2102 CRC Nash Building pay request 10 1
EIAPMEN,
PFD r0
APebh/Private
aTWv Partnership N
CRC
City of Carmel
Indiana
CARMEL REDEVELOPMENT COMMISSION
Disbursement Number#10
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 September 2, 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: rate.:Lit.hedittf
Diana L. Cordray, Clerk-Treasur
30 WEST MAIN STREET, SUITE 220, CARMEL, IN 46032 OFFICE 317.571.ARTS (2787) FAX 317.571.2789
1
CARMEL REDEVELOPMENT COMMISSION
Register of Claims
9/2/2014
Payment Request#10
Amount of Wire
Vendor Address Invoice Description Instructions
720 3rd Ave SW Carmel,IN Pay app 10,Nash garage
Signature Construction Services 46032 $ 1,958.45 construction mgt IF NEEDED
2601 N Arlington Ave
Maxwell Electric Indianapolis,IN 46218 $ 399.64 Pay app 9,Garage&ramp IF NEEDED
2747 N Emerson Ave
Robert Haines Company Indianapolis,IN 46218 $ 61,758.00 Pay app 5,Garage&ramp IF NEEDED
Total: $ 64,116.09
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: $ 64,116.09
((AA-e.) � A/19//1
Director of the CRC Date
APPLICATION AND CERTIFICATION FOR PAYMENT AlA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Nash Garage APPLICATION NO:Application ti'3 l 0 Distribution to:
Carmel Indiana 46032 Signature costs OWNER
ARCHITECT
PERIOD TO: 08/26/2014 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services LLC A
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 0703,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 A 2) $ 156,776.00 r
4. TOTAL COMPLETED&STORED TO $ 153,565.25 / .....____-------c---- Date: S �Z G il 1
5. RETAINAGE: Thomas . oontz,President p /
a. 10 %of Completed Work $ 0 Subscribed an wom to before me this e76 L of O —/L
(Column D+F..on 0703)
b /of Stored Material $ sd. ``?' LINDA G.BUCHANAN
(Column F on G703)
"oTPar' Hdr1CACk
Total Retainage(Lines 5a+5b or sett �dr1I..
Total in Column 1 of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PAYME ' oF,oY:: �)`�° ""lion Expires
August 20,2019
6. TOTAL EARNED LESS RETAI :AGE $ 153,565.25 In accordance with the Contract Documents,based on on-site observations anc Sreare-" '-
(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) $ 151,606.80 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 1,958.45 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 3,210.75 rr
(Line 3 less Line 6) AMOUNT CERTIFIED $ q Sle
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied.Initial all figures on this
Total changes approved A •ication and onthe Continuation Sheet that are changed to conform with the amount certified.)
in previous months by Owner TECT: 1 /
Total approved this Month �� 1 I ~
l Date:
TOTALS $0.00 90.00 Th. ertificate is not ne_otiable. T+ AMOUNT CER IFIED is payable only the
Co+ actor named herein.issuance,. yment and acceptance of payment are without
NET CHANGES by Change Order $0.00 pre dice to any rights of the Owner or Contractor under this Contract.
AlA DOCUMENT G702'APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION•AIA'®1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N W.,WASHINGTON,DC 200063292
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 # 11
8/26/11
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 59,445.80 1,958.45 61,404.25 95% 3,210.75 0.00
156,776.00 0.00 156,776.00 151,606.80 1,958.45 153,565.25 98% 3,210.75 0.00
C
AR Type Document
Application and Certification for Payment
Page 1 of 2
TO(OWNER):City of Carmel PROJECT:CITY CENTER GARAGE APPLICATION NO: 3314-9 DISTRIBUTION
Redevelopment Commission ONE PEDCOR SO TO:
9-54 Parking Garage&Ramp 720 3RD AVE.S.W. PERIOD 70:8/15/2014
IN 46032 CARMEL,IN 46032 OWNER.
__ARCHITECT
FROM(CONTRACTOR): MAXWELL ELI CTRiC VIA(ARCHITECT): _CONTRACTOR
ARCHITECTS
2601 N ARLINGTON AVE
INDIANAPOLIS,IN 46218 PROJECT NO:
CONTRACT FOR:
CONTRACT DATE:
CONTRACTOR'S APPLICATION FOR PAYMENT The Undersigned Contractor certifies that to the best of the Contractors knowledge,information and
Application belief the work covered by this application for Payment has been completed in accordance with the
pplication 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 CONTRACTOR:/lir WELL ELECTRIC
f 501 N ARLINGT VE/�NQIANAPOLIS, IN 46218
3.CONTRACT SUM TO DATE (Line 1 +2) $ 157,244.00
4.TOTAL COMPLETED AND STORED TO DATE $ 157,244.00 i
. // l
By /vt ._ Date: J/.71--P /.;y,
5.RETAINAGE:
Paul Hood / Project Manager
a. 10.00%of Completed Work $ 15,724 40 State of:IN
.
County of Marion
b_ 0.00%of Stored Material ~?! +r-
$ 0.00 Subscribed and Sworn to before me this �,1(,.y' Day of -y 1-
4
Total retainage(Line 5a+5b) $ 15,724 40 Notary Public ;
My Commission Expires:2 Z7. 1 1 / \ Ir' `� i s �
6.TOTAL EARNED LESS RETAINAGE $ 141,519.60 /
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYME 4A
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on "site observations and the data corn-
(Line 6 from prior Certificate) $ 141,119.96 prising the above application, the Architect certifies trier that to the best of the Architect's
knowledge, information and belief the Work ha's.psogressed as indicated,the quality of the work
8.CURRENT PAYMENT DUE . . -. $ 398.64 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) $ 15,724.40 6 f
AMOUNT CERTIFIED $ 3 'r
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all fit gures on this
AppF.-lion and on the ntin-a ion Sheet that are changed to conform t• the a •unt certified.)
Total changes approved in
IE previous months by Owner AR
,•.T /A
��
0.00 0.00 By: /
�.i i .g �J Date:
Total approved this Month 0.00 0.00 This irtificate 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
t
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 Center Garage
PARTIAL WAIVER: that the balance due from the General Contractor is the sum of
Dollars 1 $399.64 )
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 f S 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.
el'
c�c>r�IRR: //^ f t
Hy: A
Printed:Paul 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 St te,this
18th day of Aug ,20l4. ✓ .9
My commission expires: 2/22/20 / � r M ,:
Residing in Hancock Si4atur
2-`)
Pr"trod:tacki Hough "
//NOTARY PURL ' 4.
.y..
f
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: 6 Distribution to:
30 W.Main Street,Suite 220 [OWNER
, Carmel,IN 46032 PERIOD TO: August 31,2014 [ARCHITECT
FROM: VIA(ARCHITECT): ARCHITECTS NO: [CONTRACTOR
(Contractor) Robert Haines Company PROJECT NO: 0
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 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 $199,875
Approved this Month (Column G on G703)
Number Date Approved 5.RETAINAGE:
a. 10 %of Completed Work $19,988
(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) $19,988
Net change by Change Orders 6.TOTAL EARNED LESS RETAINAGE $179,888
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 all amounts have been PAYMENT(Line 6 from prior Certificate) $118,130
paid by the Contractor for Work for which previous Certificates for Payment were 8.CURRENT PAYMENT DUE 861,758
issued and payments received from the Owner,and that current payment shown 9.BALANCE TO FINISH,PLUS RETAINAGE $30.113
herein is now due. (Line 3 less Line 6)
CONTRACTOR:Robert Haines Co. State of: Indiana Count( f:t I I f I 1///,,,, Marion
Subscribed and s own to before me 's day \\'�� u , A "i,�
--- Notary Public: `\.` G, +.•.....••.-.7f? ','
By: Date: August 25,2014 My Commission expires: 4/..-' 9/17/2021 �J
–'� AMOUNT CERTIFIED .... L j — (I
ARCHITECT'S CERTIFICATE FOR PAYMENT �` �
(Attach explanation if amount certified differs from the aglo�tt apR �
In accordance with the Contract Documents,based on on-site observations and the ARCHITECT: –1 '• I'
/4( � ;� ' U6LIC .�Z�
data comprising the above application, the Architect certifies to the Owner that to the / /'•.
best of the Architects knowledge,information and belief the Work has progressed as B . 1�/V2 /1 A -A/ /I Ji,� '„, 0 .'•..Date ,.`
indicated,the quality of the Work is in accordance with the Contract Documents,and This Certificate is no otiable. The Ai •' NT!3' IFIED is•: :bfe oKtls' �1. \\\\\ `
the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractor named h: n. Issuance,payment an:acceptance of payment are wrthdus t I I I I
prejudice to any rig .of the Owner or Contractor under this Contract.
Rev11/16/94
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 6
d
t!
Y
CONTINUATION SHEET AIA DOCUMENT G70,3 Page 2 of 2 pages
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: 6
Contractor's signed Certification is attached. APPLICATION DATE: Aug 25,2014
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Aug 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 (G/C) TO FINISH
PREVIOUS STORED AND STORED (C-G)
APPLICATION (NOT IN TO DATE
(D+E) D OR E) (D+E4f)
1 Submittals,Bonding&Insurance 7,500 7,500 7,500 100% 750
2 Firestopping 146,000 70,080 68,620 138,700 95% 7,300 13,870
3 071700 Bentonite Waterproofing 56,500 53,675 53,675 95% 2,825 5,368
210,000 131,255 68,620 199,875 95% 10,125, 19,988
Ravi 1/18,94
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 6
SUBCONTRACTOR'S SWORN STATEMENT OF
INDEBTNESS&CONDITIONAL WAIVEROFLIEN
)
J t M F'(2- t 1) (i E N Being duly sworn upon his/her oath disposes and says that:
1. He/she Is the P .E`S/ D e— t r (inserting sole proprietor, partner 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 theFieL I'?JjLC-t Subcontractor 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 purpos of inducing Signature Construction, LLC, to make payment to
Su contr tor In the amount of $ - / /58--00 representing Payment Application # (o dated
/ 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$ I I S"4 .(7u 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
(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
T C P. I Or c_ Ftz 0 nrk 'Pr) I N FULL S-7-0
#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 day of
(Auth. =d Representati s retractor)
County of M 2. t O f■ )
State of I M D t A-At Q )
subscribed sn wor2t before me,a Notary Public in and for said County and Slate,this A6-111:day of
(Notary Public) ��'`\> "•' , ''9'�
L 7. 4 P1 . /4714 MON NOrq��,'''.
(Printed Name) 'a • SE ,t T Z _
My Commission Expires: I -17-02
s7 ..
VBLlG
NOTARY SEAL MUST APPEAR ON THIS FORM.
1