HomeMy WebLinkAboutGEIGER & PETERS, INC. - 1087 - 21,222.00 - 8/19/2010 7/
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION PAGE ONE OF FIVE PAGES t
AIA DOCUMENT G702/CMa (Instructions on reverse side)
)TO(OWNER): City of Carmel Commmi iy Develop.Corp.o PROJECT:Village on the Green APPLICATION NO. 07-09139 Dtstrib0tan to-
30W Main St Sake 220 City Center Dr&3rd Awe SW PERIOD TO 6/30/10 —OWNER k;
Carmel,IN 46032 Camel IN 46032 PROJECT NOS: CO N r_ 'a" v
VIA(CONSTRUCTION MANAGER): RS Canstreelon •i ) x 1 ••IJ f rc 01 I�] (r; v
• FROM(CONT'RACTOR): Geiger Peters,Inc. 11711 N Pennsylvania St Salts 200 CONTRACT DATE: CONTR 'r • Lt U I-.+[ D "t'
; P O Box 33807 Carmel IN 46032 - 3 2010 S.
Indianapolis,Indiana 16203 (� JUN 1/
e.
317-359-9521
CONTRACT FOR Structural Steel r '
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned ContactoraniNes t tattothebetoftheeontnctm'sknowledge. nor ---�
Application a made for Paayment as shown below,in connection with the Convect. mation and belief the Work covets this Application for
by that s have been has been yompleted p
Continuation Sheet AU Document G703,is ettacthed. in accordance with the Contact Documents,that ell amounts have been paid by the
Contractor for Work for which previous Certilkates for Payment were issued and pay-
t
I.ORIGINAL CONTRACT SUM S 800,930.00 meets received from the Owner,and that current payment shown herein is now due.
y 2.Net change by Change Orders S 54,130.00 CONTRACTOR.In ,N \�/�\ L
t 3.CONTRACT SUM TO DATE(Line I*7).._......_ . S 855.060.00 By r f,.-s--t_ki k `•'r�-'1,.�( 7}4._. Date: 6121110
a
4.TOTAL COMPLETED 8 STORED TO DATE S 778.160.00
(Column G on G703) State of Moans
' 5.RETAINAGE: Caflyd Manz
a. 10 xof[mnplaed Work fubfcrhMd ad swan tobdae
maths 2ta day d3ma2a10
(Column DHE oncmll S 77,818.% a as, a a...- « S
b. ID Woe Stored Material a
(cohmn F m G7171/ _ I / 'i <AMINE M 3RACE
Total Raai {( .. zz �1df-oC. A:N. Votary Rmla. Gaunt%Indiana
mg(Liu Sn56m .. �`.e, lABnOn fA)UIRS 1
Toll in Cohvm I ot070 l)•......._................._. ....._......_ S 77,81800 Notey Puttee: Krishna M Great '.
. .... My Commission extarea: 61812013 :Joe-:.♦/ Ml'Ciunetlib 4013
Ewan.
8.TOTAL EARNED LESS RETAINAGE tune lib GO7S
5 700,-362.00
(Lane I less Line 5 TOW)
ARCHITECTS CERTIFICATE FOR PAYMENT
7,LESS PREVIOUS CERTIFICATES FOR PAYMENT In accordance with the Contract Documents,based co on-site observations and the data
(Line 6 from prior Cenifine).. S 679.140.00 comprising this application,the Architect certifies to the Owner that to the best of the
Owner's knowledge,information and belief the Work has progressed as indicated,the
quality of the Work is in accordance with the Contract Documents,and cue Contractor
8.CURRENT PAYMENT DUE 13 21.27100 I is entitled to payment of the AMOUNT CERTIFIED.
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED Z/f Z 2-1.-
(Lane)less Line 6) S 154,898.00 (Attach aplonana',famount amIied direnfour she mount applied for,Initial
NlJIRarcs on this Apphcntlon amino the Carrimraion Shea that en changed to
co,fwn,to the omouar cen`fied j
CHANGE ORppt SUMMARY ACOnONS
CONSTRUCTION MANAGER:
OEOLCrmNS -7/ /17
Told clmngmhs by Os in .Date previous months Monier S - -
Total approved at month S 54.13000 ARCHITECT'
TOTALS I 54,110.00 B : Das:
NET CHANGES by amp Deb 154.130.00 at,scale is not negon:'C. -T•a I• • D is payable only to the Lon-
tractor named herein. Issuance,payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract
AA DOCUMENT 0702/CM.•APPLICATION AND C nohow E FOR PAYMENT•CONSTRUCTION MANAGER-ADVISER EDITION
1942 EDMON•1993•.VA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVENUE.N,W.WASHIND7ON, P A I D AUG 1 9 161 993
D.C.2K6.3AI
. CONTINUATION SHEET AM DOCUMENT G703 (instructions on reverse side) PAGE TWO OF FIVE PAGES
,, AlA Document 0702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NO.: 07-09119
Contractor's signed Certification is attached. Geiger St Peters APPLICATION DATE: 6/21/10
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 6/30/10
Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
- A B C D I E F 0 H 1
SCHEDULED WORK COMPLETED MATERIALS TOTAL orb BALANCE RETAINAGE
VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G:C) TO FINISH
ITEM DESCRIPTION OF APPLICATION STORED AND STORED IC-G1
NO. WORK ESTIMATED (D+E) (NOT 1N TO DATE
COST D OR E) _ (D+E+F)
I Deeding&Snap Dram $ 38,700.00 S 38,700.00 S - S 38,700.00 100% $ - S 3,870.00
2 Anther Bokvnntoq, S 6,800.00 S 6,800.00 $ - S 6,800.00 100% $ - S 680.00
3 Pawn=&Performs:aen0 5 4,000.00 S 4,000.00 5 - S 4,00000 100°/0 S - 5 400.00
4 gOStlO Structural SINS $ -
5 F.Iarcewn&Mmerwl S 432,670.00 $ 432,670.00 5 - 5 432,670.00 100% 5 - S 43,267.00
6 Etcdion 5 94,620.00 5 94,620.00 $ - S 940620,00 100% S - S 9.462.00
7 YOS21e0)Axel Mai $ -
8 Maims! $ 26,500.00 5 26,500.00 S - $ 26,500.00 100% $ - $ 2,650.00
9 Engtn $ 14,600.00 5 14,600.00 $ - $ 14,600.00 100% S - 5 1,460.00
10 401310 Roof Dece $ -
11 Mewl S 10,360.00 S 10,360.00 S - S 10,360.00 100% S - S 1,036.00
12 rnciso S 5,180.00 S 5,180.00 S - 5 5,180.00 100% S - S 516.00
13 008360 boor fleck $ -
14 Magma $ 31,200.00 S 31,200.00 S - $ 31,200.00 100% $ - $ 3,120.00
15 amnion $ 15,600.00 S 15,600.00 $ - S 15,600.00 100% $ - $ 1,560.00
16 Mos11oo Meet F.yrtesta»
17 Meter& $ 5.600.00 S 2,520.00 $ 1,120.00 5 3,640.00 65% S 1,960,00 5 364.00
18 Eamon $ 1,500.00 $ 525.00 5 525.00 35% $ 975.00 S 52.50
19 CSS I Mete Stain
20 moms S 44,300.00 S 17,720.00 $ 11,075.00 5 28,795.00 65% 5 15,505.00 S 2.87950
21 e.eomn 5 18,100.00 $ 10,860.00 S 10,860.00 60% $ 7,240.00 S 1.086.00
22 NOS5213 Tube Railing
23 MaterW $ 7,400,00 S - 0% S 7,400.00 S -
24 E scan $ 4,200.00 S - 0% S 4,200.00 S -
25
S 761.330,00 $ 700,470.00 $ 23,58000 S - S 724,050.00 95% 5 37,280.00 $ 72,40500
AEA DOCUMENT 6702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE,N,W., WASHINGTON, D.C. 20006-5292
6703-1992
l'-' CONTINUATION SHEET AIA DOCUMENT C703 (Instructions on reverse side) PAGE THREE OF FIVE PAGES
. AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NO.: 07-09119
Contractor's signed Certification is attached. APPLICATION DATE 6/21/10
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 6/30/10
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT Na
A B C D 1 E F G H I
SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G:C) TO FINISH
ITEM DESCRIPTION OF APPLICATION STORED AND STORED (C-G)
NO. WORK ESTIMATED (D+E) (NOT IN TO DATE
COST D OR E) (D+E+F)
26 1057300 Dee*nmre Metal Rdaap
27 Mesenai S 26.800.00 5 - 0% 5 26,800.00 S
28 FJmion S 12,800.00 $ - 0% S 12,800.00 S
29
30 coon $ 54,130.00 S 54,130.00 $ 54,130.00 100% $ $ 5,413.00
31 clop Rn ico
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
S 855,060.00 $ 700.470.00 S 77,710.00 S - $ 778,180.00 91% S 76,880.00 $ 77,818.00
A1A DOCUMENT G702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK
AVENUE,N.W.,WASHINGTON,D.C. 20006-5292
G703-1992
WAIVER OF LIEN TO Dl ,0'
JUN �D
STATE OF Indiana f �201
COUNTY OF Marion f SS
TO WHOM IT MAY CONCERN: iIFCJ�
WHEREAS the undersigned has been employed by REl Con lion
to furnish Structural Steel
for the premises knows as Village on the Green
of which City of Cannel Community Develop.Corp, is the owner.
THE undersigned,for and in consideration of Twenty One Thousand Two Hundred Twenty Two and 001100
(S 21,222.00 ) Dollars,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
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 all labor,services,material,fixtures,apparatus or machinery.
furnished to this date by the undersigned, for the above described premises, including extras*.
DATE 6121/2010 COMPANY NAME Geiger&Peters Inc.
}} ADDRESS P O Box 33807 Indianapolis, (N 46203
SIGNATURE AND TITLE {aJ-fti {7$y\ Controller
*UMW INCLUDE BUT ARE NOT LIMITED TO CHANCE ORDERS,9Ur11 ORAL AND WRITTEN,TO THE CONTRACT
CONTRACTOR'S AFFIDAVIT
STATE OF Indiana /
COUNTY OF Marion l SS
TO WHOM IT MAY CONCERN:
THE UNDERSIGNED, Debra Burton BEING DULY SWORN, DEPOSES
AND SAYS THAT HE OR SHE IS Controller OF
Geiger&Peters Inc, WHO IS THE
CONTRACTOR FURNISHING Structural Steel WORK ON THE BUILDING
LOCATED AT City Center Dr&3rd Ave SW Carmel IN 46032
OWNED BY City of Carmel Community Develop.Corp.
That the total amount of the contract including extras*is S 855,060.00 on which he or she has received payment of
S 679,140.00 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. Thin the following are the names and addresses of all
parties who have furnished material or labor,or both,for said work and all patties 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 to each,and that the items mentioned include all
labor and material required to complete said work according to plans and specifications:
NAMES AND ADDRESSES WHAT FOR co""m�""'rE AMOUNT THIS BALANCE DUE
Uw"o LMAS• PAID PAYMENT
Geiger&Peters Inc. Structural Steel 855,060.00 679,140.00 21,222.00 154,698.00
TOTAL LABOR AND MATERIAL INCLUDING EXTRAS TO COMPLETE 855,060,00 679,140.00, 21,222.00 154,698.00
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..
.y�
DATE 672112010 SIGNATURE: ,/t{x�4,�kx.v"i7Yl
SUBSCRIBED AND SWORN TO BEFORE ME THIS 21st DAY OF June 2010
ni __
Kristine M Grace Resident of on County My Commission expires 6/6/2013
1nRAS INCLUDE BUT ARE NOT LIMITED TO CHANGE ORDERS,BOTH ORAL AND WNTIEN,TO THE CONTRACT NRISDINE IN GRACE
f,i*�: r Volans Public Statoot Indiana
+Rana COunty
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