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Home My WebLink About161083 06/25/2008 CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CHECK AMOUNT. $228,295.50 CARMEL, INDIANA 46032 720 3RD AVE SW o CARMEL IN 46032 CHECK NUMBER: 161083 CHECK DATE: 6/2512008 DEPARTMENT ACCOUNT PO N INV NUMBER AMOUNT DESCRIPTIO 902 4460805 166,929.21 RETAIL SITE ##5 902 4460874 61,366.29 IDC PARKING GARAGE APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES TO OWNER Carmel Redevelopment Commissic PROJECT: Parcel 513 APPLICATION NO Draw Number 5 Distribution to: One Civic Square Phase I Carmel City Center Signature costs OWNER Carmel, Indiana 46032 Motor Court ARCHITECT PERIOD TO: 06/01/2008 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: CSO Project 9 2 10 10 Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE 09/0 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractor's knowledge, Application is made for payment, as shown below, in connection with the Contract. information and belief the 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. L ORIGINAL CONTRACT SUM 2,841,863.00 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I :k 2) 2,841,863.00 4. TOTAL COMPLETED STORED TO 2,143,352.00 f B Date: j O 5, RETAINAGE: a. 0.099 of Completed Work 212,012.20 Ed and i� ;A day of rabitte 3, 2enr (Column D E on G703) f qT Hancock County t ..e. r b. of Stored Material s My Commission EXpir (Column F on G703) August 20, 2011 Total Retainage (Lines 5a 5b or Total in Column I of G703) 212,0 12.20 HITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 1,931,339.80 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7, LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 1,764,410.59 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 166,929.21 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 910,523.20 (Line 3 less Line 6) AMOUNT CERTIFIED CHANGE ORDER SUMMARY ADDITIONS 'DEDUCTIONS (Art explan Lion if ouni eriified differs from the amount applied. InNial all figures on this Total changes approved lip lwation a d on e Contin ati n t that are changed to conform tvith the amount certified.) in previous months by Owner CHITE Total approved this Month Date_ v Q® TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Uontractor named herein. Issuance, payment and acceptance of payment are without NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIAOOCUMENT G702- APPLICATIONAND CERTIFICATION FOR PAYMENT 1992EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEWYORK AVE., N.W., WASHINGTON, ce 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D40i Certification of Document's Authenticity from the Licensee. 4 G703 CONTINUATION SHEET Page 2 of 2 To: From: Project: Application No.: 10 Carmel Redevelopment Commission Signature Construction LLC Parcel 5s Application Date: 611108 One Civic Square 720 3rd Avenue S.W. Phase I Carmel City Center Period To: 611108 Carmel, Indiana 46032 Carmel, Indiana 46032 Motor Court Engineer's Project No. A B C D E F G H I Work Co leted Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To If 4 Description of Work Value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 132,109.09 87,192.00 13,210.91 0.00 100,402.91 76% 31,706.18 10,040.29 Bonding 113,675.00 113,675.00 0.00 0.00 113,675.00 100% 0.00 11,367.50 Insurance 25,000.00 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 2,170,090 00 1,640,737.60 156,637.40 0.00 1,797,375.00 83% 372,715.00 179,737.50 104 Masonry 50,000.00 0.00 0.00 0.00 0.00 0% 50,000.00 0.00 105 Metals 19,368.00 0.00 0.00 0.00 0.00 0% 19,368.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 68,430.00 16,100.00 7,130.00 0.00 23, 230.00 34% 45,200.00 0.00 108 Openings 6,100.00 0.00 0.00 0.00 0.00 0% 6,100.00 0.00 109 Finishes 26,360.00 0.00 0.00 0.00 0.00 0% 26,360.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 ill Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 31,000.00 0.00 0.00 0.00 0.00 0% 31,000.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 89,640.00 0.00 0.00 0.00 0.00 0% 89,640.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Construction Fee 110,090.91 1 75,962.73 7,706.36 1 0.00 83,669.09 1 76% 26,421.82 8,366.91 2,841,863.00 1 1,958,667.33 1 184,684.67 1 43,352.00 1 75% 698,511.00 1 212,012.20 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Tom Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as Parcel 5B Phase I Carmel City Center Motor Court located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of one hundred sixty -six thousand nine hundred twenty -nine dollars and twenty -one cents the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC I T m Koontz a4"" LINDA BUCHANAN "°'"Y': Hancock County My Commission Ex President 0 A ires ugust 2Q, 20f A Subscribed and sworn to before me this: ,7-q yja-a Notary Public: 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 715y4 k~ 61"1 4 1 Q• GLC Purchase Order No. 72o 4 Sc,) Terms r,•u /V L(6 03 7 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Aw. 9z9, z Total I hereby certify that the attached invoice(s), or bill(s), is '(are) true and correct and I have audited same in acc rdance with IC 5- 11- 10 -1.6. y 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF ON ACCOU ,4C vLf Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 0 ttg6e 05 164 a2f.z 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 dg ignat Q c Cost distribution ledger classification if Title claim paid motor vehicle highway fund APPLICATION AND CERTIFICATION FOR PAYMENT AL4 DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER Carmel Redevelopment Commission PROJECT: Parcel 74 APPLICATION NO l 1 Distribution to: One Civic Square Indiana Design Center =OWNER Carmel, Indiana 46032 Parking Garage P12 =ARCHITECT PERIOD TO: 06/01/2008 =CONTRACTOR FROM CONTRACTOR: VIA ENGINEER. CSO Schenkel Schultz Signature Construction LLC 600 E. 96th Street 720 3rd Avenue S.W. Indpls., In. 46240 PROJECT NOS: 23233HC Carmel, Indiana 46032 CONTRACT DATE 01/1212007 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 belief the 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 1,205,000.00 2. Net change by Change Orders 22,325.85 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 2) 1,227,32575 4. TOTAL COMPLETED STORED TO 1,227,325.85 By Date: e /z 5. RETAINAGE: Tho s E. K tz, President ,,n a. 0.05 of Completed Work 0.00 Subscrib d and s� rn to before me this day of &1'eq (Column D E on G703) If b. of Stored Material r'Py' LINDA BUCHAN (Column F on G703) Hancock Cou NOTARY Total Retamage (Lines 5a +5b or My Commission Aires Total in Column I of G703) 0.00 E OR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 1,227,325.85 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Engineer's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 1,165,959.56 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 61,366.29 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED C HANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explan ifamo Lifted differs from the amount applied Initial all figures on this Total changes approved Applicatio and whe ontinu ton to that are changed to conform lvith the amount certified.) in previous months by Owner ENGIN R: Total approved this Month By: Date: _10SPl09 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the lomractor namea herein. Issuance, payment ano acceptance of payment are without NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA @1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 1 of 1 To: From: Project: Application No.: 11 Carmel Redevelopment Commission Signature Construction LLC Parcel 74 Application Date: 611108 One Civic Square 720 3rd Avenue S.W. Indiana Design Center Period To: 611/08 Carmel, Indiana 46032 Carmel, Indiana 46032 Parking Garage P12 Engineer's Project No.: 23233HC A 8 C D E F G H 2 Work Com leted Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To if Description of Work value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D +E +F) (C -G) 101 General Requirement 277,700.00 277,700.00 0.00 0.00 277,700.00 100% 0.00 0.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 103 Concrete 455,287.50 455,287.50 0.00 0.00 455,287.50 100% 0.00 0.00 104 Masonry 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 105 Metals 140,000.00 140,000.00 0.00 0.00 140,000.00 100% 0.00 0.00 106 Wood, Plastics and Composites 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 107 Thermal and Moisture Protection 22,400.00 22,400.00 0.00 0.00 22,400.00 100% 0.00 0.00 108 Openings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 109 Finishes 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 111 Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 112 Furnishings 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 113 Special Construction 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 121 Fire Suppression 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 122 Plumbing 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 123 Heating, Ventilation AC 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 125 Integrated Automation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 126 Electrical 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 127 Communications 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 128 Electronic Safety Security 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 131 Earthwork 331,938.35 331,938.35 0.00 0.00 331, 938.35 100% 0.00 0.00 132 Exterior Improvements 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 133 Utilities 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 134 Transportation 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 140 Process Integration 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 141 Material Processing Handling Equip. 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 144 Pollution Control Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 0 1 /41 0.00 1,227,325.85 1 1,227,325.85 0.00 1 0.00 0.00 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Thomas E. Koontz being duly sworn states that he is the President of SIGNATURE CONSTRUCTION, LLC having contracted to furnish certain materials and /or labor as follows: Site Development for a project known as PARCEL 74, INDIANA DESIGN CENTER PARKING GARAGE P12 located at CARMEL, IN and owned by Carmel Redevelopment Commission and does further state: PARTIAL WAIVER: that the balance due from the owner is the sum of sixty -one thousand three hundred sixty -six dollars and twenty -nine cents (61,366.29) the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has a any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC C. a +P�• LINDABUCHANAN OTC Y'. Hancock County T mas E. Koontz My Commission Expires y'.'a.'•�' August 20, 2011 President Subscribed and sworn to before me this: U Notary Public: 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 Sr 60..J 0- Purchase Order No. Terms C a emu l ,v (AO 37 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) NC r. Lt \j 5 Total ,c3GG z q I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in ac cggr ance with IC 5- 11- 10 -1.6. C-2 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 7 i 5. �o.. s v c o. L IN SUM OF 7zC) IN c4 6- 0 3? 6- 1, 3 6,6 2 ON ACCOUNT OF APPROPRIATION FOR )b 456 -O 7y Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 1 4 ylO�� 61 364 .7 1 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 Z 20 v )Z Q Signat Title Cost distribution ledger classification if claim paid motor vehicle highway fund