177996 10/13/2009 CITY OF C4RMEL, INDIANA VENDOR: 362310 Page 1 of 1
ONE CIVIC SQUARE HAGERMAN CONSTRUCTION CORP CHECK AMOUNT: $27,461.12
CARMEL, INDIANA 46032 7930 CASTLEWAY DRIVE
«o INDIANAPOLIS IN 46250 CHECK NUMBER: 177996
CHECK DATE: 10/13/2009
DEPARTMENT ACCOUNT P NUMBER IN VOICE NUMBER AMOUNT DESCRIPTION
902, 4460867 9320 12,445.97 INDIANA DESIGN CENTER
902 4460867 9322 12,810.15 INDIANA DESIGN CENTER
902 4460867 9323 1,102.50 INDIANA DESIGN CENTER
902 4460867 9356 1,102.50 INDIANA DESIGN CENTER
k
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF PAGES
TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 Streetscape APPLICATION NO: C0007 Distribution to:
City of Carmel PERIOD TO: 5/31/2009 [:1 OWNER
Carmel, IN 46032 HCC Job #2691
Invoke #9356 PROJECTNOS.: 082691A ARCHITECT
FROM CONTRACTOR: Hagerman Construction Corporation VIA ARCHITECT: CSO Architects Inc CONTRACTOR
7930 Castleway Drive 280 East 96th Street
Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CONTRACT DATE:
CONT FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this application for Payment has been completed
Application is made for payment, as shown below, in connection with the contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM $22,050.00 CONTRACTO Hagerman Construction Corporation
2. Net change by Change Orders $0.00 ate:. ,May 19 2 009
By:
3. CONTRACT SUM TO DATE (Line I ±2) $22,050.00 roy eisler, CFO r;l,rl C. 1 j
4. TOTAL COMPLETED STORED TO DATE $22,050.00 State of: Indiana LLt °ASS /0
Allen i G N r
(Column G on 0703) County of: a ac�� �cem e �7�o
C o
5. RETAINAGE: Subscribed and sworn to before m
0 c o cnrn+
a. 0 of Completed Work $0.00 me this 19th day of May, 2009 nt Jr V SEAL
(Columns D E on 0703)
b. 0 of Stored Material $0.00 Notary Pub Y(OUM'
(Columns F on 0703) My Commission expires: 12/16/15
Total Reta;n s I o n07 6or $0.00
Total in C ARCHITECT'S CERTIFICATE FOR PAYMENT
C ol u mn s I on G703)
6. TOTAL EARNED LESS RETAINAGE %21 050.0 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) $20,947.50 quality of the Work is in accordance with the Contract Documents, and the Contractor
8.-CURRENT PAYMENT DUE $1,102.50 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED -1
.w.
(Line 3 less Line 6) (Attach explanation i amount certified differs from the amount applied for. Initial
$0.00 all, rgures on t Ap lication and on the Continuation Sheet that are changed to
conform tot e amou t cer
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE T: CS cl t
Total changes approved in
$0.00
p revious months b Owner $0.00 BY Date:
Total approved this Month $0.00 $0.00
TOTALS $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
$0.00 Contractor. named herein. Issuance, payment and acceptance of payment are without
NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIAe ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G702 -1992
AVENUE, 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 with the permission of The American Institute of Architects under License 97003 to Primavera systems. Inc. Reproduction of this document without project specific information Is not permitted. Contact The American Insdtule of Architens
to verity the current version of this document and license status."
CONTINUATION SHEET AIA DOCUMENT G7 PAGE OF I PAGES
AIA Document 0702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: C0007
containing Contractor's signed Certification, is attached. APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 5/31/2009
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082691A
A B C D E F G H 7RETArNAGE
WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED PRESENTLY COMPLETED
DESCRII TION OF WORK FROM PREVIOUS TO STORED AND STORED (NOT IN TO DATE (G -C) NO. VALUE APPLICATION THIS PERIOD FINISH
(D E) D OR E) (D +E +F)
0000010 Curb Work
0000030 Robert Indiana Street Curbs
0000040 General Conditions $1,675.00 $1,675.00 $0.00 $0.00 $1,675.00 100.000 $0.00 $0.00
0000050 Concrete Work Curbs Only $7,480.00 $7,480.00 $0.00 $0.00 $7,480.00 100.000 $0.00 $0.00
0000070 Rangeline Road Curbs
0000080 General Conditions $1,675.00 $1,675.00 $0.00 $0.00 $1,675.00 100.000 $0.00 $0.00
0000090 Concrete Work Curbs Only $11,220.00 $11,220.00 $0.00 $0.00 $11,220.00 100.000 $0.00 $0.00
$22,050.00 $22,050.00 $0.00 $0.00 $22,050.001 100.00% $0.001 $0.00
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AIA® ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK G703 -1992
AVENUE, 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 with the permission of The American Institute of Architects under License 97003 to primary— Systems, Inc. Reproduction of this document without projecl-specific information Is not permitted. Contact The American Institute of Architects
to verify the current version or this document and license status.'
l
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702 PAGEONEOF PAGES
TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 Streelscape APPLICATION NO: C0006 Distribution to:
City of Carmel HCC Job #2691 PERIODTO: 4/25/2009 OWNER
Carmel, IN 46032 Invoice #9323 PROJECT NOS.: 082691A ARCI-11'fLCf
FROM CONTRACTOR: Hagerman Construction Corporation \rlA ARCWTEC'T: CSO Architects Inc CONTRACTOR
7930 Castleway Drive 280 East 96th Street
Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CONTRACT DATE: 0
C FOR:
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certi Pies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this application for Payment has been completed
Application is made for payment, a shown below, in eomlection with the contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM S22.Q50.00 CONTRACTOR: Hagerman Construction Corporation
2. Net change by Change Orders $0.00 By 4 Date: Apr_ i l 20, 2009
3. CONTRACT SUM TO DATE (Line 1 r 2) 522,050.00 r0 H islet t CFO
State of. Indiana
4, TOTAL COMPLETED STORED TO DATE $22,050.00 P•
County of: Allen o e :4 SrOlh
(Column G on G703) S. RETAINAGE: Subscribed and sworn to before
me this v ril r 200 a. 5.000 oCCanpleteJ Work $1.102.50 (Colutttns D E on G703) Notary Pu N, %Tft;ySUL
b. 0 °roofSrored -Material S0.00 y S ?t:(;��`. •:C.'
t.olunuu F on G703 M Commission e
y 12/1615 �.;F c�
Total Retauiage(Liac5a +5b or S1,102.50 ARCHITECT'S CERTIFICATE FOR PAYMENT
Total in Colutruis I on G703)
6. TOTAL EARNED LESS RETAINAGE S!0.947.5 In accordance with the Contract Documents, based on on -site observations and the data
(Line 4 less Line 5 Tot-at) comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect know information and belief the Rork has progressed as indicated the
(Line 6 from prior Certificate) 519.845.00 quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE S 1,102.5( is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RIETAINAGE AMOUNT CERTIFIED I.....
(Litre 3 lc�s Line 6) (Attach explunution ifamount :edified diers from the urnount upplied for. Initial
51,10.50 clif fibnues un rh' plieation undon the Continuatinn Sheet that are changed to
unr c tI d.)
corj»m rn a urn
CIiAN tl; ORDL?L SUMMARY ADDITION DEDUCTION ARCHIT I c e s c
Total changes approved in By. Date: 3a
revious months b Owner S 0.00 50.00
$0.00 x;0,00 e
TOTALS $0.00 S0.0 Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein. Issuance, payment and acceptance of payment are without
rL'T CHANGES by Chang Order $0.00 p rejudice to any rig hts of the Owner or Contractor under this Contract.
AIA DOCUMENT G702• APPLICATION AND CERTU 1C_ATF FOR PAYMENT l992 LDITION AIAx ,,1092 T1IL AMERICAN INSTITLTL OF t ?CTS, 1735 NL1Y PORK G702 -1992
A VLNUE, N,W„ W'ASIiINGTON, D.C. 20(W WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
'TN, doa°nant M, hem mr, du f °IUtronitvdN wnh de pemieelnn of The /vrono°n Innvw:e M Ani,iacc ,ndn Uanse 9/003 w F4nevao S'a�crta, Y+c RapMuc'ion o! ;h• axurwnt wltl»u: t�olseapoctiM ntttr.,y�a is n°t vmtFed. Cmtec! The M�aicm Inftiv'e a MhreCn
M vmth, he aerent venlen M Jv, dx end 6C4tile geol.'
WAIVER OF LIEN
The undersigned is the dulyauthorized office rof Hagerman Construction Corporati 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 Hamilton County, State of Indiana commonly
known as Parce l 67 Streetscape, Tndih real estate is owned. by Camel
ReJMmlcpnmt03mAssicn Owner").
Design Center P12
INCONSIDERATION of the sumof One thousand one hundred two any Sn /100
DOLLARS 1,102.50 receipt of which is hereby acknowledged, and in order to procure one or more p ayments
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 orclaim or right to liens upon the land or improvements above described
which the Company may now have for services, 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 for payment
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 transfertitle to
th6 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 hereunderis 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 rights in the said services, labor, material or equipment other than 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 20th day of April 20CD-
(Name and Title)
Troy Heisler, CFO
Hagerman Construction Corporat
(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 C=X Hai sl -V
the cfo of Hagerman Construction CorpQrat'i on' 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 seal this 20th datpf. April 2008
ti e ce mGr c oG
My Commission Expires: o o, Notary Public
12/16/15
Da .7 n Thomas
My County of Residence: r F
(P(nted Name of Notary Public)
Allen
APPLICATION AND CERTIFICATE FOR PAYMENT ALAD0CUMFN PAGE ONE Or PAGES
TO OWNER: Carmel Redevelopm C PROJEC Parcel 67 Streetscape APPLICATION NO: B0007 Distribution to'
City of Carmel HCC Job #2691 PERIOD TO: 4130/2009 E] ONVNIER_
Carmel, IN 46032 Invoice #9322 PROSECT NOS.: 09269 0 ARCI-RTECT
FROM CO1 HagermAn Construction Corporation VIA ARCIRTECT CSO Architects Inc El coNrTRAcrm
7930 Castleway Drive 280 East 96th Street D
Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CONrtRACT DAIS:
CONTRACT FOR:
The undersigned Contractor certifies that to the best of the Contractor's knowledge, intor-
CONTRACTOR'S APPLICATION FOP, PAYMENT The
and belief the Work covered by this application for Payment has been completed
Application is made for payment, as shown below, in connection with the contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document 6703, is attached. Contractor for Work ork for which previous Certificates for Payment were issued and pay-
1. ORIGINAL CONTRACT SUM $270,150,00 ments received from the Owner, and that current payment shown herein is now due-
COMI-RACTO HagerMan Construe ion Corporation
2. Not change by Change Orders S-1232100 pril
Uy: Date A 20, 2009
,1
3. CONTRACT SUM TO DATE (Lirtc 1 ±2) 530147100 trol Heisler t CFO
rate of., Indiana
4. TOTAL COMPLETED STORED TO DATE
N
$256,203.00 Allen
on G703) County of-
(Coluum G
5. RETAMAGE: Subscribed and sworn to before 0
a. 5.000%of completed worm 20th April, 2009 me this day of CS dV
(Coluums D E on G703)
b. 0 0 /o of Stored Material Notary P.bCZ��k�
SO-00 AL
(Columns F on G703) My Commission expires.- 12/16/15
Total Retaina,�e (Liue 5a i 12,810.15
Total in Columnt I of% G o '703) ARCHITECT'S CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE Ta accordance with the Contract Documents, based on on-site observations and the data
(Line 4 lest; Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the
7, LESS PREMOUS CERTIFICATES FtOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) X230_582_7 quality of the Work is in accordance with the Contract Documents, and the Contractor.
8. CURRENT PAYMENT DUE $12,810.15 is entitled to payment of the AMOUNT CERTIFIED,
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED Vateaat.6
(Line A less Line 6) (Vtach explanath> ounl certified from the amount applied far. Initial
$59,084.15 'fi "'n C"', 5
alifigtures on t On the Continvaiionheet that are changed to
"P "cofo"'ona` On "'L
ConfiO?7nto eaMO nt 1 le
I I
CHLN-C ADDITIONS DEDUCTIONS ARCI.11 CT: 0 ch t I c
iE ORDER SUMMARY T
Total changes approved in $32,323.00 $0 By: Date: previous months by Owner E !I
Tolal approv t $0.00 S0.00 L. Certificate is not negotiable- The AMOUNT CERTIFIED is payable only to the
TOTALS $32,323.00 $0,00 Contractor named herein. Issuance, payment and acceptance of payment are without
NET CIMNOES by Change Orde $32323.00 oreiudice to any rights of the Owner or Contractor tinder this Contract
AIA DOCUMENT G702• APPLICATION AND CERTIFICATE rORPAYMENT 1992 EDITION ALAqD CL992 THE AMERICAN INSTITUTE OF ARCIIITECTS, L735 NEW YORK G702-1992
AVENUE. N.W. m
WASHINGTON, D.C. 20006-529,1 WARNING: Unlicansed photocopying violates U.S. co p yr i g ht l and will subject the violator to legal prosecution.
7W3 do— m
nenis IN
i pnxwed cicwtNcotlywtf The PwAASIMMThe A—h-n kildbo, OfArd&ftt"dar UMnse 87003 r Prk nqvcrn s poM5 f %proMct of 1W dmnt.1tho" 1, not pe-hed. Con! The Atn A InOVI of Alohftx',
.-by the —ion omi. d° onl Ond 111 1-
CONTINUATION SHEET AJA DOCUMENT G703 PAGE I OF i PAGES
ALA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: B0007
containing Contractor's signed Certification, is attached, APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2009
Use Column I on Contracts where variableretainage for line items may apply. ARCHITECTS PROJECT NO.: 092691A
WORKCOMPLETED MATERIALS TOTAL BALANCE RETAR�AGE
ITEM DESCRIPTION OF WORK SCHEDULED pRoMpRE.VIDUS PREsENTLY COWLETED TO "IF VARIABLE)
STORED AND STORED FINISH RATE
0000010 RAngallne Road Work
0000030 General Conditions $56,800,00 $53,960.00 $0.00 $0-00 $53,960.00 95.000 $2,840.00 $0.00
0000040 Existing Conditions I Selective Derno $13,150.00 $13,150.00 $0,00 $0,00 $13,150.00 100.000 $0,00 $0.00
0000050 Concrete (Not Including Curbs) $36,700.00 $36,100.00 $0.00 $0-00 $36,700.00 100,000 $0.00 $0.00
0000080 Electrical $57,950.00 $46,360,00 $0.00 $0.00 $46,360.00 80.000 $11.59000 $0,00
0000090 Earthwork $22,420.00 $22,42o,00 $0.00 $0.00 $22,420.00 100-000 $0-00 $0,00
0000100 Exterior Improvements $46,980.co $23,490,00 $0.00 $0.00 $23.490,00 50-Ooo $23,490.00 $0.00
0000110 Utilities $21,220.00 $21,220.00 $0.00 $0.00 $21,220.00 100,000 $0.00 $0.00
0000130 CHANGE ORDER NO. 1
0000160 CHANGE ORDER NO. 0:3
$302,473.001 $256,203-00 $0,0() L— $0.001 $2515,203.00T 81 $0.001
AIA DOCU�ENT G7;3- APPLICATION AND GERTIRCATE IORPAIIIENT 1992 EDrTION ALke C L992 THE A ENSTITUTEOF ARCHITECTS, 1735 NEW YORK G703-1992
AVENUE, N.W., WASHINGTON, D-G, 20006-5292 wARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
WAIVER OF LIEN
The undersigned is the duly authorizedofficerof Hagerman Construction Corporation ,the general contractor,
(Name of Company)
subcontractor,• materialman or other person furnishing the services, labor, material or equipment indicated below in the
i
construction of improvements upon real estate located in .Hamilton County, State of Indiana commonly
knownas Parcel 67 Streetscape, Indi h real estate isowned..by Camel Re3 velcimmtCbmAssicn "Owner
Design Center P12
INCONSIDERATIONofthesumof Twelve thousand eight hundred ten and 15/100
DOLLARS 12, 810.15 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'described
which the Company may now have for services, labor, material orequ! pmentfumishedin respect of such land orimprovements
to and! ncluding the date hereof. The undersigned warrants that the Company has not andwill 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 !fens 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 recelved 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.
i
i
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 thatthe Company has compried with all prevailingwage
requirements under applicable law or as may be set forth in the contract documents.
WITNESS the execution hereof this 20th day of April 2Q0q_
(Name and Ttle)
Troy Heisler, CFO
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
the cfo of Hagerman Construction Corporation` 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 seal this 20th day of Aril 2009
�pOr 1 6 1 I
My Commission Expires:
Notary Public
12/16/15
,5 a NOTARYSEAL o Q Q e
4 v
My County of Residence: David C Thomas
=��C.sTATE (Printed Name of Notary Public)
Allen
APPLICATION AND CERTIFICATE FOR PAYMENT AIADOCUMENTG702 PAGE 01'M Or PAGES
TO OWNER: Carmel Redevelopment Commission PROJECT: Parcel 67 Streetscape APPLICATION NO: A0007 Distlibution to:
City ofCartnel HCC Job #2691 PERIODTO: 4130/2009 OWNER
Carmel, IN 46032 Invoice #9320 PROJECT NOS.: 082691A 0 ARCHITECT
FROM CONTRACTOR. Hagerman Construction Corporation VIA ARC111TECT: CSO Architects Inc CONTRACTOR
7930 Castleway Drive 280 East 96th Sheet
Indianapolis, IN 46250 Indianapolis, INDIANA 46240 CON DATE:
CONTRACT FOIL
The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
CONTRACTOR'S APPLICATION FOR PAYMENT The
and belief the Work covered by this application for Payment has been completed
Application is made for payment, as shown below, in connection with the contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document 0703, is attached. Contractor for Work for which previous Certificates for Payment were issued and pay-
ments received from the Owner, and that current payment shown herein is flow due,
1. ORIGINAL CONTRACT SUM $304,600.00 CONTRACTOR. Hagerman Co ction Corporation
2. Not change by Change Orders 50,00 By-
Date: April 20, 2009
Q0.00 Tro 3. CONTRACT SUM TO DATE (Line 1 ±2) $304 Heisler, CFO
4. TOTAL COMPLETED STORED TODATE $2 48.9 19.50 State of Indiana
(Coluoui G on G703) County Of, Allen N
5. RETAINAGE; Subscribed and sworn to before
a. _1&00 of Compteted Work 512.445.
Inc this 20tH of 009 AO
(Columns D R an G703)
4L
b. 0 of Stored Material Notary Pub
(Cotunms F on G703) My Commission txpircs: 12/16/15
Total RetaiWe (Line Sa 5b or I $12,445.98
Total hi Cohmns I an G103) ARCHITECT'S CERTIFICATE FOP, PAYME
6. TOTAL EARNED LESS RETAINAGE S236s473.5 In accordance with the Contract Documents, based on on-site observations and the data
aAae 4 less Line 5 Total) comprising this application, the Architect certifies to the Owner that to the best of the
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT Architect's knowledge, information and belief the Work has progressed as indicated, the
(Line 6 from prior Certificate) 5224 .21. quality of the Work is in accordance with the Contract Documents, and the Contractor
8. CURRENT PAYMENT DUE $12,445. 97 is entitled to payment of the AMOUNT CERTIFIED.
9. BALANCE TO FINISH, INCLUDING RETAINAGE AMOUNT CERTIFIED VS"16A T 7
(Lim 3 Iesg Line 6) $68,126.48 (A nach explanation Y amount certified differs from the amount app lledfor. Initial
all figums On As Application and on the Continuation Sheet that are changed to
conform to amount cW11fied)
CHANOE MDER SUMMARY ADDI'IONS DEDUCTIONS ARC
Total changes approved in
previous months by Owner $0.00 $0,00 Y' Date:
Toul approwd 6s MQnth $0.00 50.0 TIlls Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the
TOTALS $0.00 _$0'0 Contractor named herein. Issuance, payment and acceptance of payment are without
CHA NGE S NET 3 S0.00
by C han Order preiudige to any rights of the Owner or Contractor under this Contract,
AIA DOCUMENT cvv• APPLICATION AND CERTIFICATE FOR PAYMENT 1992 EDITION AtAo c 1992 THE AMERICAN rNsTmn OF ARCHITECTS, 1735 NEW YORK
AVENUE.N.W., WASHINGTON, D.C_ 20006-5292 WARNING: Unlicenssil phatocopying vlolatm U.S. copyright lawn and Wfil Subject the vlolatw to legal prosecution. 6702-1992
IN& d�r�t has been npdmd dncvcdc*jvNh the PMdsM0n 011b* kmi= hVIbste of Ardftda u dm Umwo OM03 t, ftwvm SystMM I=
to MilY *0 WOW %=11M d INS dQMMM and Sawa -M--'
CONTINUATION SHEET AIA DOCUMENT G703 PAGE I OF 1 PAGES
AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO.: A0007
containing Contractor's signed Certification, is attached, APPLICATION DATE:
In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 4/30/2009
Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO.: 082691A
A B C D E F G H I
WORK COMPLETED MATERIALS TOTAL BALANCE RETAINAGE
ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO (IF VARIABLE)
NO. VALUE APPLICATION THIS PERIOD STORED AND STORM FRI13SH RATE
(NOT IN TO DATE (G-C) (C-G)
(D+ E) DORE) (D+E+F)
0000010 Robert Indiana Street Work
0000030 General Conditions $46,150.00 $43,842.50 $0.00 $0.00 $43,842.50 95.000 $2,307.50 $0.00
0000040 Existing Conditions I Selective Demolition $8,770-00 $8,770.00 $0.00 $0.00 $8,770.00 100.000 $0.00 $0.00
0000050 Concrete Work Not Including Curbs $24,430.00 $24,430.00 $0,00 $0.00 $24,450.00 100.000 $0.00 $0.00
0600060 Metals $2,190.00 $2,190.00 $0.00 $0.00 $2,190,00 100.000 $0,00 $0.00
0000070 Specialties $6,570.00 $0.00 $0.00 $0.00 $0.00 0 $5,570.00 $0.00
0000080 Electrical $41,640.00 $33,312.00 $0.00 $0.00 $33,312.00 80.000 _$8,328.00 $0.00
0000090 Earthwork $41,500.00 $37.360.00 $0.00 $0.00 $37,350.00 90.000 $4,150.00 $0.00
0000100 Exterior Improvements $70,650.00 $35,325.00 $0.00 $0.00 $35,325.00 50.000 $35,326.00 $0.00
0000110 Utilities $63,700.00 $63,700.00 $0.00 $0.00 $63,700,001 100.000 $0.00 $0.00
I $3 60.00 $248,919.60 $0.001 $0.001 $248,91950 81.72% $55,680.
AIA DOCUMENT G703• APPLICATION AND CERTIFICATE FORPAYNEENT 1992 EDITION ALk9 C 1992 THE AMERICAN INSTITUTE OF ARCHITEM, 1735 NEW YORK G703-1992
AVENUE, N.W., WASHINGTON, D.0 20006-5 -WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution.
I
i
WAIVER OF LIEN
e
Ha rman Construction Corporation .the general contractor,
Theundersignedisthedr�lyauthorizedofficerof g
(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 In ana commonly
known as Parcel 67 Streets �2 ndi h real estate is owned.by Canml Reds` a (it Diaz ("Owner").
Design Center P12 j
INCONSIDERATIONofthesumof Twel thousand four hundred forty five and 97/100 i
DOLLARS 12,445.97 receipt of which is hereby acknowledged, and in order to procure one or more pay ments
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'described i
which the Company may now have for services, labor, material or equipmentfumished in respect of such land orimprovements
to and including the date hereof. The undersigned warrants that the Company has not and will not assign any plaim for payment I
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
th6 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 orequipment 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. i
The material, labor, services or equipment furnished are more particularly described in the affidavit for payfnent submitted of
even date herewith. The undersigned furtherwarrants and represents thatthe Company has compGedwith all prevailing wage
requirements under applicable law or as may be set forth in the contract documents.
i
WITNESS the execution hereof this 20th day of April 2Q02-
i
(Name and Title)
Troy Heisler, CFO
Hagerman Construction Corporati
(Name of Company)
State of Indiana County of A llen
SS: Before me, the
undersigned, a Notary Public in and for said County and State, personally appeared Troy
the cfo of Hagerman Construction Corpora ion' 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 1
Company and the-free act and deed of said officer.
WITNESS my hand and notarial seal this 20th dr,pf A r'
2009
orp���
My Commtsslon Expires: Notary Public
12/16/15
o NOTARYSEAL o
My County of Residence: �o s. David C Thomas tary Public
C (Printed Name of No
Allen
I
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.
rr
Payee
'v;' (rurp Purchase Order No.
J T "V n Terms
/y `f62 54 Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bill(s))
Og 3 2 D 7' o y7< /W 7�✓ N, 7 `l./ ar� /2 �/y✓ 9 7
3 13 i
2S0 9 32 1067 Cv 4%,k
S 3/ 6 g 3 S6 P 67
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
c1�9�✓'� +7 �'��s7� ✓v�7i�•7 Ca�,0_ IN SUM OF
-79 3o CAsf7'g
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #!TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
6 7 12 YIYS,'97 bill(s) is (are) true and correct and that the
9 3 22 z a867 12 F /O /S materials or services itemized thereon for
3 23 y 160S'6 02,SD which charge is made were ordered and
GO 67 received except
20 0 i
I natu e
Director o �pera ions
Cost distribution ledger classification if Title
claim paid motor vehicle highway fund