252678 12/15/15 1'..�,A,�f. CITY OF CARMEL, INDIANA VENDOR: 367514
® it ONE CIVIC SQUARE JBM CONTRACTORS CORP CHECK AMOUNT: $***124,113.00*
_� CARMEL, INDIANA 46032 5299 W OLD 106TH ST CHECK NUMBER: 252678
?y,._oN.�; ZIONSVILLE IN 46077 CHECK DATE: 12/15/15
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 32956 4 124,113.00 PALLADIUM LANDSCAPING
A11A Document G732 - 2009
Application and Certificate for Payment, Construction Manager as Adviser Edition
TO(OWNER): City of Carmel Redevelopment Commission PROJECT:The Palladium at the Center for the Performing Arts APPL.NO.: 4 DISTRIBUTION TO:
30 West Main Street,Suite 220 Landscape Package OWNER
Carmel,IN 46032 PERIOD TO: 11/30/2015 CONSTRUCTION MANAGER
CONTRACT DATE: ARCHITECT
FROM(CONTRACTOR): JBM Contractors Corp VIA(CONSTRUCTION MANAGER):Shlel Sexton PROJECT NO.S: CONTRACTOR
5299 W.Old 106th Street 902 North Capitol Avenue FIELD
Zionsville,IN 46077 Indianapolis,IN 46204 OTHER
CONTRACT FOR: Landscape Package VIA(ARCHITECT):CSO Architects
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge.Information
Application Is made for Payment,as shown below,in connection with the Contract. and belief the Work covered by this Application for Payment has been completed In accordance
Continuation Sheet,AIA Document G703,Is attached. with the Contract Documents,that all amounts been paid by t or for Work which
previous Certifications for Pa ment wer d e eceived m the Owner,and that
1.ORIGINAL CONTRACT SUM........................_..................__..........._................... $ 1,243,000 current paymen wnherelr e.
2.NET CHANGES IN THE WORK_............._.___......»...._—».................._.._..... $ 0 CONTRACTOR:
3.CONTRACT SUM TO DATE(Une 1+2)—.......»._.__».._.......»—__..........._.__... $ 1,243,000 BY: DATE: I J
4.TOTAL COMPLETED&STORED TO DATE........____....................................._ $ 1,007,888
(Column G on G703) State of: Inclana EMICHAELHN STUERErIBERGCounty of: Boone5.RETAINAGE: Subscribed and sworn to before �a. 10.0% of Completed Work me this II &/„(DotumnD+E onG703) $ 62,150 b. 10.0% of Stored Material NotaryPubliv'�� n Expires Feb.22,202
(Column F on G703) $ 0 My commission expires: ���i2�ZQTid
Total Retalnage(Line Sa+Sb or Total InColumn IofG703)._......._..................... $ 62,150 CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents,based on on-site observations and the data comprising
6.TOTAL EARNED LESS RETAINAGE......_._......._—_—»............_........................ $ 945,738 this application,the Construction Managerand Architect certify to the Owner that to the best of their
(Line 4less Line 5Total) knowledge,Information and belief the Work has progressed as Indicated,the quality of the Work Is In
accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT
7.LESS PREVIOUS CERTIFICATES FOR PAYMENT..._....................._...................._....... $ 821,625 CERTIFIED.
(Line 6 from prior Cert&ate)
8.CURRENT PAYMENT DUE......................__._.............._._................................ $ 124,113 AMOUNT CERTIFIED......................................._......._..._._........................... $ 124,113
(Attach explanation If amount certified differsfrom the amount applied for.Initial
9.BALANCE TO FINISH,INCLUDING RETAINAGE all figures on this Application and on the Continuation Sheet that are changed to
conform to the amount certified.)
(llhe 3less line 6) $ 297,262
CONSTRUC11ON MANAGER: Shlel Sexton
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS
Total charges approved In ARCHITECT: CSO Architects
previous months by Owner $ $
Total approved this month $ 0.00 $ By: Date:
TOTALS $ 0.00 $ 0.00
NET CHANGES by Change Order $ 0.00 This Certificate 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 rights f the Owner
or Contractor under the Contract.
AIA DOCUMENT G732-2009(formerly G702 Cma-1992)APPLICATION AND CERTIFICATE FOR PAYMENT•CONSTRUCTON MANAGER-ADVISER EDITION I
1992 EDITION•1992•AiA 1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,
D.C.2OD6-5292
Page 2 of 2
CONTINUATION SHEET AIA DOCUMENT G703
AIA Document G702,APPLICATION AND CERTIFICATE FOR PAYMENT,containing APPLICATION NO.: 4
Contractor's signed Certification is attached. APPLICATION DATE: 11/30/15
In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11/30/15
Use Column I on Contracts where variable retainage for line Items may apply. PROJECT NO.S: 0
A B C D E F G H I
SCHEDULED WORK MATERIALS TOTAL
VALUE COMPLETED PRESENTLY COMPLETED
FROM PREVIOUS STORED AND STORED BALANCE
ITEM DESCRIPTION OF ESTIMATED APPLICATION (NOT IN TO DATE % TO FINISH 10.01A
NO. WORK COST (D+E) THIS PERIOD D OR E) (D+E+F) (G:C) (C-G) RETAINAGE
1 Supervision $ 42,000 31,500 5,250 0 36,750 88% 5,250 0
2 Bonds $ 18,100 18,100 0 0 18,100 100% 0 0
3 Contingency Allowance $ 50,000 0 0 0 0 0% 50,000 0
4 Mobilization $ 1,000 1,000 0 0 1,000 100% 0 0
5 Demobilization $ 1,000 0 0 0 0 0% 1,000 0
6 Insurance/Hazcom/Safety $ 2,500 2,500 0 0 2,500 100% 0 0
7 Submittals $ 7,500 7,500 0 0 7,500 100% 0 0
8 Field Engineering $ 10,000 10,000 0 0 10,000 100% 0 0
9 Closeout $ 5,000 0 4,000 0 4,000 80% 1,000 0
10 Misc.General Conditions $ 30,900 23,175 3,863 0 27,038 88% 3,862 0
11 Temporary Walk Protection $ 28,000 20,000 0 0 20,000 71% 8,000 0
12 Temporary Fence $ 10,000 10,000 0 0 10,000 100% 0 0
14 Strip Sod $ 15,000 15,000 0 0 15,000 100% 0 0
15 Subsurface Drains $ 25,000 25,000 0 0 25,000 100% 0 0
16 Concrete Foundations $ 165,000 165,000 0 0 165,000 100% 0 0
17 Masonry $ 305,000 305,000 0 0 305,000 100% 0 0
18 Metal Fabrications $ 15,000 10,000 5,000 0 15,000 100% 0 0
19 Cast Iron Urns $ 160,000 80,000 80,000 0 160,000 100% 0 0
20 Waterproofing $ 30,000 20,000 10,000 0 30,000 100% 0 0
21 Joint Sealants $ 12,000 0 6,000 0 6,000 50% 6,000 0
22 Plant Plumbing System $ 50,000 50,000 0 0 50,000 100% 0 0
23 Electrical $ 120,000 80,000 10,000 0 90,000 75% 30,000 0
24 Irrigation $ 40,000 10,000 0 0 10,000 25% 30,000 0
25 Landscaping $ 100,000 0 0 0 0 0% 100,000 0
26 0 0 0 0 #DIV/01 0 0
27 0 0 0 0 #DIV/01 0 0
28 0 0 0 0 #DIV/0i 0 0
29 0 0 0 0 #DIV/O! 0 0
30 0 0 0 0 #DIV/01 0 0
31 0 0 0 0 NDIV/01 0 0
32 0 0 0 0 #DIV/01 0 0
33 0 0 0 0 #DIV/0! 0 0
34 0 0 0 0 #DIV/01 0 62,150
35
1,243,000 883,775 124,113 0 1,007,888 81.1% 235,112 62,150
AIA DOCUMENTG702 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK
AVENUE,N.W.,WASHINGTON,D.C.20006-5292
G703-1992
AIA DOCUMENT G703 APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA 1992
G703 1992
THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,D.C. 2006-5292
illi!
111�111ik BM
CON i RhcToa i CCRP.
PARTIAL CONDITIONAL WAIVER OF LIEN
WHEREAS, JBM Contractors Corp has pursuant to an agreement with City of Carmel
Redevelopment Commission furnished certain materials, equipment, services,and/or labor for the project known as
The Palladium at the Center for the Performing Arts—Landscape Package located at One
Center Green,Carmel,IN 46032 ;
WHEREAS,the undersigned is duly authorized to execute this Partial Conditional Waiver of Lien for and
on behalf of the subcontractor/supplier;
NOW,THEREFORE, JBM Contractors Corp upon receipt of the sum of $ 124,113 waives
and releases any and all liens or rights of liens, bond claims or statutory rights against the Tenant, Contractor,
Subcontractor,any and all Owners of any title or interest in the real estate upon which the Project is situated(Owner),
the Project and the improvements located thereon or any right against any labor and/or material payment bond it has
or may have on account of any and all materials,equipment,services,and/or labor furnished for or in connection with
the Project through the date of 11/30/2015- 'represents and warrants to Tenant, Contractor, Subcontractor
and Owner that no other person or party has any right to a lien or claim on account of any materials, equipment,
services, and/or labor fumished on or before the Current Date by, to or through the Contractor, and agrees to
indemnify,defend,and hold the Tenant, Contractor,Subcontractor and Owner harmless from and against any and all
liabilities,losses, costs,expenses,including attorney fees,by reason of claims or liens for any materials,equipment,
services, and/or labor famished for or in connection with the Project prior to the Current Date by,through or to the
Contractor including but not limited to claims or liens by the Contractor's subcontractors,whatever tier,suppliers,or
equipment lessors.
JBM Contractors Corp acknowledges that this Partial Conditional Waiver of Lien is given to
induce the payment recited above, and that upon receipt of the Current Payment by the Contractor, this Partial
Conditional Waiver of Lien becomes valid,enforceable and of full effect,and may be recorded.
JBM Contractors Co
Name of Subco a r
Authorized Representative
Senior Project Manager/Estimator
Title
11/30/2015
Date
STATE OF Indiana )
SS:
COUNTY OF Boone )
Before me,a Notary Public in and for said County and State,personally appeared Keith Cochrun who
acknowledged the execution of the foregoing Partial Conditional Waiver of Lien,and who,having been sworn,stated
that the requirements therein contained are true.
Witness my hand and Notarial Seal this day of NO�e�•tl ,20 S
My Commission Expires:MA
TUERENBERG Printed: Michael Stuerenberg
Notary Public SEAL
Notary Public,State of Indiana
My Commission Expires Feb.22,2020
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No.201(Rev.1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
�l� Con�r�C�OrS (orb Purchase Order No.
52.99 V 01� 100 -7q, Terms
Z)6 30N , I A[ �0/ 7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
p0d,kkm la>1as< i n I z� 113 °0
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accor-
dance with IC 5-11-10-1.6.
, 20-
Clerk-Treasurer
20Clerk-Treasurer
VOUCHER NO. WARRANT NO.
f ALLOWED 20
'J bA �U►1+r���arS ����• — IN SUM OF $
52'� 1,! OU OWN
Z°I 4n5y'i«e 1:1V W-7
$ 12.q, 113,to
ON ACCOUNT OF APPROPRIATION FOR
a4
Board Members
PO#or
D PT.# INVOICE NO. ACCT#!TITLE AMOUNT I hereby certify that the attached invoice(s),
or bill(s) is (are) true and correct and that
the materials or services itemized thereon
for which charge is made were ordered and
received except
12--11-2015
Signature
Executive Director
Title
Cost distribution ledger classification if Carmel Redevelopment Commission
claim paid motor vehicle highway fund