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CIRCLE B CONSTRUCTION SYSTEMS- 001342- 11/18/2010 .Fa C,A.RMEL-REDEVELOPMENT COMMISSION 001342 I r e Circle B Construction Systems Check: 1342 5636 5 Meridian St Date: 11/18/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 17-2 46 426.72 426.72 0.00 0.00 426.72 Application 17 25' 39 115,754.99 115,754.99 0.00 0.00 115,754.99 Application 25 116,181.71 116,181.71 0.00 0.00 116,181.71 !"-i:Fir.r ".WalriPMMiTHIS CHECK±HASNCOO ' 'ipVesl\ Carmel Redevelopment Commission 001342 30-West Main Street A REGIONS ( l Suite 220 - - zo iazinao Isrgic / Carmel, IN 46032 1342. • ' DATE .. - . AMOUNT 11/18/2010 ".;****116;181.71. PAY THE SUM OF ONE HUNDRED SIXTEEN THOUSAND ONE HUNDRED EIGHTY ONE DOLLARS AND 71.CEN1 TO THE ORDER ' . ' , OF Circle B Construction Systems 5636 5 Meridian St BENS, Indianapolis, IN 46217 F —_ — M • POO I3t. 20 ':0 740 14 2 1 31: 008 7 501. 1 1 1ii° CARMEL REDEVELOPMENT COMMISSION 001342 Circle B Construction Systems Check: 1342 5636 S Meridian St Date: 11/18/2010 Indianapolis, IN 46217 Vendor: CIRCLEB1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 17-2 46 426.72 426.72 0.00 0.00 426.72 Application 17 P5 39 115,754.99 115,754.99 0.00 0.00 115,754.95 Application 25 —_ 116,181.71 116,181.71 0.00 0.00 116,181.71 T axis yea 0100 AIA Document G702/CMa'N - 1992 Application and Certificate for Payment Construction Manager-Adviser Edition v6, TO OWNER: PROJECT: APPLICATION NO: 17 . Distribution to: CARMEL REDEVELOPMENT COMMISSION CARMEL PERFORMING ARTS CENTER PERIOD TO: 9/15/2010 OWNER ❑ ONE CIVIC SQUARE INDIANAPOLIS, IN 46032 CONSTRUCTION MANAGER El FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT ❑ CIRCLE B CONSTRUCTION SYSTEMS SHIEL SEXTON COMPANY PROJECT NOS: / / CONTRACTOR ❑ 5636 S MERIDIAN ST. VIA ARCHITECT: FIELD INDIANAPOLIS, IN 46217 SCO ARCHITECTS , INC. CONTRACT FOR: FIREPROOFING ❑ CONTRACTOR'S APPLICATION FOR PAYMENT the undersigned Contractor certifies that to the best of the Contractor's knowledge. information and Application is made for payment, as shown below,in connection with the Contract belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document G703,is attached. Contract Documents, at all amounts have been paid by the Contractor for Work for which previous Certificates for Pa./- t er. issued and payments received from the Owner, and that current I.ORIGINAL CONTRACT SUM -- $ 368,425.00 payment shown ,J T 'os due. 2. Net change by Change Orders SID,_194..9b CoNTRACTO: �// I B 'RUCTION-`SYSTEMS 3.CONTRACT SUM TO DATE (Line 1 t.2)' $ B �7 Date: 9/2312010 —358-,-fi19_g6 > �� 4.TOTAL COMPLETED 8 STORED TO DATE(Column G on G703) S 353;153.68 State of I tl' V stsosstuwr••" GARY `"' MA1�I O • +.. . ....,p0 5 RETAINAGE . County of , ., ,v..•• " a. �c of Completed Work Subsea d ands orn to of re C A•• A•GAIL E s61,sA (Column D +Eon 67113) $ 17 ,931.00 me on 23 du• 1 s l�(� ors a?r 0 NTY�iw0 fr b. 40 of Stored.V1aterial Nular Public: -� / C�'� ' In P. e•• 2{77 (Column F on 0703) $ My Commissio xpires: V 8"P •: Total Retamage(Lines 5a+56 or Total in Column I or G703).. $ 17 931.•.AO— CERTIFICATE FOR PA MENT 0�••.•..........:A�yQ;=' In accordance with the Contract Documents. based on on-site observatilbie'atfflicAraaeompusina S.TOTAL EARNED LESS RETAINAGE $ 335 727 .68 this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge_information and belief the Work has progressed as indicated,the quality of the Work is in 7.LESS PREVIOUS CERTIFICATES FOR PAYMENT $ 334,795 .96 accordance with the Contract Documents.and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERT'IF'IED, y L 8.CURRENT PAYMENT DUE - $ 426. 72 AMOUNT CERTIFIED $ 1i2( f~ 9.BALANCE TO FINISH,INCLUDING RETAINAGE (Attach erpkntnlian ifarrou amount certified differs from the,anuimit applied. Initial all figures on this Application and or he Can thtnatiwr 'beer t c changed t0 tonfonn with the amount certified.) (Line 3 less Line 6) i $ 23,397.28 CONS -UCTIO+�y• / By N. i.a r� i'/ Date' ©9 Z f II10 ADDITIONS DEDUCTIONS „w A'',, ( r CHANGE ORDER SUMMARY ARC r Total changes approved'm previous months by Owner $ $ By • /' ---- Date: j Total approved this Month $ $ This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor '1'O'1'ALS $ $ named herein. Issuance. payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order S the Owner or Contractor under this Contract. 1 ‘. G CAUTION:You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. 1 AIA Document G70210Ma19—1992.Copyright C 1992 by The American Institute of Architects.All rights reserved.WARNING:This Ale Document is protected by U.S.Copyright Law and International Treaties. i i. .,.. Una:dhorized reproduction or distribution of this AIA® Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,cepyrighi@aia erg. V 4Ynin Document G703'M - 1992 ri-A6 9s 36--6 o Continuation Sheet AIA Document 0702,APitt( AMON'AND CERTIFICATION FOR PAYMENT. APPLICATION NO: containing=Contractor's signed cerlilicaiion is attached APPLICATION DATE: 17 In tabulations hclow.amounts are stated to the nearest dollar. PERIOD TO: 09/23/2010 • Use Column 1 on Contracts where variable retainage for tine items may apply. ARCHITECT'S PROJECT NO 0 912 3 2010 A H C D I E F 0 fl I i WORK COMPLETED MA[L.RIALS 'TOTAL BALANCE. CD ail DESCRIPTION OF WORK 6CIII:DOLI:D r PRESEEN'ILI COMPLETED ,d TO RETAINAGH VO. FROM PRE\IOUS STORED AND STORED (IF VARIAHI-E VALUE APPLICATION THIS PERIOD ([;OF IN '10 DATE, CG-f-) FINISH RATF,) ED-F) D OR E) (D+6+F) (C.G) 700 rMUNE I/_A'Ili )1,, DED9OBL 7.500,00 7,500.00 7.500.00 I00.00 701 BOND PREMIUM 6.000.00 0 COO.00 6000.00 ion 00 702 IIRIiPROOF'PINS'PING 5.500.00 5,500,00 5,500.00 100.00 703 1ST FL 1 LABOR 32-99_.00 32,993.00 31 993.00 100-00 704 1STFL F/P MATERIAL 49.490.00 49,490,00 49490.00 100.00 705 2ND PL F/1' LABOR 31.556.00 31.85600 31,556.00 100.00 706 2ND FL F/P rMATFRT_AL 47.753-00 47-753.00 47,733-00 100-00 707 13:11-CON 1' 1'A' LABOR. 26.167.00 26.167.00 26,167.00 100.00 708 P-ALCO:N 119 MATERIAL 39.251.00 39251.00 39-751-00 100.00 709 ATTIC FP LABOR 22.754.00 22.774.00 22.754,00 100.00 710 ATTIC F/I' MA'I'EICAL 34.131.00 34,131.00 34,1:,1.00 100.00 S00 CONTRACT ALLOWANCE 45,000.00 _9.107.00 426 72 39,533.72 S7.83 5-466.28 '•DOA ALLOWANCE DEDUCTION -29.000.60 -29.000.00 -29,000.00 100.00 1-00I3 VOID LINE I ENM 800A 29,000 no 29,000-00 29,000.00 100.00 501 C11AN'GIS ORDER o1 4.525.00 4-525-00 4.525.00 100.00 802 CHANGE ORDER ;12 -5.007.00 -5.007.00 -7.007.00 100.00 303 CHANGE ORDER 73 -5.000.00 -5.000.00 -5,000.00 100.00 304 C1.1ANrG G ORDER#4 15376.96 1 a-378-96 15.376,96 100.00 10B'101 L—S: I I5.".,,619.;8 :s2,7-26-96 4-26-7a— 00 _5-,.I55.68 5.496.28 1;,921.00 CAUTION: You should sign an original AIA Contract Document,on which this text appears In RED. An original assures that changes will not be obscured. AIA Document G703'm—1992.Copyright(' 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 AIM Document,or any portion of It,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright®aia.org, ,FFIDAVIT AND WAIVER OF LIEN FINAL PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN M.ABBOTT BEING DULY SWORN THAT HE IS THE PRESIDENT OF CIRCLE 6 CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS: FIREPROOFING FORA PROJECT RENOWN AS CARREL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF THE AFOREiMENTIONED SUBCONTRACTORSUPPLIER. PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR ES THE SUM OF THREE HUNDRED THREE THOUSAND NINE HUNDRED NINETY FOUR DOLLARS AND 96/100 (5303.999.96) .KN. RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; FINAL WAIVER)THAT THEE FINAL BALANCE DUE IS THE SUM OF: • RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN I1TIICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. THEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO THE OWNER OF SAID PREMISED, ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO,AND FURTHER THAT NO OTHER PARTY RAS ANY CLAIM OR RIGHT TO A LIEN ON ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FOR R L T AND WITHIN THE SCOPE OF THIS AFFIDAVIT AND WAIVER. CIRCLE B CONSTR. SYSTEMS,LLC BY: TITLE: PRESIDENT • 40inumen44044, ,/ I T- Y AEAL THIS 17111 DAY OF AUGUST 201 (L--:\: A. ,I `� TA BVC MY CORM ISSI19 --fiIRES: Oj/ RESIDENT OF SOI 'F SAS J,.Z'i'- , . ':”"rrwneeuUPPh� • • k1RCLE B Construction Systems OWNER: CARMEL REDEVELOPMENT COMMISSION 09/20/2010 CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695-3060 FIREPROOFING PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: • APPLICATION NO. AMOUNT PAID #1 $ 29,560.72 #2 $ 7,423.47 #3 $ 12,619.94 #4 $ 23,371.15 #5 $ 13,669.42 #6 $ 139,459.42 #7 $ 25,845.02 #8 $ 990.00 #9 $ 1,485.00 #10 $ 7,994.44 #11 $ 6,318.80 #12 $ 2,943.82 #13 $ 27,632.76 #14 $ 3,306.00 1115 $ 1,375.00 TOTAL PAID TO DATE: $ 303,994.96 CIRCLE B CONSTRUCTION SYSTEMS, // 10/1 'O RESIDENT (317) 787-5746 fax(317)780-2654 - 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opportunity Employer, 1 RCLE B Construction Systems OWNER: CARMEL REDEVELOPMENT COMMISSION 08/17/2010 CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695-3060 FIREPROOFING PAYMENT VERIFICATION AFFIDAVIT: THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: APPLICATION NO. AMOUNT PAID #1 $ 29,560.72 #2 $ 7,423.47 #3 $ 12,619.94 #4 $ 23,371.15 #5 $ 13,669.42 #6 $ 139,459.42 #7 $ 25,845.02 #8 $ 990.00 #9 $ 1,485.00 #10 $ 7,994.44 #11 $ 6,318.80 #12 $ 2,943.82 #13 $ 27,632.76 #14 $ 3,306.00 #15 $ 1,375.00 TOTAL PAID TO DATE: $ 303,994.96 CIRCLE B CONSTRUCTION SYSTEMS, I M. A:BOTT, PRESIDENT (317)787-5746 fax(317)780-2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opportunity Employer. AFFIDAVIT AND WAIVER OF LIEN FINAL, PARTIAL PAYMENT TO FOLLOW STATE OF INDIANA COUNTY OF MARION SS'. JOHN M. ABBOTT BEING DULY SWORN THAT HE IS 'I PRESIDENT OF CIRCLE B CONSTR. SYSTEMS, LLC HAVING CONTRACTED WITH CARMEL• REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS FIREPROOFING FOR A PROJECT KNOWN AS. CARMEL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION DOES HEREBY FURTHER STATE OF BEHALF OF TI-IL AFOREMENTIONED SUI3CON I I:ACI'OR/SUPPLIER: PARTIAL WAIVER)THAT THE BALANCE DUE FROM THE CONTRACTOR IS THE SUM OF THREE I-IUNDRFD THREE THOUSAND NINE HUNDRED NINETY FOUR DOLLARS AND 96110( I.S3CU,994.96) NN RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR TI•IE PAYMENT OF W]JICFI HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR TEIIS AFFIDAVIT AND PARTIAL WAIVER OF LIEN, WHICH IS GIVEN TO AND FOR SAID AMOUNT, EFFECTIVE UPON RECEIPT OF PAYMENT; [FINAL WAIVER) THATTI-lIF. FINAL BALANCE DUE IS THE SUM OF: RECEIPT OF WHICH IS HEREBY ACKNOWLEDGED: OR THE PAYMENT OF WHICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR TI•IIS AFFIDAVIT AND WAIVER OF LIEN WHICH SHALL BECOME EFFECTIVE UPON RECEIPT OF SUCH PAYMENT. 'F]IEREFORE THE UNDERSIGNED WAIVES AND RELEASES UNTO TI-IF OWNER OF SAID PREMISED, ANY AND ALL LIEN OF CLAIM WHATSOEVER ON THE ABOVE DESCRIBED PROPER I Y AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MA'T'ERIAL DR BOTI-I, FURNISHED BY THE UNDERSIGNED THERETO, AND FURTHER THAT NO OTHER PARTY HAS AN) CLAIM OR RIGITF'FO A LIEN ON ACCOUNT OF WORK PERFORMED OR MATERIAL FURNISHED TO THE UNDERSIGNED FORS 1R.-/I:CT AND WIT/-IIN TI-B SCOPE OF TI•IIS AFFIDAVIT AND WAIVER. /jJ • CIRCLE B CONSTR SYSTEMS, LLC BY: �if TITLE: PRESIDENT Ifounnu b;ry i * jN,y` 140 40 AI' ' ,S fYt 'h• �0" AI& %t ALTHIIS17`hDAY01' AUGUST,2(]( A • A. II 1I CTA if . IB.Ca MYCONIN IS51Ck iRES: IQ} / RESIDENT OE.IOFf .' GQJJw1 ® . c "s.--- go- 9D • � = �A Document G702/CMaTM — 1992 39 Application and Certificate for Payment Construction Manager-Adviser Edition TO OWNER: PROJECT: ,APPLICATION NO: 25 Distribution to: CARMEL REDEVELOPMENT COMMISSION CARMEL PERFORMING ARTS CENTER PERIOD TO: 9/15/2010 OWNER ❑ ONE CIVIC SQ L UARE CONSTRUCTION MANAGER ❑ CARMEL-;11N FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: CONTRACT DATE:4/2ARCHITECT 1:1 2/08 CIRCLE B CONSTRUCTION SYSTEMS SHIEL SEXTON COMPANY PROJECT NOS: I I CONTRACTOR ❑ 5636 S. MERIDIAN ST. VIA ARCHITECT: 2695/4090 FIELD ❑ INDIANAPOLIS, IN 46217 CSO ARCHITECTS CONTRACT FOR: INT/EXT FINISHES ❑ CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies that to the best of the Contractors knowledge, information and Application is made for payment,as shown below,in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet,AIA Document 6703,is attached. Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Cenificates for Payn en were issued and payments received from the Owner, and that current 1.ORIGINAL CONTRACT SUM $ 6.394,500. OOpayment sho I r•'t ' now due. 2. Net change by Change Orders . ., :. $ 28,431 .00 CONT• A/' B CONSTRUCTIONS $I�,44grtnh„, / Uf 3.CONTRACT SUM TO DATE(Line I ±;2) $6 4 7.931 OOBY / 4 �. N,,,„, �` x 0/1 s/,O I O 4.TOTAL COMPLETED&STORED TO DATE(Column 0 on 6703) $ 6,406, 596.84State//INDIANA • �'••:G% 5.RETAINAGE - C°1-ii o : MARIE - -fie 0 ••�1 a. % of Completed Work St "cribed and sw m1to before ! s—I. CA GINDER _ Inc this of 1 '' FATE OF INDIANA (ColumnL)+EonG703) $ 318.746, 55— 15 y EPT X010 ��0 COUNTY b %u of Stored Material Notary Public: (/f` '•,AMY r* -i I UP.FEEL 1,2017 (Column F on 6703) $ My 7 Commissi >t♦it s. .n4i/N,©I Al��ra Total Retainage(Lines Sa+5b or Total in Colman I of G703).. $ 318,746.55 _ CERTIFICATE FO PAYMENT .,....:,,:,• gintt„t• In accordance with the Contract Documents, based on on-site observations and the data comprising 6.TOTAL EARNED LESS RETAINAGE $ 6,087.850.29 this application,the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated,the quality of the Work is in 7. LESS.PREVIOUS CERTIFICATES FOR PAYMENT $ 5,972 ,095.30 accordance with the Contract Documents, and the Contractor is entitled to payment of the AMOUNT (Line 6 from prior Certificate) CERTIFIED. 41 -y Si 8.CURRENT PAYMENT DUE $ 115, 5 . 99 1 AMOUNT CERTIFIED $ HSa 1 S+ 9.BALANCE TO FINISH,INCLUDING RETAINAGE ... (Attach explanation tf amauat certified differs an t a anoint applied.Initial all figures nn!)ifs _ Application and on the Continuation.Sheet if ar are flanged to cnnfon11 With the arrrnunl certified) (Line 3 less Line 6) $ 335,080.71 CON UCTIO MA AJ•' By: \: ..�,��._ i S,- Date: €, 27 ft CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS ARC s: � e- l J Total changes approved in previou_s months by Owner $ $ By ui, Dale: J� �ri,1Ui Total approved this'Month $ $ This Certirtcate is not negotiable. The AMOUNT CERTIFIED is payable only to the Contractor TOTALS $ $ named herein. Issu wee°payment and acceptance of payment are without prejudice to uny rights of NEC CHANGES by Change Order $ the Owner or Contractor under this Contract CAUTION:You should sign an original AlA Contract Document,on which this text appears in RED.An original assures that changes will not be obscured. AIA Document G7022CMaTM-1992.Copyright ©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 prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)copies of this document when completed,To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org, #AIA Document G703" - 1992 Continuation Sheet AIA Document Cr 702,APPLICATION AND CERTIFICATION FUR PAYMENT_ APPLICATION NO: containing Contractor's signed certification is attached. APPLICATION DATE: 23 In tabulations below,amounts are stated to the nearest dollar, PERIOD TO: 09/23/2010 Use Column 1 on Contracts where variable retainaee for One items may apply. ARCHITECT'S PROJECT NO: 0023/2010 A B C. D I F F (; I H I 1VORK COMPLETED MATERIALS TOTAL HALANC'E I ILIv1 t?ESCREVTION OF WORK SCFIF,DULF.D PRESENTLY COMPLETED , A RETAINAOF FROM PREVIOUS • STORED AND STORED (IF VARIABLE„ NO. VALUP. (G'C) FINISH APPI„ICATION 'E'HiS PERIOD (NOT IN TO llXf'F RATE) (D=E) DORE) (D+E+F) (C-C) 100 13ASEh4E17. 1' FRAME Ai V1 1, 107 259.00 107.279 041 107259.00 100.00 101 BASLMI .9 ,'l' FRAME LABOR 85,992.00 55.99290 55992-00 100.00 10' BASEMENT HANG NIA TL 125,006.00 125.006.00 125.005.00 100.00 103 BASEMEN] HANG LABOR 132.158.00 133,1;8.00 133155.00 100.00 104 ORCI'1 GSTRA FRAME vI.A 1-I. 118.670 00 115.670.00 118.670.00 I00-00 105 ORCHESTRA FR NIL LAB 100.713.00 100,713.00 100,713.00 100,00 106 ORC111 151'RA HANG N1Ai 1 124 796-00 124,796.00 124.796-00 100.00 107 ORCHESTRA HANGG iAB 141.031.00 141631.00 141631,00 106-00 108 RALCO\‘11-1 RANH_ IMA"EL 105.051.00 105,051.00 108,051.00 100.00 109 BALCONY 012 ANTE LABOR 92,419-00 57,798,05 4.620.95 92,419.00 100.00 110 BALCONY 1IANC MA Fl. 115.731.00 115.731-00 115,731-00 100.00 1 I 1 BALCONY HANG T.,AI3OR 129.22= 00 1 16.300-70 12.922-20 129,223 00 100.00 112 BOX TIER FRAME D4.ATI_ 135,171,00 135.171.00 135.171.00 100.00 I13 BOST IS FRAME LABOR 113,321,00 113,521.00 11;_521-00 100.00 114 BOX'1'I13191 HANG MAI I,. 140,356 00 140.350.00 140350-00 100.00 115 BOX TIER 11 ANC LABOR 175.584.00 175.554.00 178.584.00 100.00 116 ATTIC FRAME MAUL 102:176.00 102.176-00 102.176.00 100.00 117 ALA(' FRAME LABOR 37922-00 57.922,00 871'2-00 100.00 11S _ATTIC H ANC MA II,- 90226.00 90226.00 90,226.00 1 00 00 119 ATTICHANG LABOR 110.839.00 110,389.00 110.389.00 100.90 120 ACOUS CEILING NI ATI. 52941-00 52,941.00 52.941.00 100.00 PALE I'0 I'A LS : 2.394.429.00 2.376,885.75 1'540.25 .00 2,394-429.00 CO .00 CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G7031°-193.2 Copyright G1963,1955, 1966 1967 1970,1978,1983 and 1992 by The American Institute of Architects.All rights reserved.WARNING:This AIA°Document is protected by US Copyright n Law and International Treaties. Unauthorized reproduction or distribution of this AIA°Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten(10)rapes of this document when completed.To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects legal counsel,copyrightu aia.erg. . *AIA Document G703" - 1992 Continuation Sheet A IA Document G702..APPL ICAT1ON AND CERTIFICATION FOR PAY MENT'. APPLICATION NO: containing Contractor's signed certification is attached- APPLICATION DATE: 25 In tabulations below,amounts are stated ro the nearest dollar. PERIOD TO: 09/?31,0 10 Use Column Ion Contracts where variable retainage Ibr line items may apply_ ARCHITECT'S PROJECT NO: 09/23/2010 A B I C b E F 0 H i 1 WORK COMM.ETED - MATERIAL S TOTAL ITEM BALANCE. bESCRIYl'fON OF WORK SCHEDULED PRESENTLY C'OMPLET'ED ,A 10 KE'I'ARI AGE NO FROM PREVIOUS STORED AND STORED (IF VARIABLE VALUE APPLICATION THIS PERIOD (0+CI FINISH jNOT IN '1'O DATE RATE) (D+P-) DORE) (D+E+F) (C-O) 121 ACOUS CEILING LABOR 40,759 00 36.683.10 4,075.90 40,759.00 100.00 122 INSUL_A ['ION MATL 82,670.00 82.670.00 82,670.00 100.00 123 INSULATION LABOR 117.330.00 1 1 1.4 6 3.3 0 5.8666.50 11 7.330.00 100.00 200 NIS 171.10 CLG,ME"I.ALM 51.131 00 51,331.00 51,331-00 100.00 201 N/S FLIP CLC) METAL L 201,384-00 201384.00 201384-00 100.00 202 NIS FLIP CLG'PI_ASH 74.360.00 74.360.00 74.360.00 130.00 203 7,11/S BLIP CLG PLAS L 435 153.00 438,153.00 43s,153 00 100.00 204 MAIN FLIP CLG MET],. M 52412.00 52,412.00 52,412.00 IOU 00 205 MAIN ELIP CLC MITL L 168,703.00 168,703-00 168,70:.00 100.00 206 MAIN air CLG PLASM 71,273-00 71,273 00 71273.00 100-00 207 MAIN FLIP 01.0 PLAS L 430.314.00 430.314.00 430.314.00 100.00 205 UP/LOW BALCNY ME LL NI 15004,00 15304.00 15,30400 100.00 209 UPILOW BALCNY METE L 143,318.00 143,515.00 143.515.00 100.00 210 UPILOW BALCNY PI-AS M 37,975.00 37.975.00 37.973.00 100.00 211 UP/LOW BALCNV PLAS L 63352200 633522.00 633,522.00 100.00 212 BOX 'flliRICOLMEl'AI,. M 10.245.00 10245.00 10.245.00 10000 213 BOX -TIER/COL ME 1:A1_ I. 1 18.363.00 118.363.00 1 18.363.00 100 00 214 BOX 1117UCOL PLAS NI 70300.00 70,300.00 70,300.00 100.00 215 BOX TiEbucOL PLAS I. 319 455.00 319.455,00 319.455.00 100.30 216 ORGH 1-1/6 MEIAi Ni 5.317,00 5,317 00 5,317-00 100,00 217 ORO-I I-IR,Mil GAL I. 1 12,967 00 112,967.00 I 17,967.0o 100.00 218 00011 N/L PLAS NI 15,260.00 15.260.00 15.260,00 100.00 PACK-T'O'TALS : 3,210.915.00 3,200.972-60 9.942.40 -00 3,210.915.00 .00 .00 CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703r"-1992.Copyright tb 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 I - Law and International Treaties.Unauthorized reproduction or distribution of this AIA"Document,or any portion of it,may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.Purchasers are permitted to reproduce ten(10)copies of this document when completed,To report copyright violations of AIA Contract Documents,e-mail The American Institute of Architects'legal counsel,copyright @aia.org. =* AIA Document G703TM - 1992 Continuation Sheet AIA Docurl%otG702.APPLICATTON AND CERTIFICATION FOR PAYMENT, APPLICATION NO: containing Contractor's signed certification is att ached. APPLICATION DATE 25 In tabulations below amounts are stated to the nearest dollar. PERIOD TO 09/2312010 Use Column I on Contracts where variable retainae for line items may apply ARCHITECT'S PROJECT NO 098_312010 A B C D I E F C H 1 WORK C0MPLE I FD MATERIALS TOTAL ITEM PRESENTLY COMPLETED BALANCE RETAI.N'AGE DhSCRIPTION OF WORK SCHEDULED FROM PREVIOUS TO NO STORED AND STORED 11F VARIARI-F. VALUE APPLICATION THIS PERIOD (C1°C) FINISH (NOT IN '10 DATE RATE) ID-1') DORE) (D.EeF) CC GI 219 ORCIINILPLASL 3)5.844-00 264.259.60 31.584.40 315.844.00 10000 220 4090 A C1EN', ALLOWANCE 21-_000.00 203-176.37 5.438-97 205.665.54 92.74 16.334.16 221 400013C AI) 11 LOW- 1iNU L 5.000.00 5.00000 5,000.00 100.00 222 4100A CEN ALLOWANCE 175.000,00 155.734.03 16.265,97 17s 000 no 100.00 223 410013 CADALLOWANCE. 5.000-00 5,000-00 500000 100,00 224 ADDC1'ONA1_4090 ALLOW 29.000-00 29.000.00 29000.00 10090 224A DELETE LINE 224 -29-000.00 -29-000.00 -29,000.00 100.00 300 BOND PREMIUM 63 312.00 63 312.00 63,:12.00 100.00 301 C,O. 411CCR 'nun 5 60,100.00 54,090.00 6.010.00 6010000 100.00 302 C-0#2/CCR #101 I 27 970-00 27,970-00 27970.00 100-00 303 C.O- 43/1 CR #1012 1.20000 1200,00 1,200.00 10000 304 C 441CCR#1014 19,500.00 15.540.00 3.160.00 19.500.00 160.00 305 C C.#5ICC1,' #1015 31.680.00 19-005.00 12,672.00 31,680.00 100.00 306 Co. #61CCR #1016 27,720.00 16,632.00 11 058.00 27,720.00 100,00 205 CO 48/P aC0O6t( 07 in 20,490.00 20 490,00 20.490.00 100.00 309 C091A11,0Aa'ANC17 ADI -226269.00 -226269.00 -226269,00 100.00 310 CO411I1IICH hall NJ, 17.740,00 17.740.00 17.740.04 100-00 311 C0!412 'DM II- STEEL 45.000,00 45-00400 45,000.00 100.00 .10B "1'01'Al.S : '3.'122,92-hC0 0,290.511.2` 1 1 15,-,34"7 00 c I00.176.54 16-334-1 G 318,"'6-5_` I CAUTION: You should sign an original AIA Contract Document,on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703T"-1992.Copyright©1563, 1965, 1966 19E7 1970, 1978. 1983 and 1992 by The American institute of Architects.All rights reserved.WARNING:This Alle Document is protected by U.S.Copyright r - Law and International Treaties..Unauthorized reproduction or distribution of this AIA°Document,or any portion of it,may result In severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law-Purchasers are permitted to reproduce ten(10)copies of this document when completed.To report copyright violations of AIA Contract Documents,a-mail The American Institute of Architects'legal counsel,copyrights aia.org. AFFIDAVIT AND WAIVER_ OF LIEN FINAL PARTIAL PAYMENT TOFOLLOW STATE OF INDIANA COUNTY OF MARION SS: JOHN :M. ABBOTT BEING DULY SWORN 'H-TAT I-IFT IS THE PRESIDENT OF CIRCLE 13 CONSTR, SYSTEMS.LLC HAVING CONTRACTED WITH CARMEL REDEVELOPMENT COMMISSION TO FURNISH CERTAIN MATERIALS AND/OR LABOR AS FOLLOWS: INTEI:IORJEXTERICIR FINISHES FOR A ]'ROIECI' KNOWN AS: CARMEL PERFORMING ARTS CENTER AND OWNED BY: CARMEL REDEVELOPMENT COMMISSION ODES HEREBY FURTHER STATE OF BEHALF OF TI-II:i AFOREMENTIONED SUBCONTRACTOR/SUPPLIIER: PARTIAL WAIVER) TI-IAT THE BALANCE DUE FROM THE CONE'RACTOR IS THE SUM 0I- IT,c Million Four Hundred Piny Thaus;ind Fight Hunch-cc' Twenty Eight Doll:Ts.lC1 96/100 (55,450ii25 96) XX RECEIPT OF WI-I]CI-I IS HEREBY ACKNOWLEDGED: OR TI-IF PAYMENT OF WHICH HAS BEEN PROMISED AS TI-IL SOLE CONSIDERATION FOR TI ITS AFFIDAVIT AND PARTIAL WAIVER OF LI13,N, WHICH IS GIVEN TO AND FOR SAID AMOUiNT, EFFECJJVIT• IiI'UN RECEIPT OF PAYMENT; fRINAL WAIVER)TI-IAT TI-TIE FINAL 13A1.A NCI: DUE IS THE SUM OF RECEIPT OF WI-IICI-I 1S HEREBY ACKNOWLEDCED: OR TI-IL PAYMENT OF WI-IICH HAS BEEN PROMISED AS THE SOLE CONSIDERATION FOR THIS AFFIDAVIT AND WAIVER OF LIEN WHI]CI-1 SHALE_BECOME EFFECTIVE UPON RECEIPT DI SUCH PAYMENT. THEREFORE TI-II; UNDERSIGNED WAIVES AND RELEASES UNTO THE OW,NER OF,SAID PREMISED, ANY AND ALL LIEN OE CLAIM WHATSOEVER ON THE ABOVE DESCRII3ED PROPERTY AND IMPROVEMENTS ON ACCOUNT OF LABOR OR MATERIAL OR BOTH, FURNISHED BY THE UNDERSIGNED THERETO, AND FURTHER THAT NO OTHER PARTY HAS ANY CLAIM OR RICHT TO A LIEN ON ACCOUNT OF WORK.PERFORMED OR iMA'LEILIAL FUR.AlIID VITAE WAIVEGNEI) POk / E1'AND1VITh]IA' 'I'!-IFSCOP130}'' ]'I lIS AP]�1DA\'IT AND 1VA1\%I?li. CIRCLE E3 CONSTR. SYS I HMS, LLC B /Ili TI'T'LE: I'RESIDEN'T p9tlNtluglltl• W f "t Tr VD NT- z I.,: LAL ,SSS 2iINo? t-4,),I SEPTEMBER , 20 I0 G CB. .... .r Y\ .1731 r A41' CO,M 510. I AI']RBS: 02/01/29!7 z-c i C- RESIDENT OF lO]-INSON COUNTY =m °�_ '',,QUANP' o�`' rrounrer untt' ROLE B Construction Systems OWNER: 09/20/2010 CARMEL REDEVELOPMENT COMMISSION CM: SHIEL SEXTON COMPANY PROJECT: CARMEL PERFORMING ARTS PROJECT NO. 2695-4090 DRYWALL PAYMENT VERIFICATION AFFIDAVIT: • • THE FOLLOWING PAYMENTS HAVE BEEN RECEIVED: • APPLICATION NO. AMOUNT PAID #1 $ 56,980.80 #2 $ 8,369.42 #3 $ 16,209.00 #4 $ 44,810.04 #5 $ 57,634.11 #6 $ 76,202.64 #7 $ 201,168.08 #8 $ 169,090.74 #9 $ 280,896.48 #10 $ 35,997.80 #11 $ 8,465.60 #12 $ 437,984.92 413 $ 514,933.22 #14 $ 357,219.33 #15 $ 546,768.67 #16 $ 621,587.91 #17 $ 622,044.57 #18 $ 438,354.80 • #19 $ 604,713.75 #20 $ 226,649.20 421 $124,747.88 • TOTAL PAID TO DATE $ 5,450,828.96 CIR � "RUCTION SYSTEMS JO f(AB TT, PRESIDENT (317)787-5746 fax f317) 780-2654 5636 South Meridian Street Indianapolis, Indiana 46217 Equal Opprnlunity Employer U. S. DEPARTMENT OF LABOR ; MONTHLY EMPLOYMENT JOB NUMBER: C08004 CURRENT GOALS: REPORTING PERIOD: _ EMPLOYMENT STANDARDS ADMINISTRATION,OFCCP UTILIZATION REPORT CARMEL PER ART-INFERIOF - MINORITY: 0.0 FROM: 08/01/2010 Tills REPORT IS REQUIRED BY EXECUTIVE ORDER 11246 SEC.203. FAILURE EMPLOYERS I.D. NO. - TO REPORT CAN RESULT IN CONTRACTS BEING CANCELLED,TERMINATED OR 20-2118199 FEMALE: 0.0 TO: 08/31/2010 SUSPENDED IN WHOLE OR IN PART AND THE CONTRACTOR MAY BE DECLARED r INELIGIBLE FOR FURTHER GOVERNMENT CONTRACTS.OR FEDERALLY ASSISTED NAME AND LOCATION OF CONTRACTOR: FEDERAL CONSTRUCTION CONTRACTS. CIRCLE B CONST SYS.LLC FUNDING 5636 S MERIDIAN STREET AGENCY INDIANAPOLIS. IN 46217 (317) 787-5746 < WORK HOURS OF EMPLOYMENT (FEDERAL Si NON-FEDERAL) > TOTAL NUMBER OF TOTAL ALL AFRICAN AMERICAN ASIAN OR AM. INDIAN NUMBER OF MINORITY CONSTRUCTION EMPLOYEES (NON-HISP) HISPANIC PACIFIC ISLES OR ALASKAN MNRTY FEM EMPLOYEES EMPLOYEES TRADE M F NI F M F NI F NI F % % NI F M F 1 CARPENTER Journeyman 600.0 .0 .0 .0 .0 .0 .0 .(1 .0 .0 .0 .0 6 0 0 0 Apprentice 327.0 .0 .0 .0 127.5 .0 .0 .0 .0 .0 39.0 .0 3 0 I 0 Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 927.0 .0 .0 .0 127.5 .0 .0 .0 .0 .0 13.8 .0 9 0 I 0 2 PLASTERER Journeyman 1225 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 5 0 0 0 Apprentice .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 122.5 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 5 0 0 0 3 FINISHER Journeyman 435.0 .0 .0 .0 280.0 .0 .0 .0 .0 .0 64.4 .0 4 0 2 0 Apprentice 158.0 .0 .0 .0 158.0 .0 .0 .0 .0 .0 100.0 .0 1 0 1 0 Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 593.0 .0 .0 .0 438.0 .0 .0 .0 .0 .0 73.9 .0 5 0 3 0 4 LABORER Journeyman 85.5 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 3 0 0 0 Apprentice .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 U-S. DEPARTMENT OF LABOR MONTHLY EMPLOYMENT JOB NUMBER: C08004 CURRENT GOALS: REPORTING PERIOD: EMPLOYMENT STANDARDS ADMINISTRATION.OFCCP UTILIZATION REPORT CARMEL PER ART-INTERIOF MINORITY_ 0-0 FROM: 08/01/2010 THIS REPORT IS REQUIRED BY EXECUTIVE ORDER ] 1246 SEC.203. FAILURE EMPLOYERS I.D.NO ` TO REPORT CAN RESULT IN CONTRACTS BEING CANCELLED,TERMINATED OR 20-2115199 FEMALE: 0.0 TO: 08/31/2010 SUSPENDED IN WHOLE OR IN PART AND THE CONTRACTOR MAY BE DECLARED INELIGIBLE FOR FURTHER GOVERNMENT CONTRACTS OR FEDERALLY ASSISTED NAME AND LOCATION OF CONTRACTOR: FEDERAL CONSTRUCTION CONTRACTS, CIRCLER CONST SYS, I,I.0 FUNDING 5636 S MERIDIAN STREET AGENCY INDIANAPOLIS. IN 46217 (317) 787-5746 WORK HOURS OF EMPLOYMENT (FEDERAL&NON-FEDERAL) > TOTAL NUMBER OF TOTAL. ALL AFRICAN AMERICAN ASIAN OR AM. INDIAN NUMBER OF MINORITY CONSTRUCTION EMPLOYEES (NON-/ ISP) HISPANIC PACIFIC ISLES OR ALASKAN MNRTY FEM EMPLOYEES EMPLOYEES TRADE M F M F M F M F M F % o M F M F Trainee .0 .0 .0 .0 0 .0 .0 .0 .0 0 .0 .0 0 0 0 0 Sub Tntal 85.5 0 A) 0 .0 .0 .0 0 .0 .0 .0 .0 3 0 0 0 Total Journeyman 1.243 0 0 .0 .0 280.0 .0 0 .0 .0 .0 22.5 .0 18 0 2 0 Total Apprentice 48].0 .0 .0 .0 285.5 .0 .0 .0 .0 .0 58.9 .0 4 0 2 0 Total Trainee 0 .0 .0 .0 0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Grand Totals 1.728.0 0 .0 .0 565.5 0 .0 .0 .0 .0 32.7 .0 22 0 4 0 COMPANY OFFICIALS SIGNATURE AND TITLE TELEPHONE NUMBER DATE SIGNED _e, J (317) 787-5746 /j Tic) Subcontractor CIRCLE 13 CONST SYS, LTC Project and Location Payroll If 488 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEL PER ART-IN'T'ERIOR Week Ending; 08/07/2010 (317)787-5746 C08004 Page # I - Day and Date Employee Sun Mon Tue Wed Thu Fri Sat Total Pay Y; 8/1 8/2 8/3 8/4 8/5 8/6 817 Hours Rate Work Classification UEGEL, DAN XXX-XX-2306 M 0� H'I' 7.00 8.00 8.00 8.00 8.00 39.00 28.420 CARPENTER • Joh ham- 1,108.38 FICA: 84.79 FIE 116.26 State: 37.69 Local/SDI: H.08 Oth Dees: 94.72 Adj Net: 0.00 Tot Earn: 1,10838 lot Deds: 344.54 fin Vac: 39.00 Benefits: 522.60 tin Mist 5.85 Un Dues: 49.87 Net Pay: 763.84 I3UDIMIR, FRANO �� XXX-XX-1850 S 2 8.00 8.00 24.930 FINISHER Joh Earn: 199.44 PICA: 83.92 PIT: 148.14 Slate: 35.33 Local/SDI: 15.36 Oth Deds: 43.88 Adj Net: 0.00 Tot Earn: 1,096.92 Tot Deds: 326.63 Lin Vac: 0,00 Benefits: 438.00 finMise: 0.00 IinDues_ 43.88 Net Pay: 770.29 CHAMP,TRAVIS \\ XXX-XX-9349 S 0 / 8.00 8.00 25.040 PLASTERER Job Earn: 200.32 FICA: 61.30 FIT: 109,33 Slate: 26.26 Local/SDI: 19.63 Oth Duds: 66.24 Adj Net: 0.00 Tot Earn: 801.28 Tot Deds: 282.76 lin Vac: 0.00 Benefits: 403.88 Un Misc: 12.16 lit Dues: 54.08 Net Pay: 518.52 COCHRAN, MA'T'T XXX-XX-0049 S 0 8.00 8.00 25.040 PLASTERER Job Earn: 200.32 FICA: 61.30 FIT: 109.33 Stair: 27.24 Local/S1)1: 19.63 Oth Duds: 185,61 AM Net: 0,00 Tot Earn: 801.28 Tot Duds: 403.11 Un Vac: 0.00 Benefits: 402.88 fin Misc: 12.16 Un Dues: 54.08 Net Pay: 398.17 CHILD SU 117.37 FEES 2.00 GONZALEZ, CARLOS ;} XXX-XX-8452 M 7 1 } 7.00 8.00 7.00 8.00 8.00 38.00 14.960 FINISHER Job Ear,': 568.48 FICA: 43.49 PIT: 0:00 State: 12.46 Local/SDI: 9.21 Oth fled : 22.75 Adj Net: 0.00 Tot Earn: 568,48 Tot Deds: 87.91 Un Vac: 0.00 Benefits: 334 78 lln Misc.: 0.00 11n Dues: 22.75 Net Pay: 480.57 GUZZO, ROBERT XXX-XX-I 155 S I 8.00 8 00 16.00 22.380 LABORER Joh Earn: 358.08 FICA: 55.25 FIT: 76,15 Stale: 23.57 Local/SDI: 10,11 Oth Duds: 28.88 Adj Net: 0.00 Tot Earn: 727-16 Tot Duds: 193.96 Un Vac: 0.00 Benefits: 347.52 [In Misc.: 0.00 Un Dues: 28.88 Net Pay: 528.20 Subcontractor CIRCLE B CONST SYS. LLC Project and Location Payroll# 488 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INFERIOR Week Ending 08/07/2010 (317)787-5746 C08004 Page If 2 - < Day and Date > Gmpbyee fn formation Sun Mon Tue Wed Thu Fri Sat Total Pay 811 8/2 8/3 8/4 8/5 8/6 8/7 Bouts Rate Work Classification JIMENEZ, MARCOS XXX-XX-0903 M 1 8.00 8.00 8.00 8.00 8.00 40.00 22.740 CARPENTER Job Earn: 909.60 RCA: 69.61 FIT: 75.91 State: 29.95 Loeat/SDI: 14.74 Oth Dcds: 86.93 Adj Net: 0.00 Tot Earn: 909.60 Tot Dads: 277.14 IJn Vac: 40.00 Benefits: 481.20 Un Misc: 6.00 (In Dues: 40-93 Net Pay: 632.46 KARR, DANA XXX-XX-1845 M 0 ) 8.00 8.00 8.00 R.00 8.00 40.00 30.920 CARPENTER Job Fain: 1,236.80 PICA: 94.61 fill'. 135.52 State: 41.07 local/SDI: 33.64 Oth Deds: 101.66 Adj Net: 0.00 Tot Earn: 1,236.80 Tot Dads: 406.50 Un Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 Un Dues: 55.66 Nct Pay: 830,30 KARL DARIN XXX-XX-1829 S 0 8.00 8.00 8.00 8.00 7.00 39.00 28.420 CARPENTER Joh Earn: 1,108.38 RCA: 84.79 FIT: 186.10 State: - 37.69 Local/SDI: 30.15 Oth Dads: 94.73 Adj Nat: 0.00 Tot Earn: 1,108.38 nit Deds: 433.46 tin Vac: 39.00 Benefits: 522.60 On Misc: 5.85 Un Dues: 49.88 Net Pay: 674.92 LANG,TROY XXX-XX-4334 M I 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.96 FIT: 109.99 State: 37.67 Local/SDI: 18.42 0th Dcds: 292.16 Ad Net: 0.00 Tot Earn: 1,136.80 Tot Dcds: 545.20 Un Vac: 40.00 Benefits: 536.00 IJn Misc: 6.00 Un Dues: 51.16 Net l'ay: 591.60 J CHILD SU 193.00 FEES 2.00 LECK li,JOHN XXX-XX-7582 S I 8.00 8.00 8.00 8.00 8.00 40.00 27.000 CARPENTER Job Earn: 1,080.00 FICA: 82.64 FIT: 161.46 State: 35.74 local/SDI: 17.50 Oth Duds: 04.60 Adj Net: 0.00 Tot Far': 1,080.00 Tot Deds: 391.94 Un Van: 40.00 Benefits: 522.40 I In Misc: 6.00 IIn Dues: 48.60 Net E'ay: 688.06 LOZANO. OSCAR \ XXX-XX-2708 M 3 J 8.00 8.00 4.00 20.00 24.930 FINISHER Job Earn: 498.60 PICA: 68,65 PIT: 53.04 State: 27.57 Local/SDI: 14.54 Orb Duds: 35.89 Adj Net: 0.00 Tot Earn: 897.48 Tot Deds: 199.69 tin Vac: 0.00 Benefits: 394.20 Un Misc: 0.00 Ur Does: 35,59 Net Pay: 697.79 SANDERS, RUSTY `\ XXX-XX-3297 S 0 J 8.00 8.00 8.00 7.00 31.00 27.430 FINISHER Subcontractor CIRCLE B CONST SYS, LTC Project and Location Payroll II 488 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/07/2010 (317) 787-5746 C08004 Page# 3 Day and Date > Employee Information R/ Mon Tue Wed Tha Fri Sat Total Pay R/I 8/2 8/3 8/4 8/5 8/6 8/7 Hours Rate Work Classification Joh Earn_ 850.33 PECA: 65.05 NT: 121.59 State: 27.93 Local/SDI: 13,78 Oth Dadti_ 34,01 Ark Net: 0.00 Tot Earn: 850.33 Tot Dads: 262.36 Un Vac: 0.00 1lenelns: 339.45 lIn Misc: 000 Un Dues: 34.01 Net Pay: 587.97 N. ZEPEDA, LUIS XXX-XX-2948 M I 8.00 8.00 4.00 20.00 24.930 FINISHER lob Earn: 498.60 FICA: 76.29 PET: 89.05 State: 32.92 Local/SDI: [6.15 Oth Dads: 39.88 Adj Net: 0.00 'rot Earn: 997.20 Tot Deis: 254.29 Un Vac: 0,00 Benefits: 438.00 Un Misc: 0.00 Un Dues: 39.88 Net Pay: 742.91 ATKISON, DAVID \\ XXX-XX-5656 S 0 8.00 6.00 8.00 8.00 30.00 28.420 CARPENTER Job Earn: 852.6(1 RCA: 65 23 FIT: 122.16 State: 28.99 Local/SDI: 13.81 Oth Dods: 72.87 Adj Ncl: 0.00 'lot Earn: 852.60 Tot Dcds: 303.06 Un Vac: 30.00 Benefits: 402.00 Un Misc 4.50 IIn Dues: 38,37 Net Pay: 549.54 Prop.Count Job(lours Joh Gross FICA Taxes FIT Slate Taxes Total Deduct Total Gross Arljustrncn Is Nat 15 417.00 10,806.73 1,083.88 1,614.03 462.08 4,712.55 14,167.69 0.00 9,455.14 Date 08 107/2010 (41 That. _ le})Where fringe benefits are paid to approved plans,funds,or programs I' In addition to the basic hourly wage rates paid to each laborer or mechanic do hereby slate: listed in the above referenced payroll,payments of fringe benefits as Baled in the contract have been or will be made to appropriate programs for the benefit nfsuch employees,except as noted in Section 4(c)below_ (I) That I pay or supervise the payment of the persons employed by (h) Where fringe benefits are nail in Grab CIRCLE li CONST SYS,LI_C on the CAI2MEI.PER ART-INTER Each laborer or mechanic listed in the above referenced payroll has been that during the payroll period enmmenclnrn on the 1 day of August 2016 paid-as indicated on the payroll,an amount not less than the sum and ending the 7 day of August 2016,all persons employed of the applicable basic hourly wage rate plus the amount of the on said prnieet have been paid the loll weekly wages earned,that no rebates have been required fringe benefits as listed in the contract,except as noted in ur will he made either directly or indirectly to or on behalf of said Section 4(c}below. C11(CI.E It CONS'1'SYS,I.LC Nun the full weekly wages earned (c) Rxceptions by any person and that no deductions have been made either directly or indirectly from the full wages earned by any person,other than pemii.ssihle deductions as defined in Exception(Craft) Explanation Regulations,Part 3(29 CPR Subtitle Al issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat 948,63 Stat. 10R, 72 Stat,90:76 Stat,357,40 U.S.C.276c).and described below: 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 Inr tahnrcrs or mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contrach that the classi hcation.s set forth therein fur each laborer nr naccbmoie conturm with the work he perfiarrned. (31 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 States Department of Labor-or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training.United States Department of Labor_ r7v z{ ✓ (Signature) (Name and'Fide) • The willful falsification of any of the above statements may subject the ennractor or subcontractor to civil or criminal prosecution_ See Section 10111 of Tale IR and Section 231 or Title 31of the United States Code. Subcontractor CIRCLE B CONST SYS.LLC Project and Location Payroll # 492 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEI.. PER ART-INFERIOR Week Ending 08/07/2010 (317)787-5746 C08004 Page# 1 < Day and Date > Employee Information Sun Mon Tue. Wed Thu Fri Sat Total Pay 8/1 8/2 8/3 8/4 8/5 8/6 8/7 Flours Rate Work Classification HEL.DMAN, RYAN 1629 PINETREE WAY E GREENWOOD. IN 46142 XXX-XX-8681 M 5 8.00 8.00 28.420 CARPENTER Job Earn: 227.36 FICA: 17.40 FIT: 0.00 State: 7.73 Local/SDI: 2.27 Oth Deds: 19.43 Adj Net: 0.00 Tot Earn: 227.36 Tot Deds: 46.83 Un Vac: 8.00 Benefits: 107.20 Un Misc: 120 Un Dues: 10.23 Net Pay: 180.53 Emp.Count Job Hours Job Gross FICA faxes FIT State Taxes Total Deduct Total Gross Adjustments Net I 8.00 227.36 17.40 0.00 7.73 46.83 227.36 0.00 180.53 Date 08/07/2010 (41 Than • iii) where fringe benefits are paid to approved plans,funds.or programs ht addition to the basic hourly wage rates paid to each laborer or mechanic do hereby state: listed in the above referenced payroll,payments of fringe benefits as listed in the contract have bred or will he made to appropriate programs for the benefit of such employees,except as noted in Section 4(e)below. (I) That I pay or supervise the payment of the persons employed by (b) Where ftinec benefits are paid in Cash CIRCLE 13 CONST SYS. LTC on the CARMEL PER ART-INTER _ Each laborer or mechanic listed in the above referenced payroll has been that during the payroll period commencing on the 1 day of August 2010 nnid,as indicated on the payroll,an amount not less than the sum and ending the 7 day of Autugt 2010 all persons employed of the applicable basic hourly wage rate plus the amount of the on said project have been paid the full weekly wages earned.that no rebates have been required fringe benefits as listed in the contract,except as tooted in or will be made either directly or indirectly to or on behalf of said Section 4(c)below. CIRCLES CONST SYS.LLC from the full weekly wares earned (c} Exceptions by any person and that no deductions have been made either directly or indirectly from the full wages earned by any prison.other than permissible deductions as defined in Exception(Gnfq Explanation Regulations.Pan 3(29 CFR Subtitle A)issued by the Secretary of Labor under the Copeland Act.as amended(4S Slut.948.63 Stet-103.72 Stat.967;76 Sort, 357;40 U.SC 276c).and described below; Remarks (21 That any Payrolls otherwise under this canna reunited to be submitted far 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 fur each laborer Cr mechanic conform with the work he performed. (3) That any apprentices employed in the above period are duly registered in a bona Ink apprenticeship program registered with a State apprenticeship agency recognized by the Bureau of Apprenticeship and Training.United States Depamnent of Imhof,or if no.such recognized agency exists in a State,arc registered with the Bureau of Apprenticeship and'Braining,United States Department of Labor (Sjrnntu)�—�) (Name and Tide) The willful falsification of any of above statements may subject the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title 18 and Section 231 of Title 3 lot the United States Coda Subcontractor CIRCLE B CONST SYS, LLC Proiect and Location Payroll!? 493 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/14/2010 (317) 787-5746 C08004 Paacld I - Day and Date > Sun Mon Tue Wed Thu Fri Sat Total Pay Employee Information 818 8/9 81111 8/11 8/12 8/13 8/14 Hours Rate Work Classification BEGH1'EL, DAN 7712 BOMBAY LANE INDIANAPOLIS. IN 46239 XXX-XX-2306 M 0 8.00 8.00 8.00 24.00 28.420 CARPENTER lob Earn: 682.08 PICA: 86.96 FIT: 120.52 State: 38.65 Local/SDI: 11.37 Oth Duds: 97,16 Adj Net: 0.00 Tot Earn: 1,136.80 Tut Deds: 354.66 Un Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 Un Dues: 51.16 Net Pay: 782.14 DONOVAN, PETER 3334 S CA1'LIN RD 1 V/ ROCKVILLE, IN 47872 I . XXX-XX-1528 S 2 8.00 8.00 8.00 8.00 8.00 40.00 25.580 CARPENTER lob Earn: 1,023.20 PICA: 78.28 PIT: 129.71 State: 33.81 Local/SDI: 23.53 Oth Dads: 92.05 Adj Net 0.00 Tot Earn: 1,023.20 Tot Deds: 35738 Un Vac: 40.00 Benefits: 508.80 Un Misc: 6.00 Un Dues: 46.05 Nut Pay: 665.82 GONZALEZ,CARLOS APT 3 kl INDIANAPOLIS, IN 46224 XXX-XX-8452 M 7 8.00 8.00 8.00 8.00 8.00 40.00 14.960 FINISHER Job Earn: 598.40 RCA: 45.78 FIT: 0.00 State.: 13.48 Local/SDI: 9.69 Oth Duds: 23.93 Adj Nut: 0.00 "Pot Earn: 598,40 Tot Deds: 92.88 Un Vac: 0.00 Benefits: 352.40 Un Misc: 0.00 Un Dues: 23.93 Net Pay: 505.52 GUZZO, ROBERT 238 N ADAMS ST - BROWNSBURG, IN 461 12 XXX-XX-1155 S I / 4.00 4.00 22.380 LABORER lob Earn: 89.52 FICA: 69.17 PPP: 117.51 Stale: 29.76 Local/SDI: 12.66 DM Deds: 36.16 Adj Net: 0.00 Tot Earn: 904.20 Tot Dods: 265.26 Un Vac: 0,00 Benefits: 434 40 Un Misc: 0.00 Un Dues: 36.16 Nut Pay: 638.94 Subcontractor CIRCLE 13 CONST SYS, LI..0 Project and Location Payroll # 493 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Endinfi 08/14/2010 (317) 787-5746 C08004 Parefr 2 Day and Date Employee Information Sun Mon 'rue Wed Thu Fri Sat Total Pay 8/8 8/9 8/10 8111 8/12 8/]3 8114 Flours Rate Work Classification JIMENEZ, MARCOS J� ` 6240E SOUTHPORT RD 1 L✓/ INDIANAPOLIS, IN 46237 XXX-XX-0903 M I 8.00 8.00 7.50 23.50 22.740 CARPENTER fob Earn: 534.39 FICA: 68.72 FCC: 74.21 State: 29.56 Local/SDI: 14.55 Odt Deds: 85.84 Adj Net: 0.00 Ton Earn: 898.23 Tot Dcds: 272,X8 En Vac. 39.50 Benefits: 475.20 Lin Misc: 5,93 Ili Does: 40.41 Net Pay: 625.35 KARR. DANA 10061 NORTH DAYHUEF RD MOORESVILI.}/, IN 46158-6158 XXX-XX-1845 M 0 8.00 8.00 8.00 8.00 8.00 40,00 30.920 CARPENTER Job Earn: 1,236.80 FICA: 94.61 FIT: 135.52 State: 41.07 Local/SDL 33.64 Git Deds: 101.66 Atlj Net: 0.00 Tot Rarn: 1,236,80 Tot Deds: 406.50 En Vac: 40.00 Benefits: 536.00 tin Misc 6.00 Lin lbws: 55.66 Net Pay: 830.30 KARR. DARIN 10830 N INTERURBAN I.,N MOORESVILL,E. IN 46158 XXX-XX-1829 S 0 8.00 8.00 8 00 8.130 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.98 I'll': 193.21 Stale: 38.65 Local/SDI: 30.92 Oth Deds: 97.16 Adj Net: 0.00 Tot Barn: 1,136.80 'lot Delis: 446.92 Cu Vac: 40.00 Benefits: 536.00 Lin Misc: 6.00 tin Does: 51.16 Net Pay: 689.88 LANG, TROY 10271 MEMORIAL KNOLL DR INDIANAPOLIS. IN 46234 XXX-XX-4334 M 1 8,00 8.00 8.00 600 30.00 28.420 CARPENTER Joh Earn: 852.60 FICA: 65.22 FIT: 67.36 State: 28,01 Local/SDI: 13.8] Oth Dads: 267.87 Adj Nat: 0.00 Tin Earn: 852.60 Tot Dads: 442.27 I in Vac: 30.00 Benefits: 402.00 I In Misc: 4.50 Un Dues: 38.37 Net Pay: 410.33 CI 01.D SIJ 193.00 FEES 2.00 Subcontractor CIRCLE B CONSC SYS, LLC Project and Location Payroll 1/ 493 . Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08114/2010 (317)787-5746 C08004 Paue I/ 3 Day and Date Employee Inf'orna[ion Sun Mon Tile Wed Thu Fri Sat Total Pay 8/8 8/9 8110 8/11 8/12 8113 8/14 Hours Rate Work Classification • LECK 11,100N 5936 SOUTHERN SPRINGS AV .- INDIANAPOLIS, IN 46237 XXX-XX-7582 S I 8.00 8.00 8.00 8.00 7.50 39.50 27,000 CARPENTER fob Earn: 1,066.50 FICA: 81.60 FIT: 158.09 State: 35 28 Local/SDI: 17,28 Oth Deds: 93.42 Ad)icier 0.00 Tot Earn: 1,066.50 Tot Dods: 385.67 Un Vac: 39,50 Benefits: 515.89 Un Misc: 5.93 lin Dues: 47.99 Net l'ay: 680.83 LOZANO,OSCAR 4940 PEONY PLACE INDIANAPOLIS, IN 46254 XXX-XX-2708 M 3 8.00 8.00 8,00 8.00 8.00 40.00 24.930 FINISHER loh Earn: 997,20 PICA: 7629 FCC 67.99 State: 30.96 Local/SDI: 16.15 0th Duds_ 39.88 Adj Net: 0.00 Tot Earn: 997.20 Tot Deds: 231.27 lln Vac: 0.00 Benefits: 438.00 tin Misr: 0.00 Un Dues: 39.88 Net Pay: 765.93 SANDERS, RUSTY 8411 COUNTRY CHARM DR INDIANAPOLIS, EN 46234 XXX-XX-3297 S 0 8,00 8.00 8.00 8.00 4.00 36.00 27.430 FINISHER Job Earn: 987.48 FICA: 75.54 EIT: 155.88 State: 32.59 Local/SUI: 16.00 0th Deds: 39.50 Adj'Nei 0.00 Tot Earn: 987.48 lot Dols: 319.51 On Vac: Q00 Benefits: 394.20 Un Mise: 0.00 Un Dues: 39.50 Net Pay: 667.97 ZEPEDA,1.,UIS 4109 VILLAGE TRACE BLVD INDIANAPOLIS, IN 46254 XXX-XX-2948 M I 8.00 8.00 8.00 8.00 8.00 40.00 24.930 FINISHER Job Earn: 997.20 PICA: 76.29 FH'I': 89.115 State: 32.92 Local/SDI: 16.15 Oth Deds: 39.89 Adj Net: 0.00 Tot Earn: 997.20 - Tut Duds: 254.30 Un Vac: 0.00 benefits: 438.00 Un Misc.: 0.00 Un Dues: 39.89 Net Pay: 742.90 • Subcontractor CIRCLE 13 CONST SYS, LLC Project and Location Payroll it 403 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEL PER ART-INTERIOR Week Ending 08/]412010 (3171787-5746 C08004 Page it 4 c Day and Date > Employee ]nfitrmaiion Sun Mon Tue Wed Thu Fri Sat Total Pay 8/8 813 8/10 8/11 8112 8113 8114 Flours Rate Work Classification HOLLHA[1SEN. STEVE 815 WALLACE AVE ENDIANAI'OI,TS, IN 46201 XXX-XX-6805 M 3 8.00 WOO 8.00 24.00 25.040 PLASTERER Job hare: 600.96 PICA: 76.62 FIT: 68.65 State, 34.05 Local/SD}: 1623 0th Deals: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tut Duds: 278.35 IJn Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Iln hues: 67.60 Nct Pay: 723.25 • Film.Count Job hours Joh Gross PICA Taxes FIT Slate Taxes Total DrtilucL 'total Gross Adjustments Not Is 421.00 10,803.13 982.06 1,377.70 418.79 4,107.85 12,837.01 0.00 8,724.16 Date 08/14/2010 (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 do hereby state: listed in the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made In appropriate programs for the benefit of such employees.except as noted in Section 4(e)below. (I) That I pay or supervise the payment of the persons employed by (b) Where fringe benefits are paid in Cash CIRCLE 13 CONSI'SYS,LLC on the CARMEL PER ART-INTER , Each laborer or mechanic listed in the above referenced payroll has been that during the payroll period commencing on the 8 day of August 2010 paid-as indicated on the payrtdl,an amount not less than the sum and ending the 14 day of August 2010 ,all persons employed or the applicable basic hourly wage rate plus the amount of the on said project have been paid the full weekly wages earned.that no rebates have been required fringe benefits as listed in the contract,except as noted in or will he made either directly or indirectly to or on behalf of said Section 4(c)below. CIRCLE B CONS'f SYS-I.I-C from the full weekly wages earned (c) Exceptions 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 Exception(Crap) Explanation 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.276c),and _ described below: Remarks (2) That any payrolls otherwise under this contract required 10 he 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 pertommed. (31 That any apprentices employed in the above period are duly registered in a bona fide apprenticeship program registered with a Slate 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 Slates Department of Labor. (Signature) (Name and'title) 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 I R and Section 231 of Title 3l of the United States Code. Subcontractor CIRCLER CONS'1' SYS, LI.0 Project and Location Payroll/i 498 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEL PER ART-INTERIOR Week Ending 08/212010 (317)787-5746 C08004 Page 4 I ` < Day and Date > Sun Mon The Wed Thu Fri Sat Total Pay Employee Information 8/15 8/16 8117 8/18 8/19 8/20 8/2] Flours Rate Work Classification Bail DEL, DAN 7712 BOMBAY LANE INDIANAPOLIS, IN 46239 XXX-XX-2306 M 0 8.00 8.00 8.00 8.00 32.00 28.420 CARPENTER lob Eam: 909A4 FICA: 84.80 FIT: €16.26 State: 37.69 Local/SDI: 11.08 Oth Deds: 94.73 Adj Net: 0.00 Tot.Earn: 1,108.38 Tot Deds: 344.56 Un Vac: 39.00 Benefits: 522.60 bIn Misc: 5.85 Un Dues: 49.88 Net Pay: 763.82 DONOVAN, PETER. / 3334 S CATI.IN RE) J ROCKVILLE, IN 47872 XXX-XX-1528 S 2 8.00 8.00 8.00 8.00 8.00 40.00 25.580 CARPENTER Job Earn: 1,023.20 PICA: 78..28 FIT: 129.71 State: 33.8E Local/SDI: 23.53 Oth Beds: 92.05 Adj Net 0.00 Tot Earn: 1,023.20 Tot Beds: 357.38 Un Vac: 40.00 Benefits: 508.80 Un Misc: 6.00 Un Dues: 46.05 Net Pay: 665.82 GONZALEZ, CARLOS APT 3 9 INDIANAPOLIS. IN 46224 XXX-XX-8452 M 7 8.00 8.00 8.00 LOU 8.00 40.00 14.960 FINISHER Job Earn: 598.40 FICA: 45.78 FIT: 0.00 State: 13.48 Local/SDI: 9.69 Odl Deds: 23.92 Adj Net: 0,00 Tot Rant 598.40 Tot Beds: 92.87 tin Vac: 0.00 Benefits: 352.40 Un Misc: 0.00 Un Dues: 23.92 Net Pay: 505.53 JIMENEZ, MARCOS 6240 E SOUTHPORT RD INDIANAPOLIS, IN 46237 XXX-XX-0903 M l 8.00 8.00 8.00 8.00 32.00 22.740 CARPENTER Job Earn: 727.68 PICA: 69.59 FIT: 75.9[ State: 29.95 I..ucal/SDI: 14.74 Oth Beds: 86.93 Adj Net: 0.00 Tot Earn: 909.60 Tot Duds: 277.12 Un Vac: 40.00 Benefits: 48].20 Un Mise: 6 00 Un Dues: 40.93 Net Pay: 632.48 Subcontractor CIRCLE B CONS'!'SYS. LLC Project and Location Payroll if 498 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/21/2010 (317)787-5746 C08004 Page I/ 2 C Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Flours Rate Work Classification KARR, DANA 10061 NOR9li DAYI-TUFF RD MOORESVILLE, IN 46158-6158 XXX-XX-1845 M 0 8.00 8.00 8.00 8.00 8.00 40.00 30.920 CARPENTER Joh Earn: 1,236.80 RCA: 94.62 FIT: 135.52 State: 41.07 Local/SDI: 33.64 0th Deds: 101.65 Adj Net: 0.00 Tot Earn: 1,236.80 Tot Deds: 406.50 11n Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 11n Dues: 55.65 Net Pay: 830.30 KARR, DARIN 10830 N INTERURBAN 1.N MOORESVILLE, IN 46158 . XXX-XX-1829 S 0 8.00 8.00 8.00 6.00 8.00 38.00 28.420 CARPEN'T'ER Job Earn: 1,079.96 FICA: 82.62 FIT: 179.00 State: 36.72 Local/SDI: 29.38 Oth Deds: 92.30 Adj Net: 0.00 Tot Earn: 1.07996 Tot Dads: 420.02 IJn Vac: 38.00 Benefits: 509.20 Un Misc: 5.70 Un Dues: 48.60 Net Pay: 659.94 LANG, 'TROY 10271 MEMORIAL KNOLL DR . INDIANAPOLIS, IN 46234 XXX-XX-4334 M I 8.00 8.00 8.00 8.00 32.00 28.420 CARPENTER Job Earn: 909.44 FICA: 69.58 FIT: 75.89 State: 29.94 Local/SDI: 14.73 Oth Beds: 272.72 Adj Net: 0.00 Tot Earn: 909.44 Tot Deds: 462.86 I In Vac: 32.00 Benefits: 428.80 Un Misc: 4.80 Un Dues: 40.92 Net Pay: 446.58 CHILD Sll 193.00 FEES 2.00 LOZANO,OSCAR 4940 PEONY PLACE INDIANAPOLIS. IN 46254- XXX-XX-2708 M 3 8.00 8.00 8.00 8.00 8.00 40.00 24.930 FINISHER Job Earn: 997.20 PICA: 76.29 FIT: 67.99 State: 30.96 Local/SDI: 16.15 Oth Deds: 39.88 Adj Net: 0.00 Tot Earn: 997.20 Tot Deds: 231.27 Un Vac: 0.00 Benefits: 438.00 Tin Misc: 0.00 lin Dues: 39.88 Net Pay: 765.93 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll # 498 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/21/2010 (317)787-5746 C08004 Page 4 3 < Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat 'Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Flours Rate Work Classification SANDERS, RUSTY 8411 COUNTRY CHARM DR INDIANAPOLIS. IN 46234 XXX-XX-3297 S 0 8.00 8.00 8.00 8.00 8.00 40.00 27.430 FINISHER Job Earn: 1,097.20 FICA: 83.94 HT: 183.31 State: 36.32 Local/SDI: 17.77 0th Deds: 43.89 Atli Net: 0.00 Tot Earn: 1,097 20 Tot Deds: 365.23 Un Vac: 0.00 Benefits: 438.00 lin Mist: 0.00 11n Dues: 43.89 Net Pay: 731.97 ZEPEDA, LUIS 4109 VILLAGE TRACE BLVD INDIANAPOLIS, IN 46254 XXX-XX-2948 M I 8.00 8.00 8.00 8.00 8.00 40.00 24.930 FINISHER Job Earn: 997.20 FICA: 76.29 FIT: 89.05 State: 32.92 Local/SDI: 16.15 Oth Deds: 39.89 Adj Net: 0.00 Tot Earn: 99720 Tot Deds: 254.30 tin Vac: 0.00 Benefits: 438.00 tin Misc: 0.00 Fin Dues: 39.89 Net Pay: 742.90 FIOLZHAUSEN, STEVE 815 WALLACE AVE INDIANAPOLIS, IN 46201 XXX-XX-6805 M 3 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 FICA: 76.63 FIT: 68.65 State: 34.05 Local/SDI: 16.23 0th Deds: 82.80 Adj Net: 0.00 'lot Earn: 1,001.60 Tot Deds: 278.36 Un Vac: 0.00 Benefits: 503.60 11n Misc: 1520 tln Dues: 67.60 Net Pay: 723.24 Emp.Count Job I tours Job Gross FICA'Taxes FIT Slate Taxes Total Deduct Total Gross Adjustments Net 11 414.00 10,578.12 838.42 1,121.29 356.91 3,490.47 10,958.98 0.00 7,468.51 Date 08/21/2010 (4) That: • _ • 0 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 do hereby stale: 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. (1) That I nay or supervise the payment of the persons employed by (h) Where fringe benefits are paid in Cash CIRCLE fi CONST SYS.1.1.0 on the CARMEL PER ART-IN'I'13R Each laborer or mechanic listed in the above referenced payroll has been That during the payroll period commencing on the 15 day of August 2010 paid,as indicated on the payroll,an amount not less Wan the sum and ending the 21 day of August 2010 all peons employed of the applicable basic hourly wage rate plus the amount of the on said project have been paid the lull weekly wages earned.that no rebates have been required fringe benefits as listed in the contract,except as noted in or will he made either directly or indirectly to or on behalf of said Section 4(e)below. CIRCLE U CONSI'SYS,I.LC from the full weekly wages earned (c) Exceptions by any person and that no deductions have been made either directly or indirectly limn the full wages earned by any person,other than permissible deductions as defined in Exception(Craft) Explanation Regulations,Part 3(29 CFI(Subtitle A)issued by the Secretary of Labor under the Copeland Act,as amended(48 Stat.948.63 Stat. 108,72 Stat.967:76 Slat.357;40 U.S.C.276e),and described below: _._ Remarks (2) That arty payrolls otherwise under this contract required to be submitted for the above period are correct and complete:that the wage rates(hr 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,or if no such recognized agency exists in a State,are registered with the Bureau of Apprenticeship and Training.United States Department of labor (Signature)-,_ (Name and Title) 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. Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll (i 502 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/28/2010 (317)787-5746 C08004 Paget/ I < Day and Date - Employee In(hrtnation Sun Mon Tue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification ALFORD, WILLIAM 6348 GLEN SHIRE LANE INDIANAPOLIS, IN 46237-6237-- XXX-XX-8072 S 2 8.00 8.00 8.00 8.00 7.00 39.00 24.030 LABORER Job Earn: 937.17 FICA: 71.69 FIT: 128.21 State: 31.86 Local/SDI: 15.18 Oth Dais: 37.49 Adj Net: 0.00 Tot Earn: 937.17 Tot Deds: 284.43 Un Vac: 0.00 Benefits: 423.54 tin Misc: 0.00 IJn Dues: 37.49 Net Pay: 652.74 I3EGHTEL, DAN 7712 BOMBAY LANE INDIANAPOLIS, IN 46239 XXX-XX-2306 M 0 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.96 FIT: 120.52 Stale: 38.65 Local/SDI: 11.37 Oth Deds: 97.15 Adj Net: 0.00 Tot Earn: 1,136.80 Tot Deds: 354.65 Un Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 tin Dues: 51.15 Net Pay: 782.15 DONOVAN, PETER 3334 S CATLIN RD / ROCKVILLE. IN 47872 v XXX-XX-1528 S 2 8.00 8.00 8.00 8.00 8.00 40.00 25.580 CARPEN'T'ER Job Earn: 1,023.20 FICA: 78.28 FIT: 129.71 Slate: 33.81 Local/SDI: 23.53 Oth Deds: 92.05 Adj Net: 0.00 Tot Earn: 1,023.20 Tot Beds: 357.38 Un Vac: 40.00 Benefits: 508.80 lln Misc: 6.00 Un Dues: 46.05 Net Pay: 665.82 GONZALEZ,CARLOS APT 3 INDIANAPOLIS. IN 46224 XXX-XX-8452 M 7 8.00 8.00 8.00 8.00 8.00 40.00 14.960 FINISIIER Job Earn: 598.40 FICA: 45.78 FIT: 0.00 Slate: 13.48 Local/SDI: 9.69 Oth Beds: 23.93 Adj Net: 0.00 Tot Earn: 598.40 Tot Deck: 92.88 Un Vac: 0.00 Benefits: 352.40 Un Misc: 0.00 lJn Dues: 23.93 Net Pay: 505.52 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll It 502 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/28/2010 (317)787-5746 C08004 Page II 2 < Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Flours Rate Work Classification HUFFMAN, RANDY 150 W HAYDEN WAY PENDLETON, IN 46064-6064 XXX-XX-9987 M I 8.00 8.00 25.040 PLASTERER Job Earn: 200.32 FICA: 76.62 FIT: 89.71 Stale: 33.07 Local/SDI: 12.52 Oth Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 294.72 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 706.88 HUFFMAN.JEFFREY 3416 W. 1000 S PENDLETON, IN 46064-6064 XXX-XX-9983 M 0 4.00 6.00 6.00 4.00 4.00 24.00 26.490 PLASTERER Job Earn: 635.76 PICA: 81.06 PIT: 158.94 State 35.05 Local/SDI: 13.25 Oth Dcds: 82.80 Adj Net: 0.00 Tot Earn: 1,059.60 . Tot Deds: 371.10 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.10 tin Dues: 67.60 Net Pay: 688.50 JIMENEZ. MARCOS 6240 E SOUTHPORT RI) ,(� / INDIANAPOLIS, IN 46237 j�J�\ �/ XXX-XX-0903 M I 8.00 8.00 8.00 8.00 32.00 22.740 CARPENTER Job Earn: 727.68 PICA: 55.67 PIT: 48.62 State 23.76 Local/SDI: 11.79 0th Dais: 69.55 Adj Net: 0.00 Tot Earn: 727.68 Tot Deds: 209.39 Un Vac: 32.00 Benefits: 384.96 Un Misc: 4.80 tin Dues: 32.75 Net Pay: 518.29 KARR, DANA 10061 NORTH DAYHIJPP RD MOORESVILLE, IN 46158-6158 XXX-XX-1845 M 0 8.00 8.00 30.920 CARPENTER Job Earn: 247.36 PICA: 18.93 HT: 0.00 State: 7.43 Local/SDI: 6.73 Oth Dads: 20.33 Adj Net: 0.00 Tot Earn: 247.36 Tot Deds: 53.42 Un Vac: 8.00 Benefits: 107.20 I In Misc: 1.20 Un Dues: 1 1.13 Net Pay: 193.94 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll it 502 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/28/2010 (317) 787-5746 C08004 Page# 3 < Day and Date > Employee In(bnnation Sun Mon -1'ue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification KARR, DARIN 10830 N INTERURBAN I.N MOORESVILLE, IN 46158 XXX-XX-1829 S 0 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.96 EH: 193.21 State: 38.65 Local/SDI: 30.92 Oth Deds: 77.72 Adj Net: 0.00 Tot Earn: 1,136.80 Tot Deds: 427.46 Lin Vac: 32.00 Benefits: 428.80 tin Misc: 4.80 Lin Dues: 40.92 Net Pay: 709.34 LANG, 'TROY 10271 MEMORIAL KNOLL DR INDIANAPOLIS, IN 46234 XXX-XX-4334 M I 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.97 FIT: 109.99 State: 37.67 Local/SDI: 18.42 Oth Beds: 292.16 Adj Net: 0.00 Tot Earn: 1,136.80 Tot Beds: 545.21 Un Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 tin Dues: 51.16 Net Pay: 591.59 CHILD Sti 193.00 FEES 2.00 LOZANO, OSCAR 4940 PEONY PLACE INDIANAPOLIS, IN 46254 J\ XXX-XX-2708 M 3 8.00 8.00 8.00 8.00 8.00 40.00 24.930 FINISHER Job Earn: 997.20 FICA: 76.29 FIT: 67.99 State: 30.96 Local/SDI: 16.15 Oth Deds: 39.89 Adj Net: 0.00 Tot Earn: 997.20 Tot Deds: 231.28 Un Vac: 0.00 Benefits: 438.00 Un Misc: 0.00 Un Dues: 39.89 Net Pay: 765.92 SANDERS. RUSTY 8411 COUNTRY CHARM DR INDIANAPOLIS, IN 46234 XXX-XX-3297 S 0 8.00 8.00 8.00 8.00 8.00 40.00 27.430 FINISHER Job Earn: 1,097.20 FICA: 83.94 FIT: 183.31 State: 36.32 Local/SDI: 17.77 Oth Beds: 43.90 Adj Net: 0.00 Tot Earn: 1,097.20 Tot Beds: 365.24 Un Vac: 0.00 Benefits: 438.00 tin Misc: 0.00 Un Dues: 43.90 Net Pay: 731.96 Subcontractor CIRCLE B CONST SYS, 1.I.0 Project and Location Payroll it 502 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-INTERIOR Week Ending 08/28/2010 (317)787-5746 C08004 Page H 4 - < Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total I'ay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Flours Rate Work Classification 71?I'EDA, LUIS 4109 VILLAGE TRACE BLVD \\) INDIANAPOLIS, iN 46254 XXX-XX-2948 M I 8.00 8.00 8.00 8.00 8.00 40.00 24.930 FINISHER Job Earn: 997.20 FICA: 76.29 FIT: 89.05 State: 32.92 Local/SDI: 16.15 Oth Deds: 39.90 Adj Net: 0.00 Tot Earn: 997.20 Tot Deds: 254.31 Un Vac: 0.00 Benefits: 438.00 Un Misc: 0.00 Un Dues: 39.90 Net Pay: 742.89 HOL/_IIAIJSEN, STEVE 815 WALLACE AVE \ INDIANAPOLIS, IN 46201 J1 XXX-XX-6805 M 3 8.00 2.50 10.50 25.040 PLASTERER lob Earn: 262.92 FICA: 76.62 FIT: 68.65 State: 34.05 Local/SDI: 16.23 0th Deds: 82.81 Adj Nee 0.00 Tot Earn: 1,001.60 Tot Itetls: 278.36 Un Vac: 0.00 Benefits: 503.61 Un Misc: 15.20 Un Dues: 67.61 Net Pay: 723.24 Emp.Count Job hours Job Gross FICA Taxes FIT State Taxes Total Deduct Total Gross Adjustments Net 11 441.50 11,134.81 1,002.06 1,387.91 427.68 4,119.83 13,098.61 0.00 8.978.78 nate 08/28/2010 (4) That .. )Where fringe benefits are paid to approved plans.lunds,or programs In addition to the basic hourly wage rates paid to each laborer or mechanic do hereby stag: 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. (I) That I pay or supervise the payment of the Persons employed by (h) Where fringe benefits are paid in Cash CIRCLE B C,ONSI'SYS,LLC on the CARMEL PER ART-IN'1'Elt . that during the payroll period commencing on the 22 day of August 2010 Each laborer or mechanic listed in the above reference)navn9l has been paid.as indicated on the payroll,an amount not less than the sum and ending the 28 day of August 2010 .all persons employed of the applicable basic hourly wage rate plus the amount of the on said project have been paid the full weekly wages earned,that no rebates have been required fringe benefits as listed in the contract,except as noted in or will he made either directly or indirectly to or on behalf of said Section 4(c)below. CIRCLE B CONST SYS,1.1C front the full weekly wages earned (c) Exceptions 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 Exception(Grail) Explanation Regulations.Part 3(29 CPR Subtitle A)issued by the Secretary of Labor under the Copeland Act.as amended(4%Stat.94%,63 Stat. 10%,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 he submitted for the above period arc 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 Kona 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 States Department of Labor. (Signature)— (Name and'title) The willful falsification of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution. Sec Section 1001 of Title I%and Section 231 of"fide 31 of the tinned States Code. U. S. DEPARTMENT OF LABOR MONTHLY EMPLOYMENT JOB NUMBER: C0S004P CURRENT GOALS: REPORTING PERIOD: EMPLOYMENT STANDARDS ADMINISTRATION,OFCCP UTILIZATION REPORT CARMEL PER ART-PI..AS'I ER MINORITY: 0.0 FROM: 08101/2010 THIS REPORT IS REQUIRED BY EXECUTIVE ORDER 11246 SEC.203. FAILURE EMPLOYERS I D. NO. - TO REPORT CAN RESULT IN CONTRACTS BEING CANCELLED,TERMINATED OR 20-2118199 FEMALE: 0.0 TO: 085 I/2010 SUSPENDED IN WHOLE OR IN PART AND THE CONTRACTOR MAY BE DECLARED INELIGIBLE FOR FURTHER GOVERNMENT CONTRACTS OR FEDERALLY ASSISTED NAME AND LOCATION OF CONTRACTOR: FEDERAL CONSTRUCTION CONTRACTS. CIRCLE B CONST SYS,LLC FUNDING 5636 S MERIDIAN STREET AGENCY INDIANAPOLIS. IN 46217 (317) 787-5746 WORK HOURS OF EMPLOYMENT (FEDERAL&NON-FEDERAL) - TOTAL NUMBER OF TOTAL AEI- AFRICAN AMERICAN ASIAN OR AM. INDIAN NUMBER OF MINORITY CONSTRUCTION EMPLOYEES (NON-HISP) HISPANIC PACIFIC ISLES OR ALASKAN MNRTY FEM EMPLOYEES EMPLOYEES TRADE M F M F NI F NI F NI F % '7o M F NI F 1 CARPENTER Journeyman 175.0 0 .0 .0 .0 .0 .0 .0 0 .0 .0 .0 3 0 0 0 Apprentice 99.5 .0 .0 .0 24.0 .0 .0 .0 .0 .0 24.1 .0 2 0 I 0 Trainee .0 .0 .9 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 274.5 .0 .0 .0 24.0 0 .0 0 0 0 8.7 .0 5 0 I 0 2 PLASTERER Journeyman 1,735.5 0 .0 .0 2193) .0 .0 .0 .0 .0 12.6 .0 IS 0 2 0 Apprentice 192.0 .0 160.0 .0 .0 .0 .0 .0 .0 .0 83.3 .0 2 0 1 0 Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Toren 1,9275 .0 160.0 .0 219.0 0 0 .0 0 .0 19.7 .0 17 0 3 0 3 FINISHER Journeyman 36.0 .0 .0 .0 36.0 .0 .0 .0 .0 .0 100.0 .0 2 0 2 0 Apprentice .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 trainee .0 .0 .0 .0 .0 0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 36.0 .0 .0 .0 36.0 0 .0 .0 .0 .0 100.0 .0 2 0 2 0 4 LABORER Journeyman 327.5 .0 0 0 .0 .0 .0 .0 .0 .0 .0 .0 6 0 0 0 Apprentice .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 U. S. DEPARTMENT OF LABOR MONTI ILY EMPLOYMENT JOB NUMBER: COS004P CURRENT GOALS: REPORTING PERIOD: EMPLOYMENT STANDARDS ADMINISTRATION,OFCCP UTILIZATION REPORT CARMEL PER ART-PLASTER MINORITY: 0.0 FROM: OS/01/2010 THIS REPORT IS REQUIRED BY EXECUTIVE ORDER 11246 SEC 203. FAILURE EMPLOYERS I.D. NO. - TO REPORT CAN RESULT IN CONTRACTS BEING CANCELLED,TERMINATED OR 20-2118199 FEMALE: 0.0 TO: 08/312010 SUSPENDED IN WHOLE OR IN PART AND THE CONTRACTOR MAY BE DECLARED INELIGIBLE FOR FURTHER GOVERNMENT CONTRACTS OR FEDERALLY ASSISTED NAME AND LOCATION OF CONTRACTOR: FEDERAL CONSTRUCTION CONTRACTS. CIRCLE 13 CONST SYS,LLC FUNDING 5636 S MERIDIAN STREET AGENCY INDIANAPOLIS. IN 46217 (317) 787-5746 < WORK HOURS OF EMPLOYMENT (FEDERAL&NON-FEDERAL) > TOTAL NUMBER OF TOTAL ALL AFRICAN AMERICAN ASIAN OR AM. INDIAN NUMI3ER OF MINORITY CONSTRUCTION EMPLOYEES (NON-HISP) HISPANIC PACIFIC ISLES OR AI..ASKAN MNRTY ITEM EMPLOYEES EMPLOYEES TRADE M F h7 F M F M F M F % % M F M F Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Sub Total 3275 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 6 0 0 0 Total Journeyman 2,274.0 .0 .0 .0 255.0 .0 .0 .0 .0 .0 11.2 .0 26 0 4 0 Total Apprentice 291.5 .0 160.0 .0 24.0 .0 .0 .0 .0 .0 63.1 .0 4 0 2 0 Total Trainee .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 0 0 0 0 Grand Totals 2,565.5 .0 160.0 .0 279.0 .0 .0 .0 .0 .0 17.1 .0 30 0 6 0 COMPANY OFFICIAL'S SIGNATURE AND TITLE TELEPHONE NUMBER DATE SIGNED �-_J (/�� ` (317) 787-5746 Ii //L2 Subcontractor CIRCLE B CONST SYS, I,LC Project and Location Payroll // 354 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending (18/07/2010 (317)787-5746 C08004P Page I/ I - < Day and Date Sun Mon Tue Wed Thu Fri Sat Total Pay Employee Information 8/1 8/2 8/3 8/4 8/5 8/6 8/7 Hours Rate Work Classification ALFORD, BRIAN XXX-XX-7530 S 2 8.00 8.00 8.00 24.00 26.490 PLASTERER Job Earn: 635.76 RCA: 48.64 FIE: 52.66 State: 20.64 Local/SDI: 7.63 Oth Dcds: 49.68 Adj Net: 0.00 Tot Earn: 635.76 Tot Deds: 179.25 Un Vac: 0.00 Benefits: 302.16 Un Misc: 9.12 I In Dues: 40.56 Net Pay: 456.51 ALFORD. WILLIAM XXX-XX-8072 S 2 3.00 3.00 24.030 LABORER Job Earn: 72.09 PICA: 73.53 FIT: 134.21 State: 32.68 Local/SDI: 15.57 Oth Dcds: 38.44 Adj Net: 0.00 Tot Earn: 961.20 'I'm Dcds: 294.43 tin Vac: 0.00 Benefits: 434.40 tin Misc: 0.00 (In Dues: 38.44 Net Pay: 666.77 ALLISON, BRIAN XXX-XX-3852 S 1 N) 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.96 FIT: 175.66 State: 37.67 Local/SDI: 14.21 0th Deds: 97.15 Adj Net: 0.00 Tot Earn: 1.136.80 Tot Deds: 411.65 tin Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 (In Dues: 51.15 Net Pay: 725.15 ALLENDER,THOMAS XXX-XX-3716 M 2 ) 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.62 PIT: 99.18 State: 42.09 Local/SDI: 22.52 Oth Dcds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 323.21 Un Vac: 0.00 Benefits: 503.60 (in Misc: 15.20 Un Dues: 67.60 Net Pay: 678.39 CHAMP.TRAVIS XXX-XX-9349 S 0 8.00 8.00 8.00 24.00 25.040 PLASTERER Joh Earn: 600.96 FICA: 61.30 FIT: 109.33 State: 26.26 Local/SDI: 19.63 Oth Dcds: 66.24 Adj Net: 0.00 rot Earn: 801.28 Tot Dcds: 282.76 tin Vac: 0.00 11enefts: 402.88 tin Misc: 12.16 Un Dues: 54.08 Net Pay: 518.52 COCHRAN, MA'I"I' `\) XXX-XX-0049 S 0 ✓ 8.00 8.00 8.00 24.00 25.040 PLASTERER Job Earn: 600.96 FICA: 61.30 FIT: 109.33 State: 2724 Local/SDI: 19.63 Oth Deds: 185.61 Adj Net: 0.00 Tot Earn: 801.28 Tot Deds: 403.11 tin Vac: 0.00 13enefits: 402.88 tin Misc: 12.16 tin Dues: 54.08 Net Pay: 398.17 CI(ILD S11 1 17.37 FEES 2.00 Subcontractor CIRCLE B CONSI' SYS, LLC Project and Location Payroll # 354 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/07/2010 (317)787-5746 ' C08004P Page ti 2 - c Day and Date > Sun Mon Tue Wed Thu Fri Sat Total Pay Employee InfortnaLion 8/1 8/2 8/3 8/4 8/5 8/6 8/7 Flours Rate Work Classification DOOL.EY,LOWE.LL XXX-XX-4694 M 3 --- 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.62 FIT: 68.65 State: 31.1 1 Local/SDI: 16.23 4th Duds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot t7eds: 275.41 On Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Imes: 67.60 Net Pay: 726.19 GUZZO, ROBERT XXX-XX-1155 S I J 8.00 8.00 23.130 LABORER Joh Earn: 185.04 FICA: 5525 Fl]: 76.15 State: 2357 I.ncaI/SDI: 10.11 Orb Deds: 28.88 Adj Net: 0.00 Tot Earn: 722.16 Tot Deds: 193.96 Un Vac: 0.00 Benefits: 34752 I In Misc: 0.00 Un Duos: 28.88 Net Pay: 528.20 II]NSLIAW, DANIEL XXX-XX-6666 S 0 8.00 LOG 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.62 PIT: 184.41 State: 44,05 Local/SI)I: 10.02 Oth Deds: 82.80 Adj Net: 0.00 Tor Earn: 1,001.60 'rot Deds: 397,90 tin Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 603.70 IIUPFMAN, RANDY XXX-XX-9987 M 1 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Jab Earrr, 1,001.60 FICA: 76.62 FIT: 89.71 State: 33.07 Local/SDI: 12.52 0th Deds: 82.80 Adj Net: 0,00 Tot Earn: 1,001.60 Tot Deds: 294.72 Un Vac: 0.00 RenellIS: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 706.88 HUFFMAN,JEFFREY XXX-XX-9983 M 0 9.50 8.00 8.00 25.50 26.490 PLASTERER 8.00 8.00 39.735 PLASTERER Job Earn: 993.38 FICA: 75.99 PIT: 149.01 State: 32.79 L•cal/SDI: 12.42 Oth Dads: 69.35 Adj Net: 0.00 Tot Earn: 993.38 Tot )eds: 339,56 Un Vat: 0.00 Benefits: 421.77 Un Misc: 12.73 Un Dues: 56,62 Net Pay: 653.82 LEWIS, DEWAYNE XXX-XX-2646 M 5 8.00 8.00 8.00 8.00 8.00 40.00 22.540 PLASTERER Joh Earn: 901.60 FICA: 68.98 PIT: 32.60 State: 25.75 Local/SDI: 14.61 Oth Deds: 334.80 Adj Net: 0.00 Tot Earn: 90 L60 Tot Deds: 476.74 lin Vac: 0.00 Reiteilts: 503.60 I In Misc: 15.20 Un Dues: 67.60 Net Pay: 424.86 CHILD St0 250.00 FEES 2.00 LOZANO,OSCAR XXX-XX-2708 M 3� 8.00 8.00 16.00 24.930 FINISHER Subcontractor CIRCLE B CONSr SYS, I.I.0 Project and Location . Payroll // 354 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/07/2010 (317)787-5746 -C08004P Page k 3 Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay R/I 8/2 8/3 8/4 8/5 8/6 8/7 Hours Rate Work Classification . lob Earn: 398.88 FICA: 68.65 FIT: 53.04 State: 27.57 Local/SI)I: 14.54 Oth Deds: 35.89 Adj Net: 0.00 Tot Earn: 897.48 Tot Deds: 199.69 Un Vac: 0.00 Benefits: 394.20 Un Misc: 0.00 tin Dues: 35.89 Net Pay: 697.79 • NEAL, JEFF XXX-XX-0621 S 2 3.00 3.00 23.130 LABORER Job Earn: 69.39 FICA: 70.78 PIT: 105.21 State: 26.55 Local/SDI: 11.57 0th Deds: 37.01 Adj Net: 0.00 Tot Earn: 925.20 Tot Deds: 251.12 Un Vac: 0.00 Benefits: 434.40 Un Misc: 0.00 tin Dues: 37.01 Net Pay: 674.08 SCOTT,THOMAS XXX-XX-2031 S 2 J 8.00 8.00 25.040 PLASTERER Job Earn: 200.32 RCA: 61.30 PIT: 77.49 State: 25.28 Local/SDI: 8.01 0th Deds: 66.24 Adj Net: 0.00 Tot Earn: 801.28 Tot Deds: 238.32 tin Vac: 0.00 Benefits: 402.88 Un Misc: 12.16 Un Dues: 54.08 Net Pay: 562.96 SIIAEVITZ, DAVID XXX-XX-4153 S 2 8.00 8.00 8.00 8.00 8100 40.00 27.000 CARPENTER Job Earn: 1,080.00 FICA: 82.62 FIT: 143.91 State: 35.74 Local/SDI: 17.50 Oth Deds: 94.60 Adj Net: 0.00 Tot Earn: 1,080.00 Tot Deds: 374.37 tin Vac: 40.00 Benefits: 522.40 tin Misc: 6.00 tin Dues: 48.60 Net Pay: 705.63 VELAZOUEZ, JORGE -\ XXX-XX-2787 M 1 +) 4.00 4.00 25.040 PLASTERER Job Earn: 100.16 FICA: 76.62 FIT: 89.71 State: 33.07 Local/SDI: 10.02 0th Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,00 1.60 Tot Deds: 29222 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 tin Dues: 67.60 Net Pay: 709.38 VANDENBERG JR, BRIAN XXX-XX-3058 S 0 \ 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80) PICA: 86.96 FIT: 213.21 State: 38.65 Local/SDI: 11.94 0th Deds: 97.15 Adj Net 0.00 Tot Earn: 1,136.80 Tot Deds: 447.91 Un Vac: 40.00 Benefits: 536.00 Un Misc: 6.00 tin Dues: 51.15 Net Pay: 688.89 VELAZQUEZ. H000 XXX-XX-6406 M 5 4.00 4.00 25.040 PLASTERER Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll# 354 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/07/2010 (317) 787-5746 C08004P Page 0 4 < Day and Date Employee Information Sun Mon 'lee Wed Thu Fri Sat Total Pay R/I 8/2 8/3 8/4 8/5 8/6 8/7 Hours Rate Work Classification lob Earn: 100,16 FICA: 76.62 FIT: 47.60 State: 29.15 Local/SDI: 10.02 Oth Deds: 179,80 Atjj Net: 0,00 'lot Hans 1.001.60 Tot Deds: 343.19 Un Vac: 0.00 Bcnel its: 503.60 Un Misc: 15.20 tln Dues: 67.60 Net Pay: 658.41 CHILD SD 95.00 PEES 2.00 ZEPEDA, LUIS XXX-XX-2948 M l. 8.00 8.00 4.00 20.00 24.930 FINISHER Jeh Earn: 498.60 PICA: 76.29 FIT: 89.05 Stan: 32.92 Local/SDI: 16.15 Oth Deds: 39.88 Adi Net: 0.00 Tot Earn: 997.20 Tot Deds: 254.29 Un Vac: 0.00 31enehts: 4380.0 Un Mise: 0.00 lin Dues: 39.88 Net Pay: 742.91 l-TOLZ'IAUSEN, STEVE XXX-XX-6805 M 3 J 8.00 8.00 8.00 8.00 32.00 25.040 PLASTERER Job Earn: 801,28 PICA: 61.30 FIT: 38.61 State: 27.24 Local/SDI: 12.98 0th Duds: 66,24 AM Net: 0.00 Tut Earn: 801.28 Tot Deds- 206,37 IJn Vat: 0.00 Benefits: 402.88 On Misc: 12.16 Un Dues: 54,08 Net Pay: 594,91 Pmp. Count Job Hours Job Gross F1CA'taxes FPI Stale Taxes Total I/educt Total Gross Adjusuncats Net 21 523.50 13,518.58 1.499.57 2,138.73 653.09 6,480.18 19.602.30 0.00 13,122.12 Data 08/07/2010 (4l Thath (/F .' a)JWhere fringe benefits arc paid to approved plans,funds,or programs t do hereby Slate[ In addition to the basic hourly wage rates paid to each laborer or mechanic fisted in Ole above referenced payroll,payments of fringe benefits as listed in the contract have been or will he made to appropriate programs (err the benefit of such employees,except as noted in Section 4(e)below_ (1) That t pay or supervise the payment of the persons employed by (h) Where fringe benefits are paid in Cash CIRCLE 13 CONST SYS,I,LC on the CARMEL I'SR ART-PLASI that during the payroll period commencing on the 1 day of August 201 fl , Each laborer or mechanic listed in the above referenced payroll has been paid,as indicated on the payroll,an amount not less than the stint and end the 7 day of August _ 2010 ,all persons employed of the applicable basic hourly wage rate plus the amount of the on said project have been paid the fall weekly wages earned,that no rebates have been required fringe benefits as listed in the contract,except as noted in or will he made either directly or indirectly to or on behalf of said Section 4(e)below. CIRCLER CONST SYS,ITC from the full weeklywaees earned (e) Exceptions by any person and that no deductions have been made either diredly ur indirectly from the full wages earned by any person,other than permissible deductions as defined in Eseentipn(Craft) Explanation Regulations.Part 3(29 CFR Subtitle Al issued by the Secretary of Labor under the Copeland Act as amended ON Star.948.6]Sot 10(t,72 Stat_967,76 Stat,357;40 U.S.C.276e).and desert bed below: Remarks (2) 'I hat any payrolls otherwise tinder 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 elassificatians set forth therein for each laborer nr mechanic conform with the work he performed. (3) That any apprentices employed m the above period are duly registered in a bona tide apprenticeship',rowan'registered with a'State apprenticeship agency recognized by the Bureau of Apprenticeship and Training,United States Department of Labor_or if nu such recognized agency exists in a State,are registered with the Bureau of Appreuticeshin and Training.United States Department of Labor, (Signature.) (,/�/Cf/9-.Y 1/—LA". i� -_ (Name;nd Title) 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 Tide 71M'the United States Coda Subcontractor CIRCLE 13 CONST SYS. LLC Project and Location Payroll It 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL.PER ART-PLASTER Week Ending 08/14/2010 (3171 787-5746 C08004P Page# I < Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/8 8/9 8/10 8/11 8/12 8/13 8/14 Hours Rate Work Classification AI.F'ORD, BRIAN 154 LEONAINIE COURT GREENFIELD, IN 46140 XXX-XX-7530 S 2 8.00 8.00 8.00 8.00 8.00 40,00 26_490 PLASTERER Joh Earn: 1,059.60 PICA: 81.06 FIT: 138.81 State: 35,05 LocalSD]: 12.72 Oth Dcds: 82.80 Adj Net: 0.00 Tot Earn: 1,059.60 'lot Deets: 350.44 Un Vac: 0.110 Benefits: 503.60 lin Misc.: 15.20 Un Dues: 67.60 Nut Pay: 709.16 ALFORI), WILLIAM 6348 GLEN SHIRE LANE INDIANAPOLIS, IN 46237-6237 XXX-XX-8072 S 2 8.00 8.00 8.00 8.00 32.00 24.030 LABORER Joh Earn: 768.96 RCA: 7353 FIT: 134.21 State: 32.68 [atcal/SDl: 15.57 Oth Duds: 38.45 Adj Net: 0.00 Tut Earn: 961.20 Tot Dcds: 294.44 Un Vac: 0.00 Benefits: 434.40 tin Misc: 0.00 Un Dues: 38.45 Net Pays: 666.76 ALLISON, BRIAN 9051 N RAIDER RD MIDDLETOWN, IN 47356 XXX-XX-3852 S 1 _ 8.00 8.00 8.00 8.00 32.00 28.420 CARPENTER Joh Earn: 909.44 FICA: 69.58 FIT: I I8.82 State: 29.94 Local/SDI: 11,37 Oth Dads: 77.73 Adj Net: (1.00 Tot Earn: 909.44 Tot Dcds: 307.44 Un Vac: 3200 Benefits: 428.80 tln Mise: 4.80 Un Dues: 40.93 Net Pay: 602,00 ALI.ENDER,THOMAS 4114 E 36ST 3 ANDERSON, IN 46017 XXX-XX-3716 M 2 8.00 8.00 8 00 8.00 8.00 40.00 25.040 PLASTERER Joh Earn: 1,001.60 FICA: 76.62 Flt`_ 99.18 State: 42.09 LocaUSDI: 22.52 Oth Dcds: 82.80 Adj Net 0.00 Tot Earn: 1,001.60 Tot Dcds: 323.21 IJn Vac: 0.00 Benefits: 503.60 11n Misc: 15.20 Un Dues: 67.60 Net Pay: 678.39 Subcontractor CIRCLE B CONST SYS. LLC Project and Location Payroll 8 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEL PER ART-PLASTER Week Ending 08/14/2010 (317) 787-5746 C08004P Page # 2 - < Day and Date Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/8 8/9 8/10 8/11 8/12 8113 8/14 Hours Rate Work Classification BLGI'FFEL, DAN 7712 BOMBAY LANE INDIANAPOLIS, IN 46239 XXX-XX-2306 M 0 8.00 8.00 16.00 28.420 CARPENTER Jah Farn: 454.72 PICA: 86.96 FIT: 120.52 State: 38.65 Local/SDI: 11.37 Oth Dads: 97.16 Atlj Net: 0.00 Tot Earn: 1.136.80 Tot Dells: 354.66 Un Vac: 40.00 Benefits: 536.00 Ifn Misc: 6.00 Un Dues: 51.16 Net Pay: 782.14 CHAMP,TRAVIS W 460 5 RE REDKEY, 1N 47373 J XXX-XX-9349 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.62 FU': 159.41 State: 33.07 Local/SDI: 24.54 0th Deds: 82.80 Atl,j Net: 0_00 Tot Earn: 1,001.60 Tut Deds: 376.44 lin Vac: 0.00 Fitments: 503.60 Un Misc: 15.20 Un Dues: 67,60 Net Pay: 625.16 COCIIRAN, MA7"F 33 N SPENCER ST REDKIY, IN 47373 XXX-XX-0049 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.62 Fit': 159.41 State: 34.05 Local/SDI: 24.54 Oth Deds: 202.17 Ad.] Net: 0.0(1 Tot Earn: 1,001.60 Tot Deds: 496.79 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 504.81 CHILD SD 117.37 FEES 2.00 FINES, JOSHUA 5890 MASON COURT MAR'I'INSVIL.LE., IN 46151 XXX-XX-4587 S 1 4,50 4.50 23.130 LABORER Job Earn: 104.09 PICA: 36.28 PIT: 38.95 State 15.14 Local/SDI: 12.90 Oth Deds: 18.96 Adj Net: 0.00 Tot Earn: 474.17 Tut Duds: 122.23 Un We: 0.00 Renelits: 222.65 Un Misc: 0.00 Un Dues: 1 8,96 Net Pay' 35194 Subcontractor CIRCLE B CONST SYS. LE.O Project and Location Payroll # 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/14/2010 (317) 787-5746 C08004P Palle # 3 - C Day and Date > Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/8 8/9 8/10 8/11 8/12 8/13 8/14 Flours Rate Work Classification OUZZO, RO13EIRT 238 N ADAMS ST BROWNSE3URO, IN 46112 XXX-XX-I 155 S I 4,00 8.00 12.00 23.130 LABORER Job Earn_ 277.56 FICA: 69.17 IF 117.51 Slate: 29.76 Local/SD1: 12.66 0th Deds: 36.16 Adj Net: 0.00 Tot Earn: 904.20 Tot Deds: 265.26 Un We: 0.00 Benefit-s: 434.40 tin Misc: 0.00 Un Dues: 36.16 Net Pay: 638.94 H INS!-IAW, DANIEL PO B0X. 588 ARCADIA. IN 46030 Jl XXX-XX-6666 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.63 PIT: 184.41 State: 44.05 Local/SDI: 10.02 0th Deds: 82.80 Adj Nei: 0.00 Tot Earn: 1.001.60 Tot Deds: 397.91 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 603.69 I-[UFPMAN,RANDY 150 W HAYDEN WAY PENDLETON, IN 46064-6064 XXX-XX-9987 M I 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER lob Earn: 1,001.60 FICA: 76.63 FIT: 89.71 State: 33.07 Local/SDI: 12.52 0th Deds: 82.80 Adj Nee 0.00 Tot Earn: 1,001.60 Tot Deds: 294.73 Un We: 0.00 Benefits: 503.60 lln Misc: 15.20 Un Dues: 67.60 Net Pay: 706.87 13UFFMAN, JEFFREY 3416 W. 1000 S PENDLETON, IN 46064-6064 XXX-XX-9983 M 0 8.00 8.00 8.00 8.00 8.00 40.00 26.490 PLASTERER lob Earn: 1,059.60 PICA: 81.06 FIT: 158.94 Stale: 35.05 L.ueal/SDI: 13.25 0th Duds. 82.80 Adj Net: 0.00 Tot Earn: 1,059.60 Tot Duds: 371.10 tin Vac: 0.00 13enelits: 503.60 Un Misc: 15 20 Un Dues: 67.60 Net Pay: 688.50 Subcontractor CIRCLE B CONST SYS, LTC Project and Location Payroll # 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/14/2010 (317)787-5746 C08004P Page# 4 Day and Date > Employee Information 8/8 Mon Tue Wed Thu Fri Sat 'fatal Pay R/8 8/9 8/10 8/11 8/12 8/13 3/14 Hours Rate Work Classification JIMENEZ, MARCOS Av Li 6240 E SOUTHPORT RD INDIANAPOLIS, IN 46237 t XXX-XX-0903 M I 8.00 8.00 16.00 22.740 CARPENTER Job Earn: 363.84 FICA: 68.72 FIT: 74.21 State: 29.56 Local/SDI: 14.55 0th Deus: 85.84 Adj Net: 0.00 'rot Earn: 898.23 Tot Deds: 272.88 tln We: 39.50 Benefits: 475.20 Un Misc: 5.93 Un Dues: 40.41 Net Pay: 625.35 LEWIS,DEWAYNE 8521 SIERRA RIDGE DR ✓// INDIANAPOLIS, IN 46239 XXX-XX-2646 M 5 8.00 8.00 8.00 5.00 1300 40.00 22.540 PLASTERER Joh Earn: 901.60 FICA: 68.97 FIT: 32.60 State: 25.75 Local/SDI: 14.61 0th Deds: 334.80 Adj Net: 0.00 Tot Earn: 901.60 Tot Deds: 476,73 Un Vac: 0.00 Benefits: 503.60 tin Mise: 15.20 Un Does: 67.60 Net Pay: 424.87 C!11LDStJ 250.00 FEES 2.00 NEAL,JEFF • 408 E.N. MAIN STREET SUMMITVILLE, IN 46070-6070 XXX-XX-0621 S 2 8.00 8.00 8.00 8.00 32.00 23.130 LABORER Job Earn: 740.16 FICA: 70.79 Eli': 105.21 State: 26.55 Loeal/SDI: 11,57 0th Deds: 37.01 Adj Net: 0.00 Tot Earn: 925.20 Tot Deds: 251.13 En We: 0.00 Benefits: 434.40 Un Misc.: 0.00 Un Dues: 37.01 Net Pay: 674.07 SCOTT."THOMAS i l 12 S OPEL 5'F SIiERIDAN. IN 46069 XXX-XX-2031 S 2 8.00 8.00 8.00 8,00 8.00 40.00 25.040 PLASTERER • Job Earn: 1,001.60 FICA: 76.62 FIT: 124,31 Slate: 32.09 Local/SDI: 10.02 0th Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 325.84 I In Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 675.76 Subcontractor CIRCLE 13 •ONST SYS. LLC Project and Location Payroll # 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/14/2010 (3l7)787-5746 C080041' Page ti 5 - Day and Dale > Employee Information Sun Mon Tire Wed Thu Fri Sat Total Pay 8/8 8/9 8/10 8/11 8112 8113 8/14 Hours Rate Work Classification • SHAEVITZ, DAVID n 6123 COPELAND MILLS CT I - INDIANAPOLIS, IN 46221 I \ XXX-XX-4153 S 2 4.00 7.50 8.00 8.00 8.00 35.50 27.000 CARPENTER Job Earn: 958.50 RCA: 73.33 Pl'C: 113.54 State: 31.61 I.ncal/SDI: 15.53 Oth Dols: 83.97 Adj Net: 0.00 Tot Earn: 958.50 Tot Dub: 317.98 11n Vac: 35.50 Rena ts: 463.65 Un Misc.: 5.33 Un Dues: 43.14 Net Pay: 640.52 VELAZQUEZ,JORGE 4253 AMESBURY N011l.ESVII,LF IN 46062 XXX-XX-2787 M I ` 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER 0.50 0.50 37.560 PLASTERER lob Earn: 1,020.38 FICA: 78.07 FIT: 92.53 State: 33.71 Local/SDI: 10.20 Oth Dods: 83.84 Adj Ni:o 0.00 'Cot Earn: 1,020.38 Tot Deds: 298.35 Un Vac: 0.00 Benefits: 509.90 Un Misc: 15.39 Un Dues_ 68.45 Net Pay: 722.03 VANDENBERG JR, BRIAN 2403 N BUCKLES MUNCIE, IN 47303 XXX-XX-3058 S 0 8.00 8.00 8.00 8.00 8.00 40.00 28.420 CARPENTER Job Earn: 1,136.80 FICA: 86.96 FIT: 213.21 State: 38.65 Local/SDI: 11.94 Oth Deds: 97.16 Ad] Net: 0.00 lot Earn: 1,136.80 Tot Deds: 447.92 Un Vac: 40.00 Benefits: 53600 Un Mise: 6.00 Un Dues: 51.16 Net Pay: 688.88 VELAZQUEZ. HUGO 4253 AMESBURY PLACE WESI'FIELD, IN 46062 XXX-XX-6406 M 5 8.00 8.00 8.00 8.00 32.00 25.040 PLASTERER 0,50 0.50 37.560 PLAS"I'ERER Snhconlractor CIRCLE n CONST SYS, LLC Project and Location Payroll# 359 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMF..I. PER ART-PLASTER Week Ending 08/14/2010 (317) 787-5746 C08004P Page# 6 Day and bate . Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/8 8/9 8110 8111 8/12 8/13 8/14 Hours Rate Work Classification lob Earn: 820.06 FICA_ 62.73 FIT: 20.47 State: 22.98 Local/SDI: 8.20 Oth Dods: 164.28 Adj Nut: 0.00 Tot Earn: 820.06 Tut Deds: 278.66 Un Vac: 0.00 Benefits: 409.18 Un Misc: 12.35 I in Dues: 54.93 Net Pay: 541.40 CHILD SIJ 95.00 FEES 2.00 74OLZI IAUSEN, STEVE 815 WALLACE AVE INDIANAPOLIS, IN 46201 XXX-XX-6805 M 3 8.00 8.00 16.00 25.040 PLASTERER Joh Earn: 400.64 FICA: 76.62 FIT_ 68.65 Stale: 34.05 Local/SDI: 16.23 Oth Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,00 L60 Tot Reds: 278.35 11n Vac: 0.00 lienetits: 503.60 (in Misc: 15.20 tin Dues: 67.60 Net Pay: 723.25 Emp.Count Job hours Job Gross RCA'faxes FIT State Taxes Total Deduet Total Gross Adjus[mcnts Net 21 669.00 16,985.55 1,543.57 2,364.61 677.55 6902.49 20,176.98 0.00 13,274.49 Date 08/14/2010 (4) 'rhati (:)..)Where fringe benefits are nail to approved plans,funds,or programs In addition to the basic hourly wage rates paid to each laborer or mechanic do hereby state: listed in the above referenced payroll,payments of fringe benefits as listed in the contract have been or will be made to appropriate programs (I) That I pay or sunervisc the payment of he persons employed by for the benefit of such employees,except as noted in Section 4(c)below. CIRCLE 13 CONST SYS,I.I.0 on the CARMEL PER ART-PLAS'I (b) Where fringe benefits are nail in Cash Each laborer or mechanic listed in the above referenced payroll has been that during the payroll period commencing on the 8 day of August . 2010 day n( August 2010 ,ell persons employed paid,as indicated on the payroll,an amount not less than the sum and ending the 14 of the applicable basic hourly wage rate plus the amount of the on said project have been paid the full weekly wages earned,that no rebates have been required fringe benefits as listed in the contract,except as noted in or will be made either directly or indirectly to or on behalf of said Section 4(c)below. CIRCI. 13 CONSI'SYS,Id.0 from the full weekly wages earned (c) Exceptions by any person and That no deductions have been made either directly or indirectly Gam the full wages canted by any person,other than permissible deductions as defined in Exception(Craft) Explanation Regulations,Part 3(29 CIRt 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 11.SC.276c).and • described below: Remarks (2) That any payrolls otherwise under this contract required to he submitted Ihr 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 Kona fide apprenticeship program registered with a State apprenticeship agency recognized by the Bureau ofApprenticahip and Training,United Stales Department of • Labor.or if no such recognized agency exists in a State.are registered with the Bureau of Apprenticeship and Training,United States Department of Labor. /lam (Signature) '�"�y-� �,L�C.( .) (Name and Title) The willful falsification of any of the above statements may subject the contractor or subcontractor In civil or criminal prosecution. See Section 100 I of Title I8 and Section 231 of'l'itle 3lof the United States Code. Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll # 364 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/21/2010 (317) 787-5746 C08004P Page I/ I < Day and Date Employee Information Sun Mon T'ue Wed Thu Fri Sat Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Flours Rate Work Classification ALFORD, BRIAN 154 LEONAINIE COURT GREENFIELD. IN 46140 XXX-XX-7530 S 2 8.00 8.00 8.00 8.00 8.00 40.00 26.490 PLASTERER Job Earn: 1,059.60 FICA: 81.07 PIT: 138.81 State: 35.05 Local/SDI: 12.72 0th Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,059.60 Tot Deds: 350.45 Un Vac: 0.00 Benefits: 503.60 tin Misc: 15.20 tJn Dues: 67.60 Net Pay: 709.15 ALFORD. WILLIAM 6348 GLEN SHIRE LANE INDIANAPOLIS, IN 46237-6237 XXX-XX-8072 S 2 )))\ 8.00 8.00 8.00 8.00 8.00 40.00 24.030 LABORER Job Earn: 961.20 FICA: 73.53 Ff1': 134.21 State: 32.68 Local/SDI: 15.57 0th Deds: 38.44 Adj Net: 0.00 Tot Earn: 961.20 Tot Duds: 294.43 Utt Vac: 0.00 Benefits: 434.40 Un Misc: 0.00 (In Dues: 38.44 Net Pay: 666.77 ALLENDER, THOMAS 4114 E 36Sf ANDERSON, IN 46017 XXX-XX-3716 M 2 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 FICA: 76.63 PIT: 99.18 State: 42.09 Local/SDI: 22,52 0th Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Dcds: 323.22 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 678.38 BEGHTEL, DAN • 7712 BOMBAY LANE INDIANAPOLIS, IN 46239 \/\ XXX-XX-2306 M 0 7.00 7.00 28.420 CARPENTER Job Earn: 198.94 PICA: 84.80 FIT: 116.26 State: 37.69 Local/SDI: 11.08 0th Deds: 94.73 Adj Net: 0.00 Tot Earn: 1,108.38 Tot Deds: 344.56 Un Vise: 39.00 Benefits: 522.60 tin Misc: 5.85 (In Dues: 49.88 Net Pay: 763.82 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll IF 364 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/21/2010 (317) 787-5746 C080041) Page If 2 Day and Date > Employee Information Sun Mon The Wed Thu Fri Sat Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Hours Rate Work Classification BL1113ALIG1-[, DANA 4625 N HAPPY HOLLOW RI) BLOOMINGTON, IN 47408 XXX-XX-9437 S I 8.00 7.00 8.00 8.00 31.00 25.040 PLASTERER Joh Earn: 776.24 PICA: 74.71 PIT: 135.60 State 32.22 Locai/SD[: 10.25 Oth Deds: 80.73 Adj Net: 0.00 Tot Earn: 976.56 Tot Duds: 333.51 Un Vac 0.00 Benefits: 491.01 On Misc: 14.82 tin Dues: 65.91 Net Pay: 643.05 CHAMP, TRAVIS 8921 W400S REDKLY. IN 47373 XXX-XX-9349 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Joh Earn: 1,001.60 FICA: 76.62 FIT: 159.41 State: 33.07 Local/SI)I: 24.54 0th Dells: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Duds: 376.44 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 625.16 COCHRAN. MA1'T 33 N SPENCER S'I- REDKEY, IN 47373 --)XXX-XX-0049 S 0 8.00 8.00 8.00 800 8.00 40,00 25.040 PLASTERER fob Earn: €,001.60 FICA: 76.62 FIT: €59.41 State: 34.05 Local/SDI: 24.54 Oth Duds: 202.17 Adj Net 0.00 Tot Earn: 1,001.60 Tut Duds: 496.79 Un Vac: 0.00 Benefits: 503.60 1ln Misc: 15.20 Tin Dues: 67.60 Net Pay: 504.81 CI III.D SU 117.37 FEES 2.00 DOOLEY, LOWELL • 6422 W MORRIS ST INDIANAPOLIS, IN 462. XXX-XX-4694 M 3 8.00 8.00 8.00 8.00 32.00 25.040 PLASTERER Job Earn: 801,58 I"]CA: 61.30 FIT: 38.61 State: 24.30 Loeai/SDI: 12.98 Dth Delis: 66.24 Adj Net: 0.00 Tot Earn: 801.28 Tot Dells: 203.43 Un Vac: 0.00 Benefits: 402.88 ' Un Misc: 12.16 Tin Dues: 54.08 Net Pay: 597.85 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll It 364 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/21/2010 (317) 787-5746 C08004P Page II 3 < Day and Date > Employee Information Sun Mon l'ue Wed Thu Fri Sat Total Pay 8/IS 8/16 8/17 8/18 8/19 8/20 8/21 Hours Rate Work Classification FINES, JOSHUA 5890 MASON COURT MARTINSVILLE, IN 46151 XXX-XX-4587 S I 8.00 8.00 8.00 8.00 8.00 40.00 23.130 LABORER Job Earn: 925.20 FICA: 70.78 FIT: 122.76 State: 30.48 Lucal/SDI: 25.17 Oth Deck: 37.01 Adj Net: 0.00 Tot Earn: 925 20 Tot Dcds: 286.20 Un Vac: 0.00 Benefits: 434.40 Un Mise: 0.00 Un Dues: 37.01 Net Pay: 639.00 FISHERO, BENJAMIN 2753 GRAND FIR DR _\ GREENWOOD. IN 46143 J\ XXX-XX-5070 S I 8.00 8.00 8.00 8.00 32.00 25.040 PLASTERER Job Earn: 801.28 FICA: 76.63 PTT: 141.86 State: 33.07 Local/SDI: 10.02 Oth Deck: 82.80 Adj Net: 0.00 lot Earn: 1001.60 Tot Duds: 344.38 Un Vac: 0.00 Benefits: 503.60 IIn Misc: 15.20 Un Dues: 67.60 Net Pay: 657.22 (JUZZO, ROBERT 238 N ADAMS ST BROWNSI3URG. IN 46112 \) XXX-XX-I 155 S I 8.00 8.00 23.130 LABORER Job Earn: 185.04 PICA: 68.94 P11': 116.76 State: 29.66 Local/SDI: 12.62 Oth Dcds: 36.05 Adj Net: 0.00 Tot Earn: 901.20 Tot Dcds: 264.03 Un Vac: 0.00 Benefits: 434.40 Un Misc: 0.00 Un Dues: 36.05 Net Pay: 637.17 IIENSLEY, STEVE 2940 WEST 53RD ST ANDERSON, IN 46011 XXX-XX-3053 M I 8.00 8.00 23.130 LABORER Job Earn: 185.04 PICA: 70.32 FIT: 92.35 State: 30.27 Local/SDI: 11.49 Oth Dcds: 66.78 Adj Net: 0.00 Tot Earn: 919.20 Tot Dais: 271.21 1In Vac: 0.00 Benefits: 434.40 Un Misc: 0.00 11n Dues: 36.78 Net Pay: 647.99 GARN 30.00 • Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll 4 3fi4 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/21/2010 (317)787-5746 C0800413 Page 0 4 - r Day and Date > Employee Information 8/15 Mon Tue Wed Thu Fri Sat Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Hours Rate Work Classification I-IINSHAW, DANIEL PO BOX R A , [CAD IA [N 46030 XXX-XX-6666 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Hain: 1,001.60 FICA: 76.62 Fi'1': 184.41 Slate: 44.05 Local/SDI: 10.02 0th Deis_ 82.80 Adj Net: 0.00 'I'nt Earn: 1,001.60 Tot Dads: 397.90 Un Vac: 0.00 Benefits: 503,60 Tin Misc: 15.20 IJn Dues: 67.60 Net Pay- 603.70 HUFFMAN, RANDY 150 W HAYDEN WAY PENDLETON, IN 46064-6064 XXX-XX-9987 M I 8.00 8,00 8.00 8,00 8,00 40.00 25.040 PLASTERER Job Earn: 1,001.60 FICA: 76.62 F1T: 89.71 State: 33.07 Local/SDI: 12.52 Dth Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,001 60 Tol Dads: 294.72 Un Vac: 0.00 Benefits: 503.60 lIn Misc: [5.20 Iln Racy: 67.60 Nct Pay: 706.88 HUFFMAN, JEFFREY 3416 W. 1000 S •\\\ PENDLETON, IN 46064-6064 XXX-XX-9983 M 0 8.110 8.00 8.00 8.00 8.00 40.00 26.490 PLASTERER Job Earn: 1,059.60 FICA: 81.07 FIT: 15894 State: 35.05 Local/SDI: 13.25 OIh Dcds: 82.80 Adj Net: 0,00 Tot Earn: 1,059,60 To[Dads: 371.11 UFn Vac: 0.00 Benefits: 503.60 fin Misc: 15.20 Un Dues: 67.60 Nat Pay: 688.49 JIMENEZ, MARCOS 6240 E SOUTHPORT RI) INDIANAPOLIS, IN 46237 -. XXX-XX-0903 M 1 8.00 8.00 22.740 CARPENTER Job Gann: 181.92 FICA: 69.59 FIT: 75.91 State: 29.95 Local/SIN 14.74 Oli Dads: 86.93 Adj Net: 0.00 Tot Earn: 909.60 Tot netts: 277.12 Un Vac: 40.00 Benefits: 481.20 Un Misc: 6.00 Un Onus: 40.93 Net Pay: 63148 Subcontractor CIRCLE B CONST SYS, 1.LC Project and Location Payroll 8 364 Address 5636 S MERIDIAN STREET INDIANAPOLIS. IN 462 CARMEL PER ART-PLASTER Week Ending 08/21/2010 (317) 787-5746 C08004P Page 11 5 < Day and Date > Sun Mon Tue Wed Thu Fri Sat Total Pay Employee Information 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Hours Rate Work Classification LEWIS. DEWAYNE / / 8521 SIERRA RIDGE DR rJ v INDIANAPOLIS, IN 46239 XXX-XX-2646 M 5 8.00 8.00 8.00 8.00 8.00 40.00 22.540 PLASTERER Job Earn: 901.60 PICA: 68.97 FIT: 32.60 State: 25.75 Local/SDI: 14.61 Oth Deds: 334.80 Adj Net: 0.00 Tot Earn: 901.60 Tot Deds: 476.73 tin Vac: 0.00 Benefits: 503.60 tin Misc.: 15.20 Un Dues: 67.60 Net Pay: 424.87 CI IILD SU 250.00 FEES 2.00 NEAL,JEFF 408 F.N. MAIN STREET SUMMITVILLE, IN 46070-6070 "" XXX-XX-0621 S 2 8.00 8.00 8.00 8.00 8.00 40.00 23.130 LABORER Job Earn: 925.20 PICA: 70.78 PIT: 105.21 State: 26.55 Local/SDI: 11.52 0th DecIs: 37.01 Adj Net: 0.00 Tot Earn: 925.20 Tot Deds: 251.12 Un Vac: 0.00 Benefits: 434.40 tin Misc: 0.00 lln Ines: 37.01 Net Pay: 674.08 RAY, WILLIAM 631 N 150 W GREENFIELD, IN 46140 XXX-XX-9922 M 0 8.00 8.00 4.00 1.50 21.50 25.040 PLASTERER Job Earn: 538.36 FICA: 41.19 FIT: 30.75 State: 18.30 Local/SDI: 8.72 0th Deck: 44.51 Adj Net: 0.00 Tot Earn: 538.36 Tot Deds: 143.47 Un Vac: 0.00 Benefits: 270.69 Un Mix: 8.17 lln Dues: 36.34 Net Pay: 394.89 SCO1"I','I'I10MAS 1112SOPELST SHERIDAN, IN 46069 XXX-XX-203I S 2 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.63 FIT: 124.31 State: 32.09 Local/SDI: 10.02 0th Deds: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 325.85 Un Vac: 0.00 Benefits: 503.60 lln Misc: 15.20 Un Dues: 67.60 Net Pay: 675.75 Subcontractor CIRCLE B CONST SYS, LLC Project and Location Payroll tl 364 _ Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLAS'T'ER Week Ending 08/21/2010 (317)787-5746 C08004P Page if 6 - < Day and Date > Employee Information Sun Mon Ttte Wed Thu Fri Sat Total Pay 8/15 8/16 8/17 8/18 8/19 8/20 8/21 Flours Rate Work Classification SIIEIKIIALMOLOOKI, ARASIl A 128 PLAZA CENTRAL GREENWOOD, IN 46143 XXX-XX-7345 S 2 8.00 8.00 8.00 8.00 32.00 15.020 PLASTERER Job Earn: 480.64 FICA: 45.96 FIT: 47.41 Suite: 18.47 Local/SDI: 6.01 Oth Deds: 82.80 Adj Net: 0.00 Tot Earn: 600.80 Tot Deds: 200.65 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 400.15 VELA%QIJEZ.JORGE 4253 AMESBURY NOf3LESVILLE. IN 46062 XXX-XX-2787 M 1 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER...) Job Earn: 1,001.60 PICA: 76.62 OT: 89.71 State: 33.07 Local/SI)I: 10.02 Otb Dads: 82.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Dcds: 292.22 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 709.38 VELAZQUEZ, ItliGO 4253 AMESBURY PLACE WESTFIELD, IN 46062 XXX-XX-6406 M 5 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 FICA: 76.62 FIT: 47.60 State: 29.15 Local/SDI: 10.02 0th Deds: 179.80 Adj Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 343.19 Un Vac: 0.00 Benefits: 503.60 tJn Misc: 15.20 Un Dues: 67.60 Net Pay: 658.41 CI111.D SU 95.00 FEES 2.00 Rep.Count Job flours Job Gross FICA Taxes Eli State Taxes Total Deduct Total Gross Adjustments Net 23 739.50 17,993.94 1,652.62 2,441.78 720.13 7,262.73 21,602.18 0.00 14.339.45 Dom 08/21/2010 (41 Thal: 11 Where fringe benefits arc paid to approved plans, bands.or programs In addition to the basic hourly wage rates paid to each laborer or mechanic tin hereby state listed in the shove 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 Seel ion 4(c)below_ (I) That I pay or supervise the payment of the persons employed by (h) Where fringe hcnnhts are paid in Cash CIRCLE B CONST SYS,LLS: on the CA RAW L PER AIL'C-1'1.A51 Each laborer or mechanic listed in the above referenced payroll has been that during the payroll period commencing on the ti day of August 2010 paid,as indicated on the payroll,an amount not Less that the sum and ending the 21 day of August 2010 ,all persons employed of the applicable basic hourly wage rate Plus the amount of the on said protect have been paid the full weekly wages earned,that no rebates have been required fringe benefits as listed in the contract,except as noted in or will he made either directly or indirectly to or en hchallbf said Section 4(c)below. CIRCLE R CDNS'f SYS,I.LC from the full weekly wages earned Ic) Exceptions 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 Exception(Crab) fanlannUnn Regulations,Part 3(29 CPR Subtitle A)issued by the Secretary of lmhor under the Copeland Act,as amended(48 Slat_948.63 Stat, 108,72 Slat 967:76 Stat.357:40 U_S _276e),and described below. Remarks (21 That env payrolls otherwise under this contract required to he submitted for the abnve 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 detcnntnation incorporated into the contract:that the classilications set forth therein for each laborer or mechanic eonlbrm 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,linked States Department of labor,or if no such recognized agency exists in a Stale,are registered with the Bureau of Apprenticeship and Training,ltnited States Department of I.nbnr. (Signs W rC) {None and Title) The willful Ihlsilicauun of any of the above statements may subject the contractor or subcontractor to civil or criminal prosecution_ See Section 1601 of Title 18 and Section 231 nfTitle 3 for the United Slates Code. Subcontractor CIRCLE B CONST SYS, UK- Project and Location Payroll if 368 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/28/2010 (317)787-5746 0180041' Pate II I - < Day and Date Employee ]nfonnauon Sun Mon Tue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification ALFORD, BRAN 154 LEONA]NIE COURT - GREENFIELD, IN 46140 XXX-XX-7530 S 2 8M0 8.00 1.00 8.00 8.00 33.00 26.490 PLASTERER Job Earn: 874.17 PICA: 66.88 FtT: 92.46 Star: 28.74 Locul/SDI: 10.4') 0th Dells: 68.31 Adj Nee 0.00 Tot Earn: 874.17 'nit Deds: 266.88 Un Vac: 0.00 Brnetits: 415.47 lin Misc: 12.54 Un Dues: 55.77 Net Pay: 607.29 ALI.ENDER,THOMAS 4N4E ANDERSON, IN 46017 XXX-XX-3716 M 2 8.00 8.00 8.00 8,00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.62 I'll. 99.18 State: 42.09 Local/SDI: 22.52 0th Duds: 82.80 Adj Nell 0.00 NI Earn: 1,001.60 Tot Deds: 323.21 tin Vac: 0.00 Benefits: 503.60 En Misc: 15.20 Un Dues: 67.60 Nut Pay: 678.39 BLUEIAUGLI, DANA 4625 N HAPPY I[OLL.OW RD I3LOOMINGTON, IN 47408 XXX-XX-9437 S 1 8.00 8.00 8.00 8,00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.6(1 PICA: 76.63 FIT: 141.86 State: 33.07 Local/SIN: 10.52 0dt Duds: 82.80 Adj Net: 0.00 Tot Ear : 1,001.60 Tot Dells: 344.87 tin Vac: 0.00 Benefits: 503.60 I In Misr. 15.20 Un Dues: 67.60 Nut I'uy: 656.73 CHAMP,TRAVIS 8921 W 400 S RI3DKEY, IN 47373 XXX-XX-9349 5 0 8.00 8.00 8.00 8.00 8.00. 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.62 PTT: 159.41 Slate: 33.07 Local/8Di 24.54 0th Dols: 82.80 Adj Net: 0.00 Tot Earn: 1M01.60 Tot Dads. 376.44 tin Vac: 0.00 Benefits: 503.60 En Misc: 15.20 Un Dues: 67.60 Nut Pay: 625.16 I I Subcontractor CIRCLE B CONST SYS, LTC Project and Location Payroll// 368 Address 5636 S MERIDJAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/2812010 (317)787-5746 C08004P Paige 11 2 Day and Date > Employee Information 8/22 Mon Tue Wed Thu Fri Sat Tina] Pay 8/2_ 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification COCIIRAN, MATT 33 N SPENCER ST '1/4) REDKIW, IN 47373 XXX-XX-0049 S 0 8.00 8.00 8.00 8.00 8.00 40.00 25,040 PIASTERER Joh Barn: 1,001.60 FICA: 76.63 HT: 159.41 Stale: 34.05 L.ncal/SDI: 24.54 0th Dads: 202.17 Adj Neu: 0.00 Tot Earn: 1,001.60 Tot Dials: 496.80 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Net I'ay: 504.80 CHILD SU 117.37 FEES 2.00 DOOi.EY, L,OWELI. 6422 W MORRIS Si' INDIANAPOLIS. IN 46241 XXX-XX-4694 M 3 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.62 ELF: 68.65 Slate: 3 1.1 1 Local/SDI. 16.23 Oth Dads: 82.80 Adj Nat: 0.00 Tut Earn: 1,001.60 Tot Dads: 275.41 Un Vac: 0.00 Bandits: 503.60 Un Misc: 15.20 Un Dues: 67.60 Not ray: 726.19 FINES, JOSHUA 5890 MASON COURT MAIRTINSVILLE, IN 46151 XXX-XX-4587 S I 8.00 8.00 8_00 7.00 8.00 39.00 23.130 LABORER lob Earn: 902.07 PICA: 69.01 Eff: 1 16.98 State: 29.69 Local/SD]: 24.54 0th Dads: 36.09 Adj Net: 0.00 lot Earn: 90207 Tot Deck: 27631 Un Vac: 0.00 Benclits: 423.54 Un Misc: 0.00 Iln Dues_ 36.09 Net Pay: 625.76 FISHERO, BENJAMIN 2753 GRAND FIR DR GREENWOOD, IN 46143 XXX-XX-5070 S 1 8.00 8.00 8.00 24.00 25.040 PLASTERER fah Earn: 600.96 FICA: 45.97 EII.: 5297 State: 19.45 Local/SD1: 6.01 Bib Dads: 49.68 Adj Nee 0.00 Tot Earn: 600.96 Tut Dads: 179.08 Un Vac: 0.00 Renelits: 302.16 tin Misc: 9.12 Un Dues: 40.56 Net Pay: 421.88 Subcontractor CIRCLE B CONST SYS, LEO Project and Location Payroll // 368 _- Address 5636 S MER]DIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/28/2010 (317)787-5746 C080041' Page 4 3 - Day and Date > Employee hiloanaGon Sun Mon 'I'ue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification GUZZO, ROBERT 238 N ADAMS SI' BROWNSBURG, IN 46] 12 XXX-XX-I 155 S 1 8.00 8.00 16.00 23.130 LABORER Job Earn: 370,08 PICA: 69,40 FIT: 118.26 State: 29.86 Local/SDI: 12.70 Oth Deds: 36.28 Adj Nee 0.00 Tot Earn: 907.20 To Duds: 266.50 Un Vac: 0.00 Benefits: 434.40 Un Mise: 0.00 Un Dues: 3628 Net Pay: 640.70 ]TFNSI[AW, DANIEL PO BOX 588 ARCADIA, IN 46030 XXX-XX-6666 5 0 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 FICA: 76,62 FIT: 184.41 State: 44.05 Heal/SDI: 10.02 Oth Deds: 82,80 Adj Net: 0.00 Tot Earn: 1.001.60 Tot Deds: 397.90 11n Vac: 0.00 Benefits: 503,60 Un Misc: 15.20 Un Dues: 67.60 Net Pay: 603.70 HUFFMAN, RANDY - 150 W HAYDEN WAY PENDLETON, IN 46064-6064 XXX-XX-9987 M I 8.00 8.00 8.00 8.00 32.00 25.040 PLASTERER Joh Earn: 80128 FICA: 76.62 FIT: 89.71 State: 33.07 Local/SDI: 17.52 0th Dais: 83.80 Adj Net: 0.00 Tot Earn: 1.001.60 Tot Duds: 294.72 EH Vac: 0.00 Benefits: 503.60 lin Misc: 15,20 Iln Dues: 67.60 Net Pay: 706.88 HUFFMAN,JEFFREY 3416 W. 1000 S PENDLETON, IN 46064-6064 XXX-XX-9983 M 0 4.00 2.00 2.00 4.00 4.00 [6.00 26.490 PLASTERER Joh Earn: 42184 FICA: 81.06 FIT: 1 58.94 State: 35.05 Local/SOF 13.35 Olh Deds: 82.80 Adj Net: 0,00 Tot Earn: 1,059.60 Tot Duds: 371.10 Un Vac: 0.00 Benefits: 503.60 1In Misc: 15.20 Un Dues: 67.60 Net Pay: 688.50 Subcontractor CIRCLE II CONST SYS, LLC Project and Location Payroll if 368 Address 5636 S MERIDIAN SIREDf INDIANAPOLIS. IN 462 CARMEL PER ART-PLASTER Week Endinu 08/28/2010 (317)787-5746 C08004P Page// 4 < Day and Date -> Employee Information Sun Mon Tue Wed Thu Fri Sat Total Pay 8/22 8/23 8/24 8/25 8/26 8/27 8/28 Flours Rate Work Classification LEWIS, DEWAYNE 8521 SIERRA RIDGE DR J INDIANAPOLIS, IN 46239 XXX-XX-2646 M 5 8.00 8.00 8.00 8.00 8.00 40.00 22.540 PLASTERER Job Earn: 901.60 PICA: 68.97 PIT: 32.60 Slate: 25.75 Local/SDI: 14.61 Oth Dais: 334.80 Adj Net: 0.00 Tot Earn: 901.60 Tot Deds: 476.73 Un Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 lin Dues: 67.60 Net l'ay: 424.87 CHILD SD 250.00 FEES 2.00 NEAL,JEFF 408 E.N. MAIN STREET SUMMITVILLE, IN 46070-6070 XXX-XX-0621 S 2 8.00 8.00 8.00 8.00 8.00 40.00 23.130 LABORER Job Earn: 925.20 FICA: 70.78 FIT: 105.21 State: 26.55 Local/SDI: 11.57 Oth Deds: 37.01 Adj Net: 0.00 Tot Earn: 925.20 Tot Deds: 251.12 tin Vac: 0.00 licnetits: 434.40 tin Misc: 0.00 On Dues: 37.01 Net Pay: 674.08 RAY, WILLIAM 631 N O W GREEN REENFIELD, IN 46140 .) XXX-XX-9922 M 0 8.00 8.00 8.00 24.00 25.040 PLASTERER Job Earn: 600.96 PICA: 45.98 PIT: 40.14 Stale: 20.43 Local/SDI: 9.74 Oth Deds: 49.68 Adj Net: 0.00 Tot Earn: 600.96 Tot Deds: 165.97 tJn Vac: 0.00 Benefits: 302.16 Un Misc: 9.12 Un Dues: 40.56 Net Pay: 434.99 SCOTT, THOMAS I 112 S OPEL ST \\) SI-1ERIDAN. IN 46069 XXX-XX-2031 S 2 8.00 8.00 8.00 8.00 8.00 40.00 25.040 PLASTERER Job Earn: 1,001.60 PICA: 76.62 FIT: 124.31 Stale: 32.09 Local/SDI: 10.02 Oth Deds: 82.80 Adj Net 0.00 "Pot Earn: 1,001.60 tot Deds: 325.84 1In Vac: 0.00 Benefits: 503.60 Un Misc: 15.20 tin Dues: 67.60 Net Pay: 675.76 Subcontractor CIRCLE E3 CONST SYS, LLC Project and Location Payroll# 368 Address 5636 S MERIDIAN STREET INDIANAPOLIS, IN 462 CARMEL PER ART-PLASTER Week Ending 08/28/2010 (317)787-5746 C08004P Page Al 5 - < Day and Date -. Employee Information 8122 Mon Tue Wed Thu Fri Sat Total Pay 8122 8/23 8/24 8/25 8/26 8/27 8/28 Hours Rate Work Classification VELAZOUE"Z., JORGE 4253 AMESBURY ) • NOI3LESVILLE, IN 46062 XXX-XX-2787 M 1 8.00 8.00 8.00 7.00 31.00 25.040 PLASTERER lab Earn: 776.24 FICA: 59.39 1']T: 55.91 State 25.41 Local/SDI: 7.76 Oth Deds: 64.17 Adj Net 0.00 Tot Earn: 776.24 Tot Deds: 212.64 [In We: 0.00 Benefits: 390.29 IIn Misc: 11.78 Un Dues: 52.39 Net Pay: 563.60 VELAZ.OUEZ, El UGO 4253 AMIESBURY PLACE WISTFIELD. IN 46062 :-.) XXX-XX-6406 M 5 8.00 4.00 8.00 7.00 27 00 25.040 PLASTERER Job Earn: 676.08 PICA: 51.73 P11': 6.07 State: 18,08 Local/SDI: 6.76 Oth Deds: 152.89 Adj Net: 0.00 Tot Earn: 676,08 Tat Dais, 735.53 Un Vac: 0.00 Benefits: 339,93 Un Misc 10.26 Un Dues: 45.63 Net Pay: 440.55 CHILD SU 95.00 FEES 2.00 HOLZhIAUSI=N, STEVE 815 WALLACE AVE .-..)% INDIANAPOLIS, IN 46201 XXX-XX-6805 M 3 5.50 8.00 8.00 8.00 29.50 25.040 PLASTERER fah Earn: 738.68 MA: 76.62 FIT: 68.65 Slate: 34.05 Local/SDI: 16.23 Oth Dods: 82.81 AU]Net: 0.00 Tot Earn: 1,001.60 Tot Deds: 278.36 Un Vae: 0.00 Benefits: 503.61 Cu Misc: 15.20 I In Dues: 67.61 Net Pay: 723.24 Emp.Count lob!lours fob Gross PICA 'Taxes Fur State Taxes Total Deduct Total Gross Adjustments Net 19 631.50 15,602.36 1.3 18.76 1,880.13 575.66 5,815.41 17.238.48 0.011 11,423.07 Date 08/28/2010 (4) T rat: ® Where fringe hcncftls arc paid to approved Hans,funds,nr programs In addition to the basic hourly waoe rates paid to each laborer or mechanic do hereby state: listed in the above referenced payroll,payments of fringe benefits as listed in the contract have been er will he made to annropriale programs tiff the benefit of such employees,except as noted in Section 4(c)below. (I) That I pay or supervise the payment of the persons employed by (h) Where fringe benefits are paid in Cash CIRCLE 13 CONST SYS,3_LC on the CARMET,PLR ART-PI.AS7 that during the payroll period commencing on the 22 day of August 2010 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 and ending the 28 day of Au vast 2010 ,all ners ms employed of the applicable basic hourly wage rate plus the amount of the on said protect have been paid the full weekly wanes earned.that no rebates have been reuuired fringe belie hs as listed in the contract,except as noted in or will be made either directly or indirectly to or on behalf of said _ Section 4(c)below. CIRCI-13 13 CONS''SYS,I.161 from the lull weekly wages earned (c) Exceptions by any person and that no deductions have been made either directly or indirectly from the nib wages earned by any person,other than permissible deductions as defined in Exception(Craft) Explanation Regulations. Part 3(29 CFR Subtitle Al issued by the Secretary of Labor under the Copeland Act,as amended ON Stat.948.63 Stat. 108, 72 Stat 967:76 Slat.357:40 LI St 276c),and described below_ Remarks (2) 'Thal any payrolls otherwise under this contract required to he submitted for the ahove period are correct and complete;that the wage rates Er 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 firth therein for each laborer or mcohmh is conform with the work he per[nrmctl. (3) That any apprentices emnloyed in the above period are duly registered in a bona fide apprenticeship program registered with a State apprenticeship agency recognized by Me Bureau orAppmnticeship and Training,United States Depanrnut of Labor,or if no such recognized agency exists in a State.are registered with the Bureau of Apprenticeship and'Graining.United States Uepanment of Labor. (S lbpllYllC� ( Maine and Title) The willful talsi ligation Pfany of the above statements may suhiect the contractor or subcontractor to civil or criminal prosecution. See Section 1001 of Title t$and Section 231 of Tine 3 tor the l Inilest States Cod. wi i DIte : 09/01/10 - wed Monthly Employment Utilization Report Page : 11 Job: PEHART Carmel Performing Arts Contractor: PERRY ACOUSTICS, INC. Pay Period : 09/01/10 - 0E/31/10 interior Parcel 7A 701 EAST BRIDGE ST. MOORESVILLE, IN 46199 Employers Id 0: 35-1815172 TRADE 1 TOTAL HOURS 1 B L A C K 1 HISPANIC I AMER, INDIAN I A S I A N I MIN 1 FEM IMTN HMP ITOT FMP CLASS - LEVEL 1 M F 1 M F I M P I M F 1 M F 1 % 1 % I M P I M F Carpenters - JO 181.00 .00 -00 00 00 .00 .00 .00 .00 .00 -00 00 0 0 2 0 TRADE LEVEL TOTALS Journeymen 181.00 .00 .00 -00 .00 .00 00 .00 .00 .00 .00 -00 0 0 2 0 JOB TOTALS 181.00 .00 .00 .00 .00 .00 .00 .00 .00 .00 00 .00 0 0 2 0 COMPANY OFFICIAL'S SIGNATURE AND TITLE TELEP•ONE N:./ER •clude area code) I DATE SIGNED I C�11 il,a %7) ee,--1 I 9—/—i0 v7( ej 11:7 lQ11/L!?/-) - CZ/7i ij/-1/43y5 ' y S T A T E M E N T O F C O M P L I A N C E DATE: 08/04/10 I, WILLIAM MCQUEEN, VICE PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed by PERRY ACOUSTICS, INC. on the (building or work) Carmel Performing Arts that during the payroll period 07/28/10 - 08/03/10 all persons employed on said project have been Paid the full weekly wages earned, that no rebates have been or wilt be made either directly or indirectly to or on behalf of said (Contractor or Subcontractor) PERRY ACOUSTICS, 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 Al,issued by the Secretary of Labor under the Copeland Act,as amended■4B Stat, 940)63 Etat- 100;72 Stat. 967;26 Stat. 357740 V.S.C. 2'16c),and described below: Aflac,Aflac,Garnishment,Retirement,Cope,Medical Ins,Vecation,Ducs,Employee Loan,Child support.Travel Pay,Ircc Mkt.Rec.Pr (2) That any payrolls otherwise under this contract required to be submitted for the above period are correct and complete:that the wade rates for laborers and mechanics contained therein are not less than the applicable wage rates contained in any wage determination incorporated into the contract;thet 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. 14) That: (a) WHERE FR.LNGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR PROGRAMS 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 be made to appropriate programs for the benefit of such employees,except as noted in Section 41c) below. (b) WHERE FRINGE BENEFITS ARE PAID IN CASE 1_1 Each laborer or mechanic li=sted 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 us noted in Section 4(c) below. 1c7 EXCEPTIONS /CRAFT) EXCEPTION EXPLANATION ) Remarks: NAME AND TITLE /jiff SIGNATVRE WILLIAM I4CQUEEN, vrCE PRESIDENT • THE wILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OP S CONTRACTOR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1.001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES COLE, I , Dete : 08/&4/10 - Wed 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 Sob: DEPART Carmel Performing Aros Contractor: PERRY AC00STICS, INC. Pay Period : 07/28/10 - 09/03/10 'interior Parcel 7A 7O1 EAST BRIDGE ST. MOORESVILLE, IN 46158 Employers Id $: 35-121.5172 Employee 1 Hours Worked This Project I PAY IJOE EARN FED I STATEISIN DEDI TOT I NET InfOrmation I WED TWA FRI MON TUES SAT SUN TCTALI RATEITOT EAENI FICA! LOCALI MISC I DED I PAY Dowell, Steven J. 290 W. Washington St ST - - 8.00 8.00 8.00 - - 24.00 29.92 718.08 89.82 42.44 83.03 Monrovia, TN 46157 OT - - - - - - - .00 .00 1002.32 76.67 26.74 .00 83.05 683.60 5S $ 313-92-1619 SEX M Carpenters-Journeymen DSP 1 Lathrop, Chris J. 6795 Crown Dr. ST - - 8.00 8.00 8,00 - - 24.00 29.92 718.08 159.31 36.30 100.53 Brownsburg, IN 46112 OT - - - - - - - .00 .00 1211.76 92.70 16.16 .00 100.53 805.76 SS 4 309-92-8415 SEX M Carpenters-Journeymen DEP 3 J o b T o t a l s : Hours: 48.00 Earnings: 1436.16 • •1 A('. t S T A T E M E N C O F C O M P L I A N C E DpfE: 00f11/1.0 I, WILLIAM MCQUEEN. VICE PRESrOEN'1' do hereby state: (11 That I pay or supervise the payment of the persons employed by PERRY ACOUSTICS, INC. on the (building or work) Carmel Performing Arts ;that during the payroll period 08/04/10 - D8/10/1.0 ;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) PERRY ACOUSTICS, 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(49 Stat. 948;63 Stat. 108:72 Stat. 967;76 Stat. 357;40 U.S.C. 276CI .and described below: Aflac,Aflac,Garnishment,Retiremeot.Cope,Medical. Ins,Vacation,Dues,Employee Loan.Child Support,Travel nay,lrcc Mkt.Rec.PC (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 sage 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 grate Department of Labor. (4) That: (a) WHSH.E FRINGE BENEFITS ARE PAID TO APPROVED PLANS, FUNDS, OR eROGHAMS 1_1 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 4lc) below_ 1b) 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) 11010w. (e) EXCEPTIONS { (CRAFT) EXCAPTION ExPLANATION { { { { { { Remarks. NAME AND TITLE SIGNATURE I h'ILLIAM MCQUEEN, VICE PRESIDENT { TEE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUE1RC[ THE CONTRACTOR OR SOBCONTRACTOR TO CIVIL OR CRIMINAL { { PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF TEE UNITED STATES CODE, { I .'.Y t._ Page 1 De3e : 08/11/10 - 'Wed C E R T I F I E D P A Y R O L L R E G I S T E R Contractor: PERRY ACOUSTICS, INC. Pay Period : 08/04/10 - 08/10/10 I Parcel Job: PERART Carmel re Arts 701 EAST BRIDGE ST. Interior aYC el 7A Employers Id p: 35-1815172 MOORESVILLE, IN 46159 Employee N Hours Worked This Project I PAY JOB BAR FED 1 STATE1UN DEDI TOT 1 NET Information I WED THUR FRI MON TUBS SAT SUN TOTAL RATEITOT EARN PICA LOCAL MISC I DED I PAY Dowell, Steven J. - - - 8.00 2 9.92 239.36 92.06 42.95 84.88 290 W. a St ST 8.00 - - - .00 .00 1017.28 77.63 27.15 .00 84.80 692.4 1 Mo neovia, INn46N 45115 57 OT - - - SS A 313-92-1619 SEX H Carpenters-Journeymen DEP 1 Lathrop. Chris J. - - _ 8.00 29.92 239.36 110.69 29.68 50.88 6795 sbUr9 DI ST 8.00 - - - .00 .00 1017.29 77.82 13.43 .00 50.88 734.78 Brownsburg, IN 46112 OT - - - 5S N 309-92-0415 SEX M Carpenters-Journeymen DEP 3 J o b T o t a l s Hours: 16.00 Earnings: 476.72 ill • ,. S T A T E M E N T O F C O M P L I A N C E D/$E: 08/25/10 I, WILLIAM MCQUEEN, VICE PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed by PERRY ACOUSTICS, INC. on the (building or work) Carmel Performing Arts that during the payroll period 08/18/10 - 08/24/10 :ail 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) PERRY ACOUSTICS, 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. 276c) ,and described below: Aflac,Aflac,Garnishment,Retirement.Cope,Medical Ins,Vacation,Dues,Employee Loan,Child Support,Travel Pay,Ircc Mkt.Rec.Pr (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 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 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(c) below. (c) EXCEPTIONS I (CRAFT) EXCEPTION I EXPLANATION I I I I I I I I I I I I I Remarks: NAME AND TITLE 1 SIGNATURE I �v'F SIGNATURE I WILLIAM MCQUEEN, VICE PRESIDENT I I THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBC NT'PAC'ICR TO CIVIL OR CRIMINAL PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 OF TITLE 31 OF THE UNITED STATES CODE. D,f.9 : 08/25/10 - Wed 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 Job: PERART Carmel Performing Arts Contractor: PERRY ACOUSTICS, INC. Pay Period : OB/18/10 - 08/24/10 Interior Parcel 7A 701 EAST BRIDGE ST. MOORESVILLE, IN 46158 Employers Id 0: 35-1815172 Employee Hours Worked This Project I PAY 'JOE EARN' FED I STATE'UN DEDI TOT I NET information WED THOR PRI MON TOES SAT SUN TOTAL' RATEITOT EARN' PICA' LOCALI MISC I DED I PAY Dowell, Steven J. 290 W. Washington St ST 8.00 8.00 8.00 8.00 8.00 - - 40.00 29.92 1196.80 118.99 49.06 99.86 Monrovia, IN 46157 OT - - - - - - - .00 .00 1196.80 91.56 32.03 .00 99.86 805.30 S5 # 313-92-1619 SEX M Carpenters-Journeymen DEP 1 Lathrop, Chris J. 6795 Crown Dr. ST 8.00 8.00 8.00 8.00 8.00 - - 40.00 29.92 1196.80 1.55.57 35.79 99.86 Drownsburg, IN 46112 OT - - - - - - - .00 .00 1196.80 91.55 15.95 .00 99.86 798.08 SS # 309-92-8415 SEX M Carpenters-Journeymen DEP 3 J o b T o t a l s : Hours: 80.00 Earnings: 2393.60 .. 1� I. " '<-` S T A T E M E N T O F C O M P L I A N C E DAE: 09/01/10 : I, WILLIAM MCQUEEN, VICE PRESIDENT do hereby state: (1) That I pay or supervise the payment of the persons employed by PERRY ACOUSTICS, INC. on the (building or work) Carmel Performing Arts 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) PERRY ACOUSTICS, 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 Seat. 108;72 Stat. 962;96 Stat. 357;40 U.S.C. 29Gc),and described below: Aflac,Aflac,Garnishment.Retirement,Cope,Medical Ins,Vacation,Dues,Employee Loan,Child Support,Travel Pay,Ircc Mkt.Rec.Pr (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 I_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 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 - 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. (o) EXCEPTIONS (CRAFT) EXCEPTION EXPLANATION • � I I 1 � I I I I I Remarks: I � I NAME AND TITLE 1 SIGNATURE I G�Vv" L ' WILLIAM MCQUEEN, VICE PRESIDENT THE WILLFUL FALSIFICATION OF ANY OF THE ABOVE STATEMENTS MAY SUBJECT THE CONTRACTOR OR SUBCONTRACTOR TO CZ'✓IL OR CRIMINAL I PROSECUTION. SEE SECTION 1001 OF TITLE 18 AND SECTION 231 uF TITLE'31 OF THE UNITED STATES CODE. I '" 40,E - - Dele : 09/01/10 - Wed 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: PERART Carmel Performing Arts Contractor: PERRY ACOUSTICS, INC. Pay Period : 08/25/10 - 06/31/10 interior Parcel 7A 701 EAST BRIDGE ST. MOORESVILLE, IN 46158 Employers Id #: 35-1815172 Employee I Hours Worked This Project I PAY IJOB EARN FED I STATEIUN DEDI TOT I NET Information I WED THUR FRI MON TUBS SAT SUN TOTAL' RATEITOT EARNI FICAI LOCAL' MISC I DED I PAY Dowell, Steven J. 290 W. Washington St ST 8.00 8.00 4.50 - - - - 20.50 29.92 613.36 94.31 43.46 78.08 Monrovia, IN 46157 OT - - - - - - - .00 .00 1932.24 78.96 27.55 .00 78.06 709.88 SS # 313-92-1619 SEX M Carpenters-Journeymen DEP 1 Lathrop, Chris J. 6795 Crown Dr. ST - - 4.50 - - - - 4.50 29.92 134.64 .00 .00 11.24 Brownsburg, IN 46112 OT - - - - - - - .00 .00 134.64 10.31 1.08 .00 11.24 112.01 SS # 309-92-8415 SEX M Carpenters-Journeymen DEP 3 J o b T o t a l s : Hours: 25.00 Earnings: 748.00 •