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Home My WebLink AboutKEYSTONE CONSTRUCTION- 002621- 1/18/2012 CARMEL REDEVELOPMENT COMMISSION 0 0 2 6 2 1 t Keystone Construction Check: 2621 47 South PA St, 10th Floor Date: 1/18/2012 Indianapolis, IN 46204 Vendor: KEYSTON1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 101012 10,242.94 10,242.94 0.00 0.00 10,242.94 P47 Streetscape thru 12/31 • 10,242.94 . 1.0,242.94 0.00 0.00 10242.94 • , I °,"y.':'THE KEY,TODOCUMENT;_SECURIVEHEAT ACTIVATEATHUMB PRINT:jAODITIONAIEsE CURIVLF,EATURESINCE:UOED1SEE BAGK;FOR DETAIL'S p,BSDBnti Carmel Redevelopment Commission ' t 30 West Main Street REGIONS 002621 Suite 220 20-141/zrao ; ;.1117 ;Carrnel;.IN 46032 ` rirwict c. 2621, . _ DATE " .AMOUNT 1/18/2012 " ..,"`•'10,242'94 PAY THE SUM OF T EN THOUSAND TWO HUNDRED FORTY TWO DOLLARS AND 94 CENTS-"""'"'"""""• TO THE _ _ . ORDER ■ OF Keyystone:Corstruction..- . 47 South PA St, 10th Floor • Indianapolis, IN 46204 • 2 . . ._-__�_____ Ae 000262 &II' 1:0740 £42131: 0013 7504kkLu• �� CARMEL REDEVELOPMENT COMMISSION 002621. Keystone Construction Check: 2621 47 South PA St, 10th Floor Date: 1/18/2012 Indianapolis, IN 46204 Vendor: KEYSTON1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 101012 10,242.94 10,242.94 0.00 0.00 10,242.94 P47 Streetscape thru 12/31 10,242.94 10,242.94 0.00 0.00 10,242.94 • //II 611-52 COMPUTEREASEFORMS DIVISION{B77)577-5791 T37229 . le l; APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 PAGE 1 OF PAGES TO OWNER: PROJECT: Parcel 47 Streetscape APPLICATION NO: 101012 Distribution to: City of Carmel Cannel,Indiana - ,]OWNER ARCHITECT PERIOD TO: 12/31/11 ]CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: • Keystone Construction Corp. 47 S. Pennsylvania Street PROJECT NOS: 1010 Indianapolis, IN 46204 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract information end belief the Work covered by this Application for Payment has been Continuation Sheet,ALA Document G703,is attached. 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. I. ORIGINAL CONTRACT SUM $ 137,370.00 2. Net change by Change Orders $ 34,942.84 CONTRACT•'. /� KEYSTO(!E CO" RUCTION CORPORATION 3. CONTRACT SUM TO DATE(Line I+2) $ 172,312.84 11J/l D 4. TOTAL COMPLETED&STORED TO $ 172,312.84 DATE (Column G on G703) By: —. ''''.t Date: 12/16/2011 5. RETAINAGE: / V ' a. %of Completed Work S State of:Ind County of:Marion (Column D+Eon G703) _ Subscnhed an vvornto before this 0:2t sa y 1• December,20 b. 10 %of Stored Material 5 0.00 Notary Public: - . V • ANDREA M. ROELL (Column F on G703) My Commissio expires: NOTARY PUBLIC Total Retainage(Lines 5a+56 or SEAL Total in Column)of 6703) $ 0.00 A-CHITECT'S CERTIFICATE FOR PAY ENT n1F.Rlcu!mu I' 6. TOTAL EARNED LESS RETAINAGE $ 172,312.84 In accordance with the Contract Documents,based on on-site observatio s and the data MY COIMMISSIOPI EXPIRES (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to th best of the NOVEMBER 6,2016 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 162.069.90 the quality of the Work is in accordance with the Contract Documents,and the Contractor �/� 8. CURRENT PAYMENT DUE 5 10,242.94 is entitled to payment of the AMOUNT CERTIFIED. •9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED S (df 2464 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation he•mount certified diersfrom the amount applied Initial all figures on this Total changes approved Application an ontinu on Sheet that are changed to conform with the amount certified) in previous months by Owner 524,699.90 ARCHITEC 62L"---""--Total approved this Month $10,242.94 By: '�C.�') Date: (Z123/fI TOTALS 534,942.84 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Lontractor named herein.Issuance,payment and acceptance of payment are without NET CHANGES by Change Order $34,942.84 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 0702 APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION AIA -01992 THE AMERICAN INSTITUTE OF ARCHITECTS 1735 NEWYORK AYE.,N.W,WASHINGTON,DC 21500-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. CONTINUATION SHEET A/A DOCUMENT G703 EASE 2OF2PAG_5 ALA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 101012 Contractor's signed certification is attached. APPLICATION DATE: 12/31/2011 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 12/31/2011 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: 1010 A B C D i E F G H f ITEM — DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (C-C) TO FINIS!i (IF VARIABLE APPLICATION STORED AND STORED (C-C) RATE) (D+E) (h'OT TN TO DATE D OR E) {D+E+F) _ I General Conditions& CM Fee $137,370.00 $137,370.00 _ S]37,370.00 100% $0.00 2 Gilbrahar Change Order4l $3,500.00 $3,500.00 $3,500.00 100%_ 50.00 3 Gilbraltar Change Order#2 $11,694.10 SI1,694.10 $11,694.10 100% $0.00 4 Gilbraltar Change Order#3 -S2,000,00 -$2,000.00 -$2,000.00_ 100% $0.00 5 Gilbraltar Change Order#4 53,238.60 $3,238.60 $3,238.60 100% $0.00 6 Gilbraltar Change Order#5 $5,997.20 $5,997.20 $5,997.20 100% $0.00 7 Gilbraltar Change Order#6 $0.00 50.00 #DIV/0t $0.00 8 Gilbrattar Change Order#7 5896.00 $896.00 $896.00 100% 50.00 9 Gilbraltar Change Order 48 $657.10 $657.10 5657.10 100% $0.00 _ 10 _Gilbraltar Change Order N9 -$1,060.00 -$1,060.00 -$1,060.00 100% $0.00 _ 11 Gilbraltar Change Order#10 $1,776.90 $1,776.90 $1,776.90 100°! $0.00 Gen Conditions& CM Fee to date as 12 of 12/16/2011 =$172,312.84 $10,242.94 $10,242.94 510,242.94 100% $0.00 • PAGE TOTAL $172,312.84 $172,312.84 $0.00 50.00 $172,312.84 100% $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 • fl Final X Partial X Payment to Follow State of Indiana, Count'of Marion. SS: Bob Crowder, being (luly sworn, states that she 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 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 Ten Thousand Two Hundred Forty Two& 94/100 Dollars ( S 10 242.94 l I 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 )• I I 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 I..ien 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 LA13OR 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 undersi ed for said . .leer, and within the scope of this affidavit and waiver. Keystone Construction Corporation By 41,4 4 / Title Project Director (Company) (A'Primer. :cnlnlivc) WITNESS M ' HAND AND NOTA A I. SEAL, t is 16th day of December, 2011. Noun) I'ublie' 9 I Stale of India c ■ Ntarion ANDREA M. ROELL Printed Name Andrei\7. Itnell NOTARY°pl RACIias101 i xpirei N wemhrr R 2rlln SEAL STATE OF INDIANA MARION COUNTY MY COMMISSION EXPIRES: NOVEMBER 8,2016 Prescribed by Slate Bead of Accounts C1N Foim No.201 (Peer,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. Payee Keys/one Ce eucf et) _ Purchase Order No. 9 7 S. / '11/I %vR. ,'� S fiPe� Terms /Zit h a0o l s /49 `4,20 / Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2.A 1/4/ /0,0,2 r 7 5 t—J.,. r q� /O 2V2.,9% i.; Total /o, 211'2 .95� I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I . .'-�=d same ' accordance r. with IC 5-11-10-1.6. at 119 20s7--- -•- reasurer