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DIVERSIFIED PAINTING COMPANY -001681 -3/3/2011 - CARMEL REDEVELOPMENT COMMISSION 001681 Diversified Painting Company Check: 1681 1661 Expo Lane Date: 3/3/2011 Indianapolis, IN 46214 Vendor: DIVERSI1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 15 53 33,681.04 33,681.04 0.00 0.00 33,681.04 Application 15 33,681.04 33,681.04 0.00 0.00 33,681.04 ! AIA t. Document G702/Ma" - 1992 Application and Certificate ate for Payment Construction Manager-Adviser Edition 3 TO OWNER: PROJECT: APPLICATION NO: 15 ' Distribution to: Carmel Redevelopment Commission PARCEL 7A, Regional Performing Arts Center One Civic Square Interior Finish Package P5 PERIOD TO 1/20/11 OWNER ❑ Carrnel IN'46032 Bid Pack#5160,Painting CONSTRUCTION MANAGER ❑ FROM CON1 A6VQPainting Company VIA CONSTRUCTION MANAGER: CONTRACT DATE: Febuary 24,2009 ARCHITECT ❑ 1681 Expo Lane CSO Architects 2695 PROJECT NOS: / / 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 due. 2. Net change by Change Orders $ (23 629 00) CONTRACTOR: D. .Co nc.7"/ - $.CONTRACT SUM TO DATE(Line.1 +2) $ 2,076,371.00 By: Date: 1/20/2011 4.TOTAL COMPLETED&STORED TO DATE(Column G on G703) $ 2,072,921 A0 State of INDIA A' 5.RETAINAGE County of: Boone a. %of Completed Work Subscribed and sworn to before .: Thomas E. Hill o f° • (Column D.+Eon G703) $4,072.00 me this day of 1/20/ ?ot•R}. Notary Public State of Indiana b. 10%of Stored Material Notary Public Thomas EHill /a g �� in.P. Boone County (Column F on G703) $8,150.00 My Commission expires: 11/08/2017 Nov 8,2017 II Retainage(Lines 5a+Sb or Total in Column I of G703). $ CERTIFICATE FOR PAYMENT .• 102,222.08— In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 1,970,699.00 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge,information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 1.937.017.96 accordance with the Contract.Documents,and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 8.CURRENT PAYMENT DUE $ 33,681.04 AMOUNT CERTIFIED $ .3-C2a I 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if amount certified differs from le c no nt,applied.Initial all figures on this Application and on t Continuation.Sli° hat a e ch nged'to conform with the at want •ertified.) (Line 3 less Line 6) 105,672.00 CONS • CTIO G •O I +y By �i ���,�' Date: r 9 ADDITIONS DEDUCTIONS ` CHANGE ORDER SUMMARY ARCH! T: ti - 0'E 3t l l Total changes approved in previous months by Owner $ $ By �- � Date: Total approved this Month $ $ This Certifir ate is ni ncg;ter 1e. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ - $ - named her'.n. IssiAice,'pa),r,ent and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order $ - the Owner br C,,,itractor 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. e1Pv AIA Document G702/CMaTM—1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA Document is protected by U.S.Copyright Law and International Treaties. '° unauthorized reproduction or distribution of this 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 i Architects'legal counsel,copyright@aia.org. DirectOT of Redeveloprtmut it ,L/ 001,0 7 . i =as: Document G702/CMaTM - 1992 Instructions Application and Certificate for Payment Construction Manager-Adviser Edition A.General Information AIA Document G702/CMa,Application and Certificate for Payment,Construction Manager-Adviser Edition,is to be used in conjunction with AIA Document G703, Continuation Sheet.These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner,but not as a constructor,and where multiple Contractors have direct Agreements with the Owner.Procedures for their use are covered in AIA Document A201/CMa,General Conditions of the Contract for Construction,Construction Manager-Adviser Edition,1992 Edition. B.Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA.There is no implied permission to reproduce this document,nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702/CMa,but only for use in connection with a particular project.The AIA will not permit reproduction outside of the limited license for reproduction granted above,except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AlA 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. 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 G703form or at the end of the basic schedule.The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702/CMa form. Construction Change Directives:Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders.Amounts remaining in dispute should be dealt with according to Section 7.3 in A201/CMa. (,I - fly E.Making Payment -- -• •The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and'Architect on AIA Document G702/CMa, Application and Certificate for Payment,Construction Manager-Adviser Edition.The completed farm contains the name aridiaddress of the Contractor.Payment should not be made to any other party unless specifically indicated on G702/CMa. AIA Document G702/CMa TM-1992.Copyright ©1992 by The American Institute of Architects.All rights reserved.WARNING:This 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. ...... . : Document G703 TM - 1992 page 1 ' Continuation Sheet AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 15 containing Contractor's signed certification is attached. APPLICATION DATE: 40563 In tabulations below,amounts are stated to the nearest dollar. Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 1(20/2011 ARCHITECT'S PROJECT NO A B C D E F . G H 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 (D+E) (NOT IN TO DATE (C C) RATE) D OR E) (D+E+F) I Bonds 73,500.00 73,500.00 73,500.00 100% 0.00 7,350.00 2 Moblilization 5,000.00 5,000.00 0.00 5,000.00 100% 0.00 500.00 3 Insurance/Hazcom/Safety 4,000.00 4,000.00 4,000.00 100% 0.00 400.00 L 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 37,000 00 100% 0.00 3,700 00 6 09-84-00,ACOUSTICAL WALL PANELS Labor 51,500.00 51,500.00 0.00 51,500.00 100% 0.00 5,150.00 Material 480,000.00 480,000.00 0.00 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 BALM 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 SUB TOTAL PAGE-1. 1,095,950 00 1,095,950 00 0-00 0 00 1,095,050.00 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 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. IMMO =g'--"ATA Document G703"- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AlA 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 ALA 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 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 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 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 cr Continuation Sheet fo•work in progress.Please note that dollar amounts shown below are for illustrative put poses only,and are not intended to reflect actual construction costs, A R C n 1 F. F WORK COMPLETED _ MATERIALS TOTAL BALANCE PRESENTLY COMPLETED o, RETAINACE ITEM SCHEDULED FROM PREVIOUS .o TO DE:SCH PITON OF WORK STORED AND STORIED _ [IF VARIABLE NCI. VALUE APPLICATION TIIIS PF_0100 (NOT IN TO DATE (0 C) FINISH RATE) '"IF) O OR C) (10 0P) IC-(I) 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 6 MISC.CONC. 5,000 0 0 0 0 ❑ 5,000 6 PAVING,UPPER DRIVE 20,000 ❑ 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 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 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. .*AIA IA Document G7Q3 TM - 1992 Continuation Sheet page 2 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: In tabulations below amounts are stated to the nearest dollar. 15 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: 40563 ARCHITECT'S PROJECT NO:1/20/2011 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 (1F VARIABLE NO VALUE APPLICATION THIS PERIOD (G_C) FINISH (NOT IN TO DATE RATE) (D+E) D OR E) (D+E+F) (C-CO 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 HALL S 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 LOBE 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 LOBB 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 LOB,STR WAL LAB 48,000.00 48,000.00 0.00 48,00000 100% 0.00 4,800.00 SE ORCH LOBSTR WAL MAT 8,700.00 8,700.00 0.00 = 8,700 00 100% 0.00 870.00 gUIB TOTAL 1=2AG.E-2 699,100 00 699,100 00 CL 6 0 00 697,100 00 24 00 0 00 6.210 00 1 • 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 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. I._ AA= Document G703 TM- 1992 Instructions Continuation Sheet GENERAL INFORMATION Purpose and Related Documents.AIA Document G702,Application and Certificate for Payment,is to be used in conjunction with 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 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 AlA. Rights to reproduce the document may vary for users of AlA software.Licensed AIA 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. 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 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 jhr work in progress.Please note that dollar amounts shown below are for illustrative purposes only-.and are not intended to reflect actual construction costs. A R C D li P 1, II 1 WORK COMPLGCI'GS 'M1-RESI'RIA LS TOTAL BALANCE LANCI3 ITEM SCIirUUI I:D FROM PRESENTLY COMPLETED REI'AIN'AGE R MP PREVIOUS TO D3:SCRII'rR1N/1P��'ORK STOREY) AND STORED 111'VARIABLE N0. VALUE APPLICATION TINS PIBOOD (NOT IN TO DATE CG+CI I INI511 RATE) (U+E) DCIR E) (D+E+F) (c-co • 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 6 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 10000 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 AlA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. o *AIA Document G703TM - 1992 Continuation Sheet ::, page 3 AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractors signed certification is attached. 15 APPLICATION DATE: In tabulations below.amounts are stated to the nearest dollar. 40563 Use Column I on Contracts where variable retaina e for line items apply. PERIOD TO: g may t PP Y 1/20/2011 ARCHITECT'S PROJECT NO A B C D E F 0 H I WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS % TO ITEM DESCRIPTION OF WORK STORED AND STORED HE VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G_C) FINISH RATE) (D+E) D OR E) (D+E+F) (C-G) BAL L/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 RIvI 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 15,000.00 0.00 15,000.00 100% 0.00 1,500.00 1D GENERAL ALLOWANCE 100,000.00 96,618.96 3,381.04 100,000.00 100% 0.00 10,000.00 11 SUPPLIES ALLOWANCE 15,000.00 11,200.00 3,800.00 15,000.00 100% 0.00 1,500.00 12 LABOR ALLOWANCE 75,000.00 48,500.00 26,500.00 75,000.00 100% 0.00 7,500.00 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 5,200.00 0.00 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 288,321.00 251,189.96 33,681.04 0.00 284 8.71.00 20.00 3,450.00 28,487.10 SUB TOTAL PAGE 1 1,095,950.00 1,095,950.00 0.00 0.00 1,095,950 00 22.00 0.00 109,595.00 SUB TOTAL PAGE_2 697,1nn nn Ra2,1nn 00 0 00 n 0o 692,100 00 24 00 0 00 69,210 00 GRAND TOTAL 2,076,371.00 2,039,239.96 33,681.04 0.00 2,072,921.00 66.00 3,450.00 207,292.10 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 A€A Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. li . . • %� TM •-' Document G703 — 1992 Instructions s 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 0703,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 C. 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 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 an example ofa Continuation Sheet.16r work in progress.Please note that dollar anmun/S shmvn below arefOr illustrative purposes only,and are not intended to reflect actual construction costs. A R C I) IF F 0 II I WORK COMPL IIT1=U MATERIALS 'RNA', H,ALANC:F: PRF,SRNTI,7' COMPLETED RCTAI�'nGC ITEM SCHEDULED FROM PREVIOUS :� TO NC7 OI:SC RIP'fl()N OF WORE VALUE APPLICATION TIIIS PERIOD ST(FRF:n AND SYYiRL-D ((I+C) _ FINISIE OF VARIABLE (0 5) (NOT IN TO DATE. (C-r7 RATE,) D OR E) (D+L+El 1 MOBILIZATION 5000 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 5900 0 15000 100 0 4 LOWER RETAINING WALL 10,000 0 5,000 0 5,000 50 5,000 5 CURES S 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 11 1 105,000 20,000 10,000 . 10,000 40,000 • 65,000 AIA Document G703T"—1992.Copyright©1963, 1965,1966,1967,1970, 1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING: This AIA®Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIA®Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org.