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HomeMy WebLinkAboutKEYSTONE CONSTRUCTION- 001600- 2/3/2011CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice P.O. Num. 100801 Application 100801 103601 Appliction 103601 P47 00 6 0 Check: 1600 Date: 2/3/2011 Vendor: KEYSTON1 Prior Invoice Amt Balance Retention Discount 6,423.57 6,423.57 0.00 0.00 3,215.00 3,215.00 0.00 0.00 9 638.57 9,638.57 0.00 0 .00 Amt. Paid 6,423.57 3,215.00 6,638.57 —1-1641"*MciITHISICHECKNASWCOLOREDIBACKGROLINDIANOZCONTAINVMULTIPLESECURITY*EATURESSEVBACKEDFMETAILSW*TEMIFAMNI , Carmel Redevelopment Commission 30 West Main Street , . Suite '220 - Carmel; IN 46.032 - REGIONS 2.01421/740 • . . • . - . bAtE • 00 .4600 1600 AMOUNT 2/3/2011 - *************9 ,638.57 • PAY THE-SUM,OF NINE THOUSAND SIX HUNDRED THIRTY EIGHT DOLLARS AND 57 CENTS ORDER - Keystone Construction 47 South PA St, 10th Floor sENs„. Indianapolis, IN 46204 •001,600• 1:07400112L31: 00875041LLP CARMEL REDEVELOPMENT COMMISSION Keystone Construction 47 South PA St, 10th Floor Indianapolis, IN 46204 Invoice P.O. Num. 100801 Application 100801 103601 Appliction 103601 P47 001600 Check: 1600 Date: 2/3/2011 Vendor: KEYSTON1 Prior Invoice Amt Balance Retention Discount Amt. Paid 6,423.57 6,423.57 0.00 0.00 6,423.57 3,215.00 3,215.00 - 0.00 _ 0.00 3,215.00 9,638.57 9,638.57 0.00 0.00 9,638.57 - AIA Document G7O2TM -1992 Application and Certificate for Payment TO OWNER: City of Carmel, FROM CONTRACTOR: PROJECT: Parcel 47 Site Utilities 110 W. Main Street Carmel, Indiana Keystone Construction CorpoyltiCHITECT: 47 S Pennsylvania Street FL 10 Indianapolis, IN 46204 APPLICATION NO: 100801 PERIOD TO: 11/15/2010 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 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 b. (Column F on G703) $ 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 minus Line 6) 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 6,423.57 that current payment shown herein i now due 0.00 CONTRACTS 4 Kstt Cotructton Corporation 6,423.57 By: 6,423.57 0.00 State of: County o Subscribed and sworn to before me this day of Notary Public: My commission expires: Date: /l ft) /U ANDREA M. ROELL NOTARY PUBLIC 9 O SEAL STATE OF INDIANA MARION COUNTY COMMISSION EXPIRESC NOVEMBER 8, 2016 6,423.57 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising 0.00 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. 6,423.57 0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ Total approved this month $ $ TOTAL $ $ NET CHANGES by Chan e Order $ AMOUNT CERTIFIED $6, /L'ij�T�� (Attach explana ' if amount certified differs from the amount applied. Initia all figures on this Application n the97ntinuation Sheet that are changed to conform with the amount certified.) ARCHIT By: Date: /2I27Ilit) This Certificate is nonnegotiable. 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 complete To report co righ viola ons of AIA Contract Documents e- ail Than Institute of Architects' legal counsel, copyright @aia.org. Director of Redevelopment / qq 6.0It �' '44 A IA Document G7O2TM— 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 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 A201. 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 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. I EXECUTING THE DOCUMENT Persons executing the document should indicate the capacity in whicl 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 =fir resolution authorizing the individual to act on behalf of the m or;en "1ity should be attached. i ?7v_ t: 3 m 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'InterationalTreaties. 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. *ALLV Document 6703 TM - 1992 Continuation Sheet 100801 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: ARCHITECT'S PROJECT NO: 11/15/2010 11/15/2010 1008 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 COMPLE;IbD 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 2 General Conditions to Date % Cons Management Fee to C 3,518.02 2,905.55 3,518.0' 2,905.5 , 3,518.12 2,905.'5 100.10 100.10 CAUTION: You should sign an original AIA Contract Document, on which this text appears in F#ED. 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 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 Payment to Follow Christi Minars, being duly sworn, states that she is the Controller 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 Cannel, 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 Four Hundred Twenty Three & 57/100 Dollars ($ 6,423.57 [ ] 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 B (Company). WITNESS MY HAND AND Notary Public: Title Controller authorized Representative) AL SEAL, this 22nd day of December 2010. State of Indiana County of Marion Printed Name: Andrea M. Roell i ANDREA a1)b Fusion Expires 'sovember 8, 2016 NOTARY PUBLIC L STATE OF SEA INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER 8, 2016 1!AIA . Document 0702TM -1992 Application and Certificate for Payment TO OWNER: City of Carmel PROJECT: Parcel 47 Service Package 110 W. Main Street Carmel, IN 46032 FROM CONTRACTOR: Keystone Construction CorpoakARCHITECT: 47 S Pennsylvania Street FL 10 Indianapolis, IN 46204 APPLICATION NO: !:103601 PERIOD TO: 11/30/2010 CONTRACT FOR: CT PROJECT ONTRAC NOS: DATE: 1036 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 G7O3TM, Continuation Sheet, is attached. 1. ORIGINAL CONTRACT SUM 2. NET CHANGE BY CHANGE ORDERS. $ 3. CONTRACT SUM TO DATE (Line I ± 2) $ 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 5. RETAINAGE: a. % of Completed Work (Columns D + E on G703) $ b. %o of Stored Material (Column F on G703) $ 9,294.00 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 6from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 minus Line 6) 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 paym-4 t shows erein is now due. 0.00 CONTRA ction Corporation' 9,294.00 By: 3,215.00 State of: County of: Mario Subscribed and sworn, to be me this —7-11" day of 0.00 Notary Public: My commission expires: Date: i l i/ 1,0 ANDREA M. ROELL a ©i O NOTARY PUBLIC SEAL STATE OF INDIANA:-.' ION COUNTY MY COMMISSION EXPIREBC .-.- NOVEMBER 8. 2016 3,215.00 ARCHITECT'S CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on bn -site observations and the data comprising 0.00 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. $ 3,215.00 6,079.00 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 (Attach explan Application ARCHIT nd if amount certified differs from the amount applied. Initial all figures on this ltatior Sheet that are changed to conform with the amount certified) $ 3 ,215.4V- the C By: I 'V Date: /2. ZZ.�rl� 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 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 taw 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 Th merican Institute of Architects' legal counsel, copyright @aia.org. Director of Redevelopment / 604911 7 *MA Document G7O2TM- 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 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 A201. 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 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 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 documelnt. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of th { firm or entity should be attached. • j m 7 2 � M 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 (ill 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._...._J OAIA Document G703" 1992 Continuation Sheet In3.111 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: ARCHITECT'S PROJECT NO: 11/30/2010 11/30/2010 1036 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 1 M Fee 9,294.00 3,215.00 3,215.01 34.'9 6,079.10 • .TT• . •• 111.111111 . CAUTION: You should sign an original AIA Contract Document, on which this text appears in'RED. An original assures that change will not be obscured. AIA Document G70311' — 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 State of Indiana, County of Marion. SS: X Partial I XI Payment to Follow Christi Minars, being duly sworn, states that she is the Controller 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, Service Package, 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 Three Thousand Two Hundred Fifteen & 00 /100 Dollars ($ 3,215.00 [ ] 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) uthuri ed Representative) Title Controller WITNESS MY HAND AND NOTARIAL SEAL, this 22nd day of December, 2010. Notary Public: Printed Name: Andrea M. Roell State of Indiana County of Marion My Commission Expires Novcnber 8, 2016 ANOTARY UBLIC SEAL STATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER B. 2016