The URL can be used to link to this page

Home My WebLink AboutSIGNATUER CONSTRUCTION, LLC- 149- 1/5/2011 Signature Construction, LLC Check: 149 720 3rd Ave., SW Date: 1/5/2011 Carmel, IN 46032 Vendor: SIGNAT01 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7-12 2,549.79 2,549.79 0.00 0.00 2,549.79 App 12 on P7C-10 Engineering 2,549.79 2,549.79 0.00 0.00 2,549.79 149 1/5/2011 *****"****2,549.79 THE SUM OF TWO THOUSAND FIVE HUNDRED FORTY NINE DOLLARS AND 79 CENTS ""`""'"""""" Signature Construction, LLC 720 3rd Ave., SW Carmel, IN 46032 Signature Construction, LLC Check: 149 720 3rd Ave., SW Date: 1/5/2011 Carmel, IN 46032 Vendor: SIGNAT01 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 7-12 2,549.79 2,549.79 0.00 0.00 2,549.79 App 12 on P7C-10 Engineering 2,549.79 2,549.79 0.00 0.00 2,549.79 T • APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT 6702 PAGE ONE of 2 FAGEL2 TO OWNER CRC at City of Carmel PROJECT: 7C-10 General Site Engineering APPLICATION NO Application a i2 1 Distribution to: One Civic Square Signature costs (OWNER Cannel Indiana 46032 ARCHITECT PERIOD TO: 1 1/29/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARC/IITECT: Pedcor Design Signature Construction Services LTC I 1 720 3rd Avenue S.W, PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies t hat to the best of the Contractor's knowledge, Application is made for payment,as shows below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet,AlA Document 0703, 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()Amer,and that current payment shown herein is now due, 1. ORIGINAL CONTRACT SUM $ 70,260.95 2. Net change by Change Orders S 400 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I a 2) $ 52,341E0 4. TOTAL COMPLETED&STORED TO $ 52,345_80 if j By C / ---- /j Date: /7//Z y / 5 RETAINAGE Thomas oontz,Pres ident (((!!! a. 0 Vs of Completed Work S Subscribed sworn to before me this gdayof rildlni l D''yu (Column D+E an G703) i b. %of Stored Material $ (Column F on 0703) ate.a'Ti LINDA BUCounty ( ) ,,,z.:.. . Hancock County Total Retainage(Lines 3a+5b or - ' t/ Comm€ss€on Ex Tres Total in Column I of G703) $ 000 ARCHITECT'S CERTIFICATE FOR PAYMENT.`,,:' '• ^°5°'`9'2411 6, TOTAL EARNED LESS RETAINAGE $ 52,341 E0 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5Total) comprising the application,the Architect certifies to the Owner that to the'hest 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 49,792 di the quakity of the Work is in accordance with the Contract Documents,and the Contractor E. CURRENT PAYMENT DUE $ 2,349.79 is entitled to payment of the AMOUNT CERTIFIED, 9. BALANCE TO FINISH,INCLUDING RE['AIN:AGE S 0.00 - (Line 3 less Line 6) AMOUNT CERTIFIED.. ,., ,., ...S -- I. l I (FLANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attack explanation if remnant certified drifersdiiner the amount applied. Initial all figures on this Total changes approved AppGcolion and onthe Continuation Sheet dear are changed in conform with the amount certified.) in previous months by Owner -.-,6ILCFf!CL b C-/-✓.w ---- ' Total approved this Month E / /' , ✓ �� Date: /'J:L/)L G' TOTALS $000 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contactor named heron_Issuance,payment and acceptance of payment are wnnout NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. PIA DOCUMENT a]e2.APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA 91992 THE ANISRICAN INSTITUTE OF ARCHITECTS,1195 NEW YORK FOE.,NSW WASHINGTON.Cc 2Z-O5-5292 Users may obtain validation of this document by requesting a completed AIA Document 0401-Certification of Document's Authenticity from the Licensee. pot- • 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 Village on the Green Parcel 7c Site Engineering, 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 two thousand five hundred forty-nine dollars and seventy-nine cents ($2,549.79) 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, finished 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 Tomas E®Koontz, President /Subscribed and sworn to before me this: NG+/ `! ddi v Notary Public: _g,:a:'•=.';4.R_ LINDA euchANAN norm., : Hancock County .y s:>. .,i My Commission Expires `•'�;.;. ,��, August 20,2011 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana. 46032 Application 11 12 11/29/10 7C-10 General Site Engineering Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH RETAINAGE Pre-Constructin Services 9,470. 94 9,470.94 0.00 0.00 9,470. 94 100% 0.00 0,00 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 2,503.00 2,753.30 0.00 0. 00 2,753.30 110% (250.30) 0.00 Site Supervision 10,502.11 5,508.24 0.00 0.00 5,508.24 0% 4,993.87 0.00 Construction Management 4,680,94 0.00 0.00 0.00 0.00 0% 4,680.94 0.00 Site Safety Director 866.84 283.67 0.00 0.00 283.67 0% 583.17 0.00 Design Drawings 975.20 0.00 0.00 0.00 0.00 0% 975.20 0.00 Sanitary Facilities 676.14 430.69 0.00 0.00 430. 69 64% 245.45 0.00 Field Office 1,014,20 1,073.30 0.00 0.00 1,073.30 106% (59.10) 0.00 Temporary Electric 195.04 195.04 0.00 0.00 195.04 100% 0.00 0.00 Office Supplies 195.04 195.04 0.00 0.00 195.04 100% 0.00 0.00 Temporary Telecommunications 370.57 276.20 0.00 0.00 276.20 75% 94.37 0.00 Temporary Water 39.01 39.01 0.00 0.00 39.01 100% 0.00 0.00 Tools and Equipment 1,560.31 1,354.16 0.00 0.00 1,354.16 87% 206.15 0.00 Temp Electric Site 975.20 0.00 0.00 0.00 0.00 0% 975.20 1.00 Temp Fire Protection 146.28 0.00 0.00 0.00 0.00 0% 146.28 2.00 Temp Lighting 1,625.33 0.00 0. 00 0.00 0.00 0% 1,625.33 3.00 Temp Water 624.13 0.00 0.00 0.00 0.00 0% 624.13 4.00 Project Signage 97.49 0.00 0.00 0.00 0.00 0% 97.49 5.00 Temp Fencing 130.03 130.03 0.00 0.00 130.03 100% 0.00 6.00 Field Eng. and Surveying 260.05 260.05 0.00 0.00 260.05 100% 0.00 0.00 Health and Safety 195.04 0.00 0.00 0.00 0.00 0% 195.04 0.00 Waste Disposal 2,763.06 0. 00 0.00 0.00 0.00 0% 2,763.06 0.00 Construction Management Fee 30,395.00 27,822.34 2,549.79 0.00 30,372.13 100% 22.87 0.00 70,260,95 49,792.01 2,549.79 0.00 52,341.80 74% 17, 919.15 21.00