HomeMy WebLinkAbout180759 12/30/2009 CITY OF CARMEL, INDIANA VENDOR: 034249 Page 1 of 1
ONE CIVIC SQUARE CALUMET CIVIC CONTRACTORS
CARMEL, INDIANA 46032 4898 FIELDSTONE DRIVE CHECK AMOUNT: $85,986.00
WHITESTOWN IN 46075
CHECK NUMBER: 180759
CHECK DATE: 12/30/2009
DEPARTMENT ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460893 1 16,650.00 IND DESIGN STREETSCAP
902 4460893 2 69,336.00 IND DESIGN STREETSCAP
2
OUST: CITY OF CARMEL JOB:CARMEL PARCEL 93 STREETSCAPE APPLICATION NO: 1 Page: 1
BOARD OF PUBLIC WORKS SAFST•f South Rangeline Road PERIOD ENDING 10/33/09
Carmel
FROM: Calumet Civt: Contractors, Inc ARCHITECT:CITY OF CARMEL CONTRACT NO:
4894 F'ialdstone Drive BOARD OF PUBLIC WORKS SAFETY CONTRACT DATEt 09/15/09
Whitestbwn, IN 46075
JOB DESCRIPTION: Carmel Parcel 93 Streetacape
i CHANGE ORDERS
ADDITIONS j DEDUCTIONS ORIGINAL CONTRACT AMOUNT 104,540.00
TOTAL CHANGE ORDER AMOUNT .00
j PREVIOUS TOTAL .•OO .00 TOTAL CONTRACT INCLUDING CHANGE ORDERS 104,540.00
i
CURRENT j j AMOUNT COMPLETED TO DATE 18,500.00
i--- -i RETAINAGE 10.001r OF WORK COMPLETED................ S 1,850.00
Number Data i 10.00% OF STORED MATERIAL
i -j l j COMPLETED TO DATE LESS RETAINAGE 16,650.00
j f PREVIOUS AMOUNT BILLED S .00
SALES TAX .00
1 CURRENT AMOUNT DUE 16,650.00
AMOUNT REMAINING 87,890.00
j
TOTALS TO DATE .00 .00 j
1 I
j N5,•r AMOUNT .00
The undersigned Contractor certifies that to the best of jj ARCHITECT'S CERTIFICATE FOR PAYMENT
the ContractOr'e knowledge, information and 'belief the Work (j
covered by this Application for Payment has been completed In accordance with the Contract Documents, based on nn site
in accordance with the Contract Documents, that all amounts observations and the data comprising this application, the Ar
have been paid by the Contractor for work for which previoua(( certifies to the Owner that to the beat of the Archi- tect's kn
Certificate$ tor Payment were Issued and payments received information and belief the work has progesssed as indicated,
from the owner, and that current payment shown herein is (j quality of the work is in accordance with the Contract Docume
now due. and the Contr r is entitled to payment of the AMOUNT CERTI
��jj
CONTRACTOR; C UM CIVII. 'ONTRACTORS, INC. jj AMOUNT TIFI {p�l�•
I(
By 11 ARCHI CT:
Date:
By: Date
State of Indiana
cc ty of Boone Certificate is not negotiable. The AMOUNT CERTIFIED is p
St scribed and savor to before me th12 J day Of VJ.IM 1W (�/1� to the Contractor named herein. Issuance, payment and
acceptance of payment are without prejudice to any rights of
Owner or Contractor under this Contract.
tars ublic: L. 1,."
My comsq&diorl expires. Iiu l-vounty_ j 0702 -1
Job Nuabe.r: 9067 CARMEL PARCEL 93 STREETSCAPE Application No.: 1 Period From: 09/15/09 Page Number 2
Project 7 invoice Number 12686 Thru: 10/23/09
-WORK COMPLETED COMPLETED
ITEM SCHEDULED PREVIOUS THIS STORED AND STORED BALANCE
NUMBER DESCRIPTION OF WORK VALUE APPLICATION PERIOD MATERIALS TO DATE k TO FINISH RETAINAGE
1 Mobilization Material 1,000.00 .00 1 .00 1,000.00 100 .00 100.00
2 Mobilization Labor 21000.00 .00 2,000.00 .00 2,000.00 100 .00 200.00
3 Concrete Material 51000.00 .00 .00 .00 .00 0 5,000.00 .00
4 Concrete Labor 12,000.00 .00 .00 .00 .00 0 12,000.00 .00
5 Ele ^_trical Rough in Material 2,500.00 .00 2,500.00 .00 2,500.00 100 .00 250.00
6 Electrical Rough in Labor 5 .00 5,000.00 .00 51000.00 100 .00 500.00
7 Fixtures Material 20,000.00 .00 .00 .00 .00 0 20,000.00 .00
8 Fzxt.utes Labor 12,500.00 .00 .00 .00 .00 0 12,500.00 .00
9 Earthwork Material 5,000.00 .00 2,500.00 .00 2,500.00 50 2,500.00 250.00
10 Earthwork Labor 6.000.00 .00 3,000.00 .00 3,000.00 50 3,000.00 300.00
11 Earthwork Subcontractor 5,000.00 .00 2,500.00 .00 2,500.00 50 2,500.00 250.00
12 Asphalt Material 7,000.00 .00 .00 .00 .00 0 7,000.00 .00
13 Asphalt Labor 11,540.00 .00 .00 .00 .00 0 11,540.00 .00
14 Landscape Material 2,500.00 .00 .00 .00 .00 0 2,500.00 .00
15 Landscape Labor 2,500.00 .00 .00 .00 .00 0 2,500.00 .00
16 Allowance 51000.00 .00 -00 .00 .00 0 5,000.00 .00
Total 104,540.00 .00 18,500.00 .00 18,500.00 18 86,040.00 1,850.00
J o b 7' 0 t a a 104,540.00 .00 18,500.00 .00 18,500.00 18 66,040.00 1,850.00
AFFIDAVIT AND WAIVER OF LIEN
FINAL X )PARTIAL )PAYMENT TO FOLLOW
STATE OF INDIANA
)SS:
COUNTY OF BOONE
James A. Sylvester being duly sworn states that he is the Secretary- Treasurer of Calumet Civil Contractors
Inc.having contracted with The City of Carmel to fin certain materials, and/or labor as follows: asphalt
paving and related items for a project known as Carmel Parcel 93 Streetscape
in Hamilton County, Indiana and owned by The City of Carmel, Indiana,
and does hereby further state on behalf of the aforementioned Subcontractor /Supplier.
(PARTIAL WAIVER) that the balance due from the contractor is the stun of Sixteen Thousand
Six Hundred Fifty and /OODollars, ($16,650.00)
receipt of which is hereby acknowledged or
(x the payment of which is 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;
(FINAL WAIVER) that the final balance due from the owner is the sum of
DOLLARS (S
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration for this Affidavit and Final
Waiver of Lien which shall become 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 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 aU;;iTzz
Calumet Civil Contractors, Inc. By y Treasurer
WITNE SS My HAND AND NOTARIAL SEAT. thl day of f VA/AftL 2009
My Commission Expires
Residing in t I l i County
-I
APPLICATION AND CERTIFICATE FOR PAYMENT
AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF TWO PA GES
TO: CITY OF CARMEL BOARD OF PUBLIC WORKS PROJECT: APPLICATION NO.: 2 Distribution to:
CARMEL PARCEL 93 STREETSCAPE PERIOD TO: 11120/09 OWNER
SOUTH RANGELINE ROAD PROJECT NOS.: CONSTRUCTION
MANAGER
FROM: CALUMET CIVIL CONTRACTORS, INC. CONTRACT DATE: 9/1512009 ARCHITECT
4898 FIELDSTONE DR CONTRACTOR
WHITESTOWN, IN 46075
VIA CONSTRUCTION MANAGER:
VIA ARCHITECT:
CONTRACTOR'S APPLICATION FOR PAYMENT
Application is made for payment, as shown below, in connection with the Contract. The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
Continuation Sheet, AIA Document G703, is attached. mation and belief the Work covered by this Application for Payment has been completed
in accordance with the Contract Documents, that all amounts have been paid by the
1. ORIGINAL CONTRACT SUM 104,540.00 Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is now due.
2. Net Change By Change Orders 0.00
CONTRACTOR: CAL IVIL CONTRACTORS, INC.
3. CONTRACT SUM TO DATE (Line 1+/- 2) 104,540.00 �.2 -1/ v5
By: Date:
4. TOTAL COMPLETED STORED TO DATE 95,540.00 JAMS A SYLVESTER, SECRETARY TREASURER
(Column G on G702)
State of: INDIANA
S. RETAINGE: County of: BOONE
a. 10% of Completed Work $9.554.00 Subscribe and swon11Q before
(Columns D E on G703) me thisZ%rr96 2 aA
b. 10% of Stored Material $0.00
(Column F on G703) Notary Public:
Total Retalnage (Line 5a 5b or
Total in Column 1 of G703) 9,554.00 My Commission Expires: D C)
CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 85,986.00 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 54 Total) comprising this application, the Construction Manager and Architect certify to the Owner
that to the best of their knowledge, information, and belief the Work has progressed as
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Indicated, the quality of the Work is in accordance with the Contract Documents, and
(Line 6 from prior Certificate) 16650.00 the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE ..............................3 69,336.00 AMOUNT CERTIFIED (o
(Attach explanation if amount certified differs from the amount applied for. Initial
9. BALANCE TO FINISH, INCLUDING RETAINAGE all figures on this Applicatigi Ad on the Continuation Sheet that changed to conform
(Line 3 Less Line 6) $18,554.00 to the amount certiCrr•
CONSTRUCTION MANA ER
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: O
Total changes approved in 0.00 By: Date:
p revious months by Owner
Total approved this Month 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con
TOTALS 0.00 0.00 tractor 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.
AIA DOCUMENT G7021CMa APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION
1992 EDITION AIA -1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE., N.W., WASHINGTON,
D.C. 20006 -5292 WARNING: Unlicensed photocopying violated U.S. copyright laws and will subject the violator to legal prosecution. G7021CMa -1992
CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE TWO OF TWO PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 2
containing Contractors signed Certification, is attached. APPLICATION DATE: 11/20/09
In tabulations below, amounts are stated to the nearest dollar, PERIOD TO: 11/20/09
Use Column 1 on Contracts where variable retainage for line items may apply.
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
PRESENTLY COMPLETED BALANCE RETAINAGE
ITEM SCHEDULED FROM PREVIOUS STORED AND STORED TO IF VARIABLE)
NO. DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD (NOT IN) TO DATE (G C) FINISH RATE)
r) F:1 DORE D +E +F C G
t MOBILIZATION MATERIAL 1,000,00 1,000.00 1,000.00 100 50.00
2 MOBILIZATION -LABOR 2,000.00 2,000.00 2,000,00 100% 100.00
3 CONCRETE- MATERIAL 5,000.00 5,000.00 5,000.00 100% 250.00
4 CONCRETE -LABOR 12,000.00 12,000.00 12,000.00 100% 600.00
5 ELECTRICAL ROUGH IN- MATERIAL 2,500,00 2,500.00 2,500.00 100 125.00
6 ELECTRICAL ROUGH IN -LABOR 5,000.00 5,000.00 5,000.00 100% 250.00
7 FIXTURES MATERIAL 20,000.00 20,000.00 20,000.00 100% 1,000.00
s FIXTURES -LABOR 12,500.00 12,500.00 12,500.00 100% 625.00
9 EARTHWORK- MATERIALS 5,000.00 2,500.00 2,500.00 5,000,00 100 250.00
10 EARTHWORK -LABOR 6,000.00 3,000.00 3,000.00 6,000.00 100% 300.00
11 EARTHWORK-SUBCONTRACTOR 5,000.00 2,500.00 2,500.00 5,000.00 100% 250.00
12 ASPHALT MATERIAL 7,000.00 7,000.00 7,000.00 100 350.00
13 ASPHALT -LABOR 11,540.00 11,540.00 11,540.00 100% 577.00
14 LANDSCAPE- MATERIAL 2,500.00 0% 2,500.00
15 LANDSCAPE LABOR 2,500.00 0 0 /0 2,500.00
16 ALLOWANCE 5,000.00 1,000.00 1,000.00 20% 4,000.00 50.00
TOTALS 104,540.00 t 18,500.00 1 77 040.00 1 95,540.00 1 91.00 9,000.00 4,777.00
AIA DOCUMENT G703 CONTINUATION SHEET FOR G702 -1992 EDITION AIA -1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 6703 -1992
AFFIDAVIT AND WAIVER OF LIEN
FINAL X )PARTIAL )PAYMENT TO FOLLOW
STATE OF INDIANA
)SS:
COUNTY OF BOONE
James A. Sylvester being duly sworn states that he is the Secretary- Treasurer of Calumet Civil Contractors
Inc.having contracted with The City of Carmel to furnish certain materials, and/or labor as follows: asphalt
paving and related items for a project known as Carmel Parcel 93 Streetscape
in Hamilton County, Indiana and owned by The City of Carmel, Indiana,
and does hereby fiuther state on behalf of the aforementioned Subcontractor /Supplier.
(PARTIAL WAIVER) that the balance due from the contractor is the sum of Sixty -nine Thousand
ThreeHundred Thirty-six and /OODollars, ($69,336.00)
receipt of which is hereby acknowledged or
(x the payment of which is 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;
(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 as the sole consideration for this Affidavit and Final
Waiver of Lien which shall become 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 any
claim or right to a lien on account of any work performed or material finnished to the undersigned for
said project, and within the scope of this affidavi and waiver.
Calumet Civil Contractors, Inc. B
J s A. Syl s er, Secretary Treasurer
WITNESS MY HAND AND NOTARIAL SEAL thi day of 1 v0VA,. kU/, 2009
My Commission Expires �—gI 3
Residing in r N "bounty
Prescrib @d 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
Cq /�s,�rP7� �i �Go•� fro �foY3 Purchase Order No.
//Y /ds��.�� lJ��' "vim Terms
0 75- Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
110123/0 93 5 _e f s C Y F 33�.Ud
/23 l 9 3 St.�
q. 5
Total 00
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same inkacQordance
with IC 5- 11- 10 -1.6. �A
20 e
Clerk- Treasurer If
VOUCHER NO. WARRANT NO.
ALLOWED 20
�oy7�ra ��t- IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or
DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
F9 3 0 bill(s) is (are) true and correct and that the
93 16,65).00 materials or services itemized thereon for
which charge is made were ordered and
received except
2;L2 2
Lvuj ly 4X6-
Signat
Direntnr of Operations
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund