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223628 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367103 Page 1 of 1 ONE CIVIC SQUARE RENASCENT INC CARMEL, INDIANA 46032 935 W TROY AVE CHECK AMOUNT: $30,624.97 INDIANAPOLIS IN 46225 CHECK NUMBER: 223628 CHECK DATE: 8127/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 211 4462300 2 30, 624 . 97 DRAINAGE IMPROVMTS CONSTRUCTION PROJECT INVOICE DATE: July 31, 2013 COMPANY NAME: Renascent, Inc. AND ADDRESS 935 West Troy Avenue Indianapolis, Indiana 46032 TELEPHONE NO.: (317)-783-1500 FAX NO.: (317)-783-4860 PROJECT NAME: Nash Building Utility Relocation PROJECT NO.: Project No. 13-03 INVOICE NO.: 2 TOTAL EARNINGS TO DATE: $ 146,347.00 MINUS 10% RETAINAGE: $ 14,634.70 TOTAL EARNED MINUS RETAINAGE: $ 131,712.30 MINUS PREVIOUS PAYMENTS: $ 1 , . TOTAL AMOUNT DUE: 301624.97 Tiffa ' Boo Construction Inspector City of Carmel APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 2 TO OWNER: PROJECT: Project 13-03 APPLICATION NO: 298-A112 Distribution to: The City of Carmel Nash Building Utility Relocation X OWNER One Civic Square PO 25266 ARCHITECT Carmel,IN 46032 PERIOD TO: 7/20/2013 CONTRACTOR FROM CONTRACTOR: ARCHITECT_ : Renascent,Inc. 935 West Troy Avenue Telephone: 317.783.1500 PROJECT NO: Indianapolis,Indiana 46225 Fax Number: 317.783.4860 CONTRACT DATE: 4/10/2013 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 and belief the Work co%cred by this Application for Payment has been Continuation Sheet,AIA Document G703, is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which p.c iVs Certificates for Payment were issued and payments received from the Owner,at tha4,cuxzjch1'r jmymcntjshown herein is now due. 1. ORIGINAL CONTRACT SUM $ 157,777.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: NOta SARAH C. HALL 3. CONTRACT SUM TO DATE(Line 1 +2) $ 157,777.00 ! rY Public,State of Indt 4. TOTAL COMPLETED&STORED TO $ 146,347.00 J "„' My Com SEAL ./ / 3 DATE (Column G on G703) By: ►►►iSSiC19,&Plres/' l 5. RETAINAGE: a. 10 %of Completed Work $ 14,634.70 State of: NDIANA County of: MARION�` ^ (Column D+L'• on G703) — Subscribed and sworn t before me this / day of /3 b. 0 %of Stored Material $ 0.00 Notary Public: f% (Column F on G703) My Commission expires: Total Retainage(Lines 5a+5b or ,� 8 Total in Column I of G703) $ 14,634.70 ARCHITECT'S CERTIFICATE F R PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 131,712.30 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 101,087.33 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 30,624.97 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH INCLUDING RETAINAGE 26,064.70 (Line 3 less Line 6) AMOUNT CERTIFIED. . . . . . . . . .. (Attach explanation if amount certified differs from the amount applied. Inilial all figures on this Total changes approved Application and ation Sheet that are changed to conform lvith the amount certified.) in previous months by O�Jner $0.0(1 $0.00 ARCI IITECT: Total approved this Monti i $0.01) $0.00 By: Date: TOTALS $0.0.1 $0.00 This Ccrtifice. The AMOUNT CERT IFIED is payable only to the Contractor named herein. issuance,payment and acceptance ofIlaymcnt are without N t UlAAM LN ny uIlange Vrder fU.UU preluolce to any rights of the Uwner or Contractor unoer mis Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 2 APPLICATION NO: 298-AP2 Contractor's signed certification is attached. APPLICATION DATE: 7/20/2013 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 7/20/2013 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: . Nash BUilding Utility Relocation; PO 925266 A B C D E F G H Cost DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS 'TOTAL % BALANCE RETAINAGE Code VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G-C) TO FINISH (1F VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 3000 Storm Sewer 69,000.00 55,200.00 13,800.00 69,000.00 100% 0.00 6,900.00 3800 Water 50,000.00 42,500.00 7,500.00 50,000.00 100% 0.00 5,000.00 4000 Jersey Barriers 14,000.00 12,600.00 1,400.00 14,000.00 100% 0.00 1,400.00 1500 Demo Existing Storm and Water 6,000.00 0.00 6,000.00 6,000.00 100% 0.00 600.00 4000 New Sidewalk and curb 12,700.00 0.00 1,270.00 1,270.00 10% 11,430.00 127.00 1400 Erosion Control 4,077.00 1,019.25 3,057.75 4,077.00 100% 0.00 407.70 9250 Mob and Demob 2,000.00 1,000.00 1,000.00 2,000.00 100% 0.00 200.00 GRAND TOTALS 157,777.00 112,319.25 34,027.75 0.00 146,347.00 1 92.76%1 11,430.00 1 14,634.70 AIA DOCUMENT G703•CONTINUATION SHEET FOR G702- 1992 EDITION AIA-®1992 - G703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D.C.20006-5292 RECEIPT, WAIVER, AND RELEASE OF LIEN RIGHTS Partial❑X Final Upon receipt of check in paymt of the below application, the undersigned acknowledges the payment and satisfaction in full for all labor, services and materials furnished or supplied up to and including the date: 7/20/2013 Application 298-AP2 relating to use, to be used, or contributing to the construction, addition, or development of the work or improvements concerning that certain real property, commonly known as: Project No: Renascent Project#298 Project Name: Nash Building Utility Relocation; Project 13-03 PO 25266 . Location: Carmel, IN Owner or General Contractor: City of Carmel The undersigned hereby expressly waives, releases, and discharges the real property described above and the Owner thereof, of and from any and all claims for mechanics' liens and rights to any such claim which the undersigned has or may have for labor, services, or materials or otherwise in connection with said work of improvements and every part thereof up to and including the date hereof and does hereby waive and release any and all right that the undersigned now has or may have to levy or place any mechanics' lien, attachment lien, judgment lien, or execution lien on or against the real property described above for any existing indebtedness of the Owner of said real property to the undersigned. Subcontractor/Supplier: Renascent, Inc. Amount: $30,624.97 Signature: Name (printed) Linda Campbell Title: President Date: 7/18/2013 WITNESS by hand and official seal, this Day of I Notary Public: Name (printed): S fk t F C � � - - r Not SARAN C A County of Residence: �o2t ;,J ;o; arY Public,States << c mmi C. a 1 Commission expires: 3. - � �� " My Co ss/nEX rr oftnd'an P es_4*2019 Renascent,Inc.dba Campbell Land Development dba Construction Waste 935 W.Troy Ave. Indianapolis,IN 46225 317.783.1500 Fax 317.293.7108 Accounting @callCW.com 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. Pa-y�eee Purchase Order No. I VV� Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1 -h b2 %� Total o 1 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5-11-10-1.6. 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF $ ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# Iq hereby certify that the attached invoice(s), or ia 1524.blll(s) Is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except g ufd Cost distribution ledger classification if Title claim paid motor vehicle highway fund