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Home My WebLink About175667 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 356511 Page 1 of 1 ONE CIVIC SQUARE DAWSON INC s' CARMEL, INDIANA 46032 6221 S HARDING ST CHECK AMOUNT: $22,883.60 INDIANAPOLIS IN 46217 CHECK NUMBER: 175667 CHECK DATE: 8/6/2009 DEPA RTMENT ACCOUNT P O NUMBER INVOICE NUM AMOUN DESCRIPTION 902. 4460805 10 22,883.60 RETAIL SITE #5 APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES TO OWNER: Carmel Redevelopment Commission PROJECT: APPLICATION NO: 0010 Distribution to: One Civic Square Carmel. Parcel 5 PERIOD TO: 6/30/2009 OWNER Carmel, IN 46032 PROJECT NOS.: ARCHITECT FROM CONTRACTOR: Dawson Incorporated Contractor's Project No. 250007 CONTRACTOR 6221 S. Harding Street ARCHITECT: Shuck Corporation Indianapolis, IN 46217 3050 South Harding CONTRACT DATE: 6/23/2005 Indianapolis, IN 46217 CONTRACT FOR: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractors knowledge, information and belief the Work covered by this application for Payment has been completed 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 S392.700.00 from the Owner, and that current payment shown herein is now due. CONTRACTOR: Dawson Incorporated 2. Net change by Change Orders $34,268.00 B Date: 6/10/2009 3. CONTRACT SUM TO DATE (Line I ±2) $426,968.00 4. TOTAL COMPLETED STORED TO DATE $426,968.00 State of INDIANA (Column G on G703) County of: MARION 5. RETAINAGE: Subscribed and sworn to before a. 0 of Completed Work $0.00 me this 6/10/20 9 (Columns D E on G703) b. 0 of stored Materiat $0.00 Notary Publi (Columns F on 6703) My C expires: 7/14/2009 Total Total in Coll Columns (Line a G70 or $0.0 ARCHITECT'S CERTIFICATE FOR PAYMENT Total in Columns I on G703) 6. TOTAL EARNED LESS RETAINAGE $426,968.00 In accordance with the Contract Documents, based on 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 f orn prior Certificate) 404,084.40 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 $22,883.601 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED (Line 3 less Line 6) W00 (Attach explanation if amount certified differs from the amount applied far. Initial all figures on this Ap ation and on the Continuation Sheet that are changed to C HANGE ORDER SUMMARY ADDITIONS DEDUCTIONS conform to the a ounI ertified Total changes approved in ARCHITECT: p revious months by Owner $34,268.00 $0.00 By: Date: C- 00 91 Total app roved this Month $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the TOTALS $34 $0.00 Contractor named herein. Issuance, payment and acceptance of payment are without NET CHANGES b Change Order $34, prejudice to any rights of the Owner or Contractor under this Contract. J/ AIA DOCUMENT G7132 APPLICATION AND CERTIFICATE FOR PAYMENT. 1992 EDITION AIAV. (c1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G702.1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. _"is docurnt has been reproduced electronically vnth the permission of The American Institute of Architects ender L:,. 97003 to Primavera Systems, 1— Reproduction of this document vdthout preiect- specific information is nat permitted. Contact The American t"titute of Architects to verify the current version of this document and license stLms." CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF I PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 0010 containing Contractor's signed Certification, is attached, APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2009 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 ITEM SCHEDULED PRESENTLY COMPLETED RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS TO STORED AND STORED TO FINISH NO. VALUE APPLICATION THIS PERIOD IF VARIABLE) (D E) (NOT D OR E) DATE (D +E +F) (O -C) (C G) 000000001 SANITARY SEWER 000000002 Labor $66,256.00 $65,593.44 $662.56 $0.00 $66,256.00 100.000 $0.00 000000003 Material $95,344.00 $94,390.56 $953.44 $0.00 $95,344.00 100.000 $0.00 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 D00000008 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 OOOO00016 Material $88,200.00 $88,200.00 $0.00 $0.00 $88,200.00 100.000 $0.00 000000019 I Change Order No. 1 $34,268.00 $34,268.00 1 $0.00 1 $0.00 I $34,268.00 100.000 $0.00 TOTAL.. $426,968.09 $425,352.00 $1,616.0 $O.Od $426,968.0 100.00 %1 $0.01 AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIAQJ• 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 'G703 -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. /ate. "This document has been Inc. Re repmduc d electronically with the permission cf The American Institute of Architects under License 97003 to Primavera systems, f document h to verifv the rumen, version of this document angrlicense status." y pfO duction o this oc without p.ej�i(ic information is not permided. Contact The American institute of Architects 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: 0010 PERIOD TO: 6/30/2009 for payment in the amount of: $22,883.60 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 party 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: Carmel Parcel 5 PROJECT NO: ARCHITECT: Shuck Corporation CONTRACT: Dawson Incorporated CONTRACTOR Date: 6/10/2009 B State of INDIANA County of: MARION Subscribed and sworn to before me on: 6/10/2009 Notary Public: f 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 1/y�vsoy Z��oroarf°� Purchase Order No. 62Z/ S'. Terms /G�9 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 2 SY3 60' Total 2 F 3 -�D 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 2 ON ACCOUNT OF APPROPRIATION FOR i'a��y�Ga�yG.s Board Members PO# or INVOICE NO, ACCT #fTITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 4W6 F-D 22- MZ0 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 Gg U Signature Director of Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund