HomeMy WebLinkAbout186669 06/21/2010 CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1
(0 ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP
CARMEL INDIANA 46032 7930 CASTLEWAY DRIVE CHECK AMOUNT: $107,528.70
INDIANAPOLIS IN 46250 CHECK NUMBER: 186669
CHECK DATE: 6/21/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 24 107,528.70 PERFORMING ARTS CENTE
Document G7021CMa TM 1992
Application and Certificate °for Payment Construction Manager Adviser Edition
TO OWNER: PROJECT: Parcel 7A, Regicnal. performing Arts APPLICATION NO 24 Distribution to:
Carmel Redevelopment Commission
Ctnter
City of Carmel
PERIOD TO 04/30/10 OWNER
Carmel, IN 46032 HCC Job #2613
Invoice #9758 CONSTRUCTION MANAGER
ROM CON 4CT%R: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
agerman ons ruction Corporation 2695
P.O. Sox 10690 Shiel Sexton PROJECT NOS: 1 CONTRACTOR
Fort Wayne, IN 46853 VIA ARCHITECT: FIELD
CONTRACT FOR: CSO Architects
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
Certificates for Payment were issued and payments received from the Owner, and that current
1.ORIGINAL CONTRACT SUM 5,588,000.00 payment shown herein is now due.
2. Net change by Change Orders 343,671.00 CONTRACTOR. Hag an o struction Corporation
3. CONTRACT SUM TO DATE Line 1 2 5,931,671.00 B Date�}� 2010
4. TOTAL COMPLETED STORED TO DATE Column G on 6703 5,842 693.05 State of: troll o° mb2r Q
India a Qu a ���.:N.
5. RETAINAGE: County of: Allen O t1fr o
a. of Completed Work Subscribe nd sworn to bef re �e
Column D E on G703j 296, 583.55 me this
�nd of O
re 20 �'o
b. °lo of Stored Material Notary Fu 8 �e
(Column F on G703) My Commission l es:
Total Retainage (Lines 5a Sb or Total. in Column I of G703)
296,583.55 CERTIFICATE FOR PAYMENT` sir o a E 4 J
In accordance with the Contract Documents, based on on -site observations and the data comprising
6. TOTAL EARNED LESS RETAINAGE 5,546,109.50 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 5,438,5130,80 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
k Q
8. CURRENT PAYMENT DUE 107,528. AMOUNT CERTIFIED lZ 1f SZy
2 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach eaplan' tlora if amount certified differs from the anti unrapplied. Initial all fig,cre,s on this
Application car d ori the ontinuation Sheet that are. changed to conform with the amount certified.)
(Line 3 less Line 6) 385, 561.50 CONSTRUC I N N R:
By: Date: 2 2 0( o
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: r�Q
Total changes approved in previous months by Owner $365, 744. By: Date; 00
Total approved this'Month —0— This Certificate is-66 t negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS $371, 646.0 27 975 .00 named herein. Issuance payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order $343, 671.00 the Owner or Contactor 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.
xN 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, 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 A201 /CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment,
Construction Manager- Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is 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 ContTkfor. Payment should
not be made to any other party unless specifically indicated on G702 /CMa.
AIA Document G7021CMal" 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, copyrightCa aia.org.
CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF 5 PAGES
AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00024
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED e TO RETA[ AGE
DESCRIPTION OF WORK FROM PREVIOUS �o IF VARI ABLE)
NO VALUP STORED AND STORED FINISH
APPLICATION THIS PERIOD (NOT IN TO DATE (G C) RATE
CC G)
(D E) D OR E) (D +E +F)
0000010 GENERAL CONDITIONS
0000020 Bond $41,375.00 $41,375.00 $0.00 $0.00 $41,375.00 100.000 $0.00 $0.00
0000030 General Conditions $169,586.00 $167,890.14 $0.00 $0.00 $167,890.14 99.000 $1,695.86 $0.00
0000040 Supervision Engineering $320,164.00 $316,962.36 $0.00 $0.00 $316,962.36 99.000 $3,201.64 $0.00
0000045 Equipment l Operators $383,328.00 $383,328.00 $0.00 $0.00 $383,328.00 100.000 $0.00 $0.00
0000050 Owner Allowance $55,000.00 $42,222.00 $0.00 $0.00 $42,222.00 76.767 $12,778.00 $0.00
0000055 Subtotal General Conditions $969,453.00 $951,777.50 $0.00 $0.00 $951,777.50 98.177 $17,675.50 $0.00
0000060 EARTHWORK
0000070 Excavation Backfill $795,000.00 $755,250.00 $15,900.00 $0.00 $771,150.00 97.000 $23,850.00 $0.00
0000080 Site Utilities $200,000.00 $150,000.00 $10,000.00 $0.00 $160,000.00 80.000 $40,000.00 $0.00
0000090 Soil Treatment (Termiticide) $6,448.00 $6,448.00 $0.00 $0.00 $6,448.00 100.000 $0.00 $0.00
0000095 Subtotal Earthwork $1,001,448.00 $911,698.00 $25,900.00 $0.00 $937,598.00 93.624 $63,850.00 $0.00
0000110 CONCRETE
0000120 Footings Labor $206,046.00 $206,046.00 $0.00 $0.00 $206,046.00 100.000 S0.00 $0.00
0000130 Footings Material $202,588.00 $202,588.00 $0.00 $0.00 $202,588.00 100.000 S0.00 $0.00
0000140 Foundation Walls/Piers Labor $603,561.00 $603,561.00 $0.00 $0.00 $603,561.00 100.000 $0.00 50.00
0000150 Foundation Walls /Piers Material $414,224.00 $414,224.00 $0.00 $0.00 $414,224.00 100.000 $0.00 $0.00
0000160 Slabs on Grade Labor S47,650.00 $47,650.00 $0.00 $0.00 $47,650.00 100.000 $0.00 $0.00
0000170 Slabs on Grade Material 591,157.00 $91,157.00 $0.00 $0.00 $91,157.00 100.000 $0.00 $0.00
0000180 Elevated Stabs Labor $29,485.00 $29,485.00 $0.00 $0.00 $29,485.00 100.000 $0.00 $0.00
0000190 Elevated Slabs Material $24,740.00 $24,740.00 $0.00 $0.00 $24,740.00 100.000 $0.00 $0400
0000200 Elevator Shafts Labor $167,945.00 $167,945.00 $0.00 $0.00 $167,945.00 100.000 $0.00 $0.00
0000210 Elevator Shafts Material $61,125.00 $61,125.00 $0.00 $0.00 $61,125.00 100.000 $0.00 $0.00
0000220 Columns Labor $134,436.00 $134,436.00 $0.00 $0.00 $134,436.00 100.000 $0.00 50.00
0000230 Columns Materiai $51,221.00 $51,221.00 S0.00 $0.00 $51,221.00 100.000 $0.00 $0.00
0000240 Slabs on Metal Deck Labor $116,191.00 $116,191.00 $0.00 $0.00 $116,191.00 100.000 $0.00 $0.00
0000250 Slabs on Metal Deck Material $245,878.00 $245,878.00 S0.00 $1 $245,878.00 100.000 $0.00 $0.00
0000260 Topping Slab /Stair /Curb Labor $88,023.00 $83,621.85 $0.00 $0.00 $83,621.85 95.000 $4,401.15 $0.00
0000270 Topping Slab /Stair /Curb Material $61,1 $57,974.70 $0.00 $0.00 $57,974.70 95.000 $3,051.30 $0.00
0000280 Rebar Labor $239,605.00 $234,812.90 $4,792.10 $0.00 $239,605.00 100.000 $0.00 $0.00
0000290 Rebar Material $406,775.00 $406,775.00 $0.00 $0.00 $406,775.00 100.000 $0.00 $0.00
0000300 Misc. Metals Labor $27,015.00 $13,507.50 $13,50 $0.00 $27,015.00 1 $0.00 $0.00
AIA DOCUMENT G703- APPLICATION AND CERIIF[CATE FOR PAYMENT 1992 EDITION AIAO• 4N992 THE AMERICAN [NSTrruTEOFARCHITECTS, 1735 NEW YORK G703_1992
AVENUE. Nt.W., WASHINGTON, D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
This document has been reprice uced electronically with the permission of The American Institute of Architects under License 97003 to Prima ara Systems, Inc. Reproduction of this document without projec- speuric information is not permuted. Contact The American institute of Architects
to verity the current version of this document end license status
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 2 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00024
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2610
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H I.
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED e TO RETAI AGE
DESCRIPTION OF WORK FROM PREVIOUS /o IF VARI ABLE)
STORED AND STORED FINISH
APPLICATION THIS PERIOD (NOT IN TO DATE {G C) RATE
NO. VALUE
(C C)
(D E) D OR E) (D +E +F)
0000310 Mlsc, Metals Material $38,003.00 $22,801.80 515,201.20 $0.00 538,003.00 100.000 $0.00 $0.00
0000315 Subtotal Concrete $3,256,694,00 $3,215,740.75 $33,500.80 $0.00 $3,249,241.55 99.771 $7,452.45 $0.00
0000330 THERMAL AND MOISTURE PROTECTION
0000340 Insulation Labor $3,877.00 $3,877.00 $0.00 $0.00 $3,877.00 100.000 $0.00 $0.00
0000350 Insulation Material $15,268.00 $15,268.00 $0.00 $0.00 $15,268.00 100.000 $0.00 $0.00
0000360 Waterproofing Labor $90,000.00 $85,500.00 $4,500.00 $0.00 $90,000.00 100.000 $0.00 $0.00
0000370 Waterproofing Material $122,960.00 $116,812.00 $6,148.00 $0.00 $122,960.00 100.000 $0.00 $0.00
0000380 Caulking Labor $13,300.00 $0.00 $13,300.00 $0.00 $13,300.00 100.000 $0.00 $0.00
0000390 Caulking Material $16,600.00 $0.00 $16,600.00 $0.00 $16,600.00 100.000 $0.00 $0.00
0000400 Subtotal Thermal Sr Moisture Protection $262,005.00 $221,457.00 $40,548.00 $0.00 $262,005.00 100.000 $0.00 $0.00
0000420 SPECIAL CONSTRUCTION
0000430 Vibration Sound Control Jack Up Floor Systel S98,400.00 $98,400.00 $0.00 $0.00 $98,400.00 100.000 $0.00 $0.00
0000450 CHANGE ORDER #01
0000460 Alternate Parking ($20,000.00) ($20,000.00) $0.00 $0.00 ($20,000.00) 100.000 50.00 $0.00
0000480 CHANGE ORDER #02
0000490 Oculus Alternate $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 S0.00 $0.00
0000510 CHANGE ORDER #03
0000520 PC 10R2 -Elevator Changes $27,828.00 $27,828.00 $0.00 $0.00 $27,828.00 100.000 50.00 $0.00
0000540 CHANGE ORDER #04
0000550 PC 10R2 Elevator Changes $11,926.00 511,926.00 $0.00 $0.00 $11,926.00 100.000 $0.00 $0.00
0000570 CHANGE ORDER #05
0000580 PC 18 Sanitary Sewer Force Main Piping $9,707.00 $9,707.00 $0.00 $0.00 $9,707.00 100.000 $0.00 $0.00
0000600 CHANGE ORDER #06
0000610 PC 05R1 ASI #2 Speaker Boxes $26,221.00 $26,221,00 $0.00 $0.00 $26,221.00 100.000 $0.00 $0.00
0000630 CHANGE ORDER #07
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE. FOR PAYMENT 1992 EDITION AIA 1992 THE AMERICAN tNSTITUTE OF ARCHITECTS. 1735 NEW YORK G703 -1992
AVENUE. N.W,. WASHINGTON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
'This document has been reproduced electronically_ with the permission of The American Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document wlthoul projeci_speciric information is not permitted. Contact The American Institute of Architects
to vehH the current version of this document and license status'
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3OF5 PAGES
AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00024
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/20 LO
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E P G H
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED e TO RETAI AGE
DESCRIPTION OF WORK FROM PREVIOUS /e 1F VARI ABLE)
NO. VALUE APPLICATION THIS PERIOD STORED AND STORED FINISH RATE
(NOT IN TO DATE (G -C) (C G)
(1) E) D OR E) (D +E +F)
0000640 PC 12R1 Foundation Changes $5,744.00 $5,744.00 $0.00 $0.00 $5,744.00 100.000 $0.00 $0.00
0000660 CHANGE ORDER #08
0000670 PC #15R1 Reduce Size of HDPE Pipe ($1,175.00) $0.00 ($1,175.00) $0.00 ($1,175.00) 100.000 $0.00 $0.00
0000690 CHANGE ORDER #09
0000700 PC 22 HDPE Single Wall Pipe $554.00 $554.00 $0.00 $0.00 $554.00 100.000 $0.00 $0.00
0000720 CHANGE ORDER 410
0000730 PC 23 Change Drainage Layer Stone $14,139.00 $14,139.00 $0.00 $0.00 $14,139.00 100.000 $0.00 $0.00
0000750 CHANGE ORDER #11
0000760 PC 04R2 ASI #1 Modification to Utility Tunne $1,757.00 $1,757.00 $0.00 $0.00 $1,757.00 100.000 $0.00 $0.00
0000780 CHANGE ORDER #12
0000790 PC 06R2 -ASI #3 Added Columns $12,142.00 $12,142.00 $0.00 $0.00 $12,142.00 100.000 50.00 $0.00
0000810 CHANGE ORDER 913
0000820 PC 09R2 AS] #6 Various Changes $22,449.00 $22,449.00 $0.00 $0.00 $22,449.00 100.000 $0.00 $0.00
0000840 CHANGE ORDER #14
0000850 PC 0982 ASI 96 Various Changes $32,257.00 $32,257.00 $0.00 $0.00 $32,257.00 100.000 $0.00 $0.00
0000870 CHANGE ORDER #15
0000880 PC 02R1 Added Extended Piers $6,578.00 $6,578.00 $0.00 $0.00 $6,578.00 100.000 $0.00 $0.00
0000900 CHANGE ORDER 916
0000910 PC 35 Water Main Sleeve 51,757.00 $1,757.00 $0.00 $0.00 $1,757,00 100.000 $0.00 $0.00
0000930 CHANGE ORDER #17
0000940 PC 05131 Speaker Boxes West $29,820.00 $29,820.00 $0.00 $0.00 $29,820.00 100.000 $0.00 $0.00
0000960 CHANGE ORDER #18
0000970 PC 34132 ASI #40 Sanitary Force Main $18,987.00 $18,987.00 $0.00 $0.00 $18,987.00 100.000 $0.00 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION MAO cc, 1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEw YORK G703 -1992
AVENUE, KW., WASHINGTON, D.C. 20006 -52.92 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
"Thscocument has been reproduced electronically with the permtssion of The American Institute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this decumont witnoUt proleCtspecific information is net p-ined. Contact The American Institute of ArchUects
IO V2rity IhE Curren[ Vefslon Ot [his tlOLUTCnI and Iir2n5L Status'
CONTINUATION SHEET AIA D G703 PAGE 4 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00024
containinc Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H t
WORK COMPLETED MATE=RIALS TOTAL BALANCE
RETAENAGE
PRESENTLY COMPLETED ti
ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS /o TO (IF VARIABLE)
NO. VALUE APPLICATION THIS PERIOD STORED AND STORED FINISH RATE
(NOT IN TO DATE (G C) (C G)
(D E) D OR E) (D +E +F)
0000990 CHANGE ORDER #19
0001000 Credit for Commercial Stone in lieu of INDOT ($6,800.00) ($6,800.00) $0.00 $0.00 ($6,800.00) 100.000 $0.00 $0.00
0001020 CHANGE ORDER #20
0001030 PC 26 ASI 911 Added Curbs $5,428.00 $5,428.00 $0.00 $0.00 $5,428.00 100.000 $0.00 $0.00
0001050 CHANGE ORDER #21
0001060 PC 27R2 ASI 17 Utilitly Vauit Modifications $8,505.00 $8,505.00 $0.00 $0.00 $8,505.00 100.000 $0.00 $0.00
0001080 CHANGE ORDER #22
0001090 PC 07 Unsuitable Soils at Tunnel $22,060.00 $22,060.00 $0.00 $0.00 $2.2,060.00 100.000 $0.00 $0.00
0001110 CHANGE ORDER 423
0001120 PC 03 Unsuitable Soils $9,520.00 $9,520.00 $0.00 $0.00 $9,520.00 100.000 $0.00 $0.00
0001140 CHANGE ORDER #24
0001150 PC 33 Unsuitable Soils $3,678.00 $3,678.00 $0.00 $0.00 $3,678.00 100.000 $0.00 $0.00
0001170 CHANGE ORDER 925
0001180 PC 37 Generator Slab $2,132.00 $2,132.00 $0.00 $0.00 $2,132.00 100.000 $0.00 $0.00
0001200 CHANGE ORDER #27
0001210 PC 31 Added Masonry Footing $3,751.00 $3,751.00 $0.00 $0.00 $3,751.00 100.000 $0.00 $0.00
0001230 CHANGE ORDER #28
0001240 PC 41 R1 ASI #27 SOG Modifications $4,293 -00 $4,293.00 $0.00 $0.00 $4,293.00 100.000 $0.00 $0.00
0001260 CHANGE ORDER #29
0001270 PC 28R1 ASI #18 Garbage Vacuum Pit $3,181.00 $3,181.00 $0.00 $0.00 $3,181.00 100.000 $0.00 $0.00
0001290 CHANGE ORDER #30
0001300 PC 29 ASI 921 South Entrance Stairs $7,870.00 $4,722.00 $3,148.00 $0.00 $7,870.00 100.000 $0.00 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA& X1992 THE AMERICAN INs'rt'rUiE OF ARCHITECTS, 1735 NEW PORK G703 -1992
AVENUE. N.W.. WASHINGTON. D 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
This document has been reproducetl electronically Win the permission of The Ameri- Institute at Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document wltneut pmjeci,speclto information is not permined. Contact Tho American Institute of Architects
to verity the current version of this documenl and license status
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 5 OF 5 PAGES
AIA Document 6702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00024
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL BALANCE
PRESENTLY COMPLETED RETAINAGE
ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO IF VARIABLE)
NO. VALUE APPLICATION TINS PERIOD STORED AND STORED FINISH RATE
(NOT IN TO DATE (G. C) (C G)
(D E) D OR E) (D +E +F)
0001320 CHANGE ORDER #31
0001330 PC 30R1 ASI #22 Platform Lift Pit $5,106.00 $5,106.00 $0.00 $0.00 $5,106.00 100.000 $0.00 $0.00
0001350 CHANGE ORDER #32
0001360 PC 36R4 Column Encasement East $27,521.00 $27,521.00 $0.00 $0.00 S27,521.00 100.000 $0.00 $0.00
0001380 CHANGE ORDER #33
0001390 PC 36R4 Column Encasement West $28,000.00 $28,000.00 $0.00 $0.00 $28,000.00 100-000 $0.00 $0.00
0001410 CHANGE ORDER #34
0001420 PC 43R1 Slab Openings $1,414.00 $1,414.00 $0.00 $0.00 $1,414.00 100.000 $0.00 $0.00
0001440 CHANGE ORDER 435
0001450 PC 45R1 Saw Cutting of Foundation Wall $1,419.00 $1,419.00 $0.00 $0.00 51,419.00 100.000 50.00 $0.00
0001470 CHANGE ORDER 937
0001480 PC 4281 ASI 968 Columns Modifications $2,671.00 50.00 $2,671.00 $0.00 $2,671.00 100.000 SO.00 SO.00
0001500 CHANGE ORDER #38
0001510 PC 51 Chipping Gutter Wall to 4' 51,784.00 $0.00 $1,784.00 $0.00 $1,784.00 100.000 $0.00 $0.00
0001530 CHANGE ORDER #39
0001540 PC 49 Locate Water Main Valve $1,447.00 $0.00 $1,447.00 $0.00 $1,447.00 100.000 $0.00 $0.00
$5,931,671.00 $5,734,869.25 $107,823.80 $10.00 $5,842,693.05 98.50% $88,977.95 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AI.AQ u[992 THE AMERICAN INSTITUTE OF ARCHITFC'1 S. 1735 NEW YORK G703 -1992
AVENUE. N.W.. WASHINGTON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
This document has been reproduced electronically with the perm mn of The American Inslilute of Architects under License 97003 to Primavera Systems, Inc. Reproduction of this document without proiec4specific information is not permitted. Contact The American Inslilute of Architects
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WAIVER, OF LIEN
The undersigned is the duly authorized offfcerof Hagerman r nstniction roriaoration thegeneralcontractar3
(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 carmel Performing Arts which real estate is owned.by "Owner
Center Commission
INCONSIDERATION ofthesumo Five milliai five- huyW.Lc=_six.th3asar lcrae nine a rd_5Q4M
D6CURS 5, 546,109.50 receipt of which is hereby acknowledged, and in order to procure one or more payments
for services, labor, material or equipment in such construction, the Company does thereby 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 orclaim or right to Ilens uponthe land or improvements above'described
which the Company may now have for s e rvices, labor, material orequipmentfurnishedin respect of such land orimprovements
to and including the date hereof. Theundersigned warrants that the Company has pot and will not assign any claimforpayment
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 solewnsideration received by
the Company for said services,labor, material orequipment 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 rateral, labor, services or equipment furnished are more particularly described n the affidavit for payment submitted of
even date herewith. The undo rsignedfurtherwarrants and represents that the Company has complledwith all prevailing wage
requirements under applicable law or as may be set forth in the contract documents.
WITNESS the execution hereof this 22nd day of April 2010
m a dd Tt 1
�y H sler C
Hagerman C'.onst rorporatJ on_
(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 'T'rCLy Rni 3er
the controller Of gagarman nnaf•vi,nf -R'+n I�r.vr+rr++-Zg who acknowledged
J
(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. y
WITNESS my hand acid notarial seal this a of A 1 20
My Commission Expires: ��,emb$rr�.
a Notary Public
®i u, to e
l =Or
%,a� `c0ii,T b�`�'
My County of Residence: V
r, 4 David C. Thomas .7 °sP
sTAT (Printed Name of Notary Public)
Allen
PAYROLL CERTIFICAnON
PROJECT NO HCC Job 12613
#2695
I CERTIFY THAT THE PAYROLL RECORDS FOR Hadb=an. Constructibn Corporation
(Contractor)
PAY PERIOD FROM TO ARE :TRUE AND CORRECT, TO
THE BEST OF MY KiNOWLEDGE AND .BELIEF AND THE WAGE SCA -E-AS
REQUIRED BY I.C. 5- I6 -7-1 HAS BEEN ADHERED TO.
STATE OF Truii -Ana
SS:
COUNTY OF, Al 1 Pn
BEFORE ME, THE UNDERSIGNED, A NOTARY PUBLIC, PERSONALLY
'APPE ARED Troy Heisler controller
�VIT
(Name) (Title)
ACKNOWLEDGED E CUTION OF THE ABOVE CERTIFICATION
THIS AY OF D
^i�LP
1D
1 044, �?q NOTARY PUBLIC (signature)
z cn cn.
NoTAft David C. Thomas
NAME (Printed)
F
MY COMMISSION =I ES: RESIDING IN Allen COUNTY
12/16/15_
-7
REV 2198 SOBC
a
T Y;
Av
L i`r1s
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 5995)
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
ror7 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2
f
w
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.
1 L ALLOWED 20
(�4'yrrl�lyE >��sfiz�c cJ� CoIi,COr'9'�O� IN SUM OF
1d7 5 ,7D
ON ACCOUNT OF APPROPRIATION FOq
Pay from TIF 10
f
Board Members
PO# or INVOICE NO. ACCT /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
got 1 i' 7 A 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
��s
U
201
Signature
Cost distribution ledger classification if Itie
claim paid motor vehicle highway fund