185037 04/28/2010 CITY OF CARMEL, INDIANA VENDOR: 363792 Page 1 of 1
ONE CIVIC SQUARE W R DUNKIN SON, INC CHECK AMOUNT: $302,526.00
CARMEL, INDIANA 46032 PO BOX 2247
ANDERSON IN 46018 CHECK NUMBER: 185037
CHECK DATE: 4/28/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 13 36,675.00 PERFORMING ARTS CENTE
902 4460807 23A 265,851.00 PERFORMING ARTS CENTE
Document G70 1 Mar -1992
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER Carmel Redevelopment PROJECT: Parcel 7A, 44050 Carmel APPLICATION NO: 023 r9 Distribution to:
Commission Performing Arts OWNER: X
One Civic Square 777 3rd Ave. S.W. PERIOD TO: March 31.2010 CONSTRUCTION MANAGER: X
Carmel, IN 46032 Carmel, IN 46032 ARCHITECT: X
FROM W.R. Dunkin Son, Inc. VIA CONSTRUCTION Shiel Sexton Co., Inc. CONTRACT DATE: May 08, 2008 CONTRACTOR: X
CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 25310 2695 -4050 2695 FIELD:
Anderson, IN 46018
CO NTRACT FOR BP- #4050 General Trades VI ARCH ITECT: CSO Architects OTHER:
CONTRACTOR APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's know ledge, information and
belief the Work covered by this Application for Payment -Kas been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. Contract Documents, that all amounts have been 4 for VAlork for which previous
Continuation Sheet, AIA Document G703, is attached. Certificates for Payment were��rued pa s receive from the Owner, and that current
1. ORIGINAL CONTRACT SUM 9,966,300.00 Paytnent shown here] o 'due.
2. NET CHANGE BY CHANGE ORDERS 231,504.00 C N RAC W R o nc
3. CONTRACT SUM TO DATE (Line 1 t 2) 9,734,796.00 y: Date: March 15, 2010
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 7,675,967.00 S P' ndiana
5. RETAINAGE: County of: Madison
a. 5 of Completed Work Subscribed and sworn to before
(Column D E on G703) 486,739.80 methis 15th dayof March, 010
b• 0 of Stored Material Notary Public: Martha A. Carpenter
(Column F on 6703) 0.00 My Commission expires: January 08, 2017
Total Retainage (Lines 5a 5b or Total in Column 1 of G703) 486,739.80 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 7,189,227.20 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 6,923,376.20 knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Lane 6 from prior Certificate) CERTIFIED. 00
8. CURRENT PAYMENT DUE 265,851.00 AMOUNT CERTIFIED V III SA
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied Initial all figures on this
Application and on the Continuation Sheet MyknIT changed to conform with the amount certified.)
(Line 3 less Line 6) 2,545.568.80 CONST UCTION AG
By: Date: 4D
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI E T:
Total changes approved in previous months by Owner 528,826.00 760,330.00 B I Date:
Total approved this Month 0,00$ 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 528,826.00 760,330.00 gamed herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Chan e Order 231,504.00
AIA Document G7021CMaTM —1992. Copyright O 1992 by The Am rican 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. This document was produced by AIA software at 14:49:59 on 03/18/2010 under Order No.0754240912_1 which expires on 0511012010, and is not for resale.
User Notes: (1178167089)
-I Document G103 ®1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 023
containing Contractor's signed certification is attached. APPLICATION DATE: 03/15/2010
In tabulations below, amounts are in US dollars.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 03/31/2010
ARCHITECT'S PROJECT NO: 25310
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE)
APPLICATION (NOT IN D OR E)
D +E (D+E +F)
PERFORMANCE
01010 BOND 106,000.00 106,000.00 0.00 0.00 106,000.00 100.00% 0.00 10,600.00
MOBILIZE/DEMOB
01015 ILIZE 29,000.00 15,000.00 0.00 0.00 15,000.00 51.72% 14,000.00 1,500.00
SUPE RV I S10N /CO
01020 ORDINATION 361,000.00 323,800.00 0.00 0.00 323,800.00 89.70% 37,200.00 28,480.00
GENERAL
01025 CONDITIONS -M 380,000.00 336,000.00 0.00 0.00 336,000.00 88.42% 44,000.00 27,000.00
GENERAL
01026 CONDITIONS -L 98,000.00 89,200.00 0.00 0.00 89,200.00 91.02% 8,800.00 7,000.00
GENERAL
01027 CONDITIONS -0 262,990.00 199,000.00 8,800.00 0.00 207,800.00 79.01 55,190.00 0.00
ALLOWANCE-
STONE
140A0 WALKWAY 8,500.00 0.00 0.00 0.00 0.00 0.00% 8,500.00 0.00
ALLOWANCE-
TEMPORARY
140B0 HANDRAIL 38,000.00 31,198.00 0.00 0.00 31,198.00 82.10% 6,802.00 2,776.90
ALLOWANCE
TEMPORARY
DOORS/FRAMES/H
14000 ARDWARE 10,000.00 0.00 5,972.00 0.00 5,972.00 59.72%1 4,028.00 0.00
140DO ALLOWANCE -ICE 13,500.00 2,289.00 0.00 0.00 2,289.00 16.96% 1 1,21 1.00 207.10
ALLOWANCE
140E0 SECURITY 1 31,000.00 0.001 0.00 0.00 0.00 0.00% 31,000.00 0.00
140FO ALLOWANCE- 1 191,700.00 67,797.001 6,831.00 0.00 74,628.00 38.93% 117,072.00 3,987.90
AIA Document 0703'"' 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 1
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03/1812010 under Order No 0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
APPLICATION THIS PERIOD DATE (G C) (C G) RATE)
(NOT IN D OR E)
(D E) D +E +F)
DUMPSTERS
ALLOWANCE-
TRAILER
140GO CONNECTOR 34,000.00 32,617.00 102.00 0.00 32,719.00 96.23% 1,281.00 2,200.90
ALLOWANCE
TRAILER.
140HO CLEANING 19,169.00 1.4,582.00 780.00 0.00 15,362.00 80.14%1 3,807.00 1,066.10
ALLOWANCE -SITE
14010 SIGNAGE /SAFETY 22,000.00 10,839.00 0.00 0.00 10,839.00 49.27% 11,161.00 1,055.90
ALLOWANCE
140J0 GENERAL LABOR 320,000.00 219,516.00 42,080.00 0.00 261,596.00 81.75% 58,404.00 594.40
ALLOWANCE
TEMPORARY
FENCE
140KO MODIFICATIONS 5,000.00 4,008.00 0.00 0.00 4,008.00 80.16%1 992.00 400.80
ALLOWANCE -42
140LO OR #53 STONE 37,900.00 18,856.00 0.00 0.00 18,856.00 49.75 19,044.00 1,885.60
ALLOWANCE-
WAREHOUSE
140M LEASE /LAYDOWN
0 /PARKING 500,000.00 500,000.00 0.00 0.00 500,000.00 100.00% 0.00 942.70
ALLOWANCE
PARKING LOT
INSTALL /MAINTAI
140N1 N 1.00,000.00 80,324.00 0.00 0.00 80,324.00 80.32% 19,676.00 5,532.40
ALLOWANCE
MAINT. -OFF SITE
STAGING /PARKIN
140N2 G 35,000.00 7,509.00 651.00 0.00 8,160.00 23.31 %1 26,840.00 685.50
ALLOWANCE-
PARKING LOT
REMOVE /REFURBI
14000 1 SH 100,000.00 2,745.00 0.00 0.001 2,745.00 2.75% 97,255.001 274.50
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 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 0 311 81201 0 under Order No.0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE)
APPLICATION (NOT IN D OR E)
(D E) (D +E +F}
ALLOWANCE
HAUL /DISPOSE
UNSUITABLE
140PO MATERIAL 25,000.00 14,794.00 0.00 0.00 14,794.00 59.18% 10,206.00 1,479.40
ALLOWANCE -6
OZ. GEOTECH
140Q1 FABRIC 4,700.00 3,207.00 0.00 0.00 3,207.00 68.23%1 1,493.00 320.70
ALLOWANCE-
140Q2 ITENSAR GEOGRID 8,500.00 0.00 0.00 0.00 0.00 0.00 8,500.00 0.00
ALLOWANCE42
1.4080 STONE 26,200.00 10,275.00 0.00 0.00 10,275.00 39.22% 15,925.00 1,027.50
ALLOWANCE
CABLE PASS
140S0 THRU (FOH) 6,456.00 0.00 0.00 0.00 0.00 0.00% 6,456.00 0.00
ALLOWANCE-
CABLE PASS
140T0 THRU (BOH) 5,165.00 0.00 0.00 0.00 0.00 0.00% 5,165.00 0.00
ALLOWANCE-
140U CABLE PASS-
0 THRU (FLOOR) 17,217.00 0.00 0.00 0.00 0.00 0.00%1 17,217.00 0.00
ALLOWANCE
TEMPORARY
ELEVATOR
140VO USAGE 200,000.00 18,527.00 11,341.00 0.00 29,868.00 14.93% 170,132.00 0.00
ALLOWANCE
1.40W DONOR
0 RECOGNITION 100,000.00 100,000.00 0.00 0.00 100,000.00 100.00 0.00 0.00
GENERAL
140X0 ALLOWANCE 400,000.00 130,980.00 73,794.00 0.00 204,774.00 51.19 195,226.00 598.00
ALLOWANCE -AS-
1.40Y0 BUILD /CAD 5,000.00 4 0.00 0.00 4,242.00 84.84% 758.00 0.00
FIELD
01501 OFFICE /STORAGE 16,400.00 15,400.00 0.00 0.00 15,400.00 93.90% 1,000.00 1120.00
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 3
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14,51 18 on 0 311 8/2 01 0 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G C) FINISH (IF VARIABLE
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
TRAILER -M
FIELD
OFFICE /STORAGE
01502 TRAILER -L 5,500.00 4,950.00 0.00 0.00 4,950.00 90.00% 550.00 405.00
TEMPORARY
TOILETS /WASHIN
01503 G STATIONS -M 41,800.00 35,600.00 1,000.00 0.00 36,600.00 87,56%1 5,200.00 2,860.00
TEMPORARY
TOILETS /WASHIN
01504 G STATIONS -L 7,600.00 6,500.00 150.00 0.00 6,650.00 87.50% 950.00 555.00
FIRE
PROTECTION/EME
01505 RG.STATIONS -M 19,300.00 19,300.00 0.00 0.00 19,300.00 100.00 0.00 1,930.00
FIRE
PROTECTION/EME
01506 RG.STATIONS -L 4,000.00 3,500.00 0.00 0.00 3,500.00 87.50% 500.00 310 .00
FURNISH/MAINTA
01507 IN TRASH CANS -M 6,000.00 6,000.00 0.00 0.00 6,000.00 .1.00.00 0.00 600.00
FURNISH/MAINTA
01508 IN TRASH CANS -L 40,000.00 30,200.00 1,200.00 0.00 31,400.00 78.50% 8,600.00 2,350.00
TEMPORARY
ROAD /MAINTENA
01510 NCE 148,000.00 138,000.00 0.00 0.00 138,000.00 93.24% 10,000.00 12,220.00
TEMPORARY
FENCING
REMOVE/RELOCA
01520 ITE 15,800.00 15,800.00 0.00 0.00 15,800.00 100.00% 0.00 1,580.00
TEMPORARY
01521. FENCING -GATES 6,500.00 6,500.00 0.00 0.00 6,500.00 100.00% 0.00 650.00
TEMPORARY
FENCING
01522 SCREENING 8,744.00 8,744.001 0.001 0.00 8,744-001 100.00 0.001 874.40
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 4
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03118/2010 under Order No.0754240912_1 which expires on 0 511 012 01 0, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
TEMPORARY
01523 BARRIERS -M 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 680.00
TEMPORARY
01524 BARRIERS -L 7,500,00 7,500.00 0.00 0.00 7,500.00 100.00% 0.00 750.00
TEMPORARY
01530 ENCLOSURES -M 10,800.00 10,800.00 0.00 0_00 10,800.00 100.00%1 0.00 1,050.00
TEMPORARY
01.531 ENCLOSURES -L 14,000.00 14,000.00 0.00 0.00 14,000.00 100.00 0.00 1,360.00
SCAFFOLDING-
SET
UP /CONSUMABLE
01.540 S 398,000,00 398,000.00 0.00 0.00 398,000.00 100.00% 0.00 37,620.00
SCAFFOLDING
MONTHLY
RENTAL /INSPECTI
01541 IONS 228,000.00 199,500.00 19,000.00 0.00 218,500.00 95,83% 9,500,001 10,450.00
SCAFFOLDING
DISMANTLE /REM
01542 OVE 55,000.00 0.00 0.,00 0.00 0.00 0.00% 55,000.00 0.00
STAIR TOWERS
01543 SETUP 54,000.00 18,000.00 0,00 0.00 18,000.00 33.33% 36,000.00 1,800.00
STAIR TOWERS
MONTHLY
01544 RENTAL 28,500.00 9,500.00 0,00 0.00 9,500.00 33,33%1 19,000.00 350.00
STAIR TOWERS
01545 IDISMANTLE 6,700.00 0.00 0,00 0.00 0.00 0.00% 6,700.00 0.00
HOIST- EXTERIOR-
1546.1 SET UP 14,300.00 0.00 0,00 0.00 0.00 0.00% 14,300.00 0.00
HOIST- EXTERIOR-
RENTAL/OPERATI
1546.2 ON 1 139,040.00 0,001 0.001 0.001 0.00 0.00% 139,040.00 0.00
HOIST- EXTERIOR-
1546.3 DISMANTLE 1 8,000. 0.00 0.00 0. 0.00 0.00%1 8, 000.00 1 0.00
AIA Document 0703 1992. Copyright C 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 5
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03/18/2010 under Order No.0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
STORED
NO. WORK VALUE THIS PERIOD DATE (G. C) (C G) RATE)
APPLICATION (NOT IN D OR E)
(D E) (D +E +F)
HOIST- STAIR2 -SET
1547.1 UP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00
HOIST -STAIR 2-
RENTAL/OPERATI
1547.2 ON 1.39,040.00 0.00 0.00 0.00 0.00 0,00% 139,040.00 0.00
HOIST -STAIR 2-
1547.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00
HOIST -ROOM 100-
1548.1 SET UP 95,000.00 95,000.00 0.00 0.00 95,000.00 100,00% 0.00 9,500.00
HOIST -ROOM 100
RENTAL /OPERATI
1548.2 ON 211,000.00 198,250.00 7,500.00 0.00 205,750.00 97.51 %1 5,250.00 16,975.00
HOIST -ROOM 100-
1548.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0.00 2,500.00 0.00
HOIST
ALLOWANCE -SET
1549.1 JUP 9,830.00 0.00 0.00 0.00 0.00 0.00% 9,830.00 0.00
HOIST
ALLOWANCE-
RENTAL/OPERATI
1549.2 ON 97,500.00 0.00 0.00 0.00 0.00 0.00% 97,500.00 0.00
HOIST
ALLOWANCE-
1549.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0.00% 2,500.00 0.00
01556 ITRASH CHUTES -M 52,000.00 47,300.00 1,500.00 0.00 48,800.00 93.85% 3,200.00 4,490.00
01557 TRASH CHUTES -L 58,000.00 46,000.00 3,000.00 0.00 49,000.00 84.48% 9,000.00 2,500.00
GENERAL CLEAN
01560 UP -M 5,000.00 3,940.00 1.50.00 0.00 4,090.00 81.80% 910.00 314.00
GENERAL CLEAN
01561 UP -L 60,000.00 47,600.00 1,500.00 0.00 49,1.00.00 81.83 10,900.00 3,560.00
01562 1171N CLEANING 65,000.001 0.00 0.00 0.001 0.00 0.00% 65,000.00 0.00
021.10 EXCAVATION /BA 12,019.00 12,019.00 0.00 0.001 12,019.00 400.00%1 0.00 1,201.90
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. AJI 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 6
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03/1812010 under Order No.0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes: (1664228726)
A B C D E F G H. I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
APPLICATION THIS PERIOD DATE (G. C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
CKFILL- SUMPS -M
EXCAVATION /BA
CKFILL SUMPS -L
02111 EQ 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00 0.00 2,500.00
02240 SHORING 209,800.00 209,800.00 0.00 0.00 209,800.00 100.00 0.00 20,980.00
CAST IN PLACE
03301 CONCRETE -M 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00 %1 0.00 1,000.00
CAST IN PLACE
03302 CONCETE -L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00 0.00 3,500.00
PRECAST
PLANKS -12"
03410 HOLLOW CORE 161,000.00 161,000.00 0.00 0.00 161,000.00 100.00 0.00 16,100.00
PRECAST
PLANKS -12"
03411 SOLID 898,000.00 898,000.00 0.00 0.00 898,000.00 100.00 0.00 89,800.00
PRECAST
03412 PLANKS -6" SOLID 107,000.00 107,000.00 0.00 0.00 107,000.00 1.00.00 0.00 10,700.00
PRECAST
03413 TRUCKING 82,000.00 82,000.00 0.00 0.00 82,000.00 100.00 0.00 8,200.00
PRECAST
03414 ERECTION 186,000.00 186,000.00 0.00 0.00 186,000.00 1.00.00 0.00 1.8,600.00
INTERIOR :METAL
FABRICATIONS-
05504 SUBMITTALS 102,000.00 102,000.00 0.00 0.00 102,000.00 100,00%1 0.00 10,200.00
STEEL STAIRS
05505 WITH RAIL -M 179,000.00 179,000.00 0.00 0.00 179,000.00 100.00% 0.00 14,857.00
STEEL STAIRS
05506 WITH RAIL -L 80,000.00 73,000.00 0.00 0.00 73,000.00 91.25% 7,000.00 6,600.00
05507 LADDERS -M 26,000.00 26,000.00 0.00 0.00 26,000.00 100.00% 0.00 2,600.00
05508 LADDERS -L 12,500.00 12,500.00 0.00 0.00 12,500.00 100.00% 0.00 1,220.00
CATWALK
05509 FRAMING -M 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 6,300.00
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 7
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14 51 18 on 03/18/2010 under Order No.0754240912_1 which expires on 0511 W2010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H 1
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
APPLICATION DATE (G C)
THIS PERIOD (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
CATWALK
05510 FRAMING -L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00 0.00 1,710.00
MISCELLANEOUS
05511 METALS -M 441,000.00 425,550.00 0.00 0.00 425,550.00 96.50% 15,450.00 13,615.00
MISCELLANEOUS
05512 METALS -L 275,000.00 268,250.00 0.00 0.00 268,250.00 97.55% 6,750.00 8,094.30
INTERIOR ROUGH
061.00 CARPENTRY -M 31,000.00 18,920.00 3,500.00 0.00 22,420.00 72.32% 8,580.00 372.00
INTERIOR ROUGH
061.01 CARPENTRY -L 44,000.00 25,640.00 4,200.00 0.00 29,840.00 67.82% 14,160.00 484.00
FOUNDATION
WATERPROOFING
07110 -M 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00%1 0.00 510.00
FOUNDATION
WATERPROOFING
07111 -L 6,600.00 6,600.00 0.00 0.00 6,600.00 100.00% 0.00 660.00
07210 DUCT LINERS -M 97,000.00 97,000.00 0.00 0.00 97,000.00 100.00% 0.00 9,700.00
07211 DUCT LINERS -L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00%, 0.00 1,120.00
07810 FIRESTOPPING -M 24,000.00 19,800.00 0.00 0.00 19,800.00 82.50% 4,200.00 1,680.00
07811 FIRESTOPP.ING -L 16,000.00 14,200.00 0.00 0.00 14,200.00 88.75% 1,800.00 1,220.00
JOINT SEALANTS
07910 M 35,000.00 2,500.00 3,000.00 0.00 5,500.00 15.71 29,500.00 0.00
JOINT SEALANTS
07911 L 80,000.00 6,000.00 8,000.00 0.00 14,000.00 17.50%1 66,000.00 0.00
STEEL DOORS
08110 FRAMES -M 0.00 0.00 0.00 0.00 0.00 0.00
STEEL DOORS
08111 FRAMES -L 0.00 0.00 0.00 0.00 0.00 0.00
FLUSH WOOD
08140 DOORS -M 0.00 0.00 0.00 0.00 0.00 0.00
FLUSH WOOD
08141 DOORS -L 0.001 0.001 0.00 0.00 0.00% 0.00
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 8
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 0 3/1 81201 0 under order No. 0754240912_1 which expires on 05/1 012 0 10, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SC14EDULED FROM PRESENTLY AND STORED TO FINISH (IF VARIABLE
THIS PERIOD
NO. WORK VALUE PREVIOUS STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
STILE RAIL
081.43 WOOD DOORS -M 0.00 0.00 0.00 0.00 0.00% 0.00
STILE RAIL
08144 WOOD DOORS -L 0.00 0.00 0.00 0.00 0.00% 0.00
SOUND CONTROL
DOORS
08347 WINDOWS -M 0.00 0,00 0.00 0.00 0.00%1 O-00
SOUND CONTROL
DOORS
08348 WINDOWS -L 0.00 0,00 0.00 0.00 0,00% 0.00
OVER COILING
08355 DOORS -M 0.00 0.00 0.00 0.00 0.00% 0.00
OVERHEAR
08356 COILING DOORS -L 0.00 0.00 0.00 0.00 0.00% 0.00
ALUMTRAMED
ENTRANCES /STOR
08410 EFRONTS -M 0.00 O.00 0.00 0,00 0.00% 0.00
ALUM.FRAMED
ENTRANCES /STOR
08411 EFRONS -L 0.00 0.00 0.00 0.00 0,00% 0.00
INTERIOR ALUM.
DOORS
08413 FRAMES -M 0.00 0.00 0.00 0,00 0.00% 0.00
INTERIOR ALUM.
DOORS
08414 FRAMES -L 0.00 0.00 0.00 0.00 0.00% 0.00
REVOLVING
DOOR
08423 ENTRANCES -M 0.00 0.00 0.00 0.00 0.00% 0.00
REVOLVING
DOOR
08424 ENTRANCES -L 0.00 0.00 0.00 0.001 0.00% 0.00
08440 IGLAZED ALU,, 1 325,000,001 214,500.00 9,800.001 0.001 224,300-001 69.02% 100,700.00 11,375.00
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 9
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03/1812010 under Order No.0754240912_1 which expires on 05110/2010. and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I.
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE)
APPLICATION (NOT IN D OR E)
(D E) (D +E +F)
CURTAIN WALLS
M
GLAED ALUM.
CURTAIN WALLS
08441 L 148,000.00 29,600.00 44,000.00 0.00 73,600.00 49.73% 74,400.00 0.00
08710 HARDWARE 525,000.00 499,000.00 8,000.00 0.00 507,000.00 96.57% 18,000.00 18,800.00
INTERIOR
08810 GLAZING -M 11,000.00 220.00 0.00 0.00 220.00 2,00% 10,780.00 22.00
INTERIOR
08811 GLAZING -L 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00
FIRE PROTECTION
1.0440 SPECIALTIES -M 7,580.00 0.00 0.00 0.00 0.00 0,00% 7,580.00 0.00
FIRE PROTECTION
10441 SPECIALTIES -L 1,800.00 0.00 0.00 0.00 0.00 0.00% 1,800.00 0.00
10450 KNOX BOX 650.00 0.00 0.00 0.00 0.00 0,00% 650.00 0.00
LOADING DOCK
11130 EQUIPMENT -M 18,500.00 16,475.00 0.00 0.00 16,475.00 89.05 2,025.00 1,647.50
LOADING DOCK
11131 EQUIPMENT -L 3,800.00 2,200.00 0.00 0.00 2,200.00 57.89 1,600.00 220.00
ELEC.TRACTION
ELEVATORS
14210 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
ELEC.TRACTION
ELEVATORS-
MATERIAL/EQUIP
14211 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
ELEC.TRACTION
14212 ELEVATORS -L 0.00 0.00 0.00 0.00 0,00%1 0.00 0.00
HYDRAULIC
ELE V ATOR-
14241 JENGfNEERING 1 0.001 0.001 0.001 0.00 0.00% 0.001 0.00
14242 1HYDRAULIC 1 0.001 0.001 0.001 0.00 0.00% 0.001 0.00
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 Ale 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 10
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03118/2010 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NO, WORK VALUE THIS PERIOD STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
ELEVATOR-
MATERIAL/EQUIP
MENT
HYDRAULIC
ELEVATOR
14243 LABOR 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00
WHEELCHAIR
LIFT
MATERIAL /EQUIP
14421 IMENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
WHEELCHAIR
14422 LIFT- PERMITS 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00
WHEELCHAIR
14423 LIFT -LABOR 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CHANGE ORDER
17001 NO. 01 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00 0.00 450.00
CHANGE ORDER
17002 NO. 02 9,031.00 9,031.00 0.00 0.00 9,031.00 100.00 0.00 0.00
CHANGE ORDER
17003 NO. 03 2,196.00 2,196.00 0.00 0.00 2,196.00 100.00 0.00 30.00
17000 CHANGE ORDER
4 NO. 04 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
17000 CHANGE ORDER
5 NO. 05 98,741.00 98,741.00 0.00 0.00 98,741.00 100.00% 0.00 9,874.10
17000 CHANGE ORDER
6 NO. 06 17,527.00 17,527.00 0.00 0.00 17,527.00 1.00.00 %1 0.00 1,400.00
17000 CHANGE ORDER
7 NO. 07 11,292.00 11,292.00 0.00 0.00 11,292.00 100.00% 0.00 1,129.20
17000 CHANGE ORDER
8 NO. 08 44,936.00 44,936.00 0.001 0.00 44,936.00 100.00% 0.00 4,493.60
17000 C14ANGE ORDER
9 NO. 09 14,683.00 14,683.00 0.00 0.00 14,683.001 100.00%1 0.001 0.00
AIA Document G703T' 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 11
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 0 3/1 812 01 0 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1684228726)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE
APPLICATION DATE (G C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
17001 CHANGE ORDER
0 NO. 10 760,330.00 750,573.00 0.00 0.00 750,573.00 98,72% 9,757.00 38,016.50
17001 CHANGE ORDER
2 NO. 12 49,062.00 49,062.00 0.00 0.00 49,062.00 100.00% 0.00 2,453.10
17001 CHANGE ORDER
3 NO. 13 3,801.00 3,801.00 0.00 0.00 3,801.00 100,00% 0.00 190.05
17001 CHANGE ORDER
4 NO, 14 787.00 787.00 0.00 0.00 787.00 100.00% 0.00 39.35
17001 CHANGE ORDER
5 NO. 15 34,158.00 34,158.00 0.00 0.00 34,158.00 100.00% 0.00 1,707.90
17001 CHANGE ORDER
6 NO. 16 7,529.00 7,529.00 0.00 0.00 7,529.00 100.00%1 0.00 376.45
17001 CHANGE ORDER
7 NO. 17 7,083.00 7,083.00 0.00 0.00 7,083.00 100.00% 0.00 354.15
GRAND TOTAL $9,734,796.00 $7,410,116.001 $265,851.00 $0.00 $7,675,967.00 78,85% $2,058,829.00 $486,739.80
AIA Document G703- 1992. Copyright 1963, 1965, 1966, 1967,1970, 1976, 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 12
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:51:18 on 03/18/2010 under Order No.0754240912_1 which expires on 0511012010, and is not for
resale.
User Notes: (1684228726)
AFFIDAVIT AND WAIVER OF LIEN
]FINAL X PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Madison SS
Bradley A. Tyler being duly sworn states that he is the Project Manalzer of W. R. Dunkin
Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish
certain materials and /or labor as follows: Bid Package 4050- General Trades for a project
known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and
owned by City of Carmel and does hereby further state on behalf of the aforementioned
Contractor.
Application for Payment 4 20 has been received for work performed through 12/31/09
(PARTIAL WAIVER) that there is due from the contractor the sum of
Three Hundred Ninety -two Thousand Nine Hundred Thirty dollars and 00 /cents 392,930.00
Application for Payment 4 has been received for work performed through
(FINAL WAIVER) that the final balance due from the Owner is the sum of
dollars and 00 /cents (S
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim
whatsoever on the above described property and improvements thereon on account of LABOR or material or both,
furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further
certifies that no other party has any claim or right to lien on account of a r erformed or material furnished
to the undersigned for said nd -wat e'scope of t is affida nd aive
C W. R. Dunkin &San, Inc. B Title: Project Manager
WITNESS MY HAND AND NOTARIAL SEAL, this 19' day of March 2010
(Notary Pub
My Commission Expires: January 08, 2017 Printed Martha A. Carpenter
Residing in Madison County
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
R 06'17t V 5147 /nom Purchase Order No.
1 36K Zz Y 7 Terms
)A/ Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total
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
IN SUM OF
P4 �o�s `227
ON ACCOUNT OF APPROPRIATION FOR
Paz 7
Board Members
Po# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice or
yo2 2 3 x 6,!6 P 26sksI.v 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/,)
ignature
Director of Redevelanmant
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund
1 2 11 -tAIA TM Document G7021C a 1992
Application and Certificate for Payment Construction Manager Adviser Edition i
TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A, #5010 Carmel APPLICATION NO: 013 Distribution to:
Commission Performing Arts OWNER: X
One Civic Square 777 3rd Ave S.W. PERIOD TO: March 31.2010 CONSTRUCTION MANAGER: X
Carmel, IN 46032 Carmel, IN 46032 ARCHITECT: X
FROM W.K. Dunkin Son, Inc. VIA CONSTRUCTION Shiel Sexton Co., Inc. CONTRACT DATE: February 23, 2009 CONTRACTOR: X
CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 25310H 2695/5010 2695 FIELD:
Anderson, IN 46018
OTHER:
CON TRACT FOR: Bid Pkg 4501.0 VIA ARCHITECT: CSO Architects
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application fo a ment has been completed in accordance with the
Application is made for payment, as shown below, in connection evith the Contract. Contract Documents, that all amounts have paid by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Ce issued an aytne ece ed from the Owner, and that current
1. ORIGINAL CONTRACT SUM 1,480,000.00 due.
2. NET CHANGE BY CHANGE ORDERS ...I 81,040.00 S n, I
3. CONTRACT SUM TO DATE (Line 1 2) 1,398,960.00 Date: March 15, 2010
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 625,735.00
5. RETAINAGE: County of:
8. 10 of Complete d Work Subscribed and sworn to before
(Column D E on G703) 62,573.50 me this 15th day of MaYC X10
b• 0 of Stored Material Notary Public: Martha A Carpenter
(Colman F on G703) 0.00 My Commission expires: January 08, 2O f7
Total Retainage (Lines 5a 5b or Total in Column 1 of 6703) 62,573.50 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 563,161.50 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7, LESS PREVIOUS CERTIFICATES FOR PAYMENT 526,486.50 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 36,675.00 AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differ om the amount applied. Initial all figures on this
Application and on the Continuation Shee th are changed to conform with the amount certified.)
(Line 3 less Line 6) 835,798.50 CONST UCTION NA ER:
By: Date: 0- j 6 0 )110
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE T'
Total changes approved in previous months by Owner 0.00$ 81,040.00 By: Date:
Total approved this Month 0.00$ 0.00 This Certificate is not negotiable. Tlse AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 0.00$ 81,040.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order 81,040.00
AIA Document G7021CMaTM 1992. Copyright O 1992 by The Am rican 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. This document was produced by AIA software at 14:08:35 on 03118/2010 under Order No. 0754240912_1 which expires on 05/10/2010, and is not for resale.
User Notes: (1651270262)
r+
ti;`
t r +i
a
TM
Document G703 -1992
Continuation Sheet
AIA Document. G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 013
containing Contractor's signed certification is attached. APPLICATION DATE: 03/15/2010
In tabulations below, amounts are in US dollars.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 03/31/201.0
ARCHITECT'S PROJECT N0: 2531 OH
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
PREVIOUS AND STORED TO FINISH (IF VARIABLE
APPLICATION (NOT IN D OR E)
NO. WORK VALUE THIS PERIOD STORED DATE (G C) (C G) RATE)
D E (D +E +F)
01010 Performance Bond 26,400.00 26,400.00 0.00 0.00 26,400.00 100.00 0.00 2,640.00
Mobilize
01015 Demobilize 8,000.00 4,000.00 0.00 0.00 4,000.00 50.00 4, 000.00 400.00
Supervision
01020 Coordination 87,000.00 54,000.00 3,000.00 0.00 57,000.00 65.52%1 30,000.00 5,700.00
General Conditions
01025 M 30,000.00 18,900.00 1,500.00 0.00 20,400.00 68,00% 9,600.00 2,040.00
General Conditions
01026 L 34,000.00 20,400.00 1,200.00 0.00 21,600.00 63,53% 12,400.00 2,160.00
1400A Organ Facade Pipes 200,000.00 86,720.00 0.00 0.00 86,720.00 43.36% 113,280.00 8,672.00
Carpentry Labor
1400B Hours 32,000.00 32,000.00 0.00 0.00 32,000.00 100.00% 0.00 3, 200.00
Provide Tie -Off
1400C Points at Balconies 25,000.00 0.00 0.00 0.00 0.00 0.00 25,000.00 0.00
Vertical Partition
System Backfold
1400D Doors 15,000.00 0.00 6,600.00 0.00 6,600.00 44.00% 8,400.00 660.00
16'X16' Temporary
1400E Overhead Door 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 600.00
Temporary OHD
Enclosure and
140OF Insulation 10,000.00 1,644.00 0.00 0.00 1,644.00 16,44% 8,356.00 164.40
1000 SY of BX 1200
1400E Tensar Geogrid 17,000.00 4,117.00 0.00 0.001 4,117.00 24.22% 12,883.00 411.70
1400H 1350 CY of 42 Stone 18,200.00 5,718.00 0.00 o.001 5,718.001 31.42 12,482.001 571.80
AIA Document G703T -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 1
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:16:10 on 03118/2010 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (846744950)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE
APPLICATION THIS PERIOD DATE G C (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
1400J 200 CY of 453 Stone 10,000.00 1,746.00 0.00 0.00 1,746.00 17.46% 8,254.00 174.60
1400K General Allowance 75,000.00 50,000.00 0.00 0,00 50,000.00 66.67% 25,000.00 5,000.00
CAD As -Built
1400L Allowance 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
General Clean Up
01560 M 4,000.00 300.00 150.00 0.00 450.00 11.25% 3,550.00 45.00
01561 General Clean U L 25,000.00 2,800.00 1,500.00 0.00 4,300.00 17.20% 20,700.00 430.00
Final Cleaning (Items
01562 in .BP 5010 10,000.00 0.00 0.00 0.00 0.00 0.00% 10,000.00 0.00
Dewatering for 9
02110 Months -M -Eq 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00%1 0.00 1,850.00
Dewatering for 9
02111 Months L -Eq 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00 °f° 0.00 2,800.00
Piping from Tri -Plex
02240 to Lift Station 21,000.00 21,000.00 0.00 0.00 21,000.00 100.00% 0.00 2,100.00
Interior Metal
Fabrications
05504 Submittals 6,200.00 6,200.00 0.00 0.00 6,200.00 100.00% 0.00 620.00
Interior Metal
Fabrications
05505 Materials 86,500.00 86,500.00 0.00 0.00 86,500.00 100.00%1 0.00 8,650.00
Interior Metal
05506 Fabrications- Erection 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00 0.00 2,400.00
Miscellaneous Metals
05511 M 5,640.00 5,640.00 0.00 0.00 5,640.00 1.00.00 0.00 564.00
Miscellaneous Metals
05512 -L 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00 0.00 250.00
Interior Rough
06100 Carpentry M 28,000.00 6,000.00 8,400.00 0.00 14,400.00 51.43% 13,600.00 1,440.00
Interior Rough
06101 Carpentry L 36,500.00 10,000.00 6,000.00 0.00 16,000.00 43.84% 20,500.00 1,600.00
07810 Skylight Shade M 62,000.00 62,000.00 0.00 0.00 62,000.00 100.00% 0.00 6,200.00
AIA Document G703T" -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 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:16:10 on 03/18/2010 under Order No.0754240912_1 which expires on 0511 012 01 0, and is not for
resale.
User Notes: (846744950)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE THIS PERIOD STORED DATE (G C} C G) RATE
APPLICATION (NOT IN D OR E)
(D E) D +E +F
Skylight Shade
07811 Installation 29,500.00 29,500.00 0.00 0.00 29,500.00 100.00 0.00 2,950.00
07910 Joint Sealants M 48,000.00 0.00 5,800.00 0.00 5,800.00 12.08% 42,200.00 580.00
07911 Joint Sealants L 24,500.00 0.00 3,400.00 0.00 3,400.00 13,88% 21,100.00 340.00
08810 Interior Glazing 42,000.00 840.00 0.00 0.00 840.00 2.00% 41,160.00 84.00
09610 Access Flooring 19,500.00 0.00 0.00 0.00 0.00 0.00% 19,500.00 0.00
09710 FRP Wall Panels M 1,000.00 0.00 0.00 0.00 0.00 0.00% 1,000.00 0.00
09711 FRP Wall Panels L 2,000.00 0.00 0.00 0.00 0.00 0.00% 2,000.00 0.00
Acoustic Fabric
09712 Wrapped Panels 42,500.00 0.00 0.00 0.00 0.00 0.00% 42,500.00 0.00
10210 Toilet Compartments 44,000.00 0.00 0.00 0.00 0.00 0.00%1 44,000.00 0.00
Backfold Door
10220 Tracks M 5,000.00 5,000.00 0,00 0.00 5,000.00 100.00% 0.00 500.00
Backfold Door
10221 Tracks- L 4,560.00 4,560.00 0.00 0.00 4,560.00 100.00% 0.00 456.00
10222 Operable Partition 21,000.00 0.00 3,200.00 0.00 3,200.00 15.24% 17,800.00 320.00
10223 Wire Mesh Partitions 9,500.00 0.00 0.00 0.00 0.00 0.00%1 9,500.00 0.00
Toilet Accessories
10224 M 34,000.00 34,000.00 0.00 0.00 34,000.00 1.00.00 0.00 3,400.00
Toilet Accessories
10225 L 28,000.00 1,000.00 0.00 0.00 1,000.00 157% 27,000.00 100.00
1.0510 Metal Lockers 16,500.00 0.00 0.00 0.00 0.00 0.00% 16,500.00 0.00
10520 Phenolic Lockers M 110,000.00 0.00 0.00 0.00 0.00 0.00% 110,000.00 0.00
10521 Phenolic Lockers L 29,000.00 0.00 0.00 0.00 0.00 0.00% 29,000.00 0.00
10610 Corner Guards -M 9,500.00 0.00 0.00 0.00 0.00 0,00% 9 0.00
10611 Corner Guards L 3,500.00 0.00 0.00 0.00 0.00 0.00 o 3,500.00 0.00
17001 Changr Order No. 01 81,040.00 80,000.00 0.00 0.00 80,000.00 98.72% 1,040.00 8,000.00
GRAND TOTAL $1,398,960.00 $584,985.00 $40,750.001 $0.00 $625,735.00 44.73% $773,225.00 $62,573.50
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 AIO Document, or any portion of it, may result in severe civil and criminal penalties, and will be 3
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14.16:10 on 0 3/1 81201 0 under Order No.07 5424 091 2_1 which expires on 05110/2010, and is not for
resale.
User Notes: (846744950)
AFFIDAVIT AND WAIVER OF LIEN
]FINAL X PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Madison SS
Bradley A. Tom being duly sworn states that he is the Project Manager of W. R. Dunkin
Son, Inc. having contracted with City of Carmel .Redevelopment Commission to furnish
certain materials and /or labor as follows: Bid Package 5010- Interior Finishes for a project
known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and
owned by City of Carmel and does hereby further state on behalf of the aforementioned
Contractor.
Application for Payment 10 has been received for work performed through 12/3 1/09.
(.PARTIAL WAIVER) that there is due from the contractor the sum of
Thirty -eight Thousand Two Hundred Fifty dollars and 00 /cents S 38,250.00
Application for Payment has been received for work performed through
(FINAL WAIVER) that the final balance due from the Owner is the sum of
dollars and 00 /cents (S
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim
whatsoever on the above described property and improvements thereon on account of LABOR or material or both,
furnished by the undersigned thereto, subject to limitations or conditio ex ressed herein, if any; and further
certifies that no other party has any claim or right to a lien on accoun ny k performed or material furnished
to the undersigned for said prime and-n t1•ei�e p of is of rt an waiver.
W. R. Dunkin Son 1 B Title: Project Manager
WITNESS MY HAND AND NOTARIAL SEA this 1 day of March 1 2010
(Notary Pu c)
My Commission Expires: January 08, 2017 Printed Martha A. Carpe ter
Residing in Madison County
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
22 1 -17 Terms
Q/ Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Total 7S?
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
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
Board Members
Pop or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
Y/"/ Y X 67 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
Signature
Director of Redevelopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund