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LITTLE CONSTRUCTION CO., INC.- 172- 2/11/2011
Little Construction Co., Inc. Check: 172 104 South Harrison Street Date: 2/11/2011 Greenfield, IN 46140 Vendor: LITTLE1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-3 26,352.05 26,352.05 0.00 0.00 26,352.05 App 3 P7C1 Theater 26,352.05 26,352.05 0.00 0.00 26,352.05 172 2/11/2011 **********26,352.05 THE SUM OF TWENTY SIX THOUSAND THREE HUNDRED FIFTY TWO DOLLARS AND 05 CENTS * Little Construction Co., Inc. 104 South Harrison Street Greenfield, IN 46140 Little Construction Co., Inc. Check: 172 104 South Harrison Street Date: 2/11/2011 Greenfield, IN 46140 Vendor: LITTLE1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-3 26,352.05 26,352.05 0.00 0.00 26,352.05 App 3 P7C1 Theater 26,352.05 26,352.05 0.00 0.00 26,352.05 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE OF PAGE TO CONTRACTOR: PROJECT: Village on the Green APPLICATION NO: 3 Distribution to: Carmel Theater Development Co. Theater OWNER 11711 North Pennsylvania St.,Ste.200 ARCHITECT Cannel,IN 46032 PERIOD TO: 12/30/2010 X CONTRACTOR FROM SUBCONTRACTOR: VIA ARCHITECT: Pedcor Design Group,LLC Little Construction Inc. 355 City Center Dr. 104 South Harrison PROJECT NOS: Greenfield,IN 46140 CONTRACT FOR: CONTRACT DATE: 07/09/10 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors 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. 1. ORIGINAL CONTRACT SUM $ 195,000.00 2. NET CHANGE BY CHANGE ORDERS $ (3,249.00) CONTRACTOR: Little Construction Inc. 3. CONTRACT SUM TO DATE(Line 1 t 2) $ 191,751.00 4. TOTAL COMPLETED&STORED TO DATE $ 88,668.75 • (Column G on G703) BY _ d- ..yr- .,,,./ .,,z:4 Date: /J— 5. RETAINAGE: . a. 10 %of Completed Work $ 8,087.03 State of Indiana County of:Hancock ` (Column D+Eon G703) Subscribed and swom to before me thi ( day of kCak=-cam 6 b. 10 %of Stored Material $ 779.85 Notary Public: �‘� .( &+L (Column F on G703) • My Commission a Tres: 7/8/15 TOTAL RETAINAGE $ 8,866.88 . Lines 5a+5b or Total in Column I of G703) ARCHITECTS CERTIFICATE FOR PAYMENT - - 6. TOTAL EARNED LESS RETAINAGE $ 79,801.88 In accordance with the Contract Documents,based on on-site observations and the data (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 PAYMENT $ 53,449.83 Architect's knowledge,information and belief the Work has progressed as indicated, (Line 6 from prior Certificate) the quality of the Work is in accordance with the Contract Documents,and the Contractor ,. 8. CURRENT PAYMENT DUE $ 26,352.05 is entitled to payment of the AMOUNT CERTIFIED, 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 11 1,949.13 AMOUNT CERTIFIED $ 6 35- L. 6 Si (Line 3 less Line 6) 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 ($3,249.00) ' \ 'fr J e ' / Total approved this Month $0.00 By: !,�` 2 Date: • TOTALS 0.00 (3,249.00) This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the 3,249.00 Contractor named herein.Issuance,payment and acceptance of payment are without NET CHANGES by Change Order 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. CONTINUATION SHEET ALA DOCUMENT G703 PAGE OF PAGE • AIA Document 0702, Owner: Cannel Theater SUBCONTRATOR: Little Construction Inc. APPLICATION NO:3 APPLICATION AND CERTIFICATION FOR PAYMENT,containing Develop.Corp.LLC JOB NAME: Village on the Green-Theater APPLICATION DATE:12/14/10 Contractor's signed certification is attached. 11711 N.Penn.St Ste.200 PERIOD TO: 12/30/10 In tabulations below,amounts are stated to the nearest dollar Cannel,IN 46032 LOCATION ARCHITECT'S PROJECT NO: 12012 Use Column I on Contracts where variable reta rage for line items may apply. Cannel,IN 46032 A B C D I E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO, VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (0+C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (D+El (NOT IN TO DATE D ORE) (D+E+F) 107-1000 Air/Moisture Barrier Material 29,108.00 26,197.20 2,910.80 29,108.00 100% 2,910.80 107-1001 Air/Moisture Barrier Labor 67,921.00 33,960.50 10,188.15 44,148.65 65% 23,772.35 4,414.87 107-1002 EIFS Material 25,995.00 7,798.50 7,798.50 30% 18,196.50 779.85 107-1003 EIFS Labor 48,276.00 4,827.60 4,827.60 10% 43,448.40 482.76 107-1044 Misc.Material 3,550.00 1,065.00 1,065.00 30% 2,485.00 106.50 107-1005 Misc.Labor 8,300.00 2,490.00 2,490.00 30% 5,810.00 249.00 107-1006 P&P Bond 1,850.00 1,850.00 1,850.00 100% 185.00 107-1007 Allowance 10,000.00 630,00 630.00 6% 9,370.00 63,00 107-1008 C0.47-Tax Exemption (3,249.00) (3,249.00) (3,249.00) 100% (324.90) • GRAND TOTALS $191,751.00 $59,388.70 $21,481.55 $7,798.50 $88,668.75 46% $103,082.25 $8,866.88 Users may obtain validation of this document by requesting of the license a completed A1A Document 0401-Certification of Document's Authenticity _ AIA DOCUMENT G703'CONTINUATION SHEET FOR 6702•1992 EDITION•AIA•01992 0703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D.G.20006-5232 fi CONTINUATION SHEET AIA DOCUA EIVTG703 PAGE OF PAGE - AMA Document G702, SUBCONTRATOR: Little Construction,Inc. APPLICATION 1 3 APPLICATION AND CERTIFICATION FOR PAYMENT,containing JOB NAME: Village on the Green Theater APPLICATION DATE:12/14/10 Contractor's signed certification is attached STORE ii: PERIOD TO: 40,542 In tabulations below,amounts are stated to the nearest dollar. LOCATION: ARCHITECT'S PROJECT NO: Use Column Ion Contracts where variable retainege for line items may apply. _ — A B C D I E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (0-,C) TO FINISH (IF VARIABLE APPLICATION STORED AND STORED (C-G) RATE) (D+E) (NOT IN TO DATE D OR E) (D+E+F) Allowance$10,000.00 Change Order#36-PR.14 630.00 630,00 630.00 100% 63.00 GRAND TOTALS $10,000.00 $630.00 $0.00 $0.00 $630.00 6% $9,370.00 $63.00 Users may obtain validation of this document by requesting of the license a completed AIA Document D401•Certification of Document's Authenticity AIA DOCUMENT G703.CONTINUATION SHEET FOR 0702.1992 EDITION••AIA••©1992 0703-1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D.C.20006-5232 PRIME CONTRACTOR'S SWORN STATEMENT OF INDEBTNESS &WAIVER OF LIEN STATE OF Indiana C UNTY OF Hamilton Being duly sworn upon his/her oath disposes and says that: 1. He/she is C SidtQn-1' (inserting sole proprietor, partner or corporate office held, as the case maybe), of L;-.-4k O 5{-Y 4i mn 1 r c. 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 E1f.5 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 11(19,-Ike d -PCF Lct a_ - RAS b �czt fne ncoI) #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 / day of , 20 /G - (Authorized Representative of Prime Contractor, Title) County of ncoc_ ) State of n(-3..i ci nc ) Subscribed and sworn to/before me, a Notary Public in and for said County and State, This )9" Day of 2.101 10 n • L- (Notary Public) ? nq L Oct.-I-c Re— My Commission Expires:7��'f5 (Printed Name) NOTARY SEAL MUST APPEAR ON THIS FORM. LITTLE CONSTRUCTION CO., INC. 1 1110t 104 S. HARRISON ST. GREENFIELD, IN 46140 PHONE 317-462-9700 7237 /CUSTOMER ORDER NO. DATE SHIPPED SHIPPED VIA OUR NO. ��� SALESPERSON 1 b SHIP TO: {li SOLD TO: I 1 IQ a fan :11R �een Th2;:der Fr© r-1 .-n U-Q-n-V©r ao 4czQUANTITY DESCRIPTION , - -&Ai< . -sP ?) - - _y ' '- -1 w rYleskf - - - Loh d M es 3.7Q+5 30 -2" Foci ry) ba3 1 Fb )1)r) l D Ect35 3! Fcayn - - CARTONS TOTAL WEIGHT ORDER COMPLETE BALANCE TO FOLLOW I PACKED BY CHECKED BY • 2 PLEASE NOTIFY US IMMEDIATELY • IF ERROR IS FOUND IN SHIPMENT