
AMOUNT CERTIFIED
(Line 3 less Line 6) $27 489.20 (Attach explanation if amount certified differs from the amount applied for. Initial
all figures on t Application and on the Continuation Sheet that are changed to
CHANGE ORDER SUMMARY ADDITIONS DEDUCTION conform t e inoitn tifie
Total changes approved in ARC E
p revious months by Owner $34,268.00 $0.00
BY Date:
t his $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
TI)tal approved TOTALS $34 $0.00 Contractor named herein. Issuance, payment and acceptance of payment are without
N ET CHANGES by Change Order $34 268-00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT. 1992 EDITION AIAQ. 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
ggq AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright taws and will subject the violator to legal prosecution, 6702 1992
'rhis document hsa been reproduced alectmnlcoily with tha parndsslon of The Amedcen Irmtltute of Architects under Llconse 07003 to Pdmavam aystenn, Inc. Reproduction o(tNs document vdihmd Pmlecl apeel9c Information is not permitted.
Contact The American Instituta of Architects to vedfy the current vemlon of this document and license status.'
CO SHEET AIA DOCUMENT G703 PAGE 1 OF I PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO,: 0008
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 7/30/2008
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO IF F VARIABLE)
E)
NO, VALUE APPI [CATION THIS PERIOD STORED AND STORED TO FINISH RATE
(D E) (NOT IN D OR E) DA "PE (D +E +F) (C 'T C) (C G)
000000001 SANITARY SEWER
000000002 Labor $66,256.00 $58,967.84 $4,637.92 $0.00 $63,605.76 96.000 $2,650.24
21000000003 Material $95,344.00 $84,856.16 $6,674.08 $0.00 $91,530.24 96.000 $3,813.76
000000005 MONON TRAIL
000000006 Asphalt $23,000.00 $23,000.00 $0.00 $0.00 $23,000.00 100.000 $0.00
000000007 Labor $27,400.00 $27,400.00 $0.00 $0.00 $27,400.00 100.000 $0.00
000000008 Material $29,900.00 $29,900.00 $0.00 $0.00 $29,900.00 100.000 $0.00
000000010 EXISTING DITCH
000000011 Labor $3,900.00 $3,900.00 $0.00 $0.00 $3,900.00 100.000 $0.00
000000012 Material $6,900.00 $6,900.00 $0.00 $0.00 $6,900.00 100.000 $0.00
000000014 STORM SEWER
000000015 Labor $51,800.00 $51,800,00 $0.00 $0.00 $51,800.00 100.000 $0.00
000000016 Material $88,200.00 $88,200.00 $0.00 $0.00 $88,200.00 100.000 $0.00
000000019 I Change Order No. 1 $34,268.00 1 $29,470.48 1 $4,797.52 1 $0.00 1 $34,268.00, 100.000 $0.00
TOTA 1 $426,968.01 $404,394.481 $16,109.52 $0.01 $420,504.01 98.49 $6,464.0(1
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT e 1992 EDITION AIAN 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G703 -1992
AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S, copyright laws and will subject the violator to legal prosecution.
'rhls document hes been reproduced electronicallyy with the permission of The American Institute of ArchRecl° under Ucense 07003 to Prlmevera System, Inc. Reproduction of this document vAthout pmPediAc Infomtaton is not permitted. Contact The American Institute of Architects
to vedfv the current version of this document and license status!'
PARTIAL WAVIER OF LIEN
STATE OF INDIANA
SS:
COUNTY OF MARION
KNOW ALL MEN BY THESE PRESENTS, That the undersigned:
Dawson. Incorporated
for and in consideration of: APPLICATION NO: 0008 PERIOD TO: 7/30/2008
for payment in the amount of $15,304.04
does upon receipt of said payment hereby waive, release and surrender any and all liens or claims or rights to
lien, for labor, material and/or services, and further certifies that no other party has any claim or right to a lien,
on account of any work performed or material furnished to the undersigned for said project situated in the
County of Marion, State of Indiana, described as follows:
PROJECT: Carmel Parcel 5
PROJECT NO:
ARCHITECT: CSO Architects
CONTRACT:
Dawson Incorporated
CONTRACTOR
Date: 7/24/2008
By:
State of INDIANA
County of MARION
Subscribed and sworn to before me on: 7/24/2008
Notary Public:
My Commission expires: 7/14/2009
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.
n/ Payee
*'Call p o '-c 4 C 0( Purchase Order No.
I f Terms
f'N G 2 7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
7/ 3 b8 NA P S I S Soy ail
3
t
X,
Total I S d3o y o y
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.Y
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
fN q �o7- r
ON ACCOU T OF APPROPRIATION FOR
`l I F
Z� 44G0 SOS
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
lot N A 4vG6 ?os 15 3oti. y 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
20 a�
Igna r
o c e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund