HomeMy WebLinkAbout182706 03/02/2010 CITY OF CARMEL, INDIANA VENDOR: 363794 Page 1 of 1
ONE CIVIC SQUARE GENERAL PIPING, INC CHECK AMOUNT: $132,548.09
CARMEL, INDIANA 46032 PO BOX 34367
INDIANAPOLIS IN 46234 CHECK NUMBER: 182706
CHECK DATE: 3/212010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 15 132,548.09 PERFORMING ARTS CENTE
SL Subcontract Billing Report
For Work Invoiced From 12/01109 to 12/31/09
Subcontra6t 12695_4300:;4300 =`HVAC Piping
Job: 2695- Carmel RPAC Construction Vendor: 9501 GENERAL PIPING, INC.
777 3rd Ave. SW
Carmel, IN 46032
�Contract, T Da te THis Period'
Item Units UM Unit Cost Amount Units/% Amount Units/% Amount
1 4300- HVACPiping LS 3,846,500.00 81.68% 3,141,984,47 3.16% 121,646.29
2 Settlement with bonding LS 291,276.00 0.61% 1,776.00 0.00% 0.00
company to take over F.E.
Irish work
Total Contract Items 4,137,776.0 3,143,760.47 121,646.29
Change Orders
3 Leach Russel T &M Credit LS 24,090.0 100.00% 24,090.00 0.00% 0.00
5 SSC -1079 ASI -037 Suppl't LS 17,328,00 50.00% 8,664.00 0.00% 0.00
1 Bsmt Warm'g Kitchen 034
rev'ns
6 CCR -1048 RCP -006 Suppl't LS 85,312.00 81.36% 69,411.53 17.02% 14,517.76
1 Box Tier catering space
rev'ns
7 SSC -1080 ASI -038 Suppt 1 LS 30,693.00 100.00% 30,693.00 0.00% 0.00
Triplex rev'ns- add control
panel
8 SSC 1138 AS070 Triplex LS 61,694.0 100.00% 61,694.00 0.00% 0.00
structure rev'ns
Total Change Order Items 170,937.0 146,372.53 14,517.76
Subcontract Totals: 4,308,713.00 3,290,133.00 136,164.05
Total Billinqs: 3,290,133.00 136,164.05
Unpaid Retainage: 216,312.31 0.00
Discounts: 0.00 0.00
Net Billings: 3,073,820.69 136,164.05
98 SSC CMa Projects Page 1 12/17/09 02:42:05 PM
Date Format MM /DD /YY SLSubBillingReport .rpt
Document G702 /DMa Tie ®1992
Application and Certificate for Payment Construction Manager Adviser Edition
TO OWNER: City of Carmel PROJECT: Carmel Performing Arts Center APPLICATION NO: 015 Distribution to:
OWNER:
PERIOD TO: December 31, 2009 CONSTRUCTION MANAGER:
FROM General Piping, Inc. VIA CONSTRUCTION Shiel Sexton CONTRACT DATE: June 11, 2008 ARCHITECT:
CONTRACTOR: P.O. Box 34367 MANAGER: PROJECT NOS: NIA 2829 N/A CONTRACTOR:
Indianapolis, IN 46234 FIELD:
CONTRACT FOR Bid Package No. 4300 VIA ARCHITECT: CSO Architects OTHER:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application for Payment has been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. 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 4,136,000.00 payment shown herein is now due.
2. NET CHANGE BY CHANGE ORDERS 172,713.00 CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 2) 4,308,713.00 By: Date:
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 3,290,133.00 State of: In
5. RETAINAGE: County of: Hendricks
a• 100 of Completed Work Subscribed and sworn to before
(Column D E on G703) 2.16,312.30 me this 15 day of bee-
b. 0 of Stored Material Notary Public: Luke Roseboom
(Column F on G703) OAO My Commission expires: July 07, 2012
Total Retainage (Lines 5a 5b or Total in Column I of G703) 216,312.30 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 3,073,820.70 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
7, LESS PREVIOUS CERTIFICATES FOR PAYMENT 2,937,656.65 knowledge, information and belief the Work has progressed as indicated, the quality of the Work is
to accordance with the Contract Documents, and the Contractor is entitled to payment of the
(Line 6 from prior Certificate) AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE J 136,164.05 AMOUNT CERTIFIED 136,164,05
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs the amount applied. Initial all figures on this
Application and on the Continuation et tl at ar changed to conform with the amount certified.)
(Line 3 less Line 6) 1,234,89230 CONSTRUCTION AGE
By: Date: 2
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC
Total changes approved in previous months by Owner 196,803.00 24,090.()0 By: Date: to
Total approved this Month 0.00$ 0.00 This Certi rcate is not negotiable. The AMOUNT CERTIFIED is payable only to the ontractor
TOTALS 196,803.00 24,090.00 named herein, Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order 172,713.00
AIA Document G702JCMaTu —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 y
under the law. This document was produced by AIA software at 09:59: on 1211512009 under Order No.1000389341_1 which expires on 5/13/2010, and is not for resale.
User Notes:
(2883765075)
CONTINUATION PAGE
Page 2 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 401 I Bond $27,350.00 $27,350.00 50.00 $0.00 $27,350.00 1 100% $0.00 $2,735.00
1 t f Supervision /Project Mgmt/Gen. Conditi I I I
1 003 1 Labor 1 $181,855.00 1 $158,213.86 1 $1,818.56 1 $0.00 1 $160,032.42 i 88 $21,822.58 I 510,911.30 1
1004 I Material 1 $72,013.00 I $62,651.321 $720.141 $0.001 $63,371.46 I 88 %1 $8,641.54 I $4 I
1 005 1 Submittals 1 $21,869.00 1 $21,869.00 1 $0.00 1 $0.00 1 $21,869.00 1 100 %1 $0.00 1 $2,077.56 1
006 1 Punclist 1 $12,000.00 1 $0.00 I $0.00 1 $0.00 1 $0.00 1 0 %1 $12,000.00 1 $0.00 1
1 007 1 Closeout 1 $6,000.00 1 $0.00 1 $0.00 1 $0.00 1 $0.00 1 0 $6,000.00 1 50.00 I
1 1 3D CAD /Coordination I I I 1 I I I I I
1 009 1 Labor 1 $34 $34,726.001 $0.00 $0.001 $34,726.001 100 %1 50.001 $3,279.581
1 010 1 Material 1 $64,200.00 $64,200.001 50.00 $0.001 $64,200.00 100 %1 $0.001 $6,099.001
1 011 1 Daily Clean -up 1 $15,000.00 1 $10,200.00 1 $300.00 1 $0.00 1 $10,500.00 1 70 %1 $4,500.00 1 $675.00 1
1 012 1 AW #8 Plumbing (4290A) 1 $83,102.00 1 $0.00 1 $0.00 1 $0.00 1 $0.00 1 0 %1 $83,102.00 1 $0.00
1 013 1 AW #9 Project Water /Gas (4290B) 1 $145,935.05 1 50.00 1 $0.00 1 $0.00 I $0.00 1 0 %1 $145,935.05 1 5317.94 I
014 1 AW #10 liydronic (4300A) 1 $29,718.00 1 $0.00 1 $0.00 1 $0.00 I $0.00 1 0 %1 $29,718.00 1 $0.00 1
TOTALS $b93,768.05 $379,210.18 $2,838.70 $0.00 J $382,048.88 55 %1 $311,719.17 I $30,416.16
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE
Page 3 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Cannel Perfonning Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H 1
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
015 1 AWN 16 CAD (BP 4290) $10,000.00 $0.00 I $0.00 $07 $0.00 I 0% $10,000.00 $0.00
016 I Allowance 16 CAD (BP 4300) I $10,000.00 I $0.00 I $0.00 I $0.00 I $0.00 I 0 $10,000.00 I 50.00
Mechanical ID
1 018 I Labor I $5,100.00 $0.00 $765.00 $0.00 $765.00 15 %1 $4,335.00 $0.00
1 019 I Material I $5,100.00 $1,020.001 $2,295.00 $0.00 $3,315.00 65 %1 $1,785.00 $0.001
Firestopping I 1 1 1 1 I I I
1 021 I Labor I $5,350.00 $3,210.001 $107.00 $0.00 $3,317.00 62 %1 $2,033.00 $160.501
022 I Material I $5,939 I $3,563.42 I $118.78 I $0.00 I $3,682.20 I 62 %1 $2,256.80 I $178.18 1
Housekeeping Pads 1 1 1 1 1 I I I
024 I Labor I $1,411.00 I $1,411.00 I $0.00 I 50.00 I $1,411.00 I 100 %I 50.00 I $141.10 1
1 025 I Material $2,676.001 $2,676.001 $0.00 $0.00 $2,676.00 100 $0.00 $267.61
026 I Painting 1 $3,000.00 I $2,610.00 I $240.00 I $0.00 1 $2,850.00 1 95 %1 $150.00 I $135.00 1
1 1 Sleeves /Core Drill Holes I 1 1 1 I 1 I I I
028 I Labor I $19,200.00 $17,088.00 I $1,152.00 I $0.00 I $18,240.00 I 95 %I $960.00 I $1,536.00 I
TOTALS $761,544.05 $410,788.601 $7,516.48 $0.001 $418,305.0 5 5 %1 $343,238.97 1 $32,834.55
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE
Page 4 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO`: 15
containing Contractor's signed Certification Is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D +E) (D +E +F) (C G) RATE)
029 1 Material $31,800.00 $28,302.001 $1,908.00 $0.00 $30,210.00 1 95% $1,590.00 $2,544.00
Grease Interceptor 1 f 1 I I 1
1 031 1 Labor 1 $3,360.001 $0.00 $0.00 $0.00 $0.00 0 $3,360.00 $0.00
1 032 1 Material 1 516,830.001 $0.00 $0.00 $0.00 $0.00 0 %1 $16,830.00 $0.00
1 033 1 Cranes and Lifts $24,000.00 1 $18,720.00 $480.00 1 $0.00 1 $19,200.00 80 %1 $4,800.00 1 $1,440.00 I
1 Underground Waste and Vents I I I 1 1 I I I I
1 035 1 Labor 1 $28,186.00 $28,186.00 $0.00 $0.00 $28,186.00 100 %1 $0.00 $2,818.60
1 036 1 Material 1 $35,120.001 $35,120.001 $0.00 $0.00 $35,120.00 100 %1 $0.00 $3,512.001
1 1 Underground Store I I I 1 I I I I
1 038 1 Labor 1 $6,303.00 $6,303.001 $0.00 $0.00 $6,303.00 100 $0.00 $630.30
1 039 1 Material 1 $10,637.00 $10,637.001 $0.00 $0.001 $10,637.00 100% $0.001 $1,063.701
Underslab Drainage I I I I I I I I
1 041 I Labor 1 $9,500.00 $9,500.001 $0.00 $0.00 $9,500.00 100 %1 50.001 $950.001
1 042 1 Material 1 $1,714.00 $1,714.00 $0.00 $0.00 $1,714.00 100 %1 $0.001 $171401
TOTALS $928,994.05 $549,270.60 $9,904.48 $0.00 $559,175. 60 %1 $369,818.97 I
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Pa 5 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 043 I Aboveground Waste and Vents (Bulk M $165,426.00 $163,771.74 1 $0.00 $0.00 $163,771.74 1 99% $1,654.26 1 $14,8894
Aboveground Waste and Vents (Labor) I I I I I I I I
1 045 I Basement I $33,050.00 $26,440.001 $1,652.50 $0.00 $28,092.50 85 %1 $4,957.50 $2,247.40
1 046 I Plenum I $17,879.00 I $17,879.00 1 $0.00 I $0.00 1 $17,879.00 1 100 %1 $0.00 I 5446.98 I
1 047 1 Orchestra I $22,368.00 $16,776.001 $671.04 $0.00 $17,447.04 78 %1 $4,920.96 $559.21
1 048 I Box Tier I $18,144.00 I 57,257.60 1 $I,814.40 1 50.00 1 $9,072.00 1 50 %1 $9.072.00 1 $453.60 I
1 049 I Balcony I $18,409.00 $1,840.92 1 $0.00 1 50.00 1 $1,840.92 I 10 $16,568.08 1 592.05 I
1 050 I Attic I 57,121.001 $712.121 51,068.161 50.00 $1,780.28 25 $5,340.72 $35.61
1 051 I Aboveground Storm (Bulk Material) 1 $67,165.00 1 $66,493.36 1 $0.00 I $0.00 1 $66,493.36 1 99 %1 $671.64 1 $6,044.86
Aboveground Storm (Labor) I I I I I I I I I
1 053 I Basement 1 $6,120.00 1 $6,120.00 I $0.00 $0.00 1 $6,120.00 1 100 %1 50.00 1 $459.00 1
1 054 1 Plenum I $365.00 $365.001 50.001 50.001 $365.001 100 %1 $0.001 $0.001
1 055 1 Orchestra I $7,856.00 $5,892.01 $785.60 50.001 $6,677.61 1 85 %1 $1,178.391 5314.241
1 056 1 Box Tier 1 $3,665.00 1 $2,748.76 1 $549.76 1 $0.00 1 $3,298.52 1 90 %1 $366.48 1 $18.33
TOTALS $1,296,562.05 $865,567.1 I I $16,445.94 $0.00 I $882,013.05 6 8 %1 $414,549.00 I $71,524.17
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 6 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Cannel Perfonning Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D +E) (D +E +F) (C G) RATE)
1 057 1 Balcony $15,976.00 $12,780.80 1 $1,597.60 $0.00 $14,378.40 1 90% $1,597.60 1 $127.81
1 058 I Attic 1 $9,667.00 $5,800.201 $0.00 $0.00 $5,800.20 60 %1 $3,866.80 $77.34
Force Main 1 I I I I I I I I
1 060 1 labor 1 $7,546.001 $6,036.801 $0.00 $0.001 $6,036.801 80 %1 $1,509.201 $528.221
061 1 Material 1 $27,882.00 1 $27,045.54 1 $0.00 1 $0.00 1 $27,045.54 1 97 %1 $836.46 1 $2,369.98
Sewage Ejector /Triplex Pumps I I I I I I I I I
1 063 1 Labor 1 $26,640.00 $25,308.001 $0.001 $0.00 $25,308.001 95 %1 $1,332.001 $2,530.81 1
1 064 1 Material 1 $167,273.00 $167,273.001 $0.00 $0.001 $167,273.00 100 %1 $0.00 $16,727.30
Domestic Pumps I I I I I I I I
1 066 1 Labor 1 $4,440.001 $1,776.001 $0.00 $0.001 $1,776.00 40 %1 $2,664.001 $0.00
1 067 1 Material 1 $27,066.00 $27,066.00 $0.00 $0.00 $27,066.00 100 %1 $0.00 $2,706.60
1 068 1 Domestic Water Above Slab (Bulk Mate $184,831.00 1 $182,982.70 1 50.00 1 $0.00 1 $182,982.70 1 99 %1 $1,848.30 1 $15,710.64 I
I Domestic Water Above Slab (Labor) I I I I I I I I I
1 070 1 Basement 1 $85,091.00 $51,054.621 $4,254.56 $0.001 $55,309.18 65 %1 $29,781.821 $2,046.171
TOTALS $1,852,974.05 $1,372,690.771 $22,298.10 $0.001 $1,394,988.8 75 %1 $457,985.18 1 $114,349.04
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE
Paoe 7 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: t5
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D +E) (D +E +F) (C G) RATE)
1 071 1 Plenum $19,393.00 $11,635.82 I 52,908.96 $0.00 $14,544.78 I 75% $4,848.22 5232.72
072 I Orchestra $26,728.00 1 $16,036.80 1 $5,345.60 1 $0.00 1 $21,382.40 i 80 %1 $5,345.60 I $320.74
073 I Box Tier 1 $18.955.00 1 $5,686.50 1 $568.66 1 $0.00 I $6,255.16 I I 33 %I $12,699.84 I $227.46
1 074 1 Balcony 1 $17,692.00 $1,769.20 $0.00 $0.00 $1,769.20 10 %1 $15,922.801 $123.84
075 1 Attic 1 $823.00 $82.32 I $0.00 1 $0.00 1 $82.32 1 10 %1 $740.68 I I $5.76 1
1 Incoming Dom, Water Service and UndeI I I
1 077 I Labor 1 $6,864.001 $2,745.601 $0.00 $0.00 $2,745.60 40 %1 $4,118.401 $274.561
1 078 1 Material 1 $7,163.001 $7,163.001 $0.00 $0.00 $7,163.00 I00 %1 $0.001 $716.301
1 079 1 Drains and Cleanouts (Bulk Material) 1 $25,175.00 1 $25,175.00 1 $0.00 1 $0.00 1 $25,175.00 1 100 %I $0.00 1 $2,517.50 1
I 1 Drains and Cleanouts (Labor) 1 I I I I I I I I
1 081 1 Basement 1 $21,076.001 $21,076.001 $0.00 $0.00 $21,076.00 100 %1 $0.001 $2,107.601
1 082 1 Plenum 1 $1,920.001 $1,920.001 $0.001 $0.001 $1,920.00 100 %1 $0.001 $153.601
1 083 1 Orchestra 1 $1,320.001 $1,320.001 $0.00 $0.00 $1,320.00 100 %1 $0.001 $118.801
1 084 1 Box Tier 1 $3,120.001 $3,120.001 $0.001 $0.001 $3,120.00 100 %1 $0.001 $249.601
TOTALS $2,003,203.05 71,470,421.01 I $31,121.32 $0.00 j $1,501,542.33 75 %1 $501,660.72 $121,397.52
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Paqe 8 1}�
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts %PPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G 1 C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
085 I Balcony $2,400.00 $2,400.00 I $0.00 $0.00 $2,400.00 I 1001 $0.00 $120.00
f 086 I Attic I $3,720.00 I $3,720.00 $0.00 f $0.00 $3,720.00 1 100 %I $0.00 1 $186.00
1 087 I Carriers (Bulk Material) 1 $12,347.00 1 $12.347.00 1 $0.00 1 $0.00 1 $12,347.00 1 100 %1 $0.00 1 $1,222.35
I Carriers (Labor) I I I I I I I I I
1 089 I Basement 1 $1,200.001 $1,140.001 $0.00 $0.001 $1,140.00 1 95 %1 $60.001 $102.00
1 090 I Plenum 1 $6,750.00 $6,412.501 $0.00 $0.00 $6,412.50 95 %1 $337.501 $573.761
1 091 1 Orchestra 1 $2,100.00 1 $1,995.00 1 $0.00 1 $0.00 1 $1,995.00 1 95 %1 $105.00 1 $178.50
1 092 1 Box Tier 1 $4,500.00 1 $4,050.00 1 $0.00 1 $0.00 1 $4,050.00 1 90 %1 $450.00 1 $382.50 I
1 093 1 Balcony 1 $3,000.001 $2,700.001 $0.001 $0.001 $2,700.00 1 90 %1 $300.001 $225.001
1 094 1 Attic 1 $300.00 $270.001 $0.00 $0.00 $270.001 90 %1 530.001 $22.501
Gas Pressure Regulator 1 I I I I I I I I
1 096 1 Labor 1 $480.00 $0.001 $0.00 $0.00 $0.00 0 %1 $480.001 $0.001
1 097 1 Material 1 $277.001 $0.001 $0.00 $0.00 $0.00 0 %1 $277.001 $0.001
1 1 Gas Piping I I I I 1 1 1 1 1
TOTALS $2,040,277.0 1,505,455.51 $31,121.32 $0.00 I $1,536,576. 7 5 %1 $503,700.22 I $124,410.13
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Paae 9 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 099 I Labor $2,858.00 $0.00 $0.00 $0.00 $0.00 0% $2,858.00 $0.00
1 100 I Material I $1,220.00 $1,098.001 $0.001 $0.00 $1,098.001 90 %1 $122.00 $109.801
i 101 I Kitchen Connections I $6,000.00 I $0.00 I $0.00 1 $0.00 I $0.00 1 0 %1 $6,000.00 I $0.00
Plumbing Fixtures I I I I I I I I 1
1 103 I Labor I $54,840.00 $5,484.001 $0.00 $0.001 $5,484.00 10 %1 $49,356.00 $274.20
1 104 I Material 1 $111,082.00 $111,082.001 $0.00 $0.00 $111,082.00 100 %1 $0.00 $11,108.20
Water Heater I I I I I I I I
1 106 I Labor 1 $4,080.001 $408.001 $0.00 $0.00 $408.00 10 $3,672.00 $20.40
107 I Material 1 $62,669.00 1 $62,669.00 1 $0.00 1 50.00 1 $62,669.00 1 100 %1 $0.00 1 $6,266.90 1
Water Softener I I I I 1 I I
1 109 I Labor 1 $2,400.00 $0.00 $0.00 $0.00 $0.00 0 %1 $2,400.00 $0.001
i 110 I Material 1 $1,453.00 1 $0.00 1 $0.00 1 $0.00 I $0.00 1 0 %1 $1,453.00 1 $0.00 I
Thermostatic Mixing Valves I I I I I I I I I
1 112 I Labor 1 $840.00 $0.00 $0.00 $0.00 $0.00 0 %1 $840.001 $0.001
TOTALS $2,287,719.05 $1,686,196.51 $31,121.32 $0.00 $1,717,317.8 75 %1 $570,401.22 $142,189.63
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 10 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts NPPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
113 I Material $1,159.00 $1,159.00 1 $0.00 $0.00 $1,159.00 1 100% $0.00 S115.9 0
Backtlow Preventers
1 115 I Labor I $1,920.00 $0.00 $0.00 $0.00 $0.001 0 %1 $1,920.00 $0.00
116 I Material I $4,337.00 I $4,337.00 I $0.00 $0.00 1 $4,337.00 1 100 %1 $0.00 I $433.70
1 117 I Vibration Isolation 1 $29,532.00 1 $28,055.41 1 $0.00 1 $0.00 1 $28,055.41 1 95 %1 $1,476.59 1 $1,033.63 1
1 118 I Condensate Piping (Bulk Material) I $1,608.00 I $1,447.20 1 $0.00 I $0.00 1 $1,447.20 1 90 $160.80 1 $112.56 1
Condensate Piping (Labor) I I I I I I I I I
1 120 I Basement 1 $8,592.001 $2,148.001 $429.601 $0.00 $2,577.60 30 %1 $6,014.40 $0.00
1 121 I Orchestra I $928.001 $0.00 $0.001 $0.001 $0.00 0 %1 $928.00 $0.001
122 I Box Tier I $353.00 1 $0.00 1 $0.00 I $0.00 1 $0.00 0 %1 $353.00 1 $0.00 1
1 123 I Hydronic Piping (Bulk Material) I $197,044.00 1 $191,132.68 I 50.00 I $0.00 1 $191,132.68 1 97 %j $5,911.32 1 $15,763.52 1
Hydronic Piping (tabor) I I I I I I I I
1 125 I Basement 1 $90,564.00) $76,979.41 $2,716.92 $0.00 $79,696.33 88 %1 510,867.67 $1,358.46
1 126 I Plenum 1 $14,180.00 $3,545.001 $5,672.00 $0.001 $9,217.00 65 %1 $4,963.00 $0.00
TOTALS $2,637,936.05 $1,995,000.21 $39,939.84 $0.001 $2,034,940.05 77% $602,996.00 I $161,007.40
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 11 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 127 I Orchestra $26,716.00 $6,679.001 $2,671.60 $0.00 1 $9,350.60 1 35% $17,365.40 $0.00
1 128 I Box Tier I $25,375.00 I $2,537.52 I $11,418.76 I $0.00 1 $13,956.28 1 55 %1 $11,418.72 I $0.00
1 129 1 Balcony I $43,190.00 $4,319.001 $19,435.50 $0.00 $23,754.50 55 %1 $19,435.50 $0.00
1 130 1 Attic I $13,309.00 I $0.00 1 $665.46 1 $0.00 1 $665.46 1 5 %1 $12,643.54 I $0.00 I
1 Anchors and Guides I I I I I I I I I
1 132 1 Labor 1 $2,880.00 1 $2,448.00 I $0.00 I $0.00 1 $2,448.00 1 85 %1 $432.00 1 $172.80 1
1 133 I Material 1 $1,834.00 $1,834.001 $0.00 $0.00 $1,834.00 100 %1 $0.00 $183.40
134 1 Miscellaneous Supports I $79,294.00 1 $71,364.60 1 $1,585.88 1 $0.00 1 $72,950.48 1 92 $6,343.52 I $4,757.65
135 1 Hydronic Specialties 1 $77,660.00 I $73,777.00 1 $0.00 1 $0.00 1 $73,777.00 1 95 $3,883.00 1 $0.00
1 1
HVAC Pumps I I I I I I I I I
1 137 1 Labor I $6,120.001 $5,936.401 $0.00 $0.00 $5,936.40 97 %1 $183.601 $0.001
1 138 1 Material 1 $28,061.00 $28,061.001 $0.00 $0.00 $28,061.00 100 %1 $0.001 $2,806.101
Water Treatment I I I I I I I I I
1 140 1 Labor I $600.00 $480.001 $30.00 $0.00 $510.00 85 %1 $90.001 $0.001
TOTALS $2,942,975.05 $2,192,436.731 $75,747.04 $0.00 I $2,268,183.7 7 7% $674,791.28 1 $168,927.35
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 12 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 141 Material $3,132.00 $3,132.00 $0.00 $0.00 1 $3,132.00 100% $0.00 I $0.00
f 142 I HVAC Equipment I $120,532.00 $114,505.40 $3,615.96 I $0.00 $118,121.36 I 98 %I $2,410.64 I $9,039.90
143 I Rigging and Offloading HVAC Equipm $3,840.00 I $2,496.00 f $384.00 f $0.00 $2,880.00 I 75 %I $960.00 I $0.00
144 I AHU Connections I $55,320.00 I $44,256.00 I $2,766.00 I $0.00 I $47,022.00 I 85 $8,298.00 I $0.00 I
1 145 I Duct Heating Coil Connections I $1,260.00 I $0.00 I $0,00 I $0.00 I $0.00 1 0 $1,260.00 I $0.00 I
1 146 I VAV Box Connections Basement I $8,285.00 $0.00 I $248.56 I $0.00 I $248.56 I 3 $8,036.44 I $0.00 I
147 I VAV Box Connections Plenum I $1,763.00 I $0.00 I $52.90 I $0.00 I $52.90 I 3 %I $1 I $0.00 I
148 I VAV Box Connections Orchestra I $1,586.00 I $0.00 I $47.58 I $0.00 I $47.58 I 3 $1,538.42 I $0.00 1
149 I VAV Box Connections Box Tier I $4,231.00 I $0.00 I $126.94 I $0.00 I $126.94 I 3 %I $4,104.06 I $0.00
I
1 150 I VAV Box Connections Balcony I $3,173.00 I $0.00 I $95.20 I $0.00 I $95.20 I 3 %I $3,077.80 I $0.00 I
151 I VAV Box Connections Attic I $2,820.00 I $0.00 I $84.60 I $0.00 I $84.60 I 3 %I $2,735.40 I $0.00 I
152 I Unit Heater Connections Basement I $428.00 I $0.00 I $0.00 I $0.00 I $0.00 I 0 $428.00 I $0.00 1
154 I Unit Heater Connections Orchestra I $215.00 I $0.00 I $0.00 I $0.00 I $0.00 I 0 %I $215.00 I $0.00 I
1 155 I Unit Heater Connections Box Tier I $107.00 1 $0.00 I $0.00 I $0.00 I $0.00 I 0 $107.00 I $0.00 1
TOTALS $3,149,667.05 $2,356,826.13 $83,168.78 $0.00 $2,439,994.91 77 $709,672.14 $177,967.25
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE
Page 13 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts 4PPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
156 Fan Coil Connections Basement $2,057.00 $0.00 I $102.86 $0.00 $102.86 I 5% $1,954.14 $0.00
157 I Fan Coil Connections Orchestra j $1,028.00 I $0.00 I I $51.40 I $0.00 I $51.40 I 5%I $976.60 I $0.00
158 I Fan Coil Connections Box Tier I $515.00 I $0.00 I $25.76 I $0.00 I $25.76 I 5%I $489.24 I $0.00 I
I I Radiant Floor Systems I I I I I I I I I
1 160 I Labor I $20,483.001 $20,483.00 $0.00 $0.00 $20,483.00 100 %1 $0.00 $1,904.921
1 161 1 Material I $11,816.001 $11,816.001 $0.00 $0.00 $11,816.00 100 $0.001 $1,181.601
1 162 I Humidifier Connections 1 $15,360.00 $2,304.00 1 $0.00 I $0 .00 I $2,304.00 1 15 %1 $13,056.00 1 $0.00 I
1 163 1 Fin Tube Connections Basement I $664.00 1 $66.41 I $0.00 1 $0.00 1 $66.41 1 10 $597.59 1 $0.00 1
1 164 I Fin Tube Connections Plenum I $2,656.00 1 $265.61 I $531.19 1 $0.00 I $796.80 I 30 $1,859.20 1 $0.00 I
165 I Fin Tube Connections Orchestra 1 $14,605.00 1 $0.00 I $4,381.50 I $0.00 I $4,381.50 1 30 %1 $10,223.50 1 $0.00 1
166 I Fin Tube Connections Box Tier 1 $6,307.00 1 $0.00 I $1,892.10 1 $0.00 I $1,892.10 1 30 %1 $4,414.90 1 $0.00 1
1 167 I Fin Tube Connections Balcony I $9,958.00 1 $0.00 1 $2,987.40 I $0.00 I $2,987.40 1 30 %1 $6,970.60 1 $0.00 I
1 168 I Fin Tube Connections Attic 1 $1,992.00 1 $0.00 1 $0.00 I $0.00 1 $0.00 I 0 %1 I ,992.00 I $0.00 I
I Insulation Basement I 1 I I 1 I 1 1 1
TOTALS $3,237,108.05 $2,391,761.15 $93,140.99 $0.00 $2,484,902.1 77 %I $752,205.91 I $181,053.77
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 14 19
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
170 1 Labor $31,937.00 $21,397.80 I $2,554.96 $0.00 $23,952.76 I 75% $7,984.24 1 $638.74
1 171 I Material 1 $27,208.00 $27,208.001 $0.00 $0.00 $27,208.00 100 %1 $0.00 $2,176.64
Insulation Plenum I I I 1
1 173 I Labor 1 $18,103.00 $7,603.261 $2,534.42 $0.00 $10,137.68 56 %1 $7,965.32 $0.00
1 174 1 Material 1 $15,423.00 1 $15,423.00 1 $0.00 1 $0.00 1 $15,423.00 1 100%1 $0.00 1 $0.00 I
i I Insulation Orchestra I I I I I I I I
1 176 1 Labor 1 $14,914.00 $7,158.73 $745.70 $0.001 $7,904.431 53 %1 $7,009.571 $0.001
1 177 1 Material 1 $12,706.00 1 $12,706.00 I $0.00 1 $0.00 1 $12,706.00 1 100%1 $0.00 I $0.00 I
Insulation Box Tier I I I I I I I I
1 179 1 Labor 1 $13,835.00 $0.001 $0.001 $0.001 $0.001 0 %1 $13,835.001 $0.001
1180 1 Material I $11,786.001 $0.001 $0.001 $0.001 $0.001 0 %1 $11,786.001 $0.001
1 Insulation Balcony I I 1 I I I I I I
1 182 1 Labor I $13,835.001 $0.00 $0.00 $0.001 $0.00 0 %1 $13,835.001 $0.001
1 183 1 Material 1 $11,786.00 $0.00 $0.00 $0.00 $0.00 0 %1 $11,786.001 $0.001
TOTALS $3,408,641.05 $2,483,257.94 $98,976.07 $0.00 $2,582,234.0 76 %1 $826,407.04 I $183,869.15
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 15 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 Insulation Attic
1185 I Labor I $13,835.00 $0.00 $0.00 $0.00 $0.00 0 %1 $13,835.00 $0.00
1 186 I Material I $11,786.00 $0.00 $0.00 $0.001 $0.00 0 %1 $11,786.00 $0.00
187 I Temperature Controls Engineering I $64,446.00 1 $64,446.00 I $0.00 I $0.00 1 $64,446.00 1 100 %1 $0.00 1 $6,444.60 1
Temperature Controls Basement I I I I I I I I I
1 189 I Labor I $83,003.00 $49,801.81 $12,450.461 $0.00 $62,252.27 75 %1 520,750.73 $0.00
1 190 1 Material 1 $151,376.00 $151,376.001 $0.00 $0.00 $151,376.00 100 %1 $0.001 $12,110.091
Temperature Controls Plenum I I I I I I I I
1 192 1 Labor I $51,877.00 $14,006.801 $5,706.48 $0.001 $19,713.281 38 %1 $32,163.721 $0.001
1 193 I Material I $78,178.00 $78,178.001 $0.00 $0.00 $78,178.00 100 %1 $0.001 $5,472.461
1 I Temperature Controls Orchestra I I I I I I I I I
1 195 I Labor 1 $15,563.00 $2,801.361 $1,556.30 $0.00 $4,357.66 28 %1 $11,205.341 $0.001
196 1 Material 1 $25,508.00 I $25,508.00 1 $0.00 1 $0.00 1 $25,508.00 1 100 %1 $0.00 1 $0.00 1
1 1 Temperature Controls Box Tier I I 1 I I 1 I 1
TOTALS $3,904,213.05 $2,869,375.91 I $118,689.31 $0.00 I $2,988,065.2 77 %1 5916,147.83 I $207,896.30
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE
Pape 16 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractors signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G I C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
1 198 I Labor $15,563.00 $3,423.861 $778.16 $0.00 $4,202.02 1 27% $11,360.98 $0.00
1 199 1 Material 1 $25,508.00 $25,508.001 $0.00 $0.00 $25,508.00 100 %1 $0.001 50.00
1 1 Temperature Controls Balcony I I I I I I I I I
1 201 Labor 1 $15,563.00) $1,867.56 1 $933.78 1 $0.00 1 $2,80134 1 18 %1 512,761.66 1 $0.00
1 202 1 Material 1 $22,701.001 $22,701.001 $0.001 $0.001 $22,701.00 1 100 %1 $0.001 $0.001
Temperature Controls Attic I I I I I I I I I
1204 1 Labor 1 $15,563.00 $1,867.561 $1,245.04 $0.001 $3,112.60 1 20 %1 $12,450.401 $0.001
1 205 1 Material 1 $16,170.00 $16,170.001 $0.00 $0.001 $16,170.001 100 %1 $0.001 $0.001
1 206 1 Test and Balance 1 $19,474.00 1 $0.00 1 $0.00 1 $0.00 1 $0.00 1 0 %1 $19,474.00 1 $0.00 1
1 207 1 CO #1 GPI #2 LEACH RUSSEL 1 ($24,090.00)1 ($24,090.00)1 $0.00 1 $0.00 1 ($24,090.00)1 100°/x1 $0.00 I ($2,409.00) 1
1 208 1 CO #2- GPI #3- ASI #18 1 $1,776.00 $1,776.00 $0.00 $0.00 $1,776.001 100 %1 50.001 $177.601
1 209 1 GPI 46 Triplex Sump Basin 1 $61,694.00 1 $61,694.00 1 $0.00 1 $0.00 1 $61,694.00 1 100 %1 50.00 1 $3,084.70 1
1 210 1 GPI #7A Basement Kitchen Rev. 1 $17,328.00 1 $13,862.40 1 $519.84 1 $0.00 1 $14,382.24 I 83 %1 $2,945.76 I $356.26 I
1 211 I GPI #10 Box Tier Catering Kitch. 1 $85,312.00 1 $46,921.62 1 $12,796.80 1 $0.00 1 $59,718.42 I 70 %1 $25,593.58 1 $1,706.25 1
TOTALS $4,176,775.05 $3,041,077.91 I $134,962.93 $0.00 j $3,176,040.8 76% 51,000,734.21 I $210,812.11
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 17 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts >PPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A t3 C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
212 1 GPI #23B Strm Water Control Panel $30,693.00 $30,693.00 1 $0.00 $0.00 $30,693.00 1 100% $0.00 $3,069.30
1 213 1 AW 4300A F #15 Oculus Cntris 1 $7,277.00 1 $7,277.00 1 $0.00 1 $0.00 1 $7,277.00 1 100 %1 $0.00 1 $72.78 1
1 214 I AW 4300A F #18 OA Damper 1 $8,605.00 1 $8,605.00 1 $0.00 1 $0.00 1 $8,605.00 1 100 %1 $0.00 1 $86.06 1
1 215 I AW 4290A- F #5 W. Mech. Drain 1 $1,392.00 1 $1,392.00 1 $0.00 1 $0.00 1 $1,392.00 1 100 %1 $0.00 1 $139.21 1
1 216 1 AW 4290A F #8 N Wall Storm 1 $1,372.00 1 $1,372.00 1 $0.00 1 $0.00 1 $1,372.00 1 100 $0.00 I $137.21 1
1 217 I AW 4290A F #9 E. Mech FD 1 $1,845.00 1 $1,845.00 1 $0.00 1 $0.00 1 $1,845.00 100 %1 $0.00 1 $184.50 1
218 I AW 4290B F #19 Fiberoptic Line 1 $8,044.00 1 $8,044.00 1 $0.00 1 $0.00 1 $8,044,00 1 100% $0.00 1 $80.44
1 219 I AW 4290A F #23A Stone 1 $5,361.00 1 $5,361.00 1 50.00 1 $0.00 1 $5,361.00 1011 $0.00 1 $536.10 1
1 220 1 AW 4290B Water /Sewer Bills 1 $6,020.95 1 $4,819.84 1 $1,201.12 1 $0.00 1 $6,020.96 1 100 %1 ($0.01)1 $317.94
221 I AW 430OA -005 F 927 1 $21,740.00 $9,783.00 1 $0.00 1 $0.00 1 $9,783.00 1 45 %1 $11,957.00 1 50.00 1
1 222 1 AW 430OA -003 F #24 1 $5,023.00 1 $5,023.00 $0.00 1 50.00 $5,023.00 1 100 %1 $0.00 1 $0.00
1 223 1 AW 4290A -005 F #28 1 $6,928.00 1 $1,039.20 1 $0.00 1 50.00 1 $1,039.20 1 15 %1 $5,888.80 1 $0.00 1
1 224 1 AW 430OA- 006 F #25 1 $10,104.00 1 $10,104.00 1 $0.00 1 $0.00 1 $10,104.00 1 100% $0.00 1 50.00 f
1 225 1GPI #22- CROSSOVFRBRIDGE 1 $17,533.001 $17,533.001 $0.00 $0.00 $17,533.00 100 %1 50.001 $876.651
TOTALS $4,308,713.00 $3,153,968.951 $136,164.05 $0.00 I $3,290,133.00 76 %1 $1,018,580.001 $216,312.30
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
CONTINUATION PAGE Page 18 18
APPLICATION FOR PAYMENT PROJECT: 002829 APPLICATION NO.: 15
containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE: 12/04/2009
PERIOD TO: 12/31/2009
Use Column I when variable retainage for line items may apply. PROJECT #s:
A B C D E F G H I
COMPLETED WORK
ITEM SCHEDULED FROM STORED TOTAL BALANCE
WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS OMPLETED AN TO RETAINAGE
APPLICATION (NOT IN D OR E) STORED (G C) COMPLETION (IF VARIABLE
(D E) (D E F) (C G) RATE)
TOTALS $4,308,713.00 $3,153,968.95 $136,164.05 $0.00 $3,290,133.00 76%1 $1,018,580.00 $216,312.30
CONTINUATION PAGE FOR APPLICATION FOR PAYMENT
Application #13
Affi davit and Waiver of Lien
Final
x Partial
x Payment Received
State of Indiana County of Marion SS:
Anthony Richardson being duly sworn states that he is the Secretary /Treasurer of General Piping, Inc.
having contracted with the City of Carmel to furnish certain materials and/or labor as follows:
Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City
Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of
the aforementioned Contractor:
Partial Waiver
...that there is due from the Owner the sum of One Hundred Fifty Seven Thousand Six Hundred Seventy
Nine Dollars and 77 Cents ($157,679.77)
x receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit and Partial
Waiver of Lien which is given solely with respect to said amount, and which waiver shall be
effective only upon receipt of payment thereof by the undersigned;
Final Waiver
...that the final balance due from the Owner is the sum of
receipt of which is hereby acknowledged; or
the payment of which has been promised as the sole consideration of this Affidavit and Partial
Waiver of Lien which shall become effective upon receipt of such payment.
Therefore, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim
whatsoever on the above described property and improvements thereon on account of labor or material or both,
furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further
certifies that no other party has any claim or right to a lien on account of any work performed or material
furnished to the undersigned for said project, and within the scope of this affidavit and waiver.
General Piping, Inc. Secretary /Treasurer
(Firm) (Au �i�e Representative) (Title)
Witness my hand and Notorial Seal, this 15` day of December, 2009
Luke Roseboom Zk Z
(Printed) (Notary Public)
My Commission Expires: July 7, 2012 Residing in Hendricks County
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 T
e nerO F I p i h 9 I_ n C Purchase Order No.
1 'x 3 36 Terms
p -1 o1l Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
G1- 13 tE�1. S
Total
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.
ALLOWED 20
P t t "T
(o� rd P� P r IN SUM OF
Fo Bey .3 567
Zr,� s, 1N '4(7
D2 54S o�
J
ON ACCOUNAOFPPROPRIATION FOR
IO
9�2 6907
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
q02 IS 6Dd0`' X32 5� }�,Q�j bill(s) is (are) true and correct and that the
materials or services itemized thereon for
1
which charge is made were ordered and
received except
�2 20 /b
na ure
irector of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund