HomeMy WebLinkAbout189652 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 363792 Page 1 of 1
0 ONE CIVIC SQUARE W R DUNKIN SON, INC
CHECK AMOUNT: $26,770.50
CARMEL, INDIANA 46032 Po BOX zza7
on _.o ANDERSON IN 46018 CHECK NUMBER: 189652
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 16 26,770.50 PAC JUNE
\���i TM
Document 7021CMa -1992
992
Application and Certificate for Pa Construction Manager Adviser Edition 51
TO OWNER: Carmel Redevelopment PROJECT Parcel 7A, 45010 Carmel APPLICATION NO: 016 Distribution to:
Commission Performing Arts OWNER: X
One Civic Square 777 3rd Ave S.W. PERIOD TO: June 30, 2010 CONSTRUCTION MANAGER: X
Carmel, IN 46032 Carmel, IN 46032 ARCHITECT: X
FROM W.R. Dunkin Son, Inc. VIA CONSTRUCTION Shiel Sexton Co., Inc. CONTRACT DATE: February 23, 2009 CONTRACTOR: X
CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 25310H 2695/5010 2695 FIELD:
Anderson, IN 46018
CONTRACT FOR: Bid Pkg 95010 V ARCH I T ECT: CSO Architects OTHER:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application for Payment- as been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. Contract Documents, that all at�i its have bes pat h ontractor for Work for which previous
Continuation Sheet, ALA Document (3703, is attached. Certi s for Pa me i efe i uec�and pa s receive om the Owner, and that current
1. ORIGINAL CONTRACT SUM 1,480,000.00 pa ho m is ow lie.
1. NET CHANGE BY CHANGE ORDERS 81,040.00 CONTRA R: W NK 1 N,
3. CONTRACT SUM TO DATE (Line I 2) 1,398,960.00 By: Date: June 16, 2010
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 71.1,585.00 ate of: Indiana
5. RETAINAGE: County of: Madison
a. 5 of Completed Work Subscribed and sworn to before
(Column D E on G703) 69,948.00 me this 16th day of June, 20 LO
b• 0 of Stored Material Notary Public: Martha A. Carpenter
(Column F on G703) 0.00 My Commission expires: January 08, 2017
Total Retainage (Lines 5a 5b or Total in Column I of G703) 69,948.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 641,637.00 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 614,866.50 knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
6. CURRENT PAYMENT DUE 26,770.50 AMOUNT CERTIFIED 26,770.50
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amo pplied. Initial all figures on this
Application and on th onlinuation Sheet d are than d to conform with the amount certified.)
(Line 3 less Line 6) 757,323.00 CONSTRUCTION MA A ER:
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI T:
Total changes approved in previous months by Owner 0.00S 81,040.00 By: Date:
Total approved this Month 0.00$ 0.00 This Certific6 not gotiable. The AMOUNT CERTIFIED is payable only t the Contractor
TOTALS 0.00$ 81,040.00 named hereinan payment and acceptance of payment are without prejudice to any rights of
the Owner or .tor under t his Contract.
NET CHANGES b Change Order 81,040.00
AIA Document G7021CMaTM 1992. Copyright 0 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. This document was produced by AIA software at 11:16:33 on 06/21/2010 under Order No.0168420739_1 which expires on 0 511 01201 1, and is not for resale.
User Notes: (1949258051)
TM
=I Document 0703 -1992
Continuation Sheet
AIA Document, G702 -1992, Application and Certification for Payment, or G736 -2009, APPLICATION NO: 01.6
Project Application and Project Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE: 06/16/2010
containing Contractor's signed certification is attached.
In tabulations below, amounts are in US dollars. PERIOD TO: 06/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 25310H
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAMAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE RATE
NO. WORK VALUE THIS PERIOD STORED DATE (G C} (C G)
APPLICATION (NOT IN D OR E) DATE
D +E
01010 Performance Bond 26,400.00 26,400.00 0,00 0.00 26,400.00 100.00% 0.00 2,640.00
Mobilize
01015 Demobilize 8,000.00 4,000.00 0.00 0.00 4,000.00 50.00% 4,000.00 400.00
Supervision
01020 Coordination 87,000.00 63,000.00 3,000.00 0.00 66,000.00 75.86%1 21,000.00 6,600.00
General Conditions
01025 M 30,000.00 23,400.00 1,000.00 0.00 24,400.00 81.33 5,600.00 2,440.00
General Conditions
01026 L 34,000.00 24,000.00 1,200.00 0.00 25,200.00 74.12% 8,800.00 2,520.00
1400A Organ Facade Pipes 200,000.00 86,720.00 0.00 0.00 86,720.00 43.36% 113,280.00 8,672.00
Carpentry Labor
1400B Hours 32,000.00 32,000.00 0.00 0.00 32,000.00 100.00% 0.00 3,200.00
Provide Tie -Off
1400C Points at Balconies 25,000.00 0.00 0.00 0.00 0.00 0.00%1 25,000.00 0.00
Vertical Partition
System Backfold
1400D Doors 15,000.00 15,000.00 0.00 0.00 15,000.00 100.00 0.00 1,500.00
16'X16' Temporary
1400E Overhead Door 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00 0.00 600.00
Temporary OHD
Enclosure and
1.40OF Insulation 10,000.00 1 0.00 0.00 1,644.00 16.44% 8,356.00 164.40
1000 SY of BX 1200
14006 Tensar Geogrid 17,000.00 4,117.00 0.00 0.00 4,1 17.00 24.22 12,883.00 411.70
1400H 350 CY of #2 Stone 8,200.00 5,718.00 0.00 0.00 5,718.00 31.42 /.1 12,482.00 571.80
AIA Document G703 -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 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 Document, or any portion of it, may result in severe civil and criminal penalties, and will be 1
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 10:56:48 on 0612112010 under Order No.0168420739_1 which expires on 05/10/2011 and is not for
resale.
User Notes: (1734900042)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM. DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO (G C) FINISH (IF VARIABLE
APPLICATION THIS PERIOD DATE (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
1400J 200 CY of 953 Stone 10,000.00 1,746.00 0.00 0.00 1,746.00 17.46% 8,254.00 174.60
1400K General Allowance 75,000.00 50,000.00 0.00 0.00 50,000.00 66.67% 25,000.00 5,000.00
CAD As -Built
1400L Allowance 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
General Clean Up
01560 M 4,000.00 1,100.00 300.00 0.00 1,400.00 35.00%1 2,600.00 140.00
01561 General Clean U L 25,000.00 9,300.00 2,000.00 0.00 11,300.00 45.20%1 13,700.00 1,130.00
Final Cleaning (Items
01562 in BP 5010 10,000.00 0.00 0.00 0.00 0.00 0.00% 10,000.00 0.00
Dewatering for 9
02110 Months -M -Eq 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00% 0.00 1,850.00
Dewatering for 9
02111 Months L -Eq 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00%1 0.00 2,800.00
Piping from Tri -Plex
02240 to Lift Station 21,000.00 21,000.00 0.00 0,00 21,000.00 100.00% 0.00 2,100.00
Interior Metal
Fabrications
05504 Submittals 6,200.00 6,200.00 0.00 0.00 6,200.00 100.00% 0.00 620.00
Interior Metal
Fabrications
05505 Materials 86,500.00 86,500.00 0.00 0.00 86,500.00 100.00%1 0.00 8,650.00
Interior Metal
05506 Fabrications- Erection 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00 0.00 2,400.00
Miscellaneous Metals
05511 -M 5,640.00 5,640.00 0.00 0.00 5,640.00 100.00 0.00 564.00
Miscellaneous Metals
05512 -L 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00 0.00 250.00
Interior Rough
06100 Carpentry M 28,000.00 22,400.00 4,200.00 0.00 26,600.00 95.00% 1,400.00 2,660.00
Interior Rough
06101 Carpentry L 36,500.00 27,400.00 7,200.00 0.00 34,600.00 94.79% 1,900.00 3,199.50
07810 Skylighht. Shade M 62,000.001 62,000.00 0.00 0.00 62,000.00 1.00`00 0.00 6,200.00
AIA Document G703 `TM 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale 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 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 10:56.48 on 0 6/2 11201 0 under Order No.0168420739_1 which expires on 05/1012011, and is not for
resale.
User Notes: (1734900042)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM. DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED THIS PERIOD AND STORED TO (G W C} FINISH (IF VARIABLE
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
Skylight Shade
07811 Installation 29,500.00 29,500.00 0.00 0.00 29,500.00 100.00% 0.00 2,950.00
07910 Joint Sealants M 48,000.00 7,600.00 0.00 0.00 7,600.00 15.83% 40,400.00 760.00
079.11 Joint Sealants L 24,500.00 4,200.00 0.00 0.00 4,200.00 17.14% 20,300.00 420.00
08810 Interior Glazing 42,000.00 840.00 0.00 0.00 840.00 2,00% 41,160.00 84.00
09610 Access Flooring 19,500.00 0.00 0.00 0.00 0.00 0.00% 19,500.00 0.00
09710 FRP Wall Panels M 1,000.00 0.00 0.00 0.00 0.00 0.00% 1,000.00 0.00
09711 FRP Wall Panels L 2,000.00 0.00 0.00 0.00 0.00 0.00 2,000.00 0.00
Acoustic Fabric
09712 Wrapped Panels 42,500.00 10,000.00 0.00 0.00 1.0,000.00 23,53%1 32,500.00 1,000.00
10210 Toilet Compartments 44,000.00 0.00 0.00 0.00 0.00 0.00%1 44,000.00 0.00
Backfold Door
10220 Tracks M 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00 0.00 500.00
Backfold Door
10221 Tracks- L 4,560.00 4,560.00 0.00 0.00 4,560.00 100.00 0.00 456.00
10222 Operable Partition 21,000.00 3,200.00 0.00 0.00 3,200.00 15.24%1 17,800.00 320.00
10223 Wire Mesh Partitions 9,500.00 0.00 0,00 0.00 0.00 0.00% 9,500.00 0.00
Toilet Accessories
10224 M 34,000.00 34,000.00 0.00 0.00 34,000.00 100.00% 0.00 3,400.00
Toilet Accessories
10225 L 28,000.00 1,000.00 0.00 0.00 1,000.00 3.57% 27,000.00 100.00
10510 Metal Lockers 16,500.00 0.00 0.00 0.00 0.00 0.00%1 16,500.00 0.00
10520 Phenolic Lockers M 110,000.00 0.00 0.00 0.00 0.00 0.00%1 1 10,000.00 0.00
10521 Phenolic Lockers L 29,000.00 0.00 0.00 0.00 0.00 0.00% 29,000.00 0.00
10610 Corner Guards M 9,500.00 0.00 9,500.00 0.00 9,500.00 100.00% 0.00 0.00
10611 Corner Guards L 3,500.00 0.00 0.00 0.00 0.00 0,00% 3,500.00 0.00
17001 Changr Order No. 01 81,040.00 80,000.00 0.00 0.00 80,000.00 98.72% 1,040.00 8,000.00
GRAND TOTAL $1,398,960.00 $683,185.00 $28,400.00 $0.00 $711,585.00 50.87 $687,375.00 $69,948.00
AIA Document G703T 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved, WARNING: This Ale 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 3
prosecuted to the maximum extent possible under the law, This document was produced by AIA software at 10:56:48 on 06/21/2010 under Order No.0168420739_1 which expires on 05/10/2011 and is not for
resale.
User Notes: (1734900042)
AFFIDAVIT AND WAIVED. OF LIEN
]FINAL X PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Madison SS
Bradley A. Tyler being duly sworn states that he is the Project Manager of W. R. Dunkin
Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish
certain materials and /or labor as follows: Bid Package 5010 Interior Finishes for a project
known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and
owned by City of Carmel and does hereby further state on behalf of the aforementioned
Contractor.
Application for Payment 13 has been received for work performed through 03/31/10.
(PARTIAL WAIVER) that there is due from the contractor the sum of
Thirty -six Thousand Six Hundred Seventy- seven dollars and 00 /cents 36,675.00
Application for Payment has been received for work performed through
(FINAL WAIVER) that the final balance due from the Owner is the sum of
dollars and 00 /cents
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim
whatsoever on the above described property and improvements thereon on account of LABOR or material or both,
furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further
certifies that no other party has any claim or right to a lien o ac of a war. performed or material furnished
to the undersigned for said pr Je d zdl pe of his a avft
W. R. Dunkin Son, Inc. Title: Project Manager
WITNESS MY HAND AND NOTARIAL, SEAL, this 1.6 day of June 1 2010
(Notary P ic)
My Commission Expires: January 08, 2017 Printed Martha A. Carpenter
Residing in Madison County
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
jU�Kl� Sa /rac Purchase Order No.
�6) 6aX 22 `/7 Terms
n //("l
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
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
�a���'� �;5�� ILaC IN SUM OF
22{7
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. 1 hereby certify that the attached invoice(s), or
X02 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 /G
�Ignature
rNractor of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund