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HomeMy WebLinkAboutMACDOUGALL PIERCE - 1231 - 23,829.30 - 9/16/2010 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES _ TO OWNER: PROJECT: APPLICATION NO:4 Distribution to: VILLAGE ON TEl GREEN nOWNER _ PERIOD TO: ARCHITECT FROM CONTRACTOR: VIA OWNERS REP: 7/31/2010 nCONTRACTOR REI CONSTRUCTION SERVICES MACD_ OGA. -CCT'IERGL• PROJECT NOS: n CONTRACT FOR:'_--Y CONTRACT DATE: 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 A plieation for Payment has been completed Continuation Sheet,ALA Document G703,is attached. in accordance with the Contract Documents, all amounts have been paid by the Contractor for Work for which previous Certificates v yment were issued and payments received current from the Owner,and that curt pa .•nt shown ltesein is 7w due. I. ORIGINAL CONTRACT SUM . . 908,425.00 - / / / 2. Net change by Change Orders 1 1.675.00 CONTRACTO'. •. ce t,onst non,rn?- 3. CONTRACT SUM TO DATE(Line I ±2) 920,100.00 `� ,`, • 4. TOTAL COMPLETED&STORED TO DATE.. 461,589.00 By: ,I.r'.�. - S ` au 7/26/10 5. RETAINAG E: 1� 'jr a. l0% %of Completed Work 46,158.90 Stile of: is'ana County of: I .milton \ (Column D+E on G703) Subscrib-d and swo • • bit� 26t ii J 010 h. %of Stored Material NOTAR ' PUBLIC: ./ 4 4� v�`– (Column F on G703) My Comm sion expir:. 3/21 Total Retainage(Lines 5a+56 or Total in Column 1 of G703). 46,158.90 OWNER'S REP. CERT ICATE FOR PAYMENT 6. TOTAL EARNED LESS RIE TIP 415,430.10 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5'natal) comprising the application,the Owners Rep certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Owner's rep knowledge,information and belief the Work has progressed as indicated,the quality PAYMENT(Line 6 from prior Certificate).... 391,600.80 of the Work is in accordance with the Contract Documents,and the Contractor is entitled to 8. CURRENT PAYMENT DUE. .. . .. ... 23,829'.30:; payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINA. 504,669.90 p 2� (Line 3 less Line 6) AMOUNT CERTIFIED $23 g234. 3 RDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differesf om the amount applied. Initial all figures on this Total changes approved Application and on the Continuation Sheet that are changed to conform to the amount certifier).) in previous months by Owner $11,675.00 Owners Rep: / / Total approved this Month $0.00 By: - -1 Date: '/4/h C7 TOTALS 511,675.00 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 Orde $11,675.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702-APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION-AIA.01992 THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 200065292 PAID StP Jj ?�]J,0 ,:/,46,91 OC es PARTIAL LIEN WAIVER AFFIDAVIT WHEREAS, MacDougall Pierce Construction,Inc. ("Contractor") has been heretofore employed Village-on the Creen(Company")to furnish certain material, supplies, equipment or labor for or in connection with improvements owned by, Same ("OWNER" and located on Indianapolis, In (Hereinafter collectively referred to as the Premises"); and WHEREAS, the undersigned is duly authorized to execute this Partial Waiver of Lien for and on behalf of the Contractor: NOW, THEREFORE, the Contractor, For and in consideration of the receipt of Twenty three thousand eight hundred twenty nine-30/100 ($ 23,829.30 ) Hereby waives, and releases the Owner of the Premises and the Company from any and all liens, rights of lien or claims of whatsoever kind or character on or against the Premises or the improvements located thereon on account of any and all labor, supplies, equipment or material furnished for, in connection with or incorporated in the Premises by the Contractor on or before the date hereof. This Partial Waiver of Lien is given in order to induce the Company to pay II amount indicated above, and upon receipt of such amount by the Contractor, this release m: c-h recorded, become valid,enforceable and of full effect. 1acDouy6ll iet�—:y-.::. ' on Inc. �r�!r% By. pa Ems. / igillIn re P Abii dRtp scntative L/ Brent Houston 1'rinred Name TITLE PiHect Manager DATE: 8/2110 STATE OF INDIANA COUNTY OF Hamilton Before me,a Notary Public in and for said county and State,personally appeared Brent Houston Who acknowledged the execution of the foregoing Partial Waiver of Lien, and who, having been sworn, stated that the representations therein contained are true. Witness my hand and Notarial Seal thiso2 d• •of August , 201 0 My Commission expires er cc v 7 0.-" 3-20-16 Notary Pub'c .ame Tanya Fanelli County of R6NAdence Delaware [CONTINUATION SHEET A(A DOCUMENT G703 ! PAGE OF E.tJEs AIP:Document G702,APPLICATION AND CERTIFICATION FO_R PAYMENT,containing APPLICATION NO 4 001 Can rate's signed cgrtlicatlon is attached TV lCt MGL UPI I Fit GKttry APPgCA I lOrTDA I L. 2, .Jul-501 _ In tabulations below,amounts are stated to 1 PERIOD TO I 31-Jul-101 _ Use Column Ion Contracts where variable retainage for line items may apply. I jCM'S–PROJECTCNO'. 1 A 3 C D E F 1 I H i ITEM DESCRIPTION UP WORK SCHEDULED WORK COMPLETED MA ERIALS TOTAL % BALANCE RETAI AGE NO VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G-C) TD FINISH pr VARJAEL E APPLICATION STORED AND STORED (C-0) RAT ) (D+E) —(NOT IN TO DATE D OR E) (D+E+F) ENGINEERING $7,500,001 $7,500.00 1 1 $7,500.00 $1.001 $750.00 _ BOND PREMIUM $7,500.001 $7,500.00 $7,500.00 $1.001 $750.00 GENERALCONDITIONS(M) $9,205.00 $4,602.00 $1,534.00 $6,136.00 $0.671 $3,069.00 $613.60 GENERAL CONDITIONS(L) $57,039.00 $28,520.001 $9,506.00 $38,026.00 $0.67 $19,013.00 $3,802.60 GFRC COLUMN COVERS(M) 1 516,763.001 $16,763.00 GFRC COLUMN COVERS(L) $2,500 00r $2,500.00 ROUGH CARPENTRY(M) $6,696.00! $6,696.00 I $6,696.00 $1.00 1 $669.60 ROUGH CARPENTRY(L) $9,988.001 $8490.001 $499.001 $8,989.00 $0.90 $999.00 $898.90 FINISHCARPENTRY(M) $7,309.00 52,193.001 1 $2,193.00 $0.30 $5,116.00 $219.30 FINISH CARPENTRY(L) $8,936.00 _ $1,340.00 1 $1,340.00 $0.15 $7,596.00 $134.00 GFRP FABRICATIONS (M) 1 $67,658.00 $3,333.00 1 $3,333.00 $0.05, $64,325.00 $333.30 GFRP FABRICATIONS(L) 1 $5,930.00 I $5,930.00 CABINETRY(M) 1 $13,018.00 $13,018.00 CABINETRY(L) 1 $3,254.00 1 $3,254.00 FIREPROOFING (M) $9,600.00 $9,600.00 $9,600.00 $1.001 $960.00 FIREPROOFING(L) $6,400.00 $6,400.00 $6,400.00 $1.001 $640.00 FIRESTOPPING(M) $3,120.00 L $3,120.00 FIRESTOPPING(L) $4,680.00` 1 $4,680.00 CAULKING(M) $6,000.00 $6,000.00 CAULKING(L) $14,000.00 1 $14,000.00 EXPANSION JOINT COVERS (M $5,500.00 I I I $5,500.00 EXPANSION JOINT COVERS (L) $4,000.00 1 [ $4,000.00 HOLLOW METALS (M) $12,706.00f $12,706.00 1 $12,706.00 $1.00 $1,270.60 HOLLOW METALS(L) $1,759.00 $1,759.00 1 $1 ,759.00 $1.00 1 $175.90 WOOD DOORS(M) $5,933.00 $5,933 00 1 $5,933.00 $1.00 $593.30 —1WOOD DOORS(L) $2,463.00 I $2,463.00 DOOR HARDWARE (M) $28,061.00 _ $28,061.00 DOOR HARDWARE (L) + $3,313.00 1 $3,313.00 ACCESS !DOORS(M) � $1,480.001 I $1,480.00 ACCESS DOORS(L) f $400.00 1 $400.00 ROLLING DOORS(M) 1 $5,853.001 1 I f} $5,853.00 SFAIA DOCUMENT G703 - CONTINUATION SHEET FOR G702 1992 EDITION • AIA © 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE N.W., WASHINGTON, DC 20006-529211 05F 4F bGG703-1992 CONTINUATION SHEET I IA/A DOCUMENT G703 I PAGE OF PAGES _ AA.Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 4.001 Z;ontractors signed certification Is aliachedTVILLHGt UN FEGKEEIV APPLICATION DATE: 23 7.1-W1-U1 I - In tabulations below,amounts are stated tol I PERIOD TO: I I 31-Ju1-101 Use Column I on Contracts where variable retainage for line items may apply. I 1 GM'S-PROJECT-NO: I I 1 I I A B C D E F G H I ITEM UESCRIPT ON OF WORK _ SCHEDULED WORK UOMPLE I E •. 'IALS 0 AL % BALANCE RETAINAGE NO. VALUE FROM PRE IOUS 1 HIS PERIOD PRESENT'LV COMPLETED (,*CC TO FINISFC pr VARIABLE APPLICATION —STIED AND STORED (C-G) RATE) (D+E) --(NOT IN TODATE_ O OR E) (DTE-TF) ROLLING DOORS(L) $1,463.001 I_ $1,463.001 GLASS/GLAZING(M) $510.00 I $510.001 —GLASS/GLAZING(L) $340.00 $340.00 METAL STUD FRAMING(M) $124,357.00 $124,357.00 $124,357.001 $1.001 1 $12,435.70 — METAL STUD FRAMING(L) $64,332.001 $64,332.00 $64,332.00 $1.001 $6,433.20 METAL STUD TRUSSES(M) I $7,089.001 $7,089.001 $7,089.00 $1.00 $708.90 METAL STUD TRUSSES (L) I $12,440.00 $12,440.001 l $12,440.001 $1.00 $1,244.00 DRYWALL/SHEATHING(M) $27,061.00 $27,061.00' 1 $27,061.00 $1.00 $2,706.10 DRYWALL/SHEATHING (L) _ $70,220.00 _ $59,687.00 $3,511.001 $63,198.00 $0.90 $7,022.001 $6,319.80 ACOUSTICAL CEILINGS(M) $14,040.00 L $14,040.001 (ACOUSTICAL CEILINGS(L) $9,360.00 ` _ I $9,360.001 TILE(M) $34,431.00 1 $34,431.001 TILE(L) $24,000.00 $24,000.00 RESILIENT FLOORING (M) 1 $12,004.00 i $12,004.00 RESILIENT FLOORING(L) $8,002.00 1 $8,002.00 _ CARPET(M) $7,541.00 1 . $7,541.00 CARPET(L) $3,232.00 I $3,232.00 IPAINTING (M) $17,207.00 PAINTING(L) $11,471.00 —1 I $17,207.00 $11,471.00 I DIRECTORY(M) $2,200.00 i $2,200 1 $2,200.00 IDIRECTORY(L) $300.00 1 $300.00 SIGNAGE (M) 1 $1,700.00 1 $1,700.00 SIGNAGE (L) 1 $300.001 1 $300.001---- FIRE EXTINGUISHERS(M) $2,025.001 $2,025.00 _FIRE EXTINGUISHERS(L) $596.00 $596.00 TOILET PARTITIONS (M) $18,000.00 $18,000.00 _TOILET PARTITIONS (L) $4,500.00 I $4,500.00 TOILETACCESSORIES(M) $21,260.00 1 $21,260.00 TOILET ACCESSORIES(L) $2,590.00 I $2,590.00 OH&P $67,290.00 $31,365.00 $1,961.00 I $33,326.00 $0.50 $33,964.00 $3,332.60 1CO#1 $11,675.00 $11,675.00 1 1 $11,675.001 $1.00 $1,167.50 5FAIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA • © 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-529211 05F 4F bG703-1992 CONTINUATION SHEET I IAIA DOCUMENT G703 I I PAGE OF PAGES AIA,Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing !APPLICATION NO: 1 4.001 C ntractor'ssigneo certifications aElEfaTVILLHGt UN Illt lillttN I I APPLICAIIONUAYE: 23-JU(-1U - In tabulations below,amounts are stated toy I PERIOD-TO: I 31J61710 Use Column I on Contracts where variable retainage for line items may apply. CMS PROJECTNO: I I I ! I A B C D E F G H I I EM DESCRIPriON OF WORK _S(.HE ULEU WORK COM LE IL • -IALS • A % BALANCE RETAINAGE WO- —VALDE ROM PREVIOUS THIS P RIOD PRESENTLY—COMPLETED— (G*C) TO FIN)SW—(IF VARIABLE APPO A1TON STORED AND STORED - -E7-61 RATE) (D+E) —MIN TO-DATE D OR E) (D+E+F) TOTAL: $920,100.00 $435,112.00 $26,477.00 I $461,589.00 $0.501 $458,511.00 $46,158.90 I I I 1 I- I 1 I I I I I — -I I I I I 1 I I I I I - ! I —1 I I I I I I ( I I 5FAIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA • © 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006-52921105F 4F bG703-1992