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Home My WebLink AboutSIGNATURE CONSTRUCTION, LLC- 002984- 6/21/2012 CARMEL REDEVELOPMENT COMMISSION 002984 Signature Construction, LLC Check: 2984 720 3rd Ave., SW Date: 6/21/2012 Carmel, IN 46032 Vendor: SIGNATO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7-a 6,963.10 6,963.10 0.00 0.00 6,963.10 P112 Motor Court Veneer 6,963.10 6,963.10 0.00 0.00 6,963.10 • • • ' - -'`THE KEY TO.DOCUMENT.SECURITY T HEAT ACTIVATED•THUME PRINT'. SECURITY FEATURES INCLUDED•SEE BACK FOR DETAILS " '' tP++6a1j. Carmel Redevelopment Commission A REGtoHS 002984 t r c,,: 30 West Main Street o-,EGI Suite 220 `Tp"""1L1 Carmel, IN 46032 �R 2984 DATE AMOUNT 6/21/2012 *********"6,963.10 PAY THE SUM OF SIX THOUSAND NINE HUNDRED SIXTY THREE DOLLARS AND 10 CENTS************ TO THE ORDER OF Signature Construction, LLC • 720 3rd Ave., SW • Carmel, IN 46032 M y 5i 0jr H'00 298411° 1:0 740 14 2 1 31: 0 0 8 7 5 0 4 / APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 PAGE ONE OF 2 PAGES `' TO OWNER CRC at City of Carmel PRO.IECC:PI 12 Molar Cohn APPLICATION NO Invoice M T Distribution to. ' Cannel Indiana 46032 veneer Signature costs OWNER ARCHITECT PERIOD TO: 05125/201T X CONTRACTOR FROM CONTRACTOR: VIA A Re]1ITECI':Pedeor Design Signature Construction Services LLC 720 3rd Avenue S.W. PRO.IliC T NOS: Carmel,Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifresthat to the best el Mai Contractor's knowledge. Application is made for payment,as shown below,in connection with the Contract, information and belief the Work coyote('by this Application Tor Pavment 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 end pas received from the Owner,and that current payment shown herein is now due_ I. ORIGINAL CONTRACT SUM S 49.100 00 3. Net change by Change Orders S 0.00 CONTRACTOR: 3. CONTRAC I'SUM To DATE(Line I ±2) S 49,100.80 e1ix/ 4. TOTAL COMPEL"!ED STORED TO S 46,12920 t Dale: s1 zs�1 z- 5. RETAINAGE: r-_Koonv,Presidenta. 0 %of Completed Work S 0 sworn to before trio this day of r✓1 Pt r 2 0 c Z (Column Id+ Eon C703) ,•:; b. °o of Stored Material S ;F '„"n,. LINDA G.bUCHANAN 1 Hancock County (Column F on G703) = sru _'- My Commission Expires '[olat Retainage(Lines 5a+5b or 1 �)':r'at' Annuct 9p,2019 Total in Column lcif G703) s CI DO ARCHITECT'S CERTIFICATE FOR PAYM NT 6. TOTAL EARNED LESS RE.AINAGE S 46,129.00 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 ecru lies to the Owner that to the best of the 7. LESS PREVIOUS CHR1 IPICAT13S FOR Architect's knowledge. information and halicI the Work has progressed as indicated. PAYMENT (Line 6 from prior Certificate) $ 39,16590 the quality of the Work is in aeeerduneu with the Contract IJOCUments,and the Contractor 8. CURRENT PAYMENT DUE S 6.963.10 is entitled to payment of the AMOUNT CERTIFIED_ 9_ BALANCE"TO l'INISII,INCLUDING RE7AINACII S 2,971.00 �� (Line 3 less Line 6) AMOUNT CERTIFIED S ..444&.i Le- ChIANCIG ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation rfanmu (eon fled fersfronr the WHOM(app!led.Initial all/idarre.S on nut 'GOUT!changes approved .fpplication and on .. _ i •anion Sheet that are changed to conform with the amount cart fed.) in previous months by Owner ARCHITECT: 1 1 Total approved this Month Lay: y�}� ? .. Date: tt�,Ci. )'7 TOTALS $0.00 $0.00 This Certificate is n .Jieaatia 'e. he AMOUNT CERTtFFFD is payable my t the Contractor Bart_ ea try in Issuance,payment one acceptance 01 payment are with Ut NET CHANCES by Change Order 5'0.00 prejudice to any rights of the Owner or Contractor under this Contract. AU DOCUMENT G702-APPLICATION AND CERTIFICATION FOP PAYMENrr.1932 EDITION-AIA P01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.WASHINGTON,00 20006.5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Cedifi5.at of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 7 5/25/12 P112 Motor Court Veneer - 12036 Carmel, Indiana WORE 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 4 FINISH Cost I General Requirements: Site Supervision 9,500.00 9,500.00 0.00 0.00 9,500.00 100% 0.00 9,500.00 Site Supervision Alt 1 6 5 14,050.00 13,143.83 906.17 0.00 14,050.00 100% 0.00 14,050.00 CRC Meetings 1,000.00 322.37 677.63 0.00 1,000.00 100% 0.00 1,000.00 Construction Management Fee 10,500.00 8,595.00 1,905.00 0.00 10,500.00 100% 0.00 10,500.00 Construction Management Fee Alt 16 5 14,050.00 7,604.70 3,474.30 0.00 11,079.00 79% 2,971.00 11,079.00 49,100.00 39,165.90 6,963.10 0.00 46,129.00 94% 2,971.00 46,129.00 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 P112 Motor Court Veneer, 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 six thousand nine hundred sixty-three dolllars and ten cents ($6,963.10) 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 hom . Koontz, President Subscribed and sworn to before me this: Sth /716 .1 '0/ 2 Notary Publica .put':>, .; LINDA G.BUCHANAN a .munr•. : Hancock County ',y..svL My Commission Expires August20,2019 Prescribed by State Board at 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 Sj q Cc:i;fror# ':n Purchase Order No. 720 5rd'l S-/i' Terms /Z/ "Ye 32 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 5125/12 7/MG S/fP Sarizr'g•21r 4 2 3-/O Total I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have a Bite• same in accor- dance with IC , -L5-11-10-1. � c� , 20 IZ - - •-Treasurer