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Home My WebLink AboutARCHITECTURAL GLASS & METAL CO- 155- 1/5/2011 Architectural Glass& Metal Co Check: 155 6334 E 32nd Court Date: 1/5/2011 Indianapolis, IN 46226 Vendor: ARCIT1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-18037 308.70 308.70 0.00 0.00 308.70 App 2-18037 glass & glazing 308.70 308.70 0.00 0.00 308.70 155 1/5/2011 308.70 THE SUM OF THREE HUNDRED EIGHT DOLLARS AND 70 CENTS ..«........«........................... Architectural Glass & Metal Co 6334 E 32nd Court Indianapolis, IN 46226 Architectural Glass& Metal Co Check: 155 6334 E 32nd Court Date: 1/5/2011 Indianapolis, IN 46226 Vendor: ARCIT1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discoun Amt. Paid 2-18037 308.70 308.70 0.00 0.00 308.70 App 2-18037 glass & glazing 308.70 308.70 0.00 0.00 308.70 - ; HYNLIL A I IIJN ANU UEK I IF-IC;A I t I-UN PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGes TO OWNER: Carmel Theater Development Corp., LLC PROJECT: Village on the Green Theater APPLICATION NO.: 2-18037 BILL TO: Signature Construction PERIOD TO: 11.30 2010 - 720 3rd Avenue SW PROJECT NO.: 12012 Carmel, IN 46032 FROM CONTRACTOR VIA ARCHITECT: CONTRACT DATE: Architectural Glass&Metal Co., Inc. 6334 E. 32nd Court I Indianapolis IN 46226 CONTRACT FOR: Commercial Glass &Glazing CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infer- Application is made for payment, as shown below,in connection with the mation and belief the Work coverd by this Application for Payment has been completed Contract.Continuation Sheet,AIA Document G703, is attached. 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 pay- 1. ORIGINAL CONTRACT SUM...... ....._........ $ 207,000.00 ments received from the Owner,and that current payment shown herein is now due. 2. Net change by Change Orders . CONTRACTOR, Architectural Glass & Metal Co., Inc 3.CONTRACT SUM TO DATE..,....., . _...,..__..... $ 207,000 00 By: fairok., C( /fib VP of Finance Date: November 17, 2010 4.TOTAL COMPLETED&STORED TO DATE,..,..... $ 7,126.00 State Of: Indiana (Column Con 6703) County Of: Marion 5. RETAINAGE: a. _ 1 Olt of Completed Work $ 712.60 Subscribed and Sworn to before (Columns D+Eon G703) me this 17th day of November 2010 .at.m a.A..1.- L d 21S AO CAYLE TOLLIVER b. of Stored Material �pc ravraya�yw,sxrni otmaimio 1.i4i 1.'.aim G�u�ry Toal i Column I on G703)..._.... . $ 712.60 My Commission Expires: 12/14 2017 Ets rnbe.11o., ,201 (Column ) �'. DacamSa:14,2017 Total ftetainage(Line Sa+ 5b or Notary Public: (f,.�-LC�.�J ARCHITECT'S CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE.., _._.__ $ 6,413 40 In accordance with the Contract Documents, based on on-site observations and the data comprising this application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the (Line 6 for prior Certificate)............................ $ 6,104.70 quality of the Work in in accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 6.CURRENT PAYMENT DUE $ 308.70 AMOUNT CERTIFIED.............. ..... .. ..,..,..,..,.........., �C7&. -72C-r) _ (Attach explanation if amount certified differs from the amount applied for Initial 9. BALANCE TO FINISH,INCLUDING RETAINAGE all figures on this Application and of the Continuation Sheet that are changed to (Line 3 less Line 6) $ 200,586.60 conform to the amount certified) r`Wn_ti r'�J CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS A°,_,.xGkrrEe Total changes approved in By: ��f''/�, . ,/ Date: /7 ?,./) c previous months by Owner - ifili Total approved this Month This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Con- TOTALS _ tractor named herein.Issuance, payment and acceptance of payment are without NET CHANGES by C.O,s prejudice to any rights of the Owner or Contractor under this Contract. SCHEDULE OF VALUES AM DOCUMENT G703 PAGE OF AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO; 2-18037 containing Contractor's signed Certification, is attached. APPLICATION DATE: 11.17.2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11.30 2010 Use Column I in Contracts where retainage for line items may apply. ARCHITECT'S PROJECT NO.: 12012 VILLAGE ON THE GREEN THEATER A B C D I E F G H T _ WORK COMPLETED MATERIALS TOTAL !TEM SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS THIS PERIOD STORED AND STORED (G/C) TO (IF VARIABLE APPLICATION (NOT IN TO DATE FINISH RATE) (D+EI DOREI N+E+F3 (C-G) Section 05 58 00 - Formed - _ Metal Fabrications - 108-1000 Material $ 4,040.00 - 0% 4,040.00 - 108-1001 Labor 5 590.00 0% 590.00 - Section 07 92 00 -Joint Sealants (Partial) 108-1002 Material $ 3,925,00 - _ 0% 3,925.00 - 108-1003 Labor $ 5;500.00 . - 0% 5,500.00 - Section 08 43 13 -Glazed - Aluminum Framed SF 108-1004 Material $ 1,270.00 - 0% 1,270.00 - 108-1005 Fabrication Labor $ 415.00 _ - 0% 415.00 - 108-1006 Field Labor $ 300.00 - 0% 300.00 - Section 08 44 13 - Glazed Aluminum CW 108-1007 Material $ 72,110.00 - 0% 72,110.00 - 108-1008 Fabrication Labor $ 6,880.00 - 0% 6,880.00 - 108-1009 Field Labor $ 24345.00 - 0% 24,545.00 - $119,575.00 $ - $ - $ - S - $ 119,575.00 $ - Architectural Glass&Metal Co.,Inc.is authorized to re-pi-admit A1A Documents under License Agreement$1119474 through 08-31-01. SCHEDULE OF VALUES A/A DOCUMENT G703 PAGE OF MA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 2-18037 ' containing Contractor's signed Certification, is attached. APPLICATION DATE: 1 1.17.2010 hi tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11.30.2010 Use Column I in Contracts where retainage for line items may apply. ARCHITECTS PROJECT NO.: 12012 _VILLAGE ON THE GREEN THEATER A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED PRESENTLY COMPLETED % BALANCE RETAINAGE NO. DESCRIPTION OF WORK VALUE FROM PREVIOUS THIS PERIOD STORED AND STORED (G/C) TO (IF VARIABLE APPLICATION (NOT IN TO DATE FINISH RATE) (D+E) DORE) (D-FE+F) (C-G) Section 08 41 26 -All-Glass Entrances & Storefronts 108-1010 Material $ 21,640.00 - 0% 21,640.00 - 108-1011 Labor $ 1,760.00 - 0% 1,760.00 - Section 08 80 00 - Glazing 108-1012 Material $ 18,925.00 - 0% 18,925.00 - 108-1013 Labor $ 4,940.00 - 0% 4,940.00 - 108-1014 Administration $ 6,855.00 1,028.00 343.00 .1,371.00 20% 5,484.00 137.10 108-1015 Shop Drawings $ 5,755.00 5,755.00 5,755.00 100% - 575.50 108-1016 Payment/Performance Bond $ 2,550.00 - 0% 2,550.00 - ' 108-1017 Allowance :$ 25,000.00 - 0% 25,000.00 - $207,000.00 $ 6,783.00 $ 343.00 $ - $ 7,126.00 3% $ 199,874.00 $ 712.60 Architectural Glass&Metal Co.,Inc. is authorized to re-product AlA Documents under License Agreement 4119474 through 08-31-01. PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton 'PG-I'YICIQ CL SChITI* Being duly sworn upon his/her oath disposes and says that: 1. He/she is Vt Of fl (inserting sole proprietor, partner or corporate office held, as the case maybe), of Lithko Contracting, Inc. 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 Prime 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 3 • /A 1 #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 LlfIl day of HbV ern IOtV , 20 U l �y r� y { V1 Pettit i4 Ct'. ;Iciur.f V 1' or f tr . nc� (Authorized Representative of Prime Contractor, Title) County of U'1C1.1Ct,Yl&u ) State of may)on ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This )'- l Day of N bVLrn bu' , 20 ) b 4 -c (Notary Public) TDLLiver (Printed Name) A. Yur:ltfE� My Commission Expires: , r•nnr;n' -SV,_oimaca NOTARY SEAL MUST APPEAR ON THIS FORM. ' F` :>C;„;InCrl i_ta _ De.cember 14,2017 1