185784 05/26/2010 CITY OF CARMEL, INDIANA VENDOR: 363782 Page 1 of 1
ONE CIVIC SQUARE HORNING ROOFING
CARMEL, INDIANA 46032 2340 ENTERPRISE PARK PLACE CHECK AMOUNT: $118,089.00
INDIANAPOLIS IN 46218
CHECK NUMBER: 185784
CHECK DATE: 5/26/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 10 118,089.00 PERFORMING ARTS CENTE
1 011 TM
Document G7021CMa -1992
ty
Application and Certificate for Payment Construction Manager Adviser Edition SZ
TO OWNER: PROJECT: APPLICATION NO Distribution to:
PERIOD TO v2 OWNER
(p d 3 z �I�''a� CONSTRUCTION MANAGER
FROM CONT TOR:,r� VIA CONSTR CTIO MANAG El R: CONTRACT DATE: ARCHITECT
R PROJECT NOS: CONTRACTOR
/40 a�3 y° fir rj�r2 �`'ar VIA ARCHITECT FIELD 1:1 c 1WR GA il ��l El
CONTRACTOR 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 P vent were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM 3�o S`d. Payment shown in is no d e.
2. Net change b Cha Orders
g y g S QO CONTRACTOR`.
3. CONTRACT SUM TO DATE (Erne 1 2}......... �f �f 6 By: j I� J Date:
4. TOTAL COMPLETED STORED -TO DATE (Column G on G703) Z D6 State of:.IoClj6�, 7c,
5. RETAINAGE County of:
a. of Completed Work Subscribed and sworn to before
(Column D E on G703) d
D me this B LS day of r� t�
b• of Stored Material Notary Public:
(Column F on G703) D My Commission expires:
Total Retaina (Lines 5a 5b or Total in Column l ofG703) 3 _66 CERTIFICATE FOR PAYMENT
�6 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 $7d7 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 AMOUNT CERTIFIED o• �C�
eclan e
9. BALANCE TO FINISH, INCLUDING RETAINAG E (Attach exp lanati on on if amount certified differs,fror amunt applied. Initial all gures on this
Application and of t e Continuation She t that b d to conform with the amount certified.)
(Line 3 less Line 6) 3� D(0
CONS W 7t7
By: Date: p
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH Total changes appro in ved previous months by Owner l B
Date:
Total approved this "lVlonth This Certificate is not ;:negotiable, The AMOUNT CERTIFIED is payable onl to the Contractor
TOTALS 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 07021CMaTM 1992. Copyright O 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIO 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.
X
Document G702/CMa -19921nstructionS
Application and Certificate for Payment Construction Manager- Adviser Edition
A. General Information
AIA Document G7021CMa, 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 A2011CMa, 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 (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 G7021CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 f=orm
Heading: This information should be completed to be consistent with similar information on AIA Document G7021CMa, 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 G7021CMa 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 A2011CMa.
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 Ddcument 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 Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
Copyrighif 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 compVeted.
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 1 of 1
Application No: /D
Application Date: 02/25/2U ;0
JOB NAME CARMEL -R PAC CONSTRUCTION Period To: 03/01/2010
HORNING JOB 8 -2408 Architect's Project No:
A B C D E F G H I
Work Completed Materials Total Balance Retainage
From Previous Presently Completed to Finish
Application Stored Stored to Date (G /C)
Item# Description of Work Scheduled Value (D+ E) This Period (Not in D or E) (D +E +F)
1 Roofing Labor $107,140.00 $47,430.00 $29,860.00 $77,290.00 $29,850.00 $7,729.00
2 Roofing Material $166,980.00 $166,980.00 $166,980.00 $0.00 $16,698.00
3 Nailbase Material $105,300.00 $105,300.00 $105,300.00 $0.00 $10,530.00
4 Nailbase Labor $38,180.00 $34,540.00 $3,640.00 $38,180.00 $0.00 $3,818.00
5 Sheet Metal Labor $57,350.00 $30,070.00 $30,070.00 $27,280.00 $3,007.00
6 Sheet Metal Material $146,390.00 $146,390.00 $146,390.00 $0.00 $14,639.00
7 Tile Dome Material $112,000.00 $112,000.00 $112,000.00 $0.00 $11,200.00
8 Tile Dome Labor $39,800.00 $0.00 $0.00 $39,800.00 $0.00
9 Tile Balance Material $168,000.00 $41,000.00 $60,000.00 $101,000.00 $67,000.00 $10,100.00
10 Tile Balance Labor $59,700.00 $0.00 $15,000.00 $15,000.00 $44,700.00 $1,500.00
11 Paver Material $56,700.00 $0.00 $0.00 $56,700.00 $0.00
12 Paver Labor $18,900.00 $0.00 $0.00 $18,900.00 $0.00
13 Bond $15,010.00 $15,010.00 $15,010.00 $0.00 $1,501.00
14 Subcontractor $250,000.00 $2,100.00 $2,100.00 $247,900.00 $210.00
15 Submittals $5,000.00 $5,000.00 $5,000.00 $0.00 $500.00
16 SafetylStart -up $7,500.00 $3,000.00 $3,000.00 $4,500.00 $300.00
17 Clean -up /Closeout $7,500.00 $0.00 $0.00 $7,500.00 $0.00
1$ Change Order #1 ($1,430.00) ($1,430.00) ($1,430.00) $0.00
($143.00)
19 Change Order #2 $419,400.00 $134,000.00 $134,000.00 $285,400.00 $13,400.00
20 Allowance $5,000.00 $0.00 $0.00 $5,000.00 $0.00
21 Change Order #4 $33,870.00 $33,870.00 $33,870.00 $0.00 $3,387.00
$1,818,290.00 $875,260.00 $108,500.00 $0.00 $983,760.00 $834,530.00 $98,376.00
HORNING ROOFING SHEET METAL CO, LLC
AFFIDAVIT AND WAIVER OF LIEN
INVOICE 10
STATE: INDIANA FINAL PARTIAL X PAYMENT TO FOLLOW
COUNTY OF: MARION
_RON PHELPS II_ Being duly sworn that he is the President of _Horning Roofing Sheet Metal Company, LLC
contract with Carmel Redevelopment Commission to furnish certain materials
and/or labor as follows: As Per Contract for a project known as as: Carmel Regional Performing Arts
Center located in: Carmel
and owned by and does hereby further state
on behalf of the aforementioned subcontractor supplier:
(PARTIAL WAIVER) That there is due from the contractor the sum of
DOLLARS: $72,234.00
X receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration of the affidavit.
and Partial Waiver of Lien which is given solely with respect to said amount and
which waiver shall be effective only upon receipt of payment thereof by the
undersigned.
(FINAL WAIVER) That there is due from the contractor the sum of
DOLLARS:
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration of the affidavit
and Final Waiver of Lien which is shall become effective upon receipt of such
payment.
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, in any, and further certified that no other party has any claim or right
to lien on account of any work performed or material fur hed to undersigned for said project
and within the scope of this affidavit and wavier.
_Horning Roofing Sheet Metal Co.,LLC_ By: President
Von 1 II
WITNESS MY HAND AND NOTARIAL SEAL THIS: 11/17/09
MY COMMISSION EXPIRES: 02 -02 -11
COUNTY OF RESIDENCE: Morgan NOTARY
Kevin L. Moore
i
Document G702JCMa 1992
Application and Certificate for Payment Construction Manager- Adviser Edition
TO OWNER: PROJECT: APPLICATION NO Distribution to:
('C� rrn� /�t°C/�Y.e PERIOD TO IS V6 OWNER
A :.s L� Q3 CONSTRUCTION MANAGER
FRbIN C CTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT 0 t1 rrt ill?
PROJECT NOS: o2(o�s! 1 CONTRACTOR
�3
VIA ARCHITECT: FIELD yU /��'"/�'f"� El N KAL'�T 1 1'4 l a' �S (J E]
CONTRACTOR APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM Q75 payment shown in is now due.
2. Net change by Change Orders 66 CONTRALTO
3. CONTRACT SUM TO DATE (Line 1 2j By: Date:
4. TOTAL COMPLETED 8 STORED TO {)ATE Column G on G703 State of:'
d 9 60L�S /,Qii��
5. RETAINAGE County of: rYlaii on
a. of Completed Work Subscribed and sworn to before 2
(Colum
n D E on G703) 0 �56 me this y' day of .Y'i t
b. Io of Stored Material Notary Public:
(Column F on G703) My Commission ekpires: UAtV V
Total Retaina (Lines 5a+ 5b or Total in Column I of G703) CERTIFICATE FOR PAYMENT
In accordance with the Contract Documents, based on on -site observations and the data comprising.
6. TOTAL EARNED LESS RETAINAGE 91pp ,�5. SZ) this application, the Construction Manager and Architect certify to the Owner that to the best of their
(Line 4 Less Line 5 Total) p y knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (,3U d6 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 I s 93, 1 -16 sD AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE. (Attach explanation if amount certified differs from the arrtfunLapplied. Initial all figures on this
Application nd on the Continuation Sheet that are changed to conform with the amount certified.)
(Line 3 less Line 6) y Sd CONSTRU T10N N R:
By: Date: 4 ,1 7 +:t lo
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC
Total changes approved to previous months by Owner By: 1 Date:
Total approved this Month This Certificate is. not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS named herein. Issuance "payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order a� the Owner or Contractor under this Contract.
CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this 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.
AIA
TM 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, not 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 (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G702/CMa 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 1CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G702 1CMa 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.
0. 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 1CMa,
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 Document G7021CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AJO 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 vioiations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @aia.org.
CONTINUATION.SH,EET AIA DOCUryINT G Page 1 of 1,
Application No: 25
Application Date: 03/23/2010
JOB NAME CARMEL -R PAC CONSTRUCTION Period To: 04/01/2010
HORNING JOB 8 -2408 Architect's Project No:
A B C D E F G H I
Work Completed Materials Total Balance Retainage
From Previous Presently Completed to Finish
Application Stored Stored to Date (G /C)
Item# Description of Work. Scheduled Value (D +E) This Period (Not in D or E) (D +E +F)
1 Roofing Labor $107,140.00 $77,290.00 $20,000.00 $97,290.00 $9,850.00 $7,290.00
2 Roofing Material $166,980.00 $166,980.00 $166,980.00 $0.00 $16,698.00
3 Nailbase Material $105,300.00 $105,300.00 $105,300.00 $0.00 $10,530.00
4 Nailbase Labor $38,180.00 $38,180.00 $38,180.00 $0.00 $3,818.00
5 Sheet Metal Labor $57,350.00 $30,070.00 $30,070.00 $27,280.00 $3,007.00
6 Sheet Metal Material $146,390.00 $146,390.00 $146,390.00 $0.00 $14,639.00
7 Tile Dome Material $112,000.00 $112,000.00 $112,000.00 $0.00 $11,200.00
8 Tile Dome Labor $39,800.00 $0.00
$0.00 $39,800.00 $0.00
9 Tile Balance Material $168,000.00 $101,000.00 $101,000.00 $67,000.00 $10,100.00
10 Tile Balance Labor $59,700.00 $15,000.00 $15,000.00 $44,700.00 $1,500.00
11 Paver Material $56,700.00 $0.00 $0.00 $56,700.00 $0.00
12 Paver Labor $18,900.00 $0.00 $0.00 $18,900.00 $0.00
13 Bond $15,010.00 $15,010.00 $15,010.00 $0.00 $1,501.00
14 Subcontractor $250,000.00 $2,100.00 $2,100.00 $247,900.00 $210.00
15 Submittals $5,000.00 $5,000.00 $5,000.00 $0.00 $500.00
16 Safety /Start-up $7,500.00 $3,000.00 $3,000.00 $4,500.00 $300.00
17 Clean -up /Closeout $7,500.00 $0.00 $0.00 $7,500.00 $0.00
18 Change Order #1 ($1,430.00) ($1,430.00)
($1,430.00) $0.00 ($143.00)
19 Change Order #2 $419,400.00 $134,000.00 $56,000.00
$190,000.00 $229,400.00 $6,377.50
20 Allowance $5,000.00 $0.00 $0.00 $5,000.00 $0.00
21 Change Order #4 $33,870.00 $33,870.00 $33,870.00 $0.00 $3,387.00
$1,818,290.00 $983,760.00 $76,000.00 $0.00 $1,059,760.00 $758,530.00 $90,914.50
HORNING ROOFING SHEET METAL CO, LLC
AFFIDAVIT AND WAIVER OF LIEN
INVOICE 11
STATE: INDIANA FINAL PARTIAL X PAYMENT TO FOLLOW
COUNTY OF: MARION
_RON PHELPS II_ Being duly sworn that he is the President of _Horning Roofing Sheet Metal Company, LLC
contract with Carmel Redevelopment Commission to furnish certain materials
and /or labor as follows: As Per Contract for a project known as as: Carmel Regional Performing Arts
Center located in: Carmel
and owned by and does hereby further state
on behalf of the aforementioned subcontractor supplier:
(PARTIAL WAIVER) That there is due from the contractor the sum of
DOLLARS: $97,650.00
X receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration of the affidavit
and Partial Waiver of Lien which is given solely with respect to said amount and
which waiver shall be effective only upon receipt of payment thereof by the
undersigned.
(FINAL WAIVER) That there is due from the contractor the sum of
DOLLARS:
receipt of which is hereby acknowledged or
the payment of which has been promised as the sole consideration of the affidavit
and Final Waiver of Lien which is shall become effective upon receipt of such
payment.
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, in any, and further certified that no other party has any claim or right
to lien on account of any work performed or material furnished to undersigned for said project
and within the scope of this affidavit and wavier.
Horning 9 Roofin Sheet Metal Co-,LLC_ By: f E7 1 President
n Phelps II
WITNESS MY HAND AND NOTARIAL SEAL THIS: 11/17/09
MY COMMISSION EXPIRES: 02 -02 -11
COUNTY OF RESIDENCE: Morgan NOTARY
Kevin L. Moore
Prescribed by Slate Board of Accounts City Form No. 201 (Rev. 1995)
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
Nor n ih�
Ro b -Fin) Purchase Order No.
2 3 �O Eh +ef hs,- &pl( PJd(c Terms
.,1 dian9oll5, ZN L fwg Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2 -z -10 f d q 10 o RPA( 97 �50.06
cR� or ah �s9.0 20 N39.00
C'T oi-f ah 63 022- J 0
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
9orP'12 Pie
Leo ►h IN SUM OF
23gn E s� Perk Pfdce
T h d ahtbs 1A 4 62&
X18, a�9.
ON ACCOUNT OF APPROPRIATION FOR
T1- r 1114
9 02 X60 S07
Board Members
Po# or INVOICE NO. ACCT #(TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
�0 2 60807 9 7 650, t?0 bill(s) is (are) true and correct and that the
qOZ L*6 W 20 4qg.da materials or services itemized thereon for
which charge is made were ordered and
received except
�1 2010
Signature
hirddor of Redevelopment
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund