Loading...
HomeMy WebLinkAbout185024 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 358222 Page 1 of 1 ONE CIVIC SQUARE M A B ASSOCIATES CHECK AMOUNT: $42,021.90 CARMEL, INDIANA 46032 7648 CAMELBACK DRIVE INDIANAPOLIS IN 46250 CHECK NUMBER: 185024 CHECK DATE: 4/28/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 5 42,021.90 PERFORMING ARTS CENTE F J A F .wwl- 1A Document G702IC a T11 —1992 Application and Certificate for Payment Construction Manager Adviser Edition yo TO OWNER: L n PROJECT: CA $Met 41,7 i 474- t APPLICATION NO: �N- Distribution to: PERIOD TO: 21-61, C OWNER q6o 3 CONSTRUCTION MANAGER FROM CONTRACTOR: VIA CONS UCTICM MWGER: CONTRACT DATE: Z� ARCHITECT /9-1- g ,f A,�OC, A 1 C. 511l,.� 1f C p PROJECT NOS: '�695+1�1 Z© CONTRACTOR VIA ARCHITECT: 0 So A/zciA 12 CTS FIELD CONTRACT FOR: r L�,�,�,�,u.T -a l Q CONTRACTOR'S APPLICATION FOR PAYM NT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment, as shown below, in cc :aa ectinn with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents,_thatall amounts have been paid by the Contractor for Work for which previous Continuation Sheet, AIA Document G703, is alt xa ::d. a� Certi tcatesffor Payment were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM .253 yment shown herein i; ow due. 2. Net change by Change Orders /3, <f ld,. NTRACTOR: laA R( 3. CONTRACT SUM TO DATE (Line 1 2) z(o7 3 c By: Date: 1 (Lo 4. TOTAL COMPLETED STORED TO DATE (Column G on 6703) P43. State of: 5. RETAINAGE: County of: fo t /45t N. a. of Completed Work Subscribed an sworn to before A6tidgfrq Of (Column D E on G703) me this /(r J 'da o c{(c1 40 Tit a �Coynty b. of Stored Material Notary Public! ii+►� *4=13 (Column F on G703) My Corn 'I n expires: 'ryy A b S Total Retainage (Lines 5a 5b or Total in Column I of G703) 3o CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE Sao, 70 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 that to the best of their (Line 4 Less Line 5 Total) r knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT i I 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 Z ,Z O AMOUNT CERTIFIED V27-1 9, BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explancuinn if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation feet th a a changed to con with the amount certifued.) (Line 3 less Line 6) S 0 CONST UCTION G By: Date: Q ,Z b c CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI Total changes approved in previous months by Owner By. Date: ZI Lo Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS named herein- Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contrac 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 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 Date 3/17/2010 APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: five Contractors signed Certification is attached. APPLICATION DATE: -3117, In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 313112010; Use Column I on Contracts where variable retsina a for line items may apply. ARCHITECT'S PROJECT NO. `19122' A B C t7 E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORKCOMPLETED MATERIALS TOTAL BALANCE RETAINAGE NO, VALUE kFROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G/C) TO FINISH PLICATION STORED AND STORED (C-G) (D +E) (NOT IN TO DATE D ORE D -F 0100 Base Contract 0101 Performance Payment Bond- 3870.00 3 870.00 3 870.00 100% 0.00 387.00 0102 Detailirt 8En ineerin 16695.00 16695.00 16,695.00 100% 0.00 1669.50 0103 Material MT 1a rail 10 1 1.340.00 14 15 962.00 100% 0.00 1596.20 0104 Fabrication MTla 9,546.00 954600 14% 58645.00 954.60 0105 Installation 0% 15600.00 0.00 0106 Material MT lb 9271.00 9,271.00 100% 0.00 927.10 0107 Fabrication MT lb 0% 33202.00 0.00 0108 Installation 3,700.00 0% 8700.00 0.00 0109 Materia$ MT 1c 9,52800 9,528.00 9,528.00 100% 0.00 952.80 0110 Fabriation MT1c 29,952.00 1 0% 29952.00 0.00 0111 Installation 7 0% 7990.00 0.00 0112 Material Vine 3,724.00 3,724.00 s 3,724.00 100%j 0.00 372.40 0113 Fabrication 5,916.00 0% 5916.00 O.00 $114.00 Installation 2,183.00 0% $2,163.00 0.00 0115 Power Coat MT 1a 11,091.00 0% $11,091.00 0.00 0116 Power Coat MT 1a 3,482.00 o% $3,482.00 0.00 0117 Power Coat MT 1a 7,352.00 0% $7,352.00 0.00 1,173.00 0% $1,173.00 0.00 Change Order #1 5 8,460.00 0% $8,460.00 0.00 Cash Allowance Authorization 5,000.00 0% $5,000.00 0.00 TOTAL 267,342.00 21,905.00 46,691.00 68,696.00 0% $198,746.00 AFFEDAYIT AND WAIVER OF LIEN Final Partial Payment to follow ST TE INDIANA, COUNTY OF C t being duly sworn states that he/she is the J of /fit d (title) (supplier or subcontractor) having contracted with &A to furnish certain material contractor) and/or labor as follows: 2= (description) for the prof tt kno as— �0-t cwt located at r r,� and weed by �e:�� architect S and does hereby er state on behalf of the aforementioned subcontractor /supplier: PAR that th balanced from con "r is the sum of Ste' dollars($ receipt of which is ereby acknowl edged; '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 for such payment; 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 partial Waiver of Lien which shall become effective upon receipt for such payment. THEREFORE, the undersigned waives and releases unto the owner of said premises, any and All lien of claim whatsoever on the above described property improvements thereon on account of labor and materials, 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 aunt, within the scope of this affidavit and waiver. off An", 'ia (name of claimant) authorized°representativ6) (title) Witness my hand and notarial sea], this /r" day of 1-9 My commi ires: Residing in County Printed'e of o T tah oW1Yft My CWd"bWW Eris: X45 A CRD CERTIFICATE OF LIABILITY INSURANCE OP ID C DATE /2.1 MAB &A -1 07 21 /09 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Connolly Ford Leppert, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR post office Box 441099 AL TER THE COVERAGE AFFORDED BY THE POLICIES B ELOW. Indianapolis IN 462.44 -1099 Phone: -236 -616 Fax:317- 236 -6149 INSURERS AFFORDING COVERAGE NAIC# INSURED INbUR�RA.: indi— insurance c 22659 I... INSURCR B: M.A.B. Associates, Inc. NsuRERC� Matt Berg 7648 Camelback Drive IsuRERD Indianapolis IN 46250 INSURER L COVER THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERMOR COIVD1TION OF ANY CONTRACT OR OTHER DOCUMENT WITH RFSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS, OF SUCH POLICIES. AGGREGATE L lW37 S $HO'NN MAY HAVE E °:EFEN REDUCED BY PAID CLAIMS. ENSR J4T)Q'I7_ c POLICY NUMBER DATE 1MMlODfYY) DATE MM1D01'Y) i LIMITS LTRINSRO TYPE. OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE 5 1 0 O:ATAL:E- tC7AETTTEU A X COMMERCIAL GENERAL 1ABIOTY CBP8042570 (09) 07/10/09 07/10/10 PRrMI SESIEa oc wrerc e 100,000 CLAIMS aYaOE X OCCUR 1 MED EXP (A one p erson) S 5 0 0 0 PERSONAL 8 ADV INJURY j s 1 1 0 00,000 G a 2 000,000 e GLN'L AGGREGA E UrAIT APPLIES PER: PRODUCTS COMPfOP AGG 1 a 2, 000,0 00 POLICY Ix Lor JECT f AUTDMOBILELIABILITY COMBINED SINGLE LIMIT 1, 000,000 A X ANY AUTO BA8042970 (09) 07/10/09 07/10/10 ALL OWNED AUTOS 8001LY INJURY I I SCHEDULED AUTOS EPer persan4 c WRFC AUTOS I I IIODILY INJURY jPeraccldenl} X 3 NONL' JNEU AUTC.S I 1 PROPERTY DAVAGE f d e, acc:Jere' i GARAGE LIABILITY AUTO ONLY EA ACCIO£N'L t ANY d LA ACC, S 1 OTHE.R THAN I AUT'00NLY: ACL• C I EXCESSlUMBRELLA LIAWL1I Y k EACHOCCURRENCE S3,000,000 A iX OCCUR 3 CLAIMS MADE. iCiJ8043270(09) 07/10/09 07/10/10 AGGREGATE 3 000,000___ t I f I t OEDUCTIDtE 3 IX RETENTION S 0 1 WORKERS COMPENSATION AND X m4, L IMITS R I EMPLOYERS' LIABILITY A WC8043170 (09) 07/10/09 07/10/10 j FA EACH ACCIDENT 500 000 ANY PRC)PRIEIUW°ARINEFL'ICf ECUTIVE OFFICEPA.EMBER EXCLUDED? i t I EL. DISEASE. EA E MPLOYEE! e 5001 000 If yea describe uitier SPECIAL PROVISIONS below C.L. DISEASE POLICY LI MIT 500 OTHER 3 A ,,•AUTOMOBILE BA8042970(09) 07/10/093 07/10/10; COMP $250 DED. PHYSICAL DAMAGE COLLISION $250 DED. DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT i SPECIAL PROVISIONS RE: Project Parcel 7A REGIONAL PERFORMING ARTS CENTER CORE SHELL PACKAGE P3. CERTIFICATE HOLDER CANCELLATION CARMEL- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOI DATE THEREOF, TIT£ ISSUING INSURER WILL ENDEAVOR TO !JAIL 30 PAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL 2 11 C ty Center Drive 1 C ity t Carmel IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 2 Carmel IN 46032 REPRESENTATIVES. AUTOO REPR ENTATIVE ACORD 25 (2001108) O ACORD CORPORATION 1981 M d A 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 Purchase Order No. Terms jet y17 17,1' j 1 G 2 S Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /�rr7 S �,�f 3l20 Total 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 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members P49 or INVOICE NO. ACCT /TITLE AMOUNT DEPT. i hereby certify that the attached invoice(s), or -7 y2 -0 (,So 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 7 7 20/ Director 8WOopment Cost distribution ledger classification if Title claim paid motor vehicle highway fund