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HomeMy WebLinkAbout220059 05/21/2013 a emu. CITY OF CARMEL, INDIANA VENDOR: 367157 Page 1 of 1 ONE CIVIC SQUARE ANGELA PAINTING CHECK AMOUNT: $75.00 CARMEL, INDIANA 46032 8535 TWIN POINT CIRCLE INDIANAPOLIS IN 46236 CHECK NUMBER: 220059 CHECK DATE: 5/21/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460805 2 75 . 00 RETAIL SITE #5 APPLICATION AND CERTIFICATION FOR PAYMENT MA DOCUMENTIG702 PAGE ONE OFTWO TO OWNER: Ci IRS G PROJECT: East Retaining Wall APPLICATION NO: 2 Distribution to: =OWNER Carmel, Indiana 46032 =ARCHITECT PERIOD TO: =CONTRACTOR FROM CONTRACTOR: Angela Painting VIA CONSTRUCTION MANAGER: 8535 Twin Point Circle Signature Construction,LLC Indianapolis, IN 46236 720 Third Avenue,SW PROJECT NO: (317)281-1648 Carmel,Indiana 46032 CONTRACT DATE: 9/17/2012 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to die 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 SUNI $ 1,500.00 1"Q 1 ffa,-.Po��2. Net change by Change Orders $ 0.00 CONTRACTOR: , 3. CONTRACT SUM TO DATE(Line I f 2) $ 1,500.00 4. TOTAL COMPLETED&STORED TO DATE $ 1,500.00 By: Date: 5. RETAINAGE: + ��t PA. CY T1-11A r a. 5 u of Completed Work S 0.00 S S °� rrd sworn t�ie'f'or n42 t17t5 day of p - rion ounty -- (Column D+Eoil G703) SFa My Commission Expires b. 5 "rh of Stored Material S 0.00 'sP iO"T August 3,2016 (Column F on G703) Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 0.00 ENGINEER'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED 1-1-SS RETAINAGE $ 1,500.00 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR 0.00 Engineer's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 1,425.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 75.00 is entitled to payment of the AMOUNT CERTIFIED, 9. BALANCE TO FINISI-1,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED $__�C — CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all ftgures on thi. Total changes approved Application and o !ii it ion Sheet that are chentged 10 conform With the anuruni certiliet in previous Change Orders $0.00 $0.00 ENGINEER: Total approved this Change Order $0.00 $0-00 By: Date: TOTALS $0.00 $0.00 This Ce ificate i not neg le. The AMOUNT CERTIFIED is paya e o ,to the C ontrac[o herein. Issuance,payment and acceptance of paymen are without NET CHANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 6702 APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDfT*N 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. G703 CONTINUATION SHEET Page 2„r 2 To: From: Project: Application No.: 2 Signature Construction,LLC Angela Painting Fast Retaining Wall Application Date: 720 Third Avenue,SP1' 8535 Twin Point Circle Period To: Carmel,Indiana 46032 Indianapolis;IN 46236 Carmel,Indiana 46032 Engineer's Project No.: 0 A B C D E F C H I Work Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored '% To II # Description of Work Value Application This Period INot in To Dale (G/C) Finish Variable D or G) (D+F:tF) (C-C.) 1 Painting 1300.00 1,5(m1111 0.00 0.00 1,50(.1111 100'%, 0.00 0.00 0.00 0.00 0.00 0.00 #DIV/0! 0.00 0.00 0.00 0.110 0.00 0.01) #DIV/O! 0.00 0.0O 0.00 0.00 0.00 0.01) #DiV/0! 0.00 0.00 0.4111 0.00 0.00 0.01) #DIV/0! 0.00 0.11(1 0.00 0.00 O.1)O 0.1111 #DIV/0! 0.00 11.1111 0.00 0.00 0.00 0.00 #DIV/O! 0.(10 11.1111 1,5011.1111 1,5011.011 0.00 0.00 1,5110.00 100'% OM 0.110 INTERIM LIENICLAIM WAIVER F ro M: Proi�ect: 7,9 Mvinq Re!e�,se) LL- o ec 71 4-a Me-) us:asss press; Carmel. iR! i �,—,ro—fe dTdE,—t�—,gi� Contact Projec', Manager: Contact Telephone: Project Telephone CONDITIONAL RELEASE UNCONDITIONAL RELEASE The undersigned does hereby acknowledge that The undersigned does hereby acknowledge that the upon receipt by the undersigned of a check from(Name of undersigned has- received progress payments in the sum Firm writing check): The Pedcor companies of S in the sum of$ - __1A for i7b(;T'services,equipment or m and when the -check has bear,properly endorsed and h_9_ materials furnished to the above referenced job and does hereby release pro t2ntc, been paid by the bank upon which it was drawn, this any and all claims and rights of lien which the document shall become effective to release pro tanto any undersigned has on the above referenced job, and all claims and rights of lien which the undersigned This release covers all payment for labor services, equipment, has on the above referenced'iob. This release covers a materials furnished and/or claims tc the above referenced progress payment for labor, services, equipment, job through ;date) materials furnished and/or claims through (date, only and does not cover any retention or items after that.date. furnished only and does not cover any retention or items-furnished after that date. Before any recipient of this document NOTICE' THIS DOC UM-ENT WAIVES RIGHTS relies on it said Party should verify evidence of payment to UNCONDITIONALLY AND STATES THAT YOU HAVE the undersigned. BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF You HAVE NOT BEEN PAID, USE A CONDITIONAL I CERTIFY UNDER PENALTY OP PPRJURY UNDER RELEASE FORM. LAWS OF THE STATE OF THAT THE I CERTIFY UNDER PENALTY ABOVE IS A TRUE AND CORRECT STATEMENT. LAWS OF THE STATE OF_ OF PERJURY UNDER Signature- ABOVE IS A TRUE AND CORRECT ST ATEMENT,THAT THE Signat nom!edt,,�,,O .........................I.................7 cet!a ngiivwrrer� (////�' `` 7� , -1 '31 ___ 1) 1 A Dated this-day of �I Dated this 0__day of a Subscribed and sworn before me day and vr ar first above t: written: Subscribed and sw CYNTH WOODS orn before me da written: SrAl 11&2. first abmgo County My COmnii sion Expires Augus 3 2016 -------------- Notary Public My commission expires tic t Notary olary tic MY commission expires To: Signature Construction Warranty for lower level wall: Angela Construction gives warranty for the painting lower level wall for one year starting October 2012 through October 2013. Any issue that surfaces from the lower level wall please let us know we will take care of it. Thank You, Vladimir 04/17/13 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form 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. Q 1 J Payee Purchase Order No. IOam f oln4 (;' CJc Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) e' Soo i Total 75 0 1 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 Abuld IN SUM OF $ $535 T�i� Poii�f <,r�IP hc��cli�itboiis ;�/�/ �623 6 $ ON ACCOUNT OF APPROPRIATION FOR X182,1 Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), �}Q2 Z Q^ 5 75, or 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 Signature Executive Director Title Cost distribution ledger classification if Carmel Redevelopment Commission claim paid motor vehicle highway fund