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HomeMy WebLinkAboutBYBEE STONE CO INC- 114,598.80- 11/30/2010 - NO CHECK WRITTEN BY CRC 5 TA Document G7021CMai1" @ 1992 2 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 24-FINAL Distribution to: City of Carmel Performine Arts Or CRC Carmel TN PERMOO TO: 1 1 /3 0 / 1 0 OWNER ❑ One Civic Square Cannel IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 1 1 /30/0 7 ARCHITECT ❑ 'Bvhee.Staneealnc, Shiei Sexton 629YN artthews Dr PROJECT NOS:2695-2025 CONTRACTOR ❑ E13ettsvilleTN 47429 VIA ARCHITECT: FIELD ❑ C50 Architects Inc CONTRACT FOR: Performing Art ❑ 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 i Shcct,AIA Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued end payments received from the Owner, and (hat current 1.ORIGINAL CONTRACT SUM................................................................. $ 7 R S D 0 f10 payment shown herein is now due, 2.Net change by Change Orders $ 3 6 5 , 4 7 0 CONT CTOR: `..�� 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 3 , 215 . 420 By Le. - 41-4r-'n� Date: I a t m i �•Q 1,0 4.TOTAL COMPLETED 3 STORED TO DATE(Column Con0703) ._,_.,_....$ 3215, 420 State of: In d1' n° 5.RETAINAGE: County of Owen a. _i_o_a/o of Completed Work Subscribed and s nl to bef (Column D+E on G703) $ 114 5.9 R An me this 7 ay of �w h. MI of Stored Material Notary Public: � 1 ��r� (Colman F on 0703) $ My Commissio expires: "i 2 O 1 5 Total Retainage(Lines Sn+5b or Total in Column I of G703).. 5114 , 598 .80 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE ...............,..,.,.......,.,:.......,..,.. $3 1 O n , 8_21 7 0 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 $3 . 1 O n , A 71 . 7 0 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. TO 8.CURRENT PAYMENT DUE I $1 1 4 , 598 .80J I . AMOUNT CERTIFIED ...................................._....__,.... .,,.,....?,.,.......,.,. $ A 9.BALANCE TO FINISH, INCLUDING RETAINAGE (4tAteh ezylannrian if amount cerl fed di(J"ers frwrn t e amount applied Initial alllrgtnes err this • Application and on ii. Contirraaiiot Sdreel f ore c'range{I to conform with the amount certified) (Line 3 less Line 6) $ 0 CONS CTION W4• r /7111310thip CHANGE ORDER SUMMARY ADDITIONS l DEDUCTIONS ARC ECT: ��I jrr_ _ _ _ �7 7 `_nl Total changes approved in previous months by Owner $ 415 , 000$ 49 , 580 By 1 Date: 1C.�� 7t11Y Total approved this Month $ $ This Certificate is not negotiable, The AMOUNT CERT1F1ED is payable only to the Contractor TOTALS $ 415 , 000s 4 9, 580 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order C the Owner or Contractor under this Contract. 3.b5,4.20 AIA Document 67021CMa'"-1942 Copyright ©1982 by The American Institute of Architects.All rights reserved.WARNING:This AIk"Uocvment is protected by U.S.Copyright Law and International Treaties, unnrrthortzed reproduction or llist,rrbrltinn of this AlA' Document,or any portion of lt,may result in severe clell and criminal pon:dnos,and will be prosecuted to the maxirtlurn extent possllee underlie law.This document was created at 11:25.14 vibTon 08!1912905 under leo karats of license number 26001 issued by the American Institute of Architects,and is not for resale.This document is licensed for one lime use Only and may ant be renmdaced odor to its comolciian, eO ,� 3/4.0 /_/d<.yr m . . 414AT § Document G703TM �z - 1992 Continuation Sheet MA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 24-FINAL containing Contractor's signed certification is attached. APPLICATION DATE: Nov. Eft,2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Nov.30,2010 Use Colutim I on Contracts where variable retainage for line items may apply. AIICIIITEC r':S PROJECT NO: 2695-2025 CONTRACTOR: Bybee Stone Co Inc A B C D E F 0 H I I WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED BALANCE RETAINAGE ITEM' DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS STORED AND STORED % TO (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G-C) FINISH i RATE) (D+E) D OR F) (D+E+F) ( ) • 1 Shop Drawings 387,000 387,000 0 00 0 387,000 100% 0.00 34,530.00 2 Raw Material 911,400 911,400 0.00 0 911,400 100% 0.00 61,525.00 3 Material Storage 0 0 0.00 0 0 0% 0.00 0.00 4 Shop Fabrication 1 301,600 1,301,600 0.00 0 1,301,600 100% 0.00 52,064.00 5 Material Delivery 100,000 100,000 0.00 0 100,000 100% 0.00 100.00 6 Engineering Allowance 150,000 150,000 0.00 0 150,000 100% 0.00 7,329.80 7 Change Order#1 415,000 415,000 0.00 0 415,000 100% 0.00 8,330.00 8 Change Order#2 -49,550 -49,580 0.00 0 -49,580 100% 0.00 -49,580.00 9 Retainage 114,598.80 0 -114,598.80 • • Totals 3 215 4711 3 5 47C 11ry9R an 0 Iz X1 0 ______„go 0 00 MA Docurnent6703'"—1992.Copyright CP 1963, 1965, 1966,1967,1970,5979,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and international Treaties,Unauthorized reproduction or distribution of this AIA:'Document.or any portion of it,may result in tavern civil arid criminal penalties,and will be prosecuted to the maxintutrI exlent possible under the law.This document was created at09: &2d MDT on 0711'32009 under the terms of license number 26001 issued by the American Institute oI Architects,and is not for resale.This document Is licensed for one time use only and may not be reproduced prior to its completion. FINAL WAIVER OF LIEN STA FE OF INDIANA) Gtyk: SS COUNTY OF MONROE) Escrow#: - TO WHOM IT MAY CONCERN: WHEREAS the undersigned has been employed by the City of Carmel. Carmel Redevelopment Commission to furnish Limestone for the premises know as Regional Performing Arts Center of which the City of Carmel is the owner. THE undersigned, for and in consideration of $114.598.80 , and other good and valuable considerations, the receipt whereof is hereby acknowledged, do(es) hereby waive and release any and all lien or claim of,or right to, lien, under the statutes of the State of Indiana, relating to mechanics' liens, with respect to and on said above described premises, and the improvements thereon, and on the material, fixtures, apparatus or machinery^ furnished and on the moneys, funds or other considerations due or to become due from the owner, on account of labor services, material, fixtures, apparatus or machinery, hereto furnished to this date by the undersigned for the above described premises, INCLUDING EXTRAS*. Date: Nov. IS, 2010 Company Name: Bybee Stone Company, Inc nn Address: 6293 N. Matthews Dr, Ellettsville,IN 47429 Signature and Title: 1 *EXTRAS INCLUDE BUT ARE N T LIMITED TO CHANGE ORDERS, BOTH ORAL AND WRITTEN.-10 THE CONTRACT. CONTRACT'OR'S AFFIDAVIT STATE OF INDIANA) SS COUNTY OF MONROE THE undersigned, Mary Beth Haas, being duly sworn, deposes and says that he or she is Vice Pres. of Bybee Stone Company, Inc who is the contractor furnishing Limestone for the building located at Carmel, Indiana owned by the City of Carmel, Carmel Redevelopment Commission . That the total umotmt of the contract including extras is S 3,215,420.00 on which he or she has received payment of $3,100,821.20 prior to this payment. That all waivers are true, correct and genuine and delivered unconditionally and that there is no claim either legal or equitable to defeat the validity of said waivers. That the following are the names of all parties who have furnished material or labor, or both, for said work and all parties having contracts or sub contracts for specific portions of said work or for material entering into the construction thereof and the amount due or to become due each, and that the items mentioned include all labor and material required to complete said work according to plans and specification: NAMES WHAT FOR CONTRACT AMOUNT II EIS BALANCE PRICE PAID 1'AVM ENT DUE BYBEE STONE COMPANY,INC LIMESTONE 53,215,420.00 $3,III0,N21211 $I 14,598.80 50.00 TOTAL LABOR&MAT'L TO COMPLETE $3,215,420.00 $3,100.821.20 SI I4,59%.811 SIL1111 That there are no other contracts for said work outstanding,and that there is nothing due or to become due to any person for material, labor or other work of any kind done or to be done upon or in connection with said work other than above stated. Date: Nov. 18,2010 Signature: — � ; 1(}.,t�!ice President, Subscribed and Sworn to Before Me This 7th Day of Dec , 2010. 4 Extras included but are not limited to Change Orders, • Both oral and written to the contract. 44441 ��, , r Notary Public �jC/l�/ Commission Expires: 5/25/2016 r.1722K5/a vrta I by chic,go Talc Inavmuum Campanr U.S Denarnueni of Labor NOT APPLICABLE Form Approved Wage and Hour Division Badger Bureau No 44-R1093 • Dare 11 /18/1 0 ST'AT'EMENT' OF COMPLIANCE Mara Beth Haas vice president do hereby state: (haler ef5igg+awry nary) Jinni (I)That l pay or supervise the payment of the persons employed by qBybee Stone Co Inc on the: t (Coneactororsubcencracror) ,T01O that during tine payroll period commencing tm toa 1 S tday of J a n i&iim 6 and ending the�0-ds'y of 444XX,,all persons employed on said • project have been paid the full weekly wages earned that no rebates have been or will be made either directly or indirectly to or on behalf on said Bybee Stone Co Inc from the full weekly wages tamed by any person and that no deductions have been made either (Conrracmr or Seen nsacmr) directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A), issued by the Secretay of Labor under the Copeland Act, as Amended (48 Stat 948,63 Stan 108,72 Stat. 967; 76 Stan 357; 40 U.S.C. 276x),and described below: 12) That any payrolls otherwise under this contract required to he submitted fur the above period are correct and complete;that the wage rates for laborers or mechanics contained rum em are not less than the applicable wage rates contained in any wage de€5 crmi nation incorporated into the contract; that the classifications set forth thesis for each laborer or mechanic conform iwht the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship prop am registered with a State apprentice- ship agency recognized by the Bureau of Apprenticeship and Training,United States Department cif Labor,or if no such recognized agency exists in a Staate are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) Thai: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS, OR PROGRAMS K In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above reverenced payroll payments of fringe benefits as listed in the contract have been or will be made to appropriated programs for the benefit of such employees,except as noted in Section 4(c)below, (h) WHERE FRINGE BENEFITS ARE PAID IN CASH 1 Each Laborer or mechanic listed in the above referenced payroll has been paid as indicated on the payroll,an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in section 4(o)below. (c) EXCEPTIONS EXCEP nowS(CRAFT) f - Remarks { { Name and Title Signature Mary Beth Haas, VP q ,i 1 , The xilE li falsification of any of Ike above ssntmeurs may subject the conaacter or subcontractor to civil or criminal prosecutir nn...-`Skeet-seLclti onn !!061 of 4tl•18 and section 23!of tide 31 of the United Stares code. Farm WH-345(1!68)Purchase this form directly from the Supt.of Dominants • CITY Or CARiMF1. It is A1'BEE:STONE COMP ANIV CONTRACT CHANGE 0'9. NDRTH yL417HElVR CIKI VF I)A FE: _ !Jcctruhe( '0llj� fiLLE]CrSVI I•I-Ii, IWJ:434 I'ROA'C1'.'1AM i'nnnc RP.A(:('ui,inieiioo CITY Rho NO. CITY PO NO.: Eh' f°t�Ii DTI 11.11 L- diiccicd I++n1nl::rill lollaukng cnumg<3 in Ihis Crwnacl: St]IEI)I ry.EI)AVJ.rt;c TI1 I PA4T ITEM :1N IO]Iln i' OII i'-1❑A','S Pcribno all lcod: in nuconlande nidl Work I)ireitiv: Cfunlct No.20:5-O0 I 1;0,00 Pcr N'nrk Dirt[dcc f':'L•oii No 2P2 -ai11 II -nllmcrng Llocuirl:nls l'un1'rr 1e nhr the chin ^_r t.l!Ilivai In f':I t r]pir 1.;led.Ire in l-c arn.Id le•1 a part ,fihie l Im c(11-+ R1 P.. n:^ P+ n.0 N 02,5001 Th .:iiiuJ, ; rcau i lu the inl ov:, rE:xljttiinf.nl nl Ct'ner::.I 'ii c mkt Ri 10 Fmk- : nurucl I'ncc pri, : Ili IIIN&Ilunnz ;vie' 265 ho HI r rA111r.rdlhicr uili he rnercitw•J•JatihS>c;l hi hi]Uhuupc Grrilo• - Rik), . .11•l•nlnlcl 0:i5 Lhenec 4:3111r v __ :-'05 NO1/.i.0 1.'ontrad 11111r i'rr:r I0 fni]l_,I ci)rd7 'flir`ulrr.,.n!'n.;eci ( oini'I:rinu l):ik. 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