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HomeMy WebLinkAbout155903 01/23/2008 CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CHECK AMOUNT: $646,701.00 CARMEL, INDIANA 46032 720 3RD AVE SW CARMEL IN 46032 CHECK NUMBER: 155903 CHECK DATE: 1/23/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460805 525,091.00 RETAIL SITE #5 902 4460874 121,610.00 IDC PARKING GARAGE i( APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 74 APPLICATION NO: 10 Distribution to: One Civic Square Indiana Design Center DOWNER Carmel, Indiana 46032 Parking Garage P 12 F___�ARCFIITECT PERIOD TO: 12131/2007 ®CONTRACTOR FROM CONTRACTOR: VIA ENGINEER: CSO Schenkel Schultz 0 Signature Construction LLC 600 E. 96th Street 720 3rd Avenue S.W. Indpls., In. 46240 PROJECT NOS: 23233HC Carmel, Indiana 46032 CONTRACT DATE: 1/12/2007 CONTRACTOR APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. mtormation and beliet'the Work covered by this Application for Payment has been Continuation Sheet, AIA Document 6703, 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. L ORIOINALCONeKACI'SUM 1,205,000.00 2. Net chap eb Change o. IKAC'1 OR: g Y g CON 3. CON "I'RACI SUM '1'0 DATE (Line 1 f 2) o. o 4. '1'OT'AL COMPLEt'ED c� ST'OKEll'1'U By: l 1 ate ''.r�1k`+1W P1 fW, 1-i' 5. RETA1NAUE: as ntz, rest n 4' t 1 I'"H 0 MSC a. U.US of Completed Work 61,366.29 Subscr a and orn to betore me this day of I� 2 7J� o umn D L on G703) b. of Stored Material o umn F' on 6703) Total Retainage (Lines 5a+ 5b or Total in Column 1 ofG703) 61,366 -24 6. IUTAL EAKNEll LESS KETAINAUL In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 '1 otal) comprising the application, the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CEKt'1FTCAI ES FOR Engineer's knowledge, mlormation and belief the Work has progressed as indicated, PAYMENT' (Line 6 trom prior Certificate) 1,044,349.56 the quality of Work is in accordance with the Contract Documents, and the Contractor -8. CURRENT PAYMENT' DUE is entitled to payment of the AMOUNT' CEK11FTED. 9. BALANCE'10 FINISH, INCLUDINU RETAINAGE 6 1,7667T (Line 3 less Line 6) AMOUNT CEICIIF'lED (Attach expl ation amount ruyi differs front the amount applied. Initial all figures on this T otal changes approved Applicatio and o he C n nu tion eel that are changed to conform with the amount certified.) in previous months by Owner ENGIN R: Total approved this Month By: Date 1'21/9107 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the k Omraculr narneu nereln. issuance, payment anu acceptance of payment are W1muut NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 1 of 1 To: grom: Project: Application No. 10 Carmel Redevelopment Commission Signature Construction LLC Parcel 74 Application Date: 12/31/07 One Civic Square 720 3rd Avenue S.W. Indiana Design Center Period To: 12/31/07 Carmel, Indiana 46032 Carmel, Indiana 46032 Parking Garage P12 Engineer's Project No. 23233HC A B C D E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To If Description of Work value Application This Period (Not in To Date -(G /C) Finish variable D or E) (D +E +F) (C -G) 101 General Requirement 277,700.00 258,261.00 19,439.00 0.00 277,700.00 100% 0.00 0.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 455,287.50 447,718.60 7,568.90 0.00 455,287.50 100% 0.00 0.00 104 Masonry 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 105 Metals 140,000.00 140,000.00 0.00 0.00 140,000.00 100% 0.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0100 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 22,400.00 22,400.00 0.00 0.00 22,400.00 100% 0.00 0.00 108 openings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 109 Finishes 0.00 0.00 0.00 0.00 0.00 0 9 6 0.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 111 Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 123 Heating, ventilation AC 0.00 0.00 0.00 0100 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0100 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 331,938.35 292,008.80 39,929.55 0.00 331,938.35 100% 0.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 .0.00 0 9 6 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 0 9 6 0.00 1,227,325.85 1,160,388.40 66,937.45 0.00 1, 227, 325. 85 100 0.00 0.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as PARCEL 74, INDIANA DESIGN CENTER PARKING GARAGE P12 located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of one hundred twenty —one thousand six hundred and ten dollars (121,610.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC I N ICC Tho s E. Koontz p lion Cox ft Wir-� President Subscribed and savor to before me this: Notary Public:' APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 74 APPLICATION NO: 10 Distribution to: One Civic Square Indiana Design Center =OWNER Carmel, Indiana 46032 Parking Garage P12 =ARCHITECT PERIOD TO: 12/31/2007 ®CONTRACTOR FROM CONTRACTOR: VIA ENGINEER: CSO Schenkel Schultz Signature Construction LLC 600 E. 96th Street 720 3rd Avenue S.W. Indpls., In. 46240 PROJECT NOS: 23233HC Carmel, Indiana 46032 CONTRACT DATE: 111.2!2007 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractor's knowled Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document 6703, 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. I. OK16INAL CON 1 RAC I SUM 1,205,000.00 2. Net change by Change Orders 22,325.85 CONTRAC I OR: 3. CON 1'RAC'I SUM 10 DA I'E (Line I f 2) 4. '10 FAL COMPLE I Ell ST'ORED'1'U By: irate: i,.-- 5. RE'I'AINAUE: omas oon rest ent �i °��'tl� _E1, a. 0.05 %ot Completed Work 61,366.29 Sub cubed an sworn to before me this I day of 4__R ©r3 o umn D E on 6703) jiorj CCA01th b. of Stored Material oumnFonU703) Total Retainage (Lines 5a 5b or Total in Column I of G703) 61,366.29 6. 'YOTAL EAKNED LESS RE°I'AINAGE 16.0o 9..) .o In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 51 otal) comprising the application, the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CEK'FIF'ICA'I'ES FOR Engineers knowledge, mtormation and beliefthe Work has progressed as indicated, PAYMENF (Line 6 from prior Certificate) 1,044,349.56 the quality ofthe Work Is in accordance with the Contract Documents, and the Contractor 8. CUKREN I PAYMENT' DUE 121,610,00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE FU FINISH, INCLUDINU KE'1'AINAGE (Line 3 less Line 6) AMOUN CEK'I'11•' lo.� T (Atlach ex anatio tf amount certified differs from the amount applied. Initial ali figures on this ota changes approved Applica on and nhe t at eet that are changed to conform with the amount certified.) in previous months by Owner ENGI EER Month B N Date lZ Total approved this M Y 1 JP/4" TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to tT� l,UmraCWr nameu nerem. issuance, paymeni anu acceptance U1 payment are wanout NET CHANGES by Change Order $0.00 prejudice to any rights ofthe Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLiCATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 019S2 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 1 of 1 To: From: Project: Application No. 10 Carmel Redevelopment Commission Signature Construction LLC Parcel 74 Application Date: 12/31/07 One Civic Square 720 3rd Avenue S.W. Indiana Design-Center Period To: 12/31/07 Carmel, Indiana 46032 Carmel, Indiana 46032 Parking Garage P12 Engineer's Project No. 23233HC A B C D E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To If Description of work value Application This Period (Not in To Date (G /•C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 277,700.00 258,261.00 19,439.00 0.00 277,700.00 100% 0.00 0.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 455,287.50 447,718.60 7,568.90 0.00 455,287.50 100% 0.00 0.00 104 Masonry 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 105 Metals 140,000.00 140,000.00 0.00 0.00 140,000.00 100% 0.00 0.00 106 wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 22,400.00 22,400.00 0.00 0.00 22,400.00 100% 0 -00 0.00 108 Openings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 109 Finishes 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0 9 6 0.00 0.00 111 Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 123 Heating, ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 integrated Automation 0100 0.00 0.00 0 -00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0100 0.00 0 -00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 331,938.35 292,008.80 39,929.55 0 -00 331,938.35 100% 0 -00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0100 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process integration 0.00 0.00 0.00 0.00 U.QO 0% 0.00 0.00 141 Material Processing a Handling Equip. 0.00 0.00 0.00 0.00 4.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 0% 0.00 1,227,325.85 1,160,388.40 66,937.45 0.00 1,227,325.85 100% 0.00 0.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as PARCEL 74, INDIANA DESIGN CENTER PARKING GARAGE P12 located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of one hundred twenty -one thousand six hundred and ten dollars (121,610.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC �a' F Val sEAL f' r 1Cd� ly ri 1C omas E. Koontz q President Subscribed and sworn t efore me this: 1 T'lT v7 Notary Public: vlr Y+"' APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 74 APPLICATION NO: 10 Distribution to: One Civic Square Indiana Design Center =OWNER Carmel, Indiana 46032 Parking Garage P 12 =ARCHITECT PERIOD TO: 12/31/2007 =CONTRACTOR FROM CONTRACTOR: VIA ENGINEER: CSO Schenkel Schultz 0 Signature Construction LLC 600 E. 96th Street 720 3rd Avenue S.W. Indpls In. 46240 PROJECT NOS: 23233HC Carmel, Indiana 46032 CONTRACT DATE: 1/12/2007 CONTRACTOR APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. mtormation and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document UM3, 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. ORIGINALCON'I'RACt SUM 5 1,205,000.00 2. Net change by Change Orders 5 CONTRACTOR: 3. CON I RAC 'I SUM '1'0DATE (Line lf2) 5 1,22 4. 'I O'I'AL COMPLETED S I URED'1'O 5 1,22 5. 1•.r A By: 1. Dateh, vy a A A 5. RE I AINA(JE: omas n President a. 0.05 of Completed Work 61,3bb.29 Sub ri ed an s orn to before me this r day of 7_ TC oru m n D E on 6703) j L p ,1 e i *f W4L jo b. %of Stored Material 5 a umn F on G703} .J.trnt1 't Z r"3 Total Retainage (Lines 5a+ 5b or Total in Column I ofG703) 61,366.29 6. TO I AL EARNED LESS REFAINAGE 1,16 .),9_ In accordance with the Contract. Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTI>ICAIES F'OR Engineer's knowledge, Information and belief the Work has progressed as Indicated, PAYMENT' (Lme 6 from prior Certificate) 1,044,349.56 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT' DUE is entitled to payment of the AMOUNT' CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RET'AINAGE 5 n (Line 3 less Line 6) AMOUeCER 5 7 (Attach mount certi fied difJers from the amount applied Initiai al! figures on this ota c anges approve Applica'ontinu n Sheel that are changed to conform with the amount certified.) in previous months by Owner ENGIN Total approved this Month By. Date: T�Q� TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the i.unuacwr narncu nerem. Issuance, paymcnL anu dccepiance 01 payrneni arc wnnout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W.. WASHINGTON, DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 1 of 1 To: From; Project: Application No. 10 Carmel Redevelopment Commission Signature Construction LLC Parcel 74 Application Date= 12/31/07 One Civic Square 720 3rd Avenue S.W. Indiana Design Center Period To: 12/31/07 Carmel, Indiana 46032 Carmel, Indiana 46032 Parking Garage P12 Engineer's Project No. 23233HC A B C D E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To if 4 Description of Work value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 277,700.00 258,261.00 19,439.00 0.00 277,700.00 10 0s 0.00 0.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0$ 0.00 0.00 103 Concrete 455,287.50 447,718.60 7,568.90 0.00 455,287.50 100% 0.00 0.00 104 Masonry 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 105 Metals 140,000.00 140,000.00 0.00 0.00 140,000.00 100 0.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0 9 6 0.00 0.00 107 Thermal and Moisture Protection 22,400.00 22,400.00 0.00 0.00 22,400.00 100% 0.00 0.00 108 Openings 0.00 0.00 0.00 0.00 0.00 0 9 6 0.00 0.00 109 Finishes 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 111 Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0100 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 331,938.35 292,008.80 39,929.55 0.00 331,938.35 100% 0.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0100 133 Utilities 0.00 0.00 0.00 0100 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0100 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 0$ 0.00 1,227,325.85 1,160,388.40 66,937.45 0.00 1,227,325.85 100% 0.00 0.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as PARCEL 74, INDIANA DESIGN CENTER PARKING GARAGE P12 located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of one hundred twenty –one thousand six hundred and ten dollars (121,610.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC N SEAL Sarah 6� Tho as E. Koontz d��Y P� a?an q. sr.e ray xr, ua�..f:: President E. E wa J:L. t c:� Subscribed and sworn o before me this: Notary Public: APPLICATION AND CERTIFICATION FOR PAYMENT 41A DOCUMENT G 702 PAGE ONE OF 2 PAGES TO OWNER Carmel Redevelopment Commissit PROJECT: Parcel 5B APPLICATION NO: Draw Number 5 Distribution to: One Civic Square Phase I Carmel City Center Signature costs =OWNER Carmel, Indiana 46032 Motor Court =ARCHITECT PERIOD TO: 12/14/2007 =CONTRACTOR FROM CONTRACTOR. VIA ARCHITECT: Pedcor Design Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: CSO Project 1121010 Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE 9/7/2007 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the 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. I. ORIGINAL CONTRACT SUM 2,841,863.00 2_ Net change by Change Orders 0,00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I f 2) 2,841,86100 4. TOTAL COMPLETED STORED TO 998,890.00 B y' HnF 5. RETAINAGE: Th as E. Ko 'tz, President z 'rota Marion County a- 0.1 of Completed Work 99,489.00 Subscri and st m to before me this 14t day of D dmber•,-�007 My Commission Expires (Column D E on G703) sen b. of Stored Material S /pi+ .FO2jyo' April 19, 2009 (Column F on G703) Total Retamage (Lines 5a 5b or Total in Co[umn I of G703) 99,489.00 6. TOTAL EARNED LESS RETAINAGE 899,401.00 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) S 374,310.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 525,091.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 1,942,462.00 (Line 3 less Line 6) AMOUNT CERTIFIED. C HANGE ORDER SUMMARY ADDI I JONS DEDUCTIONS (Atta6ex ation f amount ed d�ers from the amount applied. Inatal all figures on this Total changes approved 4ppld 1he Con a that are changed to conform with the amount certified.) in previous months by Owner ARC Total approved this Month By: Date: TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the lontractor namea herein. issuance, payment and acceptance of payment are without NET CHANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N w„ WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 2of2 To: From: Project: Application No.: 5 Carmel Redevelopment Commission Signature Construction LLC Parcel 5B Application Date: 12/14/07 One Civic Square 720 3rd Avenue S.W. Phase I Carmel City Center Period To: 12125107 Carmel, Indiana 46032 Carmel, Indiana 46032 motor Court Engineer's Project No. A B C D E F G H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To If Description of Work Value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 132,109.09 19,816.36 26,421.82 0.00 46,238.18 35% 85,870.91 4,623.82 Bonding 113,675.00 113,675.00 0.00 0.00 113,675.00 100% 0.00 11,367.50 Insurance 25,000.00 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 2,170,090.00 240,895.00 530,550.00 0.00 771,445.00 36% 1,398,645.00 77,144.50 104 Masonry 50,000.00 0.00 0.00 0.00 0.00 0% 50,000.00 0.00 105 Metals 19,368.00 0.00 0.00 0.00 0.00 0% 19,368.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 68,430.00 0.00 4,000.00 0.00 4, 000.00 6% 64,430.00 0.00 108 Openings 6,100.00 0.00 0.00 0.00 0.00 0% 6,100.00 0.00 109 Finishes 26,360.00 0.00 0.00 0.00 0.00 0% 26,360.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 lit Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 31,000.00 0.00 0.00 0.00 0.00 0% 31,000.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 89,640.00 0.00 0.00 0.00 0.00 0% 89,640.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0.Q0 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Construction Fee 110,090.91 1 16,513.64 1 22,018.18 0.00. 38,531.82 1 71,559.09 3,853.18 2,841,863.00 915,900.00 582,990.00 0.00 998,890.00 35% 1,842,973.00 99,489.00 1 r- PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as Parcel 5B Phase I Carmel City Center Motor Court located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of Five Hundred Twenty -Five thousand ninety -one dollars (525,091.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC f Tho s E. Koontz President Subscribed and sworn to before me this: Notary Public: APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUAfENTG702 PAG ONE OF 2 PAGES TO OWNER Carmel Redevelopment Commissil PROJECT: Parcel 5131 APPLICATION NO Draw Number 5 Distribution to: One Civic Square Phase I Carmel City Center Signature costs =OWNER Carmel, Indiana 46032 Motor Court ARCHITECT PERIOD TO: 12/14/2007 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: CSO Project 2 10 10 Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE 9/7 /2007 CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the best of the Contractors knowled 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. L ORIGINAL CONTRACT SUM 2,841,863.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I -L 2) 2,841,863.00 4. TOTAL COMPLETED STORED TO 998,890.00 By: 5. RETAINAGE: homas E. ontz, President ;o pAr'd�a J NNIF R K. H E a. 0.1 of Completed Work 99,489.00 S scribed and Yom to before me this 14th day ;T� er, 2007 Marion County (Column D E on G703) =s: 5� My Commission Expires K of Stored Material /1 U "',FOkI April 19 2009 (Column F on Total Retainage (Lines Sa Sb or Total in Column I of G703) 99,489.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 899,401.00 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 374,310.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 525,091.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 1,942,462.00 0 1. (Line 3 less Line 6) AMOUNT CERTIFIED 5J7 SUMMARY CHANGE OTMrTZ A (Attach expla ton if mount certified differs from the amount applied. Initial all figures on this Total changes approved Applicatio and and Contin: to Sheet t t are changed to conform with the amount certified.) in previous months by Owner ARCHI CT PP Total approved this Month By: Date: Z p TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named rierem. Issuance, payment and acceptance of payment are wnnout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 6702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUA'T'ION SHEET Page 2 of 2 To: From: Project: Application No.: 5 Carmel Redevelopment Commission Signature Construction LLC Parcel 5B Application Date: 12/14/07 One Civic Square 720 3rd Avenue S.W. Phase i Carmel City Center Period To: 12/25/07 Carmel, Indiana 46032 Carmel, Indiana 46032 Motor Court Engineer's Project No. A B C D E F G H I Work Com leted Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To if Description of Work Value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 132,109.09 19,816.36 26,421.62 0.00 46,238.18 35% 85,870.91 4,623.82 Bonding 113,675.00 113,675.00 0.00 0.00 113, 675.00 100% 0.00 11,367.50 Insurance 25,000.00 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 2,170,090.00 240,895.00 530,550.00 0.00 771,445.00 36% 1,398,645.00 77,144.50 104 Masonry 50,000.00 0.00 0.00 0.00 0.00 0% 50,000.00 0.00 105 Metals 19,368.00 0.00 0.00 0.00 0.00 0% 19,368.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 68,430.00 0.00 4,000.00 0.00 4,000.00 6% 64,430.00 0.00 108 Openings 6,100.00 0.00 0.00 0.00 0.00 0% 6,100.00 0.00 109 Finishes 26,360.00 0.00 0.00 0.00 0.00 0% 26,360.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 111 Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 31,000.00 0.00 0.00 0.00 0.00 0% 31,000.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0100 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 89,640.00 0.00 0.00 0.00 0.00 0% 89,640.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0,00 f 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Construction Fee 1 110,090.91 1 16,513.64 22,018.18 1 0.00 38,531.824 1 3050%101 71,559.09 3,853.18 2,841,863.00 415,900.00 562,990.00 0.00 998,890.00 35 1,842,973.00 99,469.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as Parcel 5S Phase I Carmel City Center Motor Court located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of Five Hundred Twenty -Five thousand ninety -one dollars (525,091.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC T omas E. Koontz President Subscribed and sworn to before me this: Notary Public: f APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 2 PAGES TO OWNER Carmel Redevelopment Commissil PROJECT: Parcel 5B APPLICATION NO: Draw Number 5 Distribution to: One Civic Square Phase I Carmel City Center Signature costs =OWNER Carmel, Indiana 46032 Motor Court ARCHITECT PERIOD TO: 12/14!2007 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: CSO Project 4 2 10 10 Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE 9/7/2007 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best o €the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the 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 2,841,863.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 t 2) 2,841,863.00 4. TOTAL COMPLETED STORED TO 998,890.00 By r A 5. RETAINAGE: homas E. K tz, President RY'Ppee� a. 0.1 of Completed Work 99,489.00 Su scribed and sw m to before me this 14th day o 2007 Ma[IO[ COUfIIy (Column D E on G703) seal My Commission Expires b. of Stored Material "FOdt ifl'` April 19, 2009 (Column F on G703) opt*+ Total Retainage (Lines 5a+ 5b or Total in Column I of G703) 99,489.00 =HIMCT'S'CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 899,401.00 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the T LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 374,310.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor A 8. CURRENT PAYMENT DUE S 525,091.00 is entitled to payment of the MOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 1,942,462.00 (Line 3 less Line 6) AMOUNdCERTIFI S A L (Attach e ount Cer d differs from the amount applied. Initial all figures on dtis Total changes approved Applicatontit aria She hat are changed to conform with the amount certified.) in previous months by Owner ARCHIT l Total approved this Month By: Date: I Z f T7 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. issuance, payment and acceptance of payment are wltnout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G7 0 3 CONTINUATION SHEET Page 2 of 2 To: From: Project: Application No.: 5 Carmel Redevelopment Commission Signature Construction LLC Parcel 5B Application Date: 12/14/07 One Civic Square 720 3rd Avenue S.W. Phase I Carmel city Center Period To: 12/25/07 Carmel, Indiana 46032 Carmel, Indiana 46032 Motor court Engineer's Project No. A B C D E F G H I Work Completed Materials Total Presently completed Balance Retainage Item Scheduled From Previous Stored and Stored To If Description of Work Value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 132,109.09 19,816.36 26,421.82 0.00 46,238.18 35% 85,870.91 4,623.82 Bonding 113 113,675.00 0.00 0.00 113,675.00 100% 0.00 11,367.50 Insurance 25,000.00 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 2,170,090.00 240,895.00 530,550.00 0.00 771,445.00 36% 1,398,645.00 77,144.50 104 Masonry 50,000.00 0.00 0.00 0.00 0.00 0% 50,000.00 0.00 105 Metals 19,368.00 0.00 0.00 0.00 0.00 0% 19,368.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 68,430.00 0.00 4,000.00 0.00 4,000.00 6% 64,430.00 0.00 108 Openings 6,100.00 0.00 0.00 0.00 0.00 0% 6,100.00 0.00 109 Finishes 26,360.00 0.00 0.00 0.00 0.00 0% 26,360.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 ill Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 31,000.00 0.00 0.00 0.00 0.00 0% 31,000.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 89,640.00 0.00 0.00 0.00 0.00 0% 89,640.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0.00 0:00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00. 0.00 0.00 0% 0.00 0.00 Construction Fee 1 110,090.91 1 16,513.64 1 22,018.18 1 0.00 38,531.82 35%1 71,559.09 1 3,853.18 2,841,863.00 415,900.00 1 582,990.00 0.00 998,890.00 35% 1,842,973.00 99,489.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION,_LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as Parcel 5B Phase I Carmel City Center Motor Court located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of Five Hundred Twenty -Five thousand ninety -one dollars (525,091.00) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above- described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC T omas E. Koontz President Subscribed and sworn to before me this: Notary Public: Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 S1g.+, Ld,, r� ..�f•. e LG Purchase Order No. r Terms Ca �»t• 1 TN Y 0 3 Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) r7 �d l 2 /'q a7 p w�t�f !y ��rrl�,,. 6;. -q IZI alp tZ SZ S O I t z a� i r.. Total (A-07 a 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. 'A. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF gv C4(.0 q 6 7 -o ON ACCOUNT OF APPROPRIATION FOR Z XX X Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or RoZ �fy[�opas zr omtt bill(s) is (are) true and correct and that the qa z glf&o g 7 Ly I z f I to. materials or services itemized thereon for which charge is made were ordered and received except 20 CLR Si na cre /I Cost distribution ledger classification if T itle 1 claim paid motor vehicle highway fund