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HomeMy WebLinkAboutGibraltar, LaFever Electric, Meyer Najem - $205,824.50 +1 ' 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 Amphitheater Equipment and Improvements installment purchase contract Invoice 02-11-750-02(Meyer Najem) April 2011 $ 17,915.38 Application 2(LaFever) April 2011 $ 13,249.12 Application 1 (Gibraltar) April 2011 $174,660.00 Total Authorized Disbursement $205,824.50 All terms used in these Disbursement Instructions without definition shall have the meanings ascribed thereto in that certain Loan Agreement (Equipment and Improvements), dated July 22, 2010, by and between Regions Bank and Carmel Theater Development Company, LLC. Dated: 6//7/ CITY OF CARMEL REDEVELOPMENT CO SION 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 Amphitheater (Meyer Najem) March 2011 (invoice 02-11-750-01) Paid by the Carmel Theater Development Company $ 2,861.32 April 2011 (invoice 02-11-750-02) Amount to be paid by the Carmel Theater Development Company $ 17,915.38 • 13099 Parkside Drive Fishers, IN 46038 P 317-577-0007 oAtd317-577-0286(fax) CONSTRUCTION. April 25,2011 CSO Invoice#: 02-11-750-02 8831 Keystone Crossing Terms: Net 30 Days Indianapolis, IN 46240 Attn: Brandon Bogan Project: Carmel Amphitheater For Period Ending: 4/25/11 Schedule of Value' Prior Billings I Current Billing I Cumulative Total I. Staffing $ 13,165.00 $ 2,108.40 $ 7,516.02 $ 9,624.42 II. General Conditions $ - III. Construction Manager Fee $ 13,165.00 $ 752.92 $ 10,399.36 $ 11,152.28 $ 20,776.70 $ 26,330.00 TOTAL AMOUNT DUE $ 17,915.38 Tim Russell,President If you have any questions,please reference the invoice number. Draft Amphitheater (LaFever Electric) March 2011 (application 1) Paid by the Carmel Theater Development Company $ 11,655.00 April 2011 (application 2) Amount to be paid by the Carmel Theater Development Company $ 13,249.12 4AIA Document G702/CMaTM — 1992 RECEIVED • Application and Certificate for Payment Construction Manager-Adviser Edith A' 5 2011 TO OWNER: PROJECT: 7B-2 Amphitheater APPLI L�'Q TauunO� Distribution to: Carmel Theatre Dev. Commission 3rd Avenue Southwest MEYER NAJ 30 West Main Street, Suite 220 Carmel, Indiana PERIOD TO 4/22/2011 OWNER ❑ Carmel, Indiana 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: 3/7/2011 ARCHITECT ❑ LaFever Electric, Inc. Meyer Najem Construction, LLC PROJECT 1777 131 N. Rangeline Road / CONTRACTOR ❑ Carmel, Indiana 46032 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CSO Architects, Inc. ❑ 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 Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 41,500.00 payment shown herein is now due. 2.Net change by Change Orders $ 0.00 CONTRACT( f aFeyer Ele ic, Inc 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 41,500.00 By: (/�Cd" 4 Date: 4/22/2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 27,671.25 State of: Indiana \q yri'5"'A':'�atever,Vice-President 5.RETAINAGE: County of: Hamilton °°,x\�° .... �� 'f%, a. 10 %of Completed Work Subscri a swo• to bef /0 2,097.38 4n , r' (Column D+Eon G703) $ me this day of\. " 1, \ Colleen S. Marvel b. 10 %of Stored Material 669.75 Notary Public: y *A� .Lt�s .1.-: (Column F on G703) $ My Commission ire . 2 767.13 Total Retamage(Lines 5a+5b or Total in Column I of G703). $ ' CERTIFICATE FOR PAYMENT .: 24 904.12 In accordance with the Contract ll'ticcu .paw pti on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ ' this application,the Construction Ma'f ru'stndiWkintect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) 11,655.00 knowledge,information and belief the Work has progressed as indicated;the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR.PAYMENT $ accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 1 8.CURRENT PAYMENT DUE $ 13,249.12 AMOUNT CERTIFIED $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount applied. Initial al figures on this Application and on •� ontinuation Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 16,595.88 CONSTRUCT!,■ trl By _■—_' _ Date: I CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: Total changes a roved in previous months by Owner $ - $ - f g PP P Y BY: �� Date: s e 1 Total approved this Month $ - $ - .�/ This Certifica-� s not ��'a.,,'. The A! SUNT CERTIFIED is payable on to ie Contractor TOTALS $ - $ - named here Issuan -, pay !=-n . eptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ - the Own- r Con tor un .rr this tract. 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. fin+\IIV 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 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. �y'-'�� 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.Contractorsihave 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 notapermit 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 0703 that have been changed to conform to thelamounf 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. t 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 pjojects 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. '�� r `y E.Making Payment • -M g 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 afffdress of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa;' " � AIA Document G702/CMaT"'-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNIr4G: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. JOB NAME 7B-2 Amphitheater APPLICATION DATE 4/22/2011 PAGE NUMBER 1 APPLICATION NUMBER 2 PERIOD TO 4/22/2011 A B C D ' E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G+C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 1 Conduit M 2,500.00 875.00 1,575.00 50.00 2,500.00 100 - 250.00 - - L 4,500.00 1,575.00 2,835.00 4,410.00 98 90.00 441.00 2 Wire M 4,525.00 - 3,167.50 1,357.50 4,525.00 100 - 452.50 - - L 2,200.00 - 1,540.00 1,540.00 70 660.00 154.00 3 Switchgear M 5,000.00 - 250.00 4,750.00 5,000.00 100 - 500.00 - - L 2,525.00 - 126.25 126.25 5 2,398.75 12.63 4 Light Fixtures M 3,600.00 - 3,060.00 540.00 3,600.00 100 - 360.00 - - L 1,200.00 - 1,020.00 1,020.00 85 180.00 102.00 5 Excavating 1,000.00 600.00 400.00 1,000.00 100 - 100.00 6 Core Drilling and Weatherproofing 2,200.00 2,200.00 - 2,200.00 100 - 220.00 7 Allowance 10,000.00 - - - 10,000.00 - 8 Payment and Performance Bond 750.00 750.00 - 750.00 100 - 75.00 9 Submittals 500.00 300.00 200.00 500.00 100 - 50.00 10 Mobilization 500.00 500.00 - 500.00 100 - 50.00 11 Closeout 500.00 - - - 500.00 - - - L - - - - - - - - M - - - - - - - - - L - - - - - - w - - M - - - - - - - - - L - - - - - - - - M - - - - - - - - - L - - - - - - - - M - - - - - - - - - L - - - - - - I41,500.00 6,800.00 14,173.75 6,697.50 27,671.25 13,828.75 2,767.13 WAIVER OP LIEN TO DATE Std Of Indiana )ss County of Hamilton Pile 41: • TO WHOM Tin MAY COiVCERNi WHEREAS the undersigned has hem employed by_ LaFever Electric,Inc. Reg dQwea,Cy.nicfpd9alhrCnear to lltrttlsit Electrical Work fir the premises described ss 7B-2 Amphitheater acmes sow.r:re se oeo*a. af which_ Carmel Theatre Development Commission i9ttmodroe Thirtee'rrfhltsand Two Hundred Forty-nine Dollar and Twelve Cents THE undersigned,for and in consideration of (S 13,249A2 )Dogs,and other good and valuable consideration,the receipt whereof is bin shy acknowledged,defer)hereby waive and Meme any and all lien or claim or right of Ban under the Stets of the Sate wherein the land it kc,reladag to I Aeehaahf c's Hens,on the above described promises and httprovements thereon,and on the Mania or other considerations due or to become doe Rom the owner,on wool art of labor or genus,material,fatness or appatahw hcretofbee f'rnfsbed to this data by the undersigned for the above&earibcd preasfcea. g ' 22nd` dayee April .20 11 Chris A. LaFever,Vice-President am NOTE:All waives mast be for the fall amount paid.If waiver is for a earperaNan,corporate name should be geed,corporate seal affheed and dde o(cfflaer elgterg waiver should be set form;if welter is for a partnership,the partnership mime should be used,partner should iign and designate biUCI f ae paritQ. t 'ONTIiACTOR'8 AFFIDAVIT Stacie of Indiana )SS County of Hamilton TO WHOM IT MAY CONCERN: 7}t1r cactfcrsIgnc.being duly sworn,deposes end says that he is Vice-President of LaFever Electric,Inc. who is rho eardraetor for the metrical Work work on the banding located at 3rrdd AAvenue Southwest, Carmel Indiana 46017 �_ owned by armel eatre eve o s menu ommission That flu toted amours of the contrast Including cats is S 41,5 00.00 on Thiel ha has caaalved payment of S 11.,655.00 prior to this paytnetit.Tlmt all walvas are t<ue,correct and genuine and delivr rod unconditionally and that Mae Is no claim either legal or equitable to datbnt the validity of said waivers.That the following aro the maces dell parties who have furnished material or labor,or bath,Sr said work and all palsies having contrasts or forbeensreaa ibr specific portions of said work or for material entering Into the carat ruction thereof and die amount due or to became due to and that the items mentioned included all labor and material to said work ace to lane end ens: µ rnc e mg Inc. -TSI I)89I-1202 k Excavation 1,000199 _ _ 11 I t tr I1I Tt3TAL LA".ill D*IAT Rent.TO Ct -PT€ I.OQOAO 611 dim NMI= 11�1I Ttet theta am nro other contras=for said wort outstanding,end at them is nothing duo or to became due to any pent t m — tabor or odder work o any kind done or to be done upon or in ooanacdpn with said work other than above staled. signed this 22nd day of _ April ,2o 11 kN' I'0 .1g4. LaFever, Vice-President 22nd e April �p2O 11 Suhsaibcd seed sworn to bcRH+e me this sty of p ' 1$1 CD18 OdfOlnool = lleelI S. t Draft Amphitheater (Gibraltar) April 2011 (application 1) Amount to be paid by the Carmel Theater Development Company $ 174,660.00 1AIA Document G702/CMaTM - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition . TO OWNER: PROJECT: APPLICATION NO: Distribution to: Carmel Redevelopment Commission Parcel7-B,Center for the Performing Arts#26238 1 30 West Main Street,Suite 220 PERIOD TO: 4/30/11 OWNER ❑ • Carmel,IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ Gibraltar Construction Corp 4/13/10 2932 N.Webster Ave. PROJECT NOS: / / CONTRACTOR ❑ Indianapolis, IN 46219 VIA ARCHITECT: FIELD ❑ CONTRACT FOR: CSO Architects,Inc. ❑ Amphitheater Package CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certi ■ 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 As lineation for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amo is have been paid by the Contractor for Work for which previous Certificates for Payment ■re is ed and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 221,800.00 1 r payment shown herein is no due. 2.Net change by Change Orders $ 0.00 CONTRACTOR:Gibraltar,vr 0 ns uction Corp 3.CONTRACT SUM TO DATE(Line 1 ±:2) $ 221,800.00 By: / Date: i i/ 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 185,750.00 State of j1y)/,, e �� � t 5.RETAINAGE: County of: j''4 1/1 ' ^ v F 4, BRIAN R. MCBRIDE a. %of Completed Work Subscribed and sw.j to b fore ^ Rees. of Hancock County (Column D+Eon G703) $ 11,090.00 me this �4ay o I b. %of Stored Material Notar Publ. " My Comm. Ex o. 11-29-2017 (Column F on G703) $ My Commission expires: /j�_2.1 i7 7 D I PN Commss on # 611862 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ CERTIFICATE FOR PAYMENT 174,660.00 In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE .$ 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 $ 0.00 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. /�� 8.CURRENT PAYMENT DUE $ 174,660.00 AMOUNT CERTIFIED $ 171;, 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from the amount,applied. Initial all figures on this Application and on the Continuation.Sheet that are changed to conform with the amount certified.) (Line 3 less Line 6) $ 47,140.00 CONSTRUCTION M ra By: — •.. Date: V2-/ s_ CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITECT: =• Archite = _ ' Total changes approved in previous months by Owner $ $ By / Date: 2 1 I Total approved this Month $ $ This Certificate is •t negoti �. he AM11....:".1'. �CERTIFI is payable only to the ntractor TOTALS $ $ named herein. I lance, '9- e;i and accepta-' e of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or contract nder 1 is Contrac 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 Ale 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. kll 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. IlffAIA 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 theioriginal 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 erid 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 ortiginal 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 s(<iould 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 t • The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager gd+Architect on Alk.Docurnent G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name lgtikiddress of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. a AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARPING: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. T.o report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. CONTINUATION SHEET Page 2 of 2 APPLICATION AND CERTIFICATE FOR PAYMENT, containing Contractor's signed Certification, is APPLICATION NO. : 1 attached. In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where APPLICATION DATE: 4/30/2011 variable retainage for line items may apply. PERIOD TO: 4/30/2011 ARCHITECT'S PROJECT NO. : A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL ITEM FROM PREVIOUS PRESENTLY COMPLETED AND % BALANCE TO RETAINAGE NO. DESCRIPTION OF WORK SCHEDULED VALUE APPLICATION THIS PERIOD STORED(NOT IN STORED TO DATE (G/C) FINISH (IF VARIABLE (D+E) D OR E) (D+E+F) (C-G) RATE) 1 Allowance $10,000.00 $0.00 0% 10,000.00 2 General Conditions $17,000.00 $12,500.00 $12,500.00 74% 4,500.00 3 Bond $3,500.00 $3,500.00 $3,500.00 100% - 4 Excavation $24,000.00 $24,000.00 $24,000.00 100% - 5 Backfill/Underdrains $10,900.00 $9,500.00 $9,500.00 87% 1,400.00 6 Sump Pit $14,300.00 $7,800.00 $4,500.00 $12,300.00 86% 2,000.00 7 Concrete Foundations $11,900.00 $11,900.00 $11,900.00 100% - 8 Concrete Ramps/Steps $8,400.00 $5,000.00 $5,000.00 60% 3,400.00 9 Block&Brick $81,000.00 $81,000.00 $81,000.00 100% - 11,090.00 10 Limestone $23,000.00 $500.00 $18,500.00 $19,000.00 83% 4,000.00 11 Steel Railings $7,750.00 $750.00 $750.00 10% 7,000.00 12 URNS $5,800.00 $5,400.00 $5,400.00 93% 400.00 13 Irrigation $1,800.00 $900.00 $900.00 50% 900.00 14 Sod $1,700.00 $0.00 0% 1,700.00 15 Joint Sealants $750.00 $0.00 0% 750.00 $221,800.00 $0.00 $157,350.00 $28,400.00 $185,750.00 84% $36,050.00 $11,090.00 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 7B, Center for Performing Arts, Amphitheater Package and owned by Carmel Theatre Development Corporation, 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 Seventy Four Thousand Six Hundred Sixty and No/100 Dollars ($174,660.00) ❑ 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 ( ) El receipt of which is hereby acknowledged; or El 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 th Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereo account of LABOR or material or both,furnished by the undersigned thereto, subject to limitations of condition .;;expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work ,,}erf.s rmed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Gibraltar Construction Corp By I, Title President / 7 WITNESS MY HAND AND NOTORIAL SEAL, 4 s day of April, 2011. (Notary Public) vF BRIAN R. MCBRIDE •40 1974 0401A NA SUBCONTRACTORS ASSOCIADOh INCORPORATED * ^•* Res of Hancock County ` U auyno*«teo Repeod„ctwn Pi b,wa My Comm, Exp. 11-29-2017 Rev A sa DI ■N Comm!SS'on # 611862