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Ebenisterie Beaubois Ltee - $29,860.50
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 Dlebureomant Amount of Authorized Disbursement AMaun± ).o e paid dy YJIt Fi'hen�;n;LLB Appl.c��;t,n 25 (Be& J is) I'ldreh 2011 $2� SO. CO Total Authorizod Disbursement Wa lt-p z ,i , - 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: S/Z�i/ji CITY OF CARMEL REDEVELOPMENT COMMISSION By Printed Les .s. OILS Title E XL C 44 i v e Direct-qv Draft PAC Mill Work (Ebenisterie) Up Through November 2009 Total Contract Amounts through application 10 Completed and Stored to date $ 305,661.51 Retention held $ 30,566.15 Paid to date $ 275,095.36 Amount reimbursed to CRC $ 275,095.36 December 2009 Total Contract Amount for application 11 Completed and Stored to date $ 20,046.38 Retention held $ 2,004.64 To be paid $ 18,041.74 Paid by Village Financial $ 18,041.74 January 2010 Paid by Village Financial $ 10,717.61 February 2010 Paid by Village Financial $ 300,531.36 March 2010 Paid by Village Financial $ 256,445.90 April 2010 Paid by Village Financial $ 169,791.37 May 2010 Paid by Village Financial $ 415,953.29 June 2010 Paid by Village Financial $ 464,375.77 July 2010 Paid by Village Financial $ 454,849.95 August 2010 Paid by Village Financial $ 238,415.04 September 2010 Paid by Village Financial $ 100,487.23 October 2010 Paid by Village Financial $ 183,423.55 November 2010 • Paid by Village Financial $ 77,329.28 December 2010 Paid by Village Financial $ 11,699.93 March 2011 Amount to be paid by Village Financial!$ 29,860.50 =g® lit cu O nt 7 2IC a 1992 Application and Certificate for.Payment Construction,Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 026 Distribution to: 049 a Garr?' Carvnel P Pac ay,5-i. . PERIOD TO: ID vk) 315+ I/ OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ E► n1•5.1-en ecitA,Bcf. kita Shlel Sep PROJECT NOS: 2195 xQy kh I / CONTRACTOR ❑ Si '& c ( c, ec �]O/-.j)VIA ARCHITECT: FIELD ❑ CONTRACT FOR: m i l l Loori . CS0 ()roil'+eC4 ❑ 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 �,l -/,,0 Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $3 I T`l 0 . payment shown herein is now due. ca CONTRACTO' / 2.Net change by Change Orders $ 31212 DQ'� 3.CONTRACT SUM TO DATE(Line 1 ±2) $6205 2(x... o a By•� rtti► 0 s, . . . , Date: Q3J 30)(pm 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $, 0SS78? u6' State of: ' •17 I 4 5.RETAINAGE: County of: op U.. ,. a. %.of Completed Work '/ Subscribed�a d¢sworn to before �,nmmissaire 1 Assermentatinn (Column D+Eon G703) $ i 264' / me this `►1 day of. NCI 20 I t Commissioner for oath b. %of Stored Material Notary Public:6211 ?v'GC../--'\— Marion Poulin (Column F on G703) $ My Commission expires: 1,-1() \ 10 2-013 t 163 850 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ '58,_.,, ./0 CERTIFICATE FOR PAYMENT District Be ucc true;;brr° q In accordance with the Contract Documents, based on 0 -5 i ckg "din Pt fd a comprising 6.TOTAL EARNED LESS RETAINAGE $30'-17017 / this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 3S knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $3 0/7 � -1. I 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 $ 29 &6'0 -60 AMOUNT CERTIFIED $ 26k ,?AA — 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fr m the:',mount applied. Initial all figures on this Application and oi.�ie Continuation Si •t th are ch nged to conform with the a ount certified.) (Line 3 less Line 6) $165 2&L- l 1 CONS :UCTION • AGE'i g BY: ���:► -:-.0._� u i s Date: 40 7 f CHANGE ORDER SUMMARY ARCH EC II/40 ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ B r y: � : Date: t 1 (, 1, Total approved this Month $ $ . .. . This Certi cate is not negotiable. The AMOUNT CERTIFIED is payable only to t e 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. 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. APPLICATION NO: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 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 0% No. of work (D+El (not in D or E) (D+E+F) G/C MAT BASEMENT LEVEL 52 098.35$ 52 098.35 $ 0.00$ 0.00$ 52 098.35$ 0.00 $ 0.00 $ LAB 11 883.71 $ 11 883.71 $ 0.00$ 0.00$ 11 883.71 $ 0.00 $ 0.00 $ MAT North 6 886.93$ 6 886.93$ 0.00$ 0.00$ 6 886.93 5 0.00 5 0.00$ MAT Miscellaneous items 45 211.43$ 45 211.43$ 0.00$ 0.00$ 45 211.43$ 0.00$ 0.00$ LAB North 1 257.05$ 1 257.05$ 0.00$ 0.00$ 1 257.05$ 0.00$ 0.00$ LAB Miscellaneous items 10 626.66$ 10 626.66$ 0.00$ 0.00 5 10 626.66$ 0.00$ 0.00$ MAT PLENUM LEVEL 49 668.53 $ 49 668.53 $ 0.00$ 0.00$ 49 668.53 $ 0.00 $ 0.00 $ LAB 42 456.67$ 42 456.67$ 0.00$ 0.00$ 42 456.67$ 0.00 $ 0.00 $ MAT Miscellaneous items 12 287.66$ 12 287.66$ 0.00$ 0.00$ 12 287.66$ 0.00$ 0.00$ MAT South 37 380.88$ 37 380.88$ 0.00$ 0.00$ 37 380.88$ 0.00$ 0.00$ LAB Miscellaneous items 26 524.29$ 26 524.29$ 0.00$ 0.00$ 26 524.29$ 0.00$ 0.00$ LAB South 15 932.38$ 15 932.38$ 0.00$ 0.00$ 15 932.38$ 0.00$ 0.00 5 MAT ORCHESTRA LOW LEVEL 884 071.73 $ 884 071.73 $ 0.00$ 0.00$ 884 071.73 $ 0.00 $ 0.00 $ LAB 317 235.98 $ 317 235.98 $ 0.00$ 0.00$ 317 235.98$ 0.00 $ 0.00 $ MAT Auditorium 536 641.30$ 536 641.30$ 0.00$ 0.00$ 536 641.30$ 0.00$ 0.00$ MAT East 137103.55$ 137103.55$ 0.00$ 0.00$ 137103.55$ 0.00$ 0.00$ MAT North 101 619.95$ 101 619.95$ 0.00$ 0.00$ 101 619.95$ 0.00$ 0.00$ Page 1 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO 25 In tabulations below,amounts are stated to the nearest dollar, APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F • G H 1 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 West 50 922.96$ 50 922.96$ 0.00$ 0.00$ 50 922.96$ 0.00$ 0.00$ MAT Miscellaneous items 57 783.98$ 57 783.98$ 0.00$ 0.00$ 57 783.98$ 0.00$ 0.00$ LAB Auditorium 161 191.08$ 161 191.08$ 0.00$ 0.00$ 161 191.08$ 0.00$ 0.00$ LAB East 40 499.18$ 40 499.18$ 0.00$ 0.00$ 40 499.18$ 0.00$ 0.00$ LAB North 16 932.65$ 16 932.65$ 0.00$ 0.00$ 16 932.65$ 0.00$ 0.00$ LAB West 26 471.63$ 26 471.63$ 0.00$ 0.00$ 26 471.63$ 0.00$ 0.00$ LAB Miscellaneous items 72 141.44$ 72 141.44$ 0.00$ 0.00$ 72 141.44$ 0.00$ 0.00$ MAT ORCHESTRA HIGH LEVEL 132 847.59 $ 132 847.59$ 0.00$ 0.00 $ 132 847.59 $ 0.00 $ 0.00 $ LAB_ 92 280.19$ 92 280.19$ 0.00$ 0.00$ 92 280.19 $ 0.00$ 0.00 $ MAT Auditorium 4 621.74$ 4 621.74$ 0.00$ 0.00$ 4 621.74$ 0.00$ 0.00$ MAT East 485.32$ 485.32$ 0.00$ 0.00$ 485.32$ 0.00$ 0.00$ MAT South 101 013.48$ 101 013.47$ 0.00$ 0.00$ 101 013.48$ 0.00$ 0.00$ MAT West 485.32$ 485.32$ 0.00$ 0.00 S 485.32$ 0.00$ 0.00$ MAT Miscellaneous items 26 241.73$ 26 241.73$ 0.00$ 0.00$ 26 241.73$ 0.00$ 0.00$ LAB Auditorium 2 262.18$ 2 262.18$ 0.00$ 0.00$ 2 262.18$ 0.00$ 0.00$ LAB East 381.52$ 381.52$ 0.00$ 0.00$ 381.52$ 0.00$ 0.00$ Page 2 CONTINUATION SHEET AIA Document G703 Format AIA Doc.6702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column I on Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 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 ID+E) (not in D or E) (D+E+F) (G/C) (C-G) LAB South 40 723.56$ 40 723.56$ 0.00$ 0.00$ 40 723.56$ 0.00$ 0.00$ LAB West 381.52$ 381.52$ 0.00$ 0.00$ 381.52$ 0.00$ 0.00$ LAB Miscellaneous items 48 531.41 $ 48 531.41 $ 0.00$ 0.00$ 48 531.41 $ 0.00$ 0.00$ MAT BOX TIER LEVEL 326 347.94$ 326 347.95 $ 0.00$ 0.00$ 326 347.94$ 0.00 $ 0.00$ LAB 278 078.48$ 278 078.48 $ 0.00$ 0.00$ 278 078.48$ 0.00$ 0.00$ MAT Auditorium 11 727.05$ 11 727.05$ 0.00$ 0.00$ 11 727.05$ 0.00$ 0.00$ MAT East 44 650.44$ 44 650.44$ 0.00$ 0.00$ 44 650.44$ 0.00$ 0.00$ MAT North 16 580.44$ 16 580.44$ 0.00$ 0.00$ 16 580.44$ 0.00$ 0.00$ MAT South 81 787.06$ 81 787.06$ 0.00$ 0.00$ 81 787.06$ 0.00$ 0.00$ MAT West 82 441.76$ 82 441.76$ 0.00$ 0.00$ 82 441.76$ 0.00$ 0.00$ MAT Miscellaneous items 89 161.20$ 89 161.20$ 0.00$ 0.00$ 89 161.20$ 0.00$ 0.00$ LAB Auditorium 6 058.74$ 6 058.74$ 0.00$ 0.00$ 6 058.74$ 0.00$ 0.00$ LAB East 26 800.35$ 26 800.35$ 0.00$ 0.00$ 26 800.35$ 0.00$ 0.00$ LAB North 6 898.68$ 6 898.68$ 0.00$ 0.00$ 6 898.68$ 0.00$ 0.00$ LAB South 37667.50$ 37667.50$ 0.005 0.00$ 37 667.50$ 0.00$ 0.00$ LAB West 42 037.97$ 42 037.97$ 0.00$ 0.00$ 42 037.97$ 0.00$ 0.00$ LAB Miscellaneous items 158 615.24$ 158 615.24$ 0.00$ 0.00$ 158 615.24$ 0.00$ 0.00$ Page 3 CONTINUATION SHEET AIA Document G703 Format AIA Doc.0702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 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) MAT BALCONY LOW LEVEL 30 066.12$ 30 066.12$ 0.00 $ 0.00$ 30 066.12$ 0.00$ 0.00 $ LAB 48 121.87$ 48 121.87$ 0.00 $ 0.00 $ 48 121.87$ 0.00$ 0.00$ MAT Auditorium 5 584.31$ 5 584.31 $ 0.00$ 0.00$ 5 584.31$ 0.00$ 0.00$ MAT East 849.32$ 849.32$ 0.00$ 0.00$ 849.32$ 0.00$ 0.00$ MAT North 242.66$ 242.66$ 0.00$ 0.00$ 242.66$ 0.00$ 0.00$ MAT South 4 378.44$ 4 378.44$ 0.00$ 0.00$ 4 378.44$ 0.00$ 0.00$ MAT West 849.32$ 849.32$ 0.00$ 0.00$ 849.32$ 0.00$ 0.00$ MAT Miscellaneous items 18 162.07$ 18 162.07$ 0.00$ 0.00$ 18 162.07$ 0.00$ 0.00$ LAB Auditorium 2 674.80$ 2 674.80$ 0.00$ 0.00$ 2 674.80$ 0.00$ 0.00$ LAB East 667.66$ 667.66$ 0.00$ 0.00$ 667.66$ 0.00$ 0.00$ LAB North 190.76$ 190.76$ 0.00$ 0.00$ 190.76$ 0.00$ 0.00$ LAB South 2 740.40$ 2 740.40$ 0.00$ 0.00$ 2 740.40$ 0.00$ 0.00$ LAB West 667.66$ 667.66$ 0.00$ 0.00$ 667.66$ 0.00$ 0.00$ LAB Miscellaneous items 41 180.59$ 41 180.59$ 0.00$ 0.00$ 41 180.59$ 0.00$ 0.00$ MAT BALCONY HIGH LEVEL 143 538.52$ 143 538.52$ 0.00$ 0.00 $ 143 538.52$ 0.00 $ 0.00 $ LAB 105 766.53 $ 105 766.53 $ 0.00$ 0.00$ 105 766.53$ 0.00 $ 0.00 $ MAT Auditorium 6 701.17$ 6 701.17$ 0.00$ 0.00$ 6 701.17$ 0.00$ 0.00$ • Page 4 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: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 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 ID+El (not in D or El (D+E+F) (G/C) (C-G) MAT East 8 672.67$ 8 672.67$ 0.00$ 0.00$ 8 672.67$ 0.00$ 0.00$ MAT North 121.33$ 121.33$ 0.00$ 0.00$ 121.33$ 0.00$ 0.00$ MAT South 85 647.88$ 85 647.88$ 0.00$ 0.00$ 85 647.88$ 0.00$ 0.00$ MAT West 5 840.25$ 5 840.25$ 0.00$ 0.00$ 5 840.25$ 0.00$ 0.00$ MAT Miscellaneous items 36 555.23$ 36 555.23$ 0.00$ 0.00$ 36 555.23$ 0.00$ 0.00$ LAB Auditorium 3 504.20$ 3 504.20$ 0.00$ 0.00$ 3 504.20$ 0.00$ 0.00$ LAB East 5 910.02$ 5 910.02$ 0.00$ 0.00$ 5 910.02$ 0.00$ 0.00$ LAB North 95.38$ 95.38$ 0.00$ 0.00$ 95.38$ 0.00$ 0.00$ LAB South 39 165.15$ 39 165.15$ 0.00$ 0.00$ 39 165.15$ 0.00$ 0.00$ LAB West 3 896.68$ 3 896.68$ 0.00$ 0.00$ 3 896.68$ 0.00$ 0.00$ LAB Miscellaneous items 53 195.10$ 53 195.10$ 0.00$ 0.00$ 53 195.10$ 0.00$ 0.00$ MAT ALLOWANCE 105 000.00 $ 75 139.48$ 29 860.52$ 0.00 $ 105 000.00 $ 0.00 $ 0.00 $ 5060 General Allowance 50 000.00$ 35 030.48$ 15 696.52$ 0.00$ 50 727.00$ 101% -727.00$ 0.00$ 1 25 000.00$ 25 000.00$ 2 -27 461.17$ -27 461.17$ 3 -5 758.35$ -5 758.35$ 4 8201.00$ 8201.00$ 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 MA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie Beaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for tine items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 ARCHITECT'S PROJECT NO: Carmel Regional Performing Arts Center,Carmel,IN A B C D I E F G H I Work Completed Material Total Item Description Scheduled Previous This Presently Complete % Balance Retainage Value application Period Stored and stored to Finish 0% No. of work ID+E) (not in D or El (D+E+F) (G/C) (C-G) 9 1 057.00 5 1 057.00$ 10 1 280.00$ 1 280.00$ 11 743.00$ 743.00 5 12 2 597.00$ 2 597.00$ 13 1212.00$ 1212.00$ 15 4 525.00 5 4 525.00$ 16(Quotes 5037-048-701-702) 15 696.52$ 15 696.52 5 5060 CAD Allowance 5 000.00$ 5 000.00$ 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00 S 0.00$ 5 000.00 5 5070 General Allowance 25 000.00$ 15 109.00$ 7 214.00$ 0.00$ 22 323.00$ 89% 2 677.00$ 1 15 000.00$ 15 000.00$ 2 1 078.00$ 1 078.00$ _ 3 -969.00 5 -969.00 5 4(Quotes 5037=062-701-702) _ 7 214.00 5 7 214.00 5 5070 CAD Allowance 5 000.00$ 5 000.00$ 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00 5 0.00 5 5 000.00 5 5080 General Allowance 15 000.00$ 10 000.00$ 6 950.00$ 16 950.00$ 113% -1 950.00$ 1 10 000.00$ 0.00$ 10 000.00$ 2(Quotes 5037.700.702-7031 6 950.00$ 6 950.00$ 5080 CAD Allowance 5 000.00$ 5 000.00 5 0.00$ 5 000.00$ 100% 0.00$ 1 5 000.00 5 0,00 5 5 000.00 5 SUB TOTAL 2 619 462.22$ 2 589 601.71 $ 29 860.52$ 0.00$ 2 619 462.22$ 100% 0.00$ 0.00$ Administration Fees MAT Shop Drawings 174 383.84$ 174 383.84$ 0.00$ 174 383.84$ 100% 0.00$ 0.00$ INST MAT Engeneering and cutting sheet 116 255.86$ 116 255.86$ 0.00$ 116 255.86$ 100% 0.00$ 0.00$ INST MAT Bond 20 325.26$ 20 325.26$ 0.00$ 20 325.26$ 100% 0.00$ 0.00$ Page 6 CONTINUATION SHEET AIA Document G703 Format AIA Doc.G702,APPLICATION AND CERTIFICATE FOR PAYMENT Contractor:Ebenisterie 8eaubois Ltee containing Contractor's signed Certification is attached. APPLICATION NO: 25 In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:03/20/2011 Use Column Ion Contracts where variable retainage for line items may apply. APLICATION PERIOD:03/01/2011-03/31/2011 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 D or E) (D+E+F) (G/C) (C-G) INST MAT Projet Management/Living/Travel 125 378.55$ 125 378.55$ 0.00$ 125 378.55$ 100% 0.00$ 0.00 S INST MAT Superintendant/Living/Travel 118 264.27$ 118 264.27$ 0.00 S 118 264.27$ 100% 0.00$ 0.00$ INST TOTAL BASE CONTRACT 3 174 070.00$ 3 144 209.49$ 29 860.52$ 0.00$ 3 174 070.00$ 100% 0.00$ 0.00$ Change Orders Change order#001 $ 5 156.00 $ 5 156.00 0.00$ 5 156.00$ 100% 0.00$ 0.00$ Change order#002 $ 17 479.00 $ 17 479.00 0.00$ 17 479.00$ 100% 0.00$ 0.00$ Change order#003 $ (65 000.00) $ (65 000.00) 0.00$ -65 000.00$ 100% 0.00$ 0.00$ Change order#004 0.00 S 0.00 5 100% 0.00$ 0.00$ Change order#005 $ 5 146.00 $ 5 146.00 0.00$ 5 146.00$ 100% 0.00$ 0.00$ Change order#006 $ 40 000.00 $ 40 000.00 0.00$ 40 000.00$ 100% 0.00$ 0.00$ Change order#007 $ 24 150.00 $ 24 150.00 0.00$ 24 150.00$ 100% 0.00$ 1 207.50$ Change order#008 $ 4 281.00 $ 4 281.00 0.00$ 4 281.00$ 100% 0.00$ 214.05$ TOTAL CHANGE ORDERS $ 31 212.00 $ 31 212.00 $ - $ - $ 31 212.00 100% $ - S 1 421.55 I TOTAL I$ 3 205 282.00 I $ 3 175 421.49 I S 29 860.52 I$ - I$ 3 205 282.00 I 100% I$ - I $ 158 264.10 t r Calone -;-I Page 7 WAIVER OF LIEN The undersigned is the duly authorized officer of Ebenisterie Beaubois Ltee , the general contractor, subcontractor, materialman or other person furnishing the services, labor, material or equipment indicated below in the construction of improvements upon real estate located in_Hamilton County, State of_Indiana , commonly known as_Carmel Performing Arts Center , which real estate is owned by Carmel Redevelopment Commission («Owner »). IN CONSIDERATION of the sum of One Three million seventeen thousand one hundred fifty seven dollars and fourty five cents DOLLARS ($3,017,157.45) receipt of which is hereby acknowledged,and in order to procure one or more payments for services, labor, material or equipment provided in such construction, the Company does hereby waive, release and quit claim in favor of the Owner of the real estate and the lender or lenders providing funds with which payment of construction costs is or is to be made, and their assigns, all liens or claim or right to liens upon the land or improvements above described which the Company may now have for services, labor, material or equipment furnished in respect of such land or improvements to and including the date hereof. The undersigned warrants that the Company has not and will not assign any claim for payment nor any right to perfect a lien against the real estate, and that he has the right to execute this waiver and release of liens on behalf of himself(herself)and the Company. The undersigned further warrants and represents that the Company has the right to transfer and does hereby transfer title to the services, labor, material or equipment to the Owners or Lenders named above in consideration of the payment received hereunder. The undersigned further states that the consideration received hereunder is the sole consideration received by the Company for said services, labor, material or equipment furnished to date, and that the Company has neither received nor made any security interest, title retention interest or lien rights in the said services, labor, material or equipment other than that released and transferred hereby. The material, labor, services or equipment furnished are more particulary described in the affidavit for payment submitted of even date herewith. The undersigned further warrants and represents that the Company has complied with all prevailing wage requirements under applicable law or as may be set forth in the contract documents. WITNESS the execution hereof this 30th day of March 2011 can- ick Samson,Adm. 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 Jean-Rock Samson 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 30th day of_March_, 2011 My Commission Expires : May 10 2013 5.�� t .��rm nom. „ r Fjc,, f Notary Public My County of Residence : ``''"t` '' Poulin g 163 850 Beauce District Besuce-Qu y, n Poulin Rea,lice-Quebec District (Printed Name of Notary Public)