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Home My WebLink AboutBROADY-CAMPBELL, INC. -002349 -10/20/2011 , CARMEL REDEVELOPMENT COMMISSION 002349 Broady-Campbell, Inc. Check: 2349 2115 Dr. A.J. Brown Ave. Date: 10/20/2011 Indianapolis, IN 46202 Vendor: BROADY- Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-1 900.00 900.00 0.00 0.00 900.00 p112 wAYFINDING & sITE 900.00 900.00 0.00 0.00 900.00 • Application and Certificate for Payment • TO OWNER: SIGNATURE CONST.LLC PROJECT: P112 WAYFINDING&SITE APPLICATION NO: 1 Distribution to: CUST# S1G2 ONE PEDCOR SQUARE PERIOD TO: 09/14/2011 OWNER ❑ 720 3RD AVENUE SW CARMEL IN 46032 CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: BROADY-CAMPBELL,INC. VIA ARCHITECT: CONTRACT DATE: 07/11/2011 CONTRACTOR ❑ 2115 Dr.A.J.Brown Ave. PEDCOR DESIGN GROUP PROJECT NOS: FIELD LI Indianapolis,IN 46202 P112 WAYFINDING&SITE JOB# 211078 OTHER CI 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 Continuation Sheet,is attached. 3,140.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1. ORIGINAL CONTRACT SUM $ that current payment shown herein is now due. u.uu 2.Net change by Change Orders $ CONTRACTOR: Broady-Campbell, Inc. 3,140.00 3.CONTRACT SUM TO DATE(Line 1 ±2) $ By:.__ t Date: 9-14-2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on 603LS1).... $ 1,000.00 State of: Indiana 5. RETAINAGE: County of: Marion 10.00 a %of Completed Work 0.00 Subscribed and sworn to before r�8� (( umn D+Eon 603LS1) - $ me this 14th day of September 2011 b. %of Stored Material (Column F on 603LS1) $ 100.00 Notary Public: _ _v. j ice, f .d ^ 100.00 My Commission expires: 5-5-2016 Il( Total Retainage(Lines 5a+5b or Total in Column I of 603LS1)... $ 6.TOTAL EARNED LESS RETAINAGE $ 900.00 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 0.00 this application, the Architect certifies 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 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 900:00-1 AMOUNT CERTIFIED. S. CURRENT PAYMENT DUE $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE 2,240.00 AMOUNT CERTIFIED $ -411 (Line 3 less Line 6) $ (Attach explanation if amount certified differs from the amount applied.India all figures on this Application and on the Co inuation Sheet that are changed to conform with the amount certified. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in previous months by Owner $ 0.00 $ 0.00 _ By `j l-\� A Date: -l)"Le i. Total approved this Month $ 0.00 $ 0.00 TOTALS $ 0.00 $ 0.00 This Certific.; . not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor 0.00 named herein. uance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. {� REORDER FORM NO.604LS1 � �1 I 0 Cl 41101.tom 0 .. e■iet, i, t i 1Czik r Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Page 1 of 1 AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 1 containing Contractor's signed Certification,is attached. APPLICATION DATE:• 09/14/2011 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 09/14/2011 ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE TO CE RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS (IF VARIABLE) NO. VALUE STORED AND STORED (G + C) FINISH APPLICATION THIS PERIOD RATE) (D+E) D OR E) (D+E+F) DATE (C-G) 01 STONE LABOR 1,170.00 1,170.00 02 STONE MATERIAL 1,000.00 1,000.00 1,000.00 100.00 100.00 03 FOUNDATION 970.00 970.00 JOB TOTALS : 3,140.00 .00 .00 1,000.00 1,000.00 2,140.00 100.00 . G703-1992 r , BROADY-CAMPBELL, INC. Masonry Contractors 2115 ANDREW J.BROWN AVENUE INDIANAPOLIS,INDIANA 46202 PHONE {317) 925-4261 o PAX (317) 925-4263 WAIVER OF LIEN PARTIAL XX OR FINAL PAYMENT TO FOLLOW XX KNOW ALL MEN BY THIS PRESENTS,THAT THE UNDERSIGNED Broady Campbell inc. FOR AND IN CONSIDERATION OF NINE HUNDRED 00/100 REPRESENTING THE ACCUMULA 1ED AMOUNT PAID TO THE UNDERSIGNED FOR PAY PERIOD ENDING 9-14-2011_,RECEIPT THEREOF IS HEREBY ACKNOWLEDGED,DOES WAIVE,RELEASE AND SURRENDER ANY AND ALL`LIEN OR CLAM OR RIGHT OF LIEN,TO THE DATE OF THIS WAIVER,FOR LABOR,MATERIAL AND/OR SERVICES FURNISHED UPON THE PREMISES SITUA 1ED LN THE COUNTY OF MARION .STATE OF INDIANA . DESCRIBED AS FOLLOWS: MASONRY PROJECT:P112 Wayfinding&Site BY:____ 1 c-LK0/ TITLE: Vice-President DATE: 9-28-2011 SUBSCRIBED AID SWORN TO BEFORE ME THIS_28th_DAY OF_September _,2011. __. NOTARY A.Lts_] � EXPIRATION DATE: 05-05-2016 COUNTY:- HAMILTON "" m Equal Opportunay Employer ti- orAtew- INVOICE C • ma ism Irma MASONRY CONTRACTORS 2115 ANDREW J. BROWN AVE. • INDIANAPOLIS, INDIANA 46202 21930 ph. (317) 925-4261 fax (317) 925-4263 Signature Const. LLC Date 9-14-2011 TO: One Pedcor Square 720 3rd Avenue SW Job No?11078 Carmel, IN 46032 P.O. No. RE: P112 Wayfinding & Site ESTIMATE NO: 1 Labor, material, equipment and accessory appurtenances in place or stored to date at the above referenced project: 1,000.00 Less 10 % retained 100.00 Total earned less retainer 900.00 Less Previous applications 0.00 TOTAL DUE THIS ESTIMATE NO: 1 900.00 REIIVD 5EP 2 0 200 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 ... Purchase Order No. 27/c g ive Terms /040,7,17045 /41 202 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) P/(2 -.:• ;-. .7;• Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have au. ed same in accordance with IC 5-11-10-1.6. , 20 - -Treasurer 2. VOUCHER NO. WARRANT NO. ALLOWED 20 67'c4 ��TL 4c- IN SUM OF $ 2/( Cr- M\77- v�;s !ie/ "7/ 2D2_ 00 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# INVOICE NO. ACCT#!TITLE AMOUNT DEPT..# I hereby certify that the attached invoice(s), or 5�2 `/"4iafa5 gl2 1V 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 - 20/K nature Executive Director Cost distribution ledger classification if Title claim paid motor vehicle highway fund Cannel Redevelopment Commission