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HomeMy WebLinkAboutBybee Stone, Horning Roofing - $302,422.50 The National Bank of Indianapolis hereby is instructed to make a disbursernent Of Loan Proceeds from the Borrower Loan Account tb (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 Ainount'of Aiithbrized .Disbuesement Amounts lo,be paid by Carmel Theater.Deveioprnent"Company,LLC as per the Lirhestone Materiatand Fabhcation.installmeni Urctiese contract,.the Red Clay Tile:Roofing,instaliment purchase'contract,the Carpel,-Tile and Access Flooring Installment purchase contract and the Wood Flooring installment purchase contract _ Application,11(Homing Roofing) April 2010 $ 63,022.50 Application 13(Horning Roofing) June 2010 $229,100.00 ...Iication'22-(8ybee Stone) August 2010 $ 10,000.00 Applica.•• Cinclnnati;Floor Company) August 2010 S 89,228.70 Application3:Cinclnnati o• -.. .any) September2010 S.389,103,00 Application 5(Certified Floorcovering) August 2010, $ 10.97715 Application 6,(Ceitified Floorcovering) September 2010 Total Auttiorized:Disbursement F5 888?g19 k 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/National Bank of Indianapolis and Carmel Theater Development.Company, LLC. Dated: /�/Zir /o CITY OF CARMEL REDEVELOPMENT / COMMISSION By: "Or Les.S. Olds Printed:: Executive Director Title: Draft Alternate Clay Tile Roofing (Horning Roofing) Up Through January 2010 Partial Contract Amounts through application 8 Completed and Stored to date $ 134,000.00 Retention held(based on 10%retention) $ 13,400.00 Paid to date $ 120,600.00 Paid by Carmel Theater Development Company $ 120,600.00 April 2010 Partial Contract Amount for application 11 Total $ 83,461.50 Amount CRC is paying $ 20,439.00 Remaining $ 63,022.50 Amount to be paid by Carmel Theater Development Company $ 63,022.50 June 2010 Partial Contract Amount for application 13 Total $ 457,990.00 Amount CRC Is paying $ 228,590.00 Remaining $ 229,400.00 Amount to be paid by Carmel Theater Development Company $ 229,400.00 �i /�1, TM :p,p'1e= Document c� 702/C[ a — 1992 O rr Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT:,/-e_d 7 APPLICATION NO: // Distribution to: ea 077'>f ed--e12/12,Y,eM1-- -- .e i on et_/-Pre 71'/'77%riey PERIOD TO:,.-/5/0 OWNER v/7Ll L ' k_ �3 r"- I�Yfl een12'Y CONSTRUCTION MANAGER ❑ £' rR01�CO CTO�R: d3� VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Ala r /i d o /` .— Jbei1 t5e 6/1 PROJECT NOS: .2lags-1 I • CONTRACTOR 0 a31/O� ., ter,Y�',/e fear/''P/ VIA ARCHITECT: FIELD ❑ `r�N�f1Acc-4 R: y ecli e- 'S.€ ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies 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 Application.for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. 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 1.ORIGINAL CONTRACT SUM $//34 1/5b,0O payment shown in is now due. 2.Net change by Change Orders $ , j, CoNTRACTO D 3.CONTRACT SUM TO DATE(Line 1 ±3) $/ i .'.2 6.id By: /// ,!/G/F//�lef..-- Date: y.2,-/d 4.TOTAL COMPLETED 8 STORED TO DATE(Column G on G703) $ 1/D59 1 764 06 State of It,d;e24,. 5.RETAINAGE: County of:/'rlOr/Or,. a. %of Completed Work Subscribed and sworn to before ,� �O/ (Column D+EonG703) $ 9D, 9'z o me this 2 — da ofet fr , b. %of Stored Material Notary Public: �Uo�9^' (Column•F on 0703) $ f},DO My Commission expires: 1C}qgr9dltRV az,ZO/, Total Retainage(Lines 5a+5b or Total in Column I of 0703).. $ 90, 9/ (5.--6 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ iod 82/5 Jra In accordance with the Contract Documents,based on on-site observations and the data comprising / 7 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) p / knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $O t7�7/J�t�� d� accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. ,//- 8.CURRENT PAYMENT DUE I$ 83, 4' /.,5'b i AMOUNT CERTIFIED $ 1:' "7 t L 5-6 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach etplanatiorr if amount certified differs-from the amount applied.initial all figures on this Application r nd on the Continuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 8-2/q qyy S� CONSTRUF� ON MANGIER: By: 111 ' Date: 4.)? .-LQiv CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHiTEC t !J �q Total changes approved in previous months by Owner $/��q y0.11 $ //y3 l6 By: � "" 1 Date: 4l 'Z- t. •I Total approved this Month $33 et.Da $ Tilis Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ named herein. Issuance,payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 1/..C/1144�J .10 the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on whichthisiext appears in RED.An original assures that changes will not be obscured. AIA Document G702VCMan,—1992 Copyright et 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Low and Inlernalionol Treaties. Unauthorized reproduction or distribution of this AlA°Document,or any portion of il,'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 len(10)copies of this document when completed.To repon copyright violation ei AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @ala.org. CONTINUATION SHEET .. AIA DOCUMENT G703 Page.1.of 1_. . Application No: 25 Application Date: 03/23/2010. JOB NAME CARMEL-R PAC CONSTRUCTION Period To:. 04/01/2010 HORNING,JOB# 8-2408 Architect's Project No: A B C . D E F G H I Work.Completed Materials Total Balance Retainage From Previous Presently Completed& to Finish Application Stored Stored to Date (G!C) Item# Description of Work Scheduled Value (D+E) ThisPeriad " (Not in D or E). (D+E#F) 1 Roofing Labor $107,140:00 .$77,290.00 $20;000:00: $97;290:00 $9,850:00 $7,290:00 2 Roofing Material $166;980:00 $166,98000, $166980.00 $0.00 $16,698.00 3 Nailbase Material $105,300.00 $105,300:00 $105,300.00 $0.00 $10,530.00 4 Nailba'se.Labor $38,180.00. $38,180.00 $38;180'.00 $0`.00. $3;818.00 5 Sheet:Metal Labor $57,350:00 $36,070.00" $30,070.00 $27,280.00. $3,007:00 6 Sheet Metal Material $146,390:00 $146,390:00 $146,390:00 $0.00 $14;639:00 7 Tile.Dome Material $112;000:00 $112,000:00 $112,000:00 $0:00 $11,200:00 8 Tile'Dome Labor $39,800:00 $0.00: $0:00 $39,800.00 $0.00 9 T1e,Balance Material -.$168;000.00 $101,000.00: $101,,000:00 $67;000:00 $10,100.00 10 Tile.Balance:Labor $59,700.00 $15;000.00 $15,000:00 $44;70600 $1",500.00. 11 Paver:Material $56,700:00 '$0.00 $0.00 $56,700:00 $0.00 12 Paver Labor $18',900.00 $0.00 .$0:00 $18,900.00 :$0.00 . 13 Bond $15;010:00. $15,010.00 $1 5;01.0.00 $0.00 $1,501.00, 14 Subcontractor $250;000.00. $2;100.00 $2,100:00 $247,900.00 $210.00 15 Submittals $5;000.00 $5;000:00 $5;000:00 $0.00: ..$500.00: 16 Safety/Start-up $7:;500.00 $3;000.00 $3,000:00 $4,500.00 $300.00 17 Clean-up/Closeout $7,500.00 $0.00 $0:00. $7,500.00 $0.06 18: Change`Order#1 '($1,430.00), ($1;430.00), ($1;430:00) $0.00 ($:143:00) 19 Change'Order-#2 $419;400.00; $134;000.00. $56,000:00 $196000:00 $229;400.00 $6,377.50. 20 Allowance $5,000.00; $0.00 $0.00 $5,000:00 $0.00 21 Change'Order#4 $33,870.00, $33;870.00'. $33;870.00 $0.00 $3,387.00' $1;81"8,290.00 ' $983;760:00' $76,000.00 $0:00 $1-,059;760.00 $758;530:00'. $90,91.4.506,.` 4 HORNING ROOFING &SHEET METAL CO, LLC AFFIDAVIT ANb WAIVER OF LIEN INVOICE# 12 STATE:INDIANA 'FINAL PARTIAL X PAYMENT TO FOLLOW COUNTY OF:MARION _RON PHELPS II_Being duly sworn that he is the President of_Homing Roofing&Sheet Metal Company,LLC contract with _. . Carmel Redevelopment.Commission to furnish ce_rtai_nmaterials, and/or lab or as follows: As Per Contract for a project known a:as Carmet Regional Performing Arts Center located in: Carmel and owned by and'does hereby further state on behalf the afo ementione'd'subcontractbr l supplier. (PARTIAL WAIVER) That there is due from the contractor the sum of DOLLARS: $83,461.50 X receipt of which is hereby acknowledged or the,payment of which.has been promised as the sole consideration of the affidavit and.Partial Waiver of Lion'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 there is due from the contractor the sum of DOLLARS: receipt of-which is hereby.acknowledged or the payment-of,which has been promised as the sole consideration of the affidavit and Final Waiver bf.l_ien which is 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 onlhe above-described property and improvement's thereon on account of labor or-material or both,furnished by the.undersigned thereto,subject to limitations or conditions•expressed herein,in,any,and further certified that no-other party has any claim or right to lien on account of any-work performed-or materialfurnished to undersigned-for =id project and within the scope of this,affidavit and'wavier. _Homing Roofing&Sheet Metal Co.,LLC_By: /. ' . President. Ron-Phelps Ii. WITNESS MY HAND:AND NOTARIAL SEAL THIS: 05/25/10 MY COMMISSION EXPIRES;..02-02-11 COUNTY OF RESIDENCE:-Morgan - NOTARY Kevin L.-Moore X41 I Application apd.Certificate°for.Payment-construction:Manager-Adviser Edition e1, s e d / a ,t� , ,. s2 T: OWNER:. PROJECT: �/ ' APPLICATION'N� '� �` Distribution to: �-rrne/�C oft--fq•Y e .nfe r 7 �/' ' � i 0 n�(.Tr 7�' ;ri�. .PERIOD T0: 6„,/.-/0 OWNER: ❑ ham°.6iNe/e,. -L a-rte r ren` -r CONSTRUCTION MANAGER ❑ ar ne/ 7-.A/ ylo03Z FROM CO CTO : • VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ s°t/or`/0%hI bp72',x: �, �`7e f/Se fik� PROJECT NOS: .2/9 Q`7 1 CONTRACTOR ❑ 62.3 y0."'t�"f 9,-7.2 ``lg'pael {�� VIA ARCHITECT: -)/�/d /✓ ,116,. /.." FIELD ❑ CONTRACT FOR: e.so ❑ CONTRACTOR'SAPPLICATION FOR.PAYMENT The Undersigned.Contracior:certifies'that to the best,bf the Contractor's knowledge,inforrnation,and Application is made'for.payment,as;shown below,in connection.with[he Contract. belief•the Work covered by this;Application for,.Payment'has.been:completed:in accordance with the 'Continuation Sheet,AIA Document;G703,is attached. Contract.Documents,thatall:amounts.have been paid by;the.Contractor'for Work for which,previous Certificates- for P went were issued and payments received-from the Owner, and that cufrent 1.ORIGINAL.CONTRACTSUM V 34 tI .rib yj�! paymentshawn ein:is now;du . 2.Net change.by Change Orders $ 'ys"/ yGt.DO CONTRACTO , 3:CONTRACTSUM'TO DATE(Line-L±2) $ '' t :oZ 90J.r0 By: /4' . G�1-", Date: 6p IF'/O 4.TOTAL COMPLETED`&STORED•TO DATE(Cblumn G on,G703) $, -7•q7 /�Q.00Staie of: • ,1�G`i!�/'7G:/ J i 5.RETAINAGE: County of: 1? c.•r/e) a. Q/e of Completed Work Subscribed and sworn to before (Column-D+Eon 6703) $ q6l Cf/4 me this 2_ d,y,o1 J _'2 e 6?-0/O b. %of.Stored'Ma[erial Notary Public: (Column F on-6703) $ a 0 0 My Comthission-expires: TotalRetainage:(Lines`�a+5b or Total:in Column,Lof G703).., $ Op ..x%/4 5O CERTIFICATE FOR PAYMENT In accordance with;the'Cont act,Documents,;based:on on-Site,observations.and the data.comprising 6,TOTAL EARNED LESS;RETAINAGE . _ $ // 70(e, 2QS,t'this application,die Construction Manager and.Architect certify to the Owner that to:the-best Of their (Line 4,Less,Line 5 Total) knowle-dge,,information and belief:the Work has progressed•as,indicated,the duality of the.Workcis in 7.LESS,P.REVIOUS'CERTIFICATES FORPAYMENT. /.-I Z5!,Y 1:(51.5 $_/ . accordance with the;Contract,Documents,and the.Contractor is entitled to payment of the AMOUNT (Line6 from,prior,CertiGcate) CERTIFIED. 95-7,, 9_g;o.U o Ale. 8.CURRENT PAYMENT DUE yS 7'Egan•0.9 $ ,-at, 36 4, 00, AMOUNT CERTIFIED 5— "` '° J. 9:BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation ifainount certified differs from:d' a nount.applied:initiate ftgiires:an,this Application;and;on[ a Continuation S/i-:t.,t/tat:ar .chat ged-to conform wiilrthe'amount certified.) (Line,3 less:Line 6) $ /47, iM475 CONST:UCTIO ' 'GE-, BY' ;►.14i�li .ait...`,a��Ire .../. . ' • Date: D�7. 10 CHANGE ORDER SUMMARY ' ADDITIONS: DEDUCTIONS. ARCHI �`" r Total.changes.approved in previqus moriths by Owner $le/iiyi),lu$ By: ' Date: �Cp f sa1Lfr Total approved,this.Month • $ '5, This'Certi ate is ot,negotiable. The ,AMOUNT CERTIFIED is payable only to the.Contractor TOTALS $ r• , named'h• ein::Is. •ance;payment and acceptanceof payment are without prejudice'to any.rights of NET CHANGES by,Changc-Order _$i.Yi,5_1/1_90 U d the Ow er or, .ntractor'under this,COntram CAUTION:-You'shouldsign an original.AIA.Contract-Document,:on which-thisiext appears-in RED.An original assures that changes will nofbe'obscured. AIA Document G702fCMa?a—1992.Copyright.©1992 by The American institute.oiArchitects.Ati.rights reserved.WARNING:This Ale Document is-protected by U.S..Copyright Law and Ihternational.Trearies. Unauthorized rep'roductlon or distribution of this.AlAt°'.Document,or any portion of it;may result In severe civil and criminal,penalties,and will be prosecuted''to,ihe maximum extentposslbie,under the lava. Purchasers:are,perreilted to reproducelen'(1O).copies.ol this,document when.completed.To-report,copyrightviolationsof AIA Coniraet Documents,e-mail The American Institute,ot Architects'.legal counsei,,copyrighi @ala.org. CONTINUATION SHEET AIA DOCUMENT G703 Page1:of 1 NO MORE RETAINAGE Application No: gi Application.Date: 05/17/2010 JOB NAME CARMEL-R:PAC CONSTRUCTION Period To: 06/01/2010 HORNING JOB# 8-2408 Architect's'Project No: A B C 0 E F G H I Work Completed Materials Total Balance Retainage From Previous Presently Completed & to Finish Application Stored Stored to Date (G/C) y Item# Description of Work SchedUled Value (D+E) This Period (Not:in D,or E) (D±E±F) . 1 Roofing Labor $107,140.00. $1.07,140.00. y $107,140:00 $0.00 $5;357.00. 2 Roofing Material $166,980.00 $166,98000 $166;980:00 $0:00 $8,349.00 3 _Nailbase;Material '$105,300.00. :$105;300:00 $105300:00 $0.00 $5,265.00 4 Nailbase,Labor $38;180:00' $38,180.00 $38,180.00 $0.00 $1,909.00'. 5 Sheet'Metal`.Labor $57,350:00 $48,740.00' $5;740.00 $54,480.00 ' $2,870.00 $2,724.00 6` Sheet°Metal Material ,$146,390:00 $146,390:00. $146;390:00 $0.00 $7,319.50: 7 Tile Dome Material $112,000:00. $112,000.00 $1.12,000.00 $0.00 $5,600.00, 8 Tile Dome Labor $39;800.00 $29,850:00. $9;950.00 $39;800.00' $0.00 $1,990.00 9 Tile Balance Material $168,000:00 $168,000..00: $168;000'.00 $0.00. $8,400.00 1:0 Tile Balance Labor $59,700:00 $44,000.00 $15,700.00 $59,700:00 $0.00 $2,985.00 11 Paver Material $56,700.00 $000' $56;700.00 $56;700.00, $0.00 $2,835.00: 12 Paver Labor $18;900.00 $0:00 $18;900.00 $:18;900.00 $0.00 $945.00: 13 Bond $15,01000 $15,01000. $15;010.00 $0.00 $750.50 14 Subcontractor $250,000.00. $127,100:00 :$.110,400.00 $237;500.00 $12,500.00 $11;87500 15 Submittals $5,000100. $5;000:00' $5,000.00 $0:00, $250.00 16 Safety/Start=Up .$7,500:00 $3,000.00 $4;500.00 $7,500.00' $0.00 $375:00; 17' Clean-up/Closeout $7,500:00. $0:00 $6,700.00 $6;700.00. $800.00 $335..00. 18 Change.Order#1 ($1,430:00) ($1,430:00) ($:1:,430.00) $0.00: ($71:50) 19 Change Order#2 $419,400.00 $190;000:00' 15229;400.00 $419,400.00' $0.00 $20970.00 20 Allowance $5;000:00 $0:00.. $0.00 $5,000.00, $0.00 21 Change.Order#4 $33,870:00; $33,870:00' _ $33;870.00 $0.00 $2;752:00' $1,818,290:00; $1,339,130:00 $457;990.00 $0.00 $1;797;120.00 $21,170.00 $90,914:50 PER RYAN ANDERSON RETAINAGECANNOT EXCEED 5%o OF THE CONTRACT AMOUNT MAX REATAINAGE $90,914.50 DELETE CHANGE..ORDER•#5:TO BE BILLED UNDER:SEPARATE'CONTRACT PER RYAN ANDERSON 10/26:;2010 10:27 FAX 317:6360134 HORNING 'ROOFING l?j002 .HORNING ROOFING & SHEET METAL CO, LLC AFFIDAVIT AND WAIVER OF LIEN INVOICE# 15 STATE:INDIANA FINAL PARTIAL X PAYMENT TO FOLLOW COUNTY OF:MARION RON PHELPS II Being:ditty:sworn.that he is the President of_Homing Roofing 8 Sheet Metal,Conipany,LLC contract with Carmel Redevelopment Commission :to furnish certain materials and/or labor as follows: As Per Contract fora project known to as Carmel Regional Performing Arts Center ioc_ated in: Carmel and owned by and does hereby further state on behalf of the aforementioned subcontractor/supplier. (PARTIAL WAIVER) That there is.due from the contractor the sum of: DOLLARS: 5488,366:00 receipt"of which is her"ebyacknowledged or X the payment of which has been promised as the sole consideration of the 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 there is due from the contractor the sum of: DOLLARS: receipt:of which is hereby acknowledged or the payment of which has been promised as the sole consideration ofthe.affidavii and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFORE, the•,undersignedWaives and releases unto the Owner of said premises,any and all lien or"claim whatsoever on theAbove=described property and Improvements thereon on account of labor or material or both,.fumished by the undersigned thereto,subject to limitations or conditions expressed herein,in any,and:further certified that no other party has any claim orright to lien onaccount of any work performed or material furnished to undersigne_d for said project and within the scope,of this afidavit:and wavier. _Horning Roofing&Sheet Metal Co.,LLC_By i President Ron Phelps ' WITNESS MY"HAND AND.NOTARIAL SEAL THIS: 06/10/10 MY COMMISSION EXPIRES:'02-02-11 COUNTY OF RESIDENCE:Morgan �_ .. •. /L.:" NOTARY Kevin L.Moore HORNING ROOFING '11 SHEET METAL CO, LLC AFFIDAVIT AND WAIVER OF LIEN INVOICE # 14 STATE: INDIANA FINAL PARTIAL X PAYMENT TO FOLLOW COUNTY OF:MARION .RON PHELPS II_Being duly swornihathe is the President of_Homing Roofing&Sheet Metal Company,LLC contract with Carmel'Redevelopment Commission to furnish certain materials and/or labor as follows: As Per Contract for a project known as as; Carmel Regional Performing Arts Center located in: Carmel and owned by and does hereby'further state on behalf of ihe,aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there'is due from the contractor the sum of: DOLLARS,: $279,370.00 receipt of which is hereby'acknowledged or the payment which has been promised as the sole consideration of the 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 there:is duefrbm the contractor the sum of DOLLARS: receipt of which is hereby acknowledged or the paymentef which has been promised as the sole consideration of the affidavit and Final Waiver of'Lien which is 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 or material or both,furnished by the undersigned thereto,subject to limitations or :conditions expressed herein,in•any,and further certified that no other party has any claim or right to lien'on account of any work.performed.or material furni hed to undersigned for said project and within the scope of.this affiday.it'and wavier. s� Horning Roofing&Sheet Metal Co:,LLC_By: President RC.; Phelps I WITNESS MY'HAND AND NOTARIAL SEAL THIS: 06/10/1i MY COMMISSION EXPIRES:02-02-11, tOUNTY OF RESIDENCE:Morgan i . NCiTARY Kevin L. Moore Draft Limestone Cladding (Bybee Stone) Up Through December 2009 Total Contract Amounts through application 19 Completed and Stored to date $ 3,131,018.00 Retention held $ 164,178.80 Paid to date $ 2,966,839.20 Amount reimbursed to CRC $ 2,966,839.20 January 2010 Total Contract Amount for application 20 Completed and Stored $ 108,982.00 Retention held $ - To be paid $ 108,982.00 Paid by Carmel Theater Development'Company $ 108,982.00 February 2010 Total Contract Amount for application 21 Completed and Stored $ 15,000.00 Retention held $ - To be paid $ 15,000.00 Paid by Carmel Theater Development Company $ 15,000.00 August 2010 Total Contract Amount for application 22 Completed and Stored $ 10,000.00 Retention held $To be paid $ 10,000.00 Amount to be paid by Carmel Theater Development Company $ 10,000.00 SA][A TaiDucat mm,lt •G702/C[Ma ,© x992. Application and Certificate for Payment:Corlsftuctioti;Manager-Adviser Edition 'TO"OWNERf PROJECT: APPLICATION-NO: 22 Distribution to: City:of Carmel Performing Arts Ctr CRC Carmel IN PERIOD:TO: OWNER ,❑ One Civic Square 8/31 /10 Carmel IN 46032 CONSTRUCTION MANAGER ❑ FROM:CONTRACTOR: VIA>CONSTRUCTION MANAGER: CONTRACT DATE: 11 /3 0/07 ARCHITECT ❑ BybeeStone:Co,Inc Shiel Sexton 6293N VIatthews,Dr PROJECTNOS:2695-2025 CONTRACTOR ❑ Ellettsville IN 47429 VIAARCHITECT: FIELD ❑ CSO,Architects.Inc CONTRACT FOR: Performing Art. ❑ CONTRACTOR'S';APPLICATiON:.FOR PAYMENT The undersigned Contractor certifesrthat to the best,of the:Contractor's knowledge; information and • Application'is made,for payment,'as shown,below,;in connection with fire Contract. belief the Work.covered by this'Application,for:Payment has:been completed'in accordance with the Continuation Sheet,AIA Document 67.03,is:attached.. Contract Documents,thatall amounts-have-been paid by'the Contractorfor Work for which previous 2 y 8 5 0,0 0 0 "Certificates.for Payment were issued and payments received from the Owner, and that current 1:ORIGiNAI,CONTRACT,SUM $ pay,ment"shown'heieid is now,.duc... 2 .Net change`:by:Change Orders $ 41'5-400.0 CONTACTOR', I 3,CONTRACT SUM TO.DATE(Line I=•2) • $ .3', 7 6.5, 0 0 0 By: A Date: S 4 t La l calms k C.7 4.TOTAL.COMPLETED,&STORED IODATE,(Column 0 oli"G703) . $ 3•,'2'6.5,.000 Stateof I n a 5.RETAINAGE County'of:•Owen ai 1 0%of Completed'Work Subscribed ands otn to before (Column D;+,E an.G703) $ 1 6 4, 1 7 8..80 me-this. /6, f 4 4,of , 02.0'10 b. %of Stored"Material Notary Publigv,, i• 1. OA '' m 4 (Colun.F on"6703) $ My.Commission expires: 8/ , 2:01-+ A Total;Retainage(Lines 5a+5b'orTotal-in Columli I of 0703)... $ 1 64,,:1 7.8.. 80 CERTIFICATE FOR..PAYMENI 4 In accordance°with the Contract.Documents,"based.on on-site observations andthe-data,comprising 6.TOTAL EARNED LESS RETAINAGE 53,.1 00 , 8 21 —20 this application,the..Construction Manager,and Architect certify to the:Owner that to the best of their (Line 4:Less'Line 5.Total) I nowledge,.•information;and"belief.the Work has.progressed as indicated,therquality of the Work is:in 7.LESSPREVIOUS CERTIFICATES,FOR PAYMENT $3 ,OH,821 .20' accordance with the•Contract•Documents,-and'the.Contractor.iS entitled'.to-payment of the AMOUNT (Line 6'ti•om prior-Certificate) CERTIFIED. 8.-CURRENT PAYMENT DUE . '5 1 0 , 00.0 .0 0 rA MOUNT CERTIFIED _, $ ��a '�' 9,BALANCE TO.FINISH,INCLUDING RETAINAGE: (Anacli:etplanatiom`if gnioiint cerfif ed differs f•otir:the,a wit applied:initial all figrureson this Application and on continuation Sheet/ t are ange to conform with the,amount certified.) (Line.3-less Line 6) ' 64 • 1 7 8 .8.0 CON ' r CTIO rt p By' re.s.�'./!r i 0.11. -.4 Date: /• l I CItANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC CT. T i Totnl•changes approved in previotis`montba•by'O�wier -$•4 1,:5,,,0 0 O $ By: ^/�. •,. Date: �� t) 1 i 0 Total;approved this,Monlh - $ $ This Certifi tiabi NT.•'ERTIFIED-is'payable-only ,the Contractor !y ' p6 TOTALS` $ 41-5,,:0;00 $ named.he� nee; payment•and acceptnnce,o" pttymerit:are without,prejudice'IO any-rights of NET CHANGES by'Change"Order -5 4 1..5,,,.0 00 tlre.Own ontractar under't its Contract. AIA•Document G7021CMaT9-"1992::Copyright:©1992 by-The-American InstItule;dt.:Architects:All rights reservod:WARNING:"This•AfAa'thoc a lent is protected by U:S.Copyright L•aw-and-Iniornationai Trontiec. Urinulhorlied rb•roductlon erdi;tribution of this:Aln'Dncuinont,-or'any.,portien dl'ii,may fesiilt tn•::ovure Civil and.crinminalpei aitios,.and will.be tiroi:uculod1o.tliu meximurn oritent'poseiblo•uniter,the law.This. document was"created at I1:25:hi MD:l'ori o81i9t2001tunderlheterms arIiconse number 26001 issued by,lhe American Institute of Architects,"and i;not forresalo:This.docurnent is licensed for one;lime.use„only and+may:notbe• Jtlf reproduced:odor to,its,comoletion. YY IELA\ r� G7O3 - 1.992 Continuation Sheet AIA,Document 0702,APPLICATION AND.CERTIF.ICATIONI OR PAYMENT, APPLICATION NO 22 •containing Contractor's signed-certifilintion is.attached. APPLICATION'DATE:-Aug 12,2010 In tabulations below,amounts are stated to the,nearestdollal'. PERIOD TO Aug 31,2010 Use Column:I'on.ContractS where variable retainage for line items may apply. ARCHITECTSPPROJECP NO: 2695-2025 CONTRACTOR:.Bybee Stone Co Inc A B C D E F G _ H, I _ WORIGCOMPLETED MATERIALS TOTAL BALANCE SCEIEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK VALUE APPLICATION THIS'PERIOD STOTEIN ATO DO E D (G%'c) 'FINISH (IF VARIABLE•NO. (I`lv. (C G) (D+E} D ORE) (D+E+F) 1 Shop Drawings 387,000 '387;000 0 0 387,000. 1:00% 0.00 34,830:00 2 Raw•Material 911,400' 911:,400 0 0 911",400 100% 0.00 61,525:00 3 Material.Storage 0 0 0 0 0 0% 0.00 0:.00 4 ShOp-Fabrication 1.,301,600 1;30,1,600 0. .0 • 1,301,600 100% 0.00'. 52;064i00 5 Material Delivery 100,000 90;000 1.0,000 0 100,000 100% 0'.00. 100.0.0 6 Engineering.Allowance 150,000 150;000 0 0 150,000 100% 0.00. 7,329:80 • 7 Change Order:#1 . 41,5,000 415;000 0 0 415,000 100%. 000, 8,330.00 • • Totals 3,765 .' 7 S,?(].tt... .... .. ...10„QQQ ! ---43',-265,000 0.09 1647,F78700-' AIA Document'•G703TM'='1992.,Copyrlght 0;1963,1965,1966;1967,1970,1:978,1969 anrl'1992 by The Arnerican,lnstilute or Architects.All rights rosorved.WAI1NINGi9'hi ';AIAA'Dbcumetit is protocted•by,U,S:Copyright Law and.luternalionat'.Treatlas.imaytherized reproduction or distribution of this A1A't Document,of°any-portion o'f It,'owy resift t r.scvere,civil,anr!criminal pen:ilnna,and will Inc prop niutocl to'the in'1 riin rn rl out ;posnlblo under,fhe Iaw..Thls document was created at09i50'1)Ml)I'on 07/I712aiiR'under the terms of license number 26001 issued.by the American Institute of Architects,and is.not for resale.This document is'licensed ler one ,lirne.urse.only,and may riot be reproddcecl prior,lo its completiun. PARTIAL WAIVER OF,LIEN STATE OF INDIANA) Gtyft: SS COUNTY OF MONROE) Escrow.#: TO WHOM IT MAY CONCERN`. WHEREAS the undersigned has been employed by the City.of Carmel. Carmel Redevelopment Commission to furnish Limestone for'the.premises know as Regional:P.erforming Arts Center of which the City of:Carrrlel is,tlne owner. THE undersigned, for and in consideration of 510,000.00 , and other good and valuab.le considerations, the receipt whereof is hereby acknowledged;--,do(es),hereby waive and release any and all lien or clairii of or right•-to,lien,under the statutes of the State of Indiana, relating to mechanics' liens, with respect to and on said above described premises, and the improvements thereon, and on the material,, fixtures; apparatus or machinery furnished and on the funds'orr other'considerations due or to become due from the owner, on account of labor services, material, fixtures,apparatus or machinery, hereto furnished to this date'by the undersigned for the above described 'premises; INCLUDING-EXTRAS*. Date: Aug 16, 2010 Company Name: .BYbee.Stone.Company; Inc Address: '6293 N.Matthews Dr; Ellettsville.IN 47429 Signature and Title: _ U P *EXTRAS INCLUDE-BUT ARE OT LIMITED'TO CHANGE•ORDERS,.BOTH ORAL-AND WRITTEN;TO THE"CONTRACT. CONTRACTOR'S AFFIDAVIT STATE OF INDIANA) SS COUNTY OF MONROE ) THE undersigned, Mary Beth Haas;,being duly sworn, deposes and says that he'or she is Vice Pres. of .Bybee-Stone Company, Inc who is the contractor furnishing Limestone for'the building located at Carmel,Indiana .owned by the City of Carmel.Carmel Redevelopment Commission . That the:total amount of the contract including extras,is S:3:265;000,00 on which he or she.has received payment of 53,090;901:20 prior to this payment. That all waivers are true, correct-and genuine and delivered unconditionally and that.there'is no claim either legal or equitable.to defeat,the validity of:said waivers. That the following;are the names of all parties who have furnished material or'labor; or,both, for said work and all.pttrties having contracts or .sub contracts for specific portions.:of said.work.or for material entering into the construction thereof and the amount due or lo become due each and that the items mentioned-include all labor-and material re`wired to.corii.lete said:work according to plans and specification: _ NAMES WHAT FOR CONTRACT .AMOUNT' THIS BALANCE •PRICE. PAID PAYMENT DUE BYBEE STONE-COMPANY,INC LIMESTONE S3;265:000.00 S3,099,901.20 59,9200.00 'S 1¢4,178:80 TOTAL LAI OR-&MATT TO COMPLETE 53;265,000.00 53,490,901:20 -59,9200:00 S164,178:80 That there are no other contracts for said work outstanding;and,.that there is nothing due onto become due to any person.for material, labor'or other work ofany-kind'done or to be done upon or iii cone ect oti with said work other-than naabbove stated. Date: Aug..16,2010 Signature: �eSC�C :-2qNice:President, Subscribed-and Sworn to Before Me This 16th Day Of Aug , 2010. Extras included.but are not limited to Change Orders, Both oral and written to the contract. X;1 N.tary Public Commission Expires: 8/25/2016' r•.I T_21uM6 1 PFoviJed by Chia-G.011 de trisurdnce Company if1 U.S.Department of Labor NOT APPLICABLE Form Approved Wage and Hour Division Budget bureau No.44-R1093 STATEMENT OF COIVIPLNIACE Date MarK .Beth Haas vice president do hereby state: ,(Nam e of sigtito6r, —aity—) (Title) (1)That:I,pay orsupeeVise thespernent of the personS ethnleyed by Bybee St one Co Inc-do, ,-./6.-/0 the: netramor or Subcontractor) 1.6 10. 73 10 that.-thiring the payroll period commencing on the, ...1 S,tday of Jan 1,9X..M and ending tlieday ofkl all persons employed on said project have been paid the ftilti.veekly.Wages earned that no rebates have been or will be made either'three Or indirectly to or'on.behalf on said Bybee—Stone, Co Inc from theftiTll weekly wages gamed by any person and that no dedtptions have been Made either (Contractor Subcontractor) directly or indirectly from the fullWagesearnedby.any pees-oa,other than permissible deductions as defiriedin Regulations;Part 3(29 CFR Subtitle A), issued by the,Secretary of Labor under the Copeland Act,as'.A.mended(48 Stat.948,.63 Stat. 108,72 Stat.967;76 Stat-357;40 U.S.C.276C),and desertheci beldw (2) That any payrolls otherwise under this,contractTrequired to be submitted for the above period are correct and complete r;that the wage rates for laborers or mechanics contained therein are not less than.theitopiidable wage rates:contaitiedinany wage,det5errriination incorporated into the contract; that the classificationsset forth therm n for each laborer or mechanic Conform i*In.the Wink he perfthined, (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a Stateappreotiee- Ship agency recognized by the Bureau of Apprenticeship and Training,:United States Department of Labor,or if no such recognized agency exists in a State;are registered-with the Bureau of Apprenticeship and Training,United StateDanditriient of Labor. (4) That: (a)-WI-IEREFRINGEBENEFITS ARE PAID TO APPROVED PLANS,'FUNDS,OR PROGRAMS' "Tc-1 In addition to the basic hourly wage rates paid to each laborer:or-mechanic listed in the above referenced payroll payments-of-fringe benefits-aS listed in the contract have'been or will be made to appropriated programs for the benefitof such employees,except as noted in Section 4(c).beloW. (b) WHERE FRINdE,BENtITS ARE"'AID ,CASH Each Laborer Or mechanic listed in.the above referenced payroll has been paid as indicated on the payroll,art amount not less than the sum of the applicable basic:hourly'Wage,rate plus the amount of the required fringe as listed in the contract,except as noted insection 4(c)below., (c) EXCEPTIONS EXCEPTIONS(CRAFT) • Remarks Narne_and Tide :Si attire Mary Beth Baas , VP The.,„„,kfalsificatiOn of aoy of the above station*may subject the contractor or subcontractor to civil or Criminal prosecution. See section 1061 of title 18 and • section 23 Iof,title 31 cif theIlnited States code, F:=Orpf Wk-348'(1/68)'Pitrche.&e this faith directly from the Supt.of Documents A-6