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Home My WebLink AboutSANTAROSSA MOSAIC & TILE CO INC - 1012 - 13,258.12 - 8/2/2010 CARMEL REDEVELOPMENT COMMISSION Santarossa Mosaic & Tile Co., Check. 1012 Date: 8/2/2010 Vendor: SANTARO1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt Paid 7 57 14,731.25 14,731:25 1,473.13 0.00 13,258.12 Application 7 14,731.25 14,731.25 1,473.13 0.00 13,258.12 "):.:111• 52LTC3 ComputerEase Forms D vimon (877)577-5791 1N506700 I i AIA Document G702/CMa" — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition 5 7 TOOWNER:(1ffl?met Vedeffel vpO ill-eaflfISSwUIPROJECT: Ifl1e1 Pfly APPLICATION NO: q Distribution to: o(lel IVIC Q PERIODTO: D5/2 ilt),, OWNER ❑ &Aff e , S too, -,wv.2 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR:9QPI� �e It IA CONSTRUCTION MANAGER: CONTRACT DATE: DbiQil�t ARCHITECT ❑ 1101(, 016, ill 4104 PROJECT NOS: O4-20I / / CONTRACTOR ❑ I �b VIA ARCHITECT: FIELD ❑ CONTRACT FOR1j ftfllt Ot 4Tif ❑ 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 is Sheet.AIA Document G703,is low,i attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous n Certificates for Payment were issued and payments received from the Owner. and that current 1.ORIGINAL CONTRACT SUM $ 941 ,450.00 payment shown herein is now du 2. Net change by Change Orders $ .0 CONTRAC OR:'I(i{QQES "----C TIC(ATIK'• 3.CONTRACT SUM TO DATE(Line I ±2) $ S (of t�tj4? By: Al Date: Q�''20/0 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) S 1 tp (a� c'J State t Ar/wow. 5.RETAINAGE: County of: M(,(gitil a. 10 %of Completed Work fI Subscribed an sworn to he ore (Column D+E on G703) $ I A �J/y(�,43 me this �.o .f x,A t b. _%of Stored Material ' Notary Public' •. t I (column Eon G703) $ My Commissi 1 c pires:M15 17 I Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ )4 00.43 CERTIFICATE FOR PAYME T . 6.TOTAL EARNED LESS RETAINAGE $ 132 2/3. 8z• In accordance with the Contract Documents, based on on-site observations and the data comprising 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 $ I(R q5510 Q_ accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. ti.. 8.CURRENT PAYMENT DUE I S l3, 258 a- AMOUNT CERTIFIED $ 13 2S$ ..� 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from,amount applied. Initial all figures on this Application and on .Continuation 57 et the ,r�l lunged to conform with the amount certified.) (Line 3 less Line 6) $ lak2,�,(p•(2 CONS •UCTI'. M •': I By: �','■-iris Date: 07'arlt. f9 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH '�O f f� 6 rte{ t _ -- 52'L •KJ Total changes approved in previous months by Owner $ S By: f t! � Date: Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS S $ named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order S the Owner or Contractor under this Contract. A♦,V1rp A CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will lnnot btdb�curetl. 2010 AIA Document G702ICMar°—1992.Copyright m 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA° 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 severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. WAIVER OF LIEN AND AFFIDAVIT ( ) FINAL (I) PARTIAL ( ) PAYMENT TO FOLLOW ( I . .11 '.I At being duly sworn states that (s) he is 'if Li '. . t 1 T' of SANTAROSSA MOSAIC & TILE Co., INC. having contracted wit 111t I/K to furnish certain materials and/ labor a ollows: (iQ4 NMI Tile, tor:a project known as �10 e� j C, located at � it Tama, and owned b}' QP,I I�docs hereby further state on behalf of the aforementioned sub/contractor supplier. PARTIAL WAIVER That the balance due from the contractor is the sum of: I" 1I 1-' II.. n TI f ' e. ..'_" _ - W O! '"11�F1OLLARS ($ i',3pz ,3n ( : eceipt of which is hereby acknowledged: or (0) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (PARTIAL) which is given to and for said amount effective upon receipt of such payment. FINAL WAIVER That the final balance due from the contractor is the sum of: DOLLARS (S ) ( ) Receipt of which is hereby acknowledged: or ( ) Payment of which has been promised as the sole consideration for this AFFIDAVIT AND WAIVER OF LIEN (FINAL) which is given to and for said amount effective upon receipt of such payment. THEREFORE: the undersigned waives and releases unto the said owner of said premises any and all lien or claim whatsoever on the above described property and improvements thereon on account of..labor.and,material.or both..furnished.by the undersigned.thereto,.. . and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this AFFIDAVIT and WAIVER. SANTAIO SSA MOSAIC & TILE CO., INC. BY: wii, se .� ..._%.i a!%, TITLE: (IQQj(�Q�,_�QQ(S],l WITNESS , hand an' notarial seal this lh day of 1 - , 20_(Q. ) My Commission Expires: Ill 61(3 is , _�v Public Residing in Marion, County of Indiana �� Printed 09201 et CONTINUATION SHEET 7 '- AIA DOCUMENT G703 (Instructions on reverse side) RAGE of PAGES t AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 5/17/2010 containing Contractor's signed Certification, is attached. APPLICATION DATE: 5/23/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. ARCHITECF'S PROJECT NO.: A B C D I E F G H I I WORK COMPLETED MATERIALS TOTAL SCHEDULED COMPLETED BALANCE ITEM PRESENTLY RETAINAGE NO. DESCRIPTION OF WORK FROM PREVIOUS AND STORED' TO VALUE APPLICATION THIS PERIOD (NO IN TO DATE (G + C) FINISH (IF VARIABLE) (0 + E) D OOR I) (D+E+F) (C —C) RATE) 01.000 STONE FLOORING 01.100 MATERIAL 402,325.00 90,000.00 10,581.25 100,581.25 25 301,743.75 10.058.13 01.200 LABOR 349,950.00 24.031.00 24,031.00 7 325,919.00 2,403.10 01.300 01.400 STONE TOPS 01.500 MATERIAL 20,000.00 7917.00 7,917.00 40 12,083.00 791.70 01.600 LABOR 28,000.00 7,050.00 4,150.00 11.200.00 40 16,800.00-- 1,120.00 01.700 01.800 QUARRY TILE 01.900 MATERIAL 1,500.00 1,500.00 02.000 LABOR 1,500.00 1,500.00 02.100 022001 GENERAL ALLOWANCE 35,000.00 35,000.00 02.300 CAD AS-BUILT ALLOWANCE 5,000.00 • 5.000.00 03.400 BOND 3,175.00 3,175.00 3,175.00 100 317.50 03.500 • 03.600 CHANGE ORDER#1 03.700 • • I y . 1 I. • 846,450.00 132,173.00 14,731.25 146,904.25 17 699,545.75 14,690.43 �t AIA DOCUMENT G703 • CONTINIIAI'ION SHEET'FOR G702 • 19'92 EDITION • AIAe • 01992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK �,0, AVENUE,NW1,WASHINGTON,DC.20006.5292•WARNING:Unlicensed photocopying violates H.S.copyright laws and will subject the violator to legal prosecution. G703-1992 •'9 •c CAUTION:You should use an original AIA document which has this caution printed in red.An original assures that changes will not be obscured as may occur when documents are reproduced.