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HomeMy WebLinkAboutCIRCLE B CONSTRUCTION SYSTEMS -002164 -8/18/2011 CARMEL REDEVELOPMENT COMMISSION 002164 Circle B Construction Systems Check: 2164 5636 S Meridian St Date: 8/18/2011 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 35 10,000.00 10,000.00 0.00 0.00 10,000.00 Application 35 10,000.00 10,000.00 0.00 0.00 10,000.00 , itiCAIA TM Document G702/CMa - 1992 . Application and Certificate for Payment Construction Manager-Adviser Edition 3 9 TO OWNER: PROJECT: APPLICATION NO: 35 Distribution to: C A u r REDEVELOPMENT PME T .C l I ION OWNER ❑ �tiRl1LE nEBE�TtLOrr1rI31 �OPu11SS10LV CARMEL PERFORMING ARTS CENTER PERIOD TO: /-;� /-,r„ , ONE CIVIC SQUARE 7/ LO/ LV11 lCCARMEL, IN 46032 CONSTRUCTION MANAGER ❑ FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE B CONSTRUCTION SYSTEMS SHIEL SEXTON COMPANY PROJECT NOS: / / CONTRACTOR ❑ 5 3 MERIDIAN nm �u�6 S. r1LiC1111ti1V Jl. VIA ARCHITECT: • FIELD ❑ INDIANAPOLIS T11 //-'11 / /.!�n , 11V 4UL1/ 2695-4090 INTERIOR FINISHES CSO ARCHITECT.S CONTRACT FOR: I TERIOR F11v1JHES ❑ 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,t•a all amounts have been paid by the Contractor for Work for which previous Certificates for ,'5.1 were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 6,394,500.00 payment so:• n ''•�, . now due. 2.Net change by Change Orders $ 137,392.00 CON •i�CTO- Tr, Ti nn mmn 1nm TnA1 nvn mnnln r T n LL, D Ul/INJ 1nUL 11VLV JSJ 1L'1.1J, LLI.+ 3.CONTRACT SUM TO DATE(Line 1 ±2) $ 6,531,092.00 By: ��� Date:_..,ti/ 2.0 2C I I B. Js2 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 6,523,346.31 State o;./ i,1nT A � 014�`'Br, 11VL1 ri-i t, ••e°°'.°.°°°• P'��r 5.RETAINAGE: Cow y of: ° �;;, a. %of Completed Work S scribed and op n to efore �•° •, c ATi1',A>,GINDER: (Column D+Eon G703) $ me this I ' ^TT TT /� C ' V r Lo J u V,1 1JOTAI4Y PUBL10'ST.T>;OFaNDIANA`' b. %of Stored Material Notary Publi r' % 0.,mJ HNSON°t�AU c (Column F on G703) $ My Commissi i e : MY COMMISSION L�XB, 1 tra ( ) Y se-z•• � . _ Total Retainage(Lines 5a+5b or Total in Column I of G703).. $ -0- CERTIFICATE F PAYMENT r °'p•� ®••• ,>•�• In accordance with the Contract Documents, based on on-site observati n��and�1`theaata comprising 6.TOTAL EARNED LESS RETAINAGE $ 6,5 i 3.1/46- i this • application,the Construction Manager and Architect certify to the Own'e'r°•tT/?t'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 $ 6,513,346.31 accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE $ 10,000.00 AMOUNT CERTIFIED $ IQs l//��YJtC°7��tu�� 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fro tie rmount applied. Initial all figures on this Application and on tl a ontinuation Sher that re cha ged to conform with the a nouns certified.) (Line 3 less Line 6) $ o,546.69 CONS ' CTION MA rf ER 1 By: \Wsj ::� 4 - ` i _/ Date: CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHI T "� f , Total changes approved in previous months by Owner $ $ B __ — I By: �I�� _...._.. Date: � i2� 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. </ Q19 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. • w. Le AI „raw:. Arig 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 OR a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. 2 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 fom or:at he 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 forrn. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated intopne or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A2t/CMa:} E.Making Payment `'`� The Owner should make payment directly to the Contractor based on the amount certified y,,tthe.Construction Manager arid.Architect on AIA Dociirffient G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The complete>r1 fortxl contains the name an Address of the Contracigr.Payment should not be made to any other party unless specifically indicated on G702/CMa. t; N 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. /,' � ..),,,..AIA Document G703TM - 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: 35 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 07/28/2011 07/28/2011 A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM PRESENTLY COMPLETED ° RETAINAGE DESCRIPTION OF WORK SCHEDULED FROM PREVIOUS �0 TO STORED AND STORED (G_C) FINISH NO VALUE (IF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D-E) D OR E) (D+E+F) (C-G) 103 BASEMENT FRAME MATL 107,259.00 107,259.00 107,259.00 100.0) 101 BASEMENT FRAME LABOR 85,992.00 85,992.00 85,992.00 100.00 102 BASEMENT HANG MATL 125,006.00 125,006.00 125,006.00 100.0) 103 BASEMENT HANG LABOR 133,158.011 133,158.00 133,158.00 100.0) 104 ORCHESTRA FRAME MATL 118,670.00 118,670.00 118,670.00 100.0) 105 ORCHESTRA FRAME LAB 100,713.011 100,713.00 100,713.00 100.0) 105 ORCHESTRA HANG MATL 124,796.00 124,796.00 124,796.00 100.0) 107 ORCHESTRA HANG LAB 141,631.00 141,631.00 141,631.00 100.0) 103 BALCONY FRAME MATL 108,051.011 108,051.00 108,051.00 100.00 109 BALCONY FRAME LABOR 92,419.00 92,419.00 92,419.00 100.00 110 BALCONY HANG MATL 115,731.00 115,731.00 115,731.00 100.0) 111 BALCONY HANG LABOR 129,223.00 129,223.011 129,223.00 100.0) 112 BOX TIER FRAME MATL 135,171.011 135,171.011 135,171.00 100.00 113 BOX TIER FRAME LABOR 113,521.011 113,521.00 113,521.00 100.00 114 BOX TIER HANG MATL 140,350.00 140,350.00 140,350.00 100.0) 115 BOX TIER HANG LABOR 178,584.011 178,584.00 178,584.00 100.0) 115 ATTIC FRAME MATL 102,176.011 102,176.00 102,176.00 100.00 117 ATTIC FRAME LABOR 87,922.00 87,922.00 87,922.00 100.0) 118 ATTIC HANG MATL 90,226.011 90,226.00 90,226.00 100.0) 119 ATTIC HANG LABOR 110,889.00 110,889.00 110,889.00 100.0) 12) ACOUS CEILING MATL 52,941.00 52,941.00 52,941.00 100.0) PAGE TOTALS : 2,394,429.01 2,394,429.10 .0C .0C 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. 1!AIA M Document G703 - 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 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. COMPLETING THE G703 FORM. Heading:This information should be completed in a manner consistent with similar information on AlA 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: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 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 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 STORED AND STORED ( ) FINISH (IF VARIABLE NO. VALUE PREVIOUS G-C APPLICATION THIS PERIOD (NOT IN TO DATE RATE) - fD+E) D OR El ID+E+F) IC 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 5 EARTH WORE 15 000 10.000 5.000 0 15.000 100 0 4 LOWER RETAINING WALL 10000 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 20000 7 PAVING.LOWER DRIVE 20.000 0 0 0 0 0 20.000 & PAVERS 20.000 0 0 10.000 10000 50 10.000 9 BRICK WORT: 5.000 0 0 0 0 0 5.000 10 100.000 20.000 10.000 WW.000 40.000 55.000 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 / ii g Vtle- 9(C--.Ve4 . . , , 1-424AIA Document G703 - 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 T0: 35 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 07/28/2011 07/28/2011 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM 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) 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 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 G703 - 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 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. . 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: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 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 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 NO DESCRIPTION OF WORK VALUE PREVIOUS STORED AND SPORED THIS PERIOD (G-C) FINISH OF VARIABLE APPLICATION (NOT IN TO DATE IC-GI RATE) (D+E) DOR E( ID+E+FI 1 M06ILIZA11ON 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 10000 5.000 0 15000 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.LOWER DRIVE 20000 0 0 0 0 0 20.000 8 PAVERS 20000 0 0 10.000 10.000 50 10,000 SPICY.WORK 5000 0 0 0 0 0 5.000 10 11 105.000 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 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. 1-WAIA Document G703 - 1992 (10 !/ . 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: 35 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 07/28/2011 07/28/2011 A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM DESCRIPTION OF WORK SCHEDULED PRESENTLY COMPLETED % TO RETAINAGE FROM PREVIOUS STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (C-'-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 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(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 21,454.31 21,454.31 71.51 8,545.69 PAGE TOTALS : 909,883.00 901,337.31 .00 .00 901,337.31 8,545.69 .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 G703T",—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. • -A eAIA 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 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, 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 Dr 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 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 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 C H 1 WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAINAGE NO. DESCRIPTION OF WORK VALUE PREVIOUS STORED AND STORED (IF VARIABLE THIS PERIOD fG-C) FINISH APPLICATION (NOT IN TO DATE (C-G) RATE) ID+El DOREI ID+E+F) 1 MOBILIZATION 5000 5000 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 15000 100 0 4 LOWER RETAINING WALL 0000 0 5.000 0 5.000 50 5.000 5 CURBS&MISC.CONC. 5.000 0 0 0 0 0 5000 6 PAVING.UPPER DRIVE 20.000 0 0 0 0 0 20.000 7 PAVING.LOWER DRIVE 20.000 0 0 0 0 0 20000 8 PAVERS 20.000 0 0 10,000 10.000 50 10.000 BRICK WORK 5000 0 0 0 0 0 5.000 10 l 100.000 50.000 10.000 10.000 40.000 65.000 . 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. oiw� �l/ d 4,44AI gpa -- . ._._ wk, � Document G7O3TM - 1992 Continuation Sheet AlA 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: 35 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT N0: 07/28/2011 07/28/2011 A B C D E F 0 H I WORK COMPLETED MATERIALS TOTAL. PRESENTLY COMPLETED BALANCE RETAINAGE ITENI DESCRIPTION OF WORK SCHEDULED TO NO FRONI PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (G-C) FINISH (NOT IN TO DATE (C G) RATE) (D=E) DORE) (D+E+F) 316 CO#17/BOX TIERS 16,665.00 16,665.00 16,665.00 100.00 JOB TOTALS : 6,531,892.00 6,523,346.31 .00 .00 6,523,346.31 8,545.69 .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. s-livaltAIA 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 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. 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: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 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 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 P G t{ I WORK COMPLETED MATERIALS TOTAL BALANCE ITEM SCHEDULED FROM PRESENTLY COMPLETED % TO RETAI AGE DESCRIPTION OF WORK STORED AND STORED NO. VALUE PREVIOUS (G=C) FINISH IIF VARIABLE APPLICATION THIS PERIOD (NOT IN TO DATE RATE) (D+E) OR E) (D+E+F) 1 005ILIZATION 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 10000 0 5.000 0 5,000 50 5.000 5 CURDS&MISC.CONC. 5.000 0 0 0 0 0 5.000 6 PAVING.UPPER ORE'S 20000 0 0 0 0 0 20.000 7 PA19NG.LOWER 0,21VE 20.000 0 0 0 0 0 20.000 & PAYERS 20.000 0 0 10.000 10.000 50 10.000 DRICK WORK 5000 0 0 0 0 0 5.000 10 11 100.000 ,0.000 10.000 10.000 40.000 00.000 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: JOI—fl M. ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC 1-LAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS: INTERIOR FINISFIES FOR A PROJECT KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTI-IER STATE OF BEHALF OF THE AFOREMENTIONED SUBCONTRACTOR/SUPPLIER: PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF Six Million Five Hundred Thirteen Thousand Three Hundred Forty Six Dollars and 31/100 ($6,513,346.31) XX RECEIPT OF WHICI-I IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WI-IICH FIAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR TI-IIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; (FINAL WAIVER)THAT TI-llE FINAL BALANCE DUE IS THE SUM OF: RECEIPT OF WI-IICI-I 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 WI-IATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISI-IED 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 FO A 41 PROJECT AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. I i CIRCLE B CONSTR. SYSTEMS, LLC BY I • TITLE: PRESIDENT t.iki.5;1;5:,,,.•t 1°.`to`t`_ N 0 / 1� r S NIY ID NDNOTA, LSE_L-TI-IIS 8TI-1 DAY°OFJULY, 201I �• }' _ 4 i '' 164<R)(1-3U D L I C ? ,; s mot", (..._ MY COM ( SSION EXPIRES: 02/01/2017 "�'Q''. °``'' <•",, RESIDE OF JOHNSON COUNTY , ) 'v•._..; `' CIRCLE B CONSTRUCTION SYSTEMS, LLC OWNER: 07/28/2011 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 #30 $ 218,746.55 #31 $ 50,000.00 #32 $ 4,860.88 #33 $ 16,665.00 #34 $ 40,000.00 TOTAL PAID TO DATE $ 6,513,346.31 CIRCLE B CONSTRUCTION SYSTEMS,JOHN M. ABBOTT- PRESIDENT Prescribed by State Board of Accounts City Form No.201(Rev.1995) ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Cf''a/P Ca.75/�uc' Purchase Order No. S�36 S 5/ Terms /7/- i , '{/2/7 Date Due Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) ,?/// 3S /7", 5 0,7 7 /6a Total /G 7c%UU I hereby certify that the attached invoice(s), or bill(s), is (are) true and corre -•• save -_dited same in accordance with IC 5-11-10-1.6. 8-1-1- , 20 U L�r►"i -C1Ct kr-Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 C(ei 'c(y, Coy574rcrcf u', 5.7-s74,—«.5 IN SUM OF $ 56 3 2 S st. /4 2/7 $ l0 OOo,O o ON ACCOUNT OF APPROPRIATION FOR Board Members PO#or INVOICE NO. ACCT#/TITLE AMOUNT DEPT.# I hereby certify that the attached invoice(s), or god 3 5 h'y6G?o7 i6;cex..aa bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 8-3 20// ignature - , - Cost distribution ledger classification if claim paid motor vehicle highway fund