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173038 05/27/2009
CITY OF CARMEL, INDIANA VENDOR: 00350511 Page 1 of 1 ONE CIVIC SQUARE SMOCK FANSLER CORP CARMEL., INDIANA 46032 2910w MINNESOTA Sr CHECK AMOUNT: $7,505.95 JNDIANAPOUS IN 46241 CHECK NUMBER: 173038 CHECK DATE: 5127/2009 D AC COUNT PO NUMBE INVOIC NUMBER AMOUNT DESCRIPTION 902 4460848 4 7,505.95 4TH GATEWAY /RANGELINE r API?LICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION AIA DOCU MENT G702 (Instr o n rcvcrse side) PAGE ONr or PAGPS TO OWNI -R: City of Carmel PROJECT` Carmel Parcel 48 Gateway Arch AP1'l,ICAI'ION NO.: 4 Distribution to: Les Olds, Director of CRC PERIOD TO: 04/30/09 OWNER One Civic Square PROJECT NOS.: CONSTRUCTION Carmel, IN 46032 MANAGER FROM CONTRACTOR: CONTRACT DAT 12/23/08 ARCHITECT Smock Fansler Corporation CONTRACTOR 2910 W. Minnesota St. VIA CONSTRUCTION MANAGER: l CONTRACT- FO Jndianapolis, IN 46241 VIr\ ARCHITI ?,CT: CONTRACTOR'S APPLICATION FOR PAYMENT The tmdersigncd Contractor certifies that to the best of the C ontractor's knowledge, infor- mation and belief the Work covered by this Application for Payment has been completed Application is made for payment, is shown below, in Connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the Continuation Shect, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Paymcni were Issued and pay 71, 675.00 meats received from the Owner, and that current papmelAt shown herein is note due: U. 1. ORIGINAL CONTRACT SUM 1 1 1 1 o 2. Net Change By Change Orders S 25 450.00 CONTRACTOR, 13v: 04/22/09 3. CONTRACT SUM TO DATE (Line 1 2) 97,125.00 v" G� D:,te: State of: INDIANA 4. TOTAL COMPLETED STORED TO DATE 5 7 9,172.38 County of: MARION o���� (Column G on G702) Subscribed and sworn to before �.��0 RETAINAGE: file this 22nd day of April, 2009 J. 10 of Completed Work 7,917.24 (COlumns D E on 6703) SEAL, Notar} Public: b. `Y, of Stored Material (Column F on G703) R9v Commission espirts: D/2016 Total Retainage (Line 5a 51) or �i T 1111 7'917'24 Total in C011.111111 i of G703) 1111 5 CERTIFICATE FOR PAYMENT ;t4 6. TOTAL EARNED LESS RETAINAGE 8 71,255-14 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as 63,749.19 indicated, the quality o f the Work is in accordance with the Contract Documents, and (Line 6 from prior Certificate) Contractor is entitled to payment of the ANIOUNT CERTIFIED. 8. CURRENT PAYMENT DUE 5 7,505 AMOUNT CERTIFIED 5 7�r 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach m ax if crmrurnt certt%ied differs Jrn 7•o the amoaual applied for. Initial (Line 3 less Line 6) 25,869.86 all figilres on this Applicatio7 i cind on the Continuation Sheet that changed to confin "r to 117e ,Lwlol.lnt cerWlieelj CONSTRUCTI V 1 AGER: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner 25 ,450 .00 ARCH6TC/ Total approved this Month 13y: Date: TOTALS 25,450-00 1 This Certificate is not negotiable. The AMOUNT CER 'TIF[FI7 is payable only to the C on NET CHANGES by Change Order 25,450.00 tractor named herein. Issuance, pavment and acceptance of paplllent are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G7021CMa APPLICATION AND CERTJ 171CV14 F i. PA)'MF'Nl CON.STRUCt1ON %1ANAGrR- ADVISER EDITION J 1992 EDITION AIAII ©1992 Tlili A[kli RWAN 1NSTITUE 7 OF ARCHITECTS. M5 NEW T(RE` A),TNUF. N.W. WASHINGTON, D.C. 20(1OC, -5292 •WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G702/CMa-1992 .rte CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. 8�����0U���U���� x%����� SHEET FnK�\IADOCUK46N[(1702/044AyPiTCA[QN AND CEK]lJlC&lEIORPAYMENT T /l cj B. COMPLETING THE Q7O3/CK8aFORW AhcrrbcCvuorum/ has c x|A Documcm 6701 Coucinnxvmls|Wu.^vmmxr?mN' Illation, x|mu|d hc�muvKc,nJ m /]A[xwumcorWUN[wx and CuhDrou bu ,v;nzoc. C*x/rvk-iou Edition. Thc Comno,,, ^h"o|d xyo 67uzKAu, hx,, x /`ondzcd and n'hmh W n`ge'h,, vx}` (,7\)!. u` the Coosxuuao muuou�r and axh/uo. Ax dx.oU nncv G and ';�y `xdL J.hx? arc x/.cpnd`k.om`;\o, 01r(10, lor, pursuk, it- rt;) I) ra�' ph s 9,� and 9b U At" Wkla Thcv should then inilidl all figUICS 011 67o2 and 6 111:,[ 11 C. COMPLETIPG THE G703 FORM: Meedi yf�,nzuxmmnsh.wkih,uun�&ndu.hro./piunn'vi/b^/mi|:,mhxnmxm`ovAM/^xom/m67.VvAUxNdimuno J u for !ayi^;of. C.myocdun �aox�r��dv�osWdoo CuumndA.B&QTbWCco{umooWn,u|d hccompAtCdhyiJ,ouh.mgm*,uhou^poukm�,of'bcp,oicc'xnd U161 S(x� uoicd ru!ucuouhtcm%j/hrh�xdcdulco!vu!vwxuhmu/,du,rhcWhinrtv/ the u`mmonccmrol'fr\cCro}c'/.vsmkxcqu�nd� ,�/oxwA Mc hwubJ",'o mcy bc by vxzion^'fcbc vY"rk to by 6vhmmouma and xbouk! onuio om,w,ul 1hnx`ghovl ku ymi,u },uki;k ^houW hc vm"Juh,n "cqniod. Wuo/n C s In ,nhuxu}uJa/ dhoh.nmm 10-tell mmv /hxo one yxgr i/ op*! ^n� u/udcJ on We |ua pigr. \niQU� `M mm| `h..o|dcqon| dc.lox| C�x/muSom Th'vxx| orco!umu C ,u; W ,Jjvm.J by (]mnIx OWN Juig Hh, P^icct. Column D: it) dV�, vduo`u 'bc �mnuu/ o/o,v`piunJ ,^.,k u',cpcd h, d`c p, %`ocu xppboum` (cohono� D c hom the Iwarovxup[Jicxh"nVr^!u"hnmc"|omo[(QatcriA^rox oc*'WoU)fvm/chcmwAm//ofyxcuiooQmHnothceuaud in /:/xoJumo Column E: Cwc,harc Ow ,x|uc(Work u`u`p!c(cdm the riouof tbi/op(dicuuon, including d`c mill( ybnu/,jz)s�u�qn`mud mu, /hc pn;co voich nru |isw4 on chc upp/icxhmn under vunrj:k Piesu`/|y �mod W`k'm^ H, Column F: [our h,,c ,h� cuiuc o/Muu�"O$ pu�cud> �wrcd b/r �vhich pxy,ncol jS *,uW111. Inc n`xd o| /h, ^Jumv h, ^zabv\u'-d [h, u`d of each ['.)v pcnod. Tkia value o.r'n ho'b mxrchxh w,/\y e"rcd h,, *hidh pujmc`z is y/vp`l, u116 cuccFiu|'; purkIltJ�sw,cd *hidhmv ^M yu inoogxMo::dmmchcPv.ic,/ 14Ucpzymuu by du0p/oUhn,SLOW mxo^u|s ckxo not wu|, in u dnduchoo [ouu ON o1vmuy OQ as muor/b|" ,o mou[x/ru/*J inm On Pr"inci is /bci, rn|uc dc,ucwd kom [hi^ (:,Junin nnJ iuu`g^ nud !nn` 'o}vmo C (*\xk Cnmp|,^U--Tbis P,,ivd Column G: Enzohczr)cmn|'fu.|omnxD.[ and F [,|m|uncNc u,mlA,nihydiridiog"`/umx6b>u`k.m^c Co H: Eourhc*Ohcdi[fcv(�:nn:hmwc,u(oiumuC(Scbr]v|cdvx|uc)y^Ju,|omu6(l'xx|.�,mpIcroJ^oJ�modw/mW Co Thix n`|omo normally uwd only k`/ cou'mos °hc`x rxuuhW cuioup: i:, p,nuiiuU on x |io, o,m It o,rd not bccompk on pvx'uo vbnu 'n^suo' om|nupoc is vi/obJd bom (h, "k-cnU c"nuac/ nmovnt ChengmOndors:y/hou8|.(Axn`XcU^1caoxddhcmcn,00ruud hy changing d`r,d`,/hlo4,:k/c, cat do`,z(]unpOukr isudUo to thc Puiou. W 0mn ou'muUydnw P`ouU?, (J*oXc OWN uu Wcd^rpycuccly"6,b',om Weir o*n GAO Wilt o,uI.'hcouU.` the /`auik MOM or"N`c"npi/aiuon/muxd|`oudkyO�xoSc orders vn/hcvoocodio,b,xypn+ p/iuoc)'uxduo oil ilx67ol/CMx horn. Cons rucVon Change Oirec1vay; Amounts ,`o/ in dispute that haw hc,u hodoced i^ Cn.`^t,ouNn cbonxc Dircu/vs �Auu|d hc incurpoocd iom'me or now Chn:B, Onkn. Wows nmv`nioA in J�pvu/bo'dd bcdRa|, "id` arond:ig mPxmpupb mx`0|/(:!mo D. MAKING PAYMENT 1lhw0vvnc,�bou|d nx'kc p'youm 4imn|y w the Coutouo/buocdoo Uleu/noumccrUO,d h, UhcCooxnucd,`n %Ix:ag�,rxnd xrcNn,c, on ma rxxsmuwG7V2/r\u. ipp|i,udnouoU ccu|bcou.hn poym,uc Cno*momo mu.agcPAWi,c/ EUoion. Ole cnuTiewd[vxoo`urnho'h, name and ;T ufdhcCoo/mr^x.P,ynrn,nhou|dumhc made m any w|w,[woyunkoxprciUcdlT joJ/o,*d on 07v2/Cmx. 852 REQUEST FOR PAYMENT DETAIL. Project: 080981 CARMEL PARCEL 48, GATEWAY AR .Invoice: 2547 Draw: APP00004 Period Ending Date: 4/30/2009 Detail Page 2 of 2 Pages Item ID Description Total Previously Work Presently Completed Balance Retainage Contract Completed Completed Stored And Stored Comp To Balance Amount Work This Materials To Date Finish Period 001 MOBILIZATION 5,000.00 2,500.00 2,500.00 5,000.00 100.00 500.00 002 CONCRETE 57,675.00 57,675.00 57,675.00 100.00 5,767.51 003 PAINT 4 4,000.00 4,000.00 100.00 400.00 004 LANDSCAPE PAVERS 5,0,00.00 1,000.00 4,000.00 5,000.00 100.00 500.00 005 CHANGE ORDER 1 25,450.00 5,657.44 1,839.94 7,497.38 29.46 17,952.62 749.73 Totals 97,125.00 70,832.44 8,339.94 79,172.38 81.52 17,952.62 7,917.24 F AFFIDAVIT AND WAIVER OF LIEN Final [X] Partial [X] Payment to Follow State of Indiana County of Marion T.M. Fansler being duly sworn states that lie is the C.E.O. of SMOCK FANSLER CORPORATION having contracted with: Ci of Carmel to furnish certain labor, materials, and /or services as follows_ Misc. Construction for a project known as: SFC #08 -098 Carmel Parcel 48, Gateway Arch 4 located at Carmel, Indiana and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the owner the sum of: ($7,505.95) Seven Thousand Five Hundred rive Doiiars and 95/100 receipt of which is hereby acknowledged; or [X] the payment of which has been promised as the sole consideraion 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 due from the owner is the sum of 0.00) 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 receipt of such paynent. 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, Materials, and /or Services, 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, materials, or services furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SMOCK FANSLER CORP. By Title C.E.O. T.M. Fans Ter WITNESS MY HAND AND NOTARIAL SEAL, this 22 day of April 2009. ',,011" C� C), A IR Y 'P Melissa J. Bis op Nota Public �EAT, My commission expires 11/30/2016 Residing in Morgan County OF IiiNiD�M�p��������� Prescbed 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 rc" r rQ�. Purchase Order No. Z9�o <9 "SaA-�. -57 Terms z�/ 2 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) L113 01,9 z7l cow pJ�� sas 9s Total .7 S_0_5-,9y 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 .S�iTdC'(� �l�sas/ wr• �d /�aryy� a IN SUM OF ON ACCOUNT TION FOR 0 2 6j Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT, I hereby certify that the attached invoice(s), or 902 1 1 1 160� 4 L 9 7soS9s 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 O Director Operations Cost distribution ledger classification if Title claim paid motor vehicle highway fund