Loading...
HomeMy WebLinkAboutGibraltar, Signature, Smock Fansler - $610,443.47 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 pald.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 11(Signature) November 2010 $ 13,255.00 Application S(Smock Fenster) November 2010 $238,590.00 Application 12(Signature) November 2010 .5 26,741.77 Application 8(Gibraltar) November 2010 5 331,778.70 October NBI Lender Attorney's fee $ 78.00 Total Authorized Disbursement , 8106949!%1 �-,.�=,",'i ,- :„° ”' 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 ati nal Bank of Iridiariapolis and Carmel Theater Development Company, LLC. Dated: IZ r.Ia CITY OF CARMEL REDEVELOPMENT COMMISSION Psi: 111111P,-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 Paid by Carmel Theater Development $ 17,450.11 November 2010 Application 11 Amount to be paid by Carmel Theater Development $ 13,255.00 • APPLICATION AND CERTIFICATION FOR PAYMENT ALA DOCUMENT G702 PAGE ONE OF 2 PAGES2 TO OWNER Cannel Theater Development Corp PROJECT: Carmel Parcel 73 APPLICATION NO Invoice#i t 1 Distribution to: Invoice i 7 Streetscape Signature costs OWNER Carmel Indiana 46032 I 'ARCHITECT PERIOD TO: 1 1/29/2010 I X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pcdcor Design Signature Construction Services LLC I 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 $ 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 $ 89,785.86 By: j '' Date: yl/z 9/v 5. RETAINAGE: Thomas . .oontz,President a- 0 %of Completed Work $ 0 Su cribed and?vom to before me this a 9 " day of Ale'I; 'I`r ei . (Column D+Eon G703) ° i M*.. •. LINDA BUCHANAN i b. %of Stored Material $ p.. �=: (Column F on G703) 5 1�?M*. Harm Hancock County ' �� :.": My Commission Expires Total Retainage(Lines 5a+5b or .'; iii:.;; ' Total in Column l of G703) S 0.00 AR H TE T'S ERTI CATE FOR PA VI ''- -- t �" ' 6. TOTAL EARNED LESS RETAINAGE S 89,785.86 In accordance.with the Contract Documents,based on omsite observations and the data (Line 4 Lcss-Line-S 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) $ 76,530.86 the quality of the Work is in'accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 13,255.00 is-entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 35,359.14. .(Line 3 less Line 6) AMOUNT CERTIFIED . $ 13.265°°• CHANGE ORDER SUMMARY ADDFI'IONS DEDUCTIONS (Attach explanation . •mount certified differs front the amount applied Milled all figures on this Total changes approved Application am • Continuation Sheet that are changed to-conform reith the amount certified.) in.previousmonths by Owner ARCHITECT /�� Total approved this Month By: a K��---- Date: `iiNtitiftt TOTALS $0.00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the t.ontractornameu Herein.Issuance,payment ant 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 0702-APPLICATION AND CERTIFICATION FOR PAYMENT-1992 EDITION-AIA-01992 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.AlA Document 0401 -Certification of Documents Authenticity from the Licensee. p19v SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 11 11/29/10 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 0.00 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 34,383.25 13,255.00 0.00 47,638.25 0% 14,934.25 47,638.25 125,145.00 76,530.86 13,255.00 0.00 89,785.86, 72% 35,359.14 89,785.86 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 thirteen thousand two hundred fifty-five dollars ($13,255.00) 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 • • • homes E' oontz, President / r/ Subscribed and swom to before me this: AJ) ,7 .?•0/0 Notary Public:" _ LINDA BUCHANAN : ``'`• Hancock County { 'i�s�,nr. ;I y; My Commission Expires '2;a•,, 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 Amount to be paid by Carmel Theater Development $ 238,590.00 REQUEST FOR PAYMENT From: Smock Fenster Corporation To: CARMEL THEATER DEVELOPMENT CORP Invoice: 3000 2910 W.Minnesota Street 11711 N PENNSYLVANIA ST. Draw: APP00005 Indianapolis,IN 46241-4541 CARMEL,IN 46032 Invoice date: 11/19/2010 Period ending date: 11/30/2010 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 $952,765.00 Contract date: Add-ons to date $0.00 Taxes to date $0.00 Less retainage $95,276.50 Architect: Total completed less retainage $857,488.50 Scope: Less previous requests $618,898.50 Current request for payment $238,590.00 Current billing $265,100.00 Current additional charges $0.00 Current tax $0.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Less current retainage $26,510.00 Changes approved in previous 20,185.00 Current amount due $238,590.00 months by Owner Total approved this Month 33,340.00 Remaining contract to bill $447,486.50 TOTALS 53,525.00 NET CHANGES by Change Order 53,525:00 I hereby certify that the work performed and the materials supplied to date,as shown on the above represent the actual value of the accomplishment under the terms of the Contract(and all authorized changes thereof)between the undersigned and the CARMEL THEATER DEVELOPMENT CORP relating to the above referenced project. I also \��`�`UUUn4uuunniire,"4/1/41. certify that the contractor has paid all amounts previously billed and paid by the owner. \,\•�`O BY hUeZ ,..,,J sr••• • C CONTRACTOR: Smoc Fancier Corporation State Of INDIANA County Of MORGAN _ _ / / �/t, i ST-7A� nY By: % - 1�..! Subscribed and sworn to before me this 1711' day of /t 1���,�1�'0 i�(llO `*' � � Date: /1 A / /ii Notary Public �� �!/, —•-- My commission expires: 7 S .... v..:,-�'0 /30 aofg, ice,. �t1 sr2aLroaA /yl.ov4acR ent I =1 yrG G 8 `%3 �"�"�+V 'r/3o"°D Director of Redevelop►� � Ass, cgc$ i 2313,00.B® qj REQUEST FOR PAYMENT DETAIL , Project: 10052!CARMEL PARCEL 73 HARDSCAPE Invoice:.3000 Draw:APP00005 Period Ending Date: 11/30/2010 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 8,750:00 26,250.00 75.00 8;750.00 2,625.00 02 FIELD ENGINEERING 9,700.00 7,275.00 1,455.00 8,730.00 90.00 970.00 873.00 03 TRAFFIC CONTROL 10,300.00 7,725.00 1,545.00 9;270.00 90.00 1,030.00 927.00 04 DEMOLITION 54,000.00 54,000.00 54,000.00 100.00 5,400.00 05 EARTHWORK,DRAINAGE,UTIL 102,300.00 86,955.00 5;115.00 92;070.00 90.00 10,230.00 9,207.00 06 ASPHALT PAVEMENT 109,700.00 16,455.00 76,790.00 93,245.00 85.00 16,455.00 9,324:50 07 CONCRETE PAVEMENT 154,150.00 123,320.00 15,415;00 138,735.00 90.00 15,415.00 13,873,50 08 LANDSCAPING 46,500.00 11,625.00 23,250.00 34',875.00 75.00 11,625.00 3,487.50 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 23,800.00 23,800.00 47,600.00 70.00 20,400.00 4,760.00 11 METAL RAILING 95,700.00 95,700.00 12 MECHANICAL 103,100:00 67,015.00 67,015.00 65;00 36,085.00 6,701.50 13 ELECTRICAL 114,100.00 74,165.00 11,410.00 85,575:00 75:00 28,525.00 8,557.50 14 UNIT PAVERS 184,500.00 46,125.00 92,250.00 138,375.00 75.00 46,125.00 13,837.50 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 18 CHANGE ORDER#4 6,500.00 3,250.00 3,250.00 50.00 3,250.00 325.00 19 CHANGE ORDER#'5 16,490.00 16,490.00 20 CHANGE ORDER#6 10,350.00 2,070.00 2,070.00 20.00 8,280:00 207.00 Totals 1,304,975.00 687,665.00 265,100.00 952,765.00 73.01 352,210.00 95,276.50 AFFIDAVIT AND WAIVER OF LIEN r [ ] 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: ($238,590.00) Two Hundred Thirty Eight Thousand Five Hundred Ninety Dollars and No/100 [ ] receipt of which is hereby acknowledged;or [X] the payment of which hm 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 11/42 (e CEO T. M.Fansler WITNESS MY HAND AND NOTARIAL SEAL,this 19"' day of November,2010. 7i(I AA : 71L �a�atRY.... ,,ii,,.;� Melissa J. Bis op Nota, Public SEAL • My commission expires November 30.2016 Residing in Morgan County OF 1Nn\P ""�rnrrnuumum,���a:` 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 Amount to be paid by Carmel Theater Development $26,741.77 APPLICATION AND CERTIFICATION FOR PAYMENT AIADOCUMENT'G702 PAGE ONE OF 2 PAGES2 TO OWNER Cannel Theater Development Com1 PROJECT: Cannel City P i l l Waterproofing APPLICATION NO Invoice 1t 12 1 Distribution to: Invoice 1t 1 1 Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 11/29/2010 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 W6dk'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 173,96129 2. Net change by Change Orders 0.00 CONTRACTOR: 3. CONIRACf SUM TO DATE(Line 1±2) $ 173,961.29 *Hid 4. TOTAL COMPLETED S:STORED TO 5 156,677.22 By: f t Date: /�Zf J -5..RETAINAGE: Thoma .Koontz,President a. 0.%of Completed Work $ 0 Su scribed a d&sworn to before me this 7 day of Deeembcr,2009 lie Y I .?d/0 (Column D+E on 0703) ___._._I b. %of Stored Material $ f;:Ai ,, LINDA BUCHANAN } �i.�. Hancock County l (Column F on e(Lines 1, . ;EA, My Commission Expires Total Retainage(Lines Sa+5b or k :,,,:a*' M1urc:2A/n11 Total in Column 1 of G703) $. 0.00 ARCHITECT'S CERTIFICATE FOR PAYMENT - 6. TOTAL EARNED LESS RETAINAGE $ 156,677.22 In accordance with the Contract Documents,based-omon-site observations and the data (Line 4 Less Line.5 Total): comprising the application,the Architect certifies ta,ehe 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) -$ 129,935.45_ the quality of the Work is-in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENI:.DUG $ 26,74L77 is eiititled.to payment of the AMOUNT CERTIFIED. 9. BALANCE TOFINISH,INCLUDING RETAINAGE $ 17,284.07 (Line 3 less Line 6) AMOUNT CERTIFIED $ 2C 744.17 CHANGE ORDER SUMMARY .ADDITIONS DEDUCTIONS (Attach explanation rfaulau er fled diprsfront.the amount applied.Initial all figures on this Total changes approved Application and anthe ntinuat on Sheet at re changed to conform with the amount certified.) in previous months by Owner ARCHITECT: Total approvedthis Month By: ate: 11130/f I/ TOTALS $0.00 $0.00 This Certificatei5 not negotiable. The-AMOUNT CERTIFIED is payable only to the O\ Contractor named'herein.Issuance,.payment and acceptance ot.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 •01902 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 • 11./29/10 Carmel City Pill Waterproofing - Gibraltar Carmel, Indiana i I Total Work RETAINAGE 1 BALANCE . Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED. TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE I % 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 Testin. and Ins.ectin. 2,500.00 930.90 0.00 315.78 1,246.68 0% 1,253.32 Project Management 1,500.00 0.00 0..00 758.46 758.46 0% 741.54 Site Supervision 67;934.00. 6,870..61 0.00 52,295.67 59,166.28 87% 8,767.72 , Site Safety Director 4.,666..67 399.89 0.00 2,756.63 3,156.52 68% 1,510.15 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 0.00 554.53 662.75 66% 337'.25 Tools and.Eguipment 2,,000.00. 0.00 0.00 1,281.07 1,281.07 64% 718.93 Field En.ineerin. and Surve in. 6,000.00 0.00 0.00 810.00 810.1)0 14% 5,190.00 Construction Management.Fee 82,.673.62. 18,432.15 0.00 59,988..85 78,421..00 95% 4,252:62 173,961.29 26,741.77 0.00 129,935.45 156,677.22 90.E 24,574.86 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 Carmel City Center P11.1, 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 twenty-six thousand seven hundred forty-One dollars and seventy-seven cents($26,741.77)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 -e omas E. oontz, President Su scribed and sworn to before me this: -(-1,11 Notary Public: .....:e •. LINDA BUCHANAN ..• �, �r.Ar Hancock County $ L ;, My Commission Expires `'•?da; August 20,241,1 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 Amount to be paid by Carmel Theater Development $331,778.70 �+ ��i_ , TM .va Document G7 2/C� ,1a = 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: Distribution to: Carmel Theater Development Company . Cannel City Cntr-P111 Waterproofing&Paving Comp. 8 PERIOD TO: 11/30/10 . OWNER ❑ • CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 1/18/10 2932 N.Webster Ave. PROJECT NOS: / 1 CONTRACTOR ❑ Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ Pedcor Design Group,LLC , CONTRACT FOR: Waterproofing&Topping Slabs ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies tlr t 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 Applic;tion for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amounts we been paid by the Contractor for Work for which previous Certificates for Payment were i a cd and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $1 61nq.A7 4n payment shown herein is now du, 2.Net change by Change Orders 5 98,806.00 CONTRACTOR:Gibraltar Co r u c 0 n Corp 3.CONTRACT SUM TO DATE(Line i ±2) $1.709.773.40 By: d Date: 11:••••• i1 Q 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $1,563,238.00 State of: ,�A/0jp / � "',E BRIAN R. MCBRIDE 5.RETAINAGE: County of:j l]M. ,/ �� _ _.{ County a. %of Completed Work Subscribed and swop/0 .efore ,� _ 156,323.80 i%�' M COMM 11-29-201 7 (Column D+Eon 0703) $ me this day of AJ©vL✓!AJ ay y b. %of Stored Material Notary Publ' • *-+0I ar Co""r7'4 # 611862 (Column F on G703) $ My Commission expires: //i9.--/ Total Retainage(Lines 5a+5b or Total in Column I of 0703). $ CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ f,406,914.20 In accordance with the Contract Documents,based on on-site observations and the data comprising this application,the Construction Manager and Architect certify to the Owner that 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 s 1,075,135.50 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 $ 331.778,70 AMOUNT CERTIFIED $ 3' 1,rn '.110 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if 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 0100001 certified.) (Line 3 less Line 6) $ 302,859.20 CONSTRUCTION MANAGER' J/ By: 4,. . �.W.__ / Date: iI/ao/N) CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC. CT: ,�ilr Total changes approved in previous months by Owner $ $ _ �j .c�P Design Group,L ` egli t `O PP P Y 73 94+'9 By Li .. '�i ille Date: Total approved this Month $ (.,, $ This Certificate is not negotiable. The AM t+•UNT C RTIFIED is payable �nly(o the Contractor TOTALS $�a2'j 6 $ named herein. Issuance. payment • d ace . once of payment are without prejudice to any rights of NET CHANGES by Change Order �� the Owner or Contractor under this C. tact. 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/CM©TM+-1992.Copyright @ 1992 by The American Institute of Architects,All rights reserved.WARNING:This AIA°Document is protected by U.S.Copyright Law and International Treaties. I/ Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil-and criminal penalties,and will be prosecutedto the maximum extent possible under ttie.law. \i)V 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 3 of 3 APPLICATION NO. : 8 APPLICATION AND.CERTIFICATE.FOR PAYMENT,containing Contractor's signed Certification,is APPLICATION DATE: 11/30/2010 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: 11/30/2010 ARCHITECTS PROJECT NO..: A B C D E F G H 1 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 OR E) (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 $3,006:00 $1;002.00 $4,008.00 100% - 400.80 29 Change Order#8 $14,921.00 $13,428.00 $1,493.00 $14,921.00 100% - 1,492.10 30 Change'Order#9 $8,529:00 $8,529100. $8,529.00 100% - 852.90 31 Change`Order#10 $12,192:00 $0.00 $0.00 0% 12,192.00 - 32 Change Order#1,1 $1,959.00 $0:00 $0.00 0% 1,959.00 - 33 Change Order#12 $2,265.00 $0.00 $0.00 0% 2,265.00 - 34 Change.Order#13 $8,441.00 $0.00 $8441.00 $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 $1,194,595.00 $368,643.00 $0.00 $1,583,238.00 91% $130,119.40 $156,323.80 CONTINUATION SHEET Page 2 of 3 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification,is APLICATI ION NO. : 8 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column Ion Contracts where APPLICATION DATE: 11/30/2010 variable retainage for line items may apply. PERIOD TO: 11/30/2010 ARCHITECTS PROJECT NO. : A B C D ( E F G H I WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED AND, g6 BALANCE TO RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS FINISH (IF VARIABLE NO. APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G!C) (D+E) DORE) (D+.E±F) (C-G) RATE) 1 Allowance $25,000.00 $25,000.00 $25,000.00 100% - 2,500.00 2 Supervision $47,500.00 $33,250.00 $9,500.00 $42,750.00 90% 4,750.00 4,275.00 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 $23,070.00 $6,545.00 $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 $8,250.00 $1,650.00 $9,900.00 90% 1,100.00 990.00 9 Trench Drairi`Material $59,000.00 $59,000:00 $59,000:00 100% - 5,900.00 10 Trench Drain Labor $15,000:00 $12,750.00 $2,250.00 $15,000.00 100% - 1,500.00 11 Demolition Labor $35,000.00 $26,250.00 $8,750.00 $35,000.00 100% - 3,500.00 12 Topping Slabs&Curbs Material $170,000.00 '$.136,500.00 $33,500.00 $170,000.00 100% - 17,000.00 13 Topping Slabs&Curbs Labor $164,900.00 $1'07,291.00 $57,609.00 $164,900.00 100% - 16,490.00 14 RebarMaterial $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 $596,800.00 $74,200.00, $0.00 $671,000.00 90% 71,000.00 67,100.00 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 $138,000.00 75% 46,000.00 13,800.00 22 Change Order#1 -$18,400.00 -$11,040.00 -$7,360.00 -$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 $18,808.00 $8,063.00 $26,871.00 100% - 2,687.10 ISA Form#1-402 P is 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 Three Hundred Thirty One Thousand Seven Hundred Seventy Eight and 70/100 Dollars ($331,778.70) ❑ 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 Owner .f said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon accou of LABOR or material or both,furnished by the undersigned thereto, subject to limitations of conditions expres es -rein, if any; and further certifies that no other party has any claim or right to a lien on account of any work perform-s •r I aterial 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, this 22 'd'•:y of No ember, 2010. - (Notary Public) BRIAN R MCBRIDE Q 1979 *HDIANA SUBCONTRACTORS ASSOCIATION tNCOPPORATED 2'. - j-�,.=. v• --c.,c County unauthot.:Od ROA•�ucltOn Pron,b,IOd * SE.--.L r my co-rim :yy 11-29-2011 Rev 1 W 4 .- CC,r1 .,;.S. r # 611862 ir I iii :"J:\ I lONAI I �, BANI 'IP\�� � ��� /� q�O��� 107 N. Pennsylvania Street j In dianapolis, Indiana 46204 Bill To: Due Date Carmel Theater Development Company, LLC Date ATTN: Lanny Sledge Payable within 11711 N. Pennsylvania Street 11/23/2010 15 Days Suite 200 Carmel, IN 46032 Lender Account Number JRB Fee(s) Due Description Amount Attorney's Fees Hall, Render, Killian, Heath & Lyman, P.S.C. 78.00 For October 2010 Remit Payment to: The National Bank of Indianapolis Attn: Debbbie Thompson 107 N. Pennsylvania St., Ste. 700 Indianapolis, IN 46204 Thank you for choosing The National Bank of Indianapolis! Total $78.00 U HALL, RENDER, KILLIAN, HEATH & LYMAN, P.S.C. PLEASE SENO PAYMENT TO: 39778 Treasury Center Chicago.IL 60694-9700 (3171 633-4884 Fade ral IO.N:35.1427161 • • • . Invoice No. : 190111 • National Bank of Indianapolis Billing Atty: JJU Attn: Jason Boyewsky . 107 North Pennsylvania Street November 10, 2010 • Indianapolis, IN 46204 • • • • . Matter Number: 104332-000001 .Carmel Redevelopment •Commission-Financing FOR 'PROFESSIONAL SERVICES RENDERED 10/27/10 JAM Review disbursement requests received from CRC; .30 • forward comments thereon 'to National Bank of Indianapolis • • FEE SUBTOTAL $78.00 • TOTAL THIS INVOICE $78.00 TOTAL BALANCE NOW DUE $78.00 Consistent with our past practice;this bill reflects the October 1 increase to our rates. All invoices are due and payable upon receipt. Interest will accrue at a rate of 1% per month on balance not paid within 30 days Of the invoice date. HALL, RENDER, KILLIAN, HEATH & LYMAN, P.S.C. PLEASE SEND PAYMENT TO: 39778 Treasury Center Chicago.IL 60694.9700 13171833-4884 Fadeial!Ot:35.1427161 • Invoice No. : 190111 National Bank Of Indianapolis Billing Atty: JJU Attn: Jason Boyewsky 107 North Pernisylvania Street November 10, 2010 Indianapolis, IN 46204 • • Matter Number: . 10433'2-000001 • Carmel Redevelopment Commission Financing REMITTANCE PAGE TOTAL FEES FOR THIS INVOICE $78.00 TOTAL THIS INVOICE $78.00 TOTAL BALANCE NOW DUE $78.-00 PLEASE RETURN THIS PAGE WITH YOUR. PAYMENT.