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HomeMy WebLinkAboutWR Dunkin, Simplex Grinnell - $14,613 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 ��jj������ Amount Amount Owed Disbursement Disbursement Amount to be paid by Carmel�l+ed�tei9 t Development as per the Elevators,Fire Protection,and Pumps installment purchase contract Application 32 (WR Dunkin) January $ 13,700.00 2011 Application 26 (Simplex) January 2011 $ 913.00 Grand Total Total'DUe • - .' ' . , $ 14,613.00 / CRC has inspected the portions of the PAC Equipment completed by Borrower to confirm the Percent Complete in the applicable column above. 1 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 Lo n Agreement, dated January 28, 2010, by and between the same parties. Dated: Z. 2y// CITY OF CARMEL REDEVELOPMENT COMMISSION • 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 Paid by Carmel Garage Development Company $ 15,000.00 January 2011 Amount to be paid by Carmel Garage Development Company $ 13,700.00 MVP s A PocuientG732TM i . ocu . .{ent 7 200 . I Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A,#4050 CPA APPLICATION NO:032 B DISTRIBUTION TO: Commission Carmel,IN 46032 OWNER Carmel,IN 46032 PERIOD TO:January 31,2011 CONSTRUCTION MANAGER FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Shiel Sexton Co.,Inc. CONTRACT DATE: ARCHITECT CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:25310/2695-4050/2695 CONTRACTOR 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 of the Contractor's knowledge, information and belief the Work covered by this Application for Pa fnent 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 bee. .aid by the Contractor for Work for which previous AIA Document G703TM Continuation Sheet,is attached. Certificates for Payment vee?e issued a I. ents rece' fed from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 2,268,700.00 payme is.•.9etefn i a'w due. / 2.NET CHANGES IN THE WORK $ 0.00 C,ONTRAC •-. W ' I/U IN/. .0 , IN . 3.CONTRACT SUM TO DATE(Line 1±2) $ 2,268,700.00 I • irz/I`/_ (■ Date: January 17,2011 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ 2,268,700.00 Stat of:Indiana / 5.RETAINAGE: County of:Madison a. 5 %of Completed Work Subscribed and sworn to before (Column D+E on G703) $ 113,435.00 me this 17th day of January, 2-011 ' b. 0 %of Stored Material Notary Public:Martha A.Carpenter "/rte%t /._/-- ( •" .I' (Column F on G703) $ 0.00 My Commission expires:January 08,2017 Total Retainage(Lines 5a+5b, or Total in Column Ion G703) $ 113,435.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 2,155,265.00 In accordance with the Contract Documents, based on evaluations of the Work and the data (Line 4 minus Line 5 Total) comprising this application,the Construction Manager and Architect certify to the Owner that to the 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 2,141,565.00 best of their knowledge, information and belief the Work has progressed as indicated,the quality of (Line 6from prior Certificate) the Work is in accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 8.CURRENT PAYMENT DUE $ 13,700.00 AMOUNT CERTIFIED $ I?j 100 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fro-1 the amount applied.Initial all figures on this Application and o he Continuation Sh, that re ch.nged to conform with the amount certified) (Line 3 minus Line 6) $ 113,435.00 CON TRUCTION a AG 7'. _ _ 'r1 ®( 3/ BY: .i!i: . �i_�!_.�`�`i Date: �� SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS AR -''r . '" ultiple Prime Contractors are responsible for perform ling rtions of the Project raid hi;e1's Certification is not required) Total changes approved in previous months by Owner $ 0.00$ 0.00 i ._- 1 Total approved this month including Construction By — �+ t ;� r"� Date: ���� Change Directives $ 0.00 $ 0.00 This Ceruucate is not negonaulc. 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 IN THE WORK $ 0.00i AIA Document G732T"—2009(formerly G702T"CMa—1992).Copyright©1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted I to the maximum extent possible under the law.This document was produced by AIA software at 15:15:36 on 01/20/2011 under Order No.0168420739_1 which expi es on 05/10/2011,and is not for resale. User Notes: Director of Redevelopment X14/6 d7 (963866947) , r t I 1 , ..,• - _.% i' I`4 Document 7037M - 1992 _ IeY Continuation Sheet MA Document,G702TM-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 32 B Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE:01/17/2011 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO:01/31/2011 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 FROM PRESENTLY 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) 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 1,000.00 0.00 15,000.00 100.00% 0.00 200.00 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 2,000.00 0.00 34,000.00 100.00% 0.00 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 50,000.00 0.00 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 64,000.00 5,700.00 0.00 69,700.00 100.00% 0.00 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 O 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 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 15:10:57 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (725181538) 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 STORED AND STORED TO (G±C) FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR 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 186,000.00 181,000.00 5,000.00 0.00 186,000.00 100.00% 0.00 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 14,000.00 0.00 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 $2,255,000.00 $13,700.00 $0.00 $2,268,700.00 100.00% $0.00 $113,435.00 AIA Document G703T"-1992.Copyright O 1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:10:57 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (725181538) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [X]PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Payment for Application # 32B for work performed through 1/31/11 , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of Thirteen Thousand Seven Hundred dollars and 00/cents ($ 13,700.00 ) Payment for Application # for work performed through 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 dollars and 00/cents ($ 0.00 ) 3 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 erfo eIi or material furnished to the undersigned for said project,and within the scope of is affidavit and/waiver. W.R.Dunkin&Son, Inc. : , Title: Project Manager WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 Ari (Notary Publi Commission Expires:January 08,2017 Printed Martha A. Carpenter Residing in Madison County AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [ ]PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Bradley A. 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. Application for Payment # A has been received for work performed through 11/30/11 . (PARTIAL WAIVER)that there is due from the contractor the sum of dollars and 00/cents ($ 0.00 ) Application for Payment # 31B has been received for work performed through 11/30/11. (FINAL WAIVER)that the final balance due from the Owner is the sum of Fifteen Thousand dollars and 00/cents($ 15,000.00 ) 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 acct of any work performed or material furnished to the undersigned for said project and jjthin t ( cope idavi .nd waiver. W.R.Dunkin&Son,Inc. ':''r � Title: Project Manager O WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 (----Att.,(4-) - , 10 otary Pub c) My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County 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 Paid by Carmel Garage Development Company $ 4,847.92 December 2010 Paid by Carmel Garage Development Company $ 10,750.00 January 2011 Amount to be paid by Carmel Garage Development Company $ 913.00 `� �'� ==-!� Document G702/CMa TM - 1992 q3 Application and Certificate for Payment Construction Manager-Adviser Edition . TO OWNER: PROJECT: APPLICATION NO: 2 6 PERIOD T0; ;,,:1 Distribution to: Carmel Redevelopment Comm. Parcel 7A Regional -3:1 One Civic;°Square Performing Arts Center -2 011 OWNER ❑ Carmel, . IN 46032 CONSTRUCTION MANAGER kl FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 6-20-2009 ARCHITECT ❑ SimplexGrinnell LP Shiel Sexton C. PROJECTNOS: 2695 / 4280 I CONTRACTOR ❑ 11820 Pendleton Pike VIA ARCHITECT: FIELD ❑ Indianapolis, IN 46236 CONTRACT FOR: Auto Fire ProtectionCSO Architects ❑ 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 th' Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents, that al a' ounts have been paid by the Co•tractor for Work for which previous Certificates for Payment • e issued and payments receiv'• from the Owner, and that current 1.ORIGINAL CONTRACT SUM $615 , 359 . 0 0 payment shown herein is o' due. 2.Net change by Change Orders • $ 49 , 571 . 0 0 CONTRACTO- 6 6 By: `` 1/- i a e.' .r 3.CONTRACT SUM TO DATE(Line 1 +2) $ 4, 9 3 0 . 0 0 /�i 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $6 5 8 , 2 9 8 . 0 0 State of: nd i ana PAULA K. LEWIS Notary Public-Seal 5.RETAINAGE: County of: Marion State of Indiana a. 5 %of Completed Work Subscribed and sworn to before My Commission Expires Aug 12,201 (Column.D+EonG703) $ 30 , 746 . 50 me this 24th day ofJanu��r/y, 2011 b. '%of Stored Material - Notary Public: 9� �'�' j (Column F on G703) $ 0 . 00 My Commission expires: 8-12-2017 Total Retainage(Lines 5a+5b or Total in Column I of G703)., $ 30 , 746 . 50 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 627 , 551 . 5 0 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 $ 626 , 638 . 50 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 9 ea 8.CURRENT PAYMENT DUE • $ 913 . 00 AMOUNT CERTIFIED • $ {13 --- 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fr 'e amount applied.Initial all figures on this Application and on the Continuation Sheet that e hanged to conform with the amour t certified.) .. (Line 3 less Line 6) $ 37 , 378 . 50 CONS - CTION GE;." • . By: '►,� �-e;t i1L�r- 1. '- Date: ©I 5 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH! �• ', Total changes,approved in previous months by Owner $7 4 , 721 $(25 , 150) By: A, . Date: 01 1;k II Total approved this Month $ $ This :rtificate '•,now eg�fiable. Tie AMOUNT CERTIFIED is payable onl to the Contractor TOTALS $7 4 , 721 $(2 5 , 15 0) nam� herein.) suance, I:+ayment d acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 49 , 571 . 00 the Q wnery ontractor u Ydde is 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. n 1I/ 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. IY 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. Director of Redevelopment /y1(608-©'7 Document G702/CMaTM - 1992 Instructions 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 G702/CMa 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 Section7.3 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. - -:1; AIA Document G702/CMa TM-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 a're 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. Simplex-Grinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 26 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 01/20/2011 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 01/31/2011 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 $4,500.00 $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 $12,381.00 $0.00 $0.00 $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 SiniplexGrinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 26 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 01/20/2011 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/31/2011 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 $17,179.00 $0.00 $0.00 $17,179.00 100% $0.00 $0.00 30060 Orchestra Low Level $26,620.00 $26,620.00 $0.00 $0.00 $26,620.00 100% $0.00 $0.00 30070 Orchestra High Level $15,012.00 $15,012.00 $0.00 $0.00 $15,012.00 100% $0.00 $0.00 30080 Box Tier Level $31,572.00 $31,572.00 $0.00 $0.00 $31,572.00 100% $0.00 $0.00 30090 Balcony Low Level $16,328.00 $16,328.00 $0.00 $0.00 $16,328.00 100% $0.00 $0.00 30100 Balcony High Level $34,822.00 $34,822.00 $0.00 $0.00 $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 $1,782.00 $0.00 $0.00 $0.00 $0.00 0% $1,782.00 $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 4280A-015 $4,019.00 $4,019.00 $0.00 $0.00 $4,019.00 100% $0.00 $0.00 4280A-016 $5,463.00 $5,463.00 $0.00 $0.00 $5,463.00 100% $0.00 $0.00 4280A-018 $549.00 $549.00 $0.00 $0.00 $549.00 100% $0.00 $0.00 4280A-019 $719.00 $719.00 $0.00 $0.00 $719.00 100% $0.00 $0.00 4280A-020 $913.00 $0.00 $913.00 $913.00 100% $0.00 $0.00 SimplexGrinnell DETAIL AND CONTINUATION SHEET APPLICATION AND CERTIFICATE FOR PAYMENT, SimplexGrinnell LP APPLICATION NO.: 26 containing Contractor's signed Certification, is attached. CARMEL PERFORMING ARTS APPLICATION DATE: 01/20/2011 In tabulations below, amounts are stated to the nearest dollar. PERIOD TO: 01/31/2011 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) FINISI-I RATE D OR E) (D+E+F) (C-G) - 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 Steel Issue $50,000.00 $50,000.00 $0.00 $0.00 $50,000.00 100% $0.00 $0.00 TOTALS $664,930.00 $657,385.00 $913.00 , $0.00 $658,298.00 99% $6,632.00 $0.00 SimplexGrinnell 11820 Pendleton Pike,Indianapolis,IN 46236 NCO Fire & Security SimplexGrinnell CONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT Upon receipt by the undersigned of a check from Carmel Redevelopment (Maker of Check) in the sum of$ 913 . 00 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 . l3efore any recipient of this document relies on it, the party should verify evidence of payment to the undersigned. DATED: Jarruary 24 2011 SimplexGrinne,l (citt BY: Michael M. MacDonald Offices&Representatives in Principal Cities throughout the World