185760 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1
ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP
CHECK AMOUNT: $788,440.00
CARMEL, INDIANA 46032 7930 CASTLEWAY DRIVE
INDIANAPOLIS IN 46250 CHECK NUMBER: 185760
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 14 -2 788,440.00 PERFORMING ARTS CENTE
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F r TM
Document G7021CMa -1992
Application and Certificate for Payment Construction Manager Adviser Edition s q
TO OWNER: CARMEL REDEVELOPMENT COM PREUECT: Carmel Regional Performing Art APPLICATION NO: API' #:000'14 Distribution to:
211 City Center Drive
Carmel. IN 46032 3/31/2010 OWNER X
PERIOD T0:
CONSTRUCTION MANAGER ❑X
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 1/30/2008 ARCHITECT ❑X
Hager Construction Corp ave rewer
m
P.O. Box 10640 Shiel Sexton PROJECT NOS: 08- 2619 -1/ 1 CONTRACTOR
Fort Wavne, IN 46853 -0690
VIA ARCHITECT: Brandon Bogan INVOICE N0: 9726 FIELD
CSO Architects Inc
CONTRACT FOR: Masonry
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
6 126,000.00 Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM payment shown herein is now due.
2. Net change by Change Orders 939,223.1 CONTRACTOR: iagerman Co st ct;on r
P
3. CONTRACT SUM TO DATE (Line 1 2) 7,065,223.1 By: Date:
M...h 19 2010
4. TOTAL COMPLETED STORED TO DATE (Colunul G on G703) 5.735.429.1 I State of: ana Troy. Heisler, Controller 0111191 l.r,
5. RETAINAGE County of: Allen \Q
a. 6.16 of Completed .Work Subscribed and sworn to;,betore
t o o
a.
(Column D E on G703) 353.261.16 me this
b. of Stored Material Notary Pu
(Column F on G703) My Commission expires: L d►o® a
Total Retainage, (Lines 5a 5b or Total in Column I of G703) 353,261.1 CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observ�o Pi i mprising
6. TOTAL EARNED LESS RETAINAGE 5 3R7 167 9 5 this application, the Construction Manager and Architect certify to the 0WH c Wiest of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated,.t -4 a ity of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 4.593.727.9 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 788.440.0 AMOUNT CERTIFIED 788._440.00
(Attach explanation if amount certified differs from the a� owq applied. Initial all figures on this
9. BALANCE TO FINISH, INCLUDING RETAINAGE A and on the Continuati:ou. Sheet th e cheue ed to conform with the amount certified.)
(Line 3 less Line 6) 1,683.055.20 CONST UCTION NA Dave rewer iel'Sexton
By: Date: ®3 V
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI ECT: t o o n 'CSO cts Inc
939,223.
Total changes approved.id previous months by Owner B Date:
Total approved this Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 939,223. 5b Warned herein. IsSuance'paytnent and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order 939,223.15 the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
>:S 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.
ix�''� TM
A IA Document G702 /CMa -1992 Instructions
Application and Certificate for Payment Construction Manager Adviser Edition
A. General Information
AIA Document G702 /CMa, 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 G7021CMa, 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 (EULA).
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 G702 /CMa, 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 A2011CMa. 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 permitted 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 schedule 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 G703 form or at the 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 G702 /CMa form.
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 in A201 /CMa,'
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certified by.the Construction Manager and Architect on AIA Document G702 /CMa,
Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and address of the Contractor. Payment should
not be made to any other party unless specifically indicated on G702 /CMa.
.AIA Docoment G702/CmaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal
penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed.
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org.
CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF 2 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00014
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 3/31/2010
Use. Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO,: 092619A
A B C D L- F G If I
WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGG
1TGM SCHEDULED PRESENTLY COMPLETED TO
DESC121PT]ON OF O1.K FROM PREti ]OUS STORED AND STORF,D If VARIABLE)
N0. VALUI> APPLICATION T111S PERIOD FINISH RATE:
(NOT IN TO DATE, -C
(D E) D OR C) (D+E +F)
00000 $0.00 $0.00 $0.00 $0.00 $0.00 0 $0.00 $0.00
000000
0000019 GENERAL CONDITION
0000020 Bonding Insurance $56,000.00 $56,000.00 $0.00 $0.00 $56,000.00 100.000 $0.00 SO.00
0000030 Submittals $10,000.00 $10,OOo.Oo 50.00 $0.00 $10,000.00 100 000 $0.00 $0.00
0000040 Project Meetings $10,000.00 $8,500.00 $500.00 $0.00 S9,000.00 90.000 S1,000 -00 $0.00
0000050 Mobflizaiion $28 ,000.00 528,000.00 $0.00 $0.00 528,000.00 100.000 $0.00 $0.00
0000060 Demobilization $25,000.00 $0.00 $0,00 $0.00 $0.00 0 $25,000.00 $0.00
0000070 Contract Close Oul 56.000.00 $().Oo $0.00 $0.00 $0.00 0 $6,000.00 $0,00
0000080 Allowance 94 As- buiits $5,000.00 $0.00 $0.00 $0.00 $0.00 0 $5,000.00 $000
0000100 EXTERIOR MASONRY
0000110 CMU North Labor $30,000.00 $30,000.00 $0.00 $0.00 $30,000.00 100.000 50.00 $0,00
G000120 CMU East Labor $25.000.00 $17,500.00 57,500.00 $0.00 $25,000.00 100.000 $0,00 $0.00
0000130 CMU South Labor $37,000.00 $0.00 $0.00 $0.00 $0.00 0 $37,000.00 $0.00
0000140 CMU West Labor $25,000.00 $0.00 50.00 $0.00 $0.00 0 $25,000.00 $0.00
0000150 CMU Drum Labor $39,000.00 $39,000.00 50.00 $0.00 $39,000.00 100.000 $0.00 $0.00
0000160 CMU North Materials $9,000.00 $9,000.00 $0.00 $0.00 $9,000.00 100.000 $0.00 $0.00
0000170 CMU East Materials $7,000.00 $7,000.00 50.00 $0.00 $7,000.00 100.000 $0.00 $0.00
0000180 CMU South Materials S10.000.00 $0.00 $0.00 $0.00 $0.00 0 $10,000.00 50.00
0000190 CMU West Materials $7,000.00 $0.00 $0,00 $0 -00 $0.00 0 $7,000.00 $0.00
0000200 CMU Drum Materials $12,000.00 $12,000.00 $0.00 $000 $12,000.00 100.000 $0.00 $0.00
0000210 Vapor Barrier Labor i62,000.00 $162,000.00 $0.00 $0.00 5162,000.00 100000 $0.00 $0.00
0000220 Vapor Barrier Materials $98,000.00 $98,000.00 $0.00 $0.00 $98,000.00 100.000 $0.00 $0.00
0000240 EXTERIOR VENEER
00002.50 Granite Labor $205,000.00 $164 530,750.00 $0.00 5194,750.00 95.000 $10,250.00 50.00
0000260 Granite Materials $504.000.00 $504,000.00 $0.00 $0.00 $504,000.00 100.000 $0.00 S0.00
0400270 Limestone North Labor $878,000.00 $878,000.00 $0.00 $0.00 $878,000.00 100.000 $0.00 $0.00
0000280 Limestone North Materials $126,000.001 S126,000.00 $0.00 $0.00 $126,000.00 100000 $0.00 $0.00
0000290 Limestone East Labor $734,000.00[ $697,300.00 $22,020.00 50.00 $719,320.00 98.000 $14,680.00 $0.00
0000300 Limestone East Materials $107,000.00 5105,930.00 $1,070.00 $0.00 $107,000.00 100.000 $0.00 $0.00
0000310 Limestone South Labor $890,000.00 $356,000.00 $178,000,00 $0 "00 $534,000.00 60.uo0 $356,000.00 $0.00
0000320 Limestone South Materials $132,000. $79,200.00 $26,400.00 $0.00 $105,600.00 80.000 526,400.00 $0.00
AIA DOCUMENT G703• APPL ICATION AND CERTIFICATE FOR PAYMENT €992 LDITION AIA: lc2i992 TrIG ANIER]t;AN INS rr1 U IT 01' ARCHVIT.C'I'S, 1735 NEW YORK G703 -1992
AVE.NUF, K.W., WASHINGTON. I) C. 211006-529? WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution,
71.15 11 -11 nas been tepcutlucea elncllonically-I,, Ine po'-slan of Trc Aran rican 1153tlute of Arch;i cis under 1-Ir.- Y7003 to Pmtia- s,'sterns. Ine. R- dudtlen of this do -ew A11iout p,d T,pec III, W.or -l is Mt pent I tied. Contact Tice .A -Ioen I-ilute of Architects
to veld, Ilse cement wr 5100 of friS document d;.-l- status:
Y•
CONTINUATION SHEET AIA DOCUMENT G703 PAGE20F2PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00014
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 3/31/2010
Use Cofunln I on Contracts where variable retainage for (isle items may apply_ ARCHITECT'S PROJECT NO.: 082619A
A r3 C E F G I{ I t
W ORK COMPLETED MATERIALS TOTAL BALANCE R6TAINAGE
ITEM SCHEDULED PRESENTLY COMPLETED r 1F VARIABLE)
DESCRIPTION OF WORK FROM PREVIOUS /a TO r
NO. VALUE APPLICATION THIS PERIOD STORED AND STORED FINISH RATS=
(NOT IN TO DATE (G C) (C; G)
(D F) D OR 1) (D +E hh)
0000330 Limestone West Labor $734,000.00 $110,100.00 $330,300.00 $0.00 $440,400.00 50.000 $293,600.00 $0.00
0000340 Limestone West Materials $107,000.00 $32,100.00 $53,500.00 $0.00 $85,600.00 80.000 $21,400.00 $0.00
0000350 Cast Stone Drum Labor $249,000.00 $249,000.00 $0.00 $0.00 $249,000.00 100.000 $0.00 $0.00
0000360 Cast Stone Drum Materials S330.000.00 $330,000.00 $0.00 $0.00 $330,000.00 100000 S0,00 $0.00
0000370 Cleaning Caulking Labor S288,00000 $57,600.00 $28,800.00 $0.00 $86,400.00 30.000 $201,600.00 $0.00
0000380 Cleaning Caulking Materials $241,000.00 $48,200.00 $24,100.00 $0.00 $72,300.00 30.000 $168,700.00 $0.00
0000400 CHANGE ORDERS
0000410 CO #1 Limestone Field Stone
0000420 Limestone Field Labor $480,000.00 $336,000.00 $48,000.00 $0.00 $384,000.00 80.000 $96,00000 $0.00
0000430 Limestone Field Material $250,000.00 $187,500.00 $37,500.00 $0.00 $225,000.00 90.000 $25,000.00 $0.00
0000450 CO 2 Drum Veneer
0000460 Drum Veneer Labor $110,000.00 $110,000.00 $0.00 $0.00 $110,000.00 100.000 $0.00 $0.00
0000470 Drum Veneer Materials $90,000.00 $90,00000 $0.00 $0.00 $90,000.00 100.000 $0.00 $0.00
0000490 CO #3 PAC 0251 Granite Jointing
0000500 Granite Labor $492.14 $359.11 S0.00 $0.00 $369.11 75.001 $123.03 $0.00
0000510 Granite Material $7.150.00 $7,150.00 50,00 $0.00 $7,150.00 100.000 $0.00 $0.00
0000530 CO 94 Granite Door Jamb
0000540 Granite Labor $41.01 $0.00 $0.00 $0.00 $0.00 0 $41.01 $0.00
0000550 Granite Material $1,540.00 $1,540.00 $0.00 $0.00 $1,540.00 100.000 $0.00 $0.00
57,065,223.15 $4,946,989.11 $788,440.00 $0.00 $5,735,429.11 $1.18% $1,329,794.04 $0Q0
AIA DOCUMENT G703• AN'LICATiON AND CER'I'IF €CA'141 FOR t'AYMEN'r €492 L•,nITIUN AIAT) ;k992 THE Alv]l3RICAN INS 'PITUFEOF ARCHITEC'r5. 1735 NEW YORK 6703 -1992
AVF,M)E, N.w., WASHINGTON, D,C. 201)06 -5292 WARNING: Unlicensed photocopying violates U.S, copyright laws and will subject the viotatot to legal prosecution.
"TMs dh-al has been reproducer eLcromcx6y wish cne lse;misshn °t TM A--an Insm, o °f A- dr'ilntlF under LI-se 97W3 1r p6navera Syslems, lhc. R- oduclion c4 tNs doctlmsnl wh rn jt proicctspecillc inlOrmslfon Is not pomllltnd. Canlacf The Amad- Inslllute of A« hilacts
la verity 1Re --enl ver h o! t- dot:finent and Ncersa ^tatus"
6+
WAIVER OF LIEN
The vndersignedis the duly authorized officer of Hagerman c- ongtn;Ct Cnr=ration the general contractor,
(Name of Company)
subcontractor,'materialman or other person furnishing the services, labor, material or equipment indicated below in the
construction of improvements upon real estate located in Hamilton County, State of Indiana commonly
known as gmrrel. Regional. Perfcndng Arts which real estate is owned. by r-i t-�rnf rAnml rae5e�pjcpmmt "Owner
OmtE' Nlesrnry
IN CONSIDERATION ofthesumo
QOLLARS J3, t 7,� receipt of wh h is hereby ackno dged, and in order to procure one o��oMy ments
for services, labor, material or equipmentprovided in such construction, the Company does hereby waive, release and quit
claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction
costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above'described,
which the Company may now have forservices, labor, material or equipment fumished in respect of such land or improvements
to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim for payment
nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on
behalf of himself (herself) and the Company.
The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to
the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received
hereunder. The undersigned further states that the consideration received hereunder is the sole-consideration received by
the Company for said services,labor, material or equipment furnished to date, and that the Company has neither received nor
made any security interest, title retention interest or lien rights in the said services, labor, material or equipment otherthan that
released and transferred hereby.
The material, labor, services or equipment furnished are mere particularly described in the affidavit for payment submitted of
even date herewith. The undersigned further warrants and represents that the Company has compliedwith all prevailing wage
requirements under applicable law or as may be set forth in the contract documents.
WITNESS the execution hereof this 19th day of March 2010.
roy eis� e t t o e l ler
Hagerman Construction Corporation
(Name of Company)
State of Indiana County of Allen SS: Before me, the
undersigned, a Notary Public in and for said County and State, personally appeared Troy Heisler
the controller of Hagerman r'.onstrtirtion Corporation who acknowledged
(Title) (Name of Company)
the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such
Company and the-free act and deed of said officer.
WITNESS my hand and notarial seal this 19th day of March 2010.
419 lo
M
My Commission Expires: C N �="21
W
Notary Public
12/16/15 w
y OT0 SM
My County of Residence: navid Thomas
(Printed Name of Notary Public)
Allen p7 m, !r! O'[
Y t
Bre ad by State Board of Accounts City Form No. 201 (Rev. 1995)
j 4R ACCOUNTS PAYABLE VOUCHER
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
//u 416 j" a 96) 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
%OI ICHER NO. —WARRANT NO.
ALLOWED 20
IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
T IF 11A
Board Members
Po# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
ADZ /-y Z ys���o7 7 9,F 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 /a
Director wiW 66opment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund