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HomeMy WebLinkAboutArteasian Deisgn, Diversified Painting, Chance Bros., Circel B - $17,892.79 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 4(Antreasian Design) December 2010 $ 4,449.90 Application 6(Antreasian Design) February 2011 $ 10,482.00 Application 2(Chance Brothers) February 2011 $ 974.00 Application 2(Diversified Painting) February 2011 $ 500.89 Application 3(Circle B) December 2010 $ 1,486.00 Total Authorized Disbursement •h$ 17;89294' 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 B nk and Carmel Theater Development Company, LLC. Dated: 3 Ile G( 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 December 2010 (application 4) Amount to be paid by the Carmel Theater Development Company $. - 4;449190.: January 2011 (application 5) Paid by the Carmel Theater Development Company $ 5,808.80 February 2011 (application 6) Amount to be paid by the Carmel Theater Development Company $: 10,482.00; 8` 3 - 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 8: Four Distribution to: 11711 N Pennsylvania Street Suite 200 Carmel,IN 46032 Application Date: 12/10/2010 OWNER Attnv Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR From Contractor: Period Ending: 12/31/2010 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 ft: 10/28/10 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 $29,564.00 payments received from the Owner and that current payment shown is herein now due 2.Net Change by Change Orders 14,935.00 Contractor: ,A 3.Contract Sum To Date 44,499.00 By: t f - - DATE: / —I 0 —l 6' State of: IC ''TL.... County Of. ,tt(fo n 4.Total Completed&Stored to Date 44,499.00 Notary Public:IG1b`,,k.(( VnC rc l� My Commission Expires: --'' L 5.Retainage ►01414015- �� ARCHITECT'S CERTIFICATION $0.00 In accordance with the contract documents,based on on-site observations and the data comprising this application,the Construction Manager and Architect certify to the Owner that Total Retainage: 0.00 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 44,499.00 is entitled to payment of the AMOUNT CERTIFI `+`j101 Q0� e 7.Less Previous Certificates for Payment 40,049.10 AMOUNT CERTIFIED 1 1941 \\\` ` KAY /�.;' ', ,d V�...eeeeeeee" C ' C/ ! 8.Current Payment Due [ $4,449 90 (Attach explanation if amount certified differs from the am.. .pplied for. 0�0 e e . 19 ! Initial all figures o ''s application and on the continual', ,et that are =41 IOTA/3 y y 9 9.Balance Due to Finish,Including Retainage $0.00 changed to conf. the amount certified, s : ■ Q : : SE�,, • �_ Change Order Summary Additions Deductions CO."t�RY�O—/' %`� _' •.1e • s N • P1/BL1Ci `• Total changes approved in ' " �� �7 .A �: :• • previous months by owner 10,366.00 (220.00) ARCH C t _ Q� P.' 1� .j 9 _�� Total approved this month(December-10) 4,789.00 By: , I�� Date: F5Z" .s T4 . \Q` ,.∎ Totals 15,155.00 (220.00) '0, OP AND .•� Net change by Change Order: 14,935.00 , 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:1 PAGE 2 OF 2 PAGES AIA DOCUMENT G702,APPLICATION AND CERTIFICATE FOR PAYMENT, APPLICATION NO: Four containing Contractor's signed Certification, is attached. APPLICATION DATE: 12/10/2010 PERIOD TO: I 12/31/2010 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 Surface Tops&Plas.Lam Interiors 1 (ADI J/N 10-120) 20114.00 20114.00 0.00 0.00 20114.00 100% 0.00 2011.40 Crown&Band Trim-Paint by Others. 2 (ADI J/N 10-120) 2584.00 2584.00 0.00 0.00 2584.00 100% 0.00 258.40 Solid Surface Drink Counter on steel posts(Brass footrail by Others)(ADI 3 J/N 10-120) 2140.00 2140.00 0.00 0.00 2140.00 100% 0.00 214.00 4 Delivery(ADI J/N 10-120) 891.00 891.00 0.00 0.00 891.00 100% 0.00 89.10 5 Installation(ADI J/N 10-120) 3835.00 3835.00 0.00 0.00 3835.00 100% 0.00 383.50 Base Cabinets for Box Office(ADI C/0'1 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 1 a J/N 10-131) -220.00 -220.00 0.00 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 C/O 3 Misc.Carpet Trim(ADI J/N 10-141) 4789.00 4789.00 0.00 0.00 4789.00 100% 0.00 478.90 44499.00 44499.00 0.00 0.00 44499.00 100% 0.00_ 4449.901 YT7N1 • SHIEL SEXTON COMPANY, INC. FINAL WAIVER AND RELEASE OF LIENS AND CLAIMS STATE OF /J COUNTY OF '714-r,\'''" Whereas, A vrir4 c:si4 n ��. 1,.,, , ("Subcontractor") who has furnished certain materials, equipment, services,and/or labor pursuant to a subcontract agreement or a purchase order with Shiel Sexton Co.,Inc.for the project known as Rt.rce 1 7/ l e ,Po—ftnM, Arts 0,(`Project"),which is located at (L rnRe i , 2,' (collectively referred to as the"Property"),and a owned by Czrvh�:11-g4 t D 'C:;4(_(. (*Owner"). Upon receipt of the sum of$ `-J`/Li ("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 Der ,3 i ,20J ("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$ '-j , `i C) c) ("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 j O`µ day of D E'- d~1"1 12e r' ,20 r a t AYt41 " ,.••' cc �i A-1 r-ea s i c r1 lie s 1' .r•, 7rr�c • �( .• S� Company S Si:t A t t A, �.Signed C. _ (SEAL) 7" �e Pl/9UG I b By: J'7 ra ` r'�"u 5 ct eriC#A.. .... •C� Title / '�� �Jre,,,+*'" SUBSCRIBED AND.SWORN TO before me this /r' day of LJ'LetlUa _Guy ,P0/ %I��s— j • My commission expires • -C- k,e (AAjf Aal / Rve-r-eZ6•C Subcontract# Nbt ry Pub c 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#: Six Distribution to: 11711 N Pennsylvania Street Suite 200 Carmel,IN 46032 Application Date: 2/17/2011 OWNER Attn: Les Olds,AIA,Director of Redevelopment CONSTRUCTIO MGR , From Contractor: Period Ending: 2/28/2011 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, 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 $29,564.00 payments received from the Owner and that current payment shown is herein now due 2.Net Change by Change Orders 31,225.80 Contractor /I .. 3.Contract Sum To Date 60,789.80 By: DATE: -.2—/l7/I i State of , .�-4N.3 County Of: to cy1 4.Total Completed&Stored to Date 60,789.80 Notary Public: ,_ +,,A,Koilitr',i. My Commission xpires:j0,q IS 5.Retainage ARCHITECT'S CERTIFICATION $0.00 In accordance with the contract documents,based on on-site observations and the data comprising this application,the Construction Manager and Architect certify to the Owner that Total Retainage: 0.00 to the best of their knowledge,information and belief the Work has progressed as indicated,the . . . ...i • quality of the work is in accordance with the Contract Documents;and the-Contractor 6.Total Earned Less Retainage 60,789.80 is entitled to payment of the AMOUNT CERTIFIDa. n 7.Less Previous Certificates for Payment 50,307.80_ AMOUNT CERTIFIED `�,V� `,'1"'iigg�/ 8.Current Payment Due I $10,482.001 (Attach explanation if amount certified differs from the a- • nt applied for. *` ,4 T 4/,.,//// Initial all figures on this application and on the continu • sheet that are ,04 @Arf.••••••••.. C1 /i/ 9.Balance Due to Finish,Including Retainage $0.00 changed to conform to the amount cent' '•.) ♦. '9 1.Ca STRU�TI. r/GER �/ ::$1®• t4OTAgy .%0 Change Order Summary Additions Deductions By: �,, 17.'4... ` ♦4 •L.. ■ _ Date: © ..Y! SEAL i n» Total changes approved in / ;v.-71;j., _ j previous months by owner 20,963.80 (220.00) ARCHITECT % I i r • PUMA Total approved this month(February-11) 10,482.00 By: Date: i/ �'•• Q Zr Totals 31,445.80 (220.00) / •'•..,» ..•'•P� Net change by Change Order: 31,225.80 ///�rF QF.�NQ` ��`` his c. ificate is.rio egotiable The amount certified is payable only to the /.111,11110°`` .ontrac•_.med 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: Six containing Contractor's signed Certification,is attached. APPLICATION DATE: 2/17/2011 PERIOD TO: I 2/28/2011 SUBCONTRACTOR: Antreasian Design,Inc.,3124 N.Ridgeview Drive,Indianapolis,IN 46226,317-546-3234 ARCHITECT'S PROJECT NO: PAC-2695 A B C D 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 INDORE) 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"- C/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 C/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) 789.80 789.80 0.00 0.00 789.80 100% 0.00 0.00 C/O 5 Add wd trim&wood base(10-141) 5,019.00 5,019.00 0.00 0.00 5,019.00 100% 0.00 0.001 Add Organ Bay Trim,Casing&Plinth blocks in Unisex RR,Modify door heads for closers,speaker trim,& C/O 6 150'of 71/2"base primed 3,168.00 0.00 3,168.00 0.00 3,168.00 100% 0.00 CIO 7 Add Speaker Covers 7,314.00 0.00 7,314.00 0.00 7,314.00 100% 0.00 60,789.80 50,307.80 10,482.00 0.00 60,789.80 100% 0.001 0.001 SHIEL SEXTON COMPANY, INC. FINAL WAIVER AND RELEASE OF LIENS AND CLAIMS STATE OF;Indian et-- COUNTY OF rrt_t f7t !1 Whereas, rAirkre .SI&V) )fSt9 n f"Subcontractor") who has furnished certain materials, equipment, se%v ices and/or labor p ua to a subcontract agreement or a purchase ordcr with Shiel Sexton Co.,Inc.for the project known as NQ rt Q i `7 (.. 1Jff brr i Project"),which is located at (.:41,1(MO . i1 (collectively referred to as the"Property"),and is ned by etxcrr t.t t ' l2r b42.% CW L(,CQwner"). Upon receipt of the sum of$t vrt}6 a.C?U ("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 Contr ctor,Owner and the Property or any right against any labor and/or material payment bond it has or may have through the,date of .it 201j("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$ 89• 0 ("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 terns hereof. Given under hand and seal this `'-" day of Q' ,• �•9O l Company AoTAR y =3 m Wed (SEAL) mom. Y S u A = By:Eic.f V. 14n— 'Qa.S ta,�, • Pfe.6(40442-nT 0��s �F/OFri N� SUBSCRIBED AND SWORN TO before me this '7' day of "I—CID at.L.0.1- ,20( My commission expires I t,f q 7.)-0(S" . IJJ Subcontract# o . Pubf• - Draft Cafe Improvements (Chance Bros.) January 2011 (application 1) Paid by the Carmel Theater Development Company $ 8,766.00 February 2011 (application 2) Amount to be paid by the Carmel Theater Development Company $ 974:00 *AIA ®c 702 TM - 1992 • Application and Certificate fcf y . TO OWNER:CARMEL THEATRE DEV.CO., CO' ' �O'��PROJEC ''RCP#PAC-026 APPLICATION NO: iwO Distribution to " CAFÉ BUILDOUT-SCC PROJ.#2695 PERIOD TO: 02/20/11 OWNER 17i • ‘ CONTRACT FOR: CERAMIC TILE ARCHITECT ❑ FROM CONTRACTOR: �� V 'ARCHITECT: CONTRACT DATE: CONTRACTOR ❑ Chance Bros. Marble&Tile, In ., PROJECT NOS: / / FIELD ❑ ,,,,„ zbi 114 W. McCarty St., Indjanarnll�w eaooc \ - - OTHER ❑ CONTRACTOR'S APPLICATION FOR PAYMENT ' The undersigned Contractor certifies that to the best,of the Contractor's knowledge, information Application is made for payment,as shown below,in connection with the Contract. and belief the Work covered by this Application fop Payment has been completed in accordance AIA Document ade f or',Continuation Sheet;is attached. with the Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and 1.ORIGINAL CONTRACT SUM $ 9740 on that current payment shown herein is now due. 2. NET CHANGE BY CHANGE ORDERS $ 0.00 CONTRACTOR: Chance Bros.Marble&Tile, Inc. 2/16/2011 3.CONTRACT SUM TO DATE(Line 1±2) $ 9740.00 By: . _' _ _,••∎�_-1,..... ,_ Date: 4.TOTAL COMPLETED&STORED TO.DATE(Column G on G703) $ 9740.00 State of: Indiana l 5.RETAINAGE: County of: Marion a. %of Completed Work Subscrib Tg d sworn-to before . 1 Columns D+Eon G703) $ 0.00 me this ' day of • FEBRUARY . ?2011 b. •%of Stored Material �. '- (W 1 g1Column F on G703) $ 0.00 .Notary Public: �0 My commission expires: ���✓ Lc.�r-�C Total Retain e(Lines 5a-+Sb, or Total in Column I of G703 $ 0.00 .. ;- r 6.TOTAL EARNED LESS RETAINAGE $ 9740.00 ARCHITECT'S CERTIFICATE FOR PAYMENT.. '). (Line 4 minus Line 5 Total) In accordance with the.Contract Documents,based on on-site observations and the data comprising 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 8766.00 this application,the Architect certifies to the Owner that to the best of the Architect's knowledge, information and belief the Work has progressed as indicated, the"quality of the Work is in (Line.6 from prior Certificate) accordance with the Contract Documents, and the Contractor is entitled to payment of the 8.CURRENT PAYMENT DUE $ 974.00 AMOUNT CERTIFIED: 00 9.BALANCE TO FINISH,INCLUDING RETAINAGE AMOUNT CERTIFIED $ C31 ; (Line 3 minus Line,6) $ (Attach explanation if amount certified differs from the amount applied.Initial all figures on this 0.00' . ApplicatioA:nd on he Continuation Sheet that are changed to conform with the amount certified) CHANGE ORDER SUMMARY. ADDITIONS DEDUCTIONS ARCH Date:, ,/ . Total changes us ges approved in previo ,months by Owner $ $ �� o � By: � 1712,\Zi31 - Total approved this month $ - $ 0,00 0,00 This Certificate is not negotiable.The AMOUNT CERTIFIED is payabl: ly to the Contractor TOTAL $ 0.00 $ 0.00 named herein. Issuances payment and acceptance oAayment are withot . ejudice to any rights of NET CHANGES by Change Order $ oo he Owner or Contractor,ender this Contr..,. s , / CAUTION,.Youshould sign an original AIA Contract Document,-on which this text appears in RED.An original assuresahat changes wi not .- ---•d. AIA Document G702T"—1992.Copyright ©1953,1963,1965,1971,1978,1983 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. V0% ® Document 6703 TM — 1992 Continuation Sheet AIA Docuient G702TM;"Application and Certification for•Payment, . APPLICATION NO: containing Contractor's:signed:certification is attached. • SSC PROJ.#2695 , ` TWO . APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. CAFE BUILDOUT 2/20/2011 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 I WORK COMPLETED- . TOTAL :MATERIALS BALANCE COMPLETED SCHEDULED FROM PREVIOUS PRESENTLY % TO RETAINAGE ITEM DESCRIPTION OF WORK AND STORED NO. VALUE APPLICATION THIS PERIOD STORED TO DATE (G=C) FINISH (If variable rate) (D+E) (Not inDorE) (D+E+F) (C—G) CERAMIC TILES LABOR 3,860.00 3,860.00 0.00 0.00 3,860.00 100% 0.00 0.00 • MATERIALS 5,880.00 5,880.00 0.00 0.00 5,880.00 • 100% 0.00 0.00 • GRAND TOTAL 9,740.00 9,740.00 , 0.00 0.00 9,740.00 0.00 0 00 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 Ale 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. • ISA Form 0 1 407 _ rtii rnRi iN OuPtii i-lt nvoi.c.:i( S„ocovii'acici•Sur A1IIDAVIT AND WAIVER Or I C N •X Final _- Pail,al r'a ,men/ 10 Follow Stale of Indiana County ofMARION _ __ SS LAWRENCE CONWAY OFFICE MANAGER/AUTHORIZED PERSON . _ —. _ being duly sworn states that he is the iNar+,e Of Otticeii fl,iiel - CHANCE BROS. MARBLE&TILE, INC. having contracted with _ CARMEL THEATRE DEV.CO.,LLC to furnish Cerid ,S„bcnrs+ acio' S.,on+•eit tCo�i acroil ,i■aleiiais and/or labor as totlows CERAMIC TILE ^____ tOesci.oriont __ ____ ___ _ for a protect known as CAFE BUILDOUT-SCCPROJ_#2695 rotated at CARMEL IN __ and owned by Carmel Theatre Dev. Co.,LLC -- tp,,.,nert 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 HUNDRED SEVENTY •_. •• _ e- .• a `• k -- Dollars I S 974.00 I I reoeipt of which is hereby acknowledged or I ) the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver c Lien which is given solely with respect to said amount. and which waiver shall be effective only upon ieceic of payment thereof by the undersigned. (FINAL WAIVER) chat the Iinal balance due from the contractor is the Sum Of Dollars 15 ) I receipt of which is hereby acknowledged or I I the payment of which has been promised as the Sole consideration for this Affidavit and Final Waiver t Lien 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 whatsoevt on the above described property and improvements thereon on account of LABOR or material or both furnished by th undersigned (hereto. subject to limitations or conditions expressed herein. if any: and further certifies that no other part has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said drolec and within the scope of this affidavit and waiver CiCHANGE BROS.MARBLE&TILE, INC. OFFICE �/WGER --- , By % . t F„m1 taufi+oiizeo Rep,esen - ■ WITNESS MY NANO AND NOTARIAL SEAL. this - __ 16TH. _ day of FEBRUARY; __2011 19 '. - C- t- 1 lNOiaiy Pvt)!,CI My Commission E xpil es 3/2/2016 P CONSTANCE:F,.CARROLL :1' • Residing in ___ N__ _ _ County f: 1979 t,(:),.Nn SUBCONrRACrOPS ASSOciAIinN iNrnPPnRATFn Draft Cafe Improvements (Diversified Painting) January 2011 (application 1) Paid by the Carmel Theater Development Company $ 9,516.92 February 2011 (application 2) Amount to be paid by the Carmel Theater Development Company $ 500.89,` , M 1I•/ DocUment i2/C a .. — 1992 9 Application and Certificate for Payment Con struction Manager-Adviser Edition TO OWNER PROJECT: APPLICATION NO: '2 Distribution to: . Carmel Redevelopment Commission CAMEL RPAC CAFE BUILDOUT • • One Civic Square PERIOD TO: 2/24/11 OWNER ❑ Cannel,IN 46032 CONSTRUCTION MANAGER ❑ FROM CONIWCI :Painting Company VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ 1681 Expo Lane CSO Architects Indianapolis,IN 46214 PROJECT NOS: I I CONTRACTOR ❑ p 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 G703,is attached. Contract_Docuinents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were iss . 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: / O P. Corinc. • 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 10.017.81 By: / ..,- Date: 2124!2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 10,017.81 State of INDIANA Thomas E. Hill 5.RETAINAGE: County of: Boone :• •+0''4,- Notary Public State of Indiana a. 0�of Completed Work Subscribed and sworn to before '1,•LAG :' Boone County (Column D+Eon G703) $ me this day of __ ,.% 2/24/11 �� Expires Nov 8 201 7 b. 504b of Stored Material Notary Public: Thomas E Hill - . ter, (Column F on G703) $ - My Commission expires: 11!08/,- ,7•/"7// .c.---7 Total Retainage(Lines 5a+5b or Total in Column I ofG703). $ CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising- 6.TOTAL EARNED LESS RETAINAGE $ 10,017.81 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 9 51 B 9, CERTIFIED. (Line 6 from prior Certificate) Srt 8.CURRENT PAYMENT DUE $ 500.89 AMOUNT CERTIFIED $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE _ (Attach explanation i amount certified differs from •amount applied. Initial all figures-on this Application,and on 1'Continuation..'h--t that a anged to conform with the a aunt ce ified.) (Line 3 less Line 6) $ - CON\,4 UCTI• A i / By �•:.,r"�� I .A � _� Date: 0 •CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC C':l P .. Total changes approved in previous months by Owner $ $ By: . I Date: 02.. ./I' Total approved this Month $ $ This C-rficate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor . TOTALS $ - $ - name. herein. :suance;'payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ - the 0 ner o ontractor 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. 40/4 . °, AT Document G703" 1992 , m®c0 y, page 1 Continuation Sheet MA 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. 40598 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 BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G-C) FINISH (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C G) • 1 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 0.00 3,000.00 100% 0.00 150.00 i • GRAND TOTAL 10,017.81 10,017.81 0.00 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 AIA5 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. D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 1 STATE: INDIANA XXXX FINAL - PARTIAL XXX 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: FIVE HUNDRED AND 89/100 DOLLARS: $ 500.89 receipt of which is hereby acknowledged or XXXX 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 Kevin M<Blume WITNESS MY HAND AND NOTARIAL SEAL THIS: 02/22/11 MY COMMISSION EXPIRES: 11-08-2017 ..� fI COUNTY OF RESIDENCE: Boone ( NOTARY Thomas E. Hill l 5rate of Indiana 1 E:wc's+Jne County Aires Nov 8,2017 Draft Cafe Improvements (Circle B) October 2010 (application 1) Paid by the Carmel Theater Development Company $ 10,030.50 November 2010 (application 2) Paid by the Carmel Theater Development Company $ 3,343.50 December 2010 (application 3) Amount to be paid by the Carmel Theater Development Company $ 1',48600 STY/1 A I A Aracves Document 7 2/C a" - 1992 g -- Application and Certificate for Payment Construction Manager-Adviser Edition • TO OWNER: PROJECT: APPLICATION NO: 3 FINAL RETENTION Distribution to: CAR EL REDEVELOPMENT COMMISSION CPAC ONE CIVIC SQUARE PERIOD TO: 12i 29i 2010 OWNER ❑ ON CIVIC SQUARE' C{A-Li+Ln', DUILDOVT CARMRL, IN 460032 CONSTRUCTION MANAGER CI FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE B CONSTRUCTION SYSTEMS ShTnu SEXTON nonP tv1 PROJECT NOS: / CONTRACTOR ❑ 3030 S. MERIDIAN Sm. - .,�„� ,,C,,, INDIANAPOLIS T,.r ,.'11 7 VIA ARCHITECT: 267J-2001 FIELD ❑ , 11V 4021/ . CONTRACT FOR: FRAMING & DRYWALL CST, AR nm JLm. ❑ 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 '.ym- t ere issued and payments received from •the Owner, and that current 1.ORIGINAL CONTRACT SUM $ ,14,860.00 payment sho • :+a• S .w due. 2. Net change by Change Orders $ CONT• r rr CONSTRUCTION SYSTEMS }!111milun /4, ,,i► •/1/Al L. D VVLJJ II�UV IIOLV J1J1L�1'1J Sl I/ 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 14,860.00 By: T L /2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 14,860.00 State of: I 1J J_ RIA i f• •.• Ay 5.RETAINAGE: County ••: V.4'ION _ a. %of Completed Work, Subsc ;:ed•and : o' to .efore i C•'; ►t; . INIi (Column D+E on G703) $ -0- met 's 29' r' DF';1'M,. 2010 i, ( RYPUBhII; •TE *DIANA b. %of Stored Material Not ry Publi,:.. -: / / /® I I OIS S� 'y0 F 1.2017 w ISSION (Column F on G703) $ My Commis _ es: " 's. ',''® ..........,Q; ,�'�� • CERTIFICATE F P'A MENT ,,,:,,, Total Retainage(Lines 5a+5b or Total in Column I of G703). $ _0- _ In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 14,860.00 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 $ 13 3.7 4.00 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 $ 1,486.00 AMOUNT CERTIFIED $ I IMGD 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differ -o the amount applied. Initial all figures on this Application and o e Continuatio heet at a e changed to conform with the. ount ertified.) (Line 3 less Line 6) $ CONST,` CTIOL y Date: •© - • BY: _41 �/././.'� ' CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE� ` . Total changes,approved in previous months by Owner $ $ BY: , • Date: v Z,Z13 11 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. me. &ell, 7V- 46qs.______,s.6/ A Document G703TM - 1992 criTh • Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 3 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 12/29/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 12/29/2010 A B C D E F G • H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED %a TO RETAINAGE FROM PREVIOUS STORED AND STORED (IF VARIABLE NO. 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 8,500.00 8,500.00 100.00 101 FRAME/HANG LABOR 6,360.00 6,360.00 6,360.00 100.00 JOB TOTALS : 14,860.00 14,860.00 .00 .00 14,860.00 .00 .00 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 arid 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 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: CARMEL PERFORMING ARTS CENTER CAFE BUILD OUT 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 THIRTEEN THOUSAND THREE HUNDRED SEVENTY FOUR. ($13,374.00) XX RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR 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 TIIE 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 SAID PROJECT AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE : CONSTR. SYSTEMS, LL(C BY: TITLE: PRESIDENT I MY HA !�AiT A' SEAL THIS 29th DAY OF DECEMBER X010 4 „ ,, ' `►►UpUi► emee�ejeej'so' MY COMMIS'ION E PIRES: 02/01/2017 O •°• ••°• °L RESIDENT OF JOHNSON COUNTY P. �; ° �' ‘VI CL;Construction Systems OWNER: 12/29/2010 CARMEL REDEVELOPMENT COMMISSION PROJECT: CARMEL PERFORMING ARTS CM: CAFE BUILDOUT SHIEL SEXTON COMPANY PROJECT NO. 2695-2601 PAYMENT VERIFICATION AFFIDAVIT THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED APPLICATION NO. AMOUNT PAID #1 $ 10,030.50 #2 $ 3,343.50 TOTAL PAID TO DATE: $ 13,374.00 14k-' 449 (317)787-5746 fax(317)780-2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opportunity Employer