HomeMy WebLinkAboutSIGNATURE CONSTRUCTION, LLC- 002710- 2/16/2012 CARMEL REDEVELOPMENT COMMISSION 002710
Signature Construction, LLC Check: 2710
720 3rd Ave., SW Date: 2/16/2012
Carmel, IN 46032 Vendor: SIGNATO1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
1-5 157.00 157.00 0.00 0.00 157.00
LaFever site amenities
4-7 3,248.95 3,248.95 0.00 0.00 3,248.95
P112 Motor Court Veneer
i 12012-1 11,684.00 11,684.00 0.00 0.00 11,684.00
Snow and ice removal costs
15,089.95 15,089.95 0.00 0.00 . 15,089.95
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THE KEY TO DOCUMENT SECURITY•HEAT ACTIVATED THUMB PRINT•!ADDITIONAL SECURITY FEATURES INCLUDED •SEE BACK FOR DETAILS -.
.is6Di Carmel Redevelopment Commission REGIONS 002710 O 2 71 O
• ~ 30 West Main Street 20-14211140
Suite 220
\ ""``" �Carmel, IN 46032 -
2710
DATE AMOUNT
2/16/2012 15,089.95
PAY THE SUM OF.FIFTEEN THOUSAND EIGHTY NINE DOLLARS AND 95 CENTS
TO THE
ORDER
OF
Signature Construction,LLC
720 3rd'Ave., SW ' '
Carmel, IN'46032 °'
00027 £011' 1:0740L42L31: 0087504LLL0
CARMEL REDEVELOPMENT COMMISSION 002710
Signature Construction, LLC Check: 2710
720 3rd Ave., SW Date: 2/16/2012
Carmel, IN 46032 Vendor: SIGNATO1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
1-5 157.00 157.00 0.00 0.00 157.00
LaFever site amenities
4-7 3,248.95 3,248.95 0.00 0.00 3,248.95
P112 Motor Court Veneer
12012-1 11,684.00 11,684.00 0.00 0.00 11,684.00
Snow and ice removal costs
15,089.95 15,089.95 0.00 0.00 15,089.9E
X.11.52 COMPUTEREASE FORMS DIVISION(877)577-5791 T-37228 ;`
Ig ure
tion
010
nstruc , L C
Carmel Redevelopment Commission
Parcel 5 Plaza - Snow & Ice Removal
702 South Rangeline Road
Carmel, IN 46032
ATfN: Matt Worthley
INVOKE
Date: January 20, 2012
•
Invoice: 0001
Snow and ice removal costs for the following:
12-8-11 Ice Melt $876
Fees $238 Total 12-8-12 = $1114
12-27-11 - Snow Removal $2500
Ice Melt $876
Fees $238 Total 12-27-11 = $3614
1-2-12 - Ice Melt $876
Fees $238 Total 1-2-12 = $1114
1-12-12 - Snow Removal $2500
Ice Melt $876
Fees $238 Total 1-12-12 = $3614
1-13-12 - Ice Melt $876
Fees $238 Total 1-13-12 = $1114
1-14-12 - Ice Melt $876
Fees $238 ___Total 144-12 = $1114
TOTAL INVOICE $ 11,684 Ic/
Please make check payable to: Signature Construction, i1!:
If you have questions, please contact Jason Springer at 3]7-94_:-7E7.'_`.
One Pedcor Square
720 3rd Avenue, S.W. • Carmel, IN 46032
Tel (317) 817-0360• Fax 1317) 8170362
r
Lam'
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 1
1/25/12
P112 Site Amenities - Broady
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:
Site Supervision 157.00 0.00 0.00 0.00 0.00 0% 157.00 0.00
Construction Management Fee 157.00 0.00 157.00 0.00 157.00 100% 0.00 157.00
319.00 0.00 157.00 0.00 157.00 50% 157.00 157.00
I- '"
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
Site Amenities, 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
one hundred fifty-seven dollars and zero cents ($157.00) 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
J." 1
horn.. . '. tz, 'resnent '
Subscri ed and sworn to before me this: ...7• iia et -Dora,
Notary Public:
r",''.€'..-. LINDA G.BUCHANAN
` ��� _- Hancock County
mft ,,zs My Commission Expires
"``G4`"` August 20,2019
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 three thousand
two hundred forty-eight dolllars and ninty-five cents ($3,248.95) 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
1 upon receipt of such cash payment.
THEREFORE, the undersigned waives and releases unto the Owner of said premises any
I 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 mas E. ontz, President •
Su scribed and sworn to before me this: — �a n . a or
Notary Public: .4rai 441._
r,
S. 4„, LINDA BUCHANAN
m. Hancock ck County
., ft Commission Expires
n" August20,2019
/
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Invoice # 4
1/25/12
P112 Motor Court Veneer - 12036
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 8 FINISH Cost
General Requirements:
Site Supervision 10,500.00 9,602.82 0.00 0.00 9,602.82 91% 997.12 9,602.82
Site Supervision Alt 1 & 5 14,050.00 0.00 2,251.45 0.00 2,251.45 16% 11,798.55 2,251.45
Construction Management Fee 10,500.00 7,597.50 997.50 0.00 0,595.00 82% 1,905.00 8,595.00
Construction Management Fee Alt le 5 14,050.00 2,355.00 0.00 0.00 2,355.00 17% 11,695.00 2,355.00
49,100.00 19,555.32 3,248.95 0.00 22,804.27 46% 14,600.73 20,449.27
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT(5702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Cannel PROJECT: P112 Motor Court APPLICATION NO invoice44 -7 Distribution to:
Carmel Indiana 46032 Veneer Signature costs OWNER
ARCHITECT
PERIOD TO: 01/25/2012 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Constmction Services LLC
720 3rd Avenue S.W. PROJECT-NOS:
Cannel. Indiana 46032
CONTRACT FOR: CONTRACT DATE: a
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 $ 49.100.00
2. Net change by Change Orders $ 0.00 CON'T'RACTOR:
3. CONTRACT SUM TO DATE(Line 1 ±2) $ 49,100.00
4. TOTAL COMPLETED&STORED TO $ 22,804.27 //
By: �� Date: / /ZS /Z
5, RETAINAGE: l'homas F. omnt2,President id-
a. f
0 %of Completed Work $ 0 Su scribed and worn to before me this day of 3G el - .2 0t -- - -—
(ColumnD+E on(1703) ...' •.. LINDA G.BUCHANAN
h. %of Stored Material $ f�io w.n4,y"{ Hancock County
(Column F on G703) t„;._WL 4,..7 My Commission Expires
'Total Retainage(Lines 5a+5b or '?!ra K:" August20,2019
'fatal in Column l of G703) s 0.00 ARCHITECT'S CERTIFICATE FOR PAY - . -""°°`
6. TOTAL EARNED LESS RETAINAGE $ 22,804.27 In accordance with the Contract Documents,based on on-site observations and die data
(Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the hest 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) $ 19,555.32 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE S 3,248.95 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 26,295.73
(Line 3 less Line 6) AMOUNT CERTIFIED... ...... .$ 3-2 r 4'7
CHANGE ORDER SUMMARY AUL/FIIGNS DEDUCTIONS (Attach explanation ifamam certified differs from the amount applied. Initial all figures on this
Total changes approved Application and oral- - nit union Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT: , -
Total approved this Month By: rt, (/ 'A Date: 1\' ) 17
TOTALS $0.00 $0.00 This Certificate is tt negotiable. The AMOUNT CERTIFIED is payabl ly fiat contractor name ereun.issuance,payment and acceptance of payment a wit ���-""",/��'
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contracts / j2
AIA DOCUMENT 6702.APPLICATION AND CERTFICATION FOR PAYMENT•1992 EDITION•AIA •01992 THE AMERICAN INSTTUTE OF ARCHITECTS.1735 NEW YORK AVE..NW..WASHINGTON.DC 200065292 —/
Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.
APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel I'I2O.IECT: site Amenities APPLICATION NO Invoice a I — S Distribution to:
Carmel Indiana 46032 Lafecer Signature costs OWNER
ARCH I I'I'ECT'
PERIOD TO: 0125/2012 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services!LC ,
720 3rd Avenue S.W. PROJECT NOS:
Cannel, Indiana 46032
CONTRACT FOR: CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contmetor'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 $ 314.00
Net change by Change Orders S 0.00 CON'T'RACTOR:
3. CONTRACT SUM TO DATE(Line I a:2) S 314.u0
4. TO•rAl.COMPLETED Sc STORED TO S Ie r.u0
5. RETArNAGE: lit. omas -. nt{ 'resident
Date: i/25- Z�
a. 0%of Completed Work S 0 Subs ribed and s om to before me this .2 S.— day of;l4e7- 20I a
LINDA G.BUCHANAN F;
Tan%of Eon6703) Fw�"� : Hancock County A
h.
%of Stored Material S it My Commission Expires
(�Irn F Dne(Lin '
total Retamage(Tines ca+en or "Cltg.if?" August 20,2019
Total in Column l of G703) $ 0,00 ANCHI IEC I'5 ULNA ICAIL f-UN I'AYMtN
6. TOTAL.EARNED LESS RETA[NAGE S Ie7.ot1 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 CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated,
PAYMENT(Line 6 from prior Certificate) S 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor
S. CURRENT PAYMENT DUE S I s uu is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING REfAINAGE 5 la7.00 ���—
(Line 3less Line 6) AMOUNT CERTIFIED S
IHANGI:URDLR SuMMAR1 AUDI I IONS ULU(R.I IONS (lunch explanation if amount certified differs from the amount applied.Initial all figures on this
I otal changes approved Application and onth Doan of Sheer r/rat are changed to conform with the amount certified)
in previous months by Owner ARCIIITECT:
Total approved this Month By: Date: le A 1 2
TOTAI.S S0.00 $0.00 This Certificate is not e 6It able. The AMOUNT CERTIFIED is pa on on tp t
contractor names ne In.issuance,paymlent anu acceptance m pay nt are 5' no I
NET CIIANGES by Change Order $0.00 prejudice to any g is of the Owner or Contractor under this Contra 't i /7 9 L
ALA DOCUMENT G702-APPLICATION AND CERTIFICATION FOR PAYMENT.1992 EDITION.CIA .01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEWYORK AVE.,N.W.,WASHINGTON, 2C007-5292 `�,
Users may obtain validation of this document by requesting a completed AEA Document D401 -Certification of Document's Authenticity from the Licensee.
•
Prescribe by Slate Bear,f of Accourils Clly Furni 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
},'�F,q�✓,Qa (1 0.1 jtrn71"; :, �.�ar c �? L� - Purchase Order No.
72 G . Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
/-25- 5r74r itect, 1/111 ai "G y ��arr /l'2 /5 ? 00
P/ 2° �4tdrCots" Y ,fl 3,241?. 95—
Aa
Total 3,'(0-57-?c---
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correc :Fited s- e in accor-
dance with IC 5-11-10-1.6.
02-1.( , 20 Ids I_
r: -Treasurer
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.
\ r
Payee
S 19i kkrt C9. "uC a / L LC Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
kw t r_\ 5 S n"c rtrnw&\ 11-g 1-ci �h Ili 6 8'x.°"
Total
II,btl.
I Hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- w
dance with IC 5-11-10-1.6. `?
1,2.-' . , 20/Z
• -Treasurer