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HomeMy WebLinkAboutHAGERMAN CONSTRUCTION CORP- 170- 2/11/2011 Hagerman Construction Corp Check: 170 10315 Allisonville Road Date: 2/11/2011 Fishers, IN 46038-2016 Vendor: HAGEERM1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-7 9,729.70 9,729.70 0.00 0.00 9,729.70 App 7 on P7C-Theater 9,729.70 9,729.70 0.00 0.00 9,729.70 170 2/11/2011 ***********9,729.70 THE SUM OF NINE THOUSAND SEVEN HUNDRED TWENTY NINE DOLLARS AND 70 CENTS ******* Hagerman Construction Corp 10315 Allisonville Road Fishers, IN 46038-2016 Hagerman Construction Corp Check: 170 10315 Allisonville Road Date: 2/11/2011 Fishers, IN 46038-2016 Vendor: HAGEERM1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-7 9,729.70 9,729.70 0.00 0.00 9,729.70 App 7 on P7C-Theater 9,729.70 9,729.70 0.00 0.00 9,729.70 7 O s q ® i TM d i4 Document G7O2ICMa - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Carmel Theater Dev.Corporation LLC PROJECT: Village on Green Theater APPLICATION NO: APP#:00007 Distribution to: 1 171 1 N Pennsylvania Street 3rd Avenue Southwest Suite 200 Carmel. IN 46032 PERIOD TO: 12/31'/2010 OWNER ❑X Carmel,IN 46032 CONSTRUCTION MANAGER ❑X FROM CONTRACTOR: VIA CONSTRUCTIONMAkI`�AGEI CONTRACT DATE: 4/4/2010 ARCHITECT ❑X Hagerman Construction Corp uc awoc ka P.O. Box 10690 Signature Construction LLC PROJECT NOS: 10-2817-1/ / CONTRACTOR ❑ Fort Wayne, IN 46853-0690 VIA ARCHITECT: INVOICE NO: 10045 FIELD ❑ CONTRACT FOR: ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for 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,AIA Document shown is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous 715,214.00 Certificates for .Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ payment shown herein is now due. 2. Net change by Change Orders $ 0.00 CONTRACTOR: Hagerman Co. action Corp y c� t $ii,. 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 715,214.00 By: �cr� �_ Dat a`ae� :� 4, 2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 672,689.55 State of: Indiana Theresa Lan ing, Treasur ,e"° oq°® 5.RETAINAGE: 4:,,;„•_op- ' ° County of: Allen a O gt 164, 4t°; a. l0.0(d/o of Completed Work ° ) 1'1 0 i Subscribed and sworn to before 4°-- Si o f t a 4 ' (Column D.+Eon G703) 14th day 0,®m . • ( ) $ 67,268.96 me this da of D r 2 10 'e C g b. %of Stored Material Notary Public: David C. om a �QT{1 11Ig (Column F on G703) $ My Commission expires: 12.16.2015 .> • ;� Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 67,268.96 CERTIFICATE FOR PAYMENT �''QI°°°,L.....,--,` In accordance with the Contract Documents,based on on-site observations IfhtWlhec' ata comprising 6.TOTAL EARNED LESS RETAINAGE $ 605,420.59 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 $ 595,690.89 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT'PAYMENT DUE L 9,729.70 AMOUNT CERTIFIED $ 9,729.70 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that ar Changed to conform with the amount certified.) (Line 3 less Line 6) $ 109,793.41 CONSTRUCTION MANAGE Rhuc- Sawo ka-- i• ature Construction LLC By: __A� �.�..-�/_d � Date: // J G// _ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: __ Total changes approved in previous months by Owner $ $ By; Date: Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED iS payable only 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 Contractor under this Contract. — CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaTM-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 AlA® 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(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. CONTINUATION SHEET AIA,DOCUMENT G703 PAGE I OF 1 PAGES AlA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00007 - containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts arc stated to the nearest dollar. PERIOD TO: 12/31/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 102817A A B C U E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED lye TO (IF VARIABLE) NO. VALUE STORED AND STORED FINISH APPLICATION THIS PERIOD RATE (NOT IN TO DATE (G C) (C-Ci) (D E) D OR E) (D+£+F) 0000 JOB 12012 104-1000 Sumbittals $2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100.000 $0.00 $0.00 104-1001 Mobilization $2,000.00 $2,000.00 $0.00 $0.00 $2,000.00 100.000 $0.00 $0.00 104-1002 Demobilization $2,000.00 $0.00 $0.00 $0.00 $0.00 0 $2,000.00 $0.00 104-1003 Clean-up $2,000.00 $1,800.00 $100.00 $0.00 $1,900.00 95.000 $100.00 $0.00 104-1004 Punchlistl Closeout $1,988.00 $0.00 $0.00 $0.00 $0.00 0 $1,988.00 $0.00 104-1005 Stair 1 CMU Labor $17,520.00 $17,520.00 $0.00 $0.00 $17,520.00 100.000 $0.00 $0.00 104-1006 Stair 1 CMU Material $6,570.00 $6,570.00 $0.00 $0.00 $6,570.00 100.000 $0.00 $0.00 104-1007 Stair 1 Rebar,Grout,Accessory Labor $13,920.00 $13,920.00 $0.00 $0.00 $13,920.00 100.000 $0.00 $0.00 104-1008 Stair 1 Rebar,Grout,Accessory Material $10,950.00 $10,950.00 $0.00 $0.00 $10,950.00 100.000 $0.00 $0.00 104-1009 • Stair 2 CMU Labor $16,320.00 $16,320.00 $0.00 $0.00 $16,320.00 100.000 $0.00 $0.00 . 104-1010 Stair 2 CMU Material $6,120.00 $6,120.00 $0.00 $0.00 $6,120.00 100.000 $0.00 $0.00 104-1011 Stair 2 Rebar,Grout,Accessory Labor $12,970.00 $12,970.00 $0.00 $0.00 $12,970.00 100.000 $0.00 $0.00 104-1012 Stair 2 Rebar,Grout,Accessory Material $10,200.00 $10,200.00 $0.00 $0.00 $10,200.00 100.000 $0.00 $0.00 104-1013 Elevator CMU Labor $10,080.00 $10,080.00 $0.00 $0.00 $10,080.00 100.000 $0.00 $0.00 104-1014 Elevator CMU Material $3,780.00 $3,780.00 $0.00 $0.00 $3,780.00 100.000 $0.00 $0.00 104-1015 Elevator Rebar,Grout,Accessory Labor $8,010.00 $8,010.00 $0.00 $0.00 $8,010.00 100.000 $0.00 $0.00 104-1016 Elevator Rebar,Grout,Accessory Material $6,300.00 $6,300.00 $0.00 $0.00 $6,300.00 100.000 $0.00 $0.00 104-1017 Theater CMU Labor $120,726.00 $114,689.70 $3,621,78 $0.00 $118,311.48 98.000 $2,414.52 $0.00 104-1018 Theater CMU Material $45,450.00 $43,177.50 $1,363.50 $0.00 $44,541,00 98.000 $909.00 $0.00 104-1019 Theater Rebar,Grout,Accessory Labor $96,300.00 $91,485.00 $2,889.00 $0.00 $94,374.00 98,000 $1,926.00 $0.00 104-1020 Theater Rebar,Grout,Accessory Matetrial $75,750.00 $71,962.50 $2,272.50 $0.00 $74,235.00 98.000 $1,515.00 $0.00 104-1021 Proscenium CMU Labor $74,880.00 $74,880.00 $0.00 $0.00 $74,880.00 100.000 $0.00 $0.00 104-1022 Proscenium CMU Material $28,080.00 $28,080.00 $0.00 $0.00 $28,080.00 100.000 $0.00 $0.00 104-1023 Proscenium Rebar,Grout,Accessory Labor $59,500.00 $59,500.00 $0.00 $0.00 $59,500.00 100.000 $0.00 $0.00 104-1024 Proscenium Rebar,Grout,Accessory Material $46,800.00 $46,800.00 $0.00 $0.00 $46,800.00 100.000 $0.00 $0.00 104-1025 Allowance $35,000.00 $2,764.07 $564.00 $0.00 $3,328.07 9.509 $31,671.93 $0.00 $715,214.00 $661,878.77 $10,810.78 $0.00 $672,689.55 94.05% $42,524.45 $0.00 AIA DOCUMENT 0703.APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIAMU• ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK G703-1992 AVENUE,N.W.,WASHINGTON,D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronically with the permission of The American Institute of Architects under license 97003 to Primavera Systems,Inc.Reproduction of this document without profecbrpedfic Information is not permitted.Contact The Amer:can Institute of Architects to verily the current version of Ibis document and license status: G703 CONTINUATION SHEET Page 2-of 2 To: From: Project: Application No. : 7 Carmel Theater Development Corporation,LLC Hagerman Construction Corporation Village on the Green Application Date: 11711 North Pennsylvania St,Salle200 10315 Allisonville Road Parcel7C1-Theater Period To: 12/31/2010 - Carmel,IN46032 Fishers, IN 46038 Carme4IN46032 Engineer's Project No. : 12012 A B C D I E F G H I Bork Completed Materials Total Presently Completed Balance Retainage Item Scheduled From Previous Stored and Stored % To If # Description of Work Value Application This Period (Not in To Date (G/C) Finish Variable D or E) (D+E+F) (C-G) 104-1025 Allowance = $35,000 VOG.7C1.00.007 - Door Frames 13,883.00 4,026.07 0.00 0.00 4,026.07 29% 9,856.93 985.69 VOG.7C1.00.009 - P10.004 (605.00) (605.00) 0.00 0.00 (605.00) 100% 0.00 0.00 VOG.7C1.00.013 - PR.005 564.00 0.00 564.00 0.00 564.00 100% 0.00 0.00 VOG.7C1.00.017 - PR.007 (657.00) (657.00) 0.00 0.00 (657.00) 100% 0.00 0.00 0.00 35,000.00 2,764.07 564.00 0.00 3,328.07 10% 31,671.93 985.69 • • PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS&WAIVER OF LIEN STATE OF Indiana COUNTY OF _Allen Theresa Lanning Being duly sworn upon his/her oath disposes and says that 1. He/she IL treasurerinserting sole proprietor, partner or corporate office held, as the case maybe), of Hagerman Construction Corporation 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 masonry 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 z 3 Analaassadr'r Gtes1 0.00 Anderson Block & Brk 0.00 #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 14th day of December , 20 10 (Authorized Representative of Prime Con 4y;, Title) County of Allen ) Theresa Lanning, Treasurer State of Indiana ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This 14th- Day of December , 20 10 (Notary PublictA• 0,0""Ii• oa \VIIO •••�s David C. Thoma�� ,arm o. (Printed N ) �. a My Commission Expires: 12/16/15 e0.46) "' o* • NOTARY SEAL MUST APPEAR ON THIS FORM. - • NOTARYSEAL 41c Ug1/C,�STA'tC".r • • , f PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS&WAIVER OF LIEN STATE OF Indiana COUNTY OF, Allen Theresa Lanning Being duly sworn upon his/her oath disposes and says that: 1. He/she is_treasurer 'g'nserting sole proprietor, partner or corporate office held, as the case maybe), of Hagerman Construction Corporation 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 masonry 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 Irving Materials 38,360.34 All Seasons Bldg Mat 0.00 #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 14th day of December , 2010 _ c (Authorized Representative of Prime Co tra tor, Title) County of Allen ) Theresa Lanning, Treasurer State of Indiana ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This 14th Day of December , 20 10 dr (Notary Publi Q., ° °•e,AP David C. ThomaS.°c,� der�6 9 (Printed Name', i` j ; �' ;* My Commission Expires: 12/16/15 "; 6,110411) NOTARY SEAL MUST APPEAR ON THIS FORM. ?;4° NOTARY SEAL t$ , fB(�C STP(. ; PRIME CONTRACTOR'S UNCONDITIONAL PROGRESSIVE WAIVER OF LIEN Theresa Lanning Being duly sworn upon his/her oath disposes and says that: 1. He/she is treasurer__ (inserting sole proprietor, partner or corporate office held, as the case maybe), ofFiagermairtnhereafter 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 masonry Prime Contractor for the construction of the Village on the Green — Parcel 7C1 — Theater Building development, located 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. Prime Contractor hereby waives and releases any and all liens and rights to claim a lien to which Prime Contractor is or may be entitled for services, labor, and/or materials furnished for the Development for work covered by and through the date of the Prime Contractor's Application and Certification for Payment number sated December 14,. 2010 07-10045 4. There are no bills, charges, costs or expenses for services, labor, and/or material which could now or hereafter result in lien being filed, or a right to claim a lien, against the Development or a claim being asserted against the Owner for this work. S. Prime Contractor has been paid in full,exclusive of retainage, for all services, labor, and materials furnished to, provided for, or used in connection with, the Development through the period noted above and acknowledges the receipt of S to date. 605/420.59 IN WITNESS WHERE OF,affiant has signed this document on behalf of the Prime Contractor this 14th day of December ,2010 • (Authorized Representative of Prime Contracto , Title) Theresa Larining, Treasurer County of Allen State of Indiana Subscribed and sworn to before me,a Notary Public in and for said County and State, This 14th Day of December 20 10 -- - (Notary Public) navid C. Thomas ld o���a tbe �0berra, ° My Commission Expires: 12/16/15 (Printed Name): 4 ®®®��N o NOTARY SEAL MUST APPEAR ON THIS FORM. a NOTggySEA d'F • ';TPcTG