HomeMy WebLinkAbout186682 06/21/2010 s CITY OF CARMEL, INDIANA VENDOR: 358222 Page 1 of 1
ONE CIVIC SQUARE M A B ASSOCIATES
CARMEL, INDIANA 46032 7648 CAMELBACK DRIVE CHECK AMOUNT: $60,176.45
INDIANAPOLIS IN 46250
CHECK NUMBER: 186682
CHECK DATE: 6/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 6 60,176.45 PERFORMING ARTS CENTE
1
TM
Document G702/CMa 1992
Application and Certificate for Payment Construction Manager Adviser Edition
PROJECT
TO OWNER: itfl.,,,, s APPLICATION NO:
CA�IMIL �Mr[ !0 Distribution to:
JCt N�Ll.rj/C� .Nt. 7 ��'�'IM•+. S
qq PERIOD TO: f 1 (f OWNER 11
C',Dflut.�,+�• ��0 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIAL C NS UCTI M CONTRACT DATE: ZI a ARCHITECT
��J.l sw �3
�y� �d>� rC PROJECT NOS: Z�y.�I/ �Q I CONTRACTOR El 76 ,04 VIA ARCHITECT: CSO FIELD
CONTRACT FOR: rem..:^ 0,fw4,u,T -al 4 -P
CONTRACTOR'S APPLICATION FOR PAYM NT The undersi Contractor certifies that to the best of the Contractor's knowled information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Contract Documents, that all amunts have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Cert' r ayment were i and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM z 5 j U 2- pa ntent shown herein is w ¢t
2. Net change by Change Orders Z `I S CO CTOR: •d. si AT. r wl
3. CONTRACT SUM TO DATE (Line 1 2) zinc J JS� By: bate: 7 f U
4. TOTAL COMPLETED STORED TO DATE (Column G on 6703) S Z 3 State of:
5. RETAINAGE: County of 1447, 0—
a• of Completed Work Subscribed and sworn to before
(Column D E on G703) me this 2 7 dA u 2'45 J 0
b. of Stored Material Notary Public: (Column F on G703) My Commission e 3 fj
Total Retainage (Lines Sa +5b or Total in Column I of G703). %3 Z�7, �S C ERTIF ICA TE FOR PAYMENT R esklentOf
rian
In accordance with the Contract Documents, basc"� Ma
C bse pi ng
6. TOTAL EARNED LESS RETAINAGE Js /S this application, the Construction Manager and Ar to t wn tithe best of it
(Line 4 Less Line 5 Total) 7b knowledge, information and belief the Work hasp in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 7� 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 AMOUNT CERTIFIED 1 A0
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs frorn the amount applied. Initial all tgures on this
f r� Applicatir I on th Continuation Sheet that are changed to conform with the amount certiflied.)
(Line 3 less Line 6) 1 Z7 4 9 J CONSTRUMAN R:
y= l Date: 4
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT'
Total changes approved in previous months by Owner By. Date: ZG7
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 Contract Document, on which this text appears in RI=D. 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 Date 4/27/2010
APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: six
Contractor's signed Certification is attached. APPLICATION DATE: 4/15/2010
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 413011930
Use Column I on Contracts where variable retains a for line items may apply. ARCHITECT'S PROJECT NO. 19122
A B C 1) E F G H I
ITEM DE5CRIPTION OF WORN SCHEDULED WORKCOMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO, I VALUE FROM PREVIOUS THISPERIOD PRESENTLY COMPLETED (GIC) TO FINISH
1 APPLICATION STORED AND STORED
(D-E) (NOTIN To DATE
D ORE D.EIF
0100 Base Contract
0101 Performance Payment Bond 3 S 3,870.00 S 3,870.00 0% 0.00 3$7.00
0102 Detailing Engineering 16 16,695.00 16 695.00 0% 0.00 1669.50
0103 Material MT la rail 15 962,00 15 962.00 15 962.00 0% 0.00 1596.20
0104 Fabrication MT la 68,191,00 13.372.00 S 41597.00 54,969.00 0% 13222.00 5496.90
0105 Installation 15 600.00 3.750.00 S 3,750.00 0% 11850.00 375.00
0106 Material MT 1 b 9 9,271 00 9,271.00 0% 0.00 927.10
01D7 Fabrication MT 1b 28 202 00 0% 28202.00 0.00
0108 Installation 8 0% 8700.00 0.00
0109 Matenal MT 1c 9,528.00 9,528.00 S 9.528.00 0% 0.00 0.00
0110 Fabriation MTlc 29,952.00 19,468.00 1946800 0% 10484.00 1946.80
Installation 7,990.00 3 3,750.00 0% 424000
Material 1 -line 3,724.00 3,724.00 3,724.00 0.00
Fabrication 5,916.00 5916.00
Installation 2,183.00 $2,183.00
Powder Coat MT 1a 11,091.00 1,121.00 1,121.00
Powder Coat MT 1a 3,482.00
Powder Coal MT 1 a 7,352.00
Powder Coat Single line 1,173.00
Chan a Order Al 8 460.00 2 S 2,00200 4,000.00
Cash Allowance Authorization $5,000 S 2 2,000.00
Chan e Order #3 $1,815 1,815.00 1815.00
TOTAL 264,167.00 85,043.00 64,880.00 149,923.00 0% $114,774.00
AFF][DAVIT AND WAIVER OF LIEN
Final
Partial Payment to follow
r..�_'-
Y OF j 9�.E SS•
sT� COUNT he/she is the
ATE Qf being duly swam states that
of
(tide) t (supplier or subcontractor)
having contracted with -fl
to furnish certain material
ontractor) 12
and/or labor as follows:
(descripti n)�
for the pro} kno as
tiJ and caned by
located at �n �r and does hereby er state on behalf
architect S 61
of the aforementioned subcontractorlsupplicr:
PARTIAL WAIVER that the [aalanca duo from contractor is the stundo
�r
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 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
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 t acco o f any work perforated or material
furnished to the undersigned fo said payMnt, wi0iin the scope of this affidavit and waiver.
(name of claimant) (authorizarepresentativill5 (title)
Witness my hand and notarial s al, i s day o
My commiss' xpires:
(stgndturc of notary)
Residing in County Prin
t�:a0
Of
huft COW"
r 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.
�i Payee z:
Ad, sso�,sri��s /i�� Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
ys
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF 1 110
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT I hereb
DEPT. y certify that the attached invoice(s), or
4U6U6��7 6, 7Ks%s 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
5 7 2VO
Signature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund