2012 CRC Nash Building pay request 09 �EQE�ELOPM€NF [.O
A Public/Private 3�
• Partnership _
CRC
City of Carmel
Indiana
CARMEL REDEVELOPMENT COMMISSION
Disbursement Number#9
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 August 11, 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
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
Register of Claims
8/13/2014
Payment Request #9
Amount of Wire
Vendor Address Invoice Description Instructions
720 3rd Ave SW Carmel,IN Pay app 9,Nash garage
Signature Construction Services 46032 $ 2,584.60 construction mgt IF NEEDED
2602 N Arlington Ave
Maxwell Electric Indianapolis,IN 46218 $ 9,671.40 Pay app 6,Garage&ramp IF NEEDED
2602 N Arlington Ave
Maxwell Electric Indianapolis,IN 46218 $ 5,253.41 Pay app 7,Garage&ramp IF NEEDED
2602 N Arlington Ave
Maxwell Electric Indianapolis,IN 46218 $ 399.63 Pay app 8,Garage&ramp IF NEEDED
2747 N Emerson Ave
Robert Haines Company Indianapolis,IN 46218 $ 53,217.00 Pay app 5,Garage&ramp IF NEEDED
Total: $ 71,126.04
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: $ 71,126.04
(ivui YYL0 - 11311
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 W I Distribution to:
Carmel Indiana 46032 Signature costs OWNER
I-I ARCHITECT
PERIOD TO: 07/24/2014 X CONTRACTOR
FROM CONTRACTOR: VIA ARCI-IITECT: Pedcor Design
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 Contractors 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.
I. ORIGINAL CONTRACT SUM S 156,776.00
2. Net change by Change Orders 5 0.00 CONTRACTOR:
3. CONTRACT SUM TO DATE(Line 1±2) $ 156,776.00
4. TOTAL COMPLETED&STORED TO $ 151,606.80 /--- ' r z ) / 'l
By: Date: T// 1 1
5. RETAINAGE homas E ntz,President _ 4/I .
a. 10%of Completed Work $ 0 Su scribed and ors to before me this a' day of i u� I a �I/49/
(Column D+E on 0703)
....... LINDA G.BUCHANAN
Hancock County
b n of Stored Material $ i,•, ,_
(Column F on G703)
My Commission Expires
s6A _
Total Retainage(Lines 5a+5b or f
Total in Column lofG703) $ 0.00 ARCHITECT'S CERTI ICATE FOR PAYMENT '- ... _- AugusI20,201s
6. TOTAL EARNED LESS RETAINAGE $ 151,606 80 In accordance with the Contract Documents,based on on-site observations and the data
(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) $ 149,022.20 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE S 2,584.60 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 5,169.20 �j���
(Line 3 less Line 6) AMOUNT CERTIFIED $ _ Yet /dj1
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied Initial all figures on this
Total changes approved Application and _ the Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner ARCHITECT: 1
Total approved this Month By: - 'j, Date: 2 9 4
TOTALS $0.00 S0.00 This Ce 'fixate is it negotiable. The AMOUNT CERTIFIED is payable on to t e
Contracto'named erein.issuance,payment and acceptance of payment are wttho
NET CHANGES by Change Order $0.00 prejudice to: y rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702'APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION-AIA-01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292
Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee.
SIGNATURE CONSTRUCTION LLC
720 3rd Avenue, S. W.
Carmel, Indiana 46032
Application # 9
7/24/14
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 56,861.20 2,584.60 59,445.80 92% 5,169.20 0.00
156,776.00 0.00 156,776.00 149,022.20 2,584.60 151,606.80 97% 5,169.20 0.00
E•
AIA Type Document (f / 0 /
•
Application and Certification for Payment 7 (O U �j Page 1 of 2
TO(OWNER):City of Carmel PROJECT:CITY CENTER GARAGE
Redevelopment Commission ONE PEDCOR SO APPLICATION NO: 3314 6 DISTRIBUTION
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD TO:5/16/2014 TO:
IN 46032 CARMEL, IN 46032 _OWNER
_ARCHITECT
FROM(CONTRACTOR):MAXWELL ELECTRIC VIA(ARCHITECT): ARCHITECTS -CONTRACTOR
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS,IN 46218
{
CONTRACT FOR:
CONTRACT DATE:
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 Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM $ 157,244.00
2.Net Change by Change Orders $ 0.00 CONTRA TOR: MAXWELL ELECTRIC
I ( 2601 NrARLINGTON AVE INDIANAPOLIS,IN 46218
3.CONTRACT SUM TO DATE (Line 1 +2) $ 157,244.00 II '
4.TOTAL COMPLETED AND STORED TO DATE .. .. .$ 150,518.80 ( (L4,../,_,)% � �
Date: c:.' I
Paul Hood / Project Manager :.'
5.RETAINAGE: 1 9 � �._ : t
a. 10.00%of Completed Work State of:IN •t,,,,°
$ 15,051.88
County of: Marion 144:7. 1
b. 0.00%of Stored Material -ti '.`
$ 0.00 Subscribed and S•.rn to before me this '" ra:'+ �
/ Day of ��... � _ zre
Total retainage(Line 5a+5b) $ 15,051.88 Notary Public: -
My Commission Exp'.es: ' �? ' �-e}
6.TOTAL EARNED LESS RETAINAGE $ 135,466.92 .�
(Line 4less Line 5Total) ARCHITECT'S CERTIFICATE FOR PAYMENT
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data com-
(Line 6 from prior Certificate) $ 125,795.52 prising the above application, the Architect certifies to owner that to the best of the Architect's
knowledge,information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 9,671.40 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED.
(Line 3 less Line 6) $ 21,777,08
AMOUNT CERTIFIED $
(Attach explanation if amount certified differs from the amount applied.Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation Sheet that are changed to conform to the amount certified.)
Total changes approved in
previous months by Owner ARCHITECT:
0.00( 0.00 By' Date:
Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named herein. Issuance,Payment and acceptance of payment are without prejudice to any
TOTALS 1 0.00 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 0.00
AIA Type Document
Application and Certification for Payment
Page 2 of 2
TO(OWNER):City of Carmel
Redevelopment Commission PROJECT: CITY CENTER GARAGE APPLICATION NO: 3314-6 DISTRIBUTION
ONE PEDCOR SQ
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD TO:5/16/2014 TO:
IN 46032 CARMEL,IN 46032 _OWNER
._ARCHITECT
FROM(CONTRACTOR):MAXWELL ELECTRIC _CONTRACTOR
VIA(ARCHITECT): ARCHITECTS
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS, IN 46218
CONTRACT FOR:
CONTRACT DATE:
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE
1 Light Fixtures 17,200.00 15,308.00 1,032.00 0.00 16,340.00 95.00 860.00 1,634.00
2 Lighting Installation 16,440.00 10,686.00 4,932.00 0.00 15,618.00 95.00 822.00 1,561.80
3 Gear/Panels 37,900.00 37,142.00 0.00 0.00 37,142.00 98.00 758.00 3,714.20
4 Gear/Panel Installation 21,364.00 20,295.80 0.00 0.00 20,295.80 95.00 1,068.20 2,029.58
5 General Material 41,300.00 36,757.00 2,478.00 0.00 39,235.00 95.00 2,065.00 3,923.50
6 General Material Installation 23,040.00 19,584.00 2,304.00 0.00 21,888.00 95.00 1.152.00 2,188.80
REPORT TOTALS $157,244.00 $139,772.80 $10,746.00 $0.00 $150,518.80 95.72 $6,725.20 $15,051.88
1
I •
SUBCONTRACTOR'S AND SUPPLIER'S AFFIDAVIT,
WAIVER OF LIEN
AND AGREEMENT FOR INDEMNIFICATION
FINAL PARTIAL
Paul Hood being duly sworn stated the following:
Name of Subcontractor or Supplier: S'gnature Construction
Name of General Contractor: Maxwell Electric
Project Location: City CPntnr Garage
PARTIAL WAIVER: that the balance due from the General Contractor is the sum of
Dollars j $ 9.671,40 )
receipt of which is hereby acknowledged;or
the payment of which has been promised as the sole consideration for this Affidavit and
Partial Waiver of Lien which is given,effective upon receipt of such payment;
FINAL WAIVER: That the final balance due from the General Contractor is the sum of
Dollars t $
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 is given,effective upon receipt of such payment;
THEREFORE,the undersigned waives and releases the Owner of said premises,any and all lien or claim
whatsoever on the above-described property and Improvements thereon on account of labor or material or
both, furnished by the undersigned,and further certifies that no other party has nay claim or right to a lien
on account of any work performed or material furnished to the undersigned for said project,and within the
scope of this affidavit and waiver.
Unconditional Agreement to Indemnify. Upon the condition that Subcontractor receives payment of the
above listed amount,and in consideration of that payment,Subcontractor/Supplier agrees to indemnify and
hold Owner and Contractor harmless against all claims and mechanic's liens on or against the Premises for
any labor,materials,equipment,tools or services performed or provided by or through
Subcontractor/Supplier relating to the Project.
CONTRACTOR.`
By: . i/
Printed:Pau Hood
Title: Project Manager
STATE OF In
)SS:
COUNTY OF Marion )
Subscribed and sworn to before me,a Notary Public in and for said County and State,this •
5th day of May ,2014. . •:
;;\My commission expires: 2/22/20 / I a �.r �3�' al •
.
Residing in Hancock Signa
Print acki Hough it •
OTARY PUBLIC
40) } z T g*hooky z 4 12.1duRri)loos �?=Tanncn.$4■1i 4-1113"t-eX0/t.II J 'mot\e T [ f-z0 ?}u 0 0 9%z 5
AIA Type Document
Application and Certification for Payment Page 1 of 2
1�1t }I
TO(OWNER):City of Carmel
PROJECT:CI-T-Y-CENT-E-R GARAGE APPLICATION NO: 3314-7 DISTRIBUTION
Redevelopment Commission ONE PEDCOR SQ TO:
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD TO:6/20/2014 _OWNER
IN 46032 CARMEL, IN 46032 _ARCHITECT
FROM(CONTRACTOR): MAXWELL ELECTRIC _CONTRACTOR
VIA(ARCHITECT): ARCHITECT'S
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS, IN 46218
CONTRACT FOR: CONTRACT DATE:
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 Type Document is attached. Certificates for Payment were issued and payments received from the owner, and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM $ 157,244.00
2.Net Change by Change Orders $ 0.00 CONT TOR: MAXWELL ELECTRIC
2601 N ARLINGTON AVE INDIANAPOLIS, IN 46218
3.CONTRACT SUM TO DATE (Line 1 +2) $ 157,244.00
4.TOTAL COMPLETED AND STORED TO DATE $ 156,355.92 By: b-ki i-r_ 5---4Q Date:"( - ` �1
5.RETAINAGE:
Paul Hood I Project Manager
a. 10.00%of Completed Work $ 15,635.59 State of IN D,` -{ :. `
County of: Marion tz=?"r >`,
b._ 0.00_%of Stored Material $ �'� /,�
0.00 Subscribed and Sworn to before me this y, y l 20 i�
aYct
Notary Public: - .,
Total retainage(Line 5a+5b) $ 15,635.59 A� O.
My Commiss pires : �, dd— A '
6.TOTAL EARNED LESS RETAINAGE $ 140,720.33
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYMENT
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data com-
(Line 6 from prior Certificate) $ 135,466.92 prising the above application, the Architect certifies to owner that to the best of the Architect's
knowledge, information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 5,253.41 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED.
(Line 3 less Line 6) $ 16,523.67
AMOUNT CERTIFIED $
(Attach explanation if amount certified differs from the amount applied. initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and on the Continuation t Sheet that are changed to conform to the amount certified.)
Total changes approved in ARC lik CT
previous months by Owner 0.00 �. t e/
0.00 gy ,� / .i / Date:
f
Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named herein. Issuance, Payment and acceptance of payment are without prejudice to any
TOTALS 0.00 0.00 rights of the Owner or Contractor under this Contract.
NET CHANGES by Change Order 0.00
AIA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):City of Carmel PROJECT: CITY CENTER GARAGE
APPLICATION NO: 3314-7 DISTRIBUTION
Redevelopment Commission ONE PEDCOR SO TO:
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD TO:6/20/2014 OWNER
_
IN 46032 CARMEL, IN 46032 _ARCHITECT
_CONTRACTOR
FROM(CONTRACTOR): MAXWELL ELECTRIC VIA(ARCHITECT): ARCHITECT'S
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS, IN 46218
CONTRACT FOR: 'I O)6 CONTRACT DATE:
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED o BALANCE RETAINAGE
1 Light Fixtures 17,200.00 16,340.00 860.00 ik(0,,,:i 0.00 17,200.00 100.00 0.00 1,720.00
2 Lighting Installation 16,440.00 15,618.00 822.00 rJv (o ai 0.00 16,440.00 100.00 0.00 1,644.00
3 Gear/Panels 37,900.00 37,142.00 758.00 t:}v (a;2. 0.00 37,900.00 100.00 0.00 3,790.00
4 Gear/Panel Installation 21,364.00 20,295.80 640.92 I-)a 10.)3 0.00 20,936.72 98.00 427.28 2,093.67
5 General Material 41,300.00 39,235.00 2,065.00 iJts (If 0.00 41,300.00 100.00 0.00 4,130.00
6 General Material Installation 23,040.00 21,888.00 691.20 'Dili' ,' S 0.00 22,579.20 98.00 460.80 2,257.92
REPORT TOTALS $157,244.00 $150,518.80 $5,837.12 $0.00 $156,355.92 99.44 $888.08 $15,635.59
Jj
SUBCONTRACTOR'S AND SUPPLIER'S AFFIDAVIT,
WAIVER OF LIEN
AND AGREEMENT FOR INDEMNIFICATION
FINAL PARTIAL
Paul Hood being duly sworn stated the following:
Name of Subcontractor or Supplier: Signature Construction
Name of General Contractor: Maxwell Electric .
Project Location: City C entAr Garage
PARTIAL WAIVER: that the balance due from the General Contractor is the sum of
Dollars c $5,253.41
receipt of which is hereby acknowledged;or
Kthe payment of which has been promised as the sole consideration for this Affidavit and
Partial Waiver of Lien which is given,effective upon receipt of such payment;
FINAL WAIVER: That the final balance due from the General Contractor is the sum of
Dollars i $ )
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 is given,effective upon receipt of such payment;
THEREFORE,the undersigned waives and releases the Owner of said premises,any and all lien or claim
whatsoever on the above-described property and Improvements thereon on account of labor or material or
both, furnished by the undersigned,and further certifies that no other party has nay claim or right to a lien
on account of any work performed or material furnished to the undersigned for said project,and within the
scope of this affidavit and waiver.
Unconditional Agreement to Indemnify. Upon the condition that Subcontractor receives payment of the
above listed amount,and in consideration of that payment, Subcontractor/Supplier agrees to indemnify and
hold Owner and Contractor harmless against all claims and mechanic's liens on or against the Premises for
any labor,materials,equipment,tools or services performed or provided by or through
Subcontractor/Supplier relating to the Project.
CONNRRACTOR:
By: '`� EL w` ,,,:,....
Printed:Doug .yes
Title: Project Manager/Agent
STATE OF In )
)SS:
COUNTY OF Marion )
Subscribed and sworn to before me,a Notary Public in and for said County and State,this
19th day of June ,2014. �--.r
My commission expires: 2/22/20 , , 0 `
: �ata L
Residing in Hancock ,,.
S •• a[,pr
Tintedc, - •4 4 tom
NiXA''' BLIC
•
AIA Type Document
Application and Certification for Payment
Page 1 of 2
TO(OWNER):City of Carmel PROJECT:CITY CENTER GARAGE APPLICATION NO: 3314-8 DISTRIBUTION
Redevelopment Commission ONE PEDCOR SO TO:
9-54 Parking Garage Si Ramp 720 3RD AVE.S.W. PERIOD TO:7/15/2014
IN 46032 CARMEL,IN 46032 _ARCHITECT
•
FROM(CONTRACTOR):MAXWELL ELECTRIC VIA(ARCHITECT): _CONTRACTOR
( ) ARCHITECTS
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS,IN 46218
I
CONTRACT FOR: CONTRACT DATE: g
1:
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 ii
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 Type Document is attached. Certificates for Payment were issued and payments received from the owner,and that
current payment shown herein is now due.
1.ORIGINAL CONTRACT SUM $ 157,244.00
2.Net Change by Change Orders $ 0.00 CONT••o OR; MAXWELL ELECTRIC
2601 N A'lllf 1GTON AVE INDIANAPOLIS,IN 46218 r.
3.CONTRACT SUM TO DATE (Line 1 +2) $ 157,244.00 \ ri
4.TOTAL COMPLETED AND STORED TO DATE $ 156,799.96 r �\ Date: `,
Paul •ad 1 Project Mana er Ii
5.RETAINAGE: 9
a. 10.00%of Completed Work $ 15,680.00 State of: IN j/ :? ,�
County of: Marion
b. 0.00%of Stored Material $ 0.00 fa •4' ....' li li
Subscribed and Sworn to before me this } . of 20 I
Total retainage(Line 5a+5b) Notary Public: �, *':• I
.... $ 15,680.00 L a
My Commissio. x•-es.: a-
6.TOTAL EARNED LESS RETAINAGE $ 141,119.96
(Line4lessLine5Total) ARCHITECT'S CERTIFICATE FOR PAYMENT
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data corn-
(Line 6 from prior Certificate) $ 140,720.33 prising the above application, the Architect certifies to owner that to the best of the Architect's
knowledge,information and belief the Work has progressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE $ 399.63 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED.
(Line 3 less Line 6) $ 16,124.04 rete(`
AMOUNT CERTIFIED. $ �L t
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this
Application and o tinuation Sheet that are changed to conform to the amount certified.)
Total changes approved in
previous months by Owner ARCHITECT:
0.00 0.00 By: t
- . � }_ _ Date: Z l`r
Total approved this Month 0.00 0.00 This Certifica of negotiable, The AMOUNT CERTIFIED is payab only to the Contractor
named herein. ,ante,Payment and acceptance of payment are without prejudice to any
TOTALS 0.00 0.00 rights of the Ow •r or Contractor under this Contract.
NET CHANGES by Change Order
0.00
1
I
MA Type Document
Application and Certification for Payment Page 2 of 2
TO(OWNER):City of Carmel PROJECT: CITY CENTER GARAGE
Redevelopment Commission ONE PEDCOR SO APPLICATION NO: 3314-8 DISTRIBUTION
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD TO:7115/2014 TO:
IN 46032 CARMEL,IN 46032 OWNER
ARCHITECT
CONTRACTOR
FROM(CONTRACTOR):MAXWELL ELECTRIC VIA(ARCHITECT): ARCHITECTS
2601 N ARLINGTON AVE PROJECT NO:
INDIANAPOLIS,IN 46218
CONTRACT FOR:
CONTRACT DATE:
SCHEDULE PREVIOUS COMPLETED STORED COMPLETED
ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED o BALANCE RETAINAGE
._........ .._ ...
1 Light Fixtures 17,200.00 17,200.00 0.00 0.00 17,200.00 100.00 0.00 1,720.00
2 Lighting Installation 16,440.00 16,440.00 0.00 0.00 16,440.00 100.00 0.00 1,644.00
3 Gear/Panels 37,900.00 37,900.00 0.00 0.00 37,900.00 100.00 0.00 3,790.00
4 Gear!Panel Installation 21,364.00 20,936.72 213.64 0.00 21,150.36 99.00 213.64 2,115.04
5 General Material 41,300.00 41,300.00 0.00 0.00 41,300.00 100.00 0.00 4,130.00
6 General Material Installation 23,040.00 22,579.20 230.40 0.00 22,809.60 99.00 230.40 2,280.96
`
REPORT TOTALS $157,244.00 $156,355.92 $444.04 $0.00 $156,799.95 99.72 $444.04 $15,680.00
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SUBCONTRACTOR'S AND SUPPLIER'S AFFIDAVIT,
WAIVER OF LIEN
AND AGREEMENT FOR INDEMNIFICATION
FINAL X PARTIAL
Paul Hood being duly sworn stated the following:
Name of Subcontractor or Supplier: Signature
• Name of General Contractor: Maxwell Electric
Project Location: City Center Garage
PARTIAL WAIVER: that the balance due from the General Contractor is the sum of
Dollars ( $ 399,63
receipt of which is hereby acknowledged;or
X the payment of which has been promised as the sole consideration for this Affidavit and
Partial Waiver of Lien which is given,effective upon receipt of such payment;
FINAL WAIVER: That the final balance due from the General Contractor 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 is given,effective upon receipt of such payment;
THEREFORE,the undersigned waives and releases the Owner of said premises,any and all lien or claim
whatsoever on the above-described property and Improvements thereon on account of labor or material or
both,furnished by the undersigned,and further certifies that no other party has nay claim or right to a lien
on account of any work performed or material furnished to the undersigned for said project,and within the
scope of this affidavit and waiver.
Unconditional Agreement to Indemnify. Upon the condition that Subcontractor receives payment of the
above listed amount,and in consideration of that payment,Subcontractor/Supplier agrees to indemnify and
hold Owner and Contractor harmless against all claims and mechanic's liens on or against the Premises for
any labor,materials,equipment,tools or services performed or provided by or through
Subcontractor/Supplier relating to the Project.
CON' CTO :
By:
Printer: Paul Hood
Title: Project Manager
STATE OF In
)SS:
COUNTY OF Marion )
Subscribed and sworn to before me, a Notary Public in and for.sa l ,V te,this
22nd day of July _,2014. *'
SEPaj
My commission expires: 2/22/20
Residing in Hancock Sig "attire /
Punted: Jacki Hough:.
NOTARY PUBLIC
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 Page ONE of 2 pages
TO(OWNER): Carmel Redevelopment Commission PROJECT: CCC-Parcel 9-54 Garage&Rar APPLICATION NO: 5 Distribution to:
30 W.Main Street,Suite 220 nOWNER
Carmel,IN 46032 PERIOD TO: July 31,2014 (ARCHITECT
FROM. VIA(ARCHITECT): ARCHITECTS NO: r-ICONTRACTOR
(Contractor) Robert Haines Company PROJECT NO: Q
2747 N.Emerson Avenue RHC# 13C275
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 G703,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
$131,255
Approved this Month
(Column G on G703)
Number Date Approved 5.RETAINAGE:
a. 10 %of Completed Work $13,126
(Column D+E on G703)
b. %of Stored Material
Column F on G703)
Total Retainage(Line 5a+5b or
Approved this Month TOTALS Total in Column I of G703) $13,126
Net change by Change Orders 6.TOTAL EARNED LESS RETAINAGE $118,130
The undersigned Contractor certifies that to the best of the Contractors 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 all amounts have been PAYMENT(Line 6 from prior Certificate) $64,913
paid by the Contractor for Work for which previous Certificates for Payment were 8.CURRENT PAYMENT DUE 555,217
issued and payments received from the Owner,and that current payment shown 9.BALANCE TO FINISH,PLUS RETAINAGE $91,871
herein is now due (Line 3 less Line 6) -
CONTRACTOR:Robert Haines Co. State of: Indiana
Subscribed an s wn to before me is day County ul 22,201�`���ti�Ar�9�fl/////
Notary Public: , � i�
BY Date: July 22,2014 My Commission expires: 9H71Y\ C.,P',. 'M' H'�A`/.i.
AMOUNT CERTIFIED ota
ARCHITECTS CERTIFICATE FOR PAYMENT .:-.Z# R� 'Z_ 3��
(Attach explanation if amount . d differs from the amount applied ID tq r
In accordance with the Contract Documents,based on on-site observations and the ARCHITECT: r 1 j le
data comprising the above application, the Archi tect certifies to the dinerthat tothe pLISL1C ,
best of the Archlteci's knowledge,information and belief the Work has progressed as g ,`
indicated,the quality of the Work is in aceordanace with the Contract Document,and y �h � `�' 1�t
This Certificate Is no -.otiabl•. h MOUNT CEf rineD is payable only to the 'j, .� 111
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
Contractor named he: . Issuan ,payment and acceptance of payment are without i%.�CDV �%
prelualceto any rightsof ow ror contractor under thisGontracl. '/ri.cr11tti��
Rev11/19194
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 5
CONTINUATION SHEET AIA.DOCUMENT G703 Page 2 of 2 pages
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 5
Contractors signed Certification is attached. APPLICATION DATE: Jul 22,2014
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Jul 31,2014
Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECTS PROJECT NO:
A B C D 1 E F G H _1 I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL To BALANCE RETAINAGE
NO. VALUE FROM THIS PERIOD PRESENTLY COMPLETED (GfC) TO FINISH
PREVIOUS STORED AND STORED (C-G)
APPLICATION (NOT IN TO DATE
(D*E) D OR E) (D+E+F)
1 Submittals, Bonding&Insurance 7,500 7,500 7,500 100% 750
2 Firestopping 146,000 10,950 59,130 70,080 48% 75,920 7,008
3 071700 Bentonite Waterproofing 56,500 53,675 53,675 95% 2,825 5,368
210,000 72,125 59,130 131,255 63% 78,745 13,126
Revvi n ata4
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 5
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS&CONDITIONAL WAIVER OF LIEN
/M P.P I 1&C AI Being duly sworn upon his/her oath disposes and says that:
1, He/she is the 7)12._ (Inserting sole proprietor, partner or corporate office held, as the case
maybe),of ROBERT HAINES CO.INC.(hereafter cailed 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 the w I P Subcontractor for the construction of the BUILDING development known
as NASH BUILDING, located inCARMEL (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 purpose express u
p rpose of Inducing Signature Construction, LLC, to make payment to
Subcontractor in the amount of $ ),;1 I-7.00 representing Payment Application # S dated
a 2-/Lt 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 retalnage, for all services, labor and materials
furnished to, provided for or used in connection with the Development through the data 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$L y,ql�.a o to date.
4.Listed below are all suppliers or other persons who either has furnished or might furnish the Subcontractor with
materiels,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
t ,L (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
MA-TEia I A-L Fe.0 nil at? i n FULL— G.T4
#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 sign=d this document on behalf of the Subcontractor this alAabla of
�UL �{ ,201 . y
(Auth. • •epresen ative of '"'ac or)
County of A) t 0 1� )
State of N b , ANA )
Subscribed and sworn to before me,a Notary Public in and for said County and State, this AA x Allay of
�f)( ,20
(Notary Public) \\\ H.q�'�i,�•
e_05-4 EA-tiro/4(Printed Name) • OTAi�`1. 2
= * SEAL
My Commission Expires: ;y f U 8 L l C
NOTARY SEAL MUST APPEAR ON THIS FORM. yy•. ••