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Home My WebLink About160820 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 356511 Page 1 of 1 ONE CIVIC SQUARE DAWSON INC CHECK AMOUNT: $32,162.44 a CARMEL, INDIANA 46032 6221 S HARDING ST INDIANAPOLIS IN 46217 CHECK NUMBER: 160820 CHECK DATE: 6/25/2008 EPARTMENT ACCOUNT PO NU INVOICE NUMBER AMO DESCRIPTION 902 4460805 32,162.44 RETAIL SITE #5 i APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGEONEOF PAGES TO OWNER: Carmel Redevelopment Commis PROJECT: CRC Parcel #5 APPLICATION NO: 0006 Distribution to: One Civic Square PERIOD TO: 5/30/2008 OWNER Carmel, IN 46032 E] 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: C ONTRA C TOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge information and belief the Work covered by this application for Payment has been cormpletecl 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 By: t Cc�� c Date: 5/22/2005 3. CONTRACT SUM TO DATE (Line I ±2) $426,968.00 4. TOTAL COMPLETED STORED TO DATE $327 ,90920 State of INDIANA (Colunm G on G703) County of: MARION 5. RETAINAGE: Subscribed and sworn to before a. 5.000 of Completed work $16,395.46 me this 5/22/2005 (Columns D E on G703) G✓� b. 0 %ol'Stored Material $0.00 Notary Public: /�/L�� (Columns F on G703) My Commission expires: 7/14/2009 Total i ainage (Line on G703) Sb or $16 ,395.46 ARCHITECT'S CERTIFICATE FOR PAYMENT Total ul Columns I on 43703) 6. TOTAL EARNED LESS RETAINAGE $311,513.74 In accordance with the Contract Documents, ents based o 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 from prior Certificate) $279,351.30 quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE $32,162.44 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED (67.4 (Line 3 less Line 6) $115,454.26 (Attach explanation if amount certified differs from the amount applied,for. Initial till figures oil this Apph` and on the Continuation .Sheet that are changed to CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS conform to the on; on cert' fed Total changes approved in ARCHITECT: p revious months by Owner $34,268.00 $0.00 By: Date: 3 D$ Total approved this 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 N CHANGE by Ch O $34,268.00 prejudice to any rights of the Owner o C ontractor under this Contract. AIA DOCUMENT 43702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIArlb. r61992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 -5_92 WARNING: Unlicensed hotoco in violates U.S. copyright laws and will sub'ect the violator to legal P osecution. G702 -1992 Rf 1 I Y b b J b r 'This document has been reproduced electronically with the per ssion of The American Institute of Architects under License 97903 to Primavera Systems, Inc. Reproduction of this document without project- specific information is not permitted. Contact The American Institute of Architects to verify the current version of this document and license status." CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF 1 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 0006 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 5/30/2008 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 RETA[NAGE ITEM SCHEDULED PRESENTLY COMPLETED (IF VARIABLE) DESCRIPTION OF WORK FROM PREVIOUS STORED AND STORED TO VALUE APPLICATION NO. THIS PERIOD FINISI4 RATE (D E) (NOT IN D OR E) DATE (D +E +F) (G -C (C G) 000000001 SANITARY SEWER 000000002 Labor $66,256.00 $10,600.96 $11,926.08 $0.00 $22,527.04 34.000 $43,728.96 000000003 Material $95,344.00 $22,882.56 $21,929.12 $0.00 $44,811.68 47.000 $50,532.32 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 000000019 1 Change Order No. 1 $34,268.00 1 $29,470.48 $0.00 II $0.00 I $29,470.48 86.0001 $4,797.52 TOTAL I $426,968.0 $294,054.00 $33,855.20 $0.0 $327,909.2 76.80 %I $99,058.8 i AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA00 (01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WAS[ IINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703 -1992 '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 pa,pentific information is not permitted. Contact The American Institute of Architects to vertfv the current vi;rsion 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: 0005 PERIOD TO: 3/31/2008 for payment in the amount of: $14,702.70 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 parry 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: CRC Parcel #5 PROJECT NO: ARCHITECT: CSO Architects CONTRACT: Dawson Incorporated CONTRACTOR Date: 4/25/2008 By: State of INDIANA County of. MARION Subscribed and sworn to before me on: 4/25/2008 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 nc Purchase Order No. Terms 4^g001tJ, tti q(02t r l Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) S' b8 Pis 3Z i6z 5 Total 3:Z�°Ij(oZ y 1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in a cordance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Q io, "�.ro' Cyr �Z*� IN SUM OF «,.g r ON A =APPPFO FO R �o y�fGaBos Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or qo2 32 t67 qcy 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 7 2 r' Sign it �r o �,•�tic� Cost distribution ledger classification if Title claim paid motor vehicle highway fund