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HomeMy WebLinkAboutArteasian Deisgn, Diversified Painting, Chance Bros. - $24,091.72 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 Amount to be paid by Carmel Theater Development Company as per the Café Improvements installment purchase contract Application 5(Antreasian Design) January 2011 $ 5,808.80 Application 1 (Diversified Painting) January 2011 $ 9,516.92 Application 1 (Chance Bros.) January 2011 $ 8,766.00 Total Authorized Disbursement .$ 24,091.72 . 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: 2/2y/( 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) Paid by the Carmel Theater Development Company $ 8,823.60 December 2010 (application 3) Paid by the Carmel Theater Development Company $ 16,271.10 January 2011 (application 5) Amount to be paid by the Carmel Theater Development Company $ 5,808.80 S3 • APPLICATION AND CERTIFICATE FOR PAYMENT PAGE ONE OF TWO AIA DOCUMENT G702/CMa PARCEL 7A, REGIONAL PERFORMING ARTS CENTER To Contr: Project: Carmel Theater Development Company,LLC Application#: Five Distribution to: 11711 N Pennsylvania Street Suite 200 Carmel,IN 46032 Application Date: 1/18/2011 OWNER Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR From Contractor: Period Ending: 1/31/2011 ARCHITECT Antreasian Design,Inc VIA Construction Manager: Shiel Sexton Co.,Inc. CONTRACTOR 3124 N Ridgeview Drive Indianapolis,In 46226 Via Architect. CSO,Inc. Contract For Contract Date#: 10/28/10 CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, I J 2 <f 4 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 ATP 1 Continuation Sheet,AIA Document G703 attached. completed in accordance with the contract documents,that all amounts have been paid by 11 ! 9 the Contractor for work for which previous certificates for payment were issued and � y !j 1.Original Contract Sum $29,564.00 payments received from the Owner and that current payment shown is herein now due �0-t-1 2.Net Change by Change Orders 20,743.80 Contractor: 3.Contract Sum To Date 50,307.80 By: ;�' DATE: I— / g — II `j,%11110//// Stateof: C[ /)( ,, County Of: /)/ (k' r/Cr `‘‘ Y /// 4.Total Completed&Stored to Date 50,307.80 Notary Public s 47( '( �� `� y `�•�..,nCc, /., My Commission Expires: `��t,Q'►�•'• •. '9.n 5.Retainage tbie/ •0JS� �/• ) 9 4 99% ARCHITECT'S CERTIFICATION = NQTARY �• �_ 1 ,$0.00 In accordance with the contract documents,based on on-site observations and the data ®� : SE♦T S (T1 A � comprising this application,the Construction Manager and Architect certify to the Owner that Y ;• AL Total Retainage: / 0 0S to the best of their knowledge,information and belief the Work has progressed as indicated,the PUB\,\ quality of the work is in accordance with the Contract Documents,and the Contractor �'•• ••j' 6.Total Earned Less Retainage 4-s/65-71-.7) 60,107-To is entitled to payment of the AMOUNT CERTIFIED. ' rr ' �' 7.Less Previous Certificates for Payment 41%/ 04' 94499700 AMOUNT CERTIFIED ✓j W Y OF .,.` 8.Current Payment Due I $5,808.80 I (Attach explanation if amount certified differs from •-amount applied for. Initial all figures on this application and on the c■ ation sheet that are 9.Balance Due to Finish,Including Retainage $0.00 changed to conf•rm to the amount car :d.) Cr.. TR ...It 0,:..-,4,/ R ©/ � �' Change Order Summary Additions Deductions By Jc `11/4L�r -/�.a Date Total changes approved in previous months by owner 15,155.00 (220.00) ARCHI r ' I + //��, Total approved this month(January-11) 5,808.80 By: i _ - A. - - KJ Date: J< Totals 20,963.80 (220.00), + Net change by Change Order: 20,743.80 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: Five containing Contractor's signed Certification, is attached. APPLICATION DATE: 1/18/2011 PERIOD TO: I 1/31/2011 SUBCONTRACTOR: Antreasian Design, Inc. , 3124 N.Ridgeview Drive, Indianapolis, IN 46226,317-546-3234 ARCHITECT'S PROJECT NO: PAC-2695 A B C D 1 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) 20,114.00 20,114.00 0.00 0.00 20,114.00 100% 0.00 0.00 Crown&Band Trim-Paint by Others. 2 (ADI J/N 10-120) 2,584.00 2,584.00 0.00 0.00 2,584.00 100% 0.00 0.00 Solid Surface Drink Counter on steel posts(Brass footrail by Others)(ADI 3 J/N 10-120) 2,140.00 2,140.00 0.00 0.00 2,140.00 100% 0.00 0.00 4 Delivery(ADI J/N 10-120) 891.00 891.00 0.00 0.00 891.00 100% 0.00 0.00 5 Installation(ADI J/N 10-120) 3,835.00 3,835.00 0.00 0.00 3,835.00 100% 0.00 0.00 Base Cabinets for Box Office(ADI C/O 1 J/N 10-131) 2,779.00 2,779.00 0.00 0 2,779.00 100% 0.00 0.00 Delete Install of Box Cabinets (ADI C/O la J/N 10-131) -220.00 -220.00 0.00 0.00 -220.00 100% 0.00 0.00 -_____ Add Wood Base Trim-7"&10"- ` O 2 1100 If each(ADI J/N 10-134) 7,587.00 7,587.00 } 0.00 0.00 7,587.00 100% 0.00 0.00 `CIC/O 3 Misc.Carpet Trim(ADI J/N 10-141) 4,789.00 4,789.00 / 0.00 0.00 4,789.00 100% 0.00 0.00 Color Change on Lam.&Solid C/O 4 Surface(10-120) 789.80 0.00 789.80 0.00 789.80 100% 0.00 0.00 C/O 5 Add wd trim&wood base(10-141) 5,019.00 0.00 5,019.00 0.00 5,019.00 100% 0.00 0.00 50,307.80 44,499.00 5,808.80 0.00 50,307.80 100% 0.00 0.00 r 1 i� SHIEL SEXTON COMPANY, INC. � + FINAL WAIVER AND RELEASE OF LIENS AND CLAIMS STATE OF •�roita-n4.-- COUNTY OFNXt o(1 Whereas,Apk►'fa5d..U;bZS 1 rt t1L ("Subcontractor") who has furnished certain materials, equipment, ervices,and/. labor pursuant to a sObcontract agreement or a purchase ordtr with Shiel Sexton Co.,Inc.for the project known as • ("P,roject'),which is located at CarniLl/ i-, (collectively referred to as the"Property"),and is owned by Liirrot( `r('L &fev I �,tra,u(("Owner"). Upon receipt of the sum-of$S 9C7$"-.1D ----_ ("Final Payment'),the Subcontractor waives and releases any and all liens or claims of liens and all claims,demands,actions,causes of action or other rights against the Contractor,Owner and the Property or any right against any labor and/or material payment bond it has or may have through the date of f i/$ ,20 jL("Current Date"). Further,the Subcontractor covenants and agrees to apply sums received as the Final Payment first,and in no event later than 15 days after the receipt of the Final 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. 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. Upon consideration of the sum of$ S� 3 0'7, ,lrc ("Total Contract Amount"), the Subcontractor waives and releases any and all claims,demands,actions,causes of action or other rights against the Contractor,Owner and the Property,at law,under a contract,in tort,equity or otherwise,and any and all liens or claims of liens or any right against any labor and/or material payment bond it has, may have had or may have in the future upon the foregoing described Property or in relation to the Subcontractor's performance of work on or the furnishing of equipment,services,and/or labor for the Project. This Waiver and Release applies to all facts, acts, events, circumstances, changes, constructive or actual delays, accelerations, extra work,disruptions,interferences and the like which have occurred,or may be claimed to have occurred prior to the date of this Waiver and Release,whether or not known to the Subcontractor at the time of execution of this Waiver and Release. The Subcontractor acknowledges that this Waiver and Release is in substantial conformity with the requirements of applicable law and shall be binding and conclusive against the Subcontractor for all purposes, subject only to payment in full of the amount set forth above. 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. • Given under hand and seal this • 'T" day of Jahn f ,20 /t 4 oQ 0, 000 04Y MC %:V J ........'• . �x ,•9� O s` Company ARY o �0 , m Signed (SEAL) PU�UG By: er,S f�+� 2[T s ra v! 001 A, \ �/ �.." % Title U r Cr t°16 S °°°o�a OF„tltv,o`% SUBSCRIBED AND SWORN TO before me this I d d' day of ,A1 ,2011. My commission expires i 0/4'./-01 e r Subcontract# otary Pub c Draft Cafe Improvements (Diversified Painting) January2011 (application 1) Amount to be paid by the Carmel Theater Development Company $ 9,516.92 „,,jAI ® ....,,.., Document G702/CMa TM - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 1 Distribution to: • Carmel Redevelopment Commission CAMEL RPAC CAFE BUILDOUT One Civic Square PERIOD TO: • 1/20/11 OWNER ❑ Carmel,IN 46032 CONSTRUCTION MANAGER ❑ FROM CON1 :Painting Company VIA CONSTRUCTION MANAGER: . CONTRACT DATE: • ARCHITECT ❑ 1681 Expo Lane CSO Architects PROJECT NOS: I I CONTRACTOR ❑ Indianapolis,IN 46214 280 E.96th Street,Suite 100 VIA ARCHITECT: Indianapolis, IN 46240 FIELD ❑ Bid Pack 5160;Painting • CONTRACT FOR: ❑ 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 G103,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 $ 10,017.81 payment shown herein is now due. 2. Net change by Change Orders $ _ CONTRACTOR:, - ”13 P/C. o�n'' 3.CONTRACT SUM TO DATE(Line.1 ±2) $ 10,017.81 By: / �� Date: 1/20/2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 10,017.81 State of: �./�gone NA7 5.RETAINAGE: County of: a. % of Completed Work Subscribed and sworn to before (Column nn D+Eon G703) $ 500.89 me this day of D -,' 1,20,),.. Thomas E. Hill b. 5°�%of Stored Material Notary Public: Thomas E Hill./' l /�7Z 744-4b-46-46.42°422-1116-46-+°"4., Notary Public State of Indian (Column F on 0703) $ - My Commission expires: I .*0.,.‘c• Boone Boone County 11/08/2017 CApi,es Nev 8,2017 4 Total Retainage(Lines 5a+Sb or Total in Column I of G703). $ 500.89 CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 9,516.92 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 $ - accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. Q�' �Z 1 8.CURRENT PAYMENT DUE $ 9,516.92 AMOUNT CERTIFIED $ St 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the mount applied. Initial all figures on this Application and on , Continuation SI r,�'t that re ch raged to conform with the at ount ertified.) (Line 3 less Line 6) $ 500.89 CONS`UCTION M, , r .. By: .�;, . ice Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC ECT: Total changes,approved'in previous months by Owner $ $ By: 4rj ./Airi Date: 01[41 Total approved this Month $ $ This Certific 4111Prnet net. tabl• The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ - $ - named herein. Issuance,payer and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ - the Owner or Contractor un er this Contract. C� y608 i CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original as a 1g34' aita biele4itI IStS ured. AIA Document G702/CMaM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Co yright 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®A 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). 1 1 - 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. 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. • • 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. T E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager anrchitect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed-form contains the name.acd address of the•Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. _ _ • 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. Aa`t ` /a ® TM Document 6703 — 19 2 page 1 • Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 1 containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. 40563 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL PRESENTLY COMPLETED BALANCE RETAINAGE ITEM DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS STORED AND STORED °lo TO NO. VALUE APPLICATION THIS PERIOD (G_C) FINISH (IF VARIABLE (D+E) (NOT IN TO DATE (C G) RATE) D OR E) (D+E+F) PAINTING LABOR 7,017.81 7,017.81 7,017.81 100% 0.00 350.89 2 PAINTING MATERIAL 3,000.00 3,000.00 3,000.00 100% 0.00 150.00 • • GRAND.TOTAL., • 10,017.81 0.00 10,017.81 0.00 • 10;017.81 2.00 0.00 500.89 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 AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale 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. III�I \�1i114/ • =ç4ATA® 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 perniission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document.The ALA 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 G703-1992 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 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 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 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. The.following is an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown below are for illustrative purposes only,and are not intended to reflect actual construction costs. A H C D E F 0 11 I WORK COMPLETED MA1'EKI.ILS TOTAL BALANCE PRESENTLY COMPLETED STO (IF VARIABLE I'I CSI SCHEDULED FKO\I PREVIOUS .0 70 NO DESCRIPTION OF WORK VALUE APPLICATION THIS PERIOD STORED AND STORED IG-C) FINISH HF\ARIAHLE NOT IN TO DATE, RATE) (D EI IC-GI D OR El (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 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 20,000 10,000 10,000 40,000 65,000 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 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. D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 1 STATE: INDIANA FINAL XX PARTIAL _ PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_ Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: CAMEL RPAC CAFE BUILDOUT located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of : NINE THOUSAND FIVE HUNDRED SIXTEEN AND 92/100 DOLLARS: $ 9,516.92 XXXX 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 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 of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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 furnished to undersigned for said project and within the scope of this affidavit and wavier. ' -----7_Diversified Painting Co. Inc._ Bye'' ' President Kevin M. Blume WITNESS MY HAND AND NOTARIAL SEAL THIS: 02/22/11 MY COMMISSION EXPIRES: 11-08-2017 � COUNTY OF RESIDENCE: Boone �J —% nisi-7/f NOTARY Thomas E. Hill Thomas E. Hill �o*Ap: Notary Public State of Indiana .-e1� . Boone County Expires Nov 8,2017 D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 1 STATE: INDIANA FINAL XX PARTIAL _ PAYMENT TO FOLLOW COUNTY OF: MARION kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: CAMEL RPAC CAFE BUILDOUT located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of: NINE THOUSAND FIVE HUNDRED SIXTEEN AND 92/100 DOLLARS: $ 9,516.92 XXXX 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 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 of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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 furnished to undersigned for said project and within the scope of this affidavit and wavier. _Diversified Painting Co. Inc. By.' President _ KevinAll. Blume WITNESS MY HAND AND NOTARIAL SEAL THIS: 02/22/11 MY COMMISSION EXPIRES: 11-08-2017 ±-r COUNTY OF RESIDENCE: Boone .'47-///#7 NOTARY Thomas E. Hill ThomaYs E. HIII Notary Public Stat e of Indian ° Boone County Expires Nov 8, 2017 , Draft Cafe Improvements (Chance Bros.) January 2011 (application 1) Amount to be paid by the Carmel Theater Development Company $ 8,766.00 TN IIAJA Document 701 a 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: i APPLICATION NO: Distribution to: CARMEL THEATRE DEV. CO.:LLC RCPf;PAC-026 PERIOD TO: ONE OWNER ❑ CAFÉ SUILDOUT-SCC PROJ.#2695 01:26111 CONSTRUCTION AIANAGER ❑ CERAMIC TILE .. FROM CONTRACTOR: VIA CONSTRUCTIONPAANAGER: CONTRACT DATE: - . .• -= °ARCHITECT ❑ . Chance Bros.Marble&Tile, Inc. PROJECT NOS: r / CONTRACTOR ❑ 114 W.McCarty Si. VIA ARCHITECT: FIELD ❑ CONTRACT . anapolis,IN 46225 ❑ 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 0703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issue Ind payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM S 9740.00 payment sho 4t r f n is noA Inc. 2. Net change by Change Orders S 0.00 CONTRA0 , 1 Ch:n a Br's. Marble&Tile, Inc. 112612011 3.CONTRACT SUM TO DATE(Line l ±Z 9740.00 y I��,/I1�L A ��.a1�/Ali ( ) S B J ( Date: 4,TOTAL COMPLETED&STORED TO DATE(Column G on G703) . S 9740.00 State of: '' I 'air ' �_ — i 5.RETAINAGE: County of: firion a. 1n 0i of Completed Work 0.00 Subscribed and en to before 1 JANUARY •4'2D11 " - Column D+E on 0703) (Column S me this . (9�' cl ,'of i;3 - t . b. %of Stored Material Notary Public: 1/1 y1-. �,f(C 974.00 _ C_— (� i olumn F on 6703) S My Commission expires –2 / Total Retainage(Lines 5a+Sb or Total in Column T of G+03). $ 974.00 CERTIFICATE FOR PAYM NT ' 6.TOTAL EARNED LESS RETAINAGE-. $ 876D In accordance with the Contract Documents,based on on-site observatiduv andlhe data-comprising this application,the Construction Manager and Architect certify to the Oty c r,that.to•lfie best of their (Line 4 Less Line f Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in . 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 0.00- 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 S 8768.00 i AMOUNT CERTIFIED S 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation,famount certified differs from .mount applied.Initial all figures on this Application and. e Continuation She' that a,•• red to conform with the air tint ce i fred_) (Line 3 less Line 6) $ 974'00 CON 'UCTI / By: �,il.::!G!4� A4 ..� - `! Date: ADDITIONS i DEDUCTIONS w r'' CHANGE ORDER SUMMARY ARC ITE p� Total changes approved in previous months by Owner S 0.0C $ 0.00 By: �' Date: ® (.0, I/I I Total approved this Month g 0.00 $ 0.00 This Certificate is not negotiable- The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 0.00 $ 0-00 named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ 0.00 the Owner or Contractor under this Contract. n`� CAUTION: You should sign an original AlA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. {�\\ AIA Document G702'CMeTM-1992.Copyright 0 1992 by The American lnsEtute of Archilects.All rights reserved.WARNUIG:This AIA' Document Is protected by U.S.Copyright Law and International Trestles. Unoulhorized 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 raw- Purchasers are permitled to reproduce len i 1 Di copies o1 this document when completed.To report copyright violations of AIA Contract Documents.e-mail The American Institute of A.rchilects'legal counsel,copyrightOu aia.org. Director of Redevelopment/t-/q0 . 7 JCo Al r " . , a'?i TM Document G7 O3 ® 1992 Continuation Sheet AIA Document G702T',Application and Certification for Payment; SSC PROJ.42695 APPLICATION NO: ONE containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stared to the nearest dollar. CAFE BUILDOLIT Use Column Ion Contracts where variable retainage for line items may apply. PERIOD TO 1/26,2011 . ARCHITECT'S PROJECT NO: • A B C D f E la G H I WORK COMPLETED 70TAi. MATERIALS BALANCE ITEM DESCRIPTION WORK SCIIEDULED FROM PREVIOUS PRESENTLY COMPLETED % TO RETAINAGF NO. VALUE APPLICATION 7'FItS PERIOD STORED AND STORED G C S TO DATE - FINIH f rorrotIn rare) (D fE) (Not inDorE) {C-C,') t_______ CE RAM ICTILES r LABOR 3,860.00 0.00 . 3,860.00 0.00 3,860.00 s 100% 0.00 385.00 MATERIALS } 5,880.00 s , 0.00 5.880.00 0.00 5,880.04 100% 0.00 I 588.00 j I I - 1 1 i } t GRAND TOTAL 9,740.00 0.00 9,740.00 0.00 9,740.00 0.00 974.00 CAUTION:You should sign an original AlA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G703" —1992.Copyright©1963,1965,1966, 1967,1970, 1978.1983 and 1992 by The American Institute of Architects.Alt rights reserved.WARNING:This Ate Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution or this Ate Document,or any portion of It,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible undertho law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of ANA Contract Documents.e-mail The American Institute of Architects'legal counsel,copyright @aia.org. FEB-03-2011 12:44 CHANCE BROS MARBLE 3176368976 P.02 • ISA Form C IA 02 I' '.Q rRtIAFI IN t)u�t ILL7t "i.' 95;1' :. n�.a.,,,,{ CQM.2[la, f w .`7 (7 vot∎c:,lc SvDCOn1.0(Ic"i'SuOrdq, S y a t; L 1` AFFIDAVIT AND WAivLR OF LIEN F-i-yR0. ',y Pa,Ha1 Payment to r'oliow Slate of Indiana. County of MARION SS LAWRENCE CONWAY OFFICE MANAGER/AUTHORIZED PERSON a( __________ _ - • being duly Sworn slates that he is the )Name of Ofl,cc ) itiiiri Carmel Theatre Lev. Co.r LL,C to furnish cerlaln _..C}JANGBf3(� ,MAgOLE&TILE,IIJ_C having contacted with _ to SL,pnr. ,1 (Cor„ aclorl ,ndttl■als ano,or labor as follows ____ ,_CERAMIC TILE __W — IDescr,or.on) -. • — —._. _.,..... ____.._ for a project known as -FCP#P7s;C-028 -- - localed at 001 uhtlauS,..INDIANA , and owned by C',AFF RLIILDOUT .-- ._ ICwne,l and does hereby further state on behalf of the aforementioned subcontraCtorlsupPlier (PARTIAL WAIVER) that there Is due from the contractor the sum of - -£1-iFiTTHOI'1S' •• 7 • • 7.- '• p: w•=- • -N6- �-- — L7 o I I a r s (5 $766.00 y _. I I reoerpt of which Is hereby acknowledged. Or I I the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lienwhich is given solely with respect to said amount.and which waiver shall be effective only upon receipt of payment thereof by the undersigned, (FINAL WAIVER) that the final balance due from the contractor Is the sum of • Dollars is ) I 1 receipt of which is hereto/ acknowledged. or . I 1 the payment of which has been promised as the sore Consideration for his Affidavit and Final Waiver of Len which shall beCome effective upon receipt of such payment THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and'improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein. if any, and further certifies that no other party has any claim O, right to a Lien on account of any work performed or material furnished to the undersigned for said project, and within the scope Of this affidavit and waiver. _ CHAnlcE I3ROS_MAIRBLE&TILE.INC_ wmm...,,_. ,_.. By E1MANAGER- I F■rml lav,np, rcd Rap,fc Cl' r • t,VITNESS MY HAND AND NOTARIAL SEAL, this __ -?6TH. day of JANUARY ""-. ,2Ott_• I9 ..r : Q.,C4_,.. v! u:r,ca ' I oral Printed --� -- My Commission Exp+r es ,._....,.---3teizolc Residing in ,--•- _ _ —:. County i, A'.'•..,: MARION - r TOTAL P.02