189650 09/14/2010 CITY OF CARMEL, INDIANA VENDOR: 363784 Page 1 of 1
0 ONE CIVIC SQUARE POYNTER SHEET METAL CHECK AMOUNT: $18,101.00
CARMEL, INDIANA 46032 PO BOX 427
BLOOMINGTON IN 47402 -0427 CHECK NUMBER: 189650
CHECK DATE: 9/14/2010
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
902 4460807 APP 23 -B 18,101.00 PAC JUNE
APPLICATION AND CERTIFICATION FOR PAYMENT A DOCUMENTG702 PAGE ONE OF I PA 4 HI
hO OWNER: PROJECT: Parccl 7A. Regional Performing APPLICATION NO: 23-B Distribution to:
Carmel Redct elopmcnt Commission Arts Center OWNER
One CiVK' S jU1rC PERIOD TO. 30- Jun -10 r7ARCI-IITECT
Carmel. IN 46032
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Shiel- Scxton Co.. In( PROJECT NO: 2695 -4310 F]CONTRACI'OR
l'oyntrrShcct A- teial. Inc•. Att: Lynda Weaver PSM 14065 F1
8765 N, SR '3 902 N. Capital Avenue 0
Bloomington. IN 4740.1 Indianapolis. IN 46204 CONTRACT DATE 18- Apr -08
CONTRACT FOR: 18163- 1570 -00 -00133
CONTRACTOR'S APPLICATION FOR PAYMENT The undersig Co ntractor certifies that to the bes of the Contractor knowled
Application is made for payment, as shown below in connection with the Contract informa €ion and belief the Work covered by this Application for Pavntent has beer
Continuation Sheet_ AIA Document G703, is attached completed in accordance cvith the Contract Documents. that all amounts have been paid b.�
the Contractor Yor Work 1or which previous Certificates for PaYnnem were issued and
payments received from the Owner, and that current payment shown herein is now due
L- ORIGINAL. CONTRACT SUM 2._340.500
2. Net chanEc by Change Orders S (87239) CONTRACTOR Poynter t Metal
3. CONTRACT SUM TO DATE (Line I 2) S 2.253,26 t
4_ TOTAL COMPLETED K STORED TO 2,218.032
DATE (Column G on G703) 13v:
Dat
5_ RETAINAGE: Joseph Lausdc Pr ode
a 5 of Completed Work S 112.663 State of Indiana 11,1 County of 1
(Col-min D F_ on G703) Subscribed and sworn to bc^,:yre this TO a
In ofStored Material S 0 Notary Public, p j
(Column I: on G703) My Commission expires
Total Retainage (Lines 5a 5b or
Toted in Column I ofG703) 112.663 ARCHITECT'S CERTIFICATE FOR PAYMENT
6_ TOTAL EARNED LESS RETAINAGE S !-.21 In accordance vvith the Contract Documents, based on on -site ohservations and the dat.
tL_.ine 4 Less Line 5 Total; comprising the application,_ the Architect certifies to the 0mier that to the best of th,
7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge information and belief the Work has progressed as indicated
PAYNIFNT (Line 6 from prior Certificate) S 2.199931 the quality of the Work is in accordance with the Contract Documents. and the Contract()
8 CURRENT PAYMENT DUE S 18,101 is entitled to payment ofthe.AkIOUNTCI RTIFIED
9. BALANCE TO FINISH. INCLUDING RETAINAGE
(f, one 3 Less Line 6 AMOUNT CERTIFIED S Z
CHANGH. ORDER SUMMARY ADDITIONS DEDUC'I'ION$ "'(Tt r(rclr anrurnn r rrn"n cel d rJ ers m r{ r lice n gill 'S an u
Total changes approved I ppl c�ntro nrtd arrthe Cnntir�ucrtlon Sheet due! cu'e chrtrrged ro cur fnrm til�ith tJre aurorrret certrJiecl J���
it) prcvious months by Owner $87,761 S175,000 ARCIf[IhC`
Total approv this Month $o S0 t3v. Date:
TOTALS $47.761 S 175,000 This Certified is not ne e. The AlMOUNT CERTIFIED is payable only to the
Contractor med here Issuance, payment and acceptance of payment arc without
NET CHANGES hp Chnn_e Order (S87-23 prejudice o any r s of the Owner or Contractor under this Contract.
AIA DOCUMENT G702 APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AI l 01992 THEAME N INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., N.W., WASHINGTON, DC 20006 -5292
CONTINUATION SHEET AIA DOCUMENTG703 2 PAGE or PAGES 4
AIA Document 6702, APPLICATION AND CERTIFICATION FOR I'AtiT1EN "r. containing A4'PL1CATlON NO: 23R
Cuntractur's signedcertilication is attached .APPLICATION DATE: C; 1 =.1/:.'.010
In tabulations b0ow, amounts are stated to the nearest dollar. I'SM .JOB#: 14065 PERIOD T0: 30/201D
Use Column I on Contracts where variablc retuinagc for line items may apply. NAME Carmel PAC CONTRACT NO 2595 4310
A B C D E F G H I
L1NE DESCRIP "FION OF WORK SCHEDULED WORK C'OMPLE FED MATERIALS TOTAL o BALANCE RETAIN,IGE
NO_ VALUE FROM PREVIOUS THIS PERIOD PRESENTLY CONII'LETED (c, C) TO FlNIS11 (IF VARIABLE.
APPLICATION STORED AND S I ORLD (C G) R,1TEi
i D E i (NOT IN TO DATE
D OR E) 1D +E +FI 5
I GENERAL CONDITIONS 200.000.00 S20().000 SO $o `6200,( }00 100% $10,000
2 BOND INSURANCE 45.000.00 $45,000 $o $0 $45,000 100% $2?50
3 MOBILIZATION 15.000.00 $15.000 $0 $0 $15,000 100% $760
4 ALLOWANCE NO 11 BP 4310 651.00 $0 $0 $0 $0 0% 5651 $0
5 ALLOWANCE NO 16 CAD AS- BUILTS 10.000.00 55,000 $5,000 $0 $10,000 100% $500
6 DRAWINGS /COORDINATION 80.000.00 580,000 $0 $0 $80,000 100% $4.000
7 MECH BASEMENT LEVEL
8 MATERIAL 48,000.00 543,000 $0 $0 $48,000 100% $2,400
9 LABOR 50,700.00 $50.193 $0 $0 $50,193 99% $507 52,510
tO LAGGING 7.000.00 $7.000 $0 So $7,000 100% 5360
II BACKHOUSE
12 MATERIAL 56,000.00 $6,000 SO $0 556,000 t00% $7,S00
G LABOR 59,000.00 $59,000 50 $0 $59,000 t00% $2,950
14 KITCHEN HOOD DUCT
15 MATERIAL 15.400.00 515,=400 $0 SO $15.=400 100 %a $770
16 LABOR 10.800.00 $10 $0 SO '610,800 100% $540
17 INSULATION 10,100.00 $10,100 So $0 $10.100 100% 5505
IS MECH RM 1
19 MATERIAL 50.400.00 $50.400 $0 $0 $5o.400 100% $2,520
20 LABOR 56,300.00 $56,300 $0 $0 `656.3 100% 52,815
21 INSULATION 16,800.00 $16,800 $0 $0 $16 800 100% 8840
22 MECH RM 2
23 MATERIAL 77.000.00 $77,000 $0 $0 .'672000 100% $3.850
24 LABOR 93.900.00 $93.900 $0 $0 $93,900 100% $4.695
25 INSULATION 16,800.00 $6,720 $10.080 $0 $16 100`6. $840
26 MECH RM 3
27 MATERIAL 84,900.00 $84 $0 50 "4.900 100 %1 $4,245
IS LABOR 94,500.00 S94500 $0 $0 $94,600 100% 54,725
29 INSULATION 16.800.00 $16,800 V) $0 $16,800 100% 5840
30 PLENUM LEVEL
31 MATERIAL 49.100.00 549.100 $0 $U $49.100 100% $2,455
32 LABOR 75,000.00 575,000 $0 SO 573.000 100% $3,750
33 LAGGING 13.000.00 `$13.000 $0 SO $13.000 100% $650
34 ORCHESTRA HIGH LEVEL
35 MATERIAL 34.600.00 S34600 $0 5o 534600 100% $1,730
36 LABOR 35.400.00 $33 630 $0 $0 533.630 95% $1,770 $1.682
37 ORCHESTRA LOW LEVEL
38 MATERIAL 49.400.00 '$49,400 SO 50 ;'49.400 100% $3.470
39 LABOR 62.600.00 S�9.470 $0 $0 $59.470 95 /n $3.130 $2.974
J CONTINUATION SKEET AAA D OC UM ENT G703 3 PAGE OF PAGES
AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT_ containing APPLICATION No 23D
Contractor's signed certification is attached. APPLICATION DA FI 6 19 j x'.0
In tabulations below, amounts are stated to the nearest dollar. PSM JOR9 14065 PERIOD TO: G 3 0/ 2010
Use Column 1 on Contracts where variable retainaee fix line items may appl%. NAME Carmel PAC CONTRACT NO: 2b 05 431. G
A B C D E
LINE DESCRIPTION OF WORK SCHEDULED WORD CO3MPLETED MATERIALS TOTAL BALANCE RETAINAGE
NO VALUE FRO \4 PREVIOUS THIS PERIOD PRESEN FLY COMPLETED (G C) TO FINISH (IF VAR LABLE
APPLICATION STORED AND STORED (C GI RATE)
(D -E) (NOT IN TODATL
D OR El (D -ETFI 3 1
40 BOX TIER LEVEL
41 MATERIAL 70,000.00 $70,000 $0 $0 $70,000 IGO% 53.500
42 LABOR 100,300.00 595.285 $0 $n $95,285 95'% $5.015 54764
43 LOW BALCONY LEVEL
44 MATERIAL 94,100.00 S94,t00 $0 $0 $94,100 100 0 /0 $4,705
45 LABOR 85,300.00 S8L035 $0 SO $81,035 95% S4266 S4,052
46 HIGH BALCONY LEVEL
47 MATERIAL 38,400.00 $33,400 $0 $0 $38,400 100% $1,920
48 LABOR 50,200.00 S47 690 $0 $0 $47 95% 52,510 $2,383
49 ATTIC LEVEL +50
50 MATERIAL 41,600.00 541,600 $0 SO $41 100% $2.080
51 LABOR 44,700.00 S42,465 $0 $0 $42,465 95% 52.235 $2.123
52 ATTIC LEVEL +61
53 MATERIAL 16,800.00 $16.800 $o $0 $16,800 100 5840
54 LABOR 16,300.00 515,485 $o S0 $15.485 95% $815 $774
33 ATTIC LEVEL +66
56 MATERIAL 39,500.00 539,500 $0 $O $39,500 100% $1,975
57 LABOR 37,900.00 536.005 $0 $0 $36,005 95% $1.895 51.800
58 ATTIC LEVEL +79 -6
59 MATERIAL 6,700400 56.700 $0 $0 $6,700 100% 5335
60 LABOR 5,200.00 55.142 S(1 SO $5 99% $58 5257
4 -A ALLOWANCE NO. 11 BP 431O(ASI -031) 7,322.00 ST= $O $0 $7,322 100% $366
4 -B ALLOWANCE NO 11 BP 431 OA -002 10,000.00 $7,51 S SO $0 $7,518 75% $2.482 $376
4 -C ALLOWANCE NO 11 BP 431OB -002 4,798.00 54,793 SO $0 54,798 100% 5240
4 -D ALLOWANCE NO 11 BP 431OB -003 1,534.00 SI-534 SO $0 $1.534 100% $77
4 -E. ALLOWANCE NO 11 BP 431OB -004 27,142.00 S2T142 'S'O $0 $2214'- 100' $1,357
4 -F ALLOWANCE NO 11 BP 431OB -005 9,625.00 59,625 SO $0 52625 100% $481
4 ALLOWANCE NO 11 BP 431OB -006 175.000.00 5175,000 $0 $0 $175,000 100% $9,750
4 -11 ALLOWANCE NO 11 BP 431OB -007 546.00 $546 SO $0 $546 100% $27
4 -1 ALLOWANCE NO 11 BP 431OB -008 10,933.00 510.933 SO $0 $10.933 100% $547
4 -J ALLOWANCE NO 11 BP 431OB -009 12,449.00 $12449 SO $0 $12.449 100% $622
4 -K ALLOWANCE NO 11 BP 431OB -010 $30K $0 $0 R) SO 0% $0
4 -L ALLOWANCE NO 11 BP 431OB -011 5,001.00 $o $0 $0 $0 0/ $0
4 -1%1I ALLOWANCE NO 11 BP 431OB -012 3,021.00 $0 $0 SO $0 0% S0
4 -0 ALLOWANCE NO 11 BP 43108 -013 6,103.00 $0 $0 $0 SO 0% $0
4-P ALL NO 11 BP 431OB -014 5,979.00 $0 1 $0 1 SD I $0 I I $0
CONTINUATION SHEET AIA DOCUMENTG703 4 PAGE OF PAGES 4
AIA Ducumen[ 6702, AI'I'I_ICATION AND CLRTIFICAT[ON POR PA1'RJI N"I', containing APPLICA TION NO 233
Contractor's signed certification is attached. APPLICATION DATE G% 1.i1'20io
In tabulations belo��, amounts are stated to the nearest dollar, PSM J0134 14065 PI_RIOD TO: 6x'3 /2010
Use Column I on Contracts where variable retainage for line items may appl.v. NAMIi Carmel PAC CONTRACT NO 2695 4310
r\ B
L IN E DESCRIPTIONOlrWORK SCHEDULED WORKC0;AjPL1-TI ,.D MATERIALS TOTAL BAL.ANCF RETAINAGB
N0. VALUE 1 °ROAI P RTE V10US TI711S PERIOD PRESFV'TI,Y COMPLETED (G C) TO FINISI I €F VARIABLE
APPLICATION STORED AND STORED IC G) RATF.1
ID (NOT IN 1 0 DATE
D OR L') (D -E +F)
900 PENDING CHANGE ORDERS
901 CHANGE ORDER #1 38,542.00 $38,$42 $0 $0 $38,542 100% 51.927
902 CHANGE ORDER #2 (RCP -10) 19,219.00 $19,219 $o $o $19,219 100% $961
903 CHANGE ORDER #3 BP 431OB 005 175,000.00 ($1 75,000) $0 $o ($175,000) 100% ($8,750)
904
903 CHANGE ORDER #5 $30.000 $17,083 '63,021 $0 $20,104 67% $2896 $1,005
$2,2 3 2,19993 14,101 0 2?[8,03" 98% 35,229 112,663
SHEET MErAL
POYNTER SHEET METAL, INC.
CONTRACTOR'S AFFIDAVIT AND WAIVER OF LIEN
PARTIAL (X) FINAL,
We, the undersigned, having been employed by CARMEL REDEVELOPMENT
COMMISSION furnish labor and materials to do construction work on the premises known as
PARCEL 7A, CARMEL REGIONAL PERFORMING ARTS CENTER hereby warrant that
the premises of the above named _job cannot be made subject to any valid lien by anyone who
furnished material, supplies, labor or services to the undersigned for use in the above named
project for any labor, materials or supplies furnished or services performed through 06/30/10 to
the extent that the undersigned has been paid as set forth herein.
This waiver is given in order to induce payment in the amount of 518,101.00 and upon receipt of
the amount due by the undersigned, this waiver as to the amount due becomes valid, enforceable
and of full effect. Upon attachment of the canceled check and the legal description of the
project, this waiver may be recorded by the Owner or mortgage holder(s) of the project.
This Contractor's Affidavit and Waiver o1" Lien only applies to the extent paid, and does not
apply to or cover retention, unresolved claims or unresolved changes, change orders or change
requests.
Given under our hand and seal this 14""' day of JUNE, 2010
POYNTER S E TAL, INC.
Signature o -ed Representative
Joseph R. Lansdell
PRESIDENT
Title of Authorized Representative
STATE OF: Indiana
COUNTY OF: Monroe
Subscribed and sworn to before me this 14 day of JUNE, 2010
(Notary Public)
Commission Expires: August 29, 2014
County of Residence: Morgan
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
10 0y;'2 f-, '71 Purchase Order No.
F76 F Terms
`oe)k 1
1y �an /lv Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
6/31) to 23 2 7
Total
1 hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
x
ON ACCOUNT OF APPROPRIATION FOR
//O
Board Members
PO# or p PT. INVOICE NO. ACCT #!TITLE AMOUNT 1 hereby certify that the attached invoice(s), or
902 Z 3 q�'�eGi 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
9 9 20 1,:57
Signature
pirector of Redevelopment
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund