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Home My WebLink AboutSignature - $24,862.20 The National Bank of Indianapolis hereby is instructed to make a disbursement of Loan Proceeds from the Borrower Loan Account to (or for the account of) Borrower in: (a) the amount of the "Total Authorized Disbursement" line in the "Amount of Authorized Disbursement" column below; and (b) accordance with the terms and conditions of the Agreement, the other Loan Documents, and the Disbursement Instructions. Purpose of Authorized Disbursement Amount of Authorized Disbursement Amounts to be paid by the Carmel Theater Development Company as per the City Center Drive/Rangeline Road Streetscape Improvements installment purchase contract. Application 4(Signature)April 2010 $ 7,382.79 Application 5(Signature)May 2010 $ 2,998.20 Application 6(Signature)June 2010 $ 8,685.83 Application 7(Signature)July 2010 $ 5,795.38 Total Authorized Disbursement $;'24;862:20:_. All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated February 23, 2010, by and between The National Bank of Indianapolis and Carmel Theater Development Company, LLC./ Dated: 2/2 171/0 CITY OF CARMEL REDEVELOPMENT • COMMISSION • By: Les S. Olds Printed: Executive Director Title: P73 Streetscape (Signature) April 2010 Application 4 Amount to be paid by Carmel Theater Development $ 7,382.79 May 2010 Application 5 Amount to be paid by Carmel Theater Development $ 2,998.20 June 2010 Application 6 Amount to be paid by Carmel Theater Development $ 8,685.83 July 2010 Application 7 Amount to be paid by Carmel Theater Development $ 5,795.38 APPLICATION AND CERTIFICATION FOR PAYMENT ALA DOCUAIENT G702 PAGE ONE OF 2 PAGES2 TO OWNER:CRC at City of Carmel PROJECT:Cannel Parcel 73 APPLICATION NO: invoice e 4 I Distribution to: One Civic Square Streets cape Signature costs OWNER Cannel Indiana 46032 ARCHITECT PERIOD TO: 04/26/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design I Signature Construction Services LLC I 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 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 0703,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 $ 19,973.55 2. Net change by Change Orders S 0.00 CONTRACTOR: 3. CONTRACT SUM TU DATE(Line I±2) 5 19,9/3.33 4. TOTAL COMPLETED K STORED TO S 19,9/3.33 By: c ..011.11".. Date: y/Z7�a 5. REI'AINA(JE: am oontr. rest.ent �^^- / a 0%olComplcied Work 5 0 Subrcnbed and wore to before me this 2'D'day of (l1 s J , 210(c-2 (T Tiimn ll+Eon 0703) b. %of Stored Material S (}0_ i,4-05:.. ."` KENDRA DIANE WILBURN I'Colu in F on 6703) Marion Courtly total Retainage I Lines 1a'r or t Total in Column I of G703) s 0.00 ARCHIThCT°SSChRT1F� -+ 6. TOTAL EARNED LESS RETAINAGE S 19,973.» In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5'I'otal) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CER'TIFICA'TES FOR Architect's knowledge.Information and belief the Work has progressed as indicated, PAYMENT(Line 6 from pnor Certificate) S 12.590.76 the quality of the Work is in accordance with the Contract Documents,and the Contractor B. CURRENT PAYMENT DUE S /,381.79 is entitled to payment oI'the AMOUNT CERTIFIED 9. BALANCE TO FINISH.INCLUDING REIAINAGE 5 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED 5 7,3:;7.1c5 LHANUL UKLL•K SUMMARY AUMJI I IONS ULIJUL I IONS (,Irtach erpinn i n ifamount certified differs from the amount applied.Initial all figures on this total changes approved .4pplication n omlie cony, r rio,,SI eel that are changed to conform with the amount cent/led.) in previous months by Owner ARCIiI'1' C"1': r� � Total approved this Month By. J(/ ti'� Date: 4-I 7j of i O TOTALS 50.00 50.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Lontractor names nercm.issuance,payment ano acceptance or payment are minnow NET CHANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract. AU DOCUMENT 6702•APPUCATION AND CERTIFICATION FOR PAYMENT•11192 EDITION•AU•01992 THE AMERICAN INSTITUTE OF ARCHITECTS.1775 NEW YORK AVE.N,W..WASHINGTON,DC 20008.5292 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 # 4 4/26/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORE COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost Pre-Construction Services 4,452.07 4,371.77 80.30 0.00 4,452.07 100% 0.00 4,452.07 General Requirements: 0.00 0.00 0.00 0.00 .0.00 0% 0.00 0.00 Testing and Inspecting 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Site Supervision 15,521.48 8,218.99 7,302..49 0.00 15,521.48 0% 0.00 15,521.48 Construction Management 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Site Safety Director 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Design Drawings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Sanitary Facilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Field Office 0.00 0.0D 0.00 0.00 0.00 0% 0.00 0.00 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Office Supplies 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Telecommunications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Water 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Tools and.Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Jobsite Trailer 0.00 0.00 0.00 0.00 0.00 0% 0.00 0,00 Field Eng. and Surveying 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Health and.Safety 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Waste Disposal 0.00 0.00 ' 0.00 0.00 0.00 0% 0.00 0.00 Final Clean 0.00 0.00 0.00 0,00 0.00 0% 0.00 0.00 Construction Management Fee 0.00 0.00 H 0.00 0.00 0.00 0% 0.00 0.00 19,973..55 - 12,590.76 7,382.79 0.00 19,973.55 100% 0.00 19,973.55 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and!or labor as follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of seven thousand three hundred eight-two dollars and seventy-nine cents($7,382.79)the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC /" i� Thomrs E. K ntz, President 7/ Subscribed and sworn to before me this: 6.10./ '"' !. 2Cl0 ti_ KENDRADUwEwi 'r u", Public: (�•oit)• WiL. -- :worm•s Marlon County V- 1.1 My Commisdon Expires March 20,2011 APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Cannel Parcel 73 APPLICATION NO Invoice it 5 I Distribution to: One Civic Square Strcclscape Signature costs I OWNER Carmel Indiana 46032 I ARCHITECT PERIOD TO: 05/24/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design I 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 ofthc 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.ALA 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 5 71,724.57 2. Net change by Change Orders S 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Linc I±2) 5 71,724.57 4. TOTAL COMPLL rL•D&STORED TO 5 2,971,75 r �J 13y: - / / — Date: 5/r-S io 5. RETAINAGE: Thom .Koontz.President Al%of Completed Work 5 0 Sbscrihed a sworn to before me this --lay of ,I y , '!0 (Column D+E on G703) - LINDA BU:hWNAN f:'':.,...,..... *b. oof Stored Nlatcrial $ Hancock Courtly ec7Eutn I on G703) - :w.�.4.` My Commission Expires Total Retainagc(Lints 5a+5b or I.E.;iF ' Amato ,2011 Total in Column I of 0703) s 0.00 ARCHITECT'S CER IFICATE FOR PAYME 6. TOTAL EARNED LESS RETAINAGE 5 22,971.75 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) 5 19,973.55 the quality of the Work is in accordance with the Contract Documents.and the Contractor 8. CURRENT PAYMENT DUE S 2,998.20 is entitled to payment ofthe AMOUNT CERTIFIED. 9. BALANCE TO FINISH.INCLUDING RETAINAGE $ 48,752.82 (Line 3 less Line 6) AMOUNT CERTIFIED S 2.;$5458, CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expl•tarn.:if amount certified diftirs from the amount applied.Initial al figures on this Total changes approved Applicata'n and ware Cot ' anon Sheet that are c/ranged to conform with the ontouni certified) in previous months by Owner ARCH ,CT: Total approved this Month By: Date: 55/27/ 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 01 payment arc without NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 0702•APPLICATION ANO CERTIFICATION FOR PAYMENT•1992 EDITION-MA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS.1715 NEW YORK AVE.,N W..WASHINGTON.DC 20000.9292 Users may obtain validation of this document by requesting a completed AlA Document D401 -Certification of Document's Authenticity from the Licensee. CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and/or labor as follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of two thousand nine hundred ninty-eight dollars and twenty cents($2,998.20)the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC Th9fnas E. ontz, President Subscribed and sworn to before me this: it)/ d S .?0/0 Notary LINDA BUCHANAN Hancock County My Commission Expires ?G " August 20,2011 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel,, Indiana 46032 Invoice # 5 5/24/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD. STORED STORED TO DATE .% FINISH Cost Pre-Construction Services 4,452.07 4,452.07 0.00 0.00 4,452.07 100% 0.00 4,452.0.7 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 9,550.00 0.00 0.00 0.00 0.00 0% 9,550..00 0.00 Site Supervision 36,000.00 15,521.40 2,998.20 0.00 18,519.68 51% 17,480.32 18,519.68 Construction Management 5,000.00 0.00 0.00 0.00 0.00 O% 5,000.00 0.00 Site Safety Director 500.00 ', 0.00 0.00 0.00 0.00 0% 500.00 0.00 Design Drawings 3,000.00 0.00 0.00 0.00 0.00 04 3,000.00 0.00 Temporary Electric 1,750.00 0.00 0.00 0.00 0.00 0% 1,750.00 0.00 Temporary Lighting 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Office Supplies 250.00 0.00 0.00 0.00 0.00 056 250.00 0.00. Temporary Firs Protection 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Water 1,000.00 0.00 0.00 0.00 0.00 04 1„000.00 0.00 Tools and Equipment 1,022.50 0.00 0.00 0.00 0.00 0% 1,022.50 0.00 Projection Signage 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Field Eng. and Surveying 2,500.00 0.00 0.00 0.00 0.00 05 2,500.00 , 0.00 Health and Safety 200.00 0.00 0.00 0.00 0.00 0% 200.00 0.00 Waste Disposal 3,500.00 0.00 0.00 0.00 0.00 0% 3,500.00 0.00 Construction Management Fee 0.00 0.00 0.00 0,00 0.00 04 0.00 0.00 71,724.57 19,973.55 2,998.20 0.00 22,971.75 32% 48,752.82 22,971.75 l - APPLICATION AND CERTIFICATION FOR PAYMENT .ALA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER CRC at City of Carmel PROJECT: Cannel Parcel 73 APPLICATION NO mvolce is 6 I Distribution to: One Civic Square Streetscape Signature costs OWNER Carmel Indiana 46032 ARCI IITECT PERIOD TO: 06/24/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services L.LC 720 3rd Avenue S.W. PROJECT NOS: Carmel,Indiana 46032 CONTRACT FOR: CON'T'RACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ot'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,AMA 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 Or Payment were issued and payments received from the Owner.and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM $ 71,724.57 2. Net change by Change Orders I 0 00 CON'T'RACTOR: 3 CONTRACT SUM TO DA'Z'E(Line 1±2) 5 71./24.37 4. "TOTAL COMPLETED K STORED TO $ 31,6a7.s8 By tt , .-___--^�'Q Date: G/� /a 5. RETAINAGE: this Koontz.I)residcnI a (1%of Completed Work $ 0 Subscribed nd sworn to before me this _t yday of J oritrt 0/O u wnn D+Eon 0703) •"a LINDA BUCHANAN b. %of Stored Material $ o wnn F on 6703) r NOT,nv' Hanccck County t Drat t(etatnage(Lines pa+oD or :; 5Eti..r My Comrttission Expires 0 "''�? August 20,2011 Total in Column I of G703) 5 0.00 ARCM l EG I'S CE I I}-ICATE FOR PAYMhN F',.._�..�_._� 6. TOTAL EARNED LESS RI/FAINAGE $ 31.6)7.38 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 PREVIOLS CERTIFICATES FOR Architect's knowledge.information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 22,971.75 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 8,68 83 is entitled to payment of the AMOUNT C:LR'I'IFIED. 9. BALANCE TO FINISH.INCLUDING RETAINAGE $ 40,066.99 (t.inc 3 less Line 6) AMOUNT Cl:RfIF .1. . ...5 fTj /_2,5 SIj CHANUb.ORDER SUMMARY ADM I IONS ULDUL I IONS !:Vlach expl rations n'am .n t co.,fled differs_from the amount applied.Initial all figures on this I otal changes approved application and on to C ntinua(' n . 1 are changed to cot form with the amount certified.) in previous months by Owner ARCHTT.CI': 'total approved this Month By: /. Date: G I r(A TOTALS $0.00 $0.00 This Certificate is not negotiable The AMOUNT'CERTIFIED is payable only o the Contractor natneu nercin.issuance,payment ana acceptance of payment arc witnout 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 0401 -Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice * 6 6/24/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FIINISH Cost Pre-Construction Services 4,452.07 4,452.07 0.00 0.00 4,452.07 100% 0.00 4,452.07 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 9,550.00 0.00 0.00 0.00 0.00 0% 9,550.00 0.00 Site Supervision 36,000.00 18,519.68 8,685.83 0.00 27,205.51 76% 8,794.49 27,205.51 Construction Management 5,000.00 0.00 0.00 0.00 0.00 0% 5,000.00 0.00 Site Safety Director 500.00 0.00 0.00 0.00 0.00 0% 500.00 0.00 Design Drawings 3,000.00 0.00 0.00 0.00 0.00 04 3,000.00 0.00 Temporary Electric 1,750.00 0.00 0.00 0.00 0.00 06 1,750.00 0.00 Temporary Lighting 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Office Supplies 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Fire Protection 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Water 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00 Tools and Equipment 1,022.50 0.00 0.00 0.00 0.00 0% 1,022.50 0.00 Projection Signage 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Field Eng. and Surveying 2,500.00 0.00 0.00 0.00 D.00 0% 2,500.00 0.00 Health and Safety 200.00 0.00 0.00 0.00 0.00 0% 200.00 0.00 Waste Disposal 3,500.00 0.00 0.00 0.00 0.00 0% 3,500.00 0.00 Construction Management Fee 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 71,724.57 22,971.75 8,685.83 0.00 31,657.58 44% 40,066.99 31,657.58 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and/or labor as follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of eight thousand six hundred eighty-five dollars and eighty-three cents ($8,685.83)the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC 1 / (Thomas fl oontz, President \ Subscribed and sworn to before me this: .0i ti- ✓a•it ,o7 U Notary Public: ; LINDA BUCHANAN <O,.A f : Hancock County L ,. :. ::.; My Commission Expires ••fi''..i..' August 20,2011 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Carmel Parcel 73 APPLICATION NO invoice it 7 I Distribution to: Invoice#7 Streetscape Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 07/21/2010 X CONTRACTOR FROM CONTRACTOR: ViA ARCHI'T'ECT: Pcdcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: 27206 CONTRACT DATE: 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,AlA 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 $ 75.335.577 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I =2) $ 75.335.57 4. TOTAL COMPLETED&STORED TO $ 37,452.96 /� l jA9 ►1y: f , —� Date: 7/ Zj 5. RETAINAGE: 'l'honr I .Koontz,President , t a. 0%ofCompleted Work $ 0 )Subscribed d sworn to before me this / day of , '1• ; - (Column D+Eon 6703) \ LINDA BUCHANAN b. %ofStored Material $ (Column F on(1703) !�A� Hancock County ::E,.. My Commission Expires Total Retainage(Lines 5a+Sb or .?'a;`"` Au ust 20,2011 Total in Column I ofG703) $ 0.00 ARCHITECTS CERTIFICATE FOR PAYM 6. TOTAL EARNED LESS RETAINAGE 5 37,452.96 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 CER'T'IFICATES FOR Architect's knowledge.information and belief the Work has progressed as indicated. PAYMENT(Line 6 from prior Certificate) $ 31,657.58 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 5,795.38 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH.INCLUDING RIi'FAINAGE S 37,882.61 s (Line 3 less Line 6) AMOUNT CERTIFIED $ 5/95.Jt, CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if con it certified differs from the amount applied.Initial all figures on this Total changes approved Application and onth ..o !intuition ,t that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: Total approved this Month By: Date: 7f 27l(t) TOTALS $0.00 $13.00 This Ceniticate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor namea herein.Issuance,payment anU acceptance oI payment are without NET CHANGES by Change Order $0.00 prejudice to any rights ofthe Owner or Contractor under this Contract. AlA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT'1992 EDITION AIA .01992 THE AMERICAN INSTITUTE OF ARCHITEC7S.1735 NEW YORK AVE.,N,W.,WASHINGTON,DC 20008-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee, Director of Redevelopm nt/-'. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 7 7/21/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost Pre-Construction Services 4,452.07 4,452.07 0.00 0.00 4,452.07 100% 0.00 4,452.07 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 9,550.00 0.00 0.00 0.00 0.00 0% 9,550.00 0.00 Site Supervision 36,000.00 27,205.51 2,184.38 0.00 29,389.89 82% 6,610.11 29,389.89 Construction Management 5,000.00 0.00 0.00 0.00 0.00 0% 5,000.00 0.00 Site Safety Director 500.00 0.00 0.00 0.00 0.00 0% 500.00 0.00 Design Drawings 3,000.00 0.00 0.00 0.00 0.00 0% 3,000.00 0.00 Temporary Electric 1,750.00 0.00 0.00 0.00 0.00 0% 1,750.00 0.00 Temporary Lighting 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Office Supplies 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Fire Protection 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Water 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00 Tools and Equipment 1,022.50 0.00 0.00 0.00 0.00 0% 1,022.50 0.00 Projection Signage 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Field Eng. and Surveying 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Health and Safety 200.00 0.00 0.00 0.00 0.00 0% 200.00 0.00 Waste Disposal 3,500.00 0.00 0.00 0.00 0.00 0% 3,500.00 0.00 Construction Management Fee 3,611.00 0.00 3,611.00 0.00 3,611.00 0% 0.00 3,611.00 75,335.57 31,657.58 5,795.38 0.00 37,452.96 50% 37,882.61 37,452.96 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract tot 27205.51 follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of five thousand seven hundred ninty-five dollars and thirty-eight cents ($5,795.38) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC Thomas/. Koontz, President Subscribed and sworn to before me this: . . • Notary Public: LINDA BUCHANAN ' '�=•� z': Hancock County SEAL My Commission Expires August 20,2011