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Home My WebLink AboutSIGNATURE CONSTRUCTION, LLC- 202- 3/16/2011 Signature Construction, LLC Check: 202 720 3rd Ave., SW Date: 3/16/2011 Carmel, IN 46032 Vendor: SIGNAT01 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5-16 112,600.77 112,600.77 0.00 0.00 112,600.77 app 16 on P7c1 Theater 112,600.77 112,600.77 0.00 0.00 112,600.77 202 3/16/2011 """""112,600.77 THE SUM OF ONE HUNDRED TWELVE THOUSAND SIX HUNDRED DOLLARS AND 77 CENTS '""`" Signature Construction, LLC 720 3rd Ave., SW Carmel, IN 46032 Signature Construction, LLC Check: 202 720 3rd Ave., SW Date: 3/16/2011 Carmel, IN 46032 Vendor: SIGNAT01 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 5-16 112,600.77 112,600.77 0.00 0.00 112,600.77 app 16 on P7c1 Theater 112,600.77 112,600.77 0.00 0.00 112,600.77 APPLICATION AND CERTIFICATION FOR PAYMENT AM DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER CRC at City of Carmel PROJECT: 7C-I Main Theater APPLICATION NO:Application a 16 Distribution to: Application k 16 Signature costs OWNER Carmel Indiana 46032 _ ARCHITECT PERIOD TO: 01/25/2011 _ X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedant'Design Signature Construction Services LIE 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,AlA 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 liom the Owner,and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM S 1092,564,34 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I=2) 5 10Y,564.44 4. TOTAL COMPLETED&STORED TO $ 662,U44.45 � By: _/--h 7� Date: 7 ^-1 /7 5. RETAINAGE: homas E.ko _Press ent a, 0%of Completed Work S 0 Sub cribed and swo to before me this 7 i day of R DO. o I l - oumnD+E on G703) ° U _ LINDA BUCHANAN b. %of Stored Material E ock County (C`orumn F on G703) j'.NOr My C°::11111:5 ission EXpires �'I',',';�,,., st 20, l amt rcnramaac(ants 5a*5o or .�t - 2011 Total in Column I of0703) $ 0.00 ' ' • • b r u.t' 6. TOTAL EARNED LESS RETAINAGE S 661,034.45 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less I.ine 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) $ 549,433.71 the quality of the Work is in accordance with the Contract Documents,and the Contractor S. CURRENT PAYMENT DUE $ 112,600.77 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE to FINISH,INCLUDING RETAINAGE 5 430,529.56 (Line 3 less Line 6) AMOUNT CERTIFIED S I1? ,rt2 -�� .. THANUEURUtk SUMMARY ADUI INN'S Uhlltlt.I IONS (Attach explanation ifaaount earthed differs from the amount applied.Initial all figures on rs 1 otal changes approved Application and •the('.•,, ion She t that are changed to conform with the amount certitfied.J in previous months by Owner ARCHITECT: • Total approved this Month By: �,. �Laa Date: )1 151 TOTALS $0.00 $0.00 This Certi care is no egatiable. 'the AMOUNT CERTIFIED is payable onlf to th L,onlnwtor amend cm.issuance,payment ana acceptance or payment are witnout NET CHANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract. NA DOCUMENT G7e2.APPLICATION AND CERTIFICATION FOR PAYMENT'1992 EDITION'ALA•01992 THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW vORK AVE.,N'W.,WASHINGTON,DC 200.6.6]42 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. • Q\ / SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Application # 16 1/25/11 7C-1 Main Theater 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-Construction Services: Site Supervision 20,921.29 20,921.29 0.00 0.00 20,921.29 100% 0.00 0.00 Construction Management 3,139.47 3,139.47 - 0.00 3,139.47 100% 0.00 0.00 Design Drawings 5,068.68 5,068.68 0.00 0.00 5,068.68 100% 0.00 0.00 Jobsite Trailer 2,947.03 2,947.03 0.00 0.00 2,947.03 100% 0.00 0.00 General Conditions: Testing and Inspecting 31,430.00 28,844.25 1,797.45 0.00 30,641.70 97% 788.30 0.00 Site Supervision 255,689.00 164,533.39 27,166.62 0.00 191,700.01 75% 63,988.99 0.00 Construction Management 113,964.00 11,222.50 3,777.96 0.00 15,000.46 13% 98,963.54 0.00 Site Safety Director 21,104.00 4,712.51 807.90 0.00 5,520.41 26% 15,583.59 0.00 Design Drawings 48,742.53 33,624.46 44.73 0.00 33,669.19 69% 15,073.34 0.00 Sanitary Facilities 16,461.00 2,810.68 0.00 0.00 2,810.68 17% 13,650.32 0.00 Field Office 24,692.00 5,431.35 1,306.37 0.00 6,737.72 27% 17,954.28 0.00 Temporary Electric 4,748.00 281.59 0.00 0.00 281.59 6% 4,466.41 0.00 Office Supplies 4,748.00 4,523.31 0.00 0.00 4,523.31 95% 224.69 0.00 Temporary Telecommunications 9,022.00 286.43 0.00 0.00 286.43 3% 8,735.57 0.00 Temporary Water 949.00 112.46 0.00 0.00 112.46 12% 836.54 0.00 Tools and Equipment 56,026.21 7,242.40 5,782.97 0.00 13,025.37 23% 43,000.84 0.00 Access Road 5,979.60 5,436.00 0.00 0.00 5,436.00 91% 543.60 0.00 Field Eng. and Surveying 6,331.00 3,050.00 0.00 0.00 3,050.00 48% 3,281.00 0.00 Insurance 17,432.00 16,141.00 0.00 0.00 16,141.00 93% 1,291.00 0.00 Health and Safety 4,748.00 147.66 0.00 0.00 147.66 3% 4,600.34 0.00 Waste Disposal 67,270.00 2,162.75 2,858.80 0.00 5,021.55 7% 62,248.45 0.00 Project Signage 2,373.00 0.00 0.00 0.00 0.00 0% 2,373.00 0.00 Temp fencing 8,005.00 4,400.00 3,200.00 0.00 7,600.00 95% 405.00 0.00 Temp Electric Site 23,743.00 5,638.08 3,908.86 0.00 9,546.94 40% 14,196.06 0.00 Temp Lighting Site 39,570.00 0.00 0.00 0.00 0.00 0% 39,570.00 0.00 Temp Water ite 15,194.00 0.00 0.00 0.00 0.00 0% 15,194.00 0.00 Temp Fire Protection 3,561.00 0.00 0.00 0.00 0.00 0% 3,561.00 0.00 Construction Management Fee 278,705.53 216,756.42 61,949.11 0.00 278,705.53 100% 0.00 0.00 1,092,564.34 549,433.71 112,600.77 0.00 662,034.48 61% 430,529.86 0.00 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA ) COUNTY OF HAMILTOP) 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 Main Theater, 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 twelve thousand six hundred dollars and seventy-seven cents ($112,600.77) 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 T omas E. ontz, President c Subscribed and sworn to before me this: 9 6,4 .)v /I r Notary Public:.--s,-r„ ' ice .n;.=o--. LINDA BUCHANAN oun• , Hancock County E.0% 6.; My Commission Expires August 20,2011 January 201 I Pay Request Black Box Theater REQUISITION NO. 66 FOR DISBURSEMENT FROM ACQUISITION FUND The undersigned hereby states and certifies: (i) that he/she is the duly appointed, qualified and acting Chief Financial Officer of REI Real Estate Services, LLC, the sole member of Carmel Theater Development Company, LLC (the "Company"), and, as such, is familiar with the facts herein certified and is authorized to certify the same; (ii) that, pursuant to Section 3.5 of the Trust Agreement by and among Wells Fargo Bank, N.A., as trustee (the "Trustee"), and the Company, dated as of December I, 2009 (the "Trust Agreement"), the undersigned hereby requests the Trustee to disburse this date from the Acquisition Fund under the Trust Agreement, to the payees set forth on the attached Annex I, the amounts set forth on the attached Annex L and (iii) that each obligation referred to herein is a proper charge against the Acquisition Ft.ind, and that payment for such charge has not previously been made. CARMEL THEATER DEVELOPMENT COMPANY, LLC By: REI Real Estate Services, LLC, sole Member B y: �: I v4� Prime �0.�4 A 1 5. :Title: Date: 3/ /D/// CONSENT GIVEN: CITY OF CARMEL REDEVELOPMENT COMMISSION, for and on behalf of the City of Carmel Redevelopment District By: Printed: LAS .°LOS Title: mfr ✓J f " cc 70 Date: 3`q�/ January 2011 Pay Request Black Box Theater Annex I ACQUISITION FUND DISBURSEMENTS Item Purpose of Number Payee Name and Address Obligation Amount Verkler Construction Payment for services $30,801.15 for 7C Black Box January 7240 Georgetown Road Indianapolis. IN 46268 2 Ideal Heating Inc. Payment for services $774.00 for 7C Black Box January 1417 N. Harding St. Indianapolis, IN 46202 3 MacDougal Pierce Payment for services $68,004.00 for 7C Black Box January 12720 Ford Drive Fishers, IN 46038 4 Indianapolis Stage Payment for services $32,535.00 for 7C Black Box January 905 Massachusetts Ave. Indianapolis, IN 46218 5 ESCO Communications, Inc Payment for services $217,505.70 for 7C Black Box January 8940 Vincennes Cr. Indianapolis, IN 46268 6 REI Construction Construction $32,401.08 management services for 7C Black Box 11711 N. Pennsylvania Street, Ste 200 Carmel, IN 46032 1-1 January 2011 Pay Request Black Box Theater Total Amount for Requisition #66 $382,029.93 INDS01 NWS 117766k! 1-I