HomeMy WebLinkAbout187184 07/06/2010 CITY OF CARMEL, INDIANA VENDOR: 362780 Page 1 of 1
ONE CIVIC SQUARE LITHKO CONTRACTING
CARMEL, INDIANA 46032 PO BOX 270
CHECK AMOUNT: $46,200.12
MONROE OH 45050
CHECK NUMBER: 187184
CHECK DATE: 7/6/2010
DEPARTMENT AC PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460805 APP 6 46,200.12 CITY CENTER
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES
TO r "g PROJECT: CARMEL CITY APPLICATION NO: 6 RETAINER REQUEST Distribution to:
CITY OF CARMEL, REDEVELOPMENT COMMISSIC CENTER PHASE 1 PERIOD TO: May 31, 2010 OWNER
1 1 1 WEST AMIN ST., SUITE 180 PROJECT NOS: 7ARCHITECT
CARMEL, IN 46032 LCI JOB# L5429 CONTRACTOR
FROM CONTRACTOR: CHECK REMITTANCE ADDRESS: CONTRACT DATE: e
LITIIKO CONTRACTING, INC LITHKO CONTRACTING, INC.
P.O. BOX 270 P.O. BOX 270
MONROE, OHIO 45050 MONROE, OHIO 45050
CONTRACT FOR: Place/Finish Concrete VIA ARCHITECT:
CONTRACTOR'S APPLICATION FOR PAYMENT The 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 436,000.00
2. Net change by Change Orders 26,001.16 CONTRACTOR: LIT. HKO CONTRACTING, INC.
3. CONTRACT SUM TO DATE (Line 1 t 2) 462,001.16
4. TOTAL COMPLETED STORED TO 462,001.16
DATE (Column G on G703) By: Date: May 20, 2010
5. RETAINAGE: ANDREA GANNON, I LING COORDINATOR
a. 0% of Completed Work 0.00 State of: OHIO County of WARREN
(Column D E on G703) Subscribed and sworn to before me this C`ti_ ro day M Ptat ee 0
b. of Stored Material
(Column F on 6703) Notary Public: fir'
01 ry Publi hio
Total Retainage (Lines 5a 5b or My Commission expires: Mi Pnmmiccin it .c
Total in Column I of G703) 0.00 ARCHITECT'S CE l ..PTE�QR PAIN ENTa
6. TOTAL EARNED LESS RETAINAGE 462,001.16 In accordance with the Contrac b onion sifel.dl• WNRRWflei�'nd the data
(Line 4 Less Line 5 Total) comprising the application, the A ft 'PN the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information ip e Work has progressed as indicated,
PAYMENT (Line 6 from prior Certificate) 415,801.04 the quality of the Work is in accordance lh t le Contract Documents, and the Contractor
S. CURRENT PAYMENT DUE 46,200.12 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expla ation if amount certified differs from the amount applied. Initial all figures on this
Total changes approved Applicatio nd onthe Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner $26,001.16 $0.00 ARCH T:
Total approved this Month $0.00 $0.00 By: Da 5AZZ&
TOTALS $26,001.16 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
NET CHANGES by Change Order $26,001.16 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
UTers may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
JMP92 -22 -F Effective /31/01
Page l of l
.CONTINUATION SHEET AIA DOCUMEAr7 G703 PAGE 0P PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 6 RETAINER REQUEST
Contractor's signed certification is attached, APPLICATION DATE: 5/20/2010
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 5/3112010
Use Column I on Contracts where variable retainage for line items may apply. AR.CHIT'ECT'S PROJECT NO:
CARMEL CITY CENTER PHASE 1< Lothko
1.5429 C ON TRACT IN 4, INC.
A B C D E F G 1I I
ITEM DESCRIPTION OF WORK. SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G =C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C G) RATE)
(NOT IN TO DATE
D OR E) (D +E +F)
1 PAYMENT PERFORMANCE BOND 4,800.00 4,800.00 0.00 0.00 4,800.00 100% 0.00 $0.00
2 MOBILIZATION 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 $0.00
3 GENERAL CONDITIONS LAYOUT 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 $0.00
4 FIRESTOPPING 12,000.00 12,000.00 0.00 0.00 12,000.00 100% 0.00 $0.00
5 LIGHT POLE BOLLARD PEDESTALS 20,000.00 20,000.00 0.00 0.00 20,000.00 100% 0.00 $0.00
6 MOTOR COURT REBAR INSTALLATION 11,375.00 11,375.00 0.00 0.00 11,375.00 100% 0.00 $0.00
7 MOTOR COURT REBAR MATERIALS 38,500.00 38,500.00 0.00 0.00 38,500.00 100% 0.00 $0.00
8 MOTOR COURT PREP, PLACE FINISH 88,800.00 88,800.00 0.00 0.00 88,800.00 100% 0.00 $0.00
9 VETERANS WAY REBAR INSTALLATIO 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $0.00
10 VETERANS WAY REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $0.00
VETERANS WAY PREP, PLACE FINISH 49,600.00 49,600.00 0.00 0.00 49,600.00 100% 0.00 $0.00
HANOVER SQ REBAR INSTALLATION 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $0.00
HANOVER SQ REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $0.00
HANOVER SQ PREP, PLACE, FINISH 49,600.00 49,600.00 0.00 0.00 49,600.00 100% 0.00 $0.00
COURT PLAZA REBAR INSTALLATION 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $0.00
COURT PLAZA REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0,00 $0.00
COURT PLAZA PREP, PLACE FINISHI 49,600.00 49,600.00 0.00 0.00 49,600.00 1.00% 0.00 $0.00
RE MOB FOR CRANE AREA REBAR INSTALL 1,625.00 1,625.00 0.00 0.00 1,625.00 100% 0.00 $0.00
REMOB CRANE AREA REBAR MATERIALS 4,950.00 4,950.00 0.00 0.00 4,950.00 100% 0.00 $0.00
REMOB CRANE AREA PREP, PLACE, FINISH 10,400.00 10,400.00 0.00 0.00 10,400,00 100% 0.00 $0.00
CO #I ASI #I 2 DRAWING REVISIONS 3,315.87 3,315.87 0.00 0.00 3,315.87 100% 0.00 $0.00
CO #2 ASI #3, #4 ESI 16 CHANGES 22,685.29 22,685.29 0.00 0.00 22,685.29 100% 0.00 $0.00
GRAND TOTALS 462,001.16 462,001.16 0.00 0.00 462,001.16 100% 0.00 $0.00
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
c
Page I of I JMP92 -20 -F Effective 1/31/01
Lithko Contracting, Inc.
(513) 539 -4144 n
Remittance Address r.
P.O. BOX 270
MONROE, OHIO 45050 C O N T R A C T I N G INC.
149837
TO: CITY OF CARMEL, REDEVELOPMENT COMMISSION
11.1 WEST AMIN ST., SUITE 180 Invoice No.
CARMEL, IN 46032 26783 RI
C/O SIGNATURE CONSTRUCTION, LLC.
720 THIRD AVE., S.W. Invoice Date
CARMEL, IN 46032 5/20/10
Job name: Lithko Job No. Customer Job No. P.O. No.
CARMEL CITY CENTER PHASE z. L54
Description Amount
6 RETAINER REQUEST 46,200.12
COMMUNICATIONS CONVEYED ON CHECK TENDERED STATING
PAYMENT IN FULL AND /OR WAIVING OF LIEN RIGHTS TO ANY
EXTENT MUST BE SENT TO SELLER AS FOLLOWS:
ATTN: ACCOUNTS RECEIVABLE DEPT., LITHKO CONTRACTING, INC.
P.O. BOX 270, MONROE, OH 45050
Payment Terms 3o DAYS TOTAL AMOUNT DUE b
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS WAIVER OF LIEN
STATE OF Indiana
COUNTY OfIlamilton
Being duly sworn upon his/her oath disposes and
says that
1. He /she i kA G=- (inserting sole proprietor, partner or corporate office held, as the case maybe),
of Lithko Contracting hereafter called the "Subcontractor He /she is over the age of twenty -one.
He /she is authorized to make this affidavit on behalf of Subcontractor.
2. Subcontractor is the co")aFV_ Subcontractor for the construction of the development known as
CARMEL CITY CENTER located in CARMEL (City), INDIANA (state), hereafter referred to as the
"Development pursuant to the contract between the Subcontractor and Signature Construction, LLC,
the General Contractor.
3. This affidavit is made for the express purpose of inducing Signature Construction, LLC, to make
payment to Subcontractor of the invoice submitted herewith for labor and materials furnished pursuant to
said Contractor. Upon receipt of said payment the Subcontractor hereby waives any lien rights to which
Subcontractor is entitled for labor or materials furnished for the development to the date hereof.
4. listed below are all suppliers or other persons who either has furnished or might furnish the
Subcontractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the
development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a
waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case
also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered
to the General Contractor. 3.) If the initial delivery has not been made.
Supplier List (Add list if necessary 1 1. Amount Owed 3
Acsfknlowr{s Ock W RF4(ovo vJ VAS TbE E".0012s UVO
#1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC
is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly
payable to Subcontractor and such creditor, as Signature Construction, LLC shall determine.
5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result
in lien being filed against the Development or a claim being asserted against the General Contractor
except the persons or businesses named in Paragraph 4 above.
IN WITNESS WHERE OF, affiant has signed this document on behalf of the Subcontractor this
day of 0 LO
(Authorized Representative f Subcontractor)
County of
State o f A dOtMk
Subscribed and sworn to before me, a Notary Public in and for said County and State,
This MP' Day of Aeou 20
(Notaq Public)
(Printed Name)
My Commission Expires:
NOTARY SEAL MUST APPEAR ON THIS FORM. (Revised
6
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995
ACCOUNTS PAYABLE VOUCHER
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 �LL
4� 0 �o�J7�ra�T,'�iG i ���c Purchase Order No.
i
Terms
r
//a ro 5 0 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 2051 fZ
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.
/f ALLOWED 20
IN SUM OF
l"0 fox 270
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF t 1lo
-5
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
y 20/o
Signature
Director of Redevelopment
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund