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HomeMy WebLinkAboutJ.R. Clancy - $2,875,751.98p Exhibit D Disbursement Instructions Mercantile 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 r Amount to be paid by Village Financial, LLC March work (JR Clancy) $ 2,875,751.98 Total Authorized Disbursement $ 2,875,751.98. All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (PAC Equipment), dated, as of August 3], 2009, by and between Lender and Village Financial, LLC. Dated: .515- / 5- /0 CITY OF CARMEL REDEVELOPMENT COMMI SION By Printed Title Les S. Olds Executive Director Draft Theater Equipment JR Clancy (Mercantile) January 2010 Amount to be paid by Village Financial $ 13,956.69 February 2010 Amount to be paid by Village Financial $ 11,219.41 March 2010 Amount to be paid by Village Finanacial $ 2,875,751.98 APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER - ADVISER EDITION AIA DOCUMENT G702lCMa (Instructions on reverse side) 55 PAGE ONE OF PAGES TO OWNE c�r►rnel VQ`D CG ROJECT: Zip` vie Ci vi c vax/ aLrm l fAC- Ca v rule/ , -TO 4112032 FROM CONTRACTOR: J• R C L /}(' l �Lktn v- �t',',{Q fed. SA. Y0.c e , -lTi 3 AV12 SvJ aV M2t 1-1.600 2- (�,, ,� �,I (� . �. t VIA CONSTRUCTION MANAGEI (Q1 S" sr 1 CONTRACT FOR:p e 1A kfc 1 rii1 p miry -AY1-c (C� tli2CHiTECT APPLICATION NO.: 1 PERIOD TO: �31 (3 PROJECT NOS.: 24.45 CONTRACT DATE: 2112' Distribution to: 0 OWNER ❑ CONSTRUCTION MANAGER ❑ ARCHITECT ❑ CONTRACTOR CONTRACTOR'S APPLICATION FOR PAYMENT Application is made for payment, as shown below, in connection with the Contract. Continuation Sheet, AlA Document G703, is attached. ,1 1. ORIGINAL CONTRACT SUM $ -1195)V3\ / �1 2. Net Change By Change Orders $ ?25 11.10.(X0 3. CONTRACT SUM TO DATE (Line I ± 2) $ go olio 00 4. TOTAL COMPLETED & STORED TO DATE 8 I Oq2, 1 . t o0 (Column G on G702) 5. . ) AGE: a. a. �% of Completed Work olumns D + E on G703) b. % of Stored Material (Column F on G703) Total Rctainage (Line 5a + 5b or Total in Column 1 of G703) 3-ici so? no $ 0.00 6. TOTAL EARNED LESS RETAINAGE (Line 4 Tess Line 5 Total) 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT (Line 6 from prior Certificate) S $ 3243 202 00 s Z, 8. CURRENT PAYMENT DUE t )63.02- s 2_1(r-1571511B 9. BALANCE TO FINISH, INCLUDING RETAINAOF „. �' ! 40 (Line 3 less Line 6) S '1j i I '-t CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS Total changes approved in previous months by Owner OLD t / )C-1ilir,aa (] QQ Total approved this Month tn TOTALS c2i (52.5 -.-1(.0n 66) NET CHANGES by Change Order Zj -1 (Q('}CC) The undersigned Contractor certifies that to the best of the Contpictor s,krtoygicdge, infor- mation and belief the Work covered by this Application for Payment•i)as been i-ornplcfted in accordance with the Contract Documents, that all amounts itakt: ?befn P3id•by the Contractor for Work for which previous Certificates for Payrnestttvere IsSlled`Ln*i pa;i- ments received from the Owner, and that current payment shgwit heriintis tioR' duff. CONTRACT i'.I.i2 •C(aAC-ti. -(, By: State of: IQECJ C ount y--o : O Qd 0- Subscribed an sworn to before me this 3 ! St Notary Public: My Commission expires: ay ;fL`'t4Q MICHAEL JAY PARKIN �o�y Public; State cif New.Yorlt qualified inprionriaga County ltd otPA98o7278 r'Fxplits May.31:'20 JD x0)0 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 $ 2t$7St T5t (Attach explanation if amount certified differs from the amount applied for Initial all figures on this Application and on t g ntinuation Sheet that changed to conform to the antount certified.) C • STRU N l ,i AGE BysW .: I iii ARCH!' "or By: .. Date: 19 jt Date- t la (OS S® This Certi'catc is not negotiable. The AMOUNT CERTIFIED is payable only to the Con- tractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT 6702/CMa • APPLICATION AND CERTIFICATE FOR PAYMENT • CONSTRUCTION MANAGER-ADVISER EDITION 1992 EDITION • AIA° • ©1992 • THE AMERICAN INSTITUTE OF ARCHITECTS. 1735 NEW YORK AVENUE. N.W., WASHINGTON. D.C. 2000&5292 • WARNING: Unlicensed photocopying violates US. copylfght laws and wa1 subject the violator to legal prosecution. G702/CMa-1992 raltnnw• v .. chnnIrl ..ca an nrInInal AIA AAr..man! which hoc *Ala ra.rfInn nrinfael In rorl An minimal acw.rac that rhannac wilt am* ha nhc.v.rarl ac may nrr_.n whop enr:.fmantc .ry ranmAn.r:aA. CONTINUATION PAGE Page 2 of 4 PROJECT: 2695 Carmel PAC Payment Application containing Contractors signature is attached. APPLICATION #: DATE OF APPLICATION: PERIOD THRU: PROJECT #s: 11 03/15/2010 03/31/2010 2695 A B C D E F G H I ITEM # WORK DESCRIPTION SCHEDULED AMOUNT COMPLETED WORK STORED MATERIALS (NOT IN D OR E) TOTAL COMPLETED AND STORED (D + E + F) % COMP. (G / C) BALANCE TO COMPLETION (C -G) RETAINAGE (If Variable) AMOUNT PREVIOUS PERIODS AMOUNT THIS PERIOD 1 Bond $47,266.00 $47,266.00 $0.00 $0.00 $47,266.00 100% $0.00 2 Engineering /Project $415,534.00 $207,767.00 $20,776.70 $0.00 $228,543.70 55% $186,990.30 Management/Mobilization 3 Master Control System $238,100.00 $0.00 $202,385.00 $0.00 $202,385.00 85% $35,715.00 4 Control System Electrical Work . $33,750.00 $3,375.00 $3,375.00 $0.00 $6,750.00 20% $27,000.00 5 Control System Turn on and $68,900.00 $0.00 $0.00 $0.00 $0.00 0% $68,900.00 Testing 6 CYC, FOH, Lighting Truss $1,356,800.00 $0.00 $678,400.00 $0.00 $678,400.00 50% $678,400.00 Motorized Rigging 7 CYC, FOH, Lighting Truss $514,200.00 $0.00 $92,556.00 $0.00 $92,556.00 18% $421,644.00 Motorized Rigging Installation 8 Canopy Rigging and Cable Reels $1,301,000.00 $0.00 $1,040,800.00 $0.00 $1,040,800.00 80% $260,200.00 9 Canopy Rigging and Reel $348,800.00 $0.00 $62,784.00 $0.00 $62,784.00 18% $286,016.00 Installation 10 Loudspeaker Motorized Rigging $316,200.00 $0.00 $316,200.00 $0.00 $316,200.00 100% $0.00 11 Loudspeaker Rigging Installation $55,800.00 $0.00 $10,044.00 $0.00 $10,044.00 18% $45,756.00 12 Variable Acoustic Curtains $118,000.00 $0.00 $0.00 $0.00 $0.00 0% $118,000.00 13 Curtain Installation $17,700.00 $0.00 $0.00 $0.00 $0.00 0% $17,700.00 14 Variable Acoustic Tracks /Blocking $426,000.00 $383,400.00 $42,600.00 $0.00 $426,000.00 100% $0.00 & Actuators 15 Track & Actuator Installation $131,745.00 $98,808.75 $19,761.75 $0.00 $118,570.50 90% $13,174.50 16 Extension Lift & Railings $607,521.00 $0.00 $546,768.90 $0.00 $546,768.90 90% $60,752.10 SUB - TOTALS $5,997,316.00 $740,616.75 $3,036,451.35 $0.00 $3,777,068.10 63% $2,220,247.90 CONTINUATION PAGE Quantum Software Solutions, Inc. Document CONTINUATION PAGE Page 3 of 4 PROJECT: 2695 Carmel PAC Payment Application containing Contractor's signature is attached. APPLICATION #: DATE OF APPLICATION: PERIOD THRU: PROJECT #s: 11 03/15/2010 03/31/2010 2695 A B C D E F G H I ITEM # WORK DESCRIPTION SCHEDULED AMOUNT COMPLETED WORK STORED MATERIALS (NOT IN D OR E) TOTAL COMPLETED AND STORED (D + E + F) % COMP. (G / C) BALANCE TO COMPLETION (C -G) RETAINAGE (If Variable) AMOUNT PREVIOUS PERIODS AMOUNT THIS PERIOD 17 Lift Installation $90,000.00 $0.00 $72,000.00 $0.00 $72,000.00 80% $18,000.00 18 Extension Lift Wagons $111,300.00 $0.00 $0.00 $0.00 $0.00 0% $111,300.00 19 Extension Lift Wagon Installation $18,000.00 $0.00 $0.00 $0.00 $0.00 0% $18,000.00 20 House Mix Lift & Railings $248,000.00 $0.00 $0.00 $0.00 $0.00 0% $248,000.00 21 House Mix Lift Installation $60,000.00 $0.00 $0.00 $0.00 $0.00 0% $60,000.00 22 House Mix Lift Wagons $70,000.00 $0.00 $0.00 $0.00 $0.00 0% $70,000.00 23 House Mix Lift Wagon Installation $16,000.00 $0.00 $0.00 $0.00 $0.00 0% $16,000.00 24 Loudspeaker Wagon $35,384.00 $0.00 $0.00 $0.00 $0.00 0% $35,384.00 25 Loudspearker Wagon Installation $7,000.00 $0.00 $0.00 $0.00 $0.00 0% $7,000.00 26 Demountable Risers $45,000.00 $0.00 $0.00 $0.00 $0.00 0% $45,000.00 27 Demountable Riser Installation $4,800.00 $0.00 $0.00 $0.00 $0.00 0% $4,800.00 28 Chorus Wagons $189,000.00 $0.00 $0.00 $0.00 $0.00 0% $189,000.00 29 Package 5170 Allowance $200,000.00 $150,609.50 $42,680.00 $0.00 $193,289.50 97% $6,710.50 30 Package 5180 Allowance $200,000.00 $150,000.00 $0.00 $0.00 $150,000.00 75% $50,000.00 31 Package 5190 Allowance $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100% $0.00 32 CAD As- Builts 5170 & 5180 Allowance $20,000.00 $10,000.00 $0.00 $0.00 $10,000.00 50% $10,000.00 SUB - TOTALS $7,316,800.00 $1,056,226.25 $3,151,131.35 $0.00 $4,207,357.60 58% $3,109,442.40 CONTINUATION PAGE Quantum Software Solutions, Inc. Document CONTINUATION PAGE Page 4 of 4 PROJECT: 2695 Carmel PAC Payment Application containing Contractor's signature is attached. APPLICATION #: DATE OF APPLICATION: PERIOD THRU: PROJECT #s: 11 03/15/2010 03/31/2010 2695 A B C D E F G H I ITEM # WORK DESCRIPTION SCHEDULED AMOUNT COMPLETED WORK STORED MATERIALS (NOT IN D OR E) TOTAL COMPLETED AND STORED (D + E + F) % COMP. (G / C) BALANCE TO COMPLETION (C -G) RETAINAGE (If Variable) AMOUNT PREVIOUS PERIODS AMOUNT THIS PERIOD 33 CAD As- Builts 5190 Allowance $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100% $0.00 34 Orchestra Risers $194,000.00 $0.00 $0.00 $0.00 $0.00 0% $194,000.00 35 37 C/O #1 Orchestra riser /slack line deletions, chairwagon - bronze, C/O #2 Allowance Reductions ($203,040.00) ($322,720.00) $0.00 ($320,000.00) $0.00 $0.00 $0.00 $0.00 $0.00 ($320,000.00) 0% 99% ($203,040.00) ($2,720.00) 38 C/O #3 Work Directive $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTALS $6,990,040.00 $741,226.25 $3,151,131.35 $0.00 $3,892,357.60 56% $3,097,682.40 CONTINUATION PAGE Quantum Software Solutions, Inc. Document UNCONDITIONAL WAIVER AND RELEASE UPON PROGRESS PAYMENT The undersigned has been paid and has received a progress payment in the sum of $ . Lc) .5 : for labor, services, equipment, or material furnished to (e tie (Your Customer) on the 'ob of (1 Y V\ei . wilt ,A A ! 1 (rYi r (Owner) located arri Sys/ 09)2-- (Job Description) and does hereby release any mechanic's lien, stop notice, or bond right that the undersigned has on the above referenced job to the following extent. This release coves _a pro,9re payment for labor, services, equipment, or materials furnished to L7-11/1 Q,l_ "efrD11.1 (Your Customer) through 12t3 t [ oci , (Date) only and does not cover any retentions retained before or after the release date; extras furnished before the release date for which payment has not been received; extras or items furnished after the release date. Rights based upon work performed or items furnished under a written change order which has been fully executed by the parties prior to the release date are covered by this release unless specifically reserved by the claimant in this release. This release of any mechanic's lien, stop notice, or bond right shall not otherwise affect the contract rights, including rights between parties to the contract based upon a rescission, abandonment, or breach of the contract, or the right of the undersigned to recover compensation for furnished labor, services, equipment, or material covered by this release if that furnished labor, services, equipment, or material was not compensated by the progress payment. Dated: i n 110 J.v. Ctounct i c. COMPANY NAME (Print Name and Title) U.S. Department of Labor Employment Standards Administration Wago and Hour Division PAYROLL (For Contractor`s Optional Use; Sea Instructions, Form WH -347 Inst.) Persons are not required to respond to the collection of Information unless It displays a currently valid OMB control number. NAME OF CONTRACTOR o OA SUBCONTRACTOR N eneral Steel Fabricatin. Co Inc ADDREFIS 5230 East 26 Street Ind•Is IN 46218 •Me 0.121, -0140 re PAYROLL NO. 1 OR WEEK ENOING 03/03/10 PRwEDTA"DwcAlCarmel Arts Performing Ctr PROJECT OR CONTRACT NO. (1) NAME AoDRE83, AND SOCIAL NUMBER (2) R • (3) CL4SQIFICAT)ON (4) DAY AND DATE (5) HOURS (0) OF PAY (7) GROSB EARNED DEDUCTIONS (9) NET WAGES FOR WEEK II 626 F MI M © 26 2 28 1 2 3 FICA WiTH- HOLDING State Local Union DEDUCTIONS HOURS WORKED EACH DAY Knott, David xxx -xx -4987 Ironworker Journeyman o 419.20 ,048.01 80.18 44.03 35.63 17.29 31.44 839.43 a ■ g 8 16 26 20 Schaub, Stephen xxx -xx -3935 Ironworker Journeyman 0 '• 419.20 1048.00 80.18 86.14 35.63 10.48 31.44 243.87 804,13 a 8 8 16 26.20 0 .. a • / 0 a r 0 e r o a 1 1 O y • _ s r o ' a r We estimate that it will take an average of 56 minutes to complete this collection o information, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. If you have any oommento regarding these estimates or any other aspect of this collection of Information, Including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, ESA, U. S. Department of Labor, Room S3502, 200 Constitution Avenue, N. W., Washington, b. C. 20210. F0RU W H.347, Rvvlood Nov. 1096 • FORMERLY 60L 154 • PURCHASE MO FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS Dat8March 11, 2010 Elaine A. Lee Sec/Treasurer (Name or signatory Forty} (TiU6} do hereby state: (1) That I pay or supervise the payment of the persons employed by General Steel Fabricating Co Inc (Contractor or Subcontractor) Carmel Arts Center ; that during the payroll period commencing on the (Building or wort) 25th day of February,2010 , and ending the 3rd day of March , 2010 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or Indirectly to or on behalf of said General Steel Fabricating Co Inc on the (Contractor or Subcontractor) from the full weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations, Port 3 (29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 83 Start. 108, 72 Stat. 987; 78 Stat. 357; 40 U.S.C. 278c), and described below: (2) That any payrolls othenMse under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained In any wage determination Incorporated Into the contract; that the classifications set forth therein for each laborer or mechanlo conform with the work ho performed. (3) That any apprentices employed In the above period are duly registered In a bona fide apprenticeshlp program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, of If no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed In the contract have been or wilt be made to appropriate programs for the benefit of such employees, except as noted In Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH — Each laborer or mechanic fisted In the above referenced payroll has been paid, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, except as noted In Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE Elaine A. Lee, Sec/Treasurer sraruruae G�C THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 10D1 OF TITLE 18 AND BECTON 231 OF TITLE 31 OFTHE UNITED STATES CODE ' U.S. Q.P.0.:1947 919.001 U.S. Department of Labor Employment Standards Administration Wage and Hour Division PAYROLL (For Contractor's Optional Use; See Instructions, Form WH -347 Inst.) Parsons are not required to respond to the collection of information unless 11 displays a currently valid OMB control number. • NAME OF CONTRACTOR Q ORSUECONTRACTOR If eneral Steel Fabricating Co Inc ADDRESS 5230 East 26 h Street Ind.ls IN 46218 °MBNo.''o1invo4 PA ROLL NO, 2 aRWEEKENDING 03/10/10 PRO LO JECTANOCATCNarmel Arts Performing Ctr PROJECT OR CONTRACT NO. (1) NAME. ADDRESS. AND SOCIAL SECURITY NUMBER OF EMPLOYEE (2) 2 g (3) WORK CLASSIFICATION (4) DAY AND OVATE (5) TOTAL HOURS (0) RATE OF PAY (7) GROSS AMOUNT EARNED Pi DEDUCTIONS (31 NET WAGES PAID FOR WEEK T F S S M T W FICA WnHi. HOLDING TAX State Local Union Support 18.86 TOTAL DEDUCTIONS 4 g 4 5 5 6 7 8 9 10 10 g HOURS WORKED EACH DAY 48.11 44.32 21.38 6.29 138.96 489.84 Brandenburg, David xxx -xx -9521 Ironworker Journeyman o 628.80 e 8 8 ' 8 24 26.20 628.80 Cole, Eugene xxx-xx-6144 Ironworker Journe an ° 461.12 117.94172.25 52.42 25.44 46.26 414.31 1,127.56 a 8 8 16 28.87 1.541.87 Lucas, Jason xxx -xx -6753 Ironworker Apprentice ° 188.64 14.43 .00 6.41 4.28 5.66 145.00 175.78 12.86 e 8 8 3.58 188.64 Knott, David xxx -xx -4987 Ironworker Journeyman o 835.78 89.83 62.99 39.93 19.38 35.23 247.36 927.05 s 5 8 8 8 29 !28.82 174.41 Schaub, Stephen xxx -xx -3935 Ironworker Journe an 0 528.80 80.17 86.14 35.63 10.48 31.44 243.86 804.14 8 8 8 24 ,26.20 .048.00 Zeller, Andrew xxx-xx-2024 Ironworker Journeyman ° 144.10 91.49 155.38 40.67 11.96 35.88 335.38 860.65 8 5 5 :28.82 1 .196.0 0 r s f 0 _ 0 _ _, , We estimate that it will take an average of 56 minutes to complete this collection of Informs Ion, including time for revleWing Instructions searching existing data sources, gathering and maintaining the data needed,'and completing and reviewing the collection of information. It you have any comments regarding these estimates or any other aspect of this collection of Information, Including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, ESA, U, S. Department of Labor, Room S3502, 200 Constitution Avenue, N, W., Washington, D. C. 20210. ror0.1 WN317, Rovwd Nw. 1008 • FORMERLY Solt 4 - PURCHASE THIS FORM DIRECTLY FROM THE SUPT, OF DOCUMENTS ;0March 11, 2010 Elaine A. Lee (Name of Signatory Party) Sec/Treasurer (ntlo) hereby state: (1) That I pay or supervise the payment of the persons employed by General Steel Fabricating Co Inc on the (Contractor or Subcontractor) Carmel Arts Center ; that during the payroll period commencing on the (Building Of Worlt) 4th day of March ,2010 , and ending the 10th day of March 2010 persons employed on said project have been paid the full weekly wages earned, that no rebates have an or will be made either directly or Indirectly to or on behalf of said General Steel Fabricating Co Inc )rom the full (Contractor or Subcontractor) ekiy wages earned by any person and that no deductions have been made either directly or Indirectly m the tuft wages earned by any person, other than permissible deductions as defined In Regulations, Part 29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat, 948, Start. 108, 72 Stat, 987; 76 Stat, 357; 40 U.S.C. 276c), and described below (2) That any payrolls otherwlso under this contract required to be submitted for the above period are rrect and complete; that the wage rates for laborers or mechanics contained therein are not less than the pllcable wage rates contained in any wage determination incorporated Into the contract; that the ;sslflcations set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed In the above period are duly registered In a bona fide prenticeshlp program registered with a State apprenticeship agency recognized by the Bureau of prenticeship and Training, United States Department of Labor, of if no such recognized agency exists In a Ito, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS X — in addition to the basso hourly wage rates paid to each laborer or mechanic fisted in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employees, except as noted In Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH - Each laborer or mechanic listed In the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, except as noted in Section 4(o) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATiON REMARitS: NAME AND TITLE Elaine A. Lee, Sec/Treasurer St4NATURE (-.t.e-7:--4---- /).---- THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 10 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. • u n n n (. ,, n G, [, O M A I Payroll #3 Date : 03/17/2010 GENERAL STEEL ERECTORS, INC. Page : 9 Time: 12:07:41PM 5230 E. 26TH STREET INDIANAPOLIS IN 46218 - CERTIFIED PAYROLL REGISTER For the pay period ending 03/17/2010 Job : 7569 CARMEL REG PERF ARTS CTR - EREC JOB EARN TOT EARN TAX EARN EMPLOYEE MINORITY _ HOURS WORKED EACH DAY THIS PAY PERIOD - • - - - -- DEDUCT SOC SEC NUM 3/11 3112 3/13 3/14 3/15 3116 3/17 PAY BFT THIS JOB UNION/WCOMP TAXES NET SKILL LEV SEX TYP Thu Fri Sat Sun Mon Tue Wed TOTAL RATE RATE ADJUSTMENTS BRANDEN D M None Male 5 40.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 26.200 DED 31.44 FIT 107.20 1,048.00 IRONWORKER BFT 764,85 SSMD 80.16 1,048.00 XXX-XX-9521 Journeyman BFTNET 0.00 State 35.63 1,048.00 Local 10.48 264.91 Other 0.00 783.09 KNOTTDAVID None Male S 40.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 28.820 DED 34.58 FIT 59.75 1,152.80 XXX-XX-4987 IRONWORKER BFT 770.73 SSMD 88.19 1,152.80 Journeyman BFTNET 0.00 State 39.20 1,152.80 Local 19.02 240.74 Other 0.00 912.06 LUCAS J A None Male S 40.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 23.580 DED 173.30 FIT 109,72 943.20 XXX-XX-6753 IRONWORKER BFT 758.96 SSMD 72.15 943.20 Apprentice BFTNET 0.00 State 32.07 943.20 Local P1.41 408.65 Other 0.00 534.55 SCHAUB SJ None Male S 40.00 0.00 0.00 0.00 0.00 0.00 0.00 40.00 26.200 DED 31.44 FIT 86.14 1,048.00 XXX -XX -3935 IRONWORKER BFT 764.65 SSMD 80.16 1,048.00 Journeyman BFTNET 0.00 State 35.63 1,048.00 Local 10.48 243.85 Other 0.00 804.15 PYCei tRci rot DateMarch 18, 2010 1, Elaine A. Lee (Nome of Signatory Party) do hereby state: Sec/Treasurer (nlle) (1) That I pay or supervise the payment of the persons employed by General Steel Fabricating Co Inc (Contractor or Subcontractor) Carmel Arts Center ; that during the payroll period commencing on the (Building or Work) 11th day of March ,2010 and ending the 17th day of March , 2010 all persons employed on said project have been pald the full weekly wages earned, that no rebates have been or Will be made either directly or indirectly to or on behalf of said General Steel Fabricating Co Inc on the (Contractor or Subcontractor) byre the full weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as dented In Regulations, Part 3 (29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948, 63 Start. 108, 72 Stat. 967; 76 Stat. 357; 40 U.S.C. 276c), and described below: - (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete; that the wage rates for laborers or mechanics contained therein are not (ass than the applicable wage rates contained In any wage determination Incorporated Into the contract; that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered In a bona Ode apprenticeship program reglstered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training, United States Department of Labor, of If no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training, United States Department of Labor. (4) That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS — in addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as Ilsted In the contract have been or will be made to appropriate programs tor the benefit of such employees, except as noted In Section 4(c) below. (h) WHERE FRINGE BENEFITS ARE PAID IN CASH ❑ — Each laborer or mechanic listed In the above referenced payroll has been pald, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract, except as noted In Section 4(c) below. (c) EXCEPTIONS EXCEPTION (CRAFT) EXPLANATION REMARKS: NAME AND TITLE Elaine A. Lee, Sec/Treasurer SIGNATURE _ `7 THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1091 OF TITLE 18 AND SECT10N 231 OF TITLE 31 OF THE UNITED STATES CODE. ..i0 noel•tnc, 410 RR1