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Home My WebLink About157666 03/19/2008 F CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CHECK AMOUNT: $141,672.19 e CARMEL INDIANA 46032 720 3RD AVE SW CARMEL IN 46032 CHECK NUMBER: 157666 CHECK DATE: 3/19/2008 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460805 141,672.19 RETAIL SITE #5 E jI APPLICATION AND CERTIFICATION FOR PAYMENT A.IA DOCUMENTG702 PAGE ONE OF 2 PAGES TO OWNER: Carmel Redevelopment Commission 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: 2/21/2008 7C CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT. Pedcor Design 0 Signature Construction LLC 720 3rd Avenue S.W. PROJECT NOS: CSO Project 21010 Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: 9/7/2007 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best oftbe 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 6703, is attached. completed in accordance with the Contract Documents, that all amounts have bee LINDA BUCHANAN the Contractor for Work for which previous Certificates for Payment were issued io a•._ payments received tiom the Owner, and that current payment shown herein is now Ise: Hancock County My Commission Expires L UKIGINAL CONTRACT SUM S 2,841,863.00 .'F August 20, 2011 2. Net change by Change Orders U.00 CONTKAC'I'OK: 3. CONTRACT SUM'I'O DA'I E (Lme I t 2) 4. '1'01'AL COMP LE'I ED ST'ORED'TU By; Date: 5. REIAINAGE' e rte a. 0.0998 of Completed Work S 179,465.86 Subscribed and swom to before me this 25th day of February, 2007 o umn D E on G703) b. of Stored Material S o umn F on G703) total Retamage tLines �a+ �o or Total in Column 1 of G703) 179,465.86 6. 'TOTAL EAKNED LESS REI AINAGE In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Dotal) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CER'I'IF'ICA'I'ES FOR Architect's knowledge, information and beliefthe Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) S 1,477,520.58 the quality of the Work 1s in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT• DUE 141 is entitled to payment of the AMOUNT CER "fiFIED. 9. BALANCE TO FINISH, INCLUDING RE'TAINAGE (Line 3 less Line 6) AMOUNT CEK I IFIED i may 2 ,1 9 (Atmch espl lion J amount certified differs from the amount applied. Initial all figures on this ota changes approve App(icat in previous months by Owner AKC 1'EC'I': n and o the C ulio Sheel that are changed to conform with the amount cerlified.) Total approved this Month By. Date: TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Lontractor nameu nerem. issuance, payment anu acceptance or payment are worroui NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. A €A DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVE., NW, WASHINGTON, DC 20006 -5292 Users may obtain validation of this document by requesting a completed AIA Document D401 Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET Page 2 cf 2 To: From:. Project: Application No. 7 0 Carmel Redevelopment Commission Signature Construction LLC Parcel 5B Application Date: 2/21/08 One Civic Square 720 3rd Avenue S.W. Phase I Carmel City Center Period To: 2/21/08 Carmel, Indiana 46032 Carmel, Indiana 46032 Motor Court Engineer's Project No. A B C D E F G H I Work Co pleted Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored To If Description of Work Value Application This Period (Not in To Date (G /C) Finish Variable D or E) (D+EhF) (C -G) 101 General Requirement 132,109.09 75,302.18 7,926.55 0.00 83,228. 63% 48,880.36 8,322.87 Bonding 113,675.00 113,675.00 0.00 0.00 113,675.00 100% 0.00 11,367.50 Insurance 25,000.00 25,000.00 0.00 0.00 25,000.0 100 0.00 2,500.00 102 Existing Conditions 0.00 0.00 0.00 0.00 0.00 0$ 0.00 0.00 103 Concrete 2,170,090.00 1 149,487.00 0.00 1,511,104.0 70% 658,986.00 151,110.40 104 Masonry 50,000.00 0.00 0.00 0.00 0.00 0 9 6 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 4,000.00 0.00 0.00 4,000.00 6% 64,430.00 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 0100 0.00 0% 26,360.00 0.00 110 Specialties 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 111 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 9 6 0.00 0.00 114 Conveying Equipment 0.00 0.00 0.00 0.00 0.00 0S6 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 0100 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 Oak 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 0.0.0 0% 0.00 0.00 Construction Fee 110,090.91 1 61,650.91 (0.00) 0.00 61,650.91 56$ 48,440.00 6,165.09 2,841,863.00 1,641,245.09 157,413.55 0.00 1,798,658.64 63% 1,043,204.36 179,465.86 PARTIAL Payment to Follow AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA SS: COUNTY OF HAMILTON Steve Warne being duly sworn states that he is the Vice 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 forty one thousand six hundred seventy —two dollars and nineteen 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 toff "P' LINDA BUCHANAN teven Warne °rpA" Hancock County My Commission Expires Au ust 20, 2011 Vice President Subscribed and sworn to before me this: 9 6 ADO P` Notary Public: Prescribed b{; 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 (0- s14 c Purchase Order No. �Ve CJ Terms (Q0 3Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2 /4' la P4,- I S'Q M� Co�.� 1 N! 72 Total L 14-. 2a '72 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in`a rdance with IC 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 L`c IN SUM OF t Tit/ �f Z ON ACCO LINT OF PROPRIATION FOR 1� yqlaokaS Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or c O' 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 11 06- Sign Cost distribution ledger classification if T claim paid motor vehicle highway fund