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182708 03/02/2010
CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1 ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP INDIANA 46032 7930 CASTLEWAY DRIVE CHECK AMOUNT: $419,639.95 CARMEL INDIANAPOLIS IN 46250 CHECK NUMBER: 182708 CHECK DATE: 3/2/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 11 419,639.95 PERFORMING ARTS CENTE SL Subcontract Billing Report For Work Invoiced From 12/01109 to 12131/09 r Sdbcontract: 2695- 3110 3110Lime "stone Cladding Job: 2695- Carmel RPAC Construction Vendor: 3105 HAGERMAN CONSTRUCTION COMPANY 777 3rd Ave. SW Carmel, IN 46032 1 g„ k Contract E ToDate This P' eriod T Item Units UM Unit Cost Amount Units/% Amount Units/% Amount 1 3110 Limestone Cladding LS 6,126,000.00 62,47% 3,827,150.00 6.65% 407,290.00 Total Contract Items 6,126,000.0 3,827,150.00 407,290.00 Change Orders 2 CCR 1006 Limestone Field LS 730,000.00 43.56% 318,000.00 0,00% 0.00 Alternate 3 CCR 1007 Cast Stone LS 200,000.00 100.00% 200,000.00 0.00% 0.00 Drum Alternate 4 RFI No. PAC -0251 Granite LS 7,642,14 96.78% 7,396.07 0.00% 0.00 Shop Drawings Joint. 5 RFI No. PAC -0252 Granite LS 1,581.01 97,41% 1,540.00 0.00% 0,00 Shop Drawings OIH 7 3110 Limestone Installation LS -5,000.00 0.00% 0.00 0.00% 0.00 Total Change Order Items 934,223.1 526,936.07 0.00 Subcontract Totals: 7,060,223.15 4,354,086.07 407,290.00 Total Billinqs: 4,354,086.07 407,290.00 Unpaid Retainage: 353,261.16 0.00 Discounts: 0.00 0.00 Net Billings: 4,000,824.91 407,290.00 98 SSC CMa Projects Page 1 12/17/09 02:42.34 PM Date Format MM /DD /YY SLSubBillingReport .rpt y�- TM �k Document G7021CMa -1992 Application and Certificate for Payment Construction Manager Adviser Edition TO OWNER: CARMEL REDEVELOPMENT COMPORCIJECT: Carmel Regional Performing Art APPLICATION NO: APP 9:00011 Distribution to: 211 City Center Drive Carmel IN 46032 PERIOD TO:_ 12/31/2009 OWNER ❑X CONSTRUCTION MANAGER ❑X FROM CONTRACTOR: VIA CONSTRUCTION MtIAGER: CONTRACT DATE: 1/30/2008 ARCHITECT ❑X ave rewer Hagerman Construction Corp P.O. Box Shiel Sexton PROJECT NOS: 08- 2619 -1 l CONTRACTOR Fort Waynee, IN N 46$53 -0690 VIA ARCHITECT: Brandon Bogan INVOICE NO: 9612 FIELD 11 CSO Architects Inc CONTRACT FOR: Masonry CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowled information and Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous 6 126,000.00 Certificates for Payment were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM .............I —......._......1$ payment shown herein is now due. 2. Net change by Change Orders 939,223.1 CONTRACTOR: german Cons tr ction Co 2) 3. CONTRACT SUM TO DATE (Line 1 7,065,223.1 Bys Dat {ag bar_ 15, 200 4. TOTAL COMPLETED STORED TO DATE Column G on G703 State I Tana �S' 4 354.086.0 roy. Heisler, Controlle 5. RETAINAGE County of: Allen °,e a. 5 ('/o of ComplcEed Work Subscribed and sworn to before (Column D+ E on G703) 353,261.16 y' :N t I r Ar N a me this 15th da er 009 b. of Stored Material Notary Public: David C. a (Column F on G703) My Commission expires: I ►ypT{r�Y$�AL Total Retainage (Lines 5a 5b or Total in column I of G703) 353,261.1 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observeyi' hMay�g tta comprising 6. TOTAL EARNED LESS RETAINAGE 4,000,R24 9 1 this application, the Construction Manager and Architect certify to the terahat "to the best of their (Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 3,593,534.9 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6from prior Certificate) CERTIFIED. 8. CURRENT PAYMENT DUE Is 407,290.0 AMOUNT CERTIFIED 407,290.00 9. BALANCE TO FINISH,JNCLUDING RETAINAGE (Attach explanation if amount certified differs from the ain6unt applied. Initial all figures on this Application and or ntinu Sheet t tat are changed to conform with the amount certified.) (Line 3 less Line 6) 3,064,39$.24 CONSTRU AGER: Shiel Sexton By: Date: pCC 2 oel CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AR61E, T: n 'CS�O.Arc�cts Inc �j Total changes approved in previous months by Owner 939,223. B Date: 4C/ Total approved this "Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS 939,223. 56 named herein. Issuance 'payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order 939,223.15 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 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 taw. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations o1 AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. CONTINUATION SHEET AIA DOCUME G 703 P 2I't1OM AIA Docuine ni G702, A.l'PUC:ATION AND CERTIFICATE FOR PAYte?IL N "1% APPLICATION ION NO.: 130011 s;0W.141ing Contractors signed Certification, is atiaclse� APPLICATION' DATE: In tabulations below, am6unti :ire ststed to the ricarest dpllar. PERIOD TO: 12131,'2009 Use 1Colunur I or1 Contracts where var=iabic rctainfkgc •tor line items may apply, APCI-t(TFC'rS PIZC)l'> cr No.: 171;26 A B WORTO COMPI,E T \IA'6t1i1AUS TOTAL HAIvA°4CE ITev, SCI�}'.L71iLED PRESFXTI-Y C MPLFF-11 -1) WrAIiNAGE I�ESi CZIF TICS ti C7I W �PiONI I REVIOUS °fv TO [IF VARIABLE) NO- VI+LUE `ITORE0 A�1I.1MPFI) FI?� "ISIi R APPLIGr1TIt3�I 111S PERIOD r \TE 0N�`C_te� 7O ]aATG IC G) (D E) t) 6k, Fl (D- E +F) 00000 $0,00 20 -00 $0.00 SO.00 0 50.00 $0:00 006000 0000010 GENERAL CONDITION 0000020 Bonding. Insurance $56.000,00 $56,000.00 50:00 50100 S56'0D0,00 104.000 $000 $0,00 0000030 Subminals 5101000.00 $10:000.00 $0:00 $0.00 $10.000'00 100.000 $0.00 $0,00 0000040 Project !Meetings $10,000;00 $7,00000 $5 1:00 $0.00 $7,500,00 75:000 $2,500;00 50100 0000050 molaiil7viarl $28,000:00 V&DOO .'00 50,00 S28000.00 100,000 $0.OD $0.110 000006D Derno0 allon $25:000:00 3(1.00 $0.00 50;00 50.00 0 $25.000.00 $0 009171370 Contract Close Out S6:00O:00 $0.00 $0:00 $0,00 50.00 0 $s,00o.0d 50:00 0000M Alkn anpe #A Al bullts $5.1}00;00 so.00 $0.00 583 -00 $a 00 0 $5,040:00 50:00 0000100 EXTERIOR MASONRY 0000110 Ct7 0 4orth Labor $30,000.00 $30.000:00 SO.r30 50:00 530.1 W0 00 100,000 5100 $0.00 0000120 CMU East Labor S2'5,000.00 517,500:00 $0,00 50,00 S17.500 70.000 $7 :500.00' $0.00 0000730 07113 South Labor S37,000,00' 30.00 S00o 50.00 50,00 D $37,001).00 $0,00 0000140 CMU West Latrar s,2s,6O000 56.00 $0:00; SO40 $0.00 0 525;000100 $0,00 0000150 CMU Arum Labor 5331000;00 S39:000.00 $0.00 50:00 $39000.00 100.000 $0.04 $0.00 0900160 C mu, N felt ►tariols $9,000.00 99:000,04 $0,00 SO= 59;000°00 100400 $0.00 $D:00' 0000170 CMU EasE s 5700:40 $4,900.00 50100 S0;00 54,900.00. 70.11017 $2,100.00 50:00 00001180 Ct%, Soulh Material. 510.0=00 $0.00 $0.00. 50100 50:00 0 si'0406.00 $0.00 00170190 CMU Writ N4oterials s7.00i? ©0 $0:013 $Q�00,, S0,00 S0.do .6 37,000:00 50;013 00042Q0 C4l1 C3rui11 h"latariais 5 2;00000 $-I Zddo;tao SEL00 $0:00 &12.000.00 100,000 O:Ot X0.40 0004240 VaporBaalerLanor $1fi2,O00:00 583,900100 548.6170.012 SO= 5137,700;00 85.000' 524;360,(30 $0:00 W00220 %4ppr Barvier-Matenals s�l8;000.00 $88,20000 541.00 $03 00 $48;200.00 80.0001 S9:BQ0:00 50:00) 0000240 EXTERIOR VENEER 0000250 Granite tabor: 5205.000.00 $143,500.00 S0:Q0 59000 5143,500.00 70.000 561,500.00 -$0:00 0D002[0 Granlle'matrrials S504.000 :00 0504.000.01( S4.00 SO.00 SSO4:000,00 104.:6 10:00 50:00 D000270 Limestone-Nonh Labor 5878;000:00 $859 660.00 $26 0 $0;110 $678;000.00 100.000 $0:00 SD:00 0000280 L itve to ne North Materials 5126,Q90,00 S128.000..00 50.00 so.00 5126:000:01 100.000 .$4.00 $O'. 0000290 tlmeslor;4 East'U60r S734.00:00 $440 400:00 5110 50.00 $550,500:00 75.000 5183,500:00 $0:40 0000300 t:trnastarial East KlateFials $107 00000 $40,950!,00 510:700,.00 50.00 S10'I, 95.400 $5,350.00. 5000 0111}0314 111111 tcir so South Laticsr 5390 040;0(3 $133.SOO:QO 5178040;00 Sff (J0 S31 ,500 :00 35,040 5578.500100 X000 0000320 L- m asto6il� Souil'i'Materials $_`132.000:00 5119 400.00! $6, :00 S0 00 iFiG,040.00' 50 90� S68;tMJ1):00 WOO AtA�06CUMEN.T'G701'• R1'rq LCA"4IU A?3)`CS trttrG!�rFF0RPAI'11«Zrr .`,r7vz r1�t1'117N n3ASP• X31 itTtTA99tylii�A itv�rrrtjr i:OFARC:tlTFC'ra, VOIk roYL (tR 14+ C' A5i 6111 td5 L t� lttrltsdi -3'_J3 iNAfitdlNG: UnIIG3�+6Rd pttato�dtry3ng,vlcsittias 7U3 1,992 U.S, rop3 right tativs ar�d will- ar+trjott 1?tio violet t;isi tn041 prosoeuticn.. 'Tfi�6s%v+l�ivlss yea+ /oarad,:ead a3errm4,�f'#r.+= sfR+D�+' ^IDS rAa;Lmaiata•,p.:Nlei /a of AishaactlV�� +[tctrse 87GQa.to (?ir: oven �ws:sms. tisc n�amtta[K#+MSSaiq;asy wi4fita3 �9cretsPesarp deF#fiQot ea ew�cnev.nid.. Centnet raeM'aI�rn Nplmrs..M trxi�esb k miet�4:t;.a�'cen_v�ertitm+a tiF is�`s e,:ea�ae�.ro-3d dfwnta std: CONTINUATION SHEET AIA DOCUMENT G703 taA(;F 2 OK, J AGF S AIA Doctiment G702. APPL Aj 0- C'6R'l1r1CATi rojt,P Y "M N- APPLICATION NO.: 0061 conwining Contractor's signed Certification, is .'q chccl. APPLICATION DATE in (abulacions. below, aniclunts site stated to the neAresi 8ollar. vI.iF, too `ro: i w ii7 110q Use Column 1 tart CDntrac.ts whom variable retainage for line penis nlny apply, x'LI2cwTEM'S PROJECT NO.: 0826 19A WORK COMPLETED mATER1ALS 'FOTAl. BALANCE CLL°CA1l1AGt: r SCHEDULED P�eESEa�iTL Y Cc)mPLE CICh1 t3teS f±FPflCav i5f 1' C1tik }'Ftc1W VR1 Vtt)U$ TO VAL,U STORED AND STORED t iNISlt iF V ZAT E E3LE1 1 APPL1CAl7C1v` THIS F'- ERit4C RAT `t?tiC1T t'�� TO DATE (�Cl Ic c'J (D+F„1" DORE) P"Ei -F) VVest Lp!)ar =,DOO:flt1 vt3.[t4; S{i.0[} 50;iKi Sf}.DQ 0 S7 4, ©04,00 $0.40 w W est t, y C x0,00 e :00 00 W.M. 30,00 52 €:400'00 20.000 S85.60000 $0.00 10 f3 F tZf�f S forum L fi,ia S24 x.000:00 5249,000,00 sub WOO 5349.000,00 100,000 50,0.0 $0.00 Dfuln r't 4aal 0r,t1O0.00 s3'3,000.03j so.ou 50,00 S330.0Q0.00 100,000 "0:00 .50.04 x! €asitt u tSkirr �u3 2216 �im,?04.G3` S7 ;•40Q. O.Ois s51.600.00 20.OD0 $230,400.00 $0:00 UMM) ,0, Ang CetrtiiliJ 14 610i W%i 5241.000:{}0 $3t�,150:00 514050.00 $0:00 S48,2MOO 20.06D 5192,800,00 0.00 0600400 C14ANGE ORDERS 0000410 CO #1- 'Umestonc Ftpld Stone 000(W0 Um Field Labor 54130,000:00 S168 MOD 50 $168,000.00 35.(700 $312,000:00 so 0000 Limestone Field klaterial 5250,060.00 $150 54,00, 50.00 x150,000.00 60.000 5100;CD0,00 $0.04 0000450 CO A 2 Dr6m ver??e t 0000460 Drum Veneer Labor S110,000,0O $110,000.00 SO.00 50.00 5110,000,00 160,000 50:00 S0 -00 0000470 Drum Vzxeer Matetials" $90.Ia00,OQ $94,000;Dii $4.00 54.00 590.000,00 100;000 s0:00 $6:00 0040400 CO 0 PAC: 0251 Granite JttCtrting 0000soo Gfoniie Labot $492:14 $246,07 $0:40 WOO 5240:07 50.06o $24- $0.00 0WO510 GranitteMateliai '$7,150.40 $7,150.00 50.015 s0.tu0 S7,1E50,00 100:000 $0.00 $0.00 0000530 06#4 Granite l3i»r jamb 0400540 Granite La6ai 541,01 $0,00 50.00 WOO $0,00 01 1x01 $fl;00 i 0000550 Grarlite 5late6al 51.540.00 $1,544,00 30:00 50.E 51.540.00' 100.000 $0;00 50;00 y7,065.223:15 53 ,946 796 =03 5447,294.04 50.04 $4,354,085.07 61 o3?Ja S2,711 13 7 ;08 30:00 A -WCUMENTGa03 IM ED1710' Atilt' CH92- THE M RIC&1'1NPTUfEOF -A :ft *HnECSS_ vb -kk rtiEtii t R N .vStdt*rL�tt3�. Li,C ?OiKJS 3392 wARNIFtG: Unikeasad pti ocopjFn0 A0 3 U.S.:ca"righttaws acrd! v3tl sutsja+ t tha vioistcr:to lageI prasmraaq. G703-1992, ''bf 11.swnLP33tat6�zre rBgr¢ai5esa aid[" Gat' �ammx3i�a tlP TMp li:lc +n hr3£:ua NddtaC vifdR i3cems 4T4aJ WrtFKYd N{rt"�aia, kec ,�q:Ks kf'a Aaic! *wrq .w.iuic t+?�w�3A:as `.4vrrszaz2 iv RcS O.eressa: Cwincf,Tlm M+sika'rc ImCUtaal A[cM1l'.ezli. �Y.ISti:Y@fHC[btNlP SYifaaJtWCAfEMGk4Nxfl li'iffiftfiA=3' I WAIVER OF LIEN The undersigned is the duly authorized officerof Hagman nnR n�rt-inn C nr=r at inn the general contractor, (Name of Company) subcontractor," materialman or other person furnishing the services, labor, material or equipment indicated below in. the construction of improvements upon real estate located in Hamilton County, State of Indiana commonly known as Qwmel Regime PELIdndng Arts which real estate isow of cane -A R�>plcrmmt "Owner Oa Center Nla y T rPL; 11i' o r /�i M !i u r �t� 7C}; S /x /t i ,c a= A v n 7�i. INCONSIDERATIONofthesu of DOLLARS ($-2,9 3 z receipt of which Is hereby acknowledged, and in order to procure one or more paymen s for services, labor, ma edal or equipment provided in such construction, the Company does hereby 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 forservices, labor, material or equipment furnished in respectof such land orimprovements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim forpayment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfertitle to the services, labor, material or equipment to the Owners or tenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the sole consideration received by the Company for said services,labor, material or equipment furnished to date, and that the Company has neither received nor made any security interest, title retention interest or lien rights in the said services, labor, material or equipment other than that released and transferred hereby. The material, labor, services or equipment furnished are more particularly described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has compliedwith all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 111A day of 200 ,9 Troy Heist R Co tlVe Hagerman Construction Corporation (Name of Company) State of Indiana County of Allen SS: Before me, the undersigned, a Notary Public in and for said County and State, personally appeared Troy Heisler the cam 7 ZZ2 Of Haaarman rnnstructi on rnrporad C] who acknowledged (Title) (Name of Company) the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such Company and the free act and deed of said officer. I WITNESS my hand and notarial seal this Id fp c 9nn C OMM. My Commission Expires: 6 /Notary Public 9- Oft 1 CIS ALLEN �OF My County of Residence: (Printed Name of Notary Public) Alen ��IND��` Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1395) 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 Purchase Order No. 9 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(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 IN SUM OF 2 O NT OF PPROP TION FOR Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. 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 3 20110 op ig ature Cost distribution ledger classification if Title- claim paid motor vehicle highway fund SL Subcontract Billing Report For Work Invoiced From 12/01/09 to 12131/09 Sukicontract: 269&3000 OG&Concrete Job: 2695- Carmel RPAC Construction Vendor: 3105 HAGERMAN CONSTRUCTfON COMPANY 777 3rd Ave. 5W Carmel, IN 46032 Contract a To Date This3Periotl h,• Item Units UM Unit Cost Amount Units!% Amount Units Amount 1 3000 Concrete LS 5,588,000.00 96.43% 5,388,425,25 0.22% 12,349.95 Total Contract Items 5,588,000.0 5,388,425.25 12,349.95 Change Orders 28 CCR #1010 Owner Provided LS 20,000.0 100,00% 20,000.00 0.00% 0.00 Parking Alternate 29 CCR 1008 Oculus LS 10,000.0 100.00% 10,000.00 0.00% 0.00 Alternate 30 CCR 1020 ASI No LS 27,828.00 100,00% 27,828.00 0.00% 0.00 PAC -009 Elevators #1 2 31 CCR 1020 ASI Na LS 11,926.00 100.00% 11,926.00 0,00% 0.00 PAC -009 Elevator 43 32 CCR 1021 ASI No. LS 9,707.00 100.00% 9,707.00 0.00% 0.00 PAC -010 Sanitary Sewerage 34 CCR 1017 ASI No. LS 5,744.00 100.00% 5,744.00 0.00% 0.00 PAC -007 35 CCR 1030 ASI No. LS -1,175.00 0.00% 0.00 0.00% 0.00 PAC -005 Storm Sump Elimination 36 CCR 1031 Add Solid Pipe LS 554.00 100.00% 554.00 0.00% 0.00 Underslab Drain 37 CCR 1032 RFI No. LS 14,139,00 100.00% 14,139.00 0.00% 0.00 PAC -0200 Backfill of Interior Wails 38 CCR 1033 ASI No, LS 1,757.00 100.00% 1,757.00 0,00% 0.00 PAC -001 Isolated Slab in Util. Tunnel 39 CCR 1034 ASI No. LS 12,142.0 100,00% 12,142.00 0.00% 0.00 PAC -003 Ductwork Ceiling Clearances 40 CCR #1029 -ASI No. LS 22,449.00 100.00% 22,449.00 0.00% 0.00 PAC -006 BP #4 Mod. Embeds SOMD 41 CCR 1029 ASI No. LS 32,257.00 100.00% 32,257.00 0.00% 0.00 PAC -006 BP #4 Mod. Column Encase. 42 CCR 1035 RFI No. LS 6,578.00 100.00% 6,578.00 0,00% 0.00 PAC -0053 Pier dimension reinforcemen 43 CCR 1036 Equipment Pit LS 1,757.0 100.00% 1,757.00 0,00% 0.00 Water Main Sleeve 44 CCR 1027 ASI No, LS 26,221 LO 100.00% 26,221.00 0.00% 0.00 PAC -002 Speaker Boxes East 45 CCR 1027 ASI No LS 29,820.00 100.00% 29,820.00 0.00% 0.00 PAC -002 Speaker Boxes West 46 ASI No. PAC -040 Sanitary LS 18,987.0 100.00% 18,987.00 0.00% 0.00 Force Main 47 .RFI. No. PAC -0200 Backfill of LS 6,800.00 100,00% 6,800.00 0.00% Ho Interior Walls Commercial 98 SSC CMa Projects Page 1 12/17/09 02:42:53 PM Date Format MMIDD /YY SLSubBil ling Report .rpt SL Subcontract Billing Report For Work Invoiced From 12/01109 to 12/31109 :Subcontract :•,2695- 3000 -3000 Concrete; Continuetl Job: 2695- Carmel RPAC Construction Vendor: 3105 HAGERMAN CONSTRUCTION COMPANY 777 3rd Ave. SW Carmel, IN 46032 e Contra °ct E To` Date This Period Item Units UM Unit Cost Amount Units/% Amount Units/% Amount 49 CCR 1022 ASI No. LS 5,428.00 100.00% 5,428.00 0.00% 0.00 PAC -011 -Grillage Framing 50 CCR 1028 ASI No. LS 8,505.0 100.00% 8,505.00 000% 0.00 PAC -017 Arch.- Struct. Conflicts Du% 51 CCR xxxx Undercutting of LS 22,060.00 100.00% 22,060.00 0,00% 0.00 Soils per All Wilzig 52 CCR xxxx Undercutting of LS 9,520.00 100.00% 9,520.00 0.00% 0.00 Soils per Alt Witzig 53 CCR xxxx Undercutting of LS 3,678.00 100.00% 3,678.00 0.00% 0.00 Soils per Alt Witzig 54 Generator Slab LS 2,132.00 100.00% 2,132.00 0.00% 0.00 56 3000 Concrete LS 8,505.00 100.00% 8,505.00 0.00% 0.00 58 RFI No. 282 Elevator Machine LS 3,751.00 100.00% 3,751.00 0.00% 0.00 Room Wall Ftg. 59 ASI #PAC -036 Column LS 27,521.00 100.00% 27,521.00 0.00% 0.00 Encasements East 60 ASI #PAC -036 Column LS 28,000.00 100.00% 28,000.00 0.00% 0.00 Encasements West 62 CCR xxxx ASI No LS 3,181.00 100.00% 3,181.00 0.00% 0.00 PAC -018 Central Garbage Vacuum Pit 63 ASI No. PAC -021 South LS 7,870.00 60,00% 4,722.00 0.00% 0.00 Portico Entry Stair 64 ASI No. PAC- 022 Platform LS 5,106,OC 100.00% 5,106.00 0.00% 0.00 Extension Lift Pit 65 3000 Concrete LS 11,419.0C 100.00% 1,419.00 0.00% 0.00 66 3000 Concrete LS 4,293.00 100.00% 4,293.00 0.00% 0.00 67 3000 Concrete LS -8,505,OC 100,00% 8,505.00 0.00% 0.00 68 3000 Concrete LS 1,414.0 100,00% 1,414.00 0.00% 0.00 Total Change Order Items 337,769.0 335,796.00 0.00 Subcontract Totals: 5,925,769.00 5,724,221.25 12,349.95 Total Billings: 5,724,221.25 12,349.95 Unpaid Retainage: 296,288.45 0.00 Discounts: 0.00 0.00 Net Billings: 5,427,932.80 12,349.95 98 SSG CMa Projects Page 2 12/17/09 02:42:53 PM Date Format MM /DD /YY SLSubBilling Report, rpt TM Document G7021CMa -1992 Application and Certifica t6l for Payment Construction Manager Adviser Edition TO OWNER: PROJECT:�� A APPLICATION NO Distribution to: Carmel Redevelopment Commission City of Carmel HCC fob #2613 PERIOD TO 12/31/09 OWNER Carmel, IN. 46032 Invoice #9613 CONSTRUCTION MANAGER FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT Hagerman Construction Corporation Shiel Sexton PROJECT NOS: 2695 1 CONTRACTOR P.O. Box 10690 Fort Wayne, IN 46853 VIA ARCHITECT: FIELD CONTRACTFOR: CSO Architects 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 Continuation Sheet, AIA Document G703, is attached. 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 1. ORIGINAL CONTRACT SUM 5, MA3,pQp_Qp payment shown herein is now due. 2. Net change by Change Orders 337,769.00 CONTRACTO Hagerman Construct Corporation 3. CONTRACT SUM TO DATE (Lme.l 2) �i,�325,7Fs9_(X� gY tuber 15, 2009 4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 5,724,221.25 State fro eisler, C roller e i e �j�j 5. RETAINAGE County of: Indiana ll/ *rv'y .4 tf' a• of Completed Work. Subscribed and sworrnto.betore t tlbB y (Column D E on G703) 296, 288.45 me this 15 olbece e 2909 b. /o of Stored Material Notary Pu ic: (Column F on 6703) My Commission e S. Total Retaina (Lines 5a 5b or Total in Column I of G703) 296 CERTIFICATE FOR PAYMENT cam In accordance with the Contract Documents, based on on-sitt on-sit 6 141 KM e, data comprising 6. TOTAL EARNED LESS RETAINAGE 5,40 f 932. this application, the Construction Manager and Architect certify tt, tke;OFgrki ihat 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 5,415,582.85 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 12,349. AMOUNT CERTIFIED 1 3 IS 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from. the amount applied. Initia, all figures on this Application and crn ie Continuation Street that are "changed to conform with the amount certified.) (Line 3 less Line 6) 497,836.20 CONSTRU ANAGER d By: Date: Z3P -Z 2Gwci CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC EC Total changes approved in previous months by Owner $365 744. Q 27, 975 00 By: Date: Total a roved this Month v pp —Q— -Q- This Certificate i5 not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $365 744.0 27,975 named herein. Issuance; "payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $337 769.00 the Owner or Contractor under this Contract. CAUTION: You should sign an original AEA 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 CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF5PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00022 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED eta TO RETAINAGE NO. VALUE STORED AND STORED FINISH VARIABLE) APPLICATION THIS PERIOD (NOT IN TO DATE (G C) RATE (D E) D OR E) (D +E +F) (C G) 0000010 GENERAL CONDITIONS 0000020 Bond $41,375.00 $41,375.00 $0.00 $0.00 $41,375.00 100.000 $0.00 $0.00 0000030 General Conditions $169,586.00 $166,194.28 $1,695.86 $100 $167,890.14 99.000 $1,695.86 $0.00 0000040 Supervision I Engineering $320,164.00 $313,760.72 $3,201.64 $0.00 $316,962.36 99.000 $3,201.64 $0.00 0000045 Equipment Operators $383,328.00 $383,328.00 $0.00 $0.00 $383,328.00 100.000 $0.00 $0.00 0000050 Owner Allowance $55,000.00 $42,222.00 $0.00 $0.00 $42,222.00 76.767 $12,778.00 $0.00 0000055 Subtotal General Conditions $969,453.00 $946,880.00 $4,897.50 $0.00 $951,777.50 98.177 $17,675.50 $0.00 0000060 EARTHWORK 0000070 Excavation Backfill $795,000.00 $755,250.00 $0.00 $0.00 $755,250.00 95.000 $39,750.00 $0.00 0000080 Site Utilities $200,000.00 $150,000.00 $0.00 $0.00 $150,000.00 75.000 $50,000.00 $0.00 0000090 Soil Treatment (Termiticide) $6,448.00 $6,448.00 $0.00 $0.00 $6,448.00 100.000 $0.00 $0.00 0000095 Subtotal Earthwork $1,001,448.00 $911,698.00 $0.00 $0.00 $911,698.00 91.038 $89,750.00 $0.00 0000110 CONCRETE 0000120 Footings Labor $206,046.00 $206,046.00 $0.00 $0.00 $206,046.00 100.000 $0.00 $0.00 0000130 Footings Material $202,588.00 $202,588.00 $0.00 $0.00 $202,588.00 100.000 $0.00 $0.00 0000140 Foundation Walls/Piers Labor $603,561.00 $603,561.00 $0.00 $0.00 $603,561.00 100.000 $0.00 $0.00 0000150 Foundation Walls/Piers Material $414,224.00 $414,224.00 $0.00 $0.00 $414,224.00 100.000 $0.00 $0.00 0000160 Slabs on Grade Labor $47,650.00 $47,650.00 $0.00 $0.00 $47,650.00 100.000 $0.00 $0.00 0000170 Slabs on Grade Material $91,157.00 $91,157.00 $0.00 $0.00 $91,157.00 100.000 $0.00 $0.00 0000180 Elevated Slabs Labor $29,485.00 $29,485.00 $0.00 $0.00 $29,485.00 100.000 $0.00 $0.00 0000190 Elevated Slabs Material $24,740.00 $24,740.00 $0.00 $0.00 $24,740.00 100.000 $0.00 $0.00 0000200 Elevator Shafts Labor $167,945.00 $167,945.00 $0.00 $0.00 $167,945.00 100.000 $0.00 $0.00 0000210 Elevator Shafts Material $61,125.00 $61,125.00 $0.00 $0.00 $61,125.00 100.000 $0.00 $0.00 0000220 Columns Labor $134,436.00 $134,436.00 $0.00 $0.00 $134,436.00 100.000 $0.00 $0.00 0000230 Columns Material $51,221.00 $51,221.00 $0.00 $0.00 $51,221.00 100.000 $0.00 $0.00 0000240 Slabs on Metal Deck Labor $116,191.00 $116,191.00 $0.00 $0.00 $116,191.00 100.000 $0.00 $0.00 0000250 Slabs on Metal Deck Material $245,878.00 $245,878.00 $0.00 $0.00 $245,878.00 100.000 $0.00 $0.00 0000260 Topping Slab /Stair /Curb Labor $88,023.00 $79,220.70 $4,401.15 $0.00 $83,621.85 95.000 $4,401.15 $0.00 0000270 Topping Slab /Stair /Curb Material $61,026.00 $54,923.40 $3,051.30 $0.00 $57,974.70 95.000 $3,051.30 $0.00 0000280 Rebar Labor $239,605.00 $234,812.90 $0.00 $0.00 $234,812.90 98.000 $4,792.10 $0.00 0000290 Rebar Material $406,775.00 $406,775.00 $0.00 $0.00 $406,775.00 100.000 $0.00 $0.00 00003 Misc. Metal L abo r 1 27,015.00 $13,507.50 $0.00 $0.00 $13,507.50 50.000 $1 3,507.50 $0. AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIAV ©1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 6703 -1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronically with the permission of The Amencan Institute Of Architects under !_icense 97003 to Pnmavera Systems, Inc. Reproduction of this document without pmjea specific information is not permitted. Contact The American In stltute Of Architects to verifv the current version of mis document and license status.' CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 5 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00022 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED di TO F VARIA BLL NO. VALUE STORED AND STORED FINISH RATE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) RATE (C G) (D E) D OR E) (D +E +F) 0000310 Misc. Metals Material $38,003.00 $22,801.80 $0.00 $0.00 $22,801.80 60.000 $15,201.20 $0.00 0000315 Subtotal Concrete $3,256,694.00 $3,208,288.30 $7,452.45 $0.00 $3,215,740.75 98.742 $40,953.25 $0.00 0000330 THERMAL AND MOISTURE PROTECTION 0000340 Insulation Labor $3,877.00 $3,877.00 $0.00 $0.00 $3,877.00 100.000 $0.00 $0.00 0000350 Insulation Material $15,268.00 $15,268.00 $0.00 $0.00 $15,268.00 100.000 $0.00 $0.00 0000360 Waterproofing Labor $90,000.00 $81,000.00 $0.00 $0.00 $81,000.00 90.000 $9,000.00 $0.00 0000370 Waterproofing Material $122,960.00 $110,664.00 $0.00 $0.00 $110,664.00 90.000 $12,296.00 $0.00 0000380 Caulking Labor $13,300.00 $0.00 $0.00 $0.00 $0.00 0 $13,300.00 $0.00 0000390 Caulking Material $16,600.00 $0.00 $0.00 $0.00 $0.00 0 $16,600.00 $0.00 0000400 Subtotal Thermal Moisture Protection $262,005.00 $210,809.00 $0.00 $0.00 $210,809.00 80.460 $51,196.00 $0.00 0000420 SPECIAL CONSTRUCTION 0000430 Vibration Sound Control Jack Up Floor Systel $98,400.00 $98,400.00 $0.00 $0.40 $98,400.00 100.000 $0.00 $0.00 0000450 CHANGE ORDER #01 0000460 Alternate Parking ($20,000.00) ($20,000.00) $0.00 $0.00 ($20,000.00) 100.000 $0.00 $0.00 0000480 CHANGE ORDER #02 0000490 Oculus Alternate $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00 0000510 CHANGE ORDER #03 0000520 PC 10R2 Elevator Changes $27,828.00 $27,828.00 $0.00 $0.00 $27,828.00 100.000 $0.00 $0.00 0000540 CHANGE ORDER #04 0000550 PC 10R2 Elevator Changes $11,926.00 $11,926.00 $0.00 $0.00 $11,926.00 100.000 $0.00 $0.00 0000570 CHANGE ORDER #05 0000580 PC 18 Sanitary Sewer Force Main Piping $9,707.00 $9,707.00 $0.00 $0.00 $9,707.00 100.000 $0.00 $0.00 0000600 CHANGE ORDER #06 0000610 PC 05R1 ASI #2 Speaker Boxes $26,221.00 $26,221.00 $0.00 $0.00 $26,221.00 100.000 $0.00 $0.00 0000630 CHANGE ORDER #07 AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA9 01992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G703 -1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronically with the perm ission of The Amendan Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this dowment without projacFspecife information Is not permitted. Comm t The American Institute of Ardiitects to verity the current version of this document and 11-se status. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 OF 5 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00022 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO IF F VARIABLE) NO. VALUE STORED AND STORED FINISH E} APPLICATION THIS PERIOD (NOT IN TO DATE (G C) RATE (C G) (D E) D OR E) (D +E +F) 0000640 PC 12R1 Foundation Changes $5,744.00 $5,744.00 $0.00 $0.00 $5,744.00 100.000 $0.00 $0.00 0000660 CHANGE ORDER #08 0000670 PC #15R1 Reduce Size of HDPE Pipe ($1,175.00) $0.00 $0.00 $0.00 $0.00 0 ($1,175.00) $0.00 0000690 CHANGE ORDER #09 0000700 PC 22 HDPE Single Wall Pipe $554.00 $554.00 $0.00 $0.00 $554.00 100.000 $0.00 $0.00 0000720 CHANGE ORDER #10 0000730 PC 23 Change Drainage Layer Stone $14,139.00 $14,139.00 $0.00 $0.00 $14,139.00 100.000 $0.00 $0.00 0000750 CHANGE ORDER #11 0000760 PC 0482 ASI #1 Modification to Utility Tunne $1,757.00 $1,757.00 $0.00 $0.00 $1,757.00 100.000 $0.00 $0.00 0000780 CHANGE ORDER 912 0000790 PC 06R2 ASI #3 Added Columns $12,142.00 $12,142.00 $0.00 $0.00 $12,142.00 100.000 $0.00 $0.00 0000810 CHANGE ORDER #13 0000820 PC 09R2 ASI #6 Various Changes $22,449.00 $22,449.00 $0.00 $0.00 $22,449.00 100.000 $0.00 $0.00 0000840 CHANGE ORDER #14 0000850 PC 09R2 ASI #6 Various Changes $32,257.00 $32,257.00 $0.00 $0.00 $32,257.00 100.000 $0.00 $0.00 0000870 CHANGE ORDER 915 0000880 PC 02R1 Added Extended Piers $6,578.00 $6,578-00 $0.00 $0.00 $6,578.00 100.000 $0.00 $0.00 0000900 CHANGE ORDER #16 0000910 PC 35 Water Main Sleeve $1,757.00 $1,757.00 $0.00 $0.00 $1,757.00 100.000 $0.00 $0.00 0000930 CHANGE ORDER #17 0000940 PC 05R1 Speaker Boxes West $29,820.00 $29,820.00 $0.00 $0.00 $29,820.00 100.000 $0.00 $0.00 0000960 CHANGE ORDER #18 0000970 PC 34R2 ASI 940 Sanitary Force Main $18,987.00 $18,987.00 $0.00 $0.00 $18,987.00 100.000 $0.00 $0.00 AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT t992 EDITION AIA® C1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK G703.1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced elactmniniry with the permission of The Amencen Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without umiactspeci is information is not permitted. Contact The Amerfmn Institute of Architects to verity the current version of this document and license status' CONTINUATION SHEET AIA DOCUMENT G703 PAGE 4 OF 5 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00022 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED ale TO RETAINAGE NO. VALUE STORED AND STORED FINISH ]F VARIABLE) APPLICATION TINS PERIOD RATE (NOT IN TO DATE (G-C) RA (D E) D OR E) (D +E +F) (C G} 0000990 CHANGE ORDER #19 0001000 Credit for Commercial Stone in lieu of INDOT ($6,800.00) ($6,800.00) $0.00 $0.00 ($6,800.00) 100.000 $0.00 $0.00 0001020 CHANGE ORDER #20 0001030 PC 26 ASI #11 Added Curbs $5,428.00 $5,428.00 $0.00 $0.00 $5,428.00 100.000 $0.00 $0.00 0001050 CHANGE ORDER #21 0001060 PC 27132 ASI 17 Utilitly Vault Modifications $8,505.00 $8,505.00 $0.00 $0.00 $8,505.00 100.000 $0.00 $0.00 0001080 CHANGE ORDER #22 0001090 PC 07 Unsuitable Soils at Tunnel $22,060.00 $22,060.00 $0.00 $0.00 $22,060.00 100.000 $0.00 $0.00 0001110 CHANGE ORDER #23 0001120 PC 03 Unsuitable Soils $9,520.00 $9,520.00 $0.00 $0.00 $9,520.00 100.000 $0.00 $0.00 0001140 CHANGE ORDER #24 0001150 PC 33 Unsuitable Soils $3,678.00 $3,678.00 $0.00 $0.00 $3,678.00 100.000 $0.00 $0.00 0001170 CHANGE ORDER #25 0001180 PC 37 Generator Slab $2,132.00 $2,132.00 $0.00 $0.00 $2,132.00 100.000 $0.00 $0.00 0001200 CHANGE ORDER #27 0001210 PC 31 Added Masonry Footing $3,751.00 $3,751.00 $0.00 $0.00 $3,751.00 100.000 $0.00 $0.00 0001230 CHANGE ORDER #28 0001240 PC 41 R1 ASI #27 SOG Modifications $4,293.00 $4,293.00 $0.00 $0.00 $4,293.00 100.000 $0.00 $0.00 0001260 CHANGE ORDER #29 0001270 PC 28R1 ASI #18 Garbage Vacuum Pit $3,181.00 $3,181.00 $0.00 $0.00 $3,181.00 100.000 $0.00 $0.00 0001290 CHANGE ORDER #30 0001300 PC 29 ASI #21 South Entrance Stairs $7,870.00 $4,722.00 $0.00 $0.00 $4,722.00 60.000 $3,148.00 $0.00 AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA®• X1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 6703 -1992 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 WARNING; Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronically with the permission cf The American Institute of Archilects under License 97003 to Rnmavera Systems, Inc. Reproeuctlon of this document without proJect perdfic information is not permitted. Contact The American Institute of Architects to verity the current version of this document and license status' V. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 5 OF 5 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00022 containing Contractor's signed Certification, is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 12/31/2009 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO F V A AR NO. VALUE STORED AND STORED FINISH VI ABLE) AGE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) RATE (C G) (D E) D OR E) (D +E +F) 0001320 CHANGE ORDER #31 0001330 PC 3GR1 ASI #22 Platform Lift Pit $5,106.00 $5,106.00 $0.00 $0.00 $5,106.00 100.000 $0.00 $0.00 0001350 CHANGE ORDER #32 0001360 PC 36134 Column Encasement East $27,521.00 $27,521.00 $0.00 $0.00 $27,521.00 100.000 $0.00 $0.00 0001380 CHANGE ORDER 433 0001390 PC 36R4 Column Encasement West $28,000.00 $28,000.00 $0.00 $0.00 $28,000.00 100.000 $0.00 $0.00 0001410 CHANGE ORDER 934 0001420 PC 43R1 Slab Openings $1,414.00 $1,414.00 $0.00 $0.00 $1,414.00 100.000 $0.00 $0.00 0001440 CHANGE ORDER 935 0001450 PC 45R1 Saw Cutting of Foundation Wall $1,419.00 $1,419.00 $0.00 $0.00 $1,419.00 100.000 $0.00 $0.00 $5,925,769.00 $5,711,871.30 $12,349.95 $0.00 $5,724,221.25 96.60% $201,547.75 $0.00 AIA DOCUMENT G703' APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA® C1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G703 -1992 AVENUE, N.W., WASHINGTON,. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 'This document has been reproduced electronicalty with the permission of The American Institute of ArOhiteets under License 97003 to Primavera Systems, Inc. Reproduchon of this document without projecFspecific information Is not permitted. Contact The American Institute of Architects to verity the current version of this document and license status' WAIVER OF LIEN The undersigned is the duly authorized office rof T4;;ge ann (I nn.i- n,rt•ion carporzit•inn the general contractor, (Name of Company) subcontractor,' materiaiman or other person furnishing the 'services, labor, material or -equipment indicated below In the construction of improvements upon real estate located in Rami I fon County, State of •Indiana commonly knownas which real estate isowned.by RPtjeV10=,=n+- "Owner"). CommissiorL Center OVA rr�� ��H� r rx �Y rl 1-1 iN G_ONSID ERATION ofthe sumof DOLi-1kRS receipt of which is hereby acknowledged, and in order to procure one or more payments for services, labor, material or equipment In such construction, the Company does hereby walve,-release and quit claim In favor of the Owner of the real estate and the lender or lenders providing funds with which payment of constructlon costs Is or is to be made, and their assigns, all (lens or claim or right to Bens upon the land or improvements above'described whichthe Company may now haveforservIces, labor, material orequipmentfumishedlnrespectofsuch land orimprovements to and inclucifngthe date hereof. The underslgnedwarrants that the Company has not and will not assign any plalmforpayment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself (herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder Is the sole-consideration received by the Company for sald services,labor, material orequipment furnished to date, andthat the Company has neither received nor made any security interest, title retention interest or Ilen rights in the said services, labor, material or equipment other than that released and transferred hereby. The irmateriai, labor, services or equipment fumished are more particularly described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has compiled with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this f G day of b-- 9 00 9 (NamA and 7.1tlA1 Troy Heisler, C.o,, Magarman Const- rilrt r'nr=nrAfinM (Name of Company) State of Indiana County of Allen SS: Before me, the undersigned, a Notary Public In and for sald County and State, personally appeared Trnv HAi ni A the 7 o of who acknowledged (Title) (Name of Company) j the execution of the foregoing Walver of Lien on behalf of such Company and that the same Is the free act and deed of such Company and the -froe act and deed of said officer. WITNESS my hand and notarial seal this L ..y� fy 2 MyCommisslon Expires: Exrtt? SV! 1/l5 6V ly N tary Public RMD M CW c1' AU&4 cmj" My County of Residence: T 9 iND `P�� (Printed Name of Notary Public) Allen 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 Purchase Order No. Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(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 Gyrr��•7�Di/SJ,,"cc /.o�? ��rf1 IN SUM OF f ON ACCOUN OF APPROPRIATION FOR Board Members Po# or INVOICE NO. ACCT#ITITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or *7 607 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 2- 26 20'6 t D o n Voprinent Cost distribution ledger classification if Title claim paid motor vehicle highway fund