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Ebenisterie Beaubois Ltee - $293,137
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 ' 1 Amount of Authorized Disbursement (en)1-kck i \ IherkS lt; \le c TT 2.75" 095.3 b L Q1 (one t�.(}C ��.�mNhT �ti {t' mQ c eAr C Rc' 4Anil 1 U 0A-I:7 Lt t • t Ca�1j�l rre, e, V n14AAP �`ti11Qh(i 1�.1I LL C Total Authorized Disbursement te �.-� 'rte"' �' 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, LLC. Dated: Z 2?/0 _ CITY OF CARMEL REDEVELOPMENT ff Cs MISSION B 1.6111: 19. Printed LE-I- S . 01-a S Title 6-40 7/cdac p/`ro'c7Dre 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 Requested $ 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 Amount Requested $ 18,041.74 Overall Amount Requested $ 293,137.10 jrA Document G702/CMa - 1992 Application and Certificate for Payment Construction Manager:Adviser Edition TO OWNER: PROJECT: ` APPLICATION NO 0-11 Distribution to Ohl of Grad atrrry,1 1 Ce d- . PERIOD TO,; CQ►m limit 31 51' Z0c/ OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR:: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ 1b en'5`e,(0Q bectu.855 kbi2, ShIQrl 4)Y) PROJECT NOS: 2615 / 60 70 I CONTRACTOR ❑ VIA ARCHITECT: /1 FIELD ❑ CONTRACT FOR: I1►'I I INA C'.50 Qrchi ffc /00/, .P.2-0 0 1+� , 3 8 ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. eo Contract Documents,that all amounts have been paid by the Contractor for Work for which previous iI l- j Certificates'for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM `7 payment sho.•• •-rein is now du . 2.Net change by Change Orders $ °O 635 CONT• •CTOR: - 3.CONTRACT SUM TO DATE(Line-1 ±2) $ " B - C3--e -e54--f /�,J l 40051 y: Date: `1 f 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ State o • ..�' ''C X25, X07 5.RETAINAGE : my of of: 6Eu UC2 a. 10 %of Completed Work 79 Subscribed and sworn to before (Column D.+Eon G703) $ COmr111556irG 'd i'Assermentati0n b. %of Stored Material , J�O me this Ilih day of ZAa9 Commissioner for oath (Column F on G703) $ Notary Public: LQ . My Commission expires:Hay /0 c2oi Manon Poulin Total Retainage(Lines 5a+5b or Total in Column I of G703).. $gip? 570, ' CERTIFICATE FOR PAYMENT District Beauce-Quebec 6.TOTAL EARNED LESS RETAINAGE $ 2.48 )i 7 /0r In accordance with the Contract Documents, based on on-site clBp tQggtty ;1;StriCtiprising this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 3, knowledge,information and belief the.Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 276(09'6 • accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CER'1'11 IED. 8.CURRENT PAYMENT DUE $ 1(5"1 04/. 7 y AMOUNT CERTIFIED $ l gt ett` - 9.BALANCE TO FINISH,INCLUDING RETAINAGE „ (Attach explanation if amount certified differs, . the::amount,.applied.Initial all figures on this d Application and.• the Continuation Sheet at a,;e changed to conform with the amount certified) (Line 3 less Line 6) 010,567.g CON• RUCTION .-•: / B '� /2)23 Y� ■:. _ i��i�■ �� Date: �c�j CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS AR •�1. '/ ( / Total changes approved in previous months by Owner $ $ `.. hret lI� By: Date: Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CER'111-41h,D 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 ©199®by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® 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 nnnvrinhtnaia nrn .t. .tr CONTINUATION SHEET Ala Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached, APPLICATION NO: 11 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2009-12/31/2009 ARCHITECTS PROJECT NO: Cannel Regional Performing Arts Center,Carmel,IN A B C D 1 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 10% No. of work (D+E) (not In D or E) (0+E+F) (G/C) (C•G) MAT West 50 922.96$ 0.00$ 0.00$ 0.00$ 0.00$ 50 922.96$ 0.00$ MAT Miscellaneous items 57 783.98$ 0.00$ 0.00$ 0.00$ o.00 S 57 763.98$ 0.00$ LAB Auditorium 161 191.08$ 0.00$ 0.00$ 0.00$ 0.00$ 161 191.08$ 0.00$ LAB East 40 499.18$ 0.00$ 0.00$ 0.00$ 0.00$ 40 499.18$ 0.00$ LAB North 16 932.65 5 0.00$ 0.00$ 0.00$ 0.00$ 16 932.65$ 0.00$ • LAB West 26 471.63$ 0.00$ 0.00 5 0.00$ 0.00$ 26 471.63$ 0.00$ LAB Miscellaneous items 72 141.44$ 0.00$ 0.00$ 0.00$ 0.00$ 72 141.44$ 0.00$ MAT ORCHESTRA HIGH LEVEL 132 847.59$ 0.00$ 0.00$ 0.00$ 0.00$ 132 847.59$ 0.00$ LAB 92 280.19$ 0.00$ 0.00$ 0.00$ 0.00$ 92280.19$ 0.00$ MAT Auditorium 4 621.74$ 0.00$ 0.00$ 0.00$ . 0.00$ 4 621.74$ 0.00$ MAT East 485.32$ 0,00 5 0.00$ 0.00$ 0.00$ 485.32$ 0.00$ MAT South 101 013.48$ 0.00$ 0.00$ 0.00 S 0.005 101 013.48$ 0.00$ MAT West 485.32$ 0.00$ 0.00$ 0.00$ 0.00$ 485.32$ 0.00$ MAT Miscellaneous items _ 26 241.73$ 0.00$ 0.00$ 0.00 5 0.00$ 26 241.73$ 0.00$ LAB Auditorium 2 262.18$ 0.00$ 0.00$ 0.00$ 0.00$ 2 262.18$ 0.00$ LAB East 381.52 S 0.00$ 0.00$ 0.00$ 0.00$ 781.52 5 0.00$ Page 2 CONTINUATION SHEET AIA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubols Ltee containing Contractor's signed Certification Is attached. APPLICATION NO: 11 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2009•12/31/2009 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A a C D I E F . G H i Work Completed Material Total Item Description Scheduled Previous This Presently Complete lete % Balance Retainage Value application Period Stored and stored to Finish 10% No. of work (0+E) (not In D or E) (D+E+F) (G/C) (C-0) MAT BALCONY LOW LEVEL 30 066.12$ 0.00$ 0.00$ 0.00$ 0.00$ 30 066.12$ 0.00$ LAB 48 121.87$ 0.00$ 0.00$ 0.00$ 0.00$ 48 121.87$ 0.00$ MAT Auditorium 5 584.31$ 0.00$ 0.00$ 0.00$ 0.00$ 5 584.31 S 0.00$ MAT East 849.32$ 0.00$ 0.00$ 0.00$ 0.00$ 849.32$ 0.00$ MAT Norht 242.66$ 0.00$ 0.00$ 0.00$ 0.00$ 242.66$ 0.00$ MAT South 4 378.44$ 0.00$ 0.00$ 0.00$ 0.00$ 4 378.44$ 0.00$ MAT West 849.32 S 0.00$ 0.00$ 0.00$ 0.00$ 849.32 S 0.00$ MAT Miscellaneous items 18 162.07$ 0.00$ 0.00$ 0,00$ 0.00$ 18 162.07$ 0.00$ LAB Auditorium 2674.80$ 0.00$ 0.00$ 0.00$ 0.00 S 2674.80$ 0.00$ LAB East 667.66$ 0.00$ 0.00$ 0.00$ 0.00$ 667.66.$ 0.00$ LAB North 190.76$ 0.00$ 0.00$ 0.00$ 0.00$ 190.76$ 0.00$ LAB South 2 740.40$ 0.00$ 0.00$ 0.005 0.00$ •2 740.40$ 0.00$ LAB West 667.66$ 0.00$ 0.00 5 0.00$ 43.00$ 667.66 S 0.00$ LAB Miscellaneous items 41 180.59 5 0.00$ 0.00$ 0.00$ 0.00$ 41 180.59$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 0.00$ 0.00$ 0.00$ 0.00$ 143 538.52$ 0.00$ LAB 105 766.53$ 0,00$ 0.00$ 0.00$ 0.00$ 105 766.53$ 0.00$ MAT Auditorium 6701.17$ 0.00$ 0.00$ 0.00$ 0.00$ 6701.17$ 0.005 Page 4 I_ .. t iT CONTINUATION SHEET AIA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebentsterie Beaubois Ltee containing Contractors signed Certification is attached. APPLICATION NO: 11 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 12/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 12/01/2009-12/31/2009 • ARCHITECTS PROJECT NO: Carmel Regional Performing Arts Center,Carmel,Pt 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 10% No. of work (CI+E) (not lnDorE) (0+E+F) (G/C) (C•G) Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84$ 100% 0.00 5 17 438.38$ INST MAT Engeneering and cutting sheet 116 255.86$ 34 876.76$ 11 625.59$ 46 502.34$ 40% 69 753.52 S 4 650.23$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00 S 20 325.26$ 100% 0.00$ 2 032.53 S INST MAT Projet Management/Living/Travel 125 378.55$ 53 912,78$ 2 507.57 S 56 420.35$ 45% 68 958.20$ 5 642.03$ INST MAT Superintendent/Living/Travel 118 264.27$ 17 739.64$ 5 913.21$ 23 652.85$ 20% 94 611.42$ 2 365.29$ INST TOTAL BASE CONTRACT 3 174 070.00$ 305 661.51$ 20 046.37$ 0.00$ 325 707.89$ 2 848 362.12$ 32 570.79$ Change Orders MAT Change order#001 $ 5 156.00 0.00$ 0.00$ 0% 5 156.00$ 0.00$ INST Change order#002 $ 17 479.00 0.00$ 0.00$ 0% 17 479.00 5 0.00$ MAT INST TOTAL CHANGE ORDERS S 22 635.00 S - S - $ - $ - f 22 635.00 S TOTAL I S 3 198 705.00 j S 305 661.51 1 S 20 046.37 1$ - I S 325 707.89 I j$ 2 870 997.12 I S 32 570.79 I Calculer Matrise Page 6 :147/.A ....b. Iil asamos Document 6702/CnllarM — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO Ci�.i o P �r�t ��� Distribution to: CarIme1 -?()QC Cog}' PERIOD TO: .ov iY, i 3014 2oOi OWNER ❑ CONSTRUCTION MANAGER ❑ FROM I _CONTRACTOR,. VIA CONSTRUCTION"MANAGER: CONTRACT DATE: ARCHITECT ❑ berll54-afI'e t is 0-ee 51'110 l A)-Cin PROJECT NOS: a 6,9'5 I 50 l0 I CONTRACTOR ❑ VIA ARCHITECT: I FIELD ❑ CONTRACT FOR: I 1 1.I Iwo(I, . c. 50 6irch i Ifct5 ❑ CONTRACTOR'S APPLICATION FOR PAYMENT : The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract'Documents,that all amounts have been paid by the Contractor.for Work for which previous ' a° Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $3 .)4`i 010 payment shown herein is now due. 2.Net change by Change Orders $ „?a ,9, 5°° CONT• ' TOR: 3.CONTRACT SUM TO DATE(Line 1 +2 °0 , - ) f/ / ( - ) $3 /9(° 7oJ BY -�. Date: I ( I OOCj 4.TOTAL COMPLETED&STORED TO DATE(Column"G on G703) $ 2-0‘) 6h/.6/ State • 'eec 5.RETAINAGE: ounty of: UCe COmmissaire a I'Assermentatian a. To of Completed Work r Subscribed and sworn to before Commissioner for oath (Column D+Eon G703) $ 30,66'6. l 3 me this Ilp+h day of r�Q eyyl I 9 Manon Poulin b. %of Stored Material Notary Public://41, f- _ # 163 850 (Column F on G703) $ My Commission expires: y` oI0 r�QiO Distr ct Beaks OU4b9s Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 7�), lv(2. 15 CERTIFICATE FOR PAYMENT Beauce-Quebec District RETAINAGE $ z7 In accordance with the Contract Documents, based on.on-site observations and the data comprising 6.TOTAL EARNED LESS 75,095. 3e this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ Z(p j �lj�. 7 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 2 G 7 8.CURRENT.PAYMENT DUE $ I7jJ 9: 8, (y2- AMOUNT CERTIFIED $ 1 ?j1 l 7g 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs s he amount:applied.Initial all figures on this Application and on he Continuatio .heet at are •hanged to conform with the mount certified.) (Line 3 less Line 6) $2 q21 (y Of. 64 CONST- CTION p . BY .b1_ 4.7%.^4_54- .4... ■■' = Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI ''• Total changes approved in previous months by Owner $ $ ' Date: 1(( - .01-041 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 AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® 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:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:11/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009•11/30/2009 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 10% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT BASEMENT LEVEL 52 098.35$ 0.00$ 0.00 $ 0.00$ 0.00 $ 52 098.35$ 0.00$ LAB 11 883.71 $ 0.00$ 0.00 $ 0.00$ 0.00$ 11 883.71 $ 0.00$ MAT North 6 886.93$ 0.00$ 0.00$ 0.00$ 0.00$ 6 886.93$ 0.00$ MAT Miscellaneous items 45 211.43$ 0.00$ 0.00$ 0.00$ 0.00$ 45 211.43$ 0.00$ LAB North 1 257.05$ 0.00$ 0.00$ 0.00$ 0.00$ 1 257.05$ 0.00$ LAB Miscellaneous items 10 626.66$ 0.00$ 0.00$ 0.00$ 0.00$ 10 626.66$ 0.00$ MAT PLENUM LEVEL 49 668.53$ 0.00$ 0.00$ 0.00 $ 0.00$ 49 668.53 $ 0.00$ LAB 42 456.67$ 0.00$ 0.00$ 0.00 $ 0.00$ 42 456.67$ 0.00$ MAT Miscellaneous items 12 287.66$ 0.00$ 0.00$ o.00 S 0.00$ 12 287.66$ 0.00$ MAT South 37 380.88$ 0.00$ 0.00$ 0.00$ 0.00$ 37 380.88$ 0.00$ LAB Miscellaneous items 26 524.29$ 0.00$ 0.00$ 0.00$ 0.00$ 26 524.29$ 0.00$ LAB South 15 932.38$ 0.00$ 0.00$ 0.00$ 0.00$ 15 932.38$ 0.00$ MAT ORCHESTRA LOW LEVEL • 884 071.73 $ 0.00$ 0.00$ 0.00$ 0.00$ 884 071.73 $ 0.00$ LAB 317 235.98$ 0.00$ 0.00$ 0.00$ 0.00$ 317 235.98 $ 0.00$ MAT Auditorium 536 641.30$ 0.00$ 0.00$ 0.00$ 0.00$ 536 641.30$ 0.00$ MAT East 137 103.55$ 0.00$ 0.00$ 0.00$ 0.00$ 137 103.55$ 0.00$ Page 1 ■ CONTINUATION SHEET AIA Document 6703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:11/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009-11/30/2009 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 10% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT North 101 619.95$ 0.00$ 0.00$ ' 0.00$ 0.00$ 101 619.95$ 0.00$ MAT West 50 922.96$ 0.00$ 0.00$ 0.00$ 0.00$ 50 922.96$ 0.00$ MAT Miscellaneous items 57 783.98$ 0.00$ 0.00$ 0.00$ 0.00$ 57 783.98$ 0.00$ LAB Auditorium 161 191.08$ 0.00$ 0.00$ 0.00$ 0.00$ 161 191.08$ 0.00$ LAB East 40499.18$ 0.00$ 0.00$ 0.00$ 0.00$ 40499.18$ 0.00$ LAB North 16 932.65 5 0.00$ 0.00$ 0.00$ 0.00$ 16932.65$ 0.00$ LAB West 26 471.63$ 0.00$ 0.00$ 0.00$ 0.00$ 26 471.63$ 0.00$ LAB Miscellaneous items 72 141.44$ 0.00$ 0.00$ 0.00$ 0.00$ 72 141.44$ 0.00$ MAT ORCHESTRA HIGH LEVEL 132 847.59$ 0.00$ 0.00$ 0.00 $ 0.00$ 132 847.59$ 0.00$ LAB 92 280.19$ 0.00$ 0.00$ 0.00 $ 0.00$ 92 280.19$ 0.00$ MAT Auditorium 4 621.74$ 0.00$ 0.00$ 0.00$ 0.00$ 4 621.74$ 0.00$ MAT East 485.32$ 0.00$ 0.00$ 0.00$ 0.00$ 485.32$ 0.00$ MAT South 101 013.48$ 0.00$ 0.00$ 0.00$ 0.00$ 101 013.48$ 0.00$ MAT West 485.32$ 0.00$ 0.00$ 0.00$ 0.00$ 485.32$ 0.00$ MAT Miscellaneous items 26 241.73 5 0.00$ 0.00$ 0.00$ 0.00$ 26 241.73$ 0.00 5 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:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE 11/20/2009 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009-11/30/2009 ARCHITECTS PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D 1 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 10% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) LAB Auditorium 2 262.18$ 0.00$ 0.00$ 0.00$ 0.00$ 2 262.18$ 0.00$ LAB East 381.52$ 0.00$ 0.00$ 0.00$ 0.00$ 381.52$ 0.00$ LAB South 40723.56$ 0.00$ 0.00$ 0.00$ 0.00$ 40723.56$ 0.00$ LAB West 381.52$ 0.00$ 0.00$ 0.00$ 0.00$ 381.52$ 0.00$ LAB Miscellaneous items 48 531.41$ 0.00$ 0.00$ 0.00$ 0.00$ 48 531.41$ 0.00$ MAT BOX TIER LEVEL 326 347.94$ 4 423.24$ 0.00$ 0.00$ 4 423.24$ 321 924.71 $ 442.32$ LAB 278 078.48 $ 0.00 $ 0.00$ 0.00$ 0.00$ 278 078.48$ 0.00$ MAT Auditorium 11 727.05$ 0.00$ 0.00$ 0.00$ 0.00$ 11 727.05$ 0.00$ MAT East 44 650.44$ 4 423.24$ 0.00$ 0.00$ 4 423.24$ 40 227.20$ 442.32$ MAT North 16 580.44$ 0.00$ 0.00$ 0.00$ 0.00$ 16 580.44$ 0.00$ MAT South 81 787.06$ 0.00$ 0.00$ 0.00$ 0.00$ 81 787.06$ 0.00$ MAT West 82 441.76$ 0.00$ 0.00$ 0.00$ 0.00$ 82 441.76$ 0.00$ MAT Miscellaneous items 89 161.20$ 0.00$ 0.00$ 0.00$ 0.00$ 89 161.20$ 0.00$ LAB Auditorium 6 058.74$ 0.00$ 0.00$ 0.00$ 0.00$ 6 058.74$ 0.00$ LAB East 26 800.35$ 0.00$ 0.00$ 0.00$ 0.00$ 26 800.35$ 0.00$ LAB North 6 898.68$ 0.00$ 0.00$ 0.00$ 0.00$ 6 898.68$ 0.00$ Page 3 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:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:11/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009-11/30/2009 ARCHITECTS 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 10% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) LAB South 37 667.50$ 0.00$ 0.00$ 0.00$ 0.00$ 37 667.50$ 0.00$ LAB West 42 037.97$ 0.00$ 0.00$ 0.00$ 0.00$ 42 037.97$ 0.00$ LAB Miscellaneous items 158 615.24$ 0.00$ 0.00$ 0.00$ 0.00$ 158 615.24$ 0.00$ MAT BALCONY LOW LEVEL 30 066.12$ 0.00$ 0.00$ 0.00$ 0.00$ 30 066.12$ 0.00 $ LAB 48 121.87$ 0.00$ 0.00$ 0.00 $ 0.00$ 48 121.87$ 0.00$ MAT Auditorium 5 584.31$ 0.00$ 0.00$ 0.00$ 0.00$ 5 584.31$ 0.00$ MAT East 849.32$ 0.00$ 0.00$ 0.00$ 0.00$ 849.32$ 0.00$ MAT Norht 242.66$ 0.00$ 0.00$ 0.00$ 0.00$ 242.66$ 0.00$ MAT South 4 378.44$ 0.00$ 0.00$ 0.00$ 0.00$ 4 378.44$ 0.00$ MAT West 849.32$ 0.00$ 0.00$ 0.00$ 0.00$ 849.32$ 0.00$ MAT Miscellaneous items 18 162.07$ 0.00$ 0.00$ 0.00$ 0.00$ 18 162.07$ 0.00$ LAB Auditorium 2 674.80$ 0.00$ 0.00$ 0.00$ 0.00$ 2 674.80$ 0.00$ LAB East 667.66$ 0.00$ 0.00$ 0.00$ 0.00$ 667.66$ 0.00$ LAB North 190.76$ 0.00$ 0.00 5 0.00$ 0.00$ 190.76$ 0.00$ LAB South 2740.40$ 0.00$ 0.00$ 0.00$ 0.00$ 2740.40$ 0.00$ LAB West 667.66$ 0.00$ 0.00$ 0.00$ 0.00$ 667.66$ 0.00$ Page 4 CONTINUATION SHEET AMA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:11/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009-11/30/2009 ARCHITECTS 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 10% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) LAB Miscellaneous items 41 180.59$ 0.00$ 0.00$ 0.00$ 0.00$ 41 180.59$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 0.00$ 0.00$ 0.00 $ 0.00$ 143 538.52$ 0.00 $ LAB 105 766.53$ 0.00$ 0.00$ 0.00$ 0.00$ 105 766.53 $ 0.00 $ MAT Auditorium 6701.17$ 0.00$ 0.00$ 0.00$ 0.00$ 6701.17$ 0.00$ MAT East 8 672.67$ 0.00$ 0.00$ 0.00$ 0.00$ 8 672.67$ 0.00$ MAT North 121.33$ 0.00$ 0.00$ 0.00$ 0.00$ 121.33$ 0.005 MAT South 85 647.88$ 0.00$ 0.00$ 0.00$ 0.00$ 85 647.88$ 0.00 S t MAT West 5 840.25$ 0.00$ 0.00$ 0.00$ 0.00$ 5 840.25$ 0.00$ MAT Miscellaneous items 36 555.23$ 0.00$ 0.00$ 0.00$ 0.00$ 36 555.23$ 0.00$ LAB Auditorium 3 504.20$ 0.00$ 0.00$ 0.00$ 0.00$ 3 504.20$ 0.00$ LAB East 5 910.02$ 0.00$ 0.00$ 0.00$ 0.00$ 5 910.02$ 0.00$ LAB North 95.38$ 0.00$ 0.00$ 0.00$ 0.00$ 95.38$ 0.00$ LAB South 39 165.15$ 0.00$ 0.00$ 0.00$ 0.00$ 39 165.15$ 0.00$ LAB West 3 896.68$ 0.00$ 0.00$ 0.00$ 0.00$ 3 896.68$ 0.00$ LAB Miscellaneous items 53 195.10$ 0.00$ 0.00$ 0.00$ 0.00$ 53 195.10$ 0.00$ MAT ALLOWANCE 105 000.00$ 0.00$ 0.00$ 0.00 $ 0.00$ 105 000.00$ 0.00$ Page 5 CONTINUATION SHEET MA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:010 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:11/20/2009 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:11/01/2009-11/30/2009 ARCHITECTS 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 10% No. of work (D+El (not in D or E) (0+E+F) (G/C) (C-G) 5060 General Allowance 50 000.00$ 0.00$ 0.00$ 0% 50 000.00$ 0.00$ 5060 CAD Allowance 5 000.00$ 0.00$ 0.00$ 0% 5 000.00$ 0.00$ 5070 General Allowance 25 000.00$ 0.00$ 0.00$ 0% 25 000.00$ 0.00$ 5070 CAD Allowance 5 000.00$ 0.00$ 0.00$ 0% 5 000.00$ 0.00$ 5080 General Allowance 15 000.00$ 0.00$ 0.00$ 0% 15 000.00$ 0.00$ 5080 CAD Allowance 5 000.00$ 0.00$ 0.00$ 0% 5 000.00$ 0.00$ SUB TOTAL 2 619 462.22$ 4 423.24 S 0.00$ 0.00$ 4 423.24$ 2 615 038.98$ 442.32$ Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84$ 100% 0.00 S 17 438.38$ INST MAT Engeneering and cutting sheet 116 255.86$ 29 063.97$ 5 812.79$ 34 876.76 5 30% 81 379.10$ 3 487.68$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00 S 20 325.26$ 100% 0.00$ 2 032.53 S INST MAT Projet Management/Living/Travel 125 378.55$ 50 151.42$ 3 761.36$ 53 912.78$ 43% 71 465.77$ 5 391.28$ INST MAT Superintendant/Living/Travel 118 264.27$ 11 826.43$ 5 913.21$ 17 739.64 S 15% 100 524.63$ 1 773.96$ INST TOTAL BASE CONTRACT 3 174 070.00$ 290 174.15$ 15 487.36$ 0.00$ 305 661.51 $ 2 868 408.49$ 30 566.15$ Change Orders MAT Change order#001 $ 5 156.00 0.00$ 0.00$ 0% 5 156.00$ 0.00$ INST Change order#002 $ 17 479.00 0.00$ 0.00$ 0% 17 479.00 S 0.00$ MAT INST TOTAL CHANGE ORDERS $ 22 635.00 $ - $ - $ - $ - $ 22 635.00 $ - ■ [ I TOTAL I$ 3 196 705.00 I$ 290 174.15 I$ 15 487.36 1$ - I$ 305 661.51 I I$ 2 891 043.49 1$ 30 566.15 CalculerMatnce;� Page 6 SL Subcontract Billing Report For Work Invoiced From 11/01/09 to 11/30/09 Subcontract: 2695-5070 5070 Custom Casework Job: 2695- Carmel-RPAC Construction Vendor: 9846 EBENISTERIOA BEAUBOIS LTEE 777 3rd Ave. SW Carmel, IN 46032 Contract To Date , This Period Item Units UM Unit Cost Amount Unitsl% Amount Units/Y. Amount 1 5070 Custom Casework LS 3,174,070.00 9.63% 305,661.52 0.49% 15,487.36 Total Contract Items 3,174,070.00 305,661.52 15,487.36 ***Change Orders*** 2 Bid Alternate-Donor Amenity LS 17,479.00 0.00% 0.00 0.00% 0.00 Upgrades 3 Bid Alternate-Multipurpose LS 5,156.00 0.00% 0.00 0.00% 0.00 Room Upgrades Total Change Order Items 22,635.00 0.00 0.00 Subcontract Totals: 3,196,705.00 305,661.52 15,487.36 Total Billings: 305,661.52 15,487.36 Unpaid Retainage: 30,566.16 1,548.74 Discounts: 0.00 0.00 Net Billings: 275,095.36 13,938.62 98 SSC-CMa Projects Page 1 11/19/09 11:59:40 AM Date Format-MM/DD/YY SLSubBillingReport.rpt •AIA TM Document G702/CMa - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition 5de l'B TO OWNER: (� /� PROJECT: r APPLICATION NO: co 9' Distribution to: C1 I 0 I• l�v,,,e I Grwe l K Pat al-15i- PERIOD TO 10 I=31 (`a CX)C) OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION ANAGER: CONTRACT DATE: ARCHITECT ❑ L ein)5 4-en'e to hG S L l,°e S h i e I A kr) PROJECT NOS: 205" I solo I CONTRACTOR ❑ VIA ARCHITECT: FIELD ❑ CONTRACT FOR: M,I Ii 14/Gi(K 6-064 CSC QiT,hl e ❑ 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 Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703 is attached. a ' Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ /IL/ 010 payment shown herein is now due. 2.Net change by Change Orders $ c2a 4.35 `� CONT- ' OR: 2) $ 9 OS B Date: 3.CONTRACT SUM TO DATE Line I + 5.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ jp /IV, 15 State of• •' '1.df C my of: ..fe(AUC I? CAfY1PIlISS31Y @'.�,s r:ii lentati�� a. K) %of Completed Work Subscribed and sworn to before GOmmlSSir r r to (Column D+Eon G703) $ Q/�. y2 me this 20 i4) day of 200°1 i Manor OU!I+' b. .4 of Stored Material Notary mmiss: //Z � # 163 850 (Column F on 0703) $ My Commission expires: -1f .J 10 2010 Diatriet 1 P.SUCe Ou2beL Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ eQ 9 0/i• �2 CERTIFICATE FOR'PAYMENT Beams-Quebec District / In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $a(D 1, l6tt' this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) /p knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ o�8.38®' i' accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 521.71k9(60 i 8.CURRENT PAYMENT DUE $ �jo? 76p3, /L/ AMOUNT CERTIFIED $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE` (Attach explanation if amount certified differs from the amount.applied. Initial all fgures on this Application and on the Continuation Sheet that ' ihanged''to conform with the amount certified.) (Line 3 less Line 6) $ a q.35 6v..-7-7 CONSTRUCTION MO'G BY: �,s . r. !%�ij[a. / Date: /19/tOiel CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI �. '� of, Total changes approved in previous months by Owner $ $ By � Date: I 1 1.g 1 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 Ale Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA" Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. àAIADocument 6702/CMa" - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition 5, lig TO OWNER: PROJECT: r. APPLICATION NO: c7b :_ Distribution to: C o�` Cr ) CQYtm e I PaC Ccii5 PERIOD TO: Oq�5O 12W 9 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: 1- VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Chen 1.5-l-et1 e &aut ]^I?e �'j�li?/ '` PROJECT NOS: 2.q6 / 507O / CONTRACTOR ❑ VIA ARCHITECT: FIELD ❑ CONTRACT FOR: h i 1 worK �� Qrc v eCk5 ❑ 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.bysthis Application for Payment has been completed in accordance with the Continuation Sheet, for Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous a° Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $;) )11/010 payment she - -- ein is now due. 2.Net change by Orders 9 Y Chan a 9 - $ aa 635"" CONT'/,CTOR: 3.CONTRACT.SUM TO DATE(Line 1 ±2) $3 (C1(p ,V5 p0 By: C — Q Date:04, I 1/f dwc, 4.TOTAL COMPLETED&STORED:TO DATE(Column G on G703) $ 75 l,J State of n 2 ?C 5.RETAINAGE: Cotinty of:Beau ce a. %of Completed Work sworn e 1(7 P Subscribed-and sworn to before COIrll1'lISS81fed I ASSer177.,ntatiOt1 (Column D+Eon G703) $ 3 376 61 me this a th day of I�er 4t� b. '%of Stored Material Notary Public: � Commissioner for :;sth (Column F on G703) $ My Commission expires: G1 y 0 is # 16:1 85010 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 95 % / • 5/ CERTIFICATE FOR PAYMENT District Beauce-Quebec �Od In accordance with the Contract Documents, based on on-si yf iM�ikwIJif9tcomprising 6.TOTAL EARNED LESS RETAINAGE $4�dj.58 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 5`1/i/6, accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERILhIhD. z� 8.CURRENT PAYMENT DUE $ 13 8'18.2e, AMOUNT CERTIFIED $ 131 $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach.explanation if amount certified diffe om the amount applied. Initial an figures on this Application and o# he Continuatis Sheet that gre changed to conform with the mount certified.) Line 3 less Line 6 $ CON.T•UCT •N 3 A BY: ‘V.01.. .V,Vier"444 .. _'— ® Date: 9 ADDITIONS DEDUCTIONS CHANGE ORDER SUMMARY ARC ECT• P' Total changes approved in previous months by Owner $ $ By: /t I Date: la/ Total approved this Month pP $ $ 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 AIA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA` 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. l tvgAIA Document G702ICMa - 1992 Application and Certificate for Payment Construction-Manager-Adviser Edition TO OWNER.• PROJECT: APPLICATION NO COI Distribution to: CI t`i O CGLrer Hof C Orel -gPae 5t • PERIOD TO: Ll 3f 51 OWNER ❑ Car l (n 4�o3a v �1 � CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ �,bi nisiG�)�` e3UhoI5 Ova, S hle1 _.2k 1-00 PROJECT NOS:. (765 / 6270 / CONTRACTOR ❑ VIA ARCHITECT:. FIELD ❑ CONTRACT FOR: l-1 II ofK. CSQ archi ecbS ❑ 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 the Contract. belief the Work covered by this Application for Payment-has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amounts have been paid by the•Contractor for Work for which previous a° Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $. 'ill Q?O. payment she • erein is now due. 2. Net change by Change Orders $ o-0 o� �1, a,(r636 CONT •:GTOR: , ad i{ 3.CONTRACT SUM TO DATE(Line 1 ±2) $a, /96'"7(,6.. By: \ Date:Q6 J/6 12009 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 2M.3�a'/1b State of eeC 5.RETAINAGE: C.. ty.of: ,1106110t,ta2 Commissaire a I'Assermentatinn a. I Q To of Completed Work Subscribed nd sworn to before &) Commissioner for o�;'L (Column D.+Eon G703) $ , i me this 1o{-h day of,'QU A LI3+ Arii Manon Poulin b. %of Stored Material Notary Public: 0)4,02C- efeli(Jar1� # 163 850 (Column F on G703) $ My Commission expires:.r-ic y to ,.. 010 I?[g}rlet'RPanrw_nuebe , Total Retainage(Lines 5a+5b or Total in Column I of G703). $ �,cYa' CERTIFICATE'FOR PAYMENT 9eauce-Quebec District 3c� In accordance with the Contract Documents, based on-on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $�i�,J y(} this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $2o/.21/-5. 12' accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. �e� 8.CURRENT PAYMENT DUE $ �7j x97.22 AMOUNT CERTIFIED $I • 1e 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from th .• mint;.applied. Initial all figures on this Application and on the Continuation Sheet that ar- han•ed'to conform with the amount certified.) (Line 3 less Line 6) $2 9. 1 16. �/ CONST'UCTION M GE ri BY: ‘e....i� . ,j-. 5�/ Date: • i rr ADDITIONS DEDUCTIONS ARCHITE T ,• CHANGE ORDER SUMMARY B �� /260 �Total changes approved in previous months by Owner $ $ ` y; ®�; Date. ' 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.AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA" Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. �,��1®/! 0`: 7M Document.G702/JCMa - ' 992 Application and Certificate for Payment Construction Manager Adviser Edition TO 0 NER` PROJECT: - APPLICATION NO:000 : Distribution to: C_I`N of (GrfmCl �( r► l- Pac PERIOD TO W I t o-+ OWNER 0 ✓ I i ' 140_,N CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: • ARCHITECT ❑ E I n 14 rl p ul3 JiS el ax,.1-C'r) PROJECT NOS: 0,q(p3" 1 solo / . CONTRACTOR ❑ VIA ARCHITECT:. FIELD ❑ CONTRACT FOR: q,iiha,t, c 04,l"JS ❑ CONTRACTOR'S APPLICATION FOR PAYMENT" The undersigned.Coritractor certifies that to the best of the.Contiactor's knowledge, information and Application is made for payment,as shown below,in connection with the Contract: belief.the-Work.covered'by.this.Application=for.Payment.has been completed'in accordance with the Continuation Sheet,AIA Document G703,is attached. oo ContractdDocuments;.that all amounts;have been paid by.the'Contractor for'Work for which previous Certificates for Payment were.issued and_.payments received,from..the.Owner, and that current 1`ORIGINAL CONTRACT SUM $��'�!�0 payments herein is now.due. or7 2.Net change by Change Orders $ , � CONT CTO 3.CONTRACT SUM TO DATE(Line 1 +2) 0/97'066`c By ( Date: 07 / i(p /a005 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ c3 42_. '17 StateMl" GtC?C r 5.RETAINAGE: County of GP" wire .I'Assermentetien fommis a. /0 %of Completed'.Work Subscribed and sworn to before (Column D+Eon G703) $ K2a 20,.= ComMano nPouli oath me this� �(9 fh day of �. �Do� . Marron Poulin b. %of Stored Material Notary Public Cray�L " '\— # 163.850 (Column F on G703) $ My Commission expires i 4 10 (9010 Dl3tricf:Beauce-n uebee Total Retainage(Lines 5a+5b or Total in Column I of G703). $off,, .. CERTIFICATE FOR PAYMENT Beaune-Quebec District $ 1 rl �a In accordance with the Contract.Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE c this application,the Construction:Manager and Architect,certify to the Owner that to.the best of their (Line 4 Less Line 5 Total) 5, knowledge;information and belief the Workhas progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ /516' ,p/' '/' accordance with,the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE $ 'J"I L// �1 3 �78 �'�� AMOUNT CERTIFIED $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fro he amount applied.Initial all figures on this R Application ando e Continuation Sheet tha changed to conform with the amount certified.) (Line 3 less Line 6) $ 7 gv CONS 'UCTION 0 '. By its/t '■e�4/. _. . Date: l ADDITIONS DEDUCTIONS �'� CHANGE ORDER SUMMARY ARC fCT - �� Total changes approved in,previous months by Owner $ $ By f ate. . 1 ' `t11 Total approved this Month $ $ This Cert` s not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ named i. . Issuance payment pa ment and acceptance of payment are without rejudice to any rights of NET CHANGES by Change Order $ the`O%•'eror 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 G7021CMaTM_1992.Copyright'©1992 by The American Institute of Architects.All rights reserved:WARNING:This Ale Document is protected by U.S.Copyright,Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. pp ma 0 ! AIA Document 6702/CMa - 19.92 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO Dos Distribution to City c r i.rrn,e1 \ (\'C\ MIL L r r r . PERIOD TO ,�,,i�L -1/t *I\ My39 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ EbL:t, tvt. tt f■1.1\1,M.6 Ltel 5rtA i PROJECT NOS: elko / S0,,0 / CONTRACTOR ❑ VIA ARCHITECT:. FIELD ❑ CONTRACT FOR R Alt Orl'. CHi> ar'ttrtS El CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract,Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current j�'1 1.ORIGINAL CONTRACT SUM $ , ,ODD E .'v payment:sh • • erein is now due. 2. Net change by Change Orders $ '''' CONT' • TOR: 3 CONTRACT SUM TO DATE(Line;(+2) v01 4,0 4 D.' By • Date b(n I i 5 I aLLYI 4 TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ i il lS3 59 State o :.. vi.r 5.RETAINAGE: %ounty of beech P, a. ID To of Completed Work Column D.+Eon G703 1 7J-c) Subscribed and sworn to before �y��jgS$jre �.I'ASSermen#8tjOr ( ) $ I A, 1�, me this.\r�t'n day of r m1 Commissioner for oath b %of Stored Material Notary Public �L � th Marion Poulin(Column F on G703) $ My Commission expires: -1 �b dDL) # 163 850 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ I/„.1j1'x )3� CERTIFICATE FOR PAYMENT District Beauce=QuebeQ 6.TOTAL EARNED LESS RETAINAGE $ �3 In accordance with the Contract Documents, based on I s itid`thCetdata comprising i�l�..��ni{, this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 10r), 13/3 " accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE $ fj 1 I I%i• ° AMOUNT CERTIFIED $ St 19 ,. . 9 BALANCE TO FINISH,INCLUDING RETAINAGE. .. (Attach explanation if amount certified differs from the;;amoun,applied.Initial alltfgures on this Application and on the Continuation .eet th' e changed to conform with the amount certified.) (Line 3 less Line 6) $ �,�� 65. " CONST• CTION ;A f�q D . s. �-.; .n ' Date: /"/ CHANGE ORDER SUMMARY. ADDITIONS DEDUCTIONS ARCHITECT I' (( ��( Total changes approved in previous months by Owner $ $ By j' Date G, �a''v 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/CMa TM—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties. 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 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,a-mail The American Institute of Architects'legal counsel,copyright @aia.org. ‘,1 1_ 0 i y, s?t.r...,4. . . .. Document G702/CMa 1992 , , . . . . Application and Certificate for Payment Construction Manager-Adviser Edition TO•DWNE,ft:, _ PROJECT: r, APPLICATION NO: 00 9,-,,.. Distribution to: Ca`j OF Cdr(rig/ ' . ex rive 1 It-Pac ari5+ , PERIOD TO: M 3 5.1 Zoo OWNER 0 CONSTRUCTION MANAGER 0 ' . FROM CONTRACTO VIA CONSTRUCTION MANAGER: C ben i-6ieti'a---"Pect-1-1 18°1 : -- 4. CONTRAC T RACT DATE ARCHITECT 0 1 ie I ,) cn PROJECT NOS: 2 62ct 5 / 507 0 / CONTRACTOR 0 VIA ARCHITECT: FIELD 0 CONTRACT FOR: M I. ii L,t)()(141 C 50 arch . I=.) CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for Payment has been completed in accordance with.the Application is made for payment,as shown below,in connection with the Contract. Contract Documents, that all amounts have been•paid by the.Contractor.for Work for which previous Continuation Sheet,AIA Document G703,is attached. Do Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $3 III/ 070 payment shown .erein is now due. 2. Net change by Change Orders $ IT CONTRAC OR ' ...c...tirkeLe tve 3.CONTRACT SUM TO DATE(Line.1 ±2) $ gi By: Date: 6-. 115/2oa9 . 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) $ / , i , "I State of. 0(4 f.k'C , ' i ' a 5.RETAINAGE - Co. ty of: aga,../A.ce • „. - Commissaire a l'Assermentation - a. /0 7043PCompleted Work 0 V , Subscribed and sworn to , Commissioner for oath _ (column D+E on G703) $ /1, 441'7 me this 161-1-, day of "tiPt q 400 5 Manon Poulin b . %of Stored Material Notary Pubhc: - # 163 850 (Column F on 0703) $ 0 Le/ My Commission expires: ik-fci 4 f p,e),00 . D:otrict EaRlk9 OU4t)947 „ 1 ' Total Retainage(Lines 5a+5b or Total in Column I of G703). $ IL 4,87 CERTIFICATE FOR PAYMENT Beauce-Quebec District , 7 In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $105 , /e3. this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) o 7 knowledge information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 77 9'g, ''' ' accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. le" (Line 6 from prior Certificate) ,.),i ,..),), ,/-0 8.CURRENT PAYMENT DUE $cif 011/0''') Ilt AMOUNT CERTIFIED $ 2:1J 22,„S V 9 BALANCE TO FINISH INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied Initial all pores on this ' '.. . , Application and on the Continuation Sheet t ..al;g"changed to conform with the amount certified) (Line 3 less Line 6) ‘ 4-5 $3 oW rcP . CONST-UCTION giNAG.R: ' By t■ :. ..tre-4,..‘,". _..... Date: ••.- 0 ' CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARcHl .An.. A' ,_ C , 1,.‘gb, Total changes approved in previous months by Owner $ $ By: --- --Z..--- Date: (.9 11,., , Total approved'this Month _ $ $ • Certifi..te is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ n ed h in Issuance; payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ th:-6 •ner 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/CMa TM-1992.Copyright 0 1992 by The American Institute of Architects All'rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA6 Document,or any portion of it may result in severe civil and criiiiinhi 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 orq. _ -....--- - Document G702/CMa 1992 • Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER:01,I Or COr,(Ke"'f'' PROJECT Co. eO APPLICATION NO 00 5 nl PC ,' Distribu PERIOD TO: . apill 3c1t•h 2)99 OWNE CONSTRUCTION MANAGE FROM CONTRACTOR: 0 VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITEC e.,1?tinl5tri'e Deaunol 5 PROJECT NOS 2 - 5070 i CONTRACTO 51' i.e 1 SeA )-00 Co Orch VIA ARCHITECT: FIEL CONTRACT FOR: 11 I Gucirk_ CONTRACTOR'S.APPLICATION FOR.PAYMENT The.undersigned Contractor certifies that to the best of the Contractor's knowledge, mformat 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 v Continuation Sheet AIA Document G703 is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which p no Certificates foi Pa ment were issued and payments received from the Owner, and that 1.ORIGINAL CONTRACT SUM $3 IN OK) payment show. erein s now due 2.Net change by Change Orders .... .... $ ) CONTRACTO-: - OP r,, , .(-) _ ,• 3.CONTRACT SUM TO DATE(Line 1 ±2) $Q / • 0 By. 'M- - .1. CA--4.--"-t.) c"' Date Q1// /1009 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ n 6/40. 0 State of g' 'C 5.RETAINAGE , ' Count of 400ED LiCe , - - a. /() %of Completed Work Subscribed and sworn to before r, Cornmissaire a l'Assermentation (Column D+E on G703) i - ^ 0 $ 8 b(0 i. . nie this 2151- day,of a;Dr i —00.7 ( ,....,t, , .' 1 NotarY Public:c'tva(- -- Commissioner for oath b %of Stored Material Marlon Poulin (Column F on G703) $ My Commission expires: HO 10 c2o/o # 163 850 0 Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 0,opow0(.. CERTIFICATE FOR PAYMENT District Beauce-Chl.ene $ r77 qb.-8,dry In accordance with the Contract D......ocuments, based on onBia431;116fierQMOsechPgriAtta comj 6.TOTAL EARNED LESS RETAINAGE this application, the Construction manager and Architect certify to the Owner that to the best c (Line 4 Less Line 5 Total) knowledge information and belief the Work has progressed as indicated,the quality of the Woi 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT accordance with the Contract Documents,and the Contractor is entitled to payment of the AM( (Line'6 from prior Certificate) i i CERT 11-.IED q i 1 8.CURRENT PAYMENT DUE 1 $q 551 q`3 I AMOUNT CERTIFIED $ I a SS1 -- I (Attach explanation if amount certified differs from thearzzuntoapphed Initial all figures on thi. 9.BALANCE TO FINISH,INCLUDING RETAINAGE , Application and on the Continuation Sheet that are■changetrto conform with the amount certifie (Line 3 less Line 6) ' $309&/1/ 73 CONSTRUCTION MANAGE:. g 65 ba, .3:6 asfOr ' B y / , Date: 4/-29 -,0 li■ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: ...„ ,soi Total changes approved.in previous months by Owner $ $ By. ,adir , Date 47* .>0• idill 1 Total approved this Month $ $ This Certifica is no, egouable. The AMOUNT CERTIFIED is payable only to the Conn TOTALS $ , $ named here . Isst . ce., payment and acceptance of payment are without prejudice to any rigl NET CHANGES by Change Order $ the Owne or C. tractor under this Contract CAUTION: You should sign an original AlA Contract Document,on which this text appears in RED.All original assures that changes will not be obscured. AIA Document G702/CMaTM•-•1992 Copyright 0 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by US Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed To rennrt rrinvnnht Winantinne,,f A IA rs..............n-- ---.- - ,- • iv AT IA Document G702ICMe 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 002 City of Carmel Carmel-RPAC Const. Distribution to: PERIOD TO; March 31st 2009 OWNER ❑ CONSTRUCTION MANAGER ❑ • FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ E • benisterie Beaubois Shiel Sexton PROJECT NOS:2695-5070 CONTRACTOR ❑ V •• IA ARCHITECT: • CSO architects FIELD ❑ CONTRACT FOR: Millwork 0 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and i 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,ALA Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous 1.ORIGINAL CONTRACT SUM Certificates fo Payment were issued and payments received from the Owner, and that current $ 3,174,070.00 payment. Olaf : in is now due. 2.Net change by Change Orders $ CONT.'.•CTOR: - r', 3.CONTRACT SUM TO DATE(Line l±2) $3,174,070.00 By: . 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 72,673.72 State of: •--bee Date: 03/25/2009 5,RETAINAGE: COfllrllissaire a rAsserment atior Cou • of: Beauce a, %ofCompleted Work Commissioner x•�r `;F (Column D+Eon G703) 7,267.37 S �scribcd and sworn to before I,., 03 1 b, e $ me this 25th day of Marc 2009 klar!or' Poulin /o of Stored Material Notary Public: ? //%,� �j� 133 650 (Column F on G703) $ My Commission expires: May 10,2010 Ci 1i1 t 5�r.ttlCO-. 1.1t;DCC Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ CERTIFICATE FOR PAYMENT EIeatice- District 6,TOTAL EARNED LESS RETAINAGE In accordance with the Contract Documents,based on on-site observations and the data crising $ 65,406.35 (Line 4 Less Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best of their knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7,LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 60,191.01 accordance with the Contract Documents,and the Contractor is entitled to payment of the AM UNT (Line 6 from prior Certificate) CER11t tJrD, 11 3.CURRENT PAYMENT DUE Is 5,215.34 I AMOUNT CERTIFIED �1ItA �' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified d(Ifers from the amount applied.Initial all figures on this (Line 3 less Line 6) $ 3,108,663.65 j Application and on the ontinuation Sheet i at are c ed to conform with the amount art fed.) ,� CONSTR• T10N MAN S 32-7 0 . CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS By, a ��'' Ly Date: orgy ARCHITECT Total changes approved in previous months by Owner $ $ `y Total approved this Month By: -` Date: $ S This Certi to is negotiable. The AMOUNT CERTIFIED is payable on!_ to the Contractor TOTALS $ 5 named h .•in. ;-;mice,payment and acceptance of payment are without preJu•ice to any rights of the Own ' ".ntractor under this Contract. NET CHANGES by Change Order S AIA Document G7021CMer"—1992,Copyright CO 199^by The American Institute of Architects.All rights reserved,WARNING:This Ale Document Is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document,or any portion of it,may result in severe civil and criminal penalttes,and will be prosecuted to the maximum extent possible under the law.This document was created at 13;10:10 MST on 02/34/2009 under the terms of license number 26001 issued by the American Institute of Architects,and N not for resale.This document is licensed for one time use only and may not be reproduced prior to its completion.