186693 06/21/2010 A
CITY OF CARMEL, INDIANA VENDOR: 363784 Page 1 of 1
ONE CIVIC SQUARE POYNTER SHEET METAL CHECK AMOUNT: $76,007.00
CARMEL, INDIANA 46032 PO BOX 427
ro BLOOMINGTON IN 47402 -0427 CHECK NUMBER: 186693
CHECK DATE: 6/2112010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460607 21 76,007.00 PERFORMING ARTS CENTE
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER- ADVISER EDITION
A N DOCUMENT G7021CMa ��c�\ PAGE ONE OF 3 PAGES
TO OWNER: \PROJECT: Farce! 7A Regional Performing APPLICATION NO: 21 B Distribution to:
Carmel Redevelopment Comml�ii"oh �O Arts Center OWNER
One Civic Square PERIOD TO: 4/30/10 CONSTRUCTION
Carmel, IN 46032` 1 PROJECT NO: 2695 -4310 MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Shiel Sexton Co., Inc. (PSM #14065) OARCHITECT
F'OYNTEFt SHEET ,l c STN: Ltt�da 1� %eaver, 902 N. Capitol l Avenue. Indianapolis, IN 46204 CONTRACT DATE: 04/18/08 CONTRACTOR
8768 N. STATE: RD. 3 /VIA ARCHITECT:
B1.,C)01fIN(i "1 4'404
CONTRACT FOR: Bid Package #4310 'H'VAC Sheet Metal
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment, as shown below, in connection with the Contract. information and beliefthe Work covered by this Application for Payment has been
Continuation Sheet, AIA Document G703, is attached. completed in accordance with the Contract Documents, that all amounts have been paid
by the Contractor for Work for which previous Certificates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM 2,340,500.00
2. Net change by Change Orders CONTRACTOR:
3. CONTRACT SUM TO DATE (Line 1 2)
4. TOTAL COMPLETED STORED TO DATE 2 1 73,5 09.00
(Column G on G703) By: Date: O
5. RETAINAGE: 5% of Contract Total Joseph R, ansde resi nt
a. 5 of r' ^m�„ 1 12,663.00 State of: IN ANA County c MONROE
o umn D E on G703) Subscribed and re me hi �rp day of a p/Q
b. of Stored Material S 0.00 Notary Public:
o umn F on G703) My Commission plres: ugust ?9, I4
Total Retainaae (Lines 5a 5b or
Total in Column I of G703) S 112,663.00 IL A NT
6. TOTAL EARNED LESS RETAINAGE 2,060,846.00 to accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Inc 5'I otai) comprising this application, the Construction Manager and Architect certity to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best oftheir knowledge, information and beliefthe Work has
PAYMENT (Line 6 trom prior Certificate) 1 progressed as indicated, the quality of the Work is in accordance with the Contract
S. CURRENT PAYMENT DUE 76.007.iTF Documents, and the Contractor is entitled to payment ofthe AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE S 192,415.00 r 00
(Line 3 less Line 6) AMOUNT CERTIFIED �4 07
(Attach explanation if amount certified differs fi om the amount applied for. Initial all
Total changes approved figures on this Application and on the Continuation Sheet that changed to con form to the
in previous months by Owner $57,761.00 $175,000.00 amouru ce!`tifiecl.f
CONS C'f]" N" NAGER:
Total approved this Month $30,000.00 50.00 Bv: Date: L �e c7i L`
ARCHI
TOTALS $87,761.00 $175,000.00 By: Dare: Z�
NET CHANGES by Change Order ($87,239.00) This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
a a-
THE AMERICAN INSTITUTE OF ARCHITECTS, 1745 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 Certification of Document's Authenticity
CO NTINUATION SHEET AIA DOCUMENTG703 2 PAGE Of PAGES 3
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 21B
Contractor's signed certification is attached. APPLICATION DATE: 4/15,12010
In tabulations below, amounts are stated to the nearest dollar. PSM J0119: 14065 PERIOD T0: 4/30/20
Use Column I on Contracts where variable retainage for line items may apply. NAME Carmel PAC CONTRACT NO: 2691 1 -4310
A B C D E F G H I
LINE DESCRIPTION OF WORK SCHEDULED WORT: COMPLETFD MATERIALS TOTAL o BALANCE RETATNAGF
NO, VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G =C) TO FiNTSH (IF VARIABLE
APPLICATION STORED AND STORED (C G} R.A7 L)
(D E) (NOT IN TO DATE
D OR E) (D +E +F) 5%
1 GENERAL CONDITIONS 200,000.00 $192,000 $8,000 $G $200.000 100% $10,000
2 BOND INSURANCE 45,000.00 $46,000 $0 $0 $45,000 100% $2,250
3 MOBILIZATION 15,000.00 $15,000 $0 $0 $15,000 100% $750
4 ALLOWANCE NO 11 BP 4310 651.00 $0 $0 $0 $0 0% 5651 $G
5 ALLOWANCE NO 16 CAD AS- BUILTS 10,000.00 $0 $0 $0 $0 0% 510,000 $0
6 DRAWINGSICOORDI NATION 80,000.00 580,000 $0 $0 580,000 100% $4,000
7 MECH BASEMENT LEVEL
8 MATERIAL 48,000.00 $48,000 $0 $0 $48,000 100% $2.400
9 LABOR 50,700.00 $50,193 $(1 $0 $50,193 99% $507 $2.510
10 LAGGING 7.000.00 $7,000 $0 $0 $7.000 100% $350
11 BACKHOUSE
12 MATERIAL 56,000.00 $56,000 $0 $0 $56,000 100 $2,800
13 LABOR 59,000.00 $59,000 $0 $0 $59,000 100% 52,950
14 KITCHEN HOOD DUCT
15 MATERIAL 15,400.00 $t5,400 $0 $0 515,400 100% 5770
16 LABOR 10,800.00 5[0,260 $0 $0 510,260 95% $540 $513
17 INSULATION 10,100.00 $8,080 $0 $0 $8,080 80% $2,020 $404
18 MECH RM 1
19 MATERIAL 50,400.00 550.400 $0 $0 $50,400 100% $2,520
20 LABOR 56,300.00 556,300 $0 $0 $56,300 100% 52.815
21 INSULATION 16,800.00 516,800 $0 $0 $16.800 100% $840
22 MECH RM 2
23 MATERIAL 77,000.00 $77,000 $0 $0 $77,000 100% $3,850
24 LABOR 93,900.00 $93 $0 $0 $93.900 100% $4,695
25 INSULATION 16,800.00 $0 $3,360 $0 $3,360 20% $13440 $168
26 MECH RM 3
27 MATERIAL 84,900.00 $84,900 $0 $0 $84,900 100% $4,245
28 LABOR 94,500.00 $94,500 $0 $0 $94.500 100% $4,725
29 INSULATION 16,80000 $16,1'_0 $L680 $0 $E6,800 100% $840
30 PLENUM LEVEL
31 MATERIAL 49,100.00 $49,100 $0 $G S-49 100% $2,455
32 LABOR 75,000.00 $75,000 $0 $0 $`75,000 100% $3,750
33 LAGGING 13,000.00 $13,000 $0 $0 $13,000 100% $650
34 ORCHESTRA HIGH LEVEL
35 MATERIAL 34,600.00 $34,600 $o $0 $34,600 100% $1,730
36 LABOR 35,400.00 $31.8(10 $1770 $0 $33,630 95% $1,770 $1,682
37 ORCHESTRA LOW LEVEL
38 MATERIAL 49,400.00 $49400 $0 $0 $49,400 100% S2,470
1 391 LABOR 1 62,600,001 $56,340 1 $3,130 1 $0 1 9,470 1 95%1 $3,130 1 $2,974
1 11 r� /1r C� 1, 7� 7 7
CONTINUATION SHEET A JA DO UME I G703 PAGE OF PAGES 3
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, containing APPLICATION NO: 218
Contractor's signed certification is attached. APPLICATION DATE: 4, S /2Czi7
In tabulations below, amounts are stated to the nearest dollar. PSM JOB#: 14065 PERIOD TO: 4/30
Use Column I on Contracts where variable retainage for line items may apply. NAME Carmel PAC CON IRACTNO: 2695 -4310
A B C D E F G H I
LINE DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL- BALANCE RETAINAGE
NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C G) RACE)
(D E) (NOT IN TO DATE
D OR E) (D =E +F) 5%
40 BOX TIER LEVEL
41 MATERIAL 70,000.00 $70,000 $0 $0 $70,000 100% $3,500
42 LABOR 100,300.00 $93,285 $0 $o $95,285 95% $5,015 $4,764
43 LOW BALCONY LEVEL
41 MATERIAL 94,100.00 $94,100 $0 $0 $94,100 100% $4,705
45 LABOR 85,300.00 $81,035 $0 $0 $81,035 95% $4,265 $4.052
46 HIGH BALCONY LEVEL
47 MATERIAL 38,400.00 $38,400 $0 $0 $38,400 100% 1,920
48 LABOR 50,200.00 $33,140 $12,550 $0 $47,690 95% $2,510 $2,385
49 ATTIC LEVEL +50
50 MATERIAL 41,600.00 $41,600 $0 $0 $41,600 100% $2,080
51 LABOR 44,700.00 $40,230 $2,235 $0 $42,465 95% $L35 $2,123
52 ATTIC LEVEL +61
53 MATERIAL 16,800.00 $16,800 $0 $0 $16,800 100% $840
54 LABOR 16,300.00 $13,040 $815 $0 $13,855 85% $2.445 $693
55 ATTIC LEVEL +66
56 MATERIAL 39,500.00 $27,650 $11,850 $0 °9,500 100% $1.975
57 LABOR 37,900.00 $18.950 $7,580 $0 $26,530 70% $11,370 $1.327
58 ATTIC LEVEL +79 6
59 MATERIAL 6,700.00 $6,700 $0 $0 $6,700 100% 5335
60 LABOR 5,200.00 $5,142 $0 $0 $5,142 99% $58 $257
4 -A ALLOWANCE NO. 11 BP 4310(ASI -031) 7,322.00 $7,322 $0 $0 $7,322 100% $366
4 -13 ALLOWANCE NO 11 BP 431OA -002 10,000.00 $6,600 $918 $0 ;17,518 75% $2,482 $376
4 -C ALLOWANCE NO 11 BP 431OB -002 4,798.00 $4,798 $0 $0 5;4,798 100% $240
4 -1) ALLOWANCE NO 11 BP 431OB -003 1,534,00 $1.534 $0 $0 $1,534 100% $77
4 -E ALLOWANCE NO 11 BP 431OB -004 27,142.00 $27,142 $0 $0 $27,142 100% $1,357
4 -F ALLOWANCE NO 11 BP 431OB -005 9,625.00 $9,625 $0 $0 $9,625 100% $0
4 -G ALLOWANCE NO 11 BP 43108 -006 175,000.00 $175.000 $0 $0 $Ii5,000 100% $0
4 -H ALLOWANCE NO 11 BP 431OB -007 546.00 $546 $0 $6 $546 100% $0
4 -1 ALLOWANCE NO 11 BP 43106 -008 10,933.00 $0 $10933 $0 $10,933 100% $0
4 ALLOWANCE NO 11 BP 431OB -009 12,449.00 $12.449 $0 $0 $12,449 100%
900 PENDING CHANGE ORDERS
901 CHANGE ORDER #1 38,542.00 $38 $0 $0 $38,542 100% $1.927
902 CHANGE ORDER #2 (RCP -10) 19,219.00 $19.219 $0 $0 $19,219 100% $961
903 CHANGE ORDER #3 BP431OB -005 175,000.00 ($175.000) $0 $0 6175,005)) 100% ($8,750)
904
905 CHANGE ORDER #5 $30,000 $0 $12,686 $0 $12,686 42% $17,314 $634
$2,253,261 -096,002 77,507 0 2,173,509 96% 79.75 1 112.663
4
SHEET ft METAL
POYNTER SHEET METAL, INC.
CONTRACTOR "S AFFIDAVIT AND WAIVER OF LIEN
PARTIAL (X) FINAL
We, the undersigned, having been employed by CARMEL REDEVELOPMENT
COMMISSION furnish labor and materials to do construction work on the premises known as
PARCEL 7A, CARMEL REGIONAL PERFORMING ARTS CENTER hereby warrant that
the premises of the above named job cannot be made subject to any valid lien by anyone who
furnished material, supplies, labor or services to the undersigned for use in the above named
project for any labor, materials or supplies furnished or services performed through 04/30/10 to
the extent that the undersigned has been paid as set forth herein.
This waiver is given in order to induce payment in the amount of $76,007.00 and upon receipt of
the amount due by the undersigned, this waiver as to the amount due becomes valid, enforceable
and of full effect. Upon attachment of the canceled check and the legal description of the
project, this waiver may be recorded by the Owner or mortgage holder(s) of the project.
This Contractor's Affidavit and Waiver of Lien only applies to the extent paid, and does not
apply to or cover retention, unresolved claims or unresolved changes, change orders or change
requests.
Given under our hand and seal this 16 day of APR[L, 2010
POYNTER EET METAL, INC.
"4ac-cr
Signatu►e oAns
ori ed Representative
Joseph IZ.
PRESID ENT
Title of Authorized Representative
STATE OF: Indiana
COUNTY OF: Monroe
Subscribed and sworn to before me this 16""' day of APRIL, 2010
(Notary Public)
Commission Expires: August 29, 2014
County of Residence: Morgan
Prescribod by State 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.
a�
Payee f
L �e f
Poyhfer J je� rW
L a Purchase Order No.
87 IY• �T��� lld 3 Terms
bl ocMi, n jiQ h TA( 474/Oq Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
-30 —IO 2 21 -P10 r 76
007 00
Total 7 D (}a
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
V,OUCHER NO. WARRANT NO.
l�Q�d I ALLOWED 20
shee
IN SUM OF
87Y N. Sa Rd 37
RI omm+Dn S/V 7
76 047 DO
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF I �V
902,1 `f
Board Members
PO# or DEPT k
INVOICE NO. ACCT #!TITLE AMOU l hereby certify that the attached invoice(s), or
q0 2 e2-1 Lfq 6D ?07 74,(107. U bill(s) is (are) true and correct and that the
Z,z. materials or services itemized thereon for
which charge is made were ordered and
received except
i
S f/— 20 /Q
Signature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund