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Home My WebLink AboutBROADY-CAMPBELL, INC.- 002667- 2/16/2012 CARMEL REDEVELOPMENT COMMISSION 002667 Broady-Campbell, Inc. Check: 2667 2115 Dr. A.J. Brown Ave. Date: 2/16/2012 Indianapolis, IN 46202 Vendor: BROADY- Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paic 2-2 1,926.00 1,926.00 0.00 0.00 1,926.0C P112 Wayfinding & Site 1,926.00 1,926.0.0 0.00 0.00 1,926.0C k;,,, . ;THeisgy;T,o otrfi ENT*SECURITYiCii ACTIVATEE NUMB ERINT ADDITIONAL 3EWEAT&WESINC DEp•SEE Ere F,ORLDETAILS AiL 15461°4,0 Carmel Redevelopment Commission 30 West Main Street REGIONS 0 0,2 6 6 7 Sui te 220 zo-idzinao ,CARMFL' - - °IsT,/ Carmel, IN 46032 2667 DATE AMOUNT 2/16/2012 1,926:00 PAY THE SUM OF ONE THOUSAND NINE HUNDRED TWENTY SIX DOLLARS AND NO CENTS '"****'k***** TO THE ORDER OF Broady-Campbell,-Inc. 2115 Dr.A.J. Brown Ave. BPS SENSif 1 Indianapolis, IN 46202. s m; hP crl OO 266 711' 1:0 740 L4 2 L 31: 00137504 L L LH' CARMEL REDEVELOPMENT COMMISSION 002667 Broady-Campbell, Inc. Check: 2667 2115 Dr. A.J. Brown Ave. Date: 2/16/2012 Indianapolis, IN 46202 Vendor: BROADY- Prior Invoice P.O. Num. Invoice Amt" Balance Retention Discount Amt. Paid 2-2 1,926.00 1,926.00 0.00 0.00 1,926.00 P112 Wayfinding & Site 1,926.00 1,926.00 0.00 0.00 1,926.00 11-52 COMPUTEREASE FORMS DIVISION(877)577-5791 '1-37228 4:0 • Application and Certificate for Payment 0) TO OWNER: SIGNATURE CONST.LLC PROJE P112 W.AYFINDING ITF APPLICATION NO: 2 Distribution to: CUST 4 SIG2 ONE PEDCOR SQUARE ' I PERIOD TO: 11/23/2011 OWNER I 720 3RD AVENUE SW CARMEL IN 46032 CONTRACT FOR: 8 ARCHITECT FROM CONTRACTOR: BROADY-CAMPBELL,INC. VIA ARCHITEI? G CONTRACT DATE: 07/11/2011 1 CONTRACTOR 2115 Dr.A.J.Brown Ave. PEDCOR DESIGN GROUP PROJECT NOS: FIELD Indianapolis,IN 46202 OTHER PI I2 WAYFINDING&SITE JOB# 211078 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 Continuation Sheet, is attached with the Contract Documents, that all amounts have been paid by the Contractor for Work for 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. 2. Net change by Change Orders $ 0.00 CONTRACTOR: 9 Y 9 Broady—Campbell, INC. 3. CONTRACT SUM TO DATE (Line 1 +2) $ 3,140.00 B}. d,,� Date: 11-23-2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on 603LS1).... $ 3,140.00 State of: Indiana 1 5. RETAINAGE: County of Marion a. 1 0.00%of Completed Work Subscribed and sworn to before (Column D+ Eon 603LS1) $ 314.00 me this 23rd �da y of November 2011 b. 10 00%of Stored Material ,( (Column F on 603LS1) $ 0.00 Notary Public: 'f` �'--5�-' � L My Commission expires: 5-5-2016 Total Retainage(Lines 5a+5b or Total in Column I of 603LS 1) ... $ 314.00 6.TOTAL EARNED LESS RETAINAGE $ 2,826.00 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 $ 900.00 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 Contactor is entitled to payment of the 8. CURRENT PAYMENT DUE $ 1,926.00 AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED S )a7 314.00 Attach e.vplanation i amount errti tad di ers rom the amount applied. /nitro al�urc.c on this (Line 3 less Line 6) $ ( I � � �f / 11 � l Application ar on the .)'tin rtiat Shec t that arc(hanged to can/itrm >>ith the amount c cr1/fica. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: A Total changes approved in previous months by Owner $ 0.00 $ 0.00 By: ��a' ', _ `. 2 �� Date: Total approved this Month $ 0.00 $ 0.00 TOTALS $ 0.00 $ 0.00 This Cc tificate is of negotiable. The AMOUNT CERTIFIED is pay ' on , to the Contractor 0.00 named he . n. Issua,�ce, payment and acceptance of payment are wi out ,reiudice. to any rights of NET CHANGES by Change Order $ the Owner or . • ctor under 's Contract. // /^y///'J�///� REORDER FORM NO.604LS1 ✓ `J / . /� "�//L f col (/o6___ INSTRUCTION SHEET -604LS1 and 603LS1 A. GENERAL INFORMATION a. Purpose and Related Documents 604LS1,Application and Certificate for Payment, is to be used in conjunction with 603LS1, Continuation Sheet. These documents are designed to be used on a Project where a Contractor has a direct Agreement with the Owner. B. COMPLETING THE 7604LS1 FORM: After the Contractor has completed 603LS1, Continuation Sheet,summary information should be transferred to 604LS1,Application and Certificate for Payment. The Contractor should sign 604LS1,have it notarized and submit it,together with 603LS1,to the Architect. The Architect should review 604LS1 and 603LS1 and, if they are acceptable,complete the Architect's Certificate for Payment on 604LS1. The Architect may certify a different amount than that applied for. The Architect should then initial all figures on 604LS1 and 603LS1 that have been changed to conform to the amount certified and attach an explanation. The completed 604LS1 and 603LS1 should be forwarded to the Owner. C. COMPLETING THE 603LS1 FORM: Heading: This information should be completed to be consistent with similar information on 604LS1,Application and Certificate for Payment. Columns A, B&C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed work covered by the previous application(columns D+E from the previous application). Values from column F(Materials Presently Stored)from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F: Enter here the value of Materials Presently Stored'for which payment is sought. The Total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work completed—This Period). Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C(Scheduled Value)and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually, Change Orders are listed separately, either on their own 603LS1 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the 604LS1 form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. D. MAKING PAYMENT • The Owner should make payment directly to the Contractor based on the amount certified by the Architect on 604L51,Application and • Certificate for Payment. The completed form contains the name and address of the Contractor. Payment should not be made.to any •"� other party unless specifically indicated on 604LS1. E. EXECUTION OF THE DOCUMENT • Each person executing the Agreement should indicate the capacity in which they are acting(i.e.. president secretary, partner, etc.)and tf e authority under which they are executing the Agreement. Where appropriate, a copy of the resolution authorizing the individual to act on behalf of the firm or entity should be attached. • - " r> 1 Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Page 1 of 1 ALA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 2 containing Contractor's signed Certification,is attached. 11/23/2011 `In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: I Use Column I on Contracts where variable retainage for line items may apply, PERIOD TO: 11/23/2011 ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE 1 ITEM SCHEDULED PRESENTLY COMPLETED % RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS TO NO. VALUE STORED AND STORED (G_C) OF VARIABLE) APPLICATION THIS PERIOD (NOT IN TO DATE FINISH RATE) (D+E) D OR E) (D+E+F) (C-G) 01 STONE LABOR 1,170.00 1,170.00 1,170.00 100.00 117.00 02 STONE MATERIAL 1,000.00 1,000.00 1,000.00 100.00 100.00 03 FOUNDATION 970.00 970.00 970.00 100.00 97.00 JOB TOTALS: 3,140.00 1,000.00 2,140.00 .00 3,140.00 .00 314.00 • . G703-1992 BROADY-CAMPBELL, INC. Masonry Contractors 2115 ANDREW J. BROWN AVENUE INDIANAPOLIS, INDIANA 46202 PHONE (317) 925-4261 • FAX (317) 925-4263 WAIVER OF LIEN PARTIAL XX OR FINAL PAYMENT TO FOLLOW KNOW ALL MEN BY TFIFS PRESENTS, THAT THE UNDERSIGNED Broady Campbell Inc. FOR AND IN CONSIDERATION OF One Thousand Nine Hundred Twenty Six Dollars and 00/100 REPRESENTING THE ACCUMULATED AMOUNT PAID TO THE UNDERSIGNED FOR PAY PERIOD ENDING 11-23-2011_, RECEIPT THEREOF IS HEREBY ACKNOWLEDGED,DOES WAIVE,RELEASE AND SURRENDER ANY AND ALL'LIEN OR CLAIM OR RIGHT OF LIEN,TO THE DATE OF THIS WAIVER,FOR LABOR,MATERIAL AND/OR SERVICES FURNISHED UPON THE PREMISES SITUATED IN THE COUNTY OF MARION ,STATE OF INDIANA . • DESCRIBED AS FOLLOWS: MASONRY PROJECT: P112 Wayfinding&Site BY: / TITLE: President DATE: 12-20-2011 • SUBSCRIBED AND SWORN TO BEFORE ME TIUS_20rd_DAY OF_December _,2011 NOTARY EXPIRATION DATE: 05-05-2016 COUNTY: HAMILTON Equal Opportunity Employer Mo eau *, INVOICE BROADY-CAMPBELL, INC. Ism ® ® ENE MASONRY CONTRACTORS 2115 ANDREW J. BROWN AVE. • INDIANAPOLIS, INDIANA 46202 22122 ph. (317) 925-4261 fax (317) 925-4263 Signature Const. LLC �r Date 11-23-2011 TO: One Pedcor Square `,f1/ 0� 211078 720 3rd Ave. SW Der G Job No. Carmel, IN 46032 per 4'01 P.O. No RE: P112 Wayfinding & Site ESTIMATE NO: 2 Labor, material, equipment and accessory appurtenances in place or stored to date at the above referenced project: 3,140.00 Less 10 % retained 314.00 Total earned less retainer 2,826.00 Less Previous applications 0.00 TOTAL DUE THIS ESTIMATE NO: 2 2,826.00 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 /7 1 7/-7 Purchase Order No. l( Or, J. /42v, - Terms // 4/7q, O/f?, ///.2 .2/6;<70 Z Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) l 1/4 // P//2 c/ �,5/ P / 92 .UG f` 4h Total / OU N I hereby certify that the attached invoice(s), or bill(s), is (are) true and correc audited same in accor- dance with IC 5-11-10-1.6. 02. /J , 20 / .clerk-Treasurer VOUCHER NO. WARRANT NO. • ALLOWED 20 //7 c . 2 /( S Dr', /9, 1, g IN SUM OF $ /ti 4/6.z 2 • $ 1 , 92C _O � ON ACCOUNT OF APPROPRIATION FOR 9oz Board Members D PT.# INVOICE NO. ACCT#/TITLE AMOUNT I hereby certify that the attached invoice(s), 2 4/6 39°5- /,92- ,60 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 - ' 2012 Signature Execut've f)irector Title Cost distribution ledger classification if claim paid motor vehicle highway fund Carmel Redevelopment Commission