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HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC -002312 -9/22/2011 CARMEL REDEVELOPMENT COMMISSION 002312 Signature Construction, LLC Check: 2312 720 3rd Ave., SW Date: 9/22/2011 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1A 2,753.33 2,753.33 0.00 0.00 2,753.33 Site amenities 1B 4,306.55 4,306.55 . 0.00 0.00 4,306.55 Site amenities 7,059.88 7,059.88 0.00 0.00 7,059.88 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Site Amenities APPLICATION NO Invoice#I P' Distribution to: Carmel Indiana 46032 Lafever Signature costs OWNER ARCHITECT PERIOD TO: 8/25/201 1 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pcdcor 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 $ 28,290.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I±2) $ 28,290.00 4. TOTAL COMPLETED&STORED TO $ 2,753.33 By: AM. T - Date: 8 �Y /j 5. RETAINAGE: "homas -. if ontz,President a. 0 %of Completed Work $ 0 Subsc bed and /torn to before me this a-e/ day of 1YS,20 fi (Column D+E on G703) ,o;, vAw`., LINDA G.BUCHANAN b. %of Stored Material $ F=-sornar'' Hancock County (Column F on G703) SE,L: / My Commission Expires Total Retainage(Lines 5a+5b or I u'• 6F:NO,1•' August20,2019 Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMEN 6. TOTAL EARNED LESS RETAINAGE $ 2,753.33 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) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor `� 8. CURRENT PAYMENT DUE $ 2,753.33 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 25,536.68 (Line 3 less Line 6) AMOUNT CERTIFIED $ 2 755.Y> 7 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Total changes approved Application and onth, ontinuat on Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: • V 2_9 Total approved this Month By: �!� `�,�• Date: 11 TOTALS $0.00 $0.00 This Cert.' tcate is rot negotiable. he AMOUNT CERTIFIED is payabl only to the Contractor . ecl •eretn.Issuance,payment and acceptance of payment are without 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 •©1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AV , .W.,W HINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity rom th Licen e` 1• SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 1 8/25/11 P112 Site Amenities - Lafever 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 13,145.00 0.00 1,487.05 0.00 1,487.05 11% 11,657.95 1,487.05 Meetings 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00 Construction Management Fee 14,145.00 0.00 1,266.28 0.00 1,266.28 9% 12,878.73 1,266.28 28,290.00 0.00 2,753.33 0.00 2,753.33 10% 25,536.68 2,753.33 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 Site Amenities, 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 seven hundred fifty-three dollars and thirty-three cents ($2,753.33) 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 Z---- homa . oontz, President Subscribed and sworn to before me this: ac,/ .1c-1 drc� // (T r Notary Public li -/g .•.1..::4.4:F6-,•, LINDA G.BUCHANAN , OTAR '"a Hancock County S=A, My Commission Expires "i'o?; '?` August 20,2019 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Site Amenities APPLICATION NO Invoice#I /3 Distribution to: Carmel Indiana 46032 smock Signature costs OWNER ARCHITECT PERIOD TO: 8/25/2011 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 $ 5,198.50 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I ±2) $ 5,198.50 _ 4. TOTAL COMPLETED&STORED TO $ 4,306.55 By: /NW; f Date: 84- 1)// 5. RETAINAGE: T auras E. . '1tz,President � a. 0 %of Completed Work $ 0 Subscri l ed and swsin to before me this �I day of/Am ?d1r' ' ,, LINDA G.BUCHANAN O�nPYPUBI�••- (Column D+E on G703) f='NOTAav°"a Hancock County b. %of Stored Material $ "" (Column F on G703) seAi : My Commission Expires �•-. pe� August 20,2019 Total Retainage(Lines 5a+5b or - • Total in Column I of 0703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 4,306.55 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) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 4,306.55 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 891.95 (Line 3 less Line 6) AMOUNT CERTIFIED $ 2197Q j,`J�5 Cl-IANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount cc tified differs from the amount applied.Initial all figures on this Total changes approved Application and on C:: . ion Sheet that are changed to conform with the amount certified.) �// in previous months by Owner ARCHITECT: (1 4f' Total approved this Month By: _���', Date: ,' 1\ TOTALS $0.00 $0.00 This Certificate i not negotiable''he AMOUNT CERTIFIED is payable'only to the contract r name neretn.issuance,payment ana acceptance 01 payment are without NET CHANGES by Change Order $0.00 prejudice at 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,W NG ON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from t Lic see .. . -C a/3tf, • • SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 1 8/25/11 P112 Site Amenities - Smock 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 2,599.25 0.00 2,516.85 0.00 2,516.85 97% 82.40 2,516.85 Construction Management Fee 2,599.25 0.00 1,789.70 0.00 1,789.70 69% 809.55 1,789.70 5,198.50 0.00 4,306.55 0.00 4,306.55 83% 891.95 4,306.55 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 Site Amenities, 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 four thousand three hundred six dollars and fifty-five cents ($4,306.55) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC f homas . Koontz, President ■ Subscribed and sworn to before me this: -i7 Notary Public:!%' . 4144.''F . LINDA G.BUCHANAN NOTARY : °= Hancock County • . �•.5EAL My Commission Expires -'1$. M°s Au ust 20,2019 Prescribed by State Board ot Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Sy ti<77C/V-°C oj7_5 �4,c7% </ LL Purchase Order No. 72D Yi„/ .,v6z7:. S Terms �i //v 2/6- '32 Date Due Invoice Invoice Description Amount Date Number 11 (or note attached invoice(s) or bill(s)) �2L✓I� /� 5, e ��Pt7,,''1'�/�� Lg '4;ve?, 7 5-3 _ 3 S -25 /, 1�} - '{306.5 ya Total ,SJ ?. I hereby certify that the attached invoice(s), or bill(s), is (are) true a.: . - t a dl h. - . sited same in accordance with IC 5-11-10-1.6. i �4. 20 rk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 .Sid/74/2" P CO/7-57( <5. 5.;/-0';-.75 L`C IN SUM OF $ -720 3r ' 6.ec/. //I/ '4/e.032 $ 7, O5-9, 8.8 ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT hereby certify invoice(s), DEPT.# I hereb certif that the attached invoices , or 41qWo7 753.33 bill(s) is (are) true and correct and that the ✓,3 71 9 7 L/3o6.55- materials or services itemized thereon for which charge is made were ordered and received except l 1320I/ ExeCuh ve Director Title Cost distribution ledger classification if Carmel Redevelopment paid motor vehicle highway fund pment Commission