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Home My WebLink AboutSIGNATURE CONSTRUCTION, LLC- 003068- 8/16/2012 CARMEL REDEVELOPMENT COMMISSION 003068 Signature Construction, LLC Check: 3068 720 3rd Ave., SW Date: 8/16/2012 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1-73 8,823.00 8,823.00 0.00 0.00 8,823.00 P73 East Stairway 8,823.00 8,823.00 0.00 0.00 8,823.00 1„44., THE KEVA TODOCUMENTASECURRYZHEATfACTIVATEDTHUMBFIRINTDADDITIONAIfSECURITY,FEATORESINCLUDED ITSEE.BACK FORDETAIIS num p��AE.--- DEN. Carmel Redevelopment Commission 003068 ' 1r4 Su West Main Street A REGIONS fig_ Suite 220 2o-ta2lnaD ”"-'"`Y Carmel, IN 46032 �rSTR1GS 3068 DATE AMOUNT 8/16/2012 8,823.00 PAY THE SUM OF EIGHT THOUSAND EIGHT HUNDRED TWENTY THREE DOLLARS AND NO CENTS "' TO THE ORDER OF Signature Construction, LLC 720 3rd Ave., SW Carmel, IN 46032 I 1 [ y ° 00306811' ':0740 L4 2 L31: 0087904 L i Li" CARMEL REDEVELOPMENT COMMISSION 003068 Signature Construction, LLC Check: 3068 720 3rd Ave., SW Date: 8/16/2012 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1-73 8,823.00 8,823.00 0.00 0.00 8,823.00 P73 East Stairway 8,823.00 8,823.00 0.00 0.00 8,823.00 %-it-52 COMPUTEREASE FORMS DIVISION(977)577-5791 T-71771 • i3 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES2 - TO OWNER CRC at City of Carmel PROJECT: Parcel 73 APPLICATION NO Invoice a 1 –?3 Distribution to: , Cannel Indiana 46032 Past Stairway Signature costs OWNER ARCHITECT PERIOD TO: 06/22/2012 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT:Pedcor Design Signature Construction Services LLC _ 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge. Application is made for payment,as shown below,in connection with the Contract, information and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached, completed 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 payments received from the Owner,and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM S 8,823.00 e(r qn/ b 2. Net change by Change Orders S 0.00 CONTRAC'T'OR: 3. CONTRACT SUM'10 DATE(Line I *2) $ 8,823.00 / 4. 'TOTAL COMPLETED&S'C'ORED TO S 8,823.00 _ 4/z_ 13y /11, Date: S ,'7- 5. RE'TAINAGE �hom • Koontr President n a. 0%of Completed Work $ 0 'ubseribed an sworn to before me this a S y of U i2A[r g n '"•'° 4: LINDA G.BUCRANAN (Column D t E on 0703) 'P»T.M.. c Hancock County b. %of Stored Material S \ , z My Commission Expires (Column F on 0703) :f S'' August 20.2019 _. Total Retainage(Lines 5a+$b or Total in Column l of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RE'I'AINAGE S 8,823.00 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5'total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CER'T'IFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 8,823.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISI I,INCLUDING RETAINAGE S 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED S CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation famoat certfed differs from the amount applied. Initial all figures on this Total changes approved Application and SO union Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: '7 /� 'total approved this Month By: _�— Date: G Z. l TOTALS 50.00 $0.00 This Certile c t ne_eotia,ie. e AMOUNT CERTIFIED is pavablljonly t the Contractor named crew, Issuance,payment anu acceptance of payment are wan t NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT.1992 EDITION•AIA •01992 THE AMERICAN INSTITUTE OF AR • ECTS.1795 NEW YORK AVE.. NW,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document 0401 -Certification of I- • ent's Aut enticity from the Licensee. Osc /L SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 1 6/22/12 Parcel 73 East Stairway Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost General Requirements 4,411.50 0.00 4,411.50 0.00 4,411.50 100% 0.00 4,411.50 Construction Management Fee 4,411.50 0.00 4,411.50 0.00 4,411.50 100s' 0.00 4,411.50 8,823.00 0.00 8,823.00 0.00 8,823.00 100% 0.00 8,823.00 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and /or labor as follows: Construction Management Services for a project known as Parcel 73 East Stairway, located at Carmel, Indiana and owned by the Carmel Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of eight thousand eight hundred twenty-three dolllars ($8,823.00) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material 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 perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC T omas E. oontz, President Subscribed and sworn to before me this: Cunt JC A20/2. Notary Public: :p•,..t�.yti; LINDA G.BUCHANAN r .wum. c Hancock County Sy..SEAL ; My Commission Expires "•'"'d,';^'" August 20,2019 Prescribed by Slate Board of Accotaits City Form No.�„R�.,995, 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 Sijso.r,cve �Coy,A T°��oi i, Lit Purchase Order Na 720 /rr/ rT✓Arlvr 5<U Terms C4nn/1.40 /' c'O32— Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 6 22 !z 1- 73 P 73 L tf- 3/44 �23•U� Total 8F23.Gel I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have ame in accor- dance with IC 5-11-10-1.6. R-tr , 20 f Z� asurer