HomeMy WebLinkAbout166961 12/11/2008 CITY OF CARMEL INDIANA VENDOR: 00353266 Page 1 of 1
ONE CIVIC SQUARE A S I SIGN SYSTEMS CHECK AMOUNT: $470.00
Ja CARMEL, INDIANA 46032 2017 w 18TH ST
INDIANAPOLIS IN 46202 CHECK NUMBER: 466961
CHECK DATE: 12/1112008
DE PARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
y 853 5023990 5 470..00 OTHER EXPENSES
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APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION
AIA D0CUAI ENT G7021CMa PAGE ONE OF 3 PAGES
TO OWNF- R:CarmellCay Board of Parks and PROJECT: Central Park Outdoor Aquatics APPLICATION NO: 5 Distribution to:
Recreation Exterior Si na e
9 9 a+ rr Ow t4F -R
760 3rd Avenue S.W. Suite 100 Bid Releasi 8' =T IOD TO: 7/1/2008 CONSTRUCTION
Carmel, IN 46032 l NFU
1 2 o 2008 P OTECT NO: MANAGER
FROM CONTRACTOR: ASI Sign Systems EIARCHITECT
2017 W. 18th Street NTRACT DATE: 212812007 CONTRACTOR
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 beliefthe Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached, completed in accordance with the Contract Documents, that all amounts have been paid
by the Contractor for Work for which previous Certificates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 203,159.5
2. Net change by Change Orders 3 b0 CONTRACTOR: �LI 010 &Zt(t K
3- CONTRACT SUM TO DATE (-Line i 2) ZOI, Z
4. TOTAL COMPLETED STORED TO DATE S 201,78 :55
(Colurrm G on G703) BY: Date:
5. ItETAINAGE:
a_ 10 of Completed Work 0 Z0 UC.d State of h b", County of:
o umn D E on G703) Subscribed and rn to before me this ss� day of
b. 10 of Storcd Material Notary Public r'-j a
Lo umn F on G703) My Commission expires:
Total Retainage (Lines 5a+ 5b or C0 JI OF IDEN WARD COUNTY
Total in. Column I of G703) �0 ZA t31. Up CERTIFICTTrEl WENT
6. TOTAL EARNED LESS RETAINAGE I+t�51 -55 In accordance with the Cdntraet Documents, based on on -sitc observations and the dales
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certi to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYNMNT (Line 6 from prior Certificate) 181 181.55 progressed as indicated, the quality of the Work is in accordance with the Contract
S. CURRENT PAYIN ENT DUE S A/ 76. Documents, and the Contractor is entitled to payment of the AMOUNT CE.RTIFIED-
9, BALANCE TO FINISH, INCLUDING RETAMAGE 0 Z 131 00J
(Line 3 less Line b) AMOUNT CERTIFIED Cx)
(41tach explanation if arnount certified differs from the amount applied for. Initial all
f�
ota c anges approve figures on this Application and on the Continuation Sheet that changer! to conform to 1�0�
i n previous months by Owner 377. bC7 amount certified.) i
CONSTRUCT AGER:
Total approved this Month By: Date:
ARCHIT (,viu.j4
TOTALS 377. By: Date:
NET CHANGES by Change Order This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights ofthe.Owner or Contractor under this Contract.
A'A DOCUMENT G7o2lCNCa APPLIC�4TION AND CERTIFICATION FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION 1992 EDITION AIAO 1992 G702 /GMa 1992
THE AMERICAN INSTIL UTE OF ARCHITECTS, 1145 NEW YORK AVE., N.W., WASHINGTON, DC 20005 5292
CONTINUATION SHEET APPLICATION NO. 5 DATE 7/1/08
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED [G /C[ TO FINISH
APPLICATION STORED AND STORED [C G]
[D +E] [NOT IN D OR E] TO DATE
Carmel Park Recreation App. #4 D +E +F
1 Sign SIDM -5 Main ID $24942.25 $24942.25 $0.00 $0.00
$24942.25 100%
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 1DO% $0.00
4 Sign Type VDM 3, 4, 5 $16322.85 $16322.85 $O.QO $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 i 2 $9738.50 $9738.50 $0+ $9738.50 100% $0.00
8 Sign Type PD 15 16 $8440.00 $8440.00 $0. I 00 $8940.00 100% $0.00
9 Sign Type T map $1543.50 $1543.50 $0.(p $1543.50 100% $0.00
10 Sign Type WBD $1040.00 $1040.00 sac( $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 $1135500 $11355.00 $01)0 $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 $0.0,0 $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 $O.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 $O.O 1 0 $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. 5
DATE 7111/08
IF
30 Aquatic "Wave" Mobils $7018.00 $7018.00 $0.00 $7018-00 1001% $0.00
1
31 Allowance For Temporary signs $5000.00 $3153-00 $470.00 $3623.00 72% iz)
32 Bid Bond Performance Bond costs $3670.00 $3670.00 $0.00 $3670.00 100','- $0.00
1
33 Planter Walls SEM I 2 $41860.00 $41860.00 $0.00 $41860.00 100% $0-00
34 Installation of signage $17500-00 $17500.00 $O. $17500.00 100% $0-00
I
CIAL-01 �4,,A
R �6� $2013125,5
TOTALS "Miq1 9 q11 $470 ��$0(10 �$2 991/0
SUBCONTRACTOR'S AFFIDAVIT. PARTIAL WAVER AND RELEASE OF LIEN
(For use with periodic progress payment application)
STATE OF rNDIANA, COUNTY OF Hamilton SS: Date: 7/17/08
TO: Geupel DeMars Haberman
Owner: Carmel 1 Clay Board of Parks and Recreation GDH ProjectNo,: 03060
Pay Request No.: 5
Architect: Williams Architects
450 E Gundersen Drive
Carol Stream, IL 60188
Project: Carmel Clay Central Park
Carmel, M
Contractor: Geupel DeMars Hagerman
7930 Castlewav Drive
Indianapolis,. Indiana. 46250
Subcontractor: ASI- Modulex
01"7 Wei I M
Indian polis Indiana, 46202
Subcontractor
Scope of Work: Sianage
Subcontract No.: Bid Release 8 Subcontract Dated: 2/28/07
The undersigned, being duly sworn, deposes, certifies and says that: (i) be(she) is an officer of, and is duly authorized to
make this affidavit, partial waiver and release on behalf of the above -named Subcontractor; (ii) Subcontractor has
con«aeted with Contractor to furnish certain labor and/or materials as follows: Si gnage
for the above Project; (iii) the current balance due from Contractor for labor performed and material furnished to said
Project is the sum of Four hundred. twenty -three ()I /too Dollars
423.00 (iv) Subcontractor has received all payments due to date under its Subcontract referred to above,
less applicable retention; (v) Subcontractor has paid in full or otherwise satisfied all of its obligations to its
subcontractors, rnaterialmen, equipment suppliers, vendors, laborers, and employees for all labor performed, materials
and equipment furnished, and services rendered to the Project up to and including the date hereof, and has paid or
otherwise satisfied all other claims and indebtedness associated with the performance of the Subcontract, up to and
including the date hereof; and (vi) no other party has any claim, or right to a Lien on account of any work performed,
materials or equipment furnished, or services rendered for said Project under the Subcontract:
FOR GOOD AND VALUABLE CONSIDERATION, including without limitation the payment received and to be
received by it under the Subcontract, and in anticipation of thepayment to it of the approved amount of the above request
and effective upon and subject only to payment of such approved amount Subcontractor, for itself and its subcontractors,
materialmen, equipment suppliers, vendors, laborers and employees HEREBY:
(A) EA'1 RESSLY AND FOREVER WAIVES, RELEASES AND RELINQUISHES all rights to hold, assert,
enforce or file any and all claims and liens which Subcontractor now has or may have against Owner, any other equitable
or legal interest holder in the Project, the Project itself (including 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 Owner or any third party, and any thud party
contractor and its surety an the Project with whom Owner has a contract, for any and all labor performed, materials and
equipment furnished, and services provided to or for the Project by or through Subcontractor as of the date of execution
of this instrument; and
(B) EXPRESSLY AND FOREVERAGREES TO INDEMNIFY, DEFEND AND.TTTOLD HARALLESS Owner,
its Officers, agents, representatives and employees, any other equitable or legal interest holder in the Project, Architect
and Contractor and Contractor's Surety, from and against any claim or lien of any kind whatsoever asserted through or
under Subcontractor, including without limitation any claim or lien asserted by any person who has furnished labor,
materials, equipment or services to Subcontractor, and from and against any and all damages, losses and expenses,
including attorney fees, arising therefrom or incurred in connection therewith.
This Affidavit, Partial Waiver and Release of Lien has been executed and tendered by the undersigned on behalf of
Subcontractor to induce payment by Owner of the above amount.
Date: 7/17/08 SUBCONTRACTOR: AST- odulex
By:
___Name; Cathy L. Fai
Title: Sec Treas
STATE
COUNTY OF
ubscribed and sworn .to before me a Notary Public, in a td' for said County and State this
c� Clay o `J
Signature:
Printed:,\ CAS
Notary Public
My Commission Expires:
COUNTY OF RESIDENCE, HOWARD COUNTY
County ofResidence: MY OMM1SSION EXPIR MAY 162016
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.
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
711108 A p. 5 Outdoor Aquatics Exterior Signage Central Pk 470.00
Total 470.00
i hereby certify that the attached invoice(s), or bills) is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6
1 20
Clerk- Treasurer
Voucher No. Warrant No.
ASI Sign Systems Allowed 20
2017 W. 18th Street
Indianapolis, IN 46202
In Sum of
470.00
ON ACCOUNT OF APPROPRIATION FOR
853 Gift Fund
PO# or INVOICE NO. ACCT #/TITL AMOUNT Board Members
Dept ept
853 App. 5 5023990 470.00 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
1 -Dec 2008
1
Signature
470.00 Accounts Payable Coordinator
Cost distributi ledger classification if Title
claim paid rnOtor vehicle highway fund