179085 11/10/2009 CITY OF CARMEL, INDIANA VENDOR: 356515 Page 1 of 1
10� ONE CIVIC SQUARE SIGN CRAFT INDUSTRIES CHECK AMOUNT: $1,916.60
s4 CARMEL, INDIANA 46032 8920 CORPORATION DRIVE
INDIANAPOLIS IN 46256 CHECK NUMBER: 179085
CHECK DATE: 11/10/2009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
j902 4460848 2 1,916.60 4TH GATEWAY /RANGELINE
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION
AIA DOCUMENT 6702 1CMa PACE ONE of ONE ['ACES
TO Contractor: Keystone Construction Corp PROJECT: Carmel A€ts Design District APPLICATION NO: 1 Distribution to:
47 S Pennsylvania Gateway #4
Indianapolis, IN 46204 Carmel, IN 46032 =OWNER
PERIOD TO: 5/31/2009 =CONSTRUCTION
FROM: Sign Craft Industries PROJECT NO: MANAGER
8816 Corporation Drive
Indianapolis, IN 46256 =ARCHITECT
Phone 317.842.8664
Fax 317.842.3015 CONTRACT DATE: ®CONTRACTOR
*Please note we have move to a new location
CONTRACT FOR:
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 $18,230.00
2. Net change by Change Orders $936.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 t 2) $19,166.00
4. TOTAL COMPLETED STORED TO DATE $19,166.00
(Column G on G703) Date:
5. RETAINAGE:
a. 10% of Completed Work 1,916.60 State of: INDIANA County of: MARION
(Column D E on G703) Subscribed an worn t for
o e m is day of I Z�
b. 10% of Stored Material 0:00 Notary Public: c
(Column F on G703) My Commission expires: i
Total Retainage (Lines 5a 5b or 1 8 2 U O 1 y u+' `6HC A
Total in Column I of G703) $1,916.60 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $17,249.40 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 Total) $0.00 comprising this application, the Construction Manager and Architect certify to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) progressed as indicated, the quality of the Work is in accordance with the Contract
8. CURRENT PAYMENT DUE $17,249.40 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE $1,916.60
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation ifamount certified differs from the amount app lied (or. Initial all
Total changes approved figures on this Application and on the Continuation Sheet that changed to conform to the
in previous months by Owner amount certified.)
CONSTRUCTION MANAGER:
Total approved this Month $936.00 By: Date:
ARCHITECT:
TOTALS $936.00 1 $0.00 By: Date:
NET CHANGES by Change Order $936.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702/CMa APPLICATION AND CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION' 1992 EDITION AIA' @1992 G702 /CMa-1992
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W., WASHINGTON, DC 200063292
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION
AIA DOCUMENT G7021CM,3 PAGE ONFC11 f,NE PAGE',
TO Contractor: PROJECT: APPLICATION NO: Distribution to:
=OWNER
PERIOD TO: =CONSTRUCTION
FROM:
PROJECT NO: MANAGER
=ARCHITECT
17 1 3
CONTRACT DATE: [K]CONTPACTOR
CONTRACT FOR:
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 $19,166.00
2. Net change by Change Orders $936.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 2) $19,166.00
4. TOTAL COMPLETED STORED TO DATE $19,166.00
(Column G on G703) By:. Date:
5. RETAINAGE:
a. 10% of Completed Work 0.00 State of: INDIANA County of: MARION
is
(Column D E on G703) Subscribed a n d s vi9rn to before me this �1 day of OIP— oy
b. 0% of Stored Material 0.00 Notary Public: 4 Irv;
(Column F on G703) My Commission Ca "d-
Total Retainage (Lines 5a 5b or pires I f 0 0 6_
Total in Column I of G703) $0.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $19,166.00 In accordance with the Contract Documents, based on on-site observations and the data
(Line 4 less Line 5 Total) $0.00 comprising this application, the Construction Manager and Architect certify to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) $17,249.40 progressed as indicated, the quality of the Work is in accordance with the Contract
8. CURRENT PAYMENT DUE $1,916.60 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED $I 0 5un
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation Ifamount certified differs from the amount applied for Initial all
Total changes approved figures on this Appolxati o"nd on the Gontinuabon Shot that changed to conform to the
in previous months by Owner amount certified.)
CON UCM N r-, th
Total approved this Month $936.00 $0.00 Date:
I
ARCHIT
TOTALS $936.00 1 $0.00 By: Date:
L NET CHANGES by Change Order $936.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the owner or Contractor under this Contract.
AIA DOCUMENT G702/Cma APPLICATION AND CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER-ADV EDITION 1992 EDITION AIA 11992 G702,1CM.-I992
THE AMERICAN 114STI TIJIF OF ARCHITECTS, 1 1+5 NEW ,OPK AVE_ N.W.. WASHINGTON, DC 20006-5292
Users may obtain validation of this document by requesting Of the license a completed AIA Document D401 Certification of Document's Authenticity
CONTINUATION SHEET AIA DOCUMENT G703 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 2
Contractor's signed certification is attached. APPLICATION DATE: 5/31/2009
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 5/31/2009
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
A B C D E F G H I
MATERIALS TrEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED L o RETAINAGE
NO. VALUE 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 Signage for Gateway #4 $15,026.00 $15,026.00 $15,026.00 100.00%
2 Installation $3,204.00 $3,204.00 $3,204.00 100.00%
3 Change Order $936.00 $936.00 $936.00 100.00%
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
GRAND TOTALS $19,166.00 $19,166.00 I I $19,166.00 1 100%
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
}fin 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
Purchase Order No.
1�2U /c is/ ✓a Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
Ci^u' s IN SUM OF
n
916,.6o
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
902 2 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
/G /y 2008
1� I
Sig ture
Director of perations
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund