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W R DUNKIN & SONS, INC. -001686 -3/3/2011
CARMEL REDEVELOPMENT COMMISSION 001686 i W R Dunkin & Son, Inc. Check: 1686 PO Box 2247 Date: 3/3/2011 Anderson, IN 46018 Vendor: DUNKINW1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-1 68 53,200.00 2,800.00 0.00 0:00 2,800.00 Application 1 on Energy Center 23 51 312.00 312.00 0.00 0.00 312.00 Application 23 34A 35 9,666.00 9,666.00 0.00 0.00 9,666.00 Appliction 34A on P7 63,178.00 12,778.00 0.00 0.00 12,778.00 \ k�% TM AIA Document 6732 ® 2009 6 r, �s '� Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: Carmel Redevelopment PROJECT: PARCEL 7C,#1000 CAMEL APPLICATION NO:003 DISTRIBUTION TO: Commission PERFORMING ARTS OWNER One Civic Square 777 3RD AVE S.W. PERIOD TO:January 12,2011 CONSTRUCTION MANAGER Carmel,IN 46032 CARN4EL, TN 46032 ARCHITECT FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Slid Sexton Co.,Inc. CONTRACT DATE:January 04,2010 CONTRACTOR CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: / / FIELD Anderson,IN 46018 OTHER CONTRACT FOR: General Construction VIA ARCHITECT: CSO Architects CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and belief the Work covered by this Application for P vent has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have beet aid ie Contractor for Work for which previous MA Document G703TM Continuation Sheet,is attached. Certificates for Payment t e issue. . . p n-d(s •-ceived from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 56,000.00 payment shown . :in is-. due. 2.NET CHANGES IN THE WORK $ 0.00 CO i�ttytT' W`. ' 0) ' INC. 3.CONTRACT SUM TO DATE(Line 1 f 2) $ 56,000.00 B) w,`f( ,AIL______ Date: January 12,2011 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ 56,000.00 Sta ' o • - . ana 5.RETAINAGE: C•unty of:Madison a. 0 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 0.00 me this 12th day of% Janua` 2010 ' b. 0 of Stored Material Notary Public:Martha A.Carpenter /� (Column Fon G703) $ 0.00 My Commission expires:January 08,2017 Total Retainage(Lines 5a+5b, or Total in Column Ion G703) $ 0.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 56,000.00 In accordance with the Contract Documents, based on evaluations of the Work and the data (Line 4 minus Line 5 Total) comprising this application,the Construction Manager and Architect certify to the Owner that to the 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 53,200.00 best of their knowledge, information and belief the Work has progressed as indicated, the quality of (Line 6 from prior Certificate) the Work is in accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. � � 8.CURRENT PAYMENT DUE L 2,800.00 AMOUNT CERTIFIED .. $ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs fron the.mount applied. Initial all figures on this Application and. 1e Continuation Sheet at ar:chat ged to con form with the amount certified.) (Line 3 minus Line 6) $ 0.00 CON '.,CTfON �E�� D BY: �,Lr -- -IZ�+�fa. Date: +/ 7j1 JII SUMMARY OF CHANGES IN TILE WORK ADDITIONS DEDUCTIONS ARC"' CT: I T''.'If lultiple Prime Contractors are responsible for perform ting p rtions of the Project,*the Architect's( rfil cation is not required.) 4 Total changes approved in previous months by Owner$ 0.00$ 0.00 By: _° " Date: &Li 3\ \ 1 t Total approved this month including Construction — t $ 0 Change Directives 0.00 $ 0.00 This toet:tllrc t •, negotiable. The nivivUNT CERTIFIED is payable only to the Contractor TOTALS $ 0.00 $ 0.00 named herein.—Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES IN THE WORK $ 0.00 the Owner or Contractor under this Contract. AIA Document G732"—2009(formerly G702T'"CMa-1992).Copyright 01992 and 2009 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 1 to the maximum extent possible under the law.This document was produced by AIA software at 12:08:28 on 01/12/2011 under Order No.0168420739_I which expires on 05/10/2011,and is not for resale. User Notes: Director of Redevelopment {1499810356) • It Document G703 - 1992 Continuation Sheet AIA Document,G702Tm-1992,Application and Certification for Payment, or G73&' -2009, APPLICATION NO: 003 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE:01/12/2011 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO: 01/12/2011 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C D E F G H I - WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH. (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G '.-C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE} (D+E) (D+E+F) PERFORMANCE 01010 BOND 1,200.00 1,200.00 0.00 0.00 1,200.00 100.00% 0.00 0.00 MOBILIZE/ 01020 DEMOBILIZE 1,000.00 1,000.00 0.00 0.00 1,000.00 100.00% 0.00 0.00 SUPERVISION/ 01030 COORDINATION 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 0.00 GENERAL 01040 CONDITIONS-M 3,000.00 3,000.00 0.00 0.00 3,000.00 100.00% 0.00 0.00 GENERAL 01050 CONDITIONS-L 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 0.00 GENERAL CLEAN 01510 UP-M 500.00 500.00 0.00 0.00 500.00 100.00% 0.00 0.00 GENERAL CLEAN 01520 UP-L 1,000.00 1,000.00 0.00 0.00 1,000.00 100.00% 0.00 0.00 FINAL CLEANING 01530 (ITEMS IN BP 501.0) 1,000.00 1,000.00 0.00 0.00 1,000.00 100.00% 0.00 0.00 02010 DEMOLITION -M 3,500.00 3,500.00 0.00 0.00 3,500.00 1.00.00% 0.00 0.00 02020 DEMOLITION-L 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 0.00 04010 MASONRY 2,800.00 2,800.00 0.00 0.00 2,800.00 100.00% 0.00 0.00 06210 CARPENTRY-M 4,600.00 4,600.00 0.00 0.00 4,600.00 1.00.00% 0.00 0.00 06220 CARPENTRY-L 4,600.00 4,600.00 0.00 0.00 4,600.00 100.00% 0.00 0.00 09010 FINISHES 8,200.00 8,200.00 0.00 0.00 8,200.00 100.00% 0.00 0.00 10010 SPECIALTIES 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 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 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 I prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 12:09:49 on 01/12/2011 under Order No.0168420739_1 which expires on 05/1012011,and is not for resale. User Notes: (1886670404) I A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO -- FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED (G C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) GRAND TOTAL $56,000.00 $56,000.00 $0.00 $0.00 $56,000.00 100.00% $0.00 $0.00 AIA Document G703T"--1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 12:09:49 on 01/12/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. " User Notes: (1886670404) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [ X]PARTIAL [ ]PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son. Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 1000-Engery Center P7C for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel. Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 1 has been received for work performed through 09/30/10. (PARTIAL WAIVER)that there is due from the contractor the sum of Fifty Thousand Four Hundred One dollars and 00/cents ($ 50,400.00 ) Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ 00.00 ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or co ditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien .- .cco.nt of.• • work performed or material furnished to the undersigned for said project n th• Cope • thi a fl davi . • waiver. W. R.Dunkin&Son, Inc. B .1L/`/ Title:Project Manager i WITNESS MY HAND AND NOTARIAL SEAL,this 12th day of January ,2010 ■led, '4, (Notary Pus c) My Commission Expires: January 07,2017 Printed Martha A. Carpenter Residing in Madison County AFFIDAVIT AND WAIVER AIVER OF LIEN [ ]FINAL [ X]PARTIAL [ ]PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 1000-Engery Center P7C for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel,_ Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 2 has been received for work performed through 10/31/10. (PARTIAL WAIVER)that there is due from the contractor the sum of Two Thousand Eight Hundred One dollars and 00/cents ($ 2,800.00 ) Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($00.00 ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to . lien o .tco of any work performed or material furnished to the undersigned for said prof-ex. a.e .m t s ope o his of n avit and •-r. W. R. Dunkin& Son,Inc. ' �� ` Title:Project Manager WITNESS MY HAND AND NOTARIAL SEAL,this 12th day of January ,2010 AZ,t-r/IA___./4' ',C(/ --`t- (Notary Pup/c) My Commission Expires: January 07,2017 Printed Martha A. Carpenter Residing in Madison County CONSENT OF AO CNHITRECT ❑ SURETY COMPANY CONTRACT ❑ OR TO FINAL PAYMENT SURETY OTHER AIA DOCUMENT G707 PRF7612829 00 PROJECT: Parcel 7C— Energy Center: Phase I I Expansion, 777 VI Ave. S.W., Carmel, IN 46032 (name, address) TO (Owner City of Carmel, Indiana 7 ARCHITECT'S PROJECT NO: One Civic Square CONTRACT FOR: Parcel 7C—Energy Center: Phase I I Carmel, IN 46032 Expansion CONTRACT DATE: January 4, 2010 CONTRACTOR: W.R. Dunkin & Son, Inc. In accordance with the provisions of the Contract between the Owner and the Contractor as indicated above, the (here insert name and address of Surety Company) FIDELITY AND DEPOSIT COMPANY OF MARYLAND ,SURETY COMPANY, 9229 Delegates Row, Suite 300 Indianapolis, IN 46240 on bond of (here insert name and address of Contractor) W.R. Dunkin & Son, Inc. 2911 Enterprise Drive , CONTRACTOR, Anderson, IN 46013 hereby approves of the final payment to the Contractor, and agrees that final payment to the Contractor shall not relieve the Surety Company of any of its obligations to (here insert name and address of Owner) City of Carmel, Indiana, One Civic Square, Carmel, IN 46032 , OWNER, as set forth in the said Surety Company's bond. IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this .12`h day of January 2011 FIDELITY AND DEPOSIT COMPANY OF MARYLAND Surety Company BY: e Attest: Signature of Authorized resen ative (Seal): - Carol J. Hudson, Attorney-In-Fact Title Attorney-In-Fact NOTE: This form is to be used as a companion document to AIA DOCUMENT G706, CONTRACTOR"S AFFIDAVIT`OF-PAYMENT OF DEBTS AND CLAIMS, Current Edition AIA DOCUMENT G707 • CONSENT OF SURETY COMPANY TO FINAL PAYMENT • APRIL 1970 EDITION • AIA® ONE PAGE ©1970 • THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C.. 20006 Power of Attorney FIDELITY AND DEPOSIT COMPANY OF MARYLAND KNOW ALL MEN BY THESE PRESENTS: That the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, a corporation of the State of Maryland, by THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, Assistant Secretary, in pursuance of authority granted by Article VI, Section 2, of the By-Law e id Company, which are set forth on the reverse side hereof and are hereby certified to be in full force and eff-.t a a tdal -reof, does hereby nominate, constitute and appoint Paula SOLLARS and Carol J. HUD I 1614 rso 1 y,i►ana, EACH its true and lawful agent and Attorney-in-Fact,to make, execute, seal .,• `:'rte 1j oe ',a&WIMP'y, and as its act and deed: any and all bonds and undertakings, and t i • :nom':"h b e�a— �e� "gs in pursuance of these presents, shall be as binding upon said Co. ..∎, y,c • a •al. c - 1 t$ and purposes,as if they had been duly executed and acknowledged b • �g' 1j� ,ti' ctteed goal. It er—pany at its office in Baltimore, Md., in their own proper persons. Th' r, .ehalf of Tim PATISHALL, Paula SOLLARS, Carol J. HUDSON, dated F46749 20�\� 2 ,. The said Assistant %e :Z LesV#e1*eby certify that the extract set forth on the reverse side hereof is a true copy of Article VI, Section 2,of the By-L s lrrsaid.Company,and is now in force. IN WITNESS WHEREOF, the said Vice-President and Assistant Secretary have hereunto subscribed their names and affixed the Corporate Seal of the said FIDELITY AND DEPOSIT COMPANY OF MARYLAND, this 18th day of November,A.D.2009. ATTEST: FIDELITY AND DEPOSIT COMPANY OF MARYLAND �V DEP0.5, O t �Iti va 4'�Al#04 1�JGt f-U/� ' By: Gregory E Murray Assistant Secretary Theodore G. Martinez State of Maryland ss: City of Baltimore On this 18th day of November, A.D. 2009, before the subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified, came THEODORE G. MARTINEZ, Vice President, and GREGORY E. MURRAY, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and they each acknowledged the execution of the same, and being by me duly sworn, severally and each for himself deposeth and saith,that they are the said officers of the Company aforesaid, and that the seal affixed to the preceding instrument is the Corporate Seal of said Company, and that the said Corporate Seal and their signatures as such officers were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. ,It1 N 111111/ ♦ I / I j/ ` 4i i a 0■ Maria D. Adamski Notary Public My Commission Expires: July 8, 2011 POA-F 044-2077 EXTRACT FROM BY-LAWS OF FIDELITY AND DEPOSIT COMPANY OF MARYLAND "Article VI, Section 2. The Chairman of the Board, or the President, or any Executive Vice-President, or any of the Senior Vice-Presidents or Vice-Presidents specially authorized so to do by the Board of Directors or by the Executive Committee, shall have power, by and with the concurrence of the Secretary or any one of the Assistant Secretaries, to appoint Resident Vice-Presidents, Assistant Vice-Presidents and Attorneys-in-Fact as the business of the Company may require, or to authorize any person or persons to execute on behalf of the Company any bonds, undertaking, recognizances, stipulations, policies, contracts, agreements, deeds, and releases and assignments of judgements, decrees, mortgages and instruments in the nature of mortgages,...and to affix the seal of the Company thereto." CERTIFICATE • I, the undersigned, Assistant Secretary of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that the Vice-President who executed the said Power of Attorney was one of the additional Vice-Presidents specially authorized by the Board of Directors to appoint any Attorney-in-Fact as provided in Article VI, Section 2, of the By-Laws of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND. This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at a meeting duly called and held on the 10th day of May, 1990. RESOLVED: "That the facsimile or mechanically reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereafter, wherever appearing upon a certified copy of any power of attorney issued by the Company, shall be valid and binding upon the Company with the same force and effect as though manually affixed." IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the said Company, this day of , 9,0/1 . 4(.,:,_, ,z), Assistant Secretary Jf F A oc ent 706"M ® 1994 Contractor's Affidavit of Payment of Debts and Claims PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER:❑ PARCEL 7C,#1000 CARMEL ARCHITECT:❑ PERFORMING ARTS CONTRACTOR:❑ 777 3RD AVE S.W. CONTRACT FOR: General Construction SURETY:❑ CARMEL,IN 46032 OTHER: ❑ TO OWNER: (Name and address) CONTRACT DATED:January 04,2010 Carmel Redevelopment Commission One Civic Square Carmel,IN 46032 STATE OF: Indiana COUNTY OF:Madison The undersigned hereby certifies that,except as listed below,payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished,for all work,labor,and services performed,and for all known indebtedness and claims against the Contractor for damages arising in any manner in connection with the performance of the Contract referenced above for which the Owner or Owner's property might in any way be held responsible or encumbered. EXCEPTIONS: NONE SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Consent of Surety to Final Payment. Whenever W.R.Dunkin&Son,Inc. Surety is involved, Consent of Surety is PO Box 2247 required. ALA Document G707,Consent of Anderson,IN 46018 Surety,may be used for this purpose Indicate Attachment ® Yes ❑ No `/dAd.1r The following supporting documents should be attached (Signature o ed represe at e) hereto if required by the Owner: Bradley Tyler,P oject Manag 1. Contractor's Release or Waiver of Liens, (Printed name and title) conditional upon receipt of final payment. 2. Separate Releases or Waivers of Liens from Subscribed and sworn to before me on this date: Subcontractors and material and equipment January 12, 2011 suppliers,to the extent required by the Owner, accompanied by a list thereof. Notary Publics/32,12 Martha A. Carpenter 3. Contractor's Affidavit of Release of Liens My Commission Expires: January 08,2017 (A1A Document G706A). AIA Document G706T"—1994.Copyright O 1970 and 1994 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.This document was produced by AIA software at 09:41:13 on 01/12/2011 under Order No.0168420733_1 which expires on 05/10/2011,and is not for resale. User Notes: (1483952723) *AIA TM Document 6706 ® 1994 Contractor's Affidavit of Release of Liens PROJECT: (Name and address) ARCHITECT'S PROJECT NUMBER: OWNER:❑ PARCEL 7C,#1000 CARMEL ARCHITECT:❑ PERFORMING ARTS 777 3RD AVE S.W. CONTRACT FOR: General CONTRACTOR: ❑ CARMEL,IN 46032 Construction SURETY:❑ TO OWNER: (Name and address) CONTRACT DATED: January 04, 2010 Carmel Redevelopment Commission OTHER:❑ One Civic Square Carmel,IN 46032 STATE OF:Indiana COUNTY OF:Madison The undersigned hereby certifies that to the best of the undersigned's knowledge,information and belief, except as listed below,the Releases or Waivers of Lien attached hereto include the Contractor,all Subcontractors,all suppliers of materials and equipment,and all performers of Work,labor or services who have or may have liens or encumbrances or the right to assert liens or encumbrances against any property of the Owner arising in any manner out of the performance of the Contract referenced above. EXCEPTIONS: NONE SUPPORTING DOCUMENTS ATTACHED HERETO: CONTRACTOR: (Name and address) 1. Contractor's Release or Waiver of Liens, W.R.Dunkin&Son,Inc. conditional upon receipt of final payment. PO Box 2247 Anderson,IN 461 (11111.1" 2. Separate Releases or Waivers of Liens from BY: Subcontractors and material and equipment Signature of aut fl suppliers,to the extent required by the Owner, representative accompanied by a list thereof. Bradley Tyler • oject Manager (Printed name and title) Subscribed and sworn to before me on this date: January 2, 2011 Notary Public: d/t Martha A.Carpenter My Commission Expires: January 08,2017 AIA Document G706AT"—1994.Copyright 1t 1982 and 1994 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.This document was produced by AIA software at 09:40:15 on 01/12/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1748198451) \� i A. ,. rfa AIP1. ocument 6732 ® 2009 5 Application and Certificate for Payment, Construction Manager as Adviser Edition TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A,#4050 Carmel APPLICATION NO:034 A DISTRIBUTION TO: Commission Performing Arts OWNER Carmel,N 46032 Carmel, IN 46032 PERIOD TO:January 31,2011 CONSTRUCTION MANAGER FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Shiel Sexton Co.,Inc. CONTRACT DATE:May 08,2008 ARCHITECT CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:25310/2695-4050/2695 CONTRACTOR Anderson,IN 46018 FIELD CONTRACT FOR: Bid Package#4050-General VIA ARCHITECT: CSO Architects OTHER Trades CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Payment has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have beet paid by t - Contractor for Work for which previous AlA Document G703TM,Continuation Sheet,is attached. Certificates for Payment were issued and p. nents 5,-ived from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 9,966,300.00 payment shown here' is no`due. 2.NET CHANGES IN THE WORK $ -60,864.00 CONT •T-• W) DUNK . t . "'ON, NC. 3.CONTRACT SUM TO DATE(Line I f 2) $ 9,905,436.00 By: ._/ .`Z�__/ Date: January 17,2011. 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ 9,303,057.00 State if:Indiana ,LJ 5.RETAINAGE: County of:Madison a. 5 %of Completed Work Subscribed and sworn to before (Column D+FonG703) $ 491,833.80 me this 17th day of Janua y, 011 b. 0 %of Stored Material Notary Public:Martha A.Carpenter (Column F on G703) $ 0.00 My Commission expires:January 08,20 7 Total Retainage(Lines 5a+5b, or Total in Column Ion G703) $ 491,833.80 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 8,811,723.'0 In accordance with the Contract Documents, based on evaluations of the Work and the data (Line 4 minus Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner that to the 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 8,801,557.20 best of their knowledge, information and belief the Work has progressed as indicated,the quality of (Line 6 from prior Certificate) the Work is in accordance with the Contract Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED. . 8.CURRENT PAYMENT DUE $ 9,666.00 AMOUNT CERTIFIED $ 9(.Q�,Q_LA` 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from th- in.unt applied.Initial all figures on this Application and o e Continuation Sh that are hang•d to conform with the amount c ;lied) (Line 3 minus Line 6) $ 1,094,212.80 CONS_RUCTION . •G By: �_.,�/ Viii 11 y: ,:;• �•.•4 Date: SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS ARC.,++' :(16. ";I t uliiple Prime Contractors are responsible,for perform ting p rtions of the Project,-the r_chut P's Certification t ibt required.) p� Total changes approved in previous months by Owner $ 699,466.00$ 760,330.00 By: _Dale: f</ 311 it Total approved this month including Construction Change Directives $ 0.00$ 0.00 This {:_..:.. _ ' to n,v10UNT CERTIFIED is payable only to the Contractor . Issuance,TOTALS $ 699,466.00 $ 760,330.00 named hereince, payment and acceptance of payment are without prejudice to any rights of the Owtr or Contractor under this Contract. NET CHANGES EN THE WORK $ -60,864.00 AMA Document G732TM—2009(formerly G702TMCMa—1992).Copyright@ 1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S. �IOL Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted 1 /.3 to the maximum extent possible under the law.This document was produced by AIA software at 15:20:35 on 01/2012011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1295336247) Director of Redevelopment lit(6 off 07 $1AIA D - 1992 Continuation Sheet AlA Document, G702Tm-1992,Application and Certification for Payment, or G736Tm 2009, APPLICATION NO:034 Project Application and Project Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE: 01/23/1932 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO:01/17/2011 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: 25310 A B C D E F G H 1 WORK COMPLETED TOTAL MATERIALS ITEM. DESCRIPTION OF SCHEDULED PFROM S PRESENTLY COMPLETED AND STORED TO % BALANCE TO RETAINAGE FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D OR.E) (D+E) (D+E+F) PERFORMANCE 01010 BOND 106,000.00 106,000.00 0.00 0.00 106,000.00 100.00% 0.00 10,600.00 MOBILIZE/DEMOB 01015 ILIZE 29,000.00 28,000.00 1,000.00 0.00 29,000.00 100.00% 0.00 1,500.00 SUPERVISION/CO 01020 ORDINATION 361,000.00 359,900.00 1,100.00 0.00 361,000.00 100.00% 0.00 28,480.00 GENERAL 01025 CONDITIONS-M 380,000.00 380,000.00 0.00 0.00 380,000.00 100.00% 0.00 27,000.00 GENERAL 01026 CONDITIONS-L 98,000.00 98,000.00 0.00 0.00 98,000.00 100.00% 0.00 7,000.00 GENERAL 01027 CONDITIONS-O 262,990.00 262,990.00 0.00 0.00 262,990.00 100.00% 0.00 0.00 ALLOWANCE- STONE 140A0 WALKWAY 8,500.00 0.00 0.00 0.00 0.00 0.00% 8,500.00 0.00 ALLOWANCE- TEMPORARY 140B0 HANDRAIL 38,000.00 37,039.00 0.00 0.00 37,039.00 97.47% 961.00 2,77690 ALLOWANCE- . TEMPORARY DOORS/FRAMES/H . 14000 ARDWARE 10,000.00 5,972.00 0.00 0.00 5,972.00 59.72% 4,028.00 ' 0.00 140D0 ALLOWANCE-ICE 13,500.00 2,943.00 0.00 0.00 2,943.00 21.80% 10,557.00 207.10 ALLOWANCE- 140E0 SECURITY 31,000.00 63,836.00 0.00 0.00 63,836.00 205.92% -32,836.00 0.00 140F0 ALLOWANCE- 191,700.00 122,994.00 3,240.00 0.00 126,234.00 65.85% 65,466.00 3,987.90 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 of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 1 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 15:17'59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (927362901) • A B C D E F G H I _ WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM. PRESENTLY COMPLETED BALANCE TO RETAINAGE% PREVIOUS AND STORED TO FINISH (IF VARIABLE APPLICATION (NOT IN D OR NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C-G) RATE .E) ) (D+E) (D+E+F) DUMPSTERS ALLOWANCE- TRAILER 140G0 CONNECTOR 34,000.00 33,500.00 0.00 0.00 33,500.00 98.53% 500.00 2,200.90 ALLOWANCE- TRAILER 140H0 CLEANING 19,169.00 15,720.00 0.00 0.00 15,720.00 82.01 % 3,449.00 1,066.10 ALLOWANCE-SITE 14010 SIGNAGE/SAFETY 22,000.00 11,623.00 0.00 0.00 11,623.00 52.83% 10,377.00 1,055.90 ALLOWANCE- 140J0 GENERAL LABOR 320,000.00 328,204.00 2,131.00 0.00 330,335.00_ 103.23% -10,335.00 594.40 ALLOWANCE- I'EMPORARY FENCE 140K0 MODIFICATIONS 5,000.00 4,008.00 0.00 0.00 4,008.00 80.16% 992.00 400.80 ALLOWANCE-#2 140L0 OR#53 STONE 37,900.00 48,226.00 0.00 0.00 48,226.00 127.25% -10,326.00 1,885.60 ALLOWANCE- WAREHOUSE 140M LEASE/LAYDOWN 0 /PARKING 500,000.00 500,000.00 0.00 0.00 500,000.00 100.00% 0.00 942.70 ALLOWANCE- PARKING LOT INSTALL/MAINTAI 140N1 N 100,000.00 80,324.00 195.00 0.00 80,519.00 80.52% 19,481.00 5,532.40 ALLOWANCE- MAINT.-OFF SITE STAGING/PARKIN 140N2 0 35,000.00 25,115.00 0.00 0.00 25,115.00 71.76% 9,885.00 685.50 ALLOWANCE- PARKING LOT REMO V E/REFURBI 14000 SH 100,000.00 2,745.00 0.00 0.00 2,745.00 2.75% 97,255.00 274.50 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 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 2 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (927362901) A 13 C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE % ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (G-C) (C-G) RATE) (NOT IN D OR E) (D+E+F) (D+E) ALLOWANCE- HAUL/DISPOSE UNSUITABLE 140P0 MATERIAL 25,000.00 14,794.00 0.00 0.00_ 14,794.00 59.18% 10,206.00 1,479.40 ALLOWANCE-6 OZ. GEOTECH 140Q1 FABRIC 4,700.00 0.00 0.00 0.00 0.00 0.00% 4,700.00 320.70 ALLOWANCE- 140Q2 TENSAR GEOGRID 8,500.00 8,126.00 0.00 0.00 8,126.00 95.60% 374.00 0.00 ALLOWANCE-#2 140R0 STONE 26,200.00 23,580.00 0.00 0.00 23,580.00 90.00% 2,620.00 1,027.50 ALLOWANCE- CABLE PASS- 140S0 THRU(FOH) 6,456.00 6,456.00 0.00 0.00 6,456.00 100.00% 0.00 0.00 ALLOWANCE- CABLE PASS- 140T0 THRU(BOH) 5,165.00 5,165.00 0.00 0.00 5,165.00 1.00.00% 0.00 0.00 ALLOWANCE- ]40U CABLE PASS- () THRU(FLOOR) 17,217.00 17,217.00 0.00 0.00 17,217.00 100.00% 0.00 0.00 ALLOWANCE- TEMPORARY ELEVATOR 140V0 USAGE 200,000.00 162,328.00 0.00 0.00 162,328.00 81.16% 37,672.00 0.00 ALLOWANCE- 140W DONOR 0 RECOGNITION 100,000.00 100,000.00 0.00 0.00 100,000.00 100.00% 0.00 0.00 GENERAL 140X0 ALLOWANCE 400,000.00 443,444.00 0.00 0.00 443,444.00 110.86% -43,444.00 598.00 ALLOWANCE-AS- 140Y0 BUILD/CAD 5,000.00 4,242.00 0.00 0.00 4,242.00 84.84% 758.00 0.00 FIELD 01501 OFFICE/STORAGE 16,400.00 16,400.00 0.00 0.00 16,400.00 100.00% 0.00 1,320.00 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 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 3 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. . User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G C) FINISH (IF VARIABLE APPLICATION DATE - (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) TRAILER-M FIELD OFFICE/STORAGE 01502 TRAILER-L 5,500.00 5,500.00 0.00 0.00 5,500.00 100.00% 0.00 405.00 TEMPORARY TOILETS/WASHIN 01503 G STATIONS-M 41,800.00 41,800.00 0.00 0.00 41,800.00 100.00% 0.00 2,860.00 TEMPORARY TOILETS/WASHIN 01504 G STATIONS-L 7,600.00 7,600.00 0.00 0.00 7,600.00 1.00.00% 0.00 555.00 FIRE PROTECTION/EME 01505 RG.STATIONS-M 19,300.00 19,300.00 0.00 0.00 19,300.00 100.00% 0.00 1,930.00 FIRE PROTECTION/EME 01506 RG.STATIONS-L 4,000.00 4,000.00 0.00 0.00 4,000.00 100.00% 0.00 310.00 FURNISH/MAINTA 01507 IN TRASH CANS-M 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 600.00 FURNISH/MAINTA 01508 IN TRASH CANS-L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 2,350.00 TEMPORARY ROAD/MAINTENA 01510 NCE 148,000.00 148,000.00 0.00 0.00 148,000.00 100.00% 0.00 12,220.00 TEMPORARY FENCING- REMOVE/RELOCA 01520 TE 15,800.00 15,800.00 0.00 0.00 15,800.00 100.00% 0.00 1,580.00 TEMPORARY 01521 FENCING-GATES 6,500,00 6,500.00 0.00 0.00 6,500.00 1.00.00% 0.00 650.00 TEMPORARY FENCING- 01522 SCREENING 8,744.00 8,744.00 0.00 0.00 8,744.00 100.00% 0.00 874.40 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 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 4 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10)2011,and is not for resale. . User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO °O FINISH (IF VARIABLE DATE NO. WORK VALUE PREVIOUS THIS PERIOD STORED DATE (G-C) (C G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D ) TEMPORARY 01523 BARRIERS-M 6,800.00 6,800.00 0.00 0.00 6,800.00 100.00% 0.00 680.00 TEMPORARY 01524 BARRIERS-L 7,500.00 7,500.00 0.00 0.00 7,500.00 100.00% 0.00 750.00 TEMPORARY 01530 ENCLOSURES-M 10,800.00 10,800.00 0.00 0.00 10,800.00 100.00% 0.00 1,050.00 TEMPORARY 01531 ENCLOSURES-L 14,000.00 14,000.00 0.00 0.00 14,000.00 1 00.00% 0.00 1,360.00 SCAFFOLDING- SET UP/CONSUMABLE 01540 S 398,000.00 398,000,00 0.00 0.00 398,000.00 1.00.00% 0.00 37,620.00 SCAFFOLDING- MONTHLY RENTAL/INSPECTI 01541 ONS 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 1.0,450.00 SCAFFOLDING- DISMANTLE/REM 01542 OVE 55,000.00 55,000.00 0.00 0.00 55,000.00 100.00% 0.00 0.00 STAIR TOWERS- 01543 SETUP 54,000.00 54,000.00 0.00 0.00 54,000.00 100.00% 0.00 1,800.00 STAIR TOWERS- MONTHLY 01544 RENTAL 28,500.00 28,500.00 0.00 0.00 28,500.00 1.00.00% 0.00 350.00 STAIR TOWERS- 01545 DISMANTLE 6,700.00 6,700.00 0.00 0.00 6,700.00 100.00% 0.00 0.00 HOIST-EXTERIOR- 1546.1 SET UP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00 HOIST-EXTERIOR- RENTAL/OPERATI 1546.2 ON 139,040.00 0.00 0.00 0.00 0.00 0.00% 139,040.00 0.00 HOIST-EXTERIOR- 1546.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00 ' 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 of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 5 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. . User Notes: (927362901) A B C D E F G H 1 WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) ( ) HOIST-STAIR2-SET 1547.1 UP 14,300.00 0.00 0.00 0.00 0.00 0.00% 14,300.00 0.00 HOIST-STAIR 2- RENTAL/OPERATI 1547.2 ON 139,040.00 0.00 0.00 0.00 0.00 0.00% 139,040.00 0.00 HOIST-STAIR 2- 1547.3 DISMANTLE 8,000.00 0.00 0.00 0.00 0.00 0.00% 8,000.00 0.00 HOIST-ROOM 100- 1548.1 SETUP 95,000.00 95,000.00 0.00 0.00 95,000.00 100.00% 0.00 9,500.00 HOIST-ROOM 100- RENTAL/OPERATI 1548.2 ON 211.,000.00 211,000.00 0.00 0.00 211,000.00 100.00% 0.00 16,975.00 HOIST-ROOM 100- 1548.3 DISMANTLE 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00% 0.00 0.00 HOIST- ALLOWANCE-SET 1549.1 UP 9,830.00 0.00 0.00 0.00 0.00 0.00% 9,830.00 0.00 HOIST- ALLOWANCE- RENTAL/OP ERATI 1549.2 ON _ 97,500.00 20,971.00 0.00 0.00 20,971.00 21.51 % 76,529.00 0.00 HOIST- ALLOWANCE- 1549.3 DISMANTLE 2,500.00 0.00 0.00 0.00 0.00 0.00% 2,500.00 0.00 01556 TRASH CHUTES-M. 52,000.00 52,000.00 0.00 0.00 52,000.00 100.00% 0.00 4,490.00 01557 TRASH CHUTES-L 58,000.00 58,000.00 0.00 0.00 58,000.00 1.00.00% 0.00 2,500.00 GENERAL CLEAN 01560 UP-M 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 314.00 GENERAL CLEAN 01561 UP-L 60,000.00 60,000.00 0.00 0.00 60,000.00 100.00% 0.00 3,560.00 01562 FINAL CLEANING 65,000.00 65,000.00 0.00 0.00 65,000.00 100.00% 0.00 0.00 02110 ,EXCAVATION/BA 12,019.00 12,019.00 0.00 0.00 12,019.00 100.00% 0.00 1,201.90 AIA Document G703''-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 AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 6 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05110/2011,and is not for resale. . User Notes; (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D ORE) (D+E) (D+E+F) CKFILL-SUMPS-M EXCAVATION/BA CKFILL-SUMPS-L 02111 EQ 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 2,500.00 02240 SHORING 209,800.00 209,800.00 0.00 0.00 209,800.00 100.00% 0.00 20,980.00 CAST IN PLACE 03301 CONCRETE-M 12,000.00 12,000.00 0.00 0.00 12,000.00 100.00% 0.00 1,000.00 CAST IN PLACE 03302 CONCETE-L 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 3,500.00 PRECAST PLANKS-12" 03410 HOLLOW CORE 161,000.00 161,000.00 0.00 0.00 161,000.00 1.00.00% 0.00 16,100.00 PRECAST PLANKS-12" 03411 SOLID 898,000.00 898,000.00 0.00 0.00 898,000.00 100.00% 0.00 89,800.00 PRECAST 03412 PLANKS-6" SOLID 107,000.00 107,000.00 0.00 0.00 107,000.00 100.00% 0.00 10,700.00 PRECAST 03413 TRUCKING 82,000.00 82,000.00 0.00 0.00 82,000.00 1.00.00% 0.00 8,200.00 PRECAST 03414 ERECTION 186,000.00 186,000.00 0.00 0.00 186,000.00 100.00% 0.00 18,600.00 INTERIOR METAL FABRICATIONS- 05504 SUBMITTALS 102,000.00 102,000.00 0.00 0.00 102,000.00 100.00% 0.00 10,200.00 STEEL STAIRS 05505 WITH RAIL-M: 179,000.00 179,000.00_ 0.00 0.00 179,000.00 100.00% 0.00 14,857.00 STEEL STAIRS 05506 WITH.RAIL-L 80,000.00 80,000.00 0.00 0.00 80,000.00 100.00% 0.00 6,600.00 05507 LADDERS-M 26,000.00 26,000.00 0.00 0.00 26,000.00 100.00% 0.00 2,600.00 05508 LADDERS-L 12,500.00 12,500.00 0.00 0.00 12,500.00 100.00% 0.00 1,220.00 CATWALK 05509 FRAMING-M 63,000.00 63,000.00 0.00 0.00 63,000.00 100.00% 0.00 6,300.00 AMA Document G703"4-1992.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 of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be 7 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. • User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE PREVIOUS AND STORED TO FINISH (1F VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C G) RATE APPLICATION (NOT IN D ORE) ) (D+E) (D+E+F) CATWALK 05510 FRAMING-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,710.00 MISCELLANEOUS 05511 METALS-M 441,000.00 441,000.00 0.00 0.00 441,000.00 100.00% 0.00 13,615.00 MISCELLANEOUS 05512 METALS-L 275,000.00 275,000.00 0.00 0.00 275,000.00 100.00% 0.00 8,094.30 INTERIOR ROUGH 06100 CARPENTRY-M 31,000.00 31,000.00 0.00 0.00 31,000.00 100.00% 0.00 372.00 INTERIOR ROUGH 06101 CARPENTRY-L 44,000.00 44,000.00 0.00 0.00 44,000.00 100.00% 0.00 484.00 FOUNDATION WATERPROOFING 07110 -M 5,100.00 5,100.00 0.00 0.00 5,100.00 100.00% 0.00 510.00 FOUNDATION WATERPROOFING 07111 -L 6,600.00 6,600.00 0.00 0.00 6,600.00 100.00% 0.00 660.00 07210 DUCT LINERS-M 97,000.00 97,000.00 0.00 0.00 97,000.00 100.00% 0.00 9,700.00 07211 DUCT LINERS-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,120.00 07810 FIRESTOPPING-M 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00% 0.00 1,680.00 07811 FIRESTOPPING-L 16,000.00 16,000.00 0.00 0.00 16,000.00 100.00% 0.00 1,220.00 JOINT SEALANTS- 07910 M 35,000.00 35,000.00 0.00 0.00 35,000.00 100.00% 0.00 0.00 JOINT SEALANTS- 07911 L 80,000.00 80,000.00 0.00 0.00 80,000.00 100.00% 0.00 0.00 STEEL DOORS& 08110 FRAMES-M 0.00 0.00 0.00 0.00 0.00% 0.00 STEEL DOORS& 08111 FRAMES-L 0.00 0.00 0.00 0.00 0.00% 0.00 FLUSH WOOD 08140 DOORS-M 0.00 0.00 0.00 0.00 0.00% 0.00 FLUSH WOOD 08141 DOORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 AIA Document G703T"-1992.Copyright O 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 of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 8 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. . User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % BALANCE TO RETAINAGE PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) STILE& RAIL 08143 WOOD DOORS-M 0.00 0.00 0.00 0.00 0.00% 0.00 STILE&RAIL 08144 WOOD DOORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 SOUND CONTROL DOORS& 08347 WINDOWS-M 0.00 0.00 0.00 0.00 0.00% 0.00 SOUND CONTROL DOORS& 08348 WINDOWS-L 0.00 0.00 0.00 0.00 0.00% 0.00 OVER COILING 08355 DOORS-M 0.00 0.00 0.00 0.00 0.00% 0.00 OVERHEAR 08356 COILING DOORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 ALUM.FRAMED ENTRANCES/STOR 08410 EFRONTS-M 0.00 0.00 0.00 0.00 0.00% 0.00 ALUM.FRAMED ENTRANCES/STOR 08411 EFRONS-L 0.00 0.00 0.00 0.00 0.00% 0.00 INTERIOR ALUM. DOORS& 08413 FRAMES-M 0.00 0.00 0.00 0.00 0.00% 0.00 INTERIOR ALUM. DOORS& 08414 FRAMES-L 0.00 0.00 0.00 0.00 0.00% 0.00 REVOLVING DOOR 08423 ENTRANCES-M 0.00 0.00 0.00 0.00 0.00% 0.00 REVOLVING DOOR 08424 ENTRANCES-L 0.00 0.00 0.00 0.00 0.00% 0.00 08440 GLAZED ALU,. 325,000.00 325,000.00 0.00 0.00 325,000.00 100.00% 0.00 11,375.00 AIA Document G703T"-1992.Copyright O 1963,1965,1966,1967,1970,1976,1983 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 of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 9 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No 0168420739_1 which expires on 05/10/2011,and is not for resale User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD STORED DATE (G C) (C-G) RATE) (D+E) (NOT IN D OR E) (D+E+F) CURTAIN WALLS- M GLAED ALUM. CURTAIN WALLS- 08441 L 148,000.00 146,000.00 2,000.00 0.00 148,000.00 100.00% 0.00 0.00 08710 HARDWARE 525,000.00 525,000.00 0.00 0.00 525,000.00 100.00% 0.00 18,800.00 INTERIOR 08810 GLAZING-M 11,000.00 11,000.00 0.00 0.00 11,000.00 1.00.00% 0.00 22.00 INTERIOR 0881.1. GLAZ1NG-L 8,000.00 8,000.00 0.00 0.00 8,000.00 100.00% 0.00 0.00 FIRE PROTECTION 10440 SPECIALTIES-M 7,580.00 7,580.00 0.00 0.00 7,580,00 100.00% 0.00 0,00 FIRE PROTECTION 10441 SPECIALTIES-L 1,800.00 1,800,00 0.00 0.00 1,800.00 100.00% 0.00 0.00 10450 KNOX BOX 650.00 650.00 0.00 0.00 650.00 100.00% 0.00 0.00 LOADING DOCK 11130 EQUIPMENT-M 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00% 0.00 1,647.50 LOADING DOCK 11131 EQUIPMENT-L 3,800.00 3,800.00 0.00 0.00 3,800.00 100.00% 0.00_ 220.00 ELEC.TRACTION ELEVATORS- ]4210 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ELEC.TRA.CTION ELEVATORS- MATERIAL/EQUIP 14211 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ELEC.TRACTION 14212 ELEVATORS-L 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 HYDRAULIC ELEVATOR- 14241 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 14242 HYDRAULIC 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ' 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 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 I0 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (927362901) A B C D I E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED (G-C) APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) ELEVATOR- MATERIAL/EQUIP MENT HYDRAULIC ELEVATOR- 14243 LABOR 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR LIFT- MATE RIAL/E QUIP 14421 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR 14422 LIFT-PERMITS 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR 14423 LIFT-LABOR 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 CHANGE ORDER. 17001 NO. 01 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 450.00 CHANGE ORDER 17002 NO.02 9,031.00 9,031.00 0.00 0.00 9,031.00 100.00% 0.00 0.00 CHANGE ORDER 17003 NO. 03 2,196.00 2,196.00 0.00 0.00 2,196.00 100.00% 0.00 30.00 17000 CHANGE ORDER 4 NO. 04 0.00 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 17000 CHANGE ORDER 5 NO. 05 98,741.00 98,741.00 0.00 0.00 98,741.00 100.00% 0.00 9,874.10 17000 CHANGE ORDER 6 NO. 06 17,527.00 17,527.00 0.00 0.00 17,527.00 100.00% 0.00 1,400.00 17000 CHANGE ORDER 7 NO. 07 11,292.00 11,292.00 0.00 0.00 11,292.00 100.00% 0.00 1,129.20 17000 CHANGE ORDER 8 NO. 08 44,936.00 44,936.00 0.00 0.00 44,936.00 100.00% 0.00 4,493.60 17000 CHANGE ORDER 9 NO. 09 14,683.00 14,683,00 0.00 0.00 14,683.00 100.00% 0.00 0.00 • 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 AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 11 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. _ User Notes: (927362901) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE%ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK VALUE THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) 17001 CHANGE ORDER 0 NO. 10 -760,330.00 -760,330.00 0.00 0.00 -760,330.00 100.00% 0.00 -38,016.50 17001 CHANGE ORDER 2 NO. 12 49,062.00 49,062.00 0.00 0.00 49,062.00 100.00% 0.00 2,453.10 17001 CHANGE ORDER 3 NO. 1.3 3,801.00 3,801.00 0.00 0.00 3,801.00 100.00% 0.00 190.05 17001 CHANGE ORDER 4 NO. 14 787.00 787.00 0.00 0.00 787.00 100.00% 0.00 39.35 17001 CHANGE ORDER 5 NO. 15 34,158.00 34,158.00 0.00 0.00 34,158.00 100.00% 0.00 1,707.90 17001 CHANGE ORDER 6 NO. 16 7,529.00 7,529.00 0.00 0.00 7,529.00 100.00% 0.00 376.45 17001 CHANGE ORDER 7 NO. 17 7,083.00 7,083.00 0.00 0.00 7,083.00 100.00% 0.00 354.15 17001 CHANGE ORDER 8 NO. 18 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 1,129.55 17001 CHANGE ORDER 9 NO. 19 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 1,129.55 17002 CHANGE ORDER 0 NO. 20 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 1,129.55 17002 CHANGE ORDER 1 NO. 21 22,591.00 22,591.00 0.00 0.00 22,591.00 100.00% 0.00 1,129.55 17002 CHANGE ORDER 2 NO. 22 68,760.00 68,760.00 0.00 0.00 68,760.00 100.00% 0.00 0.00 17002 CHANGE ORDER 3 NO. 23 4,562.00 4,562.00 0.00 0.00 4,562.00 100.00% 0.00 228.10 17002 CHANGE ORDER 4 NO. 24 6,954.00 6,954.00 0.00 0.00 6,954.00 100.00% 0.00 347.70 GRAND TOTAL $9,905,436.00 $9,293,391.00 $9,666.00 $0.00 $9,303,057.00 93.92% $602,379.00 $491,833.80 AIA Document G703^"-1992.Copyright©1963,1965,1966,1967,1970,1976,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be .12 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 15:17:59 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (927362901) AFFIDAVIT AND WAIVER OF LIEN [ ]:FINAL [X]PARTIAL [X]PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Payment for Application # 34A for work performed through 1/31/11 , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of Nine Thousand Six Hundred Sixty-six dollars and 00/cents ($ 9,666.00 ) Payment for Application # for work performed through , of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount,and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER)that there is due from the contractor the sum of dollars and 00/cents ($ 0.00 ) 3 Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ ) THEREFORE,the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed o'' material furnished to the undersigned for said project,and within the scope of this affidavit and w ''er. W. R.Dunkin& Son, Inc. 11114tW / � Title: Project Manager WITNESS MY HAND AND NOTARIAL SEAL,this 20'x' day of January , 2011 Ae-/C//, � / (Notary Public My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [ ' PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Bradley A. Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 31A has been received for work performed through 10/31/10 . (PARTIAL WAIVER)that there is due from the contractor the sum of Two Hundred.Sixty-eight Thousand Nine Hundred Sixty-five dollars and 20/cents ($ 268,965.20 ) Application for Payment # B has been received for work performed through 10/31/10. (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ 0.00 ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on ac5cdunt of any work performed or material furnished •i to the undersigned for said projeet—ans the/scope ofths%a davit and aiver.• W.R.Dunkin&Son,Inc. B l! f _ _f./ Title: Project Manager WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 ; (Notary P A ic) My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County AFFIDAVIT AND WAIVER OF MEN [ ]FINAL [X] PARTIAL [ ]PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Bradley A. Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 32A has been received for work performed through 11/30/10 . (PARTIAL WAIVER)that there is due from the contractor the sum of One Hundred thirty-seven Thousand Seven Hundred thirty-three dollars and 00/cents ($ 137,733.00 ) Application for Payment # B has been received for work performed through 10/31/10. (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ 0.00 ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on acco of any work performed or material furnished to the undersigned for said project, and within the dope of ttii,a aviitt and'w'aiver. W. R. Dunkin& Son,Inc. i -.� '`k_ - Title: Project Manager c- WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 A ■ J j&� '_ 4 (Notary Pub/) My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County _. A!� . . w Document G732TM - 2009 Application and Certificate for Payment, Construction Manager as Adviser Edition I TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A,#5010 Carmel APPLICATION NO:023 DISTRIBUTION TO: Commission Performing Arts OWNER Carmel,IN 46032 Carmel,IN 46032 CONSTRUCTION MANAGER PERIOD TO:January 31,2011 FROM W.R.Dunkin&Son,Inc. VIA CONSTRUCTION Shiel Sexton Co.,Inc. CONTRACT DATE:February 23,2009 ARCHITECT CONTRACTOR: PO Box 2247,Anderson,IN MANAGER: PROJECT NOS:25310H/2695/501.0/2695 CONTRACTOR 46018 FIELD CONTRACT FOR: Bid Package#5010-General VIA ARCHITECT: CSO Architects OTHER Trades CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge,information and belief the Work covered by this Application for Paymev,has been completed in accordance with the Application is made for payment,as shown below,in connection with the Contract. Contract Documents,that all amounts have been ai „IS" thy�.. on for for Work for which previous A1A Document G703TM,Continuation Sheet,is attached, Certificates for Payment were issued and-T1� p fl!s yrefceiv 'from the Owner, and that current 1.ORIGINAL CONTRACT SUM.... $ 1.480,000.00 payment= n ereiiTts now due. / 2.NET CHANGES IN THE WORK $ -81,040.00 CONTRACTOR W R/er1NK '& "ON, 3.CONTRACT SUM TO DATE(Line 112) $ 1,398,960.00 B). ., r / - ,,„! Date: January 17,2011 4.TOTAL COMPLETED AND STORED TO DATE(Column G on G703) $ 1,338,055.00 Sta —of:Indiana 5.RETAINAGE: County of:Madison a. 5 %of Completed Work Subscribed and sworn to before (Column D+Eon G703) $ 69,948.00 me this 17th day of Jpanua y, 1G�ti`�-- f b. 0 %of Stored Material Notary Public:Martha A.Carpenter /, It. (Column Fon G703) $ 0.00 My Commission expires:January 08,2017 Total Retainage(Lines 5a+5b, or Total in Column Ion G703) $ 69,948.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 1,268,107.00 In accordance with the Contract Documents, based on evaluations of the Work and the data (Line 4 minus Line 5 Total) comprising this application, the Construction Manager and Architect certify to the Owner that to the 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 1,267,795.00 best of their knowledge, information and belief the Work has progressed as indicated, the quality of (Line 6 from prior Certificate) the Work is in accordance with the Contract Documents,and the Contractor is entitled to payment of _ the AMOUNT CERTIFIED. 4'7 8.CURRENT PAYMENT DUE $ 312.00 AMOUNT CERTIFIED $ �FL 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from - ount applied.Initial all figures on this Application and on t de Continuation She, that 'e char ed to conform with the amount certified.) (Line 3 minus Line 6) $ 130,853.00 CONS RUCTION M.�,GEJc. By: i:11: *a0/' Date: P! 31 1/ SUMMARY OF CHANGES IN THE WORK ADDITIONS DEDUCTIONS ARC `'CT: iTO '. I I tultiple Prime Contractors are responsible for perform ting onions of the Project, th c itent}r-Certificationis not required) Total changes approved in previous months by Owner $ 0.00$ 81,040.00 By: y _ Date: ell-. l ii,l Total approved this month including i r Change Directives 0.00 $ 0.00 This Cerrlili„ate is not negonabie: ,ne AMOUNT CERTIFIED is payable only to the Contractor TOTALS 5 0.00 $ 81,040.00 named hcreeiiuelssuance, payment and acceptance of payment are without prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES iN Ti-fE WORK $ -81,040.00 AEA Document G732'"—2009(formerly G702TMCMa—1992).Copyright 1992 and 2009 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S. V Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted ,( it 1 v to the maximum extent possible under the law.This document was produced by AIA software at 15:00:07 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1328771883) Difoctor of Redevelopment / (& 5 ,07 :ir: I ocu nt G703" - 1992 iyc: ■ Continuation Sheet AIA Document,0702TM-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 023 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE:01/17/2011 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO:01/31/2011 Use Column I on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:25310H A B C D E F G H I WORK COMPLETED TOTAL MATERIALS ED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY AND STORED TO % FINISH (IF VARIABLE NO. WORK VALUE PREVIOUS THIS PERIOD STORED DATE (G-C) (C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) 01010 Performance Bond 26,400.00 26,400.00 0.00 0.00 26,400.00 100.00% 0.00 2,640.00 Mobilize/ 01015 Demobilize 8,000.00 8,000.00 0.00 0.00 8,000.00 1.00.00% 0.00 400.00 Supervision/ 01020 Coordination 87,000.00 87,000.00 0.00 0.00 87,000.00 100.00% 0.00 6,600.00 General Conditions- 01025 M 30,000.00 30,000.00 0.00 0.00 30,000.00 100.00% 0.00 2,440.00 General Conditions- 01026 L 34,000.00 34,000.00 0.00 0.00 34,000.00 1.00.00% 0.00 2,520.00 1400A Organ Facade Pipes 200,000.00 200,000.00 0.00 0.00 200,000.00 100.00% 0.00 8,672.00 Carpentry Labor 1400B Hours 32,000.00 32,000.00 0.00 0.00 32,000.00 100.00% 0.00 3,200.00 Provide Tie-Off 1400C Points at Balconies 25,000.00 6,688.00 312.00 0.00 7,000.00 28.00% 18,000.00 0.00 Vertical Partition System&Backfold 1400D Doors 15,000.00 15,000.00 0.00 0.00 15,000.00 100.00% 0.00 1,500.00 16'X16' Temporary 1400E Overhead Door 6,000.00 6,000.00 0.00 0.00 6,000.00 100.00% 0.00 600.00 Temporary OHD Enclosure and 1400F Insulation 10,000.00 1,644.00 0.00 0.00 1,644.00 16.44% 8,356.00 164.40 1000 SY of BX 1200 1400G Tensar Geogrid 17,000.00 4,117.00 0.00 0.00 4,117.00 24.22% 12,883.00 411.70 1400H 350 CY of#2 Stone 18,200.00 5,718.00 0.00 0.00 5,718.00 31.42% 12,482.00 571.80 • AIA Document G703" -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 of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be .1 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14;54:57 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. User Notes: (1096895056) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO (G-C) FINISH (IF VARIABLE APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (D+E) (D+E+F) 1400J 200 CY of Stone 10,000.00 1,746.00 0.00 0.00 1,746.00 17.46% 8,254.00 174.60 1400K General Allowance 75,000.00 74,070.00 0.00 0.00 74,070.00 98.76% 930.00 5,000.00 CAD As-Built 1400L Allowance 5,000,00 5,000.00 0.00_ 0.00 5,000.00 100.00% 0.00 500.00 General Clean Up- 01560 M 4,000.00 4,000.00 0.00 0.00 4,000.00 100.00% 0.00 140.00 01561 General Clean Up-L 25,000.00 25,000.00 0.00 0.00 25,000.00 100.00% 0.00 1,130.00 Final Cleaning(Items 01562 in BP 5010 10,000.00 10,000.00 0.00 0.00 10,000.00 100.00% 0.00 0.00 Dewatering for 9 02110 Months-M-Eq 18,500.00 18,500.00 0.00 0.00 18,500.00 100.00% 0.00 1,850.00 Dewatering for 9 02111 Months-L-Eq 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 2,800.00 Piping from Tri-Plex 02240 to Lift Station 21,000.00 21,000.00 0.00 0.00 21,000.00 100.00% 0.00 2,100.00 Interior Metal Fabrications- 05504 Submittals 6,200.00 6,200.00 0.00 0.00 6,200.00 100.00% 0.00 620.00 Interior Metal Fabrications- 05505 Materials 86,500.00 86,500.00 0.00 0.00 86,500.00 100.00% 0.00 8,650.00 Interior Meta] 05506 Fabrications-Erection 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00% 0.00 2,400.00 Miscellaneous Metals 05511 - M 5,640.00 5,640.00 0.00 0.00 5,640.00 100.00% 0.00 564.00 Miscellaneous Metals 05512 - L 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00% 0.00 250.00 Interior Rough 06100 Carpentry-M 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 2,660.00 Interior Rough 06101 Carpentry-L 36,500.00 36,500.00 0.00 0.00 36,500.00 100.00% 0.00 3,199.50 07810 Skylight Shade-M 62,000.00 62,000.00 0.00 0.00 62,000.00 100.00% 0.00 6,200.00 • AIA Document G703"-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 of this AlAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:54:57 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. - User Notes: (1096895056) A B C D E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO DATE (G-C) FINISH IF VARIABLE(C-G) RATE) APPLICATION (NOT IN D OR E) (D+E) (D+E+F) +Skylight Shade- 07811 Installation 29,500.00 29,500.00 0.00 0.00 29,500.00 100.00% 0.00 2,950.00 07910 Joint Sealants-M 48,000.00 48,000.00 0.00 0.00 48,000.00 100.00% 0.00 760.00 07911 Joint Sealants-L 24,500.00 24,500.00 0.00 0.00 24,500.00 100.00% 0.00 420.00 08810 Interior Glazing 42,000.00 42,000.00 0.00 0.00 42,000.00 100.00% 0.00 84.00, 09610 Access Flooring 19,500.00 19,500.00 0.00 0.00 19,500.00 100.00% 0.00 0.00 09710 FRP Wall Panels-M 1,000.00 1,000.00 0.00 0.00 1,000.00 100.00% 0.00 0.00 09711 FRP Wall Panels-L 2,000.00 2,000.00 0.00 0.00 2,000.00 100.00% 0.00 0.00 Acoustic Fabric 09712 Wrapped Panels 42,500.00 42,500.00 0.00 0.00 42,500.00 100.00% 0.00 1,000.00 10210 Toilet Compartments 44,000.00 44,000.00 0.00 0.00 44,000.00 1.00.00% 0.00 0.00 Backfold Door 10220 Tracks-M 5,000.00 5,000.00 0.00 0.00 5,000.00 100.00% 0.00 500.00 Backfold Door 10221 Tracks-L 4,560.00 4,560.00 0.00 0.00 4,560.00 100.00% 0.00 456.00 10222 Operable Partition 21,000.00 21,000.00 0.00 0.00 21,000.00 100.00% 0.00 320.00 10223 Wire Mesh Partitions 9,500.00 9,500.00 0.00 0.00 9,500.00 100.00% 0.00 0.00 Toilet Accessories- 10224 M 34,000.00 34,000.00 0.00 0.00 34,000.00 100.00% 0.00 3,400.00 Toilet Accessories- 10225 L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 100.00 10510 Metal Lockers 16,500.00_ 16,500.00 0.00 0.00 16,500.00 100.00% 0.00 0.00 10520 Phenolic.Lockers-M 110,000.00 110,000.00 0.00 0.00 110,000.00 1.00.00% 0.00 0.00 10521 Phenolic Lockers-L 29,000.00 29,000.00 0.00 0.00 29,000.00 100.00% 0.00 0.00 10610 Corner Guards-M 9,500.00 9,500.00 0.00 0.00 9,500.00 100.00% 0.00 0.00 10611 Corner Guards-L 3,500.00 3,500.00 0.00 0.00 3,500.00 1.00.00% 0.00 0.00 17001 Changr Order No.01 -81,040.00 -81,040.00 0.00 0.00 -81,040.00 100.00% 0.00 -8,000.00 GRAND TOTAL $1,398,960.00 $1,337,743.00 $312.00 $0.00 $1,338,055.00 95.65% $60,905.00 $69,948.00 • MA Document G703TM-1992.Copyright©1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA® Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be 3 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 14:54'57 on 01/20/2011 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. . User Notes: (1096895056) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [ ]PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Bradley Tyler , being duly sworn states that he is the Project Manager of W. R. Dunkin & Son, Inc. having contracted with. City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 5010-Interior Finishes for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and g Performing owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 21 has been received for work performed through 11/30/10. (PARTIAL WAIVER)that there is due from the contractor the sum of Fifty-five Thousand One Hundred Eighty-one dollars and 00/cents ($ 55,181.00) Application for Payment # has been received for work performed through . (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on accoun f any,rk performed or material furnished to the undersigned for said project, and within the cope of I's'.f avi :nd-waiver. W.R.Dunkin& Son,Inc. SZL-- .--7 Title: Project Manager 2(- 4000...'- WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 Ae.„6/41 of ,tor, #746...L., (Notary P .lic) My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X]PARTIAL [ ] PAYMENT TO FOLLOW State of Indiana,County of Madison. SS Bradley Tyler , being duly sworn states that he is the Proiect Manager of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 5010-Interior Finishes for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Application for Payment # 20 has been received for work performed through 10/31/10. (PARTIAL WAIVER)that there is due from the contractor the sum of One Hundred Forty-three Thousand Two Hundred ninety-nine dollars and 00/cents ($ 143,299.00) Application for Payment # has been received for work performed through (FINAL WAIVER)that the final balance due from the Owner is the sum of dollars and 00/cents($ ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described property and improvements thereon on account of LABOR or material or both, furnished by the undersigned thereto, subject to limitations or con.'tions expressed herein, if any; and further certifies that no other party has any claim or right to a lien nt of any work performed or material furnished to the undersigned for said project,and wi 0 in the scope of thi/ss d waiver. W.R.Dunkin& Son, Inc. •1�� Title: Project Manager WITNESS MY HAND AND NOTARIAL SEAL,this 20th day of January ,2011 (Notary Publ.' My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County