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318662 11/21/17 ♦o,C.IM* <<,^ CITY OF CARMEL, INDIANA VENDOR: 357430 O ONE CIVIC SQUARE CHARLES C BRANDT CONSTRUCTION CHECK AMOUNT: $.....2,276.67* `,+ CARMEL, INDIANA 46032 1505 N SHERMAN DRIVE CHECK NUMBER: 318662 'M�>ow�. INDIANAPOLIS IN 46201 CHECK DATE: 11/21/17 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 100741 217117-3 2,276.67 PALLADIUM 4TH FLOOR C 0 -0 n < « S \ qQ 0 O I : O 2220 2 2 > CL c o c n k ? c k :3 CD q R n \CA) 03 m $ < CD k k m d o $ 2 2 0 ( § m o O A O # ] -n q q a k o n k \ -0 m 0 \ \ , 8 0 0 � / ( N) A § � j_ / 2 7 ^ cn > CL ® 0 z 2 � 0 2 \ # > -n 0 CD CZ = w w 4 a E 3 7 - z :Z. § § k ƒ ? 0 ¥ E £ + E 7 § m = m ® ? n -n 0 & § ] 7 i - i - m # f ƒ § / 0 \ E - E 7 / \ / § } I - o E R & m 7 ƒ COD \ 2) 0 \ 0 \ C $ A E § C ® l ) 7 � , - , 0 a f 7 � © ° m 0CD z - - cr - § m k 0. CD 0 k ■ ; _ CD or / E D 3 � - ) \ 7 n [ , c < a 0 85 to d z 0 E \ CD§ q ° m ƒ C o 0 £ & * # % _ Z0 CD 00 a E � \ / \ & 2 $_0 �k -v ( D % q D i m \ \ a f o $ 0 / \ k ] _E / c I ¥ k / ] $ ( { 2 � t o 7 k / } 0 E CD k 2 CD M \ k § m CL § \ \ / i 0 \ CL 69 > K ° % o \ )� k ® \ APPLICATION AND CERTIFICATE FOR PAYMENT To(Owner): Carmel Redevelopment Commission Project: Palladium Tenant Build Out 30 West Main St.,Suite 220 Carmel,IN 46032 CCB Invoice Number: 217117-3 Appropriation#902-4460807 Application Number: Three P.O.#100254 Period to: 10/6/17 From(Contractor): Charles C. Brandt Construction Company 1505 N.Sherman Drive Indianapolis,IN 46201 CONTRACTOR'S APPLICATION FOR PAYMENT Change Order Summary Additions Deductions Original Contract Sum $283,700.00 Previous Months $7,563.47 Net Change by Change Orders $27,007.35 This Month $22,766.74 -$3,322.86 Contract Total to Date $310,707.35 Total Completed to Date $310,707.35 Retention $0.00 Totals $30,330.21 -$3,322.86 Net Change by Change Orders $27,007.35 Total Earned Less Retention $310,707.35 Previous Certificates for Payment $308,430.68 The undersigned contractor certifies that to the Current Payment Due $2,276.67 best of the contractor's knowledge,information and belief the work covered by this application for payment has been completed in accordance with the contract documents. State of: Indiana County of: Marion Subscribed and sworn to before me this 6th day Contractor:Charles C.Brandt Construction Company of October,2017. By: 10/6/2017 Notary Public: Ruth A.DiLiberto Steven E.Lankton,President Commission Expires: February 1,2022 C� CHARLES C. BRANDT CONSTRUCTION Co. CHARLES C.BRANDT CONSTRUCTION COMPANY APPLICATION COST BREAKDOWN Application Date: 10/6/17 Project: Palladium Tenant Build Out Application Number: Three Period To: 10/6/17 CCB Proj#: 217117 Work Completed Materials Total Comp. Scheduled Previous This Presently &Stored Percent Balance Item Description Value Application Period Stored To Date Complete To Finish Job Directs 9,855.00 9,855.00 0.00 9,855.00 100% 0.00 General Conditions 26,231.00 26,231.00 0.00 26,231.00 100% 0.00 Site Work 978.00 978.00 0.00 978.00 100% 0.00 Concrete 180.00 180.00 0.00 180.00 100% 0.00 Woods&Plastics 9,294.00 9,294.00 0.00 9,294.00 100% 0.00 Thermal&Moisture Protection 464.00 464.00 0.00 464.00 100% 0.00 Doors and Windows 38,221.00 38,221.00 0.00 38,221.00 100% 0.00 Framing&Drywall 44,032.00 44,032.00 0.00 44,032.00 100% 0.00 Acoustic Ceiling 18,332.00 18,332.00 0.00 18,332.00 100% 0.00 Carpet&Resilient Flooring 12,883.00 12,883.00 0.00 12,883.00 100% 0.00 Painting&Wallcovering 14,912.00 14,912.00 0.00 14,912.00 100% 0.00 Specialties 465.00 465.00 0.00 465.00 100% 0.00 Fire Protection 11,470.00 11,470.00 0.00 11,470.00 100% 0.00 Plumbing 6,865.00 6,865.00 0.00 6,865.00 100% 0.00 HVAC 20,750.00 20,750.00 0.00 20,750.00 100% 0.00 Electrical 42,000.00 42,000.00 0.00 42,000.00 100% 0.00 Change Order #1 5,460.90 5,460.90 0.00 5,460.90 100% 0.00 Change Order #2 1,045.90 1,045.90 0.00 1,045.90 100% 0.00 Change Order #3 1,056.67 1,056.67 0.00 1,056.67 100% 0.00 Change Order #4 22,766.74 20,490.07 2,276.67 22,766.74 100% 0.00 Change Order #5 (3,322.86) (3,322.86) 0.00 (3,322.86) 100% 0.00 Bond and Builder's Risk 2,514.00 2,514.00 0.00 2,514.00 100% 0.00 Overhead 14,132.00 14,132.00 0.00 14,132.00 100% 0.00 Fee 10,122.00 10,122.00 0.00 10,122.00 100% 0.00 END [TOTALS 310,707.35 308,430.68 2,276.671 0.00 310,707.35 100.0% 0.00 CO3 Page 1 CHARLES C. BRANDT CONSTRUCTION Co. AFFIDAVIT AND WAIVER OF LIEN Type: Final Payment To Follow State of Indiana County of Marion,SS: Steven E. Lankton, being duly sworn states that he is the President of Charles C. Brandt Construction Co., having contracted with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows:general construction for a project known as Palladium Tenant Build Out and owned by Carmel Redevelopment Commission; and does hereby further state that the balance due from the Owner is the sum of$2,276.67 the payment of which is the sole consideration for this Affidavit and Final Waiver of Lien which shall be effective upon receipt of 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 and 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. Charles C. Brandt Construction Co. By , President WITNESS MY HAND AND NOTARIAL SEAL,this 6th day of October 2017. lol,-t Lk-�" Ruth A. DiLiberto My Commission Expires: February 1, 2022 Residing in Hancock County Building visions into reality since 1907 ® 1505 NORTH SHERMAN DRIVE, INDIANAPOLIS, IN 46201 317.375.1111 CCBRANDT.COM