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Cincinnati Floor - $59,735
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 and the Wood Flooring installment purchase contract Application 5(Cincinnati Floor Company) November 2010 $ 59,735.00 Application 8(Certified Floorcovering) November 2010 $ 31,985.50 Total Authorized Disbursement $191,720.50 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: /2.40//e5 CITY OF CARMEL REDEVELOPMENT COMMISSION C i By: 110,w Les S. Olds Printed: Executive Director Title: Draft Wood Flooring (Cincinnati Floor Company) May 2009(Application 1) Amount reimbursed by Carmel Theater Development Company $ 4,911.30 August 2010 Paid by Carmel Theater Development Company $ 89,228.70 September 2010 Paid by Carmel Theater Development Company $ 383,103.00 October 2010 Paid by Carmel Theater Development Company $ 94,292.00 November 2010 Amount to be paid by Carmel Theater Development Company $ 59,735.00 * AIA Document G702/CMaTM - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 5 Distribution to: One Civic Square Carmel Regional Performing Arts Center September 30,2010 PERIOD TO: OWNER ❑ Carmel, In 46032. 777 3rd Ave. S.W. CFC JOB# IW443 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: March 23, 2009 ARCHITECT ❑ Cincinnati Floor Company, Inc PROJECT NOS: 2695 / I CONTRACTOR ❑ 8320 Brookville Rd, Suite M VIA ARCHITECT: CFC INVOICE# 36992 FIELD ❑ Indianapolis IN 46239 CSO DATE OF INV: 11/22/2010 CONTRACT FOR:Brazillian Cherry Sleeper/Subfloor SALESMAN: KAP ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous 689,495.00 Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ -2R 000 00 payment shown herein-is now due. 2. Net change by Change Orders $664,495.00 CONTRACTOR: Cincinnati Floor Co Inc 3.CONTRACT SUM TO DATE(Line I ±2) $ By: 4 kaGz Date: 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $664,495.00 State of: U 11/22/2010 IN Zack Maricle, Contract Manager 5.RETAINAGE: County of: MARION r'FGtyY " t,: ' ....�. 1a. %of Completed Work Subscribed and sworn to befo �tG1r1"riv L RU (Column D+E on G703) $ 33,225.00 me this 22 eay,of Nb�/EMBER, 2010 SEAL S' ATi O�� '`EVA P?A-' %of Stored Material Notary Public: My Conl:,t„si.n c?pites J.fvA, t2 ••;, (Column F on G703) $ My Commission e i -s: Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 33,225.00 CERTIFICATE FOR PAYMENT . -. In accordance with the Contract Documents, based on on-site observation 'and,the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 631,270.00 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 $ 571535.00 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. a Jbe 8.CURRENT PAYMENT DUE $ 59,735.00 AMOUNT CERTIFIED $ S 1 l i$ 9.BALANCE TO FINISH INCLUDING RETAINAGE (Attach explanation if amount certified differs from . •amount applied. Initial all figures on this Application and of e Continuation,'Q.et that re c fanged to conform with the amount certified.) (Line 3 less Line 6) $ 33,225.00 CONS -UCTION A '': By: .�V;41 1 Date: II 24 I D I r � CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH! Total changes approved in previous months by Owner $ $ By: a'1 , 1 / Date: A 3Er 1ces Total approved this Month $ $ This Certif.-IMF- is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. , AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. 0 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. J. 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_Chahge Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201(CMa ._o E.Making Payment ; ; f ; The Owner should make payment directly to the Contractor based on the amount certified by the.Construction Manager aril-Architect on AlA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.-The completed form,contains the name andiaddress of the Contrac,Jor.Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed. To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. vgyi -743...0: Document G703TM - 1992 Continuation Sheet 6 AIA Document G702TM,Application and Certification for Payment, APPLICATION NO 11/19/2010 containing Contractor's signed certification is attached. APPLICATION DATE: 11/30/2010 In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: $ - ARCHITECT'S PROJECT NO A Carmel Rcgienal r'ertonaing Alta Center C D E F G H I WORK COMPLETED TOTAL MATERIALS BALANCE 777 3r� e COMPLETED ITEM %1_k �prM,/O SCHEDULED FROM PREVIOUS F WORK PRESENTLY AND STORED % TO RETAINAGE VALUE NO APPLICATION THIS PERIOD STORED (G=C) FINISH (If variable rate) (D+E) (Not inDorE) TO DATE (C—G) Bonds $ 5,457.00 $ 5,457.00 5 45(D 5 4 5 p) ° $ 457 00 100 .- Materials Platform $ 170,063.00 $ 170,063.00 $ 170,063.00 100%.. Brazillian Cheery Sleeper/Sub Non-Stage General Allowance $ 15,000.00 $ 1,350 00 $ 13,650.00 $ 15,000.00 100% Non-Stage As Built Allowance $ 5,000.00 $ 5,000.00 $ 5,000 00 100% Labor Platform $ 30,007.00 $ 17,404 00 $ 12,603.00 $ 30,007.00 100% Brazillian Cherry Direct Apply Materials Orchestra High $ 100,026.00 $ 95,024.00 $ 5,002.00 $ 100,026.00 100% aterials Orchestra Low $ 100,026.00 $ 95,024.00 $ 5,002.00 $ 100,026.00 100% Material Box Tier $ 100,026.00 $ 95,024.00 $ 5,002.00 $ 100,026.00 100% _abor Orchestra High $ 24,712.00 $ 9,885.00 $ 14,827.00 $ 24,712.00 100% _abor Orchestra Low $ 24,712.00 $ 22,241.00 $ 2,471.00 $ 24,712.00 100% Labor Box Tier $ 24,712.00 $ 18,534.00 $ 6,178.00 $ 24,712.00 100% • Material Donor Amenity $ 54,278.00 $ 54,278.00 $ 54,278.00 100% . Labor Donor Amenity $ 20,476.00 $ 20,476.00 $ 20,476.00 100% Stage As Built Allowance $ 5,000 00 $ 5,000.00 $ 5,000 00 100% CO#1 $ (25,000 00) $ (25,000.00) $ (25 000.00) 100% ' $ 564,495.U0 $ 604, 60.00 $ 59,735.00 $ - $664,495.00 100% $ - $ GRAND TOTAL CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G703TM—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 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. IA Document G703"- 1992 Instructions Continuation Sheet • GENERAL INFORMATION Purpose and Related Documents.AIA Document G702TM,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703,Continuation Sheet.These documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201TM,General Conditions of the Contract for Construction. Use of Current Documents.Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition. 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 G703,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. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A, B&C.These columns should be completed by identifying the various portions of the Project and their scheduled values 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 in the project that 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 1.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 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown below are for illustrative purposes only,and are not intended to reflect actual construction costs. A B C D 1: F G I I I WORK COMPLETED 'TOTAL MATERIALS BALANCE COMPLETED ITEM SCHEDULED FROM PREVIOUS PRESENTLY TO RETAINAGE NO. DESCRIP HON OE WORK AND STORED VALUE APPLICATION THIS PERIOD STORED (G-:C) FINISH (Ifvartable race) (D E) (Nor in D or E) TO DATE (C-G) (D,E+F) 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS 6 MISC.CONC. 5,000 0 0 0 0 0 5,000 6 PAVING.UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING,LOWER DRIVE 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 GRAND TOTAL 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be 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. 8320 Brookville Road Since 1894 Suite M TELEPONE: (317)357-3562 Indianapolis, IN 46239 CINCINNATI FLOOR FAX: (317)357-5338 COMPANY AFFIDAVIT AND PARTIAL WAIVER OF MECHANIC'S LIEN I, Zack Maricle , being first duly sworn, state that I am the Contract Manager of Cincinnati Floor Company(hereafter referred to as the"Company") and am familiar with the following facts stated herein: 1. The undersigned, in consideration of, and upon receipt of payment in the sum of $ 59,735.00 does hereby waive, release and relinquish any and all liens and claims for liens for labor or work performed and/or material furnished through the 30 day of NOVEMBER, 2010 to the construction project commonly known as Carmel Regional Performing Arts Center located at 777 3rd Ave. S.W. Carmel, In 46032 (hereinafter the "Project"). 2. All laborers, material men, and subcontractors or the Company have been paid for all sums which were due for work, labor and/or material machinery provided by said parties for the Project and for which the Company has received payment. 3. The Company represents that it is not aware of any Mechanic's lien having been filed by or presently threatened to be filed against the Project by any party having performed work and labor for the Company and/or furnished material, machinery, equipment, and fuel to the Company for the project. 4. This waiver excludes retainage withheld and any change order work not yet billed. Zack Maricle Contract Manager BYE . jJ , STATE OF INDIANA COUNTY OF MARION Sworn to and subscribed in my presence this 22 day of NOVEMBER, 2010 -7- r Y EF E E.�Ca NOTARY PU1 UC till A .(; My Commission Expires: SEAL $TATS INDIANA 2015 My Commiss'ic+n cxri+re Jul2015