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HomeMy WebLinkAbout185012 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 363456 Page 1 of 1 ONE CIVIC SQUARE FILSON EARTHWORK COMPANY, INC CHECK AMOUNT: $17,598.40 CARMEL, INDIANA 46032 Po Box ssa NOBLESVILLE IN 46061 CHECK NUMBER: 185012 CHECK DATE: 4/28/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460847 1003 -2 15,303.50 HEARTHVIEW OLD TOWN 902 4460847 1004 -2 2,294.90 HEARTHVIEW OLD TOWN APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 6702 To: Carmel Redevelopment Comm. Project. Parcel 47 Sump Pump Storm Application No: 1004 -2 RETAINAGE Distribution to: 30 W. Main St., Ste 220 110 W. Main St. Carmel, IN 46032 Carmel IN App Date: February 19, 2010 OWNER CONSTRUCTION MGR. From: Filson Earthwork Company Inc. Period to: September 28, 2010 El ARCHITECT CONTRACTOR PO Box 538 Project Nos: OTHER Noblesville, IN 46061 Contract Date: Contract For: Construction Manager: Keystone Constructon Architect: 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 Application is made for payment, as shown below, in connection with the Contract. completed in accordance with the Contract Documents, that all amounts have been Continuation Sheet, G703, is attached. paid by the Contractor for Work for which previous Certificates for Payment were 1. ORIGINAL CONTRACT SUM 22,949.00 issued and payments received from the Owner, and that current payment show herein is now due. 2. Net Change By Change Orders 0.00 3. CONTRACT SUM TO DATE 22,949.00 CONTRACTOR: FILSON EARTHWORK COMPANY, INC. 4. TOTAL COMPLETED AND STORED TO DATE 22 ,949001 By. Date: February 19, 2010 5. RETAINAGE eg Fil n, President State of: IN a. 0% of Completed Work 0.00 County of: Hamilton b. 0% of Stored Material 0.00 Subscribed and sworn before me this 19th day of February 2010 Total Retainage 0.00 Notary Public 6. TOTAL EARNED LESS RETAINAGE 22 ,949.00 My Commission expires: 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 2 o,65a.10 CERTIFICATE FOR PAYMENT 8. CURRENT PAYMENT DUE 2,294 -90 In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0001 that to the best of their knowledge, information 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 f 7id�� Total changes approved in 0.00 0.00 CONSTRUCTION MA ER: previous months by Owner Total approval this Month 0.00 0.00 By. Date: TOTALS 0.001 0.00 NET CHANGES by Change Order 0.00 ARCHITECT: By: ate: 3 ho This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the TORGO SOFTWARE nup:wwww torgo.net ©1996 2002 ALL RIGHTS RESERVED Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET G703 PROJECT: Parcel 47 Sump Pump Storm Filson Earthwork Company, Inc. Page 1 of 1 Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1004 -2 RETAINAGE Contractor's signed Certification is attached. APPLICATION DATE: February 19, 2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: September 28, 2010 PROJECT NUMBER: A B C D E F G H I Item Description of Work Scheduled Work Completed Materials Total Completed Balance Retainage Value From Previous This Presently and Stored To to Finish Application(s) Period Stored Date SITE DEMOLITION 2,209.00 2,209.00 0.00 0.00 2,209.00 100% 0.00 0.00 STORM SEWER 16,866.00 16,866.00 0.00 0.00 16,866.001 100% 0.00 0.00 GENERAL CONDITIONS 3,874.00 3 0.00 0.00 3,874.00 100% 0.00 0.00 TOTAL: 1 22,949-001 22,949.001 0.00 0.001 22,949.00 100% 1 0.00 0.00 A =Line Item Number B =Brief Item Description C =Total Value of Item D =Total of D and E From Previous Application(s) (If Any) E =Total Work Completed For This Application TORGO SOFTWARE http: //w .torgo. net ©1996 -2002 ALL RIGHTS RESERVED AFFIDAVIT AND WAIVER OF LIEN Final Partial Payment to Follow State of Indiana, County of N SS: being duly sworn states that he is the 2 S of (Name of Officer) (Title) I OLs,,. Co having contracted with l�N� MEc Qcr�CJtrclJl' "�'°n"' to furnish certain (Subcontractor /Supplier) (Contractor) materials and /or labor as follows: (Desc -1 for aproject known as located at W %A'Xi y CZ— 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 receipt of which is hereby acknowledged, or the payment of which has been promised as the sole consideration of this 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 the final balance due from the contractor is the sum of Dollars receipt of which is hereby acknowledged, or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which 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, if any; 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. LQAAL �p. aJ[. B Title (Firm) Authorized Represent &live) WITNESS MY HAND AND NOTARIAL SEAL, this day of a2 (No Public) My Commission Expires I d� l `p Printed Residing in County APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 To: Carmel Redevelopment Comm. Project: Parcel 47 BACKFILL Application No: 1003 -2 RETAINAGE Distribution to: 30 W. Main St., Ste 220 110 W. Main St. Carmel, IN 46032 Carmel IN App- Date: February 19, 2010 OWNER CONSTRUCTION MGR. Period to: February 28, 2010 ARCHITECT From: Filson Earthwork Company, Inc. CONTRACTOR PO Box 538 Project Nos: OTHER Noblesville, IN 46061 Contract Date: Contract For: Construction Manager: Keystone Constructon Architect: 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 Application is made for payment, as shown below, in connection with the Contract. completed in accordance with the Contract Documents, that all amounts have been Continuation Sheet, G703, is attached. paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment show 1. ORIGINAL CONTRACT SUM 153,035.00 herein is now due. 2. Net Change By Change Orders 0.00 3. CONTRACT SUM TO DATE 153,035.001 CONTRACTOR: FILSON EARTHWORK COMPANY, INC. 4. TOTAL COMPLETED AND STORED TO DATE 153,035.00 By: 4, Date: February 19, 2010 5. RETAINAGE: reg F `on, President State of: IN a. 0% of Completed Work 0.00 County of: Hamilton b. 0% of Stored Material 0.00 Subscribed and sworn before me this 19th day of February 2010 Total Retainage o.0o Notary Public: 1__� ,_0 6. TOTAL EARNED LESS RETAINAGE 153,035.00 My l d t l My Commission expires: �.Q 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT F7 137,731.50 CERTIFICATE FOR PAYMENT 8. CURRENT PAYMENT DUE 15,303.50 In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Construction Manager and Architect certify to the Owner 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.001 that to the best of their knowledge, information 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 1p 5v Total changes approved in 0.00 0.00 CONSTRUCTION NAGER: previous months by Owner Total approval this Month 0.00 0.00 By: Date: TOTALS 0.00 0.00 NET CHANGES by Change Order 0.00 ARCHITECT: By: Date: 3 3f �i0 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the TORGO SOFTWARE hQp /1vmv.mrgo.net 01996 -2002 ALL RIGHTS RESERVED Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. CONTINUATION SHEET G703 PROJECT: Parcel 47 BACKFILL Filson Earthwork Company, Inc. Page 1 of 1 Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1003 -2 RETAINAGE Contractor's signed Certification is attached. APPLICATION DATE February 19, 2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: February 28, 2010 PROJECT NUMBER A B C D E F G H I Item Description of Work Scheduled Work Completed Materials Total Completed Balance Retainage Value From Previous This Presently and Stored To to Finish Application(s) Period Stored Date LT BASEMENT BACKFILL 152,128.001 152,128.00 0.001 0.001 152,128.00 100% 0.00 0.00 LT GENERAL CONDITION 1 907.00 907.00 0.00 0.00 907.00 100% 0.00 0.00 TOTAL: 153,035.00 153 0.00 0.001 153,035.00 100% 1 0.00 0.00 A =Line Item Number B =Brief Item Description C =Total Value of Item D =Total of D and E From Previous Application(s) (If Any) E =Total Work Completed For This Application TORGO SOFTWARE http JAvww.torgo.net 01996 -2002 ALL RIGHTS RESERVED AFFIDAVIT AND WAIVER OF LIEN O inal 0 Partial FG,yment to Follow State of Indiana, County of SS: S a+ being duly sworn states that he is the (i �S of (Name of Officer) (Title) `rJ( having contracted with �tp£VtcD ►nr�` �cJ,nM to furnish certain (Subcontractor /supplier) (Contractor) materials and /or labor as follows: p (Description) for a project known as C�- Li 7 located at VA CAA- b 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 receipt of which is hereby acknowledged, or the payment of which has been promised as the sole consideration of this 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 the final balance due from the contractor is the sum of c Dollars 1 S 3 3. J O receipt of which is hereby acknowledged, or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. 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, if any; 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, �Ya�t� t rL� r By T itle (L (Firm) uihorized Representative) WITNESS MY HAND AND NOTARIAL SEAL, this dc� day of (No Public) My Commission Expires t Printed Residing in �"�`�`g County Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995) 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 5011 'i m4 vr trk �wnb U Purchase Order No. P Box 539 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2 1���0 `opt 1 e�e►��'� ®r. Q X17 Su m Total 17 5 98. �fO 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. ALLOWED 20 FI s�n E m -Aw A Lomb( \m Inc. IN SUM OF R Sq g N O o ON ACCOUNT OF APPROPRIATION FOR Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or Q 02 1 0 T4 n 9 4 7 bill(s) is (are) true and correct and that the 0 lnO3 2 4 0947 1536 materials or services itemized thereon for which charge is made were ordered and received except 20 /0 signature Director of Redevelopment Title Cost distribution ledger classification if claim paid motor vehicle highway fund