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181720 01/25/2010 CITY OF CARMEL, INDIANA VENDOR: 363782 Page 1 of 1 1. ONE CIVIC SQUARE HORNING ROOFING I' CARMEL, INDIANA 46032 2340 ENTERPRISE PARK PLACE CHECK AMOUNT: $145,305.00 \'4., 0 INDIANAPOLIS IN 46218 CHECK NUMBER: 181720 CHECK DATE: 1/25/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 6 145,305.00 PERFORMING ARTS CENTE SL Subcontract Billing Report For Work Invoiced From 11101/09 to 11/30/09 S ubcontract: 2695 7 3 040;Roofing 040'- 3 Job: 2695- Carmel RPAC Construction Vendor: 3271 HORNING ROOFING 777 3rd Ave. SW Carmel, IN 46032 "Contracts To Date This Period E Item Units UM Unit Cost Amount Units!% Amount Units/% Amount 1 3040 Roofing LS 1,366,450.00 41.70% 569,830.00 11.82% 161,450.00 Total Contract Items 1,366,450.00 569,830.00 161,450.00 Change Orders 2 CCR 1008 Oculus LS 1,430.00 0.00% 0.00 0.00 0.00 Alternate 3 CCR 1009 Clay Tile Roof LS 419,400.00 20.03% 84,000.00 0,00 0,00 Alternate Total Change Order Items 417,970.00 84,000.00 0.00 Subcontract Totals: 1,784,420.00 653,830.00 161,450.00 Total Billings: 653,830.00 161,450.00 Unpaid Retainage: 65,383.00 16,145.00 Discounts: 0.00 0.00 Net Billings: 588,447.00 145,305.00 98 SSC CMa Projects Page 1 11/19/09 12:00:56 PM Date Format MM /DD /YY SLSubBillingReport rpt .r Document G702 /CMaTM 1992 Application and Certificate' for Payment Construction Manager A• dition TO OWNER: -Ur y Cam (na1�' PROJECT: 9 PLICATION NO: Distribution to: 0 OD TO -2Ga q OWNER �b `j, l CONSTRUCTION MANAGER Ii v V 3. 2 Ads 32 FROM CONTRACTOR: VIA CONSTR CTION MANAL' NTRACT DATE: ARCHITECT 0 P•t' 1 n� I P ROJECT NOS: ,5'1 f CONTRACTOR 4590 �1� a an 0 VIA ARCHITECT: FIELD -itiOnniiDDii3) in) CONTRACT FOR: 830 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment, as shown below, in connection with the Contract, belief the Work covered by this Application for Pa ment has been completed in accordance with the Continuation Sheet, AIA Document 0743, is attached. Contract Documents, that all amounts have been by the Contractor for Work for which previous Certificates for Payment were issued" an, p is received from the Owner, and that current 1. ORIGINAL CONTRACT SUM 00p ayment shown herein w du 2. Net change by Change Orders CONTRACTOR: 3. CONTRACT SUM TO DATE (Line :1 2) 8 .Q�S -I Date: 9 4. TOTAL COMPLETED STORED TO DATE Column G on G703) ta o f: 0 5. RETAINAGE: County of: a. /0 of Com leted Work sworn e P Subscribed and swor to befor n (Column D E on 0703) 66;383. ice me this day of I g. 9 b. of Stored Material Notary Public: (Column F on G703) Q CC) My Commission expires: t Total Retainage (Lines 5a 5b or Total in Column I of G703) 66' 383. Go CERTIFICATE FOR PAYMENT "T In accordance with the Contract Documents, based on on -site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE .T this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $'9'/3 /91. Q7 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8. CURRENT PAYMENT DUE /95 5 t 6 C3 AMOUNT CERTIFIED /9 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amrunt Initial all figures on this Application a d on the Continuation Sheet that are changed to conform with the amount certified.) 3 (Line 6) /96 9 ij CONSTRU• TI! N MA C' jP By: I "tom 1, Date: 2_ 1/ I CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE r✓ T_ Total changes approv in previous months by Owner $9/9 1 cx y •IV By Date: It- g 0 Total approved this'Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS 4n9 9 0 named herein. Issuance;" payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order 4i/ 9 9 /o, ,QG the Owner or Contractor under this Contract. n CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law- Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. CONTINUATION SHEET AIA DOCUMENT G703 Page 1 of 1 Application No: 20 Application Date: 10/27/2009 JOB NAME CARMEL R PAC CONSTRUCTION Period To: 11/01/2009 HORNING JOB 8 2408 Architect's Project No: A B C D E F G H I Work Completed Materials Total Balance Retainage From Previous Presently Completed to Finish Application Stored Stored to Date (G /C) Item# Description of Work Scheduled Value (D +E) This Period (Not in D or E) (D +E +F) 1 Roofing Labor $107,140.00 $47,430.00 $47,430.00 $59,710.00 $4,743.00 2 iRoofing Material $166,980.00 $88,000.00 $78,980.00 $166,980.00 $0.00 $16,698.00 3 Nailbase Material $105,300.00 $105,300.00 $105,300.00 $0.00 $10,530.00 4 Nailbase Labor $38,180.00 $30,540.00 $30,540.00 $7,640.00 $3,054.00 5 Sheet Metal Labor $57,350.00 $0.00 $11,470.00 $11,470.00 $45,880.00 $1,147.00 6 Sheet Metal Material $146,390.00 $30,000.00 $30,000.00 $116,390.00 $3,000.00 7 Tile Dome Material $112,000.00 $41,000.00 $71,000.00 $112,000.00 $0.00 $11,200.00 8 Tile Dome Labor $39,800.00 $0.00 $0.00 $39,800.00 $0.00 9 Tile Balance Material $168,000.00 $41,000.00 $41,000.00 $127,000.00 $4,100.00 10 Tile Balance Labor $59,700.00 $0.00 $0.00 $59,700.00 $0.00 11 Paver Material $56,700.00 $0.00 $0.00 $56,700.00 $0.00 12 Paver Labor $18,900.00 $0.00 $0.00 $18,900.00 $0.00 13 Bond $15,010.00 $15,010.00 $15,010.00 $0.00 $1,501.00 14 Subcontractor $250,000.00 $2,100.00 $2,100.00 $247,900.00 $210.00 15 Submittals $5,000.00 $5,000.00 $5,000.00 $0.00 $500.00 16 Safety /Start -up $7,500.00 $3,000.00 $3,000.00 $4,500.00 $300.00 17 Clean -up /Closeout $7,500.00 $0.00 $0.00 $7,500.00 $0.00 18 Change Order #1 ($1,430.00) $0.00 $0.00 ($1,430.00) $0.00 19 Change Order #2 $419,400.00 $84,000.00 $84,000.00 $335,400.00 $8,400.00 20 Allowance $5,000.00 $0.00 $0.00 $5,000.00 $0.00 $1,784,420.00 $492,380.00 $161,450.00 $0.00 $653,830.00 $1,130,590.00 $65,383.00 HORNING ROOFING SHEET METAL CO, LLC AFFIDAVIT AND WAIVER OF LIEN INVOICE 6 STATE: INDIANA FINAL PARTIAL X PAYMENT TO FOLLOW COUNTY OF: MARION _RON PHELPS II Being duly sworn that he is the President of _Horning Roofing Sheet Metal Company, LLC contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: As Per Contract for a project known a as: Carmel Regional Performing Arts Center located in: Carmel and owned by and does hereby further state on behalf of the aforementioned subcontractor supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of DOLLARS: $77,400.00 X receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of DOLLARS: receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become 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 material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, in any, and further certified that no other party has an /aim or right to lien on account of any work performed or material furnished to undersi. f. said project and within the scope of this affidavit and wavier. IP _Horning Roofing Sheet Metal Co.,LLC_ By: AY/ 1 Pre sident Ron helps I WITNESS MY HAND AND NOTARIAL SEAL THIS: 11/17 '69 MY COMMISSION EXPIRES: 02 -02 -11 COUNTY OF RESIDENCE: Morgan NOTARY Kevin L. Moore PAYROLL IFOR CONY' ^TOW'S OPTIONAL USE) NAME OF CONTRA... _rl 1 OR SUBCONTRACTS R n ADDRESS 2340 E111ERPRISE PARK PI_ STE A [CORNING INVESTMENTS LLC S729 INC [ANAPOLIS IN 46218 1-.. to Y 1 S r PROJECT AND LOCATION PROJECT OR CONTRACT NO. PERIOD BEGIN 11/0912009 PERIOD END 11/15/2009 82408 s o 0 m CI) 121 131 (41 DAY AND DATE [5I 181 11[ i ISl 01 NAME AND INDIVIDUAL DEDUCTIONS CHECK NO. I IDENTIFYING N.UMBER ia.g.. 10. OF WORK Sun Mon CZ Ned Thu W Sat TOTAL 1eATE GROSS 1 I o ET LAST FOUR DIGITS OF SOCIAL W hI1oi. IN0 CLASSIR S 09 10 11 gm 4140 RS OF PAY WEEK FICA FED STATE OTHER OTHER TOTAL NE P AGES m SECURITY NUNINER[ OF WORKER EXEMPTIONS CATION WfH TAXES HOURS WORKED EACH DAY FOR WEEK RAKER, 89111) MICHAEL DIRDEP R 5 I 60.56 1614.80 1 8.00 8.00 8.00 8.00 8.00 40,00 40.37 1614,80 121.40 292.90 78.70 493.00 1121.80 1- C PE5 TYtE, AARON D oy 5 0 60.56 1614.80 2 S 8.00 8.00 8.00 8.00 8.00 40.00 40.37 1614.80 118.28 261.78, 75.99 456.05 1158.75 ER 111LLIAII J 8 "9: P 11 1 60.56 968.88 0 S 8.00 8.00 8,00 24.00 40.37 1332.08 100.25 140.78 61.77 302.80 1029.28 HOIIPSO CHRISTOPHER k 1 T DIRDEP N 0 37.13 990.00 a 4 s 8.00 8.00 8.00. 8.00 8.00 40.00 24.75 990.00 72.59 46.43 43.78 162.80 827.20 M o O 0 0 s -1 o 0 S 1 0 E S S I I 1 H r j I i fl El S r 0 5 Ov ma Created by Paycfilex, Inc. (Rev. Dec. 2008) e' PAYROLL {FOR CON" 'CTOA'S OPTIONAL USE:) NANIE OF CONTRAC 10R t] OR SUBCONTRACTOR 0 ADDRESS 2340 ENTERPRISE PARK PL STE A HORNING INVESTMENTS LLC S729 INDIANfAPOLIS IN 46218 -0000 co PAYROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO. N PERIOD REGIN 11/0912009 PERIOD END 1//1512009 82408 R or o m {11 12? Sal 1.4} DAY AND DATE CM 48) QRUS [71 4B 4 1 NAME AND INDIVIDUAL c DEDUCTIONS CHECK rva. IDENTIFYING NUMBER le.g,. NO. OF WORK Mn o Tue Wed Thu Fri Sat TOTAL RATE PROD S LAST FOUR DIGITS OF SOCIAL WITHHOLDING CLASSIFI- 15 09 10 11 12 13 14 °HOURS OF PAY FICA FED STATE OTHER OTHER TOTAL NET WADES m M HOURS WORKED EACH DAY SECURITY NUMBER) OF WORKER EXEMPTIONS CATION WEEK WIN TAXES PAID FOR WEEK GONZA EZ, DANIEL G A 111 1 5 5 1.50 8.00- 9 31.98 303.81 e..., 0 IIIIII 2 ©1111.111ill 0 -00 21.32 1245.35 95.27 182.82 60.58 338.67 906.68 GO ZA .FEDE•ICO R. A :i 6 O S 8.00, 1.50 9.50 31.98 303.81 4 D 0.00 21.32 1245.35 94.87 146 -44 58.40 945.64 0 E s t 0 S '.-E n o x 0 0 M 0 0 S I I f 3 ff S 1 I S C 0 S 0 itg 0 I 0 0 0 Overtime Strea (Time Created by Paychex, Inc. (Rev. Dec. 2005) `"'r PAYROLL {FOR CON ':TOfi'S OPTIONAL USE; NAME OF CONTRAC •vR OR SUBCONTRACTOR ADDRESS 2340 ENTERPRISE PARK PL STE A 1-` r BOR111M6 INVESTMENTS LLC 5729 INDIANAPOLIS IN 46218 co PAYROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO_ ro PERIOD BEGIN 11/09/2009 PERIOD END 11115/2009 82408 R d ca Ili 121 (31 ICI DAY AND DATE (51 {61 177 I81 1- §I NAME AND INDIVIDUAL Ir MI {{Pd Thu ra 5at TOTAL RATE GRO65 DEDUCTIONS CHECK Na. IDENTIFYING NUMRER 10.9.• OF WORK �iiii� PR❑J HEr wnces LAST FOUR 010118 OF SOCIAL ITlillOLDIN€i C LASSIF I- 15 09 10 ME 12 13 14 HO URS OF PAY W FICA FED STATE OTHER OTHER TOTAL PAID co SECURITY NIJIJISERI OF WORKER E1%IPTIONS CATION HOURS WORKED EACH DAY 1 E WIH TAXES FOR WEEK 41 60NZAL;;7, DANIEL IIAGAMA 8 S 31.98 469_04 2 S 8.00 7.50 6 22 21.32 1245.35 95.27 182.82 50.58 338.67 906.68 r w GOM2 L d, FEIR111C0 11AGAt1A 1 5 0 31.98 469.04 to ta b S 8.00! 7.50 6. 50 22.00 21. 32; 1245.35 94,87 146.44 58.44 299.71 945.64 50 T 8019 Lb ALAN DTRDEP M O 31.98 341.12 0 S r 8.00 8.00 16.00 21.32 616.25 47.15 34.02 29.38 1 110.55 505.70 CA GAL, >JILLIAH P 11 v MI M O 43.59 1075.22 0 0 S 8.00 7.50 3.00. 8.00 8.00 2.50 37.00 29.06 1300.22 94.37 125.38 59.96 279.71 1023.51 n p S r I O S Q 1 i O S S O gi d o 1 r i 1 d d a O4ertlma Created by Paychex, Inc. (Rev. Dec_ 2008) yr S Strarght. Thna 10/,27/2009 09:18 FAX 3176369134 HORNING ROOFING 0i001 Date: j �9 To: Shiel Sexton 777 3rd Avenue South West Carmel, IN 46032 Phone Number (317) 688 -6856 Fax Number (317) 688 -6889 Attn: GEOFF PRATT From: Leanne Torres Payroll Administrator Horning Roofing Sheet Metal Company, LLC 2340 Enterprise Park Place, Suite A Indianapolis, Indiana 46218 Phone Number (3] 7) 636 -9128 Fax Number (317) 636 -9134 Pages Including Cover: On the following pages you will find the Certified Payroll for the Carmel Performing Arts Center Project the following payroll dates: Week Beginning /0 9 -09 Week Ending /0 21 9 Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending I. a N /j 0 O f Z 0 m Date )b) WHERE FRINGE BENEFJTS ARE PAID IN CASH o �/y� t -Q I�r� n Qp� y ,�C�Q {My m i, O 1 Y 1 ILA7 1 Ir J d h V iLJ 1 e r tc 3 y et Each laborer or mechanic Ilsted In the above rnforencod payro9 Iras bean paid. co (Name of Signatory Party, (Title) as TTT as Indicated on the payroll, an amount nal Less than the sum of the applicable do hereby stale: basic hourly wage rate plus the amount of the required hinge benefits as Ilsted In the conked, except as noted In Seaton 410 WNW. (1) That t pay or supervise the payment of the persons employed by ce he 1 1 y y r (c) EXCEPTIONS he ea t 1 =tractor Subcontractor) ar) EXCEPTION (CRAFT) EXPLANATION ,A .4A s #J,o i T 4 I.t 4 0 fs that during the payroll period commencing on the m ce (Building or o pre J thy of Sand ending the g1 day of al persons employed on said project have been paid the full weekly wages earned. that no rebates have been or MD he made either directly rx indirectly to re on behalf of said lobrp n PWSt S,, firm the full cJ vntractor Suhcontre .f M weekly wages earned by any person and that no deductions have been made either directly or Indirectly Pe from the fultvages earned by any person, other than perrnlsseee deductions as defined in Regutattons. Part 4 3 {2g CFR Seblllle A issued by the Secretary of Labor under the Copeland Act. as amended (48 Slat. 348, I-1 63 Start. 408, 72 Stat. 967; 76 Stat. 357; 40 U.S.G. 276c), and described below: 0 0 0 r~ z n If REMARKS: (2) That any payrolls oiberwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for labelers or mechanics contained therein aro not Tess than the applicable wage rates contained in any wage determination Incorporated into. the contract: that the dasslflcatlees set forth therein for each laborer DT mechanic conform e(h the work ha performed. (3) That any apprentices employed In the above period are duly registered in a bona fide apprenticeship program registered with a Stale apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United Slates Department of Labor, of if no such recognized agency mists In a State, are-registered with the Bureau of Apprenticeship and Training. United States Department of tabor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS j h Tbrre SIGNATURE In addition la the basic hourly wage rates paid to each laborer or metanlc listed in rninialirrilive fire610 A/2'42' ,,Yi isi the above referenced payroll, payments of fringe benefits as listed In the emitted THE INIALFUI FAt.SIFICATIrRI OF ANY OF TH E ABOVE STATEMENTS MAY SUBJECT THE CLH-/ TRACTOR OR C have been or will be made to appropriate programs for the benefit of Stith SUBCONTRACTOR TO CIVIL OR C IRAINAU. PAOSECtfl.Orl, gEE SECTION 1UOI OF TITLE 18 AND SECTION 231 OF TITLE emptoyeea. except as noted In Section 4(c) below', .310F THE UNREe STATES CODE- N u s_0v.O_199r5 irAar PAYROLL (FOTI CON CTOWS OPTIONAL USE NAME OF CONTRACT oR fl OR SUBCONTRACTOR ADDRESS 2340 ENTERPR! SE PARK PL STE A 0 HORNING INVESTMENTS LLC S729 11101ANAP0LI5 IN 46 21 8 -0000 'Ri 1 A PROJECT AND LOCATION PROJECT OR CONTRACT NO. PERIOD BEG EN 10/19 {2009 PERIOD END 10 {25/2009 82408 s O7 0 CD 111 121 I31 14i DAY AND DATE [5} 161 i71 18Y 191 NAME AND INDIVIDUAL Sun Non Wed Sat GADSS DEDUCTIONS C;+WI< NQ_ co IDENTIFYING NUMBER Ie.g„ 0. OF WORT[ TOTAL RATE PROD. HOURS W ORKED EACH DAY 4 LAST FOUR DIGITS OF SOCIAL ITFIHOLnIN0 01 19 20 MI 22 24 HOURS of PAY Ti, FED STATE OTHER 43THER TOTAL NET WA GES t-+ SECURITY NUMBERI OF WORKER EXEMPTIONS CATION 4Y 111101 FED FOR W EEK F6 WEEK CO 8- E', BR AN 1 HAEL 111111 11111 ',1� GIROEP S 1.54 1,50 64.56 90.83 1 MEM IIIIII ill 4.00 40.37 1713.41 128.92 320.40 83.63 532.95 7180.06 CO 1111111111111111110M11.1111111111 MEI C4 CD SO ME 0 NENE ill 11 1111 1.1111111111 ME 0 II= II III MEM 1111 I-1 III o imiimm CI MR MI III all MI 111111 a raa.Ijr II IIIIIIIIIIIIIIIIIIIIIIII IIII 1111111111111111.111111 MIME 1111110 111.1111111 IIIII Ell II III a IIN o II EM 111 Ma MU Ill 111 III II a 1111 1.11 .111 0 MI 111. a 11•1111M1 MO III El D trslflIg h I 'Time S St� Created by Paychex, Inc. (Rev_ Oec. 2008) PAYROLL {FOR CON" CTOR'S OPTIONAL USE NAME IF CONTRA(..J OR UBCONTRACTOR Q AADDRESS 2340 ENTERPRISE PARK PL STE A a HORNING INVESTMENTS LLC 5729 INDIANAPOLIS IN 46218 -000 N N 'AYI%OLL ND. PROJECT ARID LOCATION PROJECT OR CONTRACT RIO. ro PERIOD BEGIN 10119/2009 PERIOD ENO 10/25/2009 82408 S a m 111 (2I [31 r 1 14} DAY AND DATE IS) ILO I7} I8I 191 NAME AND INDIVIDUAL Sun Mon Tue Wed Thu Fri Sat GROSS DEDUCTIONS CHECK No. m IDENT NUMBER (e.g., NO- OF WORK TOTAL RATE PROD 1 r <EI wp LAST FOUR DIGITS OF SOCIAL WITHI-IOLDIN OLASSIFI- 25 20 21 'm 24 HOURS OF FAY WEEK FICA FED STATE ()THEP OTHER TOTAL pale SECURITY NUMBER) OF WORKER EXEMPTIONS CATION HOURS WORKED EACH DAY W1H TAXES FQR WEAK BAKER, BRIAN MICHAEL 6IR0£P s O 60.56 968.88 G 1 8.00 8.00 8.00 24.00 40.37 1713.01 128.92 320.40 83.63 532.95 1180.06 S CZ ROBERT50 IIILLIAM J 8 98011080 w to H 0 60.56 1029. 0 b 8.401 8.0 .O 0 8D 1.50 25.50 40.37 1517.38 414.8E 167.68 70.78' 353.28 1164.10 a O c. I z 5 z 0 O X 0 r 0 Z 1 S O I S O S 1111 i O S 4 v Overtime Created by Paychex, Inc. €Rev. Dec. 2008) S Straight Time PAYROLL FOR CON' CTOR'S OPTIONAL USE} NAME OF CONTRAC !OR OR SUBCONTRACTOR D ADDRESS 2340 ENTERPRISE PARK .PL STE A o HORNING INVESTMENTS LLC 8729 INDIANAPOLIS IN 46218 0000 I PROJECT AND LOCATION PROJECT OR CONTRACT NO. ra PERIOD BEGIN 10/19/2009 PERIOD ENU 10/25/2009 82408 R o m I13 I23 (33 Id} DAY AND DATE [53 .16.I [73 181 tgl NAME AND INDIVIDUAL DEDUCTIONS CHECK NO. m Nom fed Thu Fri C ROSS IDENTIFYING RUNNIER (e.g.. O. OF WORK TOTAL RATE PROJ. M Ef wn w LAST POUR DIGITS OF SOCIAL ITHIIOLOING CLASSIFI- 25 19 20 21 22 23 24 HOURS OF PAY WEEK FICA FED STATE OTHER OTHER TOTAL SECURITY NUMIER3 OF WORKER EXEMPTIONS CATION HOURS WORKED EACH DAY WAI TAXES FOR PAID ,y GLAPESATTLE, AA'114 D 18 "'80 51.27 1042.49 c.,, I:I 8.00 8.00 6.50 8.00 30.50E1 1076.49 77.09' 123.42 48.97 249.48 827.01 co GONZALEZ, D. 1EL MAGA 8 1051 O m 31.98 682.24 U S 8.00 8.00 8.00 8.00 32.00 21.32 682.24 52.19 57.47 32.32 141.98 540.26 a GONZALEZ, FEDERICD t1AGAtW ERE! 8 "9.0 15 S 682.24 4 I:I 8.00 8.00 8.00. 8.00 32.00 682.24 51.80 35.64 30.13 117.57 564.67 MAGAtfA, MARTiN 80LAN05 D 111.■ 8 "98011261 x S 20.43 326.88 MI 4 s 8.00 8.00 8.00 24.00 326.88 25.01 0.00 12.55 37.56 289.32 MAGANA PINENTEL, MIGUEL 8`' •111 N O 1111111 21.75 464.00 0 8.00 8.00 8.00 8.00 ME 32.00 14.50 464.00 35.50 0.00 15.57 51.07 412.93 MAGA A RA 3REZ, S•LVAIgR 8'.'1 0.2 5 O 31.98 682.24 4 S 8,00 8.00 8.00 8.00 32.00 21.32 682.24 52.19 36.41 30.39 118.99 563.25 THOMPSON, C `ISTOPHER A DIRDEP M O 42.30 860.10 4 S 8.00 8.04 6.50 8.00 30,50 28.20 860.10 62.66 26.94 37.25 126.85 733.25 CARG L, 11 LL IA i 8" 1 s h[ 0 43.59 1002.57 O S 8.00 7.50 8.00. 8.00 3.00 34.50 29.06 1140.07 82.11• 102.08 52.16 236.35 903.72 0 O NM I Q 1 J O Overtime rime Straight Created by Paythex, Inc. (Rev. Dec. 2008) 11/03/2009 09:01 FAX 3176369134 HORNING ROOFING 8 001 Date: Othcp_in 3 9 To: Spiel Sexton 777 3" Avenue South West Carmel, IN 46032 l?ho.ne Number (317) 688 -6856 Fax Number (317) 688 -6889 Attn: GEOFF PRATT From: Leanne Torres Payroll Administrator Horning Roofing Sheet Metal Company, LLC 2340 Enterprise Park Place, Suite A Indianapolis, Indiana 46218 Phone Number (317) 636 -9128 Fax Number (317) 636-9134 Pages Including Cover: '9 On the following pages you will find the Certified Payroll for the Carmel Performing Arts Center Project the following payroll dates: Week Beginning /0 :le 09 Week Ending J/ 09 Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending_ Week Beginning Week Ending Week Beginning Week Eliding Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending s O cs o Date to �C�y� rte {�-y� lb} WHERE FRINGE BENEFITS ARE PAID IN GASH y j,( r I, i n 5 i f it Each laborer or mechanic listed In the above referenced payroll has boon paid, (Name of Signatory Party) (TiIJe) as Indicated on the payroll, an amount not less than lire sum of the applicable do hereby slate; basic hourly wage rate plus the amount at Ibe required fringe benefits as listed in the conlraci, except as noted le Section 4 [cf below. I— (1) That I pay or supervise the payment of the persons employed by (c) EXCEPTIONS co °RVnat 1rr or bcontracter) EXCEPTION (CRAFT) FXFLANATlON ?Llt�I ��6 Iril fr.7 hat during the payroll period commencing on the (Building or Wo 2 .6. day of and ending the day of fOCAd eteD9 a$ persons employed on said project have been paid the full weekly wages earned, That no rebates have been or will be made ether directly co Indirectly to or on behalf al said kir2:1 ��R CO.) C from the lull y ontraclar rSuboonlra r) o weekly wages earned by any person and that no deductions have been made either directly or Indirecily from the full wages earned by any person. other than permissible deductions as defined in Regulations. Part Z 3 (29 CFR Subtitle A. Issued by the Secretary of Labor under the Copeland Act, as amended (46 Slat 948, 63 Start_ 1fl8, 72 Stat. 967; 76 Stet. 357; 40 U.S -C. 2760, and described below. O 'n r-r z G] l REWRKS: (2) That any payrutis otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract; that the classifications set forth therein for each taborer or mechanic conform with the work he performed. (3) That any apprentices employed In the above period am duly registered in a krona fide apprenticeship program registered %Rath a State apprenticeship agency recognized by the Bureau of Apprenticeship end Training, United Stales Department of Labor, of if no such recognized agency exists In a State, are registered xlih the Bureau of Apprenticeship and Training, United Slates Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS. DR PROGRAMS �Ti q SIGNATURE In addition to the basic hourly wage rates paid to each laborer er mechanic listed in it It If slur.— the above referenced paylel, payments of fringe benefits as listed In the Contract THE wILiFuL FAL5IFlCATiOM or ANY OF THE AIMDVE STATEr6£NTs WA' SUBJECT THE CONTRACTOR OR ry have bean or wig be made to appropriate programs for the benefit of suddi suecurineAcioe TO CML Qrt CRIM3 ALPROSECUTION.SEE SECTION tact OF TITLE is ANO seCT+0a 231 of rinLE employees. except as neled in Section 4(c` below. 31 OF THE UNITED STATES COOS. `U a. e.P..o.mier soma PAYROLL WON CON 'CT0R'S OPTIONAL USE} NAME OF CONtaAL...R fl -OR 8UBCONTRACToR ADDRESS 2340 E#TERPRISE PARK PL STE A HORNING INVESTMENTS L LC S729 INDIANAPOLIS IN 46218 -0000 o PAYROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO. PERIOD BEGIN 10126/2009 PERIOD END 11/01/2009 82408 R o to (11 I2) 13p (411 DAY AND DATE I 45) (6} 471 E81 Cc) 0 NAME AND INDIVIDUAL DEDUCTIONS CHECK NOM NUBER (e. NO. OF WORK SIM Mon lied Es Fri Set GROSS TOTAL RATE PIIOJ_ LAST FOUR bums OF SOCIAL 'WITHHOLDING CLASSlFF 01 26 MI 28 29 30 31 HOURS EOF PAY WEEK FI FED STATE OTHER OTHER TOTAL NET SNAGer CATION WM TAXES PAID SECURITY NUMBER) OF WORKER EXEMPTIONS HOURS WORKED EACH DAY FOR WES CLAPESATTLE, AARON 0 I ":P 5 O 51.27 991.22 cs 2 S 8.00 5.00 8.00 8.00 29.80 34.18 991.22 70.57 102.10 44.69 773 -I GONZALEZ, ANIEL MAGANA I `'9'D 0 ca f _t S I 0 f 31.98 682.24 2 j S 8.00 5.00 8.00 9.00 2.00 32.00 21.32 700.24 53.56 60-17 33.22 146.95 553.2C GONZALEZ, FEDERICO HAGANA 8"9801110 5 I 0 31.98 682.24 4 S 8.00 5.00 8.00 9 -04 2.00 32.00 21.32 700.24 53.18 38.34 31.03 122.55 577.65 AIIA, MARTIN B0LANOS i 1 8 "9801111g 5 D 20.431 231.54 4 S 8.00 9.00 17.00 13.62 231.54 17.72 0.00 7.76 25.48 206_DEi G MAGANA PI+IENTEL, MIGUEL F I 8011116 H 0 1 21.75 130.50 0 8 5 i 9.00 9.00 14.50 130.50 9.98 0.00 0.00 9.98 120.52 Z GANA RAMIREZ, SA VADCR 8'98011117 S 0 31.98 618.28 1 4 S 8.00 5.00 8.00 8.00 29.00 21.32 618.28 47.30 26. 27.18 101.30 516.98 SUITS, RONALD ALAN DIIMP M 0 E 31.98 501.02 0 5 5.00 8.00 9.00 1.50 23.50 21.32 554.27 42.40 25.19 26.43 94.02 460.25 THOMPSON, Ci4RISTONIER A DIRDEP M 0 42.30 817,80 4 S 8.00 5.00 8.00 8.00 29.00 28.20 817.80 59.42 20.60 35.13 115.15 702.65 ckRSAL, I! LLIAR P 8 011142 M 0 43.59 988.04 0 S 8.00 5.00 7.00 8.50 4.00 1.50 34.00 29.06 1175.54 84.83 107.24 53.89 245.96 929.58 O >g 1 1 r.,, s D Chief t Time Stm S Sirslgh Created by Paychex, Inc. (Rey_ Dec. 2008) PAYROLL )FOR CONT "TOR'S OPTIONAL USE) r NAME OF CONTRAC g vri J OR SUBCONTRACTOR 0 ADDRESS 2340 ENTERPRISE PARK PL STE A 1- HORNING INVESTMENTS LLC S729 INDIANAPOLIS IN 46218 ca PAYROLL ND. PROJECT AND LOCATION PROJECT OR CONTRACT NO 0 PERIOD BEGIN 10 126/2009 PERIOD END 11/0T/2009 82408 S m i11 12} 131 E4) DAY AND DATE 161 16) I7f I8] MI a NAIVIE AND INDIVIDUAL Sun Non Tue L #ed Thu Fri Sat G DEDUCTIONS CHECK NO. IDENTIFYING NUMBER Ie Q., O. OF WORK TOTAL RATE FROJ. LAST FOUR DIGITS OF SOCIAL ITIIHOLDING CLASSNFI- 01 26 CATION 27 28 29 30 31 OF PAY FICA FED NET WADESh' TAXES WEEK PAID SECURITY NUMBER) OF WORKER EXEMPTIONS HOURS WORKED E4CF DAY Wilt 27 WEEK `rj BAKER, BRI VAR D3RDEP k INCI co 1 141.34 220.18 1 965 -35 to `GBBRTSON, IJ LL T' :1 3: m R .ca0 1r +0 0 102.20 62.99 309 -61 1042. 79 d' I 0 x 0 xi z z 4 a 'ii w I o SI IMEMII" 4 C7 v Overtime Created by PaycIiex, Inc- (Rev. Dec. 2008) S straight Time 11/10/2009 11:00 FAX 3176369134 HORNING ROOFING 21001 Date: kaantitrAlai9 To: Shiel Sexton 777 3rd Avenue South West Carmel, IN 46032 Phone Number (317) 688 -6856 Fax Number (317) 688 -6889 Attn: GEOFY+ PRATT From: Leanne Torres Payroll Administrator Horning Roofing Sheet Metal Company, LLC 2340 Enterprise Park Place, Suite A Jndianapolis, Indiana 46218 Phone Number (317) 636 -9128 Fax Number (317) 636 -9134 Pages including Cover: S On the following pages you will find the Certified Payroll for the Carmel Performing Arts Center Project the following payroll dates; Week Beginning //-1-d9 9 Week Ending /1 9 Week Beginning Week Ending Week Beginning Week Ending_ Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending Week Beginning Week Ending PAYROLL {FOR CON CTOR'S OPTIONAL USE) NAME OF GONTRAC.oR 0 OR SUBCONTRACTOR 9 ADDRESS 2340 ENTERPRISE PARK PL STE A 1- HORNING INVEST$ENTS LLC S729 INDIANAPOLIS IN 46218 0000 0 PAYROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO. IV PERIOD BEGIN 11102/2009 PERIOD END 11/08/2009 82408 S 07 °o to (1} t2) 13) Id) DAY AND DATE I51 t6} I7} {BI I91 NAME AND INDIVIDUAL Sun Mvn Tue !led Thu Fr i Sat GROSS DEDUCTIONS CHECK h10. I—& NUMBER le.g.. N0. Oi WORK TOTAL RATE PROtI LAST FOUR DIGITS OF SOCIAL V71TH1101d7N[i CI-AMR 08 02 03 04 05 06 07 HOURS OF PAY WEEK FICA FED STATE OTHER OTHER TOTAL ry Pturzr}r SECURITY NUMBER} OF WORKER EXEMPTIONS CATION HOURS WORKED EACH DAY N11H TAXES FUR WEEK 1—.. HAILER, BRIAN MICHAEL I f OTPDEP S 1,00 1.00 .60.56 60.56 1 I G 1 1 j 0.00- 40.37 1652.99 124.33 303.601 80.62 508.55 1144.44 y of, BERT 4)ILLIAM J 1 F 8'98011199 co RO M 0 1.00 1.00 60.56 60.56 w 0 S A 0.00 40.37 1657.69 125.16 194.88 77.14 397.18 1260.51 a 1 S O CO 4 5 a o 0 s z 0 o 5 I 0 s 0 s f —il 5 D El 0 LI i 5 I t. 0 Overtana Created by Paychex, Inc. (Rev. Dec. 2008) 5 Straight Time PAYROLL )FOR CON CTOR'S OPTIONAL USE) NAEAE OF CONTRAC..7R 0 OR SUBCONTRACTOR 0 ADDRESS 2340 ENTERPRISE PARK PL STE A HORNING INVESTRENTS LLC S729 INDIANAPOLIS IN 46218 4000 a rrAVROLL NO. PROJECT AND LOCATION PROJECT OR CONTRACT NO. PERIOD BEGIN 91/02/2009 PERIOD END 11108/2009 82408 5 00 m 01 (2) 130 (4) OAY AND DATE (5) ISO (7) C80 197 NAME AND INDIVIDUAL Han Wed Thu Fri Sat GROSS I DEDUCTIONS CIAO( NO. N IDENTIFYING NUNIEER (e.g.. NO. OF WQRK TOTAL RATE PROD, FIST WAGES LAST FOUR DIGITS OF SOCIAL HHDLDING CLASSIFI- 08 02 03 04 05 06 07 HOURS OF PAY WEEK FICA FED STATE OTHER OTHER TOTAL PAID F ,CATION W/11 TALES SECURITY HUMBER] OF WORKER ExEMPTIONS HOURS WORKED EACH DAY FOR WEEK .,I BAKER. BRIAN MICHAEL 0IR0EP S 0 60.56 1574.43 G 1 8.00 8.00 8.00 8.00 7.00 39.00 40.37 1652.99 124.33 303.60 80.62 508 -55 1144.44 S L PES E, AARON D 8 os S 0 60.56 1574.43 IT ce 2 0 S 8.00 8.0G 8.00 8.00 7.00 39.0 40.37 1574.43 115.18 250.46 73.97 439.63 1134.80 MAMMA* 11111111 ROBERTSON, WILLIAM J 8"9801 4 0 60.56 1574.43 O S 8.00 8.00 8.00 8.40 7.00 39.00 40.37 1657.69 125.16 194.88 77.14 397.18 1260.51 THOMASON, C RISTOP R A 1 0]RDEP x 11 O 37.13 990.00 0 4 s 8.00' 8.00 8.00 8.00 8.00 40,00 24.75 990.00 72.59 46.43 43.78 162.80 827.20 N O ro a 0 ql S r1 o o O S S 0 S i 1 0 7 S T O 0 1 J 1 1 o ffi Owenftne Time tra[ghi 5 m S Created by Paychex, Inc. (Rev. Set. 2008) PAYROLL (FOR COP `cTOR'S OPTIONAL USE) NAME OF CONTRAt.I UR OR SUBCONTRACTOR Q ADDRESS 2340 ENTERPRISE PARK Pt STE A ItORNIND INVESTMENTS LL{ S729 INDIANAPOLIS IN 46218-0000 a `R PROJECT AND LOCATION PROJECT OR CONTRACT NO. o PERIOD BEGIN 11/02/2009 PERIOD END 11/08/2009 82408 R a a IT} (2} (3) 143 DAY AND DATE 5} IS 1 173 I81 491 NAME AND INDIVIDUAL GROSS DEDUCTIONS CHECK NO. WORK Hon Ea lied Thu Sat IDENTIFYING FR .g.. N O. OF MASSIF' 08 02 03 04 05 06 07 HOURS OF PAY WEEK FICA FED STATE OTHER OTHER TOTAL NET WA6 o TOTAL RATE Km, LAST FOUR DIGITS TS O OF SOOCIAL THHOLpING WEEK PAID SECURITY NUMBER] OF WORKER EMPTIONS CATION HOURS WORKWD EACH DAY Will TAXES FOR iP1 EX by GONZA 2, CA MAUA #A el MEM tom r p�d S 31.98 671.58 2 111 8.00 8.00 8.00 7.50 1111 31.50 21.32 815.58 62.40 77.47 39.01 178.88 636.70 v oa GO IALEZ, FEQERICO AGANA O ��m■■m■m� 1. a 671,58 G.5 DM 8,00 8.OD 8_00 7.50 ME 31.50 815.58 62.00 55.64 36.82 154.46 661.12 i AGANA, RTIN 90LANOS O MENEM 1 S 20.43 217.92 4 CI Mil 8.00 8.00 a Ma 16.00 Oil 319.92 24.48" 0.00 12.20 283.24 11 7 I PINE EL, GU L ZS 7• N 1:1 ENE El 21.75 232.00 M 8 11 8.00 8.00 1111 16.00 14,50 348.00 26.63 0.00 9.75 36,38 311.62 HA4ANA'kF1IRE2, SALVADOR :-:o 111 MEM. "`'I 1 77 S 31.48 671.58 0 4 C■ 8.00 8.00 8.00 7.50 31.50 8(13.58 61.47 54.61 36.48 651.02 41 Sir TS,RO'F i AIfT' 0 111111111 D]RDEP M 842.14 0 111111 8.00 8.00 8.00 730 8.00 III 39.50 21.32 842.14 64. 66.21 40.16 170.79 671.35 N 43.59 1147.87 O I:I 8.00 8.00 8.00 7.50 $.00 M 39.50 29.06 1160.37 83.67 105.03 53.15 918.52 O MEM Ea El 0 MEE. 13 II ME .1111111111111111111 o C III III ■.11111 c, O Overtime Created by Payclzex, Inc. (Rev. Lec. 2008) S Straight Time C. r• 1-- 6 'F+ O O LTate/ 4V �p (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 1, t o ur 4 I Ca r r ft9E li V i.a t t Each laborer or mechanic listed In Ilia above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll. en amount not less than the sum of the applicable do hale by tale: basic hourly wage role plus Iha amount of the required fringe benefits es listed in the contract except as noted in Section 4(c} bokrw. r (t) That I pay or supervise the payment of lite persons employed by itr 91 1 4 (c) EXCEPTIONS t C J �■.1a (4 ontraCtoro I the 'f EXCEPTION;CRAF F EXPLANATION i 3atOn8� i that during the payroll period commencing an the (6uIlding or y Q day of Y Sand ending the day of Orli ,'p all persons employed on saki project have been paid the MI weekly wages earned. that no rebates have been or will be made either directly or Indirectly to or on behalf of sa f Non? n 0j• ir4i c•1 Zi�.a from the full ntractor Subcontra r} weekly wages earned by any person and that no deductions have been made either directly or Indirectly t a from the full wages earned by any person. other Than permissible deductions as defined In Regulations, Pal 3 (29 CFR Subtitle Al, Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, G) 63 Siart. 198, 72 Stat. 967; 76 Stat. 357; 46 U.S.C_ 2760, and described below: �rl a REMARKS; (2) That any payrolls nther ao under Ibis contract required to be submitted for the above period are correct and complete; Thal the wage rates for Laborers or mechanics contained therein are not less than the applicable wags rates contained In any wage determination incorporated Into the contract; that Iha classifications set forth therein far each laborer or mechanic conform with the work he performed. (3) That any apprentices employed In the above period are duty registered In a bona tide apprenticeship program registered with a Slate apprenticeship agency recognized by the Bureau of Apprenticeship end Training, United Slates Depth-nett of Labor. of If ho such recognized agency exists In a Slate, are registered with the Bureau of Apprenticeship and Training, United States Department of tabor. (4l Thal: (a) WHERE FRINGE BEI4EF Fes ARE PAID TO APPROVED PLANS, FUNDS. OR PROGRAMS Eii�Tr m a-. SIGNATURE !n add/Ikm hr the basic howdy wage rates paid to each laborer o mechanic listed In the above referenced payroll, payments of fringe benefits as listed In the contract THE WILLFUL FALSIFICATION OF PNY OF THE ABOVE SrATElh@nTS MAY SUBJECT THE coYITRACPOR OR ra have been or aril be made to appropriate programs for the benefit of such suscort1RACTUR TO CIi1L OR CRIMINAL F OSEc ITION.SEE SECTION 1001 OF TITLE la Arm sEcrioN 231 OF tine employees, except as noted In Section 4 {c) betnw. t 3t of The UNITEO STATES COVE V.6. oP.D.irm 619.esr Prescribed by State Board of Accounts City Form No, 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee /7 1,, /oa7r� Purchase Order No. 2: L: ,77�7 pr, "s., Terms /Q".-- 0r:„G 0 /r /4/ 1/42 /g Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) lr(t770 6 f 6 l' 7 b Total 5 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. p ALLOWED 20 J7'�%/ /1 a, (7 '772- IN SUM OF 230 ,2 A< 55,- /7,4r 4,=:? o 7S 7/V 4/E 2/ Y /�{S3 S oG ON ACCOUNT OF APPROPRIATION FOR fir► Board Members PO# o #/TITLE AMOUNT hereby certify invoice(s), r INVOICE NO. ACCT I hereb certif that the attached invoices or nL 6 l7Wo8 /1(S3c5709 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 /—(y 2 'A Si ature Director of perations Cost distribution ledger classification if Title claim paid motor vehicle highway fund