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HomeMy WebLinkAboutW R DUNKIN & SON, INC.- 001358- 11/18/2010 f te—LARMEL�REDEVELOPMENT COMMISSION 001358 I W F2 Dunkin & Son, Inc. Check: 1358 PO Box 2247 Date: 11/18/2010 Anderson, IN 46018 Vendor: DUNKINW1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-1 68 53,200.00 53,200.00 2,800.00 0.00 50,400.00 Application 1 on Energy Center 19-2 51 142,350.00 142,350.00 0.00 0.00 142,350.00 Application 19 29A 35 89,731.00 89,731.00 0.00 0.00 89,731.00 Application 29A 285,281.00 285,281.00 2,800.00 0.00 282,481.00 ISPEMwnU91 THIS.CHECKiHAS'A'CO'ORED!BACKGROUND7AND-CONTAINS!MULTIPLESECURITY,FEATURES'SEE:BACKIFORIDETAIL'SalaaW 6°E Carmel Redevelopment Commission 0-01358 rpt4fa 30 West Main Street REGIONS Suite 220 20-1 421/740 • 0/sw S Carmel, IN 46032 S}RIL 1358 DATE AMOUNT 11/18/2010 282,481.00 PAY THE SUM OF TWO HUNDRED EIGHTY TWO THOUSAND FOUR HUNDRED EIGHTY ONE DOLLARS . • TO THE ORDER OF W R Dunkin & Son, Inc. . PO Box 2247 It 5ew5 0.L Anderson, IN 46018 .. 11'00 1 3 5811' I:0 740 11i 2 L 31: 008 7 504 L L Li" CARMEL REDEVELOPMENT COMMISSION 001358 9 - W R Dunkin & Son, Inc. Check: 1358 PO Box 2247 Date: 11/18/2010 Anderson, IN 46018 Vendor: DUNKINW1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 2-1 68 53,200.00 53,200.00 2,800.00 0.00 50,400.00 Application 1 on Energy Center 19-2 51 142,350.00 142,350.00 0.00 - 0.00 142,350.00 Application 19 29A 35 89,731.00 89,731.00 0.00 0.00 89,731.00 Application 29A 285,281.00 285,281.00 2,800.00 0.00 282,481.00 . ° TT 35 i AIA Document G702/CMarg - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Cannel Redevelopment PROJECT: Parcel 7A,44050 Carmel APPLICATION NO:029A Distribution to: Commission Performing Arts OWNER:X One Civic Square 777 3rd Ave. S.W. PERIOD TO: September 30,2010 CONSTRUCTION MANAGER:X Carmel,IN 46032 Carmel, IN 46032 ARCHITECT:X FROM W.R. Dunkin&Son,inc. VIA CONSTRUCTION Shiel Sexton Co..Inc. CONTRACT DATE:May 08,2008 CONTRACTOR:X CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:25 310/2695_405012695 FIELD: Anderson,IN 46018 CONTRACT FOR: BP-#4050 General Trades VIA ARCHITECT: CSO Architects OTHER: 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 been paid by the Contractor for Work for which previous Continuation Sheet, AIA Document G703,is attached. Certificates for Payment were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 9,966,300.00 payment shor erein is now due. 2.NET CHANGE BY CHANGE ORDERS ......_.. .......................................... $ -141.140.00 CONTRACTOR. W Son, Inc. 3.CONTRACT SUM TO DATE(Line 1±2) $ 9.825,160 00 By / f Date: September 22.2010 4.TOTAL COMPLETED&STORED TO DATE(Column G on 0703) .... .. .. $ 8,805,049.00 State of a diana 5.RETAINAGE: County of:Madiso a. 5 %of Completed Work Subscribed and sworn to before (Column 0+Eon 0703) $ 491.258.00 me this 22nd day of Septemeer� b 2010 b. 0 %of Stored Material Notary Public:Martha A. Carpenter W/ «� (Column F on G703) $ 0.00 My Commission expires:January 08,2017 G Total Retainage(Lines 5a+Sbor Total in Column IofG703) $ 491.258.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 8,313,791.00 In accordance with the Contract Documents,based on on-site observations and the data comprising (Line 4 Less Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best of their 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT _.. ..$ 8,22-1,060110 knowledge,information and belief the Work has progressed as indicated.the quality of the Work is in ..°°°°°.. . . accordance with the Contract Documents.and the Contractor is entitled to payntenl of the AMQi�T (Line 6 from prior Certificate) CERTIFIED. �� �� �6/ 8.CURRENT PAYMENT DUE $ 89,731.00 AMOUNT CERTIFIED $ e 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation ifamount certified differs from the amount applied. Initial all figures on this Application and on - e Continuation Sheet tha ire changed to conform with the amount certified.) (Line 3 less Line 6) $ 1.511.369.00 CONST-UCTIO MO•GEe / r7y Bit �':s a!F�fAS�. + '-— Date: �9 L_1 writ 1� d CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARCHITE Total changes approved in previous months by Owner $ 619,190.00$ 760,330.00 By. - Date: II Total approved this Month $ 0.00$ 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 619.190.00 $ 760.330.00 named herein. Issuance, payment and acceptance of payment arc without prejudice to any rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order $ -141,140.00 AM Document G702/CMa°—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 he prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:56.01 on 09122(2010 under Order No.0168420739_1 which expires on 05/10/2071,and is not for resale. User Notes: (7194947627) tAIA Document G703r" - 1992 Continuation Sheet AIA Document, G702TM-1992,Application and Certification for Payment, or G736TM-2009, APPLICATION NO: 029A Project Application and Project Certificate for Payment, Construction Manager as Adviser Edition, APPLICATION DATE:09115/2010 containing Contractor's signed certification is attached. In tabulations below,amounts are in US dollars. PERIOD TO:09/30/2010 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 FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS STORED AND STORED TO (0-C) FINISH (II'VARIABLE THIS PERIOD DATE (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 1LIZE 29,000.00 18,300.00 0.00 0.00 18,300.00 63.10% 10,700.00 1,500.00 SUPERVISION/CO 01020 ORDINATION 361,000.00 348,600.00 4,200.00 0.00 352,800.00 97.73% 8,200.00 28,480.00 GENERAL 01025 CONDIT1ONS-M 380,000.00 365,200.00 7,000.00 0.00 372,200.00 97.95% 7.800.00 27,000.00 GENERAL 01026 CONDITIONS-L 98,000.00 95,200.00 1,300.00 0.00 96,500.00 98.47% 1,500.00 7,000.00 GENERAL 01027 CONDI'T'IONS-O 262,990.00 247,300.00 7,000.00 090 254,300.00 96.70 % 8,690.00 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 34,231.00 2,496.00 0.00 36,727.00 96.65% 1,273.00 2,776.90 ALLOWANCE- TEMPORARY DOORSIFRAMES/H 14000 ARDWARE 10,000.00 5,972.00 0.00 0.00 5,972.00 59.72% 4,028.00 0.00 14000 ALLOWANCE-ICE 13,500.00 2,725.00 218.00 0.00 2,943.00 21.80% 10,557.00 207.10 ALLOWANCE- 140L'0 SECURITY 31,000,00 19,900.00 12,315.00_ 0.00 32,215,00 10392% -1,215.00 0.00 140F0 ALLOWANCE- 191,700.00 109,674.00 -2,610.00 0.00 107,064.00 55.85% 84,636.001 3,987.90 MA Document G703Th'-1992.Copyright 1953,1965,1966, 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 AIAI 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 14:59:23 on 09/2212010 under Order No.016 8420 7 3 9_1 which expires on 05/10/2011,and is not for resale. User Notes: (1131424624) A B C D I E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO REI:AINSAGE 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) +E) (D+E+F) DUMPSTERS ALLOWANCE- TRAILER I40G0 CONNECTOR 34,000.00 33,391.00 55.00 0.00 33,446.00 98.37% 554.00 2,200.90 ALLOWANCE- TR.AILER 140110 CLEANING 19,169.00 18,863.00 -3,14300 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 320,000.00 311.092.00 10.752,00 0.00 321,844.00 100.58% -1,844.00 594.40 ALLOWANCE- TEMPORARY 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 18,856.00 0.00 0.00 18,856.00 49.75% 19,044.00 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/M AINTAI 140N1 N 100,000.00 80,324.00 0,00 0.00 80,324.00 80.32% 19,676.00 5,532.40 ALLOWANCE- MAINT:OFF SITE STAGING/PARKIN 140N2 G 35,000.00 20,708.00 844.00 0.00 21,552.00 61.58% 13,448.00 685.50 ALLOWANCE- PARKING LOT REMOVE/REFURBI 14000 SH i 100,000.00 2,745.00 0.00 0.00 2,745.00 2.75% 97 255.00 274.50, MA Document 0703m-1992.Copyright 01963,1965, 1966, 1967,1970,1978,1953 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document is protected by U.S.Copyright Law and international Treaties.Unauthorized reproduction or distribution of this AIAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 • prosecuted to the maximum aatent possible under the law,This document was produced by AIA software at 14:59.23 on 09/2212010 under Order No 9168426739_1 which expires en 05H0/2011,and is not for resale_ i User Notes: (1131424624) A B C D I E F 0 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 (11°VARIABLE APPLICATION (NOT IN D OR E) DATE (C-G) RATE) (D+E) (D+E+F) ALLOW ANCE- 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 01. GEOTECH 1400.1 FABRIC 4,700.00 3,207.00 -3,207.00 0.00 0.00 0.00% 4,700.00 320.70 ALLOWANCE- 140Q2 TENSARGEOCIRID 8,500.00 0.00 8,126.00 0.00_ 8,126.00 95.60% 374.00 0.00 ALLOWANCE-82 140R0 STONE 26,200.00 10,275,00 (3,305.00 0.00 23_,580,00 90.00% 2,620.00 1,027.50 ALLOWANCE- CABLE PASS- ]40S0 THRU(FO1-1) 6,456.00 6.456 00 0.00 0.00 6,456.00 100.00% 0.00 0.00 ALLOWANCE- CABLE PASS- 140T0 THRU(BOW 5,165.00 5,165.00 0.00 0.00 5,165.00 100,00% 0-00 0.00 ALLOWANCE- 140U CABLE PASS- O 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 200,000.00 116,356,00 5,151.00 0.00 121,507.00 60.75 % 78,493.00 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 400,000.00 367,398.00 -2,896,00 0.00 364,502.00 91.13% 35,498.00 598.00 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 G703"-1992.Copyright®1963,1965,1966,1967,1970.1978,1983 and 1992 by The American Institute of Architects.MI rights reserved.WARNING:This AIAe Document is protected by U.B.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 3 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14'.5923 an 09(2212010 under Order No_916 39 207 3 9_1 which expires on 05/10/2011,and is not for resale. Upor Notes: (1131424624) A _ B C D I 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 THISPERIOD STORED DATE (G'C) (C-G) RATE) (1)+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/WA SHIN 01503 G STATIONS-M 41,800.00 40,600.00 400.00 0.00 41,000.00 98,09% 800.00 2,860.00 TEMPORARY TOILE7-S/WASHIN 01504 G STATIONS-1.. 7,600.00 7,350.00 75.00 0.00 7,425.00 97.70 % 175.00 555.00 FIRE PROTECTION/EME 01505 RG.STATIONS-M [9,300.00 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 FURNISHIMAINTA 01508 IN TRASH CANS-I- 40,000.00 40.000.00 0.00 0.00 40,000.00 100.00% 0.00 2,350.00 TEMPORARY ROAD/MAINTENA 01510 NCB 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_ 6,500.00 100.00% 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 AlA Document G7031"-1992.Copyright C 1953,1965,1966, 1967,1970,1975,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe Document is protected by U.S.Copyright Law and International Treaties,Unauthadted reproduction or distribution of this AIAe Document,or any portion of it,may result in severe elyil and criminal penalties,and will be 4 ' prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 14:59:23 on 09/2212010 under Order No,D168420739_1 which expires on 05110/2011,and is not for resale_ User Notes: (1131424624) A B C D I E F Ci 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 DA'Z'E (G=C} (C C) RAPE) APPLICATION (NOT IN D OR E} (D+E) (D+E+F) 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 14,000.00 100.00% 0.00 1,360.00 SCAFFOLDING- SET UP/CONSUMABLE 01540 S 398,000,00 398,000.00 0.00 0.00 398,000.00 100.00% 0.00 37,620.00 SCAFFOLDING- MONTHLY RENTAL/INSPECT! 01541 ONS 228,000.00 228,000.00 0.00 0.00 228,000.00 100.00% 0.00 10,450.00 SCAFFOLDING- DISMANTLE/REM 01542 OVE 55,000.00 55,000.00 0.00 0.00 55,000.00 100.00% 0.00 0.00 S'T'AIR TOWERS- 01543 SETUP 54,000.00 18,000.00 0.00 0.00 18,000.00 33.33% 36,000.00 1,800.00 STAIR TOWERS- MONTHLY 01544 RENTAL 28,500,00 9,500.00 0.00 0.00 9,500.00 33.33% 19,000.00 350.00 STAIR TOWERS- 01545 DISMANTLE 6,700.00 2,200.00 0.00 0.00 2,200.00 32_S4% 4,500.00 0.00 - HOIST-EX"I'ERIOR- 1546.1 SETUP 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- 15463 DISMANTLE 8,000.00 0.00 0.001 0.00 0.00 0.00% 8,000.00 0.00 AIA Document G783"-1992.copyright Cr 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 AlAW Document,or any portion of it,may result in severe civil end criminal penalties,and will be 5 ' prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 14:59.23 on 09/2212010 under Order No.016 64 2 070 9_1 which expires on 05 110/2011,and is not for resale. l{ser Notes: (1131424624) 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 a�O FINISH IF VARIABLE NO. WORK VALUE APPLICATION THIS PERIOD STORED DATE (O _C) (C-G) ( RATE) (D +E) (NOT IN D OR F.) (D+F+F) 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/OPERAT1 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- 15483 DISMANTLE 2,500.00 2,500.00 0.00 0.00 2,500.00 100.00 4liu 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 HOT S'I'- ALLOWANCE- RENTAL/OPERATI 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 58,000.00 100.00% 0.00 2,500.00 GENERAL CLEAN 01560 UP-M 5,000.00 4,590.00 150.00 0.00 4,740.00 94.80% 260.00 314.00 GENERAL CLEAN 01561 UP-L 60,000.00 56,600.00 1,200.00 0.00 57,800.00 96.33 % 2,200.00 3,560.00 01562 FINAL CLEANING 65,000.00 2,000.00 0.00 0.00 2,000.00 3.08 % 63,000.00 0.00 02110 EXCAVATION/BA 12,019.00 12,019.00 0.00 0.00 12,019.00 100.00% 0.00 1,20 L90 AM Document G703131-1992.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 6 ' prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 14:59:23 on 09/22/2010 under Order No01 6 84 20 73 9_1 which expires en 0510/2011,and is not tot resale. User Notes: (1131424624) A B C D I E F 0 H I WORK COMPLE'T'ED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS THIS PERIOD STORED AND STORED TO FINISH (IF VARIABLE APPLICATION DATE (G_C) (C-G) RATE) (D_+E) (NOT IN D OR 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-I, 40,000.00 40,000.00 0.00 0.00 40,000.00 100.00% 0.00 3,500.00 PRECAST PLANKS-]2" 03410 FIOLLOW CORE 161,000.00 161,000.00 0.00 0.00 161,000.00 100.00% 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 82,000.00 100.00% 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 AIA Document 6703"-1992.Copyright®1963,1985,1966, 1967,1970, 1978.1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe 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 7 ' prosecuted to the maximum extent possible under the law.Tills document was produced by AlA software at 14:59:23 on 09/22/2010 under Order No.01 9 84 20 73 9_1 which expires on 05/10/2011,and is not for resale. Uger Notes: (1131424624) A B C D F F G H I WORK COMPLETED MATERIALS TOTAL ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. WORK VALUE PREVIOUS STORED AND STORED TO (G_C) FINISH (IF VARIABLE APPLICATION 'I'HISPERIOD DATE (C-G) RATE) (D+E) (NOT IN D OR F.) (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 META LS-L 275,000.00 275,000.00 0.00 0.00 275,009.00 100.00 % 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 071 I I -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 0721 1 DUCT LINERS-L 28,000.00 28,000.00 0.00 0.00 28,000.00 100.00% 0.00 1,120.00 07810 F1RESTOPP1NG-M 24,000.00 24,000.00 0.00 0.00 24,000.00 100.00% 0.00 1,680.00 07811 FIRESTOPP1NG-L 16,000.00 16,000.00 0.00 0.00 16,000.00 100.00% 0.00 3,220.00 JOINT SEAL.ANTS- 07910 M 35,000.00 18,000.00 5,000.00 0.00 23,000.00 65.71 % 12,000.90 0.00 JOINT SEALANTS- 07911 L 80,000.00 40,000.00 12,000.00 0.00 52,000.00 65.00% 28,000.00 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 MA Document G703"'-1992.Copyright®1963.1965.1966,1967.1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe 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 8 prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 14:59:23 on 0 9/2212 01 0 under Order No.0166420739_1 which expires on 05/10f2011,and is not for resale, • User Notes: (1131424624) A B C D I E F G H 1 WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY NO. WORK VALUE PREVIOUS AND STORED TO FINISH OF VARIABLE APPLICATION THIS PERIOD STORED DATE (c C) (C-G) RATE) (D+E) (NOT IN D OR E} (D+F+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 9.00 0.00 0.00% 0.00- OVER COILING 08355 DOORS4I 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 0.00 000 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.. 325,000.00 321,300.00 0.00 0.00 321,300.00 98.86% 3300.00 11,375.00 AMA Document 67031m-1992.Copyright©1963, 1965,1966.1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This ARC 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 9 ' prosecuted to the maximum extent possible under the law.This document was produced by AA software at 14'.59:23 on 0912212010 under Order No 0168420739_1 which expires on 0541012011,and is not for resale. User Notes: {1131424624) 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 TIll AND STORED TO S PERIOD STORED (G C) FINISH (IF VARIABLE APPLICATION (NOT IN D OR E) DATE (C -G) RATE) (D+ F) (D+E+F) CURTAIN WALLS- M CLAW ALUM. CURTAIN WALLS- 08441 L [48,000.00 133,600.00 10,000.00 0.00 143,600.00 97.03% 4.400.00 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-NI 11,000.00 11,000.00 0.00 0.00 11,000.00 100.00% 0.00 22.00 INTERIOR 08811 GLAZING-L 8,000.00 8,000.00 0.00 0.00 8,000.00 100.00% 0.00 0.00 FIRE PROTECTION 10440 SPECIAL1'IES-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 1,400.00 0.00 0.00 1,400.00 77.78% 400.00 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 16,475.00 0.00 0.00 16,475.00 89.05 % 2,025.00 1,647.50 LOADING DOCK 11131 EQUIPMENT-L 3,800.00 2.200.00 0.00 0.00 2,200.00 57.89% 1,600.00 220.00 ELEC.TRACTION ELT VATORS- 14210 ENGINEERING 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 ELEC.TRACTION 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 G703 TM-1992.Copyright ED 1963, 1965,1966,1987,1970,1978,1983 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 AIAi Document,or any portion of it,may result in severe civil and criminal penalties,and will be 10 ' prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:5923 on 09/2212010 under Order No.0168420739_1 which expires on 0910/2011,and is not for resale. User Notes: (1131424624) A B C D E F G H I _ WORK COMPLETED TOTAL MATERIALS BALANCE TO RETAINAGE WORK DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED % NO. ORK 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+F) ELEVATOR- MATERIAL/EQUIP M ENT HYDRAULIC ELEVATOR- 14243 LABOR 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR. LIFT- MATERIAL/EQUIP 14421 MENT 0.00 0.00 0.00 0.00 0.00% 0.00 0.00 WHEELCHAIR 14422 LI1 1'-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 14,68100 0.00 0.00 14,683.00 100.00% 0.00 0.00 MA Document G703"'-1992.Copyright©1953.1965,1966, 1967,1970,1976,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA5 Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this MA* Document,or any portion of it,may result in severe civil and criminal penalties,and will be 1.I ' prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 14:59:23 on 09122(2010 under Order No.0168420739_I which expires on 05/10/2011.and is not for resale. Usnr Notes: (1131424629) A B C D I E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY 11.11 PREVIOUS AND STORED TO FINISH (IF VARIABLE NO. WORK. VALUE THIS PERIOD STORED (0-Cl APPLICATION (NOT IN D ORE) DATE (C-G) RATE) (I)+E) (D+E+F) 17001 CHANGE ORDER 0 NO. 10 -760.330.00 -750,573,00 0.00 0.00 -750,573.00 98.72% -9,757.00 -38,016.50 17001 CHANGE ORDER 2 NO. 12 49_.062.00 49.06100 0.00 0.00 49,062.00 100.00% 0.00 2,453.10 17001 CHANGE ORDER 3 NO. 13 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 1,179.55 GRAND TOTAL $9,825,160.00 $8,715,318.00 S89,731.00 $0.00 $8,805,049.00 89.62% $1,020,111.00 $491,258.00 AIA Document G703" -1992.Copyright®1963.1965,1966,1967.1970,1978,1983 and 1992 by The American Institute at Architects.All rights reserved.WARNING:This AIA" Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA" Document,or any portion of it.may result in severe civil and criminal penalties,and will be 12 prosecuted to the maximum edent possible under the law.This document was produced by AlA software at 14:59:23 on 09/22/2010 under Order No.0155420739_1 which expires on 05/10!2011,and is not for resale. , tl,ser Notes: (1131424624) AFFIDAVIT AND WAIVER OF LIEN [ ]F1NAL [X] PART]AL [ X ] PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Craig R. Dunkin , being duly sworn states that he is the President/Treasurer of W. R. Dunkin & Son, Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 4050-General Trades for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor. Payment for Application f; 29A for work performed through 09/30/10 , oi which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall he effective only upon receipt of payment thereof by the undersigned. (PARTIAL WAIVER) that there is due from the contractor the sum of Eighty-nine Thousand Seven Hundred Thirty-one dollars and 00/cents ($ 89.731.00 ) Payment for Application # 29B for work performed through 09/30/10 , 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 Four Hundred Seven Thousand One Hundred Forty dollars and 00/cents ($ 407,140.00 ) 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(S ) 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 or material furnished to the undersigned for said project, and within the scope of this aft t iit and A.'aaiivvveeer./////(�' W.R. Dunkin& Son, Inc. By '[ F C }C/�Crt-y,�,� Title: President/Treasurer WITNESS MY HAND AND NOTARIAL SEAL,this (l[ 22°d day of September , 2010 (Notary Pt lic) My Commission Expires: January 08. 2017 Printed Martha A. Carpenter Residing in Madison County 1 AFFIDAVIT AND WAIVER OF LIEN L ]FINAL [X j PARTIAL [ j PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Craie K. Dunkin , being duly sworn states that he is the President/Treasurer of W. R. Dunkin & Son, Inc. having contracted with City of Cannel 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 # 26A&B has been received for work performed through 06130110 . (PARTIAL WAIVER)that there is due from the contractor the sum of One Hundred Eighty-three Thousand Six hundred Five dollars and 45/cents (S 183,605.45 ) 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(S ) THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above described properly 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 or material furnished to the undersigned for said project, a within the scop f this affidavit and waiver. W. R. Dunkin& Son, Inc. By .�// Mai _ Title: PresidentlTreasurer J WITNESS MY HAND AND NOTARIAL SEAL,this 22nd day off September ,2010 l (Notary Pub ) My Commission Expires: January 08,2017 Printed Martha A. Carpenter Residing in Madison County Date : 09/16/10 - T11ur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1 Job: 09-385 CPA - EP 4080 P4 GEN TRADES Contractor: W. R. DUNKIN & SON. INC. Pay Period : 09/00/10 - 09/14/10 777 3RD AVE S.W. P.O. ROX 2247 CARMEL, IN 40032 ANDERSON, IN 46018 Employers Id #: 35-0280890 Employee 1 Hours worked This Project 1 PAY 130E EARNI FED STATEItN DEDI TOT 1 NEI Information ] WED TEOR FRI SAT SON MON TOES TOTAL' RATEITOT EARNI FICAL LOCAL MISC 1 DED 1 PAY SOLING, RYAN L ST 0.00 6,00 8.00 - - 6.00 6.00 35.00 28.42 1023.12 78.40 37.34 97.15 OT 00 .00 1136.90 86,98 19.22 .00 97.15 817,72 ID M *.*_•._5181 SEX M Carpenter-Journeyman DEP 4 BROWNING, CHRISTOPHER A. ST 8.00 9.00 0.00 - - 0.00 8.00 40.00 29.04 1161.60 100.81 35.57 .00 OT .00 .00 1161.60 88.85 10.48 .00 .00 925.90 ID 4 664-4.-221i SEX M Laborer-Journeyman DEP 2 830531NC, CAMP A, ST 8.00 8.00 8.00 - - 8.00 8.00 40.00 23.11 924,40 88.66 31,43 36.98 OT -00 .00 824.40 70.72 16.18 .00 35.99 680.43 ID R ***-*4-7100 SEX M Laborer-Foreman DEP 0 BROWNING, JOHN W. ST S.00 8.00 8.00 - - 8.00 6.00 38.00 43.36 1847.68 220.38 58.32 .00 OT - - - - - - - 00 .00 1734,40 132.68 30.02 00 .00 1253.00 ID R ***-*.-7394 SEX M Carpenter-Superintend DEP 1 BROWNING, PAUL W. ST 8.00 8.00 6.00 - - 8.00 5.00 40.00 31.17 1246.80 115.96 41.08 192.11 09' - - - - - - - .00 00 1246.80 95.39 21.15 .00 132.11 791.11 ID R "*-**-5820 SEX M Carpenter-CA-S/3.25-V DEP 2 HARVEY, SHELLEY to ST - - 3.00 - - - - 3.00 27.92 83.76 .00 2.19 .00 ^'T .00 .00 83.76 6.40 1.11 00 .00 74.04 ID M ***-**-9119 SEX F Laborer-Journeyman DEP 1 HOFFNJN, KYLE P. ST 8.00 5.50 - - - - - 13.50 31.92 430.92 186.73 39.50 95.70 OT .00 .00 1191.04 90.34 20.33 .00 95.70 748,44 ID S *46-*4-5575 SEX K Carpenter-Superintend DEP 1 KEESLING, ROEERT R. ST 8.00 8.00 7.00 - - 8.00 7.00 38.00 28.42 1079.96 108.81 35.41. 92.30 CT -00 .00 1079.96 82-62 18.23 -00 92.30 742.59 ID N ***_**_4365 SEX M Carpenter-Journeyman DEP 4 Date a 09/10/10 - Thu[ C E R T I F I E D P A Y R O L L R E G I S T E R Page : 2 Job: 08-385 CPA - BP 4050 P4 GEN TRADES Contractor: w, R. DUNKIN & SON, INC. Pay Period . 09/08/10 - 09/14/10 777 3RD AL'E S.W. P.O. BOX 2247 CA.RMEL. IN 40032 ANDERSON. I:1 46018 Emp/oyete Id #: 35-0280890 Employee I Hours Worked This Project PAY !JOB EAENI FED STATEIDN DEDI TOT I NET Ia£oroat ion I WED THUR PRI SAT SON MON IDES TOTAL! RATEITOT EARN! PICA! LOCAL! M19C I DED I PAY RERR, WILLIAM W. ET 5.00 8.00 8.20 - - 9.00 8.00 40.00 22.11 384.40 130.11 30.07 35.39 OT .00 00 884.40 37.55 9,29 00 35.38 62.1,89 ID # ...-^-0605 SEX M Laborer-Foreman DEP 0 LAMBERTSON, BRIAN K. ST 8.00 8.00 8.00 - - 8.00 0.00 40.00 23.42 1138.80 67.85 38.65 97.16 OT .00 .00 1135.80 86.58 11.94 .00 97.16 834.19 ID # 4**_ *_8102 SEX M Carpenter-Journeyman DEP 5 LOZOWSKI, (LAMES M. ST 8.00 0.00 8.00 - - 8.00 8.00 40.00 29.04 .1.3.61,60 124.24 49.49 -011 OT -00 .00 1161.60 88.87 20.33 .00 .00 878.67 ID X ww«_..-3093 SEX M Laborer-Journeyman DEP 0 MIRANDO, JOHN T ST 0.30 8.00 8.00 - - 8.00 8.00 40.00 20,42 1136.50 120.52 38.65 97.16 OT 00 .00 1136.60 86.56 14.21 .00 97.16 779.30 ID # ***_fl-2916 SEX M Carpenter-Journeyman DEP 0 J o b T o t a l e : Hours 408.50 Earnings: 11917.84 ' S T A T E M E N T O F C O M P L I A N C E DATE: 09/16/10 I, MARTI CARPENTER, EXEC.ASST./ PR CLERK do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN & SON, INC. on the (building or work) CPA - BP 4050 P4 GEN TRADES ;that during the payroll period 09/08/10 - 09/14/10 ;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been Cr wi.l.l be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Art,as amended(48 Stat. 546;63 Stat. 108;72 Stat. 967;76 Stat. 357;40 U.S.C. 276c) ,and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local Prom/Pac,Loans,Union Dues, Market Recovery,INTERNAT'L DUES,United Way !2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the coneract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. 13) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS iIn addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, �' payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c) below. (b) WHERE PRINCE BENEFITS ARE PAID IN CASH 1_1 Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION Remarks: NAME AND TITLE 1 SIGNATURE MARTI CARPENTER, EXEC.ASST./ PR CLERK I \ y/1 i r �/ THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR S CONTRA TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 CF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Date r 09/05/10 - Tnur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1. Job: 08-386 CPA - EP 4050 P4 GTN TMRDES Contractor: W. R, DUNKIN o SON, INC. Pay Period 09/01'10 - 09/07/10 777 3RD AVE S . P.O. PDX 2247 CARMEL, IN 45032 ANDERSON, IN 46018 Employers Id #: 35-0289859 Employee Hours Worked This PYOjeCt I PAY I JOB EARN! FED STATEION DRDI TOT NET Information WED THOR FRI SAT SON MON TOES TOTAL! RATEITOT EARN! FICA! LOCAL! MISC DED PAY BOLTNG, RYAN L ST 8.00 8.00 8.00 - - - - 24.00 26.42 682.08 13.69 21.88 9(3.29 01 .00 00 682.08 52.18 11.26 00 58.29 524.78 ID # ***-**-5183 SID[ N Carpenter-Journeyman DEP 4 BROWNTNG, CHRISTOPHER A. ST 8.00 8.00 8.00 - - - 8.00 32.00 29.04 929.28 65.56 27.57 00 CT - - - - - - - .00 .00 929.28 71.05 8.14 .00 .00 756.42 ID # ***-**-2255 SEX M Laborer-:Journeyman DEP 2 BROWN LEG, CAVIL) A. ST 8.00 8.00 8.00 - - - 8.00 22.00 23.11 739.52 60.53 25,14 29.55 06' .00 .00 739.52 56.57 12.94 .00 29,56 554.36 ID # ,"-**-710.) SEX M Laborer-1'Ox7em&R DEP .) BRMIN G, PAUL W. ST 8.00 8.00 8.00 - - 8.00 8.00 40.00 31.17 1248.80 115.96 41,08 153,68 60 00 00 1246.80 95.38 21.15 .00 153.68 019.55 ID # """-""-5830 SEX M Carpenter-CA-913.25-V DEP 2 HARTER, RONDA X. 3.00 - - - - 3.00 27.92 83.76 00 00 .00 OT .00 .00 83.76 6.40 .00 .00 .00 77.35 ID # ^""_"•-5899 SEX F Laborer-Journeyman DEP 5 HOFFNAN, KYLE P. ST 2.00 - - - - - 4.00 6.00 31.92 191.52 146.83 94,08 82,76 CT - - - - - - - .00 .4A 1.021.44 78.14 17.54 .00 82.76 552.09 ID # **"-""-8575 SS% M Carpenter-Superintend DEP 1 KEESLING, ROBERT R. 3T 8.00 8.00 8.00 - - - 8.00 32.00 28.42 509.44 72,64 29,61 77.72 CT .00 .00 909.44 69.55 15.24 .00 77.72 644.67 ID # ""*-**-4365 SEE M Carpenter-Journeyman DEP 4 KERR, WILLIAM W. ST 8.00 8.00 8.00 - - - 8.00 32.00 22.11 90'4.52 85.89 24.06 28.30 OT - - - - - - - .00 00 900.52 54.12 7.43 .00 28.30 507.72 ID # """-""-0605 SEX M Laborer-Foreman DEP 0 Date : 09/05/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 2 Job: 0P-385 CPA - PR 4050 P4 GEN TRADES Contractor: W. R. DUNKIN h SON, INC. Pay Period : 05/01110 - 09/07/10 779 3RD AVE S.W. P.O. BOX 2247 C:.RMEL, IN 46932 ANDERSON, IN 46018 Employers 'd k+ 35-0280890 Employee 1 Hours Worked This Project I PAY PPE EARN1 FED I STATE1ON MIDI TOT 1 NET Information WED TEOR FRI SAT SUN NON TOES TOTAL RATEITOT moan' PICAI LOCAL NISC DIM 1 PAY LA14RERTSON, BRIAN M, ST 8.00 2.00 6.00 - - - 9.00 32.00 28.42 909.44 33.77 30.92 77.72 OT 00 .00 909.44 69.97 9.55 .00 77.72 6687.91 ID # " 6102 SEX M Carpenter-Journeyman DEP 5 LOZOWSKI, JAMES N. ST 8.00 8.00 8.00 - - - 8.00 32.00 29.04 929.28 89.39 41.60 .00 OT .00 .00 929.28 71 09 16-26 .00 .00 716.94 ID 0 ""-44-8033 SEE N Laborer-Journeyman DEP 0 MIPA1S0, JOHN T ST 8.00 8.00 8.00 - - - 0.00 32.00 28.42 909-44 86.42 30.92 77.72 OT .00 -00 909.44 65.50 11.37 .00 77.72 633.43 ID N •rx_.,r_2915 SEX M carpeneer-,Journeyman DEP 0 J o b T o t a 1. s : Hours: 297.00 Earlings: 8238.08 S T A T E M E N T O F C O M P L I A N C E DATE: 09/09/10 I. Marti Carpenter, Exec.Asst./ FR Clerk do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN & SON, INC. on the (building or work) CPA - BP 4050 Ph OEN TRADES that during the payroll period 09/01/10 - 01/07/10 all persons employed on said project have been paid the full weekly wages earned, that no tebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle Aj ,issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat. 94B;63 scat. 108;12 Stat. 907;76 Stat- 357;40 U.S.C. 276cl .and described below, 'sues-initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund.GARNISHBENT ,Local Prom/Pac.Loans,union Dues, Market Recovery,INTERNAT•1. OUES,Un.i.ced Way (2) That any payrolls other'w,i.Ee under this contract required to be submitted for the above period are correct and complete:that the sage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the class,l.f.'Lcations set forth therein for each laborer or mechanic conform with the work performed, )31 That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Cmaining,United States Department, of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. )4) That: la) WEEKS FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS 1 - In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, PPPP��- payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(cl below. (b) WHERE FRINGE EmiMPITS ARE PAID IN CASH 1_1 Each laborer or mechanic listed in the above referenced payr011 has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS (CRAFTI EXCEPTION EXPLANATION Remarks: E I NAME AND TITLE i SIGNATURE �a Y,arti. Carpenter, Exec:Asst./ PR Clerk �J THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAT SUBJECT THE CONTFACrOR OR SS CON CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 Mali SECTION 231 OF TITLE 31 OF 1'HE UNITED STATES CODE. Date 09/02/10 - Thee C E R T I F I E D P A Y R O L L R E S I S T E R Page : 1 Job: 08-385 CPA - BE 4050 P4 GEN TRADES Contractor: W. R. DUNKIN 5 SON, INC. Pay Period : 08/25/10 - 05/31/10 777 3RD AVE S.W. P.O. BOX 2247 CARMEL, IN 46032 ANDERSON, IN 45018 Smployere Id k: 35-0280890 Employee Hoorn Worked This Project I PAY IJOR EARNI FED I STATSIRI DEDI TOT I NET Information WED THOR PRI SAT SON NON To85 TOTALI RATEITOT EARN' PICA1 LOCALI MiSC DED I PAY BOLING, RYAN L ST 8.00 8.00 8.00 - - 3.00 B.00 40.00 28.42 1136.80 79.40 37.34 97.16 OT .00 .00 1135.80 86.98 19.22 .00 97.16 017.70 ID R ***_**_5183 SEX M Carpenter-Journeyman DSP 4 BROWNING. CHRISTOPHER A. ST 8.00 8.00 8.00 - - 8.00 8.00 40.00 25.04 1161.60 100.81 35,57 .00 CT .00 .00 1161.60 88.86 10.46 .00 .00 925.90 ID 8 •••-:*-2265 SEX M Laborer-Journeymen DEP 2 BROWNING, DAVID A. ST 8.00 6.00 - - - 8.00 8.00 32.00 23.11 739.52 60.93 25.14 29.58 OT .00 .00 739.52 50.57 12,94 00 25.58 554.36 in P **-** 7100 SEX M Laborer-Foreman DEP 0 0ROWNTNG, PAUL W. ST 8.00 8.00 8.00 - - 8.00 8.00 40.00 31.17 1240.80 115.96 41.09 192.11 OT .00 .00 1246.80 95.37 21.15 .00 192.11 781.13 in $ ***-*f-5830 SEX N. Carpenter-CA-S/3-25-V DEP 2 HARVEY, SHELLEY M ST - - 3.00 - - - - 3.00 27.92 53.76 .00 2.19 .00 OT .00 .00 03.76 6.42 1..3.3 .00 .00 74.02 ID $ +^__*-5119 SEX t' Laborer-Journeyman DEP 1 HC££MAN, KYLE P. ST 2.00 2.00 4.00 31.92 127.58 186.73 39.50 95.70 0'f - .00 .00 11131.04 90.36 20.33 .00 95.70 748.42 ID # 4-1t-'7-11575 SEX M Carpenter-Superintend DEP 1 KEESLING, ROBERT R- ST 8.00 8.00 6.00 - - 8.00 8.00 40.00 28.42 1135.80 123.02 37.34 97.16 OT .00 .00 1135.80 86.97 1.9.22 .00 97.16 773.09 ID 0 *-*-**-4365 951 74 Carpenter-Journeyman DEP 4 KERR, WILLIAM W. ST 8.00 8.00 4.00 - - 10.00 8.00 39.00 22.11 840.18 141.17 31.57 37.14 OT .00 .00 928.62 71.05 9.75 .00 37.14 637.94 ID M ***-**-0605 SEX M i.abOrec-Foreman DEP i Date: 09/02/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 2 Job: 98-385 CPA - EP 4050 P4 GEN TRADES Contractor: W. R. DUNKIN & SON, INC. Pay Period 08/25/10 - 08/31/10 777 3RD AVE S.F. P.O. LOX 2247 CAR:SEA, IN 46032 ANDERSON, IN 48018 Employers Id #: 39-0260890 Employee Hours Worked This Project I PAY JOE RJRNI FED I OTATEIUN DEDI TOT I NET Information WED THUR PRI SAT SON MON TUES TOTALI RATEITOT RARNI PICAI LOCALI MISC I DED I PAY LNABERTSON, BRYAN M. SI 8.00 8.00 8.00 - - 8.00 8-00 40.00 28.42 1136.80 67.8B 38.65 96116 OT .00 .00 1136.80 66.96 11.94 .00 97.1.6 834.21 ID # ***-*4_8102 SEX M Carpenter-Journeyman DEP 5 LOZOWSKI, JAMES M. ST 8.00 6.00 8.00 - - 8.00 8.00 40-00 29.04 1161.60 124.24 49.49 .00 02 - _ - - - - - .00 .00 1121.60 88.86 20.23 .00 -00 378.68 ID # ***_**-8093 SEX M LabOrer-3OUrieyman DEP 0 MIRANDO, JOHN T ST 8.00 8.00 8.00 - - 0.00 8.00 40.00 28.42 1130.60 120.52 38.65 97.16 OT .00 .00 1130.80 96.96 14.21 -00 97.16 779.30 ID P **r_r•_2916 SEX M Carpenter-Journeyman DEP C STORK, KEITH E ST 8.00 8.00 16 00 26.92 430.72 00 12.68 .00 OT - - - - - - - .00 .00 430.72 32.96 2.53 00 00 373.55 ID # ***-**-0063 SEX M Laborer-Journeyman DEP 3 J o b T o t a l s : HourS: 373.00 Eeernings: 10339.06 S T A T E M E N T O P C O M P L I A N C E DAIE( 09/02/10 I, Marti Carpenter, Exec.Asst.% PR Clerk do hereby state( (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN & SON. INC. on the (building or work) CPA - EP 4050 P4 GEN TRADES that during the payroll period 08/25/10 - 08/31/10 ;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W_ R_ DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3i29 CFR Subtitle Al ,issued by the Secretary of Labor under the Copeland Act,as amended(40 Stat. 548;63 Stat. 10B;72 Stat. 569(96 Stat. 35'140 U.S.C. 296c),and described below, Dues-Initiation,Child Support,Vacation Fund,VACATION HUND,Vacation Fund,CARNTSHMENT ,Local Prom/Fac,NAans,Union Dues, Market Recovery,INTERNAT'L DUES,United Way (2) That any Payrolls otherwise under this contract required to be submitted for the above period are correct and complece;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenti,oeship program registered with a State apprenticeship agency recogn.i,xed by the Bureau of Auprert cemhip and training,United States Department of Lebor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, PONDS, OR PROGRAMS In addition to the basic hourly vase rates paid to each laborer or mechanic lasted in the above referenced payroll, r payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(0) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH I Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract., except as noted in Section 4(c) below. Ic) EXCEPTIONS (CRAFT) RECEPTION EXPLANATION III Remarks' NAME AND TITLE I SIGNATURE Marti Carpenter, Exec.Asat./ PR Clerk `/�J ^/ / a THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 1B ANT SECTION 231 CC TITLE 31 OF THE UNITED STATES CODE. ,Date : 08/26/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : Job: 06-385 CPA - BP 4050 P4 GEN TRADES Contractor: W. R. OUNKIN a SON, INC. Pey Period 08/18/10 - 08/24/10 777 3RD AVE S.W. P.O. BOX 2247 CAPNEL, IN 46032 ANDERSON, IN 46018 EmplOyers Id e: 35-0280890 Employee Mourn Worked Thin Project I PAY ]008 EARN! FED I STATEION DET] TOT I NET Information WED TRUE PRI SAT SON MON TOES TOTAL RATE]TOT EARN] FICA LOCAL' MISC I DED I PAY BOLING, RYAN) L ST 6,00 8.00 8.00 - - 8.00 0.00 40.00 28.40: 1136-80 78.40 37.34 97.16 CT .00 -00 1136.80 86.96 15.22 -00 97.15 817.72 TD # .er-•+-5183 SEX hl Carpenter-Journeyman DEP 4 BROWNING, CHRISTOPHER A. ST A.00 8.00 8.00 - - - 8-00 32.06 29.04 929.28 65-96 27.67 .00 OT - - - -. - - - .00 .00 929.28 71.10 8.14 .00 .00 756.41. ID # 999-94-2266 SEX m Laborer-Journeyman DEP 2 FROWNING, DAVID A. ST - 5,00 9.00 - - 8.00 8.00 32.00 23,11 739.52 85.20 30.54 36.05 OT .00 00 501.30 0.8 as 15.77 .00 36.05 664.69 ID a ^■-'x_71.00 SEX M Laborer-Foreman DEP 0 BROWBJHO, PAUL W. ST 8,00 8.00 8.00 - - 8.00 8.00 40.00 31.17 1245.80 115.96 41.09 192-11 01 .00 -00 1246.80 95.38 21415 00 192.11 761.12 ID # '•1-''-5830 SEX M Carpenter-CA-S/3-25-V DEP 2 HARVEY, SHELLEY M ST - - 3.00 - - - - 3.00 27.52 63.76 .00 2.19 00 OT 00 00 83.76 6.40 1.13 .00 00 74,04 ID it '"-++_9119 SEX F Laborer-Journeyman DEP 1 HOFFMAN, KYLE F. ST 2.00 6.00 R.00 31.92 255.36 210.67 42.76 103.46 OT .00 .00 1276.80 97,67 22.01 .00 103.46 800-23 ID q 949-••-6575 SEX M Carpenter-Superintend DEP 1 KEESLTNG, ROBERT R. ST 8,00 9.00 9,00 - - 6.00 8.00 40.00 28.42 1136,80 123.02 37.34 47 1X OT .00 .00 1136.80 96-96 19.22 .00 97.16 773.10 I➢ # •••-"-4365 SEE M Carpenter-0OUnne3man DEP 4 KERR, WILLIAM W. ST 8.00 8.00 3.00 - - 5.00 8.00 32.00 22.11 737.52 119.06 28.57 33.61 OT .00 .00 840.18 64,27 8.82 .00 33-61 585.35 ID # 49'-''-0605 SEX M. Laborer-Foreman DEP 0 • ,Date : 08/26/10 - Thur C E R T I P I E D P A Y R O L L R E G I S T E R Page ; 2 Job: 08-385 CPA - BP 4050 P4 GEN TRADES Contractor: W. R. DUNKIN & SON, INC. Pay Period : 00/16)10 - 08/24)10 777 320 AVE S.N. P.O. BOX 2247 CARMEL, IN 46032 ANDERSON, iN 46018 Employers Id R: 35-0280890 Employee ' Hours Worked This Project I PAY 1JCP EARN' PSD I STATEIDN DEDl TOT I NET Information WED THOR PRI SAT SUN MON TOES TOTAL' RATEITOT BARN PICA' LOCAL M150 I OED PAY LANBERTSON, BRIAN M. ST 3.00 8.00 8.00 - - 0.00 8.00 40.00 28.42 1136.80 67.99 38.65 03.16 OT .00 .00 1136.80 86.96 11.94 .00 97.16 834,21 ID * *66-'*-31.02 SEX N Carpenter-Journeyman DEP 5 L020NSKI, JAMES N. ST 8.00 8.00 8.00 - - 8.00 8.00 40.00 29.04 1161.60 124.24 45.49 .00 OT - - - - - - - .00 .00 1161.60 88.87 20.33 .00 .00 878.67 IL # ***_**_8053 SEX M Laborer-Journeyman DEP 0 M IP.ANDD, JOHN T ST 8.00 8.00 - - - 8.00 8,00 32.00 28,42 909.44 86.42 30.92 77.72 OT - - - - - - - 00 .00 909.44 69.58 11.37 .00 77.72 677.43 ID * ***_*4_2916 SEX M Carper:ter-Journeyman DEP 0 STORK, KEITH E ST - 8.00 0.00 - - 8.00 8,00 32.00 26.92 851.44 47.63 27.33 .00 OT .00 .00 861.44 65-90 14.07 .00 .00 706-51 ID # ee6_*._0063 SEX M Laborer-Journeyman DEP 7 J o b T o t a l s : Hours: 371.00 Earnings: 10305.12 S T A T E M E N T O P C O M P L I A N C E DATE: 06/26/10 I, MARTT CARPENTER, EXEC_ASST./ PR CLERK do hereby state; (ii That I pay or supervise the payment of the persons employed by W. R. OUNEIN A SON, TNC. on the (building or work) CPA - BP 4050 Pi OEN TRACES :Char during the payroll. period 08/la/10 - 08/24/lO :all persons employed on said project have been paid the full. weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DONKIN & SON, INC. from the fuLL weekly wages earned by any person, and that no deductions have been made either directly or indirectly exam the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A) ,issued by the Secretary of Labor under the Copeland Ac es amended(48 Stat. 940;63 Stat. 1,00:72 Stat. 967;76 Stat. 357:40 V.S.C. 276c),and described below: Dues-Initiation.ehild Support,Vacation Fund,VACAl'ION E'UeD,Vacation Fund,GARNISHhrENT ,Local Pram/Par,Loans,union nues, Market Recovery,I6'TERNAT'L DUES,united Way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications sec forth therein for each laborer or mechanic conform with the work performed. (3( That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department oe Labor.or if no such recognized agency exists in a Sta(e,are registered with the Bureau of Apprenticeship and Training,United State Department of tabor. (4) That: (a) WWHERE PRINGE BENEFITS ARE PAID TO APPROVF,D PLANS, FUND, OR PROGRAMS I_1 in addition to the basic hourly wage rates paid to each laborer Cr mechanic listed in the above referenced payroll, /// payments of fringe benefits as listed in the contract have been or will be made to appropriate programs For the benefit of such employees,except as noted in Section 4(c) below. (b) WHERE PRINCE BENEFITS ARE PAID IN CASH 1_1 Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required Fringe benefits as listed in the contract, except as noted in Section 4(c) below. (e) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION Remarks: NAME AND TITLE 1 SIGNATURE NARTI CARPENTER, EYE[.AS ST./ PR CLERK �(�- .,.. J_,./ 1 1 THE WILLFUL FALSIFICATION OF AMY OF THE ABOVE TATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUUTION, SEE SECTION 1002 OF TITLE 18 AND SECTION 231 OF TITLE 11 CF THE UNITED STATES CODE. tIG, LIIIGY I GI/I VII 5 G110Vr II✓1. 'e rind: 05/3112010 • 06/06/2010 ob: 8024-CARMEL PERFORMING ARTS IAC :ontract: 8024- CARMEL PERFORMING ARTS !AC . Hours ""^°Liabilities"--•- .•".""Weakly Totals"^"^ {Week Ending 6/6110) Project - mployee Mon Tue Wed Thu Fri Sat Sun Total Rate Amounts Descrlption Rate Amounts Gross Deductions Net Pay- • RINYEP CHARLES R. -68 312-02-8543 M/IX: M13 Race/Sex CAW Carpenter it-Jymn EEO Class: Journeyman Check# 4401331 arpenter Zl-Jynin Regular 0.00 cod 0.00 8.00 800 0.00 0.00 18.00 28.420 454.72 Apprentice 0,45000 7.19 Fed Tax:WM 55.00 Other Taxable 0.00 CIPC 0.06000 ass Rea-55 WM. 56,38 Other Nan Taxable 0.00 CAPCI 0.07000 1.11 Pea-Medicare WI 1.318 Project Total 454.72 Heath 8 Welfare ,5.80000 9280 Indiana WM 30.92 Pension 5.80000 9260 Vacation 32.00 Drug Testing 0136000 • 1.28 Dues-% 40.92 TFIEF 0.10030 1.60 COPE AnnuEry'Local 60 104000 16,64 Market Recover-E 4.80 Other 59.74 Marion County 1581 274,12 909.44 24621 66123 Hours gleg/OT): 3200/000 , - 2.'r-0,:e` e.„7s % ` ti ', S":H "`"""^.LfabilrLes'':'"""" -'%•_` 4WeekitTetafS s' o niff:714 (Week,Ending 67611 q), ., Project Total ..- Job Totals Hours Mon rue Wed Thu, . Fri: Sat -Sdn. TOlit!, - -Amounts Description• Rate Amounts . . . :Bross Deductions -.NeCPay, Regular 0.00 0.00 0.00 8,00 8.00 0.00 0.00 16.00 454.72 Apprenika 719 I Fed Tax WM 55.00 Other Taxable 0.00 CIPC 0.961 Fla-55 WM 55.38 Other Non Taxable 0.00 CAP01 1.11 Flea-Medicare WI 13.18 -- Project Total 434.72 Health&WeIrare 92.80 lndana W/H 30.92 Pessioa 92.60 Vacation 5200 Drug Testing 1.28 Dues-% 40.92 TFIEF 1.60 COPE • . Annully-LOca160 16.64 Market Recovery-E 4.80 _ - Other 5974 Marion County 15.01 274.12 909.44 24621 661.23 Hours(Reg/OT)t 32.00 10.30 • Gibson-Lewis of Indianapolis,LLC Page20 6/8/2010 242:37PM PRW klyComplianceNew.rpt NORMA GOMEZ ACCOUNTING CLERK ❑ - Each laborer or mechanic listed in the above referenced payroll has • ubry Pant/ (Title) been paid, as indicated on the payroll, an amount not less than the (Name or s,y Sum of the applicable basic hourly wage rate plus the amount of the • required fringe benefits as listed in the contract, except as noted N lo hereby state: Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by • Gibson-Lewis of Indianapolis,LLC on the (c)EXCEPTIONS (Contractor or Submvaea) Job: 8024- CARMEL PERFORMING ARTS IAC ;that during the payroll penal commencing on the EXCEPTION(CRAFT) EXPLANATION th • I U,ldag or won't • • 31 day of May 2010 and ending the 6 day of June 2010 • II persons employed cn said project have been paid the full weekly wages earned,that no rebates have _ een or will be made either directly or indirectly to or on behalf of said Gibson-Lewis of Indianapolis,LLC (Conway vi Subrvnaaol • om the full weekly wages earned by any person and that no deductions have been made either directly r indirectly from the full wages earned by any person,other than permissible deductions as defined In regulations. Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as mended(48 Stat.948.63 Slat. 108.72 StaL 967;76 Stat.357;40 U.S.C.276c),and described below: • (2)That any payrolls otherwise under this contract required to.be submitted for the above period are REMARKS: )rrect and complete;that the wage rates for laborers or mechanics contained therein are not less than e applicable wage rates contained in any wage determination incorporated into the contract that the assifications set forth therein for each laborer or mechanic conform with the work he performed (3) That any,apprentices employed in the above period are duly registered in a bona fide )prenticeshlp program registered with a State apprenticeship agency recognized by the Bureau of dprenticeship and Training, United Slates Department of Labor,of if no such recognized agency exist a State, are registered with the Bureau of Apprenticeship and Training, United States Department of thor. NAME AND TITLE SIGNATURE (4)That: NORMA GOMEZ t. ACCOUNTING CLERK \ t M (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED THE WIIJ.FUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS nv. OBJECT RLI 1!�l—�_-�_+NTCTOR OR PLANS,FUNDS,OR PROGRAMS SUBCONTRACTOR TO CM RI L OR CRIMINAL PROSECUTION.SEE SECTION 1 1 OF T"te(`8 MO SECTION 231 OF TITLE 310F THE UNITED STATES COOE �w1111 ❑- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c)below. Date 7(812010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ ACCOUNTINGCLERK 0 - Each laborer or mechanic listed In the above referenced payroll has (Name al Signatory Party) MVO been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed In the contract,except as noted in do hereby state: Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by Gibson-Lewis of Indianapolis,LLC (c)EXCEPTIONS (COrt.eer a subaMracigr on the Job: 8024- CARMEL PERFORMING ARTS IAC • EXCEPTION(CRAFT) EXPLANATION (Building a MCC .. that during the payroll period commencing on the 7 day of June 2010 ,and ending the 13 day of . • . June 2010 • all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said Gibson-Lewis of Indianapolis, LLC (Catalan"'aWcwaracfor) from the full weekly wages earned by any person and thal,no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations. Part 3 (29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland Act, as amended (48 Stat. 948,63 Stat. 108,72 Stat 987;76 Stat 357:40 U.S.C.276c),and described below: Na Work Performed REMARKS: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable NAME AND TITLE SIGNATURE wage rates contained In any wage determination Incorporated Into the NORMA GOMEZ contract;that the classifications set forth therein for each laborer or mechanic ACCOUNTING CLERK \. conform with the work he performed — THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE ST 1,CLIENT (Y SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CM.OR CRIMINAL PROSEC ON,BEE SECTION (3) That any apprentices employed In the above period are duly 10010FTILEI5 AND SECTION 2310FTIrLE 310F THE UNITED STATES CODE registered in a bona Ode apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training.United States Department of Labor,of If no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training.United States Department of Labor. (4)That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS.OR PROGRAMS ❑- In addition to the basic hourly wage rates paid to each laborer • e or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c)below. • • Date 7(8/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ ACCOUNTING CLERK ❑ - Each laborer or mechanic listed In the above referenced payroll has (Homo or Sirs tog Putyi (LBSI been paid, as Indicated on the payroll,an amount not less than the ' sum of the applicable basic hourly wage rate plus the amount of the do hereby stale: required fringe benefits as listed in the contract, except as noted In Section 4(c)below, (1) That I pay or supervise the payment of the persons employed by Gibson-Lewis of Indianapolis,LLC (c)EXCEPTIONS fccramearar fi�cmh+darl • on the Job; 8024- CARMEL PERFORMING ARTS IAC EXCEPTION(CRAFT) EXPLANATION .. iBwm,gaWork) that during the payroll period commencing on the 14 day of June 2010 ,and ending the 20 _ day of • - . June 2010 • all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or a n behalf of said Gibson-Lewis of Indianapolis,LLC (Cantos orSnmwaclar) from the full weekly wages earned by any person and that ha deductions have been made either directly or indirectly from the full wages earned by any person,other than permissibly deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act, as amended(46 Stat.946, 63 Slat 108, 72 Stat.087;76 Stet 357; 40 U.S.C.2784.and described below: No Work Pertcnned • REMARKS: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable NAME AND TITLE !SIGNATURE wage rates contained in any wage determination incorporated into the NORMA GOMEZ contract;that the classifications set forth therein for each laborer or mechanic ACCOUNTING CLERK conform with the work he performed. THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE TEMENT EURJECT The CONTRACTOR OR SUBCONTaACTOR TO CIVIL OR CRNI PROSE ON,SEE SECTION (3) That any apprentices employed in the above period are duly loot OF TRLE 1a ANO SECTION 2910E TITLE 510E THE UNITED STATES CODE. registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Slates Department of Labor,of If no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training,United Stelae Department of Labor, (4)That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED • • PLANS,FUNDS,DR PROGRAMS 0- In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted In Section 4(c) below. • • • Date 718/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ ACCOUNTING CLERK . Each laborer or mechanic listed to the above referenced payroll has 08888 al sI9nsiorr FAA 111Se] been paid, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract except as noted in do hereby state: Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by Gibson-Leers of Indianapolis,LLC (c)EXCEPTIONS i C aiador e r SobwI b e C W rt on the - Job: 8024- CARMEL PERFORMING ARTS IAC EXCEPTION(CRAFT) EXPLANATION that during the payroll period commencing on the 21 day of June 2010 ,and ending the , 27 day of , . June 2010 all persons employed on said project have boon paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to Or on behalf of said Gibson-Lewis of Indianapolis,LLC {Cmraefor or SVewnV Wart from the full weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person. other than permissible deductions as defined In Regulations,Fart 3 (28 CFR Subtitle A), issued by the Secretary of Labor under the Copeland Act,as amended(48 Slat 04B,89 Stet 108.72 Stat.267;76 Stak 957;40 U.S.C.2764 and described below: No Work Performed • REMARKS (2) That any payrolls otherwise under this contract required to he submitted for the above period are correct and complete;that the wage rates for Iebnrers or mechanics contained therein are not less than the applicable NAME AND TITLE SIGNATURE wage rates contained In any wage determination incorporated Into the NORMA GOMEZ contract;that the classRications set forth therein for each laborer or mechanic ACCOUNTING CLERK \\ t � Conform with the work he performed. THE WILLFUL FAISIFICATICN OF ANY OF THE ABOVE STA MERE SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PR OSEC N SEE SECTION (3) That any apprentices employed in the shove period are duly hmf or 1111.E to AND SECTION ZahoF TITLE 31 OF THE UNITED BTATES coOE. registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,of if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training,Linked States Department of Labor. (4)That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS 0- In additlan to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed In the contract have been or will he made to appropriate programs for the benefit of such employees,except as noted In Section 4(c)below, •Date 7!8/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ ACCOUNTING CLERK 0 - Each laborer or mechanic.listed In the above referenced payroll has (Name of Swaim"Early) (The) been paid, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in do hereby state: Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by Gibson-Lewis of Indianapolis,LLC (c)EXCEPTIONS (Cwtwur a,boonuecion on the Job: 8024- CARMEL PERFORMING ARTS IAC EXCEPTION(CRAFT) EXPLANATION (Bulking or won* that during the payroll period commencing on the . 28 • day of June , 2010 ,end ending the 4 day of . July , 2010 all persons employed on said project have been paid the fu‘II weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said Gibson-Lewis of Indianapolis,LLC (ConVLLw or Sulkoa v.uar) from the full weekly wages earned by any person and that no deductions have bean made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations, Part 3 (29 CFR Subtitle A), Issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat 948,63 Stet 108.72 Stat, 967;76 Stat, 357;40 U.S.C.276e),and described below. No Work Performed REMARKS (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable NAME AND TITLE SIGNATURE wage rates contained In any wage determination Incorporated Into the NORMA GOMEZ 1(� contract;that the classifications set forth therein for each laborer or mechanic ACCOUNTING CLERK • ` \ conform with Na work he performed. THE WILFUL FALSIFICATION OF ANY OF THE ABOVE EMENTB Y OBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CNIL OR CRIMINAL PROSECU? .SEE SECTION (3) That any apprentices employed In the above period are duly 10010F TITLE 15 AND SECTION 2310F TITLE 310F THEUNRED STATES CODE registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,of if no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS ❑- In addition to the basic hourly wage rates paid to each laborer or mechanic listed In the above referenced payroll, payments of fringe benefits as fisted In the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted In Section 4(c)below. Date 7/20/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ ACCOUNTING CLERK 0 . Each laborer or mechanic listed In the above referenced payroll has pin orapa.mry Petty) (etal.) been paid, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted In do hereby state: Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by Gibson-Lewis of Indianapolis,LLC (c)EXCEPTIONS (Contrwor or suxaWactan on the Job: 8024- CARMEL PERFORMING ARTS IAC • EXCEPTION(CRAFT) EXPLANATION (aua& oorWOM .. that during the payroll period commencing on the 5 day of July , 2010 ,and ending the 11 day of . July 2010 all persons employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or indirectly to or on behalf of said Gibson-Lewis of Indianapolis,LLC (CONracbx ar svbrm*auor) from the full weekly wages earned by any person and that no deductions have been made either directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948,63 Stat. 108, 72 Stat 967;76 Stet 357;40 U.S.C.276c),end described below: No Work Performed • REMARKS: (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete:that the wage rates for laborers or mechanics contained therein are not Tess than the applicable NAME AND TITLE 'ry wage rates the claed In any wage determination far each laborer or Into the NORMA ACCOUNTING GOMEZ I SI I UV contract;that the cork he performed. set forth therein far each laborer or mechanic ACCOUNTING CLERK t 1 Y 6 conform With the work he pBffortned. THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SIAJ C THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECIT1ON.SEE. TION (3) That any apprentices employed in the above period are duly 1001 0F TITLE 1e AND sECTON2Jt OF TITLE elor THE UNITED STATES COLE registered In a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Leber,of If no such recognized agency exists In a State, are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS 0- In addition to the basic hourly wage rates paid to each taborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Secton 4(c)below. Data 7202010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH I, NORMA GOMEZ - ACCOUNTING CLERK - Each laborer or mechanic listed in the above referenced payroll has (Nr.orslg.aoryvwn (rue) been paid, as Indicated on the payroll, an amount not less than the sum of the applicable basic hourly Wage rale plus the amount of the required fringe benefits as listed in the contract, except as noted in do hereby state Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by Gibson-Lewis of Indianapolis, LLC (c)EXCEPTIONS (Cantmcke ar&.econ1ra[wr) on the Job: 8024- GARMEL PERFORMING ARTS]AC EXCEPTION(CRAFT) EXPLANATION (eWM1'naorWaNJ •. that during the payroll period commencing on the • 12 day of July 2010 ,and ending the 18 day of . July 20W • all persona employed on said project have been paid the full weekly wages earned,that no rebates have been or will be made either directly or Indirectly to or on behalf of said Gibson-Lewis of Indianapolis,LLC • (Cantor co SWmmnnor) • from the full weekly wages earned by any person and that no deductions have been made ether directly or Indirectly from the full wages earned by any person, other than permissible deductions as defined In Regulations, Part 3 (29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended (46 Stat.948,63 Stat 108,72 Slat. 967;76 Stat. 357;40 L.I.S.C.276c),and described below; No Work Performed REMARKS (2) That any payrolls otherwise under this contract required to be submitted for the above period are corred and complete;that the wage rates for laborers or mechanics contained therein are not leas than the applicable 'NAME AND TITLE SI , TORE wage rates contained in any wage determination Incorporated Into the NORMA GOMEZ �� pj contract;that the classifications set forth therein for each laborer or mechanic ACCOUNTING CLERK `� rLl "YJ, conform with the work he performed. THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY S : THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL DR CRIMINAL PROSECUTION,SE • CTION (3) That any apprentices employed in the above period are duly I001CF TITLE 1a AND SECTION 231OFTITLE 31 OFTIIE UNITED STATES COOS registered in a bone fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,of if no such recognized agency exists in a State, are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS 0- In addition to the basic hourly wage rates paid to each taborer or mechanic listed In the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(o)below. .�-C�\ ` ' lO (mac C� e 0° 3u` Dale` 07/22/2010 GENE$TEEL"ERECTORS.INC, ` Page: 1 Tine'. 9:07'37AM 5230 E.25TH STREET INDIANAPOLIS IN 46218- .CERTIFIED PAYROLL REGISTER For the pay period ending 07/21/2010 Job : 7403 $CARMEL!PERFFORMING'ARTSTCENTER JOB EARN TOT EARN TAX EARN EMPLOYEE MINORITY -------------- HOURS WORKED EACH DAY --------------- THIS PAY PERIOD-------------- DEOUCS SOC SEC NUM 7(15 7116 7117 7118 7l19 7/20 7121 PAY BFT THIS JOB UNIONJWCOMP TAXES NET SKILL LEV SEX TYP Thu Frl Sat Sun Mon Toe Wed TOTAL RATE RATE ADJUSTMENTS ZELLERJA None Male 5 24.00 0.00 0.00 0.00 0.)0 0.00 0.00 24.00 30.250 DEO 21.75 FIT 55.55 726.00 4- BFT 474.20 SSMO 55.54 726.00 XXX-XX-2024 J( \Ly� .._ C BETNET 0.00 Stale 24.58 725.00 Local 7.25 164.91 Other 000 551.09 Totals for Job 7483 — Earnings---- ------------Taxes----------- Joo 726.00 FIT 55.65 Gross 7200 SSMD 55.54 Tax Gross 72800 State 24.6E Net 55109 LocaE 7.26 Hours 24.00 Other 0.00 • U.S. Department of Labor PAYROLL Employment Standards Administration (For Contractor's Optional Use;See Instructions, Form WH-347 Inst.) � Wage and Hour Division Persons era not required to respond to the colledfon al Inromla:on unless It cespleys a currently veeb OW control number. \`' NAME OF CONTRACTOR ❑ OR SUBCONTRACTOR general:Steel Fabricating Co Inc ADDRESS 5230 East 26th Street, Indpls, IN 46218 ja No.: S20033 PAYROLL NO. I 102 roil WEEK ENDING 07/28/10 PROJECT AND LOCATION C RA alifeIArtsiCentera PROJECT OR CONTRACT NO. 08-385 (I) 102 (2) (3) (4)DAY AND DATE (s) le) P) - fel (e) gC T F S S M T W DEDUCTIONS FF NET NAME.ADDRESS.ANC, IS y 6 22 23 24 25 26 27 2E WITH- L I WAGES SOCIAL SECURITY NUMSER ftuy WORX TOTAL RATE AMOVNT HOLOWG StatC I.,OC31 Union 'DTAL PAID OF EMPLOYEE g CLASSIFICATION S HOURS WORKED EACH DAY HOURS OF PAY EARNED FtDA TAX I D ACTIONS FOR WEEK No Work This Week 0 o B / o / - 0 / a r 0 / - a r 0 /II 0 /I o J — a r We estimate that It will take an average of 50 minutes to complete tNs collection of intonation, including time for reviewing instructions searching edsting data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. If you have any comments regarding these estimates or any other aspect of this collection of Information, including suggestions for reducing this burden, send diem to the Administrator, Wage and Hour Division, ESA, U. S. Department of Labor, Room S3502, 200 Constitution Avenue,N.W.,Washington,D.C.20210. !Om*Nan.Raw.w..11101•FORMERLY wL tar PIPTONSE TICS FORM DIRECTLY FROM TIE SUP/.Of DOCLWENTS • U.S. Department of Labor PAYROLL Employment Standards Administration (For Contractor's Optional Use;See Instructions, Fonn WH-347 inst.) - � wage and Hour DIVjeIDn Ramon are not gWmed to respond 10 the oWledlon of info/i o i unless II oxsp'ays•amenity vend OMB control number. '� NAME OF CONTRACTOR Q O RaUECONTMCTOR, �; 9 OGRESS 26th OAIa NP.:121S-0M he al Steel Fabricating Co Inc 5230 East 26 Street, Indpls, }N 46218 &Mix: e9131f2oO3 p PAYROLL NO. 103 r1DA WEEK ENDING 08/04/10 -ROJECT AND LOCATION 'CarneIAr.istCenterf �PRQIECT OR CONMAURO. 08-385 111 42t I 13) (41 DAY MO DATE 151 lal • in (°I • 5 1a) F 5 5 M T W ceoucnoNs NET NAME.AD ORE SS.ANU ✓4 GROSS WnR. 1 1 WAGES SOCIAL SECUR LT,/NUMBER � WORK ff\ir'30®�©© 4 TOTAL MIS AMOUNT HOLDING Stat_ LACnl Union VIM- PAmO OF EMPLOYEE [ CLASSIFICATION o HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX O UCTIONS FOR WEEK 0 No Work This Week 1"""'.40 t_. 11111111® . C • _ We estimate that It will take an average of 55 minutes to complete MIAs collection of Information, Including time for reviewing Instnictions searching existing data sources, palhering and maintaining the data needed, and completing and reviewing the coltectlon of Information. if you have arty comments regarding these estimates or any other aspect of this collection of Information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, ESA, U. 5. Department of Labor, Room 53502, 200 Constitution 1. Avenue,N.W.,Washington,D.C.20210. PONY Wrwrr.11/4"1“4 Hoc'Ml•el:smar fl me PURCWISE Tres FORM DIRECRYAKS?me SUMO(DO'CuMENTS • r U.S. Department of Labor PAYROLL Employment Standards Administration (For Contractor's Optional Use;See instructions, Form WH-347 Inst.) - �� Wage and Hour Division Persons are not niquir.d to respond k the collodion of lnlwmercn unless U dodgy!•curryMfy valid 0MR mnhol number. \\���� NAME OF CONTRACTOR ❑ OR SUBCONTRACTOR l enetalsS#eelfFabricatin. /CO Inc w as 5230 East 261h Street, lndpls, IN 46218 L5s4r OS2112 PA TROLL NO, 104 •W WEEK ENDING 08/11/10 -MEDI AND LOCATION Carmel€ArtstCentertl PROJECT OR CONTRACT NO. 08-385, - In (21 Cs) 0)DAY AND PATE (5) (El IT) let VP F S S M T W DEDUCTIONS NET NAME ADDRESS.AND b II $ 6 8 9 GROSS WITH, I WAGES SOCIAL SECURITY NUMBER W WOWS ® mm TOTAL RATE AMOUNT HOLDING Stat. I.,OL. Union 'OTAL PAID OF EMPLOYEE 4 CLASSIFICATION 0 HOURS WORKED EACH DAY FlOURS OF PAY EARNED FICA TAX O UCTIONS FOR WEEK G . No Work This Week 1..,•,..� 1..,.■..�;...... . . ... 11111111__10/1 9111111110 0 • 1111111 IIII . , e • e • ! 0 II , We estimate that 11 will take an average of 56 minutes to complete this collection of information, Including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. If you have any comments regarding these estimates or any other aspect or this collection el Information, Including suggestions for reducing INs bunion, send them to the Administrator, Wage and Hour Division, ESA, U. S. Department or Labor, Room 83502, 200 Constitution -. Avenue, N.W.,Washington,D.C.20210. • • sore WM40.ponisi>b.Lee•te,.IEPlr t0.IN-P&$OCSE PCS FORM DIRECTLY FROM THEORY.Lis DOCLNNENTS • ' Honthiy Buployment Utilization Report US 0oparrment of 4aboz 09/e3/7010 Employment Standards Acurinisrration Office Of Federal Contract Cou,pllance Programs This report is required by Executive Order 11246.Sec.203. Failure to report can 1. Covered Area (.SMSA or EA) 2. Emp ID No result in contracts being cancelled, terminated or suspended in whole or in part Carmel Performing Arts Center 36-2357423 and the contractor may be delclared ineligible for further Government contracts or Federally assisted construction contracts. Reporting Period Name and Location of Contractor Your No. 08-385 Federal Funding Acency 08 / 2010 KONE Inc Our f No. 9039133 - 0420 One HONE Court, Moline 14 61265 6. Total Federal a Non-Federal Construction Work Hours 6.a. Total all Gb. 6c. 6d. 6e. 7. 8, 9. 10. Construction employees by Black Hispanic AsianiPaciEic American Indian Min Fem Potal % oral Trade trade. Islander National Alaskan % % Employees ilinoritics M F M F M r M F M F M F N F Mechanic 11.00 02 Helper Prot Help Apprentice Totals 11.00 02 'Gloria Haut HR Associate (3091 764-6771 t ; 6 • • VP i = IA Document G702/CMaTM — 1992 5I Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: Carmel Redevelopment PROJECT: Parcel 7A,45010 Cannel APPLICATION NO: 019 Distribution to: Commission Perlhrnting Arts OWNER:X One Civic Square 777 3rd Ave S.W. PERIOD TO:September 30,2010 CONSTRUCTION MANAGER:X Carmel,IN 46032 Carmel, IN 46032 ARCHITECT:X FROM W.R. Dunkin& Son,Im_ VIA CONSTRUCTION Shiel Sexton Ca.Inc. CONTRACT DATE:February 23, 2009 CONTRACTOR: X CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS:2531OH 1 2695/5010/2695 HELD: Anderson.EN 46018 OTHER: CONTRACT FOR: Bid Pkg 115010 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 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 been paid by the Contractor for Work for which previous Continuation Sheet,AIA Document G703,is attached. Certificates for avmenl were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 1.480,000.00 payment showy f *rem is now due. 2.NET CHANGE RY CHANGE ORDERS $ -81,040,(X) CONTRACT DugX•in S/M n' Inc- 3.CONTRACT SUM TO DATE(Line I f 2) $ 1,398.960.00 By: i , Date: September 22,2010 4.TOTAL COMPLETED&STORED TO DATE(Column Cr on Ci703) $ 1.138,748.00 State of:L ri na 5.RETAINAGE: County of:Madiso a. 5 %of Completed Work Subscribed and sworn to before (Column D+Eon0703) $ 69,948.00 me this 22nd day of Septerbe 201 dtn,_ ''],' b. 0 %of Stored Material Notary Public: Martha A.Carpenter ,CJ� �'t?-�Z.r��`J (Column I'on 0703) $ 0.0(1 My Commission expires:January 08,2017 1' Total Rctainagc(Lines 5a+55 or Total in Column I of 0703) $ 69,948.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ I,068,800,00 In accordance with the Contract Documents,based on on-site observations and the data comprising (Line 4 Less Line 5 Total) this application,the Construction Manager and Architect certify to the Owner that to the best of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 926,450.00 knowledge,information and belief the Work has progressed as indicated, the quality of the Work is in accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. B.CURRENT PAYMENT DUE $ 142,350.00 AMOUNT CERTIFIED $ 147-,393°D 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation f amount certified differs from the amount applied Initial all figures on this Application and on the Continuation Sheer t1 are 'hanged to conform with the amount certified) (Line 3 less Line 6) $ 330,160.00 CON Nth. ' AG r1 By 1.r.. �i�,, i a 0 Date: ` D •CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC CT: .per Total changes approved in previous months by Owner$ 0.00$ 81,040.00 s /t,�I Date: �I V-lI tlitr B,. Total approved this Month $ 0.00 $ 0.00 This Certificate is not negotiable_ The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ 0,00$ 81,040.00 named herein, Issuance, payment and acceptance of payment are without prejudice to any rights of — the Owner or Contractor under this Contract. NE]'CHANGES by Change Order $ .8 L040.00 .. AIA Document G7021CMaTN-1992.Copyright®1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by 3,5.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlA5 Document,or any portion of it.may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible 1 • under the law.This document was produced by ALA software at 13:53:19 on 09122/2010 under Order No.0168420739-1 which expires on 05(1012011,and is not for resale. User Notes: t1362585022) a . tAJA Document G703r" - 1992 Continuation Sheet AlA Document,07021M-1992,Application and Certification for Payment,or G7301-2009, APPLICATION NO:019 Project Application and Project Certificate for Payment,Constntction Manager as Adviser Edition, APPLICATION DATE:09/15/2010 containing Contractor's signed certification is attached, In tabulations below, amounts are in US dollars. PERIOD TO: 09/30/2010 Use Column 1 on Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO:25310H A B C D I E I' G H I WORK COMPLETED TOTAL 11,4ATERIALS 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 (C3+f,) (C G) RATE) (D+E) (NOT IN D OR E) (D+E+11) 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 4.800.00 0.00 0.00 4,800.00 60.00% 3,200.00 400.00 Supervision/ 0]020 Coordination 87,000.00 74,000.00 4,000.00 0.00 78,000.00 89.66% 9,000.00 6,600.00 General Conditions- 01025 M 30,000.00_ 26,400.00 1,000.00 0.00 27,400.00 91,33% 2,600.00 2,440.00 General Conditions- 01026 L 34,000.00 27,600.00 2,000.00 0.00 29,600.00 87.06% 4.400.00 2,520.00 1400A Organ Facade Pipes 200,000.00 86.720.00 78.350,00 0.00 165,070.00 82.54% 34,930.00 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 25.000.00 895.00 0.00 0.00 895.00 3,58% 24,105.00 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'N16' Temporary 1400E Overhead Door 6,000.00 6,000.00 0.00 0.00 6,000.00 ]00.00% 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 FIX 1200 1400G Tcnsar 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 0t2 Stone 18,200.00 5,718.00 0.00 0.00 5,718.00 31.42% 12,482.00 571.80 AIR Document GT03e'-1992.Copyright 69 1963,1965,1966.1967,1570.1978,1983 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 MC 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 AlA software at 13:55:25 on 09122/2010 under Order No.0168420739_1 which expires on 09/10/2011,and is not for resale_ or user Notes: (1855955426) A B C D F F G 1-1 WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RET.AINACiE 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 E (C-(3) RATE) (D+E) (D+E+F) 14001 200 CY of#53 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 51,988.00 0.00 0.00 51,988.00 69.32% 23,012.00 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 2,000.00 0.00 0.00 2,000.00 50.00% 2,000.00 140.00 01561 General Clean lip-L 25,000.00 16,300.00 0.00 0.00 16,300.00 65.20% 8,700.00 €,130.00 Final Cleaning(Items 01562 in BP 5010 10,000.00 0.00 0.00 0.00 0.00 0.00% 10,000.00 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-Flex 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 Metal 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 -I. 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.Copydghtn 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 AlAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be 2 r prosecuted to the maximum extent possible under the law.This document was produced by AlAsoftware at 13:55.28 on 09/22,2010 under Order Me 016E1420729 1 which expires on 05110/2011,and is not for resale - • Ulcer Notes: (1865955426) A B C D I E F G Fl I WORK COMPLETED TOTAL MATERIALS ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY COMPLETED BALANCE TO RETAINAGE NO. 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) Skylight Shade- 0781 1 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 24,000.00 8,000.00 0.00 32,000.00 66.67% 16,000.00 760.00 07911 Joint Sealants-L 24,500.00 12,330.00 4,000.00 0.00 16,330.00 66.65% 8,170.00 420.00 08810 Interior Glazing 42,000.00 840.00 3.500.00 0.00 4,340.00 10.33% 37,660.00 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 \Vall Panels-L 2,000.00 1,000.00 1,000.00 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 31,000.00 5,000.00 0.00 36,000.00 81.82% 8,000.00 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 14,000.00 7,000.00 0.00 21,000.00 75.00% 7,000.00 100.00 10510 Metal Lockers 16,500.00 12,000.00 2,500.00 0.00 14,500.00 87.88% 2,000.00 0.00 10520 Phenolic Lockers- M 110,000.00 98,000.00 6,000.00 0.00 104,000.00 94.55% 6,000.00 0.00 10521 Phenolic Lockers- L 29,000.00 0.00 20.000.00 0.00 20,000.00 68.97% 9,000.00 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 0.00 0.00 0.00 0.00 0.00% 3,500.00 0.00 17001 Chang Order No.01 -81,040.00 -80,000.00 0.00 0.00 -80,000.00 98.72% -1,040.00 -8,000.00 GRAND TOTAL 81,398,960.00 $996,398.00 $142,350.00 $0.00 $1,138,748.00 81.40% $260,212.00 $69,948.00 AIA Document G703"'-1992.Copyright 0 1963,1965,1966,1967,1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AlA°Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AlAe Document,or any portion of it,may result in severe civil and criminal penalties,and will be 3 prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 13:55',28 on 09/22/2010 under Order No.0168420739_1 which expires on 05/10/2011,and is not for resale. - • User Notes: (1865955426) AFFIDAVIT AND WAIVER OF LIEN [ ]FINAL [X ] PARTIAL [ 1 PAYMENT TO FOLLOW State of Indiana, County of Madison. SS Craig R. Dunkin , being duly sworn states that he is the PresidentlTreasurer of W. R. Dunkin & Son. Inc. having contracted with City of Carmel Redevelopment Commission to furnish certain materials and/or labor as follows: Bid Package 5010-Interior Finishes for a project known as Parcel 7A, Carmel Regional Performing Arts Center located at Carmel, Indiana and owned by City of Carmel and does hereby further state on behalf of the aforementioned Contractor, Application for Payment t 16 has been received for work performed through 06/30110. (PARTIAL WAIVER)that there is due from the contractor the sum of Twenty-six Thousand Seven Hundred Seventy dollars and 50/cents ($ 26,770.50) Application for Payment d 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 (S 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 or material furnished to the undersigned for said project, a vithin the scgpe 'this affidavit and waiver. W. R. Dunkin&Son, Inc. By l 1• (!(4 1 Title: President/Treasurer WITNESS MY HAND AND NOTARIAL SEAL,this 220d day of September .2010 LMuz /� - (Notary Pu c) My Commission Expires: January 08, 2017 Printed Martha A. Carpenter Residing in Madison County Date : 09/16/10 - Thu= C E R T I P I E D P A Y R O L L R E G I S T E R Page : 1, Cob: DA-293 CPA-EP 5010 P5 INTER FINISHES Contractor± W. R. DNNRIN s SON, INC. Pay Period : 09%03/i0 - 09/14/10 777 3RD AVE. S.41. P.O. PDX 2247 CARMEL, IN 46032 ANDERSON, IN 4601$ Employers Id 4: 35-0280890 Employee Hours Worked This Project I PAY IJOB RARNI PAD 1 STATE IUN DEDI TOT NET Information WED THm PRI SAT SUN MON TUES TOTALI RATEITOT EARN FICA I LOCAL MISC DED PAY POLING, RYAN L ST 2.00 2.00 4.00 28.42 313.68 78.40 37.34 97.16 OT - - - - - - - .00 ,00 1136.00 60.96 19.22 .00 57.16 817.72 ID p wwx_xw_S183 SEX M Carpenter-Journeyman DEP 4 HDFFMAN, EYLE F. Si - 1,50 8,00 - - 8,00 5.00 22.50 31.92 713.20 196,73 39.50 95.70 CT - - - - - - - .00 .00 1161.04 90.34 20.33 00 95.70 748.44 ID R ***--**-6.57.5 Sax M Carpenter-Superintend DEP 1 J o b T o t a 1 a : Hours: 26.50 Ea Onings; 831.88 S T A T E M E N T O F C O M P L I A N C E DATE: 09/16/10 I, MAR'fI CARPENTER, EXEC.ASST./ PR CLERK do hereby state Ili That I. pay or supervise the payment of the persons employed by W. R. DUNKIN & SON, INC. on the (building or work) CPA-EP 5010 PS INTER FINISHES that during the payroll period 09/00/10 - 09/14/10 ;all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will be made either directly or indirectly to or on behalf of said (contractor or Subcontractor! W. R. DUNKIN k SON, INC. From the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Reeulations,Part 3129 C?R Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat. 948;63 Stat. 106;72 Stat, 967;76 Stat. 357;40 D.S.C. 276c) ,and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUNE,Vacation Fund,GARNISHMENT ,Local Prom/Pat,Loans,Union Dues, Market Recovery,INTRRNAT'L DCES,United Kay 12( That any payrolls otherwise under this contxlsct required to he submitted for the above period are correct and complete:that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training/United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,Nnited State Department of Labor. 14( That: la) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly' wage rates paid Co each laborer or mechanic listed in the above referenced payroll_ 7777��—��� payments of fringe benefits as listed in the contract have been or will be made to appropriate prr:grams for the benefit of such employees,except as noted in Section 41c1 bel(w. lb) WHERE FRINGE BENEFITS ARE PAID IN CASH I_I Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below, (c) EXCEPTIONS (CRAFT) #XCEPTION I EXPLANATION Remarks: NAME AND TITLE I SIGNATDEE I J FJ.RTI CARPENTER, BYKC.AS.ST./ PR CLERK I i ///�.t� (4)94,44)// /L-I THE WILLFUL FALSIFICATION CF ANY OF THE AEDVE STATEMENT'S MAY SUBJECT /THE CONTRACTOR CR SVIiCCNTRACTOR TO CIVIL OR CRIMINAL PROSECU'TICN, SEE SECTION 1001 OF TITLE lB AND SECTION 231 CF TITLE 31 OF THE UNITED SLATES CODE. Date : 05/07/10 - Thur C E R T I F I E D P A Y R O L L, M Z S I S T S R Page : ]. Job: 08-393 CPA-EP 5010 P5 INTER FINISHES Contractor: W. R. DUNKIN & SON, INC. Pay Period : 09/D1/10 - 09/D7/10 777 380 AVE. S.F. P.O. 20X 2247 CARMEL, IN 46032 ANDERSON, IN 46018 Employers Id k: 35-0280090 Employee Hours Worked This Project PAY I JOE FEENI FED I $TATEIVN DEDI TOT I NET Information WED THOR FAY SAT SUN MON TUBS TOTAL FATE TOT EARNI FICAI LOCALI MISC I DED I PAY HOF'F'[4AN, KYLE P. ST 6.00 9.00 8.00 - - - 4.00 25.00 31.92 798.00 146.87 39.08 82.76 CT .00 .00 1021,44 78.14 17.54 .30 82.78 862.09 ID # *""-.*-6575 SEX M Carpenter-SuperinI:end PEP 1 J o b T o t a l s : Hours: 25.00 Earnings: 798-00 S T A T E M E N T O F C O M P L I A N C E DATE: 09/09/10 I, Marti Carpenter. Exec.Asst./ Pp Clerk do hereby state: 11) That I pay or supervise the payment of the persons employed by W. R_ DUN%IN c SON, INC. on the ;'building or work) CPA-PP 5.010 PS INTER FINISHES that during the payrci.1 period 09/01/10 - 09/07/10 ;all persons employed on said project have been paid the toll weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN S SON, INC. from. the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle Ai .issued by the Secretary of Labor under the Copeland Robes amended(48 Stat_ 948;63 Stat. 108;72 Stat. 967;76 Stat. 357;40 U.B.C. 27Cc) ,and described below: Rues-Initiatlon,Child Support,Vacation Fund,VACA'h10N FUN➢,Vacation Fund,GARN'.ISHMENT ,Local Prom/Fac,Loana,Un,ion Dues, Marker: Recovery,INTERNAT'L DUFS,United Way 12) That any payrolls otherwise under this contract required to be submitted for the above period are correct and r_omprete;that the wage rates for laborers and mechanics contained therein are not leas than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform: with the work performed. )3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Pureau at Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a SI:a[e,are registered with the Bureau of Apprenticeship and Training,Uniced State Department of Labor. (4) Thaw (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS IIn addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payrutl„ payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section S (c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 1_1 Each 'laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in section 4)c1 below. (c) EXCEPTIONS I ICRAPT) EXCEPTION EXPLANATION Remarks NAME AND TITLE 1 ��I ///%%%��- SIGNATURE Maxi Carpenter, Exec.Asst./ PR Clerk Amy,- �y�� C/t THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS NAY SUBJECT THE CONTRACTOR OR SOECONTNACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF T'IT'LE 18 AND SECTIOV 231 OF TITLE 31 OF THE UNITEED STATES COPE_ Det 09/07/10 - Thus C E R T I F I E D P A Y R O L L R E G I S T E R Page : Job: 08-393 CPA-HP 5010 P5 INTER PTNT$HG$ Contractor: W. R. DUNKIN & SON, INC. Pay Period : 08125/10 - 08/31/10 777 3RD AVE. S.W. P.O. BOX 2247 CARMEL, TN 46032 ANDERSON, IN 46018 Employers Id F: 35-0280890 Employee Hours Worked This Project I PAY IJOB EARRI FED I STATEIUN DED1 TOT I NET Information WED THUR FRI SAT SUN MON TOES TOTAL RATEITOT HARM FICA LOCAL' MISC 1 DED I PAY HOFFMAN, KYLE P. ST 4.00 6.00 7,00 - - 8.90 8.00 33.00 31.92 1053.36 114.73 39.50 95.70 OT 00 _CC 1181.04 90.36 20.33 .00 95.70 748.42 ID $ •a-..-65:5 SEX M Carpenter-Superintend DEP 1 KERR, WILLIAM W. ST - - 4.00 - - - - 4.00 22.11 88.44 141.17 31,57 37.14 OT .00 .00 925.52 71.05 9.75 .00 37.14 537,94 ID Y att-ta-0605 SEX N Laborer-Foreman DEP 0 J o b T o t a l s : Hours! 37.00 Earrings, 1141.80 S T A T E M E N T O F C O M P L I A N C E DAT( 09/02,'10 I, Marti Carpenter, Exec.Asst./ PR Clerk do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN & SON, INC. on the (building or work) CPA-BP 5010 P5 INTER FINISHES that during the payroll period 08/25/10 - 06/31/10 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat. 948;63 Stat. 1.08;72 Stat. 967;76 Stat. 357;40 U.S.C. 276c) ,end described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local Prom/Pac,LOans,Union Dues, Market Recovery,INTERNAT'L DUES,United Way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a Stace,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS 1 i In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will he made to appropriate programs for the benefit of such employees,except as noted in Section 4(0) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH 1_1 Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS (CRAFT) EXCEPTION 1 EXPLANATION Remarks: NAME AND TITLE 1 //�J SIGNATURE Marti Carpenter, Exec.Asst./ PR Clerk I 7////�/�//.//C e '/�/(ffg'^:/VO THE 'WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Date : 08/25/10 - a'h=r C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1 Job: 08-393 CPA-BP 5010 P5 INTER FINISHES Contractor: W. R. DUNKIN I. SON, INC. Pay Period 08/13/10 - 0$/24/1D 777 3RD AVE. S.W. P.O. PDX 2247 CARMEL, IN 46032 ANDERSON. IN 46018 Employers Id X; 35-0280890 Employee Hours Worked This Project I PAY JOE EARN Pan 1 STATEIUN DEDI TOT I NET Information WED THOR FRI SAT SUN MON TOES TOTAL' RATEITOT EARNS PICAI LOCAL MISC 1 DED 1 PAY HOFFMAN, KYLE P. ST - - 9,3'0 - - 4.00 5.00 10.00 31.92 574.56 210.57 42.76 103.46 OT .00 00 1276.60 37.67 22.01. .00 103.46 800.23 ID P ***-**-6575 SEX M Carpenter-Superintend DEP 1 (ERR, WILLIAM W. ST - - 5.00 - - 1.00 - 6.00 22.11 132.66 119.06 25.57 23.61 OT .00 .00 840.18 64.27 0.02 .00 33.61 585.65 ID # ***_n*_0605 SEX M Laborer-Foreman DEP 0 J o b T o t a l s : Hours: 24.00 Earnings: 707.22 S T A T E M E N T O F C O M P L I A N C E DATE: 08/26/10 I, MARTI CARPENTER, EZEC.ASST./ PR CLERK do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN & SON, INC. on the (building or work) CPA-BP 5010 P5 INTER FINISHES that during the payroll period 08/18/10 - 08/24/10 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations.Part 3(29 CFR Subtitle A) ,issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat. 948;63 Stat. 108;72 Stat. 967;76 Stat. 357;40 U.S.C. 276e),and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local Prom/Pao,Loans,Union Dues, Market Recovery,INTERNA'1"L DUES,Uni.ted Way (2) That any payrolls otherwise under this contract required to be submitted tor the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work performed. (31 That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS (;)In In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH I_I Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(ci below. (c) EXCEPTIONS I (CRAFT) EXCEPTION EXPLANATION I I I I I I 1 1 Remarks: NAME AND TITLE 1 SIGNATURE I MARTI CARPENTER, EXEC.ASST./ PR CLERK - ��_ CC/C.1 THE WILLFUL FALSIFICATION OF ANY OF THE ADOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CIVIL OR CRIMINAL I PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. U.S. Department of Labor PAYROLL . � � Employment Standards Administration (For Contractors Optional Use; See Instructions, Form WH-347 Inst.) `° Wage and Hour Division Persons are no!required to respond to the collection of ioformation unless it displays a currently valid OMB control number. NAME OF CON IRACTOR 0 OR Sea ('�CONTRACTOR KA ADDRESS 8196 Corporation Dr.,Suite D OMB No.'. 1215-0149 Allen-Kretler Co,Inc. Indianapolis. IN 46256 Expires: 0313112006 PAYROLL NO. FOR WEEK ENDING PROJECT AND LOCATION • PROJECT OR CONTRACT Na. 1 0710312010 Carmel Performing Arts Center Cannel, IN 1) 12) (•) 17)DAY AND DATE 151 161 171 (5) eN 1W a-6 r DEDEDUCTIONS S M T W Th F S as o NET NAME.ADDRESS.AND 2 GROSS WITH- WAGES SOCIAL SECURITY NUMBER �- WORK o 17 E 29 'll 1 - i TOTAL, RATE AMOUNT HOLDING I I TOTAL PAID OF EMPLOYEE VaI 3a CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Dale Klingler 308-52-9146 sheetmetal c us' 0.50 541.00 $97077 1502 Geri Dr. 1 374,22 5134.03 &20X25 5755.13 Lebanon,IN 46052 s e.r 4a. ..r 7.25 7.511 34.75 IN v, 5963 33 Daniel Wilson 307-76-4720 sheelmetal o 534 1.63 820 Jean Ct. 0 526.13 $62.76 588.89 5252.74 . Lebanon,IN 46052 s ._N ae 12,50 82t I/ 5341 93 5 / o 5 // O / o / ID IIS / 3 / / We estimate that it will lake an average of 56 minutes to complete this collection of information, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. If you have any Comments regarding these estimates or any other aspect of this collection of - information. including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, ESA. U. & Department of Labor, Room $3502, 200 Constitution Avenue.N.W..Washington, D. C.20210. FORM W H-347,Revised Nov. 1996- FORMERLY SQL 184-PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS Date 07/22/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Bonnie Kretler V. President ❑ Each laborer or mechanic hated in the above referenced payroll has been paid, (Name of Signatory Party) (Thiel as indicated on the payroll, an amount not less than the sum of the applicable do hereby state, basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in Section 4(c)below. (1) That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Allen-Kretler Co., Inc. on the (Contractor or abcontractor) EXCEPTION(CRAFT) EXPLANATION Carmel Performing Arts Center that during the payroll period commencing on the (Building or Work) 27 chy et S 2010 , and ending the 3 day of 7 2010• all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said Allen-Kretler Co., Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations, Part 3(23 CFR Subtitle A).issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948, 63 Start. 108.72 Stat.967,76 Stat 357;40 U.S.C. 276c),and described below REMARKS. (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the weds tie performed. (3) That any apprentices employed in the above period are duly registered in a bona tide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United Stales Department of Labor,of if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training.United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS,OR PROGRAMS NAME AND TITLE SIGNf1 RE Bonnie Kreller,V.President — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in t y-Lt.w—p5 the above referenced payroll, payments of fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE AEOVE STATEMENTS Mat SuEJEDTHE CONTR,icroe op have been or will be made to appropriate programs for the benefit of such SURCONTPACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEE SECTION 1001 OF TITLE IS AND SECTION 211 OF TITLE employees, except as noted in Section 4(c)below. 31 OF THE UNITED STATES CODE. •u.5.000.:1997 519 Sri • U.S. Department of Labor PAYROLL � Employment Standards Administration * (For Contractor's Optional Use: See Instructions, Form WH-347 Inst.) Wage and Hour Division Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. NAME OF CONTRACTOR 0 OR SUBCONTRACTOR ® ADDRESS 9190 Corporation Dr.,Suite D OMB No.: 1215-0149 Allen-Kretler Co.,Inc. Indianapolis,IN 46256 Expires: 03/31/2006 • PAYROLL NO FOR WEEK ENDING PROJECT AND LOCATION PROJECT CR CONTRACT NC. 2 07/10/2010 Carmel Performing Arts Center Carmel,IN • n) (71 (3) (4)DAY AND DATE (5) (6) (7) 91 6) a'0 tI S NI T W Th F S DEDUCTIONS • NAME.ADDRESS.AND Y O NET o n .f m J 5 6 7 8 9 10 GROSS WITH- I WAGES SOCIAL SECURITY NUMBER Orb WORK o TOTAL RATE AMOUNT HOLDING TOTAL PAID OF EMPLOYEE z 3 w CLASSIFICATION HOURS WORKED EACH DAY HOURS OF PAY EARNED FICA TAX OTHER DEDUCTIONS FOR WEEK Dale Klingler 308-82-9146 sheetmetal 0 $403'1' 1502 Geri Dr. 1 530.84 553.37 584.21 5318.91 Lebanon,IN 46052 s :w 7:3 14.75 527.33 5403.12 o s / / o 5 / IO /S 5 / 0 S / 5 / We estimate that it will take an average of 56 minutes to complete this collection of information, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed. and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection of - information, including suggestions for reducing this burden, send them to the Administrator. Wage and Hour Division. ESA, U. S. Department of Labor, Room S3502, 200 Constitution Avenue, N.W.,Washington.D.C.20210. FORM WH-347,Revised Nov. 1998- FORMERLY SOL 184-PURCHASE THIS FORM DIRECTLY FROM THE SUPT. OF DOCUMENTS Date 07/22/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Bonnie Kretler V. President © — Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated on the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract,except as noted in Section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Allen-Kretler Co., Inc. rn the (Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Cannel Performing Arts Center that during the payroll period commencing an the (Building or Work) 4 day of 7 2010 , and ending the 1D day of_ 7 2010• •all persons employed on said project have been paid the full weekly wages earned. that no rebates have been or will he made either directly or indirectly to or on behalf of said Allen-Kretler Co., Inc. from the kilt (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations.Part 3 (29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended{48 Stet,948, 63 Start. 108, 72 Slab 967:76 Slat.357,40 U.S.0. 276c),and described below. REMARKS (2)That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work he performed, (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor,of if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. (4)That: • 1 (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS NAME AND TITLE SICIATURE Bonnie Kretler,V_President ` I in ti ✓ — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in he above referenced payroll, payments or fringe benefits as listed in the contract THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUSIE T THE CONTRACTOR OR have been or will be made to appropriate programs for the benefit of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION.SEP SECTION loot OF TITLE is AND SEOUON 231 OF TITLE employees,except as noted in Section 4(c)below. 31 OF THE UNITED STATES COLE. U,£M3,0..19975%9 551 U.S. Department of Labor PAYROLL Employment Standards Administration (For Contractor's Optional Use; See Instructions, Form WH-347 Inst.) fJ Wage and Hour Division - Persons are not required le respond to the cdflecrian of informer,on unless it displays a currenfly valid OMB central number. NAME OF CONTRACTOR O OR SIRCONTRAOTOR ADDRESS 9190 Corporation Dr.,Sulte D OMB No.:1215-0149 Allen-Kretler Co.,Inc. Indianapolis,IN 46256 ; Expires: 03/31/2006 PAYROLL NO FOR WEEX ENDING PROJECT AND LOCATION PROJECT OR CONTRACT NO. 3 07/172010 - Carmel Performing Arts Center Carmel, IN Ill 121 (31 (4)DAY AND DATE I 15/ 150 OI I (9) IS) S S M T W Th F S DEDUCTIONS D NET FAME,ADDRESS.AND .5 ° GROSS I WITH- WAGES SOCIAL SECURITY NUMBER z�w WORK o I _' 13 14 I A 17 TOTAL RATE AMOUNT HOLOING I TOTAL PAID Or EMPLOYEE CLASSIFICATION HOURS WORXED EACH DAY HOURS OF PAY EARNEO FICA TAx OTHER DEDUCTIONS FOR WEEK Dale Klingler 3178-32-9146 sheetmetal a 5167.98 1502 Geri Dr, 1 512.54 522.56 535,10 511_8.ES Lebanon.IN 46052 5 sIe 6.00 127.33 5163.48 o / s //// s / / 5 / o O — We estimate that it will lake an average of 56 minutes to complete this collection of information, including time for reviewing instructions searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding these estimates or any other aspect of this collection of information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division. ESA, U. S. Department of Labor. Room 53502, 200 Constitution _ Avenue,N.W,Washington,D.C.20210. FORM WH-347,Revised Nov. 1998- FORMERLY 50L 184-PURCHASE THIS FORM DIRECTLY FROM THE SUPT.OF DOCUMENTS Date 07/22/2010 (b)WHERE FRINGE BENEFITS ARE PAID IN CASH Bonnie Kretler V. President Each laborer or mechanic listed in the above referenced payroll has been paid, (Name of Signatory Party) (Title) as indicated en the payroll,an amount not less than the sum of the applicable do hereby state: basic hourly wage rake plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c)below. (1)That I pay or supervise the payment of the persons employed by (c)EXCEPTIONS Allen-Kretler Co., Inc. the oh(Contractor or Subcontractor) EXCEPTION(CRAFT) EXPLANATION Carmel Performing Arts Center ;that during the payroll period commencing on the (Building or Work) 11 day of 7 2010 and ending the 17 day of 7 2010 all persons employed on said project have been paid the full weekly wages earned, that no rebates have • been or will be made either directly or indirectly to or on behalf of said Allen-Kteller Co., Inc. from the full (Contractor or Subcontractor) weekly wages earned by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A),issued by the Secretary el Labor under the Copeland Act, as amended(48 Stat 948, 63 Start. 108,72 Stat.967-, 76 Slat 357;40 U.S,C.276c),and described below- REMARKS' (2)That any payrolls otherwise under this centred required to be submitted for the above period are correct and complete;that the wage rates for laborers or mechanics contained therein are not less than the applicable wage rates contained in any wage determination Incorporated into the contract: that the classifications set forth therein for each laborer or mechanic conform with the work he performed. (3) Thal any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of - Apprenticeship and Training,United States Department of Labor,of if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship arid Training,United States Department of Labor. (4)That: (a)WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS,FUNDS,OR PROGRAMS NAME AND TITLE Sine TITRE Bonnie Kretler,V.President )t.,,I 1• — in addition to the basic hourly wage rates paid to each laborer or mechanic listed in p r y'�,(,.ty V, the above referenced payroll, payments of hinge benefits as listed in the contract THE wiLLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SU CT THE CON—TracroR OR have been Cr will be made to appropdate programs for the benefit of such SUBCONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION-SEE SECTION 1001 OF TITLE AND SECTION 231 OF TITLE employees,except as noted in Section 4(c)below. at OF THE UNITED STATES CODE. •u s.GPO.'.I 7&ie361 d 9.3 1004:a cn c... v/0/tea/c) � ti y C — ,/!/mil -INYV/�/7 (J!.//N tarn:amrc r a m�arklossso�a en acaae rat voocaa pled ev e b pa!QC= �c-. a (file) as i aaa l orbs pawl as arrant rct'en 1F+3 She ben d iln ecea=add" Ilgne oT Signarcry P ar'tr) bade Iaad'+ags nes plat U e se alm of rs ins slag Mr.borers as Wed — o (a(�,�yfib. 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NBDHlS. a (2) Rlae all peyre3 dhsrt t.Ueda the moved required m Co sAenmes eta rha eons Wad ere axed era m,rpk*e,Sad to a nr%es lc1 b'Sere re Irrdtahbs cprcr o issen Nana trts tbas a. nWW1 rA 6R,IOU its.iemachCoro meddWC wfiYna n ee*ab to es fzusso . Nal ass 13) Thal anf 1pr.l,L+s 'srp yr4 h Its stave parkd era 6.a4 reste nd IA a baba eh 2nrerrpvvr� ereg'r The regesereo Baal a W axeeneweNe nerdy recelrAee Cf Rya Belie? re ¢ �+ = App IanV .Vp era mimes Unlee Setea pcpa ivrsa.d 1akr,dl ho srch I. r.ITed e5eacy crlets ha sar r `a L" 3o:r.ere rypistu ad with IISnem%re Peren1lresI V an7 'trail.so,Uralic galas taperbn.4t al Laiar (a:WHERE FRIP:E BEtiEAt<ARE PAID 10 APPROVEG91ANS w 4 OR pRoGRAMS " jr -ry)/DEra 1sr.,yty( ¢ - it a ddean la c, tee h WOILyaps rags pa to to atA Itnrer I) mr il+c Itched tc ry t4 ry Del abCre istarerrEO pynlL Day'ele\tl or Ii Irse ber.stEr as Heeed h the ercebo t rhE t(LI 1ALSiICanON e,r axy tr e5C anmg ENnt N<V rlL1Etr ri* Rafe}arts ( -c hope Ceara nr pal be roads bi sppop/at- preen for err bans% of ugh 9vsteet =rM TO 3yY M:AWIeW.Rlr2ete rex 2-E sea le N rmr v 1fl4.rlNae'_t':1WGlOr 1411 ..r n a K Wend sm-at CD@_ - _ � errperaef,eY..r.cs rin'3a all f ccerin S(G)UdOK \ ^ S _ aJ -us e r0.rn nreT a Sep., 16. 2010 9: 07AM unisfrui 3178445558 Na 1 10 P. 2 Sopld1UUN:l/a micro tuft ���, I,��1 Aus. 24. 201'', 3•46PM unis` rut . • _ c y I D. 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'Inv 114L • C n tiI G • t September 27,2010 Brandon 13ogan CSO Architects 280 E. 96th Street, Suite 200 Indianapolis, IN 46240 RE: Carmel City Center— Parcel 7C Carmel Energy Center Phase 11 Expansion Payment Application #07 Mr. Bogart, Shiel Sexton has reviewed the attached Prime Contractor ALA payment applications and requests payment of the amounts indicated, Also attached for review and approval are the Construction Management Services/ Reim bursahles and Construction Management He paymeru applications. Below is a Payment Request Sumary, Upon review and approval, please ward to Les Olds for approval and payment. Spiel Sexton requests a copy of the prime Contractor payment cheeks for the project riles. Payment Request Sunnnary 1000: Leach and Russell Mechanical Connectors, Inc. (Mechanical) $ 0.00 2000: W,R. Dunkin & Son, Inc.. (General 'I'rades) S 50,400.00 Sincerely, _or II David C. 13ure lard Construction Manager • = AIA Document G702/CMaT" — 1992 Application and Certificate for Payment Construction Manager-Adviser Edition (' TO OWNER: Cannel Redevelopment PROJECT: PARCEL 7C.111000 CARME , APPLICATION ND: 00 t Distribution to: Commission PERFORMING ART'S OWNER: One Civic Square 777 3RD AVE S.\V. PERIOD TO: September 30,2010 CONSTRUCTION MANAGER: Cannel. IN 46032 CARMEL, IN 46032 ARCHITECT: FROM W.R. Dunkin&Son,Inc VIA CONSTRUCTION Shier Sexton Co.,Inc. CONTRACT DATE:January 04,2010 CONTRACTOR: CONTRACTOR: PO Box 2247 MANAGER: PROJECT NOS: 1 FIELD: Anderson.IN 46018 CONTRACT FOR: General Construction VIA ARCHITECT: CSO Architects OTHER: 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 paynnenL as shown below,in connection with the Contract, Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Continuation Sheet,ALA Document G703,is attached. Certificates for Payment were issued and papnents received from the Owner, and that current 1. ORIGINAL CONTRACT SUM............. .,..........,.........,....,.. $ 56,000,01) payment show crcin is now due. 2. NET CHANGE BY CHANGE ORDERS ....__................................................ $ 0.00 CONTRACT R- W R I n-:n . S n, Inc. 3,CONTRACT SUM TO DATE(Line 1 3 2) $ 56.000.00 By: f 1 ,t- • Date: September 22, 2010 r 4.TOTAL COMPLETED&STORED TO DATE(Column 0 on 0703) .............$ 53,209.00 State of:In 'any 5.RETAINAGE: County of:Madison a. 5 °/a of Completed Work Subscribed and swot to before (Column D+E on 0703) $ 2,800.00 ale this 22nd day of Sep C ern e , 20 0 b. 0 %of Stored Material Notary Public:Martha A. Carpenter „�( � r (Column F on 6703) S 0.00 My Commission expires:January 08.2010 �/ Total Retainage(Lines 5a+5h or Total in Column I of 0703) 5 2,800.00 CERTIFICATE FOR PAYMENT 6.TOTAL EARNED LESS RETAINAGE $ 50,400.00 In accordance with the Contract Documents, based on on-site observations and the data comprising (Line 4 less Line 5 Total) this application, the Construction Manager and Architect certify to the Ocher that to the hest of their 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ OAp knowledge,infbnnation and belief the Work has progressed as indicated, the quality of the Work is in 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 $ 50,400.0 AMOUNT CERTIFIED $ Ssaty�y�CS 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach explanation if-mount cerrified Ayers fro 'e amount applied.Initial all figures on this Application and on the Continuation S reel th are ci urged to conform with the amount certified) (Line 3 less Line 6) $ 5,600.00 CONS RUCTION ` 'NAG / we p 1/J BY: mss:.�. 5,/�►a A Date: 09 Z7 I a CHANGE ORDER SUMMARY ADDITTONS DEDIJCTTONS ARCH ECT: r WI Total changes a ro•ed in revious mouths b•Owner w' - _- PP P 3 $ 0.00$ 0.00 By. Date: el Z.gli or Total approved this Month $ 0.00$ 0.00 This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only t the Contractor ' O'['ALS S 0.00$ 0.00 named herein. Issuance, payment and acceptance of payment are without prejudice to rosy rights of the Owner or Contractor under this Contract. NET CHANGES by Change Order S 0.00 AIA Document G702ICMant—1992.Copyright 01992 by The American Institute of Architects.All rights reserved.WARNING:This AIAe 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 1 under the law.This document was produced by ALA software at 13:25:03 an 09422/2010 under Order No.0188420739 1 which e)1lires en 05/1012011,and is miller resale. user Notes: 0882541650) SAJA Document G7O3TM - 1992 Continuation Sheet AIA Document, G702""-1992, Application and Certification for Payment,or G736T51-2009, APPLICATION NO: 001 Project Application and Project Certificate for Payment,Construction Manager as Adviser Edition, APPLICATION DATE:09/15/20 10 containing Contractor's signed certification is attached. In tabulations below, amounts are in US dollars. PERIOD TO:09/30/2010 Use Column Ion Contracts where variable retainage for line items may apply. ARCHITECT'S PROJECT NO: A B C 0 I E F G H I WORK COMPLETED TOTAL MATERIALS COMPLETED BALANCE TO RETAINAGE ITEM DESCRIPTION OF SCHEDULED FROM PRESENTLY cn NO. WORK VALUE PREVIOUS STORED AND STORED TO FINISH (IF VARIABLE APPLICATION THIS PERIOD DATE (G C) (C-G) RATE) (NOT IN D OR F..) (D+E) (D+E+F) - PERFORMANCE 01010 BOND 1,200.00 0.00 1,200.00 0.00 1,200.00 100.00% 0.00 0.00 MOBILIZE/ 01020 DEMOBILIZE 1,000.00 0.00 1,000.00 0.00 1,000.00 100.00% 0.00 0.00 SUPERVISION/ 01030 COORDINATION 6,800.00 0.00 6,800.00 0.00 6,800.00 100.00% 0.00 0.00 GENERAL 01040 CONDITIONS - M 3,000.00 0.00 3,000.00 0.00 3,000.00 100.00% 0.00 0.00 GENERAL 0]050 CONDITIONS - L 5,000.00 0.00 5,000.00 0.00 5.000.00 100.00 0.00 0.00 GENERAL CLEAN 01510 UP- NI 500.00 0.00 500.00 0.00 500.00 100.00% 0.00 0.00 GENERAL CLEAN 01520 UP- L 1,000.00 0.00 1,000.00 0.00 1,000.00 100.00% 0.00 0.00 FINAL CLEANING 01530 (ITEMS IN BP 5010) 1,000.00 0.00 0.00 0.00 0.00 0.00% 1,000.00 0.00 02010 DEMOLITION - NI 3.500.00 0.00 3,500.00 0.00 3,500.00 100.00% 0.00 0.00 02020 DEMOLITION - L 6,000.00 0.00 6,000.00 0.00 6,000.00 100.00% 0.00 0.00 04010 MASONRY 2,800.00 0.00 2,800.00 0.00 2,800.00 100.00% 0.00 0.00 06210 CARPENTRY-M 4,600.00 0.00 4,600.00 0.00 4.600.00 100.00% 0.00 0.00 06220 CARPENTRY-L 4,600.00 0.00 4,600.00 0.00 4,600.00 100,00% 0.00 0.00 09010 FINISHES 8,200.00 0.00 8,200.00 0.00 8,200.00 100.00% 0.00 0.00 10010 SPECIALTIES 6,800.00 0.00 5,000.00 0.00 5,000.00 73.53% 1,800.00 0.00 GRAND TOTAL $56,000.00 $0.00 $53,200.00 $0.00 $53,200.00 95.00 % $2,800.00 $0.00 AIA Document G703 w-1992.Copyright 5 1963,1965,1966,1967,1970.1976, 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 1 • prosecuted to the maximum extent possible under the law.This document was produced by AlA software at 13:26:03 on 09/2222010 under Order No 01681207391 which expires on 05110E2011,and is not far • resale. user Notes: (1366127719) Date : 09/16/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1 Job:. 09-406 CPA-BP 1000 P7C-GEN_TRADES Contractor: W. R. DUNKIN A SON, INC. Pay Period 09/09/10 - 09/14/10 ' 777 3RD AVE S.W. P.O. HOX 2247 CANNEL, IN 46032 ANDERSON, IN 46018 Employers Id #: 35-0280890 Employee Hours Worked This Project I PAY IJOB EARN FED I STATEIUN 0801 TOT I NET Information WED THOR FRI EAT SUN MON TOES TOTALI RATEITOT BASSI FICAI LOCALI MISC I TIED I PAY HOFFMAN, KYLE P. ST - 1.00 - - - - - 1.00 31.92 31.92 186.73 39.50 95.70 GT .00 .90 1141.34 90.34 20.33 .00 95.70 748.44 ID # 555-55-5575 SEX M Carpenter-Superintend DEP 1 J o b T o t a l a : Hours: 1.00 Earnings: 31.92 V S T A T E M E N T O F C Q M P L I A H C S DATE: 09/16/10 I, MARTI CARPENTER. EXEC.ASST./ PR CLERK. do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. OUNKIN s. SON, INC. on the (building or work) CPA-BP 1000 P'C-GEN,TRADES ;Chat during the payroll. period 09/08/10 - 09/14/10 all persons employed on said project have been paid the Eull weekly wages earned, that no rebates have been or will. be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Pert 3129 CFA Subtitle Ai,issued by the Secretary of Labor under the Copeland Act,ee amended(4e Stat. 348;63 Stat. 108;72 Stat. 987;75 Stat. 357;40 G.S.C. 276c) ,and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FOND,vacation Fund,GARNISHMENT ,Local Prom/Pac,Loans,Union Dues, Market Re covery,INTERNAT'L DUES,Unifed Way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work performed. 13) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Rnreau of Apprenticeship and Training,United State Department of Labor, a! That; (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, PONDS, OR PROGRANS XIn addition to the basic hourly wage rates paid to each 'laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c) below, (b■ WHERE FRINGE BENEFITS ARE PAID IN CASE 1_I Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION (III III Remarks; NAME AND TITLE 1 SIGNATURE I , MARTI' CARPENTER, £XEC.A£GT./ PR CLERK I /y�Gj� 4 THE WILLFUL FALSIFICATION OF ANY OF THE ARO'JC STATEMENTS MAY SUSPECT THE CONTRACTOR OR ST CONTRACTOR TO CIVIL OR. CRIMINAL PR0SECUTION. SRS SECTION 1001 OF TITLE 19 AND SECTION 231 OE TITLE 01 OF THE UNITED STATES CODE, Date : 09/09/10 - TDur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1 Jobs 09-406 CPA-BP 1000 P7C-GEN.TRADES Contractor: W. R, ONNKIN & SON, INC. Pay Period 09/01/10 - 09/07/10 777 3RD AVE S.W. P.O. BOA 2247 CARMEL, IN 46032 ANDERSON, IN 46019 Employers Id #: 35-0280890 Employee Hours Worked This Project I PAY ICOR EARNI FED I STATEIUN DEDI TOT NET Information WED THOR FRI SAT SUN MON TPES TOTAL' RATEITOT ELRN1 FICAI LOCAL MISC PHD I PAY HOFFMAN, KYLE P. ST - 1.00 - - - - - 1.00 31.92 31.92 146.93 34.00 02.76 OT .00 .00 1021.44 79.14 17.04 .00 82.76 662.09 ID # f._w._6575 SEA M Carpenter-Superintend DEP 1 J o b T o t a 1 a : Hours: 1.00 Earnings: 31.92 S T A T E M E N T O F C O M P L I A N C E OATS: 09/09/10 II, Marti Carpenter, Exec,Asst./ PR Clerk do hereby state: • (1) That x pay or supervise the payment of the persons employed by W. P. DUNKIN 6 SON, INC. on the (building or work) CPA-EP 1000 F7C-GEN.TFADES that during the payroll period o9/01/10 - 09/07/10 ;all persons employed on said project. have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or SubconteattolU W. R. DUNKIN & SON, INC_ from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, ocher than permissible deductions as defined in Regulntione,Part 3)29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amendedl48 Stat, 948;63 Stat. 108;72 Stat. 967;76 Stat. 357;40 U.S.C. 27Cc) ,and described below: Dues-Initiation,Chiid Support,'Uacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local Prom/Pac,Loans Uniun Dues, Markel: Recovery,INTERNAT'L DUES,United Way 121 That any payrolls otherwise under this contract required to he submitted for the above period are correct and camplete;that the wage rat:ee for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporaoed into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. '.31 That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labcr,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Treining,united State Department of Labor. (4) That_ la) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS ti In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll. / payments of fringe benefits as listed in the contract have been or will be made Co appropriate programs for the benefit of such employees,except as noted in Section 4(cl below. Ib) WHERE FRINGE BENEFITS ARE PAID IN CASE 1_1 Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. lc/ EXCEPTIONS (CRAFT) EXCEPTION 1 EXPLANATION 1 1 1 1 1 1 Remarks: NAME AND TITLE 1 SIGNATURES Marti Carpenter, Exec.Aest./ PR Clerk �/// - / ,,e6 J/i/ THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR S CONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE I8 AND SECTION 231 OF TITLE 31 OF THE NN1T'EO S'PA'CES CODE_ S T A T E M E N T O F C O M P L I A N C E DATE • 08/19/10 I, Marti Carpenter, Exsc.Asst./ PR Clerk do hereby state: (1) That I pay or supervise the payment of the persons employed by 'd. R. DUNKIN F SON, INC. on the (building or work) CPA-SP 1000 POC-OEN.TRADES ;chat during the payroll period oB/li/10 - 08/17/10 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly on indirectly to or cn behalf of said (Contractor or Subcontractor) W. R. DUINKIN A SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3129 CFR Subtitle A) ,issued by the Secretary of Labor under the Copeland Act,as amended(43 Stat. 948;63 Etat- 108;92 Stat. 967;96 Stat, 357,40 U.S.C. 275c) ,and described below'. Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,OARNTSHMEN'T ,Local Prom/Pac,Loans,union Rues, Market Recovery,INTERNAT'L DUES,Uni,ted way (2) Mat any payrolls otherwise under this contract required to be submitted for the above period are correct and complete:that the wage rates for laborers and mechanics ,_un twined therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Oepdrtment of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS. FUNDS, OR PROGRAMS Y' In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made Co appropriate programs for the benefit of such employees,except as noted in Section 4(e) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below, (c) EXCEPTIONS ICRAFT) EXCEPTION EXPLANATION Remarks NAME AND TITLE SIGNATURE Marti Carpenter, Exec,ASS t../ PR Clerk 7 7a C �j / _t (. THE WILLFUL FALSIFICATION OF ANT OF THE ABOVE STATEMENTS MAY SUBJECT TUE CONTRACTOR OR SUBCONTRACTOR TO CCIIVVIIL OR CRIMINAL PNOSFCETTION. SEE SECTION 1001 OF TITLE 16 AND SECT'.ION 231 OF TITLE 31 CF THE UNITED STATES CODE, Da& : 08/19/10 - THur C E R T I F I E D P A Y R O L L R E C I S TER Page , 1 Sob: 09-406 CPA-BP 1000 177C-GEN.TRADES Contractor: W. R. DUNKIN 6 SON, INC. Pay Period : 08/11/10 - 08/17/10 777 3RD AVE S.W. P.0. 60x 2247 CARMEL, IN 46072 ANDERSON, IN 46018 Employers Id B: 35-0290950 Employee I Hours Worked This Project I PAY HOB EARN' FED I STATEIEN DEDI TOT I NET Information WED THEM PRI SAT SUN MON TEES TOTALI RATEITCT EARN PICAI LOCAL MISC I DELI I PAY HOFFMAN, KYLE P. ST - 4.00 - - - - 8.00 12.00 71.92 363.04 63.57 21.05 51.73 OT .00 .00 632.40 48.94 10.09 .00 51.73 442.37 ID R **"-**-6575 SEX M Carpenter-Superintend DEP 1. C o b T o t a l s : Hours: 12.00 Earnings 383.04 Date : 08/26/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : 1 Job: O9-406 CPA-EP 1000 P7C-CEN.TRADES Contractor: W. R. DUNKIN 6, SON, INC. Pay Period : OS/18/10 - 08/24/10 717 3RD AVE S.W. P.O. BOX 7247 CARMEL, IN 46032 ANDERSON, IK 44016 Employers Id #: 35-0280890 Employee I Hours Worked This Project I PAY 1,10E RAPS I no STATE INN DEOI TOT I NET It£ormatiou WED THUR PRI SAT SON MON TUBS TOTAL I RATE TOT EARNI FICA L LOCALI MISC I OED I PAY ROFFMAN, KYLE P. ST 6.00 2.00 - - - 4.00 2.00 14.00 31.92 446.88 210.67 42.76 103.46 C'2 - - - - - - - .00 .00 $21.6.80 07.67 22.01 .00 103.46 800.23 SO # ••*-••-6575 SEX M Carpenter-Superintend DEP 1 S o b T o t e l.s : Hours_ 14.00 Earrir12s: 446.88 S T A T E M E N T O F C O M P L I A N C E OATS: 08/26/111 I, MARTT CARPENTER, EXEC ASST./ PR CLERK do hereby state: IL) That I pay or supervise the payment of the persons employed by W_ R. DUNKIN & SON, INC. on the (building or work) CPA-H • 1000 P7C-GEN.TRADES ;that during the payroll period 08/10/10 - 08/2a 110 ;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor: W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3129 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(49 Stat, 948,63 Slat. 108:72 Stat. 967;76 Stet. 117;40 0.5,T. 296c) ,and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local. Prom/Pac,Loans,Union Dues, Market Recovery,TNTF.RN:T't DUES,United way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and completerthat the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above taxied are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,0nited States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Traininc,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the beref it of such employees,except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH Li Each laborer cr mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate pins the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(G below. (c) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION Remarks: NAME AND TITLE 1 �/� //JJ SIGNATURE MARTI CARPENTER, EXEC ASST./ PR CLERK I y t) r' C A/ ice2 THE WILLFUL FALSIFICATION OF ANY OF THE AEOVE STATEMENTS wAy SUBJECT THE CONTRACTOR ea UPCON'TPACTOR TO CIVIL OR CRIMINAL PROSECUTION, SEE SECTION 1001 OF 'TI'TLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. o ia a Date 07/01/30 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page 1 Job: 09-406 CPA-BP 1000 P7C-GEN.TRADES Contractor: W. R. DUNKIN & SON, INC. Pay Period : 06/23/10 - 06/19/10 777 3RD AVE S.W. P.O. BOX 2247 CARMEL, IN 46032 ANDERSON, IN 46018 Employers Id U: 35-0280890 Employee I Hours Worked This Project I PAY !JOB EARNI P® I STATE'ON DEDI TOT I NET Information WED THOR PRI SAT SON MON TUBS TOTAL RATEITOT EARN' PICAI LOCAL' MISC I DBD I PAY BROWNING, JEFFREY ST 2.00 2.00 30.40 60.80 195.47 40.69 .00 OT - - - - - - - .00 .00 1216.00 93.02 20.94 .00 .00 865.88 ID R .••-•'-3138 SEX M Laborer-Journeyman DHP 1 Job T o t a l s : Hours: 2.00 Earnings: 60.80 • S T A T E M E N T O F C O M P L I A N C E DATE: 07/01/10 I., Marti Carpenter, Exec.Asst./ PR Clerk do hereby state: (1) That 1 pay or supervise the payment of the persons employed by W. R. DiNKIN 6 SON, INC. on the (building Or work) CPA-PP 1005 07C-CEN.TRAD6S ;that during the payroll period 0e/23/10 - 06/19/10 ;all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN & SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulatiens,Psrt 3(29 CFR Subtitle A) ,rceued by the Secretary of Labor under the Copeland Act,as amended)48 Stat. 948;63 Seat. 108;72 Stat. 567:76 Stat. 757;40 U.S.C. 276c1 and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FOND,vacation Eund,CARNISHMENT ,Local Prom/Pac,Lcans,Enion Dues, Market R.eCOvery,TNTEHNAT'L OOES,pnited Way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Euneau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with. the Sureau of Apprenticeship and 'rraining,United State Department of Labor. (4) That_ (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS IXI In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, ,• payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c) below. (b) WHERE PRINCE BENEFITS ARE PAID IN CASH 1_I each laborer or mechanic listed in the above referenced payroll has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. (c) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION Remarks: NAME AND TITLE 1 SIGNATURE Marti Carpenter, Exec.AS St./ PR Clerk I � �" L /I „ Cktee. THE WILLFUL EAL$IFICATJON Cr airy OF THE LEONE STATEMENTS MAY SUBJECT/THE CONTRACTOR O(H'(/FURCO-N!TRACTORR TO CIVIL OR CRIMINAL PRCSECU'1'1ON_ SEE SECTION 1001 OF 'II'ILE 1E AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. Date : 04/22/10 - Thur C E R T I F I E D P A Y R O L L R E G I S T E R Page : Job: 09-406 CPA-BP 1000 P7C-GEN.TRADES Contractor: W. R. DUNKIN 6 SON, INC. Pay Period : 04/14/10 - 04/20/10 777 3RD AVE S.W. P.C. BOX. 2247 CARMEL, IN 46032 ANDERSON, IN 46018 Employers Id N: 35-0280890 Employee 1 Hours Worked This Project I PAY IJOB EARN' FED I $TATEION DEDI TOT I NET Information WED THOR FRI SAT SON MON TDES TOTAL' RATEITOT EARN' FICAI LOCAL' MISC I DED I PAY ROFFMAN, KYLE P. ST - 4.00 - - - - - 4.00 31.59 126.36 207.37 42.31 102.86 CT - - - . - - - - .00 .00 1263.10 96.66 21.78 .00 102.86 792.62 ID k ""-"-6575 SEX M Carpenter-Superintend DEP 1 J o b T o t a l s : Hours: 4.00 Earnings: 126.36 • c i 1 r S T A T E M E N T O F C O M P L I A N C E DATE: 04/22/10 I, Marti Carpenter, Exec.Asst./ PR Clerk do hereby state: (1) That I pay or supervise the payment of the persons employed by W. R. DUNKIN 6 SON, INC. on the (building or work) CPA-BP 1000 P7C-GEN.TRADES ;that during the payroll period 04/14/10 - 04/20/10 all persons employed on said project have been paid the full weekly wages earned, that no rebates have been or will be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) W. R. DUNKIN 8 SON, INC. from the full weekly wages earned by any person, and that no deductions have been made either directly or indirectly from the full wages earned by any person, other than permissible deductions as defined in Regulations,Part 3(29 CFR Subtitle A),issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat. 948;63 Stat. 108:72 Stat. 967;75 Stat. 357;40 U.S.C. 276c),and described below: Dues-Initiation,Child Support,Vacation Fund,VACATION FUND,Vacation Fund,GARNISHMENT ,Local Prom/Pac,Loans,Union Dues, Market Recovery,INTERNAT'L DUES,United Way (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete;that the wage rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract:that the classifications set forth therein for each laborer or mechanic conform with the work performed. (3) That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and training,United States Department of Labor,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training,United State Department of Labor. (4) That: (a) WHERE FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS In addition to the basic hourly wage rates paid to each laborer or mechanic listed in the above referenced payroll, payments of fringe benefits as listed in the contract have been or will be made to appropriate programs for the benefit of such employees,except as noted in Section 4(c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASH H Each laborer or mechanic listed in the above referenced payroll. has been paid, as indicated on the payroll, an amount not less than the sum of the applicable basic hourly wage rate plus the amount of the required fringe benefits as listed in the contract, except as noted in Section 4(c) below. lc) EXCEPTIONSS (CRAFT) EXCEPTION EXPLANATION 1 Remarks: � 1 NAME AND TITLE 1 SIGNATUR E ' Marti Carpenter, Exec.Asst./ PR Clerk I g„ q4y/ — m Z V✓ THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUkONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. 1 f 41