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HomeMy WebLinkAboutGibraltar, Signature, Smock Fansler - $564,954.26 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 10(Signature) October 2010 $ 17,450.11 Application 4(Smock Fansler) October 2010 $309,289.50 Application 11 (Signature) October 2010 $ 14,432.35 Application 7(Gibraltar) October 2010 $223,782.30 Total Authorized Disbursement :' g . Ftf, w q'4 1`r.= 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: ///27 /v CITY OF CARMEL REDEVELOPMENT COMMISSION I By: //I. Les S. Olds Printed: Executive Director Title: 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 Amount to be paid by Carmel Theater Development, $.-17,450.1,1 • APPLICATION AND CERTIFICATION FOR PAYMENT ALA DOCUMENTG702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Corp PROJECT: Cannel Parcel 73 APPLICATION NO Invoice S 10 1 Distribution to: Invoice#7 Streetscape Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 10/25/2010 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: PedcorDesign 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 6703,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 $ 125,145.00 2. Net change by Change Orders $ 0.00 CONTRACTOR: 3. CONTRACT SUM TO DATE(Line I±2) $ 125,145.00 4. TOTAL COMPLETED&STORED TO 5 /6,330.86 1 By: — �_-----' Date: /, ' Z 5 5. RETAINAGE: omas *7'oontz, re-1 = t a. 0 %of Completed Work $ 0 Sub.cribed and• orn to before me this,,,?S day of dc. ,JO/U (Column D+Eon G703) _ ' '••'e LINDA BUCHANAN b. %of Stored Material $ , 'NOTARY ° Hancock County (Column F on 0703) :v:. SEAL..,i My Commission Expires total Retamage(Lines 3a+36 or "9•e%vi, :" AtiQust 20,2011 Total in Column I of G703) $ 0.00 AKGHI I EC I'5 GLR i IFIGA I-E I-OK NAYMtN " —. .......=..-®-o. 6. TOTAL EARNED LESS RETAINAGE $ /6,530.86 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) $ 59,080.75 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 17,450.11 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 48,614.14 (Line 3 less Line 6) AMOUNT CERTIFIED. $ /7 440.r( CHANUE ORDER SUMMARY ADM I 1UNS DEDUC I IONS (Attach explanation .mount certified differs from the amount applied.Initial all figures on this total changes approved Application and: e Continua ' Sheet that are changed to conform with the amount certified.) in previous months by Owner ARCHITEC"" Total approved this Month By: Date: �0 2 0 0 • pp d/� TOTALS $0.00 $0 00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor namea nerein.issuance,payment ano acceptance or payment are wimout 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,NM.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. Director of Redevelopment///y6,U8 7 3 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 10 10/25/10 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 2,500.00 261.75 267.36 0.00 529.11 0% 1,970.89 529.11 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 0% 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 17,200.50 17,182.75 0.00 34,383.25 0% 28,189.25 34,383.25 125,145.00 59,080.75 17,450.11 0.00 76,530.86 61% 48,614.14 76,530.86 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 seventeen thousand four hundred fifty dollars and eleven cents ($17,450.11)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 ho(Z.R4-` oont z, President ubscribed and��sworn//to before me this: �/ � �ti Notary Publicev,� 4l "a °�a• LINDA BUCHANAN Hancock County 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 Amount to be paid by Carmel Theater Development $ 309,289.50 REQUEST FOR PAYMENT From: Smock Fansler Corporation To: CARMEL THEATER DEVELOPMENT CORP - - -- . ,7----z–tnvoice: 2979 2910 W. Minnesota Street 11711 N PENNSYLVANIA ST. ' ;I Draw: APP00004 Indianapolis, IN 46241-4541 CARMEL, IN 46032 Invoice date: 10/20/2010 (-I I, ' '' 1 Period ending date: 10/29/2010 Contract For: `-- i Request for payment: _ --_- Original contract amount $1,251,450.00 Approved changes $20,185.00 Project: 10052 Revised contract amount $1,271,635.00 CARMEL PARCEL 73 HARDSCAPE Contract completed to date $687,665.00 Contract date: Add-ons to date $0.00 Taxes to date $0.00 Architect: Less retainage $68,766.50 Total completed less retainage $618,898.50 Scope: Less previous requests $309,609.00 Current request for payment $309,289.50 Current billing $343,655.00 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $34,365.50 Changes approved in previous Current amount due $309,289.50 months by Owner _ Total approved this Month 20,185.00 Remaining contract to bill $652,736.50 TOTALS 20,185.00 NET CHANGES by Change Order 20,185.00 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 certify that the all contractor authorized as pa d as thereof)amounts previously the h bided and paid and the the owner.CARMEL THEATER DEVELOPMENT CORP relating to the above referenced project. I also \\\� o"�PRY pUa�1C / • CONTRACTOR: Smock F-nsler Corporation State Of INDIANA County Of MORGAN – _ By: �i ]f/1.i Subscribed and sworn to before me this p(d 4'day of , 9_0/0 = S E1kL . / V r r Date: ( �/ /l Notary Public s — My commission expires: G~/ Si.•.. •. . •.•�P.\\\\\�� it �0%4/� T FIN \C ',...J %) /<u Director of Redevelopment /%o P7 #3091 ZOO.coAope red FoR Ayw�tF. /7w )2 73 pip'. REQUEST FOR PAYMENT DETAIL Project: 10052/CARMEL PARCEL 73 HARDSCAPE Invoice: 2979 Draw:APP00004 Period Ending Date: 10/29/2010 Detail Page 2 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 17,500.00 17,500.00 50.00 17,500.00 1,750.00 02 FIELD ENGINEERING 9,700.00 5,820.00 1,455.00 7,275.00 75.00 2,425.00 727.50 03 TRAFFIC CONTROL 10,300.00 4,120.00 3,605.00 7,725.00 75.00 2,575.00 772.50 04 DEMOLITION 54,000.00 43,200.00 10,800.00 54,000.00 100.00 5,400.00 05 EARTHWORK,DRAINAGE,UTIL 102,300.00 61,380.00 25,575.00 86,955.00 85.00 15,345.00 8,695.50 06 ASPHALT PAVEMENT 109,700.00 5,485.00 10,970.00 16,455.00 15.00 93,245.00 1,645.50 07 CONCRETE PAVEMENT 154,150.00 61,660.00 61,660.00 123,320.00 80.00 30,830.00 12,332.00 08 LANDSCAPING 46,500.00 11,625.00 11,625.00 25.00 34,875.00 1,162.50 09 CONCRETE WALLS,STAIRS 164,400.00 73,980.00 57,540.00 131,520.00 80.00 32,880.00 13,152.00 10 MASONRY 68,000.00 23,800.00 23,800.00 35.00 44,200.00 2,380.00 11 METAL RAILING 95,700.00 95,700.00 12 MECHANICAL 103,100.00 30,930.00 36,085.00 67,015.00 65.00 36,085.00 6,701.50 13 ELECTRICAL 114,100.00 39,935.00 34,230.00 74,165.00 65.00 39,935.00 7,416.50 14 UNIT PAVERS 184,500.00 46,125.00 46,125.00 25.00 138,375.00 4,612.50 15 CHANGE ORDER#1 3,875.00 3,875.00 3,875.00 100.00 387.50 16 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 Totals 1,271,635.00 344,010.00 343,655.00 687,665.00 54.08 583,970.00 68,766.50 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: ($309,289.50) Three Hundred Nine Thousand Two Hundred Eighty Nine Dollars and 50/100 [ ] 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.•...14.SMOCK FANSLER CORP. By rtle CEO T. M.Fansler WITNESS MY HAND AND NOTARIAL SEAL, this 20th day of October,2010. NRY Po, 6 \\\\00U1tIIIIII IIIIIIII1////J//i//�i Melissa J. Kop N to Public ? _ • A I , My commission expires November 30, 2016 Residing in_Morgan County I — — ��/Ojiiiii/I IIOIF!nN ���oo 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 Amount to be paid by Carmel Theater Development $14,432.35 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Corn PROJECT: Carmel City PI l 1 Waterproofing APPLICATION NO Invoice# 11 l Distribution to: invoice 4 I 1 Signature costs [ OWNER Carmel Indiana 46032 [ 1ARCHITECF PERIOD TO: 10/25/2010 l X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pedcor Design l 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 0703.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. t ORIGINAL CONTRACT SUM 173,961.29 2 Net change by Change Orders 0.00 CONTRACTOR: 3 CONTRACT SUM TO DATE(Lute I ±2) 5 173,961.29 #### 4 TOTAL COMPLETED&STORED TO $ I29,935.45 / ' y: Date. lD Z 5 /Q . 5 RETAIN AGE T%as 'oontz, 'rest ent �, c '1 •, c.'6 a 0 %of Completed Work 5 0 Subscri. d and sworn to before me this ,..,;23-- day of Decemberr2009 _ • -.. (Column D--E on G703) b /o of Stored Material $ • �..., LINDA BUCHANAN (Column F on 0703) -.•, :NOTARY'. Hancock County I otai Ketainage(Lines 55+DO or . SEA, .'- My Commission Expires Total in Column I of 0703) $ 0.00 . ' , '''..9.r.!: •0,2011• 6. TOTAL EARNED LESS RETAINAGE $ 129,93 .45 In accordance with the Contract Documents,based on on-site .observations and the.ata (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) 5 1 15,503.10 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8 CURRENT PAYMENT DUE 5 14,432 35 is entitled to payment of the AMOUNT CERTIFIED 9 BALANCE TO FINISH,INCLUDING RETAINAGE $ 44,025 84 ��y (Line 3 less Line 6) AMOUNT CERTIFIED .. .. . $ 14 4'Z. CHANGE ORDER SUMMARY AUDI HUNS DEDUC t IONS (Attach explanation ' ount certified differs from the amount applied.Initial all figures on this Fowl changes approved Application and th Continuati heel that are changed to conform with the amount certified.) in previous months by Owner ARCHITECT' !l Total approved this Month By: Date: `V,Z 2/(P TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor namea nerein.issuance,payment ano acceptance 01 payment are wunout 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 ©1992 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 0401 -Certification of Document's Authenticity from the Licensee. Director of Redevelopment/i./y ., 3'0 5 0 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 -� -------- -- -- ------ Invoice # 11 _10/25/10 Carmel City _P111 Waterproofing - Gibraltar_ Carmel, Indiana Total Work RETAINAGE _ _ 1 BALANCE l P - - - - Scheduled Completed WITHHELD- PREVIOUS TOTAL COMPLETED- - - - = TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE I, % FINISH Pr -- - - - - -- - - - - Pre-Construcc tion Services: Project Management --- - �- - -- g--- ---- ------- - - - -- ---- ------ 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 ------------- - Ins ec ti n 0.00------ ---- -------- -- - -------2,500.00------------ -- 0.00 315.78 315.78 0% 2,184.22 Project Management 1,500.00 0.00 0.00 758.46 758.46 0% 741.54 Site Supervision 67,934.00 2,000.00 0.00 50,295.67 52,295.67 77% 15,638.33 Site Safety Director 4,666.67 0.00 0.00 2,756.63 2,756.63 59% 1,91010.04 04 ---- ------ ------------ Design Drawings -------- - 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 lies _.. PP - __ 1,000.00 0.00 0.00 554.53 554.53 55% 445.47 Tools and Equipment -__.._-_. -__ - -------_-- _-_-__-- _- --- ---_,.--- ----.4}i P - --- _-- - -- ---__--2,000_00 --- --- 0.00----------0.00--------1,281_07 1,281.07 64% 718.93 Field Engineering and Surveying 6,000.00 0.00 0.00 810.00 810.00 14% 5,190.00 -- - ------- - - Construction Management Fee 82,673.62 12,432.35 0.00 47,556.50 59,9888..85 73% 22,684.77 173,961.29 --14,432.35 0.00 115,503.10 129,935.45 75% 51,316.63 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 forteen thousand four hundred thirty-two dollars and thirty-five cents ($14,432.35) 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 f Th• as E(oontz, President S bscribed and sworn to before me this:— 5 6c' v c)61/C) Notary Public: .u ._}-----' •W LINDA BUCHANAN 0T.Aa. -. - Hancock County SEAL .� 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 Paid by Carmel Theater Development $174,561.30 October 2010 Application 7 Amount to be paid by Carmel Theater Development $223,782.30. 0 olio A 4'f Document 7021C a M ® 1992� ;M 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. 7 PERIOD TO: 10/30/10 OWNER ❑ CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 1/18/10 2932 N.Webster Ave. PROJECT NOS: / I CONTRACTOR ❑ Indianapolis, IN 46219 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: Pedcor Design Group,LLC ❑ Waterproofing&Topping Slabs CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certif s 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 A plication for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents, that all amo nts have been paid by the Contractor for Work for which previous Certificates for Payment v:,e i sued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 1,610,967A0 payment shown herein is'"i'y'duiy; 2. Net change by Change Orders $ 73.949.00 CONTRACTOR: Gibra •rU ., s truction Corp 3.CONTRACT SUM TO DATE(Line 1 +2) $ 1 6844916.40 By: 1; ' I Date: ,L , i� a/ - 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) $ 1,194,595.00 State of L,0",,c \i 5.RETAINAGE: County of: ♦ %'o_.J z /—�`'-� SIDE a. %of Completed Work Subscribed ant rn to before ,, _ °- "' 1,'-DrI, .r, WIV (; Ml yI. (Column D+E on G703) $ 119,459.50 me this �/3'day of l F 1'!9-201 7 ✓C I at.' b. %of Stored Material Notary Public: - -'' 't 611662 (Column F on G703) $ My Commission expires: //-- 'J-7 Total Retainage(Lines 5a+5b or Total in Column I of G703). $ CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE 5 1,075,135.50 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 $ 851,353.20 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 $ 223,782 30 AMOUNT CERTIFIED $ a'3:1,10. 30 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation it amount certified differs from the amount applied. initial all figures on this Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 609,780.90 CONSTRUCTION r' ' ` • R:- By. /r ■ Date: /0 4.70 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT.' r �Ai Total changes approved in previous months by Owner $73 9�/ $ By: -" Date• kOk Q►?,r Total approved this Month $ $ This Certific Mr negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $73 9y9 $ named rein. s, ce, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order _9_- 9GpG the er o-Con actor t nder this Contract. i� j up,a , rear, Agaiho, Sign/7g230 CAU.I-(ION: You should sign an original NA Contract Document,on which this text appears in RED. An original ssures that changes will riot be obscured. -_ AIA Document G702/CMaTM—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA' Dccuiiient is protected by U.S.Copyright Law and International"rreoUo-;_ tinr:u:■;,.rrize,1 reproduction or distribution of ibis AIA' Document.or any portion of ii,may result in severe civil and crirn,nal pe3aitias.and will be prosecuted to the maximum eater?sos ibte under t! .:: Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-ma uThe A eric r t g counsel,copyright@ara.wg. irec or OT /76.0clo5— CONTINUATION SHEET Page 2 of 3 APPLICATION NO. : 7 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION DATE: 10/30/2010 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: 10/30/2010 ARCHITECT'S PROJECT NO. : A B C D 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) DORE) (D+E+F) (C G) RATE) 1 Allowance $25,000.00 $0.00 0%' 25,000.00 - 2 Supervision $47,500.00 $26,125.00 $7,125.00 $33,250.00 70% 14,250.00 3,325.00 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 $18,162.00 $4,908.00 $23,070.00 70% 9,654.40 2,307.00 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 $5,500.00 $2,750.00 $8,250.00 75% 2,750.00 825.00_ 9 Trench Drain Material $59,000.00 $59,000.00 $59,000.00 100% - 5,900.00 10 Trench Drain Labor $15,000.00 $11,250.00 $1,500.00 $12,750.00, 85% 2,250.00 1,275.00 11 Demolition Labor $35,000.00 $26,250.00 $26,250.00, 75% 8,750.00 2,625.00 12 Topping Slabs& Curbs Material $170,000.00 $102,500.00 $34,000.00 $136,500.00 80% 33,500.00 13,650.00 13 Topping Slabs& Curbs Labor $164,900.00 $57,821.00, $49,470.00 $107,291.00 65% 57,609.00 10,729.10 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 $1,000.00 83% 200.00 100.00 17 Waterproofing & Exp. Joints $742,000.00 $448,400.00 $148,400.00 $0.00 $596,800.00 80% 145,200.00 59,680.00 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% 184,000.00 - 22 Change Order#1 -$18,400.00 -$11,040.00 -$11,040.00 60% (7,360.00) (1,104.00) 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 $14,778.00 $4,030.00 $18,808.00 70% 8,063.00 1,880.80 CONTINUATION SHEET Page 3 of 3 APPLICATION NO. : 7 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification, is APPLICATION DATE: 10/30/2010 attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts PERIOD TO: 10/30/2010 where variable retainage for line items may apply. ARCHITECT'S PROJECT NO. : A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE TO RETAINAGE ITEM FROM PREVIOUS PRESENTLY COMPLETED AND oa N0. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) FINISH (IF VARIABLE (D+E) DORE) (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 $2,004.00 $1,002.00 $3,006.00 75% 1,002.00 300.60 29 Change Order#8 $14,921.00 $11,190.00 $2,238.00 $13,428.00 90% 1,493.00 1,342.80 30 Change Order#9 $8,529.00 $4,265.00 $4,264.00 $8,529.00 100% - 852.90 31 32 33 34 35 36 37 - 38 - 39 . 40 41 42 43 _ . 44 45 46 47 _ 48 49 50 $1,684,916.40 $945,948.00 $248,647.00 $0.00 $1,194,595.00 71% $487,826.40 $119,459.50 ISA Form # 1-402 z; �t 3j AFFIDAVIT AND WAIVER OF LIEN El 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 Two Hundred Twenty Three Thousand Seven Hundred Eighty Two and 30/100 Dollars ($223,782.30) ❑ 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 El 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 Ow r of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon acco nt of LABOR or material or both,furnished by the undersigned thereto, subject to limitations of conditions expr-s4� herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work pert,,,,', e or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By /' Title President WITNESS MY HAND AND NOTORIAL SEAL, s 2nd day •f October, 2010. (Notary Public) IAN. . , fvi C DE. C 1979 INDIANA SU9CONTaACTOO*ASSOCIMIiON INCORPORATED � 1 ' c.,7 g►nau+nor•arG ArMOtiveteon Wori+bltid / - 17 Rev IMP 41ni�' +';,lrr- 1'502