CF-Fire Station 2-CS 970815STATE OF TEXAS §
§ SWORN STATEMENT OF ACCOUNT
COUNTY OF DALLAS §
BEFORE ME THE UNDERSIGNED AUTHORITY on this day personally
appeared J.D. Green, who, after being by me duly sworn did depose and say:
1. "My name is J. D. Green, I am the President of Metro Custom Concrete
and am over the age of 18 and authorized to make this affidavit and I have personal
knowledge of the statements contained herein and they are true and correct;
2. "Metro Custom Concrete has an outstanding and unpaid claim in the
amount of $28,072.30 for labor and/or materials provided to Schoelerman
Incorporated d/b/a Boyd Construction, the prime contractor, at intervals beginning
August 1996 through July 1997.
3. "The amount of Metro Custom Concrete's unpaid account for which
this claim is filed is just and correct and all just and lawful offsets, payments and
credits known to the undersigned have been allowed.
4. "The above amount includes contractual retainage in the amount of
$28,072.30 which is now due.
5. "Attached hereto are true and correct copies of the original invoices on
which the above-described claim is based.
METRO CUSTOM CONCRETE
By: ~D. ~oreenj President
SUBSCRIBED AND SWORN TO BEFORE ME on this ]~-u.- day of August,
1997.
~..-.."-*~"~'~'-'~-"--~-',~ Notary Public in and for the State of Texas
~ ~. ~/ ,~ ~n~ NO~ ~blic ~
METRO CUSTOM CONCRETE
P.O. Box 1169
Rowlett, Texas 75088-1160
(972) 412-2567
Fax: (972) 412-8027
STATEMENT OF ACCOUNT
Date Description Amount
07/25/97 Pay Application #8 (Retainage) $27,701.30
04/18/97 Request for Change Order (Retainage) 371.00
TOTAL AMOUNT DUE, OWING AND UNPAID: $28,072.30
EXHIBIT A
COPPELL FIRE STATION #2 & #3
SUBCONTRACTOR'S APPLICATION FOR PAYMENT
PAY REQUEST NI.FMBER Eieht INVOICE #
Subcontractor: Metro Custom Concrote
LQ: Box ! 169
Rowlett. Texas 75088-1160
Phone: 972-412-2567 Fax: 972-412-8027
Period: 6-25-97 to 7-25-97
I. Original Contract Amoum $253,000.0_0
2. Net Change by Ch;rage Order (see C O. sum below) $ 24.013.00
3. Co.tract Sum to Date {add Lines i mid 2) $277.013,00
4, Total Complete & Stored to Date % $ 277 013 00
5, Rctamage (multiply Linc 4 by 10%) $ 4__:
6. Total 'Earned Lc~s Retaumge (Line 4 minus Line 5) $277.013,00
7. Less Previous Application for Payanent (Line 6 fi'om Prior Application) $249,311.70
8. Current Payment Duc (Line 6 Minus Line 7) $ 27,701.30
9. Balance to Finish (Linc 3 Minus Line 6) $ -O-
Change Order Summary
CO#1 15,488.00 C O #2 _~,525.00 CO#3 CO#4
CERTIFICATE OF SUBCONTRACTOR.
I hereby certify that thc work pcr£onned and Ihc ,nalcrials supplied to date represent rite actual value of
uccu.,plishmcnt under the ternm of tim Conlracl bclween thc undersigned and lloyd Construction relating
Io the above referenced project, I also certify ttmt I have paid in full or have oflmrwise satisfied all
ol>ligations, through the period covered tn/ previous paymcnl$ received from Ihe conlractor, for all
materials and ~uipmem fumishcd, for all work, labor, and services performed, and for all known
indebtedness and claims again.~t Ibc Contractor for damages arising in any nmnner in cotmeetion with the
peffornmnce or fl~c Contrac~ referenced above for which the Owner or his property mighl in any way I~
held responsible. I l%rther certify I have complied with Fodcml, Slate and local lax laws, including Social
Sccurily laws and Uacmploymcm Compensalion laws and Workanea's Compet~ation laws inso£ar as
applic~able Po thc p~fformance of this Conlracl.
SUBCONTRACTOR ~'t-.~-.,.6 /~///~.
N~ EXHIRIT ~4 {CONTI~ ^¢ ~T~R~S AI~iDAV[1. AND C(iNi)fi-iONAi. WAiVi.:R OF LiEi~r) lvliJ~T B~ ArTACHT~D ~ ~3 ~LiCATiQ~
File 9609_a.doc
AUG-16-S7 THU 7:59 PM ~ 9
CU,STO~A CO~ICRETE
P,O, BOX 1169
RO~YL~TT, Tf;~S 7.50,3~-1160
Phone: 214-412-2567 Fa~: 214-412-8027
SubdUed To:
~ch~fl Sch~le~ : 'April 18, 1997
Boyd Cons~cfion Co ~ Coppeli Fire~ati0n g2 & 3
1110 W. H~s S~te 126 Mac~ n~ Condor
~lingon, Tex~ 76017 To,me Center & P~ay
Ph: M817467-2525 Cop~ll, Texas
Fmx: 817468-9665 Arclfitect:
~e following ch~ges have been requested:
1. Hose Tower Fo~fion: 5' x 5' x 7' deep (Includes excavation) $1,380.00
2. PSA ~9 fflme instaHafion, includes c~b demo) $ 650.00
3. Remove ~d replace concrete in approach fo(b~ck pavers $1,680.00
Tot~ of Adjustments made by this change order Add $3.710.00
Note: Prices for a~ve items ~e valid oily ff ~1 ite~ ~e done at stone time.
Sincerely,
Dems Hoppe
Es~nator