HomeMy WebLinkAboutWaltek - $132,822 Disbursement instructions
(PAC Acoustical Equipment)
Regions Bank hereby is instructed to make a disbursement of Loan Proceeds from the Borrower Loan
Account to (or for the account of)Borrower in:(a)the amount of the"Total Authorized Disbursement"line in
the"Amount of Authorized Disbursement"column below; and (b)accordance with the terms and conditions
of the Agreement, the other Loan Documents, and the Disbursement Instructions.
Purpose of Authorized Disbursement Amount of Authorized Disbursement
6)nirra - Ores*' jlrcvicu51)I nii"k4e (RC, 127 ;
Draft
PAC Acoustical Equipment
(Waltek)
Up Through November 2009
Total Contract Amounts through application 9
Completed and Stored to date $ 141,830.00
Retention held $ 14,183.00
Paid to date $ 127,647.00
Amount Requested $ 127,647.00
December 2009
Total Contract Amount for application 10
Completed and Stored to date $ 5,750.00
Retention held $ 575.00
To be paid $ 5,175.00
Amount Requested $ 5,175.00
Overall Amount Requested $ 132,822.00
' APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa (Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #10 Distribution to:
Carmel Performing Arts Center ❑ OWNER
Commission 777 Third Avenue, SW PERIOD TO: 12-31-2009
One Civic Square Cannel,IN 46032 PROJECT NOS.: 2695 El CONSTRUCTION
Carmel, IN 46032 MANAGER
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
2130 Waycross Road /l ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITECTS. j00/ 7 5 D. 01)
CONTRACT FOR: Acoustical Canopy
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that this Application lica iothe for Payment knowledge,en completed
i eted
mation and belief the Work covered by this Application for Payrncnt has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the
Contractor for Work for which previous Certificates for Payment were issued and pay
Continuation Sheet,AIA Document 0703, is attached.
1. ORIGINAL CONTRACT SUM _ . . .._ .. S
$1,360,000.00 ments received from . ! •.t current payment shown herein is now due.
$0.00 CONTRACT()t. ,
2. Net Change By Change Orders _ -_ _. .. $ �'
By:_ C,:::) Date: 12-09-2009
3 CONTRACT SUM TO DATE (Line I + 2) _ _._ - . $ $1,360,000.00
$147,580.00
State of: Ohio f
4 TOTAL COMPLETED&STORED TO DATE . . _ $ County of: Hamilton _-
, .
(Column G on G702) Subscribed and sworn to before • 142111Pilt.
5. RETAINAGE: me this 9th day of December,2009- .. ',t,;,;''••r MY �1
a 10% % of Completed Work S $14,758.00 •. .' ,
•
•
(Columns D+ E on 0703) '"'�.", ••tt°
b. 10% %of Stored Material s $0.00 C r2 1 l (2A l 3
i My Commission expires:
(Column F on G703) Nota Public: ��
Total Retainage(Line 5a+56 or
Total in Column I of 0703) . _ _ _ . - _ _ _ $ $14,758.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE . . .. . $ $132,822.00 In accordance with the Contract Documents, based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$127,647.00 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE . . _ __ . .. . ._.. .. l S $5,175.00 CERTIFIED $ 5 -rs-
1
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified dijfers.from the amount applied for,initial
(Line 3 less Line 6) S $1,227,178.00 all figures on Ibis Application and on the ContinuationSheet that changed to conform
to the amount certified.)
ADDITIONS DEDUCTIONS CO STRUCTI 14 MA AGER: S
CHANGE' (1RDFR SUMMARY \ ....0•1_ f n3
Total changes approved in BY: M•;,-_ �)c`-ai1aA. �� Date: / !�
previous months by Owner
p y $0.00 $0.00 AR TAVAr
Total approved this Month $0.00 $0.00 Bv: .�_ "" +
_-��-. Date:TOTALS $0.00 $0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only\Mr
o the Con-
NET CHANGES by Change Order $0.00 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT 0.702/CMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER.ADVISH EDITION
, 11/., 1992 EDITION-AIA'--K 1992-THE AMERICAN-INSTITUTE OF ARCHITFCTS,1-i-NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
_`4 DC 20006--292.WARNING:Unlicensed photocopying violates U.S.copyright laws and win subject the violator to legal prosecution. G702/CMa-1992
CARMEL PERFORMING ARTS CENTER AIA DOCUMENT G703
Construction Manager: Shiel Sexton
Job# 2695 Contract # 2695-5550 APPLICATION NUMBER : 10
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION DATE: 9-Dec-2009
CONTRACTOR'S SIGNED CERTIFICATION IS ATTACHED. PERIOD TO: 31-Dec-2009
IN TABULATIONS BELOW, AMOUNTS ARE STATED TO THE NEAREST DOLLAR. REVISED DATE:
USE COLUMN I ON CONTRACTS WHERE VARIABLE RETAINAGE FOR LINE ITEMS MAY APPLY. ARCHITECTS PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
NO VALUE FR PREVIOUS THIS PRESENTLY COMPLETED & (G/C) TO FINISH 10.0%
APPLICATION PERIOD STORED STORED TO DATE
(D+E) (not in D or E) (D+E+F) (C-G)
1. ENGINEERING 140,000.00 140,000.00 - 140,000.00 100% - 14,000.00
2. MOBILIZATION 10,000.00 - - - 0% 10,000.00 -
3. SPACE FRAME SYSTEM:
Material 269,000.00 - 4,000.00 4,000.00 1% 265,000.00 400.00
4. LAMINATED ACOUSTICAL GLASS:
Material 446,000.00 - 1,500.00 1,500.00 0% 444,500.00 150.00
5. ON-SITE INTALLATION 235,000.00 - - - 0% 235,000.00
6. OWNER ALLOWANCE 1 250,000.00 1,830.00 250.00 2,080.00 1% 247,920.00 208.00
7. OWNER ALLOWANCE 2 10,000.00 - - - 0% 10,000.00 -
•
TOTAL - THIS APPLICATION 1,360,000.00 141,830.00 5,750.00 - 147,580.00 11% 1,212,420.00 14,758.00
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: -A APPLICATION NO.: #09-R1 Distribution to:
Commission Carmel Performing Arts Center �. :'s,.\ ❑ OWNER
One Civic Square 777 Third Avenue SW \. PERIOD TO: 11-30-2009
q IN 46032 , ❑ CONSTRUCTION
Carmel IN 46032
Cannel, �, ',. . " .• \PROJECT NOS.: 2695 MANAGER
' Subcontract#2695-5550; ` • `.�<^_'c ONTRACT DATE: 02-27-2009 ❑ ARCHITECT
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. e_ .;.
2130 Waycross Road ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITEC ,.\
CONTRACT FOR: Acoustical Canopy \� -% .,J•
The undersigned ' tractor certifies:16M to the best of the Contractor's knowledge, infor-
CONTRACTOR S APPLICATION FOR PAYMENT nation and belief th\Work deed by this Application for Payment has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with t Contr•.et Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for W. ••.•:.• . evious Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM _ _ __ _ _ S
$1,360,000.00 ments recei . from he'Owner, an. hat current payment shown herein is now due.
2. Net Change By Change Orders __ __-..$ $0.00 CONTRAC 04,
3 CONTRACT SUM TO DATE (Line I + 2)_ ____-..$
$1,360,000.00
By: �� C'' Date: 11-16 2009
4 TOTAL COMPLETED&STORED TO DATE $ $141,830.00 State of: Ohio � .
County of Hamilton ^,'` .
(Column G on G702) i . ``
Subscribed and sworn to before if
5. RETAINAGE: me this 16th day of Novem` ` t`':
a 10% /o of Completed Work S $14,183.00 .Y✓ * «
_' '. rr.
(Columns D+ Eon G703) ,a .OR ,:,0
b. 10% %of Stored Material $ $0.00 E.-
(Column F on G703) ge (Ii,Q My Commission expires:
Total Retainage(Line 5a+5b or Nota Public:
Total in Column I of G703) _ _ $ $14,183.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE _ __ - _ $ $127,647.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$125,820.00 indicated,the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) : the Contractor is entitled to payment of the AMOUNT CERTIFIED. gta.
8. CURRENT PAYMENT DUE ._ .. __.. .. S $1,827.00 AMOUNT CERTIFIED __._.$ 1'611—�
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied for.Initial
(Line 3 less Line 6) S $1,237,970.81 all figures on this Application and on the ".ntinuationSheet that changed to conform
to the amount certified.)
CH NC F. ORDFR SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTI4 MA AGER: I
Total changes approved in By: \L,•4 0/.�`' tl• Dale: /` 7-4 D
previous months by Owner 0.� j. ,
Woo $0.00 ARCHI 1' 1
Total approved this Month $0.00 $0.00 < �' 0' �` i 2 �'�(°
By: Date:t ` J -Kr 1
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
NET CHANGES by Change Order $0.00 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702/CMa -APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
,41J1', 1992 EDITION-AIA'--K199'2-THE AMERICAN INSTITUTE OF,," '.y DC 20006.-292.WARNING:Unlicensed photocopying violates U.S..copyright laws and win subject the violator to legal prosecution. G702/CMa-1992
CARMEL PERFORMING ARTS CENTER AIA DOCUMENT G703
Construction Manager: Shiel Sexton
Job# 2655 Contract # 2695-5550 APPLICATION NUMBER : 9-R1
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION DATE: 4-Nov-2009
CONTRACTOR'S SIGNED CERTIFICATION IS ATTACHED. PERIOD TO: 30-Nov-2009
IN TABULATIONS BELOW, AMOUNTS ARE STATED TO THE NEAREST DOLLAR. REVISED DATE: 16-Nov-2009
USE COLUMN I ON CONTRACTS WHERE VARIABLE RETAINAGE FOR LINE ITEMS MAY APPLY. ARCHITECTS PROJECT NO:
A B C D E F G H I
ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE
NO VALUE FR PREVIOUS THIS PRESENTLY COMPLETED & (G/C) TO FINISH 10.0%
APPLICATION PERIOD STORED STORED TO DATE
(D+E) (not in D or E) (D+E+F) (C-G)
1. ENGINEERING 140,000.00 139,800.00 200.00 140,000.00 100% - 14,000.00
2. MOBILIZATION 10,000.00 - - - 0% 10,000.00 -
3. SPACE FRAME SYSTEM:
Material 269,000.00 - - - 0% 269,000.00 -
4. LAMINATED ACOUSTICAL GLASS:
Material 446,000.00 - - - 0% 446,000.00 -
5. ON-SITE INTALLATION 235,000.00 - - - 0% 235,000.00 -
6. OWNER ALLOWANCE 1 250,000.00 - 1,830.00 1,830.00 1% 248,170.00 183.00
7. OWNER ALLOWANCE 2 10,000.00 - - - 0% 10,000.00 -
TOTAL - THIS APPLICATION 1,360,000.00 139,800.00 2,030.00 - 141,830.00 10% 1,218,170.00 14,183.00
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR::Carmel Redevelopment PROJECT: APPLICATION NO.: #08-R1 Distribution to:
Commission Carmel Performing Arts Center'.!;;_;:.` ❑ OWNER
777 Third Avenue, SW PERIOD TO: 10-31-2009
One Civic Square _ ❑ CONSTRUCTION
Carmel, TN 46032
C ' PROJECT NOS.: 2695 MANAGER
Carmel, IN 46032 Subcontract#2695-e5550 '-'''�- %' ARCHITECT
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. \. CONTRACT DATE: 02 27 2009 ❑
2130 Waycross Road \\ `a El CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITE C '�cv : , `::.
CONTRACT FOR: , ' .
Acoustical Canopy 5-S SO f- 5 06 S o
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned evo tractorQctifies that to the best of the Contractor's knowledge, infor-
mation and belief the ork covered by this Application for Payment has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Shect, AIA Document G703, is attached. Contractor for Work for'vhich previous Certificates for Payment were issued and pay
. . ments received from the Owner, and that current payment shown herein is now due.
1. ORIGINAL CONTRACT SUM _. S $1,360,000.00
$0.00
CONTRACTOR.
2. Net Change By Change Orders $ i
3 CONTRACT SUM TO DATE (Line I + 2) _ .._ . .. _. $
$1,360,000.00 By: CA) Date: 10-19-2009
State of: Ohio a�„p.m.,.
$139 800.00 .a�`. st•
4 TOTAL COMPLETED &STORED TO DATE $ County of: Hamilton ri:,.:..,
(Column G on G702) � �
( ) Subscribed and sworn to before ,_ • ti R-•
5. RETAINAGE: me this 19th day of October, �N�'. ° °M�^°`rR.x `-
a 10% %of Completed Work S $13,980.00 I 1 +• �'� 3 4►76:.
(Columns D+ E on G703) , )'
b. __10°A__%of Stored Material $ $0.00 M in
'� ` e_ My Commission expires:
(Column F on G703) Notary Public:
Total Retainage(Line 5a+5b or
Total in Column I of G703) $ $13,980.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $125,820.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$122,220.00 indicated,the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) ___ .___ __._.__ s the Contractor is entitled to payment of the AMOUNT CERTIFIED.
CO
8. CURRENT PAYMENT DUE __ __.. __ _ _. S $3,600.00 AMOUNT CERTIFIED ___. .$ `(D W,-....-
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.fro n the amount applied for.lnitial
(Line 3 less Line 6) S $1,234,180.00 all figures on Ibis Application and on the ContinuationSheet that changed to conform
to the amount certified.)
CONSTRUCTI'L M AGER:
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS I / ��
Total changes approved in By: .:. .��.•*ii�r . '.� Date: 14 O
previous months by Owner it r
$0.00 $0.00 ARC
Total approved this Month $0.00 $0.00 By: i / 1,t' 2: 0O\
Q: . Date:
TOTALS $0.00 $0.00 This C eicate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
NET CHANGES by Change Order $0.00 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702/CMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
,AM., 1992 EDITION-AIA'—-KI992-THE AMERICAN INSTITUTE OF ARCHITECTS,I-i—NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
/; DC 20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. G702/CMa-1992
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa (Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #07 Distribution to
Commission Carmel Performing Arts Center OWNER
777 Third Avenue, SW PERIOD TO: 09-30-2009
One Civic Square Carmel, IN 46032 ❑ CONSTRUCTION
Carmel, IN 46032 PROJECT NOS.: 2695 MANAGER
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
2130 Waycross Road ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCI-IITECT:CSO ARCHITECTS.
CONTRACT FOR:Acoustical Canopy 6 S So 5 g".0
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this Application for Payment has been completed
Application is made for payment, as shown below, in connection with the Contract in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Shect,AIA Document G703, is attached. Contractor for Work :_ Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM -.-- -.--_- __ _ $
$1,360,000.00 ments receive• role • Iwner, and that c. rent payment shown herein is now due.
2. Net Change By Change Orders _ $ $0.00 CONTRAC OR
-- --- .
3 CONTRACT SUM TO DATE (Line I + 2) ____,. _.$ $1,360,000.00 By' '?� / Date: 09-15-2009
ra^. ,s
State of: Ohio ,*?o Z�1 ''. E
4 TOTAL COMPLETED&STORED TO DATE $ $135,800.00 •
County of: Hamilton . :� Ate, .
(Column G on G702) h' ",,,'
Subscribed and sworn to before ?< �'r Y t T��,w . 1 ..nf•
5. RETAINAGE: me this 15th '`" 9 r)4 ~'
a. 10% %of Completed Work $ $13,580.00 day of September,2009
(Columns D+ E on G703)
b. 10% %of Stored Material $ $0.00 �n,
(Column F on G703) + L '"mil My Commission expires:
Total Retainage(Line 5a+5b or Notary Public:
Total in Column I of 0703) $ $13,580.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE _._ $ $122,220.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Wolk has progressed as
(Line 6 from prior Certificate) _ _ _ .. $113,400.00 indicated,the quality of the Work is in accordance with the Contract Documents and
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE _ .. .. _ - $8,820.00 Oa
S AMOUNT CERTIFIED __ .._____ ___ _ _ etW
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.from the amount applied for Initial
(Line 3 less Line 6) S $1,237,780.00 all figures on ibis Application and on the _ontinuationSheet that changed to conform
to the amount certifi'ed.) /
DEDUCTIONS CO,STRUCTI 1 M. orAGER: /
CHANGE ORDER SUMMARY ADDITIONS C�
Total changes approved in By� k�/�_�! 441 g AP' Date: / giq 0�
previous months by Owner fly/�$0.00 $0.00 ARCHI Total approved this Month $0.00 $0.00 tillir TOTALS $0.00 $0.00 By — Date.
NET CHANGES by Change Order $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
iii, AIA DOCUMENT G702/CMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
,1"1., 1992 EDITION-AIA'—-K1992-THE AMERICAN INSTITUTE OF ARCHITECTS,1-i—NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
DC 20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. G702/CMa-1992
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa (Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #06 Distribution to:
Carmel Performing Arts Center OWNER
Commission 777 Third Avenue, SW PERIOD TO: ❑
One Civic Square 08 31 2009 ❑ CONSTRUCTION
Carmel, IN 46032 Carmel,IN 46032 PROJECT NOS.: 2695 MANAGER
Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. ❑ CONTRACTOR
2130 Waycross Road
Cincinnati,0I-145240-2719 VIA ARCHITECT:CSO ARCHITECTS.
CONTRACT FOR Acoustical Canopy
CONTRACTORS APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this Application for Payrnent has been completed
Application is made for payment, as shown below, in connection with the Contract.
in accordance with the Contract Documents,that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which revious Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM S
$1,360,000.00 ments received f s the Owner, ans at current payment shown herein is now due.
2. Net Change By Change Orders $ $0.00 CONTRAC" •R:
By: ' / CA-c..) Date: 08-12-2009
3 CONTRACT SUM TO DATE (Line I + 2) $ $1,360,000.00
$126,000.00
State of: Ohio '% ' n
,
4 TOTAL COMPLETED&STORED TO DATE ___.__$ County of: Hamilton , , ',"_:,,-v,,
(Column G on G702) :�„`,1 ti
Subscribed and sworn to before
1'1- , ,:
5. RETAINAGE: me this 12th day of August,2009. :.,��
a. 10% %of Completed Work S_ $12,600.00 4,,,„/-� . .A...
(Columns D+ E on 6703) �''�
b. 10% %of Stored Material $ $0.00 C9 Y1 ll„ _ -
(Column F on G703) 6,3 I k(QJ� My Commission expires:
Total Retainage(Line 5a+5b or Nota Public:
total in Column I of 0703) $ $12,600.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE __ .. $ $113,400.00 in accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application,the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
(Line 6 from prior Certificate) __.__._____.. s
$109,620.00 indicated,the quality of the Work is in accordance with the Contract Documents. an=
the Contractor is entitled to payment of the AMOUNT CERTIFIED, '-:1=
8. CURRENT PAYMENT DUE S $3,780.00 AMOUNT CERTIFIED .$ , ad
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.fi-on2 the amount applied for Initial
(Line 3 less Line 6) S $1,246,600.00 all figures on this Application and on the ContinuationSheet that changed to conform
to the amount certified.)
drCHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONSTRUCTII MA• GER:
Total changes approved in y '∎ w - /' Date
pp B �.f .�. L_ 2L ,8�
previous months by Owner . ■
$0.00 $0.00 ARCHIT.
Total approved this Month $0.00 $0.00 `-
By.
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
NET CHANGES by Change Order $0.00 tractor named herein. issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
au AIA DOCUMENT G702ICMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
1992 EDITION-AIA'- KI992-THE AMERICAN INSTITUTE OF ARCHITECTS,1-i-NE\X YORK AVENUE.Nw.\XAS'IIINGA-ON'
WV
DC 20006--292-\\'ARNING:Unlicensed photocopying violates U.S.copyright laws and„•m subject the violator to legal prosecution. G702/CMa-1992
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(Instructions on reverse side) PAGE ONE OF 2 PA"S
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #05 Distribution to:
Carmel Performing Arts Center OWNER
Commission 777 Third Avenue, SW PERIOD TO: 07-31-2009 ❑
One Civic Square ❑ CONSTRUCTION
Carmel, IN 46032 PROJECT NOS.: 2695
Carmel,IN 46032 MANAGER
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
2130 Waycross Road ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITECTS.
CONTRACT FOR: Acoustical Canopy
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this Application for Payrnent has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet,ALA Document G703, is attached. Contractor for Work for whi 1 e - Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM ___ .. S
$1,360,000.00 ments received fron�--e Owner, and that . rrent payment shown herein is now due.
CONTRACTS':
2. Net Change By Change Orders _ _ __- __ ____ $ $0.00 t1 ee. c.0", ..x,i4,.(.4
By:
("-} Date: 07-17-2009
3 CONTRACT SUM TO DATE (Line I + 2) $ $1,360,000.00 4
4 TOTAL COMPLETED& STORED TO DATE $ $121,800.00 State of: O Hamilton
(Column G on G702) County o£ &� �
Subscribed and sworn to before = �'-'�"'� �
5. RETAINAGE: me this 17th day of July,200' p- ,t*,.' 3
a. 10% %of Completed Work S $12,180.00 fin., OF 'o`r
(Columns D +E on G703) ",
b. _10% %of Stored Material $ $0.00 ,
(Column F on G703) Rs- ' My Commission expires:
Notar Public: �4
Total Retainage(Line 5a+5b or
Total in Column I ofG703) $ $12,180.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $109,620.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$100,800.00 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) _. the Contractor is entitled to payment of the AMOUNT CERTIFIED st
8. CURRENT PAYMENT DUE . _._____.__ ______ S $8,820.00 AMOUNT CERTIFIED
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.from the amount applied for.Jnitial
(Line 3 less Line 6) S $1,2$0,380.00 all figures on this Application and on the ContinuationSheet that changed to conform
to the amount certified.)
ADDITIONS DEDUCTIONS CO STRUCTI IQ MAN GER:/
CHANGE ORDER SUMMARY r
Total changes approved in BY: �>,%, ,...��,►._�. i _ ' Date:
previous months by Owner
$0.00 $0.00 ARC ITECT:
Total approved this Month $0.00 $0.00 % 30.01
By: .. Date:
TOTALS $0.00 $0.00 This Certi'r' 's not negotiable. The AMOUNT CERTIFIED is payable only to the Con-
NET CHANGES by Change Order $0.00 tracto-- ed herein. Issuance, payment and acceptance of payment are without
prej / -6--e to any rights of the Owner or Contractor under this Contract.
bini AOCUEN G702/CMa PP FOMEAI 1992 lA EDITID ON M AIA'T--K1992-THE AM-MALI" INSTITUTE ION AND OF ACERTIFICNI RC Fr H ITFCTSR RoW,I-i-NT NE\X-CONSTRUCTION YORK AVENUE.MNAGER-ADV Nw.\XAS'ISH IINGA-ON'EDITION
•
DC 20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and viii subject the violator to legal prosecution. 6702/CMa-1992
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa (Instructions on reverse side) PAGE ONE OF 2 PACES
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #04 Distribution to:
Carmel Performing Arts Center
Commission PERIOD TO: ❑ OWNER
One Civic Square 777 Third Avenue, SW 06-30-2009
Cannel,IN 46032 ❑ CONSTRUCTION
Carmel, IN 46032 PROJECT NOS.: 2695 MANAGER
FROM SUB-CONTRACTOR: WALTER&Company, Ltd.
Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
2130 Waycross Road ❑ CONTRACTOR
Cincinnati, OH 45240-2719 VIA ARCI-IITECT:CSO ARCHITECTS.
CONTRACT FOR: Acoustical Canopy (e—�
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this Application for Payrnent has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for we'.- ,': Certificates for Payment were issued and pay
$1,360,000.00 ments received frog e Owner, and that •urrent payment shown herein is now due.
1. ORIGINAL CONTRACT SUM _ __ _ _ - ___ ; .-_. _ _ _ S /
2. Net Change By Change Orders _ - ___. _ ._- _ _ . .$ $0.00
•
CONTRACT II s'
3 CONTRACT SUM TO DATE (Line I + 2) _ _-. _ .--. $ $1,360,000.00 By: / a`� Cr-F° Date: 06-15-2009
,...,.... �.;,
4 TOTAL COMPLETED &STORED TO DATE $ $112,000.00 State of: Ohio •y ,1.
(Column G on G702)
County of: Hamilton s � ��. r•
Subscribed and sworn to before =°,; ' : �,�; ,
5. RETAINAGE: me this 15th day of June, 2009 ' y ' .-s._ gyp,,
a. 10% % of Completed Work S $11,200.00 yy��, ; �.,t '"7
F iD
(Columns D + E on 0703) °j , . "
b. 10% %of Stored Material $ $0.00 �7Zo
(Column F on G703) EU oMS.. i . - •1✓(_. ATA My Commission expires:
Total Retainage(Line 5a+5b or Nota Public:
Total in Column Iof0703) _ __.- . _ _ __ $ $11,200.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $100,800.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
S $94,500.00 indicated,the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE _ _-- .... _ _ _ _ _- _ - _ _ S $6,300.00 AMOUNT CERTIFIED
43 '`' J
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.fi-om the amount applied for.Initial
(Line 3 less Line 6) s $1,259,200.00 all figures on Ibis Application and on the ContinuationSheet that changed to conform
to the amount certified.)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CONS"1'RUC'fl iL ' ER:Total changes approved in By: .i, t (9?
L Lam' Date:
previous months by Owner � %r -
$0.00 $0.00 ARCHITC ►4 J
Total approved this Month $0.00 $0.00 / -=---- 0
TOTALS $0.00 $0.00 �,:.., y'ti .�A ,
This Certi Ica ''is not negotiable.The AMOUNT CERTIFIED is payable only to the Con-
NET CHANGES by Change Order $0.00 tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702/CMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
1992 EDITION-AIA'--K1992-THE AMERICAN INSTITUTE OF ARCHITECTS,1-i-NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
1,,
_. IV:: DC 20006.-292-WARNING:Unlicensed photocopying violates U.S.copyright laws and win subject the violator to legal prosecution. G702/CMa-1992
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(instructions on reverse side) PAGE ONE OF 2 PAU..S
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT' APPLICATION NO.: #03 Distribution to:
'Carmel Performing Arts Center
Commission 777 Third Avenue SW PERIOD TO: 05-31-2009 ❑ OWNER
One Civic Square Carmel,IN 46032 ❑ CONSTRUCTION
Carmel, IN 46032 PROJECT NOS.: 2695 MANAGER
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. Subcontract#2695-5550 - CONTRACT DATE: 02-27-2009 ❑ARCHITECT
2130 Waycross Road ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITECTS.
CONTRACT FOR: Acoustical Canopy
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, infor-
mation and belief the Work covered by this Application for Payrnent has been completed
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by the
Continuation Shect,AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were,issued and pay
1. ORIGINAL CONTRACT SUM ._ S
$1,360,000.00 ments received from the Own- an that current payment shown herein is now due.
2. Net Change By Change Orders _ _ __ __.__.______$ $0.00
CONTRACTO': •
3 CONTRACT SUM TO DATE (Line I + 2) ---- -- $ $1,360,000.00
By: �— •
'�° C 5 Date: 05-14-2009•
4 TOTAL COMPLETED & STORED TO DATE $ $105,000.00 State of: Ohio
(Column G on 0702)
County of: Hamilton , ti � -
Subscribed and sworn to befo' ��:'
5. RETAINAGE: me this 14th day of :' I 'it ....
a. 10% %of Completed Work S $10,500.00
(Columns D + E on G703) ,r .• '.:rA,
b. 10%_%of Stored Material $ $0.00 'y,"""",,,,,
•
(Column F on 0703) My Commission expires:
Total Retainage(Line 5a+ 5b of Notary Public:
Total in Column I of 0703) ___ ___ $ $10,500.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE _.___ .. $ $94,500.00 In accordance with the Contract Documents,based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$80,100.00 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) ... __. _._ _ ___. the Contractor is entitled to payment of the AMOUNT CERTIFIE r. 03.
8. CURRENT PAYMENT DUE S $14,400.00 J
AMOUNT CERTIFIED $ 1
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.from the amount applied for.form
(Line 3 less Line 6) S $1,265,500.00 all figures on tbis Application and on the ContinuationSheet that changed to
to the amount certified.) •
CHANGF ORDER SUMMARY ADDITIONS DEDUCTIONS CO STRUCT.►\N MANAGE'. I l,.
Total changes approved in By: s►�y� ` a• Date: ; S —
previous months by Owner
$0.00 $0.00 ARCHITECT: ,dt
Total approved this Month i
$0.00 $0.00
Date:
TOTALS $0.00 $0.00 By. nPli l� is
payable only to the Con-
NET CHANGES by Change Order $0.00 This Ce icate is n. negotiable. The AMOUNT CER p y
tract. named • rein. Issuance, payment and azceptance of payment are without
pre' dice : any rights of the Owner or Contractor under this Contract.
_�-----
I I AIA DOCUMENT G702/CMa -APPLICAI ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
Al) 1992 1992 EDITION-AIA'—-K1992-THE AMERICAN INSTITUTE OF ARCHITFCTS,1-i—NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON' 0702/CMa-1992
DC 20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and,yin subject the violator to legal prosecution.
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(Instructions on reverse side) PAGE ONE OF 2 PA
TO CONSTRUCTION MGR:: Carmel Redevelopment PROJECT: APPLICATION NO.: #02 Distribution to:
Commission Carmel Performing Arts Center OWNER
777 Third Avenue, SW PERIOD TO: 04-30-2009
One Civic Square CONSTRUCTI(
Carmel, IN 46032 PROJECT NOS.: 2695
Carmel,IN 46032 MANAGER
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd.
Subcontract#2695-5550 CONTRACT DATE: 02-27-2009 0 ARCHITECT
2130 Waycross Road ❑ CONTRACTOR
Cincinnati,OH 45240-2719 VIA ARCHITECT:CSO ARCHITECTS.
CONTRACT FOR:Acoustical Canopy
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, in
mation and belief the Work covered by this Application for Payment has been compk
Application is made for payment, as shown below, in connection with the Contract. in accordance with the Contract Documents, that all amounts have been paid by
Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and I
1. ORIGINAL CONTRACT SUM S
$1,360,000.00 ments received from the Owner, and that current payment shown herein is now d
2. Net Change By Change Orders .$ $0.00 CONTRACTO: .
By: - '- c Fo Date: 04-13-2009
3 CONTRACT SUM TO DATE (Line I + 2) .1 $1,360,000.00
Mat WINEXIONAt
4 TOTAL COMPLETED&STORED TO DATE $ $89,000.00 State of: Ohio Hamilton •,`,^�
County of: r
(Column G on G702) . -. e WON rillit 111101100
Subscribed and sworn to before
5. RETAINAGE: me this 13th da of April 10% %of Completed Work s $8,900.00 y p .' "+"
io
(Columns D +E on G703)
b. 10% %of Stored Material $ $0.00 — `
(Column F on G703) •• A . •'1 _ . :n" jtA My Commission expires:-
Total Retainage(Line 5a+5b or Notar ublic: \-
Total in Column l of G703) $ $8,900.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $80,100.00 In accordance with the Contract Documents,based on on-site observations and the I
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Om
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed
(Line 6 from prior Certificate) s $44,100.00 indicated,the quality of the Work is in accordance with the Contract Documents.
the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE S $36,000.00 AMOUNT CERTIFIED .$ 36 C900. a
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.from the amount applied for.lni
(Line 3 less Line 6) S $1,279,900.00 all figures on tbis Application and on the ContinuationSheet that changed to confi
to the amount certified.)
ADDITIONS DEDUCTIONS CONSTRUCTION MANAGER:
CHANCOF ORDER SUMMARY �l
Total changes approved in By: Date: 7` 21—cri
previous months by Owner
$0.00 $0.00 ARCHITECT:
Total approved this Month $0.00 $0.00
By: Date:
TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the C
NET CHANGES by Change Order $0.00 tractor named herein.Issuance, payment and acceptance of payment are with
prejudice to any rights of the Owner or Contractor under this Contract.
two AIA DOCUMENT G702/CMa.APPLICAI ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
Mt1992 EDITION-AIA'—-K1992-THE AMERICAN INSTITUTE OF ARCHITFCTS,1-i--NE\X YORK AVENUE.N.w.\XAS'l1INGA-ON'
Dc20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. C702/CMa-1•
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G7O2/CMa(Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR::Carmel Redevelopment PROJECT: APPLICATION NO.: #01-R1 Distribution to:
Commission Carmel Performing Arts Center ;
P '* PERIOD TO: ❑ OWNER
777 Third Avenue, SW ;-.1 03 31 2009
One Civic Square �; ❑ CONSTRUCTION
Carmel, IN 46032 `-
Carmel, IN 46032 PROJECT NOS.: 2695
f;.,> � • � �; ••, MANAGER 6.Subcontract#2695-5550 :;.i \-:',,',:3'CONTRACT DATE: 02-27-2009 ❑ ARCHITECT
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. r�::�
2130 Waycross Road ' `% ,q % /7::,'.>,. ❑ CONTRACTOR
ECTSvIA ARCHITECT:CSO ARCHITECTS. s `''' :
Cincinnati, OH 45240 2719 •=4,.,•=4,., ` r,
CONTRACT FOR Acoustical Canopy -%/n � ;'',�%
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned ntractor certifies to the best of the Contractor's knowledge, infor-
mation and belief th ork coveiib
�rey this Application for Payrnent has been completed
Application is made for payment, as shown below, in connection with the Contract.
in accordance with th ontrac oculnents, that all amounts have been paid by the
Continuation Shect,AIA Document G703, is attached. Contractor for Work for ' ,ich previous Certificates for Payment were issued and pay
1. ORIGINAL CONTRACT SUM _____- _ S
$1,360,000.00 ments received from s • - nd that current payment shown herein is now due.
CONTRAC 'IR:
2. Net Change By Change Orders _ _ ____ $ $0.00 ' - �/ A
3 CONTRACT SUM TO DATE (Line I + 2) $ $1,360,000.00
By: a 'r �Ll! Gam° Date: 03-18-2009
State of: Ohio xy
4 TOTAL COMPLETED &STORED TO DATE $ $49,000.00 County of Hamilton `j rtt
(Column G on G702) Subscribed and sworn to before ;Ig '`x'®'`";'" ¢ ' Notelyftlik. ,*,;,,
5. RETAINAGE: me this 18th da of March, •r� a' Y �'
a 10% %of Completed Work S $4,900.00 y , ( 4y° w"t
(Columns D+ E on G703) :'h, i p--r.,
b. 10% %of Stored Material S $0.00 -
(Column F on G703)
exam, ...``.. 1./Lu' My Commission expires:
Total Retainage(Line 5a+ 5b or Notary Public:
Total in Column I of G703) $ $4,900.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $44,100.00 In accordance with the Contract Documents, based on on-site observations and the data
(Line 4 less Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner
7. LESS PREVIOUS CERTIFICATES FOR PAYMENT that to the best of their knowledge, information and belief the Work has progressed as
$0.00 1 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) $ d the Contractor is entitled to payment of the AMOUNT CERTIFIED. ,-
8. CURRENT PAYMENT DUE S $44,100.00 \`
AMOUNT CERTIFIED _$ 4V 0/00
oramos
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs.fi-om the amount applied for.lnitial
(Line 3 less Line 6) S $1,311,000.00 all figures on this Application and on the Col tjnuationSheet that changed to conform
to the amount certified.)
CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS CO STRUCTIO0 AN=GER:
Total changes approved in By . . Date:
previous months by Owner $0.00 $0.00 ARCHITECT:
Total approved this Month $0.00 $0.00 _ -- - `' •;
TOTALS $0.00 $0.00
By: '. '-'_ . ` Date:
NET CHANGES by Change Order $0.00 This Certific, s,-�"egotiable. The AMOUNT CERTIFIED is payabl only to the on-
tractor n.•• ..:--rein. Issuance, payment and acceptance of payment are without
prejud. -.`any rights of the Owner or Contractor under this Contract.
•AlA DOCUMENT G702/CMa-APPLICAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTRUCTION MANAGER-ADVISH EDITION
1992 EDITION-AIA'--K1992-THE AMERICAN INSTITUTE OF ARCHITECTS,1-i-NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
DC 20006--292-WARNING:Unlicensed photocopying violates U.S.copyright laws and will subject the violator to legal prosecution. G702/CMa-1992