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HomeMy WebLinkAboutKEYSTONE CONSTRUCTION- 002335- 9/29/2011,CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice 101004 Application 4 P47 Streetscape P.O. Num. Invoice Amt 22,518.90 002335 Check: 2335 Date: 9/29/2011 Vendor: KEYSTON1 Prior Balance Retention Discount Amt. Pai 22,518.90 0.00 0.00 22,518.9 THE KEY TO DOCUMENT SECURITY \A EAT ACTIVATED THUMB PRINT +•,ADDITIONAL SECURITY FEATURES INCL'UDED,• SEESACK -FOR DETAILS ,;= 6DE a CARrV1EL isTR1C Carmel Redevelopment Commission 30 West Main Street Suite 220 - Carmel IN 46032 9/29/2011 * * * ** * * ** *22,518:90 PAY THE SUM OF TWENTY TWO THOUSAND FIVE HUNDRED EIGHTEEN. DOLLARS AND 90 CENTS * ** TO THE ORDER OF Keystone Construction;, 47 -South PA St, 10th; Floor Indianapolis, IN 46204 II'00 23351I® 1:0740 b4 2 b 31: 0087504 b b bll° CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice P.O. Num. 101004 Application 4 P47 Streetscape Invoice Amt 22,518.90 002335 Check: 2335 Date: 9/29/2011 Vendor: KEYSTON1 Prior Balance Retention Discount Amt. Paid 22,518.90 0.00 0.00 22,518.90 22,518.90 22,518.90 0.00 0.00 22,518.90 X -11- 52 COMPUTEREASE FORMS DIVISION (877)577 -5791 ' 7-37228 = Document G70 Application and Certificate for Payment 2TM 1992 TO OWNERCity of Carmel PROJECT: Parcel 47 Streetscane Carmel, Indiana FROM CONTRACTOR: VIA ARCHITECT: Keystone Construction Corporation 47 S Pennsylvania Street FL 10 Indianapolis, IN 46204 APPLICATION N°:101004 PERIOD TO: 3131/201 CONTRACT FOR: CONTRACT DATE: PROJECT NOS: 1010 / Distribution to: OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. AIA Document G703TM, Continuation Sheet, 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 (Columns D + E on G703) $ % of Stored Material (Column F on G703) $ $ 4',71f3n b. '13.216.30 Total Retainage (Lines 5a + 5b, or Total in Column I of G703) $ 6. TOTAL EARNED LESS RETAINAGE $ (Line 4 minus 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 minus Line 6) 000 43216 30 70 697 40 77 SIR 90 000 CHANGE ORDER SUMMARY '' ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ Total approved this month $ $ TOTAL $ $ NET CHANGES b Chan_e Order $ 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. eysto Construction Corporation of:Marion Subscribed and sworn to before me this .21•5-` " day of ri'\,aA_lk , 8 Notary Public: My commission expires: Date: 31 1 ARCHITECTS CERTIFICATE U11 ANOTARY M. SEAL MARION COON NOOVEEMBEROB, 20 6� T In accordance with the Contract Documents, based on on -site observations and the data comprising this 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 (Attach explan 7 if amount certified differs from the amount applied. Initial all figures on this Applicatioi the C uation Sheet that are changed to conform with the amount certified) ARCHITE $'11,5e01)0 By: Date: 3121 f I( 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. CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702TM — 1992. Copyright © 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AlA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent r ''t . ` possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal / counsel, copyright @aia.org. l / /!� Director of Redevelopment / 1608 y/7 +171 ® TM Document G702 -1992 Instructions Application and Certificate for Payment GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703TM, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201 TM, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The ALA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702, but only for use in connection with a particular project. The ALA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. - COMPLETING G702 After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702, Application and Certificate for Payment. The Contractor should sign G702, have it notarized, and submit it, together with G703, to the Architect. The Architect should review G702 and G703 and, if they are acceptable, complete the Architect's Certificate for Payment on G702. The Architect may certify a different amount than that applied for, pursuant to Sections 9.5 and 9.6 of A20'1. The Architect should then initial all figures on G702 and G703 that have been changed to conform to the amount, certified and attach an explanation. The completed 0702 and G703 should be forwarded to the Owner. MAKING PAYMENT The Owner should make payment directly to the Contractor based on the amount certified by the Architect on AIA Document G702, Application and Certificate for Payment. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. EXECUTING THE DOCUMENT 1 t l Persons executing the document should indicate the capacity; in which they ar re acting (i.e., president, secretary, partner, etc.) and the authority under which they are executing the documeq. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the firm or entit'should be attached. i _ ii• AIA Document G702TM — 1992. Copyright © 1953, 1963, 1965, 1971, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document, or any portion of it, may result in severe civil and criminal.penalties,.and -will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @aia.org. Continuation Sheet G7O3TM Document G703 -1992 AIA Document G702T"' 1992, Application and Certificate for Payment, or G732TM -2009, Application and Certificate for Payment, Construction Manager as Adviser Edition, containing Contractor's signed certification is attached. In tabu ations below amounts are in US dollars. Use Column 1 on Contracts where variable retainage for line items may apply. APPLICATION NO' 101004 APPLICATION DATE: 3/25/2011 PERIOD TO 3/31/2011 ARCHITECT'S PROJECT NO: 1010 A B C D E G H ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE . WORK COMPLETED FROM PREVIOUS APPLICATION (D + E) TI -IIS PERIOD MATERIALS PRESENTLY STORED (Not in D or E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) (C C) BALANCE TO FINISH (C— G) RETAINAGE (If variable rate) 1 2 General Conditions to Date 5% CM Fee to Date 34,268.67 8,947.63 19, 711.81 985.59 14,556.86 7,962.04 34,268.67 8,947.63 100.00 100.00 ':.Totals GRAND TOTAL 43,216.30 , 20,697.40 22,518.90 43,216.30 100.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM — 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA ®Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @aia.org. ,o,z,oncoa< emu Continuation Sheet Document G703'- 1992 Instructions GENERAL INFORMATION Purpose and Related Documents. AIA Document G703TM, Continuation Sheet, is to be used in conjunction with AIA Document G702TM Application and Certificate for Payment, or AIA Document G732TA1 Application and Certificate for Payment, Construction Manager as Adviser Edition. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Documents A201 T51, General Conditions of the Contract for Construction, and A232Tm, General Conditions of the Contract for Construction, Construction Manager as Adviser Edition. Use of Current Documents. Prior to using any ALA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The ALA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment, or G732T51, Application and Certificate for Payment, Construction Manager as Adviser Edition, whichever is applicable. Columns A, B and C. These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D. Enter in this column the amount of completed Work covered by the previous application (columns D & E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Column F. Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed -This Period.) Column G. Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H. Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I. This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders. Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 o'r G732 form, whichever is applicable. Construction Change Directives. Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 of AIA Document A201 or Section 7.3 of AIA Document A232. The following is an example ofa Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only. and are not intended to reflect actual construction costs. a te®® Imo ITEM NO. DESCRIPTION OF WORK SCI [EMI .I:D VALUI: IDIZEIGMEIMIIIIM MATERIALS PRESENTLY STORED (5,u,DcwEI TOTAL COMPLETED AND STORED DATE rO E*F (D +E +F) % (G C) BALA NCI : TO FINISH IC_GJ RFTAIN%GI: (lftariuhl�ralel FROM PREVIOUS APPLICATION (D +E) THIS PERIOD 1 MOBILIZATION 5000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS A MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 , 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 GRAND TOTAL 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703TM - 1992. Copyright © 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American nstitute of Architects. All rights reserved. WARNING: This AlA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. AFFIDAVIT AND WAIVER OF LIEN Final State of Indiana, County of Marion. SS: X Partial X Payment to Follow Matt Stump, being duly sworn, states that he is the Senior Project Manager 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. (PARTIAL WAIVER) that there is due from the owner the sum of Twenty Two Thousand Five Hundred Eighteen & 90/100 Dollars ($ 22,518.90 ) [ ] 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 final 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 By (Company) WITNESS MY HAND AND N Notary Public: (Authorized Represent we) Title Senior Project Manager AL SEAL, this 25th day of March, 2011. Printed Name: Andrea M. Roell State of Indiana County of !Marion A A . R.i'L1 NOTARY PUBLIC SEAL STATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER 8. 2016 6 '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�, / �� 577oi,� Co <7y7rvc7 f" it (70 f,, Purchase Order No. y 7 Sr b d oi' < 44/7/c .51-4-e---10•74 Terms /e/f4, ?r,,o /i,, //I' 2V Date Due Invoice Date Invoice Number Description (or note attached invoice(s) or bill(s)) Amount 77//// /& /ao-j l'e7‘,' qy ., ../U° oy /4/ 7 3, ,h/..5), �� /D /ooy 22 5-7Y -961 26, /65-6 Total I hereby certify that the attached invoice(s), or bill(s), is (are) true with IC 5- 11- 10 -1.6. , 20 ect . nd I have audited same in accordance - Treasurer VOUCHER NO. WARRANT NO. 's, /"V l-7'62G2- 26, /6s ON ACCOUNT OF APPROPRIATION FOR 9o2, PO# or DEPT. # INVOICE NO. ACCT #/TITLE AMOUNT /�J /c27 y'62 .9 7 //2 /o / ALLOWED 20 IN SUM OF $ Board Members I hereby certify that the attached invoice(s), or 3; .g41 . bill(s) is (are) true and correct and that the 22, 5 7? 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 73 20// i atur ExectitiveDirector Title Cannel Redevelopment Commission