POYNTER SHEET METAL- 001463- 12/17/2010 CARMEL REDEVELOPMENT COMMISSION 0•01463
Poynter Sheet Metal Check: 1463
PO Box 427 Date: 12/17/2010
Bloomington, IN 47402 Vendor: POYNTER1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
26B 41 9,282.00 9,282.00 0.00 0.00 9,282.00
Application 26B
9,282.00 9,282.00 . 0.00 0.00 9,282.00
i
P s&DEZ>. Carmel Redevelopment Commission 0.014 6 3
/ 30 west Main Street A REGIONS
I Suite 220 ^ 20-1421n4o
CARMEL Carmel, IN 46032
'1463 •
DATE • AMOUNT
12/17/2010 ************.9,282.00
PAY ', THE SUM OF NINE THOUSAND TWO HUNDRED EIGHTY TWO DOLLARS
TO THE ;
ORDER' •
OF' Poynter Sheet Metal
PO Box 427 '`°"�`
3 F
Bloomington, IN 47402 , 4- mm ".
"00146311' x:0740 14 2 1 3': D087504 L 1 VI
CARMEL REDEVELOPMENT COMMISSION 001463
Poynter Sheet Metal Check: 1463
PO Box 427 Date: 12R7/2010
Bloomington, IN 47402 Vendor: POYNTER1
Prior
Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid
26B 41 9282.00 9,282.00 0.00 0.00 9,282.00
Application 26B
9,282.00 9,282.00 0.00 - 0.00 9,282.00
V.. Ff.',Tfl /'mm .d , Gn.mc fli.i'i a'inn !fl77I TI.St 01 IN4fIFlflfl
APPLICATION AND CERTIFICATE FOR PAYMENT CONSTRUCTION MANAGER-ADVISER EDITION 4J
A/A DOCUMENT G702/CMel PAGE ONE OF 4 PAGES
TO OWNER: PROJECT: Parcel 7A, Retiiomtl Pcrh rminc APPLICATION NO: 2611 Distribution to:
Cannel Redevelopment Commission Arts Center nOWNER
One Civic Square PERIOD TO: 1 I/30/10 CONSTRUCTION
Cannel. IN 46032 PROJECT NO: 2695-4310 MANAGER
FROM CONTRACTOR: VIA CONSTRUCTION MANAGER: Shiel-Sexton.Co..Inc. (PSM#14065) ARCHITECT
POYNTER SHEET METAL ATTN: Lynda Weaver,902 N. Capitol Avenue. Indian:olk, IN 46204 CONTRACT DATE: 04/18/08 CONTRACTOR
8768 N. STATE RD. 37 VIA ARCHITECT:
131.0OMINGTON. IN 47404
CONTRACT FOR: Bid Packaae 84310- HVAC Sheet Metal
CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certilies that to the best of the Contractor's knowledge.
Application is made For payment,as shown below,in connection with the Contract. information and belief the Work covered by this Application for Payment has been
Continuation Sheet_AIA Document 0703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid
by the Contractor for Work for which previous Certilicates for Payment were issued and
payments received from the Owner, and that current payment shown herein is now due.
I. ORIGINAL CONTRACT SUM $ 2.340.500.00
2. Net change by Change Orders S 1124119-00T CONTRACTOR:
3. CON RAC SUM TO DATE(Line I =2) $ 2,321.98 LOP
4, TOTAL COMPLETED Al: STORED TO DATE $ 2.310.41 .00 • ��t
(Column G on(57014) Bp: An �4• Date: (y icile/Q
5. RETAINAGE, 5%of Contract Total Jose R. at�-President
a. 5 %a of CompL4-ed Work S 1 16,399.00 State DE INI. AN• County of. MONROE
mn D+Eon 6703) Subscriber • - t la beThre me this in nn day of of bee &Q/O
b. n of Stored Material $ 0.00 Notary I'ubl lc:u �yie 4./ 9, 2014
(7Tinn E on 0703) My Commission aspires: August 9,2014
Total Rctainage(Lines 5a*Sb or
Total in Column l ofG703) $ 116,399.00 CERTIFICATE FOR PAY ENT
6. 'TOTAL EARNED LESS RET A INAGE 2,194.019.00 In accordance with the Contract Documents,based un on-site observations and the data
(! me 4 less Line 5l au!) a comprising this application,the Construction ,Manager and Architect centre to the
7. LESS PREVIOUS CERTIFICATES FOR Owner that to the best oftheir knowledge,information and belief the Work has
PAYMENT(Line 6 Iron:prior Certificate) S 2.184.737,0U progressed as indicated,the quality of the Work is in accordance with the Contract
S. CURRENT PAYMENT DUE $ 9.282.00 Documents,and the Contractor is entitled to payment of the AMOUNT CERTIFIED
9. BALANCE TO FINISH.INCLUDING RETA1NAGE $ 133,962.00 p!t
(Line 3 less 1_ine 6) AMOUNT CERTIFIED S 12192
C HANCE ORDER.SUMMARY AVIAI I10i'S UEUUC IIONS (4ttac6 erplanatfah ifamwmrcercijied di/fersfroth the autntutr applfedjnr. hilt id all
I otal changes approved figures an This Application and ou the CeleIflate:m S reef that uhuNKed to conform to the
in previous months by Owner $161.481 00 S175.000 00 amount D cerrOieeb
Cot -"ERIK-"ERIK G ' 2: , I
Total approved this Month $0.00 50,00 By:_ in "%c_� i i Date: /0
r
TOTALS SI62,4S1 00 5175.000.00 By: -till _ I Date: L\ Z cer.
NET CHANGES by Change Order ($12,51 •.00) This Cer dtcate is not negotiable. The AMOUNT CERTIFIED is payable only to the
Contractor named herein.Issuance,payment and acceptance o(payment are without
prejudice to any rights o€the Owner or Contractor tinder this Contract.
nW DUWMENI v rvu.Ma AFFLWn,ILA ANN L TO,rlLn,WN FVk N'.t MEN I .ONSIRUI II, N MnN)ttk.AUVIbtR eutliON•1Y72 e.imps-nw-u4Lsb2 b,UNEMa-1bb2
THE AMERICAN IN5TITVTE OF ARCHITECTS.1745 NEW YORK AVE.,N.W..WASHINGTON.DC 20005-5282
Users may obtain validation of this document by requesting of the license a completed AIA Document D401 -Certification of Document's Authenticity
CONTINUATION SHEET A1,4 DOCUMENT G703 2 PAGE OF PAGES 4
AR Document 0702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 25B
Contractor's signed certification is attached A PPI,ICATION DATE: 11/1/2010
In tabulations below_amounts are stated to the nearest dollar. PSM JO13#: 14065 PERIOD TO: 11 30;201 0
Use Column I on Contracts where variable retainage for line items may apply. NAME : Cannel PAC CONTRACT NO: 2695-4310
A _ 13 C D 1 E F O H I
LINE DESCRIPTION OF WORK SCI JEDIJLED WORK COMPLETED MAI'ERIALS TOTAL % BALANCE REFAINACE
NO VALUE FROM PREVIOUS Tills PERIOD PRESENTLY COMPLETED (C T C) TO FINISH (IF VARIABLE
APPLICATION STORED AND STORIED (C-GI RAE)
(DT E) I NOT IN TO DATE
D ORE) (D-E-F) 3%
I GENERAL CONDITIONS 200,000.00 S200.000 50 SO 5200,000 100% SI0.000
2 BOND& INSURANCE 45,000.00 $45.000 SO SO 545,000 100% $2150
3 MOBILIZATION 15,000.00 $15,000 SO SO 515.000 100% $750
4 ALLOWANCE NO 11 BP 4310 651.00 SO $651 50 $651 100% $33
5 ALLOWANCE NO 16 CAD AS-BUILTS 10,000.00 $10,000 50 50 $10,000 100% $500
6 DRAWINGS/COORDINATION 80,000.00 580.000 SO SO $80,000 100% $4,000
7 MECH BASEMENT LEVEL
8 MATERIAL 48,000.00 548.000 SO SO 548,000 100% 52.400
9 LABOR 50,700-00 $50-700 SO 50 550,700 100% $2,535
10 LAGGING 7,000.00 $7.000 $0 $0 57,000 100% $350
II BACKHOUSE
12 MATERIAL 56,000.00 $56-000 $0 SO $56,000 100% $2,800
13 LABOR 59,000,00 559.000 $0 SO 559,000 100% $30050
14 KITCHEN HOOD& DUCT
15 MATERIAL 15,400.00 $15,400 $0 $0 $15,400 100% $770
16 LABOR 10,800.00 $10,800 $0 SO $10.800 100% $540
17 INSULATION 10100.00 $10,100 50 50 510.100 100% $505
18 MECH RM 1 •
19 MATERIAL 50,400.00 $50.400 $0 $0 $50,400 100% $2.520
20 LABOR 56,300.00 556.300 50 $0 556300 100% 52.815
2) INSULATION 16,800.00 $16,800 SO $0 516,800 100% $840
22 MECH RM 2
23 MATERIAL 77,000,00 577.000 SO $0 $77,000 100% 53.850
24 LABOR 93,900.00 593,000 50 $0 $93,900 100% 54.695
25 INSULATION 16,800.00 $16.800 $0 $0 $16,800 100% $840
26 MECH RM 3
27 MATERIAL 84,900.00 $84,900 $0 $0 $84.900 100% $4.245
28 LABOR 94,500.00 594,500 $0 $0 $94,500 100% $4.725
29 INSULATION 16,800.00 $16.800 SO $0 $16,800 100% S840
30 PLENUM LEVEL
31 MATERIAL 49,100.00 549.100 50 SO 549,100 100% $2,15
32 LABOR 75,000.00 $73,000 SO 50 575.000 100% $3,750
33 LAGGING 13,000.00 $13000 SO 50 513,000 100% $650
- 34 ORCHESTRA HIGH LEVEL
35 MATERIAL 34,600.00 534,600 50 SO 534,600 100% 51.730
CONTINUATION SHEET AM DOCUMENT 6703 3 PAGE OF PACES 4
AIA Document 0702.APPLICA'RON AND CERTIFICATION FOR PAYMENT,Lontr ins APPLICATION NO: _15 B
Contractor's signtd anti licalion is:Machsd. APPLICATION DATE: I 1:15'20 LO
In tabulations helms,amounts are stated to the nearest dollar_ PSM 1013#_ 14065 PERIOD TO: 11 '1337201 0
Use Column I on Contracts where varinhle retainuge for line hems may apply NAME: Carmel PAC CONICAC'L NO ,3 95-9370
A 13 C 3) E F C H ' 1
LIFE DESCRIPTION OFWORIC SCHEDULED 'IS OEtKCONIPLETED MATERIALS TOT.A1. 13Al.AATE RETAINAGE
NO. VAIJJE FROM PREVIOUS THIS PERIOD PRESENTLY COMPELED I0+C) 10 211711511 (IF VARIABLE
APPLICATION STORED AND STORED (C-G) RATE)
(D-E) (NOf IN TO DAIS
U OR F:) ID-F-) 33
36 LABOR 35.400.00 533,630 50 50 533,630 95% 51,770 3i.682
37 ORCHESTRA LOW LEVEL
.58 MATERIAL 49,400.00 549400 SO 50 549,400 100% 52,470
39 LABOR 62,600.00 559A70 50 50 559.470 95% 53.13(1 52,974
-10 BOX TIER LEVEL
41 MATERIAL 70,000.00 570900 50 50 570,000 100 1i, 53,500
42 LABOR 100,300.00 595,285 SO 50 595_285 95% 55,015 54,764
43 LOW BALCONY LEVEL
44 MATERIAL 94,100.00 $94,100 SO SO $94,100 100% 54.705
45 LABOR 85,300.00 581,035 SO 50 581.033 95% 54.265 54.052
41i HIGH BALCONY LEVEL
47 MATERIAL 36,400.00 $35400 SO SE 538,400 100% 51,920
43 LABOR 50,200.00 547,690 50 50 542690 95% 52.510 57.585
49 ATTIC LEVEL+50
50 MATERIAL 41,600.00 $41,600 50 50 541.600 1009$, 52,680
5i LABOR 44,700,00 542,465 52235 50 544.700 100% 52,235
52 ATTIC LEVEL +61
53 MATERIAL 16,800.00 516.800 50 SO S16-300 10034 $840
54 LABOR 16,300.00 515,445 SO 50 515485 95% $815 5774
SO ATTIC LEVEL +66
56 MATERIAL 39,500.00 539,300 SO SO 539.500 1001 51975
57 LABOR 37,900.00 $36,005 51.895 50 537.900 k00% Si 893
53 ATTIC LEVEL +79-6
59 MATERIAL 6,700 00 $6,700 S0 S1) $6,7(41 100 $335
60 LABOR 5,200,00 $5,142 SO SO S5-142 99% 558 $257
4-A ALLOWANCE NO. 11 8P 4310(ASI-031) 7.322.00 57,322 50 50 57722 100% $306
4-3 ALLOWANCE NO 11 BP 4310A-002 10,000.00 $8.775 51 225 SO 510.000 100% $500
4-C ALLOWANCE NO 11 BP 43108-002 4,798 00 $4,798 SO SO 54,798 10034 $240
4- ■ ALLOWANCE NO 11 BP 43106-003 1,534.00 $1,534 SO SO S1,534 10036 577
4-E ALLOWANCE NO 11 BP 431013-004 27,142.00 $27,142 S0 SO 527,142 )00% 51,357
4-F ALLOWANCE NO 11 BP 431013-005 9,625.00 59,625 SO So 59.625 190% $481
4-Cl ALLOWANCE NO 11 BP 43106-006 175,000.00 SI 75,000 50 S0 $175,000 €00% 58,750
4-II ALLOWANCE NO 11 BP 43106-007 546.00 5546 SO S0 5546 100% 527
. 4-I ALLOWANCE NO 11 BP 43106-008 10,933.00 $10,933 SO 50 510.955 10034 $547
4-I ALLOWANCE NO 11 BP 43108-009 12,44900 $12449 50 SO 512 449 1003i $622
CONTINUATION SHEET AJ/A DOCUMENT G7O3 4 PAGE OF PAGES 4
Al/ Document 0702,APPLICATION AND CERTIFICATION FOR PAYMENT.containing APPLICATION NO: 255
Contractor's signed certification is attached. APPLICATION DATE: 11/1 5/2010
In tabulations below,amounts are stated to the nearest dollar. PSM JOI7#: 141)65 PERIOD TO: 1 1/3 0/2010
Use Column I on Contracts where variable retaina_e for line items may apply NAME : Carmel MC CONTRACT NO: 2695-4310
A B C D I E P G Fl I
LINE DESCRII''IION OP WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RI:TAINAGE
NO VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED 1G*c) 'I)FINISH (IF VARIABLE
APPLICATION STORED AND STORED (C-G) RATE)
(I)-E) (NOT IN TO DATE
U OR E) (D.E+F) 5%
4-K ALLOWANCE NO 11 BP 4310B-010 530K SO SO SO SO 0% SO
4-L ALLOWANCE NO 11 BP 431013-011 5,001.00 SO $0 $0 SO 0% SO
4-M ALLOWANCE NO 11 BP 4310B-012 3,021.00 $0 SO $0 5O 0% SO
4-N ALLOWANCE NO 11 BP 43108-013 6,103.00 SO $0 $0 $0 0% 50
4-0 ALLOWANCE NO 11 BP 4310B-014 5,979.00 $0 $0 SO SO 0% SO
4-P ALLOWANCE NO 11 BP 43108-015 1,806.00 SO $0 SO SO 0% $0
4-p ALLOWANCE NO 11 BP 4310B-016 2,480.00 $0 $0 $0 5O 0% $0
4-R ALLOWANCE NO 11 BP 43108-017 2,334.00 SO $0 SO S0 0% SO
4-S ALLOWANCE NO 11 BP 43106-018 3,254.00 SO SO SO SO 0% SO
Café' 5,006.00 50 SO SO $0 0% SO
SO
SO
SO
$0
900 PENDING CHANGE ORDERS
901 CHANGE ORDER#1 38,542.00 $38.542 SO SO $38542 100% $1927
902 CHANGE ORDER#2(RCP-10) 19,219.00 $19,219 $0 SO 519.219 100% 5961
903 CHANGE ORDER#3 BP 4310B-005 -175,000.00 ($1 75,000) SO SO (S175,000) 100% ($3.750)
904
905 CHANGE ORDER#5 30,000.00 $26.724 53,27o 50 530.000 100% SI.500
906 CHANGE ORDER#6. 24,720.00 $114.720 SO So 524.720 100% $1,236
907 CHANGE ORDER#7 50,000.00 550.000 SO SO $50.000 100% 52.500
$2.327981 2.301,136 9182 0 2.310.418 99% 17.563 116.399
„ SHEET METAL .
POYNTER SF1VET METAL, INC.
CONTRACTOR'S AFFIDAVIT AND WAIVER OF l IG.N
PARTIAL ( X) FINAL ( )
We, the undersigned,having been employed by CARMEL REDEVELOPMENT
COMMISSION furnish labor and materials to do construction work on the premises known as
PARCEL 7A, CARMEL REGIONAL PERFORMING ARTS CENTER hereby warrant that
the premises of the above named job cannot he nuacle subject to any valid lien by anyone who
furnished material, supplies, labor or services to the undersigned for use in the above named
project for any labor, materials or supplies furnished or services performed through 11/30/10 to
the extent that the undersigned has been paid as set forth herein.
This waiver is given in order to induce payment in the amount of$9,282.00 and upon receipt of
the amount due by the undersigned, this waiver as to the amount clue becomes valid, enforceable
and of lull effect. Upon attachment of the canceled check and the legal description of the
project, this waiver may he recorded by the Owner or mortgage holders) of-the project.
This Contractor's Affidavit and Waiver of Lien only applies to the extent paid. and does not
apply to or cover retention, unresolved claims or unresolved changes, change orders or change
requests.
Given under our hand and seal this 18 I” day of NOVEMBER, 2010
POYNTER SHEET METAL, INC.
It Will
Signal ire $3 orized Representative
Joseph . ., - sc ell
PRESIDENT
Title of Authorized Representative
STATE OF: Indiana )
COUNTY OF: Monroe )
Subscribed and sworn to before me this 18'11 day of NOVEMBER, 2010
(Notary Public)
Commission Expires: August 29, 2014
County of Residence: Morgan
PARTIAL UNCONDITIONAL WAIVER OF LIEN
(PAY APPLICATION #23B)
To All Whom It May Concern:
WHEREAS, the undersigned has been employed by (A) THE CITY OF CARMEL
to furnish labor and materials for (B) Sheet Metal per plans & specifications
under a contract (C) PO/ Subcontract# 2695-4310 work,
for the improvement of the premises described as (D) Carmel Performing Arts Center
777 Third Avenue SW
in the City (City-Village) of Carmel County of
Hamilton State of Indiana
of which Carmel Redevelopment Commission
is the owner.
NOW, THEREFORE, this 18TH day of NOVEMBER , 20 10
for and in consideration of the sum of(E) Eighteen thousand, one hundred one and 00/100
Dollars paid simultaneously herewith, the receipt whereof is hereby acknowledged by the undersigned, the under-
signed does hereby waive and release to the extent only of the aforesaid amount, any lien rights to, or claim of lien
with respect to and on said above-described premises, and the improvements thereon, and on the monies or other
considerations due or to become due from the owner, by virtue of said contract, on account of labor, services,
materials, fixtures, apparatus or machinery furnished by the undersigned to or for the above-described premises,
but only to the extent of the payment aforesaid.
(F) Poynter Sheet Metal, Inc. (SEAL)
(Name of sole ownership, corporation or partnership)
(SEAL)
ngnature)
Josep• ' dell
TITLE President
INSTRUCTIONS FOR PARTIAL WAIVER
(A)Name person or arm Anlh whom yua agreed to mmisn either baker,Or seniors.w maledels,or Ieth.
(81 I'll'in nvww and evlem of wads;sake the wu 1F labor or the w.m Melerols d net In your fdnm Ci.
(q If yOu have mole than one centred on the seine prem6el,describe the sunhat]by number if available,date and extent of were_
Mannish an aµVrme enough desCnni0n onhe improvement and!alien dl the premises so that it can ton eishrqu.shed frern any OM,•l prom)•
(El Ameuni4wrm should be the amount aCluallyw rve.lnn Thal slate_
(F)If waives is lei a mrsSNmlcn.Corporate Mime should be abed.COrrorale Seal affixed alb title Olaf freer skirling wh,innI should Ile net Ions,hl werver is ler a WdnelOhiI.the INnnershhp name should he used.
partner shouki vgn and deSignale hlmseil as partner.
Designed By The
Construction Industry Arlilirs Committee(CIAO
TOPS 3459
LITHO IN U.S.A. C COPYRIGHT 1973,TOPS BUSINESS FORMS,CHICAGO,ILL
PARTIAL UNCONDITIONAL WAIVER OF LIEN
(PAY APPLICATION #258)
To All Whom It May Concern:
WHEREAS, the undersigned has been employed by (A) THE CI'T'Y OF CARIMMEL
to furnish labor and materials for(B) Sheet Metal per plans & specifications
under a contract (C) PO/ Subcontract# 2695-4310 work,
for the improvement of the premises described as (D) Carmel Performing Arts Center
777 Third Avenue SW
in the City (City-Village) of Carmel County of
Hamilton State of Indiana
of which Carmel Redevelopment Commission
is the owner.
NOW, THEREFORE, this 18TH day of NOVEMBER , 20 10
for and in consideration of the sum of(E) Fifty thousand, and 00/100
Dollars paid simultaneously herewith, the receipt whereof is hereby acknowledged by the undersigned, the under-
signed does hereby waive and release to the extent only of the aforesaid amount, any lien rights to, or claim of lien
with respect to and on said above-described premises, and the improvements thereon, and on the monies or other
considerations due or to become due from the owner, by virtue of said contract, on account of labor, services,
materials, fixtures, apparatus or machinery furnished by the undersigned to or for the above-described premises,
but only to the extent of the payment aforesaid.
(F) Poynter Sheet Metal, Inc. (SEAL)
(Name of sole ownership,corporation or partnership)
•' frif/&I (SEAL)
Signature)
Josere %.ell
TITLE President
INSTRUCTIONS FOR PARTIAL WAIVER
(A)Name person nr firm with whom Cu y atoned to furnish Wm labor,in cervices.Or malminb_or Ora.
II])HI in nature and extent of no,k;stnne Ice work Wm di Ihn worn mnalenals if not in sou cunlrxtl,
ICI It yrni have more than One wmred an nm same premises,Clem ithe the contract by number 11 available,date and extent of won.
(0)Furnish an acrarrn,e enough dnscnptlan al me improvement and(oration of the premises so that it can be distinguished Irene any other propene.
(E)Amount shown Mies l'.I tie Inc amouel ahauaty iPncned on that Minh,
(F)II waiver is for a reirerralion,fenprele name should he used,norm role seal unwed and rile of 011Kw signing waiver Should le,set forth:if waiver is lob a nanml¢nq,Ilse paonersmp name should to used,
panne,should SUM and designate himself as lather,
Designed 11y The
Construction Industry AlTairs Comnintcc(CIACi
TOPS 3459
LITHO IN U.S A. C COPYRIGHT 1973.TOPS BUSINESS FORMS,CHICAGO,ILL