169770 03/17/2009 CITY OF CARMEL, INDIANA VENDOR: 358569 Page 1 of 1
ONE CIVIC SQUARE KEYSTONE CONSTRUCTION CHECK AMOUNT: $61,327,72
CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR
INDIANAPOLIS IN 46204 CHECK NUMBER: 169770
CHECK DATE: 3/17/2009
DEPARTMENT ACCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
902 4460847 60, 664.87 HEARTHVIEW OLD TOWN
902 4460848 662:`:85 4TH, GATEWAY /RANGELINE
APPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUMENTG702 PAGE 1 OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 2 Distribution to:
Carmel Redevleopment Comm. Parcel 47 DOWNER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 2124109 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Keystone Construction Corp. CSOArchitects
The Majestic Building 10th Floor PROJECT NOS: 829
47 S. Pennsylvania Street
Indianapolis, IN 46204
CONTRACT FOR: GENERAL CONSTRUCTION CONTRACT DATE:
CONTRACTOR'S 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. 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 can n paymen s o iW..oRt*M
1. ORIGINAL CONTRACT SUM 58 ,261.00 NOTARY PUBLIC
SEAL
1 Net change by Change Orders CONTRA R: Keystone Construct on Corp, VAIF OF INDW A
3. CONTRACT SUM TO DATE (Line I± 2) 58,261.00 MARION COUNTY
4. TOTAL COMPLETED STORED TO 87,336.72 tWYCOMMISSEON EXPtRIES:
DATE (Column G on G703) By: NOV ER EMB 8 2016
5. RETAINAGE:
a. 0 of Completed Work State of: �_OJO A a Ft County of: N A 0
(Column D E on G703) Subscribed anWorn o b me a da b. 0 of Stored Material Notary Public
4A Y
(Column F on G703) My Commission expires: November 8, 201
Total Retainage (Lines 5a 5b or
Total in column 1 of G703) 0.00 ARCHITECT'S CERTI I AT FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 87,336.72 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) 26,671.85 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8, CURRENT PAYMENT DUE 60,664.87 is entitled to payment of the AMOUNT CERTIFIED,
9. BALANCE TO FINISH, INCLUDING RETAINAGE (29,075.72)
(Line 3 less Line 6) AMOUNT CERTIFIED
IrOOtM VA9 IS tON
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach eexplanati ount certified die rs from the amount applied. Initial a figures on this
Total changes approved Applicauation Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHI Total approved this Month By: Date: Z Z6
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 without
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.
V✓ t
CSO Architects
February 27, 2009
To who it concerns:
The contracted amount stated on Keystones February payment request was an estimate.
Keystone and the Carmel Redevelopment Commission has agreed the contract amount will
change as necessary. The amount indicated on the February Payment Request exceeds the
indicated amount in the contract. If any questions, please see Les Olds, Director of
Redevelopment.
Bob Olson
ARCHITECTURE INTERIOR DESIGN
280 East 96th Street, Suite 100 Indianapolis, Indiana 46240 Main 317.848.7800 Fax 317.574.0957 csoinc.net
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
J ja �o�, co v 12. Purchase Order No.
7-b f �3f, ice, J 16
s_ .5 Y• Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note atta invoice(s) or bill(s))
M u
�i
ct
r�
T�
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in cco� dance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer ly
VOUCHER NO. WARRANT NO.
ALLOWED 20
L�S�d �p�is /ruc�, CGrP, IN SUM OF
Tti /a, y A0
6o, 6,1 S'7
ON ACCOUNT OF APPROPRIATION FOR
1 /-W/
Board Members
PO #.or INVOICE NO. ACCT #(TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
goy �I4��08`t7 C�6��7 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 0
ti ignatur
(--e- r O G�
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE I OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NU 2 Distribution to:
Carmel Redevleopment Comm. Parcel 48 Gateway 4 =OWNER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 2125109 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Keystone Construction Corp. CSO Architects
The Majestic Building 10th Floor PROJECT NOS: 815
47 S. Pennsylvania Street
Indianapolis, IN 46204
CONTRACT FOR: GENERAL CONSTRUCTION CONTR DAT
CONTRACTOR'S APPLICATION FOR PAYMENT Th e 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. 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 Docume at all amounts have been paid by
the Contractor for Work for which previous Certific tes for r-
the �y
payments received from the Owner, and that curren payment shown 1I MELL
Y PUBUC
1. ORIGINAL CONTRACT SUM 36,079.00 SEAL
g g Y Corp S A O INDK Y
Y Change Orders
2. Net change b CONTRA Keys s ne Constructio Co "i OF IN��f
3. CONTRACT SUM TO DATE (Line 1 t 2) 36,079.00 My COMNfISSION EXPIRES;
4. TOTAL COMPLETED STORED TO 4,346.51 NO�MBER 8, 2016
DATE (Column G on G703) By: Date: 2/25
5. RETAINAGE:
a. 1 10 of Completed Work State of: j�ti J A County of MAP i Oo
(Column D E on G703) Subscribed and worn o before me 4Sq\- da of Ffj SP_ U A r1P_ y d L')(:)
b. 10 of Stored Material Notary Public:
(Column F on G703). My Commission expires: 00U„ 9, �O i(Q
Total Retainage (Lines 5a 5b or
Total in Column1ofG703) 0.00 TkRCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 4,346.51 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) 3,683.66 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 662.85 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 31,732.49
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanatio punt certfed dfersfrom the amount applied. Initial all figures on this
Total changes approved Application a onth Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITE
Total approved this Month
By: Date:
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 wlttiout
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 20008-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
Y
r'�
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 2
Contractor's signed certification is attached. APPLICATION DATE: 2/25/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 2/25/2009
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 815
A B C D E F G H
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS 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)
I General Conditions Estimate $22,658.00 $2,890.70 $65.00 $2,955.70 13.04% 19,702.30 $0.00
2 5% Construction Management Fee Estimate $1.3,421.00 $792.96 $597.85 $1,390.81 10.36% 12,030.19 $0.00
PAGE TOTAL $36,079.00 $3,683.66 $662.85 $0.00 $4,346.51 12.05% $31,732.49 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
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
Co r Purchase Order No.
'l7 S Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2125 09
T�
Total
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..p.�
ri
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
1 1 L ALLOWED 20
S l l 1 1pn5 f 7 r 017 n e ✓p IN SUM OF
�2 &S
ON ACCOUNT OF APPROPRIATION FOR
�a2 0S7
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
X5- 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
3 20 0 9
Slgnatur
r �i� r
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund