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HomeMy WebLinkAboutArteasian Deisgn, Circle B - $24,987.90 Regions Bank hereby is instructed to make a disbursement of Loan Proceeds from the Borrower Loan Account to (or for the account of) Borrower in: (a) the amount of the "Total Authorized Disbursement" line in the "Amount of Authorized Disbursement" column below; and (b) accordance with the terms and conditions of the Agreement, the other Loan Documents, and the Disbursement Instructions. Purpose of Authorized Disbursement Amount of Authorized Disbursement Amounts to be paid by Carmel Theater Development Company as per the Café Improvements installment purchase contract Application 1 (Antreasian Design) October 2010 $ 14,954.40 Application 1 (Circle B) October 2010 $ 10,030.50 Total Authorized Disbursement $ 24,984:90' . All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated July 22, 2010, by and between Regions Bank and Carmel Theater Development Company, LLC. Dated: GZ/u le CITY OF CARMEL REDEVELOPMENT COMMISSION By:_______,:: =------ -____ , Les S. Olds Printed: Executive Director Title: It is acknowledged and agreed by the parties that CRC has reserved the right to require, as a condition of authorizing disbursement of Loan Proceeds from the Borrower Loan Account to (or for the account of) Borrower: (a) completion of a satisfactory inspection by CRC of the portions of the Equipment and/or the Improvements to which the disbursement relates; and (b) receipt of customary submittals. Draft Cafe Improvements (Antreasian Design) October 2010 (application 1) Amount to be paid by the Carmel Theater Development Company $ 14,954.40 g3 APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF TWO PAGES TO CONTRACTOR: PROJECT: APPLICATION NO. One Shiel Sexton Parcel 7A, Regional Performing Arts Center PERIOD TO: 10/31/2010 902 N. Capitol Avenue PROJECT#S PAC-2695-02608 Indianapolis, In 46204 OWNER: CONTRACT DATE: 10/28/2010 FROM SUBCONTRACTOR: Carmel Theater Developmnet Company,LLC Subcontractor Invoice No. ',RS to Antreasian Design, Inc. _ 3124 N. Ridgeview Drive Distribution To: _OWNER Indianapolis, IN 46226 _ARCHITECT CONTRACT FOR: x CONTRACTOR Millwork&Casework OTHER CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment,as shown below,in connection with the CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Contract. Continuation Sheet,AIA Document G703,is attached. Total changes approved in previous months by owner 0.00 1. ORIGINAL CONTRACT SUM $ 29,564.00 Total approved this month 10366.00 TOTALS 10366.00 0.00 2. Net change by Change Orders $ 10,366.00 Net Changes by Change Order 10366.00 3. CONTRACT SUM TO DATE $ 39,930.00 The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the work covered by this Applicaation for Payment has been completed in accordance with the Contract 4. TOTAL COMPLETED&STORED TO DATE $ 16,616.00 Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates 5. RETAINAGE: for payment were issued and payments received from the Owner,and that current payment shown 49r a. _10 %of completed work $ 1,661.60 herein is now due. A - t[ 1 q 954 (column D+E on G703) f evraT �Tt Ft 6 1 b. 10%of stored material CONTRACTOR: (column F on G703) Ift1tifilf0,/�� Total Retainage(Line 5a+5b)or $ 1,661.60 By: - Date: i c/2 g//a 0 4 KAY AP'. • ..-»••. C Total in Column I of G703 `i. � • ..• 0 �. 6. TOTAL EARNED LESS RETAINAGE $ 14,954.40 Title: Vice President of ANTREASIAN DESIGN,INC. �4)",�OTAAy ••;�9 (Line 4 less Line 5 Total) Canf% titruPr( -a •� 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ - State of: INDIANA :Y_! S r' i:'` , . �I to —(Line 6 from prior Certificate) County of: MARION / N PUBLIC . 8. CURRENT PAYMENT DUE $ 14,954.40 .T 'Qr••••••••••••• 6..OF 1SC)%0% 9. BALANCE TO FINISH, INCLUDING RETAINAGE Subscribed and sworfi to befo -me this a 0- day of 0-rc , (Line 3 less Line 6) $ 24,975.60 Kimberly Kimberly McCardle My Commission Expires: 10/09/2015 AIA DOCUMENT G702 CONTINUATION SHEET AIA DOCUMENT G703 PERIOD TO:I PAGE 2 OF 2 PAGES AIA DOCUMENT G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO: One containing Contractor's signed Certification, is attached. APPLICATION DATE: 10/28/2010 PERIOD TO: I 10/31/2010 SUBCONTRACTOR: Antreasian Design, Inc. , 3124 N. Ridgeview Drive, Indianapolis, IN 46226,317-546-3234 ARCHITECT'S PROJECT NO: PAC-2695 A B C D I E F G H I WORK ITEM COMPLETED MATERIALS TOTAL COMPLETED& BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS PRESENTLY STORED TO DATE % FINISH (IF VARIABLE) VALUE APPLICATION THIS PERIOD STORED (D+E+F) (G-:-C) (C-G) RATE) (D+E) (NOT IN D OR E) Front&Back Counter&Cabinetry- Wood Exterior Surfaces, Solid 1 Surface Tops&Plas. Lam Interiors. 20114.00 0.00 6250.00 0.00 6250.00 31% 13864.00 625.00 2 Crown&Band Trim-Paint by Others. 2584.00 0.00 0.00 0.00 0.00 0% 2584.00 0.00 Solid Surface Drink Counter on steel 3 posts(Brass footrail by Others) 2140.00 0.00, 0.00 0.00 0.00 0% 2140.00 0.00 4 Delivery 891.00 0.00 0.00 0.00 0.00 0% 891.00 0.00 5 Installation 3835.00 0.00 0.00 0.00 0.00 0% • 3835.00 0.00 Base Cabinets for Box Office(ADI C/O 1 J/N 10-131) 2779.00 0.00 2779.00 0 2779.00 100% 0.00 277.90 Add Wood Base Trim-7"& 10"- C/O 2 1100 If each(ADI J/N 10-134) 7587.00 0.00 7587.00 0.00 7587.00 100% 0.00 758.70 0.00 0.00 0.00 0.00' 0.00 0.00 0.00 39930.00 0.00- 16616.00 0.00 16616.00 42% 23314.00 1661.60+ Vin;{- r`. "rt SHIEL SEXTON COMPANY, INC. INTERIM WAIVER AND RELEASE OF LIENS AND CLAIMS UPON PAYMENT STATE OF i Qn4 COUNTY OF rYtCiri0 A- Whereas, kv-e-a arI D —.. % c, ("Subcontractor") who has furnished certain materials, equipment, services, and/or labor pursuant to a subcontract agreement or purchase order with Shiel Sexton Co., Inc. ("Contractor') for the project known as Parcel 7 A Rcclanc4 PGr4v+rvur-r°arr3 Ce.�t r("Project'),which is located at .4ente( , SN (collectively referred to as the "Property"), and is owned by Curmcl Thca.+erbere.i r-. t (.o, ("Owner"). LI.L Upon receipt of the sum of$ 0-4 ct S`1' `/o [insert sum requested in current pay application]("Current Payment'), the Subcontractor waives and releases any and all liens or claims of liens and all claims, demands, actions, causes of action or other rights against the Contractor, Owner and the Property or any right against any labor and/or material payment bond it has or may have through the date of Od- 3 i ,20 r o , [insert last date of work performed that corresponds to Current Payment] ("Current Date")and reserving those rights and liens that the Subcontractor might have in any retainage on account of materials, equipment, services and/or labor furnished by the undersigned to or on account of the Contractor. Further, the Subcontractor covenants and agrees to apply sums received as the Current Payment first, and in no event later than 15 days after the receipt of the Current Payment, to pay all employees, laborers, materialmen, sub-subcontractors and sub-subconsultants employed by the undersigned in connection with the Project and all bills or indebtedness incurred through the Current Date for materials,equipment, services, and/or labor and taxes, furnished by such parties to the undersigned in connection with the execution of the Subcontractor's work on the Project. The Subcontractor further represents that all employees, laborers, materialmen, subcontractors and subconsuttants employed by the Subcontractor in connection with the Project and all bilis incurred through ,20_,[insert the last date of work performed that corresponds to the last pay application]for materials,equipment,services and/or labor,and taxes,furnished by such parties to the Subcontractor in connection with the execution of the Subcontractor's work on the Project, have been fully paid and that no obligation,legal,equitable or otherwise,are owed by the Subcontractor to such parties. Subcontractor further agrees to indemnify, defend and hold harmless the Owner and the Contractor for and against any and all liabilities, losses,costs, expenses and fees, including reasonable attorney's fees and court costs by reason of claims or liens for any labor, materials or services furnished for the Project. The Subcontractor acknowledges that this Waiver and Release is given to induce the payment recited above,and that this Waiver and Release is in substantial conformance with the requirements of applicable law. The undersigned executing this Waiver and Release hereby represents and warrants that he/she has full power and authority to bind the Subcontractor to the terms hereof. Applicable to Payment Request(s)No. b ne (or)Invoice(s)No. 9asb .�1/1111/ Given jotrkiRt s� day of (f)C+r ,20 1 O ,sek 4\4r ® t4OTAgy Si Irk . .. O Z Company 2- SEAL r' • me PUBLIC • e Signed ` (SEAL) �N� f '01,` OF 114%),0%' ' Ore r ..... Title V c 2 S�ci SUBSCRIBED AND SWORN TO before me this ZS 'day of O +o be', ,201 My commission expires /0/0/-OAS/ Notary Pub c Subcontract# Antreasian Design, Inc. Check: 17 3124 N Ridgeview Drive Date: 12/4/2010 Indianapolis, IN 46226 Vendor: ANTREAS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid one 83 16,616.00 16,616.00 1,661.60 0.00 14,954.40 Application one 16,616.00 16,616.00 1,661.60 0.00 14,954.40 17 12/4/2010 ************14,954.40 THE SUM OF FOURTEEN THOUSAND NINE HUNDRED FIFTY FOUR DOLLARS AND 40 CENTS Antreasian Design, Inc. 3124 N Ridgeview Drive Indianapolis, IN 46226 Antreasian Design, Inc. Check: 17 3124 N Ridgeview Drive Date: 12/4/2010 Indianapolis, IN 46226 Vendor: ANTREAS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid one 83 16,616.00 16,616.00 1,661.60 0.00 14,954.40 Application one 16,616.00 16,616.00 1,661.60 0.00 14,954.40 Draft Cafe Improvements (Circle B) October 2010 (application 1) Amount to be paid by the Carmel Theater Development Company $ 10,030.50 Z. - °= Document G7021CMani — 1992 82, Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 1 Distribution to: CARMEL REDEVELOPMENT COMMISSION CPAC PERIOD TO:. OWNER ❑ • ONE CIVIC SQUARE CAFE BUILDOUT 10/15/2010 CARMEL, IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE B CONSTRUCTION SYSTEMS SHEIL SEXTON PROJECT NOS: / / CONTRACTOR ❑ 5636 S. MERIDIAN ST. VIA ARCHITECT: 2695-02601 FIELD ❑ INDIANAPOLIS, IN 46217 CSO ARCHITECTS CONTRACT FOR: PLASTER WORK ❑ 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 '..yi ent . ere is nd yments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 14,860.00 payment s•:.� ,�� /i.to duel' 2. Net change by Change Orders $ CONT:,, ::,4,1/ , i , • t� 3.CONTRACT SUM TO DATE(Line I ±2) $ 14,860.00 B o, Date: ' in /p 4.TOTAL COMPLETED&STORED,TO DATE(Column G on G703) $ 11,145.00 Sta o /,�� �4: ���/Q`,;� V� 5.RETAINAGE: -. ...._ . ' • Cott . , ` •�4" a. %of Completed Work S 'scribed a . . • o bed rel` f M' 1,114.50 ethis /��� CA 'G ��<+'. (Column D+Eon G703) $ f t ` NOTARY PUH $TA '4.• DIANAif- b. %of Stored Material Notary Public: {r / • g JOHc ' ) COU (Column F on G703) $ My Commission -•• � I`�?'� '•FE 01�C7` Total Retainage(Lines 5a+Sb or Total in Column I of G703). $ 1,114.50 CERTIFICATE FO PAYMENT '`.:.���1ANP In accordance with the Contract Documents, based on on-site observations and�the.dwtart'�mprising 6.TOTAL EARNED LESS RETAINAGE $ 10,030.50 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ -0- accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. y 8.CURRENT PAYMENT DUE $ 10,030.50 AMOUNT CERTIFIED $ i$25,030.------* w,0 J0.------* 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from e amount applied. Initial all figures on this Application and on tl - Continuation SI ' ,ej t that hanged to conform with the amount certified.) (Line 3 less Line 6) $ 4,829.50 CONS -UCTION MA 'G 7 ' BY \►.C: . +�,w�AiI� Date: /0/2.54 0 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH �. 1,/Total changes approved in previous months by Owner $ $ By: Date: ', 12,41 0143/ Total approved this Month $ $ This 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 $ 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/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA® 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. =- Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet,These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated.into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). - Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted;on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. =' a: C) Change Orders:Although Change Orders could be incorporated by changing the scheduleof values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form°o.et the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form:'' Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. _ . . ; E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and.-Architect on AIA.Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name aril address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. - AIA Document G702/CMa TM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® 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. = Document G703TM ® 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: I In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 10/15/2010 .-it , Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 10/15/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED 70 TO RETAINAGE FROM PREVIOUS STORED AND STORED (IF VARIABLE (G_C) FINISH NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D-E) D OR E) (D+E+F) (C-G) 100 FRAME/HANG MATERIAL 8,500.00 6,375.00 6,375.00 75.00 2,125.00 637.50 101 FRAME/HANG LABOR 6,360.00 4,770.00 4.770.00 75.00 1,590.00 477.00 JOB TOTALS . 14,S60.00 .00 11,145.00 .00 T 11,145.00 3,715.00 1,1 14.50 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 G703TM-1992.Copyright©1963,1965,1966 1967, 1970,1978,1983 and 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 AIA®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. t t t , ; t } t i , f r i + t 13 1 t t ' I s r ' + i } 3 s 2. . . . _ . . 8 --11110 °• .• 0. Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose-and Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered-in AIA Document A201,General Conditions of the Contract for Construction. Use-of Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition . Reproductions.This'document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this.document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The AIA hereby grants the,purchaser a limited license to reproduce a maximum of ten copies of a completed G703,but only for use in connection with a particular project.The AlA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the'AIA.Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA).To report,copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel, copyright@aia.org. . COMPLETING THE G703 FORM' Heading:This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A, B,,&C:These columns should,be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at the'commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consisterit.throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C may,be adjusted,by Change Orders during the Project. ' Column D:-Enter in this column the amount of completed Work covered by the previous application(columns D&E from the previous application).Values from ' column F(Materials Presently Stored)from the previous application should not be entered in this column. Column'E:Enter here the value crf Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application under.Materials Presently Stored(column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period.This value cbvers.both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does_not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this'column and incorporated into column E(Work Completed-This Period). . Column G:Enter here the total of columns D;E and F.Calculate the percentage completed by dividing column G by column C. Column,H:Enter here the difference between column.0'(Scheduled Value)and the column G(Total Completed and Stored to Date). Column-I:This-column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall-contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on the own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to-be_entered in the appropriate location of the G702 form. Construction Change Directives:Amounts.not in dispute that have been included in Construction Change Directives should be incorporated into one or more' Change Orders:•Amounts remaining indispute`should be dealt with according to Section 7.3 in A201. The following is.an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to reflect actual construction costs. A •. B C D 1 E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE NO: DESCRIPTION OF WORK VALUE PREVIOUS STORED AND STORED OF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE (G_C) FINISH RATE) (D+E) DORE) (D+E+F) (C-C) • 1 MOBILIZATION 5.000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK 15.000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL i 10,000 0 5.000 0 5.000 50 5.000 5 CURES&MISC.CONC. 5.000 0 0 0 0 0 5.000 G PAVING.UPPER DRIVE ' 20.000 0 0 0 0 0 20,000 7 PAVING,LOWER DRIVE 20,000 0 0 0 0 0 20,000 5 PAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 11 IUb.000 c0,000 10.000 10.000 4U.000 00,000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 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 on 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.orig. AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M.ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE B CONSTR.SYSTEMS,LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MA I•ERIALS AND/OR LABOR AS FOLLOWS: INTERIOR FINISHES FOR A PROJECT KNOWN AS: CAFE BUILDOUT AND OWNED BY: CARMEL REDEVELOMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF TEN THOUSAND THIRTY DOLLARS AND 50/100 (510,030.50) RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED:OR XX THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN,WHICH IS GIVEN TO AND FOR SAID AMOUNT,EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER)THAT THIE FINAL BALANCE DUE IS THE SUM OF: • RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED,ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO,AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RIGHT TO A LIEN ON AC re T OF ORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR S• • 1' ,AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR.SYSTEMS,LLC BY: titI TITLE:PRESIDENT I •/.(' TD ■ ?T•R L 'AL THIS 3RD DAY OF DECEMBER,2010 C.,, IN V ,NOTARY PU ' 0 1 P►R 65,1%,ter CO SSION EXPIRES: 02/01/20 RESIDEN OF JOHNSON COUNTY _ e •.<' 70149 n jND\ Circle B Construction Systems Check: 18 5636 S Meridian St Date: 12/4/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 1 82 11,145.00 11,145.00 1,114.50 0.00 10,030.50 Cafe Buildout inv 1 11,145.00 11,145.00 1,114.50 0.00 10,030.50 18 12/4/2010 ************10,030.50 THE SUM OF TEN THOUSAND THIRTY DOLLARS AND 50 CENTS Circle B Construction Systems 5636 S Meridian St Indianapolis, IN 46217 Circle B Construction Systems Check: 18 5636 S Meridian St Date: 12/4/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 1 1 82 11,145.00 11,145.00 1,114.50 0.00 10,030.50 Cafe Buildout inv 1 11,145.00 11,145.00 1,114.50 0.00 10,030.50