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HomeMy WebLinkAboutGeneral Pipingl - $44,163.60 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 Amount to be paid by Carmel Garage Development as per the Elevators,Fire Protection,and Pumps installment purchase contract Application 21 (General Piping) June $ 8,799.60 2010 Application 22(General Piping) July 2010 $ 10,968.00 Application 23(General Piping) August $ 5,484.00 2010 Application 24(General Piping) $ 13,710.00 September 2010 Application 25(General Piping) October $ 2,742.00 2010 Application 26(General Piping) $ 2,460.00 November 2010 Grand Total Total $ 44;163'.60 1 CRC has inspected the portions of the PAC Equipment completed by Borrower to confirm the Percent Complete in the applicable column above. C 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: ///// CITY OF CARMEL REDEVELOPMENT COMMISSION By Les S. Olds Printed Executive Director Title 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 $ - Paid by Carmel Garage Development Company $ 1,327.72 February 2010 Paid by Carmel Garage Development Company $ 4,177.72 March 2010 Paid by Carmel Garage Development Company $ 2,545.20 April 2010 Paid by Carmel Garage Development Company $ 3,746.40 May 2010 Paid by Carmel Garage Development Company $ 3,109.20 June 2010 Amount to be paid by Carmel Garage Development Company $ 8,799.60 July 2010 Amount to be paid by Carmel Garage Development Company $ 10,968.00 August 2010 Amount to be paid by Carmel Garage Development Company $ 5,484.00 September 2010 Amount to be paid by Carmel Garage Development Company $ 13,710.00 October 2010 Amount to be paid by Carmel Garage Development Company $ 2,742.00 November 2010 Amount to be paid by Carmel Garage Development Company $ 2,460.00 v A 7 Z r Document G702/C a TM — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:021 S Distribution to: OWNER: PERIOD TO:June 30,2010 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: 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 payment 1. ORIGINAL CONTRACT SUM $ 643,496.00 shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: i/`//J 3. CONTRACT SUM TO DATE(Line 1±2) $ 643,496.00 By: �/ Date: June 23,2010 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 607,583.60 State of:Indiana 5. RETAINAGE: County of:Hendricks a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 54,549.71 me this A.3 day of J v vi e f zoo L—‘ 4_ _ b. 0 %of Stored Material Notary Public:Luke Roseboom (Column F on G703) $ 0.00 My Commission expires:July 07,2012 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 553,033.89 In accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 544,234.29 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 $ 8,799.60 AMOUNT CERTIFIED $ 8,799.60 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs fro , .mount applied.Initial all figures on this Application and on the Continuation Sheet that• • ged to conform with the amount certified.) (Line 3 less Line 6) $ 90,462.11 CON RUCTION i AG_-: / / I O By: \*i .►.'ice%Yif/v ! Date: ®�jl CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC CT: / Total changes approved in previous months by Owner$ 0.00$ 0.00 By: ' Date: r�'(o/?.t2/t'�' Y� CCC!!! Total approved this Month $ 0.00$ 0.00 This Certifica of negotiable.The AMOUNT CERTIFIED is payable only to the ontractor named TOTALS $ 0.00$ 0.00 herein.Issu. ,payment and acceptance of payment are without prejudice to any rights of the Owner or Contract r under this Contract. NET CHANGES by Change Order $ 0.00 AIA Document G7021CMa''—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 1 under the law.This document was produced by AIA software at 08:36:36 on 06/23/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (1917215595) •AIA 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:06/23/2010 In tabulations below,amounts are in US dollars. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:06/30/2010 ARCHITECT'S PROJECT NO:NA 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) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 25,840.80 532.80 0.00 26,373.60 99.00% 266.40 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 10,968.00 8,226.00 0.00 19,194.00 35.00% 35,646.00 274.20 104 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 4,039.20 40.80 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 9,039.90 GPI#23B-Storm 212 Water Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00% 0.00 3,069.30 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 AIA Document G703 TN-1992.Copyright m 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 AIAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to I the maximum extent possible under the law.This document was produced by AIA software at 08:35:14 on 06/23/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (1748055662) A B C D E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY /o 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) GRAND TOTAL $643,496.00 $598,784.00 $8,799.60 $0.00 $607,583.60 94.42% $35,912.40 $54,549.71 AIA Document G703"1—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 prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 08:35:14 on 06/23/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (1748055662) Application#21b Affidavit and Waiver of Lien [ ] Final [x] Partial [x] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping,Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A,Regional Performing Arts Center located at 211 City Center Drive Carmel,IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Eight Thousand Seven Hundred Ninety Nine Dollars and 60 Cents ($8,799.60) [ x] receipt of which is hereby acknowledged; or [ ] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping,Inc. i Secretary/Treasurer (Finn) (A/ orized Representative) (Title) Witness my hand and Notorial Seal, this 23rddd'ay of Augfst,2010 Luke Roseboom_ �Gii`' ""�''e• (Printed) (Notary Public) My Commission Expires: July 7,2012 Residing in Hendricks County v . == Document G702/CMa - 1992 t1f Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:022 3, Distribution to: OWNER: PERIOD TO:July 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:NA/2829/NA CONTRACTOR: Indianapolis,IN 46234 FIELD: CONTRACT FOR: 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 payment 1. ORIGINAL CONTRACT SUM $ 643,496.00 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: ?/21)1i6 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 618,551.60 State of: o0K� 5. RETAINAGE: County of: Lh 3 r,,,...k&, a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 54,549.71 me this .20 day of .3u( i 2.4510 b. 0 %of Stored Material Notary Public: W k Wk c Pose vy ---7 (Column F on G703) $ 0.00 1.1y Commission ex.ires: I Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 54,549.71 CERTIFICATE FOR PAYMENT , 6. TOTAL EARNED LESS RETAINAGE $ 564,001.89 In accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 553,033.89 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 $ 10,968.001 AMOUNT CERTIFIED $ 10,968.00 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 th hanged to conform with the amount certified.) (Line 3 less Line 6) $ 79,494.11 CONS RUCTIO `NA ER: BY: \J��_►ti_► i.._. %! .— Date: ®7 z 1/IO CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH - A Ti f I Total changes approved in previous months by Owner$ 0.00$ 0.00 By: (. f I. Date: '1 a lSf Total approved this Month $ 0.00$ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contract r named TOTALS $ 0.00$ 0.00 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 G702VCMan'-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 AIA®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 09:53:20 on 07/20/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1646997611) 11 i J. 11 •=_ Document G703 ® 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:022 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. APPLICATION DATE:07/20/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:07/31/2010 ARCHITECT'S PROJECT NO:NA 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 DATE (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 26,373.60 0.00 0.00 26,373.60 99.00% 266.40 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 19,194.00 10,968.00 0.00 30,162.00 55.00% 24,678.00 274.20 104 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 4,080.00 0.00 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 9,039.90 GPI#23B-Storm 212 Water Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00% 0.00 3,069.30 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 AIA Document G703TM-1992.Copyright m 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 AlA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to 1 the maximum extent possible under the law.This document was produced by AIA software at 09:52:16 on 07/20/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (2035510117) A B C D E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED e BALANCE TO RETAINAGE /o ITEM DESCRIPTION OF SCHEDULED 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) GRAND TOTAL $643,496.00 $607,583.60 $10,968.00 $0.00 $618,551.60 96.12% $24,944.40 $54,549.71 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 prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 09:52:16 on 07/20/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (2035510117) CONDITIONAL WAIVER AND RELEASE ON PROGRESS PAYMENT PROJECT: Carmel Performing Arts Center Upon receipt by the undersigned of a check from City of Carmel Rdvlpmnt Comm. in the sum of $10,968.00 payable to General Piping Inc. and when the check has been properly endorsed and has been paid by the bank on which it is drawn, this document becomes effective to release any mechanic's lien, stop notice, any state or federal statutory bond right, any private bond right, any claim for payment and any rights under any similar ordinance, rule or statute related to claim or payment rights for persons in the undersigned's position, the undersigned has on the job of City of Carmel Rdvlpmnt Comm. located at 777 3rd Ave. SW, Carmel, IN 46032 to the following extent. This release covers a progress payment for labor, services, equipment or materials furnished to the jobsite or to City of Carmel Rdvlpmnt Comm. through 07/31/10 only and does not cover any retentions retained before or after the release date; extras furnished before the release date for which payment has not been received; extras or items furnished after the release date or pending modifications and changes. Rights based upon work performed or items furnished under a written change order which has been fully executed by the parties prior to the release date are covered by this release unless specifically reserved by the claimant in this release. This release of any mechanic's lien, stop notice or bond right shall not otherwise affect the contract rights, including rights between parties to the contract based upon a rescission, abandonment, or breach of the contract, or the right of the undersigned to recover compensation for furnished labor, services, equipment, or material covered by this release if that furnished labor, services, equipment or material was not compensated by the progress payment. The undersigned warrants that he either has already paid or will use the monies he receives from this progress payment to promptly pay in full all of his laborers, subcontractors, materialmen and suppliers for all work, materials, equipment or services provided for or to the above-referenced project up to the date of this waiver. Before any recipient of this document relies on it, said party should verify evidence of payment to the undersigned. DATE: 71 2-0 I to General Piping Inc. K* ' i r (s atu e Sec.. fi . (title) v S y ==l•�- Document 6702/CMa TM ® 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:023 , Distribution to: OWNER: PERIOD TO:August 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:NA/2829/NA CONTRACTOR: Indianapolis,IN 46234 FIELD: CONTRACT FOR: 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,MA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner,and that current payment 1. ORIGINAL CONTRACT SUM $ 643,496.00 shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: V.----,(;. 3. CONTRACT SUM TO DATE(Line 1±2) $ 643,496.00 By: Date: f)2411a 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 624,035.60 State of: n dikvl 5. RETAINAGE: County of:1-1,0,4 in CkS a. 100 %of Completed Work Subscribed and sworn to before o2 (Column D+Eon G703) $ 54,549.71 me this q day of 4u/ ...,0/0 b. 0 %of Stored Material Notary Public: Luke Q7SSP�o4 Lit4- (Column F on G703) $ 0.00 My Commission expires: 7/7 2 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 569,485.89 In accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 564,001.89 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 $ 5,484.00 AMOUNT CERTIFIED $ 5,484.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs fro , e., ount applied.Initial all figures on this Application and on t - ontinuation Sliee hat. e chant ed to conform with the amount certified.) (Line 3 less Line 6) $ 74.010.11 CO -TRUCTION M. ER: / By: it_._W:2-:eI/.iS[`ik. Date: ®O SO)/0 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC ' . Total changes approved in previous months by Owner$ 0.00$ 0.00 By: I' Date: *30 11S25 Total approved this Month $ 0.00$ 0.00 This Certi I ate is no negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named TOTALS $ 0.00$ 0.00 herein.Is:uance, •.yment and acceptance of payment are without prejudice to any rights of the Owner or Contr.cto . der 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 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 1 under the law.This document was produced by AIA software at 08:02:35 on 08/24/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (946287482) ;"•'‘. " -• \ 7. . Document G703TM - 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 023 containing Contractor's signed certification is attached. APPLICATION DATE:08/20/2010 In tabulations below, amounts are in US dollars. Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO:08/31/2010 ARCHITECT'S PROJECT NO:NA A B C D E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY /o NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 26,373.60 0.00 0.00 26,373.60 99.00% 266.40 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 30,162.00 5,484.00 0.00 35,646.00 65.00% 19,194.00 274.20 104 Material 11 1,082.00 111,082.00 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 4,080.00 0.00 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 9,039.90 GPI#23B- Storm 212 Water 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 $618,551.60 $5,484.00 $0.00 $624,035.60 96.98% $19,460.40 $54,549.71 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 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 1 the maximum extent possible under the law.This document was produced by AIA software at 08:03:21 on 08/24/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1245802825) Application #23b Affidavit and Waiver of Lien [ ] Final [ x] Partial [ ] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping, Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Five Thousand Four Hundred Eighty Four Dollars and 00 Cents ($5,484.00) [ ] receipt of which is hereby acknowledged; or [ x] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping, Inc. Secretary/Treasurer (Firm) (Authorize."epresentative) (Title) Witness my hand and Notorial Seal, this 24th day o Au• 20 ! ,diar Luke Roseboom /(_ (Printed) (Notary Public) My Commission Expires: July 7, 2012 Residing in Hendricks County Application#21b Affidavit and Waiver of Lien [ ] Final [ x ] Partial [ x ] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping, Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Eight Thousand Seven Hundred Ninety Nine Dollars and 60 Cents ($8,799.60) [ x ] receipt of which is hereby acknowledged; or [ ] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping,Inc. Secretary/Treasurer (Firm) (A orized Representative) (Title) Witness my hand and Notorial Seal, this 3`d • .y of u st 2010 Luke Roseboom (Printed) (Notary Public) My Commission Expires: July 7, 2012 Residing in Hendricks County ,v� ��ei TM Document G702/CMa ® 1992 I-0 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:024 g Distribution to: OWNER: PERIOD TO:September 30,2010 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: 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 payment 1. ORIGINAL CONTRACT SUM $ 643,496.00 shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: - �y I 3. CONTRACT SUM TO DATE(Line 1±2) $ 643,496.00 By: �� Date: _ -(I2'Yl I6 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 637,745.60 State of: l �J�h 5 , 5. RETAINAGE: County of: t_letet 0 n C kS a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 54,549.71 me this q day f S f ) 2-0/d b. 0 %of Stored Material Notary Public: `vk C ee5eoo it / , (Column F on G703) $ 0.00 My Commission expires: '7/40 7/lZ Total Retainage(Lines 5a+5b or Total in Column 1 of 0703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 583,195.89 In accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 569,485.89 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 $ 13,710.00 AMOUNT CERTIFIED $ 13,710.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs f• the amount applied.Initial all figures on this Application and on the Continuation Sheet th,.t ar-changed to conform with the amount certified.) (Line 3 less Line 6) $ 60,300.11 CONS UCTION ,‘ AG ,': ./ J _i_7/_____„., /0 By: �s._i.� �.A.�.�_ Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI T Total changes approved in previous months by Owner$ 0.00$ 0.00 By: 4f..--- ---i Date: eel _ Total approved this Month $ 0.00$ 0.00 This Certifi to is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor`amed TOTALS $ 0.00$ 0.00 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/CMa"-1992.Copyright m 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 14:50:18 on 09/24/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1144215925) *AIA Document 6703 TM - 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:024 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. APPLICATION DATE:09/20/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO:09/30/2010 ARCHITECT'S PROJECT NO:NA A B C D E F G H I WORK COMPLETED TOTAL MATERIALS FROM COMPLETED e BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY /o 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) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 26,373.60 0.00 0.00 26,373.60 99.00% 266.40 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 35,646.00 13,710.00 0.00 49,356.00 90.00% 5,484.00 274.20 104 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 4,080.00 0.00 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 9,039.90 GPI#23B-Storm 212 Water Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00% 0.00 3,069.30 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 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: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 prosecuted to 1 the maximum extent possible under the law.This document was produced by AIA software at 14:50:53 on 09/24/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1296787307) A B C D E F G H I WORK COMPLETED TOTAL FROM MATERIALS COMPLETED o BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED PRESENTLY /o NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) GRAND TOTAL $643,496.00 $624,035.60 $13,710.00 $0.00 $637,745.60 99.11 % $5,750.40 $54,549.71 AIA Document G703 TN-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 prosecuted to 2 the maximum extent possible under the law.This document was produced by AlA software at 14:50:53 on 09/24/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (1296787307) Application #24b Affidavit and Waiver of Lien [ ] Final [ x] Partial [ ] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping, Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Thirteen Thousand Seven Hundred Ten Dollars and 00 Cents ($13,710.00) [ ] receipt of which is hereby acknowledged; or [ x] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping, Inc. R_a/�� Secretary/Treasurer (Finn) (Authorized epresent ve) (Title) Witness my hand and Notorial Seal, this 2 "' day f S e +er 2010 Luke Roseboom (Printed) (Notary Public) My Commission Expires: July 7, 2012 Residing in Hendricks County r�xidi Tin =•�= Document 6702/CRia - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition yy TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:025 g Distribution to: OWNER: PERIOD TO:October 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:NA/2829/NA CONTRACTOR: Indianapolis,IN 46234 FIELD: CONTRACT FOR: 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 payment 1. ORIGINAL CONTRACT SUM $ 643,496.00 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: /6/////0 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 640,487.60 State of:India 5. RETAINAGE: County of:Hendricks a. 100 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 54,549.71 me this /9 day of pel-G e_rI 2d/d b. 0 %of Stored Material Notary Public:Luke Roseboom (Column F on G703) $ 0.00 My Commission expires:July 07,2012 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 585,937.89 hi accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 583,195.89 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 $ 2,742.00 AMOUNT CERTIFIED $ 2,742.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from • •mount applied.Initial all figures on this Application and on the Continuation Sheet that• anged to conform with the amount certified.) (Line 3 less Line 6) $ 57,558.11 CONS RUCTION M 0 GE:. By: ��i; . _'>�/jlL -/°P. _. Date: /12 22; l0 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC T.,C p, Total changes approved in previous months by Owner$ 0.00$ 0.00 1 / — � 'L°��(�y BY ;d o Date: 1" Total approved this Month $ 0.00$ 0.00 This Certi cate is not negotiable.The AMOUNT CERTIFIED is payable only to the Contractor named TOTALS $ 0.00$ 0.00 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/CMarm—1992.Copyright C 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 09:51:08 on 10/20/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1097747024) . , 1 , ; ' $ :AIA DDocument 6703 ® 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO:025 containing Contractor's signed certification is attached. APPLICATION DATE: 10/20/2010 In tabulations below,amounts are in US dollars. Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO: 10/31/2010 ARCHITECT'S PROJECT NO:NA A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G-C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 26,373.60 0.00 0.00 26,373.60 99.00% 266.40 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 49,356.00 2,742.00 0.00 52,098.00 95.00% 2,742.00 274.20 104 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 4,080.00 0.00 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 • 9,039.90 GPI#23B-Storm 212 Water Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00% 0.00 3,069.30 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 • 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 AIA Document G703 T"-1992.Copyright m 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 prosecuted to I the maximum extent possible under the law.This document was produced by AIA software at 09:51:46 on 10/20/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (947482446) 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 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) GRAND TOTAL $643,496.00 $637,745.60 $2,742.00 $0.00 $640,487.60 99.53% $3,008.40 $54,549.71 AIA Document G703^,—1992.Copyright m 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 prosecuted to 2 the maximum extent possible under the law.This document was produced by AIA software at 09:51:46 on 10/20/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (947482446) Application #25b Affidavit and Waiver of Lien [ ] Final [ x] Partial [ ] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping, Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Two Thousand Seven Hundred Forty Two Dollars and 00 Cents ($2,742.00) [ ] receipt of which is hereby acknowledged; or [ x] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping, Inc. / Secretary/Treasurer (Firm) (Authorize epresentative) (Title) Witness my hand and Notorial Seal, this 20th da of October, 2010 Luke Roseboom `-///■ (Printed) (Notary Public) My Commission Expires: July 7, 2012 Residing in Hendricks County 11:4 \rigga. AIA Document 6702/CMa rtl - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: City of Carmel PROJECT: CPAC 16% APPLICATION NO:026 lb Distribution to: OWNER: PERIOD TO:November 30,2010 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: 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 payment 1. ORIGINAL CONTRACT SUM $ 643,496.0(1 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: 1!11�l [I d 4. TOTAL COMPLETED & STORED TO DATE(Column G on G703) $ 642,947.60 State of:Indiana /1____________.-- 5. RETAINAGE: County of:Hendricks a. 100 %of Completed Work Subscribed and sworn to before I (Column D+Eon G703) $ 54,549.71 me this I? day of Novara Oec 2.Old gi,"--7----------__ b. 0 %of Stored Material Notary Public:Luke Roseboom (Column F on G703) $ 0.00 My Commission expires:July 07,2012 Total Retainage(Lines 5a+5b or Total in Column I of G703) $ 54,549.71 CERTIFICATE FOR PAYMENT 6. TOTAL EARNED LESS RETAINAGE $ 588,397.89 In accordance with the Contract Documents,based on on-site observations and the data comprising this (Line 4 Less Line 5 Total) application, the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 585,937.89 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 $ 2,460.001 AMOUNT CERTIFIED $ 2,460.00 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explanation if amount certified differs from t . .. ount applied.Initial all figures on this Application and on the Continuation Sh•,t that at— chars d to conform with the a ount certified.) (Line 3 less Line 6) $ 55,098.11 CONS 'UCTION -• AGE' BY: ii: `.__�. . A•_ Date: 1/ f o CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE Total changes approved in previous months by Owner$ 0.00$ 0.00 By: Al; I Date: It 30 1 • Y� Total approved this Month $ 0.00$ 0.00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payable only to the ontractor named TOTALS $ 0.00$ 0.00 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/CMa'—1992.Copyright C 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 12:35:27 on 11/17/2010 under Order No.9656147774 1 which expires on 05/13/2011,and is not for resale. User Notes: (1315525474) . *A1A Document G703TM - 1992 Continuation Sheet AIA Document, G702n4-1992,Application and Certification for Payment, or G736Tm-2009, APPLICATION NO:026 Project Application and Project Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE: containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO: 11/30/2010 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:NA 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 AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED DATE (G-C) (NOT IN D OR E) (C-G) RATE) (D+E) (D+E+F) Sewage Ejector/Triplex 62 Pumps 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 63 Labor 26,640.00 26,373.60 266.40 0.00 26,640.00 100.00% 0.00 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 4,440.00 0.00 0.00 4,440.00 100.00% 0.00 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 52,098.00 2,193.60 0.00 54,291.60 99.00% 548.40 274.20 104 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 4,080.00 0.00 0.00 4,080.00 100.00% 0.00 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 6,120.00 0.00 0.00 6,120.00 100.00% 0.00 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 1-IVAC Equipment 120,532.00 120,532.00 0.00 0.00 120,532.00 100.00% 0.00 9,039.90 GPI#23B- Storm 212 Water Control Panel 30,693.00 30,693.00 0.00 0.00 30,693.00 100.00% 0.00 3,069.30 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00, 0.00 0.00 0.00 0.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 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 AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to 1 the maximum extent possible under the law.This document was produced by AIA software at 12:36:03 on 11/17/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1144288334) 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) GRAND TOTAL $643,496.00 $640,487.60 $2,460.00 $0.00, $642,947.60 99.91 % $548.40 $54,549.71 • 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 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 2 the maximum extent possible under the law.This document was produced by AIA software at 12:36:03 on 11/17/2010 under Order No.9656147774_1 which expires on 05/13/2011,and is not for resale. User Notes: (1144288334) Application #26b Affidavit and Waiver of Lien [ ] Final [ x] Partial [ ] Payment Received State of Indiana, County of Marion SS: Anthony Richardson being duly sworn states that he is the Secretary/Treasurer of General Piping, Inc. having contracted with the City of Carmel to furnish certain materials and/or labor as follows: Mechanical Work for a project known as Parcel 7A, Regional Performing Arts Center located at 211 City Center Drive Carmel, IN 46032 and owned by the City of Carmel and does hereby further state on behalf of the aforementioned Contractor: Partial Waiver ...that there is due from the Owner the sum of Two Thousand Four Hundred Sixty Dollars and 00 Cents ($2,460.00) [ ] receipt of which is hereby acknowledged; or [ x] the payment 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; Final Waiver ...that the final balance due from the Owner is the sum of [ ] receipt of which is hereby acknowledged; or [ ] the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which shall become effective upon receipt of such payment. 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, and within the scope of this affidavit and waiver. General Piping, Inc. / Secretary/Treasurer (Firm) (Autho '?•d Representative) (Title) Witness my hand and Notorial Seal, this 17th day of November 2010 _ Luke Roseboom(Printed) (Notary Public) My Commission Expires: July 7, 2012 Residing in Hendricks County