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SIMPLEX GRINNELL, LP -001674 -2/22/2011 G'ARMEL REDEVELOPMENT COMMISSION 001674 Simplex Grinnell, LP Check: 1674 11820 Pendleton Pike Date: 2/22/2011 Indianapolis, IN 46236 Vendor: SIMPLEX1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount A mt. Paid 3-4 2,846.16 2,846.16 0.00 0.00 2,846.16 Application 4 VOG 2,846.16 2,846.16 0.00 0.00 2,846.16 • ':ti .:,..._. =.�=s iA 8 Document G7021CMaTM — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 004 Distribution to: Carmel City Center Village on the Green 30 West Main Street 3rd Ave SW and Cotu Ctr Dr. PERIOD T0:12-31-2010 OWNER ❑ Suite 200 CONSTRUCTION MANAGER xi FFOePNTRAdATR:4 6 0 3 2 VIA CONSTRUCTION MANAGER: CONTRACT DATE: 11/18/2009 ARCHITECT ❑ SimplexGrinnell LP REI Construction LLC PROJECT NOS: 09-4123 I CONTRACTOR ❑ 11820 Pendelton Pike Indianapolis, IN 46236 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: ?ec1C'or Design Group CI Protection Sprinkler Systm CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment ,fere issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 80 , 150 . 00 payment shown herein is ,,w due. 2. Net change by Change Orders $ ?3 , 8 8 2 . 4 0 CONTRACT ---7 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 84 , 032 . 40 By: Date: 12-20-2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 84 , 032 . 40 State of: India a 5.RETAINAGE: County of: c o "" _AI, - le Y Marion a. 10 %of Completed Work Subscribed and sworn to before i PAULA K.LEWIS (Column D+Eon 6703) $ 8 , 403 . 24 me this 2 0th• of Dec m r, 2 010 Notary Public-Seal b b. %of Stored Material Notary Public: � � ( State of Indiana (Column F on G703) $ 0 . 00 My Commission expires:8—122 0 17 My Commission Expires Aug 12,2017 Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 8 ,403 . 24 CERTIFICATE FOR PAYMENT .. � A In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 75, 629 . 16 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ '7 7 , 7 8 3 - 0 0 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. g I • 8.CURRENT PAYMENT DUE $ 2, 846 . 16 AMOUNT CERTIFIED $ Z.g �6, / b 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 8 , 403 . 24 • '`' -• •• 0"'"^'4.1— By: / `- . Date: ////)✓I CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in previous months by Owner $3 , 882 . 40$ By: Date: Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $3 , 882v40$ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 3 8 8 2 . 4 0 the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S.Copyright Law and International Treaties. ,,, Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institu of Architects'legal counsel,copyright @aia.org. A = Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition, 1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedule of values''each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at:the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. Construction Change Directives:Amounts not in dispute that have been included:in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A2017/CMa: E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The,completed.form contains the name and address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. s - AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed. To report copyright violations of AIA Contract Documents,e-mail The American Institute•of Architects'xlegal'counsel,copyright @aia.org. Village on the Green APPLICATION AND CERTIFICATE FOR PAYMENT APPLICATION NO.: 4 APPLICATION DATE: 12/20/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 948363301 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO. VALUE APPLICATION THIS STORED AND STORED % TO (IF VARIABLE) (D+E) PERIOD (NOT IN TO DATE (G=C) FINISH RATE D OR E) (D+E+F) (C-G) 10000 ADMINISTRATION: 10010 Bonds&Insurance $575.00 $575.00 $0.00 $0.00 $575.00 100% $0.00 $57.50 10020 Permits&Fees $250.00 $250.00 $0.00 $0.00 $250.00 100% $0.00 $25.00 10030 Engineering&Submittals $4,600.00 $4,600.00 $0.00 $0.00 $4,600.00 100% $0.00 $460.00 10040 Drawing&Drafting Services $4,600.00 $4,600.00 $0.00 $0.00 $4,600.00 100% $0.00 $460.00 10050 Mobilization $5,610.00 $5,610.00 $0.00 $0.00 $5,610.00 100% $0.00 $561.00 20000 EQUIPMENT 20010 Overhead $27,446.00 $27,446.00 $0.00 $0.00 $27,446.00 100% $0.00 $2,744.60 20020 Stand Pipe $2,500.00 $2,500.00 $0.00 $0.00 $2,500.00 100% $0.00 $250.00 30000 INSTALLATION 30010 Overhead $31,624.00 $28,461.60 $3,162.40 $0.00 $31,624.00 100% $0.00 $3,162.40 30020 Stand Pipe $2,945.00 $2,945.00 $0.00 $0.00 $2,945.00 100% $0.00 $294.50 30050 C0000 CHANGE ORDERS C0001 Change Order 1 $3,882.40 $3,882.40 $0.00 $0.00 $3,882.40 100% $0.00 $388.24 • $0.00 0% $0.00 $0.00 $0.00 0% $0.00 $0.00 TOTALS $84,032.40 $80,870.00 $3,162.40 $0.00 $84,032.40 100% $0.00 $8,403.24