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HomeMy WebLinkAboutEbenisterie Beaubois Ltee - $183,423.55 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 Dlabursoment Amount of Authorized Dlnburoomont Afltount 40 be t&ICI `y Villa, e FinAI1LiAI per I-he M c Millwork Z PC. A?p1;(glinh 22 (Beauhoil) Oc "oje r 20/0 $ 183 If 23.55 Total Authorized Disbursement - .'..3 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto In that certain Loan Agreement(PAC Millwork), dated January 28, 2010, by and between Lender and Village Financial, LL . Dated: 5 /( CITY OF CARMEL REDEVELOPMENT COM ION By `/ „,....- Printed L eS .S. 0Idi Title Exec & iVe Direc4nj Draft PAC Mill Work (Ebenisterie) Up Through November 2009 Total Contract Amounts through application 10 Completed and Stored to date $ 305,661.51 Retention held $ 30,566.15 Paid to date $ 275,095.36 Amount reimbursed to CRC $ 275,095.36 December 2009 Total Contract Amount for application 11 Completed and Stored to date $ 20,046.38 Retention held $ 2,004.64 To be paid $ 18,041.74 Paid by Village Financial $ 18,041.74 January 2010 Paid by Village Financial $ 10,717.61 February 2010 Paid by Village Financial $ 300,531.36 March 2010 Paid by Village Financial $ 256,445.90 April 2010 Paid by Village Financial $ 169,791.37 May 2010 Paid by Village Financial $ 415,953.29 June 2010 Paid by Village Financial $ 464,375.77 July 2010 Paid by Village Financial $ 454,849.95 August 2010 Paid by Village Financial $ 238,415.04 September 2010 Paid by Village Financial $ 100,487.23 October 2010 Amount to be paid by Village Financial $ 183,423.55 4!AIA Document G7021CMa TM - 1992 yg Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 022 L Distribution to: CI T■I D r al-, vne Gyre) R iuc �3 I • PERIOD TO G 3I _ao 10 - OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: I VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ k beAnI's -&YI`e Beau.&A Lice ShYe] Je.J(�rm PROJECT NOS: Z(q 5070 I CONTRACTOR ❑ c2, (D /r. VIA ARCHITECT: CONTRACT FOR: R)0 aJE 6t O}}y. C5 Luchi Ff°ct FIELD ❑ 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 1.ORIGINAL CONTRACT SUM $2) 11.1 W o Q payment sh.ai herein is now due. 2. Net change by Change Orders $ v0 3 �?1 r CONTRAC / 1 3.CONTRACT SUM TO DATE(Line I ±2) $.5 466 G�{bc?, By J. . ... • /. . Date: /Q / f91 . aid 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ ,018 '970. 7c State of •GeBeC 4 / 5.RETAINAGE County o': ?kr)VC t a To of Completed Work Subscribed and swo to.:before );ommiss r aire a I Assermentatian (Column D+E on G703) $ ) p Ao. me this 7 .alt da of�1o&e. 9P10 Commissioner for oath b. %of Stored Material Notary Public: al, Manon Poulin (Column F on G703) $ 55 My Commission expires: NCI,/ /0 �/ 163 850 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 15(p 60. CERTIFICATE FOR PAYMENT District Beauce-Quebec �1 �] G ' //� In accordance with the Contract Documents, based on on-site .�,ga u( det rt ffprising 6.TOTAL EARNED LESS RETAINAGE $CY `' U this application,the Construction Manager and Architect certify to the Owner t at o e e's't 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 $a, 715/ 70 • U' accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. ,1 8.CURRENT PAYMENT DUE $ 183, `2.. '. 6 AMOUNT CERTIFIED $ (83,4Z3 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from e amount applied. Initial all figures on this Application and on e Continuation S eet that a hanged to conform with the amount certified.) (Line 3 less Line 6) $X '63. CONS •UCTIO ,t t.G•";f BY ►.'l. ::ji�.rf. �.' Date: �07/?i�//D ADDITIONS DEDUCTIONS I 111 CHANGE ORDER SUMMARY ARCH! T, Total changes approved in previous months by Owner $ $ By . " , ' Date: l$+(y �Vi Total approved this Month n $ $ 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. CONTINUATION SHEET AIA Document 0703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010•10/31/2010 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 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT BASEMENT LEVEL 52 098.35$ 49 493.43 $ 2 604.92$ 0.00$ 52 098.35$ 0.00 $ 0.00$ LAB 11 883.71 $ 10 101.15$ 1 188.37$ 0.00$ 11 289.52$ 594.19 $ 0.00$ MAT North 6 886.93$ 6 542.58$ 344.35$ 0.00$ 6 886.93$ i 0.00$ 0.00$ MAT Miscellaneous items 45 211.43$ 42 950.85$ 2 260.57$ 0.00$ 45 211.43$ 0.00$ 0.00$ LAB North 1 257.05$ 1 068.49$ 125.71$ 0.00$ 1 194.20$ 62.85$ 0.00$ LAB Miscellaneous items 10 626.66$ 9 032.66$ 1 062.67$ 0.00$ 10 095.33$ 531.33$ 0.00$ MAT PLENUM LEVEL 49 668.53 $ 47 185.11 $ 2 483.43 $ 0.00 $ 49 668.53 $ 0.00$ 0.00$ LAB 42 456.67$ 36 088.17$ 4 245.67$ 0.00$ 40 333.84$ 2 122.83 $ 0.00 $ MAT Miscellaneous items 12 287.66$ 11 673.27$ 614.38$ 0.00$ 12 287.66$ 0.00$ 0.00$ MAT South 37 380.88 5 35 511.83$ 1 869.04$ 0.00$ 37 380.88$ 0.00$ 0.00$ LAB Miscellaneous items 26 524.29$ 22 545.65$ 2 652.43$ 0.00$ 25 198.08$ 1 326.21 $ 0.00$ LAB South 15 932.38 5 13 542.52$ 1 593.24$ 0.00$ 15 135.76$ 796.62$ 0.00$ MAT ORCHESTRA LOW LEVEL 884 071.73 $ 787 458.42$ 83 190.15$ 0.00 $ 870 648.57$ 13 423.16 $ 0.00$ LAB 317 235.98$ 260 072.91 $ 14 136.03$ 0.00 $ 274 208.94$ 43 027.04$ 0.00$ MAT Auditorium 536 641.30$ 488 125.89$ 35 092.24$ 0.00$ 523 218.14$ 13 423.16$ 0.00$ MAT East 137 103.55$ 130 248.37$ 6 855.18$ 0.00$ 137 103.55$ 0.00$ 0.00$ MAT North 101 619.95$ 68 964.64$ 32 655.31 $ 0.00$ 101 619.95$ 0.00$ 0.00$ Page 1 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 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 0% No. of work (D+El (not in D or E) (D+E+F) (G/C) (C-G) MAT West 50922.96$ 48 376.81 $ 2 546.15$ 0.00$ 50 922.96$ 0.00$ 0.00$ MAT Miscellaneous items 57 783.98$ 51 742.71$ 6 041.28$ 0.00$ 57 783.98$ I 0.00$ 0.00$ LAB Auditorium 161 191.08$ 140 572.48$ 7 497.12$ 0.00$ 148 069.60$ 13 121.48$ 0.00$ LAB East 40 499.18$ 26 256.42$ 1 458.69$ 0.00$ 27 715.11$ 12 784.07$ 0.00$ LAB North 16 932.65$ 7 074.99$ 393.06$ 0.00$ 7 468.05$ 9 464.61$ 0.00$ LAB West 26 471.63$ 21 241.72$ 1 180.10$ 0.00$ 22 421.81$ 4 049.82$ 0:00$ LAB Miscellaneous items 72 141.44$ 64 927.30$ 3 607.07$ 0.00$ 68 534.37$ 3 607.07$ 0.00$ MAT ORCHESTRA HIGH LEVEL 132 847.59 $ 126 205.21 $ 6 642.38 $ 0.00$ 132 847.59 $ 0.00$ 0.00$ LAB 92 280.19$ 83 052.17$ 4 614.01 $ 0.00$ 87 666.18 $ 4 614.01 $ 0.00$ MAT Auditorium 4 621.74$ 4 390.65$ 231.09$ 0.00$ 4 621.74$ 0.00$ 0.00$ MAT East 485.32$ 461.06$ 24.27$ 0.00$ 485.32$ 0.00$ 0.00$ MAT South 101 013.48$ 95 962.80$ 5 050.67$ 0.00$ 101 013.48$ 0.00$ 0.00$ MAT West 485.32$ 461.06$ 24.27$ 0.00$ 485.32$ 0.00$ 0.00$ MAT Miscellaneous items 26 241.73$ 24 929.64$ 1 312.09$ 0.00$ 26 241.73$ 0.00$ 0.00$ LAB Auditorium 2 262.18$ 2 035.96$ 113.11$ 0.00$ 2 149.07$ 113.11$ 0.00$ LAB East 381.52$ 343.37$ 19.08$ 0.00$ 362.44$ 19.08$ 0.00$ Page 2 ■ CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 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 0% No. of work (D+E) (not in D or E LAB South 40 723.56$ 36 651.20$ 2 036.18$ 0.00$ 38 687.38$ 2 036.18$ 0.00$ LAB West 381.52$ 343.37$ 19.08$ 0.00$ 362.44$ 19.08$ 0.00$ LAB Miscellaneous items 48 531.41$ 43 678.27$ 2 426.57$ 0.00$ 46 104.84$ 2 426.57$ 0.00$ MAT BOX TIER LEVEL 326 347.94$ 310 251.71 $ 15 923.85$ 0.00$ 326 175.56 $ 172.39$ 0.00$ LAB 278 078.48 $ 250 270.63 $ 13 903.92$ 0.00$ 264 174.56$ 13 903.92$ 0.00$ MAT Auditorium 11 727.05$ 11 140.70$ 586.35$ 0.00$ 11 727.05$ 0.00 S 0.00$ MAT East 44 650.44$ 42 639.08$ 2 011.36$ 0.00$ 44 650.44$ 0.00$ 0.00$ MAT North 16580.44$ 15751.42$ 829.02$ 0.00$ 16580.44$ 0.00$ 0.00$ MAT South 81 787.06$ 77 697.71$ 3 916.97$ 0.00$ 81 614.68$ 172.39$ 0.00$ MAT West 82 441.76$ 78 319.67$ 4 122.09$ 0.00$ 82 441.76$ 0.00$ 0.00$ MAT Miscellaneous items 89 161.20$ 84 703.14 S 4 458.06$ 0.00$ 89 161.20$ 0.00$ 0.00$ LAB Auditorium 6 058.74$ 5 452.87$ 302.94$ 0.00$ 5 755.80$ 302.94$ 0.00$ LAB East 26 800.35$ 24 120.32$ 1 340.02$ 0.00$ 25 460.33$ 1 340.02$ 0.00$ LAB North 6 898.68$ 6 208.81 S 344.93$ 0.00$ 6 553.75$ 344.93$ 0.00$ LAB South 37 667.50$ 33 900.75$ 1 883.38$ 0.00$ 35 784.13$ 1 883.38$ 0.00$ LAB West 42 037.97$ 37 834.17$ 2 101.90$ 0.00$ 39 936.07$ 2 101.90$ 0.00$ LAB Miscellaneous items 158 615.24$ 142 753.72$ 7 930.76$ 0.00$ 150 684.48$ 7 930.76$ 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: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 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 0% No. of work (0+E) (not in 0 or E) (D+E+F) (G/C) (C-G) MAT BALCONY LOW LEVEL 30 066.12$ 28 562.81 $ 1 503.31 $ 0.00$ 30 066.12$ 0.00 $ 0.00$ LAB 48 121.87$ 43 309.68 $ 2 406.09$ 0.00 $ 45 715.78 $ 2 406.09 $ 0.00$ MAT Auditorium 5 584.31$ 5 305.09$ 279.22$ 0.00$ 5 584.31$ 0.00$ 0.00$ MAT East 849.32$ 806.85$ 42.47$ 0.00$ 849.32$ 0.00$ 0.00$ MAT North 242.66$ 230.53$ 12.13$ 0.00$ 242.66$ 0.00$ 0.00$ MAT South 4 378.44$ 4 159.51$ 218.92$ 0.00$ 4 378.44$ 0.00$ 0.00$ MAT West 849.32$ 806.85$ 42.47$ 0.00$ 849.32$ 0.00$ 0.00$ MAT Miscellaneous items 18 162.07$ 17 253.97$ 908.10$ 0.00$ 18 162.07$ 0.00$ 0.00$ LAB Auditorium 2 674.80$ 2 407.32$ 133.74$ 0.00$ 2 541.06$ 133.74$ 0.00$ LAB East 667.66$ 600.89$ 33.38$ 0.00$ 634.28$ 33.38$ 0.00$ LAB North 190.76$ 171.68$ 9.54$ 0.00$ 181.22$ 9.54$ 0.00$ LAB South 2 740.40$ 2 466.36$ 137.02$ 0.00$ 2 603.38$ 137.02$ 0.00$ LAB West 667.66$ 600.89$ 33.38$ 0.00$ 634.28$ 33.38$ 0.00$ LAB Miscellaneous items 41 180.59$ 37 062.53$ 2 059.03$ 0.00$ 39 121.56$ 2 059.03$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 136 361.59 $ 7 176.93 $ 0.00$ 143 538.52$ 0.00$ 0.00$ LAB 105 766.53 $ 93 331.50 $ 2247.90$ 0.00$ 95579.40$ 10 187.13 $ 0.00$ MAT Auditorium 6 701.17$ 6 366.11$ 335.06$ 0.00$ 6 701.17$ 0.00$ 0.00$ Page 4 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO:22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 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 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT East 8 672.67$ 8 239.03$ 433.63$ 0.00$ 8 672.67$ 0.00$ 0.00$ MAT North 121.33$ 115.26$ 6.07$ 0.00$ 121.33$ 0.00$ 0.00$ MAT South 85 647.88$ 81 365.48$ 4 282.39$ 0.00$ 85 647.88$ 0.00$ 0.00$ MAT West 5 840.25$ 5 548.23$ 292.01$ 0.00$ 5 840.25$ 0.00$ 0.00$ MAT Miscellaneous items 36 555.23$ 34 727.47$ 1 827.76$ 0.00$ 36 555.23$ 0.00$ 0.00$ LAB Auditorium 3 504.20$ 3 153.78$ 175.21$ 0.00$ 3 328.99$ 175.21$ 0.00$ LAB East 5 910.02$ 5 319.02$ 295.50$ 0.00$ 5 614.52$ 295.50$ 0.00$ LAB North 95.38$ 85.84$ 4.77$ 0.00$ 90.61$ 4.77$ 0.00$ LAB South 39 165.15$ 33 390.26$ 1 772.42$ 0.00$ 35 162.68$ 4 002.47$ 0.00$ LAB West 3 896.68$ 3 507.01$ 0.00$ 0.00$ 3 507.01 $ 389.67$ 0.00$ LAB Miscellaneous items 53 195.10$ 47 875.59$ 0.00$ 0.00$ 47 875.59$ 5 319.51$ 0.00$ MAT ALLOWANCE 105 000.00 $ 19 739.00 $ 55 400.48$ 0.00$ 75 139.48 $ 29 860.52$ 0.00$ 5060 General Allowance 50 000.00$ 19 739.00$ 15 291.48$ 35 030.48$ 70% 14 969.52$ 0.00$ 1 25 000.00$ 25 000.00$ 2 -27 461.17$ -27 461.17$ 3 -5 758.35$ -5 758.35$ 4 8 201.00$ 8 201.00$ 5 5 696.00$ 5 696.00$ 6 8 500.00$ 8 500.00$ 7 7749.00$ 7749.00$ 8 1 690.00$ 1 690.00$ Page 5 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 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 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) 9 1 057.00$ 1 057.00$ 10 1 280.00$ 1 280.00$ 11 743.00$ 743.00$ 12 2 597.00$ 2 597.00$ I 13 1 212.00$ 1 212.00$ 15 4 525.00$ 4 525.00$ 5060 CAD Allowance 5 000.00$ 5 000.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ 5070 General Allowance 25 000.00$ 15 109.00$ 15 109.00$ 60% 9 891.00$ 1 15 000.00$ 15 000.00$ 2 1 078.00$ 1 078.00$ 3 -969.00$ -969.00$ 5070 CAD Allowance 5 000.00$ 5 000.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ 5080 General Allowance 15 000.00$ 10 000.00$ 10 000.00$ 67% 5 000.00$ 1 10 000.00$ 10 000.00$ 5080 CAD Allowance 5 000.00$ 5 000.00$ 5 000.00$ 100% 0.00$ 1 5 000.00$ 5 000.00$ SUB TOTAL 2 619 462.22$ 2 281 483.51 $ 217 667.43$ 0.00$ 2 499 150.94$ 120 311.28$ 0.00$ Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84$ 100% 0.00$ 0.00$ INST MAT Engeneering and cutting sheet 116 255.86$ 113 930.74$ 2 325.12$ 116 255.86$ 100% 0.00 5 0.00$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00 S 20 325.26 5 100% 0.00 5 0.00 S INST MAT Projet Management/Living/Travel 125 378.55$ 125 378.55$ 0.00$ 125 378.55$ 100% 0.00$ 0.00$ INST Page 6 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: 22 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE: 10/20/2010 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD: 10/01/2010-10/31/2010 ARCHITECT'S 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 0% No. of work (D+E) (not in D or E) (D+E+F) (G/C) (C-G) MAT Superintendent/Living/Travel 118 264.27$ 118 264.27$ 0.00 S 118 264.27 S 100% 0.00 5 0.00$ INST TOTAL BASE CONTRACT 3 174 070.00$ 2 833 766.17$ 219 992.55$ 0.00$ 3 053 758.72$ 120 311.28$ 0.00$ Change Orders Change order#001 _ $ 5 156.00 $ 5 156.00 0.00$ 5 156.00$ 100% 0.00$ 0.00$ Change order#002 $ 17 479.00 $ 17 479.00 0.00$ 17 479.00$ 100% 0.00$ 0.00$ Change order#003 $ (65 000.00). -65 000.00$ -65 000.00$ 100% 0.00$ 0.00$ Change order#004 0.00$ 0.00$ 100% 0.00$ 0.00$ Change order#005 $ 5 146.00 $ 5 146.00 0.00$ 5 146.00$ 100% 0.00$ 0.00$ Change order#006 $ 40 000.00 $ 40 000.00 0.00$ 40 000.00$ 100% 0.00$ 0.00$ Change order#007 $ 24 150.00 24 150.00 5 24 150.00$ 100% 0.00$ 0.00$ Change order#008 $ 4 281.00 4 281.00$ 4 281.00$ 100% 0.00$ 0.00$ TOTAL CHANGE ORDERS Si 31 212.00 $ 67 781.00 I. (36 569.00) $ - $ 31 212.00 $ - $ - I TOTAL I$ 3 205 282.00 I $ 2 901 547.17' $ 183 423.55 1$ - I$ 3 084 970.72 I I$ 120 311.28 1 $ 156 842.55 I Culer M atnce l alc Page 7 INTERIM LIEN/CLAIM WAIVER From:. Ebenisterie Beaubois Ltee Project: Carmel Regional Performing Arts Center (Name of Firm Giving EFelease) (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$ 2,365,802.37 in the sum of$ 183,423.55 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) 07/31/2010 materials furnished and/or claims through (date) only and does not cover any retention or items furnished October 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 QUEBEC THAT THE ABOVE IS A TRUE AND CORRECT STATEMENT. Sign re: Sign ure: 7112Lt.� lSt /� uthonzed Crate Officer/Partner/Owned (, Mario Rodri u Adrr�ii4strative Director ((Authhon(ze orporate Officer/Partner/Owner) (Title) M rio Rodrig e, Adml istrative Director (Title) Dated this 27th day of October , 2010 Dated this 27th day of October , 2010 at: St-Georqes, Beauce Quebec . at: St-Georges, Beauce, Quebec . Subscribed and sworn before me day and year first above written: Subscribed and sworn before—m. e d�y apd year first above written: mm ssa re 1 f'Assermentation Gomtisuioner to Math Amm Wife '‘4,c,;.>4: '';� '�;;,. cL�6� l;�an �n Poulin iee lo ` f63850 C3i j 11$r oath e-e -\ mcRETgr Ri expires : May 10,2013 Nota Public District Beauce-Quebec `R '`"` i My commission expires . May 10ftlalOce-Quebec District n. 163 850 D strict Beauce-Quebec Beauce-Quebec District WAIVER OF LIEN The undersigned is the duly authorized officer of Ebenisterie Beaubois Ltee , the general contractor, subcontractor, materialman or other person furnishing the services, labor, material or equipment indicated below in the construction of improvements upon real estate located in_Hamilton County, State of_Indiana , commonly known as_Carmel Performing Arts Center , which real estate is owned by Carmel Redevelopment Commission («Owner »). IN CONSIDERATION of the sum of One Two million three hundred sixty five thousand eight hundred two dollars and thirty seven cents DOLLARS ($2,365,802.37) receipt of which is hereby acknowledged,and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which the Company may now have for services, labor, material or equipment furnished in respect of such land or improvements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself(herself) and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or Lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the sole consideration received by the Company for said services, labor, material or equipment furnished to date, and that the Company has neither received nor made any security interest, title retention interest or lien rights in the said services, labor, material or equipment other than that released and transferred hereby. The material, labor, services or equipment furnished are more particulary described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 27th day of October 2010 . M. io Rodrig e, A41,,inistrative Director _Ebenisterie Beaubois Ltee (Name of Company) State of Quebec , County of Beauce , SS : Before me, the undersigned, a Notary Public in and for said County and State, personally appeared Mario Rodrigue The Administrative Director , of Ebenisterie Beaubois Ltee , who acknowledged the execution of the foregoing Waiver of Lien on behalf of such Company and that the same is the free act deed of such Company and the free act and deed of said officer. WITNESS my hand and notarial seal this 27th day of October , 2010 My Commission Expires : Commissaire a I'Assermentatic May 10,2013 Commissioner for oathC� Manon Poulin Notary Public My County of Residence : t 163 850 District Beauce-Quebec Beauce Beauce-Quebec DiStrlG,t1anon Poulin (Printed Name of Notary Public)