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HomeMy WebLinkAbout185003 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 363789 Page 'I of 1 f ONE CIVIC SQUARE CIRCLE B COMPANY, INC CARMEL, INDIANA 46032 5636 S MERIDIAN ST CHECK AMOUNT: $476,473.54 INDIANAPOLIS IN 46217 CHECK NUMBER: 185003 CHECK DATE: 4/28/2010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 13 27,632.76 FIREPROOFING 902 4460807 18 438,354.80 INTERIOR FINISHES 902 4460807 C08004PPI 10,485.98 EMER ENCLOSURE i Jr 2 '11& A1A TM Document G1021CMa -1992 r Application and Certifi for Pa yment Construction Manager- Adviser Edition, TO OWNER: PROJECT: APPLICATION NO: 13 Distribution to: i CARMEL REDEVELOPMENT` °COMMISSION CARMEL PERFORMING ARTS CENTER PERIOD TO .3/15 /2010 OWNER El ONE CIVIC SQUARE: INDIANAPOLIS;'' IN 46032 CONSTRUCTION MANAGER FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT CIRCLE B CONSTRUCTION SYSTEMS SHIEL SEXTON COMPANY PROJECT NOS: 2695 3060 1 CONTRACTOR 5636 S. MERIDIAN ST. INDIANAPOLIS, IN 46217 VIA ARCHITECT: FIELD CONTRACT FOR: FIREPROOFING CSO ARCHTIECTS, INC. El 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 e 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 ent w e i sued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM 425.00 pay m 2. Net change by Change Orders 10 ,194.96 CON ent s n he n CONSTRUCTION SYSTEMS 3. CONTRACT SUM TO DATE (Line 1. 2)........ 358 619.96 By: Date: 4. TOTAL COMPLETED 8, STORED TO DATE (Column G on G703) 317, 244. 96 Sta e of: 5. RETAINAGE Coun y of: a. of Completed Work Subscribe swo n o;be CATHY A. GINDER WTAlqy (Column D.+ E on G703) 17,931.00 me this a r� PUBLIC STATE Of lifdDlAttW n HNSON COUNTY b. of Stored Material Nota Public: WWPM ISSIO1 1.2MY (Column F on G703) My Commission ptres: t Total Retainage (Lines 5a 5b or Total in Column I of G703)., 17,931 CERTIFICATE FOR PAYMENT 299, 313 .96 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 271, 681.20 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 27 ,632.76 AMOUNT CERTIFIED 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified dii fe rn the aiWMun,..applied. Initial all figures on this Application and on the Continuation Shee that are changed to conform with the amounrcertif ed.) (Line 3 less Line 6) 59,306.00 CONST UCTION A A By: Date: p CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approied"in previous months by Owner By: Date: Z Total a roved this Month PP This Certificate is not The AMOUNT CERTIFIED is payable on to the Contractor TOTAL 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 G7021CMaTM 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'af 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. A IA Document G702/CMa -1992 Instructions Application and Certificate for Payment Construction Manager Adviser Edition A. General Information AIA Document G7027CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition. B. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EUL.A). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. C. Completing the G7021CMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G71 Application and Certificate for Payment, Construction Manager Adviser Edition. The Contractor should sign G702 /CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect. The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded to the Owner. D. Completing the G703 Form Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager Adviser Edition. Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E (Work Completed This Period). Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitt& on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedile of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G70Xfor 'atthe.end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G7021CI� foirri Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 ineA2Q11C,Ma. E. Making Payment The Owner should make payment directly to the Contractor based on the amount certifred.by he Construction Manager and Architect on AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager Adviser Edition. The comp'ieted4orm contains the name and`address of the Contractor. Payment should not be made to any other party unless specifically indicated on G7021CMa. a- AIA Document G7021CMaTM 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. -1992 TM ®cement G703 Continuation Sheet i AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 13 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 03/11/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 03/15/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM PRESENTLY COMPLETED BALANCE RETAINAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS 7 o TO NO. VALUE STORED AND STORED (G C) FINISH (IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 700 MOI31_LIZATION/DEMOBL 7,500.00 7,500.00 7,500.00 100.00 701 BOND PREMIUM 6,000.00 6,000.00 6,000.00 100.00 702 FIREPROOF TESTING 5,500.00 4,125.00 4,125.00 75.00 1,375.00 703 1ST FL F/P LABOR 32,993.00 32,993.00 32,993.00 100.00 704 1ST FL F/1 MATERIAL 49,490.00 49,490.00 49,490.00 100.00 705 2ND FL F/P LABOR 31,856.00 31,856.00 31,856.00 100.00 706 2ND FL F/P MATERIAL 47,783.00 47,783.00 47,783.00 100.00 707 BALCONY F/P LABOR 26,167.00 26,167.00 26,167.00 100.00 708 BALCONY F/P MATERIAL 39,251.00 39,251.00 39,251.00 100.00 709 ATTIC F/P LABOR 22,754.00 22,754.00 22,754.00 100.00 710 ATTIC F/P MATERIAL 34,131.00 34,131.00 34,131.00 100.00 800 CONTRACT ALLOWANCE 45,000.00 5,000.00 5,000.00 11.11 40,000.00 801 CHANGE ORDER #1 4,825.00 4,825.00 4,825.00 100.00 802 CHANGE ORDER #2 5,007.00 5,007.00 5,007.00 100.00 803 CHANGE ORDER #3 5,000.00 5,000.00 5,000.00 100.00 804 CHANGE ORDER #4 15,376.96 15,376.96 15,376.96 100.00 CAUTION: You should sign an original AIA Contract Docu 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 (1l}) 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. CONSENT OF SURE'T'Y OWNER ED TO REDUCTION IN OR ARCHI 0 PARTIAL RELEASE OF RETAINAGE CONTRACTOR AIA DOCUMENT G707A SURETY OTHER Bond No,: 929446740 PROJECT. Parcel 7A, Regional Performing Arts Center (name, address) TO (Owner) City of Carmel, Indiana ARCHITECT'S PROJECT NO: One Civic Square Carmel, fN 46032 CONTRACT FOR: Bid Package 3060 Fireproofing CONTRACT DATE: In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety as it appears in the bond). Continental Casualty Company, 333 S. Wabash Avenue, Chicago, IL 60604 on bond of (here insert name and address of Contractor as it appears in the bond) Circle B Construction Systems, LLC, 5636 S. Meridian Street, Indianapolis, IN 46217 hereby approves the reduction in or partial release of retainage to the Contractor as follows; Reduce Retainage from 10% to 5% The Surety agrees that such redaction in or partial release of retainage to the Contractor shall not relieve the Surety of any of its obigations to (here insert name and address of Owner) City of Carmel, Indiana, One Civic Square, Carmel, IN 46032 as set forth in the said Surety's bond. IN WITNESS WHEREOF, the Surety has hereunto set its haled this 12th day of March 2010 Continental Casualty Company Surety B ��svr'LLII Signature of Authorized Representative Attest: Cynthia L. Jenkins Attomey -in -Fact (Seal): Title AIA AOCUMENT G707A CONSENT OF SURETY TO REDUCTION IN OR PARTIAL RELEASE OF RETAINAGE TUNE 1971 ONLY PAGE EDITION AIA® C 1971 TI-M AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 S -4870 POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY -IN -FACT Know All Men By These Presents, That Continental Casualty Company, an Illinois corporation, National Fire Insurance Company of Hartford, a 'Connecticut corporation, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania corporation (herein called "the CNA Companies are duly organized and existing corporations having their principal offices in the City of Chicago, and State of Illinois, and that they do by virtue of the signatures and seals herein affixed hereby make, constitute and appoint Michael M Bill, Edward L Mournighan, Michael H Bill, Cynthia L Jenkins, Ginger J Krahn, Sheree Hsieh, Brenda Johnston, Cindy H Stellhorn, Individually of Indianapolis, IN, their true and lawful Attorney(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on their behalf bonds, undertakings and other obligatory instruments of similar nature In Unlimited Amounts and to bind them thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of their corporations and a] I the acts of said Attorney, pursuant to the authority hereby given is hereby ratified and confirmed. This Power of Attorney is made and executed pursuant to and by authority of the By -Law and Resolutions, printed on the reverse hereof, duly adopted, as indicated, by the Boards of Directors of the corporations. In Witness 1Whereor., the CNA Companies have caused these presents to be signed by their.Senior. Vice President and their comorate seals to be hereto affixed on this 26th day of August, 2005. r,AS 0ASO4 PA W VA Continental Casualty Company National Fire Insurance Company of Hartford 0 0pPORATp 4 QRFD1?4? American Casualty Company of Reading, Pennsylvania f0 SEAL i 1902 I a IOwl NAR0 Michael Gengler Seni r Vice President State of Illinois, County of Cook, ss: On this 26th day of August, 2005, before me personally came Michael Gengler to me known, who, being by me duly sworn, did depose and say: that he resides in the City of Chicago, State of Illinois; that he is a Senior Vice President of Continental Casualty Company, an Illinois corporation, National Fire Insurance Company of Hartford, a Connecticut corporation, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania corporation described in and which executed the above instrument; that he knows the seals of said corporations; that the seals affixed to the said instrument are such corporate seals; that they were so affixed pursuant to authority given by the Boards of Directors of said corporations and that he signed his name thereto pursuant to like authority, and acknowledges same to be the act and deed of said corporations. 'OFFICIAL SEAL" j MARIA M. MEDINA Notary Public, State of 1111noia My Commission Expires 3i15M My Commission Expires March 15, 2009 Maria M. Medina Notary Public CERTIFICATE I, Mary A. Ribikawskis, Assistant Secretary of Continental Casualty Company, an Illinois corporation, National Fire Insurance Company of Hartford, a Connecticut corporation, and American Casualty Company of Reading, Pennsylvania, a Pennsylvania corporation do hereby certify that the Power of Attorney herein above set forth is still in force, and further certify that the By -Law and Resolution of the Board of Directors of the corporations printed on the reverse hereof is still in force. In testimony whereof I have hereunto subscribed my name and affixed the seal of the said corporations this 12th day of March 2010 r 0,AS %Hsugt PIWAe Continental Casualty Company 0 N�" National Fire Insurance Company of Hartford GOP P°nArc AA 11�DRPDpgT�D American Casualty Company of Reading, Pennsylvania p 2 iu18021 n 1897 NART4� Mary A. R ikaiokis Assistant Secretary Form F6853- 11/2001 Authorizing By -Laws and Resolutions ADOPTED BY THE BOARD OF DIRECTORS OF CONTINENTAL CASUALTY COMPANY: This Power of Attorney is made and executed pursuant to and by authority of the fallowing By -Law duly adopted by the Board of Directors of the Company. "Article IX Execution of Documents Section 3. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Fxecutive, Senior or Group Vice President may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of authority, shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company thererto. The Chairman of the Board of Directors, the President or any Executive, Senior or Group Vice President or the Board of Directors, may, at anytime, revoke all power and authority previously given to any attorney -in- fact.° This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 17 day of February, 1993. "Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted pursuant to Section 3 of Article IX of the By -Laws, and the signature of the Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed slrall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company," ADOPTED BY THE BOARD OF DIRECTORS OF AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA: This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the Board of Directors of the Company. "Article VI— Execution of Obligations and Appointment of Attorney -In -Fact Section 2. Appointment of Attorney -in -fact. The Chairman of the Board of Directors, the President or any Executive, Senior or Group Vice President may, from time to time, appoint by written certificates attorneys -in -fact to act in behalf of the Company in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such attorneys -in -fact, subject to the limitations set forth in their respective certificates of authority, shall have full power to bind the Company by their signature and execution of any such instruments and to attach the seal of the Company thereto. The President or any Executive, Senior or Group Vice President may at any time revoke all power and authority previously given to any attomey -in- fact." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 17 day of February, 1993. "Resolved, that the signature of the President or any Executive, Senior or Group Vice President and the seal of the Company may be affixed by facsimile on any power of attorney granted pursuant to Section 2 of Article VI of the By -Laws, and the signature of the Secretary or an Assistant Secretary and the seal of the Company may be affixed by facsimile to any certificate of any such power and any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certified by certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company." ADOPTED BY THE BOARD OF DIRECTORS OF NATIONAL FIRE, INSURANCE COMPANY Of HARTFORD: This Power of Attorney is made and executed pursuant to and by authority of the following Resolution duly adopted on February 17, 1993 by the Board of Directors of the Company. "RESOLVED: That the President, an Executive Vice President, or any Senior or Group Vfce President of the Corporation may, from time ro tine, appoint, by written certificates, Attorneys -in -Fact to act in behalf of the Corporation in the execution of policies of insurance, bonds, undertakings and other obligatory instruments of like nature. Such Attorney -in -Fact, subject to the limitations set forth in their respective certificates of authority, shall have full power to bind the Corporation by their signature and execution of any such instrument and to attach the seal of the Corporation thereto. The President, an Executive Vice President, any Senior or Group Vice President or the Board of Directors may at any time revoke all power and authority previously given to any Attorney -in- Fact." This Power of Attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of the Company at a meeting duly called and held on the 17`' day of February, 1993. "RESOLVED: That the signature of the President, an Executive Vice President or any Senior or Group Vice President and the seal of the Corporation may be affixed by facsimile on any power of attorney granted pursuant to the Resolution adopted by this Board of Directors on February 17, 1993 and the signature of a Secretary or an Assistant Secretary and the seat of the Corporation may be affixed by facsimile to any certificate of any such power, and any power or certificate bearing such facsimile signature and seal shall be valid and binding on the Corporation. Any such power so executed and sealed and certified by certificate so executed and sealed, shall with respect to nay bond or undertaking to which it is attached, continue to be valid and binding on the Corporation." AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M. ABBOTT BEING DULY SWORN THAT I -IF' IS THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CAIUYIEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND /OR LABOR AS FOLLOWS: FIREPROOFING FOR A PROJECT KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER) THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF TWO HUNDRED SEVENTY ONE THOUSAND SIX HUNDRED EIGHTY ONE DOLLARS AND .20/100 ($271,681.20) RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR XX THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER) THAT THIE FINAL BALANCE DUE 1S THE SUM OF: RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT, THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED, ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISI =IED BY THE UNDERSIGNED THERETO, AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RIGHT TO A LIEN ON ACCO T OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR SAI 1 T ND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR. SYSTEMS, LLC BY: TITLE: PRESIDENT �fl S "MY N AN TARIAL SEAL THIS 30` DAY OF MARCH, 2010 4 N O /C.Lf� I GIN R TARY PUBLIC MY CO MISSION EXPIRES: 02/01/201.7 RESIDENT OF JOHNSON COUNTY CIRCLE B Construction Systems OWNER: CARMEL REDEVELOPMENT COMMISSION 03/30/2010 CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695 -3060 FIREPROOFING PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION NO. AMOUNT PAID #1 29,560.72 #2 7,423.47 #3 12,619.94 #4 23,371.15 #5 13,669.42 #6 139,459.42 #7 25,845.02 #8 990.00 #9 1,485.00 #10 7,994.44 #11 6,318.80 #12 2,943.82 TOTAL PAID TO DATE: 27.1,681.20 CIRCLE B CONSTR CTION SYSTEMS, JOH ABBOTT, PRESIDENT (317) 787 -5746 fax (317) 780 -2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opportunity Employer 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 7Gj57�r Purchase Order No. >s'.`��ry,d� /'o 217 Terms Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 7 .2 Total 2 7 cl, 1 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 SG 3 G 5 IN SUM OF �/ldi rl o �i3, /R1 �G21'7 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #!TITLE AMOUNT DEPT I hereby certify that the attached invoice(s), or ��2 6o�a7 2�l327� 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 y- 7 20 lG tune Director o Redevelopment Cost distribution ledger classification if Title claim paid motor vehicle highway fund TM AI Document G7021CMa 1992 Application and Ce for Payment Construction Manager Adviser Edition TO OWNER: PROJECT: APPLICATION NO: ,1 Distribution to: CARMEL REDEVELOPMENT COMMISSION CARMEL PERFORMING ARTS CENTER PERIOD T0 3/15f2010 OWNER ONE CIVIC SQUARE CARMEL,. IN 46032 CONSTRUCTION MANAGER FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 4/22/08 ARCHITECT a CIRCLE B CONSTRUCTION SYSTEMS SHIEL SEXTON COMPANY PROJECT NOS: 2695/4090 CONTRACTOR 5636 S. MERIDIAN ST. VIA ARCHITECT: FIELD INDIANAPOLIS, IN 46217 CONTRACT FOR: INTERIOR FINISHES C50 ARCHITECTS 0 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 e issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM 6, 394,500. 00 payment s en due. 2. Net change by Change Orders (19 569.0 C OR: ONSTRUCTION SYSTEMS 3. CONTRACT SUM TO DATE (Line 1 2) 6, 3 74 931 y: Date: 62 o /0 4. TOTAL COMPLETED STORED 70 DATE Column G on G703 4 813 464: State of: DIA A 5. RETAINAGE County P MARION a. %ofCoritpleted Work Sub ribeda savor to be raj �C� CATFKA GtNDER' (Column D E on G703) 318,746.55 this of pOQTAHY PUBLIC STATE OF INDWNA HNSON COU b. %n of Stored Material otary Public: �L (r,C �y�51ON EXP.FEB.1 (Column F on G703) My Commission Aire Total Retainage (Lines 5a 5b or Total in Column I ofG703) 318 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on -site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE s 4, 494 1 718. 13 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 4,056,363.33 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. tt &W 8. CURRENT PAYMENT DUE 438,3 54 AMOUNT CERTIFIED y .80 ...................._..:a �"E a D 2Q t 9. BALANCE TO FINISH, INCLUDING' RETAINAGE (Attach explanation if amount certified differs fron h anrount, Initial all figures on this A pp lic'"on and on he Coiiti�naratic�n S eet that :e c ranged'to cr�nforrn with the amount certified.) (Line 3 less Line 6) 1, 8$ 0 212.87 CONSTRUCTION AG B Date: �33f D CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AR Total changes approved in previous months by Owner B Date: Z Total approved this Month This Certificate is not,negotiable. The AMOUNT CERTIFIED is payable only to the Contractor JW TOTALS named herein. Issuance; payment and acceptance of paymerit 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 G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ate 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. I kS6�Igo e Vvm r AIA D ocument rM G703 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 1 In tabulations below, amounts are stated to the nearest dollar: PERIOD TO: 03/10/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0: 03/10/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM PRESENTLY COMPLETED DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO RETAINAGE NO STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G C) FINISH (NOT IN TO DATE (C G) RATE) (D E) D OR E) (D +E +F) 100 BASEMENT FRAME MATL 107,259.00 107,259.00 107,259.00 100.00 101 BASEMENT FRAME LABOR 85,992.00 85,992.00 85,992.00 100.00 102 BASEMENT HANG MATL 125,006.00 125,006.00 125,006.00 100.00 103 BASEMENT HANG LABOR 133,158.00 133,158.00 133,158.00 100.00 104 ORCHESTRA FRAME MATL 118,670.00 118,670.00 11.8,670.00 100.00 105 ORCHESTRA FRAME LAB 100,713.00 90,641.70 90,641.70 90.00 10,071.30 106 ORCHESTRA HANG MATL 124,796.00 93,597.00 18,719.40 112,316.40 90.00 12,479.60 107 ORCHESTRA HANG LAB 141,631.00 49,570.85 21,244.65 70,815.50 50.00 70,815.50 108 BALCONY FRAME MATL 108,051.00 108,051.00 108,051.00 100.00 109 BALCONY FRAME LABOR 92,41.9.00 55,451.40 9,241.90 64,693.30 70.00 27,725.70 110 BALCONY HANG MATL 115,731.00 86,798.25 5,786.55 92,584.80 80.00 23,146.20 III BALCONY HANG LABOR 129,223.00 32,305.75 19,383.45 51,689.20 40.00 77,533.80 112 BOX TIER FRAME MATL 135,1.71.00 135,171.00 135,171.00 100.00 113 BOX TIER FRAME LABOR 113,521.00 68,112.60 11,352.10 79,464.70 70.00 34,056.30 114 BOX TIER HANG MATL 140,350.00 70,175.00 28,070.00 98,245.00 70.00 42,105.00 115 BOX TIER HANG LABOR 178,584.00 44,646.00 44,646.00 25.00 133,938.00 116 ATTIC FRAME MATL 102,176.00 102,176.00 102,176.00 100.00 117 ATTIC FRAME LABOR 87,922.00 87,922.00 87,922.00 100.00 118 ATTIC HANG MATL 90,226.00 90,226.00 90,226.00 100.00 119 ATTIC HANG LABOR 110,889.00 110,889.00 110,889.00 100.00 120 ACOUS CEILING MATL 52,941.00 52,941.00 PAGE TOTALS: 2,394,429.00 1,795,818.55 113,798,05 .00 1,909,616.60 484.812.40 .00 CAUTION: You should sign an original AIA Contrac Document, on which this text appears in RED. An original assures that change will not be obscured. AIA Document G703M 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. M r iM 1,t 9,�— S� L, Document G703 1992 c yo Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: l 8 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 03/10/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 03/10/2010 A B C D E F G H i ITE WORK COMPLETED MATERIALS TOTAL M BALANCE DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED TO IF V A AGE NO. FROM PREVIOUS STORED AND STORED (IF VARI ABLE VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (C' C) FINISH RATE) (D E) D OR E) (.D +E +F) (C G) 121 ACOUS CEILINTG LABOR 40,759.00 40,759.00 122 INSULATION MATL 82,670.00 62,002.50 4,133.50 66,136.00 80.00 16,534.00 123 INSULATION LABOR 117330.00 58,665.00 11,733.00 70,398.00 60.00 46,932.00 200 N/S ELIP CLG METAL M 51,331.00 51,331.00 51,331.00 100.00 201 N/S ELIP CLG METAL L 201,384.00 201,384.00 201,384.00 100.00 202 N/S ELIP CLG PLAS M 74,360.00 74,360.00 74,360.00 100.00 203 N/S FLIP CLG PLAS L 438,153.00 438,153.00 438,153.00 100.00 204 MAIN ELIP CLG METL M 52,412.00 52,412.00 52,412.00 100.00 205 MAIN ELIP CLG METL L 168,703.00 168,703.00 168,703.00 100.00 206 MAIN BLIP CLG PLAS M 71,273.00 71,273.00 71,273.00 100.00 207 MAIN ELIP CLG PLAS L 430,31.4.00 430,314.00 430 „314.00 100.00 208 UP /LOW BALCNY METL M 1.5,304.00 15,304.00 15,304.00 100.00 209 UP /LOW BALCNY METL L 143,518.00 136,342.10 7,175.90 143,518.00 100.00 210 UP /LOW BALCNY PLAS M 37,975.00 37,975.00 37,975.00 100.00 211 UP /LOW BALCNY PLAS L 633,522.00 316,761.00 63,35120 380,113.20 60.00 253,408.80 212 BOX TIER/COL METAL M 10,245.00 10,245.00 10,245.00 100.00 213 BOX.TIER/COL METAL L 118,363.00 112,444.85 5,918.15 118,363.00 100.00 214 BOX TIER/COL PLAS M 70,300.00 70,300.00 70,300.00 100.00 21.5 BOX TIER/COL PLAS L 319,455.00 95,836.50 63,891.00 159,727.50 50.00 159,727.50 216 ORCH H/L METAL M 5,317.00 5,317.00 5,317.00 100.00 217 ORCH H/L METAL L 112,967.00 22,593.40 90,373.60 112,967.00 100.00 218 ORCH H/L PLAS M 15,260.00 1,526.00 13,734.00 15,260.00 100.00 PAGE TOTALS 3,210,915.00 2,433,242.35 260,311.35 .00 2,693,553.70 517,361.30 .00 CAUTION: You should sign an original AIA Contrac Document, on which this text appears in RED. An original assu that changes wil not be obscured. AIA Document G703 —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. Document G703"- 199 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 18 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 03/10/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0: 03/10/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE PRESENTLY COMPLETED RETA[NAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO NO. STORED AND STORED (G C) FINISH (IF VARIABLE VALUE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G} 219 ORCH H/L PLAS L 315,844.00 31,584.40 31,584.40 63,168.80 20.00 252,675.20 220 4090A GEN. ALLOWANCE 225,000.00 154,030.40 154,030.40 68.46 70,969.60 221 4090E CAD ALLOWANCE 5,000.00 5,000.00 5,000.00 100.00 222 4100A GEN ALLOWANCE 175,000.00 83,232.18 6,793.00 90,025.1.8 51.44 84,974.82 223 41008 CAD ALLOWANCE 5,000.00 5,000.00 5,000.00 100.00 300 BOND PREMIUM 63,312.00 63,31.2.00 63,312.00 100.00 301 C.O. #1 /CCR #1008 60,100.00 6,010.00 9,015.00 15,025.00 25.00 45,075.00 302 C.O. #2 /CCR #1011 27,970.00 27,970.00 303 C.O. #3 /CCR #1012 1,200.00 1,200.00 304 C.O. #4 /CCR #1014 19,800.00 19,800.00 305 C.O. #5 /CCR #1015 31,680.00 31,680.00 306 C.O. #6 /CCR #1016 27,720.00 2,772.00 2,772.00 10.00 24,948.00 308 CO #8 /PAC006(CO7 0) 20,490.00 20,490.00 20,490.00 100.00 309 CO 9/AI_LOWANICE ADJ 226,269.00 226,269.00 226,269.00 100.00 310 CO #1.1 /HIGH RAILING 17,740.00 17,740.00 17,740.00 100.00 CAUTION: You should sign an original AIA Contrac Document, o n which this text appears in RED. An original assu that changes will not be obscured. AIA Document G703TM —1992. Copyright O 1963, 1965, 1966 1967, 1970, 1976, 1963 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. I N AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M.. ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND /Olt LABOR AS FOLLOWS: INTERIOR FINISHES FOR A PROJECT KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER) THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF THREE MILLION FOUR HUNDRED THIRTY FOUR THOUSAND THREE HUNDRED EIGHTEEN DOLLARS AN D.76/100 ($3,434,318.76) RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: Olt XX THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER) THAT THIS FINAL BALANCE DUE IS THE- SUM OF: RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED, ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO, AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RIGHT TO A LIEN ON ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR SA R 1 T AND, WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR. SYSTEMS, LLC TITLE: PRESIDENT WI S' I AN NOTARIA SEAL LT 30' DAY O F MARCH, 2010 CE1 I Y A'. Ci R' OAR PUBLIC i MY COMMISSION EXPIRES: 02/01/2017 RESIDENT OF J014NSON COUNTY CIRCLE B w Construction Systems OWNER: 03/30/2010 CARMEL REDEVELOPMENT COMMISSION CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695 -4090 DRYWALL PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION NO. AMOUNT PAID #1 56,980.80 #2 8,369.42 #3 16,209.00 #4 44,810.04 #5 57,634.11 46 76,202.64 #7 201,168.08 #8 169,090.74 #9 280,896.48 #10 35,997.80 #11 8,465.60 #12 437,984.92 #13 514,933.22 #14 357,219.33 #15 546,768.67 #16 621,587.91 TOTAL PAID TO DATE 3,434,318.76 CIRXL'C STRUCTI ON SYSTEMS J OTT, PRESIDENT (317) 787 -5746 fax (317) 780 -2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opportunity Employer 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 /V 1 1b l 7 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) /r 7 3� 35� Total y3 3 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 S G 3G 5 Izi�, ,�,�;u Sf, IN SUM OF X6217 ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or gD 2 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 y— 20 Director o Moment Title Cost distribution ledger classification if claim paid motor vehicle highway fund i March 29, 2010 Mr. Les Olds Carmel Redevelopment Commission One Civic Square Carmel, IN 46032 RE: Carmel City Center Performing Arts Center Shiel Sexton Project #2695 Circle B Invoice C08004PPI (EMERGENCY BUILDING ENCLOSURE) Dear Mr. Olds: Based upon on -site observations and the data comprised in the billings, Shiel Sexton Company (Construction Manager) certifies to the owner that, to the best of their knowledge, information and belief, the Work has progressed as indicated, the quality of Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the amount requested ($10,485.98). Sincerely David C. urchard Senior Project Manager cc: Don Cleveland Mike Anderson Tony Eisenhut File j&RCLE B Invoice Number C08004PPI Construction Systems bivoice gate 04/07/2010 Customer Number 001110 INVOICE Job Number C08004 Due Date 05/07/2010 CARMEL REDEVELOPMENT COM CARMEL PER ART INTERIOR ONE CIVIC SQUARE C08004 CARMEL, IN 46032 EMERGENCY ENCLOSURE 04/0712010 PROPANE INC. 2/12/10 THRU 4/7/2010 10,485.98 GROSS BILLINGS: 10,455.98 NET BILLINGS 10,455.98 REMOT T®: (317) 787 -5746 fax (317) 780 -2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Oppodunily Employer Carmel Regional Performing Arts Center 2695 -4090 Circle B Emergency Enclosure 03/31/10 SSC -1276 temporary propane heat- 02/12/10 thru 03/05/10 Propane Date Description Rental Gallons /gallon 02/01/10 relocate tanks 187.25 02/12/10 propane 2,361.76 1,333.5 1.77 02/17/10 propane 3,551.00 2,007.1 1.77 02122/10 propane 1,449.52 816.8 1.77 02/25/10 propane 2,554.90 1,442.9 1.77 03/02/10 propane 1,861.59 1,050.2 1.77 03/05/10 pfopane 776.69 435.7 1.78 credit for unused propane 3,210.00) TOTAL 187.25 9,345.46 7,086.2 Mark -up 10% 10% SUBTOTAL 205.98 10,280.01 TOTAL s 10,485.98 Page 1 of 1 x SERVICE ORDER INVOICE NO. BILLING INVOICE NAME/AC NUMBER f Y r_- M1- DATE SERVICE'REDUESTEIr MAILING ADDRESS PHYSICAL ADDRESS PHONE: k O CASH SALE �6RARGE SALE DATE START i,:FINISH: DESCR3PTIONOF WORK 'AND /,OR SERVICES _PERFORMED RATE: AMOUNT ❑A.M. i."'T /l AA P /�"•E 6 "f :J A7 El TOTAL QUAN. PART NUMBER n MATERIALS i UNIT PRICE AMOUNT f t TOTAL MATERIALS Pli REMARKS TRIP CHARGE TRANS FUEL CHG TANK METER-:: Regulatory Compliance Charge TANK TANK TANK TANK -SANK METER METEA• DATE" SALES TAX RIFAPPLICABLE MFR. DATE MFR, SERIAL NUMBER W,C.W.P. �SERIALNUMDER READING SEAL DATE SALES TAX PIPING PRESSURE TEST SAFETY CHECK TWO STAGE INTEGRAL TWIN STAGE FfRSTSTAGE SECOND OR INTEGRALTWEN STAGE L.'A t 1� I Performed a Gas Appliance Showed Customer howao PRESSURE TIME PRESSURE TIME System Check Qyes YP_ turn offgasinanEmergency [;Nos ONo AM PSIG E] AM Clearly explained the operation Performed Odor Test and i of the Gas: Appliance System explained to Customer' Xes ONo i START 9 SIG .E PM START IN. WC []PM to the Customer gYes ©No Q'AM ❑PSIG []AM Clearly �explaihad service work Left the Customer safety fE erformed to the Customer. Q>3�es CNo information [.}'{es No FINIS 1 PSIG L'7 M. FINISW ❑IN. WC ❑PM P REGULATOR OPERATION -I CERTIFY THAT ALL THE ABOVE TESTS I HEREBYACKNOWLEDGE THAT THE ABOVE SERVICE WORK INTEGRAL FLOW LOCK IN HAVEBEEN COMPLETEDAS PRESCRIBED. WAS PERFORMED TO MY SATISFACTION AND THE TERMS OATECODE MFR. MODEL ..PRESSURE PRESSURE OF THIS AGREEMENT ARE UNDERSTOOD ANDACCEPTED. I TWIN ACKNOWLEDGE' RECEIPT OF A CONSUMER INFORMATION STAGE 1N.w.c. w w,ct PACKET. I I f S` TWO 1ST PSG PSIG Y z•�( I l� X r STAGE 2ND 1N, we IN WC .�SALE SMAt /SE RVIEEMAN CUSTOMER'S SIGNATURE PAVMEty TERN "S NET 1D DAYS DUE em❑ PAYABLE IN'FULL 10 DAYS FROM DATE All'new merchandise sold herein Is guaranteed to This order is subject to correction of errors in price and exionsion. OF DELIVERY ANDlOR SERVICE. Failure to pay the lull account hatance within 30 days the extenl of Fie manufacturersAarranty only. No C from date of delivery andlor service shall result in a default and the assessment of a warranty of any kind on used merchandise 'less SEE BACK LATE CHARGE andlora RE-BILLING CHANGE, spec diritin9haraln. FOR IMPORTANT SAFETY �1 AND BILLING INFORMATION S081 (Rev. 11101 108) WorkilowOne 866.234.76 61 5 O E� CFJAY U I INVOICE l UN1075 l UN1075 P'AOPANE INC 3175 WEST MAIN STREET 6 BROWNSBURG IN 46112 y 317 852 -89.16 02/12/2010 .12,:07 pm ID 5805 206044 6635 Sales# 424602 Account# 100 1419 -1 SN# 245698 CIRCLE 8 CONSTRUCTION SYSTEMS 5636 SOUTH MERIDIAN STREET E INDIANAPOLIS IN o' Tank% 50/80 y' Gallons ,Unit Extended Delivered Price 1333.50 $1.6500 Price $2200.28 Regulatory Compliance Charge Fuel Surcharge Taxable $3 97 Sales Tax (7.000%) $3.00 Invoice Total $2361.76 b gnat r Cus r i -Tha k o business- 1 ,V 1 E f I i C 0 I I A`' AVdOUN'I' DUE i 3 i r s w INVOICE PROPANE I UN1075 'PROPANE INC. 375 WEST MAIN STREET BROWNSBURG IN 46112 317- 852-8916 02/17/2010 9:48 am •113 5805X- 206044 -6635 `t Sales* 424614 Account# 1001419 -1 SN# 245698 1 CIRCLE B CONSTRUCTION SYSTEMS 5636 SOUTH MERIDIAN STREET INDIANAPOLIS IN I Tank° 40/80 It I Gallons Unit Extended' Delivered Price Price 2007.10 $1.6500 $3311.72 I 3 Regulatory Compliance Charge $3.97 Fuel Surcharge Taxable .$3.00 Sales Tax (7.000 $232.31 Invoice To al $3551.00 Customer igryature f I -Thank you for }o ur bus 3'ness =4 E I IR i i p Y E l i AMOtJNT,DC11; i i r INVOICE PROPANE o i UN1075 1 PROPANE INC- 7 gASpWIWVSBURGAIN S TREET 46112 317 -852 -8916 �V S 02122/2010 1:10 pm ID 5805X- 206044 -6635 w Sales# 424636 245698 1 SYSTEM, Account# 1001419 5N# CIRCLE B CONSTRUC 5636 SOUTH MERIDIAN STREET INDIANAPOLIS IN 'i Tank /a 40180 Extended Gallons Unit Price Delivered Price $1347.7 816.$0 $1.r0500 Regulatory Compliance Charge $3.97 i o Fuel Surcharge Taxable b Safes Tax (7.000 $1449.52 K Invoice Total 1 custom Signat re Thanku fort our business- y i y NmIOUNT DUE i 1 r r• �v 1 NVOICE PROPANE UN 1075 PROPANE INC BRONSBURG STREET 317 852 8916 N W 46112 02/5805X-206044 10 1:27 Pm ID 6635 Sal es# 424652 Account# 10014 9 n CIRCLE S 1 SN# 24 5698 5' 5636 CONSTRUCTION i ND l ANAP TH MERIDIAN SYSTEM,; OLIS IN STREET Tank% 50/80 Gallons y D elivered Unit 1 442.90 Pri Extended Price Re gulatory C orn z Pliance Charge Fuel Surcharge Taxable $3,97 N Sales Tax I Invoice Totaj004 $3' $167.* 04 7 i 25 54.90 Customer gna re `-Thank you for Your o usiness v. E F j R C I AMOUNT DUk? INVOICE PROPANE- UN1075 :PR ANE INC. 0 370WEST MAIN STREET BROWNSBURG IN 46112 317-852-8916 03/0212010 3:19 pm ID 5805X-206044-6635 Sales# 424681 t l Account# 1001419-1 SN# 245698 CIRCLE B CONSTRUCTION SYSTEMS 5636 SOUTH MERIDIAN STREET INDIANAPOLIS IN Tank% 50180 Gallons Unit Extended Delivered Price Price 1050.20 $1.6500 $1732.83 Regulatory Compliance Charge $3.97 Fuel Surcharge Taxable $3.00 Sales Tax (7.000%) $121.79 Invoice Total $1861-59 Customer Signature you for your business-- C 0 Y ANIOUNT.DUE j INVOICE 1 n PROPANE UN1075 n 4OPANE INC. 375 WEST MAIN STREET BROWNSBURG IN 46112 317 852 -8916 T I; 03/05/2010 8:57 am ID 5805X 20604 Sales# 424599 j Account# 1001419 -1 SN# ^-45698 CIRCLE B CONSTRUCTION SYSTEMS 5636 SOUTH MERIi71AN STREET INDIANAPOLIS IN j Tank% 50180 9 Unit Extended E Gallons Price Delivered Price 435.70 $1.6500 $718.91 Regulatory Compliance Charge $3.97 Fuel Surcharge Taxable $3.00 v Sales Tax (7.000 $50.81 0 Invoice Total $776.69 ti Customer Si nature 1 -Thank you for your business z t N L' R 1 I ANJOLINT DUE i i FROM :PROPANE INC. FAX NO. :3178527275 Apr. 07 2010 0 P2 Pro-Da ane, Inc. Relationships MIrter, 4/7/10 Circle B Construction Systems, refund iilformation for the Carmel Performing Arts Center. Gas Credit $7062,00 Pid up Fee $1284.00 Restocking Fee $2568.00 Refund $3210.00 Sincerely, Propane Inc. i i i 375 W. Mein St., P.U. Box 29"1 Brownst.mrg, IN 461 i2 -0291 Phone: 117.852.8 31 h lull Free: AOO.637.4650 Fax: 317.852.7275 www.prol)a",- fnrYou.c:orn 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. 36 S �7�, �d��� s� 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. 2a Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 C �rc lY IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Q �o� Board Members Po# or INVOICE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 902 c oSccLl W4 S 7 /o 41e59a 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 —6 20 /0 Signature Director of R Cost distribution ledger classification if I e claim paid motor vehicle highway fund