186708 06/21/2010 CITY OF CARMEL, INDIANA VENDOR: 363792 Page 1 of 1
0 ONE CIVIC SQUARE W R DUNKIN SON, INC
CARMEL, INDIANA 46032 PO Box 2247 CHECK AMOUNT: $192,117.45
ANDERSON IN 46018
CHECK NUMBER: 186708
CHECK DATE: 6121/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 14 29,025.00 PERFORMING ARTS CENTE
902 4460807 24A 163,092.45 PERFORMING ARTS CENTE
TM
Document G1021C a —1992
Application and Certificate for Payment Construction Manager Adviser Edition 51
TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A, #5010 Carmel APPLICATION NO: 014 Distribution to:
Commission Performing Aris OWNER: X
One Civic Square 777 3rd Ave S.W. PERIOD TO: April 30, 2010 CONSTRUCTION MANAGER: X
Carmel, IN 46032 Carmel, IN 46032
ARCHITECT: X
FROM W.R. Dunkin Son, Inc. VIA CONSTRUCTION Shiel Sexton Co., Inc. CONTRACT DATE: February 23, 2009 CONTRACTOR: X
CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 25310H 2695/5010 2695 FIELD:
Anderson, IN 46018 OTHER:
CONTRACT FOR: Bid Pkg #5010 VIA A RCHITECT: CSO Architects
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application for Pa went has been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. Contract Documents, that all amounts have been d by Contractor for Work for which previous
Continuation Sheet, ALA Document G703, is attached. Certificates for Payment were issued a ent e ived from the Owner. and that current
1. ORIGINAL CONTRACT SUM 1,480,000.00 paymen here' now e.
2. NET CHANGE BY CHANGE ORDERS 81,040.00 CO RACT W R D
3. CONTRACT SUM TO DATE (Line 1 t 2) 1,398,960.00 By: Date: April 15, 2010
4. TOTAL COMPLETED 8r STORED TO DATE (Column G on G703) 657,985.00 St of Indiana
5. RETAINAGE: County of. Madison
a. l0 of Completed Work. Subscribed and sworn to before y—,1�
(Column D+ E on G703) 65,798.50 me this 15th day of April, 1�CsCS��
b. 0 of Stored Material Notary Public: Martha A. Carpente
(Column F on 6703) 0.00 My Commission expires: January 08, 2017
Total Retainage (Lines 5a 5b or Total in Column I of 6703) 65,798.50 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 591186.50 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 563,161.50 knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED. Q
8. CURRENT PAYMENT DUE I S 29,025.00 AMOUNT CERTIFIED Z L t syzs
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures on this
Application and on the Continuation Sheet that are changed to conform }vith the amount certified.)
(Line 3 less Line 6) 806,773.50 CONSTRU TON M NAG_ BRt
By: l� Date: -2- 1
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT'
RCHITEC
Total changes approved in previous months by Owner 0,00 81,040.00 By: Date: 2�I
Total approved this Month 0.00$ 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 0,00$ 81,040.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CFIANGES by Change Order 81,040.00
AIA Document G7021cmaTM 1992. Copyright O 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 Me Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible
under the law. This document was produced by AIA software at 1449:37 on 0411912010 under Order No.0754240912_1 which expires on 0 511 01201 0, and is not for resale.
User Notes: (13713974279)
AIA Document 0703 TM -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 014
containing Contractor's signed certification is attached. APPLICATION DATE: 04/15/2010
In tabulations below, amounts are in US dollars.
Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 04/30/2010
ARCHITECT'S PROJECT NO: 2531.0H.
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
AND STORED TO FINISH (IF VARIABLE
NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G} RATE)
D E (D +E +F)
01010 Performance Bond 26,400.00 26,400.00 0.00 0.00 26,400.00 100.00% 0.00 2,640.00
Mobilize
01015 Demobilize 8,000.00 4,000.00 0.00 0.00 4,000.00 50.00% 4,000.00 400.00
Supervision
01020 Coordination 87,000.00 57,000.00 3,000.00 0.00 60,000.00 68.97%1 27,000.00 6,000.00
General Conditions
01025 M 30,000.00 20,400.00 1,500.00 0.00 21,900.00 73.00% 8,100.00 2,190.00
General Conditions
01026 L 34,000.00 21,600.00 1,200.00 0.00 22,800.00 67,06% 11,200.00 2,280.00
t400A Organ Facade Pipes 200.000.00 86,720.00 0.00 0.00 86,720.00 43.36% 113,280.00 8,672.00
Carpentry Labor
1400B Hours 32,000.00 32,000.00 0.00 0,00 32,000.00 100.00%1 0.00 3,200.00
Provide Tie -Off
1400C Points at Balconies 25,000.00 0.00 0.00 0.00 0.00 0.00% 25,000.00 0.00
Vertical Partition
System Backfold
1400D Doors 15,000.00 6,600.00 0.00 0.00 6,600.00 44.00% 8,400.00 660.00
16'X16' Temporary
1400E Overhead Door 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 600.00
Temporary OHD
Enclosure and
140OF Insulation 10,000.00 1,644.00 0.00 0.00 1,644.00 16.44% 8,356.00 164.40
1000 SY of BX 1200
M 140OG Tensar Geogrid 17,000.001 4,117.00 0.00 0.001 4,117.00 24.22%1 12,883.00 411.70
350 CY of 42 Stone 18,200.001 5,718.00 0.00 0,001 5,718.00 31,42%1 12,482.00 571.80
AIA Document G703T" -1992. Copyrights 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 1
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:48:14 on 04M9/201 0 under Order No.0754240912_1 which expires on 05110/2010, and is notfor
resale.
User Notes: (1365391469)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE
APPLICATION THIS PERIOD STORED DATE (G C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
1400J 200 CY of 453 Stone 10,000.00 1,746.00 0.00 0.00 1,746.00 17.46% 8,254.00 174.60
1400K General Allowance 75,000.00 50,000.00 0.00 0,00 50,000.00 66,67% 25,000.00 5,000.00
CAD As -Built
1400L Allowance 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
General Clean Up
01560 M 4,000.00 450.00 350.00 0.00 800.00 20.00% 3,200.00 80.00
01561 General Clean U L 25,000.00 4 3,000.00 0.00 7,300.00 29.20% 17,700.00 730.00
Final Cleaning (Items
01562 in BP 5010 10,000.00 0,00 0.00 0.00 0.00 0.0o %j 10,000.001 0.00
Dewatering for 9
02110 Months -M -Eq 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00 0.00 1,850.00
Dewatering for 9
02111 Months L -Eq 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00 0.00 2,800.00
Piping from Tri -Flex
02240 to Lift Station 21,000.00 21,000.00 0.00 0,00 21,000.00 100.00 0.00 2,100.00
Interior Metal
Fabrications
05504 ISubmittals 6,200.00 6,200.00 0.00 0.00 6,200.00 100.00% 0.00 620.00
Interior Metal
Fabrications
05505 Materials 86,500.00 86,500.00 0.00 0.00 86,500.00 100.00% 0.00 8,650.00
Interior Metal
05506 Fabrications Erection 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00 0.00 2,400.00
Miscellaneous Metals
05511 -M 5,640.00 5,640.00 0.00 0.00 5,640.00 100.00 0.00 564.00
Miscellaneous Metals
05512 -L 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00 0.00 250.00
Interior Rough
06100 Carpentry M 28,000.00 14,400.00 4,600.00 0,00 19,000.00 67.86 9,000.00 1,900.00
Interior Rough
06101 Carpentry L 36,500.00 16,000.00 6,000.00 0.00 22,000.00 60.27% 14,500.00 2,200.00
078.10 Skylight Shade M 62,000.00 62,000.00 0.00 0.00 62,000.00 1.00.00% 0.00 6,200.00
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:48:14 on 0411 912 01 0 under order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1365391469)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
AND STORED TO FINISH IF VARIABLE
NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G} RATE}
(D E) (D +E +F)
Skylight Shade
0781 1 Installation 29,500.00 29,500.00 0.00 0.00 29,500.00 100.00 0.00 2,950.00
07910 Joint Sealants M 48,000.00 5,800.00 1,800.00 0.00 7,600.00 15.83 %1 40,400.00 760.00
07911 Joint Sealants L 24,500.00 3,400.00 800.00 0.00 4,200.00 1.7.14 20,300.00 420.00
08810 Interior Glazing 42,000.00 840.00 0.00 0.00 840.00 2.00% 41,160.00 84.00
09610 Access Flooring 19,500.00 0.00 0.00 0.00 0.00 0,00% 19,500.00 0.00
09710 FRP Wall Panels M 1,000.00 0.00 0.00 0.00 0.00 0.00% 1,000.00 0.00
09711 FRP Wall Panels L 2,000.00 0.00 0.00 0.00 0.00 0.00%1 2,000.00 0.00
Acoustic Fabric
09712 Wrapped Panels 42,500.00 0.00 10,000.00 0.00 10,000.00 23.53 32,500.00 1,000.00
10210 Toilet Compartments 44,000.00 0.00 0.00 0.00 0.00 0.00% 44,000.00 0.00
Backfold Door
10220 Tracks M 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00
Backfold Door
10221 Tracks- L 4,560.00 4,560.00 0.00 0.00 4,560.00 100.00% 0.00 456.00
10222 Operable Partition 21,000.00 3,200.00 0.00 0.00 3,200.00 15.24%1 17,800.00 320.00
10223 Wire Mesh Partitions 9,500.00 0.00 0.00 0.00 0.00 0.00% 9,500.00 0.00
Toilet Accessories
1.0224 M 34,000.00 34,000.00 0.00 0.00 34,000.00 100.00% 0.00 3,400.00
Toilet Accessories
10225 L 28,000.00 1,000.00 0.00 0.00 1,000.00 157 27,000.00 100.00
10510 Metal Lockers 16,500.00 0.00 0.00 0.00 0.00 0.00%1 16,500.00 0.00
10520 Phenolic Lockers M 110,000.00 0.00 0.00 0.00 0.00 0.00% 110,000.00 0.00
10521 Phenolic Lockers L 29,000.00 0.00 0.00 0,00 0.00 0.00% 29,000.00 0.00
10610 Corner Guards M 9,500.00 0.00 0.00 0.00 0.00 0.00% 9,500.00 0.00
10611 Corner Guards L 3,500.00 0.001 0.00 0.00 0.00 0.00% 3,500.00 0.00
17001 Changr Order No. 01 81,040.00 -80,000,001 0.00 0.00 80,000.00 98.72 1,040.00 8,000.00
GRAND TOTAL $1,398,960.00 $625,735.00 $32,250.00 $0.00 $657,985.00 47.03%1 $740,975.00 $65,798.50
AIA Document G703T° -1992. CopyrightiD 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Al a Document, or any portion of it, may result in severe civil and criminal penalties, and will be 3
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 14:48:14 on 04/19/2010 under Order No.o754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1365391469)
AFFIDAVIT AND WAIVER OF LIEN
]FINAL X PARTIAL f PAYMENT TO FOLLOW
State of Indiana, County of Madison SS
Bradley Tyler being duly sworn states that he is the Project Manager of W. R. Dunkin
Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish
certain materials and /or labor as follows: Bid Package 5010- Interior Finishes for a project
known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and
owned by City of Carmel and does hereby further state on behalf of the aforementioned
Contractor,
Application for Payment 11 has been received for work performed through 0 1/31/10.
(PARTIAL WAIVER) that there is due from the contractor the sum of
Seventy -seven Thousand Four Hundred Seventy -seven dollars and 00 /cents 77,477.00
Application for Payment has been received for work performed through
(FINAL WAIVER) that the final balance due from the Owner is the sum of
dollars and 00 /cents
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 co itions expressed herein, if any; and further
certifies that no other party has any claim or right to a lien on a un y work performed or material furnished
to the undersigned for said i e sco of of it and waiver.
W. R. Dunkin Son, Inc. Title: Project Manager
WITNESS MY HAND AND NOTARIAL SEAL, this 15 day of April .1 2010
(Notary P lic)
My Commission Expires: January 08, 2017 Printed Martha A. CarTenter
Residing in Madison County
Prescribed by Stale 9oard of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must how: kind of service, where performed, dates &vice rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee
Purchase Order No.
f
GX 22Y7 Terms
t
�no%✓ s o., /°V �/G G Date Due
Invoice Invoice Description Amount
Date Number (or note attached involce(s) or bill(s))
t
O I Ft
e t�
Total 2 9,1, ,'S�0
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
lee
O l3ax Z2 y 7 IN SUM OF
2
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF I I 0
Board Members
PO# or DEPT. INVOICE NO' ACCT /TITLE AMOUNT I hereby certify that the attached invoice(s), or
�a2 /y 2g l e 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
f f
j 7 20
Signature
Dimator of Redeve
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund
Document G 7021CM a T -1992
i
Application and Certificate for Payment Construction Manager Adviser Edi ion
TO OWNER: Carmel Redevelopment PROJECT Parcel 7A, 94050 Carmel APPLICATION NO: 024 9 Distribution to:
Commission Performing Arts OWNER: X
One Civic Square 777 3rd Ave. S.W. PERIOD TO: April 30, 2010 CONSTRUCTION MANAGER: X
Carmel, IN 46032 Carmel, IN 46032 ARCHITECT: X
FROM W.R. Dunkin Son, Inc. VIA CONSTRUCTION Shiel Sexton Co., Inc. CONTRACT DATE: May 08, 2008 CONTRACTOR: X
CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 25310 26954050 2695
Anderson, IN 46018 FIELD:
CO NTRACT FO R: BP- 44050 General Trades VIA ARCHITE CSO Architects OTHER:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
belief the Work covered by this Application for Payment has been completed in accordance with the
Application is made for payment, as shown below, in connection with the Contract. Contract Documents, that all amounts have been id by the Contractor for Work for which previous
Continuation Sheet, AIA Document G703, is attached. Certificates for Payment were issued and p bents received from the Owner, and that current
1. ORIGINAL CONTRACT SUM 9.966.300.00 payment shown herein is due.
2. NET CHANGE BY CHANGE ORDERS 208,913.00 ONT i N, I
3. CONTRACT SUM TO DATE (Line 1 f 2) 9,757,387.00 Date: April 16, 2010
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 7.840,189.00 S e ndiana
5. RETAINAGE: County of: Madisot
a. 5 of Completed Work Subscribed and sworn to before
(Column D E on G703) 487,869.35 me this 16th dayof April, 2 11
b. 0 of Stored Material Notary Public: Martha A. Carpenter
(Column F on G703) 0.00 My Commission expires: January 08 2017
Total Retainage (Lines 5a 5b or Total in Column I of G703) ........I 487,869.35 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE 7.352,319.65 In accordance with the Contract Documents, based on on -site observations and the data comprising
(Line 4 Less Line 5 Total) this application, the Construction Manager and Architect certify to the Owner that to the best of their
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 7,189,227.20 knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in
accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED. II r
8. CURRENT PAYMENT DUE 163.092.45 AMOUNT CERTIFIED 1S1
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation ifaniount certified d ens from the amount applied. Initial all figures on this
Application and, on the Continuation Sheet that are changed to conform with the amount certified.)
(Line 3 less Line 6) 2,405.067.35 CONSTRUC ION MA G
By: n. Date: Z L b
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE T:
Total changes approved in previous months by Owner 528,826.00 760,330.00 By: Date:
Total approved this Month 22,591.00$ 0.00 This Certi ate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 551,417.00 760,330.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order 208,913.00
AIA Document G7021CMall —1992. Copyright Q 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 1
under the law. This document was produced by AIA software at 15:36;01 on 04/1912010 under Order No.0754240912_1 which expires on 05/10/2010, and is not for resale.
User Notes: (828585562)
Document 6703 TM -1992
Continuation Sheet
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 024
containing Contractor's signed certification is attached. APPLICATION DATE: 04/15/2010
In tabulations below, amounts are in US dollars.
Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: 04/30/2010
ARCHITECT'S PROJECT NO: 25310
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
(NOT IN D OR E)
APPLICATION THIS PERIOD DATE (G C} (C G) RATE)
D E (D +E +F)
PERFORMANCE
01010 BOND 106,000.00 106,000.00 0.00 0.00 106,000.00 100.00 0.00 10,600.00
MOBILIZE /DEMOB
01015 ILIZE 29,000.00 15,000.00 0.00 0.00 15,000.00 51,72% 14,000.00 1,500.00
SUPERVISION /CO
01020 ORDINATION 361,000.00 323,800.00 0.00 0.00 323,800.00 89.70% 37,200.00 28,480.00
GENERAL
01025 CONDITIONS -M 380,000.00 336,000.00 0.00 0.00 336,000.00 88.42% 44,000.00 27,000.00
GENERAL
01026 CONDITIONS -L 98,000.00 89,200.00 0.00 0.00 89,200.00 91.02% 8,800.00 7,000.00
GENERAL
01027 CONDITIONS -0 262,990.00 207,800.00 7,900.00 0.00 215,700.00 82.02% 47,290.00 0.00
ALLOWANCE
STONE
1.40A0 WALKWAY 8,500.00 0.00 0.00 0.00 0.00 0.00%1 8,500.00 0.00
ALLOWANCE
TEMPORARY
140B0 HANDRAIL 38,000.00 31,198.00 0.00 0.00 31,198.00 82.10% 6,802.00 2,776.90
ALLOWANCE
TEMPORARY
DOORS/FRAMES/H
14000 ARDWARE 10,000.00 5,972.00 0.00 0.00 5,97100 59.72% 4,028.00 0.00
140DO ALLOWANCE -ICE 13,500.00 2,289.00 0.00 0.00 2,289.00 16.96% 11,211.00 207.10
ALLOWANCE
140E0 ISECURITY 1 31,000.00 0.00 0.00 0.00 0.00 0.00% 31,000.00 0.00
1 40F0 ALLOWANCE- 191,700.0 74, 628.00 6,237.00 0.00 8 0,865.00 42.18% 110,835.00 3,987.90
AIA Document G703- -1992. Copyright m 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 1
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO {G C) FINISH (IF VARIABLE
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
DUMPSTERS
ALLOWANCE-
TRAILER
140GO CONNECTOR 34,000.00 32,719.00 69.00 0,00 32,788.00 96.44% 1,212.0 2,200.90
ALLOWANCE
TRAILER
140HO CLEANING 19,169.00 15,362.00 780.00 0.00 16,142.00 84.21 3,027.00 1,066.10
ALLOWANCE -SITE
140I0 SIGNAGE /SAFETY 22,000.00 10,839.00 330.00 0.00 11,169.00 50.77% 10,831.00 1,055.90
ALLOWANCE-
140J0 GENERAL LABOR 320,000.00 261,596.00 26,653.00 0.00 288,249.00 90.08 31,751.00 594.40
ALLOWANCE
TEMPORARY
FENCE
140KO MODIFICATIONS 5,000.00 4,008.00 0.00 0.00 4,008.00 80.16% 992.00 400.80
ALLOWANCE #2
140LO OR 453 STONE 37,900.00 18,856.00 0.00 0.00 18,856.00 49.75% 19,044.00 1,885.60
ALLOWANCE
WAREHOUSE
140M LEASE /LAYDOWN
0 /PARKING 500,000.00 500,000.00 0.00 0.00 500,000.00 100.00% 0.00 942.70
ALLOWANCE
PARKING LOT
INSTALL /MAINTAI
140NI N 100,000.00 80,324.00 0.00 0.00 80,324.00 80,32%1 19,676.00 5,532.40
ALLOWANCE
MAINT. -OFF SITE
STAGING /PARKIN
1.40N2 G 35,000.00 8,160.00 3,605.00 0.00 11,765.00 33.61 23,235.00 685.50
ALLOWANCE
PARKING LOT
REMOVE /REFURBI
14000 1 SH 100,000.001 2,745.00 0.00 0.001 2,745.00 175 97,255.001 274.50
AIA Document G703--1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/1912010 under Order No. 0754240912_1 which expires on 05110!2010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM. PRESENTLY
PREVIOUS AND STORED TO FINISH (IF VARIABLE
NQ WORK VALUE THIS PERIOD STORED (G C)
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
ALLOWANCE
HAUL/DISPOSE
UNSUITABLE
140PO MATERIAL 25,000.00 1.4,794.00 0.00 0.00 14,794.00 59.18% 10,206.00 1,479.40
ALLOWANCE -6
OZ. GEOTECH
140Q1 IFABRIC 4,700.00 3,20700 0.00 0.00 3,207.00 68.23%1 1,493.00 320.70
ALLOWANCE-
140Q2 TENSAR GEOGRID 8,500.00 0.00 0.00 0.00 0.00 0.00% 8,500.00 0.00
ALLOWANCE -42
140RO STONE 26,200.00 10,275.00 0.00 0.00 10,275.00 39.22% 15,925.00 1,027.50
ALLOWANCE
CABLE PASS
140S0 ITHRU (FOR) 6,456.00 0.00 0.00 0.00 0.00 0,00% 6,456.00 0.00
ALLOWANCE
CABLE PASS
140T0 THRU (BOH) 5,165.00 0.00 0.00 0.00 0.00 0.00% 5,165.00 0.00
ALLOWANCE-
140U CABLE PASS-
0 THRU (FLOOR) 17,217.00 0.00 0.00 0.00 0.00 0.00% 17,217.00 0.00
ALLOWANCE
TEMPORARY
ELEVATOR
140VO USAGE 200,000.00 29,868.00 18,760.00 0.00 48,628.00 24.31 %1 151,372.00 0.00
ALLOWANCE
140W DONOR
0 RECOGNITION 100,000.00 100,000.00 0.00 0.00 100,000.00 100.00% 0.00 0.00
GENERAL
1.40X0 ALLOWANCE 400,000.00 204,774.00 5,247.00 0.00 210,021.00 52.51 189,979.00 598.00
ALLOWANCE -AS-
140Y0 BUILD /CAD 5,000.00 4,242.00 0.00 0.00 4,242.00 84.84% 758.00 0.00
FIELD
01501 OFFICE /STORAGE 16,400.001 15,400.00 250.00 0.00 15,650.001 95.43% 750.00 1,320.00
AIA Document G703T° -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 3
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/1912010 under Order No.0754240912_1 which expires on 05/1012010, and is not for
resale.
User Notes:
(1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM. DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINLSH (IF VARIABLE
APPLICATION DATE (C' C)
(C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
TRAILER -M
FIELD
OFFICE /STORAGE
01502 TRAILER -L 5,500.00 4,950.00 0.00 0.00 4,950.00 90.00% 550.00 405.00
TEMPORARY
TOILETS /WASHIN
01503 G STATIONS -M 41,800.00 36,600.00 1,000.00 0.00 37,600.00 89.95%1 4,200.00 2,860.00
TEMPORARY
TOILETS /WASHIN
01504 G STATIONS -L 7,600.00 6,650.00 150.00 0.00 6,800.00 89.47% 800.00 555.00
FIRE
PROTECTION/EME
01505 RG.STATIONS -M 19,300.00 19,300.00 0.00 0.00 19,300.00 100.00 %1 0.00 1,930.00
FIRE
PROTECTION /EME
01506 RG.STATIONS -L 4,000.00 3,500.00 0.00 0.00 3,500.00 87.50% 500.00 31.0.00
FURNISH/MAINTA
01507 IN TRASH CANS -M 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00 0.00 600.00
FURNISH/MAINTA
01508 JIN TRASH CANS -L 40,000.00 31,400.00 1,200.00 0.00 32,600.00 81.50% 7,400.00 2,350.00
TEMPORARY
ROAD/MAINTENA
01510 NCE 148,000.00 138,000.00 1,500.00 0.00 139,500.00 94.26% 8,500.00 12,220.00
TEMPORARY
FENCING
REMOVE/RELOCA
01520 TE 15,800.00 15,800.00 0.00 0.00 15,800.00 100.00%1 0.00 1,580.00
TEMPORARY
01521 FENCING -GATES 6,500.00 6,500.00 0.00 0.00 6,500.00 100.00% 0.00 650.00
TEMPORARY
FENCING-
01522 ISCREENING 1 8,744.00 8,744.001 0.001 0.00 8,744.00 100.00% 0.00 874.40
AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 4
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes:
(1748059250)
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL
ITEM .DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
(NOT IN D OR E)
APPLICATION THIS PERIOD DATE (G C) (C G) RATE)
(D E) (D +E +F)
TEMPORARY
01523 BARRIERS -M 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00 0.00 680.00
TEMPORARY
01524 BARRIERS -L 7,500.00 7,500.00 0.00 0.00 7,500.00 100.00 0.00 750.00
TEMPORARY
01530 ENCLOSURES -M 10,800.00 10,800.00 0.00 0.00 10,800.00 100.00 %1 0.00 1,050.00
TEMPORARY
01531 ENCLOSURES -L 14,000.00 14,000.00 0.00 0.00 14,000.00 100.00 0.00 1,360.00
SCAFFOLDING
SET
UP /CONSUMABLE
01540 S 398,000.00 398,000.00 0.00 0.00 398,000.00 100.00 %1 0.00 37,620.00
SCAFFOLDING
MONT14LY
RENTALANSPECTI
01541 ONS 228,000.00 218,500.00 9,500.00 0.00 228,000.00 100.00 0.00 10,450.00
SCAFFOLDING
DISMANTLE /REM
01542 OVE 55,000.00 0.00 0.00 0.00 0.00 0.00%1 55,000.00 0.00
STAIR TOWERS
01543 SETUP 54,000.00 18,000.00 0.00 0.00 18,000.00 33.33 36,000.00 1,800.00
STAIR TOWERS
MONTHLY
01544 IRENTAL 28,500.00 9,500.00 0,00 0.00 9,500.00 33.33 19,000.00 350.00
STAIR TOWERS
01545 DISMANTLE 6,700.00 0.00 0.00 0.00 0.00 0.00% 6,700.00 0.00
HOIST- EXTERIOR-
1546.1 SET UP 14,300.00 0.00 0,00 0.00 0.00 0.00%1 14,300.00 0.00
HOIST- EXTERIOR-
RENTAL /OPERATI
546.2 ON 139,040.00 0.00 0.00 0.00 0.00 0.00% 139,040.00 0.00
HOIST- EXTERIOR-
1546.3 DI 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.001 0.00
AIA Document G703rm 1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 5
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30,44 on 04119/2010 under Order No. 0754240912_1 which expires on 05/10/2010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE
APPLICATION THIS TORED S PERIOD DATE (G. C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
HOIST- STAIR2 -SET
1547.1 UP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00
HOIST -STAIR 2-
RENTAL/OPERATI
1547.2 ON 139,040.00 0.00 0,00 0.00 0.00 0.00% 139,040.00 0.00
HOIST -STAIR 2-
1547.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00%1 8,000.00 0.00
HOIST -ROOM 100-
1548.1 SET UP 95,000.00 95,000.00 0.00 0,00 95,000.00 100.00% 0.00 9,500.00
HOIST -ROOM 100
RENTAL/OPERATI
1548.2 ON 211,000.00 205,750.00 5,250.00 0.00 211,000.00 100.00% 0.00 1.6,975.00
HOIST -ROOM 100-
1548.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0,00% 2,500.00 0.00
HOIST-
ALLOWANCE-SET
1549.1 UP 9,830.00 0.00 0.00 0.00 0.00 0.00% 9,830.00 0.00
HOIST
ALLOWANCE-
RENTAL/OPERATI
1549.2 ON 97,500.00 0.00 0.00 0.00 0.00 0.00% 97,500.00 0.00
HOIST
ALLOWANCE-
1549.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0,00% 2,500.00 0.00
01556 TRASH CHUTES -M 52,000.00 48,800.00 450.00 0.00 49,250.00 94.71 %1 2,750.00 4,490.00
01557 TRASH CHUTES -L 58,000.00 49,000.00 1,300.00 0.00 50,300.00 86.72% 7,700.00 2,500.00
GENERAL CLEAN
01560 UP -M 5,000.00 4,090.00 150.00 0.00 4,240.00 84.80% 760.00 314.00
GENERAL CLEAN
01561 UP -L 60,000.00 49,100.00 1,500.00 0.00 50,600.00 84.33% 9,400.00 3,560.00
01562 FINAL CLEANING 65,000.00 0.00 0.00 0.00 0.00 0.00% 65,000.00 0.00
02110 EXCAVATION /BA 12,019.00 12,019,001 0.001 0.00 12,019.00 100.00 %1 0.00 1,201.90
AIA Document G703 1992. Copyright 1963, 1965. 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 6
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.07 5 424091 2_1 which expires on 05110/2010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED NtATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED PREVIOUS FROM PRESENTLY COMPLETED AND STORED TO BALANCE TO RETAINAGE
NO. WORK VALUE THIS PERIOD STORED (G C) FINISH (IF VARIABLE
APPLICATION (NOT IN D OR E) DATE (C G) RATE)
(D E) (D +E +F)
CKFILL- SUMPS -M
EXCAVATION /BA
CKFILL SUMPS -L
02111 EQ 25,000.00 25,000.00 0.00 0.00 25 100.00 0.00 2,500.00
02240 SHORING 209,800.00 209,800.00 0.00 0.00 209,800.00 100.00 0.00 20,980.00
CAST IN PLACE
03301 CONCRETE -M 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00 0.00 1,000.00
CAST IN PLACE
03302 CONCETE -L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00 0.00 3,500.00
PRECAST
PLANKS -12"
03410 HOLLOW CORE 161,000.00 161,000.00 0.00 0.00 1.61,000.00 100.00 0.00 16,100,00
PRECAST
PLANKS -12"
0341.1 SOLID 898,000.00 898,000.00 0.00 0.00 898,000-00 100.00 0.00 89,800.00
PRECAST
03412 PLANKS -6" SOLID 107,000.00 107,000.00 0.00 0.00 107,000.00 100.00 0.00 10,700.00
PRECAST
03413 TRUCKING 82,000.00 82,000.00 0.00 0.00 82,000.00 100.00 0.00 8,200.00
PRECAST
03414 ERECTION 186,000.00 186,000.00 0.00 0.00 186,000.00 100.00 %1 0.00 18,600.00
INTERIOR METAL
FABRICATIONS
05504 ISUBMITTALS 102,000.00 102,000.00 0.00 0.00 102,000.00 100.00% 0.00 10,200.00
STEEL STAIRS
05505 WITH RAIL -M 179,000.00 179,000.00 0.00 0.00 179,000.00 100.00 0.00 14,857.00
STEEL STAIRS
05506 WITH RAIL -L 80,000.00 73,000.00 0.00 0.00 73,000.00 91.25 7,000.00 6,600.00
05507 LADDERS -M 26,000.00 26,000.00 0.00 0.00 26,000.00 100.00%1 0.00 2,600.00
05508 LADDERS -L 12,500.00 12,500.00 0.00 0.00 12,500.00 100-00% 0.00 1,220.00
CATWALK
05509 FRAMING -M 63,000.00 63,000.00 0.00 0,00 63,000.00 100.00% 0.001 6,300.00
AIA Document G703TM -1992. Copyright O 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 7
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/1912910 under Order No.0754240 which expires on 0511012010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
THIS PERIOD
APPLICATION DATE {G C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
CATWALK
05510 FRAMING -L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00 0.00 1,710.00
MISCELLANEOUS
05511 METALS -M 441,000.00 425,550.00 8,500.00 0.00 434,050.00 98.42% 6,950.00 13,615.00
MISCELLANEOUS
05512 METALS -L 275,000.00 268,250.00 0.00 0.00 268,250.00 97.55%1 6,750.00 8,094.30
INTERIOR ROUGH
06100 CARPENTRY -M 31,000.00 22,420.00 0.00 0.00 22,420.00 72.32 8,580.00 372.00
INTERIOR ROUGH
06101 CARPENTRY -L 44,000.00 29,840.00 1,000.00 0.00 30,840.00 70.09% 13,160.00 484.00
FOUNDATION
WATERPROOFING
07110 -M 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00%1 0.00 510.00
FOUNDATION
WATERPROOFING
07111 -L 6,600.00 6,600.00 0.00 0.00 6,600.00 100.00%1 0.00 660.00
07210 DUCT LINERS -M 97,000.00 97,000.00 0.00 0.00 97,000.00 100.00% 0.00 9,700.00
07211 DUCT LINERS -L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,120.00
07810 FIRESTOPPING-M 24,000.00 19,800.00 1,000.00 0.00 20,800.00 86.67% 3,200.00 1,680.00
07811 FIRESTOPPING -L 16,000.00 14,200.00 0.00 0.00 14,200.00 88.75% 1,800.00 1,220.00
JOINT SEALANTS
07910 M 35,000.00 5,500.00 0.00 0.00 5,500.00 15.71 29,500.00 0.00
JOINT SEALANTS-
07911 L 80,000.00 14,000.00 0.00 0.00 14,000.00 17.50 66,000.00 0.00
STEEL DOORS
081.1.0 FRAMES -M 0.00 0.00 0.00 0.00 0.00 0.00
STEEL DOORS
08111 FRAMES -L 0.00 0.00 0.00 0.00 0.00 0.00
FLUSH WOOD
08140 DOORS -M 0.00 0.00 0.00 0.00 0.00 0.00
FLUSH: WOOD
08141 DOORS -:L 0.00 0.00 0.001 0.00 0.00 0.00
AIA Document G703- -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 8
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240912_1 which expires on 0 511 012 01 0, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE
APPLICATION THIS PERIOD STORED DATE (G C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E+F)
STILE RAIL
08143 WOOD DOORS -M 0.00 0.00 0.00 0.00 0.00% 0.00
STILE RAIL
08144 WOOD DOORS -L 0.00 0.00 0.00 0.00 0.00% 0.00
SOUND CONTROL
DOORS
08347 WINDOWS -M 0.00 0.00 0.00 0.00 0.00%1 0.00
SOUND CONTROL
DOORS
08348 WINDOWS -L 0.00 0.00 0.00 0.00 0,00% 0.00
OVER COILING
08355 DOORS -M 0.00 0.00 0.00 0.00 0.00% 0.00
OVERHEAR
08356 COILING DOORS -L 0.00 0.00 0.00 0.00 0.00 0.00
ALUM.FRAMED
ENTRANCES /STOR
0841.0 EFRONTS -M 0.00 0.00 0.00 0.00 0,00% 0.00
ALUM.FRAMED
ENTRANCES /STOR
08411 EFRONS -L 0.00 0.00 0.00 0.00 0.00%1 0.00
INTERIOR ALUM.
DOORS
08413 FRAMES -M 0.00 0.00 0.00 0.00 0.00% 0.00
INTERIOR ALUM.
DOORS
08414 FRANCES -L 0.00 0.00 0.00 0.00 0.00% 0.00
REVOLVING
DOOR
08423 ENTRANCES -M 0.00 0.00 0.00 0.00 0.00 0.00
REVOLVING
DOOR
08424 ENTRANCES -L 0.00 0.00 0.00 0.00 0.00 1 0.00
08440 IGLAZED ALU,. 325,000.92L 224,300.00 32,000.001 0.00 256,300.001 78.86 %1 68,700.00 11,375.00
AIA Document G703T' 1992, Copyright m 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 9
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240 which expires on 05/1012010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
COMPLETED BALANCE TO RETAINAGE
NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE
STORED
APPLICATION THIS PERIOD DATE (G. C) (C G) RATE)
(D E) (NOT IN D ORE) (D +E +F)
CURTAIN WALLS
M
GLAED ALUM.
CURTAIN WALLS
08441 L 148,000.00 73,600.00 0.00 0.00 73,600.00 49.73% 74,400.00 0.00
08710 HARDWARE 525,000.00 507,000.00 0.00 0.00 507,000.00 96.57%1 18,000.00 18,800.00
INTERIOR
08810 GLAZING -M 11,000.00 220.00 5,300.00 0,00 5,520.00 50.18 5,480.00 22,00
INTERIOR
08811 GLAZING -L 8,000.00 0.00 2,000.00 0.00 2,000.00 25,00% 6,000.00 0.00
FIRE PROTECTION
10440 SPECIALTIES -M 7,580.00 0.00 0.00 0.00 0.00 0.00% 7,580.00 0.00
FIRE PROTECTION
10441 SPECIALTIES -L 1,800.00 0.00 0.00 0.00 0.00 0.00%1 1,800.00 0.00
10450 KNOX BOX 650.00 0.00 0.00 0.00 0.00 0.00% 650.00 0.00
LOADING DOCK
11130 EQU1PMENT -M 18,500.00 16,475.00 0.00 0.00 16,475.00 89.05 2,025.00 1,647.50
LOADING DOCK
11131 EQUIPMENT -L 3,800.00 2,200.00 0.00 0.00 2,200.00 57.89% 1,600.00 220.00
ELEC.TRACTION
ELEVATORS
14210 JENGINEERTNG 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
ELEC.TRACTION
ELEVATORS-
MATERIAL/EQUIP
14211 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
ELEC.T.RACTION
14212 ELEVATORS -L 0.00 0.00 0.00 0.00 0,00%1 0.00 0.00
HYDRAULIC
ELEVATOR
14241 JENGINEERING 0.00 0.00 0.001 0.00 0.00% 0.001 0.00
14242 JHYDRAULIC 0.00 0.00 0.00 0.00 0.00% o.001 0.00
AIA Document G703 TO -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 10
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240912_1 which expires on 0511012010, and is not for
resale.
User Notes:
(1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
NO PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
WORK VALUE
APPLICATION THIS PERIOD DATE (G C) (C G) RATE)
(D E) (NOT IN D OR E) (D +.E +F)
ELEVATOR-
MATERIAL/EQUIP
MENT
HYDRAULIC
ELEVATOR
14243 LABOR 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00
WHEELCHAIR
LIFT
MATERIAL /EQUIP
14421 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
WHEELCHAIR.
14422 LIFT- PERMITS 0.00 0.00 0.00 0.00 0.00%1 0.00 0.00
WHEELCHAIR
14423 LIFT -LABOR 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
CHANGE ORDER
17001 NO. 01 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 450.00
CHANGE ORDER
17002 NO. 02 9,031.00 9,031.00 0.00 0.00 9,031.00 100.00%1 0.00 0.00
CHANGE ORDER
17003 NO. 03 2,196.00 2,196.00 0.00 0.00 2,196.00 100.00% 0.00 30.00
17000 CHANGE ORDER
4 NO. 04 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
17000 CHANGE ORDER
5 NO. 05 98,741.00 98,741.00 0.00 0.00 98,741.00 100.00% 0.00 9,874.10
17000 CHANGE ORDER
6 NO. 06 1.7,527.00 17,527.00 0.00 0.00 17,527.00 100.00% 0.00 1,400.00
17000 CHANGE ORDER
7 NO. 07 11,29100 11,292.00 0.00 0.00 11,292.00 100.00% 0.00 1,129.20
17000 CHANGE ORDER
8 NO. 08 44,936.00 44,936.00 0.00 0.00 44,936.00 100.00% 0.00 4,493.60
17000 CHANGE ORDER
9 NO. 09 14,683.00 14,683.00 0.00 0.00 14,683.00 100.00%1 0.00 0.00
AIA Document G703TM -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 11
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240 which expires on 05110/2010, and is not for
resale.
User Notes: (1748059250)
A B C D E F G H I
WORK COMPLETED TOTAL
MATERIALS COMPLETED BALANCE TO RETAINAGE
ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY
PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE
NO, WORK VALUE
APPLICATION THIS PERIOD DATE (G. C) (C G) RATE)
(D E) (NOT IN D OR E) (D +E +F)
17001 CHANGE ORDER
0 NO. 10 760,330.00 750,573.00 0.00 0.00 750,573.00 98.72% 9,757.00 38,016.50
17001 CHANGE ORDER
2 NO. 12 49,062.00 49,062.00 0.00 0.00 49,062.00 100.00% 0.00 2,453.10
17001 CHANGE ORDER
3 NO. 13 3,801.00 3,801.00 0.00 0.00 3,801.00 100,00% 0.00 190.05
17001 CHANGE ORDER
4 NO. 14 787.00 787.00 0.00 0.00 787.00 100.00% 0.00 39.35
17001 CHANGE ORDER
5 NO. 15 34,158.00 34,158.00 0.00 0.00 34,158.00 100.00% 0.00 1,707.90
17001 CHANGE ORDER
6 NO, 1.6 7,529.00 7,529.00 0.00 0.00 7,529.00 100.00% 0.00 376.45
17001 CHANGE ORDER
7 NO. 17 7,083.00 7,083.00 0.00 0.00 7,083.00 100.00 0.00 354.15
17001 CHANGE ORDER
8 NO. 18 22,591.00 0.00 22,591.00 0.00 22,591.00 100.00% 0.00 1,129.55
GRAND TOTAL $9,757,387.00 $7,675,967.00 $164,222.00 $0.00 $7,840,189.Q0 80.35% $1,917,198.00 $487,869.35
AIA Document G703 -1992. Copyright 1963, 1965, 1966, 1967,1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by
U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be 1 2
prosecuted to the maximum extent possible under the law. This document was produced by AIA software at 15:30:44 on 04/19/2010 under Order No.0754240 which expires on 05/1012010, and is not for
resale.
User Notes: (1748059250)
i
AFFIDAVIT AND WAIVER OF LIEN
]FINAL X PARTIAL PAYMENT TO FOLLOW
State of Indiana, County of Madison SS
Bradley A. Tyler being duly sworn states that he is the Project Manager of W. R. Dunkin
Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish
certain materials and /or labor as follows: Bid Package 4050- General Trades for a project
known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and
owned by City of Carmel and does hereby further state on behalf of the aforementioned
Contractor.
Application for Payment 4 21 has been received for work performed through 01/31/10
(PARTIAL WAIVER) that there is due from the contractor the sum of
Three Hundred Fourteen Thousand Seven Hundred Fifty -one dollars and 00 /cents 314,751.00
Application for Payment has been received for work performed through
(FINAL WAIVER) that the final balance due from the Owner is the sum of
dollars and 00 /cents
THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim
whatsoever on the above described property and improvements thereon on account of LABOR or material or both,
furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further
certifies that no other party has any claim or right to a lien on accou of ork performed or material furnished
to the undersigned for sa' in t scope i id it waiver.
W. R. Dunkin Son, Inc. Title: Project Manager
WITNESS MY HAND AND NOTARIAL SEAL, this 15 day of April 2010
(Notary P lic)
M Commission Expires: January 08, 2017 Printed Martha A. Carpenter
Residing in Madison County
Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
JJ,' Payee
K Y� sore Purchase Order No.
225
Terms
r'��r��c•�, �(a�jf�j Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
2 y'
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
IN SUM OF
22 4 17
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF r
Board Members
PO# o r�
INVOICE NO ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
*2 2�f9, y�'G��Gi /63 0g2y5 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
/j
5-7 20 id
Signature
Director of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund