2012 CRC Nash Building pay request 02 QE�ELOPMENT
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City.of Carmel
Indiana
CARMEL REDEVELOPMENT COMMISSION
Disbursement Number#2
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
Tom Crowley
Commissioner Dear Kim:
Jeff Worrell On November 12, 2013, 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
Commissioner checks to:
Carmel Redevelopment Commission
Attention: Mike Lee
Les Olds,AIA 30 W Main Street, Suite 220
Executive Director Carmel, IN 46032
City of Carmel, IN
.69-aufe
By:
Diana L. Cord ray, 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
11/12/2013
Payment Request #2
Amount of Wire
Vendor Address Invoice Description Instructions
720 3rd Ave SW Carmel,IN pay app 2,Nash garage
Signature Construction Services 46032 $ 37,101.14 construction mgt IF NEEDED
2601 N Arlington Ave
Maxwell Electric Indianapolis,IN 46218 $ 33,256.80 Pay app 1,Garage&ramp IF NEEDED
Total: $ 70,357.94
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: $ 70,357.94
,./ )4, ,//°l,° '/
Director`of the CRC Date
L4 Nik_
AIAType Document
Application and Certification for Payment Page 1 of 2
TO(OWNER):City of Carmel PROJECT: Parking Garage and Ramp APPLICATION NO: 3314-1 DISTRIBUTION
Redevelopment Commission ONE PEDCOR SQ TO:
9-54 Parking Garage&Ramp 720 3RD AVE. S.W. PERIOD TO:10/15/2013 _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
RECEIVED OCT 2 1 2013
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 CONTRACTOR MAXWELL ELECTRIC
01 N ARLINGTON/ E IN IANAPOLIS, IN 46218
3.CONTRACT SUM TO DATE (Line 1 +2) $ 157,244.00 / (
4.TOTAL COMPLETED AND STORED TO DATE $ 36,952.00 By. 1C� Date: /t1/./ /3.
J
Paul Hood I Project Manager
5.RETAINAGE:
a. 10.00%of Completed Work $ 3,695.20 State of: IN
County of Marion '
b. 0.00%of Stored Material $ 0.00 Subscribed and Sworn to before me this
g.1.--
Day of A„„IfirPrIi‘ 3 Mk
tit . Y 4
5a+5b Notary Public:
Total retainage(Line , ^
g { ) $ 3,695.20 ,r
My Commission Expires: Z'27,1w 6 • t •.i t`. 'DV IF t°)
, lope
6.TOTAL EARNED LESS RETAINAGE $ 33,256.80 *
(Line 4 less Line 5 Total) ARCHITECT'S CERTIFIC A E R PAYM ' IN .' P
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract.Documents, b-sed o on-site observations and the ad to corn-
(Line 6 from prior Certificate) $ 0 00 prising the above application, the Architect certi ie o 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 $ 33,256.80 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the
9.BALANCE TO RETAINAGE FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED. /
(Line 3 less Line 6) $ 123,987.20 AMOUNT CERTIFIED $ 33Zs6.80
(Attach explanation if a ,L. •;i. ified differs from the amount applied. Initial all figures on this
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Application and o e Contin) ion Sheet that are changed to conform to the amount certified.)
Total changes approved in 1
9 PP ARCHITECT:
previous months by Owner 0.00 0.00 By: ` ,I
Date: (C17- 4 3
Total approved this Month 0.00 0.00 This Certificate is of negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
named here . =uance, 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
SUBCONTRACTOR'S AND SUPPLIER'S AFFIDAVIT,
WAIVER OF LIEN
AND AGREEMENT FOR INDEMNIFICATION
FINAL XX PARTIAL
Paul Hood being duly sworn stated the following:
Name of Subcontractor or Supplier: Maxwell Flectric
Name of General Contractor: Signature Construction
Project Location: Kroger J933
PARTIAL WAIVER: that the balance due from the General Contractor is the sum of
Dollars (" $4.966.74 )
receipt of which is hereby acknowledged;or
XX 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.
CONTRACTOR
By:
did
Printed: / / OW
Title: Project Manger/Agent
STATE OF Indiana
)SS:
COUNTY OF Marion )
Subscribed and sworn to before me,a Notary Public in and for said County and State,this 18th
day of October ,2013. nxP :
My commission expires: 2/22/20 I
AP
SEAL, o•
Residing in Hancock County,IN Sig ature �#
Pri ted: Jacki Hough
OTARY PUBLIC A
:,j
APPLICATION AND CERTIFICATION FOR PAYMENT AAA DOCUMENT G702 PAGE ONE OF 2 PAGES 2
TO OWNER CRC at City of Carmel PROJECT: Nash Garage APPLICATION NO:Application 5 2 Distribution to:
Carmel Indiana 46032 Signature costs OWNER
]ARCHITECT
PERIOD TO: 10/25/2013 X CONTRACTOR
FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design
Signature Construction Services LL,C
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 I f 2) S 156,776.00
4. TOTAL COMPLETED&STORED TO S 108,960.90 / j
B . J Date: AQ Z t,
5. RETAINAGE: Thomas II, oontz,President ._
a. 10%of Completed Work $ 0 subscribed an.sworn to before me this 7 3 day of /t7 //3
(Column D+E on G703) 'P LINDA G. k C County
b. %of Stored Material $ _:neunv:- Hancock County
Column F on G703 . sEAL.?;= My Commission Expires
Total Retainage(Lines 5a+5b or " "' N;` August 20,2019
Total in Column l of G703) $ 0,00 ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ 108,960.90 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) $ 71,859.76 the quality of the Work is in accordance with the Contract Documents,and the Contractor
8. CURRENT PAYMENT DUE $ 37,101.14 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 47,815.10
(Line 3 less Line 6) AMOUNT CERTIFIED $
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 onthe Continuation Sheet that are changed to confirm with the amount cert fed.)
in previous months by Owner ARCHITECT:
Total approved this Month By: Date'
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CER'T'IFIED is payable only to the
Contractor named herein,Issuance,payment and acceptance of payment are without
NET CHANGES by Change Order 50.00 prejudice to any rights of the Owner or Contractor under this Contract.
AtA 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 # 2
10/25/13
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 RETAINAG
General Conditions 92,161.00 92,161.00 57,644.46 34,516.54 92,161.00 100% 0.00 0.01
Construction Management Fee 64,615.00 64,615.00 14,215.30 2,584.60 16,799.90 26% 47,815.10 0.01
156,776.00 0.00 156,776.00 71,859.76 37,101.14 108,960.90 70% 47,815.10 0.01