HomeMy WebLinkAbout187194 07/06/2010 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: $18,745.99
CARMEL IN 46032
CHECK NUMBER: 187194
CHECK DATE: 7/6/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460873 2 -73 4,127.88 PARCEL 5 STREETSCAPE
902 4460805 3 -11 5,308.63 RETAIL SITE #5
902 4460873 3 -73 4,184.80 PARCEL 5 STREETSCAPE
902 4460805 4 -111 4,425.87 RETAIL SITE #5
902 4460805 7 -110 698.81 RETAIL SITE #5
APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCUM G PAGE ONE OF 2 PAGES2
TO OWNER: CRC at City of Carmel PROJECT: Carmel City P I I l Waterproofing APPLICATION NO: Invoice 9 3 1 Distribution to:
One Civic Square Signature costs =OWNER
Carmel Indiana 46032 ARCHITECT
PERIOD TO: 02/26/2010 =CONTRACTOR
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 Contractors knowled
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 16,00441
2. Net change by Change Orders U77 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I f 2)
4. TOTAL COMPLETED STORED TO
By: Date: 511 1
5. RETAINAGE: om Koontz, rest ent r-
a. 0 of Completed Work 0 5u scribed d sworn to before me this b� day of Inn w
(C olumn D E on G703) ArP s LINDA BUCHANAIV
b. %of'Stored Material a p.• •.y�.
o umn P on 6703)
no'rnar Hancock County
t tat tcetama e Lm a 4' n 5 a My Commission Expires
o g >bo r
Total in Column I of G703) 0.00 -`Z'
6. TOTAL EARNED LESS RETAINAGE 16 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) S 10,695.78 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 5,3077T is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY AI)Dl I IONS Dt-DUC I JUNS (Attach explana n if iouni certified diJJers from the amount applied. Initial alligures on this
ota changes approve Application a d onth Continu n to eonfonn with the amount certified)
in previous months by Owner ARCHITE
Total approved this Month By: Date:
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
t_ ontracior named neretn. issuance, payment ana 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 W992 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.
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 five thousand three hundred
eight dollars and sixty -three cents ($5,308.63) 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
om Koontz, Preside
ti
Subscribed and sworn to before me this:
Notary Public:
LINDA BUCHANAN
Hancock County
Nay Commission Expires
August20, 2011
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
1
Invoice 3
2/26/10
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 3,117.15 100% 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 4,501.34 4,127.84 0.00 373.50 4,501.34 0% 0.00
Site Safety Director 0.00 0.00 0.00 0.00 0.00 0% 0.00
Design Drawings 3,164.26 132.77 0.00 3,031.49 3,164.26 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 Orb 0.00
Office Supplies 24.75 24.75 0.00 0.00 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 1,023.27 1,023.27 0.00 0.00 1,023.27 0% 0.00
Project Signage 0.00 0.00 0.00 0.00 0.00 0% 0.00
Field Engineering and Surve 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
16,004.41 5,308.63 0.00 10,695.78 16,004.41 100 0.00
10,695.78 1
Date: 03/01/2010 Const Mgt Projects Signature Page: 1
Time: 8:34:37AM CASH REQUIREMENTS REPORT
Invoice Description Invoice Due Invoice Retention Discount Workers' Paid Payment
Date Date Comp to Date
Vendor: 2808 SIGNATURE CONSTRUCTION
3/P111 SIGNATURE CONSTRUCTt 02/26/2010 03/31/2010 5,308.63 0.00 0.00 0.00 0.00 5,308.63
Vendor Total 5,308.63 0.00 0,00 0.00 0.00 5,308.63
Number of Checks 1
Company Totals 5,308.63 0.00 0.00 0.00 0.00 5,308.63
GENERAL LEDGER ACCOUNT TOTALS
Account Description Debit Credit
CASH 0.00 5,308.63
2010 ACCOUNTS PAYABLE 5,308.63 0.00
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2
TO OWNER: CRC at City of Carmel PROJECT. Carmel Parcel 73 APPLICATION NO: Invoice 2 1 Distribution to:
One Civic Square Streetscape Signature costs =OWNER
Carmel Indiana 46032 =ARCI ITFCT
PERIOD TO: 02/26/2010 =CONTRACTOR
FROM CONT'RACT'OR. VIA ARCI- 117TECT: Pedeor 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 undersigned Contractor certifies that to the best onthe Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and belief 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 8,405.96
2. Net change by Change Orders 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I t 2)
4. TOTAL COMPLETED STORED TO 8,40).
5.
13 l� Date: .3 1, 0
5. RETAINAGE: omas RoonV, r�eslcent
a. U of Completed Work U Sus a
bbed and worn to before me this day of(t 1f— t
o umn D E on G703) rr
b. of Stored Material ...•..s LINDA BUCHANAN
(C olumn h on 6703)
pro. av Hancock County
g My Commission Expires
i otal Keta es
ma c Lines -a ob or
Total in Column I of G703) 0.00 ""i'' ugust 27 7 2011
6 TOTAL EARNED LESS RETAINAGE 9 96 In accordance with the Contract Documents, based on on -site observation' an t
(Line 4 Less [.,me 5 'I'otal) 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,
PAYMEN'1' (Line 6 dom prior Certificate) S 4,278.08 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8- CURRENT PAYMI -NT DUE is entitled to payment ol'the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE
(Line 3 less Line 6) AMOUNT CERTIFIED S 4 IV
(Attach explanation if rtified differs from the amount applied. Initial all figures on this
otal changes approveH Application and onthe C tin ation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT`.
Totat approved this Month Lay: Date: 3 3i l 0
TOTALS $0.00 50.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only o the
k-,ontracmr nameo nerem. issuance, payment ano acceptance of payment are wltnout
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 01992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE_ N.W., WASHINGTON, OC 20006 -5292
Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee.
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 four thousand
one hundred twenty -seven dollars and eighty -eight cents ($4,127.88) 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
ho E. Koontz, P
h
Subscribed and sworn to before me this: 5-- i o
Notary Public:
LINDA BUCHANAN
h yo*AAY Hancock County
,ta My Commission Expires_.
August 2 0, 2011
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice 2
2/26/10
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 4,278.08 4,278.08 0.00 0.00 4,278.08 100% 0.00 4,278.08
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 4,127.88 0.00 4,127.88 0.00 4,127.88 0% 0.00 4,127.88
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 Oak 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 09 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 1 6 0.00 0.00
Construction Management Fee 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00
8,405.96 4,278.08 4 0.00 8,405.96 100% 0.00 8,405.96
Date: 03/01/2010 Const Mgt Projects Signature Page: 1
Time: 8:36:03AM CASH REQUIREMENTS REPORT
Invoice Description Invoice Due Invoice Retention Discount Workers' Paid Payment
Date Date Comp to Date
Vendor: 2808 SIGNATURE CONSTRUCTION
2 /PAR73 SIGNATURE CONSTRUCTI 02/26/2010 03/3112010 4,127.88 0.00 0.00 0.00 0.00 4,127.88
Vendor Total 4,127.88 0.00 0 0.00 0.00 4,127.88
Number of Checks 1
Company Totals 4,127.88 0.00 0.00 0.00 0.00 4,127.88
GENERAL LEDGER ACCOUNT TOTALS
Account Description Debit Credit
CASH 0.00 4,127.88
2010 ACCOUNTS PAYABLE 4,127.88 0.00
APPLICATION AND CERTIFICATION FOR PAYMENT A IA DOC UMENT G 7 PAGE ONE OF 2 PAGES2
TO OWNER: CRC at City of Carmel PROJECT: Cannel Pucel 73 APPLICA'T'ION NO: hnoicc P 3 I Distribution to:
One Civic Square Streeetscape Signature costs =OWNER
Carmel Indiana 46032 =ARCHITECT
PERIOD TO: 03/25/2010 OCONTRACTOR
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 undersigned Contractor certifies that to the best of the Contractors knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and beliefthe 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 imm the Owner, and that current payment shown herein is now due.
I ORIGINAL, CONTKACI' SUM 12,590.76
2. Net change by Change Orders 0.00 CON TRACTOR:
3. CONTRACT SUM TO DATE (Line 1 f 2) 12,5 90.76
4. TOTAL COMPLETED STORED TO 12,o 90. 76 O
5. RETAINAGE: om Date:
Koontz, President
a. 0 of Completed Work 0 Subscribed`an sworn to betore me thisG day of(.�/ r �U
(Column D +Eon G703) +P�' LINDA BUCHANAN
b. of Stored Material
n umn F' On G7U3) Hancock County
Lotal Ke[amage(Lmes �a +obor "sue
My Commission Expires
Total in Column I of G703) 0.00 20 2011
6 TOTAL EARNED LESS RETAINAGE I Z,� qu. In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Less Line 5 1 otal) comprising the application, the Architect certifies to the Owner that to the best of the
T LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and beliefthe Work has progressed as indicated,
PAYMENF (Line 6 tirom priorCertiflcate) 8,405.96 the quality ofthe Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 4,184.80 is entitled to payment of the AMOUNT CER'17FIED.
9. BALANCL-' TO FINISH, INCLUDING RETAINAGF. S 0,00
(Line 3 less Line 6) AMOUNT CERTIFIED
(Attach explanation ifam certified differs f tom the a ap plied. Initial all figures on this
otal changes approved Application and onthe nt nuatiorr 'heel that are changed to conform with the amount certified)
in previous months b Owner ARCHTfECT:
Total approved this Month 13y: Date. 3 re
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable onl
contractor nameo nerem. issuance, payment ana acceptance or payment are wanouT
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT 0702 APPLICATION AND CERTIFICA710N FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORKAVE., 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.
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 1 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 four thousand
one hundred eight -four dollars and eighty cents ($4,184.80) 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
homas Koontz, President
Subscribed and sworn to before me this: .?6 /I'
Notary Public:
;'�a P LINDA BUCHANAN
'NOUnr': Hancock County
My Commission Expires
FOF August 20, 2011
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invo±ce 3
3/25/10
Carmel City Parcel 73 Streetscape
Carmel, Indiana
WORK COMPLETED MATERIALS TOTAL BALANCE
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 4,371.77 4,278.08 93.69 0.00 4,371.77 100% 0.00 4,371.77
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 8,218.99 4,127.88 4,091.11 0.00 8,218.99 0% 0.00 8,218.99
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 01b 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
12,590.76 8,405.96 4,184.80 0.00 12,590.76 100 0.00 12,590.76
Date: 03/26/2010 Const Mgt Projects Signature Page: 1
Time: 8:11:52AM CASH REQUIREMENTS REPORT
Invoice Description Invoice Due Invoice Retention Discount Workers' Paid Payment
Date Date Comp to Date
Vendor: 2808 SIGNATURE CONSTRUCTION
MAR/73 SIGNATURE CONSTRUCTI 03/25/2010 04/30/2010 4,184.80 0.00 0.00 0.00 0.00 4,184.80
Vendor Total 4,184.80 0.00 0.00 0.00 0.00 4,184.80
Number of Checks 1
Company Totals 4,184.80 0.00 0.00 0.00 0.00 4,184.80
GENERAL LEDGER ACCOUNT TOTALS
Account Description Debit Credit
CASH 0.00 4,184.80
2010 ACCOUNTS PAYABLE 4,184.80 0.00
APPLICATION AND CERTIFICATION FOR PAYMENT 414 DOCUMENT G702 PAGE ONE OF 2 PAGES2
TO OWNER: CRC at City of Carmel PROJECT: Carmel City P I 1 I Waterproofing APPLICATION NO: Invoice 4 1 Distribution to:
One Civic Square Signature costs =OWNER
Carmel Indiana 46032 =ARCHITECT
PERIOD TO: 03/25/2010 =CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services LLC
720 3rd Avenue S.W. PROJECT NOS:
Carmel, Indiana 46032
CONI'RACI' FOR: CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowled
Application is made for payment, as shown below, in connection with the Contract. information and beliefthc 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.
L ORIGINAL, CONTRACT SUM 20,43028
2. Net change by Change Orders 7ur CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I t 2)
4. TOTAL COMPLETED STORED TO
By: Date:
5. RETAINAGE: I hdmas E t7, rest dent yp
a. 0 of Completed Work 0 Subscr ed and swo to before me this .7 day of I�eeerttb
o umn D E on 6703) LINDA BUCHANAN
b. of Stored Material
Hancock County
(Column F on 6703) ,rR PAy Comm ission Expires
1 otal Ketatnage (Lines Da or
1
Total in Column I ofG703) 0.00
6. TOTAL EARNED LESS R ETA INAGE In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 Less Line 5 otat) 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 beliefthc Work has progressed as indicated,
PAYMENT (L.ine 6 from prior Certificate) 16,004.41 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE S/ is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE, TO FINISH, INCLUDING RETAINAGE o
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SU1717AKY ADDI I IONS DEDUC I IONS (Attach esplanatiot amo oft certified differs fi the amount applied. Initial all figures on this
ota changes approve Application and the C ttinu t n Sh at are changed to conform with the amount certified.)
in previous months by Owner ARCLIrrECT- II
Total approved this Month By: Date. 3�3r1
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
contractor namea nerem. issuance, payment aria acceptance or payment are wunout
NET C14ANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT 0702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 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.
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 1 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:
I
CONDITIONAL WAIVER:
that the balance due from the owner is the sum of four thousand four hundred
twenty -five dollars and eighty -seven cents ($4,425.87) the payment of which has been
promised as the sole consideration for this Affidavit and Conditional Waiver
of Lien which is given to and for said amount, effective upon receipt of such
cash payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any
and all line or claim whatsoever on the above described property and improvements
thereon on account of labor or material or both, finished by the undersigned thereto, and
further certifies that no other party has any claim or right to a lien on account of any
work perform or material furnished to the undersigned for the said project, and within the
scope of this affidavit and waiver.
SIGNATURE CONSTRUCTION, LLC
T mas E. ontz, Presl ent
L
bscribed and sworn to before me this: ,2e
Notary Public:
LINDA BUCHANAN
NARY Hancock County
5 .=P My Commission Expires
August 20, 2011
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 4603
Invoice 4
3/25/10
Carmel City P111 Waterproofing
Carmel, Indiana
Total Work RETAINAGE RAT.ANCE
Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO
DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE FINISH
Pre Construction Services:
Project Management 3,117.15 0.00 0.00 3,117.15 3,117.15 100w 0.00
Site Supervision 4,173.64 0.00 0.00 4,173.64 4,173.64 100% 0.00
General Conditions: 0.00 0.00 0.00 0.00 0.00 0$ 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 8,592.49 4,091.15 0.00 4,501.34 8,592.49 0% 0.00
Site Safety Director 157.53 157.53 0.00 0.00 157.53 0 0.00
Design Drawings 3,164.26 0.00 0.00 3,164.26 3,164.26 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
Tem 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 1,200.46 177.19 0.00 1,023.27 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
20,430.28 4,425.87 0.00 16,004.41 20,430.28 100% 0.00
16,004.41
Date: 03/2612010 Const Mgt Projects Signature Page: 1
Time: 8:10:39AM CASH REQUIREMENTS REPORT
Invoice Description Invoice Due Invoice Retention Discount Workers' Paid Payment
Date Date Comp to Date
Vendor: 2808 SIGNATURE CONSTRUCTION
MAR /P111 SIGNATURE CONSTRUCTI 03125/2010 04130/2010 4,425.87 0.00 0.00 0.00 0.00 4,425.87
Vendor Total 4,425.87 0 -00 0.00 0.00 0.00 4,425.87
Number of Checks 1
Company Totals 4,425.87 0.00 0.00 0.00 0.00 4,425.87
GENERAL LEDGER ACCOUNT TOTALS
Account Description Debit Credit
CASH 0.00 4,425.87
2010 ACCOUNTS PAYABLE 4,425.87 0.00
APPLICATION AND CERTIFICATION FOR PAYMENT AIA Do PAGE ONE OF 2 PAGES2
'f0 OWNER: CRC at City of Cannel PROJECT: Carmel City Phase l PI 10 APPLICATION NO' Invoice 7 1 Distribution to:
One Civic Square Signature costs =OWNER
Carmel Indiana 46032 =ARCHITECT
PERIOD TO: 03/25/2010 CONTRACTOR
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 ofthe 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 65,896.72
2. Net change by Change Orders S CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I +2) 6 5, 896.72
4. TOTAL COMPLETED STORED TO S
rSubscribed Dale: 'd 5 RETAINAGE: ontz, resr ent 0 of'Completed Work 5 0 d om to before me this y� day of
a.
Co umn D E on G703)
:SPAYP� LINDA BUCHANAN
b. ofStoredMatelial S
NOrAnr
TC_ oTu m n F on 6703) Hancock County
SEAL
g l My Commission Expires
1 Otffi KOlaln3 a Li ne s �a 'r' �tJ Or
Total in Column 1 ofG703) 000 August 20, 2011
6. TOTAL EARNED LESS RETAINAGE 50,17971 In accordance with the Contract Docum qsrts, 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 oi' the
7. LESS PREVIOUS CERTIFICATES FOR .Architects knowledge, information and beGet` the Work has progressed as indicated,
PAYMENT (Line 6 from prior Cenificare) S 49,480.90 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8 CURRENT PAYMENT DUE 69881 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE a
(Line 3 less Line 6) A -MOUNT CERTIFIED. S 41 p. O(
S M1 71714 ADDI I IOt (Attach explanation ii of t certiji drfjers the amount applied. Inriial all figures on this
otal changes approved application and or w(A) tinuat n 5'I et chat are changed io conjornr rrirh the anmuni cerrrjied.)
in previous months by Owner ARCHITECT: rI
Total approved this Month 13y: Date.
5J.3 I b
TOTALS $0.00 SO 00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
contractor named nerem, Issuance, payment and acceptance or payment are wnnom
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECT$ 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.
CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN
STATE OF INDIANA
COUNTY OF HAMILTOP
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 5b
P110 Topping Slab, 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 six hundred
ninty -eight dollars and eighty -one cents ($698.81) the
payment of which has been promised as the sole consideration for this Affidavit
and Conditional Waiver of Lien which is given to and for said amount, effective
upon receipt of such cash payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any
and all line or claim whatsoever on the above- described property and improvements
thereon on account of labor or material or both, finished by the undersigned thereto, and
further certifies that no other party has any claim or right to a lien on account of any
work perform or material furnished to the undersigned for the said project, and within the
scope of this affidavit and waiver.
SIGNATURE CONSTRUCTION, LLC
Tho E. tz, President
Subscribed and sworn to before me this: o? rt'�4 'o
Notary Public: 'e 'WA
ey B L LINDA BUCHANAN
OTARV'.. Hancock County
:sE, My Commission Expires
�6FjT August 20, 2011
SIGNATURE CONSTRUCTION LLC
j 720 3rd Avenue, S. W.
I Carmel, Indiana 46032
Invoice 7
I 3/25/10
I Carmel Cit Phase 1 P110
Carmel, Indiana
I I l I I I I
Total Work RETAINAGE BALANCE
Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO
DESCRIPTION Value This eriod THIS PERIOD APPLICATIONS TO DATE FINISH
I
General Requirement:
Testing and Inspecting 3,000.00 0.00 0,00 3,515.83 3,515.83 117% (515.83)
Pro Management 6 0.00 0.00 3,005.24 3,005.24 50% 2,994.76
Site Supervision 16,153.85 0.00 0.00 18,061.90 18,061.90 112% (1,908.05)
Site Safet Director 1,333.33 0.00 0.00 0.00 0.00 0$ 1,333.33
Design Drawin 5,000.00 0.00 0.00 1,262.93 1,262.93 25$ 3,737.07
Sanita Facilities 1,248.00 0.00 0.00 0.00 0.00 0% 1,248.00
Field Office 1,512.00 0.00 0.00 0.00 0.00 0% 1,512.00
Temporar Electric 225.00 0.00 0.00 0.00 0.00 0% 225.00
Office Su 225.00 0.00 0.00 0.00 0.00 0% 225.00
Temporary Telecommunications 225.00 0.00 0.00 0.00 0.00 0% 225.00 t
Temporary Water 225.00 0.00 0.00 0.00 0.00 0% 225.00
Tools and Eq 600.00 0.00 0.00 0.00 0.00 0% 600.00
Pro Signa 100.00 0.00 0.00 0.00 0.00 0% 100.00
Field Engineering and Surveying 5,000.00 0.00 0.00 1 1,835.00 37% 3,165.00
Health and Safet 1,000.00 0.90 0.00 0.00 0.00 0% 1,000.00
Waste Dis 1,083.75 O.DO 0.00 0.00 0.0 0$ 1,083.75
Final Clean 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00
Construction Management Fee 21,965.79 698.81 0.00 21,800.00 22,498.81 102% (533.01)
I I
I I
I 65,896.72 698.81 0.00 49,480.90 50,179.71 76% 15,717.01
I I
I I 1 I I I I I I
49,480-90 1
I I I 27,680.90
I I I I 27,`080.90
I
f I 0.00 I
E I I I I I I I i I
i I I I I I I I i j
I I I I I I I I I
E I I I I I I I
E I I I I E
f I I I I I I I I I
Date: 03/26/2010 Const Mgt Projects Signature Page: 1
Time: 8:09:27AM CASH REQUIREMENTS REPORT
Invoice Description Invoice Due Invoice Retention Discount Workers' Paid Payment
Date Date Comp to Date
Vendor: 2808 SIGNATURE CONSTRUCTION
MAR /P110 SIGNATURE CONSTRUCTI 03125/2010 04/30/2010 698.81 0.00 0.00 0.00 0.00 698.81
Vendor Total 698.81 0.00 0.00 0.00 0.00 698.81
Number of Checks 1
Company Totals 698.81 0.00 0.00 0.00 0.00 698.81
GENERAL LEDGER ACCOUNT TOTALS
Account Description Debit Credit
CASH 0.00 698.81
2010 ACCOUNTS PAYABLE 698.81 0.00
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 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.
J Payee
rC CcnjS rwC L C Purchase Order No.
r
Terms
T J r l o
(Nr L
IBC I 1 I U U> 2 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1-2- 13-
425.27
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
�2D r Av.. s w
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF rY r/d
0)- Ax
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
I k 3 1 1 1+41 SL)5 5 309 tj bill(s) is (are) true and correct and that the
l a 2 -33 4607 T 12- 7, 9� materials or services itemized thereon for
162- -7 I wr( /Y q, 3j which charge is made were ordered and
qK q -1 1 1 �4� ,S 4 1 q 2 5 .3 i received except
2 7 1I0 LAq Sb 6
ignature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund