SANTAROSSA MOSAIC & TILE CO.,- 001464- 12/17/2010 CARMEL REDEVELOPMENT COMMISSION 001464
•
Santarossa Mosaic& Tile Co., Check: 1464
2707 Roosevelt Avenue Date: 12/17/2010
Indianapolis, In 46218 Vendor: SANTARO1
Prior
Invoice = P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
13 57 38,064.38 38,064.38 i 0.00 0.00 38,064.38
Application 13
38,064.38 38,064.38 0.00 0.00 ' 38,064.38
i` 'fl THISiCHECKIHASPASCO
a+Iss5'°�s1°y Carmel Redevelopment Commission AR4ctelvs 001464
30 Wesl Main Street
m-razrnao
Suite 220 =
CARRME` Carmel, IN 46032
1464
DATE AMOUNT '
12/17/2010 """*** *t3.8,064.38 .
PAY THE SUM OF THIRTY EIGHT THOUSAND SIXTY FOUR DOLLARS'AND 38 CENTS . ,
TO THE
ORDER , _ .
OF, _ - Santarossa Mosaic& Tile Co., -
'2707 Roosevelt Avenue >"sEHS'.
• Indianapolis, In 46218 ' .
i'DO IL,64u• 1:0 740 14 2 1 31: DOB 7 SOLI 1 Z. Llo
CARMEL REDEVELOPMENT COMMISSION 001464
Santarossa Mosaic &Tile Co., Check: 1464
2707 Roosevelt Avenue Date: 12/17/2010
Indianapolis, In 46218 Vendor: SANTARO1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
13 57 38,064.38 38,064.38 0.00 0.00 38,064.3F
Application 13
38,064.38 38,064.38 0.00 0.00 38,064.3F
i
A7.:t
It A
.1.* IA Document G702/CMa'M - 1992
Application and Certificate for Payment Construction Manager-Adviser Edition 7
TO OWNER: .12i Neel Drat [!gy�ft)ISTld) PROJECT:(...W r1QJ APPLICATION NO j3 .' _ Distribution to:
In W CIVIC SIgUQ!?2 Q��/4 SQ 5-5117 PERIOD TO (1)2311D OWNER ❑
PtYl- IA:108 Ir
CONSTRUCTION MANAGER ❑
FROM CONTRACTOR. 1 1) SQMDS31L -i tI IOy�VIA CONSTRUCTION MANAGER: CONTRACT DATE 05 01 JW ARCHITECT ❑
tDi Vti+ V�l PROJECT NOS
9thanacitlit t 41ia1 OC{-21 1 ! CONTRACTOR
VIA ARCHITECT: FIELD ❑
CONTRACT FOR:a j111.e1 Quay-Lif ❑
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge. information and
Application is made tilt payment,as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AlA Document G703,is attached 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
1.ORIGINAL CONTRACT SUM -- S MG 45aW payment shown herein is now due.
2.Net change by Change Orders $ i CONTRAC ORt oux�M t1 �,,e�,li/�f I�i Uo- J'&
3.CONTRACT SUM TO DATE(Line 1 +2) $ ✓t By' (l9�YJ .f.�if�pliet.� s - Date: I I /77 ill CI
4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) .,. ..,.....$ I Let .0)5 State o . ow
5.RETAINAGE: County of M(�QIe/1 `� I
a 5 Ti,of Completed Wark� Subscribed ant st m to before
(Column.D+ F on 6703) $ 4z, 322.5D me this 2 a o DY-91 f
b „ %of Stored Material Notary Pubhc r"
(Column F on 6703) $ My Commissif e gtr J I i
Total Retainage(Lines 5a+5h or Total in Column I of0703).. $ 42,522.5D CERTIFICATE FOR PAYMENT
b.TOTAL EARNED LESS RETAINAGE S M 04.60 In accordance with the Contract Documents, based on on-site observations and the data comprising
this application.the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT .. $ ?35 (P20 II- accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) /1 CERTIFIED.
8.CURRENT PAYMENT DUE $ gig, x114 O AMOUNT CERTIFIED $ 3Sfd7.`�
9. BALANCE TO FINISH,INCLUDING RETAINAGE
(Attach explanation if amount certified differs fr the amount applied. initial alf figures on this
Application and on c Conlirrvatiare 57 eel!h changed tncorhform with the mount eertiferd.)
(Line 3 less Line 6) 5 12�1v5.5o CONS CTID
By: !ill 1. r.mss' i - t Date: a
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI r Total changes approved in prey ions months by Owner $ By �1 ,�i - h Date: le le-
1 ily approved this>Month $ $ This Curti e is not negotiable.-The AMOUNT CERTIFIED is payable e y to the Contractor
_ TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order $ the Owner or Contracfon:uner this Contract.
CAUTION:
You should sign an original MA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. _
AlA Document G7a7JCMa*v-1992.Copyright C 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document is protected by U.S.Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA°Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten(Eh copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American institute of Architects'legal counsel,cepyriohi @aia.org.
09201
CONTINUATION SHEET AEA. DOCUMENT G703 (Instructions on reverse side) FAC>E ii of mac ES
AlA Document 1,702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 13
containing Contractors signed Certification, is attached, APPLICATION DATE: 11/17/2010
In I:nailalions below, amounts are stated to the nearest dollar_ PERIOD TO: 11!2'3/2030
Ilse Column I on Contracts where variable retalnage for line items may apply- ARCHITECT'S PROJECT NO.:
A B C 0 F. F - C• II I
\'TORK COMPLIE'I'ED MATERIALS 1'O7YI I. BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED R ETA/NAG E
NO. DESCRIPTION OF WORE
FROM PREVIOUS STORED AND STORED G e' C FINEST( (IF 1`ARIABI.Ii
CA WE APPLICATION THIS PERIOD (NOT TN TO DATE 1 ) RATE)
)
(D + E) D OR E) (Da 8-t F) (C - C)
01.001 STONE FLOORING
01101 MATERIAL 402,325.00 402,325.a 402,325.00 100 38,515.10
01.200 LABOR 349,950.00 330,820.62 19,129.38 349,950.00 100 1.786.651
01.3301
01900 STONE TOPS
0150( MATERIAL 20,000.00 20,000.00 20,000.00 100 1,000.00
01.600 LABOR )8,000.00 14,065.00 13,935.00 28,000.00 100 703.25
01.70(
01.801 QUARRY TILE
01.90( MATERIAL 1,500.00 1,500.0( 1,500.00 100
02.00( LABOR 1,500.00 1,500.0( 1,500.00 100
02.101
02201 GENERAL ALLOWANCE 35,000.00 4,557.01. 4,557.00 13 30,443.00
02.301 CAD AS-BUILT ALLOWANCE 5,000.00 5,000.00 5,000.00 100
03.401 BOND 3,175.00 3,175.0( 3,175.00 100 317.50
03.50(
03.60( CHANGE ORDER#1
03.70(
846,450.00 777,942.62 38,064.38 8]6,007.00 96 30,443.0( 42,32251
•
IMA DOCUMENT G703 •CONTINUATION SHEET FOR 0702 • 1992 EDP ERN • AIM' • ®1992 • THE AMERICAN INSTITUTE OF ARCHITECT'S, 1735 NEW l'ORR
AVENUE,NW,WASHINGToK,DC.211i10&5291•WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 0703-1992
. al
CAUTION:You should use an original AIA document which has this caution printed in red.An original assures that changes will not be obscured as may occur when documents are reproduced.
WAIVER OF LIEN AND AFFIDAVIT
O FINAL (A PARTIAL ( ) PAYMENT TO FOLLOW
1�11 M. I iii I i being duly sworn states that (s) he is
ION_ t _ _!f Li 1 f of SANTAROSSA MOSAIC & TILE CO.. INC. having
contracted wi 1 ci lle j' I to furnish certain materials
and/er labor< .��foon .�
follows: ithin `, fora project known
as it U 1 Ftl ■_ � located at p
and owned b Ii!,fit A1; I ! ,[11 q. does hereby further state on behalf of the
aforementioned sub/contractor/supplier.
PARTIAL WAIVER.That pthe^balance due from the contractor is the sum of: A
—HI R.-G`(� lilulBeinD.'lixiSIA� f1DD DOLLARS ($ �JT�iNA., � )
( ) Receipt of which is hereby acknowledged: or
(✓'Payment of which has-been promised as the sole consideration for this AFFIDAVIT
AND WAIVER OF LIEN (PARTIAL) which is given to and for said amount effective
upon receipt of such payment.
FINAL WAIVER That the final balance due from the contractor is the sum of:
DOLLARS ($ )
( ) Receipt of which is hereby acknowledged: or
( 1 Payment of which has been promised as the sole consideration for this AFFIDAV.I
AND WAIVER OF LIEN (FINAL) which is given to and for said amount effective upon
receipt of such payment.
TI-IEREFORE: the undersigned waives and releases unto the said owner of said premises
any and all lien or claim whatsoever on the above described property and improvements
thereon on account of labor.and.anaterial-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 performed or material furnished to the undersigned for said project,and within the
scope of this AFFIDAVIT and WAIVER.
SANTA SSA MOSAIC & "I'ILI CO.. INC. BY: 4a 4l_/�/ % eys,
TITLE: f,� ��QQSpiL MMES./my hand an' notarial seal this V.
day of Noontea , 20 10 -
OiJ(
My Cormnissiun Lxpires: )1, )1� i
Npt ry Public (� p
Residing in Marion, County of Indiana U Q� �. dJ i V
Printed - L+