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Legacy TIF draw 22 112315 ,_____,D FALCON NEST II , LLC Oil November 16,2015 Diana L. Cordray Carmel Clerk Treasurer (317)571-2414 Via E-mail: DCordravcarmel.in.gov: csheekst carmel.in.gov; iohn.alexanderCa�regions.com: jake.taylor aC�starfinancial.com Re: Legacy TIF—Draw#22 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, .........ii__ 7/C✓/ Rajai Zumot Member of SALT, LLC 1356 BEVERLY RD SUITE 250 • MCLEAN, VA •22101 PHONE: (703) 893-7233 • FAX: (703) 893-5267 STATEMENT NQ. 22 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 TRUSTEE 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 $43,672.85 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 filed with the Trustee under the provisions hereof; and (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 WHE} OF, the authorized representative of the Company has set his hand as of the 1‘1 day of IV UV t,t 1' ,20 I , . 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: R(V7 ajai Zumot, - ber of SALT, LLC approved: CITY OF ARMEL1 IP ANA Diana L. Cordray,{AMC, Clerk- if urer 2 Legacy TIF Draw Application No: 22 • • Application Date: • 16-Nov-15 Prepared By: Kathy Tekulve • Telephone No: (317) 863-2052 • Amount: S 43,672.85 Reference or Total Retainage Invoice Work This Invoice Code Contractor J Payee Number • Completed Period Amount 4 Weihe Construction 4593 $ 3,000.00 $ (300.00). $ 2,700.00' Weihe Construction 4410 $ 1,000.00 $ (100.00). $ 900.00>� Weihe Construction 4588 $ 435.00 $ (43.50) $ 391.50V $ 4,435.00 $ (443.50) $ 3,991.50 8 Weihe Construction 4588 $ 9,088.30 $ (908.83): $ _ 8,179.47 V Concrafters, Inc. 74 $ 5,873.00 • $ - $ 5,873.00J Concrafters, Inc. 75 $ 16,000.00 1 S - $ 16,000.00 V $ 30,961.30 $ (908.83) $ 30,052.47 11 Hittle Landscaping 67865 $ 6,581.94 $ - S 6,581.94 / $ 6,581.94 . $ - S 6,581.94 • Management Fees 1105 $ 3,148.37 $ (101.42) $ 3,046.94 Z $ 3,148.37 $ (101.42). $ 3,046.94 Total $ 45,126.61 $ (1,453.75)' $ 43,672.85 0 l of 1 PLATINUM PROPERTIES MANAGEMENT COMPANY, LLC INVOICE 1105 November 16, 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 November 2015 Construction Costs: Weihe Construction, Inc. $ 12,170.97 Concrafters, Inc. $ 21,873.00 Hittle Landscaping $ 6,581.94 Total Monthly Costs $ 40,625.91 Development Fee @ 7.5% $ 3,046.94 Please remit payment to: Platinum Properties Management Company, LLC 9757 Westpoint Drive,Ste 600 Indianapolis, IN 46256 { 3u3 pp 9757 Westpoint Drive,Suite 600, Indianapolis, IN 46256 (317)818-2900 APPLICATION FOR PAYMENT PROJECT NAME:The Overlook at The Legacy Section 2 OWNER: Falcon Nest Il.LLC CONSTRUCTION MANAGER: Platinum Properties Mgmt Co..LLC CONTRACTOR:Weihe Construction,Inc. INVOICE NO: 4593 CONTACT: CONTACT:Tim Walter CONTACT:15215 Stony Creek Way APPLICATION DATE: 10/30/2015 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 Co 776-3050(D DATE: 11/10/2015 _ A B Cr _ Cs _ D E I 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 Retainago 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 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 $14,623.00 103% $1,462.30 $1,462.30 $1,462.30 Lgy P2 4g Site&Finish Grading NA $15,620.00 $12,620.00 $3,000.00 $15,620.00 100% $1,262.00 $300.00 $1,562.00 S1,562.00 $2,700.00 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 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 $999.95 $111,797.95 100% $11,079.80 $100.00 $11,179.80 $11,179.80 $899.96 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 Cherry Creek Blvd Constructio Lgy TIF 4a Demolition NA $10,555.00 $10,555.00 $10,555.00 100% $1,055.50 $1,055.50 $1,055.50 Lgy TIF 4c Stripping 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 $1,773.30 Lgy TIF 411 Soil Stabilization(roadway) NA $18,935.00 $18,935.00 $18,935.00 103% $1,893.50 $1,893.50 $1,893.50 Lgy TIF 4h Soil Stabilization(multi-use path) NA $10,284.00 $10,284.00 $10,284.00 100% $1,028.40 $1,028.40 $1,028.40 Lgy TIF 4g Site&Finish Grading NA $25,411.00 $22,411.00 $3,000.00 $25,411.00 100% $2,241.10 $300.00 $2,541.10 $2,541.10 $2'712¢.00 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 ii FL : d-1,--47:e �d 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 Lgy P2 5b CO#5-Sanitary Sewer NA $746.03 $746.03 $746.03 100% $74.60 $74.60 $74.60 TOTAL $531,432.597 $524,432.64_ $6,999.95 $531,432.59 100% $52,443.26 $700.00 $53,143.26 $53,143.26 $6,299.96 '614. AI Document G702' - 1992 1 Application and C0410?for Payment z 11 TO OWNER: :'- PROJECT: APPi.1CAT1 • Pint�'nfP�crties Overlook at the Leeacv Sec 2 p +�{�' �9_ � ��i 9757 Weipoint Drive P43ze. ONR1ERx❑ ' F`'-Suite 600 AST FOR: ARCHITECT 0 FROM Cf9N`fi3A9liD$aiis„N 46256 VIA ARCHITECT: Weihe Construction,Inc. CONTRACT DATE CONTRACTOR 0 - 15215 Stony Creek Way PROJECT NOS:20151 I-0I / 1 FIELD ❑ Noblesville,IN 46060 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The Contractor certifies that to thie bat of the'ConCaeror't knowledge,Information Application is made for payment,as drawn below,is connection with the Contract • and belief the Work covered by this Application for Payment has been camplated in aaocadanaa AI cDa ion is ade for Confirmation as own t.i ,anlcd with the Contract Documents,that all amounts have been paid by the Contractor for Walk far which previous CettiBcataa for Fryman were issued and payments received from the Owner,and C 1.ORIGINAL CONTRACT SUM S 501,979.04 that currompayment shown heroin is now due. . 2.NET CHANGE 8Y CHANGE ORDERS' • S 71;453 55• OHTRA9OR: Weihe C,pnstruction,Inc. j 3.CONTRACT SUM TO DATE(L/eta t&7f s 531437.59 �'. rn �-t/r JLr -D'-%-'-` _ Date:, /°'i Il 5 4.TOTAL COMPLETED&STOR1 �'ObATE(Column G on G703)...... S 531,432.59 State of'Indiana U 5.RETAINAGE calmly oe Hamilton a. may%of 4mpteted work , Subsaibad and aurora to ltafore 2gal taro 4 E on G703) 5_ 53,143.27 ma this Vt,t 7(thy cf n.g of Stared Materia! , t Gf?�" C CJ r -, ' (Column F on 6703) S Notary Public_`V \i L !�'v `[J� j-.:T%::- -' My commission expires: ,D 12_O 5 Total Retainage(Liner 5a+Sb,or Total in Cabana I qt.G703)...... S ,3.143.27 6,TOTAL EARNED LESS RETAINAGE S 4)8.28932_ ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 minus-Una 5 Total) In accordance with the Coamet r Dooumm:ts,based on on-site observations and the data comprising 7.LESS PREVIOUS,CERTIFICATESFOR PAYMENT 5 471,989.38 thus applitatioitr the Arehitoot codifies to the Owner that to the beet of the Architect's knowledge ) �) (Line 6jromprior Cerxj2cate) information and belief the Work has progressed as indicated,the quality of tba Wort is in t/ ii,{ accordance with the Con. hut Documents, and the Contractor is entitled to payment of the 9.-.7 V, 8.CURRENT PAYMENT DUE � �... $ ( 6,299.44 AMOUNTCRT b 9.BALANCE TO FINISH,INCLUDING RETAINAGE tilt AMOUNT CERTIFIED..,«.....»�»......................_...... .._.S • � tJ 7� {Line 3 minus Line 6) .- " S 53,143.27 (.ittaah=planaion rammed certi ed d{f aSfro&the amount applied Nita all f Aural on this . .Applleation and on the Continuation Shat thes are changed m esteem with the mnorau ambled) CHANGE ODER SUI�YT ADDITIONS DEDUCTIONS ARCHITECT: s, . Total changes ap( ev&I is pftvious months by Owner S S By: Date: Total,. ' nibnth S • _S / named Certificate_s payment abiet andThaareD is payable�ithou�ndice toe anyytractor rim of • TOTAL S t Owner Cadbacaor under this Can4sct NET CAANGBS.by Change Order S CAUTION:You should sign an original ALA Contract Document,on which this text appear&in RED.An original assures that changes will not be obscures& AA Document 0702"'—7092.Copyright©1053.Ma,1985.1977,1575,195a end 1592 by The Amarlrsn hennas of An:Nue:is.A5 tights reamed.WARNING:This AIA'Document Is protected by U.S.Copyright I-Me and intanurional Treaties.Unauthorized reproduction or d etdba$on of this ALA'Document,or my pardon at it may result In moves slug and criminal penallst,and will ho ptoaseutod to the era4aaam sxmst poeclhle under the law.?ie hosors are Remiead to raproduee tea 110)eoples at thle ddma erawhaa campkiad.To rsooet worsens via:sans or ALA Coated Doourosnta,waist The Amnikan ywtl7um Of nothltnolg Isgal counsel,capyrlglltZSafa.arp. CONTINUATION SHEET AIA.DOCUMENT G703 (Instructions on reverse side) PAGE OF MORS ALA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPISCATION NO.: containing Contractor's signed Certification,Is attached. APPLICATION.DATE: In tabulations below,amounts are sated to the neatest dear. PERIOD TO: Use Column I on 9Ontracts where variable retainage for Elle items may apply. ARCHITECT'S PROJECT NO.:4593 10/30/2015 ligB c D B F . G H , I • •:a; •r•e: I I O. tdt1BRIAIS TOTAI. _ CE ITEM DESCRIPTION OP WORK SCHEDULED FROM PREVIOUS , PRSLSEtiTLI'RRO COMPLETED I D STORED ' TO (IF VASIAHLB)RETAINSGg NO• VALUE APPLICATION THIS PERIOD (NOT 70$DATE (G..C) ?RUSH RATE) CD 0 OR Ii) (D F) C-G 11-00 .tripping Topsoil 4,267.00 4,267.00 4,267.00 100.00 426.70 12.00 •relim Erosion Control 18,697.00 18,697.00 18,697.00 100.00 1,869.70 03.00 ass Excavation&Mounding 45,118.00 45,118.00 45,118.00 100.00 4,511.80 'P•-00 .0i1 Stabilization 14,623.00 14,623-00 r 14,623.00 100.00 1,462.30 15-00 -ite&Finish Grading 15,620.00 12,620.00 3,000.00 . 15,620.00 100.00 1,562.00 4.-00 -anitarySewerLaterals 10,095.84 10,095.84 10,095.84 100.00 1,009.58 ,7-00 -ubsurfacs Drains 31,452.50 31,452.50 31,452.50 100.00 3,145.25 18-00 atermains 111,797.95 110,798.00 999.95 111,797.95 100.00 11,179.81 19-00 ater Service Laterals 10,894.80 10,894.80 10,894.80 100.00 1,089.48 0-00 harry Creek Blvd Construction 1-00 ■-molition 10,555.00 10,555.00 10,555.00 100.00 1;055.50 2-00 tripping Topsoil 5,426.00 5,428.00 5,428.00 100-00 542.80 3-00 ass Excavation&Mounding 17,733.00 17,733.00 17,733.00 100.00 1,773.30 4-00 -oil Stabilization(Roadway) 18,935.00 18,935.00 18,935.00 100.00 1,893.50 5-00 +oil stabilization(path) 10,284.00 10,284.00 . 10,284.00 100.00 1,028.40 6-00 -tie&Finish Grading 25.411.00 22,411.00 3,000.00 25`411.00 00.00 2,541.10 7-00 -(arm Sewers 148,171.95 148,171.95 1 148,171.95 00.00 14,817.20 8-00 -ubsurface Drains 3,895.00 3,895.00 3,895.00 00.00 ,„389.50 !0-01 hange Order#1 6,265.79 6,265.79 6,265.79 00/00 626.58 •1-02 hange Order#2 11,470.00 11,470.00 11,470.00 00.00 1,147.00 !!-03 ha nge Order#3 5,553.50 5,553.50 5,553.50 00.00 555.35 00-04 hange Order#4 912.83 912.83 912.63 00.00 9t28 •1 I ..I.- a .- . ,♦. as. • Itirj1 n Coos•CONDzeo10x 92•i� •�1 ED t� 1=r iettthE OF R�a Ydo:V°.00 5 a g82 U'• trm,aesloNatort,D.C.e,ztsa642Pa- ar CAUTION:You should use an orlglnel AIA document which has thio caution printed In red.An original assures that obangee will not be obscured as may occur when documents are 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 Section 2 Owner Platinum Properties Application Number 4593 Date 10/30/2015 Period From 10/1/2015 To 10/30/2015 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 $ 531,432.59 Value of Material Stored on Site $ - Total Earned to Date $ 531,432.59 Retained Percentage $ 53,143.27 Total Earned Less Retainage $ 478,289.32 Less Previous Certificates for Payment.. $ 471,989.38 Current Payment Due $ 6,299.94 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 vaild 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 daims 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$ $ 6,299.94 and on receipt of Amount Due by the Undersigned,this release as to the Amount Due becomes vaild,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 $ 6,299.94 ,the receipt and sufficiency of which is hereby acknowledge. Dated this 30th day of October 2015 Weihe Construction,Inc. Cu tr ror pll arae) p State of Indiana ) By:( y7/, 'i� _ {acne) h • 7�_ ) SS: (Undersig ) County of Hamilton ) The: HR/Accounting Assistant Before me,a Notary Public In and for said County and State,this 30th day of October 2015, personally appeared xlmheriy 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 30th day of October 2015 • My commission expires: Oct 2015 1IA4Q (Jtaj Notary Public My county of residence is: Hamilton Michelle Garcia (Printed) e€; p ellAiil Document 7025M — 1992 Application and Cert4ficate for Payment TO OWNERAIatinum Properties PROJECT: Meadows ea Leeacv Section 3 •APPLICATION Ni 10 Distribution to: 9757 Westpoint Drive PERIOD TO: OWNERX 0 ' , ,Suite 600 CONTRACT FOR: ARCHITECT D Indianapolis„TN 46256 VIA ARCHITECT: FROM CONTRACTOR:Weihe Construction,Inc. CONTRACT DATE: CONTRACTOR ❑ 15215 Stony Creek Way PROJECT NOST01422-01 ./ Noblesville,IN 46060 FIELD 0 OTHER 0 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been"completed in accordance Application is made for payment,as shown below,in tonneeticn with the Contract. with the Contract Documents,that all amounts have been paid by the Contractor for Work for ACA Document 07031w,Continuation Sheet,is attached, which previous Certificates for Payment were issued and payments received from the Owner,and 1.ORIGINAL CONTRACT SUM $ 525.940.17 that current payment shown herein is now due. 2.-NET CHANGE BY CHANGE ORDERS • $ 25,063.17 CONTRACT :Weihe Construction,Inc. k 3.CONTRACT SUM TO DATE(Line l±2) 551,003.34 By:! / Date: 7I?f i J}C5 4.TOTAL COMPLETED&STORED 7O DATE(Column G on 6703) $ 532,890.04 State ofJndiana ` / `t jj 5.RETAINAGE: County o1Ha n'Iten U a.2.66 %of Cnrhpleted Work Subscribed and sworn to before++ (Columns D+Eon G703) $ 14,190.34 me this Z_, '). day,of j Ix.` b. PA of Stored Material � 1 `�� (Column F on G703) $ Notary Publicj, IiC1, My commission expires:(6 ` Total Retainage(Lines 5a+56,orTotal In Column I of G703) $ 14,190.34 1 in t S 6.TOTAL EARNED LESS RETAINAGE - $ 518,699.70 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 minus Line S Total) to accordance with the Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 517,799,70 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, _/ information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) `Y _< accordance with the Contract Documents, and the Contractor is entitled to payment of the> ,(1 900.02 AMOUNT CERTIFIED. 8.CURRENT PAYMENT DUE X. $ f` r • ' I.BALANCE 70 FINISH,INCLUDING RETA1NAG7 ,\r AMOUNT CERTIFIED $ lab (Line 3 minus Liar 6) $ 32,303.64 (7rrltoch explanation ffamount certified differs from the amount applied initial all figures on this Application and on the Continuation Shhet that are changed to conform with the amount certified) CHANGE ORDER SUIyf i AIL'! ADDITIONS DEDUCTIONS _ ARCHITECT: T • otal changes appmeed it ptEvious months by Owner $ $ Byt Date: 1g Total apprcLvec{'Lgisttionth $ $ _ This Certificate is not negotiable.The AMOUNT'CERTIFIED is payable only3to th Contractor � _ - without TOTAL $ S named herein.Issuance,payment and acceptance of payment are prejudice to my rights of the Owner or Contractor under this Contract. NET C1'?ANGFS by Change Order $ CAUTION:You should sign an original AEA Contract Document,on which this text appears In RED.An original assures that changes will.not be obscured, . AlA Document 0702x",-1992.Copyright 01953,1903,1955,1971,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document is protected by U.S.copyright+aw and internatlonet Trestles.Unaunrodxed reproduction or distribution of this AIA°Document,or any portton of It,may result In severe civil and ertminel penalties,and will be prosecuted to the mseimum extent possible under the lifo-12thehar.,aro permlaed S reproduce ten(10)copies of this document when completed,To report copyright violations of AIA Contract Documents,e-mail The American Institute of Acchpects'legal counsel,eopyrightbalaarg. 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: 4410 CONTACT: CONTACT:Tim Walter CONTACT:Alan Small APPLICATION DATE: 11/10/2015 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)818-2900590-8817(M) Phone:317-776-2966(0776-3050(q DATE: 11/10/2015 A B CI C2 D E ( F G H=E+F+G _1=11/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 This Stored Md stored To Date Compl. 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 $41,544.27 100% ($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 $10,841.00 100% 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% Lgy 03 6b Subsurface Drains NA $50,532.00 $50,532.00 $50,532.00 100% 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 $22,344.00 100% Lgy03 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 Cherry Creek Blvd Constructic Lgy TIF 4c Stripping Topsoil NA $3,184.00 $3,184.00 $3,184.00 l00% Lgy TIF 4e Mass Excvation and Mounding NA $8,641.00 $8,641.00 $8,641.00 1oc% 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 $1,000.00 $13,253.00 100% $1,225.30 $100.00 $1,325.30 $1,325.30 $900.00 Lgy TIF 6a Storm Sewers NA $24,225.60 $24,225.60 S24,225.60 100% Lgy TIF 8a Chair Back Curb and Gutter $7.60/If $12,600.80 $10,000.00 $10,000.00 79% $2,600.80 Lgy TIF 8b Multi Use Path Wheel Chair Ran$1,100/es $4,400.00 $4,400.00 Lgy TIF 8b 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 Gond 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 S1.00/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 $2,937.00 100% 4111 TOTAL $551,003.34 5534,890.04_ $1,000.00 $535,890.04 97% $1,225.29 $100.00 $1,325.30 $16,43860 49002:001 ?AI 114 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE of PAGES AlA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,is attached. APPLICATION,DATE: 4410 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 7/28/']015i. Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: A ' B C D E F G '201422-i1 I • WORK COMPLETED MATERIALS TOTAL. BALANCE TO ITEM SCHEDULED PRESENTLY COMPLETED • RETAINAGE Na DESCRIPTION OF WORK VALUE FRAM PREVIOUS STORED AND STORED %C) FINISH (IF VARIABLE) APPLICATION THIS PERIOD (NOT IN TO DATE (G _ FCG) - RATE) (D + E) D OR E) (D+E+F) )1-00 On-Site 72-00 Stripping Topsoil 5,179.00 5,179.00 5,179.00 100.00 03-00 Prelim Erosion Control 9,181.00 9,181.00 9,181.00 100.00 04-00 Mass Exc&Mounding 41,544.27 41,544.27 41,544.27 100.00 05-00 Soil Stabilization 19,442.50 19,442.50 19,442.50 100.00 06-00 Site&Finish Grading 10,841.00 10,841.00 10,841.00 100.00 1,084.10 p7-00 Sanitary Sewer Mains 75,730.20 75,730.20 75,730.20 100.00 08-00 Sanitary Sewer Laterals 32,895.00 32,895.00 32,895.00 100.00 09-00 Storm Sewers 36,051.80 36,051.80 36,051.80 100.00 3,605.18 0-00 Subsurface Drains 50,532.00 50,532.00 50,532.00 100.00 5,053.20 11-00 Watermain 108,516.40 108,516.40 108,516.40 100,00 2-00 Water Service Lateral 26,837.60 26,837.60 26,837.60 100.00 3-00 Roll Curb and Gutter 22,344.00 22,344.00 22,344.00 100.00 4-00 5'Wheel Chair ramps 1,200.00 1,200.00 5-00 Common Area Sidewalk 2,625.00 2,625.00 '6-00 Cherry Tree Blvd Construction 7-00 tripping Topsoil 3,184.00 3,184.00 3.184.00 100.00 8-00 Mass Exc&Mounding 8,641.00 8,641.00 8,641.00 100.00 9-00 Soil Stabilization 12,428.50 12,428.50 12,428.50 100.00 20-00 iSite&Finish Grading 13253.00 9,253.00 1,000.00 , 10,253.00 77.36 ' 3,000.00 `1,025.30 21-00 Storrs Sewer 24,225.60 24,225.60 24,225.60 100.00 2,422.56 22-00 Chair Back Curb&Gutter 12,600.80 10,000.00 10,000.00 79.36 2,600.80 1,000.00 23-00 Multi Use Path Wheel Ramps 4,400.00 4,400,00 '4-00 Common Area Sidewalk 4,287.50 4,287.50 _ CD-01 _ime Nath 4,360.00 4,360.00 4,360.00 100.00 AlA DOCUMENT G703•COIITIIeUATION SHEET FOR G702•1992 EDITION•AIA •©1992•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW SURE ktAVENUE.N.W.,WASHINGTON.D.C.20005.5292•WARNING:Unlicensed photocopying violates US.copyright laws and writ subject the volator to legal prosecution. G703-1992 CAUT1ONt 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 occur when documents are reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,is attached. APPLICATION,DATE: 4410 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 7/28/2015 Use Column I on Contracts where variable retainage for line items may apply, ARCHITECT'S PROJECT NO.: 1 • A B C 0 E F . 0 H 1 WORK COMPLETED MATERIALS TOTAL ITEM PRESENTLY COMPLETED BALANCE RETAINAGE NO. DESCRIPTION OF WORK SCHEDULED LED FROM PREVIOUS STORED AND STORED G/ C; FINISH (IF VARIABLE) APPLICATION THIS PERIOD (NOT IN TO DATE { RATE) (D + 5) D OR E) (D+E+F) (C-G) CO-02 Conduit Crossings 11,017.50 11,017.50 11 017.50 .100.00 CO-03 \Cherry Creek-Subgrade Prep 5,090.67 5,090 67 5,090.67 100.00 00-04 Concrete Blankets 4,595.00 4,595.00 4,595.00 100.00 7ntal� 551,003.34 531,890.04 1,090.00 532,890.04 96.71 18,113.30 1 14,190.34 1 AAA DOCUMENT 07133•CONTINUAt70N SHEET FOR G702•1992 EDITION•AIA5 •W1992•THE AMERICAN INSTITUTE OF ARCHITECTS,[735 NEW YORK A1\ d AVENUE,N\V.,WASii]NGTON,A.C.20009 5292•WARNING:UnRcense9 plwtocopying vintaNs U,S.copyright laws and will subject the violator to legal prosecution. G703-1992 CAUTION:You should use an original MA document which hes this caution printed In rod.An original assures that changes will not be obscured as may occur when documents are 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) Meadows @ Legacy,Section 3 Owner Platinum Properties Application Number 4410 Date 7/28/2015 Period From 7/1/2015 To 7/30/2015 Original Contract Sum $ 525,940.17 Net Change by Approved Change Orders $ 25,06347 Contract Sum to Date $ 551,003.34 Total In-Place Work Completed $ 532,890.04 Value of Material Stored on Site $ - Total Earned to Date $ 532,890.04 Retained Percentage . $ 14,190.34 Total Earned Less Retainage $ 518,699.70 Less Previous Certificates for Payment,, $ 517,799.70 Current Payment Due $ 900.00 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 vaild 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$ $ 900.00 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 $ 900.00 _,the receipt and sufficiency of which is hereby acknowledge. Dated this 28 day of July 2015 Weihe Construction,Inc. (5 r .....r Supplier Name) State of Indiana ) By: ) SS: (Unde pn`" County of Hamilton ) Title: HR/Safety Di -ctor Before me,a Notary Public in and for said County and State,this 28 day of July 2015, personally appeared Brian Nifong known to me to be HR/Safety Director 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 28 day of July 2015 My commission expires: Oct.2015 t\V,L [P > .- . ) ttt LY Notary Public 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:Welhe Construction,Inc: INVOICE NO: 4588 CONTACT: CONTACT:Tim Walter CONTACT:Alan Small APPLICATION DATE: 10130/2015 ADDRESS: 1356 Beverly Road,Suite 300 ADDRESS:9757 Westpolnt Drive,Suite 600 ADDRESS:15215 Stony Creek Way RETAINAGE: 10% McLean,VA 22101 Indianapolis,IN 46256 Noblesville,IN 46060 APPROVED BY:EEF Phone: Phone:j317L618-2900.590.8817(Ml Phone:317-776-2966(c1,776-30501f) DATE: 11/10/2015 L A B 1 Cl C2 D E 1 F _ G H=E+F+G 1=H = /D J K L=J+K MD•H+L N Project Cost{III Work Description Unit Scheduled Work Completed Materials Total Completed % Previous Retalnege Total BAL.TO Net Pay Code Code Price Value Previous This Stored And stored To Date Comp!. Retainage This Period Retained PAY This Month The Meadows at The Legacy Section 3 On-site construction Lgy 03 4c Stripping Topsoil NA S5,179.00 $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 $41544.27 $41,544.27 $41,544.27 s0o% ($0.00) Lgy03 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 $10,841.00 100% Lgy 03 Sb Sanitary Sewer Mains NA $75730.20 $75,730.20 S75,730.20 100% Lgy 03 5c SanitarySewer 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% Lgy 03 6b Subsurface Drains NA $50,532.00 $50,532.00 $50,532.00 100% 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 $22,344.00 100% Lgy 03 8b 5'Wheel Chair ramps $600/ea $1,200.00 $1,200.00 $1,200.00 100% $120.00 $120.00 $120.00 $1,080.00 Lgy 03 8b Common Area Sidewalk $3.50/sf $2,625.00 $2,625.00 $2,625.00 t00% $262.50 $262.50 $262.50 $2,362.50 Cherry Creek Blvd Constructlo 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 $13,253.00 $13,253.00 100% $1,325.30 $1325.30 $1,325.30 Lgy TIP 6a Storm Sewers NA $24,225.60 $24,225.60 $24,225.60 100% Lgy TIF E'8a CF air,Back Curb'and Gutter $7.60/If $12,600.80 $10,000.00 $2,600.80 $12,600.80 100% $260.08 $280.06 $260.08 $2340:721 tx L`gy-IF 8b Multi Use Path'Wheel:ChairRam$1,100/e2 $4,400.00 $2,200.00 $2,200.00 50% $220.00 $220.00 $2,420.00 $1,98Q O0' LgyTIA 8b:=Common'Area'Sidewalk $3.50/sf $4,287.50 $4,287.50 $4,287.50 100% $428.75 $428.75 $428.75 $3,858:754 CO#1-Cherry Creek Blvd Lgy TIF 4h Multi-use Path Stabilization NA $4,360.00 $4360.00 $4,360.00 100% CO#2-Conduit Crossings Lgy 03 Se Utility Conduits NA $11,017.50 $11,017.50 $11,017.50 100% CO113-CC Blvd Spec Cond Lgy TIP 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 blankets $1.00/ff $1,658.00 $1,658.00 $1,658.00 t00% Lgy 03 8a Onsite-Curb Concrete Blankets $1.00/If $2,937.00 $2,937.00 $2,937.00 l00% p(i_.!:.) CO#5-Grading Lgy TIF,,Ag Stone Shoulder along CC Blvd $435.00 $435.00 $435.00 100% 543.50 543.50 $43.50 x$391 561 r ` -(4/11 Lgy 03 4g Fill in swale next to Lot 71 $2,595.00 $2,595.00 $2,595.00 100% $259.50 t $259.50 . $259.50 `-$2.335.5.0.---, TOTAL $554,033.34 $535,890.04 $12,913.30 $551,833.34 t00% $1,325.29 $1,594.33 $2,919.63 $5,119. 3 $14,348.97 LCI41 W'8 'o ° J Y .„, .�. A�... l ,a Document G742r" -- 1992 Application and Ctfafe for Payment ,; T4 DINNER: :-- PROJECT: APPLICATIQ Pia' ernes Meadows(a..Leaacv Section 3 g8 �� P 975estpaintDrive Pl:RiOiTt +* OwNERXi7 ' ;`•Suite 600 CT FOR: ARCHITECT CI FROM Ctidl1`I't lis„IN 46256 VIA ARCHITECT: , LONTRAGT DATE CONTRACTOR D Weihe Construction,Inc. . 15215 Stony Creek Way PROJECT NOS:201422-ot / I FIELD CI Noblesville,IN 46060 OTHER IC CONTRACTOR'S APPLICATION FOR PAYMENT rhe rmdaresu t Contractor cedilla that to the beat Of the'Contractor's know information Application is made for payment,na:Lown in commotion with the Contract • and bad the WC coveted by this Application for Payment bas been eomptated to aaoo:daaee AZA Document made for aym++nmoon Sheet,is below,attco w the Contract Do t.that all smetmts have been paid by the Contrast=115 Work for C 1.ORIGINAL CONTRACT SUM.. S which previous Catf$oataa for Payment were lamed and payments received from the Owner,and 525.940.17 that assent payment&wen hernia Is now due. 2.NET CHANGE WI CHANGE ORDERS S 2R 093.1? • OR: Weihe Cortsmlction,Inc. J IJ` D J r�5 3.CONTRACT SUM TO OATS(Line f 2r A, ...,. S 5541133_14 18Y .x. :0 ' I Date: 4,TOTAL COMPLETED&$T08ED�li?DATE(Column G on G703) S 551.833.34 State e. Indiana / ' 5.RETAINAGE County el3 Hamilton -.a• 541 9f 6pleted Woz5 Subaan'hed and swamies pre (Akee.7+E on 0703) S 2919.63 me this 30(40 tiyoLa Faz'%..) .2016 :' b. _.ey 4.•'A'of Stored Material "ltI .�i n (Gbtume Fon 0703) S Notary Public 1 '4 l.U"W-t..' /' WIC O IvipTotal Retainage{Lfeas Sa+Sb,or Total In Colwnn 1 of G703) S 2,919.63 ==-�ia.imt d I 10 s V - - 6.TOTAL EARNED LESS RETAINAGE S 548,913.71 ARCHITECT'S CERTIFICATE FOR PAYMENT ` (Lena 4 asb ua.Llne 5 Total) In accordaoca with the Contract DOOGmenta,based as omit:ObaervadOna and tits data comprising T.LESS PREVIOUS PERTIFICATES FOR PAYMENT S 534,564.74 lig applitat;Da,the Architect cattMu to the Owoar that to the hest of the Architect's knowledge, (Line d from prior Cat ttilcate} S information and betiaf the Work tea progressed as}n At vrp 1,the gtssllty of the Wwic th 8.CURRENT PAYMENT DUE t0tV S ..14,348.97 seootdence with the Contract Documents, and the emirate:*IS =tided to Filing= "I { (� AMOTJNT CERTiPX_D. a/ 9.L3ALA�NCE TO FINISH,INCLUDING RETAIN`& .V 7� �~----' AMOUNT CERTIFIED_ „..,.... - .-.......�..,.,.,,...S r S lie JP 1 (Luna 3 rufous Line 6) .. S 5,119.63 ��y'� lea an this �� _ (aJ�explanation trammed ,lfom 8t!amount aPPllad jl$ha'as �/�- t dpplltbtIan and on the Cordlmratlon that ars eleanged m=Ann with tka Dssounf certified) CHANGE ORDER SIXte.V.c ADDITIONS ,_ DEDUCTIONS ARCHITECT: 7 Total chaagea ap iii p/tivicm months by Owner S S By: Data: I' 5" Yarm a i•'rah S S This Certificate Ea' ' gotiahia The AMOUNT CERTIFIED is only the _ TOTAL S i S ttsmad�pgymeru and acceptance of payment am�prgjtldlra m any sights of NET CAANQES.by Manse Order 1$ - the Owner or under this Contract. CAUTION:You should sign an original AlA Contract Deoument,on which this text appear*In RED.An eating assures that changes will not be obscured AIA Document nun,.-isea.Copyright 0 iota,toss,toad.1271,1278,1023 ane 1292 by TheAtesskan MILO ofArchitects.All dghta ruentect,ritnitlittgn This AIA DOWmaat Ia protaoted by 11.6.CepydghtLaw and Intarnallonal Treaties.Unauthorized tapreduadon or liisIsdutlon of thla AIA'Document.or any penton ask,may result to severe elvil and ododnal patanias,and A be prosecuted to the maximum=DU Possible under the lav,Purahwera era Oendt ua to repraduee tan(lot coax of Ws ddaonontwhon completed.To tpat oopyrtnt4A4{adans et AIA:anent Danmlanta.04t50 Tho Aawrban laseane aA ohltaots'tad wunaou.cep e1ghtlata.emm. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reversestde) MGE OF PAGES AIA Document G702,APPLICATION AND CERTIPIC.ATE FOR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,Is attscbed. APPLICATION,DATE: In tabulations below,amounts are stated CO the nearest dollar PERIOD TO: , Use Column I on Cpnttacts where variable retainage for line items may apply. ARCHITECTS PROJECT NO.:4588 10/3012015 A ' B C D 6 F . G 18 , 1 TCCAL WORK COMPLETED MATERIALS COMPLETED • 10l42a t)tts.•„� RETAINAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS P AND STVR$A y� To VARIABLE) NQ VALUE APPLICATION TATS PERIOD CR IN TO DATE (G+C) FINISH (D + E) STORED DOR E) (0+2+P) • (C-G) 1 CI-00 Qn-Site 02-00 Stripping Topsoil 5,179.00 5,179.00 5,179.00 100.00 03-00 ."relim Erosion Control 9,181.00 9,181.00 9,181.00 00.00 04-00 I'ass Exc&Mounding 41,544.27 41,544.27 f 41,544.27 00.00 05-00 !on Stabilization 19,442.50 19,442.50 • 19,442.50 '00.00 06-00 I ite&Finish Grading 10,841.00 10,841.00 10,841.00 '00.00 n 07-00 Sanitary Sewer Mains t 75,730.20 75,730.20 75,73020 '00.00 08-00 Sanitary Sewer Laterals 32,895.00 32,895.00 . 32,895.00 '00.00 09-00 .torm Sewers 36,051.80 36,051.80 36,051.80 '00.00 10-00 Subsurface Drains 50,532.00 50,532.00 50,532.00 '00.00 11-00 Natermain 108,516.40 108,516.40 108,518.40 '00.00 12-00 Water Service Lateral 26,837.60 26,837.60 26,837,60 '00.00 13-00 s,all Curb and Gutter 22,344.00 22,344.00 22,344.00 '00.00 14-00 t'Wheel Chairramps 1,200.00 1,200.00 1,200.00 00.00 120.00 15-00 0.ommon Area Sidewalk 2,625.00 • 2,625.00 2625.00 100.00 262.50 16-00 4 heny Tree Blvd Construction s 11-00 :tripping Topsoil 3,184.00 3,184.00 3,184.00 100.00 16-00 class Exc&Mounding 8,¢41.00 8,641.00 8,641.00 100.00 , 19-00 ,oil Stabilization 12,428.50 12,428.50 12,428.50 100.90 20-00 :ite&Finish Grading 13,253.00 13,253.00 13,253.00 100.00 1,325.30 2)-00 :tone Sewer 24,225.60 24,225.60 • 24,225.60 100.90 22-00 shah-Back Curb&Gutter 12,600.80 10,000.00 2,600.80. • 12,600.80 100.00 260.08 23-00 ulti Use Path Wheel Remps 4,400.00 2.200.00. _ _ 7,2n4Ina 50.00 . • 2200,00 220.00 • 24 (3 •ommonArea Sidewalk 4,287-50 • ' 4,287.50 4,287.50 100.00 428.75 CO-01 Um Path 4,360.00 4,360,004,360,00 10,00 • • I 1 •..iji A1A nommen coos•CONTINUATION=MT FOR 0702•1992 ARSON•Ale •01992•THE AMb1UCAti INT0TtTTR OF asCM'rSCts.I755 New YORK G703-1992 ,.../, Asxus,N-W,.V alliSN rON,Dc 20006.8292•w « aRN1NG4 Unticonood photuPrkw vtotatw 'copyright pyr saes end wm subpar Zs**dor to!egad pmseau9on. S?Z CAUTION:lieu should use en original A1A document which heathts caution painted fn rod.An odglnal enures thet ehanges will not be obscured as may occur when documents aro reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Inatrucdons on reverse side) PAGE OF PAGES _ AIA Document G702,APPLIC CION AND CERTIFICATE POR PAYMENT, APPLICATION NO.: containing Contractor's signed Certification,is attached. APPLICATION,DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Use Colum.I on Cpntracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 4588 10/30/2015 A ' B C D E P . G H I WORE COMPLETED MATERIALS TOTAL ;0142&211,4C8 COMPLETED 96• TO RETAINAGE ITEM DESCRIPTION OF WORK SC V� FROM PREVIOUVALUES P STORED AND DArs (G t C) ' FINISH VARIABLE) APPLICATION) THIS PERIOD gol 44144) • (C_G) RATE) • OR C3-02 3onduitCrossings 11,017.50 11,017.50 71,017.50 100.00 C3-03 Cherry Creek-Subgrade Prep 5,090.67 5,090.67 5.017.50 100.00 C 3-04 Concrete Blankets 4,595.00 4,595.00 4,595.00 100,00 CO-05 Fill in Swale 3,0.30.00 3,030.00 3,030.00 00.00 303.00 • • • • • VA:7 tux 04 tam•CON iNUMION atauffiirO M It%ErE/9 418906814 •r nym 5 CAN=MOTE or�tidel�.60 2,200.00 2,47%e992 AEE NEL NW WADimdGZDN,OC 70006 3292•wAANING2 Ualleuxad 9 0099012dud 44.t.• P W n Ma subleat ttr i • CAUI10PI:Ibu should use an original AIA document which Magda caution printed In red.An original assures Slut changes vat not be obscured ss may occur when deoumenta are reproduced, APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN Subcontractor or Supplier Name Weihe Construction,Inc. Subcontractor or Suppler Address Noblesville,IN 46060 Phone (317)776-2966 Type of Service Furnished Construction Construction Cost Division Number Project(Building Number) Meadows at.Legacy Section 3 Owner _ Platinum Properties Application Number 4588 Date 10/30/2015 Period From 10/1/2015 To 10/30/2015 Original Contract Sum $ 525,940.17 Net Change by Approved Change Orders $ 28,093,17 Contract Sum to Date $ 554,033.34 Total In-Place Work Completed $ 551,833.34 Value of Material Stored on Site $ Total Earned to Date $ 551,833.34 Retained Percentage $ 2,919.63 Total Earned Less Retainage $ 548,913.71 Less Previous Certificates for Payment.. $ 534,564.74 Current Payment Due $ 14,348.97 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$ $ 14,348.97 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 $ 14,348.97 ,the receipt and sufficiency of which is hereby acknowledge. Dated this 30th day of October 2015 Welhe Construction,Inc Su•.gerNe••-) State of Indiana ) By:1_ 17/176ia: I ) S5: (Und, • ed) County of Hamilton ) lite: HR/Accounting Assistant Before me,a Notary Public in and for said County and State,this 30th day of October 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 Seat. Dated this 30th day of _ October 2015 Y46(1)(4&) � My commission expires: Oct 2015 ( , J 1)(4&) Notary Public My county of residence is: Hamilton Michelle Garda (Printed) 3� fi w ,1, lY V �r • C fters9 Ines Invoice 16795 North Gray Road _ r, Noblesville, IN 46062 Date Invoice# • 10!27/2015 74 ./n. . 1.4M joel@concrafters.com '°' 3=fry 317-538-3545 Falcon Nest II L.L C. 9' r Legacy Onsite (6veataess Ogg,2) P.O. No. Project Quantity Description Rate Amount 7 Install ramps as per plan 400.00 2,800.00 878 Install walks as per plan 3.50 3,073.00 ( — 8 Total 15,873 0 ) *Concrafters, Inc. requires a 10%non-refundable deposit to schedule work,40%when job begins,and remaining 50% 0 tf immediately upon completion. \`V *Concrafters, Inc.does not guarantee against cracking. However, we will attempt to minimize its occurrence by properly preparing the base, and by use of crack control joints and expansion joints. *There may be some damage to lawn. Concrafters, Inc. does not repair such damage unless previously agreed to in writing. * Your signature below indicates that you have read this contract in its entirety and agree to all terms and conditions set forth herein. Signature &Date AFFIDAVIT AND WAIVER OF LIEN X FINAL PARTIAL X PAYMENT TO FOLLOW 0 f►-1 1• 1being duly sworn,state that he/she is the ka of I Concraflers Inc. having contracted with Platinum Properties Management Co.,LLC. to 'sh certainmaterials and/or labor as follows: Invoice No.74 for a project known as The Overlook at The Legacy Section 2 ,located at 146th Street and River Road ,and owned by Falcon Nest II,LLC ,and further states: PARTIAL WAIVER: that the balance due by the owner is the sum of Dollars($ )- Receipt of which is hereby acioaowledged;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 by the owner is the sum of Five Thousand Eight Hundred Seventy-Three And 001100 Dollars($5 873.00). Receipt of which is hereby acknowledged;or X 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. •mpany N kfir V, , .ionized Representative 'tie 401 re WITNESS: ` Il�u'«i..A� KRISTEN E STEPHENS Signatureslar, NOTARY PUBLIC SEAL /cJTAJ <Si t,n4-✓.1 STATE OF INDIANA Printed Name of Witness MY COMMISSION EXPIRES SEPT.15,2022 Co r cr fters, Inc. invoice 16795 North Gray Road Noblesville,IN 46062 Date Invoice# '* 10/27/2015 75 joel@concrafters.comzirf 317-538-3545 Falcon Nest II L.L.C. Legacy ) � Chevy Creek Blvd. '`, r„ i P.O.No. Project Quantity Description Rate Amount 8 Install ramps as per plan 400.00 3,200.00 6 Install ramps as per plan Multi use 10'walks 500.00 3,000.00 2,800 Install walks as per plan 3.50 9,800.00 -11C e)6 Total $16,000.00 * Concrafters,Inc.requires a 10%non-refundable deposit to schedule work,40%when job begins,and remaining 50% immediately upon completion. * Concrafters,Inc.does not guarantee against cracking. However,we will attempt to minimize its occurrence by properly preparing the base,and by use of crack control joints and expansion joints. * There may be some damage to lawn.Concrafters,Inc. does not repair such damage unless previously agreed to in writing. * Your signature below indicates that you have read this contract in its entirety and agree to all terms and conditions set forth herein. Signature&Date 1 AFFIDAVIT AND WAIVER OF LIEN X FINAL PARTIAL _ X PAYMENT TO FOLLOW 4d'4 ..L 14 being duly sworn,state that he/she is the ' A of Concrafters Inc. having contracted with Platinum Properties Management Co., LLC. to rnish certain materials and/or labor as follows: Invoice No.75 for a project known as The Overlook at The Legacy Section 2 ,located at 146th Street and River Road ,and owned by Falcon Nest II,I..LC ,and further states: PARTIAL WAIVER; that the balance due by the owner is the sum of Dollars($ ), Receipt of which is hereby acknowledged;or The payment of which has been promised as the sole consideration for this Affidavit and 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 Sixteen Thousand And 00110.0 • Dollars($16,000.00). Receipt of which is hereby acknowledged;or X 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. ___f-01 a—: . _:,:i• _ Alb 4/- . Company lame 0 4r 1 Authorized Representative 0 Title 1 10 C > I KRISTEN E STEPHENS I WITNESS: ` C �I ':�'► NOTARY PUBLIC Signature / ' SEAL STATE OF INDIANA 'sT'w . STr A MY COMMISSION EXPIRESPT SE .15,2022 i Printed Name of Witness t a ' Ift40IC;nc. :. �_ 67865 H1TTLE LAND . . .. PING 17778 Sun Park Drive•Westfield,IN 46074 317.896.5697 • 317.896.2471 fax www.NiBletandscape,cam Job Location Meadows at Legacy Section 3 Platinum Properties Bill to: 9757 Westpoint Drive, Suite 600 Indianapolis, IN 46256 N0111 e44 1494 19027 Nett 36 10/20/2015.-: /2015'.: 1 Landscape Install 6,581.94 6,581.94 Tax SUBTOTAL 6,581.94 T?y<;til� 0.0G Tax 0.00 Buyer shall pay a late payment charge of 1 1/2%per month(which is an annual percentage of 18%)on any portion of ascountt not paid within terms on invoice. Buyer shall pay all reasonable collection expenses including reasonable attorneys fees. = 6,581.94 APPLICATION FOR PAYMENT CAP702 Page: 1 of Z To. PROJECT Platinum Properties Management Co., MEADOWS LEGACY Application No.!: Application Date Period To, Contract Date: 9757 Westpoint Drive Meadows et Legacy Section 3 Suite 600 SW Corner Community Dr& CherryCrk 1 OCT 23,2015 OCT 23,2015 APR 30,2015 Indianapolis, IN 46256 tY Project Nos Carmel, IN From Contractor: ViAARCHITECT El Owner ❑ Construction Mgr Hittle Landscaping Inc. Distribution List El Architect — Field 17778 Sun Park Drive Westfield IN 46074 Contractor U Other Phone:(317)896-5697 CONTRACT FOR Landscaping Contractor's Application for Payment CONTRACTOR'S CERTIFICATION: - -- -..- ; Application is made for payment as shown below,with attached Continuation Sheet. The Contractor's signature here certifies that,to the best of their knowledge, 1. Original Contract Amount: $ 6,581.94 this document accurately reflects the work completed in this Application ( g 9 for Payment.The Contractor also certifies thatall payments have been made ( o . 2. Net of Change Orders: $ 0.00 for work on previous Applications fS P ymf and also that the Current 4 3. Net Amount of Contract: $ 6,581.94 Payment is Due. G / 432 V � e El o `l 4.Total Completed &Stored to Date: $ 6,581.94 (Authorizing11 _�v._ing Signature) � �* 5. Retainage Summary: Hittle Landscaping, lnG. 4 r v a a� • Date: OCT 23,2015 m ' a i.S,a,. a. 0.00 %of Completed Work $ 0.00 State Authorized: Indiana o g" b. 0.00 %of Stored Material $ 0.00 County of: HAMILTON Subscribed andvorn to before ca Total Retainage: $ 0.00 me this 03 day of C4..._, t a 01`7- 6.Total Completed Less Retainage: $ 6,581.94 Notary Public: Debra S Kulaga _±: My Commission expires: April 30,2022 7. Less Previous Applications: $ 0.00 - -� ' — ----- - ARCHITECT'S CERTIFICATION: f_________1 8. Current Payment Due,This Application: $ 6,581_94_ The Architect's signature here certifies that, based on their own observations, I - - --.. - ---.--._-- the Contract Documents and the information contained herein,this document accurately reflects the work completed in this Application for Payment. 9. Contract Balance(Including Retainage): $ 0.00 The Architect also certifies the Contractor is entitled to the amount certified 'CHANGE ORDERActivity'_ Additions k Subtractions for payment. i 1 Total previously approved: 1 0.00 0.00i .__- _.-----___�— .__ i________ -----_.__.-- AMOUNT CERTIFIED: 4r +• V Total approved this Month: 0.00 0.00 I Sub Totals: 0,00 0.00 740101 Date: �� � NET of Change Orders; 0.00 (Architects Signature) Software by:PEM Software Systems,Inc. 1-800-803-1315 Copyright 2012© APPLICATION FOR PAYMENT - CONTINUATION SHEET CAP703 Page 2 of 2 Pages From To: Protect: i Application No: 1 i Hittle Landscaping, Inc. Platinum Properties Management Co., MEADOWS LEGACYAap ;littio:,pat-6: 10/23/2015 17778 Sun Park Drive 9757 Westpoint Drive Meadows at Legacy Section 3 Period To: 10/23/2015 Westfield, IN 46074 Suite 600 SW Corner Community Dr& Cherry CrkContract Date: 4/30/2015 Phone:(317)896-5697 Indianapolis, IN 46256 Carmel, IN Architects Project#: A B C D E F I I t Work Completed _I Materials Te alCompleted- Balance Retainage Item Description of Work I Contract From Previous This Period Presently and;Stored To Finish (If Variable In No i Value Application Stored(NotTO D&;e t,G t.C) (C-G) (D+E) D or E) t E4F) i Rate) 1 Landscape Installation { 6,581.94 0.00 6,581.94 0.01 6,581.94 100 i 11.00 0.00 E 1 1 f ' i ` d I I i i l) it I I 1— ... --_ ..<...... . _._.._.. ....: ..... .........mom�_..... 6,581.94 0.00 6,581.91 0.10 6,581.54 100 i 0,00 0,00 Software by:PEM Software Systems,Inc. 1-800-803-4315 Copyright 2012 AFFIDAVIT AND WAIVER OF LIEN X FINAL PARTIAL X PAYMENT TO FOLLOW Henry Janzen being duly sworn,state that he/she is the President of Hittle Landscaping, Inc. having contracted with to furnish certain materials and/or labor as follows:_ Landscape Maintenance for a project known as Meadows at Legacy Section 3 ,located at Community Drive & Cherry Creek and owned by Falcon Nest II, LLC ,and further states: PARTIAL WAIVER: that the balance due by the owner is the sum of Dollars(S )' Receipt of which is herebyacknowledged;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 Six thousand,five hundred eighty one& 94/100 Dollars($ 6,581.94 ). Receipt of which is hereby acknowledged;or X 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. Hittle Landscaping, 'nen Company Nate t/ Authorized Representative President Title WITNESS: Signature Debra S. Kulaga Printed Name of Witness