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Ebenisterie Beaubois Ltee - $162,381.10
Disbursement Instructions (PAC Millwork) Regions Bank hereby is Instructed to make a disbursement of Loan Proceeds from the Borrower Loan Account to(or for the account of)Borrower in: (a)the amount of the"Total Authorized Disbursement"line in the"Amount of Authorized Disbursement"column below;and(b)accordance with the terms and conditions of the Agreement, the other Loan Documents, and the Disbursement Instructions. Purpose of Authorized Disbursement Amount of Authorized Disbursement Atno1,43 +E do pea Vi)I&o Financial Apppli(4.1-teh 26 (13e6u6ois) hay toil 158 Atlicakiew 9-27 (8etu 6o13) De tp tnber toll �."° Total Authorised Disbursement '��-+ ,p-a+ ..." iy All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto In that certain Loan Agreement(PAC Millwork),dated January 28,2010,.by and between Lender and Village Financial,'LL C. Dated: ///9 �2 CITY OF CARMEL REDEVELOPMENT 7777 COMMIS ION By —1 Printed C S S. 0'ds Title E xecu�t I1C O IrCckt^ Draft PAC Mill Work (Ebenisterie) Up Through November 2009 Total Contract Amounts through application 10 Completed and Stored to date $ 305,661.51 Retention held $ 30,566.15 Paid to date $ 275,095.36 Amount reimbursed to CRC $ 275,095.36 December 2009 Total Contract Amount for application 11 Completed and Stored to date $ 20,046.38 Retention held $ 2,004.64 To be paid $ 18,041.74 Paid by Village Financial $ 18,041.74 January 2010 Paid by Village Financial $ 10,717.61 February 2010 Paid by Village Financial $ 300,531.36 March 2010 Paid by Village Financial $ 256,445.90 April 2010 Paid by Village Financial $ 169,791.37 May 2010 Paid by Village Financial $ 415,953.29 June 2010 Paid by Village Financial $ 464,375.77 July 2010 Paid by Village Financial $ 454,849.95 August 2010 Paid by Village Financial $ 238,415.04 September 2010 Paid by Village Financial $ 100,487.23 October 2010 Paid by Village Financial $ 183,423.55 November 2010 Paid by Village Financial $ 77,329.28 December 2010 Paid by Village Financial $ 11,699.93 March 2011 Paid by Village Financial $ 29,860.50 May 2011 Amount to be paid by Village Financial I S. 158,264.10; December 2011 Amount to be paid by Village Financial($ 4,117.00 ' '`� �` Document ent 702/C a t — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition "18 TO OWNER: PROJECT: APPLICATION NO: C��1 , 0.� ��1.�1, � �z�O Distribution to: y C cruel 1-3aC Co�'. PERIOD TO: Q C,C 1-10_(; 3l�- 200 1 oNr�,ER ❑ CONSTRUCTION MANAGER ❑ FROM CON-RACTO VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ e Jl l--e-ri to rs tor[. yo fh Q(/Q• S I l l d se, 00 PROJECT NOS: 2693 7,0 I CONTRACTOR ❑ 3-1 -Gegree5 ?It ( e C & /01-H VIA ARCHITECT: FIELD ❑ CONTRACT FOR:1`'("I/I w o r K " C i Q Or Ob I.70- CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information a 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. a 0 Contract Documents,that all amounts have been paid by the Contractor for Work for which previous 1.ORIGINAL CONTRACT SUM ! Certificates for Payment were issued and payments received from the Owner, and that current $3 1?7 0/0 a payment sh eM is now due 2. Net change by Change Orders o 3.CONTRACT SUM TO DATE(Line_1 ±2) $ �r p 0 BY' �- C� J Date: ( ' / i/ 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) 205 2 ° State of Q G jjj 5.RETAINAGE: ���� t_t)m^,.sscire a I'Assermentation C9u'nry of: a. %of Completed Work Lo rt issioner for oath Subscribed and syorn to,bef re (Column D+E on G703) $ 0 me this 25"I" ;•.y;of (✓i 201 Ivianon Poulin b• °o of Stored Material Notary Public ' .,/ �__.- r # 163 850 (Column Fon G703) $ 01 My Commis 'en expires: ',"..istrict Quebec Total Retainage(Lines 5a+5b or Total in Column I of 0703)". $ CERTIFICATE FOR PAYMENT �;aekr:rc.fa5l iz l 6.TOTAL EARNED LESS RETAINAGE $ 3 9 28:2 o,0 In accordance with the Contract Documents, based on on-site observations and the data comprising c.=� this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 9 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT . $3 6 LI7 017, I accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT Irif (Line 6 from prior Certificate) CER i'f1 IED. 8.CURRENT PAYMENT DUE I S / 8 2((/ /Oil AMOUNT CERTIFIED Ise 20 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation i .mount certified differs fro the an ourit applied.Initial all figures on this Application and on.' Co .lion Shee at ar:.ehan•ed`to conform with the onto nt ce ified.) (Line 3 less Line 6) $ (' CONS •UCTION • .;■_ oc- 3l �..rv.I -'. Date CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS y. '` ARCHI T Total changes approved in previous months by Owner $ $ r Total approved this Month $ $ By: •■ Date: e 1 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the C. tractor TOTALS $ $ 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 $ . CAUTION:You should sign an original MA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. I MA Document G702/CMam—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document Is protected by U.S.Copright Law and internationai Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the m ximum extent possible under the law. Purchasers are permitted to reproduce ten(50)copies of this document when completed.To report copyright violations of AlA Contract Documents,e-mail The American Institute of Architects legal counsel,copyright @aia.org" • CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebor isserte Bcaubois Ltee containing Contractors signed Certification Is attached. APPLICATION NO 26 In tabulations below.amounts are stated to the nearest dollar. APPLICATION DATE:05/20/2011 Use Column Ion Contracts where variable retalnage for line items may apply. APLICATION PERIOD:05/01/2011•05/31/2011 ARCHITECTS PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C 0 ` E i - F I G H 1 I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retafnage Value ; application Period Stored and stored to Finish 0% No. of work I (D+E) I (not in D or E) (D+E F MAT BASEMENT LEVEL 52 098.35$ 52 098.35$ 0.00$ 0.00 5 52 098.35$I 0.00 5 0.00 $ LAB _ 11 883.71 $ 11 883.71 $ 0.00 5 0.00$ 11 883.71 $ 1 0.00$ 0.00$ MAT I North 6 886.93 S 6 886.93 Si 0.00 S 0.00$ 6 886.93$ 0.00$ 0.00$ I MAT Miscellaneous items 45 211.43 5 45 211.43$ 0.00 5 0.00 5 45 211.43$ 0.00$L 0.00$I LAB North 1 257.05$ 1 257.05$ 0.00 S 0.00$ 1 257.05$ 0.00$ 0.00 5 LAB Miscellaneous items 10 626.66 5 10 626.66$ 0.00 5 0.00$ 10 626.66$ 0.00$ 0.00$ ' MAT PLENUM LEVEL 49 668.53$ 49 668.53$ 0.00$ 0.00 5 49 668.53 $ 0.00 $ 0.00 $ LAB 42 456.67$ 42 456.67$ 0.00$ 0.00$ 42 456.67$ 0.00$ 0.00$ 1. MAT Miscellaneous items 12 287.66$ 12 287.66$ 0.00$ 0.00$ 12 287.66$ 0.00$ 0.00 S MAT South 37 380.88 S 37 380.88$ 0.00$ 0.00 5 37 380.88 S 0.00 5 0.00$ ``.-% LAB Miscellaneous items 26 524.29$ 26 524.29$ 0.00 S 0.00$ 26 524.29$ 0.00$ 0.00$ LAB South 15 932.38$ 15 932.38$ 0.00$ 0.00$ 15 932.38$ 0.00$ 0.00$ MAT ORCHESTRA LOW LEVEL 884 071.73$ 884 071.73 $ 0.00$ 0.00$ 884 071.73 $ 0.00$ 0.00 S LAB 317 235.98$ 317 235.98$ 0.00$ 0.00$ 317 235.98$ 0.00$ 0.00 $ MAT Auditorium 536 641.30 5 536 641.30 5 0.00 5 0.00 5 536 641.30$ _ 0.00$ 0.00$ MAT East 137 103.55$ 137 103.55$ 0.00$ 0.00$ 137 103.55$ 0.00 5 0.00 5 MAT North 101 619.95 5 101619.95$ 0.00$ 0.00$ 101 619.95 5 0.005 0.00$ Page 1 • CONTINUATION SHEET A!A Document G703 Format AIA Ooc,0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaabnls Ltee containing Contractors signed Certification is attached. APPLICATION NO:26 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:05/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD.05/01/2011•05/31/2011 ARCHITECT'S PROJECT NO: Cannel Regional Performing Arts Center,Carmel,IN J A B I c 0 I E F I G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% Ho. I of work ID•EI (not in 0 or Et (D s E n F) (G/C) (C-G) ` MAT West 50 922.96$ 50 922.96$ 0.00$ 0.00$ 50 922.96$I 0.00 5 0.00$ MAT Miscellaneous items 57 783.98 5 57 781.98 5 0.00 5 0.00$ 57 783.98$ 0.00$ 0.00$ f LAB Auditorium 161 191.08$ 161 191.08 5 0.00 5 0.00 5 161 191.08 5 _ 0.005 0.005 LAB East 40 499.1E1$ 40 499.18$ 0.00 5 0.00 5 40 499.18$ 0.00$ 0.00$ LAB North 16 932.65$ 16 932.65$ 0.00$. 0.00$ 16 932.65 5 0.00$ 0.00 5 LAB West 26 471.63$ 2b 471.63 5 0.00$1. 0.00 5 26 471.63$ 0.00 5 0.00$ LAB Miscellaneous items 72 141.44$ 72 141.44 5 0.00 5 0.00 51 72 141.44$ 0.00 5 0.00 5 1 . MAT ORCHESTRA HIGH LEVEL 132 847.59$ 132 847.59$ 0.00$ 0.00$ 132 847.59$ 0.00$ 0.00$ LAB 92 280.19$ 92 280.19$I 0.00 Si 0.00$ 92 280.19$ 0.00 S 0.00$ i y' ' MAT } Auditorium I 4 621.74$ 4 621.74$ 0.00$ 0,00$ 4 621.74$ 0.00 5 0.00$ MAT East 485.32$ 485.32$ 0.00$ 0.00$ 485.32$ 0.00$ 0.00$ MAT South 101 013.48 5 101 013.47 5 0.00$ 0.00$ 101 013.48$ 0.00$ 0.00 5 MAT West 485.32 5 485.32 5 0.00 S 0.00$ 485.32 5 0.00 5 0.00 S • MAT Miscellaneous items 26 241.73$ 26 241.73$1 0.005 0.00 51 26 241.73 S 0.00$ 0.00$ • • • LAB Auditorium 2262.185 2 262.18$ 0.00 5 0.00 5 2 262.18$ _ 0.00 5 0.00 5 LAB East 381.52$ 381.52 5 0.00 5 0.00$I 381.52 5 0.005 0.00 5 • I • • i i Page 2 CONTINUATION SHEET AIA Document G703 Format AMA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:EbCATIOrie Beau6ois Ltee containing Contractors signed Certification Is attached. In tabulations below,amounts are stated to the nearest dollar. APPLICATION NO:26 Use Column l on Contracts where variable ret lnage for Ilee Items may a I APPLICATION DATE:05/20/2011 apply. APLICATION PERIOD:05/01/2011•05/31/2011 ARCHITECTS PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B { C I D E F 7 G 1 H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored No. of work ID E) to Finish 0% ,� (not in 0 or E) I (D+E.F) (G/C) (C-G) j South 40 723.56$ 40 723.56$ 0.00 Si 0.00$ 40 723.56$ \•,,/ 0.00$ 0.00$ West 381.52 5 381.52 5 0.00$ 0.00$ 381.52$ 0.00 S 0.00 Si LAB Miscellaneous items I I 48531.41$ 48531.41$ 0.00$ 0.005 48 531.41$ 0.005 0.00$ MAT BOX TIER LEVEL 326 347.94$ 326 347.95$ 0.00$ 0.00$ 326 347.94$ 0.00$ 0.00 5 LAB 278 078.48$ 278 078.48$ 0.00$ 0.00 $ 278 078.48$ 0.00 $ 0.00 $ MAT Auditorium 11 727.05$ 11 727.05$ 0.00 S 0.00 S 11 727,05$ 0.00 5 0.00 5 MAT East 44 650.44 S 44 650-44$ 0.00$ 0.00 S 44 650,44$ 0.00$ 0.00$ MAT North 16 580.44$ 16 580.44 5 0.00 5 0.00$ 16 580.44$ 0.00 S 0.00$ MAT South 81 787.06$ 81 787.06 5 0.00$ 0.00 5 81 787.06$ o.o0 5 0.00$ MAT West 82 441.76$ 82 441.76$ 0.00$ 0.00 S 82 441.76$ 0.00 5 0.00 S � 00$ 0 t(.' MAT Miscellaneous items 89 161.20$ 89 161.20$ . 0.00$ 89 161.20$I 0.005 0.005 `,:� LAB Auditorium 6 058.74 5 6 058.74$ 0.00 S 0.00$ 6 058.74 5 0.00$ 0.00 5 LAB East 26 800.35 5 26 800.35$ 0.00 S 0.00$ 26 800.35 5 0.00 S 0.00 5 • NILAB North 6898.68$ 6898.685 0.005 0.00$ 6898.685 o.00$ 0.005 South 37 667.50$ 37 667.505 0.00 5 0.00$ 37 667.50$ 0.00 S 0.00$ West 42 037.97 5 42 037.97$ 0.00$ 0.00$I 42 037.97$ I 0.00$ 0.00$ Miscellaneous items 158 615.24$ 158 615.24 S 0.00$ 0.00$ 158 615.24$ 0.00 S D.00 S Page 3 . CONTINUATION SHEET Ala.Document 0703 Format ALL Doc.6702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO 25 In to bulaDons below,amounts are stated to the nearest dollar. APPLICATION DATE:05/20/2011 Use Column ton Contracts where variable retainage for line items may apply. APLICATION PERIOD:05/01/2011-05/31/2011 ARCHITECTS PROJECT NO: Carmel Regional Pergortntng Arts Center,Cannel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retalnage Value application Period Stored and stored to Finish 0% No. of work ID+E) _ (not In 0 or E) (D+E+F) (G/C) (C-G) .^1 MAT East 8 672.67$ 8 672.67 S 0.00$ 0.00$ B 672.67$ 0.00$ 0.00$ MAT North 121.33$ 121.33$ o.00$ 0.0o$ 121.33 5) 1 0.00 5 0.00 S I MAT ( South 85 647.88$ 85 647.88 5 0.00$ 0.00$ 85 647.88$ 0.00 5 0.00$ MAT West 5 840.25$ 5 840.25$ 0.00$ 0.00$ S 840.25$ 0.00$ 0.00 S MAT Miscellaneous items 36 555.23$ 36 555.23$ 0.00 S 0.00$ 36 555.23 5 0.00$1 0.00 5 LAB Auditorium 3 504.20$ 3 504.20$ 0.00$I 0.005 3 504.20$ 0.00$ 0.00$ LAB East 5910.02$ 5910.02$ 0.00$ 0.00$ 5910.02 SI 0.00$ 0.00$ LAB North 95.38$ 95.38$ 0.00 5 0.00$ 95.38 5 0.00$ 0-00 5 LAB South 39 165.15 5 39 165.15$ 0.00 5 0.00$ 39 165.15$r 0.00$ 0.00$ LAB West 3 896.68$ 3 896.68 5 0.00$ 0.00$ 3 896.68$ 0.00$ 0.0o$ LAB Miscellaneous items 53 195.10$ 53 195.10$ 0.00 S 0.00$ 53 195.10$I 0.00$ 0.00$ MAT ALLOWANCE 105 000.00$ 105 000.00 $ 0.00$ 0.00$ 105 000.00$ 0.00$ 0.00$ $060 General Allowance 50 000.00 S 50 727.00 5 0.00$ 0.005 50 727.00$ 101% -727.00$ 0.00 5 1 25 000.00$ 25 000.00 S - 2 -27 461.17$ -27 461.17$ 3 I -5 758.35 S -5 758.35$ 4 I 8 201.00$ • 8201.00$ 5 _ 5 596.00$ 5 696.00$ _ 6 8 500.00$ 8 500.00 5 7 7 749.00 5 7 749.00$ 8 1 690.00$ I 1 690.00$ Page 5 CONTINUATION SHEET AlA Document 0703 Format • AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:EDentsterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:26 In tabulations below,amounts are stated to the nearest dollar. APPLICATION GATE:05/20/2011 Use Column I on Contracts where variable retainage for lire items may appty, APLICArION PERIOD:05/01/2015-05/31/2011 ARCHITECTS PROJECT NO: Correct Regional Performing Arts Center,Carmel,IN A B C 0 .I E V F G Work Completed 1 Total Material H I Item Description Scheduled Previous This Presently Complete % Balance Retatnage Value application Period Stored and stored to Finish 0% No. 1 of work (0+E) not In D or E) (D+E+F) (G/C 1 9 1 057.00 5 I 1 057.00 S . . 10 1 280.00 S 1 280.00$ I 11 743.00 5 743.00 5 . 12 2 597.00 5 2 597.00 5 .•• 13 1212.00 S 1 212.00 5 •• 4 525.00$ 16(0.dOtes..5037D4B-701-702) .. 15 696.52 5 15 696.52 5 5060 CAD Allowance 5 "' ••• ••S 0.00$ 5 000.00 Si 100% 0.00 5, 000.00 5000.005 • • 25 000.00 22 323.00 0.00$ 0.00$ 22 323.00 5 89% 2 677.00 5 t 15 C00.00 15 000.00$ 078.00 1 078.00$ I ••5 -969.00 5 4(Quotes':5037-062.701-702): 7 214.00 5 1 � I -I 5070 CAD Allowance 5 000.00$ 5 000.00 5 0.00$ •• 100% 0.00 5 1 5 000.00$ 000.00 5080 General ADowance 15 000.00$ 16 950.00 S 0.00$ 16 950.00 5 113% -5 950.00$ I 10 000.00 5 10 000.00 S _ .2f rItiotes 5037.70¢702-703),•? .- 6 950.00$ 6- 1 5080 CAD Allowance 5 000.00$ 5 000.00$ 0.00 51 5 000.00$ 100% 0.00$ 1 5 000.00 5 ( 000.00$ f 1 SUB TOTAL 2 619 462.22$ 2 619 462.23$ 0.00$ 0.00$ 2 619 462.22$ 100% 0.00$ 0.00 5 Administration Fees - . I MAT Shop Drawings 174 383.84 S 174 383.84 St 0.00$ 174 383.84 S 100% 0.00 S 0.00$ INST MAT Engeneering and cutting sheet 116 255.86$ 116 255.86$ 0.00 5 116 255.86 S 100% 0.00$ 0.00$ INST MAT 'Bond 20 325.26$ 20 325.26$ 0.00 S 20 325.26$ 100% 0.00 5 0.00 5 Page e • CONTINUATION SHEET AIA Document 6703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie BeauSois Ltea containing Contractor's signed Certification Is attached. APPLICATION NO:26 In tabulations below,amounts are stated to the nearest dollar.- APPLICATION DATE:05/20/2011 Use Column I on Contracts where variable retainage for line Hems may apply. APLICATION PERIOD:05/01/2011•05/31/2011 ARCHITECTS PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C I p i E F I G H Work Completed Material Total 1 Item Description Scheduled Previous This Presently Complete % Value Balance Ret0nage No. of work application E�n Period Stored and stored to Finish 0% (not in O or E) (D+E.F) (G/C) (C-G) 1NST MAT Prajet Management!Living!Travel 125 378.55 S 125 378.55 5 0.00 S 125 378.55$ 100% 0.00 5 0.00 S INST MAT Superir.tendant/Living/Travel 118 204.27 S 118 264.27 S I 0.00 S 118 264.27 5 100% 0.00$ 0.00$ INST • 1. TOTAL BASE CONTRACT 3 174 070.00$ 3 174 070.00$ 0.00$ 0.00$ 3 174 070.00$ 100% 0.00$ 0.00$ Change Orders Change order 8001 $ 5 156.00 5 5 156.00 0.00 5 5 156.00 5 100% 0.00 5 0.00 5 Change order 6002 $ 17 479.00 5 17 479.00 0.00$ 1 17 479.00$ 100% 0.00 5 0.00 5 Change order#003 I 6 (BS 200.00) S (65 000.00) 0.00$ fi5 000.00$ 100% 0.00$ 0.00$ Change order 6004 0.00 5 0.00 5 100% 0.00 5 0.00 5 Change order 8005 $ 5 146.00 5 5 146.00 0.00$ 5 146.00 5 100% 0.00$ 0.00 5 Change order6008 S 40 020.00 5 40 000.00 0.00 5 _ 40 COO.03$ 100% 0.00 5 0.00$ Change order#007 S 24 150.00 1$ 24 150.00 0.00 5 24 150.00$ 100% 0.00$ 0.00$ Change order#008 S 4 281.00 1 S 4 281.00 0.00$ 4 281.00$ 100% 0.00$ 0.00 5 f TOTAL CHANGE ORDERS I$ 31 212001 S 31 212.00 $ - 5 - 1 5 31 212.00 100% $ - I g - I1 TOTAL I$ 3 205 282.00 I$ 3 205 28200!S (0.00)I$ - 1$ 3 205 262.00 I 100% LS - I$ - e.� °,:i:`I r..`40 t:l1�i:,.s,y^.'sxil_" .....nn- ..I tr. :eCata 1erdlatrc "d1 --::2 • Page 7 INTERIM LIEN/CLAIM WAIVER'-- From:. Ebenisterie Beaubois Ltee Project: Carmel Regional Performing Arts Center (Name of Firm(living Release) (Proje Name) 521, 6th Ave Carmel, IN (Business Address) (Project Address) St-Georges (Quebec) G5Y OH1 (City,State,Zip Code) Contact Person: Steeve Lapointe Project Manager: Contact Telephone: 418-228-5104 Project Telephone: CONDITIONAL RELEASE UNCONDITIONAL RELEASE The undersigned does hereby acknowledge that The undersigned does hereby acknowledge that the upon receipt by the undersigned of a check from(Name of undersigned has received progress payments in the sum Firm writing check): The Pedcor Companies of$ 3,017,157.45 in the sum of$ 158,264.10 for labor, services, equipment or materials furnished to the and when the check has been properly endorsed and has above referenced job and does hereby release pro tanto been paid by the bank upon which it was drawn, this any and all claims and rights of lien which the document shall become effective to release pro tanto any undersigned has on the above referenced job. This and all claims and rights of lien which the undersigned release covers all payment for labor services, equipment, has on the above referenced job. This release covers a materials furnished and/or claims to the above referenced progress payment for labor, services, equipment, job through (date) 12/31/2010 materials furnished and/or claims through (date) only and does not cover any retention or items furnished May 31st 2011 after that date. only and does not cover any retention or items furnished after that date. Before any recipient of this document NOTICE: THIS DOCUMENT WAIVES RIGHTS relies on it said party should verify evidence of payment to UNCONDITIONALLY AND STATES THAT YOU HAVE the undersigned. BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS . DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM. I CERTIFY UNDER PENALTY OF PERJURY UNDER LAWS OF THE STATE OF QUEBEC THAT THE I CERTIFY UNDER PENALTY OF PERJURY UNDER ABOVE IS A TRUE AND CORRECT STATEMENT. LAWS OF THE STATE OF QUEBEC THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Signature: - w A--(6,------ ,-4, Signa . e: G- t thorned Corporate 0 er/Owner) Germain Alexandre, Ass.General Manager (AuthorzedC�rporaleOfticarlPaiiner/Owner) • (Tee) Germain Alexandre, Ass.General Manager .• • • (Title) Dated this 25th day of May ,2011 • Dated this 25th day of May , 2011 at: St-Georges, Beauce Quebec . at: St-Georges, Beauce, Quebec • Subscribed and sworn before me day and year first above written: Subscribed and sworn before me day and year first above written: Notary 0lic X/17Q-27 17,-- _ My cFommissairexpat� sseinjuntati May 1Q2013 Note Publi�ommissaire a{'Assermentation Commissioner for oath My'commission a wi imneofpo9gth • Manon Poulin Manon Poulin • # 163 850 # 163 850 • District Quebec Drstriet Quaff Quebec District Quebec District • WAIVER OF LIEN The undersigned is the duly authorized officer of Ebcnisterie Beaubois Ltee , the general contractor, 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 Carmel Performing Arts Center , which real estate is owned by_Carmel Redevelopment Commission («Owner a). IN CONSIDERATION of the sum of One Three million seventeen thousand one hundred fifty seven dollars and fourty five cents DOLLARS ($3,017,157.45) 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 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 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 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 particulary 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 25th day of May 2011 • • a Germaia'Alexandre,A.s.General Manager Lbenisterie Beaubois Ltee (Name of Company) State of Quebec , County of Beauce , SS : Before mc, the undersigned, a Notary Public in and for said County and State,personally appeared Germain Alexandre `Ass.General Manager , of_Ebenisterie Beaubois Ltee , who acknowledged the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act deed of such Company and the free act and deed of said officer. • WITNESS my hand and notarial seal this 25th day of May_, 2011 My Commission Expires : May 10,2013 Oft' (60 Commissaire a I'Assermentation Notary Public Commissioner for oath My County of Residence : Manon Poulin Beauce # 163 850 District Quebec Manon Poulin Quebec District (Printed Name of Notary Public) NO.MS3096337(GCNA)/6617847(GENERAL) OWNER CONSENT OF SURETY ARCHITECT TO FINAL PAYMENT CONTRACTOR Conforms with the American Institute of SURETY Architects,AIA Document G707 OTHER U TO OWNER: ARCHITECTS PROJECT NO.: AGREEMENT NO.2695-5070 (Nance and address) CITY OF CARMEL 1 CIVIC SQ CARMEL. 46032 CONTRACT FOR: PARCEL 7A,REGIONAL PERFORMING ARTS CENTER-INTERIOR FINISH PACKAGE P5, PROJECT: CONTRACT DATED: NOVEMBER 5,2008 (Name and address) CARMEI.REGIONAL PERFORMING ARTS CENTER 575 WEST CARMEL DRIVE CARMEL IN 46032 In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above,the (Insert name and address of Surety) GENERAL INSURANCE COMPANY OF AMERICA SAFECO PLAZA SUITE 1700 SEATTLE WA 98185-0001 ,SURETY, on bond of (Insert name and address of Contractor) EBENISTERIE BEAUBOIS LTEE 521 6TII AVENUE ST-GEORGES QC G5Y 5117 ,CONTRACTOR, hereby approves of the final payment to the Contractor,and agrees that final payment to the Contractor shall not relieve the Surety of any of its obligations to (Insert name and address of Owner) CITY OF CARMEL I CIVIC SQ CARMEL IN 46032 ,OWNER, as set forth in said Surety's bond. IN WITNESS WHEREOF,the Surety has hereunto set its hand on this date: MAY 27,2011 (Insert in writing the month followed by the numeric date and year.) GENERAL INSURANCE COMPANY OF AMERICA (Surety • Attest: (Signature of authorized resentative) • CAROL PAYNE,A"1TORNEY-IN-PACT (Printed name and tire) • S-2134/GE 10/01 XDP Safeco Insurance Company of America General Insurance Company of America Liberty POWER 1001 4th Avenue , , Mutual. OF ATTORNEY Suite 1700 Seattle,WA 98154 No 7480 KNOW ALL BY THESE PRESENTS: That SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA, each a Washington corporation,does each hereby appoint ********************YVES BOILARD;MICHEL BOURQUE;LUC LANTHIER;CAROL PAYNE;BENOIT PHENIX; ROSELLINA RUSSO;NATHALIE SANSCARTIER;R.F.SMITH;Montreal,QC Canada*****'*"*****'**********"***""*" its true and lawful attorney(s)-in-fact,with full authority to execute on its behalf fidelity and surety bonds or undertakings and other documents of a similar character issued in the course of its business,and to bind the respective company thereby. IN WITNESS WHEREOF, SAFECO INSURANCE COMPANY OF AMERICA and GENERAL INSURANCE COMPANY OF AMERICA have each executed and attested these presents 21st March 2009 . this day of 1tr4e7 , , ,. • Dexter R.Leqq,Secretary Timothy A.Mikolajewski,Vice President CERTIFICATE Extract from the By-Laws of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA: "Article V,Section 13.-FIDELITY AND SURETY BONDS...the President,any Vice President,the Secretary,and any Assistant Vice President appointed for that purpose by the officer in charge of surety operations,shall each have authority to appoint individuals as attorneys-in-fact or under other appropriate titles with authority to execute on behalf of the company fidelity and surety bonds and other documents of similar character issued by the company in the course of its business...On any instrument making or evidencing such appointment, the signatures may be affixed by facsimile. On any instrument conferring such authority or on any bond or undertaking of the company, the seal, or a facsimile thereof, may be impressed or affixed or in any other manner reproduced; provided,however,that the seal shall not be necessary to the validity of any such instrument or undertaking." Extract from a Resolution of the Board of Directors of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA adopted July 28, 1070. "On any certificate executed by the Secretary or an assistant secretary of the Company setting out, (I) The provisions of Article V,Section 13 of the By-Laws,and (ii) A copy of the power-of-attorney appointment,executed pursuant thereto,and ' (iii) Certifying that said power-of-attorney appointment is in full force and effect, the signature of the certifying officer may be by facsimile,and the seal of the Company may be a facsimile thereof." I,Dexter R.Legg ,Secretary of SAFECO INSURANCE COMPANY OF AMERICA and of GENERAL INSURANCE COMPANY OF AMERICA,do hereby certify that the foregoing extracts of the By-Laws and of a Resolution of the Board of Directors of these corporations,and of a Power of Attorney issued pursuant thereto,are true and correct,and that both the By-Laws,the Resolution and the Power of Attorney are still in full force and effect. • IN WITNESS WHEREOF,I have hereunto set my hand and affixed the facsimile seal of said corporation this 27th day of May 2011 • • OtE • e r fr, O J�0trE COMpqPo CtR1�TTE SEAL w SEAL. 3' Px* A T a� 1953 0� 'c.- !21 kill .0 v � 1-eaSO4‘ Dexter R.Legg,Secretary 5-0974/DS 3/09 WEB PDF • • v INTERIM LIEN/CLAIM WAIVER From:. Ebenisterie Beaubois Ltee Project: Carmel Regional Performing Arts Center (Name of Firm Giving Release) (Protect Name) 521, 6th Ave Carmel,IN (Business Address) (Project Address) St-Georges(Quebec) G5Y OH1 ply,State,Lip Code) Contact Person: Steeve Lapointe Project Manager: Contact Telephone: 418-228-5104 Project Telephone : CONDITIONAL RELEASE UNCONDITIONAL RELEASE The undersigned does hereby acknowledge that The undersigned does hereby acknowledge that the upon receipt by the undersigned of a check from (Name of undersigned has received progress payments in the sum Firm writing check): The Pedcor Companies of$ 3,205,282.00 in the sum of$ 158,264.10 for labor, services, equipment or materials furnished to the and when the check has been properly endorsed and has above referenced job and does hereby release pro tanto been paid by the bank upon which it was drawn, this any and all claims and rights of lien which the document shall become effective to release pro tanto any undersigned has on the above referenced job. This and all claims and rights of lien which the undersigned release covers all payment for labor services, equipment, has on the above referenced job. This release covers a materials furnished and/or claims to the above referenced progress payment for labor, services, equipment, job through(date) 05/31/2011 materials furnished and/or claims through (date) only and does not cover any retention or items furnished May 31st 2011 after that date. only and does not cover any retention or items furnished after that date. Before any recipient of this document NOTICE: THIS DOCUMENT WAIVES RIGHTS relies on it said party should verify evidence of payment to UNCONDITIONALLY AND STATES THAT YOU HAVE the undersigned. BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM. I CERTIFY UNDER PENALTY OF PERJURY UNDER LAWS OF THE STATE OF QUEBEC THAT THE I CERTIFY UNDER PENALTY OF PERJURY UNDER ABOVE IS A TRUE AND CORRECT STATEMENT. LAWS OF THE STATE OF QUEBEC THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Signature: C' Signature: Autnor(zed Corporfi cerlPartner/ovmer) Germa' Alexandre,Ass.General Manager (Ar,tr,«,�doo�rateomce�a ,er/ovrner) (Tale) Ger Alexandre, Ass.General Manager (Title) Dated this 27th day of January , 2012 Dated this 27th day of January , 2012 at: St-Georges, Beauce Quebec at St-Georges, Beauce, Quebec Subscribed and sworn before me day and year first above written: Subscribed and sworn before me day and year first above ' written: 1 l 1} p Notary Public j My commission expires : c (� t Notary Public .;�� My commission expires: -6,j �( r� CommissaireafAsserm tation pour leQue:; Commissaireal"Asses Nation pour leQuea Commissioner for oath forQuebec Commissioner fnr(aath tor Qi)ehar Francine Nolet #136 018 Francine Nolet #136018 TRANSFER OF TITLE Ebenisterie Beaubois Ltee (C'.ON1 RACTORE ("Contractor")transfers to Village Financial,LLC any and all right,title and/or interest that Contractor has in any labor and/or materials described in(i)that Affidavit of Waiver of Lien executed by the Contractor on may 3lth , ,20 11 ,and(ii)in the"Amount of this Request" section of that Affidavit executed by the Contractor on May 31th , ,2011 • "CONTRACT R" By: '' dr pri Germain Alexandre L 1111 Ass. General Manager Title: WAIVER OF LIEN The undersigned is the duly authorized officer of_Ebenisterie Beanbois Ltee the general contractor, subcontractor, materialman or other person furnishing the services,labor,material or equipment indicated below in the construction of improvements upon real estate located in_Ha milton County, State of_Indiana ,commonly known as_Carmel Performing Arts Center ,which real estate is owned by_Carmel Redevelopment Commission («Owner»). IN CONSIDERATION of the sum of One Three million forty-seven thousand seventeen dollars and ninety- seven cents DOLLARS ($_3,047,017.97) 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 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 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 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 particulary 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_27th day of January 2012 . Ge.. ain Alexandre,Ass.General Manager Ebenisterie Beaubois Ltee (Name of Company) State of Quebec , County of_Beauce , SS : Before me, the undersigned, a Notary Public in and for said County and State,personally appeared Germain Alexandre The_Ass.General Manager ,of_Ebenisterie Beaubois Ltee ,who acknowledged the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this_27th day of_January_,_2012 My Commission Expires: CC A My County of Residence: Con missalre a l'Assermentati i r e t; Commissionerforoath for Quebec Beau Francine Nolet #136 01 Frinted Name of Notary Public) \� '/�s TM AIADoCumentG7O2/CMa - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: �` PROJECT: APPLICATION NO: G&'7 _ Distribution to: O �� l C�YVY12� CG flm�� 19aC CO/6K PERIOD TO l ?Celm ?r �I St,201 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRAC OR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ E�en►SFerI•� �uUOis i�.�Lee. 1, 6 4 h Q ve Sh)6'1 t}oY) . PROJECT NOS: (0�5 / 5-o lo / CONTRACTOR ❑ 51 -a5 G C DNI OH I VIA ARCHITECT: FIELD ❑ CONTRACT FOR:>, j I I I wcr' . C.' j ()rCh i Vfed ❑ 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, or Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous 06 Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM 2$ ., 1141 0/Q payment she - _-rein is now due. 2. Net change by Change Orders $ °y �{ �' CONT• • TOR: c 3.CONTRACT SUM TO DATE(Line 1 ±2) $3ao 9�gG. ° B y — – ea G a" Date: I. /(2 / Oi / 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $?j, of] '2)9Q 0'.' State of: )Kr(' 5.RETAINAGE: Coun • of:Q .,j . Commissaire a I'Assermentation a. To of Completed Work ..scribed and sworn to before Commissioner for oath (Column D+Eon G703) $ m me this 21.5+ day of,.ICe) e r pro id �` Manon Poulin b. %of Stored Material a Notary Public: •cG ! r ��;iy� # 163 850 (Column F on G703) $ a My Commission expires: Not O 10 -00i3 nistrlst QuOboo Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ Gi CERTIFICATE FOR PAYMENT Quebec District 6.TOTAL EARNED LESS RETAINAGE $ 2)Zq ')-I ac In accordance with the Contract Documents, based on on-site observations and the data comprising I this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total), 2 op knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 3 a05 a accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. is,RP 8.CURRENT PAYMENT DUE $ .( I -+• 6 0 AMOUNT CERTIFIED $ /111 , 9.BALANCE TO FINISH,INCLUDING RETAINAGE '.!. (Attach explanation if amount certified differs from t e a ount applied.Initial all figures on this Application and on t ontinuation Sheet t are ha ged'to conform with the amount c tified.) (Line 3 less Line 6) $ CONS CTION -/ F r / CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS By. , �,�I i Date: 1 � ' ARCH , Total changes approved:in previous months by Owner $ $ By: /L r: - Date: ) ' 'Qj . ZO 12... Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAe Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlAe 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 Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Cannel Regional Performing Arts Center,Cannel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT BASEMENT LEVEL 52 098.35$ 52 098.35 $ 0.00 $ 0.00 $ 52 098.35 $ 0.00 $ 0.00$ LAB 11 883.71 $ 11 883.71 $ 0.00 $ 0.00$ 11 883.71 $ 0.00$ 0.00$ MAT North 6 886.93$ 6 886.93$ 0.00$ 0.00$ 6 886.93$ 0.00$ 0.00$ MAT Miscellaneous items 45 211.43$ 45 211.43$ 0.00$ 0.00$ 45 211.43$ 0.00$ 0.00$ LAB North 1 257.05$ 1 257.05$ 0.00$ 0.00$ 1 257.05$ 0.00$ 0.00$ LAB Miscellaneous items 10 626.66$ 10 626.66$ 0.00$ 0.00$ 10 626.66$ 0.00$ o.00 S MAT PLENUM LEVEL 49 668.53 $ 49 668.53 $ 0.00 $ 0.00$ 49 668.53 $ 0.00 $ 0.00$ LAB 42 456.67$ 42 456.67$ 0.00 $ 0.00 $ 42 456.67$ 0.00$ 0.00$ MAT Miscellaneous items 12 287.66$ 12 287.66$ 0.00$ 0.00$ 12 287.66$ 0.00$ 0.00$ MAT South 37 380.88$ 37 380.88$ 0.00$ 0.00$ 37 380.88$ 0.00$ 0.00$ LAB Miscellaneous items 26 524.29$ 26 524.29$ 0.00$ 0.00$ 26 524.29$ 0.00$ 0.00$ LAB South 15 932.38$ 15 932.38$ 0.00$ 0.00$ 15 932.38$ 0.00$ 0.00$ MAT ORCHESTRA LOW LEVEL 884 071.73 $ 884 071.73 $ 0.00 $ 0.00$ 884 071.73 $ 0.00$ 0.00 $ LAB 317 235.98 $ 317 235.98 $ 0.00$ 0.00$ 317 235.98$ 0.00$ 0.00 $ MAT Auditorium 536 641.30$ 536 641.30$ 0.00$ 0.00$ 536 641.30$ 0.00$ 0.00$ MAT East 137 103.55$ 137 103.55$ 0.00$ 0.00$ 137 103.55$ 0.00$ 0.00$ MAT North 101 619.95$ 101 619.95$ 0.00$ 0.00$ 101 619.95$ 0.00$ 0.00$ Page 1 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Cannel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) (not in 0 or E) (D+E+F) (G/C) (C-G) MAT West 50 922.96$ 50 922.96$ 0.00$ 0.00$ 50 922.96 S 0.00$ 0.00 5 MAT Miscellaneous items 57 783.98 5 57 783.98$ 0.00 5 0.00 5 57 783.98 5 0.00$ 0.00$ LAB Auditorium 161 191.08$ 161 191.08$ 0.00$ 0.00$ 161 191.08$ 0.00$ 0.00$ LAB East 40 499.18$ 40 499.18$ 0.00$ 0.00$ 40 499.18$ 0.00$ 0.00$ LAB North 16 932.65$ 16 932.65$ 0.00 5 0.00$ 16 932.65 5 0.00 5 0.00$ LAB West 26 471.63$ 26 471.63$ 0.00 5 0.00$ 26 471.63$ 0.00$ 0.00 5 LAB Miscellaneous items 72 141.44$ 72 141.44$ 0.00$ 0.00$ 72 141.44 5 0.00 5 0.00 5 MAT ORCHESTRA HIGH LEVEL 132 847.59 $ 132 847.59$ 0.00 $ 0.00$ 132 847.59 $ 0.00 $ 0.00 $ LAB 92 280.19 $ 92 280.19 $ 0.00 $ 0.00 $ 92 280.19 $ 0.00$ 0.00 $ MAT Auditorium 4 621.74 5 4 621.74$ 0.00$ 0.00$ 4 621.74$ 0.00 5 0.00 5 MAT East 485.32$ 485.32$ 0.00$ 0.00$ 485.32$ 0.00$ 0.00$ MAT South 101 013.48$ 101 013.47$ 0.00$ 0.00$ 101 013.48$ 0.00$ 0.00$ MAT West 485.32 S 485.32$ 0.00$ 0.00$ 485.32$ 0.00$ 0.00$ MAT Miscellaneous items 26 241.73$ 26 241.73$ 0.00$ 0.00$ 26 241.73$ 0.00$ 0.00$ LAB Auditorium 2 262.18$ 2 262.18$ 0.00$ 0.00$ 2 262.18 5 0.00$ 0.00$ LAB East 381.52$ 381.52$ 0.00$ 0.00$ 381.52$ 0.00$ 0.00$ Page 2 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) LAB South 40 723.56$ 40 723.56$ 0.00$ 0.00$ 40 723.56$ 0.00$ 0.00$ LAB West 381.52$ 381.52$ 0.00$ 0.00$ 381.52$ 0.00$ 0.00$ LAB Miscellaneous items 48 531.41$ 48 531.41$ 0.00$ 0.00$ 48 531.41$ 0.00$ 0.00$ MAT BOX TIER LEVEL 326 347.94$ 326 347.95$ 0.00 $ 0.00$ 326 347.94$ 0.00$ 0.00 $ LAB 278 078.48 $ 278 078.48$ 0.00 $ 0.00$ 278 078.48 $ 0.00$ 0.00 $ MAT Auditorium 11 727.05$ 11 727.05$ 0.00$ 0.00$ 11 727.05$ 0.00$ 0.00$ MAT East 44 650.44$ 44 650.44$ 0.00$ 0.00$ 44 650.44$ 0.00$ 0.00$ MAT North 16 580.44$ 16 580.44$ 0.00$ 0.00$ 16 580.44$ 0.00$ 0.00$ MAT South 81 787.06$ 81 787.06$ 0.00$ 0.00$ 81 787.06$ 0.00$ 0.00$ MAT West 82 441.76$ 82 441.76$ 0.00$ 0.00$ 82 441.76$ 0.00$ 0.00$ MAT Miscellaneous items 89 161.20$ 89 161.20$ 0.00$ 0.00$ 89 161.20$ 0.00$ 0.00$ LAB Auditorium 6 058.74$ 6 058.74$ 0.00$ 0.00$ 6 058.74$ 0.00$ 0.00$ LAB East 26 800.35$ 26 800.35$ 0.00$ 0.00$ 26 800.35$ 0.00$ 0.00$ LAB North • 6 898.68$ 6 898.68$ 0.00$ 0.00$ 6 898.68$ 0.00$ 0.00$ LAB South 37 667.50$ 37 667.50$ 0.00$ 0.00$ 37 667.50$ 0.00$ 0.00$ LAB West 42 037.97$ 42 037.97$ 0.00$ 0.00$ 42 037.97$ 0.00$ 0.00$ LAB Miscellaneous items 158 615.24$ 158 615.24$ 0.00$ 0.00$ 158 615.24$ 0.00$ 0.00$ Page 3 CONTINUATION SHEET AIA Document G703 Format AIA Doc.6702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECTS PROJECT NO: Carmel Regional Per forming Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT BALCONY LOW LEVEL 30 066.12$ 30 066.12$ 0.00$ 0.00$ 30 066.12$ 0.00$ 0.00 $ LAB 48 121.87$ 48 121.87$ 0.00$ 0.00$ 48 121.87$ 0.00$ 0.00$ MAT Auditorium 5 584.31$ 5 584.31 $ 0.00$ 0.00$ 5 584.31$ 0.00$ 0.00$ MAT East 849.32$ 849.32$ 0.00$ 0.00$ 849.32$ 0.00$ 0.00$ MAT North 242.66$ 242.66$ 0.00$ 0.00$ 242.66$ 0.00$ 0.00$ MAT South 4 378.44$ 4 378.44$ 0.00$ 0.00$ 4 378.44$ 0.00$ 0.00$ MAT West 849.32$ 849.32$ 0.00$ 0.00$ 849.32$ 0.00$ 0.00$ MAT Miscellaneous items 18 162.07$ 18 162.07$ 0.00$ 0.00$ 18 162.07$ 0.00$ 0.00$ LAB Auditorium 2 674.80$ 2 674.80$ 0.00$ 0.00$ 2 674.80$ 0.00$ 0.00$ LAB East 667.66$ 667.66$ 0.00$ 0.00$ 667.66$ 0.00$ 0.00$ LAB North 190.76$ 190.76$ 0.00$ 0.00$ 190.76$ 0.00$ 0.00$ LAB South 2 740.40$ 2 740.40$ 0.00$ 0.00$ 2 740.40$ 0.00$ 0.00$ LAB West 667.66$ 667.66$ 0.00$ 0.00$ 667.66$ 0.00$ 0.00$ LAB Miscellaneous items 41 180.59$ 41 180.59$ 0.00$ 0.00$ 41 180.59$ 0.00$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 143 538.52$ 0.00 $ 0.00$ 143 538.52$ 0.00 S 0.00 $ LAB 105766.53 $ 105766.53 $ 0.00 $ 0.00$ 105766.53 $ 0.00$ 0.00 $ MAT Auditorium 6701.17$ 6701.17$ 0.00$ 0.00$ 6701.17$ 0.00$ 0.00$ Page 4 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total • Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) not in D or E) (D+E+F MAT East 8 672.67$ 8 672.67$ 0.00$ 0.00$ 8 672.67$ 0.00$ 0.00$ MAT North 121.335 121.33$ 0.00$ 0.00$ 121.33$ 0.00$ 0.00$ MAT South 85 647.88 5 85 647.88$ 0.00$ 0.00$ 85 647.88$ 0.00$ 0.00$ MAT West 5 840.25$ 5 840.25$ 0.00$ 0.00$ 5 840.25$ 0.00$ 0.00$ MAT Miscellaneous items 36 555.23$ 36 555.23 5 0.00$ 0.00$ 36 555.23$ 0.00$ 0.00$ LAB Auditorium 3 504.20$ 3 504.20$ 0.00$ 0.00$ 3 504.20$ 0.00$ 0.00$ LAB East 5 910.02$ 5910.02$ 0.00$ 0.00$ 5910.02$ 0.00$ 0.00$ LAB North 95.38$ 95.38$ 0.00$ 0.00$ 95.38$ 0.00$ 0.00$ LAB South 39 165.15$ 39 165.15$ 0.00$ 0.00$ 39 165.15$ 0.00$ 0.00$ LAB West 3 896.68$ 3 896.68$ 0.00 5 0.00$ 3 896.68$ 0.00$ 0.00$ LAB Miscellaneous items 53 195.10$ 53 195.10 5 0.00 5 0.00$ 53 195.10$ 0.00$ 0.00$ MAT ALLOWANCE 105 000.00$ 105 000.00 $ 0.00$ 0.00$ 105 000.00 $ 0.00 $ 0.00 $ 5060 General Allowance 50 000.00$ 50 727.00$ 0.00$ 0.00 5 50 727.00$ 101% -727.00$ 0.00$ 1 25 000.00 S 25 000.00$ 2 -27 461.17$ -27 461.17$ 3 -5 758.35 5 -5 758.35$ 4 8201.00$ 8201.00$ 5 5 696.00$ 5 696.00$ 6 8 500.00 5 8 500.00 S 7 7 749.00$ 7 749.00$ 8 1 690.00$ 1 690.00 5 • Page 5 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) 9 1 057.00$ 1 057.00$ 10 1 280.00$ 1 280.00$ 11 743.00$ 743.00$ 12 2 597.00$ 2 597.00$ 13 1 212.00$ 1 212.00$ 15 4 525.00 5 4 525.00$ 16(Quotes 5037-048-701-702) 15 696.52$ 15 696.52$ . 5060 CAD Allowance 5 000.00$ 5 000.00$ 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ 5070 General Allowance 25 000.00$ 22 323.00$ 0.00$ 0.00$ 22 323.00$ 89% 2 677.00$ 1 15000.00$ 15000.00$ 2 1 078.00 5 1 078.00$ 3 -969.00$ -969.00$ 4(Quotes 5037-062-701-702) 7 214.00$ 7 214.00$ 5070 CAD Allowance 5 000.00$ 5 000.00$ 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ 5080 General Allowance 15 000.00$ 16 950.00$ 0.00$ 16 950.00$ 113% -1 950.00$ 1 10 000.00$ 10 000.00$ 2(Quotes 5037-700-702-7031 6 950.00$ 6 950.00$ 5080 CAD Allowance 5 000.00$ 5 000.00$ 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ SUB TOTAL 2 619 462.22$ 2 619 462.23$ 0.00$ 0.00$ 2 619 462.22$ 100% 0.00$ 0.00$ Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84 5 100% 0.00$ 0.00$ INST MAT Engeneering and cutting sheet 116 255.86$ 116 255.86$ 0.00 5 116 255.86$ 100% 0.00$ 0.00$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00 5 20 325.26$ 100% 0.00 5 0.00$ Page 6 CONTINUATION SHEET AIA Document G703 Format AIA Doc.6702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 27 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2011-12/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work (0+El (not in D or El (D+E+F) (G/C) (C-G) INST MAT Projet Management/Living/Travel 125 378.55$ 125 378.55$ 0.00$ 125 378.55$ 100% 0.00$ 0.00$ INST MAT Superintendant/Living/Travel 118 264.27$ 118 264.27$ 0.00 5 118 264.27 5 100% 0.00$ 0.00$ INST TOTAL BASE CONTRACT 3 174 070.00$ 3 174 070.00$ 0.00$ 0.00$ 3 174 070.00$ 100% 0.00$ 0.00$ Change Orders Change order#001 $ 5 156.00 $ 5 156.00 0.00$ 5 156.00$ 100% 0.00$ 0.00$ Change order#002 $ 17 479.00 $ 17 479.00 0.00$ 17 479.00$ 100% 0.00$ 0.00$ Change order#003 $ (65 000.00) $ (65 000.00) 0.00$ -65 000.00$ 100% 0.00$ 0.00$ Change order#004 0.00$ 0.00 5 100% 0.00$ 0.00$ Change order#005 $ 5 146.00 $ 5 146.00 0.00$ 5 146.00$ 100% 0.00 5 0.00$ Change order#006 $ 40 000.00 $ 40 000.00 0.00$ 40 000.00$ 100% 0.00$ 0.00$ Change order#007 $ 24 150.00 $ 24 150.00 0.00$ 24 150.00$ 100% 0.00$ 0.00$ Change order#008 $ 4 281.00 $ 4 281.00 0.00$ 4 281.00$ 100% 0.00$ 0.00$ Change order#009 $ 4 117.00 4 117.00 5 4 117.00$ 100% 0.00$ 0.00$ TOTAL CHANGE ORDERS $ 35 329.00 $ 31 212.00 $ 4 117.00 $ - $ 35 329.00 100% $ - $ - I TOTAL I$ 3 209 399.00 I $ 3 205 282.00 I $ 4 117.00 I$ - I$ 3 209 399.00 I 100% I$ - I$ - Page 7 INTERIM LIEN/CLAIM WAIVER From:. Ebenisterie Beaubois Ltee Project: Carmel Regional Performing Arts Center (Name of Firm Giving Release) (Project Name) 521, 6th Ave Carmel, IN (Business Address) (Project Address) St-Georges (Quebec G5Y OH1 (City,State,Zip Code) Contact Person: Steeve Lapointe Project Manager: Contact Telephone: 418-228-5104 Project Telephone : CONDITIONAL RELEASE UNCONDITIONAL RELEASE The undersigned does hereby acknowledge that The undersigned does hereby acknowledge that the upon receipt by the undersigned of a check from (Name of undersigned has received progress payments in the sum Firm writing check): The Pedcor Companies of$ 3,047,017.97 in the sum of$ 4,117.00 for labor, services, equipment or materials furnished to the and when the check has been properly endorsed and has above referenced job and does hereby release pro tanto been paid by the bank upon which it was drawn, this any and all claims and rights of lien which the document shall become effective to release pro tanto any undersigned has on the above referenced job. This and all claims and rights of lien which the undersigned release covers all payment for labor services, equipment, has on the above referenced job. This release covers a materials furnished and/or claims to the above referenced progress payment for labor, services, equipment, job through (date) 03/31/2011 materials furnished and/or claims through (date) only and does not cover any retention or items furnished December 31st 2011 after that date. only and does not cover any retention or items furnished after that date. Before any recipient of this document NOTICE: THIS DOCUMENT WAIVES RIGHTS relies on it said party should verify evidence of payment to UNCONDITIONALLY AND STATES THAT YOU HAVE the undersigned. BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM. I CERTIFY UNDER PENALTY OF PERJURY UNDER LAWS OF THE STATE OF QUEBEC THAT THE I CERTIFY UNDER PENALTY OF PERJURY UNDER ABOVE IS A TRUE AND CORRECT STATEMENT. LAWS OF THE STATE OF QUEBEC THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Sig nat .., Signature: f u orized Cor orate Officer/Partner/Owner) r Germain Alexandre, Ass.General Manager Authorized Corpora. Officer/Partner/Owner) (Title) Germai lexandre, Ass.General Manager (Title) Dated this 21st day of December , 2011 Dated this 21st day of December , 2011 at: St-Georqes, Beauce Quebec . at: St-Georges, Beauce, Quebec . Subscribed and sworn before me day and year first above written: Subscribed and sworn before me day and year first above dG'M_/:77 , /),,,,,,,A ' 'i2 written: Notary Public /a Chi ry 7 , ���:GF�1�� My commission e c ri{t��s:oeif:e a I,As yngitgaa Notary Public Co riri issaire a I'Asserm My commission expires enta:ion Commissioner for oath y p s : May 10 2013m- isgiorrer for oath Manon Poulin Manon Poulin # 163 850 # 163 850 District Quebec - District Quebec Quebec District Quebec District TRANSFER OF TITLE Ebenisterie Beaubois Ltee IC ' RA 'E.?1?.E ("Contractor") transfers to Village Financial, LLC any and all right, title and/or interest that Contractor has in any labor and/or materials described in (i) that Affidavit of Waiver of Lien executed by the Contractor on December 21st , 20 11 , and (ii) in the"Amount of this Request" section of that Affidavit executed by the Contractor on December 21st , , 20" "CONT• : CR" By: Pri ed: Germain Alexandre - Ass. General Manager Title: WAIVER OF LIEN The undersigned is the duly authorized officer of Ebenisterie Beaubois Ltee , the general contractor, 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_Carmel Performing Arts Center , which real estate is owned by_Carmel Redevelopment Commission («Owner»). IN CONSIDERATION of the sum of One Three million forty seven thousand one seventeen dollars and ninety seven cents DOLLARS ($3,047,017.97) 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 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 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 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 particulary 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 December 2011 _ olp Germ; Alexandre,/ s.General Manager Ebenisterie Beaubois Ltee (Name of Company) State of Quebec , County of_Beauce , SS : Before me, the undersigned, a Notary Public in and for said County and State, personally appeared Germain Alexandre The_Ass.General Manager ,of_Ebenisterie Beaubois Ltee , who acknowledged the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 21st day of_December_,_2011 My Commission Expires : Commissaire a I'Assermenta May 10,2013 Commissioner for oath r ���� fi'` `n' Manon Poulin Notary Public My County of Residence : # 163 850 District Quebec _Beauce Quebec District Manon Poulin (Printed Name of Notary Public) INTERIM LIEN/CLAIM WAIVER From:. Ebenisterie Beaubois Ltee Project: Carmel Regional Performing Arts Center (Name at Firm Giving Release) (Project Name) 521, 61h Ave Carmel, IN (Business Address) (Project Address) St-Georges(Quebec) G5Y OH1 (City,State,Zip Code) Contact Person: Steeve Lapointe Project Manager: Contact Telephone: 418-228-5104 Project Telephone : CONDITIONAL RELEASE UNCONDITIONAL RELEASE The undersigned does hereby acknowledge that The undersigned does hereby acknowledge that the upon receipt by the undersigned of a check from (Name of undersigned has received progress payments in the sum Firm writing check): The Pedcor Companies of$ 3,209,399.00 in the sum of$ 4,117.00 for labor, services, equipment or materials furnished to the and when the check has been properly endorsed and has above referenced job and does hereby release pro tanto been paid by the bank upon which it was drawn, this any and all claims and rights of lien which the document shall become effective to release pro tanto any undersigned has on the above referenced job. This and all claims and rights of lien which the undersigned release covers all payment for labor services, equipment, has on the above referenced job. This release covers a materials furnished and/or claims to the above referenced progress payment for labor, services, equipment, job through (date) 12/30/2011 materials furnished and/or claims through (date) only and does not cover any retention or items furnished December 31st 2011 after that date. only and does not cover any retention or items furnished after that date. Before any recipient of this document NOTICE: THIS DOCUMENT WAIVES RIGHTS relies on it said party should verify evidence of payment to UNCONDITIONALLY AND STATES THAT YOU HAVE the undersigned. BEEN PAID FOR GIVING UP THOSE RIGHTS. THIS • DOCUMENT IS ENFORCEABLE AGAINST YOU IF YOU ;% SIGN IT, EVEN IF YOU HAVE NOT BEEN PAID. IF YOU _ ./ HAVE NOT BEEN PAID, USE A CONDITIONAL RELEASE FORM. I CERTIFY UNDER PENALTY OF PERJURY UNDER LAWS OF THE STATE OF QUEBEC THAT THE I CERTIFY UNDER PENALTY OF PERJURY UNDER ABOVE IS A TRUE AND CORRECT STATEMENT. LAWS OF THE STATE OF QUEBEC THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Signature: Signature: ( orized Corporate cer/Pettner/Owner) (Authonzed Corport cer/Partner/Owner) Germain xandre,Ass.General Manager (Title) Germ ' Alexandre, Ass.General Manager (I die) Dated this 271h day of January , 2012 Dated this 27th day of January , 2012 at: St-Georges, Beauce Quebec . at: St-Georqes, Beauce, Quebec . Subscribed and sworn before me day and year first above written: Subscribed and sworn before me day and year first above written: ) \3,__ .LC ►._k o k)• \ %-I Notary Public `�^�� �__ 1v,,C As‘ ``-LCD ��'rr #' My commission expires : .X 4 Notary Public n. kr-- ),--. .� My commission expires � i Li Commissaire al'Assermentatlon pour le Duet Commissaire a I'Asserment�tlon pour le Queaec Commissioner for oath for Quebec Commissioner for oath for Quebec _ Francine Nolet Francine Nolet #136018 #136018 TRANSFER OF E;benisterie Beaubois Ltee FONT RACT R? ("Contractor")transfers to Village Financial, LLC any and all right,title and/or interest that Contractor has in any labor and/or materials described in(i)that Affidavit of Waiver of Lien executed by the Contractor on December 30th , 20 11 , and(ii)in the"Amount of this Request" section of that Affidavit executed by the Contractor on December 30th ,2fl 11 "CONTRACTOR" By: printed. ermain Alexandre Ass. General Manager Title: WAIVER OF LIEN The undersigned is the duly authorized officer of_Ebenisterie Beaubois Ltee , the general contractor, 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_Carmel Performing Arts Center ,which real estate is owned by_Carmel Redevelopment Commission («Owner»). IN CONSIDERATION of the sum of One Three million two hundred five thousand two hundred eighty-two dollars and zero cents DOLLARS ($_3,205,282.00) 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 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 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 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 particulary 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_27th day of January 2012 Ge . n Alexandr- s.General Manager _Ebenisterie Beaubois Ltee (Name of Company) State of_Quebec , County of_Beauce , SS: Before me, the undersigned, a Notary Public in and for said County and State,personally appeared_Germain Alexandre The Ass.General Manager , of_Ebenisterie Beaubois Ltee ,who acknowledged the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 27th day of January_,_2012 My Commission Expires : Notary Pu\lic My County of Residence: Corr mi ssaire8i'ASSErrllNillationpourleQue3:-.1 Beauce Commissioner for oath icr Quebec Francine ©iPrinted Name of Notary Public) #136 018