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Home My WebLink About176095 08/18/2009 a CITY OF CARMEL, INDIANA VENDOR: 356934 Page 1 of 1 4 ONE CIVIC SQUARE SIGNATURE CONSTRUCTION LLC CARMEL, INDIANA 46032 7203RD AVE SW CHECK AMOUNT: $14,145.21 CARMEL IN 46032 CHECK NUMBER: 176095 CHECK DATE: 8/18/2009 DEPAR TMENT ACCOUNT PO N UMBER INVOI NUMBER AMOUNT DESCRIPTION 902 4460913 2.1 6,071.76 GARAGE /PARKING STRUCT 902 4460911 2.2 8,073.45 MAIN THEATER ar APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: 7C -I Main Theater APPLICATION NO: invoice s 2 1 Distribution to: Invoice 2 Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 07/22/09 MCONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 478.9 CONTRACT FOR: 6066 CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT 1091 The undersigned Contractor certifies that to the best ofthe 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 15,709.38 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line I t 2) 15,709.38 4. TOTAL COMPLETED STORED TO 15,709.38 By(ho Date: 7 2 Z 5. RETAINAGE: Coontz,President a. 0 of Completed Work 0 Su d a sworn to before me this of July, 2009 (Column D E on G703) LINDA BUCHANAN PV Py'•. b. of Stored Material �broTw F Hancock County (Column F on G703) 9Eh My Commission Expires Total Retainage (Lines 5a 5b or Tod d" Au9USt 20, 2011 4 Total in Column 1 of G703 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE 15,709.38 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated,. PAYMENT (Line 6 from prior Certificate) 7,635.93 the quality of the Work is in accordance with the Contract Documents, and the Contractor ,X rt 8. CURRENT PAYMENT DUE 8,073.45 is entitled to payment of the AMOUNT CERTIFIED.; 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 ��y�� (Line 3 less Line 6) AMOUNT CERTIFIED CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation ifa out certified differs from the amount applied. Initial all figures on this Total changes approved Application and ont Con hnuation el that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: Total approved this Month By: /t/' l.J Date: TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor nameu herein. issuance, payment ana 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 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. r t y SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. qarm4 .l Indiana 46032 Invoice 2 7/22/09 Carmel City Phase 7C Main Theater Carmel, Indiana I WORK BALANCE COMPLETED RETAINAGE PREVIOUS TOTAL COMPLETED TO_ ORIGINAL BUDGET Co-tt.d DESCRIPTION THIS PERIOD WITHHELD APPLICATIONS TO D ATE I FI BUDGET ADJUSTMENTS Cost General Testing and Inspecting 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Constructin Management 0 478.91 478.9 00 478.91 478.91 site supervision 7,685.06 0.00 _6,066.41 13,751.47 0% 0.00 ---0.00 13,751.47 13,751.47 Site Safety Director 0.00 0.00 0.00 0% 0 0 .00 0.00 0.00 Design Drawings 224.18 0.00 1,090.61 1,314.79 0% 0.00 0.00 1,314.79 1,31 79 Sanitary Facilities 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Field Office 0.00 0.00 0.00 0% 0.00 0.00 0.00 Temporary 0.00 0.00 0.00 0% 0.00 ----.-0.00 0.00 Office Supplies 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Temporary Telecommunications 0.00 0.00 0. 00 0% 0.00-- 0.00- 0.00 0.00 Temporary Water 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Tools and Equipment 0.00 0.00 0 0% 0.00 0. 00 0.00 0.00 Jobsite Trailer 164.21 0.00 0.00 164.21 0% 0.00 164.21 164.21 9- 00 Field Engineering a n d Surveyi 0.00 0.00 0.00 0.00------. 0.00 Health and Safety 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Waste Disposal 0. 00 0 00 0.00 0% 0.00 0.00 0.00 0.00 Final Clean 0.00 0.00 0% 0.00 0.00 0.00 0.00 Constructin Management Fee 0.00 0.00 0.00 0 0.00 -0.00---- 0.00 0.00 8,073.45 0.00 7,635. 93 15,709.38 00 0.00 15,709.38 15,709.38_ J APPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUME PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: 7C -3 VOG Parking Garage APPLICATION NO: Invoice 0 2 1 Distribution to: Invoice 2 Signature costs =OWNER Carmel Indiana 46032 =ARCHITECT PERIOD TO: 07/22/09 CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe 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 21,535.91 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE (Line 1 f 2) 21,535.91 4. TOTAL COMPLETED STORED TO 21,535.91 rSubscri I Date: 5. RETAINAGE: Th s E. Koontz, President a. 0 of Completed Work 0 d and swom to before me this day of July, 2009 (Column D+ E on G703) LINDA BUCHANAN Hancock County b. of Stored Material (Column F on G703) ara My Commission Expires Total Retainage (Lines 5a 5b or \r?• Total in Column I of G703) 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT ;t August 20,2011 6. TOTAL EARNED LESS RETAINAGE 21,535.91 In accordance with the Contract Documents, based on on -site observations and the data (Line 4 Less Line 5 Total) comprising the application, the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge, information and belief the Work has progressed as indicated, PAYMENT (Line 6 from prior Certificate) 15,464.15 the quality of the Work is in accordance with the Contract Documents, and the Contractor 8. CURRENT PAYMENT DUE 6,071.76 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE 0.00 (Line 3 Tess Line 6) AMOUNT CERTIFIED CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanatio hf mount certified differs from the amount applied. Initial all figures on this Total changes approved Application an nth C'oruinu ion ,Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITEC Total approved this Month By: Date: 7 3 P9 TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payab e only to the ontractor 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 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. SIGNATURE CONSTRUCTION LLC Carmel, Indiana 46032 Carmel City Phase 7C-3 VOG Pa. Carmel, Indiana WORK BALANCE _COMPLETE RETAINAGE PREVIOUS TOTAL COMPLETED TO BIJ Committed F BUDGET ADJUSTMENTS DESCRIPTION THIS PERIOD WITHHELD APPLICATIONS fO DATE F[N [SH Cost General Requirement: Testing and Inspecting 0.00 0.00 0.00 0% 0.00 0.00 0.00 Site Supervision 3,612.56 0.00 11,930.42 15,542.9 0% 000 15,542.98 15,542-98 Construction Management 912.84 0.00 ___478. 92 1,391.76 0% 0.00 0.00 1,3911.76 1,391.76 Site Safety Director 0.00 0.00 0.00 0 0.00 0.00 0.00 0.00 Design Drawings 0.00 1,090.62 1,090.62 6 0.00 1,090.62 1,090.62 Sanitary Facilities 0.00 0.00 0.00 0% 0.00 0.00 0.00 0.00 Temporary Electric 0.00 375.00 375 00 0 0.00 0.00 375.00 375.00 Tools and Equipment 0.00 526.49 526.49 0% 0.00 0.00 526.49 526.49 Jobsite Trailer 1,040 99 0.00 1,018.11 2,059.10 0.00 0.00 2, 59 10 2,059-10 Field Engineering and Surveying ----4.15.00 415 00 0% 0.00 0.00 415.00 415.00 Health and Safety 0.00 0.00 0.00 6 0.00 0 0.00 0.00 Constructin Management Fee 0.00 0.00 0.00 1 0% 0.00 0.00 0.00 0.00 f Prescribed by State Board of Accounts City Form No. 201 (Rev. 1 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 Purchase Order No. Terms f�I/ `�Ga3 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) (j 72 2_ z 2 /Q 7C -3 G D 71 76 U 7�2 D Z All 2- 175 Total /'y'2 Q .A 1 hereby certity that the attached invoice(s) or bill(s), is (are) true and correct and I have audited same in accordance h 1C 5- 11- 10 -1.6. �ZO C \erk�reasurec VOUCHER NO. WARRANT N0. ALLOWED IN SUM OF 0 3 L 7,2Q 3 r� f yr� S- LC/- ON ACCOUNT OF APPROPRIATION FOR Board NI Pock or e�b�rs DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached i ��2- 2,1 07 /-;g bill(s) is (are) true and correct and th or at the 2 2 Y i/ ��73.5'S materials or services itemized thereon for which charge is made were ordered and received except r 4 Signare Cost distribution ledger classification if claim paid motor vehicle highway fund