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HomeMy WebLinkAboutDIVERSIFIED PAINTING COMPANY -001585 -2/3/2011 CAR■ EL REDEVELOPMENT COMMISSION 001585 Diversified Painting Company Check: 1585 1661 Expo Lane Date: 2/3/2011 Indianapolis, IN 46214 Vendor: DIVERSI1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 14 53 19,500.00 19,500.00 0.00 0.00 19,500.00 Application 14 19,500.00 19,500.00 0.00 0.00 19,500.00 w7 ® TM = � = Document G702/CMa - 1992 S3 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: APPLICATION NO: 14 Distribution to: Carmel Redevelopment'Commission PARCEL 7A,Regional Performing Arts Center • One Civic Interior Finish Package P5 PERIOD TO 12.15-10 OWNER I=1 Carmel IN 46032 Bid Pack#5160;Painting CONSTRUCTION MANAGER FROM CON6tPainting Company VIA CONSTRUCTION MANAGER: CONTRACT DATE: Febuary 24,2009 ARCHITECT ❑ • 1681 Expo Lane CSO Architects PROJECT NOS: / 2695 1 CONTRACTOR ❑ Indianapolis, IN 46214 280 E.96th Street,Suite 100 VIA ARCHITECT: Indianapolis,IN 46240 FIELD ❑ Bid Pack 5160;Painting CONTRACT FOR: ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractor's knowledge, information and Application is made for payment,as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 2,100,000.00 payment shown herein is now due. 2. Net change by Change Orders $ (23,629.00) CONTRACTOR: ll D. P CoInnc' 3.CONTRACT SUM TO DATE(Line 1 ±,2) � `�$ 2,076,371.00 By: Date: 12.15-10 4.TOTAL COMPLETED&STORED TO DATE(Column 0 on G703) $ 2,039,239.96 State of INDJ NA 5.RETAINAGE County of: Boone a. %.of Completed Work Subscribed and sworn to before —t6% . (Column D+Eon 0703) 8;4,072.00 me this day of -12.15710 b. 10%of Stored Material Notary Public: Thomas E Hill 7,1 for'& (Column F on 0703) $8,150.00 My Commission expires: 11/08/2017 Total Retainage(Lines 5a+Sb or Total in Column I of 0703).. $ CERTIFICATE FOR PAYMENT - Thomas E. HI 102,222.00 • SS* Notary Public ate of Indiana'. In accordance with the Contract Documents, based on on-s' • p er'. limns tt • b rising 6.TOTAL EARNED LESS RETAINAGE $ 1,937,017.96 this application,the Construction Manager and Architect ce;i'vvtet Owpwr 14,3he s it VIJ � (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed .s inr"ated,tIE o ZIYe cr is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 1 917 517.96 accordance with the Contract Documents,and the Contracts. •.• i 1 i tti .. , (Line 6 from prior Certificate) CERTIFIED. q� 88 8.CURRENT PAYMENT DUE $ 19,500.00 AMOUNT CERTIFIED $ V 1 621.0r_. 9.BALANCE TO FINISH,INCLUDING RETAINAGE. (Attach explanation if amount certified differs ion the amount applied. Initial all figures on'this Application and or ie Continuation .et the ar, changed to conform with the amount •ertified.) (Line 3 less Line 6) 139,353.04 CONS •UCTION 7 AG By t► a - -'Av./>11°'�L4.`�� Date: ! f o CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC '� ff �}( Total changes approved in previous months by Owner $ $ By. f Date: 6 4,11 ��" Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ - $ - named herein. Issuance, payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ the Owner or Contractor under this Contract. ' CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G702ICMaTM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. Unauthorized reproduction or distribution of this Ale' Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. � ® Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AEA 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 A201ICMa.They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation.The completed G702/CMa and G703 should be forwarded to the Owner. D.Completing the G703 Form Heading:This information should be completed to be consistent with similar information on AIA Document G702/CMa,Application and Certificate for Payment, Construction Manager-Adviser Edition. Columns A,B&C:These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted.The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project.Multiple pages should be used when required. • • Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page.Initially,this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D:Enter in this column the amount of completed work covered by the previous application(columns D&E from the previous application).Values from column F (Materials Presently Stored)from the previous application should not be entered in this column. Column E:Enter here the value of Work completed at the time of this application,including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored(column F). Column F:Enter here the value of Materials Presently Stored for which payment is sought.The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated.into the Project.Mere payment by the Owner for stored materials does not result in a deduction from this column.Only as materials are incorporated into the Project is their value deducted from this column and incorporated into column E(Work Completed-This Period). • Column G:Enter here the total of columns D,E and F.Calculate the percentage completed by dividing column G by column C. Column H:Enter here the difference between column C(Scheduled Value)and column G(Total Completed and Stored to Date). Column I:This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. r • Change Orders:Although Change Orders could be incorporated by changing the schedule of values each time.a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the erid of the`basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7,3 in A2011CMa. ! E.Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager andArchitect on AIA-Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed form contains•the name and address-of the Contfactor.Payment should not be made to any other party unless specifically indicated on G702/CMa, AIA DdcumentG702/CMaTM—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA® Document is protected by U.S. Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA'8•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 reporl copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. ` TM ., e3j�e Document G7O3TM - 1992 page Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO 14 containing Contractors signed certification is attached. APPLICATION DATE: 12.15-10 In tabulations below,amounts arc stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO 12.15-10 ARCHITECT'S PROJECT NO: A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD {NOT IN TO DATE (G C) FINISH RATE} (D+E) D OR E) (D+E+F) (C G) Bonds 73,500.00 73,500.00 73,500.00 100% 0.00 7,350.00 Moblilization 5,000.00 5,000.00 0.00 5,000.00 100% 0.00 500.00 d Insurance/Hazcom/Safety 4,000.00 4,000.00 4,000.00 100% , 0.00 400.00 lil Submittals 4,800.00 4,800.00 4,800.00 .100% 0.00 480.00 5 09-72-00;WALLCOVERING Labor 18,750.00 18,750.00 0.00 18,750.00 100% 0.00 1,875.00 Material 37,000.00 37,000.00 0.00 37,000100. 100% 0.00 3,700.00 .. .:.:.,:.. E 09-84-00;ACOUSTICAL WALL PANELS Labor 51,500.00 46,500.00 5,000.00 51,500.00 100% 0.00 5,150.00 Material 480,000.00 466,300.00 13,700.00 0.00.:: 480,000.00 100% 0.00 48,000.00 7 09-91-00; PAINTING BASE MECH Labor 36,680.00 36,680.00 0.00 36,680.00 100% 0.00 3,668.00 BASE MECH Material 9,000.00 9,000.00 0.00 9,000.00 100% 0.00 900.00 BASE ELECT LABOR 10,080.00 10,080.00 0.00 10,080.00 100% 0.00 1,008.00 BASE ELECT MATER 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 INT CONST BASE LAB 10,880.00 10,880.00 0.00 10,880.00 100% 0.00 1,088.00 INT CONST BASE MAT 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 PLEM LABOR 8,480.00 8,480.00 0.00 8,480.00 100% 0.00 848.00 PLEM MATERAIL 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 CON HALL N WALL LABOR 69,120.00 69,120.00 0.00 69,120.00 100% 0.00 6,912.00 CON HALL N WALL MATERIAL 27,500.00 27,500.00 0.00 0.00 27,500.00 100% 0.00 2,750.00 CON HALL N DOME LABOR 45,920.00 45,920.00 0.00 45,920.00. 100% 0.00 4,592.00 CON HALL N DOME MATERIAL 30,000.00 30,000.00 0.00 . 0.00 30,000.00 . 100% 0.00 3,000.00 CON HALL BALY'WALL LAB 122,240.00 122,240.00 0.00 122,240:00. 100% 0.00 12,224.00 CON HALL BALY WALL MAT 44,000.00 44,000.00 0.00 0.00 44;000.00 100% 0.00 4,400.00 1,095,95000 1;077;250.00 18 70 0n 0 22.00 0 00 109,595_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 AIAeDocument 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,copyrights iaia.org. t t'' Document G703"— Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with ALA 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 AlA Document A20I,General Conditions of the Contract for Construction. ' Use of Current Documents.Prior to using any AlA 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 AlA software users should consult the End User License Agreement(EULA).To report copyright violations of AIA Contract Documents,c-mail The American Institute of Architects' legal counsel,copyright@aia.org. aia.org. COMPLETING G703-1992 Heading.This information should be completed in a manner consistent with similar information on AIA Document 0702,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 column G(Total Completed and Stored to Date). Column 1.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Constriction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example pia Continuation Sheet jar work in progress.Please note that dollar amounts.sholvn below are far illustrative purposes only,and are not intended to reflect actual construction costs. A R C U C F 0 I I I s'URK cororf iLAD MATERIALS TOTAL BALANCE PRESENTLY COmpLETED RETANAGE ITEM SCHEDULED FRO.MPREVIOUS TO NO, DESCRIPTION WORK VALUE APPLICATION T111S PERIOD sTor,su AND S'T'ORED (�1-�.) FINISH (IP VARIABLE (NOT IN TO DATE KATE) ()±E) 150)0) (I)+STF] (C.G) 1 MOBILIZATION 5,000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5.000 0 0 5,000 100 0 3 EARTH WORK 15.000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL. 10000 0 5000 0 5,000 50 5,000 5 CURBS d 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 20,000 0 0 0 0 0 20,000 B PAVERS 20,000 0 0 I0000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 20,000 19,000 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 Ale Document is protected by U.S.Copyright Law and International Treaties,Unauthorized reproduction or distribution of this Ale Document,or any portion of it may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.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. 1.1111571 8 7M JJAI4 Document G703 - 1992 ,- Continuation Sheet Page 2 ,• AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT. APPLICATION NO: containing Contractors signed certification is attached. APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. 14 Use Column 1 on Contracts where variable retainage for line items may apply. . PERIOD TO: 12.15-10 .. ARCHITECT'S PROJECT NO:12.15-10 A B C 0 E :F::....,. G H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS 7o TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G;C) FINISH (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C-G) CON HALL DOME LABOR ;. . 100,260.00 100,260.00 0.00 100,260.00 100% 0.00 10,026.00 CON HALL DOME MATERAIL 55,000.00 55,000.00 0.00 0.00 55,000.00 100% 0.00 5,500.00 CON HALLS WALL LABOR 45,120.00 45,120.00 0.00 45,120.00 100% 0.00 4,512.00 CON HALL S WALL MATERIAL 29,500.00 29,500.00 0.00 0.00 29,500.00 100% 0.00 2,950.00 CON HALL S DOME LABOR 45,920.00 45,920.00 0.00 45,920.00 •` 100% 0.00 4,592.00 CON HALL S DOME MATERIAL 25,000.00 25,000.00 0.00 0.00 25,000.00 100% 0.00 2,500.00 N TIER LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 N TIER MATERIAL 6,500.00 6,500.00 0.00 - 6,500.00 100% 0.00 650.00 N ORCH LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 N ORCH MATERIAL 6,500.00 6,500.00 0.00 6,500.00 100% 0.00 650.00 W LOBB LABOR 28,800.00 28,800.00 0.00 28,800.00 100% 0.00 2,880.00 W LOBB MATERAIL 6,500.00 6,500.00 0.00 6,500.00 100% 0.00 650.00 W LOBB CEIL LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 W LOBB CEIL MTERAIL 6,500.00 6,500.00 0.00 6,500.00 100% 0.00 650.00 E LOBBY LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 E LOBBY MATERIAL 7,000.00 7,000.00 0.00 7,000.00 100% 0.00 700.00 E LOBBY CEIL LABOR 38,800.00 38,800.00 0.00 38,800.00 100% 0.00 3,880.00 E LOBBY MATERIAL 9,300.00 9,300.00 0.00 9,300.00 100% 0.00 930.00 S LOBB LABOR ..45,000.00 45,000.00 0.00 45,000.00 100% = 0.00 4,500.00 S LOB13 MATERIAL . `11,000.00 11,000.00 0.00 11,000.00 100% 0.00 1,100.00 SW ORCH LOB,STR WAL LAB.' 48,000.00 48,000.00 0.00 48,000.00 . 100% 0.00 4,800.00 SW ORCH LOB,STR WAL MAT 8,700.00 8,700.00 0.00 8,700.00 : 100% 0.00 870.00 SE ORCH LO13,STR WAL LAB 48,000.00 48,000 00 0.00 48,000.00:' 100% 0.00 4,800.00 SE ORCH LOBS'PR WAL MAT 8,700.00 8,700.00 0.00 .l' '8,700.00 100% 0.00 870.00 STIR'TQTAI,PAC;R 9 692,100 00 1 92,103 00 00.0 0 00 . 6491(3[1 0.0 24 00 0.-00_ 69,210.00 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 Ale 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. 7,0 TM -'= 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. aia.org. COMPLETING G703-1992 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 column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis.It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done.Usually,Change Orders are listed separately,either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the 0702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is cm example of Continuation Sheet fOr work in progress.Please rlOte that dollar amounts-shown below are for illustrative purposes only,and cu e not intended to reflect actual construction casts. A P C U li F G II I WORK COMPLETED MATERIALS TOTr\l, ''ALAN""PRLSE�'TLO' COMPLETED KI:TAINACE SCHEDULED FROM PREVIOUS TO ITEM [F WORK STORED 11D STORED IS H III'VARIABLE NO VALUE APPLICATION TILL;PERIOD (C. C) (PPIN l0 DATE RATE) {USE] DOR E) (D+•EFIE rG-C) • 1 MOBILIZATION 5.000 5,000 0 0 5,000 100 0 2 STUMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15,000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS&MISC.CONC. 5,000 0 0 0 0 0 5,000 6 PAVING,UPPER DRIVE 20,000 0 0 0 0 0 20,000 7 PAVING,LOWER DRIVE 20,000 0 0 0 0 0 20,000 B PAVERS 20,000 0 0 10,000 10,000 50 83,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 11 105,000 20,000 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 of this AlA®Document,or any portion of ii,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 coun:ol,copyright©aia.org. 0 $ AIA Document G703 7M - 1992 Continuation Sheet page 3 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO_ containing Contractor's signed certification is attached. 14 APPLICATION DATE: In tabulations below,amounts are stated to the nearest dollar. " 12.15-10 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO 12.15-10 ARCHITECT'S PROJECT NO A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G=C) FINISH (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C-CO BALL/H LABOR 28,000.00 28,000.00 0.00 28,000.00 100% 0.00 2,800.00 BAL L/H MATERAIL 6,800.00 6,800.00 0.00 6,800.00 100% 0.00 680.00 INT CON ATTIC LABOR 17,000.00 17,000.00 0.00 17,000.00 100% . 0.00 1,700.00 INT CON ATTIC MATERIAL 3,500 00 3,500.00 0.00 3,500.00 100% 0.00 350.00 8 09-97-23; STAINS, SEALERS .. BASEMENT Labor 7,700.00 7,700.00 0.00 7,700 00 100% 0.00 770.00 BASEMENT Material 5,800.00 5,800.00 0.00 5;800:00 100% 0.00 580.00 BASE MECH RM LABOR 2,500.00 2,500 00 0.00 ,:'" 2;500.00 100% 0.00 250.00 BASE MECH RM MATER 1,500.00 1,500.00 0.00 1,500.00 100% 0.00 150.00 PLEM LABOR 2,500.00 2,500.00 0.00 2,500.00 100% 0.00 250.00 PLEM MATERAIL 1,500 00 1,500.00 0.00 1,500.00 100% 0.00 150.00 CON HALL BALCONY LAB 4,500.00 4,500.00 0.00 4,500.00 100% 0.00 450.00 CON HALL BALCONY MAT 1,500.00 1,500.00 0.00 1,500.00 100% 0.00 150.00 ORCH LOB, STR LAB 7,500.00 7,500.00 0.00 7,500.00 100% 0.00 750.00 ORCH LOB, STR MAT 3,000.00 3,000.00 0.00 3,000.00 100% 0.00 300.00 9 DAILY CLEAN UP 15,000.00 14,500.00 500.00 15,000.00 100% 0.00 1,500.00 10 GENERAL ALLOWANCE 100,000.00 96,618.96 0.00 96,618.96 97% 3,381.04 9,661.90 11 SUPPLIES ALLOWANCE 15,000.00 11,200.00 0.00 11,200.00 75% 3,800.00 1,120.00 12 LABOR ALLOWANCE 75,000.00 48,500.00 0.00 48,500.00 65% 26,500.00 4,850.00 13 CAD ALLOWANCE 5,000.00 5,000.00 0.00 5,000.00 100% 0.00 500.00 14 PROGRESS MEETINGS 5,200.00 4,900.00 300.00 5,200.00 100% 0.00 520.00 15 CLOSE-OUTS . 3,450.00 0.00 0% 3,450.00 0.00 CO 1 DED ALLOWANCE -55,000.00 -55,000.00 0.00 -55,000.00 100% 0.00 -5,500.00 CO 2 / 3 -550.00 -550.00 0.00 .- -550.00 :. 0% 0.00 -55.00 CO 4 31,921.00 31,921.00 0.00 0.00 31,921.00. 100% 0.00 3,192.10 SIBTOTAL PAGE 288,321 00 250,389.96 800.00 0.00 - 251,189.96 1 9.36 37,131 04 25,119.00 SUB TOTAL PAGE 1 1,095,950 00 1,077,250.00 18,700.00 0.00 1,095,950 00 22.00 0.00 109,595.00 S B TO AL•• 692.100.00 692A00.01) (L00 0 on " 697,100 00 2L00 0 00 69,21.0.00 GRAND TOTAL 2,076,371.00 2,019,739.96 19,500.00 0.00 , 2,039,239.96 65.36 37,131.04 203,924.00 _ 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 G703T4-1992.Copyright O 1963,1965,1966,1967, 1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this Ale'Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AlA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright@aia.org. x�� = = 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 ALA Contract Document,users should consult www.aia.org or a local AlA 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 AlA 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 AlA software users should consult the End User License Agreement(EULA).To report copyright violations of ALA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. • COMPLETING G703-1992 • 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 column G(Total Completed and Stored to Date). Column I.This column is normally used only for contracts where variable retainage is permitted on a line-item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders.Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project,this is not normally done. Usually,Change Orders are listed separately,either on their own 0703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 form. Construction Change Directives.Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201. The following is an example of a Continuation Sheet for work in progress.Please note that dollar auxxrnts shown below are for illustrative purposes only,and are not intended to reflect actual construction costs. A It C D L I' 0 II I MURK COMPLETED MATERIALS TOTA1. PRESENTLY COMPLETED "LANCE,, KEIT 111:NI Si;I tI;DU LI;U FROM PREVIOUS �� TEl DPSC'kll''rl(IN OF WORK SNO!IN AND STORED (O VAkI.\l3LL NO. VALUE APPLICATION 'I'711S PERIOD (NOT IN TO DATE ((i-1,) PINI511 RATED (D t 11 DOE!L) {D+L'+P) ((„O] 1 MOBILIZATION 5,000 5.000 0 0 5,000 100 0 2 STOMP REMOVAL 5,000 5,000 0 0 5,000 100 0 3 EARTH WORK 15.000 10,000 5,000 0 15,000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURBS d 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 20,000 0 0 0 0 0 20,000 8 PAVERS 20,000 0 0 10,000 10,000 50 10,000 9 BRICK WORK 5,000 0 0 0 0 0 5,000 10 it 105,000 20,000 10,000 10,000 40,000 65,000 AIA Document G703TM–1992.Copyright©1983,1965,1966,1967,1970,1978,1983 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 - 'courael,copyright @aia.org. D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment # 10 1334 STATE: INDIANA FINAL XX PARTIAL _ PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: Parcel 7A; Regional Performing Arts Center located in: Carmel, IN and owned by City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of: THREE HUNDRED THIRTY-FIVE THOUSAND EIGHT HUNDRED SEVENTY FIVE AND 00/100 DOLLARS: $335,875.00 XXXX receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of: DOLLARS: $ - receipt of which is hereby acknowledged or _ the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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, in any, and further certified that no other party has any claim or right to lien on account of any work performed or material furnished to undersigned for said project and within the scope of this affidavit and wavie _Diversified Painting Co. Inc._ B President Kevifi M. Blume WITNESS MY HAND AND NOTARIAL SEAL THIS: 11/15/10 MY COMMISSION EXPIRES: 11-08-2017 COUNTY OF RESIDENCE: Boone NOTARY Thom Thomas E. Hili 1a Notary Public State of Indiana • Boone Expires No County 0 ,2417 D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 11 1345 STATE: INDIANA FINAL XX PARTIAL - PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting & Wallcovering for a project known as: Parcel 7A;Regional Performing Arts Center located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor th'`sum of: ONE HUNDRED NINETY-SIX THOUSAND EIGHT HUNDRED AND 00/100 DOLLARS: $ 196,800.00 XXXX receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of DOLLARS: $ - receipt of which is hereby acknowledged or _ the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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, in any, and further certified that no other party has any claim or right to lien on account of any work performed or material furnished to,undersigned for said project and within the scope of this affidavit and wavier. _Diversified Painting Co. B : ,.� 16� }�'" President 9 Inc._ Y es dent Kevin.M. Blume WITNESS MY HAND AND NOTARIAL SEAL THIS: 11/20/10 MY COMMISSION EXPIRES: 11-08-2017 COUNTY OF RESIDENCE: Boone /� - fry NOTARY Thomas E. Hill Thomas E. Hill "°t Notary Public State of Indiana'' Boone County Expires Nov 8, 2017 D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment # 12 check 1427 STATE: INDIANA FINAL XX PARTIAL _ PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: Parcel 7A; Regional Performing Arts Center located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of: two hundred forty-five thousand six hundred twenty-five and 001100 DOLLARS: $245,625.00 XXXX receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of: DOLLARS: $ receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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, in any, and further certified that no other party has any claim or right to lien on account of any work performed or materiel furnished to undersigned for said project and within the scope of this affidavit and wavier. _Diversified Painting Co. Inc._By: / / / President Kevin M. BI WITNESS MY HAND AND NOTARIAL SEAL THIS: 12/10/10 MY COMMISSION EXPIRES: 11-08-2017 J�L COUNTY OF RESIDENCE: Boone I NOTARY Thomas E. Hill Thomas E. Hill °U4,.. Notary Public State of Indiana Boone County Expires Nov 8,2017 D. P. Co. Inc. AFFIDAVIT AND WAIVER OF LIEN Payment# 13 check 1457 STATE: INDIANA FINAL xxx PARTIAL - PAYMENT TO FOLLOW COUNTY OF: MARION _kevin M. Blume_Being duly sworn that he is the Secretary of Diversified Painting Co. Inc_being in contract with Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Painting &Wallcovering for a project known as: Parcel 7A; Regional Performing Arts Center located in: Carmel, IN and owned by_City of Carmel Redevelopment Commission and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) That there is due from the contractor the sum of: one hundred fifty-three thousand four hundred sixty-one and 00/100 DOLLARS: $ 153,461.00 XXXX receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Partial Waiver of Lien which is given solely with respect to said amount and which waiver shall be effective only upon receipt of payment thereof by the undersigned. (FINAL WAIVER) That there is due from the contractor the sum of: DOLLARS: $ receipt of which is hereby acknowledged or the payment of which has been promised as the sole consideration of the affidavit and Final Waiver of Lien which is shall become effective upon receipt of such payment. THEREFO 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, in any, and further certified that no other party has any claim or right to lien on account of any work tcrforrned or material furnished io ui idersigrled For said project and within the scope of this affidavit and wavier. Diversified Painting Co. Inc._By: l . President Kevin M. ume WITNESS MY HAND AND NOTARIAL AL THIS: 12/15/10 MY COMMISSION EXPIRES: 11-08-2017 /` COUNTY OF RESIDENCE: Boone 1 ` NOTARY E. Thomas E. Hill 4 0z4:9 .. Notary Public State of Indiana s .•(dir %,, Boone County ► Expires Nov 8,2017 61