171085 04/16/2009 ,a f CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1
r ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC
CARMEL, INDIANA 46032 720 3RD AVE SW CHECK AMOUNT: $7,184.32
CARMEL IN 46032
o CHECK NUMBER: 171085
CHECK DATE: 411612009
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460805 1 6,207.44 RETAIL SITE #5
902 4460807 5 33.50 PERFORMING ARTS CENTE
902 4460867 5 943.38 INDIANA DESIGN CENTER
a.
s
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 1 PAGES
TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO 1 Distribution to:
One Civic Square City Project 26236 Signature costs =OWNER
Carmel, Indiana 46032 Curb Construction =ARCI- IITECT
PERIOD TO: q 03/23/09 =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.
1. ORIGINAL CONTRACT SUM 2,205.00
2. Net change by Change Orders 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 t 2) 2,205.00
4. TOTAL COMPLETED STORED TO DATE 2,171.50
By: Date: 3 Z
5. RETAINAGE: Tom Koo Pres dent
a. 0 of Completed Work Su scribed sworn to before me this day of
(Column D E on G703)
b. of Stored Material
(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 2,171.50 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) 2,138.00 the quality of the Work is in accordance with the Contract. Documents, and the Contractor
8. CURRENT PAYMENT DUE 33.50 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 33.50 �I
(Line 3 less Line 6) (w AMOUNT CERTIFIED 33.50
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this
Total changes approved Application and he C nuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHTTEC"
Total approved this Month By: Date: 09
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named neretn. Issuance, payment and acceptance of payment are without
NET CHANGES by Change Order L $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.
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
Purchase Order No.
72 Gr�G��a�P Ski Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3 /z 31
Total 33 5 0
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
�ij0 C�� c� ZL
IN SUM OF
2
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
EPT. her certi I hb that the attached invoice or
D 'Y
a0 2 5 -Y6 7 5o 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
Si;are
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 Draw;N44er, #5 1 Distribution to:
One Civic Square City Project 26236 Signature costs =OWNER
Carmel, Indiana 46032 Rangeline StreetScapes =ARCHITECT
PERIOD TO: I= f 03%23/09; OCONTRAC "fOR
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 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, CONTRACT SUM TO DATE ([..me 1 t 2) 30,247.30
4. TOTAL COMPLETED STORED TO DATE 22,921.40 r
By: C hate:
5. RETAINAGE: I Koontl President
a. 0 of Completed Work Subsc� ibed and vorn to before me this day of
(Column D E on G703)
b. of Stored Material
(Column F on G703)
Total Retainage (L,ines 5a 5b or
Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 22,921.40 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) 22,779.40 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8, CURRENT PAYMENT DUE 142.00 1� is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 7,325,90 p/
AMOUNT 3 less Line 6) pv AMOUNT CERTIFIED 142.00
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach esplan n if amount certified differsfrom the amount applied. Initial all figures on this
Total changes approved Applicotio and nthe Con uation Sheet that are changed to conform x ith the amount certified.) Pf
in previous months by Owner ARCI-II" nCT: tV
Total approved this Month By: Date: 3 3r
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, DO 20006 -5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
PFescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 207 (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
L.LC Purchase Order No.
720 3�� Sc� Terms
03 Z Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
b
1'
Total Oa
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
VOU HER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
�2D 3- /��P•, s�y
/S`2 _U6'
ON ACCOUNT OF APPROPRIATION FOR
T 0
96 2 /yy� o $G 7
Board Members
PO# or
D PT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
4�2 Ae'y�o8 7 ly2.00 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
09
Q" C��)- I
n Signa re L�
V
6- p4 n�,?
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2
TO OWNER City of Carmel Redevelopment Co PROJECT: Carmel City Phase I PI 10 APPLICATION NO Draw Numbe I Distribution to:
Signature costs =OWNER
=ARCHITECT
PERIOD TO: 03125/2009 OCONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design 0
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 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 S 65,730.93
2. Net change by Change Orders S 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I f 2) 65,730.93
4. TOTAL COMPLETED STORED TO 6,207.47 f
rubscibed C Date;
5. RETAINAGE: Koontz, President t�
a, 0 of Completed Work 0 d sworn to before me this ry day of December, 2005
(Column D E on G703)
K of Stored Material F_ BUCH ANAN
County (Column F on G703) .Hancock (9unty Total Retainage (Lines 5a 5b or M y Commission Expires
Total in Column IofG7o3) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT augustzo,2o�1
6. TOTAL EARNED LESS RETAINAGE 6,20T47 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) 0.00 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 6,207.47 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 59,523.46
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach esplan or if amount cert fed differs from the amount applied. Initial all figurer on this
Total changes approved 4ppltcntion rd o the Contin tton Sheet that are changed to conform with the amount certified)
in previous months by Owner ARCHIT T: /y p
Total approved this Month By: Date: Jf-3f V J
TOTALS $0,00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor namea 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.. NW, WASHINGTON, DC 200o6 -529
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
3/25/09
Carmel City Phase f P110
Carmel, Indiana
f
WORK BALANCE
COMPLETED RETAINAGE PREVIOUS TOTAL COMPLETED TO ORIGINAL BUDGET Committed
DESCRIPTION THIS PERIOD WITHHELD APPLICATIONS TO DATE FINISH BUDGET ADJUSTMENTS Cost
General Requirement: J
Testing and Inspecting 3 ,000.00 0.00 0.00 0.00 0% 0.00 0.00 O.flO 0.00
Project Management 6,000.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Site Supervision 16, 153. 0.00 0.00 0.00 I 0% 0.00 0.00 0.00 0.00
Site Safety Director 1,333.33 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Design Drawings 5,000.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Sanitary Facilities 1,248.00 0.00 0.00 0.0 0 0.00 0.00 0.00 0.00
Field Office 1,512.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Temporary Electric 225.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Office Supplies 225.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Temporary Telecommunications 225.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Temporary Water 225.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Tools and Equipment 600.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Project Signage 100.00 0.00 0.00 0. oo 0% 0.00 0.00 0.00 0.00
Field Engineering and Surveying 5,000.00 0.00 0.00 0.00 0 1 /0 0.00 0.00 0.00 0.00
Health and Safety 1,000.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Waste Disposal 1,083.75 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Final Clean 1,000.00 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00
Constructin Management Fee 21,800.00 0.00 0.00 6,207 .47 1 28% 15,592.53 21,800.00 0.00 21,800.00
65,730.93 0.00 0.00 6,207. 47 15,592.53 21,800.00 0.00 21,800.00
Y
Prescribed by Sate 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
Purchase Order No.
7 2 0 �fUP S.G/ Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/ 2 o
P fi
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.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
,Xi"l�
Board Members
INVOICE NO. ACCT #/TITLE AMOUNT
DEPT I hereby certify that the attached invoice or
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
Signa e ft
O
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
APPLICATION AND CERTIFICATION FOR PAYMENT AJA DOCUMENTG7oz PAGE ONE OF I PAGES
TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO: Draw Number 45. 1 Distribution to:
One Civic Square City Project 26236 Signature costs =OWNER
Carmel, Indiana 46032 Robert Indiana Street Work ARCHITECT
PERIOD TO: 03/23/09 CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: 0
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 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.
L ORIGINAL CONTRACT SUM 30,460.00
2 Net change by Change Orders 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 t 2) 30,460.00
4. TOTAL COMPLETED STORED TO DATE 20,823.93
Byocribedand Date: l �y
5. RE"I'AINAGE: President T
a. 0 !a of Completed Work Su m to before me this K day of
(Column D E on G703) LINDA SUCH ANAN
b. !o of Stored Material
TAY Hancock County
(Column F on G703) s� My Commission Expires
Total Retainage (Lines 5a+ 5b or
Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYME
6. TOTAL EARNED LESS RETAINAGE 20,823.93 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) 20,022.55 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 801.38 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 9,636.07
(Line 3 less Line 6) AMOUNT CERTIFIED 801.38
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explart ro ifamounl certified differs from the amount applied. /initial all figures on this
Total changes approved AppliC.or nd 11he Co luaI' Sheet thnt are changed to conform with the amount certified.)
in previous months by Owner ARCHIT T:
Total approved this Month By: Date: 71 z ([,A
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.
Presclfbed 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
�j� LGc Purchase Order No.
O fir. S. �rJ., Terms
�6G 3 2 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
r�
w
-x
Rl�
yY
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in acco-rdance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Gj�
Board Members
PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
gd 6- y1 5 'e.7 39 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
CA i
Siignat e
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund