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HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC -002402 -10/20/2011 CARMEL REDEVELOPMENT COMMISSION 002402 Signature Construction, LLC Check: 2402 720 3rd Ave., SW Date: 10/20/2011 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-7 674.63 674.63 0.00 0.00 674.63 Site amenities- Smock 2-21 12,273.00 12,273.00 0.00 0.00 12,273.00 Site Ameneties LaFever 4-5 1,003.04 1,003.04 0.00 0.00 1,003.04 Hanover Square Fountain 13,950.67 13,950.67 0.00 0.00 13,950.67 1 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Hanover Square Fountain APPLICATION NO Invoice k 5 1 Distribution to: Carmel Indiana 46032 Signature costs OWNER ARCHITECT PERIOD TO: 9/25/2011 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 $ 33,150.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I±2) $ 33,150.00 4. TOTAL COMPLETED&STORED TO $ 32,207.50 / Q/Z ,// i By ` Date: 5. RETAINAGE: homas C' 5'sontz, resi.cnt a. 0 %of Completed Work $ 0 Su •cribed and/orn to before me this 13 da of a if (Column D+Eon G703) b. %of Stored Material $ ' ''... LINDA G.BUCHANAN (Column F on G703) = NOTARY': : Hancock County rota'Retalnage(Lines.)a+.fibor -.5:.S .:,.' My Commission Expires Total in Column I of G703) $ 0.00 ' - - - ■ • - ' • ' ► 1 ''•^,•••,' . ''. st 20,2019 6. TOTAL EARNED LESS RETAINAGE $ 32,207.50 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) $ 31,204.46 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 1,003.04 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 942.50 (Line 3 less Line 6) AMOUNT CERTIFIED.... ......$ /003.041 CHANGE ORDER SUMMARY ADM I IONS DEDUC I IONS (Attach explanation i : : .•rtified differs from the amount applied.Initial all figures on this ^� Total changes approved Application and of •Continuo '., heet that are changed to conform with the amount certified.) IlJ in previous months by Owner ARCHITECT: I Total approved this Month By: latigr Date: 7/4 alp I(/ TOTALS $0.00 $0.00 This Certifica e is no.ntgoti . The AMOUNT CERTIFIED is payable only to the • contractor na ea ner•I .issuance,payment aria acceptance of payment are witnout NET CHANGES by Change Order $0.00 prejudice to any • s 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 N ORK E.,N.W.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document 0401 -Certification of Document's Aut enticity rom icensee. 9/zi . . , SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 5 9/25/11 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 16,575.00 0.00 0.00 16,575.00 100% 0.00 16,575.00 Construction Management Fee 16,575.00 14,629.46 1,003.04 0.00 15,632.50 94% 942.50 15,632.50 33,150.00 31,204.46 A 1,003.04 0.00 32,207.50 97% 942.50 32,207.50 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 one thousand three dollars and four cents ($1,003.04) 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 I Thom Ko tz, President Subscri ed and sworn to before me this: 3 2 oil Notary Public: 4 r c, LINDA G.BUCHANAN ivoTnar• = Hancock County 5u, ...,i My Commission Expires •,9,OF INO ' August 20,2019 Prescribed by State Board of 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 Col 7[rvc ci}j ec«3, 1,4a- Purchase Order No. 720 30 'pr '-' ' 5-a/- Terms Ca' •-e. /t) 4(6032 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) (2x1// �� j,y /4 Ol3 .6 y !{�sdJP% — GT=t'�P Total , ao _ 05' I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I hav= . same in accordance with IC 5-11-10-1.6. 20 le !-% - - reasurer VOUCHER NO. WARRANT NO. ALLOWED 20 S a/ IN SUM OF $ 72(0 n2i/c°)./ •-�;�,� /V 32 1. $ 1� 003. o ' ON ACCOUNT OF APPROPRIATION FOR 90 2 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 902. S 171y60g0s /o0 W1 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except /O —S— 20 4/ ignature Extive Director Cost distribution ledger classification if claim paid motor vehicle highway fund Carmel Redevelopment Commission APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: Site Amenities APPLICA'T'ION NO Invoice#2 Distribution to: Carmel Indiana 46032 Smock Signature costs OWNER ARCHITECT PERIOD TO: 9/25/2011 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Cannel,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 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 $ 0.150 CONTRACTOR' 3. CONTRACT SUM TO DATE(Line 1 t 2) 5 2,198 20 / 1/ 4. TOTAL COMPLETED&STORED TO $ 4,981.18 ?/Z3 / By: AM( T 9 Date' f 1 5 RETAINAGE. omas ".entz, •resi•ent a 0%of Completed Work $ 0 Subsc ibed and sw.rn to before me this a 841••y of.45...-)4 a0!/ (Column D+Eon 0703) '�"'°gig• LINDA G.BUCHANAN b. %of Stored Material $ ••' ' •N T^WY': = Hancock Coun (Column F on 0703) *:.s� My Commission E fires I otat teetainage(Lines ba+2b or ` Commt 20,20 9 Total in Column I of G703) $ 0.00 - - 6 TOTAL EARNED LESS RETAINAGE 5 4,981 18 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) 5 4,306.55 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8 CURRENT PAYMENT DUE 5 674.63 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 217.33 (Line 3 less Line 6) AMOUNT CERTIFIED $ 01.03 CHANGE ORDER SUMMARY AUDI I IONS UEDUC I IONS (Attach explanation famonnt ce idled d; ers from the amount applied.Initial all figures on this Total changes approved Application and on -. • ..• S eet tat are changed to conform with the amount certified.) in previous months by Owner ARCI-IITECT: Total approved this Month By: `i�� I Date: q/l0/1/ TOTALS $0.00 $0.00 This Certificate is n t n•gotiable Ile AMOUNT CERTIFIED is payable only to the Loniractor na •ea n rein.issuance,payment ana acceptance of payment are wimoui NET CHANGES by Change Order $0.00 prejudice to any ri• is of the Owner or Contractor under this Contract AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT'1992 EDITION AIA '©1992 THE AMERICAN INSTITUTE OF ARCHIT ` 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 Docu .• Aut ticity from the Licensee. r ii2Vi( \O� Q • SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 2 9/25/11 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 2,516.85 0.00 0.00 2,516.85 97% 82.40 2,516.85 Construction Management Fee 2,599.25 1,789.70 674.63 0.00 2,464.33 95% 134.93 2,464.33 5,198.50 4,306.55 674.63 0.00 4,981.18 96% 217.33 4,981.18 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 six hundred seventy-four dollars and sixty-three cents ($674.63) 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 l Thofnas ' ontz, President Sub cubed and sworn to before me this: c,? , Af. a a 1/ Notary Public: P‹.- Prescribed by State Board of 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 s�r5�v 7LVS-r Coin f7tl e/c i/oh Sf'vv < � L Lc, Purchase Order No. 720 3rd AlaP./,,-, 5- . Terms - C4 /'U 3 Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9/257/// Total 7y I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have a :'�r-: :� e in accordance, with IC 5-11-10-1.6. // to—it , 20 �( - -- easurer ,�, VOUCHER NO. WARRANT NO. ALLOWED 20 5,��/?�vr���aSTi�cTiUt S"vvec�i� �C 72a 3��/ve S �, IN SUM OF $ ///,1 1l032 $ (,7y,�3 ON ACCOUNT OF APPROPRIATION FOR Board Members or INVOICE NO. ACCT#/TITLE AMOUNT oEPPO#,-.# I hereby certify that the attached invoice(s), or X02 2 '7Y6odd 7 67,.&3 bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except /O- .5-201( .gnature Executive Director itle Cost distribution ledger classification if claim paid motor vehicle highway fund Cannel Redevelopment Commission .. fi APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER CRC at City of Carmel PROJECT: Site Amenities APPLICATION NO Invoice#2 Distribution to: 'x4. Carmel Indiana 46032 Lafever Signature costs 'OWNER fiy ARCHITECT PERIOD TO. 9/25/2011 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 $ 28,290 00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1 ±2) $ 28,290 00 / 4. TOTAL COMPLETED&STORED TO $ 1 x,026.33 z By: r late: 9 !� 5 RETAINAGE: p 'omas -. Ka/ tz,before m t ' S(�� /( "w;'(%k LINDA G.BUCHANAN a. 0%of Completed Work $ 0 Subscr bed and SW.. to before me this day. ° Hancock County NOTARY (Column D+Eon G703) -. SEAL *` My Commission Expires b. %of Stored Material $ L'":55,!f : August 20,2019 (Column F on G703) 1 otai Retamage(Lines as+26 or — Total in Column IofG703) $ 0.00 ARt:HIIEGI'S GEKIIFIGAIt 1-OR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 1 2,026 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) $ 2,753.33 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 12,273.00 is entitled to payment of the AMOUNT CERTIFIED. 9 BALANCE TO FINISH,INCLUDING RETAINAGE $ 13,263.68 (Line 3 less Line 6) AMOUNT CERTIFIED $ I a,r3 CHANGE ORDER SUMMARY AUDI I IONS DEDUC I IONS (Attach explanation famoun1 certified differs from the amount applied.Initial all figures on this I otal changes approved Application an. r •Conti, bn heel that are changed to conform with the amount cell fired.) in previous months by Owner ARCHTTEcT. 1 • Total approved this Month By: Date: ' (Q/I( -- ya TOTALS $0.00 $0.00 This Certificate is •it egotiable. The AMOUNT CERTIFIED is payable only to the Lontraciortnamea n ref•.issuance,payment anu acceptance or payment are wimout P\ i NET CHANGES by Change Order $0.00 prejudice to\@ny ngo ts of the Owner or Contractor under this Contract AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT.1992 EDITION.AIA -©1992 THE AMERICAN NTITUTE OF ARCHITECTS.1735 YORK VE.,N.W,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's A henticit from th icensee. 477Z it f 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 twelve thousand two hundred seventy-three dollars and zero cents ($12,273.00) 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, 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 Th(flas E. K ntz, President Subscribed and sworn to before me this: c?s of ao e/ Notary Public: 5 ;'43.• 'P;', LINDA G.BUCHANAN �TAR Hancock County N. SEAL; My Commission Expires �EOF iNOP` August 20,2019 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 2 9/25/11 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 1,487.05 11,657.95 0.00 13,145.00 100% 0.00 13,145.00 Meetings 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00 Construction Management Fee 14,145.00 1,266.28 615.05 0.00 1,881.33 13% 12,263.68 1,881.33 28,290.00 2,753.33 12,273.00 0.00 15,026.33 53% 13,263.68 15,026.33 Prescribed by State Board of 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 579,7q/Ly e a«7747-4.-cf c 4 vie } LL Purchase Order No. 72 34-0/ 5_ Terms C� �� /4„) 4/6032 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 9&5/l( 2 5/A, 2.0 40°ve",— 12(213.60 • �.x Total /( ?3.- U .: I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I •_ .- . dit s.me in accordance' with IC 5-11-10-1.6. to -lk , 20 '1 ce:` / I - reasurer VOUCHER NO. WARRANT NO. ' ALLOWED 20 $ ig7vv� CoirSfrac-7 6.7 vr�_ Lzz. IN SUM OF $ 7 2 d Coe. -/, //t/ `/L O 3 2 $ T2, 2-73 ,v� ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or INVOICE NO. ACCT#!TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or 2 Y2/6 i z7 1212.1,6b bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except /0-6 20 /7 ignature Executive Director e Cost distribution ledger classification if claim paid motor vehicle highway fund Carmel Redevelopment Commission