HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC -002123 -7/25/2011 CARMEL REDEVELOPMENT COMMISSION 002123
Signature Construction, LLC Check: 2123
720 3rd Ave., SW Date: 7/25/2011
Carmel, IN 46032 Vendor: SIGNATO1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
13-2 14,570.93 14,570.93 0.00 0.00 14,570.93
Hanover Sq Fountain
19 1,190.00 1,190.00 0.00 0.00 1,190.00
App 19 on P111 Waterproofing
15,760.93 15,760.93 0.00 0.00 15,760.93
APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Hanover Square Fountain APPLICATION NO Invoice#2 1 Distribution to:
Carmel Indiana 46032 Signature costs [ OWNER
ARCI-1 l'TECT
PERIOD TO: 6/23/2011 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.
I. ORIGINAL CONTRACT SUM $ 33,150 00
2. Net change by Change Orders $ 0.00 CONTRACTOR:
3 CONTRACT SUM TO DATE(Line 1+2) $ 33,150.00
4 TOTAL COMPLETED&STORED TO $ 24,121.36
B/ - f l�Date: G /z3/7/,
5 RETAINAGE: ( I horns .Koontz,President /
a. 0 %of Completed Work $ 0 ubsenbed d sworn to before me this day of 0---u AG 4 1G//
(Column D+Eon G703) •:'p,'<,6' LINDA BUCHANAN
b. %of Stored Material $ .='=NO,ARY`"`_ Hancock County
(Column F on G703) My Commission Expires
,s9 SEAL;?;
I otat Retamage(Lines na+ab or •"-•.i.oa■4O"` August 20,2011
Total in Column I of G703) $ 0.00 AKGH1 I EC I'S GEK I IF IGA 1 E FUK PAYMEN
6 'TOTAL EARNED LESS RETAINAGE $ 24,121 36 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) $ 9,550 43 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 14,570.93 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 9,028.65 $ /{S t ^ /f1/Q�
(Line 3 less Line 6) AMOUNT CERTIFIED
CHANGE ORDER SUMMARY AUDI I IONS D0DUC I IONS (Attach explanatio ' • .unt certified differs from the amount applied.Initial all figures on this
'I otal changes approved Application and*tithe Conti AL n Sheet that are changed to conform with the amount certified.) •
in previous months by Owner ARCFIITECT. `
Total approved this Month By Milk_ `, Date: ' •
TOTALS $0.00 $0.00 This Cert of egottable. Th AMOUNT CERTIFIED is payab •only t.,the
contractor n. . erem.Issuance,payment ana acceptance of payment a•wttn. I
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 -Certifica ' n of Document's Authenticity from the Licensee.
la-87L-- 6/3 of cr
v
I
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 2
6/23/11
Hanover Square Fountain
Carmel, Indiana
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed
NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost
General Requirements:
Site Supervision 16,575.00 4,827.77 9,512.71 0.00 14,340.48 87% 2,234.52 14,340.48
Construction Management Fee 16,575.00 4,722.66 5,058.22 0.00 9,780.88 59% 6,794.13 9,780.88
33,150.00 9,550.43 14,570.93 0.00 24,121.36 73% 9,028.65 24,121.36
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
Hanover Square Fountain, 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 forteen thousand
five hundred seventy dollars and ninty-three cents ($14,570.93) 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, furnished 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
/Thoma oontz, President
Subscribed and sworn to before me this:;_ii,e a 3
Notary Public: "r -,✓ ,
aaYPJ LINDA BUCHANAN
z NoTAR °'= Hancock County
se;L My Commission Expires
August 20,2011
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER Carmel Redevelopment Commissic PROJECT: Carmel City P 11 1 Waterproofin APPLICATION NO Invoice# 19 1 Distribution to:
One Civic Square Smock Signature costs OWNER
Carmel Indiana 46032 ARCHITECT
PERIOD TO: 6/23/2011 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,A1A 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
I. ORIGINAL CONTRACT SUM $ 81,776.00
2. Net change by Change Orders $ 1,190.00 CONTRACTOR
3. CONTRACT SUM TO DATE(Line 1 t 2) $ 82,966.00
4. TOTAL COMPLETED&STORED TO $ 82,966.00 7---------- //
By Date' G Z3 /(
5. RETAINAGE: Thomas L' oontz,President / Q"4 A t r 2.o i/
a. 0 %of Completed Work $ 0 S•bscribed a sworn to before me this 3 day of -:,,,o_o!+:•i-? - •----- ---
(Column D+Eon G703) LINDA BUCHANAN
`PRY PUe(''•,
b. %of Stored Material $ ',P.' V. Hancock County
(Column F on G703) •.- ` My Commission Expires
i otai Ketainage(Lines 2a+..5b or s'rs `"`' Au•ust20,2011
. f - A • - i 'r'��.!.i+ _. .,.:.....,.
Total in Column I of G703) $ 0.00 -- "'• •
6. TOTAL EARNED LESS RETAINAGE $ 82,966.00 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) $ 81,776.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 1,190.00 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE 5 0.00
(Line 3 less Line 6) AMOUNT CERTIFIED.. .. ... $
CHANGE ORDER SUMMARY ADDI I IONS DEDUC t IONS (Attach explanation ifanioi certified differs from the amount applied.Initial all figures on tins
t otal changes approved Application and.• e Con G .at ion Sheet that are changed to con form with the amount certified.)
in previous months by Owner ARCHITECT:
Total approved this Month By: _1 A, Date. L-A
TOTALS $0.00 $0.00 This Ce 'ficate is not egotiab*. The AMOUNT CERTIFIED is payable onl to th-
contracto .amen 'rein issuance,payment ana acceptance or payment are wi nout
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 AV .W.,WASHINGTON,DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenti ' om the Licensee.
E 6 (
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 19
6/23/11
Carmel City P111 Waterproofing-SMOCK
Carmel, Indiana
Total Work RETAINAGE I 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 36,483.00 1,190.00 0.00 35,293.00 36,483.00 100% 0.00
Site Safety Director 0.00 0.00 0.00 0.00 0.00 0% 0.00
Design Drawings 5,000.00 0.00 0.00 5,000.00 5,000.00 100% 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 0.00 0.00 41,483.00 41,483.00 100% 0.00
82,966.00 1,190.00 0.00 81,776.00 82,966.00 100% 0.00
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 one thousand
one hundred ninty dollars and zero cents ($1,190.00) 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
l
Thomat---
ontz, President
Subscribed and sworn to before me this:d .,..J.,, 4.7 3, ,a I/
Notary Public4 lg44-G•
;d' LINDA BUCHANAN
1 '„CITAR •.: Hancock County
=:s.,5E; My Commission Expires '
'.;oF;N�.'•?` August 20,2011