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Legacy TIF draw 21 102015 tg FALCON NEST II , LLC Oil 1j- October 19,2015 Diana L.Cordray Carmel Clerk Treasurer (317)571-2414 Via E-mail: DCordrayCc carmel.in.gov; csheeksacarmel,in.gov; john,alexander(cD.regions.com; l 1ake.taylorestartiinancial.com Re: Legacy TIF—Draw#21 Dear Diana: Attached please find the Legacy TIF draw for the current month. If everything is in order, please sign the Request for Disbursement Form and forward this draw to the Trustee. Also attached is a budget sheet that will track all costs to date. Please let me know if you have any questions. Sincerely, //''' Rajai Zu t .,,. .:...:.!.,. "_. Mernber. of ALT,:LLC. , i 1356 BEVERLY RD SUITE 250 • MCLEAN, VA •22101 PHONE: (703) 893-7233 • FAX: (703) 893-5267 STATEMENT NO. 21 REQUESTING DISBURSEMENT OF FUNDS FROM PROJECT FUND PURSUANT TO SECTION 4.3 OF THE TRUST INDENTURE BETWEEN THE CITY OF CARMEL, INDIANA AND REGIONS BANK,AS TRUS 1 E,E Pursuant to Section 4.3 of the Trust Indenture (the "Indenture") dated as of December 1, 2013, between the City of Carmel, Indiana (the "Issuer") and Regions Bank (the "Trustee"), the undersigned, as the Authorized Representative (as defined in the Indenture) of the Company, hereby requests and authorizes the Trustee, as depository of the Project Fund created by and as defined in the Indenture to pay to the Company or to the person(s) listed on the Disbursement Schedule attached hereto out of the moneys on deposit in the Project Fund, the aggregate sum of $80,116.41 to pay such person(s) or to reimburse the Company in full, as indicated in the Disbursement Schedule, for advances,payments and expenditures made by it in connection with the items listed in the Disbursement Schedule. In connection with the foregoing request and authorization, the undersigned hereby certifies that: (a) the costs of an aggregate amount set forth in this written request have been made or incurred and were necessary for the construction of the Project and were made or incurred in accordance with the construction contracts, plans and specifications, or purchase contracts therefor then in effect or that the amounts set forth in such written request are for allowable Costs of Construction of the Project; (b) the amount paid or to be paid, as set forth in this written request, is reasonable and represents a part of the amount payable for the Costs of Construction of the Project all in accordance with the cost budget; and that such payment was not paid in advance of the time, if any, fixed for payment and was made in accordance with the terms of any contracts applicable thereto and in accordance with usual and customary practice under existing conditions; (c) no part of said costs was included in any written request previously Illg with the Trustee under the provjsions hereof and •f fir� 7 ?, .�',y:.ti� 3t�}4'. 1._ P .i:•i.t.o( �- 'rJ'1^r "1...1,'.. .gin » tIK (d) such costs are appropriate for the expenditure of proceeds of the Bonds under the Act. This statement and all exhibits hereto, including the Disbursement Schedule, shall be conclusive evidence of the facts and statements set forth herein and shall constitute full warrant, protection and authority to the Trustee for its actions taken pursuant hereto; and This statement constitutes the approval of the Company of each disbursement hereby requested and authorized. IN WITNESS WHEREOF, th_authorized repress tative of the Company has set his hand as of the 2' day of C�l/f ,20 1 . Pursuant to Section 4.3 of the Indenture the foregoing disbursement request is hereby FALCON NEST II LLC, an Indiana limited liability company By: SALT, LLC, Member By: Rajai Zumot, Memb= of SALT, LLC approved: CI Y OF CARME INDIANA Diana L.Cordray,IAMC,CI-Treasurer 2 Legacy TIF Draw Application No.: 21 Application Date: 19-Oct-15 Prepared By: Kathy Tekulve Telephone No: (317) 863-2052 i I Amount: $ 80,116.41 Reference or Total Retainage Invoice i Work j This Invoice Code Contractor 1 Payee Number Completed Period Amount ! 3 Stoepelwerth&Assocs., Inc. 199971 $ 4,470.00 $ - $ 4,470.00 $ 4,470.00 ' $ - $ 4,470.00 4 `Weihe Construction 4538 ' $ 2,000.00 $ (200.00); $ 1,800.00 Weihe Construction 4518 : $ 3,000.00 $ (300.00); $ 2,700.00 $ 5,000.00 $ (500.00) $ 4,500.00 6 ;Weihe Construction i 4519 • $ - $ 2,422.56 $ 2,422.56 $ - $ 2,422.56 i $ 2,422.56 i 8 ;Weihe Construction 4519 $ - $ 1,000.00 $ 1,000.00 Conco Curbs& Paving, LLC App 1 $ 28,163.70 $ (2,816.37) $ 25,347.33 $ 28,163.70 $ (1,816.37), $ 26,347.33 9 -Globe Asphalt Paving Co., Inc. , App 1 $ 31,060.00 , $ (3,106,00); $ 27,954.00 $ 31,060.00 $ (3,106.00 i $ 27,954.00 10 :Manley Finish Grading 6203 ! $ 8,833.00 ! $ - _ $ 8,833.00 $ 8,833.00 $ - : $ 8,833.00 Management Fees 1103 $ 5,814.50 $ (224.99)1 $ 5,589.52 , - $ 5,814.50 ' $ (224.99)! $ 5,589.52 i Total 1 $ 83,341.20 ' $ (3,224.80)' $ 80,116.41 ( 0 k I I i i 1 loll li I PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC INVOICE 1103 October 19, 2015 Zumot Real Estate Management, Inc. rzumot@zumot.net Falcon Nest II, LLC 1356 Beverly Road Suite 300 McLean, VA 22101 Re: Development Service Fees-The Legacy TIF Draw Summary of October 2015 Construction Costs: Stoeppelwerth &Assocs., Inc. $ 4,470.00 Weihe Construction, Inc. $ 7,922.56 Conco Curbs & Paving, LLC $ 25,347.33 Globe Asphalt Paving Co., Inc. $ 27,954.00 Manley Finish Grading $ 8,833.00 Total Monthly Costs $ 74,526.89 Development Fee @ 7.5% $ 5,589.52 Please remit payment to: Platinum Properties Management Company, LLC 9757 Westpoint Drive,Ste 600 Indianapolis, IN 46256 9757 Westpoint Drive,Suite 600, Indianapolis, IN 46256 (317) 818-2900 ` ` b S T 0 E P P E L W E R T H oft: 317.849.5935 7965 East 106th Street \:-.4.......0s fax: 317.849.5942 Fishers,Indiana 46038-2505 ALWAYS ON www.stoeppelwerth.com FALCON NEST II, LLC Invoice number 199971 C/O PLATINUM PROPERTIES, LLC Date 10/12/2015 9757 WESTPOINT DRIVE SUITE 600 Project 55115PLA-CC2 OVERLOOK AT INDIANAPOLIS,IN 46256 LEGACY,SEC 2-CHERRY CREEK BOULEVARD Professional Services for the Period:September 2015 Contract Percent Total Prior Current Description Amount Complete Billed Billed Billed Final Design Construction Document Preparation 11,950.00 100.00 11,950.00 11,950.00 0.00 Project Management I Permitting 1,500.00 100.00 1,500.00 1,500.00 0.00 Coordination with Williams Creek Consulting 1,000.00 100.00 1,000.00 1,000.00 0.00 Micro Pool Design&Construction Plans 1,950.00 100.00 1,950.00 1,950.00 0.00 Subtotal 16,400.00 100.00 16,400.00 16,400.00 0.00 Construction Services Construction Staking 9,000.00 100.00 9,000.00 5,400.00 3,600.00 Subtotal 9,000.00 100.00 9,000.00 5,400.00 3,600.00 Completion Certifications Ditch in center of Boulevard 1,300.00 0.00 0.00 0.00 0.00 Storm Sewers 1,800.00 0.00 0.00 0.00 0.00 Sanitary Sewers(Including Lateral &Clean Out 170.00 0.00 0.00 0.00 0.00 Locations) Streets 1,900.00 0.00 0.00 0.00 0.00 Digital GIS Submittal 950.00 0.00 0.00 0.00 0.00 Subtotal 6,120.00 0.00 0.00 0.00 0.00 Monumentation Street Centerline Monuments 2,040.00 0.00 0.00 0.00 0.00 Concrete Monuments 1,500.00 0.00 0.00 0.00 0.00 Subtotal 3,540.00 0.00 0.00 0.00 0.00 Additional Services 0.00 0.00 2,150.00 1,280.00 870.00 '3RD RE-CHECK OF CURB HUBS ALONG CC BLVD-$870 Total 35,060.00 78.58 27,550.00 23,080.00 4,470.00 /�("IT/e(0)1141. ( 4( ` ;-; ;5(J.- Invoice total j 4 4. 70.00 Aging Summary - Invoice Number Invoice Date Outstanding Current Over 30 Over 60 Over 90 Over 120 199971 10/12/2015 4,470.00 4,470.00 i y v i'7 Total 4,470.00 4,470.00 0.00 0.00 0.00 O.00 f FALCON NEST II,LLC Invoice number 199971 Proje 554, 5PtA-6C2 OVERLOOK AT LEGACY,SEC 2-CHERRY CREEK BOULEVARD Date 10/12/2015 If any portion of this invoice is in dispute, it is the client's responsibility to notify Stoeppelwerth&Associates,Inc.in writing within thirty (30)calendar days from the date of the invoice. The client remains responsible for paying the undisputed portion of the invoice by the due date. Any invoices unpaid after 30 days shall incur a finance charge of one-and-one-half(1%)percent of the invoiced amount per month, excepting any disputed portion of the invoiced amount. Payment thereafter shall be applied first to accrued interest and then to the unpaid principal amount. F 1 I I k 1 1 1 i APPLICATION FOR PAYMENT PROJECT NAME:The Overlook at The Legacy Section 2 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4538 CONTACT: CONTACT:Tim Walter CONTACT: 15215 Stony Creek Way APPLICATION DATE: 9/3012015 ADDRESS: 1356 Beverly Road.Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:#REF! RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY: El Phone: Phone: 317)818.2900.590-8817(M) Phone:317-776-2966(o) 776-3050(f) DATE: 9/10/2015M=D-M=D-1-141_A B 1 Ci Cu r D _ E F _ G H=E+F+G l=H/D J K L=J+K _ M=D- • N Project Cost Work Description Unit Scheduled Work Completed _ Materials Total Completed l % Previous Retainago Total BAL.TO Net Pay Code Code Price Value Previous This Stored And stored To Date Camel. Retainage This Period Retained PAY This Month The Overlook at The Legacy Section 2 On-site construction Lgy P2 4c Stripping Topsoil NA $4,267.00 $4,267.00 $4,267.00 100% $426.70 $426.70 $426.70 Lgy P2 4d Prelim Erosion Control NA $18,697.00 $18,697.00 $18,697.00 100% $1,869.70 $1,869.70 $1,869.70 Lgy P2 4e Mass Excvation and Mounding NA $45,118.00 $45,118.00 $45,118.00 100% $4,511.80 $4,511.80 $4,511.80 Lgy P2 4h Soil Stabilization NA $14,623.00 $14,623.00 $14,623.00 100% $1,462.30 $1,462.30 $1,462.30 Lgy P2 4g Site&Finish Grading NA $15,620.00 $10,620.00 $2,000.00 $12,620.00 81% $1,062.00 $200.00 $1,262.00 $4,262.00 $1,8 .00 Lgy P2 5c Sanitary Sewer Laterals NA $10,095.84 $10,095.84 $10,095.84 100% $1,009.58 $1,009.58 $1,009.58 t Lgy P2 6b Subsurface Drains NA $31,452.50 $31.452.50 $31,452.50 100% $3,145.25 $3,145.25 $3,145.25 Lgy P2 7b Water Mains NA $111,797.95 $110,798.00 $110,798.00 99% $11,079.80 $11,079.80 $12,079.75 Lgy P2 7e Water Service Laterals NA $10,894.80 $10,894.80 $10,894.80 100% $1,089.48 $1,089.48 $1,089.48 a ClherrylCteek13Ivd1Constructro4Jit'1 `-• Lgy TIF 4a Demolition NA $10,555.00 $10,555.00 $10,555.00 10o% $1,055.50 $1,055.50 $1,055.50 Lgy TIF 4c Skipping Topsoil NA $5,428.00 $5,428.00 $5,428.00 100% $542.80 $542.80 $542.80 Lgy TIF 4e Mass Excvation and Mounding NA $17,733.00 $17,733.00 $17,733.00 100% $1,773.30 $1,773.30 S1,773.30 Lgy TIF 4h Soil Stabilization(roadway) NA $18,935.00 $18,935.00 $18,935.00 100% $1,893.50 $1,893.50 $1,893.50 Lgy TIF 4h Soil Stabilization(multi-use path) NA $10,284.00 S10,284.00 $10,284.00 100% $1,028.40 $1,028.40 $1,028.40 f'=LaTlF=4g)l Site&Finish Grading NA $25,411.00 $20,411.00 $2,000.00 $22,411.00 88% $2,041.10 $200.00 $2,241.10 $5,241.10r,:08-60'.00M:1 Lgy TIF 6a Storm Sewers NA $148,171.95 $148,171.95 $148,171.95 100% $14,817.20 $14,817.20 $14,817.20 Lgy TIF 6b Subsurface Drains NA $3,895.00 $3,895.00 $3,895.00 100% $389.50 $389.50 $389.50 Change Orders Lgy P2 5b CO#1-Raise sanitary MH NA $1,245.29 $1,245.29 $1,245.29 100% $124.53 $124.53 $124.53 Lgy P2 6b CO#1-Additional 8"SSD NA $1,722.00 $1,722.00 $1,722.00 100% $172.20 $172.20 $172.20 Lgy P2 7b CO#1-Add 12"GV&Elbow NA $3,298.50 $3,298.50 $3,298.50 100% $329.85 $329.85 $329.85 Lgy TIF 4e CO#2-Undercut CCBlvd NA $11,470.00 $11,470.00 $11,470.00 100% $1,147.00 $1,147.00 $1,147.00 Lgy P2 7b CO#3-Ex sewer Lat Conflict NA $5,553.50 $5,553.50 $5,553.50 100% $555.35 $555.35 $555.35 Lgy P2 14h CO#4-Remove trash from site NA $912.83 $912.83 $912.83 100% $91.28 $91.28 $91.28 Lgy P2 6a CO#5-Storm Sewer NA $3,505.40 $3,505.40 $3,505.40 100% $350.54 $350.54 $350.54 $ 4.86 Lgy P2 5b CO#5-Sanitary Sewer NA $746.03 $746.03 $746.03 100% $74.60 $74.60 $74.60 $6 1.43 TOTAL $531,432.59 $516,181.21 $8,251.43 $524,432.64 99% $51,618.12 $825.14 $52,443.26 $59,443.21 7,4 6.29 J • .:� ` A A Document G702T - 1992 _ Application and Cvsfacatte for Payment `. TO OWNER: - ` PROJECT: APPLICATIQ Ss Plat' F4ckies Overlook at the Lceacv Sec 2 a J�IefllblttlQA to: P,975 slpoint Drive • PERIpIrk. OWNER( ❑ . 'Suite 600 - L'O FOR: ARCHITECT f:1FROM CE0A�'riarteld@RTiis„IN 46256 VIA ARCHITECT: N7RACT DATE: CONTRACTOR ❑ Weihe Construction,Inc. • - 15215 Stony Creek Way PROJECTNOSR0t511-01 , ( FIELD 0 Noblesville,IN 46060 . • OTHER 0 CONTRACTOR'S APPLICATION FOR PAYMENT The tuntersigned Contntotor certifies that to:r;e best of tho'Caattantar's knowledge,Information Application is made for payment,as shown below,in connection with the Contract - • and belief the Work covered by this Application for Payment has been completed In accotdaiue App ca ion is dfor Continuation e Sheet,is w,in c t • with dm Contract its.that all antotmee have been paid by the Contractor for Work for C which previous Cada for Payment were iisucd and payments received from the Owner,and I.ORIGINAL CONTRACT SUM S 502,979.04 that Current payment shown herein Is now due. 2,NET CHANGE BY CHANGE ORDERS S 28,453.55 OliT'1-.R Weihe onstruction C. �j 3.CONTRACT SUM TO DATE(.lne!erI) . _. .. S 531,432.59 r• /l;. A....41.4.....4.04 . /4- Data /�/Iiz'/I�✓ 4.TOTAL COMPLETED&STOEE11Y0 DATE(Colsenn G on 0703) S 524,432.64 State of I•d lana 0 5.RETAINAGE Com,oLHamilton ; a. %4f mpin Work ma ` to tl 4 �ty,T„^ D 15 Of i ond0703)alS 52,443.26 ed an b. .1,14 of Stored Material Pro-NULL/ - (G4rArmnFon G703) S Notary Public:-1.N\ / ;;ro- UL 1 MyTotal Retainage(tines Ja+Sb,or Total to Cohann!if G703)...... S 52,443.26 commis n 1 O!7 O 1 5 • 6.TOTAL EARNED LESS RETAINAGE S 471,989.38 ARCHITECT`S CERTIFICATE FOR PAYMENT ' (Liu 4 mlrma.LAtc S Total) In accordance with the Contract Documents,hued on on sato observations and the data comprising 7.LESS PREVIOUS.CERTIFICATES FOR PAYMENT $ 464,563.09 this application,the Architect unifies to the Owner that to the beat of the Architect's knowledge, (Etna 6from prior CeisfJimteJ inform and belief the Work hag progressed as Indicated,the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to gamut of the 8.CURRENT PAYMENT DUE S 7,426.29 l AMOUNT CERTIFIED. j/ .'S /; 9.BALANCE TO FINISH,INCLUDING RETAINAdli . AMOUNT CER1IF1EB.......----.......-.......1.—.----.. S tet' L "i (Lire 3 maubLine 6) .. S 59,443.2 I (Autmb oxpianat1on graawwn csrttfied d1 s front tith mount applied Initial all figures on this f Application and on the Continuation pats rani are changed m cot jbrm with the msromtr CHATSGBORDER SU AIg.Y. ADDITIONS DEDUCTIONS ARCHITECT: r Total changes app !Q pf6vlous months by Owner S S t3y: ..---• Dem: v i y Total appy'' lrmonth ,S -S - Ws Certificate ;notable.me Amyx'.Amyx'.CERTIFIED is payable only to tractor v,-- D TOTAL S S named herd payment and acceptance afpayment are without peajudlco to tights of NET OUNCES.by Change Order S the Owner or runder MU Contract. CAUTION;You shoutd sign an orlgnal AIA Contract Document,on which tats text appear in RED.An original assures that changes will not bo obeeurad. Al'.Document 0702'"-1aa2.Copyright 01853,ton.1085,1971,1978,1983 and 1992 by The A eerie n!nstuts of Ard.QeatzAtl rights resarvad,WARNIWO:Thin ALA°Document Is protected by U.S,Copyright Law ono International Treaties.Unauthorised reproduction or dtsatbutlen of this AtA°Doauwsnt,or any portion OIL may reauttlo•cyan.crit and eimlzel penatnes,and wilt he prosecuted t°ilte auodmum eltmat euseibla under the taw.Purchasers ere parnSha to reproduce ten(10)copies or INS dum obarttrrtt°n cmuup rep tsd.To ort wpyright vloteBoru or AIA Core=Documents,s.rtiaa The Amartasn Inetibtte at"r'''' "" d couneet.coppightsigala.erg• CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OP PAGES ' ACA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,Is attached. APPIICATION,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: • Use Column I on 9ontracts where variable retainage for line items may apply. „ ARCHITECT'S PROJECT NO:4538 9/30/2015 A ' B C D E P . G H . 1 • WORK COMPLETED MATERIALS TOTAL gsgmy COMPLETED 23151BALANCE RETAINAGE NO. DESCRIPTION OP WORK ITEM SCHwon EDULED PROMTO PREVIOUS THIS PERIOD P STORED 1.ND STORED TO DATE (G ' C) FINISH OF RAST) (D +ID - DOR E) (D+E+P) - (C-G) 0 -00 Stripping Topsoil 4,267.00 4,267.00 4,267.00 00.00 426.70 0•-00 Prelim Erosion Control 18,697.00 18,697.00 18,697.00 '00.00 1,869.70 Cit 00 Mass Excavation&Mounding 45,118.00 45,118.00 45,118.00 '00.00 4,511.80 I. 00 Soil Stabilization 14,623.00 14,623.00 14,623.00 00.00 1,462.30 0•-00 Site&Finish Grading 15,620.00 10,620.00 2,000.00 - 12,620.00 80.79 3,000.00 1262.00 0--00 Sanitary Sewer Laterals 10,095.84 10,095.84 10,095.84 00.00 1,009.58 0'-00 Subsurface Drains 31,452.50 31,452.50 31,452.50 00.00 3,14525 0: I fatermains 111,797.95 110,798.00 110,798.00 99.11 999.95 11,079.80 0: 00aterService Laterals 10,894.80 10,894.80 10,894.80 '00.00 1,089.48 11-00 Water Creek Blvd Construction 1 -00 emolition 10,555.00 10,555.00 10,555.00 '00.00 t,055.50 1'-00 Stripping Topsoil 5,428.00 5,428.00 1 5,428.00 '00.00 542.80 11 00 Mass Excavation&Mounding 17,733.00 17,733.00 17,733.00 '00.00 1,773.30. 1' 00 S oil Stabilization(Roadway) 18,935.00 18,935.00 18,935.00 '00.00 1,893.50 1•-00 :oil stabilization(path) 10,284.00 10,284.00 . 10,284.00 '00.00 1,028.40 1.00 Site&Finish'Grading 25,411.00 20,411.00 2,000.00 22,5+11.00 88.19 3,000.00 2,241.10 1'-00 Storm Sewers 148,171.95 148,171.95 148,171.95 '00.00 14,817.20 1:-00 Subsurface Drains 3,895.00 3,895.00 3,895.00 '00.00 ,.,389.50 C0-01 Change Order#1 6,265.79 6,265.79 6265.79 '00.60 626.58 00-02 Change Order#2 11,470.00 11,470.00 11,470.00 '00.00 1,147.00 Cu-03 Change Order#3 5,553.50 5,553.50 5,553.50 '00.00 555.35 C0-04 Change Order#4 912.83 912.83 - 912.83 '00.00 91.28 CO S C hangs:0,4.'115 a175113 . 4,28143• - 4,264.43 '4)0,00. - ' 426.11 . • �/.�4_A1>WM9rT 0703•CONntausiON SHEET 992ID o•®1992•efoOAH/1nOF AICQ{fT6 I' YOrtx iii;,, 'fN�Ara ,o HIPPG7011 D.C.25006-5292• ��Wlatee tr& sna wi0 wt>jeGthe vbta udorc 8.68 6,999.95 5 982 CAUTION:Abu should use an original AIA document which hne this caution printed In red.An original mourns that ohenges will not be obscured as may occur when documents era reproduced. APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN Subcontractor or Supplier Name Weihe Construction,Inc. Subcontractor or Supplier Address Noblesville,IN 46060 Phone (317)776-2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) Overlook at the Legacy Sec 2 Owner Platinum Properties Application Number 4538 Date 10/5/2015 Period From 9/1/2015 To 9/30/2015 Original Contract Sum $ 502,979.04 Net Change by Approved Change Orders $ 28,453.55 Contract Sum to Date $ 531,432.59 Total In-Place Work Completed $ 524,432.64 Value of Material Stored on Site $ - Total Earned to Date $ 524,432.64 Retained Percentage $ 52,443.26 Total Earned Less Retainage $ 471,989.38 Less Previous Certificates for Payment.. $ 464,563.09 Current Payment Due $ 7,426.29 The undersigned hereby certifies that the amount Earned and Due the Undersigned for all materials,supplies furnished,and labor and services of every nature performed by the Undersigned for the use on or in connection with the above named Project. 1) Has been paid in full as per shown(except Amount Due as listed below)through the above-mentioned pay period;and 2) The Undersigned hereby warrants that the premises of the above-named job cannot be made subject to any valid lien or claim by anyone who furnished materials,supplies, labor or services to the Undersigned for use in the above-named Project;and 3) The Undersigned hereby waives any and all claims of whatsoever kind or nature against the General Contract,and the Owner,and against the building(s),Improvements or Project,and the land on which same is located for any labor,materials,or supplies furnished or services performed through the above-mentioned pay period. This release Is given in order to induce payment In the Amount Due of$ $ 7,426.29 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes valid,enforceable and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by the Owner or Mortgagee of the Project. Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all Hens or rights to liens upon the premises,improvements thereto,or monies due in connection therewith, with respect to monies due the Undersigned for previous payment requests in the total sum of $ 7,426.29 ,the receipt and sufficiency of which is hereby acknowledge. Dated this 12th day of October 2015 Weih Construction,Inc. sup. State of Indiana ) ay: ( or r r J ) SS: (Undersig ^ l/ County of Hamilton ) Title: HR/Accounting •t-scant Before me,a Notary Public in and for said County and State,this 12th day of October 2015, personally appeared igroberiy 6uriesun known to me to be the HR/Acct Assistant of the Undersigned who acknowledge the execution of the foregoing for and on behalf of the Undersigned. WITNESS my hand and Notarial Seal. Dated this 12th day of October 2015 My commission expires: Oct.2015 1,111 ) $V\LAJ.3. LNotaryc My county of residence is: Hamilton Michelle Garcia (Printed) } APPLICATION FOR PAYMENT PROJECT NAME The Meadows at The Legacy Section 3 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4518 CONTACT: CONTACT:Tim Walter CONTACT:Alan Small APPLICATION DATE: 9/30/2015 ADDRESS: 1356 Beverly Road.Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:15215 Stony Creek Way RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY:EEF Phone: Phone: 317)818-2900,590-88171M) Phone:317-776-2966(o),776-3050 f j DATE: 10/14/2015 I A B Ci Cs D _ E Ij F G H=E+F+G I=H/D J K L=J+K M=D-H+L N Project Cost Work Description Unit Scheduled _ Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay— Code Code Price Value Previous Thls Stored And stored To Date_ Gomel. Retainage This Period Retained PAY This Month The Meadows at The Legacy Section 3 On-site construction Lgy 03 4c Stripping Topsoil NA $5,179.00 $5,179.00 $5,179.00 100% Lgy 03 4d Prelim Erosion Control NA $9,181.00 $9,181.00 $9,181.00 100% Lgy 03 4e Mass Excvation and Mounding NA $41,544.27 $41,544.27 $41,544.27 t00% ($0.00) ($0.00) ($0.00) Lgy 03 4h Soil Stabilization NA $19,442.50 $19,442.50 $19,442.50 100% Lgy 03 4g Site&Finish Grading NA $10,841.00 $10,841.00 $10,841.00 l00% $1,084.10 $1,084.10 $1,084.10 Lgy 03 5b Sanitary Sewer Mains NA $75,730.20 $75,730.20 $75,730.20 100% Lgy 03 5c Sanitary Sewer Laterals NA $32,895.00 $32,895.00 $32,895.00 100% Lgy 03 6a Storm Sewers NA $36,051.80 $36,051.80 $36,051.80 100% $3,605.18 $3,605.18 $3,605.18 Lgy 03 6b Subsurface Drains NA $50,532.00 $50,532.00 $50,532.00 t00% $5,053.20 $5,053.20 $5,053.20 Lgy 03 7b Water Mains NA $108,516.40 $108,516.40 $108,516.40 100% Lgy 03 7e Water Service Laterals NA $26,837.60 $26,837.60 $26,837.60 100% Lgy 03 8a Roll Curb and Gutter $7.00/If $22,344.00 $22,344.00 $22,344.00 loci Lgy 03 8b 5'Wheel Chair ramps $600/ea $1,200.00 $1,200.00 Lgy 03 Sb Common Area Sidewalk $3.50lsf $2,625.00 $2,825.00 Cherry Creek Blvd Constructic 04" qt.- Lgy 'qQ/Lgy TIF 4c Stripping Topsoil NA $3,184.00 $3,184.00 $3,184.00 100% Lgy TIFti 4e Mass Excvation and Mounding NA $8,641.00 $8,641.00 $8,641.00 100% Lgy TIF 4h Soil Stabilization NA $12,428.50 $12,428.50 $12,428.50 100% J Lgy TIF r4g +Site&Finish Grading NA $13,253.00 $9,253.00 $3,000.00 - $12,253.00 92% $925.30 $300.00 $1,225.30 $2,225.30 :$2,700.00 Lgy TIF 6a Storm Sewers NA $24,225.60 $24,225.60 $24,225.60 100% $2,422.56 $2,422.56'. $2,422.56 Lgy TIF 8a Chair Back Curb and Gutter $7.60/If $12,600.80 $10,000.00 $10,000.00 79% $1,000.00 $1,000.00 $3,600.80 Lgy TIF Sb Multi Use Path Wheel Chair Ran$1,100/es $4,400.00 $4,400.00 Lgy TIF Sb Common Area Sidewalk $3.50/sf $4,287.50 $4,287.50 CO#1 -Cherry Creek Blvd Lgy TIF 4h Multi-use Path Stabilization NA $4,360.00 $4,360.00 $4,360.00 100% CO#2-Conduit Crossings Lgy 03 6e Utility Conduits NA $11,017.50 $11,017.50 $11,017.50 100% CO#3-CC Blvd Spec Cond Lgy TIF 4i Subgrade Special Conditions NA $5,090.67 $5,090.67 $5,090.67 100% ($0.00) ($0.00) ($0.00) CO#4-Winter Protection Lgy TIF 8a CC Blvd-Curb concrete blanket $1.00/if $1,658.00 $1,658.00 $1,658.00 100% Lgy 03 8a Onsite-Curb Concrete Blankets $1.00/If $2,937.00 $2,937.00 $2,937.00 1o0% TOTAL $551,003.34 $531,890.04 - $3,000.00 $534,890.04 97% -$14,090.33 $300.00 $14,390.33 $30,503.63 527,00100b 4'.1 ,l,ls .w.41 p' \FLA A 3 el,t' Document 67:42 - 1992 Application and C rate for Payment ;; • TO OWNER:Platinum Pros-* PROJECT: Meadows r2 Leeacv Section 3 APPLiCATTQ� S'18 DiShillulion td' 9757 es(_poitit Drive PERIOI?�'FL ,r,.. OWNER 0 F.-Suite 6b0 ,gyp• `' X `" indlanapolis IN 46256 ,4n CT FOR: ARCHITECT 0 FROM COl3TRACTOR: Weihe Construction,Inc, VIA ARCHITECT: t:ONTRACT DATE: CONTRACTOR 0 15215 Stony Creek Way PROJECT NOS v."01422-01 ft FIELD ❑ Noblesville,IN 46060 OTHER q CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the-Contractor's knowledge,information Application is for payment,as shown is connection with the Contract • and belief the Work covered by this Application for Payment has been completed in accordance AIA Documentnismadede3or na s Sheet below,in co with the Contract Documents,that aU amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and 1.ORIGINAL CONTRACT SUM 3 525,940.17 thatcarrcntpayaneatshown herein is now due. 2.NET CHANGE BY CHANGE ORDERS S 25,063.1 7 . '•C IR: 'eih' ..strut ion,Inc. 9,/,30//�� 3.CONTRACT SUM TO DATE(Line I s:Z) S 551,003.34 'By:' 00 _ Date: 4.TOTAL COMPLETED&STOREDTO BATE(Column G on 0703) 5 535,890.04 State• nm i area 5.REMIAGE: County oriamilton a. %r4 I rEonttd Work me this Subscribed and sworn to ��/� �� 14,490.34 WP/..Ogre :::::(Colydr+nr'J7+Eon GT03J S me this Jam_ b. �} t of Stored Material , J_ k (Ghiumn F on G703) 3 Notary Public ,I + My commission expires: Total Refaivage(Lines S¢+Sb,or Toro(in Column!of G703) S 14,490.34 6.TOTAL EARNED LESS RETAINAGE S 521,399.70 ARCHITECT'S CERTIFICATE FOR PAYMENT • (Line 4 Infirm-Line S 7bta1) In accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT •, s , 518,699.70 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, iofbrmation and belief the Work has progressed as indicated,the quality of the Work is in (Line 6from prior Certificate) �� accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE `�(.. s 2 700.00 AMOUNT CER iLl'lbD. 9,BALANCE TO FINISH,INCLUDING RETAINAGE `o AMOUNT CERTIFIED «....1.__.._ S • (Line 3 minus Gine 6) .. S 29,603.64 (Attach etpiataiiotr ifamount certified differs fron3 the amount applied.Initial all figinr.s on this _ Application and on the Continuation Sheet that the changed to conform with the amount certified) CHANCE ORDER SUN1Y ADDITIONS DEDUCTIONS ARCHITECT: �; _Total changes apppiv itt pttiviols months by Owner S S By: Date: r' i Total a e$ tidtnibnth g S This Certificate Is:si$gt gotiable.The AMOUNT CERTIFIED is payable only to the Contactor �' TOTAL $ g mimed herein,IQBtxoc,payment and acceptance of payment are without prejudice to any rights of NET CI#ANGES by Chase Order S the Owner or Obehaetor under this Centrad CAUTION:You should sign an original AIA Contract Document,on which Vile text appears in RED.An arlginai assures that changes will not be obscured. AIA Document G702a•-1892.Copyright o 1953,1963,ices,1971,197B.1883 and 1902 by The American inaande of Architects.Alt rights reserved.WARNING:This Alp'Oocumant Is protected by U.S.Copyright Law and International Treaties.Unauthorized raproduetlon or distribution of this AEAe Document,or any portion of It.coy result In severe civil and criminal penalSee,and will be prosecuted to the maximum consort possible under the law.Purchasers aro pamIttod to rapreduce ton(10}copies of tide docurnent%Awm mmplated,To report cop1ri0M vlatatIons of AlA Contract Documents,e-mea The Arnoriart Institute reArtkkacte'legal =NMI,tanYeghI ete.org, CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PACE OP PACES , AIA Document G702,APPLICATION ANI)CERTIFICATE FOR PAYMENT APPLICATION NO.: containing Contractor's signed CertlRcatIon,is attached. APPLICATION,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: • Use Column Ion Contracts where variable retainage for line Items may apply. „ ARCHITECTS PROJECT NO.4518 9/30,2015 A ' r B 1 C D E F . G H . I WORK COMPLETED MATERIALS TOTAL 2C 14'11-UI ITHM PRESENTLY COMPLETED SCHEDULED BAA CE RETAINAGE DESCRIPTION OF WORK TO FROM PREVIOUS STORED AND STORED (IF VARIABLE) NO. VALUEAPPLICATION THIS PERIOD (NOT IN TO DATE (G +C) FINISH RATE) (D + H) D OR E) (D+E+F) • (C-G) 01-00 0 -Site 02-00 SI'pping Topsoil 5,179.00 5,179.00 5,179.00 1)0.00 0300 Pr-lim Erosion Control 9,181.00 9,181.00 9,181.00 100.00 04-00 ss Exc&Mounding 1 41,544.27 41,544.27 41,544.27 100.00 05.00 S.1 Stabilization 19,442.50 19,442.50 • 19,442.50 130.00 06-00 Si-&Finish Grading 1 10,841.00 10,841.00 10,841.00 130.00 1,084.10 07-00 S-nitary Sewer Mains 75,730.20 75,730.20 75,730.20 130.00 08-00 S-nitary Sewer Laterals 32,895.00 32,895.00 - 32,895.00 130.00 09-00 St.rm Sewers 36,051.80 36,051.80 36,051.80 100.00 3,605.18 10-00 S .surface Drains 50,532.00 50,532.00 50,532.00 1)0.00 5,053.20 11.00 W,termain 108,516.40 108,516.40 108,516.40 1)0.00 12-00 W'ter Service Lateral ' 26,837.60 26,837.60 26,837.60 1)0.00 13.00 R•II Curb and Gutter 22,344.00 22,344.00 22,344.00 100.00 14-00 5' heel Chair ramps 1200.00 1,200.00 15-00 C•mmonArea Sidewalk 2,625.00 - 2,625.00 16-00 C erryTree Btvd Construction 17-00 St-aping Topsoil 3,184.00 3,184.00 3,184.00 100.00 18- 0 M.as Exc&Mounding 8,641.00 8,641.00 8,641.00 100.00 19-00 S•I Stabilization 12,428.50 12,428.50 12,428.50 100.00 21:i-00 Sit &Finish Grading 13,253.00 10,253.00 3,000.00 13,253.00 100.00 1,325.30 21-30 St-rrn Sewer 24,225.60 24,225.60 24,225.60 100.00 2,422;56 22-30 C -ir Back Curb 8 Gutter 12,600.80 10,000.00 10,000.00 79.36 ' 2,600.80 1,000.00 23-30 M.Ili Use Path Wheel Ramns 4 400 00 . • . 4,100.00' 24-h0 C• mon Area Sidewalk I 4,287.50 4287.50 CO-31 LI e Path I4,360.00 4,360.004,360.00 100.00 -- ATA DOCUMENT 0703•CONTINUATION SH!BT FOR 0702•1971 ROmON•Ale •01992•THE AMERM AN BSRTtnZ OF ARCHITRCrs,1735 NEW YORK 1 iii:i. AVENUE.N.w,easimGION,De.200065292•WARNIN e Urnfeenaed photocopying violates Its,eep/dnM 1.115 mad will•r*legit the violator to legal prasamatron. G703-1992 Li,; CAUTION:'ibuahoutd use an original AIA document which has this caution printed fn rad.An original assures that changes will not be obscured as may occur when documents are reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) ` FACE OF PACES , AlA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,Is attached. APPLICATLON,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TC)F513 Use Column I on contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO5/30/2015 A ' B C D E F , G n 472-01 H ' I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED % I,O RETAINAGE NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS STORED AND STORED (IF VARIABLE) APPLICATION THIS PERIOD (NOT IN TO HATE (G y C) ' PINISH RATE) (D + E) DOR E) (D+E+P) • (C-G) i 1,017.50 11,017.50 11,017.50 100.00 CO 02 C nduit Crossings 5,090.67 100.00 1 CO-03 C erry Creek-Subgrede Prep 5,090.67 5,090.67 4,595.00 4,595.00 100.00 CO 04 C ncrete Blankets 4,595.00 -r • . AMA DOCUMENT GSM•CONTINUATION SHEET I+pR �199.292® etin• t� term E of ARCHITECH3SxB9t)aDr4YORx97.26 15,113.30 y0 + :,:.. ,ww,WASHINGTON,DC.20006-5292•Wl.•- t aa�nsed pl hs�wbre.U.S.eep/�Nmet will subtedt the motator to teal prosecution. 0703-1992 CAUTION:You should uae an original AIA document which hes thla caution printed fn red.An original assures that changes writ not be obscured ea may occur when documents are reproduced. APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN Subcontractor or Supplier Name Welhe Construction,Inc. Subcontractor or Supplier Address Noblesville,IN 46060 Phone (317)776-2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) Meadows @ Legacy Section 3 Owner Platinum Properties Application Number 4518 Date 9/30/2015 Period From 8/30/2015 _ To 9/30/2015 Original Contract Sum $ 525,940.17 Net Change by Approved Change Orders $ 25,063.17 Contract Sum to Date $ 551,003.34 Total In-Place Work Completed $ 535,890.04 Value of Material Stored on Site $ - Total Earned to Date $ 535,890.04 Retained Percentage $ 14,490.34 Total Earned Less Retalnage $ 521,399.70 Less Previous Certificates for Payment.. $ 518,699.70 Current Payment Due $ 2,700.00 The undersigned hereby certifies that the amount Earned and Due the Undersigned for all materials,supplies furnished,and labor and services of every nature performed by the Undersigned for the use on or in connection with the above named Project. 1) Has been paid In full as per shown(except Amount Due as listed below)through the above-mentioned pay period;and 2) The Undersigned hereby warrants that the premises of the above-named job cannot be made subject to any valid lien or claim by anyone who furnished materials,supplies, labor or services to the Undersigned for use in the above-named Project;and 3) The Undersigned hereby waives any and all claims of whatsoever kind or nature against the General Contract,and the Owner,and against the building(s),Improvements or Project,and the land on which same is located for any labor,materials,or supplies furnished or services performed through the above-mentioned pay period. This release Is given in order to induce payment in the Amount Due of$ $ 2,700.00 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes valid,enforceable and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by the Owner or Mortgagee of the Project Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all liens or rights to liens upon the premises,improvements thereto,or monies due in connection therewith, with respect to monies due the Undersigned for previous payment requests in the total sum of $ 2,700.00 ,the receipt and sufficiency of which is hereby acknowledge. Dated this 29th day of September 2015 Weihe Construction,Inc. State of Indiana ) By, t,yy actr ) 55: tuna ned) County of Hamilton ) Title: HR/Accounting Assistant Before me,a Notary Public in and for said County and State,this 29th day of September 2015, personally appeared Kimberly Burleson known to me to be the HR/Acct Assistant of the Undersigned who acknowledge the execution of the foregoing for and on behalf of the Undersigned. WITNESS my hand and Notarial Seal. Dated this 25th day of September 2015 My commission expires: Oct.2015 11�t Y��L1 ( (, Notary Public My county of residence Is: Hamilton Michelle Garcia (PrInted) • a y R APPLICATION FOR PAYMENT PROJECT NAME The Meadows at The Legacy Section 3 OWNER: Falcon Nest II.LLC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4519 CONTACT: CONTACT:Tim Walter CONTACT:Alan Smell APPLICATION DATE: 9/3012015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:15215 Stony Creek Way RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY:EEF Phone: Phone:(317)818-2900,590-8817(M) Phone:317-776-2966(o],776-3050(f) DATE: 1 011 41201 5 A B Cr Cz _ D E I F G H=E+F+G I=HID J K _ L=J+K M=D-H+L N Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value Previous This Stored And stored To Date Compi. _ Retainage This Period - Retained PAY This Month The Meadows at The Legacy Section 3 On-site construction Lgy 03 4c Stripping Topsoil NA $5,179.00 $5,179.00 $5,179.00 100% Lgy 03 4d Prelim Erosion Control NA $9,181.00 $9,181.00 $9,181.00 100% Lgy 03 4e Mass Excvation and Mounding NA $41,544.27 $41,544.27 $41,544.27 t00% ($0.00) Lgy 03 4h Soil Stabilization NA $19,442.50 $19,442.50 $19,442.50 100% Lgy 03 4g Site&Finish Grading NA $10,841.00 $10,841.00 $10,841.00 t00% $1,084.10 ($1,084.10) $1, 4.10 Lgy 03 5b Sanitary Sewer Mains NA $75,730.20 $75,730.20 $75,730.20 100% Lgy 03 5c Sanitary Sewer Laterals NA $32,895.00 $32,895.00 $32,895.00 100% Lgy 03 6a Storm Sewers NA $36,051.80 $36,051.80 $36,051.80 100% $3,605.18 ($3,605.18) $3, 0 .18 Lgy 03 6b Subsurface Drains NA $50,532.00 $50,532.00 $50,532.00 l00% $5,053.20 ($5,053.20) $5,0 .20 Lgy 03 7b Water Mains NA $108,516.40 $108,516.40 $108,516.40 100% Lgy 03 7e Water Service Laterals NA $26,837.60 $26,837.60 S26,837.60 100% Lgy 03 8a Roll Curb and Gutter $7.00/If $22,344.00 $22,344.00 $22,344.00 100% Lgy 03 8b 5'Wheel Chair ramps $600/ea $1,200.00 $1,200.00 Lgy 03 8b Common Area Sidewalk $3.50/sf $2,625.00 $2,625.00 Cher. ;CreekBlv`d'Constructic;64:14W/4 Lgy TIF 4c Stripping Topsoil NA $3,184.00 $3,184.00 $3,184.00 100% Lgy TIF 4e Mass Excvation and Mounding NA $8,641.00 $8,641.00 $8,641.00 100% Lgy TIF 4h Soil Stabilization NA $12,428.50 $12,428.50 $12,428.50 100% Lgy TIF 4g Site&Finish Grading NA $13,253.00 $12,253.00 $12,253.00 92% $1,225.30 $1,225.30 $2,225.30 Lg TIF¢t6a Storm Sewers NA $24,225.60 $24,225.60 $24,225.60 100% $2,422-56 ($2,422.56) &$2 422:56{-';€ d LgysTIFc18ar)Chair Back Curb and Gutter $7.60/If $12,600.80 $10,000.00 $10,000.00 79% $1,000.00 ($1,000.00) $2,600.80 $4990:001,, Lgy TIF 8b Multi Use Path Wheel Chair Ran$1,100/e9 $4,400.00 $4,400.00 Lgy TIF 8b Common Area Sidewalk $3.50/sf $4,287.50 $4,287.50 C0#1-Cherry Creek Blvd Lgy TIF 4h Multi-use Path Stabilization NA $4,360.00 $4,360.00 $4,360.00 100% CO#2-Conduit Crossings Lgy 03 6e Utility Conduits NA $11,017.50 $11,017.50 $11,017.50 100% CO#3-CC Blvd Spec Cond Lgy TIF 4i Subgrade Special Conditions NA $5,090.67 $5,090.67 $5,090.67 t00% ($0.00) ($0.00) ($0.00) CO#4-Winter Protection Lgy TIF 8a CC Blvd-Curb concrete blanket $1.00/1f $1,658.00 $1,658.00 $1,658.00 100% \1. Lgy 03 8a Onsite-Curb Concrete Blankets $1.00/If_ $2,937.00 $2,937.00 $2,937.00 100% L TOTAL $551,003.34 $534,890.04 $534,890.04 97% $14,390.33 ($13,165.04) $1,225.301 $17,338.60 L7a-"$43t 6tQ4`i Q_. 4,.... A JAIA ..r AIA Document 6702' -- 1992 Application and Ctrc> fe for Payment • • TO OWNER: - "� PROJECT: APPLICATHpN �,. Distribution hoz Platini t•No�rties Meadows eLegacv Section 3 ,"qt 5Y9 PERIOI Tat„. OWNERX 0 .9757 Westpoint Drive 'iPg. uite600f ACT FOR: ARCHITECT 0 FROM Cbts„IN 46256 VIA ARCHITECT: CaNTRACT DATE: CONTRACTOR 0 Weihe Construction,Inc. • 15215 Stony Creek Way PROJECT NOSp01422-0I ' t FIELD ❑ Noblesville,IN 46060 OTHER 0 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contactor certifies that to the best of the'Contractor's knowledge,information Application is made for payment,se,shown below,in connection with the Contract and belief the Work covered by this Application for Payment has been completed in accordance AIA Document is amide G70for ayment,Continuas sn Shea it w,attin co with the Contact Documents,that all amounts have been paid by the Contractor for Work for T.ORIGINAL CONTRACT SUM S which previous Certificates for Payment were issued and payments received from the Owner,and c7S,94n 17 that current payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS S 7 X63 1, CONTRAC •R:Weihe CC.r ction,Inc. ��pn J 3 CONTRACT SUM TO DATE(Line f .. $ t c I J p3 34 - :�y /. tee!” �t�� Date: /.5° 4.TOTAL COMPLETED ti STOREDYODATE(Column G on G703) S 31,09n n4 Stat':In I'ana . - 5.RETAINAGE: County ofiiarnilton •a %ofmplattd Work Subscribed and swore t0 fore J1/�v J� er+terD+Eon G703) S t;7510 me this dayof b. '�y.?••%ofStored Material - (Cuiwnn Fon G703) S Notary Public: L Ka [.Ai My commission expires: Total Retainage 21nes Sa+Sb,or Total in Column I of G703} 5 1 395.34 6.TOTAL EARNED LESS RETAINAGE $ 544 564 74 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 miotic-Line S Total} In accordance with the Contract Documents,based on on-site observations end the data comprising application,the Architect certifies to the Owner that to the best of the Architect's knowledge, 7.LESS PREYIOUSGERTIFICATES FOR PAYMENT $ 1 t ormaaon and belief the Work has progressed as indicated,the quality of the Work is in (Line 6from prtar Certificate) � ;y-- ...: with the Contract Documents, and the Contractor Is entitled to payment of the S.CURRENT PAYMENT DUE k ND/ ' OUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE \C)` - . AMOUNT CERTIFIED .,h. .....................$ (Line 3 minus Line 6) .. S 16,435.60 (Attach explanation(famorotr cert flied diff from thfr amount applied Initial all figrves on this T Application and on the Continuation Sheet that are changed to conform with the amount cert$ed) CHANGE ORDER SU A X ADDITIONS DEDUCTIONS ARCHITECT: Total changes app,v7 d la I ous months by Owner S S By: Date: Total cep itamonth $ $ This Certificate la�g,�'tnegotiable.The AMOUNT CERTIFIED is payable only to the Contractor £ TOTAL S S named hereins re,.,pari;payment end acceptance of payment are without prejudice to any rights of NET ORANGES by Change Order $ the Owner or Cbdksetar under this Contract. CAUTION:You should sign an original AMA Contract Document,on which this text appears In RED.An original ensures that changes will not be obscured. AIA Daeument G702*.—1982.Copyright 0105.3,194 1955.1871,1978,1983 end 1092 by The Mmedean Institute of Arddtocb.AN rights reserved.WARNING:This AIA Document Is protected by U.S.Copyright Law and International Treaties.Unauthorised reproduction or distribution of trace AIA Document,or any portion of it.may result In severe civil end abetters penstnes,end wilt be prosecuted to the maximum extent possible under the law.Purchaser"are pormNaed to reproduce tan(10)eoplea of Ulla doburnentwhen completed.To repot espyrtght violation*ot AYA Contract Documents.s-ntss no ArnMean InaSWte of Architects'iagel counsel,eopyrlghteata.org. CONTINUATION SHEET ATA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES „ AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT APPLICATION NO.: N containing Contractor's signed Certification,Is attached. APPLICATIO ,DAT : In tabulations below,amounts are stilted to the nearest dollar. - PERIOD Use Column I on ntracrs where variable reT4519. • tainage Por line Items may apply. ARCHITECT'S PROJECT N%02015 A ' a C D I E F G 7n a77-nt H • i • WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED • BALANCE R$FAINAGE NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS STp REp AND STORED % TO (IP VARIAE APPLICATION THIS PERIOD (NOT IN '[0 DATE (0 4 C) FINISH iD + E) D OR E) (D+E+F) • (C-G) 0100 On-Site D 00 Strip ping Topsoil 5,179.00 5,179.00 5,179.00 1100.00 0 00 Prelim Erosion Control 9,181.00 9,181.00 9,181.00 100.00 •• $I Mass Exc&Mounding 41,54427 41,544.27 41,544.27 100.00 0-rr Soil Stabilization 19,442.50 19,442.50 19,442.50 100.00 •a r I S4e&Finish Grading 10,841.00 10,841.00 10,841.00 100.00 0 $0 Sanitary Sewer Mains 75,730.20 75,730.20 75,730.20 100.00 0=-00 Sriitary Sewer Laterals 32,895.00 32,895.00 32,895.00 00.OD : Sone Sewers 36,051.80 36,051.80 36,051.80 00.00 1 i a. Subsurface Drains 50,532.00 50,532.00 50,532.00 00.00 1 -00 Watermain 108,516.40 108,516.40 108,516.40 00.00 1.-00 Water Service Lateral 26,837.80 28,837.60 26,837.60 '00.00 ' 1 a$ Roll Curb and Gutter 22,344.00 22,344.00 22,344.00 00.00 1 •i 5 Wheel Chair ramps 1,200.00 1,200.00 1, .r Common Area Sidewalk 2,625.00 2,825.00 1- la Cherry Tree Blvd Construction .. 1 -00 Stripping Topsoil 3,184.00 3,184.00 3,184.00 I 00.00 11-00 Mass Exc&Mounding 8,641.00 8,641.00 8,841,00 100.00 1:00 Soil Stabilization 12,428,50 12,428.50 12,428.50 100 00 21 $0 Site 8 Finish Grading 13,253.00 13,253.00` 13,253.00 100.00 1,325.30 2 -00 Storm Sewer 24,225.60 24,225.60 24,22560 100.00 /� •-00 Chair Back Curb&Gutter 12,600.80 10,000.00 10,000.00 79.36 2,600.80 a r 0 Multi-Else Path vvneet tramps 4,488700 4,400.0.0 00 Common Area Sidewalk 4,287.50 4,287.50 C.wi.imA Path 4,360.00 4,360.00 4,360.00 100.00 • NA DOCUMENT GUM•Cotcrfi area SKEET FOR G7@•1992 EDITION•ADP •0197E•THE AMERICAN INsrrrtrrE OP ARCHrracTs.1735 NEW YORK . AVENUE,N,m,WASTING-ION,D.C.200063292•WARNPJ(x Unlicensed photocopying**galas U.S.copyright tam aid war ablest the violator to keret prosecution. (3703-1992 CAUTION:1'6u should use an originei AIA document which hes this caution printed In red.An original assures that changes wilt not be obscured as may occur when documents ere reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OP PAGES • AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,Is attached. APPLICATION,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD T04519 Use Column 1 on Contracts where variable retainage for line Items may apply. ARCHITECT'S PROJECT Nao 015 A ' B C D E P . G 7rile27-01 _ • WORK COMPLETED MATERIALS TOTAL ITEM PRESENTLY COMPLETED SAN RETAINAGE NO. DESCRIPTION OF WORK S�VALUE D FROM PREVIOUS APPLICATION THIS PERIOD STORED (NOT IN AND STORED TO (IFVARIABLE) TO DATE (6 =C) FINISH (D + E) DOR E) (D+E+F) (C-G) CO-02 Conduit Crossings 11,017.50 11.017.50 11,017.50 00.00 CO-03 C'terry Creek-Subgrade Prep 5,090.67 5,090.67 5,090.67 00.00 CO-04 Concrete Blankets 4,595.00 4,595.00 4,595.00 00.00 • • AIA DOCUVENr G7oa•CONTINUATION SHEET POR CO27 •1992 RD9• ••01992••THE AMERICAN INSTITUTE OR AStGtlrrsc a Rlr 97.26 15,113.30 1,325.30 ..:1: few.,Nw.vthsltl.2cron,D.C.200065292•wA98t3G �msco p� l)oteias ltll owlet laws and eta sublecttbs+4olamr so kp prosecution. CAUTION:You should use an original AIA document which has this caution printed In red.An original assures that changes will not be obscured as may oecarwhen documents are reproduced. g• APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN Subcontractor or Supplier Name Weihe Construction,Inc. Subcontractor or Supplier Address Noblesville,IN 46060 Phone (317)776-2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) Meadows @ Legacy Section 3 Owner Platinum Properties Application Number 4519 Date 9/30/2015 Period From 8/30/2015 To 9/30/2015 Original Contract Sum $ 525,940.17 Net Change by Approved Change Orders $ 25,063.17 Contract Sum to Date $ 551,003.34 Total In-Place Work Completed $ 535,890.04 Value of Material Stored on Site $ - Total Earned to Date $ 535,890.04 Retained Percentage $ 1,325.30 Total Earned Less Retainage $ 534,564.74 Less Previous Certificates for Payment., $ 521,399.70 Current Payment Due $ 13,165.04 The undersigned hereby certifies that the amount Earned and Due the Undersigned for all materials,supplies furnished,and labor and services of every nature performed by the Undersigned for the use on or In connection with the above named Project. 1) Has been paid in full as per shown(except Amount Due as listed below)through the above-mentioned pay period;and 2) The Undersigned hereby warrants that the premises of the above-named job cannot be made subject to any valid lien or daim by anyone who furnished materials,supplies, labor or services to the Undersigned for use in the above-named Project;and 3) The Undersigned hereby waives any and at claims of whatsoever kind or nature against the General Contract,and the Owner,and against the bulding(s),improvements or Project,and the land on which same is located for any labor,materials,or supplies furnished or services performed through the above-mentioned pay period. This release Is given in order to Induce payment in the Amount Due of$ $ 13,165.04 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes valid,enforceable and of full effect. Upon attachment of the legal description of the Project,the release my be recorded by the Owner or Mortgagee of the Project. Notwithstanding the foregoing,the Undersigned does hereby unconditionally waive and release any and all liens or rights to liens upon the premises,improvements thereto,or monies due in connection therewith, with respect to monies due the Undersigned for previous payment requests in the total sum of $ 13,165.04 ,the receipt and suffidency of which is hereby acknowledge. Dated this 29th day of September 2015 I{III{ Weihe Construction,Inc.. (s U.CLl State of Indiana } By; 2. SS: " (u ) County of Hamilton ) Title: HR/Accounting istant Before me,a Notary Public in and for said County and State,this 29th day of September 2015, personally appeared Kimberly Burleson known to me to be the HR/Acct Assistant of the Undersigned who acknowledge the execution of the foregoing for and on behalf of the Undersigned. WITNESS my hand and Notarial Seal. Dated this 25th day of September 2015 1, ` L My commission expir1 1�Aes: Oct 2015 a Notary Puck My county of residence Is: Hamilton Michelle Garcia (Printed) • APPLICATION FOR PAYMENT PROJECT NAME:The Overlook at The Legacy Section 2 OWNER: Falcon Nest II.LLC CONSTRUCTION MANAGER:Platinum Properties Mgmt Co.,LLC CONTRACTOR:Conco Curbs&Paving,LLC INVOICE NO:#1 CONTACT: CONTACT:Ed Fleming CONTACT:Ryan Wallis APPLICATION DATE: 9/22/2015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:P.O.Box A RETAINAGE: 141P McLean,VA 22101 Indianapolis,IN 46256 Tipton,IN 46072 APPROVED BY: I Phone: Phone:j317)818-2900,590-8817LM) Phone:317-281-9775(0),765-675-2656(f) DATE: 1v1ji/5s A B CI C2 D E I_ F _ G H=E+F+G l=HID J K L=J+K _ M=D-H+L N Project Cost Work Description Unit Scheduled _ Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value Previous This , Stored And stored To Date Comet. Retainage This Period Retained PAY This Month The Overlook at The Legacy Section 2 On-site construction Lgy P2 8a Roll Curb&Gutter $6.30/LF $18,118.80 $18,118.80 $18,118.80 100% $1,811.88 $1,811.88 $1,811.88 $1R 6.92 Lgy P2 8b Common Area Sidewalk $3.17/SF $3,074.90 $3,074.90 Lgy P2 8b ADA Ramps(5 Ft.) $400 Ea $2,800.00 $2,800.00 Lgy P2 15b Maintenance Bond $550.00 $550.00 1 Cher"ry_CreekBlidieCnslructic&'47,j #LLgyIITJ dElaI Chairback Curb&Gutter $10.98/LF $28,163.70 $28,163.70 $28,163.70 100% $2,816.37 $2,816.37 $2,816.37 &$25;347.33`x' Lgy TIF 8b Common Area Sidewalk $3.17/SF $5,369.98 $5,369.98 Lgy TIF 8b ADA Ramps(5 Ft.) $400 Ea $3,200.00 $3,200.00 Lgy TIF 8b ADA Ramps(10 Ft.) $650 Ea $3,900.00 $3,900.00 Lgy TIF 15b Maintenance Bond $850.00 $850.00 TOTAL $66,027.38 $46,282.50 $46,282.50- 70% $4,628.25 $4,628.25 $24,373.13 $41,654.25 3; APPLICATION AND CERTIFICATION FOR PAYMENT A1A DOCUMENT G702 PAGE ONE OF TWO PAGE(S) 215034 TO OWNER: PROJECT: APPLICATION NO: 1 Distribution to: Platinum Properties Mgmt Co.,LLC Overlook @ Legacy Sec.2 9757 Westpoint Dr..Suite 600 Indianapolis,IN 46256 PERIOD TO: nOWNER FROM CONTRACTOR: VIA ARCHITECT: 9/22/2015 ARCHITECT Conco Curbs&Paving,LLC CONTRACTOR P.O.Box A PROJECT# Tipton,IN 46072 SUBCONTRACT# 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 and belief the Work covered by this Application for Payment has been Continuation Sheet,AlA Document 0703,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. 1. ORIGINAL CONTRACT SUM $ $66,027.381 2. Net change by Change Orders S $0.00 CONTRA 0". / 3. CONTRACT SUM TO DATE(Line I ±2) $ S66,027.38 4. TOTAL COMPLETED&STORED TO $ $46,282.50 �, / DATE (Column G on 0703) By: Date: t-L( 1 5 5. RETAINAGE:(Original Contract Only) Ryan ``fai'I Project Manager /3/�6‘.....—( KRIS TEEN WALTERS a. 10%of Completed Work $ 4,628.25 State of lid'�a County oNTARY PUBLIC STATE OF INDIANA (Column D+Eon G703) Subscribe .k.d s o to before me this(7,2.da off5ej- b. 0 %of Stored Material $ Notary P 1 eliy, MADISON COUNTY (Column F on G702) My Co / 'sion Ex ires: .7---f--1 g MY COMMISSION EXPIRES 07/08/18 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 4,628.25 ARCHITE T' -TI ICAT •R 'AYMENT 6. TOTAL EARNED LESS RETAINAGE $ 41,654.25 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) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 41,654.25 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 24,373.I3 /_ '7 c (Line 3 less Line 6) AMOUNT CERTIFIED $ ''jt [!7 (I L CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified d(ersfrom the amount applied.Initial all figures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified) in previous months by Owner ARCHITECT: , r Total approved this Month(41) By: lW Date: I Cl/tt i h TOTALS This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,payment and acceptance of payment are wttnout NET CHANGES by Change Order prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION'AIA-01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292 CONTINUATION SHEET AIA DOCUMENT G703 215034 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 1 Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: SUBCONTRACT NO. A B C D t E F G H l ITEM DESCRJPIION OF WORK CON'IUCT WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS T1-BS PERIOD PRESENTLY COMPLETED (G-C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE ,_ D OR El (D+E+F) 10% On-site Construction 1 8a-Roll Curb $18,118.80 $18,118.80 $IR,1'18.80 100% $0.00 $1,811.88 8b-Common Area Sidewalk $3,074.90 50.00 0% $3,074.90 $0.00 81)-ADA 5ft $2,800.00 $0.00 0% $2,800.00 $0.00 15h-Maintenance Bond $550.00 $0.00 0% $550.00 $0.00 Cherry Creek Blvd Construction 8a-Chairback Curb $28,163.70 $28,163.70 $28,163.70 100% $0.00 $2,816.37 • 8b-Common Area Sidewalk $5,369.98 50.00 0% $5,369.98 $0.00 8h-ADA 50 $3,200.00 50.00 0% $3,200.00 $U.00 86-ADA 10ft $3,900.00 $0.00 0% $3,900.00 $0.00 15b-Maintenance Bond $850.00 $0.00 0% $850.00 $0.00 Change Orders GRAND TOTALS $66,027.38 $0.00 $46,292.50 $0.00 $46,282.50 $19,744.88 $4,628.25 ASA DOCUMENT 0733-CONTINUATION SHEET FOR 0702•1902 EDIPON.AIA•0 1992 6703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D.C.20009-5292 ALA DOCUMENT 0703•CONTINUATION SHEET FOR 2702•1992 EDITION•AIA-®1597 THE AMERICAN INSTI fUTE OF ARCHITECTS,1735 NEW YORK AVENUE.N.W.WASHINGTON,D.C.'20015-5232 G703-1992 • • AFFIDAVIT AND WAIVER OF LIEN Final X Partial X Payment to follow State of Indiana County of Tipton SS: Ryan Wallis being duiy sworn states that she/he is Estimator/Project Manager of Conco Curbs&Paving,LLC having contracted with Platinum Properties Mgmt to furnish certain material and labor for a project known as Overlook at Legacy Sec.2 and does further state: Final Waiver: that the balance due from the owner is the sum of ( ) dollars and /100 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. Partial Waiver: that the balance due from the owner is the sum of ( $41,654.25 ) Forty-One Thousand Six Hundred Fifty-Four dollars and 25/100 receipt of which is hereby acknowledged; or X the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount,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 materials or both furnished by the undersigned thereto,and further certifies that no other pa ha - y claim or right to a lien on account of any work performed or material furnished to the undersigne. o • •roject,and wi I..the scope of this Affidavit and Waiver. /API /'w'-Snature) 9/22/2015 lif (date) Witness my hand and notary seal,this (9,2- day of JG!'/ ,205 KRISTEEN WALTERS 1011/11'.&---W (signature) NOTARY PUBLIC STATE OF INDIANA MADISON COUNTY My commission expires: 4 MY COMMISSION EXPIRES 07/08118 My county of residence: I AO15:0X/ 0-i•,5+ f 10L-+ ,,,5 (Notary Public Print) ' APPLICATION FOR PAYMENT PROJECT NAME:The Overlook at The Legacy Section 2 OWNER: Falcon Nest II,LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co.,LLC CONTRACTOR:Globe Asphalt Paving Co.,Inc. INVOICE NO:#1 CONTACT: CONTACT:Ed Fleming CONTACT:Bill Shumaker APPLICATION DATE: 8/3112025 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpoint Drive,Suite 600 ADDRESS:6445 E.30th Street RETAINAGE: 10% A cLean,VA 22101 Indianapolis,IN 46256 Indianapolis.IN 46219 APPROVED BY: -[d F I f 5/ Phone: _ Phone:(3171818-2900,590-8817(M) Phone:317-568-4344(o1 317-568-4277(f) DATE: t R A 8 C1 Cu D E I F G H=E+F+G 1=HID J K L=J+K M=D-H+L N Project Cost Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retainage Total BAL.TO Net Pay Code Code Price Value Previous This Stored And stored To Date Compl. Retainage This Period Retained PAY - This Month The Overlook at The Legacy Section 2 On-site construction Lgy P2 9a Stone Base 11.80/TO $18,414.00 $18,414.00 $18,414.00 100% $1,841.40 $1,841.40 $1,841.40 $16, .60 Lgy P2 9a Asphalt Base .70/SYD $28,484.00 $28,484.00 Lgy P2 9a Asphalt Binder .40/SYD $20,954.00 $20,954.00 Lgy P2 9b Tack and Surface Coat .50/SYD $18,007.00 $18,007.00 Cherrys'Creek;Bl"vd Constructi e ix,s f l ii `" 1Lgy._TIF l'9. Stone Base 13.15/TO $31,060.00 $31,060.00 $31,060.00 100% $3,106.00 $3,106.00 $3,106.00 $27„954.00. Lgy TIF 9a Asphalt Base .70/SYD $38,367.00 $38,367.00 Lgy TIF 9a Asphalt Binder .40/SYD $28,224.00 $28,224.00 Lgy TIF 9b Tack and Surface Coat .50/SYD $18,007.00 $18,007.00 Lgy TIF 9e 10'Multi-Use Path $2.55/SF $56,681.00 $56,681.00 Lgy TIF 9h Thermoplastic Markings NA $3,000,00 $3,000.00 I TOTAL I $261,198.00 $49,474.00 $49,474.00 19% $4,947.40 $4,947.40 I $216,671.40 $44,526.60 • • PAYMENT APPLICATION Page 1 TO: Platinum Properties,LLC PROJECT The Overlook at Legacy Sec 2 APPLICATION# 1 Distribution to: 9757 Westpoint Drive Suite 600 NAME AND Carmel,IN p LOCATION: PERIOD THRU: 08/31/2015 OWNER Indianapolis,IN 46256 PROJECT#s: C-15168 ARCHITECT Attn:Accounts Payables CONTRACTOR FROM: Globe Asphalt Paving Co.,Inc. ARCHITECT: DATE OF CONTRACT: 04/28/2015 0 6445 E.30th Street, P.O.Box 19168 0 Indianapolis,IN 46219 FOR: Asphalt Paving CONTRACTOR'S SUMMARY OF WORK Contractor's signature below is his assurance to Owner,concerning the payment herein applied for, that:(1)the Work has been performed as required in the Contract Documents,(2)all sums previously Application is made for payment as shown below. paid to Contractor under the Contract have been used to pay Contractor's costs for labor, materials and other obligations under the Contract for Work previously paid for,and(3)Contractor is legally Continuation Page is attached. entitled to this payment. 1. CONTRACT AMOUNT $261,198.00 CON CRAGaving Co.,Inc. 2. SUM OF ALL CHANGE ORDERS $0.00 By: 4.‹.: Date: 09/11/2015 3. CURRENT CONTRACT AMOUNT (Line 1 +1- 2) $261,198.00 William A.Shumakar,President 4. TOTAL COMPLETED AND STORED $49,474.00 State of: Indiana (Column G on Continuation Page) County of: Marion 5. RETAINAGE: Subscribed and sworn to before • a. 10.00% of Completed Work $4,947.40 me this 11th day of September 2015 (Columns D+E on Continuation Page) 7,.._.,..,..., b. 0.00% of Material Stored $0.00 Notary Public: Alma Hodges / (Column F on Continuation Page) /`` Total Retainage(Line 5a+5b or My Commission Expires: 9/30/17 �— �J --' r Column I on Continuation Page) $4,947.40 ARCHITECT'S CERTIFICATION / 6. TOTAL COMPLETED AND STORED LESS RETAINAGE $44,526.60 Architect's signature below is his assurance to Owner,concerning the payment herein applied for, (Line 4 minus Line 5 Total) that:(1)Architect has inspected the Work represented by this Application,(2)such Work has been 7. LESS PREVIOUS PAYMENT APPLICATIONS $0.00 completed to the extent indicated in this Application,and the quality of workmanship and materials conforms with the Contract Documents,(3)this Application for Payment accurately states the amount of Work completed and payment due therefor,and(4)Architect knows of no reason why payment 8. PAYMENT DUE $44,526.60 should not be made. , 9. BALANCE TO COMPLETION CERTIFIED AMOUNT jr-1t 6j 24 6r:, r (Line 3 minus Line 6) $216,671.40 (If the certified amount is different from the payment due,you should attach an explanation. Initial all the figures that are changed to match the certified amount.) SUMMARY OF CHANGE ORDERS ADDITIONS DEDUCTIONS Total changes approved in ARCHITECT: previous months $0.00 $0.00 B / Total approved this month $0.00 $0.00 y ` Date: _ �Jii� `? TOTALS $0.00 $0.00 Neither this Application nor payment applied for herein is assignable or negotiable. Pa1yme t shall be _ made only to Contractor,and is without prejudice to any rights of Owner or Contractor under the NET CHANGES $0.00 Contract Documents or otherwise. PAYMENT APPLICATION Quantum Software Solutions,Inc.Document CONTINUATION PAGE Page 2 of 2 PROJECT: The Overlook at Legacy Sec 2 APPLICATION#: 1 Carmel,IN DATE OF APPLICATION: 08/31/2015 Payment Application containing Contractor's signature is attached. PERIOD THRU: 08/31/2015 PROJECT#s: C-15168 A B C D L E F G H I COMPLETED WORK STORED TOTAL % BALANCE ITEM# WORK DESCRIPTION SCHEDULED AMOUNT AMOUNT MATERIALS COMPLETED AND COMP. TO RETAINAGE AMOUNT PREVIOUS THIS PERIOD (NOT IN D OR E) STORED (G/C) COMPLETION (If Variable) PERIODS (D+E+F) (C-G) 01 The Overlook at The Legacy Sec 2 02 On-site construction 03 Lgy P2-9a-Stone Base $18,414.00 $0.00 $18,414.00 $0.00 $18,414.00 100% $0.00 $1,841.40 04 Lgy P2-9a-Asphalt Base $28,484.00 $0.00 $0.00 $0.00 $0.00 0% $28,484.00 $0.00 05 Lgy P2-9a-Asphalt Binder $20,954.00 $0.00 $0.00 $0.00 $0.00 0% $20,954.00 $0.00 06 Lgy P2-9b-Tack and Surface $18,007.00 $0.00 $0.00 $0.00 S0.00 0% $18,007.00 $0.00 Coat 07 Cherry Creek Blvd,Construction 08 Lgy TIF-9a-Stone Base $31,060.00 $0.00 $31,060.00 $0.00 $31,060.00 100% $0.00 $3,106.00 , 09 Lgy TIF-9a-Asphalt Base $38,367.00 $0.00 $0.00 $0.00 $0.00 0% $38,367.00 $0.00 10 Lgy TIF-9a-Asphalt Binder $28,224.00 $0.00 $0.00 $0.00 $0.00 0% $28,224.00 $0.00 11 Lgy TIF-9b-Tack and Surface $18,007.00 $0.00 $0.00 $0.00 $0.00 0% $18,007.00 $0.00 Coat 12 Lgy TIF-9e-10'Multi-Use Path $56,681.00 $0.00 $0.00 $0.00 $0.00 0% $56,681.00 $0.00 13 Lgy TIF-9h-Thermoplastic $3,000.00 $0.00 $0.00 $0.00 $0.00 0% $3,000.00 $0.00 Markings TOTALS $261,198.00 $0.00 $49,474.00 $0.00 $49,474.00 19% $211,724.00 $4,947.40 CONTINUATION PAGE Quantum Software Solutions,Inc. Document s ' yN..�. meq 'L}�.h*�.' WS�,A l'-1. W CO;N7 il.aCTOR P AFFIDAVIT AND WAVER OF LIEN HaFEiq L. ( PARTIAL el— PAYMENT TO FOLLOW ,' r r� A . II!;r, �� , tits c being duly sworn,state that be/she is the ff Perim_".:± of Globe Asphalt Paving Co., Inc.having contracted with Platinum Properties Management Co.. LLC. to furnish certain materials,labor and/or equipment as follows: all road and street paving for a project known as The Overlook at Legacy Section_2 ,located at Carmel.Indiana,and owned by Falcon Nest Il,LLC _,and further states: ,/ PARTIAL WAIVER: that the balance due from the owner is the sum of -ct„�u -A-t) ---gx:f.�c rr,r�-(:l �'rP &cLt/ —1061;-. �,kr .(4 c°Xo r-- Dollars($ `-/ -/.`-r?Ca, o ). Receipt of which is hereby acknowledged;or The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount,effective upon receipt of such payment. FINAL WAIVER: that the final balance due from the owner is the sum of _r._ Dollars($ 1 _Receipt of which is hereby acknowledged;or The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount,effective upon receipt of such payment. THEREFORE,the undersigned waives and releases unto the Owner of said premises any and all lien or claims whatsoever on the above-described property and improvements thereon on account of labor or material or both,furnished by the undersigned thereto,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. Globe Asphalt P no Co., Inc. ,ompany Name 'L\ /C2- e i', Authorized Representative ' {n; I'es?cieni~ Title r( 1 ' ,/ \VI7NESS:L . 4;L,�_( .. - . .•�..�. tgnature i- 4i_ r f 4(0,,_'Ft cr4.t's --- Printed Name of Witness 9 Manley Finish Grading Inc® DATE INVOICE# 10/13!2015 6203 3'UU1. .\11'1'F I(11-:II.I:I; RI). I\I)j \ \P(Ofl.iS. I\t)l.i\.\ 4,220 0:31- R) -8554 F.%X, :;l--)s:-'35', BILL TO FALCON NEST II LLC C/O PLATINUM PROPERTIES 9757 WESTPOINT DR. SUITE 600 INDIANAPOLIS,IN. 46256 P.O.NO. TERMS PROJECT LEGACY NET 30 MEADOWS QUANTITY DESCRIPTION RATE jMOUNN 62,100 S.F. OF EROSION CONTROL BLANKET 0.13 1 DROP INLET PROTECTION 160.00 tliiit r JO�$,fl60.00 t).5 ACRE OF PAD SEED 'j ' 19� 60.00 1,200.00 L11 4-j fm 600.00 Yf 1 1 1 fi i a i / �a THANK YOU FOR YOUR BUSINESS ,` �- Total $8,833.00 / t Mill'I':::'t.,LEY ' FINISH 6RAL1I NG { • AFFIDAVIT AND WAIVER OF LIEN FINAL X PARTIAL X PAYMENT TO FOLLOW' JOHN MANLEY being duly sworn,state that heishe is the PRESIDENT of MANLEY FINISH GRADING INC.having contracted with FALCON NEST II, LLC to furnish certain materials and/or labor as follows: INVOICE 6203 for a project known as LEGACY MEADOWS ,located at INDIANAPOLIS, IN ,and owned by_ FALCON NEST Il LLC ,and further states: PARTIAL WAIVER: that the balance due by the owner is the sum of EIGHT THOUSAND EIGHT HUNDRED THFRTY-THREE ...001100 Dollars(`6 8,833.00). Receipt of which is hereby acknowledged;or X The payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount,effective upon receipt of such payment. FINAL WAIVER: that the final balance due by the owner is the sum of Dollars($ �). 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 is given to and for said amount effective upon receipt of such payment. THEREFORE,the undersigned waives and releases unto the Owner of said premises any and all lien or claims whatsoever on the above-described property and improvements thereon on account of labor or material or both,furnished by the undersigned thereto,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. MANLEY FINISH GRADING.INC.__ Company Name . Authorized Representative PRESIDENT Title WITNESS: Signature LYNDA MANLEY Printed Name of Witness al