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HomeMy WebLinkAboutREAL MECHANICAL- 206- 4/6/2011 Real Mechanical Check: 206 Date: 4/6/2011 Vendor: REALMEC1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 10 ret 2,529.55 2,529.55 0.00 0.00 2,529.55 app 10 for retention 16 950.00 950.00 0.00 0.00 950.00 App 16 on Garage parking struc 17 ret 29,072.60 29,072.60 0.00 0.00 29,072.60 App 17 for retention 32,552.15 32,552.15 0.00 0.00 32,552.15 206 4/6/2011 **********32,552.15 THE SUM OF THIRTY TWO THOUSAND FIVE HUNDRED FIFTY TWO DOLLARS AND 15 CENTS **** Real Mechanical Real Mechanical Check: 206 Date: 4/6/2011 Vendor: REALMEC1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paid 10 ret 2,529.55 2,529.55 0.00 0.00 2,529.55 app 10 for retention 16 950.00 950.00 0.00 0.00 950.00 App 16 on Garage parking struc 17 ret 29,072.60 29,072.60 0.00 0.00 29,072.60 App 17 for retention 32,552.15 32,552.15 0.00 0.00 32,552.15 A9PLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 TO: Carmel Garage Development C< PROJECT: Village On The Green Base Bid APPLICATION NO: 16 Distribution to: 11711 N Pennsylvania St., STE 200 Garage Parking Structure OWNER Carmel, IN 46032 290412 PERIOD TO: 01-20-11 ARCHITECT FROM CONTRACTOR: VIA ARCHITECT: CONTRACTOR Real Mechanical, Inc. Parcel 7C-3 475 Gradle Drive PROJECT NOS: Signature 12011 n Carmel, IN 46032 Carmel#4460913 CONTRACT FOR: Plumbing/HVAC CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies 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 G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 539,000.00 2. Net change by Change Orders $ 42,452.00 CONTRACTOR:Real Mech 'cal,Inc. 3. CONTRACT SUM TO DATE(Line I±2) $ 581,452.00 4. TOTAL COMPLETED&STORED TO $ 581,452.00 DATE (Column G on G703) By: Date: 1-20-,1.balifiOth 5. RETAINAGE: Thomas E. ine,CFO \���b''' NN CAR°,ies/ a. 5 %of Completed Work $ 29,072.60 State of:Indiana l Cou ty of: H.+ i U i�_,,,......4.s7/0,1;,...T�9//oie (Column D+Eon G703) Subscribed and sworn to before me this 20th day of Js - �2f 5 b. 5 %of Stored Material $ :-_, 0.00 Notary Public:K.Dawn Carter i o"s , 26,c'}-,4..'s 9m (Column F on G703) My Commission expires: 6p0-5---15 * ° ®, �'o Total.Retainage(Lines 5a+5b or / /�®�> nlr1rnov gc, Total in Column I of G703) $ 29,072.60 ARCHITECT'S CE,RT-I CATE FOR FA fTtila °��® 6. TOTAL EARNED LESS RETAINAGE '^. CO����Oav°� $ 552,379.40 In accordance with the Contract Documents,based on on-site observant; d (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the!f� { i+'®ye 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as in icatfe8, PAYMENT(Line 6 from prior Certificate) $ 551,429.40 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ ;::::'950.00::: is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 29,072.60 (Line 3 less Line 6) AMOUNT CERTIFIED $ et 5-6 '/.."'" CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied.Initial all figures on this Total changes approved Application and ont ontinua on Sheet that are changed to co corm with he'mount certified.) in previous months by Owner $52,803.00 $0.00 ARCHITECT. .� Total approved this Month $0.00 ($10,351.00) By: ir Date: 112:15— ''t TOTALS $52,803.00 ($10,351.00) This Ce ificate i, no negotiable. The AMOUNT CERTIFIED is payable onl to the Uontractt na -d herein.Issuance,payment and acceptance ot payment are without NET CHANGES by Change Order prejudice to any rights of the Owner or Contractor under this Contract. I ' AIA DOCUMENT G702�APPLICATION AND CERTIFICATION FOR PAYMENT�1992 EDITION�AIA �01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.,N.W:,WASHINGTON,DC 20006-5292 ,/� by&o 9/3 p�y� ,f DOCUMENT ? Page 1 of 2 CONTINUATION SHEET AIA G703 Village On The Green Base Bid-290412 PAGE OF THREE PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 16 Contractor's signed certification is attached. Parcel 7C-3 APPLICATION DATE: 01-2 0-11 In tabulations below,amounts are stated to the nearest dollar. Carmel#4460913 PERIOD TO: 01-2 0-11 Use Column 1 on Contracts where variable retainage for line items may apply. Signature#12011 ARCHITECT'S PROJECT NO: Garage Parking Structure A B C D I E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G-C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) Plumbing 1 Storm/Sanitary-Material $64,850.00 $64,850.00 $64,850.00 100.00% $3,242.50 Labor $37,900.00 $37,900.00 $37,900.00 100.00% $1,895.00 2 Domestic Water-Material $700.00 $700.00 $700.00 100.00% $35.00 Labor $1,000.00 $1,000.00 $1,000.00 100.00% $50.00 3 Drains&Cleanouts-Material $8,500.00 $8,500.00 $8,500.00 100.00% $425.00 Labor $5,100.00 $5,100.00 $5,100.00 - 100.00% $255.00 4 Hydrants&Backflows-Material $800.00 $800.00 $800.00 100.00% $40.00 Labor $650.00 $650.00 $650.00 100.00% $32.50 5 Excavation/Backfill $32,000.00 $32,000.00 $32,000.00 100.00% $1,600.00 6 Fire Protection-Material. $125,500.00 $125,500.00 $125,500.00 100.00% $6,275.00 Labor $83,500.00 $83,500.00 $83,500.00 100.00% $4,175.00 7 Design Drawings $25,000.00 $25,000.00 $25,000.00 100.00% $1,250.00 HVAC 8 Electric Unit Heaters-Material $5,400.00 $5,400.00 $5,400.00 100.00% $270.00 Labor $1,500.00 $1,500.00 $1,500.00 100.00% $75.00 9 Fans&Louvers-Material $28,400.00 $28,400.00 $28,400.00 100.00% $1,420.00 Labor $3,500.00 $3,500.00 $3,500.00 100.00% $175.00 • AIA DOCUMENT G703 CONTINUATION SHEET FOR G702 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N .WASHINGTON,D . 20006-5232 G703-1992 CONTINUATION SHEET SHEET Page2ofCONTINUATION AIA DOCUMENT G703 Village On The Green Base Bid-290412 PAGE OF THREE PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 16 Contractor's signed certification is attached. Parcel 7C-3 APPLICATION DATE: 01-2 0-1 1 In tabulations below,amounts are stated to the nearest dollar. Carmel#4460913 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: O 1 2 0 11 Y a PP Y� Signature#12011 ARCHITECT'S PROJECT NO: Garage Parking Structure A B C D E F ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED LETED G H I NO. MATERIALS TOTAL % BALANCE RETAINAGE VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G_C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 10 Ductwork-Material $12,300.00 $12,300.00 $12,300.00 100.00% Labor $615.00 $7,100.00 $7,100.00 $7,100.00 100.00% $355.00 11 Controls-Material $10,300.00 $10,300.00 Labor $10,300.00 100.00% $515.00 $5,500.00 $5,500.00 $5,500.00 100.00% $275.00 12 Test&Balance $1,500.00 $1,500.00 $1,500.00 100.00% $75.00 13 Submittals/Detailing $8,500.00 $8,500.00 $8,500.00 100.00% $425.00 14 Bond $11,500.00 $11,500.00 $11,500.00 100.00% $575.00 15 Mobilization $3,000.00 $3,000.00 $3,000.00 100.00% $150.00 16 General Conditions $28,000.00 $28,000.00 $28,000.00 100.00% $1,400.00 17 Allowance $25,000.00 $14,649.00 $10,351.00 ° $25,000.00 100.00% $1,250.00 18 Closeout/Record Drawings $2,000.00 $1,000.00 $1,000.00 ° $2,000.00 100.00% $100.00 19 CO 5 $3,048.00 $3,048.00 $3,048.00 100.00% $152.40 20 CO 10 $32,400.00 $32,400.00 21 CO 11 $32,400.00 100.00% $1,620.00 $16,499.00 $16,499.00 $16,499.00 100.00% $824.95 22 CO 13 $856.00 $856.00 $856.00 100.00% $42.80 23 CO Allowance Deduct 00) ($10,351.00) ($10,351.00) ° ($10,351.00) 100.00% ($517.55) GRAND TOTALS $581,452.00 $580,452.00 $1,000.00 $581,452.00 100.00% $29,072.60 AIA DOCUMENT G703 CONTINUATION SHEET FOR 0702 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N .WASHINGTON,0. 20006-5232 G703-1992 AFFIDAVIT AND WAIVER OF LIEN ❑ Final ® Partial ® Payment to Follow State of Indiana, County of Hamilton, SS: Thomas E. Fine being duly sworn states that he is the CFO of Real Mechanical, Inc. having contracted with Carmel Garage Development Co to furnish certain materials and/or labor as follows: HVAC for a project known as Village on the Green Garage Parking Structure - 4460913 Signature 12011 located at Parking Garage West, Parcel 7C-3, Carmel, IN 46033 and owned by and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the contractor the sum of: Nine Hundred Fifty Dollars & 00/100 ($ 950.00 ) ❑ receipt of which is hereby acknowledge; or ® the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of: ($ ❑ receipt of which is hereby acknowledge; or 1 ,.f.. ❑ the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, subject to limitations to condition or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed on material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Real Mechanical, Inc. BY — Title CFO WITNESS MY HAND AND NOTARIAL SEAL, this 20th D-y of J--nuary 2 11 \:�`‘®\�9�!z DAWN nr��ri/f apt • ne 5 ''<<`.*'53 • v■ir (Notary P [ tic (37-4RYS My Commission Expires: June 5, 2015 Printed,: K. Dawn Carter �,,,,,</0• °..•EoF\NOed��,q. -10f,iffiii01RN0 Residing in Boone County • APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 TO: Carmel Garage Development Cc PROJECT: Village on the Green Alt 9 APPLICATION NO: 10 Ret Distribution to: 11711 N Pennsylvania St., STE 200 290414 OWNER Carmel, IN 46032 PERIOD TO: 01-20-11 ARCHITECT FROM CONTRACTOR: VIA ARCHITECT: CONTRACTOR Real Mechanical, Inc. Parcel 7C-1 475 Gradle Drive PROJECT NOS: Signature 12012 Carmel, IN 46032 Carmel#4460911 CONTRACT FOR: Plumbing/HVAC CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies 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 G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 36,000.00 2. Net change`by Change Orders $ 14,591.00 CONTRACTOR:Real Mech. .- ,Inc. 3. CONTRACT SUM TO DATE(Line 1±2) $ 50,591.00 ie6yt hadElBlgpgttt 4. TOTAL COMPLETED&STORED TO $ 50,591.00 e\voa*,� K.DAi/jn/0/4 DATE "(Column G on G703) q i, BY: Date�'`°�-2Q.1, GMMISS;°•°'9� 5. RETAINAGE: - Thomas E.Fine,CFO -e a- 4' ,Diie 6 boy f, a. 5 .%of Completed Work $ 0.00 State of:Indiana Cou of: H. ,° '—° ° (Column D+E on G703) Subscribed and sworn to before me th. 0th y of nu.. 0111i0 �.'• b. 5 %of Stored Material $ 0.00 Notary Public:K.Dawn Carter - TARVS ° (Column F on G703) My Commission expires: 6-0$-15 / r °G � Eq( �° Total Retainage(Lines 5a+5b or "s�B�j�F�OUN Y ° Q.��°• Total in Column I of G703) $ 0.00 ARCHITECT'S CE TI - ATE FOR PAYIiitEisia ' ego 6. TOTAL EARNED LESS RETAINAGE $ 50,591.00 In accordance with the Contract blocuments,based on on-site observations and the data (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to the best of the 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 48,061.45 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $ ; ;::;2,529:55:;: is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED $ 252.41 E-S" CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied. Initial all figures on this Total changes approved Application and ont - .nuation heet that are changed to conform)with the am nt certified.) in previous months by Owner $14,591.00 $0.00 ARCHITECT: ..� ,, Total approved this Month $0.00. $0.00 By: ; . 3 Date: 1125 11 TOTALS �lI $14,591.00 $0.00 CThis fOD is ble y h ontra C rti.r name.cate is erein.+t negotiable.IssuanceThe,payment AM UNT and acceptance CERTIFIE of payment paya are onl withoto ut e NET CHANGES by Change Order prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702.APPLICATION AND CERTIFICATION FOR PAYMENT.1992 EDITION AIA ®1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE,N.W.,WASHINGTON,DC 20006-5292 yydO7// ®Otl 1 I1tlU/'�TI®d� SHEET Page 1 of 1 4+ AIA DOCUMENT G703 Village On The Green Alt 9-290414 PAGE TWO OF Two PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing Contractor's signed certification is attached: APPLICATION NO: 10 RET Parcel 7C-I APPLICATION DATE: 01-2 0-11 In tabulations below,amounts are stated to the nearest dollar. Carmel#4460911 e for line items may apply. PERIOD TO: O 1 2 0 11 Use Column Ion Contracts where variable retainage Y PP Y� Signature#12012 ARCHITECT'S PROJECT NO: A B C D E ITEM DESCRIPTION OF WORK F G H I SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED APPLICATION (G+C) TO FINISH PPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) 1 HVAC Piping-Material $15,250.00 $15,250.00 Labor $15,250.00 100.00% $0.00 $13,300.00 $13,300.00 $13,300.00 100.00% $0.00 2 Excavation/Backfill $4,450.00 $4,450.00 $4,450.00 100.00% $0.00 3 Core Drilling $750.00 $750.00 $750.00 100.00% $0.00 4 Submittals/Detailing $1,500.00 $1,500.00 $1,500.00 100.00% $0.00 5 Bond $750.00 $750.00. $750.00 100.00% ':$0.00 6 CO 12 $14,591.00 $14,591.00 $14,591.00 100.00% $0.00 • GRAND TOTALS $50,591.00 $50,591.00 $50,591.00 100.00% AIA DOCUMENT G703-CONTINUATION SHEET FOR G702 1992 EDITION AIA 01992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N.W.WASHINGTON,D . 20006-5232 G703-1992 . / AFFIDAVIT AND WAIVER OF LIEN I ® Final ❑ Partial ® Payment to Follow State of Indiana, County of Hamilton, SS: Thomas E. Fine being duly sworn states that he is the CFO of Real Mechanical, Inc. having contracted with Carmel Garage Development Co to furnish certain materials and/or labor as follows: HVAC for a project known as Village on the Green Alt 9 - 4460911 Signature 12012 located at Parking Garage West, Parcel 7C-1, Carmel, IN 46033 and owned by and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the contractor the sum of: ($ ) I receipt of which is hereby acknowledge; or U the payment of which has been promised .s the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of: Two Thousand Five Hundred Twenty Five Dollars & 55/100 ($ 2,529.55 ❑ receipt of which is hereby acknowledge; or the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, subject to limitations to condition or conditions expressed herein, if any; and further certifies that no other party has any claim or right to a lien on account of any work performed on material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Real Mechanical, Inc. BY .. < Title CFO WITNESS MY HAND AND NOTARIAL SEAL, this 20th Day of January 2011 ON`� NCAR/ ';,. OPF9` � •• riF . SEAL =C / (Notary Publics' "" c•'m:g. °9,9p°•8'ONEGO�°O�spA 7 My Commission Expires: June 5, 2015 Printed: K. Dawn Carter ®°���o�'e«�,S 70 a�� ✓ Residing in Boone County APPLICATION AND CERTIFICATION FOR PAYMENT AIA DOCUMENT G702 b :'O: Carmel Garage Development C< PROJECT: Village On The Green Base Bid APPLICATION NO:17 RET Distribution to: ° 11711 N Pennsylvania St., STE 200 Garage Parking Structure nOWNER Carmel, IN 46032 290412 PERIOD TO: 01-20-11 ARCHITECT FROM CONTRACTOR: VIA ARCHITECT: CONTRACTOR Real Mechanical, Inc. Parcel,7C-3 475 Gradle Drive PROJECT NOS: Signature 12011 El Carmel, IN 46032 Carmel#4460913 CONTRACT FOR: Plumbing/HVAC CONTRACT DATE: CONTRACTOR'S APPLICATION FOR PAYMENT The undersigned Contractor certifies 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 G703,is attached. completed in accordance with the Contract Documents,that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner,and that current payment shown herein is now due. 1. ORIGINAL CONTRACT SUM $ 539,000.00 2. Net change by Change Orders _ , $ 42,452.00 CONTRACTOR:Real Mechanical,Inc. 3. CONTRACT SUM TO DATE(Line I±2) $ 581,452.00 4. TOTAL COMPLETED&STORED TO $ 581,452.00 DATE (Column G on G703) 11 R 111111 By: Date:.jt klj I CfI ''//sirs 5. RETAINAGE: Thomas E.Fin-, ' ,,>' a. 5 %of Com leted Work $ •°°°° RT'°✓s P 0.00 State of: Indiana Co my of: iii -..' �SSION � ®% (Column D+E on G703) Subscribed and sworn to before me h s 20t day of an ; •GLQ�I 5',076-4„...9•, b. 5 %of Stored Material $ .. 0.00 Notary Public:K.Dawii Carter ;7:-......" ,,... (Column F on G703) / / r a ...10.: ; My Commission expires:' 6-05-. 5 • � , Total Retainage(Lines 5a+5b or NOTARY SEAL a� Qe. Total in Column I of G703) $ 0.00 ARCHITECT'S CERTI CATE FOR PAS(` 1 4 o`r�� 6. TOTAL EARNED LESS RETAINAGE (�( °°° �°°° $ 581,452.00 In accordance with the Contract Documents,based on on-site observa�tj 414*tr.� q�y�i (Line 4 Less Line 5 Total) comprising the application,the Architect certifies to the Owner that to tl'e DNeuOrme 7. LESS PREVIOUS CERTIFICATES FOR Architect's knowledge,information and belief the Work has progressed as indicated, PAYMENT(Line 6 from prior Certificate) $ 552,379.40 the quality of the Work is in accordance with the Contract Documents,and the Contractor 8. CURRENT PAYMENT DUE $.. 29;0.72--W; is entitled to payment of the AMOUNT CERTIFIED. 9. BALANCE TO FINISH,INCLUDING RETAINAGE $ 0.00 (Line 3 less Line 6) AMOUNT CERTIFIED $ 'I€j'a'i,•° CHANGE ORDER SUMMARY ADDITIONS DEDUCTIONS (Attach explanation if amount certified differs from the amount applied.Initial a l figures on this Total changes approved Application and onthe Continuation Sheet that are changed to conform with the amount certified.) in previous months by Owner $52,803.00 $0.00 ARCHITECT: lip, "' , Total approved this Month $0.00 ($1 0,351.00) By: Afillit,, I Date: 1 l 1—cl It TOTALS $52,803.00 ($10,351.00) This Cei ti of negotiable. The AMOUNT CERTIFIED is pay ab le only to the Contractor n. ed herein.issuance,payment and acceptance of payment are without NET CHANGES by Change Order prejudice to any rights of the Owner or Contractor under this Contract. AIA DOCUMENT G702.APPLICATION AND CERTIFICATION FOR PAYMENT 1992 EDITION AIA -©1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVE.. N.W.,WASHINGTON,DC 20006-5292 4i/6a 91 /2 Page 1 of 2.S HEET AIA DOCUMENT G703 Village On The Green Base Bid-290412 PAGE OF THREE PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 17 RET Contractor's signed certification is attached. Parcel 7C-3 APPLICATION DATE: 01-2 0-11 In tabulations below,amounts are stated to the nearest dollar. Carmel#4460913 PERIOD TO: 01-2 0-11 Use Column I on Contracts where variable retainage for line items may apply. Signature#12011 ARCHITECT'S PROJECT NO: Garage Parking Structure A B C D I E F G H I ITEM DESCRIPTION OF WORK SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G+C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) Plumbing 1 Storm/Sanitary-Material $64,850.00 $64,850.00 $64,850.00 100.00% $0.00 Labor $37,900.00 $37,900.00 $37,900.00 100.00% $0.00 2 Domestic Water-Material $700.00 $700.00 $700.00 100.00% $0.00 Labor $1,000.00 $1,000.00 $1,000.00 100.00% $0.00 3 Drains&Cleanouts-Material $8,500.00 $8,500.00_ $8,500.00 100.00% $0.00 Labor $5,100.00 $5,100.00 $5,100.00 100.00% $0.00 4 Hydrants&Backflows-Material $800.00 $800.00 $800.00 100.00% $0.00 Labor $650.00 $650.00 $650.00 100.00% $0.00 5 Excavation/Backfill $32,000.00 $32,000.00 $32,000.00 100.00% $0.00 6 Fire Protection-Material. $125,500.00 $125,500.00 $125,500.00 100.00% $0.00 Labor $83,500.00 $83,500.00 $83,500.00 100.00% $0.00 7 Design Drawings $25,000.00 $25,000.00 $25,000.00 100.00% $0.00 HVAC 8 Electric Unit Heaters-Material $5,400.00 $5,400.00 $5,400.00 100.00% $0.00 Labor $1,500.00 $1,500.00 $1,500.00 100.00% $0.00 9 Fans&Louvers-Material $28,400.00 $28,400.00 $28,400.00 100.00% $0.00 Labor $3,500.00 $3,500.00 $3,500.00 100.00% $0.00 AIA DOCUMENT G703 CONTINUATION SHEET FOR G702 1992 EDITION'AIA'©1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N .WASHINGTON,D.C. 20006-5232 G703-1992 Page 2of2 CONTINUATION SHEET AIA DOCUMENT G703 Village On The Green Base Bid-290412 PAGE OF THREE PAGES AIA Document G702,APPLICATION AND CERTIFICATION FOR PAYMENT,containing APPLICATION NO: 17 RET • Contractor's signed certification is attached. Parcel 7C-3 APPLICATION DATE: 01-2 0-11 In tabulations below,amounts are stated to the nearest dollar. Carmel#4460913 e for line items may apply. PERIOD TO: O 1 2 0 11 Use Column Ion Contracts where variable retaina g Y PP Y� Signature#12011 ARCHITECT'S PROJECT NO: Garage Parking Structure A B C D I E F ITEM DESCRIPTION OF WORK W G H I SCHEDULED WORK COMPLETED MATERIALS TOTAL % BALANCE RETAINAGE NO. VALUE FROM PREVIOUS THIS PERIOD PRESENTLY COMPLETED (G_C) TO FINISH APPLICATION STORED AND STORED (C-G) (D+E) (NOT IN TO DATE D OR E) (D+E+F) I 0 Ductwork-Material $12,300.00 $12,300.00 $12,300.00 100.00% Labor $7,100.00 $7,100.00 $7,100.00 100.00% $0.00 $0.00 11 Controls-Material $10,300.00 $10,300.00 $10,300.00 100.00% Labor $0.00 $5,500.00- . $5,500.00 $5,500.00 100.00% $0.00 12 Test&Balance $1,500.00 $1,500.00 $1,500.00 100.00% $0.00 13 Submittals/Detailing $8,500.00.. $8,500.00 $8,500.00 100.00% $0.00 14 Bond $11,500:00 $11,500.00 $11,500.00 100.00% $0.00 15 Mobilization $3,000.00 $3,000.00 $3,000.00 100.00% $0.00 16 General Conditions $28,000.00 $28,000.00 $28,000.00 100.00% $0.00 17 Allowance $25,000.00 $25,000.00 $25,000.00 100.00% $0.00 18 Closeout/Record Drawings $2,000.00 $2,000.00 $2,000.00 100.00% $0.00 19 CO 5 $3,048.00 $3,048.00 $3,048.00 100.00% $0.00 20 CO 10 $32,400.00 $32,400.00 21 COIL $32,400.00 100.00% $0.00 $16,499.00 $16,499.00 $16,499.00 100.00% $0.00 22 CO 13 $856.00 $856.00 $856.00 100.00% $0.00 23 CO Allowance Deduct ($10,351.00) ($10,351.00) - GRAND TOTALS , ($10,351.00) 100.00% $0.00 $581,452.00 $581,452.00 $581,452.00 100.00% AIA DOCUMENT G703-CONTINUATION SHEET FOR G702-1992 EDITION-AIA-©1992 THE AMERICAN INSTITUTE OF ARCHITECTS,1735 NEW YORK AVENUE,N .WASHINGTON,D . 20006-5232 G703-1992 AFFIDAVIT AND WAIVER OF LIEN ® Final ❑ Partial ® Payment to Follow State of Indiana, County of Hamilton, SS: Thomas E. Fine being duly sworn states that he is the CFO of Real Mechanical, Inc. having contracted with Carmel Garage Development Co to furnish certain materials and/or labor as follows: HVAC for a project known as Village on the Green Garage Parking Structure -4460913 Signature 12011 located at Parking Garage West, Parcel 7C-3, Carmel, IN 46033 and owned by and does hereby further state on behalf of the aforementioned subcontractor/supplier: (PARTIAL WAIVER) that there is due from the contractor the sum of: ($ ) ❑ receipt of which is hereby acknowledge; or ® the payment of which has been promised as the sole consideration of this Affidavit and Partial Waiver of Lien which is given solely with respect to said amount, and which waiver shall be effective only upon receipt of payment thereof by the undersigned; (FINAL WAIVER) that the final balance due from the contractor is the sum of: Twenty-Nine Thousand Seventy-Two Dollars & 60/100 ($ $29,072.60 ) [ receipt of which is hereby acknowledge; or ® the payment of which has been promised as the sole consideration of this Affidavit and Final Waiver of Lien which shall become effective upon receipt of such payment. THEREFORE, the undersigned waives and releases unto the Owner of said premises, any and all lien or claim whatsoever on the above-described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto~ subject to;,limitations to condition or conditions expressed herein, if any; and further certifies that no other party has any clairn or right to a lien on account of any work performed on material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. Real Mechanical, Inc. BY Title CFO co N WITNESS MY HAND AND NOTARIAL SEAL, this 20th Day of January 2011 �L, �:o�MV ion;°•F9°�, NOTARY SEAL ° it n ,L •,�e (Notary / C STASEJq ��. My Commission Expires: June 5, 2015 Printed: K. Dawn Carter Residing in Boone County