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HomeMy WebLinkAboutSANTAROSSA MOSAIC & TILE CO.,- 001436- 12/2/2010 CARMEL REDEVELOPMENT COMMISSION 001436 Santarossa Mosaic& Tile Co., Check: 1436 2707 Roosevelt Avenue Date: 12/2/2010 Indianapolis, In 46218 Vendor: SANTARO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 12 57 63,000.00 63,000.00 0.00 0.00 63,000.00 Application 12 63,000.00 63,000.00 0.00 0.00 63,000.00 i.7,i:_4SB THISiCHECK!HAS'A'CO Pptsrtt�r� Carmel Redevelopment Commission REGIONS 0.0143.6 30 West Main Street Suite 220 20-1421/740 OCARME t Carmel, IN 46032 • 5T0.1� 1436 DATE AMOUNT 12/2/2010 63,000.00 PAY THE SUM OF SIXTY THREE THOUSAND DOLLARS TO THE ORDER OF Santarossa Mosaic & Tile Co., 2707 Roosevelt Avenue >`""s"% Indianapolis, In 46218 F if P AE<IU "00 / 4360 1:0740 /4 2 1 31: 0087504LLLii• CARMEL REDEVELOPMENT COMMISSION 001436 Santarossa Mosaic&Tile Co., Check: 1436 2707 Roosevelt Avenue Date: 12/2/2010 Indianapolis, In 46218 Vendor: SANTARO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 12 57 63,000.00 63,000.00 0.00 0.00 63,000.00 Application 12 _ 63,000.00 63,000.00 0.00 0.00 63,000.00 SALkDocument G702/CMa1M - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition b 7 TO OWNER:NMI Vid &ptfltIE ktfIllTh SSteIl PROJECT:riff , APPLICATION NO 12. Distribution to ��ilee. U . wciI� - JPa�erk'a(11`I�44QSsi 2. 55 11 IC PERIOD TO IQI23lId OWNER ❑ kG11� � 14V1C1I2 �C CONSTRUCTION MANAGER ❑ FROM CONTRACTOR 0 OS � IIIQkp" VIA CONSTRUCTION MANAGER CONTRACT DATE 051010O'0 ARCHITECT ❑ ,' ` b55e elf `ue PROJECT NOS. -Vdlampollt, l Ifa18 OQ ZGi CONTRACTOR ❑ VIA ARCHITECT: FIELD ❑ CONTRACT FORQiQf,11'llIfl Didafi.1j'rlCa ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the hest of the Contractors knowledge,information and Application is made for payment, as shown below,9n connecton with the Contract. belief the Work covered by this Application for Payment has been contplete.d in accordance with the Continuation Sheet,AIA Document G7D3,is attached. Contract Documents, that all amounts have been paid by Contractor fo v r Work for which previous - /RI Certificates for Payment were issued and payments received from the Owner, and aril current 1.ORIGINAL CONTRACT SUM s W� ,re payment show n��litre in is now due. 1I 2 Net change by Change Orders ' S CONTRACT.•:,yA* •20STA /AI Sall IC UDanL;, 3 CONTRACT SUM TO DATE (Line 1 ±?) .... ... .............. ... . $ i r 5C. 1 R1': air /. i Date 10251 10 4 TOTAL COMPLETED 8 STORED TO DATE(Column G on G703) ... $M19 I State of I liana 5 RETAINAGE County of:MAW a 5 %o of Complete Work Subscribed wit worn to hetorer (Column D+Eon 0703) $ 42,322,5( me this 1.5in 1501 n. Ere4 OW , I b %dof Stored Material Notary Publi 1 I f (Column'F on G703) $ My Commis n expires I' - ' Total Re[ainage(Lines 5a+tit,or Total in Column I of G703)., $ 421322.50 CERTIFICATE FOR PAY NT 6.TOTAL EARNED LESS RETAINAGE $735 (�2�.L� In accordance with the Contract Documents, based on on sac observations and the data comprising this application, the Construction Manager and Architect cenify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the IN has progressed as indicated the quality of the Work is in 7,LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 1J32,tI7a li accordance with the.Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) "22 CERTIFIED, , y,Ir�r eV 8.CURRENT PAYMENT DUE S 1P'1,000.00 AMOUNT CERTIFIED $ (. ;i ofaz 9 BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if ammo certified differs fro to -in tent applied.Initial all karts on In Application and o it Ccntot vet ron S .f that or r I tnfad to conform tilt!!the amount certified.) (lane 3 ley.i me f $ 1ID2 I� q,8�' CONS cUCTION G•`: - ��� By uAt '.'/+ 44 ,- Date: 0� CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT ' — 7-oral changes approved in prevrous months by Owner $ $ g I z Zpat 10 y: 1_ s—' ar Date "l focal approved this Month $ $ This Certificate is not negotiable The AMOIJ IT CERTIFIED is payable only to the Contractor er _ TOTALS $ $ named herein. Issuance payment and acceptance of payment cure without prejudice to any rights of NET CHAPdGES by Change Order $ the Owner or Contractor:under this Contract. • CAUTION:You should sign an original AlA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. Auk Document G7021CMaTe-1992.Copyright ©1992 by The American Institute of Architects,All rights reserved.WARNING!This AIA& Document Is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Ale 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 pramiaed to reproduce ten(10)copies of tuts document when completed.To report copyright violations at AlA Contract Documents,a-mail The American Institute of Architects'legal counsel,copyright @aia.ore 09201 CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse Side) FAGS- a OF 2PAG ES AIA Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICA'T'ION NO.: 12 10/13/2010 containing Contractor's signed Certification, is attached, APPLICATION DATE: 10/23/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable relainage for line items may apply. ARCHITECT'S PROJECT NO.: A 13 C D E F C H I WORK COMPLETED MATERIALS 'TOTAL l3.ALANCB ITEM SCHEDULED PRESENTLY COMPLETED RETAINAGE DESCRIPTION OF WORK FROM PREVIOUS AND STORED NO. VALLIF. (NOR STORED (C + C) FINISH (Ili VARIABLE) APPLICATION THIS PERIOD (NOT IN TO DATE KATE) (D + E) D OR E) (D4-1:-`-F) (C - C) 01.000 STONE FLOORING 01.10011 MATERIAL 402,325.00 402,325.00 402,325.00 100 38,515.10 01.20 LABOR 349,950.00 270,820.62 60,000.00 330,820.62 95 19,129.38 1,786.65 01.300 01.400 STONE TOPS 01.500 MATERIAL 20,000.00 20,000.00 20,000.00 100 1,000.00 01.60 LABOR 28.000.00 14,065.00 14,065.00 50 13,935.00' 70325 01.70 01.80 QUARRY TILE 0190 MATERIAL 1,500.00 1,500.00 1,500.00 100 02.00 LABOR 1,500.00 1,500.00 1,500.00 100 02.100, GENERAL ALLOWANCE 35,000.00 4,557.00 4,557.00 13 30,443.00 02.300 CAD AS-BUILT ALLOWANCE 5,000.00 5,000.00 03.400 BOND 3,175.00 3,175.00 3,175.00 100 317.50 03.500 03.600 CHANGE ORDER#1 03.70( • 846,450.00 714,942.62 63.000.001 777,942.62 92 68507.38 42,322.50 AIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA* • x©1992 • THE AMERICAN INSTITUTE OF.ARCHI'T'ECTS, 1735 NEW YORK • Sip,. AVENUE,NW,WASHINGTON,DC.20006-52.922•WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 6703-1992 £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 ( ) FINAL (0 PARTIAL ( ) PAYMENT TO FOLLOW _p being duly sworn states that (s) he is t4eeee-Deg oat ea of SANTAROSSA MOSAIC & TILE CO.. INC. having contracted with _ 1 ' LI to furnish certain materials an./or labo• as follows: erlairal for a project known as _I located at .!' A/ I, , 1 and owned b)n! .e'' I 1 GM. does hereby further state on behalf of the aforementioned sub/contractor/supplier. (PARTIAL WAIVER That the balance due from the contractor is the sum of: 2�X�1, 11��e�Y L5UflD E ��I� DOLLARS ($ U3 ODD. 00) ( ) Receipt of which is hereby acknowledged: or 04-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 ($ O Receipt of which is hereby acknowledged: or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (FINAL) which is given to and for said amount effective upon receipt of such payment. THEREFORE: 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 laborand 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 performed or material furnished to the undersigned for said project, and within the scope of this AFFIDAVIT and WAIVER. SANTARjOSSA MOSAIC & TILE CO., INC. BY:4i A 411,,ft,„,;si TITLE: J Q�QQy� fQQQ9UQk� WITNE. ►. my hand and notarial seal this P' day of (.X D JYX , 2010 _ �/41,�,M y Commission �j 1��nnission Expires: � � � • t ta_y Public Residing in Marion, County of Indiana ) (11)eell A. Dyr, Printed J WAIVER OF LIEN AND AFFIDAVIT ( ) FINAL (v'PARTIAL ( ) PAYMENT TO FOLLOW 170 I 1 I being duly sworn states that (s) he is Lh1 I e of SANTAROSSA MOSAIC & TILE CO.. INC. having contracted v ith Y Jibe old d to furnish certain materials and/: r labor • : follows: _ 1 rat1 .�' . for a project known as L; ►, 11 • located at TndianO and owned b, i I1 h II ,A " ►sll►,LLI.101lSSlf(1 does hereby further state on behalf of the aforementioned sub/contractor/supplier. PARTIAL WAIVER That the balance due from the contractor is the sum of: ---w4ljMMSTIousanD3V�n nikISMO DOLLARS ($ -ROM (✓I-Receipt of which is hereby acknowledged: or O Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (PARTI ) wh ch•is iven to and for said amount effective upon receipt of such payment. Al pip ,2 c FINAL WAIVER That the final balance due from the contractor is the sum of: DOLLARS ($ ) ( ) Receipt of which is hereby acknowledged: or ( ) Payment of which has been promised as the sole consideration lot this AFFIDAVIT AND WAIVER OF LIEN (FINAL) which is given to and for said amount effective upon receipt of such payment. THEREFORE: 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 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 performed or material furnished to the undersigned for said project, and within the scope of this AFFIDAVIT and WAIVER. SANTA OSSA MOSAIC & TILE CO., INC. BY: . u TITLE: QQ, (f 1 SUQ.J. WITNESS fly hand a notarial seal this day of � � , 20 My Commission Expires: I�15jiq- 1� I IA/ o ry Public Residing in Marion, County of Indiana _ Q([' ' , Printed