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Home My WebLink About163700 09/17/2008 CITY OF CARMEL, INDIANA VENDOR: 356511 Page 1 of 1 ONE CIVIC SQUARE DAWSON INC CHECK AMOUNT: $4,605.60 CARMEL, INDIANA 46032 6221 S HARDING ST INDIANAPOLIS IN 46217 CHECK NUMBER: 163700 CHECK DATE: 9117/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER A MOUNT DESCRIPTION 902 4460805 4,605.60 RETAIL SITE #5 i APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT 6702 PAGEONEOF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: Carmel Parcel 5 APPLICATION NO: 0009 Distribution to: One Civic Square PERIOD TO: 8/30/2008 OWNER Carmel, IN 46032 ARCHITECT PROJECT NOS.: FROM CONTRACTOR: Dawson Incorporated ARCHITECT: CSO Architects CONTRACTOR 6221 S. Harding Street 280 E. 96th Street Indianapolis, IN 46217 Indianapolis, IN 46280 CONTRACT DATE: 6/23/2005 CONTRACT FOR: The undersigned Contractor certifies that to the best of the Contractor's knowledge, information CONTRACTOR'S APPLICATION FOR PAYMENT and belief the Work covered by this application for Payment has been completed in accordance Application is made for payment, as shown below, in connection with the contract. with the Contract Documents, that all amounts have been paid by the Contractor Continuation Sheet, AIA Document G703, is attached. for Work for which previous Certificates for Payment were issued and payment received 1. ORIGINAL CONTRACT SUM $392,700.00 from the Owner, and that current payment shown herein is now due. CONTRACTOR: Dawson Incorporated 2. Net change by Change Orders $34,268.00 Date: 8/25/2008 By: 3. CONTRACT SUM TO DATE (Line 1 ±2) $426 ,968.00 4. TOTAL COMPLETED STORED TO DATE $425,352.00 State of INDIANA (Column G on G703) County of: MARION 5. RETAINAGE: Subscribed and sworn to before a. 5.000 ofCompleted Work $21,267.60 me this 8/25/2008 (Columns D+ E on G703) b. 0 of Stored Material $0,00 Notary Public; (Columns F on G703) My Commission expires: 7/14/2009 Totalae nsIonG70 $21'267.60 ARCHITECT'S CERTIFICATE FOR PAYMENT Total in Columns I on G703) 6. TOTAL EARNED LESS RETAINAGE $404,084.40 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 less Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the (Line 6 fi prior Certificate) $399,478.80 quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE $4 605.60 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED D (Line 3 less Line 6) $22,883.60 (Attach explanation if cunount certified differs front the amount applied for. Initial all figures on this pplication and on the Continuation Sheet that are changed to CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS con Fonn tot at ount ti /ied) Total changes approved in ARCH IT CT: revious months by Owner $34,268.00 $0.00 gy. Date: Total I r e hi s Month $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the TOTALS $34,268.00 $0,00 Contractor named herein. Issuance, payment and acceptance of payment are without NET CHANGES by Chan e Order $34 2 prejudice to any rights of the Owne or Co under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT. 1992 EDITION AIA(Io. V1992 "I111 AMERICAN INSTITUTE OP ARCIi1 "1'ECrS, 1735 NEW YORK G702 -1992 AVENUE. N.W., WASHINGTON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. his document has been reproduced electronically with the permission of The American Institute of Architects under License 97003 to Primavera systems, Inc. Reproduction of this document without pro ect -s y pr 1 petite information is not permitted. C_ Contact The American Institute (Architects to verily the current version of this document and license status." CONTINUATION SHEET A TA D OCUMENT G703 PAGE 1 OF 1 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 0009 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 8/30/2008 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE D ITEM PRESENTLY COMPLETED IF VARIABLE) SCHEDULED o TO DESCRIPTION OF WORK S FROM PREVIOUS /e NO. VALUE APPLICATION THIS PERIOD STORED AND STORED TO FINISH RATE (D E) (NOT IN D OR E) DATE (D +E +F) (G -C) (C G) 000000001 SANITARY SEWER 000000002 Labor $66,256.00 $63,605.76 $1,987.68 $0.00 $65,593.44 99.000 $662.56 000000003 Material $95,344.00 $91,530.24 $2,860.32 $0.00 $94,390.56 99.000 $953.44 000000005 MONON TRAIL 000000006 Asphalt $23,000.00 $23,000.00 $0.00 $0.00 $23,000.00 100.000 $0.00 000000007 Labor $27,400.00 $27,400.00 $0.00 $0.00 $27,400.00 100.000 $0.00 000000008 Material $29,900.00 $29,900.00 $0.00 $0.00 $29,900.00 100.000 $0.00 000000010 EXISTING DITCH 000000011 Labor $3,900.00 $3,900.00 $0.00 $0.00 $3,900.00 100.000 $0.00 000000012 Material $6,900.00 $6,900.00 $0.00 $0.00 $6,900.00 100.000 $0.00 000000014 STORM SEWER 000000015 Labor $51,800.00 $51,800.00 $0.00 $0.00 $51,800.00 100.000 $0.00 000000016 Material $88,200.00 $88,200.00 $0.00 $0.00 $88,200.00 100.000 $0.00 10 000000019 1 Change Order No. 1 1 $34,268.00 1 $34,268.00 1 $0.00 II $0.00 I $34,268.00 100.000 $0.00 TOTAL 1 $426,968.00 $420,504.001 $4,848.00 $0.0 $425,352.0 99.62 %1 $1,616.0 `�1II AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA(R) (01992 THE AMERICAN INSTITUTE OI' ARCHITECTS, 1715 NEW YORK G703 -1992 Unlicensed AVENUE, N.W., WASHINGTON. D.C. 20006 -5292 WARNING: censed hotoco �6 p eying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronically with the permission of The American Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without prep�ific information is not permitted. Contact The American Institute of Architects to verifv the current version of this document and license status PARTIAL WAVIER OF LIEN STATE OF INDIANA SS: COUNTY OF MARION KNOW ALL MEN BY THESE PRESENTS, That the undersigned: Dawson Incorporated for and in consideration of. APPLICATION NO: 0009 PERIOD TO: 8/30/2008 for payment in the amount o£ $4,605.60 does upon receipt of said payment hereby waive, release and surrender any and all liens or claims or rights to lien, for labor, material and /or services, and further certifies that no other party has any claim or right to a lien, on account of any work performed or material furnished to the undersigned for said project situated in the County of Marion, State of Indiana, described as follows: PROJECT: Carmel Parcel 5 PROJECT NO: ARCHITECT: CSO Architects CONTRACT: Dawson Incorporated CONTRACTOR Date: 8/25/2008 State of INDIANA County of. MARION Subscribed and sworn to before me on: 8/25/2008 Notary Public: My Commission expires: 7/14/2009 Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee so.. c o� po o� Purchase Order No. GZZ f 5, s�cl Terms Poles, R AJ `t (a 7, r'7 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /zSl /o$ ti A P 4�c./ S T loos. C-- Total Lf 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 VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF 1 a� 4 nt�Cll fAJ q &Z t G ON ACCOUNT OF APP ON FOR N Y& ONO Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 407 N 4 94reo?ar 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 9 rS Z20 0$ `7 r/ Signature Cost distribution ledger classification if Title claim paid motor vehicle highway fund