HomeMy WebLinkAboutCertified Floorcovering - $89,847.36 The National Bank of Indianapolis hereby is instructed to make a disbursement of Loan Proceeds from
the Borrower Loan Account to (or for the account of) Borrower in: (a) the amount of the "Total Authorized
Disbursement" line in the "Amount of Authorized Disbursement" column below; and (b) accordance with
the terms and conditions of the Agreement, the other Loan Documents, and the Disbursement
Instructions.
Purpose of Authorized Disbursement Amount of Authorized
Disbursement
Amounts to be paid by Carmel Theater Development Company as per the
Carpet,Tile,and Access Flooring installment purchase contract
Application 3(Certified Floorcovering)June 2010 $75,598.80
Application 4(Certified Floorcovering)July 2010 $14,248.56
Total Authorized Disbursement $:89,847.36'[,,
All terms used in these Disbursement Instructions without definition shall have the meanings ascribed
thereto in that certain Loan Agreement (Equipment and Improvements), dated February 23, 2010, by and
between The National Bank of Indianapolis and Carmel Theater Development Company, LLC.
Dated: f CITY OF CARMEL REDEVELOPMENT
COMMISSION
By:
Les S. Olds
Printed:
Executive Director
Title:
Draft
Carpet and Resilient Flooring
(Certified Floorcovering)
April 2010
Paid by Carmel Theater Development Company $ 4,320.00
May 2010
Paid by Carmel Theater Development Company $ 61,153.20
June 2010
Amount to be paid by Carmel Theater Development Company $ 75,598.80
July 2010
Amount to be paid by Carmel Theater Development Company $ 14,248.56
,'.?PLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF 5 g3
AIA DOCUMENTG702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER
To Contr: Project:
Carmel Redevelopment Commission(Owner) Application#: 3 Distribution to:
One Civic Square
Carmel,IN 46032 Application Date: 6/10/2010 OWNER
Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR _
From Contractor: Period Ending: 6/30/2010 ARCHITECT _
Certified Floorcovering Services,Inc VIA Construction Manager: Shiel Sexton Co.,Inc. CONTRACTOR
5150 West 84th,Street —'
Indianapolis,IN 46268 Via Architect: CSO,Inc.
Contract For: Contract Date#: 07/29/09
Carpet&Resilient Flooring-Contract#2695-5130
Pencil copy to Geoff Pratt(gpratt@shielsexton.com)by 15th of the month. Billing due 20th of the month
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment as shown below,in connection with the Contract information and belief the Work covered by this application for payment has been
Continuation Sheet,AIA Document G703 attached. completed in accordance with the contract documents,that all amounts have been paid by
the Contractor for work for which previous certificates for payment were issued and
1.Original Contract Sum 5440,900.00 payments received from the Owner and that current payment shown is herein now due
2.Net Change by Change Orders 2,885.00 Contractor: Certified Floorcovering Services,Inc
Caro .Mil• V-ce r sldent
3.Contract Sum To Date 443,785.00 By: DATE: June 23,2010
Staley of I Iona County Of.a Marion 1v"`'/`
4.Total Completed&Stored to Date 156,746.80 Notary Public: Sandra A.Knox Signed:.Couty Of. Crion /
My Commission Exp 03/06/13
5.Retainage
a. 10.00%of Completed Work $12,593.80 ARCHITECT'S CERTIFICATION
b. 10.00%of Stored Material $3,081.00 In accordance with the contract documents,based on on-site observations and the data
comprising this application,the Construction Manager and Architect certify to the Owner that
Total Retalnage: 15,674.80 to the best of their 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
6.Total Earned Less Retalnage 141,072.00 is entitled to payment of the AMOUNT CERTIFIED.
r8413'3_,....7.Less Previous Certificates for Payment 65,473.20 AMOUNT CERTIFIED 7 S`Sct 8
8.Current Payment Due $75,598.80 (Attach explanation if amount certified differs from the amount applied for.
Initial all figures on this application and on the continuation sheet that are
9.Balance Due to Finish,Including Retainage • $302,712.88 changed to conform to the amount certified.)
CON T•U TI'. ,AG -
Change Order Summary Additions Deductions By: ',IV Date: 6. 2v, l!D.
Total changes approved in
previous months by owner 2,885.00 - ARCHIT `� `,
Total approved this month(June-10) - - By: Date: SCJ
Totals 2,885.00 -
Net change by Change Order: 2,885.00
T - 'ficate is not negotiable The amount certified is payable only to the
Contractor named herein.Issuance,payment&acceptance of payment are
without prejudice to any rights of the owner or contractor under this contract.
APPLICATION FOR PAYMENT-CONTINUATION SHEET
A B C D E F G H I
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE.OF
AIA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER.
To Conic Project:
Carmel Redevelopment Commission(Owner) Application#: 3 Distribution to:
One Civic Square
Carmel,IN 46032 Application.Date: 6/10/2010 OWNER
Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR _
From Contractor: Period Ending: 6/30/2010 ARCHITECT
Certified Floorcovering Services,Inc VIA Construction Manager: Shiel Sexton Co.,Inc. CONTRACTOR _
5150 West 84th Street.
Indianapolis,IN 46268 Via Architect: CSO,Inc.
Contract For: , Contract Date#: 07/29/09
Carpet&Resllient.Flooring-Contract#2695-5130
ITEM SCHEDULED PREVIOUS .COMPLt I tD STORED TOTAL CP& % BALANCE TO RETAINAGE
NO. DESCRIPTION OF WORK VALUE WORK THIS PERIOD MATERIALS STORED TO DATE (G/C) FINISH(C-G) 10:00%
1 BASEMENT 0'00 . 0.00 0.00 0.00 0.00 0.00% 0:00 0.00
2 Resilient.Material 5,500.00 0.00 0.00 3,850.00 3,850.00 70.00% 1,650.00 385.00
3 Resilient Labor 3,000.00- 0.00 0.00 0.00. 0.00 0.00% 3,000.00 0.00
4 Carpet Material. 17;000:00 0.00 0.00 2,550.00 2;550.00 .15:00% 14,450.00 255.00
5 Carpet.Labor 3,100.00 0:00 0.00 0.00 0.00 0.00% 3,100.00 0.00
6 Grout System Material. 0.00 0.00 0.00 0.00 0.00 100.00% 0.00 0:00
7 Grout.System Labor 0.00 0.00 0.00 0.00 0.00 100.00% 0.00 0.00
8 PLENUM 0:00 0.00 0.00 ,0.00 0.00 0.00% 0:00 0.00
9. Resilient Material 2.400:00 . 0.00 0.00 '1,680.00 1,680.00 70.00% 720.00 '168.00
10 Resilient Labor 1,300.00 0.00 0.00 .0.00 0:00 0:00% 1,300.00 0.00
11 Carpet Material 29,000.00 0.00 0.00 0:00 0.00 0.00% 29,000.00 0.00
12 Carpet Labor 6,100.00 0.00 0.00 0.00 0.00 0.00% 6,100.00 0.00.
13 Grout System Material 4,680:00 0.00 3,744.00 0.00. 3;744:00 80.00% 936.00 374.40
14 Grout System Labor 3,600.00 0.00 2,880.00 0.00 2,880.00 80.00% 720.00 288.00
15 ORCHESTRA LOW 0.00 0.00 0.00. 0.00 0.00 0.00% 0.00 0.00
16 Resilient Material 8,500.00 0.00 0.00 5,950.00 5,950.00 70100% 2,550.00 595.00
17 Resilient Labor 4,400.00 0.00 0.00 0.00 0.00 0.00% 4,400.00 0.00
18 Carpet Material. 12,000.00 0.00 0.00 1,800:00 1;800.00 15.00% 10,200.00 180.00
19 Carpet Labor 2,100.00 0.00 0.00 0.00 0.00 0.00% 2,100.00 0.00
20 Grout System Material 2;600.00 0.00 2,080.00 0.00. 2;080.00 80.00% 520.00 208.00
21 Grout System-Labor 2,000.00 0.00 1,600.00 0.00 1,600.00 80.00% 400.00 160.00
22 ORCHESTRA HIGH 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
23 Resilient Material 900.00 0.00 0.00 630.00. 630.00 70.00% 270.00 63.00
24 Resilient Labor 400.00 0.00 0.00 0.00 0.00 0.00% 400.00 0.00
25 Carpet Material 36,000.00 0.00' 0.00 0.00 0.00 0.00% 36,000:00 0:00
26 Carpet Labor 6,300:00 ' 0.00 0.00 0.00 0.00 0.00% 6,300.00 0;00
27 Grout System Material 3,510.00 ;b 0.00 2,808.00 0.00 2,808.00 80.00% 702.00 280:80
28 Grout System Labor 2;700:00 - 0.00 2,160.00 0.00 2,160.00 80.00% 540.00 216.00
29 BOX TIER 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
30 Resilient Material 5,100:00 0.00' 0.00 3,570:00 3,570.00 70.00% 1,530.00 357.00
31 Resilient Labor 2,900.00 0.00 0.00 0:00 0:00 0.00% 2,900.00 0.00
32 Carpet Material. 56,000.00 .0.00 0.00 8,400100 8,400.00 15.00% 47,600.00 840.00
33 Carpet.Labor 10,500.00 0.00 0.00 0.00 0.00 0:00% 10,500.00 0.00
34 Grout System Material 42,770.00 21,385.00 12,831.00 0.00 34,216.00 80.00% 8,554.00 3,421.60
APPLICATION FOR PAYMENT-CONTINUATION SHEET
A B C D E F- G H
ITEM. SCHEDULED PREVIOUS COMPLETED STORED- TOTAL CP& % BALANCE TO RETAINAGE
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF
AIA DOCUMENT'G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER
To Contr: Project:
Carmel,Redevelopment.Commission(Owner) Application#: 3 Distribution to:
One Civic Square
Carmel,IN 46032 Application Date: 6/10/2010 OWNER _
Attn: Les Olds,AIA;Directorof Redevelopment CONSTRUCTIO MGR
From Contractor: Period Ending: 6/30/2010 ARCHITECT
Certified Floorcovering Services,Inc VIA Construction Manager::Shiel Sexton Co.,Inc. CONTRACTOR
5150 West 84th Street
Indianapolis,IN 46268 Via Architect:.CSO,Inc.
Contract For: Contract Date#:. 07/29!09
Carpet&Resilient Flooring-Contract#2695-5130
NO. DESCRIPTION OF WORK, VALUE WORK THIS PERIOD MATERIALS STORED TO DATE (G1C) FINISH(C=G) 10%
35 GroutSystem Labor 31,056:00 15;528.00 9,316.80 0.00 24,844.80 80.00% 6,211.20. 2,484.48
36 BALCONY LOW .
37 Resilient Material 1,500.00 0.00 1,050.00 1,050.00 70.00% 450.00 105.00
. 38 Resilient•Labor 800.00' 0.00 0.00 0.00 0.00 0.00% 800.00 0.00
39 Carpet Material 19,800.00 0:00 0.00 0.00 0.00 0.00% 19,800.00 0.00
40 Carpet Labor 4,000.00 0:00 0.00 0.00 0.00 0.00%. 4,000.00 0.00
41 Grout System Material 7,800.00 0.00 8,240:00 0.00 6,240.00 80.00% 1,560.00 624.00 t
42 GroutSystem Labor 6,000.00 0.00 4,800.00 0.00 4,800.00 80.00% 1,200.00 480.00
43 BALCONY HIGH '0.00 0:00 0.00 0.00 0.00% ,0.00 0.00
44 Resilient Material 1,300.00 . 0.00 0.00 910.00 910.00 70.00% 390:00 91.00
45 Resilient Labor 800.00 0.00 0.00 0.00 0.00 0.00%. 800.00 0.00
48 Carpet Material 26,800.00 0:00 0.00 0:00 0.00 0.00% 26,800.00 0.00
47. Carpet Labor 5,200.00 0.00 0.00 0.00 0.00 0.00% 5,200:00 0.00
48 Grout System Material 20,384.00 18,345:00 0.00 0.00 18,345.00 90.00% 2,039.00 1,834.50
49 Grout System Labor 14,100.00 12,690.00 0.00 0.00 12,690.00 90.00% 1,410.00' 1,269.00
50 ATTIC 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
51 Resilient Material 600.00 0.00 0.00 420.00 420.00 70.00% 180.00 42:00
52 Grout System Labor 400.00 '0.00 0.00 0.00 0.00 0:00% 400.00 0.00
53 ALLOWANCE#5 15,000.00 0.00 4,729.00 0.00 4,729.00 31.53% 10,271:00 472.90
54 ALLOWANCE#6.CAD,DRAWINGS 5,000.00 0.00 0:00 0.00 0.00 0.00% 5,000.00. 0.00
55 BOND/SUBMITTALS/CLOSEOUT' 6,000.00 4,800.00 0.00 0.00 4,800.00 80.00% 1,200.00 480.00
56 CO#1 RCP PAC 006 Changes 2,885.00 0.00 0.00 0.00 0.00 0.00% 2,885.00 0.00
0:00 0.00 0.00
TOTALS: $443,785.00 $72;748.00 $53;188.80 $30,810.00 $156;746.80 $0.00 $287;038:20 $15,674.68
�k
AFFIDAVIT AND WAIVER OF LIENS
• o Final X Partial a Payment to Follow
State of Indiana,
SS
County of Marion
Carol S. Milli,being duly sworn states that she Is the Vice-President of Certified Floorcovering Services,
Incorporated having contracted with Carmel Redevelopment Commission to furnish certain materials and/or labor
as follows: FLOORING;for a project known as: Parcel 7A. Regional..Performinc(Arts Center and owned by
Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned
subcontractor/supplier:
(PARTIAL WAIVER)that there is due from the contractor sum of Seventy-Five Thousand Five Hundred Ninety-
eight Dollars and$0/100($75.598.80).
_
[X)receipt of which is hereby acknowledged;or
[ j the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of
Lien which is given solely with respect to said amount, and which waiver shall be effective only upon
receipt of payment thereof by the undersigned;
(FINAL WAIVER)that the final balance due from the contractor is the sum of
($—_)
[ j receipt of which is hereby acknowledged;or
[ ]the payment of which has been promised as the sole consideration of this Affidavit and Final 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.
Certified Floorcovering Service, Incorporated By Carol S.Milli,Vice-President.Signed: deti44/ 11111-14;*
Carol S. MIlli/ President
WITNESS MY HAND AND NOTARIAL SEAL, this 301h day of June , 2010 .
te x_11
My Commission Expires:03-06-2013 S- dra—,. Knox
Residing in Marion County - _
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF 58
AIA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER
To Contr: Project:
Carmel Redevelopment Commission(Owner) Application#: 4 Distribution to:
One Civic Square
Carmel,IN 46032 Application Date: 7/13/2010 OWNER _
Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR
From Contractor: Period Ending: 7/31/2010 ARCHITECT
Certified Floorcovering Services,Inc VIA Construction Manager: Shiel Sexton Co.,Inc. CONTRACTOR
5150 West 84th Street
Indianapolis,IN 46268 Via Architect: CSO,Inc.
Contract For: Contract Date#: 07/29/09
Carpet&Resilient Flooring-Contract#2695-5130
Pencil copy to Geoff Pratt(gpratt@shielsexton.com)by 15th of the month. Billing due 20th of the month
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,
Application is made for payment as shown below,in connection with the Contract information and belief the Work covered by this application for payment has been
Continuation Sheet,AIA Document G703 attached. completed in accordance with the contract documents,that all amounts have been paid by
the Contractor for work for which previous certificates for payment were issued and
1.Original Contract Sum $440,900.00 payments received from the Owner and that current payment shown is herein now due
2.Net Change by Change Orders 2,885.00 Contractor: Certified Fioorcovering,Services,Inc
rot 14.S. illi e i
3.Contract Sum To Date 443,785.00 By: ����/ .� DATE: July 13,2010
State of; Indiana County Of: Marion
4.Total Completed&Stored to Date 172,578.40 Notary Public: Sandra A.Knox Signed: .j ti _ _ .j /
My Commission Exp 03/06/13
5.Retainage
a. 10.00%of Completed Work $17,257.84 ARCHITECTS CERTIFICATION
b. 10.00%of Stored Material $0.00 In accordance with the contract documents,based on on-site observations and the data
comprising this application,the Construction Manager and Architect certify to the Owner that
Total Retainage: 17,257.84 to the best of their 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
6.Total Earned Less Retainage 155,320.56 is entitled to payment of the AMOUNT CERTIFIED. ppQ�, Slab
7.Less Previous Certificates for Payment 141,072.00 AMOUNT CERTIFIED 14 i Z L9 )'
8.Current Payment Due $14,248.56 (Attach explanation if amount certified differs from the amount applied for.
Initial all figures on this application and on the c• ration sheet that are
9.Balance Due to Finish,Including Retainage • $288,464.44 changed to conform to the amount certified.)
:k C 5 STRUCT'. a 'j'GER y —f
Change Order Summary Additions . Deductions By:'►yi• _�,!I/Ls�; :�4. _ //" Date: D ` f�t I'
Total changes approved in �"' 'ip�`���'�
previous months by owner 2,885.00 - ARCHI a , p��Total approved this month(July-10) - - By: i Ili' -- Date: 0 .70 •J�/
Totals 2,885.00 -
Net change by Change Order: 2,885.00
This certificate is not negotiable The amount certified is payable only to the
Contractor named herein.Issuance,payment&acceptance of payment are
without prejudice to any rights of the owner or contractor under this contract.
APPLICATION FOR PAYMENT-CONTINUATION SHEET
A B C D E F G H I
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF
AIA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER
To Contr: Project:
Carmel Redevelopment Commission(Owner) Application#i 4 Distribution to
One Civic Square
Carmel,IN 46032 Application Date: 7/13/2010 OWNER _
Attn:.Les Olds,AIA,;Director of Redevelopment CONSTRUCTIO MGR _
From.Contractor: Period:Ending: 7/31/2010 ARCHITECT _.
Certified Floorcovering Services;Inc VIA Construction Manager Shiet Sexton Co Inc. CONTRACTOR
5150:.West 84th Street
Indianapolis,IN 46268 Via Architect: CSO,Inc
Contract For:. Contract Date#: 07/29109.
Carpet&Resilient Flooring-Contract#2695-5130
NO. DESCRIPTION OF WORK? VALUE WORK THIS PERIOD MATERIALS STORED'TO.DATE (G/C) FINISH(C-G) 10%
35 Grout System Labor 31,056:00 24,844:80 3,105.60 0.00 27,950.40 90.00% 3,105.60 2,795.04
36 BALCONY LOW
37 Resilient Material 1,500.00 I 1,050:00 300.00 0.00 1,350:00 90.00% 150.00 135.00.
38 Resilient Labor 800.00. 0:00 0:00 0.00 0.00 0.00% 6.00.00 0.00
39. Carpet Material 19,800:00 0:00 0.00 0.00 0.00: 0:00% 19;800.00 0.00.
40 Carpet Labor 4,000.00 0.00 0.00 0.00 0.00 0.00% 4,000.00 0.00,
41 Grout System Material 7 800.00. 6,240 00 780.00 .0.00 7,020.00 90:00% 780:00 702.00
42. Grout System Labor 6;000:00 4,800 00 600:00 0.00 5,400.00 90:00% 600:00 540.00
43 BALCONY HIGH 0.00 0.00 0.00 0.00. 0.00% 0.00 0:00
44 Resilient Material 1,300:00 ,910110 260.00 0.00. 1,170.00 90.00% 130.00 117.00.
45 Resilient Labor 800.00 0.00 0.00 0.00. 0.00 0.00% 800.00 0.00
46 Carpet Material 26,800.00 0700 0.00 0.00, '0.00 0:00% 26,800:00 0.00
47 Carpet Labor .5,200.00 0.00 0.00 0.00. 0.00. 0.00% 5,200.00 0.00.
48 Grout System Material. 20,384.00 18,345:00 0:00 0.00 18,345.00 90.00% 2,039.00 1,834:50'
49 Grout System Labor 14,100.00 12,690.00 0.00 0.00 12,690.00 90.00% 1,410.00 1,269.00.
50 ATTIC 0.00 0.00 0.00 0.00 0.00% 0.00 ,0.00
51 Resilient Material 600.00 420:00 120.00 0.00 540.00 90.00% 60.00 54.00,
52 Grout System Labor 400:00 0:00 0.00 0.00' 0.00' 0.00% 400.00 0:00
53 ALLOWANCE#5 15,000.`00 4,729.00 0.00 0.00, 4,729.00 31.53% 10,271:00 472.90
54 ALLOWANCE#6,CAD DRAWINGS 5;000:00 0:00 0.00 0.00 0.00 0.00% 5.000.00 0.00
55 BOND/SUBMITTALS/CLOSEOUT 6,000.00 4,800:00 0.00 .0.00 4,800.00 80.00% 1;200.00 480.00
56 CO#1 RCP PAC.006 Changes 2,885:00 0.00 0.00 0.00 0:00. 0.00% 2,885: 00 .0.00.
0.00 0.00 0.00
TOTALS: $443,785.00 5156,746:80 $15,831.60 $0.00 $172,578.40 $0.00 $271,206.60 $17,257.84
JL
•
APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF
AlA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER
To Contr: Project:
Carmel Redevelopment Commission(Owner) Application#: 4 Distribution to:
One•Civic Square
Carmel,IN 46032 Application Date: 7/13/2010 OWNER _
Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR _
From Contractor. Period Ending: 7/31/2010 ARCHITECT _
Certified Floorcovering Services,Inc VIA Construction Manager Shiel Sexton Co.,Inc. CONTRACTOR
5150 West 84th Street
Indianapolis,IN 46268 Via Architect: CSO,Inc.
Contract For: Contract Date#: 07/29/09
Carpet&Resilient.Flooring-Contract#2695-5130
ITEM SCHEDULED PREVIOUS COMPLETED STORED TOTAL CPA % BALANCE TO RETAINAGE
NO. DESCRIPTION OF WORK. VALUE WORK THIS PERIOD MATERIALS STORED TO DATE (G/C) FINISH(C-G) 10.00%.
1 BASEMENT 0.00: 0.00 0.00 0.00' 0.00 0.00% 0.00 0.00
2 Resilient Material 5,500.00 3,850.00 1,100.00 0.00 4,950.00 90.00% 550.00 495.00
3 Resilient Labor 3.000.00• 0.00 0.00 0.00 '0.00 0.00% 3,000.00 0.00
4 Carpet Material 17;000.00 2;550.00 0:00 0.00 2,550.00 15.00% 14,450.00 255.00
5 Carpet.Labor 3,100.00 0.00 0.00 0.00 0.00 0.00% 3,1d0.00 0.00
6 Grout System Material 0.00" 0.00 0.00 0.00 0.00 100.00% 0:00 0.00
7 Grout System Labor 0.00 0.00 0.00 0.00' 0.00 100.00% 0.00 0.00
8 PLENUM 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
9 Resilient Material 2,400.00 . 1,680.00 480.00 0.00 2,160.00 90.00% 240.00 216.00
10 Resilient Labor 1,300.00 0.00 0.00 0.00 0.00 0.00% 1,300.00 0.00.
11 Carpel Material 29,000.00 0.00 0.00 0.00' 0.00 0.00% .29,000.00 0.00
12' Carpet Labor 6,100.00 0:oo 0.00 0.00 0.00 0.00% 6;100.00 .0.00
13 Grout System Material 4,680.00. 3,744.00 468.00 0.00 4,212.00 90.00% 468.00 421.20
14 Grout System Labor 3,600.00 2,880.00 360.00 0.00 3240.00 90.00% 360.00 324.00
15 ORCHESTRA LOW 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
16 Resilient Material 8,500.00 5,950.00 1,700.00 0.00: 7;650.00 90.00% 850.00 765.00.
17 Resilient Labor 4;400.00 0.00 0.00 0.00 0.00. 0.00% 4,400.00 0.00
18 Carpet Material 12,000.00. 1,800.00 0.00 .0.00 1,800.00 15.00% 10,200.00 180.00
19 Carpet Labor 2,100.00 0.00 0.00 0.00 0.00 0.00% 2,100:00 0.00
20 Grout System Material 2,600:00 2,080.00 260.00 0.00 2,340.00 90.00% 260.00 234.00
21 Grout System Labor 2,000.00 .1,600.00 200.00 0.00 1,800.00 90.00% 200.00 180.00
22 ORCHESTRA HIGH 0.00 0.00 0.00 0.00 ,0.00 0.00% 0.00 0.00
23 Resilient Material 900.00 630.00 180.00 .0.00. 810:00 90.00% 90.00 81.00
24 Resilient Labor 400.00 0.00 0.00 0:00 .0:00 0.00% 400.00 0.00
25 Carpet Material 38;000:00 , 0.00 0.00 0.00 0.00 0.00% 36;000.00 0.00
26 Carpet Labor 6,300.00 0.00 0.00 0.00 0.00 0.00% 6,300.00 0.00
27 Grout System Material 3,510:00,. 2,808:00 351.00 0.00 3,159.00 90.00% 351.00 315:90
28 Grout System Labor '2,700.00 2,160.00 270.00 0.00 2,430:00 90.00% 270.00 243:00
29 BOX TIER ' 0.00 0.00 0.00 0.00 0.00% 0.00 0.00
30 Resilient Material 5;100;00' 3,570.00 1,020.00 0.00. .4;590.00- 90.00% 510.00 459.00
31 Resilient,Labor 2;900:00 0.00 0:00 '0.00' 0.00 0.00% 2,900.00 0.00
32 Carpet Material 56,000:00 8,400:00 0.00 0.00 8;400.00 15.00% 47,600.00 .840:00
33 Carpet Labor 10,500.00 0.00 0.00 0.00 :0.00 0.00% '10;500.00 0.00
34 Grout System Material 42,770.00 34,216.00 4,277.00 0.00. 38;493.00 90.00% 4,277.00 3;849.30
APPLICATION FOR PAYMENT-CONTINUATION SHEET
A B C D' E• F G H
ITEM SCHEDULED PREVIOUS. COMPLETED STORED TOTAL CP& % BALANCE TO RETAINAGE
AFFIDAVIT AND WAIVER OF LIENS
- Final X Partial = Payment to Follow
State of Indiana,
SS
County of Marion
Carol S. Milli, being duly sworn states that she is the Vice-President of Certified Floorcovering Services,
Incorporated having contracted with Carmel Redevelopment Commission to furnish-certain materlals`arid/or labor
as follows:FLOORING fora project known his: Parcel'7A..Regional Performino Arts Center and owned by
Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned
subcontractor/supplier:
(PARTIAL WAIVER)that there is due from the contractor sum of Fourteen Thousand Two Hundred Foity-Eight
Dollars and 56/100($14.24. .56). _ .
(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 contractor is the sum of
(
[ ] receiptof which is hereby acknowledged; or
[ ] the payment of which has been promised as the sole consideration of this Affidavit and Final 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 'arid . •
further certifies that no other party has any claim or right,to.a lien on accauntof any work performed or'materiat'
furnished to the undersigned for said project and within the scope of this affidavit and waiver.
Certified Floorcovering Service, Incorporated By Carol S. Milli, Vice-President.
• Y
Signed: ��u!r •
Carol S. Milli/Vice:President
WITNESS MY HAND AND NOTARIAL SEAL, this 101° day:of July . 20 10
My Commission Expires;03-06-2013 SandraA. Knox
Residing in Marion County