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Home My WebLink AboutI WEISS & SONS, INC.- 171- 2/11/2011 I Weiss & Sons, Inc. Check: 171 815 Fairview Avenue, Unit 10 Date: 2/11/2011 Fairview, NJ 07022 Vendor: IWEISS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 1,809.00 1,809.00 0.00 0.00 1,809.00 App 1 on P7C1 Theater 1,809.00 1,809.00 0.00 0.00 1,809.00 171 2/11/2011 ***********1,809.00 THE SUM OF ONE THOUSAND EIGHT HUNDRED NINE DOLLARS AND NO CENTS ******************* I Weiss&Sons, Inc. 815 Fairview Avenue, Unit 10 Fairview, NJ 07022 I Weiss & Sons, Inc. Check: 171 815 Fairview Avenue, Unit 10 Date: 2/11/2011 Fairview, NJ 07022 Vendor: IWEISS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 1,809.00 1,809.00 0.00 0.00 1,809.00 App 1 on P7C1 Theater 1,809.00 1,809.00 0.00 0.00 1,809.00 Aw-LIVA I IUN AND c:hK I IFIGATION FOR PAYMENT AIA DOCUMENT G702 PAGE 1 OF 2 TO OWNER Carmel Theater Development PROJECT: Village On The Green APPLICATION NO:1 Distribution to: ` Corporation,LLC Parcel 7C1 Theatre Bldg OWNER 11711 North Pennsylvania St, Suite 200 3rd Avenue, SW ARCHITECT _ Carmel,IN 46032 Carmel,IN 46032 PERIOD TO: 12/31/2010 CONTRACTOR FROM SUB-CONTRACTOR: VIA ARCI-IITECT: Pedcor Design Group, LLC I.Weiss&Sons,Inc. 355 City Center Drive J 815 Fairview Avenue,Unit 10 Carmel,IN 46032 PROJECT NOS: 12012 Fairview,NJ 07022 Stage Drapery&Manual Acoustic Curtains CONTRACT FOR: CONTRACT DATE 10/13/2010 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,AIA 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,and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM $ 75,175.00 2. Net change by Change Orders $ CONTRAC •R: .W,e &Sons, c. 3. CONTRACT SUM TO DATE(Line I±2) $ 75,175.00 81. F irview 4� enue,Unit 10 4. TOTAL COMPLETED&STORED TO $ 2,010.00 ai iew,NJ 7022 DATE (Column G on G703) By: Date: J)--/Y'-` U 5. RETAINAGE: II avid ^osenberr -President a. 10%of Completed Work $ 201.00 State of: "runty of: LAUREN A. DUFFY (Column D+E on G703) Subscribed and sworn to before this day of b. of Stored Material $ 0.00 Notary Public: \,, NOTARY PUBLIC, STATE OF NEW YORI (Column F on G703) My Commission expires: NO. 01-DU6194542 Total Retainage(Lines 5a+Sb or Q�l r/+ �j, •` FiED I1`1 WFSTCHESTER COUNT Total in Column I of G703) $ 201.00 ARCHITECT'S CERTIFICATE FOIERT', ,itiViettiEXPIRES OCTOBER 6, 21 6. TOTAL EARNED LESS RETAINAGE $ 1,809.00 In accordance with the Contract Documents,based on on-site observations and the data 11 (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 0.00 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 1,809.00 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETA11 $ 73,366.00 p '� (Line 3 less Line 6) AMOUNT CERTIFIED $ / !' 044.----e' 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.) in previous months by Owner 1 eHt-"FEC3rEM-""°'`N Total approved this Month By: ff Date: /J/ A TOTALS $0.00 $0.00 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 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. ?1 i01 t CONTINUATION SHEET AIA DOCUMENT G703 PAGE2 OF 2 - AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 1 Contractor's signed certification is attached. APPLICATION DATE: 12/7/2 010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 12/31/2 010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 12 012 Village On The Green Parcel 7-C-1 Theatre Building _ A B C D I E F G H I ITEM DESCRIPTION OF WORK ' SCHEDULED - WORK COMPLETED - MATERIALS TOTAL - % BALANCE RETAINAOE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G=C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (D+E) (NOT IN TO DATE 10.00% D OR E) (D4-E+F) 111-6000 Drafting,Engineering,Mobilization&Travel $4,900.00 $735.00 $735.00 15.00% $4,165.00 $73.50 111-6001 Drapery Track&Hardware $8,000.00 $0.00 0.00% $8,000.00 $0.00 111-6002 Stage&Acoustic Drapery $45,000.00 $0.00 0.00% $45,000.00 $0.00 111-6003 Installation of Stage Hardware&Drapery $6,340.00 $0.00 0.00% $6,340.00 $0.00 111-6004 Installation of Acoustic Hardware&Drapery $4,660.00 . $0.00 0.00% $4,660.00 $0.00 111-6005 Bond $1,275.00 $1,275.00 $1,275.00 100.00% $0.00 $127.50 111-6006 Allowance $5,000.00 • GRAND TOTALS $75,175.00 $0.00 $2,010.00 $0.00 $2,010.00 2.67% $68,165.00 $201.00 Users may obtain validation of this document by requesting of the license a completed AlA Document D401 -Certification of Document's Authenticity AIA DOCUMENT 0703•CONTINUATION SHEET FOR 6702•1992 EDITION•AlA•®1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D.C. 20006-5232 G703-1992 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF New Jersey COUNTY OF Bergen David Rosenberg Being duly sworn upon his/her oath disposes and says that: 1. He/she is President (inserting sole proprietor, partner or corporate office held, as the case maybe), of I. Weiss & Sons, 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 Bid Package 4D-Stage Drapery and Manual Acoustic Curtains 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 #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. i IN WITNESS WHERE OF, affiant has signe his doc ent on oehal.f/of the Prime Contrac _ is day of ( ,� , 20 2e (A . orized RepiresKitatii C.citractor, Title) County ofL0e;*clnq1e)r State of v3r, ‘zQvr< ) Subscribed and sworn to before me, a Notary Public in and for said County and State, This Day of , 20 \ (Notary Public) LC.A.-Lk..‘c'- .r\ . (Printed Name) My Commission Expires: NOTARY SEAL MUST APPEAR ON THIS FORM. LAUREN A. DUFFY NOTARY PUBLIC, STATE OF NEW YORK NO. 01-DU6184542 QUALIFIED IN WESTCHESTER COUNTY COMMISSION EXPIRES OCTOBER 6, 20\7