HomeMy WebLinkAbout174393 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 358569 Page 1 of 1
ONE CIVIC SQUARE KEYSTONE CONSTRUCTION
CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR CHECK AMOUNT: $48,804.fi2
INDIANAPOLIS IN 46204
CHICK NUMBER: 974393
CHECK DATE: 718/2009
DEPA RTMENT A CCOUNT PO NUMBER I NVOICE NUMBER AMOUNT DESCRIPTION
902 4460847 4 22,407.85 MANAGEMENT FEES
902 4460848 4 8,599.82 MGT FEE
902 4460847 5 17,796.95 MGT FEE
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APPLICATION AND CERTIFICATION FOR PAYMENT ALA DOCUMENT G702 PAGE 1 OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 5 Distribution to:
Carmel Redevleopment Comm. Parcel 47 OWNER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 5125109 =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 CO NT RA CT D ATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractoes 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, ALA 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 CONTRACTOR: Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 t 2)
4. TOTAL COMPLETED STORED TO 172,411.77
Date: 5/26109
DATE (Column G on G703) By:
5. RETAINAGE:
a. 0 of Completed Work State of. Indiana County f: Marion ANDREA M. ROELL
(Column D E on G703) Subscribed and sworn to before me this 6th da ay, 2009 NOTARY PUBLIC
b. 0 of Stored Material Notary Public: A'�-�.J yam, SEAL
(Column F on G703) My Commission expires. November 8, 2016 MARION IND
Total Retainage (Lines 5a 5b or
Total in Column I of G703) ARCHITECT'S RTIFI A E. 2016
6. TOTAL EARNED LESS RETAINAGE 172,411.77 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) 154,614.82 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 17 ,796 .95 is entitled to payment of the AMOUNT CERTIFIED,
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMTAARY ADDITIONS DEDUCTIONS (Attach explanation ifamount certified differs from the amount applied Initial all figures on this
Total changes approved Application and Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCITECT•
H
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 tterem- issuance, payment and acceptance of payment are without
NET CHANGES by Change Order $a.00 prejudice to any rights of the Owner or Contractor under this Contract.
9A DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA C1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE_ N.W., WASHINGTON. DC 20008-
I kUsers may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
c,
C ONTINUATION SHEET AIA DOCUMENT G703 PAGE 2OF2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 5
Contractor's signed certification is attached. APPLICATION DATE: 5/25/2009
In tabulations below, amounts are stated to the nearest dollar, PERIOD TO: S/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 $73,129.00 ($7,007.50) $66,121.50
2 AT &T payment $13,369.00 $13,369.00
3 5% Construction Management Fee $68,116.82 $24,804.45 $92,921.27
PAGE TOTAL $0.00 $154,614.82 $17,796.95 $0.00 $172,411.77 $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
I/
e
,.,Frescribeuby 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
r >�s5�rmac /iv�> Purchase Order No.
t?
7 r S�`✓ Terms
9' 1 2 ZIL/ Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
325 0 A17 17 7��6_ �5
yy
�a
C"
Total f 7, -7,9�,�'J5'
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 L�P
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
2
Board Members
Po# or INVOICE NO. ACCT #1TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�jo 2 S y�G -d��'7 177g� �5 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
/7 0.9
Sign ure
Director of Operations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
0
APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCUMENT G702 PAGE OF3PAGES
TO OWNER: PROJECT: APPLICATION NO: 4 Distribution to:
Carmel Redevleopment Comm. Parcel 48 Gateway 4 OWNER
One Civic Square OARCHITECT
Carmel, Indiana 46032 PERIOD TO: 4125109 =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 CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersi 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, ATA 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 CONTRACTOR: Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 f 2)
4, TOTAL COMPLETED STORED TO 27,101.99
DATE (Column G on G703) By: Date: 4/24/09
5. RETAINAGE:
a. 10 of Completed Work State of: Indiana County of: anon ANDREA M. ROELL
(Column D +Eon G703) Subscribed and n sworn to before this 24th da of A nl, 2009. NOTARY PUBLIC b. 10 of Stored Material Notary Public: f�v� Z SEAL
(Column F on G703) My Commission expires: 11/08/2016 STATE OF INDIANA
Total Retainage (Lines 5a 5b or MARION COUNTY m
Total inColunlofG703) ARCHITECT'S ERTIFICATE FOR PA
2016
6. TOTAL EARNED LESS RETAINAGE 27,101.99 In accordance with the Contract Documents, based on on -site ohs erva ions ana THE M
(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) 18,502.17 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 8,599.82 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED 2
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expl amount certified differs from the amount applied. Initial all figures on this
Total changes approved Applicati on and anation i o e Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT:
Total approved this Month By: Date: _3Q,Q9
TO TALS $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
L NE T CHANGES by Change Order t $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CF,RTIFICATION FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W. WASHINGTON, DC 2000 6-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
ti
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 4
Contractor's signed certification is attached. APPLICATION DATE: 4/24/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/24/2009
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 815
A B 7SCHEDULED D E F G H I
ITEM DESCRIPTION OF WORK WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. 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 $9,780.00 $6,506.00 $16,286.00 $0.00
2 5 °/a Construction Management Fee $8,722.1.7 $2,093.82 $10,815.99 $0.00
PAGE TOTAL $0.00 $18,502.17 $8,599.82 $0.00 $27,101.99 $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
.y
Prescribed by State Board of Accourns 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
��'E s�v�� C�>'s�rL� tUir� Purchase Order No.
17 r�lvJ �S e ��ii ;�5r IC r
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
V/Z "ezp P 599 s�
Total 5% �2
1 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
VQUCHER NO. WARRANT NO.
ALLOWED 20
/�i IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
GJ Ig
Board Members
Po or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
got Yy�, O8 4 19 6 599.�z 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
5 200)
Dire &Rf tgrations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AI4 DOCUM-ENTG702 PAGE 1 OF 3 PAGES
TO OWNER: PROJECT: APPLICATION NO: 4 Distribution to:
Carmel Redevleopment Comm. Parcel 47 DOWNER
One Civic Square =ARCHITECT
Carmel, Indiana 46032 PERIOD TO: 4125109 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT:
Keystone Construction Corp. CSO Architects
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 current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders CONTRACTOR; Keystone Construction Corp.
3. CONTRACT SUM TO DATE (Line 1 1 2)
4. TOTAL COMPLETED STORED TO 154,614.82
DATE (Column G on 0703) By: Date: 4124109
5. RETAINAGE; NN
a. 0 of Completed Work State of Indiana County of ANDREA M. ROELL
(Column D E on G703) Subscribed and swo to be re this 24th ay of pril, 2009 NOTARY PUBLIC
b. 0 of Stored Material Notary Public: SEAL
(Column F on G703) My Commission expires: November 8, 2016 STATE OF INDIANA
Total Retainage (Lines 5a 5b or
MARION COUNTY
Total in Column I ofG703) ARCHITECT'S CERTIFICATE FOR PA -'N e, 2016
6, TOTAL EARNED LESS RETAINAGE 154,614.82 In accordance with the Contract Documents, based o OtIbUl VdLiuffrMTTTe 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 beliefthe Work has progressed as indicated,
PAYMENT (Line 6 from prior Certificate) 132,206.97 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 22,407.85 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 explanation ifamount certified differs from the amount applied. Initial all figures on this
Total changes approved Application and onthe Winuation Sheet that are changed to conform with the amount certified)
in previous months by Owner ARCHITECT: rl
Total approved this Month By 4 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 AA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W. WASHINGTON, DC 20006 -5292
4 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee,
Y.+
C ONTINUATION V E ET AL 4 DOCUMENT V 703 PAGE 2 OF 2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 4
Contractor's signed certification is attached. APPLICATION DATE: 4/24/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/24/2009
Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 829
A B 7SCHEDULED D E F G H i
ITEM DESCRIPTION OF WORK WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. 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 $57,725.00 $15,404.00 $73,129.00
2 AT &T payment $13,369.00 $13,369.00
3 5% Construction Management Fee $61,112.97 $7,003.85 $68,116.82
PAGE TOTAL $0.00 $132,206.97 $22,407.85 $0.00 $154,614,82 $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
t:
f
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
Q H Con s7�. -��7 07 COL'e Purchase Order No.
y S Terms
�9 s 2G y Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Y1251-,9 9 -4
Total
1 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
yy- s v ��s T y �u
IN SUM OF
zzo 7_ F.5
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
9 -7/ 22 ib%S 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
200,:
Signature
Cost distribution ledger classification if I e
claim paid motor vehicle highway fund