174445 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 362321 Page 1 of 1
ONE CIVIC SQUARE NATIONAL SALVAGE SERVICE CORP
CHECK AMOUNT: $500,201.95
CARMEL, INDIANA 46032 Po sox soo
CLEAR CREEK IN 47426 CHECK NUMBER: 174445
CHECK DATE: 7/8/2009
DEPARTMENT ACCOUNT P NUMBER INVOICE NUMBER AMOUNT DE SCRIPTION
902 4460847 3 26,069.30 HEARTHVIEW OLD TOWN
902 4460847 3 X23,457.55 LOFTS SITE DEOM
902 4460847 4 --323,675.10 SOIL REMOVAL
902 4460847 5 27,000.00 DEMOLITION
APPLICATION and CERTIFICATE for PAYMENT DOCUMENT G702
To: City of Carmel, IN Redev. Comm. Project: Parcel 47E, Carmel Arts District Application No: Nz:�, Distribution to:
One City Square Lofts Site Demolition
Carmel, IN 46032 App. Date: May 14, 2009 OWNER
CONSTRUCTION MGR.
Period to: May 20, 2009 ARCHITECT
From: National Salvage Service Corp. CONTRACTOR
P.O. Box 300 Project Nos: OTHER
Clear Creek, IN 47426 Contract Date: November 18, 2008
Contract For: Demolition ATTN: Bruce Stauffer
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 completed
Continuation Sheet, G703, is attached. 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
1. ORIGINAL CONTRACT SUM 25 received from the Owner, and that current payment shown herein is now due.
2,000.00
2. Net Change By Change Orders 45,119.00 CON TR TO N ional Salvage Service Corp.
3. CONTRACT SUM TO DATE 297,119.00 By: Date: M aw/ 14 2009
4. TOTAL COMPLETED AND STORED TO DATE 182 ,619.50 trafg Bent Project Mana
5. RETAINAGE: State of: Indiana County of: Monroe
a. 10% of Completed Work 18,761.95 Subscribed and sworn before me this 14th day of j May 2009
b. 0% of Stored Material Craig Bentley, Project Manager, personally appeared before me, the undersigned notary:' e y
0.00 public, and provided satisfactory evidence of identification to be the person who signed this'.
TOTAL RETAINAGE document in my presence and swore or affirmed to me that the contents.of this'documerit are
18,761.95 truthful and accurate to the best of his /herrknowledge and belief.
6. TOTAL EARNED LESS RETAINAGE 163,857.55
Notary Public: =f M v My Commission expires: b?Aq y
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 140,400.00
ENGIN ER' RTIFICATE FOR PAYMENT
8. CURRENT PAYMENT DUE 23,457.55 In accordance with the Contract Documents based on on -site observations and the data
9. BALANCE TO FINISH, INCLUDING RETAINAGE comprising this application, the Engineer certifies to the Owner that to the best of the
133,261.45 Engineer's knowledge, information and belief the Work has progressed as indicated, the
quality of the Work is in accordance with the Contract Documents, and the Contractor is
4 tl entitled to payment of the AMOUNT CERTIFIED.
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AMOUNT CERTIFIED &05_467
Total changes approved in 20,691.00 0.00 (Attach explanation if amount certified differs from the amount applied for. Initial all figures
previous months by Owner on this Application and on the Continuation Sheet that are changed to conform to the amount
Total approval this Month 24,428.00 0.00 certified.)
TOTALSI 45,119.00 0.00 ENGINEER
NET CHANGES by Change Order 45,119.00 By: Date:
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
Prejudice to any rights of the Owner or Contractor under this Contract.
TORGO SOFTWARE http: ,torg•t.net 01996.2008 ALL RIGHTS RESERVED
CONTINUATION SHEET G703 PROJECT: Parcel 47E Carmel Arts District National Salvage Service Corp. Page 1 of 1
Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: V�s
Contractor's signed Certification is attached. APPLICATION DATE: May 14, 2009
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: May 20, 2009
PROJECT NUMBER:
A B C D E F G H I
Item Description of Work Scheduled Work Completed Materials Total Completed Balance Retainage
Value From Previous This Stored Used and Stored to Finish
Application(s) Period Prior Current To Date
0.00 0.00 0.00 0.00 0.0
0.0
1 Mobilization 3,400.00 3,400.00 0.00 3,400.00 100.00 0.00 340.0
2 Bond 4,800.00 4,800.00 0.00 4,800.00 100.00 0.00 480.0
3 Site Preparation 72,000.00 0.00 0.00 0.00 0.00 72,000.00 0.00
4 Erosion Controls 1,800.00 1,800.00 0.00 1,800.00 100.00 0.00 180.00
5 Removal of Site Furnishings 2,800.00 2,800.00 0.00 2,800.00 100.00 0.00 280.0
6 Demolition: #41 12,200.00 12,200.00 0.00 12,200.00 100.00 0.00 1,220.0
7 Demolition: #121 9,800.00 9,800.00 0.00 9,800.00 100.00 0.00 980.0
8 Demolition: #130 36,000.00 36,000.00 0.00 36,000.00 100.00 0.00 3,600.0
9 Demolition: #120 29,000.00 29,000.00 0.00 29,000.00 100.00 0.00 2,900.0
10 Demolition: #110 41,000.00 41,000.00 0.00 41,000.00 100.00 0.00 4,100.0
11 Concrete Demolition 16,500.00 13,200.00 3,300.00 16,500.00 100.00 0.00 1,650.0
12 Asphalt Demolition 7,700.00 0.00 7,700.00 7,700.00 100.00 0.00 770.0
13 lAlternate #2 Move House 10,000.00 0.00 5,000.00 5,000.00 50.00 5,000.00 500.0
14 Alternate #4 LEED 5,000.00 2,000.00 3,000.00 5,000.00 100.00 0.00 500.0
15 Change Order #1 House Move 20,691.00 0.00 10,345.50 10,345.50 50.00 10,345.50 1,034.5
16 Peele House Foundation 27,154.00 0.001 0.00 0.00 0.0 '27,154.00 0.0
17 Allowance Credit (not used) 5,000.00 Q 0.0 5,000.0 5,000.00 100.00 0.00 0.0
18 IVFW Interior Removals 2,274.00 0.001 2,274.001 2,274.00 100.00 0.001 227.4
GRAND TOTAL: 297,119.001 156,000.001 26,619.501 1 182,619.501 61.461 114,499.50 18,761.95
A =Line Item Number B =Brief Item Description C =Total Value of Item D =Total of D and E From Previous Application(s) (If Any) E =Total Work Completed For This Application
F= Materials Purchased and Stored for Project G =Total of All Work Completed and Materials Stored for Project H= Remaining Balance of Amount to Finish 1= Amount Withheld from G
TORGO SOFTWARE httpalw .tbrgo.net 01996 -2008 ALL RIGHTS RESERVED +'Lr
WAIVER OF LIEN
Date: May 14, 2009
To All Whom it may Concern:
Whereas, National Salvage Service Corporation (CONTRACTOR) has been
employed by the City of Carmel, Indiana Redevelopment Commission (OWNER) to
furnish SERVICES for the premises known as Parcel 47E, Carmel Arts District Lofts
Lofts Site Demolition, Carmel, Indiana,
The undersigned, for and in consideration of payments in the amount of
($23,457.55) Twenty three thousand four hundred fifty seven and 55 1100 dollars for
supplies or services and other goods and valuable consideration, the receipt whereof is
hereby acknowledged, does hereby waive and release any and all lien, and claim or right
to lien on said above described building and premises under the Statutes of the State of
Indiana, relating to Mechanics' Liens, on account of labor or services, material, fixtures
or apparatus heretofore furnished to this date by the undersigned for the above described
premises.
Natioml Salvage Service Co oration
orp ation/Co p y Nam
Affix
(Signatur o uthori ed Rep esentative) Corporate
Seal
Craig Bentley, entley, Project Manager
(Title)
May 14, 2009
(Date)
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
AArA'16h ,�g 447 Cc L Purchase Order No.
PCB eo ,3oG Terms
C/1101 4KII/� /i(/ y 7 y2 G Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
A 3 L4' 4i 1
�r
n
Y
Total 23:5 7 sS
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. r
20 L L f
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
Bair 300
Z 3 ys 7 56 7
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or
DEPT. INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or
a2 3 4 /5/& 6 'y5'7 23 5'5 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
Signat Pe
Tit e
Cost distribution ledger classification if
claim paid motor vehicle highway fund
S
C
F
National Salvage Service Corp.
Date: May 14, 2009
From: National Salvage Service Corp.
P.O. Box 300
Clear Creek, IN 47426
To: City of Carmel, Indiana Redevelopment Commission
One City Square
Carmel, IN 46032
ATTN: Bruce Stauffer of Keystone Construction Corporation
Project: Parcel 47E, Carmel Arts District Lofts Site Demolition
Pay Application #5
Work Completed
Units Quantity Unit Price This Period
Alternate #1A VFW Demolition per the allowance
in the contract LS 1 $20,000.00 $20,000.00
Alternate #1 B VFW Demolition Delayed per the
allowance in the contract LS 1 $10,000.00 $10,000.00
Total Work Completed This Period $30,000.00
Less: Retainage of 10% $3,000.00
Current Payment Due $27,000.00
zs�
P.O. Box 300
Clear Creek, IN 47426
f
WAIVER OF LIEN
Date: May 14, 2009
To All Whom it may Concern:
Whereas, National Salvage Service Corporation (CONTRACTOR) has been
employed by the City of Carmel, Indiana Redevelopment Commission (OWNER) to
furnish SERVICES for the premises known as Parcel 47E, Carmel Arts District Lofts
Lofts Site Demolition, Carmel, Indiana,
The undersigned, for and in consideration of payments in the amount of
($27000.00) Twenty seven thousand and 00 /100 dollars for supplies or services and other
goods and valuable consideration, the receipt whereof is hereby acknowledged, does
hereby waive and release any and all lien, and claim or right to lien on said above
described building and premises under the Statutes of the State of Indiana, relating to
Mechanics' Liens, on account of labor or services, material, fixtures or apparatus
heretofore furnished to this date by the undersigned for the above described premises.
National Salvage Service Corporation
(C po ation/C y Name)
Affix
(Signatur f Authorized e resentative) Corporate
Seal
Craig ey, Project Manager
(Title)
May 14, 2009
(Date)
r
National Salvage Service Corp.
Date: May 14, 2009
From: National Salvage Service Corp.
P.O. Box 300
Clear Creek, IN 47426
To: City of Carmel, Indiana Redevelopment Commission
One City Square
Carmel, IN 46032
ATTN: Bruce Stauffer of Keystone Construction Corporation
Project: Parcel 47, Carmel Arts District Lofts Below Grade Removals
Pay Application #4
Work Completed
Units Quantity Unit Price This Period
Addt'I VFW Contaminated Soil Removal per contract Ton 9281 $38.75 $359,639.00
Total Work Completed This Period $359,639.00
Less: Retainage of 10% $35,963.90
Current Payment Due $323,675.10
czz- 41 view
P.O. Box 300
Clear Creek, IN 47426
WAIVER OF LIEN
Date: May 14, 2009
To All Whom it may Concern:
Whereas, National Salvage Service Corporation (CONTRACTOR) has been
employed by the City of Carmel, Indiana Redevelopment Commission (OWNER) to
furnish SERVICES for the premises known as Parcel 47, Carmel Arts District Lofts
Below Grade Removals, Carmel, Indiana,
The undersigned, for and in consideration of payments in the amount of
($323,675.10) Three hundred twenty three thousand six hundred seventy five and 10 /100
dollars for supplies or services and other goods and valuable consideration, the receipt
whereof is hereby acknowledged, does hereby waive and release any and all lien, and
claim or right to lien on said above described building and premises under the Statutes of
the State of Indiana, relating to Mechanics' Liens, on account of labor or services,
material, fixtures or apparatus heretofore furnished to this date by the undersigned for the
above described premises.
National Salvage Service Corporation
Cignaore"of oration/Company Name)
Affix
Author' d Representative) Corporate
Seal
Craig Bentley, entley, Project Manager
(Title)
May 14, 2009
(Date)
i
Prescribed 4y 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
/Va /Z" �eLlll#— Cf Purchase Order No.
Terms
/V -1 75 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
So,`
5 /y ay
F .S
Total 3
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
0
with IC 5- 11- 10 -1.6.�
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
/Vr�,v•7��,.Sy /yo�� Sf���,�� �o��. IN SUM OF
7 oN .3Go
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
go 323 (,7s�o bill(s) is (are) true and correct and that the
902 S yyl�o�y7 ?761W.061 materials or services itemized thereon for
which charge is made were ordered and
received except
/7 ?0
D ire o
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
National Salvage Service Corp.
Date: April 16, 2009
From: National Salvage Service Corp.
P.O. Box 300
Clear Creek, IN 47426
To: City of Carmel, Indiana Redevelopment Commission
One City Square
Carmel, IN 46032
ATTN: Bruce Stauffer of Keystone Construction Corporation
Project: Parcel 47, Carmel Arts District Lofts Below Grade Removals
Pay Application #3
Work Completed
Units Quantit Unit Price This Period
Addt'I Contaminated Soil Removal per contract Ton 3176 $38.75 $123,071.00
VFW Contaminated Area Excavation per contract LS 1 $8,006.00 $8,006.00
Addt'I Water Removal per contract Gal 4500 $2.00 $9,000.00
Total Work Completed This Period $140,077.00
Less: Retainage of 10% $14,007.70
Current Payment Due $126,069.30
D69. 0
P.O. Box 300
Clear Creek, IN 47426
WAIVER OF LIEN
Date: April 16, 2009
To All Whom it may Concern:
Whereas, National Salvage Service Corporation (CONTRACTOR) has been
employed by the City of Carmel, Indiana Redevelopment Commission (OWNER) to
furnish SERVICES for the premises known as Parcel 47, Carmel Arts District Lofts
Below Grade Removals, Carmel, Indiana,
The undersigned, for and in consideration of payments in the amount of
($126,069.30) One hundred twenty six thousand sixty nine and 30/100 dollars for
supplies or services and other goods and valuable consideration, the receipt whereof is
hereby acknowledged, does hereby waive and release any and all lien, and claim or right
to lien on said above described building and premises under the Statutes of the State of
Indiana, relating to Mechanics' Liens, on account of labor or services, material, fixtures
or apparatus heretofore furnished to this date by the undersigned for the above described
premises.
National Salvage Service Corporation
noration/Com y Name
Affix
(Signatur Authoriz d Rep sentative) Corporate
Seal
Craig Bentley, Project Manager
(Title)
April 16, 2009
(Date)
P�agcribed b}yState 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.
AA Payee
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number J (or note attached invoice(s) or bill(s)) n
y to O" J /off Gr�o/.� �.�o✓ I y �67 30
Total 126 U69.30
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.
1 ALLOWED 20
IN SUM OF
)26, 065 -3�
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
gay y5'�o3'y� �2�, l�C 3Co 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
200,9
Signature
Director of Operations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund