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HomeMy WebLinkAbout227074 12/11/2013 *F CITY OF CARMEL, INDIANA VENDOR: 358582 Page 1 of 1 ONE CIVIC SQUARE PATTERSON HORTH INC CHECK AMOUNT: $149,273.50 a CARMEL, INDIANA 46032 5745 PROGRESS DRIVE INDIANAPOLIS IN 46241 CHECK NUMBER: 227074 CHECK DATE: 12/11/2013 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 106 5023990 36195 1 149, 273 . 50 FOUNDERS PARK PAVILLI Purchase FOWCIER PARK Q Ccscription 'PAV ILA QN3 9117030' � _AIA® P.O.# (e 14 Sr F Document 7 2rM ® 1992 B t iQ6 -tea �o Line Descr Application and Certificate for Payment Purchaser Date Z ., TO OWNER: Carmel Clay Board of Parks and PROJECT: Founders Park Pavillion Project APPLICATION NO: 001 Distribution to: Recreation 11675 Hazell Dell Parkway PERIOD TO:November 30,2013 OWNER: 1411 E. 116th St. Carmel,IN 46032 Carmel,IN 46032 CONTRACT FOR: General Construction ARCHITECT: FROM VIA CONTRACT DATE: CONTRACTOR: CONTRACTOR: Patterson-Horth,Inc. ARCHITECT: PROJECT NOS: /21324/ FIELD: 5745 Progress Road Indianapolis,IN 46241 OTHER: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM ......................................................................... $ 1,160,000.00 Payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS ......................................................... S 0.00 CONTRA 3. CONTRACT SUM TO DATE(Line I f 2)..................................................... S 1,160,000.00 By: Date: November 29,2013 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703)........... S 157,130.00 State of:Indiana 5. RETAINAGE: County of:Marion a. 5 %of Completed Work Kri Se State p Subscrib d a sworn to before tary Public Seal State of Indiana (Column D+E on G703) $ 7,856.50 me thQ day of�Qr✓. Hendricks County b. 0 %of Stored Material y C mmission Expires 06/0 312 01 8 I (Column F on G703) $ 0.00 Notary Public: Total Retainage(Lines 5a+5b or Total in Column I of G703) ................ S 7,856.50 My Commission expires: 6. TOTAL EARNED LESS RETAINAGE.................................................I.......... $ 149,273.50 ARCHITECT'S CERTIFICATE FOR PAYMENT (Line 4 Less Line 5 Total) In accordance with the Contract Documents,based on on-site observations and the data comprising 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT ..................................... $ 0.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and beliefthe Work has progressed as indicated,the quality of the Work is in accordance (Line 6 from prior Certificate) with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT 8. CURRENT PAYMENT DUE.......................................................................... I $ 149,273.5 CERTIFIED. 9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED .................................................................................. $ 149,273.50 (Line 3 less Line 6) $ 1,010,726.50 (Altnch explanation if amount certified differs,jrom the amount applied.Initial all figures on this Application and n e Conti_n_uation Sheet that are changed to conform with the amount certified.) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in previous months by Owner $ 0.00$ 0.0 By: Date: 'Z ,3 Total approved this Month $ 0.00S 0.0 TOTALS $ 0.00$ 0.0 This Certificate ' n ne o ' e. The AMOUNT CERTIFIED is payable on to t e Contractor named herein. Is uance,payment and acceptance of payment are without prejudice to any rights of ET CHANGES by Change Order $ 0.0C the Owner or Contractor under this Contract. AIA Document G702 TM—1992.Copyright©1953, 1963,1965,1971,1978,1983 and 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 result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:04:49 on 11/29/2013 under Order No.1857109399_1 which expires on 07/12/2014,and is not for resale. User Notes: (1499804739) TM Document 703 ® 1 AIA Continuation Sheet AIA Document, G702 TM_1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 001 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE: 11/30/2013 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO: 11/30/2013 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 1 WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE APPLICATION DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) 1 P&P Bond 15,584.00 0.00 15,584.00 0.00 15,584.00 100.00% 0.00 779.20 2 Supervision 23,068.00 0.00 3,124.00 0.00 3,124.00 13.54% 19,944.00 156.20 Misc. General 3 Conditions 2,675.00 0.00 0.00 0.00 0.00 0.00% 2,675.00 0.00 4 Earthwork 127,974.00 0.00 89,157.00 0.00 89,157.00 69.67% 38,817.00 4,457.85 5 Paving 6,993.00 0.00 0.00 0.00 0.00 0.00% 6,993.00 0.00 6 Landscaping 8,855.00 0.00 0.00 0.00 0.00 0.00% 8,855.00 0.00 7 Concrete 114,676.00 0.00 34,068.00 0.00 34,068.00 29.71 % 80,608.00 1,703.40 8 Masonry 102,000.00 0.00 0.00 0.00 0.00 0.00% 102,000.00 0.00 9 Structural Steel 33,800.00 0.00 0.00 0.00 0.00 0.00% 33,800.00 0.00 10 Rough Carpentry 142,237.00 0.00 0.00 0.00 0.00 0.00% 142,237.00 0.00 11 Roofing 43,850.00 0.00 0.00 0.00 0.00 0.00% 43,850.001 0.00 Doors, Frames, 12 Hardware 14,133.00 0.00 0.00 0.00 0.00 0.00% 14,133.00 0.00 13 Glass &Glazing 43,837.00 0.00 0.00 0.00 0.00 0.00% 43,837.00 0.00 Framing, Drywall, 14 Ceilings 132,100.00 0.00 0.00 0.00 0.00 0.00% 132,100.00 0.00 15 Flooring 26,442.00 0.00 0.00 0.00 0.00 0.00% 26,442.00 0.00 16 Painting 11,700.00 0.00 0.00 0.00 0.00 0.00% 11,700.00 0.00 17 Misc Specialties 36,076.00 0.00 0.00 0.00 0.00 0.00% 36,076.00 0.00 18 HVAC &Plumbing 103,000.00 0.00 15,197.00 0.00 15,197.00 14.75 % 87,803.00 759.85 19 Electrical 121,000.00 0.00 0.00 0.00 0.00 0.00%- 121,000.00 0.00 20 Allowance 50,000.00 .0.001 0.00 0.001 0.00 0.00%1 00 0 50,000. .00 AIA Document G7031"-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 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 result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:01:46 on 11/29/2013 under Order No.1857109399_1 which expires on 07/12/2014,and is not for resale. User Notes: (1098085492) A B C D E F G H 1 WORK COMPLETED M TOTAL ATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED DATE (G_C) (C-G) RATE) (D+E) (NOT 1N D OR E) (D+E+F) 0.00 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.001 0.001 0.00 0.00 0.00% 0.00 0.00 GRAND TOTAL $1,160,000.00 $0.001 S157,130.001 $0.00 $157,130.001 13.55 %1 $1,002,870.00 $7,856.50 AIA Document G7031"-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 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 result in severe civil and criminal penalties,and will be prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 10:01:46 on 11/29/2013 under Order No.1857109399_1 which expires on 07/12/2014,and is not for resale. User Notes: (1098085492) rLIL PATTERSON NORTH C ENERA1. CON'I'RAC'1'ORS OWNER AFFIDAVIT AND WAIVER AND RELEASE OF LIEN AND CLAIMS The undersigned, being duly sworn upon his oath, states that he is the principal owner, officer, or authorized agent of Patterson-North, Inc. ("Contractor"),and is duly authorized to enter into this agreement and make these affirmations on behalf of the Contractor,which is contracted with Carmel Clay Board of Parks and Recreation to furnish materials, labor or services for a project known as Founders Park Pavillion Project (hereinafter"Project'), owned by Carmel Clay Board of Parks and Recreation and does hereby further state that the sum of $ 149,273.50 is due Contractor,the payment of which is made as consideration for this Affidavit and Waiver and Release of Liens and Claims and constitutes full and complete satisfaction of all sums owing to Contractor(less retainage)up to November 29, 2013 (date of application). Therefore, as to the following entities: Patterson-North, Inc. Fidelity and Deposit Company of Maryland and all other entities have an interest in this project,the undersigned as duly authorized agent for Contractor hereby waives and releases any and all claims,Verified Statement of Claims and Mechanic's Liens, and further waives and releases any and all other liens or claims or rights to liens or claims whatsoever on the above-described property, on account of labor, materials or services furnished by Contractor. Contractor further certifies that all funds received from this project have been applied for the payment for labor, material and services furnished to this project by employees, subcontractors and material suppliers and that no other party has any lien or claim on account of any work performed or material furnished for said Project, and within the scope of this Affidavit and Waiver up to November 29, 2013 (date of application). c By: Printed: Michael K. Patterson Title: President STATE OF INDIANA ) SS: COUNTY OF MARION ) The foregoing, before me, a notary public, personally appeared Michael K. Patterson as President , duly authorized officer or agent of Patterson-Horth, Inc. who having been duly sworn, acknowledged the execution of the foregoing Affidavit and Waiver and Release of Liens and Claims,for and on behalf of said corporation and stated that the representations therein contained are true. ff WITNESS my hand and notary seal this 29th day of November 20 13 Signed: , Printed: ris in e Notary Public My Commission Expires: My County of Residence is: Contractor further certifies that upon receipt of payment listed above, the unpai I or or services for the project is $ 1,010,726.50 Kristina Rlftey tlota:j Public Seai State of Indiana Hendricks county My commission Expires o6/031201 6 Patterson - Horth Inc. ONVOICE 5745 Progress Drive IndpIs., IN 46241 Invoice Number: 2938 Invoice Date: Nov 29,2013 Page: 1 Voice: (317)243-6104 Fax: (317)243-6398 0 Carmel Clay Board of Parks& Rec. Carmel Clay Board of Parks& Rec. 1411 E 116th St. 1411 E 116th St. Carmel, IN 46032 Carmel, IN 46032 1,F011,MW ciimome 0-0 P* (Carmel Clay Net 30 Days ppin thiddf- kk 4-tq Courier 12/29/13 6 fty4i�'- ount Progress Billing#1 157,130.00 Retaiange -7,856.50 Subtotal 149,273.50 Sales Tax Total Invoice Amount 149,273.50 Check/Credit Memo No: Payment/Credit Applied m. 0 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of 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 Purchase Order No. Patterson-Horth, Inc. Date Due 5745 Progress Road Indianapolis, IN 46241 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) PO# Amount 11/30/13 Pay App# 1 Founders Park Pavillion project 36195 $ 149,273.50 Total $ 149,273.50 1 hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance with IC 5-11-10-1.6 120 Clerk-Treasurer Voucher No. Warrant No. Allowed 20 Patterson-North, Inc. 5745 Progress Road Indianapolis, IN 46241 In Sum of$ k $149,273.50 ON ACCOUNT OF APPROPRIATION FOR 106 Park Impact Fee PO#or INVOICE NO. kCCT#/TITLI AMOUNT Board Members Dept# 36195 Pay App# 1 5023990 $149,273.50 1 hereby certify that the attached invoice(s), or bill(s)is(are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 5-Dec 2013 $149,273.50 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund