HomeMy WebLinkAbout189649 09/14/2010 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: $21,121.00
INDIANAPOLIS IN 46250 CHECK NUMBER: 189649
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 8 21,121.00 PERFORMING ARTS CENTE
Docu
ment G7021CMa —1992
Application and Certificate for Pay ment Construction Manager Adviser Edition yd
TO O ER: PROJECT: 04 i? 1 j
Alr[ g�_-1 5 fly T c APPLICATION NO: JG Distribution ion to:
PERIOD TO: 6/9 V OWNER
CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA C NS,RUCTI MgAlr4GER: CONTRACT DATE: 37
ARCHITECT /NA. g ,F Aoloc',AT�s C. ;rY SA k( PROJECT NOS: 12O
�''ds+t rL 'b^ Z�9 Sr 3 1 CONTRACTOR
v VIA ARCHITECT: 0- So ,4�.2c
FIELD
CONTRACT FOR: rt O�,vrl.a.T �1 a
CONTRACTOR'S APPLICATION FOR PAYNI NT The undersigned Contractor ce: 6fies 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 y this Arplication for Payment has been completed in accordance with the
Contract Documents, that al amounts have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Cenif es- for ere issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM Z�3 �'s' Z pays ent sho�wn.•herei is now due.
2. Net change by Change Orders i6 2-7 5' CON CTOR: SScc,�i —s
3. CONTRACT SUM TO DATE (Line I t 2)._ Z f> t 7 By: Date: fa
4. TOTAL COMPLETED S STORED TO DATE (Column G on 6 6 State of:
5. RETAINAGE: County of
a. of Completed Work Subscribed and sworn to before "'r PAOMMOI
(Column D E on G703) me this 4"py, f��, z o; .+t courtt�►
b. of Stored Material Notary Pi My MY
(Column F on G703) My Como.
To tal Retainage (Lines 5a 5b or Total in Column I of G703). Z- Z07 CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE Z p I 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 1'eO �V accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
ZI /Z I. oo AMOUNT CERTIFIED
8. CURRENT PAYMENT DUE
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if, amount certified differs fr a amount applied. Initial all figures on this
Application and o e Continuation S et th t are anged to conform with the mount cerrifrPd j
(Line 3 less Line 6) �Zj �0, CONS CTION N G *fir
By: Date: lJj Q
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC T:
Total changes approved in previous months by Owner By: Date: 3
Total approved this Month This Cert c not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS S named n. Issuance, payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Ow er 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 G7021CMa"' 1992. Copyright p 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 Ale Documeni, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible tender 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, copyrightCaNaia.org.
Johnson, Sandy M
From: Cleveland, Don H
Sent: Tuesday, September 14, 2010 6:49 AM
To: Johnson, Sandy M
Cc: 'Mike Anderson'
Subject: RE: MAB Associates
It appears that the vendor simply forgot to change the application number on the back -up. The total completed
matches, and the current payment due matches. Even the period to matches. Please process as application 8 and pay as
presented. I will ask MAB for a corrected backup and will provide it to you. I don't think that mistake should hold up
their pay.
Don Cleveland, Finance Manager
Carmel Redevelopment Commission
30 West Main Street, Suite 220
Carmel, IN 46032
dcleveland (d)carmel.in.aov
317 571 -2795 to desk
317 -571 -2789 fax
317 796 -9061 cell
From: Johnson, Sandy M
Sent: Monday, September 13, 2010 3 :29 PM
To: jim .higgins @londonwittegroup.com; Cleveland, Don H
Cc: Cordray, Diana L
Subject: MAB Associates
Don,
You have submitted a claim in the amount of $21,121.00 for MAB Association for work performed on the Performing
Arts Center. The AIA documents and claim state this is application number 8, but the back up is for application number
6.
Please correct this claim, so that we can make this payment.
Saruly Johnson
Asset Manager
City ol' Carmel Gerk 'hrcasurci's Office
One Ci\ is Square
Gu Indiana
317-571-2628
i
CONTINUATION SHEET Date 6/19/2010
APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: six
Contractors signed Certification is attached. APPLICATION DATE: 6111842010
In tabulations be[ow, amounts are stated to the nearest dollar. PERIOD TO: 6/3012010
Use Column I on Contracts where variable retsina a for line items may apply. ARCHITECT'S PROJECT NO. 19122
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL X SA LANCE RETAINAGE
NO VALUE FROMPREVIOUS THIS PERIOD PRESENTLY COMPLETED 4G/C) TO FINISH
APPLICATION STORED AND STORED (CG)
(D +E) (NOT IN TO DATE LON
O ORE OFE+F
0100 Base Contract
0101 Performance Payment Bond 3870:00 3 870.00 3 100% 387.00
0102 Detailing Engineering 16 695.00 16 16,695.00 100% 1669.50
0103 Material MT 1 a rail 15 962.00 15 15 962.00 100% 1596.20
0104 Fabrication MT l a 60191.00 68191.00 68,191.00 100% 6819.10
0105 Installation 15 600.00 7,750,00 1 7,750.00 49% 7 775.00
0106 Material MT 1b 9 9 9,271.00 100% 927.10
0107 Fabrication MT lb 28,202.00 8460.00 5641.00 14,101.00 50% 14,101.00 1410.10
0108 Installation 8,700. 0 0% 8 0.00
0109 Materal MT 1c 9,528.00 9,528.00 9 100% 0.00
0110 Fabdalion MT1c 29,95200 26 956.00 2 29 952.00 0% 2995.20
Installation 7 3,750.00 s 3,750.00 0% 4
Material 1 -line 3,724.00 3,724.00 3,724.00 100%
Fabrication 5,916.00 5,916.90
Installation 2,183.00 2,183.00
Powder Coat MT 1A 11,091.00 4,121.00 6,970.00 11,091.00 100% 7,000.00
Powder Coat MT 1 B 3,482.00 3,482.00
Powder Coat MT 1C 7,352.00 5,514.00 5,514.00 7,352.00
Powder Coat Singteline 1,173.00 1,173.00
Change Order #1 8460.00 8460.00 8,460.00 100%
Cash Allowance Authorization $5 1 5 5,000.00 100%
Chan e Order #3 $1.815 1,815.00 1,815.00 100%
TOTAL 264,157.00 193,553.00 1 21,121.00 214,674.00 1 0% 49,483.00
AFFIDAVIT AND WAIVER OF ]LIEN
Final Partial Payment to follow
ST TE OF rNDIA,NA, COUNTY SS:
being duly sworn states that he/she is the
o f
:(title) r (supplier or subcontractor)
having contracted with l" �K &A I to furnish certain material
con +*actor}
and/or labor as follows:
(descnpti n)�
for the pro) kn07 as 6 k, Ibi
c�
located at and dwned, by
architect 61 and does hereby ,er state on behalf
of the aforementioned subcontractor /supplier.
PARTIAL WAIVER that the balance due from contractor is the sum of 7
dollars($
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
dollars(S
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 pie t of any work performed or material
furnished to the undersigned f said payment, witbin the scope of this affidavit and waiver.
IJIL64A5'roc-4 Ls
(name of claimant) (authorixed'representativtf) U (title)
Witness my hand and notarial s this day of
My commis a e ires:
(sj
Residing in c�,, J Pti
ef notary)
Neft" of
o
MV MOM COMM-W
A i i i� �'irfa i5 C
'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
f S Purchase Order No.
Terms
25 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total G
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
ON ACCOUNT OF APPROPRIATION FOR
g-�.2 /yyGa �a7
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice 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
20/
Signature
p�o� ^r ^r of Recl�velopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund