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Home My WebLink About180108 12/08/2009 CITY OF CARMEL, INDIANA VENDOR: 360193 Page 1 of 1 ONE CIVIC SQUARE HARCO ASPHALT PAVING CHECK AMOUNT: $72,214.89 CARMEL, INDIANA 46032 1650 HARCO WAY a INDIANAPOLIS IN 46217 CHECK NUMBER: 180108 CHECK DATE: 12/8/2009 DEPARTMENT A CCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460894 1 72,214.89 RANGE LINE ROAD -SOUTH APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 (Instructions on reverse side) PAGE ONE OF 2 PAGES TO OWNER: CITY OF CARMEL REDEV. COMM. PROJECT: Parcel 94 Streetscape APPLICATION NO.: 1 Distribution to: 33 WEST MAIN STREET, SUITE 220 PERIOD TO: 1012012009 G 1 OWNER CARMEL, IN 46032 I j I PROJECT NOS.: ARCHITECT ATTN: LES OLDS, AIA, DIR. OF REDEVELOPMENT LJ, 01 CONTRACTOR FROM CONTRACTOR: HARCO ASPHALT PAVING INC. ARCHIZECT�SI�NURE CONSTRUCTION LLC CONTRACT DATE: 11 1650 HARCO Way 720 3RD VE. SW 11 Indianapolis, IN 46217 CARMELI, IN 46032 CONTRACT FOR: ASPHALT PAVING _A T _TN JASON SPRINGER CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the contractor's knowledge, infor- Application is made for payment, as shown below, in connection with the Contract. mation and belief the Work covered by this Application for Payment has been completed Continuation Sheet, AIA Document G703, is attached. 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 pay- ments received from the Owner, and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $97,600.00 CONTRA Harco Asphalt,Pav' g Inc. 2. Net change by Change Orders 3. CONTRACT SUM 70 DATE (Line 1 2) $97,600.00 B C r Date: Paul G. Harding, President &CEO 4. TOTAL COMPLETED STORED TO DATE $77,095.00 (Column G on G703) State of: INDIANA County of: MARION 5. RETAINAGE: Subscribed and sworn to before a. 6.33% of Completed Work 4,880.11 me this day of e2 z (Columns D E on G703) j� b. of Stored Material (Column Fon 6703) Notary Public: j�� Total Retainage (Line 5a 5b or My Commision expires: Total in Column I of G703) $4 ,880.11 ARCHITECTS CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $72,214.89 (Line 4 less Line 5 Total) In accordance with the Contract Documents, based on on -site observations and the data comprising this application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Archtiect's knowledge, information and belief the Work has progressed as indicated, the (Line 6 from prior Certificate) 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 $72,214.89 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED 0 MAK -A (Line 3 less Line 6) $25,385.11 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this Ap ation and on the Continuation Sheet that are changed to CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS confrom to the am n certified) Total changes approved in p revious applications by Owner ARCHITECT: Total approved this Application By Date: TOTALS This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Cony NET CHANGES bX Change Order tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the O wner or Contractor under this Contract. AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006 G702 -1992 r CONTINUATION SHEET AIA DOCUMENT G703 (Instruction on reverse side) PAGE 2 OF 2 PAGES Aix' DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1 Contractor's signed Certification is attached. HARCO ASPHALT PAVING APPLICATION DATE: 10/20/2009 In tabulations below, amounts are stated to the nearest dollar. Parcel 94 PERIOD TO: 10/20/2009 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE NO VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH APPLICATION STORED AND STORED (C G) (D E) (NOT IN TO DATE DORE) (D +E +F) 1 MOBILIZING AND DEMOBILIZING $1,000.00 $0.00 $1,000.00 $0.00 $1,000.00 100% $0.00 $63.30 2 EXCAVATION $4,620.00 $0.00 $4,620.00 $0.00 $4,620.00 100% $0.00 $292.45 3 CONCRETE $37,320.00 $0.00 $37,320.00 $0.00 $37,320.00 100% $0.00 $2,362.36 4 HAC $8,400.00 $0.00 $8,400.00 $0.00 $8,400.00 100% $0.00 $531.72 5 BRICK WALK PAVERS $6,960.00 $0.00 $6,960.00 $0.00 $6,960.00 100% $0.00 $440.57 6 ELECTRIC $13,000.00 $0.00 $13,000.00 $0.00 $13,000.00 100% $0.00 $822.90 7 SOD $300.00 $0.00 $300.00 $0.00 $300.00 100% $0.00 $18.99 8 TRAFFIC CONTROL $2,000.00 $0.00 $2,000.00 $0.00 $2,000.00 100% $0.00 $126.60 9 TESTING $1,000.00 $0.00 $1,000.00 $0.00 $1,000.00 100% $0.00 $63.30 10 Allowance $5,000.00 $0.00 $2,495.00 $0.00 $2,495.00 50% $2,505.00 $157.93 LIGHT FIXTURES $18,000.00 $0.00 $0.00 $0.00 $0.00 0% $18,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 L $0.00 1 $0.00 1 $0.00 $0.00 0% $0.00 $0.00 $97,600.00 $0.00 $77,095.00 $0.00 $77,095.00 950% $20,505.00 $4,880.11 AIA DOCUMENT 0703 APPLICATION AND CERTIFICATE FOR PAYMENT MAY 1983 EDITION AIA 0 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N,W., WASHINGTON, D.C. 20006 -5292 G703 -1992 AFFIDAVIT AND WAIVER OF LEIN FINAL PARTIAL XX WHEREAS, HARCO ASPHALT PAVING INC. 1650 Harco Way, Indianapolis, IN 46217 (Contractor) has been heretofore employed by CITY OF CARMEL to furnish certain material, supplies PARCEL 94 STREETSCAPE. hereinafter collectively referred to as the "premises and WHEREAS, the undersigned is duly authorized to execute this Waiver of Lien for and on behalf of the Contractor. Now, therefore, the Contractor, for SEVENTY TWO THOUSAND TWO HUNDRED SEVENTEEN DOLLARS AND 89/100(S72,217.89) herby waives and releases the Owner of the Premises and the Company from any and all liens., rights and in consideration of the receipt of lien or claims of whatsoever kind or character on or against the Premises or the improvements located thereon on account of any and all labor, supplies, equipment or material furnished for, in connection with or incorporated in the Premises by the Contractor on or before the date hereof; represents and warrants that no other person or has any right to a lien or claim on account of any labor worked performed or material, supplies or equipment furnished by, to or through the Contractor, on or before the date hereof, and agrees to indemnify, defend and hold the Owner and The Company harmless from and against any and all claims or lien for any labor, material or services furnished or in connection with or incorporated on the Premises by through or to the Contractor prior to the date hereof This Waiver of Lien is given in order to induce the Company to pay the amount indicated above, and upon receipt of such amount by the Contractor, this release may be recorded, becomes valid, enforceable and of full effect. Harco Aspha4 Paving Inc' Paul G. Harding, President STATE OF Indiana) ss. COUNTY OF Marion) Before me, a Notary Public in and for said County and State, personally appeared Paul G. Harding, who acknowledged the execution of the foregoing Waiver of Lien, and who, having been sworn, stated that the representation therein contained are true. 7 Witness my hand and Notarial Seal this 21 s r of Octobe 009. i Notary Public Cynthia L. Sartain County of Residence: Hamilton Commission Expires 9/20/2017 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. 11/I Payee Purchase Order No. /G ,5 O �ja ro �T/� Terms 1h -7 /?J 42/ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7,2 2-1 v Total .r 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 u z;7 7Z 2- 9 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 U Si ature Director of perations Cost distribution ledger classification if Title claim paid motor vehicle highway fund