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HomeMy WebLinkAboutGibraltar, Signature, Smock Fansler - $360,791.79 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 Authorised Disbursement Amount of Authorized Disbursement Amounts to be paid by,Carmel Theater Development Company as per the Veteran's Way improvements.Instaliment purchase pontract and the City Center Dave/Rangeline Road Streetscape Impriviernebtsleittailinent purchase contract, Application 91Signature)September P73 $ 9,302:86 Application 3(Smock Fansler) September P73 S 166;914.00 Application 10(Signature) September P111 S 10:013.63 • Application 6(Gibraltar) September P111 S 174,561.30 Total Authorized.Disbursement $980,791', 9 -'•; .3� '4 All terms used in these Disbursement Instructions without definition shall have the me anings ascribed thereto in that certain Loan Agreement(Equipment and Improvements), dated February 23, 2010, by and between The National Bank of Indianapolis and Cannel Theater Development Company, LLC. Dated: /0 2 S- 1 CITY OF CARMEL REDEVELOPMENT COMMISSION By: Les S. Olds Printed: Executive Director Title: • P73 Streetscape (Signature) 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 Amount to be paid by Carmel Theater Development $ 9,302.86 APPLICATION AND CERTIFICATION FOR PAYMENT .41,4 DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO'OWNER,Carmel Theater Development PROJECT: Cannel'Piircel 73 APPLICATION'NO Invoice tt 9 1 Distribution to: Company;LLC--Jeff Sporleder 1 1'7.1,1 N.Pennsylvania Street.Suite Streetseapc Signature costs I [OWNER. 200 ARCHITECT Carmel:IN .46032 PERIOD TO: 09/24/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT:.Pedcor:Design I I Signature•Consttuction Services LLC 720 3rd Avenue:S.W.: PROJECT NOS: Cannel,Indiana 46032 CONTRACT FOR:' CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies•that io 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.Applit:ation•for.Payment has been Continuation Sheet,AMA Document 0703,isattached. completed in accordance with'the'Contract Documents,that all amounts hays.been paid:by the'Conttactorlor Work,f'or:which previous Certificates_for'Payment were issued'and payments receivedaiom.the Owner,and'that.current payment'shown herein;ts•now due. 1. ORIGINAL CONTRACT SUM $ 125,145.00 2: Net change by.Change_Orders $ 0.00 CONTRACTOR:•• 3. CONTRACT SUM TU:DATE(Line I±2) '5 12a;14).00 4.'TOTAL COMPLETED&STORED TO $ 09,080.h '• BY: _ .. .Date:. 9/=7//0 5. RETAIN/WE: omas:- 'i.ontz, resue t / a. 0%of Completed'Work S 0 Sub. ribedand s am to betore'rne this 7 • day of f/ '0' + (Column D E oil 0703) b. %ofSoared•Material 5 *,!vii, LINDA'BUCHANAN t (Column F on.G703) __ imr = Hancock Coiinty: total ItU image(Lines Da-I-.aD or r G . ,, MyCommission Expires Total in Columna.ofG703) $ 0.00 ARG I-ICA LE FOR P/ YtAIE1QT '`'rte~. August_2o,2O11 6. TOTAL EARNED'LESS RE;TAINAGE t $ 0),080.70 in accordance'ivi[h tfic ContracvDoctanents,.based on,on-site■obscrvatiorts and the dam .(Line 4 Less,Line'5 Total) comprising the application;the Architect'certities'to the Owner that to the'best of die 7. LESS'PREVIOUS CERTIFICATES FOR Architect's know)edge,.information'andbcliefthe Work'has progressed as indicated, PAYMENT(Line 6.tiom•prior Certificate) 5 49,777:89 the quality ot•the'Work is in accordance.yith-the Contract Documents,and.the Contractor 8. CURRENT PAYMENT'DUE S 9,3112:86' is entitled to payment oFthe AMOUNT CERTIFIED. 9. BALANCETOTINISFI,°INCLUDING RETAINAGE S 6b,064.ba•(Line 3 less Line'6) .AMOUNT CERTIFIED...............$' t HAN(r>°:OIWbK SUMMAILE AUDI t TUNS- ULUUC_I IONS (Attach eTplan ` n ,antoidN'certjJied riWersfroni.the amour applied.Initial all figures on this Total changes approved :Ipplication rd on ie Cant- don'Sheet.tlrat,are.changedrip canforin with;the antoiuu certified.) in previous•months,by,Owner ARCIiIT" T:.• Total.appro"wed this Month By; a Date: ,fiW/dl TOTALS •$0.00 50:00' ThisCcnificate•is not negotiable TheAMOUNT CERTFIED is:payable'only to the L:ontractor'namea ncrem;issuance;paytnent,anp acceptance.01',paymentare witnout, NET CI IANGES`by Change Order $0.00 prejudice to any rights df the Owner orConuactor underahis Contract. `AMA DOCUMENT.G702•APPLICATIONAND CERTIFICATION FOR.PAYMENT•1992 ELATION•MA'•CH992 THE•AMERICAN INSTITUTE OF ARCHITECTS;1735 NEW YORK AVE...N.W.,WASHINGTON,DC 20009.5292 Users may obta.imvalidation of this documentby requesting a:completed AlA Document'D401-Certification of Document'sAuthenticity:from the Licensee: Director of.Redevelopment/y4W 8 73 SIGNATURE CONSTRUCTION LLC 720 .3rd.Aveciue, S. W. Carnal, Indiana 46032 Invoice # 9 9/24/10 Carmel City Parcel 73 Streetscape Carmel, Indiana WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF SCHEDULED FROM PREVIOUS, I THIS PRESENTLY COMPLETED AND TO Committed, mix RK VALUE APPLICATIONS PERIOD STORED STORED TO DATE % .FINISH Cost Pro-Construction Services 0.00 4,452.07 29..86 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 2,500.00 261:75 0.00 0.00 261:75 04 2,238.25 261.75 Site Supervision 48,322.50 37,018.51 0.00 0.00 37,018.51 77% 11,303.99 37,018.51 Conatrudtion,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 0% 381.,94- 318,.06 Design'D=awinga 3,000.00 0.00 0.00 , 0.00 0:00 0% 3,000.00 0.00 Temporary'Electric 0.00, 0.00 O.AO 0.00, 0:00. 0% 0:00 0.00 Temporary Lighting 0.00 0.00 0.00 0.00 0:00 04 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 2,000.001 0.00 0.00 0.00 0.00 0% 2,000:00 0.00 ConatreCtibn-Management Fee 62,572.50 7,927.50 9,273..00 0.00 17,200.50 0% 45,372.00 17,200.50 125,145:.00 49,77,7.89 9,302...86 ,.00'. 59,080.75 47% 66,064.25 " 59;080.75 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 Redevelopment Commission and does state: CONDITIONAL WAIVER: that the balance due from the owner is the sum of nine thousand three hundred two dollars and eight-six cents ($9,302.86)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 TromasyKoontz, Presi ent Subscribed and sworn to before me this: f/ 7/G Notary Public: 4. ^:g LINDA BUCHANAN ! ' Hancock County \...BE,,,...:,,..: I , Pdy Commission Expires Ci "'?�'f-'= ;. August 20,2011 P73 Hardscape (Smock Fancier) 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 Amount to be paid by Carmel Theater Development $ 166,914.00 ;2t T Iv REQUEST FOR PAYMENT From: Smock Fansler Corporation "i To: CARMEL THEATER DEVELOPMENT CORP Invoice: 2951 2910 W.Minnesota Street 11711 N PENNSYLVANIA ST. Draw: APP00003 Indianapolis,IN 46241-4541 ,_ . ______ CARMEL,IN 46032 Invoice date: 9/17/2010 Period ending date: 9/30/2010 Contract For. Request for payment: Original contract amount $1,251,450.00 Approved changes $0.00 Project: 10052 Revised contract amount $1,251,450.00 CARMEL PARCEL 73.HARDSCAPE Contract completed to date $344,010.00 Contract date: Add-ons to date $0.00 Taxes to date $0.00 Architect: Less retainage $34,401.00 Total completed less retainage $309,609.00 Scope: Less previous requests $142,695.00 Current request for payment $166,914.00 Current billing $185,460.00 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $18,546.00 Changes approved in previous Current amount due $166,914.00 months by Owner Total approved this Month Remaining contract to bill $941,841.00 TOTALS NET CHANGES by Change Order 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 authorised changes thereof)between the undersigned and the CARMEL THEATER DEVELOPMENT CORP relating to the above referenced project. I also \\`��ttiuuwuunillo.��0� certify that the contractor has paid all amounts previously billed and paid by the owner. ,0\ OD AU @��%'rr%• CONTRACTOR: Smock Fansler Corporation State Of INDIANA �/ County Of MORGAN _ — By: \,d7? ? r / Subscribed and sworn to before me this f'/ 'day of�, x/'1/69 lt4.• S F 1\.1L K - Date: 9/1°6' Notary Public �,7eL,+/(( ��:% � % — — My commission expires: I r/` �}` t ll/ S,T� \ .;Q . . / w./r,7/��uO nii 14+0,1\\\�`'. Lt�rJsitivCip i IYlA�1/�' o ` �l /�7 /ice J “o 11 " S. .0 �`5�/`o ��q! Director of Redevelopment/ t 1�1 0�5 73 REQUEST FOR;PAYMENT DETAIL Project: 10052/CARMEL PARCEL 73 HARDSCAPE Invoice: 2951 Draw:APP00003 •Period Ending Date:',.9130/2010 Detail Page,a of'.2'Pages 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 8,750.00 8;750:00 17;500.00 50.00 17,500.00 1,750.00 02 FIELD ENGINEERING 9',700.00 :3;395.00 2;425.00 5;820:00 60.00 3,880.00 582.00 03 TRAFFIC,CONT.ROL 10,300.00 1,030.00 3,090:00 4;120:00 40.00 6;180.00 412.00 04 DEMOLITION 54,000.00 32,400.00 10;800.00 43;200.00 80:00 10,800.00 4.320:00 05 EARTHWORK,DRAINAGE,UTIL 102,300.00 40,920.00 20,460:00' :61,380.00 60.00 40,920.00 6,138.00 06 ASPHALT PAVEMENT 109,700:00. 5',485.00 5,485.00 5:00 104,215.00 548.50 07 CONCRETEPAVEMENT 154;-150.00 30,8.30.00 30,830:00 61;660.00 40.00 92,490.00 6;166.00 08 LANDSCAPING 46;500.00 46,500.00 09 CONCRETEWALLS,STAIRS 164400.00 24,660.00 49;320.00 73,980.00 45.00 90,420.00 7,398.00 10 MASONRY 68;000.00 68,000.00 11 METAL RAILING 95,700.00 95,700.00 12.MECHANICAL 103;100:00 5155:00 25775:00 30,930.00 30.00 72;170.00 3;093,00 13'ELECTRICAL '114;100.00 11,410.00 28,525.00 39,635.00 35:00 74.165:00 3,993.50 14 UNIT PAVERS 1'84,500.00 184,500:00 Totals 1,251,450.00 158,550.00 -185;460.00 ;344,010.00 27.49. 907;440:00. 34,401:00 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: ($166,914.00) One Hundred Sixty Six Thousand Nine Hundred Fourteen Dollars and No/100 [ ] 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($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 `/ - �..i_'_ Tit e CEO T.M. Fansler WITNESS MY HAND AND NOTARIAL SEAL,this 17`x' day of September,2010. \��,,,�n�u���l+�������+u,t,,,,,��� �`'0-1ARY PU � A � Melissa J. Bishop Nota,Public ' xL SEA• My commission expires November 30.2016 Residing in Morgan County J s. TArFOF IND\*P1/4`. �\ ';a'a'n roumm111110o�\\ Pill 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 Amount to be paid by Carmel Theater Development $10,013.63 APPLICATION AND CERTIFICATION FOR PAYMENT Alil DOCUMENTG702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Comi PROJECT: Carmel City PI I 1 Waterproofing APPLICATION NO Invoice 1: 10 I Distribution to: One Civic Square Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 09/24/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCI-IITECT: 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,ALA 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 $ 165,347.24 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I+2) $ 165.34724 4. TOTAL COMPLETED x STORED TO $ 115,503.10 By: f +G� Date: 9/2:72., 5. RETAINAGE: ,Thomas L. oontz,President r� y�/�r/J� a. 0%of Completed Work $ 0 Subs ribed and vorn to before me this JJ day of 1Teeember,2t107 (Column D+Eon G703) ;:a .• LINDA BUCHANAN I b. /a of Stored Material $ `� ``'° Hancock County i r.re0renr: a i (Column F on G703) My Commission Expires i Total Retainage(Lines 5a+5b or i...;,.-•...• Total in Column I of G703) $ 0.00 ARC. ECT'S CERTIFICA E FOR PA •i=r'.`- - --------------------1 6. TOTAL EARNED LESS RETAINAGE $ 115,503.10 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) $ 105,489.47 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 10,013.63 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 49,844.14 (Line 3 less Line 6) AMOUNT CERTIFIED $ JOt Op .b3 CHANGE ORDER SUMMARY ADDITIONS DEDUC'T'IONS (Attack esplwtatiot • amount certified d(ers from the amount applied.Initial all figures on this Total changes approved Application an nil e Continuation Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITE ' : Total.approved this Month By: LP7\------ Date: /(3C11, TOTALS $0.00 _ $0.00 This Ccrtiflgate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named Herein.Issuance,payment and acceptance tat payment are WIII1out 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•1002 EDITION-AIA 01002 THE AMERICAN INSTITUTE OF ARCHITECTS.1735 NEW YORK AVE..N,W.,WASHINGTON.DC 20006-5202 Users may obtain validation of this document by requesting a completed AIA Document 0401 -Certification of Document's Authenticity from the Licensee. Director of Redevelopment pi 4/6 (.15 _ _ SIGNATURE CONSTRUCTION N LLC w _----_---- —_ _.__-_---__ __-- 720 3rd Avenue,, S. W7-- . ___ - -- _ `—_ _____ I _ -�_Carmel� -Indiana 46032. .�_-�I __- . Invoice # 10 9124/10 Carmel City P111 Waterproofing J �� Carmel., Indiana I f I - i Total Work RETAINAGE ; 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 2500.00 315.78 0:..00 -_ 0.:.00 315:78 0% 2,184-,-22 Project Management _ 1,500.00 0.00 0.00 _ 758.46, '758.46 - 0% 741.54 Site .Supeivision 594819,95. D.00 0,00-_ 50,295..67 50,295.67 84% 9;524'.x28 Site' Sa£ety'Director 6,:666.67' 0..00 0...00 2,756.63 2,75'6.,63 41% 3,910.04 • Design :Drawings 7',187.00 __._- 0:00 _ 0.x00 3,88367 3,883.67 54% 3,303:33 .Temporary.Electric 0.,00 0.00 - 0..00 _ 0.00 0.00 #DIV/0! 0.00 Office Supplies 1,000.00 0..00 0.00 55453 554.53 55% 445.-47 'Tools and.Equipment 2,000..00, 0,00 0..00 1,281.0.7 1,281.07 64% 718.93 Field.Engineering and Surveying_ . 2-;000..00 0.00 0.00 810.00' 810.00 41% 1,190:00 Construction Management Fee' _ _ 82,673 2,697.85_ 0.00 ___37,858.65'__ _47,556.50_ 58% 35,11/42_ 165,,`347.24 10,01.3.63 '0.00 105,489'.47 215,-503..10 70% 57,134.93 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 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 thirteen dollars and sixty-three cents ($10,013:63) 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 Troma oontz, President Subscribed and sworn to before me this: y'/-74) Notary Public: LINDA BUCHANAN Hancock County My Commission Expires •": ;:r: August 20,2011 .. 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 Amount to be paid by Carmel Theater Development $174,561.30 -{. � e j , TM r. x..19, Document G7©2/C a e 1992 Application and Certificate for Payment Construction-Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: Distribution to: Carmel Theater Development Company , Carmel City Cntr-P111 Waterproofing&Paving Comp. 6 PERIOD TO: 9/30/10 - OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 1/18/10 2932 N.Webster Ave. PROJECT NOS: / / CONTRACTOR ❑ Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: Pedcor Design Group,LLC Waterproofing&Topping Slabs ❑ -CONTRACTOR'S,APPLICATION FOR PAYMENT The undersigned Contractor certifies i at,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 ppl anon for Payment has been completed in accordance with the Continuation Sheet.ALA Document G703,is attached. Contract Documents,that all an qunt: nave been paid by the Contractor for Work for which previous Certificates-for Payment were.'ssue-4 and payments received from the Owner. and that current 1.ORIGINAL CONTRACT SUM $ 1 61D,9t3z o-_ payment shown herein is now J t •. 2.Net change by Change Orders $ 73.949.GO / CONTRACTOR: Gibraltar !,oil s tion Corp 3.CONTRACT SUM TO DATE(Line I ±2) $•1 684,916 40 By: A Date: 51)--aC��/f7 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 945,948.00 State of:, f oi,o it P. I 5.RETAINAGE: County of: 14q4-1.: I tr�W%°�E BRIAN R. MCBRIDE a. %of Completed Work Subscribed and swo• to before • �� (Column D+Eon G703) $ 94,594.80 me this 49:310 day of.. 0...4-1 ��4h ,, P..55. Cf Hancock County b. %of Stored.Material Notary Public: My Comm. ExD. 11-29-2017 (Column F on 0703) $ My Commission expires:,/7.--2./..,-/-7 vD WN Commicc100 61 1 QRg Total Retainage(Lines 5a+5b or Total in Column I of 0703).. $ CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 851,353.20 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 $ 676,791.90 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 $ 174 561 nn AMOUNT CERTIFIED $ PH S(�,i • 3E) 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs front the amount applied.Nina'all figures on this Application and on the C011tinuatrou Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 833,563.20 CONSTRUCTION M, AGER: By: ,.-. f� Date: /A')1(b CHANGE-ORDER SUMMARY ADDITIONS' DEDUCTIONS ARCHITECT: ;r Total changes approved in previous months by Owner $ $ Pedcor Design.Gro . LL•►' PP P Y 73 9y� By: g Alas.L r.� A Date: Z] Total approved this Month $ $ This Certificate is not negotiab . The AM* T C l' IFIED is payable my the Contractor TOTALS $?3 gI/9 $ named herein. lance payment - acceptance-of payment are without prejudice to any rights of NET'C!lANGES by Change Order $ ! the Owner C Ara un us Contract.es, ,CAUTION:You should sigman.original:AIA Contract-Document,on-which this text appears in RED.An 9'iginal assures that changes.will not-be obscured: AIA Document G702/CM2W-1992.Copyright'©1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this=AlAe 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.AlA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. Director of Redevelopment iyy(005-c7l-/-'- CONTINUATION.SHEET Page 2 of 3 APPLICATION AND:CERTIFICATE FOR PAYMENT,containing,Contractor's signed Certification,is APPLICATION.NO. : 6' attached. In tabulations'below,amounts are stated to the nearest dollar. Use Column I on Contracts:where APPLICATION'DATE: '9/30/2010 'here far line.items may apply. PERIOD TO: 9/30/2010 . ARCHITECTS,PROJECT NO.: A B C. D ( E F G H I WORK COMPLETED. MATERIALS 'TOTAL ' ITEM FRgM PREVIOUS PRESENTLY COMPLETED AND ry, BALANCE TO. RETAINAGE DESCRIPTION OF WORK SCHEDULED VALUE FINISH (IF VARIABLE N0. APPLICATION THIS PERIOD STORED,(NOT IN STORED;TO DATE (G,f C) (C.-G) RATE) :(D'+E) :D OR E) (D+E+.,F} 1 Allowance $25,000:00 .$0.00 0% 25,000:00 - _ -2 Supervision $47;5001'00 '$20,900.00 $5;225.00 $26;125:00 . .55%' .21,375:00 2,612.50 .3 Demobilization $2,000:00 •$1.;000.00 $1;000:00 '50% 1,000:00 , 100:00 4 Submittals. $16000:00 $18,000.00 $18,000:00 ' 1:00% , - 1,800.00 .5 Misc..General'Conditions $32;724:40 ;$14,562.00 $3;600.00 $18;162:00 <55% 14,562.40. 1;81,6:20 6 Excavation at North Ramp $4;643:00 $4,643.00 .$4,643.00 100°/x' - '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 $2,200.00 $3;300.00 $5;500:00 •50% 5,500.00 550.00 .9 Trench Drain.Material $59,000.00 $59,000.00 $59,000:00 100% - 5;900:00 10' Trench Drain Labor $15,000.00 $3,750.00 $7;500.00 $11,250.00 '75% 3;750.00 1',125'.00 11 Demolition Labor $35,000.00. .$26;250:00 $26,250:00 75% 8;750.00 4625:00 12, Topping Slabs'&Curbs.Material $170;000:00 $77,000:00' $25;500:0Q $102,500.00 60% 67,500.00 '10;250:00 i3 ' Topping Slabs&;Curbs Labor $164;900:00 .$33,086.00 $24;735.00 $57;821.00 '35% '107,079.00 5,782.10 14 Reber 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 ' $1-,000M0. . `83% 200.00 100:00 17' Waterproofing&.Exp.Joints $742,000.00 .,$337,100.00 $1.11,300:00 .$0.00 $448,400:00, '60% 293,600.00: 44,840.00 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 $0.00 '0% 18000.00 - 22. Charige-Otder#1: -$18,400:00. $0.00 0% (:18,400.00) - 23; Change,Order#2 $5,182:00, , :$5,182.00 $5,182:00 100% - .51820 ' 24.' Change-Order#3 $3;252.00 ' $2;926.00 $326.00 ' $3;252:00 100% - `325.20 25 Changer-Order#4 $26,871.00 • $11,823.00 $2;955:00 $14,778.00 .55% 12,093:00, 1,477:80 CONTDNUA11ON SHEET Page 3:of 3' APPLICATION NO.: 6 APPLICATION AND'CERTIFICATE'FOR,PAYMENT,containing Contractor's.signed Certification,.is APPLICATION DATE: 9130/2010 attached: Imtabulations below,amounts;are stated to the nearest dollar. Use Column I on:Contracts where variable retainage for"line items"may.apply. PERIOD TO: 9/30/2010 ARCHITECT'S.PROJECT NO.: A B C D E F G H WORK'COMPLETED MATERIALS TOTAL ITEM FROM PREVIOUS .PRESENTLY COMPLETED_AND % BALANCE TO RETAINAGE DESCRIPTION OF WORK SCHEDULED VALUE FINISH (IF VARIABLE NO. APPLICATION THIS PERIOD STORED(NOT IN 'STORED TO DATE (G t C) (C-G) RATE} (D'+E) D,OR E} (D'+E.+F) 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 . $1,002.00 $1,002:00 $2,004:00 50% 2,004.00 '200:40 29' Change'Order'#8 $14;921:00 $4;47600 $6,714:00• $11,1'90'.O0 75% 3;7,31.00 1.,119:00 30 Change Order#9 $8,529.00, $4;265:00 $4,265.00 50% 4,264:00 426.50 31 32 33` 34: 35 36:, .37' - 38 - 39 40 41 42 43' 44 45 46 47 48 49 "50 $1',684';916.40 $751,,991.00 $193;957:00 '$0.00 $945,948.00 56% $728;969.40 $94,594.80 ISA Form#1-402 tt . t o ti, ' , ;A `� '; AFFIDAVIT AND WAIVER OF LIEN ❑ 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 One Hundred Seventy Four Thousand Five Hundred Sixty One and 30/100 - ---- Dollars ($174,561.30) ❑ 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 Ii ner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon = count of LABOR or material or both,furnished by the undersigned thereto, subject to limitations of conditions e pr- ed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work - o ed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By 14 I Title President f 1 , WITNESS MY HAND AND NOTORIAL SEAL, is 20th day of September, 2010. (Notary Public) ,._ BRIAN R. MCBRIDE * SEAL. rt P_s of Hancock County c 1979 INDIANA SUBCONTRACTORS ASSOCIATION INCORPORATED My Comm. Ext. 11-29-2017 Rev IOW Un,u1hor•teA ReOIOduCllon Ploh,b,Ied 01 Ccm n son # 611862