187178 07/06/2010 a CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1
ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP
s CHECK AMOUNT: $968,994.04
CARMEL, INDIANA 46032 7930 CASTLEWAY DRIVE
INDIANAPOLIS IN 46250 CHECK NUMBER: 187178
CHECK DATE: 7/6/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 15 968,994.04 PERFORMING ARTS CENTE
Document G7021CMa TM -1992
Application and Certificate for Payment Construction Manager Adviser Edition
TO OWNER: CARMEL REDEVELOPMENT COM ,JECT: Carmel Regional Performing Art APPLICATION NO: APP #:.00015 Distribution to:
211 City Center Drive
Carmel. IN 46032 PERIOD TO: 4/30/2010 OWNER X
CONSTRUCTION MANAGER X
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 1/30/2008 ARCHITECT ❑X
Hagerman Construction Corp Dave Brewer
P.O. Box 10690 Shiel Sexton PROJECT NOS: 08- 2619 -11 1 CONTRACTOR El
Fort Wayne, IN 46853 -0690 VIA ARCHITECT: Brandon Bogart INVOICE NO: 9745 FIELD
CSO Architects Inc
CONTRACT FOR: Masonry 1-1
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and
Application is made for payment, as shown below, in connection with the Contract, belief the Work covered by this Application for Payment has been completed 'in accordance with the
Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous
6 126.000.00 Certificates for Payment were issued and payments received from the Owner, and that current
1. ORIGINAL CONTRACT SUM
2. Net change by Change Orders 93%223.1 CO:0�f CTOR: ]agerman Co traction C
3. CONTRACT SUM TO DATE Line 1 +.2 y ro e s er, ontrolleat
4. TOTAL COMPLETED STORED TO DATE (Column G on G703) 6
704-423 i c Sta In Lan a y er Dat e nl n
5. RETAINAGE: County of: Allen �SS %'a.
P Subscribed and sworn to:before
a. 27 of Com leted Work
(Column D E on G703) 353.261.16 me this 19 1 b. %n of Stored Material Notary Public.
(Column F on G703) My Commission
Total Retainabe (Lines 5a +5b or Total in Column I of G703).. 351261.1 CERTIFICATE FOR PAYMENT A.LfyL,v *o r'
In accordance with the Contract Documents, based on on -site observatioN}%y", tkV4 *,c °°inpnsing
6. TOTAL EARNED LESS RETAINAGE 6 151 161 9 9 this application, the Construction Manager and Architect certify to the Owner t, 4,to.the best of their
(Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quaftty'of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 5.381167.9 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
CURRENT PAYMENT DUE I s 968.994.4 AMOUNT CERTIFIED 968.994.04
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amoitnt,upplied. Initial all figures on this
Application a td on the Continuation Sheet that are chai zg_ed to confortt� with the amount certified.)
Line 3 less Line 6 714.06 L 16 CONSTRUCT ON M R:
Dave Brewer Shicl Sexton
By: (n Date: Z Z l
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT:; Br Bop-an CSO Architects Inc
Total changes approved m previous months by Owner 939,223. 1 By: Date:
Total approved this`Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS 939,223.15 named herein. Issuance payment and acceptance of payment are without prejudice to any rights of
the Owner or Contractor under this Contract.
NET CHANGES by Change Order 939 223.15
1 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured.
AIA Document G702 /CMaTM —1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties.
Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law.
Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
a
Document G702/CMa TIM -1992 Instructions
Application and Certificate for Payment Construction Manager Adviser Edition
A. General Information
AIA Document G7021CMa, Application and Certificate for Payment, Construction Manager Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A2011CMa, General
Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition.
B. Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org.
C. Completing the G7021CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G7021CMa, Application and
Cerlificate for Payment, Construction Manager Adviser Edition.
The Contractor should sign G702 /CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect.
The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G7021CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G702 /CMa, Application and Certificate for Payment,
Construction Manager- Adviser Edition.
Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of
values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors
and should remain consistent throughout the Project. Multiple pages should be used when required.
Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum.
The total of column C may be adjusted by Change Orders during the Project.
Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F
(Materials Presently Stored) from the previous application should not be entered in this column.
Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the
previous application under Materials Presently Stored (column F).
Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period.
This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment
by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this
column and incorporated into column E (Work Completed This Period).
Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C.
Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date).
Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. it need not be completed on projects where a
constant retainage is withheld from the overall contract amount.
Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not
normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G702 /CMaJorm.
Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change
Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa.
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702 /CMa,
Application and Certificate for Payment, Construction Manager- Adviser Edition. The completed form contains the name and address of the Contractor. Payment should
not be made to any other party unless specifically indicated on G702 /CMa.
AIA Document G702(CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S.
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.
CONTINUATION SHEET AIA DOCUNIENTG703" PAGE. I OF 2 I'A(:;[-"s
AAA [)ocumem G702, APPLICATION AND Cl RTIFICA'1'E F()R PA YN11"N'l, APPLICATION NO,: 00015
containing (7-cimmictoes sinned Cerrific:mon, is atl'jdlcd. A Pill, I CATI ON DATF:
I n latsulatiolls below. arnoulits 1,11V Stated w flx-, vlear(*t dol PERIOD TOE 4i101 010
t Isc Column I tin Coill racl,-, where variable retAinage for kne items may apply. ARC IJk0JI'CI' Nf 'OX 1
A C
W'(WK CONIftr .4 I'M Al- HALAM'1" RFTAINAGI�
!T 11 A
I DF-�CWW) 0F kVORK SCHENJI'l-'r) FRON4 11REVICA!" NFISEN"I'L V 0)"11PLETED TO IF 1 "AkbWl-7z;
NO STCRED A ND S'L0K 1)
VALUE AlPLICA'110N 1111S PDUOD !N TO ')A J'F (2 FINISH RATF
I if) 1) OR, F i I
00000 SOM so'ool som 50-00 $0.00
000000
0000010 GENERAL
0000020 Bonding I ri'tium Ott $56,000 00 50,00 $0,00 $0.00
00DO030 SubmMals 000 00 50100 00 100.000 50.00 $000
0000040 Project Me-e-,in95 S IW)00.00 59 S500,00i 50,00 59,500,00 95,000 $0M
00001050 MobdizWnn 528,000.00 528.000.00 so()(] so -001 528,000.00 100.000 MOD $0.00
0000080 Demobilization 525,00000 SO-o0 SO,O() $0- Moo 0 325,000.00 $0,00
0040070 C w 1! a.;1 Close Out scl SO,oO 50.00 S(Loo 50,00 0 56,000.00 Woo
0000080 .Allowance As -bulls 55,000.00 Sul Som 51"%00 so.w 0 55,000,00 So..00
0000100 MASONRY i
0000110 CNIM Nlrnh Labor 530.000-00 $30.00C.0011 SC1,00 56'00 S 100,000 9s0-00 $0:00
0000120 CMU east Labor 525,000100 525.000.001 S G. 01) so'co sa Ono oo 100.000 SoM S0,00
0000 130 C M U £x1:151 aba; 537.1300.00 50.00( $35,156,00 SO.00 S35.!50,1)0 95,000 $1,850,00
0000',4L) CMIJ West Labor S25.000M $0.001 S23,7`i0M S0'D0 573,75000 95,000 $'1,250,00
0000150 CMIJ Drurn Labor 5I9.000'00 53t),000.00i WOO 50,00 S5 100,000 $0,00 $0.60
0000160 CtAU Norio MateflatS 59.001M sqmo.00� $0,00 50,00 sq Do MAW S0100 $0.00 1
170001 Mu Fast Materials S7.000100 57.000.001 50,00 $0,00 57.000-00 100.000 $0,00 SOM�
4000180 C Sown Materials W.000100 $0.00! S9500.00 SO-00 $9.500.00 95,060 $500,00 50.00
on 00 1 0 CPAU Wes: NlalwaN 57,000.00 $0.001 S6,650M, 50,00 56.65000 95.000 $350.00 SOM
OGW200 CIMU Drum 4Niateiials 5 12.000.00 S12,000-00� $0,00 SO'w S 12 100,000 $0.00 $0.010
W0021 Vapor Barrier Labot $i62.000.00 162.000,00 $Uo 50100 51152-000M 100I000 $0.00 SOM
0000220 Vapor Barrier Materials $98.000.00 598,4o0'00i so-Oo 50.00 598 1=000 $0.00 50.00
0000240 EXTERIOR VFNEER
0000250 Granite Labor 5205.000,00 $194.750,ODI 50 so-rlo S15Z'750M 95-000 S10250.00 $000
0000260 Gran4e Matenals SMKOOD'Go S.504.000,00 50,00 S504,00D�00 100�000 SO $0,00
000 L mwone N Latxof $87a,000:00 Sa78;0()O,Qol $0,00 SO-PO $878,000,00 100.000 $0,00 WOO
0000280 Limestone Nor uhh'alemils, $126,000_00 5126,000.00I SOM $0.00 S126,ODC.00 '100-000 $0.00 $0.0o
0000290 Limestone East La,"; 5734 $719.320-00 $114:680-00 50.00 5734.000:00 100,000 $0.00 Mon
0000300 Umesione East Wterials $107,00000 $107.000,OD $0.00 50.00 S107,000,00 100=0 $0.00 s4.06
0060310 Limestone Swirl Labor 5890,000.00 S534,00000 $311,50000 $0,00 5 5 95,0001 $44,5 SO
0000M e5
Lfmtor�e Sou h maierials S 5105.600.00 S19,800M 50,00 $1 25400;001 95,W01 sa,600.00 $0.001
AIA DOCUMENT G703 APiUCAIION AND CFWr1FlCA'm r(:jk pky.vL yl, 197 ION mXg- 01"2 111P YORK G703-1992
AvC,,Ur;, N M!, WASHWIGION, 1),(' 200"421.1 WARNING: Unlicongod pbolonapyinil violates U-S. Copyright taws and will stit)jed th6'%'1Gl'1zof to legal wosecution.
CONTINUATION SHEET AIA DOCUMENT C.1703 ;'A(;i 2 Ol' 2
AAA Doctanew 6702. APPLICATION ANI) PAYIMFNT, APPLICATION N 00015
containing Contractor's signet! Ccrilfication, i$ allajlcd APPLICATION I)ATEI:
III tabulfilions below. -alm'.null's are staled to the mcnrem dollw% ITRI01) TO: 40,0
Use Column I on Co ntracts whuc variabic rei:iinagt: for line iims may -.Ipjyly. ON2619A
A It
WORK COMP1,17ly-1) MATERIALS TOTAI,
L 11 t COM P LETED To
Df--SCRiM (IF W()KK SCI FROM I*Evious STOKED .1UNT C I Q R ]F VARIABLE)
I HN fS I i
VALUL APPIj('ATJ(YN T] IIS PLRIOT.) 04 IN M I)ATE t6 Co
0000330 Limestone West LuDof S734.000,00 $440 40000 5256.900.00 S0,00 r-,697,300.00 95.000 $36,700,00 $0-00
00003 umemonp west M werials 5107,000M $85,601:1,00 1 0 700,00 so DO $96.300,00 90,000 S10300,00 $0.00
0000350 r—asl S Oum Lanor S24S,000.00 $249,000,00 S0,00 S0,00 S20,000M 1=000 50.00 MOO
0000360 Czi,&l Stone Owm Material $330,000.00 $330,000.00 $0.00 $0,00 5330,000M 100,000 SOLOO 50.0
0000370 Clewing 4 Caulking Labw $288.000.00 $86,400.00 586,4()O,M so.ou S 172.800.00 60,000 $115,200,00 MOO
0000380 Oeaninu -9 Cautkim Materials S2X 1.000,00 S72,300,00 572.300.00 50.00 51'.4,800.00 07,000 S56 $(Lbo
0000440 CHANGE OROEIRS
0000410 CO x Limestone Ftelc Sium-
WOO-420 1-4nestone Field Labor 5480,000.00 S384,000.00 556,0010,0o so'col 54811,000,00 100,000 $0,00 SOAX)
0000430 I-Imeswe Field 1,18 urial 5250.()00.00 S225.000M 525;300,011 SO 00 5250,1330.00 100.000 $0.00 som
0000450 CO t 2 Drum Veneel
0000460 C%jm Veneer Labor 51 10.000.00 S 1 10,000.00 S0.00 51.00 $110 100000 50.00 $0.00
0000470 Orum Veneer f0aia"jals 590,000100 S90.000,00 50.00 S0.01 590,00{5.00 100.000 50,000 50.00
0000490 t' 0 ti3 PAC 0 GFan to foie am t
0000500 Granile. Labor 5360.11 5M 03 $0.00 $492.14 100:000 $0,00 SOM
0000510 Go anile mwle6al $7.1150.00 57.150.00 $0.00 SOM 57,15C1_00 100,000 $0,00 $0.00
00005M CO t, Granite [)not Jamb
0000540 Granite Labw S41,01 50,00 54 1.01 59.00 $41 IO0.()00 $0.00 $G a
I
0000550 Granite M314--lial 5 1 .640.00 S1,540,00 S0,00 SO 51 ,540,1110 MOM() $9.00 50.00
57,085,2 S5,7'35,429.11 $968,9CM,N $0.00 $5,704.423.1 94M% 5,360,800.00 50.
ALA DOCUMENT G703- APKIC A P,0N AN'D CTP.Tirtc.An: F6R'PAYMF'Kl 092 I'DIT)ON AlA* 011'�92 I i G703-1 §92
AVENGU NW- WASIll"iMON, Dr(", WARNING: Unlicensed photocopying violates U_S. copyright laws and YAII subjact tho Aolator to legal prosecution.
m "ot, M, s#mraa
WAIVER OF LIEN
The undersigned is the duly authorizedofficerof Hagerman ronst n;nt;nn Om, parat the general contractor,
(Name of Company)
subcontractor,' matedalman or other person furnishing the 'services, labor, material or equipment indicated below in. the
construction of improvements upon real estate located in Hamilton County, State of Indiana, commonly
known as Regicral PerfccmL g Arts which real estate is owned.by ioa R� 1 gpl�t "Owner
Y
IN CONSIDERATION of the sum of Five million three h xdred eighty tvio tlmusarad cne hnxdLed sixty sever r o cxnm
66dL RS 5,382,167-95 receipt of which is hereby acknowledged, and in order to procure one or more payments
for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit
claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction
costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above'desedbed
which the Company may now have forservices, labor, material or equipment furnished in respect of such land or improvements
to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim forpayment
nor any right to perfect a lien against the real estate, and that he has the right to execute thi waiver and release of liens on
behalf of himself (herself) and the Company.
The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to
the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received
hereunder. The undersigned further states that the consideration received hereunder is the sole-consideration received by
the Company for said senrices,labor, material or equipment furnished to date, and that the Company has neither received nor
made any security interest, title retention interest or lien rights in the said services, labor, material or equipment otherthan that
released and transferred hereby.
The material, labor, services or equipment furnished are more particularly described in the affidavit for payment submitted of
even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage
requirements under applicable law or as may be set forth in the contract documents.
WITNESS the execution hereof this 19th day of April 2010
Troy Hesse Ttle}
Controller
Hagerman Construction Corporation
(Name of Company)
State of Indiana County of Allen SS: Before me, the
undersigned, a Notary Public in and for said County and State, personally appeared Troy Heisler
the co ntroller of Ha ge rman C'ni3stni t Cn=r_�tinn who acknowledged
(Title) (Name of Company)
the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act and deed of such
Company and the free act and deed of said officer.
WITNESS my hand and notarial seat this 19th day of Aril 2010
A
�o•�1R1>Mlsaf�l�V �9d,
My Commission Expires: %bery
Notary Public
12/16/15
A10TARySrAL o
O T
My County of Residence: -0�. c9j, David C. Thomas
(Printed Name of Notary Public)
Allen ,STAM
f
,Presciibed 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 gym1
Purchase Order No.
P 0 13 o7f /0 6 9C% Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
r
�y
k
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
�4'%'�C��d �G�'� /��F�o� CoY� IN SUM OF
U�x /O6 Sa
Aa 4 I Z6.53 11 6 9D
q� x91/.6 y
ON ACCOUNT OF APPROPRIATION FOR
Pay from TIF L LL
Board Members
PO or INVOICE NO. ACCT# /TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
S- 20/G7
Owl
Signature
Director of Redevelopmffd
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund