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187177 07/06/2010 V CITY OF CARMEL, INDIANA VENDOR: 363750 Page 1 of 1 ONE CIVIC SQUARE ERMCO INC s CHECK AMOUNT: $300,790.49 CARMEL, INDIANA 46032 PO BOX 1507 INDIANAPOLIS IN 46206 CHECK NUMBER: 187177 CHECK DATE: 7/6/2010 DEPAR ACCOUNT PO NU MBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 APP 24 300,790.49 PERFORMING ARTS CENTE TM Document G702 /CMa -1992 Application and Certificate for Payment Construction Manager- Adviser Edition TO OWNER: Carmel Redevelopment CommiSPROJECT: Parcel 7A, Regional Performing ArtsAPPLICATION NO Distribution to: 1 Civic Square Center Interior Rough PERIOD TO 4/30/2010 OWNER Carmel, IN 46032 Construction Package P4 CONSTRUCTION MANAGER D FROM CO NT RTkb INC. VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT P.O. Box 1507 Shiel Sexton PROJECT NOS: 2695_4320 I CONTRACTOR Indianapolis, IN 46206 VIA ARCHITECT: FIELD 0 CSO Architects CONTRACT Fgj$ctrical Installation Project 25310H CONTRACTOR'S APPLICATION FOR PAYMENT Th e 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 505,000:00 payment shown herein is now due. 2. Net change by Change Orders CONTRACT 467,808.00 ERMCO C 3. CONTRACT SUM TO DATE Une 1 2 037,192.00 B Date: 4/15/2010 7 By J 4: TOTAL COMPLETED STORED TO DATE (Column G on G703) State of: Indiana 5. RETAINAGE County of: Marion a. of Completed Work SubscribecJ nd sworn to before 351,8 9.60 I[Cl April, 2010 (Column D +Eon 6703) me this day of N b• of Stored Material Notary Public: {Column F on G703) My Commission expires: 12/1912015 Total Retainage (Lines 5a 5b or Total in Column I of G703) 351 ,859.60 CERTIFICATE FOR PAYMENT 5 913,242.15 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 5,612 ,4 5 1. 66 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. G� 4q 8. CURRENT PAYMENT DUE 300,790.49 AMOUNT CERTIFIED 300 �I l 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amountapplied. Initial all figures on this Application an the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) 1, 12 3 ,9 49.85 CONSTRUC 0, M A By: Date: 2, t1 ai CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT r Total changes approved m previous months by Owner 7$1 ,499.00 $509,121.00) By: Date'`. Total approved this Month 10A,000.00 X130,186.00) This Certificate ts.not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS 17$1,499.00 %639,307.00) named herein. issuance,`payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order (467,8 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. r. AIA Document G702 1CMaTM 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. TM AIA Document G7021CMa -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 6703, Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition. B. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G7021CMa, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. C. Completing the G7021CMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 1CMa, 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 G7021CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G7021CMa. 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 G7021CMa 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 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 alid Architect on AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and•address of the Contractor. Payment should not be made to any other party unless specifically indicated on G7021CMa, 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. ERMCO Contract i 2695--4320 124070 Document G703 TM -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION, N.O. 24 containing Contractor's sigiied.certiFication is attached. APPLICATION DATE: 4/15/201.0 In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT N0: A B C D E F G H WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED SCHEDULED FROM PREVIOUS TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G =C) FINISH (NOT IN TO DATE RATE) (D E) D OR E-) (D +E +F) (C G) 0.001 MOBILIZATION 15,000.00 15,000.00 15,000.00 100 0.002 P.M. 200,000.00 162,999.00 5,285.00 168,284.00 84 31,716.00 0.003 CAD ENG 80,000.00 80,000.00 80,000.00 100 0.004 TEMP L 75,000.00 66,578.00 2,000.00 68,578.00 91 6,422.00 0.005 TEMP M 45,000.00 41,875.00 750.00 42,625.00 95 2,375.00 0.006 CLEAN UP 15,000.00 9,620.00 800.00 10;420.00,: 69 4,580.00 0.007 BOND 72,000.00 72,000.00 72,000.00 100 0.008 TESTING, 18,000.00 12,000.00 12,000.00 67 6,000.00 0.009 SITE OFFICE 23,000.00 22,050.00 250.00 22,300.00 97 700.00 0.010 DEMOBILIZATION 5,000.00 5,000.00 0.011 ALLOWANCE 12 550,000.00 466,772.00 (85,000.00) 381,772.00 69 168,228.00 0.012 ALLOWNACE 13 350,000.00 141,544.56 122,382.19 263,926.75 75 86,073.25 0.01.3 ALLOWANCE 14 100,000.00 75 75,000.00 75 25,000.00 0.014 ALLOWANCE 15 5,000.00 5,000.00 5,000.00 100 0.015 ALLOWANCE 16 10,000.00 10,000.00 10,000.00 100 0.016 EO.11 0.017 MAT 10,000.00 10,000.00 10,000.00 100 0.018 LABOR 6,000.00 6,000.00 6,000.00 100 0.019 EXCAVATION 35,000.00 35,000.00 35,000.00 100 0.020 EO.12 0.025 BRANCH R M 500.00 500.00 500.00 100 0.026 BRANCH R L 1,500.00 1,500.00 11506M,;; 100 0.027 BRANCH F M 100.00 100.00 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 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 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. y ='r Document G703 —1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 often copies of a completed G703, 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 AfA 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, copyrightt�aia.org. COMPLETING G703 1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document 6702, Application and Certificate for Payment. Columns A, B &c C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 cohmul. Column E. Enter here the value of Work completed at the time of this application, including the value of materials incorporated in the project that 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. More payment by the Owner for stored materials does not result in a deduction Pram 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 1. This column is normally used only for contract's 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 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. The following is an example of a Continuation Sheer for work in progress. Please note that dollar amounts shown below ore, for illustrative purposes on1v. and are not intended to reflect actual conjunction casts. A 13 C. D L" F C.1 II WORK COMPLM En MA'I'FRIALS TOTAI. HALANG3 PRE EN'I'LY CON11'LF ITI) RF.]'AINAGE "rl'M SC]IIiDUI.FD FROM1f PREVIOUS l'O NO. D1iBCRII''I'10U OF WORK VALUF AI'PLICATION TIIIS PERIOD (No IN AND STOKED FINISH RATE) lN0'f IN TO DATE RATE) (1) '171 DOR I?) 10 I El F) fC C1 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CVP35 d MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20 000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20000 8 PAVERS 20,000 0 0 10,000 l0 000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 20,000 10,000 10000 40,000 1 65,000 AIA Document G703TI 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. At) 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. ERMCO Contract 2695 —x+320 124070 TM A Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 24 containing Contractor's signed certification is attached. APPLICATION DATE: 4/15/2010 In tabulations below, atnounts are stated to the nearest dollar. 4/30/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S PROJECT N A B C D E F. G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETA[NAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C} FINISH RATE) (D E) D OR E) (D +E +F) (C G) 0.028 3RANCH F L 200.00 200.00 0.029 1.01 0.030 EEDER M 975,000.00 970,750.00 4,250.00 975,000.00 100 0.031 EEDER L 600,000.00 595,500.00 4,500.00 600,000.00 100 0.032 1.02 0.033 Q M 250,000.00 24b,000.00 2,000.00 248,000:00 99 2,000.00 0.034 Q L 150,000.00 143,500.00 3,500.00 147,000.00 98 3,000.00 0.035 E 1.03 0.036 Q R M 10,000.00 10,000.00 10,000.00 100 0.037 Z Q R L 15,000.00 14,500.00 500.00 15,000.00 100 0.038 Q F -M 30,000.00 28,000.00 1,000.00 29,000.00 97 1,000.00 0.039 Q F L 8,000.00 5,000.00 1,500.00 6,500.00 81 1,500.00 0.040 71.04 0.041 Q R M 10,000.00 10,000.00 10,000.00 100 0.042 Q R L 15,000.00 12,500.00 1,000.00 13,500.00 90 1,500.00 0.043 E Q F M 25.000.00 21,500.00 1,500.00 23,000.00 92 2,000.00 0.044 ZQ F L 8,000.00 6,000.00 1,000.00 7,000.00 88 1,000.00 0.045 1.05 0.046 =Q R M 5,000.00 4,000.00 1,000.00 5,000.00 100 0.047 Q R L 5,000.00 1,000.00 2,000.00 3,000.00 60 2,000.00 0.048 Q F M 35,000.00 30,000.00 2,500.00 32,500.00 93 2,500.00 0.049 Q F L 8,000.00 6,000.00 1,000.00 7,000 00... 88 1,000.00 0.050 2.00 &A &P 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 G703TM 1992. Copyright (D 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 Ale 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 00) 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. TM Document G103 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AfA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction, Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 G703, 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. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 colLUnn 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 in the project that 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 1. 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 6703 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 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 A20 The fbllowing is an example of a Continuation Sheet for n=ark in progress. Please note that dollar amounts shown be/ow arefot' ilhesirntive proposes oniv. ctnd Ore not intended to reflect actual construction costs. A 11 c D e c n WORK C MATFRIALs TOI'AI. HALANCE PI SIOK D A N DST ETED e Ii F; rAINA 1TF_M SC VAL ULEU r'ROPI PREVIOUS DI:SCRII''P10N OF R'ORK STORED ANDS "rOKI?U (I(11: \'A RIAF31,1; NO. \'ALUL APPLICA "rLON' TI1151'FRIOD (0 FINISH TO [NOT I: 'I'O DA IF RA71?) [D f EI DOA F) CDtf: +F'1 (c-U) I MOBILIZATION 5,000 5,000 0 0 5 000 100 0 2 5TUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5000 50 5.000 5 CURB5 d MISc. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER ORIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20000 0 0 0 0 0 20,000 B PAVERS 20000 0 o 10.000 10,000 50 10090 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 1k 1 05,000 20.000 1 0,0 0 0 10 000 10,0 00 65 000 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 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. AI A ERMCO Contract 2695 --4320 �l TM 124070 Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO: 24 containing Contractors signed' certification is attached. APPLICATION DATE: 4 /15 /2010 In tabulations below amounts are stated to the nearest dollar. 4/30/201.0 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S PROJECT NO: A B C D E F: G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED PRESENTLY COMPLETED TO RETAINAGE LED FROM PREVIOUS ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (G C) FINISH {NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 0.051 RIGGING 35,000.00 35,000.00 35,000.00 100 0.052 MQ R M 30,000.00 30,000.00 30,000.00 100 0.053 Q R L 20,000.00 18,000.00 1,000.00 19,000.00 95 1,000.00 0.054 FQ F M 575,000.00 570,000.00 2,500.00 572,500.00 100 2,500.00 0.055 EQ F L 30,000.00 25,000.00 1,500.00 26,500.00 88 3,500.00 0.056 RANCH R M 17,000.00 17,000.00 17,006M: 100 0.057 RANCH R L. 13,000.00 11,300.00 1 12,300.00 95 700.00 0.058 RANCH F M 7,000.00 5,000.00 1,000.00 6,000.00 86 1,000.00 0.059 RANCH F L 5,000.00 2,000.00 1,500.00 3,500.00 70 1,500.00 0.060 EEDER R M 550,000.00 548,500.00 1,500.00 550,000.00 100 0.061 EEDER R L 250,000.00 247,000.00 3,000.00 250,000.00 100 0.062 EEDER F M 6,000.00 5,000.00 1,000.00 6,000.00 100 0.063 EEDER F L 10,000.00 9,000.00 1,000.00 10,000.00 100 0.064 2.01 E2.02 0.065 RIGGING 10,000.00 10,000.00 10,000.00 100 0.070 BRANCH R M 15,000.00 15,000.00 15,000.00 100 0.071 BRANCH R L 8,000.00 6,580.00 500.00 7,080.00 89 920.00 0.072 BRANCH F M 2,500.00 1,500.00 500.00 2,000.00 80 500.00 0.073 BRANCH F L 3,500.00 1,000.00 500.00 1,500.00 43 2 0.074 2.03 A 0.075 BRANCH R M 20,000.00 17,900.00 1,000.00 18,900.00 95 1.100.00 0.076 BRANCH R L_ 16,000.00 12,820.00 1,500.00 14,320.00 90 1 0.077 BRANCH F M 1,000.00 1,000.00 1,000.00 100 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 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 AlA 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, copyrightCaaia.org. Document G703"- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document (3703, Continuation Sheet. These documents are designed for use 01) Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 G703, 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 [lie End User License Agreement (EULA). To report copyright violations of AlA Contract Documents, c -mail The American Institute of Architects' legal counsel, copyright@aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 fi 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 in the project that 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 L 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 form. Construction Change Directives. Amount 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. The following is an example of'o Continuation Sheet for work in progress. Please mote that dollar crrnowas shown helot+- are fcrr illuslrolive pmToses only, and ai•e not intended to reflect actual COILS WCtion costs. A R C D li P G II WORK COMPLE 11?D y {ATGRIe \7.5 TOTAL EALANCE PRESENTLY COMPLETED REIAINAGF rCI:AI SCHI:DU LLD DRUM PREVIOUS TO DESCRIPTION OF WORK 5POKF, AND ST6RED UI'VAKIAI3LL' NU. VALUE APPLICATION TIIIS PERIOD ND11 (C -C) FINISH {D L) r) OR 'I'ODATC (C.';) RA IT) D OR L) (D +E 1 MOBILIZATION 5,000 5,000 0 0 5.000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS a MISC, cONc. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVIN6, LOWER DRIVE 20,000 0 0 0 0 0 20,000 B PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 C 0 0 5,000 10 11 1 105,220L 20,000 10,000 1 0,0 0 0 40,000 1 1 65,000 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 Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA 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. ERMCO Contract 2695 -4320 TM 124070 a Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO: 24 containing Contractors signed certification is attached, APPLICATION DATE: 4/15/2010 In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on;Contracts where variable retainaae for line items may apply. PERIOD 'TO: ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED I° TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) (D E) D OR E) (D +E +F) (C G) 0.078 BRANCH F L 2,500.00 750.00 750.00 30 1,750.00 0.079 EEDER R M 65,000.00 63,800.00 1,200.00 65,000.00 100 0.080 EEDER R L 45,000.00 43,400.00 1,600.00 45,000.00 100 0.081 zEEDER F M 2,500.00 1,000.00 1,500.00 2,500.00 100 0.082 7 EEDER F L 5,000.00 3,000.00 2,000.00 5,000.00: 100 0.083 2.04 0.084 BRANCH R M 6,000.00 4,420.00 750.00 5;170.00 86 830.00 0.085 BRANCH R L 8,000.00 5,660.00 1,200.00 6,860.00 86 1,140.00 0.086 BRANCH F M 1,000.00 750.00 750.00 75 250.00 0.087 BRANCH F L 1500.00 1,200.00 1,200.00 48 1,300.00 0.088 E 2.05 0.089 BRANCH R M 15,000.00 12,550.00 1,500.00 14,050.00 94 950.00 0.090 BRANCH R L 14.000.00 10,280.00 1,500.00 11,780.00 84 2,220.00 0.091 BRANCH F M 800.00 800.00 0.092 BRANCH F L 1,500.00 1,500.00 0.093 2.06 0.094 BRANCH R M 4,000.00 1,030.00 1,000.00 2,030.00 51 1,970.00 0.095 BRANCH R L 6,000.00 3,000.00 1,200.00 4,200.00 70 1,800.00 0.096 BRANCH F M 600.00 600.00 0.097 BRANCH F L 1,200.00 1,200.00 0.098 E2. 07 0.099 BRANCH R M 8,000.00 6,060.00 1,000.00 7,060.00 88 940.00 0.100 BRANCH R L 10,000.00 7,000.00 1,500.00 8;500.00 85 1,500.00 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 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 A10 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. AI A Document G703 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 oCArchitects confer any further lights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, 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, copyrights aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that 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 columm 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 1. This column is normally used only for contracts where variable retainage is permitted on a iine -itenm 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 Conn. 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, The fi)llowing is an example o% a Continuation Street for work in Progress. Please note that dollar amounts shown he/ow are for illustrative purposes on1 v, and are oot intended to reflect actual construction costs. A fi C F 1' G II WORK(ONIPLFTEI) MATERIALS TOTAL BALANCE PR GSENTLY C()M PLETE:I) RETAINAGI: iTEM1I SC V 101 FROMPREVIOUS !n TO NO_ ISESC'RII'TION OL'v,'ORK \'ALUI' APPLICATION THIS PERIOD (NO TEN ANDS TOCEO (GEC:) FINISU (LP RATE) (1)1E1 DORE) (1),E +1� (C -O] 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5000 5,000 0 0 5,000 100 C 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS d MISC. CONC, 5,000 0 C 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20.000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 i0 11 1 105,000 L 10,000 10,000 1 40,000 1 65,000 AIA Document G703 TM 1992. Copyright 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 Ale 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. ERMCO Contract 2695 -4320 !A TM 124070 Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 24 containing Contractor's signed certification is attached. APPLICATION DATE: 4/15/2010 In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) E) D OR E) (D +E +F) (C G) 0.101 BRANCH F M 1,000.00 1,000.00 0.102 BRANCH F L 2,500.00 2,500.00 0.103 E 2.07A 0.104 BRANCH R M 15,000.00 1 1,050.00 1,500.00 12 84 2,450.00 0.105 BRANCH R L 20,000.00 15,000.00 2,500.00 17,500.00 88 2,500.00 0.106 BRANCH F M 9,000.00 4,500.00 2,000.00 6,500.00 72 2,500.00 0.107 BRANCH F G- 10,000.00 3,500.00 3,000.00 6;500'00 65 3,500.00 0.108 2.08 0.109 BRANCH R M 6,000.00 3,920.00 1,000.00 4,920.00 82 1,080.00 0.l l0 BRANCH R L 8,000.00 5,500.00 1,500.00 7,000.00 88 1,000.00 0. t l l BRANCH F M 2,000.00 1,000.00 1,000.00 50 1,000.00 0.112 BRANCH F L 3,500.00 1,500.00 1,500.00 43 2,000.00 0.113 E2.09 0.114 Q R M 8,000.00 7,500.00 500.00 8,000.00 100 0.115 E Q R L 10,000.00 8,500.00 1,500.00 10,000.00 100 0.116 E Q F M 2,500.00 2,500.00 2,500.00 100 0.117 Q F L 3,000.00 1,500.00 500.00 2,000.00 67 1,000.00 0.11.8 2.10 0.119 BRANCH R M 1,000.00 1,000.00 1,000.00 100 0.120 BRANCH R L 2,500.00 1,000.00 500.00 1,500.00 60 1,000.00 0. 121 BRANCH F M 100.00 100.00 0.122 BRANCH F L.. 500.00 500.00 0.123 E Q RE- M 6,000.00 3,500.00 2,500.00 6000OQ 100 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 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 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, copyrightpa aia.org. IN� Document G703"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This dOCL1111e11t 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 G703, 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 docmnent may vary for users of AIA software. Licensed AIA software users should consult the End Uscr License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org, COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, 8 C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 froth 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 in the project that 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 1. 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 it constant rebunage 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 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. Thefollowing is an examlile qfa Contuvuatiora Sheer for work in progress. Please note that dollar mnounis shown belon arefor illaslrutwe purposes only, cold are n01 intended to rellect actual construction Costs. A 13 c D E F G If WORK CUNIPLET171) MATERIALS TUTAI. PRE ?5EN'E'LY COn1PLE'IF,p RETAINAGE TFH SCHEIJUlED FROMPREVIVUS 3ALANCI TO 1�I:SCRIPfEON OF \YORK 5'I'URLU AND S7OREU (I1VARIAULP \'O. VALUE APPLICATION THIS PERIOD (No'r IN TO DATE (1i -C) FINISH RAPE) QI +E) 1) OR17) (D,E,F) (i. -6) 1 MOBILIZATION 5000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,00c 5,000 0 0 5,000 100 C 3 EARTH WORK 15,000 10,000 5,000 0 15.000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CUR85 d MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20.000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 C 0 C 0 0 20,000 9 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 1 2 0,000 10,000 1 1 0,000 1 40,000 1 65,022 AIA Document G703- 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. Ali rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AW 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. ERMCO Contract 2695 -4320 124070 3w. rDocument G703 rm 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO. 24 containing Contractors signed certification is attached. 4/1512010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on ,Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G H WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED %v TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH (D E) D OR E) (D +E +F) (C G) 0.124 ZQ R L 10,000.00 2,500.00 2,000.00 4,500.00 45 5,500.00 0.125 E Q F M 1,500.00 1,500.00 0:126 Q F L 2.000.00 2,000.00 0.162 E4.00 A P 0.163 S OUND R M 75,000.00 72,000.00 1,500.00 73,500.00 98 1,500.00 0.164 SOUND R L 60,000.00 56,000.00 1,500.00 5,7;500:00 96 2,500.00 0.165 4.01 A 0.166 SOUND R,-; M 40,000.00 35,500.00 1,500.00 37,000.00 93 3,000.00 0.167 SOUND R L 25,000.00 23,000.00 1,000.00 24,000.00 96 1,000.00 0.168 E4.02 A 0.169 SOUND R M 40,000.00 28,300.00 7,500.00 35,800.00 90 4,200.00 0.170 SOUND R L 25,000.00 12,500.00 4 17,000.00 68 8,000.00 0.171 E 0.172 SOUND R M 25,000.00 21,500.00 1,500.00 23,000.00 92 2,000.00 0.173 SOUND R L 18,000.00 10,900.00 2,500.00 13,400.00 74 4,600.00 0.174 E4.04 0.175 S OUND R M 25,000.00 22,000.00 1,500.00 23,500.00 94 1,500.00 0.176 SOUND R L 18,000.00 16,000.00 1,000.00 17,000.00 94 1,000.00 0.177 4.05 &.06 &.07 &.09 0.178 SOUND R M 80,000.00 66,100.00 8,500.00 74,600.00 93 5,400.00 0.179 SOUND R L 65,000.00 52,000.00 7,500.00 59,500.00 92 5,500.00 0.180 5.00 P 0.181 A. R IVI 15,000.00 12,250.00 1,000.00 7 13,250.00 88 1,750.00 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 G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AlO Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Ale 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 00) 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. 7 AIA Document G703'"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. A[A Document 6702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A20'l General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition, 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 G703, 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 reecipt 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. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent. with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, R C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that 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 colunul 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 L 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 6703 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 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 73 in A201. The jbllowing is an example of'a Continuation sheet,lbr work in progress. Please note that dollar amounts shown helow ai-e for ilhistrarive pt -poses only, cind are not intended to reflect actual construction costs. A R C D E F G 11 1 WORK COAIPLPTFD MAI EKIALS 'rUTAL C RALO K 1'lil:Sl:tiTLl' IJM I'LE'I'UU E:'I'AINAGt; ITEM SCHEDULED FKO-Ni I'KI;V IONS TO UI;SCRII'rION'OI' \FORK STORED AND STORED (R'VARIA13Ll; lO. \LUE APFLICATICIN '1'1119 PIiK10D (NOT IN TO DATE (G +CJ FI \`1511 RATE) (D X7:1 DOR E) (D,E,F) (U G] 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15000 10000 5.000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 MISC. CONE 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING. LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 I1 i 1 105,000 2 0,00C 10,000 10,000 40,000 65,000 AIA Document G703TM 1992. Copyright OO 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 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. ERMCO Contract 2695 -4320 TM 124070 Document G703 -1992 Continuation Sheet AIA Document 13702, APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION 'N0: 24 containing Contractor's signed certification is attached. APPLICATION DATE: 4/15/2010 In tabulations below, amounts are stated to the nearest dollar. 4!30/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F. G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK TO (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD STORED AND STORED (G C) FINISH (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 0.182 .A. R L 9,000.00 7,500.00 500.00 8,000.00 89 1,000.00 0.183 .A. F M 20,000.00 15,000.00 15,000.00 75 5,000.00 0.184 .A. F L 5.000.00 5,000.00 0.185 5.01 &.02 &.03 0.186 7 .A. R M 17,000.00 14,840.00 14,840.00 87 2,1.60.00 0.187 .A. R L;: 10,000.00 6,000.00 1,500.00 7;500.00 75 2,500.00 0.188 .A. F -:M 20,000.00 15,000.00 15;000.00 75 5,000.00 0.189 7 .A. F -L 5,000.00 5,000.00 0.190 -5.04.& '.05 .06 0.191 7. A. R M 20,000.00 16,400.00 1,500.00 17,900.00 90 2,100.00 0.192 7 .A. R L 17,000.00 8,000.00 3,000.00 11,000.00 65 6,000.00 0.193 .A. F M 20,000.00 15,000.00 15,000.00 75 5,000,00 0.194 F.A. F L 5,000.00 5,000.00 0.195 E5.07 &.08 &.09 &.10 0.196 F.A. R M 20,000.00 14,900.00 2,500.00 17,400.00 87 2 5 600.00 0.197 F.A. R L 15,000.00 9,000.00 3,000.00 12,000.00 80 3,000.00 0.198 F.A. F M 16,000.00 1 1,000.00 11,000.00 69 5,000.00 0.199 F.A. F L 3,000.00 3,000.00 0.200 E6.02 0.201 EQ M 55,000.00 45,00000 5,000.00 50,000.00 91 5,000.00 0.202 EQ L 20,000.00 5,000.00 5 25 15,000.00 0.203 CABLE M 35,000.00 30,000.00 30 86 5,000.00 0.204 CABLE L 45,000.00 5,000.00 5;000.00 11 40,000.00 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 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 A10 Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent K 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, copyrightC aia.org. Document G703"— 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 farther rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G703, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license l:or 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. COMPLETING G703 1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that 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 L 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 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. The foilowing is an e.xwnple of a Continuation Sheet Jor work in progress. Please none that dollar amounts shown below are Jor illustrative purposes only, and are not intended io reflect actual constsuctinn COSTS. A 13 C D L r G H I WORK MPL 61 IzQ MATFRIAI.S TOTAL BAI NCF. PRES F,N'I'I_y COMYLIrI'I:U RE1'AINAGE I'rE(tit SCH F.DD LLU FROM PREVIOUS io 'CO N(l llESCBFITI'14N Or -WORK VALUE APPIXA'I JON 'IIlls PERIOD S'I'ONF,U AND S'I'UREO (6 CI 7�INISlI (1F VARIA]il,l: (D +1:) (NO] IN 'rO DA'r[ RAT[) D OR E) (1) FIF7 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15.000 10,000 5,000 0 15,000 too 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 C 20,000 8 PAVER5 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5.000 0 0 0 0 0 5,000 10 11 1 1 1 05,000 20,000 1 10,000 1 10,000 40,000 65, 000 AIA Document (3703- 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 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. ERMCO Contract 2695 -4320 O ff AIA TM 124070 Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION N0 24 containing Contractor's signed certification is attached. APPLICATION DATE: 4/15/2010 In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column PERIOD T0: mn I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E P G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED RETAINAGE TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (G C) FINISH (D E) (NOT IN TO DATE (C G) RATE) D OR E) (D +E +F) 0.205 3R M 5,000.00 t00.00 100.00 2 4,900.00 0.206 SR L 2,000.00 2,000.00 00207 6.03 0.208 SECURFFY R M 40,000.00 800.00 25,000.00 25,800.00 65 14,200.00 0.209 3ECURITY R L 20,000.00 1000.00 9,000.00 11,000.00 55 9,000.00 0.210 3ECURITY F..-..M 18,000.00 18,000.00 0211 3ECURITY F L 6,000.00 6,000.00 0212 6.05 0.213 DIMMING M 60,000.00 54,000.00 3,000.00 57,000.00 95 3,000.00 0.214 DIMMING L 45,000.00 29,850.00 3,500.00 33,350.00 74 11,650.00 0.215 6.06 0.216 OPTIC SENSOR M 8,000.00 8,01 8,000.00 100 0.217 OPTIC SENSOR L 4,000.00 1,000.00 1,000.00 25 3,000.00 0.218 7.09 0.219 3 C M 100,000.00 92,500.00 2,500.00 95,000.00 95 5,000.00 0.220 3 C L 80,000.00 62,500.00 4,000.00 66,500.00 83 13,500.00 0.221 8.00 0222 LIGHTNING PRO M 42,000.00 27,300.00 7,500.00 34,800.00 83 7,200.00 0.223 IGHTNING PRO L 18,000.00 11,700.00 3,000.00 14,700.00 82 3,300.00 0.224 ALLOWANCE 17 40,000.00 10,765.00 10,765.00 27 29,235.00 0.225 CHANGE ORDER #1 0.226 OCULUS ALTERNATE 1,000.00 1,000.00 1,000 00 100 0.227 CHANGE ORDER 42 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 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 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 Document G703 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 G703, 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 a aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that 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 oil 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 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. The following is an example of e? Continuation Sheet for work in progress. Please note that duller arnuunts shown below are for illustrative purposes only, and are not intended to reflect actual construction costs. A U c D r E c n WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY CUNIPLLTEU kE "I AINAn E. I'NLM SCIIEDULED ERO I PREVIOUS TO NO DESCRIPTION OP N'ORK VAIUF APPLICATION THIS PERIOD N OI ID AND9 r' (G SCI FINISH 11E VARIABLE (D F,) D OR OTE) lD TODA'r {0 OI RATE) D C] I +P) 1 MOBILIZATION 5,000 5,000 0 C 5000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTHWORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5.000 5 CURBS 6 MISC. CONIC. 5,000 0 0 0 0 0 5,00c 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 a 0 0 0 0 20,000 a PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICKWORK 5,000 0 0 0 0 0 5,000 10 11 1 i 105 000 20,000 10,00c) 1 0,000 4 0,000 65,000 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 AlA o 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. ERMCO Contract fit` 2695 -4320 AIA TM 124070 Document G703 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION'NO: 2 4 containing Contractor's signed certification is attached. 4/15/2010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on Contracts where variable retainage for line items may apply, PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F:::. G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (G C) FINISH G) (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 0.228 MACHINELESS ELEVATOR 11,500.00 11,500.00 11,500.00 100 0.229 HANGE ORDER #3 0.230 RCP 4 (58,85100) (58,852.00) (58,852.00) 10,.0 0.231 HANGE ORDER #004 NO COAT 0.232 HANGE ORDER 005 0.233 31-037, RCP- 006 23,177.00 19,500.00 19;500.00 84 3,677.00 0.234 HANGE ORDER 006 0.235 RCP-01 1 (7,554.00) (7,554.00) (7,554.00) 100 0.236 CHANGE ORDER #007 0.237 S1 -038 18,732.00 16,500.00 16,500.00 88 2,232.00 0238 CHANGE ORDER 008 0239 ALLOWANCE 4320A ELEC GENEF (350,000.00) (350,000.00) (350,000.00) 100 0.240 ALLOWANCE 4330A FIRE ALARM (75,000.00) (75,000.00) (75,000.00) 100 0.241 ALLOWANCE 43306 FIRE /SECUR (5,000.00) (5,000.00) (5,000.00) 100 0242 ALLOWANCE 4320D ELECTRICAL (10,000.00) (10,000.00) (1.0,000.00) 100 0.243 BOND REDUCTION FOR ALLOW 1 (2,715.00) (2,715.00) (2,715.00) 100 0.244 CHANGE ORDER 009 0.245 WORK DIRECTIVE 4320 -001 NE 0.246 CHANGE ORDER 010 0.247 AS I- PAC -104 WATER HEATER AE 17,090.00 9,500.00 2,500.00 12,000.00 70 5,090.00 0.248 E3.03 0.249 LIGHTING R -M 30,000.00 25,100.00 2,600.00 27;700.00 92 2,300.00 0.250 LIGHTING R -L 35,000.00 24,500.00 5,000.00 29;500.00 84 5,500.00 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 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 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. Document G703 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Docwnent, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written pennission 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 G703, 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 a aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that were listed on the previous application under Materials Presently Stored (column F). Column F. Enter here the value of Materials Presently Stored ]or 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 ofcolumns 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 1. This column is normally used only for contracts where variable rctainage 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 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. The following is an example qJ a Continuation Sheefft)r work in progress. Please note that dollcm amounts shown below are for illustrative pur poses only, and are not intended io reflect actual construction costs. A N C D E F C I I I WORK W'LLIED MATERIALS 'TOTAL BALANCE- PRFSFN "rLl' COMPLETED RE'rA I:lAOE ITEM SCHF.UULE.D F1i0Yl PR F,V IOUS "/n TO NO ULSCRfI''I'IDN OF WORK V7,LUE AYFLICA'fIQN TIiIS 1'ERIpD STORED ANDSPORIED (0; C) PIN]SII (Ir VARIAN.P, (D e E) (NOT IN 'I'O DATE. D OR CI rD.F,DATE. (C- G) RATE) 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5 000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20.000 0 0 10,000 10,000 50 10000 9 BRICKWORK 5,000 0 0 0 0 0 5000 t0 I1 105 000 20, 000 1 0,000 10,000 4 0,00 0 65,000 AIA Document G703TIV 1992- Copyright 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 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. �lJ� 1A ERMCO Contract 4� 2695 -4320 Document G703TM -1992 124 070 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, 24 APPLIGA.TION. °N.O: containing Contractor's sicced certification is attached. APPLICATION DATE: 4/15/2010 In tabulations below, amounts are stated to the nearest dollar. 4/30/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T ARCHITECT'S PROJECT NO: A B C D E F G H WORKCOMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS TO PRESENTLY COMPLETED RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G C) FINISH NQ (D E) (NO OR N O �D D (C G) RATE) FF) 0.251 IGHTING F -M 350,000.00 277,178.00 48,500.00 325,678.00 93 24,322.00 0.252 IGHTING F L 22,000.00 5,000.00 2,500.00 7,500.00 34 14,500.00 0.253 HANGE ORDER 11 0,254 kLLOWANCE FROM 4320B ALLOT (100,000.00) (100 (100,000.00) 100 0.255 4 1LOWANCE TO 4320A „,ALLOW 1 100,000.00 100,000.00 100,000. 100 0256 ALLOW REDUCTION 4320B ALLO (30,000.00) (30,000.00) (30 100 0.257 BOND REDUCTION (186.00) (186.00) (186:00) 100 7,037,192.00 5,965,820.56 299,281.19 6,265 89 772,090.25 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 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 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 Document G703 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents. AIA Document G702, Application and Certificate for Payment, is to be used in conjunction with AIA Document. G703, Continuation Sheet. These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201, General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition. Reproductions. This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the ATA. There is no implied pcnnission 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 G703, but only for use in connection with a particular project. The AlA 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 (FULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyt aia.org. COMPLETING G703 -1992 Heading. This information should be completed in a manner consistent with similar information on AIA Document G702, Application and Certificate for Payment. Columns A, B C. These columns should be completed by identifying the various portions of the Project and their scheduled values 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. Colurnn 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 in the project that 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 t. 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 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. The following is an trample of a Continuation Shen t fir work in progress. Please note that dollar amounts shown below cure for illustrative par poses only, and ore not intended to ref7eci actual construction costs. A B C D l F G H I WORK COMPLF 'r ED MATERLAI_$ 7QT. \L VALANCE PRF.SEN'rLY C;OMPI_ETED ItETAINAGE ITEM SCIIEDULLD FROM PRFVIOUS TU NO. 17ESCHIP'I'IUN'Or \VORK VALU17 APPLICA'nON '1'I I IS PERIOD S'1'OREU AND STORED I( FINISH (IF VARIABLfi IN FIN TO E+F RACE) ID' L1 D OR E) fD +E +1� fC 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 loo 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS d MISC. CONC. 5,000 0 0 0 0 0 5,000 6 PAVING, UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING, LOWER DRIVE 20,000 0 0 0 0 0 20,000 a PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 1 105,000 1 20,000 1 10,000 1 10,000 1 40,000 1 1 65,000 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 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. AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA Final Partial X )SS: COUNTY OF MARION Rod Burton being duly sworn states that he is the Controller of ERMCO, INC. having contracted with Cit of Carmel 124070.024 to furnish certain materials and /or labor as follows: Electrical Installation for a project known as Parcel 7A Regional Performing Arts Center Interior Rough Construction Package P4 located in Carmel, IN and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of THREE HUNDRED THOUSAND SEVEN HUNDRED NINETY DOLLARS AND 49/100($300,790.49) the receipt of which is hereby acknowledged: or X the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO, INC. by /tJ` Rod Burton Controller Witness my hand and notarial seal, this 15 day of April, 2010 n Notary Public My Commission Expires 12/19//2015 Lou Anne Puckett Notary Public- Printed Signature County of Residence: Marion AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA Final Partial X )SS: COUNTY OF MARION Rod Burton being duly sworn states that he is the Controller of ERMCO, INC. having contracted with City of Carmel (124070.024) to furnish certain materials and /or labor as follows: Electrical Installation for a project known as Parcel 7A, Regional Performing Arts Center Interior Rough Construction Package P4 located in Carmel, 1N and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of ONE HUNDRED SEVENTY NINE THOUSAND FIVE HUNDRED DOLLARS AND NO /100($179,500.00) the receipt of which is hereby acknowledged: or X the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO, INC. by ��Z/ Rod Burton Controller Witness my hand and notarial seal, this 15 day of April, 2010) 7_ Notary Public My Commission Expires 12/19//2015 Lou Anne Puckett Notary Public- Printed Signature County of Residence: Marion AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA Final Partial X )SS: COUNTY OF MARION Rod Burton being duly sworn states that he is the Controller of ERMCO, INC. having contracted with City of Carmel 124070.rel 20RT 21A 21B 22C 22R to furnish certain materials and /or labor as follows: Electrical Installation for a project known as Parcel 7A Regional Performing Arts Center Interior Rough Construction Package P4 located in Carmel, IN and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of NINE HUNDRED EIGHTY FIVE THOUSAND SIX HUNDRED FIFTY ONE DOLLARS AND 34/100 (S985,651.34) X the receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other parry has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO, INC. by Rod Burton Controller Witness my hand and notarial seal, this 20` day of April, 20 1,0 Notary Public My Commission Expires 12/1912015 Lou Anne Puckett Notary Public- Printed Signature County of Residence: Marion Light fixtures stored off site THIS BILLING DATED' 2/10/2010 Type count Crenshaw lighting costs Type per each count Total Ship Feb Ship Mar Ship Apr F1 $28,750.00 10 $287,500.00 Mar F1A $17,250.00 1 $17,250.00 Mar F1 B $17,020.00 2 $34,040.00 Mar F2 $34,500.00 2 $69,000.00 Apr F2A $30,434.00 4 $121,736.00 Apr F3 $52,900.00 2 $105,800.00 Apr F5 $920.00 100 $92,000.00 Feb F6 $1,725.00 10 $17,250.00 Feb F8 $1,725.00 32 $55,200.00 Feb HA $1,495.00 11 $16,445.00 Feb F9 $414.00 257 $106,398.00 Apr F9A $322.00 12 $3,864.00 Apr F10 $437.00 32 $13,984.00 Apr F10A $437.00 130 $56,810.00 Apr ROMOD $437.00 14 $6,118.00 Apr F14 $690.00 34 $23,460.00 Apr F18 $1,380.00 48 $66,240.00 Apr F20 $1,495.00 64 $95,680.00 Feb F22 $862.00 28 $24,136.00 Apr FE1 $8,050.00 3 $24,150.00 Apr FE3 $2,875.00 12 $34,500.00 Feb FE4 $1,150.00 16 $18,400.00 Feb FE5 $1,725.00 6 $10,350.00 Feb Total i 1,300,311.00 $339,825.00 $338,790.00 $555,456.00 $678,615.00 ,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. Payee '?:�z rw, fr r Purchase Order No. I �aX /SG7 Terms `s. Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) 70.�Wy Total 3 U!% 7�a- 1 I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and 1 have audited same in accordance with IC 5- 11- 10 -1.6. 20 Clerk Treasurer .VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Pay from TIF Board Members PO# or INVOICE NO. ACCT /TITLE AMOUNT I hereby y invoice( s), DEPT. y certif that the attached invoices or �2 2 �/�Co�o7 3po 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 201<5 op I ature Dire ctor of e eveloprnefl, Title Cost distribution ledger classification if claim paid motor vehicle highway fund