Loading...
HomeMy WebLinkAboutGibraltar, Signature, Smock Fansler - $119,225.48 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 Amount to be paid by Carmel Theater Development as per the Veteran's Way Improvements installment purchase contract and the City Center Drive/Rangeline Road Streetscape Improvements installment purchase contract Application 10(Smock Fansler) April 2011 $ 58,639.50 Application 16(Signature) April 2011 $ 3,324.75 Application 12(Gibraltar) April 2011 $ 55,737.90 Application 17(Signature) April 2011 $ 1,523.33 Total Authorized Disbursement $119,225.48 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: CA7 !1 CITY OF CARMEL REDEVELOPMENT COMMISSION By: �i Les S. Olds Printed: Executive Director Title: P73 Hardscape (Smock Fansler) July 2010 Application 1 Paid by Carmel Theater Development $ 64,998.00 August 2010 Application 2 Paid by Carmel Theater Development $ 77,697.00 September 2010 Application 3 Paid by Carmel Theater Development $ 166,914.00 October 2010 Application 4 Paid by Carmel Theater Development $ 309,289.50 November 2010 Application 5 Paid by Carmel Theater Development $ 238,590.00 December 2010 Application 6 Paid by Carmel Theater Development $ 70,164.00 January 2011 Application 7 Paid by Carmel Theater Development $ 56,929.50 February 2011 Application 8 Paid by Carmel Theater Development $ 65,706.75 March 2011 Application 9 Paid by Carmel Theater Development $ 52,728.75 April 2011 Application 10 Amount to be paid by Carmel Theater Development $ 58,639.50 ••: .. ' AIA Type Document Application and Certification for Payment Page 1 of 3 TO(OWNER):CARREL THEATER DEVELOPMNT CORP PROJECT:CARMEL PARCEL 73 HARDSCAPE APPLICATION NO: 10 DISTRIBUTION 11711 N. PENNSYLVANIA ST. TO: PERIOD TO:4/3012011 CARMEL,IN 46032 _OWNER _ARCHITECT CONTRACTOR FRO;',,-;(CONTRACTOR):Smdck Fr.:nstor Corgorr.tlon VIA(ARCHITECT): il.P.C.7l1:77.107; 2910 W.Minnesota Street PROJECT NO: Indianapolis, IN 46241 CONTRACT FOR: CONTRACT DATE: The Lindersic:ned Contractor certifies that to the best of the Contractors knowledge.information and CC;'rial.:',CTOR'S ;%PFLICI-,TION FOR VIA Y F,ii E NT 1.3o.iuf the,.vo:'}:covered by this z:pp!ication for Payment has been completed in accordance with the !^,, ; ''..'l..,,- ;7. . '.::•,-;f,:-:.'-',!--:,;-: :.-z3 fj'r:v, :'-,:•:‘,4", n':::`.ril.i.;;',iC".•',,,,,'.,':"' (.';'";•:-::: C:. -,:r:::::7:r.a':-.•--"- t:ot o'l on-e-,:o .,, -'a.v,.:ho..-.:;r;o.r;1.;...'lha Cont:c.ctor for Wo:t:tor which prev;ou,:: Payment issued and payments received from Vie owner, and'ih.:':-:"`"'" ;,. current payment shown'nerein is now due. 1.ORIGINAL CONTRACT SUM S 1,251.450.00 if 2.Net Change by Change Orders S 75 000.00 CONTRACTOR: Smock Fansler Corporation 2910 W.Minnesota Street Indianapolis, IN 46241 : - ..., —„ 3.CONTRACT SUM TO DATE(Line 1 ±2) 5 1,326,450.00 ,.. . . 4.TOTAL COMPLETED AND STORED TO DATE S 1.290,730.00 By: VZ, /;;L'Y i'\.. 1,/a://::"..---- Date: ':.= ..'-':/ .•.. - T.M.FANSLER I CEO 5.RETAINAGE: State of IN a. 10.00%of Completed Work $ 129,073.00 County of: MORGAN b. 0.00%of Stored Material S 0.00 Subscribed and Sworn to before me this Day of c:.1)/„': ,_ 20 Notary Public: , 4 .: ."', ,: 7- . - "/ Total retainage(Line 5a+5b) S 129,073.00 My Commission Expires: /, z.:`,., , ;-.2. ,.,./., / 6.TOTAL EARNED LESS RETAINAGE S 1,161,657.00 (Line 4 less Line 5 Total) ARCHITECT'S CERTIFICATE FOR PAYMENT 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT In Accordance with the Contract Documents,based on on-site observations and the data com- prising the above application. the Architect certifies to owner that to the best of the Architect's (Line 6 from prior Certificate) S 1,103.017.50 knowledge, information and belief the Work has progressed as indicated,the quality of the work 8.CURRENT PAYMENT DUE . 5 58,639.50 is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT CERTIFIED. 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Line 3 less Line 6) S 164,793.00 AMOUNT CERTIFIED S 54 COS.5.6° . (Attach explanat. I f amount certified differs from the amount applied. Initial all figures on this CH.1',NGE ORDER ai1E1,RY ADDITIONS DEDUCTIONS Arp;,cotion E.; ,on the Co 'int:al/Gm Sheet that ore changed to conform to the amount cerhfRact; i Total changes approved in ARCHIT T: previous months by Owner ,000.00 75 0.00 By: Date: Total approved this Month 0.00 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein.Issuance,Payment and acceptance of payment are without prejudice to any TOTALS 75,000.00 0.00 rights of the Owner or Contractor under this Contract. 1NET CHANGES by Change Order 75,000.001 4 � es r 4 ` • ' '- , AIA Type Document Application and Certification for Payment Page 2 of 3 TO(OWNER):CARMEL THEATER DEVELOPMNT CORP PROJECT:CARMEL PARCEL 73 HARDSCAPE APPLICATION NO: 10 DISTRIBUTION 11711 N.PENNSYLVANIA ST. TO: CARMEL,IN 46032 PERIOD TO:4/30/2011 _OWNER ARCHITECT _CONTRACTOR FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 2910 W.Minnesota Street PROJECT NO: Indianapolis,IN 46241 CONTRACT FOR: CONTRACT DATE: SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED % BALANCE RETAINAGE 1 MOBILIZATION 35,000.00 31,500.00 1,750.00 0.00 33,250.00 95.00 1,750.00 3,325.00 2 FIELD ENGINEERING 9,700.00 9,215.00 0.00 0.00 9,215.00 95.00 485.00 921.50 3 TRAFFIC CONTROL 10,300.00 9,785.00 0.00 0.00 9,785.00 95.00 515.00 978.50 4 DEMOLITION 54,000.00 54,000.00 0.00 0.00 54,000.00 100.00 0.00 5,400.00 5 EARTHWORK,DRAINAGE,UTIL 102,300.00 102,300.00 0.00 0.00 102,300.00 100.00 0.00 10,230.00 6 ASPHALT PAVEMENT 109,700.00 93,245.00 16,455.00 0.00 109,700.00 100.00 0.00 10,970.00 7 CONCRETE PAVEMENT 154,150.00 154,150.00 0.00 0.00 154,150.00 100.00 0.00 15,415.00 8 LANDSCAPING 46,500.00 37,200.00 6,975.00 0.00 44,175.00 95.00 2,325.00 4,417.50 g CONCRETE WALLS,STAIRS 164,400.00 164,400.00 0.00 0.00 164,400.00 100.00 0.00 16,440.00 10 MASONRY 68,000.00 64,600.00 2,040.00 0.00 66,640.00 98.00 1,360.00 6,664.00 11 METAL RAILING 95,700.00 52,635.00 28,710.00 0.00 81,345.00 85.00 14,355.00 8,134.50 12 MECHANICAL 103,100.00 103,100.00 0.00 0.00 103,100.00 100.00 0.00 10,310.00 13 ELECTRICAL 114,100.00 108,395.00 0.00 0.00 108,395.00 95.00 5,705.00 10,839.50 14 UNIT PAVERS 184,500.00 166,050.00 9,225.00 0.00 175,275.00 95.00 9,225.00 17,527.50 15 CHANGE ORDER#1 3,875.00 3,875.00 0.00 0.00 3,875.00 100.00 0.00 : 387.50 16 CHANGE ORDER#2 4,500.00 4,500.00 0.00 0.00 4,500.00 100.00 0.00 450.00 17 CHANGE ORDER#3 11,810.00 11,810.00 0.00 0.00 11,810.00 100.00 0.00 1,181.00 18 CHANGE ORDER#4 6,500.00 6,500.00 0.00 0.00 6,500.00 100.00 0.00 650.00 19 CHANGE ORDER#5 16,490.00 16,490.00 0.00 0.00 16,490.00 100.00 0.00 1,649.00 20 CHANGE ORDER#6 10,350.00 10,350.00 0.00 0.00 10,350.00 100.00 0.00 1,035.00 21 CHANGE ORDER#7 14,650.00 14,650.00 0.00 0.00 14,650.00 100.00 0.00 1,465.00 MA Type Document Application and Certification for Payment Page 3 of 3 TO(OWNER):CARMEL THEATER DEVELOPMNT CORP PROJECT:CARMEL PARCEL 73 HARDSCAPE APPLICATION NO: 10 DISTRIBUTION 11711 N.PENNSYLVANIA ST. TO: CARMEL,IN 46032 PERIOD TO:4/30/2011 _OWNER _ARCHITECT CONTRACTOR FROM(CONTRACTOR):Smock Fansler Corporation VIA(ARCHITECT): ARCHITECT'S 2910 W.Minnesota Street PROJECT NO: Indianapolis,IN 46241 CONTRACT FOR: CONTRACT DATE: SCHEDULE PREVIOUS COMPLETED STORED COMPLETED ITEM DESCRIPTION VALUE APPLICATIONS THIS PERIOD MATERIAL STORED BALANCE RETAINAGE 22 CHANGE ORDER#8 6,825.00 6,825.00 0.00 0.00 6,825.00 100.00 0.00 682.50 REPORT TOTALS $1,326,450.00 $1,225,575.00 $65,155.00 $0.00 $1,290,730.00 97.31 $35,720.00 $129,073.00 AFFIDAVIT AND WAIVER OF LIEN ] Final [X I Partial [X] Payment to Follow State of Indiana County of Marion Fausler. being duly sworn states that he is the CEO of SMOCK FAINISLER CORP. having contracted with: Cannel 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 Ilardscape located at Cannel, IN and does hereby state on behalf of the aforementioned contractor: (PARTIAL\\'AIV[R)that there is due from the owner the sum of (\58,639.50) Fifty Eight Thousand Six Hundred Thirty Nine Dollars and 50/100 ] receipt of which is hereby acknowledged:or [X] the payment of which has been pronised as the sole consideration of this Affidavit tad 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. lfIFREFORE, 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. __SIIIOC'K__I_ANSI.IR CURT. Iiy \ f/,,22 .�k ---._ ....._ ------._...__ ., __... _��,•� i'''✓,s%'''�._..I%rile _— CEO T.T. M. I a nsler WITNESS MY HAND AND NO'I"ARIAL SEAI,,this 19th day of April ,2011. \rlclissa.f. Bishop Not ary/ t'iblic My commission expires November 30. 2016 Residing in ,_Norman_ County P73 Streetscape (Signature Construction) April 2010 Application 4 Paid by Carmel Theater Development $ 7,382.79 May 2010 Application 5 Paid by Carmel Theater Development $ 2,998.20 June 2010 Application 6 Paid by Carmel Theater Development $ 8,685.83 July 2010 Application 7 Paid by Carmel Theater Development $ 5,795.38 August 2010 Application 8 Paid by Carmel Theater Development $ 12,324.93 September 2010 Application 9 Paid by Carmel Theater Development $ 9,302.86 October 2010 Application 10 Paid by Carmel Theater Development $ 17,450.11 November 2010 Application 11 Paid by Carmel Theater Development $ 13,255.00 December 2010 Application 12 Paid by Carmel Theater Development $ 4,185.75 January 2011 Application 13 Paid by Carmel Theater Development $ 3,381.34 February 2011 Application 14 Paid by Carmel Theater Development $ 6,737.31 March 2011 Application 15 Paid by Carmel Theater Development $ 7,360.79 April 2011 Application 16 Amount to be paid by Carmel Theater Development $ 3,324.75 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENTG702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Corp PROJECT: Cannel Parcel 73 APPLICATION NO Invoice S 16 Distribution to: Carmel Indiana 46032 Streetscape Signature costs OWNER ARCHITECT PERIOD TO: 4/25/2011 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: Pcdcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel,Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document 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. I ORIGINAL CONTRACT SUM 5 132,645.00 2. Net change by Change Orders ' 5 0.00 CONTRACTOR- 3 CONTRACT SUM'I'O DATE(Line 1±2) 5 132,645 00 -OM.. 4. TOTAL COMPLETED&STORED TO 5 114,1/5 80 / L 4 � t/ By .Af Date 5 RE'I'AINAOE. om 7! oontz, 'resi.ent • a 0 %of Completed Work 5 0 :ubscribed. sworn to before me this c3- day of ,4,a c:11) .)'1 (Column D+6'on 0703) r Material / LINDA BUCHANAN I\'_fN B`�` Hancock County b %of Stored Mateal $ t' t NOTARY (Column F on 0703) " ; - My Commission Expires total xetamage(Lines as+ab or ,'e: _` August 20,2011 Total in Column I of G703) $ 0.00 ' ' • ' ° "' m " 6. 'I'O'I'AL EARNED LESS REI'AINAGE 5 114,//a.80 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) 5 11 1,451.05 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8 CURRENT PAYMENT DUE 5 3,324 /a is entitled to payment of the AMOUNT CERTIFIED. it BALANCE TO FINISH,INCLUDING RE'I'AINAGE 5 I/,869.20 (Line 3 less Line 6) AMOUNT CERTIFIED $ 3524- CHANGE ORDER SUMMARY ADDI I IONS I DEDUC 1 IONS (Attach ex, .natio if amount certified differs from the amount applied.Initial all figures on this l otal changes approved - App/icat'.n and.ithe Cont' .tion Sheet that are changed to coq/bran with the amowrt certified.) in previous months by Owner ARCH 'EC'I' /q Total approved this Month By: ).(/� Cif 4bitt PP y: � Date: i TOTALS $0 00 $0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the contractor named nerem.issuance,payment ana acceptance or 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 A(A '©1992 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. *.• • • - on:\ • -. en f,,CM."), • SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 Invoice # 16 4/25/11 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 1,052.89 0.00 0.00 1,052.89 42% 1,447.11 1,052.89 Site Supervision 52,072.50 44,137.48 67.00 0.00 44,204.48 85% 7,868.02 44,204.48 Construction Management 2,500.00 0.00 0.00 0.00 0.00 0% 2,500.00 0.00 Site Safety Director 500.00 500.00 0.00 0.00 500.00 100% 0.00 500.00 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 66,322.50 61,278.75 3,257.75 0.00 64,536.50 97% 1,786.00 64,536.50 132,645.00 111,451.05 3,324.75 0.00 114,775.80 87% 17,869.20 114,775.80 CONDITIONAL AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA COUNTY OF HAMILTON ) Thomas E. Koontz being duly sworn states that he is the President of Signature Construction, LLC having contract to furnish certain materials and I or labor as follows: Construction Management Services for a project known as 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 three thousand three hundred twenty-four dollars and seventy-five cents ($3,324.75) the payment of which has been promised as the sole consideration for this Affidavit and Conditional Waiver of Lien which is given to and for said amount, effective upon receipt of such cash payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises any and all line or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work perform or material furnished to the undersigned for the said project, and within the scope of this affidavit and waiver. SIGNATURE CONSTRUCTION, LLC T omas . Koontz, President Subscribed and sworn to before me this: /lipr:/f,2 s a.o,/ Notary Public:Q/,�.. 5 LINDA BUCHANAN Hancock County My Commission Expires • %E< `: August 20,2011 Pill Waterproofing and Paving (Gibraltar) May 2010 Application 2 Paid by Carmel Theater Development $331,812.00 June 2010 Application 3 Paid by Carmel Theater Development $188,748.00 July 2010 Application 4 Paid by Carmel Theater Development $ 57,970.80 August 2010 Application 5 Paid by Carmel Theater Development $ 98,261.10 September 2010 Application 6 Paid by Carmel Theater Development $174,561.30 October 2010 Application 7 Paid by Carmel Theater Development $223,782.30 November 2010 Application 8 Paid by Carmel Theater Development $331,778.70 December 2010 Application 9 Paid by Carmel Theater Development $ 50,627.70 February 2011 Application 10 Paid by Carmel Theater Development $ 14,715.90 March 2011 Application 11 Paid by Carmel Theater Development $ 7,847.10 April 2011 Application 12 Amount to be paid by Carmel Theater Development $ 55,737.90 -AIA Document G702/CMaN — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Carmel Theater Development CompanyPROJECT: Carmel City Cntr-P111 Waterproofing&P3vlrtt'CUt ION NO: 12 Distribution to: PERIOD IC: 4/30/11 OWNER El CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: Gibraltar Construction Corp VIA CONSTRUCTION MANAGER: CONTRACT DATE:1 /18/10 ARCHITECT ❑ 2932 N.Webster Ave. PROJECT NOS: I I CONTRACTOR ❑ Indianapolis,IN 46219 VIA ARCHITECT: FIELD ❑ Pedcor Design Group,LLC CONTRACT FOR: Waterproofing&Topping Slabs ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor -rt ies 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 li is r pplication for Payment has been completed in accordance with the Continuation Sheet,AIA Document payment,as G703,is attached. Contract Documents,that. 1,I urns have been paid by the Contractor for Work for which previous Certificates for Payment re ssued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 1,610,967.40 payment shown herein is i• , 2.Net change by Change Orders $ 123.063.00 CONTRACTOR:Gibral r. //t •truction Corp 3.CONTRACT SUM TO DATE(Line 1 ±2) $1,734,030.40 By: e Dater,4---/I 1,706,492.00 4.TOTAL COMPLETED&STORED TO DATE(Column 0 on G703) $ State of: 5.RETAINAGE: County of: � A BRIAN R. MCBRIDE a. %of Completed Work Subscribe and ��orn to. ore / t (Column D+EonG703) S 170,649.20 me this day o I ?-�1'/ gE ��` of N2..CJCk County b. %of Stored Material Notary Pub- . • ,_/: , My Comm. Ep. 11-29-2017 (Column F on 0703) S My Commission expires: /2-09•-1 D I OP GOrmissv #611862 Total Retainage(Lines 5a+Sb or Total in Column I of G703).. $ CERTIFICATE FOR PAYMEN' 6.TOTAL EARNED LESS RETAINAGE $ 1,535,842.80 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 $ 1,480,104.90 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED- �1 Q 8.CURRENT PAYMENT DUE $ 55,737.90 AMOUNT CERTIFIED $X37. l° 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial all figures on this 198,187 60 Application and on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) S CONSTRUCTION MANAGER: By , Dam: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE► ! 4/Ztlry Total changes approved in previous months by Owner $ $ By: a .AiMISI - Al Date: v Total approved this Month $ $ This'Cent ca e is no -gotiab The AMOUNT CERTIFIED is payabl only to the Contractor TOTALS S $ n. a he *In. Issuance,•payment and acceptance of payment are without judice to any rights of NET CHANGES by Change Order S the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. _ AIA Document G702/CMaTU—1992.Copyright m 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. r12,t% .4% _ • t ' .7; • • • -• . CONTINUATION SHEET Page 3 of 3 APPLICATION NO. : 12 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification,is APPLICATION DATE: 4/30/2011 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts PERIOD TO: 4/30/2011 where variable retainage for line items may apply. ARCHITECT'S PROJECT NO. : • A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE TO RETAINAGE DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY COMPLETED AND % FINISH (IF VARIABLE NO. APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G I C) (C-G) RATE) (D+E) DORE) (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 $4,008.00 $4,008.00 100% - 400.80 29 ChangeOrder#8 $14,921.00 $14,921.00 $14,921.00 100% - 1,492.10 30 Change Order#9 $8,529.00 $8,529.00 $8,529.00 100% - 852.90 31 Change Order#10 $12,192.00 $10,362.00 $1,830.00 $12,192.00 100% - 1,219.20 32 Change Order#11 $1,959.00 $980.00 $980.00 50% 979.00 98.00 33 Change Order#12 $2,265.00 $2,265.00 $2,265.00 100% - 226.50 34 Change Order#13 $8,441.00 $8,441.00 $8,441.00 100% - 844.10 35 Change Order#14 $2,791 - 0% 2,791 - 36 Change Order#15 $1,340 - 0% 1,340 - 37 Change Order#16 $8,042 8,042 8,042 100% - 804.20 38 Change Order#17 $2,205 2,095 110 2,205 100% - 220.50 39 Change Order#18 $3,415 2,390 1,025 3,415 100% - 341.50 40 Change Order#19 $6,464 6,140 , 6,140 95% 324 614.00 41 42 43 44 45 46 • 47 48 49 50 $1,734,030.40 $1,644,561.00 $61,931.00 $0.00 $1,706,492.00 98% $22,104.40 $170,649.20 • • CONTINUATION SHEET Page 2 of 3 APPLICATION NO. : 12 APPLICATION AND CERTIFICATE FOR PAYMENT,containing Contractor's signed Certification,is APPLICATION DATE: 4/30/2011 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where PERIOD TO: 4/30/2011 variable retainage for line items may apply. ARCHITECT'S PROJECT NO. : A S C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE TO RETAINAGE DESCRIPTION OF WORK SCHEDULED VALUE FROM PREVIOUS PRESENTLY COMPLETED AND FINISH (IF VARIABLE NO. APPUCATION THIS PERIOD STORED(NOT IN STORED TO DATE (G I C) (C-G) RATE) (0+E) DORE) (D+E+F) 1 Allowance $25,000.00 $25,000.00 $25,000.00 100% - 2,500.00 2 Supervision $47,500.00 $46,125.00 $950.00 $47,075.00 99% 425.00 4,707.50 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 $30,269.00 $1,636.00 $31,905.00 97% 819.40 3,190.50 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 $11,000.00 $11,000.00 100% - 1,100.00 _ 9 Trench Drain Material $59,000.00 $59,000.00 $59,000.00 100% - 5,900.00 10 Trench Drain Labor $15,000.00 $15,000.00 $15,000.00 100% - 1,500.00 11 Demolition Labor $35,000.00 $35,000.00 $35,000.00 100% - 3,500.00 12 Topping Slabs&Curbs Material $170,000.00 $170,000.00 $170,000.00 100% - 17,000.00 13 Topping Slabs&Curbs Labor $164,900.00 $164,900.00 $164,900.00 100% - 16,490.00 14 Rebar Material $15,000.00 $15,000.00 $15,000.00 100% - 1,500.00 15 Masonry $3,000.00 $3,000.00 $3,000.00 100% - 300.00 16 Metal Fabrications $1,200.00 $1,200:00 $1,200.00 100% - 120.00 17 Waterproofing&Exp.Joints . $742,000.00 $693,260.00 $30,000.00 $723,260.00 97% 18,740.00 72,326.00 18 Joint Sealants $200.00 $0.00 $0.00 0%, 200.00 - 19 Plumbing $18,400.00 $15,640.00 $1,840.00 $17,480.00 95% 920.00 1,748.00 20 Electrical $1,800.00 $1,800.00 $1,800.00 100% - 180.00 21 Alternate#7 $184,000.00 $165,600.00 $18,400.00 $184,000.00 100% - 18,400.00 22 Change Order#1 -$18,400.00 -$18,400.00 -$18,400.00 100% - (1,840.00) 23 Change Order#2 $5,182.00 $5,182.00 $5,182.00 100% - 518.20 , 24 Change Order#3 $3,252.00 $3,252.00 $3,252.00 100% - 325.20 25 Change Order#4 $26,871.00 $26,871.00 $26,871.00 100% - 2,687.10 ISA Form#1-402 i ' . 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 Fifty Five Thousand Seven Hundred Thirty Seven and 90/100------- Dollars ($55,737.90) El receipt of which is hereby acknowledged;or ® the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER)that the final balance due from the Owner is the sum of Dollars ( ) ❑ receipt of which is hereby acknowledged;or ❑ the payment of which has been promised as the •le consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipth•f such payment. THERFORE,the undersigned waives and releases unto the O er of said premises, any and all lien or claim whatsoever on the above-described property and improvements there• account of LABOR or material or both, furnished by the undersigned thereto,subject to limitations of conditions ex e:.ed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work p%. r, :d or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By At. Title President 1 WITNESS MY HAND AND NOTORIAL SEAL,/if da •f April, 2011. .■ (Notary Public) 1gyFJ BRIAN R. MCBRIDE q 1975 INDIANA SlACONTAACTO$S ASSOCIATION INCOAI,OAATED 2 ` Res. of Hancock County Un•utnetoted * * My Comm, Exp. 11-29-2017 ,,, vD 1 A'. Commission # 611862 P111 Waterproofing and Paving (Signature Construction) June 2010 Application 7 Paid by Carmel Theater Development $27,350.45 July 2010 Application 8 Paid by Carmel Theater Development $ 9,231.31 August 2010 Application 9 Paid by Carmel Theater Development $15,171.63 September 2010 Application 10 Paid by Carmel Theater Development $10,013.63 October 2010 Application 11 Paid by Carmel Theater Development $14,432.35 November 2010 Application 12 Paid by Carmel Theater Development $26,741.77 December 2010 Application 13 Paid by Carmel Theater Development $10,115.22 January 2011 Application 14 Paid by Carmel Theater Development $ 7,306.66 February 2011 Application 15 Paid by Carmel Theater Development $ 817.55 March 2011 Application 16 Paid by Carmel Theater Development $ 1,162.20 April 2011 Application 17 Amount to be paid by Carmel Theater Development $ 1,523.33 APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 PAGE ONE OF 2 PAGES 2 TO OWNER Carmel Theater Development Corn PROJECT: Carmel City Pill Waterproofing APPLICATION NO Invoice# 17 1 Distribution to: Invoice# 15 Signature costs OWNER Carmel Indiana 46032 ARCHITECT PERIOD TO: 4/25/2011 X CONTRACTOR FROM CONTRACTOR: VIA ARCHITECT: l'edcor Design Signature Construction Services LLC 720 3rd Avenue S.W. PROJECT NOS: Carmel,Indiana 46032 CONTRACT FOR: CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Application is made for payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been Continuation Sheet,AIA Document G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were Issued and payments received from the Owner,and that current payment shown herein is now due 1 ORIGINAL CONTRACT SUM 168,387.53 2. Net change by Change Orders 1 1,69.90 CONTRACTOR. 3. CONTRACT SUM TO DATE(Line 1±2) $ 180,047.43 4 TOTAL COMPLETED&STORED TO $ 177,602.18 / 4/z d), By f I Date: I/Z 5 RETAINAGE: 'I homas . °'ontz, rest.ent QPr;/x ]O�f a. 0 %of Completed Work $ 0 .ubscribed and orn to before me this .2 day of Dcccmbe 3007 (Column D+Eon G703) ;•';,AYPI;B•., LINDA BUCHANAN• h %of Stored Material $ `=:'NOTARY'° Hancock County (Column F on G703) ` - My Commission Expires I otat Ketainage(Lines as+DO or . ot:o,`,r? . August 20,2011 Total in Column T of G703) $ 0.00 ARCHI I EC I'5 GER 1 IFICA I E FOR PAYME ' 6. TOTAL EARNED LESS RETAINAGE $ 177,602.18 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) $ 176,078.85 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ 1, 23.33 is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 2,44a.2� (Line 3 less Line 6) AMOUNT CERTIFIED $ I5-2 ''2j CHANGE ORDER SUMMARY AUDI f IONS DEDUC I IONS (Attach explanation if amount certified di ers fr• h the amount applied.Initial all figures on this I oral changes approved Applicano • • C••htinuation : • t tha c ed to co afore with the amount certified.) in previous months by Owner ARCI Ill'f . ' �pp / / 0/0 Total approved this Month By: .--..t 1l, L Date: ,2 TOTALS $0.00 $0.00 This Certifictt:is not neg,tiabl:. The AMOUNT CERTIFIED is payable on to t contr ctor I mea nerein.Issua,ce,payment ana acceptance of payment are N snout NET CHANGES by Change Order $0.00 preiudl to any rights of the r,wner 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 D401 -Certification of Document's Authenticity from the Licensee. !.) 1• 6 SIGNATURE CONSTRUCTION LLC 720 3rd Avenue, S. W. Carmel, Indiana 46032 I I I I I 1 Invoice # 17 4/25/11 Carmel City P111 Waterproofing - Gibraltar Carmel, Indiana I Total Work RETAINAGE BALANCE Scheduled Completed WITHHELD PREVIOUS TOTAL COMPLETED TO DESCRIPTION Value This period THIS PERIOD APPLICATIONS TO DATE % FINISH Pre-Construction Services: Project Management 3,117.15 0.00 0.00 3,117.15 3,117.15 100% 0.00 Site Supervision 4,173.64 0.00 0.00 4,173.64 4,173.64 100% 0.00 General Conditions: GIBRALTAR Testing and Inspecting 2,500.00 76.78 0.00 2,423.22 2,500.00 100% 0.00 Project Management 758.46 0.00 0.00 758.46 758.46 100% 0.00 Site Supervision 68,132.57 0.00 _ 0.00 68,132.57 68,132.57 100% 0.00 Site Safety Director 3,811.31 0.00 0.00 3,811.31 3,811.31 100% 0.00 Design Drawings 4,184.47 0.00 0.00 4,184.47 4,184.47 100% 0.00 Temporary Electric 0.00 0.00 0.00 0.00 __ 0.00 0% 0.00 Office Supplies 770.97 0.00 0.00 770.97 770.97 100% 0.00 Tools and Equipment 1,618.12 0.00 0.00 1,618.12 1,618.12 100% 0.00 _ Field Engineering and Surveying 4,601.79 0.00 0.00 4,601.79 4,601.79 100% 0.00 Construction Management Fee 86,378.95 1,446.55 0.00 82,487.15 83,933.70 97% 2,445.25 180,047.43 1,523.33 0.00 176,078.85 177,602.18 99% 2,445.25 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 one thousand five hundred twenty-three dollars and thirty-three cents ($1,523.33) 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 AM" Thor as E. K.. tz, President Su scribed and sworn to before me this: lam;/ as_la rl Notary Public: .,,1,7/1 4,_64,,..e..4,-- aa.P(••• LINDA BUCHANAN No.AR Hancock County s.,, : My Commission Expires ":'t'o.'•' August 20,2011