318973 11/22/2017 tii �gAMF
CITY OF CARMEL, INDIANA VENDOR: 371894
d 21 ONE CIVIC SQUARE BO-MAR INDUSTRIES, INC. CHECK AMOUNT: $**`•12,481.29'
=q CARMEL, INDIANA 46032 3838 S.ARLINGTON AVE. CHECK NUMBER: 318973
9M. INDIANAPOLIS IN 46203 CHECK DATE: 11/22/17
t�TON�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 100729 1 12,481.29 MONON STATIC DEVICES
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 371894 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
BO-MAR INDUSTRIES, INC. IN SUM OF$ CITY OF CARMEL
3838 S.ARLINGTON AVE. An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
INDIANAPOLIS, IN 46203
Payee
$12,481.29
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
Redevelopment Commission Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
100729 1 44-608.07 $12,481.29 1 hereby certify that the attached invoice(s),or 10/31/17 1 Center Green signage $12,481.29
902 902 902 902
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Wednesday, November 22,2017
Mestetsky, Henry
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
,20
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 1
TO GC: Carmel Redevelopment Commission APPLICATION NO.: 1 Distribution to:
PERIOD TO: 10/31/17 OWNER
FROM CONTRACTOR: ARCHITECT
Bo-mar Industries, Inc. PROJECT NO.: CONTRACTOR
3838 S.Arlington Ave.
Indianapolis, IN 46203
CONTRACT FOR: Carmel Center Green Signage CONTRACT DATE: 9/19/2017
The undersigned Contractor certifies that to the best of the contractor's knowledge,information and belief
CONTRACTOR'S APPLICATION FOR PAYMENT the Work covered by this Application for Payment has been completed in accordance with the
Application is made for payment,as shown below in connection with the Copntract Documents,that all amounts have been paid by the Contractor for Work for which previous
Contract.Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued and payments received from the owner,and that current
1 ORIGINAL CONTRACT SUM $ 174,354.00
'payment shown herein is now due.
2 Net change by Change Orders $ -
3 CONTRACT SUM TO DATE(line 1+2) $ 174,354.00 CONTRACTOR: Bo-mar Industries, Inc
4 TOTAL COMPLETED&STORED TO DATE $ 13,868.10
(Column G on G703)
5 RETAINAGE: By: Date:
a. 10 %of Completed Work 1,386.81 Vill Buchanan, Treasurer
(Columns D+E on G703)
b. Stored Material % 10 -
(Columns F on G703) State of: Indiana
Total Retainage(line 5a+5b or County of: Marion
Total in Column I of G703) $ 1,386.81 Subscribednd sworn to before
6 TOTAL EARNED LESS RETAINAGE $ 12,481.29 me this �� day of2017
(Line 4 less Line 5 Total)
7 LESS PREVIOUS CERTIFICATES FOR PAYMENT ♦♦♦♦�r,It1111I����
(Line 6 from prior Certificate) $ -
♦�
8 CURRENT PAYMENT DUE $ 12,481.29 ����\�,�yahfxPlRFs4OG'9���i
9 BALANCE TO FINISH, INCLUDING RETAINAGE Notary Public: �� pYARY?'N;
(Line 3 less Line 6) $ 161,872.71 - Q, _ a
My commission expires: uIZ�i/2�2� �';. ag5L\G ;;? _�
ARCHITECT'S CERTIFICATE FOR PAYMENT �i�i 0", F `�*'
In accordance with the Contract Documents,based on-site observations and the data cY. i6�khfs♦
application,the Architect certifies to the Owner that to the best of the Architect's knowledge,infor-
mation and belief the Work has progressed as indicated,the quality of the Work is in accordance
with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AMOUNT CERTIFIED
Total changes approved in (Attach explanation if amount certified differs from the amount applied for.
previous months by Owner
Total approved this Month 0 A
TOTALS 0 Lrtificate
�,.:� l C Q.� Q,� Date. 0, 30,
NET CHANGES by Change Order 0 0 is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named
herein.Issuance,payment and acceptance of payment are without prejudice to any rights of the
of the Owner or Contractor under this Contract.
G703
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 of 2 PAGES
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 1
Contractor's signed Certification is attached. APPLICATION DATE: 10/18/17
In tabulations below,amounts are stated to the nearest dollar. PERIOD FROM: 9/19/17
Use Column I on Contracts where variable retainage for line items may apply. TO: 10/31/17
GC's PROJ NO:
A B C D E F G H
ITEM DESCRIPTION of WORK Scheduled Previous THIS APPLICATION Total Completed % BALANCE RETAINAGE
No. VALUE Application Work in Place Stored Material and Stored (G/C) TO FINISH
1 Sign Type 30 90,454.00 13,568.10 13,568.10 15% 76,885.90 1,356.81
2 Installation of Sign Type 30 3,000.00 300.00 300.00 10% 2,700.00 30.00
3 Sign Type 20 14,400.00 - - 14,400.00 -
4 Sign Type 10/15 60,000.00 - - 60,000.00 -
5 Installation of Sign Type 10/15 3,000.00 - - 3,000.00 -
6 Bond 3,500.00 - - - 3,500.00 -
TOTAL 174,354.00 1 13,868.10 1 13,868.10 1 160,485.90 1 1,386.81
G702 AND G703 BILLING Pay App 1 10-18-17 Pagel
CONTRACTOR'S AND SUPPLIER'S AFFIDAVIT AND WAIVER OF LIEN
[:]Final QPartlal ❑2 Payment to Follow
The undersigned,being first duly sworn on his oath or affirming,states that:
1 Jill Buchanan (Name) is the Treasurer (Title) of
Bo-Mar Industries (Company),(hereinafter called"Company') of and is familiar
with the facts herein stated and makes this affidavit for and on behalf of himself and the Company,being duly
authorized to bind the Company by the statements herein contained.
2 The Company,having contracted with Carmel Redevelopment Commission has performed work and labor
or furnished materials supplies'or equipment in the construction of certain improvements on the real estate commonly
known as Carmel Center Green Signage located at Carmel Center Green in,
Carmel (City), IN (State),which real estate is owned by
Carmel Redevelopment Commission (hereinafter called"Owner").
3 Company has,or will within 10 days of receipt of payment due from Carmel Redevelopment Commission noted in Item 4,
paid for all work,labor,materials,equipment,and suppliers performed or fumished by it and by its subcontractors,material-men
and suppliers upon such premises or in connection therewith and no person,other than Company,has any claim or right to a lien
for any work,materials or services on account of any transaction undertaken by company with respect to said premises,
except as specifically noted below;
Name of Company Amount Owed Explanation for Withholding Payment
NONE
4 The amount due to Company from Carmel Redevelopment Commission
PARTIAL WAVIER that the balance due is the sum of-
Twelve-Thousand
fTwelve-Thousand Four-Hundred Eighty-One and 29/100 ( $ 12,481.29 )
❑ receipt of which is hereby acknowledged,or
0 the payment of which is promised as the sole consideration for this Affidavit and Partial and Waiver of Lien which is given
to and for said amount,effective upon receipt of such payment.
FINAL WAIVER that the final balance due is the sum of:
❑ receipt of which is hereby acknowledged,or
❑ the payment of which is promised as the sole consideration of this affidavit and Final Waiver of Lien which shall become effective
upon receipt of such payment.
THEREFORE,the undersigned waivers and releases under the statutes of the state of Indiana,unto the Owner
of said premises,any and all lien of claim whatsoever on the above-described property and improvements thereon 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,except as noted above,and within the scope of this
affidavit and waiver.
Bo-Mar dustries,Inc.
(Co any ame)
Title: Treasurer
(Signatille of officer)
Subed and 7so before me this 18th day of October , 2017
County of Residence: Marion
otaryPublic)
4/24/2025
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