181468 01/19/2010 11±, CITY OF CARMEL, INDIANA VENDOR: 363784 Page 1 of 1
ONE CIVIC SQUARE POYNTER SHEET METAL
k., itt'of CARMEL, INDIANA 46032 8768 N STATE ROAD 37 CHECK AMOUNT: $11,949.00
BL O OMINGTON IN 47404 q
T CH ECK NUMBER: 181 68
CHECK DATE: 1/19/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 16 11,949.00 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 11/01/09 to 1//30109
Subcontract: 2695 -4310 4310 HVAC Sheet Metal
Job: 2695- Carmel RPAC Construction Vendor: 4744 POYNTER SHEET METAL
777 3rd Ave. SW
Carmel, IN 46032
Contract To Date This Period
Item Units UM Unit Cost Amount I Units/% Amount Units!% Amount
1 4310 HVAC Sheet Metal LS 3,345,500.0C 67.42% 2,255,685.00 3.35 111,949.00
4 RCP No. PAC -010 Fire LS 19,219,OC 100.00% 19,219.00 0.00 0.00
Damper Substitution
7 4310 HVAC Sheet Metal LS 19,219.00 100.00% 19,219.00 0.00 0.00
Total Contract Items 3,345,500.0C 2,255,685.00 111,949.00
Change Orders
2 SSC -1079 ASI -037 Suppl't LS 13,699.0C 100.00% 13,699.00 0.00 0,00
1 Bsmt Warm'g Kitchen 034
rev'ns
3 CCR -1048 RCP -006 Suppl't LS 24,843.00 30.19% 7,499.00 0.00 0.00
1 Box Tier catering space
rev'ns
6 SSC #1141 CCR #1066 LS 19,219.00 80.00% 15,375.00 0.00 0.00
RCP No. PAC -010 Alternate
Fire Damper
Total Change Order Items 57,761.00 36,573.00 0.00
Subcontract Totals: 3,403,261.00 2,292,258.00 111,949.00
Total Billings: 2,292,258.00 111,949.00
Unpaid Retainage: 170,163.05 0.00
Discounts: 0.00 0.00
Net Billings: 2,122,094.95 111,949.00
98 SSC CMa Projects Page 1 11/19/09 12:01:12 PM
Date Format MM/DD/YY SLSubBiflingReport .rpt
SL Subcontract Billing Report
For Work Invoiced From 11/01/09 to 11/30/09
Subcontract: 2695 -4310 4310 HVAC Sheet Metal
Job: 2695- Carmel RPAC Construction Vendor: 4744 POYNTER SHEET METAL
777 3rd Ave. SW
Carmel, IN 46032
Contract To bate This Period.
Item Units UM Unit Cost Amount Units!% Amount Units Amount
1 4310 HVAC Sheet Metal LS 3,345,500.00 67.42% 2,255,685.00 3.35 111,949.00
4 RCP No. PAC -010 Fire LS 19,219.00 100.00% 19,219,00 0.00 0.00
Damper Substitution
7 4310 HVAC Sheet Metal LS 19,219.00 100.00% 19,219.00 0.00 0.00
Total Contract Items 3,345,500,OC 2,255,685.00 111,949,00
Change Orders
2 SSC -1079 ASI -037 Suppl't LS 13,699.0C 100.00% 13,699.00 0.00 0.00
1 Bsmt Warm'g Kitchen 034
rev'ns
3 CCR -1048 RCP -006 Suppl't LS 24,843.0C 30.19% 7,499.00 0.00 0.00
1 Box Tier catering space
rev'ns
6 SSC #1141 CCR #1066 LS 19,219.0C 80.00% 15,375.00 0.00 0.00
RCP No. PAC -010 Alternate
Fire Damper
Total Change Order Items 57,761.00 36,573.00 0.00
Subcontract Totals: 3,403,261.00 2,292,258.00 111,949.00
Total Billings: 2,292,258.00 111,949.00
Unpaid Retainage: 170,163.05 0.00
Discounts: 0.00 '0.00
Net Billings: 2,122,094.95 111,949.00
98 SSC CMa Projects Page 1 11/19/09 12:01:12 PM
Date Format MM /DD/YY SLSubBillingReport .rpt
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION
AIA DOCUMENT G7O2 /CMa PAGE ONE OF 4 PAGES
TO OWNER: PROJECT: Parcel 7A. Regional Performing APPLICATION NO: 16 Distribution to:
Cannel Redevelopment Commission Arts Center nOWNER
One Civic Square PERIOD TO: 11/30/09 nCONSTRUCTION
Carmel. IN 46032 PROJECT NO: 2695 -4310 MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Shicl- Sexton Co,, Inc. (PSM 414065) nARCHITECT
POYNTER SHEET METAL ATTN: Lynda Weaver, 902 N. Capitol Avenue. Indianapolis, IN 46204 CONTRACT DATE: 04/18/08 n CONTRACTOR
8768 N. STATE R.D. 37 VIA ARCHITECT:
BLOOMINGTON. IN 47404
CONTRACT FOR: Bid Package #4310 HVAC Sheet Metal
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.
I. ORIGINAL CONTRACT SUM 3,345,500.00
2. Net change by Change Orders 51,761.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line I 2) 3,403,261.00
4. TOTAL COMPLETED STORED TO DATE 2,292,258.00
(Column G on G703) By: Date: ////3/O 9
5. RETAINAGE: 5% of Contract Total Joseph R. ansde 1• -nt
a. 5 of C6mpleted- aAtork 170,163.05 State of: IN D' NA County of: MONROE 0052
(Column D E on G703) Subscribed and s o ore is y day of {/j? c2
b. 10 of Stored Material 0.00 Notary Public: t (7 Z `"'Y
(Column F on G703) My Commission expires: August 29, 2014
Total Retainage (Lines 5a 5b or
Total in Column 1 of G703) 170,163.05
6. TOTAL EARNED LESS RETAINAGE 2,122,094.95 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 rota!) 5 comprising this application, the Construction Manager and Architect certity to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) 2,010,145.95 progressed as indicated, the quality of the Work is in accordance with the Contract
8. CURRENT PAYMENT DUE 111,949.00 Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE 1,281,166.05 1 q `Gj C�
1 1
(Line 3 less Line 6) AMOUNT CERTIFIED A l
1 1 1 1 1 1 1 1 1 (Attach explanation if amount certified differs from the amount applied for. Initial all
Total changes approved figures on this Application and on the Conlin r Sheet that changed to conform to the
in previous months by Owner $57,761.00 amount certified.
CO TRUC
T IJ i 111 ER: 1
Total approved this Month $0.00 By:
AR ..rr Date: 1 0
t r i i
TOTALS $57,761.00 $0.00 By a Date: 1 l 3 f
NET CHANGES by Change Order $57,761.00 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 of the Owner or Contractor under this Contract.
A1A -.6 1. 1 .a••.• •...I I• 0. r 0. i. ._.I. I.• j1:: •.p +a
t, THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W.. WASHINGTON. DC 20006 -5292
y Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
x
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k.
5.
AFFIDAVIT
State of Indiana 8/31/2009
14065 -13
County of Hamilton
The Afflant, Joseph R. Lansdell being first duly sworn, on oath deposes and says that he /she is an Authorized Representive Poynter Sheet Metal, Inc.
who has a Contract with THE CITY OF CARMEL, under its Owner Agreement with Carmel Redevelopment Commission for the project known as
v.
Carmel Performing Arts Center to provide all labor, material, equipment, supervision and insurance as required to complete all Sheet Metal Bid Package
on the following described premises in said County, to wit: 777 Third Avenue SW, Carmel, IN 46032
That for the purpose of said Contract, the following persons have been contracted with and have furnished, or are furnishing and preparing materials for and have performed or are
performing labor on said improvement; that there is due and to become due them, respectively, the amounts set forth opposite their names for materials or labor as stated; that this statement
is made to said Owner for the pupose of procuring from said Owner Partial Payment on said Contract; and this is a full, true and complete statement of all
such persons, and of the amounts paid, due, and to become due them.
NAME AND ADDRESS CONTRACT BASE EXTRAS REVISED TOTAL AMOUNT OF BALANCE TO 'c x
I FOR CONTRACT TO CONTRACT PREVIOUS THIS COMPLETE
AMOUNT CONTRACT AMOUNT REQUEST REQUEST
Validated Custom Solutions Equipment 474,900.00 3,281.00 478,181.00 456,100.00 22,081.00 xr_
Pinnacle Equipment Co., Inc. Equipment 257,500.00 1,639.00 259,139.00 133,292.00 125,847.00
JM Farrell Company Insulation 50,630.00 50,630.00 50,630.00.;
Cardinal Contracting Co. Millwrights 16,550.00 16,550.00 16,550.00
Poynter Sheet Metal, Inc. Sheet Metal /HVAC 2,545,920.00 52,841.00 2,598,761.00 997,818.90 17,922.05 1,583,020.05'
TOTALS 3,345,500.00 57,761.00 3,403,261.00 1,587,210.90 40,003.05 1,776,047.05
s
AMOUNT OF ORIGINAL 3,345,500.00 TOTAL AMOUNT REQUESTED 1,797,377.00 s',
CONTRACT
EXTRAS TO CONTRACT 57,761.00 LESS 5% of CONTRACT RETAINED 170,163.05
TOTAL CONTRACT EXTRAS 3,403,261.00 NET AMOUNT EARNED 1,627,213.95 i
CREDIT CREDIT TO CONTRACT AMOUNT OF PREVIOUS 1,587,210.90
PAYMENTS
NET AMOUNT OF CONTRACT 3,403,261.00 AMOUNT DUE THIS PAYMENT 40,003.05
BALANCE TO COMPLETE 1,776,047.05
11 is understood that the total amount paid to date plus the amount requested in this Application shall not exceed 53 of the Cost of the Work completed to date. I agree to furnish
Waivers of Lien for all materials under my Contract when demanded.
iri i
SIGNED: i `V-
i Signatory Joseph R. Lansdell, President
For: Poynter Sheet Metal, Inc.
Subcontractor Name
Subscribe and sworn to me thi NOTARY PUBLIC: 4,, .�L EL E IRDWEiJ, Wary
B day of AVONe410 e/ 2009. Residing in Morgan County.
The above sworn statement should be obtained by the Owner before each and every payment. 4 Mycommission IfeSilllgnst
-4,
VOU HIR NO. WARRANT NO
ALLOWED 20
IN SUM OF
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ON ACCOUNT OF APPROPRIATION FOR
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Board Members
P 4-or INVOICE NO ACM AMOUNT certify invoice( s), oEPr. a I hereby certi that the attached invoices or
*2 /6 yCe=o7 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
20/G
Sig ture
Director Operations
Title
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claim paid motor vehicle highway fund
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City Form No. 201 (Rev. 1995)
Hc6 S' PAYABLE VOUCHER
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
Y6•9e-7 Purchase Order No. i
g76Y ti_ S to Terms
9 Date Due
Invoice Invoice Descrip
Arnounf
Date Number (or note attached invoice(s), or bill(s)) r w
7 13 caste
•Total r .UC,
L hereby certify that the attached invoice(s), or bill(s), is (are) true%and correct and I have audited same in ac $dance
with IC 5- 11- 10 -1.6. �r
20
Clerk- Treasurer