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HomeMy WebLinkAboutKEYSTONE CONSTRUCTION- 001690- 3/3/2011CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice P.O. Num. 100802 P47 site utilities retainage 101002 P47 streetscape 001690 Check: 1690 Date: 3/3/2011 Vendor: KEYSTON1 Prior Invoice Amt Balance Retention Discount Amt. Paid 9,825.95 9,825.95 0.00 0.00 9,825.95 6,597.29 6,597.29 0.00 0.00 6,59729 16,423.24 16,423.24 0.00 0.00 16,423.24 8 THISICHECKiHAWAMOLEOREMBACKGROUND3AND'ACONTAINSIVIULTIELSISECURITYAIEEATURES7SEE4BACKTEOFODETAIMMWEINMEREM 0 0;16`9.0 is Ea DES�"1 CARMEL �fSTR%L> PAY TO THE ORDER OF Carmel Redevelopment Commission )30 West Main Street Suite 220 Carmel, IN .46032 A REGIONS 20- 1421/740 • 1690 DATE AMOUNT 3/3/2011 THE SUM OF SIXTEEN THOUSAND FOUR HUNDRED TWENTY THREE DOLLARS AND 24 CENTS * * * * * * * * * * * *16 423.24 Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 M 000L690" 1:0740L421,31: 0087504LLLII' CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 001690 Check: 1690 Date: 3/3/2011 Vendor: KEYSTON1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paic 100802 9,825.95 9,825.95 0.00 0.00 9,825.9! P47 site utilities retainage 101002 6,597.29 6,597.29._ 0.00 0.00 6,597.2! P47 streetscape 16,423.24 16,423.24 0.00 0.00 .16,423.2, kvx AI Docurnent G702TM -1992 .......... _.__... ...._ ................... Application and Certificate for Payment Director of Redevelopment /qq 9 7 7 ....... .......... TO OWNER: City of Carmel PROJECT: Parcel 47 Streetscaoe Carmel, Indiana FROM CONTRACTOR: Keystone Construction CorpoiVA RCHITECT: 47 S Pennsylvania Street FL 10' Indianapolis, IN 46204 APPLICATION No: ::101002 PERIOD TO:, 12/31/2010 CONTRACT FOR: CONTRACT DATE: PROJECT NOS: 1010 / Distribution to: OWNER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ OTHER El 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 $ 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 16,342.38 that current pay -It shown herein is now due. CONTRAC .r: Keystone Construction Corporation By: Date: / /a /0 2. NET CHANGE BY CHANGE ORDERS $ 0.00 3. CONTRACT SUM TO DATE (Line I ± 2) $ 16,342.38 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 16,342.38 5. RETAINAGE: a. % of Completed Work (Columns D + E on G703) $ b. % of Stored Material (Column F on G703) $ Total Retainage (Lines 5a + 5h, or Total in Column / 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) 0.00 State Indiana County of: Marion Subscribed and sworn ,:to'be me this PfrCA, day of Notary Public My commission expires: ■ ANDREA M. ROELL NOTARY PUBLIC SEAL STATE OF INDIANA MY COMMISSION UEXPIRES: NOVEMBER 8, 2016 16,342.38 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising 9,745.09 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. $ 6,597.29 0.00 . CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ Total approved this month $ $ TOTAL $ $ NET CHANGES by Change Order $ AMOUNT CERTIFIED $4, explanc n 'amount certified dlffus f of the amount applied. /n ��tticil all figures on this Application ind on he Contodion Sheet that are changed to conforni with the amount certified.) Date: / /Q'G / This Certificate is,,nbt 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 G702T' — 1992. Copyright © 1953, 1963, 1965, 1971, 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 AIA® 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. StAIA Document G702TM -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 A201TM, 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 AIA 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. j,' r'° 4. 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 A2611. The Architect should then initial all figures on G702 and,G703 that have been changed to conform fo the amoribt certified and attach an explanation. The completed G702 an G703 should.be forwarded to the Owner. :i=f J MAKING PAYMENT The Owner should make payment directly to the Contractor based ori-the amount certified by the Archi'fecTon AIA Document G702, Application and Certificate for Payment. Thetcompleted form contains the name and•ad'dtess of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. • • EXECUTING THE DOCUMENT Persons executing the document should indicate the capacity in,which• they are acting (i.e., president, secretary, partner, etc.) and the authority under which they are executing'the document. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the firm or ehtitq should be attached. � r I Nc AIA Document G`702TM — 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 Ale 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. Document G7O3TM — 1992 Continuation Sheet AIA Document 0702, 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: ARCHITECT'S PROJECT NO: 12/31/2010 12/31/2010 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) 4'o (G _ C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 1 I.eneral 2 ' Conditions to Date % CM Fee to Date 15,564.17 778.21 9,281.04 464.05 6,283.13 314.16 15,564.1 778.2 ' 100.10 100.10 • 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 AlA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® 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 X Partial State of Indiana, County of Marion. SS: X Payment to Follow Jason Ellis, being duly sworn, states that he is the Director of Construction 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 Six Thousand Five Hundred Ninety Seven & 29/100 [ ] receipt of which is hereby acknowledged ; or Dollars ($ 6,597.29 ) [ 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 / — Title Director of Construction (Company) hor¢ed Representative) WITNESS MY HAND AND NOTARIAL SEAL, this 18t day of January, 2011. Notary Public State of Indiana County (.)1' Marion Printed Name: Andrea M. Roe ANDREA M. RCS �IC :ommission Gxpu NOTARY PUBLIL SEAL STATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER 8, 2016 es November 8. 2016 a Al Document G702 TM -1992 Application and Certificate for Payment Director of Redevelopment/ q40,/ 7 7 TO OWNER: City of Carmel PROJECT: Parcel 47 Site Utilities 110 W. Main Street Carmel, Indiana FROM CONTRACTOR: Keystone Construction CorpoM RCHITECT: 47 S Pennsylvania Street FL 10 Indianapolis, IN 46204 APPLICATION NO: X100802 PERIOD TO: CONTRACT FOR: CONTRACT DATE: PROJECT NOS: . 1008 / 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 G703Th', Continuation Sheet, is attached. 1. ORIGINAL CONTRACT SUM 2. NET CHANGE BY CHANGE ORDERS $ 3. CONTRACT SUM TO DATE (Lint 1 ± 2) $ 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 5. RETAINAGE: a. % of Completed Work (Columns D + E on G703) $ b. :: % of Stored Material (Column F on G703) $ 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 16,249.52 that current payment s •wn herein is now due. 0.00 CONTRACT '• . %ir s e ' )p stru n Corporation'. 16,249.52 By: 16,249.52 State of: County of: Subscribed and sworn to'bef me this 1"' day of Total Retainage (Lines 5a + 5b, or Total in Column 1 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 ininurs Line 6) 0.00 16,249.52 6,423.57 9,825.95 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ Total approved this month $ $ TOTA L $ $ NET CHANGES b Chan>e Order $ Date: //7/1/ NOTARY UB C L a SEAL 4. OF INDIANA ION COUNTY CO ' :SION EXPIREt NOVEMBER B, 2016 Notary Public: My commission expires: ARCHITECT'S CERTIFICATE FOR PAYMENT 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 $ °J c2.15, (Attach explanati amount certified d ffen f. :oi the amount applied Initial all figures on this Application d on t e Co17ration Sheet that are changed to conform with the amount certified.) ARCHITE By: Date: i.fc %a 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 AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® 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. ARAIAN Document G702TM -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 G703T "1, 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 A201TM, 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 AIA 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 AIA 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 AQ1. 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 G702_atui.G703 should be,forwarded to the Owner. i The Owner should make payment directly to the Contractor based on the amount certified by the Archlte0t on AIA Document G702, Application and Certificate,for Payment. Th_e completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702. MAKING PAYMENT 1 EXECUTING THE DOCUMENT Persons executing the document should indicate the capa city -in which they are acting (i.e., president, secretary, partner, etc.) and the authority under which they are executing the document. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the -f" - • en'tit'y should be attached. R■ b 1' • AIA Document G702TM — 1992. Copyright © 1953, 1963, 1965, 1971, 1978, 1983 and 1992' by The American Institute ofikchitects. All rights reserved. WARNING: This AIA®Document is protected by U.S. Copyright Law and IriteFnatioii 1'Treaties. Unauthorized reproduction or distribution of this AIA® 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. SALA Document G7O3TM 1992 Continuation Sheet 100802 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: 12/31/2010 APPLICATION DATE: 12/31/2010 PERIOD TO: 1008 ARCHITECT'S PROJECT NO: 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 COMPLE1ED 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 I.eneral 2 Conditions to Date % Cons Management Fee to C 10,460.35 5,789.17 3,518.02 2,905.55 6,942.3 2,883.6 10,460.3. 5,789.1' 100.10 100.10 .: _ . . II II 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 G7O3TM — 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 AIA® 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 X Partial State of Indiana, County of Marion. SS: X Payment to Follow Bob Crowder, being duly sworn, states that he is Project Director of Keystone Construction Corporation (Contractor) having contracted with City of Carmel to furnish certain materials and /or labor as follows for a project known as Parcel 47, Site Utilities, 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 Nine Thousand Eight Hundred Twenty Five & 95/100 Dollars ($ 9,825.95 [ ] 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 und signed fo sal roject, and within the scope of this affidavit and waiver. Keystone Construction Corporation By •ii _ ` Title Project Director (Company) entativel WITNESS MY /HAND AN NOTAJIAL S , this % day of 1 Notary Public ! ` Q� ' ' State of Indiana Co 'v of Marion , 2011. Printed Name: Andrea M. Roell ANDREA M liRO�LC�t "' ` rvunLc. 8 2016 NOTARY PUBLIC SEAL STATE OF INDIANA MARION COUNTY MYCOMMISEION EXPIRES: NOVEMBER B. 2016