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2012 CRC Nash Building pay request 06 FE titLOPMEN, a Part1 nw nerP CO�� Pre O CRC1 City of Carmel Indiana CARMEL REDEVELOPMENT COMMISSION Disbursement Number#6 E-Mail the signed Disbursement Direction to: James Brainard Mayor Huntington National bank Corporate Trust Department (INHP22) Commissioners Attn: Kim Wilson kim.wilson @huntington.com (317) 229-4094 William Hammer Ellen Campbell Ellen.campbell @huntington.com (616) 235-5941 President David Bowers Vice President Re: Depository Agreement between the City of Carmel and Huntington National Bradley Meyer Bank, dated December 31, 2012-Trust#4087000414 Secretary Jeff Worrell Commissioner Dear Kim: Corrie Meyer On March 27, 2014,you are hereby authorized and directed, as the Depositary Commissioner under the above referenced Agreement, to pay the amounts set forth on the attached Register of Claims from the above-referenced Trust account and overnight Gregory Phillips checks to: Commissioner Carmel Redevelopment Commission Attention: Mike Lee 30 W Main Street, Suite 220 Carmel, IN 46032 City of Carmel, IN By: Diana L. Cordray, Clerk-Treasurer 30 WEST MAIN STREET, SUITE 220, CARMEL, IN 46032 OFFICE 317.571.ARTS (2787) FAX 317.571.2789 CARMEL REDEVELOPMENT COMMISSION kfE Register of Claims 427/2014 Payment Request #6 Amount of Wire Vendor Address Invoice Description Instructions 720 3rd Ave SW Carmel,IN Pay app 6,Nash garage Signature Construction Services 46032 $ 1,292.30 construction mgt IF NEEDED 2747 N Emerson Ave Robert Haines Company Indianapolis, IN 46218 $ , .50 Pay app 3,Garage&ramp IF NEEDED tql6K. D _Total: $ 1 80 ALLOWANCE OF CLAIMS We have examined the claims listed on the above Register of Claims,consisting of 1 page(s),and except for claims not allowed as shown on the register such claims are hereby allowed in the total amount of: $ 14,004.80 /b2 - iblitteL17 20/ V Director of the CRC Date APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702. PAGE ONE OF 2 PAGES 2 TO OWNER CRC at City of Carmel PROJECT: Nash Garage APPLICATION NO Application a 6 Distribution to: Carmel Indiana 46032 Signature costs OWNER ARCHITECT PERIOD TO: 03/24/2014 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design I Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel-Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached. 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 issued and payments received from the Owner,and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 156,776.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1 t 2) 5 156,776.00 4 TOTAL COMPLETED&STORED TO S 138,683.80 c, By . T Date: 5/z y 5. RETAINAGE: Thom- ~.Koontz,President a. 10 %of Completed Work $ 0 'ubscribed• d sworn to before me this `,l day of Ilia rd-t•PO 14 (Column D+Eon G703) - - - i. b. %of Stored Material $ . (Column F on G703) 4o;As;?s'.,, UNIDA G.BUCHANAN Total Retainage(Lines 5a+56 or •r10TAHV.. Hancock County ° ,�9 ,w.p2_ My Commission Expires Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT ,, ;: August 20,2019 6. TOTAL EARNED LESS RETAINAGE $ 138,683.80 In accordance with the Contract Documents,based on on-site observations and theA. (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) S 137,391.50 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8 CURRENT PAYMENT DUE $ 1,292.30 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 18,092.20 t� 1�f�,/, (Line 3 less Line 6) AMOUNT CERTIFIED $ J� CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation i amount certif.'rd differs from the amount applied.Initial all figures on this Total changes approved Application ant a the Con nu n,heel that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT: _ 1 Total approved this Month t y: r,. X17 Date: / TOTALS $0.00 $0.00 Th Certificate is .t n gotiable. Theta OUNT CE* PIED is payable o y to e Uontra • named eretn.issuance,payment and acceptance of payment are with t NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 0702-APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION•AIA'01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20005-5292 Users may obtain validation of this document by requesting a completed AIA Document D401-Certification of Document's Authenticity from the Licensee. •7 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Application # 6 3/24/14 Nash Garage Carmel, Indiana Revised WORK COMPLETED TOTAL BALANCE TO DESCRIPTION OF SCHEDULED Change SCHEDULED FROM PREVIOUS THIS COMPLETED AND FINISH WORK VALUE Orders VALUE APPLICATIONS PERIOD STORED TO DATE % LESS RETAINAGE RETAINAGE General Conditions 92,161.00 92,161.00 92,161.00 0.00 92,161.00 100% 0.00 0.00 Construction Management Fee 64,615.00 64,615.00 45,230.50 1,292.30 46,522.80 72% 18,092.20 0.00 156,776.00 0.00 156,776.00 137,391.50 1,292.30 138,683.80 88% 18,092.20 0.00 APPLICATION AND CERTIFICATE FOR PAYMENT Alit DOCUMENT G702 Page ONE of 2 pages TO(OWNER): Carmel Redevelopment Commission PROJECT: CCC-Parcel 9-54 Garage&Rar APPLICATION NO: 3 Distribution to: 30 W.Main Street,Suite 220 0 OWNER Carmel, IN 46032 PERIOD TO: March 31,2014 MN ARCHITECT FROM: VIA(ARCHITECT): ARCHITECTS NO: []CONTRACTOR (Contractor) Robert Haines Company PROJECT NO: Q 2747 N. Emerson Avenue RHC#: 13C275 0 Indianapolis,IN 46218 CONTRACT FOR: CONTRACT DATE: May 23,2013 Application is made for payment,as shown below,in connection with the Contract. CONTRACTOR'S APPLICATION FOR PAYMENT Continuation Sheet,AIA Document GT03,is attached_ ' CHANGE ORDER SUMMARY 1.ORIGINAL CONTRACT SUM $210,000 Change orders approved in ADDITIONS DEDUCTIONS 2.Net change by Change Orders previous months by Owner 3.CONTRACT SUM TO DATE(Line 1+-2) $210,000 TOTAL 4.TOTAL COMPLETED&STORED TO DATE $66,475 Approved this Month (Column G on G703) Number Date Approved 5.RETAINAGE: ' a. 10%of Completed Work $6,648 (Column D+E on 0703) b. %of Stored Material Column F on G703) • Total Retainage(Line 5a+5b or Approved this Month TOTALS Total in Column I of 0703) $6,64-8 Net change by Change Orders 6.TOTAL EARNED LESS RETAINAGE $59,828 The undersigned Contractor certifies that to the best of the Contractor's knowledge, (Line 4 less Line 5 Total) information and belief the Work covered by this Application for Payment has been 7.LESS PREVIOUS CERTIFICATES FOR completed in accordance with the Contract Documents,that at amounts have been PAYMENT(Line 6 from prior Certificate) $47,115 paid by the Contractor for Work for which previous Certificates for Payment were 8.CURRENT PAYMENT DUE $12,713 issued and payments received from the Owner,and that current payment shown 9.BALANCE TO FINISH,PLUS RETAINAGE $150,173 herein is now due. (Line 3 less Line 6) i Itlllltrr� CONTRACTOR:Robert Haines Co. Subscribed and shndta�to Fe th ay County Mar 1 t3,201���v�`. U. H A�'.ice Notary Public: � b�/� //. ��,, C % By: _ fir►- —:.� .,non Date: March 18,2014 My Commission Tres: 9!17I221'/ 0TA-. ''d '- �r_ AMOUNT CERTIFIED i� 'I ARCHITECT'S CERTIFICATE FOR PAYMENT (Attach explanation if.a.' .•rtifi-d'i ffers from the amount applied for s'•, pUBL1C In accordance with the Contract Documents,based on on-site observations and the ARCHITECT: � �`� data comprising the above application, the Architect cerrtitit es to the Owner that to the 1:7:4;":'' , .: �,00 best of the Architects knowledge,information and belief the Work has progressed as :y: �'� Datetr i t`' Lath indicated,the quality of the Work is in aecordanace with the Contract Documents,and This Certificate is •t nego .r e.The' P RTIFIED is able only to the `!iir�,f r+III.5,`.N` the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractor named he•'• -,:nce,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under thls Gontract Revt1/16/94 ,..(.„„X.7--- AIA 13C275 CCC Parcel 9-54 Garage&Ramp 3 07 i CONTINUATION SHEET MA DOCUMENT G703 Page 2 of 2 pages AlA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: I 3 Contractor's signed Certification is attached. APPLICATION DATE: Mar 18,2014 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Mar 31,2014 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO: A B C D I E F G H I ' ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM THIS PERIOD PRESENTLY COMPLETED (G1C) TO FINISH PREVIOUS STORED AND STORED (C1-G) APPLICATION (NOT IN TO DATE (11+E) D OR E) (D+E*9 • 1 Submittals,Bonding&Insurance 7,500 7,500 7,500 100% 750 2 Firestopping 146,000 10,950 10,950 8% .135,050 1,095 3 071700 Bentonite Waterproofing 56,500 33,900 14,125 48,025 85% 8,475 4,803 210,000- 52,350 14,125 66,475, 32% ;143,525 6,648, Rev11(18194 AlA 13C275 CCC Parcel 9-54 Garage&Ramp 3 • SUBCONTRACTOR'S SWORN STATEMENT OF INDEBTNESS& CONDITIONAL WAIVER OF LIEN tit Ili PR 1 DU i 7 ( Being duly sworn upon his/her oath disposes and says that: 1. He/she is the7Zr. t-pMT--'(ifirditifig sbls proprietor,"partnar"or corporate office held,-as the case maybe),of ROBERT HAINES CO. INC. (hereafter called the"Subcontractor").He/she Is over the age of twenty-one. He/she is authorized to make this affidavit on behalf of Subcontractor. 2. Subcontractor is theWATMP F/t atSubcontractor for the construction of the BUILDING development known as . NASH BUILDING, located in CARMEL. (City), IN (state), hereafter referred to as the "Development", pursuant to the contract (the 'Trade Contract") between the Subcontractor and Signature Construction,LLC,the General Contractor. 3. This affidavit is made for the express purpose of inducing Signature Construction, LLC, to make payment to Subcontractoqr In the amount of $ l;t��I -CM representing Payment Application #. dated A-1 ft—ill' for labor and materials furnished pursuant to said Trade Contract through this date. Upon receipt of said payment the Subcontractor shall be paid in full, exclusive of retainage, for all services, labor and materials furnished to, provided for or used in connection with the Development through the date noted above and hereby waives any lien rights to which Subcontractor is entitled through the above date. Subcontractor further acknowledges that upon receipt of said payment the receipt of$ -"7 r I I'ca to date. 4. Listed below are all suppliers or other persons who either has furnished or might furnish the Subcontractor with materials, appliances, machinery,fixtures or furnishing placed upon or installed on the development. Mark(X) in the appropriate column for EACH supplier listed. Place an (X) in column: 1)If a waiver of lien by supplier conditioned by payment of a specified amount Is attached hereto. (In this case also show the amount owed the supplier). 2.) If a FULL (final) lien release has been signed and delivered to the General Contractor. 3.) If the initial delivery has not been made. Supplier List(Add list if necessary) 1.'Amount Owed 2 3 A-TEX 1 L [' dr1 Pi ! m t1Ll_ ��DC.R #1 and 2 correspond to the same numbered choices on the waiver format. Signature Construction, LLC is hereby authorized to make payment to each such unpaid creditor either directly or by check jointly payable to Subcontractor and such creditor,as Signature Construction, LLC shall determine. 5.There are no bills,charges,costs or expenses for labor or material which could now or hereafter result in lien being filed against the Development or a claim being asserted against the General Contractor except the persons or businesses named in Paragraph 4 above. IN WITNESS WHERE OF,affiant has signed this document on behalf of the Subcontractor this jday of ' L. _ (Author etc Representati contractor) County of ilikt t D t'4 ) State of D 1 Prh(A ) `1,010iijur/n / Subscribed and sworn to before me,a Notary Public in and for said County anOte{ t$ ° y of 4;jai,Ml�/2-4-t4 ,20 �,,��jT' ,' p L,/' , ;NOTARY 3 SEAL (Notary Public) - �' PUBLIC (Printed Name) ,k.., My Commission Expires: 9-1 62-- NOTARY SEAL MUST APPEAR ON THIS FORM.