185029 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 363784 Page 1 of 1
ONE CIVIC SQUARE POYNTER SHEET METAL CHECK AMOUNT: $175,505.00
CARMEL, INDIANA 46032 PO BOX 427
BLOOMINGTON IN 47402 -0427 CHECK NUMBER: 185029
CHECK DATE: 4/28/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 20B 175,505.00 PERFORMING ARTS CENTE
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER ADVISER EDITION
AIA DOGYMENT C7021CMQ' PAGE ONE OF 4 PAGES
TO OWNER: PROJECT: Parcel 7A, Red =ional Performing APPLICATION NO: 20B Distribution to:
Carmel Redevelopment Commission Arts Center OWNER
One Civic Square PERIOD TO: 3/31/10 CONSTRUCTION
Carmel, IN 46032 PROJECT NO: 2695 -4310 MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Shicl- Sexton Co., Inc. (PSM #14065) ARCHITECT
POYNTER SHEET METAL ATTN: Lynda Weaver. 902 N. Capitol Avenue, Indianapolis, IN 46204 CONTRACT DATE: 04/18/08 CONTRACTOR
8768 N. STATE: RD. 37 VIA ARCHITECT:
BLOOMINGTON, IN 47404 1
CONTRACT FOR: Bid Package 44310 I Sheet Metal
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ofthe Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and betiefthe Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid
by the Contractor for Work for which previous Certificates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 2,340,500.00
2. Net change by Change Orders CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 2) 2 22 3, 261
4. TOTAL COMPLETED STORED TO DATE S
(Column G on G703) By: Date:
5. RETAINAGE: 5% of Total Joseph R. ansd Presi nt
a. 5 %Qt` FIE S 111,163.00 State of: IN NA County of: MONRO
o u D E on G703) Subscribed and m vo to e ore m his day of March
b. of Stored Material 0.00 Notary Public:
o n F on G703) My Comm Commissio e pyres: ugust 29, 1
Total Retainage (Lines 5a 5b or
Total in Column I ofG703) 111,163.00 CERTIFICATE FO ENT
6, TOTAL EARNED LESS RETAINAGE 1,984,839.00 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 Iota]) comprising this application, the Construction Manager and Architect certity to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best of their knowledge, information and belief the Work has
PAYMENT (Line 6 from prior Certificate) 1,809,334.00 progressed as indicated, the quality of the Work is in accordance with the Contract
8. CURRENT PAYMENT DUE ta,a 7. Documents, and the Contractor is entitled to payment of AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE S 238,422.00 II �y
(Line 3 less Line 6) AMOUNT CERTIFIED 17s 13
t (Attach explanation if amount certified dyers om t re amount applied for. Initial all
T otal changes approve figures on this p icatiort and on the Conti Cation heet that changed to conform to the
in previous months by Owner $57,761.00 $175,000.00 amount certifie
COI TRUC A ER:
Total approved this Month $0.00 $0.00 By: Date: D 10
AR
TOTALS $57,761.00 $175,000.00 By: Date:
NET CHANGES by Change Order ($117,239.00) This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
a
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
r:
CONTINUATION SHEET A 1A DOCUMENT G 703 2 PAGE OF PAGES 3
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 2 O
Contractor's signed certification is attached. APPLICAIIONDATF� 3/12%20-0
In tabulations below, amounts are stated to the nearest dollar. PSM JOB#: 14065 PERIOD TO: 3
Use Column I on Contracts where variable retainage Ior line items may apply. NAME: Carmel PAC CONTRACT NO: 2695
A B C D E F G H I
LINE DESCRIPTION OF WORK SCHEDULED WORK COMPLETFD MATERIALS TOTAL R.3LANCF RETAINAGE
NO VALUE FROM PREVIOUS THIS PERIOD PRFSFNTLY COMPLETED (G C) TO FINISH (IF VARIABLF
APPLICATION STORED AND STORED (C G) RATE)
(D E) (NOT IN TO DATE
D OR E) (D +E +F)
I GENERAL CONDITIONS 200,000.00 $183,400 $8,600 $0 $192,000 96% $8,000 $9,600
2 BOND INSURANCE 45,000.00 $45,000 $0 $0 $45 100% $2,250
3 MOBILIZATION 15,000.00 $15,000 $0 $0 $15.000 100% $750
4 ALLOWANCE NO 11 BP 4310 651.00 $0 $0 $0 $0 0 $651 $0
5 ALLOWANCE NO 16 CAD AS- BUILTS 10,000.00 $0 $0 $o $0 0% $10,000 $0
6 DRAWINGS/COORDINATION 80.000.00 $80.000 $0 $0 $80.000 100% $4.000
7 MECH BASEMENT LEVEL
8 MATERIAL 48,000.00 $48,000 $0 $0 $48,000 100% $2,400
9 LABOR 50,700.00 $50,193 $0 $0 $50,193 99% $507 $2,510
10 LAGGING 7,000.00 $7000 $0 $0 $7,000 100% $350
II BACKHOUSE
12 MATERIAL 56.000.00 $56,000 $0 $0 $56,000 100% $2,800
13 LABOR 59,000.00 $59,000 $0 $0 $59 100% $2,950
14 KITCHEN HOOD DUCT
15 MATERIAL 15,400.00 $15400 $0 $0 $15,400 100% $770
16 LABOR 10,800-00 $8,640 $1,620 $0 510,260 95% $540 $513
17 INSULATION 10,100.00 $8,080 $0 $0 $8,080 80% 52,020 $404
18 MECH RM 1
19 MATERIAL 50,400.00 $50,400 $0 $0 $50,400 100% $2,520
20 LABOR 56,300.00 $56,300 $0 $0 $56,300 100% $2,815
21 INSULATION 16,800.00 $5,040 $11,760 $0 $16 100% $840
22 MECH RM 2
23 MATERIAL 77,000.00 $69,300 $7,700 $0 $77,000 100% $3,850
24 LABOR 93,900.00 $75,120 518,780 $0 $93,900 100% $4,695
25 INSULATION 16.800.00 $0 $0 50 $0 0 $16._800 $0
26 MECH RM 3 50
27 MATERIAL 84,900.00 $84,900 $0 $0 $84,900 100 $4,245
28 LABOR 94,500.00 $94,500 $0 $0 $94,500 100% $4,725
29 INSULATION 16,800.00 $15,120 $0 $0 $15,120 90% $1,680 $756
30 PLENUM LEVEL
31 MATERIAL 49,100.00 $49,100 $0 $0 $49,100 100% $2,455
32 LABOR 75,000.00 $75,000 $Q $0 $75,000 100% $3,750
33 LAGGING 13,000.00 $13,000 $0 $0 $13.000 100 $650
34 ORCHESTRA HIGH LEVEL
35 MATERIAL 34,600.00 $34,600 $0 $0 $34,600 100% $1,730
36 LABOR 35,400.00 $26,550 $5,310 $0 $31,860 90 $3,540 $1,593
37 ORCHESTRA LOW LEVEL
38 MATERIAL 49.400.00 $49,400 $0 $0 $49,400 100°/ $2,470
391 LABOR 62,600.001 $46,950 1 $9.390 1 $0 1 $36,340 90% $6,260 1 $2.817
CONTINUATION SHEET AIA DOCUMENT G703 3 PAGE OF PAGES 3
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containina APPLICATION NO: 206
Contractor's signed certification is attached. APPLICATION DATE: 3/12/20
In tabulations below, amounts are stated to the nearest dollar PSM 10114: 14065 PERIOD TO: 3,%31 2 C 10
Use Column I on Contracts where variable retainage for line items may apply. NAME: Carmel PAC CONTRACT NO: 2695 -4310
A B C D E F G H I
LINE DESCRIPTION OF WORT: SCHI-DULEI7 WORK COMPLETED MATFRIALS TOTAL BALANCE RFTAINAGE
NO. VALUE FRCINI PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G +C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED IC G) RATE)
(D E) (NOT IN TO DATE
D OR E) (D +E +F) 5%
40 BOX TIER LEVEL
41 MATERIAL 70,000.00 $70,000 $0 $0 $70,000 100% $3,500
42 LABOR 100,300.00 $90,270 $5,015 $0 $95,285 95% $5,015 $4,764
43 LOW BALCONY LEVEL
44 MATERIAL 94,100.00 $94,400 $0 $0 $94,100 100% $4,705
45 LABOR 85,300.00 $68,240 $12,795 $0 $81,035 95% $4,265 $4,052
46 HIGH BALCONY LEVEL
47 MATERIAL 38,400.00 $19,200 $19,200 $0 $38,400 100% $1,920
48 LABOR 50,200.00 $17,570 $17,570 $0 $35,140 70% $15,060 $1,757
49 ATTIC LEVEL +50
50 MATERIAL 41,600.00 $37.440 $4,160 $0 $41,600 100% $2,080
51 LABOR 44,700.00 $35,760 $4470 $0 $40.230 90% $4.470 $2,012
52 ATTIC LEVEL +61
53 MATERIAL 16,800.00 $15,120 $1,680 $0 $16,800 100% $840
54 LABOR 16,300.00 $13,040 $0 $0 $13,040 80% $3,260 $652
55 ATTIC LEVEL +66
56 MATERIAL 39.500.00 $19,730 $7.900 $0 $22650 70% $11,850 $1,383
57 LABOR 37,900.00 $15,160 $3,790 $0 $18,930 50% $18,950 $948
58 ATTIC LEVEL +79 -6
59 MATERIAL 6,700.00 $6,700 $0 $0 $6,700 100% $335
60 LABOR 5,200.00 $5.142 $0 $0 $3,142 99% $58 5257
4 -A ALLOWANCE NO. 11 BP 4310(ASI -031) 7,322.00 $7,322 $0 $0 $7,322 100% $366
4 -B ALLOWANCE NO 11 BP 431 OA -002 10,000.00 $6,600 $0 $0 $6,600 66% $3,400 $330
4 -C ALLOWANCE NO 11 SP 43108 -002 4,798.00 $4,798 $0 $0 $4,798 100% $240
4 -D ALLOWANCE NO 11 BP 43108 -003 1,534.00 $1,534 $Q $0 $1,534 100% $77
4 -E ALLOWANCE NO 11 BP431OB -004 27,142.00 $27,476 ($334) $0 S27142 100% $1,357
4 -F ALLOWANCE NO 11 BP 431OB -005 9,625.00 $0 $9,625 $0 $9,625 100°/ $o
4 -G ALLOWANCE NO 11 BP 4310B -006 175,000.00 $175,000 $0 $0 $175,000 100 $0
441 ALLOWANCE NO 11 BP 43106 -007 546.00 $0 $546 $0 $546 100% $0
4 -1 ALLOWANCE NO 11 BP 431OB -008 10.933.00 $0 $0 $o $0 0% $10,933 $0
4 ALLOWANCE NO 11 BP 43106 -009 12,449.00 $0 $12,4=49 $0 $12,449 100%
900 PENDING CHANGE ORDERS
901 CHANGE ORDER #1 38,542.00 $28,907 $9,635 $0 $38.542 100% $1,927
902 CHANGE ORDER #2 (RCP-1 0) 19,219.00 $15,375 $3,844 $0 $19,219 100% $961
903 CHANGE ORDER #3 BP 43106 -005 175,000.00 ($175,000) $0 $0 ($175,000) 100% ($8,750)
$2,223,261 1,920,497 175,505 0 2,096,002 94% 127,254 1 111,163
I
i
AFFIDAVIT
State of Indiana 12/31/2009
14065 -17 I
County of Hamilton
j
The Affiant, Joseph R. Lansdeli being first duly sworn, on oath deposes and says that he/she is an Authorized Representive Poynter Sheet Metal, Inc.
I
who has a Contract with THE CITY OF CARMEL, under its Owner Agreement with Carmel Redevelopment Commission for the project known as
Carmel Performing Arts Center to provide all labor, material, equipment, supervision and insurance as required to complete all Sheet Metal Bid Package
on the following described premises in said County, to wit: 777 Third Avenue SW, Carmel, IN 46032
That for the purpose of said Contract, the following persons have been contracted with and have furnished, or are furnishing and preparing materials for, and have performed or are
performing labor on said improvement; that there is due and to become due them, respectively; the amounts set forth opposite their names for materials or labor as stated; that this statement
is made to said Owner for the pupose of procuring from said Owner Partial Payment on said Contract; and this is a full, true and complete statement of all
such persons, and of the amounts paid, due, and to become due them.
NAME AND ADDRESS CONTRACT BASE EXTRAS REVISED TOTAL AMOUNT OF BALANCE TO
FOR CONTRACT TO CONTRACT PREVIOUS THIS COMPLETE
AMOUNT CONTRACT AMOUNT REQUEST REQUEST
Validated Custom Solutions Equipment 474,900.00 3,281.00 478,181 -00 478,181.00
Pinnacle Equipment Co., Inc. Equipment 257,500.00 1,639.00 259,139 -00 167,470.00 91,669.00
JM Farrell Company Insulation 50,630.00 8,750.00 59,380.00 59,380.00
Cardinal Contracting Co. Millwrights 16,550.00 16,550.00 16,550.00
Poynter Sheet Metal, Inc. Sheet Metal /HVAC 2,545,920.00 44,091.00 2,590,011.00 1,459,893.95 84,488.50 1,045 628.55
i
I
TOTALS 3,345,500 -00 57,761.00 3,403,261.00 2,122,094.95 84,488.50 1,196,677.55
AMOUNT OF ORIGINAL 3,345,500.00 TOTAL AMOUNT REQUESTED 2,180,309.00 I I
i
CONTRACT
i
EXTRAS TO CONTRACT 57,761.00 LESS 5% OF CONTRACT RETAINED 170,163.05
TOTAL CONTRACT EXTRAS 3,403,261.00 NET AMOUNT EARNED 2,010,145.95
CREDIT TO CONTRACT AMOUNT OF PREVIOUS 2,122,094.95
I I
PAYMENTS
NET AMOUNT OF CONTRACT 3,403,261.00 AMOUNT DUE THIS PAYMENT 84,488.50 i
BALANCE TO COMPLETE 1,196,677.55 I
It is understood that the total amount paid to date plus the amount, requested in this Application shall not exceed 70 of the Cost of the Work completed to date. I agree to furnish
Waivers of Lien for all materials under my Contract when demanded.
SIGNED:
Signato Joseph R. Lansdeli, President
i
For: Poynter Sheet Metal, I nc.
Subcontractor Name I
i
Subscribed and sworn to before me this a,0 (0 NOTARY PUBLIC:
day of �/�/1arsh ELINKeIGDWal, wry PIA
The above sworn statement should be obtained by the Owner before each and every payment, RRAL" Residing in ,Morgan Ca*
r �GO1rtnISS14r11 CbpItBS���,
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
l'a Y n Purchase Order No.
�76e X/ .SA, I�� Rag��3 Terms
Date Due
Invoice invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
3/31 IO 2-0
4
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
7
_lid
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO4 or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
175 5 6-ZlO 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 is
iggnature
Director of Redevelopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund