170945 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 358569 Page 1 of 1
ONE CIVIC SQUARE KEYSTONE CONSTRUCTION CHECK AMOUNT: $59,025.91
s:r CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR
INDIANAPOLIS IN 46204 CHECK NUMBER: 170945
CHECK DATE: 4/16/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE N UMBER AMOUN DESCRIPTION
902 4460847 3 44,870.25 HEARTHVIEW OLD TOWN
.902 4460848 3 14,155.66 4TH GATEWAY /RANGELTNE
i
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE I OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 3 Distribution to:
Carmel Redevleopment Comm. Parcel 47 OWNER
One Civic Square =ARCHITECT
Carmel, Indiana 46032 PERIOD TO: 3125109 =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 a 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 current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders CONTRACTO Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 f 2)
4. TOTAL COMPLETED STORED TO 132,206.97 ANDREA M. ROELL
DATE (Column G on G703) By. Date: NOTAC�S'/RIUIC
5. RETAINAGE: SEAL
a. 0 of Completed Work State of. Indiana County of: Marion STATE OF INDIANA
(Column D E on G703) Subscribed and sworn to before,-me this 25th day of M trch, 2009. MARION COUNTY
b. 0 of Stored Material Notary Public: IUIY COMMISSION EXPIRES`
NOVEMBER 8, 2016
(Column F on G703) My Commission expires: November 8, 2016
Total Retainage (Lines 5a +5b or
Total in Column I of G703) ARCHITECT'S ERTIFI ATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 132,206.97 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) 87,336.72 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 44 ,870.25 J is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE v �r-
(Line 3 less Line 6) 1' AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explan on amount certrfed differs from the amount applied Initial all figures on this
Total changes approved Applicatron�and o he Ca uatron Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHIT CT:
Total approved this Month By: Date. 3j3e 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 without
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
t+ AIA DOCUMENT G702 APPLICATION AfLD CERT;FICA.410N 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- •ail
J
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 3
Contractor's signed certification is attached. APPLICATION DATE: 3/25/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 3/25/2009
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 829
A B C D E F G H I
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)
1 General Conditions $43,374.15 $14,350.85 $57,725.00
2 AT &T payment $13,369.00 $13,369.00
3 5% Construction Management Fee $30,593.57 $30,519.40 $61,112.97
PAGE TOTAL $0.00 $87,336.72 $44,870.25 $0,00 $132,206.97 $0.00 $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 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.
�J
Payee
Purchase Order No.
y7 Terms
a
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 /zs G 9 3 Cam rIAI_
Total 2S
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
P CUCHERNO. WARRANT NO.
ALLOWED 20
IN SUM OF
7�S, <5
ON ACCOUNT OF APPROPRIATION FOR
2� 4'�{� o 4' 7
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT- I hereby certify that the attached invoice(s), or
4ye70,y5 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
Signat
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AMDOCUMENTG702 PAGE I OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 3 Distribution to:
Carmel Redevleopment Comm. Parcel 48 Gateway 4 OWNER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 3125109 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Keystone Construction Corp. CSOArchitects
The Majestic Building 10th Floor PROJECT NOS: 815
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 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, Net change by Change Orders CONTRACTO Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 2)
4. TOTAL COMPLETED STORED TO 18,502.17
DATE (Column G on G703) By: Date: 3/25/09
5. RETAINAGE:
a. 10 of Completed Work State of: Indiana County of.
(Column D E on G703) Subscribed and o to be e me this th day ay 2009. ANDREA M. ROELL
b. 10 of Stored Material Notary Public: 1� NOIARY PUBLIC
(Column F on G703) My Commission expires: 11/08/2016 SEAL
Total Retainage (Lines 5a 5b or STATE OF INDIANA
Total in Column I of G703) ARCHITECT'S R PA WW1 SION EXPIRES;
6. TOTAL EARNED LESS RETAINAGE 18,502.17 In accordance with the Contract Documents, based on NffltQER&20T6
(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) 4,346.51 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 1.4,155.66 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expl ti n ifamount certified differ from the amount applied. Initial all figures on this
Total changes approved Applicat an onthe tinua on Sheet that are changed to conform with the amount cert fed.)
in previous months by Owner_ ARC ECT•
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 without
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
c. Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
O T UAM 11 V SH AIA DOCUMENT 6703 PAGE 2 OF 2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 3
Contractor's signed certification is attached. APPLICATION DATE: 3/25/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 3/25/2009
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 815
A B C D E F G 7BALANCE 1
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) (IF VARIABLE
APPLICATION STORED AND STORED RATE)
(D E) (NOT IN TO DATE
D OR E) (D +E +F)
I General Conditions $2,955.70 $6,824.30 $9,780.00 $0.00
2 5% Construction Management Fee $1,390.81 $7,331.36 $8,722.17 $0.00
PAGE TOTAL $0.00 $4,346.51 $14,155.66 $0.00 $18,502.17 #DIV /0! $0.00 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
�Rrescribed''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
i1 _1Z/ Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
r%
L
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.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO
ALLOWED 20
IN SUM OF
2a
/ss
ON ACCOUNT OF APPROPRIATION FOR
1
Board Members
Po #or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
3 y�oBY 1 15YZ6 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
U
Signat e
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund