The URL can be used to link to this page

Home My WebLink AboutKEYSTONE CONSTRUCTION- 002336- 9/29/2011CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice 101008 Retainage on P47 P.O. Num. 002336 Check: 2336 Date: 9/29/2011 Vendor: KEYSTON1 Prior Invoice Amt Balance Retention Discount Amt. Paid 3,646.96 ' 3,646.96 0.00 0.00 3,646.96 3,646.96 3,646.96 0.00 0.00 3,646.96 `THE;KEY To DOCUMENT SECURITY, •''HEATACTIVATED,THUMB PRINT "..ADDITIONAL SECURITY FEATURES INCLUDED .'SEE BACK FOR DETAILS Carmel Redevelopment Commission 30 West Main Street Suite 220 Carmel, IN 46032 A REGIoNs • 20 -1421 /740 DATE 002336 2336 AMOUNT 9/29/2011 * * * * ** *****3,646.96 PAY THE SUM OF THREE THOUSAND SIX HUNDRED FORTY SIX DOLLARS AND 96 CENTS * * * * * * * * * * * ** TO THE ORDER OF Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 "°0023360 1:0 740 64 2 6 31: 008 7 Soil CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice 101008 Retainage on P47 P.O. Num. -11- 52 COMPUTEREASE FORMS DIVISION (877)577 -5791 7 -37228 SENS��t P R. 002336 Check: 2336 Date: 9/29/2011 Vendor: KEYSTON1 Prior Invoice Amt Balance Retention Discount Amt. Paid 3,646.96 3,646.96 0.00 0.00 3,646.96 3,646.96 3,646.96 0.00 0.00 3,646.96 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 3 PAGES TO OWNER: PROJECT: Parcel 47 Streetscape City of Carmel Cannel, Indiana FROM CONTRACTOR: Keystone ConstructionCorp. 47 S. Pennsylvania Street Indianapolis, IN 46204 CONTRACT FOR: VIA ARCHITECT: APPLICATION NO: 101008 PERIOD TO: 7/31/11 PROJECT NOS: 1010 CONTRACT DATE: Distribution to: OWNER ARCHITECT CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM 2. Net change by Change Orders 3. CONTRACT SUM TO DATE (Line 1 ± 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 5. RETAINAGE: a. % of Completed Work $ (Column D + E on G703) b. 10 % of Stored Material $ (Column F on G703) Total Retainage (Lines 5a + 5b or Total in Column I of G703) 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 137,370.00 $ 3,500.00 $ 140,870.00 $ 140,870.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been 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. CONT KEYSTONE CONSTRUCTION CORPORATION By: Date: 8/26/2011 State of: Indiana County of: Mari n ANDREA M. ROELL Subscribed an to bef me 1 26 day of August 2011 NOTARY PUBLIC 0.00 Notary Public. My Commission expires: 0.00 ARCHITECT'S CERTIFICATE FOR $ 140,870.00 $ 137,223.04 $ 3,646.96 0.00 CHAN E ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner , Total approved this Month $3,500.00 TOTALS $3,500.00 $0.00 NET CHANGES by Change Order $3,500.00 SEAL STATE OF INDIANA MARION COUNTY EN f vlv rAPIRLS NI OVEMBER 8, 2016 — In accordance with the Contract Documents, based on on -site observations and the data comprising the application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $ %4b.431.' (Attach explan . on if a ount certified differs from the amount applied. Initial all figures on this Application .nd anthe ontinuati Sheet that are changed to conform with the amount certified.) ARCHITE By: Date: 5ASJ jr/ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. - AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT' 1992 EDITION AIA E1992 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. yy60 y7�Or/ - CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 PAGES AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing Contractor's signed certification is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO: APPLICATION DATE: PERIOD TO: PROJECT NO: 101009 8/26/2011 8/31/2011 1010 A B C D E F G H I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D+E +F) % (G - C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 1 General Conditions & CM Fee $137,370.00 $137,223.04 $146.96 - $137,370.00 100% $0.00 2 Change Order #1 $3,500.00 $3,500.00 - $3,500.00 100% $0.00 -_ - PAGE TOTAL $140,870.00 $137,223.04 $3,646.96 $0.00 $140,870.00 100% $0.00 - Users may obtain validation of this document by requesting of the license a completed AIA Document D401 - Certification of Document's Authenticity AFFIDAVIT AND WAIVER OF LIEN Final Partial Payment to Follow State of Indiana, County of Marion. SS: Christi Minars, being duly sworn, states that she is the Controller of Keystone Construction Corporation (Contractor) having contracted with Carmel Redevelopment Commission to furnish certain materials and /or labor as follows for a project known as Parcel 47 Streetscape, located at Carmel Indiana and does hereby further state on behalf of the aforementioned Contractor. X X (PARTIAL WAIVER) that there is due from the owner the sum of Three Thousand Six Hundred Forty Six & 96/100 Dollars ($ 3,646.96 [ ] receipt of which is hereby acknowledged ; or [ X ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned ; (FINAL WAIVER) that the fmal balance due from the owner is the sum of Dollars ( $ [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above - described property and improvements thereon on account of LABOR or MATERIAL or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Keystone Construction Corporation (Company) (Authorized Representative) itle Controller WITNESS M HAND AND NOTARIAL SEAL, this 26th day of August, 2011. Notary Public: Printed Name: Andrea M State of Indiana County of Marion Roell ANDREA M. ROELL My Commissioi NOTARY PUBLIC SEAL STATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER 8, 2016 Expires November 8. 2016 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL City Form No. 201 (Rev. 1995) 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�P.Zj 5740 J1 CO , rvcA` -v 701/J. Purchase Order No. ' 7 Se A -70.7 ,,A,,,, q S74rr -,-7L Terms iii /fy,?,-,,o/i.3, /4-/ .'42- V Date Due Invoice Date Invoice Number Description (or note attached invoice(s) or bill(s)) Amount 77(/// /&//49,e5 it,o7‘, -ery .- �� P 47(7 3, 6Y ,26 4 / / &oy 22, 5 ,90 26, /65 -‘ Total (fC :3 165: I hereby certify that the attached invoice(s), or bill(s), is (are) true with IC 5- 11- 10 -1.6. K , 20 ect . nd I have audited same in accordance - Treasurer VOUCHER NO. WARRANT NO. I-°/.L71- <-7ib:, /c/./ G <?-7li/ c,4 ,5 , //1-1 1/6.2&7 26, /6,5-.Y. ON ACCOUNT OF APPROPRIATION FOR 202 PO# or DEPT. # 9GZ INVOICE NO. ACCT #/TITLE AMOUNT 4/$16 L/ 7 0/o ALLOWED 20 IN SUM OF $ Board Members I hereby certify that the attached invoice(s), or 3, 641. bill(s) is (are) true and correct and that the 22,37,W materials or services itemized thereon for which charge is made were ordered and received except Cost distribution ledger classification if claim paid motor vehicle highway fund 9-73 20// Si atur Exec�`1lvebirector Title Cannel Redevelopment Commission