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Ebenisterie Beaubois Ltee - $585,744.67
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 Dlsbursomont Amount of Authorised.Olabursomont Ameun"s -10 6e lonA �,\) Village Fin nci a) ApHic on IS (E bents+erie Be6,u6ni5) I ( 1791. '38 APpdi.cQ-kiov I (E this+-er+e lea sis) 9-I5, 953.29 . Total Authorized Dlaburaomont. + h —777:7,-- 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. r1 Dated: 7-2.0--J0. CITY OF CARMEL REDEVELOPMENT COMMISSIeN B y ; Printed Le.. S. Olds Title e Xe CLO I Ve D i re c d o r 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 Amount to be paid by Village Financial $ 169,791.37 May 2010 Amount to be paid by Village Financial $ 415,953.29 •AJA TMOcUm.ent 67.02/C a . — -1992 Application and Certificate for-Payment Construction Manager-Adviser Edition yg TO OWNER: PROJECT: APPLICATION NO: 015 ° Distribution to:0 r✓v C Co rv�el PaC co15i PERIOD TO:�j rI 30 r h 8010 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: 1- VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ ibehibterl e I)eouBoo L e _S I'e I xlOf PROJECT NOS: 2645- / 5070 / CONTRACTOR ❑ S21 V'"44 Ave, VIA ARCHITECT: Src'-Ekap1;G•@S �QoG3E& A`D'D" FIELD ❑ CONTRACT FOR: M(IlworK 695'4. °W1 C50 (3rMitFQ"5 ❑ 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 PO Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $5;114,670, payment, •t - erein is now due. 2:Net change by Change Orders $ 2 (0. 5. °" CONT CTOR: ®'' 3.CONTRACT SUM TO DATE(Line 1 ±2) $.3-,g49 7U5 " By "■ s Date: 02-1 h7/?''o i p 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $) '1lft 137 c'. State 4)c I 5.RETAINAGE: ounty of:t&DUCP COPClIt19SSaire a. 10 %of Completed Work I ASSermenta'tion 71 Subscribed and sworn to be ore Commissioner for oath (Column D+E on G703) $ IN �it methis2 ('td C cJ of.L�tpf,II ,- )O Marion Poulin b. To of Stored Material Notary Public: 7 '-"ti.- # 163 850 (Column F on G703) $ My Commission expires: IMcj�l, lO rQ0�9j CERTIFICATE FOR PAYMENT I tri�,� Queb,C'Qu6t, 4 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $,.I Ili ,6 „ ii Beauee-Quebec RfStf"ICt i•6.TOTAL EARNED LESS RETAINAGE $ /;��� q 3 In accordance with the Contract Documents, based on on-site observations and t The data comprising `�O J'(IpL-')+ this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5-Total) 9-7 knowledge,.inforniation and belief the.Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ NO,, L''x. accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 37 8.CURRENT PAYMENT DUE $ 79/. 3 AMOUNTCERTIFIED $ J h a t 7 11 _ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified cliff- . rom the amount applied. Initial all figures on this Application and the Continuatio She• t are changed to conform with the amount certified.) . (Line 3 less Line 6) $ i t 061, w! CONS 'UCTION/'N• R: i I By: r `/�!=A. i.. ' — Date: e f �1r(O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH TE• ' ►. I Total changes approved in previous months by Owner $ $ By ll I Date: 441 a451,1 10 Total approved this Month $ $ This Certificate is not ne negotiable. The AMOUNT CERTIFIED is payable only to th Contractor g P Y Y 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 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. CONTINUATION SHEET AIA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO 15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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 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 $ 27 283.27$ 0.00$ 0.00 $ 27 283.27$ 22 385.26 $ 2 728.33 $ LAB 42 456.67$ 0.00 $ 0.00 $ 0.00 $ 0.00$ 42 456.67$ 0.00$ MAT Miscellaneous items 12 287.66$ 11 058.89$ 0.00$ 0.00$ 11 058.89$ 1 228.77$ 1 105.89$ MAT South 37 380.88$ 16 224.38$ 0.00$ 0.00$ 16 224.38$ 21 156.49$ 1 622.44$ 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 $ 204 773.27$ 0.00$ 101 547.28 $ 306 320.55 $ 577 751.18$ 30 632.06 $ LAB 317 235.98 $ 0.00$ 39 950.48 $ 0.00 $ 39 950.48 $ 277 285.50$ 3 995.05 $ MAT Auditorium 536 641.30$ 73 642.01 $ 0.00$ 101 547.28$ 175 189.30$ 361 452.00$ 17 518.93$ MAT East 137 103.55$ 51 907.14$ 0.00$ 0.00$ 51 907.14$ 85 196.41$ 5 190.71$ Page 1 CONTINUATION SHEET AIA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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 P 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 North 101 619.95$ 4 718.84$ 0.00$ 0.00$ 4 718.84$ 96 901.11$ 471.88$ MAT West 50 922.96$ 23 682.65$ 0.00 S 0.00$ 23 682.65$ 27 240.30$ 2 368.27$ MAT Miscellaneous items 57 783.98$ 50 822.63$ 0.00$ 0.00$ 50 822.63$ 6 961.35$ 5 082.26$ LAB Auditorium 161 191.08$ 0.00$ 39 950.48$ 0.00$ 39 950.48 S 121 240.60$ 3 995.05$ LAB East 40 499.18$ 0.00$ 0.00$ 0.00$ 0.00$ 40 499.18$ 0.00$ LAB North 16 932.65$ 0.00$ 0.00$ 0.00$ 0.00$ 16 932.65$ 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$ 0.005 MAT ORCHESTRA HIGH LEVEL 132 847.59 $ 64 188.92$ 0.00 $ 0.00$ 64 188.92 $ 68 658.67$ 6 418.89$ LAB 92 280.19$ 0.00$ 0.00 $ 0.00 $ 0.00$ 92 280.19$ 0.00 $ MAT Auditorium 4 621.74 5 3 697.39$ 0.00$ 0.00$ 3 697.39$ 924.35$ 369.74$ MAT East 485.32$ 388.26$ 0.00$ 0.005 388.26$ 97.06$ 38.83$ MAT South 101 013.48$ 37 435.82 5 0.00$ 0.00$ 37 435.82$ 63 577.66$ 3 743.58$ MAT West 485.32$ 388.26$ 0.00$ 0.00$ 388.26$ 97.06 5 38.83$ MAT Miscellaneous items 26 241.73$ 22 279.19$ 0.00$ 0.00$ 22 279.19$ 3 962.54$ 2 227.92 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:15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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 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 40 723.56$ 0.00$ 0.00$ 0.00$ 0.00$ 40 723.56$ 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$ 204 529.97$ 0.00$ 0.00 $ 204 529.97$ 121 817.97$ 20 453.00 $ LAB 278 078.48$ 0.00 $ 0.00 $ 0.00$ 0.00 $ 278 078.48$ 0.00 $ MAT Auditorium 11 727.05$ 9 381.64$ 0.00$ (3.00$ 9381.64$ 2345.41$ 938.16$ MAT East 44 650.44$ 34 192.67$ 0.00$ 0.00$ 34 192.67$ 10 457.77$ 3 419.27$ MAT North 16 580.44$ 8 211.59$ 0.00$ 0.00$ 8 211.59$ 8 368.84$ 821.16$ MAT South 81 787.06$ 39 145.53$ 0.00$ 0.00$ 39 145.53$ 42 641.54$ 3 914.55$ MAT West 82 441.76$ 33 353.47$ 0.00$ 0.00$ 33 353.47$ 49 088.29$ 3 335.35$ MAT Miscellaneous items 89 161.20$ 80 245.08$ 0.00$ 0.00$ 80 245.08$ 8916.12$ 8 024.51 $ 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 AR Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO 15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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 0 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$ 25 869.10 $ 0.00 $ 0.00 $ 25 869.10 $ 4 197.02$ 2 586.91 $ LAB 48 121.87$ 0.00 $ 0.00 $ 0.00$ 0.00 $ 48 121.87$ 0.00$ MAT Auditorium 5 584.31$ 4 467.45$ 0.00$ 0.00$ 4 467.45$ 1 116.86$ 446.74$ MAT East 849.32$ 679.45$ 0.00$ 0.005 679.45$ 169.86$ 67.95$ MAT North 242.66$ 194.13$ 0.00$ 0.00$ 194.13$ 48.53$ 19.41$ MAT South 4 378.44$ 3 502.75$ 0.00$ 0.00$ 3 502.75$ 875.69$ 350.27$ MAT West 849.32$ 679.45$ 0.00$ 0.00$ 679.45 S 169.86 5 67.95$ MAT Miscellaneous items 18 162.07$ 16 345.87$ 0.00$ 0.00$ 16 345.87$ 1 816.21$ 1 634.59$ 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$ 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 5 0.00$ 0.00$ 0.00$ 667.66$ 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:15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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) 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$ 66 647.70$ 0.00$ 0.00 $ 66 647.70 $ 76 890.81 $ 6 664.77$ LAB 105 766.53 $ 0.00$ 0.00$ 0.00 $ 0.00 $ 105 766.53 $ 0.00$ MAT Auditorium 6 701.17$ 5 360.94$ 0.00$ 0.00$ 5 360.94$ 1 340.23$ 536.09$ MAT East 8 672.67$ 4 964.82$ 0.00$ 0.00$ 4 964.82$ 3 707.85$ 496.48$ MAT North 121.33$ 0.00$ 0.00$ 0.00$ 0.00$ 121.33$ 0.00$ MAT South 85 647.88$ 20 723.36$ 0.00$ 0.00$ 20 723.36$ 64 924.52$ 2 072.34$ MAT West 5 840.25$ 2 698.88$ 0.00$ 0.00$ 2 698.88$ 3 141.36$ 269.89$ MAT Miscellaneous items 36 555.23$ 32 899.70$ 0.00$ 0.00$ 32 899.70$ 3 655.52$ 3 289.97$ LAB Auditorium 3 504.20 5 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 5 0.00$ 0.00 5 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 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:15 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:04/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:04/01/2010-04/30/2010 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 ID+E) (not in D or E) (D+E a-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$ 593 292.24$ 39 950.48$ 101 547.28$ 734 790.00$ 1 884 672.22$ 73 479.00$ Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84$ 100% 0.00$ 17 438.38 5 INST MAT Engeneering and cutting sheet 116 255.86$ 58 127.93$ 29 063.97$ 87191.90$ 75% 29 063.97$ 8 719.19$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00 5 20 325.26$ 100% 0.00$ 2 032.53$ INST MAT Projet Management/Living/Travel 125 378.55$ ' 68 958.20$ 6 268.93$ 75 227.13$ 60% 50 151.42$ 7 522.71$ INST MAT Superintendant/Living/Travel 118 264.27$ 41 392.49$ 11 826.43 5 53 218.92$ 45% 65 045.35$ 5 321.89$ INST TOTAL BASE CONTRACT 3 174 070.00$ 956 479.96$ 87 109.80$ 101 547.28$ 1 145 137.05$ 2 028 932.95$ 114 513.70$ 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$ 0.00$ MAT INST TOTAL CHANGE ORDERS $ 22 635.00 $ - $ - $ - $ - $ 22 635.00 $ - TOTAL I$ 3 196 705.00 I$ 956 479.96 I$ 87 109.80'$ 101 547.28 I$ 1 145 137.05' I $ 2 051 567.95 I $ 114 513.70 I Calculer Ma nce s', r. 1'?I Page 6 REF. N° 09-F020 CERTIFICATE OF INSURANCE: Aon Reed Stenhouse Inc. Re: Project C-5037:Carmel Performing Art Center 700,De La Gauchetiere Street West,Suite 1800 Period from April 01,2010 to April 30,2010 Montreal,Quebec H3B 0A4 tel.: 514-842-5000 fax. ;514-842-3456 Stored Material at 511,6th Avenue, St-Georges,Quebec • Certificate Holder Shiel Sexton 902 N.Capitol Avenue Indianapolis,IN 46204 Insurance as described herein has been arranged on behalf of the Insured named herein under the following policy(ies)and as more fully described by the terms, conditions,exclusions and provisions contained in the said policy(ies)and any endorsements attached thereto. Insured EBENISTERIE BEAUBOIS LTD 521,6TH AVENUE ST-GEORGES (QUEBEC) G5Y OH1 Coverage • General Liability Insurer: Chartis Insurance company of Canada Policy n°: 6645-7761 December 01,200 Effective• .._.... ..... pry: cee........_..20 10 _._. 9 Expiry December 01, --- --... 0__00___0 Perils insured: Limits Bodily.Injury&Property Damage,each occurrence $2,000,000 .___. __._.. 000.0 _._ Products and CompletedOperations,aggregate $2,000,000 Non-Owned Automobile Liability, $2,000,000 Property Insurance r p rty .... _-- ... ...... ... .... Insurer: Affiliated FM Insurance Company Policy n°: RN-437 _.. Effective: December 01,2009 Ex i : December 01,2010 Perils Insured g All Risks including flood and earthquake Limits ._ All Risks including flood and earthquake $101,547.28 USD Additional Insured Shiel Sexton and Carmel Redevelopment Commission(as the owner)are add as additional insured,but solely regarding the liability arising out of the Insured's operations with respect to the above project. THIS CERTIFICATE OF INSURANCE CONSTITUTES A STATEMENT OF THE FACTS AS OF THE DATE OF ISSUANCE AND ARE SO REPRESENTED AND WARRANTED ONLY TO THE INSURED. OTHER PERSONS RELYING ON THIS CERTIFICATE DO SO AT THEIR OWN RISK. Aon Reed Stenhouse Inc. Date: April 15, 2010 i i • Issued by: Marie-Josee Marchand, CIP A u__.____e _ . ,i_ Tel: 514-840-7715 Si.'nature THIS POLICY CONTAINS A CLAUSE THAT MAY LIMIT THE AMOUNT PAYABLE 1 OR,IN THE CASE OF AUTOMOBILE INSURANCE, THE POLICY CONTAINS A PARTIAL PAYMENT OF LOSS CLAUSE Ilif::',:-Ill BEAU.BOIS S BILL OF SALE CARMEL PERFORMING ARTS CENTER FOR GOOD CONSIDERATION, and upon payment of One hundred one thousand five hundred fourty seven 28/100 dollars ($101,547.28) and to extent as billed on Pay Request 15 the undersigned, Ebenisterie Beaubois Ltd., 521, 6th Avenue, Saint-Georges Quebec, G5Y OH 1 (« Seller ») hereby sells and transfers to Shiel Sexton Inc (« Buyer »), the following : See breakdown attached Which are stored at : Ebenisterie Beaubois Lee, 511, 6th Avenue, Saint-Georges Quebec, G5Y OH1 (418)228-5104 (418)228-3524 fax The seller warrants it has a good title to said property, full authority to sell and transfer same, and that said property is sold free of all liens, claims and encumbrances. Signed under seal this 15th day of April 2010 Ebenisterie Beaubois Ltee O. , •. a ,,, r e, c-) Ge ain Alexandre, A ssistant General Manager Cammissaire a I'Assormentat�on t. c �r� ,ti . , Commissioner for <. ,h Notary Public Manon Pot:iin # 163 850 DiJtric1 Beauce-Quebec Doat ce-Quabec District tv-kAIA Document. 6702/CMaTM — 1992 F Application and'Certificate for Payment Construction,Manager-Adviser Edition 4g TO OWNER: PROJECT: APPLICATION NO: 01 (0 Distribution to: City of GrmeI CarnmeI PaC; 0)5 . PERIOD TO .pia 9 - 3151- o2Ol.0 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: }- VIA'.CONSTRUCTION CMANAGER: CONTRACT DATE: ARCHITECT ❑ �b enl'5 t�rl`e 2Gil tl'Glg Imo- S60 I 0 n PROJECT NOS: 2(091' 6070 I CONTRACTOR ❑ 521 bviAv, VIA ARCHITECT: FIELD ❑ 5p Erma-6> s — AaA I" I CONTRACT.FOR: 111'1 I AO l< el5Y01t2 C .30 Qy-chil-e 5 ❑ 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 showti below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,MA Document G703,is attached. a 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 1.ORIGINAL CONTRACT SUM $7)f Vy070, 0 payments • • serein is now du . 2.Net change by Change Orders $ -37,/J. ° CONT•..CTOR: • l 3.CONTRACT SUM TO DATE(Line 1 ±2) $3,36 ?-Si. 616',.. By: ` Date: 06-126/ ?O/Q . 4:TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ //n0 7.7T State of 4r °►je 5.RETAINAGE: .unty of:2,eau C,e. Corrlrnissafre a i'Assermerltatiorl a. tj %of Completed Work Subscribed and sworn to before Commissioner for oath (Column D+Eon G703) $ )5t 8/12.55 me this 2. -1'1 day of �pl�f Z^ Ol a ' b. %of Stored Material . Notary Public jvw�� Manors Poulin ( ) My r�, 10 , a 0 6 163 850 Column F on G703 $ M Commission expires: 5-5 District Bcauoe Qu6boc Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 5 8 2 CERTIFICATE FOR PA MENT Beauce-Quebec District 1.A / In accordance with the Contract Documents, based on on-site observations and the.data comprising 6.TOTAL EARNED LESS RETAINAGE $'I�.v "D this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 37 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $.l 039.£23 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. (Line 6 from prior Certificate) ►'U` q /a 8.CURRENT PAYMENT DUE $ 4Iq '. 45 AMOUNT CERTIFIED $ 4 I I �4 I `[' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fr. the amount.applied. Initial all figures on this �Q/ 2 / Application and on Continuation S •t tha are .hanged to conform with the at ount certified.) (Line 3 less Line 6) $ �p8(p .JOw CONST',�CTIO a BY: . .�.!.Av%-. • .�. . �. . _� Date: 05 I® CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: r� ' / Total changes approved in previous months by Owner $ $ By: /1e Date: / ( I D 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 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,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. i • • • CONTINUATION SHEET AIA Document 0703 Format AIA DOC.6702,APPLICATION AND CERTIFICATE FOR PAYMENT • containing Contractor's signed Certification is attached. Contractor:Ebenisterie Beaubois Ltee In tabulations below,amounts are stated to the dollar. APPLICATION NO:16 s Use Column Ion Contracts where variable retainage for line items may apply. APPLICATION DATE:05/20/2010 • APLICATION PERIOD:05/01/20:10.....05/71/2010 ARCHITECT'S PROJECT NO: • • Carmel Regional Performing Arts Center,Carmel,IN. • • A 8 G H Work Completed Material' Total Item Description Scheduled Previous This Presently. ,Complete % Balance Retainage Value application Period Stored (0+E) .and stored to Finish 10% (not in Dor E) (D+E+F) (G/C) (C•G) • MAT BASEMENT LEVEL 52 098.35 $ 0.00$ 0.00$ 36 468.85$ 36 468.85 $ LAB 11 883.71 $ 0.00 $ 0.00 $ 0.00 $ , 0.00$ 15 883.71 $ 3 646.88 $ _ 11 883.71 $ 0.00 $ MAT North • 6 886.93$ 0.00$ 0.00$ 4 820.85$ 4 820.85$ 2 066.08$ 482.08$ MAT Miscellaneous items 45 211.43 S 0.00$ 0.00$ 31 648.00$ 31 648.00 5 13 563.43 S 3 164.80$ 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 5 0.00$ MAT PLENUM LEVEL 49 668.53 $ 27'283.27$ 0.00$ 7 370.35$ 34 653.63 $ LAB 42 42 456.6 456.67$ 0.00 $ 0.00 $ 0.00$ 0.00$ 1 2 456.67 $ • 3 465.00 $ 7 $ 0.00$ MAT Miscellaneous items 12 287.66$ 11 058.89$ 0.00 $ 0.00$ 11 058.89$ 1 228.77 5 1 105.89$ MAT South 37 380.88$ 16 224.38$ 0.00$ 7 370.35$ 23 594.73$ 13 786.14$ 2359.47$ • LAB Miscellaneous items 26 524.29$ 0.00$ 0.00$ 0.00 5• 0,00$ _ 26 524.29$ 0.00$ LAB •South 15 937.38$ 0.00$ 0.00$ 0.00$ 0.00$ 15932.38$ 0.00$ 'MAT ORCHESTRA LOW LEVEL 884 071.73$ 306 320.55$ 0.00$ 155 728.62$ 462 049.18 $ 422 022.56 $ 46 204.92$ LAB 317 235.98 $ 39 950.48 $ 94 471.55 $ 0.00$ 134 422.03 $ 182 813.95 S 13 442.20$ MAT Auditorium 536 641.30$ 175 189.30$ 0.00$ 73 984.68$1 249 173.97$ 287 467.33$ 24 917.40 5 MAT East 137 103.55$ 51 907.14$ 0.00$ 53 385.09$ 105 292.23$ 31 811.32 5 10 529.22 5 MAT North 101'619.95$ 4 718.84 5 0.00$ 12 315.14$ 17033.97$ 84 585.97 S • 1 703.40 5 MAT West 50 922.96$ 23 682.65$ 0.00$ 15 123.64$ 38 806.30$ 12 116.66 S ' 3 880.63$ • MAT Miscellaneous items 57 783.98$ 50 822.63$ 0.00$ 920.08$ 51 742.71$ 6 041.28$ 5 174.27$ • Page 1 • . • • CONTINUATION SHEET AIA Document G703 Faunal MA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:16 • In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:05/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:05/01/2010 05/31/2010 ARCHITECTS PROJECT NO: • Carmel Regional Performing Arts Center,Carmel,IN - • • • A g C D 1 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 (D+E) (not In 0 or E) _ (D+E+F) (G/C) (C.G) LAB Auditorium 161 191.08 S 39 950.48$ 58 400.83$ 0.00$ 98 351.31$ 62 839.77 S 9 835.13$ j LAB East 40 499.18$ 0.00$_ 0.00$ 0.00$ 0.00$ 40 499.18$ 0.00$ LAB North 16 932.65$ 0.00$ 0.00 5 0.00 5 0.00$ 16 932.65 S 0.00$ LAB West 26 471.63$ 0.00$ 0.00$ 0.00$ 0.00$ 26 471.63 S 0.00$ LAB Miscellaneous items 72 141.44$ 0.00$ 36 070.72$ 0.00$ 36 070.72$ 36 070.72$ 3 607.07$ MAT ORCHESTRA HIGH LEVEL 132 847.59$ 64 188.92$ 0.00$ 39 637.81 $ 103 826.73 $_ 29 020.86 $ , 10 382.67 LAB 92 280.19 $ 0.00$ 0.00 $ 0.00 $_ 0.00$ 92 280.19 $ 0.00 $ MAT Auditorium • 4 621.74$ 3 697.39$ 0.00$ 0.00$ 3 697.39$ 924.35$ 369.74$ MAT East 485.32$ 388.26$ 0.00$ 0.00$ 388,26$ 97.06$ 38.83$ MAT South 101 013.48$ 37 435.82$ 0.00$ 38 596.86$ 76 032.68$ 24 980.80$ 7 603.27$ MAT West 485.32$ 388.26$ • 0.00$ 0.00$ 388.26$ 97.06$ 38.83$ • MAT Miscellaneous items 26 241.73$ 22 279.19$ 0.00$ 1 040.95$ 23 320.14$ 2 921.59$ 2 332.01$ LAB Auditorium 2 262.18$ 0.00$ o.00 S o.00 S o.00$ 2 262.18 5 0.00 5 • LAB East 381.52$ 0.00 S 0.00$_ 0.00 5_ 0.00$ 381.52$ 0.00$ LAB South - 40 723.56$ 0.00$ 0.00$ 0.00$ 0.00$ 40 723.56$ 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$ 204 529.97$ 0.00 $ 60 885,54$ 265 415.51 $ 60 932.44$ 26 541,55$ LAB 278 078.48$ 0.00$ 0.00$ 0.00$ 0.00$ 278 078.48 $ 0.00 $ Page 2 • • ., CONTINUATION SHEET MA Document 0703 Format AIA Doc,0702,APPLICATION AND CERTIFICATE FOR PAYMENT containing Contractor's.signed Certification is attached. Contractor:Ebenisterie Beaubois Ltee .. In tabulations below,amounts are stated to the nearest dollar. APPLICATION NO:16 Use Column I on Contracts where variable retainage for line items may apply. APPLICATION DATE:05/20/2010 Y a PP y APLICATION PERIOD:05/01/2010-05/31/2010 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN • • ■ L E I • Work Co H Completed Material Total Item Description Scheduled Previous This Presently Complete No. of Work Value application Stored % Balance Retainage and stored Retains e ID+E) (not in 0 or E) (D+E+F) (G/C) to Finish 010% MAT Auditorium 11 727.05$ 9 381.64$ 0.00 0.00$ 9381.64$ 2 345.41$ 938.16$ MAT East - _ 44 650.44$ 34 192.67$ 0.00$ 4 098.59$ 38 291.25$ 6 359.19$ 3 629.13$ MAT North 16 580.44$ 8 211.59$ 0.00$ 4 421.16$_ 12 632.76$ 3 947.68$ 1 263.28 S MAT South 81 787.06$ 39 145.53$ 0.00 23787.42$ 62932.94$ 18 854.12$ 6 293.29 5 MAT West 82 441.76$ 33 353.47$ 0.00$ 28 578.37$ 61 931.84$ 20509.92$ 6193.18$ • MAT Miscellaneous items 89 161.20$ 80 245.08$ 0.00$ 0.00$ 80245.08$ • 8916.12$ 8024.51$ 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$ 0.005 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$ 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$ 25 869,10$ 0.00$ 0.00$ 25 869.10$ LAB 48 121,87$ 0.00 $ 0,00$ 0,00$ 0.00$ 4 197.02 $ 2 586.91 $ 48 121.87$ 0.00$ MAT Auditorium 5 584.31$ 4 467.45$ 0.005 0.00$ 4 467.45$ 1 116.66$1 446.74$ MAT East 849.32$ 679.45$ 0.00$ 0.00$ 679.45$ 169.86$ • 67.95$ MAT North 242.66$ 194.13$ 0,00$ 0.00$ 194.13 5 48.53$ 19.41$ MAT South - 4 378.44$ 3 502.75$ 0.00$ 0.00 5 3 502.75$ _ 875.69$ 350.27$ MAT West 849.32$ 679.45$ 0.00$ 0.00$ 679.45$ 169.86$ 67,95$ .. -- Page 3 .. . • • • • CONTINUATION SHEET AIA Document 0703 Format A • IA Doc,0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterte Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:16 • In tabulations below,amounts are stated to the nearest dollar. _ • - APPLICATION DATE:05/20/2010 • Use Column I on Contracts where variable retainage for fine Items may apply. APLICATION PERIOD:05/01/2010•05/31/2010 ARCHITECT'S PROJECT NO: • Carmel Regional Performing Arts Center,Carmel,IN . A B • C D I E F G H Work Completed Material Total Item Description Scheduled Previous This Present) Value application Period Stored . , Complete % Balance Retainage . No. of work (0+E) (not in 0 or E) (D+Eo+r F) G/C) t(C Finish MAT Miscellaneous items 18 162.07$ 16 345.87$ 0.00$ 0.00$ 16 345..87$ 1 816.21$ 1 634.59$ • LAB Auditorium 2 674.00 5 0.00$ ' 0.00$ 0.00$ 0.00 5 . 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$ 0.00$ 0.00$ 190.76$ 0.00$ LAB South - 2 740.40$_ 0.00$ 0.00$ 0.00$ 0.00$ 2 740.40$ 0.00$ LAB West • 667.66$ . 0.00$ 0.00$ 0.00$ 0.00$ 667.66$ 0.00$ LAB Miscellaneous items . 41 180.59$ 0.00$ 0.00$ 0.00$ 0.00$ 41160.59$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 66 647.70$ 0.00$ 43 799.86 $ 110 447.56$ • 33 090.95$ 11 044.76$ LAB 105 766.53 $ 0.00$ 0.00$ 0.00 $ 0.00 $ 105 766.53 $ 0.00$ MAT Auditorium 6 701.17$ 5 360.94 5 0.00 5 0.00$ 5 360.94$ 1 340.23$ 536.09$ MAT East 8 672.67$ 4 964.82$ 0.00 5 1 726.65$ 6 691.47 5 1 981,20$ 669.15 5 MAT North 121.33$_ 0.00$_ 0.00$ 84.93$ 84.93$ 36.40$ 8.49$ MAT South 85 647.88$ 20 723.36 5 0.00$ 41 988.28$ 62 711,64$ 22 936,24$ 6 271.16$ MAT • West 5 840.25$ 2 698.88$ 0.00$ 0.005 2 698.88$ 3 141.36$ 269.89$ • MAT Miscellaneous items 36 555.23$ 32 899.70$ 0.005 0.00$ 32 899.70 S 3 655.52-$ 3 289.97 5 LAB Auditorium 3 504.20$ 0.00 5 0.005 0.00$ 0.005 3 504.20 5 0.00$ LAB East 5 910.02$ 0.00$ 0.00 5 0.00 5 0.00$ 5 910.02$ 0.00 5 LAB - North 95.38$ 0.00$ 0.00$ 0.00$ 0.00 5 95.38 S 0.00$ LAB South 39 165.15$ 0.00$ 0.00$ 0.00$ .0.00$ 39 165.15$ 0.00 5 LAB West • 3 896.68 5 0.00$ 0.00$ 0.00 5 0.00$ ' 3 896.68 51 0.00$ • • Page 4 • • • • • • • • • • . • CONTINUATION SHEET AIA Document G703 Format • AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT. Contractor:Ebenisterle Beaubois Ltee containing Contractor's signed Certification is attached. - In tabulations below,amounts are stated to the nearest dollar. APPLICATION NO:16 Use Column Ion Contracts where variable retainage for line items may apply. APPLICATION DATE:05/20/2010 APLICATION PERIOD:05/01/2010-05/31/2010 ARCHITECTS PROJECT NO: • Carmel Regional Performing Arts Center,Carmel,IN A B C 0 I E F Work Completed Material Total H Item Description Scheduled Previous This Value Presently Complete Balance No. I application Period I and stored Retalnage of work (D+E) Stored I ( F) IG/C) to Finish 10%g (not in Dor E) D+E+F ) (C-G) ' LAB Miscellaneous items 53 195.10$ 0.00$ 0.00$ 0.00$ 0.00$ 53 195.10 5 0.00$ • MAT ALLOWANCE 105 000.00$ 0.00$ 0.00$ 0.00 $ 0.00 $ , 105 000.00 $ 0.00 $ 5060 General Allowance ' 50 000.00$ ' 0.00$ 5060 CAD Allowance 5 000.00$ 0.00$ 0% 50 000.00$ 0.00$ 0 5070 General Allowance 0.00$ • 0.00$ 0% .5 000.00$ 0.00 25 000.00$ 5070 CAD Allowance 0.00$ 0.00$ 0% 25 000.00$ 0.00$• 5 000.00$ 0.m$ 0.00$ 0% • 5080 General Allowance 15 000.00$ 5 000.00 5 0.00$ 5080 CAD Allowance D.00$ 0.0$ 0% 15 000.00$ 0.00$ 5 000.00$ 0.00$ 0.00 5 0% 5 00.00 5 0.00$ SUB TOTAL 2 619 462.22$ 734 790.00$ 94 471.55$ 343 891.03$ 1 173 152.58$ • • 1446309.64$ 117 315.26$ Administration Fees • MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ • INST 174 383.84 5 100% 0.00$ 17 438.38 5 MAT Engeneering and cutting sheet 116 255,86$ 87 191.90$ 11 t 625.59$ • INST - 98 817.48$ 85% 17 438.38$ • 9 881.75$ MAT Bond 20 325.26$ 20 325.26$ 0.0$ INST 20 325.26$ 100% 0.00$ 2 032.53$ MAT Projet Management/Living/Travel 125 378.55$ 75 227.13$ 6 268.93$ INST 81 496.06$ 65%_ 43 882.49$ 8 149.61$ MAT Superintendent/Living/Travel 118 264.27$ 53 218.92$ 5 913,21$ INST 59 132.14 5 50% 59 132.14$ 5 913.21 5 • TOTAL BASE CONTRACT 3 174 070.00$ 1 145 137.04$ 118 279.28$ 343 891.03$ 1 607 307.35 $ 1 566 762.65$ 160 730.74$ Change Orders Change order#001 • .00 0 Change order#002 $ 5 156.00 $ 0.00$ 0% 5 156.00$ 0.00 5 Change order#003 $ (85 000.00) 0.00$ 0.00$ 0% 17 479.00$ 0.00$ Change order#004 • ' Change order#005 $ 5 148.00 - • • • TOTAL CHANGE ORDERS $ (37 218.00) $ - $ $ - $ $ 22 635.00 1$ • • • • Page 5 • • • • • • • • • • CONTINUATION SHEET • AlA Document 0703 Format • • AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisierie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:16 In tabulations below,amounts are stated io the nearest dollar. APPLICATION DATE:05/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:05/01/2010.05/31/2010 • ARClill'ECT'S PROJECT NO: Carmel Regional Performing Arts Center,:Carmel,IN ' • A B C D ( E F . 0 • Work Completed Material Total — H I Item . Description Scheduled Previous This Presently Complete Value application Period Stored. and stored Balance Retai% No. of work to Finish 10% ID+E) (not in D or E) (D+E a F I I TOTAL I$ 3 136 851.00!$ 1 145 137.04 I$ 118 279.28 1_$ 343 891.03!$ 1 607 307.35 I I$ 1 589 397.65 I $ 160 730.74 • • • • • • • • • • • • • • • • • • r �ii48F�1c€tc;J 4ip.l • • • • o • • • • • • • • • • • • • • • Page 6 . • • • 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$ in the sum of$ 419,841.46 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) materials furnished and/or claims through (date) only and does not cover any retention or items furnished May 31st, 2010 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 THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Signs re: . _ (-yao Signature: (Authorize orporate Officer/Partner/Owner) (Authorized Corporate Officer/Partner/Owner) Germain Alexandre, Ass General Manager (Title) (Title) Dated this 25th day of May '2010 Dated this day of , 2010 at: St-Georges, Beauce Quebec . at: Subscribed and sworn before me day and year first above Subscribed and sworn before me day and year first above written: written: ;. � No - Public Commissaire a I'Assermentation Notary Public My commission expickft missloner � f 2013 My commission expires : Manon Poulin # 163 850 Distrint Beauce-Qu aec a. v; -Quebec District AU`BOT BILL OF SALE CARMEL PERFORMING ARTS CENTER FOR GOOD CONSIDERATION, and upon payment of Three hundred forty three thousand eight hundred ninety one and 03/100 dollars ($343,891.031 and to extent as billed on Pay Request 16 the undersigned, Ebenisterie Beaubois Ltd., 521, 6th Avenue, Saint-Georges Quebec, G5Y OH 1 (« Seller ») hereby sells and transfers to Shiel Sexton Inc (« Buyer »), the following : See breakdown attached Which are stored at Ebenisterie Beaubois Lee, 511, 6th Avenue, Saint-Georges Quebec, G5Y OH1 (418)228-5104 (418)228-3524 fax The seller warrants it has a good title to said property, full authority to sell and transfer same, and that said property is sold free of all liens, claims and encumbrances. Signed under seal this 20th day of May 2010 Ebenisterie Beaubois Ltee Germai. •lexandre, Assistant General Manager Commissaire d IAssermentation ' Commissioner for oath Notary Public on Poulin # 163 850 District Beauce-Quebec Beauce-Quebec District