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HomeMy WebLinkAboutCIRCLE B CONSTRUCTION SYSTEMS -001875 -4/20/2011 ' Transmittal Sheet Page 1 Carmel Redevelopment Comm Circle B Construction Systems Check: 1875 5636 S Meridian St Date: 4/20/2011 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2*2 70 61,760.00 6,176.00 3,651.52 0.00 2,524.48 Plaster app 2 3-2 82 3,715.00 371.50 0.00 0.00 371.50 Application 2 15 39 607,520.74 8,918.87 0.00 0.00 8,918.87 RPAC app. 15 16 39 690,653.24 69,065.33 27,984.20 0.00 41,081.13 App 16 thru 1/15/2010 32 39 4,860.88 4,860.88 0.00 0.00 4,860.88 Application 32 1249-3 39 0.02 0.02 0.00 0.00 0.02 Adjust to billed amount 3090-1 90 19,160.00 1,916.00 0.00 0.00 1,916.00 Application 1 on stucco 1,387,669.88 91,308.60 31,635.72 0.00 59,672.88 *AILV . .. ..,:..........2.:AIA Document G702/CMaTM — 1992 It n n#269.5-3090 • Application and Certificate for Payment Construction Manager-Adviser Edition . TO OWNER: PROJECT: APPLICATION NO: ; FINAL RETENTION Distribution to: CARMEL REDEVELOPMENT COt•uiISSION CPAC PERIOD TO: •• 3000—3 OWNER ❑ - ONE CIVIC SQUARE 12/29/2010 CONSTRUCTION MANAGER ❑ n AnATnr r*, i �n�n UAIN2L`L, in 4UV3L FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE D CONSTRUCTION SYSTEMS CTTr1T SEXTON Jn1nL JL'n1VLV PROJECT NOS: / / CONTRACTOR ❑ C/3/_ n ,,nn T T\T A N n m JUJU J• 1'i.Lli IHLV J1. 11VDA1iVAPOLia, in 4UL I% VIA ARCHITECT: • FIELD ❑• CSV ARCHITECTS CONTRACT FOR: STUCCO ❑ • 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 Pa ment we e issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 489,340.00 payment shown h r-:• i o 0 due. ... 2. Net change by Change Orders $ ,441,LLn•00) CONTRALTO -Jr L. D CONSTRUCTION SYSTEMS 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 40,1U.uo By: All �'[ of 2010 L ' 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 40, 120.00 State of: / T .T A' / 0......... A ,VL1HL . �S. 5.RETAINAGE: County of:, ..A n T , • : •• 11HR1 ,LV ?C . a: %of Completed Work Subscri P'd and swo t bet'. e ■.! + .GINDk1 (Column D+Eon G703) $ -0- me thi 29TH �'y ' Eii:"' N3f PU 't• ••_; ,. Q�'t#�IANA n+1 JOHNS6'f..i•urI�trIyy b. .%of Stored Material Notary Public: � ` ,A`' / �v"' ISSION '= PEB•1,2017 (Column F on G703) $ My Commissio e '�,,,0 ''••,.• .0.;' Total Retainage(Lines 5a+5b or Total in Column I of G703). $ -0- CERTIFICATE FOR •AYM' NT 1''°`F,JND I I� ' g ( )' 0!f] uitifim1N In accordance with the Contract Documents,based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 48,120.00 this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 43,308.00 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. �/Y 8.CURRENT PAYMENT DUE $ 4,o 12.0^u AMOUNT CERTIFIED $ t�2 ------~ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fr. 'amount applied.Initial all figures on this Application and o e Continuation SI t that• anged to conform with the amount certified.) (Line 3 less Line 6) $ -0- CON SUCTIO M, AGE�'i / BY: .,�.;-.,r.;�Li1L�. ___- Date: B� CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC ,. Total changes approved.in previous months by Owner $ $ By: /f% ''' . Date: ft?4\lati(t Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor . TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. • CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this 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. == = Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition, 1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted;on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. "O1 Change Orders:Although Change Orders could be incorporated by changing the schedule.of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. • E.Making Payment - n The Owner should make payment directly to the Contractor based on the amount certified by,thg Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed,form contains the name and address of the.Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. - w • AIA Document G702/CMa TM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed. To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. *AIA Document G7O3TM - 1992 ' Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 5 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 12/29/2010 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 12/29/2010 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO RETAINAGE NO. FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G-C) FINISH (NOT IN TO DATE (C G) RATE) (D-E) D OR E) (D+E+F) 100 MATERIAL 166,640.00 166,640.00 166,640.00 100.00 101 CARPENTER LABOR 157,900.00 157,900.00 157,900.00 100.00 102 PLASTERER LABOR 164,800.00 164,800.00 164,800.00 100.00 201 CHANGE ORDER#1 -391,350.00 -391,350.00 -391,350.00 100.00 202 CHANGE ORDER#2 -44,870.00 -44,870.00 -44,870.00 100.00 203 CHANGE ORDER#3 -5,000.00 -5,000.00 -5,000.00 100.00 • • 1 1 JOB TOTALS : 48,120.00 48,120.00 .00 .66 48,120.00 .00 .00 CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM—1992.Copyright©1963, 1965, 1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright - Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. ,\--70 A® .0.Document G703TM - 1992 Instructions Continuation Sheet GENERAL INFORMATION . - , Purpose-and Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation,Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered-in-AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition . 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 G703,but only for use in connection with a particular project.The AIA will notpermit 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. . • COMPLETING THE G703 FORM ' Heading:This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A, B, &C:These columns should be completed by identifying the various portions of the Project and their scheduled values 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. Colilmn C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially,this total should equal the original Contract Sum.The total of column C may be adjusted/by Change Orders during the Project. - Column D:,Enter in this column the amount of completed Work covered by the previous application(columns D&E from the previous application).Values from column F,(Materials Presently Stored)•from the previous application should not be entered in this column. Column,E:Enter here the value-of Work completed at the time of this application, including the value of materials incorporated in the project that 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.0(Scheduled Value)and the 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 the 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 of the G702 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 indispute'should be dealt with according to Section 7.3 in A201. - The following is,an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to - reflect-actual construction costs. -A - 'B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE . ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE • DESCRIPTION OF WORK NO .D VALUE PREVIOUS STORED AND STORED (G-C) FINISH (IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) DOR El (D+E+F) (C-G) - 1 MOBILIZATION 5.000 5.000 0 0 5.000 100 0 2 . STUMP REMOVAL 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK 15.000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL 10.000 0 5000 0 5.000 50 5.000 5 CURBS&MISC.CONC. , 5.000 0 0 0 0 0 5.000 . ' 6 PAVING.UPPER DRIVE j 20.000 0 0 0 0 0 20.000 7 . PAVING.LOWER,DRIVE 20.000 0 0 0 0 0 20.000 & PAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 II 100000 20.000 10.000 10.000 40.000 05.000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIM Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright©aia.orig. AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M. ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS: STUCCO FOR A PROJECT KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF FORTY THREE THOUSAND THREE HUNDRED EIGHT. ($43,308.00) XX RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT,EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER)THAT THIE FINAL BALANCE DUE IS THE SUM OF: RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED,ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO,AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RIGHT TO A LIEN ON ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR SAID.-P O.1,ECT AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. �� ``o auu uurgrrrrr�CIRC B CONSTR. SYSTEMS, LLC BY: TITLE: p IDENRQ,\ S. M • ::/AN NOTARIAL SEAL THIS 29`h DAY OF DECEM.> R,201 'C p /' • . Il2`-= ARY PUBLIC .%.7%,;°%•.• 'r -e` MY CO IS ON EXPIRES: 02/01/2017 .,9iVf�- .� RESIDENT OF JOHNSON COUNTY "",wint"`t`®����`� CIRCLE B Eponstruction Systems 12/29/2010 CARMEL REDEVELOPMENT COMMISSION CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT: #2695-3090 PLASTER PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION AMOUNT PAID #1 $17,244.00 #2 $ 26,064.00 TOTAL PAID TO DATE: $43,308.00 CIRCL /10 •TRUCTION SYSTEMS, LLC JOH. .£BOTT PRESIDENT (317)787-5746 fax(317)780-2654 5636 South Meridian Street Indianapolis,Indiana 46217 Equal Opportunity Employer *AIA TM 7 / Document G702/CMa - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition Wi}(4'404-e'- 4- -(-e' 1 TO OWNER: PROJECT: APPLICATION NO: • 31 • Distribution to: ,A,...171- nTr1TrTTT 1,710 �T.Tm ,,,M�ATn n Tn1T n A ntATT PERFORMING r1Tn A mm� CENTER Ut1R1'1e�L ADDL..v L.L0PME1V 1 VV1'1111JJ ION (T,ARMEL PERFORMING ARTS PERIOD T0: 3j:3 O. 2011 OWNER ❑ ONE CIVIC SQUARE CAR1'1EL, IN 4v^v32 CONSTRUCTION MANAGER ❑ ,, FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ ,n IRCLE D CONSTRUCTION SYSTEMS nrTTnr SEXTON COMPANY"nr MERIDIAN A 1.T nm Jn1L,L SEXTON COMPtALV Y PROJECT NOS: / / CONTRACTOR ❑ i. 5636 J. MERIDIA J1. INDIANAPOLIS,. nnr Tn Tnr , �„ , VIA ARCHITECT: - FIELD ❑ INDIANAPOLIS, IN 46L1/ CSO ARCHITECTS 2695-4090 CONTRACTFOR: INTERIOR FINISHES ❑ 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 t all amounts have been paid by the Contractor for Work for which previous Certificates a •.yme we : issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 6,3 y4,500.00 payme" s own ue. 2. Net change b Chan a Orders T^ 72 ^^ t CONTnTTnTIONT nvnrr,r'A J Y 9 $ 1LC, /Ll •VV VVLV1Ul�11LV J1J11 3.CONTRACT SUM TO DATE(Line I ±2) $ 6 5 i 5 2 2 7.0 0 B .+`'�a ,o 4. ,3,443 0 l L V 1 1 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 6,501,820.43 State of: I ' TAi A '°. �/% C9. 5.RETAINAGE: County • : r I ="-II .i ".� a. %of Completed Work Subs •ed and s ern o be sre p--t; ATHY? IDER (Column D+Eon G703) $ 50,000.00 me -1s 30 d .. 1-"RCTT 2,.,.: , OTARY"P' LI,0 STATE OF INDIANA b. %of Stored Material N any Public: 4r - JOH ON:COUNTY (Column F on G703) $ y Commission expires. ,,.. .•1fl� �+N;€XP.FEB. 1,7t?17 Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 50,000.00 CERTIFICATE FO' PA MENT "•'mi.,-,451:1°"` In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $6,451,820.43 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 $6,401 ,020.4 3 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. PO 8.CURRENT PAYMENT DUE $ 50,000.00 AMOUNT CERTIFIED $ Sz to `----' 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fe the amount applied. Initial all figures on this Application and the Continuation: eet th changed to conform with the amount certified.) (Line 3 less Line 6) $ 63,406.57 CON' RUCTION - A y BY: i �. �i�.Iv0i '- Date: © 7 CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC `rC Ni ir Total changes approved in previous months by Owner $ $ By: 1 , r Date: Total approved this Month $ $ This Certi icat-�is not negotiable. The AMOUNT CERTIFIED is payable onl ' to the Contractor TOTALS $ $ named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaT"—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA Document is protected by U.S.Copyright Law and International Treaties. - Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. ç4ATA ® :Ape. Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition, 1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. • Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders:Although Change Orders could be incorporated by changing the schedul 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,forn' Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains the name and address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. • AIA Document G702/CMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed. To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. *AIA (;) I TM ,, � 0 LY L%7r�A IA Document 0703 - 1992 (A de_ Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 31 • Use Column Ion Contracts where variable retainage for line items may apply. 03/30/201 1 ARCHITECT'S PROJECT NO: 03/30/2011 A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO RETAINAGE NO. FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G-C) FINISH (NOT IN TO DATE (C G) RATE) (D-E) D OR E) (D+E+F) 100 BASEMENT FRAME MATL 107,259.00 107,259.00 107,259.00 100.00 101 BASEMENT FRAME LABOR 85,992.00 85,992.00 85,992.00 100.00 102 BASEMENT HANG MATL 125,006.00 125,006.00 125,006.00 100.00 103 BASEMENT HANG LABOR 133,158.00 133,158.00 _ 133,158.00 100.00 104 ORCHESTRA FRAME MATL 118,670.00 118,670.00 118,670.00 100.00 105 ORCHESTRA FRAME LAB 100,713.00 100,713.00 100,713.00 100.00 106 ORCHESTRA HANG MATL 124,796.00 124,796.00 124,796.00 100.00 107 ORCHESTRA HANG LAB 141,631.00 141,631.00 141,631.00 100.00 108 BALCONY FRAME MATL 108,051.00 108,051.00 108,051.00 100.00 109 BALCONY FRAME LABOR 92,419.00 92,419.00 92,419.00 100.00 110 BALCONY HANG MATL 115,731.00 115,731.00 115,731.00 100.00 111 BALCONY HANG LABOR 129,223.00 129,223.00 • 129,223.00 100.00 112 BOX TIER FRAME MATL 135,171.00 135,171.00 135,171.00 100.00 113 BOX TIER FRAME LABOR 113,521.00 113,521.00 113,521.00 100.00 114 BOX TIER HANG MATL 140,350.00 140,350.00 140,350.00 100.00 115 BOX TIER HANG LABOR 178,584.00 178,584.00 178,584.00 100.00 116 ATTIC FRAME MATL 102,176.00 102,176.00 102,176.00 100.00 117 ATTIC FRAME LABOR 87,922.00 87,922.00 87,922.00 100.00 118 ATTIC HANG MATL 90,226.00 90,226.00 90,226.00 100.00 119 ATTIC HANG LABOR 110,889.00 110,889.00 110,889.00 100.00 120 ACOUS CEILING MATL 52,941.00 52,941.00 52,941.00 100.00 PAGE TOTALS : 2,394,429.00 2,394,429.0C .00 .00 2,394,429.00 .00 .00 , CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM-1992.Copyright©1963,1965, 1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent •possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. =`®•'= Document G703TM - 1992 Instructions Continuation Sheet _ GENERAL INFORMATION - Purpose and Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, . Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered in AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition . '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 G703,but only for use in connection with a particular project.The AIA will not perniit`reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the1AIA.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. `f 'COMPLETING THE G703 FORM.- Heading:/This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B,&•C:These columns should,be completed by identifying the various portions of the Project and their scheduled values 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 jay be adjusted;by Change Orders during the Project. ,Column D`.iEnter 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. ' • Columns E:Enter here/the value of Work completed at the time of this application,including the value of materials incorporated in the project that were listed on the previous application' ndef'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 cbvers.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 Ownei 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 liere: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.0(Scheduled Value)and the column G(Total Completed and Stored to Date). Column•l:"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 Orde s'couid 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 the own G703 form or at the end of the basic schedule.The amount of the original contract adjUted'by_Change Orders is to-be.entered in the appropriate location of the G702 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 indispute should be dealt with according to Section 7.3 in A201. • The following is an example of a`Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to . 'reflect actual construction costs. ` A , B C D i E F - G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE •DESCRIPTION OF WORK (G-C) FINISH NO:' VALUE PREVIOUS STORED AND STORED (IF VARIABLE "" APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) D OR El (D+E+F) (C-G) 1 MOBILIZATION 5.000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL 5.000 5.000 0 0 5,000 100 0 3 EARTH WORK, 15,000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL; 10,000 0 5.000 0 5,000 50 5,000 5 CURBS&MISC.CONC. . 5.000 0 0 0 0 0 5.000 6 PAVING:UPPER DRIVE I 20,000 0 0 0 0 0 20.000 7 PAVING,LOWER DRIVE _; 20,000 0 0 0 0 0 20.000 & PAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 11 105.000 c0.000 10.000 (0,000 40.000 50,000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIM'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.orig. *AIA Document G7O3TM - 1992 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: 31 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0: 03/30/2011 03/30/2011 A B C D E F G H I WORK COMPLETED - MATERIALS TOTAL ITEM BALANCE DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO (IF VARIABLE NO FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G_C) FINISH (NOT IN TO DATE (C G) RATE) (D-E) D OR E) (D+E+F) 121 ACOUS CEILING LABOR 40,759.00 40,759.00 40,759.00 100.00 122 INSULATION MATL 82,670.00 82,670.00 82,670.00 100.00 123 INSULATION LABOR 117,330.00 117,330.00 117,330.00 100.00 200 N/S ELIP CLG METAL M 51,331.00 51,331.00 51,331.00 100.00 201 N/S ELIP CLG METAL L 201,384.00 201,384.00 - 201,384.00 100.00 202 N/S ELIP CLG PLAS M 74,360.00 74,360.00 74,360.00 100.00 203 N/S ELIP CLG PLAS L 438,153.00 438,153.00 438,153.00 100.00 204 MAIN ELIP CLG METL M 52,412.00 52,412.00 52,412.00 100.00 205 MAIN ELIP CLG METL L 168,703.00 168,703.00 168,703.00 100.00 206 MAIN ELIP CLG PLAS M 71,273.00 71,273.00 71,273.00 100.00 207 MAIN ELIP CLG PLAS L 430,314.00 430,314.00 430,314.00 100.00 208 UP/LOW BALCNY METL M 15,304.00 15,304.00 15,304.00 100.00 209 UP/LOW BALCNY METL L 143,518.00 143,518.00 143,518.00 100.00 210 UP/LOW BALCNY PLAS M 37,975.00 37,975.00 37,975.00 100.00 211 UP/LOW BALCNY PLAS L 633,522.00 633,522.00 633,522.00 100.00 212 BOX TIER/COL METAL M 10,245.00 10,245.00 10,245.00 100.00 213 BOX TIER/COL METAL L 118,363.00 118,363.00 118,363.00 100.00 214 BOX TIER/COL PLAS M 70,300.00 70,300.00 70,300.00 100.00 215 BOX TIER/COL PLAS L 319,455.00 319,455.00 319,455.00 100.00 216 ORCH H/L METAL M 5,317.00 5,317.00 • 5,317.00 100.00 217 ORCH H/L METAL L 112,967.00 112,967.00 112,967.00 100.00 218 ORCH H/L PLASM 15,260.00 15,260.00 15,260.00 100.00 PAGE TOTALS : 3,210,915.00 3,210,915.00 .00 .00 3,210,915.00 .00 .00 . CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM-1992.Copyright©1963,1965,1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. 0 k\-70 ®�t= Document G703TM - 1992 Instructions ;Continuation Sheet GENERAL INFORMATION - Purpose-and Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are covered-in-AIA Document A201,General Conditions of the Contract for Construction. . Use of-Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition ,, ! '',, . . Reproductions.This`docment 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 thisddocument,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 G703,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. :1 COMPLETING THE G703 FORM,-`, Heading'This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. " Columns A,B,&C:These columns should be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architect at thecommencement 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-lie 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 `dolumniF(Materials Presently Stored)-from the previous application should not be entered in this column. Column E:Enter herethe value of Work completed at the time of this application, including the value of materials incorporated in the project that were listed on the previous application under Materials Presently Stored (column F). Columli 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 cevers.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 colu_mn.C-(Scheduled Value)and the column G(Total Completed and Stored to Date). Column-1:-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`s 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 the 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 of the G702 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 iindispute`should be dealt with according to Section 7.3 in A201. The following islan example of a Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to reflect actual construction-costs. A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM ` SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE DESCRIPTION OF (G_C) FINISH NO.' VALUE PREVIOUS STORED AND STORED OF VARIABLE • - APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) DORE) (D+E+F) (C-G) 1 MOBILIZATION I 5,000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL 5.000 5.000 0 0 5000 100 0 3 EARTH WORK 15.000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL I 10,000 0 5.000 0 5.000 50 5.000 5 CURBS&MISC.CONC. 5,000 0 0 0 0 0 5,000 6 PAVING.UPPER DRIVE I 20,000 0 0 0 0 0 20.000 7 PAVING,LOWER D RIVE 20.000 0 0 0 0 0 20.000 8 RAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5000 0 0 0 0 0 5.000 10 II 100.000 L0.000 10,000 10,000 40.000 00,000 MA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright©aia.orig. ���5 Aga *AIA TM �IA Document G703 - 1992 4a. /m.' Conti nuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. PERIOD T0: 31 Use Column I on Contracts where variable retainage for line items may apply. 03/30/2011 ARCHITECT'S PROJECT N0: 03/30/2011 A B C D E F G H I WORK COMPLETED . MATERIALS TOTAL ITEM BALANCE PRESENTLY COMPLETED ° RETAINAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS �O TO NO. VALUE STORED AND STORED (G_C) FINISH (IF VARIABLE APPLICATION THIS PERIOD (NOT IN- TO DATE RATE) (D-E) D OR E) (D+E+F) (C-G) • 219 ORCH H/L PLAS L 315,844.00 315,844.00 315,844.00 100.00 220 4090A GEN. ALLOWANCE 225,000.00 225,000.00 225,000.00 100.00 221 4090B CAD ALLOWANCE 5,000.00 5,000.00 5,000.00 100.00 222 4100A GEN ALLOWANCE 175,000.00 175,000.00 175,000.00 100.00 223 4100B CAD ALLOWANCE 5,000.00 5,000.00 • 5,000.00 100.00 224 ADDITONAL 4090 ALLOW 29,000.00 29,000.00 29,000.00 100.00 224A DELETE LINE 224 -29,000.00 -29,000.00 -29,000.00 100.00 300 BOND PREMIUM 63,312.00 63,312.00 63,312.00 100.00 301 C.O. #1/CCR#1008 60,100.00 60,100.00 60,100.00 100.00 302 C.O.#2/CCR#1011 27,970.00 27,970.00 27,970.00 100.00 303 C.O. #3/CCR#1012 1,200.00 1,200.00 1,200.00 100.00 304 C.O.#4/CCR#1014 19,800.00 19,800.00 19,800.00 100.00 305 C.O. #5/CCR#1015 31,680.00 31,680.00 31,680.00 100.00 306 C.O. #6/CCR#1016 27,720.00 27,720.00 27,720.00 100.00 308 CO#8/PAC006(CO7 0) 20,490.00 20,490.00 20,490.00 100.00 309 CO 9/ALLOWANCE ADJ -226,269.00 -226,269.00 -226,269.00 100.00 310 CO#11/HIGH RAILING 17,740.00 17,740.00 17,740.00 100.00 311 C.O.#12 'DOME STEEL' 48,000.00 48,000.00 48,000.00 100.00 312 CO#13 -RCP "030" 2,296.00 2,296.00 2,296.00 100.00 313 CO#14 ALLOW 4100A 30,000.00 30,000.00 30,000.00 100.00 314 C.O. #15 ALLOW 4100A 30,000.00 30,000.00 30,000.00 100.00 315 C.O. #16/ALLOW 4100A 30,000.00 16,593.43 16,593.43 55.31 13,406.57 JOB TOTALS : 6,515,227.00 6,501,820.43 .00 .00 6,501,820.43 13,406.57 50,000.00 . CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM—1992.Copyright©1963,1965,1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. . Document G703TM - 1992 Instructions • Continuation Sheet GENERAL INFORMATION -- - -- Purpose and-Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are 'covered-in-AIA Document A201,General Conditions of the Contract for Construction. -Use of Current Documents. Prior'to.using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition r i 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 reproducethis 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 G703,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 the1AIA.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. i • ' COMPLETING THE G703 FORM,' Heading:This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B, &C:'These columns should be completed by identifying the various portions of the Project and their scheduled values 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:1Enter 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 in the project that 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.OScheduled Value)and the 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 the own G703 form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to-be.enteredin the appropriate location of the G702 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 indisputee`should be dealt with according to Section 7.3 in A201. The following is,an example of a`Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to reflect actual construction costs, A 'B C D I E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE - DESCRIPTION OF.WORK OF VARIABLE NO. -- VALUE PREVIOUS STORED AND STORED (G_C) FINISH APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) DORE) (D+E+F) (C-G) 1 MOBILIZATION I 5,000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL I 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK 15.000 10.000 5.000 0 15.000 100 0 . 4 LOWER RETAINING WALL I 10.000 0 5.000 0 5.000 50 5.000 5 CURES&MISC.CONC. i 5.000 0 0 0 0 0 5.000 6 PAVING.UPPER DRIVE I 20.000 0 0 0 0 0 20.000 7 'PAVING._LOWER R D IVE � 20.000 0 0 0 0 0 20.000 • 8 PAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 11 100.000 L0.000 10.000 10,000 40.000 Ob.000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright©aia.orig. i ® Document G702/CMa TM - 1992 32 Application and Certificate for Payment Construction Manager-Adviser Edition • • TO OWNER: PROJECT: APPLICATION NO: nn Distribution to: n ARMEL REDEVELOPMENT COMMISSION CAnMEL PERFORMING ARTS CENTER PERIOD TO: /.,,, /.,n„ OWNER ❑ ONE CIVIC SQUARE 3/ 3u/ LVll CARMEL, IN 460032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE D CONSTRUCTION SYSTEMS JnnEL SEXTON n'OMn Ay v PROJECT NOS: / / CONTRACTOR ❑ JUJU J. MERIDIAN Jm. inv±riNAr'LJS, IN 4U L 1 i VIA ARCHITECT: FIELD ❑ CONTRACT FOR: INTERIOR 'FINISHES V SO ARCHITECTS 2695-4090 ❑ - 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 Certificate : •ayme•t A re issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 6,394,500.uQ:aym-• shown ,-re' s e due. e��eeepmm/�arnrrr inn -/nom n r' n nnu,n mnr rmm�,., SYSTEMS"� T °P ir;,,_ 2. Net change by Change Orders $ 1L0, Lr :olC �TRACTO• - D A.V1VJlR0l 1l/1V �a .;� 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 6,515,227.0 ': •. "r i° `tlDate: rin'n /'r n 1 =ice_ °•••,3`J U-/ L V l l 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 6,506,6 o 1.31State of: 1N 3�AN1 e� 5.RETAINAGE: Cou of. M A n r N `-I' "k.)...4.%17 .- a. %of Completed Work and r u�R Ly S ascribed s ern o b=:lire / � CAW_A ENDER (Column D+Eon G703) $ 50,000.0000 e this 30 d .S' .r;.Rn�rr wVARY PUBEIC'$TAT IDF INDIANA '�/�L",i e)`°•. JOHNSON,COIJNTY b. %of Stored Material Notary Public: iii, , s001`AMI tf,,3lXP FFB.1.2017 (Column F on G703) $ My Commission expires: '^'>v,, 7/�D de Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ 50,000.uc CERTIFICATE FOR PAYMENT In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 6,456,681.131 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 $ 6,45+,820.43 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. g 8.CURRENT PAYMENT DUE $ 4.860.88 AMOUNT CERTIFIED $ 4' 0 `-----4 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation i amount certified differs 'om th•amount applied. Initial all figures on this Application and on • Continuation SI t di t are hanged to conform with the am tint certified.) (Line 3 less Line 6) $ 58,545.69 CONS ' CTI•A M' By: �,i:A' '���Ita. �� Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI ' , go. Total changes approved in previous months by Owner $ $ By: . / ,. Date: 0e4.1, It Total o a approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to t e Contractor TOTALS $ $ named herein. Issuance;payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702/CMaTM/—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlAe Document is protected by U.S.Copyright Law and International Treaties. " Unauthorized reproduction or distribution of this AlAe 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. A Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software.Licensed AIA software users should consult the End User License Agreement(EULA). To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. C.Completing the G702/CMa Form After the Contractor has completed AIA Document G703,Continuation Sheet,summary information should be transferred to AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition. The Contractor should sign G702/CMa,have it notarized and submit it,together with G703,to the Construction Manager and Architect. The Construction Manager and Architect should review G702/CMa and G703 and,if they are acceptable,complete the Certificate for Payment on G702/CMa.The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201/CMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded • to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. r; Change Orders:Although Change Orders could be incorporated by changing the schedule of lues 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.a[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,forr: Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. - E.Making Payment 'i- v The Owner should make payment directly to the Contractor based on the amount certified bit the;Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The conipleeted.form contains the name and address of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G702/CMa TM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed. To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. f4AIA Document G703 - 1992 /&4--- z96 Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 32 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. 03/30/2011 ARCHITECT'S PROJECT N0: 03/30/2011 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO RETAINAGE NO. FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G_C> FINISH (NOT IN TO DATE (C G) RATE) (D-E) D OR E) (D+E+F) 100 BASEMENT FRAME MATL 107,259.00 107,259.00 107,259.00 100.00 101 BASEMENT FRAME LABOR 85,992.00 85,992.00 85,992.00 100.00 102 BASEMENT HANG MATL 125,006.00 125,006.00 125,006.00 100.00 103 BASEMENT HANG LABOR 133,158.00 133,158.00 ._ 133,158.00 100.00 104 ORCHESTRA FRAME MATL 118,670.00 118,670.00 118,670.00 100.00 105 ORCHESTRA FRAME LAB 100,713.00 100,713.00 100,713.00 100.00 106 ORCHESTRA HANG MATL 124,796.00 124,796.00 124,796.00 100.00 107 ORCHESTRA HANG LAB 141,631.00 141,631.00 141,631.00 100.00 108 BALCONY FRAME MATL 108,051.00 108,051.00 108,051.00 100.00 109 BALCONY FRAME LABOR 92,419.00 92,419.00 92,419.00 100.00 110 BALCONY HANG MATL 1 15,731.00 115,731.00 115,731.00 100.00 111 BALCONY HANG LABOR 129,223.00 129,223.00 129,223.00 100.00 112 BOX TIER FRAME MATL 135,171.00 135,171.00 135,171.00 100.00 113 BOX TIER FRAME LABOR 113,521.00 113,521.00 113,521.00 100.00 114 BOX TIER HANG MATL 140,350.00 140,350.00 140,350.00 100.00 115 BOX TIER HANG LABOR 178,584.00 178,584.00 178,584.00 100.00 116 ATTIC FRAME MATL 102,176.00 102,176.00 102,176.00 100.00 117 ATTIC FRAME LABOR 87,922.00 87,922.00 87,922.00 100.00 118 ATTIC HANG MATL 90,226.00 90,226.00 90,226.00 100.00 119 ATTIC HANG LABOR 110,889.00 110,889.00 110,889.00 100.00 120 ACOUS CEILING MATL 52,941.00 52,941.00 52,941.00 100.00 • PAGE TOTALS : 2,394,429.00 2,394,429.00 .00 .00 2,394,429.00 .00 .00 . CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM-1992.Copyright©1963,1965,1966 1967,1970,1978, 1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent " possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. iAIA 0-i cr. A Document G703 TM - 1992 Instructions Continuation Sheet -.GENERAL.INFORMATION - - ", Purpose-and-Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are - - covered'in-AIA Document A201,General Conditions of the Contract for Construction. ,,Use-of-Current Documents. Prior to using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent 'edition I } ' Reproductions.Thisldocument 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 G703,but only for use in connection with A particular project.The AIA will not perniit,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. / ,' ' ' COMPLETING THE G703 FORM: • I,' -" i Heading(This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. - ' • Columns A,B,&-C:These columns should,be completed by identifying the various portions of the Project and their scheduled values consistent with the schedule of values submitted to the Architectat the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and shouldfremain 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 Su'm.The total-of column C maybe adjusted/by Change Orders during the Project. Column D:,Enter in this.columh 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 in the project that were listed on the previous applicatiibn 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 cover`s-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/Ow-Fier-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 columnE(Work Completed-This Period). Column G:Enter he're_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 the column G(Total Completed and Stored to Date).• Column-1:-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 retainege,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 the 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 of the G702 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 indispute should be dealt with according to Section 7.3 in A201. The following is,an example of a`Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to 'reflect actual construction-costs. ' A B C D I E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE --_DESCRIPTION OF WORK (G-C) FINISH NO. .VALUE PREVIOUS STORED AND STORED IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C-G) 1 MOBILIZATION , I 5.000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL I 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK I 15,000 10.000 5.000 0 15.000 100 0 • 4 LOWER RETAINING WALL 10.000 0 5.000 0 5,000 50 5,000 5 CURBS&MISC.CONC. 5,000 0 0 0 0 0 5.000 6 PAVING.UPPER DRIVE 20.000 0 0 0 0 0 20.000 7 PAVING,LOW EP.D RIVE I 20.000 0 0 0 0 0 20.000 S PAVERS 20,000 0 0 10.000 10.000 50 10,000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 II 100.000 LU.000 10.000 10.000 40.000 05.000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AlA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright©aia.orig. • 17/1.4 (/- 'lade- g4-a6 s ---- 4-qd ditIATA Document G703 1992 • Continuation Sheet . AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 32 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. 03/30/2011 ARCHITECT'S PROJECT NO: 03/30/2011 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE PRESENTLY COMPLETED RETAINAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS % TO STORED AND STORED (IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE (C'_C) FINISH NO. VALUE RATE) (D-E) D OR E) (D+E+F) (C-G) 121 ACOUS CEILING LABOR 40,759.00 40,759.00 40,759.00 100.00 122 INSULATION MATL 82,670.00 82,670.00 82,670.00 100.00 123 INSULATION LABOR 117,330.00 117,330.00 117,330.00 100.00 200 N/S ELIP CLG METAL M 51,331.00 51,331.00 51,331.00 100.00 201 N/S ELIP CLG METAL L 201,384.00 201,384.00 - 201,384.00 100.00 202 N/S ELIP CLG PLAS M 74,360.00 74,360.00 74,360.00 100.00 203 N/S ELIP CLG PLAS L 438,153.00 438,153.00 438,153.00 100.00 204 MAIN ELIP CLG METL M 52,412.00 52,412.00 52,412.00 100.00 205 MAIN ELIP CLG METL L 168,703.00 168,703.00 168,703.00 100.00 206 MAIN ELIP CLG PLASM 71,273.00 71,273.00 71,273.00 100.00 207 MAIN ELIP CLG PLAS L 430,314.00 430,314.00 430,314.00 100.00 208 UP/LOW BALCNY METL M 15,304.00 15,304.00 15,304.00 100.00 209 UP/LOW BALCNY METL L 143,518.00 143,518.00 143,518.00 100.00 210 UP/LOW BALCNY PLAS M 37,975.00 37,975.00 37,975.00 100.00 211 UP/LOW BALCNY PLAS L 633,522.00 633,522.00 633,522.00 100.00 212 BOX TIER/COL METAL M 10,245.00 10,245.00 10,245.00 100.00 213 BOX TIER/COL METAL L 118,363.00 118,363.00 118,363.00 100.00 214 BOX TIER/COL PLAS M 70,300.00 70,300.00 70,300.00 100.00 215 BOX TIER/COL PLAS L 319,455.00 319,455.00 319,455.00 100.00 216 ORCH H/L METAL M 5,317.00 5,317.00 5,317.00 100.00 217 ORCH H/L METAL L 112,967.00 112,967.00 112,967.00 100.00 218 ORCH H/L PLASM 15,260.00 15,260.00 ' 15,260.00 100.00 PAGE TOTALS : 3,210,915.00 3,210,915.00 .00 .00 3,210,915.00 .00 .00 , CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM—1992.Copyright©1963,1965,1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIM 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. /4 =�®��= Document G7O3TM ® 1992 instructions . . Continuation Sheet _: GENERAL INFORMATION . -- Purpose-and-Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with MA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are - covered-in-AIA Document A201,General Conditions of the Contract for Construction. Use of Current Documents. Priorto using any AIA Contract Document,users should consult www.aia.org or a local AIA component to verify the most recent edition I ; '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-thisdocument, 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 G703,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 the1AIA: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. ,././ COMPLETING THE G703 FORM.' ` / Heading This information should be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B,&•C.'These columns should,be completed by identifying the various portions of the Project and their scheduled values 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 Subcontractor .and should/remain consistent throughout the Project.Multiple pages should be used when required. Column C should be subtotaled atihe 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 tie 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).ffom 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 in the project that 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 the 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 s'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 the 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 of the G702 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 indispute``should be dealt with according to Section 7.3 in A201.•' The following isan example of a Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to reflect actual construction-costs. ' A 'B -'C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM , SCHEDULED FROM PRESENTLY COMPLETED To TO RETAINAGE . .DESCRIPTION OF.WORK (G-C) FINISH NO. VALUE PREVIOUS STORED AND STORED (IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (C-G) (D+E) D OR EI (D+E+F) 1 MOBILIZATION I 5.000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL I 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK i 1 15.000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL I 10.000 0 5,000 0 5.000 50 5.000 5 CURBS&MISC.CONC. i 5.000 0 0 0 0 0 5,000 • 6 PAVING:UPPER DRIVE I 20.000 0 0 0 0 0 20.000 7 PAVING,LOWERD_RIVE I 20.000 0 0 0 0 0 20.000 8 PAVERS 20.000 0 0 10.000 10.000 50 10.000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 11 100.000 10.000 10.000 10000 40.000 50.000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.orig. ---4- Document G703 - 1992 Continuation Sheet - AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 32 In tabulations below,amounts are stated to the nearest dollar. PERIOD TO: Use Column I on Contracts where variable retainage for line items may apply. 03/30/201 1 ARCHITECT'S PROJECT N0: 03/30/2011 • •A B C D E F G H I WORK COMPLETED MATERIALS TOTAL ITEM BALANCE DESCRIPTION OF WORK• SCHEDULED PRESENTLY COMPLETED % TO (IF VARIABLE AGE NO. FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G-C) FINISH (NOT IN TO DATE (C G) RATE) (D±E) D OR E) (D+E+F) 219 ORCH H/L PLAS L 315,844.00 315,844.00 315,844.00 100.00 220 4090A GEN.ALLOWANCE 225,000.00 225,000.00 225,000.00 100.00 221 409013 CAD ALLOWANCE 5,000.00 5,000.00 5,000.00 100.00 222 4100A GEN ALLOWANCE 175,000.00 175,000.00 175,000.00 100.00 223 4100B CAD ALLOWANCE 5,000.00 5,000.00 5,000.00 100.00 224 ADDITONAL 4090 ALLOW 29,000.00 29,000.00 29,000.00 100.00 224A DELETE LINE 224 -29,000.00 -29,000.00 -29,000.00 100.00 300 BOND PREMIUM 63,312.00 63,312.00 63,312.00 100.00 301 C.O. #1/CCR#1008 60,100.00 60,100.00 60,100.00 100.00 302 C.O.#2/CCR#1011 27,970.00 27,970.00 27,970.00 100.00 303 C.O. #3/CCR#1012 1,200.00 1,200.00 1,200.00 100.00 304 C.O.#4/CCR#1014 19,800.00 19,800.00 19,800.00 100.00 305 C.O.#5/CCR#1015 31,680.00 31,680.00 31,680.00 100.00 306 C.O. #6/CCR#1016 27,720.00 27,720.00 27,720.00 100.00 308 CO#8/PAC006(C07 0) 20,490.00 20,490.00 20,490.00 100.00 309 CO 9/ALLOWANCE ADJ -226,269.00 -226,269.00 -226,269.00 100.00 310 CO#11/HIGH RAILING 17,740.00 17,740.00 17,740.00 100.00 311 C.O.#12 'DOME STEEL' 48,000.00 48,000.00 48,000.00 100.00 312 CO#13 -RCP "030" 2,296.00 2,296.00 2,296.00 100.00 313 CO#14 ALLOW 4100A 30,000.00 30,000.00 30,000.00 100.00 314 C.O. #15 ALLOW 4100A 30,000.00 30,000.00 30,000.00 100.00 315 C.O. #16/ALLOW 4100A 30,000.00 16,593.43 4,860.88 21,454.31 71.51 8,545.69 JOB TOTALS : 6,515,227.00 6,501,820.43 4,860.88 .00 6,506,681.31 8,545.69 50,000.00 CAUTION:.You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM-1992.Copyright©1963,1965,1966 1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent ' possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. Mini ®,== Document G703TM - 1992 Instructions . • Continuation Sheet GENERAL INFORMATION Purpose-and Related Documents. AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with AIA Document G703, Continuation Sheet.These Documents are designed for use on Projects where the Contractor has a direct Agreement with the Owner. Procedures for their use are -- covered-in-AIA Document A201,General Conditions of the Contract for Construction. • Use-of-Current Documents. Prior to using any AIA Contract Document, users should consult www.aia.org or a local AIA component to verify the most recent edition {' 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 thisdocument,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 G703,but only for use in connection with a particular project.The AIA will not perrriit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of Written permission from thefAIA.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.. ,,,'Y ` ' COMPLETING'THE G703 FORM. f Heading This information should : be completed in a manner consistent with similar information on AIA Document G702,Application and Certificate for Payment. Columns A,B, &•C:These columns should.be completed by identifying the various portions of the Project and their scheduled values 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 shouldremain 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 maybe adjustediby Change Orders during the Project. .Column D;Enter in this,colt mn the amount of completed Work covered by the previous application(columns D&E from the previous application).Values from 'column1F,(Materials Presently Stored)from the previous application should not be entered in this column. Column'E:Enter herejthe value of,Work completed at the time of this application,including the value of materials incorporated in the project that 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 the1Owrler 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 totalof 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 the column G(Total Completed and Stored to Date). Column-I:1T6is column is normally used onIy 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'o_l erall-contract amount. rChangg 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-dbrie.Usually,Change Orders,are listed separately,either on the 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 of the G702 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 indispute'should be dealt with according to Section 7.3 in A201. The following is,an example of a Continuation Sheet for work in progress.Please note that dollar amounts shown are for illustrative purposes only,and are not intended to - reflect-actual construction costs. A B. C D E F G H I . WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO IRETAINAGE NO. DESCRIPTION OF WORK VALUE PREVIOUS STORED AND STORED '(IF VARIABLE THIS PERIOD (G-C) FINISH APPLICATION (NOT IN TO DATE (C GI RATE) (D+E) DOREI (D+E+F) 1 MOBILIZATION 5.000 5.000 0 0 5.000 100 0 2 STUMP REMOVAL 5.000 5.000 0 0 5.000 100 0 3 EARTH WORK E 15,000 10.000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL', 10,000 0 5.000 0 5.000 50 5.000 5 CURBS&MISC.CONC. ( 5.000 0 0 0 0 0 5,000 6 RAVING,UPPER DRIVE E 20,000 0 0 0 0 0 20.000 7 PAVING,LOWER D_RIVE_ _' 20.000 0 0 0 0 0 20.000 8 PAVERS 20,000 0 0 10.000 10.000 50 10,000 9 BRICK WORK 5.000 0 0 0 0 0 5.000 10 U (00.000 50.000 10,000 10,000 40,000 Nb.000 AIA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright law and International Treaties.Unauthorized reproduction or distribution on this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.orig. AFFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW • STATE OF INDIANA COUNTY OF MARION SS: JOHN M.ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS,LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS: INTERIOR FINISHES FOR A PROJECT KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF SIX MILLION ONE HUNDRED EIGHTY THREE THOUSAND SEVENTY THREE DOLLARS AND 88/100 ($6,183,073.88) XX RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN,WHICH IS GIVEN TO AND FOR SAID AMOUNT,EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER)THAT THIE FINAL BALANCE DUE IS THE SUM OF: RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED,ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO,AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RIGHT TO A LIEN ON ACCOUNT 0 WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR SAID PRO •` AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR. SYSTEMS,LLC a / TITLE: PRESIDENT I ' i,Yi, l- 4 N TAR .1i,`$W:4140T" DAY OF MARCH,2011 •• A HY A. ' IND r , OTARY PUBLIC• MY COMMISSION EXPIRES: 02/61/201' E 4 Li 1 g: RESIDENT OF JOHNSON COUNTY Kati. p. y �f M 9e CIRCLE B CONSTRUCTION SYSTEMS, LLC OWNER: 03/30/2011 CARMEL REDEVELOPMENT COMMISSION CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695-4090 DRYWALL PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION NO. AMOUNT PAID #1 $ 56,980.80 #2 $ 8,369.42 #3 $ 16,209.00 #4 $ 44,810.04 #5 $ 57,634.11 #6 $ 76,202.64 #7 $ 201,168.08 #8 $ 169,090.74 #9 $ 280,896.48 #10 $ 35,997.80 #11 $ 8,465.60 #12 $ 437,984.92 #13 $ 514,933.22 #14 $ 357,219.33 #15 $ 546,768.67 #16 $ 621,587.91 #17 $ 622,044.57 #18 $ 438,354.80 #19 $ 604,713.75 #20 $ 226,649.20 #21 $ 124,747.88 #22 $ 282,108.48 #23 $ 48,000.00 #24 $ 191,157.86 #25 $ 115,754.99 #26 $ 40,906.16 #27 $ 4,298.72 #28 $ 18,231.71 #29 $ 31,787.00 TOTAL PAID TO DATE $ 6,183,073.88 C ' ' : J'1• ' RUCTION SYSTEMS• 1.13 , ��ABB•TT, PRESIDENT /