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Home My WebLink AboutSIGNATURE CONSTRUCTION, LLC -001973 -6/15/2011 CARMEL REDEVELOPMENT COMMISSION 001973 Signature Construction, LLC Check: 1973 720 3rd Ave., SW Date: 6/15/2011 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 3-17 16,819.33 16,819.33 0.00 0.00 16,819.33 App 17 on P111 Waterproofing 16,819.33 16,819.33 0.00 0.00 16,819.33 APPLICATION AND CERTIFICATION FOR PAYMENT Ara DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Redevelopment Commissic PROJECT: Carmel City P111 Waterproofin APPLICATION NO Invoice# 17 1 Distribution to: One Civic Square Smock Signature costs [ OWNER Carmel Indiana 46032 L ARCHITECT PERIOD TO: 4/25/2011 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,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 $ 68,718.0/ y / // z i/'( By: / Date: ■ 5 RETAINAGE. oma ' oontz, resisent APr X130/1 a 0 V.of Completed Work $ 0 :ubscnbed a . sworn to before me this ; 6 day of Deeemoci, '0...°..... (Column D+E on G703) °PAYN�a- LINDA BUCHANAN b %of Stored Material $ ' NOrARv`f'', Hancock County (Column F on G703) =s: SEA My Commission Expires I otal Retainage(Lines as+Jb or -" ;,;5 August 20,2011 Total in Column 1 of G703) $ 0.00 AKCHI I ECT'S CEK I II-ICATE FOR PAYMEN 1=' ,. ------ 6 TOTAL EARNED LESS RETAINAGE $ 68,718)7 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) $ 51,899 24 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 16,819.33 is entitled to payment of the AMOUNT CERTIFIED 9 BALANCE TO FINISH,INCLUDING RETAINAGE $ 13,0.3/.43 �� • (Line 3 less Line 6) AMOUNT CERTIFIED.. ...... $ CHANGE ORDER SUMMARY AUDI I IONS DEDUC I IONS (Attach explanation Ifamount certified differs from onl the amount applied.Initial all figures on this total changes approved Application. e C.. inuation S ee at are cha •ed to coi form 1 WI t amount certified.) in previous months by Owner ARCH1TFI d 4., I Total approved this Month By: _ A��` • I( Date. 1 TOTALS $0 00 $0.00 Thi,Cerr :to s not negoti•.le The AMOUNT CERTIFIED is payable o y to e Lont .etor n.mea nerein.issua e,payment ano acceptance or payment are irno NET CHANGES by Change Order $0.00 preju. .•to.ny rights of the Owner or Contractor under this Contract AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT'1992 EDITION AIA '©1992 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. Director of Redevelopment( �Li S 0 S e\jf - - . - SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 , Invoice # 17 4/25/11 Carmel City P111 Waterproofing-SMOCK Carmel, Indiana 1 1 - [ [ Total Work RETAINAGE I BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE I % 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 14,441.36 0.00 12,970.93 27,412.29 68% 12,880.71 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 2,377.97 0.00 38,928.31 41,306.28 100% 176.72 81,776.00 16,819.33 0.00 51,899.24 68,718.57 84% 13,057.43 • . . . 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 sixteen thousand eight hundred ninteen dollars and thirty-three cents ($16,819.33) the payment of which h• 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 T .mas E.7•ontz, President Subscribed and sworn to before me this: /4P r-%/ 2-S'( Z 0 i/ Notary Public: -1:u ( _ e< LINDA BUCHANAN N N orraY% . Hancock County— a. ° s� My Commission Expires ■ ' `~F y; August 20,2011