HomeMy WebLinkAbout166989 12/17/2008 CITY OF CARMEL, INDIANA VENDOR: 00353266 Page 1 of 1
ONE CIVIC SQUARE A S I SIGN SYSTEMS
s 0 CHECK AMOUNT: $20,131.00
CARMEL, INDIANA 46032 2017 W 18TH ST
INDIANAPOLIS IN 46202 CHECK NUMBER: 166989
CHECK DATE: 12/17/2008
DEPARTMENT AC PO NUMBER IN NUMBER AMOUNT D ESCRIPTION
853 5023990 6 20,131.00 OTHER EXPENSES
i
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION
AJA DOCUMENT GT7021 Ma PAGE ONE OF 3 PAGES
TO OWNHR: Carmel /Clay Board of Parks and PROTECT: Central Park Outdoor Aquatics APPLICATION NO: 6 Retainage Distribution to:
Recreation Exterior Signage ]OW NER
760 3rd Avenue S.W. Suite 100 Bid Relea Carmel, IN 46032 BRIOD TO: 8!4!2008 CONSTRUCTION
61ECT MANAGER
FROM CONTRACTOR: ASI Sign Systems ARCHITECT
2017 W. 18th Street ONTItACTDATE; 2/28/2007 r
Indianapolis, IN 46202
VIA CONSTRUCTION MANAGER: Geupel DeMars Hagerman
CONTRACT FOR: Signs VIA ARCHITECT: Williams Associates Architects, Ltd.
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 alt 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.
I. ORIGINAL CONTRACT SUM S 203,159.551 ASI- Modulex
2. Net change by Change Orders _($1377.00) W CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 2) S 201.782.55 L
4. TOTAL COMPLETED STORED TO DATE 201 Z82-5.5 it
(Column G on G703) Fay; Date; 9/
5. RETAINAGE:
a. 10 of Completed Work 0.00 State of: I J p t q,._t A County of:
TC oTi imn D +I; on G703) Subscribed and sworn t fore me. this zTµ day of bQ PT F_A-BGA_
b. 10 of Stored Material S Notary Public:
Lo umn F on G703) My Cozrimission e
Total Retainage (Lines 5a -t 5b or e Z
Total in Column I of G703) 20 ?7ERTI ATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 201.782.55 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 '1'otat) comprising this application, the Construction Manager and Architect certify to the
7. LESS PREVIOUS CERTIFICATES FOR ;Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) S 4&1, -9 31, 461. progressed as indicated, the quality of the Work is in accordance with the Contract
CURRENT PAYMENC DUE -Bi60 ZU 13 GO Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE S 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED 48 (_T('
CHANGE DIWER SUMMARY i (Attach explanation if amount certified differs from the amount applied for. fnitial all
ota o anges approve figures on this,4pplicationaed on the Continuation Sheet that changed to Conform to lh
in previous rrionths by Owner <1,, 317. amount certifed.) U r
CONSTRUCTIO �1N 9E G'OH
Total approved this Month Sy Date:
AR T, Wry
TOTALS 377 CXJ By: A Date: Q i(
NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable niy to the
Contractor named herein. Issuance, payment and acceptance of payment are will
prejudice to any rights of the Owner or Contractor under this Contract.
IA DOCUMENT G702JCMa APPLICATION ANO CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIAO 01992 G7021CW -1992
N.W.. WASHINGTON, DC 2000& -5292
HE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE.,
CONTINUATION SHEET APPLICATION NO. 6 (retainage) DATE 8/4/2008
A B C D I E F G H I II
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED [G /Cj TO FINISH
APPLICATION STORED AND STORED [C-G)
[D +Ej [NOT IN D OR E] TO DATE
Carmel Park Rec. A #6 retaina D +E +F
1 Sign SIDM -5 Main ID 24942.25 $24942.25 $0.00 $24942.25 100% $0.00
2 Sign Type SEM 1 Secondary Ent. $5409.25 $5409.25 $0.00 $5409.25 100% $0.00
3 Sign Type SEM 1 Secondary Ent. $5409.25 $5409.25 $0.00 $5409.25 100% $0.00
4 Sign Type VDM 3, 4, 5 $16322.85 $16322.85 $0.00 $16322.85 100% $0.00
5 Sign Type EBD -1 $12716.00 $12716.00 $0.00 $12716.00 100% $0.00
6 Sign Type EBD -2 $653.00 $653.00 $0.00 $653.00 100% $0.00
7 Sign Type BIM 1 2 $9738.50 $9738.50 $0.00 $9738.50 100% $0.00
8 Sign Type PD 15 16 $8440.00 $8440.00 $0.00 $8440.00 100% $0.00
9 Sign Type T map $1543.50 $1543.50 $0.00 $1543.50 100% $0.00
10 Sign Type WBD $1040.00 $1040.00 $0.00 $1040.00 100% $0.00
11 Sign Type WCM $1373.00 $1373.00 $0.00 $1373.00 100% $0.00
12 Sign Type WDS 6 $1050.00 $1050.00 $0.00 $1050.00 100% $0.00
13 Sign Type WDS 7 $175.00 $175.00 $0.00 $175.00 100% $0.00
14 Sign Type WDS 8 $350.00 $350.00 $0.00 $350.00 100 $0.00
15 Sign Type WAD 1 thru 6 $11355.00 $11355.00 $0.00 $11355.00 100% $0.00
16 Sign Type WPD $435.50 $435.50 $0.00 $435.50 100 0.00
17 Sign Type WR1 -a $297.00 $297.00 $0.00 $297.00 100% $0.00
18 Sign Type WR1 -b $541.50 $541.50 $0.00 $541.50 100 $0.00
19 Sign Type WR -2 $541.50 $541.50 $0.00 $541.50 100% $0.00
20 Sign Type WR -3 $570.00 $570.00 $0.00 $570.00 100% $0.00
21 Sign Type WR -4 $285.00 $285.00 $0.00 $285.00 100 $0.00
22 Sign Type WR -5 $541.50 $541.50 $0.00 $541.50 100% $0.00
23 Sign Type WRS -1 $399.00 $399.00 $0.00 $399.00 100% $0.00
24 Sign Type WRS -2 $300.00 $300.00 $0.00 $300.00 100 $0.00
25 Sign Type WRS -4 $270.00 $270.00 $0.00 $270.00 100% $0.00
26 Sign Type WPD -3 $420.50 $420.50 $0.00 $420.50 100% $0.00
27 Sign Type WPD -6 $447.50 $447.50 $0.00 $447.50 100% $0.00
28 Aquatic Banners A,B,C, D $7284.00 $7284.00 $0.00 $7284.00 100% $0.00
29 Aquatic "Current' Banners $15260.95 $15260.95 $0.00 $15260.95 100 0.00
continued on next page
CONTINUATION SHEET APPLICATION NO. 6 (retainage) DATE 8/4/2008
3D Aquatic "Wave" Mobils $7018.00 $7018.00 $0.00 $7018.00 100° /a $0.00
31 Allowance For Temporary signs $3623.00 $3623.00 $0.00 $3623.00 100% $0.00
32 Bid Bond Performance Bond costs $3670.00 $3670.00 $0.00 $3670.00 100% $0.00
33 Planter Walls SEM 1 2 41860.00 $41850.00 $0.00 $41860.00 100% $0.00
34 Installation of signage $17500.00 $17500.00 $0.00 $17500.00 100% $0.00
35 Change Order#001
Deduct leftover allowance $1377)
(item #31 above)
TOTALS 201782.55 $201782.55 $0.00 $0.00 $201782.551 100 %1 $0.00
CONTRACTOR'S AFFIDAVIT OF OWNER
PAYMENT OF DEBTS AND CLAIMS ARCHITECT
CONTRACTOR 1:1 AIA Documey7t G706 SURETY
(Ills tructjot on reverse side) OTHER
TO OWNER: Carmel /Clay Board of ARCHITECT'SPROIECT NO.: GDH Project
(A'emc cwelclddre�s) Parks and Recreation No. 03060
Carmel, IN
CON'T'RACT FOI2: signage
PROJFCh: Carmel /Clay Central Park CONT "RACT'DAT'ID: 2/28/07
(Naweawllyd bv. Carmel, IN
STATE OF: Indiana
COUNTY OF: Hamilton
'11142 undedsignecl hereby ccrtiAes that, except Lis listed below, payment has heen mace in full and all ohligations have othelAvi,se hcen
satisfied for all materials and eduipmeFlt furnished, for all 'work, hhor, and services performed, and for all known indebtedness and
claims against the Conrractor for damages arisins in ally manner in Connection with the performance of the Conu referenced above
for which the Owner or Owner's property might wally way he held responsible or cnc11411he ed.
EXCEPTIONS:
none
SUPPORT'1N6 DOCUMENTS A'17ACHED HERETO: CONTMCfOR. ASI— Modulex
rryrrnrealldrlddAcss) 2017 West 18th street
1. Consent of Surety to Final Payment. yK /henever Surety is Indianapolis IN 46202
invoh Consent of Surety is required. AIA Document
G707, Consent of Surety, may he used for this purpoSe.
Indicate attachment: F yes El no
lbefoll olvin, �r slrppoail docume >'rissbolddhectItcichedbel-oo BY
if l egleii ed bi The olvile (�Y J wowe ol c ab"i ized rr t )Ilfllhv)
I. Ctmn'actol 's Release or Waiver Of LienS, conditional upon Cathy L. Fair, Secretary- Treas urer
receipt of final payincnt. (YrilNecl wifine ro+d lick)
2. Separate Releases or W.ivel;S of Liens from 5uhcontractors Subscribed amd sworn to before me on this date: /7
and material and equipment suj7piicrs, to the extent
required by 11142 0WJ� lCl ac'conlpanied by a list thereof.
Notary I'uhlic
3. Contt'acux's Affidavit of Release of Liens (AIA Document oA J
G706A). Nlv Commission Expires: C' Z
I I CAUTION: You' should sign an original AIA document that has this caution printed in red. An
original assures that changes will not be obscured as may occur when documents are reproduced.
See Instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT G706 CONTKACI UR'S Al-T DAVIT OP 11'1lIiN "I' OP ])lit3'IS AND CIAIMS
I MF 199 FI)l 110N 'AIA 0199 -1 THE AMERICAN INS] I I'I �l F OI' ARCI IITECrS. 1735 NFW YORK
AVFNC'IC, NW. WASHINGTON, 2C. 341006 -5292 WARNING: Unlicensed photocopying G 706-1994 violates U.S. copyright laws and will subject the violator to legal prosecution.
INSTRUCTION SHEET
FOR /Q/\DOClTMBN7C706.CONTRACIUKS&6T|DAVITD[PAYMFNTOFD2DT5ANDCLAIMS
A. GENERAL INFORMATION
1. Purpose
11hi`dooumux i� in,uxW u`'LOU vhcx rhc6mxun.`ri/ "xpiu,| x. {m`,i.k, Sm`,o *m,mco' ":.i��ox /h,/ ,|�x/ m.\ dxivu
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2. Related Documents
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xJx/cJ family .fd.vomu`n,670& also) oqoi^x the xomh/o,nt .wjudin:C,n16i.kumwoor/
Affidavit of RCICJsC i )f' LiCns. and 670 Co ol Stli-Ct? lo VC(ILL0101) ill ()L RelCa,'W ()I Rclajll�lgc.
3. Use ofCurrent Documents
Prior "`omnx any Am(k)com,o',d`,v^cr ill( /k|"mmltd`cxU`.xxm/u`m|xmuxrh,p'oo,xmnw/m\m^`xnmm|i�/
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4. Limited License for Reproduction
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a*qun y*m'usi.,o tithe x|1lbc GAG `k«vmcu/ i,ioxxx|od m|v,u,,|viva /hx' is, d'//wgiox| 'k"nmnx |"o`
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B. CHANGES FROM THE PREVIOUS EDITION
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CMW"MhM MAlTlq1HC11t inlCfiols uo/|dCSiQn1v/W.
C. COMPLETING THE G706 FORM
6cw1-,'xm.. D*nc"C"mrmorxg"cmnu ix /h, usv;| xv/^zo/,cquil"J W,n"xo"o w,h as ch, mn/m,' 'ho: uod rbc nxm,,
alrd addru"cs tithe 0xncr, ,xjuz and Cont tor.
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D� EXECUT OF THE DOCUMENT
]h, m,mrr puh|u.xhnvk\ adu`imo,,x ,�,vom .,u,h I() 111C [ooxouur m«tcn ^,ocm,om appearing kill Gn/o. and
should du|,^iXo,w|,Ca| (his `kvvm,mcontaining thcC'`o,nuo./`mxoumno C706^h,.vNhx/igo*(hy the [^m'm,m,.'U`r
orp,w^mvriVr.
454
INSTRUCTION SHEET FOR AIA% DOCUMENT G706 OFIVIVI
AM) omxN^ /r*nvn'm^ Ake `rx,^wcm,^x/enn,'n',,,^maUa'n 'r^~mrWxmK
G7Q8--10S4
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CONTRACTOR'S AFFIDAVIT OF OWNER
RELEASE OF LIENS ARCHITECT
AIA Docuonew G706A CONTRACTOR
SURED
(111SU'LIC60IIS tm reverse SICIC) OTHER
TOO\VNER: Carmel /Clay Board of ARCI 11'i'l NO.: GDH Project
INomc(minddw Parks and Recreation No. 03060
Carmel, IN
CON 'TRACT FOR: signage
PROJECT: Carmel /Clay Central Park CONTRACT DATED:
owl,,,el,,,dl,dd,e.,l Carmel, IN
SPATE OF: Indiana
COUNTY OF: Hamilton
The undersigned hereby certifies that to the hest of the undersigned's knowledge, infilrmation and belief, except as listed helow, the
Releases or Waivers of Hen attached heretel includr the Ccmn_;ICI0r, Al Suhccmu all Suppliers of materialS and cyuipment, and all
performers of Work, labor or Services who have or nrry have liens or cncumhrances or the right to assert IienS or encumhr anceS against
any Of the Ownerarising in any manner DUI Of the perfia of the Cunu referenced shove.
EXCEPTIONS:
none
SUPPOR"1'ING DOCUIMI-XI'SAITACHED HERETO: CONTRACTOR: ASI— Modulex
(Xamcn„dnddreca) 2017 West 18th Street
I. COnlraCt( >r•S ReleaSC Or Waiver Of I.ICnS, conditiur1A upon Indianapolis, IN 46202
receipt of final payment.
2. Separate ReleISCS Or W Livers Of LicnS from SLIhCon U'aCIUls
and material and equipment SupplierS, to the• extent
required by the Owner, accompanied list thereOf.
13Y:
(Siq;Iat va /'alobwr 1 cy,resc„lefthC.)
C athy L. Fair, Secretary- Treasurer
II'rinled „m,te told tide)
Subscribed and sworn to hefin me On this date: 9�l 2. �D
Not;uy Public:
NIv Commission Expires:
CAUTION: You should sign an original AIA document that has this caution printed in red. An
I I original assures that changes will not be obscured as may occur when documents are reproduced.
See Instruction Sheet f Limited License for Reproduction of this document.
AIA DOCUMENT G706A CONTRACTOR'S AFFIDAVIT()[: HVITASI? O1' LIENS 199 -1
FDITION "AIA 3199 -i '111F A:AIERICAN TF Ol ARCI-11'll ?C'I'ti. 1735 NEW YORK
:a�� AVFNI'F. N V, WASHINGTON. D.C. 2000(,-5292 WARNING: Unlicensed photocopying
violates U.S. copyright laws and will subject the violator to legal prosecution.
G706A -1994
INSTRUCTM SHEET
FOR ALA DOCUMENT G706A, CON I'RACI "OR'S Al�Fll).AVI7' OF IZf:I..EASI? OF LIENS
A. GENERAL INFORMATION
1. Purpose
This doCUn)cn[ is intcnde(I fur use as a companion to ALA DOCUment 6700, Cortu Affidavit of Pavnx.ni of Dchts an(I Claim,.
2. Related Documents
'Phis ducunu•nt IMIV he used with most of the AIA's Owner Contractor agrcemcnts and gcm.T'll conditions. Such as A201 and its
rclatcd family of cloctmlents. As noted ahovc. G706A is',[ con)p:uli011 document to AIA fhxun)ent G70G.
3. Use of Current Documents
Prix l to using any AIA document, the user shnul(I consult the: AIA, an AIA con)ponCnt CI)apter or :1 current AIA Documents List t(
(Ictcrn)inc the current C(lition of eadl doCUmcnt.
4. Limited License for Reproduction
AIA Document G70eiA is a copyrigbtcd work and mmy not be reproduced or Cxcerpted from in Suhst :lnti:tl Dart without the express
written permission of the AIA. The G706A doCllll)enl is intended to he uscd as a constnrtahlC- -that is. the original document pur
chased by the u.,c:r is in[Cndcd to be consumed in the mursc of hcirlg used. Th(a'c is no implied permission to reproduce this
)Cun)ent, now doers mcinhc :ship in The American Institute ofArchiw( ts confer anv Itn'Ihcr rioht.ti rc im)(Iltcc: G-"06A.
A ('1116onalY noliCC is printed in red on the original of this document. This notice (list ir)guish(:s :u) ori,-iiml AIA dUCLIMCnI front
copics alld counterfeits. To Cnsure acCUraC• and uniforn)ity of IJll`u:lgC, purchascl:s should use only an ori-inal AIA document or
one that has been reproduced front an Original under :l special limited licenu from the ALA.
A limited license N herchy granted to retail purchascr:s to reltrod(ICC a maximum of ten copies; of a Con)plele(I or executed G 706A, but
only lot URe in COMIC CtiOn with :I particular I)ruje('t. P`urther reproductions arc prohibited without the express permission of the ALA.
B. CHANGES FROM THE PREVIOUS EDITION
A cross- reference to AIA Document A201 has hccn deleted tO permit the use of G706A with other families of AIA documents, inClu(I-
ing C011Sn man(IC11 ent, intcriOI:s and (ICSign /huild.
C. COMPLETING THE G706A FORM
GENERAL The Owner- Contractor Agreement is the usual source of rC(luired information such Is [hc colltraCt (late and [I)C narmC.S
and addresses oFthe Owner, Project :111(1 Contractor.
ARC1I1TFCf`S PROII:Cf NO.: This information is typically supplied by the Archilecl :Ind entered on the font) by the Contractor.
CONTRACT FOR: This rcfer:s to the scope of the comt'act, suCII AS "General COnsu'u(.'tion" of °!%fCrha11ical \\%ork
AFFIDAVIT: Indicatc the state 2111(1 county Ayhere the Affi(:lvi[ is nta(le. This is not mccess:lrily the san)(2 location as the Proicct, but
should he the location where the notm is authorized to administer sworn Oaths. If there are any FXCF.PTIONS to the statement,
thou should be lis[Cd ill the Space providcd; Otherwise enter as "Nonc It n)av he a stipt.1111 0 1) of the CUllll'aCt DoCU111CIMS that the
Owncr h -IS the ri({ht to rcyuire IhC COnurac'tur to furnish a bolld to cover Cae'h exception listed on ttu' Affidavit.
StTPORTING DOCI'tMI NT'S: I'll(: AIA does not publish a "Release Or Wiliver of Liens" for corurartors or Subconu'21Clol hCC >IUSC of
the gre:ll dive):sin of releases or waivers permitted by various State n)cchanics lice laws. Forms for such purposcs m :n' be availahle
born local Conn,trtors asso��i:u ion.a or 111AV he Av'riltcn with the assistance of Icgal CoUnSCI.
D. EXECUTION OF THE DOCUMENT
The Notary Public S1101.11d administer a sworn oath to the Contractor t the written Statements appearing on G706A. :Ind
shc)ulel duly sign and seal this document containing the Conu'a s cu)r' Si ;�naun'r. C;70(i:1 should he signed by the Cn
otractor or the
Contractor s aulhol 1 repreSC111 t16e.
4/94
INSTRUCTION SHEET FOR AIA DOCUMENT G706A CONTRACTOR'S AFFIDAVIT OF RELEASE OF
HFN :S 109.1 IiDI'I'IC1N AW' THE AMERICAN INs OF ARCIIITFCTS. 1735 NEW YORK AVFNILE, G706A -1994
N.AV, WV lHNU R:)N, DA:. 2000t,5292
r
Bond 3- 891 -267
AIA Document G707
CONSENT OF SURETY COMPANY
TO FINAL PAYMENT
Project: Outdoor Auquadics and Exterior Signage
TO: (OWNER) ARCHITECTS PROJECT NO.
Carmel /Clay Board of Parks and Recreation CONTRACT FOR: See Above
760 3r Ave., S.W., Suite 100 CONTRACT DATE: 3 -16 -07
Carmel, IN 46032
CONTRACTOR: Masters Architectural Graphics, Inc. d /b /a ASI Modulex
In accordance with the provisions of the Contract between the Owner and the Contracor as indicated above,
the
The Ohio Casualty insurance Company
on bond of
Masters Architectural Graphics, Inc. d /b /a ASI- Modulex
hereby approves of the final payment to the Contractor, aid agrees that final payment to the Contractor shall
not relieve the Surety Company of any of its obligations to
Carmel /Clay Board of Parks and Recreation
as set forth in the said Surety Company's bond.
IN WITNESS WHEREOF,
the Surety Company has hereunto set its hand this 6 day of August, 2008.
The Ohio Casualty Insurance Company
Attest: Helen Helen Parker, Witness
(seal) P--------
a Y. Ma ors, torn in F ct
r CERTIFIED COPY OF POWER OF ATTORNEY
THE OHIO CASUALTY INSURANCE COMPANY
WEST AMERICAN INSURANCE COMPANY
No. 34530
Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, an Ohio Corporation, and WEST AMERICAN
INSURANCE COMPANY, an Indiana Corporation, in pursuance of authority granted by Article VI, Section 7 of the By -Laws of The Ohio Casualty Insurance
Company and Article VI, Section I of West American Insurance Company, do hereby nominate, constitute and appoint: Pamela Y. Majors, Helen P. Parker
or Allen J. Grau of Indianapolis, Indiana its true and lawful agent (s) and attorney (s) -in -fact, to make, execute, seal and deliver for and on its behalf as
surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance FIFTEEN MILLION
(515.000,000.00) DOLLARS, excluding however, any bond(s) or undertaking(s) guaranteeing the payment of notes and interest thereon
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Companies, as fully and amply, to all intents and
purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Hamilton, Ohio.. in
their own proper persons.
The authority granted hereunder supersedes any previous authority heretobre granted the above named attomey(s }in -Fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company has hereunto
subscribed his. name and affixed the Corporate Seal of each Company this 29th day of Novem ber, 1999.
OEL
Sam Lawrence, Assistant Vice President
STATE OF OH10,
COUNTY OF BUTLER
On this 29th day of November, 1999 before the subscriber, a Notary Public of the State of Ohio, in and for the County of Butler, duly commissioned and
qualified, came Sam Lawrence, Assistant Vice President of THE OHIO CASUALTY INSURANCE COMPANY and WEST AMERICAN INSURANCE COMPANY,
to me personally known to be the individual and officer described in, and who executed the preceding instrument, and he acknowledged the execution of the same, and
being by me duly sworn deposeth and saith, that he is the officer of the Companies aforesaid, and that the seals affixed to the preceding instrument are the Corporate
Seals of said Companies, and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by die authority and
direction of the said Corporations.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Hamilton, State of Ohio, the day and year first above written.
`y „pumurp,�
a {e1 ,yu rp� 3
l3af�-
Notary_ Public in and for County of Butler, Stateof Ohio
MV Commission expires September 25. 2002...
This power of attorney is granted under and by authority of Article VI, Section 7 of the By -Laws of The Ohio Casualty Insurance Company and Article VI, Section I of
West American Insurance Company, extracts from which read:
Article VI, Section 7. APPOINTMENT OF ATTORNEYS -IN -FACT, ETC. "The chairman of the board, the president; any vice- president, the secretary or
any assistant secretary of each of these Companies shall be and is hereby vested with.fu!l power and authority to appoint attorney s- in- fact for the purpose of signing the
name of the Companies as surety to, and to execute, attach the corporate seat, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or
other instruments of suretyship and policies of insurance to be given in favor of any individual, firm, corporation, or the official representative thereof, or to any county
or state, or any official board or boards of county or state, or the United States of America, or to any other political subdivision."
Article VI, Section 1. APPOINTMENT OF RESIDENT OFFICERS. "The Chairman of the Board, the President any Vice President, a Secretary or any
Assistant Secretary shall be and is hereby vested with full power and authority to appoint attorneys in fact for.the purpose of signing the name of the corporation as
surety or guarantor, and to execute, attach the corporate seal, acknowledge and deliver any and all bonds, recognizances, stipulations, undertakings or other instruments
of surety -ship or guarantee, and policies of insurance to be given in favor of an individual, firm, corporation, or the official representative thereof, or to any county or
state, or any official board or boards of any county or state, or the United States of America, or to any other political subdivision."
This instrument is signed and sealed by facsimile as authorized by the following Resolution adopted by the respective directors of the Companies (adopted May 27,
1970 -The Ohio Casualty Insurance Company; adopted April 24, 1980 -West American Insurance Company):
"RESOLVED that the signature of any officer of the Company authorized by the By -Laws to appoint attomeys in fact, the signature of the Secretary or any
Assistant Secretary certifying to the correctness of any copy of a power of attorney and the seal of the Company may be affixed by facsimile to any power of attorney or
copy thereof issued on behalf of the Company. Such signatures and seal are hereby adopted by the Company as original signatures and seal, to be valid and binding
upon the Company with the same force and effect as though manually affixed."
CERTIFICATE
1, the undersigned Assistant Vice President of The Ohio Casualty Insurance Company and West American Insurance Company, do hereby certify that the foregoing
power of attorney, the referenced By -Laws of the Companies and the above Resolution of their Boards of Directors are true and correct copies and are in full force and
effect on this date.
114 WITNESS WHEREOF, I have hereunto set my hand and the seats of the Comoanies this 6th day of
S WSV
u SEAL SEAL
S- 4300 Assistant Vice President
SUDC AFFIDAVIT. FrN WAIVER AND RELFASE OF LIEN
T (For use with final progress payment application)
STATE OF INDIANA, COUNTY OF Ham ilton SS: Date: 9/12/08
TO: Geupel DeMars Haberman
Owner: Carmel Clay Board of Parks and Recreation GDH Project No.: 03060
Pay Request No.: Final
Architect: Williams Architects
450 E Gundersen Drive.
Carol Stream, IL 60188
Project: Carmel Clay Central Park
Carmel, IN
Contractor: T ill DeMars H.a -merman
7930 C'astlewa Drive
l rnrii�anapolic, lndi ana, 4.6? (O
Subcontractor: AS I -Modul ex
2017 West l8th St
In iana olis Indiana- 46202
Subcontractor
Scope of Work: Sign
Subcontract Number: Bid Release 8 Dated; 2/28/07
The undersigned, being duly sworn, deposes, certifies and says that: (i). he(she) is an officer of, and is duly authorized to
make this affidavit, final waiver and release on behalf of the above -named Subcontractor; (ii) Subcontractor has
contracted with Contractor to furnish certain labor and/or materials as follows:
for the above Project; (iii) the final balance due from Contractor for labor performed and material furnished to said
Project is the sum of Twenty thousand one hundred seventy —eight no /100-
Sollars (,S 20, 178.00
receipt of which is hereby acknowledged; (iv) Subcontractor has received all payments due under its subcontractrefered
to above; (v) Subcontractor has completed all of the work for the Project which is required under its subcontract and has
paid in full or otherwise satisfied all of its obligations to its subcontractors, materialmen, equipment suppliers, vendors,
laborers, and employees for all labor performed, materials and equipment furnished, and services rendered to the Project,
and has paid or otherwise satisfied all other claims and indebtedness associated with the performance of its subcontract;
and (vi) no other party has an) claim, or right to a Iien on account of any work performed, materials or equipment
furnished, cr'services rendered for said Project under its Subcontract,
FOR GOOD .kND VA_LUAI ;LE CONSIDERATION, including without limitation the .final payment. received b•J it
under its Subcontract, Subcontractor, for itself and its subcontractors, materialmen, equipment suppliers, vendors,
laborers, and employees HEREBY:
(A) EX.I'RESSLY AND FOREVER W. -VIES, RELEASES AND IZELINQUISHES all rights to hold assert,
enforce or file any and all claims and liens which Subcontractor now has or may have against O-' Mcr, any other equitablo
or legal interest holder in the Project, the Project. itself (i.ncluding without limitation the real property on which such
Project is located and the improvements thereon), Architect, Contractor, Contractor's Surety and Contractor's contract
proceeds to which it now or in the future may be entitled to receive from the Owner or any third party, and any third party
contractor and its surety on the Yroject wish w•honi the Owner or Contractor has a contract, for any and all labor
performed, materials and equipment f r ished, and services provided to or for the Projeci by or through Subcontractor,
and
(B) EXPRESSLY AND FOREV7ER AGREES TO B )FIMNIFY, DEFEND AND ROLD I-IAILvII,ESS Owner,
its Officers, agents, representatives and employees, any other equitable or legal interest holder in the Project, Architect,
Contractor and Contractor`s Surety, from and against any claim or lien of any l:ind.whatsoever asserted through or under
Subcontractor, including without limitation any claim or lien, asserted by atiyperson who has furnished labor, materials,
equipment or services to Subcontractor, and from and against any and all damages, losses and expenses including
atiorney fees, arising• therefrom or incurred in connection therewith.
This Affidavit, Final Waiver and Rciease of Lien has been executed and tendered by the undersigned on behalf of
Subcontractor to induce payment by Contractor and /or Owner of the above amount,
Date:_ 9/12/08 S'UBCONTRACTO'R: ASI- MQd
B Y:
Name: Cathy 1. Fai
Title:
Secretary, Treasurer
STATE OF J DI AN
COUNTY OF M ARION
p Subscribed and sworn to before me, a Notary Public, in and for said County and State this
clay /1'. H c�
of �J 6 T"E� a 6 E.2 2cv8'
Signature:
Printed: o_ A- J 0 o A_I AL
ivotar•,r Public
My Commission Expires: L o!_Z
County oi'.Residence: _9 i m �Z�
Invoices 270007 -01 and 270007 -02
AFFIDAVIT AND WAIVER OF LIEN
X FINAL PARTIAL x PAYMENT TOP OLLOW
STATE OF INDIANA
COUNTY OF MARION SS
David W. Shuck being duly sworn states that he /she is the President of Shuck Corpora
(Name) (Title) (Supplier)
IIaving contacted with AS I— Modulex to furnish certain materials and/or
(Company Name)
Labor as follows: for a project known as Carmel /Clay C entral
Park (Description)
located at Carmel, Indiana
CarMe /Clay Boar o
And owned by Parks Recreati and does further state:
(Owner)
PARTIAL WAIVER: That the balance clue from 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 is given to and for said
Amount, effective upon receipt of such payments;
FINAL WAIVER: that the final balance due from AS I Modulex i the sum of three
thousand two hundred twenty no/l
dollars 3220.00
Receipt of which is hereby acknowledged', or
x
the payinent 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.
THI:REFORE, 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, famished by the undersigned thereto, and further certifies that no other parry has any
claim or right to a lien on account of any work performed or material furnished to the undersigned for said
project, and within the scope of this affidavit and waiver.
SHUCK CORPORATION
(Company Name)
k
(Sisnaturo)
WITNESS MY HAND AND NOTARIAL SEAL, this 18th day of A u g ust 200
My Commission Expires: s
�7/14/2009
Couro oResidence:
Lauren At Ty Public
Notary Public, Printed Name
I
AUG -13 -2008 WED 01;09 PM FAX N0, P, 02/02
RrM AUG 2 7 2008
Invoice 4841
AFFIDAVIT AND WAIVER OF LIEN
X FINAL PARTIAL. PAYMENT TO FOLLOW
STATE OF
COUNTY OF SS
i
dd k_f p o leS1G�� P2S yNc
being duly sworn states that he /she is the �T�IC� I �of
(Name) (Title) (Supplier)
Having contacted with A SI— Modulex to furnish certain materials and/or
(Company Name)
Labor as follows 2 S (>�a�l6 for aproject known as Carmel /Clay C entral
Park (Des ription)
located at Carmel, Indiana
Carme /Clay oar o
And owned by Parks Recreation and does further state:
(Owner)
PARTIAL WAIVER: That the balance due from 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 partial Waiver of Lien is given. to and for said
Amount, effective upon receipt of such payments;
FINAL WAIVER: that the final balance due from ASI Modulex is the sum of
none
dollars 0
x 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.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien ar
claim whatsoever on the above described property and improvements thereon on account of labor or
material or both, famished by the undersigned theroto, and further certifies that no other parry has any
claim or right to a lien on account of any work performed or material furnished to the undersigned for said
project, and within the scope of this affidavit and waiver.
Lc 2 -D e516 OA (:0.5
(_Company Name)
(Signature)
WITNESS MY HAND AND NOTARIAL SEAL, this 20 day of u3 200
My Commission Expires:
A c 1 Z
Notary Public
County of Residence: S4mF LAy
Ma-;on 14 otar y Public, Printed Name
AUG-13-2008 WED 01 PM FAX N0, P. 02102
Invoices' 27480 ''271.83, 27113, 27417', 2742.8
r
READ UG
AFFIDAVIT AND WAIVER OF LIEN 2 2008
X FINAL PARTIAL PAYMENT TO FOLLOW
STATE OF
COUNTY OF SS p
being duly sworn states that he /she is the bier of T� e Cn Jam' n w%,c
(Name) (Titie) (Supplier)
Having contacted with AS I —Mode l ex to fttrnish materials and /or
(Company Name)
Labor as follows; for aproject known as Carmel /Clay C entral
Park (Description)
located at Carmel, Izzdiana
Carme /Clay Boarci o
And owned by Parks Recreation and does further state:
(Owner)
PARTIAL WAIVER: That the balance due from 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 is.given to and for said
Amount, effective upon receipt of such payments;
FINAL WAIVnk: that the final balance due f rum AS Modulex is the sure of
none
dollars (5 8
X 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 effeotive
Upon receipt of such payment.
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
�materW 'or,both, furnished by the undersigned thereto, and further certifies that no other parry has any
-t claim or %lit to•a lien on account of any work performed or material to the undersigned for said
project, and the scope of this affidavit and waiver. y 1 C
820 B B TON RD.
149442
S9 nature)..
WITNESS MY. HAND AND NOTARIAL. SEAL, this d of Lc. 200- 0
My CornlpissiolL Expires:
(Notary Pub
County of Residence:
U .L L -d A/ Notary Public, Printed Name
w fl y
W0MMM0N5WM
FROM <WED)AU6 13 2008 18:41/5T.13:41/No.7600000880 P 2
AUG -13 -2008 WED 01:11 PH FAX N0. P. 02/02
Invoice 2619 and 2590
AFFIDAVIT AND WAIVER OF LIEN
x FINAL PARTIAL PAYMENT TO FOLLOW
STATE OF
COUNTY OF SS
p
"t ek being duly sworn states that he /she is the y �l of G 1' 3 L,—C—
(Title) (Supplier)
Having contacted with ASI Modulex to furnish certain materials and/or
(Company Name)
Labor as follows: for aproject known as Carmel /Clay C entral
Park (Description)
located at Carmel, Indiana
armel /Clay oar o
And owned by parks Recreation and does further state:
(Owner)
PARTIAL WAIVER: That the balance due from 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 is given to and for said
Amount, effective upon receipt of such payments:
FINAL WAIVER: that the final balance due from ASI M odul ex is the sum of
None dollars
X Receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration for
This affidavir and Final Waiver of Lien which shall become effective
Upon receipt of such payment.
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, and further certifies that no other party has any
claim or right to a lien on account of any work performed or material furnished to the undersigned for said
project, and within the scope of this affidavit and waiver.
r5� LLL
(Comp y Name
�r
WITNESS MY HAND AND NOTARIAL SEAL, this day of 200
My Commission Expires: 4 SUSAN ANDERSON
COMMISSION NUMBER: 196251 Notary P}}blic
Co of Residence:
MY COMMISSION EXPIRES: r�..,� a n d p-r s o
,n,.r MARCH 12.2010 Notary Public, Printed Name
Fr6h:Dutton Architectural 423 752 0060 08/22/2008 09:11 9819 P.002/002
AUG -20 -2008 WED 01:13 PM FAX N0, P. 02
Invoice 10135
AFFMAV1T AND WAIVER OF LIEN
x FINAL PARTIAL PAYM)SNT TO FOLLOW
STATE OF
f�
COUNTY OF SS
u'1 being duly swoon snares that he/she is the of n
(Hume) (Tide) (Supplier)
Having comacted with AST- Mod ulex to fimtish certain mmrials &M/or
(Company Name)
Labor as follows: for a project known as Carmel /Clay C entral
Park (Description)
located at Carmel, Indiana
=arms /Clay Bo&kd o
And owned by Parks Recreation and does fir[her state-
(Owner)
PARTIAL WAIVER That the balance due ftom 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 partial Waiver of Lien is given to and for said
Amount, effective upon receipt of such payments;
FINAL WAIVER: that the final balance due f rom AS I- Madulex is the Sum of
none
dollars 0
X Receipt of which Is hereby acknowledged; or
the payment of which has been promised es the sole eansideration for
This affidavit and Final Waiver of Lien which $ball become effective
Upon receipt of such payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or
claim whatsoever on the above described pmperty and improvements thereon an account of labor or
material or both, furnished by the undersigned thereto, and further certifies that no other parry has any
claim or right to a lien on account of any work performed or material furnished to the undersigned for said
project, and within the amps of this affidavit and waiver.
�l u7rnov
(C (C Name)
(S' re)
WITNESS MY HAND AND NOTARIAL SEAL, this day of 2t)0 >pb110191H8P
My C a� tFxP as ���►o C
I No Fub a a• 5TAT E ^t :O�'
CQUW of Rosa e: JI M: OF
Notary Public, Printed Name TENNESSEE
�3 NOTARY
PUBLIC
��/�l Or H l l 111b1bb��
FINAL WAIVER OF LIEN
STATE OF ILLINOIS
COUNTY OF COOK SS
TO WHOM IT MAY CONCERN:
WHEREAS the undersigned has been employed by ASI Modules to furnish Signage for the premises known as Carmel /Clay Central
Park of which Carmel /Clay Board of Parks Recreation.
THE undersigned, for and in consideration of ZERO -0) and other good and valuable considerations, the receipt whereof is
hereby acknowledged, do(es) hereby waive and release any and all lien or claim of, or right to, lien, under the statues of the State of
Illinois, relating to mechanics' liens, with respect to and on said above described premises, and the improvements thereon, and on the
material, fixtures, apparatus or machinery furnished, and on the moneys, funds or other considerations due or to become due from the
owner, on account of all labor, services, material, fixtures, apparatus or machinery, heretofore furnished, or which may be furnished at
any time hereafter, by the undersigned for the above described premises, INCLUDING EXTRAS
DATE: 09/10/08 COMPANY NAME: Nelson Harkins Industries, Inc.
ADDRESS: 5301 N. Kedzie, Chicago, IL 60625
SIGNATURE AND TI ice President
*EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS, BOTH ORAL AND WRITTEN, TO THE CONTRACT.
CONTRACTOR'S AFFIDAVIT
STATE OF ILLINOIS
COUNTY OF COOK SS
TO WHOM IT MAY CONCERN:
THE UNDERSIGNED, DONALD HARKINS DULY SWORN, DEPOSES AND SAYS THAT HE IS VICE PRESIDENT of
NELSON- HARKINS WHO IS THE CONTRACTOR FURNISHING Signage Work ON THE BUILDING LOCATED AT CARMEL/
CLAY CENTRAL PARK of which CARMEL /CLAY BOARD OF PARKS RECREATION IS THE OWNER..
That the total amount of the contract including extras* is $1609.00 on which he HAS RECEIVED PAYMENT OF $1609.00 prior to this
payment. That all waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the
validity of said waivers. That the following are the names and addresses of all parties who have furnished material or labor, or both, for said work
and all parties having contracts or sub contracts for specific portions of said work or for material entering into the construction thereof and the
amount due or to become due to each, and that the items mentioned include all labor and materials required to complete said work according to plans
and specifications:
NAMES AND ADDRESSES WHAT FOR CONTRACT PRICE AMOUNT THIS BALANCE
INCLUDING EXTRAS* PAID PAYMENT DUE
Nelson- Harkins Ind Signage $1609.00 $1609.00 -0- -0-
NO SUB-
CONTRACTORS"
TOTAL LABOR AND MATERIAL INCLUDING EXTRAS* $1 609.00 $1609.00 $_0_ -0-
COMPLETED.
All materials taken from fully paid for stock and delivered per our own truck.
All labor is paid in full.
That there are no other contracts for said work outstanding, and that there is nothing due or to become due to any person for material,
labor or other work of any kind done or to be done upon or in connection with said work other than above state.
DATE: 9110108 SIGNATURE
SUBSCRIBED AND SWORN TO BEFORE ME THIS 10th DAY OF September 2008
*EXTRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS r
BOTH ORAL AND WRITTEN, TO THE CONTRACT
RY
�ALLPM
NORAMINAW $WOPUS=
Transmittal
ast ®amodulex.
Geupel- DeMars-Hagerman Construction Managers September 26, 2008
7930 Castleway Drive
PO Box 502710
Indianapolis, Indiana 46250 -7710
Attn: Kent Forman
Dear Mr. Forman,
It is our belief that ASI Modulex has fully completed the obligations for signage per the contract
documents for the Carmel Clay Central Park /Aquapark project. We have also fulfilled all outstanding
punch list items.
Attached is a copy of the warranty for this project.
Thank you and please let me know if you need anything additional.
Sin ly, r
r
Jeff Higgins, ASI Modulex
ASI Modulex 317.269.3400 Tel
2017 West 18th Street 317.269.3578 Fax
Indianapolis, IN 46202 www.asimodulex.com
asuvmodulex®
Guarantee
Project: Carmel Clay Central Park Aquatic Center Bid Release 8
ASI Modulex guarantees that the exterior yard signs, dimensional letters, and indoor
banner materials are manufactured in accordance with the specifications of the project
and that the work is free of defect, is complete and corresponds to industry standards.
Further guaranteeing that on receipt of proper notice, ASI Modulex will promptly make
good, without additional cost to the Owner, any faults developing within a period of
One Year from the date of substantial completion that are due to omissions or defects
in either material or workmanship.
Maintenance
In order to maintain the signs provided by ASI Modulex, it is recommended that the
signs be wiped with a clean, dry cloth. For signs soiled with anything other than dust, a
mild soap solution and a damp cloth may be used.
ASI Modulex 317.269.3400 Tel
2017 West 18th Street 317.269.3578 Fax
Indianapolis, IN 46202 www.asimodulex.com
V
as%amodulex®
September 26, 2008
Geupel DeMars Hagerman
7930 Castleway Drive
Indianapolis, IN 46250
Attn.:Kent Forman
Re: Carmel Clay Central Park
Dear Mr. Forman,
This will certify that ASI Modulex products are exempt from requirements to provide
Material Safety Data Sheets.
In accordance with 29 CFR 1910.1200, ASI products qualify for "Article" status per
the following definition:
"Article" means a manufactured item, other than a fluid or particle: (i) which is
formed to specific shape or design during manufacture; (ii) which has end use
function(s) dependent in whole or in part upon its shape or design during end
use; and (iii) which under normal conditions of use does not release more
than very small quantities, e.g., minute or trace amounts, of a hazardous
chemical (as determined under paragraph (d) of this section) and does not pose a
physical hazard or a health risk to employees."
By the way, none of our products contain asbestos.
We trust this will satisfy your needs, and look forward to your continued confidence in
ASI and its products.
Sincerely,
ASI Modulex
Jeff Higgins
Project Manager
cc: file
ASI Modulex 317.269.3400 Tel
2017 West 18th Street 317.269.3578 Fax
Indianapolis, IN 46202 www.asimodulex.com
ACCOUNTS PAYABLE VOUCHER
CITY OF CARMEL
An invoice of 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
Purchase Order No.
00353266 ASI Sign Systems Terms
2017 W. 18th Street Date Due
Indianapolis, IN 46202
Invoice Invoice Description
Date Number (or note attached invoice(s) or bill(s)) Amount
814108 App 6 Ret Outdoor Aquatics Exterior signage 20,131.00
Total 20,131.00
1 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
I
Voucher No. Warrant No.
Ve�nc�loY o 0 3532lot.o
ASI Sign Systems Allowed 20
2017 W. 18th Street
Indianapolis, IN 46202
In Sum of
20,131.00
ON ACCOUNT OF APPROPRIATION FOR
853 Gift Fund
PO# or INVOICE NO. ACCT #/TITLE AMOUNT Board Members
Dept
853
App 6 Ret 5023990 20,131.00 1 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
11 -Dec 2008
Signature
20,131.00 Accounts Payable Coordinator
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund