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Home My WebLink AboutSERIES USA, LLC- 195- 3/16/2011 SERIES USA, LLC Check: 195 20900 NE 30th Ave., Suite 901 Date: 3/16/2011 Miami, FL 33180 Vendor: SERIESUS Prior Invoice P.O. Num, Invoice Amt Balance Retention Discount Amt. Paid 1 13,793.85 13,793.85 0.00 0.00 13,793.85 App 1 on 7C1 theater building 13,793.85 13,793.85 0.00 0.00 13,793.85 195 3/16/2011 ****""****13,793.85 THE SUM OF THIRTEEN THOUSAND SEVEN HUNDRED NINETY THREE DOLLARS AND 85 CENTS****** ********** SERIES USA, LLC 20900 NE 30th Ave., Suite 901 Miami, FL 33180 SERIES USA, LLC Check: 195 20900 NE 30th Ave., Suite 901 Date: 3/16/2011 Miami, FL 33180 Vendor: SERIESUS Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 13,793.85 13,793.85 0.00 0.00 13,793.85 App 1 on 7C1 theater building 13,793.85 13,793.85 0.00 0.00 13,793.85 API-PULA IION AND CERTIFICATION FOR PAYMENT AIADOCLIA'IEN7'G702 PAGE ONE OF TWO PAGES TO OWNER Carmel Theater Development C PROJECT: Village on the Green Parcel APPLICATION NO: 1 Distribution to: 11711 North Pensylvania Street,Suite 200 7-C-I Theater Building OWNER Carmel IN 46032 3rd Avenue SW _IARCHITECT - _ Carmel IN 46032 PERIOD TO: January 31 2011 CONTRACTOR FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: SERIES USA LLC VIA ARCHITECT: 20900 NE 30th Ave Suite 901 PROJECT NOS: 12012 Miami Florida 33180 CONTRACT FOR:Fixed Theater Seats CONTRACT DATE Nov 5,2010 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the hest of the Contractors knowledge, Application is made fot 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 0703,is attached, completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for'‘Fork for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herd ris now due.... ...,AAS , ' a' wan c.+ °I. ORIGINAL CONTRACT SUM $ 141,620.00 if ff _2 Net change by Change Orders $ CONTRACTOR,: Series USA LLC ,° ms co ma.E svann mIa 292 1 3. CONTRACT SUM TO DATE(Line I ±2) $ 141,620.00 t s.,, i commns • I3W I 4. TOTAL COMPLETED& STORED TO $ 15,326.50 ' DATE (Column G on 0703) D.Y. t .`',�//. Date: January 18,2011 5. RETAINAGE: f / a. 0 %of Completed Work S 1,532.65_ State ol: Florida County of Dade (Column D+Eon 0703 •�— �� — — Subscribed and ss before ih January 18,2011 1 b. _9((i of Stored Material $ '�^ Notary Public: ,mod 7,,-so- (Column j',�+lp' g `. flnETar� (Column Pon G703) My Commissn expires: loot. 012 I :�+;:p' M, Total Retainage(Lines 5a a sb or Total in Column 1 of G703) 5 1,532-65 ARCHITECT'S CERTIFICATE FOR PAYII(EKfT'"- "-.— 6. TOTAL EARNED LESS RETAINAGE $ 13,793,85 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PRLVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated. PAYMENT(Line 6 from prior Certificate) S 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8 CURRENT PAYMENT DUE $ V.K.7,93'.85:: is entitled to payment of the AMOUNT CERTIFIED, 9. BALANCE TO FINISH,INCLUDING RETAIL INAGE S 127,826-15 (Line 3 less Line 6) AM 1 AMOUNT CERTIFIED $ 2j9gT2 js lab CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified d ffersfrom the amount applied Initial al!fi$ures on this Total changes approved Application and onthe Car " ' Sheet ghat are changed to confor wit rhea '(aunt certified-) in previous months by Owner ARCHITECT —a � s�� Total approved this Month By: S . —.1:11116., Date: i 1Q•.��"ti TOTALS 0.00 0.00 This Certificate t-not ne•of bke. The AMOUNT CERTIFIED is payable ono to the Contractor name 'ere! .Issuance,payment and acceptance of payment are without NET CHANGES by Change Order 0.00 prejudice to any rights of the Owner or Contractor under this Contract. AlA COcuNl NT 0702-APPLICATION AND CERTIFICATION FOR PAYMENT•1912 EDITION AlA -01992 THE AMERICANIN5TITVTE OF ARCHITECTS.1ass HEWYCRZ AVE..NW_'WASHINGrON,DC 20005-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. CONTINUATION SHEET AlA DOCUMENT G7O3 PAGE 20F2 PAGES ASA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO. 1 _ Contractor's signed certification is attached. APPLICATION DATE 01/lB/11 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 01/31/11 Use Column Ion Contracts where variable retainage for line items may apply. PROJECT NO: 12012 A B C D I E F C H 1 ITEM DESCRIPTION OF WORK - SCHEDULED WORK COMPLdI'ED MATERIALS TOTAL % BALANCE RFTAINAGE- NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (6-C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C-C) RATE) (IJ=E) (NOT IN TO DATE D ORE) ([NEiF) 1 Project Management 6,000.00 1,500.00 1500.00 25% 4,500.00 150.00 2 Design&Engineering 8,162.00 8,i 62.00 8,162.00 100% 0-00 816-20 3 Samples,Submittals&Shop Drawings 7,0R1 00 3,540.50 3,540.50 50% 3,540.50 354.05 4 Fabric Raw Material& Shipping 12,970.00 12,970,00 0.00 5 Performance Bond 2,124.00 2,124.00 2,124.00 100% 21240 6 Fixed Seating Materials 82,925.00 82925.00 0.00 7 Installation of Fixed Scats 17,358_00 17,358 00 0-00 8 Allowance 5,000.00 5,000.00 0.00 17 GRAND TOTALS 141,620.00 0.00 15,326.50 0.00 15,326.50 126,293,50 1,532 65 Users may obtain validation of this document by requesting of the license a completed AIA Document 0401 -Certification of Document's Authenticity AIA DOCUMENT G703 CONTINUATION SHEET FOR 0732'1992 COITION'AIA-01502 6703-1942 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N,W.WASHINGTON,eC. 200005232 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS & WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton` Mnur1C\' l kwf\e- Being duly sworn upon his/her oath disposes and says that 1. He/she is 0_,E0 (inserting sole proprietor, partner or corporate office held, as the case maybe), of tenets U3 A LA—Q 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 atj -}enum.$_a} 49__PPrime 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 #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 WITNESS WHERE OF, affiant has signed this document on behalf of the Prime Contractor this day of 'CAW UCir , 2011 • - (Auth rized Representative o Prime Contractor, Title) County of )4 tg1-T1i1030&4 State of Subscribed and sworn to before me, a Notary Public in and for said County and State, This /9 Day of \I 6}46/042,—) 20 P i (22/4".otay Public) Mn rl C Brdt.H4 . (Printed Name) My Commission Expires: I c_1-"\ wuwc.w[mx 4 Or er.r aaea-Stec mrwlw 7 F; 4 Cas.porn Jan 10.2012 I • "v.:: 011111lauon.CD7133114