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HomeMy WebLinkAboutKEYSTONE CONSTRUCTION- 002827- 4/19/2012 CARMEL REDEVELOPMENT COMMISSION 0 0 2 8 2 7 Keystone Construction Check: 2827 G O L 1 47 South PA St, 10th Floor Data 4/19/2012 Indianapolis, IN 46204 Vendor: KEYSTON1 Prior Invoice PA. Num. Invoice Amt Balance Retention Discount Amt. Paid 101008-2 12,964.47 12,964.47 0.00 0.00 9,317.51 P47 Streetscape 12,964.47. 12,964.47 • . 0.00 '0.00 9,317:51 • 1 I • it- 7. THEKEYiTO'DOCUMENTSECURITIY,:IHEAT•'ACTIVATED;THUMe.PRINTJADDITIONAL SECURIT,Y,F,EATURES INCLUDED:SEE BACK FOR DETAILS-,,,P-:4, ll •�e Carmel Redevelopment C_ommission ]p�] f n 30 West Main Street' _�' REGIONS 002827 8 2 7 •t `Suite 220 ;-..20-1:12.1 nao �, ` """ Carmel; IN 46032 r " 2827 . DATE " AMOUNT 4/19/2012 ***?*t"`9,317 51 PAY THE SUM OF NINE THOUSAND THREE HUNDRED SEVENTEEN•DOLLARS AND 51 CENTS"""""` ' TO THE ,. , ( •ORDER .. -OF o Keystone•Canstructiont., 47 South PA St, 10th Floor ' Indianapolis, IN 46204 , _ lP- , , :,, M ,gyp ' 1. 11'00282711' 1:0740142131: 0087501, Li311' r CARMEL REDEVELOPMENT COMMISSION 0 0 2 E 2 7 Keystone Construction Check:• 2827 47 South PA St, 10th Floor Date: 4/19/2012 Indianapolis, IN 46204 Vendor: KEYSTON1 Prior Invoice P.Q. Num. Invoice Amt Balance Retention Diacount Ami. Paid 101008-2 12,964.47 12,964.47 0.00 0.00 9,317:51 P47 Streetscape • 12,964.47 12,964.47 0.00 • 0.00 9,317.51 • • I • • 111-52 COMPUTEflEASE FORMS DIVISION(a77)577.5791 1.37228 ail APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1OF3pAn=_s TO OWNER: PROJECT: Parcel 47 Streetscape APPLICATION NO: 101008 Distribution to: OWNER Cannel,Indiana City of Carmel I Carmel, PERIOD TO: 7/31111 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: - Keystone Construction Corp. 1010 E 47 S.Pennsylvania Street PROJECT NOS: Indianapolis,IN 46204 CONTRACT DATE: CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge, information end belief the Work covered by this Application for Payment has been Apollonian is Sheet,for Document as shaven below,in connection with Ott Contract. that all amounts have been paid b Continuation Sheet,AIA Docnmcnt 6703,is attached. completed Contractor it accordance for for which Contract Documents, P Y the Contractor[oT 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 $ 137,370.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: KEYSTO STRUCTION CORPORATION 3. CONTRACT SUM TO DATE(Line I A 2) $ 137,310.00 , 4. TOTAL COMPLETED&STORED TO S 137,223'04 r pm,un 71701 I DATE (Column C on G703) By: t� ANDREA M. ROiLL 5. RETAMAGE: State of: [ndl..a County o€Marion NOTARY PUBLIC a. n o+Completed 03) $ _ Subscribed and to, re�>Si lb4 ESt ay of August,201.1 SEAL (Column D+Eon 0703) 0 06 Notary Public: L SWIE OF INDIANA b. 10 %of Stored Material S MARION I DIANA C:c uTm F on 0703) ' My Commission expires' MY COMMISSION EXPIRES: Total Retainage(Lines 5a+5b or OVFMFro A Co14 Total in Column 1 of G703) $ 0.6b ARCHITECT'S CERTIFICATE FOA PAY MtN $ 137,223.04 In accordance with the Contract Documents,based on on-site observations and the data 6. TOTAL( ie 4 Less L LESS taTAINAGE comprising the application,the Architect certifies to the Owner that to the host of the (Line 4 Lass Line 5 Total) Architect's knowledge,information and belief the Work has progressed as indicated, 7. LESS AM NT PREVIOUS from CERTIFICATES FOR quality and the Contractor PAYMENT(Line 6 from prior Certificate) S 124,258.57 the ualiry of the Work is in accordance with the Contract Documents, 8. CURRENT PAYMENT DUE $ 12,964.47 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING REIAINAGE $ 14696 AMOUNT CERTIFIED S ]`1ti�Jfa{-4-"J (Line 3 less Line 63 CFIANGE.ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation J• a .t terrified dillies from the amount applied.Initial alfigures on this Total changes approved Application and a 'e Co inaction at that are changed to conform with the amount certified) in previous months by Owner ARCHITEC : y/ /r ,,J By: L}'1i�---. Date: JVjs/Jf Total approved this Month ! TOTALS $0.00 50.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payment eonly to the Contractor named RUM.I59UanGe,payment and acceptance of payment are without NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract NA COCOMEN(Gia2 APPLICATION AND DERTIF?RATION FOR PAYMEar'1092 EDITION'AA-01981 THE NERCAN INSTITUTE OF ARCHTECTS,1735 NEW YORK AVE,NW,WASHINGTON,DO 200e69209 Users may obtain validation of this document by requesting a completed AlA Document 0401 -Certification of Document's Authenticity from the Licensee, 3J C3L"k‘ R6 akrtd) - ditl 9.) ))7 lt CONTINUATION SHEET AL4 DOCUMENT G7O3 moo 2OF2 PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 101008 Contractor's signed certification is attached. APPLICATION DATE: 8/18/2011 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 7/31/2011 Use Column Ion Contracts where variable retainage for line items may apply. PROJECT NO: 1010 A B C D [ E F G H ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE FLL-TAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED co,C) TO FINISH bp VARIABLE APPLICATION STORED AND STORED (C•0) RATE) (D+E) (NOT IN TO DATE D OR 5) (D+E+F) I General Conditions&CM Fee $137,370.00 $124,258.57 $12,964.41 $137,223.04 100% $146.96 PAGE TOTAL $137,370.00 $124,258.57 $0.00 $12,964.47 $137,223.04 100% 5146.96 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 n Final I XI Partial © Payment to Follow State of Indiana,County of Marion. SS: Bob Crowder, being duly sworn, states that he is the Project director 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 Streeiscape, 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 Twelve Thousand Nine Hundred Sixty Four&471100 Dollars (S 12,964.47 [ ]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 (S )- [ j 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 pro'- t, and within the scope of this affidavit and waiver. A Keystone Construction Corporation By ,,i _ itle Project Director (Company) (Autho ' •resell "live) WITNESS C IMF�Ht'AND/{{AND �`J AL SEAL,this 18th day of August,20I 1. Noitry tote of hid Tara County of Marion Printed Name:rr And=M. Rucll AN NOTARY DREAY 1ilissfon Expires lluvenilxr 8.2016 SEAL SLATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER B,201E Prea9nbed by Stale Doartl of Accounts City Fenn No.201 Isev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL 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. KV L (( (� Payee eys I on e ( h34rlAc1I0`I Purchase Order No. • Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7°�I If 10(0084- remj'Inder p pay App 8 9,30. 5) • ' Total 317 51 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct`• _ -• .me in accor- c, dance with IC 5-11-10-1.6. y '-1$ , 20 tZ- CteYk-Treasurer