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HomeMy WebLinkAboutHAGERMAN CONSTRUCTION CORP- 152- 1/5/2011 Hagerman Construction Corp Check: 152 10315 Allisonville Road Date: 1/5/2011 Fishers, IN 46038-2016 Vendor: HAGEERM1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-6 40,037.04 40,037.04 0.00 0.00 40,037.04 App 6 on 7C3 40,037.04 40,037.04 0.00 0.00 40,037.04 152 1/5/2011 **********40,037.04 THE SUM OF FORTY THOUSAND THIRTY SEVEN DOLLARS AND 04 CENTS ************************** Hagerman Construction Corp 10315 Allisonville Road Fishers, IN 46038-2016 Hagerman Construction Corp Check: 152 10315 Allisonville Road Date: 1/5/2011 Fishers, IN 46038-2016 Vendor: HAGEERM1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-6 40,037.04 40,037.04 0.00 0.00 40,037.04 App 6 on 7C3 40,037.04 40,037.04 0.00 0.00 40,037.04 • a ``�A� IA TM i G702/CMa ;Mr, D®current — 1992 1® I I I I .I�! j I �, 'I 1 , I II NUV1 ,V 2010 ' Application and Certificate for Payment Construction Manager-Adviser Edition L. TO OWNER: Carmel Theater Devi Corporation LLCpROJECT: Village on Green Theater APPLICATION NO: APP#:00006 .,'Dv Distribution to: 11711 N Pennsylvania Street 3rd Avenue Southwest i . --_--- - -- Suite200 Carmel. IN 46032 PERIOD TO: 11/30/2010 OWNER ❑X Carmel,IN 46032 CONSTRUCTION MANAGER ❑X FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 4/4/2010 ARCHITECT ❑X Hagerman Construction Corp C hue awoc ka P.O.Box 10690 Signature Construction LLC PROJECT NOS: 10-2817-I/ / CONTRACTOR ❑ Fort Wayne,IN 46853-0690 VIA ARCHITECT: INVOICE NO: 10023 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 G703,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: Ha el-man Con ti or 3.CONTRACT SUM TO DATE(Line I ±2) $ 715,214.00 By: str Date: .y, . I 8, 2010 � t, 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 661,878.77 State of: Indiana Richar ::E. Sutorius, Seer °QSO 5.RETAINAGE: Q o' ��Noo•• County of: Allen Q eo �e018, _57,' . a. 10.0k of Completed Work Subscribed and sworn to before ; •,,, .`•t\, ms's i� (Column D+Eon G703) $ 66,187.88 me this 18th day of Novemb 2010 g..-•o a® S b. %of Stored Material Notary Public: David C.Th • (�`l5� Y (Column F on G703) $ My Commission expires: 1,_16_9015 • N��p e,� 's .. �,-. In accordance with the Contract Documents, based on on-site observations and the-sta comprising 6.TOTAL EARNED LESS RETAINAGE $ 595.690.89 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 $ 555,653.85 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 $ 40.037.C4 AMOUNT CERTIFIED $ 40,037.04 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 are'changed to conform with the amount certified.) (Line 3 less Line 6) $ 119,523.11 CONSTRUCTION MANAGERhuck Sawochka-- Signature Construction LLC • By: Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT.�""•t—/-r' '": Total changes approved in previous months by Owner $ $ By ' I` Date: / .;/37/ •yry 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 arc 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 AlA® 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 I PAGES AIA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00006 containing Contractor's signed Certification,is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11/30/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 102817A • A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE:, ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED d�a (IF VARIABLE) A L STORED AND STORL'D CO (IF VARIABLE) NO. VALUE APPLICATION THIS PERIOD FINISH (NOT IN TO DATE (C'_C,) (C-G) (D i E) D OR E) (D+E F) 0000 JOB 12012 104-1000 Sumbiltals $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 $1,600.00 $200.00 $0.00 $1,800.00 90.000 $200.00 $0.00 104-1004 Punchlisl/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 $102,617.10 $12,072.60 $0.00 $114,689.70 95.000 $6,036.30 $0.00 104-1018 Theater CMU Material $45,450.00 $38,632.50 $4,545.00 $0.00 $43,177.50 95.000 $2,272.50 $0.00 104-1019 Theater Rebar,Grout,Accessory Labor $96,300.00 $81,855.00 $9,630.00 $0.00 $91,485.00 95.000 $4,815.00 $0.00 104-1020 Theater Rebar,Grout,Accessory Matetrial $75,750.00 $64,387.50 $7,575.00 $0.00 $71,962.50 95.000 $3,787.50 $0.00 104-1021 Proscenium CMU Labor $74,880.00 $71,136.00 $3,744.00 $0.00 $74,880.00 100.000 $0.00 $0.00 104-1022 Proscenium CMU Material $28,080.00 $26,676.00 $1,404.00 $0.00 $28,080.00 100.000 $0.00 $0.00 104-1023 Proscenium Rebar,Grout,Accessory Labor $59,500.00 $56,525.00 $2,975.00 $0.00 $59,500.00 100.000 $0.00 $0.00 104-1024 Proscenium Rebar,Grout,Accessory Material $46,800.00 $44,460.00 $2,340.00 $0.00 $46,800.00 100.000 $0.00 $0.00 1104-1025 Allowance $35,000.00 $2,764.07 $0.00 $0.00 $2,764.07 7.897 $32,235.93 $0.00 $715,214.00 $617,393.17 $44,485.60 $0.00 $661,878.77 92.54% $53,335.23 $0.00 AIA DOCUMENT G703-APPLICATION AND CERTIFICATE FOR PAYMENT • 1992 EDITION • AIA. 01.1992 • THE AMERICAN INS11..TUTE 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 doc them has been reproduced elocuonicelly with the pemoissiai of The Arnericen Institute of Architects under License 97003 to Primavera Systems.Inc.Reproduction d this documont without project specific information is not permitted.Contact The American institute of Architecs to verify the current version of thin document and license status.' PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF Indiana • COUNTY OF Allen Richard E. Sutorius Being duly sworn upon his/her oath disposes and says that 1. He/she is_secretary ?Inserting 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 2 3 Ambassador Steel 0.00 Anderson Block & Brk 6,244.15 #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 18th day of November , 20 10 _ P-,‘-c,k-eA-A-Ce Oat>A( 7 (Authorized Representative of Prime Contractor, Title) County of Allen ) Richard E. Sutorius, Secretary State of Indiana ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This 18th-- Day of November 20/10 4111111 . vo. •„! • (Notary Public) , .• 0 I N S ,� t rurO�o David C. Thomas ° c� c�° (Printed Name) • coo. •* My p 12/16/15 ° NOTARYSEAL $�,-• M Commission Expires: NOTARY SEAL MUST APPEAR ON THIS FORM. y • PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS&WAIVER OF LIEN STATE OF Indiana COUNTY OF _Allen Richard E. Sutorius Being duly sworn upon his/her oath disposes and says that 1. He/she is_secretary '.'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 2 3 Irving Materials 17.716_"14 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 ha,s signed this document on behalf of the Prime Contractor this 18th day of November ,20 10 • (Authorized Representative of Prime Contractor, Title) County of Allen ) Richard E. Sutorius, Secretary State of Indiana ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This 18th Day of Nov-rtibPr I 0 �I Pair +,y (Notary Public) ■Gp er 4 J mb David C. Thomas 6° moo r I, (Printed Name) ro : itz64'41O "'rn: My Commission Expires: 12/16/15 s NOTAtiYSFAL NOTARY SEAL MUST APPEAR ON THIS FORM. '�a''/.,° C(P�,//� ��((((�� G esn Wli1V''ee°�,!t S'A4 1 E 0' .. PRIME CONTRACTOR'S UNCONDITIONAL PROGRESSIVE WAIVER OF LIEN Richard_ E. Sutorius Being duly sworn upon his/her oath disposes and says that: 1. He/she is secretary (inserting sole proprietor, partner or corporate office held, as the case maybe), ofHagsrman Crnst-r_trhi• whereafter 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 November 18th, 2010 06--10023 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 I date. 595,690.89 IN WITNESS WHERE OF,affiant has signed this document on behalf of the Prime Contractor this 18th day of November , 010 . (Authorized Representative of Prime Contractor, Title) Richard E. Sutorius, Secretary County of Allen State of Indiana Subscribed and sworn to before me,a Notary Public in and for said County and State,This 18th Day of November ,2010 . (Notary Pub) Davi r. Thomas My Commission Expires: 12/16/15 (Printed Name) 0$G�0111a"Q/ . 9 &C) �y••. oc-r.' ra -0, NOTARY SEAL MUST APPEAR ON THIS FORM. vim e a moo . w vO a 4i?v . !i(+� „**,%"'co,. aoao¢a 2Q