HomeMy WebLinkAbout196351 04/13/2011 CITY OF CARMEL, INDIANA VENDOR: 364048 Page 1 of 1
0 a ONE CIVIC SQUARE GIBRALTAR CONSTRUCTION CORP CHECK AMOUNT: $15,317.69
CARMEL, INDIANA 46032 2932 N. WEBSTER AVENUE
4,. INDIANAPOLIS IN 46219 CHECK NUMBER: 196351
CHECK DATE: 4/13/2011
DEPARTMENT ACCOUN PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
2200 R4462401 27459 2 15,317.69 7A STREETSCAPE PALLAD
V✓
CSO Architects
Letter of Transmittal
TO: City of Carmel Ebgineering Dept. DATE: March 31, 2011
One Civic Square PROJECT NO: 10145G
Carmel, Indiana 46032
RE: Payment Request Parcel 7A Streetscape
ATTN: Kate Neville
CONTACT PHONE: 571 -4747
WE ARE SENDING YOU: L
CO.PIES �I ?ATE Vie` era �s DESCF21PTiON;
3 3130111 Payment Requst No.2, Pacel 7A Streetsape, Construction By Gibraltar
Construction, 15,317.69
IF ENCLOSURES ARE NOT AS INDICATED, PLEASE NOTIFY US AT ONCE.
THESE ARE TRANSMITTED:
For approval Reviewed as submitted Resubmit for approval
For your use As noted Submit for distribution
As requested Revise and Resubmit Return corrected prints
For review and comment Rejected Other:
REMARKS:
Katie:
Please process this payment request for Gibraltar Construction for the work at Parcel 7A Streetscape.
N 12
Thank you, Bob ,,,p` 34 S
ry� �9
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CC: FILE
LA N
By: Bob Olson `r� �aG \N��
Courier Service: 1 -HR 3 -HR Same Day c
FedEx Services: 8:30 A.M. Delivery El 10 A.M. Delivery El 3:00 P.M. Delivery l�Oz7usL 0,
FedEx Ground Delivery Hand Delivery
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Document?
ARCHITECTURE INTERIOR DE=SIGN
8831 Keystone Crossing; Indianapolis, IN 46240 Main 317.848.7800 Fax 317.574.0957 csoinc,net
TM
Document G7021CMa 1992
Application and Certificate for Payment Construction Manager Adviser Edition
TO OWNER: PROJECT: APPLICATION NO Distribution to:
City of Carmel Carmel Parcel 7A Streetscape 2
One Civic Square PERIOD TO /23
3il1 OWNER El
Carmel, IN 46032
CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Gibraltar Construction Corp PROJECT NOS: 10/28/10 I I CONTRACTOR
2932 N. Webster Ave.
Indianapolis, IN 46219 VIA ARCHITECT: FIELD
CONTRACT FOR: CSO Architects, Inc. El
Parcel 7A- Streetsca e
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contracto cc ifies 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 b thi. Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document 6703, is attached. Contract Documents, that a ounts have been paid by the Contractor for Work for which previous
Certificates for Payment er issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM a
ment shown herein i w ue
Ana inn nn P Y
2. Net change by Change Orders 0.00 CONTRACTOR: Gibra o struction Corp
3. CONTRACT SUM TO DATE (Line l 2):, 206 200.00 BY: Date: ^�f
4. TOTAL COMPLETED 8 STORED TO DATE (Column G on G703) 145,576.88 State of:
5. RETAINAGE. County of:
a. %o of Completed Work Subscribed sw��beto /7 i C'BROE
fY ei HnEOCk Coy
(Column b E on G703) 10,310.00 me this day of f rq
:y Comm.
b. of Stared Material Notary Pu hc: 1.29 -201.7
(Column F on G703) My Commission expires:
Total Retaina (Lines 5a 5b or Total in Column 1 of G703) CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE 135,266.88 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 119 949.19 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
8. CURRENT PAYMENT DUE 15 AMOUNT CERTIFIED 31 -,IA4
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amoautt applied Ina tal ail figures on this
Application and on the Continuation Sheet that are changed to cotrfonn with the amount certified.)
(Line 3 less Line 6) 63,923.00 CONSTRUCTION MANAGER:.
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC
Total changes a roved tti previous months h Owner f
g PP P Y By: 1 Date: f
Total appro edthis Month This Certificate is not negotiable. 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 FLED. An original assures that changes will not be obscured,
AIA Document G7021CMaTM— 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.
AIA Document G702/CMa" -1992 Instructions
Application and Certificate for Payment Construction Manager Adviser Edition
A. General Information
AIA Document G7021CMa, 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 A2011CMa, 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 G7021CMa, 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 (FULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G702JCMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G7021CMa, 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 G7021CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G7021CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A2011CMa. They should then initial all figures
on G7021CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702ICMa 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 G7021CMa, 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 equal the 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 bithe previous application (columns D E from the previous application)..Values from column F
(Materials Presently Stored) from the previous application should riot 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 and Architect on AIA Document 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 G7021CMa.
AIA Document G7021CMaF°" 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIO 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.
CONTINUATION SHEET Pa 2 of
APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION NO.: 2
attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where APPLICATION DATE: 3/23/2011
variable retainage for line items may apply. PERIOD TO: 3/23/2011
ARCHITECTS PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM FROM PREVIOUS PRESENTLY COMPLETED AND BALANCE TO A AGE
N0. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G I C) FINISH (IF F VARIABLE
(D E) D ORE) (D E F) {C G} RATE)
1 Supervision $2,500.00 $2,175.00 $2,175.00 87% 325.00
2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00
3 Bonds $2,576.00 $2,576.00 $2,576.00 100%
4 Misc. General Conditions $5,024.00 $4,370.88 $4,370.88 87% 653.12
5 Earthwork $30,000.00 $25,500.00 $3,300.00 $28,800.00 96% 1,200.00 10,310.00
6 Asphalt Paving $9,700.00 $1,455.00 $1,455.00 15% 8,245.00
7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100%
8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100%
9 Joint Sealants $300.00 $0.00 $0.00 0% 300.00
10 Limestone Retaining Wall $90,000.00 $67,500.00 $9,000.00 $76,500.00 85% 13,500.00
11 Landscaping $12,000.00 $0.00 $0.00 0% 12,000.00
12 Irrigation $5,500.00 $1,100.00 $1,100.00 20% 4,400.00
$206,200.00 $133,276.88 $12,300.00 $0.00 $145,576.88 71% $60,623.12 $10,310.00
ISA Form 1 -402
Im
AFFIDAVIT AND WAIVER OF LIEN
FINAL PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Marion, SS
Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the
Owner to furnish certain materials and or labor for a project known as Carmel Parcel 7A- Streetscape and owned by City
of Carmel and does hereby further state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the Owner the sum of
Fifteen Thousand Three Hundred Seventeen and 69/100--- Dollars ($15,317.69)
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien
which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of
payment thereof by the undersigned;
(FINAL WAIVER) that the final balance due from the Owner is the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver
of Lien which shall become effective upon rece' t of such payment.
THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever
on the above- described property and improvements the eo account of LABOR or material or both, furnished by the
undersigned thereto, subject to limitations of condition exp essed herein, if any; and further certifies that no other party
has any claim or right to a lien on account of any wor erfo med or material furnished to the undersigned for said project,
and within the scope of this affidavit and waiver.
Gibraltar Construction Corp By Title President
WITNESS MY HAND AND NOTORIAL SE i of March, 2011.
(Notary Public)
BRIAN R. MCBRIDE
1919 s�,o�arcx SUBefl�ITAACT f�15 ASS OCIATION tN£lli1P[SfRA EU 2 Res ci Ha7ccck County
Univana,g6d Ralmodvctton PrO nbit0d J 1L 1 8v TEf
My Comm. Exp. 11 -29 -2017
o, PN Cc, 611862
TM
Document G7021CMa -1992
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER: PROJECT: APPLICATION NO: Distribution to:
City of Carmel Carmel Parcel 7A Streetscape 2
One Civic Square PERIOD TO: 3/23/11 OWNER
Carmel, IN 46032 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Gibraltar Construction Corp PROJECT NOS: 10/28/10 CONTRACTOR
2932 N. Webster Ave.
I
Indianapolis IN 46219 VIA ARCHITECT: FIELD
CONTRACT FOR: Carmel Parcel 7A Streetscape CSO Architects, Inc.
CONTRACTOR'S APPLICATION FOR PAYMENT The nnderSi-ne—d Conn-acto- certires that to the best of the Contractor hnowledLe. information and
belief the Work covered b thi Application for Payment has been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. Contract Documents, that a ounts have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703. is attached. Certificates for Payment ter issued and payments received front the Owner, and that current
1. ORIGINAL CONTRACT SUM 5906,200 -00— payment shown herein is 4 w due.
2. Net change by Change Orders o.00 CONTRACTOR: Gibra r r ohstruction Corp
3. CONTRACT SUM TO DATE (Line I 2) S 206 200.00 By: Date:
4. TOTAL COMPLETED STORED TO DATE (Column G on 6703) 145,576.88 State of: d
5.RETAINAGE: County of: 1S/1/jatJ t?� IAN R- MCBRIDE
a• of Completed Work Subscribed sworn to befo 2
(Column D +.E on 6703) 10,310.00 me this day of Nc(iCQC}( COURt
b. of Stored Material Notary Pu lie: a EyID. 11- 29 201 7
(Column F on 6703) Nly Commission expires: /�GJ I'a. CmTn ss!nn 11 1 18ii
Total Retaina2e(Lines 5 +5b or Total in column I ofG703). CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE S 135,266.88 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 S 119,949.19 accordance with the Contract Documents, and the Contractor is entitled to payment of the AtNIOUNT
(Line 6 from prior Certificate-) CERTIFIED.
8. CURRENT PAYMENT DUE _5.312..6.9 AMOUNT CERTIFIED S
9. BALANCE TO FINISH, INCLUDING RETAINAGE (rlttcrch e.r /vlcureuinn i� crnwrrnt certi/iet! di/ferc firom the amount applied. Miner/ all figures on this
Application and on the Cominutaion Sheet that are cho ngecl to conform u-ith the amount certified.)
(Line 3 less Line 6) 6 CONSTRUCTION MANAGER:
Bv: Date:
CHANGE ORDER SUMNIARY ADDITIONS DEDUCTIONS ARCHITECT: �q��r�
Total changes approved in previous months by Owner S 13 v: CS (/y'• to/ Date: 3 r
Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is pas bl �lo the Contractor
TOTALS S named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order S the Owner or Contractor under this Contact.
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 199 by The American Institute of Architects. All rights reserved. WARNING: This .f- Document is protected by U.S. Copyright Law and International Treativs.
Unauthorized reproduction or dlsfr'ibutlon of this AIA' fi 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 la�v.
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.
CONTINUATION SHEET Page 2 of 2
APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION NO.: 2 APPLICATION DATE: 3/23/2011
attached. in tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where PERIOD TO: 3/23/2011
variable retainage for line items may apply.
ARCHITECT'S PROJECT NC.:
A B C D E F G H i
WORK COMPLETED MATERIALS TOTAL
ITEM FROM! PREVIOUS PRESENTLY COMPLETED AND BALANCE TO AGE
A
NO DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G C) FINISH (IF F VARIABLE
(D E) D OR E) (D E F) (C G) RATE)
1 Supervision $2,500.00 $2,175.00 $2,175.00 87% 325.00
2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00
3 Bonds $2,576.00 $2,576.00 $2,576.00 100%
4 Misc. General Conditions $5,024.00 $4,370.88 $4,370.88 87% 653.12
5 Earthwork $30,000.00 $25,500.00 $3,300.00 $28,800.00 96% 1,200.00 10,310.00
6 Asphalt Paving $9,700.00 $1,455.00 $1,455.00 15% 8,245.00
7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100%
8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100%
9 Joint Sealants $300.00 $0.00 $0.00 0% 300.00
10 Limestone Retaining Wall $90,000.00 $67,500.00 $9,000.00 $76,500.00 85% 13,500.00
11 Landscaping $12,000.00 $0.00 $0.00 0% 12,000.00
12 Irrigation $5,500.00 $1,100.00 $1,100.00 20% 4,400.00
$206,200.00 $133,276.88 $12,300.00 $0.00 $145,576.88 71% $60,623.12 $10,310.00
ISA Form 1 -402
lighk AFFIDAVIT AND WAIVER OF LIEN
FINAL PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Marion, SS
Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the
Owner to furnish certain materials and or labor for a project known as Carmel Parcel 7A- Streetscape and owned by City
of Carmel and does hereby further state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the Owner the sum of
Fifteen Thousand Three Hundred Seventeen and 69/100--- Dollars ($15,317.69)
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lief I
which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of
payment thereof by the undersigned;
(FINAL WAIVER) that the final balance due from the Owner is the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver
of Lien which shall become effective upon receipt of such payment.
THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever
on the above described property and improvements the eon account of LABOR or material or both, furnished by the
undersigned thereto, subject to limitations of condition expressed herein, if any; and further certifies that no other party
has any claim or right to a lien on account of any wor erf o� med or material furnished to the undersigned for said project
and within the scope of this affidavit and waiver. l i
Gibraltar Construction Corp By Title President
i
,r
WITNESS MY HAND AND NOTORIAL S j is 0th da of March, 2011.
(Notary Public)
t
BRIAN R. MCBRIDE
C 1979 INDIANA SUBCONTRACTORS ASSOCIATION INCORPORATED r vi Hancock Coin
unaulno-sea Rewoouctlon Pro"rensa *SEAL My Comm. Exo 11 -29 -2017
m 611862
At
=3EM Document G702 /CMa 992
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER: PROJECT: APPLICATION NO: Distribution to:
City of Carmel Carmel Parcel 7A Streetscape 2
One Civic Square PERIOD TO: 3123111 OWNER
Carmel, IN 46032 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT Ll
Gibraltar Construction Corp PROJECT NOS: 10/28/10 CONTRACTOR
2932 N. Webster Ave.
Indianapolis, IN 46219 VIA ARCHITECT: FIELD
CONTRACT FOR: Carmel Parcel 7A Streetsca e CSO Architects, Inc.
CONTRACTOR'S APPLICATION FOR PAYMENT The nndersi2ned Contiaeto eer ifies that to the best of the Contr'actor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work coverer! b thi Application for Payment has been completed in accordance with the
Contract Documents, that a aunts have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. t
1. ORIGINAL CONTRACT SUM �nr gnn .nn payment tshotor Payment er issued and payments received from the Owner, and that current
herein is w dttc.
2. Net change by Change Orders 0.00 CONTRACTOR. Glbra ohstruction Corp
3. CONTRACT SUM TO DATE (Line 1 2) S 206.200 00 By: Date:
4. TOTAL COMPLETED 8 STORED TO DATE (Column G on G703) S 145,576.88 State of: 1
5. RETAINAGE: County of: E M(;BRI®
a. of Completed Work Subscribed i sworn to befo 2
(Column D+ E on G703) S 10,310.00 me this day of �CCI�� GOUfi
b• of Stored Material Notary Pu t k.0. 11 29.2017
(Column F on 6703) A 4 Commission expires: eclnn 61 1262
Total Retainage (Lines 5a 5b or Total in Column I of 6703) S CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE 135,266.88 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 S 119,949.19 accordance with the Contract Documents. and the Contractor is entitled to payment of the AMOUNT
(l 6 from prior Certificate)
CERTIFIED.
8. CURRENT PAYMENT DUE S 15.317 69 AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if mount certifier! differs fi om the amount applied. Imiticil till figu es oil this
Applicaticmi and on the Cowinuattint Sheet duu are changed to conform frith the ammirtt certtfiecl.)
(Line 3 less Litre 6) 63, 923.00 CONSTRUCTION MA tGER:
Bv: Date:
CFEANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner S 13v: C Date:
Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS g named hereiot. Issuance. payment and acceptance of pavnunt are without preiudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract.
CAUTION: You should sictn e11 orlginai AIA Contract Document, rail which this text appears in FIED. An original asaur09 that changes wiil not be obscured.
AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved.'WARNENG: This XA Document is protected by U.S. Copyright t_n A or d, hntetr}ationa! ?rea €ies.
Unauthorized reproduction or dfsti iUution of this A.]A''' Decunterit, or any portion of it, may resuft in severe civil and criminal p-onaltieE and will be prosecuted to the maximum extent r_�ossil) under the I:aw.
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, copyrightOa aia.org.
CI ONTINUATION SHEET Page 2 of 2
ON NO. 2
APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATIPLICATI APPLICATION DATE: 3!23/201)
attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where PERIOD TO: 3/23/2011
variable retainage for line items may apply.
ARCHITECT'S PROJECT NO.:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM FROM PREVIOUS PRESENTLY COMPLETED AND BALANCE TO AGE
A
NO. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G 1 C) FINISH (IF F VARIABLE
(D E) D OR E) (D E F) (C G) RATE)
1 Supervision $2,500.00 $2,175.00 $2,175.00 87% 325.00
2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00
3 Bonds $2,576.00 $2,576.00 $2,576.00 100%
4 Misc. General Conditions $5,024.00 $4,370.88 $4,370.88 87% 653.12
5 Earthwork $30,000.00 $25,500.00 $3,300.00 $28,800.00 96% 1,200.00 10,310.00
6 lAsphalt Paving $9,700.00 $1,455.00 $1,455.00 15% 8,245.00
7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100%
8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100%
9 Joint Sealants $300.00 $0.00 $0.00 0% 300.00
10 Limestone Retaining Wall $90,000.00 $67,500.00 $9,000.00 $76,500.00 85% 13,500.00
11 Landscaping $12,000.00 $0.00 $0.00 0% 12,000.00
12 Irrigation $5,500.00 $1,100.00 $1,100.00 20% 4,400.00
$206,200.00 $133,276.88 $12,300.00 $0.00 $145,576.88 71% $60,623.12 $10,310.00
ISA Form 1 -402
AFFIDAVIT AND WAIVER OF LIEN
dMEMEMEMM
FINAL PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Marion, SS
Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the
Owner to furnish certain materials and 1 or labor for a project known as Carmel Parcel 7A- Streetscape and owned by City
of Carmel and does hereby further state on behalf of the aforementioned contractor:
(PARTIAL WAIVER) that there is due from the Owner the sum of
Fifteen Thousand Three Hundred Seventeen and 691100--- Dollars ($15,317.69)
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien
which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of
payment thereof by the undersigned;
(FINAL WAIVER) that the final balance due from the Owner is the sum of
Dollars
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver
of Lien which shall become effective upon receipt of such payment.
THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever
on the above described property and improvements the eon account of LABOR or material or both, furnished by the
undersigned thereto, subject to limitations of condition expressed herein, if any; and further certifies that no other party
has any claim or right to a lien on account of any wor erf bed or material furnished to the undersigned for said project
and within the scope of this affidavit and waiver. N
Gibraltar Construction Corp By Title President
WITNESS MY HAND AND NOTORIAL SE is 0th da' of March, 2011.
(Notary Public)
`l BRIAN R. MCBRiDE
A t 9 19 4N04ANA SUOCONTAACTORS ASSOCIATION WCOPPOOW(D 2 ;`,W� ^i ha: cock C c u ntY
nsutno .tltd PaMOdvCle9n P■na+rht4ad SE,'1 11
dr I x I1 AA A Comm. mm. 1 GJ�'J 1 7
V Rte' t!r`•fi�'
C N 611862
OIP
Prescribed by State Board o1 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
Gibraltar Construction Corp
Purchase Order No.
2932 N. Webster Ave.
Terms
Indianapolis, IN 46219
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/31/11 Parcel 7A Streetscape $15,3 1
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
Gibraltar Construction Corp IN SUM OF
2932 N. Webster Ave.
Indianapolis, IN 46219
$15,317.69
ON ACCOUNT OF APPROPRIATION FOR
Department of Engineering
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
27459 2 2200 84462401 $15,397.65 which charge is made were ordered and
received except
20
Signature
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund