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Home My WebLink AboutDEALERS WHOLESALE- 338- 8/11/2011 Dealers Wholesale Check: 338 720 3rd Avenue SW Date: 8/11/2011 Carmel, IN 46032 Vendor: DEALWHO Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 8 450.00 450.00 0.00 0.00 450.00 App 8 on theater 450.00 450.00 0.00 0.00 450.00 338 8/11/2011 *************450.00 THE SUM OF FOUR HUNDRED FIFTY DOLLARS AND NO CENTS *************************************** Dealers Wholesale 720 3rd Avenue SW Carmel, IN 46032 Dealers Wholesale Check: 338 720 3rd Avenue SW Date: 8/11/2011 Carmel, IN 46032 Vendor: DEALWHO Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 8 450.00 450.00 0.00 0.00 450.00 App 8 on theater 450.00 450.00 0.00 0.00 450.00 APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER: PROJECT: APPLICATION NO 8 Distribution to: Carmel Theater Development.Corporation, LLC Village on the Green Parcel 7-C-I Theater Building OWNER 1016 3rd Avenue, SW, Suite 200 3rd Avenue SW ARCHITECT Carmel, IN 46032 Carmel, IN 46032 PERIOD TO: 5/31/2011 CONTRACTOR FROM CONTRACTOR: VIA ENGINEER: Dealers Wholesale Signature Construction, LLC 7845 E 89th St 720 3rd Avenue SW PROJECT NOS: 12012 Indianapolis, IN 46256 Carmel, IN 46032 CONTRACT DATE 7/28/2010 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet,AlA Document G703,is attached. completed 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 payments received from the Owner • that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 217,021.00 2. Net change by Change Orders $ 24,103.10 CON' R\C' Z: $ 241,124.10 0 4. TOTAL COMPLETED&STORED To $ 143,124.70 , l , .2_, 67;7/.,;e7/1 13y: or ' -.4 , Date: 5. RETAINAGE: a. 10 %of Completed Work $ 14,312 Subscribed and sworn to before me this / '7 day of 02 D / I (Column D+E on G703) b. 10 %of Stored Material $ 0 • (Column F on G703) e ``g-e yr 7-'2 7-ii Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 14,312.47 ENGINEER'S CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 128,812.23 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Engineer certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Engineer's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 128,362.23 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 450.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 112,311.87 <7-0 ��b (Line 3 less Line 6) AMOUNT CERTIFIED $ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified) �j in previous months by Owner $35,000.00 ($10,896.90) -2-11-a/-•'% li I Total approved this Month $0.00 By: /� � Date: 17/11h i' TOTALS $35,000.00 ($10,896.90) This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance,payment and acceptance of payment are without NET CHANGES by Change Order $0.00 $24,103.10 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA .01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.. N.W.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. G703 CONTINUATION SHEET To: From: iPt oject: Application No.: 8 Cannel Theater Development Corporation,LLC Dealers■Vholesale JVillage on the Green Theater _Application hate: _ 5/16/11 11711 North Pennsylvania Street __- 7845 E 89th St 3E:IIM Doors,Frames,&Iardware Period To: 5/30/11 Suite 200 Indianapolis,IN 46256 Eng.Proj# 12012 Carmel.IN 46032 317-849-4336 -- \York Completed Materials Total __ Presently Completed Balance Retainage Item Scheduled Front Previous_ _ Stored and Stored %■ To If # Description of Work _ Value Application - This Period (Not in To Date (G/C) Finish Variable I)or E) (I)+E+F) (C-G) -- - - 10% 108-8000 Hollow Metal Frames 10,325.50 9,060.60 500.00 0.00 9,560.60 92.6% 764.90 956.06 108-8001 Hollow Metal Frames Installation 2,340.00 0.00 0.00 0.00 0.00 0.0% 2,340.00 0.00 108-8002 Hollow Metal Doors 48,685.00 _ 20,900.00 0.00 0.00 20,900.00 42.9% 27,785.00 2,090.00 108-8003 Hollow Metal Doors Installation 3,545.00 900.00 0.00 0.00 900.00 25.4% 2,645.00 90.00 108-8004 Wood Doors Material 11,695.10 11,695.10 0.00 0.00 11,695.10 100.0% 0.00 1,169.51 108-8005 Wood Doors Installation 2,800.00 0.00 0.00 0.00 0.00 0.0% 2,800.00 0.00 108-8006 Hardware Material 97,551.90 93,411.00 0.00 0.00 93,411.00 95.8% 4,140.90 9,341.10 108-8007 Hardware Installation 13,057.00 280.00 0.00 0.00 280.00 2.1% 12,777.00 28.00 108-8008 Bid Bond 2,021.50 0.00 0.00 0.00 0.00 0.0% 2,021.50 0.00 108-8009 Allowance 25,000.00 6,378.00 0.00 0.00 6,378.00 25.5% 18,622.00 637.80 108-8010 Change Order #44-Tax Exempt (10,896.90) 0.00 0.00 0.00 0.00 0.0% (10,896.90) 0.00 110-8011 Change Order #101 Partitions 35,000.00 0.00 0.00 0.00 0.00 0.0% 35,000.00 0.00 __ __ Total: 241.124.10 142,624.70 500.011 0.00 143,124.711 59.4% 97,999.40 14,312.47 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS & WAIVER OF LIEN STATE OF Indiana COUNTY OF Hamilton Robert E. Nielsen Being duly sworn upon his/her oath disposes and says that 1. He/she is Executive Vice-President(inserting sole proprietor, partner or corporate office held, as the case maybe), of Dealers Wholesale 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 2 3 All Materials Used trom Stock #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 WITNE S WHERE OF, affiant has signed t is ••current on bet alf o'the Prime Contractor this f� day of A , 20 f/ 1 / �� (Authorized Representative of Prime Contractor, Title) County of Marion State of Indiana Subscribed and sworn to before me, a Notary Public in and for said County and State, This / 7 -/-A //of , 20 �y 20 - (Notary Public) �1ac;!e /JreiAte, i' (Printed Name) My Commission Expires: NOTARY SEAL MUST APPEAR ON THIS FORM.