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169781 03/17/2009 f CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CARMEL, INDIANA 46032 720 3RD AVE SW CHECK AMOUNT: $9,952.49 CARMEL IN 46032 CHECK NUMBER: 169781 CHECK DATE: 3/17/2009 DEPARTMENT ACCOUNT PO NUMBER INVO N AMOUNT DES CRIPTI ON .902 4460867 2 597.60 INDIANA DESIGN CENTER x`'902 4460867 3 1,056.15 INDIANA DESIGN CENTER 902 4460867 4 8,298.74 INDIANA DESIGN CENTER n City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Robert Indiana Street Work Budget Review and Distribution Request #4 Period Ending February 23, 2009 Checks to be Made Payable to: Hagerman Construction Corporation 11,321.10 Signature Construction, LLC 1,257.90 Total 12,579.00 r_ Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Farm 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 S y��✓��i°�� <�sfr�� LLG Purchase Order No. 7,20 Terms 3 2 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2 12 y /o9 h� S�r��J 7 .9 yr Total S 90 9 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 IN SUM OF l 2,5_;; 96 ON ACCOUNT OF APPROPRIATION FOR i �v �d2-�/�j�� 7 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 902 y y�60�o 7 25 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 Sig an e 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 Curb Cosntruction Budget Review and Distribution Request #4 Period Ending February 23, 2009 Checks to be Made Payable to: Hagerman Construction Corporation 4,358.25 Signature Construction, LLC 484.25 Total 4,842.50 City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Curb Cosntruction Budget Review and Distribution Request #4 Period Ending February 23, 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 83.75 8.38 75.38 1,256.25 1,340.00 80% 335.00 134.00 Concrete 7,480.00 1,870.00 187.00 1,683.00 5,610.00 7,480.00 100% 0.00 748.00 Rangeline Road Curbs General Conditions /Requirements 1,675.00 83.75 8.38 75.38 1,256.25 1,340.00 80% 335.00 134.00 Concrete 11,220.00 2,805.00 280.50 2,524.50 8,415.00 11,220.00 100% 0.00 1,122.00 Signature's General Conditions 1,102.50 242.13 0.00 242.13 826.88 1,069.01 97% 33.49 106.90 Signature's Profit Overhead 1,102.50 242.13 0.00 242.13 826.88 1,069.01 97% 33.49 106.90 Total 24,255.00 5,326.75 484.25 4,842.50 18,191.26 23,518.01 97% 736.99 2,351.80 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 #4 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Curb Construction ARCHITECT PERIOD TO: 02/23/09 =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 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 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 2,138.01 j By: C Date: L �L LIV-7 5. RETAINAGE: 'Tom Koontz President a. 0 of Completed Work Subscrib d and swyfn to before me this day of (Column D E on G703) b. of Stored Material '"y� LINDA BUCHANAN (Column F on G703) NOTARY Hancock County Total Retainage (Lines Sa Sb or SRA My Commission Expires T'... �P. Total in Column I of G703 0.00 ARCHITECT'S CERTIFICATE FOR PA 6. TOTAL EARNED LESS RETAINAGE 2,138.01 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) 1,653.76 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 484.25 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 66.99 (Line 3 less Line 6) AMOUNT CERTIFIED 484.25 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expl lion amount certified differs front the amount applied. Initial all figures on this Total changes approved Applicatio and on e Co mt no hat are changed to conform lvith the amount certified.) in previous months by Owner ARCH Total approved this Month By: Date: Zluhl>il� 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 PAGE ONE OF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 Streetscape APPLICATION NO: C0004 Distribution to: City of Carmel HCC Job #2691 PERIOD TO: 2/25/2009 OWNER Carmel, IN 46032 Invoice #9233 PROJECT NOS.: 082691A ARCHITECT FROM CONTRACTOR: Hagerman Construction Corporation VIA ARCHITECT: CSO Architects Inc CONTRACTOR 7930 Castleway Drive 280 East 96th Street Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CONTRACT DATE: CONTR FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation 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- ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $22,050.00 CONTRACTORHagerman Cons ruction Corporation 2. Net change by Change Orders $0.00 By Date: Februar= 2 3, 2009 3. CONTRACT SUM TO DATE (Line 1 +2 roy eislerw CFO State of: Indiana 4. TOTAL COMPLETED STORED TO DATE $21,380.00 h' of: gtt1b211 Allen GQ�IpfIISS /p�� e (Column G on G703) County ma c, 6 ,o 5. RETAINAGE: Subscribed and sworn to before o m a. 10.000 of Completed Work $2,138.00 me this 23rd February 2009 day of d° 0rA SEA( a (Columns D E on G703) 091 b. 0 of Stored Material $0.00 Notary PPit c! Ulvt (Columns F on G703) My Commission expires: 12/16/1 Total Retainage (Line 5a 5b or $2 ,138.00 ARCHITECT'S CERTIFICATE FOR PAYMENT Total in Columns I on G703) 6. TOTAL EARNED LESS RETAINAGE $19,242.00 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 less Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the (Line 6 from prior Certificate) $14- 883.75 quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE $4,358.25 is entitled to payment of the AMOUNT CERTIFIED. Q. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .............................�B (Line 3 less Line 6) (Attach explanation if ou t certified differs from the amount applied for. Initial $2,808.00 all frgrrres on this A licat' nand the Continuation Sheet that are changed to conform to the am tint c tifred CHANGE OR SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in D p revious months b Owner $0.00 $0.00 By Date: Total aj iroved't I is.Month $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the $0.00 y NET CHANGES',b' Change e Order $0.00 $0.00 Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. F EB X 4 [AIQI bOCUMENT G702• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA® (01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G702 -1992 AVENUE; N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. `This document has been reproduced electronically with the permission of The American Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without project- specific information is not permitted. Contact The American Institute of Architects to verify the cument version of this document and license status" T CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF I PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: C0004 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 2/25/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082691A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO IF VARIABLE) NO. VALUE APPLICATION THIS PERIOD STORED AND STORED FINISH RATE (NOT IN TO DATE (G- C) (C G) (D E) D OR E) (D +E +F) 0000010 Curb Work 0000030 Robert Indiana Street Curbs 0000040 General Conditions $1,675.00 $1,256.25 $83.75 $0.00 $1,340.00 80.000 $335.00 $0.00 0000050 Concrete Work Curbs Only $7,480.00 $5,610.00 $1,870.00 $0.00 $7,480.00 100.000 $0.00 $0.00 0000070 Rangeline Road Curbs 0000080 General Conditions $1,675.00 $1,256.25 $83.75 $0.00 $1,340.00 80.000 $335.00 $0.00 0000090 Concrete Work Curbs Only $11,220.00 $8,415.00 $2,805.00 $0.00 $11,220.00 100.000 $0.00 $0.00 $22,050.00 $16,537.50 $4,842.50 $0.00 $21,380.00 96.96% $670.00 $0.00 AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA® ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G703 -1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. This document has been reproduced electronically vnth the permission of The American Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without projectspecific Information is not permitted. Contact The American Institute of Architects to verify the current version of this document and license status" WAIVER OF LIEN The undersignedis the duly authorized officer of Hagerman Construction Corporation ,the general contractor, (Name of Company) subcontractor,' mate rialman 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 Streetsca e p�Lndi. real estate is owned. Carn�7 Redevelcpt�t0armi.ssirn ("Owner Design Center P12 INCONSIDERATION ofthe sumof DOLLARS receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment 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 furnished in respect of such land or improvements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claimforpayment 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 transfer title 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 other than that released and transferred hereby. The material, labor, services or equipment furnished are more particularly described iF the affidavit for payment submitted of even date herewith. The undersigned furtherwarrants 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 day of 9no (Name and Ttle) 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 T er the cfo of Hagerman Construction Corporation` 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 day of 200 My Commission Expires: o �V�ember 6 "f� Notary Public 12/16/15 o mom cn u' My County of Residence: hOraRVSEaL David C. Thomas (Printed Name of Notary Public) Allen 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 C01? 5f���f 0-7 L C Purchase Order No. 720 �j; �d� s_1� Terms Ca rYrr� Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 212 3X99 y C 6 7' i iL Total`/ 25— 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 LLG IN SUM OF 72 o :Z 5 ON ACCOUNT OF APPROPRIATION FOR TI�- //o Board Members PO# or DEPT INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), 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 3_ Signa Title Cost distribution ledger classification if 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 APPLICATION NO: Draw Number #4 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Rangetine StrectScapes =ARCHITECT PERIOD TO: 02/23/09 OCONTRAC "hOR FROM CONTRACTOR: VIA ARCI- IFTECT: 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 3,232.30 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I f 2) 30,247.30 4. TOTAL COMPLETED STORED TO DATE 22,779.41 I By: j Date: 5. RETAINAGE: Tom Voontz President a. 0 of Completed Work Subscribe and svpm to before me this day of fl 7 (Column D E on G703) b. of Stored Material LINDA BUCHANAN (Column f on G703) Total Retainage (Lines Sa 56 or: Hancock County T in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT August20, 2011 6. 'TOTAL EARNED LESS RETAINAGE 22,779.41 In accordance with the Contract Documents, based on on -site observations an'd lhe'dafa (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) 16,222.82 the quality of the Work is in accordance with'the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 6,556.59 is entitled to payment of AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 7,467.89 (Line 3 Tess Line 6) AMOUNT CERTIFIED 6,556.59V tzap CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation i to unt certified differs from the amount applied. Initial all figures on this Total changes approved Application and o he ntinua Sheet at are changed to conform with the amount certified) in previous months by Owner ARCHITECT: 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 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. APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF l PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO: Draw :Number #,4 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel, Indiana 46032 Rangeline StreetScapes =ARCHITECT PERIOD TO: 02 CONTRACTOR 723%09; X 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. 1. ORIGINAL CONTRACT SUM 27,015.00 2. Net change by Change Orders 3,232.30 CONTRACTOR: 3. CONTRACT SUM 'I DATE (Line 1 f 2) 30,247.30 4. TOTAL COMPLETED STORED TO DATE 22,779.41 Tom K ntr G Z By: Date: z l 5. RETAINAGE: President a. 0. of Completed Work Subscribed And swo to before me this day of (Column D E on G703) b. of Stored Material (Column F on G703) LINDA BUCHANAN Total Retainage (Lines 5a+ Sb or Diner'• Hare County Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAS i T Is I n xplres 6. TOTAL EARNED LESS RETAINAGE 22,779.41 In accordance with the Contract Documents, based on on -site observat ,,,August 20, 2011 (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) 16,222.82 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 6,556.59 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 7,467.89 (Line 3 less Line 6) AMOUNT CERTIFIED 6,556.59 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expla n if amounl certified differs from the amount applied. Initial all figures on this Total changes approved Applicatio an onthe ntinua 'on Sheet that are changed to conform lvith the amount certified) in previous months by Owner ARCH -CT Total approved this Month By: Date: 4 NO T TA LS $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 T 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 Rangeline Streetscapes Budget Review and Distribution Request #4 Period Ending February 23, 2009 Checks to be Made Payable to: Hagerman Construction Corporation 59,009.31 Signature Construction, LLC 6,556.59 Total 65,565.90 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 S g ��fvr� �6�s /r �cT ors, LLC Purchase Order No. �26) Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2 123 1 09 7 V 1 r' 2 M Total •3'6..5 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. 1 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 L L I N SUM OF ON ACCOUNT OF APPROPRIATION FOR °Jo 2-Z 45 �6 7 Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. 1 hereby certify that the attached invoice(s), or 7 6, sG SJ 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 Ma In l Signatu (re G 1 r Cost distribution ledger classification if Title claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G7 02 PAGE ONE OF 1 PAGES "1 OWNFR: Camel Redevelopment Commission PROJECT: Parcel 67 APPLICATION NO: Draw Number #3 1 Distribution to: One Civic Square City Project 26236 Signature costs =OWNER Carmel. Indiana 46032 Curb Construction =ARCHITECT PERIOD TO: 12/22/08 FX 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 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 2,205.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATF (Line I t 2) 2,205.00 4. TOTAL COMPLETED K STORED TO DA'Z'E 1,653.75 By: Date: 5. RETAINAGF om Koon P esident TT a. 0 of Completed Work Subs bed an sworn to before me this day of (Column D Eon 6703) b. of Stored Material (Column 1 on 6703) Total Retainagc (Lines 5a or Total in COIrm1n I ofG703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RITAINAGE 1,653.75 In accordance with the Contract Documents. based on on -site observations and the data (Line 4 Lcss 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) 597.60 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PA1'A9ENT DUE 1,056.15 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISIL INCLUDING Rl rAINAGE 551.25 (Line 3 less fine 6) �AMOUNT CERTIFIED 1,056.15 CIIANGF ORDER SUMMARY ADDITIONS DEDUCTIONS 11// (Aflach expl ati n if amount certified differs front the amount applied. Initial all figures on this Total changes approved Applicat' n an on e C nti a a Sheet that are changed to conform with the amount certified.) in previous months by Owner ARC fECT' d Total approved this \loath By: 'T— Date: �6*2 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 NE'T CI1ANGES 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. _L f f City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Curb Cosntruction Budget Review and Distribution Request #3 Period Ending January 23, 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 1,675.00 418.75 41.88 376.88 837.50 1,256.25 75% 418.75 125.63 Concrete 7,480.00 4,114.00 411.40 3,702.60 1,496.00 5,610.00 75% 1,870.00 561.00 Rangeline Road Curbs General Conditions /Requirements 1,675.00 418.75 41.88 376.88 837.50 1,256.25 75% 418.75 125.63 Concrete 11,220.00 5,610.00 561.00 5,049.00 2,805.00 8,415.00 75% 2,805.00 841.50 Signature's General Conditions 1,102.50 528.08 0.00 528.08 298.80 826.88 75% 275.63 82.69 Signature's Profit Overhead 1,102.50 528.08 0.00 528.08 298.80 826.88 75% 275.63 82.69 Total 24,255.00 11,617.65 1,056.15 10,561.50 6,573.60 18,191.25 75% 6,063.75 1,819.13 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 L Z_ C Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total �6., /S 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. i 1 ALLOWED 20 IN SUM OF 7z o ON ACCOUNT OF APPROPRIATION FOR F///O Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or X02 �Y6o,67 /05i;, 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 a �1 re Cost distribution ledger classification if Title 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 Number 1 Distribution to: y One Civic Square City Project 26236 Signature costs OWNER Carmel, Indiana 46032 Curb Construction =ARCHITECT PERIOD TO: 12/22/2008 =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 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 2,205.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 2,205.00 4. TOTAL COMPLETED STORED TO 597.60 f y: Date: zzL O 5. RETAINAGE To oontz President a. '0 of Completed Work Subscrib and sworn to before me this 22nd day of (Column D E on G703) b. of Stored Material KATHLEEN 13AR1jAGUA (Column F on G703) C NOtary PuDhc Seal Total Retainage (Lines 5a 5b or State of Indiana Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PA M rmtsston xptres c 6. TOTAL EARNED LESS RETAINAGE 597.60 In accordance with the Contract Documents, based on on -site obse (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 597.60 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 1,607.40 (Line 3 less Line 6) /AMOUNT FIED 757. G CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS 1 (,41taah explanat on if amount certified differs from the amount applied. Initial all figures on this Total changes approved 4 ication an onth o ti ation Sheet that are changed to conform it nh the amount certified) in previous months by Owner A CHITEC Total approved this Month B Date: 17fZ31QV 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. City of Carmel Parcel 67 Streetscape Indiana Design Center P12 City Project Number 26236 Curb Cosntruction Budget Review and Distribution Request 2 Period Ending December 22, 2008 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 1,675.00 586.25 58.63 527.63 251.25 837.50 50% 837.50 83.75 Concrete 7,480.00 1,496.00 149.60 1,346.40 0.00 1,496.00 20% 5,984.00 149.60 Rangeline Road Curbs General Conditions /Requirements 1,675.00 586.25 58.63 527.63 251.25 837.50 50% 837.50 83.75 Concrete 11,220.00 2,805.00 280.50 2,524.50 0.00 2,805.00 25% 8,415.00 280.50 Signature's General Conditions 1,102:50 298.80 0.00 298.80 0.00 298.80 27% 803.70 29.88 Signature's Profit Overhead 1,102.50 298.80 0.00 298.80 0.00 298.80 27% 803.70 29.88 Total 24,255.00 6,071.10 547.35 5,523.75 502.50 6,573.60 27% 17,681.40 657.36 •Pr3cribed1b ACCOUNTS PAYABLE VOUCHER y State Board of Accounts 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. L Payee LLG Purchase Order No. 72 3r�P S.W Terms 3 2 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) GO 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 720 C ON ACCOUNT OF APPROPRIATION FOR T)F Its° Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or go 2 2 7 S9?CrJ 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 2!�Z2 206 7 Mature r. Cost distribution ledger classification if Title claim paid motor vehicle highway fund