2012 CRC Nash Building pay request 12 090fIOPMEN, co
A PUbIi�l Private 33
Fm P,nnersnly v�
4
CRC z
City of Carmel
Indiana
CARMEL REDEVELOPMENT COMMISSION
Disbursement Number#12
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:
Carrie Meyer On February 5, 2015, 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
, 3 — t 411,1. i .,,,. _
.664E44)
Y:
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
2/5/2015
Payment Request #12
Amount of Wire
Vendor Address Invoice Description Instructions
2747 N Emerson Ave Pay app 8-retainage,
Robert Haines Company Indianapolis,IN 46218 $ 21,000.00 Garage&ramp IF NEEDED
Total: $ 21,000.00
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: $ 21,000.00
qs / is-
Director of the CRC Date
:r
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 Page ONE oft pages
TO(OWNER): Carmel Redevelopment Commission PROJECT: CCC-Parcel 9-54 Garage&Rar APPLICATION NO: 8ret Distribution to:
30 W.Main Street,Suite 220 nOWNER
Carmel,IN 46032 PERIOD TO: January 30,2015 nARCHITECT i
FROM: VIA(ARCHITECT): ARCHITECTS NO: 1 IOONTRACTOR
(Contractor) Robert Haines Company PROJECT NO: El
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 $210,000
Approved this Month (Column G on G703)
Number Date Approved 5.RETAINAGE:
a. %of Completed Work
(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)
Net change by Change Orders 6.TOTAL EARNED LESS RETAINAGE $210,000
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) $189,000
paid by the Contradu,for Work for which previous Certificates for Payment were B.CURRENT PAYMENT DUE $21,000
issued and payments received from the Owner,and that current payment shown 9.BALANCE TO FINISH,PLUS RETAINAGE
herein is now due. (Line 3 less Line 6)
CONTRACTOR:Robert Haines Co. State of: Indiana County of: s IMaridrtl l its,
Subscribed and awn topefore me hr day Jan 14,2015 ,,N.\\' H �00,
Notary Public . ? � •�` P. ,. ....,'71.4?, ,''■By: Date: January 14,2015 My Commiss expires: 9117/2 N - 0',
r __'-- AMOUNT CERTIFIED ,t [10T,$�F t —'r'�
ARCHITECTS CERTIFICATE FOR PAYMENT (Attach explanation if a •, n,oertifi:: .h ei frvn the amount applied fora * . ��.[-1. a
In accordance with the Contract Documents,based on on-site observations and the ARCHITECT: =-S.- PUBLIC .:Z
data comprising the above application, the Architect certifies to the Owner that to the 1�' -q i
best of the Architect's knowledge,intonation and belief the Work has progressed as �' - ..,
indicated,the quality of the Work is in accordance with the Contract Documents,and This Certificate is Qof negotabl.. Th:AMOUNT CER"TrE0 is pa.ble only to the '.i, hi co .'
the Contractor is entitled to payment of the AMOUNT CERTIFIED. Contractor named�iereln. Issu.rice,payment and acceptance of payment are without '� c 11/r,;4,s,,s ss`��\
prejudice to any rig of the ner or Contractor under the Contract
t_....1 Revivt8/54 J.
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 8 ret
T./
CONTINUATION SHEET AIA DOCUMENTG703 Page 2 of 2 pages
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NUMBER: Bret 1
Contractors signed Certification is attached. APPLICATION DATE: Jan 14,2015
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Jan 30,20151
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 f
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCES RETAINAGE
NO. VALUE FROM THIS PERIOD PRESENTLY COMPLETED (GiC) TO FINISH!
PREVIOUS STORED AND STORED (C-G)
APPLICATION (NOT IN TO DATE i
(04E) D OR E) (D*E+F)
1 Submittals,Bonding&Insurance 7,500 7,500 7,500 100%
2 Firestopping 146,000 146,000 146,000 100%
3 071700 Bentonite Waterproofing 56,500 56,500 56,500 100%
210,000 210,000 210,000 100%
Rev11!1a194
AIA 13C275 CCC Parcel 9-54 Garage&Ramp 8 ret
SIJBC RACT R' SW N EM N QF
1NDEBTf�SSS&CONDITIONAL I AIVEROF LI N
_..___ --- (:0 Being duly sworn upon he /heroath disposes and says that:
1. He/she is the TR a f i,?j T•— (inserting sole proprietor, partner or corporate office held, as the case
maybe),of ROBERT HAINES CO.INC. (hereafter called the"Subcontractor").Helshe is over the age of twenty-one.
He/she is authorized to make this affidavit on behalf of Subcontractor.
2. Subcontractor Is the i-iiae r-d P 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 purpose of inducing Signature Construction, LLC, to make payment to
Subcontractor in the amount of $ a.I,Odes )0 representing Payment Application # g e - dated
I—/N•—/6"' 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$1.101406,00 -{b ate.
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
ULt.(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
0 s vim, (15tc p
#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
,20
(Authorii s n e of
County of Llr t b )
State of
S ��bed and�swo to before re me,a Notary Public In and for said County and State, this PA.day of
/ (Notary P silo) ti NOTARY '.p
SEAL
(Printed Name) —
�F•�'_ p�1BLiG
My Commission Expires:
NOTARY SEAL MUST APPEAR ON THIS FORM. � o"