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Home My WebLink AboutBROADY-CAMPBELL, INC. - 1086 - 136,356.84 - 8/19/2010 Application and Certificate for Payment D LE Q P7 IT'17 ;UN 222010 ,z- By TO OWNER: REI PROJECT: VILLAGE ON THE GREEN RLD APPLICATION NO; 4 -----.'..1.1".---'"1714.1' ' to: CUST9 RE13 1.1711 N PENNSYLVANIA PERIOD TO: 06/17/2010 OWNER -_ STREET SUITE 200 CARMEL IN 46032 CONTRACT FOR: 09-123 ARCHITECT _ FROM CONTRACTOR: aBROADY.CAMPBEF NC. VIA ARCHITECT: CONTRACT DATE: I1i1712009 CONTRACTOR i 2115 Dr.A .Brown Ave PEDCOR DESIGN GROUP PROJECT NOS: FIELD Indianapolis,IN 06202 VILLAGE ON THE GREEN BLD JOB Pi 29080 OTHER CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge. information Application is made for payment,as shown below,in connection with the Contract and belief the Work covered by this Application for Payment has been completed in accordance Continuation Sheet, is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for 818,620.00 which previous Certificates for Payment were issued and paytrtents received from the Owner.and I.ORIGINAL CONTRACT SUM .._........................................._._.._____... $ that current payment shown herein is now due. uuu 2.Net change by Change Orders................... .. . .. .. . ...... S CONTRACTOR: Broady—Campbell, Inc. 3.CONTRACTSUM TO DATE(Line 1 t 2).............._.__. &18,620.00 g �,_ Cil�Aj 6-17-2010 ............._.....,_... S - gy. .'""`� '!`—_`1 Date: 4.TOTAL COMPLETED&STORED TO DATE(Column G on 603LS1).... S 3(8'529.60 State of Indiana 5.RETAINAGE: County of: Marion a. to IN of Completed Work P 18.292 28 Subscribed and sworn to before ((oIumn 0+E on 603LS€) S me this 17th day of June 2010 b. 100%of Stored Material j� � �{, (Column F on 603LS1) S 13,605.68 Notary Public. q•p.,C,L`'3� 31,852.96 My Commission expires: 5-5-2016 Total Retainage(Lints 5a-5b or Total in Column I of 603LS1),.. S II TOTAL EARNED LESS RETAINAGE S 286.676.64 ARCHITECT'S CERTIFICATE FOR PAYMENT (Lime 4 Less Line S Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 150,319`80 this application,the Architect certifies to the Owner that to the best of the Architects knowledge. S information and belief the Work has progressed as indicated, the quality of the Work is in (Line 6 from prior Certificate) accordance with the Contract Documents. and the Contractor is emrtled to payment of the 8. CURRENT PAYMENT DUE....._...................__.......... LS 136,356.84 I AMOUNT CERTIFIED. . ............ 9.BALANCE TO FINISH,INCLUDING RETAINAGE 5 531,943.36 t AMOUNT CERTIFIED...... s 13436. (Line 3 less Line 6) $ (Attach el-planation if amount certified differs from the amour/i npplrad hritid till flgmv..vu rhry Application and on the Continuation Sheet that an (hanged to rage:in nab the tottottnt tern/ird. _CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS !G J .-. Total changes approved in previous months by Owner S o,W S O.W By._ /!-- Dater 7/2./I0 Total approved this Month S vi S 0.00 TOTALS S U uu $ 0,00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor v 00 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. aECROERFOIM tom, PAID AUG 1 9 i %1, Continuation Sheet AIA Document G703-1992 (Instructions on reverse side.) Paee 1 of 1 ALA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 4 containing Conuanofs signed Certification, is attached. APPLICATION DATE: 06!1712010 In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line Items may apply. PERIOD TO: 06/178010 ts ARCHITECTS PROJECT NO: 09-123 A B C D I E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPIt I EU % RETAINAGE DESCRIPTION OF WORK NO. VALUE FROM PREVIOUS STORED AND STORED TO APPLICATION 11415 PERIOD (NOT IN TO DATE (G+ FINISH (IF VARIABLE) (D+ E) DORE) (DrEtF) (C-G) 01 GENERAL CONDITIONS 34.300.00 3,430.00 5,145.00 8,575.00 25.00 25.725.00 857.50 02 BRICK LABOR 103.200.00 103.200.00 03 BRICK MATERIAL 75,140.00 10,519.60 10,519.60 14.00 64,620.40 1,051.96 04 STONE LABOR 133,370.00 133,370.00 05 STONE MATERIAL 155,800.00 42.066.00 42,066.00 27.00 113,734.00 4,206.60 06 BLOCK LABOR 111,050.00 84.398.00 15,547.00 99,945.00 90.00 11,105.00 9,994.50 07 BLOCK MATERIAL 62,000.00 47,120.00 8,680.00 3,100.00 58,900.00 95.00 3,100.00 5,890.00 08 GRANITE LABOR 38,300.00 3,064.00 3,064.00 8.00 35,236.00 306.40 09 GRANITE MATERIAL 87,360.00 6.988.80 80,371.20 87,360.00 100.00 8,736.00 10 BOND 8,100.00 8,100.00 8,100.00 100.00 810.00 I1 ALLOWANCE 10,000.00 10,000.00 JOB TOTALS : 818,620.00 143,048.00 39.424.80 136,056.80 318,529.60 500.090.40 31,852.96 G703-1992 APPLICATION FOR PAYMENT tiav , filly, 2619 / PARTIAL WAIVER OF LIEN g Y tehtli Contractor. Broady-Campbell, Inc. Address: 2115 Dr. Andrew J. Brown Avenue Indianapolis, IN 46202 Project Name and Address: Village on the Green - Office Bldg. 1 3rd Ave. S.W. And City Center Drive Period to: 6-17-20 LO Job s: 09-123 The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project awned by Owner and located as indicated above, The Undersigned, for and In consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character,against, on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by, or at the request of, the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. The undersigned, for and in consideration of the total payments in the sum of $ 136,356.84 the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished, or any kind or class of lien whatsoever for said building or premises or project Dated this 17th day of June 2010 Broady-Campbell, Inc. Company Name 3Y: 74-)-- RAM‘1111 TITLE: Vice-President NAME: Greg Broady STATE OF Indiana COUNTY OF Marion Subscribed and sworn to before ma,a Notary Public In and for said Counly end State,this 17th day of June 2010 Mycommission expires 5-5-2016 My county residence is Hamilton Q Notary Printe INVOICE 3ROADY-CAMPBELL, ODIC. MI ® a MASONRY CONTRACTORS 2115 ANDREW J. BROWN AVE. • INDIANAPOLIS. INDIANA 46202 21314 ph. (317) 925-4261 fax (317) 925.4263 REI (� Da1e 6-17-2010 11711 N. Pennsylvania St. D I GE L \ 1 TO: Suite 200 JUN 29080 Carmel, IN 46032 U**� � q 2 2n IV�n jab� u P.O. No. By RE: Village On The Green Bldg. ESTIMATE NO: 4 Labor, material, equipment and accessory appurtenances in place or stored to date at the above referenced project: 318,529.60 Less 10 % retained 31 852.96 Total earned less retainer 286,676.64 Less Previous applications 150.319.80 TOTAL DUE THIS ESTIMATE NO: 4 136,356.84