HomeMy WebLinkAbout175781 08/06/2009 CITY OF CARMEL, INDIANA VENDOR: 362780 Page 1 of 1
ONE CIVIC SQUARE LITHKO CONTRACTING
CARMEL, INDIANA 46032 PO BOX 270
CHECK AMOUNT: $20,416.76
MONROE OH 45050 CHECK NUMBER: 175781
CHECK DATE: 8/6/2009
DEPARTMENT ACCOU PO NUMBER INVOICE NUMBER A DESCRIPTION
902 4460805 4 20,416.76 RETAIL SITE #5
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES
TO "'o..z:z PROJECT: CARMEL CITY APPLICATION NO: 4 Distribution to:
CITY OF CARMEL, REDEVELOPMENT COMMISSIC CENTER PHASE 1 PERIOD TO: June 30, 2009 7OWNER
1 1 1 WEST AMIN ST., SUITE 180 PROJECT NOS: 7ARCHITECT
CARMEL, IN 46032 LCI JOB# L5429 CONTRACTOR
FROM CONTRACTOR: CHECK REMITTANCE ADDRESS: CONTRACT DATE: 8
LITHKO CONTRACTING, INC LITHKO CONTRACTING, INC.
P.O. BOX 270 P.O. BOX 270
MONROE, OHIO 45050 MONROE, OHIO 45050
CONTRACT FOR: Place/Finish Concrete VIA ARCHITECT:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the 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 G703, is attached. completed 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
payments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 436,000.00
2. Net change by Change Orders 26,001.16 CONTRACTOR: LITHKO CONTRACTING, INC.
3. CONTRACT SUM TO DATE (Line 1 f 2) 462,001.16
4. TOTAL COMPLETED STORED TO 449,976.16
DATE (Column G on G703) By: Date: June 18, 2009
5. RETAINAGE: DREA GANNON, BILLING CO:QRDINATOR
a. 10% of Completed Work 44,997.62 State of: OJ Y P (j" County of: WARREN
8.
(Column° D E on G703) Subscribed and sworn to befoc�e t`i\' 1 .�181. �£'rC i of ABVC009
b. of Stored Material Z�
(Column F on G703) Notary Public 1� 3 `rotary Public, State of Ohio
Total Retaina e Lines 5a 5b or M Comm' sion i es: _n "fl Commission Expires
g y 9 9 12
Total in Column I of G703) 44,997.62 ARCH ITECT' °I.F <i_ ATE °FORsPAYti PW
Z t 42P
6. TOTAL EARNED LESS RETAINAGE 404,978.54 In accordance with the Contr1 pcurnents, based on on site observations and the data
(Line 4 Less Line 5 Total) comprising the application, fil r- -ct certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, informatio an nd belief the Work has progressed as indicated,
PAYMENT (Line 6 from prior Certificate) 384,561.78 the quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE 20,416.76 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 57,022.62
(Line 3 less Line 6) AMOUNT CERTIFIED ?p t�.IMab
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explana n i amount c i ied differs from the amount applied. Initial all figures on this
Total changes approved Application a d onth Cont' uatio Sheet that are changed to conform with -the amount certified.)
in previous months b Owner $3,315.87 $0.00 ARCHITEC
Total approved this Month $22,685.29 $0.00 By: Da wn
TOTALS $26,001.16 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
NET CHANGES by Change Order $26,001.16 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 -APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., 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.
JMP92 22 F Effective 1/31/01
Page 1 of 1
�F:
CONTINUATION SHEET AIA DOCUMENT G/OJ• PAGE OF PAGES
AIA Document 0702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 4
Contractor's signed certification is attached. APPLICATION DATE: 6/18/2009
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:
CARMEL CITY CENTER PHASE 1 Lo h ko
L5429 CONTRACTING, INC.
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 (IF VARIABLE
APPLICATION STORED AND STORED (C G) RATE)
(NOT IN TO DATE
D OR E) (D +E +F)
1 PAYMENT PERFORMANCE BOND 4,800.00 4,800.00 0.00 0.00 4,800.00 100% 0.00 $480.00
2 MOBILIZATION 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 $500.00
3 GENERAL CONDITIONS LAYOUT 5,000.00 5,000.00 0.00 0.00 5,000.00 100% 0.00 $500.00
4 FIRESTOPPING 12,000.00 12,000.00 0.00 0.00 12,000.00 100% 0.00 $1,200.00
5 LIGHT POLE BOLLARD PEDESTALS 20,000.00 20,000.00 0.00 0.00 20,000.00 100% 0.00 $2,000.00
6 MOTOR COURT REBAR INSTALLATION 11,375.00 11,375.00 0.00 0.00 11,375.00 100% 0.00 $1,137.50
7 MOTOR COURT REBAR MATERIALS 38,500.00 38,500.00 0.00 0.00 38,500.00 100% 0.00 $3,850.00
8 MOTOR COURT PREP, PLACE FINISH 88,800.00 88,800.00 0.00 0.00 88,800.00 100% 0.00 $8,880.00
9 VETERANS WAY REBAR INSTALLATIO 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $650.00
10 VETERANS WAY REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00
VETERANS WAY PREP, PLACE FINISH 49,600.00 49,600.00 0.00 0.00 49,600.00 100% 0.00 $4,960.00
HANOVER SQ REBAR INSTALLATION 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $650.00
HANOVER SQ REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00
HANOVER SQ PREP, PLACE, FINISH 49,600.00 49,600.00 0.00 0.00 49,600.00 100% 0.00 $4,960.00
COURT PLAZA REBAR INSTALLATION 6,500.00 6,500.00 0.00 0.00 6,500.00 100% 0.00 $650.00
COURT PLAZA REBAR MATERIALS 21,750.00 21,750.00 0.00 0.00 21,750.00 100% 0.00 $2,175.00
COURT PLAZA PREP, PLACE FINISHI 49,600.00 49,600.00 0.00 0.00 49,600.00 100% 0.00 $4,960.00
RE MOB FOR CRANE AREA REBAR INSTALL 1,625.00 0.00 0.00 0.00 0.00 0% 1,625.00 $0.00
REMOB CRANE AREA REBAR MATERIALS 1 4,950.00 4,950.00 0.00 0.00 4,950.00 100% 0.00 $495.00
REMOB CRANE AREA PREP, PLACE, FINISH 10,400.00 0.00 0.00 0.00 0.00 0% 10,400.00 $0.00
CO #1 ASI #1 2 DRAWING REVISION 3,315.87 3,315.87 0.00 0.00 3,315.87 100% 0.00 $331.59
CO #2 ASI #3,. #4 ESI #16 CHANGES 22,685.29 0.00 22,685.291 0.00 22,685.29 100% 0.00 $2,268.53
GRAND TOTALS 462,001.16 427,290.87 22,685.291 0.00 449,976.16 97% 12,025.00 $44,997.62
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
Page l of t JNIP92 -20 -F Effective- 1/31/01
L5429
WAIVER OF MECHANIC'S LIEN RIGHT BY SUPPLIER
WHERE AS, the undersigned furnished materials and /or services to the insured development known as
CARMEL CITY CENTER located at 101 City Center Drive, in the city of CARMEL county of
HAMILTON state of INDIANA.
WHERE AS, the undersigned desires to waive, release and quit -claim to Owner, all lien rights, including
the right to file a notice of Mechanic's Lien or hereafter a Mechanic's lien upon the above described real
estate to the extent for which the undersigned has received payment and to the extent permitted by the
laws of the state of INDIANA
NOW, THEREFORE, in consideration of the sum of One Dollar ($1,00) and other valuable consideration,
receipt of which hereby acknowledge, the undersigned has hereby waived, released and quit -claim to
Owner, (indicate either 1 or 2).
1. All lien rights as described above which it has or could have under the laws of the state
of INDIANA to the date hereof for or on account of materials, appliances, machinery,
fixtures, or furnishings, placed upon or installed on the above- described real estate. This
waiver is effective upon receipt of Dollars 32,464.322. pril 30, 2009
2. All lien rights as described above which is has or could have under the laws of the state
of INDIANA to the date hereof for or on account of materials, appliances, machinery, fixtures,
or furnishings placed upon or installed on the above described real estate. This shall constitute
a full and final waiver of the undersigned's rights to a Mechanic's Lien on the above- described
real estate.
DATED This Irk day of J(9 /V 201 Q 7
Ram Steel
(Name of Supplier)
(Name of Subcontractor)
Lithko Contracting Inc.
(Revised 10/2000 Signature)
1
Form Ap9rvved
��'�,`i�RAEN ®F CC)MPLI NCE Expims May DM9 mo. y 3 4, 1991 d'zn 7.143
q 3
Publle reporting burden for this collection of Information is estimated to average IG minutes per re-,Qome. i the time for revievving lmttvctlorn, scorching e data sources.
gathering and maintaining thgge data needed, and completing and reviewing the collection of information. Send comments regarding this Barden estimate or any other aspect athfs collection
OA Arlln onI Va22202�302t to theOfflce of Manngement Budget Paptrwor Reduction Projec ([)7pa -02 3 Washflnatona DC 2o503R�m 1215 ]ef4enon Davis k5ighrray. Suite
2. PAYROLL PAYMEA'T DATE (YY11RftADD) 3. CONTRACT NUMBER 4. DATE (YYMMOD)
9. PAVROt6 NUMBER 05/22/09
05/22/09` l
1, Karen Cole CPP Payrol l Manager do hereby state.
(!Name of signatory party) (Title/
(1) That I pay or supervise the payment of the persons employed by L1 thk0 Con n�Q r r)
on the Car 0 C that during the payroll period commencing on the 11th day of
d ing or wroi's)
May 7777 2 09 and ending 4lte 17 th day of May 7777 -20-09 ail- persons
employed on said project have been paid the full weekly wages earned, that, no rebates. have been or wiil be Made either directly or indirectly
to or on behalf of said Li thko Contracting, I from the full weekly wages earned by any person
(co"McT.f .1
and that no deductions have been made either directly or indirectly, from the full wages earned by any person, other than permissible
deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended (48
SYat 948, 63 Stat 108, 72 Stay. 967; 76 Stay. 357; 40 U.S.C. 276r), and described below:
FIT, Social Security, Medicare, State and local taxes where ap2licable and
miscellaneous authorized deductions,
(2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the
wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination
incorporated into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work performed.
prentices employed in the above p
(3) That any ap beriod are duly registered in a bona fide apprenticeship program registered with a
State apprenticeship agency recognized by. the Bureau of Apprenticeship and Training, United States Department of Labor, or if no such
recognized agency exists in a State; are registered with the Bureau of Apprenticeship. and-Training, United_ States Department of Labor.
(4) That:
.(a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS
in addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments
of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such
employees, except as noted in Section 4(c) below.
(b) MERE FRINGE BENEFITS ARE PAID IN CASH,
Each laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll, an amount not less
than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the
contract, except as noted in section 4(c), below.
(c) EXCEPTipki
EXCEPTION (Craft) EXPLANATION
S. REMARKS
6. NAME (Lash First RRiddle Initial) 7. TITLE B. SIGNATURE
Cole, CPP, Karen Payroll Mana er
The willful falsification of any of the above stateme= may subject the contractor or Subcontractor to civil or criminal proecc ion.
See Section 1001 of Title 18 and Section 231 of Title 31 of the United States Code.
Form 879, JUN 89 Previous editions are obsolete. I ®aaf67 1
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS WAIVER OF LIEN
STATE OF Indiana
COUNTY OF Hamilton
A7r QVt Being duly sworn upon his /her oath disposes and
says that:
1. He /she i 5_-A LEAD (inserting sole proprietor, partner or corporate office held, as the case maybe),
of Lithko Contracting hereafter called the "Subcontractor". He /she is over the age of twenty -one.
He /she is authorized to make this affidavit on behalf of Subcontractor.
2. Subcontractor is the CowX.¢ETE Subcontractor for the construction of the development known as
CARMEL CITY CENTER located in CARMEL (City), INDIANA (state), hereafter referred to as the
"Development pursuant to the contract between the Subcontractor and Signature Construction, LLC,
the General Contractor.
3. This affidavit is made for the express purpose of inducing Signature Construction, LLC, to make
payment to Subcontractor of the invoice submitted herewith for labor and materials furnished pursuant to
said Contractor. Upon receipt of said payment the Subcontractor hereby waives any lien rights to which
Subcontractor is entitled for labor or materials furnished for the development to the date hereof.
4. Listed below are all suppliers or other persons who either has furnished or might furnish the
Subcontractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the
development. Mark (X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a
waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case
also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered
to the General Contractor. 3.) If the initial delivery has not been made.
S upplier List (Add list if necessary 1 1. Amount Owed 3
Ew
S T5�1 u14tWc2 INGI uD�7� e� 3
#1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC
is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly
payable to Subcontractor and such creditor, as Signature Construction, LLC shall determine.
5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result
in lien being filed against the Development or a claim being asserted against the General Contractor
except the persons or businesses named in Paragraph 4 above.
IN WITNESS WHERE OF, affiant has signed this document on behalf of the Subcontractor this
day of SIwF 7N- 20 q
(Authorized Representatr o ubcontractor)
County of /rl.I�'a�
State of -,J
Subscribed and sworn to before me, a Notary Public in and for said County and State,
This Day of
r
(Nota
4P
(Print Nake)
My Commission Expires:
NOTARY SEAL MUST APPEAR ON THIS FORM.
Explro
6
LAU Contracting, Inc.
{513} 539 -4144
Remittance Address
P.O. BOX 270 Emit
3
MONROE, OHIO 45050 CONTRACTING, INC.
149837
TO: CITY OF CARMEL, REDEVELOPMENT COMMISSION
111 WEST AMIN ST., SUITE 180 invoice No.
CARMEL, IN 46032 25163 RI
C/O SIGNATURE CONSTRUCTION, LLC.
720 THIRD AVE., S.W. invoice Date
CARMEL, IN 46032 6/18/09
Job name: Lithko Job No. Customer Job No. P.O. No.
CARMEL CITY CENTER PHASE :t L54
Description Amount
DRAW# 4 GROSS 22,685.29
RET 2,268.53
20,416.76
JUD jun 1 91009
COMMUNICATIONS CONVEYED ON CHECK TENDERED STATING
PAYMENT IN FULL AND /OR WAIVING OF- LIEN RIGHTS TO ANY
EXTENT MUST BE SENT TO SELLER AS FOLLOWS:
ATTN: ACCOUNTS RECEIVABLE DEPT., LITHKO CONTRACTING, INC.
P.O. BOX 270, MONROE, OH 45050
Payment Terms 3o DAYS TOTAL AMOUNT DUE b 20,416.76
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.
ll Payee
Li 0 �o �7�v�� cT lam Purchase Order No.
�0 Dj oX 2 7� Terms
��oGj�'o��0 zISUSG Date Due
Invoice Invoice Description Amount
Date N umber (or note attached invoice(s) or bill(s))
Total ;ZO jIla -76
1 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.
1, ALLOWED 20
IN SUM OF
ON ACCOUNT OF IATION FOR
�l
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
7 /5 200,
Director. 0 4* U6
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund