182702 03/02/2010 CITY OF CARMEL, INDIANA VENDOR: 355244 Page 1 of 1
ONE CIVIC SQUARE COMPLETE MASONARY SERVICES INC
CHECK AMOUNT: $26,035.80
CARMEL, INDIANA 46032 4631 S COUNTRY RD 700 WEST
PO BOX 236 CHECK NUMBER: 182702
YORKTOWN IN 47396
CHECK DATE: 3/2/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 14 26,035.80 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 12/01/09 to 12/31/09
Subcontract •2695 4010 4010.Interior.Masonry
Job: 2695- Carmel RPAC Construction Vendor: 2208 COMPLETE MASONRY SERVICES, INC
777 3rd Ave. SW
Carmel, IN 46032
SEE
;Contract, r To Date �Ttis Period'
Item Units UM Unit Cost Amount Units/% Amount Units/% Amount
1 4010 Interior Masonry LS 2,134,000.00 98.39% 2,099,655.00 1A4% 30,820.00
Total Contract Items 2,134,000.0 2,099,655.00 30,820.00
Change Orders
2 CCR #1017 ASI No. LS 1,526.00 100.00% 1,526.00 0.00% 0.00
PAC -007
3 RCP PAC -006 LS -8,798.00 100.00% 8,798.00 000 0.00
4 CAD Cash Allowance LS 5,036.00 100.00% 5,036.00 100.00% 5,036.00
Reduction
Total Change Order Items 12,308.0 12,308.00 5,036.00
Subcontract Totals: 2,121,692.00 2,087,347.00 25,784.00
Total Billings: 2,087,347.00 25,784.00
Unpaid Retainage: 106,084.60 251.80
Discounts: 0.00 0.00
Net Billings: 1,981,262.40 26,035.80
98 SSC CMa Projects Page 1 12/22/09 08:57:42 AM
Date Format MMIDDlYY SLSubBil ling Report .rpt
T m I R AIA Document G7021CMa 992
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER: PR O JECT: pARCEL 7A APPLICATION NO: 1 4 Distribution to:
CARMEL_ REDEVELOPMENT COMMISSION REGIONAL PERFORMING ARTS CENTER PERIOD TO. OWNER El
ONE CIVIC SQUARE CARMEL, INDIANA CONSTRUCTION MANAGER El CARMEL, IN :46032
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
COMPLETE MASONRY SERVICES INC. PROJECT NOS: I 1 CONTRACTOR
P.O. BOX 236 SHIEL SEXTON CO., INC. CMS 08 -07
YORKTOWN, IN 47396 VIA ARCHITECT: AGREEMENT NO. 2695 -4010 FIELD
CONTRACT FO #4010- INTERIOR MASONRY CSO ARCHITECTS INC.
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM ..............................2 SI 34_,000.00 payment shown herein is now due.
2. Net change by Change Orders _12 ,308.00 CONTRA :i_ MASONRY SERVICES INC
3. CONTRACT SUM TO DATE (Line') 2) ............................2, 21,692.00 By: Date: 12/16/09
4. TOTAL COMPLETED 8 STORED TO DATE (Column G on G703) ..........2 X87,347.00 State of: INDIANA ERIC J. KELLY, PRESIDENT
5. RETAINAGE. County of: p E
a. 5 of NTRACT TO DATE Subscribed and swornAo before
(Column D E on G703) 106,084.60 me this day of
b. 0' of Stored Material Notary Public: 16TH DEC., 2009 G
(Column F on G703) 0.00 My Commission expires: 02/28/15
Total Retainage (Lines 5a +5b or Total in Column I of G703).. 106,084.60 CERTIFICATE FOR PAYMENT
1,981,262.40 In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 1,955,226.60 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
8. CURRENT PAYMENT DUE 26,035.80 AMOUNT CERTIFIED 2001 0
9. BALANCE TO FINISH, INCLUDING RETALNAGE' (Attach explanation if amount
certified differs fr the amo,untapplied. Initial all figures on this
Application and on e Continuation S44--et the l q,e chap "eel to conform with the amount certified.)
(Line 3 less Line 6) 140,429.60 CONST UCTION M A
By: Date: 0
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:
Total changes approved in previous months by Owner X26.00 8,798.00 By: Date:
Total approved this Month 0.00 5,036.00 Thi Certificate is not negotiable. The AMOUNT CERTIFIED is payable on] to the Contractor
TOTALS 1126.00 $I3 834.00 named herein. Issuance;' payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
TM
Document G703 AI A -1992
Continuation Sheet
AIA Document G702 APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION` NO:
OMPLETE MASONRY SERVICES INC. 14
containing Contractors signed certification is attached. AGREEMENT #2695 -0010 APPLICATION DATE: 12/16/2009
In tabulations below, amounts are stated to the nearest dollar.
Use Column I on Contracts where variable retainage for line items may apply. CMS JOB NO. 08 -07 PERIOD T0: 12/31
RETAINAGE 10% UNTIL 50% COMPLETE ARCHITECT PROJECT NO:
A B C D E :F Cr H I
WORK COMPLE MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED %v TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE
NO, VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE)
(D E) D OR E) (D +E+F) (C G)
1 BOND 20000 20000 20000 00% 0
2 MOBILIZATION 3000 3000 3000 00% 0
3 DE- MOBILIZATION 3000 2000 2000 67 1000
4 INS /HAZCOM /SAFETY 12.000 11750 11750 ...98%. 250
5 SUBMITTALS 15000 15000 15000 00 %0 0
6 DAILY CLEAN Up::. 22000 21750 21750 99% 250
7 CLOSE OUT 8000 :0 0% 8000
8 FOUNDATION_ CMU
LABOR 48000 48000 48000 00%
0
MATERIAL
CMU 5000 5000 5000 00% 0
REBAR 3500 3500 3500 00% 0
GROUT 5250 5250 5250 00% 0
SHEET METAL 2000 2000 2000 00% 0
MORTAR AND SAND 1250 1250 1250 00% 0
ACCESSORIES 4250 4250 4250 00% 0
9 BASEMENT /PLENIUM CMU
LABOR 270000 .270000 270000 00% 0
MATERIAL
CMU 26500 26500 26500 00% 0
REBAR 16650 16650 16650 00% 0
GROUT 31500 31500 31500 00% 0
SHEET METAL 10000 10000 10000 00% D
MORTAR AND SAND 7000 7000 7000 00% 0
$UB =TOTAL =537900 526400 2000 0 528400 98% 9500 0
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 0° 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this Ale Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright@aia.org.
AIA Document G703 -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION "NO:
containing Contractor's signed certification is attached. COMPLETE MASONRY SERVICES INC. APPLICATION DATE: 14
In tabulations below, amounts are stated to the nearest dollar. AGREEMENT #2695 -4010 12/16/2009
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:
CMS JOB No. 08 -07 ARCHITECT'S PROJECT N0: 12/30/2009
A B C D E F G H 1.
WORK CO MPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED ([F VARIABLE
VALUE APPLICATION THIS PERIOD (G C} FINISH
NO. (D E} D O N O RATE)
DATE (C G)
10 ORCHESTRA LOW /HI CMU
LABOR 325000 320000 320000 98% 5000
MATERIALS
CMU 30500 30000 30000 98 500
REBAR 21000 21000 21000 00 0
GROUT 32000 31350 31350 98% 650
SHEET METAL; 12000 12000 12000 00% 0
MORTAR AND ,SAND 8000 7800 7800 98% 200
ACCESSORIES 28000 28000 28000 00% 0
11 BOX TIER CMU
LABOR 175000 172000 172000 98% 3000
MATERIALS
CMU 23500 23050 23050 98% 450
REBAR 10000 10000 10000 00% 0
GROUT 19000 18650 18650 98% 350
SHEET METAL 5500 5500 5500 00% 0
MORTAR AND SAND 4500 4400 4400 98 100
ACCESSORIES 15600 15600 15600 00% 0
12 BALCONY LOW CMU
LABOR 198000 195000 195000 98%,: 3000
MATERIALS
CMU 19000 18700 18700 98% 300
REBAR 12000 12000 12000 00% 0
GROUT 19500 19200 19200 98% 300
SHEET METAL: 6000 6000 6000 00% 0
MORTAR-AND SAND 5000 4900 4900 98% 100
�J /Ay CES SORIES I I UUU ___TT0_00 0
SUB =TOTAL 1518000 1492550 2000 0 1494550 98% 23450 0
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this Ale Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyrightC@aia.org.
a
e TM
Document G703 -1992
Continuation Sheet
AIA Document 6702, APPLICATION' AND CERTIFICATION FOR PAYMENT, APPLICATION '.NO:
containing Contractor's sigricd cerfification is attached. COMPLETE MASONRY SERVICES INC. APPLICATION DATE: 14
In tabulations below, amounts are stated to the nearest dollar. AGREEMENT #26954010 12/16/2009
Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO:
CMS JOB NO. 08-07 12/3112009
ARCHITECTS PROJECT NO:
A B C D G H I
WORK COMPLETED MATERIALS TOTAL
BALANCE
SCHEDULED FROM PREVIOUS
PRESENTLY COMPLETED TO RETAINAGE
ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE
NO, VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE)
(D E) D OR F) (D +E +F) (C G)
13 BALCONY HI CMU
LABOR 195000 195000 195000 00% 0
ATERIALS
MU 17000 17000 17000 00% 0
REBAR 11000 11000 11000 00% 0
ROUT 18000 18000 18000 00% 0
SHEET METAL 6000 6000 6000 00% 0
MORTAR AND SAND 5000 5000 5000 00% 0
CCESSORIES 11000 11000 11000 00% 0
14 TTIC''CMU
ABOR 125000 125000 125000 00% 0
MATERIALS
MU 17000 17000 17000 00% 0
EBAR 11000 11000 11000 00% 0
ROUT 18000 18000 18000 00% 0
SHEET METAL 6000 6000 6000 00% 0
MORTAR AND SAND 5000 5000 5000 00% 0
CCESSORIES 11000 11000 11000 00% 0
15 EALANTS
SUBCONTRACT 85000 76500 8000 84500 99 500
16 DAMPROOFING
SUBCONTRACT 20000 20000 20000 00% 0
17 LLOWANCE GENERAL 50000 23785 15820 3960;,5;,. 79% 10395
LLOWANCE CAD 5000 5000 5000 00% 0
18 D.O. #1 1526 1526 1526 00% 0
19 .0 #2 -8798 -8798 -8798 00% 0
20 0. #3 -5036 -5036 -5036 00% 0
T OTAL 2121692 2061563 25784 0 2087347 98% 34345 106085
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G703Tm 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright
Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent
possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal
counsel, copyright@aia.org.
PAYMENT AFFIDAVIT AND PARTIAL WAIVER OF LIEN
State of Indiana
County of Delaware
Eric J. Kelly being duly sworn states that he is the President of Complete Masonry Services, Inc. having a
contract with City of Carmel, Indiana acting by and through its Redevelopment Commission to furnish certain
materials for the .following project: Parcel 7A Regional Performing Arts Center, located in Carmel, Indiana and
owned by Carmel Redevelopment Commission, One Civic Square, Carmel, Indiana 46032 and does hereby
further state on behalf of the aforementioned contractor and that the undersigned is duly authorized to execute
this Affidavit and to bind the Company by the statement herein contained:
The previous progress payment in the amount of $222,870.00, Pay Application No. 12 the receipt of which
is hereby acknowledged.
The material, labor, services or equipment furnished are more particularly described in the application and
certificate for payment (the `'Application submitted of even date herewith.
Every subcontractor, laborer, person, corporation or entity performing labor for or furnishing materials to said
Company, in connection with the above mentioned Project has been paid in full for the total amounts due for work
performed or materials supplied to the Project by said person or entity through the date of the application and
certificate referenced above, less only applicable retainage.
The undersigned acknowledges receipt of all funds due for work performed through 1012012009. The undersigned
affirmatively states that the Company has no claim for additional amounts arising from the work completed as of
the date of the Application, except those which may have been made by submission of a written claim made in
accordance with the contract documents. The Company warrants that it is on schedule and in coordination with all
others in the performance of its work under the contract documents.
In order to procure one or more payments for services, labor, material or equipment provided in such
construction, the Company does hereby warrant title to and waive, release and quit -claim in favor of the Owner of
the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be
made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which
the. Company may now have for services, labor, material or equipment furnished in respect of such land or
improvements from the commencement of the project to and including the date set forth above. The undersigned
warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien
against`the real estate.
That the. Company has not employed or procured material from, or subcontracted with, any person or persons,
corporations or entities other than those previously submitted to the Owner, and that the Company has complied
with all common wage requirements under applicable law or as may be set forth in the contract documents.
Complete asonry Services, Inc.
Eric J. Kelly
Witness by my hand and notary sea] this 10th day of D�cember, 2009
r
My Commission Expires: 02/28120.15
Resident of Delaware County,,,Indiana Diann= Jennings
PAYMENT AFFIDAVIT AND PARTIAL WAIVER OF LIEN
State of Indiana
County of Delaware
Eric J. Kelly being duly sworn states that he is the President of Complete Masonry Services, Inc. having a
contract with City of Carmel, Indiana acting by and through its Redevelopment Commission to furnish certain
materials for the following project: Parcel 7A Regional Performing Arts Center, located in Carmel, Indiana and
owned by Carmel Redevelopment Commission, One Civic Square, Carmel, Indiana 46032 and does hereby
further state on behalf of the aforementioned contractor and that the undersigned is duly authorized to execute
this Affidavit and to bind the Company by the statement herein contained:
The previous progress payment in the amount of $79,564.90, Pay Application No. 11 the receipt of which
is hereby acknowledged.
The material, labor, services or equipment furnished are more particularly described in the application and
certificate for payment (the "Application submitted of even date herewith.
Every subcontractor, laborer, person, corporation or entity performing labor for or furnishing materials to said
Company, in connection with the above mentioned Project has been paid in full for the total amounts due for work
performed or materials supplied to the Project by said person or entity through the date of the application and
certificate referenced above, less only applicable retainage.
The undersigned acknowledges receipt of all funds due for work performed through 09/20/2009. The undersigned
affirmatively states that the Company has no claim for additional amounts arising from the work completed as of
the date of the Application, except those which may have been made by submission of a written claim made in
accordance with the contract documents. The Company warrants that it is on schedule and in coordination with all
others in the performance of its work under the contract documents.
In order to procure one or more payments for services, labor, material or equipment provided in such
construction, the Company does hereby warrant title to and waive, release and quit -claim in favor of the Owner of
the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be
made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which
the Company may now have for services, labor, material or equipment furnished in respect of such land or
improvements from the commencement of the project to and including the date set forth above. The undersigned
warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien
against the real estate.
That the Company has not employed or procured material from, or subcontracted with, any person or persons,
corporations or entities other than those previously submitted to the Owner, and that the Company has complied
with all common wage requirements under applicable law or as may be set forth in the contract documents.
Complete asonry Services _tnc:
Eric J. Kelly
Witness by my hand and notary seal this 10th day of De ember, 2009
My Commission Expires: 02/28/2015 ,C �1�L_4✓
Resident of Delaware County, Indiana Diann Jennings
A.
Prescribed by State Board of Accounts City Form No. 201 (Rev. 1995)
ACCOUNTS 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
C o a17� /��P �Q Ste` °s, l� Purchase Order No.
P0bo 2 3 Terms
ID "k y� /V Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 6 5- 8O
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
,VOUCHER NO. WARRANT NO.
n r ALLOWED 20
IN SUM OF
2� Z 80
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
9 °2 /y y�O�o7
z o 35-3a 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
20G
Signature
r rf Aedevelopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund