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HomeMy WebLinkAboutGibralter, Signature, Smock Fansler - $135,092.67 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 Veteran's Way Improvements installment purchase contract and the City Center Drive/Rangeline Road Streetscape Improvements installment purchase contract Application 12(Signature) December 2010 $ 4,185.75 Application 6(Smock Fansler) December 2010 $ 70,164.00 Application 13(Signature) December 2010 $ 10,115.22 Application 9(Gibraltar) December 2010 $ 50,627.70 Total Authorized Disbursement $135,092.67 • All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated February 23, 2010, by and between The Natio al Bank of Indianapolis and Carmel Theater Development Company, LLC. Dated: I2i2$ lJ CITY OF CARMEL REDEVELOPMENT COMMISSION By: Les S. Olds Printed: Executive Director Title: P111 Waterproofing and Paving (Signature Construction) June 2010 Application 7 Paid by Carmel Theater Development $27,350.45 July 2010 Application 8 Paid by Carmel Theater Development $ 9,231.31 August 2010 Application 9 Paid by Carmel Theater Development $15,171.63 September 2010 Application 10 Paid by Carmel Theater Development $10,013.63 October 2010 Application 11 Paid by Carmel Theater Development $14,432.35 November 2010 Application 12 Paid by Carmel Theater Development $26,741.77 December 2010 Application 13 Amount to be paid by Carmel Theater Development $10,115.22 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES2 TO OWNER Carmel Theater Development Comi PROJECT: Carmel City Pill Waterproofing APPLICATION NO Invoice 4 13 1 Distribution to: Invoice 4 11 Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 12/16/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel,Indiana 46032 CONTRACT FOR: CONTRACT DATE: 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,is 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 payments received from the Owner,and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM 173,961.29 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1±2) $ 173,961.29 4. TOTAL COMPLETED&STORED TO $ 166,792.44 By: / Date: �?�/J//� 5. RETAINAGE: Thomas,r/Koontz,President j a. 0 %of Completed Work $ 0 .ubscribed an. sworn to before me this /'I —day of Decem.- _1 ta>!_ , (Column D+E on G703) •aP .. LINDA BUCHANAN County b. %of Stored Material $ �=•NOrAN���= Hancock �r (Column F on G703) My Commission Expires "Total Retainage(Lines 5a+5b or '''' ,4-.. August 20,2011 — Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE F•R PAYM '^r._ 6. TOTAL EARNED LESS RETAINAGE $ 166,792.44 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 156,677.22 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 10,115.22 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISI-I,INCLUDING RETAINAGE $ 7,168.85 n 2 (Line 3 less Line 6) AMOUNT CERTIFIED $ 10 115, Z. ' CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expiation I mount certified differs from the amount applied.Initial all figures on this Total changes approved Application d ontl e Co no lion SI eel that are changed to conform with the amount certified.) in previous months by Owner ARCI-IITE T: Total approved this Month - By. - Date: Iz/zziie TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named herein.Issuance,payment and acceptance of payment are without NET CHANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION-AIA -01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 13 12/16/10 Carmel City P111 Waterproofing - Gibraltar Carmel , Indiana Total Work RETAINAGE 1 BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE 1 % FINISH Pre-Construction Services: Project Management 0.00 0.00 0.00 3,117.15 3,117.15 100% 0.00 Site Supervision 0.00 0.00 0.00 4,173.64 4,173.64 100% 0.00 General Conditions: GIBRALTAR Testing and Inspecting 2,500.00 0.00 0.00 1,246.68 1,246.68 50% 1,253.32 Project Management 1,500.00 0.00 0.00 758.46 758.46 51% 741.54 Site Supervision 67,934.00 5,652.06 0.00 59,166.28 64,818.34 95% 3,115.66 Site Safety Director 4,666.67 654.79 0.00 3,156.52 3,811.31 82% 855.36 Design Drawings 5,687.00 0.00 0.00 3,883.67 3,883.67 68% 1,803.33 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 Office Supplies 1,000.00 108.22 0.00 662.75 770.97 77% 229.03 Tools and Equipment 2,000.00 0.00 0.00 1,281.07 1,281.07 64% 718.93 Field Engineering and Surveying 6,000.00 1,387.50 0.00 810.00 2,197.50 37% 3,802.50 Construction Management Fee 82,673.62 2,312.65 0.00 78,421.00 80,733.65 98% 1,939.97 173,961.29 10,115.22 0.00 156,677.22 166,792.44 96% 14,459.64 x� 3 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and I or labor as follows: Construction Management Services for a project known as Carmel City Center P111, located at Carmel, Indiana and owned by the Carmel Theatre Development Company and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of ten thousand one hundred fifteen dollars and twenty-two cents ($10,115.22) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, finished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC / Thdmas E. •:ntz, President Su scribed and sworn to before me this: %'/V/O Notary Public: 'aP LINDA BUCHANAN • c :NOTARY Hancock County • My Commission Expires " August 20,2011 P73 Streetscape (Signature Construction) April 2010 Application 4 Paid by Carmel Theater Development $ 7,382.79 May 2010 Application 5 Paid by Carmel Theater Development $ 2,998.20 June 2010 Application 6 Paid by Carmel Theater Development $ 8,685.83 July 2010 Application 7 Paid by Carmel Theater Development $ 5,795.38 August 2010 Application 8 Paid by Carmel Theater Development $ 12,324.93 September 2010 Application 9 Paid by Carmel Theater Development $ 9,302.86 October 2010 Application 10 Paid by Carmel Theater Development $ 17,450.11 November 2010 Application 11 Paid by Carmel Theater Development $ 13,255.00 December 2010 Application 12 Amount to be paid by Carmel Theater Development $ 4,185.75 I9G APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Corp; PROJECT: Carmel Parcel 73 APPLICATION NO Invoice#12 1 Distribution to: Invoice#7 Strcetscape Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 12/16/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pcdcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel, Indiana 46032 CONTRACT FOR: CONTRACT DATE: 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,is 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 payments received from the Owner,and that current payment shown herein is now due. I. ORIGINAL CONTRACT SUM $ 125,145.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line 1±2) $ 125,145.00 4. TOTAL COMPLETED&STORED TO $ 93,971.61 By: Date: be. /7 /C7 5. RETAINAGE: 'homas E. bntz,President d" / a. 0 %of Completed Work $ 0 Sub cribed and s‘ m to before me this /' day of is//U (Column D+E on G703) :•ha.oa LINDA BUCHANAN b. %of Stored Material $ : ...NOTARY.: e Hancock County (Column F on G703) '-.,,;:•. a ../ My Commission Expires ;!i° August 20,2011 Total Retainage(Lines 5a+5b or ni 9 Total in Column I of G703) $ 0.00 ARCHITECT'S CERTIFICATE FOR PA ENT 6. TOTAL EARNED LESS RETAINAGE $ 93,971.61 In accordance with the Contract Documents,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 89,785.86 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 4,185.75 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 31,173.39 (Line 3 less Line 6) AMOUNT CERTIFIED $ 4J 35'75 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach expl Iron if amount certified differs from the amount applied.Initial all figures on this Total changes approved Applicati a rd onthe ntimral:on Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCI-[" EC / �A Total approved this Month By: (�V/r el(i �' Date. 12.127_r 1 v TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named herein.issuance,payment and acceptance 01 payment are without NET CI-IANGES by Change Order $0.00 prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION•AIA •01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE,N W.,WASHINGTON,DC 20006-5292 Users may obtain validation of this document by requesting a completed AIA Document D401 -Certification of Document's Authenticity from the Licensee. SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 12 12/16/10 Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS THIS PRESENTLY COMPLETED AND TO Committed NO. WORK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % FINISH Cost Pre-Construction Services 0.00 4,481.93 0.00 0.00 4,481.93 0% (4,481.93) 4,481.93 General Requirements: 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Testing and Inspecting 2,500.00 529.11 287.75 0.00 816.86 33% 1,683.14 816.86 Site Supervision 48,322.50 37,018.51 0.00 0.00 37,018.51 77% 11,303.99 37,018.51 Construction Management 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Site Safety Director 500.00 118.06 0.00 0.00 118.06 24% 381.94 118.06 Design Drawings 3,000.00 0.00 0.00 0.00 0.00 0% 3,000.00 0.00 Temporary Electric 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Lighting 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Office Supplies 250.00 0.00 0.00 0.00 0.00 0% 250.00 0.00 Temporary Fire Protection 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Temporary Water 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Tools and Equipment 1,000.00 0.00 0.00 0.00 0.00 0% 1,000.00 0.00 Projection Signage 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Field Eng. and Surveying 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Health and Safety 0.00 0.00 0.00 0.00 0.00 0% 0.00 0.00 Waste Disposal 2,000.00 0.00 0.00 0.00 0.00 0% 2,000.00 0.00 Construction Management Fee 62,572.50 47,638.25 3,898.00 0.00 51,536.25 82% 11,036.25 51,536.25 125,145.00 89,785.86 4,185.75 0.00 93,971.61 75% 31,173.39 93,971.61 I CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and /or labor as follows: Construction Management Services for a project known as Parcel 73 Streetscape, located at Carmel, Indiana and owned by the Carmel Theater Development Corporation and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of four thousand one hundred eighty-five dollars and seventy-five cents ($4,185.75) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC �..� f homa ;. Koontz, 'resident Subscribed and sworn to before me this: / /7/d Notary Public:/74,4 ;�/ ✓-u� ;:,a&Ya,• LINDA BUCHANAN NoTAAY. : Hancock County s,.SEAL My Commission Expires August,20,2011 P73 Hardscape (Smock Fansler) July 2010 Application 1 Paid by Carmel Theater Development $ 64,998.00 August 2010 Application 2 Paid by Carmel Theater Development $ 77,697.00 September 2010 Application 3 Paid by Carmel Theater Development $ 166,914.00 October 2010 Application 4 Paid by Carmel Theater Development $ 309,289.50 November 2010 Application 5 Paid by Carmel Theater Development $ 238,590.00 December 2010 Application 6 Amount to be paid by Carmel Theater Development $ 70,164.00 REQUEST FOR PAYMENT From: Smock Fansler Corporation To: CARMEL THEATER DEVELOPMENT CORP Invoice: 3024 2910 W.Minnesota Street 11711 N PENNSYLVANIA ST. Draw: APP00006 Indianapolis, IN 46241-4541 CARMEL, IN 46032 Invoice date: 12/10/2010 Period ending date: 12/31/2010 Contract For: Request for payment: Original contract amount $1,251,450.00 Approved changes $53,525.00 Project: 10052 Revised contract amount $1,304,975.00 CARMEL PARCEL 73 HARDSCAPE Contract completed to date $1,030,725.00 Contract date: Add-ons to date $0.00 Taxes to date $0.00 Architect: Less retainage $103,072.50 Total completed less retainage $927,652.50 Scope: Less previous requests $857,488.50 Current request for payment $70,164.00 Current billing $77,960.00 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $7,796.00 Changes approved in previous 53,525.00 Current amount due $70,164.00 months by Owner Total approved this Month Remaining contract to bill $377,322.50 TOTALS 53,525.00 NET CHANGES by Change Order 53,525.00 I hereby certify that the work performed and the materials supplied to date,as shown on the above represent the actual value of the accomplishment under the terms of the Contract(and all authorized changes thereof)between the undersigned and the CARMEL THEATER DEVELOPMENT CORP relating to the above referenced project. I also \`\\\\ iYi�rpliii�„���i certify that the contractor has paid all amounts previously billed and paid by the owner. \ �C .. oz CONTRACTOR: Sm) k Fansler Corporation State Of INDIANA County Of MORGAN .___ ' By: `V '472, if /7 Subscribed and sworn to before me this JQ day of QoL yy1A/P,E' 0100 _ _!L�f 71 Date: (7/2/6 l d y tt, C , `�C/ol140 My commission expires: it l'l /20/6 /l/ sT�%TFC iN�\P •d •eg— C$5O4 r L 7eM, /ti ZZ//b, f 70,Ro+.00 /itrfOr • REQUEST FOR PAYMENT DETAIL Project: 100521 CARMEL PARCEL 73 HARDSCAPE Invoice: 3024 Draw:APP00006 Period Ending Date: 12131!2010 Detail Page 2 of 2 Pages r Item ID Description Total Previously Work Presently Completed % Balance Retainage Contract Completed Completed Stored And Stored Comp To Balance Amount Work This Materials To Date Finish Period 01 MOBILIZATION 35,000.00 26,260.00 26,250.00 75.00 8,750.00 2,625.00 02 FIELD ENGINEERING 9,700.00 8,730.00 485.00 9,215.00 95.00 485.00 921.50 03 TRAFFIC CONTROL 10,300.00 9,270,00 515.00 9,785.00 95.00 515.00 978.50 04 DEMOLITION 54,000.00 54,000.00 54,000.00 100.00 5,400.00 05 EARTHWORK,DRAINAGE,UTIL 102,300.00 92,070.00 5,115.00 97,185.00 95.00 5,115.00 9,718.50 06 ASPHALT PAVEMENT 109,700.00 93,245.00 93,245.00 85.00 18,455.00 9,324.50 07 CONCRETE PAVEMENT 154,150.00 138,735.00 138,735.00 90.00 15,415.00 13,873.50 08 LANDSCAPING 46,500.00 34,875.00 2,325.00 37,200.00 80.00 9,300.00 3,720.00 09 CONCRETE WALLS,STAIRS 164,400.00 131,520,00 131,520.00 80.00 32,880.00 13,152.00 10 MASONRY 68,000.00 47,800.00 47,600.00 70.00 20,400.00 4,760.00 11 METAL RAILING 95,700.00 9,570.00 9,570.00 10.00 86,130.00 957.00 12 MECHANICAL 103,100.00 87,015.00 10,310.00 77,325.00 75.00 25,775.00 7,732.50 13 ELECTRICAL 114,100,00 85,575.00 11,410.00 96,985.00 85.00 17,115.00 9,698.50 14 UNIT PAVERS 184,500.00 138,375.00 27,675.00 166,050.00 90.00 18,450.00 16,605.00 15 CHANGE ORDER#1 3,875.00 3,875.00 3,875.00 100.00 387.50 18 CHANGE ORDER#2 4,500.00 4,500.00 4,500.00 100.00 450.00 17 CHANGE ORDER#3 11,810.00 11,810.00 11,810.00 100.00 1,181.00 18 CHANGE ORDER#4 6,500.00 3,260.00 2,275.00 5,525.00 85.00 975.00 552.50 19 CHANGE ORDER#5 16,490.00 16,490.00 20 CHANGE ORDER#6 10,350.00 2,070.00 8,280.00 10,350.00 100.00 1,035.00 Totals 1 1,304,975.00 952,765.00 77,960.00 1,030,725.00 78.98 274,250.00 103,072.50 •, •AFFIDAVIT AND WAIVER OF LIEN [ ] Final [X] Partial [X] Payment to Follow State of Indiana County of Marion T.M.Fansler, being duly sworn states that he is the CEO of SMOCK FANSLER CORP. having contracted with: Carmel Theater Development Corp. to furnish certain labor,materials,and/or services as follows: Misc. Construction for a project known as: SFC#10-052 Carmel Parcel 73 Hardscape located at Carmel,IN and does hereby state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the owner the sum of: ($70,164.00) - Seventy Thousand One Hundred Sixty Four Dollars and No/100 [ ] receipt of which is hereby acknowledged;or [X] the payment of which has been promisedas 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($0.00) [ ] 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, Materials, and/or Services, 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, materials, or services furnished to the undersigned for said project, and within the scope of this affidavit and waiver. SMOCK FANSLER CORP. By 44. f/,/d/__/,L itle CEO T. M. Fansler WITNESS MY HAND AND NOTARIAL SEAL,this 10th day of December,2010. Mew 'L/(��u" • J Melissa J. Bishdp Notar)f'ublic _ --- • _ . SF AL My commission expires November 30, 2016 Residing in Morgan County 0;s--r OF IN`��P Pte\\\\\ P111 Waterproofing and Paving (Gibraltar) May 2010 Application 2 Paid by Carmel Theater Development $331,812.00 June 2010 Application 3 Paid by Carmel Theater Development $188,748.00 July 2010 Application 4 Paid by Carmel Theater Development $ 57,970.80 August 2010 Application 5 Paid by Carmel Theater Development $ 98,261.10 September 2010 Application 6 Paid by Carmel Theater Development $174,561.30 October 2010 Application 7 Paid by Carmel Theater Development $223,782.30 November 2010 Application 8 Paid by Carmel Theater Development $331,778.70 December 2010 Application 9 Amount to be paid by Carmel Theater Development $ 50,627.70 2". kkt4 • • =Ne...tATA Document G702/CMa TM — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition • TO OWNER: Carmel Theater Development Company Carmel Carmel City Cntr-P111 Waterproofing&Pavng�omp ION NO: 9 Distribution to: PERIOD TO:. 12/30/10 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: Gibraltar Construction Corp VIA CONSTRUCTION MANAGER: CONTRACT DATE:1 /18/10 ARCHITECT ❑ 2932 N.Webster Ave. PROJECT NOS: I I CONTRACTOR ❑ Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ Pedcor Design Group,LLC CONTRACT FOR: Waterproofing&Topping Slabs ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor cer.'ties it 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 thi, I.ppl ation for Payment has been completed in accordance with the Contract Documents, that all runt ave been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for Payment we.' issu:Ae and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 1,610,967.40 payment shown herein is no r ,4e. 2.Net change by Change Orders $ 98,806.00 CONTRACTOR:Gibraltar 9, ., r •tion Corp 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 1,709,773.40 By: /" '1 r Date: /Atr,1—/Q 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 1,619,491.00 State of: ..,-de. uze), .i/,At I 5.RETAINAGE: County of: ;... a. %of Work / E BRIAN R, MCBRIDE p 161,949.10 Subscribed and s�.rn to bef e� ?. �' ES of HE,-,cock jCK Cou (Column D+Eon G703) $ me this /y day-of P M b. %of Stored Material Notary Public: My Comm. Ex^, 11-29-2017 (Column F on G703) $ My Commission expires: ,/......." 09,--/---- vD I Pr' CommiSsinn if- nl 1852 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ CERTIFICATE FOR PAYMENT 1,457,541.90 In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 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 $ 1,406,914.20 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 $ 50,627.70 AMOUNT CERTIFIED $ 5'6 427,o (Attach explanation if amou�rti red differs from the amount applied.Initial all figures on this 9.BALANCE TO FINISH,INCLUDING RETAINAGE p f f f ppg 252,231.50 Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ CONSTRUCTION MANAGER: • By: Date: i�/r/ ,4 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Pedco t�: J••• ' 1 Total changes approved in previous months by Owner V.3...4 $ By: --� lCL,A. Date: '��� t0 . Total approved this Month $. f --� $ This Certifi to is"not. -pro le. , AM► NT CERTIFIED is payable only the Contractor pY Y TOTALS $<V $ named herein. ssuance; ayt.. * and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Co . cto ,. is Co act. 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. ----eglAIA Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. - Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the'end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. • Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name and address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G702ICMaTM—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. CONTINUATION SHEET Page 2 of 3 APPLICATION NO. : 9 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION DATE: 12/30/2010 attached. 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: 12/30/2010 ARCHITECT'S PROJECT NO. : A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE TO RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY COMPLETED AND % FINISH (IF VARIABLE NO. APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) (C-G) RATE) (D+E) DORE) (D+E+F) 1 Allowance $25,000.00 $25,000.00 $25,000.00 100% - 2,500.00 2 Supervision $47,500.00 $42,750.00 $1,000.00 $43,750.00 92% 3,750.00 4,375.00 3 Demobilization $2,000.00 $1,000.00 $1,000.00 50% 1,000.00 100.00 4 Submittals $18,000.00 $18,000.00 $18,000.00 100% - 1,800.00 5 Misc. General Conditions $32,724.40 $29,615.00 $0.00 $29,615.00 90% 3,109.40 2,961.50 6 Excavation at North Ramp $4,643.00 $4,643.00 $4,643.00 100% - 464.30 7 Storm Casting Materials $79,000.00 $79,000.00 $79,000.00 100% - 7,900.00 8 Storm Casting Labor $11,000.00 $9,900.00 $1,100.00 $11,000.00 100% - 1,100.00 9 Trench Drain Material $59,000.00 $59,000.00 $59,000.00 100% - 5,900.00 10 Trench Drain Labor $15,000.00 $15,000.00 $15,000.00 100% - 1,500.00 11 Demolition Labor $35,000.00 $35,000.00 $35,000.00 100% - 3,500.00 12 Topping Slabs&Curbs Material $170,000.00 $170,000.00 $170,000.00 100% - 17,000.00 13 Topping Slabs&Curbs Labor $164,900.00 $164,900.00 $164,900.00 100% - 16,490.00 14 Rebar Material $15,000.00 $15,000.00 $15,000.00 100% - 1,500.00 15 Masonry $3,000.00 $3,000.00 $3,000.00 100% - 300.00 16 Metal Fabrications $1,200.00 $1,000.00 $200.00 $1,200.00 100% - 120.00 17 Waterproofing &Exp. Joints $742,000.00 $671,000.00 $22,260.00 $693,260.00 93% 48,740.00 69,326.00 18 Joint Sealants $200.00 $0.00 0% 200.00 - 19 Plumbing $18,400.00 $15,640.00 $15,640.00 85% 2,760.00 1,564.00 20 Electrical $1,800.00 $1,800.00 $1,800.00 100% - 180.00 21 Alternate#7 $184,000.00 $138,000.00 $27,600.00 $165,600.00 90% 18,400.00 16,560.00 22 Change Order#1 -$18,400.00 -$18,400.00 -$18,400.00 100% - (1,840.00) 23 Change Order#2 $5,182.00 $5,182.00 $5,182.00 100% - 518.20 24 Change Order#3 $3,252.00 $3,252.00 $3,252.00 100% - 325.20 25 Change Order#4 $26,871.00 $26,871.00 _ $26,871.00 100% - 2,687.10 CONTINUATION SHEET Page 3 of 3 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification, is APPLICATION NO. : 9 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts APPLICATION DATE: 12/30/2010 where variable retainage for line items may apply. PERIOD TO: 12/30/2010 ARCHITECT'S PROJECT NO. : A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM FROM PREVIOUS PRESENTLY COMPLETED AND % BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) FINISH (IF VARIABLE (D+E) D ORE) (D+E+F) (C-G) RATE) 26 Change Order#5 $7,200.00 $7,200.00 $7,200.00 100% - 720.00 27 Change Order#6 $3,986.00 $3,986.00 $3,986.00 100% - 398.60 28 Change Order#7 $4,008.00 $4,008.00 $4,008.00 100% - 400.80 29 Change Order#8 $14,921.00 $14,921.00 $14,921.00 100% - 1,492.10 30 Change Order#9 $8,529.00 $8,529.00 $8,529.00 100% - 852.90 31 Change Order#10 $12,192.00 $0.00 $1,828.00 $1,828.00 15% 10,364.00 182.80 32 Change Order#11 $1,959.00 $0.00 $0.00 0% 1,959.00 - 33 Change Order#12 $2,265.00 $0.00 $2,265.00 $2,265.00 100% - 226.50 34 Change Order#13 $8,441.00 $8,441.00 _ $8,441.00 100% - 844.10 35 36 37 - 38 - 39 40 41 42 _ 43 44 45 46 47 48 49 50 $1,709,773.40 $1,563,238.00 $56,253.00 $0.00 $1,619,491.00 95% $77,959.40 $161,949.10 ISA Form# 1-402 il i s�. AFFIDAVIT AND WAIVER OF LIEN • 4 ❑ FINAL ® PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and/or labor for a project known as Carmel City Cntr-P111 Waterproofing and Paving Components and owned by Carmel Theater Development Company. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER)that there is due from the Owner the sum of Fifty Thousand Six Hundred Twenty Seven and 70/100 Dollars ($50,627.70) ❑ 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 Dollars ( ) ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, the undersigned waives and releases unto the wner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon ccount of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions - pr sed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work orfned or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By /J- Title President r,- , WITNESS MY HAND AND NOTORIAL SEAL, is 14th day of December, 2010. (Notary Public) 7=�\ BRIAN r°c. MCBRIDE 1979"INDIANA suacoNTaACToas ASSOCIATION INC CAPPOSA1(D �; of c County tln9 Fb odv€tcan Fhat<rhillltl 2 �I �Gi','�J'�� vv�� ] Rev urn r a * SEAM I, --.,.� cx, 11-29-2017 v o i!0' C.: ..—.. y_:,- # 611862