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Home My WebLink About159948 05/28/2008 CITY OF CARMEL, INDIANA VENDOR. 358569 Page 1 of 1 a O ONE CIVIC SQUARE KEYSTONE CONSTRUCTION CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR CHECK AMOUNT: $2,838.00 INDIANAPOLIS IN 46204 CHECK NUMBER: 159948 CHECK DATE: 5128!2008 DEPARTMENT ACCOUN PO NUMBER INVOICE N UMBER AMOUNT DESCRIPTION 902 4460846 2,838.00 i j APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION AIA DOCUMENT l_r 7021CAfa PAGE ONE OF ONE PAGES TO OWNER: PROJECT: Rotary PI APPLICATION NO: 1 Distribution to: CRC Parcel 0 Les Olds p XQOWNER PERIOD TO: 9/3012006 FICONSTRUCTION FROM: Keystone Construction PROJECT NO: 61 Li MANAGER 47 South Pennsylvania Street, 10th Floor Indianapolis, IN 46204 QARCIIITECT CONTRACT DATE: 06/14/06 CONTRACTOR VIA CONSTRUCTION MANAGER: CONTRACT FOR VIA ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor ccrtifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract, information and beliefthe Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached, completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM S 5,898 2. Net change by Change Orders 0.00 CONTRACTOR: KEYSTONE CONSTRUCTION CORPORATION 3. CONTRACT SUM TO DATE (Line I t 2) 5,899 4. TOTAL COMPLETED STORED TO DATE 2,838 (Column G on G703) 13 Date: S. RETAINAGE: a. 0% of Completed Work 0 state of-. =0 1# j Countyof: m/4raeo" (Column D E on G703) Subscribed and sworn to before me this F TY day of &p t 20 901<, b. 0 of Stored Material 0.00 Notary Public: (Column F on G703) My Commission expires: 1001,) 16, J C 5 B Total Retainage (Lines Sa+ 5b or Total in Column. lofG703) s o CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE S 2,838 In accordance with the Contract Documents, based on on-site observations and the data (Line 4less Line 5 Total) S comprising this application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERT'1FICATES FOR Owner that to the best of their knowledge, information and belief the Work has PAYMENT (Line 6 from prior Certificate) S 0 progressed as indicated, the quality of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE S 2,838 Documents, and the Contractor is entitled to payment ofthe AMOUNT CERTWIED- 9. BALANCE TO FINIISH, INCLUDING RETAINAGE S 3,060 (Line 3 less Line 6) AMOUNT CERTIFIED 8,0� CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach planationifamount certified dffersfmm the amount applledfor .Initiafall Total changes approved fg�res on this Ap lion and on the Condmralion Sheer that changed to conform to the in previous months by Owner amount ce CONS CTI MANA Total a roved this Month By: Date: [-RTE TOTALS $0.00 $0.00 B Date: QG NET CHANGES by Change Order s0 -0o 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 AIADOCUMENT G7DLCk% APPUCA11ON AND CERTIFICATION FOR PAYMENT'CONSTRUO"ON MANAGER- AOVISER EDRION•1992 EDMON- AIA 01992 07MCMa -1992 Ric AMERICANIi r1MEOFAROHr7EOTs, 17 45NEWYORKAVE ,N.W..WASHINOTOR.002Wo s292 7` Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of Document's Authenticity APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION AIA DOCUMENT G PACE Ot4E OF t7rtE PAGES TO OWNER: PROTECT: Rotary Plaza APPLICATION NO: 1 Distribution to: p p CRC Parcel fM6 D Les Olds ®OWNER FROM: PEMODTO: 4/30/1006 E]CONSTRUCTION Keystone Construction PROJECT NO: 611.1 MANAGER 47 South Pennsylvania Street, 10th Floor Indianapolis, IN 46204 ARCHITECT CONTRACT DATE: 06/14/06 aCONTRACTOR VIA CONSTRUCTION MANAGER: CONTRACT FOR: VIA ARCHITECT. CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Convector certifies that to the best ofthaConvactor•sknowledge, Application is made for payment, as shown Wow, in connection with the Contract. information and beltefthe Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached, completed in accordance with the Contact Documents, that a3t amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM S 5 -898 2. Net change by Change Orders 0.00 CONTRACTOR: KEYSTONE CONSTRUCTION CORPORATION 3. CONTRACT SUM TO DATE (Line 1 f 2) S 5.898 4, TOTAL COMPLETED STORED TO DATE S 2.838 (Column O on G703) By Date: 5. RETAINAGE: a. 0% of Completed Work S 0 State of -1�L`•l A i A Ai P1 county or tt1 A a I o Q (Column D E on 0703) Subscribed and sworn to before me this a s rq day of Sep r 20 0 4 P b. 01/. of Stored Material S 0,00 Notary Public: o Q (Column F on G703) My Commission eapirs; i~ AJO r Total Retainage(Llnes5a +5b or Total in Column I ofG703) o CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE S 2,838 In accordance with the Contract Documents, based on on-she observations and the dam (Line 4 less Line 5 Total) S comprising this application, the Construction Manager and Architect certify to the 7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information end belief the Work has PAYMENT (Une 6 from prior Certificate) 0 progressed as indicated, the quality of the Work is in accordance with the Contract 8. CURRENT PAYMENT DUE S 2,838 Documents, and the Contractor is entitled to payment ofthe AMOUNT CERTIFIED, 9. BALANCE TO FINISH, INCLUDING RETAWAGE S 3,060 (Line 3 less Line 6) AMOUNT CERTIFIED S CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach ecptanottwt ifamoany cerryFed differrfrun the amamw applied for, Mirial all Total changes approved figures an this Application and on the Conrimrarian Sheer drat changed to conform to the In previous months by Owner amount cerried.} CONSTRUCTION MANAGER: Tout Nproved this Month BY Date_ ARCHITECT: TOTALS $0.00 SO. DO By, Date: NET CHANGES by Change Order SO.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Cannanor named herein. Issuance, payment end /eeeptanee of payment are wt*haut prejudice to any rights of the owner or Contactor under this Contract. mA cocumun G7021CN.- Amur T1oN AND CERnmeAne" FOR PA•MENT'CONsmuenoN vAnAGCR.,. sER euncm- raft WM04•".01992 r:7a9ew•l sea rNE AN£RIr,J1N I -UTr4V E Or ARCNITECrS.1n4 NEW YORRA4F— N, W- V1N.SMNGIrON, DG zomzm Users may obtain validation of this document by requesting of the Wense a completed AIA Document D401 Certification of Documents Authenticity CONTINUATION SHEET AI DOCUMENTG703 PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 1 Contractor's signed certification is attached. APPLICATION DATE: 9/20/2006 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 9/30/2006 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PRO.ECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE NO, VALUE FROM PREVIOUS TIES PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C G) RATE) (D E) (NOT IN TO DATE D OR E) (D+E +F) 1 General Conditions $3,500 $1,750 $1,750 50.00% $1,750 $0 $o $0 $0 $0 $o $o $0 $0 $o $o $0 $o $0 $0 $0 $0 $0 $0 $0 $0 $0 $o $o $0 $o $o $o $o $o $o $o $o $0 $0 o $o $o $o $o $o $0 $o $o $o $o $o $0 $o $0 $0 $o $o $o $o $o $0 20000 OH &P(5 $2,398 $1,088 $1,088 45.37% $1,310 $o $0 $o GRAND TOTALS $5,898 $0 $2,838 $0 $2,838 48% $3,060 $o Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity r 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. Payee keyf� C oAr'g`�c Lo Purchase Order No. 4 7 Sew/ /tnnl,, 4-AA #A �d fto Terms g po<<s, rA/ qd zoy Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) APPC I Ro p14 Z �6 2 Total 7 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. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 k 1 Xr4^c Cons IN SUM OF P .A.v�.. L� I AA I.f, ratl c�GZ y z, S3 S ON ACCOUNT OF APPROPRIATION FOR 0/0 Z Z qY6 cp Y� Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. 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 20 Signature Title Cost distribution ledger classification if claim paid motor vehicle highway fund