189648 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 362310 Page 1 of 1
ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP
0 CHECK AMOUNT: $28,897.50
CARMEL, INDIANA 46032 7930 CASTLEWAY DRIVE
o� is INDIANAPOLIS IN 46250 CHECK NUMBER: 189648
CHECK DATE: 9114/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 26 28,897.50 PAC JUNE
e
I' TM
Document G7021CMa 992 zg
Application and Certificat6 foir Payment Construction Manager Adviser Edition
TO OWNER: PROJECT:Parcel 7A, RegiCnal PerfoLZnilx� Arts APPLICATION NO 26. Distribution to:
Carmel Redevelopment Commission meter
City of Carmel HCC Job #2613 PERIOD TO 06/30%10 OWNER 11
Carmel, IN 46032
Invoice #9829 CONSTRUCTION MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT
Hagerman Construction Corporation 2695
P.O. Box 10690 Shiel Sexton PROJECT NOS: 1 E CONTRACTOR
Fort Wayne, IN 46853 VIA ARCHITECT: FIELD
CSO Architects
CONTRACT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersi Contractor certifies that to the best of the Contractor knowled 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 frorn the Owner, and that current
1. ORIGINAL CONTRACT SUM 5,588,000.00 payment shown herein is now due.
2. Net change by Change Orders 343,671.00 CONTRACTOR: Hagerman Construction Corporation
3. 4. TOTAL C OMPLETED STORED TO DATE (Column G on G703) ,5,918,893.00 21, 201
State of: Richard E. Sutorius; Secretary Da^
Indiana pP•..;1 R F
5. RETAINAGE. County of: Allen
a
a. of Completed Work Subscribed and swor n to b re
Column D E on G703 296, 583.55 me thisls J 10
b. �Io of Stored Material Notary Pub i 7}
(Column F on G703) My Commission expires. /1 j N(I'
Total Retaina (Lines 5a 5b or Total in column I of G703) 296,5%3. CERTIFICATE FOR PAYMENT.
In accordance with the Contract Documents, based on on -site obse% i a�td° df°1 comprising
6. TOTAL EARNED LESS RETTA� knowledge,
NAGE 5,622,309.45 5,622,309.45 this the on and belie he Work has Arc d'
f dfie best of their
progressed as indicated, the quality of the Work is in
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 5,593, accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT
(Line 6 from prior Certificate) CERTIFIED.
SfO
8. CURRENT PAYMENT DUE I s 2B,897.501 AMOUNT CERTIFIED 2
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from t maunl applied. Initial all figures on. this
Application and o to Continuation She licit ar ch nged to conform with the amotint ce ti fed.)
(Line 3 less Line 6) 309, 361.55 CONSTRUCTION N E
By: Date:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI
Total changes approved in previous months by Owner $371 By: Date: tS2f
Total approved this Month —0— —0— This Certi ate is n t. ne tiable. The AMOUNT CERTIFIED is payable only to the Contractor
TOTALS $371,646.0 27,975.fl0 named rein. Issuari payment and acceptance of payment are without prejudice to any rights of
NET CHANGES by Change Order
$343, 671.00 the Q er or Co ctor under this Contract. r
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 G7021CMalm 1992. Copyright O 1992 by The American Institute of Architects. All rights reserved. WARNING: This A10 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
s
Document G702/CMa 1992 Instructions
Application and Certificate for Payment Construction Manager- Adviser Edition
A. General Information
AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703,
Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a
constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General
Conditions of the Contract for Construction, Construction Manager Adviser Edition, 1992 Edition.
B.' Reproductions
This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no Implied permission to
reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document.
The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular
project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission
from the AIA.
Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA).
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org,
C. Completing the G7021CMa Form
After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and
Certificate for Payment, Construction Manager- Adviser Edition.
The Contractor should sign G702/CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect,
The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The
Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures
on G702 /CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded
to the Owner.
D. Completing the G703 Form
Heading: This information should be completed to be consistent with similar information on AIA Document G7021CMa, 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 (3703 form or at the`entl of the basic schedule. The amount of the original contract
adjusted by Change Orders is to be entered in the appropriate location on the G7027CMa 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 7:31 A201 /CMa.. a
E. Making Payment
The Owner should make payment directly to the Contractor based on the amount certifiedby the Construction Manager and Architect on AIA Document G702 /CMa,
Application and Certificate for Payment, Construction Manager Adviser Edition. The c`ompleted 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 G7021CMaTM 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 INs document when completed.
To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@a aia.org.
CONTINUATION SHEET AIA DOCUMENT G70 PACE OF5PACES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00026
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2410
Use Column I on Contracts where variable retainage for line iterns may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL BALANCE RETAWAGE
ITEM
PRESENTLY COMPLETED TO IF VARIABLE)
e
DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS /o
NO. VALUE STORED AND STORED FINISH RATE
APPLICATION THIS PERIOD (NOT IN TO DATE (G =C
(D E) D OR E) (D +E +F) (C G}
0000010 GENERAL CONDITIONS
0000020 Bond $41,375.00 $41,375.00 $0.00 $0.00 541,375,00 100.000 $0.00 $0.00
0000030 General Conditions $169,586.00 $167,890.14 $1,695.86 $0.00 $169,586.00 100.000 $0.00 $0.00
0000040 Supervision /Engineering $320,164.00 $316,962.36 53,201.64 $0.00 $320,164.00 100.000 $0.00 $0 .00
0000045 Equipment l Operators $383,328.00 $383,328.00 $0.00 $0.00 $383,328.00 100.000 $0.00 $0.00
0000050 Owner Allowance $55,000.00 $42,222.00 $0.00 $0.00 $42,222.00 76.767 $12,778.00 $0.00
0000055 Subtotal General Conditions $969,453.00 $951,777.50 $4,897.50 $0.00 $956,675.00 98.682 $12,778.00 $0.00
0000060 EARTHWORK
0000070 Excavation Backfill $795,000.00 $795,000.00 50.00 $0.00 $795,000.00 100.000 $0.00 $0.00
0000080 Site Utilities $200,000.00 $176,000.00 $24,000.00 $0.00 $200,000.00 100.000 $0.00 50.00
0000090 Soil Treatment (Termiticide) $6,448.00 $6 $0.00 $0.00 $6,448.00 100.000 $0.00 $0.00
0000095 Subtotal Earthwork $1,001,448.00 $977,448.00 $24,000.00 $0.00 $1,001,448.00 100.000 $0.00 50.00
0000110 CONCRETE
0000120 Footings Labor $206,046.00 $206,046.00 $0.00 $0.00 $206,046.00 100.000 $0.00 $0.00
0000130 Footings Material $202,588.00 $202,588.00 $0.00 $0.00 $202,588.00 100.000 $0.00 $0.00
0000140 Foundation Walls /Piers Labor $603,561.00 $603,561.00 $0.00 $0.00 $603,561.00 100.000 $0.00 $0.00
0000150 Foundation Walls /Piers Material $414,224.00 $414,224.00 $0.00 $0.00 $414,224.00 100.000 $0.00 $0.00
0000160 Slabs on Grade Labor $47,650.00 $47,650.00 $0.00 $0.00 $47,650.00 100.000 $0.00 $0.00
0000170 Slabs on Grade Material $91,157.00 $91,157.00 $0.00 $0.00 $91,157.00 100.000 $0.00 $0.00
0000180 Elevated Slabs Labor $29,485.00 $29,485.00 $0.00 $0.00 $29,485.00 100.000 $0.00 $0.00
0000190 Elevated Slabs Material $24,740.00 524,740.00 $0.00 $0.00 $24,740.00 100.000 $0.00 $0.00
0000200 Elevator Shafts Labor 5167,945.00 $167,945.00 $0.00 $0.00 $167,945.00 100.000 $0.00 $0.00
0000210 Elevator Shafts Material $61,125.00 561,125.00 $0.00 $0.00 $61,125.00 100.000 $0.00 $0.00
0000220 Columns Labor $134,436.00 $134,436.00 $0.00 $0.00 $134,436.00 100.000 $0.00 $000
0000230 Columns Material $51,221.00 S51,221.00 $0,00 $0.00 $51,221.00 100.000 $01)0 $0.00
0000240 Slabs on Metal Deck Labor $116,191.00 $116,191.00 50.00 $0.00 $116,191.00 100.000 50.00 $0.00
0000250 Slabs on Metal Deck Material $245,878.00 $245,878.00 $0.00 $0.00 $245,878.00 100.000 $0.00 $0.00
0000260 Topping Slab /Stair /Curb Labor $88,023.00 588,02100 $0.00 $0.00 $88,023.00 100.000 $0.00 $0.00
0000270 Topping Slab /Stair /Curb Material 561,026.00 561,026.00 $0.00 $0.00 $61,026.00 100.000 50.00 $0.00
0000280 Rebar Labor $239,605.00 $239,605.00 $0.00 $0.00 $239,605.00 100.000 10.00 10.00
0000290 Rebar Material $406,775.00 $406,775.00 $0.00 $0.00 $406,775.00 100.000 $0.00 $0.00
0000300 Misc. Metals Labor 1 $27,015.00 $27,015.00 $0.00 $0.00 $27,015.00 100.000 $0.00 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 199' EDr1 AIAt9 r 1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK G703 -1992
AVENUE. N.W.. WASHINGTON, n -C. 20006 -5392 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
"This document has been reproduced eYectronically will the oermis -c of The American Institute of Arcnc-m mod., License 97003 to Primavera Systems, Inc, Reproduction of leis document withoul projecFspecific informalion is nor permitted, Cenlad The Americae 1ne1 of Archlteas
to verify the current version of this document and license status.'
CONTINUATION SHEET AIA DOCUMENT 6703 PAGE 2 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE. FOR PAYMENT, APPLICATION NO.: 00026
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO._ 082613A
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED RETAINAGE
DESCRIPTION OF WORK FROM t RED IOLS STORED AND STORED TO IF VARIABLE)
NO. VALUE APPLICATION THIS PERIOD FINISH RATE
t IN TO DATE (G =C}
(D E) D OR E) (D +E +F)
0000310 Misc. Metals Material 538,003.00 $38,003.00 $0.00 $0.00 $38,003.00 100.000 $0.00 $0.00
0000315 Subtotal Concrete $3,256,694.00 $3,256,694.00 $0.00 $0.00 $3,256,694.00 100.000 $0.00 $0.00
0000330 THERMAL AND MOISTURE PROTECTION
0000340 Insulation Labor $3,877.00 $3,877.00 $0.00 $0.00 $3,877.00 100.000 $0.00 $0.00
0000350 Insulation Material $15,268.00 $15,268.00 $0.00 $0.00 $15,268.00 100.000 $0.00 $0.00
0000360 Waterproofing Labor 590,000.00 $90,000.00 $0.00 $0.00 $90,000.00 100.000 $0.00 SO -00
0000370 Waterproofing Material $122,960.00 $122,960.00 $0.00 $0.00 $122,960.00 100.000 $0.00 $0.00
0000380 Caulking Labor 513,300.00 $13,300.00 50.00 $0.00 $13,300.00 100.000 $0.00 SO.00
0000390 Caulking Material $16,600.00 $16,600.00 $0.00 $0.00 $16,600.00 100.000 $0.00 50.00
0000400 Subtotal Thermal Moisture Protection $262,005.00 $262,005.00 $0.00 $0.00 $262,005.00 100.000 $0.00 $0.00
0000420 SPECIAL CONSTRUCTION
0000430 Vibration Sound Control Jack Up Floor Systel $98,400.00 S98,400.00 $0.00 $0.00 $98,400.00 100.000 $0.00 $0.00
0000450 CHANGE ORDER #01
0000460 Alternate Parking ($20,000.00) ($20,000.00) $0.00 50.00 ($20,000.00) 100.000 $0.00 $0.00
0000480 CHANGE ORDER #02
0000490 Oculus Alternate $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.000 $0.00 $0.00
0000510 CHANGE ORDER #03
0000520 PC 10R2 Elevator Changes $27,828.00 $27,828.00 S0.00 $0.00 $27,828.00 100.000 $0.00 $0.00
0000540 CHANGE ORDER #04
0000550 PC10R2- Elevator Changes 511,926.00 $11,926.00 $0.00 $0.00 $11,926.00 100.000 $0.00 50.00
0000570 CHANGE ORDER #05
0000580 PC 18 Sanitary Sewer Force Main Piping $9,707.00 S9,707.00 $0.00 $0.00 $9,707.00 100.000 $0.00 50.00
0000600 CHANGE ORDER #06
0000610 PC 05R1 ASI #2 Speaker Boxes $26,221.00 $26,221.00 $0.00 $0.00 $26,221.00 100.000 $0.00 $0.00
0000630 CHANGE ORDER #07
AIA DOCUMENT G703- APPLICATION AND CERTII TE FOR PAYMENT 1992 EDIT €ON AIAO t 199? THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NIFW YORK G703 -1992
A VENUE. N.W.. WASHINGTON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
'This document has been reproduced eleclronically with the permission of The American Institute of Architects under License 97903 to Primavera Svstems, Inc- Reproduction of this document withaut project specific information Is not permitted. Contact Tne American Institute e1 Architects
to verify the current version of this document and license status.'
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00026
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082613A
A B C D E F G H 1
WORK COMPLETED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED d TO 1ZETA VARIABLE)
AGE
DESCRIPTION OF WORK FROM PREVIOUS STORED AND STORED IF VARI
NO. VALUE APPLICATION THIS PERIOD FINISH RATE
{NOT IN TO DATE -C
(D E) D OR E) (D +E +F)
0000640 PC 12R1 Foundation Changes $6,744.00 $5,744.00 S0.00 $0.00 55,744.00 100.000 $0.00 50.00
0000660 CHANGE ORDER #08
0000670 PC #15R1 Reduce Size of HDPE Pipe ($1,175.00) ($1,175.00) $0.00 $0.00 ($1,175.00) 100.000 $0.00 50.00
0000690 CHANGE ORDER #09
0000700 PC 22 HDPE Single Wall Pipe $554.00 $554.00 $0.00 $0.00 $554.00 100.000 $0.00 $0.00
0000720 CHANGE ORDER #10
0000730 PC 23 Change Drainage Layer Stone $14,139.00 $14,139.00 $0.00 $0.00 $14,139.00 100.000 $0.00 $0.00
0000750 CHANGE ORDER #11
0000760 PC 04R2 ASI #1 Modification to Utility Tunne S1,757.00 51.757.00 $0.00 $0.00 $1,757.00 100 000 $0.00 50.00
0000780 CHANGE ORDER #12
0000790 PC 06R2 ASI #3 Added Columns $12,142.00 $12,142.00 $0 -00 $0.00 $12,142.00 100.000 $0.00 S0.00
0000810 CHANGE ORDER #13
0000820 PC 09R2 ASI #6 Various Changes $22,449.00 $22,449.00 $0.00 $0.00 $22,449.00 100.000 $0.00 $0.00
0000840 CHANGE ORDER 914
0000850 PC 09132 ASI 96 Various Changes $32,257.00 $32,257.00 $0.00 $0-00 $32,257.00 100.000 $0.00 50.00
0000870 CHANGE ORDER #15
0000880 PC 02R1 Added Extended Piers $6,578.00 $6,578.00 $0.00 $0.00 56,578.00 100.000 $0.00 $0.00
0000900 CHANGE ORDER 416
0000910 PC 35 Water Main Sleeve 51,757.00 $1,757.00 $0.00 $0.00 $1,757.00 100.000 $0.00 50.00
0000930 CHANGE ORDER 417
0000940 PC 05R1 Speaker Boxes West $29,820.00 $29,820.00 $0.00 $0.00 529,820.00 100000 $0.00 $0.00
0000960 CHANGE ORDER #18
0000970 PC 3482 ASI #40 Sanitary Force Main $18,987.00 $18,987.00 $0.00 $0.00 $18,987.00 100.000 $0.00 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA-A? X1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NFW YORK G703 -1992
AVLNUE. N.W. WASHINGTON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
'This document has been reproduced electronically wile the permission of The American Institute of Architects under License 970031. Primavera Systems, inc. Reproduction.I this document without projectspecific information Is not permitted. Contact The American Institute of Architects
to verity the current version of this document and license status
CONTINUATION SHEET AIA DOCU G703 PAGE 4 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT APPLICATION NO.: 00026
containing Contractor's signed Certification, is attached. APPLICATION DATE.:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2010
Use Colunm I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 08261.3A
A B C D E F G H 1
WORK CONIPLE7 ED MATERIALS TOTAL BALANCE
ITEM SCHEDULED PRESENTLY COMPLETED d TO RETAINAGE
DESCRIPTION 01 WORK FROM PREY IOU$ �0 E= STORED AND STORED FINISH 1F VARIABLE)
NO. VALUE THIS PERIOD (NOT IN TO DATE (G=C) RATE
(C G)
(D F) D OR E) (D -E +F)
0000990 CHANGE ORDER #19
0001000 Credit for Commercial Stone in lieu of INDOT ($6,800.00) ($6,800.00) $0.00 $0.00 ($6,800.00) 100.000 S0.00 $0.00
0001020 CHANGE ORDER #20
0001030 PC 26 ASI #11 Added Curbs $5,428.00 $5,428.00 $0.00 $0.00 $5,428.00 100000 $0.00 S0.00
0001050 CHANGE ORDER #21
0001060 PC 27132 ASI 17 Utilitly Vault Modifications $8,505.00 $8,505.00 $0.00 $0.00 $8,505.00 100.000 $0.00 $0.00
0001080 CHANGE ORDER #22
0001090 PC 07 Unsuitable Soils at Tunnel $22,060.00 $22,060.00 $0.00 $0.00 $22,060.04 100.000 $0.00 $0.00
0001110 CHANGE ORDER 423
0001120 PC 03 Unsuitable Soils $9,520.00 $9,520.00 $0.00 $0.00 $9,520.00 100.000 $0.00 50.00
0001140 CHANGE ORDER #24
0001150 PC 33 Unsuitable Soils $3,678.00 $3,678.00 $0.00 $0.00 $3,678.00 100.000 $0.00 50.00
0001170 CHANGE ORDER #25
0001180 PC 37 Generator Slab $2,132.00 $2,132.00 $0.00 $0.00 $2,132.00 100.000 $0.00 S0.00
0001200 CHANGE ORDER #27
0001210 PC 31 Added Masonry Footing S3,75100 $3,751.00 $0.00 $0.00 53,751.00 100.000 $0.00 $0.00
0001230 CHANGE ORDER #28
0001240 PC 4181 ASI #27 SOG Modifications $4,293.00 $4,293.00 $0.00 $0.00 $4,293.00 100.000 $0.00 $0.00
0001260 CHANGE ORDER #29
0001270 PC 28R1 ASI #18 Garbage Vacuum Pit $3,181.00 S3,181.00 $0.00 $0.00 $3.181.00 100.000 $0.00 $0.00
0001290 CHANGE ORDER #30
0001300 PC 29 ASI #21 South Entrance Stairs $7,870.00 $7,870.00 $0.00 $0.00 $7,870.00 100.000 $0.00 50.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIAa� 40199 THE AUIERECAN INSTITUTE OF ARCHITECTS. 1735 NE-W YORK G703 -1992
AVENUE. N.W.. W.ASHINGI ON. D.C. 20006 -5292 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
'This document has been reproduced electronically with the permission of The American Institute of Architects antler Lccense 97003 to f=rimavera Systems, Inc. Reproduction of this documem without proje Tspecific Inbrmation Is not permitted. Comaa The AmeriCae Insrlture of Archnec
ro verify the -nor, version of this document and license status."
CONTINUATION SHEET AIA DOCUMENT G703 PAGE 5 OF 5 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: 00026
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 6/30/2010
Use Column I on Contracts where variable retainage for line items may apply. ARCHIT'ECT'S PROJECT NO.: 082613A
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL BALANCE
PRESENTLY COMPLETED RETAiNAGE
ITEM DESCRIPTION OF WORK SCHEDULED I•ROM PRI =V[OUS TO IF VARIABLE)
NO. VALUE SPORED AND STORED FINISH
APPLICATION ']'HIS PI�RIOD (NOT IN TO DATE (G C) RATE
(C G)
(D F) D OR E) (D' F +F)
0001320 CHANGE ORDER #31
0001330 PC 30R1 ASI 922 Platform Lift Plt $5,106.00 $5,106.00 $0.00 $0.00 $5,106.00 100.000 $0.00 $0.00
0001350 CHANGE ORDER #32
0001360 PC 31 Column Encasement East 527,521.00 $27,521.00 $0.00 $0.00 527,521.00 100.000 $0.00 $0.00
0001380 CHANGE ORDER #33
0001390 PC 36R4 Column Encasement West 528,000.00 $28,000.00 $0.00 $0.00 $28,000.00 100.000 $0.0D $0.00
0001410 CHANGE ORDER #34
0001420 PC 43R1 Slab Openings $1,414.00 $1,414.00 $0.00 $0.00 $1,414.00 100.000 $0.00 $0.00
0001440 CHANGE ORDER #35
0001450 PC 4581 Saw Cutting of f=oundation Wall $1,419.00 $1,419.00 $0.00 $0.00 $1,419.00 100.000 $0.00 50.00
0001470 CHANGE ORDER #37
0001480 PC 42R1 ASI #68 Columns Modifications $2,671.00 52,671.00 $0.00 $0.00 $2,671.00 100.000 $0.00 S0.00
0001500 CHANGE ORDER 438
0001510 PC 51 Chipping Gutter Wall to 4' $1,784.00 51,784.00 $0.00 $0.00 $1,784.00 100.000 $0.00 $0.00
0001530 CHANGE ORDER #39
0001540 PC 49 Locate Water Main Valve $1,447.00 $1,447.00 $0.00 $0.00 $1,447.00 100.000 $0.00 30.00
$5,931,671.00 $5,889,995.50 $28,897.50 $0.00 $5,918,893.00 99.78% $12,778.00 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PA1'M6NT f99 EDITION AIA,5) C1992 THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NFW YORK G703_1992
AVENUE. N.W.. A'ASHINGTON. D.C- 20006 -5392 WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
"This document has been reproduced eledroni -Ily with the permission of The American Institute of Architects under License 97003 to Primavera Svstems. Inc. Reproduction of this document without pn i]e speafio information is not permitted. Contact The American Institute of Architects
Ip verify the current version of [his document and license status.'
WAIVER OF LIEN
The undersigned is the duly authorized officer of Hagtnrman C ons tnic t- inn C'nr poration the general contractor,
(Name of Company)
subcontractor,' materialman or other person furnishing the 'services, labor, material or equipment indicated below in the
construction of improvements upon real estate located in Hami 1 ton .County, State o€ 'Indiana commonly
known as carme i Perform Arts which real estate is owned mPi Rr cpmPn�_ "Owner').
Center Commission
INCONSIDERATION of the sumof Five mMicn six tna>db�d twenty two tharnrO three haired trine and 45/100
1300LARS 5, 622, 309.45 receipt of which is hereby acknowledged, and in order to procure one or more payments
for services, labor, material or equipmentprovided in such construction, the Company does hereby waive, release and quit
claim In favor of the Owner of the real estate and the fender 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 Ifens upon the land or improvements above'described
which the Company may now have forsetvices, labor, material or equipmentfumished i n respect of such land or improvements
to and including the date hereof. The undersignedwarrants that the Company has not and will not assign anyplaimforpayment
nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on
behalf of himself (herself) and the Company.
The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to
the services, labor, material or equipment to the Owners or lenders named above in consideration of the payment received
hereunder. The undersigned further states that the consideration received hereunder is the sole-consideration received by
the Company for said services,labor, material or equipment furnished to date, and that the Company has neither received nor
made any security interest, title retention interest or lien rfghts in the said services, labor, material or equipment otherthan that
released and transferred hereby.
The material, labor, services or equipment furnished aie 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 21st day of June 2010
Y
(Name- and Ttlp,)
Richard E. Sutorius, Secretary
_�cjPrman Consi r1int• i nn rorporat iAtl
(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 Richard E. Suto
the secretary_ of-H who acknowledged
(Title) (Name of Company)
the execution of the foregoing Walver 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 seal this 21st day of June 2010
YY'i Jl,"
••11.1••
My Commission Expires: �pMMIS,�j'• O',"
a�� 'pmblo �q Notary Public
4 !o
12 16 15
My County of Residence: 9 q,9 41 y gt.. David C. Thom
.r,�� (Printed Name of Notary Public)
Allen ,STgTFrjF�1`4
PAYROLL CERTIFICATION
PROTECT NO. HCC Job #2613
#2695
I CERTIFY THAT THE -PAYROLL RECORDS FOR HaTbrman. Construction Corporation
(Comractor)
PAY PERIOD FROM 4?10JID TO 6 ARE`.TRUE AND CORRECT, TO
THE BEST OF MY KNOWLEDGE AND BELIEF AND THE WAGE
REQUIRED BY I.C. 5- 16 -7 -1 HAS BEEN ADHERED TO.
STATE OF Tnci.iA.n a
SS:
COUNTY OF All
BEFORE ME, THE UNDERSIGNED, A NOTARY PUBLIC, PERSONALLY
(Name) (Tide)
ACKNOWLEDGED EXECUTION OF THE ABOVE CERTIFICATION
THIS
DAY OF '?'d?YD
'&p4
0 ip NOTARY PUBLIC (sipatme)
f
7 0 *see 1 David C. Thomas
C�Q R
lid, s F NAME (Printed)
MY COMMISSION EXPIRES: RESIDING IN Allen COUNTY
12/16/1.5_
REV 2198 S.OBC -7
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
y Pi (��'�7S rv�/ ,'or.� Ld vZ Iv IL o Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
G /3 Ile 2 1- 26 2 5 7.5 a
Total 2Y F�7 Sp
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
i+Ct'ry/,'� >�i C �7s� .c l G 9 Co D'�org/ IN SUM OF
ON ACCOUNT OF APPROPRIATION FOR
c� yi/6DS 0 7
Board Members
PO# or DEPT. INVOICE NO. ACCT #/TITLE AMOUNT I hereby certify that the attached invoice(s), or
2� VW,5a7 2,F 97 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
1 i 20 is
Director &MWSIOPMefit
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund