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Home My WebLink AboutBROADY-CAMPBELL, INC.- 002939- 6/21/2012 CARMEL REDEVELOPMENT COMMISSION 002939 Broady-Campbell, Inc. 2115 Dr. A.J. Brown Ave. Check: 2939 Indianapolis, IN 46202 Date: 6/21/2012 I Vendor: BROADY- Inv ice P.O Num Prior 3A P112 Wayfinding Invoice Amt Balance a entlon 314.00 314.00 �� 0.00 Disc0.0 qmt Pa & Site 0.00 0.00 314.( • 314.00 314.00 0.00 0.00 314.0 • • THE KEY-TODOCUMENTSECURITYy^^•HEAVACTIVATED)THUMe PRINTZADDITIDNAL'TSECURITY,FEATURES INCLUDED ZSEE:BACK FOR DETAILSbtf r0.6 C••�C. Carmel Redevelopment Commission 30 West Main Street a IZBGIONS 0 2 9 3 9 a Suite 220 20-1421,740 o`"" ` Carmel, IN 46032 2939 DATE AMOUNT i I PAY THE SUM OF THREE HUNDRED FOURTEEN DOLLARS AND NO CENTS 314.00 I TO THE ORDER Of Broady-Campbell, Inc. 2115 Dr.A.J. Brown Ave. Indianapolis, IN 46202 11'00293911• 1:0740 &42131: 00B7 SO4 1A1 • � u • Application and Certificate for Payment 33a% 3 di e-5 a . TO OWNER: SIGNATURE CONST.LLC PROJECT: P112 WAYFINDING&SITE APPLICATION NO: 3/Q Distribution to CUST 6 SIG2 ONE PEDCOR SQUARE PERIOD TO: 04/30/2012 720 3RD AVENUE SW OWNER ❑ CARMEL IN 46032 CONTRACT FOR: ARCHITECT ❑ FROM CONTRACTOR: BROADY-CAMPBELL INC. VIA ARCHITECT: CONTRACT DATE: 07/11/2011 CONTRACTOR ❑ 2115 Dr.Al.Brown Avc. PEDCOR DESIGN GROUP PROJECT NOS: FIELD ❑ Indianapolis,IN 46202 PII2WAYFINDING&SITE • JOB# 211078 OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract, and belief the Work covered by this Application for Payment has been completed in accordance with the Contract Documents, that all amounts have been paid by the Contractor for Work for Continuation Sheet,is attached. 3,140.00 which previous Certificates for Payment were issued and payments received from the Owner, and 1. ORIGINAL CONTRACT SUM $ 0.00 that current payment shown herein is now due. 2. Net change by Change Orders $ 3,,40.00 CONTRACTOR: Broady—Campbell, Inc. 3. CONTRACT SUM TO DATE(Line I ±2) S. By: 2 _— l ti Date: 4-30-2012 3,140.00 State of Indiana 4.TOTAL COMPLETED& STORED TO DATE(Column G on 603LS q.... $_ 5. RETAINAGE: County of: Marion 8.00 %of Completed Work 0.00 Subscribed and sworn to before (CgumnD+Eon603LS1) - S me this 30th day of April 2012 b. %of Stored Material 0.00 r (Column F on 603LS1) $ _ Notary Public: "mss , a_ti. ' 0.00 My Commission expires: 5-5-2016 Total Retainage(Lines 5a+5b or Total in Column I of 603LS l) ... S. 6.TOTAL EARNED LESS RETAINAGE $ 3,140.00 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) 2,826.00 In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ this application, the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 314.00 i AMOUNT CERTIFIED. 8. CURRENT PAYMENT DUE S 3qr 9. BALANCE TO FINISH,INCLUDING RETAINAGE 0.00 AMOUNT CERTIFIED S j (Line 3 less Line 6) S (Attach explanation i amount certified dyers from the amount applied. Initial a l gures on this . Application • • • i Continuation Sheet that are changed to conform with the amount certified. CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHRE: t 0.06 @u0 /l Total changes approved in previous months by Owner $ 0-00 $ 0�0 By; t/; Date: Total approved this Month S 0.06 $ 0.66 This Cerficat- is not negotiable. The AMOUNT CERTIFIED is payable onl to the Contractor TOTALS $ 0.00 $ named here' . stance,payment and acceptance of pay t are without prejudice to any rights of NET CHANGES by Change Order 5 the Owner or Contractor under this Contract. // ijSZ,.._REORDER FORM NO.eO4LSI /� �..� / 5�/3r��z- Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Page 1 of 1 AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENF, APPLICATION NO.: 3 containing Contractor's signed Certification, is attached. APPLICATION DATE: 04/30/2012 In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 04/30/2012 ARCHITECT'S PROJECT NO: A B C D I E F O H 1 WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED % BALANCE RETAINAGE ITEM SCHEDULED TO NO. DESCRIPTION OF WORK FROM PREVIOUS STORED AND STORED (G _C) (IF VARIABLE) VALUE APPLICATION THIS PERIOD FINISH (D 4 E) (NOT IN TO DATE (C-G) RATE) 0 OR E) (D+E+F) 01 STONE LABOR 1.170.00 1,170.00 1,170.00 100.00 02 STONE MATERIAL 1,000.00 1,000.00 1,000.00 100.00 03 FOUNDATION 970.00 970.00 970.00 100.00 JOB TOTALS : 3,140.00 3,140.00 .00 .00 3,140.00 .00 .00 G703-1992 INVOICE BROADY-CAMPBELL, INC. ® MASONRY CONTRACTORS 2115 ANDREW J. BROWN AVE. • INDIANAPOLIS, INDIANA 46202 22359 ph. (317) 925-4261 fax (317) 925-4263 Signature Const. LLC 4-30-2012 Date TO: One Pedcor Square 720 3rd Ave. SW Job No.211078 Carmel- IN 46032 P.O. No. RE: P112 Wayfinding & Site ESTIMATE NO: 3 Labor, material, equipment and accessory appurtenances in place or stored to date at the above referenced project: 3,140.00 Less 0 % retained 00.00 Total earned less retainer 3,140.00 Less Previous applications 2,826.00 TOTAL DUE THIS ESTIMATE NO: 3 314.00 Prescilbed by State Board of Accounts City Form No.201(Rev.1995( ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee erwdq —Ca. 9/ /( / 1/7<_ Purchase Order No. 2//591, 4, )_ )9rczie Terms /i7//ifrto,0A A /w y6X) -_ Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 44/72 3 . �/�2 ((iry e; i2 ,5, /P 3/y.610 r„ Total 3/y .oo I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor- r dance with IC 5-11-10-1.6. �� a � '-ZD , 20 IZ G?terk-Treasurer