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HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC -001694 -3/3/2011 CARMEL REDEVELOPMENT COMMISSION 001694 Signature Construction, LLC Check: 1694 720 3rd Ave., SW Date: 3/3/2011 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice . P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 3-14 2,302.15 2,302.15 0.00 0.00 2,302.15 Application 14 on P111 Waterpr 2,302.15 2,302.15 0.00 0.00 2,302.15 APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUM1 ENTG702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Coin PROJECT: Carmel City P111 Waterproofin APPLICATION NO Invoice 4 14 1 Distribution to: One Civic Square Smock Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 01/25/2011 X 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 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,ALA Document 6703,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 $ 80,586.00 2 Net change by Change Orders $ 0.00 CONTRACTOR' 3 CONTRACT SUM TO DATE(Line 1±2) $ 80,a86 00 4. TOTAL COMPLETED&STORED TO $ 27,382.76 �� B . / Date: Z r 5. RETAINAGE I homas E. ontz,President �/ ,- ,� •a. 0 %of Completed Work $ 0 Subscribed and vom to before me this -� } day of Decemb.. '. - _.._L; _ __ (Column D+E on 0703) %e-.- LINDA BUCHANAN b. %of Stored Material $ 1 ornwv Hancock County (Column F on G703) My Commission Expires I otal Ketainage(Lines oa+a)or / C ' ,,, August 20,2011 Total in Column I of 0703) $ 0 00 ARCH! I EC I 'S GER I IFIGA I E FUR PAYMEITI."`" '"" -- ' 6. TOTAL EARNED LESS RETAINAGE $ 27,382 76 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) $ 25,080 61 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 2,302.15 is entitled to payment of the AMOUNT CERTIFIED 9 BALANCE TO FINISH,INCLUDING RETAINAGE $ )3,203 24 (Line 3 less Line 6) AMOUNT CERTIFIED .$ ...`5 CHANGE ORDER SUMMARY ADUI 1 IONS DEDUC HUNS (Attach explanation ''• nun certified differs from the amount applied.Initial all figures on this 1 otal changes approved Application and.nth•Con ruati'n Sheet that are changed to conform with the amount certified) in previous months by Owner ARCHITECT. �,� Total approved this Month By: A4 .�,\ I Date: ) 1( TOTALS $0.00 $0 00 This Ce ificate •.i1: -=��I�w''''-'�a AMO T CERTIFIED is payable onl to th Lontractcr namea n-rein issuance,payment ana acceptance or payment are w nout NET Cl-IANGES by Change Order $0 00 prejudice any ri•Us of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT'1992 EDITION AIA 51992 THE AMERICA -ST UTE 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 -Ce-ific. ion of Do ment's Authenticity from the Licensee. ®IC6Ct or of Redeve /lopment D a ---805' j4 - //TO( '63t/ . _ ., •.. . SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 1 j i 1 t - ------- -_ Invoice # 14 1/25/11 -- _ Carmel City P111 Waterproofing-SMOCK _ Carmel, Indiana 1 1 I 1 1 [ 1 1 Total Work RETAINAGE i BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE % FINISH General Conditions: SMOCK FANSLER Testing and Inspecting 0.00 0.00 0.00 0.00 0.00 0% 0.00-- Project Management 0.00 0.00 0.00 0.00 0.00 0% 0.00-- Site Supervision 40,293.00 0.00 0.00 0.00 0.00 0% 40,293.00 Site Safety Director 0.00 0.00 0.00 0.00 0.00 0% 0.00-- Design Drawings 0.00 0.00 0.00 0.00 0.00 0% 0.00 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 Office Supplies 0.00 0.00 0.00 0.00 0.00 0% 0.00 Tools and Equipment 0.00 0.00 0.00 0.00 0.00 0% 0.00 -Field Engineering and Surveying 0.00 0.00 0.00 0.00 0.00 0% 0.00 Construction Management Fee 40,293.00 2,302.15 0.00 25,080.61 27,382.76 68% 12,910.24 _ _ 80,586.00 2,302.15 0.00 25,080.61 27,382.76 34% 53,203.24 .., CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and /or labor as follows: Construction Management Services for a project known as Carmel City Center P111, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of two thousand three hundred two dollars and fifteen cents ($2,302.15) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, finished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC I 1 / Tho ►T E. oontz, Presiden' / Subscribed and sworn to before me this: :),;-,,,i ,,,,r Notary Public: ^%/` ., ,"_=--c,---- ^ I ''F'' `INDABUCHANAN ,,cr°F " Hancock County tvly Commission Expires August 20,2011