HomeMy WebLinkAbout170826 04/16/2009 CITY OF CARMEL, INDIANA VENDOR: 00351208 Page 1 of 1
ONE CIVIC SQUARE EDWARDS ELECTRICAL MECHANICAbHECK AMOUNT: $7,541.64
CARMEL, INDIANA 46032 2350 N SHADELAND AVE
INDIANAPOLIS IN 46219 -1736 CHECK NUMBER: 170826
CHECK DATE: 4/16/2009
DEPAR ACCO PO NUM BER IN N UMBER AMOUNT DESCRIPTION
902 4460848 2 V 1,144.44 4TH GATEWAY /RANGELINE
4 902 4460848 3 6,397.20 4TH GATEWAY /RANGELINE
T TM
\J 7 G702/C a ..1992
Application and Certificate for Payment Construction Manager-Adviser Edition
Xm
TO OWNER: PROJECT: APPLICATION, NO. Distribution to:
Carmel RedevelopmeritCommission Carmel Gatcwav Site 45 2.
One Civic Square" PERIOD TO: OWNER
Indianap6lis,1N. 46032 2/28/2009 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT El
Edwards Electrical Mechanical PROJECT NOS: 1 CONTRACTOR
2350 N. Shadeland Avenue VIA ARCHITECT:
FIELD
Indianapolis, IN 46219 -1736
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT Th e undersigned Contractor certifies 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 this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. 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
1. ORIGINAL CO NTRACT: X966.00 payment shown herein is now due.
2. Net change b Change Orders
9 Y 9 R snn nn CONT CTOR:
Edwards lect �'ca] antca!
3. CONTRACT SUM TO DATE (Line 1 2) '39,466.00 By: Date:
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 73 146 60 State of: Indiana
5. RETAINAGE: County of: Edwards Job No 0104 OS QG21
Marton
a
of Completed .Work Subscribed and sworn to before Invoice No: 995754
olumn,D f E on G703) 1 G me this day of J
b. %:of Stored Material Notary Public: 19 February, 2009
(G'0l40in F on 6703) 2� My Commission expires:
Total. Retainage (Lines 5a 5b or Total in Column I of G703) 21 r CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief thauq essed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT accordance with the CRp �t' ractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate), cate). CERTIFIED.
CURRENT PAYMENT DUE AMOUNT CERTIFIED r-
9. BALANCE TO FINISH, INCLUDING RETAINAGE.:.. (Attach explanation if amount certifi�Ldiffers from the amount zrpplied. Initial all figures on this
Application and on Continuation t 2at4rZM9ed to c'anform with the amount certified.)
(Linea Less Line 6) Ig ��4 ofi CONST UCTIO MAN
B SUF3 t. Date:
ADDITIONS DEDUCTIONS RI Ofd DNS Y'
CHANGE ORDER SUMMARY ARCHITECT: {-1` ❑i
Total changes approved in previous months by Owner By:- �ate:
Total approved this Month This Certificate is not negotiable:' e AMOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein. Issuanee, payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract..
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMam 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA' Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIO Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyrightCaa aia.org.
AR 9 TM
IN 0 c
Document 0702 /CMa 1992 hstrruc c on's
Application and Certificate for Payment Construction Manager- Adviser Edition
A. General Information
AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General
Conditions of the Contract for Construction, Construction Manager Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G7021CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G702/CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and
Certificate for Payment, Construction Manager- Adviser Edition.
The Contractor should sign G702/CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G702/CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702/CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A2011CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G701 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702/CMa, Application and Certificate for Payment,
Construction Managerlldviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should.remain consistent throughout the Project.,Multiple pages should be used when required.
Column C should be subtotaled at the bottom when`more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.,.
e
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at-the end of each pay period.
This value covers both materials newly stored for which payment Is sought and materials previously stored which are not yet incorporated into the 'Project. Mere payment
by the Owner for stored materials does notresult` in .'deduction from this column. Only as materials are incorporated into the Project is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G702 /CMa form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa. 4
y.
E. Making Payment
c�
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702 /CMa,
Application and Certificate for Payment, Construction Manager Adviser Edition. The completed form contains the name and address of the Contrketor. Payment should
not be made to any other party unless specifically indicated on G702/CMa.�'
MA Document G702 /CMaTm —1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA' Document, or any portiogrot it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ter 4{ 0) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @ara.org.
e TIM
Document G703 1992
Continuation Sheet
AIA Document G702, APPLICATION' AND CERTIFICATION FOR PAYMENT, APPLICATION N0: 2
containing Contractor's signed cer ification is attached. APPLICATION DATE: 2/25/2009
In tabulations below, amounts are stated to the nearest dollar.
Use column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: 2/28/2009
ARCHITECT'S PROJECT NO:
A B C D E F G H
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED ([F VARIABLE
NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE)
(D E) D OR E) (D +E +F) (C G)
00010 General Conditions 2,500.00 1,250.00 1,250.00 2,500.00
00020 Light Fixtures /Lamps 22,500.00 19,125.00 19,125.00 85.00 3,375.00 1,912.50
00030 Panel 2,000.00 1,500.00 1,500.00 75.00 500.00 150.00
00040 General Power Material 3,966.00 396.60 396.60 10.00 3,569.40 39.66
C000 Change Order #1 8,500.00 2,125.00 2,125.00 25.00 6,375.00 212.50
Totals 39,466.00 1,250.00 1,271.60 20 625.00 23,146.60 58.65 16,319.40 2,314.66
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this A1013ocument, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org. �v /l
a_
1, AIA Document G703"— 1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are
covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent
edition.
Reproductions, This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is
no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this
document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with
a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of
written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User
License Agreement (EULA), To report copyright violations of AIA Contract Documents, e. mail The American Institute of Architects' Iegai counsel,
copyright @aia.org,
COMPLETING THE G703 FORM
Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment.
Columns A, IS C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule
of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by
Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract
Sum. The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous application). Values from
column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on
the previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay
period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.
Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value
deducted from this column and incorporated into column E (Work Completed —This Period.)
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original
contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more
Change Orders. Amounts remaining in dispute should be dealt with according to Section 73 in A201.
The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to
reflect actual construction costs.
A R C D
WORK COMPLETED ,MATERIALS 1 OTAL
BALANCE PRLSI:N "CL CONIPLEIED RE'1'AINAGE
ITEM SC1II ?fJUL1iL1 PROM ['RGVIOUS 'M� TO
DL'SCRI P'IIC1N OI WORK S']l,7RLU A, \l7 S'rOR1;U OF 1'ARIABLS
NO. VA1,lJF. APPLrCA'I'ION THIS PI:RIOP (NOT IN TO DATE Ili =Cl FINISH Al El
(I) +F.1 DOR 1 ID +G +171 CL Gl R
1 MOBILIZATION 5,000 500 0 0 5,000 100 0
2 STUMPREMOVAL 5000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,00c 5,000 0 15,000 100 0
4 LOWER RETAINING WALL 10000 0 5,000 0 5,000 50 5,000
5 CURBS 6 MI5C. CONC. 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
a PAVERS 20,000 0 c 10,000 10,000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
]0
71 i 105,000 20,000 10,000 10,000 40,000 65,000
AIA Document G703TM –1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any
portion.,of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architecls' legal
counsel, copyright @aia.org.
r d rds Job 0 04 -09 -062 t
Invoice 995754
AFFIDAVIT AND WAIVER OF LIEN
Final Partial Payment to Follow
State of Indiana, County of Marion SS:
Michael R. Sehmoll (Name of Officer) being duly sworn states that he is the C.O.O. (Title) of Edwards Electrical
Mechanical, Inc. (Subcontractor /Supplier) having contracted with Keystone Construction Corporation (Contractor)
to furnish certain materials and /or labor as follows: Electrical System (Description) for a project known as Carmel
Gateway Site 4 located at Carmel, Indiana and owned by Carmel Redevelopment Commission and does herby
farther state on behalf of the aforementioned subcontractor; /supplier;
(PARTIAL WAIVER) that there is due from the contractor the sum of
One Thousand One Hundred Fofty -Four and 44/400 Dollars ($1,144.44)
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 is due from the contractor is the sum of
Dollars
receipt of which is hereby acknowledged, or
the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver
of Lien which shall become effective upon 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, subject to limitations or conditions expressed herein, if any; 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, and within the scope of this affidavit and waiver.
Edwards Electrical Mechanical, Inc. By Z Title C.Q.O.
(Firm) (Author ed Representative)
WITNESS MY HAND AND NOTARIAL SEAL, this 20"' day of Febru r 2009.
G r i
(Votary Public)
My Commission Expires November 11, 2010 Printed Nancy J. Schrader
Residing in Hendricks County
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
Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
,b
A A
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.
yS
20
Clerk- Treasurer JY
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
J�,
r
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
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
JJ,//�//�/ ignatur "'IC
1 7 r::
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
TM
Document G702ICMa 1992
Application and Certificate for payment Construction M Adviser Edition
TO OWNER: Carmel Redevelopment Commission PROJECT: Carmel Gateway Site 4 APPLICATION N0: 3 Distribution to:
One Civic Square PERIOD TO: OWNER El 3'/31 /2009
Indianapolis, IN 46032 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Edwards' Electrical Mechanical PROJECT NOS: 1 1 CONTRACTOR 0
2350 N. Shadeland Avenue
Indianapolis, IN 462.19 -1736 VIA ARCHITECT: FIELD 0
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT Th e undersigned Contractor certifies 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 this Application foi• Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
30,9G6.00 Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM payment shown herein is now due.
2. Net change by Change Orders 8,500.00 C CTOR: Edpp Electrica ha al
3. CONTRACT SUM TO DATE (Line 1 ±,2) 39,466.00 13y: Date. 3- a5• oil
4. TOTAL COMPLETED 8r STORED TO DATE (Column G on G703) 30,254. State of: Indiana
Edwards Job No: 0104 -08 -0621
5. RETAINAGE: County of: Marton Invoice No: 995886
a. 10 00 of Com P eted Work Subscribed and sworn to before
l
(Column D E `on G703) 962.96 me this IS day of March, 2004
b. of Stored Material Notary Public: I11u.4ue�
mn F on G703) 2,062.50 My Commission expires: 1I- 11 -16)
Total Retainage (Lines 5a 5b or Total in Column I of G703) 3,025.46 CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE 27,229.14 this.application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES.: FOR PAYMENT 20,831.94 accordance with the Contract Documents, and the Contr o ik.rDta,t4 t�
payment of the AMOUNT
CERTIFIED.
(Line 6 from prior Certificate) ECEI ED
8. CURRENT PAYMENT DUE G AMOUNT CERTIFIED tNIJ4
,397.Z0
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if arnount certified diffeJPAM4i o t aat 'ielZ{l�04} tall figures o n this
Application an e Continuation Sheet that are changedao conform with the amount certif ed.)
(Line 3 less Line 6) 12,236.86 CONSTRUCT
f it115 '2 '17a
B y: t
ADDITIONS DEDUCTIONS
CHANGE ORDER SUMMARY ARCHITECT,
Total changes approved rn previous months by Ownet B �`'ATEr�IAL 6' 14 Datt❑
nn Total approved, this Month _R
PP This Certif €cate is not ne o,tiable:'The Al C FI I a y�s� o_klie Contractor.
TOTALS named herein. Issuance; payment and acceptance of payment arwithout prejudice ud e to any rights of
-IET CHANGES by Change Order the Owner or Contractor. under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured,
tIA Document G7021CMaTm 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result In severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
n n TM J�J J+� �7 r r� a
Document !lent 0 199 �nst �7 .Wolf
Applicati and Certificate for payment Construction Manager- Adviser Edition
A. General Information
AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General
Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
.The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA:.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G702/CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and
Certificate for Payment, Construction Manager- Adviser Edition,
The Contractor should sign G7021CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G7021CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702/CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G7021CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment,
Construction Manager Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the ogginal Contract Sum.
The total of column C may be adjusted by Change Orders during the Project' '3
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column. "r
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project were listed on the
previous application under Materials Presently Stored (column F). r-
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value`deducted from this
column and incorporated into column E (Work Completed This Period),
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives shorwid be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa. 'k P r
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager arid,Architect on AIA Docbument G7021CMa,
Application and Certificate for Payment, Construction Manager Adviser Edition. The completed form contains the name and address of the Contactor. Payment should
not be made to any other party unless specifically indicated on G702/CMa. V
AIA Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
Document G103 1992
araCv
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION' NO: 3
containing Contractors signed certification is attached. APPLICATION DATE: 3/25/2009
In tabulations below; amounts are stated to the nearest dollar.
Use Column on Contracts where variable retainage for line items may apply. PERIOD TO: 3/31/2009
ARCHITECT'S PROJECT NO:
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED RETAINAGE
VALUE APPLICATION THIS PERIOD
ITEM DESCRIPTION OF WORK STORED G C) FINI SH ED AND STORED N (IF VARIABLE
NO. (NOT IN TO DATE RATE)
(D E) D OR E) (D +E +F) {C G)
00010 General Conditions 2,500.00 2,500.00 2,500.00 100.00 250.00
00020 Light FixtureslLamps 22,500.00 19,125.00 19,125.00 85.00 3,375.00 1,912.50
00030 Panel 2,000.00 500.00 1,500.00 2,000.00 100.00 200.00
00040 General Power Material 3,966.00 396.60 1,983.00 2,379.60 60.00 1,586.40 237.96
CO00 Change Order #1 8,500.00 2,125.00 2,125.00 4,250.00 50.00 4,250.00 425.00
Totals 39,466.00 2,521.60 7,108.00 '20,625.00 30,254.60 76.66 9,211.40 3,025.46
(CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright OO 1963, 1965, 1966, 1957, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the lays. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright viol tions of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright @aia.org. fi V 7
l►
Document G703TM
J
—1992 Instructions
Continuation Sheet
GENERAL INFORMATION
Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are
covered in AIA Document A201, General Conditions of the Contract for Construction.
Use of Current Documents. Prior to using any AIA Contract Document, users should consult wvvw.aia.org or a local AIA component to verify the most recent
edition.
Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is
no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this
document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with
a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of
written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User
License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel,
copyright @aia.org.
COMPLETING THE G703 FORM
Heading: This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule
of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by
Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract
Sum. The total of column C may be adjusted by Change Orders during the Project,
Column D: Enter in this column the amount of completed Work covered by the previous application (columns D E from the previous application). Values from
column F (Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on
the previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay
period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.
Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value
deducted from this column and incorporated into column E (Work Completed —This Period.)
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column l: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It "need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders'are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original
contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more
Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201.
The following is an example of a Continuation Sheet for work in progress. Please note that dollar amounts shown below are for illustrative purposes only, and are not intended to
reflect actual construction costs.
A N C D
WORK COMPLETED MATERIALS T()TAL
BALANCE
PRI:S I:N'II.Y' COM1IYI_nl'I:D RI rAINAOE
ITEM SCHE ➢ll1.ED PROM f'RI.V IOl15 TO
UE:JCRIPI'ION OF WORK SI DREIJ AND STORED 11P VARIABLE
\O. VALUE APPI.IG\'I'ION 'I'I114 PI ?RIOD I,NrO'I'IN" "I'U DATG -C) 1 RATE)
I MOBILIZATION 5,000 5,000 0 0 5,000 100 0
2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0
3 EARTH WORK 15,000 10,000 5,o00 0 15,000 100 0
4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000
5 CURBS 6 misc. CONC. 5,000 0 0 0 0 0 5,000
6 PAVING, UPPER DRIVE 20000 0 0 0 0 0 20,000
7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000
a PAVERS 20,000 0 0 10,000 10,000 50 10,000
9 BRICK WORK 5,000 0 0 0 0 0 5,000
10
11 105,000 20,000 10,000 10,000 40,000 65.000
AIA Document G703 TM 1992. Copyright 0 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING:
This AIA® Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIP Document, or any
portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to
reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright aia.org.
Edwards Job N: 0104 -08 -0621
Invoice 995886
AFFIDAVIT AND WAIVER OF LIEN
Final Partial Payment to Follow
State of Indiana, County of Marion SS:
Michael R. Schmoll (Name of Officer) being duly sworn states that he is the C.O.O. (Title) of Edwards Electrical
Mechanical, Inc. (Subcontractor /Supplier) having contracted with Keystone Construction Corporation (Contractor)
to furnish certain materials and/or labor as follows: Electrical System (Description) for a project known as Carmel
Gatewa Site ite 4 located at Carmel, Indiana and owned by Carmel Redevelopment Commission and does herby
finrtber state on behalf of the aforementioned subcontractor /supplier.
(PARTIAL WAIVER) that there is due from the contractor the sum of
Six Thousand. Three Hundred Ninety-Seven and 20/100 Dollars (56,397.20)
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 is due from the contractor is the sum of
Dollars
receipt of which is hereby acknowledged, or
the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver
of Lien which shall become effective upon 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, subject to limitations or conditions expressed herein, if any; 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, and within the scope of this affidavit and waiver.
Edwards Electrical Mechanical, Inc. By Title C.O.O. z l__o
(Firm) (Authorized Representative)
WITNESS MY HAND AND NOTARIAL SEAL, this 25 day of March 2009.
A// 7
e z_ld
diary Public)
My Commission Expires November 11, 2010 Printed Nancy J. Schrader
Residing in Hendricks County
F
t
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
9—� Purchase Order No.
2 35_o Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
1
Y�
7
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. r.`a
20 "u
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
x, 7,:2 6
ON ACCOUNT OF APPROPRIATION FOR
T I F ir�o
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
-3 IPIZOFY,�� 6,39 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
y— f A 20
ignatu
Cost distribution ledger classification if
Title
claim paid motor vehicle highway fund