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HomeMy WebLinkAboutDIVERSIFIED PAINTING COMPANY- 002584- 1/18/2012 CARMEL REDEVELOPMENT COMMISSION 002584 Diversified Painting Company Check: 2584 1661 Expo Lane Date: 1/18/2012 Indianapolis, IN 46214 Vendor: DIVERSII Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 19 53 8,405.00 8,405.00 0.00 0.00 8,405.00 App 19 on painting for.P7 8,405.00 8,405.00 0:00 0:00 8,405.00 • .. THE KEY TO DOCUMENT,SECURITY•HEAT ACTIVATED THUMB PRINT•ADDITIONAL SECURITY FEATURES INCLUDED SEE BACK FOR DETAILS'''. ( S6 c'b .Carmel Redevelopment.Commission 30 West Main-Street REGIONS 00'2584 ® Suite 220 20-1i217740 OiSTRtG) Carmel; IN 46032 - - 2584 , DATE, AMOUNT 1/18/201 ***********2 8,405.00 PAY THE SUM OF'EIGHT-THOUSAND FOUR HUNDRED FIVE DOLLARS AND NO CENTS:'`***************** TO THE ORDER of Diversified Painting Company 1661 ExpoLane U _gyp SENS'L Indianapolis, IN 46214 �, m S 11600 2 584ii' 1:0 740 14 2 1 31: 008 7 504 1 1 Lil' CARMEL REDEVELOPMENT COMMISSION 002584 Diversified Painting Company Check: 2584 1661 Expo Lane Date: 1/18/2012 Indianapolis, IN 46214 Vendor: DIVERSI1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 19 53 8,405.00 8,405.00 0.00 0.00 8,405.00 App 19 on painting for P7 8,405.00 8,405.00 0.00 0.00 8,405.00 • • 11-52 COMPUTEREASE FORMS DIVISION(877)577-5791- T-37228 "C . 53 . '616' _ . . . . . „... ... . . . . . .. . . . . ' - , . Ap lication and Certificate for Payment Construction°Manager-AdviserEdition ;: TO OWNER`. . •- .._. PROJECT . . APPLICATION NO:- . He - . Distribution to:• Carmel Redevelopment'Commission PARCEL 7A:Regional Performing Arts Center - . - . One:Civic Square:: Iinterior:Finish Pecker a P5 :PERIOD-TO OWNER ❑.•S 12!•Carmel IN;46032 •� ,,Bid Pack#5160;Painting :. CONSTRUCTION MANAGER . 30/11: ONSIRU AN G FROM CON-R Painting'Company VIA:CONSTRUCTiGN MANAGER:- CONTRACT.DATE: . Febuary 24,2009 ARCHITECT ❑ t6BTExpo Lane CSO Architects PROJECT NOS: ••./. 2695 / - CONTRACTOR -O ,Indiana olis,IN•46214 p `; 280 E.96th Street,Suite 100 VIA ARCHITECT: . Indianapolis,IN 46240 FIELD 17 Bid Pack 5160;Painting CONTRACT FOR: 0 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge.information and Application is made for payment,as shown below,in connection with the Contract 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 Continuation Sheet,ALA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner. and that current 1.ORIGINAL CONTRACT SUM $_2,100,090_90— payment shown herein is now due. , 2.Net change by Change Orders $--1�63L3,03_ CONTRACTOR: D.P.Corinc. 3.CONTRACT SUM TO DATE(Line i ±2)'• S 2,118,635.03 By: -- .'`Af 2 �� State of. s 12y Ofz814 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 2,118,635.03 INDIANA /. 1 �-�m°� ' 5.RETAINAGE: County of: Boone 7" • Thomas E. Hill ..,' 4 Notary Public State of Indiana a. _ °l:of Completed or Subscribed and sworn to before --- Boone County (Column D+Eon 07031 S - me this day of 12/30/ 1 pjres Nov 8,2017 b. c of Stored Material Notary Public: Thomas E Hill l (Column F on G703) S - My Commission expires: 11/0R12Q 7/' )`dl '`-' �� Total Retainagc(Lines 5a+Sb or Total in Column l of G703). .s CERTIFICATE FOR PAYMENT In accordance with the Contract Documents. based on on-site observations and the data composing 6.TOTAL EARNED LESS RETAINAGE $ 2,118,635.03 this application.the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge.information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 2 110.910 in accordance with Uie Contract Documents.and the Contractor is entitled to payment of the AMOUNT (-Line 6 from prior Certificate) CERTIFIED. D. 8.CURRENT PAYMENT DUE S 8,405.00 AMOUNT CERTIFIED S . gs.gas'•00 9:BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs f'r it t/('. nouns applied.burial all figures on this Application and on /I f�•ontinualion She rent are cban'ed to conform with the amount certified.)• (Line 3 less line 6) S — 0— CONST CTIO ir'j' - n/ _ By: �•1.A:i� ?_:.d.,4ia mil ! _ - Date: / jO ii ' ADDITIONS I DEDUCTIONS r %� • • ` CHANGE ORDER SUMMARY ARC II�/'. / -��� f Toterl changes approved in previous months by Owner . $ $ By_ Date: /61/SP r2,... Total approved this Month $ $ This Certificate is net negotiable. The AMOUNT CERTIFIED is payable only to•the Contractor TOTALS $ - $ - named herein. Issuanci,-,-payment and acceptance of payment are without prejudice to any rights of . — Nl f CHANGES by Change Order $ the Owner or Contactor 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. _ AtA Document G702/CMr'"a -1992.Copyright w 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 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 AlA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyright @aia.org. qi o - 7 Document 0 - 19. 92 page; Continuation Sheet. ALA D .ua erit CI702'.APF'LICAHON AND:CERTIF IC A I ION FM:P_'\l NIE T. APPLICATION NO. co.r*`i�1 ni Co -1 siL c r ific t cr.t_eta,tic.9. APPLICATION DATE: 19 =.. ltr Rti,ti;0,-)1,..'0,1,,v.. u niirr it ',Well I.)the tC trest doll o.'. 40907 i�sE.ColnTr'I ,C.o�1t.:..,1;w..e.P,aii3n.. rer ins'e.or line.trirz t r't.a n1 PERIOD TO' 1 L,')' 12/30/2011 ARCHITECT'S PROJECT NO. t A _.. }l -= - - C - D I 1- - F II- I :I - -" I " - - \\ORx CO MPLE t r'1� 1 -. � I --, tiIAT.R CA L S Ti) q r 3>I A\CT. NCI! D1:LIS; ( PRi sl-NT:v COMP!FTFD n r IJ T� t E =ROM REV1O S. I �� 1- A E`:I i D'.-SCN.iP17i�V Or\�?Oi2!C sTtiRLL," � A!�nSTURI%t � r21AlsLL / VALUE " APPLICATDO,ti, 1 B-,F?'I:>Ti iC=C-j I 11N M1 Nr. iNOTIN TO )vIE R A 1) 1 il+L.) D OR L L. (D+E'+1) 4 tC Lo -� I Bonds 73,500.00 I 73,500.00 I 73,500.00 100% 0.00 7.350.00 '2 Moblilization 5,000.00 5,000.00 0.00 5,000.00 100% ! 0.00 500.00 3 Insurance/Ilazcom/Safety 4,000.00 4,000.00 I 4,000.00 100% 0.00 400.00 4 Submittals 4,800.00 4,800.00 4,800.00 " 100% 0.0 480.00 .? 09-72-00;WALLCOVERING I Labor 18,750.00 18,750.00 I 0.00 18,750.00". { 100% I 0.00 1,875.00 I Material 37,000.00 37,000.00 0.00 i 37,000.00 100% 0.00 3,700 00 l, 09-84-00;ACOUSTICAL I I WALL PANELS Labor 51,500.00 51,500.00 0.00 51,500.00 100% 0.00 5,150.00 Material � 480,000.00 . 480,000.00 0.00 0.00 480,000.00 100% 0.00 48,000.00 i' 09-91-00;PAINTING ! i BASE MECII Labor 36,680.00 36.680.00 I 0.00 36,680.00 100% 0.00 3,668 00 1 BASE MECII Material 9,000.00 9,000.00 0.00 j 9,000.00 1 100% 0.00 900.00 BASE ELECT LABOR 10,080.00 10,080.00 0.00 1 10,080.00 100% 0.00 1,008 00 BASE ELECT MATER 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 INT CONST BASE LAB 10,880.00 10,880.00 0.00 10,880.00 100% 0.00 1,088 00 I 1 INT CONST BASE MAT , I 2,500.00 2,500.00 I 0.00 2,500.00 i 100% I 0.00 250.00 PLEM LABOR 8,480.00 8,480.00 0.00 l i 8,480.00 100% I 0.00 848.00 I PLEM MATERAIL 2,500.00 2,500".00 0.00 2,500.00 100% I ' 0.00 250.00 CON HALL N WALL LABOR CON HALL N WALL MATERIAL . 27,500 .0 27,500. 00 0.00 I 0.00. .27,500.00 100% 0.00 2,750.00 i CON HALL N DOME LABOR 45,920.00 45920.00 0.00 I 45,920.00' 100% I 0.00 4,592.00 I CON HALL N DOME MATERIAL 30,000.00 30,000.00 0.00 0.00 30,000.00 100% 0.00 3,000.00 I CON HALL BALY WALL LAB j 122,240.00 122,240.00 0.00 122,240.00 100% 0.00 12,224.00 CON HALL BALY WALL MAT 44,000.00 44,000.00 0.00 0.00 44,000.00 100% 0.00 . 4,400.00 -SiS8-T81'AG RAGLS-1- i-47095,05096-'---I-47995,95000- --1---- -5.00 I ---0.00 1-171393950:00 22.U0 0.00 109,595.00 I , AL'TION:You st:asld sign an original.4":A Contract Oocxtn ant,an which this text appears in 11E0 A,tt original assures that changes will not be obscured. AIA Document G703°' -1992.Copyright R 1963 1965.1966,1967.1970,1978,1963 and?992 by roe Americas II-sten:a of Archilects.All rights reserved.WARNING Tnls A:A'a Document Is-protectee by U.S.Copyright Law and late+national Tis ties.Unasrihorized rep:ndi.e,h.:r or distrib!lion ut this Ale Duet;ment:o an;portion at ii,.rasy result to severe civil end criminal penalties,and will be prosecr iad to toe.11PAimurr.extent possible under the tae;.P..rrchasers are permuted to reproduce ten(10,copies of this duccment when completed To report copyright viol-altars of AIA Contract Documents,e-mail The American lostituto of Architects legal counsel.copyrighll 1eis.orrl. € AIA Document 7 - 1 - Continuation Sheet page 2 ,AIA Docl,rueni %102,APPLICATION:1 ND C ER.`11T=ICAT1O\:FOR PAS CIE\?' APPLICATION NO: cont<:,ing C.!1,z ct,A s s gre9:-7...'!115:..u,?i.s fltacbcd. I.n tart cns brl- n,ut t : e stated to t.'1 t rat Si do i,r APPLICATION PERIOD TO: DATE. Use t_or.i;:r:r?c�1 i::,,tuat_ .+here gar:lul..re}nn.tFe 1r 1.ne.lte;nS may'atllily. � 19 • C T'S PROJECT r 0907 U t �_... D ` T . IAr� c, R. 17 y11 -- 1 CNITE OJECT NO:t _■ A ( -i WORK r;O::.I'LL ITD t \1A FalAl S J 11,1-‘1 9 BAL tC:CE. GILL UI.:D PRCSLN1LY I :;O'`PT rTED n}t',t\}Ot 1 ITLM DF.SCRIPTInN,OI WOR? I FROM PRE OLD a I IRED AND a I731,D U (It \ AR1ti5I F 1 AT IT.. \P711< A IO:v ,;1.J P} OD 7i-C' FI.SII I(NoT(O-L-) R (C-G) DO Li (D I+P1 T CON HALL DOME LABOR i 100,260.00 100,260.00 0.00 100,260.00 100% I� 0.00 10,026.00 CON HALL DOME MATERAIL 55,000.00 I 55,000.00 0.00 0.00 55,000.00 � 100%. I 0.00 5,500.00 CON HALL S WALL LABOR i 45,120,00 45,120.00 0.00 45,120.00 100% I 0.00 4,512.00 CON HALL S WALL MATERIAL ! 29,500.00 29,500.00 0.00 0.00 29,500.00 100% 0.00 2,950.00 CON HALL S DOME LABOR 45,920.00 45,920.00 0.00 I 45,920.00 100% 0.00 4,592.00 CON HALL S DOME MATERIAL 25,000.00 I 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 N TIER LABOR 28,000.00 28,000.00 0.00 28,000.00 ( 100% 0.00 2,800.00 N TIER MATERIAL 6,500,00 6,500-00 0.00 6,500.00 100% 0.00 650.00 N ORCH LABOR 28,000.00 28,000.00 0.00 j 28,000.00 100% 0.00 2,800.00 N ORCH MATERIAL 6,500.00 6,500.00 0.00 6,500.00 1 100% 0.00 650.00 W LOBE LABOR 28,800.00 i 28,800.00 0.00 28,800.00 100% 0.00 2,880 00 W LOBB MATERAIL 6,500,00 6,500.00 0.00 6,500.00 100% 0.00 650,00 W LOBB CELL LABOR 28,000,00 28,000.00 0.00 ! 28,000.00 100% 0.00 I 2,800.00 W LOBB CELL MTERAIL 6,500.00 6,500.00 I 0.00 1 6,500.00 100% 0.00 � 650.00 E LOBBY LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800 00 E LOBBY MATERIAL 7,000.00 7000.00 0.00 7,000.00 100% 0.00 i 700.00 E LOBBY CELL LABOR 38,800.00 38,800.00 0.00 38,800.00 � 100% 0.00 3,880 00 E LOBBY MATERIAL 9,300.00 9,300.00 j 0.00 I 9;300.00 1 100% 0.00 930.00 S LOBE LABOR 45,000.00 45,000.00 0:00 45,000.00 100% 0.00 4,500.00 S LOBE MATERIAL 11,000,00 11,000.00 0.00 I 11,000.00 100% .. 0.00 1,100.00 SW ORCH LOB,STR WAL LAB 48,000.00 48,000.00 0.00 48,000.00 100%. 0.00 4,800 00 SW ORCH LOB,STR WAL MAT 8,700.00 8,700.00 I 0.00 8,700.00. 100% 0.00 870.00 SE ORCH LOB,STR WAL LAB 48,000,00 48,000.00 0.00 I 48,000.00 100% I 0.00 4,800 00 SE ORCH LOB,STR WAL MAT 8,700.00 8,700.00 0.00 i 8,700.00 100% 0.00 870.00 BAL L/H LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 BAL L/H MATERAIL 6,800.00 6,800.00- 0.00 6,800.00 100% 0.00 680.00 II , INT-.C.OI`LAT-T_IC I AROR 1-17,0^0,00 17,000.00------ 0:00--! 1?000:00-- 0%�1.- --0-00 - 1,/00.00 SUB TOTAL PAGE 2 0.00.--_--� 1 I �_ 743900.OSL__._.I_.Z43,900OLL.___t_. 000-----743;900:00- 2-7-00 I 0.00 -74301200 -- CAt_I;!O/' you should sign,an original AEA Contract Document,on which this tc-xt appee:s in RED.An origirai assures that changes will not be obscured. AIA Document G7031"`.-1992.Copyright©1963,1965,1966 1967,1970,1978,19133 aric 1992 by The A.nlercer:Institute of Architects.All rights reserved.WARNING:Thin AIA Document is protected by(I S.Copyrtgtit _aw and ieternational Tr,aces.Unauthorized reproduction or distribution of this AEA'eDo:umer:t,c■any portion of it may result in severe ciy;t ar,d cr,±ninal pena'.ties,and mlii be prosecuted to the ataximurn extent 9ossibtc order the law.Purchasers are permitted to reproduce ten(10)copies of this document whoa completed.To repot copyright v.olaoons of AIA Contract Documents,e-mail The Arnedcan Institute of Architects'legal counsel.copynghtr?aia.urg. _ ,g, . A a -„, a e Document � 3 .° 1 . Continuation Sheet page 3 AIA L ui„zucni 0702,APPLICATION AND CE TP_I('_TION- OR 1'A't i's WW1 APPLICATION NO: ,-etal. log Cr otr9 tot ;s -nod cert d ion.. +t_ cued APPLICATION DATE 19 II,taha,_t,c,n..hearc,v.amt.-nit,a, sitter,:0 the:11r.,' ar doll . Ise('ilc-.ir 1 nit( ontracts where e tnable re e,naue t;. line ite;uc ilia,ar+ply. P` 2130/2 �RIOD TO• 40907 ARCHI t FCT'S PROJECT NO:1 011 l- A I is . . ,C I.... I) c. F. I._.._ H ----�-.. r i ■ I WORK(On1Pt..LIT U { IN.IATELIA s 101.E ?FnaL 13 A',I I Y COkt-i'I� I) I I I RE I ALFA,_±. SCSIID -'-) , :O\1 PRc\7OL� • 1- '� 7'J I 1 1 H':2! +)1 SL.�TiT,C)�OF WORK. VA!UF, i Alp, f( Al.lp\ I ;I I'.PERIOD SI+)RED \�') U sd7,) (i;--Cy TI":TSH ;If `AR.Ahi v..1. NCTI\- T�D4iT. rA1Er D 16i ! O _ I (t'-Co , Cl OR ID+ .+., TNT CON ATTIC MATERIAL i 3,500.00 3,500.00 0.00 I 3,500.00 I 100% 0.00 350.00 J 09-97-23;STAINS,SEALERS BASEMENT Labor I 7,700.00 7,700.00 0.00 7,700.00 100% 0.00 770.00 BASEMENT Material 5,800.00 I 5,800.00 0.00 5,800.00 100% 0.00 580.0 BASE MECH RM LABOR 2,500.00 2,500.00 0.00 2,500.00 I 100% 0.00 250.00 BASE MECH RM MATER 1,500.00 1,500.00 I 0.00 1,500.0 100% 0.00 150.00 PLEM LABOR 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 PLEM MATERAIL 1,500.00 l 1,500.00 0.00 1,500.00 100% 0.00 150.00 CON HALL BALCONY LAB 4,500.00 4,500.00 0.00 4,500.00 100% 0.00 450.00 CON HALL ORCH LOB,ST,R LAB MAT 7,500.00 7,500.00 0.00 j 7,500.00 100% 0.00 750.0 I 9 ORCH LOB,STR MAT 3,000.00 3,000.00 0.00 3,000.00 100% 0.00 300.00 DAILY CLEAN UP 15,000.00 15,000.00 0.00 15,000.00 1 100% 0.00 1,500 00 10 GENERAL ALLOWANCE 100,000.00 100,000.00 0.00 ' 100,000.00 100% I 0.00 10,000.00 15,000 00 15,000 00 0 00 15,000 00 100% 0 00 1,500 oo lIl SUPPLIES 12 LABOR ALLOWANCE 75,000.00 75,000.00 0.00 75,000.00 100% 0.00 7,500.00 13 CAD ALLOWANCE 5,000.00 5,000.00 0.00 5,000.00 100% 0.0 500.00 14 PROGRESS MEETINGS 5,200.00 5,200.00 0.00 i 5,200.00 100% 0.0 520.00 15 CLOSE-OUTS .. � 3,450.00 3,450.00 0.00 3,450.00. 100% 0.00 � 345.00 CO I. DED ALLOWANCE i . -55,000.00 -55.000.00 0.00 I -55,000.00 . 100% 0.00 -5,50.00 CO 2/3 -550.00 -550.00 0.00 -550.00 0% 0.00 ! -55.00 I CO 4 31.921.00 31,921.00 0.00 0.00 31,921.00 ' 100% 0.00 i 3,192.10 CO 5 BOX TIER WALL f 6,965.31 6,965.31 0.00 0.00 6,965.31 100% 0.00 696.53 CO 6 CLEAR COAT I 12,704.72 12,704.72 0.00 0.00 12,704.72 100% 0:00 1,270 47 CO 7 BLACK PANEL 14,189.00 14,189.00 0.00 0.00 14189.00 100% 0.00 1,418.90 CO 8 FINAL 8,405-00 8,405.00 0.00 8,405.00 100% 0.00 840.50 SUBTOTAL PAGE _-- -`-. 270,380 8,405 00 40 . 278,785 1 27,878 50 SlB_TTAL.PAGF_1 1,095,9_50.00 1.095,950-00- 0E -0 �95 1 -H 00 G:00- lUy,5y5.U0 ------ SUB TOTAL PAGE 2 743,900.00 743,900.00 0.00 0.00 I 743,900.00 1 27.00 0.00 74,390 00 I i C A/JTION G13-91SDSEOiriStri an ortainal AA C;o2gt1816350A8nent,e2.,14':0010n1s text'apr8r408ffri.An cricina ffures t;'V e,agtwili not pi:6Ass..0 0.00 211,863 50 AIA Document G703.1-1992 Copyright©1983 1966,1966.1967,1970.1978,1913 enc.1992 by The American InstihI:e oI Auchiteols.All rights reserved.WARNING.This AIA +Document Is erotected ny U.S.Copyright +.3+:r and lrternationa!Treaties.Unauthorized teproduct!on(:•dlstr faction at this A.l.A5 0ocetm�nt.or r ny portion,of it they re,euit in severe elm!e Kd criminal psr,altie.s,and wilt ha prosecuted to th«ma',mum 5?Te nt pnss•ble m oder the Iaen.Purchasers are permitted to reproduce ten 1W conies of;his document when completed.To report copynghi violations of AlA Contract Ducumenta,e-mail The American Instil Ito of Arch tecis Inga! counsel,copyligl:t @ata.ora. D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 18 STATE: INDIANA FINAL XX PARTIAL _ PAYMENT TO FOLLOW COUNTY OF:MARION _kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: Parcel 7A;Regional Performing Arts Center located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of: . EIGHT THOUSAND FOUR HUNDRED FIVE AND 00/100----•------- —-- DOLLARS: $ 8,405.00 receipt of which is hereby acknowledged or XXXX the payment of which has been promised as the sole consideration of the 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 there is due from the contractor the sum of: DOLLARS: $ - receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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, in any, and further certified that no other party has any claim or right to lien on account of any work performed or material furnished to undersigned for said project and within the scope of this affidavit and wavier. _Diversified Painting Co. Inc._By: \ President Keen M. Bldime WITNESS MY HAND AND NOTARIAL SEAL THIS: 12/30/11 MY COMMISSION EXPIRES: 11-08-2017 �,7 �y COUNTY OF RESIDENCE: Boone t NOTARY Thom-s Hill Thomas E. H��I •. Notary Public State of Indiana Boone County Expires Nov S,2017 • Prescribed by State Board of Accounts City Form No.201(Rev.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 Purchase Order No. /4e/ L< Terms //U y62/47/ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /2/304/ /9 /%DQ /4 or ,e4 ;2 �� 727 F 5` 1i0 • Total S'� I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I ha me in accordance with IC 5-11-10-1.6. ( ^ 18 , 201E - reasurer VOUCHER NO. WARRANT NO. /� ALLOWED 20 / 97/ i7y CO � I Ex�v IN SUM OF /6 C'-,' ,7� 6 , �-' Y 2/z- $ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or Yq(o3'dl bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except // 20 /Z Signature Executive Director Title Cost distribution ledger classification if claim paid motor vehicle highway fund Carmel Redevelopment Commission