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VERKLER CONSTRUCTION -001956 -6/15/2011 CARMEL REDEVELOPMENT COMMISSION 001956 Verkler Construction Check: 1956 7240 Georgetown Road Date: 6/15/2011 Indianapolis, IN 46268 Vendor: VERKLER1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Pak 13 19,992.00 19,992.00 0.00 0.00 19,992.0( App 13 on VOG Bldg 1 Ret-2 Final 10,000.00 10,000.00 0.00 0.00 10,000.0( VOG Office Bldg One 29,992.00 29,992.00 0.00 0.00 29,992.0( i • • APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION AIA DOCUMENT G702/CMa PAGE ONE OF PAGES TO: City of Carmel Community Development PROJECT: Village on the Green Office Building No. 1, Carmel Corporation IN APPLICATION NO: 13 Distribution To: Third Avenue S.W. PERIOD TO: 3/31/2011 DOWNER Carmel, Indiana 46032 PROJECT NOS: 09-010 [' CONSTRUCTION MANAGER FROM: Verlcler Incorporated CONTRACT DATE: 11/9/2009 ❑ ARCHITECT 7240 Georgetown Road ❑ CONTRACTOR Indianapolis,IN 46268 VIA CONSTRUCTION MANAGER: REI Constructions,LLC CONTRACT FOR: Bid Item#1 VIA ARCHITECT: Pedcor Design Group LLC The undersigned Contractor certifies that to the best of the Contractor's knowledge,Infor- CONTRACTOR'S APPLICATION FOR PAYMENT Infor- mation and belief the Work covered by this Application for Payment has been completed in Application is made for payment, as shown below, in connection with the Contract. accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and payments 1. ORIGINAL CONTRACT SUM $ $807,500.00 received from the Owner,and that current payment shown herein is now due. 2. Net Change by Change Orders . $ $166,534.51 A 3. CONTRACT SUM TO DATE (Line 1 +2) , $ $974,034.51 CONTRAC . 4. TOTAL COMPLETED&STORED TO DATE . $ $974,034.51 By: Dater I l I (Column G on G703) 5 RETAINAGE: State of: Indiana a. variable%of Completed Work $ $10,000.00 County of: Marion (Columns D+E on G703) Subscribed and sworn to before b. variable%of Stored Material me this 14h day of April,2011 (Column F on G703) $ $0.00 Total Retainage(Line 5a+5b or Total in Column I on G703) . $ $10,000.00 6. TOTAL EARNED LESS RETAINAGE . $ $964,034.51 Notary Public: Janeane Arbuckle / r i I '� r (Line 4 less Line 5 Total) My commission expires: March 20,2013 LESS PREVIOUS CERTIFICATE FOR PAYMENT . $ $944,042.51 CERTIFICATE FOR P lDENT 7. 8. CURRENT PAYMENT DUE $ $19,992.00 In accordance with the Contract Doc -tits, based on on-site observations and the data 9. BALANCE TO FINISH INCLUDING RETAINAGE comprising the application, the Construction Manager and Architect certifies to the Owner that to the best of the their knowledge, information and belief the Work has progressed as (Line 3 less Line 6) $10,000.00 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 pq CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS /� / ( � �a (Attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved in figures on this Application and on the Continuation Sheet that are changed to conform to 1 the amount certified.) previous months by Owner CONSTRUCTION MAN9,GER: Total approved this Month $166,534.51 By: .f-t � __ __z,...- Date: 2 0/' ARCHITECT: TOTALS $166,534.51 $0.00 By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the NET CHANGES by Change Order $166,534.51 Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. \QU AIA DOCUMENT G702/CMa•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION•AIA •01992•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK 0 AVENUE.N.W..WASHINGTON.DC 20006-5292•Users may obtain validation of this document by requesting a completed AIA Document D401-Certification of Document's Authenticity from the Licensee. CONTINUATION SHEET AIA DOCUMENT G703 PAGE 1 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: NET CHANGES by Change Order $166,534.51 I 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. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION•AIA•01992•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.,WASHINGTON,DC 20006-5292•Users may obtain validation of this document by requesting a completed AIA Document D401-Certification of Document's Authenticity from the Licensee. G702-1992 A B C D E F G H I # Description of Scheduled Previous Work Work Presently Total % Balance to Total Retainage Work Value Complete Completed from Stored Completed & Finish This Period Stored to Date General Conditions 0001 Mobilization $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $1,500.00 0002 Performance $10,500.00 $10,500.00 $0.00 $0.00 $10,500.00 100.00% $0.00 $0.00 Bond 0003 Safety $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100.00% $0.00 $0.00 0004 Project $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $1,500.00 Superintendent 0005 Staking/Layout $3,000.00 $3,000.00 $0.00 $0.00 $3,000.00 100.00% $0.00 $0.00 General Subtotal: $47,500.00 $47,500.00 $0.00 $0.00 $47,500.00 100.00% $0.00 $3,000.00 Conditions II Bid Item#1 0006 Earthwork $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Mobilization 0007 Excavation $20,000.00 $20,000.00 $0.00 $0.00 $20,000.00 100.00% $0.00 $0.00 ` 0008 Demolition $7,000.00 $7,000.00 $0.00 $0.00 $7,000.00 100.00% $0.00 $0.00 0009 Build-Up Bldg $14,000.00 $14,000.00 $0.00 $0.00 $14,000.00 100.00% $0.00 $0.00 Pad 0010 Excavation for $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Foundations 0011 Stone @ Bldg $6,000.00 $6,000.00 $0.00 $0.00 $6,000.00 100.00% $0.00 $0.00 Pad 0012 Prep for New $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Walks 0013 Spreading of $4,500.00 $4,500.00 $0.00 $0.00 $4,500.00 100.00% $0.00 $0.00 Topsoil 0014- Remove Auger $17,000.00 $17,000.00 $0.00 $0.00 $17,000.00 100.00% $0.00 $0.00 Spoils 0015 Erosion Control $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 0016 Alt.#1 Water $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Line 0D17 Asphalt Paving- $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 CONTINUATION SHEET A/A DOCUMENT G703 PAGE 2 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: Mobilization 0018 Asphalt Paving- $7,500.00 $7,500.00 $0.00 $0.00 $7,500.00 100.00% $0.00 $0.00 Stone 0019 Asphalt Paving- $13,000.00 $13,000.00 $0.00 $0.00 $13,000.00 100.00% $0.00 $0.00 Binder 0020 Asphalt Paving- $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Finish Coat 0021 Paving Marking $1,100.00 $1,100.00 $0.00 $0.00 $1,100.00 100.00% $0.00 $0.00 0022 Bollards- Mat'l $700.00 $700.00 $0.00 $0.00 $700.00 100.00% $0.00 $0.00 0023 Piling- $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 Mobilization 0024 Piling-Test $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 Piles 0025 Piling $153,900.00 $153,900.00 $0.00 $0.00 $153,900.00 100.00% $0.00 $0.00 0026 Concrete $55,000.00 $55,000.00 $0.00 $0.00 $55,000.00 100.00% $0.00 $0.00 Reinforcement- Mat'l 0027 Concrete $25,000.00 $25,000.00 $0.00 $0.00 $25,000.00 100.00% $0.00 $0.00 Reinforcement- Labor 0028 Cast In Place- $13,000.00 $13,000.00 $0.00 $0.00 $13,000.00 100.00% $0.00 $0.00 Walls- Mat'l 0029 Cast In Place- $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100.00% $0.00 $0.00 Walls- Labor 0030 Cast In Place- $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 SOG -Mat'l 0031 Cast In Place- $17,000.00 $17,000.00 $0.00 $0.00 $17,000.00 100.00% $0.00 $0.00 SOG -Labor 0032 Cast In Place- $18,000.00 $18,000.00 $0.00 $0.00 $18,000.00 100.00% $0.00 $0.00 Elev Slabs- Mat'I 0033 Cast In Place- $55,000.00 $55,000.00 $0.00 $0.00 $55,000.00 100.00% $0.00 $0.00 Elev Slabs- Labor 0034 Misc. Concrete- $35,000.00 $35,000.00 $0.00 $0.00 $35,000.00 100.00% $0.00 $0.00 Mat'l 0035 Misc. Concrete- $35,000.00 $35,000.00 $0.00 $0.00 $35,000.00 100.00% $0.00 $0.00 Labor 0036 Site Concrete- $300.00 $300.00 $0.00 $0.00 $300.00 100.00% $0.00 $0.00 Mat'l 0037 Site Concrete- $16,500.00 $16,500.00 $0.00 $0.00 $16,500.00 100.00% $0.00 $0.00 Labor 0038 Bitiminous $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Dampproofing 0039 Bentonite $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Waterproofing CONTINUATION SHEET AIA DOCUMENT G703 PAGE 3 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: 0040 Pedestrian $30,000.00 $15,000.00 $15,000.00 $0.00 $30,000.00 100.00% $0.00 $0.00 Traffic Coating 0041 Joint Sealants $500.00 $0.00 $500.00 $0.00 $500.00 100.00% $0.00 $0.00 Bid Item#1 Subtotal: $690,000.00 $674,500.00 $15,500.00 $0.00 $690,000.00 100.00% $0.00 $0.00 Allowances 0042 Winter $70,000.00 $70,000.00 $0.00 $0.00 $70,000.00 100.00% $0.00 $7,000.00 Conditions Allowance 0043 Delete line $0.00 $0.00 $0.00 $0.00 $0.00 0.00% $0.00 $0.00 Allowances Subtotal: $70,000.00 $70,000.00 $0.00 $0.00 $70,000.00 100.00% $0.00 $7,000.00 CO#01 -Add for sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'I 0043 Add for $8,367.00 $8,367.00 $0.00 $0.00 $8,367.00 100.00% $0.00 $0.00 sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'l CO#01 -Add Subtotal: $8,367.00 $8,367.00 $0.00 $0.00 $8,367.00 100.00% $0.00 $0.00 for sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'I CO#02-Add for PCO#24/ Add for labor& CONTINUATION SHEET AIA DOCUMENT G703 PAGE 4 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: mat'I on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap 0044 Add for PCO $38,972.51 $38,972.51 $0.00 $0.00 $38,972.51 100.00% $0.00 $0.00 #24/Add for labor&mat'I on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap CO#02-Add Subtotal: $38,972.51 $38,972.51 $0.00 $0.00 $38,972.51 100.00% $0.00 $0.00 for PCO#24/ Add for labor& mat'I on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap CO#03-PCO #23B- Part 3,4 /PCO#27/ PCO#28-33- Add Back for Patriot 0045 PCO#23B- $34,008.00 $34,008.00 $0.00 $0.00 $34,008.00 100.00% $0.00 $0.00 Part 3,4/PCO #27/PCO#28- 33-Add Back for Patriot CO#03-PCO Subtotal: $34,008.00 $34,008.00 $0.00 $0.00 $34,008.00 100.00% $0.00 $0.00 #23B- Part 3,4 /PCO#27/ PCG#28-33- Add Back for Patriot CONTINUATION SHEET AIA DOCUMENT G703 PAGE 5 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: CO#04- PCO #23/PCO#39/ PCO#38 046 Add for PCO 23 $6,683.00 $6,683.00 $0.00 $0.00 $6,683.00 100.00% $0.00 $0.00 -Part 5 Temp. worker 047 Add for PCO $1,100.00 $1,100.00 $0.00 $0.00 $1,100.00 100.00% $0.00 $0.00 #39 Carmel Utilities invoice 048 Add for PCO $34,317.00 $34,317.00 $0.00 $0.00 $34,317.00 100.00% $0.00 $0.00 #38 42"of Box Culvert CO#04- PCO Subtotal: $42,100.00 $42,100.00 $0.00 $0.00 $42,100.00 100.00% $0.00 $0.00 #23/PCO#39/ PCO#38 CO#05- PCO #30/PCO#31 / PCO#34/PCO #35/PCO#36/ PCO#37/PCO #41 /PCO#42/ PCO#43 049 Add for PCO 30 $800.00 $800.00 $0.00 $0.00 $800.00 100.00% $0.00 $0.00 - Repair Existing Catch Basin 050 Add for PCO $8,716.00 $8,716.00 $0.00 $0.00 $8,716.00 100.00% $0.00 $0.00 #31 - Install Mini Blinds per PR- 31 051 Add for PCO $4,661.00 $4,661.00 $0.00 $0.00 $4,661.00 100.00% $0.00 $0.00 j #34-Garage& Office Blg. Expansion Joint Install 052 PCO#35- $3,810.00 $3,810.00 $0.00 $0.00 $3,810.00 100.00% $0.00 $0.00 Grinding of Floor Joints from Curling 053 PCO#36- Seal $2,087.00 $2,087.00 $0.00 $0.00 $2,087.00 100.00% $0.00 $0.00 Concrete Floors 054_ PCO#37- $2,978.00 $2,978.00 $0.00 $0.00 $2,978.00 100.00% $0.00 $0.00 Misc. Concrete 055 PCO#41 - $1,507.00 $1,507.00 $0.00 $0.00 $1,507.00 100.00% $0.00 $0.00 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 6 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: 13 Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: White PVC Fence @ Balcony 056 PCO#42- $13,774.00 $13,774.00 $0.00 $0.00 $13,774.00 100.00% $0.00 $0.00 Temporary Heat for Traffic Coating 057 PCO#43- $262.00 $262.00 $0.00 $0.00 $262.00 100.00% $0.00 $0.00 Install Signs in Parking Garage CO#05- PCO Subtotal: $38,595.00 $38,595.00 $0.00 $0.00 $38,595.00 100.00% $0.00 $0.00 #30/PCO#31 / PCO#34/PCO #35/PCO#36/ PCO#37/PCO #41 /PCO#42/ PCO#43 CO#06- PCO #23/PCO#44 114 Add for PCO $3,510.00 $0.00 $3,510.00 $0.00 $3,510.00 100.00% $0.00 $0.00 #23-Temp Winter Work 115 Add for PCO $982.00 $0.00 $982.00 $0.00 $982.00 100.00% $0.00 $0.00 #44- Provide #8 Stone for Temp Road CO#06- PCO Subtotal: $4,492.00 $0.00 $4,492.00 $0.00 $4,492.00 100.00% $0.00 $0.00 #23/PCO#44 GRAND TOTAL $974,034.51 $954,042.51 $19,992.00 $0.00 $974,034.51 100.00% $0.00 $10,000.00 APPLICATION FOR PAYMENT PARTIAL WAIVER OF LIEN Contractor: Verkler.. Inc. Address: 7240 JPprgetown Rd. Tndianapnlic, TN 46268 Project Name and Address: Village on the Green Office Building No. 1 Period to: 3/31/2011 Job#: 1-06-1493 The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project owned by Owner and located as indicated above. The Undersigned,for and in consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character, against,on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by,or at the request of, the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. The undersigned,for and in consideration of the total payments in the sum of $ 19,99 2.00 the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished,or any kind or class of lien whatsoever for said building or premises or project Dated this 14th day of April , 2011 Verkler, Inc. Company Name ��BY: �`!�.�'U � TITLE: CEO/Treasurer NAME: Fred H. Lusk STATE OF Indiana COUNTY OF Marion Subscribed and sworn to before me,a Notary Public In and for said County and State, this 14th day of April , -2011 My commission expires March 20, 2013 My county residence is Hamilton Notary ' 1 / ` `�` rinted Janeane Arbuckle APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION AIA DOCUMENT 6702/CAla PAGE ONE OF PAGES TO: City of Carmel Community Development PROJECT: Village on the Green Office Building No. 1,Carmel Corporation IN APPLICATION NO: Ret-2 Final Distribution To: Third Avenue S.W. PERIOD TO: 3/31/2011 DOWNER Carmel, Indiana 46032 PROJECT NOS: 09-010 ❑ CONSTRUCTION MANAGER FROM: Verkler Incorporated CONTRACT DATE: 11/9/2009 ❑ ARCHITECT 7240 Georgetown Road ❑ CONTRACTOR Indianapolis, IN 46268 VIA CONSTRUCTION MANAGER: REI Construction, LLC CONTRACT FOR: Bid Item #1 VIA ARCHITECT: Pedcor Design Group LLC CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, Infor- mation and belief the Work covered by this Application for Payment has been completed in Application is made for payment, as shown below, in connection with the Contract. accordance with the Contract Documents, that all amounts have been paid by the Continuation Sheet, AIA Document G703, is attached. Contractor for Work for which previous Certificates for Payment were issued and payments 1. ORIGINAL CONTRACT SUM $ $807,500.00 received from the Owner,and that current payment shown herein is now clue. 2. Net Change by Change Orders . $ $166,534.51 CON •CTOR: 3. CONTRACT SUM TO DATE (Line 1 ±2) . $ $974,034.51 l A 4. TOTAL COMPLETED&STORED TO DATE . $ $974,034.51 By: 4 / ! 4 / Date:41V. /I (Column G on G703) 5 RETAINAGE: $ $0.00 State of: Indiana a. 0.00%of Completed Work County of: Marion (Columns D+E on G703) Subscribed and sworn to before b. 0.00%of Stored Material me this 14th day of April.2011 (Column F on G703) $ $0.00 Total Retainage(Line 5a+5b or Total in Column 1 on G703) $ $0.00 6. TOTAL EARNED LESS RETAINAGE . $ $974,034.51 Notary Public:.laneane Arbuckle / • (Line 4 less Line 5 Total) My commission expires: March 20,2013 i LESS PREVIOUS CERTIFICATE FOR PAYMENT . $ $964,034.51 CERTIFICATE FOR p,', 1 "ENT 7. 8. CURRENT PAYMENT DUE $ $10,000.00 In accordance with the Contract Docul -ts, based on on-site observations and the data 9. BALANCE TO FINISH INCLUDING RETAINAGE comprising the application, the Construction Manager and Architect certifies to the Owner that to the best of the their knowledge, information and belief the Work has progressed as (Line 3 less Line 6) $0.00 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 $ /o "� CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (.attach explanation if amount certified differs from the amount applied for. Initial all Total changes approved in figures on this Application and on the Continuation Sheet that are changed to conform to the amount previous months by Owner certified.) CONSTRUCTION MANAG J: // Total approved this Month $166,534.51 BY: -....r_ - �1 Date: / ,/.� �i ARCI-I ITECT: TOTALS $166,534.51 $0.00 By: Date: This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the NET CHANGES by Change Order $166,534.51 Contractor named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702/CMa•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION•AIA •01992•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N W,WASHINGTON,I)C 20006-5292•Users may obtain validation of this document by requesting a completed AIA Document D401-Certification of Document's Authenticity from the Licensee. f_711')II^RA _1 00') CONTINUATION SHEET AIA DOCUMENT G703 PAGE 1 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: NET CHANGES by Change Order $166,534.51 I 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. AIA DOCUMENT G702•APPLICATION AND CERTIFICATION FOR PAYMENT•1992 EDITION•AIA •©1992•THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N W,WASHINGTON,DC 20006-5292•Users may obtain validation of this document by requesting a completed AIA Document D401-Certification of Document's Authenticity from the Licensee. G702-1992 A B C D E F G H I # Description of Scheduled Previous Work Work Presently Total % Balance to Total Retainage Work Value Complete Completed from Stored Completed & Finish This Period Stored to Date General Conditions 0001 Mobilization $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 0002 Performance $10,500.00 $10,500.00 $0.00 $0.00 $10,500.00 100.00% $0.00 $0.00 Bond 0003 Safety $4,000.00 $4,000.00 $0.00 $0.00 $4,000.00 100.00% $0.00 $0.00 0004 Project $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 Superintendent 0005 Staking/Layout $3,000.00 $3,000.00 $0.00 $0.00 $3,000.00 100.00% $0.00 $0.00 General Subtotal: $47,500.00 $47,500.00 $0.00 $0.00 $47,500.00 100.00% $0.00 $0.00 Conditions Bid Item#1 0006 Earthwork $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Mobilization 0007 Excavation $20,000.00 $20,000.00 $0.00 $0.00 $20,000.00 100.00% $0.00 $0.00 0008 Demolition $7,000.00 $7,000.00 $0.00 $0.00 $7,000.00 100.00% $0.00 $0.00 0009 Build-Up Bldg $14,000.00 $14,000.00 $0.00 $0.00 $14,000.00 100.00% $0.00 $0.00 Pad 0010 Excavation for $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Foundations 0011 Stone @ Bldg $6,000.00 $6,000.00 $0.00 $0.00 $6,000.00 100.00% $0.00 $0.00 Pad 0012 Prep for New $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Walks 0013 Spreading of $4,500.00 $4,500.00 $0.00 $0.00 $4,500.00 100.00% $0.00 $0.00 Topsoil 0014 Remove Auger $17,000.00 $17,000.00 $0.00 $0.00 $17,000.00 100.00% $0.00 $0.00 Spoils 0.015 Erosion Control $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 0016 Alt.#1 Water $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Line 0017 Asphalt Paving- $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 CONTINUATION SHEET A/A DOCUMENT G703 PAGE 2 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: Mobilization 0018 Asphalt Paving - $7,500.00 $7,500.00 $0.00 $0.00 $7,500.00 100.00% $0.00 $0.00 Stone 0019 Asphalt Paving - $13,000.00 $13,000.00 $0.00 $0.00 $13,000.00 100.00% $0.00 $0.00 Binder 0020 Asphalt Paving- $10,000.00 $10,000.00 $0.00 $0.00 $10,000.00 100.00% $0.00 $0.00 Finish Coat 0021 Paving Marking $1,100.00 $1,100.00 $0.00 $0.00 $1,100.00 100.00% $0.00 $0.00 0022 Bollards- Mat'I $700.00 $700.00 $0.00 $0.00 $700.00 100.00% $0.00 $0.00 0023 Piling - $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 Mobilization 0024 Piling -Test $15,000.00 $15,000.00 $0.00 $0.00 $15,000.00 100.00% $0.00 $0.00 Piles 0025 Piling $153,900.00 $153,900.00 $0.00 $0.00 $153,900.00 100.00% $0.00 $0.00 0026 Concrete $55,000.00 $55,000.00 $0.00 $0.00 $55,000.00 100.00% $0.00 $0.00 Reinforcement- Mat'I 0027 Concrete $25,000.00 $25,000.00 $0.00 $0.00 $25,000.00 100.00% $0.00 $0.00 Reinforcement- Labor 0028 Cast In Place- $13,000.00 $13,000.00 $0.00 $0.00 $13,000.00 100.00% $0.00 $0.00 Walls- Mat'I 0029 Cast In Place- $40,000.00 $40,000.00 $0.00 $0.00 $40,000.00 100.00% $0.00 $0.00 Walls- Labor _ 0030 Cast In Place- $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100,00% $0.00 $0.00 SOG- Mat'I 0031 Cast In Place- $17,000.00 $17,000.00 $0.00 $0.00 $17,000.00 100.00% $0.00 $0.00 SOG- Labor 0032 Cast In Place- $18,000.00 $18,000.00 $0.00 $0.00 $18,000.00 100.00% $0.00 $0.00 Elev Slabs- Mat'l 0033 Cast In Place- $55,000.00 $55,000.00 $0.00 $0.00 $55,000.00 100.00% $0.00 $0.00 Elev Slabs- Labor 0034 Misc. Concrete- $35,000.00 $35,000.00 $0.00 $0.00 $35,000.00 100.00% $0.00 $0.00 Mat'I _ 0035 Misc. Concrete- $35,000.00 $35,000.00 $0.00 $0.00 $35,000.00 100.00% $0.00 $0.00 Labor 0036 Site Concrete- $300.00 $300.00 $0.00 $0.00 $300.00 100.00% $0.00 $0.00 Mat'I 0037 Site Concrete- $16,500.00 $16,500.00 $0.00 $0.00 $16,500.00 100.00% $0.00 $0.00 Labor 0038 Bitiminous $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Dampproofing 0039 Bentonite $5,000.00 $5,000.00 $0.00 $0.00 $5,000.00 100.00% $0.00 $0.00 Waterproofing CONTINUATION SHEET A/A DOCUMENT G703 PAGE 3 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: 0040 Pedestrian $30,000.00 $30,000.00 $0.00 $0.00 $30,000.00 100.00% $0.00 $0.00 Traffic Coating 0041 Joint Sealants $500.00 $500.00 $0.00 $0.00 $500.00 100.00% $0.00 $0.00 Bid Item#1 Subtotal: $690,000.00 $690,000.00 $0.00 $0.00 $690,000.00 100.00% $0.00 $0.00 Allowances 0042 Winter $70,000.00 $70,000.00 $0.00 $0.00 $70,000.00 100.00% $0.00 $0.00 Conditions Allowance 0043 Delete line $0.00 $0.00 $0.00 $0.00 $0.00 0.00% $0.00 $0.00 Allowances Subtotal: $70,000.00 $70,000.00 $0.00 $0.00 $70,000.00 100.00% $0.00 $0.00 CO#01 -Add for sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'l 0043 Add for $8,367.00 $8,367.00 $0.00 $0.00 $8,367.00 100.00% $0.00 $0.00 sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'l CO#01 -Add Subtotal: $8,367.00 $8,367.00 $0.00 $0.00 $8,367.00 100.00% $0.00 $0.00 for sequencing of Slab Pours/ Add for re- routing Fire Hydrant Line/ Add for changing sanitary sewer pipe mat'l • CO#02-Add for PCO#24/ Add for labor& CONTINUATION SHEET AIA DOCUMENT G703 PAGE 4 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: mat'l on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap 0044 Add for PCO $38,972.51 $38,972.51 $0.00 $0.00 $38,972.51 100.00% $0.00 $0.00 #24/Add for labor&mat'l on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap CO#02-Add Subtotal: $38,972.51 $38,972.51 $0.00 $0.00 $38,972.51 100.00% $0.00 $0.00 for PCO#24/ Add for labor& mat'l on Temporary Windows/Add for PCO#26/ Add for additional work at Waterline Tap CO#03- PCO #23B- Part 3,4 /PCO#27/ PCO#28-33- Add Back for Patriot 0045 PCO#23B- $34,008.00 $34,008.00 $0.00 $0.00 $34,008.00 100.00% $0.00 $0.00 Part 3, 4/PCO #27/PCO#28- 33-Add Back for Patriot CO#03- PCO Subtotal: $34,008.00 $34,008.00 $0.00 $0.00 $34,008.00 100.00% $0.00 $0.00 #23B- Part 3,4 /PCO#27/ PCO#28-33- Add Back for Patriot CONTINUATION SHEET AIA DOCUMENT G703 PAGE 5 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: CO#04- PCO #23/PCO#39/ PCO#38 046 Add for PCO 23 $6,683.00 $6,683.00 $0.00 $0.00 $6,683.00 100.00% $0.00 $0.00 - Part 5 Temp. worker 047 Add for PCO $1,100.00 $1,100.00 $0.00 $0.00 $1,100.00 100.00% $0.00 $0.00 #39 Carmel Utilities invoice 048 Add for PCO $34,317.00 $34,317.00 $0.00 $0.00 $34,317.00 100.00% $0.00 $0.00 #38 42"of Box Culvert CO#04- PCO Subtotal: $42,100.00 $42,100.00 $0.00 $0.00 $42,100.00 100.00% $0.00 $0.00 #23/PCO#39/ PCO#38 CO#05- PCO #30/PCO#31 / PCO#34/PCO #35/PCO#36/ PCO#37/PCO #41 /PCO#42/ PCO#43 049 Add for PCO 30 $800.00 $800.00 $0.00 $0.00 $800.00 100.00% $0.00 $0.00 - Repair Existing Catch Basin . 050 Add for PCO $8,716.00 $8,716.00 $0.00 $0.00 $8,716.00 100.00% $0.00 $0.00 #31 - Install Mini Blinds per PR- 31 051 Add for PCO $4,661.00 $4,661.00 $0.00 $0.00 $4,661.00 100.00% $0.00 $0.00 #34- Garage& Office Blg. Expansion Joint Install 052 PCO#35- $3,810.00 $3,810.00 $0.00 $0.00 $3,810.00 100.00% $0.00 $0.00 Grinding of Floor Joints from Curling _ _ 053 PCO#36-Seal $2,087.00 $2,087.00 $0.00 $0.00 $2,087.00 100.00% $0.00 $0.00 Concrete Floors 054 PCO#37- $2,978.00 $2,978.00 $0.00 $0.00 $2,978.00 100.00% $0.00 $0.00 Misc. Concrete 055 PCO#41 - $1,507.00 $1,507.00 $0.00 $0.00 $1,507.00 100.00% $0.00 $0.00 CONTINUATION SHEET AIA DOCUMENT G703 PAGE 6 OF 7 PAGES AIA Document G702, APPLICATION AND CERTIFICATE FOR PAYMENT, containing APPLICATION NUMBER: Ret - 2 Final Contractor's signed Certification is attached. APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. TO: Use Column I on contracts where variable retainage for line items may apply. CONTRACTOR'S PROJECT NO : 09-010 ARCHITECT'S PROJECT NO: White PVC Fence @ Balcony 056 PCO#42- $13,774.00 $13,774.00 $0.00 $0.00 $13,774.00 100.00% $0.00 $0.00 Temporary Heat for Traffic Coating 057 PCO#43- $262.00 $262.00 $0.00 $0.00 $262.00 100.00% $0.00 $0.00 Install Signs in Parking Garage CO#05- PCO Subtotal: $38,595.00 $38,595.00 $0.00 $0.00 $38,595.00 100.00% $0.00 $0.00 #30/PCO#31 / PCO#34/PCO #35/PCO#36/ PCO#37/PCO #41 /PCO#42/ PCO#43 CO#06- PCO #23/PCO#44 114 Add for PCO $3,510.00 $3,510.00 $0.00 $0.00 $3,510.00 100.00% $0.00 $0.00 #23-Temp Winter Work 115 Add for PCO $982.00 $982.00 $0.00 $0.00 $982.00 100.00% $0.00 $0.00 #44- Provide #8 Stone for Temp Road CO#06-PCO Subtotal: $4,492.00 $4,492.00 $0.00 $0.00 $4,492.00 100.00% $0.00 $0.00 #23/PCO#44 GRAND TOTAL $974,034.51 $974,034.51 $0.00 $0.00 $974,034.51 100.00% $0.00 $0.00 APPLICATION FOR PAYMENT FINAL WAIVER OF LIEN Contractor: Verkler, Inc. Address: 7240 Georgetown Road Indianapolis, IN 46268 Project Name and Address: Village on the Green Office Building No. 1, Carmel, -IN Period to: 3/31/2011 Job#: 1-06-1493 The Undersigned has been contracted by REI Construction, LLC as a Contractor in connection with construction of the Project owned by Owner and located as indicated above. The Undersigned, for and in consideration of any and all amounts paid to the Undersigned up to and including the date of execution hereof and other good and valuable consideration, the receipt whereof is hereby acknowledged, waives and releases any and all liens, notices of liens or of character, against, on or relating to or connected with the above-described Project and improvements located thereon and related thereto, on account of labor or services, materials, equipment, tools, machinery or apparatus furnished or leased, or which may be furnished or leased by, or at the request of,the Undersigned for the Project. The Undersigned hereby warrants that the Project cannot be made subject to any valid lien or claim by anyone who furnished or leased labor or services, materials, equipment, tools, machinery or apparatus to, or at the request of, the Undersigned for use in the Project. This instrument, and the waiver, release and representations hereunder, are for the benefit of, and may be relied upon by, the Owner, its successors, assigns and mortgagees, the above-named General Contractor or Construction Manager, and any other person by or through whom payments have been made to the Undersigned. The undersigned,for and in consideration of the total payments in the sum of $ 10,000.00 the receipt of which is hereby acknowledged, does hereby waive, release remise and relinquish any and all right to claim any lien or liens for work done or materials furnished, or any kind or class of lien whatsoever for said building or premises or project Total Completed and Stored to Date: $974,034.51 Dated this 14th day of April , 2011 Verkler, Inc. Company Name . BY: /' ■ TITLE: CEO/Treasurer NAME: Fred H. Lusk STATE OF Indiana COUNTY OF Marion Subscrfbed and sworn to before me,a Notary Public in and for said County and State, this 14th day of April , 2011 My commission expires • h 20, 2013 My county residence is Hamilton t ' ' / / Note i Printed Janeane Arbuckle