HomeMy WebLinkAboutARCHITECTUARL GLASS & METAL CO- 334- 8/11/2011 Architectural Glass & Metal Co Check: 334
6334 E 32nd Court Date: 8/11/2011
Indianapolis, IN 46226 Vendor: ARCIT1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
8-18322 48,870.00 48,870.00 0.00 0.00 48,870.00
App 8-18322 on theater
48,870.00 48,870.00 0.00 0.00 48,870.00
334
8/11/2011 **********48,870.00
THE SUM OF FORTY EIGHT THOUSAND EIGHT HUNDRED SEVENTY DOLLARS AND NO CENTS *
Architectural Glass& Metal Co
6334 E 32nd Court
Indianapolis, IN 46226
Architectural Glass & Metal Co Check: 334
6334 E 32nd Court Date: 8/11/2011
Indianapolis, IN 46226 Vendor: ARCIT1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
8-18322 48,870.00 48,870.00 0.00 0.00 48,870.00
App 8-18322 on theater
48,870.00 48,870.00 0.00 0.00 48,870.00
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES
TO OWNER: Carmel Theater Development Corp., LLC PROJECT: Village on the Green Theater APPLICATION NO.: 8-18322
. , BILL TO: Signature Construction PERIOD TO: 5.31.2011
720 3rd Avenue SW PROJECT NO.: 12012
Carmel, IN 46032
FROM CONTRACTOR: VIA ARCHITECT: CONTRACT DATE
Architectural Glass& Metal Co., Inc.
6334 E. 32nd Court/Indianapolis IN 46226
CONTRACT FOR: Commercial Glass&Glazing
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
Application is made for payment,as shown below, in connection with the mation and belief the Work coverd by this Application for Payment has been completed
Contract. Continuation Sheet,AIA Document G703, is attached. 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 pay-
1. ORIGINAL CONTRACT SUM.. ....................... $ 207,000.00 ments received from the Owner,and that current payment shown herein is now due.
2. Net change by Change Orders.. .. ................ $ (7,557.20) CONTRACTOR: Architectural Glass & Metal Co., Inc.
3.CONTRACT SUM TO DATE............................. $ 199,442.80 By: Citi ci ti.;lt. :/!ci VP of Finance Date: May 17, 2011
4.TOTAL COMPLETED&STORED TO DATE........ $ 168,604.80 State Of: Indiana
(Column G on G703) County Of: Marion
5. RETAINAGE:
a. 10% of Com leted Work GAYLE TOLLUVER e
p $ 14,696.48 Subscribed and Sworn to before
(Columns D+Eon G703 i4sary.t,one:,State of Indiana '
me this 17th day of May 2011 � � crfont -r
•b. 10/° of r my cam-u:son curs
° Stored Material $ 2,164.00 ` :' D .;(;1s:ot•14.2017 ti
(Column F on G703)
Total Retainage(Line 5a+5b or Notary Public: ��;��- e--K ,t� fir.,
Total in Column I on G703)........................... $ 16,860.48 My Commission Expires: 12/14/217
ARCHITECT'S CERTIFICATE FOR PAYMENT \�
6.TOTAL EARNED LESS RETAINAGE. $ 151,744.32 In accordance with the Contract Documents, based on on-site observations and the data
comprising this application,the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated,the
(Line 6 for prior Certificate)............................ $ 102,874.32 quality of the Work in in accordance with the Contract Documents,and the Contractor
is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE.. $ 48,870.00 AMOUNT CERTIFIED 4-7g O i C
(Attach explanation if amount certified differs from the amount applied for. Initial
9. BALANCE TO FINISH,INCLUDING RETAINAGE all figures on this Application and of the Continuation Sheet that are hanged to
(Line 3 less Line 6) $ 47,698.48 conform to the amount certified.) /
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONSGkilTt?GT°? /�
Total changes approved in By: Date: 6/j/,,
previous months by Owner
Total approved this Month $ (7,557.20) This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Con-
TOTALS $ (7,557.20) tractor named herein. Issuance, payment and acceptance of payment are without
NET CHANGES by C.O.s $ (7,557.20) Deduction prejudice to any rights of the Owner or Contractor under this Contract.
SCHEDULE OF VALUES AlA DOCUMENT G703 PAGE OF
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 8-18322
containing Contractor's signed Certification, is attached. APPLICATION DATE: 5.17.2011
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5.31.201 1
Use Column I in Contracts where retainage for line items may apply. ARCHITECT'S PROJECT NO.: 12012
VILLAGE ON THE GREEN THEATER
A B C D I E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE
NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS THIS PERIOD STORED AND STORED (G/C) To (IF VARIABLE
APPLICATION (NOT IN TO DATE FINISH RATE)
(DI'E) DORE) (D+E+F) (C-G)
Section 05 58 00 - Formed
Metal Fabrications
108-1000 Material $ 4,040.00 4,040.00 _ 4,040.00 100% - 404.00
108-1001 Labor $ 590.00 590.00 590.00 100% - 59.00
Section 07 92 00- Joint
Sealants (Partial)
108-1002 Material $ 3,925.00 3,925.00 3,925.00 100% - 392.50
108-1003 Labor $ 5,500.00 2,750.00 2,750.00 5,500.00 100% - 550.00
Section 08 43 13 - Glazed
Aluminum Framed SF
108-1004 Material $ 1,270.00 953.00 317.00 1,270.00 100% - 127.00
108-1005 Fabrication Labor $ 415.00 415.00 415.00 100% - 41.50
108-1006 Field Labor $ 300.00 - 300.00 300.00 100% - 30.00
Section 08 44 13 - Glazed
Aluminum CW
108-1007 Material $ 72,110.00 72,110.00 72,110.00 100% - 7.211.00
108-1008 Fabrication Labor $ 6,880.00 4,472.00 2,408.00 6,880.00 100% - 688.00
108-1009 Field Labor $ 24,545.00 12,273.00 8,591.00 20,864.00 85% 3,681.00 2,086.40
$119,575.00 $ 96,483.00 $ 19,411.00 $ - $115,894.00 $ 3,681.00 $ 11,589.40
Architectural Glass&Metal Co.,Inc.is authorized to re-product ALA Documents under License Agreement#119474 through 08-31-01.
• - SCHEDULE OF VALUES AIA DOCUMENT GAO PAGE OF
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 8-18322
containing Contractor's signed Certification, is attached. APPLICATION DATE: 5.17.2011
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 5.31.201 1
Use Column I in Contracts where retainage for line items may apply. ARCHITECT'S PROJECT NO.: 12012
VILLAGE ON THE GREEN THEATER
A B C D I E F G H 1
WORK COMPLETED MATERIALS TOTAI.
ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE
NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS THIS PERIOD STORED AND STORED (0/C) TO IF VA AB E
APPLICATION (IF VARIABLE
(NOT IN TO DATE FINISH RATE)
(D+E) I)ORE) (D+E+-F) (C-G)
Section 08 41 26-All-Glass
Entrances& Storefronts
108-1010 Material $ 21,640.00 21,640.00 21,640.00 100% - 2,164.00
108-1011 Labor $ 1,760.00 - 0% 1,760.00 -
Section 08 80 00- Glazing
108-1012 Material $ 18,925.00 9,463.00 9,462.00 18,925.00 100% - 1,892.50
108-1013 Labor $ 4,940.00 2,470.00 2,470.00 4,940.00 100% - 494.00
108-1014 Administration $ 6,855.00 5,141.00 1,317.00 6,458.00 94% 397.00 645.80
108-1015 Shop Drawings $ 5,755.00 5,755.00 5,755.00 100% - 575.50
108-1016 Payment/Performance Bond $ 2,550.00 2,550.00 2,550.00 100% - 255.00
108-1017 Allowance $ 25,000.00 - 0% 25,000.00 -
108-1018 C.O. #48 - Tax Exemption $ (6,254.00) (6,254.00) (6,254.00) 100% - (625.40)
108-1019 C.O. #68 -AS1.017 $ (1,303.20) (1,303.20) (1,303.20) 100% - (130.32)
5199,442.80 $114,304.80 $ 32,660.00 $ 21,640.00 $168,604.80 85% $ 30,838.00 $ 16,860.48
Architectural Glass&Metal Co.,Inc.is authorized to re-product AIA Documents under License Agreement#1I9474 through 08-31-01.
BILL OF SALE
Architectural Glass & Metal Co., Inc. by this instrument,
acknowledge that upon receipt of a check in the amount of
$ 48,870.00 , not including retention, has sold to
Signature Construction — Village on the Green Theater
for the following goods:
100% - Section 08 41 26— All-Glass Entrances & Storefront .
Billed through _5/31/2011 , said material is stored at
Architectural Glass & Metal Co., Inc. / 6334 E. 32nd Court /
Indianapolis, IN 46226.
Architectural Glass & Metal Co., Inc. warrants the following:
1. The material is insured to the full value while in storage
or transportation.
2. Architectural Glass & Metal Co., Inc. will defend the title
to the property; hereby conveyed, against the just and
lawful claims and demands of all persons whomsoever.
This Bill of Sale in no way releases Architectural Glass &
Metal Co., Inc. and Architectural Glass & Metal Co., Inc.
will be responsible for repair to structural damage in
storage or shipping.
Architectural Glass & Metal Co., Inc. will be responsible
for care and custody of stored materials while in their
control.
(Note: This Bill of Sale is provided for the protection of
the Owner. For state tax purposes, the Owner has not
taken possession of this material. It will remain in
storage, until such time as it is shipped to the site and
installed by Architectural Glass & Metal Co., Inc.)
Architectural Glass & Metal Co., Inc.
`
I. oavLs 1OLu R Title: VP of Finance
hk r,y f.ui ik,'-aW Of In
7iarlc
""�-p ' tufrr!or;raun;y
F' � tilt'Comma; -.Erolr ' `�
Dccoi7iba-i4 2017 . Notary Public: :;' lam' . .�:.. . C-�='-�.°-1
" • ",.._ a My Commission Ex.i es: 12/14/2017
i" ` —
PRIME CONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS & WAIVER OF LIEN
STATE OF Indiana
COUNTY OF Hamilton
?Wirt1' a �` �C��U{� Being duly sworn upon his/her oath disposes and
says that: (;(
1. He/she is yr 0 r' (inserting sole proprietor, partner or corporate office held, as the case maybe),
of Lithko Contracting, Inc. hereafter called the "Prime Contractor". He/she is over the age of twenty-
one. He/she is authorized to make this affidavit on behalf of Prime Contractor.
2. Prime Contractor is the Prime Contractor for the construction of the development
known as VILLAGE ON THE GREEN - PARCEL 7C1 - THEATER BUILDING located in CARMEL
(City), INDIANA (state), hereafter referred to as the "Development", pursuant to the contract between the
Prime Contractor and CARMEL THEATER DEVELOPMENT CORPORATION, LLC., the Owner.
3. This affidavit is made for the express purpose of inducing and CARMEL THEATER DEVELOPMENT
CORPORATION, LLC., to make payment to Prime Contractor of the invoice submitted herewith for labor
and materials furnished pursuant to said Contractor. Upon receipt of said payment the Prime Contractor
hereby waives any lien rights to which Prime Contractor is entitled for labor or materials furnished for the
development to the date hereof.
4. Listed below are all suppliers or other persons who either has furnished or might furnish the Prime
Contractor with materials, appliances, machinery, fixtures or furnishing placed upon or installed on the
development. Mark(X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1) If a
waiver of lien by supplier conditioned by payment of a specified amount is attached hereto. (In this case
also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered
to the Owner. 3.) If the initial delivery has not been made.
Supplier List(Add list if necessary 1. Amount Owed e 3
ER:b Cvrpor-t-A116 11 g a�.%a.DO
#1 and 2 correspond to the same numbered choices on the waiver format. CARMEL THEATER
DEVELOPMENT CORPORATION, LLC.is hereby authorized to make payment to each such unpaid
creditor either directly or by check jointly payable to Prime Contractor and such creditor, as CARMEL
THEATER DEVELOPMENT CORPORATION, LLC. shall determine.
5. There are no bills, charges, costs or expenses for labor or material which could now or hereafter result
in lien being filed against the Development or a claim being asserted against the Owner except the
persons or businesses named in Paragraph 4 above.
IN WITNESS WHERE OF, affiant has signed this document on behalf of the Prime Contractor this 1-14111 day of fn CL,y , 20 I i , /� /+ �^,
/Gel d,e,.) (17-\il!I1,- V P 0-f' t' 11 LQ.n Lt.
(Authorized Representati)e of Prime Contractor, Title)
County of VYl( 1(, )
State of I nil Jana_ )
Subscribed and sworn to before me, a Notary Public in and for said County and State,
This 111 Day of 2 I. B
L' r r GAYLE TOLL.IVER
((notary Public) hahry Public,.S`l„taofIndiana
S
�•d.. line ion Lours/
h a Le T o L U.I. u�.v i .MMy cor.:x�ission expires
v `J Det.:?mbai 14,201/
(Printed Name) y4. , •-•
My Commission Expires: pit 1.1 (dbII
NOTARY SEAL MUST APP AR ON THIS FORM.
1
Client#: 67067 50ARCHITECTUI
ACO `R D,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
I 5/17/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED;the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
I NAME: Sandra McDaniel
J Smith Lanier&Co of Newnan (A/C,No,,Eel):770 683-1015 I FAX 770-683-1010
P. O. Box 71429 (Arc,No):
I E-MAIL smcdaniel@jsmithlanier.com
@fsmlthlanier.COm
Newnan, GA 30271-1429 1 PRODUCER
770 683-1000 I CUSTOMER ID#:
I INSURER(S)AFFORDING COVERAGE 'NAIC#
INSURED I INSURER A:Grange Mutual Casualty Co 14060
Architectural Glass& Metal Co., Inc. I INSURER B:Hartford Ins Co of Midwest 37478
AGM Transportation LLC; GPG Leasing LLC
INSURER C:Hartford Ins Co.of the SE 38261
6334 East 32nd Court
Indianapolis, IN 46226 1INSURERD:
I INSURER E:
I INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUBR POLICY EFF POLICYEXP
LTR TYPE OF INSURANCE INSR�.M/D POLICY NUMBER I MM/DD/YYYY) I(MM/DDfYYYY) I LIMITS
A GENERAL LIABILITY I CPP2625953 01/01/2011101/01/2012 EACH OCCURRENCE $1,000,000
X COMMERCIAL GENERAL LIABILITY i DAMAGE TO RENTED
I PREMISES(Ea occurrence) $100,000
CLAIMS-MADE II Xl OCCUR I MED EXP(Any one person) $10,000
X X,C, U Coverage. 'PERSONAL&ADV INJURY $1,000,000
�
GENERAL AGGREGATE s2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: - I PRODUCTS-COMP/OP AGG $2,000,000
—1 POLICY X PRO
JECT LOC i $
A AUTOMOBILE LIABILITY CPP2625953 01/01/2011101/01/2012 COMBINED SINGLE LIMIT
X ANY AUTO (Ea accident) $1,000,000
ALL OWNED AUTOS
BODILY INJURY(Per person) $
SCHEDULED AUTOS I I BODILY INJURY(Per accident) $
PROPERTY DAMAGE
X HIRED AUTOS $
(Per accident)
X NON-OWNED AUTOS i $
A UMBRELLA LIAB I X OCCUR CUP2625954 01/01/2011 01/01/2012 EACH OCCURRENCE s5,000,000
EXCESS LIAB j CLAIMS-MADE
;AGGREGATE s5,000,000
DEDUCTIBLE ( I $
X RETENTION $ 10,000 I I $
B WORKERS COMPENSATION 20WEOG6083 01/01/2011 01/01/2012 X ITORYU IT I )OTH-
AND EMPLOYERS'LIABILITY Y/N TORY LIMITS i i ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? N N/A I E.L.EACH ACCIDENT s500,000
(Mandatory In NH)
I
If yes,describe under ; ( i E.L.DISEASE-EA EMPLOYEE s500,000
DESCRIPTION OF OPERATIONS below , E.L.DISEASE-POLICY LIMIT s500,000
C Rented Leased 20MSJD9470 P1/01/2011101/01/2012 $200,000!$1,000 Ded
C Installation Fl 20MSJD9470 '01/01/2011101/01/2012 $500,000/$1,000 Ded
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required)
Stored Materials located at 6350 E 32nd Ct. Indianapolis, IN 46226-$2,200,000 with$1,000 Deductible
The Workers Compensation Policy described above includes Ohio Stop Gap with Substantially Certain to Occur.
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION
Signature Construction, LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
720 3rd Ave.SW THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Carmel, IN 46032
AUTHORIZED REPRESENTATIVE
I 1 1
0196-2009 ACORD CORPORATION.All rights reserved.
ACORD 26(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#S1201189/M1069017 HXS
DESCRIPTIONS (Continued from Page 1)
Job Name:Village on the Green Parcel 7-C-1 Theater Building
Signature Construction, LLC, REI Construction, LLC, Pedcor Design Group, LLC, McComas Engineers, Inc.,
L'Acquis Consulting Engineers, and CSO are named as Additional Insured as respects to the General Liability
and Auto Liability policies when required by written contract, subject to all policy terms,conditions,
limitations, and exclusions.Stored materials in the amount of$21,640.
AMS 26.3(2009/09) 2 of 2
#S1201189/M1069017