ST9502-CS 960130 (2)Application And Certificate For Payment Pa,elof, Pages
Project:
(Name)
(Address)
To (Owner):
(Name)
(Address)
Attn:
Architect:
WENDY'S OFF-SITE IMPROVEMENTS (9520-A)
112 North Denton Tap Architect's Project No:
Coppell, TX 75019
WENDY'S INTERNATIONAL, INC.
4545 Fuller Drive, Suite 404
Irving, TX 75038
Mr. Tim West
Contractor:
Change Order Summary
.C~f§ appproved by wOwn~
in prewous months-
TOTAL:
qumber I Ap, grqv,ed
taare)
1 12-06-95
2 ~ 12-19-95
TOTALS
Deduction
$0.00
Additions
$943.00
$385.00
. ~,328.~0
Net change by Change Orders ..................... $1,328.00
State of: Texas _ County of: Tarrant
WENDY'S INTERNATIONAL, INC.
Landmark General Contractors, Inc. /';;;'& ...........
Contract For:
Wendy's Restaurant CG3480, Rev. 5
Application Date: 12-27-95 Application No: 2
Period From: Dec. 5 ,1995 To Dec. 27 ,19 95
~pp!icatjo~s m, a, de f_or paym, e..nt, as shown b. elow, n ,con, nect on with the
omrac[. ~uioefine uid Ano ~ayment Sheet, is attacneo.
The present status of the account for this Contract is as follows:
Original Contract Amount ....................................
Net change by Change.Orde~,,_~^.T.~ ./.-~.-..~.~ ....
I,.,d~ ..,.~~ P.O.# ~
Contract Amount To D~t%
I: ' F'! .,~ ~',~L ....................................
Total Completed to Date.~. <c,",',_ . ...................................
(Column E)
Retainage 10 %~ ~'~';v'c'~c~'~s'~;;'-'-"-'%'"--~",'"'"'""------~ ..........
or as noted in Columr~c~sf, r~,~ ;H,~N PUF~CHAdE ORDER
$461,259
$1,328
$462,587
$244,763
$24,476
The undersigned Contractor certifies that: the Work Covered by this Applicatio Total Earned Less Ret4inag~DW~L .................................... $220,287
for Payment has been completed in accordance with the Contract Documents:
all amounts have been paid by him for work for which previous Applications Less Prior Applications For Payment .............................. $105,963
forPayments were issued and payments received from the Owner; and the
current payment as shown herein is now due. Current Payment Due .................................... $114,324
Contractor: LANDM/3~ GENERAL CONTRACTORS, INC. Suscribed and s~?rn' ts,bef?re n~.his 27th day of December 19 95
('~ "~ _ . Notary Public: ~;;;F~-/Y~ ~
By: ~,~ /t~~ Date: 12-27-95 My Commission expires: 04-11-97
Gary Gracey, as Pr~ide~t of~A~GENERAL CO~~ INC.
nn~ccordance with'the (Jontract andlliig Allfiplicatic~-~e~~a~,~~n abo~e -- - '
Architect:
By:
This Certificate is not negotiable and is payable only to the named payee and its issuance, the payment and acceptance thereof are without prejudice to any right of the Owner or Contractor
under the Contract
(~~/FINAL WAIVER OF LIEN (Strike oul inapplicable word)
9520-A
TEXAS
STATE ol TARRANT )
COUNTY o! )
SS:
To all whom it may concern:
by
WHEREAS, the undersigned
WENDY'S INTERNATIONAL, INC.
(General Contractor)
the GENERAL CONTRACT WORK (OFF-SITE IMPROVEMENTS)
LANDMARK GENERAL CONTRACTORS, INC.
has been employed
to furnish labor and/or materials for
for the Project
at
112 NORTH DENTON TAP
(Address)
(Nature of Work)
in
NOW, THEREFORE, for and in consideration of
and other valuable considerations, the receipt whereof is hereby acknowledged, the undersigned do(es) hereby
waive and release any and all lien or claim or right ct lien on the above describ.ed premises and the improvemenls
thereon, under the statutes of the state in which the aforesaid Project is located relating to mechanics' liens,
and on the monies or other consideration due or to become due from the Owner, and an account of labor
or materials, or both, or that may be furnished by the undersigned to or on account of the said individual or
firm therein named for the said premise or improvements.
COPPELL, DALLAS COUNTY, TX
(City, County and S~ale)
$18,498.39
DOLLARS
27th DECEMBER 95
19--
lhis d~v of
Given ~ 'GENE/~CONTRACTORS,~ / INC..
My Commission Expires April 11 ,19 97 //~
BY Gary Grace~, as President of /
LANDMARK GENERAL CONTRACTORS, INC.
NOTE: Alt waivers must be for the full amount paid. If waiver is for a corporation, corporate name should be
used; corporate seal affixed and title of officer signing waiver should be set forth; if waiver is for a partnership,
the partnership name should be used, partner should sign and designate himself as partner.
Guildline Bid And Payment Sheet
In computations below, round to nearest dollar.
LM #: 9520-A
Page,,~ of 4
Submittal Number:
Store Number:
Item Scope of Work to Include I Bid Value WORK COMPLETED Total Complete Balance Retainage
Previous Draw This [~raw To Date To Finish
A a C D E(C+D) % F(B-E) G
Site Work
1 Decel/RightTurn Lane $301072100~ '..__i~ ~$12'i00100 $121~i00 40%~I~ $i719~2100 / $~
2 South Roadway Paving $23,200.00 $21,000.00 $21,000.00 91%/~1~ $2,200.00 / $2,100
3 8" Water Line & Fire Hydrant $14,637.00 $14,637.00 $14,637.00 100%~ $0.00 '~ $1,46~4
4 Excavation & Grading
A. Cut , .
B. Fill
5 Spine Road and Storm ~60,644.00 $15,500.00 $15,500.00 10%~'~$145~4.00 $1,550
6 8" Sanitary Sewer ' $~:~,526.00 $48,000.00 $48,000.00 66%~j, $2741526.00 $4,800
7 Town Center Blvd. $16~,~ ~0.00 .... _$6_,_5_00.00 $6,500.00 4%;~1 $'i',~3,680.00 $650
8 Asphalt Curb
__. -_~ Concrete Walks
A. City
__ B. Building .- I .....
10 Approaches
A. Concrete
B. Asphalt
11 Asphalt Paving
12 Concrete Paving
13 Lot Striping
14 Trash Enclosure
15 Parking bumpers
16 Fencing/Screening
Site Electrical
17 Electrical Service I
18 Sign Conduit
19 Phone Conduit
20 Site Lighting
21 Transformer Pad__ I ~= - .... ~',~ ·
Site Plumbing
22 Sanitary Sewer
23 Grease Trap
24 Storm Sewer
A. Manhole(s)
__- j B. Catch sasin(s~
Guildline Bid And Payment Sheet
I'n computations below, round to nearest dollar.
LM #: 9520-A
Page .~ of 4
Submittal Number:
! ~[ore mumDer:
Item Scope of Work to Include Bid Value I WORK COMPLETED Total Complete I Balance
~PrevTO~US Dra~ Ynis Draw To Date To Finish
A a C D E{C+D) % FIB-E)
C. 6"- 8"
D. 10"- 12"
E. 18" - 24"
25 Water Service
26 Gas Service
27 Utility Extensions
2~ Decel/Excel Lane - .
29 Miscellaneous ~
A. Irrigation Sleeves
B. Clean/Dumpster
C.
Building
1 Concrete Foundation
2 Building Slab
3 Masonry
4 Structural Steel
5 Roof Joists
6 Joist Installation
7 Rough Carpentry
A. Material
B. Labor
8 Finish Carpentry
B. Labor
9 Walk-In Installation
10 Fascia Panel Installation
1__1 Building Insulation
12 Roofing & Flashing
13 Alum. Storefornt & Glaze --
14 Pick-Up Window
15 Metal~D~oor, Fra~me,~Hardwa~re_ __
Guildline Bid And Payment Sheet
In computations below, round to nearest dollar.
LM #: 9520-A
Page ..~'of 4
Submittal Number:
Store N~
Item Scope of Work to Include I. Bid Value [ WORK COMPLETED Total Complete Balance Retainage
Previous ura~l , his uraw To Date To Finish
A i B C D E{C+D) % F(B-E) G
16 Marlite Doom, Frames, _Hardw are
17 Door Hardware
1~ Drywall --
19 Acoustical Ceiling
20 Ceramic Tile
2~ Quarry Tile '
22 Decorator Tile -
23 Carpet Installation
24 Wallpaper Installation
25 Painting & Staining
26 Toilet Part, & Access.
Mechanical
27 Plumbing
28 Electrical -
29 Service Panel
30 HVAC-Incl. Hood Installation --
31 Refrig. Installation
Miscellaneous
32 Comunication System
33 Other (Specify)
A, Clean/Dumpster
B. Window Shades
C. Stainless
D. Chases/Ladder
TotalSite $461~259.00 ~;0.00 _$117,737.00 $117,737.00 26%-- $343,522.00 $11,774
Total Building
Supervision & Overhead -- '
Profit
_ Total Building & Site $461,259.0~ _ $0.00 $117,737.00 Si 17,_737.00 2~% $343,522.00 $11,774
Total $461,259.00 $0.00 $117,737.00 $117,737.00 26% $343,522.00 $11,774
zo
o~
o~
0
m
·
0 0
z Z O ~
ITl O I'n
0 0 O, z 0
-I ;e :z) m
~ " O " Z
L C
133
OO z
0~0~00
~ZO~
~0 0
o
0
0
e_oZo
OO
0
<
0 0 ;0 --
Z Z 0 -4 :3>
0
> ~ ~ o~
~ " 0 " Z
m
0
~0 z
0~0>00
~mZO~H