Loading...
HomeMy WebLinkAbout186698 06/21/2010 a CITY OF CARMEL, INDIANA VENDOR: 360381 Page 1 of 1 i ONE CIVIC SQUARE SANTAROSSA MOSAIC TILE CO INC CHECK AMOUNT: $9,360.90 CARMEL, INDIANA 46032 PO BOX 664043 INDIANAPOLIS IN 46266 -4043 CHECK NUMBER: 186698 CHECK DATE: 6/21/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 APP 6 9,360.90 PERFORMING ARTS CENTE TM 1 11 A IA Document G7021CMa -1992 0 Application and Cert ificate for P ayment Construction Manager- Adviser Edition? TO OWNER: �I� e� �D�(1 tltCOmm11311b 1 PROJECT: Qro g APPLICATION NO b Distribution to: PERIOD TO 0123IIO OWNER l J tmetj�i IU I Q I Illy 1X V'Jl CONSTRUCTION MANAGER FROM CONTRACTOR:-tfhIQMMOQ ota1 'e IICNf4C VIA CONSTRUCTION MANAGER: CO NTRACT DATE: 05101 l pq ARCHITECT Vol kAuel(k Rventy PROJECT NOS: CONTRACTOR �ld,lanU�O(IS, Tnd�Una 1 VIA ARCHITECT: FIELD CONTRACT FORS/ bnj�e, &IJa l 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 Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet, AIA Document G703, is attached. Certificates for Payme era- issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM '�jQ, paymen in is now d e. 2. Net change by Change Orders O NT R: A 3. CONTRACT SUM TO DATE (Line I 2) b 5O. OQ Date: Q�� 22�IQ 4. TOTAL COMPLETED STORED TO DATE (Column G on G703) Q� State of: n laYlQ 5. RETAINAGE: County of: a. 16 of Completed Work Subscribed a orn to b fore (Column D E on G703) ?l 21 3 d me this 22nQ YT f 1 b. %of Stored Material Notary Publi (Column F on G703) My Commis, i n s: Total Retainage (Lines 5a 5b or Total in Column I of G703) 21�. CERTIFICA E FOR PAYMENT p In accordance with the Contract Documents, based on on site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE 0 g55�1 p 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 Qq 04.86 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) ��yy q CERTIFIED. 8. CURRENT PAYMENT DUE ALP `7D AMOUNT CERTIFIED l 0 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if antomtt certified differs f n the amount applied. Initial all tgures on this ppnn^^ Application and c the Continuation eet t {r tae changed to cbnfornt with the amoantt certified.) 12�, 4 �4. �b CONS UCTI Line 3 less Line 6 By: Date: &4 �O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT Total changes in previous months by Owner By. Date: vl u Total approved this: Month This Certificate is not,ne'gotiable. 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 RED. An original assures that changes will not be obscured. AIA Document G702 /CMaTM 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. Document G702 /CMaTM -1992 Instructions Application and Certificate for Payment Construction Manager- Adviser Edition A. General Information AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager Adviser Edition, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition. B. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org. C. Completing the G702/CMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The Contractor should sign G702/CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect. The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded to the Owner. D. Completing the G703 Form Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of-the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal4he original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed This Period). Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 /CMa form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa. E. Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager anKArchitect on AIA Doqument G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and:address of the .Contractor. Payment should not be made to any other party unless specifically indicated on G702 /CMa. AIA Document G702 /CMaTM 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. 09201 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on re side) PAGE 2 O r 2 t AGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 6 containing Contractor's signed Certification, is attached. APPLICATION DATE: 4/16/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/23/2010 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: A B C D E F G 11 I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE ITEM SCHEDULED TO NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS STORED AND STORED G C FINISH (IF VARIABLE) AI PLICATION "PHIS PERIOD (NOT IN TO DATE RAZE) (D E) D OR E) (D +E +F) (C G) 01.000 STONE FLOORING oi,too MATERIAL 402,325.0 90,000.0 90,000.00 22 312,325.0 9,000.0 01.200 LABOR 349,950.0 20,997.0 3,034.0 24,031.00 7 325,919.0 2,403.1 01.30 01.400 STONE TOPS 01.500 MATERIAL 20,000.0 2,000.0 5,917.0 7,917.00 40 12,083.0 791.7 01.600 LABOR 28,000.0 5,600.0 1,450.0 7,050.00 25 20,950.0 705.0 01.70 01.800 QUARRY TILE 01.90 MATERIAL 1,500.0 1,500.0 02.000 LABOR 1,500.0 1,500.0 02.10 02.200 GENERAL ALLOWANCE 35,000.0 35,0000 02.300 CAD AS -BUILT ALLOWANCE 5,000.0 5,000.0 03.400 BOND 3,175.0 3,175.0 3,175.0 100 317.5 03.50 03.60 CHANGE ORDER #1 03.70 846,450.0 121,772.00 10,401.00 132,173.0 16 714,277.0 13,217.3 AIA DOCUMENT G703 CONTINUATION SHEET FOR G702 1992 EDITION AIA ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, NW, WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703 -1992 t CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur wham a�- WAIVER OF LIEN AND AFFIDAVIT FINAL (V PARTIAL PAYMENT TO FOLLOW Todd .�chu being duly sworn states that (s) he is of SANTAROSSA MOSAIC TILE CO. INC. having contracted with C �evlvpwnlumm w to furnish certain materials and /or labor as follows: C for a project known as located at l and owned by does hereby further state on behalf of the aforementioned sub /contractor /supplier. PARTIAL WAIVER That the balance due from the contractor is the sum o£ n .Q 5 'J)DO DOLLARS eceipt of which is hereby acknowledged: or Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (PARTIAL) which is given to and for said amount effective upon receipt of such payment. FINAL WAIVER That the final balance due from the contractor is the sum of: DOLLARS Receipt of which is hereby acknowledged: or Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (FINAL) which is given to and for said amount effective upon receipt of such payment. THEREFORE: the undersigned waives and releases unto the said owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account.ofaabor.and.materiaLor. 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 said project, and within the scope of this AFFIDAVIT and WAIVER. SANTA OSSA MOSAIC TILE CO., >�-Y_:_ TITLE: U D. WITNESS my hand and notarial seal this 22n day of 20&. My Commission Expires: tf Public Residing in Marion, County of Indiana �a wri Due Printed 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 musf'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 r ,�gyfg ✓C3S9 A, Purchase T` lam. �y�;; Purchase Order No. 2,a7 Terms I �I�C✓r1�,,Oo %s, ,�lJ y62 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) X23 0 f 16 9 �o, yo 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 q Ossg �os�i•'� T �G, f ti� IN SUM OF /62 60.20 ON ACCOUNT OF APPROPRIATION FOR Pay from TIF jot /yy6o�'�7 Board Members PO# or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or 1f �2 ySYa� l o7 g 360.90 bill(s) is (are) true and correct and that the materials or services itemized thereon for ,/4 which charge is made were ordered and received except U 20 D irector o 'Redeve Title Cost distribution ledger classification if claim paid motor vehicle highway fund