The URL can be used to link to this page

Home My WebLink AboutWR Dunkin, Simplex Grinnell, General Piping - $119,230.35 Disbursement Instructions 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 Due"line in the"Amount of Current Authorized Disbursement"column below;and(b)accordance with the terms and conditions of the Agreement,the other Loan Documents,and the Disbursement Instructions. Description of Work Percent Amount of Scheduled Complete or Amount of Prior Current Value or Contract Contract Amount Authorized Authorized Amount Owed Disbursement Disbursement (S r,rve ) far. )-2791 (S 11A\ G ov hel\) 9,00),bb (Wk Qur,kAnw \ \. _ / 385,OU (V( Qu,r, t"(\) Fed, 7( nL,bb (Gcheet� �'\ tr,9) �h I `327, 72 (60\e“.\\ �YVIVI) z 177,72 Grand Total mow 1/1:23:0' 5 Cl CRC has inspected the portions of the PAC Equipment completed by Borrower to confirm the Percent Complete in the applicable column above. El CRC either has received or waived receipt of conditional lien waivers and other submittals required to be made by Borrower in connection with a disbursement of Loan Proceeds from the Borrower Loan Account to(or for the account of)Borrower. All terms used in these Disbursement Instructions without definition shall have the meaning ascribed thereto in that certain Loan Agreement(Detention and Foundation),dated as of August 14,2009,by and between Lender and Carmel Garage Development Company,LLC.,as amended by that certain Amendment to Loan Agreement,dated January 28,201$,by -nd between the same parties. Dated: 3 S. ° CITY OF CARMEL REDEVELOPMENT MMISSION By Printed L .f l Title ttXaTuWar JP//t at?ow Draft PAC Piping and Pumps (General Piping) Up Through November 2009 IPC Amounts through application 14 Completed and Stored to date $ 580,261.80 Retention held(based on 5%retention) $ 29,013.09 Paid to date $ 551,248.71 Amount Reiumbursed to CRC $ 551,248.71 December 2009 IPC Amount for application 15 Completed and Stored to date $ 3,615.96 Retention held(no retention held this period) $To be paid $ 3,615.96 Paid by Carmel Garage Development Company $ 3,615.96 January 2010 IPC amount for application 16 Completed and stored to date $ 1,327.72 No retention was held $ _ Amount to be paid by Carmel Garage Development Company $ 1,327.72 February 2010 Amount to be paid by Carmel Garage Development Company $ 4,177.72 Draft Piping and Pumps (General Piping) 1/31/10 Contractor Equipment Contract Total Previously Completed Completed this Period Completed to Date Remaining Balance General Piping Sewage Ejector/Triplex Pumps-L $ 26,640.00 $ 25,308.00 $ - $ 25,308.00 $ 1,332.00 Sewage Ejector/Triplex Pumps-M $ 167,273.00 $ 167,273.00 $ - $ 167,273.00 $ - Domestic Pumps-L $ 4,440.00 $ 1,776.00 $ - $ 1,776.00 $ 2,664.00 Domestic Pumps-M $ 27,066.00 $ 27,066.00 $ - $ 27,066.00 $ - Plumbing Fixtures-L $ 54,840.00 $ 5,484.00 $ - $ 5,484.00 $ 49,356.00 Plumbing Fixtures-M $ 111,082.00 $ 111,082.00 $ - $ 111,082.00 $ - Water Heater-L $ 4,080.00 $ 408.00 $ - $ 408.00 $ 3,672.00 Water Heater-M $ 62,669.00 $ 62,669.00 $ - $ 62,669.00 $ - HVAC Pumps-L $ 6,120.00 $ 5,936.40 $ 122.40 $ 6,058.80 $ 61.20 HVAC Pumps-M $ 28,061.00 $ 28,061.00 $ - $ 28,061.00 $ - HVAC Equipment $ 120,532.00 $ 118,121.36 $ 1,205.32 $ 119,326.68 $ 1,205.32 Storm Water Control Panel $ 30,693.00 $ 30,693.00 $ - $ 30,693.00 $ - (Total $ 643,496.00 $ 583,877.76 $ 1,327.72 $ 585,205.48 $ 58,290.52I Amount Completed $ 1,327.72 IMOMMN tl Document 6702/CMan' — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: Carmel Performing Arts Center APPLICATION NO:016 Distribution to: OWNER:❑ PERIOD TO:January 31,2010 CONSTRUCTION MANAGER: ❑ FROM General Piping,Inc. VIA CONSTRUCTION Shiel Sexton CONTRACT DATE:June 11,2008 ARCHITECT:❑ CONTRACTOR: P.O.Box 34367 MANAGER: PROJECT NOS:N/A/2829/N/A CONTRACTOR:❑ Indianapolis,IN 46234 FIELD:❑ CONTRACT FOR: Bid Package No.4300 VIA ARCHITECT: CSO Architects OTHER:❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 4,136,000.00 payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS $ 180,659.00 CONTRACTOR: 3.CONTRACT SUM TO DATE(Line 1±2) $ 4,316,659.00 By: 4 Date: //24(14) 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 3,490,848.27 State of:Indian 5.RETAINAGE: County of:Hendricks a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 216,312.30 me this Z.o day of Jot. 2,0(O b. 0 %of Stored Material Notary Public:Luke Roseboom / 2 - ' : (Column F on 0703) $ 0.00 My Commission expires:July 07,2012 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 216,312.30 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 3,274,535.97 In accordance with the Contract Documents,based on on-site observations and the data comprising (Line 4 Less Line 5 Total) - this application,the Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 3,073,820.70 knowledge,information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the (Line 6 from prior Certificate) AMOUNT CER 1'thIbD. 8.CURRENT PAYMENT DUE 1$ 200,715.271 AMOUNT CERTIFIED $200,715.27 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and•', the Co inuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ _ 1,042,123.03 CONSTRUCTION AN)E;;e, By: r.. .. / Date:. /.2J.2010 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes approved in previous months by Owner By: - �� O g PP P Y $ 196,803.00$ 24,090.00 g � •4pPr - Date: ��• �. �0 10 Total approved this Month $ 7,946.00 $ 0.00 This Certificate is not negotiable. The AMOUNT CER l IFIED is payable only to the Contractor TOTALS $ 204,749.00$ 24,090.00 named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order $ 180,659.00 AIA Document G702/CMan"—1992.Copyright©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 i under the law.This document was produced by AIA software at 09:20:18 on 01/20/2010 under Order No.1000389341_1 which expires on 5/13/2010,and is not for resale. User Notes: (415567117) CONTINUATION PAGE Paget 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 001 Bond $27,350.00 $27,350.00 $0.00 $0.00 $27,350.00 100% $0.00 $2,735.00 Supervision/Project Mgmt/Gen.Conditi 003 Labor $181,855.00 $160,032.42 $1,818.54 $0.00 $161,850.96 89% $20,004.04 $10,911.30 004 Material $72,013.00 $63,371.46 $720.12 $0.00 $64,091.58 89% $7,921.42 $4,320.78 005 Submittals $21,869.00 $21,869.00 $0.00 $0.00 $21,869.00 100% $0.00 $2,077.56 006 Punclist $12,000.00 $0.00 $600.00 $0.00 $600.00 5% $11,400.00 $0.00 007 Closeout $6,000.00 $0.00 $0.00 $0.00 $0.00 0% $6,000.00 $0.00 3D CAD/Coordination 009 Labor $34,726.00 $34,726.00 $0.00 $0.00 $34,726.00 100% $0.00 $3,279.58 010 Material $64,200.00 $64,200.00 $0.00 $0.00 $64,200.00 100% $0.00 $6,099.00 011 Daily Clean-up $15,000.00 $10,500.00 $300.00 $0.00 $10,800.00 72% $4,200.00 $675.00 012 AW#8-Plumbing(4290A) $77,169.00 $0.00 $0.00 $0.00 $0.00 0% $77,169.00 $0.00 013 AW#9-Project Water/Gas(4290B) $144,653.21 $0.00 $0.00 $0.00 $0.00 0% $144,653.21 $317.94 014 AW#10-Hydronic(4300A) $22,576.00 $0.00 $0.00 $0.00 $0.00 0% $22,576.00 $0.00 I TOTALS I $679,411.21 I $382,048.88 I $3,438.66 I $0.00 I $385,487.54 I 57%I $293,923.67 I $30,416.16 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 3 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 015 AW#16-CAD(BP 4290) $10,000.00 $0.00 $0.00 $0.00 $0.00 0% $10,000.00 $0.00 016 Allowance#16-CAD(BP 4300) $10,000.00 $0.00 $0.00 $0.00 $0.00 0% $10,000.00 $0.00 Mechanical ID 018 Labor $5,100.00 $765.00 $1,785.00 $0.00 $2,550.00 50% $2,550.00 $0.00 019 Material $5,100.00 $3,315.00 $0.00 $0.00 $3,315.00 65% $1,785.00 $0.00 Firestopping 021 Labor $5,350.00 $3,317.00 $160.50 $0.00 $3,477.50 65% $1,872.50 $160.50 022 Material $5,939.00 $3,682.20 $178.18 $0.00 $3,860.38 65% $2,078.62 $178.18 Housekeeping Pads 024 Labor $1,411.00 $1,411.00 $0.00 $0.00 $1,411.00 100% $0.00 $141.10 025 Material $2,676.00 $2,676.00 $0.00 $0.00 $2,676.00 100% $0.00 $267.61 026 Painting $3,000.00 $2,850.00 $90.00 $0.00 $2,940.00 98% $60.00 $135.00 Sleeves/Core Drill Holes 028 Labor $19,200.00 $18,240.00 $192.00 $0.00 $18,432.00 96% $768.00 $1,536.00 I TOTALS I $747,187.21 I $418,305.08I $5,844.341 $0.00 I $424,149.42 I 57%1 $323,037.791 $32,834.55 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page4 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 029 Material $31,800.00 $30,210.00 $318.00 $0.00 $30,528.00 96% $1,272.00 $2,544.00 Grease Interceptor 031 Labor $3,360.00 $0.00 $0.00 $0.00 $0.00 0% $3,360.00 $0.00 032 Material $16,830.00 $0.00 $16,830.00 $0.00 $16,830.00 100% $0.00 $0.00 033 Cranes and Lifts $24,000.00 $19,200.00 $480.00 $0.00 $19,680.00 82% $4,320.00 $1,440.00 Underground Waste and Vents 035 Labor $28,186.00 $28,186.00 $0.00 $0.00 $28,186.00 100% $0.00 $2,818.60 036 Material $35,120.00 $35,120.00 $0.00 $0.00 $35,120.00 100% $0.00 $3,512.00 Underground Storm 038 Labor $6,303.00 $6,303.00 $0.00 $0.00 $6,303.00 100% $0.00 $630.30 039 Material $10,637.00 $10,637.00 $0.00 $0.00 $10,637.00 100% $0.00 $1,063.70 Underslab Drainage 041 Labor $9,500.00 $9,500.00 $0.00 $0.00 $9,500.00 100% $0.00 • $950.00 042 Material $1,714.00 $1,714.00 $0.00 $0.00 $1,714.00 100% $0.00 $171.40 TOTALS I $914,637.21 I $559,175.08 I $23,472.34 I $0.00 I $582,647.42 I 64%I $331,989.79 I $45,964.55 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 5 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 043 Aboveground Waste and Vents(Bulk M $165,426.00 $163,771.74 $0.00 $0.00 $163,771.74 99% $1,654.26 $14,888.34 Aboveground Waste and Vents(Labor) 045 Basement $33,050.00 $28,092.50 $2,313.50 $0.00 $30,406.00 92% $2,644.00 $2,247.40 046 Plenum $17,879.00 $17,879.00 $0.00 $0.00 $17,879.00 100% $0.00 $446.98 047 Orchestra $22,368.00 $17,447.04 $1,565.76 $0.00 $19,012.80 85% $3,355.20 $559.21 048 Box Tier $18,144.00 $9,072.00 $907.20 $0.00 $9,979.20 55% $8,164.80 $453.60 049 Balcony $18,409.00 $1,840.92 $920.46 $0.00 $2,761.38 15% $15,647.62 $92.05 050 Attic $7,121.00 $1,780.28 $1,780.26 $0.00 $3,560.54 50% $3,560.46 $35.61 051 Aboveground Storm(Bulk Material) $67,165.00 $66,493.36 $0.00 $0.00 $66,493.36 99% $671.64 $6,044.86 Aboveground Storm(Labor) 053 Basement $6,120.00 $6,120.00 $0.00 $0.00 $6,120.00 100% $0.00 $459.00 054 Plenum $365.00 $365.00 $0.00 $0.00 $365.00 100% $0.00 $0.00 055 Orchestra $7,856.00 $6,677.61 $785.60 $0.00 $7,463.21 95% $392.79 $314.24 056 Box Tier $3,665.00 $3,298.52 $183.26 $0.00 $3,481.78 95% $183.22 $18.33 I TOTALS I $1,282,205.21 I $882,013.05 I $31,928.38 I $0.00 I $913,941.43 I 71%I $368,263.78 I $71,524.17 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 6 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 057 Balcony $15,976.00 $14,378.40 $798.80 $0.00 $15,177.20 95% $798.80 $127.81 058 Attic $9,667.00 $5,800.20 $2,416.76 $0.00 $8,216.96 85% $1,450.04 $77.34 Force Main 060 Labor $7,546.00 $6,036.80 $0.00 $0.00 $6,036.80 80% $1,509.20 $528.22 061 Material $27,882.00 $27,045.54 $0.00 $0.00 $27,045.54 97% $836.46 $2,369.98 Sewage Ejector/Triplex Pumps 063 Labor $26,640.00 $25,308.00 $0.00 $0.00 $25,308.00 95% $1,332.00 $2,530.81 064 Material $167,273.00 $167,273.00 $0.00 $0.00 $167,273.00 100% $0.00 $16,727.30 Domestic Pumps 066 Labor $4,440.00 $1,776.00 $0.00 $0.00 $1,776.00 40% $2,664.00 $0.00 067 Material $27,066.00 $27,066.00 $0.00 $0.00 $27,066.00 100% $0.00 $2,706.60 068 Domestic Water Above Slab(Bulk Mate $184,831.00 $182,982.70 $0.00 $0.00 $182,982.70 99% $1,848.30 $15,710.64 Domestic Water Above Slab(Labor) 070 Basement $85,091.00 $55,309.18 $22,974.58 $0.00 $78,283.76 92% $6,807.24 $2,046.17 TOTALS I $1,838,617.21 I $1,394,988.871 $58,118.521 $0.00 I $1,453,107.39 I 79%1 $385,509.82 I $114,349.04 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 7 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 071 Plenum $19,393.00 $14,544.78 $4,266.46 $0.00 $18,811.24 97% $581.76 $232.72 072 Orchestra $26,728.00 $21,382.40 $1,336.40 $0.00 $22,718.80 85% $4,009.20 $320.74 073 Box Tier $18,955.00 $6,255.16 $3,222.36 $0.00 $9,477.52 50% $9,477.48 $227.46 074 Balcony $17,692.00 $1,769.20 $884.60 $0.00 $2,653.80 15% $15,038.20 $123.84 075 Attic $823.00 $82.32 $41.16 $0.00 $123.48 15% $699.52 $5.76 Incoming Dom.Water Service and Uncle 077 Labor $6,864.00 $2,745.60 $686.40 $0.00 $3,432.00 50% $3,432.00 $274.56 078 Material $7,163.00 $7,163.00 $0.00 $0.00 $7,163.00 100% $0.00 $716.30 079 Drains and Cleanouts(Bulk Material) $25,175.00 $25,175.00 $0.00 $0.00 $25,175.00 100% $0.00 $2,517.50 Drains and Cleanouts(Labor) 081 Basement $21,076.00 $21,076.00 $0.00 $0.00 $21,076.00 100% $0.00 $2,107.60 082 Plenum $1,920.00 $1,920.00 $0.00 $0.00 $1,920.00 100% $0.00 $153.60 083 Orchestra $1,320.00 $1,320.00 $0.00 $0.00 $1,320.00 100% $0.00 $118.80 084 Box Tier $3,120.00 $3,120.00 $0.00 $0.00 $3,120.00 100% $0.00 $249.60 TOTALS I $1,988,846.21 I $1,501,542.331 $68,555.90 I $0.00 I $1,570,098.23 I 79%I $418,747.98 I $121,397.52 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 8 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 085 Balcony $2,400.00 $2,400.00 $0.00 $0.00 $2,400.00 100% $0.00 $120.00 086 Attic $3,720.00 $3,720.00 $0.00 $0.00 $3,720.00 100% $0.00 $186.00 II 087 Carriers(Bulk Material) $12,347.00 $12,347.00 $0.00 $0.00 $12,347.00 100% $0.00 $1,222.35 Carriers(Labor) 089 Basement $1,200.00 $1,140.00 $60.00 $0.00 $1,200.00 100% $0.00 $102.00 090 Plenum $6,750.00 $6,412.50 $337.50 $0.00 $6,750.00 100% $0.00 $573.76 091 Orchestra $2,100.00 $1,995.00 $0.00 $0.00 $1,995.00 95% $105.00 $178.50 092 Box Tier $4,500.00 $4,050.00 $0.00 $0.00 $4,050.00 90% $450.00 $382.50 093 Balcony $3,000.00 $2,700.00 $0.00 $0.00 $2,700.00 90% $300.00 $225.00 094 Attic $300.00 $270.00 $0.00 $0.00 $270.00 90% $30.00 $22.50 Gas Pressure Regulator 096 Labor $480.00 $0.00 $0.00 $0.00 $0.00 0% $480.00 $0.00 097 Material $277.00 $0.00 $0.00 $0.00 $0.00 0% $277.00 $0.00 Gas Piping I TOTALS I $2,025,920.21 I $1,536,576.83 I $68,953.40 I $0.00 I $1,605,530.23 I 79%1 $420,389.98 I $124,410.13 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 9 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.: 16 containing Contractor's signed Certification is attached Carmel Performing Arts NPPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 099 Labor $2,858.00 $0.00 $0.00 $0.00 $0.00 0% $2,858.00 $0.00 100 Material $1,220.00 $1,098.00 $0.00 $0.00 $1,098.00 90% $122.00 $109.80 101 Kitchen Connections $6,000.00 $0.00 $0.00 $0.00 $0.00 0% $6,000.00 $0.00 Plumbing Fixtures 103 Labor $54,840.00 $5,484.00 $0.00 $0.00 $5,484.00 10% $49,356.00 $274.20 104 Material $111,082.00 $111,082.00 $0.00 $0.00 $111,082.00 100% $0.00 $11,108.20 Water Heater 106 Labor $4,080.00 $408.00 $0.00 $0.00 $408.00 10% $3,672.00 $20.40 107 Material $62,669.00 $62,669.00 . $0.00 $0.00 $62,669.00 100% $0.00 $6,266.90 Water Softener 109 Labor $2,400.00 $0.00 $240.00 $0.00 $240.00 10% $2,160.00 $0.00 110 Material $1,453.00 $0.00 $1,453.00 $0.00 $1,453.00 100% $0.00 $0.00 Thermostatic Mixing Valves 112 Labor $840.00 $0.00 $0.00 $0.00 $0.00 0% $840.00 $0.00 TOTALS I $2,273,362.21 I $1,717,317.831 $70,646.40 1 $0.00 I $1,787,964.23 I 79%1 $485,397.98 I $142,189.63 1 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 10 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.: 16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 113 Material $1,159.00 $1,159.00 $0.00 $0.00 $1,159.00 100% $0.00 $115.90 Backflow Preventers 115 Labor $1,920.00 $0.00 $0.00 $0.00 $0.00 0% $1,920.00 $0.00 116 Material $4,337.00 $4,337.00 $0.00 $0.00 $4,337.00 100% $0.00 $433.70 117 Vibration Isolation $29,532.00 $28,055.41 $295.31 $0.00 $28,350.72 96% $1,181.28 $1,033.63 118 Condensate Piping(Bulk Material) $1,608.00 $1,447.20 $112.56 $0.00 $1,559.76 97% $48.24 $112.56 Condensate Piping(Labor) 120 Basement $8,592.00 $2,577.60 $859.20 $0.00 $3,436.80 40% $5,155.20 $0.00 121 Orchestra $928.00 $0.00 $46.40 $0.00 $46.40 5% $881.60 $0.00 122 Box Tier $353.00 $0.00 $17.66 $0.00 $17.66 5% $335.34 $0.00 123 Hydronic Piping(Bulk Material) $197,044.00 $191,132.68 $3,940.88 $0.00 $195,073.56 99% $1,970.44 $15,763.52 Hydronic Piping(Labor) 125 Basement $90,564.00 $79,696.33 $6,339.48 $0.00 $86,035.81 95% $4,528.19 $1,358.46 126 Plenum $14,180.00 $9,217.00 $4,963.00 $0.00 $14,180.00 100% $0.00 $0.00 TOTALS I $2,623,579.21 I $2,034,940.05 I $87,220.89 I $0.00 I $2,122,160.94 1 81%I $501,418.27 I $161,007.40 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 11 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 127 Orchestra $26,716.00 $9,350.60 $8,014.80 $0.00 $17,365.40 65% $9,350.60 $0.00 128 Box Tier $25,375.00 $13,956.28 $3,806.26 $0.00 $17,762.54 70% $7,612.46 $0.00 129 Balcony $43,190.00 $23,754.50 $6,478.50 $0.00 $30,233.00 70% $12,957.00 $0.00 130 Attic $13,309.00 $665.46 $3,992.70 $0.00 $4,658.16 35% $8,650.84 $0.00 Anchors and Guides 132 Labor $2,880.00 $2,448.00 $144.00 $0.00 $2,592.00 90% $288.00 $172.80 133 Material $1,834.00 $1,834.00 $0.00 $0.00 $1,834.00 100% $0.00 $183.40 134 Miscellaneous Supports $79,294.00 $72,950.48 $1,585.88 $0.00 $74,536.36 94% $4,757.64 $4,757.65 135 Hydronic Specialties $77,660.00 $73,777.00 $1,553.20 $0.00 $75,330.20 97% $2,329.80 $0.00 HVAC Pumps 137 Labor $6,120.00 $5,936.40 $122.40 $0.00 $6,058.80 99% $61.20 $0.00 138 Material $28,061.00 $28,061.00 $0.00 $0.00 $28,061.00 100% $0.00 $2,806.10 Water Treatment 140 Labor $600.00 $510.00 $30.00 $0.00 $540.00 90% $60.00 $0.00 I TOTALS I $2,928,618.21 I $2,268,183.771 $112,948.63 I $0.001 $2,381,132.40 I 81%I $547,485.81 I $168,927.35 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 12 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:0l/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 141 Material $3,132.00 $3,132.00 $0.00 $0.00 $3,132.00 100% $0.00 $0.00 142 HVAC Equipment $120,532,00 $118,121.36 $1,205.32 $0.00 $119,326.68 99% $1,205.32 $9,039.90 143 Rigging and Offloading HVAC Equipm $3,840.00 $2,880.00 $384.00 $0.00 $3,264.00 85% $576.00 $0.00 144 AHU Connections $55,320.00 $47,022.00 $3,872.40 $0.00 $50,894.40 92% $4,425.60 $0.00 145 Duct Heating Coil Connections $1,260.00 $0.00 $189.00 $0.00 $189.00 15% $1,071.00 $0.00 146 VAV Box Connections-Basement $8,285.00 $248.56 $3,893.96 $0.00 $4,142.52 50% $4,142.48 $0.00 147 VAV Box Connections-Plenum $1,763.00 $52.90 $1,533.82 $0.00 $1,586.72 90% $176.28 $0.00 148 VAV Box Connections-Orchestra $1,586.00 $47.58 $190.32 $0.00 $237.90 15% $1,348.10 $0.00 149 VAV Box Connections-Box Tier $4,231.00 $126.94 $507.72 $0.00 $634.66 15% $3,596.34 $0.00 150 VAV Box Connections-Balcony $3,173.00 $95.20 $0.00 $0.00 $95.20 3% $3,077.80 $0.00 151 VAV Box Connections-Attic $2,820.00 $84.60 $0.00 $0.00 $84.60 3% $2,735.40 $0.00 152 Unit Heater Connections-Basement $428.00 $0.00 $0.00 $0.00 $0.00 0% $428.00 $0.00 154 Unit Heater Connections-Orchestra $215.00 $0.00 $0.00 $0.00 $0.00 0% $215.00 $0.00 155 Unit Heater Connections-Box Tier $107.00 $0.00 - $0.00 $0.00 $0.00 0% $107.00 $0.00 I TOTALS I $3,135,310.21 I $2,439,994.91 I $124,725.17 I $0.00 I $2,564,720.08 I 82%I $570,590.13 I $177,967.25 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 13 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 156 Fan Coil Connections-Basement $2,057.00 $102.86 $1,028.50 $0.00 $1,131.36 55% $925.64 $0.00 157 Fan Coil Connections-Orchestra $1,028.00 $51.40 $205.60 $0.00 $257.00 25% $771.00 $0.00 158 Fan Coil Connections-Box Tier $515.00 $25.76 $51.50 $0.00 $77.26 15% $437.74 $0.00 Radiant Floor Systems 160 Labor $20,483.00 $20,483.00 $0.00 $0.00 $20,483.00 100% $0.00 $1,904.92 161 Material $11,816.00 $11,816.00 $0.00 $0.00 $11,816.00 100% $0.00 $1,181.60 162 Humidifier Connections $15,360.00 $2,304.00 $0.00 $0.00 $2,304.00 15% $13,056.00 $0.00 163 Fin Tube Connections-Basement $664.00 $66.41 $332.00 $0.00 $398.41 60% $265.59 $0.00 164 Fin Tube Connections-Plenum $2,656.00 $796.80 $531.21 $0.00 $1,328.01 50% $1,327.99 $0.00 165 Fin Tube Connections-Orchestra $14,605.00 $4,381.50 $2,921.00 $0.00 $7,302.50 50% $7,302.50 $0.00 166 Fin Tube Connections-Box Tier $6,307.00 $1,892.10 $1,261.41 $0.00 $3,153.51 50% $3,153.49 $0.00 167 Fin Tube Connections-Balcony $9,958.00 $2,987.40 $1,991.60 $0.00 $4,979.00 50% $4,979.00 $0.00 168 Fin Tube Connections-Attic $1,992.00 $0.00 $298.80 $0.00 $298.80 15% $1,693.20 $0.00 Insulation-Basement I I TOTALS I $3,222,751.21 I $2,484,902.14 I $133,346.79 I $0.00 I $2,618,248.93 -I 81%I $604,502.28 I $181,053.77 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 14 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:OI/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 170 Labor $31,937.00 $23,952.76 $1,277.48 $0.00 $25,230.24 79% $6,706.76 $638.74 171 Material $27,208.00 $27,208.00 $0.00 $0.00 $27,208.00 100% $0.00 $2,176.64 Insulation-Plenum 173 Labor $18,103.00 $10,137.68 $6,155.02 $0.00 $16,292.70 90% $1,810.30 $0.00 174 Material $15,423.00 $15,423.00 $0.00 $0.00 $15,423.00 100% $0.00 $0.00 Insulation-Orchestra 176 Labor $14,914.00 $7,904.43 $4,325.07 $0.00 $12,229.50 82% $2,684.50 $0.00 177 Material $12,706.00 $12,706.00 $0.00 $0.00 $12,706.00 100% $0.00 $0.00 Insulation-Box Tier 179 Labor $13,835.00 $0.00 $0.00 $0.00 $0.00 0% $13,835.00 $0.00 180 Material $11,786.00 $0.00 $2,357.21 $0.00 $2,357.21 20% $9,428.79 $0.00 Insulation-Balcony 182 Labor $13,835.00 $0.00 $0.00 $0.00 $0.00 0% $13,835.00 $0.00 183 Material $11,786.00 $0.00 $2,357.21 $0.00 $2,357.21 20% $9,428.79 $0.00 I TOTALS I $3,394,284.21 I $2,582,234.01 I $149,818.781 $0.00 I $2,732,052.79 I 80%1 $662,231.42 I $183,869.15 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT IF CONTINUATION PAGE Page 15 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Carmel Performing Arts \PPLICATION DATE:01/1 1/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) Insulation-Attic 185 Labor $13,835.00 $0.00 $0.00 $0.00 $0.00 0% $13,835.00 $0.00 186 Material $11,786.00 $0.00 $2,357.21 $0.00 $2,357.21 20% $9,428.79 $0.00 187 Temperature Controls-Engineering $64,446.00 $64,446.00 $0.00 $0.00 $64,446.00 100% $0.00 $6,444.60 Temperature Controls-Basement 189 Labor $83,003.00 $62,252.27 $2,490.10 $0.00 $64,742.37 78% $18,260.63 $0.00 190 Material $151,376.00 $151,376.00 $0.00 $0.00 $151,376.00 100% $0.00 $12,110.09 Temperature Controls-Plenum 192 Labor $51,877.00 $19,713.28 $6,225.24 $0.00 $25,938.52 50% $25,938.48 $0.00 193 Material $78,178.00 $78,178.00 $0.00 $0.00 $78,178.00 100% $0.00 $5,472.46 Temperature Controls-Orchestra 195 Labor $15,563.00 $4,357.66 $2,645.72 $0.00 $7,003.38 45% $8,559.62 $0.00 196 Material $25,508.00 $25,508.00 $0.00 $0.00 $25,508.00 100% $0.00 $0.00 Temperature Controls-Box Tier I TOTALS I $3,889,856.21 I $2,988,065.221 $163,537.05 I $0.00 I $3,151,602.27 I 81%1 $738,253.94 I $207,896.30 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 16 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F _ G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 198 Labor $15,563.00 $4,202.02 $0.00 $0.00 $4,202.02 27% $11,360.98 $0.00 199 Material $25,508.00 $25,508.00 $0.00 $0.00 $25,508.00 100% $0.00 $0.00 Temperature Controls-Balcony 201 Labor $15,563.00 $2,801.34 $2,645.72 $0.00 $5,447.06 35% $10,115.94 $0.00 202 Material $22,701.00 $22,701.00 $0.00 $0.00 $22,701.00 100% $0.00 $0.00 Temperature Controls-Attic 204 Labor $15,563.00 $3,112.60 $0.00 $0.00 $3,112.60 20% $12,450.40 $0.00 205 Material $16,170.00 $16,170.00 $0.00 $0.00 $16,170.00 100% $0.00 $0.00 206 Test and Balance $19,474.00 $0.00 $0.00 $0.00 $0.00 0% $19,474.00 $0.00 207 CO#1 -GPI#2-LEACH&RUSSEL ($24,090.00) ($24,090.00) $0.00 $0.00 ($24,090.00) 100% $0.00 ($2,409.00) 208 CO#2-GPI#3-ASI#18 $1,776.00 $1,776.00 $0.00 $0.00 $1,776.00 100% $0.00 $177.60 209 GPI#6-Triplex Sump Basin $61,694.00 $61,694.00 $0.00 $0.00 $61,694.00 100% $0.00 $3,084.70 210 GPI#7A-Basement Kitchen Rev. $17,328.00 $14,382.24 $693.12 $0.00 $15,075.36 87% $2,252.64 $356.26 211 GPI#10-Box Tier Catering Kitch. $85,312.00 $59,718.42 $14,503.04 $0.00 $74,221.46 87% $11,090.54 $1,706.25 I TOTALS I $4,162,418.21 I $3,176,040.841 $181,378.931 $0.00 I $3,357,419.77 I 81%I $804,998.441 $210,812.11 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 17 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.:16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 212 GPI#23B-Stnn Water Control Panel $30,693.00 $30,693.00 $0.00 $0.00 $30,693.00 100% $0.00 $3,069.30 213 AW 4300A-F#15-Oculus Cntrls $7,277.00 $7,277.00 $0.00 $0.00 $7,277.00 100% $0.00 $72.78 214 AW 4300A-F#18-OA Damper $8,605.00 $8,605.00 $0.00 $0.00 $8,605.00 100% $0.00 $86.06 215 AW 4290A-F#5-W.Mech.Drain $1,392.00 $1,392.00 $0.00 $0.00 $1,392.00 100% $0.00 $139.21 216 AW 4290A-F#8-N.Wall Storm $1,372.00 $1,372.00 $0.00 $0.00 $1,372.00 100% $0.00 $137.21 217 AW 4290A-F#9-E.Mech FD $1,845.00 $1,845.00 $0.00 $0.00 $1,845.00 100% $0.00 $184.50 218 AW 4290B-F#19-Fiberoptic Line $8,044.00 $8,044.00 $0.00 $0.00 $8,044.00 100% $0.00 $80.44 219 AW 4290A-F#23A-Stone $5,361.00 $5,361.00 $0.00 $0.00 $5,361.00 100% $0.00 $536.10 220 AW 4290B-Water/Sewer Bills $7,302.79 $6,020.96 $1,281.84 $0.00 $7,302.80 100% ($0.01) $317.94 221 AW 4300A-005-F#27 $21,740.00 $9,783.00 $0.00 $0.00 $9,783.00 45% $11,957.00 $0.00 222 AW 4300A-003-F#24 $5,023.00 $5,023.00 $0.00 $0.00 $5,023.00 100% $0.00 $0.00 223 AW 4290A-005-F#28 $6,928.00 $1,039.20 $0.00 $0.00 $1,039.20 15% $5,888.80 $0.00 224 AW 4300A-006-F#25 $10,104.00 $10,104.00 $0.00 $0.00 $10,104.00 100% $0.00 $0.00 225 GPI#22-CROSSOVER BRIDGE $17,533.00 $17,533.00 $0.00 $0.00 $17,533.00 100% $0.00 $876.65 I TOTALS I $4,295,638.001 $3,290,133.001 $182,660.771 $0.00 I $3,472,793.77 I 81%I $822,844.23 1 $216,312.30 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT CONTINUATION PAGE Page 18 18 APPLICATION FOR PAYMENT PROJECT:002829 APPLICATION NO.: 16 containing Contractor's signed Certification is attached Cannel Performing Arts APPLICATION DATE:01/11/2010 PERIOD TO:01/31/2010 Use Column I when variable retainage for line items may apply. PROJECT#s: A B C D E F G H I COMPLETED WORK ITEM SCHEDULED FROM STORED TOTAL BALANCE # WORK DESCRIPTION VALUE PREVIOUS THIS PERIOD MATERIALS COMPLETED AND % TO RETAINAGE APPLICATION (NOT IN D OR E) STORED (G/C) COMPLETION (IF VARIABLE (D+E) (D+E+F) (C-G) RATE) 226 I AW 4300A-011 -F#45 $579.00 $0.00 $579.00 $0.00 $579.00 100% $0.00 $0.00 227 I AW 4300A-010-F#43 I $6,563.00 I $0.00 $6,563.00 I $0.00 I $6,563.00 100%I $0.00 I $0.00 228 AW 4290A-008-F#41 I $5,933.00 I $0.00 $2,966.50 I $0.00 I $2,966.50 50%I $2,966.50 I $0.00 229 I CO#8-GPI#30-Lift Station Slab I $7,946.00 I $0.00 $7,946.00 I $0.00 I $7,946.00 100%I $0.00 I $0.00 I I TOTALS I $4,316,659.00 I $3,290,133.00 I $200,715.271 $0.00 I $3,490,848.27 81%I $825,810.731 $216,312.30 CONTINUATION PAGE FOR APPLICATION FOR PAYMENT fi0l.11- j� �� x�;: ® 1 992 ��: .4 Document 70210 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:017 Distribution to: OWNER:❑ PERIOD TO:February 28,2010 CONSTRUCTION MANAGER:❑ FROM General Piping.Inc. VIA CONSTRUCTION Shiel Sexton CONTRACT DATE:June 11,2008 ARCHITECT:❑ CONTRACTOR: P.O.Box 34367 MANAGER: PROJECT NOS:NA/2829/NA CONTRACTOR:❑ Indianapolis,IN 46234 FIELD:❑ CONTRACT FOR: General Construction VIA ARCHITECT: CSO Architects OTHER:❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge.information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,ALA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 643,496.00 payment shown herein is now due. 2.NET CHANGE BY CHANGE ORDERS $ _ 0.00 CONTRACTOR' 3.CONTRACT SUM TO DATE(Line 1±2) $ 643.496.00 By: �� Date: February i 7.2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) $ _589,383.20 State of:Indian 5.RETAINAGE: County of:Hendricks a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 54,549.71 me this 11 day of Fe fl,. 1.0(0 b. 0 %of Stored Material Notary Public:Luke Roseboom (Column F on G703) $ 0.00 My Commission expires:July 07,2012 Lt/tL_ ,-4/ —t—____ Total Retainage(Lines 5a+56 or Total in Column I of 0703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 534,833.49 In accordance with the Contract Documents,based on on-site observations and the data comprising (Line 4 Less Line 5 Total)• this application,the.Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 530,65537 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the (Line 6 from prior Certificate) AMOUNT CER't tr1ED. 8.CURRENT PAYMENT DUE a$ 4,177.72 AMOUNT CERTIFIED $4,177.72 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the ntinuation Sheet that are changed to conform wills the amount certified.) (Line 3 less Line 6) $ 108,662.51 CONSTRUCT r .G-ii: `L By: Ca 4 Date: 3. .zo t o • CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC : ,1 Total changes approved in previous months by Owner$ 0.00$ 0.00 By: 1 / / Date: B.10 Total approved this Month $ 0.00$ 0.00 This Certi ca Plts not negotiable. The AMOUNT CER'1111ED is payable only to the Contractor TOTALS $ 0.00$ 0.00 named herein.Issuance,payment and acceptance of payment are without prejudice to any rights of . the Owner or Contractor under this Contract. NET CHANGES by Change Order $ 0.00 • AlA Document G702VCMaTo—1992.Copyright 01992 by The American Institute of Architects.All rights reserved.WARNING:This.AIA°Document ls,Protected by US:Copyright Leland International Trestles.Unauthort'zed reproducllon or'dlstribuuon of thls'Ate Docuieeni,at'any portion of R.may.re-snit In.severe civil and criminai'penaltles,and will be prosecuted'la the maximum extent possible 1 under the law:This document was produced by AIA software at 13:26:13 on 03/012010 under Order No.1000389341_1 which expires on 5/132010,and is not for resale. User holes: (357872445) a® L: y. Document G703 - 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 17 containing Contractor's signed certification is attached. In tabulations below,amounts are stated to the nearest dollar. APPLICATION DATE:02/17/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:02/28/2010 ARCHITECTS PROJECT NO:NA A B C D I E F G H I WORK COMPLETED TOTAL MATERIALS ITEM SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE DESCRIPTION OF WORK PREVIOUS AND STORED FINISH (IF VARIABLE NO VALUE APPLICATION THIS PERIOD STORED(NOT TO DATE (G_C) (C-G) RATE) (D+E) IN D ORE) (D+E+F) 62 Sewage Ejector/Triplex Pumps 0.00 0.00 0.00 0.00 0.00 0.00 % 0.00 0.00 63 Labor 26,640.00 25,308.00 0.00 0.00 25,308.00 95.00 % 1,332.00 2,530.81 64 Material 167,273.00 167,273.00 0.00 0.00 167,273.00 100.00 % 0.00 16,727.30 65 Domestic Pumps 0.00 0.00 0.00 0.00 0.00 0.00 % 0.00 0.00 66 Labor 4,440.00 1,776.00 2,220.00 0.00 3,996.00 90.00 % 444.00 0.00 67 Material 27,066.00 27,066.00 0.00 0.00 27,066.00 100.00 % 0.00 2,706.60 102 Plumbing Fixtures 0.00 0.00 0.00 0.00 0.00 0.00 % 0.00 0.00 103 Labor 54,840.00 5,484.00 548.40 0.00 6,032.40 11.00 % 48,807.60 274.20 104 Material 111,082.00 111,082.00 0.00 0.00 111,082.00 100.00 % 0.00 11,108.20 105 Water Heater 0.00 0.00 0.00 0.00 0.00 0.00 % 0.00 0.00 106 Labor 4,080.00 408.00 204.00 0.00 612.00 15.00 % 3,468.00 20.40 107 Material 62,669.00 62,669.00 0.00 0.00 62,669.00 100.00 % 0.00 6,266.90 136 HVAC Pumps 0.00 0.00 0.00 0.00 0.00 0.00 % 0.00 0.00 137 Labor 6,120.00 6,058.80 0.00 0.00 6,058.80 99.00 % 61.20 0.00 138 Material 28,061.00 28,061.00 0.00 0.00 28,061.00 100.00 % 0.00 2,806.10 142 HVAC Equipment 120,532.00 119,326.68 1,205.32 0.00 120,532.00 100.00 % 0.00 9,039.90 GPI#23B-Storm Water 212 Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00 % 0.00 3,069.30 GRAND TOTAL $ 643,496.00 $ 585,205.48 $ 4,177.72 $ 0.00 $ 589,383.20 91.59 96 $ 54,112.80 $ 54,549.71 AIA Document G7031l-1992.Copyright ID 1963,1965,1966,1967,1970,1978.1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:'.This AIA°Document Is protected by U.S.;Copyright Law-and International Treaties.'Unauthorized reproduction-or distribution of this AIA°Document,or any portion Wit,may,rosuliin severe civil and criminal penalties,and will be 1 prosecuted to the maximum extent possible under,the,law.This document was produced by AIA software at 12:58:05 on 03/01/2010 under Order No.1000389341_1 which expires on 5113/2010,and Is not for resale. User Notes: (774779863) Draft PAC Fire Protection (Simplex Grinnell) Up Through November 2009 Total Contract Amounts through application 13 Completed and Stored to date $ 421,362.00 Retention held $ 30,998.00 Paid to date $ 390,364.00 Amount Reiumbursed to CRC $ 390,364.00 December 2009 Total Contract Amount for application 14 Completed and Stored to date $ 76,965.00 Retention held $ - To be paid $ 76,965.00 Paid by Carmel Garage Development Company $ 76,965.00 January 2010 Amount to be paid by Carmel Garage Development Company $ 1,779.91 February 2010 Amount to be paid by Carmel Garage Development Company $ 9,060.00 re . lx,si: IA Document G702/CMaTM — 1992 Application and Certificate for Payment Construction.Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 15 Distribution to: Carmel Redevelopment Comm. Parcel 7A Regional One Civic Square Performing Arts Center PERIOD TO:..,1-31-2010 OWNER ❑ Carmel, IN 46032 CONSTRUCTION MANAGER )l FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 6-20-2009 ARCHITECT ❑ SimplexGrinnell LP Shiel Sexton Co. PROJECT NOS: 2695 / 4280 I CONTRACTOR ❑ 11820 Pendleton Pike VIA ARCHITECT: FIELD ❑ Indianapolis, IN 46236 CSO Architects CONTRACT FOR: Auto Fire Protection ❑ 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 i .ued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 615 , 359. 00 Payment shown herein is no d / / . 2. Net change by Change Orders $ 4, 601 . 00 CONTRACTOR: 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 619 , 960 . 00 By: `i - Date: 1-19-2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 500, 106 . 91 State of: Michael M MacDona l - - - - - - - - - - - - - Indiana ii PAULA K.LEWIS 5.RETAINAGE: County or.Marion a. 5 %of � 4OCContraet Value Subscribed and sworn to before Notary Public-Seal State of Indiana (Column 0+Eon G703) $ 30 , 998 . 00 me this 19t Y of a u r 2010 My Commission Expires Aug �2,2017 b. To of Stored Material Notary Public: -P�lA.lb.6 APRIPalilmirettralgregirmIPRSPRIPNVIRPRipol (Column F on G703) $ My CommissitSn ex it 0 . 00 P 8-1 - 017 Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 330 , 998 . 00 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 469 , 108 . 91 this application,the Construction Manager and Architect certify to the Owner that to the best 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 $ 467 , 329 . 00 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 $ 1 , 7 7 9 . 91 AMOUNT CERTIFIED $ / 779, 9/ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application an, on the C. tinuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 150 , 851 . 09 CONSTRUC •JI MA,y G • By: / • ,.. `■ Date: (• Z8.2.C 1 O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE �� , a. - .Total changes approved in previous months by Owner $4 601 $ By: `:r Date: CV. t 0 Lf. aol o Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $4 , 601 $ named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 4 601 . 00 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 AIA5 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. SimplexGrinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 15 containing Contractor's signed Certification,is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 01/15/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 2695-4280 A B C D E F G_ H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO VALUE APPLICATION THIS STORED AND STORED % TO (IF VARIABLE) (D+E) PERIOD (NOT IN TO DATE (G+C) FINISH RATE D ORE) (D+E+F) (C-G) 10000 ADMINISTRATION 10010 Bonds&Insurance $4,380.00 $4,380.00 $0.00 $0.00 $4,380.00 100% $0.00 $0.00 10020 Permits& Fees $500.00 $500.00 $0.00 $0.00 $500.00 100% $0.00 $0.00 10030 Submittals $20,307.00 $20,307.00 $0.00 $0.00 $20,307.00 100% $0.00 $0.00 10040 Drarwing&Drafting Srvices $33,638.00 $33,638.00 $0.00 $0.00 $33,638.00 100% $0.00 $0.00 10050 As Built Drawing Conversion to CAD $5,000.00 $0.00 $0.00 $0.00 $0.00 0% $5,000.00 $0.00 10060 Mobilization $17,910.00 $17,910.00 $0.00 $0.00 $17,910.00 100% $0.00 $0.00 20000 MATERIAL 20010 Underground $2,229.00 $2,229.00 $0.00 $0.00 $2,229.00 100% $0.00 $0.00 20020 Fire Pump $35,920.00 $35,920.00 $0.00 $0.00 $35,920.00 100% $0.00 $0.00 20030 Standpipe $13,218.00 $13,218.00 $0.00 $0.00 $13,218.00 100% $0.00 $0.00 20040 Basement $32,772.00 $32,772.00 $0.00 $0.00 $32,772.00 100% $0.00 $0.00 20050 Plenum Level $13,310.00 $13,310.00 $0.00 $0.00 $13,310.00 100% $0.00 $0.00 20060 Orchestra Low Level $18,977.00 $18,977.00 $0.00 $0.00 $18,977.00 100% $0.00 $0.00 20070 Orchestra High Level $12,010.00 $12,010.00 $0.00 $0.00 $12,010.00 100% $0.00 $0.00 20080 Box Tier Level $21,950.00 $21,950.00 $0.00 $0.00 $21,950.00 100% $0.00 $0.00 20090 Balcony Low Level $12,800.00 $12,800.00 $0.00 $0.00 $12,800.00 100% $0.00 $0.00 20100 Balcony High Level $23,900.00 $23,900.00 $0.00 $0.00 $23,900.00 100% $0.00 $0.00 20110 Attic 50 ft.Level $5,600.00 $5,600.00 $0.00 $0.00 $5,600.00 100% $0.00 $0.00 20120 Attic 66 ft Level $8,805.00 $8,805.00 $0.00 $0.00 $8,805.00 100% $0.00 $0.00 20130 Attic 80 ft Level $12,335.00 $12,335.00 $0.00 $0.00 $12,335.00 100% $0.00 $0.00 20140 Pre-action Detection $15,984.00 $7,992.00 $0.00 $0.00 $7,992.00 50% $7,992.00 $0.00 30000 INSTALLATION 30010 Underground $3,714.00 $3,714.00 $0.00 $0.00 $3,714.00 100% $0.00 $0.00 30020 Fire Pump $12,381.00 $12,381.00 ($123.81) $0.00 $12,257.19 99% $123.81 $0.00 30030 Standpipe $17,024.00 $15,322.00 ($2,554.00) $0.00 $12,768.00 75% $4,256.00 $0.00 30040 Basement $49,602.00 $49,602.00 ($496.02) $0.00 $49,105.98 99% $496.02 $0.00 SimplexGrinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 15 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 01/15/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 2695-4280 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO. VALUE APPLICATION THIS STORED AND STORED % TO (IF VARIABLE) (D+E) PERIOD (NOT IN TO DATE (G=C) FINISH RATE D ORE) (D+E+F) (C-G) 30050 Plenum Level $17,179.00 $17,179.00 ($171.79) $0.00 $17,007.21 99% $171.79 $0.00 30060 Orchestra Low Level $26,620.00 $26,620.00 ($266.20) $0.00 $26,353.80 99% $266.20 $0.00 30070 Orchestra High Level $15,012.00 $15,012.00 ($150.12) $0.00 $14,861.88 99% $150.12 $0.00 30080 Box Tier Level $31,572.00 $20,521.00 $0.00 $0.00 $20,521.00 65% $11,051.00 $0.00 30090 Balcony Low Level $16,328.00 $0.00 $1,633.00 $0.00 $1,633.00 10% $14,695.00 $0.00 30100 Balcony High Level $34,822.00 $34,822.00 ($3,482.15) $0.00 $31,339.85 90% $3,482.15 $0.00 30110 Attic 50 ft Level $4,333.00 $0.00 $1,083.00 $0.00 $1,083.00 25% $3,250.00 $0.00 30120 Attic 66 ft. Level $9,673.00 $0.00 $2,420.00 $0.00 $2,420.00 25% $7,253.00 $0.00 30130 Attic 80 ft.level $15,554.00 $0.00 $3,888.00 $0.00 $3,888.00 25% $11,666.00 $0.00 ALLOWANCE $50,000.00 $0.00 $0.00 $0.00 0% $50,000.00 $0.00 CHANGE ORDERS $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 Change Order 1 RFQ 006 $4,601.00 $4,601.00 $0.00 $0.00 $4,601.00 100% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 _ TOTALS $619,960.00 $498,327.00 $1,779.91 $0.00 $500,106.91 81% $119,853.09 $0.00 SimplexGrinnell 11820 Pendleton Pike,Indianapolis, IN 46236 VIVO Fire& Security Simplex Grinnell CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT Upon receipt by the undersigned of a check from_ Carmel Redevelopment (Maker of Check) in the sum of$63, 074 . 70 payable to SimplexGrinnell and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to release any mechanic's lien, stop notice or bond right the undersigned has on the job of Carme 1 Redevelopment_ (Owner) located at Carmel Per&orming Arts Center. (Job Description) � — - to the following extent. This release covers a progress payment for labor, services, equipment or material furnished to Carmel Redevelopment (Your Customer) through 1-25-2010 only and does not cover any retention or items furnished after said (Date) date, nor disputed claims in the amount of$ N/A . Before any recipient of this document relies on it, the party should verify evidence of payment to the undersigned. DATED: 1-25-2010 Simplexorinnel (Co/m/puny Na_ e) (/ / BY: Michael M. MacDonald Offices&Representatives in Principal Cities throughout the World M7 19 v • :, y boUrent / 02IC a - 9 , Application and:Certificate�fOr Payment Construction'Manager.-Adviser"Edition : 13• TO OWNER: _ _ " PROJECT: APPLICATION NO: 16:. :, • Distribution to:, Carmel°•Redevelopment Comm. Parcel '7A Regional Performing PERIOD TO:. 2-28-2010 One Civic,:.Square Arts Center • OWNER ❑ Carmel;_iIN' `46032 CONSTRUCTION MANAGER kit FROM CONTRACTOR: VIA-CONSTRUCTION-MANAGER: . CONTRACT DATE:. 6-20-2009 ARCHITECT ❑ SimplexGrinnell LP Shiel Sexton Co. NOS: 2695: / 4280 / CONTRACTOR ❑ `1'1820 Pendleton Pike VIA ARCHITECT: FIELD 0 Indianapolis, IN.,. 46236 CSO Architects . CONTRACT"FOR: Auto Fire Protection . . ❑' 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 Paym nt were issued and payments received'from.the Owner, and that current 1.ORIGINAL'CONTRACT SUM $615;359-.00 payment shown here;is now due. 2.Net change by Change Orders ' $ (20,549-.00) CONTRACTOR: : `m.lexG .-nn e1 ° :/:- ' • 3.CONTRACT SUM TO DATE"(Line 1 t 2) $594,810..00 By: /, `" ,.■„_I '. Date: 2/15/20113 4.TOTAL COMPLETED&STORED=TO-DATE(Column G on 0703) $500,106.91 State o•1 Mich:-' M.' MacDonald, DGM ' 5.RETAINAGE: n ana .:- 4 m:.. ,,^� O County of: Marion - 'GLORIA J.GALI.EN a. 5.0%of Completed Work -t .G`u'.,'!,�_, J. I. Subscribed and sworn to:before-_ ,�-;,, ... No�yt�mac,�oftrdlmm (Colninn D+Eon G703) $ 30,998.00 me this, 15th ; '-.,Feb r_y 2010 ••(' : 1�; hy '-b: 5.0`Yo of Stored Material Notary Public: .1'/ , / ='� January 11,2018 (Column F on G703) $ 0.00: My Commissi. xprres:. Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 30;998.00 CERTIFI ATE FOR MENT 6.TOTAL EARNED LESS RETAINAGE In accordance with the Contract Documents,based on on-site observations and the'data comprising, $ 4.78,168-.91 this application,the Construction Manager and Architect certify to the Owner that to the best 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 $ 469.108.91 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) . CER I'IFIED. - . 8:CURRENT PAYMENT DUE - 1$ 9,060.001 AMOUNT CERTIFIED - $ qP6c,ls� se~� 9.BALANCE TO FINISH,INCLUDING RETAINAGE . (Attach explanation if amount certified differs from the-amount applied.Initial all figures on this Application • on th"-Continuation Sheet that are changed to conform with the amount certified.) .• (Line 3 less Line 6) $-125,601.09 CONSTRU T I.N ^- ■r R: By: ;I ►.....0.. - ,. Date: - Zd�O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC 'r - - Total changes-_approved:in previous months by Owner $ $ / ''(0'• By: 1.i .`:,_:: Date: FJv Total approved:this Month $ $ This Certificate is;noi.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 G702JCMa*n—1992.Copyright 0 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 AIAe 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. Wimple r r nnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 16 containing Contractor's signed Certification,is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 02/20/2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 02/28/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 2695-4280 A 13 C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO. VALUE APPLICATION THIS STORED AND STORED % TO (IF VARIABLE) (D+E) PERIOD (NOT IN TO DATE (G=C) FINISH RATE D OR E) (D+E+F) (C-G) 10000 ADMINISTRATION 10010 Bonds&Insurance $4,380.00 $4,380.00 $0.00 $0.00 $4,380.00 100% $0.00 $0.00 10020 Permits&Fees $500.00 $500.00 $0.00 $0.00 $500.00 100% $0.00 $0.00 10030 Submittals $20,307.00 $20,307.00 $0.00 $0.00 $20,307.00 100% $0.00 $0.00 10040 Drarwing&Drafting Srvices $33,638.00 $33,638.00 $0.00 $0.00 $33,638.00 100% $0.00 $0.00 10050 As Built Drawing Conversion to CAD $5,000.00 $0.00 $0,00 $0.00 $0.00 0% $5,000.00 $0.00 10060 Mobilization $17,910.00 $17,910.00 $0.00 $0.00 $17,910.00 100% $0.00 $0.00 20000 MATERIAL 20010 Underground $2,229.00 $2,229.00 $0.00 $0.00 $2,229.00 100% $0.00 $0.00 20020 Fire Pump $35,920.00 $35,920.00 $0.00 $0.00 $35,920.00 100% $0.00 $0.00 20030 Standpipe $13,218.00 $13,218.00 $0.00 $0.00 $13,218.00 100% $0.00 $0.00 20040 Basement $32,772.00 $32,772.00 $0.00 $0.00 $32,772.00 100% $0.00 $0.00 20050 Plenum Level $13,310.00 $13,310.00 $0.00 $0.00 $13,310.00 100% $0.00 $0.00 20060 Orchestra Low Level $18,977.00 $18,977.00 $0.00 $0.00 $18,977.00 100% $0.00 $0.00 20070 Orchestra High Level $12,010.00 $12,010.00 $0.00 $0.00 $12,010.00 100% $0.00 $0.00 20080 Box Tier Level $21,950.00 $21,950.00 $0.00 $0.00 $21,950.00 100% $0.00 $0.00 20090 Balcony Low Level $12,800.00 $12,800.00 $0.00 $0.00 $12,800.00 100% $0.00 $0.00 20100 Balcony High Level $23,900.00 $23,900.00 $0.00 $0.00 $23,900.00 100% $0.00 $0.00 20110 Attic 50 ft.Level $5,600.00 $5,600.00 $0.00 $0.00 $5,600.00 100% $0.00 $0.00 20120 Attic 66 ft Level $8,805.00 $8,805.00 $0.00 $0.00 $8,805.00 100% $0.00 $0.00 20130 Attic 80 ft Level $12,335.00 $12,335.00 $0.00 $0.00 $12,335.00 100% $0.00 $0.00 20140 Pre-action Detection $15,984.00 $7,992.00 $0.00 $0.00 $7,992.00 50% $7,992.00 $0.00 30000 INSTALLATION 30010 Underground $3,714.00 $3,714.00 $0.00 $0.00 $3,714.00 100% $0.00 $0.00 30020 Fire Pump $12,381.00 $12,257.19 $0.00 $0.00 $12,257.19 99% $123.81 $0.00 30030 Standpipe $17,024.00 $12,768.00 $0.00 $0.00 $12,768.00 75% $4,256.00 $0.00 30040 Basement $49,602.00 $49,105.98 $0.00 $0.00 $49,105.98 99% $496.02 $0.00 Simrsplemerinisell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 16 containing Contractor's signed Certification,is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 02/20/2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 02/28/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 2695-4280 A 13 C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO. VALUE APPLICATION THIS STORED AND STORED % TO (IF VARIABLE) (D+E) PERIOD (NOT IN TO DATE (Gq C) FINISH RATE D OR E) (D+E+F) (C-G) 30050 Plenum Level $17,179.00 $17,007.21 $0.00 $0.00 $17,007.21 99% $171.79 $0.00 30060 Orchestra Low Level $26,620.00 $26,353.80 $0.00 $0.00 $26,353.80 99% $266.20 $0.00 30070 Orchestra High Level $15,012.00 $14,861.88 $0.00 $0.00 $14,861.88 99% $150.12 $0.00 30080 Box Tier Level $31,572.00 $20,521.00 $0.00 $0.00 $20,521.00 65% $11,051.00 $0.00 30090 Balcony Low Level $16,328.00 $1,633.00 $0.00 $0.00 $1,633.00 10% $14,695.00 $0.00 30100 Balcony High Level $34,822.00 $31,339.85 $0.00 $0.00 $31,339.85 90% $3,482.15 $0.00 30110 Attic 50 ft Level $4,333.00 $1,083.00 $0.00 $0.00 $1,083.00 25% $3,250.00 $0.00 30120 Attic 66 ft.Level $9,673.00 $2,420.00 $0.00 $0.00 $2,420.00 25% $7,253.00 $0.00 30130 Attic 80 ft.level $15,554.00 $3,888.00 $0.00 $0.00 $3,888.00 25% $11,666.00 $0.00 ALLOWANCE $15,940.00 $0.00 $0.00 $0.00 $0.00 0% $15,940.00 $0.00 4280A-001 $1,940.00 $0.00 $1,940.00 $0.00 $1,940.00 100% $0.00 $0.00 4280A-002 $911.00 $0.00 $911.00 $0.00 $911.00 100% $0.00 $0.00 4280A-003 Reduction $25,000.00 $0.00 $0.00 $0.00 $0.00 0% $25,000.00 $0.00 4280A-004 $531.00 $0.00 $531.00 $0.00 $531.00 100% $0.00 $0.00 4280A-005 $5,064.00 $0.00 $5,064.00 $0.00 $5,064.00 100% $0.00 $0.00 4280A-006 $614.00 $0.00 $614.00 $0.00 $614.00 100% $0.00 $0.00 CHANGE ORDERS $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 Change Order 1 RFC!006 $4,601.00 $4,601.00 $0.00 $0.00 $4,601.00 100% $0.00 $0.00 Change Order 1 ($25,150.00) $0.00 $0.00 $0.00 0% ($25,150.00) $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 TOTALS $594,810.00 $500,106.91 $9,060.00 $0.00 $509,166.91 86% $85,643.09 $0.00 SimplexGrinnell 11820 Pendleton Pike.Indianapolis,IN 46236 NCO Fire& Security Simp/exGsin»e0! CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT Upon receipt by the undersigned of a check from Carmel Redevelopment (Maker of Check) in the sum of$ 48,294.70 payable to SimplexGrinnell and when the check has been properly endorsed and has been paid by the bank upon which it is drawn, this document shall become effective to release any mechanic's lien, stop notice or bond right the undersigned has on the job of Cannel Redevelopment (Owner) located at Cannel Perdorminq Arts Center (Job Description) to the following extent. This release covers a progress payment for labor, services, equipment or material furnished to Carmel Redevelopment (Your Customer) through 2-10-2010 only and does not cover any retention or items furnished after said (Date) date,nor disputed claims in the amount of$ N/A . Before any recipient of this document relies on it,the party should verify evidence of payment to the undersigned. DATED: 2/11/10 SimplexGri ell (Company •ame) BY: Mike MacDonald, District Business Mgr. Offices&Representatives in Principal Cities throughout the World Draft PAC Elevators and Doors (WR Dunkin) Up Through November 2009 IPC Amounts through application 19 Completed and Stored to date $ 1,122,310.00 Retention held(based on 5%retention) $ 56,115.50 Paid to date $ 1,066,194.50 Amount Reiumbursed to CRC $ 1,066,194.50 December 2009 IPC Amount for application 20 Completed and Stored to date $ 56,000.00 Retention held(based on 5%retention) $ 2,800.00 To be paid $ 53,200.00 Paid by Carmel Garage Development Company $ 53,200.00 January 2010 IPC Amount for application 21 Completed and Stored to date $ 28,300.00 Retention held(based on 5%retention) $ 1,415.00 Amount to be paid by Carmel Garage Development Company $ 26,885.00 February 2010 Amount to be paid by Carmel Garage Development Company $ 76,000.00 -AVIA. i I\ E% 0,cu H went G702/C , 'ray ® 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Caramel Redevelopment PROJECT: Parcel 7A,#4050 CPA APPLICATION NO:022 Distribution to: Commission 777 3rd Ave.S.W. OWNER: One Civic Square Carmel,IN 46032 Carmel,IN 46032 PERIOD TO:February 28.20I0 CONSTRUCTION MANAGER: FROM W.R. Dunkin x Sun.Inc. VIA CONSTRUCTION Shiel Sexton Co..Inc. CONTRACT DATE:May 08,2008 ARCHITECT: CONTRACTOR: Pt)Box 2222.7 MANAGER: PROJECT NOS:25310/2695-4050/2695 CONTRACTOD: Anderson.IN 46018 FIELD: CONTRACT FOR: General Construction VIA ARCHITECT: CSO Architects OTHER: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best ophL Contractor's knowledge.information and belief-the Work covered by this Applicationlo Pavnnea(has been completed in accordance with the Application is made for payment.as shown below.in connection with the Contract. Contract Documents,that all ant rots hay beei,p5ld.hy the 'o ractor for Work for which previous Continuation Sheet.AlA Document G703,is attached. Certi- '.r_P: • weerelidsue wand p yments re• iv• front the Owner. and that current 1.ORIGINAL CONTRACT SUM $ 2,268,700,00 pa 'leant 4".. emirs is Cv Ge. 2.NET CHANGE BY CHANGE ORDERS $ 0.00 r e NTRA I' W ■ D. K 4N, a C. 3.CONTRACT SUM TO DATE(Line l±2) $ 9_,2 68,700.00 By: .� ' . O, —,` Date: February 24.2010 4.TOTAL COMPLETED&STORED TO DATE(Column Ci on G703) $ 1,282,610.00 ,,•tc of:Indiana ./. 5.RETAINAGE: County of Madison / a. 5 %of Completed Moak Subscribed and swop to belbre (Column U+F on(;7030 $ 113,435.00 Inc this 24th day of February, 2010 r'7 V�o�� b, ti %b of Stored Material Notary Public:Martha A.Carpenter ,i r.t�✓ G 0 ' ((..olumn I'on(1703) $ 0.00 My Commission expires:January 08,2017 r% Total I(etainagc(Lines 5a+Sb or Total in Column I of 0703) $ 113,435.00 CERTIFICATE FOR PAYMENT 6,TOTAL EARNED LESS RETAINAGE $ 1.169,i 75.00 In accordance with the Contract Documents, based on on-site observations and the data comprising (Line 4 Less Line 5'I'utal) this application,the Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 1.093.175.00 knowledge,information and belief-the Work has progressed as indicated,the quality of the Work is in accordance with the Contract Documents.and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 0t7 8.CURRENT PAYMENT DUE $ 76.000.00 AMOUNT CERTIFIED $ 7(a S A$ Sc 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation ifannoant certified d ersfrom the amount applied. Initial all figures on this Application ant on the antinuation Sheet that are changed to conform with the amount certified) (Line 3 less Line 6) 5 1,099,525.00 CONSTRUCT)0 M•. 'G' r: By: •, Date: '3. 4.2-61 I (Z) CI IANUN ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITEC' yr Total changes approved in previous months by Owner$ 0.00$ 0.00 By: I r a . / Date: 3. S V -l k •Rind approved this Month $ 0.00$ 0.00 This Certi�te is not egotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 0.00$ 0.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. NET CI IANGES by Change Order $ 0.00 • AIA Document G702/CMa`"—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.,Unauthoriied•reproduction or distrniution of this Ale Document,or any portion of it.may result in severe civil and criminal penalties,and will be prosecutedto the maximum exterit.posstblc 1 under the law.This document was produced by AIA software at 15:52:24 on 02/2412010 under Order No.0754240912 1 which expires on 05110/2010,and is not for resale. User Notes: (1298281014). �� j u went G7O3TM 1 992 O�� '1\. 5� k� V.i Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:022 containing Contractor's signed certification is attached, APPLICATION DATE:02/10/2010 In tabulations below,amounts are in US dollars. Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO:02/28/2010 ARCHITECT'S PROJECT NO:25310 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM EM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED eta BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS STORED THIS PERIOD AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) Steel Doors& 08110 Frances-M 73,000.00 73,000.00 0.00 0.00 73,000.00 100.00% 0.00 7,300.00 Steel Doors& ' 081 1 1 Frances-L 33,000.00 24,550.00 0.00 0.00 24,550.00 74.39% 8,450.00 2,455.00 Flush Wood Doors- 0814t) M 39,000.00 780.00 8,000.00 0.00 8,780.00 22.51 % 30,220.00 878.00 08141 Flush Wood.Doors-L 15,000.00 0.00 2,000.00 0.00 2,000.00 13.33% 13,000.00 200.00 Stile& Rail Wood 08143 Doors-M 127,000.00 11,340.00 0.00 11,340.00 8.93% 115,660.00 1,134.00 Stile& Rail Wood 08144 Doors-L 34,000.00 0.00 0.00 0.00 0.00 0.00% 34,000.00 0.00 Sound Control Doors 08347_& Windows-M 352,000.00 9,000.00 0.00 0.00 9,000.00 2.56% 343,000.00 900.00 Sound Control Doors 08 348 & \Vindows-L 50,000.00 0,00 0.00 0.00 0.00 0.00% 50,000.00 0.00 Overhead Coiling 08355 Doors-M 20,750.00 0.00 0.00 0.00 0.00 0.00% 20,750.00 0.00 Overhead Coiling ,08356 Doors-I 2,850.00 0.00 0.00 0.00 0.00 0.00% 2,850.00 0.00 Alunc.Framed Entrances/Storefronts 08410 -M 176,000.00 29,520.00 0.00 0:00 29,520.00 16.77% 146,480.00 2,952.00 \lunt.Framed Entrances/Storefronts 08411 -L 69,700.00 0.00, 0.00 0.00 0.00 0.00% 69,700.00 0.00 108413 Interior Alum. Doors 17,000.00 340.00 0.00 0.00 340.00 2.00% 16,660.00 34.00 AIA Document G7031P-1992.Copyright 01963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA°Document Is protected by. U.S.Copyright Law and International Treaties,Unauthorized reproduction or distribution at this AIA°'Document;or any'portion.of.iC may rasutt In sovere'civil and crtintrlahpenattles,and will be 1 prosecuted Co the maximum extent.posslble under ttie law.This document was produced by ALA software at 15:54:01 on 02124/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1446398546) A B C D I E F G H 1 WORK COMPLETED TOTAL MATERIALS COMPLETED °/u BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO FINISH (IF VARIABLE NU, WORK VALUE THIS PERIOD STORED DATE (0_C) (C-G) RATE) APPLICATION (NOT IN D OR E) (DBE) (D+E+F) & Frames-M Interior Alum. Doors 08-114 & Frames-L 6,000.00 0.00 0.00 0.00 0.00 0.00% 6,000.00 0.00 Revolving Door 08.423 Entrances-M 69.000.00 1,380.00 0.00 66,000.00 67,380.00 97.65% 1,620.00 6,738.00 Itevolvine Door 08424 Entrances-L 9,500.00 0.00 0.00 0.00 0.00 0.00% 9,500.00 0.00 Elec.Traction Elevators- 14210 Engineering 157.200.00 157,200.00 0.00 0.00 157,200.00 100.00% 0.00 15,720.00 Elec.Traction Elevators- 14211 Material/Equipment _ 452.000.00 452,000.00 0.00 0.00 452,000.00 100.00% 0.00 43,574.00 Elec.'I'raction 14212 Elevators-L 186,000.00 132,000.00 0.00 0.00 132,000.00 70.97% 54,000.00 0.00 Hydraulic Elevator- 14241 Engineering 69,500.00 69,500.00 0.00 0.00 69,500.00_ 100.00% 0.00 6,950.00 Hydraulic Elevator- 14242 Material/Equipment 183,000.00 183,000.00 0.00 0.00 183,000.00 100.00% 0.00 18,300.00 Hydraulic Elevator- 14243 Labor 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 6,300.00 Wheelchair Lill- 14421 Material/Equipment 48,000.00 0.00 0.00 0.00 0.00 0.00% 48,000.00 0,00 Wheelchair Lift- 14422 Permits 2,200.00 0.00 0.00 0.00 0.00 0.00% 2,200.00 0,00 Wheelchair Lift- 14423 Labor 14,000.00 0.00 0.00 0.00 0.00 0.00% 14,000.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 GRAND TOTAL $2,268,700.00 $1,206,610.00 $10,000.00 $66,000.00 $1,282,610.00 56.54% $986,090.00 $113,435.00 AIA Document G703,"-1992.Copyright 0 1963,1965,1966,1967,1970,1978,1983 and 1992 by,The American Institute of Architects.All rights reserved.WARNING:'Tfils:AIA"Document is protected by U.S.Copyrightlew'and International Treaties.,•Uiraiithorized■rep'roduction or distribution of this AtAe Document,or.any portion of it,may result in-severe'civil and criminal ponalties,and ■Ill bet 2 prosecuted.to the maximum einent possible under the law.This document was produced by AIA software at 15:54:01'on 02124/2010 under Order No.0754240912 1 which'expires on 05110/2010,and is not for resale. User Notes: (1446396546) Draft PAC Elevators, Lifts Doors (WR Dunkin) 1/31/10 Contractor Equipment Contract Total Previously Completed Completed this Period Completed to Date Remaining Balance WR Dunkin steel doors and frames-M $ 73,000.00 $ 71,500.00 $ 1,500.00 $ 73,000.00 $ - steel doors and frames-L $ 33,000.00 $ 24,550.00 $ - $ 24,550.00 $ 8,450.00 flush wood doors-M $ 39,000.00 $ 780.00 $ - $ 780.00 $ 38,220.00 flush wood doors-L $ 15,000.00 $ - $ - $ - $ 15,000.00 stile and rail wood doors-M $ 127,000.00 $ - $ 8,800.00 $ 8,800.00 $ 118,200.00 stile and rail wood doors-L $ 34,000.00 $ 2,540.00 $ - $ 2,540.00 $ 31,460.00 sound control doors and windows-M $ 352,000.00 $ 9,000.00 $ - $ 9,000.00 $ 343,000.00 sound control doors and windows-L $ 50,000.00 $ - $ - $ - $ 50,000.00 over coiling doors-M $ 20,750.00 $ - $ - $ - $ 20,750.00 over coiling doors-L $ 2,850.00 $ - $ $ - $ 2,850.00 aluminum framed entraces/storefronts-M $ 176,000.00 $ 29,520.00 $ - $ 29,520.00 $ 146,480.00 aluminum framed entraces/storefronts-L $ 69,700.00 $ - $ - $ - $ 69,700.00 interior aluminum doors and frames-M $ 17,000.00 $ 340.00 $ - $ 340.00 $ 16,660.00 interior aluminum doors and frames-L $ 6,000.00 $ - $ - $ - $ 6,000.00 revolving door entrances-M $ 69,000.00 $ 1,380.00 $ - $ 1,380.00 $ 67,620.00 revolving door entrances-L $ 9,500.00 $ - $ - $ - $ 9,500.00 electric traction elevators-engineering $ 157,200.00 $ 157,200.00 $ - $ 157,200.00 $ - electric traction elevators-material/equipment $ 452,000.00 $ 452,000.00 $ - $ 452,000.00 $ - electric traction elevators-L $ 186,000.00 $ 114,000.00 $ 18,000.00 $ 132,000.00 $ 54,000.00 hydraulic elevator-engineering $ 69,500.00 $ 69,500.00 $ - $ 69,500.00 $ - hydraulic elevator-material/equipment $ 183,000.00 $ 183,000.00 $ - $ 183,000.00 $ - hydraulic elevator-L $ 63,000.00 $ 63,000.00 $ - $ 63,000.00 $ - wheelchair lift-material/equipment $ 48,000.00 $ - $ - $ - $ 48,000.00 wheelchair lift-permits $ 2,200.00 $ - $ - $ - $ 2,200.00 wheelchair lift-L $ 14,000.00 $ - $ - $ - $ 14,000.00 'Total $ 2,268,700.00 $ 1,178,310.00 $ 28,300.00 $ 1,206,610.00 $ 1,062,090.00I Amount Completed $ 28,300.00 . A 0 ` �i Document G702/CMar" - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Cannel Redevelopment PROJECT: Parcel 7A,#4050 Carmel APPLICATION NO:021 Distribution to: Commission Performing Arts OWNER:X One Civic Square 777 3rd Ave. S.W. PERIOD TO:January 31,2010 CONSTRUCTION MANAGER:X Cannel,IN 46032 Carmel,IN 46032 ARCHITECT:X FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Shiel Sexton Co.,Inc. CONTRACT DATE:May 08,2008 CONTRACTOR:X CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:25310/2695-4050/2695 FIELD: Anderson,IN 46018 CONTRACT FOR: BP-#4050 General Trades VIA ARCHITECT: CSO Architects OTHER: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 12,235,000.00 payment shown hey in is now due. 2.NET CHANGE BY CHANGE ORDERS $ -333,924.00 CONTRACTOR: W R I k & ,on, Inc. 3.CONTRACT SUM TO DATE(Line 1 f 2) $ 11,901,076.00 By: 1, r Date: January 19,2010■ 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 8,262,735.00 State of:Indiana I 5.RETAINAGE: County of:Madison a. 5 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 595,053.80 me this 19th day of January 2010 b. 0 %of Stored Material Notary Public:Martha A.Carpenter k 7.QA ` sc-4( I �1/ v (Column F on G703) $ 0.00 My Commission expires:January 08,2017 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 595,053.80 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 7,667,681.20 In accordance with the Contract Documents,based on on-site observations and the data comprising (Line 4 Less Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 7,352,930.20 knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 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 $ 314,751.00 AMOUNT CERTIFIED $ 3i1/, ' 1,(�D 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 4,233,394.80 CONSTRUC IIN MA At By: 1 - Date: r.Zy:ZO(O CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: c. Total changes approved in previous months by Owner$ 426,406.00$ 760,330.00 0 %f _ . U�• Q By: ' Date: 04, ao/Q Total approved this Month $ 0.00$ 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 426,406.00$ 760,330.00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of - the Owner or Contractor under this Contract. NET CHANGES by Change Order $ -333,924.00 AIA Document G702/CMa"—1992.Copyright O 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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 1 under the law.This document was produced by AIA software at 11:05:32 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (944325997) "ALI Document G703 - 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:021 containing Contractor's signed certification is attached. APPLICATION DATE In tabulations below,amounts are in US dollars. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO:25310 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE C) APPLICATION THIS PERIOD STORED DATE (G- (D+E) (NOT IN D ORE) (D+E+F) (C-G) RATE) PERFORMANCE 01010 BOND 106,000.00 106,000.00 0.00 0.00 106,000.00 100.00% 0.00 10,600.00 MOBILIZE/DEMOB 01015 ILIZE 29,000.00 15,000.00 0:00 0.00 15,000.00 51.72% 14,000.00 1,500.00 SUPERVISION/CO 01020 ORDINATION 361,000.00 318,800.00 0.00 0.00 318,800.00 88.31 % 42,200.00 28,480.00 GENERAL 01025 CONDITIONS-M 380,000.00 316,000.00 14,000.00 0.00 330,000.00 86.84% 50,000.00 27,000.00 GENERAL 01026 CONDITIONS-L 98,000.00 84,000.00 4,000.00 0.00 88,000.00 89.80% 10,000.00 7,000.00 GENERAL 01027 CONDITIONS-O 262,990.00 0.00 184,000.00 0.00 184,000.00 69.96% 78,990.00 0.00 ALLOWANCE- STONE 140A0 WALKWAY 8,500.00 0.00 0.00 0.00 0.00 0.00% 8,500.00 0.00 ALLOWANCE- TEMPORARY 140B0 HANDRAIL 38,000.00 27,769.00 0.00 0.00 27,769.00 73.08% 10,231.00 2,776.90 ALLOWANCE- TEMPORARY DOORS/FRAMES/H 14000 ARDWARE 10,000.00 0.00 0.00 0.00 0.00 0.00% 10,000.00 0.00 140D0 ALLOWANCE-ICE 13,500.00 2,289.00 0.00 0.00 2,289.00 16.96% 11,211.00 207.10 ALLOWANCE- 140E0 SECURITY 31,000.00 0.00 0.00 0.00 0.00 0.00% 31,000.00 0.00 140F0 ALLOWANCE- 191,700.00 56,808.00 4,752.00 0.00 61,560.00 32.11 % 130,140.00 3,987.90 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 ,I prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912-1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED DATE (G_C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) DUMPSTERS ALLOWANCE- TRAILER 140G0 CONNECTOR 34,000.00 32,214.00 337.00 • 0.00 32,551.00 95.74% 1,449.00 2,200.90 ALLOWANCE- TRAILER 140H0 CLEANING 19,169.00 12,944.00 780.00 0.00 13,724.00 71.59% 5,445.00 1,066.10 ALLOWANCE-SITE 14010 SIGNAGE/SAFETY 22,000.00 10,839.00 0.00 0.00 10,839.00 49.27% 11,161.00 1,055.90 ALLOWANCE- 140J0 GENERAL LABOR 320,000.00 216,082.00 1,452.00 0.00 217,534.00 67.98% 102,466.00 17,948.40 ALLOWANCE- TEMPORARY FENCE 140K0 MODIFICATIONS 5,000.00 4,008.00 0.00 0.00 4,008.00 80.16% 992.00 400.80 ALLOWANCE-#2 140L0 OR#53 STONE 37,900.00 18,856.00 0.00 0.00 18,856.00 49.75% 19,044.00 1,885.60 ALLOWANCE- WAREHOUSE 140M LEASE/LAYDOWN 0 /PARKING 500,000.00 500,000.00 0.00 0.00 500,000.00 100.00% 0.00 942.70 ALLOWANCE- PARKING LOT INSTALL/MAINTAI 140N1 N 100,000.00 80,324.00 0.00 0.00 80,324.00 80.32% 19,676.00 5,532.40 ALLOWANCE- MAINT.-OFF SITE STAGING/PARKIN 140N2 G 35,000.00 7,270.00 156.00 0.00 7,426.00 21.22% 27,574.00 685.50 ALLOWANCE- PARKING LOT REMOVE/REFURBI . 14000 SH 100,000.00 2,745.00 0.00 0.00 2,745.00 2.75% 97,255.00 274.50 AIA Document G703 -1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 2 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 10:41:16 on 01/19/2010 under Order No.0754240912-1 which expires on 05/10/2010,and is not for resale. - User Notes: (1816808515) A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINIS)H (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (G_C) RATE) (D+E) (D+E+F) ALLOWANCE- HAUL/DISPOSE UNSUITABLE 140P0 MATERIAL _ 25,000.00 14,794.00 0.00 0.00 14,794.00 59.18% 10,206.00 1,479.40 ALLOWANCE-6 OZ. GEOTECH 140Q1 FABRIC 4,700.00 3,207.00 0.00 0.00 3,207.00 68.23 % 1,493.00 320.70 ALLOWANCE- 140Q2 TENSAR GEOGRID 8,500.00 0.00 0.00 0.00 0.00 0.00% 8,500.00 0.00 ALLOWANCE-#2 140R0 STONE 26,200.00 10,275.00 • 0.00 0.00 10,275.00 39.22% 15,925.00 1,027.50 ALLOWANCE- CABLE PASS- 140S0 THRU(FOH) 6,456.00 0.00 0.00 0.00 0.00 0.00% 6,456.00 0.00 ALLOWANCE- CABLE PASS- 140T0 THRU(BOH) 5,165.00 0.00 0.00 0.00 0.00 0.00% 5,165.00 0.00 ALLOWANCE- 140U CABLE PASS- O THRU(FLOOR) 17,217.00 0.00 0.00 0.00 0.00 0.00% 17,217.00 0.00 ALLOWANCE- TEMPORARY ELEVATOR 140V0 USAGE 200,000.00 2,175.00 8,824.00 0.00 10,999.00 5.50% 189,001.00 0.00 ALLOWANCE- 140W DONOR 0 RECOGNITION 100,000.00 100,000.00 0.00 0.00 100,000.00 100.00% 0.00 0.00 GENERAL 140X0 ALLOWANCE 400,000.00 130,980.00 0.00 0.00 130,980.00 32.75% 269,020.00 598.00 ALLOWANCE-AS- 140Y0 BUILD/CAD 5,000.00 0.00 0.00 0.00 0.00 0.00% 5,000.00 0.00 FIELD 01501 OFFICE/STORAGE 16,400.00 14,700.00 500.00 0.00 15,200.00 92.68% 1,200.00 1,320.00 AIA Document G703T".-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 3 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 10:41:16 on 01/19/2010 under Order No.0754240912 1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C T D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) TRAILER-M FIELD OFFICE/STORAGE 01502 TRAILER-L 5,500.00 4,650.00 200.00 0.00 4,850.00 88.18% 650.00 405.00 TEMPORARY TOILETS/WASHIN 01503 G STATIONS-M 41,800.00 33,600.00 1,000.00 0.00 34,600.00 82.78% 7,200.00 2,860.00 TEMPORARY TOILETS/WASHIN 01504 G STATIONS-L 7,600.00 6,200.00 150.00_ 0.00 6,350.00 83.55% 1,250.00 555.00 FIRE PROTECTION/EME 01505 RG.STATIONS-M 19,300.00 19,300.00 0.00 0.00 19,300.00 100.00% 0.00 1,930.00 FIRE PROTECTION/EME 01506 RG.STATIONS-L 4,000.00 3,400.00 0.00 0.00 3,400.00 85.00% 600.00 310.00 FURNISH/MAINTA 01507 IN TRASH CANS-M 6,000.00 6,000.00 0.00_ 0.00 6,000.00 100.00% 0.00 600.00 FURNISH/MAINTA 01508 IN TRASH CANS-L 40,000.00 28,700.00 0.00 0.00 28,700.00 71.75% 11,300.00 2,350.00 TEMPORARY ROAD/MAINTENA 01510 NCE 148,000.00 132,600.00 1,800.00 0.00 134,400.00 90.81 % 13,600.00 12,220.00 TEMPORARY FENCING- REMOVE/RELOCA 01520 TE 15,800.00 15,800.00 0.00 0.00 15,800.00 100.00% 0.00 1,580.00 TEMPORARY 01521 FENCING-GATES 6,500.00 6,500.00 0.00 0.00 6,500.00 100.00% 0.00 650.00 TEMPORARY FENCING- 01522 SCREENING 8,744.00 8,744.00 0.00 0.00 8,744.00 100.00% 0.00 874.40 AIA Document G7037"-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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 4 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912 1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION DATE (C-G) RATE) _ (D+E) (NOT IN D OR E) (D+E+F) TEMPORARY 01523 BARRIERS-M 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 680.00 TEMPORARY 01524 BARRIERS-L 7,500.00 7,500.00 0.00 0.00 7,500.00 100.00% 0.00 750.00 TEMPORARY 01530 ENCLOSURES-M 10,800.00 10,800.00 0.00 0.00 10,800.00 100.00% 0.00 1,050.00 TEMPORARY 01531 ENCLOSURES-L 14,000.00, 14,000.00 0.00 0.00 14,000.00 100.00% 0.00 1,360.00 SCAFFOLDING- SET UP/CONSUMABLE 01540 S 398,000.00, 398,000.00 0.00 0.00_ 398,000.00 100.00% 0.00 37,620.00 SCAFFOLDING- MONTHLY RENTAL/INSPECTI 01541 ONS 228,000.00 161,500.00 19,000.00 0.00 180,500.00 79.17% 47,500.00 10,450.00 SCAFFOLDING- DISMANTLE/REM 01542 OVE 55,000.00 0.00 0.00 0.00 0.00 0.00% 55,000.00 0.00 STAIR TOWERS- 01543 SETUP 54,000.00 18,000.00 0.00 0.00 18,000.00 33.33% 36,000.00 1,800.00 STAIR TOWERS- MONTHLY 01544 RENTAL 28,500.00 9,500.00 0.00 0.00 9,500.00 33.33% 19,000.00 350.00 STAIR TOWERS- 01545 DISMANTLE 6,700.00 0.00 0.00 0.00 0.00 0.00% 6,700.00 0.00 HOIST-EXTERIOR- 1546.1 SETUP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00 HOIST-EXTERIOR- RENTAL/OPERATI 1546.2 ON 139,040.00 0.00 0.00 0.00 0.00 0.00% 139,040.00 0.00 HOIST-EXTERIOR- 1546.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00 AIA Document G703'N-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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 5 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED (G_C) APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) HOIST-STAIR2-SET 1547.1 UP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00 HOIST-STAIR 2- RENTAL/OPERATI 1547.2 ON 139,040.00 0.00 0.00 0.00 0.00 0.00% 139,040.00 0.00 HOIST-STAIR 2- 1547.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00 HOIST-ROOM 100- 1548.1 SETUP 95,000.00 95,000.00 0.00 0.00 95,000.00 100.00% 0.00 9,500.00 HOIST-ROOM 100- RENTAL/OPERATI 1548.2 ON 211,000.00 187,250.00 4,500.00 0.00 191,750.00 90.88% 19,250.00 16,975.00 HOIST-ROOM 100- 1548.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0.00% 2,500.00 0.00 HOIST- ALLOWANCE-SET 1549.1 UP 9,830.00 0.00 0.00 0.00 0.00 0.00% 9,830.00 0.00 HOIST- ALLOWANCE- RENTAL/OPERATI 1549.2 ON 97,500.00 0.00 0.00 0.00 0.00 0.00% 97,500.00 0.00 HOIST- ALLOWANCE- 1549.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0.00% 2,500.00 0.00 01556 TRASH CHUTES-M 52,000.00 47,300.00 0.00 0.00 47,300.00 90.96% 4,700.00 4,490.00 01557 TRASH CHUTES-L 58,000.00 38,000.00 4,000.00 0.00 42,000.00 72.41 % 16,000.00 2,500.00 GENERAL CLEAN 01560 UP-M 5,000.00 3,740.00 0.00 0.00 3,740.00 74.80% 1,260.00 314.00 GENERAL CLEAN 01561 UP-L 60,000.00 42,600.00 3,000.00 0.00 45,600.00 76.00% 14,400.00 3,560.00 01562 FINAL CLEANING 65,000.00 0.00 0.00 0.00 0.00 0.00% 65,000.00 0.00 02110 EXCAVATION/BA 12,019.00 12,019.00 0.00 0.00 12,019.00 100.00% 0.00 1,201.90 AlA Document G703 TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 6 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) CKFILL-SUMPS-M EXCAVATIONBA CKFILL-SUMPS-L 02111 EQ 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 2,500.00 02240 SHORING 209,800.00 209,800.00 0.00 0.00 209,800.00 100.00% 0.00 20,980.00 CAST IN PLACE 03301 CONCRETE-M 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00% 0.00 1,000.00 CAST IN PLACE 03302 CONCETE-L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 3,500.00 PRECAST PLANKS-12" 03410 HOLLOW CORE 161,000.00 161,000.00 0.00 0.00 161,000.00 100.00% 0.00 16,100.00 PRECAST PLANKS-12" 03411 SOLID 898,000.00 898,000.00 0.00 0.00 898,000.00 100.00% 0.00 89,800.00 PRECAST 03412 PLANKS-6"SOLID 107,000.00 107,000.00 0.00 0.00 107,000.00 100.00% 0.00 10,700.00 PRECAST 03413 TRUCKING 82,000.00 82,000.00 0.00 0.00 82,000.00 100.00% 0.00 8,200.00 PRECAST 03414 ERECTION 186,000.00 186,000.00 0.00 0.00 186,000.00 100.00% 0.00 18,600.00 INTERIOR METAL FABRICATIONS- 05504 SUBMITTALS 102,000.00 102,000.00 0.00 0.00 102,000.00 100.00% 0.00 10,200.00 STEEL STAIRS 05505 WITH RAIL-M _ 179,000.00 179,000.00 0.00 0.00 179,000.00 100.00% 0.00 14,857.00 STEEL STAIRS 05506 WITH RAIL-L 80,000.00 73,000.00 0.00 0.00 73,000.00 91.25% 7,000.00 6,600.00 05507 LADDERS-M 26,000.00 26,000.00_ 0.00 0.00 26,000.00 100.00% 0.00 2,600.00 05508 LADDERS-L 12,500.00 12,500.00 0.00 0.00 12,500.00 100.00% 0.00 1,220.00 CATWALK 05509 FRAMING-M 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 6,300.00 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 7 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED o/o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE DATE (G_C) (C-G) RATE) APPLICATION (NOT IN D ORE) (D+E) (D+E+F) CATWALK 05510 FRAMING-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,710.00 MISCELLANEOUS 05511 METALS-M 441,000.00 410,550.00 15,000.00 0.00 425,550.00 96.50% 15,450.00 13,615.00 MISCELLANEOUS 05512 METALS-L .275,000.00 262,250.00 6,000.00 0.00 268,250.00 97.55% 6,750.00_ 8,094.30 INTERIOR ROUGH 06100 CARPENTRY-M 31,000.00 10,320.00 5,000.00 0.00 15,320.00_ 49.42% 15,680.00 372.00 INTERIOR ROUGH 06101 CARPENTRY-L 44,000.00 13,640.00 8,000.00 0.00 21,640.00 49.18% 22,360.00 484.00 FOUNDATION WATERPROOFING 07110 -M 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00% 0.00 510.00 FOUNDATION WATERPROOFING 07111 -L 6,600.00 6,600.00 0.00 0.00 6,600.00 100.00% 0.00 660.00 07210 DUCT L1NERS-M 97,000.00 97,000.00 0.00 0.00 97,000.00 100.00% 0.00 9,700.00 07211 DUCT LINERS-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,120.00 07810 FIRESTOPPING-M 24,000.00 16,800.00 0.00 0.00 16,800.00 70.00% 7,200.00 1,680.00 07811 FIRESTOPPING-L 16,000.00 12,200.00 0.00 0.00 12,200.00 76.25% 3,800.00 1,220.00 JOINT SEALANTS- 07910 M 35,000.00 0.00 0.00 0.00 0.00 0.00% 35,000.00 0.00 JOINT SEALANTS- 07911 L 80,000.00 0.00 0.00 0.00 0.00 0.00% 80,000.00 0.00 STEEL DOORS& 08110 FRAMES-M 73,000.00 71,500.00 1,500.00 0.00 73,000.00 100.00% 0.00 6,230.00 STEEL DOORS& 08111 FRAMES-L 33,000.00 24,550.00 0.00 0.00 24,550.00 74.39% 8,450.00 825.00 FLUSH WOOD 08140 DOORS-M 39,000.00 780.00 0.00 0.00 780.00 2.00% 38,220.00 78.00 FLUSH WOOD 08141 DOORS-L 15,000.00 0.00 0.00 0.00 0.00 0.00% 15,000.00 0.00 AIA Document G703"-1992.Copyright O 1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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 8 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.07 5 424091 2_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE PREVIOUS AND STORED TO FINISH (W VARIABLE NO. WORK VALUE THIS PERIOD STORED (G_C) APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) STILE&RAIL 08143 WOOD DOORS-M 127,000.00 0.00 8,800.00 0.00 8,800.00 6.93% 118,200.00 0.00 STILE&RAIL 08144 WOOD DOORS-L 34,000.00 2,540.00 0.00 0.00 2,540.00 7.47% 31,460.00 254.00 SOUND CONTROL DOORS& 08347 WINDOWS-M 352,000.00 9,000.00 0.00 0.00 9,000.00 2.56% 343,000.00 900.00 SOUND CONTROL DOORS& 08348 WINDOWS-L 50,000.00 0.00 0.00 0.00 0.00 0.00% 50,000.00 0.00 OVER COILING 08355 DOORS-M' 20,750.00 0.00 0.00 0.00 0.00 0.00% 20,750.00 0.00 OVERHEAR 08356 COILING DOORS-L 2,850.00 0.00 0.00 0.00 0.00 0.00% 2,850.00 0.00 ALUM.FRAMED ENTRANCES/STOR 08410 EFRONTS-M 176,000.00 29,520.00 0.00 0.00 29,520.00 16.77% 146,480.00 352.00 ALUM.FRAMED ENTRANCES/STOR 08411 EFRONS-L 69,700.00 0.00 0.00 0.00 0.00 0.00% 69,700.00 0.00 INTERIOR ALUM. DOORS& 08413 FRAMES-M 17,000.00 340.00 0.00 0.00 340.00 2.00% 16,660.00 34.00 INTERIOR ALUM. DOORS& 08414 FRAMES-L 6,000.00 0.00 0.00 0.00 0.00 0.00% 6,000.00 0.00 REVOLVING DOOR 08423 ENTRANCES-M 69,000.00 1,380.00 0.00 0.00 1,380.00 2.00% 67,620.00 138.00 REVOLVING DOOR 08424 ENTRANCES-L 9,500.00 0.00 0.00 0.00 0.00 0.00% 9,500.00 0.00 08440 GLAZED ALU,. 325,000.00 147,000.00 0.00 0.00 147,000.00 45.23% 178,000.00 11,375.00 AIA Document G703Tm-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 9 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) • A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) CURTAIN WALLS- M GLAED ALUM. CURTAIN WALLS- 08441 L 148,000.00 11,500.00 0.00 0.00 11,500.00 7.77% 136,500.00 0.00 08710 HARDWARE 525,000.00 446,000.00 0.00 0.00 446,000.00 84.95% 79,000.00 18,800.00 INTERIOR 08810 GLAZING-M 11,000.00 220.00 0.00 0.00 220.00 2.00% 10,780.00 22.00 INTERIOR 08811 GLAZ1NG-L 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00 FIRE PROTECTION 10440 SPECIALTIES-M 7,580.00 0.00 0.00 0.00 0.00 0.00% 7,580.00 0.00 FIRE PROTECTION 10441 SPECIALTIES-L 1,800.00 0.00 0.00 0.00 0.00 0.00% 1,800.00 0.00 10450 KNOX BOX 650.00 0.00 0.00 0.00 0.00 0.00% 650.00 0.00 LOADING DOCK 11130 EQUIPMENT-M 18,500.00 16,475.00 0.00 0.00 16,475.00 89.05% 2,025.00 1,647.50 LOADING DOCK 11131 EQUIPMENT-L 3,800.00 2,200.00 0.00 0.00 2,200.00 57.89% 1,600.00 220.00 ELEC.TRACTION ELEVATORS- 14210 ENGINEERING 157,200.00 157,200.00 0.00 0.00 157,200.00 100.00% 0.00 15,720.00 ELEC.TRACTION ELEVATORS- MATERIAL/EQUIP 14211 MENT 452,000.00 452,000.00 0.00 0.00 452,000.00 100.00% 0.00 40,000.00 ELEC.TRACTION 14212 ELEVATORS-L 186,000.00 114,000.00 18,000.00 0.00 132,000.00 70.97% 54,000.00 0.00 HYDRAULIC ELEVATOR- 14241 ENGINEERING 69,500.00 69,500.00 0.00 0.00 69,500.00 100.00% 0.00 6,950.00 14242 HYDRAULIC 183,000.00 183,000.00 0.00 0.00 183,000.00 100.00% 0.00 18,300.00 AIA Document G703T"-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 10 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H 1 WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY % FINISH NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G_C) (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) ELEVATOR- MATERIAL/EQUIP MENT HYDRAULIC ELEVATOR- 14243 LABOR 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 6,300.00 WHEELCHAIR LIFT- MATERIAL/EQUIP 14421 MENT 48,000.00 0.00 0.00 0.00 0.00 0.00% 48,000.00 0.00 WHEELCHAIR 14422 LIFT-PERMITS 2,200.00 0.00 0.00 0.00 0.00 0.00% 2,200.00 0.00 WHEELCHAIR 14423 LIFT-LABOR 14,000.00 0.00 0.00 0.00 0.00 0.00% 14,000.00 0.00 CHANGE ORDER 17001 NO.01 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 450.00 CHANGE ORDER 17002 NO.02 9,031.00 9,031.00 0.00 0.00 9,031.00 100.00% 0.00 0.00 CHANGE ORDER 17003 NO.03 2,196.00 300.00 0.00 0.00 300.00 13.66% 1,896.00 30.00 17000 CHANGE ORDER 4 NO.04 0.00 0.00 0.00 0.00 0.00_ 0.00% 0.00 0.00 17000 CHANGE ORDER 5 NO.05 98,741.00 98,741.00 0.00 0.00 98,741.00 100.00% 0.00 9,874.10 17000 CHANGE ORDER 6 NO.06 17,527.00 17,527.00 0.00 0.00 17,527.00 100.00% 0.00 1,400.00 17000 CHANGE ORDER 7 NO.07 11,292.00 11,292.00 0.00 0.00 11,292.00 100.00% 0.00 1,129.20 17000 CHANGE ORDER 8 NO.08 44,936.00 44,936.00 0.00 0.00 44,936.00 100.00% 0.00 4,493.60 17000 CHANGE ORDER 9 NO. 09 14,683.00 14,683.00 0.00 0.00 14,683.00 100.00% 0.00 0.00 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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 11 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) 17001 CHANGE ORDER 0 NO. 10 -760,330.00 -750,573.00 0.00 0.00 -750,573.00 98.72% -9,757.00 -38,016.50 GRAND TOTAL $11,901,076.00 $7,947,984.00 $314,751.00 $0.00 $8,262,735.00 69.43% $3,638,341.00 $595,053.80 • AIA Document G703TM—1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 12 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912_1 which expires on 05/10/2010,and is not for resale. User Notes: (1816808515) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X] PARTIAL [ ] PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Craig R. Dunkin , being duly sworn states that he is the President/Treasurer of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 18 has been received for work performed through 10/31/09 . (PARTIAL WAIVER)that there is due from the contractor the sum of Five Hundred Two Thousand Seven Hundred Forty-six dollars and 00/cents ($ 502,746.00 ) Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, . ithin the scope of this fid vit and waiver. W.R.Dunkin&Son,Inc. By /! % Title: President/Treasurer WITNESS MY HAND AND NOTARIAL SEAL,this 19th day of January ,2010 (Notary Pub c) My Commission Expires:January 08,2017 Printed Martha A. Carpenter Residing in Madison County V• AFFIDAVIT AND WAIVER OF/LIEN [ ]FINAL [X]PARTIAL H]PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Craig R. Dunkin , being duly sworn states that he is the President/Treasurer of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 18 has been received for work performed through 10/31/09 . (PARTIAL WAIVER)that there is due from the contractor the sum of Five Hundred Two Thousand Seven Hundred Forty-six dollars and 00/cents ($ 502,746.00 ) Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, . ithin the scope of this fid vit and waiver. W.R.Dunkin&Son,Inc. By / / Title:President/Treasurer WITNESS MY HAND AND NOTARIAL SEAL,this 19th day of January ,2010 (Notary Pub c) My Commission Expires:January 08,2017 Printed Martha A. Carpenter Residing in Madison County A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF R ARIABLE APPLICATION (NOT IN D OR E) DATE ) (D+E) (D+E+F) • 17001 CHANGE ORDER 0 NO. 10 -760,330.00 -750,573.00 0.00 0.00 -750,573.00 98.72% -9,757.00 -38,016.50 GRAND TOTAL $11,901,076.00 $7,947,984.00 $314,751.00 $0.00 $8,262,735.00 69.43% $3,638,341.00 $595,053.80 AlA Document G703" —1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®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 12 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 10:41:16 on 01/19/2010 under Order No.0754240912 1 which expires on 05/10/2010,and is not for resale. — User Notes: (1816808515)