HomeMy WebLinkAboutWaltek - $127,500 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.
Purpooa of Authorized Olcburoomont Amount of Authorizod Olcburcomant
Amntagt5 •0 be boil by Vi11die Findhci[/
Applirtil-iort 11+ (Wnl'-fekl Atagt,{sT 2010 4-io, aoo,tz
Agii<niioh 15 (wll+ek)Se(o+ember 20H 4.II7soo 00
Total Authorized Oloburcomant ibh2Af- Q �
�?y _ ,.:ei
All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto
In that certain Loan Agreement(PAC Acoustical Equipment),dated January 28,2010,by and between Lender
and Village Fi'and , LLC.
Dated: // /� /J CITY OF CARMEL REDEVELOPMENT
COMMI SION
By
Printed L es .,1l5, Olds
Title E Xecu+ IVe bi ref 7LOr
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 reimbursed to CRC $ 127,847.00
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
Paid by Village Financial S 5,175.00
January 2010
Paid by Village Financial S 1,350.00
February 2010
Paid by Village Financial S 3,690.00
June 2010
Paid by Village Financial S 662,918.00
August 2010
Amount to be paid by Village Financial S 10,000.00
September 2010
Amount to be paid by Village Financial S 117,500.00
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(Instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR::Carmel Redevelopment PROJEC•l':Cannel Performing Arts Center APPLICATION NO.: #14 Distribution to:
• Commission ID OWNER
777 Third Avenue, SW PERIOD TO: OS-31-2010
One Civic Square Cannel, IN 46032 PROJECT NOS.: 2695 ❑ CONSTRUCTION
Cannel,IN 46032 MANAGER
Subcontract#2695-5550
FROM SUB-CONTRACTOR: WALTEK&Company,Ltd. CONTRACT DATE: 02-27-2009 ❑ARCHITECT
2130 Waycross Road ❑CONTRACTOR
Cincinnati,OH 45240-2719 • VIA ARCIIITECT: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 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 Sheet,ALA 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 Owner, and that current payment shown herein is now due.
/
2. Net Change By Change Orders _ _ S ($207,000.00) CONTRACTOR:
By: - -'.4/ae.,' a, ''JK C', -.' Dale: 08-13-2010
3 CONTRACT SUM TO DATE (Line I + 2) S $1,153,000.00 -
4 TOTAL COMPLETED&STORED TO DATE $ $961,080.00 State of
Ohio
(Column G on G702) County of:
Hamilton O, 1 ,..'L EUGENE ON=
Subscribed and sworn to before ?�_ L Notafy Put%s.0cia`tti)
5. RETAINAGE: me this 13th day of August,20l0'-_8 _ mucomCll fl (moil
a. %of Completed Work S $9,556.76 y August, ;�L°.??. `
(Columns D+ E on G703) �f'Vt
b. %of Stored Material S �Q
$48,093.24 l"1�9J1s-� .,, ,°f0
(Column F on G703) ` �'�a IVty Commission expires:
Total Retainuge(Line 5a+5b or Notary Public:
fatal in Column I ofG703) S $57,650.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE $ $903,430.00 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
$799,430.00 indicated, the quality of the Work is in accordance with the Contract Documents. and
(Line 6 from prior Certificate) z .v. the Contractor is entitled to payment of the AMOUNT CERTIFIED.
8. CURRENT PAYMENT DUE S °" .. AMOUNT CERTIFIED _ . . _ . $_
9. BALANCE TO FINISH, INCLUDING RETAINAGE -1' .�MAP (Attach explanation if amount certified differs.fi-oin the amount applied for.lnitial
(Line 3 less Line 6) S $249,570.00 all figures on this Application and on the ContinuationSheet that changed to conform
to the amount certified.)
CONSTRUCTIt, ANGER:
f HANCF.n z FR SUMMARY ADDITIONS DEDUCTIONS n �y
Total changes approved in By: �,(;^_�7 /"1av` Date:De 2 /0
previous months by Owner $0.00 ($207,000.00) ARCH;;-==
Total approved this Month $0.00 $0.00 l ' ----'` 43240 B .
TOTALS $0.00 — Date:
($207,000.00) Phis Cc ;er snot negotiable.The AMOUNT IFIED is payable only to the Con-
NET CHANGES by Change Order ($207,000.00) track: med herein. Issuance, payment and acceptance of payment are without
y: dice to any rights of the Owner or Contractor under this Contract.
AIA DOCUMENT G702/CMa-API'LICAJ ION AND CERTIFICNI F FOR RuwMENT-CONSTRUCTION MANAGER-ADV IS1I EDITION
t' , 1992 EDITION AIA'--K1992-'rile AMERICAN INS-riYUT-E OF ARCHITFCTS,1-i-NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
_' I- ac20006--292-%%ARMING:Unlicensed photocopying violates U.S.copyright laws and c,iii subject the violator to legal prosecution. 6702/CMa-1992
CARMEL PERFORMING ARTS CENTER AIA DOCUMENT G703
Construction Manager: Shiel Sexton
Job() 2695 Contract 8 2695-5550 APPLICATION NUMBER 14
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION DATE: 13-Aug-2010
CONTRACTOR'S SIGNED CERTIFICATION IS ATTACHED. PERIOD TO: 31-.ug-2010
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
APPLICATION PERIOD STORED STORED TO DATE
(0+E) (not in D or E) (D+E+F) (C-G)
1. ENGINEERING 140,000.00 140,000.00 - 140,000.00 100% - 9,416.86
2. MOBILIZATION 10,000.00 - 10,000.00 10 10,000.00 100% - -
3. SPACE FRAME SYSTEM:
Material 269,000.00 8,100.00 260,900.00 - 269,000.00 100% - 18,093.82
4. LAMINATED ACOUSTICAL GLASS:
Material 446,000.00 1,500.00 444,500.00 - 446,000.00 100% - 29,999.42
5. ON-SITE INTALLATION 235,000.00 - 94,000.00 40% 141,000.00 -
6. OWNER ALLOWANCE 1 250,000.00 2,080.00 - 2,080.00 1% 247,920.00 139.90
7. OWNER ALLOWANCE 2 10,000.00 - - - 0% 10,000.00 -
8. C/O 81 - Allowance Reduction (207,000.00) - - - 0% (207,000.00) -
9. C/O #2 - Work Performed in C/O 81 - - - - 0% - -
TOTAL - THIS APPLICATION 1,153,000.00 151,680.00 809,400.00 - 961,080.00 83% 191,920.00 57,650.00
Client#:659329 WALTECOM2
ACORD.., CERTIFICATE OF LIABILITY INSURANCE DATE IMMIDOiYYYYI
07/14/2010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE-DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER 1 CONTACT Debbie Neace
N
USI Midwest 1 PHONE 513 852-6417 I FAX 610-537-4857
_
fAIC.Na.Er<t): (A/C,Nol:
312 Elm Street,24th Floor I ADDR E-MAIL ESS: debbie.neace @usi.biz
Cincinnati,OH 45202 )PRODUCE IY
.CUSTOMER ID 4: _
__�___ _-_____ ____! INSURER(S)AFFORDING COVERAGE (NAIL a
INSURED I INSURER A:Central Mutual Insurance Compan 120230•
Waltek&Company,Ltd
2130 Waycross Road 1 INSURER e:AGCS Marine Insurance Company 122837
Cincinnati,OH 45240
I INSURER C:All America Insurance.Company 120222
1 INSURER 0: I
I INSURER S: t
1
I INSURER F: I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS.SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS,OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR 1 ADOL SUER I POLICY EFF' POLICY EXP
t-TR I TYPE OF INSURANCE INSR WVo I POLICY NUMBER 'IMMIODIYYVY) IIMMIDDIVYYY)I LIMITS
A GENERAL LIABILITY ICLP8361142 '07/01/2010107/01/20111EACHOccuRRENCc 51,000,000
I I I DAMAGE TO RENTED,-I COMMERCIAL GENERAL LIABILITY 7 ( I PREMISES lEa occurrence) 5300,000
I I CLAIMS-MADE I Xi OCCUR
MED E7(?{Any one parson( s5,000
I X:I Stop Gap$1 Mil I I PERSONAL S ADV INJURY 51,000,000
II I IGENERALAGGREGATE S2;000,000
I GEE L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGO 52,000,000
11 POLICY I E O n L C I ! I S
C I AUTOMOBILE LIABILITY I i BAP8361141 07/01/2010 07/01/2011 COMBINED SINGLE'LIMIT S
1 X!ANY AUTO
I
(Ea accident) ` 1,000,000
i ALL OWNED AUTOS
I ! BODILY INJURY(PT:person( I S
jam' ! I BODILY INJURY.(Per accident)I S
I_1 SCHEDULED AUTOS PROPERTY DAMAGE
S
X HIRED AUTOS (Per ncddontl
X'NON-OWNED AUTOS
I5
■ Is
A I X!UMBRELLA LIAR II X II OCCUR ( ! I CXS8361143 `07101/2010107/01/20111 EACH OCCURRENCE 1 56,000,000
1 1 EXCESS LAB 1 I CLAIMS-MADE (
,AGGREGATE 1 56,000,000
I I DEDUCTIBLE I ! I S
II RETENTION S 0 I 1 I ! 1 5
A I WORKERS COMPENSATION I I I IYJC STATU- OTH-I
I AND EMPLOYERS'LIABILITY Y I N) !iIQRY LIMILS I IFR i
:ANY PROPRIETORIPARTNERJEEXECUTNE I .N/A I E.L.EACH ACCIDENT I S
OFFICERJMEMBER EXCLUDEEXCLUDED'? ' I
(Mandatary In NH) i I ( I E.L.DISEASE-EA EMPLOYEE!S
If yes,descntio under
DESCRIPTION OF OPERATIONS below I I I I E.L.DISEASE-POLICY LIMIT I S
B ,Installation I 1MZ193020166 '07/01/2010107/01/2011 $5,000,000/$1,000 Ded
B ILeased.Eq'uipment . IMZI93020166 ;07101/2010107101/2011 $250,000/$1,000 Ded
OES'CRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101.Addltlonal Remarks Schedule.II more space Is required)
Project: Regional Performing Arts Center @Carmel IN. The following is
included as additional insured under the general liability&automobile
(See Attached Descriptions)
CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
Shiel Sexton Company,Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
902 North Capital Avenue
Indianapolis,IN 46204 AUTHORIZED REPRESENTATIVE /f
@ 1988-2009 ACORD CORPORATION.All rights reserved.
ACORD 25(2009/09) 1 of 2 The ACORD name and logo are registered marks of ACORD
#54584966lM4584950 DJNAC
DESCRIPTIONS (Continued from Page 1)
liability as required by written contract: City of Carmel Redevelopment
Commission/CSO Architects/L'Acquis Consulting Engineers/Lynch,Harrison&
Brumleve, Inc.and Shiel Sexton Company
AMS 25.3(2009/09) 2 of 2
#S4584966/M4584950
WALTECOM2
DATE IMMIDONYYY)
ACORD, EVIDENCE OF PROPERTY INSURANCE 07/15/2010
THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED
BELOW.THIS EVIDENCE OF PROPERTY INSURANCE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
AGENCY 1 PHONE 513 852-6417 COMPANY
LIAIC'N E II. AGCS Marine Insurance Company
USI Midwest P Y
312 Elm Street,24th Floor
Cincinnati,OH 45202
FAX a IL
(Arc.No):6'10-5374857 I ADDRESS:debbie.neace @usi.biz
CODE: I SUB CODE:
AGENCY 65939
•
COST.MEHdD A' LOAN NUMBER I POLICY NUMBER
INSURED WT Acquisition Co LTD dba Waltek& IMZI93020166
Company,Ltd EFFECTIVE DATE EXPIRATION DATE I CONTINUED UNTIL
2130 Waycross Road 07/01/10 I 07/01/11 17_1 TE 2MINATED IF CHECKED
Cincinnati,OH 45240
THIS REPLACES PRIOR EVIDENCE DATED:
PROPERTY INFORMATION
LOCATIONIDES CRIPTION
Project: Regional Performing Arts Center @Carmel IN
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
EVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS
SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
COVERAGE INFORMATION
COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE DEDUCTIBLE
Installation $5,000,000 $1,000
Earthquake $2,500,000 5%
Temporary Storage $3,000,000 $1,000
REMARKS(Including Special Conditions'
CANCELLATION 10 Days for Non-Payment
SHOULD ANY OF THE.ABOVE DESCRIBED POLCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO
MAIL 30 DAYS WRITTEN NOTICE TO THE ADDITIONAL INTEREST NAMED BELOW.BUT FAILURE TO MAIL.SUCH NOTICE SHALL IMPOSE NO OBLIGATION
OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES.
ADDITIONAL INTEREST
NAME AND ADDRESS i MORTGAGEE ` I ADDITIONAL INSURED
Shiel Sexton Company,Inc. I f LOSS PAYEE I )c j General Contractor
902 North Capital Avenue LOAN
Indianapolis IN 46204
AUTHORIZED REPRESENTATIVE
ACORD 27(2006/07) 1 of 1 S 277136 o ACORD CORPORATION 1905.2006: All rights reserved.
The ACORD name and logo are registered marks of ACORD DJNAC
��A e I�►L LIEN_WAITER - SUBCONTRACTOR/SUPPLIE0
WALTEK & Company, Ltd (Subcontractor), upon receipt and clearance of payment of One
Thousand Three Hundred Fifty & 001100 Dollars ($1,350.00) from Shiel Sexton (Contractor)
paid in connection with the construction of the Carmel Performing Arts Center (the project)
hereby executes this Partial Lien Waiver and waives and releases any and all lien rights accruing
for materials and services furnished through January 31, 2010 (except for the applicable
retention balance of$14,908.00 as of January 31, 2010), for which the above payment is made.
The undersigned represents that all employees, .laborers, materialmen and subcontractors
employed by the undersigned in connection with the Project and all bills currently due for labor,
materials, supplies and taxes furnished in connection with the Project, have been fully paid their
respective portions of previous payments. This Partial Lien Waiver is executed in consideration
of the payment of said amount and is effective only to the extent of such payment.
Dated this ZO day of A5�3 2010.
WALTEK& Co nor, Sworn to and subscribed before me this
By: , Cr-- ZO day of / 5v5 , 2010
(Officer Signature)/
(Printed Name) (Not Public)
o
(Title-Officer of the Company)
„um„uur
4,04 'z EUGENIE MARIE TOPPUTO
A€ Notary Public,Stale of Ohio
4'1 'o My Commission Expires 02/1812013
,,, `
JoFOa,`
`PARTIAL LIEN WAIVER - SUBCONTRACTOR/SUPPLIERI
WALTEK & Company, Ltd (Subcontractor), upon receipt and clearance of payment of Two
Thousand Three Hundred Forty & 001100 Dollars ($2,340.00) from Shiel Sexton (Contractor)
paid in connection with the construction of the Carmel Performing Arts Center (the project)
hereby executes this Partial Lien Waiver and waives and releases any and all lien rights accruing
for materials and services furnished through February 28, 2010 (except for the applicable
retention balance of$15,168.00 as of February 28, 2010), for which the above payment is made.
The undersigned represents that all employees, laborers, materialmen and subcontractors
employed by the undersigned in connection with the Project and all bills currently due for labor,
materials, supplies and taxes furnished in connection with the Project, have been fully paid their
respective portions of previous payments. This Partial Lien Waiver is executed in consideration
of the payment of said amount and is effective only to the extent of such payment.
Dated this L-4"�h day of Au , 2010.
WALTEK &Co -• Ltd Sworn to and subscribed before me this
By: ■ C/a ZD- day of A-1.) ."3-1--- , 2010
(•fficer Sig - • -
Q r-
(Printed Name) (Note Public)
C.tCJ,
(Title-Officer of the Company)
°-CP'RIAL S
o 'r EUGENIE MARIE TOPPUTO
t' Notary Public,State of Ohio
`N ,o My Commission Expires 02/1812013
, 9TH„oF„`o,,
•
•
s(3
APPLICATION AND CERTIFICATE FOR PAYMENT AIA DOCUMENT G702/CMa(instructions on reverse side) PAGE ONE OF 2 PAGES
TO CONSTRUCTION MGR::Carmel Redevelopment PROJECT:Carmel Performin Arts Center APPLICATION NO.: t 15-R1 Distribution to: •
Commission g p OWNER
Third Avenue, SW PERIOD TO: 09-30-2010
•
One Civic Square ❑ 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.
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 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 Sheet,AIA Document 0703, 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 • r,an. t - rrent payment shown herein is now due.
2. Net Change By Change Orders _ S ($207,000.00)
CONTRACTOR: / L
$1,153,000.00 By: �/`i %� �-z'�� �' `„Date:09-20-2010
3 CONTRACT SUM TO DATE (Line I±2) S �P`�u�'�`�s��',,
State of: Ohio ``�: ! ��” EUGENIE MARIE TOPPUI
$984 580.00 z
4 TOTAL COMPLETED&STORED TO DATE s County of. Hamilton S e _ - State of Oh
(Column G on G702) = Notary Public,
Subscribed and sworn to before ��- ,` `O MyCominissionExp(res0a118
5. RETAINAGE: me this 20th day of September,2010 x; ��;,�'
a %of Completed Work s $57,650.00 ., ,OF„,m�`
(Columns D+ E on G703) _
b. ____%of Stored Material S $0.00 7/t$iZ of 3
(Column F on G703) � (l (f^' \ My Commission espires:Total Retainage(Line 5a+5b or
Total in Column l of G703) _. _ S $57,650.00 CERTIFICATE FOR PAYMENT
6. TOTAL EARNED LESS RETAINAGE . . __ 5 $926,930.00 In accordance with the Contract Documents,bused 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
$809,430.00 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.
8. CURRENT PAYMENT DUE S $117,500.00 fl U U S
',Le,
AMOUNT CERTIFIED _. 5 a
9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified difjers.fi•onr the amount applied for.lnitial
(Line 3 less Line 6) S $226,070.00 all figures on Ibis Application and on the ContinuationSheet that changed to conform
to the amount certified.)
ADDITIONS DEDUCTIONS CO STRUCT 0 MA AGER:
f I•IANGF ORDER SUMMARY \ ` „�/ / I
Total dlanges approved in By: i N-.�f Date: 499)271/10
previous months by Owner
$0.00 ($207,000.00) ARCI-IIT
Total approved this Month $0.00 $0.00 Da4 te: 7� ( V
By:
TOTALS $0.00 ($207,000.00) This Certificate is not negotiable.The AMOUNT CERTIFIED is payable my to the Con-
NE"I'CHANGES by Change Order ($207,000.00) tractor named herein. Issuance, payment and acceptance of payment are without
prejudice to any rights of the Owner or Contractor under this Contract.
A IA DOCUMENT 6702/CMa-APPUCAJ ION AND CERTIFICNI F FOR RoWMENT-CONSTItUCriON MANAGER-ADVISII EDITION
NA1992 EDITION-AIA'--K1992-THE AMERICAN INSTITUTE OF ARCHITECTS,I-i-NE\X YORK AVENUE.N.w.\XAS'IIINGA-ON'
DC OOO6--n2-WARNING:Unlicensed photocopying violates U.S.copyright laws and.iII subject the violator to legal prosecution. G702/CMa-1992
PO
CARMEL PERFORMING ARTS CENTER AIA DOCUMENT G703
Construction Manager: Shiel Sexton
Job# 2695 Contract 0 2695-5550 APPLICATION. NUMBER : 15-R1 .
AIA DOCUMENT G702, APPLICATION AND CERTIFICATE FOR PAYMENT, CONTAINING APPLICATION DATE: 15-Sep-2010
CONTRACTOR'S SIGNED CERTIFICATION IS.ATTACHED. PERIOD TO: 30-Sep-2010
IN TABULATIONS BELOW, AMOUNTS ARE STATED TO THE NEAREST DOLLAR. REVISED'DATE: 20-sap-2010
USE COLUMN I ON CONTRACTS WHERE VARIABLE RETAINAGE FOR LINE ITEMS MAY APPLY. ARCHITECTS PROJECT. NO:
A B C 0 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
APPLICATION PERIOD STORED STORED .TO DATE
CD+E) (not in D or E) (D+E+F) (C-G)
1. ENGINEERING 140,000.00 140,000.00 - 140,000.00 100% - 9,416.86
2. MOBILIZATION 10,000.00 10,000.00 - 10,000.00 100% - -
3. SPACE FRAME SYSTEM:
Material 269,000.00 269,000.00 - - 269,000.00 100% - 18,093..82
4. LAMINATED ACOUSTICAL GLASS:
Material 446,000.00 446,000.00 - - 446,000.00 100% - 29,999.42
5. ON-SITE INTALLATION 235,000.00 - 117,500.00 117,500.00 50% 117,500.00 -
6. OWNER ALLOWANCE 1 250,000.00 2,080.00 - 2-,O80.00 1% 247,920.00 139.90
7. OWNER ALLOWANCE 2 10,000.00 - - - 0% 10,000.00 -
8.. C/O ((1 - Allowance Reduction (207,000.00) - - - - 0% (207,000.00) -
9. C/O 02 - Work Performed in C/O 01 - - - - 0% - -
TOTAL - THIS APPLICATION 1,153,000;.00 867,080.00 117,500.00 - 984,500.00 05% 160,420.00 57,650..00
[PARTIAL LIEN WAIVER - SUBCONTRACTOR/SUPPLIER
WALTEK & Company, Ltd (Subcontractor), upon receipt and clearance of payment of One
Hundred Seventeen Thousand Five Hundred & 00/100 Dollars ($117,500.00) from Shiel
Sexton (Contractor) paid in connection with the construction of the Carmel Performing Arts
Center (the project) hereby executes this Partial Lien Waiver and waives and releases any and
all lien rights accruing for materials and services furnished through September 30, 2010 (except
for the applicable retention balance of $57,650.00 as of September 30, 2010), for which the
above payment is made. The undersigned represents that all employees, laborers, materialmen
and subcontractors employed by the undersigned in connection with the Project and all bills
currently due for labor, materials, supplies and taxes furnished in connection with the Project,
have been fully paid their respective portions of previous payments. This Partial Lien Waiver is
executed in consideration of the payment of said amount and is effective only to the extent of
such payment.
Dated this ao day of See l" , 2010.
WALTEK&Com a y d' Sworn to and subscribed before me this
By: 64/ '.-Zed, (7 5 �/>" day of -le/.7f , 2010
(Officer`S1 na ure)
ICxA't/J _• -ice Arl
(Printed Name) (Nota Public)
CQ a„nuuuu�
(Title-Officer of the Company)
0 " EUGENIE MARIE TOPPUTO
-= Notary Public,State of Ohio
=, :J , , 0 My Commission Expires 0211012013
o�
PARTIAL LIEN WAIVER -SUBCONT .ACTOR/SUPPLIER
WALTEK & Company, Ltd (Subcontractor), upon receipt and clearance of payment of Ten
Thousand & 00/100 Dollars ($10,000.00) from Shiel Sexton (Contractor) paid in connection
with the construction of the Carmel Performing Arts Center (the project) hereby executes this
Partial Lien Waiver and waives and releases any and all lien rights accruing for materials and
services furnished through August 31, 2010 (except for the applicable retention balance of
$57,650.00 as of August 31, 2010), for which the above payment is made. The undersigned
represents that all employees, laborers, materialmen and subcontractors employed by the
undersigned in connection with the Project and all bills currently due for labor, materials, supplies
and taxes furnished in connection with the Project, have been fully paid their respective portions
of previous payments. This Partial Lien Waiver is executed in consideration of the payment of
said amount and is effective only to the extent of such payment.
Dated this '0 day of St�� , 2010.
WALTEK &Com•- , td Sworn to and subscribed before me this
By: C :)°7 day of ,r-e/--/ , 2010
(Officer Signature)�1
/(/c 4,9 ,, ff_ �/% i•"r y '
(Printed Name) (Notary Public)
(Title-Officer of the Company)
``° �`�'i = EUGENIE MARIE TOPPUTO
� f
tr =' • �= Notary Public,State of Ohio
\ 4. ,o.„. My Commission Expires 02/18/2013
nnum