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Arteasian Deisgn, Circle B - $12,167.10
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 2(Antreasian Design) November 2010 $ 8,823.60 Application 2(Circle B) November 2010 $ 3,343.50 Total Authorized Disbursement $ 12,167:10 - • ' • 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: it/fiii/o 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) Paid by the Carmel Theater Development Company $ 14,954.40 November 2010 (application 2) Amount to be paid by the Carmel Theater Development Company $ 8,823.60 APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF 8 3 AIA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER To Contr: Project: Carmel Theater Development Company., LLC Application#: Two Distribution to: 11711 N Pennsylvania Street Suite 200 CaFmel, IN 46032 Application Date: 11/15/2010 OWNER Attn: Les Olds.FAA. Director of Redevelopment CONSTRUCTIO MGR From Contractor: Period Ending: 11/30/2010 ARCHITECT Antreasian Design, Inc VIA Construction Manager: Shiel Sexton Co., Inc. CONTRACTOR 3124 N Ridgeviev Drive Indianapolis, In 46226 Via Architect: 050, Inc. Contract For: Contract Date#: 10128/10 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 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 1.Original Contract Sum $29,546.00 payments received from the Owner and that current payment shown is herein iotealki i,,, ��`` MY 4 2. Net Change by Change Orders 10,146.00 Contractor: �%�QS ............CC9', ppTAR� ...•..1:::>H- . — , .. / L rr 0 ill, e 3.Contract Sum To Date 39,710.00 �By'�,, . _ , M� 4 / DATE: g: SEAL r- State of 1_,la/a nci_ County Of: I1/�Ctr i O n :Y i SEAL m 4.Total Completed&Stored to Date 26,420.00 Notary Public:,il rnh<<k1 )4• )l'1eC vcile PUBLIC . My Commission Expires: )DIG I?c I S �t %. •:• Q,= 5.Retainage '_1i ' • .••0" . ARCHITECT'S CERTIFICATION ., • $2,642.00 In accordance with the contract documents, based on on-site observations and the dafa comprising this application,the Construction Manager and Architect certify to the Owner that Total Retainage: 2,642.00 to the best of their knowledge,information and belief the Work has progressed as indicated,the quality of the work is in accordance with the Contract Documents,and the Contractor 6.Total Earned Less Retainage 23,778.00 is entitled to payment of the AMOUNT CERTIFIED. 7. Less Previous Certificates for Payment 14,954.40 AMOUNT CERTIFIED t B 8/3� 4,,,� 8.Current Payment Due $8,823.60 (Attach explanation if amount certified differs from the amount applied for. Initial all figures on this application and on the ontinuation sheet that are 9. Balance Due to Finish,Including Retainage $15,932.00 changed to conform to the amount certifie. C• ST-U� �',NAGER/ 11 to N.Change Order Summary Additions Deductions By: �.s\�,.L�, ,s.+. Date: Total changes approved in previous months by owner 10,366.00 ARCHITE�r I 12/ I /2-4 1,0 Total approved this month(November-10) (220.00) By: �_,AL Date: Totals 10,366.00_ (220.00) Net change by Change Order: 10,146.00 This certificate is not negotiable The amount certified is payable only to the Contractor named herein. Issuance,payment&acceptance of payment are without prejudice to any rights of the owner or contractor under this contract. CONTINUATION SHEET AIA DOCUMENT G703 PERIOD TO:I PAGE 2 OF 2 PAGES AIA DOCUMENT G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO: Two containing Contractor's signed Certification, is attached. APPLICATION DATE: 11/15/2010 PERIOD TO: 1 11/30/2010 SUBCONTRACTOR: Antreasian Design, Inc. , 3124 N. Ridgeview Drive, Indianapolis, IN 46226,317-546-3234 ARCHITECT'S PROJECT NO: PAC-2695 A B C D ( 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 Surface Tops&Plas. Lam Interiors 1 (ADI J/N 10-120) 20114.00 6250.00 8014.00 0.00 14264.00 71% 5850.00 1426.40 Crown&Band Trim-Paint by Others. 2 (ADI J/N 10-120) 2584.00 0.00 0.00 0.00 0.00 0% 2584.00 0.00 Solid Surface Drink Counter on steel posts(Brass footrail by Others)(ADI 3 J/N 10-120) 2140.00 0.00 2010.00 0.00 2010.00 94% 130.00 201.00 4 Delivery(ADI J/N 10-120) 891.00 0.00 0.00 0.00 0.00 0% 891.00 0.00 5 Installation(ADI J/N 10-120) 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 2779.00 0.00 0 2779.00 100% 0.00 277.90 Delete Install of Box Cabinets (ADI C/O la J/N 10-131) -220.00 0.00 -220.00 0.00 -220.00 100% 0.00 -22.00 Add Wood Base Trim-7"& 10"- C/O 2 1100 If each(ADI J/N 10-134) 7587.00 7587.00 0.00 0.00 7587.00 100% 0.00 758.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39710.00 16616.00 9804.00 0.00 26420.00 67% 13290.00 2642.00+ APPLICATION FOR PAYMENT AND PARTIAL RELEASE OF LIEN Contractor or Supplier: Project Description(s): Project//(s): Owner: Antreasian Design, inc. PARCEL 7 A Carmel Theater Development Company,LLC 3124 N. Ridgeview Drive Regional Performing Arts Ctr Indianapolis,IN 46226 Carmel, In (317)546-3234 The undersigned has been employed by Shiel Sexton Company,Inc as a Contractor in connection with construction of the Project(s)owned by Owner and located as indicated above. The Undersigned,for an in consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration,the receipt whereof is hereby acknowledged,waives and releases any and all liens,notices of liens or of character,against,on or relating to or connected with the above described Project(s)and improvements located thereon and related thereto,on account of labor or services,materials,equipment.tools,machinery or apparatus furnished or leased.or which may be furnished or leased by,or at the request of the Undersigned for the Project. The Undersigned hereby warrants that the Project(s)cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services,materials,equipment,tools,machinery or apparatus to,or at the request of the Undersigned for use in the Project. This instrument,and the waiver,release and representations hereunder,are for the benefit of,and may be relied upon by,the Owner, its successors,assigns and mortgages.the above-named General Contractor or Construction Manager.and any other person by or through whom payments have been made to the Undersigned. The release is given in order to induce payment in the Amount Due of S8823.60 and on receipt of Amount Due by the Undersigned,this release may he recorded,becomes valid.enforceable and of full effect. Dated this 15th day of November.2010 Antreasian Design,Inc, BY ` �.,;: TITLE President (Contractor or supplier name) STATE OF: Indiana COUNTY OF: Marion _ Sub'scu: • 4nd s rn to before me,a Notary Public in and for said County and State.this l 4-i14- day of (V)-(j.2jir. e...) .2010 t _ra �, / >h ��� My Commissiot� Fires: 10/09/2015 imberly ay cCardle ®�9�b6 Y Iii (Notary Public) % ../WC ,i poi My County of Residence is: Shelby NpTARY 'p• PUB 1.1G •. tf'�;:_ :�Q. Antreasian Design, Inc. Check: 30 3124 N Ridgeview Drive Date: 12/17/2010 Indianapolis, IN 46226 Vendor: ANTREAS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2 83 9,804.00 9,804.00 980.40 0.00 8,823.60 Application 2 9,804.00 9,804.00 980.40 0.00 8,823.60 30 12/17/2010 *************8,823.60 THE SUM OF EIGHT THOUSAND EIGHT HUNDRED TWENTY THREE DOLLARS AND 60 CENTS Antreasian Design, Inc. 3124 N Ridgeview Drive Indianapolis, IN 46226 Antreasian Design, Inc. Check: 30 3124 N Ridgeview Drive Date: 12/17/2010 Indianapolis, IN 46226 Vendor: ANTREAS1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2 83 9,804.00 9,804.00 980.40 0.00 8,823.60 Application 2 9,804.00 9,804.00 980.40 0.00 8,823.60 Draft Cafe Improvements (Circle B) October 2010 (application 1) Paid by the Carmel Theater Development Company $ 10,030.50 November 2010 (application 2) Amount to be paid by the Carmel Theater Development Company $ 3,343.50 60 4vg69cofitteci ::,...., - PAIA Document G702/CMa - 1992 • Application and Certificate for Payment Construction Manager-Adviser Edition 8 • TO OWNER: PROJECT: APPLICATION NO: 2 Distribution to: CARMEL REDEVELOPMENT rr,. IS,c_;ION ',ono 1\1SLLVlJLVla1L141 VV31111UU1V1Y V1 AV PERIOD TO: 1 1 !T.c I 3 n1 n OWNER ❑ nmv t'TTTTt' onTTAD7;' ti/ -L ' LV1V V. L V1 V 1V U,..eum L, t'AT.P, DTTTTnnTTm VA1'L ..J,.,-1-L.,1-,.,V 1 " CONSTRUCTION MANAGER ❑ t'ADARL'T TTT /.'tine VAl\11J.:�L, 11Y YVVJL FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CTD('T L' D t'nmemOTT,'TmM oxrcmL'\,To V11\VLl+ L • V.01U 11\V S.)..1_1.14 U 1U 11 3 1s1 CLTTT}T CL'vmnm t'mmn A Anr ��3� C T�.TL'DTnTnAT CT U111LL U1:1L\1VLY VV311AL41 PROJECT NOS: / / CONTRACTOR ❑ JVJV ....1. 111L1\1L1A1Y U 1• TATnTAATAnnT TC TV.T /.G7T -7 VIA ARCHITECT: 11YLJ1ALYA1 V1J1U, 114 YVL1, FIELD ❑ CONTRACT FOR: FR ,;iNv S. DRYWALL VSV ALRCHI ARCHITECTS ❑ 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 Pay ent were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 14„950,,co payment so s - r+in is now due. 2. Net change by Change Orders $ CONT;,, }'•;//^TDe +-- L CONSTRUCTION, SYSTEMS 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 14,860.00 By �j�� Date: ,ap.r'•'i'*+did�- Ti 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 14,860.00 State .� N'1C1M�, `` '`� �` it �''�.,,�� 5.RETAINAGE: Col , of. MARION A MARION : • ... 6A a. %of Completed Work .f.••, `:. `r. DER tscribed and r to before Column D+Eon G703) $ 1, LOG.00 this :L' ! .%NW,�iT MDL 1\' 20,1 NOTAFtY=1 t Lt OF IN© (. .. et11WSON c-;�.,; - b. %of Stored Material Notary Public �/Z��%CJ MY ■•, ". 1'� Y �d►,' G � f (Column F on G703) $ My Commis ores: -.'per., .••. ,•, -irs ti Total Retainage(Lines 5a+sb or Total in Column I of G703). $ 1, ' c. CERTIFICATE F R PAYMENT `.,::,. �/r</ "•"NP,,..�`�� In accordance with the Contract Documents, based on on-site observations`ditr th'd a°comprising 6.TOTAL EARNED LESS RETAINAGE $ 13,374.00 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 $ 10,030.50 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. t5 8.CURRENT PAYMENT DUE $ 3,343.50 AMOUNT CERTIFIED $ S, t'l 3 .--.'' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fr, .the amount applied.Initial all figures on this Application and on t Continuation S et di changed to conform with the amount certified.) (Line 3 less Line 6) . . $ 1 ,4°5.00 CONS - CTION M ,/ , . BY: _►fin:, !Z. /�[` Date: l ,�` D CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCH row- ARCH + '. Total changes.approved in previous months by Owner $ $ By: '_. Date: l L 0 t Total approved this Month $ $ This Certific 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 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. çATA®9�'s= 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. e 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 their 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 on the G702/CMa form. " _ J 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 and address of the"Contractor.Payment should • not be made to any other party unless specifically indicated on G702/CMa. w- • • r• 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. �`,,4 1, i /(- a is hq-U luo/ 1,,,.., TM �.. .. IA Document G703 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: . containing Contractor's signed certification is attached. APPLICATION DATE: 2 In tabulations below,amounts are stated to the nearest dollar. PERIOD T0: 11/15/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 11/15/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO RETAINAGE NO. FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G_C) FINISH (NOT IN TO DATE (C G) RATE) (D_E) D OR E) (D+E+F) 100 FRAME/HANG MATERIAL 8,500.00 6,375.00 2,125.00 8,500.00 100.00 850.00 101 FRAME/HANG LABOR 6,360.00 4,770.00 1,590.00 6.360.00 100.00 636.00 r,0', • - .• ' -.CO •• .. •• .. 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 i F I I I 1 riornfsell9yr¢git hialorg., . : r t 1 s : 4 1 i' r i i i t t t i t t f i Vi'i i•i i i t i r • • ; 1 t ! 1 i i 1 1 1 i-#-i F 1 i' i t I t (}#7i i i i t t t i. i s : - 7 7 _ i 1 I ? t l l I i-1 =s4®�777777,= Document G703 ® 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 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. . 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 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 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 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 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 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 (IF VARIABLE 'PHIS PERIOD (G_C) FINISH APPLICATION INOT IN TO DATE (C G) RATE) (D+E) DOR E) (D.ELF) 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 10.000 0 5.000 0 5.000 50 5.000 5 CURBS&MISC.CONC. . 5.000 0 0 0 0 0 5.000 6 PAVING.UPPER DRIVE ' 20.000 0 0 0 0 0 20.000 7 PAVING,LOWER DRIVE 1 20.000 0 0 0 0 0 20.000 8 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 11 105.000 cU.000 10.0UU 10.000 40.000 05.000 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 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.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 MATERIALS AND/OR LABOR AS FOLLOWS: FRAMING&DRYWALL FOR A PROJECT KNOWN AS: CPAC CAFE BUILDOUT AND OWNED BY: CARMEL REDEVELOPMENT 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 THREE THOUSAND THREE HUNDRED FORTY THREE DOLLARS AND 50/100 ($3343.50) 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 ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR '• D OJ ' •"T AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. `/ CIRCLE B CONSTR.SYSTEMS, LLC BY: �% ' ---- TITLE: PRESIDENT + 7 S ',Y HA►,I • A P/ OTA •' S'•L THIS 16th DAY OFD 4EQTJ){j4BER,2010 MY COMM"SS1ON EXPIRES: 02/01/2017 •.,0 RESIDENT OF JOHNSON COUNTY a ',: _ 3,' Circle B Construction Systems Check: 31 5636 S Meridian St Date: 12/17/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance R etention Discount Amt. Paid 3-2 82 3,715.00 3,715.00 371.50 0.00 3,343.50 Application 2 3,715.00 3,715.00 371.50 0.00 3,343.50 31 12/17/2010 *************3,343.50 THE SUM OF THREE THOUSAND THREE HUNDRED FORTY THREE DOLLARS AND 50 CENTS Circle B Construction Systems 5636 S Meridian St Indianapolis, IN 46217 Circle B Construction Systems Check: 31 5636 S Meridian St Date: 12/17/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 3-2 82 3,715.00 3,715.00 371.50 0.00 3,343.50 Application 2 3,715.00 3,715.00 371.50 0.00 3,343.50