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HomeMy WebLinkAbout174499 07/08/2009 CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CHECK AMOUNT: $56,660.44 s' s CARMEL, INDIANA 46032 720 3RD AVE SW CARMEL IN 46032 CHECK NUMBER: 174499 CHECK DATE: 702009 DEPA RTMENT ACCOUNT PO NUMB INVOICE NU MBER AMOUNT DESCRIPTION 902 4460873 1� ,,"3,135.00 CONSTRUCTION MANAGEM 902 4460873 1 `2,885.46 STREETSCAPE .902 4460805 2 -21,574.67 PROJECT MANAGEMENT 902 4460867 3 X16,448.32 MANAGEMENT FEE 902 4460867 6 X2,128.46 RANGELINE STREETSCAPE -..902 4460867 6 /3,771.09 STREET WORK 902 4460867 7 X 3,317.42 STREET WORK 902 4460867 7 X3,400.02 STREETSCAPE 1 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGEONEOF 2 PAGES2 TO OWNER CRCat Ciry of Carmel PROJECT: Carmel City Parcel 73 Perimt APPLICATION NO:Invoicegl I Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 04242009 QCONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design 0 Signature Concoction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undemigned Contractor certifies that to the best ofthe Contractors 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 oll amounts have been paid by the Contractor for Work for which previous Cenifiotes for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. L ORIGINAL CONTRACT SUM 5 9,909.95 2. Net change by Change Orders S 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 t 2) 9,909.95 4. TOTAL COMPLETED STORED TO S 3,135.00 j Date: L 5. REfAINAGE: T o Koonm, President a. 0 %of Completed Work S 0 Subscribe and swom to before me this day of April, 2009 (Column D E on G703) County b. of Stored Materiel S Hancock Court LINDA BUC (Column F an Total Retainaga (Lines IY es Sa+ Sb or My Commission Expires Total in Color -I of G703) s 0.00 C ITEC 'S C IFICA O PA MENT August20,2011 6. TOTAL EARNED LESS RETAINAGE S 3,135000 In accordance with the Contract Documents, baud on on -site observations and the dam (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) 5 0.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE S 3,135.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAWAGE S 6,774495 b .'(Line 3less Line 6) AMOUNT CERTIFIED........... S -3, L.W. V t.' ER S MM A D TI N n "loch espronar' n i am renified Jff rr from the amount applied /rtirial alt figurer an rhir Tom] changes ov appred Application. on rl- Cojn�vJ4 /no['te�ar(r /h/oe�S /{tee c ro cann /orni ww cerrifierlJ T T months b ARCIIITE am[ a a roved this Month By: Dam; TOTALS S0000 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the —tractor named rent- Issuance, payment ana acceptance of payment are tntnout NET CHANGES by Change Order E0.00 prejudice to any rights of the Owner or Contractor under this Contract. OOCONENrGr VNCATON ANO CENn1 FOa PAYMENT ISaa NA area] TNEANEmC IISTII TEOFMCNiiECTS.rraSNE Ya KAV ,.N.W.w H:IGTON, 521 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Carmel City Parcel 73 Perim( APPLICATION NO: Invoice 1 I Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 04/24/2009 MCONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel- Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractors 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. I. ORIGINAL CONTRACT SUM 9,909.95 1 Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 9,909.95 4. TOTAL COMPLETED STORED TO 3,135.00 Date: J/ z y O 5. RETAINAGE: Tho I Koontz., President a. 0 of Completed Work 0 (Subscribe nd sworn to before me this day of April, 2009 (Column D E on G703) :�P�'•. b. of Stored Material LINDA BUCHANAN (Column F on G703) �,�RY Hancock County Total Retainage (Lines 5a 5b or S2 My Commission Expires Total in Column I ofG703 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT :I i August 20, 2011 6. TOTAL EARNED LESS RETAINAGE 3,135.00 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) 0.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 3,135.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 6,774.95 ti T (Line 3 less Line 6) AMOUNT CERTIFIED. 3. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach esplanat n i amount certified differsfion: the amount applied. Initial all figures on this Total changes approved Application a anti Con nuatia teet that re changed to conform with the amount certified.) in previous months by Owner ARCI Total approved this Month By: Date: &Ipf TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Uontractor nameo 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 AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice 1 4/24/09 Carmel Cit Parcel 73 Perimeter Backfill Carmel, Indiana I WORK BALANCE COMPLETED RETAINAGE PREVIOUS TOTAL COMPLETED TO ORIGINAL DESCRIPTION THIS PERIOD WITHHELD APPLICATIONS TO DATE FINISH BUDGET I Project Management 0.00 0.00 0.00 0% 0.00 0.00 Site Supervision 0.00 0.00 0.00 0% 0. 0.00 Site Safety Director 0.00 0.00 0.00 0% 0.00 0.00 Design Drawings 0.00 0.00 0.00 l 0% 0.00 0.00 1 0.00 0.00 0.00 0 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Constructin Management Fee 3,135.00 0.00 0.00 3,135.00 0% 6,774.95 9,909.95 I I 3,135.00 0.00 0.00 3,135.00 0% 6,774.95 9,909.95 I I 1 I i i i I i I 1 I i I i I Document G702"' —1992 rat Application and Cerdficate for Payment TO OWNER �y b F C✓� e PK0.1EG?: D e L 3 01-1 L- APMCATM N0: ihufion ter: i; 0 PERIoD y- -o 9 Oxw CONTRACT FOR j3�°�`' ARDUTECT: FROM CONTRACT DATE: 3 3 o d CONTRACTOR PROJECT BIOS: Call- RACTORC�" JJ L ��.,.t ✓.�Ti 9 c FIELD: g g9�foS 6v.gf 0 n Y6 J OTIiE- L CONTRACTOR'S APPLICATION FOR PAYMENT The mActsi Cm =a= mff= that to t).t bey of the knovdM i amd bell' t& Work covemd by this Agpti== far Paying hs bast oomplewd m a000n1mce Application is trade for pa T=n as shovm below, to oc=cc&m alth the Cnatract uil& the Ccntraa Do arawnm that zD am=ou bm-c born paid by the Co I foc Work for C=E=afion Sheet., MA Docummi G703, is attached. atich pm i= Cexdfx=ex for PaSuirnt rise issued and Mmkeuts recen fr= the Ow= and 1. ORIGINAL CONTRACT SUM 98 that cuaeat payment shown hmein is now due. 2 Net Flange by Change Ordem S o CONTRACTO 3. CONTRACT SUFI TO DATE (line S gi g9 By. Ou r/ 02 Date: o 4. TOTAL COMPLETED 6 STORED TO DATE (Cch mn G on GM3) I 62, 7 o D_' State of S. REFA3H4(iE: County ofr. 1n 4 0 '%1 L L% of Completed Work Subsal and sworn to before (cam D+ E on 6103) S 6 7t me this 2 day of .Qrye' L i o d S b. 0 of Stored Material (Column F on 6703) S No Total Retamige (lines Sa 5b or Total m Cnhmmn I of Cr703)_ S 6 2 20 I MY &TOTAL EARNED LESS IETAINAGE 5 q3o ARCHITECT'S CERTIFICATE FOR PAYMENT aAm 4 L.r_ss fine S Total) In aaoordm= with the Cant Duets, based on on-sne obscr% oas Pad the &.a compaeng 7. LESS PREMUS CEUFMTES FOR PAYMENT S this eppEcanrn, iffic Andes catifies to the Oara tbat to the best of the Archho 's bws iadge, tuformabrm and belief the Work has progrmwd as mdicated, the tlaatuy of the Wad[ is in (lice 6 from pnoc Cai�ica>r) with the Ca== Dom zad the Coauaaar is ccu led to payment of the L CURRENT PAYMENT D[i£ 5 3 D AhIOUNT CERTUIFD_ %BALANCE TO FNISK iNCLUDNG RETAKABE °l AMOUNT Cam® S �jf� ��,C (Lme 3 [cm Line 6) 17 it a �I�+ the mmrml coed Enirial figarzs oar ttris Applrauicat n Shot that are chm sad so ow4brm with the mnamml cerr4ird) tHA NGE ORDER SL M11ARY ADDITIONS DEDUCTWINS ARCHrI r atzt chzngcs 2ppro%vd in rm-ious months by Owvar S S By' Date Q� oc-J ed this Dtout S S This Ce tlficare is not flegouable. The AMOUNT CEFLI FIED is px)mble anty to the Cowractor TOTALS S S rtmod hymn lssuaarr, pa)man ri and acccgtawe of palumt xr %ithom prejudice to Pay tights of rF' CHANGES by Change Order I S U the Oaaer or Ck mraaar tIDdrs this Gan Tact A1A G=- -1992. cart o 1 end 1 992 by Trm A-6csa trus as d A=hh=tL. Aa rtoa rya. VAEU :L: Tats ata' Dowmxnl is pro -aeo by LLS. roprrrgrl t_aa and h!z a— nal Trez_'es. Ur a-rlvcL repro tirZon ce d st-rfluff �'r at -ts AM Dcwme -R a wry portcn W f1, r-aV result t-3 �r•a ctv3 and crlm W pis, ar4 V;M Ea prosamaed to tie ffn=RIM Es7rt pozs t� �v o tar r, Tea d3cunnect ww prutned by ALA softwzre err 1)929:19 an o5fLi20W rrdw Drda tdo .1000121245 2 vdf d eaves cn 61112005. and is rsl for rem ttsv Nato= (472SEV-63) CONTINUATION SHEET AIA DOCUMENT 6703 (Instructions on reverse side) PACE OF PAGES AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Use Columh I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETA!NAGE NO. VALUE PRESENTLY COMPLETED (G C) TO FINISH FROM PREVIOUS THIS PERIOD STORED AND STORED (CzC) APPLICATION (NOT IN TO DATE (D +E) D OR 1 (D+E +F) y260 y ?o t S 9s° o 2 --51 (F v o l v d a B(� S C ,7200 O 3l� �lP�T5 AIA DOCUMENT 070.7 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA' C. 1983 C/ THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W. WASHINGTON. D.C. 20006 6703 -1983 rI 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 vyhom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee 1-L, G Purchase Order No. 720 3�� S� Terms 17' D3 2 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 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. �'O•'1 ALLOWED 20 Sj` P Srv, L L C IN SUM OF 720 ON ACCOUNT OF APPROPRIATION FOR �lo�yy� o x'73 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or GAL 3 �3Spa 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 20 459 Diredf&5f" @rations Title Cost distribution ledger classification if claim paid motor vehicle highway fund v 'i Checks to be made Payable to: Lithko Contracting Inc 154,288.13 v Signature Construction LLC 21,574.67�D APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUA PAGE ONE O 2 PAGES TO OWNER CRC at City of Carmel PROJECT: Carmel City Phase 1 PI 10 APPLICATION NO: Invoice 2 1 Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 04/22/2009 MCONTRAC"1 1 CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the best of the Contractors 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 showit herein is now due. 1. ORIGINAL CONTRACT SUM 65,730.93 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 65,730.93 4. TOTAL COMPLETED STORED TO S 27,732.14 Subscribed/y. Date: 5. RETAINAGE: Thoma Koontz, President a. 0 of Completed Work S 0 nd swom to before me this day of April, 2009 (Column D T E on G703) LINDA BUCHANAN b. of Stored Material (Column F on G703) NOTARY Hancock County Coral Retainage (Lines Sa 51b or s SEAL My Commission Expires Total in Column I of G703) S 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT Au9u st2o,2o11 W 6. TOTAL EARNED LESS RETAINAGE S 27,752.14 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) S 6,207.47 e quality of the Work is in accordance with the Contract Documents, and the Contractor S. CURRENT PAYMENT DUE S 21,574.67 s entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 37,943.79 (Line 3 less Line 6) AMOUNT CERTIFIED CHANGE ORDER SUNINIARY ADDITIONS DEDUCTION'S (Attach e.Tplm r" if """unt certified d ffer,c from the amount applied Initial al! figures on this "Total changes approved Applicario aruf o the C tin ratio 'beer char "re changed ro cot jorm with the amount certified.) in previous months by Owner ARCFII -CT: Total approved this Month By Date: 3D 0 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the ontractor nameu nerem. Issuance, payment anG 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 AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 7 3rdl Av enue, S Carmel, Indiana 4603:T 4/22/09 Carmel City Phase l P110 Carmel, Indiana BALANCE _____Tptal_��ork___ Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE i FINISH General Requirement: n Testing an 3000.00 0.00 0.00 0-00 0.00 0% 3,000.00 Ins pecting 0 99 Site Sup 49.33 0 00 Supervision 16,153.85 0.00 49.33 SCCeSafety o 3 3- 33 0. 00 _oo o.00 o. 0o 0.1. Design 0 0 0 0.00 _Prawings__ 000. 0o 0.00 0.00 Sanitary Facilities 1,248.00 0.00 0.00 0..00 0.00 .-0-%.---- 1,248.00 Field Office 1,512. 0.00 0.00 0.00 0.00 0% Temporar'KEle(Itric 225.00 0.00 0.00 0.00 o.00 0% 225.00 Office Supplies 225.00 0.00 0.00 0.00 0.00 0% 225.00 Temporar)t Temporary jd�c_qanyalc�ti 225.00 00 ______0 00 0.00 0.00 0% 225.00 _F�orjuy Water 225 00 0.00 0.00 0.00 0.00 0% 225.00 Tools and E q uipment 6 00.00 0.00 0% 600.00 Project Slq,nage 100.00 0.00 0.00 0.00 0.00 0% 100.00 Field Engineering and Surveying 5 000.00 0.00 0-00 0.00 o.00 0% 5,000.00 6 o Health and Safety 1 000. 00 0.00 0.00 ___0.00 0 n. 1 0.0o W aste Dis posa l 1,083.75 0.00 0.00 0.00 0.00 0% 1,083.75 Fnal Clean 0.00 0.00 0.00 Constructin Management Fee_ 1, C� 15,592 .53 -0-0-0-_ 6,207.47_ 21,800.00 0..00 93 21,574-67 0.00 _6,207.47 27 ,782 14 37 948 79 T J­ t i PAGES APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF TO OWNER: PROJECT: CARMEL CITY APPLICATION NO: 2 Distribution to: SIGNATURE CONSTRUCTION SERVICES, LLC. CENTER PHASE 1 PERIOD TO: April 30, 2009 7OWNER ONE PEDCOR SQUARE, 720 THIRD AVE, SW PROJECT NOS: ARCHITECT CARMEL, IN 46032 LCi JOB# L5429 CONTRACTOR FROM CONTRACTOR: CHECK REMITTANCE ADDRESS: CONTRACT DATE: e LITHKO CONTRACTING, INC LITHKO CONTRACTING, INC. P.O. BOX 270 P.O. BOX 270 0 MONROE, OHIO 45050 MONROE, OHIO 45050 l.r CONTRACT FOR: Place/Finish Concrete VIA ARCHITECT: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for pay ment, 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 436,000.00 2. Net change by Change Orders 0.00 CONTRACTOR: LITHKO CONTRACTING, INC. 3. CONTRACT SUM TO DATE (Line 1 2) 436,000.00 4. TOTAL COMPLETED STORED TO 309,375.00 DATE (Column G on G703) By: Date: April 17, 2009 5. RETAINAGE: ANDREA GANNON, BILLING COORDINATOR a. 10% of Completed Work 30,937.50 State of: OHIO. County of: WARREN (Column D E on G703) Subscribed and sworn to-b re 'me this d 17 day of April, 2009 b. of Stored Material (Column F on G703) Notary Pubic: r iLl.� Total Retaina e Lines 5a 5b or My Comt ss' ire, a a, Total in Column i of G703) 30,937.50 ARCHITECT S,,;C:E'RT1R RI'CATE" FOR NT 6. TOTAL EARNED LESS RETAINAGE 278,437.50 In accordance with `the•Cont`ract:Docurnents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application ,-sthe 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) 124,149.37 the quality of the Work is in accordance with the Contract Documents, and the Contractor S. CURRENT PAYMENT DUE 154,288.13 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 157,562.50 (Line 3 less Line 6) AMOUNT CERTIFIED CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if ount certified differs from the amount applied. Initial all figures on this Total changes approved Application and a e ntinuation Sheet that are changed to conform with the amount certified.) in previous months by Owner $0.00 $0.00 ARCHITECT: Total approved this Month $0.00 $0.00 By: l./ Da 4 0 9 1M 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 AIA ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. JMP92 -22 -F Effective- 1/31/01 Page 1 of 1 lT�6 UI? n 20U� CONTINUATION SHEET AIA DO CUMENTG7o3 PAGE of PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 2 Contractor's signed certification is attached. APPLICATION DATE: 4/17/2009 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: CARMEL CITY CENTER PHASE fithko L54 A 13 C D E P G FI I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL /G BALANCE RETAIN'AGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C G) RATE) (NOT IN TO DATE D OR E) (D +E +F) 1 PAYMENT PERFORMANCE BOND 4,800.00 4,800.00 0.00 0.00 4,800.00 100% 0.00 $480.00 2 MOBILIZATION 5,000.00 4,000.00 1,000.00 105 TO 0.00 5,000.00 100% 0.00 $500.00 3 GENERAL CONDITIONS LAYOUT 5,000.00 3,000.00 1,000.00 io3 71c`3 0.00 4,000.00 80% 1,000.00 $400.00 4 FIRESTOPPING 12,000.00 9,600.00 2,400.00 16 'i'd�(Jv 0.00 12,000.00 100% 0.00 $1,200.00 5 LIGHT POLE BOLLARD PEDESTALS 20,000.00 5,000.00 15,000.00 10 0.00 20,000.00 100% 0.00 $2,000.00 6 MOTOR COURT REBAR INSTALLATION 11,375.00 2,843.75 8,531.25 1 (i 1 fitly 0.00 11,375.00 100% 0.00 51,137.50 7 MOTOR COURT REBAR MATERIALS 38,500.00 38,500.00 0.00 0.00 38,500.00 100% 0.00 S3,850.00 8 MOTOR COURT PREP, PLACE FINISH 88,800.00 0.00 0.00 0.00 0.00 0% 88,800.00 $0.00 9 VETERANS WAY REBAR INSTALLATIO 6,500.00 0.00 6,500.00 103 0 0.00 6,500.00 100% 0.00 $650.00 10 VETERANS WAY REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00 VETERANS WAY PREP, PLACE FINISH 49,600.00 0.00 24,800.00 l03 .�bc`( 0.00 24,800.00 50% 24,800.00 $2,480.00 HANOVER SQ REBAR INSTALLATION 6,500.00 0.00 6,500.00 to j 0.00 6,500.00 100% 0.00 $650.00 HANOVER SQ REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00 HANOVER SQ PREP, PLACE, FINISH 49,600.00 0.00 49,600.00 (0 0.00 49,600.00 100% 0.00 $4,960.00 COURT PLAZA REBAR INSTALLATION 6,500.00 0.00 6,500.00 1' 03 0.00 6,500.00 100% 0.00 $650.00 COURT PLAZA REBAR NIATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00 COURT PLAZA PREP, PLACE FINISHI 49,600.00 0.00 49,600.00 �D3 T' 0.00 49;600.00 100% 0.00 $4,960.00 RE MOB FOR CRANE AREA REBAR INSTALL 1, 625.00 0.00 0.00 0.00 0.00 0% 1,625.00 $0.00 REMOB CRANE AREA REBAR MATERIALS 4,950.00 4,950.00 0.00 0.00 4,950.00 100% 0.00 $495.00 REMOB CRANE AREA PREP, PLACE, FINISH 10,400.00 0.00 0.00 0.00 0.00 0% 10,400.00 $0.00 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00 0.00 0.00 0.00 0.00 0.00 0% 0.00 $0.00 GRAND TOTALS 436,000.00 137,943.75 171,431.25 0.00 309,375.00 71 126,625.00 $30,937.50 Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity Page I of 1 JN -20 -1' Effective- 1/31/01 SUBCONTRACTOR'S SWORN STATEMENT OF INDEBTNESS WAIVER OF LIEN STATE OF Indiana COUNTY milton A o P Being duly sworn upon his /her oath disposes and 9 Y P P says that: 1. He /she i WIJAcaJZ(inserting sole proprietor, partner or corporate office held, as the case maybe), of Lithko Contracting hereafter called the "Subcontractor He /she is over the age of twenty -one. He /she is authorized to make this affidavit on behalf of Subcontractor. 2. Subcontractor is the C0t-)cl C Subcontractor for the construction of the development known as CARMEL CITY CENTER located in CARMEL (City), INDIANA (state), hereafter referred to as the "Development pursuant to the contract between the Subcontractor and Signature Construction, LLC, the General Contractor. 3. This affidavit is made for the express purpose of inducing Signature Construction, LLC, to make payment to Subcontractor of the invoice submitted herewith for labor and materials furnished pursuant to said Contractor. Upon receipt of said payment the Subcontractor hereby waives any lien rights to which Subcontractor is entitled for labor or materials furnished for the development to the date hereof. 4. Listed below are all suppliers or other persons who either has furnished or might furnish the Subcontractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered to the General Contractor. 3.) If the initial delivery has not been made. S upplier List (Add list if necessary 1 1. Amount Owed 2 3 c�ecL- G 2 n� DiNG C vGE_Oe z �ZcU4t /,+tS OA)SItE S P o GS c� c�n� CoN 7i= Wtl�(F rrvF f�verc ate. #1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly payable to Subcontractor and such creditor, as Signature Construction, LLC shall determine. 5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result in lien being filed against the Development or a claim being asserted against the General Contractor except the persons or businesses named in Paragraph 4 above. IN WITNESS WHERE OF, affiant has signed this document on behalf of the Subcontractor this day of z L_ 20 (Authorized Representati of Subcontractor) County of State o Subscribed and sworn to before me, a Notary Public in and for said County and Sta This 0 Day of A 1l_ 20 09 f (Not a Public) of (Printed Name) My Commission Expires: NOTARY SEAL MUST APPEAR ON THIS FORM. (Revised 10/2000 Signature) 6 Lithko Contracting, Inc. {513} 539 -4144 Remittance Address Itnico P.O. BOX 270 MONROE, OHIO 45050 CONTRACTING, INC. 149837 TO: SIGNATURE CONS "rRUCTION SERVICES, LLC. ONE PEDCOR SQUARE;, 720 THIRD AVE, SW invoice No. CARMEL, IN 46032 24913 RI Invoice Date 4/17/09 Job name: Lithko Job No. Customer Job No. P.O. No. CARMEL CITY CENTER PHASE 1 L5429 Description Amount DRAW# 2 GROSS 171,431.25 RET 17,143.13 154,288.13 COMMUNICATIONS CONVEYED ON CHECK TENDERED STATING PAYMENT IN FULL AND /OR WAIVING OF LIEN RIGHTS TO ANY EXTENT MUST BE SENT TO SELLER AS FOLLOWS: ATTN: ACCOUNTS RECEIVABLE DEPT., LITHKO CONTRACTING, INC. P.O. BOX 270, MONROE, OH 4505.0 Payment Terms 3o DAYS TOTAL AMOUNT DUE 154,288.13 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 6 004 s 7Lo S�w� <�s L� C Purchase Order No. 720 P, S Cr/ Terms /W,/ ��6 Date Due Invoice Invoice Description Amount G Date Number (or note attached invoice(s) or bill(s)) r/2 09 2 1 °cf %9/7�s ps�Jr• Total 21 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 1w i�G 03 2 67 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 9a2 2 y�6o 2/ S75!G 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 /l 20 Signature Director of On®rnf in= Cost distribution ledger classification if Tltle claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF I PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICA'T'ION NO: Draw Number #6 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Robert Indiana Street Work =ARCI-11 PER10D TO: .04/22/09 =CONTRACTOR FROM CONTRACTOR: VIA ARCI-IITECC: Signature Construction LLC 720 3rd Avenue S.W- PROJECT NOS: Carmel_- Indiana 46032 CONTRACT FOIL: CONTRACT DATE: October, 2008 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 30,460.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTIU \CT SUM TO DATE (Line I t 2) 30,460.00 4. TOTAL COMPLETED STORED TO DATE 24,595.02 r By: Date: y ZL o 5 5. RETAINAGE: Tom Koot r President a. 0 of Completed Work Su cribed sworn to before nre this day of 4 0 t (Column D E on G703) b. of Stored Material S Column F on G703 LINDA BUCHANAN Hancock County Total Retainage (Lines 5a 5b or Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAY T;�'" August 20, 2011 6. TOTAL EARNED LESS RETAINAGE S 24,595.02 In accordance with the Contract Documents, based on on -site observations id tie a a (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) 20,823.93 the quality of the Work is in accordance with the Contract Documents, and the Contractor S. CURRENT PAYMENT DUE 3,771.09 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 5,864.99 (].,me 3 less Line 6) AMOUNT CERTIFIED S 3,771.09/ 2Vd CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanatio 'fanuount certified differs fi the amount applied. Initial all figures on this Total changes approved Applim[ ion at on 1e Contitnt n Sheet that are changed to conform with the amount certified) in previous months by Owner r \RCI IfI L Total approved this Month fay: Date 4{30��°) 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 CI- IANGES 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., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Robert Indiana Street Work Budget Review and Distribution Request #6 Period Ending April 22, 2009 PROJECT BUDGET REVIEW SUMMARY TOTAL WORK THIS PERIOD Current BALANCE Total Scheduled COMPLETED RETAINAGE Payment PREVIOUS TOTAL COMPLETED TO Retainage DESCRIPTION Value THIS PERIOD WITHHELD Due APPLICATIONS TO DATE FINISH Held General Conditions /Requirements 46,150.00 4,615.00 461.50 4,153.50 39,227.50 43,642.50 95% 2,307.50 4,384.25 Existing Conditions /Selective Demo 8,770.00 0.00 0.00 O.DD 8,770.00 8,770.00 100% 0.00 877.00 Concrete 24,430.00 0.00 0.00 0.00 24,430.00 24,430.00 100% 0.00 2,443.00 Meltal 2,190.00 0.00 0.00 0.00 2,190.00 2 190.00 100% 0.00 219.00 Specialties (signage) 5,570.00 0.00 0.00 0.00 0.00 0.00 0% 5,570.00 0.00 Electrical 41,640.00 4,164.00 416.40 3,747.60 29,148.00 33,312.00 80% 8,328.00 3,331.20 Earthwork 41,500.00 6,225.00 622.50 5,602.50 31,125.00 37,350.00 90% 4,150.00 3,735.00 Exterior Imporvements 70,650.00 17,662.50 1,766.25 15,896.25 17,662.50 35,325.00 50% 35,325.00 3,532.50 Utilities 63,700.00 0.00 0.00 0.00 63,700.00 63,700.00 100% 0.00 6,370.00 Signature's General Conditions 15,230.00 2,137.76 0.00 2,137.76 10,011.28 12,149.04 80% 3,080.96 0.00 Signature's Profit Overhead 15,230.00 1 0.00 1 10,812.65 12,445.98 82% 2,784.03 1 0.00 Total 335,060.00 36,437.59 3,266.65 33,170.94 237,076.93 273,514.52 82% 61,545.49 1 24,891.95 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 C;pk C-a CA 2L 1 <1 Slr�4 01— t C Purchase Order No. Lj aC) 3( AL'-0_'.L'_t ScJ Terms Cu rrr," T r"U (a -o Date Due Invoice Invoice Description Amount Da Number (or note attached invoice(s) or bill(s)) JV b l0 k0 nn Q.i.Ct L d f k. 1.cJt- .iGtflClc_ �`ir Total 3 `7 1,c, 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 `1 r IN SUM OF a 0 a AV-Y-n u.-,— lc� C` a r --4 LrJ "6 0 3 2 3/`7 71, 0 Ci ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or DEPT INVOICE NO. ACCT #!TITLE AMOUNT I hereby certify that the attached invoice(s), or (?(0Z +4 o8 (9 `7 "3 rr r7 1 of 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 �c- 200q Signature Director of Operations Title Cost distribution ledger classification if claim paid motor vehicle highway fund City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Rangeline Streetscapes Budget Review and Distribution Request #6 Period Ending April 22, 2009 Checks to be Made Payable to: Hagerman Construction Corporation 23,012.10 Signature. Construction, LLC 2,128.46 Total 25,140.56 City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Rangeline Streetscapes Budget Review and Distribution Request #6 Period Ending April 22, 2009 PROJECT BUDGET REVIEW SUMMARY TOTAL WORK RETAINAGE Current BALANCE Total Scheduled COMPLETED WITHHELD Payment PREVIOUS TOTAL COMPLETED TO aetainage DESCRIPTION Value THIS PERIOD THIS PERIOD Due APPLICATIONS TO DATE FINISH Held General Conditions /Requirements 56,800.00 5,680.04 568.00 5,112.00 48,280.00 53,960.00 95% 2,840.00 5,396.00 Existing Conditions /Selective Demo 13,150.00 0.00 0.00 0.00 13, 150. oo 13, 150.00 100% 0.00 1,315.00 Concrete 36,700.00 0.00 0.00 0.00 36,700.00 36,700.00 100% 0.00 3,670.00 Meltal 6,680.00 0.00 0.00 0.00 6,580.00 6,580.00 100% 0.00 658.00 Specialties (signage) 8,350.00 0.00 0.00 0.00 0.00 0.00 0% 8,350.00 0.00 Electrical 57,950.00 5,795.00 579.50 5,215.5Q 40,565.00 46,360.00 80% 11,590.00 4,636.00 Earthwork 22,420.00 0.00 0.00 0.00 22,420,00 22,420.00 100% 0.00 2,242.00 Exterior Imporvements 46,980.00 14,094.00 1,409.40 12 684.60 9,396.00 23 4 90.00 50% 23,490.00 2,349.00 Utilities 21,220.00 0.00 0.00 0.00 21,220.00 21,220.00 100% 0.00 2,122.00 Change Order #1 23,672.00 0.00 0.00 0.00 23,672.00 23,672.00 100% 0.00 2, 367.20 Change Order #2 8,651.00 0.00 0.00 0.00 8,651.00 8 651.00 100% 0.00 865.10 Signature's General Conditions 15,123.65 850.01 0.00 850.01 11,389.70 12,239.71 81% 2,883.94 0.00 Signature's Profit Overhead 15,123.65 1 1,278.45 0 QO 1, 278.45 11 531.70 12, 810.15 85% 2,313.50 0.00 Total 332,72Q.30 27,697.46 2,556.90 25,140.56 253,555.40 281,252.86 85% 51,467.44 25,620.30 D� APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 1 PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO Draw Number #6 i Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Rangeline StreetScapes =ARCHITECT PERIOD TO: 04/22/09, CON "TR =X ACTOR FROM CONTRACTOR: VIA ARCHITECT: Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: Cannel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: October, 2008 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. I. ORIGINAL CONTRACT SUM 27,015.00 2. Net change by Change Orders 3,232.30 CONTRACTOR: 3. CONTRACTS UM TO DATE (Line I f 2) 30,247.30 4. TOTAL COMPLETED STORED TO DATE 25,049.86 f yIZL /O� By: Date: 5. RETAINAGE: I' m Koontz President a. 0 of Completed Work Subsc ibed and s4om to before me this day of (Column D E on G703) b. of Stored Material LINDA BUCHANAN (Column F on 6703) -gNOTARY.': Hancock County Total Retainage (Lines 5a 5b or M Commission Expires SEAL Total in Column I of G703 0.00 ARCHITECT'S CERTIFICATE FOR PA A ugus t 6. TOTAL EARNED LESS RETAINAGE 25,049.86 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 CERTIFICA'TIS FOR Architect's knowledge, information and belief the Work has progressed as indicated PAYMENT (Line 6 from prior Certificate) 22,921.40 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 2,128.46 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 5,197.44 (Line 3 less Line 6) AMOUNT CERTIFIED 2,128.46 tM Q CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (A ttach explanation i amount certified differs from the amount applied. Initial all figures on this Total changes approved Application and o e Conti atio Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT. I Total approved this Month By: Date: 4i T R/co 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 AIA .01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGEONEOF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 Streetscape APPLICNrION N(:) B0006 I)istribUtiOn to: City of Carmel #2691 PEP,101) TO: 4/2-5/2009 p OWNER '8i1ce #9321 RTECT Inv PROJECT NOS.: 08269 IA Carmel, rN 46032 ARCI FRO NI CONTRACTOR Hagerman Construction Corporatll VIA ARCHITECT: jQSO Architects Inc CON-IRACTOR 2 00 �;280 Fast 96th Street 7930 Castleway Drive ijj Indianapolis, IN 46250 1, Indianapolis, INDIA.NA 46240 CONTRACT DA: CONTRACT NOR: The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- CONTRACTOR'S APPLICATION FOR PAYMENT The and belief the Work covered by this application for Payment has been completed Application is made for payment, as shown below, in connection with the contract, in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for Which previous Certificates for Payment were issued and pay- 1. ORIGINAL CONTRACT SUM ments received from the Owner, and that current Rayment shown herein is now due- �270 150,00 Hagerman Construction corporation CONTR_A:C1 2. Net change by Change Orders 532323.00 Hy; Date: _April 20 2009 3, CONTRACT SUM TO DATE (Liao I:t2) 5302,473.00 Troy Heisler, CFO 4. TOTAL COMPLETED STORED TODATE S256,203.00 State of. Indiana Allen (Column G on G703) County of. 5. RETAINAGE: Subscribed and sv. to before C3 me t11is 0 a. AQ.O(K) of Completed Work S25,620.30 20th day of April, 2 9 ZZE <b 6 Cl (Cotunuis D E un G703) Notary Pub b. 0 %ofStorcd.Mlaterial 50,00 (Colunins F on 0703) My Commission expires: 12/16/15 ye °°aaoe Total Retainage (Line 5a 5b or 525,620.30 Total in Colunins I on G701) ARCHITECTS CERTIFICATE FOR PAYMENV' 6. TOTAL EARNED LESS RETAINAGE........... $21,0,58170 In accordance with the Contract Documents, based on on observations and the data (Line 4 less Line 5rotal) comprising this application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect knowledge, information and belief the Work has progressed as indicated, the (Line 6 from prior Certificate) S207-570.6 quali of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE S23,012.10 is entitled to payment of the AMOUNT CERTIFIED. 9, BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED (Line 3 less Line 6) (A ttach explanation if amount certified toffees from the arnouni aj;p1ledfor. Initial 57 890,30 all figures on ih is Fication and on the Continuation Sheet that are changed to conf orm to Me ato ni c tif CHANGE ORDER SUMMARY ADDITIONS D ED U C TIONS ARCHITEC C to S, Total changes approved in ry previous months, by Owner 532 ,3 23.00 50.00 By DE w mcezr.r: Date: I'gtA.] appr_nved this Month $0.00 $0,00 This Cerfificate is not negotiable, The AMOUNT CERTIFIED is payable only to the TOTALS S32,323.00 0.00 NET CHANGES by Change Order SK Contractor named herein. Issuance, payment and acceptance of payment are without preiudice to any ri of the Owner or Contra under this Contract. ALA DOCUMENT 43702• APPt,[CATION ANT) CERTLFICATE.rORPAY-%IF;N'T 1992 EDITION ALAR- Z1992 THEAMENCAN (NSTITUTF OFARCH[TrCTS. 1735 NEV V YORK G702-1992 AVENUE, N.W., WASHWOTON, D-C, 2000(-5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subjsctttte violator to legal prosecution. this ro, W.- mvadu d t1--vdiv —,h ft P a T_­ A-IM,1 11jM1,f Alrh. Wl under U za 97003 V PfVR verb Sy-1. fry. RWOckio of This Jtt Mmt. vA7•OL9 Pfq c-spMft A1Ch jjjj� a* z verity rho ­t version cl Ws d­­ Ind kc— w 51Q�' m is Mj peer: fed. C ­wt The Arcrfcan nrftwe -1 f.00-.3 C ONTINUATION SHEET A T A DOCUMENT G703 PACE I OF I PAGES AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 60006 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/25/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCUITECT"S PROJECT NO.: 082691A A B C D E F C H I WORK COMPLETED ;NIATERWS TOTAL BALANCE PREVIOUS PRESENTLY COvtPLETE) RJVARb%G> IT E\+( DESCRIP'I"IOti OF WORK SCHEDULED PREVIOUS TO [F VAf3G\$LEj NO. VALUE. APPLICATION THIS PERIOD STORED AND STORED FINISH RATE (NOT IN TO DATE (C' -C) (C. C) (D E) D OR E) (D +-E +F) 0000010 Rangeline Road Work 0000030 General Conditions $56,800.00 $48,280.00 $5,680,00 $0.00 $53,960.00 95.000 $2,840.00 $0.00 0000040 Existing Conditions Selective Demo $13,150.00 $13,150.00 $0.00 $0.00 $13,150.00 100.000 $0.00 $0.00 0000050 Concrete (Not including Curbs) $36,700.00 $36,700.00 $0.00 $0.00 $36,700.00 100.000 $0.00 $0,00 0000060 Metals $6,580.00 $6,580,00 $0,00 $0.00 $6,580.00 100.000 $0.00 $0,00 0000070 Specialties $8,350.00 $0.00 $0.00 $0.00 $0.00 0 $8,350.00 $0.00 0000080 EfecUical $57,950.00 $40,565.00 $5,795.00 $0.00 $48,360.00 80.000 511,590.00 50.00 0000090 Earthwork $22,420.00 $22,420.00 $0.00 $0.00 $22,420.00 100.000 $0.00 $0.00 0000100 Exterior improvements $46,950.00 $9,396.00 $14,094,00 $0.00 $23.490.00 50.000 $23,490.00 $0.00 0000110 Utilities $21,220.00 $21,220.00 $0,00 $0.00 $21,220.00 100000 $0.00 $0.00 0000130 CHANGE ORDER NO. 1 0000140 PC 02 Undercut Work $23,672 -00 $23,672.00 $0.00 $0.00 $23,672.00 100.000 $000 $0.00 0000160 CHANGE ORDER NO. 03 0000170 PC 03 Alt. Concrete ParRing Lot $8,651.00 $8,651.00 $0.00 $0.00 $8,651.00 100.000 $0.00 $0.00 $302,473.00 $230,634.00 $25,569,00 $0.00 $256,203.00 84.70% $46,270.00 $0.00 AAA DOCUMrrNTG703• APPLIGATIONANJ CERTIFICATE fORPAYMENT 1992 EDITION ALMS V199'- THEAMLR1CAN Pis rqutLorARCH1TECTS.17,15 NEW YORK G703-1992 AVt tQt'E, t \V., \6'AStitNG10N, D.C. 20906 -529, WARNING: Unlicensed photocopying vfoiates U.S. copyright laws and will subject the violator to legal prosecution. 'iTln OOa!<!1m: tws Been r °prnduwd °tnchesNC�i1y with itw P9rrisdm 61 Thu Arrcdrmn risSUe of Ardvaes under tr¢nse B7P43 !n Prirtmvem Systems. f,ic. Reprudur,.in el :fzs doofrtem, as�a1 Kojec4- W'etihe imon•xeen is nm, perry ^ad. Gor+br., the r1roHCnn h!si:u!e �f Mdeecia m retiN :hs rNrren: v°rsion d 4d3 duarreetr, and 6+:anse. s+u;us' WAIVER OF LIEN The undersigned is the duly authorized officer of Hagerman Construction Corporation ,the general contractor, (Name of Company) subcontractor," materialman or other person furnishing the services, labor, material or equipment indicated below in the construction of improvements upon real estate located in Hamilton County, State of Indiana commonly knownas Parcel 67 Streetscape. Indi h real estateisowned.by R�cgr m=t 0mTrd--9sicn "Owner Design Center P12 INCONSIDERATIONofthesumof Twenty three thousand twelve and 10/100 DOLLARS 2a m 2 i n receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above "described which the Company may now have for services, labor, material or equipment fu mished in respect of such land or improvements to and includingthe date hereof. The undersigned warrants that the Company has not and will not assign any claim forpayment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfertitle to the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the sole -consideration received by the Company for said services,labor, material or equipment furnished to date, and that the Company has neither received nor made any security interest, title retention interest or lien rights in the said services, labor, material or equipment otherthan that released and transferred hereby. The material, labor, services or equipment furnished are more particularly described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 20th day of Aril 200 as (Name and ftle) Troy Heisler, CFO Hagerman Construction Corporation (Name of Company) State of Indiana County of Allen SS: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared Troy H the cfo of Hagerman Construction Corpratiod who acknowledged (Title) (Name of Company) the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 20th day of April 2009 �!1[} C My Commission Expires: Notary Public 12/16/15 My County of Residence:� rOUM`l o \Pay Davi Thomas �1F1 \i (Printed Name of Notary Public) Allen Prescriued 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 X111/ 1/ �O 151r" I" y9 LL C Purchase Order No. 72 Terms C Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) �22 09 1 -2 6 1 8:4 Total 2 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. c 1 ALLOWED 20 7�vP �o��s�✓� c71 'o ZLC IN SUM OF 720 2, ON ACCOUNT OF APPROPRIATION FOR �o�5'yGQ G7 Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or gc2 6 X14 67 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 j mil/ 20 01 Signature n rector n�# c- perations Cost distribution ledger classification if Title claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AJA DOCUMENT G 702 PAGE ONE OF 1 PAGES TO OWNER: Cannel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO Draw:Number_ #.7 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Robert Indiana Street Work ARCHITTECT PERIOD TO: 05%2212009' =CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: U Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: October, 2008 CONTRACTOR'S APPLICATION FOR PAYMENT The undersi 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. L ORIGINAL CONTRACT SUM 30,460.00 1 Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DA'Z'E (Line I t 2) 30,460.00 4. TOTAL COMPLETED STORED TO DATE 27,925.84 By: i ate: 5. RETAINAGE: TLswom esident M1 111=14 apiMADUA a. 0 of Completed Work S S sc me this d of Nwa ry Pu blit Seel (Column D E on G703) State of Indiana b. of Stored Material my CCrtlndssW Elres Oct 13. 2016 (Column F on G703) Total Retainage (Lines 5a 5b or Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 27,925.84 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 T LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 24,608.43 [he quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 3,317.42 is entitled to payment of the AMOUNT CERTIFIED. 9, BALANCE TO FINISH, INCLUDING RETAINAGE 2,534.16 (Line 3 less Line 6) AMOUNT CERTIFIED. 3,317.42 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanati n if amount certified differs from the amount applied, Initial all figures on this Total changes approved Application a on e Co lineation Sheet that are changed to conform wish the amount certified.) in previous months by Owner ARCHITE 9 Total approved this Month By: i 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 AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE N_W.. WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Robert Indiana Street Work Budget Review and Distribution Request #7 Period Ending May 22, 2009 PROJECT BUDGET REVIEW SUMMARY TOTAL WORK THIS PERIOD Current BALANCE Total Scheduled COMPLETED RETAINAGE Payment PREVIOUS TOTAL COMPLETED TO Retai.nage DESCRIPTION Value THIS PERIOD WITHHELD Due APPLICATIONS TO DATE FINISH Held, General ConditionslRequirements 46,150.00 2,307.50 115.38 2,192.13 43 381.00 45,688.50 99% 461.50 4 568 85 Existing Conditions /Selective Demo 8,770.00 0.00 0.00 0.00 8,770.00 8 770.00 100% 0.00 877.00 Concrete 24,430.00 0.00 0.00 0.00 24,430.00 24 430.00 100% 0.00 2,443.00 Meltal 2,190.00 0.00 0.00 0.00 2,190.00 2,190.00 100% 0.00 219.00 Specialties (signage) 5,570.00 0.00 0.00 0.00 0.00 0% 5,570.00 0.00 Electrical 41,640.00 8,328.00 416.40 7,911.60 32 8 95.60 41,223.60 99% 416.40 4,122,36 Earthwork 41,500.00 4,150.00 207.50 3, 942.50 36,727.50 40,877.50 99% 622.50 4,087.75 Exteriorlmporvements 70,650.00 35,325.00 1,766.25 33,558.75 33,558.75 68,883.75 98% 1,766.25 6,888.38 Utilities 63,700.00 0.00 0.00 0.00 63,700.00 63,700.00 100% 0.00 6,370.00 101 Signature's General Conditions 15,230.00 811.89 0.00 811.89 12,325.78 13,137.68 86% 2,092.32 0.00 124 Si nature's Profit Overhead 15,230.00 2,505.53 0.00 2,505.53 12,282.64 14,788.17 97% 441.83 0.00 Total 335,060.00 53,427.92 2,505.53 50,922.39 270,261.28 323,689.19 97% 11,370.81 7� 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 C Purchase Order No. 72U 3r�/ �v S' -GU Terms //V 1 7 1 667 3 Z Date Due Invoice Invoice Description Amount Da Number (or note attached invoice(s) or bill(s)) x /22/0/ 7 /967 y o- Total 3, '3',7,7- y2 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 LG G IN SUM OF 720 s- 317 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 ;7 5'yGo�`H� 33 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 206 DS u fbperation Cost distribution ledger classification if Title claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Carmel City Phase I PI 10 APPLICATION NO: Invoice 3 1 Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 r6 7 ARCHITECT PERIOD TO: 05/22/2009 OCONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe 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 6703, 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 65,896.72 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I 2) 65,896.72 4. TOTAL COMPLETED STORED TO 44,230 46 By: f Date: 5 'Z LEE BARBAGLiA 5. RETAINAGE' oontz, President PuWk Slal a. 0 of Completed Work 0 Sub h omas be an swum to before me this day of May, 2009 M ry terry u lic a (Column D E on G703) b. of Stored Material My COfItlltt;fton Ellp m Oct 1 3. 20116 (Column F on G703) Total Retainage (Lines 5a 51b or Total in Column I ofG703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 44,230.46 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 T LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Cenificate) 27,782.14 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 16,448.32 1/ is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 21,666.26 1V (Line 3 less Line 6) AMOUNT CERTIFIED �b 2 CHANGE ORDER SUMMARY ADDITIONS DMUCTIONS (Attach explanation f a unt certified differs from the amount applied Initial all figures on this Total changes approved Application and ont minuation eei that are changed to conform with the mnouni certified.) in previous months by Owner ARCHITECT; 7 a Z�'�09 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 herein. Issuance, payment ana 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 AIA -01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE.. N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC �2O 3rd Carmel, Indiana Invoice 3 5/22/09 Carmel City Phase I Carmel, Indiana Total Work RETAINAGE BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE I FINISH General Requirement Testing and Ins pecting 3,000,00 0.00 0.00 0.00 0.00 0% 3,000.00 Project Manag ement 6,000.00 0.00 0.00 5, 932.81 932._81 99% 67,19 Site Supervision 16,153.85 15,853.52 0-00 __49-33 15, 902.95 98% 251.00 _Site Safety Director 1 �333.33 0.00 0.00 0. DO 0 00 1,333.33 594.80 00 Design Drawings 5,000.00 594.80 0.00 0 12% 4,405.20 Sanitary Facilities 0.00 0.00 0-00 0.00 0% 1,24800 Field Office 1,512.00 0.00 0.00 0.00 0.00 1,512.00 Tem porary Electric 225.00 0.00 0.00 0-00 0.00 0% 225.00 Office supplies 225.00 0.00 0-00 0.00 0.00 0% 225.00 Temporary Telecommunications 225.00 0,00 0.00 0.00 0.00 0% 225= Temporary Water 225.00 0.00 0.00 0.00 0.00 0 225,00 Tools and Equi 60000 000 0.00 0.00 0.00 0% 600.00 L _J�rojeict Siqnag�e_ 100.00 0.00 0.00 000 0.00 0% 10000 Engineering Surveying 5,000-00 0-00 0.00 0.00 5,000.00 Health and Safety 1,000.00 0.00 0-00 0-00 0.00 0% 1,000.00 Waste Disposal 1,083,75 0.00 o.QQ 0.00 0,00 0% 1,083.75 Final Clean 1,000.0o 0 0.00 0.00 0.00 0% 1,000.00 Constructin Management Fee 21,966.79 0.00 00 _21,800.00 21,800A0 99% 165.79 65,8945-72 16 ,448 32 9.00 27,782,14 44,230.46 67 21,666.26 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 1 PAGES TO OWNER: Carmel Redevelopment Commission p PROJECT: Parcel 67 APPLICATION NO: ;Draw Nurriber #7 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Curb Construction =ARCHITECT PERIOD TO: 0:$',/22/2009 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: October, 2008 CONTRACTOR'S APPLICATION FOR PAYMENT The undersi 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- l. ORIGINAL CONTRACT SUM 2,205.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3, CONTRACT SUM TO DATE (Line 1+ 2) 2,205.00 4, TOTAL COMPLETED STORED TO DATE 2,171.50 do 5, RETAINAGE: Tom oontz Presid t fit z a. 0 of Completed Work Subscrib and sworn to before m this Ja y of PtIDNC Sail (Column D E on G703) a b. of Stored Material My COf11R{I"Wa E:*ms QCt 13, 2016 (Column F on G703) Total Retainage (Lines 5a+ 5b or �i To tal in Column I of 6703) 0.00 ARCHITECT'S CERTIFICAT FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 2,371.50 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) S 2,171.50 the quality of the Work is in accordance with the Contract Documents, and the Contractor CURRENT PAYMENT DUE S 0.00/ is entitled to payment of the AMOUNT CERTIFIED. 9, BALANCE TO FINISH, INCLUDING RETAINAGE 33.54 (Line 3 less Line 6) AMOUNT CERTIFIED S 0.00 0___' CHANGE ORDER SUMMARY ADDITION J- S DEDUCTIONS {Attach explanati if a amount certified differs from the anrorint applied. Initial all figures on this Total changes approved Application o m the Conlin lion Sheet that are changed to conform lvith the aount certified) in previous months by Owner ARCHITE c Total approved this Month By. Date: ,6/ �g TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, paynnent 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 AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE. N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Curb Cosntruction Budget Review and Distribution Request #7 Period Ending May 22, 2009 PROJECT BUDGET REVIEW SUMMARY TOTAL WORK RETAINAGE Current BALANCE Total Scheduled COMPLETED WITHHELD Payment PREVIOUS TOTAL COMPLETED TO Retainage DESCRIPTION Value THIS PERIOD THIS PERIOD Due APPLICATIONS TO DATE FINISH Held Robert Indiana Street Curbs General Conditions/Requirements 1,675.00 0.00 0.00 0.00 1,675.00 1,675,00 100% 0.00 167.50 Concrete 7,480.00 0.00 0.00 0.00 7,480.00 7,480.00 100% 0.00 748.00 Rangeline Road Curbs General Conditions/Requirements 1,675.00 0.00 0.00 0.00 1,675.00 1,675.00 100% 0.00 167.50 Concrete 11,220.00 0.00 0.00 0.00 11,220.00 11,220.00 100% 0.00 1,122.00 Signature's General Conditions 1,102.50 33.50 0.00 33.50 1,069.00 1,069.00 97% 33.50 0.00 Signature's Profit Overhead 1,102.50 0.00 0.00 0.00 1,102.50 1,102.50 100% 0.00 0.00 Total 24,255.00 33.50 0.00 33.50 24,221.50 24,221.50 100% 33.50 2,205.00 i +Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 5995) 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 Purchase Order No. 7 0 j��/ r/l��c� S Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) s ly Y 4 7", (N 5. 9 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 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR 6Z Board Members PO# or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 902 3 4�GO G� �641�1�1 32- 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 20 Director of Operatione Title Cost distribution ledger classification if claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 1 PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO: 'iAw:&f]fmber #7 I Distribution to: One Civic Square City Project 26236 Signature costs OWNER Carmel, Indiana 46032 Rangeline StreetScapes =ARCHITECT PERIOD TO: =;05%22!2009, FX CON "['RAC "1'OR FROM CONTRACTOR: VIA ARCHITECT: Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: October, 2008 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, 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 27,015.00 2. Net change by Change Orders 4,068.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 f 2) 31,083.00 4. TOTAL COMPLETED STORED TO DATE 28,449.88 3 B Date: Wiabiewlim 1A 5. RETAINAGE: K tz President P1lb11C 8" a. 0 of Completed Work S ribed d sworn to before me this day of SUM Of h (Column D E on G703) F. of Stored Material X16 (Column F on G703) Total Retainage (Lines 5a+ 5b or Q Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6, TOTAL EARNED LESS RETAINAGE 28,449.88 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) 25,049.86 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 3,400.02✓ is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 2.633.12 p (Line 3 less Line 6) AMOUNT CERTIFIED 3,400.02 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Total changes approved Application an the Continuation Sheet that are changed to conform with the amount certified) in previous months by Owner ARCHITE a� Total approved this Month By: Date: 4� TOTALS $0.00 50.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. issuance, payment and acceptance of payment arc without NFET 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., N.W W. WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. f r"a} �:p ...�,c •i. '��d City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Rangeline Streetscapes Budget Review and Distribution Request #7 Period Ending May 22, 2009 PROJECT BUDGET REVIEW SUMMARY TOTAL WORK RETAINAGE Current BALANCE Total Scheduled COMPLETED WITHHELD Payment PREVIOUS TOTAL COMPLETED TO Retainage DESCRIPTION Value THIS PERIOD THIS PERIOD Due APPLICATIONS TO DATE FINISH Held General Conditions /Requirements 56,800.00 2,840.00 142.00 2,698.00 53,392.00 56,232.00 99% 568.00 5,623.20 Existing ConditionslSelective Demo 13,150.00 0.00 0.00 0.00 13,150.00 13,150.00 100% 0.00 1,315.00 Concrete 36,700.00 0.00 0.00 0.00 36,700.00 36,700.00 100% 0.00 3,670.00 Meltal 6,580.00 0.00 0.00 0.00 6,580.00 6,580.00 100% 0.00 658.00 Specialties (signage) 8,350.00 8,350.00 417.50 7,932.50 0 .00 8,350.00 100% 0.00 835.00 Electrical 57,950.00 11,590.00 579.50 11,010.50 45,780.50 57,370.50 99% 579.50 5,737.05 Earthwork 22,420.00 0.00 0.00 0.00 22,420.00 22,420.00 100% 0.00 2,242.00 Exteriorlmporvements 46,980.00 23,490.00 1,174.50 22,315.50 22,080.60 45,570.60 97% 1,409.40 4,557.06 Utilities 21,220.00 0.00 0.00 0.00 21,220.00 21,220.00 100% 0.00 2,122.00 Change Order #1 23,672.00 0.00 0.00 0.00 23,672.00 23,672.00 100% 0.00 2,367.20 Changer Order #2 8,635.00 8,635.00 431.75 8,203.25 0.00 8 100% 0.00 863.50 Change Order #3 Alt Park Conc 8,651.00 0.00 0.00 0.00 8,651.00 B, 651.00 100% 0.00 865.10 Change Order #4 (278.00) (278.00) (13.90) (264.10) 0.00 (278.00) 100% 0.00 (27.80) Signature's General Conditions 15,555.40 654.76 0.00 654.76 12,239.71 12,894.48 83% 2,660.92 0.00 Signature's Profit Overhead 15,555.40 2,745.25 0.00 2,745.25 12 810.15 15 555.40 100% 0.00 0.00 Total 341,940.80 58,027.01 2,731.35 55,295.66 278,695.96 336,722.98 98% 5,217.82 30,827.31 3,400.01 3,400.02 (0.00) APPLICATION AND CERTIFICATION FOR PAYMENT A IA DOCUMENT 0702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Carmel City Parcel 73 APPLICATION NO: Invoice I 1 Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 05/22/2009 =CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the best of the Contractors 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 9,909.95 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 9,909.95 4. TOTAL COMPLETED STORED TO 6,02046 $y: I Date: rj l l Z 5. RETAINAGE: Tomas E. nlz, President a. 0 of Completed Work 0 Subs ribed and s orn to before me (his day of May, 2009 (Column D E on G703) b. of Stored Material (Column F on G703) KATHLEEN 6AABAGLIA Total Retainage (Lines 5a 5b or bNC $eal Total in Column I of G703 0.00 AR ECT'S CERTIFICATE FOR PA ENT stlete Of IndINS 6. TOTAL EARNED LESS RETAINAGE 6,020.46 In accordance with the Contract Documents, based on on -site observations and t datAy COM11fW" EXW" OCt 13, 2016 (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best o 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indica ed, PAYMENT (Line 6 from prior Certificate) 3,135.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor S. CURRENT PAYMENT DUE 2,885.46 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 3,889.49 (Line 3 less Line 6) Iw AMOUNT CERTIFIED S ?i b CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation amount certified differs from the amwrn! applied Initial all figures on this Total changes approved Application and 1 e Cairinua Sheer drat are charrged7o conf "ohm with the amour! certified.) in previous months by Owner ARCHITEC Total approved this Month By: Date: 5 7-& 09 TOTALS $0.00 50.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the (-:ontractor named nerem, issuance, payment anti 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 6702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA .01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W- Carmel, Indiana 46032 Invoice 1 5/22/C9 Carmel City Parcel 73 Carmel, Indiana Total Work RETAINAGE BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE FINISH Gencrai Requirement: Project M anagement 1,521.41 0.00 0.00 1,521.41 0% .00 Site S 1,094 -36 0.00 0.00 1,094.36 0% Site SafeV Director 000 0.00 0.00 0.00 0% 0.00 _Design Drawings 269.6 0.00 0.00 i 269,69 0% 0.00 Sanitary Facilities 0.00 0.00 0.00 0.00 0% 0.00 Final Clean 0.00 0.00 0-00 3,135.00 3,135.00 32% 0-00 0 ement Constructin Mana Fee 9.909.95 0.00 0.00 6,774.95 .95 2,885.46 0.00 3,135.00 6,020,46 61 F 4— —V—,-- -I_ L_ I I_ T J F- 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 C6, zl 1--41 L L C Purchase Order No. 720 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 512 VO 6 7 7_ S 7 r­w7'scq _5 C s 2 S (F 1 y6 r1 P 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. .,L, L ALLOWED 20 �avi_5> /,'per 4� L IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 7 -vy6o867 3 bill(s) is (are) true and correct and that the l02 �Y6o873 zkgs -Y6 materials or services itemized thereon for which charge is made were ordered and received except 20 6V C L X X Si ture Directo f Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund