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HomeMy WebLinkAboutGibraltar - $314,343.90Regions 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 previously paid by CRC to be reimbursed by Carmel Theater Development Company, LLC as well as amounts to be paid by Carmel Theater Development Company, LLC as per the PAC Hardscape installment purchase contract. Reimbursement Application 1 (Gibraltar) May 2010 $ 34,335.00 Reimbursement Application 2 (Gibraltar) June 2010 $ 21,180.60 Application 3 (Gibraltar) July 2010 $ 108,784.80 Application 4 (Gibraltar) August 2010 $ 150,043.50 Total Authorized Disbursement •'$ 314,343.90 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated July 22, 2010, by and between Regions Bapk and Carmel Theater Development Company, LLC. Dated: 9/2 ° //b CITY OF CARMEL COMMISSION By: REDEVELOPMENT Printed: Title: Les S. Olds Executive Director 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 Hardscape (Gibraltar) Up Through June 2010 (applications 1 and 2) Amount to be reimbursed to CRC $ 55,515.60 July 2010 (application 3) Amount to be paid by Carmel Theater Development Company $ 108,784.80 August 2010 (application 4) Amount to be paid by Carmel Theater Development Company $ 150,043.50 M =C - C m Docu 1 U U of V I! ©2I1 MiTtd o 1992 Application and Certificate for Payment Construction Manager- Adviser Edition TA ntnroteD• Carmel Redevelopment Colnission 30 W. Main Street, Suite 220 Carmel, IN 46032 I-KUM UuN I KM; I UK: Gibraltar Conotruction Corp 2932 H. Webster Ave. Indianapolis, IN 46219 CONTRACT FOR: Hardacape Package PO Dort' CT: Regional Performing Arts Ctr 211 City Center Drive Carmel, IN 46032 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: C50 Architects, Inc. APPLICATION NO: 001 PERIOD TO: 05/2511° CONTRACT DATE: PROJECT NOS: 04/13/10 Distribution to: OWNER ❑ CONSTRUCTION MANAGER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ 0 CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet. AIA Document G703, is attached. 1,260,000.00 1. ORIGINAL CONTRACT SUM S 2. Net change by Change Orders S no 3. CONTRACT SUM TO DATE (Line I4. ?) `41.2ae.ano.n° 4. TOTAL COMPLETED & STORED TO DATE (Column 0 on G703) $ 38,150.00 5. RETAINAGE: a. of Completed Work (Column D + E on G703) b. ' b of Stored Material (Column F on 0703) S 3,015.00 S Total Retainuge (Lines 5u + 5b or Total in Column I of 0703). S 6. TOTAL EARNED LESS RETAINAGE S (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT S (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) 34,335.00 .00 S 14 115 nn S 1,233,665.00 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes appmved in previous months by Owner $ nn $ on Total approved this Month $ nn S nn TOTALS $ S S .00 NET CHANGES by Change Order $ .00 The undersigned Contractor certifies that to belief the Work covered by this Applica Contract Documents. that all amounts It Certificates for Payment were iss . ted payment shown herein is now due CONTRACTOR: By: State of: of: and savor be,,f�o me this i� �- of 7 Notary Public- My Commission expires: 7 CERTIFICATE FOR PAYMENT he best of the Contractor's knowledge, information and for Payment has been completed in accordance with the een paid by the Contractor for Work for which previous payments received from the Owner. and that current Date: BRIAN R. MCBRIDE Res. of Hancoci Cc. y My Comm. Exp. 11-29-2017 Commission # 611862 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 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 is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED $ s9 S (Attach exploit ion if-mount certified differs from the amount applied. milt tl all figures on this Application ant on the Carttiurratiou Sheet that are changed to conform with the amount certified.) CONSTRUCT MAN Eft-% By: Date: 5— . ZS . Z.0 ( 0 ARCHITECT: By: Dale: OO t rr, 1nC. This Certificate is not ncaotiable. The ANIOUNT CERTIFIED is payable only to the Contractor named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. Ail:original assures that changes Will not be obscured. AIA Document G702/CMaTu —1992. Copyright ©1992 by The Americaninslilule of Architects. All rights reserved. WARNING:This AIA °;Document Is,protocted by US. Copyright Law and International Treadles. ;Unauthorized reproduction ar;dislribution of this AIA° Document. or any portion of honey result In severe civil and criminal penalties, and will be,prosecuted to the maximum extent possible under the law. Purchasers are permitted Io reproduce ten NO) copies of this document when completed. To report copyright violations o1 AIA Canlract'Documents, a -mall The American Institute of Archilecls' legal counsel. copyriohl @ala.org. CONTINUATION INUATION SHEE 4 AIA DOCUMENT G703 (Instructions on reverse side) PAGE OF3� PAGES AIA Document G702', APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulation's below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable rctainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: 001 05/25/10 05/25/10 A i3 C D E F G Fl 1 ITEM NO. DESCRIPTION OF WORK WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) It (G =- C) BALANCE f0 FINISH (C - G) RETAINAGE (IF VARIABLE) RATE) SCHEDULED V ALUE FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 0001 Concrete Allowance 35,000.00 .00 .00 .00 .00 .00 35,000.00 .00 0002 Motorcoach Connect Int. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0003 14otarcoach Connect Ext. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0004 Allowance - 100 CY Stone 4,500.00 .00 .00 .00 .00 .00 4,500.00 .00 0005 Allowance - 5000 9F 0eogrid 3,500.00 .00 .00 .00 .00 .00 3,500.00 .00 0006 Allow. - 30 oalvaniced Sleeves 1,500.00 .00 .00 .00 .00 .00 1,500.00 .00 0007 Supervision 10,000.00 .00 300.00 .00 300.00 3.00 9,700.00 30.00 0009 Ronda 19,940.00 .00 19,940.00 .00 19,940.00 _00.00 .00 1,994.00 0009 Plobilication /DCmobilicatian 1,500.00 .00 750.00 .00 750.00 50.00 750.00 75.00 0010 Submittals 12,000.00 .00 10,800.00 .00 10,000.00 90.00 1,200.00 1,000.00 0011 Misc. General Cnnditiann 12,000.00 .00 360.00 .00 360.00 3.00 11,640.00 36.00 0012 Rebar Material 7,500.00 .00 .00 .00 .00 .00 7,500.00 .00 0013 Trench Drain 4,000.00 .00 .00 .00 .00 .00 4,000.00 .00 0014 Cnncretc Curbs 89,000.00 .00 .00 .00 .00 .00 09,000.00 .00 0015 Concrete Haiku/Slabs 93,000.00 .00 .00 .00 .00 .00 93,000.00 .00 0016 North Stair 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0017 Sheet Waterproofing 12,000.00 .00 .00 .00 .00 .00 12,000.00 .00 0018 Green Roo[ A Decamponed Granit 104,500.00 .00 .00 .00 .00 .00 104,500.00 .00 0019 Electrical 21,000.00 .00 .00 .00 .00 .00 21,000.00 .00 0020 , Earthwork 240,500.00 .00 6,000.00 .00 6,000.00 2.49 234,500.00 600.00 0021 Site Signage 3,000.00 .00 .00 .00 .00 .00 3,000.00 .00 0022 Joint Sealants 560.00 .00 .00 .00 .00 .00 560.00 .00 0023 Concrete Pavers 120,400.00 .00 .00 .00 .00 .00 120,400.00 .00 0024 Permeable Pavers 31,200.00 .00 .00 .00 .00 .00 31,200.00 .00 0025 Porous Pavers 14,400.00 .00 .00 .00 .00 .00 14,400.00 .00 AIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION + AI,1 • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVM AVENUE, N.W. WASHINGTON, D.C. 20006.5292 • WARNING: Unlicensed photocopying violates US. copyright taws and will subject the violator to legal prosecution. G703 -1992 CAUTION: You should use an original AtA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE 303PAGES AIA Document G704. APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. in tabulations below, amounts are stated to the nearest dollar. Use Column 1 on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD 10: ARCHITECT'S PROJECT NO.: 001 05/25/10 05/25/10 A ti c 0 E F G H I ITEM NO. DESCRIPTION OF WORT{ WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (V+E -I.I') % (G _ C) BALANCE FINISH (C - G) RETAINAGE (IF VARIABLE) RATE) SCHEDULED VALUE FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 002G 0027 Granite Pave= Topsoil 295,000.00 49,000.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 396,000.00 40,000.00 .00 .00 1,269,000.00 .00 30,150.00 .00 39,150.00 3.01 1,229,050.00 3,915.00 ar—` AEA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA' • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVENUE, N.W., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright Laws and will subject the violator to legal prosecution. CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. G703 -1992 r == 1 Document V fl ©LEIVUVUaTm o 1992 Application and Certificate for Payment Construction Manager - Adviser Edition TO OWNER: Carmel Redevelopment Comission 30 W. Main Street, Suite 220 Carmel, IN 46032 munn LUN I KAU 1 UK: Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 CONTRACT FOR: Hardscape Package P6 PRnJECT: Regional Performing Arts Ctr 211 City Center Drive Carmel, IN 46032 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: CS0 Architects, Inc. APPLICATION NO: 002 PERIOD TO: 06/15/10 CONTRACT DATE: PROJECT NOS: 04/13/10 f / Distribution to: OWNER ❑ CONSTRUCTION MANAGER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM S 2. Net change by Change Orders 6 nn 3. CONTRACT SUM TO DATE (Line I ± 2) $1.268.000.00 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) $ 61, 684.00 1,268,000.00 5. RETAINAGE: a. % of Completed Work (Column D + E on G703) $ 6,168.40 b. % of Stored Material (Column F on G703) 5: Total Retainage (Lines 5a + 5b or Total in Column I of G703) . $ 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) S 55,515.60 34,335.00 71 1Rn sn 1,212,484.40 s CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ no $ nn Total approved this Month $ nn $ nn TOTALS $ nn $ _on NET CHANGES by Change Order S .00 The undersigned Contractor certifies that belief the Work covered by this Applica Contract Documents, that all al qt is h Certificates for Payment wer payment shown herein is no CONTRACTOR: Gibra By: State of:� the best of the Contractor's knowledge, information and n for Payment has been completed in accordance with the e been paid by the Contractor for Work for which previous d payments received from the Owner. and that current County of: fo Subscribed and sworn to bcfor' me this ai /S'd day of Notary Publi •• My Commission expires: / 7 CERTIFICATE FOR PAYMENT 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 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 is entitled to payment of the AMOUNT Date: ^a /.- /O BRIAN R. MCBRIDE REis, of Hancock County My Comm. Ems. 11 -29 -2017 Ccmmissirn 8111;62 CERTIFIED. AMOUNT CERTIFIED (Attach explanation if amount certified clif/'ers from tai into Application and on Ill Continuation Sheet tl are •umg CONST• TION MA 1P4 / c• By: It. ll A. /- • • c -c ARCHIT By: This Certificate is not,+ named herein. Issua t(e the Owner or Cont a n $2f,1'1? it applied. Initial all figures 00 this to conform with the amount c'riifled. ) Date: tab e. The AMOUNT CERTIFIED is payable only to the Contractor ayment and acceptance of paytnent are without prejudice to any rights of r under this Contract. Date: CAUTION: You should sign an original AIA Contract Document, on which thistetit appears in.RED. An 'original assures•thai changes wfll not be obscured. AIA Document G7021CManl — 1992. Copyright © 1992 by The American Institute of Architects. All rights reserved. WARNiNG:•Tliis AIAe Document is protected by'U.S.,Copyright Law and International Treaties. Unauthorized reproduction or: distribution of.thisAIA Document, °,or any portion of it; may result in severe civil and_criminai penalties; end,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 @ala.org. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE a OF3 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulation's below, amounts are stated to the nearest dollar. Use Column 1 on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: 002 06/15/10 06/15/10 A B C D E F G 1-1 I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) (G C) ( BALANCE TO FINISH (C - G) RETAINAGE (IC VARIABLE) RATE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 0001 Concrete Allowance 35,000.00 .00 10,894.00 .00 10,894.00 31.13 24,106.00 1,089.40 0002 Motorcoach Connect Int. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0003 Motorcoach Connect Ext. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0004 Allowance - 100 CY Stone 4,500.00 .00 .00 .00 .00 .00 4,500.00 .00 0005 Allowance - 5000 SF Geogrid 3,500.00 .00 .00 .00 .00 .00 3,500.00 .00 0006 Allow. - 30 Galvanized Sleeves 1,500.00 .00 .00 .00 .00 .00 1,500.00 .00 0007 Supervision 10,000.00 300.00 700.00 .00 1,000.00 10.00 9,000.00 100.00 0008 Bonds 19,940.00 •19,940.00 .00 .00 19,940.00 =00.00 .00 1,994.00 0009 Mobilization /Demobilization 1,500.00 750.00 .00 .00 750.00 50.00 750.00 75.00 0010 Submittals 12,000.00 10,800.00 600.00 .00 11,400.00 95.00 600.00 1,140.00 0011 Minn. General Conditions 12,000.00 360.00 840.00 .00 1,200.00 10.00 10,800.00 120.00 0012 Rebar Material 7,500.00 .00 7,500.00 .00 7,500.00 :00.00 .00 750.00 0013 Trench Drain 4,000.00 .00 .00 .00 .00 .00 4,000.00 .00 0014 Concrete Curbs 89,000.00 .00 .00 .00 .00 .00 89,000.00 .D0 0015 Concrete Walks /Slabs 93,000.00 .00 .00 .00 .00 .00 93,000.00 .00 0016 North Stair 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 0017 Sheet Waterproofing 12,000.00 .00 3,000.00 .00 3,000.00 25.00 9,000.00 300.00 0018 Green Roof 4 Decomposed Granit 104,500.00 .00 .00 .00 .00 .00 104,500.00 .00 0019 Electrical 21,000.00 .00 .00 .00 .00 .00 21,000.00 .00 0020 Earthwork 240,500.00 6,000.00 .00 .00 6,000.00 2.49 234,500.00 600.00 0021 Site Signage 3,000.00 .00 .00 .00 .00 .00 3,000.00 .00 0022 Joint Sealants 560.00 .00 .00 .00 .00 .00 560.00 .00 0023 Concrete Pavers 128,400.00 .00 .00 .00 .00 .00 128,400.00 .00 0024 Permeable Pavers 31,200.00 .00 .00 .00 .00 .00 31,200.00 .00 0025 Porous Pavers 14,400.00 .00 .00 .00 .00 .00 14,400.00 .00 4 AIA DOCUMENT (1703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • MAC • ©1992 • TIIE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORE `+r AVENUE, NW., WASHINGTON, D.C. 20006-5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. 0 G703 -1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. CONTINUATION SHEET AMA DOCUMENT G703 (Instructions on reverse side) PAGE 3 0E3 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT. containing Contractor's signed Certification, is attached. In tabulations below, amounts are slated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: 002 06/15/10 06/15/10 A 13 C D E F t,, 1-I I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (U +E +F) �' (G _ C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE) RATE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 0026 0027 Granite Pavers Topsoil 296,000.00 48,000.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 296,000.00 48,000.00 .00 .00 1,268,000.00 38,150.00 23,534.00 .00 61,684.00 4.86 1,206,316.00 6,168.40 •, m AIA DOCUMENT G703 • CONTINUATION SHI E'r FOR 0702 • 1992 EDITION • AIM' • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 1 / AVENUE, N.W., WASHINGTON, D.C. 20006.5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and'wlIl subject the violator to legal prosecution. G703 -1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. ISA Form # 1-402 AFFIDAVIT AND WAIVER OF LIEN ❑ FINAL ® PARTIAL Z PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and / or labor for a project known as Parcel 7A, Regional Performing Arts Center, Hardscape Package P8 and owned by Village Financial, LLC. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the Owner the sum of Twenty One Thousand One Hundred Eighty and 60/100 - -- Dollars ($21,180.60) ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration of this 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 the final balance due from the Owner is the sum of Dollars ( ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of ch payment. THERFORE, the undersigned waives and releases unto the 0 -r of said premises, any and all lien or claim whatsoever on the above - described property and improvements thereon ac punt of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions .res -d herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work tj; • r - • or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By WITNESS MY HAND AND NOTORIAL S L, this 21st day of June, 2010. O 1979 INDIANA SUBCONTRACTORS ASSOCIATION INCORPORAIEO Unaulnor•tod R.otodutllon Pian,ertod Title President (Notary Public) BRIAN R. MCBRIDE RE.s. of ; iancocfi Cou: My Comm. E 11-29-2017 ,';nmm'syinr: # 511852 Rev IurR7 Document G702 /CMaTM -1992 Application and Certificate for Payment Construction Manager- Adviser Edition TO OWNER: Carmel Redevelopment PROJECT: Commission One Civic Square Carmel,IN 46032 FROM CONTRACTOR: Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 CONTRACT FOR: Hardscape Package P8 Regional Performing Arts Ctr 211 City Center Drive Carmel, IN 46032 VIA CONSTRUCTION MANAGER: VIA ARCHITECT: CSO Architects, Inc. APPLICATION NO: 003 PERIOD TO: 07 /15/10 CONTRACT DATE: PROJECT NOS: 04/13/10 / / Distribution to: OWNER ❑ CONSTRUCTION MANAGER ❑ ARCHITECT ❑ CONTRACTOR El FIELD ❑ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM $ 2. Net change by Change Orders $ 3. CONTRACT SUM TO DATE (Line 1 ± 2) 4. TOTAL COMPLETED & STORED TO DATE (Column G on G703) 1,268,000.00 .00 $1,268,000 00 $ 182,556.00 5. RETAINAGE: a. % of Completed Work (Column D + E on G703) $ 18, 255.60 b. % of Stored Material (Column F on G703) $ Total Retainage (Lines 5a + 5b or Total in Column I of G703) ., $ 6. TOTAL EARNED LESS RETAINAGE (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) $ 164,300.40 55,515.60 108 78a 80 1,103,699.60 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ 00 Total approved this Month $ .00 00 $ J10 TOTALS $ 00 $ on NET CHANGES by Change Order $ 00 The undersigned Contractor certifies t belief the Work covered by this Appli Contract Documents, that all amounts Certificates for Payment were is payment shown herein is now du CONTRACTOR: o the best of the Contractor's knowledge, information and lion for Payment has been completed in accordance with the ave been paid by the Contractor for Work for which previous and payments received from the Owner, and that current Gibraltar r;, S.t. 'ction Corp By: State of: of: Subscribed and swo me this � day .o Notary Public: My Co mission expires: Date: %jc7 BRIAN R, MCBRIDE Res, of Hancock County My Comm, Exp. 11 -29 -2017 Commission # 611862 CERTIFICATE FOR PAYMENT 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 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 is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED (Attach explanation if amount certified diff Application and on the Continuation Shee CONST CTIO : N Sri R: By: rom the amount applied. Initial all figures on this are changed to conform with the amount certified.) 7/24 yo Date: ARCH! T y y -- By: �L Date: 01 ITZ tier This Certificate is not: negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. Director of Redevelopm 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 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. ittAIA 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. 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. 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. AIA Document G702 /CMa TM - 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 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. .CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE a OF3 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: 003 07/15/10 07/15/10 A B C D E F G H I ITEM NO DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) % (G _ C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE) RATE) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 3001 Concrete Allowance 35,000.00 10,894.00 .00 .00 10,894.00 31.13 24,106.00 1,089.40 2002 Motorcoach Connect Int. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 3003 Motorcoach Connect Ext. Allow 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 3004 Allowance - 100 CY Stone 4,500.00 .00 .00 .00 .00 .00 4,500.00 .00 2005 Allowance - 5000 SF Geogrid 3,500.00 .00 .00 .00 .00 .00 3,500.00 .00 )006 Allow. - 30 Galvanized Sleeves 1,500.00 .00 .00 .00 .00 .00 1,500.00 .00 3007 Supervision 10,000.00 1,000.00 1,000.00 .00 2,000.00 20.00 8,000.00 200.00 3008 Bonds 19,940.00 19,940.00 .00 .00 19,940.00 100.00 .00 1,994.00 3009 Mobilization /Demobilization 1,500.00 750.00 .00 .00 750.00 50.00 750.00 75.00 3010 Submittals 12,000.00 11,400.00 600.00 .00 12,000.00 100.00 .00 1,200.00 )011 Misc. General Conditions 12,000.00 1,200.00 1,200.00 .00 2,400.00 20.00 9,600.00 240.00 )012 Rebar Material 7,500.00 7,500.00 .00 .00 7,500.00 100.00 .00 750.00 )013 Trench Drain 4,000.00 .00 3,000.00 .00 3,000.00 75.00 1,000.00 300.00 3014 Concrete Curbs 89,000.00 .00 .00 .00 .00 .00 89,000.00 .00 )015 Concrete Walks /Slabs 93,000.00 .00 .00 .00 .00 .00 93,000.00 .00 )016 North Stair 25,000.00 .00 .00 .00 .00 .00 25,000.00 .00 3017 Sheet Waterproofing 12,000.00 3,000.00 8,760.00 .00 11,760.00 98.00 240.00 1,176.00 3018 Green Roof & Decomposed Granit 104,500.00 .00 .00 32,312.00 32,312.00 30.92 72,188.00 3,231.20 )019 Electrical 21,000.00 .00 .00 .00 .00 .00 21,000.00 .00 3020 Earthwork 240,500.00 6,000.00 74,000.00 .00 80,000.00 33.26 160,500.00 8,000.00 3021 Site Signage 3,000.00 .00 .00 .00 .00 .00 3,000.00 .00 )022 Joint Sealants 560.00 .00 .00 .00 .00 .00 560.00 .00 )023 Concrete Pavers 128,400.00 .00 .00 .00 .00 .00 128,400.00 .00 )024 Permeable Pavers 31,200.00 .00 .00 .00 .00 .00 31,200.00 .00 )025 Porous Pavers 14,400.00 .00 .00 .00 .00 .00 14,400.00 .00 �=nrn AIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA® • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 00 h AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703 -1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. CONTINUATION SHEET AIA DOCUMENT G703 (Instructions on reverse side) PAGE 3 03 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: APPLICATION DATE: PERIOD TO: ARCHITECT'S PROJECT NO.: 003 07/15/10 07/15/10 A B C D E F G H I ITEM DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED D OR E) TOTAL COMPLETED AND STORED TO DATE (D +E +F) ° �O (G _ C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE) ( RATE) ) FROM PREVIOUS APPLICATION (D + E) THIS PERIOD 3026 D027 Granite Pavers Topsoil 296,000.00 48,000.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 296,000.00 48,000.00 .00 .00 1,268,000.00 61,684.00 88,560.00 32,312.00 182,556.00 14.40 1,085,444.00 38,255.60 AIA DOCUMENT G703 • CONTINUATION SHEET FOR G702 • 1992 EDITION • AIA° • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK 4\1�6 AVENUE, N.W., WASHINGTON, D.C. 20006 -5292 • WARNING: Unlicensed photocopying violates U.S. copyright laws and will subject the violator to legal prosecution. G703 -1992 CAUTION: You should use an original AIA document which has this caution printed in red. An original assures that changes will not be obscured as may occur when documents are reproduced. ISA Form # 1 -402 AFFIDAVIT AND WAIVER OF LIEN El FINAL ® PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and / or labor for a project known as Parcel 7A, Regional Performing Arts Center, Hardscape Package P8 and owned by Village Financial, LLC. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the Owner the sum of One Hundred Eight Thousand Seven Hundred Eight Four and 80/100 Dollars ($108,784.80) ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration of this 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 the final balance due from the Owner is the sum of Dollars ( ) ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt o such payment. THERFORE, the undersigned waives and releases unto the O w on the above - described property and improvements thereon ac undersigned thereto, subject to limitations of conditions ex.les has any claim or right to a lien on account of any work pe ; V m .'d and within the scope of this affidavit and waiver. Gibraltar Construction Corp By er of said premises, any and all lien or claim whatsoever unt of LABOR or material or both, furnished by the d herein, if any; and further certifies that no other party or material furnished to the undersigned for said project, Title President WITNESS MY HAND AND NOTORIAL SEAL,/i: ' 0th day of July, 2010. Q 1979 INDIANA SUBCONTIACTOAS ASSOCIATION lNCQgPQ ATED Unauteo ^rAA peproduciron P,oh.b tied (Notary Public) BRIAN R. MCBRIDE Rss, of Hancock County My Comm, Exp, 11 -29 -2017 Commission # 611862 a ev I - Document G702 /CMa TM -1992 Application and Certificate for Payment Construction Manager- Adviser Edition 6% TO OWNER: Carmel ,Redevelopment Commission One Civic Square Carmel, IN 46032 PROJECT: Regional Performing Arts Center FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 VIA ARCHITECT: CONTRACT FOR: Hardscape Package P8 CSO Architects, Inc. APPLICATION NO: PERIOD TO: 8/15/10 4 CONTRACT DATE: 4/13/10 PROJECT NOS: / Distribution to: OWNER ❑ CONSTRUCTION MANAGER ❑ ARCHITECT ❑ CONTRACTOR ❑ FIELD ❑ CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AIA Document G703, is attached. 1. ORIGINAL CONTRACT SUM $ 1,268,000.00 2. Net change by Change Orders $ 0.00 3. CONTRACT SUM TO DATE (Line l ± 2) $ 1,268,000 -00 4. TOTAL COMPLETED & STORED. TO DATE (Column G on G703) $ 349,271.00 5. RETAINAGE: a. % of Completed Work (Column D + E on G703) $ 34,927.10 b. % of Stored Material (Column F on G703) $ Total Retainage (Lines 5a + 5b or Total in Column I of 0703) .. $ 6. TOTAL EARNED LESS RETAINAGE $ 314,343.90 (Line 4 Less Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT $ (Line 6 from prior Certificate) 8. CURRENT PAYMENT DUE 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Line 3 less Line 6) 164,300.40 $ 150,043.50 953,656.10 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner $ $ Total approved this Month $ $ TOTALS $ $ NET CHANGES by Change Order $ The undersigned Contractor certifie belief the Work covered by this Ap Contract Documents, that all a Certificates for Payment we payment shown herein is now CONTRACTOR: Gibralta By: State of: County of: // fQ Subscribed and s rn to.b• • me this day o, Notary Public: My Commission expires: t q t to the best of the Contractor's knowledge, information and he ion for Payment has been completed in accordance with the s ave been paid by the Contractor for Work for which previous ed and payments received from the Owner, and that current CERTIFICATE FOR PAYMENT Date: BRIAN R. MCBRIDE Res, of Hancock County My Comm. Exp, 11 -29 -2017 Commission # 611862 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 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 is entitled to payment of the AMOUNT CERTIFIED. AMOUNT CERTIFIED (Attach e.rplanation if amount certified differs fr he amount applied. Initial all figures on this Application and on • Continuation S/ •et th .hanged to conform with the amount certified.) 1! •^V- './4 Date: ©6J 0 ..„.,,, so' CONST By: ARCHITECT: By: Date: B bbP(* This Certificate is n• negotiable. The AMOUNT CERTIFIED is payable only to the Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of 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 /CMa TM - 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 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. POATA 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 al 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. 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. AIA Document G702 /CMa TM - 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 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. CONTINUATION SHEET Page 2 of 3 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: 4 APPLICATION DATE: 8/13/2010 PERIOD TO: 8/13/2010 ARCHITECT'S PROJECT NO. : A B C D L E F G H I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D + E + F) "/o (G / C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) FROM PREVIOUS APPLICATION (D+ E) THIS PERIOD 1 Concrete Allowance $35,000.00 $10,894.00 $10,894.00 31% 24,106.00 1,089.40 2 Motorcoach Connect Int. Allow $25,000.00 $0.00 $0.00 0% 25,000.00 - 3 Motorcoach Connect Ext. AIIow $25,000.00 $0.00 $0.00 0% 25,000.00 - 4 Allowance - 100 CY Stone $4,500.00 $0.00 $0.00 0% 4,500.00 - 5 Allowance - 5000 SF Geogrid $3,500.00 $0.00 $0.00 0% 3,500.00 - 6 AIIow. - 30 Galvanized Sleeves $1,500.00 $0.00 $0.00 0% 1,500.00 - 7 Supervision $10,000.00 $2,000.00 $1,000.00 $3,000.00 30% 7,000.00 300.00 8 Bonds $19,940.00 $19,940.00 $19,940.00 100% - 1,994.00 9 Mobilization /Demobilization $1,500.00 $750.00 $750.00 50% 750.00 75.00 10 Submittals $12,000.00 $12,000.00 $12,000.00 100% - 1,200.00 11 Misc. General Conditions $12,000.00 $2,400.00 $1,200.00 $3,600.00 30% 8,400.00 360.00 12 Rebar Material $7,500.00 $7,500.00 $7,500.00 100% - 750.00 13 Trench Drain $4,000.00 $3,000.00 $1,000.00 $4,000.00 100% - 400.00 14 Concrete Curbs $89,000.00 $0.00 $13,350.00 $13,350.00 15% 75,650.00 1,335.00 15 Concrete Walks /Slabs $93,000.00 $0.00 $32,550.00 $32,550.00 35% 60,450.00 3,255.00 16 North Stair $25,000.00 $0.00 $0.00 0% 25,000.00 - 17 Sheet Waterproofing $12,000.00 $11,760.00 $240.00 $12,000.00 100% - 1,200.00 18 Green Roof & Decomposed Granite $104,500.00 $32,312.00 $32,312.00 31% 72,188.00 3,231.20 19 Electrical $21,000.00 $0.00 $0.00 0% 21,000.00 - 20 Earthwork $240,500.00 $80,000.00 $100,375.00 " $180,375.00 75% 60,125.00 18,037.50 21 Site Signs $3,000.00 $0.00 $0.00 0% 3,000.00 - 22 Joint Sealants $560.00 $0.00 $0.00 0% 560.00 - 23 Concrete Pavers $128,400.00 $0.00 $0.00 0% 128,400.00 - 24 Permable Pavers $31,200.00 $0.00 $0.00 0% 31,200.00 - 25 Porous Pavers $14,400.00 $0.00 $0.00 0% 14,400.00 - CONTINUATION SHEET Page 3 of 3 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is attached. In tabulations below, amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. APPLICATION NO.: 4 APPLICATION DATE: 8/13/2010 PERIOD TO: 8/13/2010 ARCHITECT'S PROJECT NO. : A B C D I E F G H I ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE WORK COMPLETED MATERIALS PRESENTLY STORED (NOT IN D OR E) TOTAL COMPLETED AND STORED TO DATE (D + E + F) % (G / C) BALANCE TO FINISH (C - G) RETAINAGE (IF VARIABLE RATE) FROM PREVIOUS APPLICATION (D +E) THIS PERIOD 26 Granite Pavers $296,000.00 $5,000.00 $5,000.00 2% 291,000.00 500.00 27 Topsoil $48,000.00 $12,000.00 $12,000.00 25% 36,000.00 1,200.00 28 #VALUE! 29 #VALUE! 30 #VALUE! 31 #VALUE! 32 33 34 35 36 37 - 38 - 39 40 41 42 43 44 45 46 47 48 49 50 $1,268,000.00 $182,556.00 $166,715.00 $0.00 $349,271.00 28% $591,729.00 #VALUE! ISA Form # 1 -402 AFFIDAVIT AND WAIVER OF LIEN ❑ FINAL ® PARTIAL ® PAYMENT TO FOLLOW State of Indiana, County of Marion, SS Michael Smith being duly sworn state that he is the President of Gibraltar Construction Corp having contracted with the Owner to furnish certain materials and / or labor for a project known as Parcel 7A, Regional Performing Arts Center, Hardscape Package P8 and owned by Village Financial, LLC. and does hereby further state on behalf of the aforementioned contractor: (PARTIAL WAIVER) that there is due from the Owner the sum of One Hundred Fifty Thousand Forty Three and 50/100 Dollars ($150,043.50) ❑ receipt of which is hereby acknowledged; or ® the payment of which has been promised as the sole consideration of this 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 the final balance due from the Owner is the sum of Dollars ( ❑ receipt of which is hereby acknowledged; or ❑ the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THERFORE, the undersigned waives and releases unto the Ow er of said premises, any and all lien or claim whatsoever on the above - described property and improvements thereon account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations of conditions exp : ss d herein, if any; and further certifies that no other party has any claim or right to a Tien on account of any work pe g. a or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By Title President WITNESS MY HAND AND NOTORIAL SEAL, , is 23rd day of August, 2010. p 1979 INDIANA SUBCONTRACTORS ASSOC■ATION INCORPORATED Uhautiho,411.3 Re ioductlon Pralubltlid (Notary Public) MCBRIDE I?e5. V! ~Gary. ^.l Courtly Esc.". 11-29-2017 ft4,K)41 # 611862 Rev 19'*7 Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 Invoice 3 -2 4 -1 Application 3 Application 4 Check: 1 Date: 9/21/2010 Vendor: GIBR1 Prior P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 69 120,872.00 120,872.00 12,087.20 0.00 108,784.80 69 166,715.00 166,715.00 16,671.50 0.00 150,043.50 287,587.00 287,587.00 28,758.70 0.00 258,828.30 1 9/21/2010 * * * * * * * ** *258,828.30 THE SUM OF TWO HUNDRED FIFTY EIGHT THOUSAND EIGHT HUNDRED TWENTY EIGHT DOLLARS AND 30 CENT; Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 Gibraltar Construction Corp 2932 N. Webster Ave. Indianapolis, IN 46219 Invoice 3 -2 4 -1 Application 3 Application 4 Check: 1 Date: 9/21/2010 Vendor: GIBR1 Prior P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 69 120,872.00 120,872.00 12,087.20 0.00 108,784.80 69 166,715.00 166,715.00 16,671.50 0.00 150,043.50 287,587.00 287,587.00 28,758.70 0.00 258,828.30