179844 11/24/2009 CITY OF CARMEL, INDIANA VENDOR: 356515 Page 1 of 1
ONE CIVIC SQUARE SIGN CRAFT INDUSTRIES
CARMEL, INDIANA 46032 8920 CORPORATION DRIVE CHECK AMOUNT: $17,439.40
INDIANAPOLIS IN 46256
CHECK NUMBER: 179844
CHECK DATE: 11/24/2009
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
,902 4460848 1 17,249.40 4TH GATEWAY /RANGELINE
902 4460850 15106 190.00 VFW
From Sign Craft Industries ow 0
8816 Corporation Drive
Aff
Indianapolis, IN 46256
Phone 317 842 -8664
Fax 317 842 -3015 ftsw
L ft
INVOICE N®. 15106
Page I of I
Bill To City of Carmel Redevelopment Comm
30 West Main St
Suite 220
Carmel, IN 46032
Invoice Date 11/16/2009
Due Date 11/26/2009
Ship To City of Carmel Redevelopment Comm Your Order
Buckingham Companies Providence Terms Net 10 days
131 St Old Meridian Our Order
Carmel, IN Tax Exempt Number 0031201550 -020
Ship Qty Description U/M Unit Price Extended
1.00 Aluminum Panel EA 114.00 114.00
1.00 Installation EA 76.00 76.00
Subtotal 190.00
Total 190.00
Remove, fabricate and installed vinyled aluminum panel for the VFW.
F"LlICIA' 101 AND' CEN I
f
rt' Cnmwa;it:)r: Keystone Construction Corp P:-"Dj=cl: Carmel Arts Design District I 11)1 Tit;: I Dis'rwtr,,,n ini,
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: X 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 I 2) $19,166.00
4. TOTAL COMPLETED STORED TO DATE $19,166.00
(Column G on G703) By: ate:
5. RETAINAGE:
a. 10% of Completed Work 1,916.60 of INDIANA County of: MARION
(Column D E on G703) Subscribed and sin to before me thl on day of oo ow r
b. 10% of Stored Material 0.00 Notary Public: 1"
(Column F on G703) My Commission expires: '4
Total Retainage (Lines Sa 5b or 7 f 2 c. tc-
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 S 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 damount Certified differs from the amount applied for, Initial all
Total changes approved Agures on this Application and on the Continuation Sheet that changed to conform to the
in previous months by Owner amount crytified)
CONSTRUCTION MANAGER:
Total approved this Month $936.00 By: Date:
ARCHITECT:
TOTALS $936.00 $000 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 DOOJMENTG702�rHa APPUCATICN AND CERTIFICATION FOR PAYMENT CONMLCnON MANAGER-ADVISER EDMOM 1992 EDITION' AIA @1992 G702ICMa-1992
THE AMERICAN INSTITUTE OF ARCHITECTS, 2745 NEW YORK AVE., N.W., WASHINGTON, Dc 20x16' 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 AI D OCUMENT 6703 PAGE CFI �AGB
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 1
Contractor's signed certification is attached. APPLICATION DATE:
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. ARCHITECT'S PROJECT NO:
A B C D E F G H I I J K
ITEM DESCRIPTION OF W RK HEDULED o a o ange urrent W RK COMPLETED MATERIAL T5TKL /o B ALANCE RETAINA E
NO. VALUE Order to Date Scheduled FROM PREVIOUS H D PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE
Value APPLICATION STORED AND STORED (C G) RATE)
(D E) (NOT IN TO DATE
D OR E) (D+E+F)
1 Si.gnage for Gateway #4 $15,026.00 $15,026.00 $15,026.00 $15,026.00 100.00% 1,502.60
2 Installation $3,204.00 $3,204.00 $3,204.00 $3,204.00 100.00% 320.40
3
4 Change Order $936.00 $936.00 $936.00 $936.00 100.00% 93.60
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
GRAND TOTALS $18,230.00 $936.00 $19,166.00 $19,166.00 $19,166.00 100% 1,916.60
Users may obtain validation of this document by requesting of the license a Completed AIA Document D401 Certification of Document's Authenticity
Presc7bed 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
Purchase Order No.
,`vc Terms
'7(25 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
111116A l 5_/06 /�cis� 4//" a�i SU /ice. a0
5 �3i /v 9 I L17
K�
P�
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in ac ordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
i
ALLOWED 20
IN SUM OF
L n
l 7,
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
172119,*v materials or services itemized thereon for
which charge is made were ordered and
received except
Director of e fiffins
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund