Loading...
HomeMy WebLinkAboutWR Dunkin, Simplex Grinnell - $19,847.92 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 Scheduled Percent Amount of Amount of Value or Complete or Prior Current • Contract Contract Authorized Authorized Amount Amount Owed Disbursement Disbursement Amounts to be paid by Carmel Garage Development Company as per the Elevators,Fire Protection,and Pumps installment purchase contract Application 31 (WR Dunkin) November $ 15,000.00 2010 Application 24(Simplex Grinnell) $ 4,847.92 November 2010 Grand Total Total Due ` ' .• ,$ 19,847.92 ❑ CRC has inspected the portions of the PAC Equipment completed by Borrower to confirm the Percent Complete in the applicable column above. ❑ 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 meanings 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, 2010, by and between the same parties. Dated: /I-Al/o CITY OF CARMEL REDEVELOPMENT COMMISSION ilkiii_ 4, By Les S. Olds Printed Executive Director Title 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 Paid by Carmel Garage Development Company $ 26,885.00 February 2010 Paid by Carmel Garage Development Company $ 76,000.00 March 2010 Paid by Carmel Garage Development Company $ 67,200.00 April 2010 Paid by Carmel Garage Development Company $ 78,200.00 May 2010 Paid by Carmel Garage Development Company $ 194,920.00 June 2010 Paid by Carmel Garage Development Company $ 27,560.00 July 2010 Paid by Carmel Garage Development Company $ 12,000.00 August 2010 Paid by Carmel Garage Development Company $ 92,650.00 September 2010 Paid by Carmel Garage Development Company $ 407,140.00 October 2010 Paid by Carmel Garage Development Company $ 77,720.00 November 2010 Amount to be paid by Carmel Garage Development Company $ 15,000.00 WO . I. WO t ��: ` �` } ®current G702iC aT" — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition 35 TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A,#4050 CPA APPLICATION NO: 031 B Distribution to: Commission 777 3rd Ave. S.W. OWNER: One Civic Square Cannel, IN 46032 PERIOD TO:November 30,2010 CONSTRUCTION MANAGER: Carmel,IN 46032 ARCHITECT: FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Shiel Sexton Co.,Inc. CONTRACT DATE:May 08,2008 CONTRACTOR'../" CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:25310/2695-4050/2695 FIELD: Anderson,IN 46018 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 said by the Contractor for Work for which previous Continuation Sheet,MA Document G703,is attached. Certificates for Payment were issued and pax ents - :ived from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 2,268,700.00 payment shown herein is no due. 2.NET CHANGE BY CHANGE ORDERS $ 0.00 CONT:, _V,', R !n NKI . S• , I$•. 3.CONTRACT SUM TO DATE(Line 1±2) $ 2,268,700.00 By: L<L„..., f Date. November 22,2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 2,255,000.00 Slat, of:Indiana 04,147,_ MARTHA A.CARPENTER z NOTARY PUBLIC 5.RETAINAGE: County of:Madison 141=V," STATE OF INDIANA a. 5 %of Completed Work Subscribed and sworn to before "eoF"0 My Commission Expires 1-8-17 (Column D+Eon G703) $ 113,435.00 me this 22nd day of Nove • 0 / • 0 %of Stored Material Notary Public:Martha A.Carpenter 4 �g 41 (Column F on G703) $ 0.00 My Commission expires:January 08,2017 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 113,435.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 2,141,565.00 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 $ 2,126,565.00 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. � 8.CURRENT PAYMENT DUE $ 15,000.00 AMOUNT CERTIFIED $ kS1250 J 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 ared to conform with the amount certified.) (Line 3 less Line 6) $ 127,135.00 CONSTRUCTION MA / BY: '' :_` %� _ _ Date: 1/ 2- /0■ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH! y Total changes approved in previous months by Owner$ 0.00$ 0.00 By: `V Date: t 0 t Total approved this Month $ 0.00 $ 0.00 This Certificate is not negotiable. 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 CHANGES by Change Order $ 0.00 AIA Document G702/CMaTM—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 under the law.This document was produced by AIA software at 13:55:32 on 11/22/2010 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (809715513) t M1 • • ! } ‘ '0 cu, 1 ent G703TM - 1992 Continuation Sheet ATA Document, G702TM-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 031 B Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE: 11/15/2010 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. PERIOD TO: 11/30/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:25310 A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PREVIOUS PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (C'-C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) Steel Doors& 08110 Frames-M 73,000.00 73,000.00 0.00 0.00 73,000.00 100.00% 0.00 7,300.00 Steel Doors& 08111 Frames-L 33,000.00 33,000.00 0.00 0.00 33,000.00 100.00% 0.00 2,455.00 Flush Wood Doors- 08140 M 39,000.00 39,000.00 0.00 0.00 39,000.00 100.00% 0.00 878.00 08141 Flush Wood Doors-L 15,000.00 14,000.00 0.00 0.00 14,000.00 93.33% 1,000.00 200.00 Stile&Rail Wood 08143 Doors-M 127,000.00 127,000.00 0.00 0.00 127,000.00 100.00% 0.00 1,134.00 Stile&Rail Wood 08144 Doors-L 34,000.00 32,000.00 0.00 0.00 32,000.00 94.12% 2,000.00 0.00 Sound Control Doors 08347 &Windows-M 352,000.00 352,000.00 0.00 0.00 352,000.00 100.00% 0.00 900.00 Sound Control Doors 08348 &Windows-L 50,000.00 47,000.00 3,000.00 0.00 50,000.00 100.00% 0.00 0.00 Overhead Coiling 08355 Doors-M 20,750.00 20,750.00 0.00 0.00 20,750.00 100.00% 0.00 0.00 Overhead Coiling 08356 Doors-I 2,850.00 2,850.00 0.00 0.00 2,850.00 100.00% 0.00 0.00 Alum.Framed Entrances/Storefronts 08410 -M 176,000.00 176,000.00 0.00 0.00 176,000.00 100.00% 0.00 2,952.00 Alum.Framed Entrances/Storefronts 08411 -L 69,700.00 58,000.00 6,000.00 0.00 64,000.00 91.82% 5,700.00 0.00 08413 Interior Alum.Doors 17,000.00 17,000.00 0.00 0.00 17,000.00 100.00% 0.00 34.00 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 I prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:57:29 on 11/22/2010 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1732798074) 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 OR E) DATE (C-G) RATE) (D+E) (D+E+F) &Frames-M Interior Alum.Doors 08414 &Frames-L 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 0.00 Revolving Door 08423 Entrances-M 69,000.00 69,000.00 0.00 0.00 69,000.00 100.00% 0.00 6,738.00 Revolving Door 08424 Entrances-L 9,500.00 9,500.00 0.00 0.00 9,500.00 100.00% 0.00 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.Traction 14212 Elevators-L 186,000.00 176,000.00 5,000.00 0.00 181,000.00 97.31 % 5,000.00 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 Lift- 14421 Material/Equipment 48,000.00 48,000.00 0.00 0.00 48,000.00 100.00% 0.00 0.00 Wheelchair Lift- 14422 Permits 2,200.00 2,200.00 0.00 0.00 2,200.00 100.00% 0.00_ 0.00 Wheelchair Lift- 14423 Labor 14,000.00 13,000.00 1,000.00 0.00 14,000.00 100.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 GRAND TOTAL $2,268,700.00 $2,240,000.00 $15,000.00 $0.00 $2,255,000.00 99.40% $13,700.00 $113,435.00 AIA Document G703'",-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:57:29 on 11/22/2010 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1732798074) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [X] PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Payment for Application # 32A for work performed through 1 1/30/10 , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of One hundred Thirty-seven Thousand Seven Hundred Thirty-three dollars and 00/cents ($ 137,733.00 ) Payment for Application # 31B for work performed through 11/30/10 , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of Fifteen Thousand dollars and 00/cents ($ 15,000.00 ) 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 a . - nd further certifies that no other party has any claim or right to a lien on account of an work per armee or ateri furnished to the undersigned for said project,and within the sco p, e , dTt and/aiver. W.R.Dunkin&Son,Inc. : f��/ �/ Title: Project Manager WITNESS MY HAND AND NOTARIA SEAL,this 22nd day of November ,2010 2 - /L� � . )4/u (Notary Pub/ My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County o°%,�, MARTHA A.CARPENTER z �4 NOTARY PUBLIC ` ,�, STATE OF INDIANA �cc My Commission Expires 1-8-17 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 Paid by Carmel Garage Development Company $ 1,779.91 February 2010 Paid by Carmel Garage Development Company $ 9,060.00 March 2010 Paid by Carmel Garage Development Company $ 42,698.50 April 2010 Paid by Carmel Garage Development Company $ 26,020.00 May 2010 Paid by Carmel Garage Development Company $ 5,463.00 July 2010 Paid by Carmel Garage Development Company $ 3,838.00 August 2010 Paid by Carmel Garage Development Company $ 851.00 September 2010 Paid by Carmel Garage Development Company $ 4,001.17 November 2010 Amount to be paid by Carmel Garage Development Company $ 4,847.92 � $ = .../ Document 6702/CMa TM — 1992 /Is Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 2 4 Distribution to: Carmel Redevelopment Comm. Parcel 7A Regional- . One Civic Square Performing Arts Center PERIOD T0: November 30 , 2010 OWNER ❑ Carmel, IN 46032 CONSTRUCTION MANAGER kl 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 Indianapolis, IN 46236 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CSO Architects ❑ 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 Payme , were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 615 , 539 . 00 payment shown herein • now due. 2. Net change by Change Orders $ 4 9 , 571 . 00 CONTRAC OR: 3.CONTRACT SUM TO DATE(Line.1 ±2) $ 664 , 9 3 0 . 0 0 By: AL LILA Date: November 17 , 2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 646, 635 . 00 State of:'Indi.na . o o — s , see s 5.RETAINAGE: County of: Marion PAULA K. LEWIS ( a. S %of Completed Work Subscribed and sworn to before Notary Public-Seal (Column D+Eon G703) $ 30 , 746 . 50 me this 17 t��X=r, 2010 1 State of Indiana b. %of Stored Material Notary Public , My Commission Expires Aug 12, 2017 (Column F on G703) $ 0 . 00 My Commission expires: 8-12-2017 do•r-^y-_ ` 4r. Total Retainage(Lines 5a+5b or Total in Column I of G703). $ 30 , 746 . 50 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 615 , 88A - 50 In accordance with the Contract Documents, based on on-site observations and the data comprising 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 $ 611 , 040 . 58 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 1Z 8.CURRENT PAYMENT DUE $ 4 , 847 . 92 AMOUNT CERTIFIED $ 4 1 7 f 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Application and oh the Continuation S eet tha e changed to conform with the amount certified.) (Line 3 less Line 6) $ 49 , 041 . 50 CONST•UCTIO t4I:. : , ArI L _ Date: 1/ 24 I G By: ■i. r� II CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI T. Total changes approved in previous months by Owner $74 , 721 $ (25 , 150) By: ill Date: el I.g Total approved this Month $ 0 $ 0 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable o ly to the Contractor . TOTALS $74 , 721 $ (25 , 150) named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 49 5 71 . 0 the Owner or Contractor under this Contract. i 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 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 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. ■ i'AJA Document G702/CMaTM - 1992 Instructions 4-7/4 Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702JCMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. . Construction Change Directives:Amounts not in dispute that have been included'in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3:in A201/CMa. • E.Making Payment ;• •The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name and.address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G702/CMa TM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA' 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.: 24 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 11/18/2010 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 11/30/2010 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 OR E) (D+E+F) (C-G) 10000 ADMINISTRATION 10010 Bonds&Insurance $4,500.00 $4,500.00 $0.00 $0.00 $4,500.00 100% $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 $15,984.00 $15,984.00 $0.00 $0.00 $15,984.00 100% $0.00 $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 $123.81 $12,381.00 100% $0.00 $0.00 30030 Standpipe $17,024.00 $17,024.00 $0.00 $0.00 $17,024.00 100% $0.00 $0.00 30040 Basement $49,602.00 $49,602.00 $0.00 $0.00 $49,602.00 100% $0.00 $0.00 Simplex rinnel! DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 24 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 11/18/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11/30/2010 Use Column I on Contracts where variable retainage for line items may apply. PROJECT NO.: 2695-4280 A B C D E F G 1-I 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) 30050 Plenum Level $17,179.00 $17,007.21 $0.00 $171.79 $17,179.00 100% $0.00 $0.00 30060 Orchestra Low Level $26,620.00 $26,353.80 $0.00 $266.20 $26,620.00 100% $0.00 $0.00 30070 Orchestra High Level $15,012.00 $14,861.88 $0.00 $150.12 $15,012.00 100% $0.00 $0.00 30080 Box Tier Level $31,572.00 $29,993.00 $0.00 $1,579.00 $31,572.00 100% $0.00 $0.00 30090 Balcony Low Level $16,328.00 $15,512.00 $0.00 $816.00 $16,328.00 100% $0.00 $0.00 30100 Balcony High Level $34,822.00 $33,081.00 $0.00 $1,741.00 $34,822.00 100% $0.00 $0.00 30110 Attic 50 ft Level $4,333.00 $4,333.00 $0.00 $0.00 $4,333.00 100% $0.00 $0.00 30120 Attic 66 ft. Level $9,673.00 $9,673.00 $0.00 $0.00 $9,673.00 100% $0.00 $0.00 30130 Attic 80 ft. level $15,554.00 $15,554.00 $0.00 $0.00 $15,554.00 100% $0.00 $0.00 ALLOWANCE $0.00 $0.00 $0.00 $0.00 $0.00 0% $0.00 $0.00 4280A-001 $1,940.00 $1,940.00 $0.00 $0.00 $1,940.00 100% $0.00 $0.00 4280A-002 $911.00 $911.00 $0.00 $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 $531.00 $0.00 $0.00 $531.00 100% $0.00 $0.00 4280A-005 $5,064.00 $5,064.00 $0.00 $0.00 $5,064.00 100% $0.00 $0.00 4280A-006 $614.00 $614.00 $0.00 $0.00 $614.00 100% $0.00 $0.00 4280A-007 $14,236.00 $14,236.00 $0.00 $0.00 $14,236.00 100% $0.00 $0.00 2695-4280-04 Addtion $13,445.00 $0.00 $0.00 $0.00 $0.00 0% $13,445.00 $0.00 4280A-009 $2,765.00 $2,765.00 $0.00 $0.00 $2,765.00 100% $0.00 $0.00 4280A-010 $1,656.00 $1,656.00 $0.00 $0.00 $1,656.00 100% $0.00 $0.00 4280A-012 $1,361.00 $1,361.00 $0.00 $0.00 $1,361.00 100% $0.00 $0.00 4280A-013 $501.00 $501.00 $0.00 $0.00 $501.00 100% $0.00 $0.00 4280A-014 $1,976.00 $1,976.00 $0.00 $0.00 $1,976.00 100% $0.00 $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 Change Order 1 ($25,150.00) $0.00 $0.00 $0.00 0% ($25,150.00) $0.00 Change Order 2 $20,120.00 $0.00 $0.00 $0.00 0% $20,120.00 $0.00 SimplexGrinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 24 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 11/18/2010 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 11/30/2010 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 1 WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED BALANCE RETAINAGE NO. VALUE APPLICATION TI-IIS 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) Steel Issue $50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $0.00 $0.00 TOTALS $664,930.00 $641,787.08 $0.00 $4,847.92 $646,635.00 97% $38,415.00 $0.00 SimplexGrinnell 11820 Pendleton Pike, Indianapolis,IN 46236 tgcci Fire & Security SimplexGrinnell CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT Upon receipt by the undersigned of a check from Carmel Redevelopment (Maker of Check) in the sum of$ , 4 , 8 4 7 . 9 2 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 Carmel Redevelopment (Owner) located at Carmel 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 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: November 17, 2010 SimplexGrinnell BY: (/ ichaLl M. MacD•• ald ,/ Q. • ems. PAULA K. LEWIS Notary Public- Seal State of Indiana My Commission Expires Aug 12,2017 Offices&Representatives in Pnncipal Cities throughout the World . . _.. x ,x� R