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HomeMy WebLinkAboutM.A.B. & ASSOCIATES, INC. -002495 -12/5/2011 Transmittal Sheet Page 1 Carmel Redevelopment Comm M.A.B. &Associates, Inc. Check: 2495 7648 Camelback Drive Date: 12/5/2011 Indianapolis, IN 46250 Vendor: MAB & Al Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 40 3,870.00 387.00 0.00 0.00 387.00 Application 1 2 40 11,187.00 1,118.70 0.00 0.00 1,118.70 appliction 2 3 40 5,508.00 550.80 0.00 0.00 550.80 Application 3 4 40 17,787.00 1,778.70 0.00 0.00 1,778.70 Application 4 5 40 46,691.00 4,669.10 0.00 0.00 4,669.10 Application 5 six 40 64,880.00 4,703.55 0.00 0.00 4,703.55 Application six 149,923.00 13,207.85 0.00 0.00 13,207.85 AIA yd .4.At v AI ........... Document 702/C a — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: r /� PROJECT: �:a met 1 t ',1,,r,,: ' s APPLICATION NO: /2... C`�e'ria:wM1 e--• Distribution to: PERIOD TO: i/.2-7i i i OWNER ❑ CA$.0te, - 44'03 z CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: . VIA C�QNS UCTIC 1 MANAGER: CONTRACT DATE: 2127/0' ARCHITECT ❑ ,. �I g 41 ,�Q dic,.,dTyr, .: 1,C'. 5U,.,Fsa k ^"-' eo PROJECT NOS: -76v? 0.401 el -bn �6 c'312 s CONTRACTOR ❑ ��tt..,a P,i,S ,...--1;,. 4-2(o VIA ARCHITECT: C'_so >Q�a;-rte cT'i FIELD ❑ CONTRACT FOR: A.t-C,i,.... 04.4,4,ii,T.4/ Z4 •'Df_ ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Doc ff ntsrtharail amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. f Cert. es for Payment,were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 25-31 '$Z pa ment shown herein . how due. 2.Net change by Change Orders $ ( CO TRACTOR: /l i r3. ' ee t 3.CONTRACT SUM TO DATE(Line I ±2) $ _Z&o 1 S 7 BY: I - - C _ Date: f�5�!i 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) $ 'Z�,i4) I S-7 State of: 5.RETAINAGE: County of�,�;,r a. %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ me this L'S— �f L' _•A' a�.ryQfy� Deborah Danville b. %of Stored Material Notary Public: I • -?°'o•..°+ Resident Of (Column F on G703) $ My Commission ex fires: Ei f ,ct= Total Retainage(Lines 5a+5b or Total in Column I of G703). $ CERTIFICATE FOR PAYMENT b+„na, 4/3/2015 In accordance with the Contract Documents,based on on-site observations an. I e ca...c.m.rising 6.TOTAL EARNED LESS RETAINAGE $ this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) ,g5- knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ Z 5ei I cf, accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. +S 8.CURRENT PAYMENT DUE $ /31 Z�7 /3 I AMOUNT CERTIFIED r $ , ' Z 1 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from a amount applied.Initial ail figures on this Application and on t eContinuation She:t hat ar changed to conform with the a unt ertified) QIC (Line 3 less Line 6) $ t� CONS •UCTIOt ,4G R: - _ Date: BY: �Rr r l.1.wfi/ A. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH '�, t t e j ` f Total char es a roved in revious months b Owner $ $ B 1% g PP P Y (t�f a'('S y: Date: I I Z Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable o 'y to the Contractor TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order $ (L,, L'7 5 CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. _ AEA Document G702/CManl-1992.Copyright©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA°Document Is protected by U.S.Copyright law and International Treaties. Unauthorized reproduction or distribution of this AIA° Document,or any portion of it,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. - ____-_--..,...:».,.••„.e.,,...4.-P ton tthi rnniPC of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. CONTINUATION SHEET Date 1/25/2011 APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: twelve Contractor's signed Certification is attached. APPLICATION DATE: 11/30/2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 1/2512011 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO. 19/22 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 (GIG) TO FINISH APPLICATION STORED AND STORED (C-G) ID.El (NOT IN TO DATE D OR E) (D*E.F) , 0100 Base Contract 0101 Performance&Payment Bond $ 3,870.00 $ 3,870.00_ $ 3,870.00 100% $ - 0102 Detailing&Englneenng $ 16,695.00 $ 16,695.00 $ 16,695.00 100% $ - 0103 Material MT la rail $ 15,962 00 $ 15,962 00 $ 15 962.00 100% $ - 0104 Fabncation MT la $ 68,191.00 $ 68,191.00 $ 68,191 00 100% $ - 0105 lnstallaton $ 15,600 00 $ 15,600 00 $ 15,600.00 100% $ 0106 Material MT lb $ 9,271.00 $ 9,271 00 - $ 9,271 00 _ 100% $ - 0107 Fabrication MT lb _$ 28,202 00 $ 28,202 00 $ 28,202 00 100% $ 0108 Installation $ 8,700.00 $ 8,700 00 $ 8,700 00 100% $ 0109 Material MT lc $ 9,528 00 $ 9,528.00 $ 9,528 00 100% $ - 0110 Fabriatlon MT1c $ 29,952.00 $ 29,952 00 $ 29,952.00 100% $ - Installation $ 7,990 00 $ 7,990.00 $ 7,990 00 100% $ Material 1-line $ 3,724.00 $ 3,724.00 $ 3,724.00 100% $ - Fabrication $ 5,916.00 $ 5,916.00 $ 5,916.00 100% $ - Installation $ 2,183.00 $ 2,183.00 $ 2,18300 100% $ - Powder Coat MT 1A $ 11,091.00 $ 11,091.00 $ 11,091.00 100% $ - Powder Coat MT 15 $ 3,482.00 $ 3,482.00 $ 3,482.00 100% Powder Coat MT 1C $ 7,352.00 $ 7,352.00 $ 7,352.00 100% $ - _ Powder Coat Single line $ 1,173.00 $ 1,173.00 $ 1,173.00 100% Change Order#1 $ 8,46000 $ 8,46000 $ 8,460 00 100% $ - Cash Allowance Authorization _ $5,000 $ 5,000.00 $ 5,000.00 100% $ - ChangeOrder#3 $1,815 $ 1,815.00 $ 1,815.00 100% $ - TOTAL $ 264,157.00 $ 264,157.00 $ - $ - $ 264,157.00 0% $ - $13,207.00 • AFFIDAVIT AND WAIVER OF LIEN ' Final _1C Partial Payment to follow -- ST INDIANA, COUNTY OF '')9k-i, '-`.� . SS: « ,, being duly sworn states that he/she is the C-e „,:c?L-k- . a k; of ,ii.a rB . tk_o-d-ac ., , := .-e' . . (tide) (supplier or subcontractor) having contracted with (I Jt C�0.-1 (.�. to furnish certain material �, ((ontractor) -CP and/or labor as follows: �1..c-{, C oc.A,,44 k-K � c Z, ,(/: VI .�;i� Vv-c�.e,v . '311'6-) /1 n r (descriptiA n�for the prof kno as C� 61--c��t t..- ge -1 j } and wned b L. :,k located at L'���r�4' � d--� Y ��� -� architect (1 Cc < . and does hereby further er state on behalf of the aforementioned subcontractor/supplier, PARTIAL WAIVBR that the balance due frorpt contractor is the sum of .5-- ' �/ /� �{ty .,.f, D dollars($Zit,Y-6c) ) �L�-t+ cY.�t,rl� G.+.t it ���'"r � 7S/:,cL. �.:�.. (SC)receipt of w ch is l ereby acknowledged; or k ( )the payment of which has been promised as the sole consideration for this affidavit and partial Waiver of Lien,which is given to and for said amount, effective upon receipt for such payment; FINAL WAIVER that the final balance due from the contractor is the sum of . dollars($ ) ( )receipt of which is hereby acknowledged: or ( )the payment of which has been promised as the sole consideration for this affidavit and partial Waiver of Lien which shall become effective upon receipt for such payment. THEREFORE,the undersigned waives and releases unto the owner of said premises,any and All lien of claim whatsoever on the above described property improvements thereon on account • of labor and materials, or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right •-a-lien-on-account of any work performed or material furnished to the undersigned or said payment, and within the scope of this affidavit and waiver. A-A-R.4 Asc,c,;0--1 :7-37-i-c., all ,......, f A (3/Ct4 GO_„1 (name of claimant) ' authorizetrepresentati - (title) Witness my han - ,notarial eal,this Z 5 day of L.. 19 i i. ,..c_ca My comm* ion expires: 47//,3724-:s I' f-=.� j (signalture of notary) • Residing i County Printed . :vat,. Deborah Ounvas .( is 4/ 15 �� AFFIDAVIT AND WAIVER OF LIEN Final Partial Payment to follow SWE Of INDIANA, COUNTY OF '21e, . SS: « `— being duly sworn states that he/she is the, ;, �� l � of 41„1 -8 (title) (supplier or subcontractor) having contracted with C° LK c iv c.� • to furnish certain material I. (Contractor) n and/or labor as follows: (6-1--(viwt (descripti n)for the proj kno as 0_.c (k(t r- j located at (16-441,1,,v and wnedb y C architect (i CC . and does hereby furflier state on behalf of the aforementioned subcontractor/supplier. PARTIAL WAIVER that the balance due from contractor is the sum of 7 9S' g L�l�cYnzcx 3� d j nA,n�c 26O NI ) receipt of wllic i hereby acknowla ; orl the payment of which has been promised as the sole consideration for this affidavit and partial Waiver of Lien,which is given to and for said amount, effective upon receipt for such payment; FINAL WAIVER that the final balance due from the contractor is the sum of dollars($ ) ( )receipt of which is hereby acknowledged: or ( )the payment of which has been promised as the sole consideration for this affidavit and partial Waiver of Lien which shall become effective upon receipt for such payment. THEREFORE,the undersigned waives and releases unto the owner of said premises,any and All lien of claim whatsoever on the above described property improvements thereon on account of labor and materials, 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 performed or material furnished to the undersigned fo • •. a • _ the scope of this affidavit and waiver. •jAc oC.--`71( C (name of claimant) authonzed•representa E) (title) 2J ( Witness my hand and notarial e ,this 2 day of 44, 19 My commissi empires: ; ( otary) ' Residing in G County Printed %/•-; 4: .i.1_.,, / "':«'% Deborah Dunville yO��N•.'L Resident Of g*:i.R 1 Marion County a��o;ept.�°'S My Commiss on Expires: • �v nor 4/3/2015 FINAL WAIVER OF LIEN undersigns is a general contractor, a subcontractor, a material man or other,,,,p, furnishing iq/gxte. crAL ;Q, in the co truction of/' pr vements upon real estate located in w.SC i� County. State of Indiana, commonly known as Aarue� l I�t�Aw+(.. s� Aa�S CO"TP°z- Upon receipt of the sum of `�iv�a f" dog si N �".--72-4.,,, -a�...),�� '�SP✓Pr✓ boo Dollars ($ /3, 2o-1 . /S'-- ), and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the undersigned will hereby waive, release and quit claim in favor of the owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made and their assigns, all lien or claim or right to lien upon the land or improvements above described which the undersigned may now have for services, labor, material or equipment furnished in respect of such land or improvements to and including the date hereof. The undersigned warrants that he has not and will not assign any claim for payment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens. The undersigned further warrants and represents that he has the right to transfer and does hereby transfer title to the services, labor, material, or equipment to the owners or lenders named above Upon receipt of the payment. The undersigned further states that the payment is the full amount due and owing to the undersigned for said services, labor, material, or equipment furnished to date, and that he has neither received nor made any security interest, title retention, or lien rights in the said services, labor, material or equipment other than that released and transferred hereby. This document is subject to I.C. 32-8-3-15 which provides that: Sec. 15. A person who: (A) performs labor, supplies services, or furnishes material or machinery in the construction, repair, or remodeling of any building, structure, or any other work; (B) accepts payment for the labor, services, material, or machinery so furnished and supplied; and (C) at the time of receiving the payment, knows he is indebted to another for labor(including fringe benefits and union dues, and including the cost of renting or leasing construction and other equipment and tools, whether or not an operator is also provided by the lessor), services, material or machinery used or employed in the construction, repair, or remodeling; 1) who, at the time of receiving the payment, with intent to defraud, fails to notify in writing the person from whom the payment was received of the existence of the outstanding indebtedness; and 2) hose failure under subdivision (2) to notify the person from whom •a ment was received causes that person to suffer a loss; commits a Class D felony. Dated i// /, itL.,. ,u4.s2J2- N. , TITLE •t ditA SUBCONTRACTOR State of ' g . _, County of :-/A •-f r , SS: Before me the undersigned a Notary Public in and for said County and State, personally appeared .L '- et,4. -73c a • who acknowledged the execution of the foregoing Waiver of Lien. Witness my hand and notarial seal this day of n/4-. 2O // . My commission expires"/�3-/-7-0>>- ( /� /� NOTARY PUBLIC .•,'':""a• Deborah Dunville A ,..r A",4 Resident Of »Cf•Af IV-,r: sEx r*= Marion County t ?Mei. a; My Commission Expires: + 4/312015 UttLETVFCRM$$UBCONTRACTS4SUB ATTACHMENT 0 REVISED 5.1506 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. M.A. B. A5iocictrrc1 Payee _ i(1 Purchase Order No. -764g Cie( b,LI' Pr:. Terms 1.4,1\ 4OI(3 11 146250 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 1-25A1 rek4edioh oh SAC work 13207. '5 a • aF , ri374 tr Total 13J 207, S' z I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct an. -.7s. - - in accordance y; with IC 5-11-10-1.6. la- , 20 ) t r-." -Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 A, 6, cA5o4es IN SUM OF $ 7491 Camel B&1k Dr. Zndanniolo,TN 46250, $ 13, 207. 15 ON ACCOUNT OF APPROPRIATION FOR aat/ 4H-Cogo7 Board Members Po#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or D2 4 rodgo7 151207.15 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 11-3-�o?; tip Ellie Director Cost distribution ledger classification if Title g Carmel Redevelopment Commission claim paid motor vehicle highway fund