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HomeMy WebLinkAboutGIBRALTAR CONSTRUCTION CORP - 1155 - 146,701.27 - 9/16/2010 t CAI Document G702/CMa'" - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: Distribution to: City of Cannel Carmel Main Street Project 1 Cannel Redevelopment Commission PERIOD TO: 7/30/10 OWNER ❑ 30 West Main Street,Suite 220 CONSTRUCTION MANAGER ❑ Carmel, IN 46032 FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 7/30/10 PROJECT NOS: / / CONTRACTOR ❑ 2932 N.Webster Ave. Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CrossRoad Engineers,P.C. ❑ Patio Seating#9-31 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies hat to the best of the Contractors knowledge, information and Application is made for payment,as shown helou•,in connection with the Contract. belief the Work covered by this App tcation for Payment has been completed in accordance with the Continuation is Sheet,AIA ayment,as 6703,is attached. Contract Documents,that all a lour have been paid by the Contractor for Work for which previous Certificates for Payment 'I is. ed and payments received front the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 129.262.39 payment shown herein is t ��. c• 25,160.00 Gibral .�co st uction Corp 2. Net change by Change Orders s CONTRACTOR: 3.CONTRACT SUM TO DATE(Line I ±2) $ 154,422.39 By: �/ Date:_7–�p_/(� 4.TOTAL COMPLETED&STORED TO DATE(Column Cl on 0703) $ 15"4,"4ZZ-39— State of: Sti •fie 1. 5.RETAINAGE: County of:07e4„pJ r ti-�lgN �' MCB?jpC a. `70 of Com leted Work "' r,'c1ncock Coo P Subscribed an swum to before My Comm. 20 (Column D+Eon G703) $ 7,721.12 the this 3,.2/4 day of UL�7 29/' !m,>� �)-29.201/ b. %of Stored Material Notary Public: �0('1mISSICO # 8j 862 (Column F on 0703) $ My Comm scion expires: / 7 Total Retainage(Lines 5a+Sb or fotal in Column I of 67031.. $ CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 146,701.27 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 S Total) 0.00 knowledge,information and belief the Work has progressed as indicated.the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ accordance with the Contract Documents.and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE $ 146,701.27 AMOUNT CERTIFIED $ Aid 7o1.1? 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach erplmmtion if amount certified differs from the amount applied. Initial all figures on this Application and on the Cnaiauativa Street that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 7,721.12 CONSTRUCTION MANAGER: By: Date: $/I1//O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: — os R gineers,P.C. p Total changes approved.in previous months by Owner $ — $ By: Date: 1/a//0 Total approved this Month $„PS/4"a $ This Certificate is not negotiable The AMOUNT CERTIFIED is payable only to the Contractor TOTALS —d< /Ls7 5 named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $O'e /4/3 the Owner or Contractor under this Contract. Director of Redevelopment/41(o . 7 CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702ICMa"-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA° 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 resuh 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 Amesdaan Institute of Architect legal counsel,copyright @aia.org. PAID SlP161010 CONTINUATION SHEET Page2of2 APPLICATION NO. : 1 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification, is APPLICATION DATE: 7/27/2010 attached. 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: 7/27/2010 ARCHITECTS PROJECT NO. : A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED AND % BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK VALUE FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) (C-G) RATE) (D+E) DORE) (D+E+F) 1 Patio Seating Project#9-31 129,262.39 129,262.39 129,262 100% - 6,463.12 2 Change Order#1 25,000.00 25,000.00 25,000 100% - 1,250.00 3 Change Order#2 160.00 160.00 160 100% - 8.00 4 5 6 -- -- ---- -- - -- - - --- - - -- -- -- - - --- - - 7 8 9 10 11 12 - - — - -- --- -- - — - . - - - - -- - ---- - - -- -.- 13 15 16 17 18 19 20 21 22 - . 23 _ . - - - - - — 24 - - __ - - - _. - - - - - - -- - - - - 25 .__ .. _ - - - - -- - - - - - 26 27 - - - - -- - -- _ - -- - ---- 28 -- - - - - - - - - -- - -. - .. 29 - -- - - - - - - - -- -- - - 30 31 . _ - _ . . - - - - -- Grand Total 154,422.39 - 154,422.39 - 154,422.39 100% - 7,721.12 ISA Form# 1-402 . . u' AFFIDAVIT AND WAIVER OF LIEN ❑ FINAL ® PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and/or labor for a project known as Main Street/Patio Seating Proiect#9-31 Located in Carmel, IN. and owned by City of Carmel-Carmel Redevelopment Commission. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the Owner the sum of One Hundred Forty Six Thousand Seven Hundred One and 27/100 Dollars ($146,701.27) n receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER)that the final balance due from the Owner is the sum of Dollars ( ) ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receip of such payment. THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever on the above-described property and improvements there i count of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions - re sed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work% r led or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By II, A Title President /- WITNESS MY HAND AND NOTORIAL SEAL is 30th day of July, 2010. (Notary Public) O 1919 INDIANA sUBCONIRmCTOnS •SSOC •TION INCORPOR•TED Are iO4.7 Unsulnor.t•U Pion/Ailed ucIIon Pion.p, O 4 / e =A A = Document G702/CMa'N - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: Distribution to: City of Carmel Carmel Main Street Project 2 Cannel Redevelopment Commission PERIOD TO: 7/30/10 OWNER ❑ 30 West Main Street,Suite 220 CONSTRUCTION MANAGER ❑ Carmel,IN 46032 FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 7/30/10 PROJECT NOS: ) ( CONTRACTOR ❑ 2932 N.Webster Ave. Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CrossRoad Engineers,P.C. ❑ Patio Seating#9-31 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor ceni=es 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( pplication for Payment has been completed in accordance with the Continuation Sheet.AIA Document G703,is low,attached. Contract Documents.that all ono was have been paid by the Contractor for Work for which previous Certificates for Payment w r . sued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 129,262.39 payment shown herein is n • ui. 25,160.00 Gibralt•• • truction Corp 2. Net change by Change Orders $ CONTRACTOR: 3.CONTRACT SUM TO DATE(Line I ±2) S 154,422.39_ By: �� Date: 7iJ?��/0 _ 154'42239 State of: 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ �n>D/ =, mac,. =- BRIAN R. MCBRIDE 5.RETAINAGE: County ol': flit /•-- < a. %oTCom Ictcd Work heft-Ice, . C�a: -._,,. Ct r.En.---r( butt Iii/ p Subscribed ant tr,om to --s ' t (Column D+Eon 6703) $ 0.00 me this, day of i�•�/O / �•1-� Comm _Y^. li-G-•2017 b. %of Stored Material Notary Public - �e ' CCmm'�SS:o^ # 611862 (Column F on G703) $ My Commission expires: //.......71...--/7 Total Retainage(Lines 5a+5h or Total in Column I of G703).. $ CERTIFICATE FOR PAYMENT 154,42239 In accordance with the Contract Documents. based on on-site observations and the data comprising . 6.TOTAL EARNED LESS RETAINAGE S this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 146,701.27 knowledge. information and belief the Work has progressed as indicated.the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ accordance with the Contract Documents.and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. �-7 8.CURRENT PAYMENT DUE $ 7,721.12 AMOUNT CERTIFIED $_ / 72 ). I Z • 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and on the Continuation.Street that are changed to cot form with the amount certified.) (Line 3 less Line 6) S 0.00 CONSTRUCTION MANAGER: 1 By: - Date: 21/2/f 10 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: rs,P.C. 'I'or.1(changes approved in previous months by Owner $ — $ By: /_-yj � Date: �}/�D��a Total approved this Month $a6 /4 a $ — _ This Certificate is not negotiahl . The AMOUNT CERTIFIED is payable only t!o the Contractor • • TOTALS $24-74.0 $ — named herein. Issuance. payment and acceptance of payment are without prejudice to any rights oCQ NET CHANGES by Change Order $ ' 4.7.5-7,� the Owner or Contractor under this Contract. Director of Redevelopment/I/mjo/z CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured, AIA Document G702/CMa"'—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA° Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA° 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 Institutes Agfriters®al cc$tstco4/rSltQlliftg. .. CONTINUATION SHEET Page2of2 APPLICATION NO. : 2 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification,is APPLICATION DATE: 7/27/2010 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts PERIOD TO: 7/27/2010 where variable retainage for line items may apply. ARCHITECTS PROJECT NO. : A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED AND y BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK VALUE FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) (C-G) RATE) (D+E) DOR E) (D+E+F) 1 Patio Seating Project_#9_-31 12_9,262._39_ 129,262.39 -- 129,262 100% _ __ _ - 2 Change Order#1 25,000.00 25,000.00 _ _ _ _ _ _ _ _2.5,000 _100% __ - ___ _ - 3 Change Order#2 160.00 160.00 160 100% - 5 - --- --- - - --- - - - -. - - - --- ---- -- - - - -- - - - 6 7 8 — '- - — - -- --- 9 . --- -.. . -- - 10 - -- - - - -- - -- --- - - -- - - -- -- 11 12 13 14 15 - - --- - - . -- — - . - - -— -- - - — - - -- __-- - - -- -- 16 -- - -- - - --- -- . - - - - - - -- -- — — -- - . -- 18 17 _. --- ---- -- - - .- -— - - ---- -- - -- - - -- - - - - -- --- --- 19 20 21 22 - - 2 23 - - - - - - - - - - 24 _ 4 25 - - - - - 27 28 29 30 31 Grand Total 154,422.39 154,422.39 - - 154,422.39 100% - - ISA Form # 1-402 Ai. ?e1 AFFIDAVIT AND WAIVER OF LIEN ® FINAL ❑ PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and /or labor for a project known as Main Street/Patio Seating Project#9-31 Located in Carmel, IN. and owned by City of Carmel-Carmel Redevelopment Commission. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the Owner the sum of Dollars ( ) ❑ receipt of which is hereby acknowledged; or n the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER)that the final balance due from the Owner is the sum of Seven Thousand Seven Hundred Twenty One and 12/100 Dollars ($7,721.12) ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon ccount of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions e prgg�ssed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work (mined ned or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. / Gibraltar Construction Corp By /I A Title President //l;• WITNESS MY HAND AND NOTORIAL S• , this 30th .ay of July, 2010. (Notary Public) R. MCBRIDE O 1979 INDIANA• SU9CONTNACTOAS •SSOCI•DON iNCORPORAtED ,(s...-AT A �V. __. or Hancock Co�— vo•utm•,.e R.p.aovPioa Y.anwa'a ��K / My Comm. Fr ' .: . p� 'P� Dinh