HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC -001759 -3/17/2011 CARMEL REDEVELOPMENT COMMISSION 0017.59
Signature Construction, LLC Check: 1759
720 3rd Ave., SW Date:. 3/17/2011
Carmel, IN 46032 Vendor: SIGNATO1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
15-2 3,614.80 3,614.80 0.00 0.00 3,614.80
Application 15
3,614.80 3,614.80 0.00 0.00 3,614.80
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER C CSC PROJECT: Carmel City P111 Waterproofin APPLICATION NO Invoice# 15 1 Distribution to:
8i+e-eit4e-,S.Ei4age Smock Signature costs OWNER
Carmel Indiana 46032 ARCHITECT
PERIOD TO: 02/22/2011 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,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 $ 81,776.00
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1 ±2) $ 81,776.00
4. TOTAL COMPLETED&STORED TO $ 30,997.56 7 By: / � Date L/r z //
5. RETAINAGE T Xmas E. 'w•ntz,President ?--(;/.2- --)""//
a. 0 %of Completed Work $ 0 Subset-lied and om to before me this 7 day of December72009 _
(Column D+E on G703) - '
b %of Stored Material $ . e,; LINDA BUCHANAN
„orA� Hancock County
,
(Column F on G703) s« My Commission Expires '
Total Retamage(Lines 5a+5b or ..:!. ..?;W August 20,2011
Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYM
6 TOTAL EARNED LESS RETAINAGE $ 30,997.56 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) $ 27,382.76 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8 CURRENT PAYMENT DUE $ 3,614.80 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE $ 50,778.44
(Line 3 less Line 6) AMOUNT CERTIFIED $ s ' 0
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount cer fled differs f•on the amount applied.Initial all figures on this \t
- Total changes approved Application cend onto• •• -tati,' i Sheet tha clrcrn to cooforn;witththe amount certified.)
�\
in previous months by Owner ARCHITECT: ' ,1 'ry'{/Z'j (1
Total approved this Month By: `4� -,I ��/X/(�.t,ate: IC, ,l
-
TOTALS $0.00 $0.00 This ∎ertificate is o negotiable. T e MOUNT CERTIFIED is payable oo th
Lontrac■ named erem. Issuance,payment and acceptance of payment are without
NET CI-IANGES 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 MA Document D401 -Certification of Document's Authenticity from the Licensee
Director of Redevelopmerli tJy L 0?
. .
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
i 1 1 1 •
•
Invoice # 15
2/22/11
Carmel City P111 Waterproofing-SMOCK
Carmel , Indiana
1 1 1
i ]
I 1
Total Work RETAINAGE BALANCE
Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO
DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE 1 % 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 41,483.00 3,614.80 0.00 27,382.76 30,997.56 75% 10,485.44
81,776.00 3,614.80 0.00 27,382.76 30,997.56 38% 50,778.44
•
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 three thousand
six hundred fourteen dollars and eighty cents ($3,614.80) the payment of which has beer
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
Ac 7,
-
Thoma. E. Koo ', President
Subscribed and sworn to before me this: b .7-) .*.),,,7/
2
/
Notary Public: 2-,1 .r_,4 7-31,,,.1„,6,.--
z'
LINDA BUCHANAN
uoTARY: Hancock County
SEAL My Commission Expires
i ''f' q, °f1'` August 20,2011