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HomeMy WebLinkAbout199937 08/03/2011 CITY OF CARMEL, INDIANA VENDOR: 364048 Page 1 of 1 ONE CIVIC SQUARE GIBRALTAR CONSTRUCTION CORP CARMEL, INDIANA 46032 2932 N. WEBSTER AVENUE CHECK AMOUNT: $952.12 INDIANAPOLIS IN 46219 CHECK NUMBER: 199937 CHECK DATE: 8/3/2011 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 2200 R4462401 27459 5 952.12 7A STREETSCAPE- PALLAD .y�,r- �cument GT�21C #Ma Application and ;Certificate for Payrnenf onsfru Ccfron,Manager Ad lser Edrfron TO OWNER:` City of Carm6l 2 1 Carmel Parcel 7A Streetscape APPLICATION N0 5 Dlstributioil:fo: One.,,Clvlc Square PERIbI? T0. 7131111 OWNER Carmel, IW 46032 CONSTRUCTION MANAGER ID Gibraltar Construction Corp 10/28/10 EC:T FROM CONTRACTOR: VIA CONSTRUCTION-MANAGER'. C ONTRACT DATE: ARCHIT El 2932 N. Webster Ave. PROJECT NOS: 1 CONTRACTOR Indianapolis, IN 46219 VIA ARCHITECT` FIELD OSO Architects, Inc. CONTRACT FOR: ,Carmel Parcel'7A- Streetscape 0 CONTRACTOR'S APPLICATION `FOR PAYMENT Tate undersi Contractor. ifies that to the best of the Contractor's knowledge, information and Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by t i Application for Payment has been completed in accordance with the Continuation Sheet, AIA Document G703, is attached. Contract.Documents, th t all a ounts have been paid by the Contractor for Work for which previous 6_from-p 206,200.00 Certificates for Paym w r issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM payment shown herei no ¢ue. 2..Net change by Change Orders CONTRACTOR: Gibr r C nstruction Corp N 3. C0 TRACT SUM TO DATE (Line l +,'2) By: Date: 4, TOTAL COMPLETED STORED TO DATE Column G on G703 State of: 5. RETAINAGE County of: 2��v�✓FG BRIA R. a. 4'o of Cornpleted Work Subscribed a orn to b r� *v MCQR(D 10,310.00 mn D +Eon G703) me this day o 'CO�if COLrT� �J Res• e (Colu b of Stored Material Not Public: D I p N My cQRll �Y Coluifin F on G703) MY Co m uission e xprr es 3Mm SS 0!? 7 201 (I roes sa sb or Total in Column I:of G7o3) CERTIFICATE FOR P Tota%`Retainage 80; In accordance with the Contract nts Docume, base "d on on site observations and the `data.compnStng 6. EARNED LESS RETAINAGE 1 :F hr s application tike Constructton;ItiIanager and Architect ceittfy to,;the Owner that tothe of their (Line 4 Less Line 5 Total) knowledge mforination and belief the Work has progressedas indicated, tfie quality of the Work is in PY 179,755:88 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT accordance wit}i the Contract Doc ments, and the Contractoris er3titled to a ment:of the AMOUNT: (Line nor Certificate) CERTIFIED 8: CURRENT PAYMENT DUE..:. AMOUNT;CERTIF[ED �rj2 l 9:$ALANCETOEINISM, INCLUDING RETAIN .AGE (Attach explanation r mount certified differs from the amount applied Initial all figisres on'lhts fi3;923:00 Appkca at are'chang'ed'''to'conform with °certified:). trap and t Coiit lion Sheet that (Linea less Line 6) CONSTRUCT N M NA B ate �r r CHANGE ORDER SUMMARY ADDTIIONS" DEDUCTIONS ARCHITECT: CSO Architects file'. Total Chan es a roved to revious months by Owner By Date: Total a rtwed thisflVlonth'; This Cactificate is nu ne t gotiable The AMOUNT CERTIFIED is payable only to, the Coittractoi r nam TOTALS ed herein Issuance payment and acceptance of payment are without prejudice' to any rights of NET CHANGES by Change order the Owner or, Contractor under t}us.Contract TION: You should sI n, on mal AIA Contract Document; on wh�ch ears;1n; RED__An on In al assures.that Chan es wIH not;be obscur d AIA Do cu en 1992:- Copyright ©.19M2 Amencan,Institute'ofArchitects All it hts +reser..ved':,WAAf I1NG: This AIA :.:Document is rotected'b U:S. Co 3i" h4 Law:and International Treaties:_- Unauthorized' reproduetion'or;dlstrlbutfon ofithisrAW ocument; ors'an ortiom:ot R may result- lrrsevere cIVlI and criminal penaRies; and wllt:;be; prosecuted to:the°mazirrium extent ossitile unde•.the law: y p y P 9 Purchasers are permitted to reproduce ten: (i0):copies;ofI is' ocumentwhen;oompleted, To report copyrinhtviolations'c AIA ContractDocuments email The Airmericari Institute of Arch�tects4'!e al counsel, copyright @aaa:org. CONTINUATION SHEET Pa 2of2 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION NO.: 5 attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where APPLICATION DATE: 7/3112011 variable retainage for line items may apply. PERIOD TO: 7/31/2011 ARCHITECT'S PROJECT NO.: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE TO RETAINAGE ITEM FROM PREVIOUS PRESENTLY COMPLETED AND N0. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED (NOT IN STORED TO DATE (G 1 C) FINISH (IF VARIABLE (D E) D OR E) (D E F) (C G} RATE) 1 Supervision $2,500.00 $2,375.00 $125.00 $2,500.00 100% 2 Allowance $20,000.00 $0.00 $0.00 0% 20,000.00 3 Bonds $2,576.00 $2,576.00 $2,576.00 100% 4 Misc. General Conditions $5,024 .00 $4,771.88 $252.12 $5,024.00 100% 5 Earthwork $30,000.00 $30,000.00 $30,000.00 100% 10,310.00 6 Asphalt Paving $9,700.00 $9,700.00 $9,700.00 100% 7 Concrete Curbs $15,600.00 $15,600.00 $15,600.00 100% 8 Concrete Walks $13,000.00 $13,000.00 $13,000.00 100% 9 Joint Sealants $300.00 $0.00 $300.00 $300.00 100 10 Lirnestone Retaining Wall $90,000.00 $90,000.00 $90,000.00 100% 11 Landsca in $12,000.00 $12,000.00 $12,000.00 100% 12 Irrigation $5,500.00 $5,225.00 $275.00 $5,500.00 100% 13 Change Order #1 $4,818.00 $4,818.00 $4,818.00 100% $211,018.00 $190,065.88 $952.12 $0.00 $191,018.00 91% $20,000.00 $10,310.00 ISA Form 1-402 1= 9 0 h o, AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL [E PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and or labor for a project known as Carmel Parcel 7A- Streetscape and owned by City of Carmel and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the Owner the sum of Nin H u n d r ed Fifty Two and 1 21100--- Dollars ($952.12) receipt of which is hereby acknowledged; or the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the Owner is the sum of Dollars receipt of which is hereby acknowledged; or the payment of which has been promised s the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon ceipt of such payment. THERFORE, the undersigned waives and releases unto he Owner of said premises, any and all lien or claim whatsoever on the above- described property and improvements the on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditi s xpressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any w rformed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By Title President WITNESS MY HAND AND NOTORIAL SE lil 9th day of July, 2011. (Notary Public) Got BRIAN R. MCBRIDE 0 199 WMAkA SUBCONTAAC70A5 ASSOCI TION INC01WO AIED RBS, Of Hcfi00Ck County U"wjh* >q" {telp"t when ftol ktmad My Comm. Exi), 11 -29 -2017 Commission 611862 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 Gibraltar Construction Corp Purchase Order No. 2932 N. Webster Ave. Terms Indianapolis, IN 46219 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 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 Qibraltar Construction Corp IN SUM OF 2932 N. Webster Ave. Indianapolis, IN 46219 $952.12 ON ACCOUNT OF APPROPRIATION FOR Department of Engineering Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or bills) is (are) true and correct and that the materials or services itemized thereon for 27459 5 2200- R4462401 $952.12 which charge is made were ordered and received except 20 Signature C A %I Erna +osik Title Cost distribution ledger classification if claim paid motor vehicle highway fund