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Home My WebLink About167342 12/23/2008 f CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1 ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP CARMEL, INDIANA 46032 7930 CASTLEWAY DRIVE CHECK AMOUNT: $71,653.95 INDIANAPOLIS IN 46250 CHECK NUMBER: 167342 CHECK DATE: 12/23/2008 DEPARTMENT ACCOUNT PO NU MBER INVOICE NUM BER AMOUNT DESCRIPTION 902 4460867 9075 71,653.95 INDIANA DESIGN CENTER j 3 y r, Ir APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCU ENT 6702 PAGE ONE OF PAGES TO OWNER: Signature Construction PROJECT: Parcel 67 Streetscape APPLICATION NO: 00001 Distribution to: 720 3rd Avenue, SW HCC Job #2691 PERIOD TO: 11/30/2008 OWNER Cannel, IN 46032 Invoice #9075 PROJECT NOS.: 082691A ARCIIITECT FROM CONTRACTOR: Hagerman Construction Corporation VIA ARCI- IITECT: CSO Architects Inc CONTRACTOR 7930 Castleway Drive 280 East 96th Street Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CONTRACT DATE: CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor- mation and belief the Work covered by this application for Payment has been completed Application is made for payment, as shown below, in connection with the contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay- ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $596,800.00 CONTRACTOR: Hagerman Construction Co 2. Net change by Change Orders $0.00 November 20 t 2008 B Date: 3. CONTRACT SUM TO DATE (Line 1 ±2) $596,800.00 Troy 1e star, CFO 4. TOTAL COMPLETED STORED TO DATE $79,615.50 State of. I ndiana ,'�•QPUID C• rti, (Column G on G703) County of: Allen o�GQ�ll�ls$ /0�°s Subscribed and sworn to before 8� C(1t1Or& o 0 5. RETAINAGE: Q me this 20th day of November 2008 a o rn °°o a. 10_000 %of Completed Work $7,961.55 0 o° (Columns D E on G703) y o d Notary Pu It. 0 of Stored Material $O.00 (Columns F on G703) My Commission expires: 12�16�15 �9 /i' 6 Total Retainage (Line 5a +5b or C $7,961.ss ARCHITECT'S CERTIFICATE FOR PAYMEI� Total in Columns I on G703) 6. TOTAL EARNED LESS RETAINAGE S71 653.95 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 less Line 5 Total) comprising this application, Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, inf a on and belief the Work has progressed as indicated, the (Line 6 from prior Certificate) $0.00 quality of the Work is i ace dance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE $71 ,653.95 is entitled to payment f AMO CERTIFIED. 653 AMOUNT CERTIFIE 71 653.95 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified d fferc frwn tl n n applie or. Initial (Line 3 less Line 6) $525,146.05 all fug7nres on this Application and on the Continuation Sheet that are changed to conform to the amount certified) CI-IANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Signature Constructio CJj Total changes approved in Date: p revious months b Owner $0 .00 $0.00 By: T1lo� a E. KCo.. T.� Total a p roved this Month $0.00 $0.00 his Cc ificate is not ncgo able. The AMOUNT CERTIFIED is payable only to the TOTALS $0.00 $0.00 ontractor named herein. ssuance, payment and acceptance of payment are without NET CHANGES b Chan e Order $0.00 re•udice to an ri tits o the Owner or Contractor under this Contract. AIA DOCUMENT G702• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIAQt� 01992 TIIE AMERICAN INSTITUTE OP ARCIi1TECTS, 1735 NEW YORK t'-'- [13702=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. i C 'This document has been reproduced electronically wilt, the permission of The American Institute of Architects under License 97003 to f'nmsvem Systems, Inc Ropmduchon of this document wdhout projoct-seecife mformetion is not p of onmftod. Contact The American Institut. A.hdect5 12 to verify the current version of this document end license shat— NOV 2 4 2008 l_ CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF I PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00001 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11/30/2008 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082691A A B C D E F G H I WORKCOMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS T O (IF VARIABLE) NO, VALUE APPLICATION THIS PERJOD STORED AND STORED FINISH RATE (NOT IN TO DATE (G- C) (C G) (D E) D OR E) (D- I -E +F) 0000010 General Conditions Requirements $106,300.00 $0.00 $15,945.00 $0.00 $15,945.00 15.000 $90,355.00 $0.00 0000020 Existing Conditions Selective Demo $21,920.00 $0.00 $21,920.00 $0.00 $21,920.00 100.000 $0.00 $0.00 0000030 Concrete $79,830.00 $0.00 $0.00 $0.00 $0.00 0 $79,830.00 $0.00 0000040 Metals $8,770.00 $0.00 $4,034.20 $0.00 $4,034.20 46.000 $4,735.80 $0.00 0000050 Specialties (signage) $13,920.00 $0.00 $0.00 $0.00 $0.00 0 $13,920.00 $0.00 0000060 Electrical $99,590.00 $0.00 $1,991.80 $0.00 $1,991.80 2.000 $97,598.20 $0 -00 0000070 Earthwork $63,920.00 $0 -00 $9,588.00 $0.00 $9,588.00 15.000 $54,332.00 $0.00 0000080 Exterior Improvements $117,630.00 $0.00 $17,644.50 $0.00 $17,644.50 15.000 $99,985.50 $0.00 0000090 Utilities $84,920.00 $0.00 $8,492.00 $0.00 $8,492.00 10.000 $76,428.00 $0.00 $596,800.00 $0.00 $79,615.50 $0.00 $79,615.50 13.34% $517,184.50 $0.00 AIA DOCUME=NT 0703t APPLICATION AND CMITIPIC'ATL' FOR PAYMl-NT 1992 L'DITION AIA1) 591992 Till! AMERICAN INHTITUTli UP ARCIlI'I'ECt'S, 1739 NHW YORK G703 -1992 AVENUE;, N.W., WASIIINGTON, D.C. 20006 -529 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. This document has been reproduced electron -Iry with the permission of The American Institute of Architects under Lice- 97003 to Pnna -em Systems, Inc Reproduction of this document wilhout projoaspecific information is not permitted Contact The American Inshlute of Amh,tects to _hfv the current version of this document and license status' ANJO' Invoice N a"" Invoice Nu o" TEEL Nu mber: 08-0710 610 V�F_ST k� I N ST. Invoice Date: GRIEEMAOOD. IN 46142 Nov 19, 2008 (317) 888-6227 VOICE (317) 882-1760 FAX Page: sanjo@sanjosteel.corn sanjoacad @sanjesteel.com Sold To: Hagerman Consrucfion Corp I oration Ship to: Indiana Design Center 7930 Castieway Drive 200 South Rangeline Road Indianapolis, IN 46250 Carmel, IN 46032 Customer ID Customer PO Pavment Terms Hagerman Constructio 2691 Net 30 Days Sales Rep ID Shipping Method Ship Date Due Date Shen Kellev Sonic Steel Delivery 11/13/08 12/19/08 Quantity liem Description Unit Price Extensi 6" Bollards x 7'-0 E 245.00 490.00 With 2 Coats Aliphatic Polyurethane Coafng 8.00, O.D. x 7.5 I.D. x 1/4 Wall D.C. PA Tube 380.00 3,040.001 Prime Only F OAT F jtqvoll wolu' 0 SU wO U�4T S GFZOSS'MA0 G&A S UB PO 6424 5425 1 6426 642' ASK CODE_a 3aas�_._ AMOU 1 40 AC 'Y'� DATE P PRO V U// 0 lti�ERIWILL�lk DATE INCLUPED Subtotal .3,830.00 Sales Tax 247.10 Total Invoice Amount 4,077.10 Check/Credit Memo No: Pa /Credit Applied TOTAL 4,077.10 WAIVER OF LIEN The undersigned is the duly authorized officer of Hagerman Construction Corporation ,the general contractor (Name of Company) subcontractor,' materialman or other person furnishing the services, labor, material or equipment indicated below in. the construction of improvements upon real estate located in Hamilton County, State of Indiana commonly known as Parcel 67 Streetscape, Tndi wWh real estate is owned. by Cam- Cinnissirn "Owner Design Center P12 INCONSIDERATION of the sum of Seventy one thousand six hundred fifty three and 95/100 DOLLARS 71, 653.95 receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above'described which the Company may now have for services, labor, material or equipment furnished in respect of such land or improvements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the soleconsideration received by the Company for said services,labor, material or equipment furnished to date, and that the Company has neither received nor made any security interest, title retention interest or lien rights in the said services, labor, material or equipment other than that released and transferred hereby. The material, labor, services or equipment furnished are more particularly described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 20th day of November 8p_ (Name and Ttle) Troy Heisler, CFO Hagerman Construction Corporation (Name of Company) State of Indiana County of Allen SS: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared T roy u the cfo of Hagerman Construction Corporation who acknowledged (Title) (Name of Company) the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 20th day of November 2008 ID C. ryo a °e.oe eas My Commission Expires: v o�lt,MISS /p�,�.�� pberl Notary Public 12/16/15 Z m moo® v, =.A NorAyv e My County of Residence: y�< S L a David C. Thomas coo (Printed Name of Notary Public) Allen Prescribed by State Board of 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 YY1G /I UGt7 ri a( Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1 1-30-08 0 16 6 I r 7 Coll ShVCA a 7l, &53,9 5 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 IN SUM OF d 7 j lAf 7 i ��1 s. ►1y �a s� s 7 71 1 653. �5 ON ACCOUNT OF APPROPRIATION FOR go rl l! 1 v 90, �y1P y867- Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 5 ,gs 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 20 ign qtU re Y7C�/1 CO Title Cost distribution ledger classification if claim paid motor vehicle highway fund