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HomeMy WebLinkAbout220237 05/21/2013 CITY OF CARMEL, INDIANA VENDOR: 367177 Page 1 of 1 ` ONE CIVIC SQUARE LENEX STEEL COMPANY CARMEL, INDIANA 46032 250 E 96TH ST SUITE 150 CHECK AMOUNT: $15,525.00 INDIANAPOLIS IN 46240 CHECK NUMBER: 220237 CHECK DATE: 5/21/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 1 15, 525 . 00 PERFORMING ARTS CENTE �� TM =: Document Gl 1 992 Application and Certificate for Payment 7O OWNER:.Carmel:Redevelop.Commission PROJECT:Palladium Steel Retrofit APPLICATION,NO .:1:` Distribution to: �•`,' ' 30.W Main St.,Suite 220 PERIOD:Tb: _`; 05/31/2013 OWNER ❑ P` Carmel IN 46032 Structural Steel ,CONTRACT FOR:: ARCHITECT ❑ FROM CONTRACTOR:' VIA ARCHITECT: CONTRACT DATE: CONTRACTOR)CO Lenex Steel Company 250 East 96th Street PROJECT NOS:" 561-13 FIELD ❑ Suite 150 " Indianapolis IN 46240 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by.this,Application for Payment has been completed'in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for AIA Document G703TM,Continuation Sheet,is attached. which previous Certificates for.Payment were issued and payments received from the Owner, and 1:ORIGINAL CONTRACT.SUM........................:........................ :S 82.000.00 that current payment shown herein,is now due. - " 2.NET CHANGE BY CHANGE ORDERS............................... $ 0.00 CONTRA TO :Lene .Steel Com any !? 3.CONTRACT SUM TO DATE Line I t 2 � � 1 "..:.................................. $ 82,000.00 BY:' "� .{A%L Date: c5 7 �3 .4.TOTAL COMPLETED&STORED TO;DATE(Column G on G703) ...... $ 17,250.00 State of: I diana ` 5.RETAINAGE: County oiHamilton k x•10.00 %of,Completed Work Subscribed and sworn to„before: (Columns D.+F on G703) $ 1,725.00 me this -d day of ��( D`�r b•10.00 %"of Stored Material ' «nY� -• TAIJi1+1Y L.DEAN- (Colrrrnn Fon G703) $ 0.00 Notary Public: b�G<�L ! ' "� °oT?S,Yk': ivlar onrJoun*y. �;� e, DEAN- ",)T My commission expires.' 7 s; •s _:,r ivly Ceramissiori Exp;res Total Retainage(Lines Sa+36, or Total in Column I of G703)...... $ 1,725.00 � 1 `' July 27,2015 6.,TOTAL EARNED LESS RETAINAGE .................................... $ 15,525.00 ARCHITECT'S CERTIFICATE"FOR PA YMEW T (Line 4 minus Line 5 Total) In accordance with the Con tract;Documents;,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT ....................... $ 0.00 this application,the Architect eertifies_to the Owner that:to the.best of the"Architect's=knowledge, information and belief.the.Work.has progressed as, indicated, the quality of the Work is in (Line 6 fi onr prior Certificate)" accordance,with the'Contract' Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE .........................'...................... $ 15,525.00 AMOUNT CERTIFIED: 9:BALANCE TO FINISH,INCLUDING RETAINAGE, AMOUNT CERTIFIED .. ..............:.:.,.:.:............... $ "15 52�.0 ... . . (Line 3 minus Line 6) $ 66475 00 (Attach explanation if amount c'ertifred.differs frorn,the amount applied.Initial all figures at'this Application and on the Continuation Sheet”that are changed to cor:forrn with the arrroi{nt certified) HANGS ORDER SUMMARY. ADDITIONS DEDUCTIONS AR&Hli� Co;,! JGTO?sG. q^74�e otal changes approved in-.previous months,by Owner $ $ By: Date: 2j Total approved this month $ $ This Certificate isxi.o.negotiable.The AMOUNT CERTIFIED is payable only to the Contractor TOTAL g0 pp;; $. named herein:Issuance,payment and,acceptance of payment are without prejudice to any rights of ET CHANGES by Change Order S 0.00 the Owner or Contractor under this Contract" 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. AIA Document G702T —1992.Copyright ©1953,1963,1965,1971,1978,1983 and 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.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract,Documents,e-mail The American Institute of Architects'legal counsel,copyright @ai,a,org. - 010711ACD. Qo' cum 3T� ent G70 1992 Cnro ion Sheet tmuat AIA Dcument G02TM-192,Apiction and Ceicate,forPaym ,or G732TM 20o 09, APPLICATION.NO: 1 A .lication and Certificate focN rnent,Coistruction' ana er;as`Adyiser Edition; 05-02-2013' Pp, Y g... ...,,..,g APPLICATION DATE: contatmn Contractor's signed certification is attached. 05/31/2013 In tabulations below;amounts are to US dollars.; p E : RIOD TO:.: 561-13. Use Column I on Contracts where variable.retainage for line items may apply. ".. ., -,ARCHITECT'S PROJECT N0: A B WORK COMPLETED a MATERIALS ;TOTAL BALANCE TO ITEM SCHEDULED:'.- PRESENTLY COMPLETED AND % FINISH RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS NO. VALUE STORED STORED TO DATE (G_C) (C_G) (If variable rate) " APPLICATION THIS PERIOD (D+E) (Nat in D or E) (D i E+F) General Conditions 6,500.00 3,500.00. 3,,500.00 53.85: 3,000.00 350.00 Bond 7,500.00 7,500.00 7,500.00 100.00 750.00 . obilization 2`,500.00 1,250.00 1,250.00 50.00. , 1,250.00 125.00 i • i etrofit T2 aterial„ 7,500.00:: 1,500'.00 1,500.00 20.00 6,000.00. 150.00 bor 30,000.00 30,000.00 etrofit T3 Material 4,000.00 - 2,000.00. 2,000.00, 50.00 2,000.00 200.00 Labor 12,000.00`:. 12,000,.00 . etrofit T4 aterial 3;000.00,: - 1,500.00 1,500.00 50.00 1,500.00 150:00 abor 9,000.00_ ' 9,000.00 Totals: 82;000.00 17,250.00 17,250.00 21:04 64,750.00 1,725.00, 00.,.., . GRAND TOTAL 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. AIA Document G703Tm—1992,Copyright @ 1963;1965,1966,1967;1970,1978, 1983-and 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 Ale 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.Purchasers are permitted to reproduce ten(10)copies 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. 10121Q CD Attachment D.1 SHIEL SEXTON COMPANY INTERIM WAIVER AND RELEASE OF LIENS AND CLAIMS UPON PAYMENT STATE OF T-;qG4.t ay'A COUNTY OF kAa r-i eN - Whereas, LENEX STEEL COMPANY ("Subcontractor")who has furnished certain materials,equipment, services, and/or labor pursuant to a subcontract agreement or purchase order with SHIEL SEXTON COMPANY("Contractor")for the project known as SSC/ SHREWSBERRY WISHARD CHC 38TH ST. ("Project"),which is located at, , IN (collectively referred to as the"Property"),and is owned by ("Owner"). 61525,00 Upon receipt of the sum of$ [insert sum requested in current pay application) ("Current Payment"), the Subcontractor waives and releases any and all liens or claims of liens and all claims,demands, actions, causes of action or other rights against the Contractor Owner and the Property or any right against any labor and/or material payment bond it has or may have through the date of 20j_�, [insert last date of work performed that corresponds to Current Payment) ("Current Date") and reserving those rights and liens that the Subcontractor might have in any retainage on account of materials, equipment,services and/or labor furnished by the undersigned to or on account of the Contractor. Further,the Subcontractor covenants and agrees to apply sums received as the Current Payment first, and in no event later than 15 days after the receipt of the Current Payment,to pay all employees, laborers, materialmen, sub-subcontractors and sub-subconsultants employed by the undersigned in connection with the Project and all bills or indebtedness incurred through the Current Date for materials, equipment, services, and/or labor and taxes, furnished by such parties to the undersigned in connection with the execution of the Subcontractor's work on the Project. The Subcontractor further represents that all employees, laborers, materialmen, subc ntractors and subconsultants employed by the Subcontractor in connection with the Project and all bills incurred through�1 20 jZ [insert the last date of work performed that corresponds to the last pay application] for materials, equipment, gervices and/or labor, and taxes, furnished by such parties to the Subcontractor in connection with the execution of the Subcontractor's work on the Project, have been fully paid and that no obligation, legal, equitable or otherwise, are owed by the Subcontractor to such parties. Subcontractor further agrees to indemnify, defend and hold harmless the Owner and the Contractor for and against any and all liabilities, losses, costs, expenses and fees, including reasonable attorney's fees and court costs by reason of claims or liens for any labor, materials or services furnished for the Project. The Subcontractor acknowledges that this Waiver and Release is given to induce the payment recited above, and that this Waiver and Release is in substantial conformance with the requirements of applicable law. The undersigned executing this Waiver and Release hereby represents and warrants that he/she has full power and authority to bind the Subcontractor to the terms hereof. Applicable to Payment Request(s) No (or) Invoice(s) No. Given under hand and seal this Z day of AAa44 201 . Company LENEX STEEL COMP/ANY Signed AV1/�,[� (0 u.(�` 540 (SEAL) By: Arn,V 6n 1_i b Title 'b irP—c-ipr cz, C:r,arnc e SUBSCRIBED AND SWORN TO before me this CZ'ld. day of 20/ My commission expires Notary Publi TQM�I��¢�+sq Syr. �7-Ani ' Marion Coin?y Subcontract#: 200-0007 s i... ;. ; My Commission FrpirF; 902 N, Capitol, Indianapolis, IN 46204 Page 47 of 52 phone: 317.423-6000 fax: 317-423-6300 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. Payee Purchase Order No. 25h °► �Ih 5ife J�D Terms 2 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 00 I Total 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 LenFX aeel 4m1� a IN SUM OF $ 2—so E os 9(f' Sf , Sidle 150 J1d d h (I b o , T/Y 1+62.46 ON ACCOUNT OF APPROPRIATION FOR X01 67 Board Members Po#or D PT.# INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s), 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 5 20^ 2013 ignature Executive Director Title Cost distribution ledger classification if Carmel Redevelopment Commission claim paid motor vehicle highway fund