223383 08/27/2013 CITY OF CARMEL, INDIANA VENDOR: 367176 Page 1 of 1
`I. ONE CIVIC SQUARE ANDREWS CONSTRUCTION CO
*� CARMEL, INDIANA 46032 7808 MARQUIS LANE CHECK AMOUNT: $4,355.50
`o INDIANAPOLIS IN 46260 CHECK NUMBER: 223383
CHECK DATE: 8127/2013
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 31345 4 2, 470 . 50 PAC ROOF REPAIR
902 4460807 31345 5 1, 885 . 00 PAC ROOF REPAIR
(Instructions on reverse side) PAGE ONE OF PAC-
APPLICATION AND CERTRIPATE FOR PAYMENT AAA DOCUMENT G702
TO(OWNER): PROJECT: APPLICATION NO: 4 Distribution to:
Carmel Redevelooment Commission Carmel Palladium Steel Retrofit 2013 W O
X R
X OW
30 W Main Street, Suite 220, Carmel, IN 46032 PERIOD TO:8-30-2013 CHITECT
C
FROM(CONTRACTOR): VIA(ARCHITECT): ARCHITECT'S ONTRACTnR
Andrews Construction Co
'7908 PROJECT NO: I
CONTRACT FOR: Steel Retrofit 44p-Zcpo CONTRACT DATE:
Application is made for Payment, as shown below,in connection with the Contract.
CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sheet,AIA Document G703, is attached,
1. ORIGINAL CONTRACT SUM............................................... $ 35,100.00
CHANGE ORDER SUMMARY
'N.._:..Change by Change Orders .......... ............. ......_ S 2.600.50
Change Orders approved in ADDITIONS--F--"------DED—UCT-I—ON-'S--'--
3
previous months by Owner CONTRACT SUM TO DATE(Line 1 ±2) __........................ $ 37,700.50
4.TOTAL COMPLETED&STORED TO DATE ....................... j17,700.50
TOTAL (Column G on G703)
5. RETAINAGE:
Number' Date Al2ELVt-L... A 10 %of Completed Work
(Column D+ E on G703)
b %of Stored Material $ 1,885
(Column F on G703)
Total Retainage(Line 6a + 5b or
Total in Column I of G703) ........ ......... $
TOTALS 1,885.00
............... 6. TOTAL EARNED LESS RETAINAGE ....................
Not change by Change Orders
(Line 4 less Line 5 Total)
The fi undersigned Contractor certifies that to the best of the Contractor's knowledge, 7. LESS PREVIOUS CERTIFICATES FOR
- � "
information and belief the Work covered by this Application for Payment has been PAYMENT(Line 6 from prior Certificate) .................... $ 33.345.00
completed in accordance with the Contract Documents, that all amounts have been
paid by the Contractor for Work for which previous Certificates for Payment were 8. CURRENT PAYMENT DUE .,........................................... $ 2.470.50
issued and payments received from the Owner, and that current payment shown 9. BALANCE TO FINISH, PLUS RETAINAGE ............... ......... 1.885.00
herein is now due. (Line 3 less Line 6)
CONTRACTOR:
Stale of: County of:
By: Scott Andrews Date: 8/01/2013 Subscribed and sworn to before me this day of 119
ry Pu
ARCHITECT'S CERTIFICATE FOR PAYMENT Nota My--- Cobmmission expires:
In accordance with the Contract Documents, based on on-site observations and AMOUNT CERTIFIED _......... ................. ............................. . $
the data comprising the above application, the Architect certifies to the Owner that to (Attach explanation if amount certified differs from the amount applied for.)
the best of the Architect's knowledge, information and belief the Work has
progressed as indicated, the quality of the Work is in accordance with the Contract ARCHITECT:
Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED, By: Date-
This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. issuance, payment and acceptance of payment are withou
prejudice to any rights of the Owner or Contractor under this Contract.
A
THE AMERICAN INSTITUTE OF ARCHITECTS,4,7015 NEW YORK AVENUE,N,W.,WASHING ION,D.C.20006 G702-1983
CONTINUATION SHEET A/A DOCUMENT G703 (instructions on reverse side) PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 4
Contractor's signed Certification is attached. APPLICATION DATE: 8-01-2413
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 8-30-2013
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A _ B _ C D E F G H I
ITEM DESCRIPTION OF WORK ' R SCHEDULED WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
VALUE c PRESENTLY COMPLETED 'c,—< TO FINISH
R0. FROM PREVIOUS THIS P�.RIOD ;
APPLICATION STORED AND STORED (C—Gj
i (D+E) ! (NOT iN TO DATE
1 _ D OR El (D+E+F) __
1 General Conditions $ 4,000 $ 4,000 I $ 0 $ 4,400 100 $ 0 +$ 200
2 Performance and Payment Bond $ 1,200 $ 1,200 $ 0 $ 1,200 ; 100 $ 0 $ 60
E i
3 Scaffolding j $ 22,700 $ 22.700 ; $ Q $ 22,700 100 $ 0 $ 1,135
4 Masonry i $ 3,000 $ 3,000 $ 0 $ 3,000 100 $ 0 $ 150
5 Fire Proofing j $ 4,200 ( $ 4,200 $ 0 $ 4,200 100 $ 0 $ 210 ?
i f
6 Change Order#1 $ 1,260.50 $ 0 $ 1,260.50 $1,260.50 100 $ 0 $ 63
E i
7 Change Order#2 $ 1,340.00 $0 $1,340.00 $ 1,340 100 $ 0 $ 67
([ i
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i
i
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4
i t
$ 37,7 0 0.50 $ 35,100 $ 2,600.50 $ 37,740.50 100 — $ 0 I $ 1,885
AM DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT•MAY 1983 EDITION•AIA'•t 1983
THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006 G703-1983
Partial Lien Waiver
WHEREAS, Andrews Construction Co, 7808 Marquis Lane, Indiana cabs IN 46260.
"Contractor". has been heretofore employed by Carmel Redeviopment Commission,30
W Main street, Suite 220 Carmel, IN 46032. to furnish certain material, supplies,
equipment, and/or labor for or in connection with improvements owned by Carmel
Redevelopment Commission and located at Carmel Palladium, Steel Retrofit, One
Center Green, Carmel, IN 46032. hereinafter collectively referred to as the "Premises:"
and
Wl IEREAS, the undersigned is duly authorized to execute the Waiver of Lien for and on
behalf of the Contractor:
NOW, THEREFORE, the contractor, for and in consideration of the receipt of Two
thousand Four hundred Seventj and -------501100 Dollars$2,470.50 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 account of any and all labor, supplies, equipment, material
furnished for, in connection with or incorporated in the Premises by the Contractor on or
before the date thereof. represents and warrants that no other person or party has any
right to a lien or claim on account of any labor or work performed or material, Supplies,
or equipment furnished to, to or through the Conti-actor, on or before the date hereof. and
agrees to indemnify, defend and hold the Owner and the Company harmless from and
against any and all claims or liens for any labor, material, or services furnished to the date
hereof. This Waiver of Lien is given in order to induce the Company to pay the amount
indicated above, and upon receipt of such amount by the Contractor, this release may be
recorded, becomes valid, enforceable and to full effect.
Andrews Construction Co LI,C
xO, N aj-ne of Contractor
Authorized Representative
Date: V3114.3
State o'fndiana
County of Mai-ion
Before me, a Notary Public in and for said County and State, personally appeared, who
acknowledged the execution of the foregoing Waiver of Lien, and vCho, having been duly
sworn. stated that the representations therein contained are true.
Witness my hand of Notarial Seal this day of'
20/
'My Commission Expires:
Public
(Instructions 0n reverse side) PAGE ONE np PAa
APPLICATION AND CERTIRCATE FOR PAYMENT AIA DOCUMENT G702
TO ER): PROJECT APPLICATION NO: 5 Distribution to:
Carmel Ruduva|urimmnt Commission Carmel Palladium Steel Retrofit 2013 X OWNER
30VVMain Street, Suite 2ZO, Carrne| IN 46032
my ACTOR
FROM(CONTRACTOR): VIA (ARCHITECT): ARCHITECT's
Andrews Construction Co 7.SC& tA.Ap PROJECT NO:
CONTRACT FOR:Steel Retrofit
r4 CONTRACT-DATE:
Application is made for Payment, as shown below,in conneiti-on with the Contract,
CONTRACTOR'S APPUCATION FOR PAYRREMT Contin0tion Sheet,AIA Document G703, is attached.
I. ORIGINAL CONTRACT SUM.......... ............................ ....... $
-Change by Change Orders ....................... ,____1 $
`~~~ge Orders approved "' 3. CONTRACT SUM T]DATE(Line 1 ±2\ ........ ...... ....... -' $
previous months by Owner
4.TOTAL COMPLETED&STORED TODATE -------'
TOTALI (Column GunG703) '
5RETA|NAGE:
Number"I Date
A10 %of Completed Work
�
(Column D+ EnnG703
! '
hY6of Stored Material $ 1 885
�
(Column FonB7O3)
i
Total Retainuge(Line 5o + 5bnv
�
Total in Column | nfG703) ------------$
I Net - ' 5. TOTAL EARNED LESS RETA|NAGE .......- ........ ............ 35 81 5.5q
i change ��~~' ............._______ �
! ' 4��8L���TO�d
'The undersigned Contractor certifies �h�� �o the best of Contractor's knowledge, LESS PREVIOUS CERTIFICATES FOR
�
information and belief the Work covered by this Application for payment has been
PAYMENT`Li' ~ ~ from prior Certificate)
--.----. ip 35816.00
completed in accordance with the Contract Documents, that all amounts have been
paid by the Contractor for Work for which previous Certificates for Payment were 8 CURRENT PAYMENT DUE ...... ...... ......................- ........
issued and payments received from the Owmer, and that current payment shown 9. BALANCE T0FINISH, PLUS RETA|NAGE ..................
herein is now due. (Line 3less Line 6)
. CONTRACTOR: County --------
B«: Scott Andrews Date: 8/01/2013 Subscribed and sworn kohofoxnmethis day of .19
/�
Notary Public:
ARCHITECT'S *ERT0F0CATE FOR PAYMENT
My Commission expires:
--------
In �CC0[U 8Dc8 with th e Contract Doouments, based on on-site observations ----'
end AMOUNT CERTIFIED..... ...............-.- ...... --------. $
�
the data comprising the above opp|icaUon. the A�h�eotu*�ifieohz the Owner that to k4daohnxp�oe�onJ amount oen�edd�em{nm��oannrun�appVedfoc/
the beat of the Architect's knowledge, information end belief the Work has
ARCHITECT:
progressed as indioated, the quality of the Work is i» accordance with the Contract
�
Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED, By: Date-
This cmmncm/e is not negotiable. The AMOUNT CERTIFIED is payable only to th^
Contractor named herein, |msuanoe, payment and acceptance of payment are withou
prejudice tn any rights of the Owner o[Contractor under this Contract,
THE AMERICAN INSTITUTE 0FARC*iTECro.1/x5 NEW YORK AVENUE,w,w..WASHING|UN.o�C2O00V G702'1983
CONTINUATION SHEET A/A DOCUMENT G703 (Instructions on reverse side) PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 5
Contractor's signed Certification is attached. APPLICATION DATE: 8-01-2013
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 8-30-2013
Use Column I on Contracts Where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:
A B j C — D F j G H_ 1
ITEM DESCRIPTION OF WORK ! SCHEDULED WORK COMPLETED MATERIALS E TOTAL "' BALANCE RETAINAGE
NO. VALUE FROM PREy'IOUS THIS PERIOD PRESENTLY COMPLETED ;� <;; TO FINISH
STORED AND STORED
APPLICATION (C—
(D+ G^}
{ I {NOT IN TO DATE
V I E) DOREl (D+E+F)
General Conditions $ 4,000 $ 4,000 $ 0 $ 4,000 100 i $ 0 $ 200
2 I Performance and Payment Bond $ 1,200 $ 1,200 $ 0 $ 1,200 100 $ 0 $ 60
r i �
3 Scaffolding $ 22,700 $ 22,700 $ 0 $ 2.2,700 100 $ 0 $ 1,135
i
4 Masonry $ 3,000 $ 3,000 $ 0 $ 3;000 1 100 $ 0 $ 150
� 1
5 Fire Proofing $ 4,200 $ 4,200 $ 0 $ 4;200 100 $ 0 $ 210
i
6 Change Order#1 $ 1,260.50 $ 1,260.50 i $ 0 $1,260.50 100 $ 0 $ 63
7 Change Order#2 $ 1,340.00 $1,340 $ 0 $ 1,340 100 $ 0 $ 67
I
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I
3 ; i
3 j
I 1
I � I
I
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I t
1 I A
i
$ 37,700.50 $ 37,700.50 $ 0 $ 37,700.50 100 $ 0 j $ 11885
r
AM DOCUMENT G703•APPLICATION AND CERTIFICATE FOR PAYMENT•MAY 1983 EDITION•AIA'•t 1983
THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C.20006 G703-1983
•
Final Lien Waiver
WHEREAS. Andrews Construction Co, 7808 Mar axis IN 46260.
Lane, Indianapofis2
"Contractor", has been heretofore employed by Carmel Redeviopment Commission,30
W Main street, Suite 220 Carmel, IN 46032. to fumish certain material, supplies,
equipment, and/or labor for or in connection with improvements owned by Carmel
Redevelopment Commission and located at Carmel Palladium, Steel Retrofit, One
Center Green,Carmel, IN 46032, hereinafter collectively referred to as the "Premises:-
and
WHEREAS, the undersigned is duly authorized to execute the Waiver of Lien for and on
behalf of the Contractor:
NOW, THEREFORE, the contractor, for and in consideration of the receipt of One
thousand Eight hundred Eighly rive and -------00/100 Dollars$1,885.00 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 account of any and all labor, supplies, equipment, material
fumished for, in connection with or incorporated in the Premises by the Contractor on or
before the date thereof. represents and warrants that no other person or party has any
right to a lien or claini on account of any, labor or work performed or material. supplies,
or equipment furnished to, to or through the Contractor, on or before the date hereof, and
agrees to indemnify, defy nd and hold the Owner and the Company harmless from and
against any and all claims or liens for any labor, material. or services furnished to the date
hereof'* This Waiver of Lien is given in order to induce the Company to pay the ainount
indicated above. and upon reccipi of such amount by the Contractor, this release may be
recorded, becomes valid, enforceable and to hill effect.
I -i Co LLC
Andrews Construction
Milton count- Narne of Contractor
"
E 1�
15 2f)1,17
Authorized Representative
Date:
State of Indiana
County of Marion
Before me, a Notary Public in and for said County and State, personally appeared, who
acknowledged the execution of the foregoing Waiver of Lien, and.who, having been duly
sworn, stated that the representations therein contained are true.
Witness my hand of Notorial Sea] this �15-' day of :1-0 1 ,3,
My Commission Expires:
NotcCry Public
i
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
An d re io _(onS Tr_a ,e Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2q
Total '�SS,5
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5-11-10-1.6.
, 20
Clerk-Treasurer
I
VOUCHER NO. WARRANT NO.
J J ( ALLOWED 20
IN SUM OF $
$ ,3SS50
ON ACCOUNT OF APPROPRIATION FOR
02,Z q,�4af07
Board Members
PO#or INVOICE NO. ACCT#!TITLE AMOUNT
DEPT.# I hereby certify that the attached invoice(s), or
3 907 ff7 A bill(s) is (are) true and correct and that the
3 q4k907 S8 ,° materials or services itemized thereon for
which charge is made were ordered and
received except
/�- 20
Si atur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund