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Home My WebLink About220058 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 367176 Page 1 of 1 ONE CIVIC SQUARE ANDREWS CONSTRUCTION CO CHECK AMOUNT: $9,450.00 o CARMEL, INDIANA 46032 7808 MARQUIS LANE INDIANAPOLIS IN 46260 CHECK NUMBER: 220058 CHECK DATE: 5121/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 1 9, 450 . 00 PERFORMING ARTS CENTE (Instructions on reverse side) PAGE ONE OF PAGES APPLICATION AND CERTIFICATE FOR PAYMENT A/A DOCUMENT G702 TO(OWNER): PROJECT: APPLICATION NO: 1 Distribution to: Carmel Redevelooment Commission Carmel Palladium Steel Retrofit 2013 X OWNER 30 W Main Street, Suite 220, Carmel, IN 46032 PERIOD TO:5-01-2013 ARCHITECT rONTRArTOR FROM(CONTRACTOR): VIA(ARCHITECT), ARCHITECT'S Andrews Construction Co PROJECT NO: CONTRACT FOR:Steel Retrofit CONTRACT DATE: Application is made for Payment,as shown below,in connection with the Contract. CONTRACTORS APPLICATION FOR PAYMENT Continuation Sheet,AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM............................................... $ 35,100.00 CHANGE ORDER SUMMARY 2 , Net change by Change Orders ....................................... $ 0 Change Orders approved in ADDITIONS DEDUCTIONS 3. CONTRACT SUM TO DATE(Line 1 t2) ............................. $ 35.100.00 previous months by Owner 4.TOTAL COMPLETED&STORED TO DATE ....................... $ t o, E'O o .00 TOTAL (Column G on G703) 5. RETAINAGE: Number' Date App A 10 %of Completed Work (Column D+ E on G703) b %of Stored Material $ 1,050 (Column F on G703) Total Retainage(Line 5a+5b or TOTALS Total in Column I of G703) ....................................$ 1,050.00 6. TOTAL EARNED LESS RETAINAGE .................................. $ .00 Net change by Change Orders (Line 4 less Line 5 Total) The undersigned Contractor certifies that to the best of the Contractor's knowledge, 7. LESS PREVIOUS CERTIFICATES FOR information and belief the Work covered by this Application for Payment has been PAYMENT(Line 6 from prior Certificate) .................... .00 completed in accordance with the Contract Documents, that all amounts have been g CURRENT PAYMENT DUE paid by the Contractor for Work for which previous Certificates for Payment were ..........................• .............•••••• 9.460.00 issued and payments received from the Owner, and that current payment shown 9• BALANCE TO FINISH, PLUS RETAINAGE ...I..................... $ 25,650.00 herein is now due. (Line 3 less Line 6) CONTRACTOR: Stale of: County of: By: Scott Andrews Date: 5/01/2013 Subscribed and sworn to before me this day of ,19 ARCHITECT'S CERTIFICATE FOR PAYMENT NotaMy Commission expires: In accordance with the Contract Documents, based on on-site observations and AMOUNT CERTIFIED............................................................... $ 9450, 00 the data comprising the above application, the Architect certifies to the Owner that to (Attach explanation if amount certified differs from the amount applied for.) the best of the Architect's knowledge, information and belief the Work has ARGIII:FEG;F: /f4,4AG-Ee- progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. By: Date- S 2•! 3 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702 APPLICATION AND CERTIFICATE A I •c i THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHING ION,D.C.20006 G702-1983 CONTINUATION SHEET AAA DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 1 Contractor's signed Certification is attached. APPLICATION DATE: 3-26-2012 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 3-31-2012 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G—C) TO FINISH APPLICATION STORED AND STORED (C—G) (D+E) (NOT IN TO DATE D OR El D+E+F 1 General Conditions $4,000 $ 1,800 $ 1,800 45 $ 2,200 $ 180 2 Performance and Payment Bond $ 1,200 $ 1,200 $ 1,200 100 $ 0 $ 120 3 Scaffolding $ 22,700 $ 7,500 $ 7,500 33 $ 15,200 $ 750 4 Masonry $ 3,000 $ 0 $ 0 0 $ 3,000 $ 0 5 Fire Proofing $ 4,200 $ 0 $ 0 0 $ 4,200 $ 0 I $ 35,100 $ 10,500 $ 10,500 30 $ 24,600 $ 1,050 AM DOCUMENT 0703•APPLICATION AND CERTIFICATE FOR PAYMENT•MAY 1983 EDITION•AIA'•t 1983 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006 G703-1983 Partial Lien Waiver WHEREAS,Andrews Construction Co,7808 Marquis Lane,Indianapolis,IN 46260. "Contractor", has been heretofore employed by Carmel Redevlopment Commission,30 W Main street,Suite 220 Carmel,IN 46032. to furnish certain material, supplies, equipment, and/or labor for or in connection with improvements owned by Carmel Redevelopment Commission and located at Carmel Palladium, Steel Retrofit,One Center Green, Carmel,IN 46032,hereinafter collectively referred to as the"Premises:'' and WHEREAS,the undersigned is duly authorized to execute the Waiver of Lien for and on behalf of the Contractor: NOW,THEREFORE,the contractor, for and in consideration of the receipt of Nine thousand Four hundred fifty and -------00/100 Dollars$9,450.00 hereby waives and releases the Owner of the Premises and the Company from any and all liens,rights of lien or claims of whatsoever kind or character on or against the Premises or the improvements located thereon account of any and all labor, supplies, equipment, material furnished for, in connection with or incorporated in the Premises by the Contractor on or before the date thereof represents and warrants that no other person or party has any right to a lien or claim on account of any labor or work performed or material, supplies, or equipment furnished to,to or through the Contractor,on or before the date hereof, and agrees to indemnify, defend and hold the Owner and the Company harmless from and against any and all claims or liens for any labor, material, or services furnished to the date hereof. This Waiver of Lien is given in order to induce the Company to pay the amount indicated above,and upon receipt of such amount by the Contractor, this release may be recorded, becomes valid, enforceable and to full effect. Andrews Construction Co LLC Name of Contractor J,,-,� a, "yu./ Authorized Representative Date: / State of Indiana County of Marion Before me, a Notary Public in and for said County and State,personally appeared, who acknowledged the execution of the foregoing Waiver of Lien, and who,having been duly sworn,stated that the representations therein contained are true. Witness my hand of Notorial Seal this �day of —5 , 20 /j My Commission Expires: d u a l h CGS` Notary Public JENNIFER ANN FICKLE NOTARY PUBLIC SEAL STATE OF INDIANA COMMISSION F. pikI S FEBRUARY 12,2020, Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Forth No.201(Rev.1995) 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 An6 V3 Cpq PU(�t"I qrl �0. Purchase Order No. 8 ` 'Z,4A P Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Do Total Q q 50,o y I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- dance with IC 5-11-10-1.6. , 20 Clerk-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 Ahlmv� �o��sfrK� ion �0 - IN SUM OF $ -1 $09 &Ng,15 � 1 dp gt10 .2 N 46Z60 $ q4�50. 00 ON ACCOUNT OF APPROPRIATION FOR Board Members Po#or D PT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), qQ� 410107 9,g5Q,06 or bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered arid received except S-2 — 2113 ignature Executive Director Title Cost distribution ledger classification if Carmel Redevelopment Commission claim paid motor vehicle highway fund