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Home My WebLink About176075 08/18/2009 CITY OF CARMEL, INDIANA VENDOR: 358569 Page 1 of 1 ONE CHIC SQUARE KEYSTONE CONSTRUCTION CHECK AMOUNT: $176,279.64 CARMEL, INDIANA 46032 47 S PENNSYLVANIA -10TH FLOOR INDIANAPOLIS IN 46204 CHECK NUMBER: 176075 CHECK DATE: 8118/2009 DEP ARTMENT ACCOUNT PO NU INV NUMBER AMO UNT DESCRIPTION 902 4460847 6 32,529.64 HEARTHVIEW OLD TOWN 902 4460850 912 -01 143,750.00 FOUNDATION APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCUMENT G 702 PAGE I OF 3 PAGES TO OWNER: PROJECT: APPLICATION NO: 6 Distribution to: Carmel Redevleopment Comm. Parcel 47 F X OWNER One Civic Square Carmel, Indiana 46032 X ARCHITECT PERIOD TO: 7/25/09 =CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Keystone Construction Corp. CSOArchitecis The Majestic Building I Oth Floor PROJECT NOS: 829 47 S. Pennsylvania Street Indianapolis, IN 46204 CONTRACT FOR: GENE C CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the 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 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 CONTRACT Keystone Construction Corp. 3. CONTRACT SUM TO DATE (Line I 2) 4. TOTAL COMPLETED STORED TO 204,941.41 DATE (Column G on G703) By. Date: 7/27/09 5. RETAINAGE: a. 0 of Completed Work State of: Indiana County of Marion (Column D E on G703) Subscribed and syvorn to before me this 2 th day of July, 2009 b. 0 of Stored Material Notary Public: YO— 11 (Column F on G703) My Commission expires: November 8, 2016 Total Retainage (Lines 5a 5b or Total in Column I of G703) ARCHITEM 6. TOTAL EARNED LESS RETAINAGE 204,941.41 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) 172,411.77 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 32,529.64 is entitled to payment of the AMOUNT CERTIFIED, 9. BALANCE TO FINISH. INCLUDING RETAINAGE (Line 3 less Line 6) AMOUNT CERTIFIED. 29 ,&4 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanati if mount certified dffersfrom the amount applied. Initial all figures on this Total changes approved Application an ant Conhnu n Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITEC Total approved this Month By: Date: 7 3 f y TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herem. issuance, payment ana acceptance or 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.. M.W., WASHINGTON, DC 2000&5292 Users may obtain validation of. ^t document by requesting a completed AIA Document B401 Certification of Document's Authenticity from the Licensee. CONTINUATION 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: 5/25/2009 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 829 A B C D E F G H 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 $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 i 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 KEYSTONE: CO N S T R U C T I O N CORP TO Carmel Redevelopment Commission FROM Carmel Lofts, LLC Invoice 912 -01 111 W. Main Street 47 S Pennsivania Street 10th Floor Invoice Date 22-Jul-09 Carmel, IN 46032 Indianapolis IN 46204 Project No: 912 Attn: Matt Worley :Due upon Receipt Mr. Matt Worley 7/22/2009 .VFW OLD MERIDIAN Foundations of Building $143,750.00 100% $0.00 $143,750.00. $143,750.00 Shell of Building $143,750.00 0% Base Interterior Work $143,750.00 0% Interior Finish $143,750.00 0% Completion of "punch list" $50,000.00 0% GRAND TOTALS $625,000.00. Total completed $143,750.00 Less Previous $0.00 TOTAL DUE $143,750.00 A late fee payment charge of 1 V2% per month or an annual percentage rate of 18% will be Imposed monthly on past due balances. If collections or attorney fees are needed, they are recoverable. w GENERAL CONTRACTORS 47 S Pennsylvania St PHONE: (317) 636 -2000 10th Floor FAX: (317) 635 -1100 w Z CONSTRUCTION MANAGERS Indianapolis, IN 46204 E -MAIL: AR @keystone- corp.com Thank you for your businessIl! AFFIDAVIT AND WAIVER OF LIEN Final FX Partial QX Payment to Follow State of Indiana, County of Marion. SS: Bob Crowder, being duly sworn, states that he is the Project Director of Keystone Construction Corporation (Contractor) having contracted with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows for a project known as Carmel Lofts/VFW Old Meridian, located in Carmel, Indiana and does hereby further state on behalf of the aforementioned Contractor. (PARTIAL WAIVER) that there is due from the owner the sum of One Hundred For!y Three Thousand Seven Hundred Fifty 00/100 Dollars $143,750.00 receipt of which is hereby acknowledged or X the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned (FINAL WAIVER) that the final balance due from the owner is the sum of Dollars receipt of which is hereby acknowledged; or J the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become 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, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the I dersigned fo id project, and within the scope of this affidavit and waiver. �R_ Keystone Construction Corporation By Title Project Director (Company) thi Td tCproentznive) WITNESS MY HAND AND NOTARI EAL, th' nd day of July, 2009. Nutan Public: Indiana C Ounty of \.larion Printed Nantc: Andrea M. Roell My Commission Iapires November 8i20I6 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 1 G �ssucJ�; o C OQ 10_ Purchase Order No. 1 s. f r•ns�y� fuiy,Q /��o�;� Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5 :.J 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 a Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 W f 57 4 0 (�c�yrX�ru� c<, ��y�, IN SUM OF S Nr�ir�iS� �O c y i rr S ON ACCOUNT OF APPROPRIATION FOR gc�zj��a� sa Board Members PO #or INVOICE NO. ACCT #/TITLE AMOUNT I hereby cert that the attached invoice(s or DEPT. Y certi 'Y 1 bill(s) is (are) true and correct and that the 6y materials or services itemized thereon for which charge is made were ordered and received except 2009 Signat e Director of Ooe tions Cost distribution ledger classification if Title claim paid motor vehicle highway fund