The URL can be used to link to this page

Home My WebLink AboutDEALERS WHOLESALE- 178- 2/11/2011 Dealers Wholesale Check: 178 Date: 2/11/2011 Vendor: DEALWHO Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 3 3,348.00 3,348.00 0.00 0.00 3,348.00 app 3 on P7C-1 Theater 3,348.00 3,348.00 0.00 0.00 3,348.00 178 2/11/2011 """""""'"""3,348.00 THE SUM OF THREE THOUSAND THREE HUNDRED FORTY EIGHT DOLLARS AND NO CENTS """" Dealers Wholesale Dealers Wholesale Check: 178 Date: 2/11/2011 Vendor: DEALWHO Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 3 3,348.00 3,348.00 0.00 0.00 3,348.00 app 3 on P7C-1 Theater 3,348.00 3,348.00 0.00 0.00 3,348.00 • . APPLICATION AND CERTIFICATION FOR PAYMENT .fuADocuvfENT G702 PAGE ONE OF 2 PAGES2 TO OWNER: PROJECT: APPLICATION NO 3 Distribution to: Carmel Theater Development Corporation, LLC Village on the Green Parcel 7-C-I Theater Building OWNER 11711 N.Pennsylvania St.,Suite 200 3rd Avenue SW ARCHITECT Carmel,IN 46032 Cannel, IN 46032 PERIOD TO: 12/30/2010 CONTRACTOR FROM CONTRACTOR: VIA ENGINEER: 1 Dealers Wholesale Signature Construction, LLC 7845 E 89th St 720 3rd Avenue SW PROJECT NOS: 12012 Indianapolis, IN 46256 Carmel,IN 46032 CONTRACT DATE 7!28/2010 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor cenifresthat 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 217,021.00 2. Net change by Change Orders S 0.00 CONT OR: ,/ S 217,021.00 4. TOTAL COMPLETED&STORED TO S 5,410.60 /��, !a 5, RETAMAGE, 8y' Data / r!/ / a. 10 %of Completed Work $ 541 Subscribed a d sworn to before me this 7 day of eC07AR IC Zr O/LS (Column D+E an G703) b. 0 %of Stored Material S (Column Fon G707) ,/rJ .7.-- z/`/S Total Retainage(Lines 5a+5b or '�f LLL��--- TotalinColumnlofG703) S 54106 E tINEER'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETA1NAGE S 4.869.54 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Engineer's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 1,521.54 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 3,348.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 212,151.46 (Line 3 less Line 6) AMOUNT CERTIFIED $ 33/f)° CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (A(each explanation ifantount certWed differs from the amount applied Initial allfigures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified) In previous months by Owner {GI `(tin-- — ✓t f� �� ,/� / Total approved this Month By'. ✓-L-�;''Lj� y� F Dates/ 2 a 1.y TOTALS $000 $0.00 This Ceni6cate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named harem.Issuance,payment and acceptance Dt payment are without • NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA D0oumEr7T Gp1•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION•AIA.€1992 THE AMERICAN INSTITUTE OF ARCHITECTS,17115 NEW YORK AVE.,NW..WASHINGTON,DC 20003.5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. it iP 6703 CONTINUATION SIIEET I I 1 1 I I I - To: I From: 1 1 Project: I 1 Application No.: 3 Cannel'Theater Development Corporation,LTC Dealers Wholesale _ Village on the Green'Theater Application Date: 1220/10 11711 North Pennsylvania Street 7845E 89th St E 3E-116I Doors,Frames,8:Hardware Period To: 1 12/30/10 Suite 200 I Indianapolis,IN 46256 Eng.1'roj 4 12012 Carmel,IN 46032 317-849-4336 Work Completed Materials Total Presently _ Completed Balance Retainage Item Scheduled From Previous Stored and Stored 7. To If it Description of Work Value Application This Period (Not in To Date (G/C) Finish Variable D or E) (D+E+F) (C-G) 10 106-8000 Hollow Metal Frames 10,325.50 1,690.60 3,720.00 5,410.60 52.4% 4,914.90 541.06 108-8001 Hollow Metal Frames Installation . 2,340.00 0.00 0.00 0.00 0.0% 2,340.00 0.00 108-8002 Hollow Metal Doors 48,665.00 0.00 0.00 0.00 0.08 48,685.00 0.00 108-8003 Hollow Metal Doors Installation 3,545.00 0.00 0.00 0.00 0.08 3,545.00 0.00 10B-8004 wood Doors Material 11,695.10 0.00 0.00 0.00 0.0% 11,695.10 0.00 108-8005 wood Doors Installation 2,800.00 0.00 0.00 0.00 0.08 2,800.00 0.00 108-8006 Hardware Material 97,551.90 0.00 0.00 0.00 0.0% 97,551.90 0.00 108-8007 Hardware Installation 13,057.00 0.00 0.00 0.00 0.08 13,057.00 0.00 108-8008 Bid Bond 2,021.50 0.00 0.00 0.00 0.0% 2,021.50 0.00 108-8009 Allowance 25,000.00 0.00 0.00 0.00 0.0% 25,000.00 0.00 Change Order 844 (10,896.90) 0.00 0.00 0.00 0.08 (10,896.90) 0.00 I Total: 206,124.10 1,690.60 3,720.00 0.00 5,410.60 2.6% 200,713.5(1 541.06 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS & WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton Robert E. Nielsen Being duly sworn upon his/her oath disposes and says that: 1. He/she is Executive Vice-President(inserting sole proprietor, partner or corporate office held, as the case maybe), of Dealers Wholesale 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 2 3 All Materials Used from Stock #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 WIT S WH RE OF, affiant has signed this document on behalf of the Prime Contractor this day of 41* , 20 /0 . , : VP ��,,,a�/ ( uthorized Representative of Prime Contractor, Title) County of Merien State of Indiana Subscribed and sworn to before me, a Notary Public in and for said County and State, This /C Day of Pet ton/1 ht , 20 to Ati (Notary Public) is /� � (Printed Name) Rf.,/ntn„„. A 1% L My Commission Expires: 7-2.1--/r NOTARY SEAL MUST APPEAR ON THIS FORM. 1