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HomeMy WebLinkAbout185957 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CARMEL, INDIANA 46032 720 3RD AVE SW CHECK AMOUNT: $16,603.91 CARMEL IN 46032 CHECK NUMBER: 185957 CHECK DATE: 5/26/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460805 111 -5 9,221.12 CITY CNT WATERPROOF 902 4460873 111 -5 7,382.79 73 -4 STREETSCAPE APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 i44665-0�r PAGEONEOF 2 PAGES2 TO OWNER: CRC at City of Carmel PROJECT: Carmel City PI 11 Waterproofing APPLICATION NO: Invoice 4 5 1 Distribution to: One Civic Square Signature costs =OWNER Carmel Indiana 46032 =ARC1-11TECT PERIOD TO: 04/26/2010 F FROM CONTRACTOR: VIA ARCHITECT: I'edcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT T he undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due_ 1. ORIGINAL CONTRACT SUM 29,651.40 2. Net change by Change Orders 977 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 4. TOTAL COMPLE "FED STORED TO t 13y: Date: Z 7 /A 5. RETAINAGE: omas oontz, President a. 0 of Completed Work 0 Subs ribed and Ora to belore me this day of (Zorn D +Eon 6703) ;;I KENDRA DIANE NLB RN b. Stored Material harionf�ot>stty i `oZum ((n F on 6703) sE. v Ci17t11fISISSiOn r9s total Ketarnave (Lines Ja +Cb or I Total in Column I of G703) 0.00 6. TOTAL EARNED LESS RETAINAGE 2 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and beliefthe Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 20,43028 the quality ofthe Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE is entitled to payment ofthe AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) AMOUNT CERTIFIED CI ORDER SUMMARY AUDI I IONS Di--DUC I IUN� (Attach explanation i n10 nt certified differs from the amount applied. Initial all figures on this otal changes approved Application and o e Co r tiny io eel that are changed to conform with the atnoant certified.) in previous months by Owner ARCHITECT: Total approved this Month By: Date: �•`3n�ld TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the L- ontractor named nerem. Issuance, payment anu acceptance or payment are wanotn NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 0702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA VS92 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N,W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice 5 4/26/10 Carmel City P111 Waterproofing Carmel, Indiana Total Work RETAINAGE BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE FINISH Pre- Construction Services_ Project Management 3,117.15 0.00 0.00 3,117.15 3,117.15 1005 0.00 Site Supervision 4,173.64 0.00 0.00 4,173.64 4,173.64 100% 0.00 General Conditions: 0.00 0.00 0.00 0.00 0.00 0% 0.00 Testing and Inspecting 0.00 0.00 0.00 0.00 0.00 0% 0.00 Project Management 0.00 0.00 0.00 0.00 0.00 0% 0.00 Site Supervision 17,102.03 8,509.54 0.00 8,592.49 17,102.03 ORS 0.00 Site Safety Director 524.95 367.42 0.00 157.53 524.95 0% 0.00 Design Drawings 3,508.42 344.16 0.00 3,164.26 3,508.42 0% 0.00 Sanitary Facilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 Field Office 0.00 0.00 0.00 0.00 0.00 0% 0.00 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 Office Supplies 24.75 0.00 0.00 24.75 24.75 0% 0.00 Temporary Telecommunications 0.00 0.00 0.00 0.00 0.00 0% 0.00 Temporary Water 0.00 0.00 0.00 0.00 0.00 0% 0.00 Tools and Equipment 1,200.46 0.00 0.00 1,200.46 1,200.46 0% 0.00 Project Signage 0.00 0.00 0.00 0.00 0.00 0% 0.00 Field Engineering and Surveying 0.00 0.00 0.00 0.00 0.00 0% 0.00 Health and Safety 0.00 0.00 0.00 0.00 0.00 0% 0.00 Waste Disposal 0.00 0.00 0.00 0.00 0.00 0% 0.00 Final Clean 0.00 0.00 0.00 0.00 0.00 0% 0.00 Construction Management Fee 0.00 0.00 0.00 0.00 0.00 0% 0.00 29,651.40 9,221.12 0.00 20,430.28 29,651.40 100% 0.00 20,430.28 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and or labor as follows: Construction Management Services for a project known as Carmel City Center P111, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of nine thousand two hundred twenty -one dollars and twelve cents ($9,221.12) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, finished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC 7h_ o as E. ontz, President KENDRA DIANE WILBURN bscribed and sworn to before me this: nor Marion County r .,S:= My Commission Expires March 20, 2011 tary Public: APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER: CRC at City of Carmel PROJECT: Carmel Parcel 73 APPLICATION N0: Invoice 4 4 I Distribution to: One Civic Square Streetscape Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 04/26/2010 MCONTRACTOR FROM CONTRACTOR VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the best of the Contractor's knowled Application is made for payment, as shown below, in connection with the Contract. informatton and belief the Work covered by this Application for Payment has been Continuation Sheet, AIA Document 6703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM S 19,973.55 1 Net change by Change Orders CONTRACTOR: 3_ CONTRACT SUM TO DAZE (Line 1--' 2) 19 13 4. TO I AL COMPLE "TE.D STORED'TO 19,9 .)S l By j Date: y/ Z /l v 5. RETAINAGE: oma oontz rest ent a. 0 of Completed Work 0 Sub cribed and�worn to before me this 2��day of.�M� t ?H o umn D E on 6703) b. %of Stored Material tom- KENDRA DIANE tMLBURN o umn h on 6703) 11UTARY Marion County I oral Ketamage tLtnes Da ob or My Commission Expires Total in Column 1 ofG703) 0.00 6, 'TOTAL I ARNE'D LESS RETAINAGE 1 9 97155 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 'Iblal) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PItFVIOUS CERTIFICATES FOR Architect's knowledge, information and beliefthe Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 12,590.76 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT' DUE 1,382.79 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) AMOUNT CERTIFIED 7 3 v2 (Attach explan i n if amount certified differs front the amount applied. Initial all figures on this ota changes approve Application nd onthe Conti tiort Sf get that are changed to cmyorn with the amount certified.) in previous months by Owner ARCH IT CT: Total approved this Month By: Date: 4 1 3 01 10 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Lontracror namea nerem. issuance, payment ano acceptance Or payment are wlmout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION -AIA ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W.. WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document 0401 Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice 4 4/26/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALAN ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE FINISH Cost Pre Construction Services 4,452.07 4,371.77 80.30 0.00 4,452.07 100% 0.00 4,452.07 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Site Supervision 15,521.48 8,218.99 7,302.49 0.00 15,521.48 0 9 6 0.00 15,521.48 Construction Management 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Site Safety Director 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Design Drawings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Sanitary Facilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Field Office 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Office Supplies 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Telecommunications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Water 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Tools and Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Jobsite Trailer 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Field Eng. and Surveying 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Health and Safety 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Waste Disposal 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Final Clean 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Construction Management Fee 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 55 19,973.55 12,590.76 7,382.79 0.00 19,973.55 100%1 0.00 19,973. CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and or labor as follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of seven thousand three hundred eight -two dollars and seventy -nine cents ($7,382.79) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above described property and improvements thereon on 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 perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC Thom s E. 7tz' resident Subscribed and sworn to before me this: Q/ o KENDRA DIANE WILBU Public: -�1�IJ Marion County 6 r My Commission Expires March 20, 2011 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 Z_ LG Purchase Order No. Terms C'gv <ra /eU 3 z- Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1115 1 g Z22 Iz `-126 is 73 y S�r p Y �s g P X73 7 3 F2 Total 1 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 T/ F IN Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 9a Z M/ S WZ 5 9 1 2 21- 1 a bill(s) is (are) true and correct and that the 9,�;2 7 3 1 1y66 1 S 73 7,3S?,7i materials or services itemized thereon for 1 ,17 which charge is made were ordered and received except •r S- 20 Signature Director of Redevelopment Title Cost distribution ledger classification if claim paid motor vehicle highway fund